Disadvantages of the studying abroad Essay

The studying abroad is the problem of youth of Kazakhstan The most difficult for a young person is looking for profitable occupation.  «Do you speak English?  » – a question that can be heard at any companies even they are not foreign ones in our country. And if you confidently answer  «Yes, I do!  », you will be supplied with the high-salaried job. It will be good chance for you to take a place in a prestigious company and develop yourself. English language is the most important language in the world, because it is so widely spoken, it has often been referred to as a â€Å"world language†. As English is an world language, it is the very first problem to know English to make a good carrier. It is expected to know it. They think if they are taught abroad, they will be chosen without any difficulties for this or that position. This necessity leads them to abroad to study. Is it right? However, do you need to study abroad to make a brilliant carrier? Cannot we gain it studying at home? â€Å"Bolashak† is the president’s program for youth of Kazakhstan. It gives a good chance to study abroad for everyone. Even the president of our country supports the study abroad. During the 20 years, there were studied thousands of students and most of them work at the state influential companies. However, do not forget about disadvantages. For 20 -year history of the program 333 people could not complete training – mainly because of their own poor progress while getting knowledge, and 47 students of Bolashak did not return to Kazakhstan. About 300 graduates could not find work at home. Does the president want this? â€Å"Tens of millions of dollars we spend on overseas training, and thus, of course support the foreign universities. Let’s maintain ours† President of Republic of Kazakhstan Nursultan Nazarbayev President of the Center of International Program â€Å"Bolashak† Sayasat Nurbek reported about unemployment of youth of our country. According to him, about 300 graduate students â€Å"Bolashak† program could not find work at home, despite the excellent education abroad. One reason is the factor of â€Å"high expectations†. â€Å"Students come to the country and believe to take a leadership position with a big salary and an official car. Alas, the real economy demands tough enough. We need employment experience and  understanding of the industry and the specifics of this particular production in Kazakhstan. For example, college graduate comes to us, and I have not been putting his department director since he took the necessary steps to understand the specifics of the industry well even he has an excellent education.† President of the Center for International Programs † Bolashak † Sayasat Nurbek Recall, at the 9th of February, deputy of Majilis Saginbek Tursunov offered to employ graduates of † Bolashak † at the public authorities. Parliamentarian doubted â€Å"whether it is necessary to continue this program and further† as part of the students cannot find work at home. Nowadays, many people continue their studies outside of their country. They think that educations in other countries is better than in their own country. In the world, many students are continuing their studies overseas. For example; Australia, Malaysia, Singapore, China and USA are the most favorite countries to study. It is believed that the studying abroad is the most significant way to improve your world view. Also the studying abroad gives many students a kind of prestige in their home country. There are some students who want to study abroad because of the pure pleasure and excitement it brings. But living in a foreign country might be difficult at times. As I mentioned before studying abroad has advantages, however it has some disadvantages on students. Some of the disadvantages are being away from your country, spending too much money. The first disadvantage is spending too much money. As Calvin (2007) mentioned â€Å"For students who want the opportunity to study overseas during their time in college, the cost of doing so can seem daunting. According to the Education Abroad Center, studying abroad in China costs $8000. Italy? $10, 000. Paris? Up to $15,000 â€Å". Also as my friend Dosan Nursultan, student of SEGI University in Malaysia, said â€Å"The single ticket for a flight from Malaysia to Almaty costs 90 000 tenge. Return ticket is 180 000 tenge. So, not all can take liberties.† But also many students say that studying abroad is not expensive. They think, it is normal to spend that much money for studying in a foreign country. In my opinion, there is no doubt that it takes money to  study abroad. It all depends on a person, because even if person goes to a foreign country it does not guarantee that this person will have successful future in life. If person has a goal of getting education, he will do whatever it takes to achieve this goal and it does not matter whether he is studying in his homeland or abroad. On the other hand, you can travel in the world with that much money and you could have more world outlook than you would have studying. The second disadvantage of studying in a foreign country is being away from your family. From my perspective, living in a foreign country, even if it is with a host family, means you might be doing things you may not have done in your home country. These include cooking, cleaning, grocery shopping, washing clothes, figuring out transportation, making living arrangements, setting up accounts for cell phones and utilities, etc. those are just some of examples of disadvantage of being away from your family. There are many opinions, which shows being away from family is a wonderful experience for everyone and it could be a wonderful opportunity to be independent. Also, there are a lot of sit uations when teenagers where so overwhelmed with living on their own, without parent control, so they started bad habits. It is third disadvantage. For example, skipping classes, constant pub visit. â€Å"We send bachelors, but they do not suit us, because the low level of training due to the fact that English is learned in the pub, that they were not the best specialists. â€Å"Bolashakers† are different, so we basically take smart, but they are not so much, â€Å"- said Talgat Musabaev at a cabinet meeting on Tuesday. I think he wanted to say about the â€Å"independent† of our students in other countries. The next disadvantage is culture shock. The trauma you experience when you move into a culture different from your home culture. A communication problem that involves the frustrations that come with the lack of understanding; the verbal and nonverbal communication of the new culture, it’s customs and it’s value systems are only a few of the problems. The differences that people may experience include lack of food, unacceptable standards of cleanliness, different bathroom facilities and fear of p ersonal safety. In addition, you will probably have times when you miss your family, friends, food, and everything familiar. Almost everyone goes through some culture shock. When you realize that it is impossible to be at home any time you want, you will understand how difficult being away from your family is. It is a time for  learning and experimentation, and it’s also a time to build your responsibility and sense of self-direction. Overall, it’s a time of discovery and that’s why it’s easy to follow â€Å"influences†. Keep in mind that they grow up in another culture, and I am afraid they will forget their own nation, own Kazakh culture. Teenagers are easily influenced by others. The influences may adversely affect their view of the world as no parents giving them advice. Ambitious young people without life experience can join extremist communities. It is hard to resist â€Å"influences† of all sorts. Most of them are not related to violence. For example in Germany, they use Neo-Nazis music to attract young people or foreign students to join into extremist groups. That is why the parent should control their children, because you do not know what awaits you on border out of the country. The last is studying in a second language. Many people think that studying your major in another language is wonderful for everyone. There are many students who want to go to other countries to learn another language. That is not true for me because you can learn the language in your country. Also many people think that they just need to live in another country and they will learn the local language, but this is not completely true. You still need to pay attention and study. There are people who live in foreign countries for many years without knowing the language well. You have to learn some information about language when you are in high school. On the other hand, studying university is the most difficult part of education. Many people are not able to study at a university even if they study in their native language. For international student it is really hard to study at a university in a foreign country. Because of the difficulties in learning, they can keep up with the program and can complete their education. If I do not trust my ability to communicate, I would prefer to study in my country. In my opinion, the educational system in our country is improving from year to year. In conclusion, everything has two sides: advantages and disadvantages. Each of us should accept that studying abroad has good sides as well as bad one. For sure many students would get over all those disadvantages but how about others who might not be able to handle all of them. It might not be good choice to study abroad for all students. They have to figure it out before they leave their country. Otherwise, those issues would affect all your life with failure. Studying abroad is a good  opportunity to chose, but the advantages and disadvantages must be weighed very carefully before a student leaves the country.

Health Information Management System Proposal Essay

Health information technology can be best described as the point where information science, medicine, and healthcare all meet. The foundation of healthcare delivery consists of three major elements: cost, access, and quality. The U.S. government reportedly â€Å"hopes most Americans have electronic health records by 2014† (Ramachandran, 2013) .It is my proposal to upgrade to a current, cutting-edge health information management system in our office. Potential Benefits to the Practice Private practices are not a thing of the past. According to the AMA’s recent survey,†53.2% of physicians were self-employed in 2012, 41.8% were employed and 5% were independent contractors† (Robeznieks, 2013). Keeping that in mind, I have listed a few of the potential benefits of HIT to our practice: †¢Increased access to care – Having patient records stored electronically is in many cases, distance becomes irrelevant when consulting with a physician or the practice. For the patients that are out of the country or simply in another town, we can access their medical records and help them over the phone or allow other physicians access to their records at the patient’s request. †¢Allows for faster diagnosis when knowing the patient’s medical history and prescription history. Could possibly mean the difference between life and death. †¢Allows for a patient to record health information they measure at home, i.e. blood pressure, pulse, weight, blood glucose levels. This updated information can be used by the practice to keep tabs on patients for future visits or the need to schedule a visit. Potential Benefits to Staff In an online article written by Ken Terry, he stated that â€Å"41% of those who don’t have online access to records would consider switching physicians to obtain it† (Terry, 2013). Therefore, we need to look at other aspects that will benefit our staff in the long run. †¢Time equals money. Staff will spend less time retrieving, finding and filing patient charts. Now they can enter a patient’s name into the system and all their information will populate the screen. †¢Less money will be spent through the elimination of a transcription service as well as the transferring and transporting of patient charts. †¢Automated billing and accounting Necessary Training As one consulting company I spoke with stated, â€Å"understanding that one of the most important factors in a successful implementation is the quality of user training that takes place prior to the system activation† (Coastal Healthcare Consulting Inc., 2013). Due to the fact that we are a small practice, it will benefit everyone who has any contact with patients will be included in the training. Challenges with Implementing a New System †¢Over reliance on the accuracy of EMRs may lead to significant errors if a patient record contains false information. †¢Privacy and security risks due to hackers can include: identity theft, unauthorized access and corruption of patient data. †¢The cost of the equipment as well as the training that needs to be done. According to the Congressional Budget Office report written back in 2008 stated, â€Å"No aspect of health IT entails as much uncertainty as the magnitude of its potential benefits† (Devon M. Herrick, 2010). Our world has been radically changed in the last 5-10 years due to digital technology. Smart phones, tablets and web-enabled devices have changed the face of health care as we know it. This is our time to get involved and bring our practice into the present and solidify our future. References Coastal Healthcare Consulting Inc. (2013). Training. Retrieved September 22, 2013, from Coastal Healthcare Consulting Inc.: http://www.coastalhealthcare.com/services/training/ Devon M. Herrick, L. G. (2010). Health Information Technology: Benefits and Problems. Dallas: NCPA. Ramachandran, V. (2013, August 15). Technology Changing Healthcare. Retrieved September 20, 2013, from Mashable: http://mashable.com/2013/08/15/healthcare-and-it-health-informatics-infographic/ Robeznieks, A. (2013, September 17). Not All Doctors Giving Up Private Practice. Retrieved September 20, 2013, from Modern Health Care.com: http://www.modernhealthcare.com/article/20130917/BLOG/309179996 Terry, K. (2013, September 17). Patients Seek More Online Access To Medical Records. Retrieved September 19, 2013, from Information Week: http://www.informationweek.com/healthcare/policy/patients-seek-more-online-ac

Implementing Quality Management System in Emmar As a UAE Based Company Term Paper

Implementing Quality Management System in Emmar As a UAE Based Company - Term Paper Example The paper will also cover the benefits and problems of six sigma strategy in the business organization. Furthermore, the paper will also relate each of these topics with Emaar which is a UAE based company. The company in order to maintain their quality standards has to take various steps of quality management in its operations.Quality management framework is basically a wide concept of management which comprises of structure of an organization, methods, processes, resources that are needed to provide quality management in an organization. It encompasses all processes in an operational life cycle of a service in an organization. These processes affect the quality from identification of the needs of clients to final satisfaction of their requirements. By this framework, quality services are rendered to clients and stakeholders (Haule, 2007). It is considered as a strategic activity undertaken by a business organization in the competitive global market. In various types of organizations, Total Quality Management (TQM) has turned out to be a paradigm of management. TQM has facilitated organizations to make significant development and achievement in their businesses. There is a great difference between the success variable of TQM related to manufacturing and service companies (University of Nebraska Lincoln, n.d.). Quality management plays a significant role in modern business organizations. TQM is a technique to maintain consistency in production process in organizations so as to uphold reliability, efficiency along with quality. The success and achievement of an organization is based upon the loyalty of customers and through this technique, an organization can achieve satisfaction of the customers. ... Quality management plays a significant role in modern business organizations. TQM is a technique to maintain consistency in production process in organizations so as to uphold reliability, efficiency along with quality. The success and achievement of an organization is based upon the loyalty of customers and through this technique, an organization can achieve satisfaction of the customers. The value of TQM is a management based approach which is characterized by three aspects: principles, practices and techniques. These three principles are focused upon continuous improvement, customer orientation along with teamwork (Hoag & Et. Al., 2010). In 1999, Dow & Et. Al. developed the model of TQM in order to examine the effect of TQM practices on the performance of a firm and its effect on the quality of an organization. There are nine dimensions of quality practices in a firm which include commitment of workforce, joint vision, customer orientation, team building, personal training, mutual relation of supplier, high-tech manufacturing methods and use of bench-marking along with principles of just-in-time (Hoag & Et. Al., 2010). The quality management system encourages an organization to examine the requirements of customers. It also assists to define the processes that add towards the attainment of product which is suitable to the customers and maintains these processes under control. The quality management also caters the framework for incessant improvement of increasing the probability of customer satisfaction as well as the satisfaction of interested parties. Due to these facts of quality management, customers along with organizations become satisfied with the products and processes (International Standard, 2000). Emaar was established in 1997, as

Ethical Issue Case study Essay Example | Topics and Well Written Essays - 1250 words

Ethical Issue Case study - Essay Example There are existing statutes that cover the case of patients like the Somali immigrant. Several cases have already been resolved by the American courts with regards to treatment to forced treatment of people with contagious diseases. This coerced consent, according to Scutchfield and Keck, is not obtained as a sham of an informed consent, but as a way to obviate the need for physically forcing the treatment on the patient (72). I can also, as an alternative, resort to outright coercion. While this is extremely rare, this is not something that is unheard of. The case is quite extraordinary. First, the patient refuses treatment because tuberculosis is supposedly a death warrant in Somali culture. Secondly, her family also acceded to her wishes and supported her decision. Finally, there are no other medical alternatives left that would accommodate the cultural beliefs of the patient. Asking for legal advice to this action is crucial as well. But this is a matter of life and death and the fact that there is the danger of to the public variable. The civil authorities are always found to rule in support of healthcare decisions made in emergency situations that are dispensed with in good faith. The patient can only contest a forced treatment if they could provide evidence that: 1) the patient’s decision was contrary to what it would have been considered consequence of the involuntariness; and, 2) the treatment resulted into harm for the woman. I am basing my decision out of the principle of Act-Utilitarianism which argues that an action is right or wrong according to the consequences it resulted. If the result is good, then the act itself must be good as well and vice versa. Put in another way, the rightness or wrongness of an action is determined by its utility or those that are intrinsically valuable under the utilitarian’s theory of value (Thomas and Waluchow 19). One may argue that Act Utilitarianism is just another version of the-end-justifies-the-me ans argument but such is not the case. Utilitarianism is not really about instances like fraud being committed in order to achieve some higher purpose. Instead, there is a moral dimension, which requires a moral agent to decide for the achievement of happiness and benefits for all. The decision-maker under Act Utilitarianism always makes the following claim: An act is right and only if there is no other action I could have done instead which either (a) would have produced a greater balance of utility over disutility; or (b) would have produced a smaller balance of disutility over utility (19). There is the need to decide in a forward-looking manner with an emphasis on the examination of the impact of such decision to those affected individuals. It is ethical because, first, it is unselfish. The decision-maker makes the decision for the good of all. Secondly, it promotes happiness, well-being or positive benefits to those affected. In moral theology (from where most of our concepts o f goodness and evil comes from) there is always a concept of the unavoidable evil in order to achieve good results if that is the only way to do so. This rationale is expressed in a duty-based morality that a doctor can use in order to address the problem posed by the woman refusing treatment. I would like to discuss the behavior of the patient from the utilitarian perspective. She is suffering from a

Discussion Questions Essay Example | Topics and Well Written Essays - 1250 words - 1

Discussion Questions - Essay Example Therefore, the id drives the individual towards making decision that will satisfy their need. For instance when one feels that they need drugs but they have to undertake a certain duty, then drugs will come first. However if the individual does not take the drugs the feeling will still remain there until they take the drug. The ego is the executive of personality as it mediates between the urgent urges of the id and the demands from the superego as stated by Rasmussen (32). For instance when one desires to use drugs the ego will intervene to make the individual know whether it is the right time to take the drugs. Therefore, the ego functions according to the reality principle hence it delays the immediate satisfaction until the appropriate time. Therefore, in the event of the urge to take drugs the ego will suppress that feeling until the right time. The superego embodies the ideals and principles of society as they are conveyed by what parents do and say. Within the superego, the conscience arises hence its role is to block the unacceptable urges by the society as stated by Sullivan (24). For instance when one feels like abusing drugs, the superego reminds the individual that the habit is not allowed and thus suppresses the feeling. This model aims at imparting information about drugs taking the assumption that children and adolescent will keep away from drugs after understanding their prospective risks. It also makes the assumption that the information will lead to students to developing negative attitude that will prevent them from abusing drugs. In brief the model speculates a casual series leading from knowledge (n drugs) to attitude change (negative) then to behavior change (non use) according to Abadinsky (226). The model seeks to shape personality. It centers on the person rather than the drugs and it assumes that young people with high self esteem can not abuse drugs. It also

How Information Technology impact in business world Research Paper

How Information Technology impact in business world - Research Paper Example Current trends in Information Technology include; cloud computing and information security. Alternatively, the view of Daintith John (2009) is that â€Å"Information Technology is the use of computers and telecommunication facilities in business; to collect, manipulate, transmit, store and retrieve data. Information Technology refers to computers plus computer networks, but can also include information transmitting equipments like satellites, phone, televisions and radios. IT infrastructure involves the framework on which information networks operate.† The infrastructure include; computers, networks, database management systems and a regulatory framework. In the field of Information Technology, infrastructure refers to physical hardware which connects computers and users, for example, telephone lines, satellites, television cables and antennas. To some people, infrastructure is anything that supports the processing of data and information. Erick Miley (2014) explains that â€Å"Information Technology is an occupation or profession that identifies with computer technology." He stresses that modern businesses use computers to ensure high standards of customer service and efficiency. The benefits if information Technology to businesses many. Computers process information at very high speeds, for examples emails deliver messages instantly. Business information can be updates on market. Increased computer speed ensures efficiency in information processing. Computers are also able to multi-task accurately and quickly, for example, solving complex mathematical equations. IT ensures low business costs; this is due to the fact that as technology becomes more common it also becomes affordable. It has led to more entrepreneurship opportunities; this is because many people nowadays work at home using the internet. (Allen and Morton 37). According to Chirantan Basu, Demand

World Issues and Anthropology Essay Example | Topics and Well Written Essays - 1000 words

World Issues and Anthropology - Essay Example Anthropological study of environment will help me in defining and determining various forces that operate in the environment and the possible ways of handling the individual forces. I value anthropological study of the environment because of its efficiency and accurateness in providing a clear and broad overview on the ways one should interrelate and transform the environment into an attractive place for my stay. In addition, anthropological study of the environment will help in understanding various concepts that dominate different community and be able to structure appropriate techniques of ensuring maximum peaceful coexistence with different individuals. Understanding environmental issues from the anthropological point of view is equally critical for the world in that it helps in fostering peace and love, which are the basic determination of a healthy world. Anthropological study of the environmental issues assists and enlightens human beings from different societies concerning various business and trading activities and principles that overrule the current world. Anthropological study of the environment enable people to discern and understand the history of politics in different societies, to help in the set up and establishment of an appropriate political system to rule particular communities. In addition, anthropological study of the environment assists people in obtaining historical socio-cultural practices of different community thereby providing a clear link to perceiving the structure of different communities in the current world. Furthermore, anthropological study of the environment enables people opportunities to innovate a nd renovate vital tools and machines used in the contemporary world by studying the history of creation of certain items. Havilland argues that human nature is the same and only differs due to environmental changes within their surroundings. Havilland portends that the changes in the

Physicians Assisted Suicide Research Paper Example | Topics and Well Written Essays - 1250 words - 1

Physicians Assisted Suicide - Research Paper Example In addition, the practice would lessen the urgency to develop new medicines designed to prolong life. Those who oppose the practice on religious grounds argue that it is ‘playing God’ therefore sinful. Health care professionals cite the Hippocratic Oath which forbids them from carrying out this procedure. This paper will examine the moral and ethical concerns surrounding euthanasia, clarify the meaning of the term, present arguments both for and against the practice and conclude with a recommendation to resolve the issue. The word euthanasia is from Greek origin meaning ‘good death.’ Writers of 1700’s Britain referred to euthanasia as a being a preferential method by which to ‘die well’ (â€Å"Definition†, 2007). Euthanasia describes a situation in which a terminally ill patient is administered a lethal dose of medication, is removed from a life-support system or is simply allowed to die without active participation such as by resuscitation. A doctor’s involvement in the procedure could be to either prescribe a lethal dose of drugs with the express intent of ending a life or by intravenously inserting a needle into the terminal patient who then activates a switch that administers the fatal dose (Naji et al, 2005). Physicians, lawmakers, and philosophers have debated the notion of euthanasia since the beginning of recorded history but the wide public debate regarding its legalization has only surfaced over the past four decades. In the 1970’s it bec ame lawful to draft ‘living wills’ which allows a patient to refuse ‘heroic’ life saving medical assistance in the event they were incapacitated and could only survive by artificial means (Rich, 2001). In other words, it gave the next of kin the right to direct doctors to ‘pull the plug’ if the patient’s condition was considered hopeless, a practice which is now broadly accepted. The unfortunate reality is the majority of people in the U.S. die a ‘bad death.’   A study determined that â€Å"more often than not, patients died in pain, their desires concerning treatment neglected, after spending 10 days or more in an intensive care unit† (Horgan, 1996).   Most Americans (53 percent) believe euthanasia to be not only compassionate but ethically acceptable and 69 percent would support the legalization of euthanasia according to a Gallup Poll conducted in 2004 (â€Å"Public Grapples†, 2004).   Opponents of a doctor-assisted suicide law often cite the potential for doctor abuse.   However, recent Oregon and UK laws show that you can craft reasonable laws that prevent abuse and still protect the value of human life.   For example, laws could be drafted that requires the approval of two doctors plus a psychologist, a reasonable waiting period, family members’ written consent and limits the procedure to specific medical cond itions.     

The Blood Brothers Essay Example for Free

The Blood Brothers Essay Willy Russell writes entertaining drama about believable characters and champions the cause of the socially disadvantaged. With reference to the historical and social context of Blood Brothers, analyse the accuracy of this statement. Blood Brothers is a musical play written in the 1980s during a recession in a United Kingdom. Written by Willy Russell, the play revolves around the subject of social class, which is definitely a constant theme throughout the play. Set in Liverpool, the story centres on a set of twins that are separated at birth with both mothers desperately trying to keep them apart in vain. In this essay I will analyse the accuracy of the statement above and relate to it throughout this essay. Russell uses a variety of techniques to make Blood Brothers an entertaining piece of drama. One way he portrays the story in an effective way to engage the audience, is by using dramatic tension. Dramatic tension is used when Mrs Lyons blackmails Mrs Johnstone to not tell anyone that the two boys are brothers, by using her fear of superstition. They say they say that if either twin learns that he was once a pair, they shall both immediately die. You wont tell anyone about this Mrs Johnstone; because of you do you will kill them. This section of the play is an excellent example of dramatic tension as it creates suspense and makes the audience sympathise with Mrs Johnstone. Dramatic irony is also another technique Russell uses to entertain the audience. The section of the play where Mickey and Edward meet as young children is great example if this. Ey, we were born on the same day that means we can be blood brothers. Do you want to be my blood brother, Eddie? The audience (and the narrators) know the full story, and know that Mickey and Eddie dont need to be blood brothers because they are already real brothers, and share the same blood. This frees up the audience to observe the implications of the characters actions and having an advantage over the story, by knowing the full plot. Blood Brothers is a musical play, and the songs involved, play an important role throughout. As well as keeping the audience entertained the songs gives us character insight, provides extra information, and carries along the storyline. The songs emphasise and highlight key moments during the play, and make the audience aware of their importance. Techniques such as foreshadowing are made clearer, and the music portrays certain moods making characters emotions and thoughts clearer. An interesting technique Russell has used at the beginning of the play is by using a prologue. This is a very effective way to engage the audience, by giving the audience an insight into the plot for example of one womb born on the self same day, how one was kept and one given away It brings forth questions in the audiences mind and the answers are revealed as the story unfolds. It frees up the audience to speculate the storyline and how the ending came to be. This intricate plot structure shows how the characters actions have severe consequences throughout the story An did you never hear how the Jonstones died, never knowing that they shared one name Foreshadowing is fantastic technique that Russell uses successfully in the prologue and throughout the play. Foreshadowing is when events that happening later on in the play are foretold or hinted by earlier events. The prologue makes foreshadowing possible because the end is revealed to the audience and makes them look for possible omens of this during the story. There are many great examples of this throughout the play, especially in the beginning when the children are playing with toy guns. But you know that if you cross your fingers, and if you count from one to ten, you can get up off the ground again, it doesnt matter the whole things just a game. The reference to guns and its just a game is repeated throughout the play, and relates to the twins death at the end as both of them are shot. At the end of the play its not just a childish game, and the reality becomes too difficult for the characters to deal with. The quotation implies a long for childish innocence from all the characters, and a cry for help from the tragic ending. Although the outcome of the Blood Brothers storyline is tragic, Russell adds comedy and humour throughout. When the boys first meet, an example of Russells humour occurs; So they took him to the hospital an put a plate in his head A plate? A dinner plate? Russell lightens the mood by injecting humour into a scene full of tension and irony. The comedy in the play makes Blood Brothers a more enjoyable and entertaining piece of drama for the audience to watch. By adding this childlike humour into the play, it shows that Russell can invent realistic and believable characters which make the audience more likely to sympathise with the characters. As well as having a great understanding of young children, Russell also has an understanding of adolescents as well. Linda, I wanna kiss y an kiss y but I dont know how to tell y because Ive got pimples an me feet are too big an me bum sticks out

Family and Delinquency Essay Example for Free

Family and Delinquency Essay How is it developed and how is it Solved? Introduction â€Å"Abuse† and â€Å"violence† are considered to be terms that are believed to be the understatement of the actual situation that is happening in the society right now. It could be observed that through the years, the number of individuals being victimized by the said dilemma are undeniably increasing making the word â€Å"abuse† not just a word but one among the many things that people within the human society fear most. Abuse is the way by which people try to maltreat their fellowmen. This is regardless of the fact that the people being maltreated are either their friends or their family members as well. It could not be denied that this dreadful situation have affected the sections of human socialization already. The school institutions, the workplace, the churches and now even within homes, the existence of abuse cannot be much controlled anymore. This is primarily the reason why it is very important to take several things regarding this particular issue into consideration for studying. This would naturally allow a more focused procedure that shall be developed to assist abused victims both young and old, men and women to recover from the situation that they have been involved with when they were abused in the past. It is pretty much appalling to know how a highly established society could be afflicted by the different effects of the abusive acts that are brought about as one of the major disadvantages of the advancements of the society. What are the sources of these major abuses? Most likely, as psychologists and sociologists point out, people are moved to create possible ways of releasing their tension regarding several experiences through afflicting the security of others. Most of those who are noted as the ones victimizing others have been once victims themselves. On their own way then, they are trying to release the depression and the pain that they are afflicted with through passing on the dreadful situation to others as revenge to those who have once victimized them. The abusive acts and their effects on the victim do not end on the actual act of abusing alone. The results of the said incidents account for further impact on the personality of the victim primarily pertaining on his or her social interaction with the community that he lives with. Most likely, isolation and the feeling of lesser self-worth eventually develop. It could not be denied that these results are hardly expected by the victims before they were involved with the abuse that they were faced with. Certainly, it is through the memories of the abuse that the pain tends to remain in complete control of the victim’s major dealings with the society. At some point, the said victims tend to become socially avoiding as they actually fear that the same thing might happen to them again in the hands of other people that they may or may not know. The trust that they used to have on other people before they were victimized eventually fades making it harder for them to recover on the past that they have experienced. The World Reports and What They Pertain to According to worldwide reports, there are several abusive acts that are taken against the â€Å"weak ones† in a daily basis. Depressingly, the numbers of the victims never cease to stop. Even though there is a strong push on the making of the different laws and ordinances that are designed to protect people from being abused on the places that they are living or working in, it is undeniable that there is still a considerable annual rise to the rate of the population becoming victims of the said dreadful situation. As mentioned above, there are numerous types of abuses that plagues the society today. With the influences of media and other publications that provoke both sexual desires and violence, the desires of people to do something awful to others to simply comply to the thirst that they feel for themselves and the satisfaction that they ought to reach become much vivid and harder to avoid. Hence, pushing the abusers to come up with destructive acts that bring others into a devastating situation. It could be noted too through psychological studies that one cause of the ways by which people are moved to follow a certain path that leads them to abusing others actually involve depression and in depth disregard of one’s self. Most of the time, when depression and stress takes over the mental system of a particular person, the deciding power of the person begins to weaken hence making it possible for him to take massive steps of destructive acts that usually lead to them abusing other people. Yes, frustrations and unfulfilled missions or aims bring much depression on human individuals. When this depression is treated in the wrong manner, the situation becomes harder to control. Psychologists particularly note this as one of the failures of the nervous system to assist one in righteously deciding for what is supposed to be acceptably right to do when hard-to-deal with circumstances arise. The said failure gradually affects to one loosing his control over his actions. Add to the fact that there are those who take addictive substances that are directly affecting their decision-making capabilities thus making it harder for them to judge of whether what they are doing are right or not. The Personal Effects of Abuse and Violence As mentioned earlier, violence and abuse are two related terms that describe the destructive situation that most people who are less able to protect themselves experience on the hands of the oppressive sector of the human population. Hence, through the study that has been presented above, it could be noted that the results of the said incidents may either be positive or negative on the part of the individual that has been victimized by the said situation. The result becomes positive when the victims primarily learns how to defend himself the next time that the same situation occurs or in some way he or she has already learned to protect themselves from actually being involved in destructive situations based on the experience that they once had. On the contrary, the results may become negative if the victim begins to view the situation as an incident that could bring her or him to a fearful state against the systems of the human society. The state of isolation becomes and self-rejection is then added to the negative results of the said incidents. Involving the Family Amidst all the successes that the society achieves through the existence of technology and communication, it is quite disturbing how the situation of the most important sector of the society suffers so much. Family, as the basic unit of the social relationships, is the one receiving the most negative effects of technological and industrial advancements. Intimacy and attachment has been much a hard case to deal with when dealing especially with the modern married couples. The thoughts of long ago regarding the long-run relationship that marriage is supposed to be had been gradually changed by the fact that system of the society today have already changed as well. The priorities and the goals of individuals have already been exchanged with the need of being economically successful in the field of their own chosen careers. Sadly, although both men and women are aware that they were meant to share a special relationship based on love, only few are able to realize to understand the reality of the vows that they give at the brink of their wedding ceremonies. Marriage, as a human contract is a special bond that should be considered as a serious link between two people who are bounded by love. However, at some point, the view of marriage has been changed during the present era. Because of the social changes, marriage has been subjected to different challenges. Today, conflicts are directly bombarded towards the relationship of married couples that in turn makes the situation much harder to deal with. As a result, many among those couples simply end up in divorce. For many years, it has been a standard definition of a family to be referred to as a group of people who are related to each other and are thus bonded together by blood. The attachment within the said group goes beyond just the existence of a common blood, but it is further linked stronger through the existence of love. With the said advancements though of the society, the family is further subjected to facing several issues that concerns the strength of its ties. . Since time is lacking, the members of the family are having a hard time creating time for themselves to at least deal with each other through communication, in turn, intimacy is lost. This is specifically true with parents, or married couples. Because of the time that they devote to their jobs, they usually find it hard to balance their time to give each other attention for the sake of the development of their relationship. As a result, the love that they once have lost the love that they once had for each other because of lack of time, communication and intimacy, their relationship’s solidity begins to drift away. On the contrary though, Donna and Roger are among the couples who are able to meet the challenges of marriage amidst all the challenges both personal and familial that are presented to the society nowadays. Although there had been some rough portions of their marriage, it could be noted through the interview that they have managed to set through their differences and were able to make adjustments so as to give themselves some room to improve as individuals and as couples. It is undeniable that being married at a young age is something that is much harder to deal with that dealing with simply the challenges of marriage itself. Aside from all the financial problems, personal adjustments certainly needed to be given attention especially on the part of the interviewees. The highlights of their relationship could be noted to have nothing to do with gaining surmountable amounts of wealth but with that of being together with their family. Seeing things in a simpler manner makes it easier for young couples to see life in a much less-complicated matter of life. It is through this that they are able to give importance to the more caring to better things that wealth itself. True, they recognize that material gains add up to the happiness of the family since it gives the members a chance to enjoy the things they want without limits at least. However, this does not mean that the happiness of family members does not only rely on the influence of money at all. Instead, real family happiness relies on the fact that family members are still able to connect with each other through communication and simply by just being together amidst the busy schedules that each member of the family deals with regarding their work or school activities as well as house chores. Making sure that each member is given the attention that they need from the family is an important key to family success. A Therapeutic Approach The Family Assessment Device has been designed to measure improvements concerning the Family Therapy. In a busy and complicated world that families have to deal with these days, it is very vital every family be able to face the challenges of today’s world. Although at times, the hardships that families has to face makes it difficult for its members to keep close and intact relationship with each other. Aside from this, the results of such a complicated life leads to different emotional and physical depressions which makes it harder for every family member to comprehend to each other’s needs and be able to cope with life’s changes at the same time. This is why many families chose to undergo several family therapies to be able to solve the growing gap between their members and thus lead a better family life. The Family Assessment Device includes six major dimensions that are connected to family functioning. The said six major scopes of the said assessment device are the problem solving, communication, roles, effective responsiveness, effective involvement and behavioral control. The dimension on Problem Solving intends to measure the capability of a family to be able to face and solve certain problems that arise within the family. With the use of questionnaires having four possible responses on agreeing to the solutions suggested and disagreeing, each family is scaled depending on their answers. The other dimensions as well follow the same pattern of questionnaires. After answering the questions, each result shall be averaged, evaluated and concluded regarding the improvements of the family in the therapies they undergo. The standard results for the Family Assessment Device which concludes that the family has already improved through the family therapy is based on how well they have comprehended with the activities they undergo during the therapy. There are major ways on how to evaluate the changes in a family. One is through the statistical significance of changes observed, another is through the percentage of dropping below clinical cut-offs and finally through the magnitude of change between intake and termination. These three major evaluation processes helps the psychologists to scale the improvements that the family being observed has already incurred. Many experts have proved the reliability of tests and family assessments such as the Family Assessment Device effective. True, at times, the application of this assessment may not be that easy but the cooperation of the family under therapy programs would really help in making assessments such as this a successful program. At times, there might be some family members who would rather depend on their own understanding of the problems they are facing than referring their problems to experts. Usually, this makes the FAD application harder to apply, but as said earlier, constant assistance and assurance to the families that they are being helped and not exploited or whatsoever, the Family Assessment could be concluded to be successful. Conclusion As it could be noted through the studies and discussion presented above, the result of violence and abuse upon the victim simply depends on his or her perception of the situation that occurred. Someone who is strong and wise enough in facing life’s challenges may look at this particular experience as a lesson that would teach him to take full responsibility of the situation the next time that the same thing happens. However, a person who is actually frail in facing the surprises that life has to offer would break down upon experiencing certain devastating incidents. Yes, it is one’s development as a person and perception towards life and the challenges that it brings that would actually determine the ways by which an individual would be affected by violence or abuse. It is only through a person’s discretion that the effects of the said situations could be identified within the growth progress that that particular person would undergo. It is also upon the person’s discretion as to how he or she would actually allow the said incident to impact her personality as well as her social dealings. In the end, yes, it will all depend on the person afflicted by the situation. References: Sexual Victimization,† Child Abuse and Neglect, 18 (1994):303–318. Browne, A. , and Finkelhor, D. , â€Å"Impact of Sexual Abuse: A Review of the Research,† Psychological Bulletin, 99 (1986):66–77. Beitchman, J. H. , et al. , â€Å"A Review of the Long- Term Effects of Child Sexual Abuse,† Child Abuse and Neglect, 16 (1992):101–118. Cathy Spatz, â€Å"Child Abuse, Neglect, and Adult Behavior: Research Design and Findings on Criminality, Violence, and Child Abuse,† American Journal of Orthopsychiatry, 59 (1989):355–67. Pfendler, B. A. (1997, April). Validation of the McMaster Family Assessment Device (FAD) in an intensive family therapy program. Psychological Association, Washington D. C. Ridenour, T. A. , Daley, J. G. , Reich, W. (1999). Factor Analyses of the Family Assessment Device. Family Process, 37,38. Sluttery, J. M. (1997). Predictors of Family Therapy Outcome. Unpublished data, Handout. Kabacoff, R. I. et al. (1990). A psychometric study of the McMaster Family Assessment Device in psychiatric, medical and nonclinical samples. Journal of Family Psychology.

The congenital heart disease

The congenital heart disease Does an Exercise Program following Cardiac Surgery for Congenital Heart Defects improve a Childs Cardiopulmonary Response to Exercise and Increase Exercise Tolerance? Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Paediatric Cardiac Problems are prevalent throughout the world with 1.5 million new cases diagnosed each year. Congenital Heart Disease (CHD) is the most common diagnosis of heart problems at birth. Between four and nine per one thousand live births each year are diagnosed with the condition (Draper 2008). In 2007, 989 live births were recorded of babies with cardiovascular abnormalities (National Statistics 2007). Congenital Heart Disease is an umbrella term which encompasses all heart defects that are present when a child is born. The child may have one or multiple defects at birth which can either be detected by a scan ante-natally or are diagnosed soon after birth. Although the diagnosis of CHD is now becoming easier, some diagnoses of the condition do not happen till later on in life. Statistics show that around 60% of congenital heart disease are diagnosed in babies aged from birth to one year, 30% in children aged one to fifteen, and 10% in adul thood (16 years and over) (BHF 2003). Many common conditions include a Ventricular Septal Defect (VSD), an Atrial Septal Defect (ASD), Pulmonary Artery Stenosis, Tetralogy of Fallot (TOF) (Fig. 1) and Transposition of the Great Arteries (TGA) (Fig. 2). Congenital Heart Disease is now not just a problem of the child, many people with the condition are now living into adulthood. It is predicted that by 2010, 185,000 people will be living in the UK with CHD (Deanfield (BHF) 2003). Treatment for Congenital Heart Conditions has changed rapidly over the last 50 years. Now surgical management is needed in most cases however some defects will either resolve themselves or require medication. Surgical treatment has changed in recent times, fewer patients are requiring open heart surgery and more are receiving a catheterisation technique. Around 3,100 operations and 725 interventional cardiac catheterisations are performed each year on babies and children with CHD (BHF 2003). The effects of surgical interventions on cardiopulmonary function have been thoroughly researched in the past. The studies have concluded that surgery does improve lung and cardiac function and reduces secondary complications (Picchio 2006). Exercise is widely known as the best treatment for most musculoskeletal problems but its effects on the cardiopulmonary system has only recently been researched into (Cullen 1991). Pulmonary and Cardiac Rehabilitation have now been shown to have an effect in adults but the research into paediatric rehabilitation classes is not widely known about. Other studies have looked at exercise training or a cardiac rehabilitation programmes following surgery and the effect of this on the patients exercise tolerance. I am going to use this review to assess these studies which look at both cardiac rehabilitation programmes and also levels of exercise tolerance following surgery. I want to discuss whether there are any gaps in the knowledge base surrounding the effects of exercise in cardiac surgery of paediatrics. I also want to conclude whether the assumption that exercise is positive, can be correctly justified. Method After deciding a topic I was able to start researching into the background area of paediatric cardiology. I started by using a combination of terms including, Exercise, Sports, Physical Activity, Paediatrics, Children, Post-Cardiac Surgery, Congenital Heart Disease, Congenital Heart Defects and Cardiac Rehabilitation. The search pages I found highlighted articles of relevance and then I used the link to related articles to find the studies (see appendix 1). I also searched on individual journal websites including, Paediatric Cardiology and Cardiology in the Young. I used databases such as Pubmed, Medline, Ovid, Sciencedirect and Springerlink to read abstracts of articles and decide their relevance to my review. I then selected the most relevant and used excel to compile a table where I could easily see the differences in the studies under headings (see appendix 4). The studies I am looking at are all based on paediatrics and are randomised controlled trials dating from 1981 to 2009. Although some of the studies are nearly thirty years old, they hold some strong evidence compared to present day studies and therefore I have not discounted older studies from this review. Other reviews have assessed whether exercise has an impact on cardiopulmonary performance and have been shown that an exercise rehabilitation class does provide benefits in cardiopulmonary performance and exercise capacity. Some of the studies that are being reviewed however are concluding with insignificant findings. The reviews have stated that research lacks long-term effects of training and also a clear understanding as to which exercise type is best (Tomassoni 1996). In this review I will try look at newer studies and see if the areas of knowledge that were found to be omitted after previous reviews have now been researched into. Review of Studies Firstly I am going to discuss the testing of the participants. All of the studies completed two exercise tests to assess the participants ability before and after either the cardiac rehabilitation program or surgery. Exercise testing is very difficult to reproduce. Many studies have problems with ensuring the test is accurate and reliable and many struggle, causing results and testing to be different and therefore not comparable. If the results are not accurate and cannot be compared to other studies the results can cause a change in average results and therefore may mislead readers into a false positive result. Each of the studies used either a treadmill test or a cycle ergometer to test their participants cardiopulmonary function and exercise tolerance. Using these two tests is the most common technique of testing function as it is very reliable. (Washington 1994) All studies used a specific protocol outlined in the Washington Guidelines with all of the studies using a treadmill test with five of the thirteen studies using Bruces protocol. Bruces protocol is where the grade of exercise is increased every 3 minutes until the participant has reached their maximum capacity and cannot continue. The bicycle ergometer tests are where the participants are required to cycle continuously at approximately 50-60rpm where the grade of exercise is increased by 10-20 watts/ minute every three minutes. This is also completed until the participant can no longer continue (Washington 1994). Exercise testing using a treadmill or a cycle ergometer causes problems because the task they are undertaking in the test are is not functional and do not relate to daily tasks. Running and cycling is functional but not to that grade of exhaustion. Many children normally will stop an exercise when they are tiring and will never push themselves to the level that these exercise tests are pushing them. The tasks are also not fun for the participants and I feel that it should be fun otherwise children will get bored. This is the same with the intervention as well and the programmes should be child orientated and individual to each child. Outcome Measures are the basis to the results of a study and therefore its effectiveness. A lack of certain outcome measures may show large flaws in a study as many can be used to assess different parts of function and physiological activities. In the studies looking at the effects of cardiovascular surgery, there were a limited number of outcome measures that were looked at. Sarubbi (2000) only looked at heart rate and blood pressure as outcome measures and this limits results. The main outcome measures were heart rate, blood pressure and maximum work rate in all the studies. These outcome measures although very limited are values that help us to understand cardiovascular activities. Other helpful measures would have been oxygen saturations, which only Rhodes studies (2005/6) looked into. Saturations are helpful to assess whether a change in heart rate or blood pressure affects saturations or whether a change in these may be due to a ventilation problem. (Rivers 2001) The outcome measures of the cardiac rehabilitation studies are all different but all have similarly looked at exercise capacity after the intervention. This is shown by all the studies using VO2 as a measure and that all the participants improved their VO2 maximum to allow for a greater exercise capacity. The only study that did not prove an increase in VO2 max was Goldbergs study (1981) which only showed an improvement in maximum work rate. This could have been due to the date in which the study was undertaken. This was one of the earlier studies done in 1981 and therefore technology may not have been as accurate or as reliable as some of the later studies done since 2000. However Goldbergs study was the one that had the most intervention time of all the studies with exercise of up to 45 minutes completed on alternate days with a strict regime to increase grade of exercise over the 6 weeks. This leads me to believe that maybe it was inappropriate testing or inaccurate technology tha t changed the results of the study as previous reviews have shown that an increase in exercise time has shown to have positive effects on health. As technology has developed since the early eighties, this may be why more accurate testing is used and therefore making results more positive to the outcome we wish. Another problem in trials of this sort is compliance. Compliance is always an issue when completing studies (Burke 1997). Initially recruiting people to participate is difficult and many people with either choose not to participate or may drop-out early in the study. Many people will not participate because of exercise testing being too invasive or because of geographical implications as the distance to the base of the study being an issue. Some of the studies had large drop-out rates with almost 30% decrease in patients initially viable for the treatment plan and those who undertook the tests in the study (Arvidsson 2009). I think this could be explained by that the studies involved child participants that are less compliant to long term programmes and who tire easily to an activity. Also due to the nature of the surgery that they have all completed, many parents will be protective over their children and be pushing the participants exercise tolerance will make many parents worried about their childs health. Much of this can be avoided by specifically explaining the procedures and answering any questions that the parent or participant may have to educate them that this a treatment plan and is not going to hinder their childs recovery or health. Also intervention time is a major issue when looking at trials. Some may be days long and others have follow-ups of years once the intervention has finished. The studies that focus on Cardiac rehabilitation all have various time scales of their intervention with the shortest program being six weeks (Goldberg 1981) and the longest around twenty weeks (Opocher 2005). The difference in timescale and the different number of sessions that the participants attend makes it difficult to assess whether it is the content of the program that affects the patients or whether just exercising over a longer, more sustained period of time effects the participants in the same way. I think studies that look at different contents of treatment programmes but have a fixed intervention time may be beneficial in deciding the aim of this review. When looking at the studies, all of the cardiac rehabilitation programs only assess the patients exercise performance straight after the program and only one study looks at the effects of the program long term. Rhodes et al 2005 firstly looked at the immediate effect of a cardiac rehabilitation program and then in 2006 did another study looking at the same participants of the previous study six months after the original program. The studies that look at exercise capacity before and after surgery also do not look at the effects of the cardiovascular system in response to exercise on a long term scale. Long term effects are the best indicator to say that function and exercise capacity has improved (Miller 2005). Sociodemographics of the subjects in a study are also important to review as to its involvement in accuracy of results. Different age ranges or male to female ratios cause studies to be inaccurate in trying to generalise the population group. Many of the studies had a very large age range within their participant groups with the largest difference being 17.6 years in Marino et als study in 2005. I feel that the exercise difference between a seven year old is very different to that of a twenty-four year old. I feel that a large age range is used to increase subject numbers. Male: Female ratios are also important and that a large majority in these studies had male participants. The biggest ratio of male to female was in Opochers (2005) study where there were nine male participants and only one female participants. The best ratio of male: female was either Moalla (2006) study with 44 males and 39 females. This is important as I believe men and women react differently to exercise. Subject numbers is also a large problem with these studies. Due to most of the studies only looking at the children that have had surgery in their trust or hospital they have decreased their subject numbers and none of the studies look at the effects on large number of subjects on a national scale. The studies that looked at cardiac rehabilitation all have subject numbers under 16 which is a very big limitation. The only studies that have larger numbers are the ones that look at exercise capacity after surgery. By having participants that are only from the immediate area of the study base also means you do not get a generalised view of everyone nationally and you may not cover different children from different backgrounds socially and economically and so may have different attitudes to rehabilitation, treatment and self-management. Studies with participants that are not generalised to their population group can therefore produce a bias result to that specific population group. Also having different backgrounds of participants is important in assessing their compliance and what individual exercise programme they should be given. Having a specific age range is particularly important as many of the subjects may be inappropriate for the programme due to their age. Some of the subjects may be too young and using subjects that are under six years old would be inappropriate due to the subjects being too young to understand the instructions of the study. Using older subjects may also cause different results as their bodies have had longer to regain independent function and the body has had time to compensate for a lack in cardiopulmonary function. I think it is important to keep variables as succinct as possible and trials should be able to based on one variable alone and truly work on whether surgery or exercise has a n effect on that variable independently. Effects of Cardiac Rehabilitation The studies looking at cardiac rehabilitation all have an exercise programme set up for their patients either at home (Moalla 2006) or in an outpatient setting (Ruttenberg 1983). These sessions ranging in therapy time from one hour alternate days to one hour once a week, all show an increase in either cardiopulmonary performance or in exercise tolerance. This shows that a rehabilitation programme is appropriate for these patients and does have a positive effect on the participants life. Rhodes studies (2005/6) had the greatest effect on the patients final outcome. Not only did most of the testing result in significant effects but the large range of outcome measures used means that we can assess not only the cardiovascular performance of the participant but also look at the pulmonary effects of the exercise and their effects of the heart and the cardiac system. What we can also see from this review is that the cardiac rehabilitation programmes are becoming more significant in results as the studies get newer. This is a good indicator that current programmes are being effective in their rehabilitation (Opocher 2005, Rhodes 2005/6, Moalla 2006) and that newer techniques and more knowledge on exercise has lead to better run classes which not only improve results more consistently than the older studies and that the effects from an initial programme can also be maintained for 6months after intervention (Rhodes 2006). Effects of Cardiovascular Surgery Two of the studies looking at effects of surgery only have exercise testing after the surgery. The study by Arvidsson only used the number of sports sessions a week that the participant goes to after the surgery. Therefore a direct comparison between their before and after the surgery ability cannot be done and so the study is only looking at their sports participation after surgery and not the effects of the surgery. However these studies do show that after surgery childrens exercise tolerance increases to the level that healthy participants are achieving (Zaccara 2003) and they are participating in equal amounts of sports participation following surgery (Arvidsson 2009) Future ideas In future studies, long term effects of cardiac rehabilitation should be researched, with a follow-up test of a least a year after their rehabilitation to see if the participant is now more active. I also think a control group should be used in the study to look at the effects of non-surgical patients that also participate in cardiac rehabilitation. This is to assess whether the improvement seen during cardiac rehabilitation is not just a response to any exercise and that if a child went back to normality and participating in sports then they will just be as exercise tolerant as children who do not have CHD. Also I would suggest that an exercise programme for the patients that is more functional but also fun and exciting for the patient should be used to increase compliance and also enjoyment for the participants and their parents. Conclusion In conclusion, Cardiac surgery is a commonly used form of reducing congenital heart defects and has been shown by these studies that the surgery does have an improvement on the patients cardiopulmonary performance. I have also found that a cardiac rehabilitation programme is beneficial for paediatric patients after cardiac surgery for congenital heart defects. References/ Bibliography Arvidsson, D (2009) Physical Activity, sports participation and aerobic fitness in children who have undergone surgery for congenital heart defects. Acta Paediatrica 98 pp. 1475-1482 Balfour, I. (1991) Pediatric Cardiac Rehabilitation. AJDC- Volume 145 pp. 627-630 Bradley, L. (1985) Effect of Intense Aerobic Training on Exercise Performance in Children After Surgical Repair of Tetralogy of Fallot or Complete Transposition of the Great Arteries. The American Journal of Cardiology Volume 56 pp.816-818 Burke, L. (1997) Compliance with cardiovascular disease prevention strategies: A review of the research. Annals of Behavioural Medicine. Volume 19, number 3, pp. 239-263 Cullen, S. (1991) Exercise in Congenital Heart Disease. Cardiology in the Young; 1: pp. 129-135 Deanfield J. (2003) Congenital Heart Disease Statistics (accessed on 8/11/09) British Heart Foundation Statistics Database www.heartstats.org disease participate in sport and in which kind of sport? Journal Of Cardiovascular Medicine, 7: pp. 234-238 Draper, Dr. Richard (2008) Congenital Heart Disease in Children (accessed on 3/11/09) http://www.patient.co.uk/doctor/Congenital-Heart-Disease-(CHD)-in-Children.htm ECHO (Evelina Childrens Heart Organisation) (accessed on 15/11/2009) http://www.echo-evelina.org.uk/ Goldberg, B. (1981) Effects of Physical Training on Exercise Performance of Children Following Surgical Repair of Congenital Heart Disease. Pediatrics Vol. 68 No.5 pp. 691-699 http://graphics8.nytimes.com/images/2007/08/01/health/adam/18088.jpg http://graphics8.nytimes.com/images/2007/08/01/health/adam/8807.jpg Marino, B. (2006) Exercise Performance in children and adolescents after the Ross procedure. Cardiology in the Young 16: 40-47 Miller, T. (2005) Exercise rehabilitation of paediatric patients with cardiovascular disease. Progress in Paediatric Cardiology Volume 20, pp. 27-37 Minamisawa, S. (2001) Effect of Aerobic Training on Exercise Performance in Patients After the Fontan Operation. The American Journal of Cardiology Volume 88 pp. 695-699 Moalla, W. (2006) Effect of exercise training on respiratory muscle oxygenation in children with congenital heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 13: 604-611 National Statistics (2007) Congenital anomaly Statistics Notifications. Office for National Statistics. Series MB3, no.22 Opocher, F. (2005) Effects of Aerobic Exercise Training in Children After the Fontan Operation. The American Journal of Cardiology Vol. 95 pp.150-152 Picchio F. (2006) Can a child who has been operated on for congenital heart Rhodes J. (2006) Sustained Effects of Cardiac Rehabilitation in Children with serious Congenital Heart Disease. Paediatrics Volume 118:3 pp.586-592 Rhodes, J. (2005) Impact of Cardiac Rehabiliation on the Exercise Function of Children with Serious Congenital Heart Disease. Pediatrics Volume 116:6 pp.1339-1345 Rivers, E. (2001) Central venous oxygen saturation monitoring in the critically ill patient. Current Opinion in Critical Care. Volume 7, issue 3, pp. 204-211 Ruttenberg, H. (1983) Effects of Exercise Training on Aerobic Fitness in Children after Open Heart Surgery. Pediatric Cardiology Vol. 4, No. 1, pp. 19-24 Sarubbi, B. (2000) Exercise Capacity in Young Patients after Total Repair of Tetralogy of Fallot. Paediatric Cardiology 21: 211-215 Tomassoni, T. (1996) Role of exercise in the management of cardiovascular disease in children and youth. Medicine Science in Sports Exercise. Volume 28(4), pp 406-413 Washington RL. Et al. (1994) Guidelines for exercise testing in the pediatric age group. Journal of the American Heart Association. Volume 90;pp. 2166-2179 Zaccara, A. (2003) Cardiopulmonary Performances in Young Children and Adolescents Born with Large Abdominal Wall Defects. Journal of Pediatric Surgery Volume 38;3 pp 478-481

Cognitive Behavioral Therapy Essay -- Psychology, Rational Behavioral

Brief history of the theory and theorist. In it's simplest form, Cognitive Behavioral Therapy, (or CBT as it will be referred to from here on out), refers to the approach of changing dysfunctional behaviors and thoughts to realistic and healthy ones. CBT encompasses several types of therapy focusing on the impact of an individual's thinking as it relates to expressed behaviors. Such models include rational emotive therapy (RET), rational emotive behavioral therapy (REBT), behavior therapy (BT), Rational Behavior Therapy (RBT), Schema Focused Therapy, Cognitive therapy (CT). Most recently a few other variations have been linked to CBT such as acceptance and commitment therapy (ACT), dialectic behavioral therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT) (Harrington and Pickles, 2009). The main aspect that all of these branches of therapy share, is that our thoughts relate to our external behaviors. External events and individuals do not cause the negative thoughts or feelings, but, instead the perception of events and situations is the root cause (National Association of Cognitive Behavioral Therapists, 2010). The idea of thoughts as they connect to behaviors can be traced back to Epictetus (55 AD -135 AD , Greek Stoic and Philosopher). He stated, â€Å"Men are not disturbed by things, but by the view which they take of them (Epictetus and Higgonson, 1944). Epictetus also wrote, â€Å"Do not strive for things occurring to occur as you wish, but wish things occurring as they occur, and you will flow well (Epictetus and Lebell, 1994).† In other words, see things for what they really are and good health will follow (Romaneck, 2007).† Another belief was that a sage or teacher was immune to unhappiness and misf... ...cur via story, instruction or through music enhancement (Deggs & Davis, 49. 2011). Homework for CBT clients may include reading suggested articles or books, taking surveys, journaling, recording thoughts and challenging negative automatic thoughts, creating timetables and graded exposures (slowing bringing feared items to the forefront). Guided discovery, structured sessions, homework and collaboration. Socratic reasoning/questioning (open questioning). Challenging NATS (Negative Automatic Thoughts), challenging core beliefs. ERP (exposure and response prevention). Cognitive behavioral therapy uses the ABC model. A stands for action or activating event, B represents beliefs or thoughts that are created from the activating event, and C represents consequences or how we react to the event. Homework is a key component of this therapy.

The Science Of Superstitions :: essays research papers

<a href="http://www.geocities.com/vaksam/">Sam Vaknin's Psychology, Philosophy, Economics and Foreign Affairs Web Sites The debate between realism and anti-realism is, at least, a century old. Does Science describe the real world – or are its theories true only within a certain conceptual framework? Is science only instrumental or empirically adequate or is there more to it than that? Jose Ortega y Gasset said (in an unrelated exchange) that all ideas stem from pre-rational beliefs. William James concurred by saying that accepting a truth often requires an act of will which goes beyond facts and into the realm of feelings. Maybe so, but is there is little doubt today that beliefs are somehow involved in the formation of many scientific ideas, if not of the very endeavour of Science. After all, Science is a human activity and humans always believe that things exist (=are true) or could be true. A distinction is traditionally made between believing in something’s existence, truth, value of appropriateness (this is the way that it ought to be) – and believing that something. The latter is a propositional attitude: we think that something, we wish that something, we feel that something and we believe that something. Believing in A and believing that A - are different. It is reasonable to assume that belief is a limited affair. Few of us would tend to believe in contradictions and falsehoods. Catholic theologians talk about explicit belief (in something which is known to the believer to be true) versus implicit one (in the known consequences of something whose truth cannot be known). Truly, we believe in the probability of something (we, thus, express an opinion) – or in its certain existence (truth). All humans believe in the existence of connections or relationships between things. This is not something which can be proven or proven false (to use Popper’s test). That things consistently follow each other does not prove they are related in any objective, â€Å"real†, manner – except in our minds. This belief in some order (if we define order as permanent relations between separate physical or abstract entities) permeates both Science and Superstition. They both believe that there must be – and is – a connection between things out there. Science limits itself and believes that only certain entities inter-relate within well defined conceptual frames (called theories). Not everything has the potential to connect to everything else. Entities are discriminated, differentiated, classified and assimilated in worldviews in accordance with the types of connections that they forge with each other.

Healthcare It Security and Cloud Computing Essay

Abstract Through the passage of the Patient Protection and Affordable Care Act of 2010, the federal government is pushing healthcare providers and hospitals to quickly move towards electronic documentation systems or be penalized for non-compliance. This push has presented many problems for physicians and hospitals alike. Probably the most important issue that needs to be kept in mind when making a decision on a system is security and patient privacy. These two pieces present technological challenges as well as practical challenges including where and how the patient data is captured, stored, and accessed. HIPAA (Health Insurance Portability and Accountability Act of 1996) is the dictating law that must be kept in mind when choosing a medical charting system and the devices needed to access the system. Patient data and privacy must remain confidential and protected above any other concerns regarding electronic systems. Cloud computing is a â€Å"hot-button† topic that is becoming popular in business and healthcare. The convenience of access data from anywhere and from multiple hardware platforms has many benefits, but this ease of access comes with security concerns. These concerns must be reviewed and policies put in place to ensure that confidential patient data is not exposed. Security Issues: Healthcare I.T. and Cloud Computing Introduction The digital age has brought about many changes in the way certain tasks are performed, the way communication takes place, the way education is performed, and the way that medicine is practiced. As government regulation regarding healthcare practice and reimbursement becomes more strict and requires documented evidence to back up medical decisions before Medicare or Medicaid will pay the providers, it is becoming increasingly important for medical personnel and hospitals to not only conform to the new technological standards, but to embrace the technology that is driving it. In the past, organizations were required to host, store, and back-up the data and applications that were used both inside and outside of the facilities. This presented many difficulties such as application maintenance, data storage and maintenance, and hardware maintenance. Cloud computing offers some solutions to these issues by allowing IT departments to rely less on physical hardware, perform backups and duplicate them easily to offsite facilities, and provide application support to platforms that previously were unsupported. However, this presents significant security risk and legal liabilities with regards to HIPAA (Health Insurance Portability and Accountability Act) laws. Purpose The purpose of this report is to discuss the options available for implementing and accessing Electronic Medical Record Systems and the issues inherent with the different options, focusing on the security and privacy concerns specific to cloud computing. Scope This report will identify the reasons and methods for implementing cloud computing within the healthcare environment. It will also point out the security risks inherent to electronic storage of confidential health information and compounded by access to this information through the internet. As background information, the core components and functions of Healthcare IT will be discussed. The research will also cover the laws that govern the protection of PHI (personal health information), who has access to PHI, and what are the differences in the laws with regards to hosting a service versus being a user of the service. Sources and Methods of Collecting Data The research for this report was done primarily through secondary resources including the transcript from a webinar performed for healthcare IT and compliance personnel covering regulatory compliance within healthcare software as well as articles from Information Technology and Healthcare journals covering issues with security and â€Å"cloud† environments. A survey was also performed in 2009 of the physicians on active staff at Terrebonne General Medical Center. The primary research is also used to demonstrate the lack of adoption within the local physician community. Healthcare Information Technology Healthcare IT is not that different from IT in other industries. The maintenance of pc’s, servers, software, and network connectivity is the same regardless of the business. The difference between Healthcare and most other industries is that the nature of the data being held within the computer systems is incredibly personal and the protection of that data is highly regulated by government entities. Up until the last few years, it was primarily hospitals that had to be concerned with ensuring that electronic patient data was stored and protected correctly. Some technologically advanced physicians have already implemented Electronic Medical Record Systems, but most physicians are only now beginning to explore the multitude of options available due to the passage of the Patient Protection and Affordable Care Act of 2010 by the US Congress. Applications Within the realm of healthcare, there are typically two major divisions in computer applications. There are financial systems and clinical systems. Financial systems have been adopted in most hospitals and physician offices, largely due to requirements from insurance companies and government bodies that require data to be transmitted electronically for payment. Clinical systems, however, have not been implemented wide due to lack of knowledge and workflow interruption concerns. â€Å"Elaborate training in new e-healthcare systems is not a luxury that is typically available to healthcare professionals – i.e., doctors, paraprofessionals, (e.g., nurses) and administrative personnel—because of the 24Ãâ€"7 nature and criticality of operations of healthcare organizations, especially hospitals, thus making peer interactions and support a key driver of or barrier to such e-healthcare system use† (Venkatesh, Zhang, & Sykes, 2011). Data and security While a paper could be written solely regarding the storage and maintenance of electronic data, for the purposes of this paper only an overview and best practices will be discussed. Data can be stored in a multitude of different manners, all of which have benefits and downfalls. Saving data locally to a particular computer or other device can be dangerous. Should that device fail, the data saved to it could be lost. Also, data that has been saved locally to a device is more difficult to secure and guarantee that the data will only be accessed by the appropriate person or persons. From an enterprise or business level, the best practice for data storage is to ALWAYS save data to a central location so that is can be backed up regularly and can be accessed from multiple locations. It is also recommended for larger business such as hospitals to have duplicated backups and in some cases the data may be backed up to an off-site facility for disaster management purposes. Though proper backup practices are vital, data security is just as important. Software applications such as Microsoft Active Directory and Novell NETWare are used to provide security to a computer network and the data stored within. Through these systems, users must log into individual workstations and based upon the credentials provided to this log in, the user will only be allowed to access certain portions of the data which is stored somewhere else on the network. This method of access and storage is much safer and more easily controlled than it would be if the data were stored to the hard drive of the device the user is accessing. Security has become more difficult to enforce with the increased adoption of mobile devices. The rapid growth in the number, types, and functionality of mobile devices has been stunning†¦ currently there are over 17,000 healthcare mobile applications listen in major app stores, of which 50% are directed to healthcare professionals (Laverty, Kohun, Wood, & Turchek, 2011). Securing data accessed by Smartphones, tablet computers, iPads, and other handheld devices presents a host of new difficulties. In many cases, these devices are not owned by the facility and thus are not being accessed in the same manner as desktop pc’s and laptops. Challenges Controlling devices that access patient data while working within the confines of HIPAA is a key challenge for healthcare organizations. HIPAA privacy rules apply to all healthcare providers, health plans, healthcare clearinghouses, and business associates (Roach & Wunder, 2009). Internally, data security can be achieved by proper user habits such as logging out of a session when the user is not actively using the system, screensavers that require a password, and automatic timeouts during periods of inactivity all help to ensure that private data cannot be accessed by someone that does not have the legal rights to view the data. Many organizations undergo periodic security audits to assist in finding vulnerabilities within the systems being run. Not only is it a challenge to provide data access security, but it is even more difficult to physically secure a device that someone carries around with them and is not stationary. Some programs like Microsoft Exchange (for email) can require that a security threshold be in place before the program can be accessed from a particular device and have the ability to remotely wipe the data from a device should it become compromised. The mobile nature of handheld devices is also a major challenge. In years passed, laptop computers were the only valid threat to data being accessed from off-campus sites. As cellular data technology has gotten fast and now mobile devices can access these wireless systems from nearly anywhere, the threat of data security breaches has increased. Another challenge is keeping up dated with users that should no longer have access to the available systems. Internally, a systems administrator can keep track of employees that are still employed with the organization. It becomes a much more difficult task to police the accessibility of users outside of an organization. Cloud Computing What is cloud computing? The term â€Å"cloud† computing originates from the telecommunications world of the 1990s, when providers began using virtual private network (VPN) services for data communication. (Kaufman, Lori M.;BAE Systems, 2009) Cloud computing shares its resources among a cloud of service consumers, partners, and vendors. (Kaufman, 2009) In simpler terms, cloud computing is a shared infrastructure where hosting and accessing of services is not site specific. The data does not live only on a server in an office or building. Cloud computing can be used to offsite data backup. In lieu of housing a set of storage servers at an offsite facility, organizations can choose to back up their data to the cloud where it will be stored by someone else for a fee. The same process can be applied to applications. Rather than having to invest in expensive hardware that requires maintenance, organizations may choose to run web based applications that are hosted by someone else over the internet for a fee . Cloud computing allows for some systems to interconnect and share data, which is the end goal of electronic medical records and forming a personal health record for patients. Cloud computing has begun to take off as vendors such as Google and Apple have begun to open up their own cloud offerings. Some vendors offer these services for free, such as Google has with its Google Documents offering. Others, such as Apple’s iCloud are offered to users for a fee. Services such as these have enabled users to access personal data from anywhere at any time. Benefit to Implementing in Healthcare Though the upside to implementing EMR systems and sharing data is evident, there are drawbacks. One key concern is that practitioners will be slowed down due to the learning curve involved with using new systems. Physicians have grown accustomed to providing medicine in a certain manner, which does not always work well with electronic charting systems. Another issue at hand is who owns the data? Physicians are not always excited to share their personal notes regarding patient care. â€Å"The whole point of cloud computing is economy (Delaquis & Philbin, 2011).† With the passage of the passage of the Patient Protection and Affordable Care Act of 2010, physician and hospital organization reimbursement for Medicare and Medicaid will be tied to meeting certain â€Å"meaningful use† guidelines. In order to get full reimbursement for services provided, these providers are being pushed to document their practice of medicine electronically and in turn this information will be t he property of the patient and shared with other providers to ensure proper continuity of care. The idea behind this is that there will be fewer medical errors and the patient will have access to all the information necessary to make informed decisions regarding their healthcare. From a provider stand point, this means that â€Å"hopefully† all medically necessary information will be available to medical professionals in order to provide the necessary medical care and fewer errors will be made due to lack of patient health history. Electronic documentation and ordering also has a few other side effects. Fewer errors should be made due to less human intervention and interpretation of orders and, with luck, better coding and documentation of services rendered will lead to increased revenue. Because physician adoption is low, the building of personal health records is moving much more slowly (see Illustration below for EMR adoption rates at a local hospital) than the growth of cloud computing as a whole. Illustration 1 Conclusion Though there are definite risks involved with the storage and transfer of protected personal health information, the use of mobile devices in the work place is driving cloud computing and will continue to do so. In order to get healthcare providers to begin adopting electronic systems, the systems must be user friendly and work well within the flow of the practice of medicine and not inhibit the proper care from provided. The environment of healthcare is changing and the delivery of healthcare information must change with it. Patients no longer expect to just be given appropriate care, but they now insist on being involved with the decision making regarding how that care is rendered. Moving health information into a cloud environment and allowing that information to be shared will eventually lead to better healthcare for everyone, no matter which hospital the patient is in or which physician is providing the care. Works Cited Delaquis, R. S., & Philbin, G. (2011). To Cloud or Not to Cloud? Issues in Information Systems, Volume XII, No. 1, 54-58. Kaufman, Lori M.;BAE Systems. (2009, July/August). http://www.computer.org. Retrieved from IEEE Computer Society: http://www.computer.org/csdl/mags/sp/2009/04/msp2009040061.html Laverty, J. P., Kohun, F. G., Wood, D. F., & Turchek, J. (2011). Vulnerabilities and Threats to Mobile Device Security from a Practitioner’s Point of View. Issues in Information Systems; Vloume XII, No. 2, 181-193. Miller, Esp., W. J. (November 3, 2011). New World of Medical Appls: Beware Regulatory Traps! Progressive Healcare Conferences. Malvern, PA. Mishra, S., Leone, G. J., Caputo, D. J., & Calabrisi, R. R. (2011). Security Awareness for Health Care Information Systems: A HIPAA Compliance Perspective. Issues in Information Systems, Volume XII, No. 1, 224-236. Pardue, J. H., & Patidar, P. (2011). Threats to Healthcare Data: A Threat Tree for Rick Assessment. Issues in Information Systems, Volume XII, No. 1, 106-113. Paullet, K. L., Pinchot, J. L., Douglas, D., & Rota, D. R. (2011). Mobile Technology: Plugged In and Always On. Issues in Information Systems; Volume XII, No. 1, 141-150. Roach, W., & Wunder, G. (2009). Privacy Under Health Insurance Portability and Accountability Act (HIPAA) of 1996: The Impact of RFID. Issues in Information Systems, 237-241.

How the Environment Plays a Role in Learning? Essay

During the 1990s, considerable interest has been generated in the design of constructivist learning environments. The promise of these systems to leverage capabilities of technology, empower learners to pursue unique goals and needs, and re-conceptualize teaching-learning practices has sparked both provocative ideas as well as heated debate. Yet, problems in grounding designs within established theory and research are commonplace, as designers grapple with questions regarding epistemology, assumptions, and methods. Problems in implementation and practice are also commonplace, as pragmatic constraints surface and conflicting values emerge. We suggest three key issues that are likely to dominate the constructivist learning environment landscape. Inertia and the Tyranny of Tradition: Old Dogs, New Tricks? Although as educators we espouse support for constructivist approaches to teaching and learning, we continue to rely on familiar pedagogical approaches such as lectures, worksheets, and rote learning practices. At the moment, educators perceive such approaches as more compatible with traditional expectations and methods of student assessment and better supported by existing infrastructures. Stated differently, it is easier and more efficient to maintain current practices than to promulgate approaches for which significant shifts–epistemological, technological, and cultural–are required. (Swef, 2002) In truth, few designers have acknowledged, much less successfully negotiated, the hurdles associated with transforming a highly traditional community of educational practice. Yet, as constructivist learning environments are repurposed to fit traditional classroom practices, mismatched theoretical foundations, assumptions, or methods may result. Instructional methods or assessment practices are often added to (or taken away from) original designs to make them more compatible with classroom pragmatics and constraints. In essence, constructivist pedagogy is applied to attain traditional goals, and the environment becomes an instance of what Petraglia ( 1998) refers to as â€Å"domesticated constructivism† (cited in Karyn, 2003). For instance, a teacher may intend to use a constructivist environment within  a climatology unit to support hypothesis generation, prediction, data collection, and analysis. The environment may also employ powerful visualization tools and complex sets of meteorology databases and resources (perhaps from the WWW) in ways that are consistent with the environment’s constructivist foundations. (Swef, 2002) Yet, as pedagogical methods are considered, they may be tempered by the prevailing cultural values of high standardized test scores and mastery learning of basic skills. Consequently, rather than engage in prediction, interpretation, and data analysis, learners instead search databases to find specific answers to questions established in advance (e.g., find the temperature in San Diego; define the greenhouse effect; what is the coldest day on record in Los Angeles). Pragmatic influences may also intervene. (Karyn, 2003) Activity may be limited to the traditional two 50-minute class meetings per week and conventional tests and assessments of the unit’s meteorology content. Perhaps only a single computer is available, and consequently the teacher chooses to project and demonstrate the tools and resources rather than allow students to define, solve, and collaborate on weather prediction problems. (Zevenbergen, 2008)Learned Helplessness and Learner Compliance: â€Å"Will This Be on the Test?† In typical constructivist learning environments, students establish (or adopt) learning goals and needs, navigate through and evaluate a variety of potentially relevant resources, generate and test hypotheses, and so forth (Oliver, 1999). Teachers clarify rather than tell, guide rather than direct, and facilitate student effort rather than impose their own approaches. For both teachers and learners, these represent radical departures from conventional school-based learning activities. Teachers have traditionally possessed the required knowledge, determined what is correct and what is incorrect, and set and enforced grading standards. (Goodyear, 2001) Students are told what knowledge is required, which answers are correct and which are incorrect, and the standards that separate good from bad students, average from substandard performance, and robins from bluebirds. A pact between teacher and student is tacitly struck and enforced: Good teachers make the preceding explicit and direct student effort accordingly, while good students learn quickly to detect and comply with the standards. Research in the late 1990s on student engagement in constructivist learning environments has underscored several disturbing patterns. Land and Hannafin (1997), for instance, examined how seventh graders used the ErgoMotion (Karyn, 2003) roller coaster micro world to learn about force and motion concepts. Despite numerous and varied features and opportunities for learners to hypothesize, manipulate, and test predictions, many learners failed to either connect key concepts well or internalize their understanding. In lieu of the teacher, and perhaps in an attempt to identify what the system required of them, most relied exclusively on the explicit proxy structure provided by the system. They frequently queried the researchers as to whether or not responses were correct or whether they had â€Å"done enough yet.† Students were dependent on, and sought compliance with, external agents to tell them what, when, and in what order to respond, as well as to judge the quality, accuracy, and completion of their efforts–skills essential to constructivist learning environments. (Kember, 2007)Similarly, numerous compliant strategies in web-based, hypermedia environments were reported among middle school (Oliver, 1999) and adult students. Learners tended to use externally provided questions almost exclusively to navigate the system and find â€Å"answers† to open-ended problems (Kember, 2007). Similarly, Karyn (2003) reported that children attempted to apply traditional strategies to presumably web-based inquiry-oriented learning tasks. They tended to view the activity as finding the correct answer to their research question and â€Å"thus reduced the task to finding a single page, the perfect source, on which the answer could be found†. In these instances, learners invoked methods that do not typically support or promote open or inquiry-based learning–ironically the strategies required for successful performance in formal education. In the late 1990s, constructivists have emphasized the importance of scaffolding learner self regulation and strategic processes to help learners manage the complexity of the environment (Karyn, 2003). It is important to determine how learners use available scaffolds and to adapt accordingly. Without strategies appropriate to student-centered learning tasks, learners may fail to either invoke the affordances of the environment or to develop the strategies engendered by them. The Situated Learning Paradox. â€Å"I Know What I Know.† Although prior knowledge and situated contexts enhance transfer potential (Oliver, 1999), they also engender incomplete, naà ¯ve, and often inaccurate theories that interfere with rather than support learning. Paradoxically, these are precisely the types of thinking constructivist learning environments build upon. Most learners, for instance, believe that heavier objects sink and lighter objects float; their personal experiences confirm this intuitive theory. The resulting misconceptions, rooted in and strengthened by personal experience, are highly resilient and resistant to change. Although personal theories are considered critical to progressive understanding, they can become especially problematic when learners become entrenched in faulty theories to explain events that cannot be tested within the boundaries of a system or fail to recognize important contradictory evidence. (Cunningham, 2008)Learners referenced pri or knowledge and experiences that either contradicted or interfered with the environment’s treatment of the concepts of force and motion (Zevenbergen, 2008). In one case, theory preservation seriously limited the ability to learn from the system. One student failed to either detect system-provided information or seek confirmatory data due to the intractability of his beliefs; he was so entrenched in his beliefs that he failed to seek and repeatedly overlooked counterevidence (Karyn, 2003). In another case, a learner recalled an operator remarking that roller coaster brakes and clamps would terminate a problem run immediately. Consequently, she mistakenly perceived the coaster to be slowing down around curves, falsely confirming her belief that brakes were applied when they were not. Because they were strongly rooted in personal experience and could not is tested using the available tools, faulty conceptions endured. Thus, the completeness of a system’s representation of simulated phenomena is critical because learner’s access related prior knowledge and experiences that may contradict the environment’s treatment of th ose concepts. In sum, several perspectives regarding design of learning environments have emerged in response to interest in alternative epistemologies. Although considerable progress has been made to advance researchers’ understanding, many questions and issues remain. Whereas some studies have identified  problems and issues related to the design and implementation of constructivist learning environments, others have reported noteworthy benefits. It is imperative that efforts continue not only to ground design practices more completely but also to better understand the promise and limitations of constructivist learning environments. References Cunningham, Billie M. (2008) Using Action Research to Improve Learning and the Classroom Learning Environment. Issues in Accounting Education, Vol. 23 Issue 1, p1-30,Goodyear, P., Salmon, G., Spector, J. M., Steeples, C. & Tickner, S (2001) â€Å"Competences for Online Teaching: A Special Report†, Educational Technology, Research & Development, Proquest Education Journals, pp 65-72Karyn Wellhousen, Ingrid Crowther (2003) Creating Effective Learning Environments. Florence, KY: Delmar Cengage Learning. Kember, David; Leung, Doris Y. P.; Ma, Rosa S. F.. (2007) Characterizing Learning Environments Capable of Nurturing Generic Capabilities in Higher Education. Research in Higher Education. Oliver, R. (1999) Exploring strategies for online teaching and learning. Distance Education, 20, 2, Proquest Education Journals, pp 240-54Swef Chiew Goh, Myint Swe Khine. (2002) Studies in Educational Learning Environments: An International Perspective. New Jersey: World Scientific Publishing Company. Zevenbergen, Robyn; Lerman, Steve. (2008) Learning Environments Using Interactive Whiteboards: New Learning Spaces or Reproduction of Old Technologies? Mathematics Education Research Journal, Vol. 20 Issue 1, p107-125