Principles of supporting change in a business environment Essay

Unit four: Principles of supporting change in a business environment Assessment You should use this file to complete your Assessment. †¢ The first thing you need to do is save a copy of this document, either onto your computer or a disk †¢ Then work through your Assessment, remembering to save your work regularly †¢ When you’ve finished, print out a copy to keep for reference †¢ Then, go to www.vision2learn.com and send your completed Assessment to your tutor via your My Study area – make sure it is clearly marked with your name, the course title and the Unit and Assessment number. Please note that this Assessment document has 3 pages and is made up of 3 Sections. Name: MARIUS LUCIAN DAN Section 1 – Understand why change happens in a business environment 1. Explain why change happens in a business environment. You should include at least three reasons in your answer. In today business world the only things that is consistent is â€Å"change†. Change is natural and essential in a business. The change can came from inside or from outside the business. When external driving forces influence the business we have reactive changes and when internal forces affects the business we call them proactive changes. External driving forces are those kind of things, situation, events that occur outside of the company and are by and large beyond of the control of the business. Examples of external driving forces are: financial crises, changing government lows and regulations, political interference, competitions etc. Examples of internal driving forces which can create proactive changes are: upgrading the office software, introducing new technology, launching a new product on the market etc. The reasons for change can be: political (changes in government and government policy); economic (economic growth, interest rates, level of unemployment); social (changes such as ageing population, cultural issues such as attitudes to work, health, religion); technological; legal; environmental (effects of global warming, concerns over protecting the environment). Whatever are internal or external forces, one thing is certain: the change will occur. A business must adapt to all this changes, be flexible and willing to respond to them in appropriate way. Without change your internal/external customers will not stay satisfied with the service/s they receive; the company will not be able to meet its targets/objectives and consequently for some companies there will no longer be the need for the business to exist. Section 2 – Understand the purpose of supporting change in a business environment 1. Identify the main reasons for reviewing working methods, products and / or services in a business environment. The reason of reviewing working methods, products and services, is to ensure that the business will develop and to aid the organisation’s continuous improvement, which enhances the organisation’s competitive position, allowing it to adapt to change when needed. In a business environment nothing remains the same and therefore it is likely that there will be continual review of its working methods, products or services to ensure that they are still be suitable and efficient. A company will want to review its services and products, so that it keeps up to date with the expectations of its customers. This will ensure the company to be competitive and/or meet its targets/objectives. A change to a service or product offered by the company could mean that related procedures need to be reviewed to ensure they are still relevant. In most businesses there is a continual process of reviewing the working methods or services and making changes to improve them, followed by a review of this changes and then making further amendments as needed. 2. When a business is going through change: a) Describe the different types of support that people may need. Some people adapt to change very well and others don’t. Where as some people thrive on the challenge of something new, others may worry about it and can become very negative. If team members feel valued and well supported during a change, they are more likely to adapt quickly and be more open to accept what need to be done. Good communication can really help people accept a change more easily and quicker. The person implementing a change will hopefully give everyone plenty of info and also get everyone involved as a team to help make decisions Training and time are also important support measures that people will need to adapt during a change. Not everyone will be able to change over night. They may take time to learn how to complete something new and also need training to be able to do so. Other ways of supporting the team can be: mentoring, coaching, giving and receiving constructive feedback as well as advice on employment issues and pay and conditions. All this support can be provided through different methods, like one-to-one sessions, delegating work tasks, work shadowing, job sharing, team briefings and trade union meetings. b) Explain the benefits of working with others. Working with others really helps to keep a positive outlook to changes. Working together as a team will provide the support and collective knowledge which will help when change may become more challenging. As mentioned before, people often adapt to change better if there is a strong informal input. It is important to remember that to support and work with colleagues effectively you will need to keep a positive outlook. Moaning and continual criticism of what you are doing will not support others at all. Working with others can have a lot of benefits like: finding out what is happening and what is going to change, as well as sharing workloads, learning and experience. By encouraging others to develop their knowledge and skills, as well as maintaining a personal network of contacts, helps to motivate each other. Section 3 – Understand how to respond to change in a business environment 1. In relation to your current business environment (or one that you are familiar with): a) Explain why you should respond positively to changes in working methods. A positive response to changes in working methods is important, so as to support not only the company but also colleagues in adapting to this changes. In my current position working as a care officer, the use of a Diary Handover sheet was introduced, to improve better communication between staff, as well as better documentation of events/issues that occurred each day. Prior to this, staff passed noted to each other, which could easily get lost and did not document clearly each day’s occurrences for management to follow. This forced me and my colleagues to record occurrences in formal way. If I opposed the change, colleagues and management would not find relevant information from my shift and could create confusion and waste their time in investigating occurrences which not recorded. b) Explain why you should respond positively to changes in products or services. If I did not respond positively to new products or services, it could to lead to conflict with managers trying to improve the service or product and be perceived by customers in a negative light. It could also create delays and create confusion amongst colleagues, if the change did not move forward. c) Identify ways of responding positively to change. The first positive action you can take is to look at the way you view change. Think of the change as an opportunity to gain new skills, improve your working procedures and even achieve career progression. Also, have willingness to learn new skills and procedures and to teach others. Attend any training available with a positive attitude, the more knowledge you have the easier you will find doing something new. Support colleagues if they are struggling, this is a great opportunity to demonstrate different skills to your colleagues. Don’t get drawn into negative conversations, this will not make you or others feel good about the situation. Think of ways to move forward, seek support from a manager or colleague if you think you need it. Even now my company is at the risk of being closed down because the county council wants to save money and cut social services, I went today to a training about Translating and interpreting languages and cultures in working with people from different backgrounds. And that’s because must go on and I want to keep myself positive and constructive. Once you have completed all 3 Sections of this Assessment, go to www.vision2learn.com and send your work to your tutor for marking.

Plan: Realism in Great Expectations and Robinson Crusoe Essay

‘Realism falls short of reality. It shrinks it, attenuates it, falsifies it.’ (Eugà ¨ne Ionesco) Discuss the relation between realist literature and the world it represents. Actual Quote â€Å"Realism falls short of reality. It shrinks it, attenuates it, falsifies it; it does not take into account our basic truths and our fundamental obsessions: love, death, astonishment. It presents man in a reduced and estranged perspective. Truth is in our dreams, in the imagination.† Start by talking about realism and realist literature. Realism began in the 19th century? My interpretation of the question. Explain that the essay will respond to the quote with reference to Robinson Crusoe and Great Expectations. I will study how the texts attempt to construct reality with issues such as gender and race but do both have problematic features that support the argument raised by Ionesco. Realism began in the 19th century? Defoe seen as the father of realism Insert and analyse quotes where possible and respond to critics/opinions. Realism in Robinson Crusoe 1. Realism ‘The editor believes the thing to be a just history of fact; neither is there any appearance of fiction in it.’ (Preface to Robinson Crusoe) ‘Given its accumulation of ‘realistic’ descriptions and detail, its capacity to name and map out time and space as if it mirrored reality, realist fiction emerged as part of a culture obsessed with the truths and realities of an increasingly scientific and secular world’ (Sean Purchase, Key Concepts in Victorian Literature (Houndmills: Palgrave Macmillan, 2006), p. 185) ‘According to Marxist critics, for example, realist Victorian fiction†¦ embodies middle-class ideologies and values, so that the very discourse of â€Å"realism† it provides is really a middle-class adaptation of reality from the outset’ (Purchase, p. 186) In The Rise of the Novel, Ian Watt identified the following elements as  characteristic of the early novel: A concern to account for probability; a concern to tell you who, what, why, where and when. Watt describes reading a novel as like listening to evidence in a court of law. Specific, recognisable and often present-day settings. Mixed characters, characters who change over time. Celebration of private, domestic (rather than public, heroic) virtues. Plain language.  (Ian Watt, The Rise of the Novel, London: Chatto & Windus, 1957) Locate evidence of each of the above in Robinson Crusoe. You might wish to focus on the opening three pages of the novel but feel free to look at any section. Defoe’s â€Å"Robinson Crusoe† began the literary genre of realistic fiction. The aspects of his writing that define â€Å"realism† would be the immense detail he uses; descriptive language; and the flow of his narrative (dialect included). Defoe concentrates on the qualities of different objects, which provide us with a picture to accompany the words. His first clay pot, the crude fashion of his garments, and the grindstone are a few of the things we can almost touch when reading. Defoe not only introduced this genre, but I believe that in many ways he is still the master. daniel defoe expresses his work in realism via : – first person narrator. – using specific dates . – using real places – using details – fallibility – diaries http://www.enotes.com/homework-help/discuss-realism-robinson-crusoe-and-why-daniel-126439 Unrealistic Rob Cru Although we do not think too highly of the literary experience of the average 18th century reader, even he would remain sceptical after taking the author at his word. Defoe’s solution to this problem is most original: Fact is his strategy, and triviality his weapon. Of course, this technique of describing as many trivial events as possible to make the story seem more realistic, has (again) become a common aspect of almost every novel to date. In almost 400 years, we have gone from one extreme to another: From a time when it was revolutionary to introduce this formula in literature, to a time where it would be almost revolutionary not to. It may seem as if I am saying I am strongly inclined to believe that Robinson Crusoe is both a terrific book and a novel which set a new standard for literature in its time. This is true. However, I am not oblivious to some of the weaker points of the book. My foremost criticism is this; Robinson Crusoe is not a real person. He is a character, faintly disguised as a person. At first we are fooled, for all that happens seems realistic enough, but as soon as Robinson is marooned on the island, the illusion is fading. His way of living, his sudden belief, his entire way of looking at the world suggests that someone indeed did make this up. Partly, this has to do with the environment. When Defoe decided to write a more realistic novel than was usual at the time, he could have done better that to opt for an uninhabitated island. It is very difficult to make a character seem more realistic when he is completely alone. It is very hard to describe in detail solitude on such a large scale of time and still remain true to realism. Solitude may be something we have all experienced at one time or other, but Robinson’s long time completely devoid of any human contact whatsoever and his logical despair is incredibly hard to describe convincingly. Realism in Great Expectations Get presentation made in seminar real and unrealistic GE: TOPIC FOUR: Genre: Realism and sensationalism In what ways might we think of this as a realistic fiction i.e. as a fiction that represents the experience of living in the world (of materiality)? What specific features make this a ‘condition of England’ novel (if any)? You should come prepared to define this term. In what ways is this an unrealistic text? You should think about the characterisation; the plot resolutions; the theatricality of some of the scenes and events; the style in which some parts of the narrative are delivered. Find at least three examples to discuss. In considering the above, you might wish to comment on the serialised form of the original publication. Is it melodramatic? Episodic? To what extent do you feel that the more melodramatic or sensationalists aspects of the text undermine its social comment (if at all)? Realism was developed by the middle of the 19th century as a response to the idealistic world of romanticism which had dominated for the past half century. It was an aesthetic movement which attempted to hold up a mirror to its society to show a true reflection of reality. Although claiming to offer a slice of life by emphasizing chiefly in the importance of the ordinary amongst the middle and lower classes, realism is a relative concept, a representation of reality which adheres to a loose collection of conventions. Many of these are offered in Charles Dickens’ Great Expectations, which follows the life and struggles of the protagonist and narrator, Pip. Dickens uses techniques such as a chronological linear narrative, an omniscient narrator, the celebration of the ordinary, and the resolution of the enigma to drive the moral undercurrents of Pip’s everyday existence. This constructed realism is essentially a representation of reality based on Dickens ideology, offerin g social commentary and reflecting the values and attitudes of nineteenth century England. The basic structure of Great Expectations follows a chronological development of Pip’s life; from his childhood innocence, to his disillusioned expectations, finally his rejection of the high life and a circular succession ending back at the beginning. This chronological structure of which Dickens narrates exemplifies Pip’s learning process through his moral and emotional turmoil and complies with the opportunity to generate a realistic setting. For example, Pip’s description of London, â€Å"a most dismal place; the skylight  eccentrically patched like a broken head, and the distorted adjoining houses looking as if they had twisted themselves to peep down at me through it,† creates an archaeologically realistic description of London, and hints a sense of foreboding, foreshadowing the futility of Pip’s expectations. This ideology developed through Pips learning process is created through a†¦ Great Expectations a novel by Charles Dickens takes reader on an epic adventure filled with unexpected encounters with a myriad of people with vastly different backgrounds that ultimately shape Pip into the man that he becomes. Pip moves from the social class that he was born to, to one that he is elevated to by an anonymous benefactor. The two people that typify the conventional expectations of romanticism and realism are Pip the protagonist and Joe Gargery the humble blacksmith. Joe clearly shows his love for Pip the entire way through the book, a love that is only acknowledged or valued until the closing pages of the book. We will look at Pip’s journey from extravagance and utter self indulgence to his ultimate enlightenment and self fulfillment. Great Expectations is narrated by an older mature Phillip Pirrip or Pip and is his reflections and recollections of his childhood through his emerging expectation, to adulthood, often seen to make fun of his younger self. Pip was reared by hand by his older malevolent sister and her meek and submissive husband Joe Gargery, after the death of his parents. The protagonist always refers to his sister as Mrs Joe, showing the reader how domineering and heavy handed she is towards not only Pip but her husband Joe. She affords little compassion or kindness to either male and you start to see the difference between the characters and their reactions to her in relation to the conventions of romance and realism. Joe lending himself to looking at life through the eyes of a realist satisfied knowing his place, where as Pip being more romantic, dreams of escape and leaving the marches for a better life. Pip was apprenticed to his brother-in –law Joe the village blacksmith, when his direction in life was to change by the chance meeting of an escaped convict in the graveyard of his parents.

Les miserables: character analysis

Jean ValjeanJean Valjean is a central character of Les Miserables. His story is that of misery, pain, and injustice. Valjean is an epitome of change. He makes transitions from one kind of man to another, as dictated by his drastic experiences in life. Valjean’s life is a story of how an honest and good man can be hardened by society in general, and prison in particular.Because of Valjean’s unfortunate experience in prison, he hardens into a criminal and a social outcast. This transformation in Valjean’s life is a recognition of the observed truth and pattern of human behavior, wherein man changes, either for better or for worse, as a result of external forces such as society. The most important part of Valjean’s personality is his resilience and positive attitude towards life and change in general. He accepts the positive effect of other people in his life, and learns to love and care for such people.Ultimately, however, the good character of Valjean surfa ces, and even the bishop realizes that, as shown by this passage:â€Å"The bishop approached him and said, in a low voice, ‘Do not forget, ever, that   Ã‚  Ã‚  Ã‚  Ã‚   you have promised me to use this silver to become an honest man.' Jean    Valjean, who had no recollection of any such promise, stood dumbfounded. The   Ã‚   bishop had stressed these words as he spoke them. He continued solemnly,   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   ‘Jean Valjean, my brother, you no longer belong to evil, but to good. It is your soul I am buying for you. I withdraw it from dark thoughts and from the spirit of   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   perdition, and I give it to God!†FantineFantine is one of the characters in Les Miserables who lived the less appealing life. She had been deprived of good opportunities since her childhood, such as education and care. Thus, she grew up to be an uneducated girl whom everyone else found easy to victimize.Fantine can easily be categori zed as a victim of society, since she had been deprived of education without her fault, and yet society readily found her corrupt and unfit for fruitful activity and relationships. A lot of people took advantage of her lack of knowledge, education and experience, and thereafter left her out in the cold. Fantine’s character is a perfect illustration of the bigotry in human society and the story of her life is but a perfect example of the way injustice ruins lives.Brought by her experiences, Fantine learned to have a different view of morality, as expressed in her statement, â€Å"[T]he guilty one is not he who commits the sin, but the one who causes the darkness.†CosetteThe character of Cosette is in many respects similar to that of Valjean, an effect largely influenced by the latter’s taking charge over her education and upbringing. Thus, like Valjean, Cosette exhibits her kindheartedness and morality through her actions, thereby manifesting that her initial exp erience with the cruel Thà ©nardiers did not corrupt her character. Cosette, at one point in the story, said, â€Å"[W]e bow to the man who kneels. A faith is necessary to man. Woe to him who believes in nothing.† Such a statement reflects her belief about man, and shows how pure Cosette’s character has remained.Fortunately for Cosette, she had not been exposed to the kind of cruelty and hardship that Valjean went through, although she expressed resentment over Valjean’s overprotective stance. When viewed as a whole, Cosette’s character does not provide a lot of conflict, she being one of the lucky personalities in the story.

Leadership and managment Assignment Example | Topics and Well Written Essays - 1500 words - 1

Leadership and managment - Assignment Example Being prepared to deal with conflicting staff allows management to implement several strategic tactics to dissolve conflict resolution and restore solace to the workplace. Diversity has emerged in the hiring practices of the work place in the areas of race, age, gender, religion and most recently culture. The globalization of the business world has jolted corporations to embrace diversity in order to maximize competitiveness and optimize human resources. However, the array of differences can lead to misunderstandings and unfortunately workplace contention. Supervision has to be well prepared to counteract confusion. Both authors Craig E. Runde and Tim A. Flanagan (2008: 92), authors of the book Effective Leadership Stems from Ability to Handle Conflict, believe that â€Å"most effective leaders are extraordinarily competent at handling conflict.† An example of such an experience is the feel-good movie Glory Road. The movie is based on The Texas Westerns college basketball team in 1966 who won the NCAA championship while promoting diversity. The coach of the team, Don Haskins, pioneered diversity by recruiting players deemed best for the positions and sidestepping traditional hiring practices. The hiring of the new folks in nontraditional roles is an exemplary example of effective leadership. These are attributes of a true leader as the attainment of the desired result outweighs skepticism and cynicism. Peter F. Drucker (1994: 100) article â€Å"The Theory of the Business† reveals that a valid theory of business suggests that the assumptions about environment, mission and core competencies must fit reality. The example of coach Haskin has to be the pinnacle of addressing conflict. Throughout the movie, strong interpersonal attitudes clashed among team members. Fights erupted and tempers boiled. In one particular scene, teammates squared off and the season

How might a seaside resort in 1870 be expected to differ from the same Essay

How might a seaside resort in 1870 be expected to differ from the same resort in 1930 What accounts for the changes - Essay Example People began to filter into the cities to find work and thus seashore towns were developed. Many of the first settlers along the seashore began to open up boarding houses and hotels. The wealthy stayed in hotels and the less wealthy people used the boarding houses. The first boarding houses rented for a fee of $8 – 12 a week for room and board and often included meals and a wagon ride through the cornfields to the beach. As an example, Point Pleasant Beach, New Jersey developed in the 1870s as a destination for visitors through Captain John Arnold. He retired from a sea career and bought land in Point Pleasant Beach. He built a railroad to the ocean, which is now known as Arnold Avenue. As in other seashore towns, the railroad was the most influential factor in development and tourism of seashore towns. The 1870s were an era of major tourism expansion brought on by developers who bought and subdivided old farms for vacation home lots. In 1877 The Point Pleasant Land Company bo ught a 250 acres farm and began selling lots. To attract buyers, a Resort House was built and began a horse-drawn trolley service for tourists. The Resort House was a four-story hotel type structure that housed 200 guests, and was the largest building in town. The resort featured shaded oak and locust trees, a manicured lawn and a clear view of the beachfront dunes. The inside included a ballroom and bowling alley, which was very upscale for that time. Several other hotels and boarding houses were built similar before the turn-of-the-century. Some of the hotels advertised access to New York and Philadelphia trains, trolley lines, water works, electric lights plants and no mosquitoes. Many of these hotels burned to the ground due to being wood structures and others lost business due to changing tastes in lodging. The first beachfront pavilion was constructed in 1880, and ten years later the first boardwalk was built. The first boardwalk was very flimsy and washed away within two year s. During the Victorian period rapid growth in population began in the seaside resorts. The railways made if possible for visitors to travel to the seashore, and it became much more affordable. The seashore had a nostalgic draw to people as a focal vacation point. A seaside holiday was considered very charming at that time. Again, only a few ordinary people owned cars or telephones until the 1950s. Even when televisions became available, they were very expensive for the average family. The working class worked hard all week in factories, offices, shops and mines and very rarely had the opportunity to travel. However, it became popular to set aside a time during the year to take a seaside holiday. This was popular both in England and the Americas. Traveling to the seaside became popular when it was decided that the sea and bathing in the sea was good for your health. Dr. Richard Russell advocated the use of seawater in bathing and in drinking to treat many early illnesses, in the lat e 1700s. So it became fashionable for the rich especially to visit the seashore. For people of England a railway trip to the seaside and a week or two-holiday stay at a resort was the highlight of the year. The popularity of holiday seaside trips grew until it became popular to take trips abroad to experience different lifestyles. This became very popular with the wealthy, as the ordinary person could not afford such luxuries. Just as the industrial revolution helped build the

Industrial Music Essay Example | Topics and Well Written Essays - 500 words - 1

Industrial Music - Essay Example Otherwise, their target audience would not be reached and knowledge, as well as existence of new compositions, musical scores, and songs would not even be able to reach the intended listeners. The uses of various media (television, radio, online sites) are traditional media for promotion and commercialization of popular music. Thus, appropriate funds and resources are invested to do this with the objective of generating profits in the end. Yes, one believes that a group, artist, or singers could be too commercial; and at the same time, not commercial enough. There are contemporary singers who could be considered overexposed as listeners tend to hear their songs in all media at almost all possible times. When hearing a particular song is perceived as way too much that audience perceives that their ears are already aching from hearing the same sounds again and again, then, this could be considered an evident proof of being too commercial. On the other hand, there could be very good musical compositions that are not effectively managed and promoted due to factors such as lack of funds, lack of competencies of the managers or promoters, wrong use of media to promote, and reaching only a limited audience. As such, these are examples of a group or singers whose songs and musical compositions are not commercial enough. If the focus is no longer on the music itself (maybe creating promotional products that promote the singer more than the songs), then somehow, there are possibilities of audience losing their interests and appeal; especially if the songs do not reach the quality expected from the music. It could initially be productive for the promoters for having served their commercial interests; but eventually, not being able to sustain a good quality of music would be detrimental to the singer, manager and promoters in the long run. Rock fans may have rebelled against the popularity

The implication of diversity on human resource, organization,and Research Paper

The implication of diversity on human resource, organization,and stakeholders - Research Paper Example The main point to be noticed here is that numbers of minorities within the workforce who are qualified and educated have increased and this makes it compulsory for the organizations to attract, hire and recruit member of the workforce who are recognized as minority. Research has been conducted for several years and the results of these researches is that hiring individuals who represent the minority s not enough to achieve success and efficiency within the organization. Questions have even been raised against the effectiveness of the training programs of diversity implemented by organizations. Those organizations that fail to attain success in creating a diversified work environment have experienced the negative implications of diversity. Such events have been experienced by world’s top most organizations such as Wal-Mart and Coca-Cola (Samson 511). When organizations fail to integrate and attain diversity, they experience downsides such as law suits based on discrimination. T hose organizations that have been successful in integrating diversity have attained favorable results and rewards. The failure to achieve diversity and deal with diversity in an effective manner is a problematic situation for private firms and firms that contribute to the list of Fortune 500 companies. These issues have not even spared the public and the nonprofit sector which is already deeply concerned due to financial issues. These organizations are mostly held responsible for not spending money on the activities of human resource management such as training and development, hiring and retention. Problems will further elevate for these organizations as Baby Boomers will obtain retirement and a shortage in the workforce will be created. According to the conventional business case in the favor of diversity, organizations should manage their diverse workforce in an appropriate manner to attain competitive advantage over its competitors. This is very essential for organizations becau se the demographics of the workforce are changing on daily basis. According to Soni, during the period of 1990 the total workforce of US comprised of 73% white and 27% minority individuals, the statistics changed to 30% minority and 70% white individuals within a time frame of ten years (Soni, 2004) . This clearly shows that employers need to pay attention to the element of diversity as the minorities are becoming an integral part of the workforce. Various benefits of diversity have been realized by organizations, diversity helps an organization in achieving its aims and objectives. This happens because employees who belong to different cultures and society play a major ole in generation of ideas and solutions to issues experienced by organizations. Diversity will lead to creation of creative teams and creativity within teams will increase and this will lead to designing and development of creative products. Another major benefit of having a diversified workforce is that diverse wor kforce is able to attract diverse amount of customers (Champoux 30). Customers feel more relaxed and want to buy more from organizations that are able to understand what their needs and wants are. Diversified workforce is able to communicate with customers according to their cultural context which makes the customers feel comfortable as they are able to express their

Looking at organizational behaviours such as managment objectives, Assignment

Looking at organizational behaviours such as managment objectives, culture, knowledge about how people- as induviduals and as groups- act within organizations - Assignment Example The easiest probable approach is to promote the common interest of the group first thus, to gather altogether the efforts and interest of each unit and channel it towards the achievement of that goal. This is primarily the foundation of the aspect of organizational management, which is to maintain the necessary values inside the organization’s environment for the effectiveness and efficiency of the member’s efforts (Robinson, 2000). To do this, the management must be able to lead its member towards the tasks and responsibilities and be able to relate to the needs of each of its units. It is through this approach that the management is able to transcend the individuality barriers and diversity environment inside the organization for their productivity towards the common goal. (Sims 2002) On a personal reflection as a member of an actual organization management committee, there are several important concepts and terminologies that one must intricately understand to function effectively as an organizational manager. Most of these key concepts include the values that are important for the functions and operations of the organization and the issues that must be thoroughly addressed inside the organization (Robinson 2000). These important concepts are organizational behavior, organizational culture, diversity, communication, business ethics, and change management. First among the list is the task of fostering organizational behavior within the group particularly the necessary values and idealism that each individual member must possess. In this aspect, the management promotes the ideal behavior that is important for the group for it to function effectively towards the common goal (Robinson 2000). Indeed, the management must primarily establish the concepts of professionalism and teamwork within its member to enhance their productivity as a group. In this aspect, the

Exploring the role of change management and new HRMS system adoption Dissertation

Exploring the role of change management and new HRMS system adoption the case of American Express Bahrain - Dissertation Example However, there are some strategic loopholes that can addressed to reap full benefits of the system. Table of Contents 1 Chapter One- Introduction 2 Chapter Two- Literature Review 3 Chapter Three- Research Methodology 4 Chapter Four- Results and Findings 5 Chapter Five- Conclusions and Recommendations 6 References 7 Appendices Chapter 1- Introduction 1.1 Title Exploring the role of change management and new HRMS (Human Resource Management System) adoption; the case of American Express Bahrain. 1.2 Aim To explore the role of change management by studying the steps American Express Bahrain has put into action to introduce the new HRMS on its employees. 1.3 Research Question What are the chronological steps that a company must apply in order to introduce new software to the organisation? 1.4 Objectives To examine the techniques that American Express Bahrain use when introducing change to employees. To establish a questionnaire to understand the steps those were taken. To draw conclusions on ways and theories that help organisations sequential their introduction of change to their employees. 1.5 Background to the study The term Change Management deals with the substitution of one thing or set of conditions for another , thus making something different from its previous condition, be it an alteration in state, or quality, variety, variation, mutation(Sofroniou,2009). Change Management is something that all managers should know how to cope with especially with our rapidly changing world and the contribution of technology to the modernisation of business functions and practises. Consequently, organisations must adapt to the environment around them in order to stay competitive by leveraging technology and new systems (Saunders, Lewis, and Thornhill, 2009). Organisations must be able to adapt to the changing environment if they are to survive. Threats to organisational existence include but are not limited to changes in technology, the tastes of consumers, the regulation s of the Government, the increase in the cost of various resources, and values and capabilities of the prospective employees, downsizing, mergers and acquisitions(Palmer et al, 2006). However, all these reasons came from one major source –Globalisation. According to Webster’s dictionary the term globalisation is the development of an increasingly integrated global economy marked especially by free trade, free flow of capital, and the tapping of cheaper foreign labor markets (merriam-webster, 2012). Thus, the world’s economy is treated as one big market which makes it difficult for organizations to be unique and different from competitors. Moreover, globalization has majorly affected organizational change. This is evident because of all the planned and unplanned changes that occur in small and multinational companies. In the recent time the most important thing faced by most of the global organization is the constant changes in the all aspects of business. Due to the technological revolution most of the organizations are practicing the new technologies related to the human resource management system(HRMS). The development in the information technology has given a new paradigm shift to the HRMS. Most of the global organizations are accepting the virtue of the HRMS (Grobler & Warnich. 2005. P, 39) The new trend in the global organization is to apply computer based technologies to create a strong HRMS. Most of the organizations like American Express are using the HRMS to revamp the HRMS

Lord of the Flies Essay Example for Free

Lord of the Flies Essay William Golding, the Nobel Prize winning author is probably best known for his novel Lord of The Flies. The story tells about how a group boys are stranded in an island in the pacific after the plane they were on was shot down. The boys attempt to recreate the culture they left behind through democracy and election but slowly the boys are lured from civility and rational thought to primeval tribalism. William Golding uses many ways to describe this change in the boys in an interesting way that will manage to keep the audience engaged. He uses many literary devices to achieve this result, one of them is symbols. An example of a symbol used frequently in the Lord of The Flies is weather. William Golding uses the elements of weather effectively in Lord of The Flies to symbolize a kind of universal assessment of the actions, making the novel more interesting, and representing the inner feelings of the characters. Golding manages to use elements of weather effectively to symbolize a kind of universal assessment of the action and dramatic events in the novel. Elements of weather are used to represent the action that is taking place and to also foreshadow future events. For example, Golding uses weather to slowly hint or indicate Simons death. This is visible in the statement There was a blink of bright light beyond the forest and the thunder exploded again so that a littlun started to whine. Big drops of rain fell among them making individual sounds where they struck (Golding, 186). By reading this, readers can feel that the atmosphere and mood has changed for the worse. When Ralph says, Going to be a storm and youll have rain like when we dropped here, Golding is trying to indicate to us that something big is about to take place later in the novel. Besides that, after Simon dies there heavy rain; The water bounded from the mountain-top, tore leaves and branches from the trees, poured like a cold shower over the struggling heap on the sand. (Golding, 188). So the rain is used here to represent the sadness caused by Simons death as he was a victim of the savage actions of the hunters. This part makes the readers feel sorry for Simon but the readers also know that Simon couldnt do anything to fight back. Golding doesnt present the sadness of Simons death directly but instead chooses to use weather to present it to the readers. In a nutshell, the elements of weather are used at the right place and at the right time, making the action and dramatic events in the  novel much more intense. William Golding also uses the elements of weather to make the story more attractive and to create a more gripping atmosphere. Golding manages to use the weather to portray some situations with a mysterious and serious air. Golding also uses weather to make the readers feel as though they are at that particular scene and can experience the weather at that time. This is done to create intense emotions in the reader. During Simons death Golding uses the weather to complement the Lord of The Flies as being omens for something evil that is about to happen. Phrases like Colours drained from water and trees and the pink surfaces of the rock, and the white and brown clouds brooded (Golding, 176) show that something bad is about to happen and creates an ill mood and also in a way makes readers more anxious as to actually what is the evil event that is going to happen. The line The blue white-scar was constant, the noise unendurable (Golding, 188) makes the reader nervous of the uncertain weat her. This also helps to create interest in the reader who will want to know whether there is a relation between the terrible weather and events that are to come. Golding realises the power of weather to explain a situation or to signify something. In the past the ancients believed in the power of weather to influence our lives. For example, they believed in rain gods and sometimes performed rituals to ensure that there was sufficient rain. Weather also can have an impact on peoples moods. For example sunny weather makes people hopeful and happy as opposed to cloudy days which create depression. All of this shows how weather has the ability to influence a person and William Golding realising this has used weather to create interest in readers and thus has made the novel more interesting. Besides that, William Golding has managed to use elements of weather successfully in the novel The Lord of The Flies to portray the inner feelings of the characters in the novel. He uses different types of weather to portray or symbolize different moods or emotions that the characters are feeling at that particular moment or period. Cloudy and dark skies are used to create an ominous mood that symbolizes that something bad is about to happen. This causes reader to feel apprehensive about future events.  Meanwhile, rain and thunderstorms are used to symbolize fear and frenzy. This element is sometimes used by Golding in place of words between characters to portray frantic activity that is taking place. Hope is also symbolized in different ways such as the sun appearing after rain and the coming of peaceful dusk. Among the examples Golding uses to symbolize hope in the boys can be found in the beginning of chapter 1. The statement The undergrowth of the side of the scar was shaken an d a multitude of raindrops fell pattering (Golding, 1) is used to symbolize hope within the boys because the way the rain stops and how the sun has come out resembles a new beginning for the boys to look forward to. Another example of hope in the boys can be found at the end of chapter 3. The statement Now the sunlight had lifted clear from the open space and withdrawn from the sky (Golding, 60) clearly illustrates how Simon feels hope that he will be at peace with nature. This is signified by cool, calm darkness setting on the jungle and the opening of the candle buds and flowers. Golding also uses weather to create a mood of gloom and impending evil. An example of this is the statement Over the island the build-up of clouds continued (Golding, 163). This creates an ominous mood among Piggy and Ralph symbolized by the large clouds covering the sky signalling that it was going to rain. Besides that, Golding also manages to use rain and thunderstorms to symbolize frenzy and fear. An example of this can be found in the statement The dark sky was shattered by a blue-white scar (Golding, 171). The element of lightning and thunder here symbolizes how the boys are increasing scared and in a frenzy as they dance and chant. Besides Goldings examples in The Lord of The Flies, elements of weather are also used in movies regardless of language. For example lightning is sometimes portrayed in movies when the characters suddenly realize something or when a dramatic event has taken place. In conclusion, elements of weather are a great way to symbolize the inner feelings of characters and William Golding has used them to great effect in his novel. In conclusion, the power of weather as a symbol cannot be underestimated. Elements of weather have the ability to portray characters emotions, foreshadow future events and to also catch and hold readers attention. Golding, realising the importance of weather as a symbol has used it  consistently throughout the book. All major events have been related to elements of weather successfully. As a result, Golding has managed to make the readers feel what he intended them to feel. So in brief, Goldings usage of the elements of weather in the Lord of the Flies has symbolized a universal assessment of the action, has made the novel more interesting and has represented the inner feelings of the characters. Work Cited: Golding, William. Lord of the Flies. educational edition. Great Britain: Faber and Faber Limited, 1996.

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study

Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan Acute Exacerbation of Bronchial Asthma (AEBA) Case Study Acute Exacerbation of Bronchial Asthma (AEBA) Case Study 1.0 CASE SUMMARY 1.1 Patient information and presenting complaints SAR, a 54-year-old female with weight of 54kg and height of 160cm was referred to the hospital by her GP due to shortness of breath which was not relieved by taking inhaler, minimum cough with yellowish sputum, abdominal pain and mild diarrhoea. Her shortness of breath had been on and off for the past 1 week and the condition was deteriorating on the day of admission. 1.2 Relevant history SAR is a non-smoker and a non-alcoholic housewife. She has had bronchial asthma since childhood. Her siblings and children were found to have family history of bronchial asthma as well. The patient has been taking inhaled salbutamol 200 µg 1 puff when required as reliever and inhaled budesonide 200 µg 2puffs bd as preventer for umpteen years. Besides that, SAR also has medical history of hypertension, diabetes mellitus and ischaemic heart disease (IHD) for 10 years. She has no relevant family history for these illnesses. For the past few years, SAR has been taking rosuvastatin 20mg at night, fenofibrate 160mg OD and ezetimibe 10mg OD for dyslipidaemia, gliclazide 60mg BD and rosiglitazone 4mg OD for diabetes mellitus, losartan 50mg OD for hypertension, ticlopidine hydrochloride 250mg OD for prophylaxis against major ischaemic events and famotidine 20mg OD to prevent gastrointestinal ulceration due to the use of anti-platelet agent. 1.3 Clinical data On examination upon admission, SARs blood pressure and pulse rate were recorded as 111/80 mmHg and 111bpm respectively. Her respiratory rate was normal (16 breaths/min). Her SpO2 measurement was 98% and it showed decreased high flow mask. Her DXT blood glucose test revealed that her random blood glucose level was abnormally high (21.6mmol/L). From the doctors systemic enquiry, SARs ankles were slightly swollen and her respiratory system showed prolonged minimal bibasal crept and rhonchi. Also, SARs chest X-ray showed shadowing in the lower zone of her right lung. The renal function tests gave results of high urea and elevated creatinine levels of 16.3mmol/L and 270 µmol/L respectively. Creatinine clearance derived from Cockcroft and Gault formula is 17ml/min which indicates that the patient has severe renal impairment. The liver function tests revealed a mild decrease in albumin concentration and an increase in the plasma globulin. On the other hand, the haematological tests showed low red blood cell count (3.41012/L), low haemoglobin count (9.4g/dL), high platelet count (410109/L), high white blood cell count (17.1109/L), high neutrophil count (16.4109/L) and low lymphocyte count (0.5109/L), whereas cardiac marker tests showed abnormally high counts in creatine kinase (156IU/L) and lactate dehydrogenase (627IU/L). 1.4 Diagnosis and Management Plan Based on the patients symptoms, medical history, physical examinations, and laboratory tests, SAR was diagnosed with chronic heart failure (CHF), acute exacerbation of bronchial asthma (AEBA) secondary to pneumonia and uncontrolled diabetes mellitus. Her doctor developed therapeutic plans which included anti-asthmatic drugs and antibiotics, and ordered further investigations such as SpO2 and PEFR. Besides that, her doctor also added diuretic to her ACEI therapy and restrict her fluid intake to not more than 800cc/day. Her uncontrolled diabetes mellitus was under monitoring of DXT blood glucose test 4 hourly and she was referred to dietician for diabetic diet counselling. 1.5 Ward medication Throughout the 3days in hospital, Sarah was being prescribed with medications as listed below: 1.6 Clinical Progress and Pharmaceutical Care Issues On the first day of admission, the patients past medication history was confirmed by appropriate patient interview and her family members were being advised to bring SARs home medication to ensure that the appropriate medications were continued and prescribed. From the interview, dust was found to be the chief precipitating factor. The patient was on appropriate drugs (nebulised ipratropium bromide 0.5mg and nebulised salbutamol 5mg in normal saline 4 hourly, IV hydrocortisone 100mg stat) for acute management of severe asthma as according to guidelines and eventually her SOB was relieved.2-3 However, she was prescribed with oral prednisolone at dose as low as 30mg od for acute asthma, it should be suggested to increase prednisolone dose to 40-50mg daily as according to evidence-based guidelines to achieve maximal effects.2-3 Another pharmaceutical care issue is regarding the patients poor inhaler technique. Thus, the pharmacist educated and assessed SAR on her inhaler technique since day 1. Appropriate antibiotics indicated for pneumonia which included IV ceftriaxone 2g stat and oral azitromycin 500mg od were initiated upon admission. Oral cefuroxime 250mg bd was added to the drug regimen on day 2 after stopping IV ceftriaxone 2g on the first day. Therefore, signs of recovery and WBC count were monitored regularly and completion of antibiotic course was ensured. In addition to that, vaccinations against pneumococcal infection and influenza should be strongly recommended in this asthmatic patient.2-3,5-8 Co-administration of high dose IV furosemide (40mg bd) and corticosteroids can increase the risk of hypokalaemia, therefore SAR should be started on potassium chloride 600mg bd which is an appropriate dose for renal insufficiency patient to avoid the potential risk.1 Besides that, potassium level of SAR should also be closely monitored during the administration of potassium chloride. The doctor added lovastatin 20mg at night to her existing triple therapy of dyslipidaemia (rosuvastatin, ezetimibe, fenofibrate). Rosuvastatin should be avoided if patients creatinine clearance is less than 30ml/min.1 Due to its same mechanism of action as lovastatin and its contraindication in patient with severe renal impairment, rosuvastatin should be withdrawn from the drug regimen. Practically, a comprehensive lipid profile of SAR should be established and monitored in order to choose the best combination of lipid lowering agents to improve the individual components of lipid profile. Combination therapy of ezetimibe and lovastatin is considered more appropriate as concurrent use of fenofibrate and statin may potentiate myopathy. Therefore, fenofibrate and rosuvastatin should not be continued. Liver function should be monitored to avoid the risk of hepatotoxicity. SAR was diagnosed with uncontrolled diabetes mellitus which means her blood glucose level was not adequately controlled with concurrent therapy of gliclazide and rosiglitazone. Her random blood glucose level was fluctuating throughout day 1 (24.9mmol/L, 14.2mmol/L, 7.3mmol/L and 14.7mmol/L). Targets for blood glucose levels should be ideally maintained between 4 and 7mmol/L pre-meal and On day 2, SAR was feeling much more comfortable and had not complaint of SOB. However, SARs maintenance management of asthma was found to be not conformed to the asthma guidelines.2-3 She was prescribed with unacceptable high dose of corticosteroids (MDI beclomethasone 200 µg 2 puffs tds) in addition to her current steroid regimen (MDI budesonide 200 µg 2 puffs bd and oral prednisolone 30mg od). SAR was at potential high risk of experiencing considerable side effects such as diabetes, oesteoporosis, Cushing syndrome with moon face, striae, acne, abdominal distension and other profound effects on musculoskeletal, neuropsychiatric and ophthalmic systems as a result of overdosage of corticosteroids.1 Oropharyngeal side effects such as candidiasis are also more common at high dose of inhaled steroids, but can be minimized if the patient rinse the mouth with water after inhalation. It should be recommended to add the long acting beta agonist (LABA) to the inhaled corticosteroids (ICS) treatment instead of initiating SAR on high dose steroid (2000 µg). Combination inhaler of formoterol and budesonide (Symbicort 200/6 Turbohaler ® 2 puffs bd) should be given and control of asthma need to be continuing assessed.2-3 If LABA is proved to be not effective, addition of 4th agent (leukotriene receptor antagonist, theophylline or oral beta agonist) can be considered.2 When SAR showed recovery of leg swelling, furosemide was given orally instead of intravenously with reduced frequency and total daily dose. On day 3, SAR was arranged to be discharged. The pharmacist should review the appropriateness of discharged medication by checking discharged prescriptions against ward medication chart and ensure all information relevant to primary care referrals are included. In addition to that, the pharmacist should also reiterate and reinforce the importance of patient compliance and follow-up reviews, counsel on indications, doses and possible adverse effects of each discharged medication, and rechecked SARs inhaler and insulin injection techniques prior discharged. Asthma education includes advice to avoid trigger factors, including caution with NSAIDs and avoidance of dust exposure. Greater attention should be paid to inhaler technique as poor technique leading to failure of treatment. SAR should be educated on the use of peak flow meters and advised to monitor and record her own PEFR at home. A written personalised asthma action plans should be designed for SAR prior discharged. Diabetic cou nselling should emphasize on proper insulin injection techniques and healthy lifestyle modifications. SAR needs to be made aware of the signs of hypoglycaemia and hyperglycaemia and how to response to them. Polypharmacy may adversely affect compliance with prescribed drug therapy, therefore SAR should be taught not to mix up her medicines by using daily pill box and her family member should also be advised to supervise her on medicine taking. 2.0 PHARMACOLOGICAL BASIS OF DRUG THERAPY 2.1 Disease background 2.1.1 Asthma Asthma is a common chronic inflammatory condition of the lung airways affecting 5-10% of the population and appears to be on the increase.5 It is especially prevalent in children, but also has a high incidence in more elderly patient. Asthma mortality is approximately 1500 per annum in the UK and costs in the region of  £2000 million per year in health and other costs.2-3,6 Symptoms of asthma are recurrent episodes of dyspnoea, chest tightness, cough and wheeze (particularly at night or early in the morning) caused by reversible airway obstruction. Three factors contribute to airway narrowing: bronchoconstriction triggered by airway hyperresponsiveness to a wide range of stimuli; mucosal swelling/inflammation caused by mast cell, activated T lymphocytes, macrophages, eosinophils degranulation resulting in the release of inflammatory mediators; smooth muscle hypertrophy, excessive mucus production and airway plugging.7 There is no single satisfactory diagnostic test for all asthmati c patients. The useful tests for airway function abnormalities include the force expiratory volume (FEV1), force vital capacity (FVC) and peak expiratory flow rate (PEFR). The diagnosis is based on demonstration of a greater than 15% improvement in FEV1 or PEFR following the inhalation of a bronchodilator.2,3,6 Repeated pre and post-bronchodilator readings taken at various times of the day is necessary. The FEV1 is usually expressed as the percentage of total volume of air exhaled and is reported as the FEV1/FVC ratio. The ratio is a useful and highly reproducible measure of lungs capabilities. Normal individuals can exhale at least 75% of their total capacity in 1 second. A decrease in FEV1/FVC indicates airway obstruction. 2.1.2 Community-acquired pneumonia Pneumonia is defined as inflammation of the alveoli as opposed to the bronchi and of infective origin. It presents as an acute illness clinically characterized by the presence of cough, purulent sputum, breathlessness, fever and pleuritic chest pains together with physical signs or radiological changes compatible with consolidation of the lung, a pathological process in which the alveoli are filled with bacteria, white blood cells and inflammatory exudates. The incidence of community acquired pneumonia (CAP) reported annum in UK is 5-11 per 1000 adult population, with mortality rate varies between 5.7% and 14% (patients hospitalised with CAP).8 Streptococcus pneumonia is the commonest cause, followed by Haemophilus influenzae and Mycoplasma penumoniae.7 2.1.3 Congestive cardiac failure Congestive cardiac failure occurs when the heart fails to pump an adequate cardiac output to meet the metabolic demands of the body. It is a common condition with poor prognosis (82% of patients dying within 6 years of diagnosis) and affects quality of life in the form of breathlessness, fatigue and oedema.6,7 The common underlying causes of cardiac failure are coronary artery disease and hypertension. Defects in left ventricular filling and/or emptying causes inadequate perfusion, venous congestion and disturbed water and electrolyte balance. In chronic cardiac failure, the maladaptive body compensatory mechanism secondary physiological effects contribute to the progressive nature of the disease.6 2.1.4 Diabetes mellitus Diabetes mellitus is a heterogenous group of disorders characterised by chronic hyperglycaemia due to relative insulin deficiency and/or resistance. It can be classified as either Type 1 or Type 2. In Type 1, there is an inability to produce insulin and is generally associated with early age onset. Decreased insulin production and/or reduced insulin sensitivity, maturity onset and strong correlation with obesity are characteristics of Type 2 diabetes. Diabetes affects 1.4 million people in the UK, over 75% of them have Type 2 diabetes.6 It is usually irreversible and if not adequately managed, its late complications can result in reduced life expectancy and considerable uptake of health resources. 2.2 Drug pharmacology 2.2.1 Treatment for asthma 2.2.1.1Beta-adrenoceptor agonists (e.g. salbutamol, terbutaline) These short-acting selective ÃŽ ²2 agonists (SABA) are the first line agents in the management of asthma and are also known as relievers. The selective ÃŽ ²2 agonists act on ÃŽ ²2 aderenoceptors on the bronchial smooth muscle to increase cyclic adenosine monophosphate (cAMP) leading to rapid bronchodilation and reversal of the bronchospasm associated with the early phase of asthmatic attack.5 Such treatment is very effective in relieving symptoms but does little for the underlying inflammatory nature of the disease. ÃŽ ²2 agonists should be initiated ‘when required as prolonged use may lead to receptor down regulation renders them less effective.5-6 Compared to SABA, long-acting beta-adrenoceptor agonists (e.g. salmeterol, formoterol) have slower rate of onset and their intrinsic lipophilic properties render them to be retained near the receptor for a prolonged period (12hours), which means that they cause prolonged bronchodilation. 2.2.1.2 Muscarinic receptor antagonists (e.g. ipratropium) Ipratropium blocks parasympathetic-mediated bronchoconstriction by competitively inhibiting muscarinic M3 receptors in bronchial smooth muscle.1,5-6 It has slower onset of action than ÃŽ ²2 agonists but last longer. 2.2.1.3 Inhaled corticosteroids (ICS; e.g. beclomethasone, budesonide) and oral prednisolone These agents are used to prevent asthmatic attacks by reducing airway inflmmation. They exert their anti-inflammatory actions via activation of intracellular receptors, leading to altered gene transcription. This results in decreased cytokine production and the synthesis of lipocortin leading to phospholipase A2 inhibition, and the inhibition of leukotriene and prostaglandins.5 Candidiasis occurs as common side effects with inhalation and systemic steroid effects such as adrenal suppression and osteoporosis, occur with high dose inhalation or oral dosing. 2.2.2 Treatment for pneumonia Antiobiotic treatment is appropriate with amoxicillin being used as first choice agent for mild, community-acquired infections. Depending on response and the strain of bacteria, other antibiotic agents can be used. Two groups of antibiotics which were given to the patient in this case scenario will be discussed here. 2.2.2.1 Cephalosporins (e.g. cefuroxime, ceftriaxone) Both ceftriaxone and cefuroxime are broad spectrum bactericidal antibiotics belong to cephalosporins group. They inhibit the synthesis of bacterial cell wall by binding to specific penicillin-binding proteins and ultimately leading to cell lysis. Second generation cefuroxime is beta-lactamase resistant and active against Gram-negative bacteria such as Haemophilus influenzae and Klebsiella pneumoniae. Being third generation cephalosporin, ceftriaxone display high beta–lactamase resistance and enhanced activity against Gram-negative pathogens (including Pseudomonas Aeruginosa), but it has relatively poor activity against Gram-positive organisms and anaerobes.1,5-6 2.2.2.2 Maclolides (e.g. azithromycin, erythromycin, clarithromycin) Maclolides prevent protein synthesis by inhibiting the translocation movement of the bacterial ribosome along the mRNA, resulting in bacteriostatic actions. Azithromycin has slightly less activity than erythromycin against Gram-positive organisms but possesses enhanced activity against Gram-negative bacteria including Haemophilus influenza. 2.2.3 Treatment for chronic cardiac failure 2.2.3.1 Loop diuretics (e.g. furosemide) Diuretics are the mainstay of the management of heart failure and provide rapid symptomatic relief of pulmonary and peripheral oedemia.5,6,9 Loop diuretics are indicated in majority of symptomatic patients and they work by inhibiting Na+/K+/2Cl- transporter in the ascending limb of the loop of Henle, inhibiting the establishment of a hyperosmotic interstitium and thus reducing the production of concentrated urine in kidney, leading to profuse dieresis.5-6 2.2.3.2 Angiotensin II receptor antagonists (e.g. losartan, candesartan, valsartan) These agents block the action of angiotensin II at the AT1 receptor, which will also reduce the stimulation of aldosterone release. Therefore AT1 receptor antagonists can be used as an alternative in patients suffering from a cough secondary to ACE inhibitors. 2.2.4 Treatment for Type II diabetes mellitus 2.2.4.1 Sulphonylureas (e.g. Gliclazide, glibenclamide, glipizide) The sulphonylureas have two main actions: increase basal and stimulated insulin secretion and reduce peripheral resistance to insulin action. They bind to receptors associated with voltage dependent KATP channels on the surface of pancreatic beta cell, causing channel closure which facilitates calcium entry into the cell and leads to insulin release. Sulphonylureas are considered in Type II diabetes patients who are intolerant to metformin, not contraindicated and not overweight. 2.2.4.2 Thiazolidinediones (e.g. rosiglitazone, pioglitazone) These new agents are ‘insulin sensitisers which act as nuclear peroxisome proliferator-activated receptor-gamma (PPAR-ÃŽ ³) agonist. They work by enhancing insulin action and promoting glucose utilization in peripheral tissue, and so reduce insulin resistance. Thiazolidinediones is known to be associated with oedema and increased cardiovascular risks, therefore these agents should be avoided in patients with heart failure.1,4,6 3.0 EVIDENCE FORTREATMENT OF CONDITIONS 3.1 Asthma 3.1.1 Evidence for the use of oral prednisolone and IV hydrocortisone in the management of AEBA There are mounting evidences suggesting that systemic corticosteroids effectively influence the airway oedema and mucus plugging associated with acute asthma by suppressing the components of inflammation, including the release of adhesion molecules, airway permeability and production of cytokines.10-12 A randomised trial involving 88 patients (aged 15-70years) with AEBA reported the significant efficacy of oral prednisolone (40mg daily for 7 days) in improving FEV1 and FVC at values of 68 ±45.3% and 53.4 ±46.5% respectively (P=0.04) in prednisolone-treated group.13 A Cochrane meta-analysis involving six trials recruiting 374 acute asthmatic exacerbation patients determined the early use of systemic corticosteroids significantly reduced the number of relapses to additional care, hospitalisation and use of short-acting ÃŽ ²2-agonist without increasing side effects, regardless of the routes of administration studied (oral/intramuscular/intravenous) and choice of agents.14 3.1.2 Evidence for the use of inhaled ipratropium bromide in the management of AEBA A double-blind, randomised controlled trials recruiting 180 patients with AEBA admitted to emergency department showed that ipratropium had beneficial effects in improving pulmonary function, with a 20.5% increment in PEF (p=0.02) and a 48.1% greater improvements in FEV1 (p=0.0001) compared to those given ÃŽ ²2-agonists alone. Ipratropium also demonstrated a 49% reduction in the risk of hospital admission.15 A more recent meta-analysis incorporating thirty-two double-blind, randomised controlled trials including 3611 patients with moderate to severe exacerbations of asthma also showed the benefits of combination treatment of nebuliser ÃŽ ²2-agonists and anti-muscarinic in reducing hospital admissions (relative risk 0.68,p=0.002) and in producing a significant increase in lung function parameters in AEBA patients (standard mean difference -0.36, p=0.00001).16 Another pooled analysis of three multicenter, double-blind, randomised controlled studies also showed that combination therapy of ipratropium bromide and salbutamol for the treatment of AEBA had decreased risk of the need for additional treatment (relative risk=0.92), asthma exacerbation (relative risk=0.84) and hospitalisation (relative risk=0.80).17 3.1.3 Evidence for addition of LABA to ICS in the management of asthma Symbicort Maintenance and Reliever Therapy (SMART) studies demonstrated the combined use of formoterol/budesonide contributes to a greater reduction in risks of exacerbations, improved lungs performance and better control of asthma than high dose of ICS with SABA.18-22 These studies also reported the advantage of this approach in terms of patient compliance as it allows the use of single inhaler for both rescue and controller therapy, and reductions in healthcare costs.18-22 A large double-blind, randomised trial reported that there was a significant 21-39% reduction of severe exacerbations in asthmatic patients treated with SMART therapy compared with high dose budesonide plus SABA.23 A meta-analysis involving 30 trials with 9509 patients showed that the use of combination inhaler (formoterol/beclomethasone 400mcg) resulted in greater improvement in FEV1, in the use of rescue SABA and in the symptom-free days compared to a higher dose of ICS (800-1000mcg/day).24 Another double-blind randomised trial investigating the effect of combination budesonide and formoterol as reliever therapy for 3394 patients who were assigned budesonide plus formoterol for maintenance therapy showed that the time to first severe exacerbation was significantly longer in as needed budesonide/formoterol group compared to as needed terbutaline group (p=0.0051). The other finding of the study is the significant lower rate of severe exacerbation for as needed budesonide/formoterol versus as needed terbutaline group (0.19 vs 0.37, p 3.2 Community-acquired pneumonia 3.2.1 Evidence use of combination therapy of second and/or third generation cephalosporins and macrolide in the management of pneumonia A multicenter, randomised trial investigated the efficacy of IV ceftriaxone 2g for 1 day followed by oral cefuroxime 500mg bd in the adult pneumonia treatment. The sequential therapy in combination with a macrolide achieved 90% of clinical success, 85% of overall bacteriologic clearance with 100% eradication of S.pneumoniae after 5-7days of treatment.27 An open label, prospective study involving 603 patients demonstrated that adding azithromycin (500mg od for 3days) to IV ceftriaxone 1g/day in the treatment of community-acquired pneumonia resulted in shorter hospital stay (7.3days vs 9.4days) and a significant lower mortality rate (3.7% vs 7.3%) than adding clarithromycin.28 Lack of randomisation and no blinding of evaluators may become the major limitations of this study; however the effectiveness of macrolide in addition to cephalosporins empirical therapy in treating pneumonia is unquestionable. 3.3 Chronic heart failure 3.3.1 Evidence use of loop diuretic in the management of chronic heart failure (CHF) A meta-analysis of 18 randomised controlled trials concluded that diuretics significantly lowered the mortality rate (odds ratio (OR) 0.25, P=0.03) and reduced hospital admissions for worsening heart failure (OR 0.31, P=0.001) in patients with CHF compared to placebo.29 Compared to active control, diuretics significantly improved exercise capacity in CHF patients. (OR 0.37, P=0.007).29 A recent review reappraisaled the role of loop diuretics as first line treatment for CHF concluded that existing evidence of association of loop diuretics with rapid symptomatic relief and decreased mortality supporting the essential role of diuretics in the management of CHF.30 3.3.2 Evidence use of angiotensin II receptor antagonists in the management of CHF The Losartan Heart Failure Survival Study ELITE II, a double-blind, randomised controlled trial involved 3152 patients with NYHA class II-IV heart failure and ejection fraction ≠¤40% reported that there were no significant differences between losartan and enalapril groups in all cause mortality (11.7 vs 10.4% mean mortality rate). However, losartan

Language Analysis of Film: Directive Illocutionary Acts

Language Analysis of Film: Directive Illocutionary Acts BY MORTEN TYLDUM ABSTRACT This assignment is entitled A study of Directive Illocutionary Acts in Passengers Movie Script by Morten Tyldum. It is aimed at describing forms and meanings of Jims utterances based on Vandervekens theory by using descriptive method. In the collecting data, I follows three stages. Those are data selection, data collection, and data classification. The selection stage was done by searching the movie script as the data source, the data collection covers collecting the data from Jims utterances in the movie script, and the data classification includes gathering Jims utterances which contain Directive Illocutionary Act. In analyzing the data, I follows several stages. They are: founding categorizing, describing, and qualifying the utterances found in the data. CHAPTER 1 INTRODUCTION Background of the Study Language is used as a means of communication where people use it as a tool to express their ideas and wishes. According to Ramelan (1991: 8), Language can help man to express his ideas and wishes to another such as when he needs some helps, so that close relationship among members of the group can be carried out. All human beings use language to interact with other members of the same speech community. It can be said that language plays an important role as a means of communication. According to Chaer Augustin (2004: 17), Communication is a process by which information is exchanged between individuals through a common system of symbol, sign or behavior. Therefore, language is an important tool in communication process: participant (at least two people or a group), topic (what is talking about), and means of communication (symbol, sign, etc.). Speech acts is the study of the meaning and the function of an utterance. The speech is used to clarify what the speaker does. Austin (1965: 108) in his book How to Do Things with Words, mention three types of speech acts; they are Locutionary Act, Illocutionary Act, and Perlocutionary Act. The Locutionary Act refers to the referential or factual meaning of the sentence: that is the literal meaning of the actual words. When we say,Im hungry, this utterance refers to the condition of the speaker which is hungry with no intention of ordering the hearer to give the speaker some food. The Illocutionary Act refers to the speakers intention in uttering the words (such as a request to close the door, or an offer of something). When we say, its very hot here, the speaker has some intention to order the hearer to open the window or to turn on the air conditioner. The Perlocutionary Act refers to the effect this utterance has on the thoughts or actions of the other person such as someone actually closing the door or helping them to the food. When we say, there is snake next to you! this sentence brings an effect to the hearer like screaming or running. This sentence has perlocutionary effect to the hearer. Movie script is a means of communication for an artist or a script writer to express their ideas. It can be in the form of written language. In spoken language, utterance makes the movie very clear. In addition, the utterance of speech act also describes or tells the viewers what the actors do in the movie. The object of this research is a movie entitled Passengers. I analyze this movie because in a movie I find out many Directive Illocutionary Acts in its script as well as to know the meaning of the utterance used in Illocutionary Act, because movie closer in daily conversation appeals of interview and talk show. 1.2 Statement of the Problem The problem of this study can be stated as follows: What the Directive Illocutionary Acts are found in the Passengers movie script? What are the meanings of the Illocutionary Acts the Passengers movie script? 1.3 Scope of the Study This study is focuses on the Illocutionary Act especially Directive Illocutionary Act in Jims utterances as the first character in the movie Passengers. In analyzing the Directive Illocutionary Act I use theory of Illocutionary Forces by Vanderveken. Objective of the Study The objectives of the study are: To identify Directive Illocutionary Acts in the Passengers movie script. To describe the meanings of utterance in Illocutionary Force found in the Passengers movie script.   CHAPTER II RESEARCH METHOD Research Design Based on the problem analysis, this research uses descriptive research because it is aimed to identify the kinds of speech, especially Directive Speech Act. According to Isaac and Michael (1987: 18), descriptive method is the method purpose is to describe systematically the facts and characteristics of a given population or area of interest, factually and accurately. About this kind of research, Mardalis (1989: 26) says that, descriptive research does not test a hypothesis or use a hypothesis; it merely describes information according to variables that are observed. By using descriptive method, this study identifies the kinds of Illocutionary Act focusing on Directive Speech Act and their functions. This study took the data from the movie script Passengers by Morten Tyldum. Unit of Analysis The unit of analysis of this study is all utterances in Passengers movie script. Source of Data I took the data from the movie script Passengers by Morten Tyldum as the source of the data. The data of this study were taken from the internet website www.dailyscript.com. Technique of Data Collection In the methodology of collecting the data, I used documentation method. Documentation method is looking for the data about things or variables which are in the form of notes, transcription, book, newspaper, magazine, leafs etc. (Arikunto, 2002: 206). I used the movie script to collect the data. In this research, I get the data through some phases. First, I search for the Passengers movie script in the internet. Second, I watch the Passengers movie to comprehend the utterances. Third, I collect the data from the movie script that contains Directive Speech Act. Finally, I select the speakers utterances that contain Directive Speech Act. Technique of Data Analysis The techniques of data analysis are as follows: Finding the Speakers utterances in the form of Directive Illocutionary Act. Categorizing the speakers utterances based on the function of Directive Illocutionary Act such as asking, requesting, begging, and commanding. Describing the meaning in the utterances of Passengers Movie Scripts. Qualifying the utterances that contain directive speech acts. CHAPTER III DATA ANALYSIS The Directive Illocutionary Acts in Jims Utterances There are 16 utterances containing Directive Illocutionary Acts. Those are Asking (6), Commanding (3), Suggesting (2), Requesting (2), Adjuring (1), Begging (1) Forbidding (1). The Directive Illocutionary Acts found in the Passengers Movie Script is presented in the following table: Table 3.1 No. Directive Illocutionary Amount Percentage (%) 1 Asking 6 37,5 % 2 Commanding 3 18,75% 3 Requesting 2 12, 5% 4 Suggesting 2 12,5% 5 Begging 1 6, 25% 6 Adjuring 1 6, 25% 7 Forbidding 1 3, 25% TOTAL 16 100% From the table above, it can be seen that Asking is the most often Directive Illocutionary Act used by Jim. Jim likes to ask someone who is related with his business for the sake of himself. The Meaning of Jims Utterances There are seven Directive Illocutionary Act used by Jim. The following sub chapter describe Directive Illocutionary Act what Jims meant by using those seventh. 3.2.1 Asking There are 6 Asking Directive Illocutionary Acts that are found in Jims utterances. Excerpt. 1 Speech event: Jane is waiting in the spacecratf, making no attempt to hide. Jim: Joost. Jane: Long time, mate. Jim: Hows Alice? Jane: Well, thanks. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Jane) about condition. The mode of achievement of the utterance is that the hearer (Jane) can give the answer of the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks to the hearer (Jane) to answer the Alices condition as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Jane) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really hopes that the hearer (Jane) can explain How Alice is condition now. The degree of strength of the utterance shows that the speakers (Jim) seriousness to get the explanation from the hearer (Jane). Excerpt. 2 Jim: Tim must be in college. Jane: Big kids, big problem you know. Jim: Companys doing well? Jane: Cant complain. Eleven wars on the continent, business is brisk. (Looks at him) Speech event: Heard you had a bit of trouble in the bush. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of Illocution of the utterance is that the speaker (Jim) asks the hearer (Jane) about something (the condition of company). The mode of achievement of the utterance is that the hearer (Jane) can give explanation to the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks the hearer (Jane) to explain their companys condition as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Jane) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really asks and really hopes the hearer (Jane) to explain the condition of their company. The degree of strength of the utterance shows that Jim just needs the answer from Jane it shows Jims seriousness to get the explanation from Jane. Excerpt. 3 Speech event: When Jim talks with the bartender, suddenly Fawaz approaches him. He is a nervous wreck. Fawaz: Oh, my God, are you all right? Jim: Wheres the farmer? Fawaz: He found a job at a hotel. Spends all his time at the refugee offices. Not exactly the behavior of a man in possession of a priceless stone. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Fawaz) about something (the existence of someone). The mode of achievement of the utterance is that the hearer (Fawaz) can give the answer of the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks to the hearer (Fawaz) to answer the existences of someone as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Fawaz) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really hopes that the hearer (Fawaz) can explain where is the farmer now. The degree of strength of the utterance shows that the speakers (Jim) seriousness to get the explanation from the hearer (Fawaz). Excerpt. 4 Speech event: Jim lights a cigarette. Aurora appears and stands quietly beside him. Together they watch the distant explosions. Auora : I didnt actually hurt your feelings? Speech event: He takes a long drag. Exhales. Jim : How long you been in Africa? Auora : Four months. Before that Kosovo. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Auora) about something (the time that she leaves). The mode of achievement of the utterance is that the hearer (Auora) can give the answer of the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks to the hearer (Auora) to answer the time that she leaves as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Auora) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really hopes that the hearer (Auora) can answer how long she leaves in Africa. The degree of strength of the utterance shows that the speakers (Jim) seriousness to get the answer from the hearer (Auora). Excerpt. 5 Speech event: Auora is waiting as Jim walks back. Jim: How is he? Auora: They say hell live. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Auora) about the condition. The mode of achievement of the utterance is that the hearer (Auora) can give the answer of the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks to the hearer (Auora) to answer the soldier condition as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Aurora) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really hopes that the hearer (Aurora) can explain How is the soldier now. The degree of strength of the utterance shows that the speakers (Jim) seriousness to get the explanation from the hearer (Aurora). Excerpt. 6 Speech event: They have been walking for twelve hours. Jim has to sit. Jim: How much farther- -? Solomon: One day more. Speech event: He kneels before Jim. The Directive Illocutionary Act is asking and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Solomon) about something (the time). The mode of achievement of the utterance is that the hearer (Solomon) can give the answer of the speakers (Jim) question. The propositional content of the utterance shows that the speaker (Jim) asks to the hearer (Solomon) to answer the time that he reached as the answer of his question. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Solomon) can answer his question. The sincerity condition of the utterance is that the speaker (Jim) really hopes that the hearer (Solomon) can answer how much farther the place that their reached. The degree of strength of the utterance shows that the speakers (Jim) seriousness to get the answer from the hearer (Solomon). 3.2.2 Commanding There are 3 Commanding Directive Illocutionary Acts that are found in Jims utterances and here is the analysis Excerpt. 7 Speech event: Three cut down trucks of Rebels SQUEAL into view and begin spraying everything with automatic weapons. Jim: Yes or no? Speech event: A whole life can change with a single syllable. Solomon: Yes. Speech event: A truck comes careening around the corner. Jim pushes Solomon as the wall behind them is stitched with bullets. Jim: Go. Go!! Speech event: They begin to run. The Directive Illocutionary Act is commanding and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Solomon) to do something (to run). The mode of achievement of the utterance is shows that the hearer (Solomon) can give the respond to the speakers (Jim) wants. The propositional content of the utterance shows that the speaker (Jim) is commanding to the hearer (Solomon) for getting what he wants (to run). The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Solomon) can respond his command. The sincerity of condition of the utterance is that the speaker (Jim) really hopes to the hearer (Solomon) can achieve his command. The degree of strength of the utterance is shows the speakers (Jim) seriousness to get respond from the hearer (Solomon). Excerpt. 8 Speech event: Jim seizes the moment sending an OPEN-HAND STRIKE to the throat of his would-be executioner, then grabbing the AK-47, and shooting him before ripping the gun out of his hands. Jim : STAY DOWN!! Speech event: Solomon remains flattened behind the tree stump, head down. The Directive Illocutionary Act is commanding and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Solomon) to do something (to stay down). The mode of achievement of the utterance is shows that the hearer (Solomon) can give the respond to the speakers (Jim) wants. The propositional content of the utterance shows that the speaker (Jim) is commanding to the hearer (Solomon) for getting what he wants. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Solomon) can respond his command. The sincerity of condition of the utterance is that the speaker (Jim) really hopes to the hearer (Solomon) can achieve his command. The degree of strength of the utterance is shows the speakers (Jim) seriousness to get respond from the hearer (Solomon). Excerpt. 9 Speech event: Behind them, the jungle erupts with gunfire Solomon throws Dia to the ground. Jim takes cover four mercenaries are advancing. Jim Return Fire, hitting two. The others hit the ground. Jim : MOVE, MOVE, MOVE!!! Speech event: He shoves Solomon and Dia to their feet. The Directive Illocutionary Act is commanding and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) asks to the hearer (Solomon and Dia) to do something (to Move). The mode of achievement of the utterance is shows that the hearer (Solomon and Dia) can gives the respond to the speakers (Jim) wants (to move). The propositional content of the utterance shows that the speaker (Jim) is commanding to the hearer (Solomon and Dia) for getting what he wants. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Solomon and Dia) can respond his command. The sincerity of condition of the utterance is that the speaker (Jim) really hopes to the hearer (Solomon and Dia) can achieve his command. The degree of strength of the utterance is shows the speakers (Jim) seriousness to get respond from the hearer (Solomon and Dia). 3.2.3 Requesting There are 2 requesting Directive Illocutionary Acts that are found in Jims utterances and here are the analysis: Excerpt. 10 Speech event: Jim has already begun heading toward Aurora. She sees him coming and watches him walk toward her. They meet in the middle of a crowded dance floor. All around them, sweaty bodies are swaying to the African beat. Aurora : I supposed to kiss you or fuck you? I cant remember. Jim : How about you dance with me? Aurora : Should I ask what happened to your face? Speech event: He takes her hand and leads her into the surging crowd. Aurora : I guess not. Speech event: They dance as best they can in the crush. The Directive Illocutionary Act is requesting and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) request to the hearer (Aurora) to do something (to dance together). The mode of achievement of the utterance is that the hearer (Aurora) can gives the speaker (Jim) permission to dance. The propositional content of the utterance shows that the speaker (Jim) request to the hearer (Aurora) to dance together. The preparatory condition of the utterance is that the speaker (Jim) believes that the hearer (Aurora) can meet his request. The sincerity condition of the utterance shows that Jim really hopes that Aurora wants to dance with him. The degree of strength of the utterance show Jims seriousness to asks for Auroras permission. Excerpt. 11 Speech event: Jim smiles Auora: Its a world phone, by the way. Jim: You should get on the plane. Aurora: So should you? Speech event: He smiles and turns away. Aurora: are you going to call me? Jim: soon as Im near a phone. Aurora: Yeah, right. The Directive Illocutionary Act is requesting and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) wants the hearer (Aurora) to do something. The mode of achievement of the utterance is that the hearer (Aurora) can give the speaker (Jim) wants. The propositional content of the utterance shows that the speaker (Jim) asks the hearer (Aurora) to get on the plane. The preparatory condition of the utterance is that Jim believes that Aurora can do his request. The sincerity condition of the utterance shows that Jim really hopes that Aurora will get on the plane. The degree of strength of the utterance shows Jim s seriousness to ask for Aurora to get on the plane. 3.2.4 Suggesting There are 2 Suggesting Directive Illocutionary Acts that are found in Jims utterances and here is the analysis: Excerpt. 12 Speech event: The troop leader takes out knife and cut into the stitches. The goat squeals a little and kicks angrily. From under the goats skin, he takes a dozen small, rough DIAMONDS. The troop leader draws his .45 on Jim. Troop Leader: You are under arrest for smuggling. Jim: Now you listen here, my man. I am a good friend of Minister Somora. He will not be pleased you have interfered with his business. Speech event: Clearly the name of Minister Samora carries some weight. Jim (contd): You know who I am, dont you? What I am? I dont think you want to mess with me. or my friends, eh? (changes his tack) How about I just look the other way and you pocket one or two of those stone. Buy something nice for the wife. Or maybe the mistress, eh? (Re the shepherds) Whos going to tell? Them? Speech event: The shepherds look, uncertain, from Jim to the Soldier. Troop Leader: No. The Directive Illocutionary Act is suggesting and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) suggest to the hearer (Troop Leader) to do something (to do suggestion). The mode of achievement of the utterance is shows that the speaker (Jim) gives the option to refuse or receive to the hearer (Troop Leader) can not achieve the speakers (Jim) wants. The propositional content of the utterance is that the happiness acts to the hearer (Troop Leader). The speakers (Jim) suggest the hearer to pocket the stone and buy something nice for his wife. The preparatory condition of the utterance is shows that the speaker (Jim) believes that the hearer (Troop Leader) can achieve his request. The sincerity of condition of the utterance shows that the speaker (Jim) really hopes to the hearer (Troop Leader) can achieve his request. The degree of strength of the utterance is shows the speakers (Jim) seriousness to the hearer (Troop Leader) in order to receive his suggestion. Excerpt. 13 Speech event: Jim and Aurora has been talked about himself. Aurora : Somehow I dont take you as the UNICEF type. Speech event: Jim just smiles. Aurora (contd): I was going to say soldier-of- fortune but its such a clichà ©. Jim: How about hired gun. People seem to like that one. Aurora: Diamonds? Jim: what if I told you I was a missionary. Aurora: (Laugh) For Dewente? Jim: Its not just rude to ask those kinds of questions, Ms. Bowen, its also dangerous. Aurora: Ill take my chances.(leans closer) Sotell me about blood diamonds. Speech event: And then, suddenly, Jim gets it. His face turns to stone. The Directive Illocutionary Act is suggesting and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) suggest to the hearer (Aurora) about something. The mode of achievement of the utterance is shows that the speaker (Jim) gives the option to refuse or receive to the hearer (Aurora) can not achieve the speakers (Jim) wants. The propositional content of the utterance shows that the speakers (Jim) suggest the hearer (Aurora) to doing what he wants. The preparatory condition of the utterance is shows that the speaker (Jim) believes that the hearer (Aurora) can achieve his request. The sincerity of condition of the utterance shows that the speaker (Jim) really hopes to the hearer (Aurora) can achieve his request. The degree of strength of the utterance is shows the speakers (Jim) seriousness to the hearer (Aurora) in order to receive his suggestion. 3.2.5 Begging There are 1 Begging Directive Illocutionary Acts that are found in Jims utterances and here is the analysis: Excerpt. 14 Speech event: Looks over at Solomon who has his arm protectively around Dia. The boy looks like the same innocent child he once was. Jim: Take your boy home. Speech event: Solomon looks back at him, tears in his eyes. He nods. In deep and simple gratitude. Jim nods back. Then Jim: Help me. Speech event: He struggles to pick up the machine gun. Solomon puts it into his hands. Jim: Put the strapover my shoulder. Speech event: Solomon helps secure it in place. The Directive Illocutionary Act is Begging and the meanings of the utterance are: The point of illocution of the utterance is that the speaker (Jim) begs the hearer (Solomon) to do something (to take his boy). The mode of achievement of the utterance is shows that the speaker (Jim) wants the hearer (Solomon) to take his boy home. The propositional content of the utterance shows that the speaker (Jim) is begging to the hearer (Solomon) for getting what he wants. The preparatory condition of the utterance is shows that the speaker (Jim) is begging to the hearer (Solomon) as the effect of his need. The sincerity condition of the utterance shows that the speaker (Jim) is sincere in begging to the hearer (Solomon) because the speaker (Jim) really wants something to the hearer. The degree of strength of the utterance is increasing the speaker (Jim) shows that he really means it in begging to the hearer. 3.2.6 Adjuring There are 1 Adjuring Directive Illocutionary Acts that are found in Jims utterances and here is the analysis: Excerpt. 15 Speech event: The sound of gunfire ECOMOG troops have seen something in the tree-line and have begun exchanging fire. Jim : Hurry it up, folks! Unless you want to end up the same way! Speech event: Solomon cant move, just stares at the boy and mother. The Directive Illocutionary Act is Adjuring and the meanings of the utte Development of the Christian Personality: Theories Development of the Christian Personality: Theories Christian Personality Development: From the Womb to the Tomb Michelle L. Stelly Abstract Research done using various peer-reviewed journal articles, a theory of personality based on Christianity is proposed. Research has shown that all development, including personality, is influenced even prior to conception based on how the future mother takes care of herself prior to implantation. It is necessary for expectant mothers to keep their stress, anxiety and depression at a minimum not just for their own health but the future mental health of their unborn child. It is the parent(s) duty to nurture all facets of the child all the way through adolescence, as prescribed by the Bible. Physical health is equally as important to personality development as mental healthcare. People have times in life when they have an apparent shift in their personality and this is all a part of development. Many have speculated about why one person grew up to one way while another became another. Empirical studies of moral personality development will be continuous to show how using an integrative structure for examining personality can readily unite Christianity and psychology. Keywords: development, infant, mother, Bible, parents Christian Personality Development: From the Womb to the Tomb Personality develops over an entire lifespan and when done according to God’s plan life is much more enjoyable. Canonical correlation analysis showed that â€Å"more religious individuals are healthier in general, which might be supported at least circumstantially by the results reported here. It makes good sense that if people have both a spiritual and a natural essence that these dimensions would be interactive† (Simpson, Newman Fuqua, 2007). Integrating psychology with biblical studies, much like done at Liberty University, will provide guidance of God’s people according to His Word in developing healthy personalities. Foundations of Personality According to Feist, Feist, and Roberts (2013), there are differing definitions of personality and each is dependent upon the theorist’s part of the world, religious experiences, and many from their time as psychotherapists (pp. 3-4). In general, personality can be defined as â€Å"a pattern of relatively permanent traits and unique characteristics that give both consistency and individuality to a person’s behavior (Roberts Mroczek, 2008)† (Feist, Feist Roberts, 2013, p. 4). In a few ways we are all the same. We all have the same personal inclinations and share a basic nature of being. We all have physical bodies and personalities and we all have thoughts and feelings. Personality is made up of various traits and each arrangement is unalike for every individual. It comes from within the person and usually remains unchanged throughout life. Nature versus Nurture Nature and nurture are both important but not interchangeable. Biology plays a huge role in personality development. Nature is the first influence on personality development as it begins in a person’s DNA. Nurture takes place after birth and is impacted by a person’s environment. Hans J. Eysenck noted three findings as evidence that personality is 75% hereditary and 25% a result of environmental influences (Feist, Feist Roberts, 2013, p. 411). Eysenck noted that research done by Robert R. McCrae and Juri Allik regarding â€Å"the five-factor model of personality across cultures† done in 2002 showed nearly identical personality traits among persons in difference parts of the world such as Uganda, Russia, and Japan (Feist, Feist Roberts, 2013, p. 411). Another piece of evidence from Eysenck’s own 1990 study that showed a â€Å"higher concordance between identical twins than between same-gender fraternal twins reared together† which suggests that heredity plays a dominant role in determining personality differences (Feist, Feist Roberts, 2013, p. 411). Personality develops from birth on. There are certain aspects of human behavior that come from human nature. Humans have natural instincts to find nutritional sustenance, seek out love and affection, and ask for help with the things they cannot do for themselves. From birth until the beginning of school age, which varies from child to child but is usually around age four or five, caretakers may notice certain behavioral traits which may mimic a personality type but essentially no permanent type has yet been established. Starting around age five until around age eleven people begin to develop the dominant personality traits begin to form and it becomes apparent as to how the child learns, such as if they are auditory or visual learners and if they work well in groups on solitary. From around age twelve or thirteen, when they are entering adolescence, traits that support the dominant feature begin to appear: how they make decisions, what they value in life, and their perception of things. Starting around age twenty, adults start to learn how their personality traits fit in with the rest of the world. This becomes very apparent when peers become coworkers rather than fellow students. For some people, sometime between the ages of 35 and 50, people may hit what is called a â€Å"mid-life crisis† because they begin to see facets of their life that they did not develop and feel a strong desire to satisfy these. After around age 50, the personality is more disciplined that those of younger stages and this is usually due to life experiences. The Unconscious. Carl Jung stated â€Å"There are certain events of which we have not consciously taken note; they have remained, so to speak, below the threshold of conscious. They have happened, but they have been absorbed subliminally† (Mlodinow, 2012, p.5). Influences that we are not consciously cognizant of influence our actions. Dream content has been shown to be a reflection of people’s view on religion. Disagreeing with the normal thought that Christianity and science â€Å"inevitably conflict with each other, dreaming offers an area of potential religion–science convergence† (Bulkeley, 2009). View of Self. â€Å"Different aspects of the self emerge in different periods of the lifespan† (Klimstra, 2012). However, once new aspects of the self emerge, existing aspects do not finish growing. Therefore, it is important to consider several aspects of the self. Neuroscientists have performed studies using human brain mapping and have concluded that â€Å"People who endorse individualistic cultural values showed greater MPFC [medial prefrontal cortex] activation to general self-descriptions, whereas people who endorse collectivistic cultural values showed greater MPFC activation to contextual self-descriptions† (Chiao, Harada, Komeda, Li, Mano, Saito, Parrish, Sadato, Iidaka 2009). Personality types. The personality can be assessed using the Myers-Brigs Personality Type Indicator (based on the theories of Carl Jung). According to this instrument, there sixteen personality types made up of four criteria. (E)xtraversion versus (I)ntraverson give a clue of if the person is focused on the outside world or only their inner circles. How they process information by either by way of the five senses (S)ensing or if they look for patterns ntuition. People make decisions by either (T)hinking or by (F)eeling. Finally, the test also measures how people prefer to live in the outside world, structured which is called (J)udging or more flexible, (P)erceiving. An example of personality type would be INFJ who is described as Seek meaning and connection in ideas, relationships, and material possessions. Want to understand what motivates people and are insightful about others. Conscientious and committed to their firm values. Develop a clear vision about how best to serve the common good. Organized and decisive in implementing their vision (Briggs-Myers, 2013). Progression of Personality Although more research is needed, there has been a link found between depressive as well as anxiety disorders in the mother prior to conception and the onset of depressive disorders and more severe anxiety disorders (Martini, et al., 2013). Progression is expected to flow in a basic manner, beginning in infancy, and personality development progresses based on modeling of caregiver’s examples. By the time the person reaches school age, people begin to progress to the next stage of internalizing all they absorbed in early childhood. Progression to maturity is exhibited by awareness of not only the self but of others and how the two work together. Life has progresses to a deeper meaning. Once a person reaches the last stage of personality progression, development slows down and people become more passive. Dementia is something people fear because it represents personality changes, even at a mild stage, and this change is intimidating, especially to the elderly experiencing it. Motivation People are striving to accomplish self efficacy as a result of their behavior. They decide what they should strive for based upon what will allow for them to satisfy their basic needs for love and acceptance and this can often be caused by how they are taught to internalize as well as environmental factors such as a desire to move out of an impoverished neighborhood. A person is motivated by desiring a sense of security and a lack of pain. â€Å"Motivation at work is not always conditioned by external environment. However, it is more governed by internal worldones own orientation† (Sengupta, 2011). Classroom activity has been shown to have an impact on motivation as well. Students are motivated either by making the best grades possible or doing enough just to not fail. Self-motivation is probably the strongest form of motivation and this is seen in school aged children. People are motivated by control and whether they realize it or not by challenges. Curiosity is a huge motivator as well. Maturation. Maturity happens primarily in adolescence when a child develops a sense of self separate from their parental unit. There are differences between genders as to when this happens and overall girls mature earlier than boys (Klimstra, Hale, III, Raajimakers, Branje Meeus, 2009). Brain mapping had proven useful in this as well. â€Å"Early prefrontal cortex damage has been associated with developmental deficits in social adaptation, moral behavior, and empathy that alter the maturation of social cognition and social emotions† (Eslinger, Robinson-Long, Realmuto, Moll, deOlivera-Souza, Tovar-Moll, Wang, Yang, 2009). Situations that were ambiguously moral activated considerably more prefrontal lobe activity than did routine moral situations, suggesting the biological nature of personality maturation. The frontal polar stimulation does not change with age and the findings further endorse a substantial role for the medial prefrontal cortex in maturation of the moral decision making process. Personality develops greater maturity as the person ages but self-distinction decreases with age. Biblical Integration Many psychological viewpoints say that man cannot change his personality makeup because it is inbred through evolution. Christians know that personality can change because when they become saved they become a new being. The Holy Spirit is able to defy science and creates a Christian personality that exudes holiness, peace, and happiness. Christians have an advantage in personality development because when they see something not progressing to their liking, they can go to the scriptures to learn to deal with their sinfulness. While the Biblical canon does not go precisely into how each family unit is handled, it does give basic rules that empower one to discover what God expects of his followers. One such rule is prescribed in Luke 2:51, â€Å"And he went down with them, and came to Nazareth, and was subject unto them: but his mother kept all these sayings in her heart† (King James Version). The guideline in this section shows that folks are given the power to coordinate, guide, and instruct and their kids by God. If Jesus allowed himself to be guided and heeded the words of his earthly mother and father, then children today need to allow theirs to do the same because this is to be as He was, and that is what people should strive for. There is the issue of original sin where the sin of Adam and Even is passed on to even the current generation as their offspring. Before the person accepts Jesus Christ as their savior, it is much easier to fall into this sinful nature. Once salvation is received, there is no excuse because the person was to have changed. This affects personality because it creates the trait of hypocrisy. While people are still flesh and blood and cannot be perfect, the Bible gives a clear example of a model for personality development: Jesus Christ. It is crucial that parents involve their children in activities that glorify God. Youth have the right to need sensible direction from their parent(s) and that unit is called upon to nurture their kids. That is, to have their backs, to raise them correctly, in the chastening and admonition of the Lord as stated in Ephesians 6:4 (American Standard Version). That is to mean that parents are be imitators of God in the reprimanding or guidance given to children. It is rebuking or disciplining based upon affection and care that forms the personality once the child is out of the womb. Before then, a parent must keep the word close to them to bless the family unit even before it is conceptualized. Conclusion Personality development starts with the mother. Her mental state before and during her pregnancy and create certain personality traits within her child. Once the child is born, it is the parents God given right and duty to nurture that child in a way that is fitting to God’s path. The home situation, the parental interaction as well as the relationship the child has with the family’s church plays a role in the nurture portion of personality while the traits one picks up during personality development and self-actualization becomes their nature. When a child reaches school age they begin to separate themselves with their parents in that they develop their own identity. It is important that they still have a strong relationship with God because He is the only one that can keep an eye on them all day, every day. When a person reaches the age to move out of their family home and embark on life’s adventures, they are still developing. They are learning just how strong their legs are for them to stand on. It is important for parents not to pick them up every time the fall so that they learn to rely on Jesus. Even until death, the human personality is still evolving. People become more set in their ways as they get older and often grow to dislike the youth and the world around them. The only time the personality stops growing is when the person becomes a nonbeing, be it through disability, coma, or death. Only with such a sturdy footing can buoy the load of the weight of personality development. Without the Bible as a foundation, the edifice would simply breakdown. Through it all, it is imperative there is a strong foundation based on God’s principles. References Briggs-Myers, I. (2013). Retrieved from http://www.myersbriggs.org/my-mbti-personality-type/mbti-basics/the-16-mbti-types.asp Bulkeley, K. (2009). The religious content of dreams: A new scientific foundation. Pastoral Psychology, 58(2), 93-106. doi: 10.1007/s11089-008-0180-8 Chiao, J. Y., Harada, T., Komeda, H., Li, Z., Mano, Y., Saito, D., Parrish, T. B., Sadato, N., Iidaka, T. (2009). Neural basis of individualistic and collectivistic views of self. Human Brain Mapping, 30(9), 2813-2820. doi: 10.1002/hbm.20707 Eslinger, P., Robinson-Long, M., Realmuto, J., Moll, J., deOliveira-Souza, R., Tovar-Moll, F., Wang, J., Yang, Q. (2009). Developmental frontal lobe imaging in moral judgment: Arthur Bentons enduring influence 60 years later. Journal of Clinical and Experimental Neuropsychology, 31(2), 158-169. doi:10.1080/13803390802298064 Feist, J., Feist, G. J., Roberts, T. (2013). Theories of personality. (8 ed.). New York, NY: McGraw-Hill. Klimstra, T. A., Hale, III, W. W., Raajimakers, Q. A. W., Branje, S. J. T., Meeus, W. H. J. (2009). Maturation of personality in adolescence. Journal of Personality and Social Psychology, 96(4), 898-912. doi: 10.1037/a0014746 Klimstra, T. (2013). Adolescent Personality Development and Identity Formation. Child Development Perspectives, 7(2), 80-84.doi:10.1111/cdep.2013.7.issue-2 Martini, J., Wittich, J., Petzoldt, J., Winkel, S., Einsle, F., Siegert, J., Hofler, M., Beesdo-Baum, K., Wittchen, Hans-Ulrich. (2013). Maternal anxiety disorders prior to conception, psychopathology during pregnancy and early infants’ development: a prospective-longitudinal study. Archives of Women, 16(6), 549-560. doi: 10.1007/s00737-013-0376-5 Mlodinow, L. (2012). Subliminal: How your unconscious mind rules your behavior. (p. 5). New York, NY: Random House, Inc. Simpson, D. B., Newman, J. L., Fuqua, D. R. (2007). Spirituality and personality: Accumulating evidence. Journal of Psychology and Christianity, 26(1), 33-44. Retrieved from http://p2048-www.liberty.edu.ezproxy.liberty.edu:2048/login?url=http://search.proquest.com.ezproxy.liberty.edu:2048/docview/237251151?accountid=12085 Sengupta, S. S. (2011). Growth in human motivation: beyond Maslow. Indian Journal of Industrial Relations. , 41(1), 102. 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