The Kawasaki disease

The Kawasaki disease Kawasaki disease is an intense systemic paediatric vasculitis disease that is seen commonly in childhood. Kawasaki disease is one of the most common heart diseases. It is the inflammatory disorder but the aetiology of Kawasasaki disease is unknown. It first appeared in 1967 by report of Tomisaku Kawasaki who was a Japanese paediatrician. He also called Kawasaki disease as mucocutaneous lymph node syndrome. There is no diagnostic test; therefore, doctors are using the clinical criteria that were proposed by Dr. Kawasaki 45 years ago to diagnose the Kawasaki disease. There are many different diagnosis of Kawasaki disease such as viral infections, genetic predisposition or environmental factors. Many research proposed that Kawasaki disease is an infectious disease that may be caused by Epstein-Barr virus, measles, adenovirus, enterovirus. However, there is no confirmed evidence. Usually, KD can found more in Japanese society but it keep spread to western countries and the incidence of K D in western countries are increase dramatically. There are typical symptoms that can be seen in KD such as rash, edema, and mucosal membrane changes. But there are more symptoms that are involved which are not typically found from every KD patients. Therefore, it is hard to diagnosis patients if they have KD or not. The treatment of KD is different depends on if patients are complete or incomplete KD and also, the susceptibility of IVIG will make treatment different along patients. The etiology is not certain but there are several researches shown that KD is caused by infectious agents, genetic factors, or immune system disorder. Current knowledge on the subject   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several symptoms that can be found in patients with Kawasaki disease. When patients have more than 5 days of fever for more than 38C and have more than 4 symptoms such as bilateral nonexudative conjunctival injection, polymorphous exanthem, nonvesicular rash, strawberry tongue, edema of hands and feet, bilateral non-suppurative cervical lymphadenopathy, and mucosal membrane changes, patients will diagnosis as KD. Kawasaki disease can be divided into complete Kawasaki disease and incomplete or atypical Kawasaki disease depending on the number of symptom that are present in the patient. When patients have more than four symptoms or have developed coronary artery abnormality, patients will be diagnosed as complete Kawasaki disease. In contrast, patients who have less than four of the diagnostic criteria and still develop coronary artery abnormality is diagnosed as atypical or incomplete KD. Because of the cause of Kawasaki disease is unknown, di agnosis of Kawasaki disease in infants are very challenging. Kawasaki disease can be divided into three phases. First, from one week to two weeks from onset is called acute phase. Typical symptoms are highly febrile, irritable and the fever approaches more than 39 Celsius. Oral changes occurs and also rash can be found in perineal area. Secondly, from two to eight weeks from onset is called subacute phase. In this phase, fever start to decrease slowly and the perineal area, soles, and periungual areas start to peel off. Lastly, from months to years from onset, it is called convalescent phase. In this phase, laboratory value gets normal but there may be severe consequences. For example, patients who had aneurysms may continuously have, for rest of their life, persistent cardiac dysfunction, or myocardial infarction.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Coronary artery aneurysm can be highly found in incomplete Kawasaki disease patients. It is defined as coronary dilatation that the diameter of coronary vessel gets enlarged 1.5 folds. It can be diagnosed by angiographically and it is similar to patients with coronary artery disease. The end-diastolic pressure, end-diastolic volume, and ejection fraction levels are not normal and the left ventricular contraction is not normal. The coronary artery aneurysms are mostly caused by atherosclerosis.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several associated symptoms that can be seen in Kawasaki patients. Diarrhea and abdominal pain and patients may develop arthritis. Also, myocardial dysfunction can be found in early phase of Kawasaki disease such as pancarditis which is the inflammation of all three layers of heart. Another symptom is periarteritis nodosa which is disease in connective tissue that is blocked by nodules in arteries thereby causing blood to not circulate properly. When Kawasaki disease shows periarteritis nodosa, other symptoms cannot be found.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Kawasaki disease can be diagnosis by physical exam but also it can be diagnose by laboratory exam and imaging technique. First, complete blood count test should be performed to look at the amount of white blood cell in blood. Complete blood count is the calculation of white blood cells, red blood cells, and platelet. The number of white blood cell increased to more than 15,000. Also, the erythrocyte sedimentation rate and C-reactive protein increase. After 2 weeks from onset of disease, the platelets level dramatically increases up to 1 to 2*106. There are other abnormalities such as sterile pyuria, increases of hepatic transaminases, hypoalbuminemia. In patients who have KD will have higher level of transaminase than normal person. Also, they will have higher level of ALAT and GGT than other patients who have other febrile diseases. When ALAT level increases, it will lead to coronary artery disease. Research proposed that almost 50% of incomplete KD p atients had pyuria in bladder urine. Pyuria can cause different diseases depends on where it is. When pyuria is in bladder, it can cause tubulointerstitial nephritis but when it is in voided urine, it will cause urethral inflammation. Another symptom to diagnosis incomplete KD is to look at acute anterior uveitis after the onset. Patients who have anterior uveitis do not have pain, photophobia, nor visual impairment. By using ophthalmological evaluation, it can detect if patients have different disease which have similar symptoms with anterior uveitis. One of the research in 2006 showed that there were 40% of KD patients had hyponatromia. It is caused by incorrect hormone secretion by cerebral vasculitis, dehydration, or tubular dysfuction. It is hard to diagnosis KD since there is no diagnosis test. To treat incomplete KD, the principle clinical criteria should be renewed in order not to miss out some patients who did not have principle symptoms. By missing out patients will develo p severe other diseases and will not be able to give proper treatments.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  KD also can be found out by using imaging technique. At acute phase, chest x-ray or echocardiography (ECG) are used to look at heart problem. Patients may develop coronary artery abnormalities in acute phase and this can be showed by ECG. When patients are very severe, heart specialists sometimes use single photon emission computed tomography to look into bloodstream of patients. SPECT will provide an image in 3D by using gamma rays. Epidemiology Kawasaki disease is new disease that is predominantly found among Asian children1,2,3. It was first found in Japan by Dr.Kawasaki in 1961. In early 1970s, Pathologist Eunice Larson and Benjamin Landing at Los Angeles recognized it as a new disease. Still today, there is no evidence of how Kawasaki disease emerged but some researchers proposed that Kawasaki disease emerged from Japan and spread to Western countries through Hawaii after World War II. Kawasaki disease was nationwide epidemics but now it is more likely a regional outbreak. The mean annual incidence rate is different in variety of countries and districts3. There are 90 to 112 per 100,000 in Japan, 8.0 to 47.7 per 100000 in US, and 3.6 to 3.7 per 100000 in the United Kingdom and Australia for children who are less than 5 years old. Research in China indicates that the incidence rate is 18.2 to 18.6 per 1000003. The statistics shows that Japan predominantly has highest incidence rate among Asian. Kawasaki disease can be fou nd commonly in males than females and the reoccurrence rate is less than 1%3. The incidence of Kawasaki disease has been increasing annually. In 2000, the incidence rate was 73.7 per 100000 but in 2002, the number of occurrence increased to 95.5 per 1000003. There are relationships between season and occurrence of Kawasaki disease3. But there are variations among different countries. From Japanese reports, there were more patients in winter but in American data shows that patients will develop KD more in the spring and winter. For female the occurrence appeared to be high in March, and highest in July. For boys, the highest occurrence rate was in May and the lowest occurrence rate was in February. As the research indicated, the season and climates have relationship with the susceptibility to Kawasaki disease3. Genetics   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Patients with Kawasaki disease may develop coronary artery abnormalities (CAAs) if patients are not treated early. Usually patients are treated with high amounts of intravenous gamma-globulin (IVGG) as well as aspirin which are used to reduce the possibility of developing CAAs2. However, 10-20% of Kawasaki patients do not response to induced intravenous gamma-globulin. Coronary artery abnormality will develop more frequently to patients who are not responding well to IVGG than patients who respond well to IVGG. Recent research reported that matrix metalloproteinase-9 (MMP-9) is involved in formation of CAA in acute phase of Kawasaki disease patients2. From research, the level of MMP-9 in serum who have Kawasaki disease have much higher than serum from children who does not have KD and patients who have other kinds of febrile diseases2. Using MMP-9 inhibitors might prevent the formation of CAA. However, MMP-9 inhibitors are not used clinically. MMP-9 is endopeptidase that depends on zinc that has zinc at the active site. MMP-9 have major role in tissue remodelling of extracellular membrane (ECM) 2. It can be seen in cardiac remodelling after myocardial infarction, plaque destabilization of atherosclerotic lesion. The mechanism of angiotensin-converting enzyme (ACE) inhibitors is involve with the bind zinc to the active site and stabilize by hydrogen bonds and hydrophobic interactions in the active site. The ACE inhibitor can inhibit the activity of MMP-9 and MMP-2, which have major role in neointimal formation and angiogenesis. The effect of the ACE inhibitor on MMP-9 can be measure by using captopril to the enzyme2. Involvement of the immune system From the studies by Satoshi Sato, Kawasaki disease is commonly found from patients who are younger than 5 years old1. The average age of occurrence of this disease is 2 years. Kawasaki disease does not occur frequently from children who is less than 6 months and can hardly find patients who are less than 3 months1. Kawasaki disease usually does not occur for adults who have immunity to common infectious disease. This result explains that children are more susceptible to Kawasaki disease because they might not produced antibodies to common infectious viruses, and bacteria1. Mannose bind lectin (MBL) is an important component of the innate immunity and is a reactant for hepatic origin which can bind to multiple lectin domains1. MBL has very important role in complement activation and opsonization. Complement activation refers to as the biochemical activity that helps to get rid of pathogen from animal and opsonization have similar activity to complement activation that plays role of pa thogens to get rid of the organism by ingestion and destruction by phagocyte1. It is usually found in bacterial cells, fungus cells, and viruses. It has repeating pattern of mannose and N-acetylglucosamine sugar. There are three single polymorphisms in chromosome 10 for MBL gene at codon 52 (CGT to TCT), codon 54 (GGC to GAC), and codon 57 (GGA to GAA). This mutation will lead to reduction of the level of MBL concentration but polymorphism of the promoter region of MBL will lead to increase the level of MBL concentration in the serum1. When the base changes from glycine to aspartic acid in codon 54, it will distract the interaction between MBL and MBL-associated serine protease. The interaction between MBL and MBL-associated serine protease defend against infection when patients are young. But when patients become older, the interaction of these two molecules will not have impact on the innate immunity1. Because, the patients will develop the mature lymphocytes and immunoglobulins a nd they will engulf the invaded pathogen. Therefore, this research proposes the susceptibility of the Kawasaki disease will be influenced by the MBL polymorphism1. Children who have Kawasaki disease develop endothelial dysfuntion in early phase after onset of disease and this will caused by the production of nitric oxide (NO)5. As described earlier, the primary innate immune system is very important feature for Kawasaki disease. Tumour necrosis factor alpha, IL-1, 6, 8, monocyte, chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) will be activated to produce cytokine storm5. After cytokines are produced, it will release iNOS (inducible nitric oxide synthase) in neutrophils, endothelial cells, and smooth muscle cells. Nitric oxide is produced by two enzymes which are endothelial NOS and iNOS5. Recent research found out that patients who developed Kawasaki disease have higher level of iNOS concentration in neutrophils in acute phase. Also, children have high level of nitric oxide metabolites such as NOx, NO3-, and NO2-. After production of Nitric Oxide, it will react with Reactive Oxygen Species (ROS) to give more bi ochemical reactions. This will be measured by new device called fluorescent indicators5. There are new devices used to measure the concentration of NO and ROS. First, Hydroxyphenyl fluorescence (HPF) was used to measure the concentration of ROS. Another device is called Diaminofluorescin-Flu Diacetate (DAF-FM DA) which is used to measure the concentration of intracellular Nitric Oxide5.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are significant evidences that the production of ROS and NO by neutrophils were much higher in Kawasaki disease patients in compare to people who have non-KD febrile children or non-febrile children5. By treating with IVIG, NO level will decrease. But, the production of NO can be beneficial or harmful. Usually, NO is cytotoxic but sometimes, it can protect cells from toxic materials. NO may react with hydroxyl radicals to produce much higher toxicity. To control the influence of NO, the duration, the amount of NO synthesis should be controlled. Therefore, in acute phase of Kawasaki disease, NO and ROS is highly produced and will cause damage to endothelial cells5. Treatment and future research   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  When patients are diagnosis as complete or incomplete KD, treatment should be induced right away. Because when patients have more than 10 days of fever will develop CAA. Major treatment that doctors use to treat KD is intravenous immunoglobulin (IVIG). Intravenous immuglobulin induced into bloodstream which contains immunoglobulin antibody G that is brought from other control blood donors. IVIG is still a major recommended treatment but some patients do not response to this treatment. The effects of IVIG last for 2 weeks up to 3 months. The typical amount of IVIG is a dose of 1000mg per kg of patients bodyweight. High amount of IVIG with aspirin will reduce the rate of coronary artery abnormalities (CAA) which includes coronary artery dilatation or aneurysms from 20% to 3 to 5%. Also, depends of patients, IVIG can also used with acetylsalicylic acid to treat KD.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There is one example about the incorrect treatment will cause severe disease. When IVIG was induced, patients could not cure coronary artery lesion. When patients induced with corticosteroid, they developed more coronary artery lesion3. There are two therapies which are antiinflammatory and antithrombotic therapy which are to treat Kawasaki disease instead of using IVIG. In antiinflammatory therapy, methylprenisolone, prednisone, prednisolone, and infliximab are used to treat Kawasaki disease. For antithrombotic therapy, Aspirin, heparin, warfarin, exoxaparin, tissue plasminogen activator, clopidogrel, and abciximab are used. Recently, infliximab proved by US Food and Drug administration to cure not only Crohn disease but also used to treat Kawasaki disease patients. It was not used at all in 2001 but today, the administration of infliximab usage increased up to 2.3% of total number of therapies used. It became favourable because of two reasons. First, it only administer to patients only one time. Secondly, by not using infliximab more than once, it reduce the complication as seen in other therapies which are used more than once. Infliximab is an antibody to tumour necrosis factor alpha, and cytokine in inflammatory response. It binds to tumour necrosis factor alpha and blocks the T-cell receptors to block the biochemical cascade. It will decrease the coronary artery abnormalities in patients who developed Kawasaki disease in early acute phase. To treat KD much better way, there should be more research. First, there should be more laboratory and echocardiographic data. Second, more development of clinical criteria and symptoms should be proposed. Even today, there is no perfect evidence that can explain the cause of KD; therefore, there should be more research on genetic factors by looking at KD patients family. Lastly, after treatment of KD in childhood, complication may be developed after several decades and there is not much information about complication. Therefore, by monitoring and keep in touch with KD patients are good way to find out more about complication after initial treatment. References Sato, S., H. Kawashima, Y. Kashiwagi, T. Fujioka, K Takekuma, and A. Hoshika. 2009. Association of mannose-binding lectin gene polymorphisms with Kawasaki disease in the Japanese. I. Jour. R. Dis. 12:307-310. Inoue, N., S. Takai, D. Jin, K. Okumura, N. Okamura, M. Kajiura, S. Yoshikawa, N. Kawamura, H. Tamai, M. Miyazaki. 2010. Effect of angiotensin-converting enzyme inhibitor on matrix metalloproteinase-9 activity in patients with Kawasaki disease. Clinica Chimica Acta. 411:267-269. Huang, G.Y., Ma, X.J., Huang, M., Chen, S.B., Huang, M.R., Gui, Y.H., Ning, S.B., Zhang, T.H., Du, Z.D., Yanagawa H., and Kawasaki T. 2006. Epidemiologic Pictures of Kawasaki disease in Shanghai from 1998 through 2002. Journal of Epidemiology. 16:No. 1. Yeo, Y.K., Kim, T.Y., Ha, K.S., Jang, G.Y., Lee, J.H., Lee, K.C., Son, C.S., and Lee, J.W. 2009. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr. 168:157-162. Yoshimura, K., Tatsumi, K., Iharada, A., Tsuji, S., Tateiwa, A., Teraguchi, T., Ogino, H., Kaneko, K. 2009. Increased nitric oxide production by neutrophils in early stage of Kawasaki disease. Eur J Pediatr. 168:1037-1041 Perrin, L., Letierce, A., Guitton, C., Tran, T.A., Lambert, V., Kone-Paut, I. 2009. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine. 76:481-485. Son, M.B.F., Gauvreau, K., Ma, L., Baker, A.L., Sundel, R.P., Fulton, D.R., Newburger, J.W. 2009. Treatment of Kawasaki Disease: Anlaysis of 27 US Pediatric Hospitals From 2001 to 2006. Pediatrics. 124:1-8. Ugi, J., Lepper, P.M., Witschi, M., Maier, V., Geiser, T., Ott, S.R. Nonresolving pneumonia and rash in an adult: pulmonary involvements in Kwasakis disease. EUROPEAN RESPIRATORY JOURNAL. 35:452-454. Climaz, R., Sundel R. 2009. Atypical and incomplete Kawasaki disease. Best Practice Research Clinical Rheumatology. 23 (5):689-697.

The Sex during the Victorian Era Essay -- discrimation, sex, women

The Victorian era brought about many changes and the introduction of new things. One issue that stood out was â€Å"The Sex.† Many things evolved around this issue like changes in laws all over, it became a topic for literary poets/ writers and also for the woman question. This term means discrimination based on a person’s sex and during the 19th century this was a vast issue toward women. This all Started from the early Victorian era with queen victoria, who was the monarch of the united kingdom of Great Britain from 1837- 1901. Being the queen she played a very substantial role during this time. As a wife she showed a domestic side. She supported Prince Albert, had his children, became very submissive and devoted to her husband a family. This image she portrayed became a trend to the outside world. Most people looked at this as what the ideal woman was during this era. The sex was a topic that began to spread and women started to fight for their voices to be heard. There were introductions of new laws in many countries such as the United Kingdom, the United States, Canada, and etcetera....

Measurement, Irony and the Grotesque in Gullivers Travels :: Gullivers Travels Essays

Measurement, Irony and the Grotesque in Gulliver's Travels  Ã‚  Ã‚  Ã‚   Postmodernity is obsessed with the Eighteenth Century. As an example of how our nostalgia for that period manifests itself, Hans Kellner has pointed out that a genre of novels and films set in Eighteenth century has exploded in popularity: Lempriere's Dictionary, Perfume, "The Madness of King George III." We could also point to the ongoing revision of scholarship on the period, of which GEMCS itself is an example. In considering what generates this contemporary fascination I have given some thought to the aesthetic and political issues surrounding the beginnings, and perhaps also the end, of the bourgeois social sphere. A conviction, argued most aggressively by Jean Baudrillard, is beginning to take hold, in and out of the academy, that this sphere, after an almost totalizing expansion, is now in decline. The panic over the loss of the social, whether supportable or not, offers a possible explanation for the contemporary nostalgia for the period in which Swift wrote Gulliver's Travels. In this age of dissolution, what do we see when we look back at the age of our creation? One thing we observe is the development of a peculiar kind of irony which we can't help but distinguish from our experience of this trope in the age of its dominance. The satirical effect of the irony in Gulliver's Travels read by the Postmodern will be precisely what it was not at the time of its production. The historical distance between Eighteenth Century and Contemporary readers can be understood by way of Hayden White's use of the master tropes in "Foucault Decoded." White assigns one of the master tropes to each of the four archeological periods described by Foucault in The Order of Things. In White's system, Foucault's Renaissance was metaphorical, locating truth in similarity. Swift wrote in what Foucault considered the Classical Period, which, for White, had metonymy as its overriding mode of reason, because a new transparency of representation made it possible to organize knowledge by a standard and represent it symbolically on a table. The Modern period was characterized by synecdoche, in that the subject of knowledge, Man, was now included in the study of the world, in a part-whole relationship. Finally, the Contemporary or Postmodern mode is ironic, characterized by a questioning of the foundations of knowledge and a Dionysian disappearance of the subject of that knowledge.

Tender Mercies Essay -- essays research papers

'Tender Mercies,'; written by Horton Foote, is a screenplay, which presents to the reader ordinary people, who are trying to live decently in an unpredictable and violent world. The reader comes to be aware of many dramatic scenes where the central characters have come to experience many complex but yet fascinating situations in their lives. Reading this screenplay the reader will come to acknowledge one of the centralized themes in 'Tender Mercies,'; which is the theme of redemption. For those who are unaware of the word, redemption as it applies to the screenplay 'Tender Mercies'; is the literary word meaning to be saved or saving someone from an experience or a situation. The reader can observe this redemption at various times through many characters, such as: Mac, Rosa Lee, Sunny, and Dixie. Each one of these characters has been redeemed by other characters or has been the redeemer of other characters. Thus, in the paragraphs to proceed, the reader will be introduced to these exa ct characters and to the situations from which these characters were redeemed from or whom they had redeemed. Alongside, the reader will also come to recognize how this theme provides the clearest reason why 'Tender Mercies'; is neither a Tragedy nor Pathos. As mentioned above, one of the centralized themes in 'Tender Mercies'; is the theme of redemption and that it can be seen through many characters, of whom is Mac. In the beginning of this screenplay, Mac is viewed as a person with a drinkin...

Is Television a Bad Influence on Children Essay

The television has become such an integral part of homes in the modern world that it is hard to imagine life without television. It provides entertainment to people of all ages especially children. Children love to watch TV and prefer to stay â€Å"glued† to the TV screen all day, rather than playing outside. In the USA, 47% of children ages 2 to 18 years have a television set in their bedrooms. On a typical day, they spend on average of 5. 5 hours using media, including television, computer games and the Internet (Kaiser Family Foundation, 2001). TV is the number one after-school activity for 6 to 17 years old. see more:impact of television on children essay Although television is loved by children and has helped them a lot, it has influenced them in a negative way. Some optimistic people can argue that children should be allowed to watch a lot of television because it is educational. Preschoolers can get help to learn the alphabet on children’s programs such as â€Å"Takalani Sesame† and grade scholars can learn about wildlife on nature shows. However, with the increased rate of working parents, most children come home from school and are left alone or with a babysitter who may not care what the children watch on TV. With no supervision nearby, children may end up watching shows with violence, sex and bad language. Children that view such shows are likely to fear that the world is scary or that something bad will happen to them. Furthermore, the children will start to show aggressive behavior or start to behave like what they see on TV. (Bandura & Ross 1963) Television has become such an integral part of homes in the modern world that it is hard to imagine life without one. It provides entertainment to people of all ages, especially children, who, consequently would prefer to stare at the TV screen all day rather than going outside to play anymore. An online journal that I read called Journal of Youth and Adolescence states that television is an easy and inexpensive way to get information, it’s the most popular way for Americans old and young to get informed. Informed on what? With the increased rate of working parents, most children come home from school and are left alone or with a babysitter who may not care what the children atch. With no supervision nearby, children may end up watching shows with violence, sex, and bad language. The journal then goes on to say that TV allows us to create a national culture because it gives people something in common to talk about. I hear it everyday, most people are talking about their comedy shows that they watched the night before rather than what they saw on the nightly news. In this generation we have to many choices. The journal also stated that children have a choice on what to watch and how long they watch television. For me, this argument is unrealistic because most children do not have self discipline. They would rather watch something entertaining rather than a documentary about nature or history for example. They would rather watch the latest â€Å"Transformers† movie which is not suitable for young children. Firstly, children’s thinking skills can be adversely affected if they watch inappropriate television programs for a long period. According to Sharif (1999), short segments with interesting presentation in modern children’s programs and music video clips encourage the development of short attention spans in children. Children may have the wrong thoughts that overwhelming all the difficulties in life will be a piece of cake as they are used to thirty minutes problem-solving programs like ‘Friends’. As a result, they always lose out patience when it is the real time for them to counter the hardship and rigor situations. Moreover, Jones claims that children who are heavy viewers are among the lowest achievers at school because they do not develop imaginative skills to create fictitious characters, situations and make-believe worlds (Leigh 2001). In short, excessive television watching hours may plague the healthy thinking of the children Secondly, the structure of children’s behaviors’ will be less desirable, particularly the emanating of wildness and violence. Television programs and even the news, televised at prime time, depict violence scenes which may cause the children to become desensitized to violence (Sharif 1999). Consequently, they may feel that violence is a plausible and acceptable way in solving problems. Furthermore, some children attempt to imitate the superhero in the television shows they have watched. For instance, there were children jumped out of trees in Superman costumes and got themselves injured (Sharif 1999). Besides, the stereotyped movies showing the narrow roles of characters played by the women and men in society influence the children’s behaviors’ towards themselves and others. These evidences prove that television viewing can be actually harmful by forming disfavor behaviors’ among children. Prolonged periods in front of the television which is a sedentary activity can trigger many health problems such as obesity and related diseases. Nowadays, people, especially the youngsters, become inured to the habits of indulging themselves with snacks while watching television (Rutherford 2002). The elevated number of couch potatoes is intractable as it spreads erratically without control. Meanwhile, extended periods in front of the television mean that children are not being physically active (Sharif 1999). Moreover, children may become autistic as television viewing encourages the development of antisocial behavior. Briefly, obesity will become the most discernible fallout when children consume too much calories, adding to the dearth of physical exercises. In conclusion, I strongly believe that television viewing can bring harmful effects such as underdevelopment of thinking skills, negative forms of behaviors’ and unhealthy lifestyles. The negative effects of television viewing are stark, albeit, some people assert that its pros outweigh the cons. However, I am prone to the stance that television viewing brings more harms than benefits. A balance point on television viewing should be adhered in order to best utilize the television by minimizing its negative effects and at the same time get ourselves refreshed and ready to concentrate on things like homework.

Operations Management: Technology and Operations Essay

Effective operations management is one of the most important factors relating to the sucess or in some cases failures of an organisation or company †because markets are volatile and demand uncertain, it is imperative that organisations become more responsive† (Christopher, M 2005:142 ) Because of this; organistaions are becoming heavily reliant on technology to perform duties that simply, because of the scale of operations, are not efficient to do ‘by hand’ . In order to remain competitive, organisations need to respond to the five main objectives of Operations which are : Speed, Flexibility, Dependability, quality and cost. The type of market is the decider of which of these objectives take priority. The aim of this assignment, using several different sources, is to provide an analysis of the technology available in different areas of operations and to provide a commentary on how they are acheiving the goals companies are employing them for. In the retail sector, technology is at the forefront of a smooth and successful operation. Customers will always see their time as a commodity therefore it is important that their experience at the store is as seamless as can be. In this consumerist age that we live in, customers are demanding a lot more from retailers. For example; customers expect that if they give their details once, they will be recorded ‘on the system’ which eliminates the need for them to produce them again. One of the methods used to aid this is the Electronic Point Of Sale system. Initially introduced to automatically tally the total of goods purchased, EPOS systems have evolved to be multifuntional and serve many purposes. Fashion jewellery retailer Swarovski are one of the many companys that use such a system. Initially, the programme used by Swarovski was a DOS based one called Retail Pro. By definition of RetailPro.Com (2011) †Retail Pro provides retail software for point of sale and retail management that helps retailers around the world operate more effectively, with a greater return on their technology investment.† This system however was not able to cope with their expansion as a company and according to a member of staff in the I.T. Department † it was becoming ‘Increasingly difficult to manage and was requiring more human intervention than was justifiable for the price’. (Stewart Pender. 2011). In May 2011, Swarovski swithched to a more advanced EPOS system that was able to efficiently manage their Point Of Sale (POS), Merchandising, Store operations and inventory control with a higher level efficiency and dependability at a lower cost. Micros was the new software introduced to Swarovski to improve efficiency and aid smoother operations. This new system also meant that their inventory control was now fully automated and linked directly to the EPOS. Micros designed their Micros X-Store to be able to monitor stock levels. Once an item is scanned on the EPOS sytem, unbeknownst to the customer the system interacts with the SAP (a global computer system to which Swarovski have access) to communicate that the item has been sold, therefore stock levels are now down by one. This occurs in Swarovski everytime an item is sold up until the cut off time, which is monday afternoon. Once the afternoon comes, the Mircos X-Store system culminates all the data it has gathered over the week and works out the ideal quantity of each individual item to re order against current inventory levels. Once this has been done, the sytems sends the order to head office where it can then be forwarded to the warehouse for picking and delivery. The automated re ordering improves lead times and overall speed of stock replenishment times. Aside from the merchandising aspect, the Micros X-Store is capable of handling human resource functions. It can manage employee reproductivity reports, employee borrow function (temporarily assigning collegues to other stores) and organise and manage customer information. Working from a fully automated warehouse the SCP Sytem receives the orders and begins to work on store specific order fufilment . Firstly, the order goes through what is called the ‘Schaefer Pack Pattern Generator’ (SPPG) which based on many complex alogarithyms, determines the optimum weight and height for the finished pallate depending on the weight and amzingly ‘stackability’ of the individual items in the order. By doing this, the SPPG can reduce the amount of pallates needing therefeore havign a direct positive impact on shipping and transport costs. As well as all of this, the SPPG generates a ‘pallate building plan’. This plan enables the next system to pick the items in the most logical sequence in relation to time and allows the items to be placed on the pallate in a ‘store friendly sequence’. By organising items into a store friendly sequence, the person unloading the items at the store does not need to spend time wandering back and forth as the items would have been palatised in respect to the store. Already a seemingly small software package has had an incredible impact on the effectiveness , efficiency and cost by †¢Ã¢â‚¬ ¢Fully utilising maximum height and weight permittance by achieveing optimium packaging density †¢Ã¢â‚¬ ¢Forecasting item positioning as to reduce damage to goods †¢Ã¢â‚¬ ¢Positioning goods correctly for optimum stability during transport. After the SPPG has done its job, another programme; Schaefer Case Picking (SCP) sytem comes in. The SCP is an automated picking system that actualises the work of the SPPG. Once it has received teh orders from the SPPG, the SCP goes about selecting the goods in order. As aforementioned, the goods are selected in the most time effeicent was as to once again improve efficiency and reduce manual labour costs. As the sytems uses an optical identification known as ‘ the vision system’, there is no need for RFID Identification tags that are very common and popular in the industry, but can be rather expensive. As the goods are selected, they are placed into a buffer area until all the goods for that order have been selected. When selection is complete the items are then placed onto the pallet in the ‘store friendly order’ as calculated by the SPPG. Once complete, the pallets are then stretch wrapped which makes them optimised in terms of goods vs density and secure for transit. The flexibility they have means that the customer’s best interests are always kept at heart and they can avoid any disruption to service by having a multitude of couriers to choose from.   One of the couriers that ASOS use is CitySprint. Based in the UK, CitySprint specialise in same and next day delivery. When an order is placed with ASOS, it is packaged by hand in the warehouse and taken to the collection point. ‘Despite increasing automation, people are still essential in most operating systems’. (Wild, R. 2005 243) From the minute it is picked up by the courier the customer has the option to track it from warehouse to their front door. By scanning the bar code of the parcel, the courier is ‘accepting the job’ and it is ready for despatch. As soon as the order has been despatched, the customer is e-mailed a unique tracking I.D., Which will allow them to follow the journey of their item(s). CourierLocator, which is CitySprint’s own technology, is what allows all of this to be possible. Every courier carries a small hand held GPS enabled device called a CityTrackker. Small but powerful, the CityTrackker’s; using CitySprint bespoke technology and a network of anywhere up to 24 satellites wirelessly transmits live real-time information on the couriers location (including latitude and longitude) back to the FleetMapper (A system that depicts the location of all ‘on call’ couriers). On request, the client (in this case ASOS) can request information on several different couriers anywhere in the UK at the click of a mouse. This kind of technology also puts the customer at the forefront of operations. By logging onto either their ASOS account, or the CitySprint website directly, the customer is able to also see the exact real-time location of the courier delivering their parcel. With such methods, ASOS; using CitySprint’s technology, is giving the customer more flexibility and a heightened sense of dependability by putting them in what seems to be control of the delivery process.

Title: What does personalised learning mean in practice

Assignment TMI Title: What does personalised learning mean in practice? Analyse the learning needs of EAL pupils, and those of SEN pupils. Discuss how the needs you Identify can be met most effectively in subject teaching. Within this context over the past ten years' the term ‘personalised learning' gained political capital and could be considered as a defining feature of the UK's educational system. Miliband 2004) Personalised learning – theory and practice The Sussex report states personalised learning is ‘characterised by high levels of participation of pupils and staff in the schools, learning to learn and pupil voice'. It is a continuous progress which facilitates a ‘deeper learning'. (University of Sussex, 2007). Personalisation is concerned with people, hence what or who is a person, their purpose, how they develop, are motivated, gain skills, form abilities and relate to others.Hence, personalised learning is not simply the acquisition of knowledge or skills but how to forge a person's capacity and capabilities to do so. Consequently, concepts of personalised learning have reflected diverse contemporary theoretical discourses, including Piaget's conceptualisation of cognitive development based on iological maturity and environmental experience to behavioural psychologists focus on learning through conditioning, through to Skinner and Watson's reward and punishment.Vgotsky explored how a person's individual social, economic and cultural influences can determine their ‘actual' and ‘potential' development levels within school based learning. Howard Gardner could be considered as a paradigm shifter (Smith 1994) as he questioned the concept of intelligence based on cognitive development, and sought to demonstrate that a child may be at different stages of evelopment at a single time, and that this is reflected in their ability to learn their maturity on dfferent learning styles.He therefore questioned the concept of scaff olding referring to seven multiple intelligences, two of which have been adopted within school environments, namely linguistic intelligence relating to the ability to learn and use of verbal and written language, and logical mathematical Intelligence relating to analysis of issues, grasping of quantitative information and the sciences. I Implemented this pedagogy with my top set 10 class while teaching controlled ssessment vocabulary.Recent UK Government policy has encouraged an educational approach that tailors support to Individual needs so that ‘every child matters'. The five core inter-related aims; be healthy, stay safe, enjoy and achieve, make a positive contribution and achieve economic well-being underpinned by practice guidance ana regulatory perTormance systems slgnlTy tne Importance 0T social, economic and environmental factors on child development. Peter Senge said â€Å"many children struggle in schools because the way they are being taught is incompatible with t he way they learn† (Capel, S. al, 2007) hence teaching and support can be improved by encouraging school based learning to be designed around a pupil's needs, hence Miliband's quote above. Assessment for learning directly relates to national teacher standard 6; ‘make accurate and productive use of assessment'. Teaching uses both formative ongoing assessments and summative assessments, normally at the end of a module, scheme of work or a part of an academic year. Summative assessments usually relate to formal examinations that inform streaming and ranking, to inform accountability (Black, Harrison, Lee, Marshall and William, 2002).Summative assessments are often isolated from normal teaching and learning, and are often areas of which teachers have little direct control in terms of personalising for learners, for example ‘6SCEs'. Key formative techniques include higher order questioning that targets towards their current level; personalised comment marking, identifyi ng clear targets for improvement, self and peer assessments and analysing and using mark schemes and feedback from summative assessments to assist individual learning plans.According to Williams (2009) the effectiveness of formative assessments can generate nearly three terms extra earning per year. However Ofsted reviews have identified teachers' difficulties in identifying clear learning objectives and outcomes by the use of attainment levels to inform structured lesson planning and assessment (Ofsted, 2007). For example in my second placement school I asked a mixed ability group of year 7's to assess sentence exemplars and explained the success criteria based on Bloom's taxonomy.This showed what was expected to answer higher order questions and levelled answers. It was difficult at first however as soon as they got accustomed to my expectations a marked improved was identified in their work. They were able to interpret the differences properly and with scaffolding the majority of them were able to vastly develop their answers. (See appendix 1) When considering Howard Gardner's multiple intelligence, personalisation leans towards the understanding and application of different learning styles, namely audio-visual, and kinaesthetic.However Cofield et al (2004) suggest that the effectiveness of this focus is varied, in terms of their reliability and as a motivator for learning. Placing the learner at the heart of the teaching process and in turn enabling them to take more responsibility or their learning can also be delivered through developing learning objectives reflective of individual and classroom needs. Bloom's taxonomy provides a classification of learning objectives under cognitive, affective and psychomotor providing a methodology for scaffolding actual and potential learning within the classroom.Differentiation can ensure a classroom of mixed ability students are all stimulated and stretched, and this can be achieved regardless of ability when setting tasks, if executed as though one were climbing a ladder in order to reach the top, or objective of the lesson. (Petty, 2009). Within the MFL department we operate an ‘ALL, MOST, SOME' to differentiate our tasks, (see appendix 2 ; 3) adding a challenge at the bottom for the most able or for native speaking students. This ensures that every single student can be accessed and also be stretched regardless of ability and rank order.Alex Moore suggests tnat a good teacner needs to De strategic In applylng models and theories to shape and develop ‘pedagogic identity (Moore, 2000). Using these ideas, together with Wgotskys theory of constructivism has helps practitioners develop and go on to plan lessons that are creative, fun, focused, tructured and interesting combined with delivering content to any ability, regardless of need (be that G&T, nixed ability or SEN) or those that encounter difficulty with focus, learning and progressing in a traditional classroom environment.Some of the methods used in the classroom to take advantage of ‘multiple intelligences' are video clips, imagery and displays for visual learners and group work such as role plays or quizz type games for interpersonal learners. For the intra-personal learners, enabling them to set personal goals and challenges for themselves, for the more verbally inclined students question and answers or ualitative assessment and finally problem solving and modelling for more kinaesthetic pupils.Curriculum entitlement and choice relates to national teacher's standard 3. The Salamanca Statement and Framework for Action recommended at a national and school level that â€Å"schools should accommodate all children regardless of their physical, intellectual, social, emotional, linguistic or other conditions† (1994) As abovementioned, and experienced in both my school and in my placement schools, many Stage and 1 and 2 EAL students are withdrawn from MFL and other on – core subjects in or der to focus on literacy and numeracy improvement.Interestingly, MFL is one of few areas that many EAL students do not feel isolated as other students are also at a new stage of learning a different language also, and thus can excel in the subject. The National Curriculum (1999) outlines that â€Å"in order to overcome any barriers to learning in MEL†; specific requirements such as laptops, support and help should be provided in order to access the learning for EAL students needing support. Indeed, this subject specific inclusion information decrees that â€Å"all upils have a right to participate in the study of MEL† (Pachler, Barnes ; Field, 2009).