Wednesday, December 25, 2019

American Political Culture And Its Representation Of...

730003850 1,478 WORDS APURBA CHAKRABORTY American political culture is altogether vast and diversified; however, it retains one singular feature – it is a contradiction. At the core, the majority ideally has subscribed to the values of democracy, equality, individualism, and liberty. Even so, history attests to the fact that bona fide enforcement of such values is not consistent. The nation has simultaneously promoted equality while it denied equality. It has exercised open-mindedness toward other cultures while it rejected aspects of multiculturalism. It has upheld an individual’s right to private property while it used property to evaluate one’s worth. Nonetheless, the nation has maintained the democratic principles†¦show more content†¦Rogers Smith argued in his thesis that the marker of America’s democratic nature as defined by Tocqueville, then reinforced in the writings of Myrdal and Hartz, stemmed from the absence of a European class system coupled with the lack of a hereditary mo narchy (Smith 1993, 549). When held in contrast, this crafted the ostensible image of a remarkably egalitarian nation. Moreover, the prevailing belief at the time was that equality was intrinsic to the white male, thereby establishing the underpinning of the practice of ascriptive hierarchy. As described by Smith, the appeal and endurance in such an inegalitarian tradition existed in aspects that affirmed â€Å"an identity that has inherent and transcendent worth, thanks to nature, history, and God† (550). That is to say, the dilemma throughout history with entirely equitable ideologies takes root in the discontent of these inherently privileged elite being placed on the same plane with those they deem culturally and biologically inferior. Justifications for ascriptive practices have manifested in actions that include discriminatory hiring practices, ill-intended immigration restrictions, disenfranchisement through voting rights, and a doctrine deeming facilities and services as â€Å"separate but equal† (560-61). Such ploys blatantly come into conflict with egalitarian aspects of the nation’s political culture by subjecting select individuals to a substandard caste in American society.

Tuesday, December 17, 2019

The About The Sunlight Burns My Skin - 1334 Words

Christopher Pinango ENC 1101 19 September 2016 The sunlight burns my skin. I can feel the pores in my face exhaust heat fumes. I’ve slept for a couple of hours, but somehow I’m still tired. I guess airplanes are not the most comfortable places to take naps in. I turn my head over my left shoulder, and I see it. Il Tricolore. Verde. Bianco. Rosso. I’ve never been so close to it before. It looks much better than in pictures, that’s for sure. I climb down the stairs, and start walking towards the terminal entrance. I can clearly notice the sign indicating I’m in the correct place. â€Å"Benvenuto L’aeroporto di Roma-Fuimicino.† I smell something very particular. I don’t know what it is, but it refreshing. Maybe it’s the wind? I’ve never been through an actual winter. Is this how it feels? It’s not as cold as I’d thought it’d be. The trees. I’ve never seen naked trees before. This is all so fascinating. I just noticed t here are many Fiats parked one behind the other. It looks a little clichà ©, but it’s funny. I can already tell I’m going to love it here; and it’s not even my last stop! *** The sky is black. The moon is nowhere in sight. I’ve been seating in this car for hours. I can hear the sound of the wheels on the pavement, going over small rocks every few minutes. My phone does not have signal, so there’s pretty much nothing to do. I rest my head on the window, and am taken aback. In the night sky, a sea of stars light it up. They’re so big. So many. I’ve never seen so many inShow MoreRelatedThe Effects Of Tanning On A Bathing Suit1426 Words   |  6 Pagesseemingly dangerous practice of tanning as I looked down at my chalky white legs and thought, is the desire to tan really that mysterious? It seems obvious that people just like the way it looks to be tan. In fact, one survey of American teenagers revealed that two thirds of them feel ‘healthier’ and ‘more sophisticated’ with a tan (qtd. in â€Å"Sun Tanning†). I know I feel better about putting on a bathing suit if I’m not so starkly white th at I worry about blinding young children. I also know that it just feelsRead MoreDescriptive Essay - Original Writing953 Words   |  4 Pageshe shook his head and i felt him brush my hair from my face Tk.........let me go... it wasn t an angry let me go it was I m sorry but you have let me go No... If you want to go take me with you. im crazy i thought as i looked up at him. More tears fell from his face. He cried beautifully without the ugly puffed lips and blotchy skin but just tears. Glassy eyes with tears of fire and ice it seemed the way the light hit them. Tears that fell onto his skin, perfectly tan and strangely nice againstRead MoreLupus : An Autoimmune Disease1143 Words   |  5 Pagesthose Autoimmune diseases. In this paper, I will be talking about Lupus and its definition. I will also be talking about its’ effects on patients with this disease. The way it is acquired. The way it is treated and, some other remedies that may be used to help deal with the day to day problems that come with having Lupus. I hope that by the end of this paper, the reader will have a lot better knowledge over this disease. It is in my opinion that everyone who would like to go into the medical fieldRead MoreEssay about Plane Crash849 Words   |  4 Pagesearlier shattered into little pieces of broken glass and metal when crashing onto the wet slimy coffee colored sand and burning with red orange colored flames. After my realization to this heart throbbing incident I began to run pressing my eight inch footsteps into the wet squishy slimy light brown sand looking in every direction with my wide open eyes filled with confusion in search of other survivors. After finding four other survivors we began moving our small petite weak legs fifty inches fromRead MoreMelanom The Most Dangerous Form Of Skin Cancer1342 Words   |  6 Pagesportion disease called skin cancer Melanoma. Melanoma is the most dangerous form of skin cancer, these cancerous growth develop when unrepaired DNA damage to skin cells, triggers mutations that lead the skin cells multiply rapidly and form malignant tumors. Dominant or Recessive Disorder/ Sex linked or autosomal: A person may either be born with genetic mutations in all of their cells or acquire a genetic mutation in a single cell during his or her lifetime. Most melanomas (about 90%) are consideredRead MoreHow We Can Make Our Body Healthy And Live A Happy Life?895 Words   |  4 Pagesour body healthy and live a happy life? In this modern era, everyone wants to be healthy because the healthy body has a healthy mind. According to Psychologies article, there are many things to do to make a happy and healthier life like get enough sunlight during various seasons, keep hydrated, proper sleep and physical exercises such as walking, resistance exercise and act of kindness, art of appreciation. These are very important to follow to remain healthy and happy. I think tips like eating a healthyRead MoreMelanom The Most Dangerous Form Of Skin Cancer Essay1342 Words   |  6 Pagesportion disease called skin cancer Melanoma. Melanoma is the most dangerous form of skin cancer, these cancerous growth develop when unrepaired DNA damage to skin cells, triggers mutations that lead the skin cells multiply rapidly and form malignant tumors. Dominant or Recessive Disorder/ Sex linked or autosomal: A person may either be born with genetic mutations in all of their cells or acquire a genetic mutation in a single cell during his or her lifetime. Most melanomas (about 90%) are consideredRead MoreClimate Change : The Change Of The Environment And World Around Us1458 Words   |  6 Pagesvaluable resources for animals. When the animals do not eat, humans cannot eat. When the ozone layer goes away, certain rays from the sun can come down and affect us. One major layer is the UV rays, UV rays can affect the skin of a person and whether or not they can contract skin cancer. Some UV rays are good, when we tan those are good UV rays. UV rays can cause the ocean to dry up, ocean goes away everything is lost. The planet then becomes a dessert, valuable animal species and major plant lifeRead MoreThe Youngest Daughter Essay1116 Words   |  5 PagesAutumn Gordon Dr. Green Writing about Literature 3 June 2012 COM1102_AutumnGordon_Wk5Essay The theme of Cathy Song’s â€Å"The Youngest Daughter† is about the youngest daughter of six growing old along with her mother. The title on the poem is also ironic because Song uses imagery to show that the daughter is no longer young. Song also uses using imagery daughter’s skin tone lacking sunlight to symbolize the isolation the daughter has because she is caring for her mother. The mother and daughterRead MoreThe Inflammation Theory or Clinical Creations1056 Words   |  4 PagesInflammation theory soon became a skin care product called, â€Å"Clinical Creations†. The formulas included to make this product were cold plasma, Acyl-Gluthione, and Vitamin C Eser. These formulas brighten, apply nutrients, and erase sun damage on the skin revealing refreshing skin (Perricone 103-117). Not every individual can afford a world known Dermatologist like Perricone, but there is some local Dermatologist around the area that is willing to help cure a skin problem. Brianna Green is a Dermatologist

Monday, December 9, 2019

Mexico Pest Analysis free essay sample

Mexico PEST Analysis Executive Summary Mexico has resulted in recent years as one of the most promising emerging economics nevertheless the downturn occurred in 2009 under the influence of the crisis in the United States. In 2010 the economy has restarted its growth trend, which according to the forecast will bring the Country among the elites of world economy. This short paper explains the fundamental factors determining Mexico economic growth using the PEST Analysis Framework. In particular it focus on how International Business activities has contributed to economic development of the Country, offering also an once-over on the main industry involved in this process. Mexico PEST Analysis Introduction Approaching the research for this paper I went through an article that caught my attention and made me consider how important could be to understand the growth of Mexico in recent years. The first lines of this article tell â€Å"Mexico will overtake Italy to become the worlds 10th largest economy (in terms of GDP at purchasing power parity) by 2020. There are two types of plastics: thermoplastics and thermosetting polymers. Thermoplastics are the plastics that do not undergo chemical change in their composition when heated and can be molded again and again. Examples include polyethylene, polypropylene, polystyrene, polyvinyl chloride, and polytetrafluoroethylene (PTFE). [4] Common thermoplastics range from 20,000 to 500,000 amu, while thermosets are assumed to have infinite molecular weight. These chains are made up of many repeating molecular units, known as repeat units, derived from monomers; each polymer chain will have several thousand repeating units. Thermosets can melt and take shape once; after they have solidified, they stay solid. In the thermosetting process, a chemical reaction occurs that is irreversible. The vulcanization of rubber is a thermosetting process. Before heating with sulfur, the polyisoprene is a tacky, slightly runny material, but after vulcanization the product is rigid and non-tacky.

Monday, December 2, 2019

The Great Gatsby Essays (886 words) - The Great Gatsby,

The Great Gatsby The Great Gatsby contains many themes. These themes are the thought of repeating the past, the image of God watching over us, and the advice that Nick receives at the beginning of the book. The theme of repeating the past is enacted throughout the whole book. You see this in the first chapter when Gatsby is portrayed as looking at the green light across the lake. The reader later on finds out that Gatsby knew Daisy before he went off to the war. He then buys a house that is in proximity to Daisy's, even though she is already married to Tom Buchanan. Gatsby then decides to have many wild parties in hopes of attracting Daisy to his home, but that doesn't work until he meets Nick. When Nick is invited to one of Gatsby's many parties; he meets him for the first time. Gatsby then finds out, through Jordan Baker, that Nick is Daisy's cousin. He then befriends Nick to get closer to Daisy. This is done when Gatsby asks Nick to invite Daisy for tea. The fact that Gatsby stops having the parties reinforces this theme because he finally has Daisy and his mission of attracting her is accomplished. At the end of the book, the final quote, ?So we beat on, boats against the current, b orne back ceaselessly into the past,? greatly supports the theme because it symbolizes the difficulty that every human has in reclaiming their past. Dr. T.J. Eckleburg symbolizes the theme of God watching over all humanity. Dr. Eckleburg resembles the eyes of God because he sees all of the immoral acts being done by the characters in the novel. He sees Myrtle Wilson having an affair with Tom. He sees what really happened and who really was at fault when the accident that killed Myrtle Wilson occurred. He knew that Daisy was driving the car, and that Gatsby had no knowledge of Myrtle, nor did she have any knowledge of Gatsby. After Myrtle's death, George, her husband, looks into the horizons and says that God is watching over us. He also told Myrtle, before she died, that God knew what she was doing, and the she could full a human, but she could never fool God. He later supplemented that theory when he was fooled by Tom into thinking that Gatsby was the one who was having the affair and he was the one who killed Myrtle. Eckleburg is not mentioned a whole lot because people do not care for a billboard as sinners care for God, and t his is shown throughout the story. The advice that Nick receives from his father is, ?Whenever you feel like criticizing someone, just remember that all the people in this world haven't had the advantages that you've had.? This theme stands out the most because of the contradiction that is portrayed by each of the characters. Even though Nick might not show it, he is very judgmental of the other characters in the book. In the first chapter he shows a slight hatred of Gatsby by saying he had an unaffected scorn for him. He might not say it, but he really thinks Tom is a dumb guy. He shows this because he knows that Daisy is seeing Gatsby secretly, yet he figures that Tom is too dumb to figure it out. He deems Jordan as a liar and even goes as far as to tell her that she is a bad driver. Notice in the first chapter, he refers to his younger years as his ?vulnerable? years. He is implying that when he was younger, he would follow any advice, and he certainly did follow his father's advice. But, as all children do, he gre w up and became an independent thinker. He even referred to all those he associated with as snobbish and careless. He told Gatsby that he was a higher form of life than Tom, Daisy, and all the other people he knew put together. At the end of the novel, he insults Tom for his assisted butchery of Gatsby, finally portraying his true feelings toward him. At the end of the novel, he is finally able to show his true feelings about everyone. The reason

Tuesday, November 26, 2019

The eNotes Blog Happy Birthday, Beckett! Celebrate the (Absurd) Waiting for GodotAuthor

Happy Birthday, Beckett! Celebrate the (Absurd) Waiting for GodotAuthor Samuel Beckett was a most interesting man- a fact that can be immediately  confirmed by the authors influential contributions to the Absurdist Movement (but well get to what that is in a moment). Though born and raised in Ireland, Beckett fell in love with Paris  in his 20s after graduating from Trinity College with a B.A. in modern languages and setting out on a cycling tour of  France. There  the young author befriended  and made a pseudo-father-figure of fellow author and Irishman  James Joyce, who provided a great deal of encouragement and assistance  to Beckett and his work. Throughout his life, Beckett suffered from bouts of severe depression and associated alcoholism, both of which took a toll on his writing until the midpoint of his career. Beckett began to use his pain and his experience in studying philosophy  to begin working in the style of  the  absurd. The Absurdist movement was centered on the concept that humanitys efforts  to find or define the inherent meaning of anything (say, human experience) are absurd because the qualities of communicable information in relation to reality make any such certainty impossible. Was that confusing? Yes, yes it was. More simply stated, Absurdism was founded on the belief that nothing can be truly confirmed, be it experience or relationships, and therefore who is to say what is real when what has happened cannot be proven? Okay, that was a little confusing, too,  but when we say that Samuel Beckett was a smart man, believe us- this fella not only understood Absurdism, but helped to establish it as a   literary and philosophical movement. Speaking of the Absurdist movement, we would like to (primarily) focus this Beckett b-day post on one of his most famous works,  Waiting for Godot. Sometimes referred to as one of the most significant English plays of the 20th century, this drama was and remains a highly influential piece. Arguably one of the most interesting elements of  Waiting for Godot is, for lack of more eloquent phrase, how very  weird  it is. Readers/viewers of this play are often struck by how nonsensical yet meaningful the play is, in addition to the notion that the play itself has no meaning And yet it must. The description of this play is becoming as confusing as the above attempt at defining the  absurd. For this reason, we shall now delve into detailing aspects of the drama/comedy itself, in hopes that piece by piece this moving work will become a more cohesive whole. What is  Waiting for Godot REALLY about? Arguably, the basis of the play is  desire for a purpose. This aim of having a purpose could be further extrapolated to the human condition and the desire to understand the meaning of life. Absurdism directly deals with the impossible conclusion to this  existential question, and it makes sense that Beckett would take this painful construction to bat in his works. How would you categorize this play? There are two basic genre categories  into we can place a given play: comedy and tragedy. A  tragedy can be described as a work with the philosophical view that life is tragic because it is filled with pain and suffering, and ultimately ends in death. Alternatively, a  comedy takes the view that life is ridiculous because people are foolish and harbor unrealistic expectations. It makes sense that an absurdist work such as  Waiting for Godot takes bits and pieces from both of these genres. As  an experimental play belonging to the Absurdist  movement, it  works to self-consciously break down and challenge the traditional generic conventions. What Are the Plays Themes? Any work of literature is going to feature at least one theme (and usually  more). A theme is very basically an ongoing subject/topic. You can see themes in  thoughts,  literary works, art exhibitions, etc. Waiting for Godot is a rather complex play, and  since the work is itself quite cyclical it can be argued that anything recurring is in some way a theme. In spite of this defensible stance, we are going to outline two major themes in the play: memory and time. Tied in with the themes of memory and time is the theme of uncertainty. Everything is uncertain in the play, and this is what makes it appear absurd. In watching/reading the play, the viewers and/or readers are often left as confused as the characters as to what is happening, when it happened, or if it happened at all.  Literary analysis is enough to make your head spin sometimes, but thats why were here! What Methods Did Beckett Use to Create The  Play? When we say methods, we mean what an author did to convey a desired message. In many cases, this methodology includes word choice, syntax, use of rhetoric, and more. By focusing on particular techniques/methodology, an author can decidedly skew a story in one direction or another, inflicting a particular interpretation or mood onto his or her audience. In Waiting for Godot, Becketts involvement in the theater becomes increasingly more apparent. Unlike his novels and short stories, Becketts plays are more definitely focused on theatrical outcome than literary objectives; instead of focusing on elements like grammatical structure to keep the story flowing, Beckett puts more emphasis into the action of what is occurring onstage rather than the behind-the-scenes drivers of the story (i.e.  action over  narration,) though he does  stake a lot on  the dialogue between characters. So,  What Was the  Meaning of the Play? Weve talked about what happens in the play, weve talked about its potential inspirations, and weve discussed how Beckett may have gone about the writing of the work, but what is  Waiting for Godot trying to tell us? To put it frankly, the play is pretty bleak. The whole piece details the story of two men waiting for someone or something that will potentially never arrive. This waiting for an event  that may never occur may be extrapolated to a commentary on the human condition- common in both existentialism and absurdism (though believers of one or the other would never agree to any similarities between these movements). Absurdism questions the motivations behind the human experience: if nothing can be explained or proven, then everything we do is arguably absurd. It can be argued, therefore, that the seemingly endless and repetitive waiting of the two main characters can be a metaphor for  humanity as a whole and how we are always, perhaps senselessly, awaiting  something. More on the plays meaning. Everybodys a Critic If youve ever read or written anything (and since youre on the   blog we can assume you have at least some  interest in the written word), you will know all about literary criticism- its just about everywhere. Back in the day, the only reputable source of literary criticism could be found in the work of scholars who had done targeted analysis on a particular piece. Nowadays, however, you can type in the name of any  work  and be taken to countless links to opinions (or tweets). A piece like  Waiting for Godot has been reviewed and criticized (and praised) a number of times from varying viewpoints with basis in all varieties of philosophical thought. One could wonder though what are the  critics themselves waiting for?

Saturday, November 23, 2019

Edward Teller and the Hydrogen Bomb

Edward Teller and the Hydrogen Bomb What we should have learned is that the world is small, that peace is important and that cooperation in science... could contribute to peace. Nuclear weapons, in a peaceful world, will have a limited importance. -Edward Teller in CNN interview Significance of Edward Teller Theoretical physicist Edward Teller is  often referred to as the Father of the H-Bomb. He was part of a group of scientists who invented the atomic bomb as part of the  U.S. government-led  Manhattan Project. He was also the co-founder of Lawrence Livermore National Laboratory, where together with Ernest Lawrence, Luis Alvarez, and others, he invented the hydrogen bomb in 1951. Teller spent most of the 1960s working to  keep the United States ahead of the Soviet Union in the nuclear arms race. Tellers Education and Contributions Teller was born in Budapest, Hungary in 1908. He earned a degree in chemical engineering at the Institute of Technology in Karlsruhe, Germany and received his Ph.D. in physical chemistry at the University of Leipzig. His doctoral thesis was on the hydrogen molecular ion, the foundation for the theory of molecular orbitals that remains  accepted to this day. Although his early training was in chemical physics and spectroscopy, Teller also made substantial contributions to diverse fields such as nuclear physics, plasma physics, astrophysics, and statistical mechanics. The Atomic Bomb It was Edward Teller who drove Leo Szilard and Eugene Wigner to meet with Albert Einstein, who together would write a letter to President Roosevelt urging him to pursue atomic weapons research before the Nazis did. Teller worked on the Manhattan Project at the Los Alamos National Laboratory and later became the labs assistant director. This led to the invention of the atomic bomb in 1945. The Hydrogen Bomb In 1951, while still at Los Alamos, Teller came up with  the idea for a thermonuclear weapon. Teller was more determined than ever to push for its development after the Soviet Union exploded an atomic bomb in 1949. This was a major reason why he was determined to lead the successful development and testing of the first hydrogen bomb. In 1952, Ernest Lawrence and Teller opened the Lawrence Livermore National Laboratory, where he was the associate director from 1954 to 1958 and 1960 to 1965. He was its director from 1958 to 1960. For the next 50  years, Teller did his research at the Livermore National Laboratory, and between 1956 and 1960 he proposed and developed thermonuclear warheads small and light enough to be carried on submarine-launched ballistic missiles. Awards Teller published more than a dozen books on subjects ranging from energy policy to defense issues and was awarded 23 honorary degrees. He received numerous awards for his contributions to physics and public life. Two months before his death in 2003, Edward Teller was awarded the Presidential Medal of Freedom- the nations highest civil honor- during a special ceremony conducted by President George W. Bush at the White House.

Thursday, November 21, 2019

Job Description Paper Essay Example | Topics and Well Written Essays - 750 words

Job Description Paper - Essay Example Undoubtedly, job descriptions are very essential for most individuals in the workplace since they define an individual’s role and accountability. This paper presents a human resource manager job description covering the key tasks of this position, tools and technology, knowledge, skills and abilities, and education requirements. It also describes two selection methods used to recruit qualified candidates and explaining why these methods would be most appropriate. The main purpose of a human resource manager is to maintain and enhance the organization’s human resources by planning, implementing and analyze employee relations among others. The position of human resource manager is charged with various tasks such as recruiting and selecting new applicants to occupy vacant posts in the organization so as to maintain the staff. Secondly, human resource manager is responsible for planning, developing and implementing strategies for human resource management including recruitment and selection practices, motivation of employees, and performance appraisals among others. In addition, HR manager need to ensure that all employees have been fully prepared to perform duties assigned to them effectively and this is possible through orientation and training programs. Human resource manager critically evaluates the information provided about workers’ salary, and control compensation and other benefits for all workers (Mathis and Jackson, 2008) . Tools and technology required in this occupation include desktop and personal computers, scanners, and surveillance video or audio recorders. Technologies needed are accounting software, human resources software, and document management software among others. Human resource managers need to acquire certain skills and abilities such as hiring and coaching skills; the ability to benefit the administration and manage employee performance at work. More so, human resource manager

Tuesday, November 19, 2019

Many high profile organisations have - through the media discussed Essay

Many high profile organisations have - through the media discussed their need to change their culture. The mining industry, p - Essay Example The managers form the largest group that spear head initialization and implementation of proposed programs in various department of any organization. Some of the roles played by the managers include provision of leadership, managing people, managing priorities and safety in the workplaces (Brown, 2004). In fact, competent managers contribute immensely to the success of a business. In relation to contextualized issue of social dynamism, the managers have a special and critical niche to occupy in a bid to achieve the overall goal of achieving a highly rated level of social diversification. Essentially, initialization and implementation of any program should follow the normal managerial process, which involves setting up the work agenda, identifying the work methods and roles, implementing management functions, applying knowledge and key management skills and organizational performance (Weidlich, 2000). A successful application of a managerial process in initializing and implementing a program or a process contributes to achievement of the intended goals. This study establishes that, mangers focus their energies through work agendas when implementing a program (Brown, 2004). ... More over, the managers should uphold high standards of managerial ethics. The aspect of social responsibility refers to the commitment of an organization to act with intent of protecting and improving the welfare of a given society. The organizational responsibility entails three key perspectives, which include invisible, and, the government and management hand (Brown, 2004). It is imperative to note that, the process of responding to any social demand requires inclusive participation of the stakeholders, which include the shareholders, employees, customers, local community, international community and the society. The bid by numerous organizations to embrace diversification in social demands and relevant response mechanisms revolve around critical societal matters related to health, education, technology, culture, environment and ways of generation of income (Hunnicutt, 2000). To define social responsibility in relation to the environment the basis of social paradigm in systems is a fundamental component for consideration. It is imperative to note that, organizations secure numerous resources and release outputs to the society in a bid to strengthen the economic and social milieu (Brown, 2004). On how to respond to the social demands through building of social response mechanism, a corporate social responsibility should take the epicenter of all events. This is the origin of the intended solutions for social demands attributed to an organization. Corporate social responsibility (CRS) can be referred to as the corporate accountability or corporate ethics. It should be noted that, the move to embrace this aspect of management is intended to establish better practices within the

Sunday, November 17, 2019

How Piagets theories support universal preK in the US Essay Example for Free

How Piagets theories support universal preK in the US Essay Jean Piaget is famous for developing one of the most influential theory, the theory of cognitive development. The theory is mainly concerned with the construction and emergence of schemata which comprises the schemes of how a person does perceive the world especially during the developmental stages when the children are gaining new means of mentally expressing information. The theory is considered constructivist in opposition to other theories which could be either nativist or empiricists, (Brainerd, C. 1978). The theory proposes that we do get to construct our cognitive abilities through the self-motivated action in ones world. The nativist theory on the other hand asserts that cognitive development is the unfolding of innate abilities and knowledge while empiricist theories defines cognitive development as a gradual process in which knowledge is acquired through experience, (Brainerd, C.J. Reyna, V.F 2002). For this theory, Piaget won the Erasmus prize. There are four main periods that Piaget used to describe the schemes that children make use of to understand the world, (Gallagher, J.M. Reid, D.K. 1981). Four stages as described by Piaget’s. Sensorimotor period. This occurs at the age of 0 to 2 years, (Piaget, J. 1929). According to Piaget, children are born with a congenital reflexes which permits them to float in the dense world beyond their drive to explore the world around them. The initial schemes that the children have at this stage is all based on the differentiation of their congenital reflexes. Since this is the first of the four stages according to Piaget it marks an important stage in which the child develops spatial abilities to understand the world in six different stages, (Piaget, J. 1929). These stages include; †¢ The reflex scheme stage that takes place from birth to one month. It is primarily associated with the development of reflexes. †¢ Primary circular reaction stage is the second stage that occurs from one month to four month. It is primarily associated with the development of habits. †¢ The secondary circular reactions phase forms the third stage. It occurs from the fourth month to the eighth month and is primarily associated with the development of vision and prehension coordination, (hand-eye coordination). †¢ The fourth sub stage is concerned with the development of the object permanence development. It is generally called the coordination of secondary course round modest circular reactions stage and occurs from the eighth month to the twelfth month. †¢ The tertiary circular reactions phase is what Piaget suggested to the fifth sub stage from twelve to eighteen months. This is the stage that Piaget suggested that the ‘little scientist’ is born through active creativity and experimentation. †¢ The sixth final sub stage here is characterized by the beginning of symbolic representation and it occurs from the eighteen months to twenty four months. At this stage the new found means of considering before taking an action gives the child new ways of eventually achieving a goal without having to go for the trial and error experiment, (Gallagher, J.M. Reid, D.K. 1981). preoperational stage This is the second of four main stages of cognitive development. Piaget demonstrated that a qualitative psychological functioning does occur as the child approaches the end of second year. According to Piaget, a preparatory thought is any particular procedure that promotes mental action on objects. The main hallmark in this stage is logically inadequate and sparse mental operations, (Flavell 1963). It is at this stage that the child learns to repress and use objects by words and images, that is symbolic thinking is evident. Since the child still has difficult of adopting other people’s viewpoint, thinking is still egocentric. It as it this stage that the child has the potential to classify similar objects together trough a single feature such as color or shape, (Brainerd, C. 1978). Piaget suggested that this stage which immediately follows Sensorimotor stage occurs between 2-7 years of stage. It at this stage that children develop their language skills and thus they begin expressing things using images and words. Worth noting here is the child relies more on intuition that the logical reasoning at this stage. At the beginning, there are more egocentric since they are not yet aware that other people are not thinking or perceiving things in the same way like they do. It at this time that their imaginative mind is very active and they thus associate emotions to certain inanimate objects, (Piaget, J. 1929). This stage is further broken down into Preconceptual stage and the Intuitive stage. The Preconceptual stage occurs at the stage of 2-4 years and is mainly characterized by egocentric thinking as well as animistic thought. A child with animistic thought is one who has the tendency to assign attributes of living things to inanimate objects such as the perception that a glass does feel pain when it is broken. The intuitive stage that occurs between the forth year to the seventh year is characterized by the potential child who is actively solving problems through the mental process. Though at this stage they do manage to achieve some goals, they are however unaware on how they achieved their conclusion. A simple example is when a child is able to correctly identify the majority from the minority just by the virtual of sight. An example is when a child is presented with seven dogs and maybe 2 cats and he/she is asked if there are more dogs that cats. As expected the child would respond positively but will also commit a logical error if supposedly asked the same question in the same way but differently such as if there are more dogs that animal, (Brainerd, C. 1978). The child will most likely respond by saying yes thus showing the use intuition at this stage. An important observation by Piaget is that children mainly learn through play and imitation through these first two stages, (Gallagher, J.M. Reid, D.K. 1981).. Concrete operational stage This is the third of the four stages in Piaget’s cognitive development theory. It follows preoperational stage and is suggested to occur between the age of 7 to 11 years, (Piaget, J. 1929). It is characterized by the appropriate use of logic and at this stage some of the important processes that have been identified include; †¢ Seriation, which is the ability to sort different objects based on shape, size or other characteristic. A good example is the potential to differentiate color gradient. †¢ Classification-the ability of the child to identify and name sets of objects based on size, appearance as well as other characteristics that may suggest that one object may include another. †¢ Decentering-this is a process where the child is able to take into account multiple aspects of a problem towards solving it. An example is the change in perception where a child will no longer will no longer hold the perception that an exceptionally wide yet short cup will hold less amount that one that is normally tall and wide. †¢ Reversibility-where the young one is able to comprehend that objects and numbers can be altered and eventually returned back their original state. Thus the child will be able to comprehend that since 3+3= 6, then 6-3=3. †¢ Conservation- the ability to understand that length, quantity or number of items is basically mot related to their appearance or arrangement. †¢ Elimination of egocentricim- this is the ability of the child to understand and view things from another perspective even though they may think incorrectly. Formal operational stage This is the fourth and the final stage in cognitive development according to Piaget’ theory. It starts at around 12 years of age soon after the Concrete Operational stage and continues all the way to adulthood, (Ashurst 1985). It is the stage that is characterized with the ability to reason logically, think abstractly, and be able to draw conclusions from the available information. It is at this young adult stage that one is able to understand such aspects as logical proofs, love and values. Some biological factors can be traced during this stage as it occurs during puberty thus marking the entry into adulthood in cognition, physiology, moral judgment (Kohlberg), psychosocial development (Erikson) and psychosexual development (Freud). It is estimated that approximately two-thirds of all the people fail to develop this type of reasoning fully for it to become their normal cognition mode and thus they remain as operational thinkers even as adults, (Flavell 1963). The above four stages have some general observation. One is that though they may vary in time, sequence does not change, (Brainerd, C. 1978). The stages also apply to thought and not to children and they universal thus they cannot be associated with any culture. Shortcoming to Piagetian stage theory. There are several challenges that have been put froth against Piagetian theory some of which even Piaget himself has noted such as the fact that development does not have to progress in such as the smooth manner that his theory has proposed. His theory is a general one since it suggests that cognitive maturation occurs across different aspects of knowledge such as logic, mathematics, language among others, (Gallagher, J.M. Reid, D.K. 1981). Application of Piagetian theory Most of the educators as well as psychologists do manage to receive piagetian theory training during their professional training. A piagetian assessment is more likely to be a familiar concept among the psychologists who work in those districts that carry out alternative assessment of cognitive ability on regular basis. A good example are the psychologists at the Southern California Diagnostic Center who do make use of the Ordinal Scale more in depth during a Piagetian assessment. For most of these psychologists, a Piagetian assessment is like a departure from the standardized intelligence testing. The standardized intelligence tests that are available usually diagnose the student’s academic achievement expectancy and it may usually take considerable amount of time and thus may not be done for more than one year. This thus limits the tests for use during short term interventions such as pre-test or post-test. More to this is that standardized cognitive tests quantify a students power or strength of abilities or processing but unfortunately the quantification does not precisely predict the intervention method that are most likely applicable or useful, (Flavell 1963). A curriculum-based measurement (CBM) can be done several times within a year by the school psychologists as a pretest or post-test on how effective the intervention is. Unfortunately, CBM does not provide details of why the intervention may or may not be successful nor does it serve as a diagnostic tool for the instructional modifications. On the other hand, Piagetian screening can be useful in giving instructional interventions especially incases to do with comprehension or math concepts, (Piaget, J. 1929). Piagetian theory gives the stage wise development of qualitative means of developing thinking from one stage to the next. Through this understanding it is possible to understand more easily why students experience learning difficulties. Thus Piagetian screening does provide an avenue of quickly estimating a student’s cognitive development level, (Ashurst 1985). In a summary thus, one can point to Piagetian tasks as signposts that indicate the level or stage that a child of a particular age is functioning. Thus it is important to understand that teaching   a child certain specific tasks does not in any way change the development stage of the child. Thus these signpost are useful when developing accommodations and modifications that do support a match between a Childs a curriculum with his/her cognitive processing ability. Necessary interventions for a child curriculum especially at the age of 4. Most of the children usually do encounter difficult math problems. Piagetian theory can be used to explain the appropriate interventions that can be adopted and especially at the age of four. For a student to effectively understand the mathematical concepts of simple subtraction and addition, there is need for him/her to acquire the concept of conservation of numbers. A child who is yet to attain conservation of number concept can still be able to perform, state or memorize various procedures such as subtraction or addition but may most likely be confused with the same concepts weeks, days or even hours later. The main reason for this is that information is stored as verbatim representations and the gist representations, (Brainerd, C. 1978). The modern theories of memory suggest that memory is stored as verbatim (exact input), or gist (concepts) and these representations of   memory   are accessed independently. Thus a child who has not yet attained the conservation of number rarely has the conceptual framework that is needed for a one-to-one correspondence since they lack the conceptual framework, (Gallagher, J.M. Reid, D.K. 1981).. At a later time when the child is not able to accurately carry out math operations, an impression of memory deficit may most likely be the first impression. But the main problem maybe that the child has not yet attained the developmental stage that is required to understand the mathematical concepts. It is in such circumstances that the child may only store verbatim memories and fail to do the same for the conceptual knowledge, gist memory. Necessary interventions in this case suggest that one ought to be very sure that the concrete operations level is emerging. If this is not the case, the child may most likely be in the pre-operational thinking stage which is also the intuitive level. The necessary interventions can be aimed at helping the child accelerate moving from intuitive stage towards the concrete stage. A good example is at the age of four, which is generally regarded as the stage of ‘why’ where the course-effect thinking is learnt in details. Worth noting is that some of the primary school-age children whom have not yet attained the level of being intuitive thinkers usually get on to ‘why stage’ one or two years later and may thus have not had the opportunity of having the questioning behavior reinforced, (Flavell 1963). Students are also known to experience problems with comprehension. The frequent complaint are usually at the 4th grade all the way to the eighth grade. The difficult maybe complex but with the application of Piagetian theory it is possible to determine whether the student did manage to attain the necessary developmental stages to be able to comprehend different concepts that do involve   some partially overlapping sets of information. Though the international model age for attaining classification task as age 9, an upward variance is usually observed. Most of the upper elementary science, literary concepts and social sciences involve also mental manipulation. Usually students gain the attention of the school psychologists due t issues that are associated social behavior.

Thursday, November 14, 2019

Ecology :: essays research papers

In the original Greek "oikos" means, "house". So ecology is "the study of the house" the place where you live, or the environment which technically includes all those factors, both nonliving and living, that affect an organism. Ecology then is the study of the interactions of organisms in their environment includes both the living (biotic) and physical (abiotic) factors of the environment. It's also the science, which formulates and tests hypotheses about environment. Ecology is the relationships, identification and analysis of problems common to all areas. Ecology studies the population and the community, evaluates cause and effects of the responses of populations and communities to environmental change. POPULATIONS The population is defined as an assemblage of individuals of a single species that live in the same place at the same time. Also, biologists add an additional condition: the individuals in a population must interact with each other to the point of being able to interbreed. Population is important to understanding many important ecological and evolutionary phenomena. Ecologists can use information from population ecology to predict the success of a given species or assemblage of species. One attribute of populations that is observed in nature is their dispersion, or the way in which individuals are distributed in a given area. Typically, biologists refer to three types of dispersion: - Clustered (aggregated), Regular (evenly spaced), Random (irregularly spaced) Populations showing a clustered pattern are common in nature and are found among many different types of organisms. Clustered dispersion patterns are often due to environment heterogeneity. Regular dispersion patterns are relatively rare in nature and occur when a resource is scarce. A good example of regular spacing occurs in animals that exhibit territoriality, a phenomenon in which animals establish an area for themselves and fight off all other individual seeking to invade that area. Regular dispersion patterns can also be observed in plants. Random patterns can be found in a variety of organisms (trout in lake or maple trees in a forest). Regardless of which organisms, the number of births almost always has the potential to be greater than the number of deaths. In other words populations of all species have the capacity to grow. That property is crucial importance to the success of all species. However, all species will not increase under all circumstance, but instead they can, given appropriate conditions. There are two models of population growth: the exponential model and the logistic model. One of the most basic models of population biology is the exponential growth equation, which is: )N/)t = rmaxN This equation states that, in a growing population, the rate of change in population size is determined by the maximal intrinsic rate of increase (rmax) multiplied by the number of individuals in that population (N). Ecology :: essays research papers In the original Greek "oikos" means, "house". So ecology is "the study of the house" the place where you live, or the environment which technically includes all those factors, both nonliving and living, that affect an organism. Ecology then is the study of the interactions of organisms in their environment includes both the living (biotic) and physical (abiotic) factors of the environment. It's also the science, which formulates and tests hypotheses about environment. Ecology is the relationships, identification and analysis of problems common to all areas. Ecology studies the population and the community, evaluates cause and effects of the responses of populations and communities to environmental change. POPULATIONS The population is defined as an assemblage of individuals of a single species that live in the same place at the same time. Also, biologists add an additional condition: the individuals in a population must interact with each other to the point of being able to interbreed. Population is important to understanding many important ecological and evolutionary phenomena. Ecologists can use information from population ecology to predict the success of a given species or assemblage of species. One attribute of populations that is observed in nature is their dispersion, or the way in which individuals are distributed in a given area. Typically, biologists refer to three types of dispersion: - Clustered (aggregated), Regular (evenly spaced), Random (irregularly spaced) Populations showing a clustered pattern are common in nature and are found among many different types of organisms. Clustered dispersion patterns are often due to environment heterogeneity. Regular dispersion patterns are relatively rare in nature and occur when a resource is scarce. A good example of regular spacing occurs in animals that exhibit territoriality, a phenomenon in which animals establish an area for themselves and fight off all other individual seeking to invade that area. Regular dispersion patterns can also be observed in plants. Random patterns can be found in a variety of organisms (trout in lake or maple trees in a forest). Regardless of which organisms, the number of births almost always has the potential to be greater than the number of deaths. In other words populations of all species have the capacity to grow. That property is crucial importance to the success of all species. However, all species will not increase under all circumstance, but instead they can, given appropriate conditions. There are two models of population growth: the exponential model and the logistic model. One of the most basic models of population biology is the exponential growth equation, which is: )N/)t = rmaxN This equation states that, in a growing population, the rate of change in population size is determined by the maximal intrinsic rate of increase (rmax) multiplied by the number of individuals in that population (N).

Tuesday, November 12, 2019

History of Healthcare and Economics

This paper will discuss the history and evolution of healthcare economics and healthcare funding timelines. In the 21st Century healthcare has proven to be one the largest industries world. The healthcare industry has changed dramatically in the last hundred years. As changes and progression are examined, it becomes clearer that healthcare and the economy it has created, is an important part of American life. The way the funds flow in the healthcare system allows financial managers to track the money through the health care system. The initial flow of funds has drastically changed throughout the years. The economics of healthcare, â€Å"the study of how scarce resources are allocated among alternative uses for the care of sickness and the promotion, maintenance and improvement of health, including the study of how healthcare and health-related services, their costs and benefits, and health itself are distributed among individuals and groups in society†, according to The journal of Mental Health Policy and Economy (2006). There are records as early as the turn of twentieth century that show that healthcare providers charged for services including surgeries such as tumor removal, appendectomies and gynecological operations. Services may have been exchanged for items such as livestock, food items, or cotton. The patient or his or her family may have exchanged services for patient care. No form of health care insurance was available; prices were not set by any organization or person. Physicians of the early twentieth century were tradesmen and essentially businessman. Patients paid the full price for the medical services offered by the physician. According to PBS (n. d. ), in the 1910’s some reformers argue that there should be some sort of health insurance. Although the idea seemed to have some support, many physicians and other interest groups did not approve. War World One took place in 1917 and for the moment healthcare reform was put on the back burner. The lack of technology and inadequate health centers raise the amount of cost needed for medical care. The current economic and war state of the country took priority over healthcare reform. General Motors offers life insurance for 180,000 workers through Metropolitan Life. The same time doctors’ wages increased. During the Great Depression, it became apparent that there should be some sort of benefits for individuals as they reached retirement age. Instead of health insurance, the Social Security Act was passed. During the Roosevelt Administration, many reformers pushed for health insurance again, but conflicts within the country once again pushed for health care insurance. Blue Cross started offering private insurance for hospital care in many states even though it was considered a bad idea by many insurance professionals. The timeline from the PBS (n. d. ), website in the 1940’s a radical reformation took place. War World Two wages were capped and controlled on American employers. Companies began offering health benefits to compete with other employers. This idea has sparked the employer-based system that is used by employers today. A Universal Healthcare plan is introduced by President Truman, but is never used. The American Medical Association (AMA) believes the plan is Communist in nature. As the Korean War approached, healthcare reform was once again a low priority. The government established a policy that would make the federal government responsible for sick poor. Many people in 1950’s can no longer afford health care insurance, especially those who do not work. The price of hospital care doubled. President Johnson signs Medicare and Medicaid into law. During the 60’s, more than 700 insurance companies are selling health insurance. During the 1980’s Medicare begins charging insurance by the diagnosis and not the treatment of the patient. Technology, vaccinations, medications, and a rise in hospital expenses raise healthcare costs tremendously. Medicare’s high expenditure rates and rapid inflation of the economy also affected the higher cost of healthcare. Health care has seen many changes over the past years, but all the changes have created the health care system and the economics of the system to this point. As the gross domestic product (GDP) , which is the total market of healthcare, started to increase annually, the private sectors of healthcare, government controlled entities, and insurance companies profit and change policies, which in turn increases the (GDP). An increase in population, aging population and communicable diseases such as Hepatitis, HIV, AIDS, and Tuberculosis has increased the cost of health care even in recent years. Small deductibles, low copayments, and employer-based healthcare insurance have molded the idea in many patients’ minds that the patient should use medical services often to â€Å"get what they pay for. † This has created an imbalance of supply and demand. There are numerous reports that there is a shortage of providers. Rapid training of Physician Assistants and Nurse Practitioners are being educated and trained to help fill the gap of the numerous amounts of patients that need medical attention. The elasticity in health care has forced changes to be made in healthcare billing and insurance. The increased amounts of patients that need medical attention have increased the amount of providers needed. The increased costs of healthcare, technology, research, drugs, and lack of funds available for Medicare have forced a price increase for patients. Many employers find it more difficult to provide costly insurance to employees. Elasticity of services might normally demand a decrease in price, but prices have been inelastic in nature. Elasticity can also have a direct impact on when the government intervenes to set a fair price for services according to Tutor2U (2006). The insurance companies play a huge role in determining the amount of money that is needed for medical care. Supply and demand differ so greatly in the health care community than any other service or industry, making supply and demand a very different story than simply buying milk or a computer. Macroeconomics is the branch of economics that deals with the economy as a whole, such as unemployment rates, deflation and inflation. Microeconomics deals with the insurance companies and other health care related aspects that are affected by the economy fall into a more specific category known as microeconomics. As the whole economy changes, families, patients and individuals must choose to make decisions based on the economy. Healthcare decisions within communities and household are examples of microeconomics. As advances in healthcare are introduced, government regulations are introduced and the economy faces multiple challenges in the future, healthcare will likely see more changes to come.

Sunday, November 10, 2019

Communication and Professional Relationships with Children, Young People and Adults

Effective communication is important in developing positive relationships with children, young people and adultsEffective communication creates positive relationships. You have to model excellent communication skills with the children and adults you work with on a daily basis. You should always think about how you approach people and how you respond back, doing so in a positive manner will help you achieve more information and communication in the long run because you are beginning to build a positive relationship with that child/person and this benefits them.We must always think about how we communicate and always make sure it is for the good of the pupil and the school. Always set a good example by behaving the way you would expect your pupil to. If you do not communicate effectively it can break down and that’s where misunderstandings occur and this can lead to negative feeling.When you use effective communication this creates a strong and positive relationship and your pup ils will benefit fully from that given situation.Explain the principles of relationship building with children, young people and adultsThe main principle of relationship building is to make others feel comfortable and at ease, if they are, they are more likely to communicate effectively. It is very important to be respectful and courteous and to listen to what they have to say. Always respect the views of others, especially if they have different cultural beliefs or values.Take the time to listen to others, this is not always easy when you are so busy but it is extremely important to build a positive relationship, always show that you are interested in what they have to say, they may need to confide in you.Have a good sense of humour, when appropriate this lightens peoples perception of you and can help people who are feeling stressed, laughter is a good way of relaxing.Always be clear on the reason you are communicating, giving people mixed messages does not create a good working r elationship, a good way of making sure people have received clear information is by asking them to repeat what is expected of them.Being considerate is a must as you may be working with a child or adult who is under strain due to work or home matters. If you are being considerate in that situation this will help you understand if they respond out of character and you may be able to help.Explain how different social, professional and cultural contexts may affect relationships and the way people communicateIt is important that you adapt your communication in different situations and always consider the context in which you are working. It is extremely important how we dress and present ourselves to others, if you are going into a formal meeting with managers and parents wearing jeans and trainers for example, this would not give a professional image of you or the school you work for.It is important if you say to either a child or an adult that you are going to get back to them with an answer, you do so as efficiently as you can, this also applies to how we respond to letters and messages and always make sure you check your spelling and grammar.Try to increase your knowledge of different cultures, as the way they behave or respond maybe different to you for example it is not polite to look another person in the eye when speaking to them in some cultures.Explain the skills needed to communicate with children and young peopleThere are certain skills needed and these skills must be used everyday in order to communicate effectively and to make the child/adult feel valued.Always make eye contact when a child is speaking to you, if you say you are listening but continue to write or look at something else it shows you are not really interested in what they have to say, giving your full attention shows that you are engaged and listening.Bring yourself to the level of the child this is less intimidating than towering over them. Always smile and react positively, use posit ive body language, don’t sit there with your arms tightly folded or your shoulders tense this can create tension, express your face when responding to what they have said this shows you are listening.A good way of showing that you are listening is to repeat what they have said and this can extend their communication by telling you more or you may need to comment on incorrect use of words to help them for next time.Always give a child an opportunity to speak this will help with their confidence and their need to express themselves and encourage them to ask questions, this will help them build conversation skills.Explain how to adapt communication with children and young peopleThe age of the child or young personDifferent ages require different levels of attention. You may need to use more physical contact to reassure very young children then as the children become older you can help talk through their concerns, you will always listen and react positively choosing correct vocab ulary.The context of the communicationDepending on the situation you need to be aware that you may need to change your verbal communication accordingly, always make sure the children are focused and pre-empt any distractions and get ready to deal with them with as little interruption as possible or if you are having general chit chat in the playground, use humour to respond to difficult questions such as Where do you live, What is your first name etc..Communication differencesMake yourself aware of the children with communication issues and always be sensitive to them by giving them more time so they do not feel pressured when speaking or signing. Some children can be very anxious so it is important to make them feel comfortable in the setting. It is important if a child has a stammer or speech impediment you do not speak for them, you cannot guess or assume you know what they wanted to say and this can create anger and stress. Do not be afraid of asking for additional training if y ou are working alongside children who use signing to communicate, for example – Makaton.Explain the main differences between communicating with adults and communicating with children and young peopleAlways remember that certain things stay the same such as being courteous and respectful and showing that you are interested, however, you must remember that if you are in a school setting and you are dealing with a child or young person you maintain that carer/child relationship and responsibility. You should not offer physical contact with children. Always be clear in what you say and what is expected of them and adapt your vocabulary accordingly.Explain how to adapt communication to meet different communication needs of adults.You must be sensitive when communicating with other adults, try and find out as much as you can beforehand, you may find they have communication difficulties, they maybe hearing impaired so always make sure you are facing them and speak clearly so they ca n lip read or the person may speak another language or very little English, make sure you have plans in place if required.Explain how to manage disagreements with children, young people and adultsA lot of the time disagreements are due to a lack of communication in the first instance and the best thing to do is to sort things out very carefully so the bad feelings do not persist. You must always respond with a positive attitude and polite manner and be sensitive to the other person’s feelings, if you feel the disagreement is spiralling out of control you may need to call in a mediator this being another member of staff who can maybe help sort things out, but hopefully if you are using the correct communication this should not be required unless you were somehow in a disagreement with a child, always seek advice from your line manager if this is the case.The best way to resolve disagreements is to find the cause and then decide on a course of action together. Offer encourageme nt and support.Summarise the main points of legislation and procedures covering confidentiality, data protection and the disclosure of informationData protection act 1998 – To provide a safe environment for our children we as a school are able to obtain certain information which is relevant such as, health and medical information, records from previous schools, records for children who have special educational needs. All this information is confidential. Parental consent would be required if this information was requested by another source.Every child matters (England 2003) – stresses the importance of sharing information between professionals, communication between us, is the key to help prevent tragic cases.You should not pass on information about the school or the children without being 110% certain you can, do not feel pressured to do so, always seek advice from your line manager if you are unsure.Explain the importance of reassuring children, young people and adul ts of the confidentiality of shared information and the limits of thisIt is extremely important that you communicate and explain fully your reasons for requiring the confidential information, you would make sure that you followed correct procedures and ask for consent if required, you also need to promote a professional image so people trust you to deal with the confidential information with the utmost respect that is needed. By doing this the children, young people and adults feel reassured their confidential information is handled appropriately and used effectively.Justify the kinds of situation when confidentiality protocols must be breached.If a child, young person or adult confides in you and you suspect child abuse or they are at risk or danger of someone or something never promise to keep it a secret you would have to tell the child, young person or adult that you are unable to keep it confidential for this reason and then you must tell and seek advice from your safeguarding point of contact.

Thursday, November 7, 2019

American medical care Essays

American medical care Essays American medical care Essay American medical care Essay These early immigrants survived the rough times and hard American clime every bit good as the wilderness on crude basic inherent aptitudes. The early colonies were frequently ravaged by famishment and disease. During the colonial epoch. doctors’ instruction was informal. Most were literate. but some who were raised outside of New England were non. A adult male who wanted to pattern medical specialty did non necessitate any type of enfranchisement. Most did hold a period of apprenticeship with an established doctor. but even this was non a demand. Up until the late nineteenth century. really few physicians had a college instruction. Medical installations were unofficial. Most patients were treated in their places. However. even the smallest towns had poorhouses. where destitute people could populate and have limited medical attention. The few infirmaries that opened in North America during the colonial period were opened in topographic points like Quebec and New Orleans. Public wellness was unknown in North America at this clip. Towns and metropoliss did non hold boards of wellness except during times of epidemics. Because most topographic points did non hold public H2O or sewer systems. most Americans got their H2O from pumps and used privies until good into the nineteenth century. There was no trash aggregation so the streets became a genteelness land for all types of disease. There were a few efforts to act upon public wellness. For illustration. when smallpox inoculations were developed in the eighteenth century. many little town physicians had groups of people that had to remain quarantined for a few yearss to do certain they merely developed a mild instance of variola. Remedies may hold killed more people than the diseases themselves. The populace developed a really disbelieving attitude towards regular physicians. In the early nineteenth century. the bash it yourself attitude of many Americans was popular. These people freely gave medical advice. emphasized the participant of the patient in his or her ain intervention. However. other medical treatments were available besides. Probably snake oil is best remembered. Andrew Taylor Still started the pattern of osteopathy. Osteopathy incorporated bodily uses. similar to those seen in modern chiropractics. In osteopathy. these uses affected the magnetic flow of energy in the organic structure. Osteopathy discouraged usage of medical specialties. but did non prohibit them. Another reaction against epic medical specialty was homeopathy. A university-trained German physician named Samuel Hahnemann started it. Heinemann said that physicians were giving their patients excessively much medical specialty. He believed that bantam sums of drugs should be diluted in H2O before being given to a patient and that practicians should take really thorough medical histories of each patient. Quackery was a manner to gull people into believing they were being cured while doing money from them. Quackery had even been licensed in London. but it was wholly ignored by the America authorities for 100s of old ages. Hydropathy was another particular instance. The mending power of H2O. hydrotherapy indicated the value of the remainder remedy. importance of holding like-minded people around. the utility of light exercising and the fact that adult females who wore baggy vesture by and large felt better and had fewer physical ailments than the 1s who did. Another particular instance is the full issue of faith-only healing. While empirical grounds in favour of faith-only healing is missing. anecdotal grounds suggests that some people who pray do experience self-generated lessening of certain diseases. The late nineteenth century saw major alterations in medical specialty in the United States. Medicine went from being mediaeval to integrating many elements of modern scientific discipline. The progresss in chemical science. and biological science had major impacts on medical specialty. As medical practicians began to understand that the organic structure was comprised of basic chemicals and non cryptic wits. effectual interventions for diseases and hurts were developed. As medical specialty became more scientific. physicians needed both preparation and licensing. In 1847. Dr. Nathan Davis founded the American Medical Association ( AMA ) in Philadelphia to assist make professional criterions for physicians and put minimum educational demands. Medical colleges opened up across the state. increasing demands from a few months without any college background to a figure of old ages with a college grade. However. these colleges provided an highly unpredictable degree of medical instruction. with some of them a sheepskin and others provided a to notch medical instruction. As American metropoliss exploded in size during the nineteenth century due to in-migration from Europe. public wellness became more of an issue. With many 100s of 1000s of people populating in metropoliss: highly crowded. insanitary conditions ; TB was frequently at epidemic degrees in the metropoliss. During the nineteenth century. people understood that TB was non caused by miasma. but was caused by bacteriums. Peoples with TB were sometimes sent out of the metropolis to topographic points in the state. where the cleaner air seemed to assist their recovery. It was obvious that people needed clean H2O for imbibing. and bathing. So metropoliss started monolithic cloaca undertakings to assist convey clean H2O into the metropoliss while taking effluent from the metropolis. Dead animate being remains and refuse littered the street until the late 1800s when metropoliss started sanitation crews to take the rubbish out of town and mopess to travel the waste to. Many metropoliss started dispensaries so the hapless could have intervention and medicines for low cost. With the urban population detonation. the poorhouses ( likely today’s HMO Urgent Care’ ) became even larger and harder to pull off. With new medical progresss. people needed to be in large metropoliss to have certain types of intervention. Americans began to construct infirmaries across the state in the nineteenth century. The new infirmaries were by and large cleaner than the old poorhouses.

Tuesday, November 5, 2019

Announcing Daily Writing Tips Pro

Announcing Daily Writing Tips Pro Announcing Daily Writing Tips Pro Announcing Daily Writing Tips Pro By Daniel Scocco When we launched Daily Writing Tips back in 2007, our goal was a simple one: to help people improve their writing skills. Over 2,000 articles later, we believe we have achieved that goal. Today, we are launching a new section called Daily Writing Tips Pro. Our plan is to provide more features and tools for our readers who are serious about improving their English. Below, youll find some questions and answers that explain how everything works. What features are included in Daily Writing Tips Pro? Pro subscribers will have access to: 1. full articles delivered via email seven days a week. 2. writing exercises delivered via email seven days a week. 3. exercise archives with over 100 interactive exercises on a wide range of topics. 4. writing courses with lessons delivered weekly via email. 5. an aggregator of online writing jobs, updated daily. What if I am already an email subscriber? Current email subscriptions will keep working. The only change is that instead of the full articles, you will now receive an excerpt of each article. In order to read the full article, just click on the link to our website. If you want the full articles via email, youll need a Pro subscription. What about access to the website will it change? Not at all. We will keep publishing all our articles on the website as we have always done, and accessing them will remain completely free. Will the exercises be available on the website? No. Exercises are available only to Pro subscribers. Once you become a member, youll start receiving them via email, and youll be able to log in to the members area to access the exercise archives. What is the cost of the Pro subscription? The subscription costs $9.90 per month if you decide to pay monthly, or $6.70 per month if you pay yearly. We will increase the price in the future, but if you sign up today youll be locking your subscription fee, so you wont be affected by future changes in the price. Which writing courses are included? Right now, the Freelance Writing Course is available. Registration used to cost $97, but youll get access to all the lessons as a Pro member for no additional cost. We plan to add one new course every quarter, and youll get access to those as well without paying anything extra. Can I try it free before deciding? Absolutely. When you sign up for a Pro account, the first 15 days are free. Youll need to set up a PayPal subscription, but you wont get charged a dime during the trial period. If you decide its not for you, simply email us, and well cancel your subscription on the same day. Ready to try it? Click here to get to the Daily Writing Tips Pro page, where you can read all the details and sign up. Youll even be able to test-drive some of our exercises, so check it out! Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the General category, check our popular posts, or choose a related post below:20 Computer Terms You Should KnowDeck the Halls5 Ways to Reduce Use of Prepositions

Sunday, November 3, 2019

Macroeconomics- comparing classical economic theories and keynesian Essay

Macroeconomics- comparing classical economic theories and keynesian economic theories - Essay Example ion, 1930s and General Theory of Employment, Interest & Money, published in 1936 is acknowledged as the best one of his life time efforts (Skousen, 2001). This essay makes an attempt to compare the classical economic theories and Keynesian economic theories. The essay takes a descriptive approach where economic theories of two different periods are compared and contrasted from three angles, namely beliefs, theories and policies. Firstly on the basis of beliefs-Malthus, one of the classical economists believed that, if increase in population was not enough to depress the rate of long term growth it would affect the diminishing returns. And also believed that to ensure growth the government should adopt laissez faire approach which included free trade and free markets. In addition to this, Adam Smith, the Father of Economics who introduced the notion of invisible hand supported the economic activity and led to optimum equilibrium (Stoft, 2002). They also viewed if there is disequilibrium between leakages and injections then the price would adjust to restore equilibrium. In spite of these beliefs they were not much happy in the initial periods but later they had confident with them that their approaches will lead to success in the market. But all this beliefs were strongly opposed by John Maynard Keynes in his Keynesian theory. He argued that the market will not reach to equilibrium at full employment but woul d reach at any level of unemployment. And also argued that need for government was not essential to interfere in the market to manage level of demand and it was the level of output restored the equilibrium and made the leakages and injections equal through his multiplier effect. Secondly on the basis of theories-the classical economist views that free trades and free markets should be adopted to encourage growth in the market. And the government should handle the situation if there is any imperfection that prevented free workings in the market by using supply

Friday, November 1, 2019

Personal Strengths, areas to develop more fully, 2 important Statement - 1

Strengths, areas to develop more fully, 2 important accomplishments - Personal Statement Example e grouped into four categories: social competence, problem solving, autonomy, and sense of purpose, which recent studies believed to transcend borders and cultures. Social competence or interpersonal intelligence, such as responsiveness, communication, empathy and caring, and compassion, altruism and forgiveness, is the ability to form positive relationship with others. Problem-solving skills or good intellectual functioning, which involves planning, flexibility, resourcefulness, and critical thinking and insight, is the ability to figure things out and find a solution to it. Autonomy, constituted of positive identity, internal locus of control and initiative, self-efficacy and mastery, adaptive distancing and resistance, self-awareness and mindfulness, and humor, is the ability to act independently and to take control of one’s own life. And, a sense of purpose, which includes goal direction, achievement motivation, and educational aspirations, special interest, creativity, an d imagination, optimism and hope, and faith, spirituality and sense of meaning, is the belief that one lives not only to breathe but to fulfill a mission. (13-35) Assessing my strengths based on the four categories stated above, I think I have strengths in all of them, specifically communication, planning, resourcefulness, critical thinking, self-efficacy and mastery, goal direction, and optimism. These aggregate of strengths help me reach my position today. However, there are areas that I have to develop more fully to further my success in life and to achieve satisfaction. Most of these fall on the category of sense of purpose. One of these is educational aspirations. This is so because though I am achievement motivated, I did not bother to further my studies. In fact, from being a market analyst of a multinational company, I have progressed to regional manager in a matter of six years, yet I lack post-graduate and relevant special studies as well to further my career. I think taking a

Tuesday, October 29, 2019

Financial Reporting and Analysis Essay Example | Topics and Well Written Essays - 1250 words

Financial Reporting and Analysis - Essay Example b) The Board may be required to abandon neutrality and establish standards of reporting that conceals the particular transactions impact from the users of the financial reports. These costs will, however, exist regardless whether or not FASB authorizes their recognition in financial statements. It will not alter the economics of transaction and it will only withhold information from the users of the financial reports while making informed decisions and, eventually, the credibility of financial reports is impaired. c) The SEC relies on the Board and the private sector predecessors to establish and upgrade financial accounting and the reporting standards Accounting standards are therefore, established through a due process and open deliberations system to improve and certify the Board’s mission of improving financial reporting. By developing neutral accounting standards to the best interest of the public, similar transactions should be treated similarly and different transactions treated differently. This clearly shows that standard setting is in private sector in US. d) Some accounting standards are subverted so that they can achieve their purpose which is not related to fair and accurate presentation of financial statements. They there fore fail in the purpose they serve and consequently lack economic effect since they are not of importance to decision makers on allocation of resources and making other economic decisions. a) Dividends should be disclosed in changes of equity statement and in the notes as follows. Dividends that are declared are entered in the Retained Earnings account on the credit side and credited to the dividends payable account. When paid, dividends are posted to the dividends payable account in the debit side and to the Cash account, are posted to the credit side. Notes concerning the dividends can be illustrated as follows; b) The provision for a law suit should not be disclosed because the likelihood of

Sunday, October 27, 2019

Case Study: Hypertension in Pregnancy

Case Study: Hypertension in Pregnancy Main Complaint My patient Madam Siti a 31 year old Indonesian maid Gravida 3 para 2 at 38 weeks and 1day of Period of Amenorrhoea (POA) was admitted to the ward for blood pressure stabilization and induction of labour (IOL). History of Presenting Illness She was referred from antenatal clinic during follow up in PPUKM on 29/11/2010. During the check up at the follow up, her vital sign showed she was afebrile, pulse rate of 90beats per minute and blood pressure was noted to be 160/100mmHg and no abnormality was found in the urine. During booking her blood pressure was noted to be 100/70mmHg and she was normotensive throughout the pregnancy up until at 38weeks and 1day of POA. She complained to have frontal headache and nausea 2 days prior to admission. She denied symptoms of impending eclampsia such as blurring of vision, epigastric pain and vomiting. There was also no dizziness, shortness of breath, chest pain, reduced urine frequency and leg swelling. She also had per vaginal discharge which was whitish and creamy in nature, no foul smelling and no pruritus vulvae. There was no urinary tract infection symptoms such as urgency and dysuria. Fetal movement was good. She was admitted to the ward for further management. Antenatal History This is an unplanned but wanted pregnancy. Her urine pregnancy test (UPT) was positive at 6weeks of POA. Dating scan done at 15weeks of POA which correspond to date. Booking was done at 15weeks of POA at private clinic at Medviron. Antenatal screening done showed that: Blood Pressure : 110/70mmHg Haemoglobin level : 12.8g/dL Height : 158cm Weight : Pre : 62kg Current : 69kg Blood Group : O Positive VDRL/HIV/HEP B : Non Reactive Urine Albumin/Sugar : Nil No MGTT was done. Despite having a family history of diabetes mellitus. Latest scan done at 38 weeks and 1day POA and all parameters are correspond to date. It was a singleton fetus on longitudinal lie and cephalic presentation. Fetal heart and fetal movement are seen. Amniotic Fluid Index are 11. Estimated fetal weight was 3.3kg and placenta was on anterior upper segment. Otherwise, antenatal visits are uneventful. Past Obstetric History On 1999, she had a full term normal pregnancy and delivered a baby girl by Spontaneous Vaginal Delivery (SVD) at a hospital in Indonesia and weight of the baby was 2.6kg and is alive and well. On 2007, she also had a full term normal pregnancy and delivered a baby boy by spontaneous vaginal delivery also at Indonesia. The baby weight 2.3kg and currently is alive and well. Both of her children stays with her mother at Indonesia. Past Gynaecology History She attained her menarche at the age of 13year old with 28 to 30days regular cycle with 7days of menses. She denied dysmenorrhoea, menorrhagia, intermenstrual bleeding, dyspareunia and postcoital bleeding. As for contraception, she uses Implanon for 4years from 2002 to 2006 between the first and the second pregnancy. She was then on Oral Contraceptive Pills for 2months and had stop taking them afterward until today. After this pregnancy, she is keen to take Intrauterine Contraceptive Device (IUCD). She had never had pap smear done before. Past Medical History Nil. Past Surgical History Nil. Allergy and Drug History No known drug allergy or food allergy. Family History Her mother is alive and was diagnosed to have diabetes mellitus and hypertension and currently on medication. Her father died on 2007 due to renal failure. She had 3siblings and currently all of them are alive and well. Social History She has been married for 12years and came to Malaysia on 2006 which was 4years ago. She lives in a terrace house at Cheras and worked as a maid. Her husband came to Malaysia 5years ago but had recently go back to Indonesia 2months ago. He previously worked as a contractor for the same employer. He planned to return to Malaysia after his permit is renewed. Both of them does not smoke or consumed alcohol. Both of their children were in Indonesia and are taken care by her mother. Relevant Clinical Examination General On examination, she was alert, conscious and she was not pale or jaundiced. Her Blood Pressure was 142/92mmHg lying and 152/104mmHg standing. Her pulse rate was 90beats per minute and respiratory rate was 20breath per minute. She was afebrile. Her current weight was 69kg. There was no pedal oedema noted. Thyroid Gland There was no scar, lump or dilated veins noted around the area of the neck. There was no lymphadenopathy noted. Breast On inspection, both breast were symmetrical and bilaterally in size. Both her nipple were not hyperpigmented or retracted. There was no nipple discharge. Her breast were non tender and no mass was palpable. Cardiovascular System On inspection of the hand, there was no clubbing and peripheral cyanosis. Inspection of the mouth showed that there was no central cyanosis and hydration status was good. There was no surgical scar and no notable abnormalities detected on the praecordium. Jugular Venous Pressure was not raised. Peripheral pulses were present with normal rhythm and good volume. There was no radio-radial delay or radio femoral delay. There was no collapsing pulse. On palpation, apex beat was not displaced it was palpable at the 5th intercostals space and left midclavicular line. There was no parasternal heave and thrills detected. On auscultation, the first and second heart sounds were heard with no murmur or added sound heard. Respiratory System On inspection, the chest moved bilateral symmetrically with inspiration. There was no scars and deformities noted. She did not use accessory muscles on breathing. On palpation, her trachea was not deviated. Chest expansion was equal bilaterally. Air entry was good and equal bilaterally as evidenced by normal vocal fremitus and vocal resonance. Percussion of both lungs were resonant. There were vesical breath sounds equal on both sides with no added sounds on auscultation. Neurological System She was orientated to time, place, and person. All cranial nerves were intact. Both her upper and lower limbs were normal. Muscle tones, power, and reflexes were all good and normal. Abdominal Examination On inspection, the abdomen was distended by gravid uterus as evidenced by cutaneous signs of pregnancy such as linea nigra and striae gravidarum. The umbilicus is centrally located and flat. No scars noted and no dilated veins seen. On palpation, her abdomen was soft and non tender and uterus was not irritable. Clinical fundal height revealed that the uterus was 38weeks in size and was correspond to date. Symphysiofundal height was 37cm. Palpation of the fetus showed that it was a singleton in longitudinal lie with cephalic presentation. The head was 3/5 palpable and not engaged. The fetal back was on the maternal left side. The liquor was adequate and estimated fetal weight was 3.2 to 3.4kg. Pelvic Examination Vaginal examination was not done. Per Rectal Examination Per rectal examination was not done. Summary of Case 31year old maid gravida3 para2 at 38weeks and 1day POA admitted for blood pressure stabilization and induction of labour (IOL) due to gestational hypertention. Diagnosis and Differential Diagnosis Provisional Diagnosis Gestational Hypertension: She develop hypertension which is a blood pressure of 140/90mmHg aand above recorded on 2 separate occasions at least 4hours apart. Hypertension occur in second half of pregnancy which is after 20weeks of gestation. She is previously normotensive. There is absence of proteinuria She had risk factor; family history of hypertension. Differential Diagnosis Pre-eclampsia: Points for: Hypertension at least 140/90mmHg recorded on 2 separate occasions at least 4hours apart. Hypertension occur at second half of pregnancy, after 20weeks gestation. She is previously normotensive. She had risk factor; family history of hypertension. Points against: There was absence of proteinuria of at least 300mg Protein in a 24hour collection of urine. She had no risk factor such as pre-existing hypertension or pre-eclampsia. Chronic Hypertension: Points for: She has a family history of hypertension. Points against: She is normotensive prior to pregnancy. She had no other disease such as renal or connective tissue disorders that can lead to hypertension. Relevant Investigations with Reasons Full Blood Count To check whether patient is anaemic or not (Hb). To confirm patient is not on any infection such as urinary tract infection (WBC). White Cell Count + 14.2 x 109/L Red Cell Count 4.18 x 1012/L Haemoglobin 12.3 g/dL MCV 37.1% MCH 88.7 Fl MCHC 29.3 Pg RDW 33.0 g/dL Mean Platelet Volume 8.0 Fl Platelet 302 x 109 /L Neutrophils ++ 10.3 x 109 /L Eosinophils 0.4 x 109 /L Basophils 0.0 x 109 /L Lymphocytes 2.6 x 109 /L Monocytes 0.9 x 109 /L Nucleated RBC 0 x 109 /L Comment: There is a reduction of Red Cell count. This is due to pregnancy, as there is haemodilutional effect due to an increase in plasma volume. Patient is not anaemic as haemoglobin is on the normal range. However, there is leukocytosis mainly the neutrophils. This suggest an infection most likely bacterial in origin such as urinary tract infection. Renal profle To exclude secondary cause of hypertension due to renal damage. To detect abnormality in the level of serum urea and creatinine that will indicate renal damage or failure. Sodium 139 mmol/L Potassium 4.0 mmol/L Urea 2.3 mmol/L Creatinine 54 umol/L Comment: There is hypouremia. This is normal in pregnancy, as there will be an increase in Glomerular Filtration Rate (GFR), therefore there will an increase in clearence of urea in the body. Besides that, a reduction in deamination process in the maternal body will also cause blood urea to be reduce. Liver Function Test To see whether patient had any liver damage Albumin 33 g/L Total Protein 68g/L Bilirubin toral 6 umol/L ALT 19 u/L ALP + 141 u/L Comment: There is hypoalbuminaemia. There is increase level of Alkaline Phosphatase (ALP) due to placenta production. Thus, making it a normal physiological reaction. Serum Uric Acid Serum uric acid is a sensitive indicator of renal damage in pre-eclampsia. Uric Acid 371 umol/L Comment: Serum uric acid level is normal. Suggesting there is no renal damage. PE/ Pre-eclampsia Chart To monitor her blood pressure on lying and standing To monitor her urine whether there is albuminuria or not. To detect pre-eclampsia. Result: Other than the increase in blood pressure prior to delivery, there is no albuminuria noted. Therefore, patient did not have pre-eclampsia. Fetal Kick Chart To monitor the fetal well being. If there is decreased fetal activity, it may indicate some degree of fetal compromise. Cardiotocography (CTG) To monitor the heart rate and contraction of the uterus to detect abnormalities in the pregnancy. Ultrasound. To assess the fetal growth. Identify The Problem in Terms of Priority Gestational Hypertension. Induction of labour in gestational hypertension. Immediate and Subsequent Management Admit to ward for BP monitoring and stabilization. Monitor for any signs and symptoms of impending eclampsia. Bed rest. BP monitoring 2hourly for 24hours. If blood pressure reduce or return to normal patient can be discharge and to come again for antenatal follow up. Bed rest continued if persistent. Antihypertensive medication given if BP consistently noted to be 150/100mmHg. Preferred agent are alpha and beta blockers agent such as labetolol or methyldopa. Pre-eclampsia chart to exclude pre-eclampsia. CTG and fetal kick chart monitoring. Gestational hypertension not resolve, induction of labour is recommended. If induction of labour fails or spontaneous delivery is not possible, prepare for lower segment caesarean section (LSCS). Final Conclusion/ Plan for Further Management/ Patient Progress On admission on 29 November 2010, her blood pressure (BP) was high which was 142/92mmHg lying and 152/104mmHg standing. She was then given 200mg labetolol TDS. Pre-eclampsia chart done to monitor albumin in the urine. She is also monitored on signs and symptoms of impending eclampsia. Her BP was monitored half hourly for 2hour and induction of labour (IOL) is done soon after BP is stabilize. On the next day , 7.15am, Bishops Score was done and result was 2/13. Therefore cervix was not favourable. First 3mg of Prostin tablet was inserted into the posterior fornix. CTG was then done after 1hour to monitor for uterine hyperstimulation of fetal distress. The abdomen and cervix will be reassess in 6hours time. Tablet labetolol was continued and signs and symptoms of impending eclampsia (IE) was monitored. Six hour later, patient had contraction (irregular) but no leaking liquor noted. There was no signs and symptoms of IE, per vaginal discharge and fetal movement was good. Her BP was 129/92mmHg which had decreased slightly. On palpation, her abdomen was soft and non tender. Uterus was 38weeks, presenting part was 3/5 palpable. Bishops Score was done again and cervix is still unfavourable at 3/13. Second prostin was inserted at the posterior fornix. CTG was done 1hour post prostin for monitoring. Six hour later, she had 2 contraction in 10 minutes and it was moderate. There was no leaking, no per vaginal bleeding and the fetal movement was good. Her BP on lying was 112/86mmHg and 122/90mmHg on standing, well controlled BP. Vaginal examination revealed normal vulvovaginal, cervix dilated to 1cm, os was 3cm membrane intact and station was -2. 2hour later, the contraction was 3 in 10minutes and no leaking liquor. Vaginal examination showed 1cm cervix, 4cm os. Artificial Rupture of Membrane (ARM) was done. Clear liquor was noted. Patient was in active phase of labour and was sent to the labour room for delivery. Entonox was given for pain management in the labour room. Contraction was 3 in 10 minutes with moderate intensity and os was 4cm. one and a half hour later, patient complained of having strong contraction and felt the urge to bear down. Vaginal examination done and os was fully dilated at 10cm. She delivered a baby boy weighing 2.53kg with apgar score of 8 in 1minute and 9 in 5minutes. The patient developed first degree tear, placenta was complete weighing 590gm. Estimated blood loss is 250cc. Cord pH was 7.312. In the ward, day 1 post SVD she was alert, conscious, comfortable and was not pale. Her BP was 118/83mmHg which was normal and her pulse rate was 96beats per minute. She was afebrile. Abdominal examination showed that her abdomen soft and non tender. The uterus was well contracted at 18weeks in size. The lochia was normal. Breastfeeding was established and she was ambulating well. The patient can tolerate orally and had pass urine and bowel movement. She had completed her family size and plans to use intrauterine contraceptive device (IUCD) for contraception. Prescription of labetolol was stopped as her BP has been stable and she had delivered her baby. She was then allowed for discharge and to come again 2weeks later to review her BP. She was given hematinics to increase haemoglobin level. Discharge Summary Name : Siti Arifah Age : 31 MRN : N285492 Race : Indonesian Gender : Female Discharge Date: 01/12/2010 Case Summary Date of admission : 29/11/2010 Date of delivery : 30/11.2010 at 22:35 Date of Discharge ; 01/12/2010 31year old, para 3 @38weeks and 4days of POA, post spontaneous vaginal delivery (SVD) with first degree tear diagnosed with gestational hypertension @ 38weeks. Antenatally, Dated at 15weeks. Antenatal clinic uneventful. Booking blood pressure (BP) 100/70mmHg. Has been normotensive throughout pregnancy (BP range 110-120/70-80mmHg) until on 38weeks, noted that BP at clinic 160/100mmHg. Tablet labetolol 200mg given stat at the clinic. Admitted to ward for BP stabilization and started on tablet labetolol 200mg TDS. Medical/surgical History Nil. VDRL/HIV/Hep B Non reactive. Admitted in for BP stabilization. Before admit and in the ward, patient complaint of headache. On day 2 of admission, cardiotocograph (CTG) showed sleeping pattern. Opted for induction of labour (IOL). Prostin inserted 2 times. After 7hours of second prostin insertion, patient went into active phase of labour, os 4cm. Artificial Rupture of Membrane (ARM) was done with clear liquor. Os fully after 1 hour 30minutes without augmentation. Second stage 10 minutes. Third stage 13minutes. She successfully delivered a baby boy of: Weight : 2.73kg pH : 7.312 TSH : pending G6PD : normal Estimated Blood Loss (EBL) : 250cc Currently she is normotensive. There is no acute complaints. No signs and symptoms to suggest of anaemia. She is tolerating orally and ambulating well. Passing urine/bowel open without problems and there is no excessive bleeding. Her baby is well and active, suckling well. BCG/Hepatitis 1st dose has been given. On examination, Her vital signs are stable. She is pink and alert. Abdomen soft and non tender. Uterus well contracted and 18weeks in size. There is no excessive bleeding. Lochia is normal. Mother Haemoglobin: 12.3g/dL Contraception: Intrauterine contraceptive device (IUCD) Plan; Off labetolol EOD BP at local clinic To come again (TCA) in 2weeks to review BP. Continue Haematinics. Medications Tablet Hematinics OD Tablet Gelusil Ponstan TDS Syrup lactulose 15mls TDS Diagnosis: Post- SVD with first degree tear. Prepared by, Connie (CONNIE KABINCONG) House Officer Obstetric and Gynaecology ward UKMMC Referral to Doctor For Continued Management To: Medical officer of Obstetric and Gynaecology Department Date: 01 December 2010 Dear Doctor, Regarding: Siti Arifah, N285492 Thank you for seeing this patient, Siti Arifah, a 31year old Indonesian maid, para 3 post spontaneous vaginal delivery (SVD) with first degree tear at 38weeks and 2days of period of amenorrhoea (POA). She was admitted for blood pressure stabilization and induction of labour. She was referred from antenatal clinic when it was noted that her blood pressure was high which was 160/100mmHg. She never had history of hypertension before until on 38weeks and 1day of POA. However, she had a family history of hypertension. She was given labetolol for blood pressure stabilization and was given tablet Prostin 2times to induce the labour. She was then delivered a baby boy by SVD and her baby was alive and well. Her blood pressure was 118/83mmHg after the delivery. She was then stopped on taking Labetolol. Kindly see this patient for blood pressure monitoring and to exclude pre-existing hypertension in this patient. Thank you. Regards, Connie (CONNIE KABINCONG) House Officer Obstetric and Gynaecology Ward UKMMC Mock Prescription: For Patient on Discharge Name : Siti Arifah Age : 31 MRN : N285492 Race : Indonesian Gender : Female Discharge Date: 01/12/2010 Tablet Haematinics OD Tablet Gelusil/Ponstan TDS Syrup Lactulose 15mls TDS By, Connie (CONNIE KABINCONG) House Officer Obstetric and Gynaecology Ward UKMMC Professionalism Component Communication Issues As communication will be crucial in our future career as a doctor, a good basic has to be established now. As a good communicator we must be able to convey our message and information to our patient either in the form of words or from plain body language. Fortunately, my patient Madam Siti was very cooperative. I was able to establish rapport with her rather rapidly. She became more comfortable while answering my questions. Management wise, I found that she was well assured and well informed about what was being done for her. The doctor in charged informed her about her condition and told her about the possible complication that may arise and enough reassurance was given. Psychosocially, she did admits that she was a little scared of the possible complication that might affect she and the baby. Furthermore, her husband was not able to be by her side for moral support. I spent some times consoling her and she felt better afterward. Financially speaking, she and her husband total household income is currently not sufficient as she only earn approximately RM1000 per month and her husband is currently unemployed and waiting for his permit to return to work to Malaysia. However she claimed that her employer are offering to help her out during her confinement period. Spiritual Issues She is a very religious woman and has a strong spiritual side. She believe that God will helped her through this challenge and it had made her become quite cheerful and optimist despite of her current state. Ethical Issues As medical student, we have been reminded from time to time that medical ethics are crucial in order to be good doctors in the future. A good doctor should always put the patients life at the highest priority and respect the patients right to autonomy, information and privacy. Madam Siti should be counseled on options, pros and cons of the choices and the choice that made by her with guidance and advice by the doctor. No information should be withheld from her. Ethically as patient they also entitled to their privacy and confidentiality. Unfortunately, in a teaching hospital such as HUKM, patients privacy is sometimes compromised. Madam Siti was continuously approached by the students who wished to clerk her although it is very tiring to repeat all the words again and again, she still can tolerate it. Unfortunately there isnt much things I can do to help her but I can learn from this by learning not to disturb patient during the visiting hours or when they are tired while still grabbing every opportunity to learn in the ward. Professional Judgement In managing obstetric patient, we must take into account that we are not only dealing with one life but two. Thus extra caution must be taken. Especially with Madam Siti condition, as hypertension in pregnancy if it is not well controlled and monitored it could easily turns into something terrible very quickly. I felt that the management of Madam Siti was fair, she was properly counseled on maternal and fetal complication that could arise from hypertension in pregnancy. She was also well informed on the results of all the investigation done on her and her current management. Critical Appraisal Hypertension in pregnancy is defined as Blood Pressure more than or equal to 140/90mmHg in previously normotensive women that occur in 20th week of gestation without proteinuria until 6weeks postpartum. Or alternatively, a rise in systolic BP of more than 25mmHg or diastolic BP of more than 15mmHg compared with booking BP. Hypertension in pregnancy caused an increase in maternal and perinatal morbidity and mortality. Normal BP usually never went beyond 120/80mmHg. However in pregnancy plasma volume increases on an average 1200ml. So vasodilatation is needed to maintain the peripheral pressure. If the vasodilatation action is counteract by arterial spasm, hypertension occurs and lead to reduction in perfusion to all organ. This includes the uterus and placental site. Hypertension in pregnancy can be divided to pre-eclampsia, gestational hypertension, chronic hypertention, pre-eclampsia superimposed of chronic hypertension. Pre-eclampsia is defined as hypertension of at least 140/90mmHg recorded on 2 separate occasions with the significant proteinuria of more than 300mg in 24hours urine collection after 20weeks of gestation in a previously normotensive women and resolve completely by 6weeks postpartum. Eclampsia is a serious complication and life threathening complication of pre-eclampsia. It is defined as convulsions occurs in a woman with pre-established pre-eclampsia in the absence of any neurological or metabolic cause. Chronic hypertension is caused either due to essential hypertension or secondary hypertension. Secondary causes include renal artery Stenosis, glomerulonephritis, cushing syndrome and pheochromocytoma. Chronic hypertension is a hypertension diagnosed prior to 20weeks of gestation or history of hypertension preconception and de novo hypertension in late gestation that fails to resolve postpartumly. Pre-eclampsia superimposed on chronic hypertension is diagnosed when there is: De novo proteinuria after 20week gestation Sudden increase in magnitude of hypertension Appearance of features of pre-eclampsia-eclampsia Sudden increase in proteinuria in women with preexisting proteinuria in early gestation in women with chronic hypertension. Risk factors for women to develop hypertension in pregnancy can be divided into obstetric, medicaland social aetiology. In obstetric aetiology, the risk factor can be further divided into maternal and fetal risk factor where: Maternal risk factors are: Nulliparity or primigravida Advanced maternal age or extreme age (35year old) Family history of hypertension, pregnancy induced hypertension, pre-eclampsia and eclampsia. Previous history of gestational hypertension, pre-eclampsia, eclampsia. Maternal obesity (>80kg) Fetal risk factors are: Multiple pregnancy Molar pregnancy Hydrops fetalis From medical aetiology the risk factors are: Diabetes mellitus or gestational diabetes mellitus Established hypertension Connective tissue disease Renal disease: glomerulonephritis, renal artery Stenosis Endocrine disease: cushings syndrome, pheochromocytoma. From social aetiology the risk factors are: Smoking Alcohol consumption Complication that can arise from hypertension in pregnancy are eclampsia, intrauterine growth restriction, renal failure, thrombocytopenia, abruption placenta, subcapsular haemrrhage and liver dysfunction. Treatment wise, patient need to be admitted to hospital first fo r BP monitoring and stabilization. Used of antihypertensive agents that may be used in hypertension in pregnancy is Labetolol, which is a combined alpha and beta blocker. By blocking alpha adrenoreceptor in the peripheral arteries, it reduced the peripheral resistance. At the same time beta blocking effect protects the heart from reflex sympathetic drive normally induced by peripheral vasodilatation. Nifedipine, a calcium channel blocker can be use as an alternative. Delivery is the ultimate treatment of hypertensive in pregnancy and its timing is dependent on the observation of fetal and maternal well being. Prolongation of pregnancy by drug therapy may reduce the risk of prematurity and improves the chances of delivery. Reference Lists Obstetrics By Ten Teachers, 18th edition; Philip N. Baker. Obstetrics Illustrated, 7th edition; Kevin P. Hanetty, Ian Ramsden, Robin Callander. Handbook of Labour Practice, 2nd edition; Dr. Yun-Hsuen Lim, Professor Dr Muhammad Abdul Jamil, and Professor Dr. Zaleha Abdullah Mahdy. A Practical Approach to Obstatric Problems for the Undergraduate, 4th edition; Professor Kulenthran Arumugam.