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Mental health nursing

Psychiatric nursing or mental health nursing is the appointed position of a nurse that specialises in mental health, and cares for people of all ages experiencing mental illnesses or distress. These include: neurodevelopmental disorders, schizophrenia, schizoaffective disorder, mood disorders, addiction, anxiety disorders, personality disorders, eating disorders, suicidal thoughts, psychosis, paranoia, and self-harm.

Mental health nurses receive specific training in psychological therapies, building a therapeutic alliance, dealing with challenging behaviour, and the administration of psychiatric medication.

In most countries, after the 1990s, a psychiatric nurse would have to attain a bachelor's degree in nursing to become a Registered Nurse (RN), and specialise in mental health. Degrees vary in different countries, and are governed by country-specific regulations. In the United States one can become a RN, and a psychiatric nurse, by completing either a diploma program, an associate (ASN) degree, or a bachelor's (BSN) degree.

Mental health nurses can work in a variety of services, including: Child and Adolescent Mental Health Services (CAMHS), Acute Medical Units (AMUs), Psychiatric Intensive Care Units (PICUs), and Community Mental Health Services (CMHS).

History
The history of psychiatry and psychiatric nursing, although disjointed, can be traced back to ancient philosophical thinkers. Marcus Tullius Cicero, in particular, was the first known person to create a questionnaire for the mentally ill using biographical information to determine the best course of psychological treatment and care. Some of the first known psychiatric care centers were constructed in the Middle East during the 8th century. The medieval Muslim physicians and their attendants relied on clinical observations for diagnosis and treatment.

In 13th century medieval Europe, psychiatric hospitals were built to house the mentally ill, but there were not any nurses to care for them and treatment was rarely provided. These facilities functioned more as a housing unit for the insane. Throughout the high point of Christianity in Europe, hospitals for the mentally ill believed in using religious intervention. The insane were partnered with "soul friends" to help them reconnect with society. Their primary concern was befriending the melancholy and disturbed, forming intimate spiritual relationships. Today, these soul friends are seen as the first modern psychiatric nurses.

In the colonial era of the United States, some settlers adapted community health nursing practices. Individuals with mental defects that were deemed as dangerous were incarcerated or kept in cages, maintained and paid fully by community attendants. Wealthier colonists kept their insane relatives either in their attics or cellars and hired attendants, or nurses, to care for them. In other communities, the mentally ill were sold at auctions as slave labor. Others were forced to leave town. As the population in the colonies expanded, informal care for the community failed and small institutions were established. In 1752 the first "lunatics ward" was opened at the Pennsylvania Hospital which attempted to treat the mentally ill. Attendants used the most modern treatments of the time: purging, bleeding, blistering, and shock techniques. Overall, the attendants caring for the patients believed in treating the institutionalized with respect. They believed if the patients were treated as reasonable people, then they would act as such; if they gave them confidence, then patients would rarely abuse it.

The 1790s saw the beginnings of moral treatment being introduced for people with mental distress. The concept of a safe asylum, proposed by Philippe Pinel and William Tuke, offered protection and care at institutions for patients who had been previously abused or enslaved. In the United States, Dorothea Dix was instrumental in opening 32 state asylums to provide quality care for the ill. Dix also was in charge of the Union Army Nurses during the American Civil War, caring for both Union and Confederate soldiers. Although it was a promising movement, attendants and nurses were often accused of abusing or neglecting the residents and isolating them from their families.

The formal recognition of psychiatry as a modern and legitimate profession occurred in 1808. In Europe, one of the major advocates for mental health nursing to help psychiatrists was Dr. William Ellis. He proposed giving the "keepers of the insane" better pay and training so more respectable, intelligent people would be attracted to the profession. In his 1836 publication of Treatise on Insanity, he openly stated that an established nursing practice calmed depressed patients and gave hope to the hopeless. However, psychiatric nursing was not formalized in the United States until 1882 when Linda Richards opened Boston City College. This was the first school specifically designed to train nurses in psychiatric care.

The discrepancy between the founding of psychiatry and the recognition of trained nurses in the field is largely attributed to the attitudes in the 19th century which opposed training women to work in the medical field.

In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum. The first psychiatric nursing textbook, Nursing Mental Diseases by Harriet Bailey, was not published until 1920. It was not until 1950 when the National League for Nursing required all nursing schools to include a clinical experience in psychiatry to receive national accreditation. The first psychiatric nurses faced difficult working conditions. Overcrowding, under-staffing and poor resources required the continuance of custodial care. They were pressured by an increasing patient population that rose dramatically by the end of the 19th century. As a result, labor organizations formed to fight for better pay and fewer hours. Additionally, large asylums were founded to hold the large number of mentally ill, including the famous Kings Park Psychiatric Center in Long Island, New York. At its peak in the 1950s, the center housed more than 33,000 patients and required its own power plant. Nurses were often called "attendants" to imply a more humanitarian approach to care. During this time, attendants primarily kept the facilities clean and maintained order among the patients. They also carried out orders from the physicians.

In 1963, President John F. Kennedy accelerated the trend towards deinstitutionalization with the Community Mental Health Act. In 1964, the Civil Rights Act was passed, which made it illegal for an organization to discriminate if federally funded. Despite this ruling, certain states such as Mississippi and Alabama fought these laws in court, promoting segregation within healthcare. Moreover, since psychiatric drugs were becoming more available allowing patients to live on their own and the asylums were too expensive, institutions began shutting down. Nursing care thus became more intimate and holistic. Expanded roles were also developed in the 1960s allowing nurses to provide outpatient services such as counseling, psychotherapy, consultations, prescribing medications, along with the diagnosis and treatment of mental illnesses.

The first developed standard of care was created by the psychiatric division of the American Nurses Association (ANA) in 1973. This standard outlined the responsibilities and expected quality of care of nurses.

In 1975, the government published a document called "Better Services for the Mentally Ill" which reviewed the current standards of psychiatric nursing worldwide and laid out better plans for the future of mental health nursing.

Global health care underwent huge expansions in the 1980s; this was due to the government's reaction from the fast increasing demand on health care services. The expansion was continued until the economic crisis of the 1970s.

In 1982, the Area Health Authorities was terminated.

In 1983, better structure of hospitals was implemented. General managers were introduced to make decisions, thus creating a better system of operation. The year 1983 also saw a lot of staff cuts which were heavily felt by all the mental health nurses. However, a new training syllabus was introduced in 1982, which offered suitable knowledgeable nurses.

The 2000s have seen major educational upgrades for nurses to specialize in mental health as well as various financial opportunities.

Interventions
Nursing interventions may be divided into the following categories:

Psychiatric medication
Psychiatric medication is a commonly used intervention and many psychiatric mental health nurses are involved in the administration of medicines, both in oral (e.g. tablet or liquid) form or by intramuscular injection. Nurse practitioners can prescribe medication. Nurses will monitor for side effects and response to these medical treatments by using assessments. Nurses will also offer information on medication so that, where possible, the person in care can make an informed choice, using the best medical-based evidence available.

Electroconvulsive therapy
Psychiatric mental health nurses are also involved in the administration of the treatment of electroconvulsive therapy and assist with the preparation and recovery from the treatment, which involves anesthesia. This treatment is only used in a tiny proportion of cases and only after all other possible treatments have been exhausted. Nurses may also be involved in gaining consent for this procedure. However, consent arrangements vary depending on the jurisdiction in which the treatment takes place.

Physical care
Along with other nurses, psychiatric mental health nurses will intervene in areas of physical need to ensure that people have good levels of personal hygiene, nutrition, sleep, etc., as well as tending to any concomitant physical ailments. In mental health patients, obesity is not rare because some medications can have a side effect of gaining weight which can cause the patient to have low confidence and lead to other health issues. To fix this problem, mental health nurses are urged to encourage patients to get more exercise to enhance their physical health, along with their mental health by improving the patients confidence and lowering stress levels, improving their mental health which has been a focus for mental health nurses because many patients do not get enough exercise. Nurses may also need to help the patients with alcohol or drug abuse because mental health patients are at a higher risk for this behavior. Mental health nurses need to be able to communicate to patients about this. The alcohol and drug abuse could cause the patient to also have a higher risk of sexually transmitted diseases because alcohol and drugs can lead to more sexual behavior.

Psychosocial interventions
Psychosocial interventions are increasingly delivered by nurses in mental health settings. These include psychotherapy interventions, such as cognitive behavioural therapy, family therapy, and less commonly other interventions, such as milieu therapy or psychodynamic approaches. These interventions can be applied to a broad range of problems including psychosis, depression, and anxiety. Nurses will work with people over a period of time and use psychological methods to teach the person psychological techniques that they can then use to aid recovery and help manage any future crisis in their mental health. In practice, these interventions will be used often, in conjunction with psychiatric medications. Psychosocial interventions are based on evidence-based practice, and therefore the techniques tend to follow set guidelines based upon what has been demonstrated to be effective by nursing research. There has been some criticism that evidence based practice is focused primarily on quantitative research and should reflect also a more qualitative research approach that seeks to understand the meaning of people's experience.

Spiritual interventions
The basis of this approach is to look at mental illness or distress from the perspective of a spiritual crisis. Spiritual interventions focus on developing a sense of meaning, purpose, and hope for the person in their current life experience. Spiritual interventions involve listening to the person's story and facilitating the person to connect to God, a greater power or greater whole, perhaps by using meditation or prayer. This may be a religious or non-religious experience depending on the individual's own spirituality. Spiritual interventions, along with psychosocial interventions, emphasize the importance of engagement, however, spiritual interventions focus more on caring and 'being with' the person during their time of crisis, rather than intervening and trying to 'fix' the problem. Spiritual interventions tend to be based on qualitative research and share some similarities with the humanistic approach to psychotherapy.

Therapeutic relationship
As with other areas of nursing practice, psychiatric mental health nursing works within nursing models, utilising nursing care plans, and seeks to care for the whole person. However, the emphasis of mental health nursing is on the development of a therapeutic alliance. In practice, this means that the nurse should seek to engage with the person in care in a positive and collaborative way that will empower the patient to draw on his or her inner resources in addition to any other treatment they may be receiving.

Therapeutic relationship aspects of psychiatric nursing

The most important duty of a psychiatric nurse is to maintain a positive therapeutic relationship with patients in a clinical setting. The fundamental elements of mental health care revolve around the interpersonal relations and interactions established between professionals and clients. Caring for people with mental illnesses demands an intensified presence and a strong desire to be supportive.

Understanding and empathy
Understanding and empathy from psychiatric nurses reinforces a positive psychological balance for patients. Conveying an understanding is important because it provides patients with a sense of importance. The expression of thoughts and feelings should be encouraged without blaming, judging, or belittling. Feeling important is significant to the lives of people who live in a structured society, who often stigmatise the mentally ill because of their disorder. Empowering patients with feelings of importance will bring them closer to the normality they had before the onset of their disorder. When subjected to fierce personal attacks, the psychiatric nurse retained the desire and ability to understand the patient. The ability to quickly empathise with unfortunate situations proves essential. Involvedness is also required when patients expect nursing staff to understand even when they are unable to express their needs verbally. When a psychiatric nurse gains understanding of the patient, the chances of improving overall treatment greatly increases.

Individuality
Individualised care becomes important when nurses need to get to know the patient. To lives this knowledge the psychiatric nurse must see patients as individual people with lives beyond their mental illness. Seeing people as individuals with lives beyond their mental illness is imperative in making patients feel valued and respected. In order to accept the patient as an individual, the psychiatric nurse must not be controlled by his or her own values, or by ideas, and pre-understanding of mental health patients. Individual needs of patients are met by bending the rules of standard interventions and assessment. Psychiatric nurses spoke of the potential to 'bend the rules', which required an interpretation of the unit rules, and the ability to evaluate the risks associated with bending them.

Providing support
Successful therapeutic relationships between nurses and patients need to have positive support. Different methods of providing patients with support include many active responses. Minor activities, such as shopping, reading the newspaper together, or taking lunch or dinner breaks with patients can improve the quality of support provided. Physical support may also be used and is manifested through the use of touch. Patients described feelings of connection when nurses hugged them or put a hand on their shoulder. Psychiatric nurses in Berg and Hallberg's study described an element of a working relationship as comforting through holding a patient's hand. Patients with depression described relief when the nurse embraced them. Physical touch is intended to comfort and console patients who are willing to embrace these sensations and share mutual feelings with nurses.

Being there and being available
In order to make patients feel more comfortable, the patient care providers make themselves more approachable, therefore more readily open to multiple levels of personal connections. Such personal connections have the ability to uplift patients' spirits and secure confidentiality. Utilisation of the quality of time spent with the patient proves to be beneficial. By being available for a proper amount of time, patients open up and disclose personal stories, which enable nurses to understand the meaning behind each story. The outcome results in nurses making every effort to attain a non-biased point of view. A combination of being there and being available allows empirical connections to quell any negative feelings within patients.

Being genuine
The act of being genuine must come from within and be expressed by nurses without reluctance. Genuineness requires the nurse to be natural or authentic in their interactions with the patient. In his article about pivotal moments in therapeutic relationships, Welch found that nurses must be in accordance with their values and beliefs. Along with the previous concept, O'Brien concluded that being consistent and reliable in both punctuality and character makes for genuinity. Schafer and Peternelj-Taylor believe that a nurses 'genuineness' is determined through the level of consistency displayed between their verbal and non-verbal behaviour. Similarly, Scanlon found that genuineness was expressed by fulfilling intended tasks. Self-disclosure proves to be the key to being open and honest. It involves the nurse sharing life experiences and is essential to the development of the therapeutic relationship, because as the relationship grows patients are reluctant to give any more information if they feel the relationship is too one sided. Multiple authors found genuine emotion, such as tearfulness, blunt feedback, and straight talk facilitated the therapeutic relationship in the pursuit of being open and honest. The friendship of a therapeutic relationship is different from a sociable friendship because the therapeutic relationship friendship is asymmetrical in nature. The basic concept of genuineness is centered on being true to one's word. Patients would not trust nurses who fail in complying with what they say or promise.

Promoting equality
For a successful therapeutic relationship to form, a beneficial co-dependency between the nurse and patient must be established. A derogatory view of the patient's role in the clinical setting dilapidates a therapeutic alliance. While patients need nurses to support their recovery, psychiatric nurses need patients to develop skills and experience. Psychiatric nurses convey themselves as team members or facilitators of the relationship, rather than the leaders. By empowering the patient with a sense of control and involvement, nurses encourage the patient's independence. Sole control of certain situations should not be embedded in the nurse. Equal interactions are established when nurses talk to patients one-on-one. Participating in activities that do not make one person more dominant over the other, such as talking about a mutual interest or getting lunch together strengthen the levels of equality shared between professionals and patients. This can also create the "illusion of choice"; giving the patient options, even if limited or confined within structure.

Demonstrating respect
To develop a quality therapeutic relationship, nurses need to make patients feel respected and important. Accepting patient faults and problems is vital to convey respect—helping the patient see themselves as worthy and worthwhile.

Demonstrating clear boundaries
Boundaries are essential for protecting both the patient and the nurse, and maintaining a functional therapeutic relationship. Limit setting helps to shield the patient from embarrassing behaviour, and instills the patient with feelings of safety and containment. Limit setting also protects the nurse from "burnout", preserving personal stability—thus promoting a quality relationship.

Demonstrating self-awareness
Psychiatric nurses recognise personal vulnerability in order to develop professionally. Humanistic insight, basic human values, and self-knowledge improves the depth of understanding the self. Different personalities affect the way psychiatric nurses respond to their patients. The more self-aware, the more knowledge on how to approach interactions with patients nurses have. Interpersonal skills needed to form relationships with patients were acquired through learning about oneself. Clinical supervision was found to provide the opportunity for nurses to reflect on patient relationships, to improve clinical skills, and to help repair difficult relationships. The reflections articulated by nurses through clinical supervision help foster self-awareness.

Pediatric mental health nursing
Nurses are vital to the evaluation and treatment of children with mental illness. Pediatric mental health nursing is the treatment/nursing of mental illness in pediatric patients. Family nurse practitioners (FNPs) are typically expected to evaluate and treat pediatric patients struggling with their mental health. One out of five children experience a mental disorder in a given year, but only 20% receive treatment of said disorder.

Canada
The registered psychiatric nurse is a distinct nursing profession in all of the four western provinces. Such nurses carry the designation "RPN". In Eastern Canada, an Americanized system of psychiatric nursing is followed. Registered Psychiatric Nurses can also work in all three of the territories in Canada; although, the registration process to work in the territories varies as the psychiatric nurses must be licensed by one of the four provinces.

Ireland
In Ireland, mental health nurses undergo a 4-year honors degree training programme. Nurses that trained under the diploma course in Ireland can do a post graduation course to bring their status from diploma to degree.

New Zealand
Mental Health Nurses in New Zealand require a diploma or degree in nursing. All nurses are now trained in both general and mental health, as part of their three-year degree training programme. Mental health nurses are often requested to complete a graduate diploma or a post graduate certificate in mental health, if they are employed by a District Health Board. This gives additional training that is specific to working with people with mental health issues.

Sweden
In Sweden, to become a registered psychiatric nurse one must first become a registered nurse which requires a BSc. (Bachelor of Science) in Nursing (three years of full-time study, 180 higher education credits). Then, one must complete one year of graduate studies in psychiatric/mental health nursing (60 higher education credits), which also includes writing a MSc. (Master of Science) thesis. The registered psychiatric nurse is an evolving profession in Sweden. However, unlike in countries such as the US, there is no psychiatric-mental health nurse practitioner, so in Sweden, the profession cannot for example prescribe pharmacological treatment.

United Kingdom
In the UK and Ireland the term psychiatric nurse has now largely been replaced with mental health nurse. Mental health nurses undergo a 3–4 year training programme at bachelor's degree level, or a 2-year training programme at master's degree level, in common with other nurses. However, most of their training is specific to caring for clients with mental health issues.

RMNs can continue into further training as Advanced Nurse Practitioners (ANPs): this requires completion of a 9-month Master's programme. The role includes prescribing medications, being on call for hospital wards and delivering psychosocial interventions to clients.

United States
In North America, there are three levels of psychiatric nursing.
 * The licensed vocational nurse (licensed practical nurse in some states) and the licensed psychiatric technician may dispense medication and assist with data collection regarding psychiatric and mental health clients.
 * The registered nurse or registered psychiatric nurse has the additional scope of performing assessments and may provide other therapies such as counseling and milieu therapy.
 * The advanced practice registered nurse (APRN) either practices as a clinical nurse specialist or a nurse practitioner after obtaining a master's degree in psychiatric-mental health nursing. Psychiatric-mental health nursing (PMHN) is a nursing specialty. The course work in a master's degree program includes specialty practice. APRNs assess, diagnose, and treat individuals or families with psychiatric problems/disorders or the potential for such disorders, as well as performing the functions associated with the basic level. They provide a full range of primary mental health care services to individuals, families, groups and communities, function as psychotherapists, educators, consultants, advanced case managers, and administrators. In many states, APRNs have the authority to prescribe medications. Qualified to practice independently, psychiatric-mental health APRNs offer direct care services in a variety of settings: mental health centers, community mental health programs, homes, offices, HMOs, etc.

Psychiatric nurses who earn doctoral degrees (PhD, DNSc, EdD) often are found in practice settings, teaching, doing research, or as administrators in hospitals, agencies or schools of nursing.

Australia
In Australia, to be a psychiatric nurse a bachelor's degree of nursing need to be obtained in order to become a registered nurse (RN) and this degree takes three years full-time. Then a diploma in mental health or something similar will need to also be obtained, this is an additional year of study. An Australian psychiatric nurse has duties that may include assessing patients who are mentally ill, observation, helping patients take part in activities, giving medication, observing if the medication is working, assisting in behaviour change programs or visiting patients who are at home. Australian nurses can work in public or private hospitals, institutes, correctional institutes, mental care facilities and homes of the patients.

title: Mental health nursing


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Social dialogue

Social dialogue (or social concertation) is the process whereby social partners (trade unions and employer organisations) negotiate, often in collaboration with the government, to influence the arrangement and development of work-related issues, labour market policies, social protection, taxation or other economic policies. It is a widespread procedure to develop public policies in Western Europe in particular.

These can be direct relations between the social partners themselves ("bipartite") or relations between governmental authorities and the social partners ("tripartite"). To make it more clear, social dialogue can mean negotiation, consultation or simply an exchange of views between representatives of employers, workers and governments. It may consist of relations between labour and management, with or without direct government involvement. Social dialogue is a flexible tool that enables governments and employers’ and workers’ organizations to manage change and achieve economic and social goals.

Examples of social dialogue activity include mutual information, open discussion, concertation (on-going tripartite dialogue), exchanges of opinions, consultation and negotiation (agreements /common opinions).

European social dialogue is enshrined in the Treaty establishing the European Community (articles 138 and 139; ex 118a and 118b) and it is promoted by the European Commission as an instrument for a better governance and promotion of social and economic reforms.

Definition
According to the ILO's definition, it means the practice of tripartism between governments and the representative organizations of workers and employers within and across borders are now more relevant to achieving solutions and to building up social cohesion and the rule of law through, among other means, international labor standards.

Purpose
The aim of social dialogue is to advance opportunities for women and men to obtain decent and productive work in conditions of freedom, equality, security and human dignity.

Enabling conditions
Social dialogue includes all types of negotiation, consultation and exchange of information between, or among, representatives of governments, employers and workers on issues of common interest

1. Respect for the fundamental rights of freedom of association and collective bargaining.

2. Strong, independent workers' and employers' organizations with the technical capacity and knowledge required to participate in social dialogue.

3. Political will and commitment to engage in social dialogue on the part of all parties.

4. Appropriate institutional support.

Means
1. Information sharing：

The inevitable foundation of effective social dialogue is to share information. Even if it doesn’t include discussion or real action, it still have its meaning.

2. Consultation：

Consultation exceeds information sharing, it needs exchanging perspective, opinion, ideas, and forms a deep conversation.

3. Negotiation/Conclude convention：

Some members need to be authorized to form the binding conventions.

4. Collective bargaining：

Collective bargaining is not only the inseparable form in social dialogue, but also be widely used. In every country, Collective bargaining is an indicator to identify the ability of social dialogue’s level.

The dilemma of pushing
Social dialogue faced challenge in some countries. Take Croatia for example, government and social partner couldn’t have consensus on adoption to overcome economic crisis in terms of public cost decrease and job saving through bargaining in several months.

The difference in nations
Social dialogue may take place at different levels and in various form, depending on national circumstances.

France
Social dialogue in France was hard to be national because of the political opposite in groups of social partner. Except for collective bargaining, it highlighted the discussion in tripartism on the issues of employment policy and human resource development. Employment committee in France proceeded consultation and participation of policy establishment on the issues of promoting employment and job training.

Germany
Because of the high coverage rate of unions and employers’ groups in Germany, and less of problems in political and ideological conflicts, social dialogue in national level elaborated higher influence on establishment of national policies. Except for job training and employment security, it also emphasized bargaining and negotiation in work conditions, including shortening of work hours and wage increase.

Austria, Denmark, Ireland and the Netherlands
When European Union (EU) suffered from the high rate of unemployment, there was brilliant performances in terms of macroeconomic development and employment rate in Austria, Denmark, Ireland and the Netherlands at the 1990s. Take 2001 for example, the unemployment rate of other 15 countries in EU was up to 7.4 percent. On the contrary, the unemployment rate of these four countries was merely 3.5 percent. ILO thought that the main reason of these four countries’ success was social dialogue, macroeconomic policies and labor market policies. For instance, the Wassenaar Agreement signed in the Netherlands in 1982, and Denmark advocated the national recovery program with Ireland in 1987. These agreements stood for the will of social partner to solve economic dilemma.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Social dialogue


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Masayuki Nagare

Masayuki Nagare (流 政之) was a modernist Japanese sculptor, nicknamed "Samurai Artist" for his commitment to traditional Japanese aesthetics. He was born in 1923 in Nagasaki to Kojuro Nakagawa, the founder and president of Ritsumeikan University in Kyoto. As a teenager, he received training in the martial arts of a samurai, particularly swordsmanship, and lived in several temples in Kyoto, where he observed the patterns of rocks, plants, and water created by traditional landscape artists.

In 1942, he enrolled at Ritsumeikan University, where he studied Shinto and was apprenticed to a master swordsmith. He left university in 1943 to join the Imperial Japanese Navy and did not return to complete his studies. Nagare served as a Zero Fighter pilot in the Pacific War. After the War, he traveled all over Honshu Island until the mid-1950s, witnessing the desolation of the ruined countryside, developing a thorough understanding of the Japanese landscape, and becoming interested in local crafts such as pottery. His fascination with graveyard tombstones that had survived wartime bombing led to his longtime choice of stone as his preferred medium.

Nagare's art is strongly influenced by Shinto, Zen Buddhism, and traditional Japanese martial arts. His principal stone-carving techniques include warehada ("cracked skin" or "broken texture"), in which the surface is left rough, with visible chisel marks, and shinogi awase ("ridges joined together"), which describes the meeting of two highly polished surfaces. Some of his works exhibit the contrast between the two techniques. His sculptures' clean lines often follow the subtle curvature of Japanese swords.

Nagare's works include Cloud Fortress, which survived the 9/11 attacks at the World Trade Center (New York City) but was destroyed in the rescue and recovery efforts, Sakimori (Frontier Guardian) installed in the Honolulu Museum of Art, Hamaritsurin Garden in Seto Ohashi Commemorative Park (Kagawa Prefecture, Japan), Receiving (受 Ju) stored at the Museum of Modern Art in New York City,  and Transcendence (informally called The Banker's Heart by locals) installed in A.P. Giannini Plaza at 555 California Street (formerly the Bank of America building) in San Francisco, California. He died in July 2018 at the age of 95.

title: Masayuki Nagare


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Packanack Lake, New Jersey

Packanack Lake is an unincorporated lake community and census-designated place (CDP) in Wayne in Passaic County, in the U.S. state of New Jersey. The community is located 30 minutes northwest of Manhattan.

The median income in Packanack Lake was $100,887, and the average income of households with children was $140,869. 95.9% of Packanack area residents are high school graduates while 57.5% are college graduates. 77.4% of residents are married. 41.4% of residents had children. The average age of residents was 40.6 years old.

Gatherings and social events are held on both East Beach (on Lake Drive East) and West Beach (on Lake Drive West) which include band concerts, craft shows, and bonfires.

Demographics
As of the 2020 United States census, the population was 6,261.

Overview
Packanack's neighborhoods include; Packanack Estates, Packanack Lake, Packanack Manor, Packanack Ridge, and Packanack Woods. Members of the Packanack Lake Community Association, also known as Packanack Lake Country Club, can use the tennis club and golf club located on Osborne Terrace. Packanack residents can send their grammar school-aged children to the Packanack School, located at 190 Oakwood Drive, and residents can also send their high school aged children to Wayne Valley High School or the many private schools in and around the township of Wayne. There are summer camps and activities for the children who live in the lake which include golf lessons, sailing lessons and competitively swimming on the Lake's swim team, The Packanack Pirates. The Packanack Lake Association collects dues from Packanack Lake residents for the purpose of funding the upkeep and use of lake activities.

Transportation to business/commercial centers throughout North Jersey is via Route 3, Route 4, Route 20, Route 21, Route 23, U.S. Route 46, Interstate 80, Interstate 287 and the Garden State Parkway. Train stations and "Park and Rides" provide access to North Jersey suburbs and New York City.

Nearby country clubs include the Preakness Hills Country Club located on Ratzer Road and the North Jersey Country Club located on Hamburg Turnpike.

History
The Packanack community began long ago when Native Americans farmed, fished and hunted in the area. One tribe, the Pacquanacs, are still remembered in the very name Packanack which is said to mean appropriately "land made clear for cultivation".

In 1780, it was farming country and marshlands not far from the Continental Army encampment of French and American soldiers. Close by were the headquarters of General George Washington at the Dey Mansion and Major-General Marquis de Lafayette at the Van Saun House. They still can be seen today.

Geology
The Packanack area sits on two ridges running in roughly a north-south direction separated by a valley of marshland that in 1928 would be cleared of trees and brush; blocked at the south with an earth and clay dam to form Packanack Lake. That was when Joseph T. Castles, who had purchased 26 farms covering approximately 700 acres of these ridges and valley in 1925, began laying the groundwork for the development of a community. The lake itself is man-made.

title: Packanack Lake, New Jersey


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User talk:Sushidroid

Welcome!

Hello, and welcome to Wikipedia. Thank you for your contributions. I hope you like the place and decide to stay. Here are a few good links for newcomers: I hope you enjoy editing here and being a Wikipedian! By the way, please be sure to sign your name on Talk and vote pages using four tildes (~~~~) to produce your name and the current date, or three tildes (~~~) for just your name. If you have any questions, see the help pages, add a question to the village pump or ask me on my Talk page. Again, welcome!
 * The Five Pillars of Wikipedia
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-Poli (talk • contribs) 14:56, 2005 July 26 (UTC)

title: User talk:Sushidroid


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Braciola

Braciola (: braciole, ) may refer to several distinct dishes in Italian cuisine.

Cut of meat
Braciola may refer to an Italian dish consisting of slices of meat that are pan-fried or grilled, often in their own juice or in a small amount of light olive oil. They are different from the finer cut fettine ('small/thin slices'), which never have bone and are generally thinner.

The French version, brageole, is made from rolls of meat, essentially beef chuck cutlets, seasoned inside with garlic, parsley, salt and pepper. The meat is usually pan-fried or grilled.

Involtini
In Sicilian cuisine, Italian-American cuisine and Italian Australian cuisine, braciola (: braciole) are thin slices of meat (typically pork, chicken, beef, or swordfish) that are rolled as a roulade (this category of rolled food is known as involtini in Italian) with cheese and breadcrumbs and fried. In Sicilian, this dish is also called bruciuluni.

Braciole can be cooked along with meatballs and Italian sausage in a Neapolitan ragù or tomato sauce, which some call sarsa or succu (Sicilian), or Sunday gravy in some areas of the northeastern United States. They can also be prepared without tomato sauce. There exist many variations on the recipe, including variations of cheese and the addition of vegetables, such as eggplant. Braciole are not exclusively eaten as a main dish, but also as a side dish at dinner, or in a sandwich at lunch.

After being stuffed and rolled, braciole are often tied with string or pinned with wooden toothpicks to hold in the stuffing. After pan-frying to brown, the rolls of meat are placed into the sauce to finish cooking, still secured with string or toothpicks.

title: Braciola


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Curtis Borchardt

Curtis Alan Borchardt (born September 13, 1980) is an American former professional basketball player. He is a 7 ft 0 in (2.13 m) tall center.

Amateur career
Borchardt played high school basketball in Sammamish, Washington (then Redmond), for Eastlake High School. He then attended Stanford University, where he was an honorable mention All-American as a junior in 2002.

Pro career
Borchardt was selected 18th overall in the first round by the Orlando Magic in the 2002 NBA draft but was traded to the Utah Jazz. Injury-prone in college, this continued as he sat out his rookie season. He made his Jazz debut in the 2003–04 campaign. He was dealt to the Boston Celtics as part of the largest trade in NBA history – a 13-player, 5-team deal on August 2, 2005. He was not included on Boston's roster in 2005–06 but played with them in the preseason, scoring seven points in seven games.

Borchardt's final NBA game was on April 12, 2005, in a 85–94 loss to the Los Angeles Clippers where he recorded 2 points and 2 rebounds. Borchardt played a total of 83 NBA career games from 2003 - 2005 and averaged 3.1 points and 3.3 rebounds.

He moved to the Spanish League club Granada in December 2005. In 2009, he joined the French League club ASVEL.

In 2012, Borchardt signed with Blancos de Rueda Valladolid of Liga ACB.

Awards and achievements:
 * 2008–09 ACB league leader in rebounding.
 * 2006–07 ACB league leader in rebounding and valuation (Player Efficiency).
 * 13-time Spanish ACB Player of the Week and 5-time Player of the Month designations 2005–12.
 * All Rocky Mountain Review NBA Summer League 1st Team 2004.
 * Selected 18th overall in the 1st round of the 2002 NBA draft by the Orlando Magic then traded to the Utah Jazz.
 * 2001–02 1st Team All-Pac-10 and AP Honorable Mention All American
 * 2001–02 Stanford's Hank Luisetti Team Most Valuable Player and Best Defensive Player
 * Set Stanford Men's Basketball Single Season Record for Blocks (85) during the 2001–02 season and currently ranks 2nd in the school's Career Blocks list at (145).
 * 2-time Pac-10 Men's Basketball conference champion at Stanford during the 1999–2000 and 2000–01 seasons.

Personal life
His wife, Susan King Borchardt, also played college basketball at Stanford University and later played professionally for the Minnesota Lynx in the WNBA.

title: Curtis Borchardt


text:
Leon Felton

Leon Felton (born December 9, 1979) is a Rhodesian/Australian former professional rugby league footballer who played in the 2000s. He played at club level for Canterbury Bulldogs, St. Helens, Warrington Wolves (Heritage № 1020), and Leigh Centurions (loan), as a, or.

title: Leon Felton


text:
File:Os Belenenses.png

Licensing
lt:Vaizdas:Os Belenenses.png

title: File:Os Belenenses.png


text:
Henry Kirke Brown

Henry Kirke Brown (February 24, 1814 in Leyden, Massachusetts – July 10, 1886 in Newburgh, New York) was an American sculptor.

Life
He began to paint portraits while still a boy, studied painting in Boston under Chester Harding, learned a little about modelling, and in 1836-1839 spent his summers working as a railroad engineer to earn enough to enable him to study further.

He spent four years (1842–1846) in Italy; but returning to New York he wanted to ensure he remained distinctively American. He bemoaned the fact that so many of the early American sculptors were dominated by Italian influence. Even so, his work combines American subject matter with the style of the Italian masters, such as Donatello.

He produced the small, bronze statuette The Choosing of the Arrow for distribution by the American Art Union, in 1849. His equestrian statues are excellent, notably that of George Washington (1856) in Union Square, New York City, which was the second equestrian statue made in the United States, following by three years that of Andrew Jackson in Washington, D.C. by Clark Mills (1815–1883), and of Brevet Lt. General Winfield Scott (1874) in Washington, D.C.. Brown was one of the first in America to cast his own bronzes. In 1847, Brown was elected into the National Academy of Design as an Associate member, and became a full member in 1851.

Among his other works are: statue of Abraham Lincoln (Union Square, New York City); Nathanael Greene, George Clinton, Philip Kearny, and Richard Stockton (all in the National Statuary Hall, United States Capitol, Washington, D.C.); De Witt Clinton (illustration, below) and The Angel of the Resurrection, both in Green-Wood Cemetery, Brooklyn, New York; and an Aboriginal Hunter.

The New York Times remarked that the DeWitt Clinton was the first American full-length sculpture cast in a single piece, when it was exhibited temporarily in City Hall Park in 1855.

Family
His nephew and adopted son, Henry Kirke Bush-Brown, was also a sculptor and pupil of Brown's.

Additional information

 * Henry Kirke Brown Papers, 1814-1886, Sophia Smith Collection, Smith College.

title: Henry Kirke Brown


text:
Andrzej Romocki

Andrzej Romocki, codename "Morro" (16 April 1923 - 15 September 1944, was a Polish Scoutmaster (harcmistrz) who attained the rank of captain in the Armia Krajowa (Polish Home Army, AK) during World War II.

Romocki was active in the Szare Szeregi (Gray Ranks) organisation from 1940 onwards and during the Warsaw Uprising he was the commander of the Rudy Company of the AK Zośka Battalion. He took command of the whole battalion on 31 August 1944 until his death in the Czerniaków district on 15 September. It's possible that he was killed as a result of "friendly fire" by soldiers of the Ludowe Wojsko Polskie (LWP, People's Army of Poland).

Wola and Starówka
The Zośka Battalion fought in the most difficult areas of Warsaw throughout the uprising. At the beginning of August 1944, Zośka was stationed in the Wola district, where, after early successes by the insurgents, which included the liberation of 350 Jews from the Gęsiówka concentration camp, the Germans launched their first major counter-offensive of the uprising (and also committed some of their worst atrocities - the Wola massacre). After 11 August, when Wola fell, Romocki and the entire Zośka Battalion relocated to Warsaw Old Town ("Starówka" or "Stare Miasto" in Polish), where they fought valiantly for the next three weeks.

By the end of August the Germans were bombing the encircled Old Town from the air every 15–20 minutes while their artillery also shelled the area throughout the day. Wave after wave of attacks by German tanks, Goliath tracked mines and infantry had been repelled by the insurgents despite heavy casualties, but they were nevertheless gradually losing ground to the vastly superior forces deployed against them, while also running out of ammunition, medical supplies, food and water.

After a failed attempt to break out of their encirclement and re-connect the Old Town with the city centre to the south and Żoliborz to the north on 30–31 August, the AK took the reluctant decision to evacuate from the Old Town via the sewers.

Only insurgents from the Zośka Battalion, commanded by Romocki, managed to escape from the Old Town to the city centre on 31 August. At one point they took off their red and white armbands and marched through enemy-held territory as if they were Germans (like many of the insurgents they wore stolen German uniforms adorned with Polish insignia). Zośka lost so many soldiers during the first month of the uprising that Romocki, despite himself being wounded in the face during the escape, became commander of the whole battalion after it relocated to the city centre.

Czerniaków
In early September Zośka was redeployed to the Czerniaków district, on the left bank of the river Vistula. On 15 September 1944, units of the LWP made their first attempt to cross the river and link up with the insurgents in Czerniaków, in spite of Joseph Stalin's ban. The exact circumstances of Romocki's death are uncertain, but it is possible that he was accidentally killed by a soldier of the LWP who mistook Romocki for a German due to the fact that he was wearing a German uniform.

Awards

 * Virtuti Militari, V class
 * Cross of Valour (Krzyż Walecznych), twice
 * Home Army Cross (Krzyż Armii Krajowej) (16 July 1985)

title: Andrzej Romocki


text:
The Captain's Paradise

The Captain's Paradise is a 1953 British comedy film produced and directed by Anthony Kimmins, and starring Alec Guinness, Yvonne De Carlo and Celia Johnson. Guinness plays the captain of a passenger ship that travels regularly between Gibraltar and Spanish Morocco. De Carlo plays his Moroccan wife and Johnson plays his British wife. The film begins at just before the end of the story, which is then told in a series of flashbacks.

In 1958, the story was made into a Broadway musical comedy, retitled Oh, Captain!.

Plot
In early 1950s North Africa, a man (Alec Guinness) is escorted through an angry crowd by a platoon of soldiers. They enter a fort, and it is clear he is to be executed. The commander (Peter Bull) orders the soldiers to line up. He gives them orders to aim and fire. As the shots ring out, the scene shifts to a ferry ship, The Golden Fleece. Passengers embark for the two-day journey from Morocco to Gibraltar. Among them is an elderly gentleman, Lawrence St. James (Miles Malleson), who has come to speak with his nephew, the ship's captain, Henry St. James, on an unspecified matter. He is shocked to learn from the captain's first mate, Carlos Ricco (Charles Goldner), that he is dead. He begs Ricco to explain what happened. He learns that Henry, the prosperous owner and skipper of the ship, ferried passengers regularly between Gibraltar and North Africa.

In flashback, we witness Henry St. James keeping two separate relationships: (1) In Morocco, he lives with his lover, Nita (Yvonne De Carlo) – a young, tempestuous woman, 23 years younger than himself. He takes her out every night to fashionable restaurants and night clubs, celebrating a wild lifestyle. (2) In Gibraltar, he shares his life with Maud (Celia Johnson) – his devoted wife, 15 years his junior – living a respectable, sober existence, and going to bed every night no later than ten. In Morocco, Henry presents Nita with lingerie and bikinis. But in Gibraltar, he buys Maud a vacuum cleaner. Both are delighted. On board his ship, he rejects all female company, choosing intellectual discussions with male passengers at his Captain's table. He has found a perfect existence – paradise. But it won't last.

All it takes is one careless mistake on the part of Henry. This leads to Ricco, up until then believing Nita to be the captain's wife, discovering that the true Mrs. St. James lives in Gibraltar. Ricco assists St. James in maintaining the deception when Maud flies to Morocco and by chance meets Nita. Henry arranges to have Maud arrested before she and Nita realise they are married to the same man. He convinces Maud that Morocco is a dangerous place and that she should never return there. The years pass. Maud has twins. She is thrilled with her two boys, but when they are sent to school in England, Maud is no longer enamoured with her marriage. She wants to dance and drink gin. On the other hand, Nita wants to stay home and cook for her man. Henry is dismayed and makes every effort to keep everything just the way it was. His attempts to maintain the status quo result in both women taking lovers. When Henry discovers Nita's infidelity, he leaves the flat as she continues the argument with her lover, Absalom. Nita shoots and kills her lover. In order to protect Nita, Henry claims he was the killer.

Return to the execution. Upon being given the order to aim and fire, the soldiers swing their rifles away from Henry and shoot their commanding officer. Henry hands them money and walks away.

Cast

 * Alec Guinness – Captain Henry St. James
 * Charles Goldner – Chief Officer Carlos Ricco
 * Miles Malleson – Lawrence St. James
 * Yvonne De Carlo – Nita
 * Celia Johnson – Maud
 * Bill Fraser – Absalom
 * Peter Bull – Firing-squad commander
 * Nicholas Phipps – The Major
 * Ambrosine Phillpotts – Marjorie
 * Ferdy Mayne – The Sheikh
 * Sebastian Cabot – Ali (vendor)
 * Arthur Gomez – Chief steward
 * George Benson – Mr. Salmon
 * Bernard Rebel – Mr Wheeler
 * Joyce Barbour – Mrs Reid, the housekeeper
 * Claudia Grey – Susan Dailey
 * Ann Hefferman – Daphne Bligh
 * Walter Crisham – Bob
 * Roger Delgado – Kalikan policeman

Production
The film was based on an original story by Alec Coppel. Nicholas Phipps wrote the script.

The original title was Paradise. In 1951, it was announced that Rex Harrison and Lilli Palmer would star. The following year press reports said Laurence Olivier and Vivien Leigh were going to star, with Olivier to direct and Alex Korda to possibly produce.

Olivier and Leigh became unavailable. According to Yvonne De Carlo, when she was offered her role by director Anthony Kimmins, she agreed to do it if Alec Guinness played the lead. Kimmins said it was unlikely to get Guinness and that they would probably go for Ray Milland or Michael Wilding; De Carlo urged they try Guinness anyway and the actor accepted. Alec Guinness had a contract with Alex Korda to make one film a year - his casting was announced in Variety in October 1952. Celia Johnson signed to play the other lead.

Kimmins said: "We're trying to show man's triple side... there's the domestic wife – pipe and slippers side; then the jungle side – the girl-in-port sort of thing. Then there's the conversational, man-to-man side... And naturally we stay tongue in cheek throughout so we don't expect to wreck any homes."

Filming finished in March 1953. Yvonne De Carlo said she enjoyed the film because she "got the chance to act". She found working with Guinness "an exhilarating experience".

UK release
The film was a hit at the British box office.

US release
The film was refused approval by the US Production Code on the ground it was immoral because the lead character was a bigamist. An extra scene was shot to say St James only lived with Nita in North Africa, he was not married to her, he was only married to Maud. This allowed the film to be released.

There were further issues with censors in the US. The film was banned in Maryland because it "made light of marriage".

Eventually further changes were made. A line referring to Guinness' character as a "saint" was cut, and an epilogue added to the end which stated the film was only a fairytale.

The movie was seen widely in the USA. A Variety article in January 1954 said: "Rising popularity of Britain's Alec Guinness among U. S. pic audiences is reflected in the fact that... [the film] is expected to outgross all that has gone before it... it has grossed $350,000 so far in 29 dates and is being helped along also by its much publicized difficulties with both the Production Code and local censors. If it continues its present pace, “Paradise” may gross more than the three prior Guinness pix together. “Lavender Hill Mob” so far has done $580,000; “Man in the White Suit” $460,000, and “The Promoter” $480,000." In April 1954, Variety observed: "Guinness films have usually won praise from the key-city critics but until now had limited pull beyond the “art' circuit. But with his current “Captain's Paradise” he's now bigtime b.o. Pic... figures to ring up $1,000,000 in theatre rentals in the U. S. and Canada...“Paradise' has chalked up $630,000 in distribution loot in less than 1,500 dates. UA figures the film is a cinch to play a total of 5,000 bookings— exhibitor deals are being set at the rate of over 200 a week — and on this basis the $1,000,000 in total rentals looks for sure. Pic has been an especially remarkable click at the Paris Theatre, N.. Y., where the run is now in its 30th week and likely will continue for about another month." By November 1954 it had earned $900,000.

Critical reviews
In the Winter 2022/3 edition of The UK's Media Education Journal Colin McArthur in an essay 'Unacknowledged Parable of (de)Colonialisation' he explores the film in terms of its 'serious account of the inevitability of decolonialisation.

DVD
Included as part of the Alec Guinness Collection,The Captain's Paradise was released on DVD in September 2002.

title: The Captain's Paradise


text:
Isotope hydrology

Isotope hydrology is a field of geochemistry and hydrology that uses naturally occurring stable and radioactive isotopic techniques to evaluate the age and origins of surface and groundwater and the processes within the atmospheric hydrologic cycle. Isotope hydrology applications are highly diverse, and used for informing water-use policy, mapping aquifers, conserving water supplies, assessing sources of water pollution, investigating surface-groundwater interaction, refining groundwater flow models, and increasingly are used in eco-hydrology to study human impacts on all dimensions of the hydrological cycle and ecosystem services.

Details
Water molecules carry unique isotopic "fingerprints", based in part on differing ratios of the oxygen and hydrogen isotopes that constitute the water molecule. Isotopes are atoms of the same element that have a different number of neutrons in their nuclei.

Air, freshwater and seawater contain mostly oxygen-16 ( 16O). Oxygen-18 (18O) occurs in approximately one oxygen atom in every five hundred and has a slightly higher mass than oxygen-16, as it has two extra neutrons. From a simple energy and bond breakage standpoint this results in a preference for evaporating the lighter 16O containing water and leaving more of the  18O water behind in the liquid state (called isotope fractionation). Thus seawater tends to contain more 18O than rain and snow.

Dissolved ions in surface and groundwater water also contain useful isotopes for hydrological investigations. Dissolved species like sulfate and nitrate contain differing ratios of 34-S to 32-S or 15-N to 14-N, and are often diagnostic of pollutant sources. Natural radioisotopes like tritium (3-H) and radiocarbon (14-C) are also used as natural clocks to determine the residence times of water in aquifers, rivers, and the oceans.

Applications
The most commonly used isotope application in hydrology uses hydrogen and oxygen isotopes to evaluate sources or age of water, ice or snow. Isotopes in ice cores help to reveal conditions of past climate. Higher average global temperature would provide more energy and thus an increase the atmospheric 18O content of rain or snow, so that lower than modern amounts of 18O in groundwater or ice layer imply the water or ice represents a period of cooler climatic eras or even ice ages.

Another application involves the separation of groundwater flow and baseflow from streamflow in the field of catchment hydrology (i.e. a method of hydrograph separation). Since precipitation in each rain or snowfall event has a specific isotopic signature, and subsurface water can be identified by well sampling, the composite signature in the stream is an indicator the proportion of the streamflow comes from overland flow and what portion comes from subsurface flow.

Stable isotopes in the water molecule are also useful in tracing the sources (or proportion of sources) of water that plants use.

Current use
The isotope hydrology program at the International Atomic Energy Agency works to aid developing states to create a detailed portrait of Earth's water resources.

In Ethiopia, Libya, Chad, Egypt and Sudan, the International Atomic Energy Agency used radioisotope techniques to help local water policy identify and conserve fossil water.

The International Atomic Energy Agency maintains a publicly accessible global network and isotopic database for Earth's rainfall and rivers.

title: Isotope hydrology


text:
Old School (novel)

Old School is an American semi-autobiographical coming-of-age novel by Tobias Wolff that was first partially published in The New Yorker as a short story ahead of novelization in 2003. It acts a memoir for a fictional unnamed writer, who recalls his senior year at a New England preparatory school in 1960–1961. The novel explores intertwining themes of identity, class, belonging and literature. It was a finalist for the 2004 PEN/Faulkner Award for Fiction.

Plot
The book is narrated by a school senior ("sixth former" in prep-school vernacular) at an unnamed elite boarding school in the northeastern United States in 1960–61. The unnamed protagonist is a scholarship student who comes from a middle-class family.

He aspires to be a writer, and the school he attends is an embodiment of a certain kind of academic fantasy, where non-English masters (teachers are "masters" here) "floated at the fringe of [the English masters'] circle, as if warming themselves at a fire," and literature is still believed to hold the key to the soul. Robert Frost, Ayn Rand, and Ernest Hemingway, with each of whom the narrator crosses paths, appear in the story, dispensing wisdom, pseudo-wisdom, vitriol. These literary appearances amount to creative satires of these authors, especially Ayn Rand. The novel revolves around themes of adolescence, class, and the role of literature.

The Penguin Random House publisher's blurb describes the book thus: "The protagonist of Tobias Wolff's shrewdly—and at times devastatingly—observed first novel is a boy at an elite prep school in 1960. He is an outsider who has learned to mimic the negligent manner of his more privileged classmates. Like many of them, he wants more than anything on earth to become a writer. But to do that he must first learn to tell the truth about himself. The agency of revelation is the school literary contest, whose winner will be awarded an audience with the most legendary writer of his time. As the fever of competition infects the boy and his classmates, fraying alliances, exposing weaknesses, Old School explores the ensuing deceptions and betrayals with an unblinking eye and a bottomless store of empathy. The result is further evidence that Wolff is an authentic American master."

In his review for the New York Times, critic A.O. Scott writes that Old School is "about nothing if not the making of a writer — though it is also, just as plainly, about a writer's failure."

Reception
Carmela Ciucaru of the Los Angeles Times wrote "In Old School, Wolff again proves himself a writer of the highest order: part storyteller, part philosopher, someone deeply engaged in asking hard questions that take a lifetime to resolve". In The Guardian, Blake Morrison called Old School a "concise, beautifully written novel" and praised Wolff for taking the "courage, in 2004, to write with nuance and affection about an all-male boarding school".

Michael Upchurch of the Seattle Times suggested that despite being written as a novel, "in period, place and emotional feel, it's clearly the link between This Boy's Life and Wolff's Vietnam War memoir, In Pharaoh's Army." He calls it "a slippery mix of truth and fiction" believing the material to be largely autobiographical. He notes that the epigraph contains lines from the poem "Elegy for my Father" by Mark Strand hinting at why Wolff chose to write a novel.

Accolades
Old School was a finalist for the 2004 PEN/Faulkner Award for Fiction. The novel was chosen as a National Endowment for the Arts "Big Read" book for communities to read together. The Libraries of Greater Kansas City chose Old School as their Big Read in 2009.

title: Old School (novel)


text:
User talk:Darc

Welcome
Welcome!

Hello,, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are a few good links for newcomers: I hope you enjoy editing here and being a Wikipedian! Please sign your name on talk pages using four tildes (~~); this will automatically produce your name and the date. If you need help, check out Where to ask a question, ask me on my talk page, or place  on your talk page and someone will show up shortly to answer your questions. Again, welcome! -- ZeWrestler  Talk 15:01, 26 July 2005 (UTC)
 * The five pillars of Wikipedia
 * How to edit a page
 * Help pages
 * Tutorial
 * How to write a great article
 * Manual of Style

title: User talk:Darc


text:
INDICARE

Goal
The overall goal of INDICARE (The INformed DIalogue about Consumer Acceptability of DRM Solutions in Europe) was to help to reconcile heterogeneous interests of multiple stakeholders, and to support the emergence of a common European position with regard to consumer and user issues of Digital Rights Management (DRM) solutions.

eContent
INDICARE responded to the 3rd call, subline 3.3: Management of rights for digital content, of the eContent Programme of the European Commission, DG Information Society. INDICARE, a so-called Accompanying Measure, was initiated March 2004 and was scheduled for two years (Ref.: EDC - 53042 INDICARE / 28609). eContent was replaced by eContentplus as of 9 March 2005.

Focus
INDICARE addresses problems pointed out in the eContent Work Programme 2003–2004: “There has been little attention to the consumer side of managing rights. Questions remain open as to the level of consumer acceptability of rights management solutions. Interface and functionality of systems, as well as policy issues linked to privacy and access to information should be the investigated. The consumer question also involves the easiness of access, the legitimate use of content and business models and the easiness of access for disabled persons” (p. 19). In addition to consumer issues, INDICARE addresses the user side, in particular concerns of creators and small and medium-sized information providers.

Approach
The INDICARE project establishes and maintains an informed dialogue about consumer and user issues of DRM. Informed dialogue means that discussions will be stimulated and informed by good quality input such as news information and profound analyses (see below). Part of the input will be derived from interdisciplinary in-depth research of the INDICARE partners as well as from knowledge of experts and stakeholders co-operating with INDICARE.

Project Consortium

 * Institute for Technology Assessment and Systems Analysis (ITAS), Karlsruhe, Germany (Project Initiator and Co-ordinator)
 * Institute for Information Law (IViR), University of Amsterdam, the Netherlands
 * Department of Measurement and Information Systems, Budapest University of Technology and Economics, Hungary
 * Berlecon Research GmbH, Berlin, Germany

title: INDICARE


text:
Joachim Rouault

Joachim Rouault (died 1478), a French soldier, was a member of an old family of Poitou. He attached himself to the Dauphin (afterwards Louis XI) and became his premier squire.

He followed Louis in his expedition against the Swiss in 1444, distinguished himself in the war against England in 1448, and received the posts of governor of Blaye and Fronsac and constable of Bordeaux. After taking an important part in the Battle of Castillon (1453), which resulted in the defeat and death of John Talbot, 1st Earl of Shrewsbury, he fought against Jean V of Armagnac in 1455. In the following year, he made a fruitless expedition into Scotland.

He took part in the campaign in Catalonia, and became Marshal of France in 1461, and governor of Paris in 1471. In 1471 and 1472 he defended Amiens and Beauvais against the Burgundian State. Towards the end of his life, he was disgraced by Louis XI and sentenced to banishment and the confiscation of his property.

title: Joachim Rouault


text:
Nerve growth factor

Nerve growth factor (NGF) is a neurotrophic factor and neuropeptide primarily involved in the regulation of growth, maintenance, proliferation, and survival of certain target neurons. It is perhaps the prototypical growth factor, in that it was one of the first to be described. Since it was first isolated by Nobel Laureates Rita Levi-Montalcini and Stanley Cohen in 1956, numerous biological processes involving NGF have been identified, two of them being the survival of pancreatic beta cells and the regulation of the immune system.

Structure
NGF is initially in a 7S, 130-kDa complex of 3 proteins – Alpha-NGF, Beta-NGF, and Gamma-NGF (2:1:2 ratio) when expressed. This form of NGF is also referred to as proNGF (NGF precursor). The gamma subunit of this complex acts as a serine protease, and cleaves the N-terminal of the beta subunit, thereby activating the protein into functional NGF.

The term nerve growth factor usually refers to the 2.5S, 26-kDa beta subunit of the protein, the only component of the 7S NGF complex that is biologically active (i.e. acting as a signaling molecule).

Function
As its name suggests, NGF is involved primarily in the growth, as well as the maintenance, proliferation, and survival of nerve cells (neurons) and is critical for the survival and maintenance of sympathetic and sensory neurons as they undergo apoptosis in its absence. However, several recent studies suggest that NGF is also involved in pathways besides those regulating the life cycle of neurons.

Neuronal proliferation
NGF can drive the expression of genes such as bcl-2 by binding to the Tropomyosin receptor kinase A, which stimulates the proliferation and survival of the target neuron.

High affinity binding between proNGF, sortilin, and p75NTR can result in either survival or programmed cell death. Study results indicate that superior cervical ganglia neurons that express both p75NTR and TrkA die when treated with proNGF, while NGF treatment of these same neurons results in survival and axonal growth. Survival and PCD mechanisms are mediated through adaptor protein binding to the death domain of the p75NTR cytoplasmic tail. Survival occurs when recruited cytoplasmic adaptor proteins facilitate signal transduction through tumor necrosis factor receptor members such as TRAF6, which results in the release of nuclear factor κB (NF-κB) transcription activator. NF-κB regulates nuclear gene transcription to promote cell survival. Alternatively, programmed cell death occurs when TRAF6 and neurotrophin receptor interacting factor (NRIF) are both recruited to activate c-Jun N-terminal kinase (JNK); which phosphorylates c-Jun. The activated transcription factor c-Jun regulates nuclear transcription via AP-1 to increase pro-apoptotic gene transcription.

Proliferation of pancreatic beta cells
There is evidence that pancreatic beta cells express both the TrkA and p75NTR receptors of NGF. It has been shown that the withdrawal of NGF induces apoptosis in pancreatic beta cells, signifying that NGF may play a critical role in the maintenance and survival of pancreatic beta cells.

Regulation of the immune system
NGF plays a critical role in the regulation of both innate and acquired immunity. In the process of inflammation, NGF is released in high concentrations by mast cells, and induces axonal outgrowth in nearby nociceptive neurons. This leads to increased pain perception in areas under inflammation. In acquired immunity, NGF is produced by the Thymus as well as CD4+ T cell clones, inducing a cascade of maturation of T cells under infection.

Ovulation
NGF is abundant in seminal plasma. Recent studies have found that it induces ovulation in some mammals e.g. "induced" ovulators, such as llamas. Surprisingly, research showed that these induced animals will also ovulate when semen from on-schedule or "spontaneous" ovulators, such as cattle is used. Its significance in humans is unknown. It was previously dubbed ovulation-inducing factor (OIF) in semen before it was identified as beta-NGF in 2012.

Mechanism of action
NGF binds with at least two classes of receptors: the tropomyosin receptor kinase A (TrkA) and low-affinity NGF receptor (LNGFR/p75NTR). Both are associated with neurodegenerative disorders.

When NGF binds to the TrkA receptor, it drives the homodimerization of the receptor, which in turn causes the autophosphorylation of the tyrosine kinase segment. The tropomyosin receptor kinase A receptor has five extracellular domains, and the fifth domain is sufficient in binding NGF. Once bound, the complex undergoes endocytosis and activates the NGF transcriptional program, following two major pathways, the Ras/MAPK pathway and the PI3K/Akt pathway. The binding of NGF to TrkA also leads to the activation of PI 3-kinase, ras, and PLC signaling pathways. Alternatively, the p75NTR receptor can form a heterodimer with TrkA, which has higher affinity and specificity for NGF.

Studies suggest that NGF circulates throughout the entire body via the blood plasma, and is important for the overall maintenance of homeostasis.

Neuron survival
Binding interaction between NGF and the TrkA receptor facilitates receptor dimerization and tyrosine residue phosphorylation of the cytoplasmic tail by adjacent Trk receptors. Trk receptor phosphorylation sites operate as Shc adaptor protein docking sites, which undergo phosphorylation by the TrkA receptor Once the cytoplasmic adaptor protein (Shc) is phosphorylated by the receptor cytoplasmic tail, cell survival is initiated through several intracellular pathways.

One major pathway leads to the activation of the serine/threonine kinase, Akt. This pathway begins with the Trk receptor complex-recruitment of a second adaptor protein called growth factor-receptor bound protein-2 (Grb2) along with a docking protein called Grb2-associated Binder-1 (GAB1). Subsequently, phosphatidylinositol-3 kinase (PI3K) is activated, resulting in Akt kinase activation. Study results have shown that blocking PI3K or Akt activity results in death of sympathetic neurons in culture, regardless of NGF presence. However, if either kinase is constitutively active, neurons survive even without NGF.

A second pathway contributing to cell survival occurs through activation of the mitogen-activated protein kinase (MAPK) kinase. In this pathway, recruitment of a guanine nucleotide exchange factor by the adaptor and docking proteins leads to activation of a membrane-associated G-protein known as Ras. The guanine nucleotide exchange factor mediates Ras activation through the GDP-GTP exchange process. The active Ras protein phosphorylates several proteins, along with the serine/threonine kinase, Raf. Raf in turn activates the MAPK cascade to facilitate ribosomal s6 kinase (RSK) activation and transcriptional regulation.

Both Akt and RSK, components of the PI3K-Akt and MAPK pathways respectively, act to phosphorylate the cyclic AMP response element binding protein (CREB) transcription factor. Phosphorylated CREB translocates into the nucleus and mediates increased expression of anti-apoptotic proteins, thus promoting NGF-mediated cell survival. However, in the absence of NGF, the expression of pro-apoptotic proteins is increased when the activation of cell death-promoting transcription factors such as c-Jun are not suppressed by the aforementioned NGF-mediated cell survival pathways.

History
Rita Levi-Montalcini and Stanley Cohen discovered NGF in the 1950s while faculty members at Washington University in St. Louis. The critical discover was done by Levi-Montalcini and Hertha Meyer at the Carlos Chagas Filho Biophysics Institute of the Federal University of Rio de Janeiro in 1952. Their publication in 1954 became the definitive proof for the existence of the protein. Levi-Montalcini later remarked:"The tumor had given a first hint of its existence in St. Louis but it was in Rio de Janeiro that it revealed itself, and it did so in a theatrical and grand way, as if spurred by the bright atmosphere of that explosive and exhuberant manifestation of life that is the Carnival in Rio."However, its discovery, along with the discovery of other neurotrophins, was not widely recognized until 1986, when it won the Nobel Prize in Physiology or Medicine.

Studies in 1971 determined the primary structure of NGF. This eventually led to the discovery of the NGF gene.

NGF is abundant in seminal plasma. Recent studies have found that it induces ovulation in some mammals. Nerve Growth Factors (NGF) were initially discovered due to their actions during development, but NGF are now known to be involved in the function throughout the life of the animal.

Interactions
Nerve growth factor has been shown to interact with Tropomyosin receptor kinase A.

Clinical Use
NGF, specifically mouse (murine) nerve growth factor, has been available as a licensed medicine in China since 2003. There is evidence of improved patient outcomes for several diseases of the nervous system, including acute intracerebral hemorrhage, global developmental delay, optic atrophy, epilepsy and cerebral palsy. This is significant as there are few medicines which can treat injuries and diseases of the nervous system. Research and clinical use outside of China is limited despite a large body of evidence supporting its use.

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Venous hum

Venous hum is a benign auscultatory phenomenon caused by the normal flow of blood through the jugular veins. At rest, 20% of cardiac output flows to the brain via the internal carotid and vertebral arteries; this drains via the internal jugular veins. The rush of blood from these veins to the brachiocephalic vein can cause the vein walls to vibrate, creating a humming noise which can often be heard by the subject.

Typically, a peculiar humming sound is heard in the upper chest near the clavicle, emanating from the supraclavicular fossa just lateral to the sternocleidomastoid muscle, usually more obviously on the right side than on the left. The sound may radiate to the upper sternal border on either side. Though the exact mechanism is still unclear, it has been suggested that the hum occurs when otherwise silent laminar flow through the internal jugular vein is disturbed by deformation of this vessel at the level of the transverse process of the atlas during head rotation.

The venous hum is heard throughout the cardiac cycle, though is typically louder during diastole. It may be easier to hear when sitting, when the chin is elevated, or when the head is rotated contralaterally (away from the location of the sound); deep inspiration and hyperkinetic circulatory states (e.g. hyperthyroidism) can also increase its intensity. It may be loud enough to result in audible pulsatile tinnitus. It is by far the most common type of normal continuous murmur, universal in healthy children, and frequently present in healthy young adults, especially during pregnancy.

The humming may be confused with a heart murmur, which may be a symptom of a potentially serious condition. The difference is easily detected by placing light pressure on the internal jugular vein when listening to the heart, which will immediately abolish or change the venous hum, whereas a true heart murmur will be unaffected by this maneuver. The murmur also disappears when the patient is in the supine position or may disappear if the subject turns their head to one side. It is also known by the names "nun's murmur" and "bruit de diable" (noise of devils).

While a venous hum may provoke consultation with a healthcare professional, the hum itself is entirely harmless and is the product of ordinary cardiac physiology. Abnormal and potentially serious conditions such as thyrotoxicosis and anemia, by augmenting blood flow through the jugular veins, can nonetheless initiate or reinforce the venous hum, making it more noticeable, and manipulation of the sound with various maneuvers has often helped physicians discover and diagnose cardiovascular disorders.

title: Venous hum


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Licensing
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