An overview: Chikungunya fever

An overview: Chikungunya fever Introduction The derivation of chikungunya came from Tanzania, when there were reports of a dengue-like symptom outbreak in 1952-1953, in the Newala and Masasi Districts of the Southern Province. However, dengue was later excluded on the basis that this epidemic involved patients suffering from debilitating joint pains and shorter incubation period which are not clinical features of dengue. Consequently, the illness was called chikungunya; (Robinson 1955) a word from the Makonde dialect describing patients contorted posture (Lumsden 1955). Chikungunya is an arthropod borne virus (arbovirus) of the genus: Alphavirus from Togaviridae family. It is transmitted to humans mainly by day biting mosquito species Aedes aegypti and Aedes albopictus (Townson and Nathan 2008). Chikungunya virus (CHIKV) contains a positive-sense single stranded RNA genome, enclosed in an icosahedral nucleocapsid (combination of nucleic acid and capsid) all enclosed in a phospholipid bilayer envelope. Embedded in the envelope are multiple copies of two encoded glycoproteins E1 and E2, a small glycoprotein E3, and a hydrophobic peptide 6K (Strauss and Strauss 1994). History There were no previous reported cases of chikungunya or dengue in Tanzania before the chikungunya epidemic in 1952 1953 thus, the inhabitants were highly susceptible in acquiring CHIKV infections (Robinson 1955). Prescott et al, 2002 stated that herd immunity; that is, the immunity that is acquired by a large proportion of the population either through vaccination, or from previous infections, thereby rendering the population resistant to the spread of the diseases. Furthermore, other factors could have contributed to the epidemic including records of unusually high rainfall during February to May 1952. Consequently, this condition was thought to provide suitable breeding environment for the mosquitoes to expand their population, suggesting that the main vector of transmissions were mosquitoes (Lumsden 1955). However, not only high rainfall was implicated in enhancing mosquitoes breeding environment, but also water filled clay jars dug in the inhabitants huts floor in preparation fo r the drought season. Consequently, these jars are rarely completely emptied, which further enhanced mosquitoes populations. Another contributing factor to the epidemic could be the living conditions and lifestyles of the indigenous populations. Animals such as fowl, pigeons and occasionally goats were reared in the inhabitants huts. Consequently, these vertebrates could also serve as CHIKV hosts, and thus, this has provided opportunities for transmissions between animals and humans. During early January 1953, the incidence of the epidemic has reached its peak (Lumsden 1955). However, once a person has acquired the infection, that person will become immune to further infections with the same virus (Robinson 1955). Subsequently, this means that as herd immunity increases, the number of viraemic inhabitants decreases. Aim Consequently, it has inspired this literature review on chikungunya in assessing its outbreaks incidence and prevalence, its associations with dengue and the vectors. Furthermore, from this to determine if it poses a risk that Western medicine should be planning for. Clinical Features Chikungunya has a viraemic incubation period of 3-12 days (Robinson 1955). Rezza et al. (2007) described chikungunya as a mild and self limited disease in most of the patients. with patients presenting with clinical features such as fever ranging from 39-39.8oC, fatigue, skin rash (sometimes itches), headache, joint pain (arthalgia), muscle pain (myalgia), diarrhoea, vomiting, photophobia, and conjunctivitis. Furthermore, Kannan et al. (2009) observed most of the above symptoms with inclusion of oedema, oral ulcers, nausea, and haemorrhage. Arthalgia and myalgia involves extremities such as wrists, ankles, hands, feet and phalanges. However, arthalgia, myalgia, oedema, lethargy, and weakness persisted even after fever had subsided (Kannan et al. 2009). However, the La Reunion outbreak observed vertical transmissions from mother to child, with newborns presenting with chikungunya infection without prior involvement of mosquitoes. These infants presented with fever, pain, poor feeding, disseminated intravascular coagulation (DIC), petechiae, distal joint oedema, and thrombocytopenia. Also involved were severe neonatal infections including encephalitis and haemorrhagic fever. Furthermore, there were cases whereby transient brain haemorrhages were complicated by the presence of DIC (Gà ©rardin et al. 2008). Table 1: represents different clinical features that were associated with chikungunya infection during several outbreaks. Clinical Features associated with Chikungunya Most common Joint pain (96.6%) Fever Fever Fever Fever (96.3%) Joint pain Joint pain Arthalgia Headache (71.2%) Arthritis Fatigue Myalgia Muscle pain (62.6%) Myalgia Skin rash Headache Cutaneous eruptions (32.5%) Arthralgia Headache Anorexia Headache Muscle pain Nausea Rash Diarrhoea Itch/ Rash Sore throat Itch/ Rash Oedema Vomiting Oral ulcer Photophobia Eye pain Conjunctivitis Vomiting Eye congestion Least common Haemorrhage Reference Renault et al. 2007 Yosulf et al. 2008 Kannan et al. 2009 Distribution of Chikungunya The World Health Organisation (WHO) alerted the Global Alert and Response Network in March 2005, of an impending outbreak of chikungunya fever in the Comoro Islands. It was the first Southwestern Indian Ocean islands to be implicated in the epidemic, subsequently; other countries were later implicated in this epidemic. The emergence of the epidemic in Mayotte was imported from Grande-Comore by mid-April and by the end of April Mauritius was also implicated. Overall, the Southwestern Indian Ocean region was believed to be afflicted by the first emergence of CHIKV (Renault et al. 2007). In April 2005, a chikungunya infection which started in Grande-Comorre was imported into La Reunion (French Overseas Territory), became its first severe reported case, in March 2004 to April 2005. It resulted in the establishment of a wide operational epidemiologic surveillance system by the islands local authority with the following objectives monitor epidemic trends, characterise cases and detect new transmission clusters to provide orientations for prevention and vector control. Unfortunately, the collection of data was not conducted scientifically, as the figures of reported cases were not scientifically correlated (Renault et al. 2007). Moreover, there were also flaws in the correlation of the epidemic curve as the capacity of the surveillance system was not sufficient to evaluate the number of cases. Consequently, this resulted in an underestimated number of reported cases. (Renault et al. 2007). Approximately 3% cases did not correspond with the criteria defining suspected cas es as an abrupt onset of fever >38.5oC accompanied by debilitating joint pain. However, Renault et al. (2007) argued that these were mainly due to some atypical cases that were confirmed by laboratory testing and also due to errors in reporting cases. Moreover, there could have been misdiagnosis of chikungunya infection as not all of the atypical cases were laboratory confirmed; and also the previous year there were outbreak of dengue. By April 2006, 203 deaths which were either directly or indirectly attributed to chikungunya infection with the mortality rate of 0.3/1000 people with a median age of 79. Consequently, the number of deaths was minimal. Moreover, the low immune status of the individual as indicated by the age could have been a contributing factor to the death, as some of these individuals were presented with other underlying conditions. However, direct association between death and infection was not confirmed due to the absence of autopsies, consequently; this made it difficult to assess the extent chikungunya virus had on death. Mayotte, an island of the Comoros archipelago was involved in the first CHIKV outbreak in April 2005 to July 2006 affecting approximately 6346 residents. The outbreak involved two waves, with peak occurring in the second wave aroIn the Maldives, an outbreak occurred during December 2006 to April 2007 with 11879 confirmed and suspected cases. Out of the 197 inhabited Maldives islands 121 islands reported CHIKV. The epidemic was thought to be associated with unusually high rainfall from October 2006 to March 2007 and post tsunami construction activities which provided breeding sites for mosquitoes. (Yoosuf et al. 2008). On the east coast of Madagascar, in Toamasina, Chikungunya virus and Dengue type 1 virus outbreak were reported during January to March 2006. The study involved interrogating 4,242 residents in 27 neighbourhoods, of which 2,863 were suspected cases and of these 44 were hospitalised cases. 55 patients serum were sampled after passing the criteria which included having less than five days of fever as well as three of these symptoms: headache, myalgia, arthralgia, retroorbital pain or rash. The results included 24 dengue patients, 4 chikungunya and 10 co-infections. As the study was only based on clinical investigations, and only a few samples were analysed, there were insufficient investigation to measure the Chikungunyas and Dengues contributions in the 2 peaks of the epidemic curve. Furthermore, 2 of the 24 Dengue patients had IgM Chikungunya virus. This could be caused by false positive or false negative results, resulting in misdiagnosis or they were in fact co-infections (Ratsitor ahina et al. 2008). The cases represented on the map are either confirmed cases or suspected cases. Reference: 1 Krastinova et al. 2006, 2 Rezza et al. 2007, 3 Pastorino et al. 2004, 4 Sissoko et al. 2008, 5 Lumsden 1955, 6 Tamburro and Depertat 2009, 7 CDC 2009, 8 WHO 2008, 9 Yoosuf et al. 2009. Transmission of CHIKV CHIKV requires an invertebrate and vertebrate host in order to complete its replication cycle (Pardigon 2009). Invertebrate hosts also known as definitive hosts are mainly the Aedes mosquito species. The Aedes mosquito becomes infected subsequent to ingesting viraemic blood meal from infected vertebrate hosts. The blood meal containing CHIKV travel to the gut, there CHIKV undergo replication within the gut wall. Subsequently, CHIKV contain mechanisms permitting its penetration into the mosquitoes tissues. From there, it passes through either the bloodstream or by other methods (not well known) to different sites of the body such as the salivary glands where it undergoes further replication. Extrinsic incubation period (EIP) is defined as the time taken for the vector to transmit CHIKV after ingesting a viraemic blood meal. Subsequently, there are factors that could influence the length of the EIP including temperature which increases when the EIP decreases. This is thought to be an i nverse proportional relationship. Moreover, the quantity of viraemic blood ingested is another factor (Cook and Zumla 2009). Furthermore, Ross (1956) research demonstrated that a mosquito could harbour viral particles for up to 30 days. Gould and Higgs (2009) suggested that vertical transmission of CHIKV from infected mosquitoes result in infected mosquitoes eggs. These eggs, due to their dessicated nature, are able to survive for long period of time in the environment where it hatches during the rainy season. Sylvatic transmission cycle involves vertebrate hosts such as primates, birds, and rodents which serve as natural hosts (Pardigon 2009). However, humans were considered accidental hosts, resulting in urban transmission cycles producing epidemics. After taking a viraemic bloodmeal from an infected human the domestic mosquitoes can also become infected thereby contributing to the outbreaks (Gould and Higgs 2009). Distributions of Aedes albopictus and Aedes aegypti The main vectors of chikungunya are Aedes aegypti and Aedes albopictus. The vector involved in the 2005/2006 Mayotte outbreak was Aedes albopictus which resided locally on the island (Sissoko et al. 2008). Aedes albopictus was involved in the 2006 Dengue fever and Chikungunya outbreak in Madagascar. The mosquito was found in drums, buckets, coconut shells, discarded cans, pots wet containers and tyres (Ratsitorahina et al. 2008). In the 2007 Italian outbreak, the only vector present was Aedes albopictus (Rezza et al. 2007). The main vector associated with recent outbreaks was Aedes albopictus. Effect of climate change Most of the cases occurred after reports of high rainfall. Association with Dengue Fever and Malaria In the 1999-2000 Democratric Republic of Congo outbreak, patients had acquired simultaneous CHIKV and Plasmodium falciparum infection. However, there were not sufficient evidence to prove co-infection between the two but it was assumed by the authors that it was probable (Pastorino et al. 2004). Compared to CHIKV, dengue virus is of the genus Flavirivirus from Flaviridae family and contains 4 serotypes (Dayal-Drager 2004 cited by Seyler et al. 2009). The 2006 Madagascar outbreak showed that the mosquito can harbour both Chikungunya and dengue virus (Ratsitorahina et al. 2008). CHIKV is often masked by dengue fever due to similar clinical features. Consequently, a study by Vazeille et al. (2008) demonstrated that Aedes aegypti has a higher susceptibility in Dengue 2 virus and a lower susceptibility to CHIKV. Moreover, studies by Vazeille et al. (2008) and Moutailler et al. (2009) demonstrated that Aedes albopictus are more effiecient at harbouring CHIKV than dengue 2 virus. Importation into Europe France Between March 2005 to August 2006, 80 visitors from Chikungunya infected countries in the Southwest Indian Ocean region (La Reunion, Mauritius, Mayotte, Comoros and India) confirmed chikungunya infection at Pitià ©-Salpà ªtrià ¨ne Hospital in Paris, France (Hochedez et al. 2007). Italy In 2007, a massive CHIKV outbreak occurred in the Emilia Romagna region in northeastern Italy. There were 205 identified cases with frebile illness reported in Castiglione di Cervia and Castiglione di Ravenna villages (171) separated by the river in Revana province, and Cervia (13) and other villages (21), between July 4 to September 27. The epidemic was believed to be imported from Kerala, India (CHIKV epidemic infested area) by a man, who after two days of his arrival in Castiglione di Cervia developed frebile illness. The majority of the cases were the elderly (median age 60) representing increased incidence with age. Aedes albopictus which causes Chikungunya was also found in the area of the epidemic which further propagated the virus. Positive CHIKV sequences were detected in 90 captured Aedes albopictus mosquitoes from Castiglione di Cervia and 125 from Castiglione di Ravenna. Most cases occurred in Castiglione di Cervia and Castiglione di Ravenna Villages with peak incidence d uring third week of August. The 13 Cervia cases were local transmission introduced from Castiglione through migration (Rezza et al. 2007). Other European Countries Due to travelling, several European countries have encountered CHIKV from viraemic travellers from epidemic countries (Panning et al. 2008). The study was conducted at the Bernhard-Nocht Institute for Tropical Medicine in Hamburg, Germany involved 680 patients. References Beran, G. W. (1994) Handbook of zoonoses. Section B: Viral. 2nd Edition. CRC Press LLC: Florida. CDC. (2009) Outbreak notice. Chikungunya in Asia and the Indian Ocean. http://wwwnc.cdc.gov/travel/content/outbreak-notice/chikungunya-fever.aspx. Accessed on 28th January 2010. CDC. (2008) Chikungunya Transmission http://www.cdc.gov/ncidod/dvbid/Chikungunya/CH_Transmission.html Downloaded on 8th December 2009. Cook, G. C., Zumla, A. I. (2009) Mansons Tropical Diseases. 22nd Edition. Saunders: China. Gà ©rardin, P., Barau, G., Michault, A., Bintner, M., Randrianaivo, H., Choker, G., Lenglet, Y., Touret, Y., Bouveret, A., Grivard, P., Le Roux, K., Blanc, S., Schuffenecker, I., Couderc, T., Arenzana-Seisdedos, F., Lecuit, M., Robillard, P-Y. (2008) Multidisciplinary Prospective Study of Mother-to-Child Chikungunya virus Infections on the Island of La Rà ©union. PLoS Medicine, 5(3), 413-423. Gould, E. A., Higgs, S. (2009) Impact of climate change and other factors on emerging arbovirus diseases. Transactions of the Royal Society of Tropical Medicine and Hygiene. 103(2), 109-121. Hochedez, P., Hausfater, P., Jaureguiberry, S., Gay, F., Datry, A., Danis, M., Bricaire, F., Bossi, P. (2007) Cases of Chikungunya Fever Imported from the Islands of the Southwest Indian Ocean to Paris, France. Eurosurveillance. 12(1-3). Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=679LanguageId=2. Accessed date: 12th November 2009. Kannan, M., Rajendran, R., Sunish, I. P., Balasubramaniam, R., Arunachalam, N., Paramasivan, R., Tewari, S. C., Philip, Samuel, P., Tyagi, B. K. (2009) A study on chikungunya outbreak during 2007 in Kerala, south India. Indian Journal of Medical Research. 129,(3), 311-315. Krastinova, E., Quatresous, I., Tarantola, A. (2006) Imported cases of chikungunya in metropolitan France. Eurosurveillance, 34(11). Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=3030. Accessed on: 28th January 2010. Lumsden, W. H. R. (1955) An Epidemic of Virus Disease in Southern Province, Tanganyika Territory, in 1952-53 II. General Description and Epidemiology. Transaction of the Royal Society of Tropical Medicine and Hgeine. 49(1), 33-57. Moutailler, S., Barre, H., Vazielle, M., Failloux, A-B. (2009) Recently introduced Aedes albopictus in Corsica is competent to Chikungunya virus and in a lesser extent to dengue virus. Tropical Medicine and International Health. 14(9), 1105-1109. Panning, M., Grywna, K., Van Esbroeck, M., Emmerich, P., Drosten, C. (2008) Chikungunya Fever in Travellers Returning to Europe from the Indian Ocean Region, 2006. Emerging Infectious Diseases. 14(3), 416-422. Paquet, C., Quatresous, I., Solet, J.-L., Sissoko, D., Renault, P., Pierre, V., Cordel, H., Lassalle, C., Thiria, J., Zeller, H., Schuffnecker, I. (2006) Chikungunya outbreak In Rà ©union: epidemiology and surveillance, 2005 to early January 2006. Eurosurveillance. 11(5). Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2891. Accessed on: 12th November 2009. Pardigon, N. (2009) The biology of chikungunya: A brief review of what we still do not know. Pathologie Biologie. 57(2), 127-132. Pastorino, B., Muyembe-Tamfum, J.J., Bessaud, M., Tock, F., Tolou, H., Durand, J.P., Peyrefitte, C.N. (2004) Epidemic Resurgence of Chikungunya Virus in Democratic Republic of the Congo: Identification of the New Central African Strain. Journal of Medical Virology 74(2), 277-282. Pialoux, G., Gaà ¼zà ¨re, B.-A., Jaurà ©guiberry, S., Strobel, M. (2007) Chikungunya, an epidemic arbovirosis. Lancet Infectious Diseases 7(5), 319-327. Prescott, L.M., Harley, J.P., Klein, D.A. (2002) Microbiology. Fifth Edition. Boston; London : McGraw-Hill. Ratsitorahina, M., Harisoa, J., Ratovonjato, J., Biacabe, S., Reynes, J.-M., Zeller, H., Raoelina, Y., Talarmin, A., Richard, V., Soares, J.-L. (2008) Outbreak of Dengue and Chikungunya Fevers, Toamasina, Madagascar, 2006. Emerging Infectious Diseases 14(7), 1135-1137. Renault, P., Solet, J.-L., Sissoko, D., Balleydier, E., Larrieu, S., Filleul, L., Lassalle, C., Thiria, J., Rachou, E., De Valk, H., Ilef, D., Ledrans, M., Quatresous, I., Quenel, P., Pierre, V. (2007) A major epidemic of chikungunya virus infection on Reunion Island, France, 2005-2006. American Journal of Tropical Medicine and Hygiene 77(4), 727-731. Rezza, G., Nicoletti, L., Angelini, R., Romi, R., Finarelli, A.C., Panning, M., Cordioli, P., Fortuna, C., Boros, S., Magurano, F., Silvi, G., Angelini, P., Dottori, M., Ciufolini, M.G., Majori, G. C., Cassone, A. (2007) Infection with chikungunya virus in Italy: an outbreak in a temperate region. Lancet. 370(9602), 1840-1846. Robinson, M.C. (1952) An epidemic of virus disease in Southern Province, Tanganyika Territory, in 1952-1953. I Clinical features. Transactions of the Royal Society of Tropical Medicine and Hygiene. 49(1), 28-32. Ross, R. W. (1956). The Journal of Hygiene. 54(2): 192-200. Sissoko, D., Malvy, D., Giry, C., Delmas, G., Paquet, C., Gabrie, P., Pettinelli, F., Sanquer, M.-A., Pierre, V. (2008) Outbreak of Chikungunya fever in Mayotte, Comoros archipelago, 2005-2006. Transactions of the Royal Society of Tropical Medicine and Hygiene. 102(8), 780-786. Staikowsky, F., Talarmin, F., Grivard, P., Souab, A., Schuffenecker, I., Le Roux, K., Lecuit, M. Michault, A. (2009) Prospective Study of Chikungunya Virus Acute Infection in the Island of La Rà ©union during the 2005-2006 Outbreak. PLoS one. 4(10), e7603. Strauss, J. H., Strauss, E. G. (1994) The alphaviruses: gene expression, replication, and evolution. Microbiological Reviews. 58(3), 491-562. Tamburro, M., Depertat, T. (2009) Protection measures against mosquito bites in Reunion island during chikungunya epidemics in 2005- 2006 and since then. Archives de Pà ©diatrie, 16(6), 763-765. Townson, H., Nathan, M. B. (2008) Resurgence of chikungunya. Transactions of the Royal Society of Tropical Medicine and Hygiene. 102(4), 308-309. Vazeille, M., Moutailler, S., Pages, F., Jarjaval, F., Failloux, A.-B. (2008) Introduction of Aedes albopictus in Gabon: what consequences for dengue and chikungunya transmission? Tropical Medicine and International Health. 13(9), 1176-1179. WHO. (2006) Chikungunya in India. Available online: http://www.who.int/csr/don/2006_10_17/en/print.html. Accessed on: 28th January 2010. WHO. (2008) Chikungunya in South-West Asia Update. Available online: http://www.searo.who.int/en/Section10/Section2246_13975.htm. Accessed on: 28th January 2010. WHO. (2009) Chikungunya Fever, a re-emerging Disease in Asia. Available online: . Accessed on: 20th February 2010. Yoosuf, A. A., Shiham, I., Mohamed, A. J., Ali, G., Luna, J. M., Pandav, R., Gongal, G. N., Nisaluk, A., Jarman, R. G., Gibbons, R. V. (2008) First report of chikungunya from the Maldives. Transactions of the Royal Society of Tropical Medicine and Hygeine. 103(2), 192-196.

Quality Assessment Essay

â€Å"Assessment practises have a powerful impact on learning and teaching† (Curriculum Council of Western Australia, 2004, p. 37). For teachers the focus is on the use of assessment results; how they use those results to inform instructional decision making and whether they provide results that verify students have indeed met the learning targets originally set. Thus, judgements are made about the quality of assessments after the students’ performance. ‘High-quality’ assessments encompass a number of criteria’s and involve a great deal more than simply measuring knowledge (McMillan, 2011) and are outlined below in seven key areas. 1. Clear Purpose – The first decision is clarify the purpose for the assessment. Why is the assessment taking place? What is to be gained from it? Will the teacher be using formative techniques to monitor student progress or will the teacher use summative techniques to establish grades (Chappuis, Chappuis, & Stiggins, 2009)? â€Å"Knowing the reason for the assessment is crucial because this will determine what the assessment should look like, how it is administered and scored, and how the results will be used (McMillan, 2011, p.10)†. 2. Defined Learning Targets –Are they reasonable and do they ‘align’ with the state standards, student characteristics and overall goals (McMillan, 2011)? Learning targets need to be clear and understandable to everyone (Chappuis, Chappuis, & Stiggins, 2009). Learning targets are important as they define expectations. 3. Assessment Methods – The assessment methods, using either selected or constructed responses, need to align with the chosen learning targets (McMillan, 2011). â€Å"Selecting an assessment method that is incapable of reflecting the intended learning will compromise the accuracy of the results† (Chappuis, Chappuis, & Stiggins, 2009). These also need to practical and efficient so as not to be too time consuming on lessons. 4. Fairness – Fair assessments are unbiased without the influence of discrimination or subjective factors (McMillan, 2011). â€Å"All students should have an equal opportunity to demonstrate their achievement† (Curriculum Council of Western Australia, 2004, p. 38). 5.Validity & Reliability – Judgements should be based on all information and multiple measures that authenticate the conclusion (Curriculum Council of Western Australia, 2004). The assessment is useless unless the inference is appropriate, useful, reasonable and consistent (McMillan, 2011). 6. Criteria – Outlining criteria contributes to students’ learning by making clear the outcomes or goals they are striving for (Curriculum Council of Western Australia, 2004). â€Å"The issue of how student responses will be evaluated lies at the heart of any type of assessment† (McMillan, 2011, p.35). 7. Feedback – Feedback should be clear and constructive. Feedback by both by the teacher and self-assessment allows students to take responsibility for their learning and helps students â€Å"identify how they can improve their learning† (Killen, 2005, p. 98) and ensure motivation is high through positive consequences. By ensuring the lessons have a clear purpose, are well planned and allow all students’ to demonstrate their achievements through a fair, valid and reliable process, learning and teaching is improved and achievement is enhanced. â€Å"High quality assessments have consequences that will be positive for both students and yourself† (McMillan, 2011, p. 86). References Chappuis, S. , Chappuis, J. , & Stiggins, R. (2009). The Quest for Quality. Multiple Measures , 67 (3), 14-19. Curriculum Council of Western Australia. (2004). Curriculum Framework. Osborne Park: W. A. Killen, R. (2005). Programming and assessment for quality teaching and learning. South Thompson: Cengage. McMillan, J. H. (2011). Classroom Assessment: Principles and Practice for Effective Standards – Based Instruction (Fifth ed. ). Boston: Pearson.

Planning For A Future Career - 3243 Words

Introduction Taking the steps to enroll in higher education, completing the courses, and earning a degree are all important aspects in career development. However, many other aspects need to be considered while planning for a future career. While it may seem very overwhelming, I am hoping that by completing this Flexible Career Plan this whole process will help me feel a little less overwhelmed. Each chapter in our textbook, Creating Career Success by Fabricant, Miller, and Stark (2014), will assist me with gathering information, evaluating that information and coming to conclusions on how to peruse the right career. We will begin with Chapter two and travel through the book ending in chapter ten. Some of the topics we will cover will be,†¦show more content†¦Continue using, learning, training and adapting the skills to new environments are all necessary to maintain the skills I already have and are motivated to use. According to Fabricant, Miller, and Stark, We develop skills thru past employment, experiential learning, past courses/projects, extracurricular activities and volunteer work. (Fabricant, Miller, Stark, 2014). I can continue to educate myself by taking classes, reading, and researching more about these skills, asking for help when I struggle and by never giving up. Other options are join groups that help develop these skills or volunteer to help others. I could also start using these skills in other areas of my life to get more practice with them. I currently volunteer at an elementary school reading to children and at a DV/SA shelter. These experiences are allow me to using my skills and gain new ones every day. The level of motivation a person has to take the steps to maintain and build skills are very important. I am currently more motivated than I have ever been in anything. I have overcome so many challenges in the past two years. I realized two years ago that I was the only one holding me back from accomplishing my goals and once I realized that I learned that I could do anything and be good at it. I am talented and I would rather try and fail than not try at all and spend the rest of my life wondering how I would have been at something. I do not want to die with

The Inconsequenstial Roles of Women in Heart of Darkness...

Wars have been fought; lives lost, and lives won because of woman, or due in no small part to women’s effect on man. Held up on a pedestal of purity and innocence, Man has fought to keep their loved ones from the terror of the real world, one filled with strife, abuse, cruelty, and all things ungodly. Women are civilization; they are the bricks that make a society civilized. Men are there to carry out the uncivilized acts so that proper society can flourish from the untarnished view that woman have of it. The â€Å"Heart of Darkness† features few female characters and when they are presented it is in a minor if not inconsequential role. They are left to mainly secretarial work or are not working when they are presented. They follow strict gender stereotypes of doing home-like jobs or knitting, so as to not have to be a part of the dark world that is around them. Kurtz is held up to a almost godlike figure. He is the man all of the other people want to be. He is a hero t o the company and has been able to harvest more ivory than anyone else; however, at a terrible cost, and that was the treatment of the natives. Kurtz had two lovers â€Å"The Intended†, as well as the tribal mistress. The woman must be protected. The protection of women is vital in keeping with civilization, for without their innocence and assumed purity, men would not be able to do the nasty things that are required for making a society function properly, things while morally ambiguous allow it to run smoothly while

Essay about Critical Study of Shakespeares King Lear

Critical Study of Shakespeares King Lear In this production of Shakespeares King Lear, a feminist reading of the play has been chosen to be presented to the audience. Certain important factors must be taken into consideration as to how this reading will be reflected on stage. Thus, we will examine, in detail, two important scenes: Act I, scene i, and Act IV, scene iv, their impact on the action and main issues of the play (ambition/ greed, power, corruption, appearance versus reality and growth through suffering) and how the characters, specifically the women roles, are to be portrayed to reflect this particular critical reading. Act I, scene i, is worthy of our attention as a valid†¦show more content†¦A feminist reading of this play could focus on a number of aspects from this opening scene. Consideration could be given to the early dialogue between Kentand Gloucester. Gloucesters blatant indiscretion to Edmonds bastardy compels the audience to see reasoning in the characters subsequent actions, I have so often blushed to acknowledge him. Edmond is seen as flawed owing to the flaws of his mother, A son for her cradle ere she had a husband for her bed. Do you smell a fault? The metaphorical devices that can be seen in this statement, husband for her bed, works to both debase the maternal figure and offend the son. Gloucester seemingly disengages himself from any form of culpability and particular emphasis on this aspect of the scene could direct more focus on the ensuing misogynistic aspects of the play. Traditionally, from a feminist perspective, the characters of Goneril and Regan are branded v illains; stock characters, conventional representations of evil. This evil is defined by acts of will, power, desire, and sexuality - acts which disrupt both conventional morality and the patrilineal orders definition of appropriate femininity and consequently must be met with punitiveShow MoreRelated Shakespeare’s King Lear Essay1464 Words   |  6 PagesViewpoints of Shakespeare’s King Lear Shakespeare’s King Lear is a tragic about an aging King of Britain and his three daughters. When it comes time to divide his kingdom, he puts his daughters through a test to prove how much they love him. The two older daughters, Goneril and Regan, give King Lear flattering answers and therefore receive great amounts of finer land. The third and youngest daughter, Cordilia, says that she has no words to describe how much she loves her father. 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Final research paper Free Essays

string(30) " and free commerce templates\." Then started sharing my idea with my best friend, Stalin Gomes, who is currently studying at Bridgeport University in Connecticut and is also a under Of this company. He also shared a similar idea and we started working towards building our company in 2010. Then we named it â€Å"Athletic Footwear†. We will write a custom essay sample on Final research paper or any similar topic only for you Order Now Our company’s USPS is â€Å"The best you can have†. We are committed to provide our customers with varieties of top quality footwear. We are working with all the top athletic footwear brands like Nikkei, Aids, Rebook, Puma, New Balance, Gender Armor, Acacias, Sketchers, Vans and Umbra to bring all the new gears to our customers. Our company’s marketing targets are runners, athletics, sneaker lovers and others. Our company’s top priority ND goal is to provide the best customer service possible and going global. We want to run our business successfully and also want to go international. To reach our goal we need a very successful website and to make it; we need storefront software that offers us similar options and services we are looking for. In the article, Starting an online store made easy and ‘really sexy’: E- commerce TTY McMahon and DOD Jones talk about the future of e-commerce. They wrote, â€Å"A whole new era of e-commerce is emerging – one where just about anyone can create high-end, custom branded online stores for next to thing. This is being made possible by a crop of emerging online e- commerce platforms backed by venture capital† (McMahon Jones 2011). These days it’s very tricky to find the right storefront software as there are so many storefront software offering different features like hosting, design, pricing and payment options, marketing tools, reports etc. There are also many fake web builders which might be harmful for businesses. The purpose of my research is to find the right storefront software for building a website for our business. The research that I have completed describes the important features that we need to consider when choosing storefront software. Below I have detailed each key features required for building a perfect website for my business. Also, I have selected three storefront software and compared their key features. At the end I have chosen the best one for my business. IMPORTANT STOREFRONT FEATURES FOR BUILDING A WEBSITE There are a lot of different storefront software companies these days offering different options and services. The most important thing to keep in mind when choosing a storefront software is our business needs, like it loudest make sense to use a smaller web hosting if we are building a huge website that requires multiple servers, it wouldn’t make sense to pay for a lot of storage and features that we are not going to use if we are launching a small blob. I have decided to compare key features between three storefront software. They are Spiffy, Evolution and Precision Web Hosting. The important features that I have chosen to write about are unlimited web hosting, customizable web design, 24/ 7 customer service security, shopping cart payment options, product management, marketing SEE, bile commerce and social media connectivity. Kari Fabian writes, â€Å"This type of application should help you design your website, upload and manage your inventory, connect to a shopping cart, and provide secure payment options to your customers† (commerce Software Review 2014). UNLIMITED WEB HOSTING Unlimited web hosting is the most important feature for building a website. I Want to expand my business in domestic level and also internationally, so it’s very important for me to choose storefront software that offers unlimited web hosting. Spiffy and Evolution both offers unlimited be hosting but precision web offers very limited web hosting. In the article, Spiffy; The brains behind the online business the author writes, â€Å"Spiffy takes care of coding storage, backup servers, security and payment administration, in return for a subscription fee and, with basic plans, a fee on each transaction† (Canadian Business 2011). Spiffy offers Content Delivery Network (CDC) which is large network of servers placed across the world to ensure that customers can load any website store quickly, no matter where they are. According to the article, For busy Evolution, e-business is good, Lori Hopkins talks about the features of Evolution. He writes, ‘Evolution helps businesses build their websites, update product information, offer online coupons, handle credit card transactions and track inventory, all in one place. Its social shopping feature lets customers add e-commerce stores to their Faceable and Namespace fan pages† (Hopkins 2010). Evolution also offers CDC, powered by Zamia, consists of tens of thousands of servers across the globe, allowing shoppers to access any site at lightning speed. Precision Web Hosting doesn’t have servers all around the web, shoppers can’t have access o all sites and also some loads slowly. That is a clear negative side of Precision Web Hosting as I want to expand my business globally. Ant my customers to access my website from any part of the world at lightning speed. All three storefront software also offer mobile common:e feature which lets users pull up smart phone ready storefronts. Evolution and Spiffy come with multiple hosted email accounts to help business owners communicate with customers. These web-based accounts allow owners to access their messages any†here they have an internet connection. On the there hand Precision Web Ho sting comes with very few hosted email accounts to help business owners communicate with customers. I want to communicate with my customers so that I can let them know about new merchandise and sales, so think Evolution and Spiffy are in a better position in this case than Precision Web Hosting. CUSTOMIZABLE WEB DESIGN Choosing storefront software that offers customizable web design is also very important for a building a perfect website. In this feature we can customize our web page just as we want it or choose from different readmes templates to make it user friendly and website attractive. Spiffy offers â€Å"Spiffy Theme Store† which hosts a collection of over 1 00 premium and free commerce templates. You read "Final research paper" in category "Free Research Paper Samples" The Theme Store includes professional looking templates for cloth ins fashion, jewelry, electronics, art photography, and other types of commerce sites. According to spiffy, many of the commerce templates found in the Spiffy Theme Store have been created by world-renown designers including happy cog, clearest and pixel union. On the other hand, Evolution offers dozens of free, ready-to-use templates by which we can make our website shine in less than sixty seconds y choosing from any of our high-quality commerce templates. With a wide variety of free templates to choose from, we will have a stylishly professional site that’s sure to impress our customers. They also offer custom design and branding services to make businesses look unique. Precision Web Hosting also offers some similar services but a bit limited. They don’t have options to design larger websites. They have limited ready to use templates and customizing options. I want to expand my business and also go international and for that I need storefront software, which is going to offer me to expand thou charging me more. Based on this information I think Spiffy and Evolution have better web customizing options then precision Web Hosting. 24/7 CUSTOMER SERVICE SECURITY One very important feature to look at when selecting storefront software is 24/7 customer service and security from the storefront software company to protect the website and also function properly. Security is very important these days. Especially with increased threats of online fraud and identify theft. In the article, Evolution; Evolution announces credit card fraud protection service for online store owners the writer wrote, † In 2009, the umber of personal records that hackers exposed – data like Social Security numbers, medical records and credit card information tied to an individual – exceeded 220 million records, compared with 35 million in 2008†³ (Information technology business 2010). Evolution, spiffy and Precision Web Hosting offers secure and flexible commerce hosting. They offer PC/Clips-certified securities which are dedicated to keep our site’s most sensitive sales and customer data safe from harmful activities. But Precision Web Hosting doesn’t have 24/7 customer service. As Precision Web Hosting doesn’t have 24/7 customer service, think it’s not perfect for my business because I want my customers to get 24/7 customer service so that they are ready to do business with my company over and over again. SHOPPING CART PAYMENT OPTIONS Another very important feature we need to consider when choosing storefront software is shopping cart. Evolution, Spiffy and Precision Web Hosting all accept credit cards. With Spiffy Payments, set up is instant, so we can accept Visa, Mastered and American Express the minute we launch our shop. Spiffy offers a low credit card rate, and no hidden fee. Evolution offers legible payment options. We can accept a variety of payment options including credit cards, Papal, Google payments and international currencies. Precision Web Hosting also offers different payment options like credit cards and Papal. Evolution, Spiffy and Precision Web Hosting all offer flexible and simple shipping options. Spiffy has shipping rates that can be set up in a number of different ways, including fixed-price, tiered, weight-based and location-based rates. Also, unlimited plan users can receive automatic shipping rates from major shipping carriers like LASS, USPS and Fed. While Evolution and Precision Web Hosting also has similar features but Spiffy has better product management and product tracking options. So, Spiffy is the best option to setup a shopping cart for our business website. PRODUCT MANAGEMENT Products make up the business of commerce. A great range of products keeps customers coming back for more. But adding thousands of products is not an easy task and is often vulnerable to errors. Also delivering and keeping track of the product is also a very important task. Spiffy have Track product inventory option through which they can help us avoid selling rodents that have run out of stock, or let us know when we need to order or make more of our product. Evolution has mass import service which can do exceedingly fast product setup and we can relax as their skilled data feed managers guarantee us error free product updates. While Precision Web has a very limited product management service with no product tracking options. As I am going to expand my business in the feature I will have more products and to track them need a storefront software that has good product management service. So, think Precision Web is not a good option for my business. MARKETING SEE Marketing and SEE is another very important feature that we need to consider when choosing a effective storefront software for our business. SEE stands for search engine optimization. Spiffy, Evolution both offers advanced SEE built right into our store, we can earn higher organic rankings in Google, Bingo and other search engines. Also, they automatically help to earn rich snippet displays like Star ratings, pricing and stock Status in organic search results. Evolution also offers their customers to sell their products on Amazon and eBay. On the other hand, Precision Web also offers similar eaters like Spiffy and Evolution but are limited. They don’t options for selling in Amazon and eBay. Spiffy, Evolution and Precision web all offers email marketing options which helps customers to know about all the latest updates and discounts of the business. I am looking for the best marketing and SEE featured software and I think Spiffy and Evolution are very good options to choose from. MOBILE COMMERCE These days almost 30% of the commerce sales are made through a mobile device. Spiffy plan includes a free, built-in mobile commerce shopping cart. This means our customers can browse and buy from our store hill on the go, using any mobile phone from anywhere. Also, we can manage our store on the go and choose from beautiful mobile responsive themes. Evolution also helps shoppers buy from businesses anytime, an)Where by delivering a completely mobile optimized experience, from browsing all the way to checkout. Instead of making shoppers fumble through the site with their thumbs, site will be fully compatible with any smart phone or tablet device. In Precision web shopping cart automatically re-sizes the Shop template to fit mobile Screen resolutions but doesn’t have beautiful mobile themes to choose from. So, I think Precision Web is not a good choice for my business. How to cite Final research paper, Essays

Effect of Transformational Leadership on Job-Samples for Students

Question: Discuss about the Transformational Leadership in Nursing. Answer: Leaders can be defined as the individuals who take on the responsibility of guiding the subordinates in ways by which achieving organizational goals become much easier. The leaders are mainly seen to help subordinates overcome various barriers that come in the way of meeting the objectives. They tend to motivate them making them work beyond their potential helping them to achieve organizational mission and vision. Everything sectors of industrialization over the year have seen examples of best leaders. they have helped the organization to overcome crisis period and emerge out victorious through proper decision making skills, risk taking abilities. They also help in encouraging employees to align with organizational goals (Vaismoradi et al., 2016). Moreover, they also ensure employee dedication in the organization by attending the issues faced by the individuals while trying to work for the betterment of the organization. In the healthcare sector, leadership is a core criterion in the nursing domain. An expert leader has the capability to encourage professionals to align with their philosophy at the same time ensuring that they are working towards maintaining the safety of the service users. With the passage of time, different types of leadership theories have come up (Fischer et al., 2016). This assignment will mainly show how transformational leadership has helped to change the face of healthcare ensuring not only the safety of patients but also high morale of nurses and better productivity of the organization and profit. The nature of the healthcare centers is continually changing due to the advancements made in the field of medical science every passing year. Modifications in the technological systems, patterns of care, new demands and needs of the present population and many others had provided an ever-changing stature of the healthcare industry (Lin et al., 2015). Due to this continually metamorphic nature of the healthcare system of the nation, researchers are of the opinion that nursing professionals need to employ transformational leadership style. The leadership style mainly aims is to encourage professionals for adaptation to changes and helps the leaders in recognizing areas where change is required. The leaders thereby guide the nursing subordinates by inspiring them about the changes and creating a sense of commitment. Researchers are of the opinion that when nursing leaders will be able to adopt the transformational leadership style effectively, they will have many advantages. They feel m ore confident and comfortable while engaging in the development of healthcare policies. They can mentor new graduate nurses, manage teamwork and the ever-changing components of healthcare technology of the present generation (Weng et al., 2015). One of the most important aspects of transformational leadership in nursing is the intellectual stimulation attribute. Researchers have put forward many studies that have shown how this attribute has become an exceptionally important aspect in the present healthcare centers. (Scully, 2015). With the help of this skill, the nursing leader can facilitate as well as encourage his or her nursing colleagues for developing critical thinking skills and problems solving skills. This would help for effective diagnosis of the patients, linking the symptoms with pathophysiology and thereby developing care plans for the patients. The leaders are also able to develop creative as well as innovative approaches for tackling daily tasks or other situations that arise on the healthcare fields. The nursing leaders should have the skills to encourage the nursing professionals for putting forwards their ideas and suggestions and asking for feedbacks for handling different situations more effectively. Her man, Gish and Rosenblun (2015) had indeed supported this attribute of the nursing leaders as they have stated that such attribute helps in promoting employee engagement as nurse feel that their suggestions are valued. They become encouraged, as they feel accepted by the organization. This in turn increases their dedication towards their work. Individualized consideration is another attribute that is extremely important for nursing leaders to adopt the transformational leadership style. The nurse leaders should develop this attribute, as this would help them to recognize the concerns of the nursing professionals and identify the barriers that they are facing during their practices for which high quality care is not provided to patients. This would help the nurse leaders to express their concerns about each of the nurses individually and help them to provide solution helping them to overcome the issues. This skill helps the nurse leaders to connect with the nursing professionals by developing proper bonds that help them to attach with the employees emotionally (Huber, 2017). When nursing professionals help subordinates to overcome the various issues they are facing by providing them advices, sharing resources, giving them training and others, the subordinates feel satisfied. They feel that they have leaders on whom they can rely in crises that in turn release their stress and pressure. Therefore, they are able to work without tensions and reduce the chances of medication errors, wrong interventions and others. Spano et al. (2016) had supported the view and had put forward certain benefits that are associated with their attribute. This ensures emotional stability in the nursing professionals and prevents the nurses from burning out. The rate of absenteeism decreases and turnover rates also become low. It also ensures job satisfaction and ensures employee engagement. Another important aspect of transformational leadership is called inspirational motivation. With the help of the skill, the nurse leader would be able to inspire as well as motivate the nursing professionals to provide their best quality work that is not only safe but also ensures patients comfort and satisfaction. The nurse leaders can accomplish this by describing the mission and vision of the healthcare delivery in the healthcare system in the hospital and assuring their compliance with the organizational goals through commitments. After setting of the vision, the nursing leaders should encourage their staff members to develop SMART objective s by which they can develop their skills and meet the organizational goals effectively. Researchers are of the opinion that nurse leaders who are expert in transformational leadership have the capability to motivate the employees by which they can work beyond their potential and help them to meet their objectives easily (Wong et al., 2015). M otivation has the capacity to make the nursing professionals to develop intrinsic ability to dedicate themselves not only for developing the goodwill of the organization but also for delivering the best care to patients and ensuring error free, high quality service delivery. Another important aspect of this style of leadership is called the idealized influence. This feature enables the nurses to be an effective, positive role model by walking the talk policy. The nurse leaders can achieve this skill by being consistent in their words as well as actions that are not only professional but also supportive of the policies and procedures of the hospitals, its policies as well as procedures. They should also display traits like honesty, dependability and enthusiasm so that nursing subordinates also get influenced and try to achieve the traits like this leaders during serving the service users (Brewer et al., 2016). This attribute not only helps in enabling a collaborative work environment that brings leaders and followers together to act as a team. This attribute thereby results in working for the professionals together in the pursuit of shared vision , nurturing of the employees, directly addressing the current nursing shortage and thereby helping in overcomi ng various barriers. Transformational leadership in nursing is of exceptional importance in healthcare as it helps the working staffs to adapt with the new modifications of the working environment with guidance of the leaders in every step. This form of leadership focuses on development of relationships among the employees at an emotional level. This helps in sharing of concerns and effective feedback exchange. This makes the employees feel satisfied and reduces the scope of burning out. It helps in inspiring people, promoting their enthusiasm and allows quick formulation of a vision. However, certain researchers have criticized the theory stating that this form of leadership results in facing the severe detail challenges might overlook reality and truth, carries potential for abuse (Cheng et al., 2016). Evidences for success rate of this form of transformational leadership are quite high and had already proved to be helpful in many healthcare sections all over the nation. From the above conclusion, it can be easily known that transformational leadership has a large number of benefits when maintained effectively by the leaders. It helps to increase morale of the nurses as they feel that the organizations care and respect their wishes and concerns. Moreover, as the leaders help the nurses at an individual level in overcoming their concerns and issues, it becomes possible for them to express their barriers and concerns. The leaders engage in effective feedback giving and receiving sessions that make employees feel that their suggestions are respected. This ensures creativity and innovation in workplace. The leaders help in solving such issues that helps to reduce their pressure and helps them to gain emotional and mental stability. This reduces absenteeism and prevents nurses from burning out. This also reduces turnover and increases job dedication. Therefore, it is expected from every nurse leaders to adopt the transformational leadership style so that employees remain motivated and dedicated in their care towards patients and help to provide evidence based care ensuring patient satisfaction. References: Boamah, S. A., Laschinger, H. K. S., Wong, C., Clarke, S. (2017). Effect of transformational leadership on job satisfaction and patient safety outcomes.Nursing outlook. Brewer, C. S., Kovner, C. T., Djukic, M., Fatehi, F., Greene, W., Chacko, T. P., Yang, Y. (2016). Impact of transformational leadership on nurse work outcomes.Journal of advanced nursing,72(11), 2879-2893. Cheng, C., Bartram, T., Karimi, L., Leggat, S. (2016). Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses.Personnel Review,45(6), 1200-1216. Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis.Journal of advanced nursing,72(11), 2644-2653. Herman, S., Gish, M., Rosenblum, R. (2015). Effects of nursing position on transformational leadership practices.Journal of Nursing Administration,45(2), 113-119. Huber, D. (2017).Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences. Lin, P. Y., MacLennan, S., Hunt, N., Cox, T. (2015). The influences of nursing transformational leadership style on the quality of nurses working lives in Taiwan: a cross-sectional quantitative study.BMC nursing,14(1), 33. Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession.Collegian,22(4), 439-444. Spano-Szekely, L., Griffin, M. T. Q., Clavelle, J., Fitzpatrick, J. J. (2016). Emotional intelligence and transformational leadership in nurse managers.Journal of Nursing Administration,46(2), 101-108. Vaismoradi, M., Griffiths, P., Turunen, H., Jordan, S. (2016). Transformational leadership in nursing and medication safety education: a discussion paper.Journal of nursing management,24(7), 970-980. Weng, R. H., Huang, C. Y., Chen, L. M., Chang, L. Y. (2015). Exploring the impact of transformational leadership on nurse innovation behaviour: A cross?sectional study.Journal of nursing management,23(4), 427-439. Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: state of the science.Journal of nursing management,23(3), 275-278