In 1968, a man called Franco Zefferelli produced a film of the Shakespeare classic Essay Example For Students

In 1968, a man called Franco Zefferelli created a film of the Shakespeare exemplary Essay In 1968, a man called Franco Zefferelli created a film of the Shakespeare great; Romeo and Juliet. Anyway in 1997 a fresher variant of the film was made by a man called Baz Lurham, and by looking at the two, you will promptly have the option to see how much the two forms vary. This is down to the distinction of translation between the two chiefs of what precisely the desires for the crowds were around then. Clearly the crowds of 1968 would have been expecting a run of the mill great adaptation of the Shakepeare play on-screen, while the crowds of 1997 would have been expecting something substantially more present day and like the world we live in today. Not exclusively is this the case, yet the way that the two chiefs have picked two very various settings for the movies will have influenced the result. Not overlooking that additionally somewhere in the range of 1968 and 1997 numerous things on the planet had changed, for instance; there were currently firearms while in 1997 they had blades, thus this would have likewise had a major influence in the contrasting of the two movies. In the Zefferelli adaptation the Capulets and the Montagues are two Roman Catholic families with a long on-going fight, both living in the town of Verona in the hour of the medieval times. While the Lurhman rendition is set in the twentieth century in the West Coast State, Venice Beach, with the Capulets being run of the mill West Coast American Hispanics and the Montagues being White Anglo-Saxon Protestants. Albeit numerous things vary in the later film from the first film, two principle viewpoints are kept the equivalent; the general storyline and language utilized. Contrasting the two movies, bits of the storyline varied yet with respect to the genuine Shakespeare story, that had not changed. In the two variants, we are acquainted with Benvolio, the Montague posse pioneer who was quite a harmony manager, especially dissimilar to Tybalt, the Capulet group pioneer who is a very firey character. Additionally in the two forms the executives decided to utilize unique Shakespearean English all through the film despite the fact that in Lurhmans adaptation it has been somewhat modernized for the crowds purpose. You could acquaint the two movies through the angle that the two families/groups are dressed as though in garbs. Anyway the closeness remains there as the in the principal the Capulet family are dressed brilliantly and the Montagues bluntly and in the second the Capulets are presently w earing dim hues and the Montagues in splendid. Not at all like Zefferelli, who utilized only the attire to recognize the two families from each other, Lurhman utilizes this yet in addition iconography utilizing group peaks, and freeze casings to distinguish the different sides in a progressively evident and sharp way. One of the fundamental contrasts between the initial scenes of the Zefferelli adaptation and the Lurhman rendition is the preamble. In the first Zefferelli rendition we are given a fairly long preface read gradually, smoothly advising us regarding the quarrel. Anyway in the second, the Lurhman variant, we are given a gigantically differentiating preamble where it blasts onto the clear screen out of the blue as a news report with breaking news, and is perused in a quick, educational and progressively genuine way. Additionally in the main, the preamble is welcomed with a quieting melody and all encompassing perspectives on the town of Verona. While in the subsequent it is welcomed with uproarious choral music catching your eye, and a mosaic of various clasps and pictures (secret reel) from further on in the film to give us a thought of what we are in for. He did this as the crowd of today can identify with it significantly more than Zefferellis as they will be accustomed to seeing breaking news gives an account of the TV. .u1a199d78c0b9cf1ee00d2d5912071eb3 , .u1a199d78c0b9cf1ee00d2d5912071eb3 .postImageUrl , .u1a199d78c0b9cf1ee00d2d5912071eb3 .focused content zone { min-stature: 80px; position: relative; } .u1a199d78c0b9cf1ee00d2d5912071eb3 , .u1a199d78c0b9cf1ee00d2d5912071eb3:hover , .u1a199d78c0b9cf1ee00d2d5912071eb3:visited , .u1a199d78c0b9cf1ee00d2d5912071eb3:active { border:0!important; } .u1a199d78c0b9cf1ee00d2d5912071eb3 .clearfix:after { content: ; show: table; clear: both; } .u1a199d78c0b9cf1ee00d2d5912071eb3 { show: square; progress: foundation shading 250ms; webkit-change: foundation shading 250ms; width: 100%; obscurity: 1; progress: haziness 250ms; webkit-change: darkness 250ms; foundation shading: #95A5A6; } .u1a199d78c0b9cf1ee00d2d5912071eb3:active , .u1a199d78c0b9cf1ee00d2d5912071eb3:hover { mistiness: 1; change: murkiness 250ms; webkit-change: mistiness 250ms; foundation shading: #2C3E50; } .u1a199d78c0b9cf1ee00d2d5912071eb3 .focused content territory { width: 100%; position: relative ; } .u1a199d78c0b9cf1ee00d2d5912071eb3 .ctaText { outskirt base: 0 strong #fff; shading: #2980B9; text dimension: 16px; textual style weight: intense; edge: 0; cushioning: 0; text-enhancement: underline; } .u1a199d78c0b9cf1ee00d2d5912071eb3 .postTitle { shading: #FFFFFF; text dimension: 16px; textual style weight: 600; edge: 0; cushioning: 0; width: 100%; } .u1a199d78c0b9cf1ee00d2d5912071eb3 .ctaButton { foundation shading: #7F8C8D!important; shading: #2980B9; fringe: none; fringe range: 3px; box-shadow: none; text dimension: 14px; text style weight: striking; line-tallness: 26px; moz-fringe span: 3px; text-adjust: focus; text-design: none; text-shadow: none; width: 80px; min-stature: 80px; foundation: url(https://artscolumbia.org/wp-content/modules/intelly-related-posts/resources/pictures/straightforward arrow.png)no-rehash; position: outright; right: 0; top: 0; } .u1a199d78c0b9cf1ee00d2d5912071eb3:hover .ctaButton { foundation shading: #34495E!important; } .u1a199d78c0b9cf1ee00d2d 5912071eb3 .focused content { show: table; tallness: 80px; cushioning left: 18px; top: 0; } .u1a199d78c0b9cf1ee00d2d5912071eb3-content { show: table-cell; edge: 0; cushioning: 0; cushioning right: 108px; position: relative; vertical-adjust: center; width: 100%; } .u1a199d78c0b9cf1ee00d2d5912071eb3:after { content: ; show: square; clear: both; } READ: The manner in which Shakespeare keeps up the crowd's consideration EssayAfter the early on preface in the principal, the camera at that point brings us into the bustling Verona advertise where we initially meet the two families. We can see the fight between them very quickly as the Capulets promptly attempt to ridicule the Montagues when they see them. The Montagues didn't fight back and looked the more harmony keeping of the two families, in spite of the fact that when the Capulets got physical, this is the point at which the counter from the Montagues came, and a tremendous blade battle broke out. When watching we see the Capulet, Ben volio attempt and separate the battle and make harmony despite the fact that he comes up short. This was on the grounds that, by then the firey, fearsome Capulet, Tybalt showed up and nearly staright away, the camera zoomed in up near his face, demonstrating the crowd he was a man of high height. He would not keep harmony and battled, for example Harmony? I detest the word! The battle continued for a brief timeframe with the camera demonstrating us a wide range of parts of the activity, however was then bankrupt up by the Verona chief, the Prince. Immediately the camera zooms in onto his face and gazes toward him, demonstrating he is of an extremely high height in the town, and is enormously regarded and legitimate. He proclaimed that if anybody somehow managed to stir up some dust again in the town, that individual would be executed, thus trusting it would stop any contention. Be that as it may, after the preface in the Lurhman form it cuts energetically with us with an entire diverse mentality and expectance. Initially we are welcomed with the Montagues being appeared as the more youthful, more youngster like posse. We at that point meet the Capulet pack who look significantly additionally scary as they give the impression of being progressively experienced, fearsome and sorted out than the Montagues, and we can see that the Montagues know this, as they are demonstrating bunches of dread towards the Capulets. Now the two pack pioneers are in the gas station shop and outside where the groups are a little contention is breaking out. We at that point see that the Montagues realize their pioneer is coming back to them thus this is the point at which the firearms are raised. Now we meet Benvolio, the Montague chief and to give us he is a principle character, there is a freeze-outline with spaghetti Western style music in the back ground for a few seconds, and he is attempting to keep the harmony, when Tybalt, the considerable Capulet pioneer comes out (another freeze-outline this time with average trouble maker music) and things get truly tense. The entirety of this shows Zefferlli utilizes the camera to give a perspective while Lurhman doesnt use it for this, and rather utilizes it for sway on his crowd. This is the point at which the weapon battle breaks out and you can plainly observe the distinction in quality, levelheadedness and experience between the two posses. The Montagues are unmistakably terrified, very uncalm and exceptionally unfocused and continue shooting fiercely hitting the petroleum sign on numerous occasions. While Tybalt is amazingly engaged and for all intents and purposes moves around the station taking shots at the Montagues as though it fell into place without a hitch for him. This at that point breaks out into a battle of a colossal scale and makes masses of devastation the city. This is then trailed by a news report demonstrating recordings of the military, police and helicopters attempting urgently to quiet things down over the entire city and winds up having the two posse pioneers (Benvolio and Tybalt) pointing weapons at each other. This general gives us a greater sentiment of stun than the Zefferrelli form as there has been significantly progressively ha rmed caused, this battle was on an a lot greater scale and that only a straightforward gnawing of the thumb has caused the entirety of this, thusly giving us how extraordinary the fight between the two groups was.

Term Paper Writing Services

Term Paper Writing ServicesIf you are looking for a way to help out with your term paper writing, then you should try looking into the services of a writer. You should have an idea about what they can do, but it is important that you know what you should expect from a writer before you decide to hire one for your assignment. You need to be sure that you are going to get a high quality job, or at least one that is worth your time and effort.One of the first things that you need to know about a writer that is working on a term paper is how much experience they have. This is important because a lot of people assume that writers are just someone who is there for their services, but this is not the case. A writer's experience is something that will stand out when you are talking to them about your assignment. You need to find out exactly how much experience they have in writing, so that you know how valuable they are to you and your assignment.One of the things that you should consider wh en looking into term paper writing services is experience. This is something that you need to take a look at when you are taking a look at the writers that are available for your assignment. When you are looking into the experience of the writers that are working for you, you want to make sure that you are getting someone who has experience that is well respected and well liked. This is something that you want to keep in mind when you are making a decision about who you are going to hire.The next thing that you need to look into when looking into term paper writing services is experience. This is something that you need to have an idea about when you are selecting the writers that you are going to work with. There are a lot of different writers that you will be able to work with, so it is important that you find someone who has good experience and a reputation that is well respected.The last thing that you should consider when you are looking into term paper writing services is expe rience. This is something that you need to look at when you are looking into people for your assignment. There are a lot of different people who are going to be able to work with your term paper writing services, so make sure that you are going to get someone who has a good reputation and has a good deal of experience when it comes to doing papers.A writer will have experience with writing that is very useful to you and your term paper writing service. They will be able to take care of all of the writing that you need for your assignment, and they will be able to give you the perfect style for your paper. This is something that you need to consider when you are looking for term paper writing services.When you are looking into term paper writing services, you want to make sure that you are getting the best. There are a lot of different writers who can work with you to help you with your paper writing. You need to take a look at the experience level and the reputation of the writers t hat are working with you, so that you are getting the right person for your assignment.Term paper writing services are an essential part of any paper writing project. You will want to make sure that you are looking into the experience level of the writers that you are going to work with. This is something that you need to consider when you are looking into hiring a writer to take care of your paper writing.

An Effect of an Acidic Fluid on Enzymatic Activity Lab Report

An Effect of an Acidic Fluid on Enzymatic Activity - Lab Report Example The specialist tells that compounds are comprised of protein atoms. They catalyze biochemical responses. The protein catalyzes the response where the reactants are a chemical and the substrate. Substrates join at a functioning site. One protein is equipped for catalyzing one response as it were. Proteins are profoundly delicate atoms and they get denatured if their temperature is changed. Proteins are additionally touchy to the pH states of the medium in which they are available; pH legitimately impacts the sub-atomic structure, it likewise influences the structure of the amino acids. Amino acids are the essential units of protein atoms and are amphoteric in nature, recommending that they keep up the sub-atomic harmony. Any adjustment in the pH will either empower the amino corrosive to lose electron or proton. One additional electron adjusts the structure of amino acids. This straightforwardly impacts the structure or modifies the capacity of the protein. The pH ranges from 1 to 14 on the pH scale. The nearness of H+ in arrangement creates acidic condition causes sharpness. More the quantity of H+ particles increasingly acidic the condition will be and subsequently the PH will be lower. The pH estimation of 7 is considered as the nonpartisan pH while pH estimation of more than 7 and up to 14 is considered as the fundamental pH. The fundamental pH has more OH-particles Acidic pH impacts the structure of the protein and furthermore its activity.â

Cultural Trauma Narratives Use of Supernatural Elements - Literature Essay Samples

Novels that are centered on traumatic events in history have used different tools to access the past. The Piano Lesson by August Wilson is a film (based on a play) that is set during the Great Depression while Octavia Butler’s Kindred is a novel that is set in the 1970s and part of the 19th century. In Kindred, protagonist Dana finds out more about her family’s past and the trauma they went through during slave times. Likewise in The Piano Lesson, siblings Boy Willie and Berniece, along with Berniece’s daughter Maretha, learn the importance of the history of their family’s piano to find out what their ancestors went through during slave times. Both stories are focused on learning, through the use of supernatural elements, about the characters’ ancestors’ traumatic experiences and the importance of family and cultural history. Kindred and The Piano Lesson use elements of the fantastic (i.e. haunting (from ghosts) and time travel) to access the past, because, through these elements, the stories engage and describe things to people from modern or close to modern times in ways they wouldn’t be able to without them, and therefore enhance their understandings of the lingering traumas of past enslavement in the United States. Before Dana travels back in time and to Maryland, she doesn’t know very much about her family’s past, only knowing the names of a few of her ancestors and a couple other things. Her cultural heritage isn’t something that means as much to her as it does later, and she doesn’t actually know how bad slave times were. But then, after the second time she goes across the country to the nineteenth century and she finds out about the kind of violence that existed then, it becomes more real to her and not something that, even though she is still a part of, is more detached from. She becomes willing to use violence on people intending to hurt her, and when asked if she will use a knife, says, â€Å"‘Yes. Before last night, I might not have been sure, but now, yes.’† (Butler 47). Butler uses the supernatural element of time travel here to show that although people may think they know what happened during the past (from history books/classes or oth er sources), they oftentimes don’t and won’t be able to fully understand it if they weren’t there. Dana’s learning about her cultural history through time travel gives us, as readers, a way to connect to it better, because unlike cultural trauma stories in which the characters are from a very different time, in Kindred, Dana has much more similar knowledge and feelings than characters from a much earlier time do to those of the modern reader, so it makes the story feel a lot more real. Placing (the at first unknowledgeable about slave times) Dana in the role of a â€Å"lone black woman† (Butler 47) in the nineteenth century gives the reader â€Å"a journey of discovery that mirrors the protagonist’s own, which enables her to imagine a â€Å"mimetic encounter† with a trauma that she did not experience and one, moreover, to which she may not have a cultural connection† (Setka 96). This is because the reader is from the same or a similar time as Dana and therefore accepts the new information that Dana receives in a similar way to her. Similarly to Dana finding out in Kindred more about her family history and cultural heritage through her travels in time, Boy Willie in The Piano Lesson realizes the importance of his family’s heritage and of keeping his family’s piano to remember that heritage, and Berniece realizes the importance of remembering and not ignoring the piano. However, unlike Dana, Berniece and Boy Willie start out already at least partly knowing the story of his family and why they though the piano was important. In The Piano Lesson, instead of using an element of the fantastic to show history to a character who didn’t know almost all of it, the supernatural element of ghosts was created to show Boy Willie and Berniece the importance of the piano and of remembering his family’s past enslavement. In the beginning of the film, Boy Willie starts out not really feeling attachment to the piano and only wanting it to make money off of it, but by the end, he has realized the import ance of the piano and of its connection to his ancestors/family history and culture, and Berniece starts out ignoring and not playing the piano, but by the end of the movie, she plays it and brings out the spirits of her ancestors, who drive out the ghost of Sutter. The most important ghost in The Piano Lesson is probably Sutters ghost because of the fact that he haunts an object that almost everyone in the story is focused on the piano. Sutters ghost makes the remembrance of the Charles familys past more unavoidable, because it makes the piano more alive and hard to ignore in the minds of some of the characters (Bernieces and Boy Willies). It is also, according to Jermaine Singleton in the article Some Losses Remain with Us: Impossible Mourning and the Prevalence of Ritual in August Wilsons The Piano Lesson the texts metaphor for the psycho-social remains of the Charles familys social history of loss, dispossession, and struggle. (46). August Wilson created Sutters ghost as the part of the familys and cultures traumatic past that both Berniece and Boy Willie are trying to ignore, but then they are both forced to confront. The siblings overcoming of the ghost (Boy Willies fighting it and Bernieces playing the piano to bring out their ancestors spirits to fight it) is similar to their embracing the importance of remembering their familys past. Sutters ghost was not able to be ignored, just like the trauma the enslavement of African-Americans in the U.S. caused are not able to be forgotten. Despite the fact that the use of supernatural elements made Kindred and The Piano Lesson stories that were obviously not true, it made the slave narratives in them something that made them something we could connect to, or at least understand, more easily. The use of elements of the fantastic in both Kindred and The Piano Lesson help us, the readers, to better understand the lingering cultural trauma of slaves in the past. These supernatural elements (time travel and haunting) are placed in the two stories also because they have no need for explanation, which makes adding unexplainable scenes, such as Danas loss of her arm in Kindred, the Charles familys ancestors spirits being a part or the piano, something like Sutters ghost symbolizing the past that Berniece and Boy Charles are ignoring, or anything else that cant be represented in a way that can be easily explained in a way that makes sense scientifically. Without these supernatural elements, the stories of enslavement in both Danas family and the Charles family, and therefore those accounts of slavery that were shown in both the novel and the film, would not have been created, and the portrayals of slavery in both Kindred and The Piano Lesson would not have been as powerful as they are right now. Both of the stories illustrate lingering traumas of enslavement in the United States in ways that enhance our understanding of them extremely well. Works Cited The Piano Lesson. Dir. Lloyd Richards. 1995. Film. Butler, Octavia E. Kindred. 1979. Boston: Beacon Press, 1998. Print. Setka, Stella. Phantasmic Reincarnation: Igbo Cosmology in Octavia Butlers Kindred. MELUS: Multi-Ethnic Literature of the U.S. Oxford University Press. 2016. 93-124. Web. Singleton, Jermaine. Some Losses Remain With Us: Impossible Mourning and the Prevalence of Ritual in August Wilsons The Piano Lesson. College Literature. Johns Hopkins University Press. 2009. 40-57. Web.

Health Disparities And The Disproportionality Of Access...

Health Disparities and the Disproportionality of Access to Care for African Americans Health disparities endure tenacious issues in the United States of America, setting certain groups at higher risk of being uninsured, limited access to care, facing a poorer quality of care, and overall negative health outcomes. The high incidence of health disparities reflects the range of individual, social, economic, racial/ethnic and environmental magnitudes. Among the minority groups, African-Americans disproportionately access health care and the health disparities clearly glow in the nationwide. Purpose of the Study The purpose of this research is to identify and measure the most common health disparities that cause African-Americans poor health outcomes, assesses the solutions, and provides alternative suggestions in order to reduce or eliminate the main health disparities. Racial discrimination Racial classification has a possibility to expose an individual to racism and health disparities by influencing access to care, scope and quality of care, and overall health outcomes. In the United States of America, the secret codes of socioeconomic status are deeply spotted by race, causing the racial differences in socioeconomic status and becomes the main element to racial differences in health and health care (Kennedy, 2013). Many studies have indicated that African-Americans distrust medical practices and medical professionals due to a long history tied to the unethical treatmentShow MoreRelatedRacial Discrimination And The Health Of African Americans911 Words   |  4 Pagesdiscrimination is the ground root of disparities letting African Americans to low socioeconomic status and poor health outcomes. Why disproportionality in health is so high among African Americans in the United States? Disparities limit the continuity of improvement in overall quality of care and population health and result in poor health outcomes as well as unnecessary costs. Despite an upsurge focus on reducing disparities and increasing a set of advantages to address disparities in the federal, state, community

Drug Abuse ( Polysubstance ) Essay - 1052 Words

On the 10/05/2016, I took care of a 29 year old female who has been on admission since 09/24/2016. EMS found her in a ditch intubated her (ETT), mechanical ventilated, and brought her to the hospital. The patient informed me that police tried to stop her and her boyfriend but her boyfriend refused to stop, so she decided to jump out of a moving vehicle. Later she informed me that her boyfriend is in jail. However, her story about her incident is unclear. Her admission record shows that she started drugs at the age of 12. In addition, she is homeless, and her mom died when she was very young. Furthermore, her past medical and surgical histories are type 1 diabetes, ADHD, depression, anxiety, history of MRSA, TB ( latent TB per history from patient’s mother), history of drug abuse( polysubstance abuse) and hysterectomy. She has no known allergies. The following list of her home medications are Seroquel, Neurontin, Celexa, Remeron, Ativan, Klonipin, and Xanax. Patient was place d on contact isolation because of MRSA TB. The admitting diagnosis is rib fracture, lung contusion, sternum fracture, femur fracture, right occipital condyle fracture, spine fractures, pelvic fractures, and right hand fractures. Due to her multiple orthopedic injuries, she was placed on morphine Dilaudid for pain relief because she rated her pain 7-10 during my shift. She was extubated on 10/04/2016 but still on 3liters of Oxygen via nasal cannula. In addition, she has a lot of stitches due to herShow MoreRelatedThe Purpose Of This Paper Seeks To Analyze The Effects1208 Words   |  5 Pagespaper seeks to analyze the effects of prescription drug abuse. In the first article identified the author seeks to identify the differences between peer and parent influence on the misuse of prescription drug as it relates to ethnicity. The second article to be investigation into prescription drug use misuse and drug problems as it pertains to motivational context. 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Advance Care Planning for Palliative Care †MyAssignmenthelp.com

Question: Discuss about the Advance Care Planning for Palliative Care. Answer: Introduction: This essay centers on the case study of Anthony Vella, aged 46. Six months ago, Anthony diagnosed with stage four pancreatic cancer. Anthony has been going for a chemotherapy since he was diagnosed with cancer, until two weeks ago, when his oncologist told him that chemotherapy is no longer effective against his condition. A few days later, he experienced severe abdominal and nausea, where he was admitted to the oncology ward. With the help of the palliative team care, Anthony significantly improved and he decided to return home. A week later, Anthony collapsed and was non-responsive. An ambulance took him to a major hospital, where he was taken to the emergency department. The remaining part of the essay explains advanced care plan (ACP) and how it could have been of benefit in the case study of Anthony Vella. This paper is structured into six parts. The first part is to define advance care planning and its possible benefits for Anthony. Explaining the point at which ACP discussion should be initiated then follows. The section that follows clarifies who should take part in the ACP discussion. The information that should be included in the ACP is the next section. The advance care plan is that is inclined to changes over time. Therefore, the part that follows is when the ACP can be reviewed. The last part of this essay discusses when the ACP should be activated. As a final point, a summary of all the points discussed is wrapped up in the conclusion part. Definition and benefits of Advanced Care Planning Advance care planning is a procedure that enables people to plan for their future medical treatment and care when they can make a rational decision (Rizzalli, 2010). It is a platform that allows individuals to express their wishes, objectives, beliefs, and values to their friends, family, and caregiver before any health crisis occur. The purpose of ACP is to ensure that a patient's wishes are known, understood and upheld as described by Holley (2005). ACP also helps by making things easier for family and caregivers as they will understand what the patient wants when he or she is too ill or unable to speak. Advance care planning is typical in context of life-limiting condition or a terminal illness. There are numerous benefits attached to ACP that include less aggressive medical care, taken care of as per according to the patient's wishes, reduced rate of hospital admission, mostly in the care home residents and reduced hospital bills as explained by Heale Noble (2017). Research shows that 57% of patients who have completed ACP spent reduced time in the hospital when nearing the end of death (Detering, Hancock, Reade, Silvester, 2010).Advance care planning is also crucial in enabling family and friends to prepare for the passing of a loved one. It also helps in resolving family conflict and with bereavement as described by Curtis (2008). In the case of Anthony Vella, ACP could have assisted in knowing what his final wishes were and how to address them. This was helpful especially when he became non-responsive and could not speak. He could have undergone ACP two weeks ago when his doctor indicated that chemotherapy is no longer effective. Since stage four pancreatic cancer is considered a terminal disease with only 1% survival rate of five years (American Cancer Society, 2016), ACP could have worked perfectly in the case of Anthony. Advance care planning helps individuals decide on the future care which is taken into consideration the moment the person loses capacity. It also increases the chances of the patient to set up for other documents such as advance directives (AD), which explains the kinds of intervention they would like to undergo (Spruit et al., 2013). Having both AD and ACP documentation minimizes family conflict while increasing likelihood of respecting patient's will as Detering, Hancock, Reade, Silvester (2010) explains. Initiating advance care discussion Different indicators can make a person go through ACP discussion. It can be due to a life-changing event such as the death of a spouse, following diagnosis of life-limiting conditions, a substantial shift in clinical focus, assessment of individual needs and multiple hospital admissions, just to mention a few. ACP discussion should be an agreement among the patient, caregivers, and families. The discussion should not be as a result of outside pressure, for instance from family members. Adams, Kabcenel, Little, Sokol-Hessner, (2015) outlined a sequential step that healthcare organization could take into consideration while preparing ACP discussions: engage, steward, respect, exemplify and connect. The first step is to engage with both the patient and family members to understand what matters to most of them. This is followed by stewardship which entails documenting the healthcare delegation and what is relevant to the patient regarding his health care (Adams, Kabcenel, Little, Sokol-Hessner, 2015). The exemplify step involves making the patient understand how ACP could be of benefit to them by showing examples of healthcare staffs that have undergone through ACP discussions. The final step is to connect with the patient in a respectful way both physically and culturally. A patient should discuss ACP when he or she is physically and mentally well enough for the patient to participate in the discussion fully and subsequently make a sound decision. The discussion should focus on their goals, cultural and religious beliefs, and values instead of other conditions such as dementia (Fried, Bullock, Iannone, O'leary, 2009). In the case of Anthony Vella, ACP discussions should have been initiated when the oncologist told him that chemotherapy has stopped to be effective. This is the time when healthcare provider could have convinced him to undergo the ACP discussion when he was still of sound mind (Fried, Bullock, Iannone, O'leary, 2009). According to the case study, it can it is to acknowledge that what matters to Anthony was spending time with his wife. However, there were no records of the religious and cultural background of Anthony, neither was there any medical care of his preferences to be applied once he became non-responsive. The participants of Advance Plan Discussion The ACP discussion involves some people, key among them are the healthcare providers, the patient, and the family members. Concerning our case study of Mr. Anthony, the participants should include his wife and his two children, professionals from his cancer team, preferably the oncologist, among many other people (Bakitas et al., 2009). If the patient has been accessed and found to be lacking the capacity to decide by himself, a reliable individual can present the patient's best interest. For example, when the patient is admitted to an emergency department, and is unconscious and requires immediate treatment. A person who is acutely aware of the patient's wishes, preferences and values can step in to make the decision needed (Bakitas et al., 2009).This is the case of Mr. Anthony since he was admitted to the emergency department and did not have ACP at hand. Information in Advanced Care Plan Unlike Advance Decisions, Advance Statements and Powers of Attorney which a person can make at any convenient time, Advance Care plan is made when a patient nears the end of life. It mainly contains the patient's care and treatment wishes. These records are attached to the medical notes where they can be of use in cases of emergency. If the patient has already made Advance Decision, Advance Statement or Powers of Attorney, the information should be part of the Advanced Care Plan (Adams, Kabcenel, Little, Sokol-Hessner, 2015). Preferred Priorities for Care (PPC) document contains some questions that are used to prompt the patient. The questions mainly revolve around "what matters to you?" (Adams, Kabcenel, Little, Sokol-Hessner, 2015). Doctors and other healthcare providers use this document when deciding what is in the patient's best interest. PPC contain questions such as where you want to receive care, where you want to be cared for when you are dying and where you prefer to die, who you want to be next to you, values such as cultural and religious beliefs, and any dietary requirements you will need (Fried et al., 2013). These questions help caregivers to understand what is crucial to the patient and subsequently, their quality of life. According to the research done by Sudore and Fried (2010) on what sort of information should be included in the APC, recommended that AD forms, what matters to the patient and the Powers of Attorney. The document should ensure that the proxy understands their role, taking into account whether the surrogates should be given liberty or adhere strictly to the patient's wishes. The Proxy is also responsible for informing friends and families of the wishes of the patient (Heale Noble, 2017). For the patient to make ideal decisions or choices, they should consult with the healthcare providers. The nurses are in a position to explain different types of treatment and options and how the choices will affect the patient and whether the patient's decision is realistic or not. ACP document should be written in a simple language that all parties involved can easily understand it (Heale Noble, 2017). This makes it much easier for those who are not much conversant with legal terms and technicalities to comprehend the information contained therein to implement the wishes of the patient entirely. This also reduces the occurrence of misunderstanding between proxy's decisions and wishes of the patient (Robinson et al., 2009). Regarding the case of Mr. Anthony, his ACP information on who takes over the power of making decisions when he was non-responsive. This could have been his wife or any other unbiased individual. His wife should have stepped in and helped in making decisions that are of the best interest of the patient. His wife or any other person taking the role of the proxy should have been reasonably ascertainable, is aware of Mr. Anthony's past and present wishes, as well as his feelings. Mr. Anthony should have appointed his health lasting power of attorney to take charge when he is incapacitated (Robinson et al., 2009). When to review Advanced Care Plan Murray and McLoughlin (2012) explained that chronic illnesses could take place in any of these three forms, acute illness signified by immense decline in physical health, for instance, cancer, long-term sickness that a person becomes ill for long duration marked with periodic occurrence of severe ill-health and a prolonged decline of physical health like in cases of dementia or aging. Healthcare providers help in observing the patient for a given period and subsequently categorize the patient into one of the three mentioned classes. This information is important as it creates awareness to both the patient and family members. The information gathered is used to come up with an ideal ACP and how to handle end of life issues Holley (2005). No specific recommendations or evidence point out to when to review ACP. Mostly, the decision to consider the ACP is based on the patient's personal experiences. Some factors can also lead to the review of ACP such as if the individual circumstances of the patient changes, for instance, place of residence or discernment of quality of life. Also, a new therapeutic approach may become available, and therefore, the possibility of the patient recovering. As the condition of the patient progresses, goals and values may change, which can affect the earlier decided on the ACP Holley (2005). Advance care planning should regularly be reviewed either to uphold or to amend something while the patient is still in a capacity to do so. This ensures that the ACP is a reflection of the patient's current wishes and also to increase its likelihood to be regarded as relevant and up to date when the opportune time Michael et al. (2013). Most cancer patients find ACP as a very dynamic document instead of a rigid one. As the illness progresses, the person's views may change Michael et al. (2013). Mr. Anthony being in stage four of pancreatic cancer might have felt the same. That is why he decided to spend the last few days of his life with his family rather than in hospital. If he could have already had a standby ACP, he could have changed his wishes. Mr. Anthony's ACP should have been addressed during the early periods of his cancer treatment. This could have given him time to adjust his ACP at different stages of the disease process. The ACP could have been reviewed the moment he was informed that the chemotherapy is no longer effective. Activating the advanced care plan The decision of when to activate the ACP is based on the patient's condition. If the formulation of ACP is per according Michael et al. (2013), then the activation of the document can take place either immediately or over a given period. When the ACP is activated, the proxy took over the role of a patient and now become in charge of the healthcare decision. Proxy only makes a decision when the patient is incapacitated, and therefore, unable to make a sound decision. The proxy temporarily takes over the role of making a decision that is of best interest to the patient until the patient regain knowledge, skills, abilities, and willingness to manage his or her ACP (Adams, Kabcenel, Little, Sokol-Hessner, 2015). The activation of the Advanced Care plan can only move forward if all the stewards agree with the wishes of the patient. All the parties should comply with the five conversation-ready principles Michael et al. (2013). In the case of Mr. Anthony, if the ACP could have been ready, then it could have been activated the time he collapsed in the marketplace and later become non-responsive. His proxy would have made the decision regarding his healthcare based on his wishes on the ACP. Conclusion The essay addressed the matters regarding advance care planning with Mr. Anthony, a cancer patient with stage four of pancreatic cancer being the reference point. Mr. Anthony situation helps in understanding why it is important to prepare Advance Care Plan that can be easily followed when a patient becomes incapacitated. ACP contains the patient's wishes concerning the treatment and care, where to receive care, who they want to be with, their preferred diet, where to receive care, among other things. AD, lasting healthcare power of attorney and other relevant documents should be attached to the document should be attached to the ACP. The reviewing of the ACP should be done from time to time to have an up to date report. In cases where the patient cannot make sound decisions, activation of the ACP should be contemplated. References Adams, K. M, Kabcenel, A., Little, K. Sokol-Hessner, L. (2015). "Conversation ready": A framework for improving end-of-life care. IHI White Paper, Cambridge, MA: Institute for Healthcare Improvement. Available from: https://ihi.org American Cancer Society (ACS).(2016). Pancreatic survival rates, by stage.American Cancer Society.Available from https://www.cancer.org Bakitas, M., Lyons, K. D., Hegel, M. T., Balan, S., Brokaw, F. C., Seville, J., ... Ahles, T. A. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. Jama, 302(7), 741-749. Curtis, J. R. (2008). Palliative and end-of-life care for patients with severe COPD. European Respiratory Journal, 32(3), 796-803. Detering, K. M., Hancock, A. D., Reade, M. C., Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. Bmj, 340, c1345. Fried, T. R., Bullock, K., Iannone, L., O'leary, J. R. (2009). Understanding advance care planning as a process of health behavior change. Journal of the American Geriatrics Society, 57(9), 1547-1555. Hartle, G. A., Thimons, D. G., Angelelli, J. (2014). Physician orders for life sustaining treatment in U.S. nursing homes: A case study of CRNP engagement in the care planning process. Nursing Research Practice, 2014, 7 pp. DOI: 10.1155/2014/761784 Heale, R., Noble, H. (2017). Advance care planning and palliative care. Evidence-based nursing, 20(1), 5-6. Holley, J. L. (2005, March). PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Palliative Care in End?Stage Renal Disease: Focus on Advance Care Planning, Hospice Referral, and Bereavement. In Seminars in dialysis (Vol. 18, No. 2, pp. 154-156). Blackwell Science Inc. Michael, N., O'Callaghan, C., Clayton, J., Pollard, A., Stepanov, N., Spruyt, O., Michael, M., Ball, D. (2013). Understanding how cancer patients actualise, relinquih, and reject advance care planning: Implications for practice. Support Care Cancer, 21, 2195-2205. DOI: 10.1007/s00520-013-1779-6 Murray, S. A. McLoughlin.(2012). Illness trajectories and palliative care. In L. Sallnow, S. Kumar A. Kellehear, International Perspectives on Public Health and Palliative Care, pp. 30-51. London: Routledge Rizzalli, C. (2010). Advanced Care Planning and Palliative Care. Health Voices, (6), 16. Robinson, L., Dickinson, C., Rousseau, N., Beyer, F., Clark, A., Hughes, J., Howel, D. Exley, C. (2012).A systematic review of the effectiveness of advanced care planning interventions for people with cognitive impairment and dementia.Age and Ageing, 41(2), 263-269. DOI: 10.1093/ageing/afr148 Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., ... Pitta, F. (2013). An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. American journal of respiratory and critical care medicine, 188(8), e13-e64. Sudore, R. L., Fried, T. R. (2010). Redefining the "planning" in advance care planning: preparing for end-of-life decision making. Annals of internal medicine, 153(4), 256.