Reflection on Nursing Presentation

Reflection on Nursing Presentation REFLECTION ON MY PRESENTATION Presentation: As a major aspect of my abroad program I needed to convey a 15 minutes introduction on decision of subject before my partners. A powerful introduction utilizes the connection between the moderator and the crowd. It takes full thought of the audience’s needs so as to catch their advantage, build up their comprehension, move their certainty and accomplish the presenter’s targets (University of Leicester, 2009). As per Nickolas (2003), to encourage a powerful introduction there are four components. They are: Planning, Preparation, Practicing, Presenting Arranging: it incorporates choice of a significant theme, finding the learning results, sorting out the substance, setting up the visuals. Readiness: The fundamental point is to get ready clear, straightforward and alluring visuals. For eg: successful force point slides. Rehearsing: Practice makes flawlessness it incorporates practice and pre practice. In practice rehearsing the things you are mean doing, however in pre practice rehearsing the things you may need to do. Introducing: It incorporates outward appearance, pace, voice, body developments, utilization of pointer, jobs etc†¦ So as to compose a reflection I chose Gibbs 1988 model. It is principally utilized by wellbeing experts. To reflect isn't sufficient, you at that point need to incorporate the learning and new understanding you have picked up in this way permitting the intelligent procedure to illuminate your training. Making a move is the key; Gibbs prompts the expert to figure an activity plan. This empowers the intelligent professional to take a gander at their training and see what they would change later on, how they would create/improve their training (Gibbs, 1988). It has got six unique stages. Which are portrayal, feeling ,assessment, investigation, end and activity plan. Depiction: As a component of my abroad nursing program I needed to convey a 15 minutes introduction on decision of subject on the last day at college. On my time of arranging I was extremely befuddled about the choice of subject. Assortment of themes was in my brain. At long last I chose my theme which was percutaneous endoscopic gastrostomy taking care of and the consideration of patient with PEG. I was truly fulfilled when I chose the point. Since I felt it will be a significant and helpful data for all the medical caretakers in their work place. Introductory time of my activity in this nation have gone over patients with PEG tube. It was another experience for me. After the determination of my point I began doing some examination on it. I read a few books, diaries, and gathered data from web search tools. Proof based practice characterize as ‘ the faithful, express and reasonable utilization of current best proof in settling on nursing choices about the consideration of individual patients’ (Sackett, 1996). As it is a critical thinking way to deal with the today’s social insurance framework, it brings better clinical choices and patient result. So as to make my introduction progressively viable and clear I chose to utilize some visuals, this was power point slides. My slides were straightforward and straightforward. When I completed my planning I began to rehearse. I rehearsed before my family just to lessen the stage dread. At the day of introduction I was certain enough to introduce before a gathering. Feeling: So as to change the time our gathering was isolated in to two. I was the third individual in the principal gathering. On the day I was marginally apprehensive particularly a couple of moments minutes before the introduction begins. Luckily I felt sure at the hour of introduction and the associates were extremely steady and responsive which expanded my solace level with in the class. Presently I feel , by doing this introduction helped me to accomplish a significant ability in my calling, as showing has a functioning part in nursing. Assessment: International Center for Alcohol Policies (2014) says Evaluation offers an approach to decide if an activity has been beneficial as far as conveying what was planned and anticipated. It has a significant job to improve own aptitudes. After my introduction I moved toward my guide and she gave me an extremely viable and clear criticism. She clarified my points, learning results, presentation of introduction was unmistakably expressed. I utilized proper guides and the conveyance of introduction was fitting, and it was proof based as well. Where I could improve was the time the board as I was minimal short on my time. Investigation: As indicated by Ritchey, (1996) Analysis is characterized as the system by which we separate a scholarly or significant entire into parts or segments. After my introduction I have experienced my experience indeed and I felt my determination of subject was directly as I saw my associates appreciated the point. In any case, I was somewhat disillusioned as I was somewhat short on my time. At the point when I was rehearsing at home I ensured I was on schedule. With this introduction I comprehended the significance of arranging and sorting out the work just as time the executives. End: I discovered it myself the open door I got from the abroad nursing program was extremely extraordinary. Instructing before a gathering of individuals was an upsetting activity for me. At the point when I understood I needed to do it I went after for the level best and the criticism from my mentor made me progressively solid. Medical caretaker has a significant job in showing the staff. In my future profession I will be increasingly sure to show individuals , on the grounds that I got that, it will expand my insight also. Activity plan: I will do another introduction in my work place seeing moving and taking care of as we have numerous new staff begun. Before I do it I will ensure I will arrive at my expected time limit. In addition that, I will experience understanding materials and set up the substance from proof based information. This segment I am intending to do it with a blend of hypothesis and down to earth. I will show them the various kinds of derricks, slings and how to utilize it. It will be increasingly more obvious the moving and dealing with strategy. Clinging to NMC code (2008) I will refresh my insight and abilities all through my profession. References: Gibbs, G. (1988). Learning by Doing: a manual for instructing and learning techniques. London: Further Education Unit. Nickolas, F (2003). Successful introductions, separation counseling: www.nickols.uk (Last got to on 04/02/2014) NMC(2008) The code. http://www.nmc-uk.org/Documents/Guidance/NMC-Guidance-on-proficient lead for-nursing-and-birthing assistance students.PDF (Last got to on 10/01/2014). Universal Center for Alcohol Policies (2014) What Is Evaluation. Online.(Last got to on 24/02/2014) . http://www.icap.org/PolicyTools/Toolkits/EvaluationToolkit/2WhatIsEvaluation/tabid/441/Default.aspx Ritchey T, (1996) On Scientific Method Based on a Study by Bernhard Riemann. Investigation and Synthesis. Online.(Last got to on 20/02/2014) http://swemorph.com/pdf/anaeng-r.pdf Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. what's more, Richardson, W.S. (1996) ‘Evidence based medication: What it is and what it isn’t’, British Medical Journal. College of Leicester (2009) Planning a successful introduction. Learning improvement .on the web. (Keep going got to on 10/02/2014). http://www2.le.ac.uk/workplaces/ld/assets/pdfs-of-study-guides/introduction abilities pdfs/arranging introduction v1.0.pdf. R PhilipPage 1 Reflection on Nursing Presentation Reflection on Nursing Presentation Working in the careful ward involves various obligations regarding a social insurance professional like me. Considering the comprehensive consideration, recuperation of patients and limiting any inconveniences from happening are a couple of those duties that a careful medical caretaker consistently needs to remember. As indicated by Anthony Lee (2007), regardless of whether it is stomach medical procedure, plastic medical procedure, or some other obtrusive careful treatment, it is perilous to expect 100% security. He additionally focused on that because of the supernatural occurrences that medical procedure gives, individuals may regularly will in general overlook the dangers and complexities that go with it. One of these dangers ordinarily connected with medical procedure is the event of profound vein apoplexy in the postoperative stage. Without thromboprophylaxis, profound vein apoplexy (DVT) is a noteworthy hazard for careful patients particularly those experiencing orthopedic medical procedure and extensive strategies (ICS 2002, SIGN 2002, Geerts et al 2004, ICS 2006, NICE 2007). This reality gave me the enthusiasm of picking DVT anticipation as my theme for the introduction in order to make me and the audience members increasingly proficient about DVT hazard appraisal counteraction subsequently annihilating this entanglement from happening. This exposition calls attention to a reflection about the 15-minute class introduction that I finished inside the course of my examination. Using the Gibbs (1988) intelligent model, I would be sharing my learning and emotions dependent in general understanding. Depiction During the primary gathering with our program mentors, we were orientated to set up a 15-minute introduction of any theme identified with our entire adjustment experience which would especially concentrate on proof based practice. This would survey not just our insight and dominance of the picked theme yet it would likewise evaluate our correspondence and presentational abilities. In view of the task given, I made an exploration about proof based practice to direct me in picking my theme. As refered to by Sackett, et al (1996), proof based practice is the scrupulous, unequivocal and wise utilization of current best proof in settling on choices about the consideration of individual patients. The act of proof based medication implies incorporating individual clinical ability with the best accessible outer clinical proof from methodical examination. In light of these discoveries, I continued with my journey for an intriguing topic.ã‚â Inside the week, I had the option to deal with a patient who was conceded for suspected profound vein apoplexy

Kjlk free essay sample

If you don't mind don't hesitate to utilize extra sources to enhance your assignments. All through the semester, you will be urged to talk about any present business news with the class, particularly on the Discussion Board. It is essential to be educated of the present outside condition and how your association is influenced. Index Description Process and task the executives and improvement of utilitarian methodologies to make an incentive for a business and their customers; the board apparatuses and approaches for breaking down activities and applications to a wide assortment of administrative decisions.Credit: Three hours. Course Learning Outcomes and Objectives Learns Eng Objectives: To assist understudies with understanding their associations in todays changing operational condition. *To help understudies to decide how to turn out to be progressively viable experts in their condition. * To support understudies certainty as they direct and adapt to the complexities of progress. Learns Eng Outcomes: * Students will have the option to basically think about the obstructions and open doors for effective authoritative change. We will compose a custom exposition test on Kjlk or then again any comparative point explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Understudies will show successful correspondence while examining operational results. * Students can clarify the effect of arrangement for association missions and operational arranging. Understudies can talk about the advancement of administration and the significance of both the inner and outside client. * Students can know about the significance of nonstop improvement in the activities of their associations. Incapacity Us port Policy Statement: Texas Womans University tries to give fitting scholarly acclimations to all people with disabilities.This University will conform to all relevant government, state, and neighborhood laws, guidelines, and rules, explicitly Section 504 of the Rehabilitation Act of 1 973, and the Americans with Disabilities Act (DAD), concerning giving proper scholastic changes in accordance with bear the cost of equivalent instructive chance. It is the obligation of the understudy to enroll with and give clinical check and scholarly timetables to Disability Support Services (ADS) toward the start of every semester and no later than the second seven day stretch of school except if in any case controlled by the coordinator.The understudy likewise should contact the employee in an opportune way to mastermind fitting scholastic alterations. For additional data with respect to Disability Support Services or to enroll for help, if it's not too much trouble contact the workplace at 898-3835 (voice), 898-3830 (ADD) or Visit 105. Scholarly Dishonesty strategy: Academic uprightness is the establishment of the scholastic network. Since every understudy has the essential obligation regarding being scholastically fair, understudies are liable for perusing and seeing all segments in the Student Handbook (p. 3-55) identifying with guidelines of lead and scholastic life. Scholastic deceptive nature incorporates cheating, unoriginality, intrigue, manufacture, adulteration, and misrepresenting scholarly records, and different acts deliberately intended to give unjustifiable bit of leeway to the understudy, or potentially the endeavor to submit such acts. Understudies who disregard college runs on scholarly snootiest are dependent upon disciplinary punishments, including the chance of disappointment or expulsion from a course, discipl inary probation, and additionally excusal from the University. See subtleties in the accompanying URL: http://www. Two. Du/o-SSL/Stultification/sedimentations. HTML Other assets identifying with scholastic trustworthiness and Plagiarism: 1. The Library has another video instructional exercise on copyright infringement. On the librarys landing page (http://www. Television. Due/library/)- (on the right), or all the more explicitly http://www. Two. Due/library/instructional exercise/written falsification/player. HTML 2. The Library likewise has a pleasant Powering introduction on a similar subject http://www. Two. Due/as/inundates/shared/apparatuses/copyright infringement. PPTP). Assignments General data: All assignments are expected at 1 :pm on the due date. Late assignments won't be accepted.If you experience a circumstance where you won't have the option to finish a task on schedule, if it's not too much trouble let us know as quickly as time permits. On the off chance that we don't get notification from you, we will expect that you decided not to finish the task and will get a score of zero. The Case Studies and the Book Assignment are printed for reviewing and should be submitted as appended word records by means of the connection under the individual task (Note: click on the task name) and might be submitted preceding their due dates. You may utilize extra sources to enhance your assignments.You may be permitted one endeavor while presenting your assignments through Blackboard, so please audit your assignments cautiously before submitting. As an understudy in this course, it is your duty to present the right and finished task. Try not to send extra entries to the email we have constrained email space and the inbox can get over-burden. In the event that we can't open your assignments, you will be reached by means of email. Task organizing: Assignments must be composed in 12 point textual style (Times New Roman), utilizing 1 inch margins.Please incorporate your name, class number, segment number, and the task number on each page in a header. In the event that you don't give this data on your archive, 10 focuses will be deducted from your task grade. Conversation Board Questions: Answers to Discussion Board questions are expected at 1 :pm on the due date. Questions can be found under the Discussions tab on Blackboard. Notwithstanding your unique reactions, answer to in any event 2-3 understudy posts for each question by the Forums due date. If it's not too much trouble make a point to give separate sections to each post you submit.Case Studies: Five (5) Case Studies will be expected all through this course. It would be ideal if you complete the inquiries for the five Case Studies; they can be found toward the finish of the parts in your MOM eBook. Contextual investigations have arrived at the midpoint of between 2-3 pages long. Book Assignment: Your Book Assignment will be over the book Good to Great by Jim Collins; you should buy this book. To increase a more profound comprehension of the key ideas saved in the book, plan composed reactions to any four (4) of the six (6) questions recorded underneath. For every reaction be attentive and concise yet not superficial.This is a huge task and ought to have thought, application, and mirror that you have undoubtedly perused the book. Book assignments have arrived at the midpoint of between 5-7 pages long. 1. 0 Level 5 Leadership Which is more diligently to develop inside yourself: modesty or will? 2. 0 Who First? On the off chance that remuneration isn't the essential driver for the opportune individuals on the transport, at that point what are the essential components in getting and keeping the perfect individuals on the transport? What job does remuneration play? 3. 0 Confront the Brutal Facts Do you have any warning systems throughout your life or association? What thoughts do you have for new ones? 4. 0 Hedgehog ConceptWhich is increasingly significant for an association, the objective to be the best at something, or reasonable comprehension of what you can (and can't) be the best at 5. 0 Culture Of Discipline Think oft individuals: One being somebody who just considers his to be her activity as a vocation and the other who comprehends that the person has an obligation. How does the distinction run its course in their work? In their own life? What would it be advisable for us to search for in finding such individuals? 6. 0 Technology Accelerators Why is there so much promotion and dread about new innovations, and what would you be able to do to see new advances with target poise?

Paper Writing Service - How to Get the Best Paper Writing Service For the Price You Can Afford

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The Simple Pleasures of Life Bring Happiness Essay

I am determined to be cheerful and happy in whatever situation I may find myself. For I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition. -- Martha Washington Happiness is not something ready made. It comes from your own actions. -- Dalai Lama An emotion is an intense feeling. Happiness is one of the many emotions humans experience. It may perhaps be the most important feeling a person can have and it is the one feeling everyone strives to achieve, yet strangely, for the most part, people seem to only get a glimpse of it. Pleasurable satisfaction, a state of well-being and contentment are the more outstanding elements of happiness. Happiness, known†¦show more content†¦Happiness is denoted by the way a person behaves. Usually when someone is happy it is obvious and they express this feeling outwardly, whether by their actions or verbally. The facial area is the main part through which happiness is shown. The expressions of the face such as a twinkle in the eyes when joyous, the ever-present laugh lines around the eyes, which constantly smile at you, makes the on-looker aware of a happy person. The mouth plays an important role in showing that a person is content, through both physical and verbal means. The ra diant smiles with the accompanying dimple, spreads delight and pleasure. Laughter, a universal expression of joy, travels through the air spreading cheer to all that hear it. Other verbal expressions of gaiety take the form of song singing, which has always been used over the years to express feelings of happiness, and exuberant chatter, which infuses the air with excitement and enthusiasm. Physical expressions of joy are not limited to the facial area alone. Extending to the whole body, happiness is shown through skipping, the swinging of hands, twirling, dancing and almost any rhythmic movement of the limbs. Children show their happiness, mostly but not solely, by running, jumping, skipping and sometimes rolling on the ground. Adults are for the most part less energetic with their expressions of joy, and show their joy by twirling and dancing, mostly females, and by punching the air. It is not necessary however, for aShow MoreRelatedHedonism, By Robert Nozick1272 Words   |  6 PagesInsufficient for Well-Being Hedonism is the belief that pleasure is the most important thing in life and everything else is trivial as long as you are getting pleasure, the goal being to accumulate the greatest amount of net pleasure in ones lifetime. I disagree with the thought that hedonism is the correct view of well-being for people. Life is more than breaking down acts into something as simple as level of pleasure and then determining happiness off of that. By examining Nozick’s experience machineRead MoreAristotle Vs. 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Through the explanation of pleasure as we ll as its arguable counterpart, suffering and the discussion of their values in addition to the counterargument of hedonic treadmill, Kupperman’s views about the role of pleasure in living a good life can be strongly supported and evaluatedRead MoreAristippus : The Philosophy Of Socrates1147 Words   |  5 Pages He was a pupil of Socrates, and became close to Socrates even though his philosophical views differed. Aristippus believed the goal of life and living revolved around pleasure, seeking pleasure no matter what the circumstance is. Aristippus believed having pleasure meant having happiness, and ones happiness revolved around everything else. Ultimately, pleasure was the true motive of living. Aristippus was the founder of the Cyreneic school of Philosophy. At this school, Aristippus taught about

Rhetorical Analysis Of The Lucifer Effect - 846 Words

Rhetorical Analysis: The Lucifer Effect The Lucifer Effect examines how the human mind has the capacity to be infinitely caring or selfish, kind or cruel, creative or destructive. This work analyses the Stanford Prison Experiment, and the author’s personal experiences as an expert witness for one of the Abu Ghraib prison guards, to raise fundamental questions about the nature of good and evil. Mankind wants us to believe that there is a little good in all of us. Zimbardo created a min blowing experiment that examine the human mind. The Stanford prison experiment was a study of the psychological effects of becoming a prisoner or prison guard. The experiment was conducted at Stanford University on August 14–20, 1971, by a team of researchers led by psychology professor Philip Zimbardo. It was funded by the U.S. Office of Naval Research and was of interest to both the U.S. Navy and Marine Corps as an investigation into the causes of conflict between military guards and prisoners. The experiment is a classic stud y on the psychology of imprisonment and is a topic covered in most introductory psychology textbooks. The participants adapted to their roles well beyond Zimbardo s expectations, as the guards enforced the measures and ultimately subjected some of the prisoners to psychological torture. Many of the prisoners passively accepted psychological abuse and, at the request of the guards, readily harassed other prisoners who attempted to prevent it. The experiment evenShow MoreRelatedThe Lamb and The Tyger by William Blake Essay1758 Words   |  8 Pageslights. â€Å"The Tyger,† written in 1774, and â€Å"The Lamb,† written five years later in 1789, are considered companion poems due to their similar humanistic topic and stark differences of each other. Through the use of specific titillation and use of rhetorical questioning, Blake sets up an ultimatum between the two poems, creating the illusion that each creature in the poems may have different creators. In this way, Blake questions traditional Christian doctrine in such a way that initiates curiosityRead MoreThe Movement t hat Revolutionized the Civil Rights: Black Panthers1333 Words   |  6 Pagesactivists they became national heroes to black people everywhere. After experiencing police brutality themselves, Bobby and Huey felt obligated to assemble an organization to deal with the injustice. A poem titled â€Å"Uncle Sammy called me fulla’ Lucifer†, written Huey made many people stop and listen to Huey and Bobby’s philosophy, thus the creation of the Soul Students Advisory which was the beginning of the movement. (USPoliticsonline.net) Many people were eager to find a leader in the 1960s who

Reflections On The Nature And Study Of Buddhism - 1676 Words

Aptly titled â€Å"Reflections on the Nature and Study of Buddhism†, chapter fourteen of Buddhism—The Ebook, by Charles S. Prebish and Damien Keown does exactly that. This part of the text explains Buddhism’s spread to western civilization and how Americans altered it, its evolution into an academic discipline in America, and the role of technology in the discipline of Buddhist Studies. On page 288 of the text, writer Stephen Batchelor describes the western hemisphere’s first encounter with Buddhism as an â€Å"Awakening of the West.† This so called â€Å"awakening† was not an instantaneous or widespread hit, but factors like Buddhist influences in the arts and a â€Å"steadily increasing number of converts and Buddhist institutions† prove that Buddhism was†¦show more content†¦There is no written documentation of the development of Buddhist Studies in America as an academic discipline; from the little that is known, it seems appropriate to attribute the beginning of Buddhist Studies to the aforementioned Paul Carus, along with Henry Clarke Warren and Charles Rockwell Lanman. The first two founding fathers, Henry Clarke Warren and Charles Rockwell Lanman, both studied Sanskrit and taught scholars how to interpret the language. 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Besides the major religionsRead MoreJapanese Literature Throughout History And History1382 Words   |  6 PagesIn Japanese literature throughout history, there tends to be an idea of nature that is not nature as it really is, but is a projection of the subjective self. This is portrayed through the concept of MappÃ… . MappÃ…  in Japanese Buddhism, is the age of the degeneration of the  Buddha’s  law, when only the teachings remained, the practices were no longer pursued, and enlightenment was a mere word. This is a concept that has substance, especially when combined with mujÃ… , the idea of impermanence. MujÃ…  becameRead MorePoets of the Tang Dynasty Essay1374 Words   |  6 Pages Throughout human history, our beliefs have influenced our actions. This is why we have studies like the humanities. During the Tang Dynasty, different religions developing during the time had enormous influence on what was being produced during the era. When it comes to literature, poets like Wang Wei, Li Bai, Du Fu, and Bo Juyi expressed their religions through their poetry during the Tang era. While it was not always directly mentioned in their poetry, there are connections between the TangRead MoreThe Impact Of Asian Immigrants On The United States With Numerous Religions1293 Words   |  6 PagesA. Overview: Asian immigrants attained in the United States with numerous religions, which includes Buddhism, Confucianism, Hinduism, Islam, and Christianity. The categories of informative structures offered by religion, as a vital foundation of ethnic factors, developed especially significant when societies are surviving with the fluctuating surroundings. It is by the structured re ligion and household demonstrating that standards and philosophies are instructed in the newer generation. Though there

Autism and Evidence-based Practice free essay sample

This document represents a remarkable collaboration by a diverse group of stakeholders all committed to a single goal – improving the lives of children and youth with Autism Spectrum Disorders. The vision and support of the Maine Department of Education and the Maine Department of Health and Human Services enabled this work to be done, while Lindsey Tweed and Nancy Connolly provided the leadership that kept the project moving forward. We received invaluable input and guidance from a variety of viewpoints, including people with autism, parents, educators, providers, researchers, and policymakers. This was a challenging task requiring countless hours of article review and discussion over a one-year period. Although opinions differed at times, enthusiasm for the project never waned, and consensus was achieved. Throughout this involved process, the focus was always on the children and families impacted by Autism Spectrum Disorders. We are grateful to the consumers and families who shared their stories, experiences, and opinions, and who gave meaning to our work. The members of the Committee collaboratively developed a common understanding of research and evidence-based practice, selected interventions to evaluate, and outlined a literature review and rating process. The Committee collectively endorses the findings and conclusions expressed herein. However, due to the diversity of perspectives and experiences within the Committee, the conclusions and thoughts on each position in this document do not necessarily represent the individual opinions of each member or the organization they represent. Page 5 CHILDREN? S SERVICES EVIDENCE-BASED PRACTICE ADVISORY COMMITTEE MEMBERS OF THE AUTISM SPECTRUM DISORDERS PROJECT Nancy Connolly (Co-Chair) Special Education Consultant Department of Education Lindsey Tweed (Co-Chair) Director of Clinical Policy and Practice Children? s Behavioral Health Services Department of Health and Human Services Amy Beaulieu (Staff) Policy Associate, Cutler Institute Muskie School of Public Service University of Southern Maine Amy Benham Special Education Teacher, Autism Program Winslow Elementary School Sharon Brady Director of Special Services Riverside RSU #26 Betty Carolin Clinical Coordinator Charlotte White Center Janine Collins Consumer Advocate Research Associate University of Maine Center for Community Inclusion Disability Studies Nancy Cronin PDD Systems Change Coordinator Maine Developmental Disabilities Council Cathy Dionne Parent Co-Director Autism Society of Maine Page 6 Cynthia Dodge Director of Clinical Services Spurwink Services Roxy Hennings Director of Continuous Quality Improvement Division of Juvenile Services Department of Corrections Alan Kurtz Research Associate University of Maine Center for Community Inclusion Disability Studies James Pelletier Program Manager Department of Health and Human Services Division of Child Welfare Lora Perry Parent Executive Director of ABA Services Providence of Maine Matthew Siegel Medical Director Developmental Disabilities Program Spring Harbor Hospital Maine Medical Center Lynn Silva Assistant Director of Student Support Services Portland Public Schools Erica Thompson Special Services Administrator, MSAD # 54 Distinguished Educator Child Development Services Interventions for Autism Spectrum Disorders STATE OF THE EVIDENCE EXECUTIVE SUMMARY| Introduction| The number of children in Maine with Autism Spectrum Disorders (ASD) has increased significantly over the past decade. Since 2000, the number of children receiving Special Education services for ASD in Maine schools jumped from 594 to 2,231in 2008 – an increase of 276%. A recent study estimated that the total cost of caring for a person with autism over his or her lifetime can reach $3. 2 million, with more than $35 billion spent collectively per year (Ganz, 2007). To conserve already scarce resources and offer the best possible services to children with ASD, it is necessary to identify and understand the treatments and methods that produce positive outcomes as proven by research. Science helps to clarify some of the confusion about what â€Å"works† and enables evidence-informed treatment decisions, thus saving precious time and resources. Autism Spectrum Disorders are a category of neurodevelopmental disorders characterized by distinct and pervasive impairment in multiple developmental areas, particularly social skills and communication (American Psychological Association, 2000). Children with ASD exhibit atypical patterns of social interaction and communication that are not consistent with their developmental age. These patterns become apparent in the first few years of life and are generally lifelong challenges (Schieve, Rice, Boyle, Visser, Blumberg, 2006). Early, intensive identification and intervention can greatly improve outcomes for children with ASD (Eikeseth, Smith, Jahr, Eldevik, 2007). Early and effective treatment also offers opportunity for significant cost/benefit improvement through regained productivity of individuals with ASD and their caregivers (Ganz, 2007). Evidence-Based Practice| Evidence-based practice is a framework for integrating what is known from research into real-world settings in a manner that responds to the individual characteristics and values of the individual being served. There are three main components to evidence-based practice (APA Presidential Task Force on EvidenceBased Practice, 2006; Burns Hoagwood, 2002): Best Research Evidence: In order to integrate research into practice, it is critical to be aware of the scope and quality of the literature. The quality and type of research is an important factor in the evaluation of evidence. Efficacy, the extent to which the treatment had the desired effect on the outcomes, is the critical determinant of empirical evidence (Chorpita, 2003). Clinical Expertise Judgment: Practitioners in an evidence-informed framework exercise their clinical judgment to select methods that address the client? s needs by taking into account the client? s Page 7 environment, life circumstances, strengths, and challenges (APA Presidential Task Force on Evidence-Based Practice, 2006). Values: Evidence-based practice is consistent with the child and family? s values and perspectives (APA Presidential Task Force on Evidence-Based Practice, 2006; Chambless Hollon, 1998; Chorpita, 2003). Engaging families in the process of evaluating, identifying, and implementing evidence-based interventions is critical. Family engagement promotes collaboration between families and practitioners and better informs individual treatment planning. This project focused on the first factor in evidence-based practice – best research evidence. The purpose of this work was twofold: Systematically review the research literature for treatment in ASD and subsequently determine the levels of empirical evidence for treatments commonly used for children with ASD. It is hoped that addressing this first element of evidence-based practice will enable providers, families, and systems to use the latest research to better inform treatment planning, decision making, policy making, and resource development. Process| In response to a growing need for information on evidence-based treatments for ASD, the Maine Department of Education and the Maine Department of Health and Human Services led a partnership of stakeholders in a systematic review of the latest research on treatment for ASD. This review was designed as an update to the Maine Administrators of Services for Children with Disabilities (MADSEC) Autism Task Force Report issued in 2000, one of the first efforts in Maine to review the treatment literature for ASD. Over the course of a year, laypersons, state agency staff, providers, and researchers, reviewed more than 150 studies of 43 different treatments for children with ASD. The Committee objectively reviewed the research using a validated rubric, the Evaluative Method for Determining Evidence-Based Practice in Autism (Reichow, Volkmar, Cicchetti, 2008), and assigned each intervention a level of evidence rating. The quality of each study was carefully evaluated using a set of primary and secondary quality indicators and factored into the determination of the level of evidence using a corresponding rating scale. Levels of Evidence| Established Evidence: The treatment has been proven effective in multiple strong or adequately rated group experimental design studies, single-subject studies, or a combination. Results must be replicated in studies conducted by different research teams. Promising Evidence: The intervention has been shown effective in more than two strong or adequately rated group experimental design studies or at least three single-subject studies. Additional research is needed by separate teams to confirm that the intervention is effective in across settings and researchers. Preliminary Evidence: The intervention has been shown effective in at least one strong or adequately rated group or single-subject design study. More research is needed to confirm results. Page 8 Studied and No Evidence of Effect: Numerous (three or more) strong or adequately rated studies have determined that the intervention has no positive effect on the desired outcomes. Insufficient Evidence: Conclusions cannot be drawn on the efficacy of the intervention due to a lack of quality research and/or mixed outcomes across several studies. Evidence of Harm: Studies or published case reports indicate that the intervention involves significant harm or risk of harm, including injury and death. Findings| Level of Evidence Intervention Category Intervention(s) Established Evidence Applied Behavior Analysis Applied Behavior Analysis for Challenging Behavior Applied Behavior Analysis for Communication Applied Behavior Analysis for Social Skills Early Intensive Behavioral Intervention (EIBI) Augmentative and Communication Picture Exchange Communication System (PECS) Alternative Pharmacological Approaches Applied Behavior Analysis Applied Behavior Analysis for Adaptive Living Skills Augmentative and Communication Promising Evidence Halperidol (Haldol) – Effective for aggression Methylphenidate (Ritalin) – Effective for hyperactivity Risperidone (Risperidol) – Effective for irritability, social withdrawal, hyperactivity, and stereotypy Voice Output Communication Aid (VOCA) Alternative Psychotherapy Preliminary Evidence Cognitive-Behavioral Therapy (CBT) for Anxiety Applied Behavior Analysis Applied Behavior Analysis for Academics – Numeral recognition, reading instruction, grammatical morphemes, spelling. Applied Behavior Analysis for Vocational Skills Augmentative and Communication Sign Language Alternative Developmental, Social-Pragmatic Models Developmental, Social-Pragmatic Models Eclectic Models Diet Nutritional Approaches Vitamin C – Modest effect on sensorimotor symptoms only Pharmacological Approaches Atomoxetine (Strattera) – Effective for attention deficit and hyperactivity Clomipramine (Anafranil) – Effective for stereotypy, ritualistic behavior, social behavior Page 9 Level of Evidence Intervention Category Intervention(s) Clonidine (Catapres) Effective for hyperactivity, irritability, inappropriate speech, stereotypy, and oppositional behavior Psychotherapy CBT for Anger Management Sensory Integration Therapy Touch Therapy/Massage Other Hyperbaric Oxygen Treatment Studied and No Evidence of Effect Pharmacological Approaches DMG Secretin Insufficient Evidence Applied Behavior Analysis Applied Behavior Analysis for Academics – Cooperative learning groups Augmentative and Communication Facilitated Communication Alternative Diet Nutritional Approaches Developmental, Social Pragmatic Models Guanfacine (Tenex) Intravenous Immunoglobin Melatonin Naltrexone (Revia) SSRIs: Citalopram (Celexa), Fluoxetine (Prozac) Valproic Acid (Depakote) Sensory Integration Therapy Auditory Integration Training Sensory Integration Training Social Skills Training Social Skills Training Social Storiesâ„ ¢ Other Page 10 DIR/Floortime RDI SCERTS Solomon? s PLAY model Pharmacological Approaches Evidence of Harm Gluten-Casein Free Diets Omega-3 Fatty Acid Supplements Vitamin B6/Magnesium Supplements TEACCH Pharmacological Approaches Intravenous Chelation Using Edetate Disodium Conclusions| Based on its investigation of the research literature, the Committee concludes the following: The research clearly indicates that there are effective treatments for some core deficits and related challenges of ASD. For instance, comprehensive behavioral treatment has some of the most compelling evidence which emphasizes the importance of early and intensive intervention for children with ASD. Substantial investment in quality research is needed to further define effective treatment for ASD. Research specific to educational and behavioral interventions for children with ASD in the context of schools is seriously lacking. This is of deep concern since children receive a great deal of services through the education system. Comparative research on the efficacy of various treatment models would be very valuable. There is a dearth of research on treatment of older youth, adolescents, and adults with ASD. This is worrisome given that the number of adults with ASD is expected to significantly increase in the coming years as children with ASD mature. Families should be informed consumers of treatment and ask questions of providers about the nature and quality of the research behind the treatment their child is receiving. Providers need to make treatment decisions in active partnership with families while integrating relevant research into their practice and treatment planning process. Resources are needed to build capacity throughout Maine in order to efficiently and effectively deliver evidence-based treatments to children in their schools, homes, and communities. This requires resources for training, evaluation, and workforce development. For example, ABA has some of the best evidence for treatment in ASD yet Maine has only 26 certified ABA practitioners, with most located in the southern counties. Evidence-based practice does not seek to dictate the interventions that should be used at the expense of others. Rather, it is a framework to integrate what is known from research into real-world practice in a manner that is accessible to families, responsive to what children need, and consistent with what providers can accomplish given available skills and resources. The first step toward evidence-based practice is creating awareness of what the best available research says. It is no longer enough to use what we believe works, we must consider what we know works in order to close the gap between science and practice, utilize limited resources wisely, and best serve Maine children with ASD. Page 11 Interventions for Autism Spectrum Disorders STATE OF THE EVIDENCE INTRODUCTION| Recent statistics indicate that the number of children diagnosed with Autism Spectrum Disorder (ASD) has skyrocketed – the latest figures suggest that approximately 1 in 91 children in the United States are currently diagnosed with ASD (Kogen, Blumberg, Schieve, Boyle, Perrin, Ghandour, et al. , 2009). In Maine, the rate is thought to be even higher with an estimated 1 in 77 children identified with ASD – the second highest rate in the nation (Thoughtful House Center for Children, 2009). In response to increasing demand for services for children with ASD in our schools and communities, the Maine Departments of Education and Health and Human Services partnered with members of the community to assess the research and determine the level of scientific evidence for interventions currently available for ASD. This project continued the efforts of the Children? s Services Evidence-Based Practice Advisory Committee (â€Å"the Committee†) to study and disseminate information on the scientific evidence for treatments of childhood behavioral health conditions. This work also serves as a comprehensive update to the Autism Task Force Report issued in 2000 by the Maine Administrators of Services for Children with Disabilities (MADSEC). To the best of the Committee? s knowledge, the MADSEC report was the first multidisciplinary effort in Maine to objectively examine the research for select interventions for ASD. In the years since MADSEC issued its report, the breadth and depth of the research of ASD has evolved; in fact, more than 2,100 studies regarding autism have been published in peer-reviewed journals since 2001i. Given the significant number of children with ASD being served in Maine and advances in research over the last decade, a new review of the literature is timely and appropriate. The Committee evaluated peer-reviewed research for more than 40 interventions for children and youth with ASD, including psychosocial, behavioral, developmental, complementary, educational, and pharmaceutical treatments. A wide variety of treatment options have been developed for children with ASD and it can be difficult for parents, educators, and practitioners to know what could be most effective given each child? s unique circumstances. Science helps to clarify some of the confusion about what â€Å"works. † Well-designed studies can show that some interventions are very effective for certain symptoms or behaviors while others are not. The implications of this information are profound; understanding what works as demonstrated by research can inform choices that improve lives (Steele, Roberts, Elkin, 2008). Page 12 How to Use This Report| This document is intended to provide an updated view of the best available research evidence for treatments for Autism Spectrum Disorders. Certain stakeholders may find this report especially useful: Families, Educators, Practitioners: Evaluating and selecting treatments can be a daunting task. This report provides an objective evaluation of the best available research evidence for the myriad of treatment options currently available for ASD (Steele, et al. , 2008). Policymakers: As Maine continues to enhance its system of care, it is hoped that policymakers will consider this information in their decision making so that all children in Maine have sufficient access to evidence-based interventions. Business Community Leaders: ASD touches the lives of many families in the places where we live and work. The Committee hopes that sharing information on effective treatment methods inspires leadership, innovation, and support among business and community leaders to improve service delivery systems. Researchers: Describing the amount and quality of research behind available treatments draws attention to areas needing further research and investigation. Children with ASD truly have a spectrum of challenges and abilities therefore treatments should be tailored to reflect their individuality. It is not enough to simply use any evidencebased treatment they are not â€Å"one size fits all. † The treatments discussed in this report vary widely in their focus, intensity, duration, and methods, and thus must be carefully evaluated and matched to a child? s unique needs. It is not the intention of this report to indicate what interventions should or should not be used; families should always decide what treatment best meets the needs of their child. Children have a right to treatment that is reflective of their individual strengths and challenges and that accommodates any change in the nature and intensity of their needs (Office of Child and Family Services, March 2008). However, families and providers should seek the most current and complete research information to factor into their decisions regarding treatment. As â€Å"Treatment† â€Å"Intervention† Treatment is generally understood as a service used to correct or alleviate a specific medical condition, issue, or problem. The effectiveness of treatment is usually evaluated and measured based on the individual? s outcome (Barker, 1999). Intervention includes treatment, but also encompasses other services or activities practitioners use to address or prevent an individual? s problems (Barker, 1999). Intervention is a term sometimes used in social work, education, and other ecological, cross-disciplinary fields to describe services that address the problems of an individual. The Committee reviewed â€Å"treatments† and â€Å"interventions† without regard to the field or entity that might utilize them. These terms are used interchangeably in this report. Page 13 science continues to evolve, it is expected that ASD treatment will be further refined. Therefore, periodic reassessments of the scientific literature will be needed so that families and providers have current information in order to inform their choices and decisions. PROJECT ORGANIZATION| The Children? s Services Evidence-Based Practice Advisory Committee formed in 2007 as the childfocused Subcommittee of the DHHS EvidenceBased Practice Advisory Committee. The Committee is charged with reviewing the research base for treatments of childhood behavioral health disorders in order to better inform policy, practice, and resource development in Maine. It is not a policy-making entity, but an advisory body that informs state agency work. The Committee is led by Children? s Behavioral Health Services, a division of the Office of Child and Family Services. Departnent of Education DHHS EvidenceBased Practice Advisory Committee Childrens Services Evidence-Based Practice Advisory Committee Autism Spectrum Disorders Project FIGURE 1: PROJECT ORGANIZATION A diverse group of stakeholders convened in 2007 to review and rate the research on psychosocial treatments for disruptive behavior disorders (Beaulieu, 2008). Following this successful review, the Committee turned its attention to ASD due to a growing concern about the needs of this population. The Maine Departments of Education and Health and Human Services agreed to jointly lead this project in recognition of the mutually important roles that education and behavioral health systems play in serving children with ASD. The Muskie School of Public Service provided technical assistance, research support, and data analysis to the project through a cooperative agreement with the Office of Child and Family Services. Due to the nuances involved in ASD research and the relevance of this issue across systems, the Committee incorporated stakeholders and experts in the field of ASD, including parents, an adult with ASD, educators, providers, and advocates. The Autism Spectrum Disorders project began in August of 2008. Initial work focused on establishing common language and understanding about ASD, research methodology, and evidence-based practice. Following a review of the literature, the Committee adopted a systematic review process with a corresponding rating scale to organize the work. ABOUT AUTISM SPECTRUM DISORDERS| Definition| Autism Spectrum Disorders, also referred to as Pervasive Developmental Disorders (PDD), are a category of neurodevelopmental disorders that include: Page 14 Autistic Disorder (autism); Pervasive Developmental Disorders-Not Otherwise Specified (PDD-NOS); Asperger? s Syndrome; Rett? s Disorder; and Childhood Disintegrative Disorder. ? ? ? Autism Spectrum Disorders are now more common than childhood cancers in the United States. (Gloeker, Percy, Bunin, 2005) Due to their lower prevalence and differing symptom profile, Childhood Disintegrative Disorder and Rett? s Disorder were not included ? ? ? in this review. Research of treatments for ASD generally does not include children with these two diagnoses. Studies that focused on children with Autistic Disorder, PDD-NOS, and/or Asperger? s Syndrome were reviewed. Because functional ability and expression of symptoms can vary widely among children with these diagnoses, from profound disability to high functioning, they are said to exist on a â€Å"spectrum. † The Committee chose to use the term â€Å"Autism Spectrum Disorders† rather than Autism or PDD in recognition that no two children are impacted by these disorders in exactly the same manner or to the same degree. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), Autism Spectrum Disorders (ASD) are characterized by distinct and pervasive impairment in multiple developmental areas, primarily social skills and communication (American Psychiatric Association, 2000). These disorders are marked by the presence of stereotypical behavior such as hand flapping and body rocking, as well as by excessive preoccupation with certain objects, interests, or activities. Children with ASD exhibit patterns of social interaction and communication that are not consistent with their developmental age. These patterns become apparent in the first few years of life and are generally lifelong challenges (Schieve, Rice, Boyle, Visser, Blumberg, 2006), although with early and effective intervention, children can often learn new skills and improve existing ones. Prevalence| Studies have consistently documented a significant increase in the number of children identified with ASD across the United States over the last 15 years (Centers for Disease Control and Prevention, Maine Children Classified with Autism in 2009; Hollenbeck, 2004; Schieve, et al. , 2006). Special Education 2000-2008 While it is not known if this increase is attributa2231 ble to how ASD is identified and diagnosed, an 276% 1760 2500 2000-2008 actual increase in prevalence, or a combination 2000 of factors, the number of children identified with 1500 594 ASD in Maine and across the country has been 1000 500 growing. ASDs are now the second most common 0 developmental disability after mental retarda2000-01 2006-07 2008 tion (Centers for Disease Control and Prevention, 2009). A recent national survey of parents by Source: Department of Education, 2009 Page 15 U. S. Department of Health Human Services estimated that 1 in 91 children ages 3-17 years old were currently diagnosed with ASD (Kogen, et al. , 2009). This is a substantial increase from earlier estimates by the Centers for Disease trol of 1 in 150 children (Centers for Disease Control and Prevention, 2009). MaineCare Recicipients with ASD 2000-2008 3000 281% 2000-2008 1929 2451 2000 1000 643 0 Prevalence in Education| 2000 2006 2008 Education data echo this trend. Federal data Source: Department of Health and Human Services, gathered for the Individuals with Disabilities in 2009 Education Act (IDEA) indicate that the number of Maine children ages 6-22 with ASD receiving Special Education services grew by 1672% between 1992 and 2003 (Hollenbeck, 2004). This is pared to a nationwide 834% increase in children ages 6-17 with ASD between 1994 2006 (Centers for Disease Control and Prevention, 2009). Maine Department of Education data shows this trend is likely to continue. Since 2000, the number of children in Maine schools classified with ASD has increased by 276% (Department of Education, 2009). Prevalence among Medicaid Recipients| Utilization data from the Medicaid program also shows an increase in the prevalence of ASD in Maine. Between 2000 and 2008, the number of people with ASD who received MaineCare services increased by 281%. The significant growth of ASD in Maine? s systems of care underscores the need for planful resource and capacity development in order to adequately address the needs of this expanding population (Department of Health and Human Services, February 2009). WHAT IS EVIDENCE-BASED PRACTICE? | Evidence-based practice is the integration of the best available research evidence with clinical expertise in the context of patient characteristics, culture, and preference. American Psychological Association Page 16 Evidence-based practice has been a priority in the behavioral health and education fields over the past decade. The growing need for high-quality children? s behavioral health services has increased the demand for treatments that are proven to produce better outcomes (Levant, 2005; New Freedom Commission on Mental Health, 2003). The education system has also emphasized the use of evidence-based practice through legislation and policy such as No Child Left Behind (Coalition for EvidenceBased Policy, December 2003). For example, federal education policy calls for educators to address the needs of students struggling with academics and behavior with interventions supported by research (Gresham, 2007). The emphasis on inter- Control condition: A comparison group of subjects in a research study that receive treatment as usual, or are placed on a waiting list for the treatment under study. Efficacy: The strength of the causal relationship between the treatment and its intended outcomes Does it work? Effectiveness: An assessment of how well the treatment generalizes to real-world settings. Randomized Controlled Trial: A type of research study in which subjects are randomly selected to receive the experimental intervention or a control condition. Single-Subject Design: A type of research that measures effects of an intervention at the level of the individual under carefully controlled conditions. ventions backed by research necessitates a common derstanding of evidence-based practice. Defining and coming to a common understanding of â€Å"evidence† is not simple (Chambless Hollon, 1998; Chorpita, 2003). Our current understanding of evidencebased practice in behavioral healthcare is largely rooted in the work of American Psychological Association Task Forces (Task Force on Promotion and Dissemination of Psychological Procedures, 1995; Task Force on Psychological Intervention Guidelines of the American Psychological Association, 1995). These Task Forces developed some of the first guidelines on research-informed practice (Chambless, et al. , 1996). The Committee has endorsed the American Psychological Association? s definition of evidence-based practice: Evidence-based practice is the integration of the best available research evidence with clinical expertise in the context of patient characteristics, culture and preference (APA Presidential Task Force on Evidence-Based Practice, 2006). This definition acknowledges that evidence-based practice does not exist in a vacuum, and that research, clinical practice, and client values influence each other. Although the terms are often used interchangeably, the meanings of â€Å"evidence-based practice† and â€Å"evidencebased treatment† are distinct. Evidence-based treatment refers to specific treatments or intervention models that have proven effective for specific problems in certain circumstances by numerous scientific studies (Levant, 2005). Evidence-based practice bridges the science-to-practice gap by using research evidence to inform clinical practice in the context of the client? s needs and environment. There are three core components to evidence-based practice: Best research evidence, clinical expertise and judgment, and client values and voice (APA Presidential Task Force on Evidence-Based Practice, 2006; Burns Hoagwood, 2002). Best Research Evidence| The main element in the determination of research evidence is efficacy (Chorpita, 2003). Efficacy refers to the strength of the causal relationship between the treatment and its intended outcomes. In other words, does the treatment have the desired effect on the target behavior or skill? Efficacy is established Page 17 â€Å"Life Journey through Autism: A Parent’s Guide to Research† is an informative guide for families. through well-designed research studies in which outcomes are observed and measured and compared to a no-treatment condition. The quality and type of a research study is an important factor in the evaluation of evidence. Research studies are conducted using different methods to varying levels of scientific integrity. Available at: Well-designed research is highly controlled, meaning that the www. researchautism. org families and children are carefully screened and selected to fit the parameters of the research, and administration of the treatme

Salim Group free essay sample

The focus of the Salim Group’s operations adapted to Indonesia’s economic policies and shifted from trading to manufacturing, and ultimately diversified into a series of unrelated sectors. Following the fall of Suharto and the 1997 Asian financial crisis, the Salim Group has continued to internationalize its portfolio with Liem’s son, Anthony Salim, as the group’s chief executive. Currently, the Salim Group’s main holdings are in food, media, automotive, property and telecom with aggregated revenues estimated at 14 billion USD in 2012. The biggest companies in the portfolio include First Pacific Ltd. , Indofood and Indomobil. The competitive landscape consists of other multinational companies and Indonesian conglomerates on a group level, and industry specific competitors in each distinct business field. Although certain elements of the Salim Group are comparable to the traditional Chinese family business, such as its extensive network of relationships, through adaptations to this model, including the professionalization of management and business, an open and informal culture, and a decision-making process supported by strict internal monitoring procedures, the group has been able to achieve significantly greater scale and success. We will write a custom essay sample on Salim Group or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Anthony Salim has already dictated the firm’s future strategy, which entails an expansion throughout Australia-ASEAN-China (‘Axis of Prosperity’), a portfolio focus on industries known to the group, and the development of local managers for regional adaptation. Going forward, the Salim Group should closely consider changes in the institutional environment of ASEAN countries, succession planning, and the centralization of control, as well as both the benefits and concerns associated with its Axis of Prosperity expansion. 1. History of the Salim Group The historical events of the Salim Group can be classified into three phases that the Indonesian conglomerate experienced. These phases are broadly grouped time periods that share characteristics and observe similar trends. We begin by examining the first phase of the Salim Group’s accomplished history, which includes the actions that led to the creation of the company and its earliest business activities. Prior to the Second World War, Liem Sioe Liong immigrated to Indonesia from China’s Fujian province. When Liem arrived in Central Java, there was already an existing and organized Chinese community. This is a direct reflection of the increase in Indonesia’s Chinese immigrant population, a group considered to be economically higher than the local Javanese as they were used by the colonists as intermediaries and traders. The importance of Liem’s ethnicity will be discussed in later sections. Liem began trading and lending in the early 1940’s before the Japanese occupation. Similar to many Chinese immigrants, Liem abandoned his Chinese name and adopted the Indonesian-sounding Sudono Salim, hereafter referred to as Sudono. Shortly after the Japanese occupation in 1942, Sudono engaged in Dangbangke trading, which consisted of smuggling small goods with bicycles. At the same time, Sudono started a family and fathered both Anthony Salim and Andre Halim, two sons that would eventually play a prominent role in the Salim Group. It is in the 1940’s that the Salim Group was founded; however, sources do not specify the exact commercial nature that Sudono pursued. After the Japanese occupation, Sudono actively supported the Indonesian Independence movement who were fighting the Dutch army. Sudono was part of the Futsing Hwee movement and helped hide revolutionary leader Hasan Din, the father-in-law of Sukarno, for over a year. This would prove to be an important connection for Sudono as the Indonesian nationalists won independence and enabled Sudono to resume trading commodities such as peanut oil, cloves, and coffee. Through his connection with Hasan Din, Sudono was labeled as a â€Å"trustworthy supplier of the military†. As a result, Sudono profited from helping the Indonesian army both during and after their independence movement (Dieleman, 2007b). Following independence, Sukarno took over Indonesia in 1957 and implemented a closed economic policy that rejected foreign capital and focused on creating a greater role for government nationalism (Dieleman, 2006). Although Sukarno’s policies attempted to favor indigenous businessmen with his Benteng program, Sudono and Indonesia’s Chinese minority economically dominated the country. Sudono moved his family to Jakarta where he would continue to supply the Indonesian army. In addition, Sudono develop several business partnerships outside of his family network with other Chinese immigrants. Dieleman points out that the Salim Group began to rapidly diversify because of Sudono’s belief that â€Å"all businesses are good† (Dieleman, 2007, p. ?). The group continued to develop textiles, became the army’s supplier of soap and purchased the Bank of Central Asia (BCA), which would grow to be Indonesia’s largest bank. The group’s â€Å"business ventures adapted to the unpredictable environment and grew by taking the opportunities as they came, without a focused business strategy† (Dieleman, 2007b). Here it can be seen that Sudono’s activities shifted from trading to manufacturing and financing. Indonesia’s political environment changed again as Suharto seized power from Sukarno in 1967. By this time, Sudono had already established large businesses and built up a powerful network of political elite. President Suharto’s New Order policy opened up private and foreign investment for many of Indonesia’s commercial industries. Sudono utilized his connections with Suharto to acquire licenses that gave him exclusive rights over certain strategic exports. In addition, Sudono kept close ties with the Indonesian Army, which was now the dominant political force. Suharto implemented policies aimed at rapid industrialization from 1970 onward that also promoted import substitution. As a result, the Salim Group expanded to include domestic flour milling, cement and automobile production. Each of these industries had established favourable conditions that encouraged domestic production through government programs. The Salim Group had companies in highly diverse sectors and profited from the wave of Indonesia’s industrialization (Dieleman, 2006). See figure 1 to see the Salim Group’s growth during Indonesia’s industrialization. 1. 2 Phase Two: Transition to the Second Generation The next phase of the Salim Group is distinguished from the previous period of unrelated diversification, a common characteristic of Chinese family businesses. In 1972, the Salim Group stopped randomly diversifying and Sudono’s strategy shifted by targeting select industries rather than being driven solely by opportunity (Dieleman, 2006). The purpose of this shift was to decrease the group’s dependency on government contacts and enable internalization. Dielmans highlights that overseas partners in Japan helped the Salim Group by providing both technology and knowledge to the company. This is likely a result of Akamatsu’s proposed flying geese strategy (Bu, 2012a). In addition, Anthony Salim and other family members joined the business in 1972 to help manage the sheer number and diversity of the companies that the Salim Group owned. However, most of Sudono’s business partners were Chinese immigrants, stemming from the bamboo network of overseas Chinese across Asia. The Salim Group continued to grow and engage in commercial activities on a much larger scale. This was aided by the government’s changing policy from import substitution to export led growth, following the pattern of many NIEs and other ASEAN governments. In addition, the Salim Group continued steady growth through the 1980’s and moved into more capital-intensive industries such as chemicals and steel-making. Sodono also recognized the risk of Indonesia’s political instability and intensified the group’s internationalization rate in the 1980’s and 1990’s, specifically in Singapore and Hong Kong. In 1982, Sodono founded First Pacific in Hong Kong, which was owned by the Salim’s and opearated businesses throughout Asia (Dieleman, 2007b). Refer to figure 2 to see a breakdown of the Salim Group’s internationalazation in the 1990’s. The result was an extremely diverse yet powerful family business that structured its business offerings across the value chain. Another major event in this phase of the Salim Group’s history was the changeover in leadership. Anthony Salim assumed control of the family company in 1993. The ever-expanding business required the help of professional managers, which Anthony continued to hire to help manage the Salim empire. By 1995, the Salim Group had become a giant, representing 5% of Indonesia’s total GDP, with revenues above 20 billion and 200,000 employees. Refer to figure 3 to see a snapshot of the Salim Group’s commercial activities in 1995. 1. 3 Phase Three: Financial Crisis and Reform The final phase of the Salim Group’s history begins with the Asian Financial Crisis of 1997 and continues to the present date. The Salim Group borrowed heavily from foreign banks to capitalize on superior lending rates, making them highly vulnerable to currency risk. As Indonesia’s currency rapidly devalued in 1997, the Salim Group was faced with increasing debt obligations. Refer to figure 4 for a breakdown on the corporate leverage of selected Asian economies and figure 5 for a breakdown of the growth of US, reflecting foreign, borowing for the Salim Group. The group’s pyramid ownership structure and internal lending compounded the situation as the largest Indonesian conglomerate’s debt-to-equity ratio skyrocketed. Even more concerning was the fall of Suharto, an important political connection that helped the Salim Group flourish under his corrupt ruling period (Dieleman, 2006) As a result of these factors, Anthony Salim was faced with tough decisions on honoring over $5 billion in loans. See figure 6 to see the impact of the Asian financial crisis on select economies. The Salim Group transferred 107 of their companies to the Indonesian government to settle their debt obligations. Many of these assets were ultimately bought back by the Salim Group at a discount, likely due to the corrupt Indonesian government. Since this period, the Salim Group has been on the road to recovery and has continued to experience growth by refocusing its portfolio while also internationalizing rapidly. See figure 7 to see how the group’s actions reflected Indonesia’s political and institutional environment and figure 8 for a complete summary of the Salim Group’s strategic actions. Using history as a basis of analysis, it is clear that the Salim Group exhibits many of the characteristics of a Chinese family business. These include centralized decision making through a dominant CEO, family ownership and control, the importance of external networks, and a high degree of strategic flexibility. The details and justifications for these characteristics are further developed in the following section of the report. Big whales swim in the deep sea, in the salt water, but we are talking fresh water here. † (Anthony Salim) The competitive environment of the Salim Group is as complex and opaque as the company itself. As the conglomerate operates in various and mostly unrelated business fields, it is not easy to determine its main competitors on an aggregate level. The second difficulty is the fact that these different operations are often spread amongst different countries in Southeast Asia. Although it is not possible to find a directly comparable conglomerate, operating in exactly the same businesses and geographical regions, it is possible to identify those whose main businesses overlap with the primary commercial activities of the Salim Group. In doing so, we found three major competitors: (1) multinational giants such as Unilever and General Electric1, (2) Indonesian conglomerates operating in similar sectors and (3) other large industry specific competitors, not necessarily conglomerates. While the first two have the potential to compete n a macro or group level, the third category of firms mainly competes in one specific business field. The American food company General Mills, for example, is a direct competitor of Indofood, but does not possess the potential to jeopardize the Salim Group as a whole. Please see figure 9 below for a peer group overview on a macro level. In summary, we find that although the group has competitors of similar and larger size, there is no competitor that could take complete market share from the Salim Group as a whole. This is primarily a result of the Salim Group’s high level of diversification. As the Salim Group operates across numerous business lines, even if one aspect of the business was facing tough competition or declining sales, the group as a whole is large enough to compensate for fluctuating financial performance. 3. Features 3. 1 Ownership and Organizational Structure Chinese family businesses (CFBs) are typically fully owned by the family members. Top-management positions are occupied exclusively by members of the core family and senior management positions are usually taken by other close relatives or long-term employees with proven loyalty. This context restricts quick promotions or the acquisition of professional management that distinguishes itself through high performance. Thus, growth is limited and the organization is maintained at a small scale. Another feature of the structure of CFBs is their aptitude for unrelated diversification in terms of products and geography, with an additional focus on short-term returns (Chen, 2004; Bu, 2012c). In contrast to these characteristics, Sudano Salim began to professionalize the group’s business while in charge. When Anthony took over, he hired even more professional managers that also had access to top management, organized the group into divisions and initiated IPOs to list companies on stock exchanges in Indonesia and abroad (Dieleman, 2007a, p. 22). The latter resulted in companies having to conform to transparency rules and to develop working organizational structures and controlling systems on the one hand, and provided access to foreign capital on the other hand. The inflow of foreign capital came along with a dilution of ownership.

The Black Dahlia Murder Case

The Black Dahlia Murder Case The Black Dahlia Murder case remains one of Hollywoods long-running mysteries and one of the most gruesome of the 1940s. A pretty young woman, Elizabeth Short, was found cut in half and posed in a sexually explicit manner in a vacant lot. It would be sensationalized in the media as the Black Dahlia murder. In the media frenzy that followed, rumors and speculation were published as fact, and inaccuracies and exaggerations continue to plague accounts of the crime until this day. Here are the few real facts that are known about the life and death of Elizabeth Short. Elizabeth Shorts Childhood Years Elizabeth Short was born on July 29, 1924, in Hyde Park, Massachusetts to parents Cleo and Phoebe Short. Cleo made a good living building miniature golf courses until the Depression took its toll on the business. In 1930, with his business suffering, Cleo decided to fake his suicide and abandoned Phoebe and their five daughters. He parked his car by a bridge and took off to California. Authorities and Phoebe believed Cleo committed suicide. Later, Cleo decided he made a mistake, contacted Phoebe and apologized for what he had done. He asked to come home. Phoebe, who had faced bankruptcy, worked part-time jobs, stood in lines to get public assistance and raised the five children alone, wanted no part of Cleo and refused to reconcile. Her High School Years Elizabeth was not academically inclined earning average grades in high school. She left high school in her freshman year because of asthma which she suffered with since childhood. It was decided that it would be best for her health if she left New England during the winter months. Arrangements were made for her to go to Florida and stay with family friends, returning to Medford during the spring and summer. Despite her parents difficulties, Elizabeth continued to correspond with her father. She was growing up to be an attractive young girl and like many teenagers enjoyed going to the movies. Like many young pretty girls, Elizabeth developed an interest in modeling and the movie industry and set her goals to someday work in Hollywood. A Short-Lived Reunion At the age of 19, Elizabeths father sent her money to join him in Vallejo, California. The reunion was short-lived, and Cleo soon grew tired of Elizabeths lifestyle of sleeping during the day and going out on dates until late at night. Cleo told Elizabeth to leave, and she moved out on her own to Santa Barbara. The Next Three Years There is much debate about where Elizabeth spent her remaining years. It is known that in Santa Barbara she was arrested for underage drinking and was packed up and returned to Medford. According to reports up until 1946, she spent time in Boston and Miami. In 1944, she fell in love with Major Matt Gordon, a Flying Tiger, and the two discussed marriage, but he was killed on his way home from the war. In July 1946, she moved to Long Beach, California to be with an old boyfriend, Gordon Fickling, who she dated in Florida before her relationship with Matt Gordon. The relationship ended shortly after her arrival and Elizabeth floundered around for the next few months. A Soft Spoken Beauty Friends described Elizabeth as being soft-spoken, courteous, a non-drinker, or smoker, but somewhat of a loafer. Her habit of sleeping late in the day and staying out at night continued to be her lifestyle. She was pretty, enjoyed dressing stylishly and turned heads because of her pale skin contrasting against her dark hair and her translucent blue-green eyes. She wrote to her mother weekly, ensuring her that her life was going well. Some speculate that the letters were Elizabeths attempt to keep her mother from worrying. Those around her know it that over the next few months she moved often, was well liked, but elusive and not well known. During October and November of 1946, she lived in the home of Mark Hansen, owner of the Florentine Gardens. The Florentine Gardens had a reputation as being a rather shoddy strip joint in Hollywood. According to reports, Hansen was said to have various attractive women rooming together at his home, which was located behind the club. Elizabeths last known address in Hollywood was the Chancellor Apartments at 1842 N. Cherokee, where she and four other girls roomed together. In December, Elizabeth boarded a bus and left Hollywood for San Diego. She met Dorothy French, who felt sorry for her and offered her a place to stay. She stayed with the French family until January when she was finally asked to leave. Robert Manley Robert Manley was 25 years old and married, working as a salesman. According to reports, Manley first met Elizabeth in San Diego and offered her a ride to the French house where she was staying. When she was asked to leave, it was Manley who came and drove her back to the Biltmore Hotel in downtown Los Angeles where she was supposed to be meeting her sister. According to Manley, she was planning to go live with her sister Berkeley. Manley walked Elizabeth to the hotel lobby where he left her at around 6:30 p.m. and drove back to his home San Diego. Where Elizabeth Short went after saying goodbye to Manley is unknown. The Murder Scene On January 15, 1947, Elizabeth Short was found murdered, her body left in a vacant lot on South Norton Avenue between 39th Street and Coliseum. Homemaker Betty Bersinger was running an errand with her three-year-old daughter when she realized that what she was looking at was not a mannequin but an actual body in the lot along the street where she was walking. She went to a nearby house, made an anonymous call to police, and reported the body. When police arrived on the scene, they found the body of a young woman who had been bisected, displayed face-up on the ground with her arms over her head and her lower half placed a foot away from her torso. Her legs were wide open in a vulgar position, and her mouth had three-inch slashes on each side. Rope burns were found on her wrists and ankles. Her head face and body was bruised and cut. There was little blood at the scene, indicating whoever left her, washed the body before bringing it in the lot. The  crime scene  quickly filled with police, bystanders, and reporters. It was later described as being out of control, with people trampling on any evidence investigators hoped to find. Through fingerprints, the body was soon identified as 22-year-old Elizabeth Short or as the press called her, The Black Dahlia. A massive investigation into finding her murderer was launched. Because of the brutality of the murder and Elizabeths sometimes sketchy lifestyle, rumors and speculation were rampant, often being incorrectly reported as fact in newspapers. Suspects Close to 200 suspects were interviewed, sometimes polygraphed, but all eventually released. Exhausted efforts were made to run down any leads or any of  the several false confessions  to the killing of Elizabeth by both men and women. Despite efforts made by investigators, the case has remained one of the most famous unsolved cases in Californias history.

Islamic accounting and financial reporting Essay - 1

Islamic accounting and financial reporting - Essay Example 16). On the other hand, IFRS was enacted to harmonize the universal accounting procedures and processes into a harmonized system. This study will cover the implementation of the IFRS by the country of Malaysia. The paper will have a candid review of the adoption of the IFRS by Malaysia, and the conflicts that this move presents to the application of the AAOIFI standards. As a start off, the paper evaluates the financial and accounting system in Malaysia. AAOFIFI and IFRS are then evaluated with respect to their components, procedures of application and treatment of various financial transactions. The paper then compares and contrast the accounting treatment of both standards before discussing the procedures that are used by the Malaysian authorities to implement IFSR and overcome Conflicts with AAOIFI (Schoon 2009, p.50). The study finalizes by analysing the effectiveness of the IFRS implementation strategy in Malaysia. The financial system of Malaysia is made up of Islamic and conventional financial institutions which operate in parallel. The apex of financial and monetary structure in Malaysia is the Bank Negara, which is the Malaysian Central bank. The financial system comprises the banking and non-banking system. The banking system is made up of 21 Islamic banks, 25 commercial banks and 15 investment banks. To compliment banking institutions are the non-banking financial institutions. In Malaysia, there are 43 insurance and re-insurance companies, 13 Takaful Operators, four retakaful operators and six development financial institutions. The Islamic financial system in Malaysia has continued to grow and develop. Currently, the Islamic financial system comprise of Takaful, Retakaful, Islamic Capital Market and Islamic Interbank Money market. MIFC (International Islamic Financial Centre) was opened in the year 2006, with the aim of strengthening

Homelessness Essay Example | Topics and Well Written Essays - 750 words - 2

Homelessness - Essay Example I have found many people around me who forced to spend their final days of their lives in rescue homes even though they have enormous wealth. An old age couple who was staying near my home forced to transfer their lives to a near rescue home recently since they failed to get enough attention from their parents. These couple had huge wealth, but their children were working abroad. They failed to get enough protection from their children and finally forced to take shelter in a rescue home conducting by a charitable trust. In another case, I have seen a person forced to live in a rented house because of unemployment. The recent recession resulted in this person losing his job. He forced to sell his house in order to repay some of his debts and forced to shift to a small rented house with his wife and two children. Before recession itself, they were struggling to find their livelihood. When we analyze both the cases mentioned above, we can see that the homelessness problem is due to structural reasons rather than the individual reasons. Unemployment, poverty, lack of affordable housing, housing policies etc are some of the structural reasons commonly cited by many sociologists for homelessness (What causes homelessness?). But in the first case given above, we can see that the family set up forced the couple to take shelter in rescue homes. Kendall (2008) mentioned that people like to form groups to meet instrumental and expressive needs. Instrumental or task oriented needs cannot be met by one persona alone, so the group work cooperatively to fulfill the goal. Moreover small groups are better for all the members to acquaint well and to interact simultaneously (Kendall, p.151-152). The first case given above can be analyzed with respect to the above perspective. As per the current trends, people like to live in nuclear families, a family with husband, wife and one or two children. It is difficult for them to accommodate more

The Relic Short Story Essay Example for Free

The Relic Short Story Essay â€Å"Come here child†¦Ã¢â‚¬  the old man said to me. It was getting late and I had to go home, but there was something in his voice that beckoned me to take notice. I stopped in my tracks. There in the middle of the empty sidewalk where I was walking along.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"Come.. come†¦ I have something important for you to see.† The old man had messy long hair that have all turned gray and he wore clothes that seemed like rags. His face was wrinkled and dirty but his eyes glimmered of a certain youth that seemed so out of place. I walked towards him, without   clear idea of why I was doing so.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   I was about to ask him what he wanted when he answered my question for me. It seemed like he knew what I was thinking. This added both to my wonder and terror of what I was experiencing.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"I have something for you..† the old man began, â€Å"It is a relic of sorts and it tells of a great story that happened a long time ago†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   He reached behind him and produced a book, thick with dust and visibly out of shape. From my point of view, it seemed to be hardbound, but at that time I could not make out the title. He stretched his hand with the book clasped between his fingers. I tried to reach it but when as my hand was closing upon it, the old man suddenly pulled the book back.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"This book has a terrible, terrible secret!† he gasped, â€Å"It has been passed on from one owner to the next and on every owner, the book imparts its terrible secret when you’ve read till the end.†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"W-what’s at the end?† I managed to ask.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"What’s at the end?!?† the old man chuckled, I could see that his teeth were rotting and the putrid smell of his breath reached my nostrils, â€Å"Child, you must find that out for yourself, but I warn you†¦ you must never, NEVER skip the pages. You have to read the entire book page after page. Learn its contents thoroughly before you arrive at the end.†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"Y-yes I underst-and.† I stuttered again, probably due to all the confusion that the experience created.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"How much do you have on you?† the old man suddenly asked.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"What?† I answered with my own startled question.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"How much do you have on you, child?† the old man raised his voice and I cringed at its sound, â€Å"Do you think that this book is free? Hah!†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"W-well, how much is it?† I asked.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"Just answer my question!† came the old man’s response.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"I surveyed my pockets and was surprised to see a hundred dollar bill. Then I remembered that the money was my salary for 4 weeks of doing odd jobs for our neighbors. I thought for a while and then reluctantly handed him my money. The old man snatched it from my hand and then pushed the book to my face.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   â€Å"Take it!† he ordered, â€Å"Take it and begone!!!†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   And so I took the book and went home bewildered at what had happened. The days followed and I began reading what I have acquired. The story within it was interesting to say the least and I was eager to find out its ending. However, I was mindful about the old man’s warning and so I did not skip to the last page. I read the book whenever I had the chance and after roughly a week, I was almost at its end.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   When the time came for me to turn the last page, I prepared myself well and made sure that I could handle whatever it was. I turned the last page, hoping that the book would be merciful, a hope that was shattered to a million pieces by what I saw.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It was terrible†¦ terrible†¦. Joey’s 2nd hand bookshop sale price! $5   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Noooooo†¦.. The end.