Art vs Design Essays

Art vs Design Essays Art vs Design Essay Art vs Design Essay If we want to talk about Design, many people will think about work of Art because we usually see those words beside each other as Art and Design such as a name of a school School of Art and Design and understand Design convey aesthetics as Art but their meaning is totally different. Moreover, lines between them are complex and intriguing. Many designers are artists and many artists are designers. Artists almost never want to be called designers but many designers seem to want recognition as artists. However, as easily explain, art is created by artists or aspiring artists or artistic creation while design is produced by designers. In fact, Art and Design have a connection between them. There are some pretty clear areas and have also identified where those areas have become blurred. Commercial sense The first point is that designers work for money in the commercial sense but artists usually recoup their cost of creation to purchase new paints or inks or paper. Design as a career pays a lot more than Art. In the real world for most cases, therefore Designers probably should be quite content not being called Artists because design often is about meeting commercial outcomes Design is start from thought, art is begun from feeling Another point, Design is about solving problems and sorting through hypotheses and alternatives to create the best solution to something â€Å" the best chair, home, garden, room, poster, or car. Design is about understanding people and the user experience. Design is a very calculated and defined process; it is discussed among a group and implemented taking careful steps to make sure the objectives of the project are met. Designers are similar to engineers in that esteem and must not only have an eye for color and style but must join to very complex functional details that will meet each objective of each project. The word design lead itself to a hint that someone or something has carefully created a thing and much planning and thought has been achieved to produce the imagery or materials used for the project. On the other hand, Art is about creating works which try to arouse a response in the viewer, to make them rethink assumptions or look in a new or specific way. Art is something completely separate. Good artists should convey a message or inspire an emotion it does not have to adhere to any specific rules. Artists are creating their own rules. Art is something that can draw a single thought or feeling such as happiness or sadness from the hands of the artist. The artists are free to express themselves in any shape, form, color, using any number of methods to transfer their message. Artists do not need to explain why or what they did something . Different roles As the beginning of the article, many designers are artists and many artists are designers. There are some designers who could be loosely called artists. However, the problem is not that designers cannot be artists but it is that being a designer is different from being an artist, just different between driving trains and trucks. A train driver can be a truck driver even though these are different roles. Potters make cups commercially as well as pieces of artwork. The sculpture made by the potter does not turn the cup into Art. Convergence between Art and Design In summary where gotten more confusing, this is a convergence grey area. Design and art are mixture that designers create their products or objects. They are not just good designs but works of art as function and aesthetic. Art affects to feeling of consumers as aesthetic while design correctly responses as a function use. If they lost either design or art, their products or objects will not be successful. Therefore designers are artists in their own right. There is no architectural design that is not art and no landscape design that is not art. Both design and art are able to go along together even though they came from difference places. This is how to create a truly harmonious balance between art and design.

How to Get Into Film School, by a USC Alum

How to Get Into Film School, by a USC Alum SAT / ACT Prep Online Guides and Tips If you're interested in going into the entertainment industry in any capacity, be it directing, writing, producing, animation, editing, or otherwise, youshould consider attending film school.I wrote this article to share my knowledge as a USC film school alum and to help you get accepted to film school as well! My Film Background and Experience I graduated from the film school that wasvoted the #1 US film school for the sixth year in a row by The Hollywood Reporter:University of Southern California’s School of Cinematic Arts.My major was Film Television Production (a program with a 3% admission rate). In addition to being accepted into a top US film school, I received a full-tuition merit scholarship to USC. During my senior year, I was asked to serve as the student representative in scholarship interviews for the film school, so I have experience reading and analyzing applications with other representatives of USC's School of Cinematic Arts.I was able to identify the qualities of a good and bad application and will share those with you below. What Do You Need to Apply to Film School? Each film school has its own application process. To find the application requirements for the film school you're applying to, simply search for "[College Name] film program application requirements" on Google.Here's an example: The conservatory style schools (e.g., AFI) only require one application, while film schools based at four-year universities (e.g., USC and NYU) typically require two applications: the application to the overall university (usually the Common Application) and the supplementary application to the film school. I won’t get into the nitty-gritty of how to write the best general application (for more on that, check out our guide tobuilding aversatile college application).This application is still important, though, because you won't be admitted to a college's film program if your test scores, transcript, letters of recommendation, and other materials are not impressive enough. Instead, I'll be talking about the supplementary application specifically (the only application for conservatory schools),and I'll be using USC’s as my example as I’m sure many of you who are reading this will be applying there. Even if you aren’t applying to USC, its application is pretty much the standard film school application. For USC’s film application, you'll need the following materials: Cinematic Arts Personal Statement Writing Sample (A or B or C) Visual Sample (Video or Photo Option) Creative Portfolio List Letters of Recommendation (3)* *These can be the same ones submitted for the Common Application and are no different from letters of recommendation for any college application. I'll go into detail for each of the components below (excluding the letters of recommendation since these are just your typical letters). #1: Cinematic Arts Personal Statement One part of the USC film school application is the personal statement. Here is how USC describes this component (all bold emphasis mine): The personal statement will be read by the Film Television Production Admission Committee as a measure of creativity, self-awareness and vision. We are looking for a sense of you as a unique individual and how your distinctive experiences, characteristics, background, values and/or views of the world have shaped who you are and what you want to say as a creative filmmaker. We want to know about the kind of stories you want to tell. Bear in mind that enthusiasm for watching films, descriptions of your favorite films and the involvement in the filmmaking process is common in most candidates. As a result, we encourage that you focus on your individuality. Note that there is no standard format or correct answer. (1,000 words or less) What should you write? In layman’s terms, your personal statement should be an essay of no more than 1,000 words that captures your individuality and your passion for film.I think USC gives very helpful hints to what makes a great (or terrible) personal statement. All film school applicants enjoy watching movies and have their favorites (if you didn't, why would you want to go to film school?), so you don’t want your personal statement to be all about that (otherwise, you'll seem unoriginal). Think about it: what distinguishes you from all those other candidates? Your individuality, who you are.What USC wants to see in your personal statement isthat you're an interesting, talented person they should add to their class. USC film school doesn't want average; it wants an engaging storyteller with unique tales to share. Does USC want you to tell them what a great storyteller you are?No.USC, as well as other film schools, want you to showthem what a great storyteller you are. To do this, you must tella story. Let me demonstrate.Here is the introduction to my personal statement from my actual USC film application: Cheerleader. A word that makes me want to hurl and is too often used to describe yours truly. I guess a bubbly, outgoing personality and attractive physique means you are a cheerleader. I sit excitedly waiting to hear my name. It’s 2006. I’m 14, and I’ve made it all the way to the Florida State Science Fair for my experiment on determining whether bacteria or fungi is more effective in cleaning up oil spills (BP could have used my help). I finally hear my name called and eagerly rush up to meet one of the judges to discuss my project. I spot him and am about to introduce myself. Before I can get a word out, he stops me, saying, "Let me guess, you’re a cheerleader." Let me clear the air now I am not now nor have I ever been a cheerleader. Firstly, I lack the acrobatic prowess required for such a role. Secondly, I hate the label. I correct the judge, to his embarrassment. We continue on to have an intelligent discussion about bioremediation, and I end up pla cing third in the state and winning an award from NASA. I'm a huge fan of complex characters. It's too easy to jump to conclusions. "A vivacious personality, a flair for style, a good-looking appearance, she clearly has no intelligence to speak of." I want to tell stories with surprises and characters that break the rules like Martin and John Michael McDonagh. In this introduction, I've told you a story about me from my past that reveals who I am, and I analyze it to show you what kind of storyteller I want to be.I know this is no easy task, but I'll try to help you brainstorm your personal statement story. Is there a moment in your life you're particularly proud (or even ashamed) of? For example, did you help someone? Win an award? Overcome a challenge? Make a big mistake? These are all great types of stories that illustrate your character and your potential to tell a story. If you're starting to put pen to paper, here are two topics to avoid: Sports victories and/or challenges:Unless you have a very rare event to discuss, don’t do it (e.g., you tore your ACL while scoring the winning goal in the state championship). Think about how many students across the country play a sport at their high schools. These are the most common stories admissions officers read, and they hate them. (This is an example of a topic that would make you seemunoriginal.) Religious experiences (such as camp stories, mission trips, etc.):Again, there might be an exception to this, but if you're talking about a religious awakening, it's an experience many people have had. Also, it might make the admissions officer feel uncomfortable. Admissions officers want to see what is special about you,so don’t tell a story that will group you in with most other applicants.Simple experiences/stories are often best. I wrote another personal statement (for my other applications) about giving money to a homeless man. After I walked away, the homeless man followed me down the street. I tried to get away from him, thinking he was trying to harass me. Finally, he caught up with me and asked for my name. I hesitated but told him it. He then shouted, "God bless, Lauren!" He had followed me to thank me and shake my hand. I was horribly ashamed that I’d thought the worst of him. Do not think that your story needs to be about saving the world. #2: Writing Sample for Film School The writing sample provides you with another opportunity to reveal what kind of storyteller you’d like to be. According to USC, your writing sample can be one of three options: A dialogue scene between two people. Provide a one-paragraph introduction describing the two characters in screenplay format. (no more than three pages) A description of a four-minute film that contains no dialogue. It can be fiction or non-fiction. The story has to be communicated visually. (no more than two pages) Describe a concept for a feature-length movie, fiction or documentary, which you would like to develop. (no more than two pages) I recommend option 2 or 3. You can attempt option 1 if you want, but I think it's the most difficult of the three to write well. I chose option 3, which I believe is the easiest option.Only submit option 2 if you feel very confident about your dialogue (i.e., that it sounds realistic and not cheesy) and scene structure (i.e., that it has a clear beginning, middle, and end). Regardless of the option you choose, you need to show a side of yourself that is different from what you show in your personal statement.For example, if your personal statement discusses how you watchedJurassic Park in the hospital with your grandmother and how passionate you are about Spielberg, it's best not to write a dialogue scene between a boy and his new alien friend (for the youngins who might not get this reference, in Spielberg’s E.T. a boy befriends an alien). In other words, you need to prove that you don't just want to become a Spielberg copy. The key here is to exhibit diversity and openness in your application(particularly in your personal statement, writing sample, and video sample). USC doesn’t want fully formed artists who will only make documentaries about one topic and who refuse to tell any other stories; rather, USC wants students who will learn from others and can be shaped into effective storytellers. In my personal statement, I discussed wanting to become a filmmaker like Martin and John Michael McDonagh (Martin is probably the better known of the two for his movies In Bruges, starring Colin Farrell, andSeven Psychopaths,alsofeaturing Farrell). Then, for my writing sample, I wrote a concept for a feature-length film set in WWII and centering on a husband and wife.This feature idea isn't just a regurgitation of my love of the McDonaghs- instead, it shows a completely different side ofme. Want to build the best possible college application? We can help. PrepScholar Admissions is the world's best admissions consulting service. We combine world-class admissions counselors with our data-driven, proprietary admissions strategies. We've overseen thousands of students get into their top choice schools, from state colleges to the Ivy League. We know what kinds of students colleges want to admit. We want to get you admitted to your dream schools. Learn more about PrepScholar Admissions to maximize your chance of getting in. #3: Visual Sample for Film School Next up is the visual sample. Here are the requirements for this application component at USC: Please submit one of the two visual samples. It is essential that you specify what role(s) you have played in your visual sample. Video Option: Create a brief narrative video in which you had a major creative role. The video can be either live-action or animation, fiction or documentary, but it should reflect your aesthetic tastes and intellectual and emotional interests. (No longer than five minutes.) Please submit only ONE video. Multiple submissions WILL NOT be reviewed. Photo Option: Prepare a series of eight photographs you have taken which, when viewed in a specific sequence, portray a unique and original character or which tell a simple narrative story. Also, include a one-page narrative about the character being portrayed in the photos. The images may either be black-and-white or in color. Please upload the photos in order of sequence (1-8). Please upload the required one page narrative into the online application. Basically,you're required to submit one visual sample, which can be either a video or series of photographs. Here's my strong recommendation:do not choose the photo option (unless you're applying for a photography degree program). I repeat: do not do the photo option.I have never met a person accepted to film school that chose this option. By contrast, I have met people who applied with the photo option and did not get in. So don’t do it! While I don't know why the photo option doesn't seem to work well for admission, I have a couple of theories. You're applying to film school to be a storyteller. In your application, film schools want to see the types of stories you want to tell. From just eight photographs, though, it's difficult to tell a complete story (and one that fits into a film genre like comedy). Simply put, telling a narrative or portraying a unique character is extremely difficult to do through photos. By opting for the photo option, you essentially disadvantage yourself since other applicants can tell a full story (and really reveal their storytelling skills) in a five-minute video. If you care at all about getting into film school, you'll take the time to throw avideo together. As with the writing sample, the video sample should capture a differentside of you or genre of storytelling that interests you.USC also lets you submit a video you had a major role in (e.g., you wrote, directed, edited, or produced it). Note that I'd only submit something you didn't write or direct if you have no interest in being a writer or director (and mention in your personal statement that you want to be an editor/DP/production designer/etc.). USC wants to see your storytelling style, and if you didn't have a major role in the work (as a writer or director), it might be hard to see your influence on the final product.I didn't have a video to submit for film school, so I wrote and directed something. My friends acted in it, and a friend with a camera filmed and edited it. It doesn’t look like a feature film, but it tells a cute, unique story.Here it is for your viewing pleasure: Star-Crossed Trekkies Password: SCA20 Objectively, it's amateurish, but I managed to tell a sweet story that demonstrated my interest in comedy.While I wrote about the McDonagh brothers in my personal statement and composed a WWII period piece for my writing sample, my video sample- a comedy about trekkies trying online dating- was completely different. The bottom line? Show an interest in multiple aspects of storytelling in your application! #4: Creative Portfolio List for Film School The final piece of your application to film school is the creative portfolio list. Below ishow USC describes this application component: The portfolio list is a written record of the applicant's creative materials. It should include a concise description of each project, the month and year the project was completed, the applicant's creative role and the purpose of the project. The material, which does not need to be film- or television-related, should give an idea of the range and depth of the applicant's creative ability. Formal recognition- such as awards, publications, jobs and exhibitions- should be noted. The name of the institution or publication should be included when listing creative materials prepared for a class or publication. Basically, you're creatingan artistic resume.USC offers examples of what kinds of projects an applicant might include in her list as well as how it should be formatted: July 2008, A Day in the Life, digital video, 12 minutes. Position: writer/director. A documentary on a homeless Iraq vet who has lived on the streets since his return from the military. Created for senior-year multimedia term project, San Raphael High School, Miami, Florida. March 2008, Doorways, a series of 5 black-and-white photographs. Position: photographer. "Second Prize Winner" in the Des Moines Sunday Journal photo contest. February 2007, Cellomorphosis, short story. Position: writer. A variation on the novella by Franz Kafka; published in Writing, vol. IV, 2007, at Amherst College, Amherst, Massachusetts. Do not worry too much about your portfolio.You don't need to have won awards to get into film school. I had won zero awards for my artwork. Your portfolio just needs to show that you have an interest in art.This could include acting, art projects (for fun or for school), and music you’ve written or performed (e.g., at a school talent show). Really, anything artistic can and should be included. Just make sure you don't include any profane or inappropriate artwork.I know this should go without saying, but in one of the applications I read at USC, thestudent had mentioned something inappropriate on hisportfolio list. So I want to make sure you don’t do this, too! Hishigh school art teacher had put an end to the project, but he'd still decided to mention it in his application. If your teacher does or did not approve of a project, it is very likely an admissions committee won’t either! Completing Your Film School Application Now that we've covered what materials you need to apply to film school, I want to give you a few pointers on completing your application. Make sure you know the application deadlines for the film schools you're applying to so you can submit your application well before it's due. If you're unsure of a school's deadline, you can either search for "[College Name] film school application deadline" on Google or check the school's application page on the college's official website.Most schools' deadlines are December 1. It's a good idea to create a timeline so you can ensure you finish your application on time. After all, your best creative work will probably take more than a week! I suggest spending the summer between your junior and senior years of high school working on your application. If you don't have a video to submit, plan on writing, filming, and editing a video over the summer so that you have it done and won't have to worry about it while you're focused on school work. Also, prepare your personal statement and written sample over the summer so you can dedicate enough time to each. You'll likely work through several drafts and need people you trust (such as teachers or your parents) to look them over for you. Working on both during the summer lets you take your time and prevents you from rushing through the process. The only part of your film school application you should not complete during the summer is the portfolio list. You can write a draft, but don't forget to add all your artistic involvements in the fall of your senior year to your portfolio later on. Final Points to Remember When Applying to Film School If you're applying to film school, you'll need to understand just how you can produce an excellent application to increase your chances of admission. Here are the essential points to remember when applying tofilm school: Show diversity/multiple interests in your application.For example, you could talk about how you're interested in comedies, period pieces, and sci-fi. Emphasize your individuality and prove that you're a unique candidate.Avoid writing about something in your personal statement that most other applicants have experienced, too, such as getting injured in a sport. Simple stories are often the best ones! Do not do the photo option for the visual sample. Always do the video option; hardly any applicants get accepted to film school with the photo option. Do not write about anything inappropriate on your application.If a project you did got canceled or was not approved by a teacher, chances are it's not appropriate to put on your application! What’s Next? Studying for the SAT? Check out our complete guide to the SAT.And if you're taking the SAT in the next month, be sure to readour guide to cramming for the test. Not sure where you want to go to college? Get tips inour guide to finding your target school. We also teach you how to find your target SAT score or target ACT score. Thinking about getting a job while in high school? Check out our guide to the eight best jobs for teensand learn how to find yours! Want to improve your SAT score by 160 points or your ACT score by 4 points?We've written a guide for each test about the top 5 strategies you must be using to have a shot at improving your score. Download it for free now:

Healthcare availability Essay Example | Topics and Well Written Essays - 1000 words

Healthcare availability - Essay Example A growing number of employers in Utah have become incapable of coping with the continuously increasing cost of healthcare, which has compelled large numbers of businesses to stop providing insurances for their employees. This produces an unfavorable feedback cycle: rising healthcare costs enlarges the population of uninsured and thus either raises healthcare premiums and costs for people who do not have insurance or boost healthcare costs for the state since the uninsured uses public services (Poulsen, Matsumori & Kroes, 2008). Hospitals in Utah are particularly distressed by uncompensated care since majority of their healthcare providers are currently paid a fixed pay. Doctors receive this pay irrespective of the capacity of the patients to pay (Poulsen et al., 2008), putting the weight of delivering uncompensated care on the hospitals. Furthermore, people who do not have insurance usually need more costly procedures because of the absence of primary and preventive care visits. According to the Utah Department of Health (UDOH), Utah locals who are uninsured are less probable to have had a common healthcare source or a regular health check visit (Books Llc., 2010). These locals are also more probable to demand primary care from an urgent care facility or emergency center, which is usually more costly than healthcare services provided by a primary care professional. Furthermore, doctors and hospitals are often not entirely paid for giving care to locals who are entitled to publicly subsidized services (Young et al., 2010) like Medicare or Medicaid. When healthcare practitioners and medical facilities ‘dismiss’ an important part of healthcare provisions, it boosts the cost of health insurance premiums. Nevertheless, raised premiums consequently forces employers to discharge workers and small businesses to shut down, swelling the population of uninsured and producing an unfavorable feedback

Case Study on Liability for Supply Defective Product Coursework

Case Study on Liability for Supply Defective Product - Coursework Example Paul Price has the right to demand for the repairing of the Actifrys or ask for a replacement or demand for a credit note. If any customer has incurred any pecuniary losses due to usage of such faulty products, the retailer has the every responsibility to make good the loss sustained by Paul Price. Under Limitation Act 1980, a customer has up to six years to initiate legal proceedings against the retailer for the supply of defective product.(Bhatia, 2008:458). APPLICATION The Sale of Goods Act (Amended) will be applicable to all transactions where products are transferred for a consideration or price. Contracts of sale may be either implied or expressed with stipulations concerning any contract, or refer to mere consumer contracts. Nonetheless, once it has been decided that the Sale of Goods Act is applicable to a transaction, there are some stipulations implied in the sale by the Act. A seller cannot avoid these stipulations. For each sale of products, the Sale of Goods Act 1979 sti pulates that wherever there is a sale of products by depiction, there exists an implied stipulation simultaneously that the products offered will have to be identical to their description. Thus, the seller must offer the consumer what has been advertised. S.13 of the Sale of Goods Act 1979 (amended) is applicable to all sales, whether by business or individuals. Anyone who offers a product to another will be covered. S.13 is applicable to all products with no concern over purchasing scenario. S.13 is a significant section as it offers the right to a consumer either to obtain a refund or to reject a product. The consumer has the right either to accept or reject a product and is not at the mercy of a seller. S.30 of the Act offers protection to a consumer where the products are not corresponding to the description, and also offers a relief to the buyer if the quantity or description of the products differs from what has been advertised or requested. S.14 of the Act stipulates that pro duct sold should be of merchantable quality. If a consumer purchased the product after 2003, he has every right to request either to repair or replace the defective products within 6 months of receiving the products. (Bryan, 2009:16). Even if the shop where the purchase was made had included an exclusion clause limiting liability, still the shop cannot escape from the liability to Paul Price. Exclusion clause cannot offer any protection to the seller even when exclusion clause tries to shun accountability to consumers. The sellers usually will incorporate the exclusion clause into the contract by trying to have a blanket avoidance of any accountability to the buyers for any detriment, loss, injury or damage and even in case of death. In the majority of cases, courts have declined to implement such clauses if they are not brought to the attention of the buyer at the time of signing the contract or if the exclusion clause imposes unduly exorbitant or onerous penalties. Further, as the exclusion clauses are so damaging to the rights of the consumers, courts will always have narrow interpretation, and this is known as â€Å"contra proferentemâ€Å" rule under English Law. (Jones & Benson, 2011:298). In â€Å"Curtis v Chemical Cleaning Co [1951] 1 KB 805†

Katrina Research Paper Example | Topics and Well Written Essays - 2000 words

Katrina - Research Paper Example Then, in the early morning of August 29, 2005, Hurricane Katrina came ashore at the mouth of the Mississippi near Orleans with 140 mph sustained winds and storm surges two stories tall. To make matters worse, many of the 500,000 residents of New Orleans live below sea level and are surrounded by the Mississippi River, Pontchartrain, and several bays. It was obvious that this was going to be a huge storm; consequently hundreds of thousands of Gulf residents evacuated on Saturday and Sunday. On Sunday night Mayor Holloway of Biloxi said that most of the residents in the lowest-lying sections of his city of 55,000 had evacuated. (Drye, 2005). Wherever possible, evacuees from low-lying areas went to higher ground to stay with relatives and/or friends. Some competed to rent limited accommodations; however, soon these were no longer available. By Sunday night shelters were filling up, even as far away as South KATRINA 3 Texas and all over Lousiana, according to Steve Rinard, meteorologist in charge of the national weather service office in Lake Charles, Louisiana (ibid.). Hurricane Katrina made landfall as a Category Four Storm on the Saffir-Simpson scale which ranks hurricanes from one to five according to wind speeds and destructive potential† (ibid.). ... rina herself was responsible for injecting the initial surprise and resulting confusion by making an unexpected jog southward as it crossed the Florida peninsula and then rapidly strengthening in the Gulf of Mexico. Residents in the Florida Keys were caught off guard by Katrina’s intensification. Katrina kept on getting stronger as it took a ragged S-shaped path across the very warm waters of the Gulf of Mexico. By Friday afternoon meteorologists feared the worst They felt that the storm would further intensify as it approached large Gulf Coast cities such as Alabama, Mobile, and New Orleans, which it did (ibid.) One has to wonder why by this point, coordinated preparations were not being made for a huge impending disaster. Emergency management officials had been concerned for sometime about a powerful storm such as Katrina hitting vulnerable areas such as New Orleans and the Florida Keys. They saw the greatest vulnerability being the coastal population growth that had occurre d during the past three decades, as well as the fact that 55,000 citizens were living below sea level. Knowing this, one wonders why coordinated plans were not in place for rapid evacuation and shelter for all these people should a Hurricane such as Katrina come to visit. They must have known that KATRINA 4 evacuation would not be easy, not only because of all of the people involved, but because there were a lot of people in the area without transportation and money to evacuate. Certainly there was a lack of preparedness for such a major storm, but, perhaps, even more to the point was a lack of communication, trust, and cooperation. Although President Bush declared a state of emergency for Louisiana and authorized the Federal Emergency Management Agency (FEMA) to provide aid, in response to

Investigation of Effectiveness of Clozapine

Investigation of Effectiveness of Clozapine Catarina Scott-Beaulieu Abstract: (250) Background: Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia. It is effective in treating the positive and negative symptoms of schizophrenia with a reduced chance of extrapyramidal side effects compared with other typical antipsychotics. Clozapine is known to have cardiac side effects including, but not limited to, myocarditis and cardiomyopathy. Approximately 75% of cases, of clozapine-induced myocarditis, occur within the first month of titration, highlighting the need for monitoring. Objectives: To assess the extent to which the monitoring guidelines for myocarditis, at a London mental health trust, are being followed. Method: Patients who were registered with ZTAS from June 2014 to October 2016, at the trust,  Ã‚   were identified. Data was collected based on the audit tool created from the guidelines. Using the patient notes and laboratory data, found using the trusts operating systems, data was collected and stored in the audit tool. Key findings: The monitoring standards were met for full blood count in the week prior to initiation and in week 3. No other standards were met. Conclusion: Introduction: (500-1000) Clozapine is the first atypical antipsychotic created and is used in treatment-resistant schizophrenia, which is defined as a lack of or an inadequate response to at least two antipsychotics.[1] It is a dibenzodiazepine derivative antipsychotic and interferes with dopamine binding with a strong affinity for D4-dopaminergic receptors   and 5-HT2a serotonergic receptor affinity [2], in addition it has an anticholinergic effect and antagonizes histaminergic receptors. [3, 4] Clozapine is useful in treating both the positive and negative symptoms of schizophrenia [4] and is less likely to cause extrapyramidal side effects when compared to first generation typical antipsychotics such as haloperidol[5, 6]. It has also been shown to significantly reduce the suicidal behaviors in schizophrenic patients [1, 7]. However, it is not used as a first line treatment due to its extensive side effect profile, most recognized being agranulocytosis which occurs in approximately 1% of patients in the first year of treatment [8, 9], explaining the need for regular, mandatory hematological tests for the duration of clozapine treatment. Other side effects include fever [4], metabolic effects and seizures.[4, 6, 10] Agranulocytosis, however, is not the only potentially fatal side effect of clozapine use. There is an increasing number of clozapine-related cardiac complaints reported in the literature, resulting in cardiac effects from clozapine treatment having become more recognized over the past few years. [5, 7] Whilst tachycardia is a common side effect it can be indicative of other, potentially more serious, cardiac effects such as cardiomyopathy and myocarditis. [9] Myocarditis is an inflammatory process of the myocardium, which is often of viral aetiology but may also include bacterial, fungal and drug-induced.[11, 12] The condition presents with a wide range of symptoms such as chest discomfort, flu-like symptoms and abnormal vital signs [9] and most are non-specific.[2] Reported cases of clozapine-induced myocarditis range from 0.15% to 1.2%,[5, 8, 13-15] with the highest incidence being reported in Australia, >1%. [16] Time to onset varies, but over 75% of cases occur within the first month of treatment. [12, 16-18] Endomyocardial biopsy was the gold standard for diagnosing myocarditis, but the procedure has only limited sensitivity and specificity. It was by proposed Ronaldson et al.[18] in 2011 that combining C-reactive protein (CRP) and troponin T/I would give a sensitivity for clozapine-induced myocarditis of 100%. This is a less invasive method of diagnosis, with a higher specificity and sensitivity for myocarditis and has led to the current guidelines that are in place for the monitoring of clozapine treatment. Whilst clozapine-induced myocarditis is still rare, the need for consistent monitoring within the first month of treatment is needed to ensure any possible cases are detected early, allowing for prompt treatment, increasing the chances of a better outcome for the patient.[1] This audit aims to assess the extent to which the monitoring guidelines for myocarditis, at a London mental health trust, are being followed. Assessments will explore the extent to which the recommended additional blood tests, CRP and troponin, are being completed and the extent to which the advised echocardiogram (ECG) are being followed. Additionally, it will aim to check to see if a clinician is checking the above objectives and assess the extent to which the nursing staff are asking the patients about signs and symptoms of myocarditis. Method: (500-1000) This audit was designed to investigate the extent to which the monitoring requirements, in regards to clozapine initiation and titration within the first four weeks of treatment, at a London mental health trust had been completed. The monitoring requirements audited were specific to the detection and diagnosis of myocarditis. Data collection occurred between October 2016 and February 2017. It is a baseline, retrospective audit of case notes and laboratory data. As per the Health Research Authority regulations, this audit did not require ethical approval. Audit standards and audit tool The standards used in this audit were taken from the trusts clozapine guideline, which can be found in table 3. The monitoring requirements for the detection of myocarditis involve an ECG, vital sign monitoring (pulse, blood pressure, temperature) and CRP and troponin T blood tests. These had to be completed prior to initiation and weekly for the first four weeks after initiation. It is also necessary for clinicians to verify the results of the CRP and troponin T tests, and for the nurses or clinicians to check if the patient has had any signs or symptoms of myocarditis. For the purpose of this audit, criterion 1 and 3 (table 3) will be met if the results of the investigations were documented. Criterion 2 (table 3) will be met if the clinician has made specific reference to CRP and troponin T tests in the patient notes, criterion 4 (table 3) will be met if there is specific reference to questions being asked about myocarditis symptoms. An audit tool was created using the specified mo nitoring requirements mentioned in the clozapine guideline, a template of the audit tool can be found in table x. Identifying patients to be involved in the audit Clozapine patients require regular and frequent prophylactic blood tests in order to initiate and continue treatment. As such, there is a mandatory need for patients to be registered to a clozapine monitoring service database, which collects and stores the results from the weekly blood tests. Zaponex Treatment Access System (ZTAS) is the monitoring company that was used by the trust. ZTAS provided a list of patients who were registered with them whilst under the care of the trust, from June 2014 to October 2016. This resulted in a total of n=57 patients. The patients were selected to be used in the audit after they adhered to the inclusion criteria, which are shown below. Data Collection Data was collected using various information sources at the hospital. Data on haematological tests were collected systematically from ZTAS, bloodresults.co.uk, and the trust clinical portal. ZTAS and bloodresults.co.uk offered information on the standard full blood count (FBC) monitoring that takes place weekly. The trusts clinical portal was used to collect information on other heamatological tests, CRP and troponin T; this source was also used to check any other available FBC test results. RiO, the trusts operating system, was used to collect information on the other standards being measured in this audit (criterion 2, 3 and 4)(table 3). The data collected was stored in the audit tool. ( table x) Inclusion and exclusion criteria The inclusion of the patients in the audit required them to have been registered with ZTAS at the trust between June 2014 and October 2016. It was also necessary for the patient to have started some (at least two) of the required monitoring standards prior to initiation. Prior monitoring requirements included an ECG within a maximum of 3 months prior to initiation and  Ã‚   FBC, CRP and troponin T within 10 days of the initiation date.   Vital sign monitoring such as pulse, blood pressure and temperature were included if they had been completed a maximum of 7 days before initiation. Patients were excluded from the audit if they had been transferred from another trust and were already on a controlled clozapine treatment regime. Method of data analysis Data analysis and statistical analysis was completed using Microsoft Excel 2013. Overview As stated previously, clozapine is associated with an increased risk of myocarditis, which has been fatal in some cases. Preventative monitoring measures for myocarditis are advised at this trust. Baseline troponin T, CRP and ECG should be done prior to beginning treatment and then weekly for the following first four weeks after initiation. These measures are specific in identifying myocarditis, but should also be done in concordance with standard monitoring during treatment. The standard monitoring procedures include pulse, blood pressure and temperature to be completed every other day and FBC weekly. These monitoring procedures are necessary in helping to diagnose myocarditis; symptoms of myocarditis are non-specific, but tend to indicate the presence of an infection (fever) or simulate myocardial infarction (chest pain). Nurses and practitioners are advised to question patients on the appearance of any side effects similar to myocardial infarction to help ascertain if they could h ave myocarditis. Patient demographics and study data In total, n=57 patients were reviewed. Of those, n=3 patients were excluded based upon the inclusion and exclusion criteria described in the method. Of the remaining n=54 patients, n= 6   (11.11%) patients did not initiate clozapine treatment, but n=5 were included in the audit as they had started the monitoring required prior to initiating treatment. Reasons for not initiating treatment are outlined in table 1. A total of n= 3 patients ceased clozapine treatment in week one (n=2) and during week three (n=1); one patient was persistently tachycardic, one patient refused to continue treatment and one patient was severely hypotensive. The patient group (n=53) was predominantly male 66% (n=35), 34% (n=18) were female. The mean age of patients who initiated treatment (n=48) was 34.42 years old, with the youngest patient age being 16.92 years old and the oldest being 65.21 years old. Length of treatment was calculated as the time between a patient commencing clozapine treatment and either ceasing clozapine or the end of the audit period. A total of n=10 patients were excluded from the calculation, as they either did not start treatment or the end of treatment time was not able to be calculated; reasons for exclusion are explained in table 2. The mean length of treatment was 387 days  ±268, with the shortest length of treatment being 1 day and the longest being 873 days. Of the 53 patients involved at the start of the audit, 65% (n=35) were initiated on an inpatient basis; this means the patients were initiated at the hospital, on a ward. ECG monitoring A baseline ECG had been completed in 96% (n=51)(Figure 1) of patients within 3 months prior to the commencement of clozapine. One patient refused to have an ECG prior to initiation. The percentage of patients who received ECGs decreased to 20% (n=9), 24% (n=11), 17%(n=8) and 9% (n=4) of patients for the following 4 weeks after commencement respectively. A total of 41 out of 45 (Table 4) patients did not receive an ECG in week four of clozapine titration. During week one, a patient complained of flu like symptoms and was given an ECG to rule out myocarditis; likewise, one patient during week three was given an ECG after complaining of centralized chest pain. Temperature monitoring The quantity of patients who had recorded temperatures fluctuated through-out the weeks, being highest in week two of monitoring (n=. Week four had the lowest recorded amount of temperature monitoring of all 5 weeks at patients 69% (n=31) (table 4). In week one, n=2 patients refused to have measurements taken. Pulse and blood pressure monitoring The amount of patients who did not receive BP monitoring was highest in the week prior to initiating clozapine (n=13) and in week four (n=13). The highest proportion of patients who had their blood pressures taken occurred during week one at 96% (n=44 ), with 63% (n=29) of them having their blood pressure taken once and 34% (n=15) having their blood pressure taken twice (one reading measured whilst lying or sitting and one reading measured whilst standing). Week four had the highest proportion of patients who did not have their pulse measured at 29% (n=13) (table 4). One patient was discontinued from clozapine after one day of treatment when the BP check revealed them to be extremely hypotensive, in conjunction with a rapid pulse. Full blood count monitoring FBC monitoring occurred in the highest proportion of patients throughout the monitoring period; 100%, 98%, 93%, 100% and 96% respectively. CRP and Troponin monitoring The majority (>50%) of patients did not receive CRP or troponin T blood tests throughout the duration of the monitoring period. Figure 2 shows a substantial decrease in the number of patients who had CRP tests prior to initiation (n=25) and the following weeks (n=10, n=11,n=11, n=7 respectively). A large propotion of patients (84%, n= 38) did not receive CRP blood tests during their fourth week of clozapine treatement. The number of patients who received troponin T tests were less than those who received CRP tests. Only 36%(n=19) of patients received troponin T tests prior to initiation, reducing to 26%(n=12), 20%(n=9), 15%(n=7) and 9%(n=4) in the following four weeks after initiation respectively. There were n=14 patients who had no CRP or troponin T tests throughout the entirety of the monitoring period. There were no patients who had weekly CRP and troponin T tests throughout the duration of the mointoring period. Other monitoring parameters In total, the number of patients who had their CRP and troponin checked by clinicians was less than 100% in all cases (69% (n=9), 75% (n=9), 56% (n=6) and 63% (n=5) for weeks one through four respectively).   Due to the lack of data regarding criterion 4 (table 3), there are no results available to be discussed. Summary of main findings FBC monitoring requirements were met in the week prior to monitoring and in week three. All other standards were not met in any of the five weeks. Over all, there was a better outcome seen in the week prior to initiation for most of the standards. CRP and troponin T tests were completed in less than 50% of patients throughout the five weeks measured. Likewise, excluding the week prior to initiation, less than 50% of patients received an ECG for weeks one to four. Limitations Study data was collected using patient notes and the trusts clinical portal, data was therefore reliant on the relevant health care professional entering the information onto the systems. Consequently, the lack of data could be attributed to the lack of documentation of the monitoring, as opposed to the lack of monitoring all together, especially in regards to criterion 4 (table 3). No useful results could be drawn for criterion 4 and criterion 2 may have also been significantly affected by a lack of documentation. The sample size of this audit was small (n=53), any conclusions drawn from this data may not be relevant to a larger sample size. However, in future studies, a larger sample size could be used, if this is not possible the audit could be expanded to include other trusts. Results could also be affected if the patient refused to have the relevant monitoring required, as advised in the trusts clozapine guidelines.    This audit is the first one to be completed at this trust, therefore it cannot be compared to any previous data. However, the results are being measured against set standards (table x) and can be used to compare to future audits. Results in context      Ã‚   Clozapine is highly effective in the management of treatment-resistant schizophrenia; it reduces the risk of suicidal behaviours[5, 6]and it is effective in the treatment of both the positive and negative symptoms of schizophrenia.[1] It is not widely used due to its extensive side effect profile [8], most recognised being haematological disorders, such as agranulocytosis and neutropenia which have strict monitoring protocols in place.   However, cardiac side effects of clozapine treatment have become more widely recognised over the past few years.[5] Myocarditis is an inflammatory condition of the myocardium, which is normally attributed to viral aetiology. Clozapine-induced myocarditis is a rare, but potentially fatal result of treatment. Over 75% of cases occur within the first month of treatment, making it important to monitor for myocarditis during the first four weeks of treatment.[2, 14-16] A study by Ronaldson et al.[18] developed an evidence-based monitoring tool, based on 75 cases and 94 controls for routine monitoring up to 28 days. It suggested that an ECG, CRP and troponin I/T should be completed at baseline, with routine vitals every other day. CRP and troponin I/T tests should also be repeated on days 7, 14, 21 and 28. This study proposes that combining CRP and troponin tests provides a 100% sensitivity for myocarditis. The trusts clozapine guidelines also suggest the same monitoring protocol, with the addition of an ECG every week, for the first four weeks. Individuals with schizophrenia have a 20% shorter life expectancy than that of the general population and a greater vulnerability to several illnesses (diabetes, coronary heart disease).[19] Due to the nature of the illness and the heightened health risks associated with schizophrenia and the antipsychotic medications used in its treatment, it is important to adhere to the relevant monitoring protocols. It is evident, from the results, that the proposed guidelines for the monitoring of clozapine-induced myocarditis are not being met. Likewise, a number of studies have shown a poor adherence to standards in the monitoring of antipsychotic medications.[20] Physicians may have doubts about the relevance of monitoring, or feel that it is not necessary as the incidence of myocarditis is very low; rate of incidence occur in approximately 0.15-1.2%[1, 13, 21] of patients. If we consider other medications with stringent monitoring protocols, such as insulin, due to health care professionals awareness of this medication and the implications if the standards are not met, there is often a higher standard of monitoring. There may also be an implication of cost; extensive monitoring is often expensive, making it appear to be an unnecessary expense, particularly when the chances of myocarditis occurring are very low. Health care professionals may have a lack of awareness of the need for the monitoring of myocarditis, and the implications if these are not met. The incidence of fatality due to clozapine-induced myocarditis can be as high as 50%[1], making it important to abide by the set guidelines. The monitoring guidelines are made to reduce the harm caused to patients and reduce the possibility of fatalities. However, a delayed diagnosis could result in poorer outcomes for the patients.[1] The standards allow for earlier detection and diagnosis of myocarditis, reducing the chance of poorer outcomes. The results of this audit indicate a need for an increased awareness of clozapine-induced myocarditis among health care professionals. This would improve the clinicians awareness of the need for the monitoring of myocarditis and highlight the implications if the standards are not met. A standardised questionnaire could be created to monitor the signs and symptoms of myocarditis and be used by nurses to document the results, this could be incorporated into the clinical notes. This baseline audit emphasises the need for future re-audits, to evaluate whether the standards have improved. Table 1: Reasons for not initiating treatment Number of patients (n) Consistent amber results 1 Patient changed mind/ refused 2 Previous health conditions made the patient unsuitable to start clozapine 2 Unknown 1 Total 6 Table 2: Reasons for not being included it length of treatment calculation Number of patients (n) Never initaited clozapine 6 Patient transferred to another trust 2 Patient returned to country of origin (unknown if they continued treatment) 2 Total 10 Table 3: Policy Title Clozapine Guide Trust-Wide Medication Policy Date July 2016 Local/National Local Standard Setting Criterion 1 Criterion 2 Criterion 3 Criterion 4 Criterion Full blood count, including troponin T, CRP, neutrophil and white blood cell count should be done prior to initiating clozapine and then weekly for the first four weeks. A clinician verifies the blood test results every week before treatment can be approved. An ECG is to be performed prior to clozapine commencement and every week for the first four weeks after initiation of clozapine. A nurse or physician enquires about the signs and symptoms of myocarditis weekly for the first 4 weeks of titration. Target 100% 100% 100% 100% Exceptions None None None None Table 4: Monitoring Prior to initiating (Total number of patients n=53) Week 1 (Total number of patients n=46) Week 2 (Total number of patients n=46) Week 3 (Total number of patients n=46) Week 4   (Total number of patients n=45) ECG Yes 51 (96%) 9 (20%) 11 (24%) 8 (17%) 4 (9%) No 2 (4%) 37 (80%) 35 (76%) 38 (83%) 41 (91%) Blood pressure Taken once 36 (68%) 29 (63%) 26 (56%) 25 (54%) 21 (47%) Taken twice 4 (7.5%) 15 (33%) 15 (33%) 12 (26%) 11 (24%) Not taken 13 (24.5%) 2 (4%) 5 (11%) 9 (20%) 13 (29%) Temperature Yes 39 (74%) 38 (83%) 40 (87%) 37 (80%) 31 (69%) No 14 (26%) 8 (17%) 6 (13%) 9 (20%) 13 (31%) Pulse Yes 42 (79%) 43 (93%) 41 (89%) 37 (80%) 32 (71%) No 11 (21%) 3 (7%) 5 (11%) 9 (20%) 13 (29%) FBC Yes 53 (100%) 45 (98%) 43 (93%) 46 (100%) 43 (96%) No 0 (0%) 1 (2%) 3 (7%) 0 (0%) 2 (4%) CRP Yes 25 (47%) 10 (22%) 11 (24%) 11 (24%) 7 (16%) No 28 (53%) 36 (78%) 35 (76%) 35 (76%) 38 (84%) Troponin Yes 19 (36%) 12 (26%) 9 (20%) 7 (15%) 4 (9%) No 34 (64%) 34 (74%) 37 (80%) 39 (85%) 41 (81%) References 1.Munshi, T.A., et al., Clozapine-induced myocarditis: is mandatory monitoring warranted for its early recognition? Case Rep Psychiatry, 2014. 2014: p. 513108. 2.Aboueid, L. and N. Toteja, Clozapine-Induced Myocarditis: A Case Report of an Adolescent Boy with Intellectual Disability. Case Rep Psychiatry, 2015. 2015: p. 482375. 3.Fineschi, V., et al., Sudden cardiac death due to hypersensitivity myocarditis during clozapine treatment. Int J Legal Med, 2004. 118(5): p. 307-9. 4.Bruno, V., A. Valiente-Gà ³mez, and O. Alcoverro, Clozapine and Fever: A Case of Continued Therapy With Clozapine. Clin Neuropharmacol, 2015. 38(4): p. 151-3. 5.Swart, L.E., et al., Clozapine-induced myocarditis. Schizophr Res, 2016. 174(1-3): p. 161-4. 6.Castle, D., et al., A clinical monitoring system for clozapine. Australas Psychiatry, 2006. 14(2): p. 156-68. 7.Annamraju, S., et al., Early recognition of clozapine-induced myocarditis. J Clin Psychopharmacol, 2007. 27(5): p. 479-83. 8.Murch, S., et al., Echocardiographic monitoring for clozapine cardiac toxicity: lessons from real-world experience. Australas Psychiatry, 2013. 21(3): p. 258-61. 9.Wooltorton, E., Antipsychotic clozapine (Clozaril): myocarditis and cardiovascular toxicity. CMAJ, 2002. 166(9): p. 1185-6. 10.Kar, N., S. Barreto, and R. Chandavarkar, Clozapine Monitoring in Clinical Practice: Beyond the Mandatory Requirement. Clin Psychopharmacol Neurosci, 2016. 14(4): p. 323-329. 11.Cohen, R., et al., A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder. Case Rep Cardiol, 2015. 2015: p. 283156. 12.Merrill, D.B., G.W. Dec, and D.C. Goff, Adverse cardiac effects associated with clozapine. J Clin Psychopharmacol, 2005. 25(1): p. 32-41. 13.Ronaldson, K.J., et al., Clinical course and analysis of ten fatal cases of clozapine-induced myocarditis and comparison with 66 surviving cases. Schizophrenia Research, 2011. 128(1-3): p. 161-165. 14.Haas, S.J., et al., Clozapine-Associated Myocarditis. Drug Safety, 2007. 30(1): p. 47-57. 15.Barry, A.R., J.D. Windram, and M.M. Graham, Clozapine-Associated Myocarditis: Case Report and Literature Review. Can J Hosp Pharm, 2015. 68(5): p. 427-9. 16.Ronaldson, K.J., P.B. Fitzgerald, and J.J. McNeil, Clozapine-induced myocarditis, a widely overlooked adverse reaction. Acta Psychiatr Scand, 2015. 132(4): p. 231-40.

Better Mental Health Care Will Stop Senseless Shootings Essay -- Gun C

Gun control is a topic which has become highly politicized. Mental health is an issue that many people do not understand. The correlation between these two issues is one that many do not see. Shootings have been on the rise and no one can come up with a good reason why. That is where these two seemingly different issues become something that has more in common than most can see. For gun related violence, and violence in general, what is a good method of dealing with these issues and saving lives? Mental health care improvement or gun control? To get a better idea of the two different options and what they may look like, one has to look at the history. The history provides a basis for what has happened with this particular issue in the past and how that might relate to the issue in the future. Mental illness plagues one out of four American citizens. Mental illness varies greatly from person to person. The spectrum of mental illness includes many illnesses including, depression and anxiety as well as some more serious illnesses such as down syndrome. All mental illness plays a role in how this person is going to function in society. These individuals have unique needs and individual strengths that need evaluated for proper care. The early history of mental illness is bleak. The belief that anyone with a mental illness was possessed by a demon or the family was being given a spiritual punishment was the reason behind the horrific treatment of those with mental illness. These individuals were placed into institutions that were unhygienic and typically were kept in dark, cave like rooms away from people in the outside world. The institutions were not only dark and gross; they also used inhumane forms of treatment o... ...shington Times, 28 Oct. 2013. Web. 01 Dec. 2013. Leupo, Kimberly. "The History of Mental Illness." The History of Mental Illness. N.p., n.d. Web. 13 Nov. 2013. Pollack, Harold. "What Happened to U.S. Mental Health Care after Deinstitutionalization." Washingtonpost.com. N.p., 12 June 2013. Web. 13 Nov. 2013. Reed, Samantha. "How We Got Here: The History of Deinstitutionalization." Roosevelt Institute. N.p., 23 July 2010. Web. 13 Nov. 2013. "Reform Is Needed With The Mental Health Care System In America." Political News. N.p., 7 Sept. 2013. Web. 13 Nov. 2013. Sanburn, Josh. "Business & Money." Business Money Americas Gun Economy By the Numbers Comments. Time Magazine, 18 Dec. 2012. Web. 25 Nov. 2013. Sanger-Katz, Margot. "Why Improving Mental Health Would Do Little to End Gun Violence." National Journal (2013). Opposing Viewpoints In Context. Web. 7 Nov. 2013.