Chapter 1 Essay

The problem and its background 1.1 Introduction A peer group is both a social group and a primary group of people. It may be defined as a group of people who share similarities such as age, background, and social status. The members of this group are likely to influence the person’s beliefs and behavior. Also, a peer group can have a serious effect in an academic status of a person. School is where many children meet peers, form friendships, and take part in groups. For friendless, rejected, or victimized children, the school must be a less-than desirable context and certainly a place that is unlikely to promote learning or well-being (Tarrant, 2002). Individuals tend to study in groups because of the fact that studying with peers is easier and fun. The study group environment offers students the opportunity to engage in a more in-depth discussion with peers, sharing information and knowledge about a course they are collectively enrolled in. Peer group studying can help with the issue of procrastination. Many students tend to cram for tests/exams on the night before or begin projects with very limited time before the due date. When involved in a study group, meeting at scheduled times can keep the active participants from procrastinating. In addition, individuals in study groups are less likely to delay or put-off assignments because they understand that other people are relying on them. Also, it can help in understanding information more efficiently; students tend to learn faster working within a group than working alone. If a student was working on his/her own, there would be a lot of time wasted puzzling over the difficulty. However, when students work in groups, they have the opportunity to explain concepts, review material, exchange ideas, and disagree/reason with one another about why one person’s answer differs from another. Thus, one can seek clarification and learn faster working in a group setting while gaining personal skills. In other countries, governments and officials are supporting peer group studying; they see it as a more effective way in learning. A number of programs focused on the early identification of at-risk students exist at the institutions in this peer group. All of these programs are designed to ease the transition from secondary school to higher education, particularly for students who are likely to be at risk once in  the university, and/or to identify these students once they have begun their first semester classes. They are overall aggressive in helping those students who need help (Sherif, 1964). In the Philippines, no agencies or government are supporting this kind of study, but individuals especially students are influenced by peer group studying. Filipino students are more comfortable in studying with their peers rather than studying alone (Benilde Students, 2008). In the Lyceum of the Philippines University – Manila, peer group studying is applied by some students, they also tend to see that group studying is more effective way to learn the lesson or courses they are studying (Lyceum Students, 2010). Nevertheless, peer group studying still have disadvantages to an individual. Peer pressure is the pressing of a member of the collective group to behave in a manner that s/he finds unacceptable. Often, when parents are telling their children they may not participate in a behavior, a child responds with what the other kids are doing. This response demonstrates a level of pressure felt by the child to participate in an activity or behavior. Another disadvantage is the feelings associated with rejection. These emotions include resentment, dislike, a feeling of isolationism and even depression. Also, peer groups are powerful agents of risk behaviors in adolescence. Adolescents typically replace family with peers regarding social and leisure activities, and many problematic behaviors occur in the context of these groups. A study (Kertz, 2012) focused on adolescents’ engagement in risk behaviors. Participants completed a self-report measure of identity commitment, which explores values, beliefs, and aspirations, as well as a self-report that measures perceived peer group pressure and control. Both peer group pressure and control were positively related to risky behaviors. However, adolescents who were more committed to their personal identity had lower rates of risk behaviors. Overall, this study shows us that adolescent identity development may help prevent negative effects of peer pressure in high-risk adolescents (http://www.montclair.edu/media/montclairedu/residentialeducation/pdffiles/Study-Group-Tips-and-Advantages-1.pdf). Another issue about peer groups is sexual activity. A longitudinal study done in 2012 followed a group of adolescents for thirteen years. Self-reports, peer nominations, teacher ratings, counselor ratings, and parent reports were collected, and results showed a strong correlation between deviant peer groups and  sexual promiscuity. Many teens claimed that the reasons for having sex at a young age include peer pressure or pressure from their partner (http://en.wikipedia.org/wiki/Peer_group). The aforesaid issues and concern about peer group studying have prompted the researchers to conduct a study on the effects on the academic performance of peer groups among freshmen CITHM students of the Lyceum of the Philippines University – Manila. 1.2 Theoretical Framework This study will be anchored on the theory of social learning (Mead, 2004). According to this theory, children begin to perceive themselves from the perspective of the generalized other, the community as a whole. Knowing the norms and values of society, children can begin to know how their actions are perceived by the generalized other. Mead said that everyone has an â€Å"I† and a â€Å"me.† The â€Å"I† is the individual or the true self and the â€Å"me† is the way one acts in different social situations under the norms of society. Through social interaction people learn the acceptable â€Å"me†. Mead felt that children develop their â€Å"selves† through interaction. Children begin to pattern their â€Å"selves† after a role model (www.webspace.ship.edu/cgboer/erikson.html). This theoretical framework can be applied to the study that mentoring has positive effects on children. The mentor acts as the generalized other and serves as a role model to the student who begins to imitate the mentor. This then reflects the positive effect of mentoring. The student changes his/her â€Å"me† to conform to the norms of society. Moreover, this study will be anchored on the theory of the Zone of Proximal development (Vygotsky, 1978). This theory focuses on the importance of a child’s culture and notes that a child is continually acting in social interactions with others. The Zone of Proximal development is defined as the gap between what a student can do alone and what the student can achieve through teacher assistance. The values and attitudes of the peer group are essential elements in learning. Those who surround themselves with academically focused peers will be more likely to internalize this type of behavior (http://en.wikipedia.org/wiki/Zone_of_proximal_development). This theoretical framework can be applied on the study that with assistance, student can achieve more lessons rather than studying alone. And by the help of peers, individuals can be more successful i n their field. 1.3 Conceptual Framework The conceptual paradigm below explains the advantages and disadvantages in studying with peer groups. Advantages in studying with peer groups. 1. Helps with procrastination. Many students tend to cram for tests/exams on the night before or begin projects with very limited time before the due date. When in a study group, meeting at scheduled times can keep the active participants from procrastinating. In addition, individuals in study groups are less likely to delay or put-off assignments because they understand that other people are relying on them. 2. Improve new study skills. There are always ways to enhance your studying methods/techniques in your study skills. Joining a study group will provide you the opportunity to observe a wide variety of study methods and incorporate them into your regimen. Note-taking and organization skills are two major study components that continue to be improved through study groups. 3. Absorb information more efficiently. Students tend to learn faster working within a group versus working alone. If a student was working on his/her own, there would be a lot of time wasted puzzling over the difficulty. However, when students work in groups, they have the opportunity to explain concepts, review material, exchange ideas, and disagree/reason with one another about why one person’s answer differs from another. Thus, one can seek clarification and learn faster working in a group setting while gaining personal skills. Disadvantages in studying with peer groups. 1. Peer pressure. is influence that a peer group, observers or individual exerts that encourages others to change their attitudes, values, or behaviors to conform to group norms. Social groups affected include membership groups, in which individuals are â€Å"formally† members (such as political parties and trade unions), or social cliques in which membership is not clearly defined. A person affected by peer pressure may or may not want to belong to these groups. 2. Aggression and prosocial behavior. Social behaviors can be promoted or discouraged by social groups, and several studies have shown that aggression and prosociality are susceptible to peer influence. A longitudinal study done in 2011 focused on these two behaviors. A sample of adolescents was followed over a one-year  period, and results showed that adolescents who joined an aggressive group were more likely to increase their aggression levels. Also, adolescents were likely to display prosocial behaviors that were similar to the consistent behaviors of the group they were in. An adolescent’s peer group plays a role in shaping him or her into an adult, and the lack of positive behavior can lead to consequences in the future. 3. Sexual promiscuity. Adolescence is also characterized by physical changes, new emotions, and sexual urges and teenagers are likely to participate in sexual activity. A longitudinal study done in 2012 followed a group of adolescents for thirteen year s. Self-reports, peer nominations, teacher ratings, counselor ratings, and parent reports were collected, and results showed a strong correlation between deviant peer groups and sexual promiscuity. Many teens claimed that the reasons for having sex at a young age include peer pressure or pressure from their partner. The effects of sexual activity at a young age are of great concern. Pregnancy and sexually transmitted diseases are only a few of the consequences that can occur. 4. Risk behaviors. Several studies have shown that peer groups are powerful agents of risk behaviors in adolescence. Adolescents typically replace family with peers regarding social and leisure activities, and many problematic behaviors occur in the context of these groups. A study done in 2012 focused on adolescents’ engagement in risk behaviors. Participants completed a self-report measure of identity commitment, which explores values, beliefs, and aspirations, as well as a self-report that measures perceived peer group pressure and control. Both peer group pressure and control were positively related to risky behaviors. However, adolescents who were more committed to a personal identity had lower rates of risk behaviors. Overall, this study shows us that adolescent identity development may help prevent negative ef fects of peer pressure in high-risk adolescents. DISADVANTAGES: STUDYING WITH PEER GROUP PEER PRESSURE ADVANTAGES: AGGRESSION AND PROSOCIAL BEHAVIOR Helps with Procrastination SEXUAL PROMISCUITY Improve New Study Skills RISK BEHAVIORS Absorb Information More Efficiently Figure 1. Conceptual paradigm of the research. 1.4 Statement of the Problem The purpose of this study is to identify the academic effects of peer group study in freshmen CITHM students of the Lyceum of the Philippines University – Manila. Specifically, the study seeks answers to the following questions: 1. How can a student obtain the advantages in peer group studying; and 2. What are the disadvantages of peer group study; and 3. What are the programs that can help a peer group in their academics. 1.5 Significance of the Study The study focused on explaining the effects of peer group study among freshmen CITHM student of the Lyceum of the Philippines University – Manila. Moreover, the results of the study will be beneficial to the following: Commission on Higher Education Department (CHED). The result of this study can help them provide a program for students on how they can improved their academic performance. Respondents. The respondents will have an awareness on the importance of the peer group program and its role on the improvement of their academic performance. Teachers/Mentors. The result of the study will help the teachers/mentors provide encouragement to think of ideas that will give proper guidance to the students. This may also increase their competency. Future Researchers. The findings of the study will serve as a reference material and a guide for future researchers who wish to conduct  the same experimental study or any study related to peer group effects. 1.6 Scope and Limitation This study covers the effects of peer group study among freshmen CITHM students of the Lyceum of the Philippines University – Manila. Nevertheless this study will not cover anyone who does not belong to the respondents. Moreover, this study covers the advantages and disadvantages of peer group study. Nevertheless, this study will not cover the reasons why a respondent faces rebellion, and this study will cover what programs of the school can help the respondents study more efficiently with their peers. Nevertheless, this study will not cover social identity. The results of this study is applicable only to the respondents of this study and should not be used as a measure of the effect of mentoring program on the students who do not belong to the population of this study. 1.7 Definition of Terms The terms in this study are conceptually and operationally defined for better understanding of the readers. * Aspiration. An individual’s need to meet realistic goals, receive feedback and experience a sense of accomplishment * Course. A unit of instruction in one subject, lasting one academic term * Cram. Is the practice of working intensively to absorb large volumes of informational material in short amounts of time. * Isolationism. A policy of national isolation by abstention from alliances. * Longitudinal. A research study that involves repeated observations of the same items over long periods of time * Norms. A principle of right action binding upon the members of a group and serving to guide, control, or regulate proper and acceptable behavior. * Peer group. Is a group of people who are equal in some way. Those in a peer group have the same status and are about the same age. They often interact with the group as a whole. * Procrastination. To put off intentionally the doing of something that should be done. * Prosociality. Beneficial to all parties and consistent with community laws and mores. * Sexual promiscuity. Is the practice of casual sex with multiple sexual partners. * Sexually transmitted diseases. are illnesses that have a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. * Social Group. Has been defined as two or more people who interact with one another, share similar characteristics and collectively have a sense of unity. * Victimized. To make a victim of. * Zone of Proximal development. Is the difference between what a learner can do without help and what he or she can do with help.

PharmaCare essay

The twenty-first century has seen pharmaceutical companies grow in unprecedented size and strength. Due to the unprecedented growth the larger pharmaceutical companies have gained leverage and power in the prescription drug industry, but they lack innovation to market and they seek ways to help the business continue to increase its profits. The pharmaceutical industry was once ethically sound and was a valuable player in the development of human health. However, overtime with the lack of innovation pharmaceutical companies are becoming an unethical market that exploits patients, doctors and anyone else it can to increase its profitability.With eyes only on profitability this can create a hazard for patients because there is deficient testing of the drugs prior to the drugs hitting the American market. In this research paper we will cover the many facets of PharmaCare, Coleria, and Wellco and the drug AD23 side effects, and its manufacturing in an impoverished nation with the low wage s and unsafe working conditions. All of which will be covered throughout this document. Marketing and Advertising The Food and Drug Administration relaxed the regulations regarding the need to advertise the side-effects of prescription drugs in 1997.  (FDA)The relaxed regulation allows for direct-to-consumer advertising and this change the marketing strategies. There is now an influx of pharmaceutical advertising using infomercials. Gary Humphreys informs us in his article, â€Å"Direct-to-Consumer Advertising Under Fire†, that pharmaceutical companies â€Å"spent just under $5 billion last year alone† (576) on this type of advertising. The infomercials somehow make consumers believe that there is a need for them to have the drug and therefore create an increase in its sales.Because consumers have a desire to take control of their health they are now going in the doctor’s office and telling the doctor’s about the infomercial and the drug that they would like to try. However, consumers are not aware that they prescription drug companies are not required to share all of the side-effects of the drugs and it may cause serious health problems when consumers can ask for drugs by name. According to the Centers for Disease Control and Prevention prescription drug abuse is not an epidemic. The high use of prescription drugs has led to a decrease use in illegal drugs.In the United States it is common for Medical Doctors to receive a sales pitch from a drug company regarding their prescription drugs and highlight the many benefits of it as well. This is target marketing in which drug companies are targeting those in the medical field and those that are most likely to offer the product to a consumer and in turn this will lead to an increase in drug sales. This practice leads to questions related to medical ethics in the industry. Intellectual Property Protection The laws and regulations have strengthened the intellectual property protection o f branded drugs.One of the primary reasons for the Intellectual Property Protection was to get the pharmaceutical world thinking and give incentives for those who are being innovative. Products can be fixed for a specified time frame if they have a patent; what this means is it eliminates any direct competition which in turn allows the inventor to set the price of the drug and many times they are charging top dollar. The inventor is trying to recoup all money spent on the creation of the drug while also making a hefty profit.The Intellectual Property Protection have increased patent life of approximately 50 percent of all drugs from 1980 to present which contributes to prescription drug spending. A 1998 Congressional Budget Office (CBO) study showed that manufactures tend to introduce new branded drugs at premium prices, and then raise these prices. The study found that even after similar branded products enter the market, drug companies often continue to increase the price. The eth ical issue is because when the patent is lengthened it delays the entrance of less expensive generic drugs.And as a result the branded drugs dominate the market and the cost is passed down to the consumer. Regulations and Product Safety The Federal Food, Drug Administration is responsible for establishing the Code of Federal Regulations which outlines the rules and regulations governing pharmaceuticals. The rules are divided into sections and include guidance based on drug categories. Due to each person having varying reactions to pharmaceutical products not all side-effects are detected during clinical testing.The Federal Food, Drug Administration is responsible for sharing the information with consumers. However, it seems a bit unethical because the large pharmaceutical companies do not have to share all of side-effect information that may assist consumers in making its choice on whether to try a product or to not try a product. Through various survey’s it was discovered th at consumers are under the opinion that pharmaceutical companies need to have improved internal controls to ensure their compliance with regulations.Due to physicians and pharmaceutical companies working together and are dependent on one another there needs to be controls in place that would have an unbiased view of the regulations. The government will need to continue introducing new regulations that will aide in monitoring the relationships. Direct-To –Consumer Marketing Direct to consumer is a form of advertising that markets directly to consumers bypassing the distributor. In the mid 1980’s pharmaceutical companies provided information about prescription drugs to doctors and pharmacists.The Federal Drug Administration (FDA) allowed print ads to run and the pharmaceutical companies had great success and were then permitted to begin running advertisement on television. Currently over $5 billion is spent annually to present this advertisement to the American public vi a direct marketing print ads, television broadcast, and online. There is an issue with this is that the FDA does not voluntarily monitor these ads and the advertisement may actually be misleading and the American public may not be aware that the ad did not pass the FDA check.The Office of Prescription Drug Promotion (OPDP) is required to take action against ads that violate the law and are required to take action along with communicating information to consumers and employees in the health care industry. Prescription-drug ads prompt nearly one-third of Americans to ask their doctors about an advertised medicine, and 82% of those who ask say their physicians recommended a prescription. The findings in a national survey by USA TODAY, the Kaiser Family Foundation and the Harvard School of Public Health come as drug advertising hit a record $4. 8 billion in 2006, up from $2.6 billion in 2002.â€Å"Our survey shows why the drug companies all these ads: They work,† says Drew Altman , president of the Kaiser Foundation. â€Å"Many people get drugs they otherwise wouldn't. While there's a debate about whether that's a good thing for patients, it does cost the country more. † Among people who requested a drug, 44% said physicians gave the one they asked about, while slightly more than half said doctors prescribed a different drug. Sometimes, doctors did both. When duplicate answers were removed, the poll found 82% of patients got some type of prescription.  (USA Today)I would make the argument against Direct-to-Consumer marketing although it seems to be is working and putting the choices back into the consumers’ hands. My argument against the direct-to-consumer advertisement is simply because consumers are not being provided all the necessary details about a product. Drug makers are ignoring the guidelines that apply to consumer education and are highlighting only a few on the many side-effects. Consumers often will not take into consideration doc tor’s recommendations also because they visit their doctor with hopes of gaining the same results as what was shown in the marketing ad.The many infomercials seem to favor male enhancements drugs such as Cialis and Viagra which can confuse children if they, see the infomercial. It should be the responsibility of physicians to determine the proper medications for their patients. Compounding Pharmacy Regulators Generally, state boards of pharmacy will continue to have primary responsibility for the day-to-day oversight of state-licensed pharmacies that compound drugs in accordance with the conditions of section 503A of the FDCA, although FDA retains some authority over their operations.For example, the adulteration or misbranding of drugs compounded under section 503A, or false or misleading statements in the labeling or advertising of such drugs, may result in violations of Federal law. Firms that register with FDA as â€Å"outsourcing facilities† under section 503B wil l be regulated by FDA and inspected by FDA according to a risk-based schedule. (FDA) In the PharmaCare scenario should have enacted the Prescription Drug User Fee Act (PDUFA) of 1992 earlier. According to Forbes magazine, to solve this problem, Congress enacted the Prescription Drug User Fee Act (PDUFA) of 1992.PDUFA provided a mechanism whereby charges were levied on pharmaceutical companies for each new drug application (NDA) filed. The revenues from these â€Å"user fees† were used to hire 600 new drug reviewers and support staff. These new medical officers, chemists, pharmacologists, and other experts were tasked with clearing the backlog of NDAs awaiting approval. Consequently, the FDA was able to reduce review times of NDAs to 12 months for standard NDAs and to 6 months for priority applications that involved significant advances over existing treatment.As a result of PDUFA,  the timing of U. S. drug approvals began to mirror that of the rest of the world. (Forbes) If the Act was in place the pharmaceuticals would have been reviewed sooner and it could have possible saved lives. Utilitarianism: The ethical theory of Utilitarianism would state that any decision concerning business conduct should be proper and the decision that is made should be best for the greatest number of people. When looking at the PharmaCare scenario did not allow all stakeholders the option to take into consideration the drug that they were providing to them.It would seem as though the management team and Coleria focused only on the thought and idea that the pharmaceuticals would produce more good than harm or bad consequences and in this case if they had gambled they would have lost. They continued to sell that drug with a thought process that the drug was helping more people than hurt with only a small number of people affected by side effects therefore it justified the need to continue producing and distributing. Deontology: The deontological ethics places morality and moral laws as a standard in which people should make their decisions.The process used by PharmaCare and Coleria did not follow deontology because although the company and its management staff was aware of the side effects of the drugs being made and the numerous deaths that were caused they did nothing to stop its production. They were more concerned about the profits they were gaining and did not take into consideration the moral outcome. PharmaCare or Coleria did not treat consumers as they would like to be treated therefore we know that PharmaCare and Coleria did not operate under the ethical values of deontology.Virtue ethics: Virtue ethics suggests that helping people is a good charitable and kind thing to do. The virtue ethics although seem as though they would be the same as deontology it differs because it focuses in the motives a moral character and emotions in our moral life. The management team at PharamaCare or Coleria did not seem to consider the virtue ethics at least not to those that worked with them. The virtue of honesty was absent in its transactions and the way that business was done.Something that is important to a person  that is operating under virtue ethics they consider the actions of what they are doing and honest people would not do dishonest acts intentionally because they would have believed that honesty is the best practice. Ethics of care: Pharmaceutical companies have a duty to provide medicines to both the physicians and the consumers that will address the health needs of its patients in a safe manner with little to no side effects. PharmaCare and Coleria again did not accomplish this simple duty of care. The company provided a medicine that caused great harm and even death to some in order to earn a few extra dollars.There was a huge conflict of interest between the PharmaCare, Coleria and the consumers who needed the medications because there was a duty to share the side effects, there was a duty to provide additional testi ng on the medicine and there was a duty to discontinue the manufacturing of the drug when the drug failed to do what consumers needed. The health of the consumer or patient should be presented to them completely free of bias or potential for bias and consumers should not be misled. Your own moral/ethical compass:PharmaCare and Coleria had a moral and ethical duty to do what was right and in my opinion that did not adhere to any moral ethical standards in their business transactions. Their lies and misleading strategies hurt those that needed them and those that were in a vulnerable condition. There were many people that requested, believed in, and should have benefited from a medicine that would help them lead a more fulfilling life and in some instances it ended their lived prematurely. PharmaCare and Coleria were obligated to share with consumers the main risks that were associated with taking the drug.When considering the moral and ethical questions in some instances when thinkin g of the case it swayed even in mid-thought on occasion. The thoughts went from what would I do if I were in need of the medication would I want to take it and risk the side effects because of a promise of improved health. Or would I pass on taking the drug and continue suffering with my illness. I was under the thought that although many died that had it not been for the large profits that the pharmaceutical companies received, that it would have been simply said that they were improving  humanity and the quality of life.There is no agreement with the steps that were taken and it seems a bit unfair for many, it was not the proper thing for PharmaCare and they should have discontinued the use and production of the drug until testing and improvement was done. PharmaCare/Coberia – Intellectual Property law The generous laws in the United States regarding Intellectual Property laws aided in protecting PharmaCare and its manufacturer Colberia. However, these protection laws fai led to protect the workers at Colberia or the many consumers that were hurt or killed due to a bad drug.It has been said that intellectual property is a pharmaceutical company’s most valuable resource because it can protect the company and help with the success of the company. Colberia a developing nation aided PharmaCare in manufacturing an affordable drug and along the way PharmaCare exploited the intellectual property laws. In the 1990’s there was an urgent need for medications and PharmaCare acted on greed without taking into consideration the harm it could do the reputation of its business due to its interpretation of intellectual rights.Because Colberia was a less developed country PharmaCare was able to find intellectual property protection. The drug AD23 was manufactured in Colberia at much lower cost which was seen as a great opportunity for PharmaCare. Unfortunately, PharmaCare was not able to manage the facilities or the business adequately. Intellectual pro perty laws have faced scrutiny over the years and increasing pressure to ensure that intellectual property laws and standards are not compromised.PharmaCare did not create economic growth in Colberia the wages it paid to the workers was unfair and unjust given the huge profits and bonuses received by PharmaCare and its management staff. PharmaCare repays Colberia PharmaCare has a moral obligation to pay Colberia and its citizens by investing in the area. There are many things that the giant pharmaceutical company can do, however it would be best if life-long improvement were made to have a positive impact on generations.The Global Poverty Info Bank says it best; â€Å"Improve the infrastructure, fighting widespread disease, and combatting poverty. Infrastructure- the physical resources like roads, telecommunication networks, schools and drains – is necessary for a society to function: people can’t access healthcare if there are no hospitals; trade can’t take pl ace if there are no roads on which to transport goods to markets. Infrastructure facilitates the basic functions of a society that are necessary to transport resources and people, produce and trade goods provide essential services and ultimately reduce poverty.Suggest at least three (3) ways the company could compensate the people and nation of Colberia for the use of its intellectual property and the damage to its environment. † I agree with the assessment of repaying Colberia with putting money and resources into the country to build new infrastructure, provide medical resources and medications to fight widespread disease and then assist with fighting hunger by providing resources to teach and provide items for growing and cultivating plant foods. PharmaCare could make amends to the entire country by aiding the citizens in developmental growth.PharmaCare vs. Nike – Ethics Both PharmaCare and Nike hired laborers to perform work that would have cost substantially more i n the United States. Both PharmaCare and Nike received a wave of consumer criticism and other negative feedback because of the unfair labor practices. Both have been accused of human rights violations and when you think of the countries in which they place the manufacturing businesses along with the working conditions, although completely different lines of business and different types of manufacturing; they both faced similar consumer backlash and economic concern.Both will need to ensure that working conditions are up to acceptable standards and that workers are fairly compensated. A Code of Conduct should be drawn up and all management and workers should sign. The Code of Conduct would consist of hours, compensation, reporting, training and employee or employer expectations. PharmaCARE and WellCo lawsuitThe lawsuits against PharmCare and Wellco are possible and would be very successful. Many of those that had taken the drug along with those that are left behind should have the ri ght to sue and be successful at gaining compensation. Due to many of the side effects that were not disclosed it lead to the hospitalization and death of the patient should ensure compensation to those affected due to their loss. Often times companies with  a lot of financial resources prefer to settle the case quickly and have little public exposure and many have all parties involved to sign a confidentiality clause. The various types of restitution are:†¢Death of a loved one †¢Loss of quality of life †¢Pain and suffering’ †¢Lost wages die to poor health †¢Medical costs Any person negatively impacted whether they are a patient or employer will have the opportunity to recoup some of its losses or acquire punitive damages. The faulty drugs had a devastating effect on many people and the pharmaceutical companies made a huge profit, and most are covered by insurance policies that would assist in paying the many forthcoming lawsuits.The PharmaCare brand At the current time PharmaCare continues to build its brand and is trying to regain consumer confidence. The mission and commitment statement of Pharmacare is stated below and as PharmaCare is rebuilding it remains cautious about its interactions so as not to cause harm to consumers and its shareholders as it has done in the past. The Mission of PharmaCare is: â€Å"is to develop an organization of regional pharmacies that is palpably different from our competition.The vision is to realize this distinction by concentrating on different patient populations, that is, those who need specialized, personal service; create partnerships with referring physicians; build loyalty among our employees; give back to the community; resurrect the time-honored practice of door-to-door delivery, and rely on word-of-mouth to create demand. PharmaCare continued with a commitment statement that reads as follows, â€Å"To our patients: Treat our patients with the same compassion, care and individual a ttention that we give to our family members.To our physicians: Understand that physicians are able to serve their better when we serve the physicians better; therefore we are available, flexible, convenient, responsive. To our Case Managers and Care Givers: Streamline the process between prescription and the medication. Streamline the process between the refill request and the medication. Provide medication-related, logistical, and financial information and assistance when requested and proactively.PharmaCare will need to continue conducting business in the same manner as stated in both the mission and commitment statement in an effort to remain a valuable resource to the pharmaceutical world. Ethical changes of PharmaCare The ethical conduct of PharmaCare is vital to the success and profitability of the company. The integrity PharmaCare will be reviewed for years to come and as such PharmaCare management team and stakeholders will need to react proactively to any negative feedback and communication that it may receive.PharmaCare will need to ensure that all employees are receiving a fair wage and that if using developed countries that they are being fairly compensated for the land, space and its residents. PharmaCare will need to ensure that all drugs are approved by the FDA and are safe to be on the market. PharmaCare will need to disclose any relevant information that is known regarding the side effects to enable them to make informed decisions on their choice of medication. PharmaCare will need to ensure that it is operating within all regulations and laws that have been set by the FDA and its affiliates.

Krueler Interview

The first Boer war was from 1880-1881 when the Boers fought England in order to recover their independence they had given up to obtain British help against the Zulus. The second was from 1899-1902 when the Orange Free State and Transvaal declared war on Britain.Pieter Krueler was one of the toughest and bravest soldiers during the war. He was interviewed and revealed the real setting of the war in his own experience which makes the critics point out and reviewed the dilemmas more clear to the minds of the people.The war started between the differences of some learned diplomats and roughhewn nesters and successful millionaires battling for gold and power to rule (Bartleby).Opinions of anti-British, when the discovery of gold in Witwatersrand, many miners or prospectors are interested to get hold of the land. Â  The Boer’s called them threat to their state. After sometime, all mines are transferred to the British’s custody. The Boer government protected the people so the y charged big taxes from Uitlanders, also known as the foreigners even though British don’t really agree to that. The Orange Free State which was the independent Boer state in South Africa formed military troops to protect their independence (Bartleby).The Boer’s protest with regards to their rights was denied. The Boer declared war. Krueler was among those soldiers who fought for the Boers. Since the Boers are highly furnished with more weapons than the British, they had gone victories over the British adjacent to Boer’s territories. The Boers are kind hearted. They treated their prisoners well enough. They even fetched water for them to drink and even get blankets for the prisoners to rest.In the Cape Colony, there were many Boers captured because the British sent well trained reinforcements that lead them to victory. Cronje who was Boer’s leader forced to surrender. It was soon the British totally occupied the Transvaal territory. Roberts, who was the leader of British who led them to victory left the place because of his perception, the war was ended. Unfortunately, it wasn’t over yet and the Boers continue their coordination that lead to Guerilla war. They cut off the communications; attacked military post stations and some captured Boer were escaped by their help (Moritz).The Boers are fighting for their land which many foreigners are eager to find ways of colonizing the land. They are fighting for their independence which many foreigners are taking them away. They are great and brave people fighting for freedom, but they were only few of them. The British were certain enough that they can defend themselves from the Boers; they decided to totally finish the war under the ruling of Kitchener (Weber).The British recognized the kindness of the Boers to their families and their fellowmen; they captured the Boer’s women and children. Kitchener commanded his men to demolish the livestock and crops, farms were being bur ned, and captured women and children into. More women especially the children got sick and there were thousands died during that captured (Weber).Imperialism during the 20th century was very rude. It’s a regretful to those who did bad things to other people. The saddest part of it was that, the British were conquering the land that was not intended for them and hurting the people who own the land. The behavior of one’s nation because of power to control one’s land is very drastic. Kitchener’s plan of using the defenseless women and children as part of the war is to win the war, but not directly to fight with the Boer’s armies (Weber).When the Boer’s troops are diminishing rapidly and that ended the war. The Boer’s government accepted the leadership of the British in the condition that the British must apply a good government concerning the people in the future. However, the war gave the Boers so much resentment which continuous to aff ect the political life of the people throughout the 20th century (Bartleby).According to Krueler’s interview, the women and children including the four thousand prisoners gave a safe passageway by the British when they surrendered for the sake of the children and women. Moreover, the British treated him not as prisoner because he presumed of being a kid.With regards to the interview Krueler, the British had a conscience to speak for themselves for giving safe passageways for those who survived during the war. All they want was to get hold of the land.During the 1899 up to 1902 has become debatable. The holocaust happened in the camps is against the international law. This violates the human rights of the people. Women and children should not treat badly because they are weak and defenseless (Moritz).Anti-British claimed justice to all people who were badly injured and died during the war because of the barbaric acts of the British. The sympathy is with the Boers who only want their own land to live, but because they are few men to fight compared with their intruders, their land was totally occupied and ruled by the British (Weber).The war was proved to be the costliest, bloodiest and longest. Furthermore, it was said to be humiliating war from the British because of the longest time to defeat the Boers knowing that they were only few men fighting against them. In addition to, they were not fighting against the armies of the Boers, but they were fighting against the weak people of the Boers (Weber).Not only had the British militaries committed crimes, but also the leaders who gave commands. It is a crime against humanity, crime that no one was punished, crime that Kitchener should pay for. Unfortunately, when Kitchener died, he was remembered because of his virtue instead of a criminal (Weber).The British leaders’ imperialistic acts and hunger for diamonds and gold brought big and unforgivable damage to the people and land of Boer. The British wer e already powerful and wealthy during that time. They forgot about the thousands of lives perished for their greediness (Weber).Krueler’s interview about the First World War seems to be more similar intentions of the German people of acquiring the land in which the British occupied during that time. He was used by the German leaders to fight for them for colonial reasons. Some European countries are aiming to win the land of gold and diamonds for the purpose of continuous power and wealth. During the European wars, there are millions of civilians and militaries died aiming for one land which was not really fair for the civilians and most especially to those who owns the land.BibliographyThe Columbia Encyclopedia 6th Edition. Bartleby. Dec 2007. Moritz, Garett. About. 1998.Weber, Mark. IHR. May 1999.

Waste to Energy Technology Research Paper Example | Topics and Well Written Essays - 1000 words

Waste to Energy Technology - Research Paper Example Undoubtedly, the waste to energy technology will address the waste disposal issues as well as the growing energy needs of the world. Waste to Energy Technology Waste to energy, or interchangeably energy from waste, can be referred to the process of generating energy in the form of heat or electricity through the incineration of waste materials. Incineration is â€Å"the process of reducing combustible waste to inert residues by high temperature combustion† (Lettsome, 2008, p.191). However, many countries have set strict emission standards for this process as many traditional WtE plants released huge amounts of sulphur dioxide, nitrogen oxides, and dioxins. Modern incineration plants are eco-friendly and they release little toxic gases or other pollutants. As Ramboll (2006) points out, modern incinerators are capable of reducing the original waste volume by 95 to 96 percent depending on the type of waste material under incineration. The use of incineration technique for the con version of municipal solid waste to energy is a conventional application of waste to energy technology. In the incineration process, generally an RDF is burned to boil water and thereby power stream generators for the purpose of generating electricity for home and business use. However, the method of incineration of municipal solid waste for the generation of electrical energy was widely criticized since this process has been damaging the environment by causing acid rain. In response to this environmental concern, companies used technologies like lime scrubbers on smokestacks. The modern incineration plants are eco-friendly, because â€Å"many times more dioxin is now released from home fireplaces and backyard barbecues than from incineration† (Rosenthal, 2010). Today, a number of new and improved technologies have been developed to produce energy from waste materials without combusting them directly. Majority of such technologies can generate more amount of electric power fr om the same volume of waste materials than through direct combustion method. As described in Bio Earth (2009), in new waste to energy technologies, corrosive components are separated from the converted fuels and therefore, this process contributes to higher combustion temperatures in internal combustion engines and boilers. Hence, they are more productive than conventional WtE plants. Some of those technologies have the potential to convert energy into liquid or gaseous fuels. As reported in World News Inc (2012), gasification, thermal depolymerization, Pyrolysis, Plasma arc gasification PGP are some of the thermal WtE technologies whereas anaerobic digestion, fermentation, mechanical biological treatment are non-thermal technologies. The popularity of waste to energy technologies has considerably increased over the last decade. During this period, industrially important countries like China and Japan built a number of WtE plants in order promote their national productivity. Global Group Consulting Services LLC operates across America and Caribbean in order to promote the application of potential waste to energy technologies and to resolve Municipal Solid Waste issues in small to mid-size cities. As Herndon (2011) reports, Fulcrum BioEnergy, Inc has been scheduled to commence the operations of its new $180 million WTE plant in 2010; and the project designers forecast that the plant may produce

Environmental Science Essay Example | Topics and Well Written Essays - 500 words - 2

Environmental Science - Essay Example Denver has taken many initiatives in the past in an effort to become self-sufficient in terms of energy needs. For example, Greenprint Denver promoted the development of a joint group of businesses, and city departments. This group was called the Neighborhood Energy Action Partnership (NEAP). The objective of NEAP is to make use of the local non-profits so that community outreach can be organized. Providing the residents with energy audits is a potential way to increase their awareness and motivation to save energy. Denver should install subsidized smart meters to lower their cost for the residents and hence, enhance their adoption. The best way for Denver to reduce its carbon footprint as well as the demand for fuel is by introducing the public bike-sharing system, regulation of traffic jams and reduction of carbon emissions being two of the major requirements of sustainable development. The bike system saves on gasoline through its link with buses and trains so that a whole web of substitute transportation is spinned in Denver. This builds resilience into the transport system so that the reliance on one type of transportation is reduced. Presently, over 400 bikes have been located at 50 bike stations in the public areas to ensure maximal usability. Success of the Denver Bike Sharing program can be estimated from the fact that more than 96000 single rides have been recorded along with a procurement of over 1765 yearly memberships (Peterson, Matthews and Weingard 17). A significant population of the residents of Denver acquires the bikes on per-day basis and pays the fee accordingly. In order to increase the popularity of energy-conservation programs among the residents, there needs to be a concerted effort made by Denver. This can be achieved by creating awareness in the masses through demonstration of the usability of such programs on TV, schools and all

History of united states Essay Example | Topics and Well Written Essays - 2000 words

History of united states - Essay Example History is at times denoted as the art of finding, and accounting on the past events. The study revolves around the social lives, cultural systems, and political systems of the target community of research problem. Data sources differ in accordance to the method of research and the target source of information. For instance, primary data sources involve the originality of researching on a particular subject for the first time, with little or no reliance to the available information. On the contrary, secondary sources serve researchers with already processed information, which calls for editing to fit the desired purpose. Therefore, the two different resource approaches imply on originality of information and borrowed data respectively (Mulhall 38). The data sources used in the study are mainly secondary data sources. The factor stimulating the use of secondary data sources is the availability of past information in a readily presented source. Examples of the secondary data sources include American historical society, and History matters. The research further involved the use of questionnaires to collect data from a sample population, instrumental to the research expedition (GrzesÃŒ kowiak-Krwawicz 64). In the 17th century, America was turning out to the most suitable continent for agriculture, and to accommodate excess population from the English countries. However, acceptability into the newly formed white society in the American territories turned to be a tricky affair (Rasor 34). Considerations revolved around the gender, ethnicity, social class, and skill of every individual. Therefore, freedom remained a disguise as the respected group of the society benefited from it at the expense of the inferior groups. Royal and American merchants turned to Africa in the zeal to obtain slaves, with a target of subsidizing labor in the settler farms. According to the governing

The effects of smoking Research Paper Example | Topics and Well Written Essays - 1500 words

The effects of smoking - Research Paper Example Moreover glucose tolerance and insulin sensitivity is impaired in the body by smoking. Eliasson et al in his research tells that smoking initially show the symptom of insulin resistance. And after some time the endothelial function is also impaired. Other toxic substances in cigarette smoke can also harm the individual's normal physiological state of body and thus increase the stress on the body. This stress is a cause of diabetes mellitus in individuals (Radzeviciene & Ostrauskas 2009). The cigarette smoke results from the burning of tobacco and it contains Tar which is a brown substance and is made up of more than 4000 chemicals. Lung diseases are commonly caused by smoking which contains Tar, such as emphysema which is a long term, progressive disease of lung tissue which causes shortening of breath and the lung tissues are destroyed and become unable to support the proper physical structure and functions of the lungs. Cigarette smoking also causes chronic bronchitis, which is the inflammation of air passages to the lungs. The inflammation of the air ways makes way for excess production of mucus which blocks the passages for air making it difficult to respire (Dentener et al 2007). The cigarette smoke also affects our heart tissue and makes it weak. The cigarette smoke causes atherosclerosis which is the thickening and hardening of blood vessels by the deposition of fats on the vessel walls, which causes coronary heart diseases and strokes. The presence of carbon monoxide in cigarette smoke lowers the affinity of blood for oxygen lowering the quantity of oxygen carried by the blood to different parts of body and heart causing angina and heart attacks. Nicotine in the cigarette smoke has...The primary focus of the government should be on the reduction of smokers to first create a smoke free environment but it should also secondarily work towards ways and methods to prevent non smokers from smoking. Increasing the number of taxes on cigarettes as well as the i mplementation of bans can prove to be useful for the purpose of discouraging the smokers from smoking and this fact has been proven as many smokers have quit smoking following these regulations. On the other hand proper education regarding the harmful effects of smoking among certain age groups can also prove to reduce the number of non smokers from smoking. Parents of school going children should be advised and taught to keep a proper watch on the children and discourage them from smoking. Smoking is a global issue which alone accounts for the death of 440,000 people annually in the United States. It poses health risks not only for those individuals who smoke but also for those who come into contact with this smoke. Many countries across the globe have taken a stand against this problem and states are justified to take measures to limit the spread of this wide spread issue.

Staff Motivation Essay Example | Topics and Well Written Essays - 250 words

Staff Motivation - Essay Example In terms of the positive aspects of current campus culture and climate, Steve Jenkins is of the opinion that respect, experience, and diversity are of greatest value. Public education can still be improved though; Mr. Jenkins would remove big tests if he was given a chance to improve the education system. This is because these tests actually do not force students to memorize concepts over the long term because all that is required is a short-term result. All aspects of school life are evaluated regularly so that the system remains of a high quality. Two books that Mr. Jenkins would recommend to anyone who is looking for further professional development in leadership is ASCD – Association for Supervision and Curriculum Development and National Association of Secondary School Principals (NASSP) – Grades 6-12. One important piece of advice that Steve Jenkins would give is to read as much as you can, become a good listener, and don’t be afraid to ask as many question s as you wish.

Sensory Integration Assessment Term Paper Example | Topics and Well Written Essays - 1750 words

Sensory Integration Assessment - Term Paper Example The visual motor abilities of the child were measured from three experiments namely, Visual Perception, Motor coordination, and Beery-VMI. The skill of acquiring and reading visual stimuli perceived from the surroundings is known as visual perception. Visual perception skills considered are visual discernment, remembrances, position in the space, structural permanence, object field, and visual closure. In a given trial, the skill of synchronizing actions of different body organs in the space is called Motor coordination. This child shows deficiency in incorporating visual perception and/or motor coordination abilities as obvious from the VMI values. This child demonstrated difficulties with regard to visual motor assimilation as indicated by the three experiments. The percentile score of this child was 75%, 25% and 16% for Visual perception, Motor Coordination and VMI respectively when compared with that of the children of the same age which was 100% on the average. This child scored only 16% for VMI which is very low. The major difficulty for this child is the deficiency in VMI which in turn will affect the handwriting and other jobs which involve the coordination of hands and eyes. This child will require extra time for the completion of homework to compensate the said deficiency. This child shows visual perception and /or motor coordination abilities but still require practice to assimilate the two areas. If not, it may show visual and /or motor deficiency. Short Sensory Profile: The Short Sensory Profile Test determines the â€Å"sensory modulation disorders† (Bundy, Lane, & Murray, 2002, p. 8). Sensory processing is the major field which is usually used for evaluation because it represents the core concept compared to just modulations. The deficiency in sensory modulations is assessed from the responses of the object to a sensory stimulus demonstrating deviations from normal. The Short Sensory Profile Test results are as under: Raw Typical Probable Definite Sensory Processing System Score Performance Difference Difference Tactile Sensitivity 22/35 X Taste/Smell Sensitivity 4/20 X Movement Sensitivity 11 /15 X Underresponsive/Seeks Sensation 17/35 X Auditory Filtering 18/30 X Low Energy/Weak 12/30 X Visual/Auditory Sensitivity 12/25 X Total 96/190 X Thus the Short Sensory Profile Test demonstrated a definite difference in all the response categories investigated except â€Å"movement sensitivity† response where it demonstrated a probable difference. Tactile System: The tactile system discerns the outside stimuli with the help of receptors present in the skin. It discriminates different tactile stimuli. The effect of light touch is fast, diffused and dispersing and warns the nervous system of expected danger. Pressure touch slows down the nervous system. Its sensation is localized and discerns different shapes, textures, and sizes just from touch stimuli. The learning process is also enhanced by the tactile system. Any de ficiency in this system will result in learning problems. The clinical observations indicate that this child is deficient in tactile system. He may not detect stimuli or may show indifference to stimuli or give a

The Harlem Renaissance Essay Example for Free

The Harlem Renaissance Essay Harlem Renaissance also known as the New Negro Renaissance evolved in the 1920s, in New York City’s locality called Harlem. â€Å"The movement started around 1918, as the American civil war had given the African American people their rights and most of the educated African American citizens then moved to places such as New York City to explore better opportunities† (Huggins Rampersad, 10). As many educated African Americans settled in various neighborhoods of New York City, areas such as Harlem became hubs of African American cultural and political activities. At this point, African American literature took on a different level and received critical acclaim; along with African American arts also evolved resulting in various economic and social developments. During this movement many intellectuals even contributed to the struggle of equal rights for all races, such as sociologist, author, civil rights activist and historian W. E. B. Du Bois who co-founded National Association for the Advancement of Colored People (NAACP). Movements such as these lifted the stigma and feeling of inequality within the community and help build racial pride amongst African Americans. Harlem Renaissance even saw the rise of Apollo Theatre where many African American artists started off their career such as the famous jazz singer Sarah Vaughan. This movement even gave popularity to Jazz and Blues music, which was widely heard throughout Harlem’s bars and musical theatres. Novels of Jesse Fauset, fiction of Charles W.  Chesnutt, jazz poetry of Langston Hughes and romantic poetry of Countee Cullen are some of the works of literature that received major recognition through the Harlem Renaissance movement. Such a movement did not just enrich the African American culture but gave them an identity, and changed the way America and the whole world perceived African Americans. This newly found identity caused many African Americans to exercise full potential and bring success to themselves and their community.

Motivational Interviewing for Smoking Cessation

Motivational Interviewing for Smoking Cessation Maria (titanium number: 47144) is a retired, 65-year-old lady who visited the clinic, for the replacement of her teeth in quadrant 4 (#33-36) after the removal of the old bridge and the abutments by a private dentist due to weakened abutments. According to the patient, her last visit to the dentist was 2 weeks before her first appointment with me. It was for the removal of the residual root of 44 which served as one of the abutments for the previous bridge. Maria brushes her teeth twice a day, using a soft bristle toothbrush and fluoridated toothpaste. She also flosses and rinses her mouth with Listerine mouthwash twice a day. The patient has underlying cardiac arrhythmia, chronic bronchitis, fracture on vertebrae T5 and T7, depression, fibrocystic breast, hypertension, sciatica leg, scoliosis, type 2 diabetes and osteoarthritis on her rotator cuffs as well as her knees. She is allergic to resedronate sodium. Socially, Maria is a smoker and she smokes 15 cigarettes a day since she was 17 and she is not thinking of quitting. She drinks occasionally. Upon oral examination, her oral hygiene is generally good with some mild plaque and calculus deposition. Her PSR score was 0 for all sextants, suggesting no active periodontal disease but generalized gingival recession was present. Her #24-27 as well as #34-36 was replaced by bridges. There were restorations on almost all of the dentitions with only 4 sound teeth. However, no active carious lesion was found. Tobacco smoking can cause damage to almost every system of the human’s body, contributing to a variety of diseases thus increasing the mortality rate.1 Moreover, studies have shown that smoking can affect oral health in diverse manners such as increasing occurrence of oral cancer, periodontitis as well as causing teeth discolouration.2 Therefore, it is the responsibility of a dental practitioner to address this issue. In Maria’s case, the habit of smoking is rather alarming because it not only can affect the oral health but her general wellness. From her medical history, it has been shown that she is suffering from multiple diseases that can be modified by tobacco smoking. Most significantly, smoking is the major cause of chronic bronchitis and can further exacerbate the symptoms.3 Hence, motivational interviewing was attempted to help Maria in quitting smoking. I started the motivational interviewing session by exploring the stage of change Maria was at. According to Maria, she has thought of quitting but it was very difficult because smoking provide her a means to relieve anxiety and depression. She also expressed that she was not ready to quit. From here, it can be deduced the she is at pre-contemplation stage. Subsequently, I asked for her permission to discuss about this issue, emphasizing that the decision of quitting is up to her. She agreed and in return, I give affirmation by thanking for her willingness to talk about quitting. To elicit the ‘change talk’, I started by further exploring the source of her barrier. She told me that her medical conditions and the need for surgery were making her depressed. From here, I presumed that her concern about health could be a good motivator. Then, I asked her the reason as to why she has thought of quitting. In response, she said that she wanted to be healthier and that she was aware of the disadvantages of smoking as her GP had always advised her to quit. Furthermore, smoking had also become a financial burden for her. At this point, I summarized that her goal was to improve her health. Hoping to develop a discrepancy between smoking and her goal, I asked her to think about the advantages of quitting smoking. She replied that by quitting smoking, she might be able to become healthier and save some money. When I asked her about her ability to make the change, she replied with ‘I really don’t know.’ As I was facing resistance, I tried t o find an alternative question. When she was asked about what she would do to make the change, I got a similar reply ‘I am not sure.’ With her permission, I introduced her to the quit line. Finally, I concluded with reiteration of the discrepancy between smoking and her goal to become healthier. A brief evaluative session was done before a restorative procedure when I updated her medical history. She told me that she just had a biopsy done, suspected with breast cancer and still using cigarette to relieve stress. Due to time pressure, the session stopped here. Judging from Maria’s response during the conversation, it can be seen that although I have successfully encouraged her to think and talk about the issue, the intention of quitting is low. The response ‘I really don’t know’ and ‘I am not sure’ suggest that she is highly in doubt of her ability to quit. In addition, it is clear that cigarette as a stress reliever is a strong ambivalence that stops her from quitting. I feel that the session was a good start for both Maria and I but there is still a lot of improvement needed. To illustrate, I lack the experience in giving appropriate affirmations. There were a few instances where my affirmations were rather awkward. Besides, I need to improve my skill in complex reflection. For instance, when she talked about the source of depression which was her health, I could have leaded her to a new thought whereby smoking cessation can improve health and hence, reducing the source of depression. I could have also asked Maria to compare the advantages and disadvantages of smoking. This might help her to recognize her goal and ambivalence better. As she has low confidence in quitting, there should be more discussion as to how help could make a difference.4 In conclusion, motivational interviewing can be a good approach to induce behavioural change in patients however practice is needed to develop the skills and to execute it effectively. References Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’observations on male British doctors. BMJ 2004; 328:1519-1528. Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J 2003; 9:271–277. Rebecca JT, Frank ES, Bernard R, Dimitrios T, Walter CW. Cigarette Smoking and Incidence of Chronic Bronchitis and Asthma in Women. Chest 1995; 108(6):1557-1561. David B. Rosegren. Building Motivational Interviewing Skills: A Practitioner Workbook. 1 edn. Washington: The Guilford Press, 2009.

Maxillary Central Incisor Tooth Form, Facial Form and Gender

Maxillary Central Incisor Tooth Form, Facial Form and Gender Title: Correlation of the maxillary central incisor tooth form with face form and gender in a section of the North Indian population – An AutoCAD analysis ABSTRACT Aim: An esthetically pleasing restoration or prosthesis should not be identifiable as artificial, but should be in harmony with the natural tooth arrangement of an individual. This study aimed to determine whether a correlation exists between the maxillary central incisor tooth form and the facial form and gender of subjects in a selected sample of the North Indian population. Materials and Methods: The study was conducted in the Department of Prosthodontics and Crown and Bridge and Implants, Manav Rachna Dental College, Faridabad. Two standardized photographs each (portrait [closed lips] and teeth in occlusion [with cheek retractor]) of 200 subjects of North Indian origin (age range 18-25 years) studying at Manav Rachna International University were assessed for facial form and tooth form, using the AutoCAD © (Autodesk Inc. 2013, California, USA) software. Results and Conclusion: A statistically significant correlation of the maxillary central incisor tooth form with the inverted face form of the subject was found in a section of the North Indian population. However, the correlation between the maxillary central incisor tooth form and gender of an individual was found to be statistically insignificant. Keywords: Maxillary central incisor, tooth form, face form, gender, AutoCAD Introduction Esthetic dentistry is fast becoming a key consideration for dentists and their patients. Although, a smile is characterized by numerous factors involving both the teeth and surrounding soft tissues, the esthetic appearance of the anterior teeth contributes to a persons self confidence and how attractive he/she is perceived by others.1 For an esthetically pleasing smile, the position, form and colour of the maxillary central incisors are the most essential factors.2 Since the maxillary central incisors play a key role in the dental composition, various anthropometric and biometric references are used in their design and selection in esthetic accordance with the facial form of the patient.3 When only parts of the dentition have to be restored, the remaining natural dentition can serve as a guide, providing a relatively simple and direct procedure to design artificial teeth that blend with or complement the natural dentition. However, in cases where all the teeth are missing and the entire dentition has to be restored, and no information can be gained from the remaining natural teeth, old photographs, or cast models, other methods have to be applied to select and design the missing teeth.1 These methods are not only useful for complete dentures but also for any complex anterior restoration.2 Esthetic dentistry tries to produce a prosthesis that defies detection. This is possible only when, the tooth form, shade and tooth size of the patient are in optimum harmony with their facial form, dimensions and facial complexion. In 1914, Williams 4 was the first to suggest that a correlation existed between the upside down facial shape and the shape of the upper central incisors. Form shape came to be guided by comparison with the inverted shape of the face. According to this classification, the dental outlines of the upper incisors were in three shapes: tapered, ovoid and square, which is still considered by prosthodontists.5 In 1955, Frush and Fisher6 introduced the concept of dentogenics or the dentogenic theory which stated that the correct tooth form should be designed or selected with regard to the patients sex/gender, personality and age (SPA factor). The prosthodontics literature pertains primarily to the non-Indian population and there is a lack of information on the selection and design of artificial anterior tooth forms in the Indian population. The knowledge of racial norms for facial appearance might aid practitioners, since the treatment given would be in harmony with the facial appearance for patients of different races. Most studies,7, 8, 9 on the subject of artificial teeth design and selection, with respect to facial form and gender, have been based on subjective evaluation and assessments of different individuals; with lack of standardized methods and techniques and unavailability of technological resources. Hence, their reliability has been questionable. This study attempts to increase the accuracy of the methodology by employing a software known as AutoCAD © (Autodesk Inc. 2013, California USA) Auto Computer Aided Design and Drafting. AutoCAD is a 2-D and 3-D, vector based, computer-aided drafting software application used in architecture, construction and manufacturing to assist in the preparation of blueprints and other engineering plans. 10 This high end technology has been applied to make the process of evaluating the maxillary central incisor tooth form, easier, objective and more accurate. The present study aims to assess whether a correlation exists between the maxillary central incisor tooth form and face form of the subject and also to assess if any gender differences could be seen in relation to the form of the maxillary central incisor. The null hypothesis of this study is that there are no gender specific differences in tooth form as well as no correlation between facial form and tooth form of a person. Materials and Methods A total of 200 dentulous subjects of North Indian origin (age range 18-25 years) studying at Manav Rachna International University, with well aligned natural maxillary anterior teeth were randomly selected. The subjects being young adults belonging to different parts of North India formed an appropriate representative sample. Each subject was interviewed, to confirm the inclusion criteria and to rule out the exclusion criteria. The exclusion criteria were: subjects with anterior teeth fractures, subjects having maxillary anterior teeth with extensive carious lesions, subjects with incisal wear of maxillary anterior teeth, subjects with gingival hyperplasia in the maxillary anterior teeth, subjects who have undergone orthognathic surgery, orthodontic treatment, and those with congenital or surgical facial defects, those with microdontia or macrodontia and subjects with any type of prosthetic restoration on their anterior teeth. A participant informed consent form (PICF) was provided in both english and hindi languages. The informed consent form was explained to each participant and was signed by them before starting the procedure. A standardized photographic procedure was used to obtain images of the face and the maxillary central incisors. Each subject was made to sit upright on a chair with the occlusal plane of the maxillary teeth parallel to the floor. Two standardized photographs were taken for each subject: portrait (closed lips) and the maxillary incisors (without lips). For each photograph, standardized distances (portrait – 100cms, teeth- 12cms) were used (from the tip of the subject’s nose to the centre of the camera lens). A fixed focus of 1:1 was used for each subject, with theEF 100 mmf/2.8 Macro USM lens. The height of the Canon EOS 1100D DSLR camera mounted on a tripod (Traveller Mini Pro Tripod For Canon EOS 1100D) was adjusted individually according to the position of the subject’s face and teeth. A full face photograph with closed lips was obtained, with lens positioned parallel to subject face. The subject’s hair did not cover any part of the face and the teeth we re in contact [Figure 1]. The standardized photographic procedure was followed as per the earlier method followed by Wolfart S et al.2 Intraoral photographs of maxillary central incisors were obtained until the lens was parallel to the labial surface of the teeth. Cheek retractors were used to obtain full exposure of the maxillary central incisors. The maxillary incisors were centred in the photograph, with the midline centred and perpendicular to the incisal plane [Figure 2]. Using the image editing software (Adobe Photoshop 8.0.1, Adobe systems, San Jose, California), the images were adjusted so that the maxillary incisors remain centred in the image, one at a time, with the long axis set vertically. [Figure 3]. The mathematical assessment of the photographs was done according to the methodology proposed by Wolfart et al 2. The outline of the upper right incisor was traced and in the next step, the median of the tooth was drawn in the sketch. (X) was the most apical point of intersection between the median and the outline. Mesial and distal tangents were constructed to the outline – parallel to the median. Two perpendiculars were drawn on the median starting from the most apical (O1) and most incisal (O2) point of intersection between the outline and the tangent. They define two points of intersection (S1 and S2). The line S1S2 was bisected (S). By taking the width of the tooth through (S) the widest stretch across the tooth was defined (TB). Dividing the line SX into five parts, the line TA could be constructed parallel to TB on 4/5 of the length of XS. The outline sketch was turned upside down for the evaluation of the face shape. The lines FB (the widest stretch across the face) and FA (a defined parallel stretch to line FB) were constructed in an analogous manner to the lines TA and TB. [Figu re 4]. For the evaluation of the face shape, the outline sketch of the portraits was turned upside down. The facial outline form was determined by the outline of the temporal bone at the height of the hairline, temporal process of the zygomatic arch and the gonion. The facial quotient (FQ) was calculated in an analogous manner to that of the tooth quotient (TQ) [Figure 5]. According to the numerical values that were obtained, dental and facial forms were classified as: [2] Tapered (≠¤ 0.61) Oval (≠¥0.61 and ≠¤ 0.70) Square (≠¥ 0.70) The data, for each subject were recorded in a standardized proforma, along with the photographs of the subject before and after analysis. Results The data obtained were arranged systematically and transferred to Statisticals Package for the Social Sciences (SPSS) version 20, IBM Inc. for analysis. The following statistical methods were employed: descriptive statistical tests, chi square tests, independent t-tests and Spearman correlation. The level of statistical significance was set at p-value ≠¤ 0.05. Chi-square test was used for comparison between categorical variables. Student’s ‘t’ test was used for comparing two groups with respect to continuous and normally distributed variables. Discussion The design and selection of maxillary anterior teeth for esthetically pleasing prosthetic rehabilitation has long posed a challenge in clinical practice. A reliable and reproducible method is required for prosthetically restoring anterior teeth in terms of their size and form, which are in proportion to the face and gender of the patient. Our first objective was to determine the maxillary incisor tooth form of each subject using the AutoCAD software. The study was then classified into three forms ovoid, square and tapering. The oval category was the most prevalent tooth form among the study population while the square tooth form was the least prevalent. These findings were in accordance with the study by Brunetto et al 11 on a Brazilian population. However, in a study conducted by Wolfart et al 2 on a German population, although the oval category of tooth form was most prevalent, the least prevalent tooth form seen was the tapered form. These differences may be due to ethnic and genetic population variability and greater software accuracy, adopted in the present study. Our second objective of the study was to determine whether a correlation existed between the maxillary central incisor tooth form and the face form. Since this finding is statistically significant in the present study sample, therefore, the null hypothesis of the study, was rejected. This was in accordance with the results of studies by Selg 12 and Sellen et al 3 which postulated that the face form of a patient was helpful in selecting the artificial tooth form for their prosthesis. Our results also confirmed William’s â€Å"law of harmony† which states that a correlation exists between the inverted facial shape and the shape of the maxillary central incisors.4 Some studies 5 and literature reviews 3,13 confirm that even despite controversies surrounding the authenticity of William’s law of harmony, it is still the simplest, the most useful and the most predictable method of artificial tooth selection for anterior teeth. On the other hand, the validity of William ’s classification has been questioned by various authors. 14,2,15,16,8,17,18 The positive correlation seen between tooth form and face form in this study as compared to statistically insignificant results obtained in various previous studies 2 can be attributed to the use of a more practical, technically advanced and precise AutoCAD © (Autodesk Inc. 2013, California USA) software which enhanced the accuracy and reliability of the analysis. Previous studies were mostly based on visual and subjective determination of the tooth and face forms and hence did not provide valid results. The genetic variability of different populations, on which past studies have been conducted, may also have some influence on the final results. Our third objective was to determine whether a correlation existed between the tooth size and the gender of a person. This correlation was found to be statistically significant. The size of the maxillary central incisor in men was found to be larger than that of women. This is in accordance with studies which concluded that tooth size is known to correlate with gender.1,19,20,21 Our fourth objective was to determine whether there was a correlation between the tooth form and the gender of the person. This correlation was found to be statistically insignificant. This result was in agreement with that of Wolfart et al 2 and Berksun et al 16 who noted no significant differences in tooth form between the genders. However, Horvath et al 1 and Brunetto et al 11, reported that maxillary anterior teeth do have gender specific differences and that tooth shapes are gender specific. In our study, the oval tooth form was found to be the most prevalent in both the genders. This was similar to the results obtained by Brodbelt et al 22 and Wolfart et al 2. Hence, choosing the oval form has a better chance of matching the original tooth, irrespective of the gender. A higher percentage of the square tooth form was seen in women as compared to men. This result was also similar to that of Wolfart et al 4 and Brunetto et al. 11 This finding suggests that opting for a square toot h form for a male patient is statistically more likely to result in a mismatch. Hence, the dentogenic concept that suggests that the female teeth should be more rounded and the male teeth should be more squarish is not supported by the results of this study. Conclusion Within the limitations of this study, it was found that in a section of the North Indian population that: The oval tooth shape was most common while the square tooth shape was least common. The tooth size was generally found to be larger in males than in females. A significant correlation could be found between the face form and tooth form of a person, thus validating William’s law of harmony.2 No correlation or gender- specific differences could be found between the tooth shape and gender of a person. Hence, the dentogenic (SPA) concept was which states that tooth form is related to the SPA of the patient is not validated and supported by this study. 1

Free Essays: Impact of the Word on Dickinson :: Biography Biographies Essays

Impact of the Word on Dickinson In Donald E. Thackrey’s essay "The Communication of the Word," he talks about how "the power of the individual word, in particular, seems to have inspired her with nothing less than reverence" (51). Dickinson approached her poetry inductively, that is, she combined words to arrive at whatever conclusion the patterns of the words suggested, rather than starting out with a specific theme or message. Instead of purposefully working toward a final philosophical point, Dickinson preferred to use series of "staccato" inspirations (51). Dickinson frequently used words with weight in her work, and as a result her works usually cannot be grasped fully in one reading without dissecting each word individually. Often Dickinson would compile large, alternative word lists for a poetry before she would come to a decision on which word was "just right" for the impact she wished to achieve (52). For example, this poem displays Dickinson’s use of alternative, thesaurus-like lists: Had but the tale a thrilling, typic, hearty, bonnie, breathless, spacious, tropic, warbling, ardent, friendly, magic, pungent, winning, mellow teller All the boys would come— Orpheus’s sermon captivated, It did not condemn.    Eventually, Dickinson came to rest on the word "warbling," but one can see the meticulous care that she put into the decision on which word to use. Another poem of Dickinson’s that shows her compositional method is "Shall I Take Thee?" the Poet Said." In this poem, Dickinson discusses from where the power of the world comes. "Shall I take thee?" the poet said To the propounded word. "Be stationed with the candidates Till I have further tried."    The poet probed philology And when about to ring For the suspended candidate, There came unsummoned in    That portion of the vision The word applied to fill. Not unto nomination The cherubim reveal. In the preceding poem, one can see the artistic style come through her composition. The best representation of that particular idea comes from the author Donald Thackrey when he says: It is significant that the revealed word comes "unsummoned" in a flash of intuition†¦.and yet the implication of the poem is that the revealing of the word must be preceded by the preparatory, conscious, rational effort of probing philology†¦She [Dickinson] herself was well aware that inspiration, while all-sufficient when present, seldom came even to a great poet.

Kant’s Formula of the End in Itself :: Ethics Kant Formula End Itself Essays

Kant’s Formula of the End in Itself ABSTRACT: Is Kant’s "Formula of the End in Itself" overly demanding? In addressing this question, I sketch a conception of co-obligation, that is, a sort of moral requirement that holds, not of persons distributively, but of persons collectively. I then raise a problem of devolution: How does a co-obligation for all persons devolve upon me? For instance, given that we must maximize happiness, it does not seem to follow that I must always act so as to maximize happiness. In partial answer to this problem, I claim that some Kantian duties do stem from co-obligations. But this claim has as a crucial assumption the following conjecture: The "Formula of the End in Itself" is to be read as implying that we must treat each person as an end and not simply as a means. I Kant’s Formula of the End in Itself, with its conception of treating persons as ends and not simply as means, has had enormous influence in the history of ethics. In this talk, I shall discuss an objection to it, namely, that it is overly demanding. To begin with, let me state this objection more fully: Suppose that, in obedience to the Formula, you want to treat your friend as an end (and not simply as a means). Your action of treating her as an end can be either a positive one or a negative one. When it is positive, she is (in some way) the object of your agency — for example, you might treat her as an end by saving her life. In contrast, when it is negative, she is not the object of your agency — for example, you might treat her as an end by refraining from lying to her. Now the obligation to treat a person as an end is not overly demanding, when such an act is a negative one. For then you are simply obligated not to do something, an obligation that you can fully comply with by exercising self-control. For instance, it is hardly burdensome to refrain from lying to people. However, when the act is a positive one, the obligation to treat a person as an end can often be overly demanding. For then your obligation to her can be a good-Samaritan one, requiring you not to allow other persons to treat her simply as a means. But an obligation of this sort can be quite difficult to comply with, because you cannot exercise the same control over other persons that you can over yourself.

Communication Delay in Children

Communication & Language Delay in Children Children communicate in many ways. Language and communication help us to socialise and express our needs. Babies use sounds, facial expressions and hand or arm gestures to express the way they are feeling. As they grow older their language skills gradually begin to develop and they will use more complex gestures such as pointing at objects. Language allows the child to express themselves and communicate. Alongside speech, reading, writing, drawing and signing are all important parts of a Childs language development. It is important to identify any delay in language or communication in a Child as soon as possible. Children need to be able to communicate with others in order to express their needs and develop their social skills. Delayed language or communication can have a big impact on all other areas of development and cause behavioural problems for the child born from frustration. A child who is unable to express themselves clearly may display disruptive or aggressive behaviour as they become frustrated that they are not being understood. They might be disciplined for their behaviour if their carer does not realise why they are acting up and brands them as a difficult child. This will cause the child to loose confidence and develop low self esteem. They may also become clingy to their parent or carer, be prone to tearful outbursts and have difficulty socialising with peers. A child with hearing difficulties may appear to be in their own little world and not respond when their name is called. They may also struggle to follow simple instructions or have trouble pronouncing words. Children who can not understand or hear what is being said to them will miss out on vital learning opportunities. The Childs overall wellbeing will suffer as they will feel isolated and upset. The child may withdraw from groups and not want to participate therefore missing out on learning important social skills. Delayed language and communication can also be a sign that there is something more seriously wrong with the child that may require treatment or specialist help such as a hearing impairment or learning difficulties. If the correct help or treatment is not supplied for the child in a timely fashion it will have a knock on effect that will delay their emotional, social and even physical development. It is therefore vitally important that child care practitioners are aware of the signs of communication and language delay in children and are equipped with the right tools and information to be able to help the children and their families. The practitioner needs to be calm, flexible and patient. A child with language difficulties will need extra support that should be tailored to their individual needs and plenty of positive encouragement and reinforcement to help build their confidence. The child may be able to take you to objects that they want or express their need by looking or pointing at objects. Some children may need help when playing alongside others. The Practitioner may need to stay close so that they can help them when they have trouble expressing themselves as well as teaching the children around them to be patient and help them to understand the child. A Childs language could be delayed for many reasons some of these reasons are detailed below: * Hearing impairments – This is a common reason for a delay in language development. There are many different types of impairments ranging from non-permanent conditions such as glue ear to permanent partial of full hearing loss. A child with hearing loss will often withdraw in to themselves and not want to interact with the outside world as they struggle to understand it. The cause of the loss needs to be established quickly so the child can receive the right treatment so their development does not suffer. Non-permanent conditions may be easily treated by a GP, whereas permanent conditions may require specialist help and hearing aids. The sooner treatment is supplied for a child the sooner they can progress their language and communication skills. The practitioner can support them within the setting by working alongside the parents to understand the condition. The practitioner c should provide one to one support and they may use sign language and encourage the other children to use it too. Physical conditions such as an enlarged tongue or a cleft pallet – A child suffering from this kind of physical impairment will usually have a very good understanding of what is being said to them and going on around them. The problem comes when they try to express themselves through speech. They may be unable to speak clearly and may mispronounce words. This will cause them to become frustrated and may result in aggressive behaviour. It might also cause them to feel different and be embarrass ed in front of their peers. Therefore they may withdraw from groups and not wish to participate in discussions. Some of these conditions can be treated by Doctors but others will require speech therapy and on-going support. The practitioner will need to work alongside the therapist and the parents in order to provide the best possible support for the child within the setting. * Stutters or stammers – A child suffering with a stutter or a stammer will usually have a good understanding of what is being said to them and going on around them. They struggle to express themselves clearly and find it difficult to get the words they want to say out correctly. They may hesitiate or say um a lot or repeat the same word over as they try to get out a sentence. This is often because their mind is working so quickly their mouth struggles to keep up! This is considered a normal stage in development for a child between the age of Most children grow out of this in time but for some it may develop in to a habit and a half to five years.. If a child is suffering with a stutter or stammer displays disruptive behaviour due to frustration and feels embarrassed in front of peers so they shy away from group activities or the non-fluency continues for more than 6 months they may require referral to a speech therapist. Practitioners can help the child within the setting by helping to relax the child in order to calm their speech by showing they are listening, making eye contact, nodding their head and smiling at the child. The practitioner should never finish the Childs sentences be patient and allow them plenty of time to speak. Lack of stimulation and language input –Some children to not recieve the level of interaction required with other people to allow there language and communication skills to develop. The child may be left on their own, for long periods and not taken out of the house. Their carer may not talk or interact with them unless it is necessary. In these circumstances the child misses out on all the im portant experiences and interactions that are required in order to enable their lanhuage and communication skills to develop. There are often underlying problems or concerns with children who are delayed due to this issue. There could be a problem with neglect at home or their carer may be depressed and need help. It is important that these issues are also addressed alongside the support required to assist there language development. Often these children simply require time, care and attention in order to help them progress. The practitioner can help by spending time with the child talking and interacting. They must provide plenty of positive reinforcement and encourage them to interact with others and try new experiences to develop their language skills. Picture cards and books can also be used to help them express what their needs and increase their vocabulary. * Shyness – Some children are simply very shy and do not like talking to people they are not familiar with or clam up in situations or places they are not used to. They have a very good understanding of what is being said to them and going on around them but find it difficult to speak due to shyness and anxiety. The parents may tell you that the child is a chatter box at home where they feel comfortable but the child may not say anything when they are at pre-school. The child will need plenty of encouragement and positive reinforcement from the practitioner in order to help them settle and feel at ease within the setting. The practitioner can support the child by playing alongside them, encouraging them to interact with other children and encouraging other children to interact with them. * The child is learning more than one language – Children who are learning more than one language may be slightly slower in learning to talk and communicate. This is because the child has to learn more than one language system. There are many circumstances in todays’ society where this is now the case. Children come from many different backgrounds. The child parents may speak one language at home such as Chinese which will be the childs home language but then they will be exposed to English when they are at preschool or the childs parents may use 2 languages at home. The childs mother might be French and speak French to the child whereas the Father may be English and only communicate with the mother and child in Engllish. Children learn through association and absorption therefore it is important that when within the preschool setting the practitioners only use one language to communicate with the child. This enables the child to associate that language with the setting and put what they are learning in to context. It is very important that the setting works with the childs parents to support their learning and ensure that the child has a positive view of both of the languages they are learning. The parents might like to be involved in some of the activities in the setting so that they can see what the child is learning and help to support their development. Learning difficulties such as Autism – There are many different learning difficulties that can occur in children and all will need specialist treatment that is specific to each individual child. Therefore it is important that they are identified early so that the child can receive the help and support they require in order to progress. Earl y signs of a learning disorder in children are problems pronouncing words, struggling to find the right word, difficulty rhyming, trouble learning the alphabet, numbers, colours, shapes and days of the week and find it difficult to follow directions or learn routines. Children with autism may have trouble making eye contact, appear disinterested in other people and what is going on around them, find it difficult connecting with people and have problems playing with other children. They may use an abnormal tone of voice, with an odd rhythm or pitch, they may repeat the same words over and over, respond to a question by repeating it instead of answering it and refer to themselves in the third person. Once a delay in a child communication and language skills has been identified it is important they receive the help and support required as soon as possible. Each setting should have access to a SENCO (special educational needs co-ordinator) and a EYAT (early years advisory teacher). They should be the first people to be that is contacted once a delay has been identified. They can them come in and carry out observations and assessments of the child in order to help establish the cause of the delay. They can then liase with the Childs parents and the practitioner to discuss what the next steps are and how best to support the child with their development. A referral should be considered if the child is delayed in any of the following areas: * Understanding language that is spoken to them Developing the range of speech sounds appropriate for their age * Developing the use of words and sentences appropriate for their age A referral should also be considered for those children that who are not following the normal patterns of development such as: * Children who use language inappropriately , for example phrases used in the wrong context or tha t don’t make sense. * Repeating learned chunks of language that have no meaning * Children who find it difficult to follow rules or join in with a conversation by looking, taking turns and sharing interest in a subject. Some children may need to be referred to a speech and language therapist. A speech therapist can help support children with a wide range of communication and language difficulties. Any referrals must be done with the full support and co-operation of parents. The SENCO will also be able to get help from the Early Years support team within Leicestershire. They are there to assist settings with the early identification of children with additional needs and provide support for the child and their families. Once again any referrals must be done with the full support and co-operation of the the parents. Practitioners should ensure that they include communication and language development within their planning for the setting. The setting should promote good communication and language skills and display their approach to parents so they can help support it within the home environment. There are many ways to promote good communication and language within the setting. All areas within the setting should be clearly labelled with words and pictures to help the children to understand what they are used for. Boxes within the setting should be labelled with pictures to help the child understand what is in them. Eg. A photo of lego on the box that contains the lego. Pictures and photo cards can also be used to help the children express their needs or to show you what they would like to do. Practitioners should be good role models for the children and ensure that they display good language and communication skills. They should ensure that they listen to the children patiently allowing them time to talk, make good eye contact and sensitively correct children when they use the wrong form of word. Eg â€Å"I readed my book† response from practitioner â€Å"Oh, you are reading your book†. Practitioners should ensure they use simple instructions with short sentences that the children can understand. Open questions encourage the children to think and with encouragement help them to extend their vocabulary and improve their sentence structure. There are many play opportunites that the practitioner can use to encourage good language and communication. One of the most effective ways of doing this is to talk allowed as you are playing with the children and provide a commentary on what you are doing. For example if you are playing with the lego you could say â€Å"We are building our tower up, it is getting higher and higher. Oh look the green block is on top. Ben has a square brick , it is red† As you are talking the child will learn from absorption pick up on the words and make the associations with the objects. Books can play a key part in developing in speech and communication skills. Picture books can be used to help the child learn colours, animals, and objects. Storybooks can be used to encourage language development and sentence structure. The practitioner can ask the child open questions such as â€Å"What is happening in the picture? † or â€Å"What do you think happened next? †. You could even get the child to tell you the story themselves. After reading the story with the child you could then ask them to read the story to you. Although they might not be able to read the words you can see how much they recall from the pictures and how well they listened to you. Roleplay is a brilliant way to encourage imaginative play and increase vocabulary. For instance you could role play a trip to the shops. There could be lots of new language words that you can introduce such as till, basket, shopping trolley, carrots, apples, broccoli, oranges, money, purse, bags etc. Role play is also a good way to get children to interact and communicate with each other in a fun and interesting way. Songs and rhyming are great way for getting children to listen they are also often help children to remember things. Songs and rhymes use intonation, stress and rhythm which all help with aspects of speech development as they are all skills we use when talking. Some songs also involve actions so they are a great way to help children link words with actions or even body parts Eg The song ‘ Head shoulders knees and toes’. It is important to remember that all children are individuals and therefor what works for one child may not work for another. That is why practitioners must ensure that there is a wide vareity of play opportuinites available within the setting to ensure they can cater for each childs needs. They should ensure that regular language and communication observations and assessments are carried out on all the children within to enable them to keep track of their development, plan their next steps and identify and signs of a delay as early as possible.