Oxygenation in Paediatrics Essay Example | Topics and Well Written Essays - 500 words

Oxygenation in Pediatrics - Essay Example This is a straightforward visual investigation and includes checking for indications of lessening cyanosis on the tongue and furthest points, for example, the palms and bottoms of the feet. This technique is straightforward and simple to execute. In any case, contrasts in skin shading and powerlessness of the wellbeing expert to observe shading change fundamentally limit this technique. For example, in blacks, cyanosis can't be effectively watched and may once in a while go unnoticed until it is past the point of no return. To explain this confinement, hardware are normally utilized. The most widely recognized of the instruments is the beat oximeter. This is a gadget that is connected to the patient’s finger and measures the real oxygen content in the blood. It, hence, screens the degree and adequacy of oxygenation (Sinha 2012, p. 312). The primary restriction of the hardware checking is that a few people may peruse and decipher the readings wrongly prompting undue frenzy or f orestalling convenient activity. What's more, the association of the gear may differ the readings. There are different techniques for oxygen organization in newborn children. These techniques are chosen relying upon the accessibility of the gear and thus moderateness, just as inclination and newborn children condition. The techniques are separated into obtrusive and non-intrusive strategies. The obtrusive techniques utilize a tracheal cylinder and are suggested for newborn children with serious breathing conditions. The non-intrusive techniques incorporate headbox oxygen organization which gauges the oxygen fixation before passage into the respiratory framework. Different strategies incorporate facemasks that help with concentrating the oxygen being conveyed around the nose. Both the headbox and facemasks represent a peril of carbon dioxide collection with expanded lapse. Nasal prongs, nasal catheters and the nasopharyngeal catheters are likewise used to convey oxygen to the lower

The effects of birth control essays

The impacts of conception prevention articles Todays lady has many anti-conception medication alternatives that permit her to arrange for whether she has youngsters, when she has kids, and the age distinction between her kids. This paper is structured as a review of accessible choices about picking a conception prevention technique that matches the physical, enthusiastic and way of life needs. I for one feel that the pill is a fantastic, moderate, 99.5% powerful technique for anti-conception medication. As indicated by Contraceptive Technology, blend pills are around 99.9 percent powerful whenever utilized impeccably. This means one of every 1,000 ladies taking the Pill will get pregnant in the time of a year. All things considered, use, around 3 percent of clients get pregnant in the course of a year Statistics express this is normally because of missing at least one pills. Be that as it may, two things that ought to be recollected. Insights are not everythingthe best type of birth control is the one you will utilize accurately and reliably. Oral contraceptives give no security from explicitly transmitted sicknesses, for example, HIV. So if that is a worry, you ought to consolidate the Pill with condoms for a great mix! At any phase of life, a lady may locate that one strategy for conception prevention suits her needs superior to other people. Intermittent audit of accessible anti-conception medication alternatives will help guarantee in pick a technique that best meets your present way of life. A few variables to consider that may be significant incorporate technique viability, permanency, comfort and assurance against explicitly A few inquiries that I have are, the way sheltered and compelling is the technique, will the strategy influence my sex drive or my accomplices sex drive, is there an age at which I should quit utilizing hormone-based contraceptives, will the anti-conception medication strategy influence my capacity to have kids in the future, what are my anti-conception medication alternatives in the event that I am breastfeeding, what anti-conception medication strategy would you ... <!

Case Study of Commonwealth Bank Australia Cross Cultural Management

Question: Talk about theCase Study of Commonwealth Bank Australiafor Cross Cultural Management. Answer: Presentation Culture is a definitive lifestyle. Culture assumes a significant job in the life of each person. Culture could impact people groups lives altogether in the two different ways and subsequently it turns out to be critical for contemporary organizations to use culture as a key instrument for improvement of the association. One might say that the greater part of the worldwide organizations the whole way across the world have taken up culture as a key angle to investigate so as to maintain their business. Culture could be characterized as the standards, convictions, qualities and thought examples of a person. Culture is created when a gathering of individuals with same convictions and contemplations are met up (Primecz et al., 2009). Working environment and culture have a solid corresponding relationship. At the point when the way of life of a working environment is appropriately rehearsed it is said to significantly affect the presentation of an association (Sderberg Holden, 2002). Simul taneously in the event that social practice inside the association is exploitative or inadequate, at that point it is probably going to have critical negative impact on the hierarchical presentation and subsequently culture is considered with most extreme significance. With the globalization occurring the whole way across the world culture has increased more extensive enthusiasm for business the idea of multifaceted administration appeared. Multifaceted administration is a basic segment of the social investigation particularly for business as it would assist the associations with going through various societies become familiar with their ways and successfully create techniques to deal with culturally diverse issues (Hult et al., 2008). Republic Bank Australia one of the main banks in the nation Australia has been effective in growing its business inside the country as well as effectively worked together abroad and this is the place the part of culturally diverse administration stand s to be significant for the association. The current examination will accept an open door to talk about the culturally diverse issues, issues and their effect on the hierarchical exhibition and will likewise give reasonable proposals to deal with these issues successfully. Diverse Management and the Workplace Diverse administration is one of the most key perspectives for the contemporary business houses. It is significant for the global organizations to address the multifaceted issues and distinguish the key issue which if not went to appropriately is probably going to influence the business to an enormous degree. For a universal professional Commonwealth Bank Australia multifaceted administration is one of the most significant administration provokes that should be dealt with adequately by the associations (Peltokorpi, 2008). Province Bank Australia is one of the biggest budgetary foundations working with organizations just as shoppers and works its association the whole way across the world and consequently this unmistakably shows the significance of having a viable diverse administration in position. According to the current writing, multifaceted administration could be characterized as the way toward overseeing work group successfully across various societies and thinking about their social contrasts, foundation and assorted variety in the work groups (Thomas et al., 2008). Province Bank works in various differentiating societies and henceforth it is significant for the association to comprehend the distinctive multifaceted issues which could hamper the business in the event that they are not appropriately tended to. Multifaceted contrasts are exceptionally noticeable in certain nations and a few nations have comparative belief systems (Stahl et al., 2010). The organization applies Hoftsedes social measurement so as to comprehend the diverse contrasts in the various social orders it works in. Diverse administration isn't just powerful for remote development of business yet it additionally serves to successfully oversee bunches inside the association itself with the goal that they can perform well for the association. District Bank executes the Model of Cultural Dimension which causes the association to outline their multifaceted system appropriately. The Geert H ofstedes Model has six unique properties which talk about a general public dependent on their way of life (Kawar, 2012). Fig 1: Hofstedes Cultural Dimension Model (Source: Tung, 2008) The idea of Hofstede is clear as it attempts to comprehend the social contrast dependent on the various traits. This is really a procedure of correlation which the directors of the Commonwealth Bank apply so as to increase appropriate experiences into the distinctive social contrasts confronting the association which could normally affect on the relational cooperations. The main property power separation encourages the chiefs to see how a general public handles the imbalances in the general public (Tung, 2008). In social orders where force separation is low individuals will in general even out the circulation of intensity which implies representatives are progressively proficient in these social orders and subsequently the workforce ought to be as needs be dealt with by the association. Case of such sort of society is India. The second quality independence and cooperation shows the social structure of a general public. It encourages the organization administrators to comprehend the g eneral example of the general public and the philosophy of the general public as far as individual development and aggregate development (Berry et al., 2010). The general public where independence is high will concentrate more on personal growth and development which encourages the directors to propel representatives independently getting compelling reaction and result for the association. In culturally diverse administration manliness and womanliness is considered as one of the key viewpoints (Testa, 2009). The manliness inclination of a general public implies that the general public is considerably more slanted to giving out material compensations for good work while gentility centers around collaboration, sharing and mindful and personal satisfaction which would help the directors of Commonwealth Bank to execute appropriate procedures to deal with the workforce and create remunerating framework. The vulnerability evasion shows the chiefs the helplessness of individuals in the gen eral public towards dubious conditions and equivocalness. It primarily expresses the circumstance that a general public can't foresee whats going to come later on and as needs be whether they grasp change or not. Long haul and momentary direction features the tendency of the general public towards remembering the past inheritances yet in addition change for the future which plainly causes associations to see how the general public will carry on in the coming barely any years and in like manner makes procedures to control business (Tung Verbeke, 2010). At long last Indulgence versus Limitation is the last property which shows the organization whether the general public is carefree society or are profoundly traditionalist about their way of life. Multifaceted Issues for Commonwealth Bank Australia There are number of various multifaceted issues which upset the business development. For Commonwealth Bank it is significant that multifaceted issues are tended to appropriately. The fundamental diverse issue that the organization needs to confront is during business connection. The organization has constantly centered around viable correspondence as it assists with cooperating appropriately with the representatives and the customers however operations in various social areas influence correspondence. It regularly makes correspondence hole between people. In a totally extraordinary culture and in conventional nations like in Russia or China individuals are hesitant to talk in any remote tongue and this frequently makes disarray particularly for an organization like Commonwealth Bank that hails from a totally English talking nation (Singh et al., 2008). Representatives of this association face issues working in outside conditions as correspondence with purchasers become an immense is sue. Then again another key issue is inward correspondence. Enrolling representatives from various foundations and culture makes correspondence hole also. As the organization works in various nations in Asia and Europe it faces issue of interior correspondence also because of the absence of legitimate correspondence. For examples if an individual isn't familiar with the way of life of a specific culture it will be difficult to speak with them and thus this is critical for an organization of the height of Commonwealth Bank to comprehend. Another key diverse issue that is confronting Commonwealth Bank is the board issues (De Mooij Hofstede, 2010). In a large portion of its worldwide locales the organization has placed in directors from Australia. The issue of ostracize acknowledgment among representatives regularly stands to be a key explanation behind the destruction of an organization or the relapse in the hierarchical exhibition. The ostracizes posted in outside conditions ought to be very much aware of the economic situations and should concentrate on building up the correspondences with the representatives particularly the nearby representatives so a common inclination is made among the administration and workforce. The administrator ought to know about the key determinants of culture which are language, religion, instruction, social structure which would assist the supervisors with handling the issues of correspondence and disarrays successfully (Ungar, 2008). Progression assumes a critical job during the time spent correspondence and on the off chance that the workers are hesitant to impart in different dialects it could be a significant issue for the association Commonwealth Bank. The Commonwealth Bank confronted critical issues with its ostracize directors working in China and India as individuals there are taught and raised with various culture and will in general be universal for the most part the Chinese individuals (Kirkman et al., 2009). Thus the ostracizes won't have the option to work if the representatives or the shoppers don't know about the nearby culture and language. Getting regard is the thing that these individuals need and subsequently particularly in Chinese market Commonwealth Ba

Ideas, Formulas and Shortcuts for Current Essay Topics 2015

Ideas, Formulas and Shortcuts for Current Essay Topics 2015 How to Find Current Essay Topics 2015 Online This type of process essay is easily split into a set of helpful directions. As an example, in college, you might be requested to compose a paper from the opposing perspective. Artistic interest and talent shouldn't go out of trend, however young or old a man or woman might be. Correct selection of topic and the acceptable process of writing are important. To begin, check you comprehend the next vocabulary. This process enables you to practice both the abilities and learn about these significant topics. Make sure you have sufficient time for revision. Besides regular essay instructions, a sample response is supplied for review. Even though the essay questions change, the topic of the essays often stays the same. Different essay types need various questions. As tempting as it might appear to skip past the extra info and go straight to the list of persuasive essay topi cs, don't do it. Moral argumentative essay topics are a few of the simplest to get carried away with. Inspiration to make your own advertising or media argumentative essay topics isn't difficult to discover. By doing this you're able to easily finish the descriptive paper. Categories, essay topics might be divided into. Researching the topic will enable you to find out more about what fascinates you, and should you pick something you truly like, writing the essay will be more enjoyable. Current Essay Topics 2015 for Dummies Droz If the money doesn't serve you, it is going to rule over you. Traveling overseas is among the most well-known topics since everybody is interested in finding new methods to minimize money exchange expenses and go far for less money. Many people think that cooking is an important life skill and ought to be taught to boys and girls in schools. When you're picking your topic, remember that it's much simpler to write about something which you presently have interest ineven in case you don't know a good deal about it. If you've already started your own Etsy business and you've been successful enough to guide others, then it's probably wise to talk about your expertise and experience. Pros and disadvantages of a cashless economy. The Current Essay Topics 2015 Game Research indicates people who weigh too much are more vulnerable to kidney stonesespecially men. In the majority of universities students concentrate on specialised subjects. Some people today think that students ought to be allowed to appraise and criticise their teachers to enhance the caliber of education. Some students find it challenging to write about themselves, but others find it a lot easier to examine their private life, in place of research ing an assigned topic. Some practical skills like money management needs to be taught at high school. Television is developing a new variant of culture The senior classes ought to be profiled Education for boys and girls ought to be separate Many individuals think the ideal way to travel is by car Activity is the sole method to knowledge The value of education is underestimated now. From time to time, technology can be hard to comprehend. Advertising and the media are now nearly inseparable from society for a whole. The Bad Secret of Current Essay Topics 2015 Possessing relevant vocabulary for each topic will provide you a huge advantage. To write a terrific argumentative essay the students first must investigate several sides of the argument, allowing them to make an educated stance. Do not seem through the topics before you opt for. Usually, relevant topics are the ones which have made headlines the past calendar year. When you are requested to opt for a great topic for your argument, start with something you're acquainted with. The main issue is that theme ought to have no less than two valid viewpoint. You'll have to back up your viewpoint with well-researched facts and data too. Select an individual scenario and go with this.

Critically Assess The Concept Of Sustainable Development...

Critically assess the concept of Sustainable Development The concept of sustainable development is generally understood in two similar but differing perspectives. The first of these is the social-scientific definition explicated most frequently in relation to the 1987 report of the Brundtland commission.1 This report defines sustainable development as our â€Å"...ability to make development sustainable—to ensure that it meets the needs of the present without compromising the ability of future generations to meet their own needs†2. The second perspective of sustainable development is that of the ecological definition, which holds that it is a necessity to maintaining healthy, thriving ecosystems in order to facilitate concurrent healthy and thriving human societies.3 Thus both of these definitions are propounding a pragmatic normativity, albeit from slightly differing outlooks: the former concerned more with socio-economic factors, and the latter more with environmental considerations.4 Although the term sustainable development was first coined within the Brundtland report,5 the concept of sustainable consumption is not a new one, with it s roots in historic forestry management practices.6 However, since the late 20th century the need for a sustainable form of development has increasingly becoming more and more evident. 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Islamic Law and Human Trafficking in Saudi Arabia Essay

Over recent years, the Kingdom of Saudi Arabia has been confronted with a great challenge: becoming a modernized country without rejecting its long-held culture and heritage. In many ways, the state has been a success story, having developed a profitable oil-based economy and considerable world influence. Less than one hundred years ago, Saudi Arabia had not yet been unified; today, it is a state with complex financial, legal, and political systems, with a culture marked by deep history and faith. Since the September 11, 2011 terrorist attacks, Saudi Arabia has continued to work on a reform agenda to promote greater participation by Saudi citizens, a vibrant economy, and a civil society. However, many†¦show more content†¦The Qur’an’s commitment to fighting slavery, trafficking, and labor abuse, as well as Saudi Arabia’s hesitant creation of anti-trafficking movements and legislation, indicate that such legislation is not necessarily in contradiction wit h the principles of Islamic law. Despite the reluctance of Western commentators and legal scholars to accept that Islamic law can reach outcomes largely similar to a Western legal system, anti-trafficking legislation and movements in Saudi Arabia have the potential to succeed. As such, more effective ways to fight human trafficking in Saudi Arabia should stem from cultural and political reforms and better enforcement of the limited anti-trafficking legislation it does have, rather than an unnecessary and politically dangerous upheaval of the legal system from outside forces. Saudi Arabia’s political culture is unfortunately not very conducive to gender equality or anti-trafficking measures. 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Statistics for Business Sustainable Development

Question: Discuss about the Statistics for Business Sustainable Development. Answer: Introduction: As the demand of the consumer products is increasing within the retail industry of UK, it is the duty of the large sector retail companies like Tesco to have sustainable form of development to ensure that there is no misuse of the natural resources. According to Ko, Hwang and Kim (2013), the green marketing policies, which is implemented to raise the level of environmental awareness among the people is one of the widely used strategies for sustainable development. All the products and methods of packaging are done in an environment friendly manner to ensure that there is no harm done to the environment. The importance of the protecting the environment is also mentioned in the promotional activities that helps to raise the awareness level of the customers. Tesco, which is the leading retail company of UK, has adopted the policy of green marketing to gain sustainable competitive advantage. The company has adopted this policy in order to deal with the issues related to the environmental degradation (Paggi et al. 2013). Research questions and problems At present the entire retail industry of UK is facing issues due to the degradation of environment and the society of UK. Hence, in order to minimize the damage that is caused due to production it is important for the company to use the techniques of sustainable development (Brindley and Oxborrow 2014). The questions of this research work is framed in order to fulfill the objective of the research work that is to analyze the importance of green marketing within the retail industry of UK and also evaluate the effectives of the green marketing policies. What is the importance of green marketing policies in the modern context? What are the factors that help to determine the competitive advantage that is gained by implementation of green marketing policies? What are the best effective ways to implement the green marketing policies and how it will help to raise the level of awareness? Research Methodology and Process The research process is the method that will be used by the research to fulfill the objective by addressing the research questions. The total protocol of the research work is mentioned in the research work. The research approach and design is mentioned in the section of research methodology (Mackey and Gass 2015). The deductive approach of research is used to establish link between the variables that are related to the elements of the research. On the other hand, the inductive approach is used to develop the new theories related to the research work (Smith 2015). In this case, the researchers will use the deductive approach that will help to establish relation between all the major existing theories related to the green marketing. This approach will also help to evaluate the policies related to the development of the green marketing that can be applied to Tesco. Research Design The design of the research will help to develop the links between the topics related to the research work. This will help the researcher to deal with the issues that are related to the issues of the research. In this case the researcher will use the descriptive form of research design that is intended to discover proper evidence to support the implication of the green marketing policies. The facts that are obtained will help to establish relationship between the variables of the research issues (Creswell 2013). Data collection method and Analysis The researchers will use both primary and secondary form of data in order to address the issues related to the research topic. The primary data is collected using the survey and interviews (Sullivan-Bolyai, Bova and Singh 2012). The researchers will use the non-probability method of sampling to select the fixed sample size for conducting the survey. The sample size will be selected as 100 people, who are the customers of Tesco. The interview on the other hand is conducted upon five senior level managers of Tesco. In order to conduct the interview the investigators will have to frame the questionnaires that are done using the Likert scale. The survey is also conducted upon the 50 of the employees of Tesco. The data that is obtained from the survey and the interviews will help the researcher to access the present situation about the impact of the Green marketing policies. The researcher will also use the secondary data, which is collected from the research articles and journal related to the study of the green and sustainable form of marketing. The primary data is obtained is analyzed using the quantitative data analysis method. The researcher will use different form of charts and Excel sheets to interpret the response that is obtained from the surveys. On the other hand, qualitative data analysis will be used to interpret the information that is obtained from the interview of the managers of Tesco. Conclusion The sustainable development is one of the major issues that are related to the retail industry of UK. As the policies of green marketing, is aimed to raise awareness among the public, the expected outcomes of the research work can be of positive type. The people are expected to give positive feedbacks about the implementation of the green marketing policies of Tesco. The managers are also expected to encourage the sustainable development policies that will help in building the future reputation of the company as an ambassador for raising the awareness of the people about environmental matters. A few percentages of people are also expected to give negative feedbacks as they believe that the implementation of green marketing policies will compromise the financial performance of the company. In the context of the modern days, the uses of the green marketing policies are crucial as it helps to improve the condition of the environment along with the health of the population. The government of UK has taken several policies to encourage the green marketing policies. Tesco is considered to be one of the eco-friendly companies of the world as it implanted the environment friendly ways in the manufacture and marketing of the products. Reference Brindley, C. and Oxborrow, L., 2014. Aligning the sustainable supply chain to green marketing needs: A case study.Industrial Marketing Management,43(1), pp.45-55. Creswell, J.W., 2013.Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications. Ko, E., Hwang, Y.K. and Kim, E.Y., 2013. Green marketing'functions in building corporate image in the retail setting.Journal of Business Research,66(10), pp.1709-1715. Mackey, A. and Gass, S.M., 2015.Second language research: Methodology and design. Routledge. Paggi, M.S., Yamazaki, F., Ribera, L., Palma, M. and Knutson, R., 2013. Domestic and trade implications of leafy green marketing agreement type policies and the food safety modernization act for the southern produce industry.Journal of Agricultural and Applied Economics,3, pp.453-464. Smith, J.A. ed., 2015.Qualitative psychology: A practical guide to research methods. Sage. Sullivan-Bolyai, S., Bova, C. and Singh, M.D., 2012. Data-collection methods.Nursing Research in Canada: Methods, Critical Appraisal, and Utilization, p.287.

Food Log Essay Example

Food Log Essay John Bradley 10/20/2010 Intro. Athletic Training Prof. Johnson My Daily Diet For the past week I have kept a record of everything I have consumed including food and drinks. I have done this to asses what kind of foods I eat and how much nutrition I am getting from my daily diet. I find it very important to know what my body is taking in and how it will affect me and my daily routine. The foods we eat play a big role in performance in class, the workplace, sports and in everything else in life. We can not expect to get the most out of our body while feeding it the wrong things and not receiving the right nutrition. In my week of researching myself and my eating habits I was pretty surprised at my findings and just how big of a role my diet plays in my active lifestyle. As a college student and athlete I lead a very demanding lifestyle that places a lot of mental and physical stress on my body. With this kind of lifestyle it is mandatory to always be running at the top of my game everyday whether it be simply taking notes during lecture or taking out a running back during football practice. To perform at my full potential a few important things are required. We will write a custom essay sample on Food Log specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Food Log specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Food Log specifically for you FOR ONLY $16.38 $13.9/page Hire Writer These very beneficial things are; at least eight or nine hours of sleep, the right attitude, self motivation, and of course my diet. While my current diet is not absolutely horrible, it is definitely not the kind of diet a student athlete should have to be at the top of their game. I have quite a few weaknesses in my diet that I plan to solve by either cutting certain foods outs or greatly limiting their intake. I was shocked to find out just how many of my calories come from fat and unsaturated fat. In many of my meals the percentage of calories from fat came pretty close to fifty percent which is completely unacceptable. The recommended amount is somewhere between twenty to thirty percent of my diet so I am pretty far from that amount which is not good at all. One more thing I found to be pretty scary was how much bad cholesterol I take in. Too much cholesterol can be a horrible thing since I definitely do not want clogged up arteries, now or later on in life. A factor that is in my advantage is how much physical activity my week consists of. I workout with weights three to four times a week and do plenty of cardio during football practice which helps burn off a lot of what I eat. This still does not justify my diet because with less fat and cholesterol intake I will have less wasted energy and can focus more on building my body up in a healthy manner. While my diet is far from perfect I do thinks there is quite a few things that I eat that definitely do help my body and keep it running effective enough. I drink plenty of water throughout the day, in fact I usually drink something close to one hundred ounces everyday but I did not include this in my food log since most of it is sweated out in football practice or while working out on my own. I also found that my protein intake is also pretty sufficient. I have a good amount of protein with every meal from breakfast through dinner. This is mandatory because of all the wear and tear I put on my body and it aids in muscle recovery so I can perform to my fullest. While too much protein can be harmful to the kidneys I believe most of the protein in my diet is utilized and any extra is flushed away safely because of all the water I consume. While my diet is still far from perfect I know that I still get a lot out of it. To make my diet better not only do I need to remove such factors such as excessive fat or sugar, but I also need to add certain things to it. In my research I found that I definitely do not eat nearly enough fruits and vegetables daily to give my body enough vitamins and minerals. This is partly because my main food source is the school’s cafeteria selection which does not always give the best selection. What I need to do is take advantage of every opportunity I do get to eat these beneficial foods. If I can find a way to get more fruits and vegetables in my diet I believe it will help a lot in balancing out my diet. While my current diet has not proved to be too much of a health problem for me right now I can see where it could be a big problem later on in my life. Right now I am very active physically and use a lot of calories for energy to get me through the day. While this proves true for me right now I know that later on in life I will not be as physically active since. It will be very hard to keep the same level of physical activity after college when I am working a full time job or even raising a family. So to stay healthy later on in life it is mandatory that I start healthy eating habits now so I can carry them with me in my older age. This research really opened my eyes and has allowed to me to pinpoint out exactly what I need to change and what I need to keep the same. So many people live their lives day in and day out thinking their diets will never catch up to them and that it does not have a huge effect on how they perform on a daily basis. I myself was one of these people until just recently, I feel now that my eyes have been opened and I know just how important it is to lead a healthy lifestyle not just with physical activity but with what I put into my body as well. Starting immediately there will be a big change in my diet and I will strive everyday to make my diet healthier and not just eat whatever I feel like eating.

The Murder of Micaela Costanzo

The Murder of Micaela Costanzo Micaela Costanzo, 16, was a good kid. She was pretty and popular. She did well in school, and enjoyed being on the high school basketball team and was considered a  local track star. She was close to her mother and sisters. She texted them regularly- especially if she had a change in schedule. So, on March 3, 2011, when Micaela- or Mickey, as everyone called her- didnt text her mother after school or answer her cell phone, her mother knew something was terribly wrong. Micaela Costanzo Goes Missing Mickey was last seen around 5 p.m. leaving through the back doors of West Wendover High School in West Wendover, Nevada. Normally, her sister picked her up from school but on this day, her sister was out of town and Mickey had planned to walk home. When she didnt arrive, her mother began calling her friends and finally the police, who immediately began investigating the teens disappearance. They interviewed her classmates and friends, including her childhood pal Kody Patten, who gave police the same story as her other friends: the last time he saw Mickey, he said, was outside the school around 5 p.m. A Gruesome Discovery at the Gravel Pits Many people organized search parties and began combing the vast desert surrounding the town, including an area known as the gravel pits. Two days later, a searcher noticed fresh tire tracks leading to what looked like fresh blood and a suspicious mound covered by sagebrush. Investigators uncovered Mickeys body. Shed been beaten and stabbed repeatedly on her face and neck. A plastic tie was found around one of Mickeys arms. The  evidence  indicated to police that shed been brought unwillingly to the location where she was murdered. Investigators turned to the schools surveillance cameras for more clues. Person of Interest When investigators found calls and text messages to Patten on Mickeys phone records at the time she disappeared, he became a person of interest in the case. In addition, school surveillance video showed Mickey and Patten in the hallway leading to the exit where she disappeared minutes later. In his first interview, Patten told police hed last seen Mickey with her boyfriend at the front of the school. Everyone else said she was at the back of the building. The High School Couple Mickey Costanzo and Kody Patten had known each other since they were kids. They stayed friends as they got older but socially, they went their separate ways. Patten became involved with Toni Fratto, a devout Mormon who, like Mickey, was popular at school. Fratto was dedicated to Patten and wanted to help the volatile teen reach his goal of joining the Marines. After dating a while, Patten and Fratto decided that they wanted to get married. Patten even joined the Mormon faith so that the couple could marry in the temple. Patten was 6-foot-8, with a quick temper- at home, and at school. After a bad fight with his father, he moved into Frattos house. Frattos parents were conflicted about having Patten stay there. Their primary concern was for their daughter, whom they knew was in love with Patten. They were also worried that Fratto might move out to be with Patten. In the end, they agreed to let him move into their home, where they could keep an eye on their daughters fiancà ©. The senior Frattos relationship with Patten improved and soon they considered him part of the family. Jealousy and Manipulation Toni Fratto was insecure about her relationship with Patten, and even more so about Pattens friendship with Mickey. Fratto kept a diary and wrote about her insecurities. She believed Patten loved Mickey and one day, he would leave her for his childhood friend. Patten began to use Frattos jealousy as a perverse form of entertainment. He would create scenes that he knew she would react to, including talking and texting with Mickey. According to Mickeys family, for months Fratto verbally insulted Mickey. Mickeys sister recalled that Mickey told her she disliked the drama, that she had a boyfriend, and that she wasnt interested in Patten. But the taunts continued and Fratto became convinced that Mickey would ruin her relationship with Patten. The First Confession Once Patten was established as the primary person of interest in the case, the police asked him to come in for an interview. It didnt take long for Patten to break down. Encouraged by his father, he confessed to his involvement in Mickeys death. Patten told police that he and Mickey had gone for a drive to the gravel pit after school. They began arguing. He said she told him to break off his engagement with Fratto  and start dating her instead- which he refused to do. The argument turned physical. When Mickey began to hit him in his chest, he shoved her back. She fell, hit her head, and went into convulsions. Not knowing what to do, he Patten tried to knock her out by hitting her in the head with a shovel. Patten said she was still making sounds, so he slashed her throat to get her to stop. Realizing she was dead, he buried her in a shallow grave and tried to burn her personal belongings. Patten was arrested and charged with first-degree murder with the possibility of a death sentence. He hired attorney John Ohlson, who had a reputation for keeping killers off of death row. Frattos Reaction Devastated by Pattens arrest, Fratto visited, wrote, and called him, telling him that she missed him and would always stand by him. Then in April 2011, while her parents were out of town, Fratto- dressed in her pajamas and accompanied by Pattens father- went to Ohlsons office and tape-recorded an entirely different version of the circumstances of Mickeys murder. Fratto said that after school she received a text from Patten with the words, Ive got her. That meant Mickey was in an SUV that Patten had borrowed and he was on his way to pick Fratto up. The three went to the gravel pits. Mickey and Patten got out of the car. Mickey began yelling at Patten and pushed him. Fratto said she diverted her eyes but heard a loud thud and got out of the SUV to see what had happened. She said Mickey was lying on the ground, not moving. Patten began to dig a grave. By the time he was finished, Mickey was semiconscious. They kicked, punched, and hit her with the shovel. When she stopped moving, they placed her in the grave and took turns slitting her throat. Fratto also admitted to sitting on Mickeys legs to hold her down during the attack. Since Patten was his client, not Fratto, there was no attorney-client privilege and Ohlson immediately turned the tape over to the police. Toni Fratto, who had not even been a suspect, was subsequently booked, charged with murder, and held without bail. Plea Deals Both Patten and Fratto were offered plea deals. Patten agreed  at first but then changed his mind. Fratto agreed to plead guilty to second-degree murder and testify against the man who she promised to stand by forever. The confession Fratto gave to the police differed from the one shed given Pattens attorney. This time, she said Patten was mad at Mickey and when she got into the SUV, she saw Mickey stuffed in the back, scared, with her hands up to her face. Patten sent Fratto a text saying, We have to kill her. When they got to the gravel pits, he ordered Fratto to stand guard. Patten dug the grave and told Fratto to hit Mickey, but she refused. Patten began punching Mickey and told Fratto to hit her with the shovel. Fratto hit Mickey in the shoulder and Patten hit her in the head. While on the ground, Fratto held down Mickeys legs. At some point, Mickey looked up at Patten and asked if she was still alive and if she could go home. Patten slit her throat with a knife. In April 2012, Fratto, 19, pled guilty to second-degree murder with a deadly weapon in the death of Micaela Costanzo and was sentenced to life behind bars with the possibility of parole in 18 years. As of August 2018, she was sent to the Florence McClure Womens Correctional Center in Las Vegas, Nevada. Patten Gives Another Version of Events In a meeting about a plea deal, Patten later gave another version of what happened the day Mickey died. He said Fratto had confronted Mickey in school that day and called her a slut. Patten suggested that Fratto and Mickey meet and talk it out. Fratto said she wanted to fight it out and Mickey had agreed. That was as far as Patten got with this version of the story. He stopped after his attorney recommended that he turn down the plea deal. In May 2012, Patten agreed to plead guilty to first-degree murder to avoid the death penalty in the death of Micaela Costanzo. As part of the presentence report, Patten wrote a letter to the judge denying that he had killed Mickey. He laid the blame solely on Fratto, saying that she slit Mickeys throat. The judge didnt buy it. He sentenced Patten to life, telling him, Your blood runs cold, Mr. Patten. There shall be no possibility of parole. As of August 2018, Patten was incarcerated in Ely State Prison in White Pine County, Nevada. One Final Version? With the two killers locked away from one another, Fratto had time to reconsider her situation. She offered one more version of the deadly story. In an interview with Dateline NBC’s Keith Morrison, she said that she had been abused and controlled by Patten during most of their relationship and that he forced her to participate in murdering Mickey. She feared for her life after she saw him beat Mickey, she said and had no choice but to go along with what he wanted.

Garmin Analysis - Following the Business Decisions Research Paper

Garmin Analysis - Following the Business Decisions - Research Paper Example Apart from this, Garmin’s return on capital employed, equity and shareholders’ funds have all declined due to lower profitability in 2011. There are no significant changes recorded in the balance sheet of the company apart from the increase in investment in marketable securities and the issuance of additional paid in capital (Garmin, 2011). Â   2011 2010 2009 2008 2007 Current Ratio 2.98 3.73 3.50 4.14 2.91 Acid Test Ratio 2.51 3.16 3.05 3.25 2.28 Return on Capital Employed 0.27 0.39 0.49 0.77 0.89 Return on Equity 0.16 0.19 0.25 0.33 0.36 Return on Ordinary Shareholders' Funds (ROSF) 28.98 32.52 70.30 73.15 78.81 (Garmin, 2011; Garmin, 2010; Garmin, 2009; Garmin, 2008) Cash Flow Trends As far as the cash flows from operating activities are concerned, the company managed to improve the picture through efficient performance in 2011. Although the net income of the company declined slightly in comparison with the previous financial year, the management still managed to sh ow an increase in the operating cash flows. Â   2011 2010 2009 2008 2007 Operating Cash Flows 822,334 770,637 1,094,456 862,164 682,088 Investing Cash Flows (488,198) (72,869) (547,869) (56,349) (175,695) Financing Cash Flows (307,413) (510,821) (161,243) (809,109) (136,117) (Garmin, 2011; Garmin, 2010; Garmin, 2009; Garmin, 2008) On the other hand, cash flows from investing activities remained negative as they have continued to be the same in the past years. However, in 2011 there has been a significant rise in the negative balance of cash outflows from investing activities. The reason behind this significant increase is the purchase of marketable securities by the company worth $ 1,172,555,000 in 2011. Similar to the trends shown in cash flows from investing activities, the cash flows from financing activities have also continued to show negative balance in 2011 as they have been in the previous four years. Major Capital Expenditures The major capital expenditures of the company in 2011, as mentioned earlier in the balance sheet analysis, included the purchase of $ 1,172,555,000. This purchase is in line with the investment policy of the company, in light of which, the company aims at investing in less risky securities. In 2011, the net investments of Garmin in fixed securities increased to $ 491 million as compared to the figure of $ 25.5 million in 2010. The result of these safe play investment decisions has earned Garmin returns of 1.7 percent in 2011 (Garmin, 2011). Although this investment policy may be justified on the grounds that there are still traces of the recent financial crisis which can influence risky play, but at the same time, it is expected that Garmin’s management shall be more prolific in determining the course of its business by exploring investment or capital expenditure options which are more effective and helpful in enabling the company to regain its lost momentum (Cavallaro, 2009). Apart from this, the company acquired severa l business entities, which is appreciable since it will allow the company to stretch its market presence further. The recently acquired business entities include NAVIGON AG, TriTronics Inc. and two other worldwide distributing companies. Although the company has faced fierce competition from other brands and has faced threatening anticipations of market share loss due to the popularity gained by smart

Managing Stress in the Workplace Research Paper

Managing Stress in the Workplace - Research Paper Example Persistent stress in an individual is reflected on the behaviors, responses, result delivery and attitude towards different people within an organization. It is characterized by continued headache, fatigue, lack of motivation to work and deliver severe withdrawal symptoms and depression (Leka, 2003). A number of workplace events create stressful employees and this reduces the overall productivity of the employees as they exhibit severe depression and lack of motivation to work on particular assignments. Stress is caused by time-constrained events, high expectation from the employer, family and relationship problems, job security and related issues and unrealistic deadlines imposed by supervisor. It is worth noting that despite the desire by a company to achieve its objectives within a specified period, the employees are overall responsible for the implementation of the policy and they are psychological beings. Pressure increases the urgency of delivering on a specific assignment but also decreases the productivity as the employees are forced to deal with both job related stress and psychological stress because of the pressures from the employees (Lee, 2000). Stress management at the work place has been given significant time in current management practices at is affects the overall productivity of the business. ... The paper will seek to provide the best approaches that an organization can develop in the management of stress and the different roles the employees play in these approaches. This paper will also seek to persuade organizational managements that stress management begins with the development of positive policies and regulation and not necessarily the adoption of the health and safety policies (Lee, 2000). Impacts of stress to employees and employer Stress is an all round problem that affects both the employees and the employer in equal proportion since the productivity of the employee is of much concern to the employer. Employees are affected in a number of ways by stressful work environments and these have significant impacts on their personal health, work productivity and the overall stat e of wellbeing. Excessive stress affects the normal brain functioning abilities resulting into significant brain related complications on employees. The brain works well in a stable emotional envir onment where an individual views the environment positively and enjoys every moment and responsibilities assigned to them (Leka, 2003). However, stress affects the emotional balance of an employee resulting into increased depression, emotional instability and psychological trauma. This affects the normal functioning of the human brain resulting into loss of coordination and concentration for the employees. Headache, fatigue, loss of interest and concentration, loss of appetite and emotional instability and the resultant effects of stressed brain and this affects the normal health of an employee (Lee, 2000). Employees enjoy working in a free environment free of intimidation, stress, strict and punishing deadline, features that characterize stressful workplaces.

Compare the descriptions of the four ghosts Essay Example for Free

Compare the descriptions of the four ghosts Essay Dickens little Christmas book, A Christmas Carol, was one of many of Christmas novels, however the book, as well as selling six thousand copies in one week, has become Dickens most famous novel. Although the Victorians opinions of ghosts were conformist and modern day readers opinions are more lax; the variety of spectres ensured it appealed to both ages and revived the charitable meaning of Christmas for the Victorians. The first ghost Dickens introduces to the reader is Marley and he uses vivid adjectives to illustrate the typical conventions of a ghost. Some of these conventions are shown when Dickens writes, The same face: the very same, and describes his clothes as, usual waistcoat, tights, and boots. In saying that the ghost has, the same, face and clothes as the person it originated from, it conforms to the stereotypical image of a ghost. This makes the reader feel more comfortable with the opening of the novel; allowing the reader to make the prediction that the other ghosts would be similar. This successfully results in the reader being shocked later on in the book. Furthermore, Dickens uses personification to create the suspense and fearfulness that the reader would expect a ghost to do. This is evident with the quote, flame leaped up, and, it cried, I know him! Marleys ghost. When the flame, leaped up, it gives the effect that it has identified something so fearful that it has gave life to in-animate objects. This makes the reader desperate to find out why this ghost is so frightening. The flame also seems to detect that the ghost is Jacob Marley, which suits the idea that a ghost haunts someone that did wrong to them in their previous life. Adding to the terrifying image of the spectre, Dickens highlights the fear with the phrase, disturbs the very marrow in his bones. The phrase strengthens the idea that Marley is a typical spectre as a Victorian reader would expect Scrooge to be immensely scared of the ghost, this is because the conformist opinion was that ghosts were to be frightened of. Although Marley is overall a conventional ghost, Dickens does use a combination of metaphors and similes to add interesting original touches. These are found when the book says, being provided with an infernal atmosphere of its own, and, as by the hot vapour from an oven. The simile highlights the alteration between Scrooge and the ghost. One interpretation of this is that the simile is a representation of how a ghost sees the world from a different perspective then a human. The simile emphasises this interpretation and suggests that the difference between the perspectives of the two characters is that the ghost looks on the earth with envy as his own world as Marleys own world agitates like, hot vapour. This is one of the first signs that the book will push the conformist boundaries of the after life; alerting the reader to the thought that this ghost has feelings, which is not expected from a Victorian audience. In contrast to the ghost of Jacob Marley, the ghost of Christmas past is strange and unconventional. Just as in the description of Marley, Dickens uses sound to build up suspense. For example, he describes the hour bell as, hollow. The use of this word may mean that the ghost is evil, however on the other hand it may suggest that it wont use discretion as it is hollow and doesnt have a heart; this is significant as it was believed that feelings came from the heart in the Victorian period. The word is successful as it makes the reader make predictions about the ghost before it arrives. This is playing with the reader and will create anxiety, as the reader will want to discover whether the prediction was right or not. In addition, Dickens confirms the idea of a ghost further. This occurs when he writes, unearthly visitor. One interpretation of this is that the word, unearthly, gives the impression that it doesnt belong on earth and is not a typical creature. This adds to the idea of a typical ghost however, a subtle implication strays from the stereotype. The word, visitor may imply that the ghost will not stay long which may seem insignificant to a modern reader but the Victorians feared that ghosts would haunt a specific person making their lives a misery. I think that this effectively created an unusual sense around the ghost that pre-emptively warns the reader that it isnt a normal ghost. Moreover, Dickens uses juxtaposition to make the reader acknowledge that the ghost represents something. The contrast is shown with phrases such as, like a child, and, like an old man. The contrast implies that what someone does in the past can alter their future so you should always do the right thing. This representation is further emphasised with the imagery, now with one leg, and, now with twenty legs as it gives an interesting, visibly imaginable example of the change. These quotes are successful as the reader can see that the ghost represents the fact that every action has a consequence.

Standardized Tests Are Ineffective Essay -- High-Stakes Standardized Te

Standardized tests are unnecessary because they are excruciating to the minds of many innocent students. Each year, the tests get tougher and stricter until the students cannot process their own thoughts. The tests become torturous to the minds of those only starting in the world of tests. The students already battling in the war are continuing to fall deeper and deeper into the world of uncreativity and narrowness. As the walls narrow in on them, they are lost and unable to become innovative thinkers. Moreover, the implementation of standardized tests into the public school systems of the United States of America has controversially raised two different views –the proponents versus the opponents in the battle of the effectiveness of standardized tests. Standardized tests require all test takers to answer the same questions; the tests are also scored in a standard manner. Thus, the education system believes that it is fair for everybody to take the same test because it is pre paring students for college learning. In reality, intelligence cannot solely be determined by a test score; therefore, standardized tests are ineffective in encouraging learning in educational environments for three reasons: they are stressful, discriminatory, and uncreative. Throughout the history of standardized testing in the United States of America, citizens have viewed the test as an effective tool to build a society on excellence and success. Furthermore, standardized tests have developed and spread in various public schools as an unproblematic way to test a large amount of students quickly. Educators use test scores to evaluate student performance, teacher proficiency, and school effectiveness. However, standardized tests are not the best way to te... ...ningful projects that can be used in real life. Works Cited Fletcher, Dan. â€Å"Standardized Testing.† Times. Times, 11 Dec. 2009. Web. 29 Nov. 2013. Popham, James. â€Å"Why Standardized Tests Don’t Measure Educational Quality.† Journal of Educational Leadership 56.6 (1999): 8-15. Web. 29 Nov. 2013. Rooks, Noliwe M. â€Å"Why It’s Time to Get Rid Of Standardized Tests.† Times. Times, 11 Oct. 2013. Web. 29 Nov. 2013. Sarason, Irwin G. â€Å"Stress, Anxiety, and Cognitive Interference: Reactions to Tests.† Journal of Personality and Social Psychology 46.4 (1984): 929-38. PsycARTICLES. Web. 29 Nov. 2013. Schmidt, Peter. â€Å"Sunday Dialogue: Too Tethered to Tests?† New York Times. New York Times, 12 Oct. 2013. Web. 29 Nov. 2013. Strauss, Valerie. â€Å"Have Standardized Tests Really Helped Kids Learn More?† Washington Post. Washington Post, 30 Apr. 2013. Web. 29 Nov. 2013.

Mhp Nursing Shared Governance Essay

What is Shared Decision Making †¢ Point of Service Decision Making – where staff who perform the work participate in decision making affecting their environment †¢ A 30 year old decision making model meant to give equal voice to nurses †¢ A decentralized style of management that creates an environment of empowerment Shared Decision Making A Journey Not a Destination We TO They Why Shared Decision Making †¢ Essential to achieving the best patient outcomes by giving nurses control of their practice – they know best! †¢ Recognizes the power already present in a role and allows that power to be expressed legitimately †¢ Builds autonomy into the profession Shared Decision Making – The Process A dynamic process that is centered on 4 critical principles of fully empowered organizations: Partnership Accountability Equity Ownership Operational Definitions †¢ Partnership – nursing staff and leadership work together at the unit and system level to move practice forward and achieve the best outcomes †¢ Accountability – staff and managers share ownership for the outcomes of our work and are answerable to our colleagues, the institution and the community we serve Operational Definitions †¢ Equity – Integrating roles to achieve outcomes; everyone contributes within the scope of their role as part of the team †¢ Ownership – Everyone must realize that success is linked to how well they do their jobs Shared Decision Making Our Model Professional Advancement Council Administrative Council Safety First C rd oo ina tin g Quality & Safety Council Cou ncil Unit Patient Research & Evidence Based Nursing Practice Council Great Place to Work Professional Nurse Council Family Community Clinical Excellence Councils Coo Education Council rdin atin g Cou ncil Think of yourself as a Patient APN Council Research Council Financial Strength CCHS Shared Decision Making Councils †¢ Quality & Safety Council †¢ Research & Evidence Based Nursing Practice Council †¢ Education Council †¢ Professional Nurse Council †¢ Coordinating Council Education Council ï‚ § Collaborates with unit and system councils to identify educational needs, develop educational priorities with appropriate time lines and determine resources for all education impacting the Department of Patient Care Services ï‚ § Disseminates approved educational strategies to unit leaders and support staff ï‚ § Develops and maintains a communication network between unit and systems councils Research & Evidence Based Nursing Practice Council ï‚ § Promotes the spirit of inquiry in clinical nursing practice ï‚ § Evaluates the literature in order to use best practices to transform clinical practice at the point-of-care Quality & Safety Council ï‚ § Provides planned, systematic and collaborative approaches to oversee and direct quality and safety relating to the nursing process, functions and services provided. ï‚ § The council’s scope includes performance improvement and safety measures throughout the Department of Patient Care Services Professional Nurse Council ï‚ § Works to enhance the professional image of nursing within CCHS and the community ï‚ § Supports the spirit of the professional advancement program ï‚ § Identifies and supports implementation of recruitment and retention strategies Coordinating Council ï‚ § Provides overall coordination of the systems councils. ï‚ § Reviews the system strategic plan and adopts the plan for the Department of Patient Care Services and the nursing Shared Decision Making structure. ï‚ § Serves as the portal for other departments or disciplines requiring assistance with the Shared Decision Making structure of nursing. Problem Solving The Old Way †¢ Problem identified by staff and communicated to manager †¢ Manager may or may not have asked for feedback about solutions †¢ Manager made final decision or had final authority for approving a solution Problem Solving The New Way †¢ Staff identify issues and communicate them to the unit council †¢ Unit council formulates a response and communicates this to staff †¢ Staff provide feedback via the comment form. How Does The New Way Work †¢ Unit Council: ï‚ § Collects Data ï‚ § Develops a proposed plan using evidenced based practice ï‚ § Develops a time line ï‚ § Presents Plan for Feedback (Open Comment) ï‚ § Revises Plan Based Upon Feedback ï‚ § Forewards plan to system council, as needed How Does The New Way Work †¢ Unit Council: ï‚ § ï‚ § ï‚ § ï‚ § Implements Plan Evaluates Outcome Report Results to Unit Staff Seeks staff feedback, formally and informally on council’s performance How Does It Work – Problem Solving Methodology †¢ Identify an Issue or a Problem †¢ Gather Data †¢ Design a Solution †¢ Obtain Feedback †¢ Finalize a Proposal †¢ Implement †¢ Evaluate †¢ Report Increased Incidence of Pressure Sores Problem Unit Problem: Unit Council Problem Solving Model Results: Positive Outcomes System Level Practice Research Problem Coordinating Operations Education Problem Solving Model Results: Positive Outcomes Nurse Manager’s Role †¢ Create a climate that is actively supportive and not just tolerant of shared decision making †¢ Facilitate a leaning environment for staff growth and comfort with shared decision making †¢ Support â€Å"release time† for staff to participate in shared decision making activities Nurse Manager’s Role †¢ Share with staff your knowledge of leadership and help staff to minimize implementation barriers †¢ Commit to the â€Å"New Way† Role of Unit Based Council Chair †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ Set meetings Develop the agenda Move council to consensus Ensure members participate (per charter) Facilitate group assignments Ensure consensus for decision making Call emergency meetings, as needed Mentor Chair-elect Benefits of Shared Decision Making †¢ Increased Staff Nurse Satisfaction (increased autonomy, increased control over practice, improved communication between nurses, physicians and administration) †¢ Improved Nursing Retention ($90,000 to replace an RN – 2006 Advisory Board) †¢ Improved Patient Safety Outcomes Benefits of Shared Decision Making †¢ Improved collaboration and team Building †¢ Improved quality of care and clinical effectiveness †¢ Increased staff confidence, personal and professional growth †¢ Development of new knowledge and skills †¢ Increased professionalism and accountability Requirements for success†¦. †¢ Place the Patient First and focus on providing the best care possible †¢ Trust and respect is essential †¢ Communicate openly and honestly †¢ Embrace change and strive for improvement †¢ Staff and managers hold each other accountable. †¢ Organizational support of accountability in the performance appraisal process Final Thought Shared decision making is a journey, not an event. It is not achieved overnight, and there is no conclusion – no point when it is fully in place. It only provides a foundation for further growth. Tim Porter-O’Grady

Learning to Learn Skills as a Foundation

Children with Autism Spectrum Disorders and other developmental disabilities often lack skills that are pre-requisites for success in school. Before a child can acquire language, hold a scissors or pencil, or learn from instruction, he or she needs to be able to sit still, pay attention and imitate the behaviors or remember the content of instruction. These skills are commonly known, among practitioners of Applied Behavior Analysis, as Learning to Learn Skills: In order to succeed with children with Autism, it is important that you evaluate whether they have those learning to learn skills. The Skill Set Waiting: Can the student stay in place while you arrange materials, or begin a session?Sitting: Can the student stay seated, on both buttocks, in a chair?Attending to others and materials: Can you get the student to pay attention to you (the instructor) or when presented with materials?Changing responses based on prompts: Will the student change what he/she is doing if directed to do so, with physical, gestural or verbal prompts.Following instructions: When given instructions, will the child comply? This implies that the child has receptive language.Following choral, or group instructions: Does the child follow directions when given to a whole group? Or does the child only respond to directions given with their name? The Continuum The learning to learn skills above are really arranged in a continuum. A child may learn to wait, but may not be able to sit appropriately, at a table. Children with Autism Spectrum Disorders often have co-morbid problems, such as Obsessive Compulsive Disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD ) and may have never sat for more than a few seconds in one spot. By finding reinforcement that a child really wants, you can often shape these primary behavioral skills. Once you have completed a reinforcement assessment (evaluating and discovering reinforcement that your child will work for,) you can begin to assess where a child is on the continuum. Will he sit and wait for a preferred food item? You can move from the preferred food item to a favorite or preferred toy. If the child has sitting and waiting skills, you can expand it to find if the child will attend to materials or instruction. Once that is evaluated, you can move on. Most often, if a child has attending skills, he may also have receptive language. If not, that will be the first step of teaching the ability to respond to prompts. Prompting. Prompting also falls on a continuum, from hand over hand to gestural prompts, with the focus on fading prompts to reach independence. When paired with language, it will also build receptive language. Receptive language is critical for the next step. Following directions If a child will respond correctly to prompts, when paired with words, you can teach following directions. If a child already responds to verbal directions, the next thing to assess is: Does a child follow choral or group instructions? When a child can do this, he or she is ready to spend time in the general education classroom. This should hopefully be an outcome for all our children, even if only in a limited way. Teaching the Learning to Learn Skills The learning to learn skills can be taught either in one to one sessions with an ABA therapist (should be supervised by a Board Certified Behavior Analyst, or BCBA) or in an early intervention classroom by the teacher or a classroom aide with training. Often, in early intervention classrooms, you will have children who come in with a range of abilities in the learning to learn skills and you will need to focus the attention of a single aide on children who most need to build the basic sitting and waiting skills. The instructional model for ABA, like the model for behavior, follows an ABC sequence: A: Instruction. This needs to fit the outcome. If the first instruction is to sit, you may have to physically guide the child into the chair, accompanied by a verbal description of what is happening: Sit down, please. Okay, were sitting with our feet on the floor, our bum on the chair.B: Behavior. What the behavior is will determine the next step.C: Feedback. This is either correcting the response or praise, either paired with reinforcement, a token (secondary reinforcement) or once you have some behavioral momentum, every second to fourth correct response, or correction. The most important thing is to be clear about what is the desired response - you never want to reinforce an incorrect response (although an approximation is appropriate when shaping behavior. Called Discrete Trial Teaching, each instructional trial is very brief. The trick is to mass the trials, in other words, bring the instruction on hard and heavy, increasing the amount of time that the child/client is engaged in the targeted behavior, whether it is sitting, sorting, or writing a novel. (Okay, thats a bit of an exaggeration.) At the same time the teacher/therapist will be spreading out the reinforcement, so that each successful trial will get feedback, but not necessarily access to reinforcement. The Goal The final outcome should be that students with Autism Spectrum Disorders will be able to succeed in more naturalistic settings, if not actually in a general education classroom. Pairing secondary or social reinforcers with those primary reinforcers (preferred items, food, etc.) will help children with more challenging disabilities function appropriately in the community, interact with people appropriately and learn to communicate, if not to use language and interact with typical peers.