Critical Question 1 - How are priority issues for Australia’s health identified?
Measuring Health Status
Role of Epidemiology The collection and analysis of the data used to make this assessment is known as Epidemiology. Measures of Epidemiology • Morbidity: The rates, distribution and trends of illness, disease and injury in a given population. • Mortality: The number of deaths for a given cause in a given population, over a set timeperiod. • Infant Mortality: The number of deaths in the first year of life per 1000 live births. • Life Expectancy: An estimate of the number of years a person can expect to live at any particular age.

Identifying Priority Health Issues
Social Justice Principles Equity Diversity Supportive environments Priority Population Groups Prevalence of condition Potential for prevention and early intervention Costs to the individual and community Direct individual costs include the financial burden that is associated with illness and disability such as ongoing medical costs (hospital charges, medical professional fees, medications, travel etc.) and loss of employment In-direct individual costs include persistent pain and loss of quality of life, possible exclusion from social activities, increased pressure on families to offer support and the emotional toll of chronic illness Direct community costs include the vast funding of the Australian health care system (which is projected to markedly increase with an ageing and growing population). Most of this supports primary health care and pharmaceuticals, and the nature of chronic illness tends to require high degrees of medical intervention to manage them In-direct community costs include the premature loss of contributing and valuable members of society and the cost for employers in absenteeism, decreased productivity and re-training

Critical Question 2 - What are the priority issues for improving Australia’s health?
These determinants can be categorised as either: • Sociocultural determinants (E.g. family, peers, media, religion and culture) • Socioeconomic determinants (E.g. education, employment and income) • Environmental determinants (E.g. geographical location and access to health services and technology)

Cambridge University Press


© Hawgood & Ponsen 2012

Groups experiencing health inequities
Aboriginal and Torres Strait Islander peoples Socioeconomically disadvantaged (Low SES) People living in rural and remote communities Overseas-born people Elderly People with disabilities

High levels of preventable chronic disease, injury and mental health problems
Cardiovascular Disease Nature • Cardiovascular Disease (CVD) refers to all diseases of the heart and blood vessels, caused by a build up of fatty tissue inside the blood vessels (i.e. atherosclerosis) and the hardening of the blood vessels (i.e. arteriosclerosis) • 3 types of CVD include Coronary heart Disease, Cerebrovascular Disease, Peripheral Vascular Disease Extent • The leading cause of death and sickness • Both mortality and morbidity is decreasing for males and females Risk Factors and Protective Factors Non-Modifiable Risk Modifiable Risk Factors Factors - Age: rates increase sharply - Smoking and alcohol abuse over 65 years of age - Diet high in fat, salt and - Being male sugar - Family history - Low physical activity levels - High blood pressure and cholesterol levels - Being overweight Determinants Sociocultural Determinants - Family history - Indigenous: higher rates of all risk factors - Males: less likely to engage in preventative health measures Socioeconomic Determinants - Low levels of disposable income - Unemployed - Low level of education Protective Factors - Nutritious and balanced diet - Daily physical activity - Responsible use of alcohol - No smoking - Maintain healthy weight - Control stress levels

Environmental Determinants - People who live in rural and remote communities

Groups at Risk • Indigenous Australians • Socioeconomically disadvantaged communities • People who live in rural and remote regions of Australia • Elderly Cancer

Cambridge University Press


© Hawgood & Ponsen 2012

Insulin Dependent Diabetes (IDDM) – Known as Type 1 – usually presents early in life and patients require insulin injections and must monitor diet and physical activity to maintain a safe BGL 2.Exposure to carcinogens .Personal screening habits e. awareness of warning signs and personal testing Groups at Risk • Indigenous Australians • Socioeconomically disadvantaged communities • People who live in rural and remote regions of Australia • Males and Females • Other minor groups include smokers. such as excessive sun exposure Socioeconomic Determinants . being .Public screening e.g. lung and melanoma and Women: breast. outdoor workers. such fair skinned as smoking. Slap.g.Low levels of education e. asbestos. Slop. lung and melanoma Risk Factors and Protective Factors Non-Modifiable Risk Modifiable Risk Factors Factors .Age: leads to increased (cancer causing agents).g. Non-Insulin Dependent Diabetes (NIDDM) – Known as Type 2 – usually presents later in Cambridge University Press 3 © Hawgood & Ponsen 2012 . colorectal.Gender: specific cancers .Tanning habits. • The most commonly occurring cancer is non-melanoma skin cancer (which is mostly nonlife threatening). young adults and people with fair skin Diabetes Nature • A disease that affects the body’s ability to take glucose from the bloodstream to use it for energy • Caused by a malfunctioning of the pancreas leading to insufficient insulin levels.g.Avoid carcinogen e.Exposure to chemicals in the workplace Determinants Sociocultural Determinants . the hormone responsible for regulation of blood glucose levels (BGL) • 3 types: 1.Lifestyle behaviours. Breast and Lung cancers are of most concern to health authorities Extent • Mortality and morbidity rates are both increasing.Unemployed: higher rates of smoking .Genetic makeup e. . risk such as smoke. colorectal.People who work outdoors . Wrap . • Skin. breast and testicular .Seeking early medical intervention Environmental Determinants .Smoking amongst young females . Slip. breast mammograms and prostate blood test .Family history UV radiation from the sun .Nature • A group of diseases leading to the uncontrolled growth of abnormal body cells.g.People who live in rural and remote communities . alcohol misuse and poor dietary habits Protective Factors . The most common life threatening cancers include: Men: prostate.

perceptions. India or Pacific Islander descent Determinants Sociocultural Determinants .People from rural and remote and Indigenous – have difficulty in accessing medical services .Having CVD or its risk .Daily physical activity Environmental Determinants .g. especially NIDDM Type 2 • The age of onset is decreasing which is a growing concern. anxiety.Low education – less awareness of prevention strategies and health lifestyle behaviours Groups at Risk • Elderly • Indigenous Australians • Socioeconomically disadvantaged • People from rural and remote regions Mental Health Problems Nature • Any illness that negatively affects a person’s emotional stability.Being Chinese. addictions.Indigenous – 10-30% may have diabetes – much is undiagnosed . especially for young people.Ageing population . drink excessive alcohol.Over 55 years of age . such as depression.Family History factors .Being overweight Aboriginal.A balanced and nutritious diet. eating disorders and dementia Cambridge University Press 4 © Hawgood & Ponsen 2012 .Technology has lead to a more passive society e. Eating 5-6 smaller meals per day .Over 35 and being of . circulatory issues in arms and legs and a strong link to CVD (similar risk factors) Extent • World’s fastest growing disease – similar issues are evident in Australia • Prevalence increases with age.Over 45 years with CVD .Junk food advertising to children Socioeconomic Determinants . Gestational Diabetes (GD) – occurs during pregnancy • The long-term effect s of each type include vision problems. bipolar disorder. be physically inactive and be overweight .High blood pressure .Being ‘time poor’ – leads to increased reliance on ‘convenient’ food Protective Factors .life.Maintaining a healthy weight . Due to unhealthy lifestyles • 3. Indian or Pacific Islander . full of Low GI foods.Low SES – more likely to have poor diet. Requires medication and lifestyle modifications 3. obsessive compulsive disorder.5% of all Australians have Diabetes Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors . Chinese. as a result of long-term poor health behaviours related to diet and exercise.Social acceptance of binge drinking .Having diabetes in risk factors pregnancy . popularity of video games . kidney disease.Healthy use of alcohol . behaviour and social well-being.

a result of reduced smoking • Mortality is also decreasing.Grief .Elderly people – increased social isolation and grief Protective Factors .Females suffer mostly Stressful situations e.Low education – risk factors .g.Extent • 20% of people suffer form a mental health problem at some stage of life • Prevalence is increasing and much is unreported • 18-24 years olds have the highest rates.g. especially refugees • People with a disability Respiratory Diseases Nature • Common diseases that affect the respiratory system include: Asthma.Uncontrolled life changes occupational stress e. Hay fever Extent • 6 million Australians have a long-term respiratory disease • Morbidity rates are now decreasing. telephone counseling .Perceived self-worth and depression and addictions sense of identity (substance abuse) .Unemployed – higher rates of depression .Family history Determinants Sociocultural Determinants .Social acceptance as legitimate health concerns .Age – increased risk of .Strong sense of connectedness with family. dementia arthritis .Lack of emotional support e. and difficult life circumstances .Stigma amongst males as well as common stoical attitudes . abuse .ABTSI – Increased alcohol and drug abuse. work mates and neighbours .Family breakdown – lack of support .Awareness of social support structures e. depression and anxiety family breakdown and . farmers during a drought Environmental Determinants . friends.People in financial distress e.g.Males suffer mostly . GP. online help.Coping skills .Difficult life circumstances e.Living in remote regions – lack of support and medical services .g. due to effective education programs • Asthma is the leading burden of disease amongst children Cambridge University Press 5 © Hawgood & Ponsen 2012 . Chronic Obstructive Pulmonary Diseases.g.Chronic disease e.g. death or abuse .Personal resiliency skills Socioeconomic Determinants . especially substance abuse and depression Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors . family breakdown Groups at Risk • Elderly • Indigenous Australians • Socioeconomically disadvantaged • People from rural and remote regions • People born overseas.g.Drug use .

exercise . Suicide and self-harm 3.Passive smoking in homes and cars Determinants Sociocultural Determinants .Use of preventative . falls. chemicals . emotional and social well being. They often result in lingterm harm of one’s physical. Workplace accidents 5.Stress . medication for asthma pollen in spring and cold and . especially MVA’s • The elderly are prone to injuries such as falls.Increased smoking amongst low SES .No smoking Environmental Determinants .Family history Socioeconomic Determinants .g.Awareness of personal asthma triggers e.People who live in remote region are further from emergency services . cuts.g.Children’s exposure to passive smoke Groups at Risk • Indigenous Australians • Socioeconomically disadvantaged • People from rural and remote regions • Smokers Injury Nature • There are many types of injuries.Indigenous Australians – higher rates of smoking .Low SES – more likely to be exposed to occupational hazards Protective Factors .Environmental changes e.g. which has a significant impact on their quality of life Cambridge University Press 6 © Hawgood & Ponsen 2012 . drowning. e. which affect all stages of life. Injuries around the home e.g.Low income – less money for preventative medication . Acts of violence 6. Sports and recreational injuries Extent • Leading cause of death in 1-44 years age group (particularly MVA’s and suicide amongst males) • Greatest cause of potential life lost under 65 years • Major cause of hospitalisation • Deaths from injuries are decreasing in frequency.Exposure to environmental dry weather patterns hazards. Road injuries and Motor Vehicle Accidents (MVA’s) 2. poisonings.Higher rates of pollution in cities . Examples include: 1. fires 4.Education about personal prevention strategies and plans for asthma attacks .Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors .

Home modifications for the elderly .g.Low education – less awareness of dangers around the home . along with an increase in life expectancy • Sustained rates of immigration from overseas The percentage of people aged over 70 years is set to double to 20% over the next forty years.Safe use of alcohol Determinants Sociocultural Determinants .Workplace injuries are most common in agricultural settings .Risk Factors and Protective Factors Modifiable Risk Factors Non-Modifiable Risk Factors .Unsafe home environment of elderly people and children can lead to increased risk of injury Groups at Risk • Elderly (Falls) • Indigenous Australians (MVA’s and self-harm) • People from rural and remote regions (occupational injuries) • Children (poisoning and drowning) • Young Adults (MVA’s.Strong social support to prevent suicide Socioeconomic Determinants .Low income – makes it harder to purchase safety equipment . pool fencing and trip hazards .Societal pressure for tougher road laws e.Suicide is highest amongst males from rural and remote regions . leading to social isolation of young people .g.Gender – higher rates of children risk taking behaviour and Occupational hazards suicide Unsafe home environment e.Effective driver education .Low SES – higher rates of hospitalisation from injuries .Family breakdown.Attitudes towards driving and risk taking amongst males .Driving behaviour and .MVA’s are highest amongst low SES populations Environmental Determinants .g.Safe roads and effective road laws . chemicals.Minimising driving distractions e.Inadequate supervision of .Positive attitude towards road and OHS rules and regulations . the total population is expected to double to 40 million people in the same time. Healthy Ageing Cambridge University Press 7 © Hawgood & Ponsen 2012 . P plate regulations .Societal awareness of hazardous environments Protective Factors . Also.Age – elderly are more at attitudes risk of falls . sport and recreational injuries and self-harm) • Males (Suicide and MVA’s) A growing and ageing population A number of significant trends have been observed in Australia’s population in the last 50 years: • A decrease in the birth rate over this time • A decline in mortality rates. Mobile phones and GPS .Indigenous people suffer more injuries .

This increase needs to include. They assist with activities such as transport. Availability of Carers and Volunteers Carers provide informal care of people living with chronic diseases and disability. meals on wheels and social activities. Increased Population Living with Chronic Disease and Disability A larger elderly population inevitably leads to more people living with chronic disease and disability. is a key strategy of the government. the full range of health services will need to expand dramatically. The contribution of volunteers is also recognised as essential in meeting the demands of our ageing population.What role do health care facilities and services play in achieving better health for all Australians? Health care in Australia Range and types of health facilities and services Category Examples • Public health services • Cancer screening • Immunisation programs • Primary and community health care • GP’s • Ambulance services • Royal Flying Doctor Service • Dental • Hospitals • Public • Private • Mental • Specialised health services • Specialised medical practitioners • Reproductive health • Mental health • Palliative care Responsibility for health facilities and services Health care provider Facilities and/or services provided Commonwealth Government • Formation of national health policies • Collection of taxes to finance the health system • Provision of funds to state/territory governments • Special concern for ATSI • Pharmaceutical funding State/Territory Government • Hospital services • Mental health • Home and community care Cambridge University Press 8 © Hawgood & Ponsen 2012 . productive and contributing life for as long as possible. Demand for Health Services and Workforce Shortages To meet the demands placed upon our government and society by a growing and ageing population. Critical Question 3 . more primary and emergency health services such as ambulances and public hospitals and more housing and accommodation for people who require assistance with basic living needs. more specialist health professionals and GP’s. shopping.Enabling and empowering people to live a healthy.

cost and access. Dads in Distress. Bulk Billing allows patients to pay nothing and the doctor receives the scheduled fee from Cambridge University Press 9 © Hawgood & Ponsen 2012 . artificial organs and transplant technology.g. households. Examples of developments in emerging treatments and technologies include: development of new machinery. Health insurance: Medicare and private Health care in Australia is provided by the public sector (Medicare) or through private health insurance. AIHW). drug advancements. e. benefits of early detection New treatments and technologies have the potential to significantly improve the health status of Australians. improvement in materials. Every Australian is covered for 85% of the scheduled fee. etc Equity of access to health facilities and services All Australians should have equal access to health care facilities and services. individuals and all levels of government. Medicare is the health-care system for all Australians. Its aim is to provide equity in terms of cost and access for health care services. Funding for Medicare comes from income tax (1. Diabetes Australia.5% of taxable income) and the Medicare levy surcharge (1% for high income earners). Less than 2% of this figure was spent on preventable services or health promotion. chiropractor.Local Government Private organisations • • • • • • • • • • • • Community groups Family health services Dental health Women’s health Health promotion Regulating health industry providers Vary from state to state Environmental control Antenatal clinics Meals on Wheels Private hospitals Dentists Alternative health services (physiotherapy. Health care expenditure versus expenditure on early intervention and prevention Health-care expenditure incorporates private health insurance. prosthetic limb development.6 billion (Australia’s Health 2010. Reasons for increasing funding for preventative health strategies include: • Cost effectiveness • Improvement to quality of life • Containment of increasing costs • Use of existing resources • Reinforcement of individual responsibility • Maintenance of social equity • Reduced mortality and morbidity Impact of emerging new treatments and technologies on health care. etc) • Local needs basis • Cancer Council. image technology in keyhole surgery. In 2007-08 Health-care expenditure was $103. This is achieved in Australia through Medicare.

30% tax rebate for people with private health insurance .Medicare. . physiotherapy.Choice of hospital Availability of bulk billing . People have the option of increasing the health insurance they have by taking out private health insurance.Shorter waiting times .Choice of doctor 85% of scheduled fee . The extra insurance covers private hospital and ancillary or extras (dental.Naturopathy. monthly.Lifetime health-care incentive with lower premiums to those who join before age 30 Medicare Private health insurance Payment Commonwealth Government Commonwealth Government Taxpayers Individuals and families Payment type Income tax Annual.Peace of mind .Private rooms in hospital .Chiropractor .Hospital services Some specialist services . etc). etc Some special benefits such as gym membership Overseas cover Complementary and alternative health care approaches Reasons for growth of complementary and alternative health products and services World Health Organization recognition Recognition of Eastern cultures Marketing strategies Proven results for many when traditional medicine had failed Desire for natural medicines Holistic nature Addition to ancillary benefits by private health insurers Societal changes with multiculturalism Societal changes with globalisation Societal changes with demographics Formal qualifications enhancing credibility Cambridge University Press 10 © Hawgood & Ponsen 2012 .Own doctor of choice .Ancillary benefits such as physiotherapy . Reasons for choosing private health insurance include: .Private or public hospital Ambulance cover Ancillary cover . fortnightly Levy surcharge premiums Benefits Basic public hospital services Hospital cover Basic medical services . naturopathy.Physiotherapy .Avoiding increase tax To combat falling private health insurance numbers the Commonwealth Government has implemented several schemes.1% Medicare levy surcharge .Hospital choice .Health cover while overseas .

diversity and supportive environments). How health promotion based on the Ottawa Charter promotes social justice Health promotion to be effective needs to address the social justice principles (equity. governing body and cost. The benefits of partnerships in health promotion The chance of successful health promotion is greatly increased when all levels of government.Creating supportive environment .Developing personal skills .Strengthening community action . sports State of inner stillness Holistic treatment aiming to treat the underlying cause as well as the symptoms of the illness How to make informed consumer choices It is important to investigate and critique health-care providers and services. communities and individuals work together towards one common goal.Building healthy public policy Levels of responsibility for health promotion The Australian government. state and local governments. experience.Range of products and services available Alternative health-care approach Acupuncture Aromatherapy Bowen therapeutic technique Chiropractic Herbalism Homeopathy Iridology Massage Meditation Naturopathy Description Involves inserting needles into skin Use of pure essential oils to influence the mind. body or spirit System of muscle and connective tissue movements that realigns the body and balances energy flow Adjustments are made to the spine to realign correct body function Uses plants and herbs System that recognises the symptoms are unique to an individual Analysis of the human eye to detect signs of wellbeing or otherwise Includes remedial. Equity Diversity Supportive Cambridge University Press 11 © Hawgood & Ponsen 2012 . Swedish. non-government organisations.Reorienting health services .What actions are needed to address Australia’s health priorities? Health promotion based on the five action areas of the Ottawa Charter The five action areas of the Ottawa Charter are: . This can include: what is it they offer. communities and individuals are all responsible for promoting health. non-government organisations. qualifications. Critical Question 4 . what are the benefits.

10 Provision of health enhancing items Lobby groups Health services for ATSI Bulk billing PBS Access to Medicare Community based support Destigmatising health conditions Lobby groups Language assistance Abstudy Health care card environment Media campaigns Legislative bans Provision of health enhancing items Lobby groups Partnerships with the community Health campaigns The Ottawa Charter in action Application of the Ottawa Charter requires critical analysis of the 5 areas of the Ottawa Charter: developing personal skills. Examples of health promotions that are based on the Ottawa Charter to an extent include: Closing the Gap.Developing personal skills Creating supportive environments Strengthening community action Reorienting health services Building healthy public policy Mandatory PDHPE K . HSC Core 2: FACTORS AFFECTING PERFORMANCE Critical Question 1 . building healthy public policy. creating supportive environments. National Tobacco Strategy. strengthening community action. Measure Up and Swap It – Don’t Stop It. National Action Plan on Mental Health.45 seconds Increased accumulation of hydrogen ions Lactic acid Removal of lactic acid with active recovery in 15 – 30 mins Aerobic system Carbohydrate Fat Protein Glucose – 36 ATP molecules Fatty acid – 130 ATP molecule Unlimited depending upon intensity Depletion of fuel sources Carbon dioxide water Restoration of glycogen – up to 48 hours Source of fuel Efficiency of ATP production Duration Cause of fatigue By-products Process and rate of recovery Types of training and training methods Cambridge University Press 12 © Hawgood & Ponsen 2012 .10 seconds Depletion of PC None PC replenishment in 2 – 5 minutes Lactic Acid system Carbohydrate Glycogen Approximately 2 ATP molecules 30 . Fresh Tastes @ School. reorienting health services.How does training affect performance? Energy Systems Alactacid system (ATP/PC) Creatine phosphate Less than 1 ATP molecule 5 .

Plyometrics involves exercises that produce an explosive muscular contraction. Hill climb) interspersed throughout the session.Decreasing muscle soreness Static stretching – the muscle is slowly and smoothly taken to the end of its range of motion and held for approximately 30 seconds. Strength training Strength is the maximal force generated by a single muscular contraction. Plyometrics is a very common training style to develop anaerobic power. this type of stretching has risks and is only recommended for elite athletes. This method is useful for rehabilitation. Therefore. Anaerobic Anaerobic training involves exercise of high intensity and therefore short duration. Ballistic stretching – involves a bouncing action at the end of the range of motion.Prevention of injury . Cambridge University Press 13 © Hawgood & Ponsen 2012 . T = type – there are a range of training types one can utilise to develop aerobic capacity Continuous training – requires training without rest for at least 20 minutes.g. T = time – will depend upon the intensity but needs to be at least 20 minutes duration. Used often during rehabilitation. F = frequency – at least 3 sessions per week are required for aerobic training to be effective. Hypertrophy – an increase in the size of the muscle fibres and connective tissues Isotonic – involves exercises where the muscle shortens and lengthens Isometric – involves exercises where the muscle does not change length Isokinetic – involves exercises where the load remains constant throughout Machine weights – very popular method allowing for isotonic contractions and are very simple to use. I = intensity – usually measured using heart rate. It is very easy to isolate muscle groups using this method of training. Flexibility Flexibility is the ability to move a muscle through its full range of motion. Dynamic stretching – involves a series of movements that replicate game movements and take the muscle through its full range of motion.Muscular relaxation . This form of stretching activates the stretch reflex. warm up and cool down. Generally the recovery rate ratio will determine the type of training and aims of the sessions. The force of the movement takes the muscle beyond its preferred length. Good flexibility will assist: . Circuit training – involves a series of exercises that are performed one after the other with little or no rest in between each exercise. Generally it involves a static stretch. Aerobic interval training – involves alternating repetitions of an exercise and a period of rest or recovery. Aerobic training usually occurs between 70% and 85% of max HR. Interval training is a very common form of anaerobic training usually requiring maximal effort. Serious athletes may complete 12 sessions. Speed. acceleration and agility are components that can be developed through anaerobic training. Fartlek training – or ‘speed play’ involves continuous exercise with sprints or a higher intensity effort (e. followed by an isometric contraction then a period of rest before being repeated. PNF stretching – proprioceptive neuromuscular facilitation involves lengthening a muscle against a resistance.Aerobic Aerobic training generally follows the FITT principle. It is popular for warm-ups.Improved coordination .

Training thresholds Training thresholds are the upper limits of a training zone and when passed take the athlete to a new level. medicine balls and kettlebells. Hydraulic resistance – effort is made against an opposing force. The aerobic training zone is when athlete is working above the aerobic threshold and below the anaerobic threshold. The general warm up will contain some running or aerobic activities and dynamic stretching. The aerobic threshold (Lactate transition 1) is approx 70% of MHR. Reversibility Training adaptations are lost once training ceases or lowers below the current capacity of the athlete. etc required for the athlete’s sport. The cool down is recommended to form part of the active recovery for the athlete. Stability balls – have become popular of late. frequency. The anaerobic threshold (Lactate transition 2 or Onset Blood Lactate Accumulation OBLA) is approx 85% of MHR. The specific component of the warm up will contain activities relating to the sport. Their focus is to develop the core muscles and majority of free weight exercises can be adapted to be performed incorporating the stability ball. A detraining effect results in the physiological adaptations gained through training being ‘reversed’. etc. Overload can be achieved by increasing intensity. It also needs to be progressive so that the stress placed on the athlete does not cause injury or fatigue. Resistance bands – are often used in rehabilitation but have become a popular form of training lately due to their convenience. repetitions. resistance. This will incorporate a general warm up followed by a more specific warm up. Good techniques are needed to avoid injury. Warm up and cool down For most sports a warm up will last approximately 20 minutes. Specificity Exercise needs to be specific for the energy systems. progressive overload needs to occur. duration. barbells. Allow a wide range of exercises. The body adapts to the training it undergoes. They allow for a range of contractions and a wide range of muscle groups. Resistance is constant through the entire movement. movement patterns. Exercise beyond this point will see a marked increase of lactic acid build up and therefore fatigue and the cessation of exercise.Free weights – include dumbbells. muscle groups and types of contractions to be catered for. The aim of the warm up is to prepare the body both physically and mentally for optimal performance. This level is sufficient to cause a training effect. Principles of training Progressive overload To continue to have training improvements. muscles. settings. Variety Completing the same or similar activities can lead to boredom which in turn may result in a reduced training effort. activities and drills. When this adaptation occurs the training needs to be increased to stress the body beyond its current capabilities to achieve further training gains. Generally Cambridge University Press 14 © Hawgood & Ponsen 2012 . Therefore it is important for training sessions to incorporate a range of training types.

It is the result of perceiving situations as threatening. The aim of the cool down is to decrease blood lactate levels and to minimise muscle soreness. myoglobin.How can psychology affect performance? Motivation Positive and negative Positive motivation is the desire to be successful in a pursuit that will result in happiness. This includes things like trophies. Extrinsic motivation is motivation that comes from external sources. Anxiety and arousal Trait and state anxiety Anxiety is a negative emotional state. money and praise. Negative motivation is the desire to be successful with the aim of avoiding unpleasant consequences. It is self-sustaining and is usually associated with an orientation towards the task. Intrinsic and extrinsic Intrinsic motivation is internal motivation. Extrinsic rewards can deter from intrinsic motivation. The motivation is to avoid something ‘bad’ happening as opposed to a positive outcome. enzymes. This type of motivation promotes longevity as external factors are not driving the athlete. An example of this is for a high jumper to hope to compete at the Olympics. It tends to have an outcome orientation. Cambridge University Press 15 © Hawgood & Ponsen 2012 . An example is training hard and playing trying to avoid being dropped from the team. For example an athlete prior to the start of a 100m race feels nervous and anxious. the bigger event the bigger the anxiety. for example continuing to play football despite regularly being in a lower grade and losing. This generally does not promote longevity as the money and praise are not often sustainable. capillary supply. satisfaction and pleasure. Physiological adaptations in response to training Resting heart rate Stroke volume Cardiac output Oxygen uptake Lung capacity Haemoglobin level Muscle hypertrophy Effect on slow-twitch muscle fibres Adaptation Decreased resting heart rate due to more efficient stroke volume Increased at rest and throughout exercise Increased maximal cardiac output Increased due to an increase in capillaries. mitochondrial function. myoglobin content enzymes and glycogen stores No change to percentage Increased ATP and PC supply. hypertrophy and lactic acid tolerance Effect on fast-twitch muscle fibres Critical Question 2 . The tension and anxiousness is related to the event. State anxiety is feelings of tension related to a specific event or moment in time. It is emphasised by feelings of satisfaction and enjoyment.this will involve low intensity exercise. mitochondria and enzyme activity Increased maximal ventilation but remains relatively unchanged Increased due to an increase in blood plasma and RBC numbers Increased size with resistance training No change to percentage Increased hypertrophy.

As arousal increases so does performance until optimal arousal and this performance is reached. Mental rehearsal/visualisation/imagery This involves creating mental images or pictures of the upcoming event. contract concerns. crowds. heart rate. Strategies for focusing or regaining focusing can include music. Shutting out distractions and irrelevant cues will assist the athlete to perform at a higher level. This allows the athlete to experience (success) prior to the actual event. If arousal continues past this point (over arousal) then performance declines. High Performance Low Low High Level of arousal Psychological strategies to enhance motivation and manage anxiety Concentration/attention skills (focusing) The ability to focus on appropriate cues is essential for an athlete. Arousal is important for successful sporting performance. selection concerns. timing and settings all need to replicate the real event. action or skill. training for distractions and focus training. cues. preparation and expectations. Relaxation will lower breathing rates. injury concerns. Athletes often train to replicate as much as possible the same environment as ‘game day’ to ensure their focus is on the important cues at the crucial time. Therefore the detail. however. A person with high trait anxiety often displays high state anxiety in competitive situations. Mental rehearsal needs to be as realistic as possible for it to be effective. set routines. One method is as spectators watching themself perform the skill and the other is from their internal view as they are actually performing the skill. Relaxation techniques Over-aroused and anxious athletes benefit greatly from having a range of relaxation strategies available to them. blood pressure Cambridge University Press 16 © Hawgood & Ponsen 2012 . Sources of stress Stress is the imbalance between what is expected of a person and their perceived ability to meet those expectations. not all athletes or sports require the same level of arousal. An archer requires a different level of arousal (calm and quiet) compared to a weightlifter (pumped up). Athletes may use various methods of mental rehearsal. Optimal arousal is generally described utilising the inverted u hypothesis. This allows the athlete to feel confident due to the fact that it is as if the athlete has been in this position previously and therefore knows how to feel and react and more importantly can picture a successful outcome. There are many sources of stress and these include: financial concerns. Optimal arousal Optimal arousal is the physical and emotional response related to a specific moment or event.Trait anxiety is a behavioural or personality disposition to display anxiety and to perceive various situations as threatening. When there is a large imbalance then the person becomes stressed.

2 litres of fluids should be consumed daily. The goals of an athlete can be about the outcome of their performance (e. This is to ensure the required fuel reserves are full and the athlete is well hydrated. A light meal can also be eaten 1-2 hours prior. swimming a personal best at the Olympics). will enable the body to perform intense physical activity. Examples of relaxation include listening to music. therefore a person who is expecting to perform intense physical activity should drink at least 3 litres in the 24 hours leading up to an event. Hydration To avoid the negative effects of dehydration on sporting performance. For a normal person. refuelling may also be necessary. Knowing what and how much to eat. Goal-setting Setting long term and short term goals can assist an athlete greatly to remain focused.Short term goals should contribute to achieving the long term goal. bananas. as well as when to eat.and muscle tension leading to greater control and focus. controlled breathing exercises. athletes should overcompensate for their projected fluid needs. At least 500 mL of water should also be consumed. Pilates.g. by meeting the recommended dietary intakes for all nutrients. Immune System). The last significant meal should be eaten 3-4 hours prior to the event. It should contain at least 100 grams of carbohydrates. massage. During Performance Continued hydration is the main priority during physical activity.g. These considerations are as important for both training and actual competition. Critical Question 3 – How can nutrition and recovery strategies affect performance? Nutritional Considerations All athletes must ensure that the food and drink they consume will support maximum performance. They also apply to both before and after intense physical activity. Small amounts of fluid should be consumed at all possible times.g. watching TV or a movie. and may need to increase their intake for 3-4 days leading up to an event. meditation and hypnosis. as well as more fluid. they ensure that glycogen is used as a primary fuel for as long as possible. Cambridge University Press 17 © Hawgood & Ponsen 2012 . such as time-outs. such as maximum glycogen stores for triathletes • Repair of damaged body tissue from training. yoga. such as vitamins and minerals Pre-performance Nutrition Changes to an athlete’s regular diet may be necessary in the days and hours leading up to an intense training session and competition. sports bars or sports drinks. such as increasing protein intake for strength training • Prevention of dehydration. lasting longer than 60 minutes. half time and stoppages (150mL per 15 minutes). be low in fat and fibre and have a small amount of protein. which should consist of some high GI Carbohydrates. through adequate fluid intake • Optimal functioning of all body systems (e. winning gold at the Olympics) or the process (e. For endurance events. By maximising muscle and liver glycogen reserves. Carbohydrate Loading Endurance athletes require more carbohydrates than other athletes. This is best achieved by eating concentrated forms of glucose such as energy gels. The primary aims of good nutrition are: • Adequate fuel reserves.

The supposed benefits of caffeine for athletes include increased alertness. Cambridge University Press 18 © Hawgood & Ponsen 2012 . overarousal and uncontrolled muscle twitches leading to decreased fine-motor control. Possible negative side effects include an elevated heart rate. which is the fuel source for the replenishment of ADP back into ATP. Vitamins and Minerals Vitamins are chemical compounds. it also acts as a diuretic. Creatine Creatine is a fuel source. Athletes must ensure they eat sufficient amounts of protein to aid recovery and promote growth of muscle tissue. high-intensity exercise. cola drinks and advertised energy drinks. which can only be sourced through dietary intake. In most cases. It is produced partly in the body cells. but can be supplemented if needed. especially from meat sources. They enable the normal functioning of the body and promote growth and development. It is also available in the form a caffeine tablets. Good food sources of protein include lean meat. repair and maintenance of muscle tissue. This is especially important for athletes who are undertaking strength training or highintensity interval training. This is commonly known as the ATP-CP Energy System. coffee. They are also normally sourced through the food eaten in a regular diet. which play a similar role in the body. Minerals of significance include: • Iron • Calcium Protein Protein is required for the growth. It is normally consumed through chocolate. which is stored in skeletal muscles. which speeds up the Central Nervous System. leading to dehydration. but regular intake of protein. Vitamins are available in a wide range of foods. The primary aims of the first 12 – 24 hours after intense exercise are: • Restore depleted glycogen • Repair damaged muscle tissue • Rehydrate the athlete Supplementation Supplementation is the process of eating additional nutrients’ to account for a deficiency in an athlete’s diet. ensures the RDI for Creatine is achieved. may achieve training benefits such as increased lean muscle mass and improved performance levels. which is why a diverse range of food is needed to meet the RDI’s of each one. which provides for ATP regeneration during short bouts of powerful. decreased perception of fatigue and the mobilisation of fat cells leading to ‘glycogen-sparing’.Post Performance The primary aim of post-exercise recovery is to return all body systems as quickly as possible to their pre-event condition. The specific details of what to eat and when will depend on the duration and intensity of the activity itself. Athletes who either train for these types of sports or undertake a heavy resistance-training program. such as 100m sprints or shot-put. In highdoses. Deficiencies of some minerals can have a direct and adverse effect on the health and performance of certain athletes. Caffeine Caffeine is a stimulant. sports nutritionists generally prefer to make regular dietary modifications. Minerals are also chemical compounds. nuts and eggs. Its role is to assist in the production of Creatine Phosphate. dairy products.

reducing the perception of localised muscle fatigue as well as decreasing general mental fatigue. For an athlete to maintain good mental and emotional health. without intentional thought about the task requirements. right through to more significant soft-tissue injuries. This can range from microscopic muscle tears as a result of heavy resistance training. to bruises and minor sprains and strains. a range of personal strategies can be employed to achieve this • Relaxation • Sleep Critical Question 4 . allowing the athlete to prepare for the next training session or game as quickly as possible. Autonomous Stage In this stage. it is common for athletes to suffer from a variety of levels of tissue damage. • Hydrotherapy • Massage Tissue Damage Strategies Following intense physical activity and competition. Examples include: • Hydration • Nutrition • Cool Down • Stretching Neural Strategies Intense physical activity is very taxing on the muscular system. but also the Central and Peripheral Nervous System. until a correct motor pattern is established in the mind and body. the athlete is able to perform the skills automatically. and this can come from both internal and external sources. These neural strategies are aimed at relaxing the body and muscles. Characteristics of the Learner Personality Cambridge University Press 19 © Hawgood & Ponsen 2012 . Associative Stage This stage is characterised by the need for the athlete to practise the skill. as well as manage their levels of motivation and anxiety.How does the acquisition of skill affect performance? Stages of Skill Acquisition Cognitive Stage This stage is characterised be the learner developing an understanding of the task requirements.Recovery Strategies Physiological Strategies Both active recovery exercises and appropriate nutrition are important factors in restoring the body to a pre-event condition. • Cryotherapy Psychological Strategies The pressure involved in participating in elite sport can be immense.

hand-eye or foot-eye coordination). • Closed Skills are performed in a leaning environment which is unchanging. tactical awareness (awareness of what equipment should feel like as it makes contact with the body). which may be influential. and quickly adapt and learn the specific skills and tactics in another sport. Some factors that can be transferred from one sport to another include: • Motor patterns • • • Tactics and strategies Skills Components of Fitness Ability Some people seem to have a natural ability at sport. They almost seem to be dominant in any game they play. a positive outlook. Some of the factors that may underpin this phenomenon include spatial awareness (awareness of who and what is around them). enthusiasm. and they must perform the Cambridge University Press 20 © Hawgood & Ponsen 2012 . Heredity Certain genetic features can provide a varying degree of advantage with regard to the potential for success. it stands alone as making a significant contribution to sporting success at the elite level Prior Experience Certain sports have common characteristics. Specific inherited factors. which is most evident in the rate that they move through the stages of skill acquisition. focus. self-discipline. especially during fast-paced sports) The Learning Environment The Nature of Skill Skills can be categorised based on the following. competiveness and whether you are an introvert or an extrovert. kinaesthetic sense (awareness of the body’s position in space).g. stable and predictable • Open Skills are performed in a leaning environment which is changing. Examples of relevant traits include confidence.Innate personality traits can have a significant effect on an athlete in all stages of skill acquisition. which can enable a person to transfer their ability from one sport. include: • Muscle Fibre Type • • Body Shape Gender Confidence Whilst this is a personality trait. motivation. such as when to bowl the cricket ball or when to commence a high jump attempt • Externally paced skills are not at the discretion of the athlete. fast reaction time and perceptive senses (enhanced sensitivity of the senses. less stable and somewhat unpredictable • Gross Motor Skills require the use of large muscle groups to produce a less refined movement • Fine Motor Skills require the use of small muscle groups to produce a precise and accurate movement • Self-paced skills are performed when the athlete chooses to. coordination (ability to move multiple limbs with timing and precision e.

or for beginners who are in the cognitive stage Feedback • Intrinsic Feedback – information that is received internally through the senses by the performer. Or they can adjust the skill the next time it is executed • Delayed Feedback – is feedback that is received after the completion of the skill. the crowd or video analysis • Concurrent Feedback – is feedback that is received during the performance. Suitable examples include golf putting or goalkeeping • Distributed Practice is characterised by shorter periods of work with more regular periods of rest.• • • skill based on forces out of their control. The athlete may be able to adjust the current movement as it is being executed. such as hitting a baseball or being a goalkeeper in hockey Discrete skills have a clearly defined beginning and end. This suits advanced learners or for skills that cannot be broken down into sub-components that can be practiced in isolation. This is suitable for monotonous or difficult activities. such as whether ball was in or not. such as archery or sailing • Part Practice involves isolating the various sub-components. As a learner continues to improve. A Refined kinaesthetic sense is critical in enabling them to analyse the feel of the movement • Extrinsic Feedback – information that is received from an external source. This is used more so by learners in the autonomous stage and can arrive from both extrinsic and extrinsic sources. Sometimes this feedback can arrive days later during a video analysis session • Knowledge of Results – information concerning the outcome or success of the skill. and is closely aligned with intrinsic feedback. and the point at which they start or end is at the discretion of the athlete. such as a batter adjusting their shot selection as the ball swings unexpectedly. for high-intensity activities that cause excessive or where motivation is low. of moderate intensity or for highly motivated athletes. This is suitable for very complex skills such as pole vault. or through an extrinsic source such as a coach. Coaches of elite athletes must be very competent in Cambridge University Press 21 © Hawgood & Ponsen 2012 . This is most useful for beginners as the develop their basic motor patterns • Knowledge of Performance – information concerning the actual technique or the patterns of play. This information can then be used to analyse why the skills was successful or not. such as a coach. It can be either intrinsic. practicing each and then combining it all together in a complete movement. such as going for a run or swim The Performance Elements • Decision making • Strategic and tactical development The Practice Method • Massed Practice is characterised by periods of continuous practice with short rest intervals. such as a golf shot. This would suit activities such as waterskiing or tackling in rugby league • Whole Practice involves practicing the complete skill in its entirety. a 100m sprint or a pass in football Serial Skills are a combination of a range of discrete skills into one whole movement. This is suitable for activities that are fun. via video analysis. they should be developing the ability to detect and correct their own errors. Team sports are require serial skills as an athlete is constantly using a variety of skills in competition Continuous Skills have no clear beginning or end.

as the coach makes a personal interpretation Validity and Reliability of tests The assessment of sporting performances must measure what it actually intends to measure (validity) and also ensure the same results are achieved regardless of who. and communicating relevant feedback and strategies for the team Assessment of Skill and Performance Characteristics of a Skilled Performance There are a number of observable differences between a skilled and unskilled performance.carefully analysing performances to detect and help correct even minor errors. Values. and Sociocultural Background The Influence of Family and Peers The Influence of Prevailing Youth Cultures Cambridge University Press 22 © Hawgood & Ponsen 2012 . However. These involve rating scales. Also in team sports. such as in diving or gymnastics. prescribed criteria are developed by the judges or governing body. • Objective Measurement – Where an assessment is not based on human interpretation or analysis. To increase the objectivity required for official competition. These measurements are the most fair and reliable in terms of who the winner was. Commitment and degree of difficulty HSC Option 1: THE HEALTH OF YOUNG PEOPLE Critical Question 1 – What is good health for young people? The Nature of Young People’s Lives How the Developmental Stage can vary in Motivations. the test is described as objective. The analysis of technique or tactical performance also relies on subjective measures. they may not provide enough information for a complete analysis of the technique or performance • Subjective Measurement – Assessment that relies on personal opinions and judgment is described as subjective. Personal versus Prescribed Judging Criteria When a subjective measurement is to be made of any sporting performance. where or when the test is administered (reliable). Sporting examples include high jump. checklists and scoring systems that minimise the chance of error or bias affecting the results. some degree of criteria is used which enables a more complete and fair appraisal. the coach must be very good at analysing the play and identifying areas of strengths and weakness in both teams. • Kinaesthetic Sense • Anticipation • Consistency • Technique • Mental Approach Objective and Subjective Performance Measures There are a range of tests that can be used in order to make a measurement or an appraisal as to the quality of performance. the 100m sprint and the score in a team sport. Some sports rely solely on a subjective measurement.

The Influence of Global Events and Trends The Influence of Technology Epidemiology of the Health of Young People Patterns of Morbidity and Mortality Comparisons of Health Status with that of Other Age Groups The Effects of the Determinants of Health on Young People Individual Factors Sociocultural Factors Socioeconomic Factors Environmental Factors Developmental Aspects that Affect the Health of Young People Revising roles within relationships Clarifying self-identity and self-worth Developing self-sufficiency and autonomy Establishing education. training and employment pathways Determining behavioural boundaries Critical Question 2 – To what extent do Australia’s young people enjoy good health? The Major Health Issues that Impact on Young People Mental health problems and illnesses Alcohol consumption Violence Road safety Sexual health Body Image Other relevant/emerging health issues that impact on the health young people include gambling. Critical Question 3 – What skills and actions enable young people to attain better health? Skills in Attaining Better Health Building Self Concept Developing Connectedness and Support Networks Developing Resilience and Coping Skills Developing Health Literacy Skills Developing Communication Skills Accessing Health Services Becoming Involved in Community Service Creating a Sense of Future Actions Targeting Health Issues Relevant to Young People Social Action Legislation and Public Policy Health Promotion Initiatives Cambridge University Press 23 © Hawgood & Ponsen 2012 . party crashes and drink spiking. cyber-bullying.

advertising and sport The economics of hosting major sporting events Consequences for spectators and participants Critical Question 2 – What is the relationship between sport and national and cultural identity? Australian sporting identity National and regional identity through sporting achievements Government funding Politics and sports The meaning of physical activity and sport to Indigenous Australians Traditional activities and sports Links between community and identity Physical activity.HSC Option 2: SPORT AND PHYSICAL ACTIVITY IN AUSTRALIAN SOCIETY Critical Question 1 – How have meanings about sport and physical activity changed over time? The beginnings of modern sport in 19th century England and colonial Australia Links with manliness. values and beliefs about sport? The relationship between sport and the mass media The representation of sport in the media Economic considerations of media coverage and sport Deconstructing media messages. sport and cultural identity The role of competition Links to cultural identity Relationships to health Ways of thinking about the body Critical Question 3 – How does the mass media contribute to people’s understanding. patriotism and character The meaning of amateur and professional sport Women’s historical participation in sport Sport as a commodity The development of professional sport Sport as big business Sponsorship. images and amount of coverage Differences in coverage for different sports across various print and electronic media The emergence of extreme sports as entertainment Critical Question 4 – What are the relationships between sport and physical activity and gender? Cambridge University Press 24 © Hawgood & Ponsen 2012 .

Lacerations and Blisters Inflammatory Response Hard Tissue Injuries Fractures Dislocations Assessment of Injuries TOTAPS Critical Question 2 – How does sports medicine address the demands of specific athletes? Children and Young Athletes Medical Conditions Overuse Injuries Thermoregulation Appropriateness of Resistance Training Adult and Aged Athletes Heart Conditions Fractures and Bone Density Flexibility and Joint Mobility Female Athletes Eating Disorders Iron Deficiency Bone Density Pregnancy Cambridge University Press 25 © Hawgood & Ponsen 2012 .Sport as a traditionally male domain Sport and the construction of masculinity and femininity Implications for participation Sponsorship. policy and resourcing The role of the media in constructing meanings around femininity and masculinity in sport HSC Option 3: SPORTS MEDICINE Critical Question 1 – How are sports injuries classified and managed? Ways to Classify Sports Injuries Direct and Indirect Soft and Hard Tissue Overuse Soft Tissue Injuries Tears. Sprains and Contusions Skin Abrasions.

Equipment and Facilities Environmental Considerations Temperature Regulation Climatic Conditions Guidelines for Fluid Intake Acclimitisation Taping and Bandaging Preventative Taping Taping for Isolation of Injury Bandaging for the Immediate Treatment of Injury Critical Question 4 – How is injury rehabilitation managed? Rehabilitation Procedures Progressive Mobilisation Graduated Exercise Training Use of Heat and Cold Return to Play Indicators of Readiness for Return to Play Monitoring Progress Psychological Readiness Specific Warm up Procedures Return to Play Policies and Procedures Ethical Considerations HSC Option 4: IMPROVING PERFORMANCE Critical Question 1 – How do athletes train for improved performance? Cambridge University Press 26 © Hawgood & Ponsen 2012 .Critical Question 3 – What role do preventative actions play in enhancing the wellbeing of the athlete? Physical Preparation Pre-Screening Skill and Technique Physical Fitness Warm-up. Stretching and Cool Down Sports Policy and the Sports Environment Rules of Sports and Activities Modified Rules for Children Matching of Opponents Use of Protective Equipment Safe Grounds.

Strength training Resistance training Weight training Isometric training Aerobic training Continuous/uniform Fartlek Long interval Anaerobic training (power and speed) Developing power through resistance/weight training Plyometrics Short interval Flexibility training Static Dynamic Ballistic Skill training Drills practice Modified and small-sided games Games for specific outcomes Critical Question 2 – What are the planning considerations for improving performance? Initial planning considerations Performance and fitness needs Schedule of events/competitions Climate and season Planning a training year (periodisation) Phases of competition Subphases Peaking Tapering Sport-specific subphases Elements to be considered when designing a training session Health and safety considerations Providing an overview of the session to the athletes Warm up and cool down Skill instruction and practice Conditioning Evaluation Planning to avoid overtraining Amount and intensity of training Physiological considerations Psychological considerations Cambridge University Press 27 © Hawgood & Ponsen 2012 .

What ethical issues are related to improving performance? Use of drugs The dangers of performance enhancing drugs For strength For aerobic performance To mask other drugs Benefits and limitations of drug testing Use of technology Training innovation Some training innovations include: Equipment advances HSC Option 5: EQUITY AND HEALTH Why do inequities exist in the health of Australians? Factors that create health inequities Daily living conditions Quality of early years of life Access to services and transport Socioeconomic factors Social attributes Government policies and priorities Critical Question 2 – What inequities are experienced by population groups in Australia? Populations Experiencing Health Inequities Aboriginal and Torres Strait Islander Peoples Homeless People Living with HIV/AIDS Incarcerated Aged Culturally and Linguistically Diverse Backgrounds Unemployed Geographically Remote Populations People with Disabilities Critical Question 3 – How may the gap in health status be bridged? Funding to Improve health Funding for Health Funding for Specific Populations Limited Resources Cambridge University Press 28 © Hawgood & Ponsen 2012 .Critical Question 3 .

Actions that Improve Health Enable (Using Knowledge and Skills for Change) Mediate (Working for Consensus) Advocating (Speaking up for Specific Groups. their Needs and Concerns) A Social Justice Framework for Addressing Health Inequities Empowering Individuals in Disadvantaged Circumstances Empowering Disadvantaged Communities Improving Access to Facilities and Services Encouraging Economic and Cultural Change Characteristics of Effective Health Promotion Strategies Working with the Target Group in Program Design and Implementation Ensuring Cultural Relevance and Appropriateness Focusing on Skills. Education and Prevention Supporting the Whole Population while Directing Extra Resources to those in High Risk Groups Intersectoral Collaboration Cambridge University Press 29 © Hawgood & Ponsen 2012 .

Sign up to vote on this title
UsefulNot useful

Master Your Semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master Your Semester with a Special Offer from Scribd & The New York Times

Cancel anytime.