Strategy for Change Management - Free Essay Example

Sample details Pages: 13 Words: 3869 Downloads: 3 Date added: 2017/06/26 Category Management Essay Type Research paper Did you like this example? Introduction Due to growing of globalization, advance technology, and organizational consolidation, change is nowadays become a crucial part of every organization in order to survive in changing business environment. To handle the change, change management is required in transitioning for both organizational and individual level to attain future desired change (Hughes, 2006). Change at organizational level is related to strategy which will indicate organizational direction and activities (Thornhill, Lewis, Millmore and Saunders, 2000). Don’t waste time! Our writers will create an original "Strategy for Change Management" essay for you Create order In developing effective organization strategy, both internal and external environments have to be taken into consideration. When the strategy has been changed as adapting to changing internal and external environments, strategic change is necessity to be utilized in change management in order to align change with developed strategy. As individual change is pivotal part of organization change, change management need to be adopted at individual level in order to initiate the change and consequently obtain successful organization change. As change agent takes responsibility of implementing change, they need to have clear understanding of strategic change concept including change models, approaches and tools in order to implement change appropriately. The essential skills required for change agent are analytical skill for analyzing change contexts, judgmental and critical thinking skills for prioritizing the contexts base on importance, and implementation, interpersonal and influencin g skills for applying change to related people in the organization (Balogun and Hailey, 2008). Besides, self awareness is also important for change agent to realize the need of change from organization perspective rather than their own perception and experience. Change Approaches and Tools In change process, there are three states which are current state, transition state and future state as shown in FIGURE 1 and detailed in APPENDIX A (Balogun and Hailey, 2008) The thought of how change can occur in organization can base on two main schools in which the models are punctuated equilibrium model and continuous model as illustrated in FIGURE 2 and 3 and details in APPENDIX B (Balogun and Hailey, 2008). To access the change, there are currently a number of approaches to change such as planned, emergent, theory O, theory E, and theory Z and tools to implement change such as PESTEL, Porters five force analysis, change kaleidoscope, and cultural web. Due to different internal and external environment of each organization together with its changing nature, there is no best approach and tool which can be applied for all organization at all the time. In order to select appropriated approaches and tools, organization needs to consider both its external environment and int ernal context. Change Approaches Some of hi-lighted approaches to change are planned and emergent approach. For planned approach, change is deliberately developed through intentional and rational process driven from top down based on assumption of stable environment (Hayes, 2002). Its original purpose is to achieve effectiveness improvement of human operation through group application of change program (Burns, 2004). It perceives that one change which is a series of linear events can be applied for all parties (Graham, Lecture session 4 16 October 2009). In contrary, change from emergent approach is initiated from contingent and unpredictable environment. It is built up from interrelated several variables such as external environment and process of decision making (Graham, Lecture session 4 16 October 2009). The process of change in emergent approach is open-ended and continuous driven from bottom up and adapted to changing organization context (Hayes, 2002). Change Tools Among number of implementing tools, well-known tools which are used for analyzing organization external business environment as illustrated in APPEXDIX C are PESTEL and Porters five forces. For internal environment or organization context, Change kaleidoscope, Culture web and Force field analysis can be applied whereas SWOT analysis is for analyzing both internal and external environment. PESTEL will provide analysis for macro-environment factors which influence success or failure of organization including political, economic, social, technological, environment and legal (Johnson, Scholes, and Whittington, 2009). While Porters five forces scope down analysis to industry which organization is in. It will identify organization competitiveness and attractiveness of industry through analysis on threat of entry, threat of substitutes, power of buyers, power of suppliers and competitive rivalry. In contrary, Change kaleidoscope concerns analysis of three components which are organization context, change contextual features, and design or implementing choices for change (Balogan and Hailey, 2008). Whereas Cultural web will point out current obstacles of change and provide direction to adjust organizational culture, force field analysis is adopted to identify driving and restraining forces to change at individual level. It suggests three stage of individual attitude changing process which is unfreezing, learning, and refreezing (Balogun and Hailey, 2008). In contrast, SWOT is applied to analyze both strengths and weaknesses of organization and opportunities and threats from outside organization. GlaxoWellcome Case Study Overview GlaxoWellcome is a UK pharmaceutical company. It was formed in 1995 by merging of Glaxo Laboratories and Burroughs Wellcome Company. In 2000, it was merged again with SmithKline Beecham to start UK based pharmaceutical, biological and healthcare company under the name of GlaxoSmithKline plc. GlaxoSmithKline plc is now became second world largest pharmaceutical and researched company with a wide range of pharmaceutical products. Glaxo had passed some periods of change before merging to be GlaxoWellcome and GlaxoSmithKline as following details. First Stage of Change at Glaxo in 1994 The first part of change was driven from increasing competition, patent expiration of its hi-light product Zantac, government legislation, and organizational change of it key customer National Health Service (NHS) in responding to government legislation in year 1988. With employee confidence in senior management competency to cope with these issues, they perceived of unnecessary for their involvement to achieve future desired change. Together with slow decision making of separated functions, the organization was unable to response to change effectively. Senior manager therefore had initially created change awareness among employees by employing RATIO program (Role clarity, Acceptance of change, Teamwork, Innovation, and Output orientation). From program, employee had learned new behaviors and applied it in their own jobs. Consequently, sense of ownership was created. The program was reinforced with a range of support change initiatives such as relating value statement with behavior , cross function project group, and encouraging more communication among functions with new office interior design. Moreover, outdoor development course suggested by outside consultant was successfully introduced for senior manager to experience and have more understanding on different behaviors. It was replicated to 700 employees in later period. However, employee interviews after change activities demonstrated that, although RATIO program seems to success in creating culture change awareness, further fundamental change needed to follow (Hailey and Balogun, 2002). Second Stage of Change at Glaxo in 1997 The second change of Glaxo was developed in 1997 through organizational restructuring and business reengineering programmes after merging with Wellcome Company. Organizational restructuring reduced Glaxos hierarchical level from 7 to 4. Its strategy was shifted from focusing on only individual product to disease management which is working collaboration with customers and reducing RD expenses through coalition with universities and bio technology organizations. Complimentary service began to be offered and relationship with key customers was developed. Employee behavior and attitude had been realigned with new strategy though team working process, improving customer interaction skill, working in networked organization, and higher business responsibility. New individual evaluation and reward system, training with increasing coaching and consulting activities for each team, and computer based personal feedback package were initiated. In business reengineering process, Glaxo has adopt ed Customer Focus view to analyze customer demands for process improvement and new potential customer identification purpose. From internal merging, 5 regional divisions were created to reflect organization structure of NHS as a part of its business reengineering (Hailey and Balogun, 2002). Evaluation of Emergent and Planned Approach As mentioned above, emergent approach to change is initiated from contingency in working and unpredictable environment without prior deliberately planning. It is beneficial to organization as change can be implemented in shorter period of time and more fluid in working process than planned approach. Change from planned approach needs to be planned through different stages and base on group performance. Therefore, in circumstance such as economic crisis that rapid transformation is needed, emergent approach is more appropriate for implementing change. However, in some case, emergent approach has limitation on practical difficulty due to uncertainty of changing factors, loss of management control and failure of implementation from lack of application skill. By return, planned approach assembles its limitation on loss of management control as its control is driven from top to bottom. Planned approach comprises of 4 interrelated complex elements which are field theory, group dynamics, action research and three-step models. While field theory and group dynamics used to analyze formation, motivation and maintenance of social group, action research and three stop models of change which are unfreezing, learning, and refreezing, work together to change of social group behavior and create long term change. Planned approach is appropriate for organization structure change rather than emergent approach (Burns, 2004). Application of Emergent Approach to Glaxo Case Study Glaxo had applied combination of emergent and planned approach in different phrases of first and second stage. As change was originated from contingency of changing business environment, emergent approach had been applied in Glaxo at beginning of its first change stage through initiating of change awareness and second change stage through developing of reengineering programmes and organizational restructuring. However, planned approach was undertaken in combination to complete organization structure change in long term. The employee behavior had been analyzed and unfreezing step of change is implemented through employment of RATIO programme in first stage. This was to create readiness for further transformational change which had been executed in second stage through change activities and new adopted systems in restructuring and reengineering programme. Change Kaleidoscope To apply change successfully, organization context needs to be analyzed in order to select appropriate implementing options. Change kaleidoscope can be utilized effectively as it provides both available range of implementing options and contextual features analysis. Change awareness from organization aspect is encouraged by using this tool in which model and details can be referred from APPENDIX D. Organization need to examine contextual constraints and enablers to change in order to evaluate its change ability and consider implementing choices of path, start point, style, target, interventions and roles. Using Kaleidoscope allows organization to understand the reason why design choice is appropriate or inappropriate to particular context. Kaleidoscope is normally used by change agent group to solve change problem through three steps which are assessing contextual enablers and constraints, determining change path, and selecting other change choices. However, to achieve complete cha nge design, other tools such as cultural web need to be implemented together with Kaleidoscope. Although Kaleidoscope establishes well structure for transition state, challenges of this tool is occurred from interventions of other changes during processing which need to be synchronized over the time. Due to complexity and resource consuming in transitioning, competencies of analytical, judgmental, and implementation skills cannot be deficient for change agent. In addition, even though Kaleidoscope can be implemented in different change circumstance, it is most appropriate to planned change which aims to achieve particular goal (Hailey and Balogun, 2002). Application of Change Kaleidoscope to Glaxo Case Study First Stage of Change From Glaxos first stage of change, contextual enablers and constraints can be identified from applying Kaleidoscope as following details. Contextual features which are enablers to change are time, scope, diversity, and capacity whereas preservation and readiness is key constraints and power and capability is neutral (Hailey and Balogun, 2002). Time (+) Although change needs to be implemented as responding to changing business environment, there is no huge urgency. Scope (+) As scope of change is realignment of employee behavior, challenge is lesser which enable to change. Preservation (-) Preservation is constraint to change of Glaxo since talented workforce have to be preserved as know-how of organization. Diversity (+) Change is required for sales division only. Therefore, diversity is low and enabler for change. Capability (n) From low experience of change management in sales divisions with highly educated workforce, capability is marked as neutral. Capacity (+) Glaxo is affluent enough for investment on change programme so mark for capacity is positive. Readiness (-) Due to low change awareness of employee, readiness is negative to change. Power (n) With high volume of employee preservation, power of directors to impose change is limited consequence of neutral mark for power. Considering nature and result of change, Glaxo made decision to initially employ big bang reconstruction path from senior management to generate change readiness for long term transformation in second stage by employing RATIO program. It was likely that senior management employed intervention rather than direction to create change awareness and sense of ownership. Also, constraint of low capability was overcome by adopting of outdoor development course suggested by outside consultants. Application of Change Kaleidoscope to Glaxo Case Study Second Stage of Change After change awareness had been created in first stage, Glaxo developed further fundamental change in which analysis of time, diversity, capacity and power is remained the same while remaining features are changed as following details. Time (+) There is no urgency for change so the mark is still positive Scope (-) Scope turns to be constraint due to challenges from long-term transformational change Preservation (n) Although Glaxo has preserved high volume of talents workforce, changing in workforce is increasingly realized. Level of preservation therefore is lower. Diversity (+) Glaxo is still homogeneous organization. Capability (+) Capability has been improved by implementing RATIO programme and outdoor development course. Capacity (+) Glaxo still maintains its strong capacity for investment. Readiness (+) Employees awareness is created through RATIO programme. The readiness for change is therefore improved. Power (n) The senior management power is remained the same. From result and nature of change, Glaxo had considered taking evolution path for further fundamental change and other implementing choices are chosen as below elucidated Change path Glaxo had taken evolution path through reconstructing and reengineering programme in order to develop long term transformational change. There is transformation of Glaxo brand and image though increasing customer focus and relationship. However, the attitude survey showed that there is no substantial change in employee values. Starting point The starting point of change is still mandated from top management. Style The style of change was judged to be participation from collaboration in real implementation although consideration of organizational strategy and change process were still made by senior management. Target Target of change is employee behavior and levels of outputs. Intervention Glaxo use interventions for power structure through restructuring, control systems through applying new appraisal and evaluation system, routines and rituals through coaching and counseling, and symbol to achieve effective change. Roles Since Glaxo change is operated by senior management and outside consultant, change roles therefore are combination of change champion and external facilitation. Conclusion Glaxo has undergone major two stages of changes. Emergent approach has been applied in combination with planned approach in order to achieve successful long term organization change and Change Kaleidoscope is used as a tool to implement change. Kaleidoscope model used to conduct analysis of each Glaxos contextual features in order to determine most appropriate implementation options available. In the first stage, it creates change readiness among employees and change organization structure from reconstruction to be evolution in second stage. However, the satisfied level of change is not achieve since the embedded of organization value is not radically change cause from insufficient change target and the deviation of conducting personal development from business strategy. Moreover, there is critical point on over optimistic of Glaxo base on its success in pharmaceutical industry, change capacity, expiration of Zantac patent, and anticipation of faster change in NHS (Hailey and Balo gun, 2002). Summary In current changing business environment driven from a range of factors, there are various approaches and tools use to manage changes. Due to different internal and external environments, each organization has to consider and analyze their own environment in order to adopt the most appropriate approach and tool to implement change successfully. For Glaxo case study, both emergent and planned approaches to change has been applied to complete long term transformational change. Change Kaleidoscope tool is used to analyze its contextual feature and select the most suitable design choices to implement the change. After executing change, Glaxo achieve increasing level of change awareness in first level of change and achieved a level of transformational change in second stage although it is not reach the preferable level due to insufficient change target, deviation of personal development from business strategy and over optimistic vision of Glaxo. APPENDIX A: Change Process (Balogun and Hailey, 2008) Current state will identify organization current competitive position, internal context and need for change. The desired change will be generated at future state through transition state in which the process can be designed after organizational current status is understood and future desired change is specified (Balogun and Hailey, 2008). APPENDIX B: Punctuated Equilibrium Model of Change and Continuous Model of Change Punctuated equilibrium model performs that interspersed change occurs periodically through convergent and revolutionary change. While convergent change creates continued minor changes through a period of time by adapting from current operation, it is punctuated by revolutionary change which is radical change emerged from simultaneously changing of organization strategy, structure, systems and culture triggered mostly by approaching crisis (Balogun and Hailey, 2008). The revolutionary change is major change during disequilibrium situation (Hayes, 2002) and will be characterized as new equilibrium for next period of change. Due to longer period of convergent change, inertia and resistance of change is formed whereas immediated new way of operation is generated from revolutionary change (Balogun and Hailey, 2008). In perspective of continuous model which is appropriate for organization in industry with intensified competition and advance technology, change needs to be implemented cont inuously in order to survive in rapid changing environment. In comparison, punctuated equilibrium model is appropriate for organization in industry which requires low frequency of change subjected to competitive condition and where competitive advantage can be maintained over a period of time without requirement for substantial change (Balogun and Hailey, 2008). APPENDIX C: Layer of Business Environment (Johnson, Scholes, and Whittington, 2009) The external business environment of organization composes of macro-environment at the highest layer, industry or sector at second layer and competitors at third layer. APPENDIX D: Change Kaleidoscope (Graham, Lecture session4 16 October 2009) Change Kaleidoscope model composes of outer ring and inner ring. The outer ring indicates organization contextual features which are time, scope, preservation, diversity, capability, capacity, readiness, and power. Whereas inner ring provides design or implementing choices which are change path, change start point, change style, change target, change levers and change roles. The details of organization contextual features and implementing choices will be as followings (Balogun and Hailey, 2008) Organization Contextual Features (Balogun and Hailey, 2008) Time The period of time which change need to be accomplished Scope The degree of change which can be separated into realignment and transformation Preservation The organization assets, practices, or characteristics which needed to be retained during change Diversity The level of difference among groups of employees and divisions, who/which will be effected of change, in terms of attitudes, values, and norms Capability The organization competency to implement change in terms of managerial skills and personal knowledge and ability Capacity Organization resources needed for change investment including cash, human resources, and time Readiness Employees level of change awareness and readiness Power The power needed for initiating change Design or Implementing Choices (Balogun and Hailey, 2008) Change Path The types of changes can be categorized into 4 types of change base on nature and result of change which are Evolution, Adaptation, Revolution, and Reconstruction as shown below Change Start Point Change start point indicate where the change is initiated which can be divided as following Top-down change Change is initiated from top management Bottom-up change Change is initiated from bottom line Pockets of good practice Change is initiated by taking advantage of good practicing in individual part of organization as model for remaining parts Pilot sites Change is initially implementing in only one individual part of organization Change Style The way to manage process of change can be divided into 5 styles as following Education and Delegation Small group briefing and discussing of change applied to gain change support from employee Collaboration High employee involvement on decision of what and how to change Participation Limited employee involvement on decision of how to delivery desired change Direction Directing and controlling of change from change leader Coercion Imposing of change with authority Change Target There are 3 types of change targets which are outputs, behaviors, and values Change Levers The level of levers and intervention needed for organization change. The cultural web can be applied to indentify organization culture and current change barrier. From below of culture web, intervention into all components of culture web which are symbols, power structures, organizational structures, control systems, routines and rituals, and stories, is inevitable to develop change successfully. Cultural Web (Graham, Lecture session4 16 October 2009) Change Roles The roles of change agent can be categorized into 4 different roles as followings Change Champion Key leaders play vital roles in success of change External Facilitation External consultant has play important role to effect change in organization Change Action Team Change is lead by a group of people Functional Delegation A particular function is delegated to take responsibility on change Reference Balogun, J., and Hailey, V.H. (2008), Exploring Strategic Change, Pearson Education Limited, England Burnes, B. (2004), Emergent change and planned change competitors or allies?: The case of XYZ construction, International Journal of Operation Production Management, Vol. 24 No. 9, pp. 886-902 Change Management Learning Center (2009), Five tips for: Succeeding in change management, Change Management Learning Center, available at: https://www.change-management.com/tutorial-5-tips-cm-success.htm (accessed 19 November 2009) Chris, R. (2009), Working with Emergent Change in Organisations, available at: https://www.oikos-uk.com/docs_influences/Emergent%20Change%20print.pdf (accessed 20 November 2009) Dellana, S.A., and Hauser, R.D. (2000), Corporate Cultures Impact on a Strategic Approach to Quality, American Journal of Business, Vol. 15 No. 1, available at: https://www.bsu.edu/mcobwin/majb/?p=284 (accessed 20 November 2009) Govindarajan, V. (1988), A Contingency Approach to Strategy Implementation at the Business-Unit-Level: Integrating Administrative Mechanisms with Strategy, The Academy of Management Journal, Vol. 31 No. 4, pp. 828-853 Hailey, V.H., and Balogun, J. (2002), Devising Context Sensitive Approaches To Change: The Example of Glaxo Wellcome, Long Range Planning, Vol. 35 No. 2, pp. 153-178 Hayes, J. (2002), The Theory and Practice of Change Management, Palgrave, New York, N.Y. Hughes, M. (2006), Change Management: A critical perspective, Chartered Institute of Personnel and Development, London Johnson, G., Scholes, K., and Whittington, R. (2009), Fundamentals of Strategy, Pearson Education Limited, England Kanter, R.M. (1999), The Enduring Skills of Change Leaders, Leader To Leader Journal, No. 13, available at: https://www.leadertoleader.org/knowledgecenter/journal.aspx?ArticleID=50 (accessed 18 November 2009) Scheffler, C., (2000), Change Analysis at Central Linen Services, Grin, available at: https://www.grin.com/e-book/98822/change-analysis-at-central-linen-services (accessed 25 November 2009) SQA (2009), Management: Strategic Change, Scottish Qualification Authority, August, pp. 3-111, available at: https://www.sqa.org.uk/sqa/files_ccc/CB4559_Stategic_change.pdf (accessed 20 November 2009) Thornhill, A., Lewis, P., Millmore, M., and Saunders, M. (2000), A Human Resource Strategy Approach: Managing Change, Pearson Education Limited, England

The Classification Of Elements Of The Periodic Table

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A play set in the 1880s Essay Example For Students

A play set in the 1880s Essay By referring to Act One and Act Four of the play, show how the character of Will Mossop is developed by Harold Brighouse. You should consider the different techniques the playwright uses to show the changes in the character.  Hobsons choice is a play set in the 1880s, at this time society was split into classes. There was working class, middle class and upper class. The women were treated with the same respect as the working class. At the start of the play Will Mossop is working class and the Hobsons are middle class. The first act is set in the interior of Hobsons Boot shop in Chapel Street, Salford. Act Four is set in Hobsons living room, the same address as the boot shop. The main characters in the play are Henry Horatio Hobson who has three daughters, Maggie, Alice and Vickey. William Mossop is Hobsons boot hand. He doesnt seem to have any family as he lodges with Mrs Figgins and her daughter Ada, who Will is betrothed to. The play follows the Hobson/Mossop family through a very eventful year. In Act One Will is working in the basement of Hobsons shop, he is a very talented boot maker. Maggie Hobson recognises Wills potential and proposes marriage. After a lot of persuading and a beating from Hobson Will agreed it would be a good idea. The third act is a month later and they have got married and moved into a cellar in Oldfield Road, this is their business and home. Act Four is a year later and with the help of Maggie, Wills character changes significantly, he becomes more confident, assertive. Will also gets educated by Maggie as that wasnt something that the working class were able to afford. At the end of the play Will and Maggie move back to Chapel Street because Hobson develops chronic alcoholism also, Will becomes partners with Hobson on the condition that Hobson is a silent partner. My first impression of Will in Act One is that he is timid, this becomes apparent in his first appearance. Mrs Hepworth says Take that when handing him a visiting card, Will flinches expecting that to be a smack. It also becomes apparent that he is shy when he is talking to Maggie;Nay, Id be feared to go in them fine places   Will is intimidated by big shops in Manchester where there are lots of rich people, I think that he is scared that the people will look down their noses at him and the fact that he doesnt have a very good education. This could also show that he doesnt like change and has no ambitions, or he doesnt have the confidence on his own to do anything bold. Will has low self-belief, when Maggie questions whether he wants to leave he says; Ive been at Hobsons all my life and Im not leaving till Im made.  He is saying that he isnt going to leave Hobsons until he dies, this could be because of low self-confidence and he doesnt believe he could actually do it. On the other hand he could not want to be mocked for having plans and dreams.  Another impression of Will is that he is not very well educated (maybe illiterate) this is shown in all of his conversations in the first act, especially in his conversation with Mrs Hepworth. Will is trying to read the visiting card but cant because its such a funny print. Another sign is as he speaks he repeats phrases a lot, such as well, by gum. He has a poor vocabulary, when he does speak it is only to answer a direct question and even then he doesnt say much. .ufbcebb77a383e6a344374348f538af2f , .ufbcebb77a383e6a344374348f538af2f .postImageUrl , .ufbcebb77a383e6a344374348f538af2f .centered-text-area { min-height: 80px; position: relative; } .ufbcebb77a383e6a344374348f538af2f , .ufbcebb77a383e6a344374348f538af2f:hover , .ufbcebb77a383e6a344374348f538af2f:visited , .ufbcebb77a383e6a344374348f538af2f:active { border:0!important; } .ufbcebb77a383e6a344374348f538af2f .clearfix:after { content: ""; display: table; clear: both; } .ufbcebb77a383e6a344374348f538af2f { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ufbcebb77a383e6a344374348f538af2f:active , .ufbcebb77a383e6a344374348f538af2f:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ufbcebb77a383e6a344374348f538af2f .centered-text-area { width: 100%; position: relative ; } .ufbcebb77a383e6a344374348f538af2f .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ufbcebb77a383e6a344374348f538af2f .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ufbcebb77a383e6a344374348f538af2f .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ufbcebb77a383e6a344374348f538af2f:hover .ctaButton { background-color: #34495E!important; } .ufbcebb77a383e6a344374348f538af2f .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ufbcebb77a383e6a344374348f538af2f .ufbcebb77a383e6a344374348f538af2f-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ufbcebb77a383e6a344374348f538af2f:after { content: ""; display: block; clear: both; } READ: Two Gentlemen Of Verona monologue from the play by William Shakespeare EssayA good characteristic that Will possesses is honesty. He tells Maggie straight out that he doesnt love her and she doesnt love him;  when it comes to marrying, Im bound to tell you that Im none in love with you  I think that Will is honest to Maggie because he has respect for her, when he tells Maggie that the reason that he cant marry her is because he is betrothed to Ada Figgins is another example of what I think is Will being honest out of respect for Maggie. It is shown in his first appearance that he is an excellent boot maker but under appreciated, when Mrs Hepworth says;  The mans a treasure, and I expect you underpay him.  Everyone can see how talented Will is and that Hobson is taking advantage of him by paying him very low wages. Until the end of the first act Will is very easily intimidated and he is pushed around by just about everyone. At the end of the act Wills character changes, He is no longer shy and always holding his tongue. Hobson had been told about the marriage between Maggie and Will and Hobson believes that Will is to blame. Will doesnt think its fair that he is being blamed for something that is not his fault;  Im none wanting thy Maggie, it her thats after me, but Ill tell you this, Mr Hobson: If you touch me with that belt, Ill take her quick, aye, and stick to her like glue. Will feels that it is wrong for Hobson to be beating him, Will has a good sense of right and wrong. I think that he also feels that he hasnt encouraged it to happen, Maggie initiated the idea so why should he get punished? This is a good example of when Will is being unpredictable, he can stand up for himself despite what people think. He knows his place in society and doesnt want to cause any problems by stepping out of place, he is a yes sir, no sir kind of guy. In Act Four Will has become ambitious, educated and assertive. The most obvious change in his character is his growth in confidence, Will appears a lot more confident and doesnt need to be threatened with violence to stand up for himself. This is shown in the stage directions when Maggie and Will enter Hobsons living room;  Will enters. Maggie follows him. He is not aggressive, but he is prosperous and has self-confidence. Against Alice and Vickey he is consciously on his mettle  Maggie is following Will now, not the other way around. Even though he appears to be full of confidence, he is on guard when it comes to Alice and Vickey. Also he still seems to be leaning on Maggie a lot, he is, in my opinion, in constant need of reassurance.

Psi Report free essay sample

Duke has a confidential informant that knows Frank White who turned Duke on to Brown. The U. C. A. became friends with Brown to get him comfortable with letting Duke on the low down of Brown’s illegal activities. Duke told Brown that he knew a better connect for a cheaper price on crack cocaine, Brown ask Duke to set the meeting up Between the Connect and White because White handled the merchandise while Black Brown secures the money. On February, 2008, the U. C. A. (Duke) telephoned Black Brown and arranged for the purchase of 5 kilos of crack cocaine. Duke later traveled to the meeting location, at 539 seven mile, Detroit, Michigan, and advised the agents in charge of the case that the vehicle of connect man was at the residence. Moments later, Brown and White drove up to the home in a black Benz. Duke informed Black that he had the five kilos of crack cocaine but Duke would have to go get it from the connect man at the â€Å"trap. We will write a custom essay sample on Psi Report or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page † (The trap is a drug-dealing location used to avoid association with the drug dealers. ) The U. C. A. traveled to the trap, met with Connect man and purchased five kilos of crack cocaine for $100,000 in cash Brown then called the U. C. A. to report that the 1/4 that remained of the transaction would arrive at the location shortly to buy crack cocaine from U. C. A. for $1,575. During a telephone call with Brown, Duke was told that the â€Å"mail box† 1/4 of crack would be ready shortly. Duke then told Brown to meet him â€Å"up top,† which was a code for Connect man’s â€Å"trap† on seven mile in Detroit. Duke and Brown later met at the location on seven mile and transacted the 1/4 crack cocaine that was the other part of the original deal on 5 kilos purchase and sale of cocaine. The crack cocaine retrieved weighed 1/4 grams. The agents later retrieved the crack cocaine, which weighed 5 kilos. On March 14, 2008, the U. C. A. arranged to consummate another transaction which turned out to be the due date of the drug bust on Black Brown and Frank White. There were over 500,000 retrieved from the home of Black Brown. There was also the five kilos the D. E. A. got (which was the connect man) from subjects. When agents bust in the home the two men did not resist arrest. Black Brown home was furnished with expensive merchandise, along with two bedrooms full of brand new shoes, clothes, jewelry. Victim Impact There are no victims in this offence. Adjustment for Observation of Justice The defendant did not attempt to flee prior to his arrest. The probation officer has no other information to suggest that the defendant did not obstruction justice. Adjustment for Acceptance of Responsibility The defendant did not attempt to flee when arrested. The probation officer has no information to suggest that the defendant did adjust accepting his responsibility. Offense Level Computation The 2008 edition of the Guidelines Manual has been used in this case. Base offense Level The guidelines of a 39

Role of Women in the Odyssey free essay sample

These ones can be seen as women in power because they use these tools in order to control men. Mothers portrayed in this epic poem are seen as the givers of â€Å"pity and sorrow† rather than true supporters of their sons and husbands when in war. In most cases, these are women who need to be guided and supported by males, whether it be a son or a husband. An example of this would be when Telemachus ordered Penelope from the room, in order to show the suitors of his intention to claim to his father’s throne. Another example would be Anticlea, Odysseus’ mother. She committed suicide because she missed Odysseus and believed he was dead. Mothers need to look after, nurture, and protect their sons and husbands. I’d say Penelope is the most complex woman I have ever read about. She is both a mother and sometimes a seductress. We will write a custom essay sample on Role of Women in the Odyssey or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page She leads the suitors on and makes them wait. She is not ready to marry again. â€Å"It is your mother’s fault not ours, for she is a very artful woman. This three years past, and close on four, she has been driving us out of our minds, by encouraging each one of us, and sending him messages without meaning one word of what she says† (Book II). Penelope mourns her lost love, and at first is completely oblivious to the attention from the suitors. She reminds me of a Siren, (seen in book 11) always singing to encourage men but not intending to fulfill any promise of love or sex. Penelope is the perfect example of a woman in the novel that is a mother, and sometimes a seductress. During the absence of her son Telemachus, she begins singing about the deadly battles where she assumes Odysseus has perished and falls to weeping. When Telemachus returns, he knocks some sense into Penelope. Odysseus is not the only man who never came back from Troy, but many another went down as well as he. Go, then, within the house and busy yourself with your daily duties, your loom, your distaff, and the ordering of your servants; for speech is man’s matter, and mine above all others- for it is I who am master here† (Book 1). The sirens and Circe are the ultimate seductresses in the epic poem. Circe turns Odysseus’ men into pi gs and tells him she will change them back only if he goes into bed with her. Odysseus does not realize that he stays in bed with her for about a year or so. Sirens sing to men at sea and make them fall in love with them and then eat them. These are great examples of seductresses. However, I believe Clytemnestra is another good example. She is Agamemnon’s wife and during his absence, suitors too surround her. Clytemnestra also went through a deep mourning and shows that women who are mothers and are devoted to their husbands, sons, and family, are prone to look for other men, in their absence. Clytemnestra falls in love with Aegisthus and they plot to kill Agamemnon when he returns. At first she would have nothing to do with his wicked scheme, for she was of a good natural disposition; moreover there was a bard with her, to whom Agamemnon had given strict orders on setting out for Troy, that he was to keep guard over his wife† (Book 3) but he was gone too long and she fell in love with someone else. In â€Å"The Odyssey† by Homer, Homer really describes women as people who are weak and fragile. He depicts women to be p rone to find another male figure in their absence (a long absence). Women in this story need men in order to feel like they are fulfilling their destiny by looking after, nurturing, and protecting their sons and/or husbands. Penelope and Circe are good examples of women in power in â€Å"The Odyssey† because Penelope uses her mother figure to in a way control Telemachus and uses seduction to control the suitors and keep them in the palace and Circe tells Odysseus she will change his men back to humans IF and only IF he goes to bed with her. I think women really do play a large role in â€Å"The Odyssey. †

Status of Qualitative Research in Early Childhood Education and Development (Eced) Essay Example

Status of Qualitative Research in Early Childhood Education and Development (Eced) Essay Example Status of Qualitative Research in Early Childhood Education and Development (Eced) Essay Status of Qualitative Research in Early Childhood Education and Development (Eced) Essay The field of human development has recently gained considerable importance globally. This results in shifting the contemporary educational discourse, one that moves ECED closer to the front of policy formation. Literature shows that developed nations are investing enormous resources into their early intervention programs, hence, during the last decade international aid agencies, and some education systems, have promoted the creation and expansion of ECED programs in developing nations too. With the innovations in ECED, there has been conducted a large number of researches to form an objective theoretical foundation (Penn, 2004) to support this advancement. Following passage presents the literature review on the status of qualitative research in the field of ECED. The reviewed articles were published in 3 international journals, Early Years, Early Education and Development and Early Childhood Education Journal during 2005-2010. The first two journals are published by Rutledge and the last one is published by Springer. The starting point for the literature review was library data base of IED, which permitted access to full text articles. Large no of qualitative studies were found in each journal however, for the present review, only 25 of them were selected on the basis of different research traditions within qualitative paradigm. 15 of them are reviewed for the present task and bibliography of the remaining articles is attached with this paper. The review of the selected research articles is presented in the perspective of trend seen in the topic addressed, methodology used and other critical findings. Present review of literature reveals that during year 2005- 2010 a variety of topics related to ECED have been addressed in the qualitative research paradigm. For the purpose of this review the topics are divided into different themes based on their focus. Stakeholders’ perceptions of early childhood setting are explored in various studies. For example, children perception of their ECED and their transition to formal schools are presented in (Linklater. 006), perceptions of parents regarding their choices of early years education for their children are discussed in (Ceglowski, Shears Furman, 2010), similarly, Rentzou Ziganitidou, (2009) in their study focused on experiences of ECED teachers, moreover, their own and societal perceptions regarding teaching in early years classrooms were also explored. Additionally, teaching and learning processes of early years were studied by (Ahn Filipenko, 2007, Chana, Juana Foon, 2008 Smith 2010). Moreover, Lives and Professional Development of early years teachers were also addressed by various studies, like, Blank (2009) studied teachers’ lives and experiences in ECED center and Brown (2009) explored the Professional development of ECE teachers in relation to engagement of parents in ECED centers. Early Years Curriculum framework and related topics were also addressed in studies like Goldstein (2008) and Squibb (2010). Addition to the topics addressed, this literature review also analyzed the methodological trends within the qualitative research paradigm. Case study method was found to be the dominated tradition in this review of research articles. 10 out of 15 reviewed studies were conducted as case studies. (Blank, 2009; Brown, Knoche, Edwards Sheridan, 2009; Ceglowski, Shears Furman, 2010; Chana, Juana Foon, 2008; Goldstein, 2008; Ranz-Smith, 2007; Saracho, 2008; Shield, 2009; Quintero, 2010 Squibb, 2010). As compare to high number of case studies only 2 were conducted as ethnographical studies (Linklater, 2006 Trawick-Smith, 2010), similarly, Ahn Filipenko (2007) and Garavuso (2006) were phenomenological studies. Moreover, some writers haven’t given their sampling procedure explicitly, however, majority of studies have used purposive sampling based on the purpose of their studies ( Ahn Filipenko, 2007; Garavuso, 2006 Linklater, 2006). Throughout the review it was found that within the qualitative approach to triangulate the data multiple strategies were used. Among multiple methods of data collection observation and semi-structured interviews remained the dominant strategies; however, some of the researchers have also analyzed related documents and artifacts. In some studies anecdotal notes and reflective journals are also used to get more comprehensive data. Addition to these, in the phenomenological and ethnographic studies participant observations were used as compare to the case studies where the researcher took the role of non-participant observer (Maxwell, 1997). Moreover, in majority of the studies interviews and discussions were audio taped and observations were videotaped. After the transcription of the data in some of the studies, data was rechecked by the esearch participants, which, is important to maintain reliability and validity of the collected data (Robson, 2002). Addition to this, ethical considerations like, maintaining the confidentiality of the research participants, prior permission for interviews, respecting participants’ autonomy were taken into consideration throughout the studies; however, none of the writer could describe their ethical framework in more detail, probably due to the word limits. Another very critical trend was found between the backgrounds of the researchers. All 0f the qualitative researches were being conducted by the people related to the field of ECED, however, only 1 of the studies were conducted by the ECED practitioner who teaches in the ECED classroom (Linklater, 2006). Most of the researchers are working as a faculty of education departments in various universities (Ahn Filipenko 2007, Chana, Juana Foon 2008, Goldstein 2008, Blank 2009, Brown 2009, Shields 2009, Trimis Sava 2009, Ceglowski, Shears Furman, 2010 Smith 2010 Squibb 2010) who no doubt have extensive experience in working in the field of ECED, but, one can argue that how much implications these studies carried out by someone from university would carry to the real classroom contexts where the ECED practitioners are making efforts to make difference in the lives of the young children. Additionally, literature review also revealed that all most all of the qualitative researches were conducted in western contexts. This exploration has serious implications for the ECED practitioners and the education systems in developing countries particularly Pakistan who is novice in the field and need to be acquainted with research based knowledge in order to strive in the field. In conclusion, the present literature review revealed informative findings regarding status of qualitative research in the field of ECED during the past 5 years in the selected journals. Case study being the well-established research strategy (Robson, 2002) was found to be dominant research tradition, hence, this also implies that qualitative researchers need to use other traditions of qualitative research particularly life histories and grounded theories in order to present more holistic picture of ECED and its important factors. ?

Iranian revolution Essay Example | Topics and Well Written Essays - 250 words

Iranian revolution - Essay Example The 1941 deposition of Reza Shah by the British and the United States and their subsequent involvements in the affairs of Iran, including the forceful inculcation of the western values and the slow eradication of Islamic fundamentals [such as the veiling of women] culminating into a coup d’Ã ©tat that ousted the democratically elected, anti-west Mohammad Mossadegh in 1953, laid a strong foundation towards a deterministic end (Mackey 184). A strong critic of Shah’s association with the west and the continued mismanagement of the country’s resources, Ayatollah Khomeini rose to prominence into 1963 with his brainchild opposition of the Shah’s White Revolution; a perceived westernization process aimed at complete eradication of Islamic values suspended by the Sharia laws in Iran. As Robin Wright rightly points out, the Iranian revolution was shaped by Khomeini’s "guardianship" principles summed up in Velayat-e faqih [Islamic Government] as an ideology (29-31). With the guardianship influence from the diaspora, Shah faced constant pressure under his very nose. The Freedom Movement of Iran, The Constitutionalist Liberals, the National Front and the more radical groups such as the People’s Mujahedin, Tudeh Party of Iran and the Fedaian guerillas all had a restorative mission of overthrowing Shah’s regime and instituting sound governance guided by Islamic ideals (Graham 71-74). Setting the stage for a final push for a change were a number of anti-public events championed by the Shah’s government in the seventies. The plundering of oil benefits into extravagance by the government as the gap between the haves and the have-nots widened; increased accumulation of oil benefits in particular; and the mutilation of the Iranian solar calendar had profound impact on the 1979 revolution (Graham

The Concept of Ethical Obligations Case Study Example | Topics and Well Written Essays - 1000 words

The Concept of Ethical Obligations - Case Study Example Bush. He is considered to have an exemplary public administration and leadership skills that had been both his strengths and his weaknesses (White, 2008, p. 420). Tenet’s career can be considered unprecedented due to his achievements but there are challenges and dilemmas he had to face when he became the director of Central Intelligence (DCI). There are factors then considered to be the main reasons why in the end his efforts failed. These factors also caused ethical dilemmas on his part. The first dilemma is setting his leadership priorities and holding a highly multitasking position as DCI. Due to the fact that a DCI holds numerous roles, he had to answer to different groups and stake holders. The DCI’s role includes manager of CIA, president’s principal intelligence advisor, and the head of the entire intelligence community of 15 agencies. Tenet’s job is highly complex that even an expert would find it very challenging (White, 2008, p. 421). In his case though, the role is difficult because he is considered as an outsider in the institution. Tenet’s leadership can be considered handicapped due to his lack of experience in different expertise required in the role because â€Å"he had never run for political office, managed a large organization, worked as an intelligence officer, shaped American foreign policy, earned academic credentials by authoring a scholarly publication, or served in the military† (quoted White, 2008, p. 421). His perspective is different from the perspectives of the DIC before him which resulted to a more diplomatic type of leadership. The second dilemma he had to face is related to the prioritization of his ethical concerns. Due to the numerous agencies and institutions with different missions, visions and priorities he has to answer to such as the decision making process in White House, CIA’s intelligence priorities and his own conscience. At different points in

Ethical Business Desicion Essay Example | Topics and Well Written Essays - 750 words

Ethical Business Desicion - Essay Example At other instances it might be a more complex issue that requires a lot of struggle and hard work before coming to a conclusion and making the right choice. Deciding what is "right" is most of the time not all that easy. Ethical decision-making may be elaborated further by the use of a real-world example of a 45-year-old lady named Sheila (Susca, 2006). Sheila is a dedicated and hardworking head of the human resource department of a large company. And just like any other leader, she too was faced with an ethical dilemma in the working environment. A few years back, her company considered hiring a former member of staff. This particular employee had in the past schemed against Sheila and had given her severe pain and suffering. She chose to remain quiet back then and had moved on as he left the company. According to his resume, he was fit for the position and had a number of good qualities and skills needed for expanding the business and the company. Now it was up to Sheila to decide what decision is in the best interest of everyone in the company and herself. Utilitarianism is the act of maximizing utility or happiness of all the concerned people. Act utilitarianism considers the maximum happiness to a maximum number of people. Rule utilitarianism however states that according to the rules, an action that brings about the greatest utility should be taken. The rule utilitarian abides by the truth. (Prevos, 2004) According to act utilitarian, that act... (Prevos, 2004) 3. A persuasive argument based on the theories and fact in the scenario. Sheila may ask herself a question: "Is this a good person to hire" According to the rule utilitarian, the honest answer according to Sheila would be "No". According to act utilitarian, that action must be taken which brings about maximum utility to maximum people. In this case, a "yes" to that question would be a good choice for Sheila as this is in the best interest of the company. Sheila is challenged with this situation. Based on the theories just mentioned, hiring back the former employee would be a good choice according to the act utilitarian theory. This would bring about fruitful results in the future. Sheila must consider the potential benefits that may occur, as she has been trusted with the responsibility of hiring good prospects. Considering otherwise, employees of her company might lose faith in her, which ultimately would result in a breakdown of her confidence. All consequences, therefore, must be evaluated carefully before making an ethical business decision. REFERENCES 1. Debra Susca. (2006). Making Ethical Business Decisions. The Journal of Connecticut Business and Industry Association, Vol. 84, No. 6 2. Peter Prevos. (2004). Rule and Act Utilitarianism. Ethics. Monash University,

Investigation of Thyroid Emergencies

Investigation of Thyroid Emergencies Unit 1 Thyroid Emergencies Authors: Dr. Khalid Khatib Dr. Subhal Dixit 1.0 Objectives After reading this unit, you will be able to: Enumerate thyroid diseases which will land the patient in the intensive care unit; Describe the clinical features, investigation and treatment of throid storm; Describe the clinical features, investigation and treatment of hypothyroid coma; and Describe the clinical features, investigation and treatment of obstructive symptoms due to goiter. 1.1 Introduction Thyroid emergencies comprise a miniscule fraction of patients with thyroid dysfunction, who land up hospitalized in the intensive care unit (ICU) as a consequence of their abnormal thyroid physiology or anatomy. As these conditions are infrequently encountered in the ICU, a proper understanding of the hormonal pathophysiology and varied clinical features will lead to appropriate and timely institution of hormonal and supportive treatment, ultimately rendering survival benefit to the patient. The following conditions constitute thyroid emergencies: i) thyroid storm, ii) hypothyroid coma, and iii) massive goiter causing compression of the airways and large blood vessels. 1.2 Thyroid Storm It is also known as thyroid crisis or thyrotoxic crisis and is an extreme physiological condition due to thyroid hormone excess. A very severe, life threatening and decompensated form of thyrotoxicosis, it is rare (seen in 1-2% of patients admitted for thyrotoxicosis); but mortality rates approach 10-20%. Thyroid storm may be seen even in patients who have not been diagnosed with hyperthyroidism. The male to female ratio is 1:3. Causes: i) Grave’s disease, Ã ¬i) Toxic multinodular goiter, iii) Solitary nodular goitre iv) Subacute thyroiditis v) Postpartum thyroiditis, vi) Thyrotoxicosis factitia, vii) Metastatic thyroid malignancy. Whatever the etiology of hyperthyroidism, its conversion to thyroid storm requires the addition of precipitating factors. Precipitating factors: i) Infection, ii) Trauma, iii) Surgery- of the thyroid gland or non-thyroidal, iv)Acute myocardial infarction or Acute coronary syndrome, v) Pregnancy, labor, complicated delivery vi) Burns vii) Medical illnesses- congestive heart failure, diabetic ketoacidosis, cerebrovascular accident, pulmonary thromboembolism, sepsis, viii) Stress- emotional ix) Abrupt interruption of thyroid drug therapy, x) Administration of iodine compounds or radioiodine (I131 or I123 ), xi) Others- chemotherapy for leukemia, radiation therapy to neck malignancies, aspirin overdose, organophosphate poisoning, exercise, status epilepticus and drugs (tyrosine kinase inhibitors, lithium, biological agents like interleukin 2 and interferon). Clinical features: i) Central Nervous System- apathy, agitation, delirium, confusion, paranoia, and coma. ii) Cardiovascular System- congestive heart failure, tachyarrhythmia (atrial fibrillation, supraventricular tachycardia, ventricular tachycardia and ventricular fibrillation,) sinus tachycardia, dilated cardiomyopathy, high cardiac output state, and pulmonary hypertension. iii) Gastrointestinal tract- vomiting, diarrhoea, jaundice, diffuse abdominal pain occasionally presenting as acute abdomen. iv) Respiratory system- dyspnea, tachypnea and acute respiratory failure. v) Thermoregulation- fever, hyperthermia and diaphoresis. vi) Nutrition- weight loss. vii) Renal- proteinuria, acute renal failure.viii) Electrolyte disturbances- hypercalcemia, ketoacidosis, lactic acidosis. viii) Hematology- leucocytosis, hypercoagulable state leading to thromboembolism. Some elderly patients may have very few signs of hyperthyroidism and present with stupor, apathy, coma, and congestive heart failure (apathetic thyroid storm). Diagnosis: i) It usually needs to be based on clinical judgment and treatment started even before laboratory results are available. A semiquantative scale developed by Burch and Wartofsky can be used to definitively identify patients with thyroid storm. ii) Thyroid function tests(TFT): TFTs reveal increase in free T3 and free T4 while TSH will be very low (even undetectable). iii) Other laboratory investigations: Serum bilirubin, transaminases, blood glucose levels may be increased while potassium and total cholesterol may be decreased. Treatment: Principles of treatment: i) Treat the hyperthyroid state. ii) Prevent the effects of circulating T3 and T4. iii) Treat the multiorgan dysfunction. iv) Treat the precipitating cause. i) Treat the hyperthyroid state: 1) Prevent new thyroid hormone synthesis (Thionamides) 2) Prevent new thyroid hormone release (Thionamides) 3) Prevent conversion of circulating T4 to T3 ( steroids, lithium, high dose iodine and iodinated contrast medium) Thionamides: Propylthiouracil, Carbimazole, Methimazole are used in the treatment of hyperthyroid state. Propylthiouracil (PTU): a) Dose: Loading dose- 500-1000 mg followed by a maintenance dose of 250 mg every 4-6 hours. b) It additionally prevents peripheral conversion of T4 to T3. c) It is given either orally (if patient is conscious and able to swallow) or through the nasogastric tube or rectally. d) Onset of action is rapid. e) PTU has potential for hepatotoxicity. f) Hence it is preferred now only in pregnancy, where other thionamides cannot be used. Methimazole or Carbimazole: a) Dose: 20-30 mg every 4-6 hours may even go up to 60-80 mg every 4-6 hours. b) They are preferred over PTU unless the patient is pregnant. c) They can be given orally, through the nasogastric tube, rectally, or even intravenously. Steroids: a) Hydrocortisone is used in the dose of 100 mg intravenously or intramuscularly every 6 hours and continued till the condition of the patient improves completely. b) If Dexamethasone is used, the dose is 2 mg intravenously every 6 hours. c) Doses of both the drugs need to be tapered appropriately before they are stopped. Lithium: a) Dose: 1200 mg per day in 3-4 divided doses. b) Lithium is used if thionamides are contraindicated and patient is allergic to iodine. c) Serum lithium levels are monitored to prevent toxicity. High dose Iodine: a) Lugol’s iodine or potassium iodide solution is used. b) Dose: 0.3 ml or 10 drops of Lugol’s iodine diluted to 50 ml every 8 hours, orally or through the nasogastric tube. c) Its action is due to the Wolff-Chaikoff effect leading to the suppression of thyroid hormone release and peripheral conversion of T4 to T3. d) It should be administered at least one hour after administration of thionamide drugs. e) Sodium iodide may be used intravenously (dose- 500-1000 mg), but it is not easily available as a sterile solution. Iodinated contrast solution: 0.5-1 gm every 12 hours. Cholestyramine at a dose of 4gm, 2-4 times a day orally, reduces enterohepatic circulation of thyroid hormones. In refractory cases, plasma exchange, peritoneal dialysis or hemofiltration may be used to reduce the circulating thyroid hormones. ii) Prevent the effects of circulating T3 and T4: Beta blockers: 1) They block the hyperadrenergic effects of the excessive thyroid hormones. 2) They can be used if there are no contraindications to their use (history of asthma, COPD or congestive heart failure). 3) They must be used with continous cardiac monitoring. 4) Propranolol is used most commonly at the dose of 60-80 mg, three times a day, orally or through the nasogastric tube. It may also be used intravenously at the dose of 10 mg; at the rate of 0.5-1 mg per minute till heart rate is less than 100 per minute and then continued orally as above. 5) If propranol is contraindicated, cardioselective betablockers (metoprolol, atenolol), calcium channel blockers or digoxin may be used. 6) Esmolol, an ultra short acting beta blocker, is preferred by some, as an intravenous infusion of 50-100 mcg/kg/min with a loading dose of 250-500 mcg/kg. iii) Treat the multiorgan dysfunction: 1) Manage the patient in intensive care unit. 2) Take care of ABC (airway, breathing, and circulation). 3) Respiratory support with oxygen therapy or mechanical ventilation (noninvasive or invasive) as required. 4) Resuscitation and hemodynamic support- Intravenous infusions to correct fluid and electrolyte disturbances. 5) Antipyretics- cooling mattresses and cold sponging are used along with paracetamol to reduce the raised temperature. Salicylates are avoided as they reduce thyroid hormone binding to thyroglobulin and may in fact worsen thyroid storm. 6) Treat hypertension. 7) Treat delirium and agitation by sedation with haloperidol and benzodiazepines. 8) Provide nutritional support with adequate dextrose infusions and vitamin (especially thiamine) supplementation. 9) Treat the tachyarrythmias with antiarrythmic drugs if patient is hemo- dynamically stable or by electrical cardioversion if unstable. Treat congestive heart failure with diuretics and ACE inhibitors. iv) Treat the precipitating cause: 1) Search and treat the focus of infection. 2) Use broad spectrum antibiotics on empiric basis as appropriate. 3) Send urine and blood cultures. 4) Treat trauma, diabetic ketoacidosis, myocardial infarction and other precipitating factors as per usual principles. Once thyroid storm has been treated the hyperthyroid state should be treated definitively with antithyroid drugs, radioiodine or thyroidectomy. 1.3 Hypothyroid coma It is also known as myxedema coma or myxedematous coma and is due to very severe, untreated hypothyroidism manifesting with reduced temperature and altered mental status. It is an emergency to be treated in an ICU and has high mortality, but fortunately it is rare. Typically the patient is an elderly female with history of hypothyroidism with or without adequate treatment, who may have stopped treatment, or may have suffered an intercurrent stressful situation (infection). Occasionally coma may be the first presentation of hypothyroidism. Rarely hypothyroid coma may be seen in young females, some of whom may be pregnant. Precipitating factors: i) Burns, ii) Trauma, iii) Surgery, iv) Severe infection- pulmonary or urinary tract infection, sepsis, v) Low ambient temperature, vi) Cardiac diseases- myocardial infarction, congestive heart failure, vii) Cerebrovascular accident viii) Labour, ix) Anesthesia x) Drugs- neuroleptics, sedatives (benzodiazepines), xi) Intake of large amounts of liquids, xii) Seizures, xiii) Gastrointestinal bleeding. Some of the common causes of hypothyroidism are: i) Chronic autoimmune thyroiditis, ii) Thyroidectomy (total or partial), iii) Graves disease treated with radioiodine, iv) Secondary hypothyroidism- hypopituitarism, v) Drugs- amiodarone, lithium. Clinical features: i) Hypothermia- is usually severe with temperature approximately 26.70C (800F). Rarely, temperature may even reach 210C. In some cases, temperature may be normal in the presence of infection. ii) Altered mental status- may present as disorientation, depression, paranoia, hallucination, cerebellar signs, amnesia, disturbed memory, abnormal EEG findings, seizures, status epilepticus, stupor, obtundation or coma. iii) Cardiovascular system- abnormalities present as bradycardia, prolonged QT interval, varying degrees of AV block, ventricular arrhythmias (torsades de pointes), pericardial effusion, reduced cardiac output or shock. iv) Respiratory system- disturbances present as hypoventilation and hypercarbia or respiratory failure requiring mechanical ventilation. v) Renal and electrolyte disturbances- manifests as hyponatremia, edema, retention of urine or rarely renal failure. vi) Gastrointestinal- manifestations are constipation, paralytic ileus, ascites, gastropare sis, and gastrointestinal bleeding. vii) Hematological- problems are coagulopathy due to vonWillebrand syndrome and reduction of coagulation factors, DIC (disseminated intravascular coagulation), granulocytopenia and microcytic or macrocytic anemia. viii) General- manifestations of hypothyroidism like macroglossia, ptosis, generalized skin swelling or cool dry skin, periorbital edema, obesity and depressed deep tendon reflexes. Diagnosis: i) It should be suspected clinically. ii) TSH is raised in most cases. It may rarely be normal in pituitary causes of hypothyroidism. Severe systemic illness and drugs (inotropes, steroids) used to treat the associated systemic illness will cause blunting of the TSH elevation. iii) T3 and T4 levels are low. iv) Hyponatremia, hypoglycemia, hypoxia, respiratory acidosis, hypercapnia, hypercholesterolemia and elevated LDH and serum creatinine kinase levels may be present. Treatment: Principles of treatment: i) Thyroid hormone supplementation. ii) Steroids. iii) Correction of fluid and electrolyte disturbances. iv) Treatment of precipitating cause. i) Thyroid hormone supplementation: a) Supplementation with L-thyroxine with or without addition of liothyronine. b) Therapy is preferably intravenous. c) There is no consensus on the best therapeutic regime. d) Dose of L-thyroxine- High dose (300-400mcg on day 1 and then 50-100 mcg/day on subsequent days) is preferred by some. Though tolerated by young patients, it may cause sudden cardiac death in the elderly. Hence a lower dose is preferred (100mcg on day 1 and then 50-100mcg on subsequent days). e) Liothyronine- at a dose of 10-25 mcg (bolus), intravenously and then 10 mcg intravenously every 4 hours for the first 24 hours and every 6 hours over the next 48 hours and then oral therapy with L-thyroxine (50-100 mcg daily), as feasible. Initial therapy with liothyronine may be preferred, as it has better bioavailability and peripheral conversion of T4 to T3 is impaired in hypothyroid coma. Care should be taken during liothyronine therapy as excess T3 may increase mortality. f) Combi ned T4+T3 approach: to avoid above complications, a combined approach with L-thyroxine and liothyronine is advised as shown in Table no. 1. Table No. 1 Combined L-thyroxine and liothyronine therapy ii) Steroids: a) Hydrocortisone at a dose of 50-100 mg intravenously every 6 hours, is preferred. b) It is required to treat the associated adrenal insufficiency. iii) Correction of associated fluid, electrolyte and other disturbances: a) Maintain airway and provide mechanical ventilation if necessary. b) Hyponatremia- is a frequent occurrence and needs correction by restricting water intake or by intravenous infusion of isotonic saline (if serum sodium is less than 120). If hyponatremia is more severe, infusion of 3% NS is used very carefully. Occasionally, Conivaptan may be used in patients with euvolemic or hypervolemic hyponatremia. c) Hypothermia- is treated with passive and gradual heating with blankets and air warmers. iv) Treatment of precipitating cause: a) Appropriate antibiotics (broad- spectrum) are started for bacterial infections. b) Diuretics are used to treat volume overload and pulmonary edema. c) Intravenous glucose is used in the presence of hypoglycemia d) Inotropes are used if shock is present while digoxin is used with care for congestive heart failure. 1.4 Airway and vascular obstruction due to goitre Gross enlargement of the thyroid gland, especially substernal and intrathoracic extension, causes compression of the airway and the great vessels at the thoracic inlet. Sometimes massive hemorrhage inside a thyroid nodule, malignant thyroid disease, metastasis to thyroid gland and Reiter’s thyroiditis may cause compressive symptoms. Symptoms and signs: i) Dyspnea- usually chronic with acute or subacute exacerbations, ii) Stridor, dysphonia, iii) Dysphagia, choking, iv) Fullness and pressure in neck, v) Superior vena cava syndrome- causing facial edema, cyanosis and venous engorgement of face and arms, vi) Esophageal varices, vii) Phrenic or laryngeal nerve paralysis, viii) Horner’s syndrome, ix) Chylothorax, and x) Sleep apnea. Treatment: a) Continous positive airway pressure (CPAP) application or intubation and mechanical ventilation for maintaining patency of the airways and to treat respiratory distress. b) In a few cases where intubation is not possible, emergency tracheostomy may be required. c) Surgery to relieve the obstruction in the form of thyroidectomy and associated sternotomy, if required. d) Radioiodine and percutaneous laser ablation may be preferred in some patients. 1.5 Let us sum it up Thyroid storm occurs in hyperthyroid patients in the presence of precipitating circumstances leading to a hyperadrenergic condition which is fatal unless treated with care. It is treated with thionamides, beta blockers and correction of abnormal organ function. Hypothyroid coma usually presents in the winter months, in elderly females, in the presence of a precipitating cause. The patient has profound hypothermia and altered mental status or coma. It is treated with supplementation of thyroid hormones and treatment of the associated multiorgan dysfunction. Obstruction of the airway and blood vessels in the neck by an enlarged thyroid gland is very rare.

Painting Interpretation :: essays research papers

Recently at the San Diego Museum of photographic arts in balboa park, there was an exhibition of Steve McCurry’s, the national geographic photographer who took the famous picture â€Å"Afghan Girl†, on his photo tour of Asia. It chronicled in splendid detail everything from India, and the most holy places in the Sikh religion, to Tibet and to the traditions inherent in the daily lives Afghani bakers. The titles and the explanatory text blobs dotting the walls told a story of deep spiritualism and introspection in the name of religion. The pieces all reflected on different religions but the theme remained and painted Asia as a place full of devout individuals who have found purpose in their respective theologies. Among these images of brooding eyes, silent prayer and reflection fell a comical image. It showed a young Uzbekistani boy holding a cigarette to the mouth of a statue; the statue of a Buddhist spiritual guru.   Ã‚  Ã‚  Ã‚  Ã‚  The image was funny. A burning Marlboro at the smiling stone lips of a 700 year old priest was funny. But the question I posed was why. If humor is the human reaction to the uncomfortable, the awkward or the indecent, what about this image made my friend and I laugh. The answer lied in its comparison. It juxtaposed a devout spiritualism with commercialization and addiction. Both things thought to be in stark contrast with the enlightenment that is supposed to be revealed to all sons and daughters of religion and especially the followers of Buddha. This image struck a chord with me, even though I am not religious, and have taken resentment to the current upswing in the inquisition like militancy that is now a part of the Christian faith in America, I have grown up in a religious society, a Christian society. My morals are based on Christian interpretations of right and wrong fore we both live in a country founded on such beliefs, and are now immersed in them. This image of comparison stuck with me because, our society is full of such paradoxical situations. Christian doctrine dictates the negative outcomes of addiction, and guffaws at commercialism as an offshoot of materialism and greed, which is a mortal sin. But despite these things the world and America in particular are in a struggle hold with people’s desire for material wealth on one side and the planet’s well being and the world’s religious quest for balance in all life on the other.

Organizational Behaviour Essay

Part A consists of three questions. Be sure to include both the questions and the responses in the document you submit. Your total combined responses for these three questions should not exceed 1000 to 1500 words. 1. Marketing specialists at Napanee Beer Co. developed a new advertising campaign for summer sales. The ads were particularly aimed at sports events where Napanee Beer sold kegs of beer on tap. The marketing group worked for months with a top advertising firm on the campaign. Their effort was successful in terms of significantly higher demand for Napanee Beer’s keg beer at sports stadiums. However, the production department had not been notified of the marketing campaign and was not prepared for the increased demand. The company was forced to buy empty kegs at a premium price. It also had to brew some of the lower priced keg beer in vats that would have been used for higher priced specialty beer. The result was that Napanee Beer sold more of the lower priced keg beer and less of the higher priced products that summer. Moreover, the company could not initially fill consumer demand for the keg beer, resulting in customer dissatisfaction. Use open systems theory to explain what occurred at Napanee Beer Co. Begin with a brief description of open systems theory. Use your own words (paraphrase) and remember to cite all sources using APA style. The open systems theory states that organizations are entities that continually exchange resources with its external environment. The organization is dependent on the external environment for resources such as raw materials, employees, financial resources, and information and equipment which are the organizations inputs. Those inputs are used by the organizations internal subsystems, such as production and marketing, and are subsequently turned into outputs such as products, services, employee behaviours, profits/ losses, and waste/ pollution (McShane & Steen, 2009, p. 4). According to the open systems theory (McShane & Steen, 2009, p. 4), the organization Napanee Beer Company’s internal subsystems were not operating efficiently. Due to the lack of communication between the marketing group and the production team, production was unaware of the increase in demand for the product and did not order enough inputs to meet this larger demand. Consequently, the materials used were much more expensive than they would have been had they been ordered earlier. This oversight cost the company sales on higher priced specialty beer and caused customer dissatisfaction. Had the production team been aware of the success of the marketing campaign, which was geared towards sporting events where Napanee Beer sold kegs of beer on tap, they would have been able to order the appropriate amount of kegs, saving the company a lot of money. This is not an issue between the external and internal environment but an issue with Napanee’s internal subsystems effectiveness (McShane & Steen, 2009, p. 4.). The lack of communication between departments weakened the company’s ability to maximize its input to output capability; therefore, the company was not functioning at a high level of efficiency (McShane & Steen, 2009, p. 5.). 2. The sales office of a large industrial products wholesale company has an increasing problem: salespeople are arriving late at the office each morning. Some sales reps go directly to visit clients rather than showing up at the office as required by company policy. Others arrive several minutes after their appointed start time. The vice-president of sales doesn’t want to introduce time clocks, but this may be necessary if the lateness problem isn’t corrected. Using the MARS model of individual behaviour, diagnose the possible reasons salespeople may be engaging in this â€Å"lateness† behaviour. Begin with a brief description of the MARS model. Use your own words (paraphrase) and remember to cite all sources using APA style. The MARS model represents the four factors that influence people’s behaviour and performance. These factors are motivation, ability, role perceptions, and situational factors (McShane & Steen, 2009, p. 26). Motivation is what drives a person in a particular direction and the passion and persistence in which they pursue something (McShane & Steen, 2009, p. 26). The ability of an employee refers to their natural aptitudes as well as their acquired capabilities (McShane & Steen, 2009, p. 27). An employee’s competencies refer to his or her skills, knowledge and other characteristics that may be beneficial to the organization (McShane & Steen, 2009, p. 27). Role perception is the third factor in the MARS model. This refers to how closely the employee’s perception of their job duties aligns with the employer’s (McShane & Steen, 2009, p. 27). The final factor in the MARS model is situational factors. Situational factors involve conditions that are not part of the employee’s skill set or personality and are often out of their control (McShane & Steen, 2009, p. 28). According to the MARS model of individual behaviour, the possible reasons salespeople may be engaging in this â€Å"lateness† behaviour is first the lack of motivation they are feeling to show up to the office at their scheduled start time (McShane & Steen, 2009, pp. 26-28). This could be due in part to the lack of incentive they receive for showing up on time. Furthermore, the absence of negative consequences for showing up late has not shown the sales reps that the company is serious about this policy. In order for the sales reps to be motivated to show up to the office in the morning instead of seeing clients first, there needs to be some kind of reinforcement from the company that demonstrates that showing up on time is a behaviour that they expect and value. The sales reps were most likely hired because of their ability to gain new customers and sell products; therefore, they see this aspect of their job as being priority and do not see the value in showing up at the office first. The biggest factor effecting this situation is role perception (McShane & Steen, 2009, p. 27). The sales reps do not have a clear understanding that arriving at the office on time is an essential part of their job duties. It is clear from the sales reps behaviour that they are not aware of the importance of being at the office in the morning before they head out to see clients. While this may be a company policy in writing, it is not well practiced in the office, so it is perceived by employees as a recommendation rather than a rule. Situational factors may also contribute to the â€Å"lateness† problem (McShane & Steen, 2009, p. 28). This could be because face time at the office does not support their task goals which are to go out and see clients and s ell products. The sales reps might find the commute to the office an inconvenience whereas they could instead cut that commute out of their day and drive straight to a client’s office. 3. Big Box Construction Company has received warnings from government safety inspectors that employees at some of its construction sites are not wearing the required safety helmets and noise-protection equipment. The company could lose these contracts if safety practices are not maintained. The company has warned employees that they could be fired if they don’t wear the safety gear, but this has had little effect. Describe an A-B-C analysis for this situation and provide two types of behaviour modification interventions that might change employee behaviour in this situation. In an A-B-C analysis of this situation the antecedent would be the warning the employees received from the company informing them that they must wear safety gear on the job site. The behaviour is that some of the employees are not wearing safety equipment on the construction sites. And the Consequences are that the employees face termination if they continue to disregard this policy (McShane & Steen, 2009, p. 66). Two types of behaviour modification interventions that might change employee behaviour in this situation are: 1) Positive reinforcement, the supervisor can offer praise to the employees who are adhering to the safety guidelines (McShane & Steen, 2009, p. 66). In addition, there could be a reward in place such as a bonus for employees who are wearing their safety equipment on the site every day. 2) Punishment, although punishment might generate negative feelings toward the company and supervisor, it is necessary because of the severity of the breach (McShane & Steen, 2009, p. 67). The type of punishment will depend on the frequency of the offence. For example, the first offence could result in a write-up, the second offence in a suspension without pa y, and the third dismissal. Part B Read Case Study 4.1: Conestoga-Rovers and Associates on pages 97 and 98 of the textbook and answer the three discussion questions that follow it. Your answer for this case study should not exceed 600 to 800 words in length and should incorporate, where appropriate, content from Lessons 1, 2, 3, and 4. Questions 1) Why does Conestoga-Rovers and Associates and other companies try to create a positive work environment? The text explains that according to the dual cognitive-emotional attitude process, the positive emotional experiences employees encounter on a daily basis at Conestoga-Rovers contributes to their job satisfaction (McShane & Steen, 2009, p. 80). When employees are satisfied with their job they are more likely to be accommodating to the organization’s clients, helpful to their co-workers, and can experience increased overall productivity (McShane & Steen, 2009, p. 87). Therefore, it is beneficial for the company to foster a positive work environment where its employees are frequently feeling positive emotional experiences, so that their outlook on their jobs and the company will be much more favourable (McShane & Steen, 2009, p.80). According to the model of emotions, attitudes, and behaviour (McShane & Steen, 2009, p. 79), our emotions will have a direct impact on our behavioural intentions which in turn will most likely affect our behaviour. If the employees at Conestoga-Rovers are bombarded with positive emotions in their work environment, than they are more likely to behave in a way that is agreeable to the company. Conestoga-Rovers acknowledges and appreciates its human capital and realizes that its employees knowledge provide a competitive advantage to the company (McShane & Steen, 2009, p. 7). They realize that in order for the company to retain its valued employees and attract new ones they need to foster a positive work environment. By â€Å"adapting employment practices† to suit the needs of their employees the company is striving to retain its valued intellectual capital (McShane & Steen, 2009, p. 6). 2) How does this company manage to provide events and perks that employees value? At Conestoga-Rovers and Associates having fun and maintaining a work-life balance are fundamental to the company and its employees. This is evident in the many perks this company offers its employees that vary from its extremely active social committee to the onsite daycare facility. As stated in the case study, an employee of Conestoga-Rovers suggested that the company build an onsite daycare facility, never really expecting that they would take her request so seriously. However, much to the employee’s delighted shock the company complied. This demonstrates the company’s dedication to its employees wants and needs. In addition the company has assembled a social committee to listen to what it is that employee’s value and have evidently been able to deliver to the Conestoga-Rovers employees what they want. By doing this for their employees the organization is building organizational commitment and loyalty to the company (McShane & Steen, 2009, p. 89). By involving employees in company decisions that affect them and listening to their needs they are strengthening their employee’s social identity within the organization. This shows employees that their opinions are not only heard but are valued and trusted by the organization (McShane & Steen, 2009, p.89). The company has a â€Å"work hard-play hard mantra†, and their â€Å"social events and activities play an integral role in the company’s culture (McShane & Steen, 2009, p. 97). This is evidently closely aligned with its employee’s values; therefore, the employee’s feel comfort in their shared values with the company prompting them to remain loyal to the company (McShane & Steen, 2009, p. 89). 3) Is it possible that employees can have too much fun at work? From personal experience, I think that it is possible to have too much fun at work. When there are too many social events at work it takes away from an employee’s personal time and time at home with their family. An employee can feel forced to participate in social events that they do not want to partake in, and this can end up having a contrary effect to what the company is striving for. This added pressure to attend social events can add stress for the employee and take away from time needed to complete his/her work. Conversely, having fun at work can help build camaraderie amongst the employees and reduce the consequences of stress such as job burnout. Attending social functions can give employees a break from the monotonous routine of their job tasks; therefore, reducing the risk of emotional exhaustion and indifference towards their jobs (McShane & Steen, 2009, p. 91). Fun events with co-workers can also help to build on an employee’s social awareness. For instance, when employees are interacting with each other and building personal relationships as well as professional relationships they are better equipped to â€Å"perceive and understand the emotions† of their co-workers (McShane & Steen, 2009, p. 84). Because they are getting to know their peers personal situations a little better, the interaction allows them to be able to experience some empathy for their co-workers.