Meaning of Life and Hope

Hope Hope, a word that we all use too commonly but not defined clearly. Hope Is a desire accompanied by expectation of belief In fulfillment. It's the feeling of wanting something that could happen. It's a word of belief In positive outcomes about events and circumstances in our life. We use hope In a positive wishful meaning. When we hope for something, we wish for It, we get the Idea that It might happen. Hope Is a source we need in our lives to live and to get through our battles.It Isn't something that we should want, It's something that we need. Without It we are lost and not complete. There are many meanings that are salary In reference to the word hope. It's a word we use to cherish with anticipation. People hope so that they can get over any obstacles that life throws at them. It gives them a reason to live and help them get through their own struggles. It is a psychological way of supporting oneself and motivating oneself also. It gives you the strength to not give up.Peopl e may hope to ass the big exam they have coming up, they may hope to pass the class, they also may hope to get the promotion at their jobs, we hope for many things. If we hope to overcome an obstacle we should always follow through and believe in ourselves. Everybody needs hope in their lives. It's our best possession, it's a part of us that makes our lives more meaningful. Hope is our best friend that will never give up on us or leave us alone. When we find ourselves alone we can find hope to overcome anything that we put our minds to.Everything that we do is based on hope. Hope Is external, there are unlimited possibilities and opportunities hope has in store for us. Hope can make you feel powerful and happy and not weak and desperate. If you hope with pessimism, doubts, confusion and fear it will spoil your hopes. Sometimes hope is all we have when were down. Hope is finding out that it's not the end! Without hope, there would be no motivation or strength of will to withstand adv ersity. There would be no long term goals, no direction, no comfort, no value or meaning of life.Hope is a vessel that carries a person through life. It's a motivator and it gives us something to look forward too each day. Hope is like a battery for our spirit to keep us believing and to have faith. Don't let doubt and fear get In the way of overcoming your obstacles. Without hope we are miserable and with hope we are powerful. In conclusion, Hope is a powerful source In our lives. It gives us direction and motivation to help overcome any obstacles that come In our way. Hope helps us succeed In anything we put our minds through It.When our thoughts are drowning tit doubts, fill your thoughts with positive thoughts. Fill your beliefs with hope and dependence that the unknown will turn out favorably. Hope Is the heartbeat In our lives, without It we are lost and Incomplete. BY Aftercare's Hope, a word that we all use too commonly but not defined clearly. Hope is a desire accompanied b y expectation of belief in fulfillment. It's the feeling of wanting something that could happen. It's a word of belief in positive outcomes about events and circumstances in our life. We use hope in a positive wishful meaning.When we pop for something, we wish for it, we get the idea that it might happen. Hope is a source we need in our lives to live and to get through our battles. It isn't something that we should want, it's something that we need. Without it we are lost and not There are many meanings that are similar in reference to the word hope. It's a word we use to cherish with anticipation. People hope so that they can get over any may hope to get the promotion at their Jobs, we hope for many things. If we hope to anything that we put our minds to. Everything that we do is based on hope.Hope is spirit to keep us believing and to have faith. Don't let doubt and fear get in the way of In conclusion, Hope is a powerful source in our lives. It gives us direction and motivation t o help overcome any obstacles that come in our way. Hope helps us succeed in anything we put our minds through it. When our thoughts are drowning with doubts, fill your thoughts with positive thoughts. Fill your beliefs with hope and dependence that the unknown will turn out favorably. Hope is the heartbeat in our lives, without it we are lost and incomplete.

John Deere and Company Essay

Complex Parts, Inc. has been a supplier of specialized parts to Deere & Company for the past 10 years, with annual sales of $3. 5 million. Over the past year the supplier has fallen behind in its ability to satisfy the guidelines outlined in Deere’s Achieving Excellence Program (AEP), a supplier evaluation process that promotes communication, trust, cooperation, and continuous improvement. Due to this decline, one of Deere’s supplier evaluation teams, consisting of four employees, has to make a quick recommendation about the future relationship between Deere & Complex Parts. The Achieving Excellence Program (AEP) evaluates, on a yearly basis, key parts of how a supplier is performing. It focuses on five key areas: quality, delivery, cost management, wavelength and technical support. The program classifies each supplier, from best to worst, as either Partner, Key, Approved or Conditional. AEP effectively assesses the supplier’s commitment to its relationship with Deere in such areas as enhancing communication, lowering costs, and improving design. The biggest drawback to the AEP is that it does not consider the full history of the supplier’s relationship to the company. The evaluation only focuses on the past year and not the historical highs and lows of productivity. The program also does not take into account the current economic conditions and how the market is performing. It examines what the supplier is doing to increase profits for Deere, but does not explore what Deere could be doing to help the supplier, beyond training, plaques and honors. The Achieving Excellence Program is an ideal way to analyze how a supplier is functioning, but it would be beneficial to include an assessment of how or what Deere & Company could do to aid the supplier. Historical information of how the supplier has performed, its current financial situation and the current market state or trends should all be considered as part of the appraisal of a supplier. Using the AEP evaluation, it is difficult to determine how Complex Parts has performed over the past year. While the supplier has done extremely well, it has also done very poorly, resulting in an adequate performance. Overall, the supplier has performed well, achieving a quality rating of 666 and a delivery rating of 8650, both well below the ideal for a Partner classification. Unfortunately, the past quarter showed a sharp drop in Complex Parts’ performance, achieving a delivery rating of 155,000, higher than the ideal rating for a Conditional supplier. Looking closer at other areas of the AEP, Complex Parts received a tepid score with both positive and negative aspects in all categories. The supplier was great at following through on suggestions for quality improvement and was very proactive, but had little plans for cost reductions or how to eliminate problems resulting in late deliveries. The company took an active role in keeping up with required specification changes, but did not return phone calls to the customer service group and cost Deere tremendously with weekly expedited deliveries. Complex Parts excellently internalized the Deere Quality Plan elements, took a lead role in getting the elements implemented, and improved quality performance over the past year, but did fall behind in employing the plan in its new facility, now 5 months into operation. Finally, Complex Parts’ R&D department was very impressive with several suggestions resulting in new product programs, but the supplied parts did not meet cost targets which reduced Deere’s projected profits, and new parts quotes were not being received in a timely fashion. Using the information received from the AEP evaluation, Complex Parts should be classified as a Key supplier. While there are many troubling areas, the exceptional performance in most areas of the AEP cannot be ignored. The supplier should not retain its Partner status, but it should be recognized as an important supply chain member. There are two main courses of action that the evaluation team can consider in regards to Complex Parts. The supplier can be downgraded to a Key or an Approved supplier or it can retain its current classification as Partner with a re-evaluation in six-months. Due to the low aspects in every category within the AEP assessment, Complex Parts should be downgraded to a Key or an Approved supplier. The company was given a performance summary every quarter and should not be surprised that its classification has dropped. The best alternative course of action would be to allow the company to keep its Partner rank with the provision that it will be re-evaluated in six months to determine the future of the relationship. Included in each alternative should also be the appraisal of the other two possible suppliers. Each company should receive an in-depth evaluation and classification for comparison with Complex Parts. There are both short-term and long-term implications to these recommendations that should also be considered before making a decision. In the short-term, Complex Parts would be rewarded for its high performance, but would recognize the need for improvement. The supplier would either enhance its troubled areas or it would risk being downgraded or replaced. Deere & Company stands to lose revenues due to increased costs in the short-term if the supplier does not quickly improve its performance. In the long-term, Deere & Company would show that the AEP is taken seriously and that long-term supplier relationships are a true goal of the company. It would also prove how dedicated the company is to achieving excellence and how continued improvement is a vital part of the company’s goals. While Complex Parts is currently a Partner supplier to Deere & Company, its future rests in the hands of the supplier evaluation team. Complex Parts has performed adequately over the past year, but falling aspects indicate that the company may not be able to live up to expectations in the coming year. With an assessment of other possible suppliers and by allowing Complex Parts to retain their supplier classification with an interim evaluation in six months to determine their fate, they will either increase performance or risk demotion. Deere & Company strives to develop long-term relationships with its suppliers and a quick decision based on only a year’s worth of data, and more specifically a low-performing quarter, would be detrimental to the company’s goals. More information needs to be included in the evaluation in order to gain the full picture of how the supplier is operating. With this additional information, Deere & Company will be able to fulfill its goal of a better supplier relationship.

The Role of Ict in Enhancing Education in Developing Countries

Journal of Education for International Development 4:2 December 2009 The Role of ICT in Enhancing Education in Developing Countries: Findings from an Evaluation of The Intel Teach Essentials Course in India, Turkey, and Chile Daniel Light Education Development Center This paper presents findings from case studies of the introduction of the Intel ® Teach Essentials Course—a professional development program focused on integrating information and communication technologies (ICT) into project-based learning—into six schools in Chile, India, and Turkey. We describe four common dimensions of change in learning environments that emerged across the countries: changes in teachers’ knowledge, beliefs, and attitudes; changes in how students engage with content; changes in relationships among students, teachers, and parents; and changes in the use of ICT tools to promote students’ learning. Three of these dimensions relate to shifts in pedagogical paradigms that appear to be prerequisites to effectively using ICT to support students’ learning. Our findings indicate that these shifts must not just occur at the teacher level, but must take hold throughout the educational system and must accompany sustained investment in infrastructure, human resources, curricular frameworks, and assessment. Key Words: ICT, developing countries, education reform I. Introduction Understanding how technology fits into the complex realities of classrooms has been a critical factor in creating real change in schools in the industrialized nations (Cuban, 1993; Honey, McMillan Culp, & Carrigg, 2000; Somekh et al. 2003), yet little is known about educational technology projects in the classrooms of the developing world. This paper examines the influence of an information and communication technologies (ICT)-focused professional development program—the Intel ® Teach Essentials Course—on classroom learning environments in six schools in Chile, India, and Turkey. Over the years, program evaluations have found that teachers across a variety of countries value their experience in the Essentials Course and report using ICT and/or making changes in their teaching practice following the program (Light, McMillan Culp, Menon, & Shulman, 2006; Light, Menon, & Shulman, 2007). However, the evaluations have also suggested that the ways in which teachers in different countries follow up vary, depending largely on factors in their school contexts. The research presented in this paper sought to examine more deeply the nature of the changes that schools in different contexts have made to integrate ICT and student-centered practices and how these changes affect the classroom (Light, Polin, & Strother, 2009). In all three countries, we found that the educators we interviewed and observed felt they had been able to implement new ICT activities and teaching approaches with their students after the Course. We also identified a consistent set of programs and policies that, combined with the motivation and skills of educators, enabled these schools to innovate. We selected the six schools in the study (two from each country) which key local stakeholders—the training agencies, the ministries of education, and the Intel Education Managers—considered to be â€Å"good examples† of using the Essentials Course to create school-level change within their national Light 1 Journal of Education for International Development 4:2 December 2009 contexts. In pursuit of the ideals established by their ministries, the teachers and administrators in these schools are attempting to transform the instructional strategies and the educational tools they use. Although each country is unique and each school is at a different starting place, all are moving toward more student-centered, project-based, and ICT-rich classroom learning activities. Across the diversity of their situations, educators in each school connected the ideas and tools offered in the Essentials Course with their own needs. From our case studies of the six schools, we identified four common dimensions of changes that are emerging to support more project-based and ICT-rich activities in the classroom: changes in teachers’ knowledge, beliefs, and attitudes; changes in how students engage with content; changes in relationships among students, teachers, and parents; and changes in the use of ICT tools to promote students’ learning. Three of these dimensions of change that emerged across schools are pedagogical in nature, supporting the idea that an appropriate pedagogical context is key to successful ICT integration. II. Theoretical Perspective When effectively integrated into a high-quality learning environment, researchers have demonstrated that ICT can help deepen students’ content knowledge, engage them in constructing their own knowledge, and support the development of complex thinking skills (Kozma, 2005; Kulik, 2003; Webb & Cox, 2004). However, ICT alone cannot create this kind of teaching and learning environment. Teachers must know how to structure lessons, select resources, guide activities, and support this learning process; many traditionally-trained teachers are not prepared to take on these tasks. As Bransford, Brown, and Cocking (2000) point out, to use technology effectively, the pedagogical paradigm needs to shift toward more student-centered learning. This shift is not trivial or easily accomplished, particularly in countries with teacher-centered educational traditions. The literature suggests that four broad sets of changes should accompany the integration of ICT and the move toward a constructivist model of teaching and learning. 1. Changes in teachers’ knowledge, beliefs, and attitudes: The literature on education reform highlights the importance of changing teachers’ beliefs and attitudes to create long-term sustainable change (Fullan, 1993). Many studies on ICT integration find that projects fall short of expectations because the educators continue working within a traditional vision of rote learning (Gersten, Chard, & Baker, 2000; Honey & Moeller, 1990; Teacher Foundation, 2005). Teachers need to believe that new approaches to teaching are effective and will make a difference for their students in order for them to continue using new approaches. Teachers’ understanding and commitment are particularly important to sustain changes in areas such as project-based learning or student-centered techniques, which require core changes to a teacher’s instructional practice (Gersten et al. , 2000). 2. Changes in how students engage with content: Research in the learning sciences has established that constructivist theories of learning provide a more reliable understanding of how humans learn than previous behaviorist frameworks (Bransford et al. , 2000). Studies have identified a variety of constructivist learning strategies (e. . , students work in collaborative groups or students create products that represent what they are learning) that can change the way students interact with the content (Windschitl, 2002). The introduction of ICT into schools and project-based approaches should change how students interact with the content through new types of learning activities. 3. Changes in relationships among teachers, student s, and parents: Recent studies suggest that, specifically, a supportive and cooperative relationship with the teacher can be very important Light 2 Journal of Education for International Development 4:2 December 2009 for learning (Marzano, 2007). Research in many different countries has found that the introduction of technology into learning environments changes teachers’ and students’ roles and relationships (Hennessy, Deaney, & Ruthven, 2003; Kozma & McGhee, 2003). 4. Changes in the use of ICT tools to promote students’ learning: The ICT integration in developing country classrooms is challenging (Akbaba-Altun, 2006; Comenius, 2008; Grant, Ross, Weiping, & Potter, 2005; Light & Rockman, 2008; Somekh et al. 2003; Vyasulu Reddi & Sinha, 2003). A number of factors—such as teacher knowledge, time, access to ICT tools, and the alignment of ICT use with pedagogical goals—appear to help teachers integrate ICT and to support students’ increased use of ICT tools for learning (Light & Manso, 2006; Perez et al. , 2003). III. Overview of the Three National Contexts A. India Of the three countries, India is perhaps the country that has most recently begun reforms to promote new teaching approaches and ICT. Across India’s decentralized education system, national and state leaders face big challenges in their efforts to support an education system that must reach so many students (Cheney, Ruzzi, & Muralidharan, 2005; PROBE Team, 1999). Efforts to shift curricula from behaviorist approaches to learning to a constructivist approach that emphasizes the personal experiences of learners are recent (India—National Council of Educational Research and Training, 2006; Pandley, 2007). A growing number of policies support ICT integration, but one expert review (Vyasulu & Sinha, 2003) found that there is still great variation in implementation of these policies and access to ICT is still limited for most students. Although there is variation by state, the duration of the standard school day is five hours, divided into 35-minute lessons. The class sizes tend to be large; the classes we visited ranged from 45 to 60 students. Indian teachers are expected to cover a lot of content, and the textbook often becomes the center of the learning process (PROBE Team, 1999; Rampal, 2002). The state curriculum varies, but in Maharashtra State, for example, the students have a very full schedule by the upper grades and study 11 compulsory subjects. B. Chile Since 1990, successive Chilean governments have pursued a consistent reform effort to modernize teaching and learning, improve and expand school infrastructure, promote student-centered curricula, institute full-day schooling, develop a national examination, invest heavily in teacher professional development, and integrate ICT into schools (Cox, 2004; Ferrer, 2004; Valenzuela, Labarrera, & Rodriguez, 2008). The Chilean school day is eight hours, with the amount of time students spend in core areas (math, language, and science) twice that spent on other disciplines, and there is reserved time for students to engage in enrichment activities or project-based learning experiences. Class periods are typically 50 minutes, with two-hour classes in core content areas. Every school is required to have a Unidad Tecnica Pedagogica (UTP—the Technical Pedagogical Unit) that provides pedagogical support to improve teachers’ practice. Chile also has an ICT program, Enlaces (Links) that, by 2007, had provided hardware, software, and connectivity to 94% of schools in Chile and trained 110,000 teachers (Cancino & Donoso Diaz, 2004; Chile—Ministerio de Educacion, 2008). Thus, most schools have a certain level of ICT infrastructure available in computer labs. Light 3 Journal of Education for International Development 4:2 December 2009 C. Turkey Turkey has been instituting educational reforms to modernize and expand its school system and align it with European Union norms since the late 1990s (Baki & Gokcek, 2005). The reforms include the expansion of compulsory education, efforts to decrease class size, introduction of a new curricular approach and materials, the use of ICT, and efforts to provide teachers with professional development. Announced in 2005, the new curriculum draws upon constructivist pedagogical principles and the theory of multiple intelligences and promotes more student-centered techniques— such as individual and group work—to encourage students to explore and develop skills (Gomleksiz, 2005). As Phase 1 of the Basic Education Program, 1998–2003, the government distributed thousands of computers to schools (Akbaba-Altun, 2006), and many schools now have labs. Turkey is moving toward full-day schooling, but many schools—including the two we visited—still have two, five-hour shifts because they cannot otherwise meet their communities’ demand. The demand for schools also means that Turkey has not yet reduced class size to 30 students. Nationally, the average primary school class size is 38. 6 students (Otaran, Sayn, Guven, Gurkaynak, & Satakul, 2003) but in the schools we observed classes ranged from 50 to 60 students. IV. Overview of the Essentials Course The core goal of the Essentials Course is to prepare teachers to integrate ICT across the curricula as a tool for learning and to design and implement inquiry-driven, project-based learning activities. The Essentials Course involves teachers in a process of developing a complete unit plan that utilizes a project-based approach, engages students in a variety of ICT activities, and organizes learning around an â€Å"essential question† that guides students’ inquiry and exploration of a given topic. Teachers are encouraged to designate time in their unit plans for students to use ICT to conduct research and to create a final product to share their research findings. The Essentials Course also discusses crucial factors for creating high-quality, issues in student-centered learning environments (e. g. , classroom management issues with technology), and approaches to assessing students’ technology products. During the unit plan development process, teachers expand their technical skills and prepare to implement their units back in the classroom. This is a vital feature of the Essentials Course, as it allows teachers to experience and evaluate the new teaching approaches (Guskey, 2002). In addition to Web resources, the Essentials Course uses commonly available software, primarily word processing software and presentation software, to support students in creating presentations, Web pages, brochures, reports, and newsletters. Figure 1: Core Components of the Intel Teach Essentials Course Content Linking ICT use to deeper learning Essential Questions or curricular framing questions Project-based approaches Student created products Internet resources Group work Holistic assessment strategies Structural Features 40 to 60 hour training Focus on commonly available software Teachers create a sample unit plan Teachers learn by doing Trainer is in the same school Emphasis on building communities of trained teachers Light 4 Journal of Education for International Development 4:2 December 2009 Intel, in collaboration with ministries of education worldwide, has offered the Essentials Course to more than 6 million teachers in 45 countries. The collaborative approach to course delivery is important. Although the core messages and goals of the program do not change, Intel works with the ministries and local educational experts to adapt Essentials Course materials to fit local needs; a local agency in each country implements the Course. In Chile, the ministry created a network of universities throughout the country that offers the Course in their regions, and the Pontificia Universidad Catolica de Chile in Santiago oversees the network. In India, the non-profit Learning Links Foundation oversees the program in the participating states. In Turkey, the Ministry of National Education (MNE) oversees the program, and trainers are based at the provincial education directorates and in larger towns. In this study, we used an instrumental case study approach (Stake, 1995) to examine how successful schools and teachers have been able to integrate ICT and new teaching strategies into their classrooms. This approach allowed us to work directly with schools that have been making changes, talk with teachers about the aspects of the Essentials Course that are useful to their practice, and develop an understanding of what teachers are actually able to do in typical schools in each country. During a two- to four-day site visit at each of the six schools, we interviewed school leaders, the Essentials Senior Trainer (ST) or Master Teacher (MT), technology-using teachers, students, and representatives of students’ parents whenever possible. As shown in Table 1, classroom observations of both typical classrooms and students engaged in the computer lab or ICT activities complemented the interviews. Table 1: Data Collected India Mumbai School Interviews Observations Focus groups Interviews Observations Focus groups Interviews Observations Focus groups Interviews Observations Focus groups Interviews Observations Focus groups Interviews Observations Focus groups 2 school leaders; 5 teachers 5 classes 14 parents; 37 students; 12 teachers 4 school leaders; 3 teachers 5 classes 3 parents; 5 students 2 school leaders; 3 teachers 4 classes 7 students 3 school leaders; 2 teachers 3 classes 5 students 2 school leaders; 8 teachers 3 classes 3 parents; 5 students 5 school leaders; 7 teachers 5 classes 5 arents; 19 students Village School Chile Santiago School Village School Turkey Ankara School Village School Light 5 Journal of Education for International Development 4:2 December 2009 As noted, to identify a sample of exemplary schools, we gained input from local stakeholders. We requested that the local training agency, the ministries, and the Intel Education Managers in each country comp ile a list of schools. We asked that they exclude schools with privileged access to resources, technology, or funds. Success was defined by the local stakeholders to represent what they felt would be reasonable expectations for schools and teachers in their country. From the list of schools, the research team made a final selection of two schools in each country. To carry out the fieldwork, we collaborated with local partners. In Chile, we worked with researchers from the Centro Costadigital at the Pontificia Universidad Catolica de Valparaiso, and in Turkey, we teamed with GLOKAL Research Consulting. Unfortunately, the arrangements for a local research partner in India fell through. V. Sites A. India We selected a private school in a middle-class neighborhood of Mumbai and a government school in a Gujarati village. The Mumbai school, with 2,000 students, is an English-medium private school from pre-K to Grade 10 and the village school is a Grade 1 to 8 Gujarati-medium public school with 309 students. In the Mumbai school, every classroom has a computer connected to a TV, there are two computer laboratories each with 60 computers, and there is a computer in the library. The labs have broadband Internet. The Gujarati village school has a lab with 14 computers and a computer on a wheeled table with an LCD projector. The lab is connected to the Internet through a dial-up modem. B. Chile We selected a government-subsidized private school in a lower middle class neighborhood of Santiago Chile and a small municipal school in a rural town. The private school has 2,500 students from pre-K to Grade 12, and the municipal school serves 97 students from pre-K to Grade 8. The private school has five ICT labs, some with as many as 20 computers. The municipal school has a lab with 15 computers, plus four laptops, a digital camera, a TV, a printer, two LCD projectors, and a wireless network. C. Turkey We selected two public schools that serve students from K to Grade 8. One school, in an outlying neighborhood of Ankara, serves 2,300 students. The second school, located in a small provincial capital on the Anatolian Plateau, serves 1,410 neighborhood children and has a population of female boarding students from villages in the province. The school in Ankara has one computer laboratory with 21 computers, 15 classrooms have a computer, and there are 350 Classmate PCs donated by Intel. The lab has broadband Internet and a wireless hub. The Anatolian school has three computer labs with 15 computers each, and five or six teachers also have a computer in their classrooms. The labs have wireless connectivity. VI. Findings: Three Common Themes The Essentials Course was not the only source of information or support for the new student-centered practices and ICT-based activities we observed in these schools, as all three ministries of education are engaged in reform with various changes such as new curricula, new standards, and new in-service Light 6 Journal of Education for International Development 4:2 December 2009 training programs. Education reform is a long and complex process that needs to be supported with multiple strategies, and our findings suggest that the Essentials Course can be one part of that puzzle. A. Changes in Teachers’ Knowledge, Beliefs, and Attitudes Because all schools in the study were considered successful, we explored what teachers had changed in their own practice. In the interviews, we asked teachers to discuss what they had learned from the Essentials Course that was useful for their classroom practice. Three themes emerged across all six schools as the teachers spoke about what they found to be valuable for their teaching: (a) their beliefs about how students learn were shifting; (b) they had a deeper understanding of new teaching strategies; and (c) they had improved their knowledge of how to use ICT as a learning tool, as well as strengthening their ICT skills. a. Teachers’ beliefs shifted to a constructivist paradigm of teaching and learning. Teachers expressed a growing belief that students can learn through exploration and discovery. The Essentials Course and, more importantly, the experience of implementing a project-based or ICT-rich learning activity appear to influence teachers’ understanding of how children learn. The interviews suggested the teachers began to value learning as different from memorization and to see that students can learn by exploring content, conducting research, and applying knowledge to real problems. For example, a Chilean history teacher remarked upon the difference from the traditional approaches of having students memorize information: â€Å"By following a question, the students acquire a lot f content through research. † In all six schools, teachers also expressed their belief that students learn more than just content with projects and Internet research. Many teachers recounted what they did â€Å"before† and â€Å"after Intel,† and their descriptions consistently included how students â€Å"learn more deeply,† â€Å"have more confidence,† and â€Å"are more motivated† by the new ways of learning. They reported that students were developing skills and attitudes such as self-assurance, curiosity, collaboration and teamwork skills, presentation skills, and organizational skills. In appreciating how effective group work had been, a teacher in Turkey reported that, â€Å"Before Intel, students did not do teamwork. [†¦] In Turkey—kids want to learn from teachers, now they have to do research on their own and can learn more deeply. Otherwise students aren’t motivated to learn. † A second Turkish teacher commented that students â€Å"were sharing ideas and thoughts with each other† and learning to â€Å"trust themselves. † B. Teachers deepened their understanding of student-centered practices. Teachers reported improving their skills with innovative teaching practices. Although some countries had more experience than others, across the board, nearly all the teachers we interviewed valued project-based approaches and reported doing projects with their students. Teachers had very clear ideas about how project-based approaches can support student learning by allowing students to explore content as they respond to a research question or problem posed by the teacher. They felt the project approaches made the content more relevant to students and required greater intellectual effort for students to find and synthesize information, which led to students learning and retaining more information. At schools in Turkey and India, principals and teachers credited the Essentials Course with helping them learn how to do projects for the first time. In Turkey, teachers told us the Course helped them better utilize the project ideas offered in their new national curricula. One school in India had been experimenting with projects prior to participation in the Essentials Course, but the teachers reported that this professional development experience gave them a solid template and a set of strategies for Light 7 Journal of Education for International Development 4:2 December 2009 project-based approaches. In Chile, teachers told us that the Course helped them learn about inquirydriven project-based strategies in addition to the problem-based approach supported by their ministry. While teachers from all three countries agreed that the Essentials Course supported their use of student-centered practices, each country’s context and educational goals influenced which topics were of most interest to teachers. For example, while all the teachers spoke about using group work and collaborative learning, the teachers in Turkey were very excited about the collaboration strategies presented in the Essentials Course. Turkey’s traditional approach to teaching is lecturebased and emphasizes individual student activities, and teachers reported that they did not have any previous experience with collaborative learning. Group work and collaboration are, however, part of the new Turkish curriculum and reform efforts and teachers expressed appreciation for how the two programs supported each other. The curriculum contains many group activities, and the Essentials Course offers strategies to facilitate group work, as well as follow-up support to practice these strategies with coaching from their MT. In India, teachers found the â€Å"Essential Questions† strategy to be compelling. Essential Questions (e. g. , â€Å"Why do we need others? †) are intriguing, open-ended questions that organize a project and are an effective way to encourage students to think deeply and to provide them with a meaningful context for learning (Wiggins & McTighe, 2001). The Indian curriculum is very demanding and the school day is crowded, so teachers felt that they could not easily integrate project work into every class. While they could not do projects during the class period, they were, however, exploring the use of questioning strategies to push students’ critical thinking and to allow students to share their perspectives and formulate their own conceptual understandings of the content. For example, one teacher asked her students what they thought the impacts of British Colonial policies were on the farmers, and a social studies teacher asked students what they valued about their community. Teachers felt that asking for student input was a significant change. As one teacher commented, they no longer just â€Å"stand and teach,† but facilitate iscussions and encourage children to share their knowledge. The teachers we visited felt the open-ended questions and ensuing dialogue between teachers and students might be the foundation of a new relationship between teachers and students. One of the schools in Chile, which already had a lot of experience with ICT and projects, focused on the use of rubric assessments presented in the Essentials Course. The principal noted that teachers were facing increasing challenges in assessing students’ work as the school moved toward complex, technology-rich student products such as presentations and websites. Through these products, students master more than just content and teachers wanted to value all aspects of students’ learning. They considered the rubrics—designed to capture the range of skills, attitudes, and content that students develop—as a key way to address these challenges. The teachers were also using rubrics to put students more directly in control of their learning process; students know from the beginning which aspects of the content teachers will evaluate. C. Teachers improved their ICT knowledge and skills. Teachers reported that they had developed the skills needed to initiate or increase the use of ICT with students. Most of the teachers in India and Turkey reported little ICT experience before Essentials, whereas most Chilean teachers had previous trainings and experience using ICT. Regardless of their experience with ICT, all teachers we interviewed who took the Essentials Course reported they increased their knowledge of how to use ICT as an educational tool. For teachers with no prior experience, the Course helped them acquire basic skills. However, all of the teachers commented on Light 8 Journal of Education for International Development 4:2 December 2009 how the Course helped them see ICT as a pedagogical tool. The strategy of having teachers design a model unit of their own choice appears to allow teachers to work on skills and areas that are new and challenging for them. VII. Changes in How Students Engage with Content The introduction of ICT into schools and the use of project-based approaches and Internet research have changed how students interact with the content in a number of ways. In the site visits, teachers and students spoke about three types of new learning activities that would, according to the literature, contribute to a constructivist learning environment: (a) learning through projects; (b) conducting Internet research; and (c) connecting school content to students’ lives (Windschitl, 2002). A. Project-based work gave students a chance to collaborate, use multiple resources, and direct their own learning. In all the schools, student projects were fundamental to bringing student-centered instructional strategies into the classrooms. The Essentials-trained teachers we interviewed spoke of doing projects with their students. Despite variations among project designs, a few core features emerged. In almost every site, projects gave students chances to work collaboratively and challenged them to take on new roles and responsibilities; students worked in groups and often had to coordinate efforts to complete the projects. Also, all of the projects described included research and culminated in a final product that required students to synthesize and share what they learned. For example, in the Gujarati village, the students did a project about water use and irrigation. They visited local experts, surveyed the community, collected data, and researched solutions. As a result of the students’ examination of drip irrigation, and their proposal of how farmers could use this new strategy, the village converted to drip irrigation. Again, the teachers in India could not fit the project into the class time, so students did a lot of the work before and after school. The municipal school in Chile did a multi-grade project on insects in which the younger grades collected bugs and wrote reports and the older grades helped them create a website. B. Independent Internet research gave students autonomy and a chance to develop and share their own perspectives. Internet research was a constant theme in these schools. Teachers, students, and parents all spoke about having students do Internet research for homework and as part of the projects. Teachers often asked students to bring in additional information on topics in the textbook (e. . , in a Turkish project students researched systems of the human body). Or, teachers asked students to research additional topics or themes (e. g. , after a lesson on farmers under the British Empire, a history teacher in India asked students to research the condition of Indian farmers today). C. Connecting school content to students’ lives made learning more meaningful to students. We found that many of the projec ts teachers designed connected students’ school work to their home life and the community more broadly. In a very simple sense, the increased use of practices such as open-ended questions and group work allowed students to share the perspectives and knowledge they bring from home. For example, a teacher in India asked her students what they had eaten for breakfast and then used this as the start of a nutrition lesson, and a Turkish teacher had his first grade students discuss how an animated story related to their own families and lives. Light 9 Journal of Education for International Development 4:2 December 2009 Yet many of the project topics also engaged students in examining real-world issues or concerns that gave them an opportunity to connect â€Å"school learning† with the real world and allowed them to develop their own opinions and perspectives about the issues. For example, the Indian village that did the irrigation project mentioned above also did projects on clean water and public health. Other projects were less ambitious, but still meaningful, such as the Chilean school where students collected stories and images from the community to publish in a booklet for their families. Our interviews ith parents in the Indian and Turkish sites also supported the perception that students were becoming a source of new information for their families. Parents credited their children’s increased use of Internet research with providing them with current information to which they would not otherwise have had access. Students are generally more excited by information they find themsel ves than the contents of a textbook, and parents reported that their children were rushing home, eager to share what they had discovered. VIII. Changes in Relationships among Teachers, Students, and Parents In keeping with the new activities and roles for students, the teachers and students in the schools we visited reported that they were transforming how they interact. The changes in teaching practices in these schools are part of a broader change in relationships within the school and between the school and the community. The educators and students described changes in the ways they collaborate with each other that grew out of the new teaching practices (e. g. , project-based approaches, open-ended questions), integrating ICT into the schools (e. g. Internet research or presentations), or both. We noticed that teachers, students, and parents reported changes in three sets of relationships: (a) among the students; (b) between students and teachers; and (c) between the school, the parents, and sometimes the community. A. Projects and ICT activities fostered collaborative relationships among students. Many of the teachers and parents interviewed said that students were developing a rang e of social and interpersonal skills that they attributed to the projects and the new roles that students were taking on. As noted, students in every school were taking on new responsibilities as they worked on projects—leading teams, conducting research, writing reports, debating with peers, and making presentations to peers, teachers, and parents. A Chilean fifth grade teacher explained how her students were developing the skills and maturity to work as a team, even across grade levels, because of the collaborative techniques she learned in the Essentials Course. Some of the parents also commented on their children’s maturity and responsibility. A Turkish father noticed a change in his daughter’s attitudes since doing the â€Å"Intel projects. † He observed that before teachers participated in the Essentials Course, his daughter did not share her things with anyone. After her teachers participated in the Course, his daughter began to share more with friends and she enjoyed working in teams. The father also said that, as a result of her involvement in projects and team work, his daughter completed her school assignments independently at home and no longer asked him for help. B. New teaching strategies allowed teachers to develop more collaborative and interactive relationships with their students. The teachers reported that, as their teaching practices changed, their relationships with their students also became more open and supportive. Teachers began to allow more intellectual discussions between themselves and their students, and students were more willing to approach teachers and share concerns and opinions. The teachers and parents in Mumbai were, perhaps, the most eloquent. One group of teachers commented that, as children, they had been afraid of their teachers and they Light 10 Journal of Education for International Development 4:2 December 2009 were happy that their students no longer â€Å"fear the teacher† but gladly ask questions and give opinions. The students we interviewed echoed these sentiments. A group of high school students from the school in Santiago, Chile explained that a good teacher is one who encourages students to disagree when they have a well-reasoned argument. A student from Mumbai shared a similar perspective: â€Å"I like that whenever I do a report I can include my own critical opinion—it is not just cut and paste. And I can learn many things outside of the textbook. † C. Innovating with projects and ICT strengthened the relationships between the school, parents, and the community. The parents we interviewed were excited by the introduction of community-focused projects and student research, and they expressed pride in what the schools were doing for their children with technology. A group of parents in India praised their school â€Å"because of the new technology, [the school] is innovative. They have very high performance, but it is not just academics-oriented. † In the four public schools we visited, parents and the community had also initiated efforts to bring additional ICT resources to the schools by donating equipment or paying for improved Internet connections. However, the parents also remarked on the new teaching practices and what these changes mean for their children. All of the parents we interviewed commented on how the school was developing the whole child since the project work was supporting teamwork, independence, and self–confidence. Parents in India and Turkey highlighted their children’s growing confidence and independence to do research or make public presentations, and they also noted the caring relationships between students and teachers. IX. Changes in the Use of ICT Tools to Promote Students’ Learning A core aim of the Essentials Course and a central objective for the ministries in Chile, Turkey, and India is to encourage the use of ICT as a learning aid for students. Although the administrators and teachers we interviewed in all six schools told us they wished they could do more, to the extent permitted by resources, space, and time, students were using ICT for learning activities. PowerPoint presentations and Internet research were, by far, the most common ICT tools that students used. All six schools promoted student use of ICT, but each adopted different strategies to realize its goals. In Turkey and India, with short school days and tight schedules, the teachers had to strategically make time—either by working outside of class, or rationing access—for students to complete their ICT projects. For example, the teachers at the Anatolian school in Turkey told us that they meet as a team each semester to decide which classes will do long-term projects to ensure every student gets a chance each year. The Chilean teachers had more flexibility to schedule lab time during school hours, although they also did afterschool activities. Perhaps the clearest change is that, in all six schools, teachers gave students Internet research activities for homework. For instance, a math teacher in India assigned students to calculate average rainfall in different parts of the world using online databases, and a Chilean history teacher had students analyze online photos for life conditions in 1900s Chile. X. Conclusion This paper presents the findings from our fieldwork that describe the nature of the changes taking place in the classrooms in these six schools as they integrate ICT activities. Since the governments point to these schools as positive examples, their experiences can help contribute to an understanding Light 11 Journal of Education for International Development 4:2 December 2009 of the process of integrating ICT into the schools of developing countries. While some educators we observed are more skilled than others, and some changes in practice are just emerging, all six schools are making changes beyond just the use of new tools. They are developing: new beliefs about learning and new practices, new ways to engage with content, changing relationships, and new ICT tools for learning. That three of the four common dimensions of change are pedagogical shifts, and that they are changes in pedagogy that are supported by the ICT, illustrate the paradigm shift required for effective ICT integration (Bransford et al. , 1999; Hepp et al. , 2004). These findings illustrate the complex sets of changes that have to occur for ICT to be deeply and meaningfully used to support student learning. This would explain why technology integration is so difficult to achieve but also points the way forward. Our findings suggest that necessary changes are much broader than just the introduction of a new tool or one new ractice. Instead, change begins by deeply reshaping life in the classrooms—from educators’ beliefs about learning to the relationships that make up the school community. In each context, the teachers found points of engagement between the model of ICT use and teaching in the Essentials Course and the possibilities and limits of their context. For Indian teac hers, it was most feasible to integrate aspects of the teaching model (i. e. , open-ended questions) into their classroom and the ICT into after-class time. In Turkey, schools brought ICT activities into scheduled lab time and group work into their class activities. And, Chilean teachers used holistic assessment strategies and inquiry-based projects in class because their school day provides a block of time for projects. But, the responsibility for change cannot rest solely on the shoulders of the teachers; bringing about these changes is a long-term, incremental process. Effective reform requires sustained investment and support along multiple dimensions of the educational system, including physical and technical infrastructure, human resources, curricular frameworks, standards, and assessment. For example, the teachers in Chile and Turkey spoke of how things like new national curricula, national computerization efforts, and professional development opportunities helped them use ICT in their classrooms and apply what they learned from the Essentials Course to their practice. Light 12 Journal of Education for International Development 4:2 December 2009 References Akbaba-Altun, S. (2006). Complexity of integrating computer technologies into education in Turkey. Journal of Educational Technology and Society, 9(1): 176–187. Baki, A. , & Gokcek, T. (2005). Comparison of the development of elementary mathematics curriculum studies in Turkey and the U. S. A. Educational Sciences: Theory & Practice, 5(2), 579–588. Bransford, J. D. , Brown, A. L. , & Cocking, R. R. (Eds. ). (1999). How people learn: Brain, mind, experience, and school. Washington, DC: National Research Council/National Academy Press. Cancino, V. C. , & Donoso Diaz, S. (2004). 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Training teachers across a diversity of contexts: An analysis of international evaluation data on the Intel ® Teach Essentials Course, 2006. New York: EDC/Center for Children and Technology. Light, D. , Polin, D. K. , & Strother, S. (2009). Emerging changes in ICT-rich learning environments: The role of the Intel ® Teach Essentials Course in changing teacher practice in three countries (pp. 6). New York: EDC/Center for Children and Technology. Light, D. , & Rockman, C. (2008). The emerging paradigm of teaching and learning in Discovery Schools, evaluation of the Jordan Education Initiative (pp. 57). Washington, DC: Education Development Center, Inc. Marzano, R. J. (2007). The art and science of teaching: A comprehensive framework for effective instruc tion (pp. 150–153). Alexandria, VA: Association for Supervision and Curriculum Development. Otaran, N. , Sayn, A. , Guven, F. , Gurkaynak, I. , & Satakul, S. (2003). A gender review in education, Turkey 2003. 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Characteristics of efficient, responsive, risk-hedging and agile Assignment

Characteristics of efficient, responsive, risk-hedging and agile supply chains - Assignment Example Risk-Hedging Supply Chain is distinguished by a high supply and low demand uncertainty, cost efficiency and hedging the risk of supplier distractions. It also has a functional product type and competitive on cost and flexibility. This form of the supply chain has a low responsiveness to market demand and uses a relation-based approach toward suppliers. Agile Supply Chain is highly sensitive to the market and able to read and respond to real market demand. Agile supply chains have extensive sharing of information between suppliers and buyers regarding supply and demand and hence, develop a virtual supply chain where physical stocks are adequately replaced with information. No, a company cannot apply both responsive and efficient supply chains. This is because responsive and efficient supply chain strategies have conflicting objectives, for instance, in terms of cost and lead-times. Whereas efficient supply chain has a low-cost strategy and long-term forecast, the responsive supply cha in has high unit cost and short-term forecasts. Yes,  management can apply both agile and risk-hedging supply chains. This is because agility works in environments with high demand and supply risks. Agile approaches unite strengths of responsive and risk-hedging approaches to respond to the uncertain demand of customers while minimizing the risk of supply disruption.

Assignment 7 Essay Example | Topics and Well Written Essays - 500 words - 1

Assignment 7 - Essay Example f psychotic disorders characterized by effective distortions of reality; emotional and mental disorganization, as well as the withdrawal of individuals from social interaction. Some theories while trying to explain schizophrenia, give primacy to biologically related factors like biomechanical imbalance. Other theories tend to emphasize on the dynamism of the family, for example, the way one expresses hostility to the ill individual. Depressive disorder entails signs of â€Å"intense sadness, feelings of futility and worthlessness, and withdrawal from others† (Sue, Sue, and Sue, 1990, p. 325). Characteristics of depression are often physically manifested in change in appetite, sleep, and motivations like boredom and apathy. Cross-cultural studies reveal that there are variations in the way cultures define and communicate symptomatology of depression. Some cultures use fewer words in conveying emotions like anger and sadness. Somatization entails the use of bodily complaints as a means of expressing psychological distress. Certain studies have proposed that certain groups, like Hispanics and Japanese somaticize comparatively more than Americans and Europeans. Some of the complaints include intestinal problems and low back pain. Therefore, the carried out research suggests that, even if previously regarded a phenomenon of culture-specific could be universal embedding meanings of culture-specific as well as expression modes. Culture-bound syndromes present the strongest relevance regarding cultural relativism in comprehending and addressing abnormality. Historically, the literature can be put into view points, with the first view proposes that psychopathology and culture are intertwined, and that one has to constrain him/herself within a given framework of culture. This approach is referred to as cultural relativism. The other view, which contrasts the first one hold proposes that even if culture plays a responsibility while determining the actual behavior, the

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Human Resource Development Job Satisfaction Essay Opportunities for training and development are paramount in decisions regarding employee career choices. It is important that those in the human resource development (HRD) look at how their work affects those who they provide service. HRD is a field that focuses on training, career development and organizational development with the goal of improving processes and enhancing the learning and performance of individuals, organizations, communities and society (Judge and Saari, 2008). To accomplish this task, HRD practitioners must look at how training and development programs affect those employees who participate in them. They must be aware of how employees who participate in them perceive the information presented. They must be aware of how employees feel about the training and programs offered to them, and they must understand the components that make up job training satisfaction from the employee standpoint. 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Compensation levels and competiveness are higher than ever before and the casualties are factors like job satisfaction. Literature Review A satisfied or happy employee may begin to develop an approach of self-complacency, and an overall sense of well-being, and consequently, his temperament may reflect his disposition (Caruso, 2011). As a result, it is all too common to see that the productivity of the employee does not always closely follow his upward level of happiness. Does that mean that employers don’t want happy employees? No, however that don’t desire to gain employees that forget why they’re employed in the first place. Another important aspect of this situation is the level of constructive conflict. If properly used and applied in the organizational arena, the managerial imbedding of a limited degree of beneficial conflict does indeed shake these smug people and satisfied employees out of their fatigue and enables them to achieve a certain individuality of action. Viewed from the perspective of the organization the key issue is not having satisfied, happy employees but maximizing productivity, the bottom line being profit (Caruso, 2011). A generation of employees who feel entitled to employee satisfaction has entered the workforce and several generations of employees for whom work never quite fulfilled their dreams, are leaving. And, they are leaving in the worst of economic times which will affect their satisfaction with the rest of the quality of life they experience. This downward trend in job satisfaction raises concerns about the overall engagement of employees and ultimately employee productivity, retention, creativity, risk-taking, mentoring, and in overall employee motivation and interest in work. Factors contributing to employee satisfaction include treating employees with respect, providing regular employee recognition, empowering employees, offering above industry-average benefits and compensation, providing employee perks and company activities, and positive management within a success framework of goals, measurements, and expectations (Egan and Young, 2004). You can tell your colleagues, coworkers and or staff how much you value them and their contribution any day of the year. No occasion is required to tell someone job well done or keep up the outstanding efforts. In fact, small surprises and tokens of your appreciation spread throughout the year help you and the people in your work life feel valued all year long. Employee recognition is limited in most organizations (Egan and Young, 2004). At my place of employment, employees complain about the lack of recognition regularly. My supervisor would respond by asking, â€Å"Why should I recognize or thank her? She’s just doing her job. † These factors combine to create work places that fail to provide recognition for employees. Employers who prioritize employee recognition understand the power of recognition, because they see the adverse effect of it in the employee. HRD employee job satisfaction is situational. Employee job satisfaction depends on the company and its practices, the expectations and needs from work, the quality of the supervision, the health of the industry, the competitiveness of the job market, the state of the economy, the success of the company, your mentor resources, and more (Lleana and Simmons, 2008). The inconsistencies are what make employee job satisfaction so challenging. Since the day to day job cycle can’t be predicted, it’s safe to say that employee satisfaction can’t be either. Conclusion The most influential factor in job satisfaction appears to be the degree to which employees think their job makes good use of their skills and abilities. This is closely followed by the extent to which employees think the work they perform is meaningful. If employees believe their work and the work of their organization is important and makes good use of their skills, there is a very good chance they will be satisfied with their job, even if they are not as positive about other aspects of the job. The next major component of satisfaction appears to be whether employees believe they are treated with respect. Higher job satisfaction is associated with working conditions where employees believe their opinions count and where they receive recognition for the work they perform. Job satisfaction is related to how well an organization is managed. This component does not seem to work in isolation from job fit and respect. In other words, a well-managed organization does not turn into high job satisfaction scores in the absence of a good match between employees and the job, or under conditions where employees do not feel respected for what they do. When a lack of respect is felt amongst an employee, a lack of respect is shown for the job at hand whether it be through work performance, attitude, or respect reciprocated. HRD is a career field that requires one to interact with others on a daily basis. With that being said, one must always exhibit a pleasant persona for the simple fact that what they do has a major impact on the individuals that they come across. HRD is also a career field where you are constantly assisting others in job advancements and etc. within an organization, which to me is satisfying all within itself.

Example Medicolegal Report

Example Medicolegal Report MEDICOLEGAL REPORT Prepared for the Court Claimant:Mrs A Address:Unspecified Date of Birth:1958 Occupation:Housewife Date of Accident:15 February 2005 Examining Doctor:Dr D Consultant Obstetrician and Gynaecologist Statement of Instruction This report is prepared on behalf of the defendant, Dr D in connection with the complications following treatment of Endometriosis on Mrs A started from 23 April 2003. Case Summary Mrs A has suffered complications from foecal peritonitis and pulmonary embolism following the procedures of total abdominal hysterectomy and bilateral salpingo-oophorectomy for the treatment of endometriosis. Case Details Mrs A was referred by her GP and attended the clinic on 23rd April 2003. Mrs A was complaining of constant, severe abdominal pain, per vaginal bleeding with irregular cycles for 2 months with a background history of tubal ligation in 1999. Dr D was unsure of the diagnosis as to whether it was due to endometriosis, polycystic ovarian disease, or tubal infection associated with the previous tubal ligation. Therefore Mrs A was admitted, prescribed with painkiller (Pethidine), and booked for laparoscopy the next day. The result of laparoscopy confirmed active endometriosis with 2 small fibroids and medical treatment of GnRH analogue (Zoladex) was discussed with Mrs A and agreed. Mrs A treatment was then to be reviewed in November 2003. On 5th November 2003, Mrs A attended the clinic and her medication was changed from GnRH analogue to Medroxyprogesterone acetate (Provera). On review in 4th February 2004, Mrs A was not happy with Provera and the prescription was reverted back to Zoladex. On review in 14th July 2004, side effects due to prolonged use of Zoladex were explained and she agreed to start on combined oral contraceptive pills (COCP). On 24th Novemeber 2014, Mrs A came in complaining of severe pain not resolved with COCP and painkiller. Surgical treatment was discussed and she was booked for operation for the removal of uterus, cervix, Fallopian tubes, and ovaries called â€Å"Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy (TAH/BSO)† in February 2005 and for the meanwhile she was also prescribed with non-steroidal anti-inflammatory drug Mefenamic acid (Ponstan) and an opioid analgesics tramadol (Zydol) to relieve the pain. On 15th February 2005, Mrs A was admitted to the hospital for TAH/BSO. On 16th February 2005, Mrs A complained of pleuritic chest pain, shortness of breath, fever, and sweating. On examination she was tachycardic, and on auscultation, there were coarse crackles on the right base of the lung and fine crackles on the left base. She was commenced on antibiiotics without delay – ciprofloxacin and gentamycin together with an anticoagulant low molecular weight heparin – Innohep post-surgery. On 17th February 2005, CT pulmonary angiogram confirmed pulmonary embolism on the right side with possibility on the left side. She was commenced on warfarin and Innohep was continued until INR stabilized. On 18th February 2005, Mrs A complained of non-pleuritic chest pain, numbness going down on the left arm and up into the neck, and tenderness over the left axilla. Cultures showed positive Gram negative coccobacili. Antibiotics treatment was continued and respiratory consult was obtained. On 21st February 2005, cultures showed anaerobic organism that usually comes from the gut – Prevotella loescheii. The antibiotic course was changed to include metronidazole. On 23rd February 2005, radiology report confirmed the diagnosis of foecal peritonitis. Stomatherapy was discussed and anaesthetic consult was obtained. This was day 9 post-TAH/BSO and Hartmann procedure was done to treat the peritonitis. On 24th February 2005, antibiotic treatment of cephalosporin (Cephradine), metronidazole, and gentamycin were continued. The Results of Investigation Mrs A was diagnosed endometriosis through laparoscopy and 2 small fibroids were also found. It was confirmed from the histopathology report. Pulmonary embolism was diagnosed through radiological findings on CTPA and increased in D-dimer while sepsis was identified from the blood culture. Peritonitis was suspected from the finding of anaerobes on culture and clinical signs and symptoms together with CT scan of the abdomen formed the diagnosis of foecal peritonitis. The Nature of Treatments Received by the Claimant Endometriosis When Mrs A first diagnosed with endometriosis, she was treated by medical treatments – GnRH analogue for 6 months, then changed to Medroxyprogesterone for the next 4 months, back to GnRH analogue for another 6 months afterwards, and changed to Combined OCP. Mrs A condition was getting worse and surgical option of TAH/BSO was decided. Pulmonary Embolism (PE) and Sepsis Mrs A was prescribed with antibiotics and anticoagulant when lower respiratory tract infection or PE was suspected. When PE was confirmed, she was already on anticoagulant (Innohep). Warfarin was prescribed after the diagnosis made and antibiotics were continued due to suspected pneumonia or sepsis. The next day, blood culture result was out and confirmed positive. Peritonitis Mrs A was suspected of having sepsis and once culture showed the presence of anaerobes from the gut (Prevatella loescheii), metronidazole was prescribed to cover the anaerobic bacteria. When bowel perforation and foecal peritonitis were confirmed, surgery was carried out to clean up the abdominal cavity. Antibiotics, painkiller, and anticoagulant were continued post-surgery. Opinion on the Patient Management It was a regretful incident that Mrs A suffered complication from peritonitis secondary to bowel perforation, either secondary to adverse event where the operating surgeon unintentionally cut the bowel or due to advanced endometriosis. My review of the managements of this patient from her initial presentation of endometriosis are they are evidence-based, performed in a timely manner, and displayed the knowledge and action of an experienced clinician, and that the complications aroused were less likely due to poor management of the patient. In 1999, Mrs A underwent a laparoscopic tubal ligation and during the operation, there was suspected retrograde menstruation found which may possibly suggest endometriosis. It was in 2003 that the patient was actually diagnosed with endometriosis. However, this could be common where there was delay between the onset of symptoms and the diagnosis of the disease. There is no difference in the delay in diagnosis between mild to moderate and severe endometriosis. In a comparison study conducted in UK and US, the average delay before the diagnosis of endometriosis was 7.5 years and this will likely decreases the women’s capability to cope with the symptoms in which they would present to the formal healthcare [Ruth Hadfield, 1996]. The clinical evaluation of Mrs A was done in a sufficient and timely manner as the diagnosis of endometriosis was suspected in the first presentation since this will usually require high index suspicion due to the wide variety of symptoms and unpredictable course of disease (Lobo, 2007). Video-assisted laparoscopy was also carried out in the second day of admission showing that the clinician involved has a very high suspicion index of endometriosis from the beginning, as laparoscopy is the gold standard to reach a definitive diagnosis of endometriosis. [Bagan et al, 2003] The approach of the management of endometriosis was done properly and the choice of medical treatment as opposed to surgical treatment is wise. Unlike surgery for cancer, Adamson GD (1997) and Sutton et al (1997) said that in the case of endometriosis, surgery is relatively more effective for severe endometriosis rather than in mild cases such as in those with chronic pelvic pain and infertility and because of that, medical treatment is much preferable in the first presentation of endometriosis apart from it being non-invasive. A Canadian study of more than 53 000 admissions showed that 25% patients who had surgical treatment would need another surgery within 4 years and 10% would require hysterectomy and therefore, continual medical management is much preferred over serial surgeries [Weir et al, 2005]. Alifano (2003) mentioned that the prescription of GnRH analogue is recommended as it may have both diagnostic and therapeutic values. The prescription of not more than 6 months in this case was also supported by clinical literatures and Royal College of Obstetrician and Gynaecology (RCOG) guideline as the treatment may result in loss of 6% bone mineral density in the first 6 months [RCOG, 2006]. Extended treatment may result in further loss of bone minerals. Falcone (2011) recommended the commencement of combined oral contraceptive pills (COCP) following the cessation of GnRH analogue and therefore, the choice of COCP after GnRH analogue in this case was also supported by clinical evidence. Shakiba et al (2008) also described the usage of COCP as cost-effective, well tolerated, and clinically effective as danazol and GnRH analogue. The medical treatment is initially acceptable for this patient as earlier laparoscopy in June 2003 showed adhesions between the omentum and uterus with multiple spots of endometriosis and thick, stale, reddish green blood while the later microscopy findings in February 2005 showed well bordered white lesion and occasional white coloured spots that may be suggestive of healed or inactive lesions which should reduce the likelihood of invasive treatment. Brosens (1994) believed that the early and very active lesion would be in red, active and advanced lesion in black, and inactive or healed lesion in white, even though this might be varied from case to case. It is worth to note that there is currently no cure for endometriosis as current treatments aim at symptoms relief such as pain and infertility and organ damage prevention in severe cases. There is no randomized clinical trial comparing medical with surgical treatments; therefore the change of medical to surgical treatment has its own advantages and disadvantages [Sally et al, 2013]. From the record, there was a gap between the patient presentation of severe pain not improving with painkiller and COCP to the last clinic before surgery in November 2004 and the booked surgery in February 2005. This may be justified by non-invasive over invasive management; for example managing the pain by prescribing stronger painkiller such as in this case, tramadol. Since there is no relationship between the severity of pain with the severity of endometriosis, short delay in deciding on hysterectomy or watchful waiting may be an advantage for the patient and the clinician as well to see if there woul d be any improvement. Apart from that, there was no guarantee that surgery may treat the endometriosis. The decision of TAH/BSO was also recommended in this case as the preservation of one or both ovaries in some women may have left the problems with endometriosis behind. Whether the hysterectomy being subtotal or total, it would definitely improve the quality of life of this patient and thus should be considerable decision by the clinician. [Thakar et al, 2004] Even though all precautions and preventive measures have been made, while incidence of internal organ injury is rare, however it does happen especially when the risk is higher in the patient with history of pelvic infection, endometriosis, and adhesive diseases [John, 1997]. However, considerations that need to be taken into account is whether the complications aroused were due to an adverse event such as bowel perforation from the surgery, expected complication arising from the condition such as secondary to adhesions from endometriosis, or the combination of both. The risk of bowel perforation in this open abdominal surgery is much lowered compared to scope-assisted hysterectomy. Bowel injuries happen in about 0.2-1% of cases and primarily due to adhesions involving bowel or cutting within the pouch of Douglas – the space between rectum and uterus. Therefore, it was difficult to expect that this case was to be an addition to the 0.2-1% risk in the study. (Gary et al, 2004) Infection is a common complication following abdominal hysterectomy carrying the risk of 6-25%. Above all, about 33% of patients develop infection after the operation regardless of careful precautions taken [Rice et al, 2006]. Other than infection, severe complications that may occur involve lung collapse, heart attack, stroke, kidney failure, and clotting in the blood vessel (ie pulmonary embolism- clot blockage in the lung) with 4% risk. Greer (1997) mentioned that the risk of developing pulmonary embolism in patient following major general or gynaecologic surgery without clot prevention treatment (thromboprophylaxis) is very low at 0.2-0.9% while in another study, the risk of pulmonary embolism for patient receiving clot prevention treatment of anticoagulants is 0.2%. Therefore, this is a rare severe complication of abdominal hysterectomy that less expected to happen. Despite psychological effects following hysterectomy and prolonged hospitalisation, patient has benefit from the improvement in the quality of life in longer term. And even though multiple complications resulted from the procedure, most women are quite satisfied with the results of the surgery and with the significant symptom relief they experience [Kjerulff et al, 2000]. Conclusion Complications after surgery despite their rareness does happen and this was unexpected incident befall upon Mrs A. However, I believed Dr D, within his capabilities, has managed Mrs A with acceptable, sufficient, and evidence-based methods from the initial treatment until the last resort of hysterectomy to prevent any complications from happening. Duty of an Expert I understand my duty is to the Court; to help the Court on matters within my expertise, and I have complied with that. I understand that this duty over-rides any obligations to those by whom I have been instructed. I believe that the facts I have stated in the report are true and within my own knowledge and that the opinions I have expressed represent my professional opinion. BIBLIOGRAPHY Brosens I. Is mild endometriosis a progressive disease? Human Reproduction 1994; 9: 2209–2211. Adamson GD. Treatment of endometriosis-associated infertility. Seminars in Reproductive Endocrinology 1997; 15: 263–271. Sutton CJG, Pooley AS Ewen SP. Follow-up report on a randomized, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertility and Sterility 1997; 68: 170–174. AstraZeneca. Zoladex 3.6mg Implant. Summary of Product characteristics. 2012. Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD008475. Falcone T. Lebovic DI. Clinical management of endometriosis. Obstetrics Gynecology. 118(3):691-705, 2011 Sep. RCOG. The investigation and management of endometriosis. Green-top guideline 24. 2006 Lobo R. Endometriosis: Etiology, Pathology, Diagnosis and Management. 5th ed. Katz VL, editor. Comprehensive Gynecology. Philadelphia, PA: Mosby Elsevier; 2007:473–499. Alifano M, Roth T, Broet SC, Schussler O, Magdeleinat P, Regnard JF. Catamenial pneumothorax: a prospective study. Chest. 2003;124:1004–1008. Bagan P, Le Pimpec Barthes F, Assouad J, Souilamas R, Riquet M. Catamenial pneumothorax: retrospective study of surgical treatment. Ann Thorac Surg. 2003;75:378–81; discusssion 81. Weir E, Mustard C, Cohen M, Kung R. Endometriosis: What is the risk of hospital admission, readmission, and major surgical intervention? J Minim Invasive Gynecol 2005;12:486–93. Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Surgical treatment of endometriosis: a 7-year follow up on the requirement for further surgery. Obstet Gynecol 2008;111: 1285–92. John D Thompson. Operative Injuries to the Ureter: Prevention, Recognition, and Management. In: John A Rock and John D Thompson. Te Lindes Operative Gynecology. Eighth. Philadelphia New York: Lippincott-Raven; 1997:Chapter 40 Pages 1135-1173. Thakar R, Ayers S, Georgakapolou A, Clarkson P, Stanton S, Manyonda I. Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. BJOG. Oct 2004;111(10):1115-20. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. Jun 1997;24(2):235-258. Wykes CB, Clark TJ, Khan KS. Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review. BJOG. Nov 2004;111(11):1204-1212. Ruth H, Helen M, David B, Stephen K. Delay in diagnosis of endometriosis: a survey of women from the USA and the UK. Human Reproduction; 1996: vol.11 no.4 pages 878-880. Kjerulff KH, Langenberg PW, Rhodes JC, et al. Effectiveness of hysterectomy. Obstet Gynecol. 2000;95:319-326. Rice CN, Howard CH. Complications of hysterectomy. US Pharm. 2006; 31(9):HS-16-HS-24. Greer IA. Epidemiology, risk factors and prophylaxis of venous thrombo-embolism in obstetrics and gynaecology. Baillieres Clin Obstet Gynaecol 1997; 11:403. Garry R, Fountain J, Mason S, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004; 328:129. Mà ¤kinen J, Johansson J, Tomà ¡s C, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001; 16:1473.

Free Essays - The Controlling Men of The Awakening :: Chopin Awakening Essays

The Controlling Men of The Awakening In The Awakening, the male characters attempt to exert control over the character of Edna. None of the men understand her need for independence. Edna thinks she will find true love with Robert but realizes that he will never understand her needs to be an independent woman. Edna's father and husband control her and they feel she has a specific duty as a woman. Alcee Arobin, also attempts to control Edna in his own way. Edna knows she wants freedom. She realizes this at the beginning of the book. "Mrs. Pontellier was beginning to realize her position in the universe as a human being, and to recognize her relations as an individual to the world within and about her (Pg. 642). Throughout The Awakening she is trying to gain that independence that she wants so bad. The Colonel, Edna's father, is very strict. He thinks very highly of discipline. At the end of The Awakening, Edna feels the struggle she has with her father. "Edna heard her father's voice and her sister Margaret's" (Pg 723). At this moment, Edna wants freedom. She wants freedom from the life that has her trapped to be someone she isn't. The Colonel thought that Mr. Pontellier should be more controlling over Edna. "You are too lenient, too lenient by far, Leonce. Authority and coercion are what is needed. Put your foot down good and hard; the only way to manage a wife. Take my word for it" (Pg. 688). Edna does everything around the house when the Colonel comes to visit because she doesn't want him to think she isn't playing her role as a woman in the family. "She would not permit a servant or one of the children to do anything for him which she might do herself" (Pg. 687). Leonce Pontellier believes women should live only for their families' well-being. "He reproached his wife with her inattention, her habitual neglect of the children. If it was not a mother's place to look after children, whose on earth was it? He himself had his hands full with his brokerage business" (Pg. 637). Mr. Pontellier never thinks for a minute that it is also his responsibility to take care of the children. Free Essays - The Controlling Men of The Awakening :: Chopin Awakening Essays The Controlling Men of The Awakening In The Awakening, the male characters attempt to exert control over the character of Edna. None of the men understand her need for independence. Edna thinks she will find true love with Robert but realizes that he will never understand her needs to be an independent woman. Edna's father and husband control her and they feel she has a specific duty as a woman. Alcee Arobin, also attempts to control Edna in his own way. Edna knows she wants freedom. She realizes this at the beginning of the book. "Mrs. Pontellier was beginning to realize her position in the universe as a human being, and to recognize her relations as an individual to the world within and about her (Pg. 642). Throughout The Awakening she is trying to gain that independence that she wants so bad. The Colonel, Edna's father, is very strict. He thinks very highly of discipline. At the end of The Awakening, Edna feels the struggle she has with her father. "Edna heard her father's voice and her sister Margaret's" (Pg 723). At this moment, Edna wants freedom. She wants freedom from the life that has her trapped to be someone she isn't. The Colonel thought that Mr. Pontellier should be more controlling over Edna. "You are too lenient, too lenient by far, Leonce. Authority and coercion are what is needed. Put your foot down good and hard; the only way to manage a wife. Take my word for it" (Pg. 688). Edna does everything around the house when the Colonel comes to visit because she doesn't want him to think she isn't playing her role as a woman in the family. "She would not permit a servant or one of the children to do anything for him which she might do herself" (Pg. 687). Leonce Pontellier believes women should live only for their families' well-being. "He reproached his wife with her inattention, her habitual neglect of the children. If it was not a mother's place to look after children, whose on earth was it? He himself had his hands full with his brokerage business" (Pg. 637). Mr. Pontellier never thinks for a minute that it is also his responsibility to take care of the children.