Gender Discrimination Essay

The video is all about the portrayal of comic manual that was released by the United States military in handling situation of homosexuality among its soldiers. The manual is aimed in explaining the necessary steps and procedures in handling homosexual cases to soldiers. It features a particular case of a low rank soldier that was caught to be engaged in a homosexual acts and how his higher command treat him (professionally) towards his discharge because of his engagement in such acts. As the video had shown, the workplace is not a gender-neutral place. This is amplified in the case of a workplace that is considered to have a military orientation as shown in the video. As concluded by Kristen Schilt in the article, in many workplaces, the masculinity of a male is valued that is why feminine males or homosexuals are being undermined and discriminated. Shown in the video, PFC Williams was discharged in the military because of his engagement in the homosexual acts. As stated by Schilt, being a man or masculinity is an attribute that is celebrated in many professions especially in the military. This is because of the association of such attribute to other important characteristics and concepts like authority, prestige and instrumentality that are perceived to be related to highly regarded position such as leaders and managers. In this respect, any form of diversion from masculinity or being a man most especially in the military is discouraged. This drops the idea of a having a free world wherein each individual are respected whoever he or she is. Scenarios like this remind to us that there is still much work to be done for us to attain as situation wherein every individual get the respect that he or she deserve from the society. References MSNBC (n. d. ) Don’t ask, don’t tell: illustrated. The Rachel Maddow Show. Web. Retrieved from [http://www. msnbc. msn. com/id/26315908/vp/38252662#38252662] Accessed 2 August 2010. Schilt, K. (2006) Just one of the guys? How Transmen Make Gender Visible at Work. Gender and Society Vol. 20 No. 4. Sociologists for Women in Society. Print. Accessed 2 August 2010. Williams, C. (1992) The Glass Escalator: Hidden Advantages for Men in the Female Professions. University of California Press. Print. Accessed 2 August 2010.

U.S. History 1919-1945 Notes

U. S. History notes Red Scare 1919: I. Mass hysteria II. Why: unrealistic irrational fear. A. Expectations up and down: 1. Prosperity: People are doubling income (1915 income: 408$ yr to 1920 835$ year) 2. Post war recession B. Super patriotism/Slackers (you’re a slacker if not a super patriot) 1. Committee for Public Relations (C. P. I. ) (Creel Committee) – Read propaganda papers, pushed conformity and supported Boy Scouts for war. 2. Espionage and sedition acts A. Clear and present danger: speech that presents this is not protected. cant yell fire in a theatre as a joke when there is no fire. Not protected by amendment). 3. Radicals: A. Industrial workers of the World (IWW): nicknamed Wobblies. Loudmouth aggressive workers, and when on strike did it vigorously to prove their point. Opposed WWI.Persecuted, charged with violating sedition acts, shut down and some thrown in jail. C. 1919 Incidents (convinced people that there are threats everywhere) 1. Bombs (mail bombs , one goes off in A. Mitchell Palmers yard so he constructed the Palmer Raids. People that went on strikes considered radicals). 2. Strikes A. Boston police: (19 police got fired for joining AFL so rest of boston police walked off the job) Coolidge convinced them they could not strike and had to go back to work, and most did. B. Steel: went on strike for higher wages, and better working conditions. C. Coal: went on strike for higher wages. 4. Centralia Massacre 11/11/19 * Wobblies thought they were going to be attacked so they opened fire on a parade that was taking place for Armistice Day. Wobblies kill a few men, allWobblies come out except for Wesley Everest who came out of the building firing at police killing one and he was eventually killed. (He was thought to be a crazy radical and a hero by some) III. Palmer Raids, Dec. 1919, Jan. 1920 – Thousands of immigrants are rounded up in cities from coast to coast, deported back to their home country or charged with a crime fo r being suspicious. Some 6-7,000 was rounded up in total. None of these people were charged with a crime when they were picked up, thus making it biggest violation of civil liberties in U. S. IV.End of Scare: May of 1920 the fear of radicals comes to an end. After WWI conformity begins and we lose a lot of cultural diversity. – Palmer (attorney general) creates Anti-Radical Division and appointed Edgar Hoover to lead it and go after radicals. – John L. Lewis: – Harding died in 1923, buried in hometown of Ohio. Had poor judgment of character, but never accused of accepting bribes. His administration collapsed bc of scandals. Harding got sick in Seattle, but a book was written about how his wife poisoned him. Harding: I. Teapot dome II. Lucid Press A. Gaston means, â€Å" The Death of Harding†B. Nam Britton, The Presidents Life – She claimed to be The presidents mistress and have sexual encounters in the White House Calvin Coolidge: – became p resident after Harding died. He was a Puritan, serious individual, and gained nickname â€Å"Silent Cal† for being very quiet and not talking much. Famous quote of his â€Å"They cant hang you for what you don’t say†. He was thought to be mean spirited (Laughed at others discomfort and misfortune). His wife was Grace Goodhue (she taught the deaf & blind), very friendly and positive influence on Coolidge and contributed to his success. Happy as V. P. c he didn’t have to do much. I. Silent Cal A. Bg B. Gov. > V. P. > President C. Cleans house – cleaned out the white house, trying to get rid of the corrupt people. Brought in Harlen Stone to bring back pride in W. H.. D. Pro Business and Capitalism – He kept the concept of pro business, was an old form of Capitalism. II. 1924 election – A. Democratic disarray – Took 100 ballots to elect representative. John Davis was Democrat’s choice. Republicans won. B. Progressi ve Party – supported Gov. Fallett, received over 4 mil votes. Disappeared after 1924. C. Republican majorities III. AdministrationA. Andrew Mellon – Old man, super rich, from Pitt, worked in steel business, owned coal, iron and steel mills. Tried to control aluminum market, didn’t work, but became even wealthier from this, volunteered service to help Republican Party to gain a positive environment. 1. Budget & accounting Act, 1921 – Harding admin. Part of modernization of American govt. 2. Revenue Act, 1921 – Coolidge admin. Established Tax rates, Cut top rate from 75% to 50% ended Excessive Profits tax. Tried to eliminate inheritance tax, didn’t work, doesn’t change lower income tax (realized this was a mistake). . Revenue Act, 1924 – Revenue acts created loopholes, made tax avoidance legal, but tax evasion was illegal. Coolidge Admin. Top rates drop again from 50% to 40%. Thought to trickle down and help the poor, and low ered poor income tax. Trickle down Economics came from these Revenue Acts. III. Fordney-McCumber Tariff Protective – 1922 (tariff is tax on imports) this taxed imports to protect domestic manufacturers. V. Balanced Budget 5. McNary-Haugen Veto, 1927, Over Production – estab. Commodity prices so farmers could make a profit. Congress passed this and Coolidge vetoed it. Controversial veto) Farmers started supporting other political leaders. 6. Hoover & Dept. of Commerce Consumerism Cont. I. Theory & structure: – Welfare capitalism: Trying to get better working conditions. II. Business as Religion – Bruce Barton III. Labor Reforms A. Taylorism * Frederick Taylor & two-motor studies B. Cellular Work Force: manufacturer’s organized their workers into groups called cells. Policed themselves, making it easier for people at higher position to have less people to watch over C. Pergs: Received bonus’s and pay raises for good work and got pe nsion plans.D. Company Unions: Yellow Dog – administered perks that went to union worker, not considered a real union group. * Councils: organized work force and dealt with stuff below management and relayed info. * Sports Teams: organized sport venues across America. E. Class Consciousness 1. Family structure a. Who works: husbands, wives, and kids do when they grow up and are old enough. b. Kids: Early childhood they sold goods to make $ for family. c. Gender roles: different sexual roles between men and women and cultural naturalism of sex. 2.Middle Class Reformers: thought if middle class family’s had less kids they would gain a better middle class status. Settlement houses 1. Hull house: ran by Jane Addams, middle class woman, supported by philanthropy. Helped uplift working class. 2. Assimilation goods a. Class: taught English, etiquette, daycare for kids, abuse programs, and cleanliness b. Ethnicity: Different ethnic groups go about their lives differently and e njoy different leisure activities. I. Auto Industry a. Sig 1. 20th century 2. Spin offs a. Steel production rises b. Closed cars (glass and leather) c. Rubber production increases d.Gasoline production increases and 4 strokes is mainly used for cars. e. Road: smoother roads were demanded. By 1920 $1billion dollars a year spent on new roads and $400 million a year on road maintenance. 3. Proliferation a. By 1912 – car sales are 150,000 yr. b. By 1921 – reaches 1 million a year. c. By 1930 – 23 mil. Sold and 1 in 5 people own a car. B. Henry Ford 1. Model T – prod. In 1908 and Model A produced in 1928. Added color to cars in 1928 due to competition. Sued a parts dealer bc Ford used the crates that the parts came in to build his model T car and they were randomly changed by the dealer who had no clue he used the wood. . Production efficiently and mass-produced on assembly line to help cost, wages and efficiency better. 3. Cost was 300$ a day and wages were 5 $ a day. C. William Crapo Durant, GM – financier/investor not a banker A. Buick, 1904 B. 1910: Ads Oldsmobile, Pontiac, and Cadillac. C. Added Chevy (cheapest of these brands); acquires suppliers such as fisher body, Remy electric and DELCO. Cars at this time were self-starters, no keys used, just crank the engine and go. D. GMAC – General Motors Acceptance Corp. loaned you the money so you could buy a GMC. E. 1929 & Depression: Crapo lost GM and Durant owned it.Crapo had the idea of building a super market, putting everything into one big warehouse to make it more convenient, but before his idea came to life he died in 1933. D. Impact of Cars 1. Accidents and Death: 30,000-40,000 deaths a year. 2. Pollution: invisible pollution from 1920-60’s was terrible due to lead in the gasoline. Removed from gas in 1970. 3. Morality – people’s morals changed w/the use of more cars. (Lovers lane, social events, statutory rape) 4. Autonomy: traditional; car s gave people more individual and reinforced their autonomy. Cars are so culturally significant and reinforce individualism.IV. Radio Advertising: first mass media, by 1927 radio sales reached 20million plus a year. A. Psych Ads > behaviorist psychology: looking at people as a mass society, studying people and stimulus, measuring a response scientifically. Stimulus ad is a buying response. B. Radio: mass media – KDKA, 1920 – commercial station – 500 & 1922 – 500 radio stations across the country. 2 years and radio blanketed America. – NBC, 1926 – first radio network. Formed by RCA, General Electric and Westing House. By 1926 conglomerates start to squeeze out the independent radio station owners. Amos and Andy, 1928: comedy radio show, black ethnic humor. 1st show that acquired a single sponsor (Pepsodent toothpaste) C. Planned obsolescence – used engineers to create certain products. – Tech Shift: continually buying new technology products. Not really a new product, just a way to stimulate the economy by making people want to buy something new. Immigration & 2nd KKK I. Old and new immigration – Old immigrants were 19th century ones coming from Britain, Germany, Ireland and other Northern Englanders. New immigrants came from southern and eastern Europe (Italians, Russian Jews (Pale), and Slavs and Greeks).II. Nativism & Restrictionist – A. Origins: 1. late 19th century 2. red scare: immigrant radical scare 3. Eugenics: fake science, ignorant people claiming a false fact. A. Madison Grant, â€Å"The passion of the Great Race, 1916† – refers to (WASP) White Anglo-Saxxon People who are going to ruin and change American culture. B. Anti-Semitism rises (anti-Jew) – III. KKK A. Rise in Atlanta, 1915 1. Col. Simmons – Runs the KKK 2. Birth of a Nation, 1915 – First recognizable movie. About American Civil War. KKK depicted as heroic in a sense. D. W . Griffith created movie reels and he’s a filmmaker. 3.Edward Clarke – comes up with KKK costumes and KKK words. He’s in it for the money and business. B. Peak 1924 – peak of the KKK. 4. 5 Mil members and dominate 7 states (Ok, Cal, Chi, Ind. are a few) 1. Political Clout – 2. Rural and Urban C. Fall 1925 1. David Stinson, Indiana – friend of Indian govt. Ed Jackson, used KKK to enrich himself, raped secretary and she tried to poison herself and died a few weeks later and Stevenson charged w/2nd degree rape and murder. This was tied into KKK. 2. Other Factors IV. Restriction Legislation A. 1917 Immigration Act – starts process of restricting certain immigrants. . Head Tax – not free to move to America. 8$ was the head tax. 2. Literacy Test – proving you can read and write in a language. Didn’t want mentally incompetent people coming into the country. B. Quota Acts – limits foreign-born number of immigrants. 1. 1921 Immigration Act – 358,000 accepted (3% of 1910 census) (200,000 were N. W. Englanders). These were the new immigrants from S. E. Europe. 2. 1924 Immigration Act – 150,000 accepted (2% of 1890 census and 132,000 could come from N. W. Europe) CRIME AS ENTERTAINMENT I. Leopold and Loeb, 1924 – smart genius kids, lived in San Fran.A. â€Å"Perfect Murder† – Bobby Franks was the 14 yr old kid they killed. Led him to a vacant lot and bludgeoned him to death. Leopold dropped his glasses at the crime scene. Police caught them and Loeb cracked first. Loeb was sexually attracted to Franks so that was his reason to kill him and Leopold was convicted as the accomplice. B. Defense 1. Clarence Darrow – Attorney of the 2 and he tried to convince the judge that they were mentally diseased. Became known as the insanity defense from then on. Both convicted to life in prison. C. Spectacle 1. â€Å"The Rope† etc. A film by Alfred Hitchcock based off the Leopold and Loeb murder. II. Hall-Mills murder, 1922-26 A. Rev. Halls and Mrs. Mills – bodies were found in a lover’s lane. No clear evidence of who did it. Allegations of Mills brothers killing them and Hall’s wife had killed them. B. Trial – only evidence here was the love affair between them 2. 1. Politics 2. Pig Woman – Pig farm was about a mile away. Daughters farmer was â€Å"pig woman† bc of her residence and appearance. She didn’t see anything just heard noise of a car/gun fire. Mother claims daughter is retarded and no one ever found out who killed them.C. Spectacle 1. Radio – Halls and Mills trial was played out over the radio for the 4 year duration of the entire event and everyone was acquitted. III. Lindbergh Kidnapping, 1932 – famous pilot who flew around the world. Lindbergh and wife lived out in country. A. Kidnapped, March 1932 – Lindbergh son was kidnapped out of 2nd story room and a lad der and ransom note were left behind. Lindberg paid a ransom, but his son was never returned. B. Trial 1. Bruno Hauptman – German immigrant accused of crime. Wood used to make ladder was from Hauptman house. He was found with some of the ransom money.Found guilty and executed. A year later the baby’s body was found. C. Spectacle 1. â€Å"Trail of the Century† – Charles Lindbergh went into hiding with his wife and they moved out of the country then back to Hawaii in a secluded area where he had to fly to get there. MOVIE INDUSTRY I. Tech Shift – movies offered motion pictures however it was 2D on a flat screen. Nickelodeons were first movie viewing attractions. Movies weaned people from nickelodeons to movie theaters. A. 3D > 2D – 1920’s shift from nickelodeons to movie theaters, attracting people bc its larger a larger than life, moving picture with music.Started in the 19teens and became a cultural phenom. B. Motion Picture 1. Gre at Train Robbery, 1903 – lasted 8 minutes 2. Motion Picture Patent Co. 1918 – Located in New Jersey, tried to create a monopoly around NYC in the movie industry 3. Independents – they didn’t agree the Motion Picture Patent Co. so they packed up and headed west. 1st stop was Flagstaff, Arizona. Settled in a town north of L. A. II. Tinsel town: Hollywood’s nickname. (1912 – 13,000 movie places, 500 in NY. Attendance by 1922 40 million and 100 million by 1930. 1925 Movie industry was 4th largest. Birth of a Nation† recognized as first reel movie, had 12 reels, was hours long, made by D. W. Griffith. ) A. Studios: squeezes true independents out; Paramount, fox, MGM, Republic, United Artist’s & Warner Bros. ) Tried to profit from every aspect possible by vertical integration. B. Stars: typecast people; people gravitated to certain actors. Clara Bow â€Å"it† girl C. Formulas III. Scandals A. Fatty Arbuckle, 1921 – c omedian in movies, despicable in real life, a person is killed of a drug overdose at his mansion, he is charged w/2nd degree murder and his movie career is over. B.Mary Pickford & Douglas Fairbanks – she divorces her first husband and married Fairbanks, her movie career was ruined by her growing old. In 1 movie she played 2 characters at the same time. IV. Censorship A. â€Å"Do’s and Don’ts†, 1924 – limited what was shown on the movie screen. B. Hays Commission – Will Hays enforced censorship; sex and violence (shown euphemistically not realistically). Sex sells so nudity was pushed as far as possible to draw bigger crowds. Golden Age of Sports I. Recreational A. Golf – # of courses tripled in the 20’s. Green fees and equipment fees were required to play. . Private-Elites 2. Municipal – Middle Class (W. C. Fields) B. Bowling: Goes back to the Dutch. 1. Duck Pins – 1st form of bowling, usually they were attach ed to saloons. Not for families at first, men usually went and drank. 2. Gentrification – 1920’s bowling teams went from 5 to 40,000 and it was more family oriented and people went to have a good time. C. Baseball Clubs 1. Urban/Industrial – baseball players were factory workers. Sponsored teams, urban and rural would travel to play each other. 2. Rural – people could just travel around looking for a team to join. II.Spectacle A. Golden Age of Baseball 1. Black Sox, 1919 – Chicago white sox accepted money from gamblers to throw the game and lose in the World Series. * Judge Landis – He had power over baseball to enforce rules keeping it fair and just. â€Å"Juiced ball† – after Landis stepped to power he supposedly juiced the ball making it easier to hit homers. (he kept Negros separate from white baseball) 2. Babe Ruth: 22 Yrs. – in the 1920’s he was a home run king. B. College Football 1. The Gate: 50,000 people watched first game. 20million was spent on football by 10million fans.Bowl games were invented after the sport kept growing. 1902 Rose Bowl started. 1935 Sugar Bowl started taking place at Tulane. Univ. of Chicago was a founder of College football and they dropped it bc of the money and how famous football became and not the college itself. 2. Icons: Knut Rockne & â€Å"Gipper† C. Boxing 1. Promoter: Tex Rickand 1. Dempsey vs. Carpienteir – 1921 – this fight drew $1Million 2. Dempsey vs. Tuney, 1926 – Tuney beat Dempsey by dancing around and not allowing Dempsey allowing to get hit. $1. 8 million in revenue 3.Rematch, 1927 â€Å"Long Count† Dempsey didn’t retreat to neutral corner and a long count was then given to Tuney to get up, which he did, danced around and didn’t allow Dempsey to hit him and he ended up winning. III. Sports & Class A. Working Class Baseball B. Elite College Football – designed to be a microcosm of leadership positions. You have to be tough. Expectations to be brave and go all out. * Amateur Ideal – WASP (ethnocentric) * 1910 NCA is formed to minimize the deaths and injuries around football, enforced rules and eliminated certain plays and added pads/helmets. * 1896 Amos Stagg forms the Western Conference. Referred to as â€Å"Ringers† (non-college student playing football). Now they are known as the â€Å"Big 10†. * NFL formed in 1920’s. George Halas was one of the founders. Became an owner, player and coach of the Staley Bears who changed their name to Chicago Bears. These players were working class men and college players. * In 1920’s College All America team played NFL all starts, but stopped in late 20’s bc NFL was getting to good and it was adults vs. kids eventually. IV. College Football Origins A. Anglo-Saxon Ethnocentrisms 1. Social Darwinism, Gilded Age 1. Herbert Baxter Addams – classic trained scholar A. Germ Theor y† – a democratic germ theory the A. S. take with them wherever they go electing their race. Picking your scholars based on merit, i. e. : meritocracy. (Basically being born into a family of power) B. Tacitus, Germania – history of German tribes, a meritocracy. 2. Saxon Warrior Culture – this warrior type leadership establishes college football (choose the best to be display their talent) V. NEW WOMAN â€Å"1920’s† I. Middle & Upper Class A. Club Women – married women who formed women’s clubs (General Federation of Women’s Clubs forms in 1892. There are 500 members and by 1917 there are 1 million women club members.B. Professional 1. Single – (Unmarried) 2. Role Model or Feminist? – not doing this to represent womankind just doing it for their personal reasons. C. Planned Parenthood – Margaret Sanger, middle class woman who tried to prevent unwanted pregnancies. Aimed at working class. This ends u p being effective to the single unmarried women who stay childless and want to keep the job they have. II. Working Class â€Å"Flapper† – These women was flat chested, wore short dress and smoked cigarettes type of bitch. Rough language, went out at night, danced and had fun times. – Aspired to marry up into the middle class. A.Peiss Thesis – working class women establish the working class phenomenon, trying to reform the working class women. Didn’t work to well so they picked up some of the working class ways. B. Middle Class 1. Freud Popularized – for mental health let your proclivities run free, to much repression results in bad symptoms 2. â€Å"Latent Hypocrisy† – Blatantly expressing ideas they don’t practice. Behavior as well as rhetoric that pushed culture. SCOPES TRIAL – trying to do away with Darwinism theory. Became known as the Butler Act. Teaching Darwinism in school was illegal and this passed in 3 s tates, Tennessee being 1.I. Dayton vs. Chattanooga: Wins this trial. Dayton agrees to be put on trial if Dayton members are present at court. II. The Trial A. Judge Raulston: wanted to get publicity from this. B. Prosecution 1. Hicks and Bryan – C. Defense 1. Darrow & Malone, et al – famous lawyers from past cases. Malone is a sophisticate from NY. III. The Argument A. Prosecution – Limit – limit trial to simple Yes/No questions. B. Defense – Expand – expand the case based on speaking the truth and including constitutional exceptions. Against 1st amendment for speaking the truth. 1. â€Å"Greatest Speech† – C. Decision 1.One Expert – Judge allowed 1 expert witness for future appeals D. The Monkey House – referred to Darrow & Malone’s decision to be the one expert that the judge would allow. 1. Cross-examination IV. Verdict A. Trial – John Scopes violated Butler Act and was fined but never had to pay the fine and the verdict was thrown out later down the road. B. Public Opinion – he wins in the court of public opinion, but was convicted in the court of Dayton. Aime Semple MacPherson I. Four Square Gospel – started a gospel in the suburb outside of L. A. church services were new, strange and she conducted herself like a movie star.Became a minor figure in the 1930’s and died in the 40’s. traditionalist who tried to use modern technologies and it backfired. II. Sensual Debauch – III. Scandal Art & Literature, 1920’s I. Lost Generation – so many ppl were killed and it seemed that generation was lost. Referred to as the high culture A. Why so glum? 1. General Cynicism 2. WWI A. Age of Irrationalism – WWI makes no sense. Tactics were irrational, terrorism started and countries were thought to be a bit barbaric. B. All quiet on the western Front, 1929. Eric Remarque – everyone dies 3. Sartre Existentialism â₠¬â€œ brand of philosophy.It means we exist and that’s all there is to life. Everything (religion, politics, etc. ) is all made up. The only lasting society connecting people is fiction. B. Any Joy? 1. Roaring 20’s 2. Behaviorist and psych C. Lit. A. Sinclair Lewis – critically acclaimed. Fits into cynical idea. 1. Main Street, 1920 – is about a woman who is married well and prosperous, but she is unhappy and runs off to a suburban town. 2. Babbitt, 1922- characterization of midwestern life. Became a midlife crisis story and he desired an affair. He was an unhappy individual. B. HL Mencken – refers to middle class as the booshwazee.He falls off the charts and people get ignored of him in 1930’s (pro Nazi) he continues to edit supporting young writers, promoting the next gen of writers. 1. Baltimore Sun D. F. Scott Fitzgerald – novels are glum and cynical. He produced great American literature. Born in 1896, St. Paul, Minnesota and died in 1940. (Alcoholic). He had many failing business’s. I. Bg. & youth A. St. Paul, 1896 B. Princeton > Army – sent to Princeton where he started writing his first book â€Å"this side of paradise†. 1917 joined army. Didn’t return to Princeton just wrote short stories. II. Zelda Sayre – his wife whom he met while training in the army.A. Southern Belle – B. Nervous Breakdown C. Jazz age couple – â€Å"Scott and Zelda† – they were drunk most of their lives, living the high life, appearing to be frivolous, she got sick, was placed in a care facility so Scott could keep writing and then he died of liver disease due to alcoholism. III. Career: * â€Å"Great Gatsby†, 1925 – secures his literary career. Its about Gatsby whose a WWI vet who acquires wealth. In the end Gatsby dies without accomplishing his goals and dreams. Told by a narrator on the outside looking in. About old money and new money. Sad genera tion story that fits into the lost generation era. This Side of Paradise, 1920 – also about the last generation. * Tender is the Night, 1934 – acclaimed and a movie was made out of it. It’s about a touching, loving family and the husband has a nervous breakdown that destroys the family. Drawn from Fitzgerald’s own personal life. * Short Stories – * Hollywood, 1939 – went to Hollywood to earn more money. He was a scriptwriter. Dies here in 1940, the last one he worked on was farewell my lovely. * The Last Tycoon, 1940 – published after his death. About Hollywood producers, scandals from the 1920’s Hollywood tinsel town era. IV. EvaluationErnest Hemingway: Split-Minded I. Bg. 1. Oak Park, 1898 – close to the prairie, spent all his time in the outdoors and skipped school. He worked for a living all the time, had a salary, didn’t just write. 2. Kansas City Star – was a stringer for the paper, trained as a journ alist from ground up, bc hes an outdoorsman his intellectual curiosity draws him to WWI where he drives an ambulance and participates in some attacks. II. WWI A. Italian Front B. â€Å"The Wound† – He was on the front line when a bomb hit his squad and wounded him in the groin area, this wound was thought to have ruined his manhood by others.He convalesces in a Italian hospital and this was the end of his frontline career. Went from here to Toronto Star. III. Paris A. Toronto Star – B. Expatriates – apart of this group, but also critique’s them. C. Serious Writings: – Men w/o Women, 1920 – (cult of masculinity – refers to flight from domesticity, relates back to Daniel Boone) Manly men doing manly things in a manly way, women are not needed. – In Our Time, 1924 – A Farewell to Arms, 1929 The Sun Also Rises, 1926 – People struggling to find relationships due to tough times, not trying to write about â€Å"t he lost generation† but inevitably was.His phrase was â€Å"The earth abides†. IV. War Correspondent A. Spanish/Civil War – 1. For When the Bell Tolls B. WWII V. Noble Prize, 1954 – he received this, but felt this was a mind block afterwards bc he thought all his work had to be up to the standard of winning the prize. A. Existentialism & â€Å"Old Man and the Sea† – existentialism will push you toward adventures but you don’t have to push it toward tragedy. Old man and the sea is about a Cuban going out on a tiny sailboat and catches a sailfish bigger than his boat.On the way back onto the shore he is attacked by sharks who want to eat the dead sailfish, but fails and when he gets to shore the sharks have eaten mostly all the fish, and the Cuban man stumbles back to his shack feeling hes a failure and felt worthless. The townspeople saw the fish bones and thought of the fisherman as a success even though he was asleep when the peop le were viewing this, not knowing what they had thought. VI. â€Å"The Code† – men doing manly things, being a man in a manly way. This is a way men can preserve masculinity in a real way by doing manly things. Charles Lindbergh, 1902 – 1974 I. Bg. biggest hero of the 1920’s for everyone at this time. A. Minnesota + Washington DC – born in Minn. In 1902. Mother name was â€Å"Lands† and her mom was a dentist. Lindbergh family was very rich. Didn’t socialize well and was left out, had few friends, and his dog was his best friend. Always referred to his dog as his best friend. Moved to D. C. to spend time w/his dad and was around congress and politics. II. Tech & Airplanes – A. Univ. of Wisconsin, 1920 – attended the univ. and had an apartment w/his mom off campus. He had bad grades so he and his mom took time away and went on a road trip to Cali. B.Flying 1. Excelsion in Nebraska – Acquires a excelsior motorcyc le and when he got back to Minnesota he traded it for a Jenny Airplane, then flew it to Lambert Field. 2. Lambert Field, St. Louis – huge aviation place. 3. Flying Circuses – traveled with the circus and did airplane acrobatics, made money doing this. (Parachute jumping, airplane walking, and other ways to earn money. ) 4. Army, 1924 – enlisted in Army Air core. Army had best airplanes and he joined so he could fly the best and fastest airplanes. Received Ceremonial General and Army didn’t want Lindbergh in army bc he didn’t fit into the system. . Airmail, 1926 – Lindbergh’s plane crashed 2x and he took the mail with him when he bailed out. Crashed due to flying into bad weather. Got the name â€Å"lucky lindy† bc of this. III. 1927 A. The Accomplishment – he planned to fly across the Atlantic from N. Y. to Paris. Tried to buy a mono winged airplane, was unable to so he contacted Ryan Aircraft in San Diego to buy one fro m them. St. Louis bankers gave him money to buy it as long as their name was on the plane. His planes name was â€Å" Spirit of St. Louis†. He made the trip in about 33 hours, only being about 20 miles off of the destination in Paris.He flew around looking for the field and people heard him and they parked their cars creating a runway with the cars headlights. B. â€Å"Well, we made it† – what Lindbergh has said when he landed and got out of the plane. said â€Å"we† bc he was talking about his him and his plane that made the trip. C. Why such a hero? – Hero bc he made it, survived, worldwide jubilation, became a celebrity, wrote a book called â€Å"we†. Caused Great Depression I. Structuralist II. Monetarist (Rose and Milton Friedman) A. Depression Cycles 1. Runs and stop payments 2. Positive result B. Federal Reserve 1. Benjamin Strong – one of 12 presidents of a fed.Reserve bank. Dominated fed. Reserve systems. Became defacto chair man of the Fed. Reserve banks. Died in 1928. After he died their was squabbling and fighting to become next president overseer. 2. Bank of the U. S. C. F. D. R. Failure 1. Moratorium (temporarily stopping business) – cause a sensation of banking monetarily by shutting them down for a few months. Hoover proposed this but would not establish it until the next president came to office. F. D. R. declines this and wants to come up with his own idea. 1932-33 no bank moratorium happened and this is when banks failed and 14 out of 48 states only had open banks.Great Depression Stats and Conditions I. Business A. US Steal, ex. – Operating at 19. 1% capacity. In 1928 made and sold 60 locomotives and in 1933 they only sold 1. B. Stock Market – stocks dropped to 11% total loss of $74 billion. Money and wealth disappeared. C. Banks – (5,000) D. Bankruptcy – 86,000 businesses declared bankruptcy and many others just shrank. E. G. N. P. (Gross Nat’l Produc t) – 124$ billion in 1928 and 1933 dropped to 41 billion. Economy shrank by over 60%. Started in ’29 and continues to summer of ’33. II. Families A. Wages – 1928 a family of 4 needs $2000 a year to exist.Making less than this you’re poor. In 1932 average family wage is $16. 21 a week making it less than $1000 a year. %60 of families below poverty line. Almost 2/3 of the U. S. population is poor. B. Evictions – people losing their homes and in 1932 273,000 people are evicted, losing their homes. C. Emigration > immigration – more people were leaving the U. S. than people were entering the U. S. D. Unemployment – 15-17 Million people unemployed and 34 million were affected. (Industrial type of family) For agricultural families they had a family size of 7-8, and 11 million were affected.With this combined 1/3 of the U. S. population was unemployed. III. Why No Revolution? Hitler comes to power in the 1930’s in Europe. No revolution in the U. S. A. Guilt – American population blamed themselves, known as the protestant work ethic. (God favors the rich and hard working, you will be successful if you work hard. If you fail its your fault bc the U. S. is land of opportunity. Citizens are inclined to blame themselves during the depression, thinking its God’s punishment for the behavior that went on in the 1920’s. ) Altruistic suicide – Neil Dunkein came up with this.The father/husband thinks that his family will be better without him bc he is a failure and dragging the family down. B. Radical Heritage C. Business Success A. Alfred Butts – created scrabble and became rich B. Howard Johnson – opened up an ice cream shop that became a successful business chain next to movie theatres and became rich C. J. Paul Ghetto – in the oil industry, his industry didn’t go under like most did. He bought up bankrupt oil companies and became a multi billionaire by c onverting oil factories to gas ones. IV. FARMS – 90% in 1770’s to 30% in the 1930’s and less than 2% today. People are migrating off farms.Declining farm commodities is driving people away. A. Prices drop – wheat is 25 cents, oats 10 cents, hogs and beef 2 ? cents per lb. , corn 7 cents a bushel. Costs a $1. 10 to raise a sheep and sell wool and you can only make 1$ back. Prices are not enough to be sufficient. No profit to be made. Drought comes upon farmers in the 30’s and makes it worse. B. Dust Bowl – refers to a geographic area out in the Oklahoma & Texas panhandle, parts of Kansas and New Mexico. Oklahoma got the image as being from the dust bowl. Long-term thing that pushed people of their land and went out west looking for jobs. Outsiders called those people â€Å"Okies†.V. The Dole – refers to private charity in place when unemployment hits. A. Local Relief – $5. 50 a week from charity a week, 286$ a year in Philly. NY is $2. 37 a week, 123$ a year & Mississippi is $1. 50 a week, 178$ a year. You have to be completely broke (no relatives to live with, no home, no job and if you accept this your kids cant go to school bc your not paying taxes since you have no property bc people pay taxes to support schools). B. Stigma VI. Middle Class Impact A. Psych Burden – Falls on the women, creating a return to domesticity. Returns to wife and mother stayiat home doing housework. B.Street Smarts – finding ways to save money (dine and dash, repairing your shoes on your own instead of buying new ones if falling apart, reusing bed sheets, filling up on as much food for as little as possible) VII. Changing US Attitudes A. Business status decreases B. Family Structure 1. â€Å"Holding their own† –Women holding their own as the domesticity returns. C. Federal Status/Image- only federal action can cure the situation. Acceptance of federal presence in everyone’s live s (G-men come about, FBI ^) D. Changing U. S. Appearance – pollution declines, water and air is cleaner, traffic is less, petty crimes increase.Movies increase as well as gas production. Okie migration, black farmers are leaving the farms in the south. Herbert Hoover – 1874-1964 I. Beginning: 19th century traditionalist A. In 1895 he had 40$, invested it and in 1908 had $4million B. Youth: he was orphaned off from Iowa he went to Oregon at age 7. C. Stanford – B. S. 1895 1. Elected class treasurer, ran for office 2x and won both. Graduated with a B. S. in Geology. D. Hard rock miner – mining through granite, igneous rock, rocks that require blasting and you go 1,000s of feet underground. 1. Nevada: 1895-97 – worked here in the silver boom-mining period.Lost his job when the rush was over, so he didn’t give u, he went to Alaska unemployed. 2. Alaska Gold Rush: 1897 A. Afghan Mine – closed abandoned mine. Hoover investigated and using h is geology skills he found that their was more gold to be found. Goes around and raises 500,000$ to onstruct a deep rock mine. He was successful and they dug out $55 million worth of gold and the investors got a 10$ million dollar profit. With this success he became a mining consultant. 3. Consultant – he became a mining consultant; going around helping mine companies dig in mines and be more successful and sufficient.E. World Travels 1. Boxer Rebellion 1900 –Boxers were rebelling the Chinese emperor about the European influence. Hoover was in Peking China with his wife and saved innocent victims from a burning building. 2. WWI – too old to fight, but is helping out with distributing American soldiers on the line. Serves on Commission of Relief, distributing relief to soldiers throughout the war. Food Admin was set up and it wasn’t doing very well so Hoover was appointed to this administration making it work terming it Hooverizing the administration due t o the success with him in charge. F. Sec. f Commerce – Harding was elected Hoover became Sec. of Commerce. II. Hoover and depression A. President, 1928-32, 29-33 – B. Causes of Depression – Stock market crashed in ’29, Hoover believed not to do anything thinking it would weed out the inefficient and the country will just ride it out. He believes the problems are external rooting from WWI debts such as war debts and reparation, thinking the European weakness was dragging us down. During the depression he was encouraging everyone, keeping businesses open, not striking or firing employees, but he was becoming aware this was doing nothing significant. C. Policy 1.Inaction – did nothing to help the economy until he realized the economy wouldn’t recover itself. 2. Action – By 1929 he enacted a Tax cut on the Ag. Market known as Ag. Marketing Act. This was enactive so the fed came up with $5mil for Ag farmers to purchase excess farm material and store them until the commodity price rose and they could sell it back off. This was ineffective in 1929 as well. Smoot Hawley Tariff was created raising tariff from 50 to 100% meant to be a wall protecting the American economy from the weak European economy. He then enacted a 1 year free of paying off loan payments from the European countries to the U.S. this did not work either. III. Bonus Army, 1932 : Hoover in 1932 enacted the Recon. Finance Corp. – meant to give large corporations 2. 5$ billion in loans in the states to do corporate work hiring workers, making the money trickle down. Doesn’t work either. Doesn’t work. Home Loan Bank Act in 1932 was created loaning money to banks so people could keep their houses, renegotiating mortgage rates and avoid foreclosure. The breathing space of a few months did not stall the foreclosure rates, just stalled it, bc if people still were unemployed they couldn’t pay the banks. Stipulations given to WWI veter ans. A.WWI Adjusted (compensation certificates, 1924) B. Walter â€Å"Hot† Waters – gave fiery speeches at govt. advocating that payments to veterans be paid now not wait unitl the 1940’s. Characterized as leader of the veteran movement. Wanted a march on Washington bc Hoover vetoed this bill allowing vets to be paid early. C. Congress vs. Hoover D. American Legion – veteran organization, they opposed early payment; do not support bonus march on Washington. They support Hoover and his veto of early payments. E. Bonus March, summer 1932 – veterans were mostly homeless, they hopped on trains and hitchhiked and there were in-between 10-20,000 appear in D.C. They flocked to Potomac flats and set up shanty towns/boxes for housing. Requires a structured living quarters. I. Anacostia Flats – some of these veterans move into rundown buildings and factories. When the police tried to remove them they threw bricks and stuff to ward off the cops. 1. Hoo ver image vs. Reality – he was considered to be unsympathetic and hard nosed. 2. Gen. D. MacArthur – Helped assist the Washington police to remove veterans from the buildings w/army warfare and they destroyed the buildings and encampments as well. Looked scary and really bad on the live newsfeed that captured it.Hoover did not order this, MacArthur did this on his own. Hoover criticized MacArthur in private voicing his displeasures. II. Hoover Reviled – Reviled bc his image was him ordering the veterans to me killed and removed when in fact this was not true. Hoover blankets (sleeping on benches covered with newspapers), hoovervilles (living quarters made out of cardboard shacks), and hoover hog (whatever edible food you could find and make or eat) was named while he was president. Last stint as a huge public icon. A. Pop Culture B. Election C. Rehabilitation, 1950 and 60 FDR & New DealsI. FDR – Most dominant political figure in American history, elec ted 4 straight times. He felt it was appropriate and just the fact that he could get elected tells how powerful and influential he was. A. Beginning and youth. He was distant cousin of Theodore Roosevelt. Heritage went back to a wealthy English family that was luxurious and didn’t have to work bc the family had millions. Grew up in the rich community, but he was hard working man who went to a private academy and attended Harvard. Worked as Police Commissioner in NY and served as assistant secretary of the navy.B. Polio, 1921 – attacks fluid in spinal column and kills nerves, paralyzing hips, knees and legs. If moved to you’re diaphragm then you had the aggressive type. Roosevelt had non-aggressive and was paralyzed from the waist down. He caught this when on vacation while on a party boat that housed a dozen or so people. Swimming back to the boat caught his polio after he swam from an island. Without polio he supposedly would not have the same success he would without it. People that voted for him knew he had polio. II. 1932 Election A. Gov. of NY B.New Deal – provide people with a do over, that would rescue the country from the depression. C. Brain Trust – old progressive idea. Means he relies on expert knowledge. Hiring people in fields that are the smartest, president doesn’t know everything of every field. These people were his Brain Trust’s listed below. They were the ones advising him on what decisions to make. He would make final decision of their arguments on certain topics. A. Ray Moley – â€Å"the mole† pro business, wrote some of early speeches for FDR. B. Louie Howe – FDR’s oldest friend. Helped him with rehab and stayed by his side.Grounding to reality type of person to keep him intact with reality. C. Jim Farley – liaison between White House and Democrats. D. Harry Hopkins – Became the face of the New Deal. Head of WPA. E. Rexford Tugwell – Head of TPA. Economics professor at Columbia Univ. III. 1st 100 Days, 1st New Deal – outpouring of legislation. 14 major pieces of legislation were passed. This means congress passed legislation that were not finalized, they were outlined, congress passed them and president Roosevelt ok’ed them. A. First inaugural – the only thing we have to fear is fear itself. Pep talk to not get people depressed. B. FDR StyleA. Pragmatist – mot tied to any ideology, makes decisions based on certain instances. He calls himself this, not publicly, but he thinks of himself as a political quarterback. Make radical ideas until the economy is back to par, and then he will become conservative. B. Final Arbiter – he had the final say so in the cabinet and if you didn’t agree you got out. C. Genius? Yes and No. Wasn’t always the brightest, he was a second class student, but confident in the ideas and philosophies he did have. 1. Intellect 2. Empathy and charisma â €“ people liked him bc he had this, just something that came naturally. D. Use of Media – 1.Fireside Chats – people listed to his speeches by the fire, communicating directly to people in their living rooms. Big power that he used to his advantage. 2. 16 Friends – FDR controlled the press, most of these were paper editors. He used these informal friends to write stories, shave stories for the better and not tell some stories in their papers. 3. Govt. Shorts – refers to short films, promoting various govt. programs. â€Å"The Plow that Broke the Plains† and â€Å"The River†. Appeared in the movie theatres that were in-between movie films. IV. Eleanor’s Role – FDR’s wife. Allowed herself to be used by her husband for political purposes.If he was unsure about an idea how it would play with the public, he would have his wife propose the issue, looking like she would give them the idea, and the President and cabinet membe rs would wait for the press to respond and see how they took the news to know if it would be a good idea. Helped insulate her husband from political fallout when necessary. V. 1st 100 days & 1st New Deal A. Cabinet 1. Henry Wallace 2. Harold Ickes 3. Frances Perkins –1st female cabinet member, lawyer by training. 4. Harry Hopkins B. Legislation 1. Banking Crisis – over 5,000 banks closed and people that had money in them lost it all.A. Bank holiday – declared bank holiday over fireside chats closing all banks for 1-2 weeks. Designed to make the public be less panicky. B. Banking Act – Gives President authority to close the banks. Takes U. S. off gold standard. Paper money no longer tied to amount of gold in federal repository. C. Glass-Steagle Act – June of 1933, reform legislation. Separates commercial and investment banking. Establishes FDIC, still in place today. 1. FDIC – Federal Deposit Insurance Corporation. $5,000 limit at the tim e. 2. National Industrial Recovery Act – 1st solution to recover the industrial industry.Created NRA (National Recovery Administration). A. NRA & Blue Eagle – symbols of politics B. Public works: PWA – NRA oversaw this. $3 Billion went to support PWA projects, paid %40-60, which was labor costs. C. Codes of Fair Competition 1. Title 1, Section 7A 3. Agricultural Adjustment Act A. Goals B. Actions – encouraged farmers to destroy livestock and crops. 1. Short Term – 2. Long term – Estab. program of subsidy to farmers to limit them on their crop growth C. Criticism – burning of crops and killing livestock b/c people are on the streets starving at the time. If you’re going to subsidize farmers farm everyone else.D. Success – stops downward spiral of overproduction. 4. Civilian Conservation Corps A. Goals – Create jobs for youth men – Employs some 300,000 men, segregated B. Program – employ males in t he age range of 18-25 that are married and jobless. 30$ monthly. Doing natural resource work (fighting fires, building buildings, fixing up communities, conservation type work). C. Criticism- CCC men are referred to as Military Brown Shirts. This is compared to things going on in Germany. People assert this to Roosevelt’s private army. D. Success – did a 180-degree swing and became very successful based on the pics.Becomes one of the most popular ideas out of the New Deal. 5. Tennessee Valley Authority A. Goals B. Accomplished C. Criticism D. Success New Deals I. Evaluations: A. Relief: Roosevelt credited w/preserving American democratic institutions. B. Recover: Considered to be a failure. WWII solved the depression not the reforms. C. Reform: put into place regulations, preserving prosperity. Insufficient reforms or to many reforms had be pulled back and repealed? Women and Great Depression I. Family status: A. Marriage: rates decline. Put on hold b/c of uncertainty of the future. B.Divorce: rates decline. Increased in the 1920’s, but collapsed in the 30’s due to having to separate and having a lack of opportunities outside of marriage. C. Births: declining rates. II. Ag Women: A. Rates are down: Ag families having 5-6 kids per family are becoming less. B. Rural Electrification – electricity to the farms were beneficial and helped even during the depression. 1935 1-10 Farms have electricity. 1941 4-10 farms have electricity. III. Working women: A. 1930 Census: 11 million women working constitute 24% of female population and are 22% of all workers at the time. B. 940 Census: 13 million women working constitute 25% of the female population and are 25% of all the workers at the time. IV. Gender Roles and Feminism A. Domesticity is up – the word feminism changes in its connotation. B. Role Models: 1. Feminist’s – Eleanor has an all female staff, gaining training in political world. 2. Traditional – s erving her husband as first lady. Women in sports represented the new woman in the 1920’s. In the 30’s you had to be beautiful and have female qualities if you wanted to be an athlete. All women were expected to be attractive. Depression Hollywood I.Stats – 60-80 movies a week and 500 a year. 1930’s attendance was 10 million. Quarter for adult and 10 cents for a kid. In between movies you saw cartoon, govt. short or other reels. II. Studios: MGM, 20th Century Fox, Paramount, Warner Bros. and RKO are the only studios that survived. Continue in vertical integration and wanted to control everything, working out deals to make profits and show movies in each other’s studios. A. Formula Evolution III. Cynicism in 1934: Hollywood is pushing censorships. IV. Censorship Est. : A. Production Code, 1930 – sometimes called the 10 commandments for movies of what they can and cant do.Violence is euphemistic, human relationships are moderated. B. Movies 19 31-33: by this time the producers are violating their own codes. Brief depictions of female nudity. Scandalous and boycotting are becoming threatening. Uproar is so great that Hollywood takes action, thinking htat if audience wont come then they finally stop with this and hire joseph Breen to view and censor movies from 1934 on. C. Joseph Breen: looks at scripts and tears out the parts that can’t be portrayed. (You can say pregnant in movies, so you say a woman is expecting.You can’t show a woman and man in bed unless one of them has a foot on the floor even if married. Hetero-social circumstances disappear due to the thought of scaring the audience away and losing money. ) Dance/musicals are the only way a man and woman can be embracing and moving in the 1960’s. V. Up Beat A. Hollywood 1934 – IV. Women’s Roles A. Light and Dark – means virtuous woman (light woman) and she always gets the guy at the end. The dark woman (licentious woman) who goes after the guy and gets him for a moment eventually comes to a bad head and he goes to get the light woman.

Representing bodies case study Essay Example | Topics and Well Written Essays - 1500 words

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A Fast Food and Bakery Take-Away counter in Downtown, Mumbai Essay

A Fast Food and Bakery Take-Away counter in Downtown, Mumbai - Essay Example The initial setup of the bakery and fast food counter would be a small one to involve as little investment and risk as possible. The preliminary research has revealed that there are very few bakeries and fast food counters in the populated areas of Mumbai and hence, the competitive edge of the project would be its location inviting a lot of pedestrian traffic on a daily basis. The main customers of the counter would be office going youngsters and students who like mobile food and snacks and have a preference for Western origin food more than their local origins. The initial setup cost of the counter including the construction, rentals, machinery, raw material, etc. is around $ 76,000, which is an estimate calculated from the data of take away counters of similar capacity. An analysis of the location tells us that Mumbai is thickly populated with people belonging to all the backgrounds: Upper class, upper middle class, middle class, lower middle class, and the lower class. The main ta rget audience of the counter would be people belonging to middle class and the higher classes. Since Mumbai is densely populated with average income people, investing in a bakery that has numerous future prospects seems like an investment that is worthwhile. Another interesting factor is the change in the eating habits of people especially among the younger lot. They prefer fast food and snacks that they can eat while on the go. Hence, a take away counter for bakery items and fast food would definitely be a profitable venture. The Gantt chart of the project shows that it would take the counter approximately more than two months starting from research up until its launch. Project Description The outcome that the project would achieve is the setup of a take-away counter selling bakery and fast food items such as hot breads, rolls, cakes, burgers, sandwiches, pizzas, etc. The location of the counter would be in downtown Mumbai, India so that it gets a lot of foot traffic from the nearb y offices, schools, colleges, etc. The target market of the counter is young and middle-aged people working in offices or students who are constantly moving and need to eat outside their homes. As mentioned earlier, the eating habits of all younger generation are very different from the older lot, they prefer fast food and bakery items and thus, a counter catering to their needs would ensure lots of people coming during lunch and teatime hours. Another possible consumer base of the counter would be people with a sweet tooth and other who like to buy cakes and pastries for celebrations and religious festivals, which are abundant in India. The counter would host products such as pastries, custom made cakes, biscuits, mini muffins, etc. The counter would also place tables and chairs nearby so that consumers who want to sit can have their meals comfortably. The counter would have self-service. The packaging would be attractive and artistically done for takeaways and gifts. A study of th e market has provided that food business, specifically bakeries, fast food, and other similar outlets suffer less even in the time of recession. Another advantage with such counters is that they are easy to setup and not a lot of technical expertise is necessary. The overall business model of such ventures is pretty straight forward with a direct revenue model that does not have a lot of risk involved. The success of such a counter depends on the following factors: market need, taste and product quality. Mumbai is a metropolitan city with the people residing here belonging to all backgrounds and coming from all parts of India bringing in their own cultural heritage and taste. Here, the

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Failures of DRM and Digital content copyright - Essay Example Additionally, according to Hombal & Prasad (2012, p. 237), the media must keep changing from one data format to another. Producers of digital materials ought to generate device-specific and product-specific licenses, which are only issued to the client after delivery, for use in specific devices. This implies that any reproduced copies only operate in the originally licensed device and the licensed product. Producers ought to collaborate with network experts such that if any attempt to reproduce digital materials in a device is sensed from any location. This requires a great deal of partnership, involving the hardware manufacturers who should install the electronic tracking units in the hardware devices. The devices can be configured to send information to central location for monitoring copyright reproduction. Campidoglio M., Frattolillo F & Landolfi F, 2009, "The Copyright Protection Problem: Challenges and Suggestions", ICIW, 2009, Internet and Web Applications and Services, International Conference on, Internet and Web Applications and Services, International Conference on 2009, pp.

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Samsung Electronics Essay Example for Free

Samsung Electronics Essay Samsung Electronics, one of the largest semiconductor manufacturers. It is also South Korea’s top electronic company. It makes many kinds of consumer devices, including DVD players, digital TVs, and digital still cameras; computers, color monitors, LCD panels, and printers; semiconductors such as DRAMs, static RAMs, flash memory, and display drivers; and communications devices ranging from wireless handsets and smartphones to networking gear. The company, which is the flagship member of Samsung Group, also makes microwave ovens, refrigerators, air conditioners, and washing machines. Nearly half of sales come from the Asia/Pacific region. II. Situational Analysis (TOWS) Threats 1) Relentless deflation 2) Rivals can buy similar technologies from other vendors without tying up capital or making long term commitments. 3) Chinese companies keep driving prices ever lower, leveraging super cheap wages and engineering talent. 4) Direct and strong Competitors (Apple Computer Inc., Motorola Inc., Sony Corp., Nokia, etc.) in a tough environment 5) Korea’s slumping economy─ and in China and other Asian countries struck by SARS epidemic.| Opportunities 1) Venture into new markets 2) Proliferate production outputs 3) Increase capitalization| Weaknesses 1) Too many diversified products 2) Inevitability to decrease price 3) Life cycle of hardware goods is brutally short and subject to relentless commoditization.| Strengths 1) Using the latest and high-end technologies in manufacturing and creating new products (CDMA, DRAM, DLP and NAND) 2) Excellent RD capabilities 3) Fewer layer of bureaucracy 4) Vertically Integrated 5) Diversified product lines 6) Competent employees| III. Hierarchy of Objectives IV. Hierarchy of Problems V. Analytical Tool: TOWS Matrix Internal External| Strengths 1) Using the latest and high-end technologies in manufacturing and creating new products (CDMA, DRAM, DLP and NAND) 2) Excellent RD capabilities 3) Fewer layer of bureaucracy 4) Vertically integrated 5) Diversified product lines 6) Competent employees| Weaknesses 1) Too many diversified products 2) Inevitability to decrease price 3) Life cycle of hardware goods is brutally short and subject to relentless commoditization.| Opportunities 1) Venture into new markets 2) Proliferate production outputs 3) Increase capitalization| S-O * Entering into the software business (S1, S2, S5, O1) * Outsource manufacturing (O2) * Attract more investors (S1, S2, S3, O3) * Exploratory technology development strategy, specifically with respect to the engineering design and prototyping effort (S1, S2, S5, S6, O1 ) * improve the control of cost, quality and delivery times of inputs in order to master vertical integration (S3, S4, O2)| W-O * Continuously tap into and augment e xisting technologies and quick application as soon as new concepts are realized (W1, W3, O1, O3) * To keep sales growing by adding new features, targeting additional segments and adjusting prices (W1, W2, W3, O1, O3)| Threats 1) Relentless deflation 2) Rivals can buy similar technologies from other vendors without tying up capital or making long term commitments. 3) Chinese companies keep driving prices ever lower, leveraging super cheap wages and engineering talent. 4) Direct and strong Competitors (Apple Computer Inc., Motorola Inc., Sony Corp., Nokia, etc.) in a tough environment 5) Korea’s slumping economy─ and in China and other Asian countries struck by SARS epidemic.| S-T * Motivate employees through incentives and by offering better compensation packages. (S5, T4) * Leveraging core competencies (S1, S2, S4, T2, T4) * Initiate CSR (Corporate Social Responsibility) programs. (S5, T5) * Focus on Vertical Integration and hardware (S1, S4, S5, T2, T3, T4)| W-T * Aggressive marketing efforts (Advertisements) to create custom er awareness (W1, W2, W3, T2, T3, T4, T5 ) * Clear differentiation and value added pricing (W1, W2, W3, T4) * Realistic profit-based pricing (W2, T3, T4)| VI. Alternative Courses of Action Alternative Coursesof Actions| Description| Pros| Cons| 1. Improve profits to keep up with sales| * adding new features, targeting additional segments and adjusting prices * to intensify marketing efforts| * greater market share * increase in profit * improve brand awareness * threatens competitors| * Increase marketing expenses * Opportunity costs financially in the other functional areas.| 2. Venturing into the software business| * aside selling hardware, Samsung could also develop proprietary software (applications, games and other multimedia)| * Higher margins * Long lead time over rivals * Thriving into a new market segment| * Copyright infringement that can stain Samsung’s brand * Additional capital outlay * High barrier to entry| 3.Aggressive marketing efforts (Advertisements) to create customer awareness| * Aggressive marketing is the back bone of any company to grow. As a matter of fact what determines performance of any company, organization is their MARKETING method .| * Increase consumer awareness globally * Increase in sales * Larger market share * Attracts/Rise in profits * Improve long-term profits * Could gain competitive advantage over competitors * helps in improvement of the quality of the goods * information of products are readily available| * Increasing advertising increases the costs of doing business and cuts into your bottom line. * might jeopardize short-term revenues| VII. Chosen Alternatives * Aggressive marketing efforts (Advertisements) to create customer awareness VIII. Implementation/Action Plan Activities| OVI| Means of Verification| Person- in-Charge(Division, Department, Agency)| Resource Requirement| 1. Meeting with top-level managers on coming up with an excellent marketing proposal| * Approved new marketing proposals| * Minutes of the meeting| * Yun, CEO; BOD’s and executive officers| * HR * Time| 2. Department heads will meet and inform their subordinates (especially the RD and Marketing Dept.) on the changes| * Acceptance and participation of Department heads and subordinates| * Memorandum, a written document signed by the top-level committees| * Department heads and their respective subordinates| * HR * Time| 3. Marketing department will implement the new and approved proposal| * Increased product exposure | * Marketing paraphernalia (Printed ads. And materials)| * Marketing Department| * Financial * Marketing materials| 4. Monitor and evaluate results through sales and profits| * Financial Analysis| * Financial statements, account records| * Both Marketing a nd Finance department| * Book of Accounts * Time * HR * Information System|

Synthesis Essay Example for Free

Synthesis Essay In Barbara Ehrenreich’s work of fiction called Serving in Florida, she describes the struggles of an average waitress trying to survive a minimum wage job. In this work, the speaker reveals how workers are not allowed breaks and â€Å"for six to eight hours in a row, you never sit except to pee† (pg. 3). She also talks about the physical pain she’s in from carrying trays saying â€Å"I start tossing back drugstore-brand ibuprofens as if they were vitamin C† (p. 4). Even with all this painstaking work, the speaker can only afford to live in a dingy trailer park because she is working off of minimum wage. As shown by the chart titled Poverty Rate Rises, the number of people living below the poverty line in 2010 was 15. 1% and it continues to increase. People are working hard as shown in Ehrenreich’s Serving in Florida, yet many are unable to rise above the poverty line because minimum wage is too low. The gap between the rich and the poor continues to widen, and nothing helpful is being done to end this. In the satire titled â€Å"Gap Between Rich and Poor Named 8th Wonder of the World†, the author shows his disapproval of the gap through sarcasm. The author describes how many people have attempted to cross the gap but â€Å"only a small fraction have ever succeeded and many have died in the attempt† (para. 11). This sarcastic quote brings out the point that very few are able to rise above poverty and be successful. The author describes how the gap has been preserved â€Å"due to a small group of dedicated politicians and industry leaders† (para. 12). This quote means that because of wealthy politicians and selfish industry leaders who do not want to pay their employees more, the minimum wage is not raised, and the gap remains. A Modest Proposal by Jonathan Swift is another satiric piece of work about how England should handle the increasing poverty in Ireland in 1729. Though this was written many years ago, it is still relevant now, because like the English, our government is doing little to help the poor. Swift presents his solution to the hunger problem in Ireland. He suggests that a child is â€Å"most delicious, nourishing, and wholesome food† (p. 395). In this essay, Swifts explains how children should be sold as food and that would solve many problems. Swift shows how insensitive and ignorant the government and the wealthy can be of the impoverished population. Instead of resorting to eating children, the minimum wage should be raised so people do not have to worry about how they will be able to afford food and other necessities for survival. The minimum wage should be raised so Americans can live a comfortable life and not worry about where they are going to get their next meal from or where they are going to sleep that night. The evidence provided showed how hardworking Americans deserve to have a higher minimum wage because that is the only way they can live without struggle.

Physiotherapy Management of Lower Limb Tendonopathies

Physiotherapy Management of Lower Limb Tendonopathies A Systematic Review of the physiotherapy management of lower limb tendonopathies Tendonitis is a condition which is comparatively commonly seen in various clinics. The largest cohort of patients tend to have developed their condition as a result of various sports-related activities but it is acknowledged that there is a substantial cohort of RSI sufferers and occupation-related forms of tendonitis. (Kader et al 2002) In this piece we aim to review the various treatment modalities and to concentrate primarily on the eccentric muscle strengthening modalities of treatment, the rationale behind them and any evidence that they actually work. Before we can consider the direct question of eccentric loading as treatment for tendonopathies we must examine the rationale for its uses well as the basic science and theory behind the actual practice. We will do this largely by the mechanism of a literature review. Methodology In this review we shall be examining the literature for not only the methods that are currently employed in treating the various lower limb tendonopathies but also for justification for these methods and the quality of the science behind them. We shall therefore critically review the literature available and present it in a rational form. In addition to this we intend to present an overview of various factors in a wider picture that are relevant to our considerations. We shall consider the current views on the pathophysiology of tendonitis and the experimental evidence on the response of the tendon to exercise in general terms. Although it is accepted that the majority of patients currently seen in clinical practice with various forms of lower limb tendonitis are suffering from a sports related injury, we shall also look at the effects of ageing on tendon physiology as it is acknowledged that the elderly are another highly represented group with tendonitis. We conclude the preamble with a number of clinical considerations, most prominently the difficulties posed by the differences in nomenclature and terminology which renders both assessments and comparisons between clinical trials difficult. We conclude the dissertation with a review of various currently employed treatment modalities and the rationale behind them. We focus specifically on the use and place of eccentric muscle strengthening exercises in the spectrum of rational treatments.. Pathophysiology of tendonitis At the macro-anatomical level, the tendon is usually easily defined as a semi-rigid white or grey structure, generally found in close proximity to synovial joints. One of its prime functions is to transmit forces generated by muscles to the skeletal system, often inducing movement. (Huxley HE 1979). At the micro-anatomical level, it’s structure is very much more complex and requires a detailed examination before we can realistically and meaningfully consider the issues relating to the therapy of tendonitis. Tendons form part of the anatomical structures that are functionally grouped together as the extracellular matrix (ECM). The rate of turnover – both synthesis and degradation – is influenced by a number of different factors including metabolic and disease related factors, but the strongest influence on the turnover rate is mechanical stress, usually as a result of various degrees of physical activity. (Agar Pet al 2000) Tendon (and intramuscular) collagen, turns over at a rate which is about half as fast as myofibrillar protein turnover. The main physiological stimulus to turnover appears to be the multiple stimuli arising from mechanical or contractile activity.(Cuthbertson D et al2005) At the cellular level, degradation of collagen is mediated largely byte metalloprotease group of enzymes and synthesis is most strongly influenced by a number of different trophic factors which are released at the cellular level. (Algren MS. 1999) These growth factors are mainly responsible for both the transcriptional changes as well as the post-translational modifications that take place as a result of either physiological changes or disease processes. (Sand Meier et al 1997) Until comparatively recently, tendon tissue was thought to be fairly inert. Recent research work has given good supportive evidence that the internal metabolic processes, the internal vascular responses (Alstom et al 1994) and the actual catabolic turnover of the collagen protein in response to physical activity, is considerably greater than originally thought. The converse is also true, as inactivity appears to have the same inhibitory effect on tendon tissue as the better known effect of wasting in muscle tissue. (Abrahamson SO et al 1996). This effect is of particular importance in our considerations (later) when we consider that some authorities suggest that outright rest is inappropriate initial treatment for tendonitis. Collagen is a large polymer-type protein made up of many repeating subunits, (triple helices of polypeptides with a high proportion of proline and hydroxyproline). It is made by fibroblasts. In the muscle, it forms a basket-like network around the muscle fibres but then forms progressively more coherent and solid structure as it forms discrete tendon. In this way it allows the efficient transmission of forces generated by the myofibrils to the tendon – and hence to the bone. (Kjaer M 2004). Training, in the form of physical work, exercise or repetitive movements, will have a trophic effect on the tendon as a whole. Collagen turnover can be increased and there can be an overall increase in the amount of collagen protein in the tendon. (Herzog W et al 2002) Collagen, in the form in which it is found in a tendon, has enormous on-elastic tensile strength and a modest degree of ability to bend under lateral stress. As the amount of collagen in a tendon increases, the tendon’s mechanical (or more accurately, viscoelastic,) properties change. It decreases it’s stress levels for a given load, and thereby renders it more load resistant.(Fowls JL et al. 2000). Again this facts of great relevance to our clinical considerations later in this piece. The stiffness, or resistance to lateral stress, is a function of the cross-linking of sulphur bonds across the parallel bands of protein. In general terms, the more cross-links, the stiffer the tendon. The degree of cross-linking is a result of a complex interaction between a number of enzyme systems in the matrix of the tendon. (Hamill OP et al.2001) Polyglycans are an important feature of this enzyme cascade and become an increasingly important functional component as age increases. Older or ageing collagen will tend to exhibit glycolated cross links in addition to the sulphur links of youth. This is part of the reason why older tendons are less flexible (and possibly more prone to injury). (Inglemark BE 1948). The functional significance of these links is that they render the tendon even stiffer and less able to bend.(Davidson PF 1989).Understanding these processes is fundamental to the prescribing of a rational treatment regime for tendon injuries and other pathologies. It is also important to have a complete understanding of both the vascular and neurologically mediated adaptation processes that are present in the my-tendon complex. These work on a far more rapid and immediate time frame than the processes that we have just described, and are primarily responses to rapid changes in the mechanical loading stresses. As muscle tissue develops physiologically, there is a symbiotic relationship between the muscle and the extracellular matrix. The various physiological mechanisms that stimulate muscle growth and hypertrophy appear to have a similar effect on the extracellular matrix. (MacLean et al 1991) But in the latter case, they are less well understood. We know that that significant and repeated mechanical loading will trigger off, or initiate a process, which starts with the activation of trophic gene in a cellular nucleus, (Banes AJ et al.1999), it progresses through the complex processes of protein synthesis and functionally ends with the deposition of collagen in the tendon tissue.(Yasuda et al 2000) Responses of the tendon to exercise There would appear to be some form of integration between the muscular and the extracellular matrix signalling pathways, which optimises the co-ordinated activity of the trophic processes in response to the stimuli (which can be both loading and tensile in nature), which produce the response in the first place. (Viidik A.1993). This co-ordination mechanism must exist, as it is a well-recognised phenomenon that a tendon hypertrophies to accommodate the increased mechanical stress that its associated hypertrophied muscle produces. (Derwin et al 1999) Considerable research effort has been expended in trying to delineate the mechanism, but to date, the results have not increased our understanding of the situation significantly. (Vierck J et al 2000) Specific studies in this area have been able to show a clear correlation between collagen response and an increase in physical training. (Langberg et al 2001). The response was detectable after a 4week training programme and was maximal at 11 weeks. When we consider the pathophysiology of RSI (repetitive strain injury) or even chronic overload syndrome, the stimuli that can produce muscle hypertrophy or increase muscle fibrosis can also produce fundamental changes in the tendon structure. (Birk DE et al 1990) These changes can include changes in both the chemistry and the functionality of cross bonding of the collagen fibres, (Barnard K et al1987), changes in the size of the collagen fibrils, areas of locally increased blood flow (known as hyper vascularisation zones), and an increase in the catabolic processes which can result in either (or both) collagen being synthesised and laid down, or increase in fibroblastic activity which increases the fibrous component of the tendon. (Greenfield EM et al 1999) It is a fundamental recognition of the fact that these processes require â€Å"adjusted loading† rather than an enforced absence of loading(immobilisation) to reverse the physiological processes, that underpins most of the thrust of this review.( Howell JN et al 1993), (Jà ¤rvinenTAH et al 2002) The experimental evidence to support this view comes from the classic set of investigations by Gibson (et al 1987) who compared the rate of collagen synthesis and turnover in an immobilising long-cast leg with the rate of turnover in the unaffected leg. The rate of collagen synthesis dropped by half over a seven week period in the immobilised leg. The investigators also found an adaptive (and compensatory)reduction in the rate of collagen degradation which had the overall effect of reducing the protein loss in the tendons. In the overall context of our investigation it is also important to note that the authors also found that minimal electrical stimulation of the muscle (5% of maximum voluntary contraction for 1 hr. per day),increased protein synthesis to such an extent that there was no net protein loss over the same seven week period of the trial. (Gibson etal 1989) In a study that was remarkable for its invasiveness (the authors took repeated biopsies of human patella tendon after periods of exercise), Miller (et al 2004) demonstrated that tendon collagen synthesis showed a 30% rise within 6hrs of exercise and up to a 50%rise within a 24 hr. period. This was found to exactly follow the pattern of protein synthesis in skeletal muscle. This finding is strongly supportive of the assertions made earlier in this essay, that there would appear to be a mechanical or humeral mechanism that links the trophic effects that are apparent in both tendon and skeletal muscle. Various authors have postulated different mechanisms (it has to be said with scant evidence), including integrin’s, (Levenhagen et al2002), growth factors including transforming growth factor beta (TGFB) (Moore et al.2005), or mechano growth factor (MGF) (Rennie et al 2004),which they suggest may be responsible for the co-ordination of the trophic effects of perimysium collagen, tendon collagen and the myofibrils. More concrete evidence exists (and is arguably of greater relevance to our investigation here), for the fact that dietary protein alone can produce a trophic stimulus for tendon collagen. (Jefferson Kimball 2001). It is postulated that there is some form of amino acid sensor that is responsive to the availability of amino acids. This haste effect of changing the availability of various protein kinases in the extracellular matrix generally and a subsequent enzymatic cascade which results in an increase in various anabolic signalling molecules which are, in turn, responsible for the activation of mRNA. This is then responsible for the increased synthesis of collagen (and other related proteins), in tendon and other extracellular matrix tissues. This series of very elegant experiments was done in carefully controlled conditions which removed the possibility of other anabolic factors being relevant as the only variable was the availability of amino acids. (Cuthbertson et al 2005) There is further evidence of the effect of exercise on tendon structure in the form of the set of experiments by Rennie and disco-workers. Looking specifically at the metabolism of collagen Rennie found that after strenuous exercise, the rate of incorporation of a marker into tendon collagen followed a specific pattern (Rennie Tipton 2000). There was a latent period of about 90 mines after exercise where there was no change in metabolic rate. It was then noticed that there was a dramatic increase to about 5 times normal rates of synthesis, which peaked at about 12 hrs., was maintained for about 12hrs, and then declined over the next 48 hrs. In line with the findings of Cuthbertson (above) the investigators noted that the rise in levels of synthesis is greatest if associated with an amino acid load just pre- or post-exercise, and this effect can be further enhanced by the administration of insulin secretagogues(such as glucose). There is therefore little doubt that feeding helps the post exercise response. (Atherton P et al 2005) The effects of ageing on tendon pathophysiology We have already commented, in passing, on the physiological effects of ageing in relation to the polyglycan cross bonding in tendons. There are a number of other changes which will naturally occur in relation to advancing years, which are of direct relevance to our considerations here. It is clearly a matter of observation that muscles, bones and tendons deteriorate as age increases. This deterioration leads to physical symptoms such as loss of strength, mobility and suppleness together with an increase in fatigability and a general reduction in proprioception. This condition is sometimes called â€Å"sarcopenia†.(Forbes 1987) Epidemiological studies (Dorrens et al 2003), provide good evidence to support the popularly held view that an active lifestyle into old age is more likely to support a higher level of bone density, muscle bulk and tendon flexibility, than a sedentary one. One can postulate that the trophic mechanisms referred to above, stay active for longer when constantly stimulated by mechanical activity. One effect of ageing that has been experimentally demonstrated, is that the trophic effects of available amino acids in the bloodstream are not as great in the elderly as in the young. The elderly appear to have an ability to develop resistance to the trophic effects of amino acids, which was not present when they were younger. (Cuthbertson et al 2005) Another physiological change that can be demonstrated in the elderly, is a reduced RNA : DNA ratio in tendon tissue, which is a marker of a reduced ability to manufacture protein. This, together with reduction in the amount of detectable anabolic signalling proteins, seems to be central in the failure of the muscle and tendon synthesising mechanisms. (Smack et al.2001). If we add these findings to other work of Smack (et al 2001) and Leverhagen (et al 2002) which shows that the elderly can show responsiveness in terms of trophic changes in the collagen content of tendons by manipulation of the diet. Both studies showed that maximising the protein : energy ratio of ingested food is a reasonable strategy. It should also be noted that they also demonstrated that one has to be careful to keep the energy content of the food low in order to minimise unwanted weight gain. The elderly could reasonably be assisted to maximise the benefit they get from training (resistance training in these particular studies), by integrating it with feeding concentrated in the immediate pre- or post-exercise period. This appears to have the effect of increasing the positive synergistic relationship between exercise and amino acid delivery.( Williams et al. 2002) Clinical considerations Differential diagnosis The first and possibly most fundamental issue that we have to consider when looking at the issues of the treatment of tendonitis, is the issue of correct diagnosis. This, sadly, is compounded by the fact that there appear to be several different terminology vocabularies in common clinical use. It therefore can be difficult to directly compare treatment studies of â€Å"tendonitis â€Å" unless one has direct and clear diagnostic criteria. (Saxena 1995) Tendonitis may be taken in some medical circles to include all those conditions which come under the broad heading of â€Å"painful overuse tendon conditions† (Khan et al 1999). This is generally accepted by the uncritical, as meaning that this equates with a painful inflammatory reaction in the tendon tissue. Histological investigation of the typical chronically painful tendon, generally shows an absence of the polymorphonuclear and other associated inflammatory cells. In some literature we can see the emergence and replacement of the term tendonitis with tendinitis. This latter term tends to be defined as pertaining to areas of collagen degeneration, increased ground substance and neo-vascularisation. (Purdue et al 1996) To both illustrate and clarify the point, let us consider thevarious clinical entities that may either present like, or may be diagnosed as, â€Å"tendonitis†. For ease of classification and clarity, in this section we shall consider the term â€Å"tendonitis† in specific relation to the Achilles tendon. Williams (1986) produced the (arguably) most commonly currently accepted definitions of Achilles tendon pathologies. He classified them into:- Rupture, Focal degeneration, Tendinitis, Per tendonitis (peritendonosis), Mixed lesions, Origin/insertion lesions, Other cases such as metabolic/rheumatic causes. In common clinical parlance, any of them can be referred to, with reasonable accuracy, as â€Å"tendonitis†. (Galloway et al 1999) The aetiologies can vary (and this may well have a bearing on treatment), from trauma, reduced flexibility, abnormal or changed biomechanical considerations (such as excessive pronation, supination or limb length inequalities) to name but a few. (Saxena, A 1998) It should be noted that the anatomy of the Achilles tendon is unusual and certainly different from any other in the lower limb. It does not have a true synovial sheath but a petition which extends from its origin in the muscle to its insertion in the calcaneus. Peritendonosisis therefore a commonly misdiagnosed as Achilles tendonitis. It is also clinically significant that there is a region of decreased vascularity in the tendon, which is typically about 6 comes above its insertion (Hume 1994). The clinical difference between these two conditions is that true Achilles tendonitis may, if chronic, be characterised by fucoid, or fatty focal degenerative, changes in the tendon itself, where asperitendonitis will not involve the Achilles tendon at all. (Kvist1994). These degenerative changes may be extremely resistant to non-surgical forms of treatment. In practice, the two conditions may well be presenting the same individual. (Killer et al 1998) The differentiating signs are, however, fairly easy to detect and the two conditions can be separately distinguished in most cases. Per tendonitis is the inflammation of the petition and can usually be clinically distinguished by the presence of clinical crepitus as the Achilles tendon tries to glide back and forth along the inflamed petition. This sign together with pain, generally tends to increase with activity and the tenderness is normally felt along the whole length of the tendon. Achilles tendonitis on the other hand classically gets better with movement and is at its worst after a period of rest. The discomfort tends to be more localised into discrete areas and is more commonly found in cases where there has been either a partial or even a complete rupture in the past. (Clement et al 1994) Other pathologies can arise associated with the Achilles tendon, and for the sake of completeness we should briefly consider them as they could be potentially confounding factors in any trial which aims to consider tendonitis. Tendocalcinosis is an inflammatory process which involves the Achilles tendon but only at the point of insertion to the calcaneal bone. It typically will result in calcification and therefore should be considered a different entity to Achilles tendonitis as such. It is characterised by localised pain, and prominence of the calcaneal insertion of the tendon which may well be associated with a retro-tendon bursitis. (Williams 1986) If we apply the same rationale to the patella tendon, we are again faced with a bewildering array of terminology and conditions which tend to get lumped together as â€Å"tendonitis† and may also therefore be confounding factors in any study. We shall therefore spend a few paragraphs delineating them. Some authors point to the fact that conditions that had been previously referred to as tendonitis, when examined at a histological level, are found to be the result of collagen breakdown rather than inflammation (Khan et al 1996), and therefore suggest the title oftendinosis is more appropriate. (Cook et al 2000) (I) The whole issue of the role of the inflammatory process in the tendonopathies appears to be far from clear. An examination of the literature can point to work (such as that by Khan – above), who demonstrated that the prime histological changes were non-inflammatory and were more typical of fucoid, hyaline or fibrous degeneration with occasional calcific processes being identified. Other investigators however, point to the clinical picture which commonly includes the classic inflammatory triad of dolour, rub our and tumour (pain, redness and swelling)(Almekinders et al 1998). This, associated with the evidence of the relieving effect of NSAIA’s or corticosteroids(Friedberg 1997) leads to an ambiguous picture. The pathophysiology of this condition is most commonly thought tube related to jumping and landing activity which is the mechanism which appears to cause the rupture of the collagen filaments and hence the histological appearances. The characteristics of this type of condition are that it tends to be focal, and often in the region of the lower pole of the patella. Initially it tends to be self healing but as the chronicity increases, the pain levels can increase to the point where pain is experienced even at rest (Cook et al 2000) (II) This type of condition must clearly be differentiated from there-patella bursitis (Housemaid’s knee) which is often mistakenly diagnosed as a patella tendonitis. (Halaby et al 1999) Factors which appear to predispose to tendonopathy Many authors identify chronic overuse as being one of the major factors in tendonopathy generally. (Kist 1994) (King et al 2000). This applies equally to the occupational tendonopathy as much as the sports-related conditions. (Jon stone 2000) (Kraushaar et al 1999). We should acknowledge that the term overuse can refer equally to overuse in terms of repetitive action just as much as it can refer to overloading. The two factors being independent (but often related). Some of the current literature points to the fact that there can be differentiation in the spectrum of overuse injuries between those conditions that arise from some form of biochemical change in the structure of the tendon itself (Joss et al 1997), those that are associated with biomechanical changes (such as change in function or previous injury) (Alstom 1998) and those that arise as a result of ageing or other degenerative changes (Alstom et al 1995). These factors can arise as a result of, or independently from, other factors such as the fact that the anatomical path of a tendon can take it over (or in close proximity to) friction-inducing structures such as a bony prominence – as in the case of the tibias posterior tendon, (Benjamin et al 1998) or factors relating to the site of insertion of the tendon into the bone – as in the case of theAchilles-calcaneum interface.(Benjamin et al 1995) We can point to evidence that extraneous factors can also predispose to tendonopathy. There are genetic factors (Singer et al 1986), and a relationship to blood type (Joss et al 1989). The presence of certain concomitant chronic or debilitating illnesses can certainly be associated with tendonopathies (Kannur et al 1991) as can the chronic use of certain medications – most notably the fluoroquinolone group.(Huston 1994)(Ribard et al 1992). The mechanism in the latter case appears to be associated with an increase in the amount of MMP and its associated activity which seems to be associated with an increase in the rate of degradation of protein (especially collagen) in certain tissues. (Williams et al 2000). Other authors have identified biomechanical factors as being significant (rather than necessarily causal), in the development oftendonopathies, but we shall discuss this in specific relation to treatment, and so will not discuss it further here The spectrum of currently available treatment Before beginning any rational consideration of the various forms of treatment available, one must appreciate a common truth in medicine, and that is that different treatments and different patients will respond differently to a specific treatment modality, and one of the factors that will influence this phenomenon is the skill and experience of the practitioner concerned. For example, a surgeon may well find that he gets good results from tenotomise but poor results from eccentric exercises and therefore will recommend surgery. Physiotherapist may find the converse. It is therefore important to be critical of such factors in any appreciation and appraisal of different techniques for the treatment of the lower-limb tendonopathies. In this section we shall examine the available literature to try to obtain an overview of the various treatment modalities that are currently being prescribed and examine the rationale behind their use and efficacy Most authors seem to agree that, before considering the specific conditions, a general approach of conservative measures (such as load reduction, strengthening exercises, and massage) should be tried before other modalities such as medication and physical interventions(ultrasound etc.), and that surgery should only realistically be considered as a last resort. The only obvious exception to that approach would be when complete (or sometimes perhaps partial ) rupture of the tendon has occurred, and then surgery may well be considered the prime intervention. (Cook et al 2000) (I) Let us consider the various options in turn. In this section we will begin (again, for the sake of clarity), by specifically considering the options available for patella tendonitis. We accept that there will, of course, be overlap between the treatments for the various tendonopathies, but it makes for a rational approach to consider each in turn. The first comment that we must make is that, after examination of the literature it is noticeable that there are only a comparatively few well constructed, placebo controlled randomised trials in this area.(Almekinders et al 1998). Those that we can examine appear to suggest that the traditional treatments aimed at minimising the inflammatory processes in the condition are largely ineffective. The authors (Cooked al 2000) (II) suggest that this may well be because of the findings we have quoted earlier (Khan et al 1996) that histologically, the prime pathology is not inflammatory. Relative Rest Cook (et al 2000) (I) points to the fact that many strategies can rationally involve load reduction and the (now outmoded) instruction to â€Å"Stop everything and rest† is positively contraindicated. The rationale for this relates to the mechanisms that we have examined earlier in this piece. Immobilisation of a tendon is actually harmful as we can point to evidence (above) that shows that tensile stress and mechanical action not only stimulates collagen production, it also is vital in tendon to ensure it’s optimal fibre alignment. Rational treatment suggests that a programme of â€Å"Relative rest† may be beneficial. By that, the authors (Cook et al 2000)(I) suggest that activity should continue as long as the prime traumas of jumping, landing or sprinting can be avoided and reintroduced in a carefully graded fashion. Biomechanical Correction Because patella tendonitis is primarily related to jumping and sprinting sports ( in numbers that present clinically), we will consider treatment in relation to them. The forces that are generated in the patella tendon on landing after a jump are considerably greater than those that produced the jump in the first place. (Richards et al1996). It logically follows that if biomechanical methods can be employed to more efficiently minimise the forces, they would be best employed on landing strategies than jumping ones. One should appreciate that the energy-absorbing capacity of the limbs dependant, not only on the patella tendon, but factors at the hip and ankle as well. Studies show that the ankle and calf are the prime sites of absorbing the initial landing load (Richards et al 1996) and, if these structures are not biomechanically sound, then this will increase the forces transmitted to the knee. Prilutskii and his co-workers (et al 1993) completed a series of studies which showed that up to 40% of the energy absorbed on landing is transmitted proximally from the ankle/calf mechanism. It follows that it must be biomechanically sound if it is to absorb the 60% bulk of the load which otherwise would be transmitted upwards to the knee mechanism. Another set of studies (Prapavessis et al 1999) concluded that when flat-foot and fore-foot landings were compared, the latter generated less forces throughout the lower limb and that the forces could be reduced further (up to another 25%) by increasing the range of both hip and knee flexion on landing. There are a number of other potential biomechanical deficiencies that can be amenable to correction and should therefore be sought outspans planes may be an obvious anatomical problem detectable at an initial examination (Kaufman et al 1999), but there are other types of functional abnormality (such as excessively rapid pronation on landing) (McCrery et al 1999), that may require far more sophisticated evaluation. Outhouses inside shoes may go a long way to help these problems Some authors, (McCrery et al 1999), regard a reduced range of movement in the sub-taller joints as an aggravating factor which places and undue stress on the Achilles tendon and that manual mobilisation of the joint is indicated in these cases. Cry therapy In the light of the histological findings mentioned earlier,cryotherapy has a rational place in treatment. It is thought th Physiotherapy Management of Lower Limb Tendonopathies Physiotherapy Management of Lower Limb Tendonopathies A Systematic Review of the physiotherapy management of lower limb tendonopathies Tendonitis is a condition which is comparatively commonly seen in various clinics. The largest cohort of patients tend to have developed their condition as a result of various sports-related activities but it is acknowledged that there is a substantial cohort of RSI sufferers and occupation-related forms of tendonitis. (Kader et al 2002) In this piece we aim to review the various treatment modalities and to concentrate primarily on the eccentric muscle strengthening modalities of treatment, the rationale behind them and any evidence that they actually work. Before we can consider the direct question of eccentric loading as treatment for tendonopathies we must examine the rationale for its uses well as the basic science and theory behind the actual practice. We will do this largely by the mechanism of a literature review. Methodology In this review we shall be examining the literature for not only the methods that are currently employed in treating the various lower limb tendonopathies but also for justification for these methods and the quality of the science behind them. We shall therefore critically review the literature available and present it in a rational form. In addition to this we intend to present an overview of various factors in a wider picture that are relevant to our considerations. We shall consider the current views on the pathophysiology of tendonitis and the experimental evidence on the response of the tendon to exercise in general terms. Although it is accepted that the majority of patients currently seen in clinical practice with various forms of lower limb tendonitis are suffering from a sports related injury, we shall also look at the effects of ageing on tendon physiology as it is acknowledged that the elderly are another highly represented group with tendonitis. We conclude the preamble with a number of clinical considerations, most prominently the difficulties posed by the differences in nomenclature and terminology which renders both assessments and comparisons between clinical trials difficult. We conclude the dissertation with a review of various currently employed treatment modalities and the rationale behind them. We focus specifically on the use and place of eccentric muscle strengthening exercises in the spectrum of rational treatments.. Pathophysiology of tendonitis At the macro-anatomical level, the tendon is usually easily defined as a semi-rigid white or grey structure, generally found in close proximity to synovial joints. One of its prime functions is to transmit forces generated by muscles to the skeletal system, often inducing movement. (Huxley HE 1979). At the micro-anatomical level, it’s structure is very much more complex and requires a detailed examination before we can realistically and meaningfully consider the issues relating to the therapy of tendonitis. Tendons form part of the anatomical structures that are functionally grouped together as the extracellular matrix (ECM). The rate of turnover – both synthesis and degradation – is influenced by a number of different factors including metabolic and disease related factors, but the strongest influence on the turnover rate is mechanical stress, usually as a result of various degrees of physical activity. (Agar Pet al 2000) Tendon (and intramuscular) collagen, turns over at a rate which is about half as fast as myofibrillar protein turnover. The main physiological stimulus to turnover appears to be the multiple stimuli arising from mechanical or contractile activity.(Cuthbertson D et al2005) At the cellular level, degradation of collagen is mediated largely byte metalloprotease group of enzymes and synthesis is most strongly influenced by a number of different trophic factors which are released at the cellular level. (Algren MS. 1999) These growth factors are mainly responsible for both the transcriptional changes as well as the post-translational modifications that take place as a result of either physiological changes or disease processes. (Sand Meier et al 1997) Until comparatively recently, tendon tissue was thought to be fairly inert. Recent research work has given good supportive evidence that the internal metabolic processes, the internal vascular responses (Alstom et al 1994) and the actual catabolic turnover of the collagen protein in response to physical activity, is considerably greater than originally thought. The converse is also true, as inactivity appears to have the same inhibitory effect on tendon tissue as the better known effect of wasting in muscle tissue. (Abrahamson SO et al 1996). This effect is of particular importance in our considerations (later) when we consider that some authorities suggest that outright rest is inappropriate initial treatment for tendonitis. Collagen is a large polymer-type protein made up of many repeating subunits, (triple helices of polypeptides with a high proportion of proline and hydroxyproline). It is made by fibroblasts. In the muscle, it forms a basket-like network around the muscle fibres but then forms progressively more coherent and solid structure as it forms discrete tendon. In this way it allows the efficient transmission of forces generated by the myofibrils to the tendon – and hence to the bone. (Kjaer M 2004). Training, in the form of physical work, exercise or repetitive movements, will have a trophic effect on the tendon as a whole. Collagen turnover can be increased and there can be an overall increase in the amount of collagen protein in the tendon. (Herzog W et al 2002) Collagen, in the form in which it is found in a tendon, has enormous on-elastic tensile strength and a modest degree of ability to bend under lateral stress. As the amount of collagen in a tendon increases, the tendon’s mechanical (or more accurately, viscoelastic,) properties change. It decreases it’s stress levels for a given load, and thereby renders it more load resistant.(Fowls JL et al. 2000). Again this facts of great relevance to our clinical considerations later in this piece. The stiffness, or resistance to lateral stress, is a function of the cross-linking of sulphur bonds across the parallel bands of protein. In general terms, the more cross-links, the stiffer the tendon. The degree of cross-linking is a result of a complex interaction between a number of enzyme systems in the matrix of the tendon. (Hamill OP et al.2001) Polyglycans are an important feature of this enzyme cascade and become an increasingly important functional component as age increases. Older or ageing collagen will tend to exhibit glycolated cross links in addition to the sulphur links of youth. This is part of the reason why older tendons are less flexible (and possibly more prone to injury). (Inglemark BE 1948). The functional significance of these links is that they render the tendon even stiffer and less able to bend.(Davidson PF 1989).Understanding these processes is fundamental to the prescribing of a rational treatment regime for tendon injuries and other pathologies. It is also important to have a complete understanding of both the vascular and neurologically mediated adaptation processes that are present in the my-tendon complex. These work on a far more rapid and immediate time frame than the processes that we have just described, and are primarily responses to rapid changes in the mechanical loading stresses. As muscle tissue develops physiologically, there is a symbiotic relationship between the muscle and the extracellular matrix. The various physiological mechanisms that stimulate muscle growth and hypertrophy appear to have a similar effect on the extracellular matrix. (MacLean et al 1991) But in the latter case, they are less well understood. We know that that significant and repeated mechanical loading will trigger off, or initiate a process, which starts with the activation of trophic gene in a cellular nucleus, (Banes AJ et al.1999), it progresses through the complex processes of protein synthesis and functionally ends with the deposition of collagen in the tendon tissue.(Yasuda et al 2000) Responses of the tendon to exercise There would appear to be some form of integration between the muscular and the extracellular matrix signalling pathways, which optimises the co-ordinated activity of the trophic processes in response to the stimuli (which can be both loading and tensile in nature), which produce the response in the first place. (Viidik A.1993). This co-ordination mechanism must exist, as it is a well-recognised phenomenon that a tendon hypertrophies to accommodate the increased mechanical stress that its associated hypertrophied muscle produces. (Derwin et al 1999) Considerable research effort has been expended in trying to delineate the mechanism, but to date, the results have not increased our understanding of the situation significantly. (Vierck J et al 2000) Specific studies in this area have been able to show a clear correlation between collagen response and an increase in physical training. (Langberg et al 2001). The response was detectable after a 4week training programme and was maximal at 11 weeks. When we consider the pathophysiology of RSI (repetitive strain injury) or even chronic overload syndrome, the stimuli that can produce muscle hypertrophy or increase muscle fibrosis can also produce fundamental changes in the tendon structure. (Birk DE et al 1990) These changes can include changes in both the chemistry and the functionality of cross bonding of the collagen fibres, (Barnard K et al1987), changes in the size of the collagen fibrils, areas of locally increased blood flow (known as hyper vascularisation zones), and an increase in the catabolic processes which can result in either (or both) collagen being synthesised and laid down, or increase in fibroblastic activity which increases the fibrous component of the tendon. (Greenfield EM et al 1999) It is a fundamental recognition of the fact that these processes require â€Å"adjusted loading† rather than an enforced absence of loading(immobilisation) to reverse the physiological processes, that underpins most of the thrust of this review.( Howell JN et al 1993), (Jà ¤rvinenTAH et al 2002) The experimental evidence to support this view comes from the classic set of investigations by Gibson (et al 1987) who compared the rate of collagen synthesis and turnover in an immobilising long-cast leg with the rate of turnover in the unaffected leg. The rate of collagen synthesis dropped by half over a seven week period in the immobilised leg. The investigators also found an adaptive (and compensatory)reduction in the rate of collagen degradation which had the overall effect of reducing the protein loss in the tendons. In the overall context of our investigation it is also important to note that the authors also found that minimal electrical stimulation of the muscle (5% of maximum voluntary contraction for 1 hr. per day),increased protein synthesis to such an extent that there was no net protein loss over the same seven week period of the trial. (Gibson etal 1989) In a study that was remarkable for its invasiveness (the authors took repeated biopsies of human patella tendon after periods of exercise), Miller (et al 2004) demonstrated that tendon collagen synthesis showed a 30% rise within 6hrs of exercise and up to a 50%rise within a 24 hr. period. This was found to exactly follow the pattern of protein synthesis in skeletal muscle. This finding is strongly supportive of the assertions made earlier in this essay, that there would appear to be a mechanical or humeral mechanism that links the trophic effects that are apparent in both tendon and skeletal muscle. Various authors have postulated different mechanisms (it has to be said with scant evidence), including integrin’s, (Levenhagen et al2002), growth factors including transforming growth factor beta (TGFB) (Moore et al.2005), or mechano growth factor (MGF) (Rennie et al 2004),which they suggest may be responsible for the co-ordination of the trophic effects of perimysium collagen, tendon collagen and the myofibrils. More concrete evidence exists (and is arguably of greater relevance to our investigation here), for the fact that dietary protein alone can produce a trophic stimulus for tendon collagen. (Jefferson Kimball 2001). It is postulated that there is some form of amino acid sensor that is responsive to the availability of amino acids. This haste effect of changing the availability of various protein kinases in the extracellular matrix generally and a subsequent enzymatic cascade which results in an increase in various anabolic signalling molecules which are, in turn, responsible for the activation of mRNA. This is then responsible for the increased synthesis of collagen (and other related proteins), in tendon and other extracellular matrix tissues. This series of very elegant experiments was done in carefully controlled conditions which removed the possibility of other anabolic factors being relevant as the only variable was the availability of amino acids. (Cuthbertson et al 2005) There is further evidence of the effect of exercise on tendon structure in the form of the set of experiments by Rennie and disco-workers. Looking specifically at the metabolism of collagen Rennie found that after strenuous exercise, the rate of incorporation of a marker into tendon collagen followed a specific pattern (Rennie Tipton 2000). There was a latent period of about 90 mines after exercise where there was no change in metabolic rate. It was then noticed that there was a dramatic increase to about 5 times normal rates of synthesis, which peaked at about 12 hrs., was maintained for about 12hrs, and then declined over the next 48 hrs. In line with the findings of Cuthbertson (above) the investigators noted that the rise in levels of synthesis is greatest if associated with an amino acid load just pre- or post-exercise, and this effect can be further enhanced by the administration of insulin secretagogues(such as glucose). There is therefore little doubt that feeding helps the post exercise response. (Atherton P et al 2005) The effects of ageing on tendon pathophysiology We have already commented, in passing, on the physiological effects of ageing in relation to the polyglycan cross bonding in tendons. There are a number of other changes which will naturally occur in relation to advancing years, which are of direct relevance to our considerations here. It is clearly a matter of observation that muscles, bones and tendons deteriorate as age increases. This deterioration leads to physical symptoms such as loss of strength, mobility and suppleness together with an increase in fatigability and a general reduction in proprioception. This condition is sometimes called â€Å"sarcopenia†.(Forbes 1987) Epidemiological studies (Dorrens et al 2003), provide good evidence to support the popularly held view that an active lifestyle into old age is more likely to support a higher level of bone density, muscle bulk and tendon flexibility, than a sedentary one. One can postulate that the trophic mechanisms referred to above, stay active for longer when constantly stimulated by mechanical activity. One effect of ageing that has been experimentally demonstrated, is that the trophic effects of available amino acids in the bloodstream are not as great in the elderly as in the young. The elderly appear to have an ability to develop resistance to the trophic effects of amino acids, which was not present when they were younger. (Cuthbertson et al 2005) Another physiological change that can be demonstrated in the elderly, is a reduced RNA : DNA ratio in tendon tissue, which is a marker of a reduced ability to manufacture protein. This, together with reduction in the amount of detectable anabolic signalling proteins, seems to be central in the failure of the muscle and tendon synthesising mechanisms. (Smack et al.2001). If we add these findings to other work of Smack (et al 2001) and Leverhagen (et al 2002) which shows that the elderly can show responsiveness in terms of trophic changes in the collagen content of tendons by manipulation of the diet. Both studies showed that maximising the protein : energy ratio of ingested food is a reasonable strategy. It should also be noted that they also demonstrated that one has to be careful to keep the energy content of the food low in order to minimise unwanted weight gain. The elderly could reasonably be assisted to maximise the benefit they get from training (resistance training in these particular studies), by integrating it with feeding concentrated in the immediate pre- or post-exercise period. This appears to have the effect of increasing the positive synergistic relationship between exercise and amino acid delivery.( Williams et al. 2002) Clinical considerations Differential diagnosis The first and possibly most fundamental issue that we have to consider when looking at the issues of the treatment of tendonitis, is the issue of correct diagnosis. This, sadly, is compounded by the fact that there appear to be several different terminology vocabularies in common clinical use. It therefore can be difficult to directly compare treatment studies of â€Å"tendonitis â€Å" unless one has direct and clear diagnostic criteria. (Saxena 1995) Tendonitis may be taken in some medical circles to include all those conditions which come under the broad heading of â€Å"painful overuse tendon conditions† (Khan et al 1999). This is generally accepted by the uncritical, as meaning that this equates with a painful inflammatory reaction in the tendon tissue. Histological investigation of the typical chronically painful tendon, generally shows an absence of the polymorphonuclear and other associated inflammatory cells. In some literature we can see the emergence and replacement of the term tendonitis with tendinitis. This latter term tends to be defined as pertaining to areas of collagen degeneration, increased ground substance and neo-vascularisation. (Purdue et al 1996) To both illustrate and clarify the point, let us consider thevarious clinical entities that may either present like, or may be diagnosed as, â€Å"tendonitis†. For ease of classification and clarity, in this section we shall consider the term â€Å"tendonitis† in specific relation to the Achilles tendon. Williams (1986) produced the (arguably) most commonly currently accepted definitions of Achilles tendon pathologies. He classified them into:- Rupture, Focal degeneration, Tendinitis, Per tendonitis (peritendonosis), Mixed lesions, Origin/insertion lesions, Other cases such as metabolic/rheumatic causes. In common clinical parlance, any of them can be referred to, with reasonable accuracy, as â€Å"tendonitis†. (Galloway et al 1999) The aetiologies can vary (and this may well have a bearing on treatment), from trauma, reduced flexibility, abnormal or changed biomechanical considerations (such as excessive pronation, supination or limb length inequalities) to name but a few. (Saxena, A 1998) It should be noted that the anatomy of the Achilles tendon is unusual and certainly different from any other in the lower limb. It does not have a true synovial sheath but a petition which extends from its origin in the muscle to its insertion in the calcaneus. Peritendonosisis therefore a commonly misdiagnosed as Achilles tendonitis. It is also clinically significant that there is a region of decreased vascularity in the tendon, which is typically about 6 comes above its insertion (Hume 1994). The clinical difference between these two conditions is that true Achilles tendonitis may, if chronic, be characterised by fucoid, or fatty focal degenerative, changes in the tendon itself, where asperitendonitis will not involve the Achilles tendon at all. (Kvist1994). These degenerative changes may be extremely resistant to non-surgical forms of treatment. In practice, the two conditions may well be presenting the same individual. (Killer et al 1998) The differentiating signs are, however, fairly easy to detect and the two conditions can be separately distinguished in most cases. Per tendonitis is the inflammation of the petition and can usually be clinically distinguished by the presence of clinical crepitus as the Achilles tendon tries to glide back and forth along the inflamed petition. This sign together with pain, generally tends to increase with activity and the tenderness is normally felt along the whole length of the tendon. Achilles tendonitis on the other hand classically gets better with movement and is at its worst after a period of rest. The discomfort tends to be more localised into discrete areas and is more commonly found in cases where there has been either a partial or even a complete rupture in the past. (Clement et al 1994) Other pathologies can arise associated with the Achilles tendon, and for the sake of completeness we should briefly consider them as they could be potentially confounding factors in any trial which aims to consider tendonitis. Tendocalcinosis is an inflammatory process which involves the Achilles tendon but only at the point of insertion to the calcaneal bone. It typically will result in calcification and therefore should be considered a different entity to Achilles tendonitis as such. It is characterised by localised pain, and prominence of the calcaneal insertion of the tendon which may well be associated with a retro-tendon bursitis. (Williams 1986) If we apply the same rationale to the patella tendon, we are again faced with a bewildering array of terminology and conditions which tend to get lumped together as â€Å"tendonitis† and may also therefore be confounding factors in any study. We shall therefore spend a few paragraphs delineating them. Some authors point to the fact that conditions that had been previously referred to as tendonitis, when examined at a histological level, are found to be the result of collagen breakdown rather than inflammation (Khan et al 1996), and therefore suggest the title oftendinosis is more appropriate. (Cook et al 2000) (I) The whole issue of the role of the inflammatory process in the tendonopathies appears to be far from clear. An examination of the literature can point to work (such as that by Khan – above), who demonstrated that the prime histological changes were non-inflammatory and were more typical of fucoid, hyaline or fibrous degeneration with occasional calcific processes being identified. Other investigators however, point to the clinical picture which commonly includes the classic inflammatory triad of dolour, rub our and tumour (pain, redness and swelling)(Almekinders et al 1998). This, associated with the evidence of the relieving effect of NSAIA’s or corticosteroids(Friedberg 1997) leads to an ambiguous picture. The pathophysiology of this condition is most commonly thought tube related to jumping and landing activity which is the mechanism which appears to cause the rupture of the collagen filaments and hence the histological appearances. The characteristics of this type of condition are that it tends to be focal, and often in the region of the lower pole of the patella. Initially it tends to be self healing but as the chronicity increases, the pain levels can increase to the point where pain is experienced even at rest (Cook et al 2000) (II) This type of condition must clearly be differentiated from there-patella bursitis (Housemaid’s knee) which is often mistakenly diagnosed as a patella tendonitis. (Halaby et al 1999) Factors which appear to predispose to tendonopathy Many authors identify chronic overuse as being one of the major factors in tendonopathy generally. (Kist 1994) (King et al 2000). This applies equally to the occupational tendonopathy as much as the sports-related conditions. (Jon stone 2000) (Kraushaar et al 1999). We should acknowledge that the term overuse can refer equally to overuse in terms of repetitive action just as much as it can refer to overloading. The two factors being independent (but often related). Some of the current literature points to the fact that there can be differentiation in the spectrum of overuse injuries between those conditions that arise from some form of biochemical change in the structure of the tendon itself (Joss et al 1997), those that are associated with biomechanical changes (such as change in function or previous injury) (Alstom 1998) and those that arise as a result of ageing or other degenerative changes (Alstom et al 1995). These factors can arise as a result of, or independently from, other factors such as the fact that the anatomical path of a tendon can take it over (or in close proximity to) friction-inducing structures such as a bony prominence – as in the case of the tibias posterior tendon, (Benjamin et al 1998) or factors relating to the site of insertion of the tendon into the bone – as in the case of theAchilles-calcaneum interface.(Benjamin et al 1995) We can point to evidence that extraneous factors can also predispose to tendonopathy. There are genetic factors (Singer et al 1986), and a relationship to blood type (Joss et al 1989). The presence of certain concomitant chronic or debilitating illnesses can certainly be associated with tendonopathies (Kannur et al 1991) as can the chronic use of certain medications – most notably the fluoroquinolone group.(Huston 1994)(Ribard et al 1992). The mechanism in the latter case appears to be associated with an increase in the amount of MMP and its associated activity which seems to be associated with an increase in the rate of degradation of protein (especially collagen) in certain tissues. (Williams et al 2000). Other authors have identified biomechanical factors as being significant (rather than necessarily causal), in the development oftendonopathies, but we shall discuss this in specific relation to treatment, and so will not discuss it further here The spectrum of currently available treatment Before beginning any rational consideration of the various forms of treatment available, one must appreciate a common truth in medicine, and that is that different treatments and different patients will respond differently to a specific treatment modality, and one of the factors that will influence this phenomenon is the skill and experience of the practitioner concerned. For example, a surgeon may well find that he gets good results from tenotomise but poor results from eccentric exercises and therefore will recommend surgery. Physiotherapist may find the converse. It is therefore important to be critical of such factors in any appreciation and appraisal of different techniques for the treatment of the lower-limb tendonopathies. In this section we shall examine the available literature to try to obtain an overview of the various treatment modalities that are currently being prescribed and examine the rationale behind their use and efficacy Most authors seem to agree that, before considering the specific conditions, a general approach of conservative measures (such as load reduction, strengthening exercises, and massage) should be tried before other modalities such as medication and physical interventions(ultrasound etc.), and that surgery should only realistically be considered as a last resort. The only obvious exception to that approach would be when complete (or sometimes perhaps partial ) rupture of the tendon has occurred, and then surgery may well be considered the prime intervention. (Cook et al 2000) (I) Let us consider the various options in turn. In this section we will begin (again, for the sake of clarity), by specifically considering the options available for patella tendonitis. We accept that there will, of course, be overlap between the treatments for the various tendonopathies, but it makes for a rational approach to consider each in turn. The first comment that we must make is that, after examination of the literature it is noticeable that there are only a comparatively few well constructed, placebo controlled randomised trials in this area.(Almekinders et al 1998). Those that we can examine appear to suggest that the traditional treatments aimed at minimising the inflammatory processes in the condition are largely ineffective. The authors (Cooked al 2000) (II) suggest that this may well be because of the findings we have quoted earlier (Khan et al 1996) that histologically, the prime pathology is not inflammatory. Relative Rest Cook (et al 2000) (I) points to the fact that many strategies can rationally involve load reduction and the (now outmoded) instruction to â€Å"Stop everything and rest† is positively contraindicated. The rationale for this relates to the mechanisms that we have examined earlier in this piece. Immobilisation of a tendon is actually harmful as we can point to evidence (above) that shows that tensile stress and mechanical action not only stimulates collagen production, it also is vital in tendon to ensure it’s optimal fibre alignment. Rational treatment suggests that a programme of â€Å"Relative rest† may be beneficial. By that, the authors (Cook et al 2000)(I) suggest that activity should continue as long as the prime traumas of jumping, landing or sprinting can be avoided and reintroduced in a carefully graded fashion. Biomechanical Correction Because patella tendonitis is primarily related to jumping and sprinting sports ( in numbers that present clinically), we will consider treatment in relation to them. The forces that are generated in the patella tendon on landing after a jump are considerably greater than those that produced the jump in the first place. (Richards et al1996). It logically follows that if biomechanical methods can be employed to more efficiently minimise the forces, they would be best employed on landing strategies than jumping ones. One should appreciate that the energy-absorbing capacity of the limbs dependant, not only on the patella tendon, but factors at the hip and ankle as well. Studies show that the ankle and calf are the prime sites of absorbing the initial landing load (Richards et al 1996) and, if these structures are not biomechanically sound, then this will increase the forces transmitted to the knee. Prilutskii and his co-workers (et al 1993) completed a series of studies which showed that up to 40% of the energy absorbed on landing is transmitted proximally from the ankle/calf mechanism. It follows that it must be biomechanically sound if it is to absorb the 60% bulk of the load which otherwise would be transmitted upwards to the knee mechanism. Another set of studies (Prapavessis et al 1999) concluded that when flat-foot and fore-foot landings were compared, the latter generated less forces throughout the lower limb and that the forces could be reduced further (up to another 25%) by increasing the range of both hip and knee flexion on landing. There are a number of other potential biomechanical deficiencies that can be amenable to correction and should therefore be sought outspans planes may be an obvious anatomical problem detectable at an initial examination (Kaufman et al 1999), but there are other types of functional abnormality (such as excessively rapid pronation on landing) (McCrery et al 1999), that may require far more sophisticated evaluation. Outhouses inside shoes may go a long way to help these problems Some authors, (McCrery et al 1999), regard a reduced range of movement in the sub-taller joints as an aggravating factor which places and undue stress on the Achilles tendon and that manual mobilisation of the joint is indicated in these cases. Cry therapy In the light of the histological findings mentioned earlier,cryotherapy has a rational place in treatment. It is thought th