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The World Administrators Alliance (WA-Alliance) is a formal membership structure (a Non-Profit Trade (profession) Association) with a Governing Council (Council) which replaced the former WA-Summit Advisory Council. The Advisory Council was an informal body that managed the WA-Summit event and the between summits research. The new WA-Alliance Council as a formal membership body is able to be more responsive, resilient, is better able to advocate for Administrative Professionals globally, and manage the between Summit research/tasks. The WA-Alliance is responsible for the WA-Summit. The WA-Alliance has a formalised membership body incorporating: More information on these changes can be found on the WA-Alliance webpage and the WA-Alliance website The term “administrators” speaks to the scope of practices and activities surrounding our roles as well as those essential to conducting business. For those in the administrative profession a significant issue is the 160+ titles both within countries and across the globe. Each country usually has its own preferred titles (for example: Personal or Executive Assistant, Office, Business or Management Assistant). These titles can appear intimidating to those who undertake general administration, for example administrative assistant, filing clerk, receptionist, etc, who do not hold such titles. However, whatever the title and tasks, the core of all these roles is administration. To administration, a range of other tasks from reception to accounts to full strategic partner reporting to a C-suite manager are added. If we look at a another profession having one word to describe a role for example: It is very hard to be heard as a cohesive group internationally if we do not have a single word which generally encompasses our work. Be proud of the overarching title as well as our own personal position title. The new structure, WA-Alliance, needed to differentiate from the WA-Summit event so we ran a survey with the 2018 Delegates and chose a different but linked name. Some responses we received in our survey on the name choice are: These responses mirror the thinking of the Task Force who worked on replacing the former WA-Summit Advisory Council. The World Administrators Summit (WA-Summit) is the 2-day working meeting of administrative professionals held every 2 years. The purpose of this global meeting is to “… guide, influence and positively develop the profession”. This meeting is focused on discussing topics of importance to all administrative professionals around the world. The topics are gathered through a global survey of those working in the profession, seeking matters that are reflective of the critical issues facing all administrative/office professionals. The topics discussed lead to an Outcomes document and feed into Administra The World Action Plan which is for administrative professional associations/networks and individuals. Administra is a set of guidelines and not rules. The 12th WA-Summit On-Line will be held on 15 and 22 October 2022, 1pm – 5pm CET. Each country may have no more than five Delegates. Formally appointed Delegates from every country in the world may attend. Most Delegates come from the professional association or network in that country for example: International Association of Administrative Professionals (IAAP), the International Management Assistants (IMA), in the UK the PA Hub, or the Association of Administrative Professionals New Zealand Inc (AAPNZ). However some countries do not have an administrative professional association or network, or their association/network does not wish to participate. Then an individual may apply to be a country Delegate. The Delegate Credentialing Form (in both Word and PDF) must be fully and properly completed before being submitted to the Chairman of the WA-Alliance Council for acceptance and all criteria must be met, including sending through a photograph. Each country may have five Delegates. It is up to each Association/Network how they select their Delegates. However, it can be helpful to hear how others have done this. However, being a Delegate is a very good role for an Immediate Past President who brings experience, knowledge and understanding to the role but does not have the same responsibility for the day-to-day running of the Association/Network. We strongly suggest that at least one of those five Delegates is part of a succession plan so that information about the WA-Summit and WA-Alliance is gathered, developed and continues through the professional body rather than stopping with those who attend each two years. Many countries only have one or two Delegates and that is perfectly fine as well. Again it is worth noting the importance of succession for each country so knowledge is not lost to the Association/Network. Associations/Networks have their own methods of sharing information with their members. However, when it comes to information about the WA-Summit and the WA-Alliance it can sometimes, incorrectly, be seen as information specifically for those who run the association/network, therefore not of great interest or importance to the members of that association. The information from the WA-Alliance and the WA-Summit is really important and valuable to every individual administrative/office professional. The topics being discussed should be discussed widely among Associations’/Networks’ members as it is their thoughts, experiences, and views, collected through a survey, which have led to those topics being selected. Once the topics have been selected and the Agenda formed, the Delegates are asked to research those topics within their own associations and networks. Members should also ask their Association/Network leaders for information on the topics and seek to provide input. Please note that each country is also asked to report on a specific goal from Administra. This goal will be advised when the Agenda is sent out. Country Delegates should follow the same process listed below to gather information within their own country as regards that goal, so their report is representative of their country’s views. The main aim is to ensure that all Delegates bring a well informed, truly representative opinion on the topics to the discussions at the summit. Associations/Networks can do this in a many ways, often using a combination of approaches. They can: After consultation, the Delegates within a country need to meet, discuss the information they have gathered, and determine how they are going to contribute to the discussions or vote on a specific matter. The Delegates discussing and agreeing is critical as where voting is required, each country has only one vote, the Delegation Leader for a country is the only person who can vote. Once the summit has completed, a document is prepared setting out the outcomes reached at the discussions. The outcomes reached at the WA-Summit, or further research undertaken by Task Forces under the guidance of the WA-Alliance, are aimed at supporting the individual administrative/office professional in their day-to-day working life. The “Outcomes” documents can be found on our website and the link is shared with; all Delegates, all associations/networks, and it is requested that they share it with all their members and wider networks. The WA-Summit is an international platform where peer-to-peer discussions are held on relevant topics which impact those working in the administrative profession. Hear from Delegates who attended the 10th WA-Summit in 2018 (Why Attend?). It provides an opportunity for each individual administrative professional to be heard and contribute to the recognition of their work as a profession. For the individual their participation is called for through responding to surveys and ensuring their country is present to represent their views. The discussions at a WA-Summit lead to outcomes which includes research to support those outcomes such as: the reports from the 2021 discussions: The 10th WA-Summit 2018 in Frankfurt – 22 countries participated with 41 Delegates. Due to Covid-19 the 11th WA-Summit was had to be split into two parts: You can see the countries names on the Delegates Page . The members of the WA-Alliance will come from around the world. They need to apply, meet the criteria of the WA-Alliance and then pay a membership fee. You can see more about this on the WA-Alliance website. You can check out these three documents which were the initial communications and a structure diagram, setting out the initial intent of moving from an information structure to a formal body. The Members of the WA-Alliance Council provide wide geographical representation, are elected for a two year term, and were nominated and voted on by the Members of the WA-Alliance at the inaugural Annual General Meeting. The WA-Alliance is global with Council members from several countries – currently Netherlands, USA, Canada, UK, Trinidad & Tobago, New Zealand and Australia. The United States of America was chosen as the country to register the WA-Alliance primarily as the USA’s Non-Profit Trade Association is aimed at organisations founded and funded by associations and/or organisations representing a specific industry (trade); in this case administrators. It is recognised that many countries in the world will have some law which the WA-Alliance could have registered under, but it was felt the USA best suited the needs of the WA-Alliance, especially for international monetary transactions. The WA-Summit Advisory Council had been a loose voluntary body, usually “based” in the country where the Chairman of the Advisory Council resided. With the WA-Alliance being registered as a Non-Profit Trade Association in the USA, it will have a stable base. However no single country (including the USA) will have control over the WA-Alliance. The WA-Alliance required funding to cover initial set-up and on-going costs, for example: Previously many of the above costs were funded through the personal generosity of the individuals involved. With a paid membership base the WA-Alliance Council can now budget and cover many of the costs required. The WA-Alliance requires an ongoing diverse funding model likely to include sponsorships, business partners, association membership, etc. Could there be a travel fund from the WA-Alliance to support those who could not otherwise attend the WA-Summit? This is a great idea and is something that the new WA-Alliance Council will try to work towards for the future. The desire is that every country should be able to send at least one Delegate to every WA-Summit every two years. Will the change to the WA-Alliance impact on an individuals relationship with IAAP? There is no plan or intention to affect the relationships of any individual with their own country professional association, be it IAAP or any of the others around the world. Nor will it affect any certifications or credentials you gain through your own association IAAP’s CAP exam – will there be a global credential to match up with this? The WA-Summit in Frankfurt, 2018, agreed to have a task force to work on a Skills Set Matrix. This matrix is to incorporate the data gathered by the International Credentialing Team between 2015 and 2021. The Global Skills Matrix (GSM – rebranded) is now freely available to all. The credentialing side of this huge task we were advised required considerably more work and so that has been put aside in the short-medium term, to ensure that the Global Skills Matrix could be launched in September 2021. The GSM has been very well received by companies, HR personnel, recruiters, trainers, associations/networks and individual administrative professionals around the world. Read the Testimonials and Endorsements (scroll down) on our website. This is a document which has the potential to change how you and your role are seen and recognised, to potentially change your working life. As the WA-Summit is a non-profit making event and is run by dedicated volunteers, sponsorship is very important. The aim of sponsorship is to keep the cost of the WA-Summit registration down so that each country can afford to attend and can consider sending their full complement of three delegates. Without sponsorship this would not be possible. Sponsors get coverage in the countries that attend, in 2021 that was 27 countries from around the world. They also get exposure through both the WA-Summit and the WA-Alliance website and through our long-term business partnership with Executive Support Magazine.

http://wa-summit.com/about-us/faqs/

SECTOR SKILLS ALLIANCES - ERASMUS+ Sector Skills Alliances aim at tackling skills gaps, by identifying sector specific labour market needs and demand for new skills with regard to one or more occupational profiles (demand side), or by enhancing the responsiveness of initial and continuing VET systems, at any level (supply side), to sector–specific labour market needs. Projects can achieve these aims by applying to one or several of the following Lots (an organisation can be involved as applicant in several proposals and Lots as long as the proposals address different sectors): Lot 1: Sector Skills Alliances for design and delivery of VET: This Lot aims at responding to identified skills gaps and needs by developing common trans-national training content for European occupational core profiles as well as teaching and training methodologies, with a focus on work-based learning. Projects can include skills anticipation aimed at identifying skills needs, gaps and training provisions in a given specific economic sector or provide evidence that the proposed design and delivery of VET is based on existing skills need identification. Lot 2: Sector Skills Alliances for implementing a new strategic approach (Blueprint) to sectoral cooperation on skills: The Blueprint for Sectoral Cooperation on Skills120 is one of the ten actions in the New Skills Agenda for Europe121. In the current call, the Blueprint will be implemented in six sectors that are experiencing severe skills shortages (see eligibility criteria). Alliances under Lot 2 will support the implementation of the Blueprint by developing a sectoral skills strategy. ACTIVITIES SUPPORTED UNDER THIS ACTION Lot1: - Designing trans-national sector-wide vocational curricula. - Delivering vocational curricula Lot 2: Sector Skills Alliances under this Lot shall set up sustainable cooperation on skills development between key industry stakeholders in a given sector, education and training providers, and public authorities. ELIGIBILITY OF APPLICANTS Any participating organisation established in a Programme Country can be the applicant. This organisation applies on behalf of all participating organisations involved in the project. Public or private VET providers, at any EQF level in particular those with an own training de-partment, those providing apprenticeships, and those providing shared training (collaborative training); EU or national organisations and networks representing industry, small and medium-sized en-terprises, social partners, professions and education and training stakeholders, including youth organisations; as well as relevant sectoral organisations; chambers of commerce, of industry or of labour, and other intermediary bodies; networks of VET providers and European or national organisations representing them; European and/or national social partners; labour ministries or associated bodies (agencies or councils); public or private employment services; labour market research institutes, national statistics offices; public or private, small, medium or large enterprises (including social enterprises); economic development agencies and organisations involved in innovation ecosystems; sectoral or professional associations of employers or employees; chambers of skilled crafts; European or national sectoral umbrella organisations; research institutes; sector skills councils; bodies providing career guidance, professional counselling and information services; public authorities responsible for education and training and or labour market issues at local, regional or national level; accreditation, BUDGET Lot 1 - Sector Skills Alliances for design and delivery of VET:

http://europeannetforinclusion.org/opportunity/sector-skills-alliances-erasmus-1

Thank you to Participating Organizations that took part in the Special Interest Group (SIG) project selection process. Participating Organizations chose Best Practices for Container Orchestration as our 2021 SIG initiative! Containerization is an increasingly popular operating system virtualization methodology that allows for the creation of what are known as "containers". Containers can be used for various needs, such as microservices, batch processing, application portability, platform as a service (PaaS), and many others. Container orchestration tools provide a means of automating the provisioning, deployment, management, scaling and security of containers throughout their lifecycle. The goal of the SIG is to provide guidance for companies on how to enhance security when using container orchestration tools in their virtual or cloud infrastructure. This guidance will include an overview of container orchestration tools as well as a breakdown of payment industry considerations for critical components of typical system implementations. SIGs are community-driven initiatives that play a key role in the development of resources for the payment card industry. Involvement in a SIG is a great way to provide your expertise to the PCI Council and help develop practical payment security resources for the industry. To be successful, SIGs require active participation and contributions from its stakeholders. SIG participants are expected to be actively involved and contribute during scheduled calls, sharing their expertise and experience in container platforms and technologies, container lifecycle management, virtualization management, cloud architecture and management, security considerations for container deployments, and related fields. If you are a Participating Organization, QSA (including PA-QSA, P2PE QSA, 3DS Assessor and PFI), CPSA, QPA, ASV or Affiliate Member and would like to join this SIG, please click the ‘Register Here’ button below and complete the interest form.Register Here Participating Organizations (PO), Qualified Security Assessors (QSA), Approved Scanning Vendors (ASV), Qualified PIN Assessors (QPA), Card Production Security Assessors (CPSA), Software Security Framework (SSF) Assessors, Founding Members, Strategic Members, Strategic Regional Members, and Affiliate Members may propose a Special Interest Group during the proposal period. Special Interest Group (SIG) initiatives focus on specific payment security challenges that the PCI community wants guidance on addressing. Recent SIG topics include: Cloud Computing, Best Practices for Securing E-Commerce, Third-Party Security Assurance, Best Practices for Maintaining PCI DSS Compliance, Protecting Telephone-based Payment Card Data, and PCI DSS for Large Organizations. SIG work may provide clarification on specific requirements within a PCI Security Standard, examine how PCI Security Standards work within a given industry or environment, or cover any other area that supports PCI SSC’s mission of raising awareness and increasing adoption of PCI Security Standards. Since the PCI SSC is focused on providing tools and resources to secure payment card data within the current payment system, and must also operate within a strict anti-trust framework, a focus outside of the current payment system is beyond our scope and would not be an appropriate topic for a PCI SSC SIG project. A PCI SSC representative chairs, leads and project manages SIG work. This collaboration allows SIG volunteers to focus on contributing subject matter expertise and developing content, without responsibility for logistical matters. This structure also ensures continued alignment between SIG contributions and PCI SSC direction. While PCI SSC provides support and facilitates the SIG process, it is the active participation and contributions by stakeholders that make a SIG successful. Participating in the SIG process, whether submitting a proposal, voting for a proposal, or serving as a lead contributor to a SIG deliverable, is one of the best ways PCI stakeholders can take part in our mission to increase payment data security globally. SIG topics are proposed and chosen by the Participating Organization membership, which represents merchants, financial institutions, vendors, associations, and payment processors. This ensures that the stakeholders involved in implementing and supporting the PCI Security Standards can select which SIG projects would be most beneficial to their needs. SIG topics may be proposed during a defined submission period. At the close of the submission period, SIG proposals are consolidated and presentations are prepared for Participating Organizations to review via the PCI portal. An election period is then initiated for Participating Organizations to vote on their preferred SIG topics. After voting is concluded, the PCI SSC shares the results and works with the selected group to create a charter for the new SIG.

https://tr.pcisecuritystandards.org/get_involved/special_interest_groups

Mentorship is a valuable tool for professional development, offering guidance, support, and opportunities for growth. However, finding and cultivating professional mentors can be challenging, particularly for young professionals who are just starting out in their careers. Here are some tips for building a mentorship network: - Identify your goals: Before seeking out mentors, identify your professional goals and the areas in which you would like to develop. This will help you find mentors who have experience and expertise in those areas. - Look within your organization: Start by looking for mentors within your own organization. This can include supervisors, managers, or colleagues who have experience and knowledge that you can learn from. - Seek out industry associations: Joining industry associations and attending networking events can provide opportunities to meet potential mentors who are leaders in your field. - Use online resources: Online platforms such as LinkedIn can help you connect with professionals in your field and find potential mentors. - Be proactive: Once you have identified potential mentors, be proactive in reaching out to them. Request an informational interview or ask for guidance on specific professional challenges. - Be respectful of their time: Remember that mentors are often busy professionals themselves. Respect their time by being prepared for meetings or conversations, and by following up on their advice. - Be open to feedback: Mentors are there to offer guidance and support, but also constructive criticism. Be open to feedback and use it as an opportunity to learn and grow. - Cultivate relationships: Building a strong mentorship relationship takes time and effort. Cultivate your relationships with mentors by staying in touch, providing updates on your progress, and seeking guidance when needed. By following these tips, you can build a mentorship network that can help you achieve your professional goals and advance in your career. Remember to be proactive, respectful, open to feedback, and cultivate relationships with your mentors.

https://www.markzides.com/building-a-mentorship-network-how-to-find-and-cultivate-professional-mentors/

Novice teacher suffers from many problems... What are the problems faced by the novice teacher? Novice teacher suffers from many problems. And most important of THIS PROBLEMS... "lack of respect the students to the teacher" ... etc.. How to face this problem?What solutions do you think? - print Print - list Cite Expert Answers calendarEducator since 2010 write979 answers starTop subjects are Literature, Social Sciences, and History Being a novice teacher is a very difficult thing because there is so much to learn. Having been a mentor for many young teachers, even student teachers who were not mine, confidence and a plan make a huge difference. An agenda on the board, time management strategies developed with the help of a mentor, and work which engages students all help with discipline. I also would talk to the administrator or counselor who works with this group for ideas. Try to figure out who the leader is. I used to do this by having students fill out a 3 by 5 card with their names, last year's favorite teacher, their favorite book OR movie, and which students in the class they would like to work with in a group project. I explained that their choices were not set in stone, but I would consider them. Whichever students' names appeared most often were my likely leaders. That meant I could try to turn their leadership into a positive which would lead the rest with them. The advice given to you by all the above teachers is all very helpful; now you must find which works for you. Related Questions - Why do some teachers suffer from a "lack of confidence"in themselves?Why do some teachers suffer... - 10 Educator Answers - What are the challenges faced by teachers in teaching science in schools? - 2 Educator Answers - What are some problems teachers face today that were not problems in the past?problems teachers... - 2 Educator Answers - Problems facing the teaching and learning of EnglishProblems facing the teaching and learning of... - 6 Educator Answers calendarEducator since 2004 write1,941 answers starTop subjects are Literature, Social Sciences, and History Another important thing that can help the struggling novice teacher is having a strong mentor who he or she can trust and go to for honest help. Teaching can feel like a very isolated experience behind the doors of that classroom, but there are lots of talented people who can help. A mentor could come in an informally observe what is going on and offer specific observations and suggestions to help the young teacher. A mentor could review lesson plans and trouble-shoot potential problems with a lesson before they happen. These things could do a lot to improve teacher confidence. bookM.A. from The University of Alabama calendarEducator since 2006 write16,150 answers starTop subjects are Literature, History, and Social Sciences If administrators support a novice teacher, the teacher will attain some respect from the students quickly as they will fear retribution for their misbehavior. However, the new teacher must build upon this support quickly by being consistent and by being as prepared for the day as possible. Engaging the students in the learning process comes from a certain amount of trial, nevertheless, and experience. But, talking to experienced teachers is also helpful; indeed, there is much to be said for mentoring. calendarEducator since 2011 write272 answers starTop subjects are Literature, Social Sciences, and History I think a lot of it has to do with confidence. Even the most novice teacher can have confidence if he/she believes in what he/she is doing. Yes, students will try to test the teacher's limits, but in the beginning, those new teachers need to put firm boundaries and be sure to follow through with those boundaries. Making empty threats and not following through with consequences is what leads to the most problems. These things of course come easier with experience, but I still thhink they are possible for a new teacher- they just have to be a little more conscious of it. briefcaseCollege Professor calendarEducator since 2011 write3,640 answers starTop subjects are Literature, Social Sciences, and Business How to overcome a lack of confidence and a lack of respect from students at the same time is a very tricky problem to solve faced by most incoming teachers. Using lesson plans from experienced teachers and time-management strategies from experienced teachers is one way to try to work around the issue. Assigning work that must be completed by students in small groups during class time can help also to give the teacher a chance to interact with smaller groups and build relationships. calendarEducator since 2009 write35,413 answers starTop subjects are History, Literature, and Social Sciences I do think that a lack of respect for the teacher comes when the teacher doesn't know what they are doing. If the teacher has a plan for the class and does not seem to be floundering aimlessly, students will give the teacher more respect. One other thing, though, is that students will often try to test teachers just for the fun of it. If the novice teacher cannot find the right line between being firm enough and being humorless and dictatorial, students will not like them. Teachers have to find a way to treat students in ways that are not too strict or too lenient. briefcaseTeacher (K-12) bookM.A. from Southern Utah University calendarEducator since 2011 write2,337 answers starTop subjects are Literature, History, and Social Sciences When I find that I'm losing control of the class, or they aren't responding to me the wayI think they should, I look at what I'm doing wrong. I make sure that I'm fully prepared the next time to keep things rolling in the class. Sometimes the kids need a learning game to play together to get out of the winter blues. Sometimes I read them stories or make them give presentations on the lesson that I would have given. Change things up. Keep them on their toes so they never know what you will do next. You have to be their friend, either. Demand respect without being disrespectful, but change things up and get their bodies moving. Don't take "no" for an answer in a humorous way! Keep smiling and never let them know they got you! calendarEducator since 2008 write15,967 answers starTop subjects are Literature, History, and Social Sciences I think lack of respect from students often comes from lack of respect the teacher has for him or herself. This often comes from insecurity. Students also have little patience for inexperience, and they don't like posing. The solution is to get more classroom experience before taking a classroom of one's own, such as subbing.

https://www.enotes.com/homework-help/novice-teacher-suffers-from-many-problems-405433

Nurturing vs. Neglecting Having a nurturing and enjoyable learning environment in the classroom is one of the most important things for children to have while in school to strengthen their ability to learn. This leads to a number of positive factors in learning. Children not only feel comfortable with their environment, but they also absorb and understand the information better. This creates a domino effect, leading teachers to have better and more understandable material because they know their students better, leading to better test scores, which increases funding for the school. In order to have a positive and nurturing learning environment, it begins with a nurturing teacher. Teachers need to include caring relationships, high expectations, and give students opportunities for important participation and involvement. By having these three supports both at home and in school, students meet their needs for love, belonging, respect, and meaning which will lead to positive social outcomes, avoidance of bad or life threatening behavior, and increase their desire to learn and succeed. Having an unsafe learning environment can cause negative consequences on children. It can lead to learning problems, behavioral problems (lack of connectedness), and not wanting to participate in school related activities. Long term consequences could be learning or physical health problems or even disturbing learning attention and absorption which can lead to lower lifetime earnings and incomes (SOPHE). Children who are abused or neglected are left with deep and lasting scars. This kind of trauma does not just have to be physical. Emotional scarring leaves children full of self-hate, lack of trust, trouble showing emotions because they feel useless or worthless. Abuse and neglect does not just happen in the home. Neglectful teachers, both knowingly and unknowingly, can cause serious problems for children’s futures. Some of the common emotional abuse that children get from teachers are constant yelling or threatening, ignoring the child as punishment, and constantly being compared to a different student or students and being told they are not as good. When students feel welcomed and safe in the school environment, they don’t feel left out. In the majority of harmful cases, like school shootings, the gunman was someone who felt neglected by everyone around them. They believed they were an outcast and did not want to be treated that way anymore. Starting with teachers, children learn to be comfortable with their surroundings in the school environment. First they get to know the teacher, then their classmates, and then the material. When teachers intentionally put children in groups with others who they feel the children would connect the most with, the children make friends with each other quickly and whole-heartedly. This leads to not only more enjoyable school years for the children, but also a safer environment for everyone in the school for the future. Children will feel more comfortable with one another so when a problem arises, students can ask any passerby to go get help. By creating a safe environment for all levels of school, there may be fewer brawls or assaults which can lead to fewer lock downs and threats. An important factor that may cause some teachers to not put a lot of effort into a nurturing classroom environment is the fact that they may not know the importance of this in a child's learning development. What new teachers have learned throughout their schooling and student teaching is all they know about the classroom and if they are not taught the importance of a nurturing environment, they won't know to put a lot of time and effort into providing that for their students. The administration has a huge influence over teachers. If they do not have the support from administration to focus more on the social emotional development of children rather than the cognitive development, teachers are forced to do so. Schools want the maximum amount of funding that they can get and that comes from having high test scores. Having high test scores makes the school look better, and if the school looks better, more people will want to attend there. While every parent want a nurturing learning environment for their child, some of them don't think that that is the most important thing in their child's education. In schools that are tougher to get into and require high test scores for admission, parents want their child focused on learning and practicing as much information as they can in preparation for these entrance tests. Having parents that focus mainly on test scores may lead to the child not only feeling pressured at school, but neglected at home. At an early age, children spend a lot of time trying to make sense of the environment in which they are placed in on a daily basis – child care. Children who begin attending childcare during infancy, will spend as much as 12,000 hours in this setting. This means that the space provided for the child must be what is considered “best” for the children. In order to place a child in their best environment, the parent must know their needs and interests and what type of teacher would best emphasize these needs. A caring teacher, combined with specific learning techniques, creates a wonderful place for young children to learn and grow. Children learn best when allowed to work in environments that are appropriate for their level of development. There should be both a play area for activities as well as a private area for quiet time. There should be spaces provided for children to work quietly as well as areas that allow children to collaborate with one another (Early-childhood News). Randall Wisehart stated “Passionate teachers continually reflect on the interplay of standards, student motivation, student learning and grades” (Wisehart). By figuring out what the students are most interested in and what motivates them, teachers can find ways to make classrooms fit their needs. By doing this, teachers connect what the students learn and the scores of their tests to show it. Samy A. Azer, an Australian medical educator, stated “We identify people as role models when they inspire imitation and influence people working with them to develop new skills and achieve their potential” (Azer). Students pick up on everything a teacher does and says. How teachers react to situations will rub off onto students and they will begin to react that way in school too. By acting professionally and remembering that students are watching, teachers can create a nurturing learning environment for students starting with how they act. A survey conducted by highly regarded teachers in a large department of medicine, where they were asked to specify the personal qualities, teaching skills and clinical competencies they considered most critical for effective role modelling in medicine found that “good teachers are enthusiastic, friendly, easy-going, able to develop rapport with learners, committed to the growth of their students, approachable, interested in learners as people, and always conscious of their status as role models.” There are little things that a teacher can do during the day to make students feel just a little extra special. Starting out the day by greeting the students as they walk in the door is a great way to start off the day. Allow some students to share with the class an object or event that has happened to them recently. This give the class a discussion topic for the entire day. Students love hearing about teachers lives, so teachers should share something that has happened to them recently. This may help students feel more connected to the teacher. In classes with a lot of diversity, it is a good idea to talk about the different cultural backgrounds that each students has. It's not only something fun and important for the children to learn, it may also make the students with different cultural backgrounds more comfortable with their peers. Teachers should also discuss bullying and how it won't be accepted, and remind the students of the golden rule, if you show respect, you will get respect back. By giving students group activities throughout the school year, it helps them build rapport and friendships with each other. When friendships form with one another, students begin to gain confidence and have high self-esteem, which is something that teachers should promote on a daily basis (Watson). Not only does a nurturing environment make learning easier and more enjoyable for the children, it also does that for the teacher as well. When the children are enjoying themselves, it shows, and it makes the teacher want to continue to make the children feel that way. This causes a reflective approach, where the teacher asks themselves how to best teach based on their students needs, to learning and most definitely makes the year go smoother for both the students and the teacher. The main focus of school needs to stop being about letter grades and test scores and start being about what the child did well and what they need to focus on. While having high test scores is both important and beneficial for schools, ultimately, teaching is about building relationships (Wisehart). Many times students just want to finish the work and don’t care about the content. When teachers have a strong relationship with their students, the students want to put in their best effort and the teacher is able to give beneficial constructive criticism that the student will really pay attention to. Teachers need to build relationships with their students and push them to achieve their best. Without nurturing environments, students lack self confidence and can lead to negative behavioral problems or even life long consequences. Teachers are the starting point in building these environments. Parents and administration can play important roles in the ability and amount of nurturing a teacher can provide students. If teachers focus more on social emotional development instead of cognitive development of students, it will be beneficial all throughout life. Works Cited Azer, Samy A. "The Qualities of a Good Teacher: How Can They Be Acquired and Sustained?" Journal of the Royal Society of Medicine. The Royal Society of Medicine, Feb. 2005. Web. 18 Mar. 2015. Isbell, Rebeccaa. "Earlychildhood NEWS - Article Reading Center."Earlychildhood NEWS - Article Reading Center. N.p., 2008. Web. 18 Mar. 2015. "Reducing Youth Health Disparities Requires A Supportive, Nurturing, & Healthy Learning Environment." SOPHE-ASCD (2010): 1-5. Www.sophe.org. 2010. Web. 18 Mar. 2015. Watson, Sue. "Create a Welcome, Non-Threatening Classroom Environment." Www.about.com/education. N.p., 2015. Web. 25 Mar. 2015. Wisehart, Randall. "Nurturing Passionate Teachers: Making Our Work Transparent." T 45 Teacher Education Quarterly (2004): 45-53. 2004. Web. 18 Mar. 2015.

http://argument-exposition.wikidot.com/arguing-cause-final-huseby

A toxic school is one that has been found to be highly problematic in terms of its social, emotional, and physical impact. When a school is found to be highly toxic, it is usually because it has violated multiple standards and regulations, which in turn can negatively affect the entire community. These standards include everything from the adequacy of the school’s facilities and resources to the quality of its educators and the manner in which they interact with the children. Students who have been identified as a “toxic” school often find it difficult to improve even when other schools around them are making gains. The reason is that the schools in question are often too dysfunctional to change. It is in the nature of a toxic school to produce toxic students. If schools are so broken, it is only logical that they are unlikely to improve. Toxic schools produce toxic students, not just because they do not teach critical thinking, but because they also create an environment that pushes students to conform to a group and prevents them from thinking independently. In schools, some students are more likely to struggle with toxic behaviors than others. These behaviors include bullying, underage drinking, substance abuse, and sexual harassment. This makes it all the more important to identify toxic schools to stop the behavior and break the cycle. Identifying a toxic school will be easy with the signs that I will share with you. - - When learning about a school’s toxic culture, people often look at or notice the relationships between teachers and students. While most schools are a place of learning, it is often a place fraught with hostility. As students go through the school system, they are often exposed to negative interactions at the hands of teachers, peers, and administrators. These encounters can cause students to lose confidence, change their behavior, or learn to disengage from school altogether. - When it comes to school, what are the rules and regulations teachers focus on and enforce most? How are they applied to students and their learning experiences? What, if anything, are the consequences when rules are broken? A toxic school is one that prioritizes rules and procedures over relationships and encourages conformity above creativity and risk-taking. Rules are necessary, but rules aren’t everything. In how schools and educational environments create safe spaces for students, there’s a great deal that goes beyond the simple rules of the school. - A toxic school is often a dysfunctional, poorly managed school. While the purpose of a school should be the education of our youth, it seems that one of the main goals of many schools today is to satisfy some sort of “purpose,” usually for the benefit of the adults running the show. Toxic schools are those that fail to engage their students, foster a sense of community, or provide students with a clear sense of purpose. Often, these schools are characterized by a lack of academic rigor, a poor quality of teachers, a lack of a rigorous curriculum, and an unsympathetic administration. When a school is toxic, students are likely to experience a negative environment that rewards bad behavior, fosters apathy, and is not conducive to learning. - A toxic school is a school that is damaging to the lives of students. The damage can be in the form of academic performance, emotional well-being, social behavior, and even physical health. If any of these areas of life are negatively affected, the school looks toxic to the students. The students at a toxic school suffer because they do not get the help they need, and, thus, the school has failed to meet their most basic needs of a healthy and safe learning environment. - Schools are supposed to be safe places where we learn new things, but more and more students are being harmed by chemicals in their classrooms. The young, the old, the sick, the suicidal, the overweight, the meek—you name it, it’s being perpetrated by toxic chemicals. A toxic school is a school it lacks safety for the students and staff. It’s important that schools have the resources in place to identify what is causing the people in school to feel unsafe to intervene and keep the school safe.

https://www.whatalisees.com/identifying-a-toxic-school/

Black students in the United States are three times more likely than their white peers to be suspended or expelled. The reason why has not been clear, until now. A new study suggests teachers are likely to interpret students’ misbehavior differently depending on race. “The fact that black children are disproportionately disciplined in school is beyond dispute,” says Jennifer Eberhardt, professor of psychology at Stanford University. “What is less clear is why.” Name the problem student Real-world primary and secondary school teachers were presented with school records describing two instances of misbehavior by a student. In one study, after reading about each infraction, the teachers were asked about their perception of its severity, about how irritated they would feel by the student’s misbehavior, about how severely the student should be punished, and about whether they viewed the student as a troublemaker. A second study followed the same protocol and asked teachers whether they thought the misbehavior was part of a pattern and whether they could imagine themselves suspending the student in the future. Researchers randomly assigned names to the files, suggesting in some cases that the student was black (with a name such as DeShawn or Darnell) and in other cases that the student was white (with a name such as Greg or Jake). Racial stereotypes Across both studies, racial stereotypes shaped teachers’ responses not after the first infraction but rather after the second. Teachers felt more troubled by a second infraction they believed was committed by a black student rather than by a white student. In fact, the stereotype of black students as “troublemakers” led teachers to want to discipline black students more harshly than white students after two infractions. They were more likely to see the misbehavior as part of a pattern, and to imagine themselves suspending that student in the future. “We see that stereotypes not only can be used to allow people to interpret a specific behavior in isolation, but also stereotypes can heighten our sensitivity to behavioral patterns across time. This pattern sensitivity is especially relevant in the schooling context,” Eberhardt says. [related] The results, published in the journal Psychological Science, have implications beyond the school setting as well, says graduate student Jason Okonofua. “Most social relationships entail repeated encounters. Interactions between police officers and civilians, between employers and employees, between prison guards and prisoners, all may be subject to the sort of stereotype escalation effect we have identified in our research.” Useful interventions with teachers would help them to view student behavior as malleable rather than as a reflection of a fixed disposition, such as that of troublemaker. While racial disparities can be lessened by psychological interventions that help improve black students’ behaviors in class, it is also important to understand how that behavior is interpreted by teachers and school authorities, Okonofua says.

https://www.futurity.org/teachers-black-students-stereotypes-900192/

When you think back to your first year of teaching, what is the one word you would use to describe that first year? Some of the words that teachers have shared with me include: confusing, overwhelming, and intense. It’s not nice having that overwhelmed feeling and it can not only be stressful, but it can also lead to burnout. I’m a believer that proactive teachers implement many preventative techniques and strategies to help cope with the different aspects of the classroom. This definitely helps with that overwhelmed feeling, and what I think is the difference between an outstanding teacher and one that is struggling. Here are some of the qualities of what I think makes an outstanding teacher. Outstanding teachers are clear and organized Outstanding teachers have fully prepared lessons, with clear objectives that are also obvious to students. They are in the classroom early and ready to go with teaching by the time students arrive. They have thought about and considered all parts of the lesson; they are structured and cater for the different learning needs of their students. Outstanding teachers use a repertoire of teaching strategies to engage students The first 5 minutes of a lesson really counts and it usually sets the tone for how the rest of the lesson will go. Outstanding teachers use a variety of teaching strategies to entice their students in the first few minutes of the lesson. They change this up and consider the best strategy to match the content of the lesson. They are confident and enthusiastic and use their voice clearly to explain concepts and keep students on track during a lesson. Outstanding teachers develop positive relationships with their students Seeking mutual respect and trust is a goal of an outstanding teacher. They are warm, pleasant, approachable and tolerant of student differences. They are consistent and fair. They learn their student’s names quickly and get to know each of them. They help their students to feel good about themselves and continually work at developing a positive relationship with individuals and the class as a whole. Outstanding teachers adapt their lessons for individual differences Not all kids are the same or learn in the same way or in the same time, each and every one of them is unique. Outstanding teachers acknowledge this, have a clear picture of where each of their students is at and cater for this when planning lessons. [Tweet “Outstanding teachers seek support to help their students to be happy and succeed at school.”] Outstanding teachers assess and evaluate student learning to identify what they learned and what they have not yet learned Outstanding teachers ask themselves: what knowledge, skills, and values did my students learn? What am I going to do to help my students learn concepts if they didn’t, or extend those students that need it? Outstanding teachers constantly evaluate how their students are progressing and use this information to direct future learning experiences. They are also very clear why they assess and know the type of information they want to collect. They choose the best assessment techniques to match the intended outcome. Outstanding teachers constantly develop their management skills Preventing student management problems from occurring in the first place is the goal of an outstanding teacher. Outstanding teachers make their expectations very clear to students and can anticipate problems and if they do arise react accordingly to prevent further disruption. Outstanding teachers have many low-key techniques for responding to inappropriate behavior and will always try to use these as a first option. Outstanding teachers do not need to yell at their students! Outstanding teachers are reflective teachers Outstanding teachers want to improve to become a more effective teacher. They participate in professional development, they connect with other outstanding teachers, they seek feedback and advice and they self-evaluate for self-improvement. “Remember, the perfect teacher does not exist, but we all can become better teachers. Continual improvement of our teaching skills is the essence of professionalism in our field” (Good & Brophy, 1991). Summing up What would you add to the list? What do you think makes an outstanding teacher? If you’re a new teacher and you’ve also been feeling overwhelmed and stressed, then I’m here to help and support you. I know what it’s like being a new teacher…..the excitement…..the trepidation…..the nerves…..and I also know the lack of support provided to new teachers. Many new teachers are told to either sink or swim…..that was certainly the case for me! But I don’t believe new teachers should be treated like this. New teachers should be nurtured and supported and provided with all of the opportunities to not only succeed but to THRIVE. And to support you on your teaching journey I’ve put together a pack of my top behavior management strategies. Use the form below to grab it now! FREE Behavior Management Tips Subscribe to our newsletter to receive regular teaching tips and updates & get instant access to the free behavior management PDF:

https://topnotchteaching.com/classroom-management/good-teacher-or-outstanding-teacher/

Showing interest in your students helps to build and develop trust with your students. Oftentimes teachers will forget that their students have lives outside of the classroom as often as students do the same to teachers. Talking about your own interests can show students that you are a person and want to share who you are with them. Establishing this rapport with your students will make it easier for you when it comes time to giving directions to students. Students are much more likely to follow directions and pay attention in class when you have good rapport with them. Make sure to strive to learn the students’ names as soon as possible at the beginning of the term to begin the relationship building process with your students. Learning about the Korean culture as much as possible will be a huge help as well in building rapport with your students.

https://www.onepointfeedback.com/show-interest

The Global Search for Education (GSE) is a regular contributor to the Edmodo Blog. Authored by C.M. Rubin, GSE brings together distinguished thought leaders in education and innovation from around the world to explore the key learning issues faced by today’s nations. Look for a new post every week and join the Global Search for Education Community on Edmodo to share your perspectives with their editorial staff. Would small data help accomplish what is called Good Data in education? Education systems around the world use big data such as standardized tests, school inspections and surveys to measure learning outcomes. Pasi Sahlberg believes that good education must be evaluated from a variety of evidence which includes both the quantitative and the qualitative. He argues that in order to understand how well schools are doing, we also need to collect “small data” using teachers’ and students’ “observations, assessments and reflections” of the teaching and learning processes in classrooms. Small data is not a new idea of course. What is new is the technology that can now support this kind of analysis. Are school-based formative assessments better than standardized ones? What are some great examples of how small data is being used effectively in schools? Small data requires more trust in teachers’ and schools’ judgments, so how do we build that trust in education? Joining me in The Global Search for Education to talk about data is Finnish educator Pasi Sahlberg, author of Finnish Lessons: What Can the World Learn from Educational Change in Finland. Pasi received the 2012 Education Award in Finland, the 2013 Grawemeyer Award in the United States, and the First Class Knight of the White Rose of Finland in 2013. Pasi, can you talk about the difference between big data and small data? Big data is a commonly used term in daily discourse that often comes with a label that big data will transform the way we think, work, and live. For many of us, this is an optimistic promise, while for others it creates anxiety and concern regarding control and privacy. In general terms, big data means data of very large size to the extent that its manipulation and management present significant practical challenges. The main difference between big and small data in education is, of course, the size of data and how these data are collected and used. Big data in education always requires dedicated devices for collecting massive amounts of noisy data, such as specific hardware and software to capture students’ facial expressions, movements in class, eye movements while on task, body postures, classroom talk, and interaction with others. Small data relies primarily on observations and recordings made by human beings. In education, these include students’ self-assessments, teachers’ participatory notes on learning process, external school surveys, and observations made of teaching and learning situations. We are entering the era of digital technology mediated learning environments in education. Promises that come with this revolution state that big data will lead to more powerful personalized learning, active student-centered pedagogies, responsive formative assessments, and increased overall efficiency in education. This said, big data in education can be seen as a purposeful or incidental recording of activity and interactions that provides variety and large amounts of analyzable data in digitally mediated educational environments. This requires new forms of ‘data skills’, especially syntheses and presentations that have led to the emergence of two new fields: educational data mining and learning analytics. Educational data mining focuses on interpreting evidence from large amounts of noisy and unstructured data, for example, correlations between student behavior and learning. It answers questions like, “What sequence of study is the most effective for a specific student?” and “Which actions indicate student engagement and satisfaction?” Learning analytics is more concerned about applying tools and techniques of larger scale in educational settings, answering questions like “When is a student at risk of failing the course?” and “What grade is a student likely to receive without intervention?” By definition, big data offers more versatile information about teaching and learning situations that can be used for tailoring more personalized learning solutions for students. Big data in education opens new doors also to researchers. Perhaps the greatest value of it, as Bill Cope and Mary Kalantzis conclude in the article, Big Data Comes to Schools, is “the possibility in any particular case to analyze a variety of data types using a variety of methods, cross-validating these against each other in a more powerfully holistic, evidence-based repertoire of research practices.” At the same time, however, we must be mindful of potential drawbacks of big data, especially those related to data privacy and research ethics. When big data is used to determine children’s educational pathways and thereby their future, or influence teachers’ careers in education, we have crossed the line of appropriate use of big data in education. Another example of an emerging big data system in education is OECD’s Education GPS that hosts massive amount of data from education systems around the world. The OECD’s data, including those from PISA, is used by policy-makers to decide the directions in their own education systems based on what seems to have worked in other countries. Again, big data analysis alone without small data will probably lead to unintended outcomes in practice. My favorite example is from my own time being a mathematics and science teacher in Helsinki. As so many of my colleagues, I soon realized that there are many students who don’t like these subjects. They thought that mathematics and sciences are too difficult to learn and often distant from their daily lives. One of the first things I learned in my classrooms was that many students, probably most of them, have self-created conceptions of science and images of mathematics. Students’ inner worlds are very difficult to capture in any other way than by helping them to think hard about their own minds and try to turn these thoughts then into tangible representations, such as stories and drawings. I spent a lot of time then collecting small data, in and out of my classroom, to understand students’ own ideas about the mathematical and scientific worlds. Only after knowing what students imagine when they think about what mathematicians do (most of those are not positive images at all) I started to find better ways to make the world of mathematics accessible and understandable to students. Small data can help teachers to understand why some students don’t learn as well as they could in schools better than big data that most often show whether students learn or not what they are supposed to learn. What kinds of data are we currently analyzing? What kinds of data should we be looking more closely at and why? I have seen a notable shift during the past decade or so from teacher-collected evidence through classroom-based assessments toward digital technology mediated data. At the same time, standardized tests have become a central tool in collecting these data. Schools around the world now post their students’ test results in school. Teachers spend more time analyzing these data and trying to make sense of what the results mean in their own work with students. I am not saying that this is necessarily a bad thing. But if teachers are steered by external data from standardized knowledge tests and inspection reports, it undermines the complexities of teaching and learning in schools. There are school systems where much broader sets of information are analyzed and used to guide the work of the school. In Finland, a central element of each school is a “student welfare team” that is made of teachers, wellbeing specialists, counselors, and school leaders. Through these first-hand small data, early interventions to help students at risk are then decided and made in schools. This team meets regularly, in most schools weekly, to discuss and process information brought in by teachers concerning their students’ wellbeing, behavior, and learning in schools. School-based formative assessments and census-based standardized assessments serve different purposes. I think that we need them both. However, in many countries, system-level standardized tests that are used to measure all the students all the time could be gradually replaced by higher quality sample-based assessments. Teacher-led formative assessments should enrich the evidence that schools use for improvement purposes. In a way, this is a sensible combination of big data and small data to accomplish what is sometimes called Good Data in education. Can students’ reflection on their own learning be incorporated into our standards of achievement? Good learning includes students’ ability to understand and regulate their own learning process. This requires, however, that students have rather developed metacognitive habits and skills to understand how they learn. Students’ reflection on their own learning can be incorporated into judgment of student achievement as soon as these skills exist at an appropriate level. Again, I believe we are talking about the conditions of using small data for student evaluation here. Small data requires more trust in teachers’ and schools’ judgments about what they do. How could trust be built in education? Trust is perhaps the most needed single ingredient missing in many education systems today. Politicians don’t trust educators. Ministers can’t rely on school principals. And, as a consequence, there is a lack of trust in teachers who, in turn, can’t trust students. Experience suggests that trust in people and in institutions can only be built by genuine deeds that give them more responsibility and agency. In Finland, trust in schools and education in general began to flourish soon after the government allowed schools to design their own curricula (steered by national framework curriculum), to evaluate the effectiveness of their own work, to control their budgets, and to professionalize the middle level leadership. Ceremonial speeches and political appeals have had diminishing impact on changing the culture of education in this respect. When schools have real ownership and responsibility for small data, I believe professionalism in schools will be enhanced. That is one of the conditions before trust in our teachers will start to grow. 1 comment. Leave new For me, small data is sufficient enough to draw significant conclusions from a specific study. Big data, however, have more noise which will entail more time and effort to exclude it from the more important gathered data. Well, it really depends on the study being conducted whether to use small data or bid data.

https://blog.edmodo.com/2017/02/03/the-global-search-for-education-would-small-data-mean-big-change/

Self-Fulfilling Prophecy Definition A self-fulfilling prophecy is a process through which someone’s expectations about a situation or another person leads to the fulfillment of those expectations. Thus, the expectancy becomes a cause, so that what is expected comes true because it was expected. The process includes three steps: (1) A perceiver forms an expectation of a situation or target person, (2) the perceiver’s expectations affects how he or she behaves in the situation or treats the target person, and (3) the situation or the target person is affected by the perceiver’s behavior in a way that confirms the perceiver’s initial expectation. Self-Fulfilling Prophecy Background and History The concept of the self-fulfilling prophecy was initially introduced by a sociologist, Robert K. Merton. In Merton’s conception, a self-fulfilling prophecy applied to social as well as nonsocial phenomena. For example, Merton discusses how a self-fulfilling prophecy could lead a stable bank to experience failure. Imagine that a group of individuals comes to believe that a bank is on the verge of bankruptcy. As a result, those individuals withdraw their savings from the bank. In turn, other depositors start to worry that their funds are not safe and consequently withdraw their funds. In the end, many depositors withdrawing their funds actually leads to the bank becoming bankrupt. Therefore, the individuals’ expectations influenced their own behavior and ultimately the very situation about which they were concerned. The type of self-fulfilling prophecy that leads to a bank failure is one that depends on the beliefs and actions of many individuals. However, most of the social psychological research on self-fulfilling prophecies has focused on how one person’s belief about another person leads to confirmation of that belief. One of the best-known studies that demonstrates the effect of self-fulfilling prophecies at the interpersonal level was conducted by Robert Rosenthal and Lenore Jacobson in the late 1960s. In this study, the researchers led classroom teachers to believe that some of their students were “potential bloomers,” who would show substantial IQ gains during the school year. In actuality, the students labeled as “bloomers” were randomly chosen by the researchers and were not really different from their classmates. So the teachers’ beliefs about the potential bloomers were initially false. Nonetheless, at the end of the school year, these bloomers had higher gains in their IQ compared with the other students. The teachers’ expectations that bloomers would experience IQ gains caused them to treat these students differently. For example, teachers were more likely to give feedback to the bloomers and challenge them more than they did their other students. These differences in the teachers’ behavior led these students to perform better. This study was important in demonstrating that individuals may unwittingly cause outcomes that they expect by changing their own behavior and thereby influencing the behavior of others. The early research on the self-fulfilling nature of teacher expectations on student achievement faced criticism about the ethics of the research and the very existence of the self-fulfilling prophecy. Experimental laboratory research, however, convincingly demonstrated that people can subtly affect the behavior of others because of their own expectations and that these self-fulfilling prophecies do occur in many situations. The experimental studies on self-fulfilling prophecies typically led perceivers to expect something of a target and then measured the target’s behavior. Because the expectations perceivers held for the targets were initially false, if the behavior of the target confirmed the expectation, this was taken as evidence of a self-fulfilling prophecy. For example, perceivers might be led to believe that a target person with whom they would interact was physically attractive by showing the perceiver a picture of an attractive person. Because people tend to believe that physically attractive individuals are friendly and outgoing, perceivers would expect an attractive interaction partner to be sociable. Perceivers would then interact with someone who was objectively physically attractive or not. In general, perceivers acted in ways that elicited the type of behavior they expected from their interaction partners. So, for example, perceivers were themselves more friendly and outgoing if they believed that they were interacting with an attractive person rather than if they thought they were interacting with an unattractive person. In turn, targets who experienced friendliness from the perceiver responded by being warm and friendly, regardless of their objective levels of physical attractiveness. These types of laboratory studies were important in demonstrating that self-fulfilling prophecies do occur, even in situations in which people do not know each other very well or have repeated contact, as a teacher might have with students. Recent research has even demonstrated that perceivers’ expectations may lead to self-fulfilling prophecies even when perceivers are unaware or not consciously thinking of their beliefs. Something in the environment may bring to mind a perceiver’s expectation, and even if the perceiver is not actively thinking about the belief, it might influence his or her behavior, and the behavior of individuals with whom they interact, leading to self-fulfilling prophecies. Although false expectations can lead to self-fulfilling prophecies, some researchers questioned whether these effects occur in the real world and how powerful they are. For example, do teacher expectations that have not been created by researchers influence student performance in real classrooms? Although self-fulfilling prophecies are not as powerful in the real world as they are in the laboratory, perceivers’ expectations do have a small effect on targets’ behaviors. But, in some situations perceivers’ expectations are unlikely to lead to the target confirming those expectations. If a person knows that others have negative expectations about him or her, he or she may work hard to disconfirm, rather than confirm, the expectations. The result might thus be a self-defeating prophecy, the opposite of a self-fulfilling prophecy. Self-Fulfilling Prophecy Importance Self-fulfilling prophecies demonstrate that people often play an active role in shaping, and even creating, their own social realities. Self-fulfilling prophecies can influence many interactions and situations, but the impact of these prophecies is particularly evident in two major areas: (1) stereotyping and perceptions of members of groups that are negatively viewed in society and (2) the effects of teacher expectations on student achievement. Stereotypes are beliefs about the traits, personalities, and abilities that characterize the typical individual of a group, and these beliefs are often difficult to change. Self-fulfilling prophecies may be one reason that this is the case. As an example, consider the case of women. One component of the stereotype of women is that the typical group member is dependent. A perceiver who expects women to be dependent may be especially likely to treat women in ways that elicit dependence. For example, a perceiver may offer help to a woman with a flat tire (even if help is not requested, or is unnecessary), and the woman may respond by accepting the offer. In such an interaction, the woman depended on another person for help, and therefore the perceiver’s stereotype of the group is confirmed. Because stereotypes are usually widely shared within a society, these types of stereotype confirming interactions are likely to occur repeatedly in the society and thus have a much stronger impact than the idiosyncratic expectations that one individual has about another individual. But the influence of self-fulfilling prophecy on stereotypes is even more pernicious when one considers that individuals do not need to be actively or consciously thinking about a stereotype for it to affect their behavior. Just being aware of a stereotype may lead the belief to automatically come to mind and influence the behavior of the perceiver when he or she interacts with members of the stereotyped group. The second application of research on self-fulfilling prophecies harkens back to the original research of Rosenthal and Jacobson on the effect of teachers’ expectation on student achievement. Rosenthal and Jacobson showed that high expectations from teachers can improve student performance, but the converse is also true; teachers’ negative expectations may impair student performance. Students from some ethnic minority groups and those with low socioeconomic status tend to achieve less academically than do their White and more economically advantaged students. These outcome differences may be partly due to teachers’ expectations. Teachers’ expectations do affect performance in real classrooms. Research has shown that self-fulfilling prophecies have stronger effects on poor and ethnic minority students, about whom teachers are likely to have the most negative expectations. So, it is important for teachers to think about their expectations for their students because these expectations have real consequences for important outcomes. References: - Jussim, L., Eccles, J., & Madon, S. (1996). Social perception, social stereotypes, and teacher expectations: Accuracy and the quest for the powerful self-fulfilling prophecy. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 28, pp. 281-388). San Diego, CA: Academic Press. - Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom: Teacher expectations and student intellectual development. New York: Holt, Rinehart & Winston. - Snyder, M., Tanke, E. D., & Berscheid, E. (1977). Social perception and interpersonal behavior: On the self-fulfilling nature of social stereotypes. Journal of Personality and Social Psychology, 35, 656-666.

http://psychology.iresearchnet.com/social-psychology/social-influence/self-fulfilling-prophecy/

When the words attachment and teaching are used in the same sentence, a whole array of reactions tend to occur. While some of these reactions are positive, many teachers become quite defensive. Some of their arguments are listed below: - Teachers already have so much to worry about and do, attachment is just one more responsibility unjustly given to teachers; - Teachers are not meant to do the parents’ job; - Teachers aren’t therapists; - Teachers need to maintain a professional distance from the students in order to protect themselves from accusations of abuse. I don’t really get the last one. To me, denying a crying child a hug is abuse in the form of neglect. But I’m getting ahead of myself. These arguments demonstrate how overworked and stressed teachers are. They are afraid that more responsibilities will be thrown at them – and they have a point, it does tend to happen on a daily basis – and they will be under even more pressure. The application of attachment theory in the classroom, however, is not meant to make teachers’ lives more difficult; it is meant to make things easier. Yes, you read it right. Easier. As an EFL (English as a foreign language) teacher I find these arguments a bit strange, not for lack of empathy for the teacher, but because language teachers have been applying attachment friendly methods for decades without much fuss. We have learned, from research, that they are very effective when teaching a foreign language, rather than traditional teacher centred methods. Therefore, we implemented them, made them the norm and have had very positive results. I wonder if it would be more difficult to do the same with other subjects. To explore this crazy idea, I’ll try to answer these three questions in the next lines: - What the hell is attachment, anyway??? - Why is it relevant to teachers? - How can we make attachment aware teaching possible… and enjoyable… and easy? Attachment According to John Bowlby – the guy who made attachment a thing – attachment is: “Proximity-seeking to the attachment figure in the face of threat, due to the capacity to sense conditions that could be dangerous: being alone, unfamiliarity, rapid approach”. Got it? No? Me neither. I needed a better explanation and I understood attachment for the first time during a training session with Suzanne Zeedyk. Click here to watch one of her lectures. Click here to access her blog. Zeedyk has a less orthodox way of explaining attachment: she talks about sabre-toothed tigers and teddy bears. Imagine prehistoric human beings using their instincts to survive from predators. If a sabre-toothed tiger attacked the group, it would likely go for the weakest, easiest prey: the babies. The babies can`t protect themselves or run away, but their parents can do that for them. While adults have the instinct of running for their lives, babies have the instinct of getting the adult`s attention so they don`t get left behind. Babies cry and scream because they don`t want to be left alone, they want to be held and kept close. This attachment is key to their survival, so it`s the most fundamental part of their nature. When they don`t have that, all that`s left is fear – which can mean trauma, anxiety and a range of emotional issues. To make it clear, Zeedyk describes an internal teddy bear. A child uses a teddy for comfort, and little by little they develop their own internal teddy bears they turn to for comfort in moments of distress; that`s them building resilience. But this can only happen properly if they had this comfort in their early childhood provided by their parents (or whatever caring figures they had) in the form of attachment. If teddy bears are the antidote to sabre tooth tiger fear, how do we build our internal teddy bears? Is it only with the help of parents or primary care-givers? If we don’t develop during our early years, is it possible to fix it? The answer to these questions is in how our brains work, which also answers the question on why this is relevant for teachers. Brains I must stress at this point, that even though I am passionate about psychology, I’m not a neuroscientist and the explanations below are rather simple. I have asked experts to check them, though, and they said it isn’t wrong, so let’s do this! This is your internal teddy bear, your frontal lobe: Not as cuddly as one might have thought, but it works wonders. The frontal lobe is, among other things, responsible for our ability to: - learn, reflect and concentrate; - plan and problem solve; - manage stress; - control impulse; - regulate emotions. As you probably gathered, our students’ frontal lobes are very important to us teachers. If they are not functioning properly, students fail to learn. They also fail to behave, which is not helpful and it makes our lives much harder. According to Margot Sunderland, author of The Science of Parenting (2015), this part of the brain is not fully developed when we are born, we need to learn how to use it. Our lower brain, however, is fully functional and very much online from birth. This part is responsible for (again, among other things we don’t need to focus on now): - hormonal forces; - emotional systems; - fight or flight reaction. This is why when a toddler is hungry they might throw themselves on the floor crying and screaming and have a distress tantrum. They don’t have a fully developed frontal lobe to warn them: food will probably come soon, your mum always makes lunch at twelve; why don’t you play for twenty more minutes and then go check if it’s ready. As adults, with a well-developed frontal lobe, when we feel hungry we tend to keep calm and go make ourselves a sandwich. The development of the frontal lobe is deeply connected to the way the lower brain is activated. It has 7 hormonal systems at work: - CARE - SEEKING - PLAY - RAGE - FEAR - PANIC/GRIEF - LUST LUST is related to sexual behaviour, so we’ll ignore it for now. Let’s talk about the other six: CARE RAGE SEEKING FEAR PLAY PANIC/GRIEF The ones on the left are pro-social hormonal systems and the ones on the right are alarm systems. Different situations may activate one or more of these systems, which function like muscles. The more they are activated, the stronger they become. Growing up with the alarm systems being frequently activated by a certain parenting style, or more severely by abuse and trauma, the child may become an adult with these systems very much present in their lives. To use Sunderland’s example, it’s like a faulty car alarm that goes off for any reason. If you work for customer service, you might have noticed how this situation is very common. Because the alarm systems were constantly activated throughout most of this person’s life, they compromised the development of the frontal lobe. Louis Cozolino, author of The Social Neuroscience of Education (2013), explains that: “Nonloving behavior signals to the child that the world is a dangerous place and warns him or her not to explore, take chances, or trust others. It also teaches him or her not to trust the information others are trying to convey”. What these alarm hormonal systems are basically saying is: you are in danger, there is a sabre tooth tiger around, you need to either run or fight it. There is no time to learn, no time to regulate emotions, you need to act or you’ll die. Many adults and children often get aggressive or withdrawn in the presence of a problem; they tend to calm down when somebody comes to their aid. Babies, who can’t fight or run, cry. When an adult picks them up and calms them down, the CARE system is activated and they feel safe. The pro-social hormonal systems are key for the development of the frontal lobe. The more they are activated, the more we make positive connections in the frontal lobe. When we feel safe, loved and are surrounded by people who make us laugh, our brains are at ease and ready to learn. If a child or adult doesn’t feel safe in the classroom, they will have a much harder time learning. Here’s a model of Maslow’s hierarchy of needs: When it comes to learning, it is believed that the deficiency needs should be met in order for the growth needs, or learning, to come about optimally. However, I dare say that “feeling safe”, or shall we say, attachment needs, should be at the bottom of the pyramid, along with basic physiological needs, such as water and food. In fact, feeling safe is more important for learning than actually being safe. I’ll tell you why. A very sad experiment conducted in the 1950’s by Harry Harlow – to be fair, it wouldn’t pass an ethics committee nowadays, but since we have the data, let’s use it – analysed the behaviour of new-born monkeys when offered two types of inanimate surrogate mothers: a cuddly cloth one and a wire one. Both surrogates provided milk for the monkeys’ nourishment. All monkeys preferred the cuddly one, even when they didn’t offer any milk. In one of the variations of these experiments, the monkeys were divided into two groups and offered either the cloth or the wire mother. The monkeys with the cloth ones survived longer than the ones with the wire ones, even after the milk was removed from the cuddly ones. The saddest part is that Harlow didn’t really need to conduct this mean experiment. We had empirical evidence from UK orphanages in the late 1800’s and early 1900’s. In reaction to the appalling death rate among the children, and thinking it was the result of the spread of germs, doctors recommended contact among children and with the staff should be kept to a minimum. That made the death rate rise even more. It only decreased when physical contact and nurturing was encouraged. Authors such as Louis Cozolino and Jeremy Rifkin, who wrote Empathic Civilization (2009), defend that nurturing, or attachment needs, are at least as important as water and food for human survival. Hence why we also need them met for learning to occur. Applying attachment theory in the classroom Now, to the practicalities. How can we activate those pro-social hormonal systems in our students’ brains to help them learn? Here are some things we do NOT need to do: - Be the students’ parent; - Be the students’ therapist; Here are some things we could do: - Listen to students and let them have say on how to make the classroom environment as comfortable as possible so that they feel safe there; - Have empathy and treat them with compassion; - Prepare attachment friendly lessons. By attachment friendly lessons I mean those who activate the CARE, SEEKING and PLAY systems of the brain and avoid the alarm systems. Cozolino has a few suggestions: Play As pointed out by Cozolino, Research shows that “play enhances sensorimotor development, social-emotional skills, abstract thinking, problem solving, and academic achievement” (2013). Jokes, games and any fun activities will help students learn, no matter the subject. That includes adults! I appreciate that the concept of fun may be different for children and adults. Getting to know your students and what they enjoy is very helpful. In my practice as an EFL teacher, I like to use quiz show style games for the boring grammar activities. They are the same activities, but the fact I turned them into a competition between two or three groups makes it a lot more interesting. Some of my peers have shared a lot of interesting games for learning and recycling vocabulary, which go from simple pick a word and give hints so the rest of the group can guess what the word is, to a twister mat with words stuck to the spots. Kahoot.com and jeopardy games go a long way using technology and fun to review materials. Role-plays are also fun and help develop a number of skills. Just by making students walk around the room and physically move during an activity you’ll be activating their PLAY and SEEKING systems. By making activities as social as possible, like group and pair work, you’ll be also activating the CARE system. Exploration When students are curious and have an urge to learn more, discover and explore, they SEEKING system is being activated. In class, I sometimes have students find the answers to a question by looking for them on the walls or under their chairs, etc. A little blu-tak can help with that. I also like to take my students out of the classroom to have a lesson somewhere more stimulating, such as a museum or a park. A stimulating classroom, with things for students to look at and resources for them to use can also be very good for the SEEKING system. Exploration is great not only for learning but also for health. “The effects of environmental stimulation on brain growth are so robust that they even counteract the effects of malnutrition” (Bhide & Bedi, 1982 apud Cozolino, 2013). When a student is curious about something, don’t dismiss them and, instead, give them the tools to find out more. Story-telling Story-telling can be used in two ways: the teacher using a story to teach something and the students sharing their own stories. Stories help organize neural integration, which means your brain cells form new connections, connecting different pieces of information to enhance knowledge. Our brains also have unlimited storage for stories and songs. Whatever is taught through them is more likely to remain in long term memory. When students share their own stories or simply write them down, this helps them regulate their emotions, which is great for their frontal lobe development. Putting feelings into words also boosts immunological health (it’s actually shown to increase T-helper response!) and lowers heart rate. Sharing their own experiences helps students calm down and feel like they belong, activating the CARE system, especially if classmates are listening and reacting positively. Student Autonomy Teachers have their own biases and judgements. We can’t help it, our brains are programmed to have them. By taking a step back and giving students autonomy in their own learning, we expose them less to these biases. One of Albert Bandura’s contributions to the study of education psychology is the self-efficacy theory, whereby he defends that one’s expectations for themselves can influence their own performance. Therefore, people may think in a self-sustaining (optimistic) or self-debilitating way, which could affect their performance positively or negatively, respectively. Because of the social nature of humans, society can widely influence our expectations of ourselves and other people. Therefore, when a teacher has low expectations for students they see as weak or less talented, they tend to live up to those expectations. Teachers can inflict such an influence because of our position of authority. Students tend to look up to and trust their teachers (which is great, otherwise they wouldn’t learn from them), so our impressions, even when not explicitly expressed, will have a powerful impact on the pupils. Their classmates, even though they can still affect how students feel, won’t have such a powerful impact. Peer teaching can be a great way to avoid that exposure. When we supply different students with pieces of information and have them teach each other, we are activating their CARE system by showing we trust them. It is also a very social activity, which is always positive. In EFL we recommend a reduction of TTT (teacher talking time) as a way to make the lesson more student-centred and give them a chance to learn from each other. In this method, the teacher is there to give students the tools to learn by themselves cooperatively rather than transfer knowledge. Teacher well-being Last, but not least, teachers need to also be feeling safe in order to teach effectively. Cozolino explains that “when a teacher is harsh, critical, dismissive, demoralized, or overly stressed, their students attune to and come to embody these antilearning states of brain and mind” (2013). Both teachers and managers have a role in maintaining the staff’s well-being. If we carry on using the attachment approach for management, the principles are the same. How do we activate the pro-social systems in teachers? I have a few ideas: - CARE – being listened to (but like, really!), belonging, having a say, participation on decision making, no micro-managing, mutual trust between staff and management, teacher autonomy… - SEEKING – professional development, training sessions, trying new methods and new activities, sharing materials, peer observations… - PLAY – staff socials, dynamic work environment, encouragement to create fun lessons, places to relax… The ellipses are there to emphasise there are many other things which can be done, these are just a few suggestions. Depending on where you work, some of these might sound obvious, but they are still rare in UK companies. For teachers – as well as other professionals – to remain motivated, they need to feel they are working together for a greater good rather than for financial reward (for themselves or the company). “The beneficial effects of this approach on productivity, efficiency and morale are well documented by experiments in factories, but whether through complacency or ignorance are largely ignored by British managers” (Sutherland, 2013). It does not mean that teachers can be underpaid and still be happy and chirpy. We still need to get paid enough so we don’t have to worry about money. Once that is out of the way and we have our other deficiency needs met, including the attachment ones, then we are ready to live up to our potential and continue to develop in our career. Happy teacher, happy students. References: - Aubrey, K. and Riley, A. (2016). Understanding and Using Educational Theories. London: Sage. - Cozolino, L. (2013). The Social Neuroscience of Education. New York: Norton. - Cozolino, L. (2014). Attachment-Based Teaching. New York: Norton. - Illeris, K. (2009). Contemporary Theories of Learning. New York: Routhledge. - Mooney, C. G. (2010). Theories of Attachment. St. Paul: Redleaf Press. - Pierson, R. (2013). Every Kid Needs a Champion. Video recording, YouTube, viewed 01 Oct, 2017, < https://www.youtube.com/watch?v=SFnMTHhKdkw> - Positive Psychology Program (2016). Albert Bandura: Self-efficacy for Agentic Positive Psychology. [online] Available at: https://positivepsychologyprogram.com/bandura-self-efficacy [Accessed 01 Oct. 2017] - Rifkin, J. (2009). The Empathic Civilization. New York: Penguin. - Sunderland, M. (2016). The Science of Parenting. 2nd New York: DK. - Sutherland, S. (2013). Irrationality. 2nd London: Pinter and Martin.

https://susanwitte.com/2018/02/

I believe that outstanding teachers are passionate, inspired, creative, compassionate, patient and understanding. They take the time to know their students and know them well. They appreciate what attributes to each child’s story and take ownership of their role in the child’s life for that school year. I feel that I have the skills and attributes of an outstanding teacher because of the pride I take in the love and support I show my students and families. I know teachers have the power to make a lasting difference and I start every year with that mindset. They also learn to carry out individual and group roles. Teachers take up a very important role in the child’s life as they teach the child specific skills. During this stage, the child’s peer group will have greater significance and becomes a great source of the child’s self esteem. The child feels that he/ she needs to win her peers approval by showing them certain skills or competences and begin to develop a sense of pride in their competences. When we encourage them for their initiative, the children begin to feel industrious and therefore feel confident in their ability to achieve their goals but if the child’s initiative is not encouraged, or if the parents or the teacher restrict it, the child begins to feel inferior and doubts his own abilities and may therefore not reach their potential. These connections are essential for students to develop a commitment to their learning. A good rapport with a teacher will motivate and inspire students to give their best. Additionally, I understand more clearly that an inspirational teacher will not overlook any of the six basic needs that dwell within each student. Determining to meet a child’s needs will produce a student who is inspired, plugged in, and has the capacity to perform at their peak ability. Consequently, when these needs are neglected, students will disengage and lack focus. All of them are related to one another. But, among all the above factors, the teacher has the most important role for efficient and quality learning. Markley (2011) stated that Good and qualified teachers are essential for efficient functioning of educational systems and for enhancing the quality of learning. A good teacher and actions to be taken on his part in the classroom play a vital role in provoking effective and efficient learning on the part of the students. Parents trust their children to be taught and educated at school, to be hoped that they will become good and qualified human beings. I would also help them work on their social skills. It is important for teachers to communicate and collaborate with fellow co-workers so I would want to make sure all my co-workers get along with one another. One way I could do this would be to have a group project or a group outing. This way this co-worker would be able to work effectively with other co-workers and can learn more about them. This would help build stronger relationships with everyone. A teacher must be able to teach all their students in accordance with whatever style the students learn best. The tutor must help the student overcome any obstacles during learning by being patient, listening as well as giving the student necessary support possible. Learning challenges should be set appropriately for different pupils, promoting equality through different teaching methods. Discrimination, bullying and other issues must be addressed in a suitable manner. Good behaviour should be rewarded be and students must have accesses to additional resources. As ethical teachers, we play a very vital role in students’ life, by not just imparting knowledge but also helping in the development of a student’s personality. Ethics in education applies to us teachers which demands us to show patience to every student despite their different learning As a teacher the writer has an advantage where she can support and implement the policy in many ways especially through essential agreement, behaviour chart in class and the concern letter system. Finally, as a member of this school the writer needs to be ready to face any challenges that may arise when completing her responsibility as a teacher in implementing the discipline policy in the school. For a greater emphasis of the policy, all the suggestion are required to put into we want to produce more teachers like Yasmin in the future. First, a good teacher should have a passion for teaching. true, there are many ways in which these qualities can manifest itself. however, a teacher should be aware that our movements will be closely watched not only by students but also considered by the whole. Passion for teaching not only provides the tools we teach the great.

https://www.ipl.org/essay/An-Outstanding-Teacher-PKHBJ7WMU5FV

To a large extent, there exists an important relationship between the market behavior of a security and its trading volume. The price of a security, like that of any other goods or services, is subject to the law of supply a demand. While there are many determinants which influence the price of a stock, the most important one is undoubtedly the perception of the prospect of future earnings. If there is a large number of traders who believe that such prospects warrant a certain price, the trading volume will be high, and vice versa. In other words, a good display of the history of a security should include not only the prices, but also the volumes at such prices. Indeed, whether viewed academically from the acclaimed efficient market theory, or technically from the momentum rule, the trading volume at different prices would be a useful indicator as to the movement of a market. Although several methods exist to display the prices, volumes, and other information relating to the trading history of a security, some methods are useful only for persons who are highly trained in matters of securities transactions. Alternatively, some displays provide only very limited information. One example of this second type of displays is a display of only the daily trading ranges and the closing prices. A second example is a time-line graph of the price of a security. Displays of this type, though of interest, would not be able to provide much important information. In volatile markets such as we are experiencing in recent years, a variation of several percentage points (or much more) between the daily highs and lows for a given security has become more a general rule rather than a special situation. Without more specifics as to the volume in which a security is traded at certain price, the financial information is incomplete. or are useful only for a person well trained in the intricacies of securities transactions. For today's markets, transparency and quickness are of importance not only to a professional trader, but also to the general investing public. This latter group, much larger in number than trained securities traders, would be benefitted by simple graphical displays of the history of both the prices and the trading volumes at such prices, and by simple graphical displays of historical boundary values such as the high, low, open, and close prices of a security during a period of interest to the specific investor. It is therefore the objective of this invention to provide, at a glance, simple and yet comprehensive snapshots of the price-volume actions of a security from one time frame to a second time frame without the need for mechanically going through pages of data and making comparative evaluations either mentally or assisted by other means. If desired, a simplified and yet informative display could be made through the elimination of daily fluctuations and the use of boundary lines for the high and low prices for a time period of interest. Alternatively, market dynamics based on addition relevant data such the high, low, close, last trade, and the trading volumes at all trading prices could also be summarized on a single axis in a comparative form in a single a display that is easy to understand. It is also the objective of the present invention to create a method for depicting both the price movements and the volumes of a publicly traded security. Such depiction can be dynamic, i.e., to reflect the instantaneous changes in price and volume, or static, i.e., at the conclusion of a trading period, e.g., one day. More specifically, it is the objective of this invention to depict the price in one dimension and the trading volume in a second dimension in the same sub-unit of a sewed time interval (e.g., one hour, one day, ten-minutes, etc.), and then depicting these sub-units sequentially by time. As the illustrations herein will show, one will then be able to visualize for any time interval the not only the high, low, and closing prices of a specific security, but also at what volume the security was (or is being)traded. Was a high or near high for that period a rare occurrence, or was it where most trades were completed? What was the sentiment at the close (or beginning) of the trading period. Or if drastic reversals or accelerations took place during the trading day, one can also easily trace all activities and coordinate them with specific events, e.g., either an anticipated or a surprise action taken by the Federal Reserve Board. In view of the importance of the financial market in a modern society, methods for depicting the prices of securities in chart form have been of interest to a number of inventors. In general, such inventions may be classified into two broad groups. The first group deals with the means for converting raw data into a display in accordance with a specified procedure. In U.S. Pat. No. 3,648,270, for example, Metz et al. described an apparatus for plotting simple stock market data with a means for storing a reference value, and for generating a dot on the display, initiating or terminating a line, and the like when a match is detected. In U.S. Pat. No. 3,731,387, Slemmons disclosed an apparatus for plotting stock market data. More recently, Black et al. disclosed in U.S. Pat. No. 6,012,042 a data conversion device which converts both technical and fundamental data about a security into a unified format for analysis by an analysis process engine in accordance with a set of rules and forwards the results to a display for viewing or used in further analysis. In U.S. Pat. No. 6,188,403 B1 and U.S. Pat. No. 6,222,540 B1, Sacerdoti et al. described versions of devices for the generation of 3D graphics for use in PC's and laptops in a business. The second group deals with the creation of said specified procedure so as to achieve a desired mode of presentation. In U.S. Pat. No. 6,272,474B B1, for example, Garcia described a method for monitoring and trading stocks and providing stock information to traders. Information are gathered and displayed on a display screen as to includes bid offers, ask offers, the size of the bid offers, the size of the ask offers, the identity of the market makers making each offer, the volume of each trade, the time of each trade, and the price of each trade. The displayed screen includes a display of bid/ask trade bars for a stock or each of selected number of stocks in which percentage of sales at bid prices and percentage of sales at ask prices are depicted. Such a display, though useful to a professional trader, are beyond the practical use of the investing public. Similarly, in U.S. Pat. No. 5,966,139, Anupam et al.disclosed a method and system for visualing relatively large amounts of data in a limited space including segmenting the data, and mapping each segment to a node within the display space based on a specified nodal layout, texture mapping each graphical display of each segment of data to its node, and displaying the data in each node of the display space as mapped. Again, as it may be obvious from the specific description by the inventors, it is beyond the practical use by the general public. In U.S. Pat. No. 6,256,628 B1, Dobson et al. also disclosed a method of displaying clustered data points in detail and in context within a data set by identifying one or more clustered sets of data points within a data set which includes a plurality of data points, where each data range sea for each cluster of data points where each data range segment has a boundary and a scale interval, and displaying the data points in each segment such that each segment is mutually distinguishing. Examples of other methods which are useful to a professional trader but not to the general public include an invention of Nevo et al. in U.S. Pat. No. 5,946,666 for finding unusual price actions based on deviations from the norm; a data analysis system by Defarto in U.S. patent application Ser. No. 2002/00047 74A1 to keep track of the trading history of a trader of securities and other financial instruments and to display a trade profile of their trading behavior; and a charting method involving polygonal displays of financial data by Kuniko in Japan 10247210 A. In U.S. Pat. No. 5,339,392 (Aug. 16, 1994) is a software program Risberg et al. which enables a user to compose a custom active document using tools provided by the program. In U.S. Pat. No. 5,347,452, Bay, Jr. described a method for displaying market trading volume and trade volumes which deviates from the average. Sets of sequential markers for preselected time interval with amplitudes representing average volume of trades of a predetermined item during a preselected time interval taken over a predetermined number of the preselected time intervals are used, and are compared with a set of second markers substantially concurrently in time with the corresponding first markers and which are positioned on the graph in proximity to the corresponding first markers. Each second marker has an amplitude representing the volume of trades in the preselected time during the most recent preselected time intervals with the difference in amplitude indicative of trade volume deviations from average trading volume. In sum, these prior art, while useful to a highly trained professional trader, appears to be beyond the practical use of the general trading public. My invention comprises the creation of charts which use a single axis to display data in the sense that the time element is integrated into the price and volume actions in the form of a modified bar diagram instead of the usual sequential display of time on the horizontal axis. As it will be shown, my invention enables a user to manipulate the time factor in a comparative form, and therefore to be able to show the comparative price action for two different time periods by the use of a common point (i.e., last closing price). Similarly, boundaries based on high, low, open, and close prices could also be displayed on said single axis in a comparative form. Furthermore, by showing the cumulative volumes at their respective prices in a side-by-side display, a user can compare at a glance the volume at each price for any two different time periods of interest. Several specific embodiments of my invention are described below. 1. A snapshot view for two consecutive trading periods. A method for period-to-period presentation is illustrated in Last Trade or Period High Price Low Price Close Price Previous 90 60 84 Current 100 70 96 The vertical axis shows the price, the horizontal bars show the volume, and the two consecutive time periods (previous and current) are drawn next to each other in the form of closed “boxes” and the upper and lower boundaries show the high/low prices for each period. By showing the direct price comparison, this gives the numbers greater value. 2. Current period versus average of a longer prior period. Last Trade or Period High Price Low Price Close Price Previous 90 60 84 Current 100 80 96 3. Continuous high/low comparison. Last Trade or Period High Price Low Price Close Price Previous 90 60 84 Current 100 70 94 4. High-volume areas emphasized. The purpose of Otherwise, the same general procedure used in 5. Open to Close. Opening Last Trade or Period High Price Low Price Price Close Price Previous 90 60 78 84 Current 100 70 — 94 6. Volume for short-Time periods. 7. Continuous Price Depictions. Last Trade or Period High Price Low Price Close Price Previous 90.00 60.00 84.00 Current 100.00 70.00 94.00 8. Percent Change of Prices. 9. Inter-Entity Comparisons. 0=no change from previous price. +=increase from previous price, and −=decrease from previous price. In my specific example, the figure shows that HP has a 4 percent gain and a 6 percent decline respectively from the previous close. Similarly, IBM had a 6 percent gain and a 2 percent decline from the previous close, and Apple had a 1 percent gain and an 8 percent decline from the previous close. The number of entities which can be so depicted is, of course, unlimited, and more can be shown in a similar manner. It should be understood that the foregoing descriptions are only for illustrative purpose only, and are not intended to limit the scope of this invention. Rather, there are numerous equivalents to the preferred embodiments which would be obvious to those skilled in the art, and such are intended to be covered by this disclosures detailed in this provision application.

https://www.freepatentsonline.com/y2002/0194114.html

Financial statistics include all numerical data that summarizes past behavior or forecasts future behavior of an individual financial security, a group of securities, or markets in a broad geographic region. It is useful to first categorize these statistics into one of three areas. Global or national statistics examine the behavior of business or economic conditions that influence the value of securities in general. Market or industrial statistics track the activity of a specific set of securities linked by a common trading market or industry classification. Company-specific statistics examine performance of individual firms. One broad class of global or national statistics is the series of economic indicators. These indicators assess where the economy is within the current business cycle and provide information useful to forecast the likelihood of improvement or deterioration, or to confirm the economy's current status. The National Bureau of Economic Research tracks several hundred measures of economic activity that are correlated with the status of the national economy. Economic indicators are typically split into three categories. Leading economic indicators correlate with patterns of future economic activity. For example, profit margins and the formation of new businesses tend to improve or deteriorate in advance of other symptoms of a change in the overall status of the economy. Coincident indicators assist in confirming of the economy's current status. Examples of these indicators are comprehensive levels of employment and industrial production. Finally, lagging indicators confirm that the economy has passed through a particular phase of the business cycle. Such indicators react after the change in economic condition has already been established. The average duration of unemployment is one example of a lagging indicator. There are many other examples of global economic statistics that have immediate relevance to financial analysis. One commonly followed statistic is the forecasted growth rate in gross domestic product (GDP). As an aggregate measure of overall output of a national economy, GDP growth is a highly anticipated figure. Many of the subcategories of GDP, such as government spending and exports, are closely followed as well. A more pervasive and continuous source of financial information is found in exchange rate statistics. An exchange rate is the price of one country's currency in terms of another's. For example, if the U.S. dollar can be exchanged for 5 French francs, then residents in either country can quickly assess the value of real or financial assets in the other country. Since this data is so important to international trade and capital flows, exchange rate statistics are widely reported in many periodicals and newspapers on a daily basis. Another set of statistics that are broadly followed in financial markets throughout the world are those associated with interest rates. Interest rates represent the price of money in a particular currency. This price includes a premium for expected inflation and another premium for risk of default. One common method of reporting interest rates is the yield curve. The yield curve represents the relationship between the maturity of a debt instrument, typically bonds, and the rate of return implied by its current price. A yield curve represents a relevant comparison of yields between different securities with different maturities only if the securities have similar default risk. As a result, the most common yield curve statistics relate to government bonds within a particular country. These statistics are frequently reported in tabular form with yields on various securities sorted by maturity. The same information is also commonly depicted in a graph. For example, early 1999 yields for U.S. Treasury bonds with maturities of 1, 5, 10, 20, and 30 years are 5.08 percent, 5.33 percent, 5.61 percent, 5.89 percent, and 5.62 percent, respectively. With the exception of the 30-year bond, this pattern is indicative of an upward sloping yield curve. This is the most common pattern, but inverted and humped yield curves have also been observed during the past two decades. Similar statistics can be graphed for corporate bonds with similar default risk ratings. The second broad category of financial statistics assesses the behavior of security markets. Most countries with well-developed financial markets have a variety of indexes that track overall market activity or activity of a specific market segment. Examples of these indexes in the United States are the Dow Jones Industrial Average, the Standard & Poor's 500, and the New York Stock Exchange Composite. Other examples include the Financial Times 100 in the United Kingdom, the Nikkei 225 in Japan, and the CAC 40 in France. Each of these widely followed indexes tracks general market conditions. Market indexes can be distinguished by their method of construction or the sample of securities they comprise. There are three basic techniques for construction of market indexes. A price-weighted index basically reports the average price per share for a sample of securities. A value-weighed index monitors changes in the aggregate market value of all shares outstanding for a sample of securities. An equally weighted index determines the change in value for each security separately and then reports the average change for all securities. Value-weighted and equally weighted indexes are expressed as a proportion of some base value determined at a particular point in time. The proportion is often multiplied by a number such as 100 before it is reported. The Dow Jones Industrial Average (DJIA) is an example of a price-weighted index. This means that the index tracks and reports the average price per share of a sample of securities. The DJIA has been in existence since 1885 when it was first constructed by Charles Dow. He selected 20 "blue chip," or well-established, companies and tracked the average price per share. In the late 1920s, the number of stocks was increased to 30. During the more than 100 years of its existence, many DJIA stocks have split (i.e., issued two new shares to replace one old share) when management felt that their share price had become exorbitant. In addition, some firms have gone bankrupt or merged with other firms and thus trading in these securities has been eliminated. A price-weighted average accounts for such changes by altering the divisor to render the event neutral. Through this technique, the divisor of the DJIA, which was 30 in the late 1920s, had fallen to 0.23006576 by 1999. As statistics of aggregate market behavior, price-weighted averages suffer from several biases. For example, a high price-per-share stock has greater influence over the index than a lower price-per-share stock even though there may be many more shares of the lower priced stock outstanding. In addition, stocks split to reduce price per share and make them more affordable to investors. A split does not alter the collective value of the stock (i.e., 100 shares at $10 are worth the same as 200 shares at $5), but it does reduce the impact of that stock on the overall index. This is relevant since it is the stocks with the highest growth that have the greatest propensity to split and implies that price-weighted averages are downwardly biased indicators of market performance. The DJIA in particular is frequently criticized for its small sample of purely industrial firms. This suggests that it may be a poor proxy for overall market behavior. Statistical analysis indicates, however, that it is highly correlated with other, broader measures of market activity. The Standard & Poor's 500 (S&P 500) is a value-weighted index that comprises a sample of 400 industrial, 20 transportation, 40 utility, and 40 financial firms. It is constructed by multiplying the current share price by the number of shares outstanding for each of its 500 firms. The sum of these products is divided by a similar sum constructed using stock prices from the period from 1941 to 1943. This ratio represents the cumulative growth of this portfolio of 500 stocks from that base period to the current period. Unlike the price-weighted average, stock splits are neutral events since the aggregate value of all shares of a firm is not changed by the split. Bankruptcies, mergers, and other events that stop public trading of a firm's stock will require adjustment of the index. While the S&P 500 comprises a much larger sample of securities, larger firms have a greater influence on its behavior. To see this more specifically, imagine ranking all 500 firms by value. Clearly, the largest firm will represent a much larger portion of the aggregate value of the entire sample of 500 firms than will the smallest. The development of an equally weighted index is an attempt to eliminate the bias just described in the value-weighted index. The idea behind an equally weighted index is to generate a ratio, or growth factor, for an individual firm by measuring its stock price today and dividing by its stock price during some base period. This process is repeated for a sample of stocks and then an average growth factor is reported. One such index that represents approximately 1,700 U.S. stocks is the Value Line Index. Equally weighted measures are considered a better measure of the behavior of the typical security during any period of time. While this discussion has focused on stock indexes for the overall market, there are many other indexes that examine other classes of securities or specific industries or segments of the market. For example, the New York Stock Exchange also tracks a value-weighted average of its listed firms in the categories of industrials, utilities, transportation, and finance. Many publications use an even finer breakdown of industrial classifications. There are also a broad variety of indexes that examine various categories of bonds and mutual funds. A final category of financial statistics are those that are firm specific. These statistics include bond ratings, price/earnings ratios, and other indicators of risk and return. It is useful to begin by considering statistics constructed from historical measures. For example, an analysis of periodic prices and cash payments from a historical period provides the data needed to construct statistics of risk and return. Historical returns can be reported as an arithmetic average (computing rate of return for a series of sequential periods and averaging) or a geometric average (computing the annualized compound interest rate that the investor would have received). Additionally, this data will allow for construction of risk statistics such as variance and standard deviation. To illustrate the computation of these historical statistics, consider the following example that uses data for Coca-Cola. Table I contains the closing price for a share of Coca-Cola stock at the end of February for five consecutive years. It also contains the dividend per share that Coca-Cola paid during each year and the one-year holding period return—or the rate of return an investor would have achieved during that particular period. The holding period return (HPR) for each one-year period is computed using the following formula: In other words, the overall return from stock appreciation and dividend income from 1995 to 1996 was 48.4 percent. Similar interpretations can be derived from the calculation for subsequent years. We can average, or annualize these returns by adding the one-year HPR and then dividing by the number of returns—four in this example. The other interesting observation that can quickly be drawn from the table of holding period returns is their significant volatility from year to year. This can be formally measured as variance or standard deviation, both important measures of risk. Variance of these returns can be computed by calculating the deviation of each individual annual holding period return from the mean return computed above, squaring this difference, adding the squared differences together and finally dividing by the number of years in the sample. The Coca-Cola data allows the following computation of variance: The variance is an aggregate measure of dispersion away from the mean return. It is commonly restated as a standard deviation by computing its square root. In this example, the standard deviation of Coca-Cola's returns is 0.244 or 24.4 percent. Equipped with a mean to measure the security's return and a standard deviation to assess its risk, meaningful comparisons can now be made with other securities that have been subjected to similar analysis. While the statistical measures constructed in the preceding example are valid, it is important to consider their purpose. If an investor was interested in performance over some prior time interval to answer questions such as "How well did my investment perform?" or "How much risk was I exposed to?," then these statistics are clear indicators. On the other hand, if an investor wants to know "How will this security perform?" or "How risky is this stock?," then the statistics must be interpreted quite differently. In the second case, the historical statistics are valuable only |Date||Price||Dividend||Holding Period Return| |Feb. 1995||S27.50| |Feb. 1996||40.38||$0.44||0.484 or 48.4%| |Feb. 1997||61.00||0.50||0.523 or 52.3%| |Feb.1998||68.63||0.56||0.134 or 13.4%| |Feb. 1999||63.88||0.60||-0.060 or -6.0%| if it is reasonable to expect future performance to correlate to past performance. It is usually reasonable to use historical risk as a proxy for expected risk. This is because risk is a function of exposure to broader economic forces and firm-specific characteristics such as financial structure and operating cost structure. These influences are not likely to change, or changes are reasonably predictable. Nevertheless, it is typically more difficult to use historical return as a proxy for expected future return. The measure of risk can be refined by dividing total risk, as measured by standard deviation, into two parts. The first part is the variation in a stock's return that results from general market movements and is referred to as systematic risk. The second component is the variation that results from factors unique to the individual firm and is referred to as unsystematic risk. There is considerable interest in the systematic risk component of a stock's overall risk because the unsystematic risk can be minimized by holding a variety of securities together in a portfolio. Systematic risk is measured by the statistic beta (j). Beta represents the volatility of an individual security relative to the average market volatility. Therefore, the average security beta is 1. Beta can be derived statistically by computing the ratio of the covariance of the individual security's returns with those of the market by the variance of the market's returns. It can also be derived by the regression procedure where the equation of the line that best fits a scatter of points—each representing return for the security and the market at a particular point in time—is determined statistically. The slope of this line represents the security's beta. Beta is a useful statistic in portfolio management because it allows managers to actively position their portfolios in an above-average, average, or below-average risk position by choosing securities with an average beta of above 1, exactly 1, or below 1, respectively. A final category of firm-specific statistics refers to the financial statements that the firm has generated in the past and allows forecasts of future financial performance. Financial ratios comprise another family of relevant statistics that are frequently used to assess the financial health and development of individual firms. While some of the more prominent financial ratios relate to profitability (e.g., net profit margin, return on equity), others can be used to assess other characteristics of a firm that ultimately pinpoint potential reasons for the resulting profitability. These other measures can be categorized into several areas. Liquidity ratios assess the firm's ability to meet its short-term financial obligations with its most liquid assets. Activity ratios measure how effectively the firm is able to use various categories of assets to generate sales revenues. Leverage ratios examine how the firm's assets are financed and how the firm's financing structure is likely to influence profits. Finally, there are many ratios that attempt to relate market values of the firm's assets to their financial statement counterparts. Collectively, these ratios can be monitored over time to detect trends in firm performance or they can be examined in relation to industry average ratios. In either case, the statistics can be very useful for probing, explaining, and forecasting a firm's financial performance. [ Paul Bolster ] Freedman, David, et al. Statistics. 3rd ed. New York: W. W. Norton, 1997. Lee, Cheng-Few. Statistics for Business and Financial Economics. 2nd ed. World Scientific Pub. Co., 1999.

https://www.referenceforbusiness.com/encyclopedia/Fa-For/Financial-Statistics.html

This overview of Wharton Research Data Services (WRDS) refer from WRDS and the Library of Harvard university. The more collection , please visit the WRDS website. Bank Regulatory The Bank Regulatory Database contains five databases for regulated depository financial institutions. These databases provide accounting data for bank-holding companies, commercial banks, savings banks, and savings and loans institutions. The source of the data is the required regulatory forms filled for supervising purposes. Blockholders This dataset contains standardized data for blockholders for 1,913 companies. Center for Research in Security Prices The Center for Research in Security Prices (CRSP) maintains the most comprehensive collection of standard and derived security data available for the NYSE, AMEX and NASDAQ stock markets. CRSP is a research center at the University of Chicago Graduate School of Business, and maintains historical data from December 1925 to the present. Compustat North America Provides more than 300 annual and 100 quarterly income statement, balance sheet, statement of cash flows, and supplemental data items on more than 7500 publicly held companies. For most companies, annual and quarterly data is available for a maximum of 20 years and 48 quarters. Compustat Global & Emerging Markets DataBase Compustat Global provides financial and market data covering publicly traded companies in more than 80 countries, representing over 90% of the world's market capitalization. It is possible to access hundreds of data items, ratios and concepts and up to 12 years of annual history. The EMDB, from S&P/COMPUSTAT, is a comprehensive compilation of emerging market information. It covers 60 markets and more than 3,000 stocks. The EMDB includes market performance, indicators, market capitalization, monthly value traded, local stock market price indexes, prices in local currency and US dollars, and more. Corporate Library Corporate Library is an independent investment research firm providing coporate governance data, analysis and risk assessment tools. It provides one complete online solution for analyzing, modeling and assessing governance, compensation and performance practices. CRSP/COMPUSTAT Merged Database Matching of CRSP historical price, distribution and total return data with COMPUSTAT fundamental data. Dow Jones Averages Data from Dow Jones Industrial Average (DJIA) (30 stocks), The Dow Jones Transportation Average (DJTA)(20 stocks) and The Dow Jones Utility Average (DJUA) (15 stocks). Daily data from 1896. EVENTUS Performs event studies using data read directly from CRSP stock databases or pre-extracted from any source. Fama French Factors Fama-French Research Portfolios and Factors. The Fama-French Portfolios are constructed from the intersections of two portfolios formed on size, as measured by market equity (ME), and three portfolios using the ratio of book equity to market equity (BE/ME) as a proxy for value. Returns from these portfolios are used to construct the Fama-French Factors. Federal Deposit Insurance Company (FDIC) FDIC files include structure data, financial time series data, complex derived integers data, ratio data, and merger history data. Foreign Exchange Rates(WRDS FX ) This database is based upon the Federal Reserve Board’s H.10 release and contains Foreign Exchange (FX) rates for over 30 world currencies and trade-weighted indices. WRDS carries all of these FX rates in currency units per U.S. dollar (e.g. yen/$) and a few are also available in “inverted form” (e.g. $/pound). Global Insight (formerly DRI Basic Economics) U.S. economic, financial and demographic statistics, including employment, finance, housing, income, population, production, and trade. Some series are available in daily or monthly frequencies. This resource is also available through the Harvard e-research portal. I/B/E/S Global summary and individual forecast information as well as buy-sell-hold recommendations for companies globally, plus cash flow, dividend, and pre-tax profit forecasts. Institute for the Study of Security Market (ISSM) ISSM contains tick-by-tick data covering the NYSE and AMEX between 1983 and 1992. There are separate files for trades and quotes for each year. OptionMetrics A comprehensive source of historical price and implied volatility data for the US equity and index options markets. The database contains historical prices of options and their associated underlying instruments, correctly calculated implied volatilities, and option sensitivities. Data available from 1996-present. Philadelphia Stock Exchange (PHLX) Data on the trading of stocks, equity options, index options and currency options. The PHLX trades more than 2,800 stocks, 740 equity options, 12 sector index options, and 100 currency pairs. Risk Metrics (Formerly IRRC) Provides impartial, independent research on corporate governance, proxy voting and corporate responsibility issues. Thomson Reuters Provides data on mutual funds, institutional holdings, and insider filing data including stock transactions, derivative transactions, and proposed sale data. Trade and Quote Database contains intraday transactions data (trades and quotes) for all securities listed on the New York Stock Exchange (NYSE) and American Stock Exchange (AMEX), as well as NASDAQ National Market System (NMS) and SmallCap issues.

http://www.management.ntu.edu.tw/en/CSIC/DB/WRDS

# Technical analysis In finance, technical analysis is an analysis methodology for analysing and forecasting the direction of prices through the study of past market data, primarily price and volume. Behavioral economics and quantitative analysis use many of the same tools of technical analysis, which, being an aspect of active management, stands in contradiction to much of modern portfolio theory. The efficacy of both technical and fundamental analysis is disputed by the efficient-market hypothesis, which states that stock market prices are essentially unpredictable, and research on whether technical analysis offers any benefit has produced mixed results. ## History The principles of technical analysis are derived from hundreds of years of financial market data. Some aspects of technical analysis began to appear in Amsterdam-based merchant Joseph de la Vega's accounts of the Dutch financial markets in the 17th century. In Asia, technical analysis is said to be a method developed by Homma Munehisa during the early 18th century which evolved into the use of candlestick techniques, and is today a technical analysis charting tool. Journalist Charles Dow (1851-1902) compiled and closely analyzed American stock market data, and published some of his conclusions in editorials for The Wall Street Journal. He believed patterns and business cycles could possibly be found in this data, a concept later known as "Dow theory". However, Dow himself never advocated using his ideas as a stock trading strategy. In the 1920s and 1930s, Richard W. Schabacker published several books which continued the work of Charles Dow and William Peter Hamilton in their books Stock Market Theory and Practice and Technical Market Analysis. In 1948, Robert D. Edwards and John Magee published Technical Analysis of Stock Trends which is widely considered to be one of the seminal works of the discipline. It is exclusively concerned with trend analysis and chart patterns and remains in use to the present. Early technical analysis was almost exclusively the analysis of charts because the processing power of computers was not available for the modern degree of statistical analysis. Charles Dow reportedly originated a form of point and figure chart analysis. With the emergence of behavioral finance as a separate discipline in economics, Paul V. Azzopardi combined technical analysis with behavioral finance and coined the term "Behavioral Technical Analysis". Other pioneers of analysis techniques include Ralph Nelson Elliott, William Delbert Gann, and Richard Wyckoff who developed their respective techniques in the early 20th century. More technical tools and theories have been developed and enhanced in recent decades, with an increasing emphasis on computer-assisted techniques using specially designed computer software. ## General description Fundamental analysts examine earnings, dividends, assets, quality, ratios, new products, research and the like. Technicians employ many methods, tools and techniques as well, one of which is the use of charts. Using charts, technical analysts seek to identify price patterns and market trends in financial markets and attempt to exploit those patterns. Technicians using charts search for archetypal price chart patterns, such as the well-known head and shoulders or double top/bottom reversal patterns, study technical indicators, moving averages and look for forms such as lines of support, resistance, channels and more obscure formations such as flags, pennants, balance days and cup and handle patterns. Technical analysts also widely use market indicators of many sorts, some of which are mathematical transformations of price, often including up and down volume, advance/decline data and other inputs. These indicators are used to help assess whether an asset is trending, and if it is, the probability of its direction and of continuation. Technicians also look for relationships between price/volume indices and market indicators. Examples include the moving average, relative strength index and MACD. Other avenues of study include correlations between changes in Options (implied volatility) and put/call ratios with price. Also important are sentiment indicators such as Put/Call ratios, bull/bear ratios, short interest, Implied Volatility, etc. There are many techniques in technical analysis. Adherents of different techniques (for example: Candlestick analysis, the oldest form of technical analysis developed by a Japanese grain trader; Harmonics; Dow theory; and Elliott wave theory) may ignore the other approaches, yet many traders combine elements from more than one technique. Some technical analysts use subjective judgment to decide which pattern(s) a particular instrument reflects at a given time and what the interpretation of that pattern should be. Others employ a strictly mechanical or systematic approach to pattern identification and interpretation. ### Comparison with fundamental analysis Contrasting with technical analysis is fundamental analysis: the study of economic & other underlying factors that influence the way investors price financial markets. This may include regular corporate metrics like a company's recent EBITDA figures, the estimated impact of recent staffing changes to the board of directors, geopolitical considerations, and even scientific factors like the estimated future effects of global warming. Pure forms of technical analysis can hold that prices already reflect all the underlying fundamental factors. Uncovering future trends is what technical indicators are designed to do, although neither technical nor fundamental indicators are perfect. Some traders use technical or fundamental analysis exclusively, while others use both types to make trading decisions. ### Comparison with quantitative analysis The contrast against quantitative analysis is less clear cut than the distinction with fundamental analysis. Some sources treat technical and quantitative analysis as more or less synonymous. While others draw a sharp distinction. For example, quantitative analysis expert Paul Wilmott suggests technical analysis is little more than 'charting' (making forecasts based on extrapolating graphical representations), and that technical analysis rarely has any predictive power. ## Characteristics Technical analysis employs models and trading rules based on price and volume transformations, such as the relative strength index, moving averages, regressions, inter-market, and intra-market price correlations, business cycles, stock market cycles or classically, through recognition of chart patterns. Technical analysis stands in contrast to the fundamental analysis approach to security and stock analysis. In the fundamental equation "M = P/E" technical analysis is the examination of M (multiple). Multiple encompasses the psychology generally abounding, i.e. the extent of willingness to buy/sell. Also in M is the ability to pay as, for instance, a spent-out bull can't make the market go higher and a well-heeled bear won't. Technical analysis analyzes price, volume, psychology, money flow, and other market information, whereas fundamental analysis looks at the facts of the company, market, currency, or commodity. Most large brokerages, trading groups, or financial institutions will typically have both a technical analysis and fundamental analysis team. In the 1960s and 1970s, it was widely dismissed by academics. In a 2007 review, Irwin and Park reported that 56 of 95 modern studies found that it produces positive results but noted that many of the positive results were rendered dubious by issues such as data snooping, so that the evidence in support of technical analysis was inconclusive; it is still considered by many academics to be indistinguishable from pseudoscience. Academics such as Eugene Fama say the evidence for technical analysis is sparse and is inconsistent with the weak form of the efficient-market hypothesis. Users hold that even if technical analysis cannot predict the future, it helps to identify trends, tendencies, and trading opportunities. While some isolated studies have indicated that technical trading rules might lead to consistent returns in the period prior to 1987, most academic work has focused on the nature of the anomalous position of the foreign exchange market. It is speculated that this anomaly is due to central bank intervention, which obviously technical analysis is not designed to predict. ## Principles A core principle of technical analysis is that a market's price reflects all relevant information impacting that market. A technical analyst therefore looks at the history of a security or commodity's trading pattern rather than external drivers such as economic, fundamental and news events. It is believed that price action tends to repeat itself due to the collective, patterned behavior of investors. Hence technical analysis focuses on identifiable price trends and conditions. ### Market action discounts everything Based on the premise that all relevant information is already reflected by prices, technical analysts believe it is important to understand what investors think of that information, known and perceived. ### Prices move in trends Technical analysts believe that prices trend directionally, i.e., up, down, or sideways (flat) or some combination. The basic definition of a price trend was originally put forward by Dow theory. An example of a security that had an apparent trend is AOL from November 2001 through August 2002. A technical analyst or trend follower recognizing this trend would look for opportunities to sell this security. AOL consistently moves downward in price. Each time the stock rose, sellers would enter the market and sell the stock; hence the "zig-zag" movement in the price. The series of "lower highs" and "lower lows" is a tell tale sign of a stock in a down trend. In other words, each time the stock moved lower, it fell below its previous relative low price. Each time the stock moved higher, it could not reach the level of its previous relative high price. Note that the sequence of lower lows and lower highs did not begin until August. Then AOL makes a low price that does not pierce the relative low set earlier in the month. Later in the same month, the stock makes a relative high equal to the most recent relative high. In this a technician sees strong indications that the down trend is at least pausing and possibly ending, and would likely stop actively selling the stock at that point. ### History tends to repeat itself Technical analysts believe that investors collectively repeat the behavior of the investors that preceded them. To a technician, the emotions in the market may be irrational, but they exist. Because investor behavior repeats itself so often, technicians believe that recognizable (and predictable) price patterns will develop on a chart. Recognition of these patterns can allow the technician to select trades that have a higher probability of success. Technical analysis is not limited to charting, but it always considers price trends. For example, many technicians monitor surveys of investor sentiment. These surveys gauge the attitude of market participants, specifically whether they are bearish or bullish. Technicians use these surveys to help determine whether a trend will continue or if a reversal could develop; they are most likely to anticipate a change when the surveys report extreme investor sentiment. Surveys that show overwhelming bullishness, for example, are evidence that an uptrend may reverse; the premise being that if most investors are bullish they have already bought the market (anticipating higher prices). And because most investors are bullish and invested, one assumes that few buyers remain. This leaves more potential sellers than buyers, despite the bullish sentiment. This suggests that prices will trend down, and is an example of contrarian trading. ## Industry The industry is globally represented by the International Federation of Technical Analysts (IFTA), which is a federation of regional and national organizations. In the United States, the industry is represented by both the CMT Association and the American Association of Professional Technical Analysts (AAPTA). The United States is also represented by the Technical Security Analysts Association of San Francisco (TSAASF). In the United Kingdom, the industry is represented by the Society of Technical Analysts (STA). The STA was a founding member of IFTA, has recently celebrated its 50th Anniversary and certifies analysts with the Diploma in Technical Analysis. In Canada the industry is represented by the Canadian Society of Technical Analysts. In Australia, the industry is represented by the Australian Technical Analysts Association (ATAA), (which is affiliated to IFTA) and the Australian Professional Technical Analysts (APTA) Inc. Professional technical analysis societies have worked on creating a body of knowledge that describes the field of Technical Analysis. A body of knowledge is central to the field as a way of defining how and why technical analysis may work. It can then be used by academia, as well as regulatory bodies, in developing proper research and standards for the field. The CMT Association has published a body of knowledge, which is the structure for the Chartered Market Technician (CMT) exam. ### Software Technical analysis software automates the charting, analysis and reporting functions that support technical analysts in their review and prediction of financial markets (e.g. the stock market). In addition to installable desktop-based software packages in the traditional sense, the industry has seen an emergence of cloud-based applications and application programming interfaces (APIs) that deliver technical indicators (e.g., MACD, Bollinger Bands) via RESTful HTTP or intranet protocols. Modern technical analysis software is often available as a web or a smartphone application, without the need to download and install a software package. Some of them even offer an integrated programming language and automatic backtesting tools. ## Systematic trading ### Neural networks Since the early 1990s when the first practically usable types emerged, artificial neural networks (ANNs) have rapidly grown in popularity. They are artificial intelligence adaptive software systems that have been inspired by how biological neural networks work. They are used because they can learn to detect complex patterns in data. In mathematical terms, they are universal function approximators, meaning that given the right data and configured correctly, they can capture and model any input-output relationships. This not only removes the need for human interpretation of charts or the series of rules for generating entry/exit signals, but also provides a bridge to fundamental analysis, as the variables used in fundamental analysis can be used as input. As ANNs are essentially non-linear statistical models, their accuracy and prediction capabilities can be both mathematically and empirically tested. In various studies, authors have claimed that neural networks used for generating trading signals given various technical and fundamental inputs have significantly outperformed buy-hold strategies as well as traditional linear technical analysis methods when combined with rule-based expert systems. While the advanced mathematical nature of such adaptive systems has kept neural networks for financial analysis mostly within academic research circles, in recent years more user friendly neural network software has made the technology more accessible to traders. ### Backtesting/Hindcasting Systematic trading is most often employed after testing an investment strategy on historic data. This is known as backtesting (or hindcasting). Backtesting is most often performed for technical indicators combined with volatility but can be applied to most investment strategies (e.g. fundamental analysis). While traditional backtesting was done by hand, this was usually only performed on human-selected stocks, and was thus prone to prior knowledge in stock selection. With the advent of computers, backtesting can be performed on entire exchanges over decades of historic data in very short amounts of time. The use of computers does have its drawbacks, being limited to algorithms that a computer can perform. Several trading strategies rely on human interpretation, and are unsuitable for computer processing. Only technical indicators which are entirely algorithmic can be programmed for computerized automated backtesting. ## Combination with other market forecast methods John Murphy states that the principal sources of information available to technicians are price, volume and open interest. Other data, such as indicators and sentiment analysis, are considered secondary. However, many technical analysts reach outside pure technical analysis, combining other market forecast methods with their technical work. One advocate for this approach is John Bollinger, who coined the term rational analysis in the middle 1980s for the intersection of technical analysis and fundamental analysis. Another such approach, fusion analysis, overlays fundamental analysis with technical, in an attempt to improve portfolio manager performance. Technical analysis is also often combined with quantitative analysis and economics. For example, neural networks may be used to help identify intermarket relationships. Investor and newsletter polls, and magazine cover sentiment indicators, are also used by technical analysts. ## Empirical evidence Whether technical analysis actually works is a matter of controversy. Methods vary greatly, and different technical analysts can sometimes make contradictory predictions from the same data. Many investors claim that they experience positive returns, but academic appraisals often find that it has little predictive power. Of 95 modern studies, 56 concluded that technical analysis had positive results, although data-snooping bias and other problems make the analysis difficult. Nonlinear prediction using neural networks occasionally produces statistically significant prediction results. A Federal Reserve working paper regarding support and resistance levels in short-term foreign exchange rates "offers strong evidence that the levels help to predict intraday trend interruptions", although the "predictive power" of those levels was "found to vary across the exchange rates and firms examined". Technical trading strategies were found to be effective in the Chinese marketplace by a recent study that states, "Finally, we find significant positive returns on buy trades generated by the contrarian version of the moving-average crossover rule, the channel breakout rule, and the Bollinger band trading rule, after accounting for transaction costs of 0.50%." An influential 1992 study by Brock et al. which appeared to find support for technical trading rules was tested for data snooping and other problems in 1999; the sample covered by Brock et al. was robust to data snooping. Subsequently, a comprehensive study of the question by Amsterdam economist Gerwin Griffioen concludes that: "for the U.S., Japanese and most Western European stock market indices the recursive out-of-sample forecasting procedure does not show to be profitable, after implementing little transaction costs. Moreover, for sufficiently high transaction costs it is found, by estimating CAPMs, that technical trading shows no statistically significant risk-corrected out-of-sample forecasting power for almost all of the stock market indices." Transaction costs are particularly applicable to "momentum strategies"; a comprehensive 1996 review of the data and studies concluded that even small transaction costs would lead to an inability to capture any excess from such strategies. In a paper published in the Journal of Finance, Dr. Andrew W. Lo, director MIT Laboratory for Financial Engineering, working with Harry Mamaysky and Jiang Wang found that: Technical analysis, also known as "charting", has been a part of financial practice for many decades, but this discipline has not received the same level of academic scrutiny and acceptance as more traditional approaches such as fundamental analysis. One of the main obstacles is the highly subjective nature of technical analysis – the presence of geometric shapes in historical price charts is often in the eyes of the beholder. In this paper, we propose a systematic and automatic approach to technical pattern recognition using nonparametric kernel regression, and apply this method to a large number of U.S. stocks from 1962 to 1996 to evaluate the effectiveness of technical analysis. By comparing the unconditional empirical distribution of daily stock returns to the conditional distribution – conditioned on specific technical indicators such as head-and-shoulders or double-bottoms – we find that over the 31-year sample period, several technical indicators do provide incremental information and may have some practical value. In that same paper Dr. Lo wrote that "several academic studies suggest that ... technical analysis may well be an effective means for extracting useful information from market prices." Some techniques such as Drummond Geometry attempt to overcome the past data bias by projecting support and resistance levels from differing time frames into the near-term future and combining that with reversion to the mean techniques. ### Efficient-market hypothesis The efficient-market hypothesis (EMH) contradicts the basic tenets of technical analysis by stating that past prices cannot be used to profitably predict future prices. Thus it holds that technical analysis cannot be effective. Economist Eugene Fama published the seminal paper on the EMH in the Journal of Finance in 1970, and said "In short, the evidence in support of the efficient markets model is extensive, and (somewhat uniquely in economics) contradictory evidence is sparse." However, because future stock prices can be strongly influenced by investor expectations, technicians claim it only follows that past prices influence future prices. They also point to research in the field of behavioral finance, specifically that people are not the rational participants EMH makes them out to be. Technicians have long said that irrational human behavior influences stock prices, and that this behavior leads to predictable outcomes. Author David Aronson says that the theory of behavioral finance blends with the practice of technical analysis: By considering the impact of emotions, cognitive errors, irrational preferences, and the dynamics of group behavior, behavioral finance offers succinct explanations of excess market volatility as well as the excess returns earned by stale information strategies.... cognitive errors may also explain the existence of market inefficiencies that spawn the systematic price movements that allow objective TA methods to work. EMH advocates reply that while individual market participants do not always act rationally (or have complete information), their aggregate decisions balance each other, resulting in a rational outcome (optimists who buy stock and bid the price higher are countered by pessimists who sell their stock, which keeps the price in equilibrium). Likewise, complete information is reflected in the price because all market participants bring their own individual, but incomplete, knowledge together in the market. #### Random walk hypothesis The random walk hypothesis may be derived from the weak-form efficient markets hypothesis, which is based on the assumption that market participants take full account of any information contained in past price movements (but not necessarily other public information). In his book A Random Walk Down Wall Street, Princeton economist Burton Malkiel said that technical forecasting tools such as pattern analysis must ultimately be self-defeating: "The problem is that once such a regularity is known to market participants, people will act in such a way that prevents it from happening in the future." Malkiel has stated that while momentum may explain some stock price movements, there is not enough momentum to make excess profits. Malkiel has compared technical analysis to "astrology". In the late 1980s, professors Andrew Lo and Craig McKinlay published a paper which cast doubt on the random walk hypothesis. In a 1999 response to Malkiel, Lo and McKinlay collected empirical papers that questioned the hypothesis' applicability that suggested a non-random and possibly predictive component to stock price movement, though they were careful to point out that rejecting random walk does not necessarily invalidate EMH, which is an entirely separate concept from RWH. In a 2000 paper, Andrew Lo back-analyzed data from the U.S. from 1962 to 1996 and found that "several technical indicators do provide incremental information and may have some practical value". Burton Malkiel dismissed the irregularities mentioned by Lo and McKinlay as being too small to profit from. Technicians say that the EMH and random walk theories both ignore the realities of markets, in that participants are not completely rational and that current price moves are not independent of previous moves. Some signal processing researchers negate the random walk hypothesis that stock market prices resemble Wiener processes, because the statistical moments of such processes and real stock data vary significantly with respect to window size and similarity measure. They argue that feature transformations used for the description of audio and biosignals can also be used to predict stock market prices successfully which would contradict the random walk hypothesis. The random walk index (RWI) is a technical indicator that attempts to determine if a stock's price movement is random in nature or a result of a statistically significant trend. The random walk index attempts to determine when the market is in a strong uptrend or downtrend by measuring price ranges over N and how it differs from what would be expected by a random walk (randomly going up or down). The greater the range suggests a stronger trend. Applying Kahneman and Tversky's prospect theory to price movements, Paul V. Azzopardi provided a possible explanation why fear makes prices fall sharply while greed pushes up prices gradually. This commonly observed behaviour of securities prices is sharply at odds with random walk. By gauging greed and fear in the market, investors can better formulate long and short portfolio stances. ## Scientific technical analysis Caginalp and Balenovich in 1994 used their asset-flow differential equations model to show that the major patterns of technical analysis could be generated with some basic assumptions. Some of the patterns such as a triangle continuation or reversal pattern can be generated with the assumption of two distinct groups of investors with different assessments of valuation. The major assumptions of the models are that the finiteness of assets and the use of trend as well as valuation in decision making. Many of the patterns follow as mathematically logical consequences of these assumptions. One of the problems with conventional technical analysis has been the difficulty of specifying the patterns in a manner that permits objective testing. Japanese candlestick patterns involve patterns of a few days that are within an uptrend or downtrend. Caginalp and Laurent were the first to perform a successful large scale test of patterns. A mathematically precise set of criteria were tested by first using a definition of a short-term trend by smoothing the data and allowing for one deviation in the smoothed trend. They then considered eight major three-day candlestick reversal patterns in a non-parametric manner and defined the patterns as a set of inequalities. The results were positive with an overwhelming statistical confidence for each of the patterns using the data set of all S&P 500 stocks daily for the five-year period 1992–1996. Among the most basic ideas of conventional technical analysis is that a trend, once established, tends to continue. However, testing for this trend has often led researchers to conclude that stocks are a random walk. One study, performed by Poterba and Summers, found a small trend effect that was too small to be of trading value. As Fisher Black noted, "noise" in trading price data makes it difficult to test hypotheses. One method for avoiding this noise was discovered in 1995 by Caginalp and Constantine who used a ratio of two essentially identical closed-end funds to eliminate any changes in valuation. A closed-end fund (unlike an open-end fund) trades independently of its net asset value and its shares cannot be redeemed, but only traded among investors as any other stock on the exchanges. In this study, the authors found that the best estimate of tomorrow's price is not yesterday's price (as the efficient-market hypothesis would indicate), nor is it the pure momentum price (namely, the same relative price change from yesterday to today continues from today to tomorrow). But rather it is almost exactly halfway between the two. Starting from the characterization of the past time evolution of market prices in terms of price velocity and price acceleration, an attempt towards a general framework for technical analysis has been developed, with the goal of establishing a principled classification of the possible patterns characterizing the deviation or defects from the random walk market state and its time translational invariant properties. The classification relies on two dimensionless parameters, the Froude number characterizing the relative strength of the acceleration with respect to the velocity and the time horizon forecast dimensionalized to the training period. Trend-following and contrarian patterns are found to coexist and depend on the dimensionless time horizon. Using a renormalisation group approach, the probabilistic based scenario approach exhibits statistically significant predictive power in essentially all tested market phases. A survey of modern studies by Park and Irwin showed that most found a positive result from technical analysis. In 2011, Caginalp and DeSantis have used large data sets of closed-end funds, where comparison with valuation is possible, in order to determine quantitatively whether key aspects of technical analysis such as trend and resistance have scientific validity. Using data sets of over 100,000 points they demonstrate that trend has an effect that is at least half as important as valuation. The effects of volume and volatility, which are smaller, are also evident and statistically significant. An important aspect of their work involves the nonlinear effect of trend. Positive trends that occur within approximately 3.7 standard deviations have a positive effect. For stronger uptrends, there is a negative effect on returns, suggesting that profit taking occurs as the magnitude of the uptrend increases. For downtrends the situation is similar except that the "buying on dips" does not take place until the downtrend is a 4.6 standard deviation event. These methods can be used to examine investor behavior and compare the underlying strategies among different asset classes. In 2013, Kim Man Lui and T Chong pointed out that the past findings on technical analysis mostly reported the profitability of specific trading rules for a given set of historical data. These past studies had not taken the human trader into consideration as no real-world trader would mechanically adopt signals from any technical analysis method. Therefore, to unveil the truth of technical analysis, we should get back to understand the performance between experienced and novice traders. If the market really walks randomly, there will be no difference between these two kinds of traders. However, it is found by experiment that traders who are more knowledgeable on technical analysis significantly outperform those who are less knowledgeable. ## Ticker-tape reading Until the mid-1960s, tape reading was a popular form of technical analysis. It consisted of reading market information such as price, volume, order size, and so on from a paper strip which ran through a machine called a stock ticker. Market data was sent to brokerage houses and to the homes and offices of the most active speculators. This system fell into disuse with the advent of electronic information panels in the late 60's, and later computers, which allow for the easy preparation of charts. Jesse Livermore, one of the most successful stock market operators of all time, was primarily concerned with ticker tape reading since a young age. He followed his own (mechanical) trading system (he called it the 'market key'), which did not need charts, but was relying solely on price data. He described his market key in detail in his 1940s book 'How to Trade in Stocks'. Livermore's system was determining market phases (trend, correction etc.) via past price data. He also made use of volume data (which he estimated from how stocks behaved and via 'market testing', a process of testing market liquidity via sending in small market orders), as described in his 1940s book. ## Quotation board Another form of technical analysis used so far was via interpretation of stock market data contained in quotation boards, that in the times before electronic screens, were huge chalkboards located in the stock exchanges, with data of the main financial assets listed on exchanges for analysis of their movements. It was manually updated with chalk, with the updates regarding some of these data being transmitted to environments outside of exchanges (such as brokerage houses, bucket shops, etc.) via the aforementioned tape, telegraph, telephone and later telex. This analysis tool was used both, on the spot, mainly by market professionals, as well as by general public through the printed versions in newspapers showing the data of the negotiations of the previous day, for swing and position trades. ## Charting terms and indicators ### Concepts Average true range – averaged daily trading range, adjusted for price gaps. Breakout – the concept whereby prices forcefully penetrate an area of prior support or resistance, usually, but not always, accompanied by an increase in volume. Chart pattern – distinctive pattern created by the movement of security or commodity prices on a chart Cycles – time targets for potential change in price action (price only moves up, down, or sideways) Dead cat bounce – the phenomenon whereby a spectacular decline in the price of a stock is immediately followed by a moderate and temporary rise before resuming its downward movement Elliott wave principle and the golden ratio to calculate successive price movements and retracements Fibonacci ratios – used as a guide to determine support and resistance and retracement percentages Momentum – the rate of price change Point and figure analysis – A priced-based analytical approach employing numerical filters which may incorporate time references, though ignores time entirely in its construction Resistance – a price level that may prompt a net increase of selling activity Support – a price level that may prompt a net increase of buying activity Trending – the phenomenon by which price movement tends to persist in one direction for an extended period of time ### Types of charts Candlestick chart – Of Japanese origin and similar to OHLC, candlesticks widen and fill the interval between the open and close prices to emphasize the open/close relationship. In the West, often black or red candle bodies represent a close lower than the open, while white, green or blue candles represent a close higher than the open price. Line chart – Connects the closing price values with line segments. You can also choose to draw the line chart using open, high or low price. Open-high-low-close chart – OHLC charts, also known as bar charts, plot the span between the high and low prices of a trading period as a vertical line segment at the trading time, and the open and close prices with horizontal tick marks on the range line, usually a tick to the left for the open price and a tick to the right for the closing price. Point and figure chart – a chart type employing numerical filters with only passing references to time, and which ignores time entirely in its construction. ### Overlays Overlays are generally superimposed over the main price chart. Bollinger bands – a range of price volatility Channel – a pair of parallel trend lines Ichimoku kinko hyo – a moving average-based system that factors in time and the average point between a candle's high and low Moving average – an average over a window of time before and after a given time point that is repeated at each time point in the given chart. A moving average can be thought of as a kind of dynamic trend-line. Parabolic SAR – Wilder's trailing stop based on prices tending to stay within a parabolic curve during a strong trend Pivot point – derived by calculating the numerical average of a particular currency's or stock's high, low and closing prices Resistance – a price level that may act as a ceiling above price Support – a price level that may act as a floor below price Trend line – a sloping line described by at least two peaks or two troughs Zig Zag – This chart overlay that shows filtered price movements that are greater than a given percentage. ### Breadth indicators These indicators are based on statistics derived from the broad market. Advance–decline line – a popular indicator of market breadth. McClellan Oscillator – a popular closed-form indicator of breadth. McClellan Summation Index – a popular open-form indicator of breadth. ### Price-based indicators These indicators are generally shown below or above the main price chart. Average directional index – a widely used indicator of trend strength. Commodity channel index – identifies cyclical trends. MACD – moving average convergence/divergence. Momentum – the rate of price change. Relative strength index (RSI) – oscillator showing price strength. Relative Vigor Index (RVI) – oscillator measures the conviction of a recent price action and the likelihood that it will continue. Stochastic oscillator – close position within recent trading range. Trix – an oscillator showing the slope of a triple-smoothed exponential moving average. Vortex Indicator – an indicator used to identify the existence, continuation, initiation or termination of trends. ### Volume-based indicators Accumulation/distribution index – based on the close within the day's range. Money flow index – the amount of stock traded on days the price went up. On-balance volume – the momentum of buying and selling stocks. ### Trading with Mixing Indicators MACD & Average directional index MACD & Super Trend MACD & Moving average MACD & RSI MACD & Moving Averages

https://en.wikipedia.org/wiki/Time_trend_analysis

Real and Financial Innovation This research group belongs to the IWH Research Cluster Productivity and Innovation. This research project contributes to the scientific literature in three main ways. First, it provides new ways to identify shocks to the financial sector in financial systems and analyses how these shocks affect intermediaries with regard to risk taking (stability), efficiency (productivity) and the market structure in banking markets in general. Second, the identified external shocks are central to measure effects that financial intermediaries have on the real sector of financial systems. Because financial intermediaries play a special role in financial systems and are subject to many regulations, it is very important to understand how, e.g., risk taking incentives or different competition structures in banking markets affect real sector outcome like sales, GDP growth or employment. Third, the group focuses on the effects of foreign banks in financial systems and specifically how shocks to these banks (e.g., via their holding companies during the recent financial crisis) affect activities (e.g., lending) in the host countries. Research ClusterProductivity and Innovation Your contact EXTERNAL FUNDING 01.2015 ‐ 12.2017 Interactions between Bank-specific Risk and Macroeconomic Performance German Research Foundation (DFG) Refereed Publications The Political Economy of Financial Systems: Evidence from Suffrage Reforms in the Last Two Centuries in: The Economic Journal , forthcoming Abstract Voting rights were initially limited to wealthy elites providing political support for stock markets. The franchise expansion induces the median voter to provide political support for banking development, as this new electorate has lower financial holdings and benefits less from the riskiness and financial returns from stock markets. Our panel data evidence covering the years 1830–1999 shows that tighter restrictions on the voting franchise induce greater stock market development, whereas a broader voting franchise is more conducive to the banking sector, consistent with Perotti and von Thadden (2006). The results are robust to controlling for other institutional arrangements and endogeneity. Bank Financing, Institutions and Regional Entrepreneurial Activities: Evidence from China in: International Review of Economics & Finance , forthcoming Abstract We investigate the effects of bank financing on regional entrepreneurial activities in China. We present contrasting findings on the role of quantity vs. quality of bank financing on small business formation in China: while we document a consistent, significantly positive relationship between the quality of bank financing and new venture formation, we find that the quantity of supplied credit is insignificant. We report that formal institutions are positively correlated to regional entrepreneurial activities, and informal institutions substitute formal institutions. Our findings also reveal that the institutional environment tends to supplement bank financing in promoting regional entrepreneurial activities. Corporate Social Responsibility and Firm Financial Performance: The Mediating Role of Productivity in: Journal of Business Ethics , forthcoming Abstract This study treats firm productivity as an accumulation of productive intangibles and posits that stakeholder engagement associated with better corporate social performance helps develop such intangibles. We hypothesize that because shareholders factor improved productive efficiency into stock price, productivity mediates the relationship between corporate social and financial performance. Furthermore, we argue that key stakeholders’ social considerations are more valuable for firms with higher levels of discretionary cash and income stream uncertainty. Therefore, we hypothesize that those two contingencies moderate the mediated process of corporate social performance with financial performance. Our analysis, based on a comprehensive longitudinal dataset of the U.S. manufacturing firms from 1992 to 2009, lends strong support for these hypotheses. In short, this paper uncovers a productivity-based, context-dependent mechanism underlying the relationship between corporate social performance and financial performance. What Type of Finance Matters for Growth? Bayesian Model Averaging Evidence in: The World Bank Economic Review , forthcoming Abstract We examine the effect of finance on long-term economic growth using Bayesian model averaging to address model uncertainty in cross-country growth regressions. The literature largely focuses on financial indicators that assess the financial depth of banks and stock markets. We examine these indicators jointly with newly developed indicators that assess the stability and efficiency of financial markets. Once we subject the finance-growth regressions to model uncertainty, our results suggest that commonly used indicators of financial development are not robustly related to long-term growth. However, the findings from our global sample indicate that one newly developed indicator—the efficiency of financial intermediaries—is robustly related to long-term growth. Is More Finance Better? Disentangling Intermediation and Size Effects of Financial Systems in: Journal of Financial Stability , 2014 Abstract Financial systems all over the world have grown dramatically over recent decades. But is more finance necessarily better? And what concept of financial system – a focus on its size, including both intermediation and other auxiliary “non-intermediation” activities, or a focus on traditional intermediation activity – is relevant for its impact on real sector outcomes? This paper assesses the relationship between the size of the financial system and intermediation, on the one hand, and GDP per capita growth and growth volatility, on the other hand. Based on a sample of 77 countries for the period 1980–2007, we find that intermediation activities increase growth and reduce volatility in the long run. An expansion of the financial sectors along other dimensions has no long-run effect on real sector outcomes. Over shorter time horizons a large financial sector stimulates growth at the cost of higher volatility in high-income countries. Intermediation activities stabilize the economy in the medium run especially in low-income countries. As this is an initial exploration of the link between financial system indicators and growth and volatility, we focus on OLS regressions, leaving issues of endogeneity and omitted variable biases for future research. Working Papers Bank-specific Shocks and House Price Growth in the U.S. in: IWH Discussion Papers , No. 3, 2017 Abstract This paper investigates the link between mortgage supply shocks at the banklevel and regional house price growth in the U.S. using micro-level data on mortgage markets from the Home Mortgage Disclosure Act for the 1990-2014 period. Our results suggest that bank-specific mortgage supply shocks indeed affect house price growth at the regional level. The larger the idiosyncratic shocks to newly issued mortgages, the stronger is house price growth. We show that the positive link between idiosyncratic mortgage shocks and regional house price growth is very robust and economically meaningful, however not very persistent since it fades out after two years. Banks and Sovereign Risk: A Granular View in: IWH Discussion Papers , No. 12, 2015 Abstract We identify the determinants of all German banks’ sovereign debt exposures between 2005 and 2013 and test for the implications of these exposures for bank risk. Larger, more capital market affine, and less capitalised banks hold more sovereign bonds. Around 15% of all German banks never hold sovereign bonds during the sample period. The sensitivity of sovereign bond holdings by banks to eurozone membership and inflation increased significantly since the collapse of Lehman Brothers. Since the outbreak of the sovereign debt crisis, banks prefer sovereigns with lower debt ratios and lower bond yields. Finally, we find that riskiness of government bond holdings affects bank risk only since 2010. This confirms the existence of a nexus between government debt and bank risk. How Effective is Macroprudential Policy during Financial Downturns? Evidence from Caps on Banks' Leverage in: Working Papers of Eesti Pank , No. 7, 2015 Abstract This paper investigates the effect of a macroprudential policy instrument, caps on banks' leverage, on domestic credit to the private sector since the Global Financial Crisis. Applying a difference-in-differences approach to a panel of 69 advanced and emerging economies over 2002–2014, we show that real credit grew after the crisis at considerably higher rates in countries which had implemented the leverage cap prior to the crisis. This stabilising effect is more pronounced for countries in which banks had a higher pre-crisis capital ratio, which suggests that after the crisis, banks were able to draw on buffers built up prior to the crisis due to the regulation. The results are robust to different choices of subsamples as well as to competing explanations such as standard adjustment to the pre-crisis credit boom. Monetary Policy under the Microscope: Intra-bank Transmission of Asset Purchase Programs of the ECB in: IWH Discussion Papers , No. 9, 2015 Abstract With a unique loan portfolio maintained by a top-20 universal bank in Germany, this study tests whether unconventional monetary policy by the European Central Bank (ECB) reduced corporate borrowing costs. We decompose corporate lending rates into refinancing costs, as determined by money markets, and markups that the bank is able to charge its customers in regional markets. This decomposition reveals how banks transmit monetary policy within their organizations. To identify policy effects on loan rate components, we exploit the co-existence of eurozone-wide security purchase programs and regional fiscal policies at the district level. ECB purchase programs reduced refinancing costs significantly, even in an economy not specifically targeted for sovereign debt stress relief, but not loan rates themselves. However, asset purchases mitigated those loan price hikes due to additional credit demand stimulated by regional tax policy and enabled the bank to realize larger economic margins. Financial Transaction Taxes: Announcement Effects, Short-run Effects, and Long-run Effects in: IWH Discussion Papers , No. 4, 2017 Abstract We analyze the impact of the French 2012 financial transaction tax (FTT) on trading volumes, stock prices, liquidity, and volatility. We extend the empirical research by identifying FTT announcement and short-run treatment effects, which can distort difference-in-differences estimates. In addition, we consider long-run volatility measures that better fit the French FTT’s legislative design. While we find strong evidence of a positive FTT announcement effect on trading volumes, there is almost no statistically significant evidence of a long-run treatment effect. Thus, evidence of a strong reduction of trading volumes resulting from the French FTT might be driven by announcement effects and short-term treatment effects. We find evidence of an increase of intraday volatilities in the announcement period and a significant reduction of weekly and monthly volatilities in the treatment period. Our findings support theoretical considerations suggesting a stabilizing impact of FTTs on financial markets.

http://www.iwh-halle.de/en/research/research-groups/detail/real-and-financial-innovation/

This article describes developments in the Australian equity market over the past century, drawing in part from a newly compiled historical dataset which begins in 1917. Over the past one hundred years, the market has increased in size relative to the economy, while its composition by industry also changed substantially. The data also provide new evidence that historical returns on Australian equities – and therefore the equity risk premium – are lower than previously thought. The equity market is one of Australia's most important and high profile financial markets. It is an important source of funding for Australian companies and a destination for a large share of households' retirement savings. The total capitalisation of listed companies in Australia at the end of 2018 was just under $2 trillion, or around 100 per cent of GDP (Graph 1). Around $5 billion in shares are traded every day. Most large, well-known companies in Australia, such as the major banks and resources firms, are listed on the Australian Securities Exchange. They account for a large share of Australian output and employment, meaning there is an important relationship between the market and real economic activity. Historical data are important for placing equity market developments in context. An example is share price valuation metrics, such as price-to-earnings and price-to-book ratios. These are often compared to their own long-run averages by investors and market commentators to determine whether at a particular point in time they could be considered high or low. Alternatively, understanding how historical economic developments, such as mining booms or recessions, have affected the share market can help us interpret both how the market might react in future should similar events occur and the importance of current developments in light of historical experience. Despite the importance of the equity market, historical data for Australia are somewhat limited. Many time series begin in the 1980s or 1990s, a period during which, among other things, interest rates were very high relative to historical averages and the financial sector was expanding rapidly. This might affect their use as benchmarks for interpreting modern data. Additionally, several existing equity market time series do not extend far enough back to cover a period of economic recession, limiting our ability to interpret how they might react if one happened in the future. In contrast, in countries where comprehensive data do exist, long-run comparisons can be informative. In the United States, for example, the Shiller price-to-earnings ratio (a measure of market valuation) in recent years reached levels comparable to the period just before the Great Depression. This led to some commentary that US equities were overvalued, or that there was excessive investor exuberance (Shiller 2017). Such comparisons are more difficult to make in the context of Australia primarily due to limited data. Other data gaps have also made recent Australian developments difficult to place in historical context. For example, reliable data on the relative sizes of different sectors of the market mostly start in the 1990s or early 2000s (depending on the source). This period does not include the deregulation and expansion of the financial sector, the decline of the manufacturing sector, nor the late 1960s/early 1970s mining boom. Therefore, it has been difficult to say how remarkable more recent shifts – such as the most recent mining boom – have been in a historical context. This article presents some extended time series on the Australian equity market, filling some of these data gaps by drawing from a newly compiled dataset on the equity market which begins in 1917. The data were constructed primarily from stock gazettes published by the Sydney Stock Exchange, one of the predecessors of the modern Australian Securities Exchange. They cover quarterly company-level data from 1917 on a range of variables of interest. Further discussion of the data collection process, and its limitations, can be found in the Research Discussion Paper Mathews (2019). As with all datasets, particularly historical ones, some caveats should be made about interpretation. The data were largely hand-entered, and market reporting conventions have changed over time, which introduces the possibility of errors. Nonetheless, the data have been carefully collected and checked, and we judge them to be of sufficient quality for research purposes. The remainder of this article highlights some interesting findings based on this dataset. Shareholder Returns The average return on equities – particularly when compared with the return on other assets – is a useful statistic for retirement planning and portfolio allocation, as well as some regulatory purposes. Since equity markets are quite volatile, however, it is appropriate to look at realised returns over very long periods of time. The length of the new dataset allows us to calculate average returns on Australian stocks over the past 100 years, providing a more accurate representation of returns. Share Prices Australian share prices have increased by a geometric average of around 6 per cent per year over the past 100 years, or by around 2 per cent after accounting for inflation. Over the long run the different industrial sectors have generally performed quite similarly, although there have been periods of over and underperformance (Graph 2). For instance, banking stocks underperformed for several decades following the Great Depression, while resources stocks outperformed the rest of the market in the late 1960s and then did quite poorly afterward, during the so-called ‘Poseidon Bubble’. Dividends: Payout ratios and yields When measuring the returns on Australian equities, it is important to take dividend payments by companies into account. This is because dividends on Australian equities are higher than in many other countries due in part to their tax treatment (Bergmann 2016). This can be observed through changes in dividend payout ratios (the share of profits paid out as dividends in any given year). Before the introduction of franking credits (where shareholders receive a rebate for the tax already paid by the company on the profits being distributed as dividends) in 1987, Australian dividend payout ratios used to track those in the United States very closely (Graph 3). Since companies have to decide between using profits to pay dividends or invest in productive assets, the similarity in Australian and United States payout ratios before 1987 is likely to reflect broadly similar economic conditions. Following the introduction of franking credits, the ratios diverge; dividend payments in Australia have remained very high even as they have declined in the United States, likely reflecting their tax treatment here. In contrast, US companies have increasingly chosen to return capital to shareholders by buying back shares instead, which in Australia would not generally receive the same tax treatment as dividends. An arguably more important statistic from the point of view of an equity investor, however, is the dividend yield: the ratio of dividends per share to share price. This shows the return on investment generated by the payment of dividends, which accounts for around half of the total return on holding Australian equities over the past century (Kohler 2018). Existing data on historical Australian dividend yields, originally published in Lamberton (1958a&b) (and continued by the Sydney Stock Exchange) tend to overstate the actual dividends shareholders would have received, particularly for the first half of the 20th century. This is because, historically, they were calculated as a simple average of all companies' dividend yields, giving undue weight to smaller companies which tend to have higher dividend payout ratios. Hence, historical dividend yields based on this simple average tend to be higher than on a market capitalisation-weighted portfolio. The Lamberton data also excluded companies paying zero dividends. The company-level data used here allow us to calculate a dividend yield based on a market capitalisation-weighted portfolio, to more accurately reflect the yield earned by a typical investor. The result is that dividends are about 200 basis points per year lower than implied by existing data. Nonetheless, the changes over time are very similar to those shown in the Lamberton data (Graph 4). The RBA series also lines up quite closely with modern data where they overlap. Total return and the equity risk premium Using the updated dividends data, the new historical series (extended with available data for more recent time periods) imply that the total nominal return on equities (i.e. the sum of capital gains and dividends) has been around 10 per cent per year over the past 100 years (based on a geometric average which allows for compounding over time) (Table 1). In real terms – i.e. after accounting for inflation – the average annual return was about 6 per cent. There have not been material differences in returns across sectors over this time, although of course there have been periods in which sectors have performed differently. Over the same period, the total nominal return on long-term government bonds has been around 6 per cent, implying an average equity risk premium (excess return of equities over safe assets) of around 4 per cent. |Total market||10.2| |– Resources||10.2| |– Financials||10.3| |– Other||10.4| |10-year government bonds||6.2| |Consumer price inflation||3.9| | | Sources: ABS; ASX; Foster (1996); Hunter (1958); Lamberton (1958a&b); League of Nations Yearbooks; RBA; Refinitiv Datastream Due to the lower dividend yields, this estimate of the equity risk premium is a bit lower than using the Lamberton data implies (Graph 5). It also suggests that the realised risk premium in Australia was materially lower than that in the United States for the period 1955–80, while similar at other times. It does bring historical estimates of the premium closer to more recent realised values in Australia, however. Composition of the Listed Equities Market The composition of the stock market – in terms of the types of companies listed – is very similar to its composition of 100 years ago. Financial corporations (particularly banks) and resources companies (particularly miners) account for about half of the market by market capitalisation, which was also true in 1917 (Graph 6). Indeed, it is often the very same companies (albeit following several mergers and acquisitions) that comprise most of the stock market. This reflects the historical importance of colonial-era banks and of mining companies founded during the resources booms of the 19th century. Nonetheless, the similarity in composition masks substantial changes that have taken place in the interim, due in part to changes in the structure of the Australian economy. Resources The resources sector, which includes mining and energy companies, is currently about 20 per cent of the stock market by market capitalisation. During the mining boom of the 2000s, it more than doubled in size (relative to the other sectors). However, the sector expanded much more rapidly during the mining boom of the late 1960s/early 1970s, where it reached a peak of over 65 per cent of the market. Even so, mining has never accounted for more than 10 per cent of employment (Connolly and Lewis, 2010) or gross domestic product (ABS 2005) so it has always accounted for a larger share of the stock market than of the real economy. Financials Financial stocks were among the first traded in the Australian colonies in the 1800s, and by the early 20th century they still accounted for over a third of the stock market by market capitalisation. These companies were the predecessors of today's large banks (excluding Commonwealth Bank, which was set up by the government in 1911 and publicly owned until the 1990s). These banks underwent many mergers in the interim, which has reduced their number. The financial sector shrank substantially in relative terms in the mid 20th century, in substantial part owing to stricter regulation following the Great Depression. As a result, for most of the past 100 years, financial corporations were a much smaller part of the stock market than is the case now. As the role of the financial sector in the economy has expanded in recent decades, however, it has accounted for an increasingly large share of the stock market. The modern listed financial sector is also much more diversified than it was 100 years ago, as insurance companies and diversified financial corporations have grown in size relative to banks. Other The ‘other’ sector – everything except financials and resources – has historically been dominated by manufacturing, consumer goods and infrastructure companies. The sector reached its peak share of about 65 per cent of the index around 1960, but declined over the next two decades and has been around 40 per cent since then. The timing of these changes aligns fairly closely with the peak and decline of Australia's manufacturing sector relative to broader measures of economic activity (ABS 2005). Large manufacturing companies such as Tooth and Co. (a brewery) and British Tobacco had been either the second or third largest companies on the market (the largest being BHP) for around 20 years, ending in the 1950s. Moreover, before the 1960s large manufacturing conglomerates like Australian Consolidated Industries (glassware and plastics), ICI (chemicals) and Australasian Paper and Pulp were among the largest listed companies as well. The value of all of these companies declined in relative terms through the mid 1960s and 1970s, and many have since ceased trading or been acquired by other enterprises. Consumer stocks have also historically made up a large share of the market. This reflects a high number of listed department stores in the early part of the century, but newspaper companies also featured prominently. Agricultural and forestry companies, which historically accounted for quite large shares of Australian output, have never been particularly important in the stock market. This may reflect the prevalence of small-to-medium enterprises (such as farms) which would not have been big enough to list publicly. Infrastructure companies have also been prominent on the stock market since its inception but, over time, railway and steamship companies have mostly been replaced by those focusing on roads and airports. Shipping, in particular, was still a very large industry on the stock market at the start of the 20th century. This reflects its important role in the economy through the 1800s when the value of listed shipping companies rivalled that of the banks and miners. Companies like the Union Steam Ship Company of New Zealand (the ‘Southern Octopus’) and Sydney Ferries were among the largest companies on the market at various times and, at its peak, the Southern Octopus was the largest private sector employer in New Zealand. Shipping overall is only a minor share of the market now, although transport companies like Transurban, Qantas and Sydney Airport remain large and significant companies. Valuations Market participants and observers calculate equity price valuations for a range of reasons. For instance, for market participants, knowing when a company's share price is high or low relative to some metric (for example, compared with its realised profits) might be taken as a sign to buy or sell its stock. One simple measure of the valuation of equities is the price-to-earnings ratio. A share price should, in theory, be the discounted present value of expected future payments to shareholders. A price-to-earnings ratio above average implies that investors anticipate above-average growth in company earnings, or are discounting those earnings at a below-average rate, or both. For these reasons, the ratio is commonly used as a measure of investor optimism regarding the prospects of listed companies and their willingness to bear risk associated with investing in them. The new data suggest that in Australia, price-to-earnings ratios are very close to their long-run average (Graph 7). This is true for the index as a whole, and for the three main subsectors. This is quite striking, since price-to-earnings ratios overseas – particularly in the United States – have been above their long-run averages of late (when considered over this horizon). And given that interest rates are quite low, we might expect price-to-earnings ratios to be above average all else being equal, since the present value of discounted future earnings will be higher with lower discount rates. Conclusion The Australian equity market has grown over the past century to be an important part of the financial system. Understanding it in historical context is important, and the new data presented here provide insight into a range of topics on the market and on listed companies more broadly. Readers with further interest are encouraged to read the Research Discussion Paper (Mathews, 2019) this article summarises, which covers many other topics over the same long-term perspective. Footnotes The author is from Domestic Markets Department. This article summarises a recently released Research Discussion Paper, and interested readers should refer to Mathews (2019) for further detail. Some of these data were also presented in Kohler (2018). [*] This is calculated from an index which includes the top 100 companies by market capitalisation for 1917–1979, and for the total market from 1980. See Mathews (2019) for further information. See Simon (2003) for further discussion of this period. The other half is attributable to increases in share prices. The data referred to here are from Lamberton (1958), who calculated historical dividend yields and share prices on behalf of the Sydney Stock Exchange, and continued to produce measures using his methodologies for some years following. This is the most widely used dataset on historical equity prices in Australia. Brailsford, Handley and Maheswaran (2008) discuss this issue in depth, and some adjustments that can be made to existing data. Different choices such as the safe asset series (i.e. long-term bonds or short-term bills), the time period, and whether to use geometric or arithmetic averages, will affect the estimate of the premium. Mathews (2019) discusses some of these issues in further detail. Battellino (2010) discusses this mining boom – and others – in more depth. See Graph 9 in Kohler (2018). References ABS (Australian Bureau of Statistics) (2005), ‘100 Years of Change in Australian Industry’, Year Book Australia, 2005, No 87, ABS Cat No 1301.0, Australian Bureau of Statistics, Canberra, pp 427–435. Battellino R (2010), ‘Mining Booms and the Australian Economy’, Address given to The Sydney Institute, Sydney, 23 February. Bergmann M (2016), ‘The Rise in Dividend Payments’, RBA Bulletin, March, pp 47–56. Black S, J Kirkwood, A Rai and T Williams (2012), ‘A History of Australian Corporate Bonds’, RBA Research Discussion Paper No 2012-09. Brailsford T, JC Handley and K Maheswaran (2008), ‘Re-Examination of the Historical Equity Risk Premium in Australia’, Accounting and Finance, 48(1), pp 73–97. Connolly E and C Lewis (2010), ‘Structural Change in the Australian Economy’, RBA RBA Bulletin, September, pp 1–10. Foster RA (1996), Australian Economic Statistics: 1949-50 to 1994-95, Occasional Paper No 8, rev 1997, Reserve Bank of Australia, Sydney. Gizycki M and P Lowe (2000), ‘The Australian Financial System in the 1990s’, in D Gruen and S Shrestha (eds), The Australian Economy in the 1990s, Proceedings of a Conference, Reserve Bank of Australia, Sydney, pp 180–215. Hunter JSH (1958), ‘Interest Rates in Australia, 1931-1956: Post-Mortem on an Era of Cheap Money’, Masters Thesis, The Australian National University. Kohler M (2018), ‘The Long View on Australian Equities’, Speech at the 31st Australasian Finance and Banking Conference, Sydney, 13 December. Lamberton DM (1958a), Security Prices and Yields 1875–1955, Pamphlet, Sydney Stock Exchange Research and Statistical Bureau, Sydney. Lamberton DM (1958b), Share Price Indices in Australia: An Examination of the Measurement and Significance of Changes in Share Prices Together with New Indices for the Period July 1936–December 1957, Law Book Co. of Australasia Pty, Sydney. Mathews T (2019), ‘A History of Australian Equities’, RBA Research Discussion Paper No 2019-04. Shiller R (2017), ‘The Coming Bear Market?’, Project Syndicate site, 21 September. Available at <https://www.project-syndicate.org/commentary/us-stock-volatility-bear-market-by-robert-j--shiller-2017-09>.

https://www.rba.gov.au/publications/bulletin/2019/jun/the-australian-equity-market-over-the-past-century.html

Based on market data, technical analysis is a technique or approach that may be used to anticipate the likely future price movement of security (such as a stock or a currency pair). For technical analysis to be valid, it must be supported by the notion that the collective actions – buying and selling – of all participants in the market accurately reflect all relevant information about a traded security and, as a result, consistently assign a fair market value to the security in question. What is technical analysis? Technical analysis is a method that is used to evaluate and anticipate the future values of securities by taking into account elements such as price movement, charts, trends, trading volume, and other factors. It is a subset of fundamental analysis. The technical analysis of an investment, as opposed to the fundamental analysis, focuses on trading signals to identify excellent investments and trading opportunities by studying the patterns of investment through its trading data and other statistical aspects. Although current or past prices are commonly seen as the best indicators of future prices, technical analysis looks to the future price of security rather than to the current or last price. Financial charts, data, and statistics are a core component of technical analysis, which relies heavily on them to forecast trends, highlight strengths, and reveal weaknesses, allowing analysts and investors to decide if security is a good investment or not. A broad variety of tools are available to technical analysts to identify patterns and trends on charts. Moving averages, support and resistance levels, Bollinger bands, and other indicators are examples of this. Technical traders may benefit from a variety of tools, all of which serve the same purpose: to make reading chart movements and detecting trends easier for them. Technical Analysis Types Top-down technical analysis: When analysts use a top-down technique to study companies, they often start with a broad perspective and narrow it down to a more detailed one — frequently starting with a major index like the S&P 500 and progressing to sector charts and then specific weekly or hourly charts for single firms. Technical analysts continue to analyze more and more precise charts to identify whether stocks appear to be a solid long-term investment. When employing the top-down technique, technical analysts evaluate a stock or security’s moving averages in a more general-to-specific time frame, such as starting with daily averages and then going on to hourly averages for a certain stock’s price movements, before concluding their analysis. Bottom-up technical analysis: In contrast to the above, using a bottom-up strategy for technical analysis involves identifying potentially cheap companies and then investigating them on a more fundamental level to identify a point of entry when the stock appears to have bottomed out. To identify stocks that are defying the general market’s trend, technical analysts utilize the bottom-up method. They then seek entry and exit points that would put them in the greatest position to earn money on a specific company. Technical analysis in cryptocurrency Even though technical analysis in the cryptocurrency market appears to be complicated, the word merely refers to the examination of historical market data in an attempt to forecast future price movements. In essence, it enables us to make educated estimates about whether the price of a digital asset will rise or fall in the future, based on historical data. Technical analysis may provide cryptocurrency traders with insight into the past of a cryptocurrency, allowing them to make more accurate forecasts for the future. In most charting software, various technical analysis tools are already built-in, and you may use them in conjunction with your research to augment them. Always strive to mix technical analysis with other approaches to achieve the best outcomes.

https://zipmex.com/th/en/glossary/technical-analysis/

an umbrella. | | | | January 1, 2020 | EXECUTIVE SUMMARY: | FORECAST: Over the long term, crude oil and gold are highly correlated. Crude oil is under performing compared to gold. see CHART 1 Earnings of the S&P large cap, mid cap, and small cap indexes appear to be overvalued relative to most financial benchmarks. This overvaluation suggests EITHER we will see as much as a 50% drop in the indexes to bring the markets to fair or undervalued, OR we need to see a strong increase in earnings. see CHART 2 The energy sector is an important segment of the stock market indexes and the low energy prices have had a very negative impact on energy stock earnings which has had a negative impact on overall corporate earnings. In 2011, when gold was $1,800 and crude was $100, and the energy sector of the S&P 500 was a significant contributor to overall earnings of the index. Currently, small cap energy earnings are less than 10% of their 2011 earnings. see CHART 3 Forecast Conclusion: The huge $1.5 trillion deficit budgeted by the US Government suggests the US has no desire to control spending, interest rates, or inflation. As long as the Fed keeps rates relatively low and gold remains firm, OIL can begin to "catch up" to gold resulting in a significant increase in stock index earnings changing the overvalued condition. FOLLOW: Stock Index Timing .com follows gold looking for divergences between gold, silver, swiss, and the gold miner stocks to identify Market Price Box areas of support and resistance. The plan is to be long gold above and short gold below the current MPB. A favorable view of gold suggests a favorable view of oil which suggests strong energy sector earnings could help the stock market move higher. Stock Index Timing looks at market trend indicators to forecast market direction, then looks to trade with a bias in the direction of the indicator forecasts. The current extremely over bought forecast indicators, an example is the Active Trader Index indicator shown in Chart 4, suggests an intermediate stock market decline that might be a possible beginning of a correction of the 9 year bull market. Alternatively, a strong rise in energy sector earnings with an accommodative Fed holding rates low, could set up another bull market leg extension. In that case, we would ONLY look for the intermediate term indicators to work off the extreme over bought condition and then look to follow the market to the buy side. A Market Price Box review of the Stock Market and Gold is posted on www.stockindextiming.com each week. BOTTOM LINE: After the over bought indicators correct, strong oil with low interest rates could signal another up leg in stocks. BOTTOM BOTTOM LINE: In 2017, the corporate tax cuts resulted in a 20% increase in earnings that extended the bull market another up leg. Strong oil prices and low interest rates could result in another 10% plus increase in overall index earnings and cause another bull market leg extension. | | CHART 1 | | CHART 2 | | CHART 3 Intermediate Term Forecast indicator: Based on the historical data shown, the Active Traders Index gives trend change signals at extreme over bought or over sold levels and momentum indicator based trend change signals. The Active Traders Index is a proprietary indicator calculated each day from the listing of the ten most active stocks on the NYSE and ten most active stocks on the Nasdaq. The red line is the cumulative Active Traders Index and the oscillator in the middle of the page is based on the daily Active Traders Index number. Chart 4. ACTIVE TRADERS INDEX If anything in this report is viewed by the reader as a trade recommendation, all aspects of any trade recommendations contained in this report are subject to modification at any time. FUTURES TRADING INVOLVES SIGNIFICANT RISK OF LOSS AND IS NOT SUITABLE FOR EVERYONE AND THE RISK OF LOSS SHOULD BE CONSIDERED CAREFULLY BEFORE MAKING ANY TRADES. A STOP LOSS MAY NOT LIMIT YOUR LOSS TO THE AMOUNT INTENDED. YOU SHOULD BE FOREWARNED THAT SYSTEMS WHICH TRIGGER FREQUENT TRADING SIGNALS AS PART OF A DAY TRADING STRATEGY CAN RESULT IN SUBSTANTIAL COMMISSIONS AND FEES. PAST PERFORMANCE IS NOT NECESSARILY INDICATIVE OF FUTURE RESULTS. ANY STATEMENT OF FACTS HEREIN CONTAINED ARE DERIVED FROM SOURCES BELIEVED TO BE RELIABLE, BUT ARE NOT GUARANTEED AS TO ACCURACY, NOR DO THEY PURPORT TO BE COMPLETE. ANY REFERENCE TO PERFORMANCE IS INTENDED TO BE UNDERSTOOD AS STRICTLY THEORETICAL. REGULATORY DISCLOSURES REGARDING HYPOTHETICAL RESULTS HYPOTHETICAL PERFORMANCE RESULTS HAVE MANY INHERENT LIMITATIONS, SOME OF WHICH ARE DESCRIBED BELOW. NO REPRESENTATION IS BEING MADE THAT ANY ACCOUNT WILL OR IS LIKELY TO ACHIEVE PROFITS OR LOSSES SIMILAR TO THOSE SHOWN. IN FACT, THERE ARE FREQUENTLY SHARP DIFFERENCES BETWEEN HYPOTHETICAL PERFORMANCE RESULTS AND THE ACTUAL RESULTS SUBSEQUENTLY ACHIEVED BY ANY PARTICULAR TRADING PROGRAM. ONE OF THE LIMITATIONS OF HYPOTHETICAL PERFORMANCE RESULTS IS THAT THEY ARE GENERALLY PREPARED WITH THE BENEFIT OF HINDSIGHT. IN ADDITION, HYPOTHETICAL TRADING DOES NOT INVOLVE FINANCIAL RISK, AND NO HYPOTHETICAL TRADING RECORD CAN COMPLETELY ACCOUNT FOR THE IMPACT OF FINANCIAL RISK IN ACTUAL TRADING. FOR EXAMPLE, THE ABILITY TO WITHSTAND LOSSES OR TO ADHERE TO A PARTICULAR TRADING PROGRAM IN SPITE OF TRADING LOSSES ARE MATERIAL POINTS WHICH CAN ALSO ADVERSELY AFFECT ACTUAL TRADING RESULTS. THERE ARE NUMEROUS OTHER FACTORS RELATED TO THE MARKETS IN GENERAL OR TO THE IMPLEMENTATION OF ANY SPECIFIC TRADING PROGRAM WHICH CANNOT BE FULLY ACCOUNTED FOR IN THE PREPARATION OF HYPOTHETICAL PERFORMANCE RESULTS AND ALL OF WHICH CAN ADVERSELY AFFECT ACTUAL TRADING RESULTS. PAST PERFORMANCE IS NOT NECESSARILY INDICATIVE OF FUTURE RESULTS. THE RISK OF LOSS EXISTS IN FUTURES TRADING.

http://www.stockindextiming.com/specialreport/20200101goldcrude/goldcrude20200101.htm

The table below lists the historical sector weightings of the U.S. stock market. The weights have been calculated using the 500 largest public companies at a given date. Currently (9/30/2021), the largest GIGS sector is clearly Information Technology, followed by Health Care and Consumer Discretionary companies. The technology sector has been dominating the U.S. stock market ever since the financial crisis of 2007-2008 and it seems that that there is no end in sight to the sector’s bull run. Note: The new Communication Services sector replaced the previous Telecommunications sector on September 2018. For comprehensive historical sector breakdown data, check the Global Equity Valuations Researcher Dataset by Siblis Research. U.S. Stock Market (Large Cap) – Sector Weightings Purchase the Global Equity Valuations Researcher Dataset by Siblis Research that provides historical sector weightings of the U.S. equity market since the year 1979. This datataset provides current and historical P/E (TTM) ratios, forward P/E ratios, CAPE ratios, dividend yields, market cap to GNI ratios, sector breakdowns and long-term interest rates of the largest economies and stock markets in the world. Check a sample dataset from here. Changes in the sector weightings during the past two decades (U.S. large cap) Compared to twenty years ago, the weighting of the Financial sector has decreased considerably. The global financial crisis of 2008 dropped the weight of the sector temporarily to just 11%. Financial services recovered quickly after the crisis but the sector is still much smaller compared to other sectors than it was before the crisis. After the financial crisis ended, the Information technology sector quickly rose from 15% to over 20% with the help of Apple, Microsoft, Facebook and Alphabet (Google). Since 2009, the weighting of the Energy sector has plummeted and its currently just a bit more than 2%. In the beginning of the 1980s, Energy was clearly the most valuable sector, making up 25% of the U.S. stock market. Also, the relative market value of the Material companies is now just a small fraction of what it used to be 35 years ago. The Difference Between Consumer Staples & Consumer Discretionary Sectors Consumer discretionary companies are selling nonessential goods and services. The businesses include car manufacturers, high-end clothing, media, hotels, and luxury goods. Consumer staples corporations sell products that people are unable (e.g. food, beverages, household items) and unwilling (e.g. tobacco) to stop consuming. Consumer staples businesses are considered non-cyclical and the demand for these products is expected to be much more staple as the consumer discretionary goods. Interested in doing your own analysis of U.S. stock market? Purchase the U.S. Historical Stock Returns Researcher Dataset by Siblis Research and analyze the historical performance of almost ten thousand public US companies for the past 40 years. The dataset provides adjusted share prices (total returns) on a monthly level of 9,622 individual public stocks. The dataset provides also market capitalizations of the companies so you can analyze the stock market returns by size and sector. Examine a sample dataset from here.

https://siblisresearch.com/data/us-sector-weightings/

Overall, even for newcomers to the crypto trading sector, various educational sources are available that can help you formulate workable strategies that combine both techniques. If you are an engineer, you should start with accounting first and then move to financial modeling courses. In addition, you must do a quick refresher of Excel Courses so that you will be all set to learn financial concepts and its applications in excel. She has 10+ years of experience in the financial services and planning industry. Fundamental analysis evaluates securities by attempting to measure their intrinsic value. What are the limitations of Fundamental analysis? Fundamental Analysis is based on wrong data Fundamental analysis is based on reported and publicly available data. But if the management has incorrectly reported financial details or you have misinterpreted it, then your decision may go wrong. It’s also necessary to base your analysis on relevant and accurate data. These often happen when participants are undecided, which means that neither the buyers nor sellers are in control, resulting in sideways moving prices within a range or a lateral consolidation. So, the simplest way to analyse the systematic risks which affect the supply and demand of a currency is to follow an economic calendar. This calendar will help you understand the impact of the weakness/strength of a country’s economic stance on its currency. This is how fundamental traders spot and trade potentially profitable trading opportunities. Fundamental analysis chooses stocks to buy; technical analysis chooses when to buy for analysts who use both. Overall, there are four categories of technical indicators, including trend indicators, momentum indicators, volume indicators, and volatility indicators. Whether you are investing in stocks or cryptocurrencies, this guide will explain what fundamental and technical analyses are and which one to choose. Return On AssetsReturn on assets is the ratio between net income, representing the amount of financial and operational income a company has, and total average assets. Technical Analysis Vs Fundamental Analysis Some are topical, some are perspective, and expect a few opinions on the state-of-play in finances. The Structured Query Language comprises several different data types that allow it to store different types of information… This guide shows Forex news you step-by-step how to build comparable company analysis (“Comps”) and includes a free template and many examples. Relative Vigor Index – oscillator measures the conviction of a recent price action and the likelihood that it will continue. What is DEA in MACD? The MACD histogram, which was developed by T. Aspray in 1986, measures the signed distance between the MACD and its signal line calculated using the 9-day EMA of the MACD, which is called the DEA. Similar to the MACD, the MACD histogram is an oscillator that fluctuates above and below the zero line. When investors decide a young company has an innovative product or compelling competitive advantage, they may start to drive the stock’s price higher. The more investors who join the party, the higher the company’s stock price is likely to rise. Such investors typically focus on metrics such as a technical analysis vs fundamental company’s historical and projected revenue growth rates when buying shares of relatively new companies. Fundamental analysis is the examination of industry trends, financial records, and economic outlook. On the other hand, the technical analysis examines price movements and market psychology. Therefore, to unveil the truth of technical analysis, we should get back to understand the performance between experienced and novice traders. If the market really walks randomly, there will be no difference between these two kinds of traders. However, it is found by experiment that traders who are more knowledgeable on technical analysis significantly outperform those who are less knowledgeable. ] that the EMH and random walk theories both ignore the realities of markets, in that participants are not completely rational and that current price moves are not independent of previous moves. They argue that feature transformations used for the description of audio and biosignals can also be used to predict stock market prices successfully which would contradict the random walk hypothesis. The efficient-market hypothesis contradicts the basic tenets of technical analysis by stating that past prices cannot be used to profitably predict future prices. Technical Analysis Vs Fundamental Analysis Strategies that can be back tested form the basis of many algorithmic trading strategies. The debate over the relative merits of fundamental and technical analysis is a contentious one. Investors and traders alike often miss out when they pick one over the other. To perform fundamental analysis, you’ll want to review a company’s financial statements, historical data, investor conference calls, press releases, analyst reports, and analyst estimates. Fundamentally focused investors often wait a long time before a company’s intrinsic value is reflected in the market, if at all. For example, value investors often assume that the market is mispricing a security over the short-term, but also assume that the price of the stock will correct itself over the long run. Contact our support if you are suspicious of any fraudulent activities or if you have any questions. Mortgageloan.com is a news and information service providing editorial content and directory information in the field of mortgages and loans. Mortgageloan.com is not responsible for the accuracy of information or responsible for the accuracy of the rates, APR or loan information posted by brokers, lenders or advertisers. Each week, Zack’s e-newsletter will address topics such as retirement, savings, loans, mortgages, tax and investment strategies, and more. Daniel Cross resides in Florida and has been writing investment and financial articles since 2005. He holds the Chartered Financial Consultant designation from the American College in Bryn Mawr, Pennsylvania. The Boutique Investor Blog These methods can be used to examine investor behavior and compare the underlying strategies among different asset classes. Systematic trading is most often employed after testing an investment strategy on historic data. Backtesting is most often performed for technical indicators, but can be applied to most investment strategies (e.g. fundamental analysis). While traditional backtesting was done by hand, this was usually only performed on human-selected stocks, and was thus prone to prior knowledge in stock selection. What is HODL Bitcoin? HODL is a term derived from a misspelling of “hold,” in the context of buying and holding Bitcoin and other cryptocurrencies. It’s also commonly come to stand for “hold on for dear life” among crypto investors. The term HODL (or hodl) originated in 2013 with a post to the Bitcointalk forum. You may find that technical analysis works better in some situations while fundamental analysis works better in other situations. Technical analysis looks at the statistics of a stock’s market activity in order to determine its potential direction in the future. The New York Institute of Finance is a global leader in professional training for financial services and related industries. NYIF courses cover everything from investment Day trading banking, asset pricing, insurance and market structure to financial modeling, treasury operations, and accounting. The New York Institute of Finance has a faculty of industry leaders and offers a range of program delivery options, including self-study, online courses, and in-person classes. Founded by the New York Stock Exchange in 1922, NYIF has trained over 250,000 professionals online and in-class, in over 120 countries. Difference Between Fundamental Analysis Vs Technical Analysis Long term investors purchase stock with large dividend payouts and hold the stock for several years through fluctuations and market shifts before finally selling them. One traditional way to weigh the value of a stock is to dig into the company’s financial statements. Sift through cash flow data, income statements, and balance sheets, and use all that information to figure out how much money this business is likely to return to investors as profits in the future. What type of analysis is better to start investing? Investors use quantitative analysis to evaluate the financial stability of a company. While some investors prefer the use of a single analysis method to evaluate long-term investments, a combination of fundamental, technical, and quantitative analysis is the most beneficial. Fundamental and technical analysis are two major schools of thought when it comes to approaching the markets, yet are at opposite ends of the spectrum. Investors and traders use both to research and forecast future stock prices. Like any investment strategy or philosophy, both have advocates and adversaries. However, many technical analysts reach outside pure technical analysis, combining other market forecast methods with their technical work. One advocate for this approach is John Bollinger, who coined the term rational analysis in the middle 1980s for the intersection of technical analysis and fundamental analysis. Fundamental Analysis For Traders Investing in stocks is a great way to build wealth and save for retirement. That’s why investors turn to strategies like fundamental and technical analysis to help them pick stocks to buy and sell. Here’s a breakdown of each approach so you can find the one that works best in any particular situation. Investors and analysts using technical analysis are sure that they can determine future performance by reviewing and analyzing various patterns and trends from performance data. Short term price movements and volatility cannot be forecast by looking at financial statements. Valuation models like the discounted cash flow model are based on numerous assumptions which are seldom very accurate. Target valuations can be useful on a relative basis but are limited when it comes to valuing a company more than one or two years into the future. Investors use quantitative analysis to evaluate the financial stability of a company. When it comes to investors like you, you may feel comfortable using a specific strategy. Both fundamental and technical analysis provide tools for helping you make the best buying decision. For example, let’s say you’re an investor who focuses on growth and are interested in how a security or company will perform over a long period time. Fundamental analysis takes into account the intrinsic value of a stock for identifying opportunities for long-term investment. The technical analysis evaluates the past price movements of a stock and predicts how a stock will perform in the future i.e., whether its price is expected to increase or decrease over a shorter period of time. In the short term, price action is affected by several factors that fundamental analysis cannot pick up. One study, performed by Poterba and Summers, found a small trend effect that was too small to be of trading value. As Fisher Black noted, “noise” in trading price data makes it difficult to test hypotheses. Technical analysts believe that investors collectively repeat the behavior of the investors that preceded them. To a technician, the emotions in the market may be irrational, but they exist. Is fundamental analysis needed for intraday trading? Fundamental analysis is a method which should be avoided for day trading in the market. This method is practised for investing and generally with a medium to long term horizon. This method should completely be avoided by intraday traders. Because fundamental analysts believe all information is not necessarily reflected in the price of an asset, they assume prices and values are different. It is this same thought process that can be applied to the investment world when it comes to the debate between fundamental versus technical analysis. Proponents of strong form efficient market theory and technical analysts are at opposite ends of the philosophical spectrum. Comparison Chart Stocks fluctuate in value due to a variety of risk factors, including changing economic, political, or market conditions or in response to events that affect particular industries or companies. Each investor should evaluate their ability to invest for a long term, especially during periods of downturns in the market. The bottom-up approach is primarily concentrated on various microeconomic factors such as a company’s earnings and financial metrics. Analysts who use such an approach develop a thorough assessment of each company to gain a better understanding of its operations. - Fundamental analysis is not impacted by external news, whereas technical analysis gets impacted by external news. - Chances of a reversal are lower if the stock has pulled back to a support level, such as a moving average or an old low. - These indicators are used to help assess whether an asset is trending, and if it is, the probability of its direction and of continuation. - Industry data and economic factors, like interest rates and retail spending, are also used to forecast future growth rates. - Fundamental analysis takes the return on assets and returns on equity concepts into its use, whereas technical analysis takes price data and dow theory into its use. - In addition, you must do a quick refresher of Excel Courses so that you will be all set to learn financial concepts and its applications in excel. When evaluating the broader scope of the stock market, investors use fundamental analysis to review economic factors, including the overall strength of the economy and specific industry sector conditions. Simple moving averages are indicators that help assess the stock’s trend by averaging the daily price over a fixed time period. Buy and sell signals are generated when a shorter duration moving average crosses a longer duration one. It can then be used by academia, as well as regulatory bodies, in developing proper research and standards for the field. The CMT Association has published a body of knowledge, which is the structure for the Chartered Market Technician exam. Stock chart showing levels of support and resistance ; levels of resistance tend to become levels of support and vice versa. The two strategies can be applied in different situations and can be used alternatively depending on whether the investment plan is long-term or short-term. Technical Analysis is a popular method to develop a point of view on markets. Technical Analysis is a popular technique that allows you to understand the risk and rewards involved while taking a trading decision.

https://h-fire.com/understanding-fundamental-vs-technical-analysis/

It has always been a significant concern for scholars to model the complex state of stock markets in the way that traders satisfaction improves. However, still this field suggested the need for more accurate and comprehensive models. Development of such models is difficult because of the unpredictable economic, social and political variables that surely affect the market manners. However, model developers of the field have escaped the above referred complexities by some simplifying assumptions that have resulted in their less practicability in real world. In this study, subsequent to an introduction to the field of portfolio optimization and a literature review of the investment approach of Technical Analysis (TA), capabilities of TA in improving the present status of investment models and its potentiality to address the main challenges of the field are discussed. The present study also proposes the modular structure in which TA would suppose to be helpful. INTRODUCTION Portfolio theory has been organized to overcome the challenge of assigning ones wealth among different assets (Deng et al., 2005). Recognizing the best portfolio of assets is one of the major challenges of financial world (Ballestero et al., 2007) and is called portfolio selection. As a matter of fact, portfolio selection is the process of making the portfolio that maximizes the investors satisfaction (Fernandez and Gomez, 2007; Huang, 2007; Elikyurt and Ozekici, 2007; Huang, 2008). It is impossible to introduce a general strategy for selecting stocks in any market since it is dependent to many factors. For example Kimiagari and Amini (2007) examined the profitability of a broad range of stock selection strategies only in Tehran Stock Exchange over a specific period while it was proved that the most successful strategy in Iran is the multivariate strategy which selects the stocks with high E/P, B/P, C/P, S/P and D/E. In spite of continuous contributions of scholars in development of better portfolio models, still they are not completely applicable in real world. Much of the inapplicability is because of the gap between realities of market and assumptions of such models. Many of the assumptions are made because the optimization techniques that are used in such models have not been developed exclusively for the field of portfolio theory. And experts of each field have analyzed the portfolio selection problem from their own perspective of expertise. So they have to simplify the complex problem of portfolio optimization to make it possible for modeling and solving. For example there are some unrealistic assumptions in stochastic programming, robust optimization and markov modeling of the portfolio problem; on distribution of parameters, change direction of uncertain parameters and manner of relationship between future and present, respectively. As a result of this approach, the models have not been welcomed by practitioners and there is a gap between products of academic community and what the stock traders apply. So always, the severe need for development of a model that is designed exclusively to optimize a portfolio is felt. The current portfolio models do have a long way to come to the ideal point of being applied by the market practitioners directly but there are three significant challenges, as follows, that they must encounter first. One of the basic assumptions that scholars have made for their models is absolute rational behavior of investors. That is emotion has no effect on investors decision making. But both of experiments and experiences have proven the necessity for entrance of psychological effects of markets into portfolio models. That is decisions made by traders struggling in the midst of the financial markets may not be as heartless as they are seemed to be. Lo and Repin (2002) study the importance of emotion in the decision-making process of professional practitioners of stock market by measuring their physiological characteristics like skin conductance, blood volume pulse during live trading sessions while simultaneously capturing real-time prices from which market events can be detected. In their sample that was ten traders, they found different physiological responses during different states of the market and across the ten traders. According to their results even the most hard-boiled trader has heart palpitations during volatility events and less experienced traders can react emotionally to a broader swath of market behavior. So it is highly critical for portfolio models to encompass the emotional factors of market but how? The world of finance never waits for anybody or never adapts itself with assumptions of scholars models; rather scholars themselves must obey its circumstances. Any simplifying assumption about the market behavior, however, small and partial may reduce the reliability of results considerably. For example if a model assumes that the stocks returns have chaotic distribution and then develops the model, the stock trader who wants to apply this model should always monitor the stocks returns to determine whether they are chaotic or not. If even the difficulties of testing the supposition are overlooked, a massive amount of work should be done continuously to determine whether the model is applicable or not in that particular market or domain. There are many other examples to demonstrate that how considerably a simple assumption can decrease the practicability of a model. So less restricted a model, more ideal it is. Nowadays flexibility or robustness of models is needed more than anytime in the past. Winkler (1989) agrees and justified his belief as follows: I prefer, however, to take the view that, in many situations, there is no such thing as a true model for forecasting purposes. The world around us is continually changing, with new uncertainties replacing old ones. As a result, the longer-term search for a true model is doomed to fail in many cases because unanticipated changes prevent us from enjoying the luxury of getting to the longer term in a stable environment. This was suggested that models should be adaptive, but even adaptive models only represent our best state of knowledge at a given time; they do not represent the truth in any sense. This century is time of rapid and discontinuous changes with new risks. Time pressures and rush of events make us design and apply adaptive, unified and efficient decision support systems (Leigh et al., 2002a). Most or even all the available models can not do well with this challenge. Because they assume future state of stock markets are in accordance with past state of them (Tanaka and Guo, 1997) but the past data have limited applicability (Ballestero et al., 2007). Efficient and practical portfolio models must be flexible and capable of rapid responses to market changes. This study is to highlight the leading role that TA can take in portfolio models to encounter the three above mentioned challenges. TECHNICAL ANALYSIS Developing a model for predicting returns is an important goal for academics and practitioners while for example famous concept of Capital Asset Pricing Model with its vast literature of works like Rahman et al. (2006a, b) or Rhaiem et al. (2007) is just a small category. TA is a category of prediction models that has been welcomed by stock traders significantly and there is little dispute that it is very common among practitioners (Roberts, 2005). The main aim of this analysis is to get a signal from market data to buy or sell the risky assets. Typically the financial services industry relies on three main approaches to make investment decisions: the fundamental approach that uses fundamental economic principles to form portfolios, the TA approach that uses price and/or volume histories and the mathematical approach that is based on mathematical models (Leigh et al., 2002b). Among them technical and fundamental analyses dominate practice. Blanchet-Scalliet et al. (2007) justifies this very well and says if one considers a non-stationary economy it is impossible to specify and calibrate mathematical models that can capture all the sources of parameter instability during a long time interval. In such an environment, one can only attempt to divide any long investment period into sub-periods such that, in each of these sub-periods, the financial assets prices can reasonably be supposed to follow some particular distribution. Due to the investment opportunity sets instability, each sub-period must be short. Therefore, one can only use small amounts of data during each sub-period to calibrate the model and the calibration errors can be substantial. The definitions of TA that have been presented in literature by different scholars are almost the same. Tian et al. (2002) know TA as a search for recurrent and predictable patterns in stock prices. Dourra and Siy (2002) define it as an attempt to predict future stock price movements by analyzing the past sequence of stock prices because of the fact that forces of supply and demand affect those prices. They believe that it dismisses such factors as the fiscal policy of the government, economic environment, industry trends and political events as being irrelevant in attempting to predict future stock prices. Roberts (2005) knows it as a broad collection of methods and strategies which attempt to forecast future prices on the basis of past prices or other observable market statistics, such as volume or open interest. According to Wang and Chan (2007), TA studies records or charts of past stock prices, hoping to identify patterns that can be exploited to achieve excess profits. Blanchet-Scalliet et al. (2007) believe that TA defines trading rules using the assets price or/and volume history. There are also other definitions in literature that imply the same meanings and implications as the mentioned ones. Background: The study of TA has a long history in academia, particularly in the practitioner literature, with mixed results. According to Cesari and Cremonini (2003) TA is perhaps the oldest device designed to beat the market. It has a secular history given that its origins can be traced to the seminal articles published by Charles H. Dow in the Wall Street Journal between 1900 and 1902, and its basic concepts became popular after contributions by Hamilton (1922) and Rhea (1932). A complete jargon of words and pictures has been developed since then and many traders, nowadays, take their buying and selling decisions on the basis of TA results appearing on their screens. The approach of academic community to TA is to some extent unconvinced because of its limited theoretical justification and its contradiction to the conclusions of the efficient market hypothesis. That is, although the vast majority of the professional traders use TA, most academics, until recently, had not recognized the validity of these methods. They prefer the much more theoretical fundamental analysis (Tian et al., 2002). This negative view of TA by academia, perhaps best typified by Malkiel (1985), Obviously, I am biased against the chartist. This is not only a personal predilection but a professional one as well. TA is anathema to the academic world (p. 132). But there are also some that are more charitable toward TA, Campbell et al. (1997) suggest perhaps some of the prejudice against TA can be attributed to semantics (Roberts, 2005) and among the rich literature that exists on whether TA is actually profitable (Roberts, 2005) a fairly comprehensive literature in various financial domains has addressed numerous effective evidences that trading success can be achieved with TA (Wang and Chan, 2007). Meanwhile it is worthy of mentioning that more recently, there has been a renewal of academic interest in the performance of TA based methods (Blanchet-Scalliet et al., 2007). In other words after many years of being held in almost complete contempt by academics, TA has enjoyed somewhat of a renaissance recently in the eyes of both practitioners and financial econometricians (Mills, 1997). Generally TA remains very popular despite a lack of theoretical foundation and has been used by professional investors for more than a century (Blanchet-Scalliet et al., 2007). Brorsen and Irwin (1987) report that only 2 of 21 large commodity fund managers surveyed used no objective TA. To be more precise in reviewing the literature of TA, it is to be noted that results obtained in the 1960s and 1970s supported the impracticability of applying TA for prediction of future. For example Alexander (1964) and Fama and Blume (1966) identifying and testing some simple technical strategies found that although they may have some predictive power, they were unable to consistently generate positive profits. Benington and Jensen (1970) conclude that TA is not useful. Over the succeeding decades, many researchers reached similar conclusions, especially when transactions costs were included in the analysis. But TA literature also owns some famous supporting studies during these decades. For example according to what cited by Wang and Chan (2007) and Levy (1967) employed the TA of relative strength. Appearance of some evidences like well-known anomalies on one hand and promising results of Brock et al. (1992) on the other hand indicated that historical prices can help in predicting future prices. Pruitt and White (1988) developed the CRISMA trading system which combined trading rules of on balance volume, relative strength and moving average and confirmed the profitability of technical trading rules. Sweeney (1988), Allen and Taylor (1990) and Taylor and Allen (1992) found that trading rules can outperform statistical models in predicting exchange rates and stock prices. Neftci (1991) unfolded the fact that technical trading rules require some form of nonlinearity in prices to be successful and nonlinearity is being increasingly found in financial time series. Brock et al. (1992), followed by Bessembinder and Chan (1995) and Ratner and Leal (1999) demonstrated the profitability of simple trading rules, moving average and trading range break out. Indeed Brock et al. (1992) after applying 26 trading rules to the Dow Jones Industrial Average found that they significantly out-perform a benchmark of holding cash. Based on this same universe of 26 trading rules, Bessembinder and Chan (1995) argued that although the technical trading rules do have predictive ability in US data, their use would not allow investors to make excess returns in the presence of costly trading. Sharpe et al. (1995) summarized some observations regarding the recent evidence in TA, stating the apparent success of these strategies offers a challenge to those who contend that the stock market is highly efficient. Sullivan et al. (1999) examine close to 8000 technical trading rules and repeat Brock et al. (1992) studied while correcting it for data snooping problems. They find that the examined trading rules do not generate superior performance out-of-sample. Hudson et al. (1996) showed that moving average trading rules can be utilized for USA and UK markets. Mills (1997) investigated the predictive ability of technical trading rules of moving average oscillator and trading range break-out by analyzing daily data on the London Stock Exchange FT30 index for the period 1935-1994. It is found that the trading rules worked, in the sense of producing a return greater than a buy-and-hold strategy, for most of the sample period, at least up to the early 1980s while Gunasekarage and Power (2001) showed that technical trading rules have predictive ability in South Asian stock markets. Academic study of TA has mainly adopted quantitative indicators as prediction variables, for example relative strength index, moving average and so on. Meanwhile, charting pattern, for example head-and-shoulder, flag, etc. are comparatively rare. Nevertheless, complying with the development of computer technology and cross-domain research, academic study has gradually paid increasing attention to pattern analysis for investment decision, including Lo et al. (2000) testing price charting patterns using kernel regression for the identification of ten patterns. Based on specific technical indicators such as head-and-shoulder or double-bottoms this study found that over the 31-year sample period, several technical indicators provide incremental information and may be useful. However, as pointed out by Jegadeesh (2000) in its comment of the Lo et al. (2000) paper, none of the TA indicators examined by the authors is able to identify profitable investment opportunities. Leigh et al. (2002a) implemented a variation of the bull flag charting pattern using a template matching technique from pattern recognition. The results of this study support the effectiveness of the TA approach through use of the >bull flag= price and volume pattern heuristic. Leigh et al. (2002b) and (2004) extended the method of Leigh et al. (2002a) to test a bull flag volume pattern for trading the NYSE Composite Index for the period of the Great Bull Market of the 1980s and 1990s. Tian et al. (2002) concentrate on markets with different efficiency level and they find that the trading rules are quite successful in predicting stock price movements in Chinese markets and allowing traders make possible excess profits in 1990s while the results in US. during the same period is disappointing. Ausloos and Ivanova (2002) present a generalization of the classical TA concepts taking into account the volume of transactions. Dourra and Siy (2002) propose a new method to map TA indicators into new inputs that can be fed into a fuzzy logic system. This method relies on fuzzy logic to formulate a decision making when certain price movements or certain price formations occur. The new stock evaluation method is proven to exceed market performance and it can be an excellent tool in the TA field. Cesari and Cremonini (2003) make an extensive simulation comparison of 9 popular dynamic strategies of asset allocation, including 2 of benchmarking type, 5 of portfolio insurance and 2 of TA. Both the historical and the Monte Carlo simulations show that no strategy is dominant in all market situations. Roberts (2005) develops some trading rules by genetic programming. The results of this study do not preclude the existence of profitable technical trading strategies. Wang and Chan (2007) examine the potential profit of bull flag technical trading rules for the Nasdaq Composite Index (NASDAQ) and Taiwan Weighted Index (TWI). The empirical results indicated that all of the TA rules correctly predict the direction of changes in the NASDAQ and TWI. Blanchet-Scalliet et al. (2007) examine chartist and mathematical models based trading strategies by providing a conceptual framework where their performance can be compared. According to Monte Carlo numerical experiments, the results show that under parameter mis-specification, the TA technique out-performs the optimal allocation strategy. There are also many other studies in field of TA that can not be referred completely here. But the already mentioned works are supposed to be enough in showing the general attitude toward TA from the beginning until now. Reliability: Based on the literature, it is not possible to state firmly about validity or good organization of TA. That is, still soundness of TA has not been proved explicitly and there are many people who suspect its outputs. However, usage of TA in financial models can be justified logically according to the following reasons: THE CHALLENGES AND TA The ability of TA based models in addressing the three challenges mentioned in part 1 is discussed in the three following sub-parts. Psychology: Markets are influenced at times by emotionalism of stock traders. As John Manyard Keynes stated, there is nothing as disastrous as a rational investment policy in an irrational world (Nison, 1991). Generally the intention from market psychology is mass psychology. For example mass psychology is a support to money applicability in market. Why is money, with no inherent worth, exchanged for something real like material? It is because of a shared psychology. Everyone believes it will be received, so it is. One time this shared or mass psychology disappears it becomes worthless. According to the above definition of mass psychology and intangibility of it mathematical approach can not encompass the factor and a review on literature of Robust Optimization, Markov chain, Multi Objective Decision Making (MODM), Possibility and Fuzzy theory or Minimax modeling of portfolio optimization, proves this. Fundamental analysis also only provides a gauge of price/earnings ratios, economic statistics and so forth and there is no psychological component involved in such analysis (Nison, 1991). But TA is capable of providing a good mechanism to measure the irrational or emotional components that are present in all markets (Nison, 1991), because securities never sell for what they are worth but for what people think they are worth (Dourra and Siy, 2002) and TA is the only mechanism that without paying attention to real worth of securities, merely considers price and volume of past transactions. TA shows that how much the market practitioners are going to value a particular stock because of the equilibrium that TA maintains among human, politic and economic events simultaneously (Chavarnakul and Enke, 2008). Since the basis of TA for giving signals is mass psychology of the market, if the result of a portfolio model is affected by outcomes of a TA processor, naturally the model would be an emotional one and the designated intensity of the influence (of TA on the final outputs) determines how much emotional it is. Simplifying assumptions: TA as an investment strategy is free of any limiting constraints that are common in present portfolio models especially mathematical ones. For example TA is independent of the distribution that the input data have. Flexibility: Flexibility of a model can be analyzed from three perspectives of That is, a flexible model is the one that on one hand its input data are updated rapidly and also the new input data affect the output significantly and on the other hand the model is independent of outer conditions. For example consider two models of A and B that are similar in the first two perspectives but according to the third one Model B is looser than A in the way that Model A only accepts data with normal distribution. Apparently Model B is more flexible because of its robustness in front of data distribution. According to the first perspective there is no difference between different approaches and this factor depends more on the established information support system. About the second perspective since the input data of TA techniques are usually from short time intervals the sensitivity of them to new data are much more than the portfolio selection models that their input data are from time intervals of several months. At last about the third perspective as was discussed in sub-part 3.2, TA is the most ideal one. It can be seen that the current state of TA without any extra contribution is a completely appropriate option to fill the mentioned shortcomings of the literature. But the questions that may arise are those, what would be the structure of TA based portfolio optimization (TAbPO) models? Or how can a model learn one or several TA rules? And so forth. The next part of the paper answers such questions. GENERAL STRUCTURE OF TAbPO MODELS The models of this family are modular ones in which one module or more are allocated to TA. The TA module/s can be parallel or along other modules but the main point here is the effect of TA module on the final output that can have any intensity. A typical TAbPO model (that is discussed in detail in Jasemi et al. (2011a) and Jasemi and Kimiagari (2011)) is depicted in Fig. 1. In the model of Fig. 1 beside TA module, module 1 also contributes to the final proposed portfolio. Module 1 is a mechanism to yield some portfolios that are on the Efficient Frontier (EF). There is a large amount of works in literature about this module, for example Jasemi et al. (2010) discussed a better selection of risk measures for more reliable results. After feeding the necessary data to module 1 and TA module, an efficient frontier and some signals are achieved. These two groups of output are combined in module 3 to give the final proposed portfolio. It is to be noted that the model depicted in Fig. 1 is just an example for this family of models and thousands of other kinds can be innovated. As another example a typical TAbPO model can be a two module one. That is besides the TA module there is only one module that is allocated to mathematical modeling of stock market like Markowitz model. Here, a logical scenario would be that; TA module produces n signals from which a signals are buy ones. The a stocks that correspond to the a buying signals will compose the final portfolio and the role of mathematical module is determination of investment percentage in each of them. For development of the TA module, there is no limit on technique or indicator that is considered and the main point is its output signals to buy, sell or hold the corresponding stock. Naturally the better this system is designed, more reliable the results will be. The TA module can also be a combination of several techniques that their results are interpreted to one of the three mentioned signals according to a pre-specified rule. For instance Chenoweth et al. (1996) have discussed some of such rules. Artificial Intelligence (AI) is a familiar tool to achieve financial goals, for example Khan et al. (2007) and Senol and Ozturan (2008) are aimed to illustrate that neural network can be used for predicting the stock price behavior in terms of its direction. The TA module can be equipped with TA by means of AI. Performing TA in financial markets by using AI has been surveyed by some researchers with promising results. Lee and Jo (1999) develop an expert system of candlestick charting analysis to forecast the best timing of stock market. Fernandez-Rodriguez et al. (2000) study the applicability of a simple technical rule on the basis of neural networks. Yao and Tan (2000) present some documents for applicability of neural network models for prediction of exchange rate of currency. In this study, time series data and technical analyses like moving average to achieve movement principles of exchange rate of currency, are fed to a neural network. Leigh et al. (2002b) show the prospect for application of modern approach of hybrid methods for assessment of buying opportunities in stock market by TA and neural network. Lam (2004) studies the applicability of neural networks especially back propagation algorithm for integration of fundamental and TA for forecasting of financial performance. Chavarnakul and Enke (2008) used a neural network for performing equivolume charting technique. As a new work, Jasemi et al. (2011b) presents a model to do stock market timing on the basis of the TA of Japanese Candlestick and concept of Neural Networks with astonishing results. Actually any shape of AI including neural network, expert system, genetic algorithm and fuzzy theory can be used. CONCLUSION In this study after a preface about portfolio optimization problem, three significant challenges of the field have been discussed. Since the paper believes that the investment approach of TA is a superior option for responding to the challenges the remainder of the paper pays particular attention to this strategy of trading. This particular attention shows itself in a literature review, a justification of TA efficiency and lastly discussing how TA is capable of addressing the challenges. Finally the general structure of TAbPO models is discussed. All the four parts of the paper are developed in the way that convinces the scholars to combine TA with their models to improve the quality of outputs. The literature of portfolio management is full of models that have been developed by mathematical approach; so a good research area would be development of TA based mathematical portfolio models and analyzing the results in a wide range of conditions.

https://scialert.net/fulltext/?doi=ajie.2011.1.12&org=11#ref

The financial markets are guided by a multitude of factors ranging from economic to socio-political dynamics in participating countries. Another very important factor that drives the world markets is market sentiment; the psychological component of the markets. It accounts for a lot of unexplained phenomena in the global financial world. For example, why does a company’s stock plunge suddenly despite a healthy annual balance sheet or good dividend payouts? Why do the currency markets become volatile following the release of vital economic indicators? The overall attitude of traders or investors towards a particular financial asset or instrument is collectively termed as investor sentiment or market sentiment. Crowd psychology is reflected in the overall price activity of the financial asset. Rising currency prices point towards a bullish market sentiment, while falling prices reflect a bearish sentiment. How a group of investors feel towards a certain market or economy is governed by various factors. This includes inflation rates, unemployment figures, natural disasters, technological issues or other political factors, such as a lack of confidence in a country-specific government. A country, whose economic and geo-political developments signal towards a strong economy, will see its currency valuation soaring, as investors will have more confidence in it. Less favourable economic indicators, for example a weaker job market, will make traders wary of investing in the domestic currency. Day traders and technical analysts have developed tools to quantify investor sentiment. They use various sentiment indicators, along with technical indicators, to confirm trends and price levels. What is important to know is that market sentiment in itself cannot be a reliable indicator to make trading decisions; but only to confirm market movements. By observing changes in market sentiment, investors try to judge whether a market is likely to be bullish or bearish. In the forex market, price actions should ideally reflect all available information, but this is true only in theory. This “Efficient Market Hypothesis” doesn’t hold true in the real markets, which is where sentiment indicators find their uses. Short-term traders use these tools wisely to quickly get in and out of positions. Contrarian traders resort to them in order to take up positions on the opposite direction of the sentiment. Here are some tools that have been used by traders to gauge market sentiment. The American Association of Individual Investors survey is one of the oldest surveys, released online every Thursday. It measures the percentage of investors who are bearish, bullish or neutral on the stock market on a short-term basis. Individuals participate in these polls on the AAII website on a weekly basis. On January 31, 2019, the AAII short-term outlook for stocks revealed a very neutral outlook; the highest in six months. This report is released by the CFTC every Friday. It covers the commodity futures market and forex futures and options market. It offers information on what type of traders traded in the derivatives market, what positions they took (size of positions) and in which direction they took these positions over the course of one week. It is a vital market sentiment indicator for intermediate and long-term forex traders. The COT report further categorises different traders according to their trading discipline and gives an idea on how they fared in the current market scenario. There are several indicators that measure the overall degree of participation of traders in a financial market. The S&P 500 and DOW release such information for the benefit of traders. The advancing issues/declining issues ratio is a popular tool in this category. Stocks that reach higher prices than the previous day are advancing issues, while those that drop to lower prices are declining issues. The Volatility Index is another important breadth indicator. The volatility index tool is popularly used by forex traders to measure implied volatility. Volatility, as we know, is the amount of movement of prices from the mean position to either extremes. Higher the implied volatility, greater is the fear among traders regarding a market. VIX is also a popular contrarian indicator. Extremely high or low VIX values signal contrarian traders that it is the time to trade against the tide. For a forex trader, an accurate assessment of trade volumes in any currency pair is important to gauge market sentiment. The MT4 Accelerator Pack has its own Sentiment Monitor tool that can accurately predict market sentiment, based on open positions. The tool shows the number of traders who are long or short on an asset. The app also shows the historic sentiment plotted against price movement. From the dashboard, a trader can see market sentiment for a variety of currency pairs, all at once. Monitoring crowd behaviour is important in assessing the right points of entry and exit, irrespective of your trading style. The supply and demand ratios of various assets are always governed by psychology of market participants. However, it should be noted that these indicators mostly report on historical prices, so they don’t take into account any current market reversals. It is wise to have risk management tools at your disposal, to ensure protection against sudden market volatility.

https://www.blackwellglobal.com/how-is-investor-sentiment-calculated/

From 1980-2018, April has been the best month of the year for the stock market, with an average 1.52% gain in the S&P 500. However, September has been the worst month, with average returns of -0.70%. The average monthly S&P500 stock market returns from 1980 to 2019 were: January: +0.82%. February: +0.29%. March: +0.96%. April: +1.51%. May: +0.97%. Category: 1 year stock market chartShow more Stock Squirrelers.com Show details Stock Returns by Month: Interesting Historical Trends. Stock returns by month are not as variable and unpredictable as one might think, over the long run. Sure, performance from one month to the next can be quite different. Some months see prices increase, other months see prices decline. Yes, there are peaks and valleys that appear when you Category: Total stock market returns historicalShow more Historical Theancientbabylonians.com Show details Historical Monthly Stock Market Returns. Here is the visual bar chart of the S&P 500 historical monthly returns over the past 45 years. I don’t know why people say sell in May and go away. There is still some meat on the table until July. It seems to me that September is the worst month rather than May. And the thing about Santa rally and new Category: Historical graph of stock marketShow more Chart Macrotrends.net Show details 109 rows · Interactive chart of the Dow Jones Industrial Average (DJIA) stock market index for … Category: Stock market performance by monthShow more Historical Finance.yahoo.com Show details 102 rows · Get historical data for the S&P 500 (^GSPC) on Yahoo Finance. View and … Category: 2021 stock market performance chartShow more Annual Pages.stern.nyu.edu Show details Annual Returns on Investments in: Value of $100 invested at start of 1928 in: Annual Risk Premium : Annual Real Returns on: Year: S&P 500 (includes dividends) 3-month T.Bill: US T. Bond Baa Corporate Bond: S&P 500 (includes dividends)3: 3-month T.Bill4: US T. Bond5 Baa Corporate Bond6: Stocks - Bills: Stocks - Bonds Category: Stock MarketShow more Historical Macrotrends.net Show details Stock Market Cycles - Historical Chart. This interactive chart shows the percentage return of the Dow Jones Industrial Average over the three major secular market cycles of the last 100 years. The current price of the Dow Jones Industrial Average as of October 12, 2021 is 34,378.34. Download Historical Data. Category: Stock MarketShow more S&P Advisor.visualcapitalist.com Show details They collected price and dividend data for almost all stocks listed on the New York Stock Exchange during its early history. From 1926-1956, returns are from the S&P 90, the S&P 500’s predecessor. Finally, from 1957 to date, returns are based on the S&P 500. Here are historical stock market returns by year: Year. Total Return. Category: Stock MarketShow more Years Moneychimp.com Show details Monthly Market Returns - The January Effect, Etc. Do some months have significantly different stock market returns than others? This calculator uses sixty-odd years of S&P 500 data to let you see for yourself. Select a month; the calculator will show you its good and bad years and overall return, for the years from 1950 until recently. Category: Stock MarketShow more Monthly Businessstatistics.us Show details Monthly % Chg Jan 7.9 Feb 3.0 Mar 1.8 Apr 3.9 May -6.6 Jun 6.9 Jul 1.3 Aug -1.8 Sep 1.7 Oct 2.0 Nov 3.4 Dec 2.9 Dec S&P 500 INDEX PRICE (percent change, monthly) Source: Standard and Poor’s and Haver Analytics. yardeni.com Figure 3. Historical Returns Page 2 / January 6, 2020 / Stock Market Indicators: Historical Monthly & Annual Returns Category: Stock MarketShow more Historical Nasdaq.com Show details Historical data provides up to 10 years of daily historical stock prices and volumes for each stock. Historical price trends can indicate the future direction of a stock. Category: BlockchainShow more Statistics Newtraderu.com Show details Have you ever been curious if certain months of the year have any statistically significant stock market returns better or worse on average than other months. Here are the statistics for monthly S&P 500 index performance from … Category: Stock MarketShow more Stock Marketvolume.com Show details S&P 500 Historical Monthly Performance. S&P 500 returns are considered a measurement of the stock market performance. By tracking the performance of the indexes we may see the overall health of the stock market. Volume Charts. for Advanced Analysis. Investors are facing the specific events in certain periods of a year. Some example are. Category: Stock MarketShow more International Eresearch.fidelity.com Show details Chart Performance figures may vary slightly from 1 Year % Change due to different timeframes used in chart calculations. GICS is an industry classification system developed by Standard & Poor's in collaboration with Morgan Stanley Capital International (MSCI). S&P uses GICS to determine the market segment to which a company is assigned. Category: Stock MarketShow more Returns Financial-calculators.com Show details advertisement. You can use this Historical Investment Calculator to compare investment returns for multiple asset classes. The calculator includes historical price data for 14 popular indices with some prices going back over 100 years. The calculator will compare nominal returns or inflation-adjusted returns. Category: BlockchainShow more Representative Consciouscapitalwm.com Show details Past performance does not guarantee future results. The Dow Jones Industrial Average is an unmanaged index that is generally considered representative of large-capitalization companies on the U.S. stock market. The S&P 500 Composite Index is an unmanaged group of securities considered to be representative of the stock market in general. Category: BlockchainShow more Information Wsj.com Show details Market Data Center. News Corp is a global, diversified media and information services company focused on creating and distributing authoritative and … Category: BlockchainShow more S&P Barchart.com Show details The Stock Market & Sector Performance page gives you a quick glance at the overall state of the U.S. market segments. A 1-year chart of the S&P 500 Index, showing percent comparisons against the 11 S&P Sectors is shown at the top of the page. Use the check boxes to show or hide certain sectors. Category: Stock MarketShow more Business Bloombergquint.com Show details Bloomberg Quint is a multiplatform, Indian business and financial news company. We combine Bloomberg’s global leadership in business and financial news and data, with Quintillion Media’s deep expertise in the Indian market and digital news delivery, to provide high quality business news, insights and trends for India’s sophisticated audiences. Category: BlockchainShow more Stock Stockpickssystem.com Show details The rate of historical returns needs to include dividend distributions in order to get an accurate measure of the total return one would have gotten from investing in the stock market. During the 20th century, the stock market returned an average of 10.4% a year. Just $1,000 invested in 1900 would be worth over $19.8 million by the end of 1999. Category: Stock MarketShow more Stock Intomillion.com Show details Stock market news live updates: Dow gains 250+ points, or 0.8%, to end 5-session losing streak - Yahoo Finance. U.S. stocks end lower, with Dow down nearly 300 points as lift from inflation reprieve fades - MarketWatch. Invesco, Lucid, Diamondback: What to Watch When the Stock Market Opens Today - The Wall Street Journal. Category: BlockchainShow more Quotes Investopedia.com Show details Stock price quotes were once hard to find for ordinary investors, and real-time data came with a hefty price tag. Today, however, several online services provide free real-time quotes for public Category: Stock MarketShow more Charts Stockcharts.com Show details These charts show long-term historical trends for commonly followed US market indexes. These charts are updated every Friday evening. Members can click on these charts to see live versions - PRO members will see complete versions while other … Category: Stock MarketShow more Historical Forecast-chart.com Show details Standard & Poor's 500 Stock Index - 17 Year Graph with annual returns table. Includes month, year, 5 year and 10 year historical performance ranking relative to global, foreign, U.S. Small Cap, Medium Cap and Large Cap stock market indexes. Category: Stock MarketShow more S&P Ycharts.com Show details S&P 500 12 Month Total Return is at 30.00%, compared to 21.58% last month and 15.15% last year. This is higher than the long term average of 8.64%. Report. S&P 500 Returns. Category: BlockchainShow more Stock Econ.yale.edu Show details Stock market data used in my book, Irrational Exuberance [Princeton University Press 2000, Broadway Books 2001, 2nd ed., 2005] are available for download, U.S. Stock Markets 1871-Present and CAPE Ratio. This data set consists of monthly stock price, dividends, and earnings data and the consumer price index (to allow conversion to real values Category: BlockchainShow more S&P Nasdaq.com Show details S&P 500 (SPX) Historical data - Nasdaq offers historical quotes & market activity data for US and global markets. Category: BlockchainShow more Return Tradingninvestment.com Show details Djia’s yearly performance is the indicator of US stock market performance and considered as proxy of US stock market yearly historical return. Investors’ average return from Dow is 7.75 percent. However, Investors can make 17.82 percent return by holding them only in positive return years. Category: Stock MarketShow more (SET50) Tradingeconomics.com Show details The SET 50 increased 77 points or 8.46% since the beginning of 2021, according to trading on a contract for difference (CFD) that tracks this benchmark index from Thailand. Historically, the Thailand Stock Market (SET50) reached an all time high of 1223.67 in February of 2018. Category: Stock MarketShow more Stock Finance.zacks.com Show details Stock Market Monthly Trends. By: Geri Terzo . October is one of the worst months for stock market performance on record, second only to September. Nonetheless, nearly half … Category: Stock MarketShow more Quotes Barchart.com Show details With Weekly Quotes or Monthly Quotes selected, you will see dates that correspond to the past 5 weeks or past 5 months along with the Open, High, Low, Last, Change, Change Percent, and Volume of each period. Price Performance. Shows historical Highs and Lows for a number of periods, based on your selected view. Category: Stock MarketShow more Monthly Statista.com Show details Coronavirus impact on stock market South Korea 2021 Monthly performance of the S&P BSE Sensex Index in India 2017-2021 Monthly … Category: BlockchainShow more Returns People.stern.nyu.edu Show details Title: Historical Returns Author: Aswath Damodaran Last modified by: Microsoft Office User Created Date: 2/15/1999 4:07:18 PM Other titles: Explanations and FAQ Returns by year S&P 500 & Raw Data T. Bond yield & return T. Bill rates Inflation Rate Summary for ppt Home Prices (Raw Data) Moody's Rates Sheet9 Sheet10 Sheet11 Sheet12 Sheet13 Sheet14 Sheet15 … Category: BlockchainShow more Index Tradingeconomics.com Show details The S&P/ASX 200 is the most important stock market index which tracks the performance of 200 large companies based in Australia. It is a market-capitalization weighted and float-adjusted index. The index has a base value of AUD3133.3, equal to the value of the All Ordinary Shares as of March 31, 2000. Category: Stock Market, Us DollarShow more S&P Novelinvestor.com Show details S&P 500 Index. 9.88%. 32.4%. -37.0%. Past performance does not guarantee future returns. The historical performance is meant to show changes in market trends across the different S&P 500 sectors over the past ten years. Returns represent total annual returns (reinvestment of all distributions) and does not include fees and expenses. Category: BlockchainShow more About Lpl.com Show details The 10-year Treasury yield continues to climb higher, but remains low by historical standards. Still, the size of the move since July 2020—and the more recent acceleration—has some market participants worried about the potential impact on stock markets if rates continue to rise. Category: Stock MarketShow more Trading Bseindia.com Show details 30 Most Active Securities of the Month. Historical Bhav Copy. Bulk Deals (All Market /Security & Period) Block Deals (All Market /Security & Period) Margin Trading (By Date, Security & Period) Odd Lot Trading (Historical) Illiquid Securities. Mode of Trading (Monthly Report) Category: Stock MarketShow more Vanguard Lazyportfolioetf.com Show details Vanguard Total Stock Market (VTI): Historical Returns. In the last 10 years, the Vanguard Total Stock Market (VTI) ETF obtained a 16.21% compound annual return, with a 13.83% standard deviation. In the last 20 years, a 9.8% compound annual return, with a 15.10% standard deviation. In 2020, the portfolio granted a 1.71% dividend yield. Category: Stock MarketShow more The worst month of the year for stocks is September. On average, the best months of the year for stocks are November through April. The worst months are May through October. According to historical records, the average annual return since its inception in 1926 through 2018 is approximately 10%. The average annual return since adopting 500 stocks into the index in 1957 through 2018 is roughly 8% (7.96%). One of the major problems for an investor hoping to regularly recreate that 10% average return is inflation. The historical rate of return for the stock market is approximately 12 percent per year. This is the rate of return that is usually taken as a benchmark when it comes to planning funding for pension, retirement and decisions related to investment and savings. How to Calculate Expected Return of a Stock. To calculate the ERR, you first add 1 to the decimal equivalent of the expected growth rate (R) and then multiply that result by the current dividend per share (DPS) to arrive at the future dividend per share. You then divide the future dividend by the current price per share...

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- What Are The Advantages And Disadvantages Of Using Fundamental Analysis? - A Brief Overview Of The Conceptual Foundation Of Technical Analysis - You Are Unable To Access Bitcoin Tax - Moving Averages Fundamental analysis also takes into account an asset’s overall impact on the economy, or the political issues facing the region in which the asset is derived. Fundamental analysis tells analysts if an asset is viable in the long term in the overall financial world, while technical analysis is used to understand short- and long-term price movements. One of the most helpful tools a trader can use when performing technical analysis is to watch for certain patterns to appear on price charts before taking a position. Using trend lines, technical analysis can draw triangles and other geometric shapes on price charts. Technical analysis gains popularity among those who believe the financial statements may not all information about a company. On the other hand, they feel that the price resembles all the relevant information. Thus, the assumption that markets become more efficient over time was supported, even when the automated trading system included transaction costs. This result was linked to the fact that the Brazilian stock market, the second oldest within the sample, generated one of the lowest average returns. This evidence suggests that the markets become more efficient as time goes by, implying that for older stock markets, historical prices may contain less information that can be used to generate above-average returns. However, since there is not a definitive a priori hypothesis that links stock market age and market efficiency, the outcome of the study cannot support this relationship decisively. The basic principle of technical analysis is that patterns related to past prices of instruments traded in the asset markets can be used to predict the direction of future prices. The objective is to enhance the return of an investment portfolio by understanding the interaction of price indicators for the portfolio’s holdings over an identified time period. - One of the most important aspects of trading is finding the right platform to trade on. - Japanese candlesticks were introduced to assist technical analysts and traders in getting tipped off of upcoming price movements. - According to Table 4, a tiny group of assets surpassed the buy and hold returns using the automated trading system. - If resistance at $1792 can be breached, by measuring the pattern, a target of $2637 can be expected. - Table3 shows the average returns per country when buy and hold was implemented. - For the South African market, one of the most consolidated of the samples, the most attractive returns were stable. - MJSS, DGFR and MGP conducted the study and the results were discussed initially with VAS and HK. The data available in Table 2 supports Table4, which shows the proportion of assets in each country that surpassed the average buy and hold return for the same country. Investors and traders typically use moving averages not only to find levels that may act as support or resistance but to understand if a trend in an asset class is changing. Technical analysis is one of the most important tools in any trader’s arsenal and can help predict the direction and even level at which a price will move, trend changes, and much more. Examination Of The Profitability Of Technical Analysis Based On Moving Average Strategies In Brics MJSS, DGFR and MGP conducted the study and the results were discussed initially with VAS and HK. We elaborated and compiled the algorithm in the R software, which allowed handling a large mass of data in an uncomplicated way. In general, the execution flow of the automated trading system can be summarized by the pseudo–code presented in Algorithm 1. This website is using a security service to protect itself from online attacks. There are several actions that could trigger this block including submitting a certain word or phrase, a SQL command or malformed data. You are solely responsible for withholding, collecting, reporting, paying, settling and/or remitting any and all taxes to the appropriate tax authorities in such jurisdiction in which You may be liable to pay tax. Logitech: Undervalued With Opportunity (Technical Analysis) – Seeking Alpha Logitech: Undervalued With Opportunity (Technical Analysis). Posted: Fri, 30 Sep 2022 17:38:00 GMT [source] The process of fundamental analysis may involve assessing the economics of a country, potential growth of industry and competitiveness of a company. Analysts spend much of their time reading financial statements to evaluate if it is worth investing in a particular company. Unlike smaller setups, all public listed companies must engage auditors to audit their financial statements. Therefore, one of the main advantages of using fundamental analysis is it relies on a reliable source of information. Table3 shows the average returns per country when buy and hold was implemented. In short, we applied the buy and hold strategy for each asset of the same country, and we extracted the average profitability of the operations for each country. Another area for future research is analysis of the role played by small cap assets in the performance of moving average strategies in emerging markets. Our findings indicated further that even though the sample countries are classified as emerging, and they are part of the same economic group, their respective stock markets are not necessarily close to each other in terms of their behavior. This conclusion is based on the difficulty identifying a single combination of moving averages common to all the countries analyzed that could generate a consistent return. Technical analysis varies greatly from fundamental analysis, but both are extremely important and helpful tools for traders to use when considering investing or taking a trade position in any financial asset. Fractals are repeating https://xcritical.com/ patterns that play out on price charts, oftentimes on increasingly lower timeframes. Fractals add validity and credence to the idea that markets are cyclical, and each cycle is a direct impact of the emotional state of traders. Gold Market, Peter Brand These sort of trader can often lead to a streak of losses, as the trader seeks to recoup losses. Support is a level on price charts in which price has typically rebounded from in the past and could provide yet another bounce if the price gets there and buyers step in. These factors will cause the price of an asset to rise or fall, depending on how the market participants react to certain events and changes in the overall market landscape. Price action is driven by a variety of factors, such as the basic balance between supply and demand, the emotional state of traders, news, rumors, and more, as well as external actors such as politics, weather, and others. Technical analysis can be performed on any type of asset, traditional, such as commodities, forex, stock indices, and more, as well as digital assets such as Bitcoin and other cryptocurrencies. Based on this study, we can point out strategies that result in above-average profitability, raising questions about the EMH in emerging markets. A question that remains to be answered, however, is why some combinations of moving averages perform better than others. For example, in South Africa the most profitable short-term MAs belonged to a very specific range. PrimeXBT shall not be responsible for withholding, collecting, reporting, paying, settling and/or remitting any taxes which may arise from Your participation in the trading with margin. Additional aspects such as customer support, reputation, and privacy should also be considered. History Of Technical Analysis As described by Booth et al. (2014, p. 3651), automated trading systems perform trades autonomously, identifying investment opportunities based on artificial intelligence methods. The procedures that define the strategy used to generate trading signals can vary substantially. Technical indicators have found wide spread use for this purpose as a result of their extensive application by market practitioners. Buy and hold is a long-term investment approach in which the investor creates a portfolio of assets, and sells only when the valuation of the assets is considered satisfactory, providing above-market average returns. For this research, we used an automated trading system that simulated the transactions based on patterns verified by the data and related to the signals of the moving averages over the prices of the assets. We prepared a comprehensive portfolio for each country, containing all the assets traded in the markets of each BRICS member. For South Africa, China, and India, we included the asset prices from 2000 to 2016. Initial capital transactions were carried out as the model issued buy and sell signals from the interaction of the series of moving averages over prices. Moreover, the authors suggested that the degree of market efficiency falls during periods of crisis, as during the financial crisis of 2008. Whereas technical analysis involves charts, trendlines, and timeframes, fundamental analysis typically starts with a financial statement and takes a long-term approach to analyzing an asset’s potential performance. The information provided does not constitute, in any way, a solicitation or inducement to buy or sell cryptocurrencies, derivatives, foreign exchange products, CFDs, securities, and similar products. Comments and analysis reflect the views of different external and internal analysts at any given time and are subject to change at any time. A dramatic news event, a major disruption to supply and demand, and other factors often suggest a trend change is possible. Technical analysis was first introduced by Charles Dow in the 1800s, and the most prominent stock index, the Dow Jones Industrial, is named after the man who popularized the discipline. Since Dow, several important figures have since contributed to the study and designed a number of tools, indicators, theories, and practices. Interested in learning about technical analysis and want to know just how accurate is technical analysis? This detailed guide will explain all the ins and outs of technical analysis to get a new trader started, as well as advanced methods to improve an experienced trader’s chances of success in the world of finance. These results indicated that similar characteristics did not lead to a single winning strategy. For our research, we constructed a portfolio composed of a wide number of holdings. This approach allowed us to verify the average profitability gained through technical analysis for all assets traded in the stock market for each BRICS member country. Given these conditions, we considered an investor who was investing US$10,000.00 in each asset of the country, converted at the exchange rate on June 24, 2016. Shynkevich concluded that the profitability of technical analysis for portfolios holding small cap assets with less liquidity was greater than for portfolios holding large cap companies from the technology area. For this reason, it is especially relevant to analyze the returns of classic technical indicators for emerging markets where more small caps are expected, possibly because of policies used to stimulate industrial activity. What Are The Advantages And Disadvantages Of Using Fundamental Analysis? Moreover, they can not constitute a commitment or guarantee on the part of PrimeXBT. The recipient acknowledges and agrees that by their very nature any investment in a financial instrument is of a random nature and therefore any such investment constitutes a risky investment for which the recipient is solely responsible. It is specified that the past performance of a financial product does not prejudge in any way their future performance. The foreign exchange market and derivatives such as CFDs , Non-Deliverable Bitcoin Settled Products and Short-Term Bitcoin Settled Contracts involve a high degree of risk. The latter included the specification of the moving average type, the range of each MA, and the initial capital to be applied. Our study aimed to update results from Chong et al. by using more recent data and adding South Africa to the analysis, the latest member to be included in the BRICS countries. Indicators include the Relative Strength Index , the Moving Average Convergence Divergence , and the Average Directional Index , among others. These indicators seek to estimate patterns of future behavior and predict buy and sell opportunities solely from the previously verified pricing of assets. More specifically, Vandewalle et al. (1999, pp. 170–172) defined moving averages as transformations of a price series that allow us to identify trends from data smoothing. For data regarding the United States of America , Alexander , Brock et al. , and Fama and Blume found that if the transaction costs were not zero, the profitability gained by applying technical analysis was not significant. In comparison, Kuang et al. achieved an average annual return of approximately 30% for emerging countries’ stock markets. However, they considered that this profitability was not accurate, since it was the result of problems arising from prior manipulation of the data to discover The Differences Between Fundamental and Technical Analysis ex-ante patterns. Ellis and Parbery highlighted the use of moving averages for the generation of buy and sell signals as a mechanism to identify price trends. While the short-term moving average is more sensitive to price changes, longer term moving averages capture medium- and long-term trends. Investors in the stock exchanges utilize technical analysis extensively, and moving averages are the most commonly used indicators because they are simple to understand and relatively easy to use. A Brief Overview Of The Conceptual Foundation Of Technical Analysis There have been few experimental tests of the profitability of the TA indicators across the typical market structures of emerging countries. In particular, further work is needed regarding the BRICS member nations, a special subgroup composed of Brazil, Russia, India, China, and South Africa. Recently, studies were carried out on isolated emerging markets that are not similar to each other, including contributions by Chang et al. , Kuang et al. , Mitra , and Mobarek et al. . However, none of these studies proposed a comparison of the results for groups of similar countries, so they failed to answer whether TA is profitable for emerging markets as a whole. Stockstotrade.com needs to review the security of your connection before proceeding. PrimeXBT Trading Services LLC is incorporated in St. Vincent and the Grenadines as an operating subsidiary within the PrimeXBT group of companies. PrimeXBT Trading Services LLC is not required to hold any financial services license or authorization in St. Vincent and the Grenadines to offer its products and services. These trendlines also represent helpful guides for where a trader or investor may be interested in opening or exiting a position to maximize gain and minimize risk. It contains information such as the high, low, opening and closing price of various time frames. One main drawback of technical analysis is that it takes a long time to master. Most traders would have given up before they reach the level of mastery required. For example, if you would like to invest in equity using cash, adopting fundamental analysis will give a much higher chance of success than using technical analysis. On the other hand, if you prefer to trade a commodity using futures, technical analysis will likely be a much better option. You Are Unable To Access Bitcoin Tax According to Stanković et al. , TA is a way of detecting trends in asset prices based on the premise that the price series moves according to investors’ perceived standards. Their study demonstrated that the duration of these standards is sufficient for the investor to make above-average profits, even if the investments incur transaction costs. Based on this context, the objective of this paper was to investigate the profitability of moving average trading strategies in the stock markets of BRICS countries. Concerning the influence of technical analysis on fundamental analysis, Almujamed et al. (2013, pp. 57–58) studied data for Kuwait. They concluded that investors check a firm’s profitability before looking at the stock chart movements and stock price trends of the company. Furthermore, they asserted that fundamental analysis that uses a more recent series of prices, usually within five years, is employed more commonly by investors in developed markets, while emerging markets are considered inefficient. If an asset trades within one of these patterns, detailed statistical analysis has been performed that suggests certain patterns will break in one direction over another, providing traders who spot such patterns an advantage in the market. Oftentimes, an asset will break down or up, but volume doesn’t follow, suggesting buyers or sellers are hesitant and uncomfortable with taking an actionable position. However, if the same movement occurs with strong volume, chances are that much higher for the move to be valid, and not result in a fakeout. Trendlines often rise and fall, and represent diagonal support or resistance. Horizontal resistance or support are often prices that represent a historic level or are a significant rounded number. A trend line typically is required to have multiple touches to be considered valid, and traders are recommended to watch for a break and close above or below trend lines, before taking any action. For the three categories of MA crossovers, and for all simulated types of cost, the short-term MA crossover at the interval [37; 40] with the long-term MA of the range [116; 120] proved to be profitable in all simulations. Thus, more efficient markets showed more conservative, but more stable, returns. In addition to volume, other helpful indicators have been developed to add to a trader’s arsenal and offer even more changes to determine future price movements before they occur. You have now understood the importance of choosing the right strategy to enter the financial market. Also, the simulations were carried out considering an application of US$10,000.00 in local currency quoted on June 24, 2016 to normalize the investment from the perspective of an external investor. Price Considers Everything These emotions lead to repeating patterns on price charts, that if spotted well enough in advance, can tip a trader off as to how the price action may unfold. Everything from an explanation of trendlines, candlesticks, chart patterns, and more are included, as well as a comparison between fundamental and technical analysis that should remove any lingering confusion. Due to its ability to “time the market,” technical analysis is commonly used for trading purpose.

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Usually, tourists visit the hilly regions to escape the summer heat. Himachal Pradesh is one of the tourist destinations which attracts thousands of tourists every year. It is mostly known as a summer destination and people also consider visiting Himachal Pradesh during the summers. Also, the peak ‘tourist season’ for Himachal Pradesh is during the summer months. Winters in Himachal Pradesh is a different story considering the view of the landscape. During the winters, people love to witness the snowfall which is still quite exciting for people coming from the cities. The summer months are quite harsh on the city-dwellers and most of the people travel during the summer season to the hill-stations of North India. December is the start of the snowfall which attracts people from all over India. If you are planning to visit Himachal Pradesh during the winter, then you can easily book your Himachal tour in December by any travel agency of your choice. The winter scene in Himachal Pradesh offers the majestic view of the snow-capped mountains, glaciers, frozen lakes along with many winter sports activities. In some parts of Himachal, you can also engage in various winter sports like Skiing, Skating, and snowboarding, etc. December is also a great time for honeymoon couples to go on their vacations. Considering that most weddings in India happen during the last months of the year, Himachal Pradesh offers some of the best places to visit in Himachal Pradesh in December. We have created a list of some great tourist destinations you can visit in the winter months. December being the beginning of the ‘real’ winter season, the places mentioned in the list are particularly best suited for December. So, let's start with the list. This list is made considering the needs of all tourists. 7 Best Tourist Places In Himachal Pradesh In December 1. Manali Mountains of Manali, Himachal (image source: Wikimedia Commons) Manali is on top of your list because of its sheer popularity among tourists. Every year, tourists flock to this picturesque hill station to witness the snow that is visible all through the year. However, particularly during the winter season starting from December, tourists visit Manali to witness the snowfall. Manali is situated at a height of around 6200 feet above sea level. The natural beauty of Manali is something that leaves everyone mesmerized. The beautiful valleys, apple orchards, and snow-covered peaks can bring a sense of tranquility which is quite hard to find in the cities. Manali is a versatile destination that is great for all tourist needs. Family groups, honeymoon couples, backpackers, and adventure enthusiasts can all find enough tourist activities to enjoy in Manali. The Winter season in Manali is a great time to witness the majesty of the Himalayas. Along with the scenic views, you can enjoy sightseeing and delicious foods available for you to enjoy. Without a doubt, Manali is an essential destination that is included in all popular Himachal travel packages. If you are planning to visit Manali in the winter, then December is probably the best month to see the grandeur of Manali. You can expect around 10 degrees Celsius as an average temperature in Manali. Tourist attractions: Rohtang Pass, Hidimba Temple, Solang valley, adventure sports, and sightseeing. Suggested Read: Soul Relaxing Places To Visit In Kullu Manali 2. Shimla The Ridge, Shimla, Himachal (image source: Wikimedia Commons) Shimla is second on our list because of its status as ‘Queen of the Hills’. Shimla is one of the favorite destinations for Indian tourists. Every summer, Shimla is packed with tourists and sometimes the highways get overcrowded because of the sheer flow of the incoming tourists. Shimla during the winter season is great for people who want to see the snow and enjoy the panoramic view of snow-covered mountains. December is the month when tourists start to flock to Shimla. Most of the tourists are couples on their honeymoon. After Manali, Shimla is one of the most visited hill stations in India. With amazing sightseeing options, delicious food, cultural events, winter sports, and adventure activities make Shimla is one of the best places to visit in Himachal Pradesh during December. You can expect an average temperature of 12 degrees Celsius during December. Families on their vacation are also among many who visit Shimla in December. Children particularly enjoy playing with the snow and enjoy many activities. Nature lovers and adventure seekers will find Shimla as an ideal vacation destination. The scenes of colonial buildings with the background of the mountain range and many sightseeing options will leave you mesmerized by this town. Tourist attractions: Kalka-Shimla train ride, Ice-skating, Skiing, adventure sports, and sightseeing. Suggested Read: Places A Trip To Manali 3. Spiti Valley Kee Monastery, Spiti, Himachal (image source: Wikimedia Commons) The wild and rugged landscape of Spiti is a scene straight out of an adventure movie. Spiti valley attracts hundreds of motorcyclists and solo travelers every year. The rainfall that you can witness in Spiti is during the winter months where it rains snowballs instead of regular rain. The Winter season is quite a popular time among the adventure junkies to travel to Spiti. Backpackers and solo travelers find Spiti as a great destination to relax and be away from all the crowded hill stations. Spiti has many beautiful monasteries to visit along with lakes and trekking trails that are worth visiting at least once in your life. Spiti Valley is a cold desert that might not be an exciting place to spend your vacation as a family. However, it is a great destination if you are willing to experience the raw beauty of this desert. December is a great time to visit Spiti as many of the important highways and passes are open for tourists. If you are planning to go on extreme trekking adventures including the trek to the beautiful Chandratal Lake, then Spiti will give you the challenge your spirit needs. Spiti is among the best destinations in Himachal Pradesh for tourists from all over the world. With the tranquil atmosphere and the spiritual vibe of the monasteries along the vast expanse as a background, Spiti will bring the feel of being nomadic in ancient times. Tourist attractions: Dhankar Monastery, Trekking, Chandratal Lake, and Camping Suggested Read: River Rafting In Himachal Pradesh 4. Dharamshala Dhauladhar mountain range, Dharamshala, Himachal (image source: Wikimedia Commons) Dharamshala is also known as ‘Dharamsala’ is a popular destination for both international and domestic tourists. The main reason for its popularity is the fact that His Holiness Dalai Lama is living here. The exiled Tibetan spiritual leader made this town popular among the international travel community. If you are planning a trip to Himachal in December, then Dharamshala is a great place to visit. Dharamshala is located in the district of Kangra in Himachal Pradesh. Some of the most popular places in Dharamshala are Mcleodganj, Dharamkot, and Bhagsu. These three towns see the most number of tourists every year. During the winter months, Dharamshala has a very laid-back vibe where you can simply relax and enjoy nature. There are many cafés and restaurants where you can enjoy multi-cultural cuisine. You can find many local musicians and concerts being held at different places. In a nutshell, you can enjoy many activities which can make your vacation to Dharamshala a memorable experience. Tourist attractions: Trekking, Dal Lake, Tibetan monasteries, Mcleodganj, Dharamkot, Bhagsu waterfall. Suggested Read: Valleys in Himachal Pradesh 5. Barot Barot valley, Mandi district, Himachal (image source: Wikimedia Commons) Barot is an offbeat destination in Himachal Pradesh that is away from the overcrowding tourists. It is a great place to enjoy time with your loved ones for a calm and relaxing vacation. Barot is located in the district of Mandi of Himachal Pradesh. It is one of the most beautiful destinations in Himachal Pradesh. Barot is a small village which is located in the lap of nature and besides the Uhl river. People who visit Barot are usually looking for a silent stay among nature’s beauty. If you are traveling to Barot during December month, you can expect an average temperature of 12 degrees Celsius. Camping and trout fishing is one of the most popular activities you can enjoy. You can also have a feast on the delicious fresh trout while sitting around a bonfire. Camping is something you can enjoy as a couple, as a family, or as a solo traveler. Although Barot is not as popular as Manali or Shimla, it deserves a mention because of its laid-back atmosphere for a relaxing vacation. Tourist attractions: Trout Fishing, Camping, Dev Pashakot Temple, Nargu Wildlife Sanctuary, and trekking. 6. Kalpa View of Kinner Kailash peak from Kalpa, Himachal (image source: Wikimedia Commons) Another offbeat destination to add to this list is the beautiful Kalpa. Kalpa is located in the district of Kinnaur in Himachal Pradesh. Kalpa got its popularity due to social media where tourists posted beautiful pictures of this amazing destination. Kalpa is located at the height of around 2700 meters and is famous for its apple orchards and rural setting with the backdrop of beautiful snow-covered mountains. During the winter months, you can see the snowfall and enjoy the scenic splendor of this place. It is one of the best places to visit in Himachal Pradesh during December. Although Kalpa is popular among backpackers and young tourists, it is also a great trekking destination in Himachal Pradesh for adventure seekers who want to enjoy nature’s beauty. Photographer and nature lovers are also drawn to Kalpa for its gorgeous valleys and majesty during the winter season. You can expect an average temperature of around 8 degrees Celsius during December. Tourist attractions: Kinner Kailash, Kamru Fort, Sangla Valley, Sapni Fort, trekking, and camping. Suggested Read: Soul Trip To Himachal Pradesh 7. Kullu Chandrakhani Pass, Kullu, Himachal (image source: Wikimedia Commons) Kullu can be best described as a paradise because of its lush green valleys and panoramic views. Along with the natural beauty, the local culture and traditions are quite interesting for the tourists who visit Kullu in large numbers every year. Kullu is also known as one of the historical places in Himachal which are rooted in history and mythology. Winters in Kullu offers a contrasting scene compared to the summer season. It is probably the best place to experience the snowfall. One thing to note is that the temperature can get quite low during the winters. If you are traveling on a Himachal tour package, then make sure you customize your itinerary according to your travel needs. People who are traveling to Kullu during the winters are mostly adventure travelers who trek through the many trekking trails available in this area. Mountaineering and Camping are some of the extreme adventure activities people engage in. For family groups, you can enjoy the many sightseeing options Kullu has along with many laid-back tourist activities. Tourist attractions: Trekking, Camping, visiting Temples, and sightseeing. Suggested Read: Famous Cuisines in Himachal Pradesh Conclusion These were the 7 best destinations that you can visit during December. This list includes destinations that are suited for almost all travel needs. If you are traveling during the winter season, make sure you pack accordingly with all the necessary warm clothes. Also, if you are someone who likes to plan your vacation instead of buying a Himachal tour package, then you can easily do that with good research online. Checking for the weather and road conditions before traveling is wise. You can also refer to our list above to choose a destination that might suit your need. Although there are many beautiful destinations in Himachal Pradesh, we have chosen the 7 best you can travel to in December 2021. One important thing to check before you travel is the Covid restrictions. The Covid guidelines have been changing quite frequently with the severity of the spread of the coronavirus. It will be wise to make sure you have the required vaccination or RT-PCR test report documents before traveling. So, start planning your short or long vacation this winter season. December would be a great time to enjoy the scenic beauty of Himachal Pradesh and hopefully, this list will help you in choosing the right destination for you.

https://indiantravelstore.com/blog/best-places-to-visit-in-himachal-pradesh-in-december

CRITERIA 1: 10 Marks Demonstrated ability to explore the secondary data to identify and analyse a major trend/issue in the tourism and hospitality industry. Identify the various factors related/ contributing to the issue/ problem. Ability to present effective (result oriented - QUANTITATIVE/QUALITATIVE) recommendations that are relevant to the issue/problem. CRITERIA 2: 2 Marks Correct use of the credible secondary resources [AVOID WIKI - MORE USE Scholarly Articles/academic journal] Correct use of APA referencing system - CRITERIA 3: 3 Marks Quality of Document including quality research, grammar, clear language, structure, citation technique referencing, (APA style) FAILED ASSESSMENT SAMPLE - AVOID LABOUR SHORTAGE IN THE HOTEL INDUSTRY IN AUSTRALIA Introduction: This report will highlight the research skills using in search engines as secondary resources and analysis available data resources. The report will mention some problems that labour shortages will facing in hotel industry in Australia as challenges. Finding: According to article “Australia’s hospitality skills shortage and how to keep good staff”, Josh said there is major threat to the Australian hospitality industry at the moment, so number of young apprentices and experienced senior talent very low and will be decreasing in the future. By the year 2020, they need extra 123,000 workers to be survive in the market compare with growth of population and growth of dinning numbers. Obviously, in high class sectors included hotels and restaurant, they are failing to attract staff. With the deregulation of the industry, there will be no regulation of quality of skills from their staff. A skill shortage in the industry has made it difficult for award-winning businesses as Lake House to hire very lots of highly skilled staff as Wolf-Tasker said. The problem stems from the kinds of training opportunities that are and attitudes in Australia where hospitality has never been a particularly popular choice as a long-term career. (Wolf-Tasker, 2018) Another problem of skills shortages is Australia Government recently changing to visa regulation and policy so that is the reason facing to numbers of employees who holding 457 visas now has replacing new Temporary Skills Shortage. This will make industry don’t have enough staff as they want to hire and training during process because changing of visa regulation and sponsorship between industry and employees. A number of initiatives and studies have addressed the issues of skill shortages and need for training and retention strategies in tourism industry. The Tourism and Transport Forum (TTF), for example, conduct regular surveys of its members Its Labour Shortages, Skills & Training (May 2005) found the following positions difficult such as chefs, cooks and food and beverages staff, trade people, sales and front door staff. The problems associated with tourism seasonality, and hence labour shortages and possible skill shortages, have led to the development of skill formation strategies with tourism. As Skill Formation in Queensland Council will be developed as a national initiative for comprehensive and ongoing skill development with all components of tourism workforce. Following step, hospitality industry facing with poor knowledge about financial responsibilities of staff because they don’t have any experienced about this so industry finding hard to given them opportunities (Josh, 2018). That will happen in every hotels or restaurants in Australia because they always hiring workers from overseas and students. According to the report from period 2015-2020, they included: business surveyed had an average vacancy rate of 7%, if reflected across the entire tourism sector- that would translate to current shortage of around 38,000 positions. There has been a large increase in the proportion of businesses identifying skills deficiencies, with 69% reporting skills deficiencies among their staff, up from 50% in 2011. Commenting on the new report, Ferguson stated “since 2011, the pace of development in the tourism and hotel sector has increased significantly and while some positives progress has been made in recruitment and retention, supply of skilled labour is not keeping up with demand. “The TRA survey identified a large increase in the proportion of businesses reporting skills deficiencies. Conclusion: Overall, The Australian Government need to be focusing on these problems and provide more opportunities for the local people who are an unemployment and don’t have jobs to work with. Industry develop more training and tell them clearly about financial and everything related to their work. Therefore, it will decrease number of unemployment and increase the Australian’s economic in the future. Recommendation: Here is some recommend for hospitality industry can change and solve the challenge with skilled shortages included: increase global marketplace and increase reliance on casual market in a more permanent capacity, and in areas of the industry that had not previously. Provide more menu item bought and less made in house due to less staff. Next, High profile businesses closing certain days and capping hours so that their employees will work. If not, employees will quit and get another job. They also need increase in hospitality groups offering perhaps slightly simpler offerings with centralised production. (Josh, 2018) ANALYSIS OF THE TOURISM ISSUES IN AUSTRALIA Introduction Tourism is one of the major industries that contribute to the overall gross domestic product of Australia. According to the data, it is seen that almost 3- 5 % of the contribution is made by the tourism sector. The domestic tourism industry has footprint of almost 47.5 billion Australian dollars. Moreover, the Australian domestic tourism sector contributes almost 70% of the whole industry. However, in the recent times there have been several issues regarding the sustainable tourism development and shortage in capacity building in hotel staffs. In this study, the focus will be on analysis of the major issues in the Australian tourism industry and finding effective recommendation for the problems. Literature review According to the opinion of Mason, (2015), the sustainable development is one of the prime issues that affect the Australian tourism industry. Since the number of foreign tourist in Australian has increased by almost 7%, it has been seen that there are exploitation of the natural resources such as water land that increases the ecological footprints. The hotels in the New South Wales due to the excessive tourist pressure exploits resource like water that causes huge amount of depletion. Moreover, pristine environment of the natural areas like Great Barrier Reef is being effected due to plastic pollution by the tourist. In the words of Altman, (2018), one of the, major problem is the enhancement in the carbon footprint in the different ecologically sensitive tourist spots that enhances problems by almost 15%. The exploitation of the resource is causing huge impact on environment and the economy and degradation of the natural resource is influencing the overall local economy of the tourism destination by almost 10 %. In the opinion of Hunt, & Smith, (2018), one of the major important factors is the development of the competencies of the staffs according to the need of the situation. In the tourism and hospitality industry of Australia, it is witnessed that the number of tourists is increasing by almost 15% in a daily basis. It has been witnessed that the employees in the tourism sector lacks competencies in the management skill that is needed to achieve the sustainable development in the tourism industry. Skills like resource management and formulation of effective communication management is lacked due to which revenue is managed by 10 %. Australia was no exception to the economic disaster that struck the whole world and threatened world economy. It is one of the countries that are still striving to recover from the 2008 recession. Though Australia still suffers in a few fields, it has managed to recover at a great pace in others, one of which being tourism. Smith (2015) suggested that Tourism has always played an important role in growth of GDP with 3.1 percent rise in GDP in the year 2018/19. The tourism sector employs over six million people, improving employment and overall socio-economic condition. In Australia, international tourism is considered as an export. It brings in foreign currency within the country from all over the world, maintaining the import costs and export revenue balance. The inbound international tourists account almost AUD $41 billion that poses the majority of their revenue. Thus international tourism is considered to be Australia’s largest export in terms of foreign currency earned. McLennan et al. (2017) opined that a huge increase in the field was seen since Australia signed the historic Australia – China Free Trade Agreement in 2014 that allowed Chinese tourists to visit. China provides with the largest pool of foreign tourists that visit Australia with about one million people participating in guided tour groups. Planning policies and strategies regarding deployment of resources and tourism of Australia is influenced by a number of factors that include environmental factors, political factors and cultural factors. Basu (2017) stated that Australia has faced many challenges over the last few decades in blooming in their tourism industry. Sensitive scenic beauty that is degrading due to over population of tourists and the lack of skilled labours to cater to the needs of foreigners, along with communication barriers have effectively hindered the international tourism industry. In such an unstable global climate, it is necessary to preserve the environmental beauty of Australia along with its ecosystem. To do so, disciplined, structured and ever evolving strategies and policies need to be adopted by the tourism industry as a whole. However, with the Free Trade Agreement signed by with China, Australia is opening up, recovering themselves from their previous economic downfall, and strongly preventing another recession within their country by promoting, marketing and advertising their greatest export business, International Tourism. According to Altman (2018) they have advertisements worldwide with catchy tag lines like “No Leave No Life” in 2009 and “There’s nothing like Australia” in the recent times that encourages people to take some time out of their daily routine and have a vacation in Australia. Recommendation The recommendations to mitigate the issues of tourism management are as below: Conclusion Australia is growing fast in the tourism industry but there still remains a lot of issue that needs to be addressed over their increase in GDP. Environmental factors acting as the primary issue that seems to degrade at a faster rate than expected with the increase in frequency of human intervention in the natural ecosystem. With ozone hole on top of Australia that affects the people visiting there, thus threatening their health, it acts as a turn down for most of the tourists. Also on the other hand, Australia seems to be desperate in staff training, covering up for the lack of skills among tourism employees. With the socio-economic conditions improving in a greater pace, catalyzed by the International Tourist industry, they also benefit in indirect or direct ways other nations that provide transport facilities to the tourists of Oceania.

https://www.abcassignmenthelp.com/analysis-of-tourism-issues-in-australia-assessment-answer

Heatwave: The Reason for the Recovery? Notwithstanding the many factors influencing tourists’ choice of holiday destination, visits to mountain regions appear to have been boosted by the early summer heatwave. According to Savoie Mont-Blanc Tourism, the shortfall in advance bookings for July, announced at the end of June, was quickly offset by last minute bookings due to the good weather. In Savoie, mountain professionals cited the good weather as the primary source of visitor satisfaction. All these factors point to the increasing popularity of the mountains as a summer destination, with traditional beach holidays on the decline.

https://cimalpes.com/en/journal/summer-season-2019/

If you have seen or visited the Taj Mahal lately, you may have noticed the worrying color, faded décor, and general state of disrepair. You may even have been alarmed at the lack of action taken, and the way the iconic landmark has steadily declined over the years. Rest assured, you are not alone. Recently, the Indian Supreme Court ordered the state government, and the administration of Uttar Pradesh, to close down the infamous site if they are not going to take the steps necessary to repair it. A Brief History The Taj Mahal was built in the 17th century, using marble. It was a once-gleaming white monument built by Shah Jahan, a Mughal emperor. It was intended to be a mausoleum for his wife, Mumtaz Maha, who died during childbirth. Hailed as one of the seven wonders of the new world, it has become a highly sought-after tourist destination and a site of importance to Indian historians. Its General Decline The building began turning yellow in the early 20th century and has since started to fade to brown and green – a far cry from the brilliant shade of white it once was. Experts believe that a number of factors are working together to create this effect, including industrial pollution and air pollution caused by smoke and toxic effluents. The prevalence of kerosene and diesel as fuel sources in the area are also likely contributors. Insects known as Chironomus calligraphus are also contributing to the issue and are probably responsible for the greenish hue the Unesco World Heritage Building has recently assumed. The Supreme Court Fed up with the state of disrepair, and worried for its future, the Indian Supreme Court feels that the time has come to order significant action. Not only is this a very popular tourist attraction bringing in a lot of money to the local economy, it is also a historic site. There is an obligation to preserve it for future generations. The Supreme Court felt that efforts already made by the government to clean up this monument are insufficient, taking too long, and may have little effect given the urgency of the situation. They had made a previous direction in May and have now become fed up with the government’s inaction. This led to the final ruling issued this past week, which ordered the government to “demolish it or restore it.” Residents of India and tourists alike hope that the Indian government takes these directions from its Supreme Court seriously and starts to work on ways to improve and restore the monument. Something of that beauty and elegance deserves to be seen and appreciated by all generations to come.

http://travelerfeed.com/restore-demolish-fate-taj-mahal/

این مقاله تقریباً شامل 7787 کلمه می باشد. Given the scarcity of research on tourist food preference, this study is a first attempt to generate in-depth understanding of Chinese tourists’ food preferences in a culturally different environment by employing on-site participant observations and focus group interviews. It provides a detailed analysis of the motivational factors underlying the Chinese participants’ food preferences when holidaying in Australia, and also proposes a typology that describes and contrasts the participants’ tourism dining attitudes, motivations and behaviors. Furthermore, this study elucidates the influence of Chinese food culture on the participants’ tourism dining behaviors and explores the disparities in dining behavioral patterns between the participants in terms of their dining motivations and the way they related tourism dining experiences to their daily experiences. Unlike other forms of travel activities and attractions, tourism dining is an art form that gratifies all of the five human senses—vision, tactile, auditory, taste, and olfaction (Kivela & Crotts, 2006). With such an idiosyncratic nature, tourism dining is often considered a sensory pleasure activity that fulfills the experiential part of a holiday experience (Hjalager & Richards, 2002). In addition, food is an essential aspect in understanding the culture of a society, and an important medium for cultural expression (Fieldhouse, 1986). Thus, food comprises a substantial part of the appeal a destination offers. Scarpato (2002) further contends that food satisfies all the conventional requirements of cultural tourism products. Hence, tourism dining has increasingly become a major conduit for tourists to appreciate the local culture of a destination (Kivela & Crotts, 2006). While it is a widely held belief that food in tourism is a significant “attraction” (Hjalager & Richards, 2002), Cohen and Avieli (2004) however stress that local food at a destination could be an “impediment” under certain circumstances. They point out that local food might become acceptable to tourists only if it is modified to the tourists’ palate, and that the confrontation with “strange” and “unfamiliar” local cuisine might present a considerable challenge for some tourists. Indeed, some tourists may suffer from “food neophobia,” a concept which refers to human’s natural tendency to dislike or suspect new and unfamiliar foods (Pliner & Salvy, 2006). Similarly, Lepp and Gibson (2003) identified “strange food” as one of the seven risk factors perceived by tourists. Hence, destination marketers, hospitality businesses, and tour operators are faced with the challenge of how to appropriately portray and present their local cuisine as an attraction and to mitigate the risk that it will be interpreted as an impediment. Such an endeavor requires an in-depth understanding of tourists’ different food preferences and dining behaviors (Quan & Wang, 2004). Nonetheless, despite the central role of dining in the holiday experience, the interface between food and tourism has received scant research attention. Cohen and Avieli (2004, p. 757) underscore that eating and drinking remain “virtually unexplored in the sociological and anthropological study of tourism, notwithstanding their obvious centrality in the experience.” Although there is a growing interest in research into food experiences in tourism, Kim, Eves, and Scarles (2009) indicate that research on tourist food consumption is at its infancy, and is still establishing its basic tenets. In addition, most of the existing research focus on Western tourists; studies based on non-Western and Asian tourists are scarce. To date, there is no empirical study examining the food preferences and dining behaviors of Chinese tourists, thereby revealing a knowledge gap in understanding this important market segment. Consequently, this study aims to fill part of this gap by investigating Chinese tourists’ food preferences while they are holidaying in Australia. The specific objectives of the study include: to explore Chinese tourists’ food preferences and the motivational factors underlying such preferences, to develop a typology describing Chinese tourists’ tourism dining behaviors, to examine the influences of Chinese food culture on tourists’ dining behaviors, and to identify any intergroup disparities in dining behavioral patterns among the Chinese tourists. Given the scarcity of research on tourist food preference, this study is a first attempt to generate in-depth understanding of Chinese tourists’ food preferences in a culturally different environment. It provides a detailed analysis of the motivational factors underlying the Chinese participants’ food preferences when holidaying in Australia, and also proposes a typology that describes and contrasts the participants’ tourism dining attitudes, motivations and behaviors. Furthermore, this study elucidates the influence of Chinese food culture on the participants’ tourism dining behaviors and explores the disparities between the participants from Mainland China, Hong Kong and Taiwan, in terms of their tourism dining motivations and the way they related tourism dining experiences to their daily routine experiences. The findings of this study provide useful information for destination marketers and hospitality businesses in developing their gastronomic products and ensuring that food used in catering are congruent with tourists food culture and dining habits (Cohen and Avieli, 2004 and Quan and Wang, 2004). Moreover, tour operators are afforded ideas in facilitating optimal meal arrangements for group tourists. On the other hand, the findings of this study contribute to the sociological and anthropological dimensions of food in tourism in the following ways. First, the findings advance the understanding of tourists’ food preference and the underlying motivational factors from the Chinese perspective, thereby providing theoretical groundwork for further studies on this important market segment. Second, the findings reveal that Chinese food culture exerted significant influence on the dining behaviors of the Chinese participants, supporting that cultural influence is a key determinant affecting tourist food preferences. Third, following on the conceptual model of the tourist experience posited by Quan and Wang (2004), the findings of this study corroborate that the intergroup disparities in dining behavior among the participants from the three regions was related to whether they seek “contrast”, “extension” or “intensification” of their daily experiences from the tourism dining experiences, thereby substantiating the applicability of the conceptual model in the analysis of tourism dining behavior. Finally, the typology proposed offers theoretical insights as well as empirical evidence into the distinctive tourism dining behaviors of the Chinese participants, which is believed to provide a useful starting point for future investigation. It is germane to point out that since this study is of an exploratory nature with no intention to generalize findings, a purposive sample was adopted. Due to practical considerations, tourists who joined all-inclusive package tours were selected instead of individual tourists. While deliberate attempt was made to select those tours with “free choice dining activities”, individual tourists might provide different insights. As such, future research may consider including individual tourists in the investigation. In addition, this study focused on Australia as the only destination in the investigation due to resource constraints. Future research might be directed at examining Chinese tourists’ eating behavior in other Western destinations in order to enhance the generalizability of the results. این مقاله شامل 7787 کلمه می باشد.

http://isiarticles.com/article/131

Israel has long been known as God’s chosen land. People throughout time have wondered why such a small nation without much power in the grand scheme of things would be God’s choice. Yet, it was. Throughout the ages, this development has caused its fair share of confusion among people and other nations. In fact, it even caused quite a bit of anger and jealousy. Still, the Land of Israel has persevered to maintain its favor in God’s eyes and see its prophecies fulfilled. Taking a Trip to Israel In light of the biblical teachings, Israel has become a highly sought-after destination for Jews and Christians from around the world. Some simply want to see the land God loved so much, whereas others make their trips a full-blown pilgrimage with great religious significance. One can find more hints on must-see destinations in Israel, but for now, take a look at some of the deeper details behind the story of this great nation. Digging Deeper Israel is located in the Middle East. It’s nestled among Egypt, Lebanon, Syria, and Jordan with the Mediterranean Sea bordering it on the west. Its landscape consists of a range of features from beaches to deserts. This country has amassed quite a long and diverse history over the centuries, and its story is still being written today. Long ago, God proclaimed that Israel was His treasure. Its small size, minimal population, and lack of ultimate power were the very factors that drew His attention. He saw potential in the people of Israel, according to realtimecampaign.com and many other sources. In time, the Israelites came to realize that God was the one true deity. They embraced Him, and he vowed to protect and make Israel a holy place. Over time, the true Israelites were exiled from their land. At that point, God said the land and people therein would not prosper until His chosen people were returned to their rightful place. That wasn’t the only time the Israelites were driven from their home, but they had faith that things would work out in the end. Coming Into the Present In 1948, Israel became a state all its own, and the Israelites’ 2,000-year exile came to an end. Though it had been considered a holy place all along, its people were finally able to return, and Jews from around the world seized the opportunity to return to their homeland. Jews and Christians were free to visit to see the Holy Land for themselves, and companies like Immanuel-Tours helped them get there. Visiting the Holy Land The recent pandemic brought pilgrimages to the Holy Land to a halt for a bit. However, a recent write-up noted, “Israel to Resume Welcoming International Tour Groups.” At this point, people are once again free to visit. Israel never ceased to be God’s treasure, and the people who belonged there were His chosen few all along. During their exile, they never stopped believing that God would see them through and bring them home. That prophecy has now been fulfilled, and even more, are destined to follow suit.

https://www.getnews.info/1166468/realtimecampaigncom-promotes-israel-group-tours-seeing-the-holy-land.html

Times of pressing staff issues and lack of skilled labor – not only in companies but in entire tourist destinations – have been dominating the hospitality industry. Previous research confirms the importance of perceived quality of life and employee commitment as influencing factors of employee behavior such as turnover. However, there is a lack of information about the younger generations Y and Z as the future backbone of the industry. Furthermore, commitment theory needs to be expanded from the individual firm to the entire destination. The present study uses a qualitative approach to analyze the perceived quality of life in a sample tourist destination and its influence on different forms of destination commitment. 15 narrative interviews with hospitality employees were conducted, the content coded in MAXQDA-12 software and examined using grounded theory in a constructivist paradigm. Reasons for destination commitment are, for example, the people in the destination, the firm, or the environment. The results led to a conceptual framework of destination commitment. The study thus expands and adjusts Meyer & Allen’s (1991) three-component model of employer commitment to the destination itself.

https://aag.secure-abstracts.com/AAG%20Annual%20Meeting%202020/abstracts-gallery/34297

View Google Analytics Statistics. Show full item record. The green movement has generated an increase in research on consumer behavior towards green products and services. The purpose of this study was to explore the factors that influence consumers to choose sustainable attractions and to develop a better understanding of whether the sustainable features of an attraction impact sustainable attraction selection by visitors. - Dominican Republic - Approaches Towards a Sustainable Tourism Development. - war on terror argumentative essay. - dissertation theses abstracts; - At a glance. The results show that the environmental practices of an attraction were not as important to visitors as other factors such as reputation, price, and the activities at the site. The results also demonstrate that when selecting among green factors, certification of a site and eco-furnishings play the largest role in determining the likelihood of visitation to a sustainable attraction. Rubright, Heather L.. https://nontingcardpovi.gq January Retrieved from the Scholarship. This thesis examines the potential impacts of climate change on destination choice and how these impacts may influence choice of tourists visiting Peniche. - Structure and contents. - Thesis research: Sustainable Development of a Tourism Destination. - commercial papers are short-term unsecured borrowings by. Therefore, Peniche, a small coastal city in Portugal, has been chosen as a case study and quantitative method was applied for the research through conducting a questionnaire to the domestic and international tourists visiting Peniche. The findings show that despite of climate change impacts, the majority of respondents will still travel to Peniche, but not in the peak seasons. The research concludes that as it is expected, climate change will influence destination choice and timing of travel through shifting peak seasons to shoulder seasons. The thesis contributes to the limited climate-related research in Portugal. Master Thesis - Ilaha Guliyeva.

https://segitenhightels.ga/master-thesis-sustainable-tourism.php

A tourist destination is generally a place of interest in which tourists visited, usually for the exhibited or natural value, cultural or historical importance, aesthetic value, recreational value, or offering entertainment and leisure. A tourist destination can also be the spot where visitors are entertained through sporting events or theatrical shows. As stated earlier, destinations are chosen based on many factors including budget, climate, number of visitors expected, proximity to the airport or major transportations, access to restaurants and shopping malls, accommodation facilities for entertainment, and tourist season (Christmas, New Year’s Eve, and summertime). The cost of a tourist destination can vary depending on the activities and accommodations provided in a destination, its proximity to popular tourist destinations, the general condition of the place and its cleanliness. It is advisable to plan your trip as far in advance as possible to avoid last minute surprises. Natural Areas The natural areas, such as national parks, beaches, forests, and other natural areas are considered by many people as the best part of a tourist destination, since these areas provide some of the most beautiful sights and places to explore, while being surrounded by beautiful landscapes and seascapes. Most people travel to areas known for culture and heritage because these places offer some of the most authentic and preserved historical sights and places. In addition, some of the best natural areas are coastal areas where there are numerous beach areas and natural areas, including, but not limited to, beaches, sand dunes, cliffs, and mountains. These places offer ideal tourist destination for those looking for serenity, tranquility, and for the all-natural beauty it offers. For those who like the beach, they will find a great variety of beach destinations. Some of the popular beach areas include Goa, the village of Varka, the village of Belgaum, the village of Anjuna, Baga beach, Candolim beach, and Kovalam beach. Cultural and Historic Remedies Heritage and culture are other factors that determine the tourist destination. There are many places in India that have significant cultural and historic importance, with the Taj Mahal in Agra being one of the most famous tourist destinations in the world. These areas are also known for their rich culture and heritage. Many tourists enjoy exploring these parts of India for their amazing charm and beauty.

https://absolutourense.com/what-makes-a-good-tourist-destination/

This beautiful city of Brazil has been chosen as the most beautiful Christmas corner. Maceió is the capital of the state of Alagoas. Located on the east coast of Brazil, it has now become a claimed tourist destination for all those travelers who wish to celebrate the end of the year in a perfect paradise beach. This year, the capital has emerged as the city located in northeastern Brazil that has the best lighting and the best Christmas decorations. That’s why Maceió is the most beautiful Christmas city There are few tourists who come to the city. This has been achieved thanks to the good connections that have their roads and highways. In addition, there are also many visitors who come from abroad, both from other parts of Brazil and from the rest of the globe. In addition, the state of Alagoas is considered one of the safest for tourism, so it is not surprising that its capital is among the destinations preferred by travelers. Other Brazilian destinations, on the other hand, have been severely criticized in terms of security because they are major sources of conflict. Nothing is what you have to envy Maceió to other beaches that are around them. In this corner, tourists can rest in exclusive hotels, visit dream beaches and beautiful crystalline waters, as well as taste an exquisite regional cuisine. They are famous, among others, their seafood, highlighting a large number of bars and restaurants that offer them. If you want to make the most of your stay in this city, you should walk quietly along its extensive promenade, much more beautiful with Christmas decorations. It is also good to know the special programming offered on New Year’s Eve. Those who have already been here, say it is a wonder.

https://noroman.net/travel/maceio-is-the-most-beautiful-christmas-city-in-brazil/

Topics that could be discussed within your tourism dissertation include:. Dark tourism is also known as grief tourism or black tourism. Dark tourism involves travelling to sites associated with suffering, death and atrocities such as castles and battlefields such as Culloden in Scotland, Auschwitz, nuclear disaster zones and genocide memorials. Dark tourists seek to and understand the causes behind these events and reflect on the nature of humans involved. Possible areas to research for your tourism dissertation include:. The case study of Ground Zero. Generally, hospitality refers to jobs in the hospitality industry, such as hotels and resorts, restaurants, catering and casinos alongside any hospitality positions that deal with tourists. Hospitality involves the relationship process between the hotel and a guest. It also involves the act of being hospitable, such as guest reception and entertainment with friendliness, goodwill and liberality. Hospitality is also known as the act of giving care and kind-heartedness to whomever is in need. Hospitality is important to modern day businesses, and one of the following topics could make for a good tourism dissertation:. The case study of Lastminute. The case study of Holiday Inn Express. Tourism management is the discipline that deals with the generalised management along with entrepreneurial, specialised and practical skills and competencies required for effective and efficient outcomes for recreation and leisure travel. Tourism is the fastest growing industry globally that has direct and indirect implications on economic, social and political indicators. In order to maximise the advantages and minimise the disadvantages from tourism development, the discipline has also included the perspectives of social sustainability and policy makers. Traditionally, the countries that have natural comparative advantage were seen as the focal point of the tourism industry, however the economic relationship of the industry has led the countries lacking such comparative advantage to use their history, heritage, culture, festivals and mega-events to promote and develop tourism. Topic suggestions below could help you narrow your research for your tourism dissertation. Critical evaluation of summer festivals in the UK as a source of domestic tourism development. The difference in cost of medical procedures in different countries combined with the lower cost of travel has led to the development of medical tourism. The price dynamics of medical procedures in developed economies is developed under stringent regulatory and legal frameworks, which is coupled with higher cost of living in these economies, therefore resulting in significantly higher costs in comparison with emerging and developing economies. This high cost differential is combined with deteriorating cost of international travel, which has resulted in the emergence of medical tourism. There may not be much literature to research in this area, but it may be an interesting area to research and discuss for your tourism dissertation. Educational tourism involves attracting students, scholars and academics to a destination due to the perception of quality education, practical skills and career development. Some really interesting tourism and hospitality dissertation topics are suggested below: How economic conditions of a country impacts its local tourism: Identifying the economic factors influencing tourism sector. Through this research, economic factors which tend to impact the local tourism of a country are going to be highlighted and critically analyzed. Moreover this research is also going to weigh the economic upsides and downsides of these factors with respect to the local tourism. Assessing the impact of social media platforms on tourism destination selection. Social media has been playing a much broader role in different sectors for the past decade. This research is going to analyze the role which is played by different social media platforms in terms of selection of tourism destinations. This research is also going to shed light on the rationale and factors because of which people rely on social media to select their tourism destination. Assessing the impact of government rules, regulations and policies on tourism development: The tourism sector of any country is greatly looked after by governmental and regulatory bodies. This research is going to analyze the role which is played by such bodies in terms of policy making and regulation implementation. This research has taken into context the developing countries because their tourism sector works differently from developed countries. Analyzing the impact of natural hazards on tourism industry of UK: Recommending effective measures to minimize risk. Increase in tourism tends to expose the host country towards natural hazards. There is a negative impact of such hazards on the tourism industry. UK is one of the countries with a successful tourism industry, this research is carried out in order to analyze the impact of such hazards on the efficiency of Tourism industry. Assessing the factors and preferences which lead the tourist to travel to a dark tourism site. With the increase in time, and shift in preferences of people with respect to tourism, dark tourism has been gaining immense popularity and success. This research is going to look into the factors which lead the tourists to select such places for their tourism destination. This area of tourism has gained tremendous popularity among academicians and researchers in the recent times. It primarily takes into consideration technical competencies and new knowledge gained outside the classroom environment. Educational tourism brings to the light the idea of travelling to learn about the cultures of other nations. Exchange student programmes are perhaps the most commonly employed educational tourism strategy, allowing students to learn about the culture of the visited nation through work and travel. Possible area of research under this field of tourism can be any of the following: Medical tourism is a new area of study in the tourism industry. Although there may not be sufficient secondary data available to analyse in this area, it is likely to provide an interesting and intriguing research opportunity to students for their tourism dissertation topics. Tourism management is perhaps the most interesting and influential areas in the tourism industry. People travelling to other countries and outside their usual environment with the intent of leisure can be classified as tourists. It should be noted that the phenomenon of tourism has grown tremendously in the recent years, thanks to the impact of globalisation. There are many countries such as Malaysia, Thailand, Singapore, Maldives and Fiji, whose largest source of income comes from the tourism industry. In these countries, tourism generates a large intake of money and also provides opportunities for businessmen and working class. The suggestions below can help you to narrow your research for your dissertation. Hospitality industry consists of casinos, resorts, restaurants, hotels, catering as well as other businesses that serve the tourists. At its core hospitality can be defined as the relationship between a guest and the hotel. Other aspects of hospitality include but are not limited to liberality, friendliness, warm welcome, entertainment, goodwill, and reception. Modern day business pride themselves on their acts of hospitality. Some topics in this area of tourism are suggested below. Database of example management dissertation Proposals - these proposals were produced by students to aid you with your studies. Search to find a specific management dissertation proposal or browse from the list below: Executive summary The management of countdown suffering from some problems related to customer service, management . Hospitality Dissertation Topics. Generally, hospitality refers to jobs in the hospitality industry, such as hotels and resorts, restaurants, catering and casinos alongside any hospitality positions that deal with tourists. Hospitality involves the relationship process between the hotel and a guest. Features of a good writing service; Getting trusted writing help; Catchy law PhD paper ideas; Business management thesis proposal; Home; Helpful Sites. Looking for help with dissertation? Order custom dissertation online from this service - 24/7 online help. Professional dissertation writing and editing services - find it out - expert PhD writers . Dissertation in Hospitality Management. The perspective that the industry of hospitality is pervaded with unique properties implies the need for a particular philosophical theory of knowledge and methodological configurations to be adopted so that its characteristics and various other activities may be effectively researched. Composing A Dissertation Proposal On Hospitality Management. Hospitality management connects with hotels and Bed & Breakfast, lodges and inns et al. Proposal And Dissertation Help Hospitality Management proposal and dissertation help hospitality management graduate admissions essay help Dissertation Proposal Service Hospitality Management i dont know what to write my paper about pay to write my paperAmericas Top Dissertation Service! PhD Staff.

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The governor of South Korea's Jeju province vowed Friday to develop the southernmost resort island as Asia's most prominent tourist destination that would accommodate more Chinese tourists. Jeju is already a hot place for vacationers from across the Yellow Sea, and Chinese investors are involved in a number of commercial and construction projects. Provincial government officials regard Chinese money as a crucial source of revenue. The island receives more than two million Chinese visitors annually. But Jeju Governor Won Hee-ryong was not complacent, saying he would step up efforts to attract more Chinese visitors. "We will develop Jeju as Asia's best hub for tourism and exchanges," he said Friday after attending a ceremony to open a joint exhibition featuring Chinese and South Korean photo artists. "Jeju is the epicenter of bilateral exchanges between South Korea and China." The exhibition titled "Beautiful China, Beautiful Korea" was held to promote cultural exchanges between South Korea and China. China's publicity chief Liu Qibao led a delegation to the exhibition as part of his four-day visit to South Korea. On Saturday, Liu will drop in Seobok (Xu Fu) Park in Seogwipo, a place frequented by Chinese tourists because of a folk tale that it has miraculous virtues for those seeking promotion. Residents in Jeju say that Xu Fu, a court sorcerer during China's ancient Qin Dynasty, visited the island to look for the elixir of life. The park has become one of the most want-to-visit places sought by Chinese officials since Chinese President Xi Jinping got promoted after praying there. Before flying to Seoul on Saturday, Liu is to inspect the sites for construction with Chinese investments. Government data showed the number of Chinese visitors to Jeju has increased from 115,000 in 2005 to 2.237 million in 2015, bringing wealth and jobs to the island. The stunning increase represents improved Sino-Korean relations which were normalized in 1992. Only over a period of two decades, the two countries have seen tremendous growth in trade, cultural, political and other exchanges. Helped by Beijing's eased restrictions on overseas travel, Jeju has emerged as a perfect place for a vacation by Chinese tourists because of its geographical proximity and a special visa-free program that would allow them to stay freely for up to 30 days. Another crucial and probably more important factor is the growing popularity of Korean pop songs, movies and TV dramas in China. Residents in Jeju said a rising flow of Chinese visitors into the island has contributed much to the region's economic growth and brought a broad change to their daily life and economic activities. "I think Chinese tourists have become an important part of our life and economy," a 29-year old Jeju native working at Jeju International Airport told Aju News on condition of anonymity. A report by the Honam Regional Statistics Office which piled Jeju-related data showed that the rate of Jeju's gross regional domestic product, measuring individual output in accommodation and food service sectors, soared by 57 percent from 15.23 million won (12,962 US dollars) in 2005 to 23.91 million won in 2014. The increasing rate was higher than a national average of 54 percent, indicating Jeju has benefited much from Chinese money. "The money spent by the Chinese tourists here is a big boost to our regional economy especially in tourism-related businesses," the Jeju native said. "Chinese tourists are very keen on buying local-made products, triggering a butterfly effect that leads to bigger sales of overall South Korean products abroad." Jeju has also seen a surge in Chinese investment in condominiums, hotels and other properties, and the wave of Chinese visitors and investment in Jeju reflects growing economic links between the two countries. China is now South Korea’s biggest trading partner. Data compiled by the state-run Korea Tourism Organization showed Chinese travelers accounted for 45.2 percent of 13.23 million foreigners who visited South Korea last year, followed by the Japanese with 13.9 percent. South Korea received 5.98 million Chinese visitors, down 2.3 percent from a year ago, in 2015 when its tourism industry was hit hard by the Middle East Respiratory Syndrome (MERS) outbreak which killed 38 people, leading to a 6.8 percent decline in the number of total foreign visitors. It was the first decline since 2003. Tourism officials, however, say the decline is temporary, and a poll released by the Korea Culture and Tourism Institute in January found that most industry players were upbeat on this year's business outlook. South Korea is still seen by Chinese tourists as a favored destination, despite complaints among them about a language barrier, high prices, and the lack of tourism-related infrastructures such as food and accommodations, and the bureaucratic red tape.

http://ajudaily.com/view/20160520185943903

Abstract: Analyzing the preferences for adventure tourism in a destination serves to design an adventure tourism package, helping to improve the offer of products in places that have natural resources for the development of this type of tourism. The present study was based on a questionnaire that was distributed to people who had practiced adventure tourism in the province of Santa Elena in Ecuador. The techniques used were variant and bivariate. The results show that visitors to this destination mainly prefer diving and snorkeling, followed by paragliding. Then they continue water skiing, canopy and paragliding. The stay is mostly three days and two nights. The results will contribute to creating products according to the demand of adventure tourism. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).01 Issue No: Vol. 13, No. 2 (2022) - Stakeholders’ Synergies in Developing Smart Tourism Destination. A Phenomenographic Study Authors: Nurdin HIDAYAH, Herlan SUHERLAN, Fajar Kusnadi Kusumah PUTRA Pages: 313 - 323 Abstract: This study aims to investigate the stakeholders' synergies in realising smart tourism destination. This study uses a qualitative method with a phenomenography approach. We adopted stakeholders' theory to valued stakeholder roles and perception in pursuing sustainability, competitiveness and managing smart tourism destination in Wonosobo, Indonesia. In-depth interviews with five main stakeholders' namely local government, media, tourism business, tourism community, and travel bloggers followed by three phenomenography qualitative data analysis stages. The findings have revealed some obstacles in implementing smart tourism from stakeholders' perspectives, such as human resource's ability, stakeholders' synergy, and government support. This study has also revealed six factors: public system development, digital promotion, Internet infrastructure, public and private sectors partnership, and human resources development to support smart tourism. This study has proposed the strategic plan for the local government to support smart tourism destinations, namely: partnerships, government support, human resource’s ability, and tourism business competitiveness, that will lead to smart tourism destinations. This study has provided a framework and managerial implication accordingly. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).02 Issue No: Vol. 13, No. 2 (2022) - Antecedents of Tourists’ Intentions to Visit in the Context of Coffee Tourism Authors: Usep SUHUD, Mamoon ALLAN, Vanessa GAFFAR Pages: 324 - 337 Abstract: Coffee plantations have been promoted by owners and local governments as tourism destinations in Indonesia. This study measures factors that influence tourists’ intentions to visit coffee plantations as a tourism destination by employing destination image, novelty seeking, experience, and perceived value as predictors. Data were collected using an online survey. This study was conducted in Jakarta, Indonesia, and participants (N = 235) were selected using a convenient sampling method. Data were analyzed using exploratory factor analysis and structural equation modeling to test the hypotheses. In total, there were eight hypotheses, and six were significant. Tourist experience had an impact on destination image, and tourist experience and novelty seeking affected visit intention. Additionally, destination image and novelty seeking influenced perceived value. This study broadens the understanding of coffee tourism, village tourism, and agrotourism. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).03 Issue No: Vol. 13, No. 2 (2022) - Theoretical and Methodological Fundamentals of the Modern Paradigm of Quality Management in the Field of Tourism Authors: Vadym Viktorovych BAYEV, Ivan Stepanovych BAKHOV, Tetiana Vitaliivna MIRZODAIEVA, Olena ROZMETOVA, Nataliya BORETSKAYA Pages: 338 - 345 Abstract: Modern effective management in the tourism industry involves the introduction of a quality management system as a means of achieving competitiveness, gaining confidence in products/services from consumers. A quality management system (QMS) is a set of interrelated or interdependent elements that provides an opportunity to set policies, objectives, and guide and control the activities of a tourism organization to improve the quality of services provided. This system consists of organizational structure, techniques, processes and resources required for overall quality management. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).04 Issue No: Vol. 13, No. 2 (2022) - Tourism Sustainability Strategy during New Normal Period for "Balkondes" in Borobudur Area Authors: Andhatu ACHSA, Rian DESTININGSIH, Fitrah Sari ISLAMI, Ivo NOVITANINGTYAS, Budi RAHARDJO Pages: 346 - 353 Abstract: The COVID-19 pandemic has had impacts on the tourism sector, including tourism destinations called Balkondes in the Borobudur area. During the normal period, Balkondes needs a strategy to become sustainable. Based on these, Balkondes needs to identify the internal and external factors and formulate the tourism sustainability strategy. The approaches used are Strengths-Weaknesses-Opportunities-Threats (SWOT) and Internal-External (IE) Matrix. The data used in this research is primary data. The respondents are the managers of Balkondes and the tourists. The number of respondents is 200 people. The data is collected by purposive sampling method. The results of this study provide managerial implications for Balkondes managers to implement strategies for optimizing tourist attractions and tourist facilities, increasing support from the government, implementing clean, health, safety, environment (CHSE). This study extends the literature related to the development of tourism strategies to recover the tourism destination during the new normal period. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).05 Issue No: Vol. 13, No. 2 (2022) - The Impact of Revolutions and Terrorist Attacks on Tourism. Case Study: Egypt Authors: Daniel BAKOTA, Magdalena MORGA, Arkadiusz PLOMINSKI, Mariusz RZETALA Pages: 354 - 366 Abstract: The essence of the research concerns the impact of armed conflicts and terrorist attacks on the arrivals of foreign tourists with Egypt selected as the testing ground. It was found that revolutions and terrorist attacks have a negative impact on the development of the tourism industry – following the social unrest that took place in Egypt in the years 1997, 2011 and 2015, the number of arrivals of foreign tourists decreased by: 13%, 33% and 42% respectively (depending on countries of the world the reduction of the flow of tourists was within the range of 21-78%). The decrease in the number of tourists which takes place after a terrorist attack is short-lived and usually does not last longer than a year, whereas the consequences of a revolution are noticeable for tourism for a period of 3 to 5 years. According to respondents, the most important consequence of social unrest (protests, demonstrations, terrorist attacks) for tourism is a drop in the number of arrivals of foreign tourists, reduction in the income generated by tourism, decline in employment in tourism and the general slowdown in the development of tourism. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).06 Issue No: Vol. 13, No. 2 (2022) - Assessment of Service Quality of Leisure Center and the Intention to Revisit a Destination Authors: Ahmed Alshiha Pages: 367 - 378 Abstract: Revisit intention is considered one of the key subjects in the current tourism industry. This paper examines the influence of the service quality of a leisure center on future intention to revisit Orlando city, as influenced by overall tourist satisfaction and destination image. Data was collected from 313 visitors of Orlando city, United States. The results indicated that leisure service quality positively affected the overall tourist satisfaction with the city and destination image. Additionally, tourist satisfaction and positive destination image positively impacted tourists’ intention to revisit the city. Moreover, tourist satisfaction and destination image fully mediated the linkage between service quality and tourist intention to revisit the destination in the model with two parallel mediators. Received results indicate that leisure service quality plays a vital role in tourist satisfaction. High quality service will positively affect the travel intentions of leisure center tourists, inclining them revisit the city. Thus, leisure centers and the leisure tourism industry should better understand the expectations and demands of tourists. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).07 Issue No: Vol. 13, No. 2 (2022) - Tourist Attraction Satisfaction Factors from Online Reviews. A Case Study of Tourist Attractions in Thailand Authors: Vimolboon CHERAPANUKORN, Prompong SUGUNNASIL Pages: 379 - 390 Abstract: In order to survive and gain competitive advantages in the post COVID-19 pandemic, tourism destinations should plan their business strategy by focusing on customer expectation. A number of research have studied tourist satisfaction, particularly, hotels and transports, however there is limited investigation with tourist attractions which have different prominence from other tourism service providers. The purpose of this study was to identify the tourists’ satisfaction components for tourist attractions by adopting an opinion mining technique and using the zero-shot text classification method. The total of 40,000 online tourists’ reviews from 40 tourist attractions in Thailand, that were posted up thought TripAdivisor.com between 2010 and 2021, were analyzed. The research findings reveal six components of tourist attraction satisfaction (TATSAT) model that includes 1) ambiance, 2) hospitality, 3) price, 4) accessibility, 5) cleanliness, and 6) security. All attributes of TATSAT model are generated from tourists’ point of view and was analyzed by the focus group discussion with five tourism experts from both academics and practitioners. This model expands the idea of HOLSAT and SERVQUAL by focusing on the tourist attraction business sector. The results can serve academics and practitioners in the research and improvement of tourist satisfaction to maximize competitive advantages for tourist attraction sector in the future. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).08 Issue No: Vol. 13, No. 2 (2022) - Challenges to Tourism Development in Sub-Saharan Africa. A Case of Malawi Authors: Mathews LAMBULIRA, Felix G. BELLO Pages: 391 - 402 Abstract: Many countries around the world continue to consider or adopt tourism primarily for the economic benefits associated with it. However, developing tourism has been a difficult aspiration for developing countries as they face significant barriers. This paper examines the challenges to tourism development and their causative factors in Malawi. In-depth interviews were used to collect primary data. Inadequate connectivity between source markets and Malawi, as well as inside the country, underdeveloped tourist destinations and limited access to tourist information emerged as the main barriers to Malawi's tourism development. It was further revealed that underfunding, the centralized management structure of the tourism industry, lack of stakeholder collaboration, and an unfriendly business operating environment contribute to Malawi's tourism development challenges. It is recommended that the government and other key tourism stakeholders should prioritise the identified causative areas and among other things decentralise tourism administration and improve tourism statistics collection and analysis. There is also a need to strengthen stakeholder collaboration and networking. PubDate: 2022-04-04 DOI: 10.14505/jemt.v13.2(58).09 Issue No: Vol. 13, No. 2 (2022) - Analyzing the Factors that Influence the Entrepreneur Business Performance of Tourism Destination of Kuala Terengganu City Centre, Malaysia Authors: Muhammad Abi Sofian Abdul HALIM, Nurul Farahiyah AWANG, Khatijah OMARm, Jumadil SAPUTRA, Siti Nor Adawiyah Azzahra KAMARUDDIN, Hazman SAMSUDIN Pages: 403 - 413 Abstract: Tourism in Terengganu deals with attractions, events, and facilities of special interest to tourists, such as Kuala Terengganu City Centre (KTCC). KTCC is a collaboration project between the Terengganu state government and the East-Cost Economic Region Development (ECERD) agency. This project purposely attracts potential foreign investors and upgrades the community's economy and social well-being in rural dan sub-urban areas in Kuala Terengganu. Therefore, this study analyzes the factors that influence the business performance among Malay micro-entrepreneurs in rural and sub-urban areas of Kuala Terengganu. The study utilized four factors, including entrepreneurial competency, financial literacy, innovation, and technology. In this survey research, non-probability has been chosen by using the purposive sampling methods. The data were collected from Malay micro-entrepreneurs operating their business, including the North and South areas of KTCC. The results showed that entrepreneurial competency and technology factors were significantly affected business performance. Meanwhile, the financial literacy and innovation factors were not significantly affected business performance among Malay micro-entrepreneurs. In general, this study's findings indicated that most Malay entrepreneurs are not concerned about the importance of managing their finance and creating innovative products in the competitive areas. Also, KTCC is a project that can benefit those Malay micro-entrepreneurs who wisely grab the opportunities. Therefore, they need to consider other entrepreneurial factors that can further develop their business performance without relying on the government and other stakeholders. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).10 Issue No: Vol. 13, No. 2 (2022) - Beach Area Development Strategy as the Prime Tourism Area in Indonesia Authors: Hailuddin HAILUDDIN, Mukmin SURYATNI, Imamudin YULIADI, Syarwani CANON, Syaparuddin SYAPARUDDIN, Endri ENDRI Pages: 414 - 426 Abstract: This research aims to study and analyze the appropriate strategies carried out and developed by stakeholders to build and develop the coastal area of Cemara Sheet as a mainstay tourist area in West Lombok. The development of the coastal regions is significant to create community welfare and educate it to take responsibility and maintain the preservation of the marine environment and the natural surroundings. The research approach used is a qualitative descriptive approach based on field observations supported by secondary data. The collected data is then analyzed using a SWOT analysis by systematically identifying various internal and external factors to formulate the desired development strategy. The logic that is built is how to maximize strengths (Strengths) and opportunities (Opportunities) but simultaneously minimize weaknesses (Weaknesses) and threats (Threats). The results showed that the tourism object of Cemara beach is very potential to be developed because of the natural support of the beach and sea and the surrounding hills. It has a clean and beautiful beach, the mangrove forest, which is still beautiful. In the background, it has an attractive green spread of Sekotong hills, a strategic position as the entrance to Lombok from the sea route, and its safe and comfortable environment. But on the other hand, several things need improvements, such as structuring the housing environment for residents, handling waste, and compliance with tourist facilities such as trash cans, ATMs, toilets, mini markets, prayer rooms, and others. Facilities and infrastructure and supporting infrastructure need attention to be better organized, such as the construction of water games, outbound, and viewing posts. Damaged and narrow road and bridge infrastructure, street and beach lighting are also necessary fixed. If all of these things can be handled properly, then the Cemara beach tourism object will charm and become a mainstay tourist destination that can compete with other tourist objects. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).11 Issue No: Vol. 13, No. 2 (2022) - Banking Risks and Lending to Tourism and Hotel Businesses amid the COVID-19 Pandemic Authors: Gulnur KOZHAMZHAROVA, Lutpulla OMARBAKIYEV, Oksana KOGUT, Saule ZHUMASHEVA, Anelya SAULEMBEKOVA, Gulnar ABDRAKHMANOVA Pages: 427 - 437 Abstract: The purpose of this paper is to explore the risks associated with lending to tourism and hospitality businesses in the context of COVID-19 restrictions. The author proposes a scoring methodology to assess the quantitative and qualitative factors of borrowers’ credit standing based on industry-related risks and the quantification of potential loss given default. The analysis of credit standing draws on actual figures from financial statements of the ten biggest tour operators present in the Russian and Kazakh tourism markets, as well as a survey of experts specialising in bank lending. The findings confirm the proposed hypothesis of a negative impact of the pandemic on the financial condition and credit standing of tourism and hospitality businesses and an increase of banks’ credit risks. The trends of lending to tourism and hotel businesses have indicated a contraction of credit supply as a result of the low credit standing of borrowers. An industry analysis shows that losses from the materialisation of credit risks in the group of tourism businesses could be significant for banks. The author concludes that to maintain financial stability and the level of credit in the industry, the state should continue to support the sector, including the provision of soft loans to help finance some items of expenses. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).12 Issue No: Vol. 13, No. 2 (2022) - The Effect of Social Marketing Strategy on Urban Tourism Growth and Economic Development in Zanjan, Iran Authors: Toktam SALARI, Omar YOUSEFI, Hossein AZIMI Pages: 438 - 444 Abstract: Tourism for cities with tourist attractions such as Zanjan can become the most important source of monetization. Provided that proper and comprehensive planning is planned and implemented for it. The concept of social marketing is based on that each organization must first determine the needs, wants and interests of its target markets, then providing those needs and demands more effective than other competitors in a way that welfare of both customers and society are provided. This article investigates the impact of social marketing strategy on the urban tourism growth and economic development with emphasis on the mediating role of trust. This study, in terms of purpose, is application-oriented and is descriptive-correlational in terms of method. The statistical population of the study consist of experts, specialists and students of Tourism science at Zanjan city. The sampling method was random, and the sample size was calculated based on the Cochran formula of 391 people. The data collection tool is the standard questionnaire which validity and reliability were evaluated by experts and Structural Equation Model (SEM) using desired Cronbach's alpha (0.896), respectively. Data were analyzed using pls3 and SPSS software. The results of the study indicated that social marketing with an intensity of "0.556" and trust with an intensity of "0.258" are effective in the tourism growth and economic development. There is also a meaningful relationship between social marketing and trust. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).13 Issue No: Vol. 13, No. 2 (2022) - A Literature Review of Efficiency Issues in Tourism Authors: Abylkair ASKEYEV, Raissa BAIZHOLOVA Pages: 445 - 455 Abstract: The article analyzes and demonstrates relevant quantitative information on scientific research devoted to the issues of efficiency in the field of tourism in the context of publication periods, journals, authors, citation scores, keyword indexes, methods, and target countries. As a result, the main trends of publication activity were revealed, the leading scientific journals, scientists, countries, the most attractive types of tourism, studied categories of efficiency, developed areas of research, existing methods and features of their use in the study of efficiency issues in the field of tourism were identified. The analysis of variance was used to investigate the relationship between the publication activity of countries in the study of tourism efficiency and the place in the World Economic Forum's travel and tourism competitiveness ranking. It is statistically proved that the publication activity of countries in the study of tourism efficiency is related to their position in the World Economic Forum's travel and tourism competitiveness ranking. “Scopus" scientometric database was used as the information base of the study. At the same time, the authors sorted, calculated and interpreted the data on the studies devoted to the study of tourism efficiency on their own on the basis of a large array of data. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).14 Issue No: Vol. 13, No. 2 (2022) - Cultural Tourism in Developed Island Tourist Destinations: The Development of an Alternative Tourism Model in Corfu Authors: Georgios KONTOGEORGIS, Nikolaos VAROTSIS Pages: 456 - 465 Abstract: The tourism model of 4s prevails as the dominant development model for tourist island destinations. Corfu following the 4s model of tourism development records negative effects which combined with increased environmental sensitivity result in the search for alternative forms of tourism. Cultural tourism based can emerge as an alternative tourism carrying capacity model. The development of the conditions of cultural tourism has not been sufficiently studied for its island destinations. The development of cultural tourism can have the effect of increasing tourism revenues and improving the standard of living in mature tourist destinations such as Corfu. Tourism policy and destination marketing should be devoted into an alternative model of cultural tourism. This article examines a possible correlation between cultural tourism and accessibility, the sun - sea, attractions and sights. Key findings of the present study are that cultural tourism is strongly related with attractions and sights. In addition, there is a relatively small correlation between cultural tourism and accessibility. These research findings can help decision makers, the regional authority, the municipal authority, entrepreneurs involved, and any interested party related to tourism policies and destination marketing understand some of the conditions required for the development of cultural tourism. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).15 Issue No: Vol. 13, No. 2 (2022) - Hotellogy - A New Branch of Philosophy of Science Authors: Sugiyanto SUGIYANTO, Ardi SURWIYANTA, Hermawan PRASETYANTO, Musoli MUSOLI Pages: 466 - 476 Abstract: A phenomenon is an embryo that comes from each science, and each science will have a branch of science. As a science, tourism has many branches of sub tourism science. One branch of tourism science is hotellogy. Hotellogy comes from the word of hotel and logy; hence hotellogy is the study of all tourist activities and the surrounding communities and other things related to tourism. There are three terms of science, e.g., ontology, axiology, and epistemology, which make the hotellogy has strong parallels with other existing sciences. Hotellogy is always dynamic and adaptive to the local and global community that has descriptive and predictions functions in various dimensions; therefore, the development of hotellogy is based on the three systems, e.g., social, economic, and biological systems. This research focuses on exploring hotel studies in Indonesia by pieces of literature. There is an opportunity for researchers to examine the situation of hotels in various countries so that the general results between countries regarding the existence of hotels will become complete and waveform knowledge so that the universal identity will become a universal identity of hotellogy becomes stronger. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).16 Issue No: Vol. 13, No. 2 (2022) - Sustainable Tourism Recovery amid the COVID-19 Pandemic. The Case Study of the Phuket Sandbox Scheme Authors: Hongrui ZHU, Mehri YASAMI Pages: 477 - 485 Abstract: As a tourism-dependent country, Thailand has suffered tremendously amid the COVID-19 pandemic. As a pioneering move to reopen the country, the Island of Phuket has begun to welcome fully vaccinated international visitors under the Phuket Sandbox Scheme since July 2021. This research gained insight into the perceived issues of reviving the tourism industry amid COVID-19 by using the Phuket Sandbox Scheme as a case study. This research undertook a focus group interview of 15 international tourists who have entered Thailand through the Phuket Sandbox Scheme in February 2022. Drawing from thematic analysis, three perceived issues have been identified, including lack of spontaneity, bureaucratic process, and lack of contingency plans. This research contributed to the existing body of knowledge and literature in the subject area of post-crisis tourism recovery and resilience. Also, this research developed a framework that shed light on the essential role played by the central government in coordinating with relevant stakeholders and parties to recover the tourism industry amid the crisis, which goes beyond the context of Phuket. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).17 Issue No: Vol. 13, No. 2 (2022) - Study of the Effects of Marketing Mix and Service Quality on Tourists’ Decisions Authors: Dwi Septi HARYANI, Octojaya ABRIYOSO, Sri KURNIA Pages: 486 - 496 Abstract: Indonesia has some types of attractive tourism in various areas captivating tourists’ interest. However, from 2016 to 2020, the number of tourists visiting tourist destinations decreased since the tourism products offered did not meet the tourists’ expectations and desires, the minimum distribution of tourism products provided, lacking promotion made to the tourists, and the people involved in the tourism industry did not perform optimum services to the tourists. Another problem was the minimum information of the culture, or local culture of an area, tourism products, distribution services, tourism destination promotion, and the characteristics of local society causing tourists reluctant to visit some areas they did not know. This research employed descriptive quantitative based on survey method through path analysis using SPSS 22. The population of this study included 120 million local tourists who would visit various areas in Indonesia in 2020. By accidental sampling technique, 100 people were taken as the samples. The research results based on the partial hypothesis stated that the variables of tourism products offered, tourism product distribution services, and people had a positive and significant effect on the quality of tourism service, and these three variables influenced tourists’ decisions to visit some areas in Indonesia. Simultaneously, the variables of tourism products, tourism product distribution services, tourism product promotion, and people had a positive and significant effect on the tourists’ decisions to visit several tourist destinations in Indonesia through the variable of the quality of tourism services that have been provided. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).18 Issue No: Vol. 13, No. 2 (2022) - Evaluation of the Main Performance Indicators of 4 and 5-Star Hotels using the Example of the Nur-Sultan City, Kazakhstan Authors: Assem BEKBULATOVA, Bakyt SYZDYKBAYEVA, Rina AGYBETOVA, Zhanar DULATBEKOVA, Zhaxylyk AKIMOV Pages: 497 - 506 Abstract: Currently, along with the leading sectors of the world economy, the share of tourism is integral and dynamically growing. Overall, in the Republic of Kazakhstan in order to achieve the proper level of tourism development and in particular the hospitality industry, a number of obvious barriers have to be overcome. At this stage of development these difficulties are related to the natural shortage of professionals, an expanded and advanced transport and information infrastructure, implementation of a number of technological solutions, etc. Undeniable is a fact of a global pandemic which caused the precarious situation of all spheres of the economy. Hotel business is an integral part of the hospitality industry and is a whole category of areas in the service sector, which includes accommodation, food and beverage, event planning, theme parks, cruise travels, airlines and additional tourism areas (Bayandinova 2016, 201). Like any other functioning market object, hotel activities are at risk. The purpose of this research is to study the current situation in the hotel business on the example of Nur-Sultan city, also to consider in detail the work of hotels of selected categories by conducting an efficiency assessment, according to the selected criteria - economic and socio-organizational. The results obtained in this article are relevant for practical application in improving the functioning and effective management in the country's hotel market, especially in current affected situation of the tourism market in general during the pandemic. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).19 Issue No: Vol. 13, No. 2 (2022) - Topical Issues in the Field of Religious Tourism. Current Challenges Authors: Svitlana PANCHENKO, Olena KAROPOL, Oleksandr CHUCHALIN, Tеtiana KOLISNYCHENKO, Kateryna SEFIKHANOVA, Ievgeniia DRAGOMIROVA Pages: 507 - 514 Abstract: The number of political and cultural shifts in Ukraine during the last years have caused the rise of the interest in Ukraine as a place of attraction for religious tourists. As a result of Ukraine's rapid withdrawal from the religious and ideological milieu of the Moscow Patriarchate, getting a Tomos and the creation of the Orthodox Church of Ukraine, the annexation of the Crimean Peninsula (where a fairly high percentage of Muslim believers (Tatars) live and are persecuted), the gradual integration of (mostly) Orthodox Ukraine into the European Union (where most countries profess Catholicism and Protestantism) attract the attention of the European community to Ukraine more than ever in the religious sphere. Today this can become a favorable environment for the world’s getting acquainted with the Ukrainian religious culture, with the promotion of its spiritual heritage, which has been created for thousands of years, for creating a general image of the country as a tourist one. According to the World Tourism Organization, at least 200 million people go pilgrimage annually. Pilgrimage is also gaining popularity in Ukraine every year. The specificity of pilgrimage is determined by the features of the religious consciousness of believers, which in turn is associated with the nature of religious doctrine and cult practices of specific regional destinations. Thus, in the context of the development of modern state tourism policy, once lost traditions of pilgrimage are gaining significant growth in the country. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).20 Issue No: Vol. 13, No. 2 (2022) - Modelling Tourist's Intention to Adopt Travel Applications during the Pandemic. A Bangladesh Perspective Authors: S.M. Shariful HAQUE, Chhali UDDIN, Ashiful ISLAM, Mahedi HASAN Pages: 515 - 529 Abstract: The study's primary purpose is to determine the factors motivating the adoption of online travel applications for booking vacations during the pandemic, specifically amongst the consumers in Bangladesh. The study aims to measure the mediating role of COVID-19 restrictions and information published from time to time on the entire adoption process. The study takes a quantitative approach. A structured questionnaire is used to gather data from 282 respondents nationwide through online mode. A total of 240 respondents showing an interest in online booking of travel are used to analyze the data using Structural Equation Modelling. The EFA and CFA conducted on the 36 items in the questionnaire extracted four factors- two independent variables: Rewarding Motivations and Health Motivations; the dependent variable of Intention to Use and the mediating variable of COVID-19 information. While generating a fit model, there is a significant influence of Rewarding Motivations found on Intention to Use online travel applications with a partially mediating role of COVID-19 information on both the relationships. Empirical evidence from this study will assist tourism marketers in taking sound strategic marketing decisions, which would help revive the tourism sector. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).21 Issue No: Vol. 13, No. 2 (2022) - A Study Architectural and Intangible Environment Affecting Occupancy Rate of Five Stars Business Hotel in Amman Authors: Emad Al Dein Al FAHMAWEE, Omar A. A. JAWABREH Pages: 530 - 545 Abstract: The main objective of the research is to justify the large discrepancy in the occupancy rate among the five-star business hotels in Amman. The study was based on analysing two aspects, namely the service quality and the architectural characteristic as basic determinants for a single category. Descriptive statistics and one way analysis of variance (ANOVA) was used using SPSS to Analyse the impact of service quality on hotel occupancy rates. The analysis of variance for the 18 hotels showed that there is not any significant difference in service quality among five stars hotels in Amman. Three hotel buildings representing the 18 hotels were selected to analyse the impact of architectural characteristics on hotel occupancy rates, interviews and surveys were conducted with the managers and staff, to collect data about the hotel's architectural characteristic Data was distributed and divided into four dimensions to facilitate the process of architectural analysis, then projected through architectural drawings for comparisons between them; they are narrative design, zoning and privacy in guest rooms, functional hotel components and the architectural composition planning, which has been proven in this research to have a significant impact on occupancy rate, customer satisfaction and loyalty. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).22 Issue No: Vol. 13, No. 2 (2022) - Villages’ Revitalization Supports a Sustainable Agritourism in Albania Authors: Anila SULAJ, Arben TËRPOLLARI, Brunilda KONDI Pages: 546 - 560 Abstract: Our study assesses the socio-economic impact of villages’ revitalization on the sustainable agritourism in Albania. From the data obtained from the interviews conducted, that the development of agritourism remains a good opportunity for the development of this sector and the promotion of entrepreneurship in rural areas. Analysis of questionnaire data on the impact of the project “100 villages” undertaken by the Government of Albania shows the impact of villages’ revitalization on supporting sustainable agritourism by increasing visitor interest, empowering entrepreneurship in rural tourism, mainly on agritourism farms through revitalization of economic activities such as agro-processing, production of traditional food and gastronomy. Revitalization of cultural heritage, objects and historical sites in villages as well as restoration of objects and archeological centers create premises for agro-tourism attractions. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).23 Issue No: Vol. 13, No. 2 (2022) - Comparative Bibliometric Analysis of the Concepts of “Ecotourism” and “Agrotourism” in the Context of Sustainable Development Economy Authors: Oleh VYSOCHAN, Natalia STANASIUK, Mykhailo HONCHAR, Vasyl HYK, Nataliia LYTVYNENKO, Olha VYSOCHAN Pages: 561 - 571 Abstract: Discussions on such concepts as rural tourism, ecotourism, agrotourism, green tourism, and farm tourism are still ongoing among tourism professionals. The article aims to outline trends and priorities in the study of the definitions of “ecotourism” and “agrotourism” in the context of sustainable development economy, to identify commonalities and differences, to identify journals and researchers engaged in research in this area. In the course of work on the article, the latest research and publications of scientists in the field of ecotourism and agrotourism were analyzed according to the Scopus Elsevier database and the Web of Science Core Collection in the period 2005-2020. On the subject of agrotourism, which indicates the greater prevalence and use of the first term. The content analysis by countries made it possible to establish that the use of the term ecotourism is typical of the Anglo-American world (United States, Australia, United Kingdom), while the term agrotourism is used mainly in Eastern Europe (Romania, Poland, Czech Republic). If we compare the concepts of ecotourism and agrotourism by keywords, it is determined that both have in common the study of tourism in sustainable development, models of interaction with the environment, prospects for rural tourism and other related topics. As a result, it can be concluded that the study of issues and problems in the field of ecotourism and agrotourism in the context of sustainable development economy are extremely popular and relevant in the scientific literature. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).24 Issue No: Vol. 13, No. 2 (2022) - The Impact of COVID-19 Pandemic on Nature-Based Tourism in National Parks. Case Studies for Poland Authors: Mateusz ROGOWSK Pages: 572 - 585 Abstract: The study aims concern to nature-based tourism in national parks, to compare visitor behavior and visitors’ spatial and temporal distribution in national parks during the COVID-19 (2020) and pre- COVID-19 period (2017–2019). The research is based on a pyroelectric sensors data, entrance fees and questionnaire survey of visitors, in order to: (1) assess the spatial and temporal distribution and changes of visitors, (2) characterize changes in visitors’ behavior. The visitor number and spatial and temporal distribution changed during COVID-19 period. The visitor’s behavior identifies three visitor clusters depending on the strength of COVID-19 pandemic impact on stay on national parks: High fear visitors (HFV), Low fear visitors (LFV) and No fear visitors (NFV). Each cluster represents a different attitude toward the pandemic and its effects. The research was conducted in two national parks in Poland: Stołowe Mountains National Park and Karkonosze/Giant Mts. National Park. The resulting data were compared with data from previous years. A total of 935 respondents participated in the survey, which demonstrated a significant impact of the ongoing pandemic on many aspects of the behaviors. Most visitors argued that the pandemic had not changed their behavior because society began to perceive national parks as safe destination with a low probability of infection. PubDate: 2022-03-31 DOI: 10.14505/jemt.v13.2(58).25 Issue No: Vol. 13, No. 2 (2022) - National and European Actions for the Development of Rural Areas - Stimulus for Ensuring the Sustainability of Economic Development Authors: Teodor Marian COJOCARU, Ramona PÎRVU, Sorin DINULESCU, Lili ȚENEA Pages: 586 - 599 Abstract: The policies of the European Union pursue a sustainable and balanced development of the territory of the Community, these aspects being found in the objectives of the UN Agenda for Sustainable Development 2030. Among these objectives are some in the field of agriculture and rural development such as: SDG 2: eradicating world hunger, EU agriculture ensures that food is produced sustainably for all EU citizens, and that EU food exports contribute to food security in third countries. EU rural development and agriculture policies also support other SDGs: SGD 1 (without poverty), DGS 8 (decent work and growth), SGD12 (responsible consumption and production) and SGD 15 (terrestrial life). The article analyses the National Rural Development Program that was created to support through non-reimbursable funds from the European Union and the Romanian Government the economic and social growth of rural areas in Romania, starting from the 6 priorities defined at the European Union level. Thus, we will study the rural development measures financed through the NRDP, in the period 2014-2020, with a total financial allocation of 9.333 billion euros, of which 8.015 billion euros from the EAFRD and 1.347 billion euros representing the national contribution. We will present these measures in detail, based on public data available in August 2021.

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biceps muscle, any muscle with two heads, or points of origin (from Latin bis, “two,” and caput, “head”). In human beings, there are the biceps brachii and biceps femoris. The biceps brachii is a prominent muscle on the front side of the upper arm. What are two 2 major muscles in the arm? Upper arm muscles - Biceps brachii. Often referred to as your biceps, this muscle contains two heads that start at the front and back of your shoulder before joining together at your elbow. … - Brachialis. This muscle lies underneath your biceps. … - Coracobrachialis. This muscle is located near your shoulder. What are the two heads of the bicep? The muscle is composed of a short head and a long head. The long head is located on the lateral side of the biceps brachii while the short head is located on the medial side. The biceps brachii works across three joints, and is able to generate movements in glenohumeral, elbow and radio-ulnar joints. What muscle is the flexor of the arm two heads? Flexor carpi ulnaris originates with two heads which are linked by a tendinous arch. The heads are named according to the bones they attach to; The smaller humeral head arises from the common flexor origin on the medial epicondyle of humerus. What muscle is 3 headed and in the arm? triceps muscle, any muscle with three heads, or points of origin, particularly the large extensor along the back of the upper arm in humans. It originates just below the socket of the scapula (shoulder blade) and at two distinct areas of the humerus, the bone of the upper arm. What muscles make up the arm? The muscles that make up the upper arm include the biceps brachii, triceps brachii, brachialis, coracobrachialis, and the anconeus. Where is deltoid muscles? The Deltoid muscle is a large triangular shaped muscle which lies over the glenohumeral joint and which gives the shoulder its rounded contour. What are the heads of the triceps? The triceps brachii actually has 3 different heads! The long head, lateral head, and medial head. The long head is the only one that actually originates from the shoulder – specifically the infraglenoid tubercle of the scapula. What is the long head of biceps? What is the long head of biceps tendon? There are two tendons that attach the biceps muscle to the shoulder: the ‘long’ head and the ‘short’ head. The long head passes into the shoulder joint through a groove in the arm bone and then a hole in the rotator cuff. Finally, it attaches to the top part of the labrum. What is the short head of the bicep? The short head of the biceps brachii is the shorter and medial of the two bodies that form the biceps brachii muscle in the upper arm. Like the long head of the biceps brachii, the short head is a flexor and supinator of the elbow joint. At the shoulder joint, the short head aids in adduction of the humerus. What is palmaris longus? The palmaris longus belongs to the anterior forearm flexor group in the human upper extremity. The muscle attaches proximally to the medial humeral epicondyle and distally to the palmar aponeurosis and flexor retinaculum. What is FCU tendon? The Flexor Carpi Ulnaris (FCU) tendon is on the palmar side of the wrist, on the small finger side. The FCU is one of the major tendons that flex the wrist. Occasionally, overuse can cause damage to the FCU tendon. What is FCU muscle? Flexor carpi ulnaris muscle (FCU) is the most medial flexor muscles in the superficial compartment of the forearm. It can adduct and flex the wrist at the same time; acts in tandem with FCR to flex the wrist and with the extensor carpi ulnaris to adduct the wrist. What are the 3 muscles of the triceps? The triceps, or triceps brachii (Latin for “three-headed muscle of the arm”), is a large muscle on the back of the upper limb of many vertebrates. It consists of 3 parts: the medial, lateral, and long head. What is a fore arm? noun. fore·arm | ˈfȯr-ˌärm Definition of forearm (Entry 2 of 2) : the part of the human arm between the elbow and the wrist also : the corresponding part in other vertebrates.

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We ask our wrists for strength and flexibility in yoga. Here are some pointers for keeping these complex joints safe and for rehabbing them if they've been strained. Yet such weight bearing is a very important part of asana practice. If you've ever had a wrist problem, you know how much it can interfere with your yoga. Wrist injuries can be especially demoralizing if you prefer a vinyasa-based style, in which you place weight on the hands over and over again as you flow through the classic Sun Salutation series—which includes Plank Pose, Chaturanga Dandasana (Four-Limbed Staff Pose), Urdhva Mukha Svanasana (Upward-Facing Dog Pose), and Adho Mukha Svanasana (Downward-Facing Dog Pose). If your wrists are strained, such asanas can cause you pain and further injury. Fortunately, a careful and gradual approach to increasing wrist flexibility and strength can help most students avoid problems—or rehabilitate the wrist if necessary. WEIGHT BEARING ON THE ARMS seems to bring out the wrist's vulnerability. After all, the wrist is a relatively small joint, and a lot of rather delicate tissues are packed into this small area. These tissues include ligaments that knit the wrist bones together, as well as tendons that connect the forearm muscles to the fingers and help give the fingers their remarkable dexterity. Strain or irritation in these tendons can be a major factor in wrist pain. To understand what causes this kind of pain, it's useful to consider the structure and function of a normal wrist. The wrist helps with control of the fine motor activities of the fingers and thumb by positioning and stabilizing the hand, which allows us to accomplish uniquely human endeavors like writing, drawing, and sewing. Most of the wrist's movement occurs at the juncture of the radius (one of the two forearm bones) and several of the carpal bones, which sit deep in the heel of the hand. Some movement also occurs at the junctures between the individual carpal bones. Most likely, you spend a lot of time every day with your wrist in mild extension. The hand has its most powerful grip in this alignment, and this position is the one we use most often in daily activities. So your wrist probably spends very little time in full flexion or full extension. Since the wrist, like any joint, will lose any part of its range of motion that isn't used regularly, most people gradually lose the ability to move easily and safely into full wrist extension (a 90-degree angle between the hand and forearm). But as soon as you take a yoga pose in which you bear most or all of your weight on your hands, you demand extension from your wrists. Several of the postures in Sun Salutation—Plank, Chaturanga Dandasana, Urdhva Mukha Svanasana—require full extension, so performing the series over and over can put a cumulatively heavy load on the wrists. Arm balances like Bakasana (Crane Pose) and Adho Mukha Vrksasana (Handstand) add insult to injury by pressing all of your body weight into your wrists while they are fully extended. Combining extreme range of motion with a heavy load and multiple repetitions can easily add up to strain. Under such conditions, it shouldn't be too surprising if the wrists send up a red flag: pain. I believe that a substantial part of yoga practitioners' wrist pain is caused by soft-tissue strain that occurs when the ligaments and tendons are forced into extension beyond their customary range. Before resuming the poses that require 90 degrees of extension—or before embarking on them, if you're a beginning yoga practitioner—it's a good idea to check the range of extension of your wrists. You can do this by coming to your hands and knees with the heels of your hands directly under your shoulders. Your wrists are now at 90 degrees of extension. Are they completely comfortable in this position? If not, you should work to gently and gradually increase your wrist extension. An easy way to do this is to put your hands together in Namaste (Prayer Position) in front of your chest. Keeping the heels of your hands together and your fingers pointing up, gently press your hands down toward your waist. Don't let the heels of your hands come apart; if you do, you'll lose the wrist stretch. If you regularly hold this stretch for a minute or two as part of your daily routine, you'll gradually be able to move the wrists into deeper extension. Other positions can also introduce the wrists to weight bearing. Adho Mukha Svanasana puts some weight on the wrists but doesn't force them into 90 degrees of extension, so the joints feel more open and are less likely to be painful than in full-extension poses. Downward Dog provides an excellent way to build arm and shoulder strength, thus helping prepare you for Plank, Handstand, and other arm balances. You might also find relief from wrist pain in Plank and arm balances by grasping dumbbells placed on your mat, pointing toward the front edge; they allow the wrists to be in a neutral position. (It's best to use dumbbells with square weights, not round ones, so they can't roll around.) A foam-covered yoga prop called Gripitz, which is shaped like a dumbbell, was recently designed for just this purpose; you can buy it at www.gripitz.com. Be very cautious when you begin to explore arm balances using wedges or dumbbells—the props shift your center of gravity and your alignment, so the poses may seem a little unfamiliar or awkward for a while. Working with the alignment of your shoulders, arms, and hands can also help take strain off your wrists. In Downward Dog, for example, many students take virtually all of their weight on the heels of their hands. Instead, press down with the knuckles where the fingers join the palms. Stretch the fingers forward and at the same time visualize that you are lifting the forearms up out of the wrists. Try to apply this action whenever you're bearing weight on the hands. Carpal tunnel syndrome is a fairly common, painful condition caused when the narrow tunnel formed by the carpal bones and adjacent ligaments puts pressure on the median nerve and finger flexor tendons that pass through the tunnel. If you think you may have carpal tunnel syndrome, it's important to get an accurate diagnosis from a health care professional. Conventional medicine usually treats the syndrome with medication, splints, or surgery, but you might also want to seek out the asana sequence created by Iyengar Yoga teacher Marian Garfinkel, director of the B.K.S. Iyengar Yoga Studio of Philadelphia. In a medical study published by the Journal of the American Medical Association (November 11, 1998), Garfinkel documented that the program she developed helped the carpal tunnel sufferers who tried it. Whatever the status of your wrists—currently painful, in recovery, or blessedly problem-free—remember that yoga is meant to be a beneficial, healing practice. Make sure you aren't straining your wrists through yoga. If you have done so, integrate some of the gentler poses mentioned in this article into your routine and give your wrists a chance to build strength, flexibility, and endurance before you take on more advanced or strenuous weight-bearing poses.

http://gudmestadyoga.com/bearing_up_under_pressure

The forearm is one of the more confounding areas of the body. Most of the muscles that move the hand are on the forearm, and for every motion of the palm and fingers there is a corresponding muscle to execute it. In order to simplify the forearm, we can break it into four masses. The first mass is brachioradialis (bray-kee-oh-ray-dee-AL-iss). This large muscle is the only flexor that attaches to the lateral epicondyle of the humerus; the rest go to the medial epicondyle. This fact, plus its size, make it a handy divider between the extensor and flexor masses described below. The flexor mass includes the rest of the muscles that curl the wrist and fingers into a closed position. All of these muscles originate on the medial condyle of the humerus. Most of them lie on the palm-side of the forearm. (An important influence on their form by biceps is described under the listing for that muscle.) The extensor mass includes muscles that straighten the wrist and fingers and pull them into an open position. All of these muscles orginate on the lateral epicondyle of the humerus, and mostly lie on the dorsal side of the forearm. The fourth division is the thumb group of the forearm. These two muscles on the forearm move the thumb. They originate lower down on the radius and ulna. Just as brachioradialis divides the the flexor and extensor masses in front, the ulna divides them in the back. The lower end of the ulna and the elbow are readily visible, and it is easy to imagine the line between them that divides the two groups. Every forearm muscle can be distinguished only on the most heroic kind of figure. More commonly, the forearm can be drawn simply in terms of the four masses, especially when the arm is relaxed. These masses provide a useful starting point for further development of the shapes of the arm. To avoid tiresome repetition, the following pronunciations and derivations are given here: |carpi||CARP-ee||referring to the carpal or metacarpal bones| |digitorum||dij-ih-TOE-rum||digits - the fingers| |pollicis||POL-iss-iss||the thumb| |radialis||ray-dee-AL-iss||the radius or radial side of arm| |ulnaris||ul-NAIR-riss||the ulna or ulnar side of arm| Extensor, flexor, longus, and brevis are used as above. This makes most of the names of the forearm muscles self-explanatory.

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Presentation is loading. Please wait. Published byEmory Armstrong Modified over 6 years ago 1 Method of Study for This Section Read assigned readings of text Use Thompson Manual and the Dynamic Human CD- ROM to help review structure of bones, joints, and muscles as necessary. This is the purpose of lab. Complete labs conscientiously and study models of articulated skeleton, shoulder, spine, and knee Lecture will only provide a selective review of structure, muscles & movements, and movement-related issues For exams, review lecture notes and understanding questions in both lecture and labs 2 Objectives Explain how anatomical structure affects movement capabilities on upper extremity articulations. Identify factors influencing the relative mobility and stability of upper extremity movements Identify muscles that are active during specific upper extremity movements Describe the biomechanical contributions to common injuries of the upper extremity. 3 Sh Jt & Girdle Ant Musculature 4 Sh Jt & Girdle Post Musculature 5 Upper Extremity – Chapter 7 Shoulder Girdle Structure: 6 Muscles and Movement of Shoulder Girdle Illustrations on next three slides Trapezius(large, superficial medial and sup to scapulae) –Upper portion - elevation, upward rotation –Middle portion - adduction, or retraction –Lower portion - depression, upward rotation Rhomboids - –elevation, downward rotation, adduction, or retraction Serratus anterior (underneath scapulae) –abduction, upward rotation Pectoralis minor (underneath pectoralis major) –downward rotation, abduction, or protraction Levator Scapulae (underneath upper trapezius) –elevation, downward rotation 7 Elevation and Depression 8 Upward & Downward Rotation 9 Protraction & Retraction 10 Shoulder Joint Structure 11 Shoulder Joint Stabilizers Stabilizers and rotators - Rotator cuff muscles – –Teres minor - external rotation –Infraspinatus - external rotation –Supraspinatus - abduction –Subscapularis - internal rotation 12 Shoulder Joint Primary Movers Anterior movers – Anterior deltoid, pectoralis major Superior movers - middle deltoid Posterior movers - posterior deltoid Inferior movers - latissimus dorsi, teres major, lower pectoralis m. Force vectors of muscles (see next slide) 13 Shoulder Jt Muscles 14 Movements of Shoulder Complex Every movement of upper extremity involves either stabilizing or accomodating action of the shoulder girdle. –If carrying something in arms, scapular elevators are involved –Arm elevation – scapular protraction and/or upward rotation (first 30°,1/5 th is scapular movement; then ½ scapular movement) 15 Shoulder Joint Impingement Syndrome What is it? Pain from shoulder area resulting from impingement of structures between humeral head, acromion, and coracromial arch. Three stages: –Stage I - edema and hemorrhage of subacromial structures –Stage II - tendon fibrosis and bursal thickening –Stage III - rotator cuff tears, biceps tendon ruptures, and bone spurs I: II:III: 16 Causes of Sh Jt Impingement Primary impingement: –Repeated movements requiring elevated and/or medially rotated humerus, compounded by weak rotator cuff muscles, causing: impingement of long head of biceps, supraspinatus Secondary Impingement: –Decreased volume of subacromial space due to glenohumeral joint instability, and perhaps joint capsular tightness Structural abnormalities: –hooked or curved acromion, calcium deposits, bone spurs, thickened bursa, thickened ligaments 17 Shoulder Jt Impingement (3) Treatment: –Related to the cause - may involve surgery, rotator cuff strengthening, and flexibility exercises. –Later, avoid humeral elevation and rotation movements. http://www.aafp.org/afp/98021 5ap/fongemie.html –Website for Shoulder JointImpingement SyndromeWebsite for Shoulder JointImpingement Syndrome 18 Elbow Joint Structure 19 Elbow and Wrist Joint Muscles True Flexor - Brachialis Flexor-Supinator - Biceps brachii Extensor - Triceps brachii Wrist flexors (medial epicondyle of humerus) –Flexor carpi ulnaris and flexor carpi radialis Wrist extensors (lateral epicondyle of humerus) –Extensor carpi ulnaris & extensor carpi radialis Force vectors of muscles on next slide KIN 330Biomechanics 20 Muscles of elbow joint: 21 Muscles and Movements of Radioulnar Joint Elbow Flexion - –Forearm Supination - Biceps Brachii – Forearm Pronation - Pronator Teres Elbow Extension - –Forearm Supination - Supinator –Forearm Pronation -Pronator Quadratus Muscle force vectors on next slide Epicondylitis –The most common cumulative trauma disorder (CTD), repetitive stress injury (RSI), repetitive motion disorder (RMD), or overuse syndrome (OS) is epicondylitis –Epicondylitis websiteEpicondylitis website 22 Radioulnar Jt Muscles 23 Bones of Wrist and Hand 24 Carpal Tunnel Syndrome Background Carpal tunnel includes median nerve and 9 flexor tendons ( 4 flex dig sup, 4 flex dig prof, 1 fl pol l) 25 Carpal Tunnel Syndrome (cont’d) Symptoms –Pain in wrist area, or referred proximally or distally –Tingling of thumb, fingers, or palmar side of hand –Loss of control of muscles affected by median nerve blockage Causes –Enlargement of tissues within tunnel –Decreased size of tunnel –Extraneous tissue in tunnel Treatment –Related to cause Website for prevention of repetitive stress injury at computer workstations: CUergo: Neutral Posture TypingCUergo: Neutral Posture Typing KIN 330Biomechanics 26 Review & Homework Problems for Chapter 7 Review problems: –Torque at shoulder with elbow flexed vs extended Fig 7-15, 7-16 –Compressive force at shoulder jt Fig 7-17, sample problem 1 p 197 –Elbow flexion force Figure 7-25, sample problem 2 p 206 Homework – due Wed October 13 –Introductory problems, p 217: # 8,9,10 –Additional problem, p 218: #10 Similar presentations © 2021 SlidePlayer.com Inc. 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Pain in elbow from armwrestling movements is nothing new. We all have experienced different kind of pain in elbow joint sometimes it`s tendons but sometimes its one or many of muscles involved in movement. With this video we are starting series that focus on things that could cause pain in elbow. Today we are talking about muscle named Pronator Teres. it`s main function is to pronate arm and flex elbow. Sometimes from all pronation and elbow flexion this muscle can get tight and shorten what you need to do is to release it with trigger point active release techniques. you need to release it. It can cause pain in medial epicondylus and in muscles surrounding your elbow, also numbness in fingers. All symptomes can cause something called Pronator Teres Syndrome. Pronator teres syndrome Pronator teres syndrome is a compression neuropathy of the median nerve at the elbow. It is rare compared to compression at the wrist (carpal tunnel syndrome) or isolated injury of the anterior interosseous branch of the median nerve (anterior interosseous syndrome). The most common cause is entrapment of the median nerve between the two heads of the pronator teres muscle. Other causes are compression of the nerve from the fibrous arch of the flexor superficialis, or the thickening of the bicipital aponeurosis. The median nerve passes through the cubital fossa and passes between the two heads of pronator teres muscle into the forearm. It then runs between flexor digitorum superficialis and flexor digitorum profundus muscles and enters the hand through the carpal tunnel. Pronator Teres Muscle The pronator teres has two heads—humeral and ulnar. - The humeral head, the larger and more superficial, arises from the medial supracondylar ridge immediately superior to the medial epicondyle of the humerus, and from the common flexor tendon (which arises from the medial epicondyle). - The ulnar head is a thin fasciculus, which arises from the medial side of the coronoid process of the ulna, and joins the preceding at an acute angle. The median nerve enters the forearm between the two heads of the muscle, and is separated from the ulnar artery by the ulnar head. The muscle passes obliquely across the forearm, and ends in a flat tendon, which is inserted into a rough impression at the middle of the lateral surface of the body of the radius, just distal to the insertion of the supinator. The lateral border of the muscle forms the medial boundary of the triangular hollow known as the cubital fossa, which is situated anterior to the elbow. Arm Wrestling Muscle Take a look at the following picture of two men arm wrestling, paying close attention to the position of the forearm of the person who is winning this match. What Does the Pronator Teres Do? The name of the pronator teres gives away its function. Pronation refers the inward rotation of a body part towards the middle of the body. Since the pronator teres is located in the forearm, its function is to rotate (pronate) the forearm inward. Think back to the arm wrestling example from the beginning of the lesson; an arm wrestler must internally rotate (pronate) their forearm in order to pin the arm of their opponent. The pronator teres is not only used during arm wrestling; this muscle is used hundreds of times each day. Performing simple tasks like brushing your teeth, combing your hair, and eating all require forearm pronation, and therefore require the use of the pronator teres. The pronator teres also functions to flex the forearm, which involves bending the arm at the elbow joint. For more Armwrestling videos click this button:

https://www.xsportnews.com/anatomy/video-get-rid-elbow-pain-release-pronator-teres-muscle/

Muscular Angelynn Torres Period 4 (Muscles & Function: (Flexor Carpi… Muscular Angelynn Torres Period 4 Major Functions of the Muscle Elasticity: Ability of a muscle cell to recoil and resume its resting length after stretching Produce movement: Skeletal muscles are responsible for locomotion and manipulation. blood coursing through body due to heartbeat and propels substances Extensibility: ability to extend or stretch the muscles Maintain posture: make adjustments to counteract gravity Contractility: the ability to shorten forcibly when stimulated Stabilize Joints: strengthen and stabilize the muscle Excitability: responsiveness, ability of a cell to receive and respond to stimulus by changing ts membrane potential. Stimulus is usually a chemical Generate Heat: generate heat as they contract, maintain body temperature Muscles & Function: Flexor Carpi Ulnaris: located on the ulnar side of the forearm adduct and flex the wrist at the same time Extensor Digitorum: Located on muscle of the posterior forearm movements of the wrists and the elbows Extensor carpi radialis: Located on the lateral side of the humerus, long -muscles that control movements at the wrist iliopsoas: anterior hip muscle flex the thigh at the hip joint latissimus dorsi: located in the middle of the back, and it is partially covered by the trapezius Extension and flexion of shoulder joint adductor longus: located in the thigh adduct the thigh teres major: located on the underside of the upper arm medial rotator and adductor of the humerus sartorius: longest muscle in the entire human body muscle found in the anterior region of the thigh flexor and rotator of the thigh at the hip joint. Infraspinatus: triangular-shaped muscle located at the back of the shoulder externally rotate the humerus and stabilize the shoulder joint gracilis: found in the groin responsible for hip adduction and assists knee flexion External oblique: located on the outer surface of the sides of the abdomen help pull the chest, as a whole, downwards rectus femoris: located in the middle of the front of the thigh helps to extend or raise the knee rectus abdominis: Located at the abdominal region Flexion of the thoracic and lumbar spine vastus lateralis:located on the side of the thigh extend the lower leg Flexor carpi radialis: Located on the anterior part of the forearm Acts to flex and abduct the hand vastus medialis: located on the front of the thigh knee extension, along with the other muscles which make up the quadriceps muscle Brachioradialis: located in the forearm muscle of the forearm that flexes the forearm at the elbow bicep femoris: hamstring muscles at the back of the thigh -extending the thigh, bending the knee, and rotating the knee toward the outside of the body Tricep Brachii: At the back of the humerus (upper arm) between the shoulder and the elbow Responsible for extension of the elbow joint semitendinosus: one of the hamstring muscles -flex the knee and extend the hip Bicep Brachii: located in the anterior region of the upper arm It helps control the motion of two different joints, the shoulder and the elbow semimembranosus: back of the thigh and runs from the base of the pelvis enabling the leg to flex and rotate Serratus Anterior: On the surface of the 1st to 8th ribs at the side of the chest Allow the forward rotation of the arm and to pull the scapula forward and around the rib cage. tibialis anterior: lateral surface of the tibia It acts to dorsiflex and invert the foot extensor digitorum longus: located at the front of the leg extend your toes and dorsiflex your feet Pectoralis Major: Large muscle in the upper chest Movement of the shoulder joint. Deltoid: The deltoid muscle is a rounded, triangular muscle located on the uppermost part of the arm and the top of the shoulder -Allows you to flex your shoulder joint and rotate the shoulder inward Sternocleidomastoid: The manubrium of the sternum and the clavicle. It travels obliquely across the side of the neck Flexes the neck and helps with movement of the head Trapezius: The trapezius muscle extends from the occipital bone. Located at the base of the skull. Used to tilt and turn the head and neck, shrug, steady the shoulders, and twist the arms. Elevates, depresses, rotates, and retracts the scapula fibularis longus: lateral shaft of the fibula flexes the ankle gastrocnemius:located on the back portion of the lower leg plantar flexing the foot at the ankle joint and flexing the leg at the knee joint soleus: back part of the lower leg plantarflexion of the foot 3 types of muscle tissue: Function: Cardiac Muscle: Striated not voluntary, can contract without being stimulated by nervous system, but no conscious control of heartbeat Skeletal Muscle: skeletal muscle fibers are longest muscle cells have striations activated by reflexes, is known as voluntary muscle, conscious control Body mobility contract rapidly tires easily needs rest adaptable force Smooth Muscle: forces fluids and substance internal body channels forms valves to regulate passage of substances through internal body openings dilates and constricts pupils forms arrecter pili muscles attached to hair follicles elongated cells no striations no voluntary control Type: Skeletal Muscle: Skeletal Muscle tissue organs attach to and cover the skeleton Smooth Muscle: in the walls of hollow visceral organs, such as stomach, urinary bladder, and respiratory passages Cardiac Muscle: Only in the heart, constitutes bulk of the heart walls Body Movement Terminology: Chewing Depression: moving elevated part inferiorly Elevation: Moving elevated part superiorly, shoulder shrug Retraction: Jaw in protraction: jaw out Circumduction: Moving a limb so that it describes a cone in space, distal end of limb moves in a circle Rotation: Turning of a bone around its own long axis Flexion: Bending movement along sagittal plane, decreases angle of joint and brings articulating bones closer Extension: Reverse of Flexion increases angle between articulating bones, straightens a flexed limb Dorsiflexion: Lifting the foot Plantar Flexion: Depressing the foot, pointing toes down Pronation: Radius rotates over the ulna Supination:radius and ulna are parallel Inversion: Sole of foot turns medially Eversion: sole faces laterally Abduction: movement away from the midline of the body Adduction: movement torwards the midline of the body Structure and organizational levels of skeletal muscle: Skeletal Muscle: Long cylindrical cell with multiple oval nuclei, just beneath its sarcolemma or plasma membrane Thin Filaments: Contain actin and extend across the I band and partway into the A band z disk Ca protein sheet, anchors the thin filaments * lateral Actin: protein with kidney shaped polypeptide subunits called globular actin Thick filaments: contain myosin and extend the entire length of the A band - connected to the middle of the sarcomere at the M line * central Tropomyosin: A rod shaped protein, spiral about the actin core and help stiffen and stabilize it Myofilaments: smaller structures within sarcomeres muscle equivalents of the actin- containing microfilaments and myosin motor proteins motility and shape change of cells Troponin: Other major protein in thin filaments is a globular protein with 3 polypeptide subunits Sarcomeres: Region of a myofibril between two successive Z disks smallest contractile unit of a muscle fiber - functional unit Elastic Filament: composed of the giant protein titin it holds the thick filament in place, maintaining organization of the A band and helps the muscle cells spring back into shape after stretching Striations: repeating series of dark and light bands evident along the length of each myofibril Dystrophin: links the thin filaments to the integral proteins of the sarcolemma Myofibrils: Densely packed in the fiber that mitochondria and other organelles appear to be squeezed between them Sarcoplasmic Reticulum: an elaborate smooth endoplasmic reticulum regulates levels of ionic calcium, stores calcium, and releases it on demand when the muscle fiber is stimulated to contract Myoglobin: Red pigment that stores oxygen T Tubules: Sarcolemma of a muscle cell protrudes deep into the cell interior, forming an elongated tube Sacroplasm: cytoplasm of a muscle cell, contains ussually large gllycosomes Physiology of muscle contraction (the sliding filament theory): The calcium binds to troponin and causes the tropomyosin to move The myosin then binds with actin and forms a crossbridge Calcium Ions are released into the sarcoplasm and eventually reach the sarcomere ADP is released from myosin and a power stroke occurs The impulse travels through the sarcolemma and down T tubules ATP binds to myosin and releases actin. ATP becomes ADP again. The myosin is ready to form a crossbridge once again The impulse goes to the motor neuron and eventually reaches a neuromuscular junction acetylcholine is released and triggers an impulse Ca^2+ is released and prevents contractions. Relaxation occurs The brain sends an impulse signal to the muscles Disorders associated with the muscular systems: Ruptured Calcaneal Tendon: rupture of the strongest tendon Shin splints: medial tibial stress syndrome, painful inflammation of muscles, tendons and connective tissue surrounding tibia.

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For many individuals popping a pill to help alleviate pain is no big deal. The danger in doing so is that you may need to consume more and more in order to get relief. If you are suffering from pain in your muscles around your elbow and you are self medicating just to get pain relief, then this short informative article will tell you everything you need to know because … Not being proactive about muscle pain and ignoring it may prolong the amount of time you will need to make a full recovery. In order to get a complete picture of what pain in your elbow muscles really means, we need to first identify the muscles that connect and come together to form your elbow. Your forearm is comprised of bone and muscle. These flexor and extensor muscles lead to and connect via tendons at your elbow. These forearm muscles sit in what is referred to as the anterior compartment. This compartment is broken down into three main categories: superficial, intermediate and deep muscles. The muscles in this compartment are responsible for forearm flexion at the fingers, wrist and pronation. Superficial Muscles There are four superficial muscles that make up the anterior compartment: pronator teres, palmaris longus, flexor carpi ulnaris and the flexor carpi radialis. What’s really important here is the attachment point of where they all meet at your elbow. The location is called the medial epicondyle. When people refer to an elbow muscle strain or perhaps a muscle spasm on the inside of their elbow, this is usually the area in which they experience pain. Inner elbow pain symptoms is a sure sign that you have golfers elbow. Flexor Digitorum Superficialis This is the only muscle that makes up the intermediate compartment of your forearm muscles. Because it’s not usually a factor when it comes to elbow problems, we will skip it’s purpose and explanation. For your own interest, you can read more about the flexor digitorum superficialis muscle and get all the facts. Extensor Carpi Radialis Longus Muscle If you are suffering from forearm muscle pain near elbow especially on the outer part of your elbow, then it is this muscle and attaching tendon that is usually injured and affected. Read: 5 Steps On How to Stop Outer Elbow Pain Quickly This muscle runs along the lateral side of your forearm and attaches at your elbow via your common extensor tendon at the lateral epicondyle. It is responsible for performing the action of extending your wrist. If you have read this far, great because medical jargon can be hard to follow but Read on to learn what works best to stop the pain in the muscles around your elbow. In a nutshell here is what is really important when it comes to figuring out why you have pain in the muscles around your elbow. It all boils down to the muscles on the inside of your forearm and the muscles on the outside. Your flexor muscles allow you to bend your wrist inwards and extensor muscles are responsible for extending your wrist upwards. Press play on the video below that goes into more detail about elbow anatomy and the muscles of the elbow: Decision Time – Where and When Does Your Elbow Hurt Most? If your pain is located mostly on the inside of your elbow, and increases when you twist your forearm inwards towards your body, then you most likely have golfers elbow. But if you are like most people, your pain is felt mostly on the outside of your elbow and gets worse when you carry something heavy, using tools such as screwdrivers/hammers, or even just gripping the kettle to pour a cup of tea – then you most likely have the number one repetitive strain injury – tennis elbow. With names like “golfers” and “tennis” elbow you would think that these injures only happen to individuals who play these sports but .. You would be wrong! To be straight up front with you, any Doctor will tell you that you are more likely to develop and get tennis elbow on the job then you are playing tennis. It’s not uncommon for people who work with their hands eight hours a day to get tennis elbow. Actions that don’t require a lot of strength or power are not usually at fault. It’s all about the movement of your arm, hand and wrist. Think repetitive and not force. So any sort of movement where you are constantly extending your wrist is how tennis elbow manifests. Performing repetitive tasks with your arm over many days or months causes your extensor tendon to inflame and become stressed. The common extensor tendon attaches your forearm extensor muscle at the lateral epicondyle, which in the end breaks down and gets torn. You should be surprised to learn that the greater the tear, the greater the pain. If you are like most people, you had early warning signs that things were not right with your elbow. Perhaps a slight pain in your elbow that used to come and go? Your grip strength getting weaker over the past few days or weeks? Dropping items more frequently? Is the pain in your elbow sharp, sudden, persistent or random? Difficulty in extending your affected arm or straightening it out? Have you noticed and elbow inflammation or swelling over the past two or three weeks? If you haven’t don’t worry because after three weeks the swelling goes away as your body lays down scar tissue to fend off the inflammation BUT your injury still remains. Don’t get to freaked out or think you are doomed because many people who have tennis elbow don’t even realize it until it gets in the way of doing things they enjoy doing or it impacts their on the job efficiency. It doesn’t matter how you got tennis elbow. Today is the day you really need to decide to take action and commit yourself to treating it once and for all. Now before you go running off to your GP, you should know that there is a cost-effective and simple way to put an end to the pain in the muscles around your elbow and fully repair your tennis elbow. No I am not referring to self medication with pain medication, elbow braces, endless trips to Physical Therapy or painful cortisone injections. All of which your GP, who is not specialized in the treatment of tennis elbow will most likely recommend. What really does work are a couple of simple, easy-to-follow home treatment techniques that have recently been endorsed by US Medical Doctors. You’ll get your very own personalized online journal where you simply track your progress and implement the strategies yourself. They take only four minutes a day, every other day to do and complete. It’s a self-paced treatment program that doesn’t require any special exercise gadgets or equipment. Sounds great doesn’t it? Grab yourself a cup of coffee or your favourite beverage and play this video tutorial which reveals the step-by-step, home treatment techniques.

https://tenniselbowsecretsrevealed.com/why-pain-in-the-muscles-around-your-elbow-could-be-a-serious-injury/

Regions of the upper limb The upper limb is essential for our daily functioning. It enables us to grip, write, lift and throw among many other movements. The upper limb has been shaped by evolution, into a highly mobile part of the human body. This contrasts with the lower limb, which has developed for stability. Maybe the most convenient way to study the anatomy of the upper limb is to do it topographically. In that manner of speaking, we will go through certain regions of the upper limb, where each of them has its own most dominant function. |Scapular region|| Bone: scapula | Muscles: supraspinatus, infraspinatus, rhomboids, trapezius, levator scapulae, teres major, teres minor Joint: scapulothoracic (physiological joint with the posterior thoracic wall supported by rhomboids and trapezius muscles) Vascularization: transverse cervical, dorsal scapular, subscapular arteries Innervation: subscapular nerve |Shoulder region|| Bones: humerus, scapula, clavicle | Muscles: rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis), deltoid, teres major muscles Joints: glenohumeral (humerus with scapula), acromioclavicular (scapula with clavicle), sternoclavicular (clavicle with sternum) Vascularization: axillary artery and its branches (medial and lateral circumflex), transverse cervical, suprascapular arteries Innervation: branches of the brachial plexus (C5-C6) |Arm|| Bone: humerus, radius, ulna | Muscles: triceps brachii (posterior compartment); biceps brachii, brachialis, coracobrachialis (anterior compartment) Joints: elbow joint Vascularization: brachial artery Innervation: musculocutaneous nerve (branch of the brachial plexus) |Forearm|| Bones: radius, ulna | Muscles: Anterior compartment superficial layer - flexor carpi radialis, palmaris longus, flexor carpi ulnaris, pronator teres, flexor digitorum superficialis; Anterior compartment deep layer - flexor digitorum profundus, flexor pollicis longus, pronator quadratus; Posterior compartment superficial layer - brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris; Posterior compartment intermediate layer - extensor digitorum, extensor digiti minimi; Posterior compartment deep layer - abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis, supinator, anconeus Joints: elbow, proximal radioulnar, distal radioulnar, wrist joints Vascularization: ulnar artery, radial artery Innervation: median nerve (mostly), ulnar nerve |Hand|| Bones: scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, hamate (carpal bones); 5 metacarpal, 5 proximal phalanx, 4 middle phalanx, 5 distal phalanx | Muscles: thenar, hypothenar, interosseous, lumbrical muscles Joints: wrist, interphalangeal (hinge), metacarpophalangeal, intercarpal joints Vascularization: ulnar and radial arteries Innervation: radial, median, ulnar nerves |Clinical relations||Winged scapula, fractures of the bones, paralyses of the nerves, carpal tunnel syndrome| In this article we will discuss the regions of the upper limb, as well as the individual components and essential functions. This will be joint by joint, with other structures mentioned throughout. - Scapular region - Shoulder region - Arm (brachium) - Forearm - Wrist - Hand - Clinical points - Sources Scapular region The scapula bone is otherwise known as the shoulder blade. Although the scapula is located on the posterior side of the body, it is not a part of the human back. It is classified as a part of the upper limb as it is so important for its functioning. Muscles The scapula has a spine, as well as two fossae that lie above and below it. These form the origin of the supraspinatus and infraspinatus respectively. Supraspinatus is a rotator cuff muscle that increases the stability of the humeral head, as well as an abductor of the shoulder. The infraspinatus is a lateral rotator of the shoulder. The scapular muscles allow us to elevate our arm beyond 90 degrees of abduction. The wing-nut like movement of the scapula allows us to elevate our upper limb above our heads. The rotation of the scapula occurs through precise and coordinated contraction of several muscles including the rhomboids (which are attached to its medial border) in addition to trapezius and levator scapulae among others (both of which are attached to the superior border). The lateral border of the scapula also gives rise to teres major and minor. These muscles are adductors of the humerus. This region has a rich blood supply via the anastomosis of several arteries including the transverse cervical, dorsal scapular and subscapular. The nerve supply is from the suprascapular nerve as well as the upper and lower subscapular nerves. Scapulothoracic joint This is a physiological joint, as the scapula has no bony attachments posteriorly, and is held in place purely by muscles. These include the rhomboids and trapezius among others. The rotation and elevation of the scapula is essential for the abduction of the upper limb. Shoulder region The shoulder region must be seen as a complex of several joints, rather than an individual joint. Classically the glenohumeral joint is what anatomists mean when referring to the shoulder joint. Glenohumeral joint This is clearly a joint designed for mobility rather than stability. The glenoid fossa is a shallow dish like surface, deepened by the labrum that is attached at its periphery. The labrum is said to provide a suction effect to the head of the humerus, as well as deepening the joint socket and therefore increasing stability. The joint is supplied by the medial and lateral circumflex arteries, which branch from the brachial arteries. Acromioclavicular joint This joint is formed between the thin surface of the clavicle laterally and the acromion process of the scapula. It is a gliding synovial joint, which ensures functional continuity between the scapula region and the thoracic wall. Learning point: The rounded side of the clavicle is the medial surface, and its thin side is the lateral surface. The underside is marked laterally by the conoid tubercle and trapezoid line which give rise to their respective ligaments. Sternoclavicular joint The manubrium is the superior part of the sternum and is attached to the clavicle laterally. It is a highly mobile synovial joint that allows for both anterior posterior and medial lateral movement. This enables the upper limb to reach a large area. All these joints are best seen as a continuous functional unit rather than a series of isolated joints. They influence each other and work in coordination to mobilize the upper limb effectively. Arm (brachium) In a colloquial sense, the term ‘arm’ refers to the whole upper limb. In an anatomical sense, it refers to the proximal part of the free upper limb only i.e. above the elbow, which consists of various muscles. The brachial artery, a direct continuation of the axillary artery, supplies the region. It becomes the brachial artery at the lower border of the teres major muscle. The elbow joint refers to the articulation of the humerus and the two forearm bones. The ulna articulates with the medial condyle of the humerus known as the trochlear. The ulna has the pronounced olecranon process on its posterior surface, which fits into the olecranon fossa of the humerus posteriorly to limit extension. The triceps brachii muscle is the three-headed muscle that extends the elbow. The head of the radius articulates with the capitulum of the humerus. The neck of the radius also forms part of the proximal radioulnar joint, which is where supination and pronation of the hand occurs. The radius acts as a wheel, and the annular ligament that encircles the radial neck and attaches it to the ulna holds it in place when both movements occur. There are named muscles that perform these movements i.e. pronator teres, supinator and pronator quadratus. Anconeus is a small muscle at the back of the elbow that abducts the ulna in pronation. Forearm The forearm is the region between the elbow and wrist joint. It comprises two bones, the radius and the ulna. The brachial artery divides into the radial and ulnar, which run down the forearm on their respective sides. The ulnar artery also gives rise to the anterior and posterior interosseus arteries that supply the deep muscles of the flexor and extensor compartment. The nerve supply is from the ulnar and median nerves (mainly median). The proximal part of the radius is the head, and the distal part is the base, and vice versa for the ulna. A tough interosseus membrane connects the two bones and distributes the load. The fibers of this membrane are very tough as well as flexible, and are orientated in an obliquely downward direction. There is also a fibrous structure called the oblique cord, which is thought by some to be vestigial, but does offer some structural advantage in connecting the bones. Wrist The wrist joint can be divided into three main parts. There is the radiocarpal joint, the ulnocarpal joint, and the midcarpal joints. The joints derive their arterial supply from the dorsal and palmar carpal arches. The radius articulates with the scaphoid laterally and the lunate medially. The ulna articulates with a triangular pad of fibrocartilage, which is interposed between it and the triquetrum bone. When extended, the wrist joint creates torque for the long flexors to perform their movements with higher strength. The mid carpal joint is between the proximal and distal row of carpals. It is active in early flexion and extension as well as radial and ulnar deviation. In late flexion and extension, the scaphoid bridges the proximal and distal carpal rows, which consequently move in unison. Hand The hand is an exquisite example of engineering. The complexity of its movements, as well as its functional use make it perfect for working with tools. The blood supply is derived from the superficial and deep palmar arches from the ulnar and radial arteries respectively. The nerve supply is from the ulnar and median nerves (mainly ulnar). The carpometacarpal joints are simple synovial joints. But the first carpometacarpal joint is more unique. It is a saddle joint that allows the thumb to oppose with the other fingers. It also enables the thumb to move with a great deal of freedom. Our thumb is much longer when compared to other primates, which signifies the move our ancestors made from the trees to the planes of the African savannah. Climbing was no longer as useful, and throwing, hammering and gripping generally were of more use to our species. The elongated, powerful and highly mobile thumb reflects this. The other joints to consider are the metacarpophalangeal (MCP) and interphalangeal (IP) joint. The MCP joints allow for flexion, extension, abduction and adduction. The IP joints, however, only allow for flexion and extension. The proximal and distal interphalangeal joints are connected by a collateral ligament, which means that extending or flexing your DIP causes your PIP to move in the same way. Understood everything? Test your knowledge about the regions of the upper limb with this quiz. Clinical points Winged scapula The long thoracic nerve (nerve roots C5, C6, C7) innervates serratus anterior. This muscle protracts the scapula, i.e. it moves the scapula forwards. This muscle is well developed in boxers who need to maximize the reach of their punches and therefore extend their arms and protract their scapulas. When the long thoracic nerve is damaged, the scapula comes away from the thorax, causing a winged appearance. Clavicular fracture The clavicle has a narrowing in its middle third. This is where the bone is most commonly fractured. The bone is close to the surface and therefore quite vulnerable. If the fractured segment is left loose, it could shear the subclavian vein (which lies anterior to the scalenus anterior) and result in fatal exsanguination. The subclavian artery lies behind the muscle, and therefore is not as vulnerable. Radial nerve palsy/Saturday night palsy The radial nerve supplies the extensor compartment of the arm and forearm. If an individual undergoes axillary compression e.g. while resting their arm on a chair in a drunken state, the nerve may also be compressed. This results in wrist drop, as the wrist extensors are not functioning. Gravity is able to extend the elbow. Carpal tunnel syndrome The median nerve supplies the thenar eminence and the first two (radial side) lumbricals in the hand. It runs in the carpal tunnel beneath the flexor retinaculum. If it becomes compressed here, the patient suffers thenar muscle wasting, as well as a burning and tingling sensation in the radial 3 and a half fingers. Scaphoid fracture The fracture usually occurs from a fall on an outstretched hand. This bone gets its blood supply from a nutrient branch of the radial artery given off in the anatomical snuffbox. The artery enters its distal pole and feeds proximally. This means a fracture in its middle third (the narrowest and therefore most vulnerable section) results in avascular necrosis of the proximal segment. Symptoms include tenderness in the anatomical snuffbox. Dupuytren’s contracture When the palmar fascia is thickened, it causes a claw appearance of the medial two fingers and sometimes more. It has an unknown aetiology and is associated with Peyronie’s disease. Regions of the upper limb: want to learn more about it? Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. What do you prefer to learn with? “I would honestly say that Kenhub cut my study time in half.” – Read more.

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The muscles that bend fingers are called flexor muscles. These muscles are existed in the forearm while their extensions, so called ‘’flexor tendons’’ go more distally to move the wrist and fingers ( Figure 1). The flexor tendons pass through some tunnels(pulleys). These pulleys prevent the flexors from moving away from the bones, and provide stabile and accurate joint functions. Flexor tendon injuries may occur after deep cuts in the forearm, wrist, hands or fingers. Depending on the exact location of the injury , nerve and/or vessel injuries may accompany as well. When the tendon is totally cut, the distal part is in place, but the proximal end of the tendon move away with its muscle contraction. In these cases the patient cannot bend the finger(s) and/or the wrist. In some cases the tendon is partially cut. These patients often feel pain although the function is provided. The untreated, incomplete tendon injuries may break off totally from the cut site when the patient continues to use his/her hand. This why, if the damage on the tendon is more than 25%, it should be repaired with a surgical intervention. After tendon surgery, the hand is placed in splint for 3-4 weeks. Following this immobilization period, a professionall physiotherapy is needed. If there is a bone fracture accompanies to the tendon injury, physiotherapy may start a bit later. If surgery is delayed more than several weeks, the proximal part of the tendon may shorten permanently. In this case, the cut ends of the tendon cannot be repaired directly. A two-stage surgery plan is made for these patients. In the first stage, a silicon rod is placed between the finger and wrist. This silicon rod helps in the formation of a tunnel and finally, proper finger flexion providing adhesions after second stage. Three months after first stage, a tendon graft is taken from the same forearm (in some cases from the leg) and put in the tunnel created by silicon rod. After first stage, no splint is worn. The patient is permitted to move his/her hand immediately after surgery. But after second stage, splinting and physiotherpy needs are exactly same as it should be after regular tendon surgeries.

https://handsurgeryturkey.com/diseases/flexor-tendon-injuries.html

The forearm is the portion of the upper extremity extending from the elbow to the wrist. The skeletal framework for this region arises from two primary osseous structures: the radius laterally and the ulna medially. These long bones serve as origins and insertions for many muscle groups allowing for normal physiologic dynamic movements. They also provide the supportive structure needed for the passage of neurovascular bundles between the proximal and distal aspects of the upper extremity. The extent of clinical pathology involving the anatomic osseous structures of the forearm includes conditions ranging from nondisplaced and displaced fractures to osseous tumors and malignancy. Within the forearm, the radius is positioned laterally and is the shorter of the two bones. The radial head has two points of articulation proximally: the radiocapitellar joint, articulating with the capitulum of the distal humerus and the radial notch of the ulna where it also has support from the annular ligament. Distally, the distal radius articulates with the proximal row of the carpal bones, including the scaphoid, lunate, and triquetrum. The radius has two primary bony prominences, the radial tuberosity on the medial aspect of the proximal end and the styloid process on the lateral aspect of the distal end. Each serves as a muscular insertion site as described in the sections below. Lister’s tubercle on the inferior surface of the distal dorsal radius serves as an anatomical landmark with the extensor pollicis longus tendon running around it. The ulna is typically considered the stabilizing bone of the forearm. Proximally, the trochlear notch of the ulna articulates with the trochlea of the humerus, the olecranon articulates with the olecranon fossa of the humerus, and the radial notch articulates with the radial head. Distally, the head of the ulna articulates with the articular disk of the distal radioulnar joint with no direct contact with the carpal bones. Bony prominences of the ulna include the coronoid process and the ulnar tuberosity proximally and the styloid process of the ulna distally. The radius and ulna connect via the interosseous membrane of the forearm, a fibrous anatomic construct that runs obliquely between the two bones. It is comprised of 5 ligaments: the central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord. Besides the obvious physical connection, this membrane also serves to conduct forces received by the hand and radius to the ulna and subsequently the humerus. It further functions to separate the anterior and posterior compartments of the forearm. Functionally, the radius and ulna serve together as the primary support structure of the forearm articulating with the humerus and carpal bones as described above. Both bones also serve as origins and insertions for muscles that are responsible for flexion and extension of the forearm, wrist, and fingers. Additionally, because the radius can pivot around the ulna, supination, and pronation of the forearm are possible. In the developing embryo, the upper extremity derives from a collection of structures termed the limb bud that first appears 26 days after fertilization. The formation of the limb bud initiates by the expression of sonic hedgehog (SHH) from the notochord. The limb bud itself is a combination of somatic mesoderm that will form muscles and neurovascular structures and lateral plate mesoderm that will form the skeletal components, including the radius and ulna. The distalmost aspect of the limb bud is termed the apical ectodermal ridge (AER) and regulates the proximodistal growth of the bud. Differentiation along the short radioulnar axis gets regulated by the zone of polarizing activity located along the ulnar aspect of the bud. Dorsoventral differentiation is under control of by non-AER ectodermal tissue. Proximal to the AER is the progress zone that sequentially differentiates into the stylopod (future arm), zeugopod (future forearm), mesopod (future wrist), and autopod (future hand). Within each of these zones, cartilage precursors accumulate centrally. Both the radius and ulna develop via endochondral ossification in a proximal to distal manner. Chondrification is first seen in these bones at 36 days of fertilization with ossification starting from 6 to 8 embryonic week. Ossification begins in the prenatal period centrally in the shaft of each bone and continues post-natally with the addition of proximal and distal ossification centers. All three of these regions fuse at 16 to 19 years. Defects in proper development can lead to radial aplasia either as an isolated event or in addition to other congenital disabilities such as in the VACTERL association or thrombocytopenia-absent radius syndrome. The ulnar and radial arteries comprise the primary blood supply of the forearm. They are terminal branches of the brachial artery arising at the inferior aspect of the cubital fossa. The ulnar artery courses medially supplying muscles in the medial and central forearm as well as the ulnar and median nerves. Named branches of the ulnar artery include the common interosseous which subsequently gives rise to the anterior and posterior interosseous arteries. The radial artery courses laterally supplying muscles in the lateral forearm. In one study of cadaveric samples, the most common origin for the nutrient artery to the radius was the anterior interosseous artery (56%) followed by the median artery (25%). In this same study, the most common origin of the ulnar nutrient artery was the ulnar artery (40%) and the anterior interosseous artery (31%). Additionally, smaller branches supplying the proximal radius originated from the radial artery while the distal radius also received penetrating vessels from the palmar arterial arches. The ulna receives small vessel input from the ulnar recurrent artery proximally and similar to the distal radius, the distal ulna received input from branches of the anastomoses between the radial artery, the ulnar artery, and the anterior interosseous artery. Classically, lymphatic vessels are thought to be absent within bone. This idea gained recent support from a study that failed to identify immunohistochemical markers of lymphatic vessels within cortical or cancellous bone. The three primary nerves of the forearm are the median, ulnar, and radial nerves. The median and ulnar nerves travel through the anterior compartment while the radial nerve presents in the posterior, extensor compartment. The median nerve gives rise to the anterior interosseous nerve and is responsible for innervating all of the muscles of the anterior compartment other than the flexor carpi ulnaris and the ulnar portion of the flexor digitorum profundus which are innervated by the ulnar nerve. The radial nerve gives rise to the posterior interosseous nerve, also known as the deep branch of the radial nerve and is responsible for innervating muscles in the posterior compartment. The radius and ulna serve as insertion sites for several muscles originating more proximally in the arm: Within the forearm, muscles are classically grouped into anterior and posterior compartments: Anterior Compartment: Posterior Compartment: Both the radius and ulna are fundamental to the structure of the upper extremity; the literature describes no significant physiologic variants. However, pathological variants such as radial aplasia as part of the VACTERL association or thrombocytopenia with absent radii have been established and are covered above. The surgeon can usually reach the ulna without endangering other structures because of its proximity to the skin surface. In contrast, the radius, particularly the proximal portion, is encircled by muscles. Additionally, the posterior interosseous nerve abuts the proximal radius. As such, an approach to the radius is typically more complicated. There are three primary surgical approaches to the forearm bones: The primary pathology involving the radius and ulna arises from fractures, which can be classified based on specific patterns and sites of involvement. Fractures usually occur in the middle third of the bones and can involve dislocation of the nearest joint due to the transmission of force via the interosseous membrane. Regardless of the site of the fracture, management should begin with a history and physical followed by plain films of the affected site, and if possible the joint above and below, orthogonal radiographic views of each site are mandatory to appropriately manage each fracture within the guidelines of the standard of care management. Common fractures include: Incomplete fracture patterns of the forearm:

https://statpearls.com/kb/viewarticle/32392/

The elbow joint, radioulnar joint and wrist The elbow is a hinge joint, with the distal end of the humerus articulating with the proximal end of both the radius and ulna. On the proximal end of the ulna is the olecranon process and this fits into the olecranon fossa on the distal end of the humerus. This feature of the joint prevents the elbow joint form hyperextending. The joint is strengthened by four ligaments, and as the elbow is a hinge joint, movement is possible in one plane only, allowing only flexion and extension to take place. The muscles on the posterior (back) of the arm are extensors. The prime mover of elbow extension is the triceps brachii muscle, and is assisted by the much smaller anconeus muscle. All anterior (front) arm muscles cause elbow flexion. These muscles are the biceps brachii, brachialis and brachioradialis. The biceps and brachialis contract simultaneously during flexion, and are the chief elbow flexors. The brachialis lies just underneath the biceps brachii and is as important when flexing the elbow. The biceps muscle also supinates the forearm (turning the palm so it faces up), and is ineffective in flexing the elbow when the forearm is supinated (palm facing down). This is why performing chin ups with the palms facing the athlete is easier than when the palms are facing away. The bulk of the brachioradialis muscle resides mostly in the forearm, and because of this it is quite a weak elbow flexor. It is used when the elbow has been partially flexed by the biceps and brachialis, and the forearm is semi-pronated (palms facing inwards as in the ‘hammer curl’). The wrist is a condyloid joint, where the distal end of the radius and ulna articulate with 3 of the carpal bones – the navicular, lunate and triquetrum bones. The wrist joint can only flex, extend, abduct and adduct. The forearm muscles can be divided into two roughly equal groups depending on their function. The first group consists of those forearm muscles that cause wrist movements, and the second consists of those that move the fingers and thumbs. Although many forearm muscles have their origin on the humerus (crossing both the elbow and wrist joints), they have little effect when flexing the elbow. Like the upper arm, the muscles of the forearm are separated into two compartments, the anterior flexors and posterior extensors. Although most of the anterior forearm muscles cause flexion of the wrist or fingers, there are two muscles in this group which cause pronation. These muscles are the pronator teres and the pronator quadratus. In contrast, the posterior forearm muscles extend the wrist and fingers. The only exception to this is the supinator muscle, which helps the biceps brachii when supinating the forearm. Although many different hand movements are possible, the hand contains relatively few of the muscles that control these various movements, these muscles being in the forearm. This helps the hand to be less bulky and more manoeuvrable. The actions of the forearm muscles are assisted and made more precise by small muscles within the hand.

https://amactraining.co.uk/resources/handy-information/free-learning-material/level-3-exercise-and-fitness-knowledge-index/level-3-68-exercise-and-fitness-knowledge-the-elbow-joint-radioulnar-joint-and-wrist/

The ulnar nerve is one of the terminal branches of the brachial plexus and has motor and sensory supply to the forearm and hand. On this page: Images: Gross anatomy Origin The ulnar nerve originates as a terminal branch of the medial cord of the brachial plexus with nerve root fibers from C8-T1. Course Arm In the arm, the ulnar nerve runs medial to the axillary artery and subsequently the brachial artery on the coracobrachialis muscle in the anterior compartment. The nerve passes to the posterior compartment through the medial intermuscular septum distally running with the superior ulnar collateral artery. Further on, it runs between medial head of triceps brachii muscle and the medial intermuscular septum to pass posterior to the medial humeral epicondyle in the superficial condylar groove (cubital tunnel). Forearm The ulnar nerve enters the forearm from the arm via the two heads of flexor carpi ulnaris (FCU) muscle. It subsequently lies superficial to flexor digitorum profundus and deep to FCU and medial to the ulnar artery. At the wrist, the ulnar nerve runs lateral to the tendon of FCU. Hand The ulnar nerve enters the hand superficial to the flexor retinaculum and inside Guyon's canal. Then it divides into its terminal branches at the level of the pisiform bone. Prior to passing the flexor retinaculum at the wrist, the ulnar nerve gives off the dorsal cutaneous branch. Branches Terminal branches - palmar cutaneous branch - branch to palmaris brevis - superficial terminal branch - deep terminal branch Supply The ulnar nerve has both sensory and motor supply: - motor - flexor carpi ulnaris, flexor digitorum profundus (medial half) - hypothenar muscles - 3rd and 4th lumbricals, interossei muscles,

https://radiopaedia.org/articles/ulnar-nerve?lang=us

Rear Window is one of the greatest work of Alfred Hitchcock and an excellent part of his experimental period. It has a very challenging concept - the audience watches almost the entire movie from the main character's rear window and that technique made Hitchcock's Rear Window a legend. The movie is focused on viewer's reaction to tension and suspense. It is persuasive, because the director puts the audience into main character's shoes. Jeff has broken his leg and is forced to stay home for more than 7 weeks already. He has nothing to do, so he starts to be Peeping Tom, watching his neighbors all day long and learning everything about each one of them. Later, he notices a strange behavior of one of the neighbors, salesman Thorwald, and eventually Jeff starts suspecting him in committing a homicide. Nobody has seen salesman's wife for a while and he kept a saw and knives in the apartment. There are some serious evidence against him, so Jeff calls his old friend, who happens to be a detective. The detective investigates everything and tries to convince Jeff that the salesman is innocent. His arguments are strong and the audience and the main character are not so sure anymore. But there is one scene that lasts less than three seconds, that totally changes main character's mind and the audience believes it as well. When the neighbor's dog dies, everyone was worried about it and started to open heir windows to see who is screaming. But there is only one person who is staying silent in his apartment. The salesman is alone in the darkness and the only light in the whole apartment comes from his cigarette. At this moment the audience understands that the man is guilty. The scene differs from the others, because up to this moment the audience and Jeff were watching the salesman without being noticed. But now we cannot be sure, because the light is so dark, we don't know if the salesman is looking at 'us'. It creates suspense and changes the direction of Jeff's thoughts. He is not convinced by the detective anymore, he is one hundred percent sure Mr. Thorwald is a murderer. The director chose to have a very low lightning, because the darkness makes people afraid, it is in their nature. Usually, all the scenes in the suspense movies, which make people scared, take place at night time. The salesman is in the dark and it makes him a dominant figure in the scene - he cannot be seen, and the audience doesn't know if their observed object is aware of being watched. Hitchcock made him smoke a cigarette, because it represents self-analyzing, so there are no doubts now, that the man is rethinking what terrible things he did. The static image of a window and a bright light of a cigarette creates a successful effect of suspense and viewer's participation in the scene. Lightning gives a deeper meaning to the viewer than expected. When the lights are on, the audience can see what exactly people are doing in the their apartments, but when it is off - like in that salesman's scene, the audience cannot know what is happening and it creates a very strong effect. This visual representation is clear and simple, but meanwhile it gives an understanding of character's emotions and feelings. Perspective always plays an important role in the movie. All the neighbor's stories are seen through their windows and it makes the audience feel they see something forbidden and private. So when they observe salesman smoking in his apartment, the perspective creates the effect of their direct participation in the story and lets them understand how the main character feels. Visual representation of this film would not influence the audience that much without lightning and perspective. Each Hitchcock's shot is a masterpiece, he doesn't want to do things in the ordinary way. He gives the feeling of mystery by making all the shots special. The master inspires us with the visual techniques and a viewer recognizes his unique signatures in every movie. His work is a pure cinematography, he was able to make the audience feel helpless, afraid, happy, lost and terrified by what is going to happen next. He made them the part of the action itself by creating a realistic atmosphere with the help of different cinematographic techniques. Rear Window has a strong message, brilliant actors, stunning visuals, great music and smart dialogues.

https://www.wowessays.com/free-samples/hitchcocks-rear-window-essay-example/

That outcome might involve the resolution of several different plot points, mysteries, or puzzles. While it is not exclusive to fiction, it is most commonly associated with that genre due to the wide variety of applications it has. A cliffhanger is one way to create suspense. The story stops short of revealing what happened, leaving the reader wanting more. This is often the case as the storyline is leading up to the climax or at the end of a novel when the writer wants readers to read a sequel. Explore Suspense Definition and Explanation of Suspense Suspense is the feeling that a reader, or audience member, gets while waiting for an unknown outcome. They have to read, watch, or listen to more in order to get to that resolution. These passages are the most intense of the novel and it’s that intensity that makes it hard to stop reading. Without this aspect, a reader will likely lose interest in the story. Types of Suspense - Narrative Suspense: also known as long-term suspense, this refers to the tension that builds from the first page until after the climax. With this type of suspense, the writer poses a question or creates a mystery of some kind. If it is well-written, then readers won’t be able to put the book or story down. - Short-term Suspense: suspense that lasts for a single scene or a brief moment and is then relieved. This might make the story’s individual parts more interesting. It could occur when two characters meet and the reader isn’t sure what they’ll think of one another. - Romantic/Comedic Suspense: occurs when the reader doesn’t know what’s going to happen between two characters. This might be related to the nature of their relationship. - Mysterious Suspense: the type of suspense commonly associated with the term. It is used in mystery novels and thrillers and encourages the reader to continue on with the novel to find out what happens next. - Horror Suspense: occurs when the reader knows that something awful is going to happen but they aren’t exactly sure what that is or when it’s going to strike. This could be a jump-scare in a horror movie. Examples of Suspense in Literature Othello by William Shakespeare In Shakespeare’s famous tragedy, Othello, the writer makes use of suspense through the implementation of dramatic irony. This technique, which allows the reader in on something that the characters don’t know. In the case of Othello, the reader or audience member is aware that Desdemona has been faithful to Othello and that Iago has been trying to convince him of the opposite. Iago’s plans to destroy Othello’s career are obvious to anyone viewing the play and the suspense builds as the audience worries about Othello and what he’s going to do. Read poetry by William Shakespeare. Harry Potter Series by J.K. Rowling Throughout the Harry Potter series, Rowling builds suspense as more and more is revealed about Harry’s background, his fate, and Lord Voldemort’s plans. As each piece of the puzzle falls into place, tension builds as readers consider what’s next. It’s only partially relieved as those plans are revealed in part. Examples of Suspense in Films The Silence of the Lambs In this well-known, award-winning horror film, the filmmakers create suspense as Hannibal’s nature is explored and Jodi Foster’s character, Clarice, makes her way through Buffalo Bill’s home at the end of the film. With the lights out, Clarice can’t see where she is or where Bill is. But, he’s able to track her with his night-vision goggles, just as the audience can. There is a particularly suspenseful moment where he comes very close to her and she has no idea. Viewers are meant to be concerned for her safety and worried about what Bill is going to do. Jaws Jaws contains many well-known examples of suspense. These are emphasized through the classic theme. The audience is aware that the shark is about to appear but the people in the water and the fishermen aren’t. Mystery or Suspense? The two terms are quite similar to one another but that doesn’t mean that they can be used interchangeably. In a suspense narrative, the protagonist of the novel gradually learns what’s going on around them, slowly becoming aware of the dangers they face. These are parts of the plot that the reader is already well aware of. In contrast, mystery novels present dangers, puzzles, and mysteries that the reader is unaware of. They are as in the dark as the protagonist is. Why Do Writers Use Suspense? Writers use suspense to put readers on the edge of their seats. It’s this element of a story that encourages the readers to keep reading. If they can make it through the most suspenseful part of the story then they’ll be rewarded with an event that relieves the tension and reveals something about the nature of the narrative. Suspense is even more effective when the reader is attached to the characters in a story or novel. They should feel concerned for the characters’ fates. Related Literary Terms - Cliffhanger: a narrative device that’s used to end a story abruptly before an action or segment of the plot is concluded. - Conflict: a plot device used by writers when two opposing sides come up against each other. - Flashback: a plot device in a book, film, story, or poem in which the readers learn about the past. - Plot: a connected sequence of events that make up a novel, poem, play, film, television show, and other narrative works.

https://poemanalysis.com/literary-device/suspense/

When the storyteller describes a gun hanging over the mantelpiece, we assume it’s there for a reason. This detail primes the audience, creating expectation, tension and suspense. It acts as a ‘red flag’, a ‘lit lantern’ alerting us to the likelihood that it will be used later. This is the principle of ‘Chekov’s gun’: irrelevant details are purged, and pertinent plot details retained. The technique of suggesting story elements to an audience is called foreshadowing. It serves a number of purposes, from setting the scene about what might happen later, to creating resonance. In Romeo and Juliet Benvolio describes Romeo’s love for Rosaline as ‘rank poison’, foreshadowing Romeo’s death by swallowing poison. Foreshadowing functions on a basic technical level as well, by creating a more believable story. When, for example, a character pulls a gun ‘out of nowhere’, it’s unbelievable, but with a hint of foreshadowing (mentioning a gun on the wall) it seems more natural. Believability plays an important part in keeping the audience involved in the story. Stories are crafted from sequences of action and reaction, assembled together to create realistic narratives, in spite of their artifice. They highlight changes of fortune in the characters we care about (and their enemies), provoking empathy for the protagonist when they face tragedy, and joy when they succeed. Foreshadowing provides audience entertainment on another level: the conversation the audience has with the writer when they attempt to predict where the story is going. Foreshadowing can occur in different ways: a precursor event (which may occur on a smaller scale and gradually increase), when a character makes a prediction about the future, and when the event is foreshadowed by anxiety and fear, of an individual, or at a group level. A common storytelling device is the inclusion of an eccentric character, often a misfit, a man or woman who prophetically sees disaster, and is dismissed as crazy. Another device is the disturbing nightmare, a warning sign that something disastrous will happen, or for a character to experience memories, as flashbacks, which are significant to his or her outcome. In The Thin Red Line (1998), the audience experiences a soldier’s memories, which explains his backstory, a sensitive human being in a violent and merciless war — but it also works as his life flashing before him at the moment of his death, which is revealed later in the story (along with the recurring motif of light pouring through the jungle canopy like a backlit cathedral window, setting the tone for the story, its spirituality, and his own mortality). These warnings can be expressed through the protagonist and his opponent, or through the environment around them. Character’s often exhibit signs of trouble when they lose their cool and inadvertently reveal their plan to their enemy, or when they become irrational and make ego-based decisions, instead of rational ones. In The Matrix (1999) the central character notices strange things happening in his world around him that he cannot explain. These are the ‘glitches’ in the Matrix, which provoke him into questioning reality. In disaster films foreshadowing often occurs when one character arrogantly states that the disaster, which we are about to witness, could never happen. Sometimes a character’s personality is enough for us to figure out what will happen. In the Second World War film Attack (1956) an officer’s incompetence, and inability to think calmly under pressure, leads to men needlessly dying under his command. In The Thin Red Line (1998) an officer who is sensible and paternal, and is able to stay rational under duress, saves his men from pointless slaughter. The warning signs usually increase on a scale as the stakes also rise. In The Poseidon Adventure (1972) carelessness and arrogance lead to a passenger ship capsizing. In The Towing Inferno (1974) an inability to take a small fire seriously, combined with safely reductions to save money, places all the occupants of a skyscraper in danger. Foreshadowing creates tension and suspense, it helps to make stories more realistic. Sometimes it works almost subliminally, in the background — through the music, the weather, or through the location — resonating with implication.

https://adriangraham.co.uk/blog/foreshadowing-in-storytelling

Warning: This is going to be a craft post, likely boring for non-screenwriting nerds. I’m reading a new book by Yves Lavadier called Constructing a Story, and I’m reading about character arcs. One thing that we talk about in drama is character want versus character need. The want tends to be a tangible, external, and a conscious goal–to complete the mission, rescue the kid, win the girl, etc. The need tends to be internal, and unconscious–some kind of step toward growth that the character needs to take–like coming to terms with the past, letting go of judgement or rigid expectations, opening his heart. Separate from that, there is a narrative tool called dramatic irony which is when the storyteller reveals information in such a way that the audience has information before the character does in order to create suspense. The audience is waiting for the character’s knowledge to catch up with our own. Like we know that there’s a dangerous intruder in our heroine’s apartment. She comes home and starts making dinner–unaware of the danger. It creates a specific kind of emotional engagement. Mr. Lavandier points out that once the audience picks up on the character’s need– it elicits a question in our minds. Will the character learn what we already know in order to emotionally grow? He notes that this is, in fact, a situation of dramatic irony. This was eye-opening for me, because, although it’s completely logical, I’d never thought about waiting for character change in as a form of suspense, suspense that could be for an entire act or maybe more.. The audience knows something and is waiting for the character to catch up to that knowledge, for her unconscious to become conscious. In life we do the same thing, kind of, but it’s less satisfying. We have friends or relatives with issues that seem obvious to us, but which said person cannot see, and we talk with or other friends or family members, about how it would be better if they could see. In life though, person generally don’t change that much, so after awhile, there’s not so much suspense. I suspect there are probably people waiting in vain for me to make certain discoveries in my life. They should probably go to the movies, which will be more satisfying, because in constructed fictional narratives, people change.

https://barringtonsmith.net/2017/05/31/character-need-what-they-dont-know-that-you-do/

How to Write a Frame Narrative Think of how it feels when your Mom tells you a story. There are always lots of different people at play and she needs you to know every single one before she can even begin, even if they’re your hairdresser’s niece whom you’ve never met. Mom often forgets bits and has to repeatedly go back for context after the punchline has already been told. Her story is coated in her own opinions- on the people within it, on the events that transpired, and on how she would’ve reacted so much better if it were her at the center of the story. Though certain parts of the story and particular details may seem insignificant to you, your Mom always insists it’s crucial to understanding the story- even when, more often than not, it isn’t (sorry, Mom). You may not know this, but all of this time your Mom has been loosely (and albeit poorly) employing a famous literary technique in her storytelling: a frame narrative structure. 1) What is a frame narrative? A frame narrative, to put it briefly, is like a story within a story- story-inception! There are a few different versions of a frame narrative or frame story. First, it could involve a narrator or main character of a story relaying various smaller stories over the course of a book like in the novel The Book of the One Thousand and One Nights. On the other hand, it could be a specific character from a story selected to relay the events of the novel as opposed to simply telling the story objectively. In this second option, it may be a specific character that has a connection to another character or characters. An example of this would be Mary Shelley’s Frankenstein, where the story is told from the perspective of Robert Walton as the information was relayed to him by Doctor Frankenstein. On the other hand, the framing could simply be that the story is told from the protagonist’s perspective, but after the events of the story have already taken place. Using this perspective allows the protagonist to relay information with insight as (s)he is an older and wiser version of him/herself. 2) Determine the purpose When used well, a frame narrative creates an incredibly fascinating and multifaceted tale with many perspectives to delve into. If used incorrectly, however, this can create a confusing and continuity-impaired story. Therefore, a writer should employ this technique only if it will truly benefit the story to do so. Before you go any further, ask yourself honestly, how will a frame narrative better my story? The main benefit of a frame narrative is to tell a story (whether it be the entirety of the book or individual stories throughout) using the voice of a specific character who exists outside the confines of the story. Whether that’s a future version of your own protagonist or a side character who would give good insight to the story’s events, ask yourself, how would this structure strengthen the events or themes of my story? 3) Choose a narrator As stated previously, the main purpose of the frame narrative is to use a specific character’s voice to convey the events of the story as opposed to using an impartial narrator or first person present perspective. Once you’ve decided to use the frame narrative structure, you must first choose who will be telling your story (or stories). Think about what your goal of using the technique is and who will be the best voice to accomplish that goal. Possibly the most popular version of this structure is using a future version of the protagonist to tell the story of what they’ve gone through. One of the major setbacks of employing this technique, however, is that it completely does away with a lot of the suspense created in a story. When your reader is hearing a story from someone years in the future, it lets them know right away that your protagonist survived the events of the story. However, remaining aloof about the protagonist’s present circumstances can allow a certain amount of suspense to remain. If you choose a narrator who isn’t your protagonist, you must ask yourself what connection this character has to the events of the story. What unique perspective will they be able to provide that no other character can? For example, in William Goldman’s The Princess Bride, William uses himself as a frame narrator, but a fictionalized version of himself who is simply editing a pre-existing story that another author, S. Morgenstern, already wrote. This creates a unique reading experience because you’re reading this swashbuckling tale and suddenly you get a little note from Goldman telling you ‘this part was too long, so I cut it,’ or ‘this was always my favorite part.’ It creates a strange line between the editing and writing process but also allows you to feel like you’re reading the story along with its biggest fan. 4) Get organized As we’re sure you can imagine, creating a story employing this technique can be extremely confusing. Since the story will be told using one person’s perspective as opposed to an omniscient narrator who can jump perspectives, you have to make sure each character’s arc is thoroughly plotted before you even begin the writing process. If done correctly, the stories will likely intercept with one another, so make sure you know where in each person’s timeline each interaction takes place. Once you have all of this thoroughly organized, the next step is to make sure your narrator is believably privy to all of this information. He/she has to be the piece of the puzzle that fits all of this together. Is the story being told this because the narrator happened to be there to witness all of this as it unfolds? If it’s not believable for the character that you chose to be in every single scene you’ve mapped out (and it likely won’t be), how will they be getting this information in order to relay it to the reader? Did they receive a letter, text, or phone call from someone who relayed the information to them? 5) Allow your narrator to interject and have opinions One of the most important and advantageous aspects of writing from a frame narrative is the character’s voice. When using this technique, allow your narrator to interject on the events as they occur. Allow them to reflect on them, have opinions, and be angry or happy or annoyed. Use them to foreshadow the climax of the story or have them give their opinions on the nature of certain characters. This is where you create intrigue. Imagine you’re using a future version of your protagonist to tell the story. The future version shows a lot of animosity towards the current protagonist’s best friend, and this allows the reader to wonder, what did that character do? thus creating suspense that wouldn’t otherwise exist. Another aspect that you may want to consider playing around with is the reliability of your narrator. Perhaps the narrator of your story clearly hates a certain character (maybe even the protagonist), but as the story unfolds, you start to see that the character is actually really kind and harmless. Or maybe the narrator is really down on him or herself, but as the story continues, the audience can see that they’re actually just being too hard on themselves. Or perhaps the narrator doesn’t remember how a certain event took place, and instead just gives the reader the gist of it. This creates another added layer to the story and allows the reader to form opinions and judgments of the narrator and their role in the story as a whole.

https://www.dorrancepublishing.com/how-to-write-a-frame-narrative/

Copyright © Stuart Griffiths 1982. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the copyright owner and the publisher. The right of Stuart Griffiths to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs, and Patents Act 1988. First published 1982. Heinemann Educational Books Ltd. Reprinted five times. Published 2000. Pontcanna Press UK. A CIP catalogue record for this book is available from the British Library. ISBN 0-9533476-1-3 Previous ISBN with Heinemann Educational Books: 0-435-18380-X www.pontcanna.com www.pontcanna.co.uk From 2007 Action is drama's most mysterious element. Formidable thinkers on the subject throughout history concur that it is also the most important. Indeed, drama is action. The word itself is derived from the ancient Greek word 'to do'. Lessing rightly said that all practitioners of the art and all critics must return to the plumb-line of Aristotle's writings on the drama. Those utterances are oracular, and appropriately cryptic at times. Aristotle defined tragedy as 'an imitation of the Action', and left it to posterity to work out exactly what he meant. One interpretation could be that the process of a drama, the whole curve of its action, should parallel some fundamental rhythm or movement of nature. The action of a good play has often been compared to a wave making towards the sea shore: small at first, swelling higher and higher, with a steady rising and falling movement, at its highest peak breaking and crashing on the shore, then the sudden final falling away. Breathing; a beating heart; the cycle of the seasons; of a human life; the course of a single day; the act of coitus: they are all valid comparisons. In another art form, the process can be realized in a great symphony. First thoughts The action of a good play may be sensed by its author before he has even begun to think in terms of plot detail, characters or dialogue. He may have a vague yet insistent general idea of what he wants the play to be, and its action grows from that. The rising action, the climactic action, combined possibly with a reversal, where the action veers round to its opposite, then the falling action and resolution, will be mapped out before a word of a play is written. In fact, the actual writing is a minor part of the work for many dramatists. It is done very rapidly. The play may have been gestating for months or even years beforehand. In different ways Ibsen, Noël Coward, Arthur Miller, John Osborne, Harold Pinter, Tom Stoppard and Alan Ayckbourn have all testified to this creative phenomenon. Similar experiences are to be found in other artistic areas. Chesterton wrote of Dickens's first masterpiece: 'A man knows the style of the book he wants to write when he knows nothing else about it. The idea of light existed when there was not a single solitary star. Pickwick is the mere mass of light before the creation of the sun or moon.' Change: Othello When one talks of a play's 'action', it is not physical action. That is only part of the process. Action must never be confused with mere activity or bustle. A drama can have a great action which carries an audience with it from beginning to end with hardly one burst of physical violence. It is emotional and mental action that counts. The long temptation scene in Othello (Act III, Scene 3) consists mainly of two men talking together. The physical action is minimal. Yet the mental stress and emotional violence of the scene are tremendous. Before our eyes we see a terrible change taking place. As we watch, Othello gradually changes, through Iago's poison, from a state of calm noble stability into one of mad, uncontrollable fury and jealousy. The Moor changes, as it were, from black to green to red. If that scene had been left out, and Desdemona simply reported to Emilia that her husband had undergone an awful transformation, the audience would have felt cheated. They actually want to see the transformation taking place. Opposed forces Equally important for dramatic action is the opposition of evenly-matched forces. If one force has its way too easily from start to finish the audience will lose interest. If it is met by an opposition worthy of it, the contending forces strain against each other, sway this way or that according to whichever has the advantage; there is stress, tension, struggle, a seesaw of fortunes, until the issue is resolved. It may be a conflict of individual wills, of ideas, of moral choices, of a man's purpose with some obstruction or flaw in his own nature. Eric Bentley, the American theatre scholar, has compared a dramatist to a perverse traffic policeman. Instead of keeping the traffic from hitting each other, he beckons and guides them into collision. Goals and obstacles The need for 'conflict' in drama can be misunderstood. It is generally better for the dramatist to concentrate on the idea of a man striving to achieve a goal, and meeting resistance from an obstacle or succession of obstacles. The goal may change of course. (Coriolanus first intends to rule Rome, then destroy it.) But it is hard to think of any great play where the principle does not apply. The obstructed will is the closest one can get to a universal dramatic theme. 14 How plays are made The obstruction need not be external, e.g. a villain. Hamlet, Coriolanus and Macbeth are examples of a protagonist whose purpose is frustrated and finally doomed by obstacles within his own nature. Furthermore, the Shakespearean action is often marked by a striking reversal after the half-way point, e.g. in Julius Caesar, Macbeth, Coriolanus, where the rising movement, carrying the fortunes of the protagonist, is met by a counter-movement, which has nonetheless been built into the ground plan of the action from the start, and which ultimately prevails. This reversal, or revolution, provides the dynamic for the second half of the play. The play's driver In many plays the central character striving for his objective is the one who guns the action forward. But this is not always the case, and someone must be there to do it. There is a toy called Action Man, and in a sense every good play has its action man. At each stage, a play needs a driver, a galvanizer, an activator, a doer, a powerful will, someone who makes things happen. This may be the hero or villain, male or female (Henry V, Richard III, Lady Macbeth), a supremely competent operator (Mr Voysey in Granville Barker's The Voysey Inheritance), or a perpetrator of comic disasters (Norman in Ayckbourn's The Norman Conquests or, in films, M.Hulot or Harpo Marx). The King is the initial driver of Hamlet and he starts the play long before curtain rise by killing his brother and marrying Gertrude. Goneril and Edmund are the drivers of King Lear as well as the King himself. Voysey Senior drives the first part of The Voysey Inheritance, then his son Edward takes over (see p. 16). These are not passive characters: they thrust the play onwards. They have objectives, and combat resistance. If the play is in danger of running out of steam a new driver can always be introduced. Powerful and colourful characters can be saved for the last act; Shaw does this with General Burgoyne in The Devil's Disciple, and Bohun QC in You Never Can Tell. The process Walter Kerr, the writer and Broadway theatre critic, has summed up the process of a dramatic action: ' There is a beginning stage in any change: a stage at which motivating pressures are beginning to clamour for a response. There is a middle stage: a stage at which the response is given and the inevitable conflict joined. There is an end stage: a stage at which the contest between pressure and response has resulted in a different relationship between these two things, a new state of affairs, a changed state of affairs. . . . All that is asked of the dramatist is that he show the beginnings of some one particular change, that he trace it through its natural turmoil, and that he bring the contending forces into a different though not necessarily a perfect balance. Things were one way; now they are another; we have seen them move.' Suspense Tension 'A great part of the secret of dramatic architecture', wrote William Archer, 'lies in the one word "Tension". To engender, maintain, suspend, heighten and resolve a state of tension is the main object of the dramatist's craft.' What do we mean by tension? It is a condition of mental stress or excitement. The mind is actually stretched. The pulse probably beats faster. It is, of course, an essential element of suspense, which has been called the nerve centre or the mainspring of drama. The two are not strictly synonymous, for there are instances of dramatic tension where the suspense factor does not commonly apply. Suspense For immediate practical purposes, however, George Pierce Baker's definition of suspense is valuable: The Wild Duck Suspense implies an imminent reversal of fortune. The Sword of Damocles hangs over the head of the protagonist. Or, if you like, a time bomb is ticking. In Ibsen's The Wild Duck, Gregers Werle enters Hjalmar Ekdal's home as a lodger. We know he will wreck the happiness of everyone in it. Hjalmar is blissfully unaware that his wife was once the mistress of Gregers' father, Haakon Werle, and that his young daughter Hedvig is not his own. Gregers' perverted idealism is bound to construe it as his duty to tell Hjalmar the truth. But it is a long time before he makes his first move. Ibsen well knows that the audience will be on the edge of their seats by then. In Ingmar Bergman's production of the play, Max von Sydow as Gregers started his long chat with Hedvig at a good distance from her across the stage. As the talk charmingly proceeded, he moved closer and closer to her: a chilling image of danger. 24 How plays are made Milking situations: Dogberry in Much Ado The 'milking' of situations involves suspense, particularly in comedy, e.g. making a character, previously established as given to verbosity, take a long time to deliver or fail to deliver a vital piece of news: Constable Dogberry in Much Ado About Nothing (Act III, Scene 5). The clown has already unwittingly stumbled on the plot to wreck Hero's wedding, and he goes with Verges to see Hero's father Leonato, the Governor of the city. But he never gets to the point because he is so swollen with self-importance, verbose, and totally lacking in any sense of priorities. Verges tries to break through his monumental circumlocutions and tell Leonato, but Dogberry shuts him up he wants to do the talking ('A good old man, sir, he will be talking; as they say, "when the age is in, the wit is out" '. . . etc.) Finally Leonato leaves impatiently for the church where tragedy awaits that could so easily have been prevented. It is a common fault with beginners to drill away at material which has small dramatic potential. But it is equally wrong to skip over material which could yield far more dramatic mileage. A writer should strive to discover all the possibilities for suspense in a scene, exploit the full temperamental range of his characters, and examine how each might affect all the others. Sympathy Suspense requires sympathy with the characters. If we do not care for them, it does not much matter if they do suffer a severe reversal. We will not be kept in alternating states of hope and fear about them. Asking questions Most of all, suspense makes the audience ask questions. The movement of a play is from question to answer, from problem to solution. Will Hamlet kill the King before the King kills him? Will Lady Teazle be discovered behind the screen? If so, what will be her reaction and that of the others on stage? We sense the imminent doom of Oedipus, but just how, and when, and by whom will this be brought about?

http://www.pontcanna.com/pages2.asp

We don’t often see Antipodean theatre on the London fringe, but when we do, it’s certainly a bit different from British progressive performance. CUT, a cinematic, fragmented solo performance with elements of interactive theatre and immersive installation, effectively evokes a constant sense of unease but the range of styles and influences create a convoluted message. Technology is used effectively to maintain audience tension, with light and sound breaking up the narrative creating an extreme environment. But despite CUT‘s slickness and a fractured story that holds viewers’ focus, there is no clear reason why the story of an anonymous female flight attendant pursued by a male stranger is told. There is no predominant theme or message, just a story that, though it is told well, isn’t particularly dynamic or interesting. Hannah Norris, an Australian actor based in London, is the only performer but the audience is a vital contributor to the piece so it’s easy to forget this is a solo performance. We are boarded onto a plane and accompany her throughout her shift and her subsequent journey home, with regular interruptions of nightmarish flashbacks, surreal characters, blackouts and loud noises. Norris’ character constantly narrates the journey, but it is never made clear what this episode from her life is meant to say. They man following her perhaps comments on male objectification of women, but it’s not particularly clear if this is an actual message of the piece – if that is the piece’s intention, it lacks conviction. The focus could just as easily be the possibilities of contemporary narrative structure influenced by pop culture and technology. The programme notes by writer/director Duncan Graham fail to elucidate despite an explanation of influences. Regardless of the lack of clarity behind the piece, Norris is an excellent performer. She morphs and changes within the blackouts, always surprising and maintaining attention. Her timing and characterisation are impeccable within the often third-person text. Sam Hopkins and Russell Goldsmith’s design almost becomes characters within their prominence, but they do not overwhelm. The nerve wracking harmony between Norris, sound and light is exquisite. With production elements that are much more impressive than the piece as a whole, CUT still has plenty of positives, but the story behind the suspense it creates is unsatisfying and anticlimactic. The narration and tech creates emotional distance, but perhaps the favouring of style over substance is too blunt for a British audience. CUT runs through 31 July. The Play’s the Thing UK is committed to covering fringe and progressive theatre in London and beyond. It is run entirely voluntarily and needs regular support to ensure its survival. For more information and to help The Play’s the Thing UK provide coverage of the theatre that needs reviews the most, visit its patreon.

https://theplaysthethinguk.com/2016/07/08/cut-the-vaults/

Suspense is an important element of fiction—and not just for stories where things go bump in the night. Suspense is “the feeling of excited or anxious uncertainty about what might happen”—which is another way of saying “tension,” or what makes readers invest in a story’s outcome. To develop the ability to write good suspense, John Gardner suggests writing a scene that takes place moments before a dead body is discovered—and withholding the discovery. The idea is that suspense is created in the withholding and that tension is created in the space between the writer’s knowledge of what’s to come and the reader’s desire to know. It’s a tease, in some ways, but in the right hands, that withholding is a chance to explore your characters and their feelings as they react to the world of the story. There was a policeman on the corner, and she thought, Why don’t I go to the police—you go to the police for a missing person. And then thought, What a fool I’d look like. She had a quick picture of herself standing in a police station, saying, “Yes, we were going to be married today, but he didn’t come,” and the policemen, three or four of them standing around listening, looking at her, at the print dress, at her too-bright make-up, smiling at one another. She couldn’t tell them any more than that, could not say, “Yes it looks silly, doesn’t it, me all dressed up and trying to find the young man who promised to marry me, but what about all of it you don’t know? I have more than this, more than you can see: talent, perhaps, and humor of a sort, and I’m a lady and I have pride and affection and delicacy and a certain clear view of life that might make a man satisfied and productive and happy; there’s more than you think when you look at me. She has placed her entire sense of self in this man’s opinion, in the idea of his love, and his abandonment thus destroys her identity. Her self-image is so fractured she can’t imagine reaching out for help without also having to defend herself: her appearance, her qualities, her humanity. She is experiencing terror as an existential crisis, and her uncertainty is the uncertainty of the story: the question of “how will this end?” creates an anxiety and an excitement in the reader which compels us to read on. “The Daemon Lover” is told in that space Gardner articulated as the “moment before a body is discovered.” In this case, “the body” would be “the fiancé,” and the story is driven forward through action that is compelled by doubt, not certainty. Conflict is the lifeblood of fiction, but in withholding a scene of direct confrontation, Jackson creates an internal conflict in her character which reveals her fears and worries and the deep psychological trauma she was experiencing. The suspense, the tension, in such a story is not in confrontation or discovery; it is in the thorough investigation of emotion. In order to create effective suspense in our fiction we must be willing to sit patiently with our characters in their uncertainty. Identify a character in a story you are working on. Ask yourself: what is the one thing which, if missing, would cause this character to question everything they believe about themselves? Then, write a scene, or a series of scenes, in which the character is searching for that lost, essential thing. Where do they go? To whom do they turn first? As their search continues and desperation mounts, how do they respond? Withhold the reclamation of this lost thing, and stay with the character in their feelings up until the moment just before they discover what they’re looking for. DUSTIN HERON is a short story writer with an MA and MFA from San Francisco State University. He has several publications, most recently in The Watershed Review and forthcoming from Long Island Literary Review, has been nominated for the Pushcart and Best of the Net prizes, and he received the Mary Tanenbaum Award in Creative Nonfiction. His first book, Paradise Stories, was published by Small Desk Press.

https://www.craftliterary.com/2017/11/27/crafting-suspense/

Explore the different techniques thatW.W. Jacobs uses to create suspenseIn 'The Monkeys Paw'. Extracts from this document... Introduction Explore the different techniques that W.W. Jacobs uses to create suspense In 'The Monkeys Paw'. The Monkey's Paw was written in 1902, a significant time in British history. At this point in history British rule governed a quarter of the Earth's population. It was known as the British Empire and India is just one of the countries included. In Jacobs' story the Sergeant Major who went to India to work in a colony came home after more than twenty years, entertains the White family with exciting and gruel some stories. Thousands of British men went to the East to learn about cultures and traditions. As they returned they brought interesting stories and souvenirs. The character just returned from India was a regular feature in British popular fiction at the turn of the century. Gothic genre stories were popular in those times. WW Jacobs was a Londoner who lived near the river and so he often included sailors & travellers in his stories. The Monkey's Paw's setting and content makes the story a gothic horror story. During these times Gothic Horror stories were very popular. Frankenstein and Dracula were the most well known stories. ...read more. Middle It creates atmosphere because as he mentions a spell was put on it by an old fakir. The character creates suspense in the story through the things they do and say. When the Sergeant-Major arrives he says 'It had a spell put on it by an old fakir'. He wanted to show that fate ruled the world, and that 3 separate men could have 3 separate wishes from it. That quote grabs Mr. White's and everybody's attention because he said 3 wishes can be made but he also said 'The man before me, his last wish was for death'. Now that line creates tension as he makes the reader ask himself, 'What did he do, that he asked for death? Herbert makes a joke about the Paw when his father wished for 200 pounds. He says 'I expect you'll find the money tied up in a big bag in the middle of your bed' as he did not take the Paw seriously, because he doesn't know that he is going to die. Mr. White believes in the curse because he is the one who made the wish and as the Sergeant Major said, he said the same. ...read more. Conclusion was throwing pulsating shadows on the ceilings and walls, until, with a flicker, it expired. These words suggest that there's an image of darkness, shadows and death because expired represents going out or death. The quotes 'he stood motionless, his breath suspended' show that the old man is terrified. When the old man is scrambling for the Paw, trying to stop the entry of his dead son in to the house, the author uses short sentences and as you read your breath quickens it builds up tension and action. 'A perfect fusillade of knocks' that suggests the knocks are surrounding Mr. White and a pattern is occurring and going all through the house. He also creates more suspense as he says that it starts quiet. As the first knock occurred he said it 'sounded on the door' then a 'third knock sounded through the house'. It gets louder and faster and then it stopped. 'The knocking suddenly ceased'. Throughout the story WW Jacobs creates suspense and tension as he uses the right words and type of sentences at the right time. In the "Monkey's Paw" I have discovered that WW Jacobs builds up suspense and tension by using different techniques. He is successful at building the suspense as he makes want to read on to see what happens. ?? ?? ?? ?? UWAIS KOMAL ...read more. This student written piece of work is one of many that can be found in our GCSE Miscellaneous section. Found what you're looking for?

http://www.markedbyteachers.com/gcse/english/explore-the-different-techniques-thatw-w-jacobs-uses-to-create-suspensein-the-monkeys-paw.html

(Question: describe visual/verbal features used in a visual/oral text you have studied. Explain how these features contributed to the text as a whole.) Dunkirk is a film directed by Christopher Nolan. The film has three timelines, The Land timeline which lasts a week, The Sea timeline which lasts a day and The Air timeline which lasts an hour. The three timelines follow different focusing characters which present different themes throughout the film. Dunkirk is based off of a real life event that happened during World War Two where the Allied Soldiers, being the French and English, were trapped at Dunkirk beach where the Germans were closing in on them. Civilians from England brought over boats to save the soldiers and the Allies were able to successfully retreat to England. Throughout the film there is the non-diegetic sound of a ticking watch. The ticking is a reference, and symbolic to Farrier, a Spitfire pilot who is the focus character of The Air timeline, whose fuel gauge is broken and he has to rely on his watch to tell how much time he has left before his fuel runs out. The ticking is not only used during scenes of The Air timeline though, it is also used in the other two timelines, this is because Nolan uses the ticking to represent time running out for the characters. Nolans use of the ticking watch creates anxiety and tension in the audience to show the viewers the risk taken, the danger the characters are in and that they are in a race against time. The link to Farrier’s fuel gauge is important because when the ticking finally stops it is when Farrier has run out of time, when he is gliding to his doom across the beach, the other characters are safe in England and are no longer in close proximity to death in war, they have all made their goals in time and the movie can end. Another verbal feature used in the film is the shepard tone which is a non-diegetic sound, composed by Hans Zimmer. Nolan jam packs this feature into many of the scenes in the film because it is useful in creating suspense and unease in the viewer, and to have it almost a constant without break sets the audience to have a glimpse into the emotions and internal experiences the characters are having throughout the film, the feeling of never truly being safe, this works especially well with The Land timeline as the dominant theme present is ‘survival’. You can see this technique in the scene where Tommy— an English soldier who is the focusing character of The Land timeline— aboards the boat at the mole, the audience can tell that Tommy is not safe because the shepard tone overtop of the other techniques creates a claustrophobic environment and setting the foreboding and dread for the audience. Shepard tone is an auditory illusion of everrising pitch, the technique is used in many horror films, such as The Exorcist, because of its effectiveness in making the audience anxious and feel that the characters are unsafe. A visual technique in the film is the use of dim lighting, used mostly in The Land timeline. Nolan uses this lighting technique effectively in the film, a notable instance being when the boat Tommy is on gets torpedoed and the lighting is very dim, almost black. It forces the audience to feel as if they are one of the characters trapped in the sinking boat and to feel the desperation to escape death. This feature contributes to the film as lighting is very important in all visual presentations and the way Nolan uses the dim lighting enhances the feeling of uncertainty by not allowing the audience to use all their senses and forcing them to pay close attention to the traumatic experience the characters are facing. This links to the real world where if you were to lose your sense of sight in real life you would feel very on edge and unsafe in your environment, sight is a big part of an average person’s life experience and so having that sense stripped away is disconcerning and causes great agitation which is exactly what Nolan is trying to achieve. During the film the Germans are barely mentioned by name. This technique is used purposefully by Nolan because he knows that referring to the Germans as ‘the enemy’ it strips away that bit of humanity and makes the audience fear them as they are now the unknown, they are the untouchable bullets shooting into the fishing trawler and they are torpedoes and the diverbombers, they are not only ‘the Germans’ or ‘the enemies’, they are the tragedy that affects the characters throughout the film are they are something that not even the audience can perceive. This is an interesting feature that Nolan uses in the film because in many other war films, the opposite is wanted, they want the enemy to be something ‘the hero’ can conquer and destroy or they want them not to be an enemy at all, they want to draw attention to the humanity of all in the war even those on the other side, such as seen in All Quiet on the Western Front. In conclusion the film techniques such as shepard tone, the ticking watch, dimmed lighting and the fear of the unknown are contributing factors to the film as a whole because they contribute to the end result of unsettling anxiety Dunkirk forces the audience to experience because Nolan wants the audience to feel this way to have them truly reach into the mind of the characters and know why they do and feel what they do and how this shapes them as characters and pushes the plot throughout the film.

https://forum.studyit.govt.nz/t/can-i-have-feedback-on-my-dunkirk-essay/1393

A reaction shot is a film technique where the camera focuses on a character reacting to something happening in the story, rather than showing what is actually happening. It’s a way of adding tension or creating intrigue by not showing exactly what characters are reacting to. This technique is common in horror films, where the viewer might see a character react to something scary in a scene before the camera cuts to show what it was that caused that reaction. It’s also seen in thrillers, where the audience sees a character react to something shocking or unexpected, such as finding a dead body, or discovering that someone has been lying to them. Let’s take a look. reaction shot What Is a reaction shot? A reaction shot is a cutaway shot used to show the audience how a person feels about what another character in a scene is saying or doing. For example, let’s say the main character makes an observation or gives an opinion. A reaction shot would be used to show the other person’s response. Reaction shots are commonly used in movies and TV shows, and they are an accepted and well-worn part of film language. Reaction shots are sometimes referred to as “cutaway” shots because they “cut away” from the main action to show something else that might be important. In a conversation, for instance, a reaction shot might show the listener’s facial expression or body language, revealing how he or she feels about what’s being said. It might be a nod of agreement, a smile of amusement or a frown of disapproval. What Is A Reaction Shot? Reaction shot is a film term for a cutaway to a character who is reacting to something that just happened. It’s similar to an insert shot, except an insert shot is usually of an object or some other non-character visual element. A reaction shot shows the face of a character as they react to some sort of stimulus. If you’re editing video, whether it’s corporate video or music video, one of the most important tools in your kit is going to be that magic little button that cuts from one shot to another. That way you can show someone doing something and then show the person’s reaction when they finish or whatever happens. There are many different ways to cut from one shot to another. There are lots of different combinations and types of shots that you can use. One thing that you want to keep in mind is what kind of feel do you want to project with your video? What do you want people to feel when they’re watching your video? Do you want them laughing at it? Do you want them crying at it? Do you want them thinking about it? One thing that I like to do in my videos is use reaction shots a lot. Reaction shots are great because they show somebody reacting after doing something or experiencing something. Reaction shots can be used as a way of cutting back and forth between two scenes, showing how events unfolding in one scene are affecting characters elsewhere. They are often used when the action moves away from one set of characters to another. This can happen at key moments in the plot; for example when an unknown assailant is revealed at the end of a murder mystery. Reaction shots can be used as a way of cutting back and forth between two scenes, showing how events unfolding in one scene are affecting characters elsewhere. What Are Reaction Shots In Film Used For? Reaction shots in film are close-ups of faces as characters react to a situation, usually conveying a sense of what the character is feeling. They can also include full body shots where the actor displays his mood through his body language. Reaction Shots in Film and TVA reaction shot is a close-up of someone’s face or body as they react to something that happens in the scene or show. It is used to show what the character is thinking or feeling, and can help us better understand their role in a story. Reaction shots are also commonly used in TV shows and movies when an actor has delivered a powerful line or speech, so we can see their facial expressions as they deliver it. This gives the audience time to process what they have said and it serves as an emotional punctuation mark at the end of the speech. In Film and TV, reaction shots are often used in combination with dialogue. This can be seen in countless scenes from classic films where two actors will be talking to each other, with one of them delivering a powerful line. The director will then use a reaction shot from the other person to show how they feel about what has been said.They are also used frequently when showing conversations between a group of people. Reaction Shot In TV Shows Reaction shot, or cutaway shot, is a camera shot that shows the subject’s reaction to something previously filmed. It is typically used in television and film to expand on a scene by providing information that adds context, or to show a character’s emotion about something that just happened. The reaction shot is frequently used in sitcoms and reality shows as a comedic device. It is also used in drama to add suspenseReaction shots are most often used after some kind of punchline or joke. They can be used to show either the person telling the joke laughing or the person he or she just told the joke to laughing. Other times they may show someone not laughing at all, or to display an emotion other than laughter (such as surprise or confusion). Sometimes a reaction shot will be intercut during the reaction itself, indicating a short time lapse between it and whatever it is reacting to. In some cases, a reaction shot is filmed after an event has already happened. In these instances, the subject of the film (usually an interviewee) will be asked questions about what they just witnessed or experienced and then shown on screen while they respond. This technique can be used to extract more information from a subject. In some cases it may seem like there was no reaction at all. What Do Reaction Shots In Film Convey Reaction shots are those that show the actor’s reaction to something. It is the opposite of the “master shot”“. Reaction shots are often used in films, documentaries and TV shows to replace dialog and to show a character’s emotions. They may be used with other camera techniques such as close ups, pans, dolly shots etc. Tone and context are very important for reaction shots as they will contribute to how we as an audience interpret them. Each shot has a different tone and might convey different emotions depending on where it appears in the film. In a horror movie perhaps one of the most common uses of reaction shots is when a character encounters a ghost or some other apparition. This is usually conveyed through extreme close up shots of eyes widening and pupils dilating, accompanied by an audible gasp or shriek from the character. In this case the reaction shot shows us that not only does our character see something but they are really scared by it too. The use of extreme close up shots makes this even more effective as it brings us right into the action so we can see every little detail. Its scary because its right in our face! Importance Of Reaction Shots In Film The reaction shot is a short scene of an actor showing their feelings about what has just been said. These shots are important because they can add a deeper dimension to the subject. One of the most famous reaction shots is the iconic wide-eyed, mouth-open look that actors such as Marilyn Monroe, James Dean, and others were famous for pulling off. In fact, this is what helped make them so famous in their time. The reaction shot is one of the most important tools that a director or producer must work with if he or she wants to be successful in the film industry. These types of shots are not always easy to get right without having a good actor in front of you. A good actor will be able to deliver exactly what he or she needs to get the message across. However, even if you have an amazing actor on hand, it’s still going to take some practice for you to learn how to properly use these shots so that they are effective and not cheesy. The reaction shot is a staple of television and film. It’s a shot of someone responding to what the other person has just said or done. The point of it is to help the viewer understand the situation by showing their response to whatever has happened. The most common reaction shot is one in which someone looks surprised or incredulous (though there are plenty of others). When you hear that a character has just been told something, your first thought is probably not, “Oh my God, they’re going to cry.” But if they do cry, you need to see that on screen. Examples Of Reaction Shots In Film Reaction shots are very important in film because they show the audience what the characters are feeling. If you’re watching a movie and the camera only shows people’s faces when they’re talking and showing their teeth, it would be hard to tell if that person is happy, sad, or even if they are mad. Tension, joy, heartbreak, happiness and so many more feelings can be shown through the eyes. This is why reaction shots are so important. The camera shows us what a character is thinking and feeling without them having to say anything.Here are some examples of reaction shots in film:(0:01 – 0:04). In this scene from “Toy Story”, you see how scared Andy is when he receives his birthday present from his mother and his father. You know that he’s not used to having toys in his room because of how excited he is with all of them being there at once.This shot is an extreme close up on his face as he looks around at all the toys.2.(0:05 – 0:11). In this scene from “The Help”, Skeeter has just finished her novel and she takes it to her editor who gives her some ideas about how to make it better for publishing. Writing Reaction Shots In A Screenplay I’m convinced that I’m a better screenwriter today because of the work I did on The Blacklist. It is, after all, one of my favorite TV shows, and it’s a thrill to be able to watch episodes each week knowing that I wrote some of those scenes. TBB is also the show where I learned how to write reaction shots in a screenplay (or “cutaway” shots, as they’re called in the industry).In my early days as a writer, I’d often cut away from dialogue scenes with a simple description like this:A busy street . . . Traffic lights change . . . A woman steps out of her car and slams the door. This was easy to write, but it was also kind of boring. When you’re reading a script, you want action — you want to see things happen. You want reaction shots! And now that’s what we do on TBB: The writers get into a room together and beat out the scene in detail with our director before turning it over to our amazing story editors. When they write the script, they include all the details — not just descriptions but dialogue, blocking (where everyone is when they say each line), camera angles and everything. Reaction Shots In Film Wrapping Up There are a lot of ways to go about getting a scene from the script on film. One of the most important is by using reaction shots. This technique has been around for decades and is used in virtually every movie made.The idea is pretty simple, you use a shot of one character to show how they react to what another character said or did. It can be funny, excited, surprised, disgusted or any number of other emotions. A great example of this is in all three Lord of the Rings movies when Gandalf smokes his pipe and blows smoke rings. Tolkien not only wrote the original story but also spent many years adapting it into the screenplay for Peter Jackson’s movie adaptations. In both situations it was important that he show how characters were reacting to the events happening around them. One of the best ways to do this was by using reaction shots like those mentioned above. The reactions can often show a lot more than just words can convey and help move the story along at a good pace. It also helps keep audiences engaged with what’s going on and helps immerse them into the world being presented on screen. You should always be looking for opportunities to add these types of shots into your own work as well as in your own life when telling stories to friends.

https://filmlifestyle.com/what-is-a-reaction-shot/

The Bourne Identity:The Bourne Identity is a spy fiction thriller directed by Doug Liman. Its narrative is focussed on one male character that is seen as the protagonist who is picked up by a fishing boat and is found with bullets in his back. From this it seems as if he has lost his memory and tries to gather as many clues to recover from amnesia. The protagonist is called Jason Bourne. This film contains many conventions which are commonly used throughout other thriller films such as mistaken identity and amnesia. The opening of the film shows a close up of a very dark, gloomy sky with flashes of lightning, giving the audience a sense of tension. Its followed by a long shot exposing more of the surroundings and the location of this opening scene. It can be seen that the focus is all on one boat which is currently in the middle of this stormy weather. The camera cuts quickly to a mid shot at a high angle which is tilted presenting men sitting at a table playing cards. Even inside this boat the low key lighting contrasts to the weather outside as the lighting is very dark and creates enigma. Furthermore these men force the viewer to start questioning who they are and where they are from. This is because diagetic sound is used to project their language and display them as unimportant figures in this film as the language they are speaking is hard to recognise placing the audience in a confused position. These are elements that combine in a build up of suspense as they create confusion to the audience. There is an extreme long shot displaying the effect the stormy weather has created to the sea. At a far distance a body floating in the middle of the sea can be seen. Here the narrative presents ordinary situations in which extraordinary things happen. This creates suspense and enigma because at this point the audience start questioning why a body is floating at sea and how it got there. Following on a birds eye view angle is used to show the passengers on board lifting the body out of the sea. At this point diagetic sound is used to represent the language the men are speaking and subtitles are presented below to help the audience engage with this mysterious finding. The weather perfectly matches the mood of the film as the aura possesses a very negative and uncomfortable vibe due to the fact that we see a man being operated. This particular scene puts the viewer in an uncomfortable scene because its clearly not a medically safe operation and it seems as if the male is experimenting on a human being. This is probably intentional from the director as it helps us as the audience engage giving us mixed emotions making us uncomfortable. An extreme close up is used to display from what seems to be a doctor cleaning a knife. Following on he starts to take out the bullets that are inside the mans body, at this point the angle tilts up creating suspense because as a viewer you start asking what hes doing and why he is helping him? There are slow transitions between shots adding to the suspense created because it contrasts with the music that is playing in the background as non- diagetic sound. As the music becomes faster during the moments of the bullet being taken out, the movement of the shots becomes slower making the viewer feel tense. In this thriller film the theme of identity is presented as the protagonist is seen to suffer from amnesia as he wakes up from a serious accident. The lighting is very dark making it harder for the viewer to see the protagonist and also creates suspense. The place he is in at the moment gives off a very cold and old sense as industrial materials are being used. As the injured man wakes up the doctor helping him returns to the room finding the man removed from the table he was placed on. This creates tension and enigma as the audience dont know when to expect him to pop out suddenly. A mid shot is used to show the man jumping from behind the doctor and screaming asking him what he is doing to him. Here the protagonist is seen putting another character in peril through an over the shoulder shot. Following on the protagonist starts questioning him on why he is here and how he got inured. The doctor reassures him and tells him that he is only trying to help and asks him what his name is. Diagetic sound is used to hint to the audience that the protagonist has amnesia that was caused by the accident he was in previously. He replies to the doctor by saying I dont know what my name is and what happened to me. This helps the audience gain more information about his identity and the position his injuries have caused him to be placed in.

https://pdfslide.net/documents/the-bourne-identity-55844cf6aefdb.html

While watching Rear Window by Alfred Hitchcock, I was able to notice two distinct themes throughout the film. These two themes are a quote about actions speaking louder than words and suspense. Hitchcock also had many different elements in his film to make it successful. My favorite element he used was sound with the radio in the background, street noise, and other ongoing conversations. One main theme that was shown through out the film was the quote “actions speak louder than words”. Also because he didn’t even know who or what he was so that added suspense too. People at the party were running from him but he thought it was a monster behind him. “When I returned I found a stone trap door immovable” he thought it was the monster in the doorway it’s a mirror and he sees his North by Northwest, is a 1959 American archetypal thriller film directed by auteur Alfred Hitchcock. This espionage neo-noir film follows protagonist Roger O.Thornhill who is mistaken for the fabricated George Kaplan. In an effort to clear his name, and demonstrate his guiltlessness, Thornhill is chased across the United States, and framed for the murder of U.N diplomat Lester Townsend. Thornhill is then forced to acquire Kaplan 's identity; whilst being confronted with a mysterious femme fatale named Eve Kendall. Through Hitchcock 's explicit usage of mis-en-scene and complex cinematic structures such as establishing shots, and point of view shots, this neo-noir film, draws intensely on the context of the 1950s era, by delivering stories Suspense, the state of tension, anxiety, and uncertainty, like waiting for an outcome that comes very slow. Authors usually create suspense by using story elements. In the story “The Monkeys Paw” by W.W. Jacobs, he uses story elements such as foreshadowing, conflict, and surprise ending. Foreshadowing is one of the biggest ways that expresses suspense in the story. For example Sergeant Major Morris states that the first owner of the paw wished for death. Webster’s Dictionary defines suspense as, “a mental uncertainty or anxiety or the state of being undecided or doubtful.” By using mystery elements in his or her writing, an author can give the readers the uncomfortable feeling of suspense while reading their suspenseful text. In various short stories, mystery elements create suspense in a variety of ways. The short stories, “Lamb to the Slaughter,” by Roald Dahl, “The Adventure of the Speckled Band,” by Sir Arthur Conan Doyle, and “Invitation to a Murder,” by Josh Pachter create suspense as a result of the mystery elements they contain. “Lamb to the Slaughter” is one of the many examples of texts that includes suspense, which the author created throughout the story. “The suspense is terrible. I hope it will last” (Oscar Wilde). Though this quote is ironic, the reasoning behind it is accurate, especially in literature. Though suspense can be quite off putting and frustrating for a reader, it also makes the story much more intriguing. Authors use suspense to pull a reader into their story, keeping them on the edge of their seats and always wondering what will happen next. Peter Bogdanovich once said,” suspense is guided by an audience’s sympathy for its characters and an intense need for something dramatic to happen.” The six fundamentals of Good suspense: 1. Subjectivity. 2. After reading acts one though four, it seems fair to say that Macbeth won’t be king for long. Most of the details in the play up to this point seems to point towards his destruction. His guilt over killing Duncan, the failed murder of Fleance, Lady Macbeth forcing him to commence the murders, the nobles suspicion of his murderous ways. I don’t know how exactly how he will fall however there are many possibilities onto how and seeing that most of England wants him dead, id probably start there. Act four’s main purpose, I think was to mostly deepen the plot and build suspense for act five. “Suspense combines curiosity with fear and pulls them up a rising slope,” quote by Mason Cooley summarizes the idea of how W.F. Harvey creates suspense in his short story, “August Heats.” Everyone likes a little suspense in their life so W.F. Harvey attracts his audience by using foreshadowing, “the use of hints to suggest events later in the plot,” (source 1) a reversal is involved, “a sudden change in a character’s situation from good to bad or vice versa,” (source 1) and the narrator withholds information from the reader. With these steps the author intrigues the audience to continue reading and cause them to feel frightened as they read. W.F. Harvey first begins to get the character interested in the reading by the way he signals hints towards the reader in order to get them thinking about events that could possibly happen. As the reader continues reading W.F. Harvey introduces more hints that might change the way of thinking of the reader. Hitchcock films are most often thrillers, pegged as such because of their suspense, psychologically complex characters, and twist endings. In a career spanning six decades he directed over fifty feature films. A film auteur is usually a writer and a director who use unique and personal styles in their films, so when someone was to watch another film of that person they will instantly refer to that filmmaker. Alfred Hitchcock is a perfect example of this because of several reasons.

https://www.ipl.org/essay/Alfred-Hitchcocks-Use-Of-Suspense-In-Film-PJTSGBT8AM

In my essay, I will discuss how tension is created in the play, and its effects on the audience and the characters throughout the play. John Boynton Priestly wrote “An Inspector Calls” in the space of one week near the end of world war two. He wrote this play because he was interested in politics, and felt the need for a change as to the way poor people were treated by the higher-class citizens. He expressed his passion in this play to get a message across to the public that there needed to be a change in the social attitude of higher-class people. An Inspector Calls’ was set in 1912 when there was a huge divide between the three classes; working class, middle class and upper class. JB Priestly did not only write ‘an inspector calls’ as a piece on entertainment but to criticise the middle and upper classes and to show them their life from a different perspective. Priestly would have wanted to create tension to leave the audience at unease and feeling apprehensive at what is going to happen next thus engaging the audience keeping them interested. He created great tension through the character of Sheila when priestly writes, ‘yes – except for all last summer when you never came near me’ Priestly cleverly used a hyphen as a dramatic device here as it is used as a dramatic pause, Priestly uses the pause to keep the audience in suspense which draws the audience into the tension of the play right at the beginning. Sheila is half-heartedly agreeing and is keeping the audience in a state of anxiety wondering why she might not agree. The sentence creates tension between the characters of Sheila and Gerald; Gerald quickly tries to get Sheila on side and explains what happened. Sheila is almost reminding Gerald that she hasn’t forgotten. The hyphen has a great affect on the audience as well as on the characters as it makes us wonder why Sheila would disagree and what really happened. Priestly is making us wait by using a hyphen as a dramatic pause which moves the mood of the play to a nervous one, which is a contrast to he happy theme and atmosphere of the party. Tension is also created though he character of Eric, as in the play Eric is shown as a rude, impertinent and immature little boy. This is made clear from the beginning of the play, as he is seen as a drunk, when for no reason what so ever he ‘guffaws’ and says ‘ I felt I just had to laugh’ this sentence makes it clear to the audience that Eric is an alcoholic and he can’t control himself. After realising who Eva Smith is he discreetly leaves the house but later returns to tell his part of the story, only to find out his mum has set him up to fall, and has put all the blame on him without her realising. He feels responsible for her death even when the inspector leaves but doesn’t think it was his fault alone. Each new revelation, prompted by the Inspector’s use of the photograph or information from the diary, adds to the overall picture of the two years in the girl’s life. Each part fits together and helps to complete the jigsaw of events and involvements. Priestly’s success in creating tension depended on the use of dramatic irony, which he creates. When Sheila has worked out that Eric might well be the father of Eva Smith’s child, there is irony in that Mrs Birling has not realised it ‘and he ought to be dealt with very severely’ and is demanding that an example should be made of the boy, who is none other than her own son. Priestly throws in a twist at the end. As we have the problem of whom the Inspector really was, a trickster determined to make fools of them or some sort of avenging spirit come to make them see the evil of their ways. Priestly also creates tension using many different methods for example he uses the time at which the play is set to create tension as it was set in 1912 just before the first world war (1914-1918) but was written and preformed in 1946 so the audience of the time would have lived and gone though the war and would have known the outcome of it. Birling says ‘wars inevitable … fiddlesticks! ‘ and as I said before, the audience knows the war had happened and knows that Birling’s prediction is false. Also Birling makes more predictions, which the audience knows to be false ‘titanic… unsinkable’ ‘Russia… behindhand naturally’ so priestly has set-up Birling to seem foolish. So to the audience from the beginning of the play gets to know what sort of person Mr Birling is. He comes across as quite arrogant when he is talking about war ‘Germans don’t want war’ and also how the titanic is ‘unsinkable. Later on in the play as the inspector arrives Mr Birling character becomes more alert. He becomes somewhat impatient when he is being asked questions about Eva smith. He goes very defensive about having anything to do with Eva Smith’s death and doesn’t feel remotely responsible. He is insensitive and uncaring about the fact that she committed suicide, and this is shown throughout the play. Also in act 1 where Birling is being questioned he becomes nervous and tries to change the subject to Eric’s lack of responsibility ‘(rather angrily)… t’s about time you leatnt to face a few responsibilities’ this also creates tension as Birling is shifting the blame onto Eric in an attempt to save himself. Gerald also creates tension between him and Sheila, as when the inspector reveals that Eva Smith changed her name to Daisy Renton, Gerald says, ‘(startled) what? ‘ Gerald has given himself away he has publicized that he knew Daisy Renton, soon after the inspector says she had changed her name he leaves with Eric, leaving Sheila and Gerald alone during this time. Sheila questions Gerald and this creates great tension between the two of them and with the audience, as we now know where Gerald was last summer when he ‘never came near’ Sheila. As soon as the inspector leaves Sheila’s first word is ‘well? ‘ and when the inspector returns he comes into the room and starts with one intimidating question ‘well? ‘ This also creates tension as it portrays that he knows about Gerald and Daisy and knows that Sheila and Gerald have just been talking about it, now he wants Gerald to confess like the others have. I believe the greatest tension created in this play, from a 1946 audience point of view, is in the inspectors final speech, it has an outlandish influential and forecasting aspect, ‘but remember this one eva… still with us’ this is not the language of an inspector which we later on find out why. The departing lines of the inspector, summarises the reflective views of Priestly his statement ‘if men will not learn this lesson then they will be taught in fire blood and anguish’ must have had a great power on the audience. For the characters on stage in 1912 the war is still looming. But priestly is telling his audience who had suffered in the war; we haven’t learnt anything from it. The middle class still feel no social responsibility for the lower class. When the inspector leaves, Mr Birling and Mrs Birling all go back to normal pretending nothing has happened; this creates tension between the adults and the children. Birling says, ‘we’ve been had. That’s all. ‘ Acting like nothing has happened but Eric and Sheila still feels the impact of the inspector once he has gone. Sheila still feels guilty about her part in it all. ‘It frightens me the way you talk’ and almost takes on the role of the inspector and feels ashamed that her family has felt that they have gotten away with it. In conclusion I believe that Priestly has affectively created tension throughout the play on various scales. At one end he created tension through the Sheila when he wrote, ‘yes – except for all last summer when you never came near me’ Priestly cleverly used a hyphen as a dramatic device here as it is used as a dramatic pause. On the other hand during the inspector’s final speech there is an immense tension period, by creating this tension Priestly makes the audience think what has been learnt from the war, the audience would have been through the war and would have left a lasting impact on them. Throughout the play Priestly asks an underlying question ‘will we ever learn our actions cause consequence for everyone? ‘ which again has a massive impact on the audience making them think, and still to this day this question cannot be answered as these same mistakes are made all the time.

https://blablawriting.net/priestly-create-tension-play-essay

Originally published at Through the Tollbooth. You can comment here or there. Sometimes when I’m browsing in a book store, I open a book to a random page and read a few sentences. For several years, I’ve wondered what I’m looking for in that random page. Finally, I’ve figured it out: voice and tension. This week, I’m examining the second of these two craft elements: how writers use tension. Tension is an essential element of story. What pulls me forward and keeps me involved in the story? Tension. Yes, I might continue reading because of great prose or I love the character or I’m interested in the story. But if there isn’t enough tension (for the type of book) I tend to set the book aside. The tension needs to match the story and genre of course, but the techniques of building tension are the same in all stories. Today my focus is on tension and character. Here are four common ways a writer creates tension on a character level. 1. Struggles The character is growing and developing throughout the story (internal arc) and facing outside elements of other characters and the environment (outer arc); these struggles create suspense and tension. A reader should feel the emotions and struggles of the character. Struggles—both internal and external to the character—create tension. This time of struggling (which is repeated over and over in a story) leads to the next tension builder . . . 2. Choice The character must make choices, often hard, challenging choices. The process of choosing produces tension. Choices can be between good things or bad things, as a choice between good and bad won’t produce much tension. Big choices create tension. Little choices create tension. Hard choices create tension. All choices add tension to the story. At some point the character takes action. This leads to more tension: what will the result of the choice be? Often the choice propels the character forward into a greater challenge and more tension. 3. Flawed character Great characters are flawed and imperfect individuals. There are many reasons to create flaws in a character. One benefit of a flawed character is that the reader can see the flaw and sense the choices the character might make, the reader sensing that the flaw will create all sorts of challenges. Even though we can see it coming, the car driving toward the edge of the cliff, we keep reading, hoping that maybe this time the character’s flaw won’t come into play. A flawed character also allows for surprise, which is another way of creating tension in a story. 4. Desire(s) The character wants something she doesn’t have. This gap creates tension. Intense desire = intense tension. There will be an overall desire or want that is a throughline of the story as well as smaller desires (often goals) in each scene. Building tension on an internal character level is critical as we craft our stories. These types of tensions help flesh out characters and bring them to life. Next time, Wednesday, I’ll tackle tension in plot or the macro level of tension in a story.

https://thru-the-booth.livejournal.com/230315.html

A few weeks ago, I solicited help from the Morlocks’ readers in deciding which early Hitchcock film to show in my advanced film history class. After weighing the suggestions and reading the comments, I chose The Lady Vanishes, the story of a British spy returning from a Balkan dictatorship with coded information important for England’s safety. Dame May Whitty stars as spry Miss Froy, who pretends to be a governess but is actually a capable secret agent. After she disappears while aboard the train bound for England, no one seems to remember her except for Iris, the young woman sharing her compartment. Was Miss Froy only a figment of her imagination? A BEHIND THE SCENES SHOT OF ONE OF THE TRAIN CARS REVEALS THE CRAMPED SET. In each of my classes, students fill out response sheets while watching the films. It’s a learning tool that forces them to be active viewers so they are better able to notice visual techniques, themes, or character types. With their permission, I thought I would share a few of their comments about The Lady Vanishes. The limited setting received a lot of attention, particularly the idea that Hitchcock could squeeze so much action and suspense from what is essentially two main sets. The first third of The Lady Vanishes takes place in a small crowded hotel; one student remarked that the film seemed claustrophobic right from the beginning. She noted, “The environment seems just slightly too small for everything that is going on,” which intentionally enhances the claustrophobia. The characters fought over rooms, dined in tiny booths in a cramped restaurant, and hosted local dancers who clogged away in the confined space of the rooms. The train proved to be an even more limited setting, with the action intensifying into fights, chases, and kidnappings. Another student suggested that the train was like a microcosm of society, with all manner of characters interacting with each other. She felt that Iris entered this environ and experienced a life-altering adventure that was also a journey of self-discovery. The suspense thriller is a genre that is no longer popular, so students are not always sure what constitutes suspense. I related Hitchcock’s adage about the bomb in the room. He always maintained that if he began a scene by showing the audience a bomb in the room and then clearly depicted where the bomb was in relationship to the characters, he would have the audience’s rapt attention for ten minutes. But, if he exploded the bomb as a surprise to the audience, they might be shocked out of their seats but he would have their attention for only ten seconds. Students rightly noticed examples of this technique in the scene in which we wait for Iris to notice the name “Froy” written on the window and during the scene in which Iris and Gilbert are about to ingest a spiked drink. The anticipation in both scenes created true suspense, and I think students came away with a better understanding of what that is. The class seemed intrigued by the characters of Caldicott and Charters, the two cricket-obsessed friends who maintain their stiff upper lips no matter the situation. The students were surprised to learn that the pair proved to be so popular that they were featured in three later movies, Night Train to Munich, Crook’s Tour, and Millions Like Us. More than one wondered if the two were supposed to be gay, a logical assumption considering their depiction in the tiny hotel room. A perceptive student inquired if the two might be patterned after vaudeville archetypes of the day. Charters—or maybe it was Caldicott—got a big laugh from the class when he was shot in the hand but barely winced, keeping his stiff upper lip intact. We were charmed in the end when the two turn out to be courageous in the final gunfight with the pseudo-Nazis. IRIS (CENTER) HAS A LAST NIGHT OF FUN BEFORE RETURNING TO ENGLAND AS A SACRIFICE ON THE ALTAR OF MARRIAGE. I find that those of us who love classic movies see their artistry and understand their cultural significance, but more importantly we realize that they carry an emotional impact that films from other eras simply can’t duplicate. We want younger generations to share in that experience, to understand the heart that these films can display. More often than not, conversations among film teachers do not focus on rare bits of history or esoteric discussions of subtext. Most of the time, we want to know: What did you show in class? How did it go over? There is an excitement when classic films are well received—like a victory for our common cause. I am gratified that The Lady Vanishes achieved such a victory and ever proud of my talented, perceptive students. Glad your students liked it and made such shrewd observations; it’s my favourite English Hitchcock movie. Iris’s internal conflict over marriage is probably more the fear of marrying the wrong person, than fear of marriage itself. The end indicates that she probably will be happy ever after with the Michael Redgrave character. One important reason that Hitchcock was not considered an artist for most of his career was that he made thrillers, which were considered lowbrow entertainment, whereas drama was considered artistically valid. Bu that lack of appreciation has been more than made up for in the last 40-odd years. Funny, I don’t know that I’d ever considered Hitchcock’s rather sour take on marriage through so many of his films. Sabotage, Rebecca, Dial M for Murder, Notorious, Marnie, the detective and his wife in Frenzy, The Trouble With Harry, the murderer and his victim in Rear Window, Suspicion and so on. I feel like I have to rewatch Mr. & Mrs. Smith just to see what his take on a happy (or at least, comedic) marriage is like, since they’re far outnumbered by the troubled ones. Hitchcock stayed with wife and creative partner Alma Reville until his death, but I gather they had their ups and downs as well. I’m glad your students enjoyed The Lady Vanishes. One small comment on your post. I think that the delightful Caldicott and Charters were avid cricket fans rather than soccer fans. When I was in college almost 40 years ago, the early Hitchcock film that was shown was the 39 Steps. After reading your various posts,I think I would have enjoyed taking a film class from you. Orson Welles used the bomb explosion very effectively at the start of his classic “Touch of Evil” [which took place off camera] to start to create an air of tension in his movie. Happy marriages make for dull movies; i think his interest was more in the possibility of friction, and therefore suspense, in a tense relationship. I think Hitchcock and Alma Reville had a creative rather more than a romantic relationship; they were kindred spirits and he valued her opinion more than that of anyone else. I remember seeing “The Lady Vanishes” at a retrospective movie theater, circa the late seventies. It was my first time seeing a “golden age” film with a large audience. It was on a double bill with “The 39 Steps”. I was impressed by how much laughter and genuine rapt attention was given bot h these then forty-year old movies, but especially “Lady Vanishes”. The film began by passion for seeing as many movies I loved with an audience. I’m so glad you picked this Hitchcock classic for your class, and their reaction seems similar to what I felt and experienced that evening. Your mention of the audience waiting for a character to notice writing on a window makes me wonder how often Hitchcock used the technique of building suspense through the audience knowing more than the characters vs. scenes where the audience and characters are equally knowledgeable (ignorant). Glad to hear your students appreciated The Lady Vanishes. It is one of my favorites. Caldicott & Charters are also featured in the British horror anthology film Dead of Night. I’m not sure of their actual names but once again they are a comic duo. Bill: You are exactly right. It was cricket and not soccer. You can certainly tell I am not a sports fan!

http://streamline.filmstruck.com/2016/03/07/the-winner-is-the-lady-vanishes/

Extracts from this document... Introduction Victroian stories Although these two pieces of writing have different storylines, the authors still use the same techniques to apply mystery and suspense to their story. Mystery and suspense is mainly trying to keep the reader guessing throughout the story and wanting to read on to find out the answers and whether their guesses are correct. The techniques used are mainly theme, character and narrative structure. The signal man and the Red Room are both pieces of unique gothic literature, which come under the ghost story genre. The object of these kinds of stories is to scare the reader and to keep them on the edge of their seats. Both of theses stories were written in the Victorian age, where ghost stories were more popular than ever, during this period of time I think people were more easily scared, that is why many ghost stories were written during this period of time. Ghost stories are still enjoyed by many people today, they still keep the reader on the edge of their seats and still terrify the reader. The title of the story, 'The Red Room' implies that the setting of the story is going to be in a red room. The colour red catches the reader's attention because of the nature of the colour red, red mainly stands for danger, fear blood, etc. ...read more. Middle The "gloomy red light and the gloomier entrance to a black tunnel" the gloomy pair seem to just say aloud 'use your imagination and see the ghost standing there' The characters in the red room are timeless and ageless to go along with the ancient setting. From the first line in the story which is, 'I can assure you that it will take a very tangible ghost to frighten me' This signifies the narrator's character instantly; it shows that he is a cocky and arrogant young man. As we progress through the story we learn that there are 3 'grotesque' old people also in the room. The first line that the old man with the withered arm says is, 'It is your own choosing' Which creates a feeling of suspense, making the man with the withered arm seem mysterious? There is also a grim old woman sat there looking in to the fire with, 'Pale eyes wide open' This tells us that her eyes appear to be lifeless, almost like a ghost. She starts to say queer things 'Ah... there are a many things to see..... A many Things to see and sorrow for... This suggests that the old woman is almost warning the narrator, trying to make him feel uncomfortable, she also, 'Swayed her head side to side' Which seems like an indirect physical warning, this adds more depth and tension to the story and the dreary old people? ...read more. Conclusion This idea of the red light makes us think of danger, and red lights are only indicated when something bad is about to happen so this adds to the tension of the story for the audience reading it. As the narrator and signalman begin to have a conversation we start to find out more about the signalman and his character, this also adds to the suspense and tension of the story, because the characters make the story. The signalman is devoted to his job, nothing means more to him than his occupation, and he is a perfectionist everything he does has to be perfect: "Exact and vigilant" The signalman would even leave a conversation halfway or stop what he was doing and attend his work. Once he had completed it he would then come back and carry on with what he was previously doing. At this point the narrator thinks that he should feel safe whilst in the presence of the signalman, but then again on the other hand he thinks that there is something creepy about him. This increases the suspense for the audience because it makes us think about what is going to happen next and why does the narrator think that there is something strange about him. Does the narrator know something we don't? But then again some people would take no notice of it and say that it's not strange at all. He's only doing his job. ...read more. This student written piece of work is one of many that can be found in our GCSE The Signalman section. Found what you're looking for?

http://www.markedbyteachers.com/gcse/english/the-signal-man-and-the-red-room-are-both-pieces-of-unique-gothic-literature.html

KINDRED, perhaps the most admired novel written by the late, great Octavia Butler is a nearly perfect novel. I rate this novel PG-13 for the violence that is shown, though not celebrated, against black slaves. I plan to write a separate post for educators after this general review of the novel. Short Review…3 Reasons to Read - KINDRED is a page-turner. As a novelist, I so admire this book. It ain’t easy to keep your audience on edge. Butler does it with genius. - KINDRED humanizes slaves and slaveholders…In my mind, KINDRED is a literary narrative because it does not simplify the incredibly complex story of slavery in US history/society. - KINDRED is literary, yet it is also an adventure story…Read the book to gain empathy, knowledge and understanding, but count on being entertained and in suspense while you learn. Longer Review Octavia Butler did write great science fiction, like The Xenogenesis Trilogy, but KINDRED falls into a different category. It’s a time-travel fantasy with fewer of the typical time travel tropes. We all know those tropes, how tension builds as the reader/audience wonders whether a character who impacts past will change the future. In KINDRED, that tension (changing the future by impacting the past) stays in the background. It is a worry, but not the primary worry. What creates the tension in KINDRED is the survival of the main character. The story premise is brilliant. Dana, whom the reader affixes to very early, is an African American woman, married to a white man living in the 1970s. She is living her life in the present as a happy person. Suddenly, she finds herself yanked back into history. It takes her a while to figure out why, but eventually, she and the reader understand that every time one of her ancestors (a white slave owner) finds his life in danger, Dana is summoned to the past. This happens multiple times. Dana comes back into real time when she finds herself in danger of being severly injured or killed. The going back and forth is painful, but an interesting narrative device. The reader, who empathizes with Dana, finds these short respites back in the modern era as hopeful and yet terrifying because the readers knows, as does Dana, that she will be yanked back in time within minutes, hours or days of her respite. Her oasis in the modern era taunts the reader and gives the reader pause. At least in part, our society has grown out of the horrifying reality of slavery. That reality cannot be denied, or at least it is harder to deny when the reader is identifying so powerfully with this main character. Dana, because of her experience of liberty in the 1970s as a black woman, becomes a guide to those in the past. She has agency, yet because of her skin color, she is also threatening to everyone who exists in this past world, including the slaves she will try to help. Regarding KINDRED’s captivating narrative, I challenge you to read the first twenty pages of this book and be able to put it down. Regarding KINDRED’s story, I challenge you to read something of greater substance that falls into the category of “time travel narrative”. I doubt you will find one.

https://allscifiallthetime.com/tag/xenogenesis-trilogy/

failure of physicians to apply available knowledge. That thought may hold more credence in the area of neurosurgery than in any other area of postoperative pain treatment. The shortcomings in this arena can be attributed to the common belief of clinicians that pain is minimal after intracranial procedures. Because of this controversial notion, many patients are undertreated in the immediate postoperative period. A comprehensive look at the issue of postoperative pain in the patient undergoing intracranial surgery led to some clarification of the issue. Dunbar compared those undergoing intracranial surgery to those with select extracranial procedures. In this 200-patient retrospective study, the intracranial group did have significantly less pain than the comparison group (p<0.05). A subset of intracranial patients did have significantly more pain than others in the group. Those requiring frontal craniotomies did have an increased need for opioids, and elevated heart rates, blood pressure, and intracranial pressure (ICP). Based on this analysis, a general statement cannot be made about all patients undergoing intracranial procedures. Other factors, including the need to monitor neurologic and cognitive functions closely, contribute to this problem. This monitoring can be affected adversely if the patient is sedated or obtunded. This conflict of treatment goals can lead to withholding pain medication and techniques. It has also led to the use of less potent opioids and banning morphine from some neurosurgical intensive care units. Recent studies have shown that when morphine and other potent opioids are titrated it does not alter the outcomes or postsurgical monitoring. Another factor complicates postoperative pain treatment in modern times. The use of new rapidly acting intravenous agents has led to rapid wake-up and recovery and unfortunately to the increased importance of postoperative pain assessment. With the rapid breakdown of these agents, the patient has no opioid level present and may experience significant pain on awakening. It is critical to realize that the treatment of pain in the neurosurgical patient may influence outcomes in a variety of ways. Studies have shown that pain in the postoperative period can adversely influence ICP. Proper pain control may stabilize hemodynamics and blood pressure as well as lower the ICP. In addition to pain issues, the perioperative period in the intracranial patient is complex in a systemic fashion. Recovery from neurosurgical anesthesia is followed by elevations in body oxygen consumption and serum catecholamine concentrations. Systemic hypertension is often present after neurosurgical procedures and has been linked to intracranial hemorrhage. The cerebral consequences of the recovery period can lead to cerebral hyperemia and increased ICP. Prevention or control of pain is one of the major factors in limiting these adverse systemic effects. Over the past decade, developments in intravenous opioids, new regional techniques, and local anesthetics have greatly enhanced our abilities to treat this patient group. Preemptive analgesia may lead to the improved stability of the patient throughout the surgical experience. To minimize pain and decrease the stress response and hemodynamic changes, the surgeon and the anesthesiologist must work as a team. The importance of the anesthesiologist in decreasing anxiety, creating a treatment plan, and executing the plan is crucial to a successful surgical experience. The opportunities to have an effect on the pain pathway are numerous. The pain response has a three-part complex. Pain transduction is the initial impulse. Pain transmission is the transfer of pain information via the C and A delta fibers through the spinothalamic tracts to the thalamus and cortex. Pain modulation is the interpretation of the pain signal. The cortex then processes this pathway into an emotional interpretation. The patient's genetic, social, and cultural backgrounds influence this interpretation. By understanding this complex pain neural network, the opportunity to impact the pain response is great. The method chosen to impact the pain network depends on the surgical procedure and patient comorbidities. I. Preoperative assessment Preadmission or presurgical considerations Reducing anxiety. Recent studies have shown that reducing anxiety preoperatively or in the immediate postoperative period enhances the ease of controlling pain. In the preoperative and postoperative patient groups, the need for medication has been reduced. There was a decrease in pain scales and hypertension. It is important for the anesthesiologist to use part of the preoperative interview to discuss the plan for postoperative pain treatment. Studies have shown that a discussion of the patient's previous experiences, expectations, and fears can be as useful as some anxiolytic medications. Patients should have a chance to ask questions and express concerns prior to the scheduled procedure. Pain treatment history. The prolonged use of oral opioids for chronic pain makes determining the baseline dose of opioids in chronic pain patients somewhat difficult. The tolerance to opioid medication can influence dosing in both the intraoperative anesthetic and postoperative pain course. It is important to realize that the use of chronic medications is for a stable pain condition and it will be necessary to supplement this baseline dose with additional medication. It is helpful to obtain a history of previous experiences with postoperative pain treatment, complications, and adverse reactions. The anesthesiologists should explain in detail the pain treatment plan; patient reassurance should be a high priority. Understanding the procedure. The physician providing the postoperative pain relief should understand the procedure being performed. An understanding of the patient's postsurgical mental status is helpful when the physician chooses a pain treatment plan. Techniques that require an alert patient, such as patient-controlled analgesia, should be offered only to those who are able to comply with instructions. Regional anesthesia is possible if the procedure involves only limited portions of the spine. Role of coexisting disease. The patient's nonsurgical disease processes must be considered when tailoring a pain treatment plan. The review of systems is critical in determining what recommendations should be made. The following factors should be considered in a presurgical assessment. Neurologic system. The site of surgery and the perioperative morbidity should be considered. The patient's baseline cognitive function also determines whether a patient-controlled analgesia (PCA) system can be used. PCA can be used in children as young as 5 years but should be instituted with caution and requires the education of both patients and their parents. Renal system. A patient with renal disease is prone to complications from drugs with metabolites removed by the kidneys. Meperidine, for example, breaks down to normeperidine, which can cause seizures in these patients. Meperidine should be used in a limited fashion in any postsurgical patient but the risk is high in those with renal impairment. Infectious disease. Neuroaxial procedures may be contraindicated in the patient with systemic infection or local infection at the site of the proposed procedure. If a patient is bacteremic or has local site infections, regional anesthesia is contraindicated. Hematologic system. The epidural hematoma is a rare but disastrous complication of regional anesthesia. Factors that may contribute to this adverse outcome include abnormalities of the clotting cascade, a history of bleeding during previous surgery, and the use of low molecular weight heparin and other coagulants during the postoperative period. This condition may be evaluated both historically and by laboratory values. Cardiovascular system. The physiological response to intracranial surgery includes hypertension, tachycardia, and catecholamine surges. An increase in blood pressure, heart rate and catecholamine results in an increase in cardiac workload and may lead to ischemia in those with perioperative risks. When in doubt, a cardiology consultation may be useful in planning the postoperative pain treatment plan. The other risk of the anesthetic and pain treatment is the issue of patients who are cardiovascularly unstable and require support. Gastrointestinal system. A history of ileus may be a cause for concern for the surgeon in regard to a local anesthetic infusion and use of narcotics. In these cases, it is important to implement a bowel support regimen as a standard part of the program when using intravenous or oral opioids or epidural infusions. Summary of the preoperative period. The preoperative period is crucial in the overall success of the neurosurgical pain treatment program. The clinician should develop a mental checklist of assessment points prior to bringing the patient to the operating theater. II. The importance of pain treatment The patient undergoing neurosurgical intervention may develop many perioperative changes that can affect the overall outcome without attempts at intervention. The stress response, which is somewhat dependent on the complexity and site of surgery, can affect the immunologic response, coagulation, cardiac function, hormonal response, and other systems crucial to the recovery of the neurosurgical patient. The anesthesiologist has several options to blunt the stress response, but these methods are successful only when the appropriate procedure is matched with the right patient. In some areas of anesthesia, the technique of postoperative pain control has been shown to have a major impact on outcomes and pain reduction. An example of this impact occurs in thoracic surgery. At the current time, no significant studies exist in the neurologic patient, and the significance of postoperative pain is unclear. III. The stress response: an overview Changes in other organ systems. The patient undergoing neurologic surgery is often very sensitive to subtle changes in other organ systems. The pathophysiologic changes associated with the stress response from surgical trauma can greatly affect the outcome from procedures with high risk of morbidity and mortality. Physiologic effects of the stress response. The stress response includes an initial depressed phase and a subsequent hyperdynamic phase. The depressed phase. In the initial portion of the response, the body responds by depressing most physiologic functions. This phase is brief in the surgical patient and might be unidentifiable in some patients. The hyperdynamic phase. The portion of the stress response of most concern to the anesthesiologist and most involved in morbidity and mortality in the neurosurgical patient is the period of recovery after surgery. This lasts for a period of time that is directly proportional to the amount of tissue trauma and the patient's preexisting disease state. A characterization of this response is given below. Endocrinologic changes. Both catabolic and anabolic responses are seen during this phase of response. (1) Catabolic changes include increases in several hormones: catecholamines, renin, angiotensin II, aldosterone, glucagon, cortisol, tumor necrosis factor, adrenocorticotropic hormone (ACTH), growth hormone, and interleukin (primarily IL-1 and IL-6). These changes lead to hemodynamic instability in some patients and perhaps to changes in cerebral blood flow (CBF) and ICP. (2) Anabolic changes include decreases in insulin and testosterone. The changes can lead to imbalances in the hormonal axis and impact wound healing and response to tissue trauma. Metabolic changes. The overall impact on the patient outcome by the stress response can be understood by considering the metabolic balance during this tumultuous time. (1) The catabolic and anabolic effects noted here create intense changes in the patient's physiologic stability. These changes include shifts in insulin resistance, muscle breakdown, glucose intolerance, fat breakdown, increased tissue oxidation with the creation of free radicals, sodium and water retention, hyperglycemia, increased acute phase proteins, and fluid shifts and third spacing. (2) The end effect is a change in fluid balance, protein metabolism, fat metabolism, and carbohydrate metabolism. Body system responses to the stress response Mechanisms to block the stress response have focused on beta blockade and blockade of other receptors. While these mechanisms are important, the physician should not forget the importance of impacting the pain pathways. Using both techniques enhances the chance of blocking the unstable response. The uninhibited stress response has been shown to increase cardiac workload; increase vascular tension; adversely affect platelet function; decrease fibrinolysis; decrease renal perfusion; decrease the urinary excretion of water, wastes, and electrolytes; decrease hepatic function; increase oxygen consumption; decrease immunocompetence; and decrease the centrally mediated temperature regulation mechanisms. Considering these enormous changes in the unbridled stress response, the importance of blunting this response in enhancing outcomes becomes critical. Pain treatment mechanisms utilized in limiting this systemic response are detailed. IV. Mechanisms of blunting the stress response to surgery General anesthesia. The use of inhalational anesthetics and total intravenous anesthetic techniques including remifentanil have been responsible for tremendous advances in improving the surgical experience and reducing pain at the time of surgery. Unfortunately, although interrupting pain at the time of surgical insult, most agents have not been shown to substantially block the metabolic and endocrine response to tissue trauma. A few anesthetic agents have shown promise compared to alternatives. Etomidate. When given by the intravenous route, etomidate may have some ability to blunt the adrenocortical system's response to stress. This effect is seen by a blunting of the rise in cortisol expected with similar tissue trauma. Etomidate is thought to accomplish this by blocking enzymes in the cortisol synthesis pathway. The clinical benefit of this drug has not been proved in prospective randomized trials. Its long recovery time may also limit its use as a neuroanesthetic agent. Inhalational agents. Sevoflurane and isoflurane are both useful drugs in low concentrations in the patient undergoing intracranial surgery. The ability to use these drugs to limit the stress response is minimal because of the effects of higher concentrations in changing CBF, cerebral blood volume, and ICP. High-dose opioids. Recent years have shown a dramatic increase in the utilization of high-potency short-acting opioids. Remifentanil, a compound of the 4-anilidopiperidine derivatives, is an ideal drug because of its ultrashort duration of action and metabolic independence of both hepatic and renal functions. The advantages of this drug may be some of the critical issues that lead to poor outcomes in regard to postprocedural pain complaints. The rapid increase in serum levels leads to an initial blunting of the stress response, but as the drug is discontinued, the patient is at risk for hyperalgesia and substantial increases in the stress response. It is critical that longer acting opioids be considered when the intravenous infusions of short-acting opioids are discontinued. Remifentanil, like other intravenous opioids, often leads to a stable hemodynamic course during the surgery. Propofol. Propofol has been used to try to limit the wake-up time from general anesthesia and to blunt the initial stress and pain responses. Limited studies provide no evidence that this drug changes the immediate stress response even when a slow reduction of dosage lengthens the wake-up phase until the patient slowly recovers to baseline cognitive function. Regional anesthesia: neuroaxial. Regional anesthetic techniques appear to have the greatest ability to block the stress response. The ability to use regional anesthetics in the neurosurgical patient is minimal and acceptable only in a few surgical techniques. Possible opportunities include spinal instrumentation, spinal repair surgeries, plexus operations, and surgery on peripheral nerves. The ability to use these techniques is also limited in surgery of the neuroaxis because it may delay the ability to do neurologic checks postsurgery. While studies have shown epidural or intrathecal analgesia has improved postoperative nitrogen balance, renal function, glucose metabolism, oxygen consumption, coagulation and fibrinolysis, and hepatic and immunologic function, and decreased cardiac workload, it has very little use in the neurosurgical patient. Peripheral nerve blockade. Peripheral nerve blocks can blunt the initial response to surgery and may be used as a sole anesthetic. The use of this technique in neurosurgical patients is limited. Common locations for peripheral nerve blockade include the brachial plexus, the cervical plexus, the femoral nerve, and peripheral nerves of the lower extremities. The need to assess nerve function in the immediate postoperative period could limit the technique. Adrenergic blockade. Clonidine has been used in patients with brain trauma and after extensive neurologic surgery to blunt the stress response. The drug has also been shown to blunt the possibilities of vasogenic edema. The use of spinal or epidural alpha-adrenergic blockade has also been shown to reduce the stress response. It is unclear whether the reduction in adrenergic response with epidural or intrathecal clonidine is a direct effect of the alpha-adrenergic blockade or a response to the clonidine-induced analgesia. The use of systemic beta-adrenergic and alpha-adrenergic agents has been shown to stabilize the hemodynamic response and the cerebral circulation. Nonsteroidals. The perioperative use of nonsteroidal anti-inflammatory drugs (NSAIDs) may enhance the ability of other techniques such as regional analgesia and anesthesia in blocking the stress response. The enhancement of regional analgesia and anesthesia is thought to be directly related to the NSAIDs' action at peripheral receptors involved in the tissue trauma cascade. Recent data on dangers of cyclo-oxygenase 2 inhibition have led to exercise of caution in using this class of drugs in the perioperative period. These drugs have been linked to hypertension, stroke, myocardial infarction, and blood clotting. Intravenous opioids. The use of PCA has led to markedly improved patient satisfaction and improved pain scores. Studies have shown that opioid-induced pain control can improve immunologic function in the patient undergoing neurosurgical procedures, which may lead to improved outcomes. Transcutaneous electrical nerve stimulation (TENS). TENS has been used to treat postoperative pain. Current data do not support its efficacy or any effect on blunting stress response. Psychological counseling. Biofeedback, music therapy, relaxation training, and simple conversation have been shown to lessen the stress response to surgery and lessen the overall stress response. V. Intraoperative and postoperative pain treatment interventions Preemptive analgesia Preoperative local anesthetic infiltration of the surgical field. The blunting of the response to incision may be crucial to the overall ability to provide a stable postoperative pain treatment course, lessen amount of anesthetic involved, and blunt the initial stage of the surgical stress response. Combining local anesthetics with general anesthetics can result in lower minimum alveolar concentrations when compared with using general anesthetics alone. Recovery is also superior with this method. The combined use of general and local anesthetic may reduce the afferent barrage of surgery, and preemptive analgesia may lead to decreased postoperative pain and blunt the stress response. Local anesthetic should be considered for the wound field even when general anesthesia is the method of choice for the anesthetic. Anesthetics and systemic opioids. There is no evidence that use of high-dose opioids or inhalational agents results in any change in postoperative pain levels or need for pain medications. Neuroaxial anesthetic techniques. Recent randomized controlled studies in the Japanese literature show that using epidural anesthesia for spine surgery has a preemptive effect on postoperative pain and leads to less perioperative bleeding. An understanding of these techniques is important to be able to use them properly. Neuroaxial infusion therapy: epidural. The use of epidural infusion therapy has increased in recent years as a primary method of acute pain control in patients undergoing surgical procedures involving peripheral nerves. The proper use of an epidural infusion requires a working knowledge of dermatomal anatomy, drug pharmacokinetics, drug synergies, and postoperative follow-up requirements. Epidural location. This is important in the dosage requirement and infusion rate required for proper analgesia. Epidural placement should ideally be within two levels of the nerve root of primary focus of the surgical procedure. Lipophilia. This is crucial in drug selection for postoperative pain. A lipophilic drug such as fentanyl requires placement of the catheter at a level near the nerve innervation of the surgical site. With morphine, which is much less lipid soluble, the catheter placement is less critical because the drug may cover several interspaces prior to being absorbed. Hydromorphone has intermediate properties. Drug synergies. For more than a decade, data have demonstrated an antinociceptive synergy between intrathecal morphine and lidocaine during visceral and somatic nociception at dosages that do not impair motor function. The combination of local anesthetics and opioids offers a synergistic effect that leads to better analgesia than either drug infused alone. Local anesthetic infusion therapy has been shown to be the most effective method of blunting the stress response to tissue trauma. The addition of opioids helps eliminate the problem of tachyphylaxis that may develop with local anesthetics alone. Neuroaxial infusion therapy: subarachnoid. The use of spinal blockade in neurosurgical procedures is somewhat limited. Continuous spinal infusion therapy is generally discouraged because of the risk of cerebrospinal fluid leaks and infection as well as the confusion of the neurologic examination. Peripheral nerve blockade. Peripheral nerve infusions of local anesthetic can be beneficial in the intraoperative period as well as for postoperative pain control. Common sites for continuous infusion include the brachial plexus and the femoral nerve. A nerve stimulator or ultrasound is helpful in the proper placement of the catheter. In general, a blunt-tipped needle is preferable to a sharp beveled needle to reduce the risk of nerve injury. PCA. The use of patient-controlled narcotic delivery may be applied to either intravenous opioid delivery or epidural infusion medications such as local anesthetics, opioids, or clonidine. The neurosurgical patient presents a dilemma in the decision-making process. Careful attention must be given equally to the baseline preoperative function in regard to the ability to understand the use of a PCA system and to the expected postoperative cognitive function and the ability to utilize the system. A team approach involving the surgeon, anesthesiologist, and patient is needed when this mode of treatment is considered. Nurse-administered intermittent analgesia. The classic method of postoperative pain relief in the neurosurgical patient is to have a nurse administer intravenous medications. This involves administration either on the patient's demand or at scheduled times at the request of the surgeon or anesthesiologist. This mode of treatment is most appropriate in the patient with altered preoperative or postoperative cognitive function. The disadvantages of this method include delay in treatment, unnecessary suffering, and excessive sedation. It is also labor intensive. TENS. There are no current data to support any change in postoperative outcome with the use of TENS for incisional pain. This method is difficult to use in the neurologic surgery population because of the technical difficulties of application. Psychological counseling. The addition of a psychologist to the postoperative acute pain team is helpful in improving the patient's ability to cope with the emotional stress of pain and disease. Unfortunately, because no good studies on the cost-effectiveness of adding this service exist, reimbursement may be difficult to obtain. Adjuvant drugs. Anticonvulsants are often used after intracranial surgery to prevent seizures. These drugs may also offer some improvement in neuropathic pain syndromes and reduce the opioid requirements. The classic drugs used for neuropathic pain are tegretol and dilantin; however, the most impressive data are with gabapentin. Baclofen has been used to treat spinal-induced spasticity and has been reported in some patients to improve pain of neuropathic origin. Cyclo-oxygenase 2 inhibitors are no longer recommended in the neurosurgical patient. Classic nonsteroidals may reduce opioid needs and improve outcomes. Intramuscular or intravenous ketorolac is generally the drug of choice; however, it should be avoided if the patient is at high risk of hemorrhage. The addition of antiemetics might also be helpful in controlling nausea that can accompany postoperative analgesics. Ondansetron is an attractive choice because it does not tend to potentiate the neurologic cognitive changes of the opioids and other pain medications. Tramadol is a mu-selective agent that has been shown in a few randomized studies to be less effective in the neurosurgical patient than either codeine or morphine. At higher doses up to 75 mg, tramadol had improved efficacy but was not tolerated because of nausea and vomiting. VI. Creating a case-specific pain management plan Intracranial procedures. The patient who has had an intracranial procedure presents one of the most difficult problems in pain management. The use of regional anesthesia is not an option. Oversedating the patient can lead to hypercarbia and hypoxemia. The cognitive function might be impaired because of the surgical area involved. Despite these limitations, controlling pain in this group is crucial because of the increased morbidity and mortality associated with uncontrolled hemodynamic response to pain and surgery. Pain treatment in this patient population must consider multiple factors. Procedures of the extremities. The patient requiring surgery of the extremities gives the anesthesiologist many options. A discussion should occur regarding the patient's postoperative neurologic function and the need for serial functional checks. If the issue of sensory loss is minimal, the use of regional anesthesia is optimal because of the blunting of both pain and the stress response. Other techniques are also acceptable in this population. Procedures involving the spine. When neurologic surgery is performed on the structures of the neuroaxis, regional anesthesia may result in improved outcomes with an effect on both postoperative pain and blood loss. These surgeries have no effect on cognitive response and are appropriate for postoperative PCA. VII. Complications of neuroanesthesia pain management Mental status changes. Serial neurologic checks are often an essential part of the postoperative course. If pain treatment interferes with this assessment, the overall benefit of the pain treatment may be lost. Establishing a team approach with the surgical team and the nursing team to balance the risks and benefits of pain therapies is crucial. Elevation of arterial carbon dioxide (CO2). The importance of ICP varies in the neurosurgical population. In patients in whom this is an important factor, it is crucial to have some method of monitoring postsurgical CO2. Despite the benefits of improved hemodynamics in ensuring the stability of the patient with elevated ICP, the risk of excessive sedation and hypercarbis could be a possible problem, and the patient must be watched closely. Arterial CO2 and pH are ways to monitor for a possible problem and may be early indicators of impending problems. Reduction of arterial O2. Hypoxemia may create multiple problems in the patient with neuronal tissue trauma. Anaerobic metabolism occurs when neurons do not have enough oxygen substrate, which can result in a reduction of adenosine triphosphate and subsequent cell death. The use of supplemental oxygen and oxygen saturation as well as serial arterial blood gas monitoring is essential in patients receiving systemic opioids. Hypotension. In the patient with possible spinal cord trauma, the use of regional anesthesia can be helpful in controlling the stress response and subsequent systemic changes. The resultant decrease in mean arterial pressure can decrease perfusion to the neurologic tissue and create ischemia. Careful attention to blood pressure is crucial when using local anesthetics postoperatively. Cerebrospinal fluid leak. The possibility of subarachnoid puncture when placing an epidural catheter must be weighed against the benefit of the catheter. The risks of brain herniation must also be discussed with the surgeon if there is any intracranial disease process. Nerve injury. When using regional techniques in those with coexisting neurologic disease, a risk of nerve injury exists if the patient has abnormal nociception in the area of the proposed procedure. This risk also exists for the patient under general anesthesia or heavy sedation who may be unable to respond to inadvertent intraneural injection. Infection 1. In the sedated patient, aspiration precautions should be ordered. This should be accompanied by frequent neurologic checks. If aspiration is a risk, sedating medications should be used with caution. 2. Regional anesthesia should be avoided in the patient with local infection at the site of the proposed regional procedure or in the patient with untreated or uncontrolled systemic infection. 3. The site of indwelling regional catheters should be checked regularly for infection. If the catheter is tunneled through a gel coat catheter, the risk of infection is more likely to be skin related. VIII. Anesthesia methods for neuroaxial pain procedures A social emphasis on the importance of treating patients with chronic pain has led to the increase in the number of practitioners performing procedures requiring anesthesia. Neurosurgeons, anesthesiologists, physiatrists, orthopedic surgeons, and neurologists now perform these procedures. Regardless of the practitioner involved, the anesthetic issues are important to achieve a stable course. Spinal cord stimulation. This procedure is most commonly performed for pain involving the extremities. Recent expansion of indications includes pelvic pain, occipital neuralgia, angina, and pancreatitis. The procedure is often separated into stages. The percutaneous trial. In either the operating room or radiology suite, a temporary stimulation system may be placed under the guidance of a fluoroscope. Anesthesia is difficult because many of these patients have taken oral opioids for long periods and are tolerant to this class of drugs. These patients may require sedation to place the lead in either the lumbar or cervical region but should remain alert and responsive to avoid nerve root injury. The patients also need to be cognitively functional for the computer screening, which involves connecting the epidural lead to the handheld computer and electrically stimulating the nerve tissue to obtain a paresthesia. This requirement for varying levels of sedation makes propofol and remifentanil attractive choices in this group of patients. Regional anesthesia should be avoided. In patients who are stoic, the procedure may be performed under local anesthesia; however, the patient selection for this technique should be very stringent. The surgical lead. A surgical lead must be placed in some patients with more anatomically difficult spines or in whom a percutaneous lead has failed. This procedure usually requires a wake-up period so the patient can discuss the perception of stimulation. This may lead to a more difficult task because the procedure itself requires a hemilaminectomy. Some surgeons request a general anesthetic with evoked potential testing for this procedure. NSAIDs should be avoided in this population because of the increased risk of bleeding. The permanent lead. In most cases, the permanent implant involves the placement of both the lead and generator. The permanent implant requires the use of a complex anesthetic because the patient needs to be conversing during the lead placement and more sedated for tunneling and pocket placement. In some cases, the lead placed for the trial procedure is used as a permanent lead. If that is the case, the patient is brought back to the operating room 1 to 4 weeks later for the connection to a permanent generator. This procedure is most often performed under monitored anesthesia care or general anesthesia. This stage requires no period of discussion. Thus, the anesthetic is much less complex. In either method, the placement of the generator pocket determines the patient's positioning. If the generator is placed in a different body area, repositioning and draping may be required, affecting the anesthetic level required. Intrathecal and epidural drug infusion systems. The use of neuroaxial infusions to treat pain that is unresponsive to oral or transdermal medications is becoming more common. Catheters may be tunneled and connected to an external infusion source or may be connected to an implantable system that is placed in the subcutaneous tissue. Totally implantable infusion systems. Placing an intrathecal or epidural pump in the subcutaneous tissue involves two steps. First, a catheter must be placed in the epidural or intrathecal space. Once this has been successfully completed, the catheter can be connected to an infusion source. Anesthesia for these procedures might consist of sedation with local infiltration, subarachnoid or epidural block at the time of catheter placement, or general anesthesia. Each method has its risks and benefits. With general anesthesia, the patient is less likely to move, and the risk of nerve injury may be diminished. In the nonresponsive patient, the risk of nerve injury may be increased, however, if the patient cannot respond to development of parasthesia. The spinal or epidural technique avoids the general anesthetic, which may be advantageous for someone at high risk for pulmonary or cardiac complications. Use of sedation with local anesthetic infiltration reduces the risk of undiagnosed nerve injury at the time of catheter insertion. In some patients, the stimulation involved in the tunneling and pocketing component of the procedure might not be successfully blunted with sedation and local infiltration alone, and a conversion to general anesthesia might be required during the course of the procedure. Externalized infusion systems. In patients in whom the need for infusion is short term or in those with a life expectancy of <3 months, an externalized system is often selected. The need for general anesthesia in this population is rare because of the lack of pocket creation. Although this procedure could be completed under neuroaxial blockade or general anesthesia, the more common scenario is to use monitored anesthesia care with local infiltration. Radiofrequency nerve ablation. The cost-effectiveness of radiofrequency ablation has led to a vast increase in the number of procedures performed annually in the United States and Europe. Pulsed radiofrequency ablation is a new technique that has shown promise in treating peripheral nerve processes without larger procedures. This technique is also being utilized more commonly in ablating the sympathetic nervous system and selected peripheral nerves. The anesthetic in these cases is inherently difficult. The patient must be sufficiently sedated to permit the placement of a large radiofrequency cannula and then allowed to awaken rapidly to be able to answer important stimulation questions involving sensory, motor, and nociceptive input. The risks of nerve injury greatly increase in the patient who is not able to fully discern the computer stimulation pattern. Because of these issues, the infusion or injection of fast-acting and rapidly-waning drugs is often utilized. Options include propofol, midazolam, fentanyl, or local anesthetic as a sole agent. Spinal endoscopy. In 1997, the United States Food and Drug Administration (FDA) approved the use of spinal endoscopy. In this method, the physician uses a fiberoptic scope to visualize and treat disease processes of the spine by an epidural route. This procedure is stimulating and requires sedation to be tolerated in most cases. The use of general anesthesia should be avoided because of the risks of nerve damage in the patient who is unable to report paresthesia. Minimally invasive disc procedures. The use of new percutaneous techniques to treat contained disc herniations and leaks of the annulus are valuable options in patients who would like to avoid more invasive techniques such as fusion or artificial disc replacement. In these cases, there is a need to converse with the patient at all times. Anesthesia should be with local anesthesia with or without mild sedation. IX. Summary The neurosurgical patient is a tremendous challenge to the team providing pain relief. The balance of controlling pain and maintaining safety for the patient in the postoperative period is a difficult task. It is critical that the anesthesiologist, surgeon, and nursing staff work together to obtain a good result. As new drugs and techniques become available, it will be important to update our knowledge of the best methods to perform this complex task.

http://www.neuroicu.info/painmanagement.htm

Anesthesiology opening in New York, New York. Anesthesiology Opportunity in Northern New Jersey - Next to NYC!! JOB SUMMARY Responsible for the pre-op assessment of the patient, administration of anesthesia and the initial post op recovery of the patient; may also provide pain management care and treatment. DUTIES & RESPONSIBILITIES: 1. Perform a pre-op assessment of the patient to evaluate the risk to anesthesia and the procedure to be performed. 2. Discusses the choice of anesthesia with the patient and explains the administration procedure. 3. Administers anesthesia in accordance with generally acceptable standards of medical practice. 4. Monitors the patient s condition throughout the procedure. 5. Works with the surgeon during the procedure and administers medications, as needed. 6. Accompanies the patient to the recovery room, reports the status of the patient to the recovery room nurse and remains with the patient through the initial assessment to ascertain the stability of the patient. 7. Is alert to sign and symptoms of respiratory and cardiac emergencies and responds appropriately. 8. As per individual privileges, provides pain management care and treatment. 9. Maintains current and complete documentation in the medical record that reflects the care and service provided to the patient. 10. Participates as a member of the medical staff and adheres to the medical staff By-Laws. 11. Participates as a member of a committee, as requested by the Medical Director. EDUCATION & EXPERIENCE: 1. Currently licensed as a Physician in the State of New Jersey. 2. Meets the definition of a qualified specialist. 3. Meets all of the requirements for appointment/reappointment of the Medical Staff. 4. Maintains ACLS Certification. Competitive Salary (to be discussed directly with the group) and a full benefits package is offered! Apply for this job now Details Job Reference: 701615773-2 Date Posted: 1 September 2022 Recruiter: DOCTORS CHOICE PLACEMENT SERVICES, INC. Location: New York Salary: On Application Sector: Healthcare & Medical Job Type:

https://jobs.wspa.com/jobs/anesthesiology-opportunity-in-northern-new-jersey-next-to-nyc!!-physician-new-york/701615773-2/

Our understanding of anaesthesia and anaesthesia includes the safe and caring care of the patient before, during and after a procedure. This includes trying to explain every step of the treatment to you as clearly as possible during a premedication talk. Anesthesia At the German Heart Institute Berlin we have a clear goal: to keep the stress of the surgical procedure as low as possible for you, with the greatest possible safety. Paediatric cardioanaesthesia The management of anaesthesia and the maintenance of circulatory functions in patients with congenital heart defects undergoing cardiac surgery requires a very specific specialisation in anaesthesiology. PACU The former term for PACU (Post Anesthesia Care Unit) is "recovery room" - this may give you a little more idea without any medical background... Intensive care Intensified monitoring and therapy is necessary after many cardiac surgery operations. This takes place at the German Heart Institute Berlin in intensive care units 1 or 2... Pain therapy Often the idea of being operated on is associated with fear of pain after the surgical procedure or even with painful previous experiences of this kind...

https://www.dhzb.de/en/abteilungen/anaesthesie/informationen-fuer-patientinnen-und-angehoerige

With anesthesia, patients are able to undergo intensive surgeries while being able to sleep through the entire procedure, not feeling a thing. Unfortunately, in rare cases, anesthesia errors may lead to a patient waking up during their surgery. Waking up during surgery can inflict significant emotional and mental trauma on a patient. If you wake up from anesthesia during a surgical procedure, what are your rights to sue for financial recovery for the harm you have endured? Anesthesia Awareness General anesthesia does three things to a patient – it causes them to fall asleep, blocks pain from the surgical incision, and also temporarily paralyzes their muscles so that they don’t inadvertently move and injure themselves during the surgery. When an anesthesia error occurs, a patient may become conscious and aware of their surroundings while still experiencing the pain-blocking and muscle-paralyzing effects of anesthesia. Or a patient may become conscious during surgery while also able to either feel pain from the surgical procedure being performed or able to move their muscles or both. When this occurs, it is a condition known as anesthesia awareness. Anesthesia awareness can be a psychologically harmful experience for patients when surgical teams don’t immediately realize that a patient has woken up during the surgery. Being aware that an invasive surgical procedure is being performed on you can be a highly emotional and traumatic experience for many people, especially if they are able to feel pain from the surgical site. Why Patients Wake Up During Surgery There are many reasons why patients may experience anesthesia awareness during surgery, including: - Failure to administer a sufficient dosage of anesthesia, which can cause the drugs to wear off during the surgery or may fail to completely render the patient unconscious or completely block pain and paralyze the patient. - Defective medication delivery equipment or failure to maintain such equipment, which may cause the patient to not get enough of the anesthetic. - Too little general anesthetic is administered to patients who may be sensitive to anesthesia, particularly older patients or patients with heart problems who can suffer complications from general anesthesia. - Individual patient resistance to anesthesia, as some patients’ bodies are naturally more resistant to anesthetics or patients may wake up more quickly from anesthesia. Pursuing a Medical Malpractice Claim If You Wake Up During Your Surgery If you wake up during your surgery, you may be entitled to recover compensation in a medical malpractice claim when the anesthesia error that led to your anesthesia awareness was caused by the negligence of your anesthesia team. Financial compensation in a medical malpractice claim arising from anesthesia awareness may include: - Medical bills, if you require additional medical treatment to repair damage that may be caused if you inadvertently move when waking up during your surgery and cause tissue damage at the surgical site. - Costs of therapy, if you require mental health treatment for the trauma you experienced due to waking up during your surgery. - Loss of wages or income if you are temporarily or permanently disabled from the emotional and mental effects of waking up during your surgery. - The physical pain and emotional distress you experienced, and the reduced quality of life from anxiety, depression, PTSD, or other mental health impacts you have suffered. Contact A Medical Malpractice Attorney for a Consultation About Your Anesthesia Error Case in New Jersey Were you or a loved one injured due to medical malpractice in New Jersey? Then you need to talk to an experienced medical malpractice lawyer as soon as possible for guidance on how to proceed. The Haddonfield anesthesia error attorneys at The Law Offices of Andres & Berger P.C. are prepared to assist you with your legal claim. We represent victims of negligent surgeons, doctors, nurses, and pharmacists throughout New Jersey, including Pennsauken, Voorhees, Lindenwold, and Collingswood. Call us today at (856) 795-1444 or fill out our online contact form to schedule a consultation. Our main office is located at 264 Kings Hwy. E., Haddonfield, NJ 08033. The articles on this blog are for informative purposes only and are no substitute for legal advice or an attorney-client relationship. If you are seeking legal advice, please contact our law firm directly.

https://www.andresberger.com/blog/can-i-file-a-medical-malpractice-claim-if-i-wake-up-during-surgery/

Bridger Vet is equipped to handle both soft tissue and orthopedic surgical cases. Patients are carefully monitored under anesthesia during procedures to reduce the risk involved. Patients are throughly examined prior to the procedure and if additional diagnostics such as blood work need to be performed to keep patients safer, a doctor or technician will be in contact before the procedure moves forward. The staff is also aware that surgical procedure are not done until the patient is well. We continue to take an active role in your patients recovery including rechecks, rehabilitation and pain management. Surgery is a team effort, even after the patient goes home safely. Bridger Vet is also in a unique situation to be able to offer some equine surgical procedures. The clinic is equipped with an equine surgical suite which allows the doctors at Bridger Vet to lay down horses in a safe environment or even use a lift system to place them on a surgical table for longer procedures. We work hand-in-hand with local equine surgeons to get your horse the best case possible wether it is in our surgical suite or theirs.

https://www.bridgervetservices.com/surgery

Anesthesia is used in surgery to minimize pain, discomfort, and shock for surgical patients. There are several types of anesthesia which can be used depending on the needs of the surgery: general, local, regional, and conscious sedation. With anesthesia, the patient feels no pain during a procedure, and often does not remember the proceedings. Anesthesia increases the patient’s comfort, which may in turn reduce the recovery time. By acting as a relaxant for the patient, anesthesia makes it also easier for the medical staff to perform procedures. General anesthesia is a complete loss of consciousness caused by a combination of injected and inhaled drugs. This type of anesthesia is often used for highly invasive surgeries or if total relaxation of the patient is required. General anesthesia carries the most surgical risk because of the state of complete unconsciousness. As a result, the anesthesiologist will manage the patient carefully throughout surgery. The exact mechanism through which general anesthesia works is unclear. It is believed that anesthesia acts on the brain to produce unconsciousness, and on the nerves and spinal cord to monitor administration of additional inhaled drugs throughout the surgery. Local anesthesia involves injected drugs which numb a small area. Many patients have experienced local anesthesia in the form of Novocain, which is used in dental applications. Any small, localized procedure, such as setting stitches, is suitable for local anesthesia. Regional anesthesia is similar to local anesthesia, except it covers a wider area of the body. Regional anesthesia works by blocking nerve impulses. Regional anesthesia allows doctors to block sensation (pain) to the entire lower body or single limbs. Conscious sedation is an anesthesia practice where the patient remains conscious but is fully relaxed, does not feel pain, and will not usually remember the anesthesia. In cases where a patient is not stable enough for general anesthesia, conscious sedation may be used.

http://dentalwebdmd.com/anesthesia/

CTG overview: - CTG staff and support humanitarian projects in fragile and conflict-affected countries around the world, providing a rapid and cost-effective service for development and humanitarian missions. With past performance in 17 countries – from the Middle East, Africa, Europe, and Asia, we have placed more than 20,000 staff all over the world since operations began in 2006. - CTG recruits, deploys and manages the right people with the right skills to implement humanitarian and development projects, from cleaners to obstetricians, and mechanics to infection specialists, we’re skilled in emergency response to crises such as the Ebola outbreak in West Africa. Key to successful project delivery is the ability to mobilise at speed; CTG can source and deploy anyone, anywhere, in less than 2 weeks and have done so in 48 hours on a number of occasions. - Through our efficient and agile HR, logistical and operational services, CTG saves multilateral organisations time and money. We handle all our clients’ HR related issues, so they are free to focus on their core services. - Visit www.ctg.org to find out more Overview of position: - Response Med is seeking to provide health professionals to deliver clinical services in UN facilities located in Somalia. - Personnel shall deliver primary care & hospital level services, including emergency, surgical, diagnostic, intensive care & general hospital services. - Personnel shall provide the services at the UN level 1+ health facility located in the UNSOS camp within the AAIA in Mogadishu & in sector health facilities, as & when required. - Additionally, personnel may be deployed to reinforce AMISOM level 2 hospitals during emergency situations that severely stress these facilities. - The UN level 1+ health facility is a capability that was established in 2012 with the objective of providing emergency & primary health care for the UN international personnel deployed in Somalia. - The facility has since been supporting UNSOS, UNSOM & AMISOM FHQ personnel. - Additionally, the facility is available to international personnel from other UN entities, diplomatic missions & UNSOS contracted vendors, on a cost recovery basis. - Services may, on occasion, also be extended to the SNA. Role objectives: - We are looking for a qualified Anesthetist to be responsible for administering the appropriate anesthetics before medical procedures. The duties of the anesthetist will include assessing the health of a patient before surgery, monitoring patients’ well being post surgery & providing assistance in emergencies. The successful candidate will demonstrate extensive knowledge of anesthetics & procedures, have solid hand eye coordination & be a team player with the ability to effectively add value to enabling good patient outcomes & shape best clinical & non clinical practice. Key responsibilities include: - Schedule & maintain use of surgical suites, including operating, wash up, waiting rooms & anesthetic & sterilizing equipment. - Review patients’ medical histories & records in order to determine anesthesia procedure before surgical operations & other medical procedures in the anesthesia centers of the hospital. - Prepare patients for surgical operations & other medical procedures as required in the surgical theatres. - Examine patient medical history & records & use diagnostic results to determine risk related to surgical operations & other medical procedures. - Administer anesthesia to patients in order to prepare them for surgical operations & other surgical procedures in the anesthesia centers. - Administer anesthesia or sedation during medical procedures, using local, intravenous, spinal, or caudal methods. - Collaborate with other medical professionals to determine type & method of anesthesia or sedation to render patient insensible to pain. - Monitor patients before, during & after anesthesia & counteract adverse reactions or complications in the anesthesia centers. - Record type & amount of anesthesia & patient condition throughout surgical operations & other medical procedure in the surgical theatres. - Povide & maintain life support & airway management & help prepare patients for emergency surgery. - Determine when patients have recovered or stabilized enough to be moved from the recovery room or ward or to be discharged following outpatient surgical procedures. Project reporting: - This role reports to the line manager. Key competencies: - A first level degree in Medicine & Surgery with a minimum of 3 years progressive post qualification clinical experience. - Board certified / postgraduate certified by an appropriate body following the successful completion of specialist training in anaesthetics / critical or intensive care / pulmonology or equivalent, with a minimum of three years’ progressive post specialist qualification. - Experience in damage control resuscitation is a requirement. - Currently registered & licensed to practice medicine & apply specialty without supervision in own country or another UN member state. - English proficiency, a minimum of level B 2 is required. - Preference / desire to live & work in Somalila. Team management: - This role does not have any team management responsibility. Further information: - Qualified female candidates are encouraged to apply for this role. - CTG is open to reviewing applications of both expats as well as Somali nationals for this role. How to apply Candidates interested in applying for this role need to register on CTG website & apply for this role using this link:

https://mena-jobs.com/job/anaesthetist/

Anesthesia is a procedure that is administered to control pain, heart rate, blood pressure and other vital parameters during a surgical procedure. It is temporary state which allows the patient to recover and gain control of his coordination a few hours after a surgical procedure. Anesthesia is an exact procedure which requires theoretical and practical expertise. Any kind of dosage variation can be fatal to the patient. During general anesthesia, patients are advised to abstain from eating and drinking 12 hours before the procedure as it may lead to aspiration associated complications during the procedure. Thorough examination of the patient history is done to evaluate for drug sensitivity and allergic patterns with respect to the type of anesthesia administered. Anesthetics such as inhalants or IV forms are given depending upon the type of surgical procedure. General anesthesia General anesthesia is administered during complicated procedures such as cardio thoracic surgery, oncogenic or organ specific surgery. In this procedure, the patient goes into a stage of total unconsciousness with administration of anesthetic gases and intravenous anesthetics such as halothane, Sevoflurane, Enflurane, Desflurane, Isoflurane, Propofol, etomidate and thiopental. Some anesthetics such as Propofol are hypnotic in nature. It has been widely used because of its nature to bring back the patient to conscious state a few hours after the surgical procedure. In addition to the inhalant and intravenous forms of anesthesia which are administered, neuromuscular blockage is also required as it helps in respiratory ventilation along with intubation. Most of these neuromuscular blockade agents are derived from curare compounds which is a skeletal muscle relaxant. Local anesthesia Local anesthetics are either administered as a combination with general anesthetics are as a post-operative anesthetic agent. Most of the local anesthetics are amides and esters. Some of the local anesthetic amides include lidocaine, prilocaine, ropivacaine and etidocaine. The ester forms of these anesthetics include tetracaine, procaine, cocaine and benzocaine. Local anesthetic drugs are given directly in the region where the surgical procedure has to take place. Most dental procedures involve the administration of local anesthetics. The patient is conscious and experiences numbness only in the region where the procedure is being done. Regional anesthesia This form of anesthesia is given to block pain in a larger area of the body where the procedure is done. Patient is sedated in most cases. Regional anesthetic drugs usually work on the principle of nerve block caused in the peripheral region. This includes a procedure called spinal anesthesia where the drug is administered in a specific area of the spine to numb the corresponding region of the body. Regional anesthesia is administered at a specific location to numb the region for surgical intervention. Local anesthetics are administered either in the topical or injectable form to desensitize the area of surgical intervention. Risk factors of anesthesia Malignant hyperthermia is one of the rare yet life threatening complications of anesthesia. This adverse reaction is caused when succinyl choline (muscle relaxant) is administered. In this reaction, the muscle fibers of the body tend to dissociate from each other. Spinal and epidural anesthetic procedures have headaches as side effects due to the leakage of cerebrospinal fluid from region of injection. Nausea, vomiting and nerve damages are some of the predominant side effects of anesthetic procedures. These are controlled by administration of IV medications. In some patients, the insertion of endotracheal tube during procedures such as bronchoscopy may lead to sore throat for a few days. Apart from all the presumptive risk factors and side effects of anesthetic drugs, some have toxic effects on liver and kidneys. In such conditions, patients are examined for tolerance and toxicity before administering anesthetic gases such as halothane. Anesthetist An anesthetist is also called an anesthesiologist. An anesthetist administers anesthetic to patients, who are going to undergo surgery or procedure. With a local anesthetic, the patient is numb only in a designated area where the medication is administered. General anesthetic involves a procedure where a patient is prepared for surgery by going to sleep and having sensation temporarily blocked. Anesthesia ensures that the surgical procedure be done without distress to the patient. Nerve Blocks A nerve block, an anesthetic injection, is used in the management of severe pain. Nerve blocks are not only used to reduce pain and inflammation but also as a pointer for identifying specific source of pain. It involves injection of a local anesthetic to specific nerves. When regional anesthesia is needed for surgery, a nerve block is often used to numb the targeted set of nerves. In surgical cases, a 'nerve catheter' might be placed to continually supply the nerves with numbing medication and prevent severe pain to the patient. Nerve blocks are more effective than IV anesthetics. Nerve blocks are used in cases of severe pain such as Raynaud's syndrome, chronic abdominal pain, severe back pain and reflex sympathetic dystrophy. This procedure is done with imaging guidance from fluoroscopy, ultrasound or CT. It allows the radiologist to view the needle movement and guide it to the right location. Soon the patient experiences numbness and pain relief. A nerve block works by blocking or reducing the signals sent to the brain. The risks of bleeding, infection, nerve injury and allergic reaction are associated with nerve block injections. Enter your health or medical queries in our Artificial Intelligence powered Application here. Our Natural Language Navigational engine knows that words form only the outer superficial layer. The real meaning of the words are deduced from the collection of words, their proximity to each other and the context. Diseases, Symptoms, Tests and Treatment arranged in alphabetical order:

https://athena.targetwoman.com/anesthetic

A laparotomy is a large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity. Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Injuries may occur as a result of blunt trauma (e.g., road traffic accident) or penetrating trauma (e.g., stab or gunshot wound). Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. In addition, bleeding into the abdominal cavity is considered a medical emergency. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed. Laparotomy may be performed to determine the cause of a patient's symptoms or to establish the extent of a disease. For example, endometriosis is a disorder in which cells from the inner lining of the uterus grow elsewhere in the body, most commonly on the pelvic and abdominal organs. Endometrial growths, however, are difficult to visualize using standard imaging techniques such as x ray, ultrasound technology, or computed tomography (CT) scanning. Exploratory laparotomy may be used to examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes, bladder, and rectum) for evidence of endometriosis. Any growths found may then be removed. Exploratory laparotomy plays an important role in the staging of certain cancers. Cancer staging is used to describe how far a cancer has spread. A laparotomy enables a surgeon to directly examine the abdominal organs for evidence of cancer and remove samples of tissue for further examination. When laparotomy is used for this use, it is called staging laparotomy or pathological staging. Some other conditions that may be discovered or investigated during exploratory laparotomy include: - cancer of the abdominal organs - peritonitis (inflammation of the peritoneum, the lining of the abdominal cavity) - appendicitis (inflammation of the appendix) - pancreatitis (inflammation of the pancreas) - abscesses (a localized area of infection) - adhesions (bands of scar tissue that form after trauma or surgery) - diverticulitis (inflammation of sac-like structures in the walls of the intestines) - intestinal perforation - ectopic pregnancy (pregnancy occurring outside of the uterus) - foreign bodies (e.g., a bullet in a gunshot victim) - internal bleeding Because laparotomy may be performed under a number of circumstances to diagnose or treat numerous conditions, no data exists as to the overall incidence of the procedure. The patient is usually placed under general anesthesia for the duration of surgery. The advantages to general anesthesia are that the patient remains unconscious during the procedure, no pain will be experienced nor will the patient have any memory of the procedure, and the patient's muscles remain completely relaxed, allowing safer surgery. Once an adequate level of anesthesia has been reached, the initial incision into the skin may be made. A scalpel is first used to cut into the superficial layers of the skin. The incision may be median (vertical down the patient's midline), paramedian (vertical elsewhere on the abdomen), transverse (horizontal), T-shaped, or curved, according to the needs of the surgery. The incision is then continued through the subcutaneous fat, the abdominal muscles, and finally, the peritoneum. Electrocautery is often used to cut through the subcutaneous tissue as it During a laparotomy, and an incision is made into the patient's abdomen (A). Skin and connective tissue called fascia is divided (B). The lining of the abdominal cavity, the peritoneum, is cut, and any exploratory procedures are undertaken (C). To close the incision, the peritoneum, fascia, and skin are stitched (E). has the ability to stop bleeding as it cuts. Instruments called retractors may be used to hold the incision open once the abdominal cavity has been exposed. Abdominal exploration The surgeon may then explore the abdominal cavity for disease or trauma. The abdominal organs in question will be examined for evidence of infection, inflammation, perforation, abnormal growths, or other conditions. Any fluid surrounding the abdominal organs will be inspected; the presence of blood, bile, or other fluids may indicate specific diseases or injuries. In some cases, an abnormal smell encountered upon entering the abdominal cavity may be evidence of infection or a perforated gastrointestinal organ. If an abnormality is found, the surgeon has the option of treating the patient before closing the wound or initiating treatment after exploratory surgery. Alternatively, samples of various tissues and/or fluids may be removed for further analysis. For example, if cancer is suspected, biopsies may be obtained so that the tissues can be examined microscopically for evidence of abnormal cells. If no abnormality is found, or if immediate treatment is not needed, the incision may be closed without performing any further surgical procedures. During exploratory laparotomy for cancer, a pelvic washing may be performed; sterile fluid is instilled into the abdominal cavity and washed around the abdominal organs, then withdrawn and analyzed for the presence of abnormal cells. This may indicate that a cancer has begun to spread (metastasize). Various diagnostic tests may be performed to determine if exploratory laparotomy is necessary. Blood tests or imaging techniques such as x ray, computed tomography (CT) scan, and magnetic resonance imaging (MRI) are examples. The presence of intraperitoneal fluid (IF) may be an indication that exploratory laparotomy is necessary; one study indicated that IF was present in nearly three-quarters of patients with intra-abdominal injuries. Directly preceding the surgical procedure, an intravenous (IV) line will be placed so that fluids and/or medications may be administered to the patient during and after surgery. A Foley catheter will be inserted into the bladder to drain urine. The patient will also meet with the anesthesiologist to go over details of the method of anesthesia to be used. The patient will remain in the postoperative recovery room for several hours where his or her recovery can be closely monitored. Discharge from the hospital may occur in as little as one to two days after the procedure, but may be later if additional procedures were performed or complications were encountered. The patient will be instructed to watch for symptoms that may indicate infection, such as fever, redness or swelling around the incision, drainage, and worsening pain. Risks inherent to the use of general anesthesia include nausea, vomiting, sore throat, fatigue, headache, and muscle soreness; more rarely, blood pressure problems, allergic reaction, heart attack, or stroke may occur. Additional risks include bleeding, infection, injury to the abdominal organs or structures, or formation of adhesions (bands of scar tissue between organs). The results following exploratory laparotomy depend on the reasons why it was performed. The procedure may indicate that further treatment is necessary; for example, if cancer was detected, chemotherapy, radiation therapy, or more surgery may be recommended. In some cases, the abnormality is able to be treated during laparotomy, and no further treatment is necessary. The operative and postoperative complication rates associated with exploratory laparotomy vary according to the patient's condition and any additional procedures performed. Laparoscopy is a relatively recent alternative to laparotomy that has many advantages. Also called minimally invasive surgery, laparoscopy is a surgical procedure in which a laparoscope (a thin, lighted tube) and other instruments are inserted into the abdomen through small incisions. The internal operating field may then be visualized on a video monitor that is connected to the scope. In some patients, the technique may be used for abdominal exploration in place of a laparotomy. Laparoscopy is associated with faster recovery times, shorter hospital stays, and smaller surgical scars. If you are really seeking for the Laparoscopic laparotomy surgery in India, kindly fill up the form for a free consultation by our surgeons. You will be provided with thorough analysis and suggestions regarding Laparoscopic laparotomy surgery in India you are seeking for.

https://www.indialaparoscopysurgerysite.com/other-laparoscopic-procedures/laparoscopic-laparotomy-surgery-india.php

Surgery for breast reconstruction after mastectomy is entirely elective in nature. Many women select to have the reconstruction done at the time of the initial surgery. Reconstruction is possible if there is no evidence of metastatic disease and the axillary sentinel node is negative. The reconstruction will be delayed if chemotherapy and/or radiation is indicated. Reconstruction done prior to radiation treatment has been shown to be associated with an increased risk of healing problems secondary to skin burns, seroma formation, and infection. Radiation may also affect the type of implant that can be used. Immediate reconstruction does result in a much longer surgery and may involve tissue expanders if there is not enough skin to cover the implant. This increased complexity commits the patient to further surgical procedures over time. There are a variety of possible flap procedures that use the patient’s own skin and muscle to create a breast or a pocket for an implant, including a TRAM flap, latissimus dorsi flap, and a gluteal free flap. All breast reconstruction surgery is elective. The only surgery after mastectomy that is urgent in nature is reconstruction that is done for bleeding or infection related to the mastectomy procedure itself. Routine medical clearance is indicated for reconstruction surgery at the time of the initial mastectomy procedure and must be reevaluated if the surgery is following chemotherapy and/or radiation treatment. Chemotherapy and radiation may have side effects on the patient’s health and implications of surgical risk. Patients should also be questioned about the level of exertion that they can accomplish without significant symptoms of fatigue, dizziness, chest pain, palpitations, or shortness of breath. Any positive findings require further medical workup prior to proceeding with this nonurgent surgery. Also, any coexisting diseases need to be evaluated and should be stable or evaluated by the patient and surgeon prior to the operation. Medically unstable conditions warranting further evaluation include myocardial infarction and active ischemia, unstable arrhythmias, stroke, TIAs, and COPD exacerbation. These diagnoses require further assessment, consultation, workup, and stabilization. Delaying surgery is indicated until any or all of these diagnoses are well controlled and unlikely to present any significant increased perioperative morbidity. Therapies such as medication changes, pacemaker and/or AICD insertion, angioplasty, stent placement, valvuloplasty, etc, may greatly improve coexisting illnesses or conditions. Although it is very unusual for a patient considering breast reconstruction to have significant comorbidities, any patient with an ASA status of 3 or 4 may require perioperative adjustments to monitoring and care. Examples include increased monitoring with an arterial line, central line or intraoperative TEE. More complex patients also require optimal medical therapy up until the time of the procedure, and these patients may require possible post-operative ICU care. Patients need to be evaluated for significant cardiac symptoms; they should be asked about any changes in symptoms of fatigue, exercise tolerance, shortness of breath, palpitations, dizziness, or chest pain. If any clinical suspicion for disease exists, workup may include a 12-lead ECG, Holter monitoring, echocardiogram, troponin levels, a stress test, or, at the very least, a cardiology consultation. Acute ischemia needs to be managed before surgery may proceed. Any patient previously cleared at the time of mastectomy but who has since undergone chemotherapy and/or radiation treatment must be reevaluated. Chemotherapeutic agents such as Adriamycin and Herceptin have been associated with myocardial depression and ventricular irritability, which can be temporary or permanent. In extreme scenarios, the myocardial dysfunction can be so severe that the patient requires cardiac transplantation. For this reason, pre and post treatment echocardiograms have become routine. Radiation treatment to the chest is associated with accelerated coronary atherosclerotic disease; any symptoms of ischemia should be taken seriously. Interventions may be as straightforward as adding beta-blockers to control heart rate and increase diastolic filling and perfusion or nitrates for ischemia. In the case of myocardial dysfunction, an anesthetic with minimal myocardial depression may be helpful; afterload reduction often improves forward flow. Preload needs to be maintained in patients with reduced ejection fractions due to myocardial depression. Foley catheters are routinely placed in these surgeries to aid in the fluid management of these patients. Most cardiac medications are continued up until the time of surgery; diuretics are the exception. Antihypertensives may be held especially if a regional anesthetic is considered for postoperative pain management. Aspirin and anticoagulants are held for the perioperative period. Patients with pulmonary disease are at increased risk of postoperative complications such as pneumonia after general anesthesia. A thorough review of smoking history, COPD exacerbations, changes in medications, and symptoms with exertion is indicated. Physical exam and baseline oxygen saturation are important. Rarely are baseline labs or pulmonary function studies indicated or useful. A chest radiograph may be helpful to rule out an infiltrate, an effusion, mild CHF, or pleuritis. Patients who have had radiation treatment can have significant pulmonary disease such as pneumonitis, restrictive disease, pleuritis, etc. The chest radiograph may show a “ground-glass” appearance even with minimal clinical symptoms. In patients with significant COPD, it is important to maintain the current medication regimen, try to minimize excessive peak airway pressures, and avoid stacking of breaths by maximizing time for exhalation. PEEP may or may not be helpful; the same is true for nebulizer treatments. Regional anesthesia may be helpful postoperatively in patients with pulmonary issues and should be considered. Symptoms of asthma are evaluated by history, physical exam, recent changes in the need for inhalers, recent steroid use, ER visits, and hospitalizations/intubations. Patients should continue all of the medications for reactive airways up to the time of surgery; an inhaler treatment is often helpful just prior to induction of anesthesia and airway manipulation. Opiates may be useful to blunt airway responses, and inhaled anesthetics are superb bronchodilators. Intraoperatively, bronchospasm can be treated by deepening the patient’s anesthetic; low-dose infusions of epinephrine may be considered if the bronchospasm is severe. Again, a regional anesthetic for postoperative pain management may be helpful in this group of patients. Routine preoperative labs including chemistries are not necessarily indicated in otherwise healthy individuals. In patients who have undergone chemotherapy, however, electrolytes and BUN and creatinine should be checked preoperatively. Patients recently receiving treatments may be dehydrated with mild to severe electrolyte disturbances—specifically, hypokalemia and hypomagnesemia; some of the chemotherapy agents can be nephrotoxic as well. It is important to correct the electrolyte issues and document renal function preoperatively. If there is pre-existing renal impairment, it is important to re-evaluate the need for potentially nephrotoxic medications such as aminoglycosides and NSAIDs. The GI issues are part of a routine preoperative assessment for all patients. A review of acid indigestion and reflux symptoms is necessary. A rapid sequence induction may be indicated; treatment of the acid symptoms may be helpful as well. TIAs and stroke symptoms need further attention prior to proceeding with any elective procedure. Any symptoms elicited in the preoperative assessment require further testing such as CT, MRI, MRA, carotid Doppler, echocardiogram, and a neurology consultation as well. Any significant disease may be a reason to reconsider a surgery such as breast reconstruction. Any acute issues are a contraindication to elective surgery. A history of disease such as seizures, vertigo, or old strokes needs to be well-documented and very stable in nature to proceed with elective surgery. A history of carotid disease should be worked up to determine whether surgery is indicated prior to scheduling other procedures. If surgery is not indicated, there should be an effort to maintain higher perfusion pressures in the perioperative period; an arterial line may be indicated. Regional anesthesia is not contraindicated; however, dosing should be conservative and gradual to avoid abrupt sympathectomy onset. Anticipation of possible hypotension is crucial, and the clinician should have appropriate medications such as phenylephrine ready for treatment. Patients should be clinically euthyroid and, if diabetic, have reasonably well-controlled glucose levels. Diabetics should be scheduled as the first case in the morning whenever possible, and insulin-dependent diabetics should have glucose checked hourly in the perioperative period. Cancer surgery as well as any lengthy procedures such as this are a risk factor for the development of deep vein thrombosis and subsequent pulmonary emboli. Patients should receive a dose of an anticoagulant such as subcutaneous heparin if the plastic surgeon is amenable, and the patient should have mechanical compression boots as prophylaxis. Additionally, patients who have undergone chemotherapy need to be evaluated for anemia, neutropenia, and any evidence of infection. If there is any suspicion of bone marrow suppression, the elective reconstruction should be delayed and hematology consult should be considered. As likely prosthetics may be used in the reconstruction, it is important to have an intact immune system. Last, anxiety in these patients cannot be underestimated. Patients planning on immediate reconstruction are focused on the mastectomy and the likely intraoperative determination of metastasis to the sentinel node. Breast cancer patients have been living with anxiety since the time of their diagnoses and are often stressed, sleep deprived, and emotionally labile. It is important to be a good listener, sympathetic, and supportive—perhaps more so than in any other preoperative interaction. Benzodiazepines are extremely helpful in the perioperative period. Even in the case of delayed reconstruction, the entire surgical experience is tied to the cancer diagnosis and is often overwhelming. Be sure to include herbals, vitamins, and relevant OTC drugs. Patients on beta-blockers should continue them. Statins should be continued as well; discontinuation may be associated with increased risk of adverse cardiac events. Antihypertensives are usually continued except for ACE inhibitors; these are held only on the morning of surgery. All pulmonary medications should be continued perioperatively. All medications for GI symptoms such as proton pump inhibitors and H2 blockers should not be stopped. Oral hypoglycemics are held on the day of surgery. Insulin is given in a reduced dose; the patient should take half of the total dose (regular and long acting) as the long acting on the morning of surgery. In the case of Lantus and some of the newer 24-hour drugs, half of that dose is indicated. A blood glucose level should be checked upon arrival to the hospital and hourly throughout the perioperative period. A glucose infusion or more Regular Insulin may be needed. Antiseizure and anti-Parkinson’s medications should be continued as ordered. Antirheumatoid arthritis medications need to be stopped 1 to 2 weeks prior to surgery depending on the medication. Psychiatric medications are to be continued perioperatively. All herbal medications, supplements, and vitamins should be held the week prior to the surgery. Patients should be off tamoxifen for the perioperative period. If they are undergoing chemotherapy, it is necessary for the last treatment, especially if it includes Herceptin, to have been at least 3 weeks prior to the surgery date. Any anticoagulants need to be stopped in the week prior to the surgery and should be restarted as soon as it is appropriate postoperatively. If the anticoagulation is for an indwelling stent; cardiology should be consulted preoperatively. All known allergies should be reviewed with the patient at the preoperative visit and again on the day of surgery. If the patient has a sensitivity or allergy to latex, the operating room needs to be prepared with latex-free products and drugs. Cephazolin is the perioperative antibiotic of choice, unless the patient has an allergy to this class of drugs. Patients with an allergy to the penicillin family have a 10% to 15% cross-reactivity with cephalosporins. To be safe, clindamycin is usually used in patients with a history of penicillin sensitivity. In patients with a history of MRSA, vancomycin is often the antibiotic of choice. Hemoglobin levels: A baseline hemoglobin prior to a lengthy surgery, such as this, may be helpful but is often not necessary unless the patient has received recent chemotherapy or other surgery. Electrolytes: This is not necessary unless the patient has been undergoing chemotherapy or been on diuretics. Coagulation panel: If the patient has not been on anticoagulation therapy, these labs are not indicated. A blood bank specimen is valuable to have prior to the start of the procedure. Imaging: Include stress tests, renal imaging tests, etc. Unless there are symptoms indicating further workup, these tests are not necessary. Other tests include thyroid tests, etc. Using the patient’s own breast tissue. Adding tissue matrix to supplement the patient’s own muscle and skin to cover the expanders or implants. Creating a variety of flaps from the lower abdomen, the upper back, or the gluteus region. For all of these possibilities, general anesthesia is necessary. In addition, the surgery is often lengthy and may require the patient to be in a variety of positions. Some flap surgeries require lengthy revascularization procedures as well. Regional anesthesia has become more desirable as an adjunct to general anesthesia to improve the perioperative experience and help manage postoperative pain issues. Pain is well controlled with a thoracic epidural, bilateral rib blocks, and paravertebral blocks. Regional anesthesia is also useful in reducing the amount of narcotics administered; this in turn reduces the likelihood of PONV. This improved perioperative experience may allow patients to leave the hospital earlier. Benefits: The benefits of an epidural, rib blocks, or paravertebral block are the better pain control for the length of the local anesthetic effect postoperatively. They are all safe to perform, and paravertebrals have become routine with the prevalence of ultrasound guidance. The pleura and surrounding anatomy are quite easy to visualize and avoid. Regional anesthesia allows patients to take deep breaths with greater ease, cough to clear secretions, and, in the patient population at risk, may reduce postoperative pulmonary issues. Intraoperatively if used, the single-shot blocks or continuous catheter administration will reduce the amount of general anesthesia needed and may result in a quicker recovery time, shorter recovery room stay, less PONV, and less hypoxia. Drawbacks: The downside of regional anesthesia is that it is another procedure that is routinely placed preoperatively. Some patients find this additional procedure to be particularly stressful, and they often prefer sedation offered for the procedure. Regional anesthesia does require at least one needle placement, which may result in hematoma, intravascular injection, local anesthetic toxicity, nerve injury, pneumothorax, or patchy or failed block. Regional anesthesia may also increase the need for hemodynamic support/vasoactive agents after placement. Yet another drawback is that regional blocks often do not cover the axilla well, and patients frequently complain of axillary pain from sentinel node dissection or drains placed for the mastectomy/reconstruction. One issue frequently mentioned is the need for a Foley catheter with the use of regional anesthesia. These patients almost always have a Foley catheter placed intraoperatively, and even in the case of a thoracic epidural, the catheter can be removed shortly after surgery as patients can usually void on their own without issue. These approaches to regional anesthesia can be done in a preoperative setting prior to moving the patient to the OR. This approach allows for the surgical team and nurses to prepare all of the equipment while the patient is receiving the regional anesthesia. The regional anesthesia placement is done under monitored anesthesia care; sedation is given, the patient is fully monitored. The team must be prepared to provide airway support, induce general anesthesia safely, and resuscitate the patient if the need arises. A provider trained in regional anesthesia issues is important to provide safe care and assist in the block positioning, sedation, and placement. General anesthesia is necessary for this procedure. Endotracheal intubation is indicated because of the length of the case and the possible need to reposition the patient depending on the needs of the reconstruction. Many surgeons will request neuromuscular blockade for the flap dissection and possible revascularization as well as the creation of a pocket for the implant beneath the pectoralis muscles. Special attention should be given to padding the patient’s arms, placement of monitors, and tension on the patient’s shoulder as the surgical team may need to work in the axilla. Careful attention should be given to make certain that there is not pressure placed on the face during the lengthy case as well. A warming blanket can be placed on the lower portion of the patient, but most of the patient’s torso remains exposed for the entire procedure. A Foley catheter should be placed to make fluid management easier and as the procedure can be quite lengthy. Airway concerns: There are no special airway concerns in these cases. Monitored anesthesia care is not an option for these procedures but is necessary for the placement of the regional anesthetic if one is placed preoperatively. My preferred method of anesthesia is the preoperative placement of a thoracic epidural catheter or paravertebral block—the choice depends largely on the patient’s anatomy and the availability of ultrasound guidance for the paravertebral blocks. The epidural catheter allows for redosing, extending the length of time the patient is comfortable before oral or intravenous narcotics are employed. Use current SCIP recommendations: Cephazolin 2 grams q 4 hours intraoperatively is the current recommendation. To provide quality anesthesia care, it is important to know the surgical plan for the reconstruction as each approach has implications for the positioning of the patient, the need for muscle relaxation, concerns around flap vascular integrity, and pain issues for the patient. If the reconstruction is performed using tissue expanders and the patient’s own skin and pectoralis muscle, the patient can remain supine and does not need to be repositioned. However, some surgeons prefer to sit the patient up during the operation to verify symmetry of the breasts prior to extubation. The deep and superficial epigastric artery flaps and TRAM flaps also require the patient to be in the supine position for the case. Muscle relaxation is helpful for dissection. The regional anesthesia options are often not sufficient to cover the large area of surgical stimulation or pain postoperatively and so are often not done. The latissimus dorsi flaps and the gluteal free flaps require the patient be prone for the initial dissection, and then the patient is turned supine for the reconstruction of the breasts. If the reconstruction is being done immediately following the mastectomy, there are several issues that are important for the best care of the patient. If a sentinel node biopsy is performed with the mastectomy, there is a chance that the patient will require an axillary lymph node dissection. Depending on the nature of the disease—the receptors, the age of the patient, the size and location of the tumor—axillary dissection may or may not be indicated and may lead to postponing the reconstruction until after further treatment of the disease. Often tissue expanders can be placed but implants are not considered if the patient will need radiation. All of these surgical possibilities need to be discussed in real time. The anesthetic must be planned with the possibility that the reconstruction will not immediately follow the mastectomy. Also, many breast surgeons do not want the patient to be paralyzed when they dissect the axilla. Succinylcholine or a short-acting relaxant may be used for the intubation, allowing recovery during the mastectomy. Many plastic surgeons will then later ask that the patient be paralyzed for the reconstruction part of the procedure. Hypotension is probably the most common intraoperative complication. Blood loss is rarely an issue; the patients are usually slightly dehydrated and then vasodilated under general or combination general/regional anesthesia. This is often easily treated with a vasoactive medication such as ephedrine or phenylephrine. Another intraoperative problem is nerve injury from positioning. Checking and rechecking all possible pressure points cannot be overstated. Neuropathies may develop from pressure points that are not sufficiently padded during the procedure. Flap vascularization may be problematic with both free flaps and flaps with vascular attachments. Avoiding hypotension and the use of excessive vasoconstrictors such as phenylephrine may be helpful. Most patients after an appropriate stay in a recovery room setting can be cared for on a regular surgical floor. The major postoperative issues are pain which can be treated with intravenous narcotics or redosing of an epidural catheter if available and PONV which can be treated with a variety of drugs including ondansetron, haloperidol, dexamthasone, scopalamine, ephedrine, and others. Other postoperative issues include emotional lability, which can be helped with family support, sympathetic recovery team, and benzodiazepines as needed. Bleeding can be picked up readily as drains are left in for days to weeks; this is not a common problem. As with any prosthetic implants, infection is a real concern and results in often several subsequent surgeries for the patient; special attention to details to limit infection are very important.

https://www.psychiatryadvisor.com/home/decision-support-in-medicine/anesthesiology/breast-reconstruction-after-mastectomy-procedures/

A Day in the Life of an Anesthesiologist Anesthesiology is one of medicine’s least-understood fields. Because it doesn’t deal with a certain organ, many people aren’t sure what it deals with at all. This World Anesthesia Day, we’ll show you what a day in the life of an anesthesiologist looks like so that you know what to expect if you ever need anesthesia. Today, let’s walk in the shoes of Dr. Guoxun Xu, who has been an anesthesiologist at Beijing United Family Hospital (BJU) for four years. 1) How many patients do you usually see each day? It varies. An anesthesiologist’s workload largely depends on the type of surgeries that we encounter each day. If we have mostly simple procedures on a given day, then I may see five to eight patients within the operating room. On the other hand, if we have a more complicated surgery case, then I might spend the entire day (10 or more hours) with one patient. But, in the outpatient clinic, it can be more than 10 patients a day. These patients need pre-operative assessments before their surgeries. Usually, we start off the day with pre-operative consultations. We go to the wards and evaluate our patients prior to surgery so that we can make safe and individualized anesthesia plans based on each patient’s clinical condition. Depending on the type of operation performed and patient’s condition, we may select general, regional, or local anesthesia. We would then prepare medications and all other monitoring equipment needed for the surgery. After the procedure, we will send patients to a recovery room and monitor them for an hour. If everything is fine, we’ll send them to their ward. 2) You mentioned there is an outpatient clinic for pre-anesthesia assessment. What types of patients do you usually see in the outpatient clinic and what are some common questions that you usually address with these patients? During our pre-anesthesia clinic, we have a large portion of patients who are pregnant and are interested in labor analgesia. In China, people are not very familiar with analgesia during labor. They are concerned that labor analgesia (a common type is labor epidural) might adversely affect the labor and delay the labor process. In fact, epidurals are good for labor. Extensive clinical research data show that effective pain control during labor reduces physiological stress on both the mother and the baby, and therefore improves birthing outcomes and the birthing experience for the mother. However, labor epidural, similar to most other medical interventions, has associated risks including minor bleeding at the puncture site, hypotension, nausea and vomiting, headache, etc. Overall, it makes for a much better labor experience. Some specific questions regarding epidurals that we would address during pre-anesthesia clinic include things like what an epidural is and how it is performed. We also explain the labor process and how an epidural fits into the process, what can you expect with an epidural in terms of pain relief, risks associated with epidurals, food and water intake prior to labor, and other concerns. We would try to address all relevant questions so that pregnant women feel prepared and have a birthing plan to make them feel reassured and less nervous. We would also see patients who are planning to undergo other types of surgery that require some form of anesthesia. And one common question that we receive is whether general anesthesia causes harm to the body, especially for children. Currently, there is no definitive evidence demonstrating harm associated with receiving anesthesia. In general, anesthesia is relative given that an appropriate anesthesia method is utilized. 3) Is there anything else that anesthesiologists do outside the operating room? Yes. For example, for patients undergoing endoscopy scans, we provide support to make the procedure more comfortable. For claustrophobic patients who need to get CT or MRI scans, anesthesiologists can supply medication to help them relax and do the procedure comfortably. We also have a pain clinic where we do pain management for patients suffering from chronic pain. Pain management involves not only medication but also minimally invasive procedures such as nerve blocks or spinal cord stimulation to control chronic pain. Some people who suffer from shingles, for example, have such severe pain that wearing clothes is painful, so we can insert a temporary spinal cord stimulator to relieve their pain so that they can go back to their normal life. 4) What does an anesthesiologist do during surgery? Our goal first and foremost is for patients to be safe and comfortable during the whole procedure and after the operation. Depending on the type of surgery, we give our patients analgesic medications (painkillers) to control the pain and anesthetic medications that will allow them to fall asleep or become unconscious (in the case of general anesthesia) and not remember the operation. Most people who are not familiar with anesthesiology are under the impression that anesthesiologists simply administer anesthetic medications and then stand around until the operation is done. In fact, in the operating room, the anesthesiologist is in charge of monitoring the patient’s vital signs, fluid inputs and outputs, and all other clinical indicators that might influence a patient’s clinical condition. We have to observe the process of the procedure. If something happens, you may need to give the patient more medication. If there’s some blood loss, the anesthesiologist pays attention to that. After the surgery, we monitor the patient in the recovery room closely until the medication wears off and the patient is fit to be released to the ward. If the patient feels sick, we can give them anti-nausea medication. If they feel pain, we can give them painkillers. If it’s a big surgery that causes a lot of pain, we can give them a patient-controlled analgesic device to let them control their painkillers where they can press a button to get more medicine. Metaphorically speaking, anesthesia induction (start of anesthesia) and anesthesia recovery (waking up from anesthesia) are like an airplane taking off and landing. They are absolutely crucial for the success of the anesthesia process and the patient’s safety. Having said that, some people think that, during a surgery, the atmosphere is very tense and serious. But it isn’t – when the procedure is very stable, we chat and make jokes. That’s when you know it’s the safest – when everyone is relaxed and in control! 5) Is general anesthesia dangerous? It’s absolutely relatively safe. Deaths from anesthesia are very rare – one in every 200,000. If you’re in a taxi, that’s more dangerous! Not only are the medications better but, more importantly, the monitoring devices are much better than before, so you can monitor almost every aspect of the patient’s clinical status. Nowadays, we can monitor the anesthesia level and the blood pressure from within the blood vessels. This way, we can have real-time monitoring so we can keep track of the patient’s situation and act accordingly. 6) Are there people who can’t get general anesthesia? There’s no contraindication for anesthesia because, in emergency cases where you absolutely need to receive a surgical intervention, it’s safer to use anesthesia than risk not doing the surgery. We can always plan the right level of anesthesia for you. If a patient just needs a skin biopsy, for example, local anesthesia might be enough. If you’re doing heart surgery or some other major surgery, general anesthesia will be planned. It may happen that elderly people have bad dreams or delirium. This is rare and it doesn’t last very long. The medications are now mostly short-acting, so you’ll usually wake up 10 minutes after the procedure. 7) What do you think about hypnosis for anesthesia? I’m not very familiar with hypnosis, but I would say it’s completely different from anesthesia. With hypnosis, you might enter a trance-like state but, with anesthesia, we don’t just make you sleep – we prevent you from feeling pain. With hypnosis, if you are slapped or hurt, you would probably wake up. But, with anesthesia, you won’t wake up. With anesthesia, you would receive sedatives, muscle relaxants, analgesics … we put all these medications together to make your operation run smoothly. 8) Is there any part of your job you wish more people knew about? I just want people to know that they don’t need to worry about anesthesia! It’s safe and it will help you get through your procedure. I know some parents get really worried if their kids need anesthesia. If their child needs a dental procedure, for example, they worry that anesthesia will be bad for them so they make the child do the procedure without anesthesia. The pain and discomfort can be quite distressing and even traumatic for the child, and so using anesthesia is a preferable alternative. The second thing is that people can trust us and believe in us! Medicine is not perfect and doctors are not perfect. There may be some side effects from medications. This is normal, but we try to minimize the effects. We’re here to make you feel comfortable, and we do our best. Most people think they should feel no pain after the procedure. Our goal is to ensure patient safety and minimize discomfort, but it’s not always possible to control all pain. Dr. Guoxun Xu is an anesthesiologist with over a decade of clinical experience. To make an appointment with him for pain-management issues, please call the BJU Service Center at 4008-919191.

https://beijing.ufh.com.cn/8161/health-information/articles/english-a-day-in-the-life-of-an-anesthesiologist?lang=en

Manipulation Under Anesthesia with Fibrosis Release Procedures (MUA-FRP) Manipulation under anesthesia (MUA-FRP) is a non-invasive procedure that has been utilized for over 70 years. It is increasingly offered for acute and chronic unresolved conditions such as: neck pain, back pain, joint pain, muscle spasm, shortened muscles, fibrous adhesions, and long term pain syndromes. The procedure consists of the patient being sedated with anesthesia (pre-op Versed or Fentanyl) and during the MUA may include the anesthesiologist’s choice of Propofol (Diprivan), Midazolam (Versed), Sufentanyl, and, occasionally, Succinylcholine, through a secured IV. The MUA-FRP is performed by a specially trained MD, DO or DC in a local surgical center. Patient selection criteria is very specific, if you have suffered with chronic back pain, shoulder pain, hip or knee pain with restricted range of motion, you may be a candidate. The link below provides more information regarding this procedure. https://www.spine-health.com/t...

http://lasvegaschiro.com/mua-frp

NAP4 identified several factors associated with major airway complications. Abstract This topic aims to discuss key aspects of anesthetic and airway management for head and neck surgery. Airway management is a central part of patient care and management in Head and Neck Surgery. Common challenges in Head and Neck surgery are shared airway, distorted airway anatomy due to existing pathology; risk of airway obstruction, disconnection or loss of airway intra-operatively; risk of soiling of the airway due to bleeding and surgical debris; and the potential for airway compromise post-operatively. The option for airway management technique is influenced by patient’s factors, anesthetic needs, and surgical requirements. Intubation technique necessitating either a small or large cuffed tracheal tube with a throat pack provides the highest level of airway protection Non-intubation or open airway techniques involve mask ventilation, apneic techniques, and insufflation techniques, or the use of a laryngeal mask airway. Lastly, jet ventilation techniques may be conducted via a supraglottic, subglottic or transtracheal routes. It is essential to have clear airway management plans including rescue airway strategies that should be communicated with the surgeons and patients at the earliest opportunity. Keywords - head and neck surgery - shared airway - airway management - anesthesia management - preoperative endoscopy - total intravenous anesthesia (TIVA) - bronchoscopy - transoral robotic surgery - functional endoscopic surgery - laser surgery - virtual endoscopy 1. Introduction Head and neck (H&N) surgery encompasses an expanded spectrum of procedures varying greatly in complexity, duration, and complications. They range from simple surgeries such as dental procedure, adenotonsillectomy to precise and image-guided laryngologic, neurotologic, and skull-base surgery, complex obstructive sleep apnea (OSA) surgery, sophisticated transoral robotic surgery (TORS), transoral laser microsurgery (TLM), and major head and neck oncological surgery with extensive free-flap reconstruction. Head and neck surgery presents unprecedented challenges for the anesthesiologists including shared airways, concurrent comorbidities, anesthesia techniques, and postoperative complications. A Shared Airway is the term commonly used in Head and Neck surgery which is characterized by “any procedure where the anesthesiologist needs to maintain a patient’s airway patency, oxygenation, and ventilation in a similar airway anatomical space in which the surgeon operates.” Both the anesthetists and surgeons must have a clear knowledge and understanding of their respective roles in managing the ‘shared airway’. The role of the anesthetist must be to provide safe general anesthesia for the patient, an uninterrupted airway during the perioperative period, and a clear field for the surgeon by applying various hypotensive anesthesia techniques. This chapter focuses on key aspects of anesthesia and airway management strategies for common Head and Neck surgical presentations, with relevance to the current evidence base and clinical guidelines. It is aimed to be a comprehensive review for residents and fellows training in the fields of anesthesia and head and neck surgery. 2. Difficult airway management in head and neck (H&N) surgery: background It is estimated that the occurrence of difficult airway and complications are more frequent in H&N patients than in the general surgical population. In the Fourth National Audit Project (NAP4) from the Royal College of Anesthetists and the Difficult Airway Society in the United Kingdom (UK), data regarding major airway complications were collected prospectively in approximately three million anesthetized patients throughout the UK . The incidence of airway-related complications was nearly 40% in H&N surgeries and almost 75% of the cases required emergency surgical airway (ESA) for “cannot intubate/cannot oxygenate” (CICO) situations. Likewise, the incidence of the emergency surgical airway (ESA) was even higher in another retrospective study of 452,461 patients in the Danish Anesthesia Database . In this study, the overall incidence of ESA in ear, nose, and throat surgery was reported as 1.6 events per thousand, which was 27 times higher than in the general surgical population (0.06 per thousand). The H&N oncological patients are at even higher risk of difficult airway management, predominantly males, with an incidence of over 12% experienced difficult direct laryngoscopy and tracheal intubation . In NAP4, of the 21 cases of difficult airway observed on anesthesia induction, 13 cases occurred in patients with upper airway tumors . Additionally, numerous studies have indicated that difficult tracheal intubation, defined as three or more attempts on direct laryngoscopy, may be observed in up to 7–9% of H&N cases [5, 6, 7], which is up to four folds higher than the general surgical population [8, 9, 10, 11]. In the NAP4 study, several factors have been associated with airway related complications (see Table 1 ). Furthermore, anesthesiologists experience greater challenges during extubation and post-anesthesia recovery period [1, 12]. |Factors associated with airway management related complication||Inadequate airway assessment| |Inadequate planning for airway management and for failure of intubation| |Multiple intubation attempts| |Inappropriate use of a supraglottic airway (SGA) device| |Obesity| |Failure to correctly interpret capnography and recognize esophageal intubation early| |Anesthesia for head and neck surgery| |Intubation in the emergency department or intensive care unit| 3. General principles: preoperative assessment The preoperative Anesthesia assessment is imperative in reducing risk during shared airway procedure and must include a detailed general medical and surgical history, previous anesthetic exposure, and general physical examination as well as a focused airway assessment. It is paramount to have a multidisciplinary approach to an anticipated difficult airway in H&N surgery which requires a high degree of cooperation and communication with the surgeon, allowing for early identification of high-risk patients, and reciprocal anticipation of the potential problems and adequate preparation to face the challenges. Expertise in H&N anesthesia and complex airway management should be encouraged as it improves the outcome and reduces airway complications. The goal of preoperative assessment is to recognize patients with potentially difficult airways, stratify the risks, manage the co-morbidities, and optimize the patient’s condition before major H&N surgery (see Table 2 ). 3.1 Airway assessment: history and physical exam Preanesthesia assessment invariably includes airway evaluation to identify and predict difficulty in airway management. The incidence of difficult airway is higher for patients who undergo H&N surgeries than for general surgical procedures. Therefore, the primary priority in airway assessment is to determine whether airway is compromised. A detailed history should be obtained before the surgery which incorporates reviewing previous anesthesia records with a particular focus on airway management, identifying risk factors of possible difficult mask ventilation and tracheal intubation. History of previous difficult tracheal intubation is one of the most important predictors of the anticipated difficult airway [9, 11]. It is worth mentioning that a history of prior easy intubation does not guarantee subsequent uneventful airway management in H&N procedures, due to the progression of the underlying pathological processes and their significant effect on the airway anatomy . Anatomic anomaly relating to the face, mouth, nose, pharynx, or larynx must be thoroughly investigated. Hoarseness, drooling, dysphagia, orthopnea, stridor, cough, and recent onset of snoring may indicate airway compromise. Patients with vocal cord paralysis may be at increased risk for perioperative pulmonary aspiration. Prior H&N radiotherapy induces tissue fibrosis as well as long-standing epiglottic and glottic edema, leading to a non-compliant airway with limited mouth opening and restricted neck movement , which may make both mask ventilation and laryngoscopy potentially difficult . Routine bedside airway assessment tools can be performed such as the American Society of Anesthesiologists (ASA) bedside airway assessment tool which includes Mallampati classification, thyromental distance, inter-incisor distance, neck mobility, and body mass index (BMI), etc. . However, it is poorly predictive of difficult airway in Head and Neck surgery because it fails to assess the inside pathology and severity of the upper airway such as base of the tongue, glottic and vallecular lesions, etc. [8, 16]. Numerous risk factors associated with difficult airway management have been identified (see Table 3 ) . |Anesthesia considerations in Head and Neck Surgery||Multidisciplinary approach and close-in line communication| |Presence of expertise in H&N anesthesia and complex airway management| |Anticipation of challenges during intubation and extubation| |Shared Airway with the surgeon and related challenges| |Different approach to airway management specific to surgery| |Different Anesthesia technique and positioning challenges| |Post Anesthesia recovery and Airway support| |Risk factors for predicted difficult airway management||Mallampati grade 3 or 4| |Decreased thyromental distance| |Male gender and Age > 57 years| |Absence of teeth| |Presence of beard| |Obstructive sleep apnea or History of snoring| |Dencreased Mandibular protrusion| |Thick or short neck| |Neck radiation changes or a neck mass| |Obesity (BMI > 30)| 3.2 Pre-operative assessment of comorbidities Head and Neck surgery may entail a wide range of patient populations from young and healthy to elderly, geriatric patients with significant cardiovascular, respiratory, endocrine, and renal diseases who are also at high risk for postoperative delirium and cognitive dysfunction. The perioperative risk related to major H&N surgery rises with advanced age and an increased number of comorbidities. As part of the multidisciplinary team, the anesthesiologist plays a crucial role in deciding the treatment plans, optimizing the patient’s condition pre-operatively, and weighing the risk to benefit ratio of the surgery. Patients with cardiovascular diseases such as uncontrolled hypertension, cerebrovascular, and coronary artery disease, chronic renal insufficiency, must be evaluated for cardiac risk prior to noncardiac surgery and if required must be referred to cardiologists. Cardiopulmonary exercise testing (CPET) can be a useful aid to decision making, particularly where more extensive or complex surgery is being performed. Also, poorly controlled heart failure (New York Heart Association Grade 3–4) is associated with poor prognosis. Brain natriuretic peptide (BNP) and N-terminal proBNP are useful biomarkers for perioperative screening of heart failure patients. Moreover, the hypotensive anesthesia technique should be avoided and intraoperative hyper or hypotension should be aggressively managed. Pulmonary comorbidities are common in H&N patients. Preoperative optimization of Chronic obstructive pulmonary disease (COPD) via treatment of acute infection and appropriate use of bronchodilators and steroids is crucial to prevent post-operative pulmonary complications. Furthermore, COPD patients may not tolerate intraoperative ventilation techniques such as spontaneous ventilation, one-lung ventilation, apneic intermittent, or jet ventilation. Likewise, patients with obstructive sleep apnea (OSA) are predisposed to difficult or challenging airways and are more sensitive to sedatives and opioids which should be used cautiously. H&N procedures involving the lower cranial nerves (Cranial nerves X, XI, and XII) may increase the risk of airway obstruction or aspiration in the post-operative period. H&N cancer patients are of particular concern as smoking and alcohol are the common cause of cancer, which also predispose them to post-operative malnutrition. 3.3 Pre-operative investigations and imaging studies Head and Neck surgery patients must have baseline investigations which include complete blood count, biochemical profile with urea and electrolytes, coagulation profile, liver function test, blood sugar, and electrocardiography. Other investigations such as chest x-ray, pulmonary function tests, and arterial blood gases may be requested based on the risk factors and symptoms at presentation. Imaging studies with computed tomography (CT) or magnetic resonance imaging (MRI) and flexible nasal endoscopy aid to determine the extent of the pathology and its impact on the airway and the surrounding soft tissues. The preoperative endoscopic airway examination (PEAE) in particular is useful for examining the upper airway to assess the significance of the swelling and distortion, the location, size, the spread of the lesions, the degree of obstruction, and vocal cords’ mobility. Moreover, preoperative awake nasal endoscopy can be carried out by the anesthesiologist before induction which gives a real-time image of the upper airway and the larynx and is useful in formulating airway management strategies including awake intubation and surgical airway . 3.4 Premedication Premedication to reduce anxiety and secretions may be helpful in patients going for H&N surgery with minor airway lesions but should be avoided in patients with H&N masses compromising the airway. Antisialagogues may be administered in the preoperative phase to minimize oral and tracheobronchial secretions. The patient should be monitored closely when premedicated, preferably in the holding area of the OR. During the preoperative visit, anesthesiologist should attempt to reduce the patient’s fears and anxiety. 4. Intraoperative anesthesia management of H&N surgery The main intraoperative goal is the appropriate choice of airway technique and airway device tailored to the patient and surgical technique. Other goals are the provision of expert airway management, a continuous plane of anesthesia, clear and immobility of the surgical field, smooth and fast recovery from anesthesia. and surgery with the implementation of enhanced recovery after surgery (ERAS) protocol for fast-track discharge of patients . 4.1 Anesthesia management 4.1.1 Intraoperative monitoring technique Standard American Society of Anesthesiologists (ASA) monitors such as Blood pressure, Electrocardiography, Pulse oximetry for O2 saturation, capnography, and temperature monitoring are usually applied during H&N surgery. Invasive blood pressure monitoring and advanced hemodynamic monitoring is usually considered in patients with significant cardiovascular disease or long procedures, and when excessive blood loss is expected. One study suggested that the use of goal-directed fluid therapy based on cardiac output monitoring helps guide fluid therapy and avoid fluid overload in free flap transfer . Processed electroencephalogram (EEG) monitoring helps assess the depth of anesthesia and guide anesthetic drug dosing to provide a stable plane of anesthesia during surgery. Moreover, Neuromonitoring such as electromyography (EMG) monitoring of facial nerve in some head and neck surgery may guide to modify the anesthesia technique accordingly. 4.1.2 Positioning The majority of head and neck surgeries are done in a supine position with a 15–20-degree head-up tilt to improve venous drainage. Anesthesiologists must pay meticulous attention to the patient’s positioning especially since the head of the operating table is usually turned 90–180 degrees away from the anesthesia machine, limiting immediate access to the airway. Thus, long ventilator tubing and vascular access lines are required and the endotracheal tube should be secured effectively to avoid accidental extubation and disconnection. The eyes should be protected with an occlusive dressing to keep the lid closed and to prevent skin preparation solution from entering the eyes. Goggles or eye pads may be used; all pressure points must be padded, and intermittent pneumatic calf compression is applied. 4.1.3 Fluid management and blood loss Large-bore venous access is essential for major resections when significant blood loss is anticipated. Also, the need for invasive or advanced cardiac output monitoring is determined by the patient’s comorbidities as well as the nature and extent of the surgery. They are useful in assessing fluid response and guiding fluid therapy. Hypotensive anesthesia and hemodilution techniques may minimize blood loss, but must be practiced with care to maintain adequate blood flow to free flaps. Moreover, urine output should be monitored in prolonged surgeries. 4.1.4 Choice of anesthesia techniques General anesthesia is the technique of choice as it provides airway protection, ensures adequate oxygenation, ventilation, immobility, and avoids distracting the surgeon. In some selected H&N surgeries, monitored anesthesia care can be provided to maintain spontaneous ventilation and a responsive patient with intact airway reflexes. The choice of induction technique for general anesthesia (intravenous versus inhalational agents) is based on patient factors, surgical needs, and potential for compromised ventilation. Preoperative assessment and consultation with the surgeon will determine the technique of endotracheal intubation (awake or asleep), selection of an intravenous versus inhalation induction technique, and whether to use a neuromuscular blocking agent (usually avoided if nerve monitoring to be used intraoperatively). The NAP4 report highlighted that inhalation induction may result in total airway obstruction in patients with H&N pathology, where patients do not exhale the anesthetic gases and rapid hypoxia ensues. The theoretical advantage of gas induction is that it is a slow induction that preserves spontaneous ventilation. Additionally, maintenance of anesthesia can be obtained either with total intravenous anesthesia (TIVA) or inhalation anesthetics or a combination of inhalation anesthetic with intravenous infusion of a short-acting anesthetic. Because many H&N surgeries are associated with high incidences of postoperative nausea and vomiting (PONV), propofol-based anesthesia may be a preferable technique of choice to prevent PONV [19, 22]. Many centers use total intravenous anesthesia (TIVA) with target-controlled infusion (TCI) of propofol and opioids (see Table 4 ). In TCI, pumps are programmed to deliver an induction bolus followed by a maintenance infusion based on patient’s demographics. TIVA is also useful to facilitate a clear surgical field by titrating the anesthetics to desired blood pressure [systolic blood pressure below 100 mmHg and mean arterial pressure of 60 to 70 mmHg ]. However, controlled hypotension should be avoided in patients with uncontrolled blood pressure, cerebrovascular or coronary artery disease, as well as chronic renal and hepatic insufficiency. |Advantages of TIVA in Head and Neck surgery||Rapid titration of anesthesia to the desired clinical effect| |Allows immobility and facilitates nerve monitoring| |Allows rapid and smooth emergence after surgery| |Reduction in Postoperative Nausea and vomiting| |Induction of moderate hypotension may reduce blood loss and provide clear surgical field| |Technique of choice in laryngologic surgery during jet ventilation or intermittent apnea ventilation| 4.2 Preparing and planning for airway management Devising safe and optimal airway management depends on close in line communication between the anesthesiologist and surgeon, airway evaluation, reviewing imaging studies, type of surgery, location of the lesion, patient’s symptoms, and tolerance of the procedure and knowing the risk associated. 4.3 Airway management techniques The technique for airway management should be formulated with the surgeon preoperatively which includes reviewing preoperative imaging studies and endoscopy, choice of airway management device, route for tracheal intubation, awake versus sleep endotracheal intubation, use of jet ventilation, and backup strategies, including preparation for a surgical airway. The goal of a pre-planned and optimal airway approach is to achieve adequate ventilation, oxygenation, and airway protection against aspiration. The following general airway management strategies should be considered: General anesthesia with endotracheal intubation General anesthesia using a supraglottic device General anesthesia using an Operative laryngoscopy in conjunction with jet ventilation Use of intermittent apnea General anesthesia using the patient’s natural airway or spontaneous ventilation Local anesthesia in conjunction with intravenous sedation, with the patient breathing spontaneously 4.3.1 Options for endotracheal intubation technique 4.3.1.1 Laryngoscopy technique It is often prudent to opt for video-laryngoscopy (VL) as a primary tracheal intubation technique because most H&N patients have high incidences of anticipated difficult airway. Multiple attempts with direct laryngoscopy (DL) should be avoided as it will lead to bleeding, soiling, edema, and fragmentation of any friable tissue in the airway that may dramatically worsen the subsequent laryngoscopic view and facemask ventilation [1, 24]. Thus, VL could be considered as a primary intubation technique in H&N patients to maximize the likelihood of first-attempt success . In one meta-analysis of randomized controlled trials that compared VL versus DL in patients with anticipated or simulated difficult airways, VL was associated with improved glottic view, more likely successful intubation, and a higher chance of first-attempt intubations . The provider should nonetheless approach all anticipated difficulties with caution. In one study, there was an overlap in predictive factors such as previous radiotherapy, malignancy, and previous surgery that led to difficulty in both DL and VL . In conclusion, multiple attempts should be avoided as it leads to airway trauma and obstruction and alternative laryngoscopic or intubation techniques should be considered with caution ( Figures 1 and 2 ). 4.3.1.2 Comparison between awake and asleep flexible fiberoptic endotracheal intubation in head and neck surgery There is a common perception that awake fiberoptic intubation (AFOI) is the safest approach to difficult airway management . Certainly, advantages of maintenance of airway patency, gas exchange, and protection against aspiration during the intubation process are offered by awake intubation. AFOI is helpful in patients with supraglottic obstruction, e.g. epiglottic or tongue base obstruction, but it is not the preferred technique in patients with a critically narrowed laryngeal inlet where there are copious secretions, difficulty in maintenance of spontaneous ventilation, and small laryngeal aperture. Adequate topicalization is key to the patient’s comfort and successful airway management. Asleep fiberoptic intubation has certain benefits such as patient comfort, avoidance of anxiety, and smooth transformation to other airway devices if necessary. However, asleep fiber optic intubation may lead to a difficult airway due to airway collapse and hypoxia from depressed respiratory function. The possibility of a successful exit strategy must be evaluated when considering asleep fiber optic intubation. In NAP4, both awake and asleep flexible fiberoptic intubation have relatively high failure rates in patients with H&N pathology, with a frequency up to 60 percent [1, 29]. The most common causes for failure of flexible scope intubation include the inability to identify the glottis, difficulty passing the scope, bleeding, and airway obstruction. In conclusion, awake fiberoptic intubation should be considered first in patients with head and neck pathology with an understanding of the pre-existing limitations to flexible scope intubation. 4.3.1.3 Surgical laryngoscopy and rigid bronchoscopy Rescue endotracheal intubation using operative laryngoscopy such as anterior commissure scope or rigid bronchoscope ( Figure 3 ) has been effective and shown to be successful in difficult airway scenarios or when direct laryngoscopy fails [31, 32, 33]. Hillel and colleagues have shown that the use of surgical laryngoscopes helped secure over 35% of difficult airways and reduced the number of emergent cricothyroidotomies to nearly half . After an operative laryngoscope or rigid bronchoscope is placed, manual ventilation can be provided safely through the lumen of the scope and subsequently, endotracheal intubation can be performed with the aid of an airway exchange catheter or a gum elastic bougie . Thus, operative laryngoscopy and rigid bronchoscopy can rescue failed tracheal intubation and cannot intubate/cannot oxygenate (CICO) situations. 4.3.1.4 Optical stylet intubation devices Optical intubation stylets (such as Bonfils, Clarus video System, Sensascope, Levitan optical stylets, etc.) may be helpful and offer an advantage over flexible scopes. These rigid optical stylets can help bypass mobile supraglottic and glottic masses, and once the glottis is entered, the endotracheal tube will follow the trajectory of the stylet in the patient’s trachea. However, studies reported a wide range of success rates with the use of optical stylet [36, 37]. Success rates are higher with experienced users with the mean time to intubation at 23 seconds . 4.3.2 Supraglottic airway devices Laryngeal mask airway (LMA) devices ( Figure 4 ) offer many advantages in H&N surgery. They may be used: as primary ventilator devices and to provide smooth emergence from anesthesia in many elective H&N surgeries, such as ear, nasal and intranasal surgery, and facial cosmetic surgery. as conduits for endotracheal intubation (intubating LMA). as rescue devices in patients who are difficult to intubate or mask ventilate. If LMAs are deemed necessary, the anesthetist should opt for the second generation whose seal design have been shown with less leakage and reduced risk of aspiration. However, there are limitations to the supraglottic airway devices in H&N pathology. They may be difficult to place in patients with history of neck irradiation; limited mouth opening; and glottic, hypopharyngeal, or subglottic lesions. 4.3.3 Combined video laryngoscopy and flexible fiberoptic intubation technique The combination of VL and flexible scope or optical stylet is gaining popularity in complex airway management [40, 41, 42]. Video laryngoscopy provides an enlarged view of the glottis and facilitates manipulation of the flexible scope or optical stylet in patients with distorted anatomy or airway tumors. The combined technique allows continuous visualization and reduced trauma to friable tumors or masses. 4.3.4 Surgical airway Surgical airway is considered when endotracheal intubation fails or when traditional endotracheal intubation is not a feasible option due to the nature and unique requirements of the surgery. Awake tracheostomy under local anesthesia should be strongly considered as a primary plan in patients with significant airway obstruction. It may also be planned as the primary intubation strategy in patients who are expected to have significant airway compromise postoperatively possibly due to extensive reconstructive surgery. An alternative is awake cricothyroidotomy (CTM) which can be safely performed for any patients with difficult airways . In case of emergency airway management, surgical cricothyroidotomy is strongly preferred over the percutaneous cricothyroidotomy as the chance of failure of emergency transcutaneous CTM is nearly 60% in H&N patients according to NAP4 report. 4.3.5 Choice of endotracheal tube The type and size of tubes depending on the type of surgeries, location, invasiveness of the surgery, and the patient’s factors ( Figure 5 ). The size and type of ETT should be determined with the surgeon. Endotracheal tubes must be appropriately sized and adequately secured to prevent accidental extubation or displacement during surgery. A reinforced, flexible ETT is an excellent choice for shared airway procedures. They are commonly utilized for intraoral surgery. Nasal endotracheal intubation (e.g. Nasal RAE tube) is commonly preferred for procedures such as transoral robotic surgery, orthognathic and maxillomandibular surgery, base of tongue surgery, and some dental procedures as it provides better visualization of the oral cavity. A small-sized micro laryngeal tube (5-mm internal diameter tube but are longer than standard tube) is commonly used for micro laryngeal surgery to facilitate surgical access. A specialized laser-resistant endotracheal tube is used for airway laser surgery. Nerve integrity monitor endotracheal tube may be used for specific H&N procedures closely approximating the laryngeal nerves. 4.4 Oxygenation and ventilation strategies Maintenance of oxygenation and ventilation is the cornerstone of shared airway management in H&N surgery as these patients are at high risk of failed tracheal intubation and a “cannot intubate, cannot ventilate” situation. Traditional methods of increasing the apneic window during induction involve spontaneous facemask ventilation with 100 percent oxygen. Transnasal high-flow rapid insufflation ventilator exchange or THRIVE delivered through a nasal high-flow oxygen delivery system has been shown to increase the apnea time in a patient with difficult airway to an average of 14 minutes ( Figure 6 ) . THRIVE provides apneic oxygenation, continuous positive airway pressure to avoid atelectasis, as well as flow-dependent dead space and carbon dioxide flushing, and its role in difficult airway management is presently being studied. Alternatively, a pre-operative transtracheal jet ventilation (TTJV) cannula or an Arndt cricothyroidotomy catheter can be used for tracheal oxygen insufflation to facilitate ventilation. For patients at risk of rapid desaturation or anticipated difficult airway, the provider may use the head-up position, then noninvasive ventilation (NIV) for preoxygenation followed by apneic oxygenation after induction of anesthesia. Various ventilatory techniques are applied to meet the demands of H&N surgery such as the type of surgery and the access required to the operative site. Following are the ventilator mode techniques used during laryngologic surgery Spontaneous ventilation with local anesthesia or sedation: this mode of ventilation allows patients to maintain their airways, but few tolerate procedures with such mode of ventilation. Spontaneous respiration with general anesthesia: common in pediatric; oxygenation and ventilation are provided via Stroz bronchoscopy for upper airway endoscopic procedures. Intermittent, Positive-pressure ventilation: this is usually carried out using a micro laryngoscopy tube (MLT), and allows for the use of standard anesthetic equipment in a normal operating setup. However, it provides a mobile operative field that moves with respiration and sometimes surgical access is reduced or obscured especially in surgery involving the posterior third of the glottis. Intermittent apnea without endotracheal intubation: this has the advantage of providing an unobstructed surgical view but poor airway protection and inadequate control of anesthesia depth. The patient’s airway is intubated in cases of desaturation and but may be extubated prior to surgery resumption. Jet ventilation: consists of rapid insufflation of gas (oxygen) at high velocity via a narrow nozzle into an open airway. It can be done at either low or high-frequencys. Jet ventilation can be delivered via supraglottic, infraglottic, or transtracheal routes and it provides the optimal surgical view with reduced stimulation ( Table 5 ). Paralysis and TIVA are usually required for this technique. Low-frequency jet ventilation (LFJV) is delivered using a high-pressure gas source via a narrow cannula attached to a suspension laryngoscope or bronchoscope. Ventilatory frequency is usually around 10–30 cycles per minute. The stream of high-velocity gas entrains air and increases the tidal volume but reduces the oxygen concentration of the inspired gas. It is easy to perform, requiring uncomplicated anesthetic equipment and allows a clear surgical view. Inhalational anesthesia may not be delivered easily, so total intravenous anesthesia is preferred. However, there are certain disadvantages such as mobility of the operative field, difficulty monitoring airway pressure, risk of gas entrainment, and barotrauma High-frequency jet ventilation is more commonly used especially for infraglottic and transtracheal routes. HFJV is usually set at 150 cycles per minute, delivering tidal volumes as small as 1 to 3 ml/kg. HFJV provides a motionless and still surgical field. TIVA is the anesthesia of choice. However, there are possible risks of gastric insufflation, carbon dioxide retention, and barotrauma |Type by technique||Type by location| |• Conventional jet ventilation or LFJV (manual via high pressure manual jet)||• Supraglottic (via rigid ENT laryngoscope)| |• High Frequency jet ventilation via machine with low tidal volumes and high frequencies||• Subglottic (via special catheter)| |• Trantracheal (via cannula)| 4.5 Analgesia A multimodal approach in the form of acetaminophen, non-steroidal anti-inflammatory drugs, gabapentin, opioids, and local as well as regional anesthesia can be given perioperatively. Post-operative patient-controlled analgesia can be considered with step down to oral opioids as required. 4.6 Postoperative nausea and vomiting (PONV) prophylaxis Patients who undergo H&N surgery are at high risk of postoperative nausea and vomiting and should be managed aggressively as it can result in increased morbidity. A multimodal approach to prophylaxis is essential, encompassing TIVA with intraoperative dexamethasone (8 mg Intravenous), 5-HT3 antagonist (e.g. ondansetron 4 to 8 mg intravenous), and utilization of multimodal analgesia to minimize opioid requirement. Classes of antiemetics are 5-HT3 receptor antagonists (e.g. ondansetron) Nk-1 receptor antagonists (e.g. aprepitant) Corticosteroids (e.g. dexamethasone) Butyrophenones (e.g. haloperidol) Antihistamines (e.g. meclizine) Anticholinergics (e.g. scopolamine) Phenothiazines (e.g., metoclopramide) 4.7 Emergence and extubation The goals of safe emergence from anesthesia include smooth, rapid emergence and extubation, avoidance of straining, bucking, and coughing, and a complete, pain-free awakening. Extubation plan should be formulated thoroughly with the surgeons in the preoperative period. One may consider the extubation guidelines as outlined by the Difficult Airway Society of the United Kingdom or American Society of Anesthesiologists Practice Guidelines for the management of the difficult airway [46, 47]. In cases of anticipated post-operative airway complications, extubation may be delayed and patient should be transported to the intensive care unit. Extubation considerations should include the following options: Fully awaken the patient and extubate immediately postoperatively If anticipating airway compromise, admit to the intensive care unit for a delayed tracheal extubation Conduct tracheostomy. 5. Postoperative management Enhanced recovery after surgery protocol should be applied to facilitate fast-track discharge as most of the H&N surgeries are done on an ambulatory basis . Those patients who require post-operative airway management should be cared for in intensive care unit. Varadarajan and colleagues proposed that any of the following could be indications for postoperative ICU admission: Patients requiring post-op assisted ventilation Patients requiring diagnostic or therapeutic bronchoscopy Patients requiring invasive hemodynamic or cardiac monitoring such as in the setting of hemodynamic instability Patients with multiorgan failure requiring critical care management. 6. Special considerations 6.1 Anesthesia considerations for transoral robotic surgery (TORS) Transoral robotic surgery is a minimally invasive surgical technique most widely used for radical tonsillectomy, oropharyngeal cancer resection, localization of occult primary head and neck tumors, supraglottic partial laryngectomy, and treatment of snoring and obstructive sleep apnea . TORS allows exceptional surgical treatment of head and neck pathology while minimizing morbidity and improving functional outcomes as compared with open surgical approaches. Anesthetic challenges include shared airway with a robot and limited access to the patient intraoperatively. Airway management includes nasal RAE or wire-reinforced endotracheal intubation and the use of TIVA with a combination of TCI propofol and remifentanil as the choice of anesthetic. Possible complications include pressure point injury and deep vein thrombosis due to prolonged surgery, risk of airway fire, aspiration, and post-operative bleeding. As TORS expands, local guidelines must be produced that support high standards of perioperative care [49, 50]. 6.2 Anesthesia considerations for laser surgery Laser surgery is employed to treat laryngeal pathoses such as papilloma, laryngomalacia, vocal cord cysts, vocal cord polyps and granulomas, and post-operative scar tissues. Laser micro laryngoscopy enables precise management of a wide range of upper airway conditions. The type of airway management required for laser surgery is determined by whether access is needed to the hypopharynx, supraglottis, larynx, or subglottis. Ventilatory techniques that may be used include continuous endotracheal intubation with specialized laser tubes, spontaneous ventilation with insufflation techniques, intermittent apneic technique, or jet ventilation (supraglottic or subglottic) and with TIVA. TIVA using propofol and remifentanil titrated to maintain spontaneous ventilation is an alternative technique. Laser-resistant endotracheal tubes are used as airway fire poses a major risk. For a fire to occur, the triad of fuel (e.g., ETT, drapes, sponges), oxygen, and ignition source is needed. The American Society of Anesthesiologists (ASA) published an operating room fire algorithm that guides managing airway fires : Declare a fire and alert the team Halt the procedure and the laser beam Irrigate the surgical field with saline Immediately cease airway gases/ventilation and remove ETT Remove sponge and other flammable materials from the airway Resume bag-mask ventilation and prepare for reintubation once the airway fire is extinguished Examine the airway for evidence of debris, thermal injury, or foreign bodies and consider bronchoscopy 6.3 Anesthesia considerations for endoscopic sinus surgery Functional endoscopic sinus surgery is an effective, low-risk procedure for chronic rhinosinusitis, nasal polyposis, epistaxis control, tumor excision, foreign body removal, treatment of sinus mucoceles, and more. Anesthetic considerations include local versus general anesthesia, supraglottic airway devices versus endotracheal intubation, inhaled anesthesia versus TIVA, and the preferences of the surgical team while taking the patient’s comorbidities into account. The main goals are to provide a bloodless surgical field, patient immobility, stable hemodynamic conditions, and smooth emergence. Different techniques are utilized to induce “controlled hypotension” which reduces bleeding and improves the surgical visual field. However, this procedure has potential major complications which include orbital hematoma resulting in blindness or reduced vision, cerebrospinal fluid leaks, renal or arterial injury, severe hemorrhage, and death. 6.4 Anesthesia consideration for major oral and maxillofacial cancer surgery Because oral cancers are associated with smoking and alcohol excess, cardiopulmonary compromise and malnutrition are more common comorbidities. Moreover, airway difficulty can arise due to distortion of the airway by the tumor or as a consequence of radiotherapy. Surgery is typically performed using general anesthesia with tracheal intubation (preferably nasal ETT) and invasive hemodynamic monitors depending on the extent of the surgery and the patient’s comorbidities. Hypotensive anesthesia is encouraged to reduce blood loss. Long-acting paralytics should be avoided when electromyography is employed, TIVA is often a preferred anesthetic choice. The application of ERAS to major head and neck cancer surgery has led to other guidelines for perioperative management. 6.5 Anesthesia consideration for free flap transfer Tissue transfer in the form of a pedicled or microvascular free flap is commonly employed to reconstruct defects following H&N cancer resection . The graft may consist of soft tissues, bone, or both. Anesthetic management aims to maintain a full, hyperdynamic circulation with increased cardiac output, liberal fluid resuscitation, peripheral vasodilation, and normothermia to maximize flap perfusion. Hematocrit should be maintained at 30–35% to improve oxygen transfer and red cell velocity within the microcirculation. Vasoconstrictors are usually discouraged as they can contribute to graft ischemia. Intraoperative and postoperative flap monitoring is achieved clinically (by bedside examination of the flap color, temperature, turgor, edema, and capillary refill), and by using technical means such as Doppler ultrasound or near-infrared spectroscopy. 6.6 Anesthesia consideration for craniofacial surgery Craniofacial surgery addresses congenital or acquired deformities through cleft lip and palate repair, temporomandibular joint surgery, and orthognathic procedures. Obstructive sleep apnea and congenital airway deformormities is common in these patients. In general, nasal intubation is frequently preferred in orthognathic surgery. Submental intubation may be required if the nasal route is difficult or if the surgeon requires access to the upper portion of the face. In submental intubation, an incision is first made through the submental skin into the floor of the mouth. After routine oral intubation, the proximal end of the endotracheal tube is passed through the floor of the mouth out to the submental skin. The process is reversed at the end of the surgery and the patient is extubated orally. Bleeding is a potential risk that can be controlled by positioning the patient head up, ensuring free venous drainage, utilizing local anesthesia containing adrenaline, and utilizing controlled hypotension. Antibiotic prophylaxis, multi-modal analgesia, PONV prophylaxis, and steroids to reduce swelling are also important components of perioperative management. 7. Virtual endoscopy and 3-D reconstruction for airway evaluation in H&N pathology Preemptive imaging of the airway is a valuable aide to traditional clinical airway evaluation for strategizing airway management. The NAP4 highlighted that 40% of the patients with head and neck pathology developed airway related complications. These failures were attributed to shortcomings in airway evaluation, planning, and adaptations of airway and anesthetic techniques according to the patient’s pathology. Virtual endoscopy (VE) has been utilized by radiologists for many years to assess, identify, and stage the various lesions. VE utilizes multidimensional CT images to construct 3D endoscopic images at various sites from the nasopharynx to a tracheobronchial tree . VE enables computer-generated 3-dimensional portrayal of the airway cavity ( Figures 7 – 9 ). Virtual endoscopy is a valuable and safe tool as it provides a complete, non-invasive, and anatomically accurate portrayal of the patient’s airway, starting from nasopharynx or oro-pharynx to the tracheobronchial tree. The virtual airway can be reconstructed from the patient’s pre-existing diagnostic CT images using the OsiriX software [54, 55, 56]. VE can contribute significantly to preemptive strategies against the NAP4 highlighted shortcomings and help improve overall patient outcome. 8. The COVID-19 pandemic and head and neck surgery The novel coronavirus disease 2019 (COVID-19) has become a pandemic exposing many unprecedented challenges to health care systems. In head and neck procedures, health care staff are at a higher risk of contracting the virus as most examinations and procedures within the respiratory tract. Understanding how to mitigate the risks is critical. The British Otolaryngology Society and the American Society of Gastrointestinal Endoscopy recommended mandatory personal protective equipment (PPE) use, procedures performed in negative-pressure rooms, and thorough decontamination of endoscopes, equipment, and rooms. All non-urgent surgery should be deferred to prevent consumption of emergency equipment and avoid outpatients spread. Airway management strategies should include designating experienced providers, closing circuits, intubating in negative pressure rooms, applying rapid sequence induction techniques, and minimizing bag-mask ventilation. All standard airway equipments should be available including bag-masks with High-Efficiency Particular Air (HEPA) filters, video laryngoscopes with disposable blades, ventilators, and tubes with inline adapter, HEPA filter, and clamp for ETT for application during tube disconnection to avoid aerosolization . On the other hand, awake intubation should be avoided as coughing and bucking may promote aerosolization. THRIVE, jet ventilation, or open-circuit positive pressure ventilation are discouraged. Laser surgery or endonasal and otologic drilling should be avoided as viral particles can spread through plumes . 9. Conclusion Head and neck surgery involves a wide range of procedures from the simple to the complex. Thus, it poses greater challenges to the anesthesiologist; he/she must optimize the patient’s comorbidities preoperatively, share the airway, implement different anesthesia and airway techniques specific to each surgery, and manage postoperative airway complications. Head and neck surgery patients often present with difficult airways due to the pathologies which impede the airway anatomy. Therefore, preoperative planning necessitates thorough history and physical examination with particular attention to the airway evaluation. High-risk patients should be identified preoperatively and medically optimized before surgery. A multidisciplinary approach and expertise in H&N anesthesia and advanced airway management should be encouraged as it decreases airway complications and improves surgical outcomes. The preoperative endoscopic airway examination is a useful aide in providing a real-time image of the upper airway and allows adequate preparation. General anesthesia with total intravenous anesthesia (TIVA) is the anesthesia of choice as it offers quick titration of anesthesia, allows immobility, prevents postoperative nausea and vomiting, reduces blood loss by inducing controlled hypotension, and facilitates smooth and rapid emergence. Airway management planning also requires close communication and cooperation with the surgical team. Endotracheal intubation is a general considered in H&N surgery because it offers optimal airway control with adequate oxygenation, ventilation, and protection against aspiration. Video laryngoscopy is recommended in H&N surgery. Different ventilator techniques including jet ventilation should be considered in H&N surgery. Furthermore, multimodal analgesia, PONV prophylaxis, use of steroids to reduce airway edema, and antibiotic prophylaxis are essential components of intraoperative management. Enhanced recovery after surgery (ERAS) guidelines in H&N surgery should be applied. The decision to admit a patient in the critical care unit postoperatively is based on the patient’s comorbidities, intraoperative events, complexities of the surgery, and requirements for airway support. Recent advances in airway management techniques (such as virtual endoscopy) and surgical techniques have been shown to improve the outcome. Conflict of interest The authors declare no conflict of interest.

https://www.intechopen.com/online-first/principles-of-anesthesia-and-airway-management-in-head-and-neck-surgery

Introduction:Blepharoplasty, which is performed for either functional or cosmetic purposes, is one of the most common surgeries around the world. This procedure can be performed under either local or general anesthesia. It depends on the surgical indication, patient’s demand, surgeon’s plan, and need for auxiliary operations. It has been proved that both local and general anesthesia have different complications. Hypnosis is a skill by which hypnotherapists can make changes in perceptual experience and can be used instead of anesthetic drugs on some occasions. The present study was conducted to survey the effectiveness of hypnosis used as an alternative to anesthesia procedures. Case Presentation:A 54-year-old woman was scheduled for bilateral upper lid cosmetic blepharoplasty. Hypnotic anesthesia was conducted owing to her fear of anesthesia and drug-related side effects. Hypnotic anesthesia was accomplished by a hypnotherapist who was an anesthesiologist, and the operation was done without any surgical complications. Conclusions:Hypnosis may be a good alternative to local anesthesia and lead to a reduction in analgesics consumption. Keywords 1. Introduction Blepharoplasty, which is performed for functional or cosmetic purposes, is one of the most common surgeries around the world. It helps people get rid of excessive skin, which leads to symptoms such as circles around the eyes, droopy eyelids, or tired-looking eyes. Improvement in appearance and visual function is the best benefit of blepharoplasty with a great effect on persons’ quality of life (1). This procedure can be performed under either local or general anesthesia. It depends on the surgical indication, patient’s demand, surgeon’s plan, and need for auxiliary operations. Local anesthesia is preferable for simple upper or lower eyelid blepharoplasty, while general anesthesia or intravenous sedation is prescribed for more invasive procedures such as fat repositioning and mid-face lifting (2). It has been proved that both local and general anesthesia have different complications, and finding new strategies to reduce intra- and post-operative complications is one of the important challenges that need to focus on it (3, 4). Hypnosis is a skill by which hypnotherapists can make changes in perceptual experience. It can be used as an anesthetic procedure solely or in combination with local anesthesia in patients undergoing different surgeries. Recent studies have shown that one of the benefits of this approach is avoidance of general anesthesia and its potential complications that become apparent during or after surgery (5-7). Moreover, hypnosis has shown positive results for disease management and suitable effects on pain management for acute and chronic pain (8, 9). The medical use of hypnosis has been approved by the British Medical Association and the American Medical Association (10). Herein, the authors of this study present a case of bilateral upper lid cosmetic blepharoplasty that was successfully performed under hypnosis. 2. Case Presentation A 54-year-old woman was presented to an ophthalmologist for bilateral upper lid cosmetic blepharoplasty in Khatam Al-Anbia Hospital, Mashhad, Iran. The patient was offered to undergo local anesthesia, but hypnotic anesthesia was programmed because of her fear of anesthesia and drug-related side effects. It is worth mentioning that in this study, the hypnotherapist and anesthesiologist were the same person (the first author) and had experience over a decade in hypnotherapy. At a session before surgery, a clinical interview with the hypnotherapist was implemented to measure the hypnotic susceptibility in the patient by taking an arm levitation test. Written informed consent was obtained after a full explanation of the process and before the study. The day before the surgery, a preoperative visit and routine examination were done. She had no remarkable medical history, and examination showed no unexpected findings. In the operation room, the minimum standards for monitoring the patient during anesthesia were continuous electrocardiography, pulse oximetry, non-invasive blood pressure measurement. Moreover, a bispectral index (BIS) monitor was utilized to assess the level of consciousness. The BIS monitor is a quantitative EEG index that is utilized to measure the depth of anesthesia by analyzing the encephalographic signals (11). Sedative and local anesthetic drugs were accessible to use in case that the patient complained of pain. Hypnotic induction was accomplished through the eye fixation technique by using appropriate verbal stimulation. Suggestions were given for comfort, in which the patient had to imagine walking in a garden alongside her son and daughter. At the next step, when a deep hypnotic state (trance state) was maintained, surgery was started. The patient underwent bilateral upper lid cosmetic blepharoplasty with fat excision. Heart rate and blood pressure were stable throughout the surgery, and no remarkable changes were detected in comparison to the baseline level. The BIS score was 90 - 96 during the operation that indicates full consciousness. The mean heart rate and blood pressure were recorded 82 beats per minute (bpm) and 110 / 75 mmHg, respectively, before the operation. Both of them had a slight reduction in the normal range as the heart rate detected 75-80 bpm and blood pressure average 105 / 70 during the surgery (Table 1). The patient was kept in the hypnoidal state and talking with the hypnotherapist and surgeon throughout the operation. |Checked Time||Just Before the Operation||After 10 Min||After 20 Min||After 30 Min||After 40 Min| |Blood pressure||110 / 75||105 / 70||100 / 70||100 / 70||105 / 70| |Heart rate||82||77||75||78||80| |BIS score||96||93||90||92||94| The operation was terminated at 40 minutes, and at the end of the operation, conditioning was used to induce post-operative analgesia, and the patient was suggested to have no pain in the eyelids 48 hours after surgery. Bilateral upper lid cosmetic blepharoplasty was done without surgical complications, and the patient did not report any complications in the next days. The patient was monitored cautiously for 8 hours after the operation and was discharged under good general condition. The follow-up visits revealed no use of analgesics and full sedation postoperatively. The patient was visited on the day five and seven following the surgery and sutures were removed seven days after the surgery. As shown in Figure 1A, the patient suffered from excessive skin on both upper lids. Figure 1B displays the patient on day five following the surgery with no complications. On day seven, sutures were removed, and no complications were reported (Figure 1C). 3. Discussion Although numerous investigations have been conducted to clarify prognostic parameters of general anesthesia complications, unpredictable side effects occur and vary widely from benign to catastrophic (12). General anesthesia is a high-risk procedure for respiratory function impairment for the reason of using mechanical ventilation (4), while one of the most important benefits of hypnotic anesthesia is the lack of need for mechanical ventilation. Cognitive dysfunction and delirium are other post-operative complications of both general and regional anesthesia as consequences of the usage of anesthetic drugs (13). Local anesthesia also has its adverse reactions such as pain, edema, bruise, infection, hyperalgesia, and muscle Trismus due to needle penetration in the skin and some adverse reactions that are related to the complications such as local or systemic toxicity, allergic and idiosyncratic reactions (3). Lidocaine is widely used as an anesthetic choice for blepharoplasty because of a rapid onset of its effect (1.5 min), intermediate length of efficacy (1.5 - 2 h), and good toleration (14). However, allergic reactions to lidocaine are rising in prevalence because of the growing application of this group of medications or the possibility of re-exposure to various substances characterized by a similar chemical structure. This phenomenon makes the risk of using this agent higher for anesthesiologists in surgical procedures (15). Several studies have shown that hypnosis can change an individual's perception of pain and make a significant reduction in postsurgical pain intensity, the consumption of analgesics, and rates of post-operative pain in patients who underwent hypnosis during the entire surgical procedure (16, 17). A meta-analysis study revealed that patients who received hypnosis during the surgical operation had comparable advantageous outcomes rather than the others. It was revealed that the application of hypnosis in patients resulted in a significant impact on variables such as anxiety, pain, analgesic usage, recovery time, and treatment time (18). Hypnosis comes into operation by changing the activation and connectivity of neuromatrix areas related to pain, including the amygdala and thalamus, striatum ACC, putamen, insula, prefrontal cortex, parietal cortex, contralateral somatosensory, and premotor cortices. The analgesic effect of hypnosis may be due to the reduction in activation of ACC, striatal, and thalamic areas (7, 19). Based on the available scientific literature, there is no case of blepharoplasty surgery that has been done just by hypnosis and with no use of analgesics or anesthetics. There was only one article that surveyed hypnosis in blepharoplasty that had been combined with local anesthesia (20). The present study examined hypnotic anesthesia for blepharoplasty as an alternative to local anesthesia. The case presented herein is the first blepharoplasty procedure performed solely by hypnosis, and no type of local or general anesthesia was used. The patient was placed into a hypnotic trance before the surgery and maintained throughout the surgery by the hypnotherapist. The BIS monitor shows the consciousness level of a patient that is usually needed to maintain between 40 to 60 in general anesthesia. BIS score upper than 60 demonstrated light anesthesia, and as it approaches 100, it shows a completely awake state (11). In this study, the BIS scores of the patient showed that she was fully awake during the surgery; meanwhile, she was in communication with the hypnotherapist, and no sign of pain or discomfort (neither verbal nor facial) was expressed by the patient. In conclusion, hypnosis is a safe and cost-effective modality, especially when it is practiced by a well-trained, experienced, licensed healthcare provider and may be used as an alternative to local or general anesthesia (7, 21, 22). In this study, the surgery was performed successfully without any complications and with the advantage of no need for analgesia postoperatively as the patient reported the lack of pain. It is concluded that hypnosis is a good alternative to local anesthesia, and it may help reduce the consumption of analgesics. References - 1. Yang P, Ko AC, Kikkawa DO, Korn BS. Upper eyelid blepharoplasty: Evaluation, treatment, and complication minimization. Semin Plast Surg. 2017;31(1):51-7. doi: 10.1055/s-0037-1598628. [PubMed: 28255290]. [PubMed Central: PMC5330792]. - 2. Venkataram M. ACS(i) textbook on cutaneous and aesthetic surgery. 2nd ed. Jaypee Brothers Medical Publishers Pvt Ltd; 2017. 1600 p. - 3. Cherobin A, Tavares GT. Safety of local anesthetics. An Bras Dermatol. 2020;95(1):82-90. doi: 10.1016/j.abd.2019.09.025. [PubMed: 31952994]. [PubMed Central: PMC7058875]. - 4. Cui Y, Cao R, Li G, Gong T, Ou Y, Huang J. The effect of lung recruitment maneuvers on post-operative pulmonary complications for patients undergoing general anesthesia: A meta-analysis. PLoS One. 2019;14(5). e0217405. doi: 10.1371/journal.pone.0217405. [PubMed: 31141541]. [PubMed Central: PMC6541371]. - 5. Trujillo-Rodriguez D, Faymonville ME, Vanhaudenhuyse A, Demertzi A. Hypnosis for cingulate-mediated analgesia and disease treatment. Handb Clin Neurol. 2019;166:327-39. doi: 10.1016/B978-0-444-64196-0.00018-2. [PubMed: 31731920]. - 6. Fathi M, Ariamanesh AS, Joudi M, Joudi M, Sadrossadati F, Izanloo A. Hypnosis as an approach to control pain and anxiety in anterior cruciate ligament reconstruction and meniscal surgeries: Two case presentations. Anesth Pain Med. 2019;9(4). e89277. doi: 10.5812/aapm.89277. [PubMed: 31754607]. [PubMed Central: PMC6825366]. - 7. Facco E. Hypnosis and anesthesia: back to the future. Minerva Anestesiol. 2016;82(12):1343-56. [PubMed: 27575449]. - 8. Adachi T, Fujino H, Nakae A, Mashimo T, Sasaki J. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions. Int J Clin Exp Hypn. 2014;62(1):1-28. doi: 10.1080/00207144.2013.841471. [PubMed: 24256477]. - 9. Deltito JA. Hypnosis in the treatment of acute pain in the emergency department setting. Postgrad Med J. 1984;60(702):263-6. doi: 10.1136/pgmj.60.702.263. [PubMed: 6728748]. [PubMed Central: PMC2417820]. - 10. Hauser W, Hagl M, Schmierer A, Hansen E. The efficacy, safety and applications of medical hypnosis. Dtsch Arztebl Int. 2016;113(17):289-96. doi: 10.3238/arztebl.2016.0289. [PubMed: 27173407]. [PubMed Central: PMC4873672]. - 11. Mathur S, Patel J, Goldstein S, Jain A. Bispectral Index. StatPearls. Treasure Island (FL): StatPearls Publishing LLC; 2020. - 12. Cardinale JP, Gillespie N, Germond L. Complications of general anesthesia. In: Fox IIIC, Cornett EM, Ghali GE, editors. Catastrophic perioperative complications and management. Springer International Publishing; 2019. p. 95-103. - 13. Mason SE, Noel-Storr A, Ritchie CW. The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimers Dis. 2010;22 Suppl 3:67-79. doi: 10.3233/JAD-2010-101086. [PubMed: 20858956]. - 14. Presman B, Vindigni V, Tocco-Tussardi I. Immediate reaction to lidocaine with periorbital edema during upper blepharoplasty. Int J Surg Case Rep. 2016;20:24-6. doi: 10.1016/j.ijscr.2016.01.002. [PubMed: 26785079]. [PubMed Central: PMC4818292]. - 15. To D, Kossintseva I, de Gannes G. Lidocaine contact allergy is becoming more prevalent. Dermatol Surg. 2014;40(12):1367-72. doi: 10.1097/DSS.0000000000000190. [PubMed: 25380091]. - 16. Faymonville ME, Fissette J, Mambourg PH, Roediger L, Joris J, Lamy M. Hypnosis as adjunct therapy in conscious sedation for plastic surgery. Reg Anesth. 1995;20(2):145-51. [PubMed: 7605762]. - 17. Mauer MH, Burnett KF, Ouellette EA, Ironson GH, Dandes HM. Medical hypnosis and orthopedic hand surgery: pain perception, postoperative recovery, and therapeutic comfort. Int J Clin Exp Hypn. 1999;47(2):144-61. doi: 10.1080/00207149908410027. [PubMed: 10208075]. - 18. Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg. 2002;94(6):1639-45. doi: 10.1097/00000539-200206000-00052. [PubMed: 12032044]. - 19. Vanhaudenhuyse A, Boly M, Balteau E, Schnakers C, Moonen G, Luxen A, et al. Pain and non-pain processing during hypnosis: a thulium-YAG event-related fMRI study. Neuroimage. 2009;47(3):1047-54. doi: 10.1016/j.neuroimage.2009.05.031. [PubMed: 19460446]. - 20. Haskins C. Blepharoplasty under hypnosis: a personal experience. Plast Surg Nurs. 2001;21(3):143-5. 160. doi: 10.1097/00006527-200121030-00006. [PubMed: 12025039]. - 21. Fathi M, Hassani M, Jafari M, Joudi M, Habibzadeh R, Joudi M, et al. Hypnosis as an alternative to general anesthesia for orthopedic hand surgery: A case report. Annals of Anesthesiology and Critical Care. 2016;2(1). doi: 10.5812/aacc.17481. - 22. Kravits K. Hypnosis: adjunct therapy for cancer pain management. J Adv Pract Oncol. 2013;4(2):83-8. doi: 10.6004/jadpro.2013.4.2.2. [PubMed: 25031986]. [PubMed Central: PMC4093417].

https://brieflands.com/articles/ans-101882.html

Arthroscopy is a type of surgical procedure that involves inserting an endoscope into a joint through a small incision. This allows you to see the inside of the joint on the monitor for a more accurate diagnosis and carry out the necessary medical procedures. For this purpose, additional incisions (usually two or three) are made, through which surgical instruments are inserted. Shoulder arthroscopy – advantages Shoulder arthroscopy is one of the most popular procedures due to its numerous advantages, such as: - minor invasiveness, - minor scarring, - short hospital stay, - rapid rehabilitation, - the ability to quickly return to daily activities and physical activity. Indications for arthroscopy of the shoulder joint: - subbar pain syndrome with subbar calcaneal inflammation, - rotator ring rupture; - degenerative changes of the shoulder-clavicle joint; - free intraarticular bodies; - chronic synovitis; - shoulder instability; - damage to the upper articular bag, articular disc and biceps tendon; - shoulder frozen-overgrown inflammation of the joint bag. Course of arthroscopic surgery of the shoulder Arthroscopy of the shoulder joint is performed under general and splint anesthesia. The type of anesthesia is discussed by the anesthesiologist before the procedure. During the procedure, the patient is placed in a semi-sitting position or on a healthy side with his hand placed on a special lift. During the operation, the joint is filled with arthroscopic fluid. The procedure is performed through small incisions (“through the keyhole”) and all actions are observed on the monitor single sutures are applied to the postoperative wound, followed by dressing. After the procedure, the patient moves independently. The hand is placed in an orthosis or immediately begins rehabilitation. The next day the patient can be discharged home. Seams are removed after approx. two weeks after surgery. Postoperative recommendations: - The day after surgery, the patient should be provided with transport home. He should not drive or use public transport on his own. Follow the prescribed prescriptions and take your medicine as directed by your doctor. - Dressings should be changed as directed by your doctor, avoiding wetting the wounds. - A check-up is carried out at the appointed time, however, in case of the appearance of the severity of pain and swelling, leakage from the wounds or fever, you should contact your doctor immediately. - Recovery can last from 1-6 months. For 1-2 weeks, the use of a sling is usually required. - Exercises should be performed according to the given recommendations of the physiotherapist Shoulder injuries are a common problem and involve especially muscles, ligaments and tendons, not just bones. Shoulder problems are most common in athletes, where these problems can develop slowly, through repetitive and intense training and minor injuries (e.g. lifting weights, tennis or swimming), but also during the simplest daily activities such as hanging curtains, washing windows or painting walls, and in connection with other forms of work that require frequent lifting of the arms above the head. Complications and recovery Most patients do not experience the desired complications after the procedure. However, this is an operation, so as in the case of everyone there is a risk. Potential problems may include infection, excessive bleeding, blood clots, or damage to blood vessels or nerves. Recovery can last from 1-6 months. For 1-2 weeks, the use of a sling is usually required. Sometimes your doctor may recommend the use of painkillers, if necessary. Although the position during sleep does not significantly affect the healing process, most patients for the first few days after the procedure sleep in a semi-reclining or propped position. Return to work and sport: depends on the type of surgery and the degree of damage. Most often there is a period of time from 1 week to several months. Rehabilitation of the shoulder – Rehabilitation of the shoulder plays an important role in the recovery of full fitness. Exercises can usually begin in the first week after the procedure. The greatest emphasis is placed primarily on strengthening and stretching exercises.

https://www.internationalshoulderjournal.org/shoulder-arthroscopy/

At METAS Adventist Hospitals, we provide a comprehensive range of clinical services, including perioperative anesthesia services, critical care medicine, and pain medicine. Our patients receive advanced medical care provided by highly trained and skilled clinicians. Our philosophy has always been to work with a multidisciplinary team approach. The Department of Anesthesiology is the premier department in the country for the practice of general and regional anesthesia. The foundation of this department is the clinical skill of our anesthesiologists who have received training and accomplishments from the best institutes around the world. We have a dedicated team of more than fifteen senior anesthetists who along with their associates & junior staff provide round the clock service. The anesthetists are helped by the state of the art anesthetic equipment. Services provided also include preoperative checkups and post-operative pain management team and a critical care team. General Anesthesia Anesthesiologist (Anesthetist) The hospital has an organized acute pain relief service using: Types of anesthesia provided depend on the patient’s medical status and type of procedure – General Anesthesia – Patient is not consciousRegional Anesthesia – Local anesthetic is injected by anesthesiologist to provide numbness in certain part of body. This could be used for pain control during/after procedure. MAC (Monitored Anesthesia Care) – Monitoring care of vitals during a procedure, may involve sedation if necessary. The anesthesiologist will meet the patient prior to the surgery and discuss the medical history, lab results and anesthesia plan. In the O.T a member of the anesthesia care will be with the patient throughout the procedure. After the procedure patient will be moved to the recovery room and a nurse will monitor the patient and provide medication to minimize pain, nausea and vomiting as needed. Then the patient will be discharged from recovery room on advice by anesthetist when he is stable and comfortable.

https://ranchihospital.metasofsda.in/centre-of-excellence/Anesthesiology

This article is a portion of a book titled "Challenges, Risks and Opportunities in Today's Spine World "edited by Stephen Hochschuler, MD, Frank Phillips, MD, and Richard Fessler, MD. You can find links to the previous chapters at the end of this article. Over the next several weeks, we will be looking at various spine care models around the US. In the next two chapters we will be looking at the HSS model. In the previous chapter we looked at the structure for Hospital for Special Surgery’s (HSS) non-operative management of low back pain, spine imaging and medical preoperative evaluations. In this chapter we will discuss the remaining relevant disciplines. Anesthesia Care: Ellen Soffin MD, Dedicated Spine Anesthesiologist. At HSS, anesthesia care teams are composed of an attending anesthesiologist, associate anesthesia providers (nurse anesthetists) and/or residents and fellows in anesthesiology. However, the spine service is attending-led, and the majority of cases are performed by a solo attending anesthesiologist. The attending anesthesiologist is present with the patient throughout the entirety of their care starting with a preoperative evaluation and ending with transfer to PACU. During the pre-anesthetic evaluation, the patient’s current state of health and the nature of the planned surgery are carefully considered. This phase of care allows the anesthesiologist to tailor a safe, effective anesthetic. We liaise closely with colleagues from medicine, radiology, the pain services and surgery to ensure all appropriate pre-operative testing is complete and the patient is optimized for surgery. Special consideration is given to the airway, particularly in cervical deformity cases. Planning for intraoperative airway management requires broad pre-operative decision making, from selection of specialized equipment, likefiberoptic or glide scope intubating tools, preparation of the patients for possible awake intubation, and referral to an otolaryngologist for consideration of a surgical airway. Spine anesthesia at HSS differs from other orthopaedic disciplines in that regional blocks are not routinely used. The exception to this is the TAP (transverse abdominus plane) block for procedures with an anterior or lateral approach. This block has been shown to decrease the opioid requirements and improve post-operative pain control in patients undergoing antero-lateral fusion procedures. Our emphasis on opioid-sparing multimodal analgesia with regional techniques is unique to spine care at HSS and contributes to positive outcomes after surgery. TIVA (total intravenous anesthetic) is used routinely and consists of a combination of sedatives and hypnotics, which when used in combination, lower the total requirement of any individual agent. Medicines such as dexmedetomidine hydrochloride, lidocaine, propofol, ketamine, methadone and remifentanil are the most commonly used. Titrating these compounds helps achieve hemodynamic and anesthetic goals, as well as to optimize perioperative analgesia in chronic opioid dependent patients. Dexmedetomidine hydrochloride is particularly useful as it tends to facilitate close control of blood pressure. Dexmedetomidine hydrochloride in combination with ketamine are useful in the opioid-tolerant patient to decrease opioid requirements intraoperatively. Finally, dexmedetomidine hydrochloride and ketamine are occasionally used for post-operative pain control in the opioid-tolerant patient population. Frequently, the role of the anesthesiologist ends at the time of PACU admission. However, anesthesia care also can extend well into the postoperative period. Members of our dedicated spine care for patients admitted to the Orthopedic Special Care Unit (OSCU) for ongoing resuscitation, blood transfusion, pulmonary and ventilator management and stabilization, as needed. The acute pain service also has representation from anesthesiologists on the spine service. Pain management is a key aspect of recovery after spine surgery and is coordinated by the primary anesthesia team and the acute/chronic pain services, and ultimately transition care back to the surgical team. Our pathways of care emphasize multimodal, opioid-minimizing analgesics which enhance recovery and promote return to independence. Surgery: Todd Albert MD, Surgeon-in-Chief. During spine surgery there is an emphasis placed on a systematic approach to patient safety. All patients undergo a pre-induction time out prior to anesthesia with the attending anesthesiologist. Following this, a standard time out procedure is completed with introductions of all team members, identification of the patient, procedure and surgical levels as well as confirmation of preoperative medications. At this point communication is completed between the surgeon, neuromonitoring, and anesthesiologists regarding the treatment plan. Our motto is “see something, say something” highlighting the expectation that all members of the care team should speak up if they notice something that they feel requires attention. Finally, after the completion of the surgery a debrief is performed where the case is reviewed. During the debrief the plan for post-operative care including pain management is reviewed by the surgeon, fellow and anesthesiologist. At this point all team members have the opportunity to voice any special concerns for the patient. The parts of the case which went well as well as areas for improvement are briefly reviewed. The appropriate care pathway is reaffirmed based on preoperative recommendations from medical team. In this fashion, all participants are on the same page regarding the patient care plan, and communication is optimized. Physician Assistant Spine Team: Mary-Ellen Zullo PA, Andrew Koo PA. At HSS there is a strong physician assistant (PA) team which supports the spine service. This team is divided into specialty care groups which include a PA team responsible for preoperative history and physicals, operative assistance to surgeons and floor management. The team system allows the physician assistants develop expertise in one area of spine patient care which streamlines the patient’s course through the hospital. For example, there is a team dedicated to interviewing the patient preoperatively and acting as a final check for things which may have been missed through the extensive preop evaluation. Following this there is a dedicated team of operative PAs that works with the surgeons in the operating room and facilitate a smooth operative course. Finally, the patients are managed by a team of floor PAs experienced in post-operative spine care. Nursing and ancillary care: In addition to the PAs there is a robust nursing culture at HSS which focuses on customer service, safety and patient care. Patients are cared for by an individual nurse who is backed up by a team of nurses such that patient needs are always tended to immediately. In addition, patients are preemptively asked about their comfort level, if they would like to get out of bed, and what their food preferences are, etc. Nursing teams then meet as part of a multidisciplinary rounds which includes the PA teams, nursing, nutrition, and physical therapy twice a day. During these rounds, each individual patient course is discussed and changes are made as needed to ensure the most efficient and quality care. Quality and Value Oversight: Cathy MacLean MD/PhD, Chief Value Officer. The overarching governing principle of the spine model at HSS is based on value—that is, providing the highest quality of care at the lowest possible cost. Quality is based first on safety, but more importantly whether or not patients are actually improving. This has been measured by instituting a PROMs (patient reported outcome measures) initiative, which is controlled by a steering committee at HSS. As a part of standard of care, every patient gets two validated measures: a general health PROM (the PROM-10) and spine specific measure (i.e the Oswestry Disability Index—ODI or NDI). Every patient is measured again at 6 months. This information is fed back to providers to help improve treatment processes. Minimal clinical improvement—or the smallest change in PROMs that can indicate a successful treatment— is also being researched heavily at HSS to help use PROMs in a more informative way. Safety is a critical component to ensuring value in spine care. This starts with the goal to perform the correct surgery the first time while keeping the chance of failure, readmission or complication low. Appropriateness of surgical procedures at HSS are based on the highest quality evidence-based medicine. In areas where literature may be lacking panels consisting of a collective group of doctors are held to determine the appropriateness of procedures. In this regard, unnecessary procedures are minimized. Safety review panels also meet regularly to discuss protocols to minimize things such as infection, thrombosis, and readmission. Conclusion: The HSS spine model functions because of the collaboration between many medical practitioners and systems each doing their part to ensure the patient is treated as safely and effectively as possible. The system is a work in progress and panels of physicians and administrators are continually making changes to improve quality, safety and efficiency. HSS is a dedicated orthopaedic hospital, and while there are many different specialties, collaboration between groups are always centered on the care of the musculoskeletal system. This fosters a unique collegiality which helps drive science and improve patient outcomes. Previous chapters:

https://www.beckersspine.com/spine/item/44200-the-hss-spine-care-model-part-2.html

The reversible and controlled induction of loss of motor and sensory function through the injection of local anesthetics into the epidural space is referred to as epidural anesthesia. This mode of anesthesia can be administered via an injector or catheter. The latter allows for the continuous addition of the local anesthetic throughout a surgical procedure and after it, to relieve postoperative pain as well. Surgical procedures below the level of the umbilicus are prime indications for epidural anesthesia. These include, but are not limited to, Cesarean section, repair of hernias, orthopedic operations involving the lower extremities, as well as gynecological and genitourinary procedures. Epidural anesthesia is a procedure that is fairly easy to perform and, in most cases, highly reliable with regard to the extent and control of anesthesia. In contrast to general anesthesia, there is no respiratory depression and the patient maintains spontaneous ventilation without the need for mechanical assistance. Furthermore, and in comparison to general anesthesia, studies show that there is a decreased incidence of complications, such as thrombosis of the deep veins and/ or the formation of pulmonary emboli, with epidural anesthesia. Additionally, patients often experience a faster recovery with regard to the functioning of the gastrointestinal system. Among the disadvantages, epidural anesthesia has a slower onset and typically requires a larger dose for the onset of action than its spinal counterpart. This means that it is imperative to monitor dosage, because toxicity can more easily and inadvertently occur with epidural anesthesia. Likewise, the rate of failure to achieve anesthesia is higher with epidural than it is with spinal anesthesia. Some patients may experience headache based on their position following management with epidural anesthesia. This may occasionally require further treatment to speed up the resolution process. Another minor complication is post-epidural discomfort, which is injection-site specific. This is generally self-limited and resolves quickly. Epidural anesthesia is given to an expectant mother during the process of labor and the delivery of the baby if desired. It is the preferred method in women who are in premature labor or those who are suffering from preexisting morbidities such as hypertension. Epidural anesthesia is safe for both the mother and the child. The local anesthetics are injected into the epidural space, with the help of bony vertebral landmarks, during the active stage of labor. These agents block pain signals from being transmitted to the brain. Within a few minutes, the parturient (i.e. the woman in labor) no longer feels any pain associated with labor. Local anesthetics are re-administered as necessary through a catheter indwelling the epidural space if the duration of the labor is prolonged. Once the baby has arrived, the epidural catheter is removed and the anesthetic effects typically wear off within an hour or two. Many patients may experience burning at this time around and inside the birth canal.

https://www.thailandmedical.news/pages/health/epidural-anesthesia

Slipped Disc Surgery A slipped disc occurs when the soft gel-like tissue between the bones of the spine is moved out of place and starts pressing on adjacent nerves. In most cases, slipped discs are caused by wear and tear or trauma to the spine. This condition is also known as herniated disc, ruptured disc, or prolapsed disc. The most common affected area is the lower back, but many discs along the spine can slip, including those in the neck. While the majority of cases don’t call for surgery, severe cases or when there is evidence of muscle malfunction, surgery may be needed. When Is Slipped Disc Surgery Done In many cases, slipped discs can get better with conservative treatment and time. If conservative treatment is not effective, spine surgery may be necessary. Surgery may also be a viable option if symptoms like lower back pain, numbness in shoulders, arms, or legs, unexpected muscle weakness, and problems bending or twisting your back are severe or worsen over time. Slipped disc surgery may involve the removal of the portion of the disc pressing on the nerves or nerve roots, along with other procedures. Traditional Open Back Surgery and Spinal Fusion for Slipped Disc “Open” spine surgery is the traditional surgical approach to treating a slipped disc. There are many disadvantages and risks associated with this type of procedure. In this approach, a surgeon creates space by removing the part of the vertebra- that lamina- that covers your spinal canal and/or part of the disc. This procedure enlarges the spinal canal and relieves pressure on the spinal cord and the nerves that pass through it. Traditional open spine surgery has a long recuperation time due to extensive dissection of muscles and tissues to access the area. Spinal fusion surgeries use bone grafts and/or hardware to permanently “lock” together two or more vertebrae for the purpose of making a section of the spine thought to be producing pain symptoms immobile. After a fusion surgery, the patient will likely lose the ability to move his/her spine at the level where the procedure was done. This puts extra pressure on adjacent vertebrae, forcing the intervertebral discs to breakdown, which can lead to a condition known as adjacent segment disease. Traditional open back surgery and spinal fusions often require an extensive dissection of muscle tissue, several days of hospitalization, and an often painful and long recovery. Failed back surgery syndrome is common in traditional open back surgery and spinal fusions with about 60% of patients experiencing failed back surgery symptoms. The Bonati Spine Institute strongly recommends against open spine surgery and spinal fusions and implants, since these procedures result in high failure rates. The Bonati Spine Procedures for Slipped Disc The Bonati Spine Procedures are safe and effective alternatives to traditional open back surgery and spinal fusions. The Bonati Spine Procedures have been shown to be highly effective in decompressing the nerves without fusions to treat spinal conditions and very successful in avoiding adjacent segments disease. The Bonati Spine Procedures do not require general anesthesia. Using conscious IV sedation and local anesthesia, the patient is comfortable, and responsive and maintains the ability to provide feedback to the surgeons throughout the procedure. The procedures are outpatient and no hospital stay is necessary. There is a short recovery time and patients are able to get back to their normal daily activities within days. The goal of slipped disc surgery is to alleviate the pain and resolve the underlying problem. The Bonati Spine Institute offers an array of procedures to treat a slipped disc, which may include: Discectomy This is perhaps the most common surgical approach to treat slipped discs. A small incision is made and a series of tubes are inserted to view the surgical area using endoscopic assistance. A portion of the herniated disc is removed to release pressure from the spinal nerves and/or spinal nerve roots. Laminectomy/Laminotomy A laminectomy is a decompressing surgery that relieves pressure on the spinal nerves. This procedure is performed one vertebral level at a time, to address the primary cause of the pain first. A laminectomy is performed through a small opening through which a series of tubes are introduced to accommodate surgical tools and imaging equipment. The lamina is then accessed through an arthroscope, and small portions of the lamina are removed to release the pressure from the spinal nerves. Foraminectomy Foramina are small openings present between every pair of vertebrae in the spine. If a part of the foramen is pressing on a nerve as it leaves the vertebral opening, a Foraminectomy may be performed. This procedure uses local anesthesia and conscious IV sedation to allow surgeons to target the source of the pain with precise accuracy. The tissue compressing the nerves is removed with a set of surgical instruments inserted through a very small incision. Before Surgery It is important to be in your best physical and mental health possible before a surgery. To assure this, maintain a healthy diet and exercise routine. Before any surgery, you may be asked to stop taking certain medications, and stop smoking. Medications to avoid include: - Advil - Anaprox - Coricidin - Aspirin - Excedrin - Ibuprofen - Naprosyn - Voltaren Make sure you have a companion who can drive you and stay during the surgery and the first night. Pack loose-fitting, comfortable clothing, preferably something that can be zipped or buttoned. During Surgery During surgery general anesthesia is not used, instead, local anesthesia and conscious IV sedation are used by the surgical team. With this approach, the patient is responsive, comfortable, and able to provide feedback to the doctors throughout the procedure without feeling any pain or discomfort. While in the operating room, the surgical team will confirm the patient is able to complete a series of mobility exercises and verify that the pain has been successfully treated. After Surgery After the procedure, the patient is transferred to postoperative care for rest and observation. Later on a postoperative consultation will determine if additional procedures are necessary. During this time, most patients are given a walking regimen schedule to start the healing process. Recovery Time from Slipped Disc Surgery Recovery time after slipped disc surgery varies from patient to patient. Every patient, every slipped disc, every circumstance is different. The Bonati Spine Procedures allow for faster recovery so most patients resume their everyday life within days. The success rate for slipped disc surgery is generally high. Patented Bonati Spine Procedures have a 98.75% patient satisfaction rate. Our procedures offer a lower risk of complications and infections by limiting the damage to surrounding areas.

https://www.bonati.com/conditions/slipped-disc/surgery/

The latest, "State of the Art Treatment" for Osteoid Osteoma is PERCUTANEOUS RADIOFREQUENCY ABLATION (also known as RFA). This is a minimally invasive procedure that is performed under a CAT Scan, usually by a highly specialized musculoskeletal radiologist, in which a needle or probe is inserted into the lesion and the lesion is heated and destroyed. The CAT scan is utilized to localize the Osteoid Osteoma so the needle can be guided directly into the tumor. It is an outpatient procedure. The patient goes home the same day. It is minimally invasive and therefore only a small stab incision or poke hole is made for the needle. The procedure does require that the patient be put to sleep with general anesthesia because insertion of the needle into the Osteoid Osteoma is very painful. The patient must also lie motionless during the procedure. The procedure is greater than 90% effective. This is the same success rate as with actual surgical removal. The pain from the osteoid osteoma is usually relieved within 1 day. Often in the recovery room after the procedure, the patient will say that the pain from the tumor is gone. There is full use of the leg or arm and return to normal activities the following day. There is virtually no blood loss and very little risk (less than 1% risk) of developing an infection after the procedure. Less than 10% of the time the procedure needs to be repeated or the patient requires a surgical procedure to remove the tumor. You can view the procedure by clicking here.

http://tumorsurgery.org/news/all-news/tabid/186/articleType/ArticleView/articleId/170/What-is-a-Percutaneous-Radiofrequency-Ablation-aka-RFA.aspx

Art by Ally Armstrong In today’s world, disagreements are not hard to come by. The “United” States of America seems to be more of a sentiment of the past than a reality of today. Conflict is exhausting, and it is tempting to insulate oneself from disagreement simply for the sake of sanity. There is a growing need, however, for people to do exactly the opposite of what this urge is telling them. People need to come into contact with points of view that differ from their own because this fosters empathy and facilitates compromise, according to the Harvard Business Review’s article “If You Disagree With Someone, Try Listening, Not Arguing” published Sept. 3, 2015. Students in particular have a responsibility to engage in mindful exposure to various opinions. One way that students can come into contact with diverse opinions is through social media. Using discretion, students should find people or media outlets that will expose them to ideas that they do not agree with. Some credible media outlets that students should investigate include The New York Times, The Washington Post, NPR, the National Review, and the American Conservative. It is tempting to hit “unfollow” when something disagreeable shows up on one’s feed, but instead students should try to seek out thoughtful — not belligerent —disagreement, according to Catherine Clifford’s article “Billionaire Ray Dalio: Here are ‘the most valuable 3 minutes of thoughts that I could possibly share'” published by CNBC on June 22. This intentional engagement will equip students with a deeper understanding, not just of the other opinion, but also of their own, according to Zachary Wood’s TED Talk “Why it’s worth listening to people you disagree with” given in April 2018. When he left office, President Barack Obama said, “If you’re tired of arguing with strangers on the internet, try talking with one of them in real life.” It is valuable for students to spend time face-to-face with someone with different perspectives than themselves. College is an invaluable opportunity for these interactions. For example, last year Pepperdine invited Ben Shapiro to speak on campus. While many students in attendance did not align themselves with Shapiro’s opinions, they were able to engage in a respectful conversation with him. This sort of discourse can be hard and uncomfortable, but it has enormous value. Without exposure to other points of view, people find themselves in “echo chambers” where there is little room for ideological growth, according to Joan Blades’s and John Gables’s article “We Should All Speak to People We Don’t Agree With” published by the Aspen Institute on May 18. Furthermore, when students insulate themselves from differing perspectives, they risk reducing the other side to a single designation. This serves to perpetuate hatred and misunderstanding according to the article “Is it wrong to unfriend or unfollow people I disagree with?” published by the Guardian on March 24, 2017. Most of the time, listening to different perspectives will not change someone’s mind. It will, however, change the way that she or he views the other side. By thoughtfully engaging with people who have different opinions, political or otherwise, students will more easily recognize the common humanity that underlies them all, according to “If You Disagree With Someone, Try Listening, Not Arguing” published by the Harvard Business Review on Sep. 3, 2015. In the “Analects,” Confucius is reported to have said, “A gentleman can see a question from all sides.” When students are exposed to opinions that differ from their own, they become more mature and understanding individuals. If a student wants to be heard, it only makes sense that he or she should also be willing to hear.

https://pepperdine-graphic.com/encounter-different-perspectives/

Civil rights is an ever changing concept. Since the very founding of our country, this movement, or series of movements, has been a foundation on which people raise their flags and rally. As society is ever evolving, so is our definition of civil rights. 50 years ago tomorrow the Civil Rights Act of 1964 was passed. Title VII of this revolutionary act is recognized, and in many cases memorized, by HR departments everywhere. It made it unlawful for any employer to “fail or refuse to hire or to discharge any individual, or otherwise to discriminate against any individual with respect to his compensation, terms, conditions, privileges or employment, because of such individual’s race, color, religion, sex, or national origin.” This act was a revolution but only one step in a continuous process; civil rights is an ongoing conversation. Today debates continue about gender, sexual orientation, relationship status, and so many other issues. If you work in HR, or are looking to hire, awareness is your first step towards success. Since the Civil Rights Act, there have been several other legal actions on the topic of discrimination in the workplace. They include: - Age Discrimination in Employment Act of 1967 - Pregnancy Discrimination Act in the 1970s - Americans with Disabilities Act of 1990 - Civil Rights Act of 1991 These acts cover several different kinds of protected classes but have not ended the controversy. Wage inequality for women and minorities and discriminatory hiring based on sexual orientation are only a few of the issues still being debated today. Opinions, regulations, and laws regarding these issues differ in each state. The landscape of civil rights is ever changing as regulations evolve to meet new challenges in civil rights. Your job is to be aware of these changes and adapt accordingly. What exactly does this mean for HR? Civil rights issues are topics of controversy that directly affect your HR department. Because the government can’t police everyone, much of the responsibility for equality falls on companies and HR departments. For this reason your company needs to be aware of recruiting a diverse workforce, not just to keep with regulations, but also because of the different skill sets and perspectives employing a diverse population presents you. Companies that hire diversely are opening themselves up to talent they may miss out on otherwise. The key to reaching a diverse population is instituting a diverse recruiting strategy and ensuring fair treatment in the workplace. This includes being aware of the laws and regulations in your state, focusing on hiring diversly, putting in place diversity training for management, putting in place diversity training for employees, and stressing the importance of respect to all employees. An example of a company that is doing exceedingly well hiring diversely is AT&T. Here is a breakdown of their diversity strategy: - Hiring from a variety of backgrounds - Providing an inclusive work environment by offering performance-based rewards - Making their senior leaders accountable for leading diversity initiatives - Creating the role of ‘Chief Diversity Officer’ - Utilizing diversity training AT&T knows having a diverse workforce is critical to their success, so they specifically seek out employees who present a variety of perspectives. Focusing on diversity education may be the key to reaching that goal of equality that was started with the passing of the Civil Rights Act in 1964. A simple way to do this is looking into implementing or improving your diverse hiring and culture-building strategy. The passing of the Civil Rights Act was a predominant moment in our history, one of many such moments that have taken place since and are still to come. If you want to protect your company from legal action and ensure that you are recruiting the best talent in the market, it is vital that you are aware of the ever-changing civil rights landscape. Responsibility for diversity falls on everybody, but it starts with HR.

https://www.opensesame.com/site/blog/modern-civil-rights-debates-what-they-mean-hr

What is this for? Facilitating groups of people to solve challenges together is an important part of innovation. This guide will help you understand exactly how to build diversity in collaboration, innovation and decision-making. Mindset and core principles Collaboration can have a limited impact if the people who are collaborating have similar perspectives and backgrounds. Overview Collaboration should include individuals with a broad range of characteristics, backgrounds, skills and experiences. There is greater opportunity for more impactful ideas and, as a result, better business outcomes. Realizing the potential of diverse perspectives The MBM Guiding Principles, in particular Knowledge, Humility and Respect, provide a framework that encourages appreciation of the value of diversity and can help us realize our objectives by enabling employees to contribute to the fullest extent of their abilities. The benefits from a diverse workforce may not occur automatically. Obstacles to realizing diversity’s potential could limit openness to new ideas. Further reading: MBM: The Value of Diversity Knowledge When we accept we don't (can't) possess all the knowledge ourselves, we are able to invites others in to build greater shared knowledge, together. Humility It's common to feel pressure to impress, to achieve, and to show we can solve problems. But when we are humble enough to accept we might be wrong we open a door to inspiration and innovation. Respect ...is a conscious choice to give due regard to the feelings, wishes, or rights of others. Allowing other's opinions to challenge us is the key to learning and enabling breakthroughs. When like meets like, there is no creative spark; but when like collides with unlike, there is often a small frisson of inspiration. - Gary Hamel A practical guide to including diverse perspectives "Companies with inclusive talent practices generate up to 30 percent higher revenue per employee and greater profitability than their competitors" - Deloitte Insights Step 1: Seek out diversity When starting any new project, innovation initiative, or workshop: - Seek out a variety of mindsets (even opposing ones) - Seek out different roles and levels to participate: - A manager ... and a junior employee - A veteran ... and a new recruit - A sales person ... and customer support person ... AND a customer! Step 2: Check yo'self with key questions At any point in your project (recommended monthly) ask yourself a few simple questions to expose any potential biases or blind-spots. - Is there any person or team I haven't thought about that could be worth including? - Am I avoiding asking someone to join because their perspective might differ from mine? - Can I avoid conflict (or roadblocks) later by bringing someone in earlier? Step 3: Test your ideas with diverse groups This is a crucial step. Becoming locked in to our ideas is one of the most common causes of failure. If someone could become a blocker for your idea down the line, try including them in the process and tackling the challenge head on. "The more tests your team runs, the more ideas they should get for new tests." - Harvard Business Review Steps: - Before you get too far ahead, mock-up your ideas (e.g. a draft doc, concept sketch, slide deck...) - Schedule a 30 min meeting with 2-3 people (or more) from adjacent teams / groups. Take action now Think of an initiative you are working on right now. Ask yourself these questions and see if there's anything you might do differently: Additional Resources Recommended reading Additional Resources Related Tools - (divergent thinking)What is Design Thinking?

https://toolkit.advanceconcepts.co/1b765db6569c46a0ae83e52d1eaa1205

Welcome to Edition 8 of the STEWARDSHIP MATTERS magazine, our regular review of Martin Currie’s work in the stewardship and ESG space, and our insight into future trends. This quarter, we have specifically focused on the important topic of Diversity and Inclusion (D&I), whether it be gender, cultural, generational, ethnic, socio-economic or any other diversity measure. In this edition, we cover: - The increasing evidence of a positive link between greater corporate focus on D&I and financial performance; - The commitment Martin Currie has taken as a firm to becoming a truly diverse, inclusive, and equitable company, and the progress we are making towards our targets; - The current state of play when it comes to how companies and countries are tackling with improvements in D&I globally, and what good looks like; - Recent engagements undertaken by our investment teams where D&I and its impact on corporate culture and customers have been the key focus; and - The need for increased transparency across all diversity measures, and the role investors have in contributing to better outcomes in this space. Supporting diverse talent in our industry is vital. Not only does a diverse workforce bring new ideas, perspectives and skills that help businesses thrive and be more resilient, it also helps our industry better reflect the investors, communities, and people we serve. Regulatory information and risk warnings This information is issued and approved by Martin Currie Investment Management Limited (‘MCIM’), authorised and regulated by the Financial Conduct Authority. It does not constitute investment advice. Market and currency movements may cause the capital value of shares, and the income from them, to fall as well as rise and you may get back less than you invested. The information contained in this document has been compiled with considerable care to ensure its accuracy. However, no representation or warranty, express or implied, is made to its accuracy or completeness. Martin Currie has procured any research or analysis contained in this document for its own use. It is provided to you only incidentally and any opinions expressed are subject to change without notice. The document does not form the basis of, nor should it be relied upon in connection with, any subsequent contract or agreement. It does not constitute, and may not be used for the purpose of, an offer or invitation to subscribe for or otherwise acquire shares in any of the products mentioned. Past performance is not a guide to future returns. The views expressed are opinions of the portfolio managers as of the date of this document and are subject to change based on market and other conditions and may differ from other portfolio managers or of the firm as a whole. These opinions are not intended to be a forecast of future events, research, a guarantee of future results or investment advice. Please note the information within this report has been produced internally using unaudited data and has not been independently verified. Whilst every effort has been made to ensure its accuracy, no guarantee can be given. The information provided should not be considered a recommendation to purchase or sell any particular strategy/fund/security. It should not be assumed that any of the security transactions discussed here were or will prove to be profitable. The analysis of Environmental, Social and Governance (ESG) factors forms an important part of the investment process and helps inform investment decisions. The strategy/ies do not necessarily target particular sustainability outcomes.

https://www.martincurrie.com/insights/stewardship-matters-edition-8-the-power-of-diversity-and-inclusion-in-investing

What is Balanced Representation? Organizers seek to achieve balance in meetings by ensuring people representing differing opinions, perspectives, and interests all have an opportunity to participate. Balance is a requirement for many non-profit and public sector meetings, where organizers must actively seek to include participants who represent diverse interests. For example, an organization working to create safety standards will include people who represent for-profit companies, government agencies, non-profit associations, and consumer groups in their committee meetings.

https://www.lucidmeetings.com/glossary/balanced-representation

Yale, other schools file brief supporting diversity in college admissions Yale has joined 15 other universities and colleges in filing an amicus (friend of the court) brief in a case about the legality of Harvard University’s whole-person admissions process. Students for Fair Admissions sued Harvard in 2014, alleging the school’s undergraduate admissions practices violate Title VI of the Civil Rights Act of 1964. The amicus brief was filed July 30 to support the argument that a diverse student body remains essential to the universities’ educational missions, that individualized, whole-person review of applications is necessary to achieve that diversity, and that race-blind admissions would preclude the schools from achieving the type of diversity that advances their educational missions. The brief supporting Harvard emphasizes the profound importance of a diverse student body. The schools maintain that the diversity they seek in their admissions policies is nuanced and multifaceted, and it encompasses a diversity of perspectives, experiences, goals, backgrounds, races, ethnicities, and interests. These schools strive to enroll a diverse student body because in their substantial experience, they have found that doing so significantly deepens the students’ educational experience both inside and outside the classroom. Because the schools are all residential institutions, they each strive to create a learning environment that fosters student interactions in residence and dining halls; in performance, artistic, athletic, and recreational spaces; in student organizations and activities; and throughout their campuses. According to the brief, a university may be the first place in which students are exposed to others whose experiences, opinions, faiths, and backgrounds differ substantially from their own. “Through that exposure, students are encouraged to question their own assumptions and biases and to appreciate the full texture of our society and the world,” the brief states. “This larger understanding prepares graduates of these institutions to pursue innovation in every field of discovery, to be active and engaged citizens equipped to wrestle with the great questions of the day, and to expand humanity’s learning and accomplishment,” the schools argue. The plaintiffs in the Harvard case suggest that whole-person review should be conducted without regard to race, but the brief argues that a “race-blind” version of whole-person review would defeat the purpose of a truly individualized assessment for many applicants. The schools assert that “it is artificial to consider an applicant’s experiences and perspectives while turning a blind eye to race. For many applicants their race has influenced, and will continue to influence, their experiences and perspectives.” The schools say that no mechanical formula can capture the breadth of experiences, interests, and viewpoints that the schools seek in their applicants. The brief asserts that a decision by the Court forbidding all consideration of race in the admissions process would compromise the schools’ efforts to attain diverse student bodies, and would be inconsistent with the letter and spirit of the Supreme Court’s jurisprudence, which has for decades upheld whole-person admissions policies. “In light of the momentous interests at stake,” the schools urge the court “to affirm the right of educational institutions to structure admissions programs that appropriately consider race and ethnicity within the context of an individualized and holistic review.” The other schools that joined in the amicus brief are Brown University, Case Western Reserve University, Columbia University, Cornell University, Dartmouth College, Duke University, Emory University, George Washington University, Johns Hopkins University, Massachusetts Institute of Technology, Princeton University, Stanford University, University of Pennsylvania, Vanderbilt University, and Washington University in St. Louis.

https://news.yale.edu/2018/07/31/yale-other-schools-file-brief-supporting-diversity-college-admissions

Different ways of thinking are generated by bringing together individuals with varied backgrounds, experiences, passions and points of view. To deliver high performance and positive influence for our clients, we deliberately seek, support and celebrate the diversity of our employees in all forms – including gender, race, ethnicity, disability, age, sexual orientation, gender identity, intersex status or otherwise. We recruit from diverse fields and create teams with skills and perspectives that perfectly complement yours. Our people listen carefully, meet you where you are and work in the spirit of genuine co-production. Our commitment to diversity and inclusion is for Nous to be a place where everyone can be their true and authentic selves, embrace their uniqueness and realise their professional aspirations. We foster a deep culture of respect and provide an environment for all our employees to flourish. Click here to read our diversity and inclusion statement. Creating a diverse and balanced workforce has been ingrained in Nous’ culture and values since the business was founded in 1999. As we’ve grown, our leadership gender ratio has stayed close to even and we are actively committed to maintaining this through our inclusive culture, gender-neutral policies and flexible work practices. Nous’ vision for reconciliation involves understanding of and respect for Aboriginal and Torres Strait Islander peoples and for all Australians to share the same living standards and opportunities. Through our Reconciliation Action Plan and our Indigenous Employment Strategy, we are working to achieve this vision. Find out more about Reconciliation at Nous on our dedicated page.

https://www.nousgroup.com/careers/diversity-inclusion/

Board Leadership by Sonia McDonald CEO & Founder LeadershipHQ The ability to oversee and govern your organisation, define its values, mission, and goals, and also create its culture, comes down to your board’s relative strength. Building a strong board is a difficult task for CEOs, Board Chairs, and allied board members, but it is more important than ever. Over the past several years, news reports from around the world have been filled with stories of various financial scandals, including product liability lawsuits, insider trading, internal theft and business failures. While the names of the institution’s involved change and the specific details differ on a few points, the one constant thread in all of these situations is a failure of leadership, an absence of integrity in the culture, and a failure on the part of the board of directors to actively provide direction. - Challenges to Effective Board Governance One reason why we are seeing more boards that are weak and lack strength is that the challenges that our top institutions face are rapidly changing. In addition to traditional governance and oversight areas such as strategic planning, recruiting top talent, and weighing in on potential mergers and acquisitions, organisations now contend with a host of other more complex issues. These issues are wide-ranging and include dealing with the effects of technological advances that both improve and disrupt the way that we live and work, seeking options for how to succeed despite increased competition from domestic and international rivals, and even how to survive actual battles for control of the direction of the organisation from activist investors. To meet all of these competing demands, it’s imperative that boards intentionally move from traditional, passive roles and embrace a more dynamic and active approach. The following are four core areas that your board must focus on improving in order to create a stronger and more effective board. - Lead by Example and Start at the Top – The Case for Ambition If you want a stronger board that is more engaged and directly involved with providing governance and oversight, you must literally start at the top. Boards must appoint Chairs that will push themselves and their fellow board members to take a more active role in investigating the key challenges facing the institution and developing strategies and solutions to these challenges that remain consistent with the organisation’s core values, mission statement and goals. The Chair sets the tone and the pace for the rest of the board, so ideally boards need Chairs that are ambitious and that will actively seek out new ideas, diverse opinions, multiple options and even contrarian viewpoints in order to find the best direction in which to guide the organisation. We love this article from Future Directors too around 5 Motivations for Wanting to Become a Board Director? - Cooperation, Partnership, and Collaboration One of the greatest challenges to effective board leadership is a lack of trust and mutual respect among its members or between the board and the CEO and other management. In order to have a strong board, the board Chair and CEO need to be able to work together in partnership and cooperation, rather than in competition with one another. Board Chairs need to able to work with their fellow board members, and their CEO and each must facilitate more frequent opportunities for communication and more open communication styles. Boards must do the hard work of taking an active approach to developing relationships with one another, their Chair, and the CEO, so that they are able to more freely discuss all issues that the institution faces and have frank, direct and sometimes even pointed discussions so that they can make better, more fully informed decisions. Strong bonds enable boards to be able to get to the heart of the matter without fear of causing offense or otherwise stepping on anyone’s toes. In the end, this more active, direct, and dynamic approach helps boards to develop better strategies for dealing with all of the changes and disruptions that are taking place within their organisation and the marketplace. This is why we are hosting a Board Leadership Workshop at Rivercity Labs on 25th July at 5.30pm. We need more Future Board Directors and Future Directors is offering a chance to win FREE Scholarship to one of those programs! Sign up here. - Dive Deep and Encourage Diverse Ideas and Perspectives Building strong bonds between the Board Chair, the CEO, and the board members, and facilitating more open communication is just one part of strengthening the strategic capacity of a board. While the board Chair and CEO must cooperate and work in partnership with one another, boards and their Chairs must still maintain their independence from the CEO and other management. As part of their oversight and governance duties, boards and their Chair must actively seek out alternative viewpoints and ensure that they have a full and unobstructed view of all of the issues and details surrounding a specific challenge. Oftentimes this means that boards will need specific training and development in order to be informed and competent in specific areas. Rather than serving as a rubber stamp for the CEO and management of an organisation, boards and their Chairs must dive deep into issues and challenges and the organisation’s comprehensive strategies. From IT and risk management to digital trends, media, marketing and branding and even the safeguarding of the organisation’s reputation, nearly every performance area of an organisation should come under the oversight of the board. - Make Meetings and Agenda Items Count Many boards only meet a few times a year, but strong boards make these meetings count by getting actual work accomplished. Board Chairs can strengthen their board and increase its impact and effectiveness by setting an aggressive and ambitious agenda. Ideally, board meetings should first begin with a short reception that will allow members to mingle, connect and bond with one another before getting down to business. This sets a collegial tone for the rest of the meeting and helps put everyone in the right frame of mind and be more willing to cooperate and work with one another. Next, the key challenges facing the organisation should become the focal point for the rest of the meeting agenda and should include potential options for strategy and other action items. To keep the board’s morale and momentum moving forward, Chairs should allow strategic thinking and planning to take up the lion’s share of the agenda, and save old business and follow up reports for the end. As boards become more actively engaged in the governance and oversight of the organisation, they should periodically review their performance, as well as that of their Chair and their CEO, to see how well they are doing at transforming their board and the organisation as a whole. Setting ambitious goals for organisational change and comparing the results against industry metrics can help boards to evaluate their performance in a more unbiased manner and help them to be able to identify and focus on new areas for improvement. How active and strong is your organisation’s board and how effective is your board at managing change? Do you know in what areas your board excels and can you identify what areas your board should focus on to improve its effectiveness? Get in touch today to learn more about how our executive board coaching and advisory or our board leadership programs can help you to develop the leadership skills that you need to help you strengthen your board and increase its effectiveness.

https://leadershiphq.com.au/5-reasons-need-board-leadership/

Welcome to the fifth day of our seven-day practice in which we expand our capacity to listen. We invite you to close your eyes and take one or two slow, deep breaths. Read the practice below and carry the invitation with you through your day. You may find it meaningful to explore the practice in the moment, and we encourage you to integrate it into your daily life as you explore the question: What happens when I make myself fully available to listen within and around me? “To listen is to lean in, softly, with a willingness to be changed by what we hear.” ~ Mark Nepo This day’s practice offers us the opportunity to actively seek out unfamiliar voices and perspectives, and approach them with grateful receptivity. Explore the voices of those who differ with you in politics, religion, race, ethnicity, gender, sexual orientation, income, etc. Seek out people in your community as well as authors, artists, musicians, filmmakers, podcasters, and even news anchors. How does your open-heartedness help you listen to the experiences and perspectives of others with humility – with genuine curiosity and a desire to learn? How might you be changed by truly listening to voices, stories, and perspectives that are different than your own? Different languages offer us an opportunity to deepen our practice of welcoming the unfamiliar. Through grateful listening, simply receive that which is shared without rushing to make meaning or seek a translation. Tune into the languages of the natural world: animals, insects, plants, clouds, the cosmos. Cherish the diversity of life’s many voices. What happens when you make yourself available to listen, even if you do not immediately understand? Deepening the Practice There’s no greater gift than someone sharing their life’s story and no greater response than to listen with a willingness to be changed by what we hear. The Moth’s Global Community Project invites people from around the world to craft their powerful experiences into succinct, poignant stories to be shared as a mechanism for global change. Their project invites us to listen for the gift of the unfamiliar. Should you be inspired, please leave a reflection below… Please log in or Create a Profile to post a comment. Write an entry in your private gratefulness journal A five-day exploration of belonging, generosity, creativity, non-violence and courage through a Pledge for Grateful… Handwriting bright word mandalas is a practice of TaikoPeace, a movement started by renowned taiko… A seven-day practice to restore our sense of kinship with nature, guided by teacher Fabiana… This site is brought to you by A Network for Grateful Living, a 501(c)(3) nonprofit. All donations are fully tax deductible in the U.S.A.

https://gratefulness.org/resource/listen-5/