Operations Management Coursework Example | Topics and Well Written Essays - 1500 words

Operations Management - Coursework Example The client is an organization engaged in providing hotel services and accommodations in each of their twelve holiday centres spread over the Mediterranean and the Caribbean. Each holiday centres also provide water sports facilities including restaurants, bars, entertainments and retail establishments. The engagement is to automate the production of quarterly reports for submission to Headquarter and to provide real time daily reports to local management and weekly reports to senior management stationed at the Headquarter. The proceeding pages will indicate the integration definition of the organization (Podeswa, 2008). Part of the engagement is to overcome the following challenges that need to be resolved quickly. Improve if not overhaul the image of the organization to negate the impact of disgruntled customers that obliterates their ability to have repeat customers. The primary focus is to determine what part of the business is having difficulties if not the part of the business where customer experience is at its worst. Gathering data related to customer satisfaction is an essential foundation for the solution that will be recommended since its success or efficacy can only be determined if a baseline performance has been measured. A primary solution that can be implemented to resolve the reporting requirement is to automate the frontline portion of the process to get an accurate data capture process that can provide reliable data. The same mechanism or process can also be employed to measure key performance indicators (Bissessur, 2010) that are primarily designed to measure customer satisfaction. Customer complaints and feedback methodology will also be used to determine if not validate the data reflected by the metrics that measures the key performance indicators for customer satisfaction. Customer Satisfaction rate = Customer Complaints received/Total

PPDP provides skills level mapping tool

PPDP provides skills level mapping tool OUT Come 14; Demonstrate responsibility for ones own learning through the development of a portfolioof practice and recognise when further learning is required. Evidence Doc; P1S3R32(Reflection on placement 1) One of the important learning from my 1st placement is the development of personal and professional development portfolio (PPDP). PPDP provides skills level mapping tool and planning for further skills (Wenzel et al 1998).PPDP is developed by nurses and other health care professionals in their professional career (Oermann 2002). When I started my placement, I have no idea; Why I need to develop PPDP? What is the importance of PPDP and how PPDP helps in building up personal and professional development (Trossman 1999)? Soon, I could understand the fact that PPDP are reflection of nurses skill level and provides a tool for development of professional skills (Kelly 1995). My PPDP consists of three main components; Assessment of skills including self, peers and mentors assessments, preparation of action plans for further development and reviews of achieved skills at various intervals. In developing the first part of my PPDP, I looked at essential skill clusters recommended by NMC for nurses (Semple et al 2003) and then I evaluated my current skill levels before developing my PPDP. A nurse should evaluate personal and professional skills throughout his/her professional career (Meeks et al 1995). Actually, it is a time of competition and perfection. In the environment of constant competition and improvement, the knowledge and skills required to enter nursing practice are never sufficient (Cary et al 2005). Therefore, it is recommended for nurses to improve their essential skills through development of PPDP (Cayne 1995). In the first part of my PPDP, I took assessment of my current skills through self evaluation, assessment by my mentor and by taking views of my peers and even clients views on my essential skills to become a good professional nurse. PPDP is an assessment tool for ones skills level (Lettus et al 2001). PPDP are used for continued personal and professional development of nurses (Meister et al 2002). Similarly, I could know that I was deficient in some skills like communication, addressing client, keeping confidentiality etc. By developing PPDP, I also identified that I need to develop some new skills to reach nursing professional standard. First, I thought that only my self assessment is sufficient to evaluate my current skills level. However, there was a question in my mind; Can we rely on self assessment only? The answer comes in No in a study conducted on physician whom self assessment were different than assessment done by external agencies (Davis et al 2006). Then I thought why only self assessment is not sufficient to evaluate ones own skill level. Actually, the assessment of PPDP depends upon assessors individuality (McMullin et al 2004). The angle, way of thinking and thinking approach of myself may be different than others. Secondly other observers like my peers and mentor would be more experienced than me and can reflect more perfectly on my deficiencies and weaknesses in my skills. An external assessor looks at the competencies or the extent of learning in comparison of individuals capacity of self evaluation ( Davis et al 2006). Self assessment could be wrong or weak (Forker et al 1996). Therefore self asse ssment should be counter checked by feedback from experienced people. In performing the evaluation of my skills level, I therefore used not only my self assessment but also feedback from my mentor and peers. Development of PPDP is used to enhance learning skills and abilities by keeping records of current essential skills and planning for development of future skills (Hoban 2003). In developing my PPDP, I recorded my trainings, qualifications and achievements in one compartment. Portfolios are individualised, organised, selective, ongoing and reflective (Hall et al 1996). Similarly, my portfolio would be different from others in arrangement and collection of myself information. I have started developing my PPDP in my first placement but it will continue throughout my training and later on in my professional career. The second compartment of my PPDP consists on action plans for development of my deficient skills and need for new skills. Development of action plans seemed to be not much important to me at the beginning of my placement. But later on, I could understand the value of action plans, without those, I could not be able to look at my deficient skills and could not take necessary steps to learn new skills. PPDP are also used as past reference of learning weaknesses and thus lead to avoid further errors in future (Karlowicz 2000). Similarly, I could find out where I have made mistakes in my first placement. For example, I was using real name of client in my reflection but my mentor asked me to used fictitious names for DATA protection act. Thus I could know the importance of confidentiality and decided not to disclose clients information without his/her consent. Again the development of action plans were a difficult job and only my understanding was not sufficient. Therefore, action plans were developed and agreed with my mentor in my supervisions. The third part of my PPDP consists on assessment reviews. It is the stage where achievement of new skills and improvement of current skills are evaluated and further developmental needs are identified (Tiwari et al 2003). I took my skill assessment reviews with my mentor. My mentor looked at last action plans and identified my achieved skills since my last action plan. Assessment reviews are also focused on needs to develop further skills in a PPDP (Weinstein 2002). Assessment reviews identify issues in PPDP where student fails to achieve required skill level (Moses 2000). Similarly, my mentor found out few skills which I could not achieve due to non-opportunity at the placement site. I have decided to use assessment reviews in my PPDP to enhance my existing skills to the professional level of nursing standard recommended by NMC (UKCC 1992). SUMMARY I learnt from development of PPDP that I can make assessment of my skills not only by self assessment but with the help of feedback from other staff and experienced people like my mentor. I can use action plans for development of my further development in the light of feedback received by my peers, mentor, myself assessment and clients view. I can use assessment reviews to identify achievement of new skills, improvement of current skills and planning for further developmental needs. OUT Come 12; Demonstrate an understanding of the role of others by participating in inter-professional working practice. . Evidence Doc; P1S3R25(Reflection on community team meeting) I started my first placement at community mental health services. I had no idea about community mental health teams (CMHT) when I started my placement. How CMHT works? Who co-ordinate CMHT activities? Who take first intervention and at what level? How clients are referred to CMHT or how client find help from CMHT? These were all question in my mind at the beginning of my placement. I could not have chance to understand the working pattern of CMHT if I had not got a chance of getting an experienced and skilled mentor with central role in CMHT. My mentor works as care- coordinator in CMHT. Therefore, I have an advantage to learn inter-professional practice of my mentor among multidisciplinary team (MDT). I found that community mental health services run through MDT (Caldwell et al 2003). MDT consists on healthcare professionals, medics, social workers, care and support workers and consultants (OConnor et al 2006). A mental health nurse participates in MDT (Van 2004). In the beginning I was confused with an idea that why a single team could not be able to provide mental health services in community. Actually MDT work together to provide care to mental health clients (Clarke 2004). Diversity of knowledge, experience and skills in MDT members provide advantage to treat various mental health issues at multidisciplinary levels (Ellefsen 2002). However, there should always be an individual with central role to coordinate and collate the activities of MDT into a successful pattern to provide mental health services to client. Such a role of inter-professional working practice was my mentors job role. The MDT at my placement site consists on continuing care team, early intervention team and crisis intervention team. In addition to these teams at placement sites, other community mental health teams like transcultural team, community day services, home treatment team and various volunteer and trust organizations like MIND, RETHINK, SPACE, Fitzwilliam center participate in MDT. Each community care team consists on individuals of various behaviour, knowledge, skills and experience. My team was continuing care team consisting on three members from various professions, experience and knowledge. My team interacts with other teams and health professionals during meetings and in providing support to client. I have got chance to look at interaction of my mentor with members of other MDT members. For example, in community meetings, my mentor took feedback from other team members and provided updating on care issues of mental health clients. Each case is discussed individually and any progress or deterioration is discussed and evaluated (Elkan et al 2000). My mentor plays a vital role in co-coordinating, monitoring and supervising inter-professional activities while caring for mental health clients. For example, a clients family was much worried about the client as they were going away for two day. The client was on Methadone and has taken detox treatment from Fitzwilliam center in last few months. However he has been taking over dose of a medicine named Zopliclone tab in last few weeks. There was risk of leaving him alone at home. The family has not taken an opportunity of recreation for long time. On this weekend family decided to go on beach for two days. Family was much worried about the client. There were multiple aspects in the care of client. On one hand clients safety was issue and on the other hand family worry needs to be considered. Furthermore, methadone dosage need reviewing, clients habit to take over dosage of Zopliclone tablet need to be considered. Many members of MDT seemed to be involved in one clients needs. Therefore, my mentor organized inters professional practice. He explained in meeting that he has arranged support worker to keep close contact with client. My mentor also contacted to home treatment team to visit client every day. In addition to that my mentor will be visiting to client as well. He requested to social worker to ensure family that the client will be safe. My mentor also mentioned that he has contacted Fitzwilliam center to review methadone dosage as client seemed to be fit on less dosage. In addition to that my mentor has contacted to GP t o review clients medication under recent changes. Actually, my mentor act to inter connects various healthcare professionals activities while providing care to the client. Thus I learnt that a care-coordinator carry out inter professional practice to combine individual efforts of care in the form of a united care plan for clients care, management. SUMMARY The role of my mentor as care co-coordinator in his inters professional working practice was enough observation for me to understand his role in organizing various professional activities. Inter- Professional practice co-ordinate activities between various health professionals. Inter- Professional practice combine efforts of various healthcare professionals to result in a united and single agreed care plan. Each member of MDT receives multiple feedbacks from various members of MDT and feedback may oscillate forward and backward creating a sense of care and treatment. For example if my mentor has not organized inter professional practice, home treatment team could not care the client at home, social worker could not know about the risk involved in leaving client alone and GP would not get feedback regarding reviewing Tab Zopliclone and changing it with less adaptive sleeping tablet. OUT Come 10; Recognose situation in which agreed plans of nursing careno longer appear appropriate and refer these to an accountable practitioner. Evidence Doc; P1S3R21(Reflection onfollow up of client LD) When I started placement, it looked impossible for me to review a care plan and to feel need to review a care plan. I was not sure, why a care plan change? How a care plan change? What are the circumstances which may change clients care plan? My initial understanding was review of a care plan at regular and fixed intervals. But my understanding about review of care plan changed when I made visits to client Ld in the supervision of my mentor. Care plans are agreed plans for providing nursing care to clients (Baker 2003). Care plans are prepared after risk assessments and client involvement. (Olofsson et al 2000). Care plans are reviewed after regular intervals but may change immediately followed by some major changes in risk assessments associated to a client. This happened when Client Lds risk assessment change followed by changes in circumstance and therefore care plane was reviewed. I made visits to client Ld with my mentor. History of Ld goes back to the time when her immigration status was changed. Ld belongs to an area where army revolution has caused many sad incidences. Rape of young girls was common and Ld was one of these victims. Ld could escape to UK and applied for asylum but could not prove evidence. Resultantly her asylum was refused. As a result of stress, Ld started getting obsessions of rape and got fits as well due to fear and anxiety of going back to same environment. The changes in Lds circumstance were negative as her mental health and socio-economical status was deteriorated. I got information by looking at Client Lds history that a care plan was revised first time when Client Ld started getting fits. Ambulance services were called and Ld was hospitalized. Then Crisis team revised care plan at first time. According to care plan, Ld was treated for mental illness called schizophrenia (Lysaker et al 2010). She was also provided free legal aid to appeal for her immigration status. Lds anxiety and insomnia was also considered as risk factor for Lds mental health. At the time, Lds immigration status was refused; she was living in shared accommodation. Financial resources were not very good as she was provided very little money in addition to shared accommodation. Then she started obsession and fits. It was the first time when Lds care plan was changed in response to quick changes. As anxiety and stress was considered as a cause of fits, a supported accommodation was planned. Medication for obsession (Tab Clozapine) and insomnia and anxiety (Tab Lorazepam) was prescribed by GP and was a part of care plan. A social worker and interpreter were also allocated to Ld for assistance in living and reducing anxiety and stress. This was the first time; I observed change in Lds care plan following by an abrupt change in Lds circumstances. The cause or change in Lds circumstances was negative as Lds mental issue and vulnerability was deteriorated. Therefore, a close observation with more precise care was recommended in care plan. When I looked at Lds mental health history and crisis teams intervention, I could understand that crisis team reviewd care plan after evaluating potential risk factors. My direct observation (when Lds care plan was changed at second time followed by change in her circumstances) was the time when Lds circumstance has positively improved. It was the second occasion when Lds care plan was changed following a steep change in her circumstance. It was the time when Lds asylum has been accepted and Ld started getting improved in her mental illness. She has not got fits for a long time. She has started living in supported accommodation. She has started going out in community to make friends and having coffee at coffee evening. Ld is due to Start College in September. I observed that it was positive change in circumstance as compared to negative changes when Lds mental health deteriorated in first intervention. I could conclude that why my mentor was suggesting review of Lds care plan. Actually risk assessment has changed as risk factors for Lds mental health are reduced. Need for medication has changed. Therefore, my mentor felt a review of medication and r eferred client to consultant for medication review. The same dose of Tab Lorazepam was causing more sleep than required for calmness when clients anxiety was high. Client Lds improvement in mental health status has identified her needs for social interaction and therefore an independent accommodation was recommended in reviewed care plan. As Client Lds social interaction will increase soon, she will need more financial help. As a result of success in asylum, Ld deserves more financial aid now. Therefore it was recommended in care plan to help Ld to apply for her benefits. As Ld would be getting more financial help, it was felt that Ld should be provided help in managing her budget as she will be living independently. Therefore, social worker was requested to help Ld making her monthly budget. It was also a part of reviewed care plan. Clients participation and consultation from experts are final steps in care plan review (Hunt et al 1994). Client Ld was involved in care plan review at all stages. My mentor asked her at each step of review if she was happy with changes in care plan. A final opinion was taken from consultant before finally reviewing Lds care plan. Client Ld case has provided me understanding that a care plan goes out of date when personal, mental health, financial and social issues change. The change in circumstance may be positive in case of improvement or negative in case of deterioration of mental health issues or socio-economical issues. Lds case is a perfect example of care plan review followed by positive and negative changes in circumstances. (Word limit 2750) SUMMARY Learning from client Lds case Is practical experience of stress vulnerability model (Zubin et al 1977). Was needed to change in care plan followed by an immediate change in circumstances of a client. For example, client Lds circumstance change twice times. Once negatively when crisis team drafted first care plan and secondly as positively when my mentor reviewed her care plan. I can understand that care plans are reviewed followed by any change in clients mental health issues and other circumstances resulting in changes in risk assessment. CONCLUSION The placement has provided me clear idea and good understanding of the skills required to be a professional mental health nurse. I learnt about development of PPDP, care plans review followed by immediately changes associated to a client environment, the role of a care coordinator to work in inter-professional practice and many other essential skills to become a professional mental health nurse. In developing a PPDP, I learnt making initial assessment of skills required to reach nursing standards, preparation of action plans to identify past mistakes, future planning for skills and review of skills at the end of each action plan duration. I learnt the inter professional practice of a health care professional (my mentor at my placement) to organize and unite efforts of various healthcare professionals in creating a single united care plan for client. I also learnt to review care plan if there is change in risk assessment for client. REFERENCE Caldwell K, Atwal A, 2003,The problems of interprofessional healthcare practice in hospitals. Brf Nurs,12:1212-18. Cayne,J.V.,1995.Portfolio: a developmental influence. Journal of Advanced Nursing,21,395-405. Cary AH, Smolenski MC.2005, Overview of competency and the methods for evaluating continued competence. American Nurses Association 1-10 Clarke, J.2004.Public health nursing in Ireland. A critical overview. Public health Nursing,21(2),191-198. Davis DA, Mazmanian PE, Fordis M, Harrison RV, Thorpe KE, Perrier L.2006, Accuracy of physician self assessment compared with observed measures of competence. J Am Med Assoc; 296-9;1094-1102. Elkan, R., Blair,M., robinson, J, 2000. Evidance based practice and health visiting;The need for theoretical underpinnings of evaluation. Journal of Advanced Nursing,31(6),1316-1323. Ellefesen, B,2002. The experience of collaboration; A comparison of health visiting in Scotland and Norway. International Nursing Review, 49(3),144-153. Forker,J.E, McDonald,M.E, 1996. Methodological trends in healthcare professions; portfolio assessment. Nurse Educator,21(5),9-10. Hoban,V.,2003.Careers-How to get the most from your portfolio? Nursing Times 99(17),58-59. Karlowicz, K.A,2000. The valueof student portfolio to evaluate undergraduate nursing programme. Nurse Educator(25) Kelly, J,1995. The really useful guide to portfolio and profiles. Nursing Standards, 9(32), 4-8 Lysaker, Paul H, Jamie, Christina, alan, Tina,2010. Personal narratives and recovery from Schizophrenia. Schizophrenia research, 121 (1-3). P.271-276. Lettus, M.K, Moessner, P.H., Dooly, L., 2001. The clinical portfolio as an assessment tool. Nursing Administration, Quarterly(25),74-80. McMullan M, Endacott R, Gray MA, Jasper M, Miller CML, Scholes J, Webb C.2003, Portfolio and assessment of competence; A review of the literature. Journal of Advanced Nursing, 41-3;283-294. Meeks, A., Hayes,T.,Stahlhammer,S., Zeaply,M, 1995. Evaluation by portfolio. Nursing Mnangement. 26(8),72-74. Meister,L.,Heath, J., Andrews,J., Tingen, M.s.,2002. Professional nursing portfolio; a global perpective. Medsurg, Nursing (11), 177-183. Moses, V., 2000. Record in nursing. The Nurse in Israel (161),12-14. Oermam, M.H., 2002. Developing a professional portfolio in nursing. Orthopaedic Nursing. 21(2),73-78. Olofsson, B., Norberg, A.2000. Experiences of coercion in psychiatric care as narrated by patients, nurses and physicians. Journal of Advanced Nursing, 33(1),89-97 OConnor M, Fisher C, Guilfoyle A 2006. Interdisciplinary teams in pallayive care ;a critical reflection. International Journal of Palliative Nursing.12(3)[132-137 Seguin TJ. 2005. The concept of the portfolio. American Nurses Association and International society of Nurses in Genetics;11-24. Semple M, Cable S, 2003, The new code of professional conduct. Nurs Stand. 19-25;17(23);40-8. Tiwari, A., Tang, C, 2003. From process to outcome; the effect of portfolio assessment on student learning. Nurse Education Today; 23(4), 269-277. Trossman, S., 1999. The professional portfolio; documenting who you are, what you do? American Nurse. 31(2), 1-3. Van Offenbeek M.A.2004, The organizational and performance effects of nurse practitioner roles, Journal of Advanced Nursing, 47, 672-681. Wittenberg-Lyles Em, 2005, Information sharing in interdisciplinary team meetings; An evaluation of hospice goals. Qualitative Health Research, 15;13, 77-1391. Weinstein, S.M, 2002. A nursing portfolio; documenting your professional journey. Journal of Infusion Nursing, 25(6),357-364. Wenzel, I.S., Briggs, K.L., Puryear, B.L., 1998. Portfolio; authentic assessment in the age of the curriculum revolution. Journal of Nursing Education. 37(5),208-212. Zubin.J, Spring.B. 1977, Vulnerability; A new view on Schizophrenia. Journal of abnormal Psychology; 86, 103-126. BIBLIOGRAPHY Barker, p. 2003. Psychiatric and mental health nursing; The craft of caring. London; Arnold. Hall, C., Redfern, L., 1996. Profiles and portfolios; a Guide for Nurses and Midwives. MacMilliam by J.Press (Padstow) Ltd. London. Hunt G, Wainwright P (1994).Expanding the role of the Nurse. Blackwell Scientific, Oxford. UKCC, 1992, The Scope of professional practice. UKCC, Code of professional conduct. NMC, London.

Educational Goals and Philosophy :: Teaching Teachers Education Essays

Educational Goals and Philosophy My idea of the perfect teacher is one that gets the right message across to all students. The perfect teacher would show his or her students good morals and ethics, and still yet deliver to the students what is in the text. The teacher would not necessarily have to teach straight from the book, but just getting the message across is the key. That might even involve a field trip or a hands-on activity, as long as students learn the best way. The best way to learn in my classroom will be the fun way. I will try my best to be as close to the perfect teacher that I can be. I will look at teaching through three of the four philosophical standpoints: idealism, realism, and pragmatism. The most emphasis will be placed on idealism. This is because I want to look at myself as a role model for the children. I also don’t believe in sending students to the office unless it is absolutely necessary. Kids this day in time don’t mind being sent to the office because they don’t want to do the class work anyway. It would only be doing them a favor to send them to the office. I am about half and half on realism. Some of the realist strategies would be very useful in the classroom but there are some I absolutely don’t agree with. I would really like to incorporate technology into the classroom because it is necessary for all children to master technology in the age we live in today. The rules and regulations will also be posted in the class at the beginning of the school year. However, students will not be grouped according to how good their test scores are. From pragmatism I will look at the classroom as a community of learners and apply problem-solving techniques. The students will also learn by engaging in activities first-hand, they do this because when the students start to get bored with what they are doing they quit learning.

Make a Wish Foundation Essay

Specific Purpose: To inform the audience about what the Make-A-Wish foundation does for children with life-altering conditions. Thesis Statement: The Make-A-Wish Foundation’s mission reflects the life-changing impact that a Make-A-Wish experience has on children, families, and entire communities. Introduction . I. Attention-getter: â€Å"A wish granted has a deep, life-affirming impact on the wish child and family, creating the hope, strength and joy so greatly needed. What makes each wish even more remarkable is the power to enrich so many others’ lives – from friends, volunteers and donors to sponsors and even entire communities.† –David Williams, President and Chief Executive Officer, Make-A-Wish Foundation of America. (Make-A-Wish, 2006) . II.Establishment of Ethos: I joined the sorority Chi-Omega this August. Chi-Omega has many great things to offer one being the opportunity to work with the Make-A-Wish Foundation. I will work with children with life altering diseases and watch them get their wishes granted. . III. Preview (each main point): First†¦ I will discuss what Make-A-Wish Foundation is all about Next†¦ I will talk about the steps included in granting a wish Finally†¦ I would like to share what Chi-Omega does for the Make-A-Wish Foundation. Transition: I will begin by telling you about the Make-A-Wish Foundation and telling a few stories of wishes. Body: I. Main Idea 1: Make-A-Wish Foundation has evolved into an organization that grants a child’s wish in the United States and its territories every 40 minutes. (Make-A-Wish, 2006) 1. Point: Since 1980 Make-A-Wish has enriched the lives of children with life threatening medical conditions through its wish-granting work. (Make-A-Wish, 2006) `. a.Sub-point: The Foundation was founded after a little Boy named Chris Greicius realized his wish in life was to become a police officer. Little did he know his wish would be the inspiration for the largest wish-granting organization in the World. (Make-A-Wish, 2006) `. b. Sub-point: Since then, the organization has  blossomed into a worldwide phenomenon, reaching more than 193,000 children around the world. (Make-A-Wish, 2006) 0. 2. Point: The Make-A-Wish Foundation grants wishes like going to Disney World, being a police officer for a day, shopping sprees, etc. (Make-A-Wish, 2006) 0 a. Sub-point: 17 year old Susana Romero has had extreme kidney problems since she was born and is severely hearing impaired. She was given the chance to make a wish. Since her condition caused her to be in her room most of the time she chose to have her room redone into something for a teen queen. She stated, â€Å"Now it looks beautiful—better than beautiful.† (Edwards) * â€Å"Because of her medical condition, Susana has to spend a lot of time indoors and it is very important for her room to be one of her favorite places.† Stated Mark Pilon president of the local Make-A-Wish Foundation. (Edwards) b. Sub-point: 11-year-old Karina Valverde has received two heart transplants, her first one when she was 11 months old and her second at age 9. She found out she was able to make a wish after seven months in the hospital. â€Å"Karina’s wish is quite unusual.† Friyana Shah, a volunteer, said. She asked to visit the State of Liberty in New York. The trip touched her and her entire family. (Perez, 2010) Transition: Since I told you about what The Make-A-Wish Foundation and a few wish stories I would like to explain the steps in granting a wish. . II.Main Idea 2: The Make-A-Wish website explains four simple steps to granting a wish. Each and every step builds on the next to create amazing experiences that please the kids and their family. 0. 1. Point: The first step in granting a wish is the referral step. `. a.Sub-point: The organization relies on referrals from medical professionals, parents and the children themselves. b. Sub-point: Children between the ages of two and a half and eighteen who have not received a wish from another wish-granting organization may be eligible for a wish. 2. Point: The second step is Medical Eligibility. a. Sub-Point: Make a wish determines a child’s medical eligibility with the help of the treating physician. b. Sub-Point: The child must be diagnosed with a life-threatening medical condition that has placed the child’s life in jeopardy. 3. Point: Step number three is finding the true wish. a. Sub-Point: Make A Wish finds one of their enthusiastic wish teams to learn all about the child’s one very important wish. b. Sub-Point: These passionate  volunteers connect with the children and help explore their imaginations for the experience that will inspire them. 4. Point: The Fourth most important step is creating joy. a. Sub-Point: The wish-granters create an unforgettable experience driven by the child’s creativity. They make it an incredible experience that will enrich not just the lives of the children and their families, but often an entire community. (Make-A-Wish, 2006) Transition: The four steps of wish granting cannot be completed without the help of volunteers such as Chi-Omega. III. Main Idea 3: One of Chi-Omegas six purposes is their philanthropy, The Make-A-Wish Foundation. Since the start of their alliance they have made a difference in a huge number of children’s lives through volunteering time, talents, and raising money. 1. Sub-Point: Chi-Omegas have organized and sponsored very successful events through volunteering and fundraising. With both they have raised financial support and public awareness. 2. Sub-Point: The Chi-Omega chapter at the University of Arkansas became a Gold Level Sponsor with the Make-A-Wish Foundation. 3. Sub-Point: Since 2001 Chi-Omegas at the U of A have raised over $3.8 million and completed over 238,000 volunteer hours. (Make-A-Wish, 2006) Transition: Now that I have told you about Chi-Omega and what I can do to help out with this great organization I will conclude my speech. Conclusion: I.Summary: This wonderful organization touches the hearts of everyone involved through fundraisers and volunteering. . II.Review (each main point): During my speech I discussed what The Make-A-Wish Foundation is all about, the steps in granting a wish, and what Chi-Omega does for the organization. . III.Creative Concluding Thought: Now that I have informed you about the Make-A-Wish Foundation, I hope you can take this in consideration to volunteer and help change children’s lives with life-threatening conditions. References Brooke Edwards. (17 July). A ROOM OF HER OWN: Wish comes true for Apple Valley teen with surprise bedroom makeover 17-year-old has kidney problems. McClatchy – Tribune Business News, Retrieved September 13, 2010, from ABI/INFORM Complete. (Document ID: 2082473241). Make-A-Wish Foundation of America (2006). Retrieved September, 2010 Perez, C. (2010, August 26). A Dream Come True: Foundation makes girl’s New York trip possible. Dodge City Daily Global.

Women in Korean Society: A Past and Present Perspective

â€Å"The Music from Gwangsang Mountian where I played in my dream† is one of the most famous poems, which was written by a woman who lived in 1500s. The poem basically means that the writer of this poem eager to escape from the patriarchal society. The poem was written by a Korean women poet â€Å"Heo Hanselheon† who lived in 1500s wrote this poem before she died. This poem is describing when she had a dream that she was in the place called â€Å"Gwangsang Mountain†. Gwangsang Mountain is actually represents the paradise that she always dreamed of which is being free from the paternalism. In the poem, the first line, â€Å"Blue sea- water permeate into beaded sea,† show the paradise she had been dreaming, also means the scene that she saw in her dream. The second line, â€Å"Blue bird line on colored bird,† means that she is tired of all her life and she need some â€Å"rest†. The third line, â€Å"Twenty- seven lotus flower fall in red† tell us that the â€Å"rest† is death when she become a twenty-seven years old, which is predicting her death. Of coarse, red would be color of blood, which also represents her death. The last line, â€Å"It is cold on the moon light frost†, is telling that the moon light frost which represents the cruel society towards her is leading her to death or doesn’t feel any guilty and sympathy to her. In the poem, most of words are represent death of her and the dream that she had. The reason why this is important because we understand and assume how harsh her life was how much she wanted leave this horrible place. Since her poem tells us that she wants to escape from patriarchal society, so which relates to our unit 2, Hidden Voice, that there were many Korean women who had same wish like writer of this poem. On the other side, the K-pop music has totally different meanings and story than the old Korean poem. The music â€Å"I Will Show You† by Ailee is one of the music that women power gets stronger and overcome the paternalism. The story of this music is very simple; there are one man and one woman who were couple but a woman was a â€Å"nerd†. As a result, a man dumped her and gets another girlfriend. However, a woman changed into a very fashionable and confident, a man changes the attitude toward her and starts to follow her. On the other hand, a woman tired to revenge to men who made her angry and sorrow. It shows that women can control over men. In the lyric, the chorus part, â€Å"I will show you totally different myself/ I will show you more beautiful myself/ I will not cry because of you who was eager love/ I will show I am happier than you when I meet a more cool man/ I don’t feel any sadness even though you are not here, I don’t collapse, boy you gatta be aware† show how much she become confident about her appearance and herself. The starting part of the second verse, â€Å"Change my hair style more fresh and do makeup better/ everyone looking at me who wear high heels and short skirt† directly shows that how she revenge to her ex- boyfriend and it represents the higher states of women. The song is showing why this states changed in the story in the song. This song is important because in the song the states of men and women changed, how men treat women towards their appearance and why women had higher states at the middle of the song. The women and the men had different choices but ended up that she wins in this â€Å"competition† of the states. Since the poem and the song were written in different people in different time, there are many similarities and differences between two. Both poem and song is telling the story in the same point of view. These are all written in women’s perspective and it tells us the story that they have. However, there are more differences between these two. In the song, the woman tired to change her and the attitude that men had towards her. On the other hand, in the poem, the writer wanted to escape from her situation not trying to change her situation.

Alice Walker Research Paper Example

Alice Walker Research Paper Example Alice Walker Paper Alice Walker Paper Journal 4 The Flowers Alice Walkers, â€Å"The Flowers†, is a short story about a young girl Myop. One day, Myop is happy and carefree as she skips around her familys cabin playing with the animals. On this day she decides to explore the woods as she had done many times with her mother in late autumn while gathering nuts. Myop then leaves the safety and peacefulness of her familys cabin to search for new and wonderful flowers. The flowers represent innocence, life, and the beauty of life. This summer morning she makes her own path and finds herself about a mile from home in unfamiliar surroundings. The cove she had come upon was gloomy, damp and had a mysterious silence. This description of the cave is very effective because it provides a picture for the reader to visualize, and makes the later events all the more shocking. In her quest to recapture the happiness of the morning, and find her way back to her cabin, she stumbles onto the remains of a man who had clearly been killed in a lynching. She sees the brittleness of his death when she discovered his large white teeth, all of them cracked or broken showing that he might have been beaten before his murder. She then looks up at a tree and sees the rotted remains of a noose. The dead man represents death, and shows that even though he was once a big, strong man, this had no bearing on preventing his own death. Myop laid down her flowers was a sign of releasing her youthfulness, as she was forced to face one of the most violent forms of racism. The end of her childhood innocence was recognized in the last sentence of the story with the statement And the summer was over.

Antrax essays

Antrax essays Antrax is a rough infectious disease caused by Bacillus anthracis, a positive gram bacteria, aerobe formed from endospores, encapsulated, that can be half ordinary cultivated. The vegetative cell is large (1-8 microns in longitude, 1-1.5 microns wide). The size of a spore is approximately 1 micron. Spores grow rapidly in all cultivated ordinary labs at 37degrees celcius. Its cell morphology and colonial allows its identification by an experienced microbiologist, even though few microbiologists outside of the vetinary community have seen antrax colonies more than in text books. The three virulence factores are: the edema toxin, the deadly toxin and a capsular antigenic. Etymology: Anthracis originated from the Greek word for carbon, anthrakis, because the disease causes black superficial injuries like carbon. The toxic properties of B. anthracis were not recognized until 1954. Previously, due to the tremendous number of observed bacteria in infected animal blood (>109 bacteria/ ml), it was supposed that death was due to the capillary obstruction, But experimentaly it was demonstrated that only approximately 3 million cells/ml are necessary to cause the animals death. Besides, the animals plasmic infection cells contain a toxic that causes antrax symptoms when it is injected in normal rabbits. From these observations it is concluded that exotoxin plays an important role in the pathogeny of antrax. Cepas: There are two even varient colonial(s) a rough(r) that are related with the ability to form a capsule. The R varients are relativaly avirulent. The capsule is not toxic, it acts as protectionj against phagocytosis and it plays its most important role during the establishment of the disease, and a less significant role in the last phase of the disease that is measured by antrax toxin. An antrax toxin component has a deadly action form that at this time is not discovered. Death is apparantly due to th ...

Top 10 Medical Careers That Dont Require a Graduate Degree

Top 10 Medical Careers That Dont Require a Graduate Degree according to the experts over at bestmedicaldegrees.com, there are at least 30 promising career options for people  with an interest in a medical profession but without the time or resources for medical school. here are the top 10 highest paying careers that require a bachelor’s degree and either on-the-job training or professional certifications. take a look at the list and see which one will be right for you!10. dietician and nutritionist ($55k)professional dieticians and nutritionists are required to have bachelor’s degrees in nutrition science and will need some kind of partnership or mentoring from physicians or fellow dieticians. these partnerships allow access to patients so dns can practice the development and implementation of schedules and lifestyle plans. they may also work in hospitals, care facilities, or other clinic or gym settings where they can work directly with clients.9. cytotechnologist ($61k)with a  bachelor’s  degree and graduation fr om an accredited cytotechnology program, certified cytotechs work in laboratories where they research cells and cellular anomalies to contribute to the diagnosis and treatment of diseases and illnesses.8. medical sonographer ($64k)sonographers operate imaging equipment during diagnostic appointments or assist physicians and surgeons during procedures. you’ll need an associate’s degree and a professional certification.7. registered nurse ($68k)rns must be licensed to practice in hospital and physicians’ offices, but many schools are moving from a two-year diploma to a two-year associate degree or a bachelor’s of science in nursing. many medical institutions are reporting a shortage of nurses, so the job prospects are promising.6. nuclear medicine technologist ($70k)an associate or bachelor’s degree in nuclear medicine technology prepares you to operate scanners and administer drugs to assist in a diagnosis or treatment of various ailments.5. radiati on therapist ($75k)â€Å"rad techs† are responsible for administering radiation treatments, most often for cancer patients, and working alongside radiation oncologists and radiation physicists. jobs may be available in hospitals, cancer centers, and outpatient clinic settings.4. biomedical engineer ($86k)biomedical engineering is a relatively recently established field that involves the research and development of diagnostic medical technology, including imaging equipment, prostheses, and pharmaceuticals. a bachelor’s degree in biomedical engineering and professional training on the job is necessary to secure a position in medical equipment manufacturing, hospital, or university settings.3. physician assistant ($90k)â€Å"pas† work closely with physicians to diagnose and treat patients; you’ll need a bachelor’s degree in a relevant field like nursing and an accredited physician assistant educational program. this in-depth but highly supervised work may also help you discover whether you want to pursue a degree in medicine further down the road.2. cardiovascular perfusionist ($94k)a cardiovascular perfusionist is responsible for maintaining heart and lung functions during surgery, monitoring blood pressure, heart rate, respiration, and blood gasses. many work in operating rooms or intensive care units and have completed perfusion training programs in addition to a bachelor’s degree in health studies.1.   medical and health services manager/administrator ($40-110k)if you like a demanding environment and excel under pressure, a position as a medical and health services manager/administrator may be for you! administrators are expected to stay up-to-date on relevant policies and laws, technological changes, and the daily operations of physicians’ offices, hospitals and clinics.

Personal statement. Application essay Example | Topics and Well Written Essays - 500 words

Personal statement. Application - Essay Example I enjoy helping them learn and I derive much joy in understanding how they discover new things in what adults find ordinary and boring. Like every primary school teacher I know, one of the greatest sources of happiness and fulfilment is to see the eyes and faces of children light up when they discover something new. It is like a lamp being switched on inside their minds. I am also at peace whenever I am with children, and I enjoy the noise and chaos that accompany them, a clear sign of their joy of life and of each one's infinite future possibilities. I see the world's future in each one, and I like it when they are noisy and active, eager to enjoy each other's company. I know how to make them quiet through a calm personal presence that adds to their enthusiasm. When I am in front of children, I know how to act according to what the situation demands and steer us all towards learning goals. I know how to motivate children and exercise patience when needed.

Critical Life Experiences that Impacted My Life Essay

Critical Life Experiences that Impacted My Life - Essay Example I must admit that one of the greatest life experiences that have shaped by values and beliefs is having been brought up in a Christian set up. I was born in a family that greatly values Christianity. My parents have always adored and upheld Christian values and taught the same to their children. I grew up to appreciate the importance of church in developing values and beliefs (Branson, 2009; Hunt, 1999). As a small child, I began to learn what is right or wrong by putting everything in the context of Christianity. Being raised Catholic in a small country town in Australia made me develop strong Christian values. I continually developed the values of truth, fairness, care, loyalty, respect, purity, equality among others (Branson, 2009). The catholic community draws values and beliefs from the Bible (Hunt, 1999) and, therefore, I have become a strong believer in biblical teachings. However, all the values that I have gained from being associated with the catholic teachings have been af firmed and cemented by my parents who have always made a follow up on my Christian development. My parents, especially my father, strongly believe that good values are nurtured since childhood. A strong family background is overwhelmingly important in impacting values and motivating children towards their set goals in life (Hunt, 1999). My experiences in a large family that upholds family values have made me grow tremendously in human values. As a family, we have always appreciated the importance of family functions, such as get together ceremonies, weddings, birthday celebrations among other family functions. These diverse family functions have really encouraged me to uphold family values and the importance of the family as a basic unit for the society (Branson, 2009). More importantly, the financial, moral, and psychological support I have received from the large family base have greatly motivated me in achieving my goals in life. Actually, I have been able to achieve much in life especially in academics by the need to meet and exceed the standards that have already been set by my family members (Tysum, 2010). Exposure to different social and cultural set ups across the world have been a great boost to my behavior and values. I have travelled and taught in different parts of the world, especially in the US and London. Admittedly, the exposure to different social set ups have greatly impacted on my behavior in my endeavor to fit in those set ups. For instance, I had to take time to learn new cultural beliefs every time I went to a new society. When I went to teach in London, I had to learn new behavior in order to fit perfectly in the society. Additionally, I had to change my behavior and adapt to the cultural system of the US. This way, I was able to integrate with the society and expedite my duties as a lecturer effectively. I must admit that the exposure to different societal set ups have acted as a great motivation. When I was teaching in the US, I came a cross teachers that are more experienced and more effective in their teaching methods. In the process, I learned to be more competitive by striving to be better than the experts are and this has indeed been a great motivation especially in my career as a teacher. Different societal set ups have different value attached to education among other social tenets (Burton, Smith & Brundrett, 2002; Branson, 2009). For instance, the European and American education systems are slightly different

Teams and Groups Case Study Example | Topics and Well Written Essays - 250 words

Teams and Groups - Case Study Example The market for timber is price-competitive and products are differentiated by their presentation and appearance. Thus customers have started to shift to the other competitors who produce similar products but of a greater quality for the same price. The activity within the packaging team of adopting time-loss pattern has become a norm to this particular work team. Thus, all temporary workers when given a chance to become part of the packaging team adopts this norm. Management can change the supervisors and instead of allowing the sawmill supervisor to overseer the packaging department choose a supervisor from packaging instead. This will assist in the empowerment of the workers when workers feel empowered they produce better. In addition, a supervisor from the packaging department would understand the culture and be able to make changes to the norm easier than an outsider. The overtime costs which would be cut can be used to provide additional incentives to this department. In order to arrest the decline in the mill’s ratings management can perhaps use the overtime money which will be reduced to use more than one supervisor in this department. One for the general overseeing of production and one for the testing of the quality of the finished products. The market for timber is price-competitive and products are differentiated by their presentation and appearance therefore Treetop must begin to differentiate based on sound quality and good appearance again. Treetop’s management can divide the packaging department into teams and allow there to be competition amongst the teams for improvement in productivity. Competition would create a focus for the team and motivate them to produce at their best. Consequently, the overall costs should begin to decline when workers begin to produce optimally due to

Business Ethics - Ethical Dilemma Essay Example | Topics and Well Written Essays - 1500 words

Business Ethics - Ethical Dilemma - Essay Example To do this, the essay will start by describing a situation at my friend Mary’s former placement workplace that posed an ethical dilemma. Later, the essay will seek to explain why the situation proved an ethical dilemma, before coming up with an appropriate solution for it. Working for a few months at Sisto Mission Hospital as a content developer and data entry clerk, Mary came across some information that placed her in a dilemma ethically. As she was gathering information as part of her daily routine, her sister’s fiancà ©Ã¢â‚¬â„¢s name came to the screen. His information said that he had recently been tested for HIV and diagnosed to be positive. In addition, the information also showed that Michael was currently under treatment at a local facility, as well as counseling services, for HIV. Mary and her sister and are close, especially since their mother passed away from cancer early in their lives, which has meant that they always look out for one another. Having met her sister at least six times in the last month, Mary was sure she did not know about Michael’s condition. If she did, Mary or her father would have known about it by now. The information comes at an especially crucial moment because her sister is preparing for her wedding in three weeks. Mary am devastated by the information and torn between her sister and family on one side and her job on the other. If she elects not to give this information to her sister with regards to her fiancà ©Ã¢â‚¬â„¢s condition, she can maintain my integrity and get a good reference from her boss. This is important, as this is a prestigious company, which will strengthen her CV significantly. However, telling her sister about Michael’s condition will inform her decision on whether to go ahead with the wedding. She could be able to evaluate her position alongside Michael and make a decision based on reality. Nonetheless, doing this could lead to termination from Mary’s current position and a poor report from her

Argument essay on achievement gap Example | Topics and Well Written Essays - 750 words

Argument on achievement gap - Essay Example The issue needs to be resolved because despite of many efforts, an analysis of the different states in 2011 revealed that there were still five states in America where this achievement gap had increased since 2003. This analysis explained that an effective policy for overcoming this issue is needed in the country (Johnson 11; Lynch). The achievement gap is a matter of concern as it affects a large number of American students and this issue needs to be addressed with strong and effective strategies for the improvement of the educational system of the country. The achievement gap has been observed not only in primary and secondary schools but it has also been seen in children during their kindergarten years. A further analysis of achievement gap in minority groups has revealed that this gap is known to exist in schools even if the economic status of the all the students is the same. This means that each cause of an achievement gap is independent and it is not essential that students co ming from good economic backgrounds would be saved from this issue (Williams 26,27). According to an analysis done by the National Assessment of Educational Progress in 2007, it was seen that white students were better achievers in reading and math tests which were conducted in the fourth and eighth grade (Lynch). Thus, these surveys and reports indicate that the achievement gap is a grave issue and needs a thorough assessment. This is because considering the statistics of the immigrants in the country; it can be judged that this gap would rise if it is not tackled. This can be assessed as statistics reveal that from the year 2000 till the year 2050, the number of whites would reduce in the United States to 49 percent from 68 percent and the Latinos would form 40 percent of the America population. In a similar trend, the African Americans would rise by 1 percent whereas the Asian population would surge by four percent (Haller). The optimal way to overcome this achievement gap in the country is the formulation of effective instructions and interventions for the students. The achievement gap reduction can be achieved by providing improvement at three levels. These include classroom interventions, targeted interventions and intensive interventions. The most important of these is the classroom intervention where eighty percent of the students of the class learn. The students should be encouraged to learn and study and should be motivated to avoid failing in class. With this, the other interventions should also run side by side for students who are in need of them. For example targeted interventions should be carried out for approximately fifteen percent of the students who have failed to achieve good grades due to their socioeconomic status or due to having difficulties in learning English and reading. Intensive interventions should be saved for students who are not motivated despite of classroom and targeted interventions and do not seem to be interested towards the improvement of their education. These students should be handled individually by a team of instructors and psychologists. This three level process is the most optimal way to overcome the achievement gap in the country (Johnson 12,13). The program focusing upon interventions has not been practiced in the United Sta

Week 6 post class 6340 Assignment Example | Topics and Well Written Essays - 250 words

Week 6 post class 6340 - Assignment Example This is so because there are many volunteers in many health care departments but not many really carry out the roles of teaching like a nurse who is a service learner that is really noble of you (Groh, Stallwood and Daniels, 2011). I had really not thought about the role technology plays in higher education and especially having more people take up nursing degrees because higher education learning will be easier than it is currently and more than it was in the past. Thank you for such insight and I totally agree with it and especially if nursing shortage is to have a permanent solution (Zarate and Burciaga, 2010). Your current work position of being a director of education is the best position to advocate for specialty certification for nurses because you have not only the capability but also power to motivate, challenge and teach about the professionalism that accompanies having a certificate and it will also open up future job opportunities and trust from prospective employers (National League for Nursing, 2009). American Association of College Nurses, (2013). Defining Scholarship for the Discipline of Nursing. Retrieved on February 10, 2013 from:

Argument essay on achievement gap Example | Topics and Well Written Essays - 750 words

Argument on achievement gap - Essay Example The issue needs to be resolved because despite of many efforts, an analysis of the different states in 2011 revealed that there were still five states in America where this achievement gap had increased since 2003. This analysis explained that an effective policy for overcoming this issue is needed in the country (Johnson 11; Lynch). The achievement gap is a matter of concern as it affects a large number of American students and this issue needs to be addressed with strong and effective strategies for the improvement of the educational system of the country. The achievement gap has been observed not only in primary and secondary schools but it has also been seen in children during their kindergarten years. A further analysis of achievement gap in minority groups has revealed that this gap is known to exist in schools even if the economic status of the all the students is the same. This means that each cause of an achievement gap is independent and it is not essential that students co ming from good economic backgrounds would be saved from this issue (Williams 26,27). According to an analysis done by the National Assessment of Educational Progress in 2007, it was seen that white students were better achievers in reading and math tests which were conducted in the fourth and eighth grade (Lynch). Thus, these surveys and reports indicate that the achievement gap is a grave issue and needs a thorough assessment. This is because considering the statistics of the immigrants in the country; it can be judged that this gap would rise if it is not tackled. This can be assessed as statistics reveal that from the year 2000 till the year 2050, the number of whites would reduce in the United States to 49 percent from 68 percent and the Latinos would form 40 percent of the America population. In a similar trend, the African Americans would rise by 1 percent whereas the Asian population would surge by four percent (Haller). The optimal way to overcome this achievement gap in the country is the formulation of effective instructions and interventions for the students. The achievement gap reduction can be achieved by providing improvement at three levels. These include classroom interventions, targeted interventions and intensive interventions. The most important of these is the classroom intervention where eighty percent of the students of the class learn. The students should be encouraged to learn and study and should be motivated to avoid failing in class. With this, the other interventions should also run side by side for students who are in need of them. For example targeted interventions should be carried out for approximately fifteen percent of the students who have failed to achieve good grades due to their socioeconomic status or due to having difficulties in learning English and reading. Intensive interventions should be saved for students who are not motivated despite of classroom and targeted interventions and do not seem to be interested towards the improvement of their education. These students should be handled individually by a team of instructors and psychologists. This three level process is the most optimal way to overcome the achievement gap in the country (Johnson 12,13). The program focusing upon interventions has not been practiced in the United Sta

Analysis of Using Feedback Loops to Explain the Circadian Oscillator Assignment

Analysis of Using Feedback Loops to Explain the Circadian Oscillator in Drosophila Paper - Assignment Example However, there is a considerable delay between when the peak levels of the per and tim mRNA are synthesized and when per and tim levels reach peak production late in the evening. The reason for this is the phosphorylation that destabilizes the PER, causing it to undergo dimerization with TIM. This occurs in the nucleus. There is little that is known with regards to how dClk mRNA is regulated. Previous studies have found low quantities of dClk mRNA in Drosophila that do not have functioning PER and TIM, indicating that PER and TIM are also responsible for activating dClk. This study involved measuring the levels of dClk mRNA levels in various mutant gene combinations. The results showed that the mutant genes did not display highly varying quantities of dClk mRNA over the circadian clock (Glossop, Lyons, and Hardin). The lack of dClk-dependent-PER alongside the relatively high levels of dClk mRNA proves that PER-dependent dClk is not activated by localization of an activator in the nucleus. mRNA quantities in the dClk mutants were measured to prove that the activation of dClk was not as a result of PER-TIM dimmers being formed due to low quantities of per and tim in dClk mutants. Results from this measurement found that the levels of dClk mRNA were almost similar to the peak level of dClk mRNA found in wild flies, proving that dClk is activated by PER-TIM via derepression. The negative feedback loop can be used to explain the observations made above. In this, the formation of PER-TIM dimers leads to sequestering of dCLK-CYC dimers that in turn hinder the CLK-CYC from functioning properly. This ultimately causes the derepression of dClk transcription. The reduction of PER-TIM quantities in the early hours of the morning causes dimerization of dCLK-CYC. These dimers cause repression of dClk, resulting in a reduction of dClk mRNA levels by the time the day ends.

Recombinant Human Epidermal Growth Factor for Diabetic Foot

Recombinant Human Epidermal Growth Factor for Diabetic Foot Recombinant Human Epidermal Growth Factor for Diabetic Foot Ulcer Healing:  A Systematic Review and Meta-Analysis Author: Lin Jin Background From 1980 to 2014, the prevalence of diabetes among adults aged 18 years and older has approximately doubled from 4.7% to 8.5%, and globally, the number of patients has almost quadrupled during this time period to an estimated 422 million people (1). Diabetic complications can arise if diabetes is improperly treated or left untreated. An example of a complication is diabetic foot ulcer (DFU), which is one of the most significant causes of amputation (2). Approximately 6% of all diabetic patients develop DFU annually (3), and they have a high risk of being infected, requiring hospital attention (4). Additionally, survival prognosis is low amongst patients with DFU, with 3-year cumulative mortality rate of 28% (3); Moreover, this rate almost doubles amongst diabetic patients with amputation (5). There is also a high economic cost associated with the treatment of DFUs owning to the long duration of the condition (6, 7), which often requires long-term hospitalization and results in loss of labour productivity (6). Therefore, DFU is rapidly becoming a growing public health challenge. DFUs are the consequence from diabetes-related vascular disease and neuropathy (8). Hyperglycemia induces several cellular mechanisms and abnormalities metabolic, leading to the endothelial dysfunction and the consequent ischemia and increased risk of ulceration (9). Neuropathy causes the reduction in feeling in the foot (8). Therefore, diabetic patients often do not notice foot injury, which can lead to ulceration. Metabolic abnormalities from Diabetes can result in ischemia of the endoneurial microvascular circulation, which further deteriorates nerves (10). Metabolic control, wound care, pressure relieving casts (11), debridement (12), pressure relief (13), and antibiotics are the rudimentary therapeutic interventions for the control of DFU. Growth factors, regarded as a relatively new therapy, function by activating growth and multiplication of cells while inducing protein production (14). These growth factors are regarded as ground-breaking  technologies in the science and art of wound healing (15). Epidermal growth factor was first isolated by Stanley Cohen from submaxillary glands of adult mice (16). It is a polypeptide that displaces strong mitogenic activity (17). Since its discovery, EGF has been isolated in human glands such as submandibular and parotid (18). It acts as an important regulator of cell growth, influencing both cell multiplication and differentiation, which can ultimately improve wound healing (19). Several randomized clinical trials (RCTs) have evaluated the efficacy of recombinant human epidermal growth factor (rhEGF) -related treatment versus control treatment in patients with DFUs. To our knowledge, however, only one systematic review of randomized clinical trials (RCTs) has been published summarizing specifically the efficacy of rhEGF for DFU healing (20). This review indicates that rhEGF has a high efficacy in treating DFUs by accelerating wound healing (20). However, it is not comprehensive as non-English publications were excluded (20). It did not inc lude certain eligible RCTs that also meet the inclusion and exclusion criteria (21, 22). In addition, it is prone to the error lack of rigorous assessment of bias risks. Objective In light of the absence of rigorous assessment and conclusive analysis about the efficacy of rhEGF for DFUs healing, we plan to conduct a systematic review and meta-analysis of RCTs evaluating the efficacy of rhEGF for DFUs healing. The proposed systematic review with a broad scope will aim to address the previously noted limitations, and provide up-to-date best available evidence through rigorous synthesis methods, including assessment of the quality of the evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Methods Sources and searches: The previous review of RCTs failed to include all eligible studies. Therefore, we plan to use the terms diabetic foot ulcer, epidermal growth factor and any relevant terms to perform search in Ovid MEDLINE, Ovid EMBASE, Ovid MEDLINE (In-Process Other Non-Indexed Citations), EBSCO CINAHL and the Cochrane Central Register of Controlled Trials, to select eligible studies. We will further manually search the reference lists of the included studies in key journals in the field. Study Selection: Randomized clinical studies, reported in any languages and published in any dates, recruiting adults ( >18 years old) with type 1 or type 2 Diabetes diagnosed with foot ulcer. Generally, DFU is classified using Wagner-Meggit (table 1) or University of Texas classification (table 2); and the proposed review includes DFU patients with any ulcer grade based on the two classifications. Trials are eligible for inclusion if the intervention is either topical application and/or intralesional infiltration of rhEGF-based formulation with or without standard treatment, and if the intervention is compared with placebo, or standard treatment. Urogastrone, Heberpro-p, Citoprot-P and Herbermin are the brand names ofrhEGF-based formulation. Standard treatment includes metabolic control, antibiotic therapy, debridement, wound dressing, and pressure relief. We will select main outcomes (patient-important for decision-making) from the Summary of finding table which lists all relevant outcomes. After r eviewing literature from primary studies, other relevant reviews, and clinical practice guidelines, we consider that any eligible studies should report at least one of the following primary outcomes, selected from the main outcomes: low limb amputation (at least one toe) rate, positive granulation response rate and time, complete wound healing rate and time, infection rate and/or ulcer recurrence rate. Main outcomes that are not selected will be taken as secondary outcomes. Exclusion criteria will apply to non-randomized control studies, e.g., case-control, cohort, case series, and other observational studies. Studies evaluating the efficacy of other types of growth factors for DFUs will be excluded.

Health Care Essay -- Papers Insurance Work Essays

Health Care Abstract "Health Care", This is becoming more important in today's world of corporate streamlining, downsizing, and increased health care costs. A compensation package for the employees of today is more valuable than it has ever been. The average employee no longer is just concerned with the wages or salary they receive, their attention has been drawn to the overall compensation package. As health care costs rise the importance of an enrollment in a health care plan grows. Health care will continue to be an important factor for employees as long as costs continue to grow. I. Health Care. Starting from the time a person leaves their parents and as they enter the workforce and continue through life healthcare is an issue. Security is a basic human need and health care is one of the biggest parts of that security. It is important to know if one becomes ill or injured that treatment is readily available to them. This includes not only the employee but also the employee's family and or life partner. Health care here in the United States is not socialized and therefore is provided through the purchase of health care plans entirely by the employer or with co-payments from the employees. A. Providing health care programs is not always a guaranteed part of a compensation package when employed. Depending on the organization and its total compensation package health care may or may not be included. The organization may chose to provide the health care to the employees free of charge or they may be required to contribute a significant amount each month. 1. An employer designs compensation packages to attract qualified employees who have the knowl... ...f the organization a viable health care plan is necessary. To ensure plans are within an acceptable expense it is necessary to educate employees in preventive health care measures. Healthy employees make for less expenditures of plans and more productivity. Reviewing the facts and reports it is clear that health plans are a necessity rather than a nicety to help the organization meet its goals. References: Compensation Management in a Knowledge-Based World, (2000). By Richard I. Henderson. Henry Holt and Company Inc., (1999). "Forbidden Love" by Gary B. Nash http://www.ebri.org/ http://www.ifeb.org/icnewind.html http://www.nbch.org/ http://www.healthgrades.com http://www.presbyterian.org/employers.html http://www.healthcareresource.net/healthplan.html http://www.ftp.bls.gov/publ/news.release/hce.txt

Essay --

Sex in Advertising Advertisement is thought to be the foundation and economic lifeblood of the mass media, and the primary purpose of the mass media is to sell audiences to advertisers. The 130 billion advertising industry is a powerful educational force not only in the United States. For example, the average American is exposed to over 1500 ads a day and will spend 1 1/2 years of his or her life watching TV commercials. Ads sell a great deal more than products. They sell values, images and concepts of success and worth, love, sexuality, popularity and normalcy. Although ads sometimes seem to be trivial, their cumulative effect may be serious. Moreover advertisements are, in my view, a product of cultural evolution. If we take the product as the individual, the customer (and sales) as the resource, advertisement is supposed to enhance the fitness of the product. In the course of time advertisements thus will "evolve" towards an optimal exploitation of the adapted mind. One if the the mes that are prone to exploitation are human mate-selection criteria. Basically, two advertisement strategies could be used to exploit men's and women's cognitive adaptations to mate-selection and the prototypic "triggering-signals" associated with this complex. The first strategy is sensory exploitation of the opposite sex. This means that advertisement would pair products for one sex with the stimulus of the other sex, thus exploiting the possible excitation the stimulus would evoke which then would be paired with the product. The second strategy could be called comparison with a normative self. In this case, the product for one sex is paired with same sex-stimuli that would be a perfect stimulus for the other sex, and the product is what makes the d... ...women are used in advertisement in order to exploit male perception. Indoctrination through identification is the main strategy. Thus, the use of sex in advertising is a two-edged sword. Although it is extremely powerful and effective when aimed at one gender, it often does so at the social expense of the other. Since humans live in a social world, consideration must be given to the feelings of the people in that world. If advertising uses the sex appeal, it must be carefully aimed and tastefully done. There is no sense in appealing to one sex by offending the other. Bibliography Morgan, Joan. When Chicken heads Come Home to Roost: My Life as a Hip-hop Feminist. New York: Simon and Schuster, 1999. 74. Cahn, S (1994) Coming on Strong. Cambridge MA: Harvard University Press. Pornography and Sexual Aggression edited by Neil M. Malamuth and Edward Donnerstein, 1984

Health Assessment Essay

Assessment of environmental processes includes agents and factors that may cause injury, illness, or death. Choose one of the following age groups: toddler, preschool, and school-age child. List some of the most frequent causes of injuries, illness, or death at the age level. Discuss and describe safety concerns specific to the age, listing the most common causes of injury, illness (acute or chronic), trauma, and death for the age level. Describe how health promotion and health prevention interventions can be incorporated into parent and child teaching. Including in-text citations and references for each of the scholarly sources used. Respond to other learners’ posts in a manner that initiates or contributes to discussion. School-age children, face daily exposure to environmental agents and factors that may cause injury, illness, or death similar to those of all other age groups. Physical agents such as fires; mechanical agents such as bicycles, skateboards, and cars; biological agents such as bacteria; chemical agents such as asbestos; and radiological agents such as x-rays are the causes of injuries or death. Accidents are the leading cause of death in children over age 1 year in the United States. Accidents from contact sports and cuts, falls, burns, and injuries from firearms, are also increasing. Typically school-age boys have more accidents than girls, perhaps due to differences in personalities, societal expectations, child-rearing practices, and more risk-taking behaviors. Most accidents happen outdoors, and it occur mostly in summer because of outside play. The nurse has a significant role in educating parents and school personnel on ways to prevent dangers to school-age children and to become involved in public initiatives to create a safer society for them. Parents of these children must be involved in community and legislative activities that provide safe play environments. Each child should have a well-maintained bicycle, ride only in safe areas approved by parents, observe rules for vehicle traffic and use a federally approved riding helmet. Parental supervision when children play close to streets and heavy traffic areas. Children should wear a seat belt or be in age-appropriate booster seat as needed; older children should ride with restraint system and in back seat until age 12. Working smoke detectors should be in place in home and school. Children need to engage in age-appropriate activities and wear protective equipment according to the sport. Parents need to ensure safety and maintenance of all sports equipment. Children should play with friends, have a plan for returning home, know home phone number and address, play in safe and known area, and report any suspicious activity threatening their safety to an appropriate adult. Children should know how to locate assistance when in an unsafe situation. Children should avoid insecticides, radiation sources, inappropriate use of medications, and pollution sources; parents need to store all known toxins, chemicals, and household cleaning agents in an adequately ventilated location that is unreachable to children. Edelman, Mandle. Health Promotion Throughout the Life Span, 7th Edition.

Ethical Decisions Scenario Analysis Essay

Reflection Question: Discuss whether you generally make ethical decisions using a traditional or a modern ethical model. Provide an example using an experience you have had in your daily life. I would have to say that what is right is right and what is wrong is wrong. Being true to oneself is ethically speaking. I used to get detention in HS and being an honor student really hurt me. Peer pressure was another feeling that couldn’t be surpassed. Stress and anxiety are add-ons to one’s life experience. I have both. Depression is yet another I have not really dealt with. These feelings are not mutual and do not come easily. Ethics are the study of moral standards and how they affect conduct, by definition. Traditional ethics are from the past and are from the way that people thought about morals and the way that life should be lived back then. Modern ethics came from traditional ethics, but were revised a bit to fit in with new times and with new ways of thinking. Ethics are a part of everyone ’s lives. Both are similar, but I believe that the development with the two came from within a person. Someone did not just make up how a person feels inside. A person knows right from wrong from being taught. With that  being said, a person would know that stealing is wrong and that there would be something inside of them saying something like if you take that money from that person that is wrong and you will feel bad if you have good morals. Both forms of ethics have changed through the years and are now at what is called the modern ethics that we have adjusted to fit into today’s society. I would think that the biggest connection between the two forms of ethics is that it is based on morals and how a person feels deep down inside. I feel that it is based on what your heart tells you.

Education System in Desperate need of Change Essay

Sir William Haley once said, â€Å"Education would be so much more effective if its purpose were to ensure that by the time they leave school every boy and girl should know how much they don’t know, and be imbued with a lifelong desire to know it†. If students were guaranteed to leave school with knowing of what they don’t know and the desire to continue learning, the method of learning will be correct. Today’s education system does not give students the opportunity to enjoy what they are learning. The banking method, where students are empty vessels which educators must deposit knowledge into, deprives them of creativity and the desire to learn. No child is given the chance to shine and be unique. Students today are simply being placed on a conveyer belt, sorted, and then labeled according to their so called intelligence. We need an education system that provides a slower learning method, a method where you focus on what is being learned instead of zipping through it, and the freedom to make mistakes as this will electrify and stimulate students to fulfill their potential. We must recognize students as individuals and keep in mind their diverse backgrounds. In â€Å"Lives on the Boundary,† Rose states, â€Å"The canon has intended to push to the margins much of the literature of our nation: from American Indian songs and chants to immigrant fiction to working-class narratives† (100). The messages that are received from the text are crucial. The students need to be able to relate to what they have before them. One of the problems with today’s education system is we are given material to read, memorize, and expected to repeat it back at the snap of a finger. But without the ability to relate and connect with the material, the learning doesn’t take place. Everything that is read or being said is just going through one ear and out the other. By adding relatable texts, you add life to learning. In â€Å"Learning in the Key of Life,† Jon Spayde states, â€Å"people cannot learn what they do not love† (69). When students are reading or learning about a subject they love, they are inspired and motivated to learn more. This alone can benefit the learning process for students. It becomes much easier to grasp concepts learned in class. Today’s education system does not allow all students to thrive in their own way. It is fast paced with limited space for creativeness. We are given large amounts of information at a time and attempt to move as quickly as possible through all that we can. There is never â€Å"time† to stay longer on a topic. The instructors try their hardest to keep the pace, but this way of teaching does not benefit any student. In â€Å"Learning in the Key of Life†, Jon Spayde states, â€Å"†¦we are focusing far too much of our energy and resources on fast knowledge, ignoring all the richness and meaning slow knowledge adds to our lives† (68). When the focus is on just getting through the material, we are skipping over the value and richness of slow knowledge. Instead of zipping through a lesson because it needs to be done by a certain day to move onto the next, the focus needs to be on what is being learned than making a time requirement. Spayde also states, â€Å"You can figure out what you can do pretty quickly, but the ethical understanding of what you ought to do comes slowly†. We need to adopt the slow learning method, without it we are missing out on more than we think. There is so much more to learning than getting through the material, the purpose of it is to benefit and gain from it. With slow knowledge we will achieve this. One of the most important changes that needs to be done is the view on mistakes. In the article, â€Å"How to Make Mistakes,† Dennett states, â€Å"Mistakes are not just golden opportunities for learning; they are, in an important sense, the only opportunity for learning something truly new†. When fear is being put into a student to never make a mistake, their education is stunted. They lose the ability to explore and take the chance of being wrong because they are repeatedly punished for being incorrect. When a mistake is made, students will learn where they went wrong and will then grow from it. The key to progress is making mistakes. The reason we are in school is to learn, but with this opportunity taken away from students their ability to learn is ripped from their grasp. Daniel C. Dennett also states, â€Å"You should seek out opportunities to make grand mistakes, just so you can then recover from them†. Instead of using all of their energy to attempt to be perfect and run from being inaccurate, every student should look for every opportunity to be wrong. Without errors, the students can not accomplish much. If you look at Todays’ education system is in desperate need of change. No student is given the opportunity to show what they are fully capable of. Instead they are told what they can do. They are simply labeled and placed where they â€Å"should be†. But when students begin to pursue their mistakes and soak in the richness of slow knowledge, they will begin to truly learn. Maria Montessori once said, â€Å"If education is always to be conceived along the same antiquated lines of a mere transmission of knowledge, there is little to be hoped from it in the bettering of man’s future. For what is the use of transmitting knowledge if the individual’s total development lags behind? †. If many students are having difficulty learning in the method we have created ages ago, why not change it? The time is now and there is no time to waste. We must refocus this outdated system to insure that the students will have a secure future and keep the standard of living that we have today.

Symbolic Interactionism of George Herbert Mead Essay

Symbolic Interactionism of George Herbert Mead - Essay Example This theory is more of how the human world nature and the people in it act in relation to it, with the main interest being on how everyone constructs and develop the real meaning and better understanding of self, others and behavior through the means of social interactions. This theory, as expounded on by George Herbert Mead in the early twentieth century, is a framework that enables for the enhanced understanding and interpretation of how information flows and the communicating individuals or groups smoothly and efficiently interact with each other through the appropriate use of symbols. Within the context of this theory, people are believed to inhibit a world that is mainly socially composed, as the meaning of objects, events, and everyday’s behaviors originate from the human given interpretations which may vary from one person or group to another depending on how the communicated idea is perceived. According to Mead explanation on this ideology of symbolic interaction, the society or people are seen as not to react with every event directly but rather are dictated depending on their interpretations of the meanings derived from the events or actions. Therefore, it is important to note that according to this theory of Symbol Interactionism by George Herbert Mead, the particular choice of words that people use in the description of human behaviors i.e. of themselves and that of other individuals are quite important. As can be derived from the description and the introduction development, this theory by Mead identifies three key principles which are meaning, language and thought as applied during communication process. The meaning of any action or event is never inherent in that particular event action. Therefore it comes to our senses that â€Å"meaning† as can be perceived of an event is never pre-existing in a state of nature; arises from the social interactions as implied by the communicator to the receiver; and can always be

Muscular System Outine Assignment Example | Topics and Well Written Essays - 250 words

Muscular System Outine - Assignment Example Another research on muscular system is on the testing of strength and rowers training (Lawton et al., 2011). This research has established that children physical activity is associated with fundamental movement skills. The second research has established that elite rowers are stronger in comparison to less competitive peers. This was based on the relationship, which exists between lean body mass and strength. Moreover, the research established that maximal strength could only be attained and sustained in cases where infrequent, but intense units of strength training were used Researchers still have questions on the relationship between behavioral and physiological outcomes in adolescents and children and fundamentals movement skills (Lubans et al., 2010). On the second research, researchers have a question on whether training should focus at attainment of optimal strength, power, and endurance, so that performance would be enhanced in the competition phase (Lawton et al.,

Proposed preliminary research design Essay Example | Topics and Well Written Essays - 1000 words

Proposed preliminary research design - Essay Example Therefore, defining the scope of romance that will be studied is the first task of the study. In creating a study that examines romance and the way in which it is constructed within social relationships that have a sexual component, creating a methodology that allows for subjective considerations will be necessary in order to develop research. In creating a study that is called The Anatomy of Romance, a built in metaphor will guide the way in which the study is constructed. In creating the concept, providing a bone structure, an internal ‘metabolism’, a pumping heart, the brain, the sex organs, and eventually the flesh that creates a living, breathing organism that is the romantic life of a couple will provide a basis for a framework and a foundation on which to build the study in context. According to Shank (2006), framing a topic within a metaphor allows for the research to present a new way of looking at the topic (p. 124). By starting with this foundation, the study can use a multitude of references in order to build a well structured One approach toward this study might be to see the work through ethnography. However, in order to do that, broad strokes of intention about the context of romance within the culture would then diminish the actual perceptions of romance. Romance seems to be an individual creation that is birthed between two people. Although there are generalities that infiltrate a culture, such as the American traditions of flowers, candy, and jewelry, romance is far more interesting beneath the surface of ethnographic generalizations - which admittedly would be far deeper than the example - but would attempt to represent a culture, rather than the concept itself as an entity of a relationship. Defining romance by its cultural adaptations rather than by the singularity in which it exists between two people is too broad a scope in which to examine

Finance Essay Example | Topics and Well Written Essays - 3000 words - 2

Finance - Essay Example Here the opportunity cost of capital is assumed to be 12%. Thus by adopting it as the discount rate for all future cash flows one can effectively obtain the NPV for them. This gives a few advantages. In the first place proper financial management requires a realistic opportunity cost to be set against capital. Though over a period of 5 years there can be considerable pressure on interest rates, a steady return of earnings would be ensured through proper cash flow management. After all the above cash flow forecasts are assumed to be constant though, in reality they might vary. The decision to make the investment is based on the apparent returns by way of future cash flows and it does not take into account the risk factor involved. For instance the investor has totally disregarded DCF method because he probably considers those future returns to be final and conclusive with respect to their values. The DCF calculations and the NPV figure of the total investment show that the decision is fairly justifiable because the NPV is equal to  £ 123,928.60 which is a considerable value against probable future inflationary pressure, i.e. the opportunity cost of capital. The importance of discounting future cash flows by using these formulas also depends on other factors as well. Discounted cash flows give a real picture of the future possibilities. Since DCF is what an individual is willing to pay at present in order to have what he expects to have in the future, it’s a process of expressing future revenue flows in terms of today’s value. Probably the most important reason behind DCF is the fact that inflation erodes the value of money in times to come, i.e. future. Therefore it’s essential to make up for the loss. That is why in each subsequent DCF multiplied by the number of years, a lower value comes up. The Internal Rate of Return (IRR) sets the present value of all future cash flows of an investment equal to zero.

Ken Frazier Case Study Essay Example | Topics and Well Written Essays - 500 words

Ken Frazier Case Study - Essay Example In this effect, Ken single gave the company its modern status by redeeming it from a possible pit that it would not rescue itself. A learning organization depends on initiative and innovation as its greatest and valuable assets. In addition, it embraces employee empowerment, creativity and takes risks in a desire to achieve its objectives. Based on this explanation, the Merck Company is a learning organization based on the risk it takes in appoints Ken as its CEO (Lussier & Christopher, 2013). Furthermore, it prioritizes innovation and creativity in its scientific application and the process of drug manufacturing. Specifically, this is through investing millions of dollars in a drug process whose certainty is unclear. Enhancing innovation is imperative for its success. In that accord, there are several actions that the CEO should eliminate or put in place to facilitate this practice. First, he should avoid the creation of rules on how activities are carried out (Lussier & Christopher, 2013). Instead, he should create a possibility box that can contain all the ideas of the workers and other essential stakeholders. Additionally, he eliminates fears of failure, making mistakes, and the fear of looking foolish and assumes an active personality. Frazier has articulated a strategy that gives the customers a center stage by carrying out market research and analysis to determine the requirement in the market. As confirmed by a board member William B. Harrison, Ken has the strategic vision, operational experience, and passion for leading the company in achieving its goals (Lussier & Christopher, 2013). Among the supporting factors that lead to the appointment of Ken as the CEO is the talent he displayed in handling a crisis in defending the Vioxx drug. Additionally, he carried out a market research in a special way that gave the firm its competitive edge

Organisational Structure Essay Example for Free

Organisational Structure Essay All organisations are designed to suit their objectives, role, and mission. Internal structure of an organisation is the way in which interrelated groups of an organisation are arranged in a particular fashion for effective communication and best possible coordination (Wikipedia, 2006). Organisational structure plays an important role in day-to-day functions of an organization. The organisational structure of an organization will dictate the delegation of authority, work specialization, and employee reporting framework. An efficient structure will facilitate decision making. A good organisational structure removes uncertainties and helps in planning for future expansion as well (Business Bureau-uk, 2002). A company would adopt a suitable combination of structure and control systems that are most effective for pursuing sustainable competitive advantage. In addition to coordinating strategy implementation, the role of structure and control is to motivate and provide incentives for superior performance. There are numerous internal and external factors affecting the way organizations structure themselves. This essay will scrutinize organisational structures of small and medium sized organizations in different countries. An evaluation of the factors affecting these structures has also been carried out coupled with an analysis of the response from these organizations to varying challenges. Organisational Structures Three major components of organisational structure identified by most theorists include complexity, formalisation, and centralisation (Robbins, 1987). Complexity is basically the degree of differentiation that exists within an organization. Horizontal differentiation considers the degree of separation between units of the same level and vertical differentiation refers to the depth of the organizational hierarchy. A well-known way of horizontal differentiation is the multidivisional (M-form) structure (Chandler, 1962). This structural form is used by firms to carry out most diverse economic activities. Other forms of horizontal differentiation are the functional structure in which people and tasks are grouped together on the basis of their common expertise and experience. Then there are the geographic structures, which use regional basis for organizing activities, and the product division structure which has a focus on products or product groups. The second component of organisational structure is the formalisation. The formalisation refers to the degree to which jobs within the organization are standardized. If a job is highly formalized, there are explicit job descriptions, lots of organizational rules, and clearly defined procedures. The formal organization however does not imply that the organisational structure will become inflexible. The informal organization on the other hand is any joint activity without conscious joint purpose, even though contributing to joint results (Barnard, 1964). The third component of organisational structure is the centralisation. It is defined by most theorists as the degree to which decision making is concentrated at a single point in the organization. Small and Medium-sized Enterprises (SMEs) in Different Countries SMEs are generally defined as having fewer than 250 employees and less than 50 million euros in annual turnover (Cardais, 2005). SMEs play a major role in developed economies. According to the United Nations Economic Commission for Europe, in 2000, 99. 8 per cent of enterprises in 19 countries in Western Europe were SMEs (Kuwayama, 2002). In the United States, small businesses employ more than half of the labor force. The SMEs constitute 96% of the total establishments and represented 69% of total employment in the US (APEC, 2006). SMEs are inherently adaptive to changing market and supply environments. SMEs help in deepening managerial and entrepreneurial skills, and are considered very attractive because of their diversity and competition in the supply of products and services. In United States, SMEs generate half of the national total sales. Most of these corporations develop market-like relationships between the different parts of their organisation. This is reflected in the greater use of the multidivisional structure form. In United States, companies are split into profit centres in pursuance of their market strategies. There is however heavy reliance on formal procedures and standardisation of organisational roles which makes American companies to coordinate a large diversity of economic activities. In Europe, 20 million small and medium sized enterprises comprise major chunk of the European economy. The SMEs in Eurpoe are providing around 65 million jobs. SMEs have greater opportunities to continuously evlove their structures keeping in view their diversified role and constantly changing competitive environments. Organisational Structure of SMEs is very dynamic in Europe. In Germany specially, SMEs are more centralized than US companies and planning and control is more integrated (Europa, 2006). The German SMEs are characterised by a strong linkage between enterprise and owner. This close relationship strongly influences the internal structure and market strategies of the enterprises (Hauser, 2000, pp. 1-2). Factors Reshaping Organisations There are many internal and external forces that can affect an organization. Internally an organization creates its own internal structure, mission, and fiscal policies. These internal forces are designed to meet the external challenges like competitors, the economy, and the demands of the customers. All these factors are having unified impact on organizations in United States and in Europe. Customer demands are influencing organizational structures directly in the same manner that supply can affect demand and vice versa. Another area influencing organizational designs is the constantly changing requirements of the human resources. Surveys conducted in United States have revealed changing workforce behaviour. Changing drives for motivating workers, and getting the best out of them affects the way a company needs to organise its resources. SMEs in developed economies are influenced by e-business to a great extent, allowing them to trade worldwide from a single website. Organisations in Europe and United States are deeply effected by the environment. The advancement of technology is forcing the companies to reengineer their processes. The general environment is dictating change in socio-cultural outlook of companies. With regard to the task environment, major forces playing their part in reshaping organisations include competitors, customers, suppliers, regulators, and strategic allies. High performance and customer satisfaction are directly related to structural design of a company. To compete effectively, the company must avoid becoming operated by a top-down approach. In an era of rapid change and high technology, companies are required to shift centralized management controls. The environment is dictating to focus on streamlining operations, and empowering workers with the knowledge, skills and resources to do their jobs. Analysis of Response to Changing Requirements Change is always viewed differently by the management and the employees. Top level management perceives change as an opportunity to strengthen the business and to advance in their career. The employees however do not welcome the change. They consider change as disruptive and intrusive. They may worry about their ability to meet new job demands. They may think that their job security is threatened, or they may simply dislike ambiguity. Some managers may also feel threatened by the change since it may be against their self-interests. Managers so affected may fight the change as well. But the change is inevitable. The only thing constant in this world is the change. Organizations in Europe and United States are changing and actively adapting to their environments. Organisations in United States are structuring to small business units to tackle complex, and highly uncertain environments in the face of huge competition. Organizations whose structures are not fitted to the environment can not perform well and eventually fail (Borgatti, 1996). The changes are being made to the tools, resources, and the physical or organizational settings of the company. Organisations in Europe and United States are redesigning their structures to meet new challenges. Customers, owners, suppliers, regulators, local communities, and other employees are changing their needs constantly which are compelling the SMEs to adopt a flexible and dynamic structure. The Impact of uncertainty avoidance dimension is forcing towards flexibility of jobs definition and task interchangeability which is quite visible in US and European companies nowadays (Hofstede, 1980). Conclusion The last decade of 20th century witnessed developments occurring within a frame work of rapidly expanding social and economic interdependence on a global scale. Organizations have evolved through periods of incremental or evolutionary change. The major work changes happening today are changes in organizational strategy, organizational structure and design, technology and human resources. In contrast to the classical scholars, most theorists today believe that there is no one best way to organize. What is important is that there be a fit between the organizations structure, its size, its technology, and the requirements of the environment including the competitors. References http://www.actetsme.org/usa/usa98.htm http://www.analytictech.com/mb021/orgtheory.htm http://en.wikipedia.org/wiki/Organizational_structure