Vap Bundles, What to Leave in, What to Leave Out Essay Example for Free

Vap Bundles, What to Leave in, What to Leave Out Essay Ventilator associated pneumonia (VAP) is a chronic and costly problem in the intensive care setting. VAP increases patient morbidity, mortality, and length of stay. These negative effects add significantly to the financial and emotional burden to the patient and family. VAP is being considered for addition to the Medicare non-reimbursable infection list, therefore healthcare providers need to proactively evaluate and implement procedures to minimize VAP rates. Article Summaries The focus of this article was identifying the lack of universal diagnostic criteria for VAP and the impact of the lack of diagnostic standardization on interpretation of hospital reported VAP rates. The author’s contention is, despite an abundance of studies on VAP prevention the inconsistencies between institutions in diagnostic criteria can provide false zero and/or falsely elevated reported rates of infection. Additionally, the study that was primarily cited by the author did not include several interventions which he felt represented a major design flaw. In summary, the disparity in diagnostic criteria and variety of VAP prevention bundles make it difficult to clearly interpret currently available data regarding efficacy of specific interventions. I included this article based upon the three criteria I chose for inclusion: publication date within five years, clinical relevance, and statistically significant data produced by the study. This article specifically addresses the quandary surrounding diagnosis and prevention of VAP. The authors of this study chose to compare the effects of mechanical treatment, pharmacological treatment, and a combination of both on VAP reduction. In preparation for the study the authors reviewed previously identified causes of VAP and chose to focus their study on the effect of reducing oropharyngeal colonization by potential respiratory pathogens. The conclusion of the study indicated that their analysis was confounded, in part by the defining criteria they chose to identify VAP. There was no significant reduction in VAP from toothbrushing(mechanical), and no sustained reduction beyond day three for the chlorhexedine(pharmacological) group. As has been noted in many studies there were additional, and perhaps more efficacious interventions concurrently in use, particularly elevation of the head of bed to thirty degrees. I included this article based upon the three criteria I chose for inclusion: publication date within five years, clinical relevance, and statistically significant data produced by the study. This article addresses the outcomes of specific nursing interventions targeting the reduction and/or elimination of VAP. Article Critiques The researchers who designed this study attempted to minimize some of the confounding factors by applying certain aspects of the institution’s ventilator bundle to all of the study participants. This clearly defined standard of care improved the ability to directly attribute the effects of the research interventions. Prior to beginning the study the researchers observed the standard care of intubated patients in the facility and identified practices that were viewed as potentially contributing to oropharyngeal colonization. Based upon their observations, during the study period advanced oral care kits were exclusively used to provide oral care for the study group along with a clearly delineated schedule for performing different components of the oral care protocol. The result for the study group was a significant reduction in VAP with increased time to VAP. There was also a decrease in ventilator days and length of intensive care unit stay. The study confirmed that VAP prevention is improved with the incorporation of comprehensive oral assessment and care. I included this article based upon the three criteria I chose for inclusion: publication date within five years, clinical relevance, and statistically significant data produced by the study. This article addresses the outcomes of specific nursing interventions targeting the reduction and/or elimination of VAP This article was published in Clinical Infectious Diseases, which is a peer reviewed journal. The subject is relevant to my topic in that it is a qualitative analysis of multiple studies on the efficacy of VAP reduction bundles. The author is a physician working in the field of infection control, affiliated with two major United States academic medical centers and as such he has professional credibility. No conflict of interest was reported by the author. The format of the article was a comparison of various VAP bundles and their outcomes from studies conducted by other researchers. The comparison group was large, comprised of seventeen different studies, all of which used the before-after design (Klompas, 2010). As a qualitative study the premise was not answerable by a yes or no hypothesis, instead it relied upon review of specific, focused research. This research substantiated the author’s initial question by defining elements that remain unaddressed in the current body of research surrounding the prevention of VAP (Klompas, 2010). The study presented in this article was a well-designed 2 x 2 factorial trial (Munro, Grap, Jones, McClish, Sessler, 2009). The principal investigator reported receiving a grant from the National Institutes of Health in support of this research, no other disclosures were reported. The investigators are fully credentialed in their respective fields. The study took place at a large academic medical center with a population that allows for broad representation. Participants were recruited from three intensive care units with clearly defined inclusion and exclusionary criteria. The study personnel were all appropriately blinded to the participants VAP status (Munro et al., 2009). The performance of the assigned treatments was completed by study personnel rather than the bedside nurse to increase the consistency of treatment delivery. The authors noted a few limitations as the study progressed. The first limitation was the definition of VAP. In this case they chose to use clinical pulmonary infection score greater than six to define VAP (Munro et al., 2009). During the course of the study they noted that even though a clinical diagnosis of pneumonia was considered exclusionary, that many of the participants in fact had a CPIS greater than six upon enrollment (Munro et al., 2009). A second limitation was enrollment attrition; by day seven the number of participants was no longer large enough to be considered statistically significant (Munro et al., 2009). Despite the noted limitations the investigators were able to draw conclusions applicable to early onset VAP (Munro et al., 2009). The study presented in this article was completed by a multi-disciplinary team, none of which reported any conflict of interest or financial disclosure. As one of the end points of the study was demonstration of a sustainable reduction in VAP rates use of cohort study was intentional, incorporating an extended time frame to counter the large number of required enrollees to otherwise demonstrate statistical significance (Garcia, Jendresky, Colbert, Bailey, Zaman, Majumder, 2009). A potential confounding factor was the facility ventilator protocol, which included many interventions which are known to directly and significantly impact on reduction and prevention of VAP i.e. head of bed maintained at thirty degrees and an active weaning protocol (Garcia et al., 2009). This study was completed at a large urban academic medical center and the participants were screened for defined eligibility criteria and are representative of the adult population at large. The authors or the study are appropriately credentialed in their fields and included a biostatistician to aid in the data analysis (Garcia et al ., 2009). The primary and secondary outcomes were clearly identified. All variables were tested or analyzed using the method demanded by the results. VAP was defined using the Centers for Disease Control and Prevention published definition (Garcia et al., 2009 ). Conclusion There remain many unanswered questions as to the etiology and prevention of VAP. In my research I observed that many of the studies included multiple interventions for VAP prevention in the study protocols. They also continued the institutions current policies for managing ventilated patients. It would seem to cloud the interpretation when there are multiple interventions making up the protocol i.e. Chlorhexedine rinse, and subglottic suctioning, and routinely scheduled oral care. Multi-factorial studies make it more difficult to determine which factor is influencing the outcome. A well designed study needs to eliminate or incorporate a single intervention at a time to determine its effect, or lack thereof. This would enable the researcher to clearly demonstrate a cause and effect relationship More carefully crafted studies will need to be performed with a universally agreed upon definition of VAP. As is always the case when research is involving people there is a reluctance to leave off anything that might be perceived as healing. In this case I believe that multiple interventions performed simultaneously are a hindrance to clearly understanding what is truly the most efficacious VAP prevention protocol design. In light of ongoing mandates from CMS to eliminate nosocomial infections there is an added impetus to define and eliminate VAP. Ventilator associated pneumonia is a chronic and costly problem in the intensive care setting. VAP increases patient morbidity, mortality, and length of stay. These negative effects add significantly to the financial and emotional burden to the patient, family, and the institution. Therefore, healthcare providers need to proactively evaluate and implement procedures to minimize VAP rates. References Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., Majumder, M. (2009). Reducing ventilator-associated pneumonia through advanced oral-dental care: A 48 month study. American Journal of Critical Care, 18(6), 523-532. Doi:10.4037//ajcc2009311 Klompas, M. (2010). Ventilator-associated pneumonia: Is zero possible? Clinical Infectious Diseases, 51(10), 1123-1126. Doi:10.1086/656738 Munro, C., Grap, M., Jones, D., McClish, D., Sessler, C. (2009). Chlorhexedine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care, 18(5), 428-438. Doi:10.4037//ajcc2009792

Developing Students Macro Skills

Developing Students Macro Skills Learning resources and materials are essential components in language instruction since they control learning and teaching processes. For that reason, an English teacher has to possess the ability to be creative and innovative in selecting, adapting and implementing learning resources and materials since the teachers ability in selecting, adapting and implementing learning resources and materials can and do enhance language teaching (Brinton, 2001 in Murcia, 2001). However, based on the writers experience and observation during Praktek Pengalaman Lapangan (PPL), the writer found out that the learning resources and materials used by teachers for their students were just in limited usage; for example, the teacher only used the materials from textbooks and printed materials. Talking about textbook, Allwright (1990) argues that materials should teach students to learn, and that there should be resource books for ideas and activities for instruction/learning. Moreover, they should give teachers rationales for what they do. From Allwrights point of view, textbooks are too hard to be used directly as instructional material. ONeill (1990), in contrast, argues that materials may be suitable for students needs, even if they are not designed specifically for them. In this case, textbooks make it possible for students to review and prepare their lessons. Also, textbooks are efficient in terms of time and money, and that they can and should allow for adaptation and improvisation. Furthermore, Willis (1996) points out that some text book activities are best done at learners own pace; for example, at out of class activities (for homework or to be checked at the next lesson). Indeed, the teacher can get the students to prepare the topic at task related to their homework prior to the task. Therefore, it is widely known that in many cases teachers and students rely heavily on textbooks, and textbooks determine the components and methods of learning, that is, they control the content, methods, and procedures of learning (Kitao, 1997). In other words, students learn what is presented in the textbook, and the way the textbook presents the material tends to determine the way students learn it. Thus, the educational philosophy of a textbook will influence the class and their teaching-learning process. Consequently, in many cases, textbooks are the center of instruction and one of the most important influences on what goes on in the classroom. Therefore, there is no doubt if Harmer, 1991; Van Lier, 1996; Richards, 1998 say that the use of textbooks in many schools and many language program has the function as a curriculum. In relation to teaching-learning resources and materials, the Department of Education in Indonesia has released a guideline for the implementing a decentralization of education at the school level (school-based management). Such management gives a broader authority to schools to run their schools and to work more actively with their communities, but at the same time it also requires more leadership, professionalism, initiatives, innovation, and creativity from principals and teachers (http://www.depdiknas.go.id). In this respect, education policy-makers in Indonesia believe that decentralization at the school level could lead to improvements, such as better school performance, greater school autonomy, better match between the services delivered and the students needs, greater parental and community involvement, and greater participation in decision-making (Depdiknas, 2003). The consequences of decentralization at school level, however, are not hard to determine. Schools, particularly public schools, are now to be responsible for the provision and financing of more training for their teacher development as well as more facilities and resources (http://pakem.org/mbs.html). In line with that, teachers role in developing students English macro skills to fulfill the national educational goals as stated in guidelines and curriculum is very prominent. Therefore, teachers play an important role in catering learning resources and materials for students to enable their success in learning, especially in developing their macro skills (listening, speaking, reading and writing). Concerning the main task of teachers in providing learning resources and materials mentioned above, theres a need to explore to what extent those learning resources and materials are procured and effectively used to develop the students English macro skills. 1.2 Research Methodology With the intention of getting data on the use of learning resources and materials in senior high school by the English teachers, a case study is selected as the research methodological design. The subjects selected are three teachers from different grades (X, XI, and XII) and their students. In order to get a holistic accurate picture and the meaning of the use of learning resources and materials, interviews, observations, questionnaires and review of documents will be conducted in this research. The use of the data collection methods will ensure the validity of the data through triangulation (Denscombe, 1998; Cresswell, 2008). 1.3 Research Questions The research questions in this study are based on the background of the study. Therefore, the statements of the problems in this study are as follows: a. What learning resources and materials are used by the senior high school teachers to develop the students macro skills? b. What learning activities are conducted in relation with the use of the learning resources and materials in the teaching-learning processes? c. Where do the teachers draw their ideas from to plan their teaching? 1.4 Objectives of the Study The study is aimed at finding out an empirical data on the kinds of learning resources and materials used by senior high school English teacher. It is also intended to explore further to what extent those learning resources and materials are effectively used to develop the students four macro skills. 1.5 Significance of the Study The results of this study provide a thick description on what learning resources and materials as well as how they are used by English teachers at senior high school. The findings can contribute to teachers by providing current information about the use of learning resources and materials for teaching-learning English as a foreign language in senior high school. The findings can also be applied for other English teachers in general to select the teaching-learning resources and materials appropriately that suit students needs. CHAPTER II LITERATURE REVIEW This chapter discusses some scholars ideas and opinions regarding the issues of learning resources and materials as well as the teaching and learning of English in high school context in Indonesia 2.1 Learning resources and materials 2.1.1 Issues of Learning resources and materials Many educators enthusiastically embrace the use of learning resources and materials as a tool for language teaching and learning since their functions are to lend the authenticity to the communicative situation in teaching and learning English. Resources and materials are important in language instructions since they can assist teachers in their jobs bringing the outside world into the classroom and also making the language learnings tasks more meaningful and exciting (Brinton in Murcia, 2001). Many scholars ideas emerged in relation to the view of learning resources and materials. This includes Allwrights (1990) argument that materials should teach students to learn and they should be resource books for ideas and activities for instruction/learning. In addition, they should give teachers rationales for what they do. Allwright further emphasizes that materials control learning and teaching. This means that in employing materials for instruction/learning, it is the teachers who underl ie the principle behind the use of materials. Another idea comes from ONeill (1990) who says that materials may be suitable for students needs even if they are not designed specifically for them; therefore, from ONeills point of view, materials help teaching and learning. Further, Woods (1996) defines the resources as factors which increase the number of possibilities or options open to a teacher, while the definition of materials is stated by Brown (1995) as any systematic description of the techniques and exercises to be used in classroom teaching. Browns definition of materials draw broad sense since they can include lesson plans, and can accommodate books, packets of audiovisual aids, games, or other types of activities that occur in the classroom. Renyaan (2002) conclude the broad definition of learning resources and material as follows: Teaching media refers to resources used by the teacher for whole class, group, and individual learning. These include texts, audio-visual resources, and authentic material. Text refers to any written materials ranging from reference books, textbooks, activity sheets to flashcards. Audio-visual resources include films, videos, overhead projectors, audiotapes, pictures, magazines, and newspapers and other texts. Authentic material refers to the resources created by native speakers, both for classroom teaching and in the world outside the classroom. ALL Guidelines (Scarino et al., 1988) categorizes resources into three categories. That is, resources which provide communicative data in the target language, resources and activities which promote communicative use of the target language, and resources for whole class, group, and individual learning. Resources which provide communicative data in the target language are sorted into teacher talk, other classroom talk, recording of talk (audio and video), specially prepared written information, other classroom written information, as well as realia and written texts from outside the classroom. While resources and activities which promote communicative use of the target language are classified into problem solving activities, information/opinion/affective gap activities, personalized activities, games, pictures, activities involving processing information from various sources, literature based activities, drama, writing activities, focus and shaping exercise, and integration of activiti es. Lastly, resources for whole class, group, and individual learning can be textbooks, films, videos, OHP and transparencies, problem solving activities, unfinished plays or stories, songs, films, poems, etc. Smith (1986) argues that learning resources and materials are important parts of task for providing the content and shape the basis of learning activities. Richards (1998) also argues that materials are often seen as a way of influencing the quality of classroom interaction and language use. Reece and Walker as cited by Wheeler (2002) add that learning resources should support the teaching strategies which assist learning. In this respect, the use of learning resources may also provide opportunities for arousing and maintaining students interests. Therefore, the teachers can get the benefit for the improvement of their teaching by using those learning resources. Brinton in Murcia (2001) summarized the rationale for using the materials in language classroom as follows: They can be an important motivator in the language teaching process They can create a contextualized situation They can lend authenticity to the classroom situation They can address the needs of students, whether they are visual or auditory learners They can expose the students to multiple input sources as well as enrich the students language experiences. They can help students call up schemata and maximize background knowledge They can provide teacher a time-efficient of presenting lesson, stimulate students senses and help students to process information readily. The importance of learning resources and materials has been figured by several teaching- learning method. For example, in Silent Way (Larsen-Freeman 1986; Stevick 1998) the use of sound-color charts and rods are for helping the teachers to elicit language and provide the students with tools for creative language construction. CLT, (Larsen-Freeman 1986, Littlewood 1981) also puts an emphasis of the need of real life objects or texts (e.g. maps, pictures, application forms, railroad time tables) in order to lend the authenticity to the communicative situation. 2.1.2 Types of Learning resources and material Some theories have been introduced by the scholars for a wide variety of learning resources and materials. Scarino, Vale, McKay Clark (1988) describe the word resources as any published or unpublished material in any medium for the purpose of language teaching and learning. The definition of resources drawn by them refer to variety of text types which may or may not be intended for teaching learning (films, maps, pictures, etc) along with hardware (audiovisual equipments, computers). Further, Marsh (2000) sorts resources into (1) resources available for use in the classroom/school, which include (a) print materials such as textbooks; reference books; project kits; pamphlets and inexpensive materials; study prints and posters; simulation games; maps, globe, and models; and (b) multimedia such as personal computers, internet and world wide web (www), CD-ROM, television, films, radio, slide tapes and filmstrips, overhead projectors, and PowerPoint projectors and (2) resources available beyond the school which consists of (a) persons including people in specific occupations; people now retired; groups, associations and organizations; and (b) materials and artifacts, such as newspapers, documents and reports, photographs, recordings, and miscellaneous personal items. Curtain and Pesola (1988) categorize the learning resources into five parts, they are: (1) Realia, e.g. balls, magnetic letters, flowers (2) Picture Visual, e.g. brochures, flash cards, pictures files (3) Classroom equipments, e.g. white board, chalk board (4) Audiovisual equipments, e.g. overhead projectors, video cassette recorder, slide projector (5) Text books or printed material. At last, Renyaan (2002) adds that it is evident that resources and materials which can be available in the classroom and beyond the classroom are essential parts of tasks as they provide the content as the basis for learning activities. Another idea comes from Richards and Rodgers (1986) who divide materials into text-based materials, task-based materials and realia. Text-based materials are generally known as textbook in which include not only sound recordings and visual aids, but also student workbooks, unit tests, games, and other activities (Savignon; 1983 in Renyaan; 2002). Task-based materials consist of a variety of games, role-plays, simulations and task-based communication activities (jigsaw, information gap, problem solving, decision making, opinion exchange, debate, question-answer, etc) (Richards and Rodgers, 1986).Realia, according to Richards and Rodgers, 1986; Little et al., 1989; Brinton, 2001 incorporate in authentic materials. For example signs, magazines, advertisements, newspapers, novels, handbooks and manuals, recipes, and telephone directories, as well as graphic and visual sources including maps, pictures, symbols, graphs, and charts. Moreover, radio and television broadcasts, computer progra mmes, and video cameras are also classed as authentic materials. 2.1.3 Textbooks as resources in language instruction Research into the use of textbooks as resources in classrooms language instruction have been done by scholars, such as by Harmer, 1991; Van Lier, 1996; Richards, 1998 who say that textbooks have the function as the curriculum. Their points of views are similar to Ariew (1982) who believe that textbook is an important part of the curriculum, especially for foreign language learning context since foreign language textbooks may represent a set of goals and specific teaching methods. Thus, textbooks for foreign language learning can reflect the assumption and belief on how a foreign language should be learned and taught. The development of teaching foreign language has brought new idea into approaches of textbooks design for the authentic data as well as realia which are integrated in the textbooks for the purpose of bringing the real world into classroom (Nunan, 1999). The important point of textbook is also suggested by Richards (1998) that textbooks can help in developing a teachers teaching skills, especially for inexperienced teachers since textbooks can provide hints on approaches to teaching grammar in the communicative class, strategies to correct errors, or how to teach writing. Despite of those positive effects of the use of textbooks in language classroom, there are negative effects of using textbooks. Swan (1992 cited in Richards, 1998) says that ready-made textbooks can seem to release teachers of their responsibility. The teachers merely peg on the textbooks which they use without participating on what to teach and how to teach the material to the students. Moreover, since the teachers only teach what are on the textbooks, teachers tend to look at the textbooks uncritically (Richards, 1998). While Renyaan (2002) argues that textbooks are resources, which, despite their drawbacks, are an essential part of the curriculum from which the teachers can generate materials by adopting, developing, and adapting them. 2.1.4 Adopting Materials As discussed before, the easiest way for the teachers to generate the materials is simply to adopt a textbook and teach systematically through the prepared materials (Brown; 1995), therefore the teachers get no difficulty since they do not have to spend too much thoughts and efforts in the lesson planning process. Though, it is the fact that not all textbooks can suit the teacher and students needs as Flynn (1982, p.39) says: While every textbook has some valuable drills, exercises, explanations, and readings, none will be suitable to every teachers needs. For the reason above, Brown (1995) points out that adopting material includes the following steps, namely: deciding on the types of materials needed, locating different types of materials, evaluating the materials, and reviewing them on an on-going basis. Deciding on types of materials Brown (1995) indicates that materials can come from various forms, different approaches, and different syllabus; therefore it is the teachers responsibility to make the decision about what specific materials to adopt. Locating materials Brown (1995) discusses the three sources of information that can help in finding existing materials: publishers catalogs, the Books Received section of journals, and teachers shelves. Evaluating materials Evaluating materials is important since it can determine the suitability to a particular program (Renyaan, 2002). Brown (1995) also argues that the best way to determine the relationships among a set of materials and a particular program, is to determine the degree to which the materials fit the curriculum. Browns argument is almost the same as Byrds (2001) that the fit between curriculum and the textbooks can create the fit situation for the teacher. On going review of materials Brown (1995) states that the materials evaluation process must continue when they are being used and after each implementation period. Further, Brown also argues that periodic review of the materials seems advisable and necessary. 2.1.5 Developing Materials Developing the materials need to be done if the tentative needs, objectives, and tests really describe a program and if all materials adoption efforts fail to uncover suitable materials to meet the purposes of the program (Brown, 1995). So, there will be a best match between the materials and curriculum. 2.1.6 Adapting Materials As Flynn (1982) argues that no single textbooks can meet the teachers and the students needs, Brown (1995) further points out that there is no such thing as a perfect textbook. This is likely to be true whether the materials in question were commercially produced or created within a given program. Indeed, as stated by Flynn and Brown, materials adaptation is prominent for the sake of fulfilling the teachers and the students needs. Moreover, Ariew (1982) points out that material adaptation is not something new; in fact, teachers constantly adapt when they teach. Concerning materials adaptation, Ariew (1982) further suggests the three categories of material adaptation: (1) the individualizing of materials; (2) modifying texts for purposes unintended by the author; and (3) compensating for the defects of a textbook. In addition, Ariew states the techniques in order to accomplish any of the three-type adaptation above, namely: supplementing, personalizing, expanding, editing, simplifying, modernizing, and localizing or modifying cultural or situational content. However, not all contents in the textbook are true and should be accepted. Textbooks may not suit a particular class or individual students interests. Therefore, it is the teacher who has the responsibility to choose what is best for their students. Harmer (1991) points out that textbooks are an important aid, but not a sacred text, so teachers will have to work out the best ways to use their books; they should never let the textbook use them, or dictate the decisions they take about the activities in which the students are going to be involved. Further, Byrd as cited in Murcia (2001) adds that in order to create the fit situation for the teacher using textbooks, the following must be addressed: The fit between curriculum and the texts It is generally known that publishers create materials based on published curriculum system. For example, in Indonesia, National Education Board (Depdiknas) arranges for publication of its own textbooks; however, it is acceptable for other publishers to publish the textbooks as long as the materials are appropriate and carry out its particular curriculum goals. The fit between curriculum and the texts is believed to be a reasonable and achievable goal. The fit between students and the texts The main reason underlies this idea is that the textbooks are for students; therefore, it must fit the needs of the students as learners of English. The fit between teachers and the texts As the textbooks are also for teachers, the fit between teachers and the textbooks is important in order to create the fit situation in using textbooks as the teaching learning materials. Byrd suggests the basic questions in relation to it: Can our teachers handle this material? and Will our teachers find that the textbook meets their needs and preferences for teaching materials? 2.2 Teaching Learning English in High School Context in Indonesia 2.2.1 English language education in Indonesia Since it was first taught, there have been problems in the teaching of English as a foreign language. For example the fact that the changing of curriculum and approaches along with the changing of the Minister of Education is not uncommon. The big class sizes and teachers with poor mastery of English are two obvious factors that contribute to the ongoing problems in ELT in Indonesia (Dardjowidjojo, 2000). Other reasons for the problems are: (1) limited time allocated for teaching English; (2) students do not have enough time to actually learn to speak English in class because the teacher is more concerned with teaching the grammar and syntax; (3) the absence of the social uses of English outside the classroom; and (4) the absence of good and authentic learning materials (Musthafa, 2001). Recent curriculum in English language education in Indonesia focuses on the teaching of English at junior and high school levels. The curriculum adopts the so-called communicative competence as its m odel of competence (Depdiknas, 2003). Communicative competence itself can be summarized as skills needed for communication, which consists of four important components. Those components are: grammatical/linguistic competence, socio cultural competence, discourse competence, and strategic competence (Richards Rodgers, 1986; Celce-Murcia, Dornyei Thurrell, 1995; Beale, 2002). In line with the concept of communicative competence, the following factors should therefore be present in an English language classroom: Fluency and acceptable language is the primary goal (Richards Rodgers, 1986). This implies that the teacher him/herself should be a fluent English speaker. Students are expected to interact with other students in order to communicate in the target language (Richards Rodgers, 1986; Freeman, 2000). This implies that the tasks should include pair and group work, and those activities like role plays, language games and problem-solving tasks are encouraged. Students should be given enough opportunities to get to know the authentic language (Freeman, 2000). Therefore, authentic materials are important in an English classroom. The role of the teacher is that of a facilitator in communication (Richards Rodgers, 1986; Freeman, 2000). This implies that the amount of teacher talking time should not be a barrier for students for using the target language (McDonough Shaw, 1993). Non-technical and technical media are important tools for language learning and teaching, particularly for carrying out language tasks (Brinton, 2001). Non-technical media include: blackboards, posters, maps, pictures, or photos. Technical media include: tape recorder, CD/Video/DVD player, or overhead projector. Whether or not English teaching and English teachers in Indonesia have met the ideals as stated above, remain a question. The real fact is that the virtues behind the so-called communicative competence as recommended by Richards and Rodgers (1986), McDonough and Shaw (1993), Freeman (2000), or Brinton (2001), and the principles stated and expected in the recent curriculum document might be implemented differently in the real English classrooms due to many unexpected factors, such as funding, unqualified teachers, and limited resources facilities. 2.2.2 Issues of teaching learning English in High School Context The Indonesian curriculum system has been developed by the National Education Board (Departemen Pendidikan Nasional) for many years in order to keep up with the global changes of the world as well as changes in the learners needs to be ready to face the world in the future. Recently, the Indonesian government through Departemen Pendidikan Nasional has made the improvement in the quality of national curriculum system. The newest one is Peraturan Menteri Pendidikan Nasional (Permendiknas) No. 22/2006. Permendiknas No.22/2006 discusses the Standard of Content (Standar Isi) of Elementary and High School level in Indonesia. Also, Permendiknas No.22/2006 contains Basic Competencies (Kompetensi Dasar) for each field of studies in every unit of elementary and high school level. They are the guidelines for the teachers in order to develop the indicators that must be achieved by the students as well as the materials that will be used in the teaching learning processes. The importance of mastering English for Indonesian students is much more felt due to the globalization in all sectors. One measurement to improve the mastery of English done by the Indonesian government is by implementing the English National Examination with a passing grade of 5.50. In Kurikulum Tingkat Satuan Pendidikan (KTSP), one of the learning purposes of Bahasa Inggris in Sekolah Menengah Atas (SMA) is developing students communicative competences in written and spoken English through an integral development of those four macro skills including listening, speaking, reading, and writing (Table 1, Standar Kompetensi Lulusan Sekolah Menengah Atas (SMA) /Madrasah Aliyah (MA) Table 1 Standar Kompetensi Lulusan Sekolah Menengah Atas (SMA) / Madrasah Aliyah (MA) Bahasa Inggris SMA/MA 1. Mendengarkan Memahami makna dalam wacana lisan interpersonal dan transaksional, secara formal maupun informal, dalam bentuk recount, narrative, procedure, descriptive, news item, report, analytical exposition, hortatory exposition, spoof, explanation, discussion, dan review, dalam konteks kehidupan sehari-hari. 2. Berbicara Mengungkapkan makna secara lisan dalam wacana interpersonal dan transaksional, secara formal maupun informal, dalam bentuk recount, narrative, procedure, descriptive, news item, report, analytical exposition, hortatory exposition, spoof, explanation, discussion, dan review, dalam konteks kehidupan sehari-hari. 3. Membaca Memahami makna dalam wacana tertulis interpersonal dan transaksional, secara formal maupun informal, dalam bentuk recount, narrative, procedure, descriptive, news item, report, analytical exposition, hortatory exposition, spoof, explanation, discussion, dan review, dalam konteks kehidupan sehari-hari. 4. Menulis Mengungkapkan makna secara tertulis dalam wacana interpersonal dan transaksional, secara formal maupun informal, dalam bentuk recount, narrative, procedure, descriptive, news item, report, analytical exposition, hortatory exposition, spoof, explanation, discussion, dan review, dalam konteks kehidupan sehari-hari All those four skills are expected to prepare senior high school students to enter the higher education or work fields, especially those requiring English skills. Due to the objectives of teaching English for senior high school, that is to develop students communicative competences through an integral development of the four macro skills, the learning resources and materials that are used in teaching learning processes have to give students more chances to communicate in English. CHAPTER III RESEARCH METHODOLOGY This chapter explains about how this research is accomplished. It considers the methodological design, the subjects, and the instruments of the study also data analysis techniques. 3.1 Design of the study This study aims at examining the use of learning resources and materials by English teachers at one senior high school in Jakarta. It is conducted through a collective case study in order to find in depth what learning resources and materials employed by English teachers. In accordance to Burns definition (2000:460) a case study is relevant to study uses how and what questions. This design is also suitable for a small-scale research which is conducted in one place. Bell (1993:8) also suggests that case study is particularly appropriate for an individual researcher as it gives an opportunity for one aspect of a problem to be studied in some depth within limited time scale. The study deals with three English teachers in one senior high school in Jakarta and their students. In order to get more information about the learning resources and materials used in classroom, the writer conduct the interview to the teachers and students, non participants observation, review of the documents, and distribute the classroom survey. 3.2 The Subjects of the Study The subjects chosen are considered as the representatives of senior high school English teaching condition in general because the school offers English to be implemented as part of its National Curriculum and has English teachers with English Education background.

Preparation Of Oxalate Complexes Of Iron Biology Essay

Preparation Of Oxalate Complexes Of Iron Biology Essay To prepare two oxalate complexes of iron namely, Potassium Trioxalatoferrate Trihydrate and Iron Oxalate and to analyse the products for iron and oxalate respectively. One of the properties known to be characterised by transition metals such as iron is complex ion formation since they are able to form stable complexes. In this experiment, two complex of iron are being formed with the oxalate ion being the common ligand in both. Potassium Trioxalatoferrate (III) Trihydrate and Iron (II) Oxalate are the two complexes being formed and are represented by the following chemical structures: Figure 1: Chemical structures of Potassium Trioxalatoferrate (III) Trihydrate and Iron (II) Oxalate respectively. The oxalate ion, apart from acting as a Lewis base can be referred to as a bidentate ligand since an oxalate ion can donates two pairs of electrons (one from each oxygen) to the iron (III) or Iron (II) cation acting as a Lewis acid from two oxygen atoms as can be seen in figure 1 above. Iron can form a variety of complexes with most of them having an octahedral geometry. In this experiment, the Iron (II) oxalate formed is characterised by an Fe2+ as the central metal cation. This is then oxidised to Fe3+ in order to synthesise the Potassium Trioxalatoferrate (III) Trihydrate complex characterised by an Fe3+ as the central metal cation. Certain complexes such as the Potassium Trioxalatoferrate (III) Trihydrate complex are unstable to light and therefore they are said to be photosensitive. For this reason, it is a must to store such a complexes under dark conditions in order to prevent the reduction of the Fe3+ ion back to the Fe2+ ion. The amount of oxalate within a complex can be determined using titrimetric analysis. Potassium permanganate is titrated with the oxalate ion and the amount of oxalate can be determined through this redox titration. No indicator is necessary in such a titration due to the fact that the endpoint is characterised by a faint pink colour resulting from the fact that at the end point, excess un reacted permanganate ions are present in the solution since all the oxalate ions would have been consumed. The amount of iron in a complex on the other hand can be analysed following the addition of zinc to the complex solution followed by heating. Once this is carried out, the resulting solutions can be treated with potassium permanganate in a redox titration as described previously above and hence, the amount of iron in a complex can be determined. In this experiment, heating is involved in the redox titrations due to the fact that since the reaction is rather slow at room temperature, in order for one to observe a quick colour change at the end point, the solution needs to be heated to around 60oC. Method Chemicals used Ferrous ammonium sulphate Hydrogen peroxide Sulfuric acid Ethanol Oxalic acid Zinc Ferrous oxalate Potassium permanganate Potassium oxalate Apparatus used Buchner funnel Heating mantle Burette Weighing boat Thermometer Filter paper Magnetic stirrer Glass wool Analytical balance Measuring cylinder Procedure Part a Preparation of Iron (II) oxalate 15g of ferrous ammonium sulphate were dissolved in 50mL warm water which had been acidified with 1mL 2M sulfuric acid. To this, a solution of 10% 75mL oxalic acid was added with rapid stirring. The mixture was gently heated until its boiling point was reached and the yellow precipitate of ferrous oxalate formed was allowed to settle. The precipitate was removed by filtration on a Buchner funnel and washed thourally with hot water followed by acetone. The product was allowed to dry on a funnel under suction and was then weighed. Part B Preparation of Potassium Trioxalatoferrate (III) Trihydrate. 3.25g of ferrous oxalate was suspended in a warm solution of (5g in 15mL water) potassium oxalate. To this, 15mL 20 vol. Hydrogen peroxide was added from a burette whilst the solution was stirred continuously and the temperature was maintained at 40oC. The solution contained a precipitate of ferric hydroxide and this was removed by heating the solution to its boiling point and adding 10mL 10% oxalic acid. Further small amounts of oxalic acid was added drop wise until the precipitate just dissolved. The hot solution was filtered and 15mL ethanol was added to the filtrate in order to re dissolve any crystals that formed by gentle heating. The solution was placed in a dark cupboard to crystallize since the product formed was photosensitive. The crystals were collected by filtration on a Buchner funnel and later washed with an equivolume mixture of ethanol and water followed by acetone. The crystals were then dried and weighed. Part C The analysis of the products for Iron and Oxalate For Iron (II) oxalate: 0.3g of oxalate were dissolved in 25mL 2M sulfuric acid and the solution was heated to 60oC and titrated with 0.2M standard potassium permanganate solution until the first permanganate pink colour was observed. 2g of zinc dust was added and the solution was boiled for 25 minutes. The solution was filtered through glass wool and the residual zinc was washed with 2M sulfuric acid. The washings were added to the filtrate and the solution was titrated with standard potassium permanganate. The percentages of iron, oxalate and water of recrystalisation in the product were determined and hence, the empirical formula could be derived. For Potassium trioxalatoferrate (III) trihydrate: 0.2g of Potassium trioxalatoferrate (III) trihydrate were dissolved in 25mL 2M sulfuric acid and titrated with 0.02M permanganate. The solution was treated with zinc dust and re-titrated with permanganate as described in the analysis of Iron (II) oxalate above. The percentages of iron and oxalate in the complex were determined and this was compared to the theoretical value. Precautions: It was made sure that in the preparation of Potassium Trioxalatoferrate (III) Trihydrate, ethanol was added to the filtrate in order to re dissolve any crystals that formed by gentle heating. It was made sure that in the preparation of Potassium Trioxalatoferrate (III) Trihydrate, the solution was placed in a dark cupboard to crystallize since the product formed was photosensitive. It was made sure that for the preparation of Potassium Trioxalatoferrate (III) Trihydrate, the temperature was maintained at 40oC to prevent hydrogen peroxide decomposition. Observations: Ferrous (II) oxalate had a yellow precipitate and at the end a yellow powder was obtained. The endpoint of the redox titrimetric titration was marked by a faint pink colouration. Ferric hydroxide had a brown precipitate which turned into a green solution upon excess oxalic acid was added. Potassium Trioxalatoferrate (III) Trihydrate formed was in the form of green crystals. 3. Results and Calculations Results: Part A: Ferrous ammonium sulphate weighed 15.042g 10% oxalic acid measured 75mL Mass of ferrous (II) oxalate obtained 5.586g Part B: Ferrous (II) oxalate used 3.269g Potassium oxalate used 5.008g Mass of Potassium Trioxalatoferrate (III) Trihydrate obtained 2.205g Part C: Ferrous (II) oxalate used 0.320g Potassium Trioxalatoferrate (III) Trihydrate used 0.200g Zinc used 2g Volume of permanganate required in the redox titration between iron (II) oxalate and permanganate 49.5mL Volume of permanganate required in the redox titration between iron (II) oxalate and permanganate in the presence of zinc 15.50mL Volume of permanganate required in the redox titration between Potassium Trioxalatoferrate (III) Trihydrate and permanganate 24.50mL Volume of permanganate required in the redox titration between Potassium Trioxalatoferrate (III) Trihydrate and permanganate in the presence of zinc 4.00mL Calculations: Analysis of products for Iron Oxalate for Iron(II) oxalate The equations taking place in the reaction are: 2MnO4- (aq) + 5C2O42- (aq) + 16H+ (aq) Æ’Â   2Mn2+ (aq) + 10CO2 (g) + 8H2O (l) 5Fe2+ + MnO4- + 8H+ Æ’Â   5Fe3+ + Mn2+ + H2O Moles permanganate reacting with oxalate and iron = Concentration of permanganate x Volume of permanganate required: Moles permanganate = 0.02 x (49.50 / 1000) Moles permanganate = 0.00099 moles Moles permanganate reacting with iron (II) = Concentration of permanganate x Volume of permanganate required: Moles permanganate = 0.02 x (15.5 / 1000) Moles permanganate = 0.00031 moles Therefore, moles of permanganate reacting with the oxalate ions = Total number of moles Number of moles of permanganate reacting with iron. 0.00099 0.00031 = 0.00068 moles From the stoichiometry of the equation it is observed that 2 moles of permanganate react with 5 moles of oxalate, thus: Moles of oxalate = 5/2 (0.00068) = 0.0017 moles Grams of oxalate = number of moles x mass of oxalate Grams of oxalate = 0.0017 x 88 Grams of oxalate = 0.150 grams Therefore % oxalate in the product: (0.150 / 0.320) x 100 = 46.9 % From the stoichiometry of the equation it is observed that 1 mole of permanganate react with 5 moles of Iron, thus: Moles of oxalate = 5 (0.00031) = 0.00155 moles Grams of Iron (II) = number of moles x mass of oxalate Grams of Iron (II) = 0.00155 x 56 Grams of Iron (II) = 0.087 grams Therefore % Iron in the product: (0.087 / 0.320) x 100 = 27.19% The mass of water = Total mass of complex (Mass of oxalate + iron (ii)) Mass of water = 0.320 (0.150 + 0.087) = 0.083g Therefore moles = grams / RMM Moles water = 0.083 / 18 Moles water = 0.0046 moles Therefore % water in product: (0.083 / 0.320) x 100 = 25.9% To calculate the empirical formula: Iron Oxalate Water 0.00155 : 0.0017 : 0.0046 0.00155 : 0.00155 : 0.00155 1 : 1 : 3 Thus empirical formula is FeC2O4.3H2O Analysis of products for Iron Oxalate for Potassium trioxalatoferrate (III) trihydrate. The equation taking place in the reaction are: 2MnO4- (aq) + 5C2O42- (aq) + 16H+ (aq) Æ’Â   2Mn2+ (aq) + 10CO2 (g) + 8H2O (l) 5Fe2+ + MnO4- + 8H+ Æ’Â   5Fe3+ + Mn2+ + H2O Moles permanganate reacting with oxalate = Concentration of permanganate x Volume of permanganate required: Moles permanganate = 0.02 x (24.5 / 1000) Moles permanganate = 0.00049 moles From the stoichiometry of the equation it is observed that 2 moles of permanganate react with 5 moles of oxalate, thus: Moles of oxalate = 5/2 (0.00049) = 0.00123 moles Grams of oxalate = number of moles x mass of oxalate Grams of oxalate = 0.00123 x 88 Grams of oxalate = 0.108 grams Therefore % oxalate in the product: (0.108 / 0.200) x 100 = 54 % Moles permanganate reacting with iron (III) = Concentration of permanganate x Volume of permanganate required: Moles permanganate = 0.02 x (4.00 / 1000) Moles permanganate = 810-5 moles From the stoichiometry of the equation it is observed that 1 mole of permanganate react with 5 moles of Iron, thus: Moles of oxalate = 5 (810-5) = 0.0004 moles Grams of Iron = number of moles x mass of oxalate Grams of Iron = 0.0004 x 56 Grams of Iron = 0.0224 grams Therefore % Iron in the product: (0.0224 / 0.200) x 100 = 11.20% Discussion: In the first part of the experiment, ferrous ammonium sulphate, also known as Mohrs Salt was treated with warm water and sulphuric acid in order to prevent the formation of rust coloured iron hydroxides and oxides. This was followed by oxalic acid. The oxalate ions replace some or all of the sulphate ligands surrounding the Fe2+ ion and as a result, a yellow precipitate of ferrous oxalate forms. The reaction taking place is as follows: H2C2O4 (aq) + Fe2+ (aq) + 2H2O (l) Æ’Â   3H2O+ (aq) + FeC2O4 (s) In order to oxidise the Fe2+ ion into an Fe3+ ion in ferrous oxalate, hydrogen peroxide, acting as an oxidising agent is added to a solution of ferrous oxalate and potassium oxalate. Temperature control is very crucial in this step due to the fact at high temperatures, hydrogen peroxide can decompose and thus would not be able to oxidise the iron (II) to iron (III) required to prepare the Potassium trioxalatoferrate (III) trihydrate complex. It is important to make sure that all the iron (ii) has been oxidised to iron (iii) due to the fact that since each complex consists of a different number of oxalate ligands, if a mixture of the two complex ions is present, the empirical formula determination would become difficult. The reaction taking place is as follows: 2FeC2O4 (s) + C2O42- (aq) + H2O2 (aq) + 2H3O+ (aq) Æ’Â   4H2O (l) + Fe2(C2O4 )3 (s) When the Fe2(C2O4 )3 precipitate was dissolved, [Fe(C2O4)3]3- forms. This reacts with the potassium ions in solution introduced via the potassium oxalate and forms potassium trioxalatoferrate (III) which is photosensitive and thus must be stored in the dark. In the analysis of the oxalate ion, no indicator is required in the redox titration between permanganate and the oxalate ions due to the fact that at the end point, since potassium permanganate is an oxidising agent, it oxidises the oxalate ions in solution into carbon dioxide and as a result, permanganate is itself reduced to Mn2+ therefore a faint pink colour is observed at the endpoint. The reactions taking place are as follows: 2MnO4- (aq) + 5C2O42- (aq) + 16H+ (aq) Æ’Â   2Mn2+ (aq) + 10CO2 (g) + 8H2O (l) In order to analyse the iron content in the complexes formed, zinc is added followed by heating the solution. Once this was complete, the solution was treated with permanganate in a redox titration similar to the one described previously above. The reaction taking place is as follows: 5Fe2+ + MnO4- + 8H+ Æ’Â   5Fe3+ + Mn2+ + H2O Conclusion: This experiment has shown that iron being a transition metal can exist as various oxidation states. These oxidation states can then form a variety of complexes with various ligands. The complexes that are formed can then be analysed using a redox titration in order to determine the percentages of iron and oxalate in the complex. In this experiment, the empirical formula of Iron (II) oxalate was found to be FeC2O4.3H2O and consisted of 46.9 % oxalate, 27.19% Iron (II) and 25.9% water where as the Trioxalatoferrate (III) Trihydrate consisted of 54% oxalate and 11.20% iron (III)

Canterbury Tales :: Essays Papers

Canterbury Tales With the presidential election at its boiling point, many try to provide their own joke every now and then. Late night comedians such as David Letterman and Jay Leno try to spit out a new joke during their ten-minute spiel, and sometimes one can assume that they are getting even with the election process. Throughout the one-hour show, the comedians do their best to trick both the viewers and all those involved with the election process by having people act out scenes, or imitate one of the presidents. Also, as just about every other comedian tries to achieve, he or she throws in a dirty joke about the president or his family to tie it all up right at the end of their spiel. These three aspects of comedy—revenge, trickery, and infidelity—can all be found in The Miller’s Tale. The Miller’s Tale encompasses a dark and infernal level of comedy, similar to that of comedy today. In The Miller’s Tale, Nicholas, a clerk, is a student of astronomy and of young women, who represents the dark and infernal level of comedy where â€Å"love cannot dwell in such society; everyone is fundamentally along, though hypocrisy and self-serving may give the appearance of friendship† (Cowan, 11). Nicholas lives with a wealthy carpenter named John, who’s an old man who protects his beautiful wife, Alison, as if it were flies on scat. In the infernal state â€Å"the pretty girl†¦ is either absent or, if she does enter the boundaries of this dark region, victimized† (11). Alison is caught between three disrespectful men. Her husband, John, won’t let his eye off his young and zealous wife; Nicholas always becomes as sly as a snake, wanting to make love to her, and trying to outwit his friend, John; the carpenters wife, fancied by Absalom, a parish clerk who has none of Nicholas’ attractiveness, but an eye for the ladies of the to wn. Although marriage is very rare in the infernal state, â€Å"old husbands tyrannize young wives, spouses are unfaithful, maidens are linked by opportunism to unsuitable mates†¦Ã¢â‚¬  (12). The old husband, John, tyrannizes his wife day after day with his over-protective personality,while she is unfaithful to him by making love and flirting with other men. Trickery is a key part in The Miller’s Tale, and found in the infernal state: â€Å"deception and disguise, characterizing marks of comedy, are used in infernal society for the purpose of gaining advantage, usually to the harm of others† (12).

Sir Thomas More Essay example -- essays research papers

Thomas More In life, belief can be a very powerful thing, powerful enough to affect major choices. Believing is having faith in an idea, person, thing or religion. In Robert Bolt's A Man for All Seasons, Sir Thomas More made many important choices the were affected by a belief in the religious theory that the Pope is the "Vicar of God" (the descendant of St. Peter, and our only link to Christ.) Throughout Mores entire life he chose to be loyal this belief, even thought it cost him his life in 1535. More chose to go against the King's divorce of Catherine, and marry of Anne. He chose to not sign to oath for the act of Succession, and towards the end of the play More was put to the ultimate test in faith, choose to go against his belief or be executed. Sir Thomas More chose always to be against the King divorce to Catherine of Aragon. He shows this when Cardinal Woolsey summons him to attend a matter concerning the "Kings business". In their meeting the topic of the Kings re-marriage is what the Cardinal wanted to talk to More about, When Woolsey says "...that thing out there is at least fertile, Thomas". More shows that he is against the divorce by saying "But she's not his wife". More again shows his beliefs that a dispensation was given so that Henry could marry Catherine and Thomas knows that the Pope will not give a dispensation on a dispensation. More believes that the Pope should make the decision about the divorce. And More ...

The Rehabilitation Nursing Environment Health And Social Care Essay

Stroke is a heterogenous syndrome caused by multiple mechanisms that result in a break of normal intellectual blood flow. Harmonizing to Kockrow and Christensen, ischemic in-between intellectual arteria shot is an unnatural status of the blood vass in the encephalon, characterised by bleeding into the encephalon of the formation of an embolus or thrombus that occludes the in-between intellectual arteria, ensuing in ischemia of the encephalon tissue usually perfused by the damaged cells. The in-between intellectual arteria supplies the largest volume of the cerebral hemisphere, including the basal ganglia, the internal capsule, and the ocular radiations from the thalamus ( Mitchell & A ; Moore 2004 ) . The disrupted blood flow in the MCA causes intellectual disfunction. Cerebral blood flow has an autoregulatory mechanism that protects against hypoxia and low perfusion ( Johnson 2012 ) . When intellectual blood flow the lessenings, the autoregulatory mechanism tries to counterbalance b y increasing the blood force per unit area and bring oning vasodilation ( Johnson 2012 ) . If the blood flow falls below a critical degree, intellectual blood volume is reduced and infarction occurs. Johnson ( 2012 ) explains that the deficiency of foods usually received from oxygenated blood and the harm which is caused by sudden hemorrhage into or around the encephalon lead to cell decease. Cerebral ischaemia initiates a figure of damaging cellular events enduring which consequence in extended cell decease and tissue harm beyond the country originally affected by the deficiency of blood flow ( Kockrow & A ; Christensen 2011 ) .Tissue plasminogen activator is a serine peptidase which converts plasminogen to plasmin, a fibrinolytic enzyme ( McElveen & A ; Macko 2009 ) . Upon disposal, recombinant TPA increases plasmin enzymatic activity, ensuing in fibrinolysis ( Harvey 2009 ) . It is used to handle the shot in the acute phase to reconstruct flow to the ischaemic country. In ischemi c stroke the dead or deceasing cells are surrounded by the penumbra-an country of cells at hazard of or enduring ischemia as explained by Harvey ( 2009 ) . Cells busying the penumbra are ill perfused and as a consequence become progressively ischemic ( Mitchell & A ; Moore 2004 ) . Circulation can be improved when TPA is administered within 3 hours in an acute ischemic shot ( Elkind 2009 ) . This will besides assist to understate decease cells in the penumbra. Collins ( 2007 ) states that the usage of TPA halts the shot by fade outing the coagulum that is barricading blood flow to the encephalon. When suitably administered to patients who fall within narrow clinical guidelines, TPA can restrict the extent of encephalon hurt and better results after shot ( Johnson 2012 ) .Describe the functions of four members of the multidisciplinary squad ( other than nursing ) who will care for Mrs Carroll.The function of the squad is to supply holistic attention which realistically develops of im port ends for Mrs Carroll and her household, whilst testing for shot complications and trouble-shooting as jobs nowadayss.Address DiagnosticiansThe address healers have established function for measuring swallow map every bit good as address ( Lindley 2008 ) . Regular address therapy can better the result after shot. Therapy begins without hold after a shot ( ideally the following on the job twenty-four hours ) and involves Sessionss of 1-2 hours per twenty-four hours as explained by Funnel, Koutoukidis & A ; Lawrence 2009. The address healers are concerned with assessing, naming and handling communicating upsets, such as formation and perceptual experience of address, the ability to joint words and to understand and originate address ( Freeman 1998 ) . The address healer will help Mrs Carroll to re learn communicating accomplishments. The address diagnostician will besides intercede closely with the nurse, dietician and household to accomplish safe swallowing schemes for Mrs Carrol l.Physical therapistsThe physical therapists will measure Mrs Carroll physical capablenesss and restrictions in a collaborative procedure ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . The physical therapist administers therapies designed to rectify or understate malformation, addition strength and mobility or relieve uncomfortableness or hurting ( William, Perry & A ; Watkins 2010 ) . Stroke rehabilitation comprises of exercising intercession, to understate the effects of the encephalon cell harm and optimise re-learning as stated by Lindley ( 2008 ) . William, Perry & A ; Watkins ( 2010 ) explain that the interventions include the usage of specific exercisings, heat, cold, aqua therapy and electro physical therapy. The function of the physical therapist besides involves educating Mrs Carroll and her household in right methods of placement, reassigning and call uping to help with the discharge.Occupational healersThe occupational healers aim is to help Mrs Carroll to be independent in executing activities of day-to-day life ( Lindley 2008 ) . Freeman ( 1998 ) explains that the occupational healers will find Mrs Carroll ‘s ability to execute basic activities of life such as lavation, dressing and feeding. Their function includes the appraisal of basic and more advanced functional activities ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . The occupational healer plants on specific undertakings in coaction with nursing staff and physical therapists ( William, Perry & A ; Watkins 2010 ) . This involves a period of appraisal including the ability to understand instructions followed by specific preparation in basic ADLS ( William, Perry & A ; Watkins 2010 ) . As Mrs Carroll has adequate motor recovery to keep sitting balance the occupational healer starts working on basic lavation ( e.g. rinsing the face, cleaning dentitions ) . As recovery returns, more complex undertakings can be assessed and practised such as showers transportations, acquiring on and off the lavatory. The occupational healers assess the demand for, and supply, adaptative devices to advance independency with bathing, eating and dressing. Home alterations are besides assessed by the occupational healers to guarantee that the place environment is safe and contributing to Mrs Carroll ‘s independency degree as elucidated by Funnel, Koutoukidis & A ; Lawrence 2009.PsychologistsPsychologist has an of import function in assisting Mrs Carroll towards a successful recovery. Their expertness is peculiarly utile in measuring temper, depression and assisting Mrs Carroll through hard accommodation periods by pull offing her choler and other hurt ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . The psychologist is concerned with the causes, bar and intervention of the single societal jobs particularly in respect to interaction between Mrs Carroll and the physical and societal environment ( Lindley 2008 ) . The psychologists will help the rehabilitation squad with schemes to pull of f Mrs Carroll ‘s behavioral perturbations that impact on the twenty-four hours to twenty-four hours rehabilitation procedure ( Freeman 1998 ) .3. Describe the schemes that may assist active engagement of the patient and household in the rehabilitation plan.The active engagement of Mrs Carroll and her household has a important function to play after her shot. Their support will be of great comfort for Mrs Carroll and when the shot has caused major jobs, their aid in the recovery procedure is a cardinal portion of good shot attention ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . The household need to understand and be involved with the rehabilitative ends that Mrs Carroll has developed with the squad and the methods selected to run into these ends as explained by William, Perry & A ; Watkins ( 2010 ) . This can include acquiring the household members to reenforce peculiar preparation Sessionss and developing the household to pull off Mrs Carroll with a position to dispatch for i llustration learning techniques to reassign Mrs Carroll from bed to wheelchair or acquiring Mrs Carroll into a attention safely ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . This will enable them to experience that they are playing a critical function in rehabilitation. Family members need to understand that their greatest part may be to let Mrs Carroll to be every bit independent as possible ( Gillespie & A ; Campbell 2011 ) . Another scheme that will assist the active engagement of the household is household conference with the multidisciplinary squad and the physician where they will have specific information on the type of shot that affected Mrs Carroll and about her advancement as illustrated by Popovich, Fox, & A ; Bandagi ( 2007 ) . Working with Mrs Carroll and her household will assist Mrs Carroll to accomplish realistic ends in their shot journey. It is besides really of import to learn the household techniques to heighten safety and communicating ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . Family members can besides supply valuable information about Mrs Carroll ‘s usual life style. The household members can help in reorienting Mrs Carroll to the affected side and implementing safety safeguards. It is besides of import for the household to be cognizant of the shortages and intercessions appropriate for Mrs Carroll ( Lindley 2008 ) .4. Mrs Carroll ‘s defeat with motor activities and address make her angry. Discuss how choler may be used to ease effectual header and how rehabilitation nurses can enable patients to utilize their energy therapeutically.Nursing intercessions to ease emotional accommodation to stroke should include hearing, detering self-blame, promoting Mrs Carroll to verbalize her feelings, advancing independency, assisting Mrs Carroll reappraise her state of affairs, and show credence and acknowledgment of her advancement as highlighted by William, Perry & A ; Watkins ( 2010 ) .It is of import that early marks of uneffectiv e header to be detected so that patients at hazard for depression may be assessed and treated. The psychologist can besides help in supplying get bying schemes for nurse and speech healer to pull off Mrs Carroll ‘s defeat and choler ( Funnel, Koutoukidis & A ; Lawrence 2009 ) . By back uping Mrs Carroll, instead than taking her, the nurse can assist her to gain her restrictions, consolidate loss and authorise her to be after for a hereafter that will be fulfilling to her.The construct of hope can be characterized by an unsure desire to accomplish ends that will let Mrs Carroll to set and travel end stations when transmutations occur as explained by Western ( 2007 ) . An achieved end or success against a nerve-racking experience creates an immediate sense of peace and good being and a generalized hope emerges for future successes harmonizing to Popovich, Fox, & A ; Bandagi ( 2007 ) . Hope is of import to recovery as it gives persons the motive and strength to accomplish their e nds ( Western 2007 ) . Empowerment so can be seen as a agency of assisting persons to recognize and accomplish their ends. Mrs Carroll becomes frustrated when she can non pass on, but alternatively of retreating from the conversation the nurse should promote her to do regular efforts to pass on with the squad and household. Hence her address will better daily and this will assist to accomplish her set ends ( ( Funnel, Koutoukidis & A ; Lawrence 2009 ) .5. Describe the medicines that Mrs Carroll is taking and discourse the grounds for administrating these medicines in his current status. Why should a cholesterin lowing agent be considered for Mrs Carroll?MetforminHarmonizing to Tiziani ( 2010 ) , Mrs Carroll was prescribed Glucophage as she has a history of Type 2 diabetes. Metformin acts chiefly by diminishing the production of glucose in the liver as described by Bullock and Manias ( 2011 ) . It besides slows soaking up of glucose signifier the intestine, inhibits glucagon secernme nt and tissue glycolisis ( Lindley 2008 ) . This medicine is prescribed when the blood sugar degree can non be controlled with diet alone ( Lindley 2008 ) .Avapro HCTThis medicine is used to handle mild to chair high blood pressure explained by Tiziani ( 2010 ) . The combination of a thiazide water pill ( hydochlorothiazide ) and angiotensin receptor adversary produces a greater decrease in blood force per unit area ( Tiziani 2010 ) .Irbesartan blocks the potent vasoconstrictive and aldosterone-secreting effects of angiotonin II by selective hostility of the angiotonin II receptors localized on vascular smooth musculus cells and in the adrenal cerebral mantle ( Bullock & A ; Manias 2011 ) . Hydrochlorothiazide increases plasma renin activity, increases aldosterone secernment, and decreases serum K. Coadministration of an angiotonin II receptor adversary tends to change by reversal the K loss associated with thiazide water pills ( Bullock & A ; Manias 2011 ) . This medicine will assi st to take down Mrs Carroll ‘s blood force per unit area.ClopridogrelThis medicine is used to forestall thromboembolic events, ischemic bosom disease and bar of shot ( Tiziani 2010 ) . Harmonizing to Bullock and Manias ( 2011 ) , it inhibits thrombocyte collection by irreversibly adhering to adenosine disphosphate thrombocyte receptor. Mrs Carroll has a past history of atrial fibrillation and she has a high hazard of shot from embolisation of cardiac thrombus ( Freeman 1998 ) . This medicine will cut down the hazard of holding a shot. Mrs Carroll ‘s LDL cholesterin degree is high and this increases the hazard of ischemic shot and bosom disease ( Lindley 2008 ) . A cholesterin take downing agent should be considered for Mrs Carroll to assist forestall farther vascular disease ( Mitchell & A ; Moore 2004 ) . William, Perry & A ; Watkins ( 2010 ) explain that the lower the blood cholesterin, the lower the subsequent hazard of ischemic shot and other thrombotic vascular disease. The cholesterin take downing agent has the ability to brace atheromatic plaque, cut down thrombogenicity every bit good as its consequence on dyslipidaemia ( Tiziani 2010 ) .6. What are the advantages and disadvantages of get downing Mrs Carroll on medicine to command her urinary incontinency?Harmonizing to Bullock and Manias ( 2011 ) , anticholinergics interfere with the parasympathetic excitations of the detrusor musculus by barricading the neurotransmitter acetylcholine, ensuing in fewer nonvoluntary contractions ( . One of the disadvantages of utilizing medicine to command her urinary incontinency is that it causes hazard of mental confusion ( Tiziani 2010 ) . Her cognitive operation has decreased since she had the autumn, hence this medicine will do it worse. Anticholinergics medicine additions hazard of terrible irregularity, Mrs Carroll suffers from irregularity already this medicine will increase the hazard of holding intestine obstructor. Furthermore, bladder preparation can better urinary incontinency and encouraging Mrs Carroll to utilize medicine will cut down her independency and motive ( Lindley 2008 ) . Mrs Carroll might experience embarrassed to go to therapy due to her urinary incontinency. Therefore she could decline therapy and this will non assist in the recovery procedure. Urinary incontinency may do clamber dislocation and roseola due to extra of wet in the genital-perineal country ( Borleis 2012 ) . This medicine will besides cut down the hazard of Mrs Carroll acquiring a urinary piece of land infection as she would non necessitate to travel to the lavatory more frequently. Furthermore, good continency attention plays a cardinal function in assisting to reconstruct Mrs Carroll self esteem and independency ( Freeman 1998 ) . The medicine will besides assist Mrs Carroll to come on with vesica preparation ( William, Perry & A ; Watkins ( 2010 ) .7. Mrs Carroll had a strong spiritual religion prior to her shot but has since refused to see the Priest or members of her church. What intercessions might you implement to assist her recover her religious well being?Mrs Carroll might b e embarrassed to run into her friends due to her status. First I would try to find the ground ( s ) for the hurt, and back up the Mrs Carroll to analyze her beliefs and values ( Tanyi 2006 ) . Supply research-based grounds to Mrs Carroll about the positive impacts of spiritualty on her wellness and operation ( Tanyi 2006 ) . Spending one on one clip with her and assist her to reflect back on her past religious well being might assist in cut downing her religious hurting.I would mention Mrs Carroll to a societal worker who may mention her farther to a psychologist ( Lindley 2008 ) . Her religious well being might non be straight related to her faith. Involve her in a speculation group with other patients who had stroke to assist her talk about her state of affairs. I would easy present one friend at a clip and see how she reacts to that. It is besides really of import to let Mrs Carroll to grief for the loss of what her life was and guarantee that she is cognizant that the nurse is a t that place to assist her. Pastoral attention services are inter-denominational and will be able to offer religious attention to Mrs Carroll ( Funnel, Koutoukidis & A ; Lawrence 2009 ) .8. How does the nurse utilise patient information obtained during admittance to help in the acknowledgment of discharge demands? What community resources would you see to assist Mrs Carroll and her hubby?A thorough nursing appraisal obtained during admittance enables the nurse to place existent and possible jobs of Mrs Carroll ( Fawcett & A ; Rhynas 2012 ) . Discharge planning is critical to advance good being and maximal recovery ( Freeman 1998 ) . On admittance, it was identified that Mr Carroll is really dependent on his married woman and that he is due for an operation in two hebdomads. Furthermore, they live in a two floor three sleeping rooms townhouse which will non be ideal for her when she come back from infirmary due to her limited mobility. To guarantee continuity of attention, the interd isciplinary procedure start on admittance by interceding with the societal worker, occupational healer, physical therapist and societal web as explained by Lindley ( 2008 ) . Mrs Carroll is active in the community and she besides has supportive friends within the Parish Community. The community can besides organize a support group for shot patients to run into other people from the community who understand what you have been through. A resource battalion can be developed for Mr Carroll supplying inside informations of community services and benefits available. On discharge, guarantee good links and information sharing between the infirmary and community squads, and between wellness and societal attention suppliers. Arrange chances for shot subsisters and households to run into cardinal community staff such as territory nurses and stroke affair nurses before discharge ( Gillespie & A ; Campbell 2011 ) .9. Mrs Carroll was an active member of his community but now has limited address. Describe any schemes you could utilize to help communicating and the discharge instruction you would supply to her hubby sing her communication with others in societal state of affairss.Communication troubles can significantly impact quality of life and cause hurt and defeat for households, friends and the patient ( Speech Pathology Services 2012 ) . A broad scope of schemes can back up communicating such as taking distractions when speaking to the patient as explained by Speech Pathology Services 2012. The usage of different sorts of communicating such as gesture, indicating or composing will assist to understand Mrs Carroll ( William, Perry & A ; Watkins 2010 ) . The nurse should explicate to Mr Carroll that it is really of import to talk in short sentences, easy and in a respectful tone with normal volume. When pass oning with Mrs Carroll, the individual should let excess clip to treat the information and repetition the message or state it in another manner ( Speech Pathology Ser vices 2012 ) . The usage of communicating devices will besides advance comprehension and apprehension ( Freeman 1998 ) . Communicating with his married woman could be really frustrating, it really of import for him to stay unagitated and patient. It is indispensable to supply accessible information for Mrs Carroll and her household on the peculiar type of address damage that Mrs Carroll has to heighten apprehension and assistance communicating ( William, Perry & A ; Watkins 2010 ) .10. Complete an admittance and discharge FIM for Mrs CarrollPlease see affiliated

IPO of Hertz Essay

1. Why are the private equity sponsors pursuing an IPO of Hertz at this time – that is, what is the purpose of the IPO? The sponsors wanted cash in order fund another special dividend. They felt that even though they had only owned the company for short time, they were in the perfect position to sell it. There are several reasons why 2006 was an opportune time for the IPO of Hertz. The market was on the rise with the S&P up over 10% on the year. The IPO market itself was incredibly strong, outperforming 2005 by November. As the case states â€Å"198 IPOs had price raisings approximately $41 billion. The pricing of IPOS also seemed solid. Of the 198 deals, the average first-day return (not annualized) was 8.8%. After four weeks, nearly 60% were trading above their offer prices†. Hertz was also recognized as one the top car rental brands in the world, it’s branding was dominant throughout North America, which in turn, gave it premium pricing power. At the time, Her tz also had the opportunity to expand in both the non-airport and equipment rental markets, which also has higher margins than general car rentals. 2. What are the differences between conventional IPOs and IPOs that arise from leveraged buyouts? First of all, it appears that private equity-led IPOs (RLBOs) are more successful than their non-buyout-backed counter parts. According to the case â€Å"a study which examined nearly 500 private equity-led IPOs from 1980 to 2002. For example, relative to $1 invested in the S&P, investors in RLBOs earned $1.05 on average over 36 months following the IPO compared to $0.81 in non-buyout-backed IPOs.† Sponsors also take it upon themselves to use debt in order to issue a special dividend and pay themselves for their work. This action typically raises concerns whether the sponsors are invested in the company over the long term. However, private equity firms claim that one of their advantages is their long-term perspective, a study by Moody’s involving 222 buyouts determined that this was not the case and that Special dividends resulted in a credit downgrade almost half of the ti me. 3. Should the sponsors have taken on additional debt and paid themselves a dividend from Hertz? No, the sponsors should not have taken on additional debt and paid themselves a dividend from Hertz. This pre-IPO action implemented by the sponsors shed negative light on themselves and the company as a whole. It portrayed entitlements of greed while hurting Hertz well established market reputation, it discouraged investors from potentially investing in the company, as well as throwing a  negative persona over the future outlook for Hertz. The dividend payment also caused a media uproar with more negative externalities being portrayed against the sponsors, as they were seen as money hungry investors with no true intention of expanding the value of Hertz. They were viewed as just wanting to receive their money and exit the company. Their actions were seen as selfish by the public and their peers, which was reflective by the demand for Hertz shares decreasing, along with the range of the IPO value falling from a stronger near $18 dollar range to a substantial decrease at around $15. The dividend payment provided doubt on the sponsors in how it was seemingly impossible to achieve value creation as well as significant management improvements in such a short time period, overall hurting the value of the company. 4. What are the pros and cons of public shareholders should consider when investing in sponsor-backed IPOs? This question boils down to the differences between investing in a sponsor backed IPO and investing in a non-sponsor backed IPO. During the time of this deal, the Great Recession was nearing its start, so the market took a big hit with that being said. Both sponsor and non-sponsor backed IPOs underwent price declines in their share-price valuation during this time, which should be viewed as a negative when considering investing in sponsor backed IPOs. To build on that with something that can be viewed as a positive, is that sponsor backed IPOs fell at a lesser rate than non-sponsor backed IPOs, decreasing at roughly 9% and 12% respectively. Another positive of sponsor backed IPOs is that they tend to generate greater post IPO price appreciation than that of non-sponsor backed IPOs. All in all, PE sponsors, â€Å"create value from being able to invest and operate with a longer-term perspective than public companies.† This long term perspective leads sponsors to make tougher decisions in terms of operations and debt, as well as being able to, â€Å"hold managers more accountable for higher levels of performance than public companies.† The quick exit tactic often used by PE sponsors does however bring to debate whether these sponsors are, â€Å"in it for the long haul or only for themselves.† 5. At the $15 offer price, does the Hertz IPO represent a good investment opportunity for Berg? Would you invest in the Hertz IPO? After conducting our analysis of the value of Hertz, we believe that offer price of $15 is still too low. We believe the share price to be about $12.69. Therefore, Hertz would not be a good  investment opportunity for Berg and I personally would not invest in the company either. 6. The sponsors invested $2.3 billion in equity (divided equally among them) to finance the $15 billion buyout of Hertz in December 2005. If the Hertz IPO is completed at the $15 offer price and the overallotment option (Greenshoe) is exercised, what is your estimate of the gross returns to the sponsors will earn on their $2.3 billion investment in Hertz (i.e. ignoring carried interest or management fees on the funds)?