The Story of an Hour by Kate Chopin Essay Example | Topics and Well Written Essays - 750 words

The Story of an Hour by Kate Chopin - Essay Example The same is the case with the marital-knot that also implements restrictions on spouses by determining their rights and obligations towards one another. Though apparently the individuals feel rejoice on entering into matrimonial relationship, by taking it as the sign and symbol of complement, harmonizing and completeness; yet unconsciously they look for revolting against the limitations had been imposed upon them in the name of love and marriage. The same is the case with Louise, the protagonist of the story under analysis by Chopin. Being the torch-bearer of feminist rights, renowned fiction-writer Kate Chopin has pointed out towards the drawbacks and constraints the woman folk has to undergo in the sacred name of home and marriage. Apparently, women are bestowed upon with financial support, protection, comforts and sexual gratification, after getting married, according to the prevailing socio-religious norms, yet in reality, they are confined within the boundaries described and det ermined by their husbands for the exercising of their talent, abilities and activities at large. There is no doubt in the very fact that they have developed emotional and sentimental bonds with their husbands, yet quite unconsciously they feel the suppression of their freedom inflicted by the males upon them. The same is the theme of the story, where the protagonist Mrs. Louise Mallard, the young lady as well as patient of depression and heart disease, bursts into tears as soon as her sister Josephine and her husband’s friend Richards mildly and indirectly break the news of her husband’s death in rail-road accident. She falls in Josephine’s arms, which throw light on her fear of being unprotected after the death of her sheltering tree i.e. Brently Mallard. (788). Hence, the author has supported the very idea that the male members of family (including fathers, husbands and brothers) are source of security, and an unseen sense of protection is attributed to them i n respect of their women. Even Louise is aggrieved on hearing the news about her husband’s death, yet she seeks sigh of relief while she is alone in her room. She opens windows and enjoys with the natural and social panorama outside the window pane. It looks that unbolting of window has wide opened new horizons of merriment, opportunities, successes and tranquility for her. (789). Even the street hawker’s voice appears to be pleasant and enjoyable to her. Chirping of birds, blowing breeze, swaying leaves and freely moving humans and other living creatures—all communicate one and the same message of liberty and independence to Louise. Thus, her sub-conscious pricks her mind that the marital-knot had tied her with the strings that were dependent of her husband for the slightest movement even. It is therefore, the depressing and painful death news gives her the message of release from the marriage prison. Louise is so absorbed in the imagination of liberty, which s he fantasizes in its full swing that she does not allow any external interference that could put her imagination in jeopardy even for the time being. It is therefore she turns the deaf ear to the Josephine’s appeals she makes to her for unlocking the door of her room. (790). By this she simply means the break the ray of sorrow Louise has been experiencing. However, it is not the case altogether, as Louise appears to be longing for a tranquil life for the future days to come. It is therefore on finding Brently alive, she cannot resist the

Macbeths Letter Essay Example for Free

Macbeths Letter Essay I am writing to you as I know that you will keep the contents of this letter a secret. The last few days have been very strange and unreal to me. I cannot believe how much my life has changed in such a short space of time. I ask you to please destroy this letter once you have read it and not tell a soul about what it contains as I have committed a terrible crime. A couple of days ago I was a noble warrior fighting against Norway and now Im king of Scotland. With my brandishd steel I approached the leader of the Norwegians, Macdonald, and unseamd him from the nave to thchaps and fixd his head on our battlements to show everyone he was dead. Norway were defeated. After the battle, Banquo and I walked along the moors and we came across three weird sisters that looked nothing I had ever seen on this earth. They greeted me by saying All hail Macbeth, hail to thee Thane of Glamis, All hail Macbeth, hail to thee Thane of Cawdor, All hail Macbeth that shalt be king hereafter. At this greeting I was rather shocked and confused. True I was Thane of Glamis but Thane of Cawdor and king? The Thane of Cawdor lived and as was the king. I was puzzled. Were these prophecies real? Whilst I was lost in my thoughts, Banquo asked them to predict something for him as they had for me. They told him that his children shall be kings but he will not be king himself. I ordered them to stay and tell me more but they were unwilling to be ordered by me and vanished into thin air. I do not think Banquo believed his prophecies as much as I did mine. We carried on walking and talked about the witches. Then we saw two men coming towards us. They said that the king had sent them because he had heard of my success in battle. One of the men said the king bade him to call me Thane of Cawdor! I asked him why he was dressing me in borrowd robes. He explained to me that the old thane of Cawdor was a traitor and would be executed. I could not help thinking that the greatest was behind. I then thought a terrible thought. Murdering king Duncan to become king. I pushed the thought out of my head and told myself if chance will have me king, why chance may crown me without my stir. I did not have to get involved in order to become king. We made our way to the kings headquarters and king Duncan told me how grateful he was for what I had done in battle. I told him it was an honour to fight for him and I felt it was my duty to him. He then made a startling announcement. His eldest son Malcolm was named the Prince of Cumberland! I could not help feeling angry on hearing this. Malcolm stood in my way of becoming king. I felt as though I was not in control of my feelings. One minute I was loyal and the next I had these evil thoughts. They disturbed me but I could not stop them. I pleaded, stars hold your fires, let not light see my black and deep desires. I did not want anyone to see these terrible thoughts I had. Duncan said that he was to stay at my castle that night so I left at once to inform my wife of his arrival. I sent a letter on to Lady Macbeth to inform her of the meeting with the witches, their prophecies and my becoming Thane of Cawdor. I know she thinks that I cannot act on my ambitions and that I am too kind to act on the information that the witches gave to me. When I arrived I told her I told her about Duncan coming to stay. She encouraged the idea of murdering him. She told me to look like thinnocent flower but be the serpent undert. I was to look innocent but be ready to strike. I felt she was taking control of this situation. She overpowered me. I was not allowed to speak. I told her I needed to think about it but she did not listen and told me to leave all the rest to her. When Duncan arrived, Lady Macbeth greeted him as my mind was too full with other thoughts. I know she showed gratitude towards him and showed fake loyalty. I could not have been false to his face. I left the feast to be alone. I thought that if I were to murder Duncan it would be best to do it quickly. But how I hoped it would be the end of it without any consequences because I knew that with murder would come horrible consequences. I was confused as to what I should do. I was his subject. I looked up to him as king. I was his host. I should be protecting him not murdering him. I thought Duncan is no enemy of mine. He is my king. He has been a good king so far. If he was to be murdered then everyone would be horrified and there would be a wild protest. Everyone would be looking for the murderer. The only thing I had to make me murder him was my ambition and that alone is not alone. Lady Macbeth came to me and I told her we would proceed no further in this business. She called me a coward and said that if I told her to kill her child then she would do so. She had managed to change my mind. If we should fail? I asked her. She told me we would not fail and that Duncan would sleep easily after his long journey. She then said that she would convince his two guards to have some wine. They would be unaware of what is happening. Then when Duncan was dead we would smear blood on their limbs and let them bear the guilt of our great quell. At that moment I could not help admiring Lady Macbeth. I told her she should only have male children for she has great strength and courage. She told me that no one would suspect us because we would be distraught with sadness at the news of his death. My mind was made up. I told her that every bit of me was going to work at this murder. Part of me wanted to show I could do this and that I was not a coward. I was walking around the castle later that night when I came across Banquo and his son. Banquo told me he dreamt of the witches and how their prophecies had come true for me. I lied to him and told him that I did not think of them. I had to lie as I was about to kill the king. After Banquo left I saw in front of me a dagger. It looked as real as the one I had in my belt. It was pointing towards Duncans chamber. I saw blood on the dagger that was not on there before. My disturbed mind was showing me things that were not there. Suddenly a bell rang and I made my way towards Duncans chamber. When I returned to my wife from Duncans chamber I heard her say that she would have murdered him herself if he did not remind her of her father. I was anxious. I looked at my hands. It was a sorry sight. Lady Macbeth tried to get me to snap out of it. I told her that as I came out of the chamber I had heard someone saying their prayers in their room and how I could not even bring myself to utter the word amen. I felt cursed. She told me I should not think about it. I could not help thinking that it was the end of me. My wife warned me that to dwell on these things would make me mad. I felt mad at that moment. I had lost all control. I had murdered sleep. I did not think I would ever be able to sleep again. My wife told me to go and wash my hands. It was then that she noticed I still had the daggers. She ordered me to go and put them back. I told her I would not go back into that room. I was frightened. I couldnt find any ounce of bravery within me. I could not face going in there again. She was disgusted with me and told me I was acting like a child. She told me to leave it all to her. She took control once again. She returned the daggers and smeared the guards with Duncans blood. I became jumpy. I looked down at my hands again. I believed that I had so much blood on them that it could change the whole sea red if I were to put them in it. I felt a sense of disgust as I stared down at the blood. Lady Macbeth returned from the chamber and her hands too were covered in blood. She called me a coward. She seemed so certain that a little water would clear us of this deed. I was not so sure. I did not feel like myself anymore. I did not feel like the noble warrior I once was. I heard knocking and wished that it would wake Duncan up and rewind this whole tragedy. Now I am king. I will not bore you with how it all happened. I fear that people will suspect me. I think Mcduff already does. I fear that I will have to kill again to ensure that Lady Macbeth and myself are not found out. I only hope you will be able to forgive the terrible sins I have committed.

Rise and fall of rome :: essays research papers

The divergence of local culture is apt to occur. With this enculturation a new language or dialect of language often is born. This paper will discuss the factors which cause language to change. It will focus on the development of â€Å"New-Englishes†. What are â€Å"New-Englishes†? They develop from areas, which have been in contact with an English-speaking colony the process involves five main steps Foundation, Exonormative Stabilization, Nativization, Endonormative Stabilization, and finally differentiation. Foundation is the first stage, this involves a group of English speaking settlers who create an English speaking base in an area where English is not a spoken language. The settlers previous accents and dialects play an enormous role in how the indigenous people learn English. As the settlers often have different dialects of English themselves, the most universal words and phrases of all the dialects are often included in the â€Å"New-English’s† vocabulary where as the regionalisms of each English dialect will often be dropped. This stage is often awkward for both the parties involved as cross-cultural understanding is often minimal and communication is limited to a few. Thus communication between the indigenous people and the settlers is inhibited. Often with military installations no attempt is made to learn the native language and the emerging dialect is mainly based on the English language. This is not the case with examples like trading posts or Linguistic Anthropologists who attempt to learn the native language to facilitate trade or research. The â€Å"New-Englishes† that emerges from these would contain a solid base fro m both Native and English languages. During this period the native language affects the English spoken, often the first words frequently used of the Native language are place names such as in the United States with Chattahoochee, Mississippi, Milwaukee, Susquehanna, Chicago, Tallahassee, all these are of Native American origin.   Ã‚  Ã‚  Ã‚  Ã‚  The second stage is where an abrupt change occurs the indigenous people realize that it is beneficial to be able to communicate with the settlers. The settlers generally do not attempt to learn the local dialect, as they often believe that they are doing a deed for their country of origin and that once they return their language will again be the norm. This is theorized for both settlers who plan to stay in the foreign country and those who will return after a period of time. The indigenous language begins to work it’s way into the English language as mentioned earlier through place names but also through new species of animals, plants, and new objects.

Regulatory Risks Essay

Risks are inherent to all business organizations. Risk management often considers several areas of practice and is an absolute necessity, not merely an option. The author will discuss regulatory risks for organizations, and explain how they can be identified and managed. Risk management requires considering and weighing risks and implementing procedures to monitor and moderate them. Risk Identification Overview Legislative and executive branches of the United States government have enacted laws that regulate all businesses.  Thousands of administrative agencies are authorized by Congress to administer and enforce statutes by regulating businesses. Administrative agencies are typically given executive power to investigate and prosecute potential infringement of statutes, administrative rules, and administrative orders (Cheeseman, 2010). Intentional Torts, Negligence, and Liability While no organization’s risks are identical to another’s, several can be identified and applied to organizations in general. There are three categories of â€Å"wrong:† intentional torts, unintentional torts, and strict liability. Intentional tort. This category of â€Å"wrong† requires that intent was present when harm was caused. Examples of intentional torts are assault, battery, and false imprisonment. The law safeguards individuals from uninvited touching, restraint, and any other contact (Cheeseman, 2010). Unintentional tort. Negligence is the â€Å"omission to do something which is a reasonable man would do, or doing something which a prudent and reasonable man would not do† (Cheeseman, 2010, p. 80). For a legitimate negligence lawsuit, several elements of negligence must be present: duty of care, reached duty, injury, act was the actual cause of injuries, and the negligent act was the legal cause of the injuries. Strict liability. Even if an individual was not negligent and had no intent, he can still be held legally liable for injuries caused by certain activities. Strict liability imposes legal responsibility for injuries sustained in the following: product liability, ultra-hazardous activities, animal care, and some statutory offenses (Butera, Beausang, Cohen, & Brennan, 2011). Disclosure of Agency Actions To prevent public perception of secrecy, Congress has allowed statutes to promote public disclosure of federal administrative agency actions, while at the same time protecting companies from overly public administrative agency actions. These statutes are the Freedom of Information Act, the Government in the Sunshine Act, the Equal Access to Justice Act, and the Privacy Act. Freedom of information act. This federal law allocates for full or limited disclosure of formerly unreleased information and documents. This law guarantee public access to government records and holds a presumption of disclosure. However, there are nine exemptions of the act. Government in the sunshine act. This law allows closed or partially closed advisory committee meetings. Closed or partially closed to the public are discussions of classified information, reviews of proprietary data, and deliberations that consider personnel privacy. Equal Access to Justice Act. A party who is subject to an action of an unjustified administrative agency can sue to recover attorney’s costs and other fees (Cornell University Law School, n. d. ). Privacy Act.  This act safe-keep records that ca be recovered from a system of records by personal identifiers like name or social security number. An individual can have access to his records and request correction if they are incomplete or inaccurate (Social Security Administration, 2011). Risk Management The Industrial Revolution caused substantial environmental pollution of solid and toxic wastes into the land and water. Companies such as Alumina, Inc. , were not efficient in voluntary pollution control, so the government took on its regulation and control (Cheeseman, 2010). Awareness of and compliance to these regulatory statutes may be the best risk management strategy available to companies who are at potential risk. Risk assessment and compliance are managed in together with one another. Compliance management includes three interrelated perspectives: preventive, detective, and corrective procedures. 80% of organizations report improvements from expanding their compliance regimens (BPM Forum, 2006). Preventive The easiest, most fiscally sound, fastest way to solve a problem is to prevent the problem in the first place. The best risk preventive practice for agencies such as Alumina, Inc is regulatory compliance. The government places a high level of importance on the preservation of the environment and has stringent means of enforcing compliance to environmental regulation. The best approach for achieving compliance, thus minimizing regulatory risk, is to have a preventative focus. Congress created the Environmental Protection Agency in 1970 as a rule-making agency to hold hearings, make decisions, and order remedies for violations of environmental laws. Air and water quality standards are established that regulate pollution rates. If companies were compliant with enacted statutes at all times of business operations, such measures would prevent regulatory risks. Although Section 5 of the FTC Act prohibits unfair and deceptive practices, some companies are in violation. Part of preventive risk management, companies must avoid misleading or omitting information. Unsubstantiated claims and bait and switch tactics must be avoided as a preventive measure. Insurance, which is governed by the law of contracts, is designed for businesses to protect themselves against risk of loss. The law requires some companies to carry a minimum of $1 million of liability insurance, which will cover negligence, wrongful acts, and misconduct by the company (Cheeseman, 2010). Liability insurance will guarantee injured third parties compensation. This measure is both preventive and corrective. Detective Compliance evaluation inspections and audits will not serve as a preventive measure; however serve to detect possible risks and is an â€Å"after-the-fact† approach. Compliance is defined as ensuring business procedures, operations, and practices are in concord with a given set of norms (Sadiq & Governatori, 2010). Detective measures are based on reporting and conducting internal and external audits. Changing legislatures and compliance requirements make it difficult to detect. â€Å"The diversity, scale and complexity of compliance requirements warrant a highly systematic and well-grounded approach,† (Lu, Sadiq, & Governatori, 2008, p. 345). Corrective Measures Organizations can raise several defenses as corrective measures against liability. While maintaining public image and damage control, defenses must be ethical in resolving potentially damaging lawsuits. Alternative Dispute Resolution. Negotiation is a simple form of alternative dispute resolution, and includes only the parties involved in the dispute. Negotiation is resolved when the parties reach a voluntary resolution. Mediation is another popular form of alternative dispute resolution. It is available through individuals and organizations like the American Arbitration Association and some court systems. Alternative dispute resolution is an attractive way to resolve disputes because of its speed and the empowerment of the involved parties. Court litigation is slow, expensive, and has uncertain results. Organizations can hold back sensitive business information from public dissemination. This will protect the disclosure of information that could hurt foreign policy or national defense, privacy of individuals, proprietary interests of business, functioning of the government, and other interests (HRSA, 2011). Corrective measures vary from the initiation of a new regulation, to breech reporting, to the company coming under surveillance and scrutiny by a control authority. In the worst-case scenario, a company can undergo an enforceable undertaking (Lu, Sadiq, & Governatori, 2008). The company will position itself favorably with regulators and other controlling authorities if corrective measures are undertaken with a proactive approach. Conclusion The states as well as the federal government administer and enforce laws related to safety. Companies are required to comply with the regulations and legal procedures of regulatory agencies just as much as they are required to follow federal laws. Managers must be aware of, and comply with federal and state laws that govern their business. Aligning business objectives with regulations and legislation will minimize tort and regulatory risks and improve business performance.

How much aggressive behaviour is shown on television? Essay

The average American child sees 32,000 murders, 40,000 attempted murders, and 25,000 acts of violence on television before the age of 18 (Ahmed, 1998). Gerbner’s studies of violence on American television (Gerbner, 1972; Gerbner & Gross, 1976; Gerbner et al. , 1980, 1986) Defining violence as: ‘†¦ the overt expression of physical force against others or self, or the compelling of an action against one’s will on pain of being hurt or killed’, Gerbner’s team have found that since 1967 the percentage of television shows containing violent episodes has remained about the same, but the number of violent episodes per show has gradually increased. In 1986, there was an average of around five violent acts per hour on prime-time television. On children’s weekend shows, mostly consisting of cartoons, about 20 violent acts per hour occurred. British research by Halloran & Croll (1972) and the BBC’s Audience Research Department were both based around Gerbner’s analysis. Both studies found that violence was a common feature of programming, although it was not as prevalent on British as on American television. Cumberbatch (1987), commissioned by the BBC, analysed all programmes broadcast on the (then) four terrestrial channels in four separate weeks between May and September 1986. The main findings from Cumberbatch’s (1987) study: Cumberbatch found that 30% of programmes contained some violence, the overall frequency being 1. 14 violent acts per programme and 1. 68 violent acts per hour. Each act lasted around 25 seconds, so violence occupied just over 1% of total television time. These figures were lower if boxing and wrestling were excluded, but higher (at 1. 96 violent acts per hour) if verbal threats were included. Death resulted from violent acts in 26% of cases, but in 61% of acts no injuries were shown, and the victim was portrayed as being in pain or stunned. In 83% of cases, no blood was shown as a result of a violent act, and considerable blood and gore occurred in only 0. 2% of cases. Perpetrators of violent acts were much more likely to be portrayed as ‘baddies’ than ‘goodies’, and violence occurred twice as frequently in law-breaking than in law-upholding contexts. Cumberbatch argued that whilst violence, and concerns about it, had increased in society in the decade up to 1987, this was not reflected by a proportional increase on television, even in news broadcasts. He concluded that: ‘While broadcasters may take some comfort from our data on trends in television violence, they must expect to be continually reminded of their responsibilities in this area and be obliged to acknowledge that a significant minority of people will remain concerned about what’s on the box’. More recently, the BBC and ITV commissioned Gunter & Harrison (1998) to look at the frequency of violence on terrestrial and satellite channels. Some findings from Gunter & Harrison’s (1998) analysis of violence on British television: The researchers monitored 2084 programmes on eight channels over four weeks in October 1994 and January/February 1995. The findings include: On BBC 1 and 2, ITV and Channel 4, 28% of programmes contained violent acts, compared with 52% on Sky One, UK Gold, SKY Movies and the Movie Channel.   Violence occupied 0. 61% of time on the terrestrial channels and 1. 53% on the satellite stations.   The greatest proportions of violent acts (70%) occurred in dramas and films; 19% occurred in children’s programmes. Most violent acts occurred in contemporary settings in inner-city locations. The majority of perpetrators were young, white males. One per cent of programmes contained 19% of all violent acts. Double Impact, shown on the Movie Channel, for example, contained 105 violent acts, as against on average 9. 7. The United States was the most common location for violence (47%), followed by the United Kingdom (12%). The third most likely location was a cartoon setting (7%), and then science fiction locations (4%). On the basis of the finding that violent acts account for 1% of programme content on terrestrial channels and less than 2% on some satellite stations, and the fact that 1% of programmes contained 19% of all violent acts, Gunter and Harrison concluded that: ‘The picture that emerges is not one of a television system permeated by violence, but rather one in which violence represents only a tiny part of the output and where it tends to be concentrated principally in a relatively small number of programmes’ (cited in Frean, 1995). An almost identical conclusion was reached by the American Academy of Paediatrics (Murray & Whitworth, 1999). As well as television, violent behaviour can also be seen at the cinema or on video (and what is shown may or may not be subsequently screened on television). Evidence indicates that a large percentage of 9-11 year olds have watched 18-rated videos, including particularly violent Nightmare on Elm Street, The silence of the lambs, and Pulp Fiction (Ball & Nuki, 1996; Wark & Ball, 1996). The effects of television on Children’s behaviour: Research into the effects of television on Children’s behaviour began in America in the 1960’s, following the publication of the results of Bandura et al’s ‘Bobo doll experiments’. These ‘first generation’ (or ‘Phase one’: Baron, 1977) studies involved filmed or symbolic) models. Essentially, Bandura et al. showed that children can acquire new aggressive responses not previously in their behavioural repertoire merely through exposure to a filmed or televised model. If children could learn new ways of harming others through such experiences, then the implication was that media portrayals of violence might be contributing to increased levels of violence in society (Baron, 1977). However, Bandura (1965) warned against such an interpretation in the light of his new findings that the learning of aggressive responses does not necessarily mean that they will be displayed in a child’s behaviour. Nevertheless, the possibility that such effects could occur was sufficient to focus considerable public attention on Bandura et al. ‘s research.

buy custom Wire Tap essay

buy custom Wire Tap essay The Wire Trap Act is a law established to protect people against illegal tapping of the communication by intelligence authorities for prosecution purposes. Initially, Title III, which was contained in the Omnibus Crime Control and Safe Streets Act that was enacted in 1968 covered the wire and oral communication only (United States Department of Justice, 2010). However, this was revised subsequently in 1986 to title I, which included electronic communications too. These laws have several provisions related to trapping on information from a person without his or her knowledge. The laws prohibit interception, use, disclosure, or even procurement of information by any person in the form of either electronic, wire, or oral from another person without his or her authorization. The laws also provide exceptions for any person who is allowed to intercept information in any of the three means, as defined by the Foreign Intelligence Act of 1978. The laws also prohibit the use of any illegally o btained information in court as evidence. Authorization to tap into any oral, electronic, or wire communication is granted by a judicial legalization whereby a judge could issue a legalization warranty of up to 30 days. Roving wire traps or multipoint wiretaps is a tracing technique used to intercept communications from a targeted individual (Lippman, 2010). The law provides that such individuals behave in a manner suggesting that they are seeking to distract surveillance or are evading interception. These forms of surveillance violate citizens' constitutional rights by allowing security agents to intercept information from individuals without permission. In fact, this sounds more of eavesdropping, which is a crime. Any right that has an attachment to privacy is utterly disregarded by such intelligence acts because they probe someone without his or her knowledge. Real evidence refers to the physical material that is brought to court as evidence of a crime committed. This evidence is displayed in the courtroom, and a case is conducted based on what is seen in the courtroom (Buckles, 2003). On the other hand, demonstrative evidence refers to evidence produced in court, in the form of an object or any other representation such as sound, picture, maps, and drawings among others. Real evidence is better because it is easy to verify any claims behind a prosecution basing on the actual or physical evidence. In other words, facts can be established easily using physical evidence other than demonstrative evidence. Buy custom Wire Tap essay

10 Ways to Stay Positive About Your First Job Out of College

10 Ways to Stay Positive About Your First Job Out of College We’re all so excited at the prospect of graduating and getting our first job out of college. Then we get there and the success feels start to wear off and the tedium of adulthood sets in. We feel a sense of let down. And it’s perfectly normal. You’ve worked hard for so long, but almost all things had an end point- courses, semesters, years, and even schools. Now your whole life is stretching out before you and you have†¦ buyer’s remorse? Boredom? Don’t worry. Your life doesn’t have to be tedious. You’re not done succeeding yet; you’re just beginning. Here are 10 things you can do to stay sharp and make the most of the world of grown-up opportunities. It takes a little longer, and a bit more strategizing, but it will be worth it in the end.1. Be purposefulYes, most people have to work. But if you’re in the privileged position of being able to choose the kind of work you do, that’s huge. Keep track of why youâ⠂¬â„¢re working. What about this field or career makes you passionate. Know your purpose- both for being where you are and for heading in the direction of your particular goal. Hold onto it. The day-to-day tedium won’t touch you.2. Connect with coworkersYes, you’re on the stairway to success. But you will need help along the way. Make friends. Your coworkers might not be your college pals, but you’re going to see a whole lot more of them. Invest in these relationships and they may prove to be invaluable. You’ll all work much better together and will succeed much faster.3. Keep learning new thingsThe difference between this job and college is this: you’re now getting paid to learn. Learn as much as you possibly can and keep looking for the next opportunity to learn. Make your success as much about the journey as the destination.4.  Pick up new skillsSet yourself goals to pick up new skill sets or certifications, or even degrees. Have targets for e very few months and every few years and hold yourself to them. If you commit to learning more and more, you’ll be amazed how much more quickly you succeed.5. Break  up your goalsIf you’re daunted by the future stretching out endlessly before you, break it up. Plot out milestones for yourself. First promotion. First big project. First big client. Fiftieth small victory. This will help you make better narrative sense of your time at this job, and any job, as a stepping stone on your way to greater things.6. Remember that your job funds your hobbiesEven if you’re not 100% fulfilled by your new job and you’d rather be at the movies all afternoon mainlining popcorn, remember that your job funds your fun. When you lose sight of all else, remember that your time at the office makes your social life possible. Save up for special things like trips to make the experience more meaningful.7. Go above and beyondBest way to combat boredom: keep looking for ways to do more. Challenge yourself to get things done before a deadline, or to double your quota, or to go the extra mile on a project. You’ll feel more satisfaction, and your dedication will be noticed, and hopefully rewarded.8. Talk to your bossChecking in regularly with your boss is a great way to keep tangible track of your progress. Having someone else help keep track of your goal-setting and goal-meeting will be useful to keep you dedicated and also to notice when you’re killing it.9. Rethink foreverYou’re sitting at your desk despairing. There’s no end in sight! Reimagine your situation. What if you think of it as endless possibility? An infinite horizon? Think bigger than you have been thinking†¦ and your open-ended forever job won’t feel so terrifying.10. Find a mentorA good mentor can make all the difference in keeping you motivated and focused on what’s most important in the scope of your career. Find someone you admire and respect an d ask them to help shepherd you through your early stages. After all, they blazed this trail before!

Thesis Writing Format

Thesis Writing Format Thesis Writing Format Thesis Writing FormatThe specifics of thesis writing format depend on the broad area of your study. In other words, the specifics of your educational process and the requirements of your supervisor determine the elements of master thesis writing format. Usually, thesis writing is a report on conducted research project. Therefore, the essential elements of thesis writing format are the following:Introduction (introduce the reader to the research thesis topics; explain the importance of your research)Literature review (show what has already been written on the chosen topic)Explain the research design (methodology should cover the steps you have taken to conduct a research)Present the findings (what did your research show? What are the key findings?)Discussion on the findings (what do the findings mean? What is the contribution of your research to the existing literature?)Conclusions (present the limitations of your study and give recommendations on further research)A typical a cademic thesis written for a university or college should include a cover page, abstract (200 words or less), outline, body with all key chapters, and a reference list. Pay special attention to the reference list style required by your teacher. APA, MLA, and Harvard are very different to each other and sometimes a small mistake in referencing may cost you a grade. Thesis Writing Format ElementsAs it was mentioned above, every institution has its own requirements for thesis writing and formatting and you should be very careful to follow all requirements in detail. You may not simply ignore the importance of referencing style or decide to leave table of contents out. If you value your own education and do not want to waste your time revising and rewriting your thesis 25 times, it is better to do everything right from the very beginning. If you do not want to spend time on writing and formatting your thesis because it is a time consuming process, you have an opportunity to request thes is writing help at our site. Our thesis writers know how to write a thesis and they are able to assist you with every aspect of thesis writing and ensure that your thesis or dissertation is written in full accordance to academic standards and format requirements. We deliver custom written theses on time and we guarantee free unlimited revisions. Thus, you get a perfect thesis written by professional thesis writers from scratch. In addition, you may request professional help with argument essay writing as well as cause and effect essay writing!

Engineering - Quality Management Research Paper

Engineering - Quality Management - Research Paper Example Looking back to the early 1980s a revolution, which can be perceived as a not-so-quiet, has been in effect in the global business. This has been an ideas revolution involving the questions of how to do business. The revolution can be said to be largely spearhead by three individuals, that is, Joseph Juran, Philip Crosby as well as W. Edward Deming. Thesis Statement The purpose of this paper is to access the similarities and the differences from the works of Deming and Crosby in quality management. On similarities, the paper will address; Customer Requirement as an important standard, the responsible quality management, goal of Quality as well as management Perspective. On the aspect of differences, the paper will address; The Basic orientation to quality, the question of what is Quality, implementation’s chief elements, inspection/ Defect control, improvement Basis, management perspective and cost of quality Discussion Similarities Customer Requirement as an important standard According to the work by Deming, he is of the view that the presence of a consumer is brought about by a necessity and as such, it is the most vital aspect of a system of production, that is, where there are no consumers, what then is the need for production? Crosby’s work define quality as conforming to certain set of specifications, which have been stipulated by the management of an organization and not some concept of goodness full of vagueness. The specifications entailed in quality are not made arbitrary either (Baxter & MacLeod, 2008). As such, they ought to be set in accordance with the needs as well as wants of the customers. The responsible quality management team According to the work advanced by Deming, it advances that quality is designed in the boardroom. In his notion of quality, he says that ideas such as; sincerity, hard work, personal responsibility as well as decency, indeed are responsible for the changed management world. He says that it is unsubstantial to just perform a task to the best of your capacity. It is necessary that one becomes aware of what he is working on. Crosby work indeed shares the same notion (Baxter & MacLeod, 2008). According to him, improvement in quality ought to commence from the top. In order to come up with a manufacturing process, with no defect, or what he term as zero defects, then the management of any organization must then set the suitable atmosphere and the tone whereby the employees will easily follow. If the management fails to establish a production system with zero defects, then it is not closer enough to a quality product. Goal of Quality In both works, they advance that quality improvement is an unending process. In Deming’s work, it is suggested that in order to meet and exceed the needs of a customer, it is necessary that there are continuous improvements. In the same notion, Crosby points out that the continuous improvements must be enhanced and as such, it should be done by setting a production with zero defects (John & Barnes, 2006). Though both works share common grounds in regard to the quality management, the largest part they share are the differences on the notion of quality management. Management Perspective In both works, drawing of comparison is mentioned

Individual Assignment Example | Topics and Well Written Essays - 750 words

Individual - Assignment Example Apart from these MySpace has a wide variety of applications like a special classifieds page which allows opportunity for the user to buy and sell products online. Thus, this company offers opportunity to expand a business into varying horizons. MySpace also offers sale of goods hassle free and with minimum overheads. The site maximizes the opportunity for product exposure through its advertisements on the website. MySpace offers business marketing. â€Å"It takes managerial talent to identify whether or not the firm has valuable resources and capabilities and to decide how best to use them to maximize returns† (Brickley 2007, p. 247). Organizational architecture is one of the key elements behind the successful functioning of any business. As a manager, it is necessary to create and sustain value and it can be done through the creation of multiple fronts and multiple pathways. â€Å"MySpace is, for identity exploration, engaging in social comparison and expressing idealized aspects of the selves they wish to become† (Manago et al. 2008, para. 1). MySpace also creates an identity for its users and they realize their own self. Besides, it allows the users unlimited flexibility to share their content. â€Å"According to the Pew Internet Project, MySpace is the most dominant social network among teens, used by 85% of teenagers who use social networks† (Hall 2011, para. 3). Since the majority of MySpace customers are teenagers, it can offer documented school researches which would be helpful to the teenagers. It can also provide a platform for promoting artistic talent. However, it may keep a restricting check on its users with respect to viewing of porn and other anti-social activities. In this way, it would be able to target more and more customers because once its offers restricted use, then the parent’s anxieties will be satisfied and they will also become members of the site. In this way MySpace

Behavioral and performance issues with a customer service Case Study

Behavioral and performance issues with a customer service representative - Case Study Example This study focuses on many challenges resulted by the recent deregulation of financial services in Canadian banking industry, many changes have been incorporated in banking system. Previously cross-ownership between four pillars (banking, insurance, trust and security) was not allowed but due to the deregulation it is possible now. This has brought many new opportunities and challenges in the market with increased competition. To meet new objectives pressure on customer service officers have been increased which also meant low flexibility in working hours and job sharing. The Canadian National bank is among the largest chartered banks in Canada with 1600 branches around the nation. The focus of this study is on one of the case of employee behavior in the Chatham branch of Canadian National bank. This case discusses two employees of Chatham branch of Canadian National bank, Lesley Mohan and Pam Stewart. Lesley was a newly hired customer service manager and Pam Stewart was 25 years employee, holding the position customer service executive. The main area of discussion is Pam’s conflicting attitude and Lesley’s respond to it.... Previously cross-ownership between four pillars (banking, insurance, trust and security) was not allowed but due to the deregulation it is possible now. This has brought many new opportunities and challenges in the market with increased competition. To meet new objectives pressure on customer service officers have been increased which also meant low flexibility in working hours and job sharing. The Canadian National bank is among the largest chartered banks in Canada with 1600 branches around the nation. The focus of this study is on one of the case of employee behavior in the Chatham branch of Canadian National bank. This case discusses two employees of Chatham branch of Canadian National bank, Lesley Mohan and Pam Stewart. Lesley was a newly hired customer service manager and Pam Stewart was 25 years employee, holding the position customer service executive. The main area of discussion is Pam’s conflicting attitude and Lesley’s respond to it. Problem statement â€Å" Although Pam’s (CSR) experience was so vast and past performance was above average, but her conflicting behavior, self superiority and resistance to change was creating difficulties for new customer manager to adopt recently made changes by higher authority and improve assigned bank branch performance while sustaining her growth and position, human resource and conflict management theories could be considered as a measure to decrease the severity of problem† Problems Pam’s (customer service representative) conflicting behavior with Lesley, new customer service manager Pam’s self superiority because of her 25 years of experience Pam’s resistance to change recently made by customer service capacity management schedule Pam’s rebellion attitude towards Lesley Sub problems

The PROS and CONS ofImplantingInformation Chips in Humans Essay

The PROS and CONS ofImplantingInformation Chips in Humans - Essay Example Due to reason, several eras has come in healthcare practice to improve the medical record system of patients to the highest logical point. As the debate rages on how medical record system can be improved, scientists have been swift in incorporating technology into the whole system. With something that started with the need to switch from paper records of patients to computer database software in keeping records of patients, we today have proposals on implanting chips in people to keep their medical records. The device is known as the implantable medical ID. Stein (2004) explains that the device is â€Å"a microchip that can be implanted under the skin to give doctors instant access to a patient's records.† Already, the proposal to implement the implantable medical records has won government approval. For now, the best thing to do is to continue detain on the pros and cons of the device and technology to come to a logical conclusion on whether or not the system would be helpful in the discharge of medical duties. Pros Already, there are health gurus who have approved of the use of the implantable medical ID and have started using them already. ... Therefore if there is the need to switch hospital at any point in time or travel inter-state, the records of the user will be ready as and when they are needed. The second point has to do with the safety of the system. Clearly, papers get burn or soaked with water and computer software gets corrupted or crashed. Any of these situations temper with the safety of records. With the implantable medical ID however, the records remain intact as long as the patient is alive. Yet again, the implantable medical ID is very reliable in emergency situations. Indeed medical emergencies come unannounced and therefore make the need to going to get a person’s records in times of medical emergencies very difficult. With the implantable medical ID however, a patient does not have to worry about emergencies because the device caters for that. It is always available and reliable. These points are supported by Merrill (2009) who states that the implantable medical ID â€Å"was designed to provide his identification and immediate access to his medical history in the event of an emergency.† Cons The beautiful advantages discussed above notwithstanding, the implantable medical ID come with a number of cons or disadvantages. There are commentators who argue as to whether or not the implantation and its removal themselves do not pose health risks and threats. There are many critics who are of the view that even though it is easier implanting the chip, removing it can be very complicated. John Halamka, MD, CIO at Harvard Medical School and CareGroup in Massachusetts, for instance laments that â€Å"it’s easy to insert but challenging to remove. I have no plan to have mine removed† (Merrill, 2009). The second demerit has to do with the cost involved in

Zoloact Essay Example | Topics and Well Written Essays - 500 words

Zoloact - Essay Example The website will also comprise of images, graphics, triangulation bars, and animations of Zoloact. Additionally, the website will include a shopping cart, which will allow potential customers to order the drugs when they access our websites. Furthermore, the website will include the prescriptions necessary for the drug and the diseases that are cured by the drug. Still, Zoloact website will include a review section whereby patients who have used the drug will give a response on drug use experience. Besides, an inquiry section will be developed where patients can ask questions related to the drug. Market Research Zoloact, as a bisphosphonate drug faces various threats and competition from its competing drugs. Alendronate (Web) notes that the current market valuation of bisphosphonate drug is $ 4.6 billion. However, the market demand of the drug is expected to decrease by 5-7 % each year (Alendronate Web). This is because of the increased awareness of the need to keep healthy by eating calcium containing food components for the elderly. Zoloact, as a bisphosphonate alternative drug, will aim at providing the best medical care to such patients by ensuring that the drug prevents loss of bone mass to the elderly.

The PROS and CONS ofImplantingInformation Chips in Humans Essay

The PROS and CONS ofImplantingInformation Chips in Humans - Essay Example Due to reason, several eras has come in healthcare practice to improve the medical record system of patients to the highest logical point. As the debate rages on how medical record system can be improved, scientists have been swift in incorporating technology into the whole system. With something that started with the need to switch from paper records of patients to computer database software in keeping records of patients, we today have proposals on implanting chips in people to keep their medical records. The device is known as the implantable medical ID. Stein (2004) explains that the device is â€Å"a microchip that can be implanted under the skin to give doctors instant access to a patient's records.† Already, the proposal to implement the implantable medical records has won government approval. For now, the best thing to do is to continue detain on the pros and cons of the device and technology to come to a logical conclusion on whether or not the system would be helpful in the discharge of medical duties. Pros Already, there are health gurus who have approved of the use of the implantable medical ID and have started using them already. ... Therefore if there is the need to switch hospital at any point in time or travel inter-state, the records of the user will be ready as and when they are needed. The second point has to do with the safety of the system. Clearly, papers get burn or soaked with water and computer software gets corrupted or crashed. Any of these situations temper with the safety of records. With the implantable medical ID however, the records remain intact as long as the patient is alive. Yet again, the implantable medical ID is very reliable in emergency situations. Indeed medical emergencies come unannounced and therefore make the need to going to get a person’s records in times of medical emergencies very difficult. With the implantable medical ID however, a patient does not have to worry about emergencies because the device caters for that. It is always available and reliable. These points are supported by Merrill (2009) who states that the implantable medical ID â€Å"was designed to provide his identification and immediate access to his medical history in the event of an emergency.† Cons The beautiful advantages discussed above notwithstanding, the implantable medical ID come with a number of cons or disadvantages. There are commentators who argue as to whether or not the implantation and its removal themselves do not pose health risks and threats. There are many critics who are of the view that even though it is easier implanting the chip, removing it can be very complicated. John Halamka, MD, CIO at Harvard Medical School and CareGroup in Massachusetts, for instance laments that â€Å"it’s easy to insert but challenging to remove. I have no plan to have mine removed† (Merrill, 2009). The second demerit has to do with the cost involved in

The Rusty Time Essay Example | Topics and Well Written Essays - 1250 words

The Rusty Time - Essay Example His father was getting more and more concerned, because Michael wasn’t the sociable little boy he used to be. As if he closed himself from the whole world, even him, his own father. No matter what he did, what he offered, Michael would bleakly, yet determinedly thank him, then refuse. He went downstairs and clicked on the big screen on the wall of the kitchen. A computerized voice greeted him facelessly, and asked what he would like to have for breakfast. He chose eggs and toast. The buzzing of machines wasn’t as loud as it was before they installed the newest Cook-O-Master. He thought to himself that his wife would have loved not having to cook anymore, but just indulge in her painting and taking care of Michael and him. He sighed and took the freshly prepared breakfast tray that the table produced before him. Michael stopped crying, but the sadness was all too visible in his demeanor. He went downstairs and joined his father at the table. He wanted no breakfast. †Å"Please, dad†¦ can we try it? Just once, I believe it is possible,† Michael started. â€Å"Mike, we’ve already had this discussion. You are putting me in an awful situation having to say no over and over again. I told you, even if we did try the procedure, it is questionable whether it would work. You know that the machine transports only live matter,† his father spoke calmly, feeling tired and heartbroken having to discuss a painful thing again. â€Å"I read somewhere that new additions are made to the machine and that they managed to transport some parts of clothing†¦ Dad, we can try, we have money now, I know†¦Ã¢â‚¬  â€Å"Michael,† his father’s voice was getting louder and more resolute, â€Å"You know it is impossible to transport money through time†¦ and you know†¦ I feel it’s my fault that we couldn’t afford to pay for your mother’s operation†¦ We could have saved her life†¦ If onlyà ¢â‚¬ ¦Ã¢â‚¬  He buried his face into his hands and went silent. Michael felt bad and hugged his father soothingly. â€Å"Dad†¦ dad†¦ it’s not your fault†¦ you couldn’t have known we would win the lottery†¦ we had no money†¦ it was†¦ it wasn’t your fault, dad, it wasn’t†¦Ã¢â‚¬  â€Å"It was, Mike, it was†¦ I am the provider, at least†¦ I was supposed to be, and I couldn’t provide your mother with the treatment†¦ it is my fault... my fault†¦Ã¢â‚¬  â€Å"No, dad†¦ listen, we can try, I read†¦ I read somewhere†¦ let’s try, we have money, we can afford it now. You can go, and pay†¦ pay everything they ask†¦ just bring mom back, please, dad, please†¦Ã¢â‚¬  Michael was crying in his father’s arms. His father was crushed by the weight of his guilt. He didn’t want to raise their hopes up, only for them to be shattered like glass. It would be like losing her again. And he wasn’t strong enough to go through that pain again. Not again. But, looking at his son, he felt stronger. Maybe, he thought to himself, maybe it is possible. If I make a few phone calls, maybe someone does know something. Having made several phone calls, he turned to Michael, who was looking at him with puppy dog eyes. â€Å"Alright, son, they said that they did manage to transport several pieces of cloth to the past. And, they said they are willing to give it a try, provided we pay them enough†¦Ã¢â‚¬  Michael jumped into his father’s arms. â€Å"But, Mike, Mike†¦ Promise me that you won’

Designing lesson plan Essay Example for Free

Designing lesson plan Essay Introduction A. Background To achieve the Content Standard (Standar Isi) in the curriculum which covers the Competency Standard (Standar Kompetensi (SK)) and the Basic Competency (Kompetensi Dasar(KD)), students should go through the teaching and learning process. Educational Ministry Regulation number 41, the year of 2007 about the Process Standard states that every school teacher should make Lesson Plans (Rencana Pelaksanaan Pembelajaran(RPP)) to foster the teaching and learning process to be interactive, inspirative, joyful, challenging, motivating the students to participate actively, and giving enough opportunities to them to be innovative, creative and self reliance according to their talents, motivations, and physical as well as psychological development. Through out this module, the important elements of a lesson plan will be discussed. You are supposed to be able to implement your knowledge concerning language teaching and learning such as language competency, methodology and approaches to foreign language learning, media and learning resources, and language assessment in developing lesson plans. By completing of every parts presented in this module you will be able to design lesson plans which can fulfill the required process standard mentioned above. B. Objective Through the elaborations and the discussions of important factors and elements in lesson planning, you will be prepared to be able to carry out the teaching and learning process as requested by the new curriculum (KTSP) C. Indicators After completing this module you are supposed to be able to : 1. state the important elements of lesson planning. 2. determine the indicators of achieving the basic competencies 3. formulate the objectives of the teaching and learning 4. select relevant learning materials 5. plan the stages of teaching and learning activities 6. assess the students achievements DESIGNING LESSON PLAN A. The Concept of Lesson Plan Activity 1 Instructions : Think about these three questions Discuss them; how they relate to the lesson planning A lesson plan is a teachers detailed description of the course of instruction for an individual lesson. (Wikipedia, accessed on the 6th of September 2009). The government regulation No. 19, the year of 2005 states that the planning for instructional process covers the sylabus and the lesson plan containing the purpose, learning materials, methodology, the learning resources and the evaluation. Those are the components of a lesson plan. But by the discussion you have just done, we may conclude that those components could be summarized into three important aspects; the purpose of the instruction (question 1), the learning activity (question2), and the feedback or evaluation (question3). Based on the ministry regulation, number 41, year 2007, the process standard, it was explained that a Lesson plan is the elaboration of syllabus which illustrates the teaching and learning activities to achieve the goals of the basic competency. Every teacher who uses school curriculum, should design a plan completely and systematically to make the teaching and learning interactive, inspirative, joyful, challenging, and be able to motivate students to be active, creative, and self reliance, in line with their talent, motivation, their physical and psychological development. This statement is mostly about the teaching and learning activities. Every stage of the lesson should be planned to fulfill the above requirements and make certain that the instructional objectives could be achieved. B. The components of a Lesson Plan Activity 2 Instructions : Share your experiences with your friends for the lesson plans you have ever made. Which components do you think is the most difficult to write? A Lesson plan is designed to meet the basic competencies, which can be carried out in one meeting or more. Things that should be written in the lesson plan are as follows: 1. Identity of the subject matter which consists of; a. Title of the lesson b. Class/ Semester c. Program (especially for Senior High) d. Theme e. Time allotment 2. Competency Standard Competency Standard is the qualification of the students’ minimal ability, which illustrates the mastery of knowledge, attitude, and skill obtained through each class or semester for every subject. 3. Basic Competency Basic competency is a sum of students’ ability for certain subjects as the reference for determining the indicators for competency achievement in a subject. 4. Indicator for competency achievement The measurable or observable behavior, which shows the achievement of specific basic competency as the reference for the subject evaluation. The indicators for competency achievement are formulated with operational verbs that can be measured which cover the knowledge, attitude, and skills. 5. The Instructional goal Instructional goal illustrates the process and the learning outcome achieved by the students in accordance to the basic competency 6. Instructional material It includes the fact, concept, principle, and the relevant procedure, and written as suitable items in relation to the indicators for competency achievement. 7. Time allotment Time is allocated as much as needed to achieve the Basic competency and the learning load. 8. Methodology Methods are used by teachers to create the teaching and learning process to enable the students to achieve the basic competency or a set of specified indicators. The choice of methods should consider the students’ situation and condition as well as the characteristics of every indicators and the competency which will be achieved in every subjects. 9. Learning activities a) Pre- activity This activity is done at the beginning of the lesson and meant for arousing the students’ motivation and to focuss the students’ attention as well, so that they can particà ­pate actively during the lesson. b) Whilst activity This is the main learning process and aimed at achieving the basic competency. This activity is conducted interactively, inspiratively, joyfully, chalenging, motivating the students to participate actively, and giving opportunities to the students to have innovation, creativity, and selfreliance in accordance to their talent, motivation, physical and psychological development. This activity is conducted systematically through exploration, elaboration, and conformation processes. c) Post activity This activity is done to end the lesson which can be in the form of summarizing, evaluation, reflection, feedback , and follow up activities. Stages of Learning Activity : 10. Evaluation The procedure and the instruments for assessment should be based on the indicators for competency achievement and refer to the evaluation standard 11. Learning Resource Selecting the learning resource should concider the competency standard and the basic competency, as well as the learning material, the teaching and learning activities and also the indicators for competency achievement. C. The Principles of Designing Lesson Plan Activity 3 Instructions : Take any English lesson plan you have had. Try to make a judgment for this (excellent, good, or poor) What criteria do you take for consideration? a. Individual differences Consider the individual differences concerning students’ level of mastery, interest, motivation, potential, emotion, learning style, special need, learning speed, socio cultural background, values, and living environment. b. Fostering students’ participation The lesson should be students-focus and fostering, crea ­tivity, initiative, inspiration, self reliance, and learning motivation. c. Developing students’ reading and writing habits Teaching and learning should develop students’ reading habits on various resources and their ability to express feelings and opinions in different forms of writing. d. Giving feedback and follow up A lesson plan should include activities which can give positive feedback, reinforcement, enrichment, and remedial. e. Link and Unity Lesson plan is designed considering the links and the unity among the competency standard, basic competency, learning material, instructional activities, and indicators for competency achievement, evaluation, and learning resources. Lesson plan should accommodate the thematic instructions, links with other subjects, across the learning aspects, and cultural diversity. f. Employing the information and communication technology Lesson plan is written to foster the use of information and communication technology, integrated, systematic, and effective depending on the situation and condition. D. The Stages of Developing a Lesson Plan A well developed lesson plan reflects interests and needs of students. It incorporates best practices for the educational field. (Skowron, Janice.2006). In Indonesian schooling, the Curriculum of School Level (KTSP) has already been set up by the content standard (SK) and the graduation standard (SKL). Therefore students should be able to achieve what so called the minimum requirements which have been stated in those two documents. The students’ interest relates to the learning materials and depends on how the learning activity is conducted. Therefore you must employ various kinds of methods and approaches. The use of teaching aids and media may also be inspiring and increasing the students’ motivation. According to the process standard (Educational Ministry Regulation no.41, the year of 2007) a lesson plan is a unit plan which covers one basic competency and the time span may be more than one meeting. But the English curriculum and syllabus developed in the content standard are directed to follow the two cycles (oral and written), and the four stages (building  knowledge of the field, model of the text, joint construction, and independent construction). Therefore, English lesson plans should be integrated units which may cover more than one single basic competency; listening and speaking for the oral cycle, reading and writing for the written cycle. Integrating all the four basic skills will also be possible. Here are the stages of designing an English Lesson Plan : Mapping the Competency Standard and the Basic Competency Determining the indicators for basic competency achievement Setting up the Purpose Selecting the Learning Material Structuring the stages of instruction Preparing the assessment The flow of a lesson development : 1. Mapping the Competency Standard and the Basic Competency This stage is ideally done when designing the syllabus. The Competency Standard and the Basic Competency which can directly picked up from the documents are to be analyzed and put into units. English or language in general has special characteristics which might be different from other subjects. The competency based curriculum developed in the content standard is prepared to teach students the communicative competency which covers the actional competence, linguistic competence, socio cultural competence, and strategic competence. The competencies are interrelated to each other and the core of those four competencies is the discourse competence. (Kurikulum Berbasis Kompetensi, Bahasa Inggris, 2004) Diagram 5: Model Kompetensi Komunikatif (Celce-Murcia et al. 1995:10) In general, there four Competency Standards; Listening, Speaking, Reading, and Writing which are states in the documents of content standard (SI), attachment for English subject. Your task is to select the basic competencies which can be combined into unit plans considering the suggested aproach in designing the stages of instruction (four stages in two cycles). Here is examples of mapping the basic competencies : Class VII/ Semester 1 SK 1 dan 3. KD Listening 1.1 dan KD Speaking 3.1 3.2 Merespon makna , melakukan : Tindak tutur : Menyapa orang yang belum/sudah dikenal Memperkenalkan diri sendiri/orang lain Memerintah atau melarang Class IX/ Semester 1 SK 5 dan 6 KD Reading 5.3 dan KD Writing 6.2 Merespon makna dan langkah retorika dan Mengungkapkan makna dan langkah retorika: monolog descriptive dan recount 2. Determining the indicators for basic competency achievement. Indicators reflect measurable or observable behavior to show the achievement for the basic competency which will be used as the reference of the assessment. Indicators for achievement should be written by using operational verbs covering the knowledge, attitude, and skills. i.e. : knowledge : mentioning, interpreting, defining, completing, summarizing, explaining, developing, etc. attitude : participating, adjusting, helping, proposing, serving, inspiring, etc. skill : expressing, practicing, fixing, arranging, demonstrating, etc. 3. Setting up the Purpose Educational Ministry Regulation No. 41, about the Process Standard states that the Purpose of Instruction describes the process and the learning outcome expected to be achieved by the students referring to the basic competency. (Tujuan pembelajaran menggambarkan proses dan ha ­sil belajar yang diharapkan dicapai oleh peserta didik sesuai dengan kompetensi dasar). The two aspects you have to include in setting up the purpose are : a.The process It reflects the expected students activities during the lesson. The activities should student centered. The more students involved through out the lesson would be the better. Consider the students’ motivation, interest, challenge, and creativity. i.e. Listening : minimal pair, sound identificatifying, gap-filling, predicting, comprehending etc. Speaking : interactive communication activities, role playing, scenario, speech, debating, interviewing, dialogue, etc. Reading : scanning, skimming, reading intensively, predicting, classifying, etc. Writing : co-operative writing, drafting, analyzing, guided writing, programming, listing, revising, reviewing, giving comments, summarizing, etc. b.The learning outcome It refers to the achievement of the basic competencies covering the knowledge, attitude, and skills. i.e. : responding meaning to different kinds of text type. expressing meaning for different kinds of purposes pronouncing, reading aloud etc. 4. Selecting Learning Material The learning materials prepared for the lesson plan should be based on the students’ literacy level; performative, functional, or informative. The latest is meant for high school. In performative level, students are taught how to use English to accompany actions, participate in classroom and school interactions, and recognize simple written English. While in the functional level students are supposed to learn to use English to get things done, for  survival purposes (buying and selling, asking and giving permission, making and canceling appointments, read and write simple texts, read popular science, etc.) You have to remember that our English curriculum is text based. Therefore we have to select the material according to the suggested text type. For junior high school are descriptive, procedure, recount, narrative, and report. While news item, discussion, explanation, exposition, and review are for senior high school. There are various resources where we can get the learning materials. Any learning material will be applicable as long as they can meet the curriculum requirement of teaching the students for communicative purposes. They might be presented in all types of communication, transactional conversation, Interpersonal conversation, Informational texts (spoken and written) in the daily life context. For example : Transactional conversation : giving directions in various contexts (kitchen, street etc.) Interpersonal conversation : talking about how to do things casually for the sake of maintaining conversation 5. Structuring the stages of instruction The lesson is carried out through three phases; Pre-activity, Whilst-activity, and Post-activity. a. Pre- activity  This activity is done at the beginning of the lesson and meant for arousing the students’ motivation and to focus the students’ attention as well, so that they can participate actively during the lesson. b. Whilst activity This is the main learning process and aimed at achieving the basic competency. This is suggested to follow the two-cycle approach (oral and written) and the four stages of lesson development; Building Knowledge of the Field (BKOF), Modeling of the Text (MOT), Joint Construction of the Text (JCOT), and Independent Construction of the Text (ICOT). This approach is in line with the flow of a lesson mentioned in the process standard;  exploration, elaboration, and confirmation. Exploration = BKOF Elaboration = MOT Confirmation = JCOT, and ICOT c. Post activity This activity is done to end the lesson which can be in the form of summarizing, evaluation, reflection, feedback, and follow up activities. 5. Preparing the assessment Assessment is a method of evaluating student performance and attainment, Microsoft ® Encarta ® 2009. This stage focuses on ensuring that your students have arrived at their intended destination and has been formulated as the indicators for competency achievement. For this, you will need to gather some evidence that they have done. You usually can do by gathering students work and assessing this work using some kind of grading rubric that is based on the indicators. You could also give test to the students on various domains as well. Here are what we have to assess : Communication that happens in texts Students’ ability to create and respond to texts In listening, speaking, reading, and writing The texts that we may use : Spoken : Informational texts -Transactional and interpersonal dialogues Monologues in the target genres Written : Informational texts Essays in the target genres Test items should not measure the students’ knowledge on the rules of the language. Instead they should be focus on meanings. The meanings tested are : Ideational meaning (isi berita) Interpersonal meaning (tujuan text, tindak tutur) -Textual meaning (termasuk punctuation) Logical meaning (hubungan logis antar gagasan) 6. An Example of a Lesson Plan Engish Version : SMP/MTs: †¦. Subject : English language Class/Semester : VII (Seven) / 1 Text types : Transactional / Interpersonal Theme : Personal Life Skill : Listening Time allotment : 2 x 40 minutes Competency Standard : 1. To understand the meaning of transactional and interpersonal dialogues to interact with the closest environment. Basic Competencies : 1.1. To response the meaning in the transactional ( to get things done) and interpersonal dialogue which is used in the simple oral communication accurately, fluently, understandable to interact with the closest environment that involves: greeting people/ friends, self introduction, others, ordering and forbidding somebody. To ask and to forbid. Greeting strangers / familiar people Introducing selves and other people Ordering / forbidding Indicators for Achievement : The students are able to: a. response the expression of hello from the strangers b. response the expression of self introduction. c. response the expressions of other people’s introductions. d. response the comment expression. e. response forbid expression. f. response the expression of hello from the familiar people Purpose : Through modeling and interactive activities, students can conduct simple communication in the transactional and interpersonal dialogues. Learning Materials: Dialogues that uses the following expressions : 1. A : Good morning. How are you ? B : Good morning. Fine thank you. 2. A : Hello, I’m Nina. Nice to meet you B : Hello, I’m Renny. Nice to meet you, too 3. A : Don’t do that ! B : No, I won’t. Don’t worry 4. A : Stop it ! B : Ok Vocabularies related to text-type and theme, e.g : name, live, address, etc. Verbs : live, meet, do, stop, have To be : is, am, are Personal Pronouns : I, you, we, they, he, she, it Standard expression : Good morning Don’t worry Thanks Nice to meet you OK How are you ? a. Teaching method/ Strategy : Three-phase technique A. Pre- activities Question and answer about things related to students’ life Students answer the questions of personnal identity B. Whilst activities 1. To discuss new vocabulary of the texts 2. To listen some sentences of teachers models 3. To guess the meaning and function of sentences produced by teachers 4. To immitate some sentences of teachers’ pornounciation 5. To listen to the dialogue of introductions 6. To answer the question of the content of the dialogue. 7. To response to the expressions of greeting, introduction, command, and prohibition. 8. To act out the teacher’s commands. C. Post-activities 1. To ask the students’ difficulties in learning activities. 2. To summarize the learning materials. 3. To give students some tasks of using expressions in the real situation Learning Resources The relevant text book : ( title, author, publisher, year, page ) Script of dialogues or dialogue recording The relevant pictures Evaluation Technique: Responding to the expressions / questions orally and written . Forms : oral questions Test Items : Part I : Listen to the expressions and give your response orally Good morning. How are you? †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Hi, I’m Reno and you are? †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Are you Anisa? †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Hello, it’s nice to meet you †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Who is that girl? †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Part II : Listen to the expressions and choose the best response, a, b, c or d. 1. A: Hello, how are you ? B : †¦ a. Fine, thanks b. I’m Renny c. Thank you d. Don’t worry 2. A: Is that your sister, Anna ? B : †¦ a. Yes, it is b. No, she’s not here c. I don’t know d. Very well, thanks. 3. A: Budi, this is my friend, Susan. B : Hi, Susan †¦ a. Fine, thanks. b. It’s Ok c. Nice to see you d. I’m alright 4. A: Open the door ! B : †¦ a. OK b. Fine b. Fine c. Good d. Really 5. A: Don’t be late to school. B : †¦ a. Yes, Sir b. No, Sir c. Ok, Sir d. Fine, Sir Scoring guide: 1. For part I, each correct item is scored 3 2. For part II, each correct item is scored 2 3. Total Score Part I : 5 x 3 = 15 Part II : 5 x 2 = 10 TOTAL : 25 4. Maximal score = 10 5. Students’ score = Rubrics for Part I: No. Uraian Skor I Content and grammar are correct The content is correct, grammar is wrong Content and grammar are not correct No answer 3 2 1 0 II For every correct answer For every wrong answer/ no answera 2 0 Approved by : School Principal English Teacher . RESOURCES FOR LESSON PLAN IDEAS ON THE INTERNET PBS TeacherSource A large collection of lesson plans, teacher guides, and online student activities correlated to 90 sets of state and national curriculum standards. http://www.pbs.org/teachersource/ Best of Education World ® 2002 http://www.education-world.com/best_of/2002/ Education World ® Lesson Planning Center http://www.education-world.com/a_lesson/ Education World ® National Standards http://www.education-world.com/standards/national/index.s

Complications Of Skeletal Traction Health And Social Care Essay

Complications Of Skeletal Traction Health And Social Care Essay In the last two decades, there have been major changes in the management of lower limb long bone fractures, surgical management has become the norm. Skeletal traction is now rarely used as the definitive form of management. Most of the patients admitted to our hospitals have skeletal injuries, and these patients have prolonged length of stay as they are initially managed non- operatively. Complications of traction have been looked at since 1947 and have been published but literature from the developing countries is lacking. This study is being conducted to evaluate the prevalence of complications associated with skeletal traction with lower extremity fractures. Objective : To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. Study Design:- This is a Hospital based Prospective Descriptive study, that will be carried out from December 2010 to March 2011. Study Setting :- The study will be carried out at the KNH orthopaedic wards. Materials and Methods :- Patients who are put on lower limb skeletal traction will be recruited into the study, They will be reviewed weekly for complications namely pin tract infection, pressure sores, venous thrombo-embolism, orthostatic pneumonia and knee stiffness, until upto the point they are taken off traction. The data will be collected using pre-designed questionnaires. INTRODUCTION Fractures of the femur are almost always the result of great violence and are sometime a threat to the patients life, not only because of the immediate complications such as bleeding or associated injuries but also because of subsequent complications related either to the treatment of the fracture or to the complications of the associated injuries. Immobilization of the fracture was recognised as essential for union. The development of splints, such as the Thomas splint and the subsequent combinations of the splints with traction methods either fixed or balanced, allowed for better control of the fracture, patients never the less had to remain in traction for three months or longer before the fracture was sufficiently stable to allow ambulation. Skeletal traction is seldom used in modern practice, usually it is only a temporary mode of treatment. Internal Fixation is still the treatment of choice for most closed injuries, this is because of higher union rates, lower rates of complications, earlier weight bearing, shorter hospital stays and early return to daily activites. In KNH majority of the patients admitted with femoral fractures are managed initially on skeletal traction. Patients with proximal femoral fractures are on Russel Hamiltons traction while patients with femoral shaft fractures are on Perkins traction. When the patient is managed on skeletal traction the patient is on prolonged bed rest and hospital stay increases also nursing care is difficult and the patient is at risk of developing morbidities due to the skeletal traction and prolonged immobilisation. The cost of care is increased and as seen in our setting most of the patients we manage come from a low socio-economic background who have difficulties in financing their healthcare. The prolonged confinements of the patients on traction is associated with certain complications, such as pin tract infections, decubitus ulcers, which can be overcome by better nursing care, but the complications of prolonged bed rest such as bladder and bowel derangements, deep venous thrombosis, osteoporosis, muscle wasting, to mention only a few cannot be prevented hence the need for early internal fixation. Literature Review Motor vehicle crashes are the leading cause of death in adolescents and young adults (1,2,3,4) and of the estimated 856 000 road deaths occurring annually worldwide, 74% are in developing countries (5). In both Nigeria (6,7) and Kenya (8), for example, a fivefold increase in traffic-related fatalities was observed over the last 30 years. Injuries cause profound morbidity and are one of top 10 causes of death and disability in both developing and developed economies (9). Kenya, like other developing countries, lacks organised efforts to reduce the burden of injuries. Although there is debate as to whether trauma systems in high-income countries are transferable to developing economies, baseline studies providing accounts of injury and injury trends in least developed countries are scanty.(10) Media reports have raised concern over rising road accident injuries in Kenya. Most of these occur in the capital city, Nairobi (11). Those injured mainly receive treatment at the Kenyatta National Hospital (KNH) the citys main hospital. The city lacks a systematic pre-hospital care and the patients arrive at the institution at any time and unannounced. As demonstrated in Saidis study, the injured are transported to hospital by private vehicles in the majority of cases. Ninety two per cent of the casualties arrive at KNH without any pre-hospital optimisation. (10) Saidi et al (12)found 31.0% of all admissions at KNH are due to injury indicating that a large volume of trauma admissions is handled at this public hospital. The average length of hospital stay of 14 days is from Saidis study is much longer than in reports from established trauma facilities. At the Vancouver General and Teaching Hospital, Canada, the length in 1997 was 9.14 days despite caring for patients with severer injuries (24% with ISS > 16) than in Saidis (12) cohort of patients (13.4% with ISS > 15) [12,13]. The excess length of hospital stay at KNH is caused by the predominance of skeletal injuries. Long bone fracture fixation is usually performed late, a practice occasioned by the local economic environment and a limiting factor for external validity of this outcome measure. An initial period of nonoperative care, which may last up to 4 weeks, is inevitable. The delay is caused by time spent to raise funds for desired implants. Many patients (90%) pay for the services out of their pockets [14]. If a policy of early fracture treatment incorporating a care reimbursement system that does not delay the operative intervention is introduced, the average length of stay may improve. This early fixation would additionally prevent pulmonary failure state, alleviate pain, ease nursing care, reduce complications [15], and allow early rehabilitation and return to work. The principles of traction are a pulling force that is applied to part of the body i.e. the limbs, the pelvis or spine and another force applied in the opposite direction called counter traction. The forces involved in traction are based on Newtons third law of motion, which states for every action there has to be an equal and opposite reaction. Malgaigne characterized as the greatest surgical historian, and author of the 1st comprehensive work on the diagnosis and the treatment of fractures (18), credits Guy de Chauliac with the introduction of continuous, isotonic traction in the treatment of fractures of the femur. This was accomplished by suspending a weight, attached to the leg by a cord over a pulley at the foot of the bed. The use of traction dates as far back as 3000 yrs. The Aztecs and the ancient Egyptians used manual traction and made splints out of tree branches and bark. (19) In 1847, Malgaigne introduced the first effective device which grasped the bone itself, these hooks were designed for the Rx of displaced patella fractures, the hooks were pressed through the skin and subcutaneous tissue to engage the proximal and distal fragment of the patella.(18) During World War One there was a rapid spread of the use of skeletal traction by application of tongs to the femoral condyles. After the war the tongs were extensively used in the United States but their popularity gradually decreased because of the complications, particularly infection associated with their use, tongs are now mainly reserved for skull traction.(21,22,23,24,25) Skeletal traction by means of the Steinman pin was popularized by Bohler and his students. Isotonic traction still remains an essential element in the closed treatment of many fractures. In many places worldwide it is standard practice to apply skeletal or skin traction to the injured limb following acute fractures prior to surgery Billsten 1996; Brink, 2005 (41). Traction may be either skin or skeletal. The main theoretical advantages of traction are that it will reduce pain at the fracture site and assist the reduction of the fracture thereby making the subsequent operation easier to perform. For intracapsular fractures reduction in circulatory complications has been proposed as traction may reduce any tamponade effect (Pressure caused by build up of excess fluid) which will compress blood vessels and block blood flow within the joint. Traction however has potential disadvantages, it makes nursing of the patients more difficult for e.g. use of a bed pan by the patient, pressure area care prior to surgery. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open closed femoral tibial fractures has become routine.(26) Traction should now be rarely used as the definitive form of management. Orthopaedic surgeons have come to appreciate that there are 4 main treatment goals for fracture management (27). These goals were created by the ASIF (association for the study of internal fixation) and are: Anatomic reduction of the number fragments, ensuring alignment, length, and angulation and rotation are corrected as required. Stable internal fixation to fulfil bio-mechanical demands Preservation of blood supply to the injured area of the extremity. Active pain free mobilization of adjacent muscles and joints to prevent the development of fracture disease There are several studies done to determine the usefulness of pre-op traction, (32,33,34,,35,36,37,38,39), though these studies are mainly looking at proximal femoral fractures. Traction prior to surgery is standard practise in some hospitals, a survey of 78 hospitals in Sweden (40) showed that a quarter of those, routinely applied skin traction to all patients with hip fractures, while another survey done by Brink et al in 2005(41) found that pre-op traction was standard practise in 20% of trauma departments in the Netherlands. These studies have shortfalls in that the type of traction used is mainly skin fraction, and the maximum duration patients are on traction is 2.3 days Brink 2005(41), while in our setting patients are on traction for minimum one week prior to internal fixation . In this study only 4 patients were put on skeletal traction of the total patients put on traction, reasons for the difference are not given. From the Cochrane review article on the pre-op benefits of traction, not many studies have looked at the complications of patients put on skeletal traction. The main outcome measures in these studies (32,33,34,35,36,37,38,39,40,41) were degree of pain, analgesia use, length of surgery, ease of fracture reduction, and it seems like incidence of pressure sores and other complications were secondary objectives. One of the earliest accounts of complications of skeletal traction is from 1946, by Kirby Fills (42) they mainly looked at complications associated with trans-fixation pins and wires in skeletal traction, from a series of 305 fractures of long bones, complications occurred in 12, of these only 3 were related with Steinman pin use one of the patients had pin tract infection (PTI), and 2 had peroneal nerve palsy, however the author clearly states many patients who had a little drainage from the pin but no signs of inflammation were not regarded as pin tract infection . Pin tract infection is defined as an abnormal condition associated with skeletal traction or external fixation devices and is characterized by infection of superficial, deeper or soft tissues or by osteomyelitis. These infections may develop at skeletal traction pin sites. Some of the signs of pin tract infection are erythema at the pin sites, drainage, pin loosening, elevated temperature, and pain. The bone pin construct is not a sterile interface, but it is a pathway between the surface of the skin, which is normally colonized by bacteria, and the medullary cavity which is sterile (43). Factors which predispose to pin tract infection are thermal necrosis (44) and accumulation of fluid around the pin (45). Regular pin care prevents crusting around the pins, thus minimizing fluid accumulation and hence transmission of bacteria, within the underlying tissues (45). Pin insertion using a hammer leads to splintering of the cortex (46). Insertion of the pin using power tools has been indicated as the main cause of thermal necrosis (44) hence hand drills are preferable for insertion. Necrosis of osteophytes and tissues due to the temperature elevation provide a fertile bed for any pathogenic bacteria. Patients who are put on skeletal traction suffer from morbidities associated with prolonged bed rest. A feature peculiar to these patients is morbidities associated with pin tract infections, which results in pain, pin loosening and subsequently need for removal of the pin. Neglect in these cases can lead to abscess formation and osteomyelitis (43). Similar morbidity of pin tract infection is associated with pins used in external fixators. Reported incidence in the world literature on pin tract infection is 5-10% (47,48,49,50). This incidence increases in cases of transfixation pins upto about 80% (51). The prevalence of pin tract infection varies dramatically in the literature from a 1% prevalence of major infections to an 80% prevalence of minor infections (52). Even in the study identified by the Cochrane review (53) the prevalence of pin tract infection varied, based on the treatment of pin sites, from 8-25% (54). A common factor in most studies of pin site complication is the lack of a standard definition of what constitutes a PTI is it inflammation around the pin site as reported in upto 41.6% in one series (55), or is it cellulitis around the pins or pin sites with draining sero-purulent discharge or is it pin loosening. Therefore this study is being done to establish what the rates of pin tract infection are when all the signs of inflammation will be used to diagnose pin tract infection. Looking at studies done closer to home in 1962 procter reported his series of 41 patients in SA (56), he was looking at use of perkins traction in femoral fracture management. PTI was found in 15% of the patients, while all the patients had full knee ROM at a period of 10 weeks. A few years later Usdin reported his own series of 58 patients, managed by perkins traction, and 5 of these patients 8.6% developed pin tract infections, and 2 cases had residual knee stiffness (57). More recently Gosselin in his series of 53 patients from Sierra Leone in 2005 reported that 23 patients (42.6%) of his patients had a pin tract infection and at an average 29 days after being put on traction.(59) Therefore it is noted incidence of PTI varies from centre to centre and is dependent on several factors , it is the purpose of this study to establish what proportion of patients on skeletal traction develop a PTI. Other complications associated with skeletal traction are decubitus ulcers, venous thromboembolism, Knee stiffness and pneumonia. There is sparse literature which reports on the occurrence of these complications in association with skeletal traction. Butt et al in his RCT of operative versus non-operative treatment of distal femoral fractures found that in the non-operative arm, a total of 26 patients developed complications. 3 of these patients had DVT, 4 had chest infections, 4 had pressure sores, 4 had UTIs (58) and 5 out of 26 patients developed pin tract infection. When critically ill patients are under our care it is important to protect them from further deterioration or delays in recovery, especially due to complications that are not related to the underlying pathophysiology that brought the patient to hospital. Immobility is associated with increased risk of VTE, decubitus ulcers and pulmonary insufficiency. Bed rest is a highly un-physiologic form of therapy and can lead to a number of complications (table1). Immobility-Associated Complications System Complications Respiratory Atelectasis Pneumonia Pulmonary embolus Cardiovascular Hypovolemia Dampened carotid baroreceptor response Orthostatic hypotension Deep venous thrombosis Gastrointestinal Constipation Ileus Renal Renal calculi Urinary stasis Endocrine Hyperglycemia Insulin resistance Musculoskeletal Muscular atrophy and deconditioning Bone demineralization Joint contractures Skin Decubitus ulcers Psychosocial Depression Decreased functional capacity Decreased respiratory excursion and stasis of secretions leads to atelectasis and pneumonia, lesser muscle contractions of the lower limbs results in reduced venous return, venous stasis and VTE. Reconditioning, loss of skeletal muscle mass and strength, is often seen because of immobilization. Bone demineralization due to absence of weight bearing stress on the skeleton, joint contraction occurs because of muscle atrophy. Pressure sores develop because of prolonged pressure on bony prominences. DVT and PE have long been recognized as major causes of morbidity and mortality in patients undergoing both elective and emergency orthopedic surgery. Numerous studies have investigated the incidence of DVT PE associated with hip and total knee arthroplasty, also the role of prophylactic anti-coagulation has been extremely investigated. When considering orthopedic trauma patients extrapolation from the arthroplasty literature is not appropriate. The incidence of DVT PE in association with hip and pelvic fracture has been looked at extensively, however there is insufficient information on patients with femoral fractures managed with skeletal traction, so as to allow the orthopedic surgeon to determine the risk or benefit rational of anti coagulation. In a prospective study done in Canada a co-host of 349 following major trauma was studied, and DVT cross found in 126 of the 182 with lower extremity orthopedic injuries, 61% of patients with pelvic fractures, 80% of patients with femoral fractures, 77% of patients with tibia fractures had confirmed DVT using venographic studies. Patients with fracture of tibia, femur are known to be at almost a 5 times more risk to have DVT as compared to patients without fractures. Geerts et al also found that only 3 of the 201 patients with confirmed DVT (ODS 1.5%) had clinical characteristics suggestive of DVT, therefore it is questionable whether clinical characteristics are adequate to make a diagnosis of DVT. Although it is well known that elderly patients have an increased risk of thrombosis. Geerts et al also found that younger patients with trauma those that are under 30years had a 46% incidence of DVT. The incidence of DVT in patients with femoral fractures on skeletal traction is unknown. The purpose of this study is to determine the incidence of DVT with positive clinical characteristics and confirmed by Doppler U/S in patients on skeletal traction for femoral fractures. Respiratory problems are common after long bone fractures, The main common complication of long bone fracture is fat embolism syndrome (FES),(60) followed by respiratory dysfunction and insufficiency.(61,62) Despite the development of medical and anesthetic management, evidence indicates that early treatment of the fractures in a multiply injured patient has a profound effect in reducing the risk of subsequent respiratory complications. (61,63,64,65,66) There are numerous studies showing that early fixation of femoral fractures can decrease the incidence of ARDS and multiple organ failure (MOF).(67,68,69,70,71,65) Over the last decade the beneficial effects of early stabilization of femoral shaft fractures by intramedullary nailing have been challenged. The association between early femoral fixation with reamed nailing and a higher risk of ARDS/MOF has been suggested.(56,64,60,61,65,66,) The first prospective study on this subject showed that among 178 patients, the incidence of pulmonary complications was significantly higher in those with late stabilized fracture.(71) In patients with single fracture, the complication rate after late fixation was 22% in comparison with 4% after early stabilization. In multiple fractures, these rates the traction were100% and 32%, respectively.(69,70) Early fixation can lead to the prevention of thrombosis, subsequent bed ulcers, and decreases the needs for analgesics.(65,74) Furthermore, early stabilization eliminates the need for supine position for skeletal traction, it improves pulmonary function and prevents atelectasis.(63,65,67,74,75) This study is aimed to determine the incidence of respiratory problems in patients who have single femoral or multiple fractures, and are awaiting operative stabilization. Severely restricted knee motion is a recognized complication of operative procedures or trauma around the knee. This is a significant problem in underdeveloped countries where the initial management of many of these injuries is suboptimal. The reported rate (76,77,78,79) of significant knee stiffness after various injuries and procedures around the knee is as high as 11% in the western literature, but may be much higher in underdeveloped countries, where ideal management of trauma is not readily available (80). A large percentage of these cases present with adhesions inside as well as outside the knee, and the management of these cases then becomes complex. Loss of extension is labelled more debilitating in western cultures, with small extension deficits impeding normal walking ; restricted flexion however is a serious problem in the Asian countries, where social and religious mores make sitting on the ground a normal requirement of everyday life. Flexion loss is mostly due to intra-articular fibrosis and scarring in the quadriceps-femoral mechanism. Anterior adhesions involve the quadriceps expansion in the lateral and medial recesses, the suprapatellar bursa, muscle adhesions to the femur, patella , or even shortening of the rectus femoris (77). A number of studies have described the complications of traction however no study from the region where patients are primarily managed on skeletal traction have looked at the complications due to skeletal traction and those associated with prolonged immobilization. STUDY JUSTIFICATION:- American College of Surgeons Committee on Trauma has recommended that femoral shaft fractures in polytrauma patients be treated within 2-12 hours after injury, provided they are hemodynamically stable.(81,82) Studies have also shown the significant benefit of intervention within the first 24 hours. Immediate fixation has been shown to decrease fatalities, respiratory complications, multisystem organ failure, and the length of ICU stays in most patients. The type of early fixation used can be debated, but the timing appears to be what makes the difference (83,84). World over fracture fixation has evolved whereby early fixation is advocated for. In the resource-poor local setting with large volumes of patients occasioned by persistently high RTA, the primary management modality is skeletal traction. There is lack of skilled personnel (surgeons/traumatologists) in most peripheral hospitals and hence most patients who have sustained fractures of the lower limb are put on skeletal traction as ORIF cannot be done therefore it is important to establish what are the common complications suffered by these patients. There is a large volume of patients who are seen at KNH, this is mainly because of the poor infrastructure at peripheral hospitals in managing major orthopaedic injuries hence most patients are referred to KNH causing a strain on its resources and ultimately leading to substandard orthopaedic care. The complications associated with skeletal traction and prolonged immobilization have been reported by several authors however most of the numbers of patients who are managed on skeletal traction in these studies are few. In our setup most of the patients with femoral fractures are put on skeletal traction while awaiting operative management therefore it is important to know what the incidence of these complications in our setting are. The incidence of pin tract infection in most studies is not adequately reported as there is no standardized definition of pin tract infection therefore this study will look at pin tract infection broadly . In KNH patients with femoral fractures are put on skeletal traction while awaiting fixation, this is mostly done on an elective operating list and it is not known what duration these patients are on traction, from this study we will establish what the mean waiting time is for a patient with femoral fracture to be internally fixed. It is not known what number of patients with femoral fractures who are put on traction in our setting develop complications hence this study is being done to establish the proportion of patients who get pin tract infections, and other complications associated with skeletal traction. BROAD OBJECTIVE:- To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. SPECIFIC OBJECTIVE:- To determine the proportion of patients on skeletal traction for LE fracture who develop pin tract infections venous thrombo-embolism knee stiffness pressure sores orthostatic pneumonia 2. Determine the proportion of those who recover from the complications 3. To determine the duration patients are on traction 4. Proportion of those with adverse outcomes following complications PATIENTS AND METHODS STUDY DESIGN This is a Hospital based Prospective Descriptive study. STUDY SETTING:- The study will be carried out at the KNH orthopaedic wards. STUDY PERIOD:- The study will be carried out over a period of four months or?until the sample size is achieved SELECTION CRITERIA :- All patients eligible to the study will be enrolled until the sample size is obtained. INCLUSION CRITERIA:- All skeletally-mature pts with lower extremity fractures put on skeletal traction as a definitive or temporary treatment option Those consenting to be recruited in to the study. EXCLUSION CRITERIA:- Skeletal immaturity determined radiologically. Pre existing disease: pneumonia, VTE, pressure sores SAMPLE SIZE CALCULATION:- The sample size will be determined by the use of the following formulae to achieve an adequate sample to accurately estimate the prevalence of complications in pin tract infection in the study population. n = Z2ÃŽÂ ±/2 X P (1-P) D2 Where n = required sample size P = prevalence of pin tract infection (42.6%, 24%  [1]  , 26%  [2]  ), based on the estimated prevalence from a similar study in Sierra Leon by Gosselin. This is the only study in the developing country performed in a similar setting. D = Precision with which to measure prevalence, set at plus or minus 1%. The ZÃŽÂ ±/2 is the cut off points along the x-axis of the standard normal probability distribution that represents probability matching the 95% confidence interval (1.96). Substituting the above in the formulae we get; n à ¢Ã¢â‚¬ °Ã‹â€  93.9 = 94 patients DEFINITIONS OF COMPLICATIONS AS WILL BE USED IN DATA COLLECTION :- Pin Tract Infection :- will be defined by signs of hyperemia,pain,crusts,seropurulent discharge around the pin site or pin loosening. Venous Thrombo-embolism :- Patients with unilateral leg swelling, calf pain, will be subjected to doppler u/s to confirm presence of a thrombus. Pressure sores : Trochanteric,sacral,calcaneal regions of the body will be examined and the use of the pressure sore grading system will be used to record presence of pressure sores :- Grade 1 :- non blanchable erythema of intact skin Grade 2:- Partial thickness skin loss involving epidermis,dermis or both Grade 3:- Full thickness skin loss involving damage o or necrosis of subcuataneous tissues that may extend down to but not through underlying fascia Grade 4 :- Full thickness skin losswith extensive destruction, tissue necrosis or damage to muscle or bone. Knee Stiffness :- Patients have a reduced range of motion of the knee of the injured limb and will determined by range of motion of less than 30 degrees, less than or equal to 90 degrees or more than 90 degrees. Pneumonia :- Patients who have recorded high temperatures, respiratory distress, cough, chest pain will be used to make a diagnosis of pneumonia. DATA COLLECTION:- Patients will be recruited into the study Consecutively Use of a questionnaire to gather data, including demographics, cause of fracture, traction system and its duration, incidence of complications and their outcome. Data will be collected as pertains to the date of commencement of traction up to the date patient undergoes operative management or is taken off traction. Patients will be recruited into the study as they are put on traction, and will be followed upto the time they are taken off traction. DATA ANALYSIS:- The data will be collected using a structured questionnaire. The questionnaires will be coded to make the data entry easy. The filled questionnaires will be kept in a safe place ready for the data entry and for the confidentiality of the patients details. After cross checking the questionnaires for any missing entries a data base will be designed in MS Access which will allow the researcher to set controls and validation of the variables. On completion of the data entry exercise the data will be exported in a Statistical Package (SPSS Version 15.0 Chicago , Illinois) for analysis. The data will be presented in tables and figures where applicable. Non- Parametric tests (Mann Whitney U test) will be used to examine whether there is any significant association between the continuous variables e.g. age and duration count, while chi-square will be used to establish the significant associations between the categorical variables. Odds Ratios (OR) and associated 95%C