The Usage Of Information And Communication Technologies Education Essay

AbstractionThe universities expenditure on computing machine substructure has increased dramatically for the last five old ages, as the establishments attempts to intermix ICTs into all facets of instruction and acquisition. And with the revolution in ICTs connectivity, handiness, package and hardware handiness is no longer an major issue. As universities are puting immense sum in incorporating ICT into faculty members and the survey aims to understand the pupils and instructors positions on the usage of information and communicating engineerings ( ICTs ) as teaching-learning tools in higher instruction. The survey aims to derive a better apprehension of the function engineerings play in back uping teaching-learning activities and penetration into what pupils and teacher perceive to be the benefits and restrictions of utilizing engineerings in higher instruction. The survey focuses on the alterations in pupil ‘s communicating form with the coming of ICTs. A study was conducted utilizing a graded sampling technique and a structured questionnaire was employed to roll up informations from five 100 pupils of Anna University across all subjects. To understand the instructor ‘s perceptual experience of ICTs an in-depth interview has been conducted among 50 instructors from Anna University. The survey reveals that the pupils are able to have big content in different formats from assorted beginnings and these content fulfil the single demands of the pupils. Networking and interaction among instructors and pupils helps to unclutter the uncertainties round the clock. The technological discovery encourages the pupils to come out of their inhabitancy and is motivated to take part in capable based treatments. This transforms the University campus from the inactive to collaborative and progressive establishment.IntroductionIntegration of ICT in Higher instruction: The bend towards the computing machine based teaching-learning over the past 20 old ages is assumed to hold revolutionized and revitalized the higher instruction sector. Thus, stark ultimatums continue to be made by instruction engineers that universities must either ‘transform or decease ‘ in the face of technological advancement ( Bates, 2004 ) . Higher instruction is undergoing a paradigm displacement by incorporating engineering to leave instruction. The ICT-driven alterations have left constructs like distance and clip wholly excess. What is needed now is the right sort of models for different manners of acquisition and it is indispensable that alterations anticipated over the following decennary or two be taken into consideration. The estimated worth of ICT in India is Rs 4,00,000 crore and is turning at 20 per cent yearly. â€Å" By the twelvemonth 2020, about 25 per cent of India ‘s economic system will be accounted by ICT entirely ( Bhatkar, 2011 ) . While universities have begun to recognize that the acceptance and integrating of information and communicating engineerings ( ICT ) has become a competitory necessity, they have besides begun to recognize that there is still much to larn about how to strategically place ICT to guarantee the greatest positive consequence on university success. ( Romaniello, Rey, Carlos, & A ; Medlin, 2010 ) . Impact of ICT can non be straight measured and can merely be measured by analyzing its indirect effects on the procedure of instruction and acquisition. Universities need to see how technology-based instructional plans are mounted to guarantee that pupils use the Internet effectively as a acquisition tool for assorted reliable larning activities such as carry oning research on a given subject or happening relevant information for an assignment. The Internet can supply the undermentioned three basic types of tools in the educational sphere: Tools for enquiry, Tools for communicating, Tools for bu ilding ( Gudanescu, 2010 ) . 1.2 Information communicating engineering revolution Introduction compose up on ICT with commendations Harmonizing to the wiki books ICT is defined as â€Å" Diverse set of technological tools and resources used to pass on, and to make, circulate, shop, and manage information. These engineerings include computing machines, the Internet, airing engineerings ( wireless and telecasting ) , and telephone. In recent old ages tremendous involvement has been shown by academicians, developers and policy shapers on how computing machines and cyberspace can be efficaciously used for instruction at all degrees. ICT has a important impact in the manner instructors and pupils communicate. Communication in the learning procedure provides a transportation of information between university instructors and pupils. e.g. e-mail communicating over the Internet. Such a natural manner of communicating is verbal ( face to face ) or non-verbal where there is an absence of personal contact of consigner with the perceiver changes the natural theoretical account of communicating between instructors and pupils. The Internet has been interfering with the class of the educational procedure at universities because the modern-day coevals of pupils is sing the Internet to be a to the full natural agencies of communicating non merely between themselves but besides with their instructors. This means of communicating is characterized by important positives ( particularly for external survey ) , but besides negative facets pre-described by the clip facet and particularly by non managing the regulations of such manne r of communicating by pupils. It is for these grounds that the part is dedicated to the Internet communicating at two degrees: university instructors and pupils, the positive and negative facets, which evidently complicate the educational procedure. ( ZeleA?akova , Pavolova , & A ; Bakalar, 2012 ) 1.3 ICT integrating At Anna University: Anna University has taken several enterprises to heighten instruction both by being the content supplier and by supplying the proficient substructure. Digital acquisition is offered to the pupils in assorted formats like Cadmium, entree to e diaries and books through the intranet, audio-video talks programmes are offered free on the web. Video Conference / Video-on-demand installation enable the pupils / module to take part in talks delivered in any campus. Anna University has late introduced Wi-Fi ( wireless cyberspace connexion ) for the pupils and staff which made cyberspace entree possible anyplace, anytime in the campus. This has lead to a dramatic addition in pupils ‘ usage of omnipresent engineerings over a period of one twelvemonth. With the turning trust on information systems and increasing celerity of the debut of new engineerings into larning environment, placing the critical factors related to user credence of engineering continues to be an of import issue. 1.4 Barriers in effectual acceptance of ICT in Universities: The organisational civilization of traditional higher instruction establishments is still defined mostly by the function of the module. The propensity of the mean module member to put in new teaching methods is undermined by two features of traditional academic civilization: the famine of inducements to advance invention in learning excellence and the isolation in which most pedagogical determinations are made. In fact, module members have about absolute liberty over determinations sing instructional quality within the schoolroom, taking one perceiver to mention to higher instruction as â€Å" one of the last centres of craft-based production † ( Taylor 1998 ) . That theoretical account will stay sustainable at some, but non all, traditional establishments. Those driven by external forces to do the most marked alterations will happen their success closely linked to their ability to prolong occupation satisfaction among their module members. 1.5 Need for the survey: Despite immense attempts to place computing machine engineering as a cardinal dogma of university instruction, the fact that many pupils and module make merely limited formal academic usage of ICT during their instruction and acquisition is less discussed by educational engineers. Contradicting the impression of the ‘cyber-campus ‘ , the existent formal usage of new engineerings in undergraduate and alumnus surveies remains inconsistent and extremely variable from class to class and establishment to establishment ( Breen et al. 2001 ; Marriott et Al. 2004 ) . Classroom uses of potentially powerful information engineerings are seen to frequently take the decreased signifier of ‘mindless activities ‘ that do little to change the outlooks, premises, and patterns of higher instruction instruction ( Moule 2003 ) . Regardless of the benefits of ICT supported instruction, it is seen that ICT supported instruction has non been promoted at a coveted degree in the instruction procedure. Among the grounds stated are the concerns that pupils involvement in topic will diminish and pupils get distracted due limited figure of computing machines. On the portion of instructors they have non acquire the needed preparation to utilize ICT efficaciously for learning acquisition and are reported non to happen sufficient clip to be able to utilize computing machines, due to the deficiency of proficient support and strength of the course of study. Above mentioned are some of the issues that are barriers in effectual execution of ICT in instruction.2. Previous ResearchMillennial, Electronic Natives, the Net Generation, many names have been used to depict the new coevals of college pupils, whom experts have identified as being clearly different from the old coevalss in footings of their technological abilities, te amwork accomplishments and openness to participatory teaching methods. However there is general understanding that younger pupils do non hold the same attributes as their older opposite numbers, bookmans and observers still offer divergent appraisals of this contrast. Such contrastive histories suggest that even if younger pupils have greater degrees of comfort or proficiency with new engineerings, it is still problematic whether such traits needfully entail more unfastened, progressive, or positive positions of the educational procedure. ICT is transforming all facets of society-from instruction to civic engagement, employment to leisure. Some writers are optimistic and argue that ICTs can take down costs, supply users with more information, make markets more efficient, and better public service. Some go farther and argue that ICTs can do societies healthier, wealthier and more democratic. While others are more doubting about the adoptability of ICT in higher instruction. Any kid born since the beginning of this century is turning up in a digital universe. Those born at the start of the century, already in the in-between old ages of primary school, have been dubbed the â€Å" Net coevals † or, more descriptively, â€Å" digital indigens † ( Prensky, 2001 ) . Oblinger and Oblinger ‘s ( 2005 ) depict the features of the ‘net coevals ‘ – pupils born after 1980 – proposing that these pupils basically differ from old coevalss in the manner they process information and communicate ( and therefore learn ) . They argue that these pupils are comfy with engineerings and suggest that the ways in which they learn is task orientated and experiential. These scholars prefer to have information rapidly, are adept at treating information and multi-tasking, and utilizing multiple/multi-modal communicating channels to entree information and communicate with friends and coachs. However, Kennedy et Al. ( 2006 ) concur with Sharpe et Al. ‘s ( 2005 ) position that there is a famine of surveies looking specifically at pupil usage of engineerings, reasoning that more empirical research is needed to back up the claims made about the net coevals. They conducted a survey looking at pupils ‘ usage of emerging engineerings, concentrating on how pupils were utilizing these to pass on, print and portion information. Their initial findings point to extended usage of engineering by pupils ; they argue that this has considerable deductions for institutional policy and pattern. Kirkwood and Price ( 2005 ) reported on informations from the Open University crossing five old ages on pupils ‘ attitudes to and experiences of engineerings. They found that there was a dramatic addition in pupils ‘ entree to and usage of ICT over the five-year period. Their meta-analysis revealed that there were differences in pupil entree to, experience of and attitude towards engineerings across capable subjects. Take together these surveies suggest that engineerings are basically impacting on the ways in which pupils learn, but that more in-depth research is needed to understand the niceties of how pupils are utilizing engineerings to back up their acquisition. Surveies that focal point at a more powdered degree of analysis of pupils ‘ usage of engineering are besides of import in the context of our research. De Laat ( 2006 ) studied emergent pupil functions and battle with e-learning activities and found that pupils are actively involved in organizing and modu lating personal and shared acquisition activities. The findings showed that pupils at assorted phases of their class developed peculiar acquisition schemes and facilitation accomplishments to back up their online acquisition. Sweeping anticipations are frequently absorbing, but most alteration processes play out in nuanced and incremental ways. While alteration in higher instruction expedited by engineering is a safe stake for the hereafter, it is every bit certain that engineering acceptance will continue unevenly across the higher instruction landscape and be driven by a broad scope of factors. Switching demographic, market, political, and other forces will necessitate many colleges and universities to redefine their institutional civilizations and missions. In an exploratory survey that examined attitudes and use of ICT among undergraduate direction pupils in Barbados Glenda Gay, et Al ( 2006 ) observed that the pupils were by and large favorable towards ICT. Males were more inclined to integrate ICT in web based direction compared to other instruction activities. Older pupils were more interested in utilizing ICT merely as a addendum to learning activities. They suggest that university decision makers need to turn to the gender and age differences sing ICT use every bit good as develop schemes to keep positive pupil attitudes and high use of ICT. Our accent on digital ICT tools and applications in instruction mirrors profound structural alterations happening worldwide in communications and information industries. The ability to digitise parallel signals and convey them over telecommunications webs is ensuing in the restructuring of the wireless, telephone, telecasting, publication, amusement, and computing machine industries into new multimedia industries that create digital merchandises uniting voice, picture, text, artworks, images, and lifes, and present these signals electronically ( Bane, Bradley, & A ; Collins, 1995 ) . Indeed, the formal usage of computing machine engineerings in many countries of higher instruction could outdo be described as sporadic, uneven, and frequently ‘low degree ‘ ( in stark contrast to the frequently inventive and informal utilizations that pupils and module brand of engineerings like nomadic telephone and other personal digital devices ) . This state of affairs has prompted some observers to disregard ICT in higher instruction as nil more than a ‘service ‘ country of course of study and teaching method which many pupils and module are loath to prosecute with in an active or sustained mode ( Reffell & A ; Whitworth 2002 ) . While rethinking the topographic point of engineering Peter goodyear states â€Å" A important portion of the kineticss of invention in the field of instruction has been engineering push. As each emerging engineering comes onto the radio detection and ranging of instruction, a mix of old and new partisans spend their clip happening jobs that can be addressed by the new solutions. This is a healthy facet of the procedures of placing the educational affordances of a new tool or artifact, but it does promote an unhelpful mentality: one in which the new thrusts out the old, continuity of professional experience is undermined, and technological carts come before educational Equus caballuss. † Students are finally the chief donees of the push to capitalise on ICT to better the entree to and quality of higher instruction. Students in the twenty-first century are ICT indigens who welcome the debut of engineerings in their acquisition procedure. They may even demand the universities to overhaul their systems and learning patterns to maintain up with workplace demands. The anyplace, anytime manner of acquisition and the networked communities harmonize really good with immature people ‘s life styles and the communicating media of their clip and age. All e-learning classs will hold to be designed to fit their acquisition manners and demands. ( UNESCO, 2011 ) . A survey on pupils and university instructors questioning who reciprocally benefit from the Internet communicating in the acquisition procedure point to deficiency of a by and large acceptable degree of the Internet communicating. It indicates that on the one manus, pupils complain about the instead long clip for responses to their electronic mails from instructors every bit good as the reluctance of university instructors to take part in on-line communications. University instructors to a greater extent knock the quality of the Internet communicating with pupils but their demands are non declared clearly plenty or are non declared at all. Both pedagogues and pupils need to be trained to utilize ICT to increase the overall quality of instruction and the effectivity of the communicating between instructors and pupils ( ZeleA?akova , Pavolova , & A ; Bakalar, 2012 ) . Bennett and Bennett ( 2003 ) , who studied the impacts of sensed features of instructional engineering on module members ‘ willingness to incorporate it in their instruction, found out that the most of import factor which impedes the usage of engineering in higher instruction is non the deficiency of technological installations or fiscal financess, but module members ‘ reluctance and their incredulity in the usage of engineering. Medlin ( 2001 ) studied different variables and identified the factors which are likely to impact instructors ‘ determinations on doing usage of electronic engineerings throughout the instruction procedure and found out that the personal motive is an of import factor which forces module members to better their instruction methods and contribute to the acquisition of pupils by technological agencies. Jenny Waycott, Sue Bennett, Gregor Kennedy, Barney Dalgarno, Kathleen Gray ( 2009 ) in their survey that investigated Australian university staff and pupils ‘ perceptual experiences and usage of current and emerging engineerings both in their day-to-day lives and in instruction and larning contexts says that â€Å" For staff, the cardinal restrictions of utilizing engineerings in higher instruction were: additions to their work loads ; usability/technical issues ; the loss of face-to-face interaction.3. AimTo cognize the Teacher ‘s attitude and use of ICT for learning acquisition. To cognize the pupil ‘s attitude and use of ICT for learning acquisition. To place the spreads in the effectual use of ICT among the instructors and pupils. To propose new attacks for effectual use better the ICT.4. METHODology ( look other articles to compose )This survey explores the issues raised in these surveies in more deepness. In order to understand the difference in the perceptual experience of engineering among pupils and instructors of Engineering plan a sample of 500 pupils and 50 instructors was taken for the survey. The research worker collected informations utilizing a ego administered questionnaire. from a graded random sample of 500 pupils from different subjects of Engineering from Anna University. The study was conducted during the month of December 2011. The survey involved an in deepness interview with the instructors from assorted sections to understand their perceptual experience on use of engineering in teaching-learning procedure. A sample of 50 instructors has been taken for the survey. Out of the 50 instructor 20 are in their early 30 ‘s and 15 are in their late 40 ‘s and 15 above 50 ‘s. ( May be in consequences )( How many questionnaire distributed? No. of respondents: aˆÂ ¦ )5. RESULTS & A ; DiscussionThis survey has followed study method and in-depth interview methods to garner the information. Data collected from the different methods loosely classified in four classs like instructors and pupils Attitude to information engineering, Access to information engineering, Usage of ICT and educational content, Change in communicating form due to ICT. These provide a higher-level description of the manner in which pupils and instructors were utilizing engineerings and their associated perceptual experiences of engineerings. The consequences are presented and discussed below.Attitudes to Information TechnologyMajority favorable attitudes to the usage of ICT within the academic environmentTyping assignments 90 %Part of their surveies 95 %Supplementing other learning activities 72 %E-mailing inquiries to instructors 70 %Use computing machines as replacings to other traditional instruction activitiesMale 55 %Female 33 %Preferred utilizing the computing machine as a addendum to learningOlder pupils ( over 22 old ages ) 81 %Younger pupils ( 19 old ages and under ) 19 %Social networking site as observed by many research workersFacebook 92 %Download packages and music 94 %Small figure of pupils on-line purchasing of tickets – ?1. Opinion on ICT based instruction S. No. Description Yes To an Extent No 1 Do you experience incorporating ICT ( Information Communication Technology ) in instruction is of import? 2 Does your college encourage you to purchase new appliances and accoutrements? 3 Do you believe ICT ( information communicating engineering ) can counter the defect in traditional acquisition? 4 Is Blended acquisition ( utilizing computing machine based instruction as a auxiliary tool for learning ) beneficial? 5 Do you believe engineering has an impact on your day-to-day life? 6 Have engineering alterations the manner you communicate with your friends? List the activities you do with the computing machines? S. No. Description Regularly Frequently Occasionally Never 1 Lab work 2 Surf cyberspace 3 Prepare presentation 4 Make assignment 5 Play games 6 Look for lucifer tonss 7 Social media sites 8 Movies/song download 9 Search for intelligence updates 10 Others ( stipulate ) 9. Click the appliances you own from the list below S. No. Description Yes No 1 Laptops 2 Desktops/personal computing machine 3 Mobile with net installation ( GSM ) 4 Mobile without net installation ( GSM ) 5 Ipod 6 Ipad 7 Personal digital assistant 8 Pen thrust 9 External difficult disc 10 Others ( Specify ) This survey found that Engineering pupils were by and large favorable to ICT in an academic scene. The bulk ( 99 % ) of the sample expressed favorable attitudes to the usage of ICT within the academic environment. Computer ownership is high and pupils have become accustomed to being able to electronically entree information. The features of the net coevals are apparent in the information. Besides there is grounds from the information that there is a displacement from inactive to more synergistic facets of acquisition. Technology is at the bosom of all facets of their lives as bulk ( 87 % ) of the pupils own more than 5 appliances namly mobile phone, laptop, desktop, pendrive, mp3. However, pupils were immune to the usage of computing machines as full replacing of the regular, traditional instruction experience. This determination suggests pupils ‘ strong penchant for both signifiers of the academic experience ( i.e. , interaction with the instructor and interaction with information engineering ) . Furthermore, Frizler ( 1995 ) asserts that although computing machines can ne'er replace instructors, computing machines can â€Å" supply first-class and reasonably cheap auxiliary stuffs to heighten schoolroom direction † ( Bataineh and Baniabdelrahman, 2005 ) . Particularly, pupils were more inclined to utilize computing machines for: typewriting assignments ( 90 % ) , portion of their surveies ( 95 % ) , supplementing other learning activities ( 72 % ) , and e-mailing inquiries to instructors ( 70 ) . With regard to gender, no important gender differences were found bespeaking that both males and females by and large had a penchant for the usage of information engineering but the appliances owned by male pupils ( more than 5 ) were relatively more than the female pupils and the clip spent with engineering were higher among the male pupils. However, males ( 55 % ) , to a important grade, by and large preferred to utilize computing machines as replacings to other traditional instruction activities, compared to females ( 33 % ) . Refering comparings utilizing age, no important differences were found. However, a important age difference was found for utilizing the computing machine as a addendum to other instruction activities. Older pupils ( over 22 old ages ) ( 81 % ) preferred utilizing the computing machine as a addendum to instruction, compared to younger pupils ( 19 old ages and under ) . Students use engineerings in their mundane interactions with household and friends are different from their penchants for engineering usage in formal acquisition scenes. For many a pupil ‘s instant messaging and ( 90 % ) societal networking remain within the range of their private lives. Their preferable societal networking site as observed by many research workers remained to be face book ( 92 % ) . Apart from chew the fating over face book they besides used cyberspace to download package ‘s and music ( 94 % ) . Small figure of pupils ( 17 % ) said they do on-line purchasing of tickets, book and appliances. A complete tabular array needed and some graphsInformation seeking and managingStudents are adept at happening and pull stringsing relevant information and synthesising across different information beginnings and utilize a assortment of communicating tools to back up their acquisition demands. Students used the web extensively to widen their apprehension of constructs and supplement class stuff. Search engines and information sites such as Wikipedia were often mentioned. Several reported that seeking with Google was their first action when seeking to acquire information for an assignment. Some of the pupils have reported that they have non found relevant information and had to utilize alternate beginnings of paper- based information. A figure of pupils highlighted that a cardinal benefit of engineerings was the chances engineerings provide in footings of handiness. Despite the many favorable remarks about engineerings there were still some usability issues. Students were critical of severely designed web sites and package which appeared ‘old fashioned ‘ . They stated happening shoping through over-structured web sites, with ill designed pilotage frustrating, as they are used to the ( deceivingly ) simple and seemingly effectual interface of hunt engines. Specialised subject-based sites were often cited. Printed text editions were considered by some to be outdated and hard to digest but were still used by many as cardinal resources. A complete tabular array needed and some graphs . Purpose of internet use: Purpose of utilizing ICT S. No. Description Yes No 1 Doubt elucidations 2 To listen to Lecture 3 Research intents 4 Syllabus based entree 5 Measure yourself 6 Interaction with experts 7 To fix for scrutinies 8 To acquire depth cognition in the country of involvement 9 For undertaking plants 10 To seek occupation chances 11 To seek inside informations about higher surveiesChange in communicating formUse of communicating engineerings to back up their surveies was extended. Many pupils reported utilizing nomadic phones often to phone and text each other, to discourse issues related to their acquisition, and peculiarly for assignment questions. They expressed positive feelings about the communicating engineerings they used, though some found the frequent breaks which arose as a effect of this changeless communicating disruptive to analyze. Email was used universally and was the chief channel for communicating with coachs. About all our communications with the university are through electronic mail. They use email to pass on with everyone, particularly lectors ; set uping meetings, inquiring inquiries about work and questions over assignments, etc. Some preferable to utilize text messages and instant messaging with equals, using the extra functionality available with the latter for sharing files and organizing meetings. Instant courier, free to utilize, easy of usage to talk to people with fast response, ability to portion files across it, ability to work on group undertakings with it, and ability to video conference. Students expected and by and large received speedy responses to their electronic mails and appreciated the flexibleness this provided. Low cost communicating engineerings such as Skype ( package which allows pupils to name people for free or at a low cost via the cyberspace ) , MSN confab and electronic mail were considered priceless signifiers of communicating and were being used in a assortment of different ways ( student-student, student-friends/family, student-department/ university or coach ) . Skype was mentioned by some of the pupils as a cheap, easy manner to maintain in touch with friends and household. For some pupils text messaging and the nomadic phone, although popular, were regarded as more expensive options. Information retrieval from the web was chiefly for text-based stuffs, but pupils besides reported seeking for images ( to include in presentations ) . A complete tabular array needed and some graphs . Mode of Study stuffs circulated by your instructors S. No. Description Regularly Frequently Occasionally Never 1 Photocopy 2 Electronic mail 3 Books ( print ) 4 Pen thrust 5 Mobile 6 Others ( stipulate )Teachers perceptual experience of TechnologyMost of the instructor who were in their early 30s had some entree to computing machine in their higher instruction and hold gone about updating their cognition as they felt learning with the engineering is really effectual. They use power point slides for their category and give online mentions to the pupils. Many instructors felt that with the aid of engineering information aggregation and storage has simplified. They besides encourage pupils to make online entry and connected to pupils through groups and societal networking sites. Many of the instructors who are in their late 40 have non received any formal preparation in computing machine and have learned computing machine on occupation. They said they felt batch of trouble in the beginning but as they started utilizing it, it has simplified and enhanced their instruction. Most of the instructors still prefer books and are more comfy reading books that the vitamin E books. Almost all instructors are comfy with smart category suites and are utilizing batch of multimedia to do their instruction interesting and enlightening. Many of the instructors have besides expressed their sentiment that integrating ICT in learning is clip devouring and needs entree to batch of substructure. They want the establishment to recognize instructors to utilize ICT and supply the necessary substructure so that others who are non users of ICT will be motivated. A complete tabular array needed and some graphs 26. What do you believe is the chief hinderance for integrating of ICT ( information communicating engineering ) in teaching-learning procedure? S. No. Description Strongly Disagree Disagree No Opinion Agree Strongly Agree 1 Lack of Time 2 Syllabus force per unit area 3 Infrastructure inability 4 Addicted to the engineering 5 Not interacting face to confront with people 6 Additions disbursals 7 Others ( delight specify ) 18. Main manner of communicate with pupils S. No. Description Most frequently Frequently Sometimes Rarely Never 1 Face to confront 2 Electronic mails 3 Mobile rivers 4 Forums 5 Chat 6 Web log 7 Others ( Specify ) Mode of Teaching S. No. Description Most frequently Frequently Sometimes Rarely Never 1 Lecture 2 talk and utilize Blackboard 3 Lecture and usage OHP projector 4 Lecture and usage LCD projector 5 Tocopherol contentFINDINGS AND CONCLUSIONSelect of import points from the Results and Discussion and revision hereThis survey found that Engineering pupils were by and large favorable to ICT in an academic scene. Older pupils were more favorable to computing machine usage as a addendum to other instruction activities, compared to younger pupils. Students had entree to computing machines and the Internet off campus. There besides seems to be widespread use of assorted signifiers of information engineering such as Internet, WebCT and electronic mail. Students are comfy with engineering and see it as built-in portion of their life. They are on the whole, sophisticated users – utilizing different tools for different intents, critically cognizant of the pros and cons. Students have specific outlooks and the cyberspace is their first port of call for information and they expect entree to up-to-date/ relevant information and communicating ( with equals, coachs, etc. ) on demand. Teachers use of engineering is promotes pupil larning. Teachers are non merely actively integrating ICT in learning but are besides active web content supplier for the Engineering talks. Experiences instructors are supplying pictures based technology talks for assorted technology classs that are transmitted via orbiter to 39 attached Engineering colleges. Teachers are bit by bit change overing these picture lectures in the vitamin E content formats. Based on the above findings, it is recommended that academicians and class decision makers pay more attending sing the usage of ICT resources as a major constituent in schoolroom instruction. This should function to pull greater support for ICT and e-learning among all classs of pupils.Mentions:Farideh Hamidi, M. M. ( 2011 ) . Information Technology in Education. Procedia Computer Science 3, 369-373. Glenda Gay, S. M. ( 2006 ) . Percepts of information and communicating engineering among undergraduate direction pupils in Barbados. International Journal of Education and Development utilizing Information and Communication Technology ( IJEDICT ) , 9. GraA?inne Conole, M. d. ( 2008 ) . ‘Disruptive engineerings ‘ , ‘pedagogical invention ‘ : What ‘s new? Findingss from an in-depth survey of pupils ‘ usage and perceptual experience of engineering. Computers & A ; Education 50, 511-524. Grineski, S. ( 1999 ) . Questioning the Role of Technology in Higher Education: Why is this the Road Less Traveled? The Internet and Higher Education 2 ( 1 ) , 45A ± 54. Jef C. Verhoeven, D. H. ( 2010 ) . Information and communicating engineerings in the life of university freshers: An analysis of alteration. Computers & A ; Education 55, 53-66. Jing Lei, Y. Z. ( 2007 ) . Technology uses and student accomplishment: A longitudinal survey. Computers & A ; Education 49, 284-296. Kennedy, G. D. ( 2006 ) . The net coevals are non large users of Web 2.0 engineerings: Preliminary findings. ICT: Providing Choices for Learners and Learning. Oblinger, D. G. ( 2005 ) . Educating the net coevals. An Educause e-book publication, ( hypertext transfer protocol: //www.educause.edu/ir/library/pdf/pub7101.pdf ) . Prensky, M. ( 2001 ) . Digital indigens, digital immigrants. On the Horizon, 9 ( 5 ) . Monetary value, A. K. ( 2005, June ) . Learners and larning in the 21st century. Surveies in higher instruction, 257-274.2005. Ran Wei, L. L. ( 1998 ) . Owning and utilizing new media engineering as forecasters of quality of life. Telematics and Information sciences 15, 237-251. Sharpe, R. , Benfield, G. , Lessner, E. , & A ; DeCicco, E. ( 2005 ) . Concluding study: Scoping survey for the teaching method strand of the JISC acquisition programme, hypertext transfer protocol: //www.jisc.ac.uk/uploaded_documents /scoping % 20study % 20final % 20report % 20v4.1.doc [ 21/4/07 ] . Selwyn, N. ( 2003 ) . Apart from engineering: understanding people ‘s non-use of information and communicating engineerings in mundane life. Technology in Society 25, 99-116. Selwyn, N. ( 2007 ) . The usage of computing machine engineering in university instruction and acquisition: a critical position. Journal of Computer Assisted Learning, 83-94.Bhatkar ( 2011 ) , ‘New larning paradigms needed ‘ , Times of India, Retrived fromhypertext transfer protocol: //articles.timesofindia.indiatimes.com/2011-02-22/pune/28625169_1_distance-learning-distance-education-ict ) . Gudanescu, S. ( 2010 ) . New educational engineerings. Procedia – Social and Behavioral Sciences, 2 ( 2 ) , 5646-5649. doi:10.1016/j.sbspro.2010.03.922 Romaniello, A. , Rey, U. , Carlos, J. , & A ; Medlin, D. ( 2010 ) . Higher instruction success and ICT. Bulletin of Applied Computing and Information Technology, 7 ( 1 ) , 109. Retrieved from hypertext transfer protocol: //books.google.com/books? id=6S0napW1w2kC & A ; pgis=1 ZeleA?akova , M. , Pavolova , H. , & A ; Bakalar, T. ( 2012 ) . Internet Communication in the Procedure of Education at Universities. Procedia – Social and Behavioral Sciences, 46, 2711-2715. doi:10.1016/j.sbspro.2012.05.552

Reduction of Demand for Drugs by Incorporation of Elasticity

Prohibited drugs have been one of the major concerns of the federal government for the past decades. Various negative effects of prohibited drugs not only on the user itself but also on the immediate community of the latter have been identified. Due to this, various programs has been launched by the federal government just to regulate and prevent citizens from drug addiction. One of the said government projects to minimize drug addiction would be the intensification of drug treatments aside from the border patrolling etc. The question now would be which of the identified two governments program will be more effective?Since prohibited drugs are addictive, users will continue to buy the said good even if there is a high risk involving its usage, not to mention that it is expensive (Kuehlwein, 2007). In other words, drug users will continue to buy as long as their will be someone who will supply them with those prohibited drugs regardless how much will it cost. Therefore, the intensific ation of drug treatment programs would be more effective as compared to the border patrolling since the former will reduce the addiction of the drug users which will eventually shifts its demand elasticity towards elastic demand.On the other hand, border patrolling will only lower down the supply of prohibited drugs in the market which only further increases its price level due to possible shortage as authorities on borders confiscate more prohibited drugs. At the end of the day, the root of the problem will not be solved by only patrolling on borders since drug users will always find ways on how to get marijuana or cocaine on the streets.This makes the intensification of drug treatment programs more effective since this attacks the root of the problem by minimizing the drug dependency of users which eventually leads to quitting drug usage. At this point, it is already clear that through reducing the demand of drug users to prohibited drugs will solve the said problem of the governm ent more effectively than with the border patrolling. It would be better on the part of the federal government to concentrate more on the drug treatment programs than with border patrolling. AppendixWith the drug treatment program, the elasticity of demand of drug users will shift from being inelastic to being elastic. The good thing with this will be, under the elastic demand; by the time drug users will quit using prohibited drugs, there is a big possibility that they will no longer go back into being drug addicts since they are no longer drug dependent. Whereas, border patrolling will do only no harm on the demand of the drug users and at the same time will only boost the prices of prohibited drugs on the streets as shown by demand curve1.Demand curve 1 is inelastic while demand curve 2 is elastic and the latter is the end effect of the intensification of drug treatment programs. Reference Kuehlwein, M. (2007). Cocaine and the Elasticity of Demand. Retrieved February 21, 2008, fr om http://images. google. com. ph/imgres? imgurl=http://www. unc. edu/depts/econ/byrns_web/GreatIdeas/ART/GI05-12. gif&imgrefurl=http://www. unc. edu/depts/econ/byrns_web/GreatIdeas/02-CoreMicro/GI-05. htm&h=411&w=909&sz=10&hl=tl&start=13&um=1&tbnid=wBaZSi2QPBBJ3M:&tbnh=66&tbnw=147&prev=/images%3Fq%3Dinelastic%2Bdemand%26ndsp%3D18%26um%3D1%26hl%3Dtl%26sa%3DN

American workforce

The behavioral component means the tendency to take negative actions against a particular group. The behavior stems form attitudes and feelings which constitute prejudice. Although prejudice is generally negative it is not as damaging as discrimination. The behavior component makes it possible to make the thoughts become real. Research has found that discrimination in any form is detrimental to the well being of the discriminated individual (Mathis Jackson, 2004). The workplace is the place in which the employee comes to work on his tasks and to carry out his profession. If the workplace is non-discriminatory, the employee is more likely to work effectively and efficiently and to increase productivity and performance as well. The most common methods employed by organizations to ensure that their work environment is non-discriminatory are to conduct sensitivity trainings, to provide provisions for grievances and complaints of discriminatory behavior and to follow non-discriminatory guidelines in terms of hiring, selection and promotions. Sensitivity trainings are common in most organizations especially if the company is culturally diverse as well as sexual orientation, disability and religion. The advantages of using sensitivity trainings to make employees become aware of the prejudices and discrimination they may have for other people and teaches the employees how to change their thoughts about minority groups in an experiential manner. It also communicates to each employee that an individual is a person in his/her own right and should be respected as such, and not be accorded respect based on one’s race, religion or sex. The disadvantage in using this method is that if  employees do not have a positive attitude towards the training then this would surely limit their capacity to learn from the sessions. Moreover, sensitivity trainings are periodically given and is not reinforced thus limiting its effectiveness. The provisions for grievances and complaints communicate to the employees that discrimination will not be tolerated by the management. It is effective as a control mechanism to lessen discrimination in the workplace and make the employees become cautious of their behavior. This method does not really ensure that the workplace would be discrimination free since it does not teach the employees why discrimination is wrong. It only holds people accountable for their actions, although it gives the employees who belong to the minority group comfort. Besides, discrimination may come in subtle forms and not even many employees who are victims of discrimination will file a complaint for fear of repercussions in terms of inter-office politics. Hiring, selection and promotion of employees based on merit and performance is a non-discriminatory principle to ensure that people become part of the organization based on criteria that can be achieved by most people. The difficulty with this measure is that although it is an objective measure, subjectivity is still present. It is common knowledge that when it comes to promotions and even selecting candidates for the job a certain amount of subjectivity that cannot be monitored by a guideline. It also does not consider that mangers may have their own prejudices which may dictate their decisions on hiring and promotion. References Bohlander, G. Snell, S. (2003). Managing Human Resources 13th ed., South-Western College Publication Fitzenz, J. (2001). How to Measure Human Resource Management 3rd. ed , New York; McGraw-Hill Mathis, R. Jackson, J. (2004). Human Resource Management 11th ed., South-Western College Publication American Workforce

The true effect of human resource management on an organizational Dissertation

The true effect of human resource management on an organizational performance - Dissertation Example This paper will begin with a brief background study on the topic of human resource management and then a brief overview of McDonald's. This paper will spell out the research problem and thereafter the objectives of the study as well as the research questions. Lastly, this essay will state the significance of the study and the scope that it will cover. The roots of human resource management can be traced back to the industrial revolution whereby companies started engaging in mass production for commercial purposes and therefore, there was an urgent need of hiring more employees to the extent that even children were introduced into the working life at a young age. During this particular time when human resources provided to be a critical part of an organization, there was little known about effective human resource management and this contributed to the widespread violation of employees’ rights since this labor sector had not been fully formalized and regulated. Stewart and Brow n stated that the numerous industrial strikes that characterized this area were necessitated by the widespread violation of employees’ rights that was going on in nearly all of the manufacturing companies. Employees’ plight during this era was denoted by low wages and poor working conditions. The industrial strikes led to the emergence of human resource management whereby the welfare of the employees received more focus from the management of the companies in order to avoid future strikes, which had proved detrimental to the companies that were affected. Factors that marked the emergence of effective human resource management included the abolishment of child labour, development of labor unions, strategic recruitment, and selection of workers. DeGraff (2010) further added that the studies by Fredrick Taylor on lean manufacturing sparked an interest on the actual contribution of the workforce on an organisation’s productivity and this contributed to human resourc es been acknowledge as a significant part in the productivity of an organisation. In the present world, human resource management is a source for organisation’s competitiveness meaning that it directly affects the performance of organisations. 1.3 McDonald’s Corporation According to Warwick (2013), McDonald Corporation is largest public traded hamburger fast food restaurant chain in the world, which serves averagely 60 million customers in over 115 countries across the world on a daily basis. The McDonald brothers originally started the company in 1940 but it was fully acquired by Ray Kroc who joined the company as a franchise agent in 1955. The McDonald’s restaurants offer a wide menu to their customers, which consist of French fries, hamburgers, chicken, cheeseburgers, soft drinks, breakfast items, desserts, milkshakes, fruits, smoothies, wraps, salads, and fish. Presently, the company boosts of total assets worth over $32 billion and total revenue of over $27 billion and a net income of over $ 5 billion in the past financial year. 1.4 Statement of the problem There are numerous studies, which have focused on the impact of human resource management but there is no or very little comprehensive studies that focuses on the relationship between human resource management functions such as selection and training, among others and how

Linguistic Essay Example | Topics and Well Written Essays - 250 words - 1

Linguistic - Essay Example instance, was added to the OED in 2001, with a description of â€Å"Expressing frustration at the realization that things have turned out badly† and cites the cartoon The Simpsons in setting both its definition and its spelling (OED s.v. â€Å"D’oh†). A dictionary attempting to set rather than describe usage would be very unlikely to include a word made famous by a television cartoon. Furthermore, the policy of the Oxford English Dictionary board itself describes the resource as descriptive rather than prescriptive. In its â€Å"Guide to the Third Edition of the OED† the board writes that â€Å"the Dictionary is intended to be descriptive, not prescriptive,† though the dictionary notes that it will indicate when usages have been popularly considered â€Å"incorrect† (OED Online). Noting a usage as being popularly â€Å"incorrect† does not make the resource prescriptive, however: it simply describes the popular usage of the

The LPN To Transition 2. APA Formating Transition into Scholarly Essay - 1

The LPN To Transition 2. APA Formating Transition into Scholarly Writing - Essay Example There are many differences in the roles of LPN and RN, as RNs has more authority and power than an LPN. Registered nurses have a larger role in the healthcare of patients. The duty of RN is deeply to analyze the issues pertaining to the health of a patient and to relate the condition of a patient with the health status of the patient. Licensed practical nurse does not have a wide scope, but they are more tasks oriented and the working criteria of LPN are less than that of RN (Weydt, 2009). The main role of RN is to perform an initial assessment of the patient as it an essential part of the duty. LPNs can perform assessments but not the initial assessment. As the criteria of work of an RN are much greater than an LPN, it has to perform more duties that include the formulating the diagnosis of a patient and to form a care plan for the patient. The primary role of LPN is to make sure that the formulated care plan made by RN is put into action. RNs have the authority to delegate the work to LPNs (Ebright, Patterson, Chalko, & Render, 2003). LPNs have no authority over RN, but they are only allowed to work on those tasks that lie in their scope as defined by their license of that state. At some workplaces, RN directly supervises the work of an LPN and make sure that the LPN performs his task in the provided manner. LPNs have no authority to make changes in the healthcare plan of the patient but if there in a need to do so, the LPN must call and report the issue to RN and get their approval, to do the needful changes. There are various advantages of an RN as compared to LPN in this field. Few strategies and suggestions can help in the transition of LPN to RN and become successful in the work. To transit from License practical nurse to Registered nurse, the applicant must either take an Associate Degree in Nursing (ADN) or a

MANAGEMENT INFORMATION AND COMMUNICATION SYSTEMS Coursework

MANAGEMENT INFORMATION AND COMMUNICATION SYSTEMS - Coursework Example Thus, banging on the perception of the require, and so vividly glimpsed by the detail that only a couple of years before Fast Company's periodic characteristic deserving "Change or die!" For most, the name is true. Change has become an integral part of organizational life for its constituents and the organization. more mighty technologies play a certain function in this, technological advancement is now nearly as very fast as data methods, so the proficiency to method data much quicker, more new submissions, innovative modes to organise data for better decisions (Moore & Fitz 2003). These innovative new modes to organise, in turn, conceived an interior dynamic of the developing organization. This is widespread, even banal currently discover constituents of all kinds of associations about the present plans for change, because the month of flavour. Although the workers (and managers) can be a bit jaded by all the alterations and the entire converse about change, it makes the method of altering bureaus in the 21st century and the convoluted phenomenon. Change bureau mentions to a change in detail made in organizational life. For each organizational change, an individual or lawful means to provoke or acknowledges any blame for the administration, implementation, upkeep or modification. This means or entity, generally an agency of change by the man called (Lacity Hirschheim and Willcocks 2004). Activity of this means or body part is called the change in the body. Organizational Alterations and Communication As is clear from the introductory consideration, there may be little or no creative consideration of the evolution of the bureau, without comprehending the environment of organizational change itself. Change and bureau, thus, characterised in common. Organizational Change Perhaps the most conversed about occurrence in the area of organizational dynamics and development over the past 20 years, organizational change mentions to the puzzling sequence of happenings, undertakings, plans and crusades to associations that have a thing in common: a kind of action of a set of ideas or demeanour in another set of ideas or behaviours (Major 2002). This action can be differentiated in periods of scale or dimensions and amount of data. This could encompass the whole association, or subsystem (the department or purposeful unit) of the organization. It may request to change the whole association, as well as in coordinating the transition from the customary hierarchy of government engagement, the flat structure, or going into unfamiliar markets with a new scheme, or it may demand other alterations, both in the reorganization of the newest expertise with the assist of output, inserting new types of individual employees, or new modes for educators to record class. It may furthermore be helpful to differentiate between alterations in notions and other periods that are affiliated with alterations and are occasionally utilised as synonyms. Change in Communicati on System The simplest delineation, but can furthermore be an international action of a somewhat steady state to another state for the time being provisional stable. The organizational alterations are progressing with the positions in which the purposes of work needed by most persons all through the association to discover new behaviours and skills. The major alterations encompass all workers and can focus on discovery and teaching of

Theories and Concepts in Leadership and Management Essay - 1

Theories and Concepts in Leadership and Management - Essay Example A leader nurse takes responsibility and guides the staff in accordance to the nurse ethics. A nurse leader identifies the strength of other staff members and utilizes to create an effective model (Kelly, 2012). Management on the other hand is an elective or appointed position. A manager works based on goals set by an entity, a successful manager is one who performs according to expectation (Kelly, 2012). Management in this case is authoritative. Consultations are done on a horizontal basis. A manager defers form a leader in the manner in which decisions is arrived at. A manager works with an aim of improving the quality and output while leader works on the negatives and work on them to ensure an appropriate working environment is created (Marquis & Huston, 2014). In some cases the two functions may overlap. In this case an authoritative manager may have the traits that qualify him as a leader. The manager works with the available staff while leaders work on their negative and motivate them towards better performance. He ensures the external and internal environments are functional and are effective to ensure quality performance (AANAC, 2013). In this case policy making and execution are enjoined as a single function. This would imply that the two functions overlap. An effective nurse should aim at ensuring the overlap created by these two functions is harmonized and effective system

Building on the Work of Others as an Integral Part of Originality Essay

Building on the Work of Others as an Integral Part of Originality - Essay Example This definition might be better explanatory â€Å"builds off of previous works in the field to make something new in some important way.† By creating a different definition of 'original,' this redefines the idea that is flawed by thinking that using other people’s ideas to be an inspiration as part of creating anything new is not original. Creation would just be a constant process of reinventing the wheel. Creating something new that is not based off of someone else’s ideas takes a lot more time and effort. Imagine what the world would be like if every single person who wanted to use a computer had to invent their own language for programming it, their own operating systems and other computer processes. For progress, creating new things has to incorporate the use of other people’s ideas to save on time and energy, and actually have time to do something new or original with it. Without this efficiency, it would be nearly impossible to actually spend any tim e on true 'original' invention. Not only does creating something from scratch take a great deal more time than using other people’s ideas and building off of them, but it also actually helps promote originality things. If someone was trying to design a car without ever having looked at a car before, they would probably create something that looked a great deal like early automobiles, because those were simple and natural designs. Could that be defined as original because there is still utilization of a previously designed concept?

The Walt Disney Method Research Paper Example | Topics and Well Written Essays - 2000 words

The Walt Disney Method - Research Paper Example He is achievements are evidenced by the creation of a successful business empire that holds its basis on the creativity he developed together with ideas. Disney’s innovative method of working remains relevant until the date and a majority of organizations still emulate the process referred to as Disney approach although it took a further development from Robert Dilts. The paper, therefore, examines Walt Disney approach as well as its usage in professional practice. The method is based on creativity with the aim directed at achieving a result that borrows from the best ideas through the elimination of the unimportant ones in the creativity process. The technique is based on Disney’s success where he managed in turning what appears as fantasies into ideas. Robert Dilts further developed the creativity technique of Disney to achieve the heights of a national language processing tool where companies across the American population perceived the method as essential in enhanci ng in achievement of organizational goals and strategies (Unamuno et al., 2007, pg 67). Organizations borrowed and still continue to borrow from the method, to enhance in presented well revised and coordinated set of ideas before embarking on any project. The most important point from Disney towards the development of the method relates looking at an issue from a different perspective as well as including all those ideas in the conclusion. Whenever Disney developed an idea for a film prepared for the public.  

Latinos Illegal Immigration Essay Example for Free

Latinos Illegal Immigration Essay â€Å"The contribution of immigrants can be seen in every aspect of our national life. We see it in religion, in politics, in business, in arts, in education, even in athletics and in entertainment. There is no part of our nation that has not been touch by our immigrant’s background† As we all know, John F. Kennedy was passionate about emigrational issues, throughout his presidency. He always said that America is a nation of people with values and traditions. He believes everybody deserves the freedom to build better lives for themselves as well as for their family members in their adopted homeland. Throughout the years, numerous folks have immigrated from all around the world to the United States. Today, Latinos are the largest minority group in the United States. â€Å"About 44 million Latinos have been officially tallied; another 9 million Latinos are living here illegally. † The Latinos substantial Illegal immigration into the United State has provoked a mayor concern. There are many concerns about Latinos illegal immigration such as, the impact on the United States economy, as well as for their motherland, also the physical danger they have to experience on their journey, and the psychological sufferings they have to live with in order to live the American dream. To begin with, going back to the 1800’s, before the Europeans immigrated into the United States, Latinos had already established settlements in New Mexico and Florida, And have contribute to the development of this country. According to the statistical abstract of the United States about 43 million people can trace back to their Hispanic origin. Even after all of the history of Latinos in America, U. S. officials begun to build a 670 miles-long-wall on the U. S. borders to control the illegal immigration. Despising protest from environmental groups and the Mexican government, the U. S. government continues work on keeping Latino illegal immigrant away from the U. S borders, but then again about 300,000 people elude detention and make it to the United States each year, and about million get arrested and return to their native land. Despite walls and border patrol official as long as there is poverty in third world countries, undocumented immigrant will continue to find a way to fight for the American dream. Then again â€Å"what is the American dream? † The American dream is to come to the United States and work hard. Their goal is not to get rich and make millions of dollar but instead all they want to do is to provide their families a better life style. Many travel the journey alone, because they know how dangerous and risky this experience can be. Some people try over and over if they were not successful the first time. Once they finally make it across; they live in the worst conditions and share their living space with 8 other people just to be able to save as much as they can so one day they can return to their motherland, and enjoy the fruit of their hard work with their loved ones. One of the biggest controversies about illegal immigration for many Americans is that if more illegal immigrant crossed the border, the jobs availability will decrease. That is understandable. Many Latinos that work in the United States work hard and have more than one job at the same time. The irony of all is that the jobs these illegal immigrants do are those ones no one wants to put their hands on, because either those jobs are difficult to do or because the pay is not enough. I do not think any of the protestants groups against Latinos illegal immigration have ever think that these people had never had the chance to go to school and educate themselves. Every American in this country had the privileged to get education. But instead there are many that chose not to take advantage of that. They rather live of welfare and social security. I do not know who is worst, us hypocrites citizens that are always trying to eat the smallest fish or these companionate people that all they care about is the wellbeing of the people they love. This type of egoism and greed is what has brought biggest empires down. Furthermore, another concern is that millions of dollars being send throughout Latino America without being tax. This concern affect us all, since must of the money from taxes is use to run public schools, hospitals, public transportation, etc. n my opinion, I agree with this concern, but in the other hand I am sure that if they were given a chance to contribute to the growth of this country; they will take care of their responsibilities. In addition to the effect of immigrants in the United states economy. I would like to talk about the physical and emotional impact of have to go through after they make the decision of fulfilling their American dreams. While doing this research I stumble upon a short article by James M. Henslin call â€Å"The Illegal Travel Guide† this article explains the experience from a different point of view. Manuel was a drinking buddy of Jose, a man I had met in Colima, Mexico. At 45, Manuel was friendly, outgoing, and enterprising. Manuel, who had lived in the United States for seven years, spoke fluent English. Preferring to live in his hometown in Colima, where he palled around with his childhood friends, Manuel always seemed to have money and free time. When Manuel invited me to go on a business trip with him, I accepted. I never could figure out what he did for a living or how he could afford a car, a luxury that none of his friends had. As we traveled from one remote village to another, Manuel would sell used clothing that he had heaped in the back of his older-model Ford station wagon. ? At one stop, Manuel took me into a dirt-floored, thatched-roof hut. While chickens ran in and out, Manuel whispered to a slender man who was about 23 years old. The poverty was overwhelming. Juan, as his name turned out to be, had a partial grade school education. He also had a wife, four hungry children under the age of 5, and two pigs his main food supply. Although eager to work, Juan had no job, for there was simply no work available in this remote village. As we were drinking a Coke, which seems to be the national beverage of Mexicos poor, Manuel ex ­plained to me that he was not only selling clothing he was also lining up migrants to the United States. For a fee, he would take a man to the border and in ­troduce him to a wolf, who would help him cross into the promised land. When I saw the hope in Juans face, I knew nothing would stop him. He was borrowing every cent he could from every friend and relative to scrape the money together. Although he risked losing everything if apprehended and he would be facing unknown risks, Juan would make the trip, for wealth beckoned on the other side. He knew people who had been to the United States and spoke glowingly of its opportunities. Manuel, of course, the salesman he was, stoked the fires of hope. Looking up from the children playing on the dirt floor with chickens pecking about them, I saw a man who loved his family. In order to make the desperate bid for a better life, he would suffer an enforced absence, as well as the uncertainties of a foreign culture whose language he did not know. Juan opened his billfold, took something out, and slowly handed it to me. I looked at it curiously. I felt tears as I saw the tenderness with which he handled this piece of paper. It was his passport to the land of opportunity: A social security card made with his name, sent by a friend who had already made the trip and who was waiting for Juan on the other side of the border. It was then that I realized that the thousands of Manuels scurrying about Mexico and the millions of Juans they are transporting can never be stopped, for only the United States can fulfill their dreams of a better life. Henslin, The Illegal Travel Guide) ? In conclusion, I believe that the illegal immigration to the United States makes a big impact on our country’s economy and Latino America’s. Nevertheless, I cannot even imaging how hard is for this people to make a life changing decision without any warranty. Crossing the borders is not easy. Many people have lost their live trying; many others are still traumatized about their journey, some have vanished in desert; their family members never heard from ever again. The psychological impact for these individuals is almost insufferable. Even knowing what the consequences might be, they leave everything behind and spend every penny they have to travel to the United States, just to offer their families a better life style. They believe this is the country of freedom, progress and opportunity, just what our founding fathers stood for. A society of immigrants, each of whom had begun life anew, on an equal footing. This is the secret of America: a nation of people with the fresh memory of old traditions who dare to explore new frontiers. â€Å"(Kennedy)

How Did the Decision to Conduct an ROI Study Influence the Design of Coaching Program Essay Example for Free

How Did the Decision to Conduct an ROI Study Influence the Design of Coaching Program Essay How did the decision to conduct an ROI study influence the design of coaching program. Nations Hotel Corporation is one of the reputed USA based hotel company, with an international presence in 15 countries worldwide. Hospitality industries are quiet competitive in nature and today’s success rule of hospitality includes knowledge, customer satisfaction and operational efficiency which provides pleasure of stay and departure to their guests. Any addition or subtraction in these components can increase or decrease the rating of any organization. Nations Hotel with 98% brand awareness and 72% as customer satisfaction ratio were still far from the race of preferred choice amongst the customers. Hence there, arose a need to identify the gap , so a study was conducted by the Nations hotel learning organizations (NHLO), as a result need for high leverage training program (Chapter 1-Introduction to employee training and development- High Leverage Training Program) was determined, which can improve the operational efficiency, help in retention of high performing employees and increase the level of customer satisfaction, so a structured coaching program was proposed in front of senior executives, which can have impact on business . (Chapter 1-Introduction to employee training and devlopment -ASTD Competency model, this model shows the role of training and how it will impact the business strategy). Since these strategic trainings, are expansive in nature , senior executives of Nations hotel were concerned with the calculation of Return on Investments (â€Å"Chapter -6, Training Evaluation-ROI) on coaching project, calculation of direct and indirect cost and benefits achieved through the coaching program became crucial factor in designing the program. Instead of directly going ahead with the coaching program for all employees , Nations hotel selected 25 employees randomly for the training( chapter 6-Training and evaluation-Pilot Testing, random assignment). This small selection of team was an effective decision , as identifying the strength and weakness of the coaching program brought an opportunity to make changes before ,this coaching program became available to all employees, besides this factor, another strong reason was individual coaching was a huge investment for Nations hotel, so through pilot testing evaluating the effectiveness of training and cost , and conducting need assessment was better approach to calculate the ROI for the coaching program, so that finally while evaluating the results and business impact after conducting the coaching program for the executives, Nations hotel can make a decision on further expanding this coaching program for rest of the employees. Hence the coaching program was designed in 14 steps, which comprised of the following steps. 1. Voluntary participation 2. Need for Coaching 3. Self Assessments 4. Commitment for data 5. Roles and responsibilities 6. The match 7. Orientation session 8. The engagement 9. Coaching session 10. Goal setting 11 . Action planning 12. Active learning 13. Progress review 14. Reporting. These steps helped in calculating various components of ROI which includes both the calculation of tangible and non tangible benefits, evaluation of confidence level amongst the newly trained employees, monetary value gained or lost, impact on turnover, measurement of service improvement, and last but not the least job satisfaction amongst employees after this coaching program, which will finally have impact on business. (Chapter 6-Training Evaluation-Results Return on Investment). Question 2. Discuss the importance of getting participants committed to provide quality data. Determining the effectiveness of training program is referred as evaluation. Kirkpatrick’s four level framework measures the outcomes of an effective training program, which includes following four levels of evaluation, also there is a fifth level of evaluation, which is out of the Kirkpatrick’s framework of evaluation, and is known as Return on Investment. (Chapter 6-Training Evaluation-Kirkpatrick’s four level of framework of evaluation criteria) Level 1 Reaction: It provides feedback about the content of the program, participant’s engagement, data gathered in this level helps in improving the training program Level 2. Learning: Knowledge and skills of trainees are tested through norm referenced test, criterion referenced test or quizzes, observations and work samples, and data collected at this level, helps to judge the skill based outcomes of trainee from the training. Level 3. Application: These are also known as affective outcomes, which are measured through collection of data via interviews and attitude surveys, to measure the skill enhancements after training. Level 4. Results or Business Impact: How much training program has paid off for the company, such as improvement in customer care inclined or declined on turn around time after the training, measuring such outcomes falls, under this level, which is measured by collecting data through performance records, observation, information system Level 5. ROI: This step compares the monetary benefits to the organization with the cost of training, such as by collecting data for both tangible and intangible benefits, which includes direct and indirect cost , level of confidence , job satisfaction , cost benefit analysis etc.. Result of one level of evaluation, becomes the benchmark for the next level of evaluation, this can be best explained by the example of Nations Hotel, where careful and quality data recorded in action plan and company records by executives helped the NHLO team in making of convincing ,coaching business impact program. The ROI process in Nations Hotel, involved gathering data through out the coaching, so that evaluation result can be evaluated in all the above mentioned five levels. Since participants (executives, senior executives, coach) provided data at every level of evaluation, which helped in further clubbing of all the data, that was collected at all five levels separately, were than integrated to provide an overall evaluation of the program, and measure how effectively the program is impacting the strategic goals of the company, careful and accurate data collection at all levels helped the NHLO team to measure the result of coaching program at every step, so that any flaw at one level , can be rectified easily before moving to the next step, for example the benefit cost ratio of NHLO was 3. 21, that is it, suggests that on every dollar spend,$3. 21 was returned, but in absence of accurate data this figure would have been misleading , and could have resulted in fiasco. Not only Nations Hotel, infact most of the companies follows similar process for evaluating the levels, by collecting data at every level, and than utilizing the data for moving ahead with the next level. These data’s were further converted into monetary value, through various ways, which was further utilized in analyzing the ROI on training. In absence of quality data, training will have no impact neither for an individual in terms of cognitive, skills application, and affective outcomes nor for any organization in terms of positive business impact and ROI, which an organization aimed for. Hence quality data from the participants has a huge impact in determining the credibility, reliability and relevance of the training program ,so active participation from the trainees and providing reliable data, is essential for an effective training program (Chapter 6-Training evaluation-Outcomes used in evaluating training programs)

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay

The Lung Chronic Disease Bronchopulmonary Dysplasia Nursing Essay Bronchopulmonary dysplasia or BPD is a form of chronic lung disease that develops in preterm neonates and is treated with oxygen and positive-pressure ventilation (PPV). In this paper I will discuss exactly what bronchopulmonary dysplasia is, its pathophysiology, the etiology, its clinical presentation, and any differential diagnosis of the disease. I will also present in my research the treatment and management for the disease, its prognosis, and the sequelae. Bronchopulmonary dysplasia formerly known as Chronic Lung Disease of Infancy is a chronic lung disorder that is more prevalent in children who were born prematurely with low birthweights, and whose lungs havent had the time to fully develop. White male infants seem to be at a greater risk for development, and genetics may contribute to some of these cases. It is also very common in those who have received prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It is ironic that the treatment for RDS is considered to be the prime cause of BPD. With the treatment of RDS the patient is treated with high pressures and high FiO2 over a period of time. Its the high pressures of oxygen delivery that can result in necrotizing bronchiolitis and alveolar septal injury; this action further compromises the oxygenation of blood. Bronchopulmonary dysplasia is characterized by inflammation and scarring in the lungs. The signs and symptoms to watch out for are the oxygen deman ds of the infant not decreasing as they should, in some cases even increasing. Fast breathing, a fast heart rate, flared nostrils, retractions, poor weight gain, and coarse crackles may be heard upon auscultation. The pathophysiology of BPD is linked to four factors. These factors are oxygen toxicity, barotrauma, the presence of a PDA (patent ductus arteriosus), and fluid overload. Exposure to high concentrations of oxygen can lead to edema and the thickening of the alveolar membrane. When you have prolonged exposure it causes the alveolar tissues to hemorrhage and become necrotic. As the disease progresses the interstitial spaces will become fibrotic. When the lung tries to heal itself, all of the new cells are damaged by the same factors as before, and it continues in a cycle. All of this can interfere with alveolarization and lead to alveolar simplification with a reduction in the surface area for gas exchange. Any damage to the lung during a critical stage of growth will result in significant pulmonary dysfunction. With patients who have left-to-right shunting through the PDA it is more likely that they develop pulmonary congestion and worsening compliance. With this problem the patient wi ll need higher ventilatory pressures and oxygen percentages to help with ventilation and oxygenation; therefore they have a higher risk of BPD. Bronchopulmonary dysplasia develops as a result of an infants lungs becoming irritated or inflamed. The lungs of premature infants are very fragile and arent fully developed, and therefore they can become easily irritated. Ventilators are used to help with the breathing by using pressure to blow air into the airways and lungs. However it is the pressures used that can irritate and harm a premature infants lungs, so they are used only when absolutely needed. Sometimes oxygen therapy is given to make sure that the infants brains, hearts, livers, and kidneys get enough oxygen to work properly. However in some cases high levels of oxygen can inflame the lining of the lungs and injure the airways, it can also slow lung development. Another cause is infections that can inflame the underdeveloped lungs of premature infants. With this problem it causes narrowing of the airways and makes it harder for infants to breathe. Lung infections can also increase the need for extra oxygen and breathin g support which in turn leads to the ventilation and extra oxygen requirements. There are some studies also show that heredity plays a role in causing BPD. Infants with bronchopulmonary dysplasia will have abnormal findings on physical exams, chestx-rays, pulmonary function testing, and histopathologic examinations. Initial findings observed shortly after birth are consistent with respiratory distress syndrome (RDS). Persistence of these abnormalities can be associated with an increased risk of bronchopulmonary dysplasia. Physical examination may reveal tachypnea, tachycardia, increased work of breathing, including retractions, nasal flaring, and grunting, as well as frequent desaturations and significant weight loss during the first 10 days of life. Infants with severe bronchopulmonary dysplasia are often extremely immature and had a very low birth weight. Their requirements for oxygen and ventilatory support often increase in the first 2 weeks of life. At weeks 2-4, oxygen supplementation, ventilator support, or both are often increased to maintain adequate ventilation and oxygenation. Dif DX Atelectasis refers to collapse of part of the lung. It may include a lung subsegment or the entire lung and is almost always a secondary phenomenon, with no sex or race proclivities; however, it may occur more frequently in younger children than in older children and adolescents. The direct morbidity from atelectasis is transient hypoxemia due to blood flowing through the lung, which does not have normal air flow. The blood does not pick up oxygen from the corresponding alveoli. This shunting results in transient hypoxemia. Hypertension Patent ductus arteriosus (PDA) is one of the more common congenital heart defects. The presentation widely varies. Depending on the size of the patent ductus arteriosus, the gestational age of the neonate, and the pulmonary vascular resistance, a premature neonate may develop life-threatening pulmonary overcirculation in the first few days of life. Conversely, an adult with a small patent ductus arteriosus may present with a newly discovered murmur well after adolescence. During fetal life, the ductus arteriosus is a normal structure that allows most of the blood leaving the right ventricle to bypass the pulmonary circulation and pass into the descending aorta. Typically, only about 10% of the right ventricular output passes through the pulmonary vascular bed. Pneumonia and other lower respiratory tract infections are the leading causes of death worldwide. Because pneumonia is common and is associated with significant morbidity and mortality, properly diagnosing pneumonia, correctly recognizing any complications or underlying conditions, and appropriately treating patients are important. Although in developed countries the diagnosis is usually made on the basis of radiographic findings, the World Health Organization (WHO) has defined pneumonia solely on the basis of clinical findings obtained by visual inspection and on timing of the respiratory rate. (See Clinical Presentation.) Pneumonia may originate in the lung or may be a focal complication of a contiguous or systemic inflammatory process. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. These derangements often significantly alter gas exchange and dependent cellular metabolism in the many tissues and organs that determine survival and contribute to quality of life. Subglottic stenosis (SGS) is a narrowing of the subglottic airway (see image below), which is housed in the cricoid cartilage. The subglottic airway is the narrowest area of the airway because it is a complete, nonexpandable, and nonpliable ring, unlike the trachea, which has a posterior membranous section, and the larynx, which has a posterior muscular section. Tracheomalacia is a structural abnormality of the tracheal cartilage allowing collapse of its walls and airway obstruction. A deficiency and/or malformation of the supporting cartilage exists, with a decrease in the cartilage-to-muscle ratio. Immaturity of the tracheobronchial cartilage is thought to be the cause in type I, whereas degeneration of previously healthy cartilage is thought to produce other types. Inflammatory processes, extrinsic compression from vascular anomalies, or neoplasms may produce degeneration. Diffuse malacia of the airway of the congenital origin improves by age 6-12 months as the structural integrity of the trachea is restored gradually with resolution of the process. Treatment and management Treatment in the NICU is designed to limit stress on infants and meet their basic needs of warmth, nutrition, and protection. Once doctors diagnose BPD, some or all of the treatments used for RDS will continue in the NICU. Such treatment usually includes: Using radiant warmers or incubators to keep infants warm and reduce the chances of infection. Ongoing monitoring of blood pressure, heart rate, breathing, and temperature through sensors taped to the babies bodies. Using sensors on fingers or toes to check the amount of oxygen in the infants blood. Giving fluids and nutrients through needles or tubes inserted into the infants veins. This helps prevent malnutrition and promotes growth. Nutrition is critical to the growth and development of the lungs. Later, babies may be given breast milk or infant formula through feeding tubes that are passed through their noses or mouths and into their throats. Checking fluid intake to make sure that fluid doesnt build up i n the babies lungs. As their condition improves, babies who have BPD are weaned or taken off NCPAP or ventilators slowly, until they can breathe on their own. These infants will likely need to continue getting oxygen therapy for some time. If your infant has moderate to severe BPD, echocardiography may be done every few weeks to months to check his or her pulmonary artery pressure. If your child needs long-term support from a ventilator, he or she will likely have a tracheostomy (TRA-ke-OS-to-me). A tracheostomy is a surgically made hole that goes through the front of the neck and into the trachea (TRA-ke-ah), or windpipe. Your childs doctor will put the breathing tube from the ventilator through the hole. Using a tracheostomy instead of an endotracheal (en-do-TRA-ke-al) tube has several advantages. (An endotracheal tube is a breathing tube inserted through the nose or mouth and into the windpipe.) Long-term use of an endotracheal tube can damage the trachea. This damage may later r equire surgery to correct. A tracheostomy may allow your baby to interact more with you and the NICU staff, start talking, and develop other skills.While your baby is in the NICU, he or she also may need physical therapy. Physical therapy can help strengthen your childs muscles and clear mucus out of his or her lungs.Infants who have BPD can recover, but many spend several weeks or months in the hospital. This allows them to get the care they need. Before your baby goes home, its important for you to learn as much as you can about your childs condition and how its treated. Your baby may continue to have some breathing symptoms after he or she leaves the hospital. Your child will likely continue on all or some of the treatments that were started at the hospital, including:Medicines, such as bronchodilators, steroids, diuretics, and caffeine. Oxygen therapy and/or breathing support from NCPAP or a ventilator. Extra nutrition and calories, which may be given through a feeding tube. Pre ventive treatment with a medicine called palivizumab for severe respiratory syncytial virus (RSV). This common virus leads to mild, cold-like symptoms in adults and older, healthy children. However, in infants-especially those in high-risk groups-RSV can be more serious, leading to severe breathing problems. Your child also should have regular checkups with and timely vaccinations from a pediatrician. This is a doctor who specializes in treating children. If your child needs oxygen therapy or a ventilator at home, a pulmonary specialist may help with long-term medical care and make treatment recommendations. Mechanical ventilation In most cases of bronchopulmonary dysplasia (BPD), respiratory distress syndrome is diagnosed and treated. The mainstay for treating RDS has been surfactant replacement with oxygen supplementation, continuous positive airway pressure (CPAP), and mechanical ventilation. The treatment necessary to recruit alveoli and prevent atelectasis in the immature lung may cause lung injury and activate the inflammatory cascade. Trauma secondary to positive pressure ventilation (PPV) is generally referred to as barotrauma. With the recent focus on a ventilation strategy involving low versus high tidal volume, some investigators have adopted the term volutrauma. Volutrauma suggests the occurrence of lung injury secondary to excessive tidal volume from PPV. The severity of lung immaturity, the fetal milieu, and the effects of surfactant deficiency determine the need for PPV, surfactant supplementation, and resultant barotrauma or volutrauma. With severe lung immaturity, the total number of alveoli is reduced, increasing the positive pressure transmitted to distal terminal bronchioles. In the presence of surfactant deficiency, surface tension forces are increased. Some compliant alveoli may become hyperinflated, whereas other saccules with increased surface tension remain collapsed. With increasing PPV to recruit alveoli and improve gas exchange, the compliant terminal bronchiole and alveolar ducts may rupture, leaking air into the interstitium, with resultant pulmonary interstitial emphysema (PIE). The occurrence of PIE greatly increases the risk of bronchopulmonary dysplasia. Many modes of ventilation and many ventilator strategies have been studied to potentially reduce lung injury, such as synchronized intermittent mechanical ventilation (SIMV), high-frequency jet ventilation (HFJV), and high-frequency oscillatory ventilation (HFOV). Results have been mixed, although some theoretical benefits are associated with these alternative modes of ventilation. Although shorter duration of mechanical ventilation has been demonstrated in some trials of SIMV, most trials have not had a large enough sample size to demonstrate a reduction in bronchopulmonary dysplasia. Systematic reviews suggest that optimal use of conventional ventilation may be as effective as HFOV in improving pulmonary outcomes. Regardless of the high-frequency strategy used, avoidance of hypocarbia and optimization of alveolar recruitment may decrease the risk of bronchopulmonary dysplasia and associated of neurodevelopmental abnormalities. PPV with various forms of nasal CPAP has been reported to decrease injury to the developing lung and may reduce the development of bronchopulmonary dysplasia. In general, centers that use gentler ventilation with more CPAP and less intubation, surfactant, and indomethacin had the lowest rates of bronchopulmonary dysplasia. Oxygen and PPV frequently are life-saving in extremely preterm infants. However, early and aggressive CPAP may eliminate the need for PPV and exogenous surfactant or facilitate weaning from PPV. Some recommend brief periods of intubation primarily for the administration of exogenous surfactant quickly followed by extubation and nasal CPAP to minimize the need for prolonged PPV. This strategy may be most effective in infants without severe RDS, such as many infants with birth weights of 1000-1500 g. In infants who require oxygen and PPV, careful and meticulous treatment can minimize oxygen toxicity and lung injury. Optimal levels include a pH level of 7.2-7.3, a partial pressure of carbon dioxide (pCO2) of 45-55 mm Hg, and a partial pressure of oxygen (pO2) level of 50-70 mm Hg (with oxygen saturation at 87-92%). Assessment of blood gases requires arterial, venous, or capillary blood samples. As a result, indwelling arterial lines are often inserted early in the acute management of RDS. Samples obtained from these lines provide the most accurate information about pulmonary function. Arterial puncture may not provide completely accurate samples because of patient agitation and discomfort. Capillary blood gas results, if samples are properly obtained, may be correlated with arterial values; however, capillary samples may widely vary, and results for carbon dioxide are poorly correlated. Following trends in transcutaneous PO2 andP CO2 may reduce the need for frequent blood gas measurements. Weaning from mechanical ventilation and oxygen is often difficult in infants with moderate-to-severe bronchopulmonary dysplasia, and few criteria are defined to enhance the success of extubation. When tidal volumes are adequate and respiratory rates are low, a trial of extubation and nasal CPAP may be indicated. Atrophy and fatigue of the respiratory muscles may lead to atelectasis and extubation failure. A trial of endotracheal CPAP before extubation is controversial because of the increased work of breathing and airway resistance. Optimization of methylxanthines and diuretics and adequate nutrition may facilitate weaning the infant from mechanical ventilation. Meticulous primary nursing care is essential to ensure airway patency and facilitate extubation. Prolonged and repeated intubations, as well as mechanical ventilation, may be associated with severe upper airway abnormalities, such as vocal cord paralysis, subglottic stenosis, and laryngotracheomalacia. Bronchoscopic evaluation should be considered in infants with bronchopulmonary dysplasia in whom extubation is repeatedly unsuccessful. Surgical interventions (cricoid splitting, tracheostomy) to address severe structural abnormalities are used less frequently today than in the past. Oxygen therapy Oxygen can accept electrons in its outer ring to form free radicals. Oxygen free radicals can cause cell-membrane destruction, protein modification, and DNA abnormalities. Compared with fetuses, neonates live in a relatively oxygen-rich environment. Oxygen is ubiquitous and necessary for extrauterine survival. All mammals have antioxidant defenses to mitigate injury due to oxygen free radicals. However, neonates have a relative deficiency in antioxidant enzymes. The major antioxidant enzymes in humans are superoxide dismutase, glutathione peroxidase, and catalase. Activity of antioxidant enzymes tend to increase during the last trimester of pregnancy, similar to surfactant production, alveolarization, and development of the pulmonary vasculature. Increases in alveolar size and number, surfactant production, and antioxidant enzymes prepare the fetus for transition from a relatively hypoxic intrauterine environment to a relatively hyperoxic extrauterine environment. Preterm birth exposes the neonate to high oxygen concentrations, increasing the risk of injury due to oxygen free radical. Animal and human studies of supplemental superoxide dismutase and catalase supplementation have shown reduced cell damage, increased survival, and possible prevention of lung injury. Evidence of oxidation of lipids and proteins has been found in neonates who develop bronchopulmonary dysplasia. Supplementation with superoxide dismutase in ventilated preterm infants with RDS substantially reduced in readmissions compared with placebo-treated control subjects. Further trials are currently under way to examine the effects of supplementation with superoxide dismutase in preterm infants at high risk for bronchopulmonary dysplasia. Ideal oxygen saturation for term or preterm neonates of various gestational ages has not been definitively determined. In practice, many clinicians have adopted conservative oxygen saturation parameters (ie, 87-92%). A delicate balance to optimally promote neonatal pulmonary (alveolar and vascular) and retinal vascular homeostasis is noted. In the Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) trial to reduce severe retinopathy of prematurity (ROP), oxygen saturations of more than 95% minimally affected retinopathy but increased the risk for pneumonia or bronchopulmonary dysplasia. The normal oxygen requirement of a preterm infant is unknown. Pulmonary hypertension and cor pulmonale may result from chronic hypoxia and lead to airway remodeling in infants with severe bronchopulmonary dysplasia. Oxygen is a potent pulmonary vasodilator that stimulates the production of nitric oxide (NO). NO causes smooth muscle cells to relax by activating cyclic guanosine monophosphate. Currently, pulse oximetry is the mainstay of noninvasive monitoring of oxygenation. Repeated episodes of desaturation and hypoxia may occur in infants with bronchopulmonary dysplasia receiving mechanical ventilation as a result of decreased respiratory drive, altered pulmonary mechanics, excessive stimulation, bronchospasm, and forced exhalation efforts. Forced exhalation efforts due to infant agitation may cause atelectasis and recurrent hypoxic episodes. Hyperoxia may overwhelm the neonates relatively deficient antioxidant defenses and worsen bronchopulmonary dysplasia. The patients oxygen requirements are frequently increased during stressful procedures and feedings. Some NICUs have adopted a conservative oxygen saturation policy of maintaining saturations of 88-94%. Caregivers are more likely to follow wide guidelines for ranges of oxygen saturation than narrow ones. Some infants, especially those living at high altitudes, may require oxygen therapy for many months. Transfusion of packed RBCs may increase oxygen-carrying capacity in preterm infants who have anemia (hematocrit The need for multiple transfusions and donor exposures can be minimized by using iron supplementation, a reduction in phlebotomy requirements, and by use of erythropoietin administration. Treatment of inflammation Elevated levels of interleukin-6 and placental growth factor in the umbilical venous blood of preterm neonates are associated with increased incidence of bronchopulmonary dysplasia. This inflammation likely affects alveolarization and vascularization of the pulmonary system of the second-trimester fetus. Fetal sheep exposed to inflammatory mediators or endotoxin develop inflammation and abnormal lung development. Activation of inflammatory mediators has been demonstrated in humans and animal models of acute lung injury. Activation of leukocytes after cell injury caused by oxygen free radicals, barotrauma, infection, and other stimuli may begin the process of destruction and abnormal lung repair that results in acute lung injury then bronchopulmonary dysplasia. Radiolabeled activated leukocytes have been recovered by means of bronchoalveolar lavage (BAL) in preterm neonates receiving oxygen and PPV. These leukocytes, as well as lipid byproducts of cell-membrane destruction, activate the inflammatory cascade and are metabolized to arachidonic acid and lysoplatelet factor. Lipoxygenase catabolizes arachidonic acid, resulting in the production of cytokines and leukotrienes. Cyclooxygenase may also metabolize these byproducts to produce thromboxane, prostaglandin, or prostacyclin. All of these substances have potent vasoactive and inflammatory properties. levels of these substances are elevated in the first days of life, as measured in tracheal aspirates of preterm infants who subsequently develop bronchopulmonary dysplasia. Metabolites of arachidonic acid, lysoplatelet factor, prostaglandin, and prostacyclin may cause vasodilatation, increase capillary permeability with subsequent albumin leakage, and inhibit surfactant function. This effects increase oxygenation and ventilation requirements and potentially increase rates of bronchopulmonary dysplasia Activation of transcription factors such as nuclear factor-kappa B in early postnatal life is associated with death or bronchopulmonary dysplasia. Collagenase and elastase are released from activated neutrophils. These enzymes may directly destroy lung tissue because hydroxyproline and elastin (breakdown products of collagen and elastin) have been recovered in the urine of preterm infants who develop bronchopulmonary dysplasia. Alpha1-proteinase inhibitor mitigates the action of elastases and is activated by oxygen free radicals. Increased activity and decreased function of alpha1-proteinase inhibitor may worsen lung injury in neonates. A decrease in bronchopulmonary dysplasia and in the need for continued ventilator support is found in neonates given supplemental alpha1-proteinase inhibitor. All of these findings suggest the fetal inflammatory response effects pulmonary development and substantially contributes to the development of bronchopulmonary dysplasia. The self-perpetuating cycle of lung injury is accentuated in the extremely preterm neonate with immature lungs. Management of infection Maternal cervical colonization and/or colonization in the neonate with Ureaplasma urealyticum has been implicated in the development of bronchopulmonary dysplasia. Viscardi and colleagues found that persistent lung infection with U urealyticum may contribute to chronic inflammation and early fibrosis in the preterm lung, leading to pathology consistent with clinically significant bronchopulmonary dysplasia.[13] Systematic reviews have concluded that infection with U urealyticum is associated with increased rates of bronchopulmonary dysplasia. Infection-either antenatal chorioamnionitis and funisitis or postnatal infection-may activate the inflammatory cascade and damage the preterm lung, resulting in bronchopulmonary dysplasia. In fact, any clinically significant episode of sepsis in the vulnerable preterm neonate greatly increases his or her risk of bronchopulmonary dysplasia, especially if the infection increases the babys requirement for oxygen and mechanical ventilation. Future management Future management of bronchopulmonary dysplasia will involve strategies that emphasize prevention. Because few accepted therapies currently prevent bronchopulmonary dysplasia, many therapeutic modalities (eg, mechanical ventilation, oxygen therapy, nutritional support, medication) are used to treat bronchopulmonary dysplasia. Practicing neonatologists have observed reduced severities of bronchopulmonary dysplasia in the postsurfactant era. Maintaining PPV and oxygen therapy for longer than 4 months and discharging patients to facilities for prolonged mechanical ventilation is now unusual. Medication Summary Many drug therapies are used to treat infants with severe bronchopulmonary dysplasia (BPD). The efficacy, exact mechanisms of action, and potential adverse effects of these drugs have not been definitively established. A study group from the NICHD and US Food and Drug Administration (FDA) reviewed many of the drugs used to prevent and treat bronchopulmonary dysplasia. Walsh and colleagues concluded that detailed analyses of many of these treatments, as well as long-term follow-up, are needed.[15] Vitamin A supplementation Seven trials of vitamin A supplementation in preterm neonates to prevent bronchopulmonary dysplasia were analyzed for the Cochrane Collaborative Neonatal review. Vitamin A supplementation reduced bronchopulmonary dysplasia and death at 36 weeks postmenstrual age. However, the need for frequent intramuscular injections in extremely premature infants has precluded widespread use of this therapy. Diuretics Furosemide (Lasix) is the treatment of choice for fluid overload in infants with bronchopulmonary dysplasia. It is a loop diuretic that improves clinical pulmonary status and function and decreases pulmonary vascular resistance. Daily or alternate-day furosemide therapy may facilitate weaning from positive pressure ventilation (PPV), oxygenation, or both. Adverse effects of long-term therapy are frequent and include hyponatremia, hypokalemia, contraction alkalosis, hypocalcemia, hypercalciuria, renal stones, nephrocalcinosis, and ototoxicity. Careful parenteral and enteral nutritional supplementation is required to maximize the benefits instead of exacerbating the adverse effects. In patients with mild hyponatremia or hypokalemia, supplementation with potassium chloride is favored over supplementation with sodium chloride. Thiazide diuretics plus aldosterone inhibitors (eg, spironolactone [Aldactone]) have also been used in infants with bronchopulmonary dysplasia. In several trials of infants with bronchopulmonary dysplasia, thiazide diuretics combined with spironolactone increased urine output with or without improvement in pulmonary mechanics. Hoffman et al reported that spironolactone did not reduce the need for supplemental electrolytes in preterm infants with bronchopulmonary dysplasia.[16] To the present authors knowledge, long-term studies to compare the efficacy of furosemide with those of thiazide and spironolactone therapy have not been performed. Bronchodilators Albuterol is a specific beta2-agonist used to treat bronchospasm in infants with bronchopulmonary dysplasia. Albuterol may improve lung compliance by decreasing airway resistance by relaxing smooth muscle cell. Changes in pulmonary mechanics may last as long as 4-6 hours. Adverse effects include increased blood pressure (BP) and heart rate. Ipratropium bromide is a muscarinic antagonist that is related to atropine; however, it may have bronchodilator effects more potent than those of albuterol. Improvements in pulmonary mechanics were demonstrated in patients with bronchopulmonary dysplasia after they received ipratropium bromide by inhalation. Combined therapy with albuterol and ipratropium bromide may be more effective than either agent alone. Few adverse effects are noted. Methylxanthines are used to increase respiratory drive, decrease apnea, and improve diaphragmatic contractility. These substances may also decrease pulmonary vascular resistance and increase lung compliance in infants with bronchopulmonary dysplasia, probably by directly causing smooth muscle to relax. Methylxanthines also have diuretic effects. All of these effects may increase success in weaning patients from mechanical ventilation. Synergy between theophylline and diuretics has been demonstrated. Theophylline has a half-life of 30-40 hours. It is metabolized primarily to caffeine in the liver and may result in adverse effects such as increase in heart rate, gastroesophageal reflux, agitation, and seizures. The half-life of caffeine is approximately 90-100 hours, and caffeine is excreted unchanged in the urine. Both agents are available in intravenous and enteral formulations. Caffeine has fewer adverse effects than theophylline. Schmidt and colleagues reported that the early use of caffeine to treat apnea of prematurity appeared to reduce ventilatory requirements and that it may decrease the incidence of bronchopulmonary dysplasia.[17] Corticosteroids Systemic and inhaled corticosteroids have been studied extensively in preterm infants to prevent and treat bronchopulmonary dysplasia. Dexamethasone is the primary systemic synthetic corticosteroid studied in preterm neonates. Dexamethasone has many pharmacologic benefits but clinically significant adverse effects. This drug stabilizes cell and lysosomal membranes, increases surfactant synthesis, increases serum vitamin A concentration, inhibits prostaglandin and leukotriene, decreases pulmonary edema (PE), breaks down granulocyte aggregates, and improves pulmonary microcirculation. Its adverse effects are hyperglycemia, hypertension, weight loss, GI bleeding or perforation, cerebral palsy, adrenal suppression, and death. Many researchers have evaluated the effects of early administration of dexamethasone to prevent bronchopulmonary dyspl