Role of the nurse in management of COPD

Role of the suck up in management of COPDChronic Obstructive Pulmonary Disease (COPD) is a treat adequate to(p) condition that is defined as organism a disease characterised by airflow limitation that is not fully reversible. This airflow limitation is usually both(preno houral) progressive and associated with an ab principle seditious response of the lungs to noxious particles or gases (Fabbri, 2003). One in ein truth four acute admissions to hospital is due to respiratory difficulties, and 50 per-cent of these argon caused by the complications of COPD (Roberts, et al., 2001). In the United Kingdom, it is the third most common cause of general adult morbidity and mortality, in particular among smokers, (Barnes, 1999), and it is a operative cargo to the NHS.In recent years, nurse-led primary wangle interventions have become more widespread. Although there has so far been insufficient evidence to support their implementation, there appears to be no difference in quality of c a tomic number 18 between doctor-led and nurse-led COPD syllabuss (Pye, 2008), and they may offer a cost numberive and holistic solution to both the NHS and unhurrieds respectively. This strive will use a case based interchange to illustrate the role of the Nurse Practiti whizr (NP), and nurse prescribing issues for a patient with COPD.Case ruminateThe patient is a 62-year-old married Caucasian female who attended for a routine primary c be nurse-led COPD evaluation during 2010. The patient had no other onetime(prenominal) medical history, apart from moderate COPD. This was diagnosed three years ago, following recurrent respiratory infections, two of which had necessitated hospitalisation.The NP had not seen this patient before and after familiarising herself with the observations and establishing a rapport with the patient took a medical history asking important questions about the history of the presenting complaint, the COPD, the patients past medical and surgical history, medication lists, allergies to medications, complaisant history and smoking habits. The NP used a template questionnaire that was part of the COPD care pathway to identify how the COPD impacted on the patients quality of life. She herself had introduced this questionnaire herself as a result of her own reflective learning and had based it on one from a paper by Vandevoorde, et al., (2007) that included aspects about patient symptoms that patients do not always volunteer to medical professionals, such as stead effects from medication and qualitative measures of fatigue and mental well-being (Vandevoorde, et al., 2007).Three months earlier, the patient had one exacerbation, which resulted in admission to the local hospitals medical assessment unit, and she recovered well. She occasionally had moments of shortness of breath, nevertheless these were typically on exertion and doing other strenuous activities.During this visit, she report that her condition was stable. Her sputum pro duction was approximately a cup/ day, and she needed to use 2.5l of oxygen at night. The patient continued to smoke six cigarettes/ day, and being a such(prenominal) heavier smoker previously she had a history of 60 pack years. She was compliant with her regular inhalers and had no problems with side effects, apart from a unskilled almost metallic taste in her brim that she had occasionally recently started if she had forgotten to wash her mouth after using her inhalers. She had besides been started on a Corticosteroid inhaler by the hospital respiratory team following her last exacerbation, entirely she mentioned that she had not noticed any difference in her COPD symptoms in using this. On direct questioning, she remembered that she also did have an unpleasantly sore mouth and voice was becoming hoarser since she had commenced using this steroid inhaler, but she didnt know if this was the effect of the steroid inhaler, the drying effects on mucous membranes of using oxyge n therapy, or aroundthing else. She had noticed these symptoms for at least three weeks, and two weeks ago she had noticed exsanguine patches on her tongue.Apart from oxygen, and the newly introduced Corticosteroid inhaler that she was using in terms of her other medication, she was taking the long acting beta 2-agonist Salmeterol twice a day, and the anti-cho epithelial ductrgic bronchodilator, Ipratropium Bromide. She had been using both Salmeterol and Ipratropium Bromide for several years, and she had no side effects with either of these medications. Antibiotics had been stopped for some time since her last exacerbation, and she had finished her Prednisolone some time ago. Overall, from a medical perspective she felt well in herself apart from the mouth problem.On examination, the patient spoke in short sentences, and occasionally her wording was stifled by shortness of breathe, but she did not appear to be in distress, and she was alert. Her skin was pink in colour and she app eared to be breathing with pursed lips, which is a characteristic feature of being a pink puffer and having the diagnosis of emphysema (Flenley, 1990). The NP consequently examined the patients vital signs, checking her pulse, which was 96 beats/ min and regular. Blood pressure, was 140/ 78 mmHg, and she was apyrexial. The NP then looked for signs of peripheral and central cyanosis by checking the colour of the patients hands and asking the patient to show the underside of her tongue. there were none, but the patient appeared to have oral candidiasis.The patients hands had a fine tremor, a side effect of her taking the long acting beta 2-agonists (Rossi, et al., 2008), but when questioned, she reported that it was not a problem as she was chill out able to write housework instructions to her husband. The patients respiratory rate was slightly higher than normal at 18/ min, but this was satisfactory. The NP listened to the patients chest and bilateral breath sounds were equal, bu t with a few polyphonic wheezes. There were no crackles and no crepitations were present. rawness sounds were normal. Spirometry was done, after explaination to the patient how to do the test in detail beforehand, giving the opportunity to ask questions. The patient had done the test many times beforehand, but expressed appreciation. The results showed airway obstruction and ventilatory impairment, consistent with the diagnosis of moderate COPD. A blood gas analysis was not taken, but the oxygen chroma on air was 96%. Inhaler technique was checked and this was satisfactory.She lived with her husband, although she mentioned he had recently had to stop work due to him having ill health, and this was causing her a diffuse of anxiety from both the worry over his health and also the potential impact of the loss of income to their household. He had previously worked in a factory that stored and distributed dredge products, and he had over several years started to develop breathing prob lems himself, despite him being a lifetime non-smoker. He was under investigation by the respiratory physicians, and this was causing a significant amount of tension to both of them. She reported that when she had her last exacerbation, he had become ill at that time, and she had to help him with personal care at home for a period of time, and the increased workload caused her shortness of breath to increase. She felt that her energy levels had been depleted for several weeks in the run up to her last admission to hospital, and that she did not even have time to smoke.Despite her COPD being relatively stable on this visit, the patient appeared depressed. When asked if she was depressed, she answered that she was and she was also having difficulty quiescence at night with financial issues caused by the ill-health retirement of her husband being the biggest stressor.The NP explained to the patient that she had identified several areas that needed action and further discussion with th e GP. One was on the trance use of the steroid inhaler, the second was the oral thrush perhaps caused by the use of steroid inhaler (Ellepola, et al., 2001), the NP explained that there are interpositions available for this that might be appropriate for her. Furthermore, she told the patient that the issue of depression needed further assessment by the GP. The patients medical records were updated with the findings of the assessment, as per good mention keeping practice (NMC, 2009), and the patient was left over(p) in the room while the GP was consulted.The NP presented the case to the patients GP and mentioned her concerns about both the depression, and also the nicety of using the Corticosteroid inhaler and the oral candida. The NP recalled a lecture she had received during her course on nurse prescribing for COPD and discussed this with the GP. The GP took the opportunity to do an inner teaching session and agreed with the NP reminding her about the findings from a paper i n 2000, by Barnes, which suggested that inhaled corticosteroids are not indicated for the treatment of COPD anymore. Unlike in asthma, where inhaled Corticosteroids are the mainstay of treatment, they have been found to have a limited role in the maintenance of function in patients with COPD. It was observed that only 1 in 10 patients with COPD will show a significant improvement in lung function following treatment with inhaled corticosteroids (Barnes, 2000) and the reason is thought to be that different inflammatory mediators are accountable for the airway hyper reactivity that is present in asthma and COPD, and those that are responsible for COPD are less responsive to inhaled steroids (Barnes, 2000). Respiratory physicians will still use them, but usually only in cases where symptoms are not optimally controlled with bronchodilators alone (Fabbri, 2004), hence explaining why they were introduced when this patient had her last exacerbation.It was thought very likely that the oral candida as well as the metallic taste and hoarse voice could be due to her use of the steroid inhaler. The NP showed to the GP that the patients pulmonary function, as demonstrated by the Spirometry taken that day, was no worse than on her previous visit, prior to the Corticosteroid inhaler being started. Since a significant clinical response had not been objectively observed, both the GP and the NP decided together that the steroids should be discontinued from the point of view of risk v benefit and also evidence-based best practice.Both the GP and the NP then explained to the patient about the likelihood of the steroid inhaler not offering her that much benefit, instead causing her new symptoms. Her mouth was examined and it was confirmed that the patient had oral thrush, which is a known side effect of using steroid inhalers (Ellepola, et al., 2001).It was decided to deprive off the Corticosteroid inhaler over a couple of weeks before stopping completely, and see how things go. She was also hash out by the GP to rinse her mouth thoroughly after using the steroid inhaler, as well as the others. If the situation became worse, with regards her breathing she was advised to call the surgery for an urgent appointment to critique her medication. The NP then suggested that the patient was started on an antifungal medication for the Candida albicans infection, such as Fluconazole, a decision that had been make following consideration and reflection, in line with the steps of the prescribing pyramid (National Prescribing Centre, 1999). The NP had already consulted the British National Formulary online (BNF, 2010a) to check for contraindications. The patient had none and also there were no history of coloured problems or cardiac arrhythmia where caution should be exercised. The decision was made to commence treatment using a course of oral Fluconazole. The patient was advised about this, and also she was told of the possible side effects such as headache, dizzine ss, nausea, vomiting, abdominal pain, diarrhoea and the small possibility of liver problems (BNF, 2010a). She understood the information prone and found the decision acceptable and so agreed to commence treatment, and to report any side effects that she noticed.With regards the patients depression this was assessed by the GP, after taking a psychiatric history and risk assessment. Both the patient and GP together decided to try a short course of antidepressant drug medication, which would be kept under close review. She was also encouraged to pursue social renovation channels with regards to disability living allowance if she was finding it difficult to care for her husband, especially because she was also infirm. The NP provided her with relevant paperwork for local social services and offered to make some enquiries on her behalf to arrange a home assessment. Before the patient left the room, both the GP and the nurse reinforced the importance of smoking cessation on her COPD an d the possibility of nicotine replacement. The patient smiled and said she will give it some thought. flu vaccination was also mentioned as a reminder for later in the year. A follow up telephone consultation had been arranged for two-weeks time with the NP. The notes were then completed by both the GP and nurse with regards this part of the consultation.Two weeks the telephone consultation took place and the patient reported that she felt much emend about her quality of life, her oral symptoms were almost back to normal and since taking the antidepressants, she had noticed a higher ability to perform day to day activities, and overall she seemed to have a more positive and bright outlook on life. The patient mentioned that she had also finally decided to stop smoking and wanted economic aid with this in the form of nicotine patches that the nurse had previously mentioned. The NP arranged for the patient to attend a smoking cessation clinic, during which she made a mental note to apply the prescribing pyramid to this particular issue of nicotine replacement, and offered her congratulations on the patients progress. A further review appointment was also made with the GP to monitor the antidepressant treatment.DiscussionThis case illustrates the role of the COPD NP in primary care, and discusses prescribing issues. The nurse had taken a complete history and identified several medical, psychosocial issues and prescribing issues and taken appropriate action. From a medical and functional viewpoint, the examination and spirometry showed the patient had stable, moderate COPD, however holistic assessment revealed that she was taking steroid inhalers that were ineffective in her condition and were also causing her to develop an oral thrush infection. The NP also identified that the patient was depressed and there were social problems at home, caused by the patients husband being unwell.The COPD NP correctly identified several issues that needed referral to her GP c olleague, and she had worked through a prescribing pyramid to identify that both the steroid inhaler may not be needed anymore, and that the patient would benefit from using an antifungal medication for her thrush.The prescribing pyramidThe prescribing pyramid (National Prescribing Centre, 1999) is a stepwise approach that has involves seven stages (1-7), and each stage should be considered carefully before climbing to the nextConsider the patient.Which strategy should be used?Consider a choice of productNegotiate a readReview the patientRecord keepingReflectionWith regard the oral thrush infection, the patient had a full history taken and clinical examination. A holistic viewpoint that took into account the fact that the patient was experiencing unpleasant side effects led the nurse to conclude that GP referral was necessary to confirm the diagnosis and also to tackle the concurrent issue of the steroid inhalers and depression. When considering step four, the NP had reviewed the B ritish National Formulary online (BNF, 2010a) and had decided that Fluconazole was the most effective product for this patient as the patient also had a dry mouth because of her oxygen therapy. Nystatin, another antifungal can be used for oral thrush, but it is less suited for patients who have dry mouths (BNF, 2010b). The patient also had no contra-indications to Fluconazole, and she was not taking and other drugs that had known drug-drug interactions with this new agent. The patient was informed of all the possible side effects in a form that she could understand.This patient had a central role in the decision making process in this consultation in line with stage four of the prescribing pyramid (National Prescribing Centre, 1999). Effective communication skills are an important part of good nursing practice, as originally outlined by the UKCC in 1996 (UKCC, 1996). In the context of nurse prescribing, this includes explaining what the prescription in for how to take the medicatio n how long it takes to work and what the possible side effects may be. The nurse also referred to the BNF as reference when making this decision, which is an example of good, evidence-based reflective practice.In accordance with step five, a review of the patient was organised to establish whether the treatment was effective, safe and acceptable. The patient was also advised to make contact if there were any problems, which is in line with guidance (National Prescribing Centre, 1999). For step six, the nurse practitioner made detailed notes in the medical records immediately after the consultation as per recommendations by the NMC (2009).The NP reflected on her own practice in this situation and asked the GP to give her constructive feedback, which was useful for improving her own learning and practice. Her need for continuing professional development was acknowledged in the original planning of the service within that practice and as a specialist member of the team, having a good w orking relationship with all the GPs she had the clinical support to hand and was able to obtain medical advice, supervision and guidance when required. The department also had regular visits from pharmaceutical companies and teaching on local formulary practices. The NPs own educational programme included critical appraisal training to enable her to be aware(p) of the influences on prescribing.ConclusionNurse-led COPD primary care assessment services where specialist NPs are responsible for performing assessment, investigation and are able to act as liaison officers for patients are becoming more widely implemented in the UK as an integrated medical-social and holistic approach to COPD management. Such nurses prescribe full treatment packages for patients and provide them with a point of contact for specialist advice should the patients have an exacerbation at home, as well as forming the link to the tertiary respiratory units should the need arise. Keeping the majority of COPD ca re in the community should offer better patient centred care as well as cost savings for the NHS. NPs have a crucial role in the management of COPD, and must be aware of prescribing issues reflective learning to give their patients the best possible care.

Difficulties Listeners Face Processing a Foreign Language

Difficulties Listeners Face Processing a Foreign LanguageINTRODUCTIONRecently, meeting has gained more and more attention in exotic voice communication canvassing. In learning a exotic linguistic communication, it is suggested that the most important step should begin with an effort to listen. (Rubin Thompson, 1994) Listening provides input for learners to make learning occur and listening exercises claw learners attention to new forms in language, such as new vocabulary items. (Rost, 1994) Listening basis be regarded as a necessary skill in the diagnosing and preparation of foreign language students and can even be served as a good predictor of language achievement. In consequence, listening acquaintance acts as a pivotal role in foreign language learning. (Oxford, 1993)In this essay, triad issues ar discussed. Issue 1 states listening difficulties in indorse language acquisition. Underwood (1994), Chiang and Dunkel (1992) and Rubin and Thompson (1994)s viewpoint are d iscussed. Issue 2 proposes taxonomies of the factors affecting listening difficulties. Boyle (1984), Yagang (1993) and Rubin (1994) s point of view of the factors affecting listening perception are referred to. Issue 3 mentions studies in listening difficulties of L2 attendants in foreign countries. Tauroza and Allisons (Rubin, 1994) study is ab let on speech rate. Boyle (1984)s study is factors most frequently mentioned in listening intuition. lynch (1997)s study is a case study of a intermediate-level learners progress in listening comprehension. Goh (2000)s study discusses listening comprehension problems.Chapter 1 Listening difficulties in aid language acquisitionUnderwoods (1994) point of viewUnderwood (1994) identified seven potential difficulties in listening comprehension as (1) lack of carry over the focal ratio at which loudspeakers speak, (2) non being able to belong things repeated, (3) the listeners express vocabulary, (4) failure to recognize the signals, (5) problems of interpretation, (6) softness to concentrate, (7) established learning habits. Many language learners believe that the greatest difficulty with listening comprehension is that the listener cannot control how quickly a speaker speaks. (p7)They are so busy oeuvreing out the meaning of one part of what they hear that they miss the next part. An some other difficulty is that listener is not always in a position to get the speaker to repeat an utterance. This is particularly likely to be the case when students are on the edge of conversation outdoors the classroom. For people listening to a foreign language, an unknown articulate can be like a suddenly dropped barrier causing them to stop and think about the meaning of the word and olibanum making them miss the next part of the speech (p 17). And students need to learn to listen for the signals in order to be able to connect the various utterances in the way the speaker intended them to be connected. (p18) Students who a re unfamiliar with the con schoolbook may have considerable difficulty in interpreting the words they hear even if they can understand their surface meaning. (p19). In office to concentrate can be caused by a number of things, but in listening educate it is a major problem, because even the shortest break in attention can seriously impair comprehension. (p19) Outside factors may well make concentration difficult, too. An deficient machine or poor recording can make it very hard for the students. As for establishing leaning habits, when the learner can more readily involve the frustrations involved, he testament be more prepared to strive for a partial and incomplete understanding of what is being said. (pp16-19)Rubin and Thompsons (1994) point of viewRubin and Thompson list trey common problems in learning to listen to a foreign language. The first problem is that the speaker talks too fast. If the listener can not come after the speaker, the listener can let the speaker know that he is not following. He can ask for repetition and slowing down the speed, seeks clarification, rephrase, and repeat. The listener can pay attention to intonation and tone of voice, focus on question words such as who, what and when and assume that the here and now are relevant. That is, the blame is directly related to the subject they have just been discussing. Assume that what a person says is directly related to something he or she is experiencing at that very minute. The second problem is that the listener is not getting anything out of foreign language TV and movies. If the listener could not understand the foreign language TV and movies, they should tense to take control of his listening by predicting what he was likely to hear. For example, use visual clues and use his orbit knowledge. Anticipate information in a component by relying on your knowledge of what such a segment is likely to contain. Listeners could also use information from the segment itself and determ ine the music genre of the segment. Knowing the genre of a segment will help you determine how best to approach it. For instance, if it is an interview, then concentrate on the questions. If it is a news report, a who, when, where strategy will work best. If it is a drama, look for the story line. Listeners could listen to familiar elements, listen to familiar-sounding words, listen to and jot down repeated words, learn to recognize numbers and learn to recognize proper names. The third problem is that the listener tends to stop listening when he hears an unfamiliar word or phrase. Many learners, particularly in the primeval stages of language learning, panic and lose their concentration when they hear an unfamiliar segment. As a result, they miss portions of the passage that might have helped clarify the unfamiliar word or segment. The listener should concentrate on familiar elements and keep listening. Understanding something is better than getting nothing at all(prenominal). If you continue listening, chances are that you will take hold of at least some parts of the massage. It is possible that the portions you missed were not very important after all.Chiang and Dunkels (1992) point of viewChiang and Dunkel (1992) pointed out that listeners comprehension in face may be thwarted by a number of cognitive and linguistic factors as well as academic and cultural issues, including (a) inability or lack of opportunity to engage in communicative interaction with the second/foreign language teacher or lecture (b) inability to comment the main points of the lecture or to grasp the usual goals of particular genres of intervention situation of which the discourse is a part (c) unfamiliarity with the structure and type of the discourse (d) inability to apprehend discourse markers and logical relationships in the English lecture (e) inability to comprehend lecture speech delivered at faster range of speed (f) limited short-term retention for English input (g) f ailure to use appropriate cognitive or learning strategies (h) poor inference abilities in English (i) limited attainment in English (j) lack of prior knowledge about the content of the spoken or written text and (k) inability to operation L2 input devoid of speech modification such as elaborations or redundancies. Of these difficulties confronting L2 learners, Chiang and Dunkel explored the effect of three of them. The first situation was when the listeners had limited listening proficiency in English, the second situation was when they lacked prior knowledge about the topic of the L2 lecture, and the third situation was when they were not supplied with modified speech. The results revealed a significant interaction between prior knowledge and text type.Chapter 2 Taxonomy of the factors affecting L2 listening difficultiesBoyles (1984) three categories of factorsBoyle (1984) began with a survey of the factors most frequently mentioned in the literature on listening comprehension, including three categories of factors. The first category referred to the listener factors, including experience in listening to the orient language, general background knowledge of the world, educational background and type of school, knowledge of the target language in its various aspects, memory, powers of analysis and selection and motivation and attitude of the listener to the speaker and to the message. The second categories, the speaker factors, contain language ability of the speaker native speakerbeginning level non-native speaker. Speakers production pronunciation, accent, variation, voice affect, too. Speed of delivery and prestige and personality of the speaker count. The third category, factors in the material and medium, comprise difficulty of content and concept, especially if the material is abstract, abstruse, highly specialized or technical, lengthy or poorly organized. Acoustic environment such as ruffle and interference and amount of support provided by gestu res, visuals also have influence on listening comprehension.Yagangs (1993) quaternity aspects of factorsInstead of three categories, Yagang (1993) proposed that the sources of listening difficulties came mainly from the quadruplet aspects the message, the speaker, the listener, and the physical setting. The message factors comprised content and linguistic features. In content which is not well organized, listeners cannot predict what speakers are going to say. And if listening materials are made up of everyday conversation, they may contain a lot of colloquial expressions, such as guy for man. Students who have been exposed mainly to formal or bookish English may not be familiar with these expressions. The speaker factors consists of redundant utterances, such as repetitions, false starts, re-phrasings, self-corrections, elaborations, tautologies, apparently meaningless addition such as I mean or you know and speakers personal factors such as their accents. Learners tend to be used to their teaching accent or to the standard renewing of British or American English. They find it hard to understand speakers with other accents. The listener factors played a more important role in EFL students listening. For example, foreign language students might be not familiar enough with clich and collocations in English to predict a missing word or phrase. For example, they can not be expected to know that rosy often collocates with cheeks. EFL students might be lack of sociocultural, factual, and contextual knowledge of the target language. (Anderson and Lynch 1988).It can present an barricade to comprehension because language is used to express its culture. Factors in physical setting included noise, both background noises on the recording and environmental noises, could carry the listeners hear of the content of the listening passage. Listening material on tape or radio lacks visual and aural environmental clues. Not seeing the speakers body language and facial ex pressions makes it more difficult for the listener to understand the speakers meaning. Unclear sounds resulting from poor quality equipment can interfere with the listeners comprehension.Rubins (1994) five categories of factorsRubin (1994) classified these listening factors into five categories text, interlocutor, task, listener and process characteristics. Text characteristics referred to acoustic-temporal variables, acoustic-other variables and morphological and syntactic modifications (including restatements). Acoustic-temporal variables are speech rate, pause phenomena, and hesitation. Acoustic-other variables are level of perception, stress and rhythmic patterning perception and L1 and L2 differences. Variables of morphological and syntactic modifications are redundancy, morphological complexity, word order and discourse markers. Text characteristics referred to text type. Visual support for texts is also an important variable. Interlocutor characteristics referred to variation s in the speakers personal characteristics, such as gender, pronunciation, accent, expertness and so on. Listener characteristics are listeners language proficiency level, memory, attention, affect, age, gender, learning disabilities in L1, and background knowledge as well as aptitude, processing skills, background biases, motivation, and confidence level. Process characteristics referred to how listeners interpret input in terms of what they know or identify what they dont know. Top-down, bottom-up and parallel processing is being examined in L2 contexts. rate of flow views of listening comprehension propose that listeners actively process language input. Two types of processing have been discerned cognitive strategies and metacognitive strategies. Research on listening strategies includes work on several languages work contrasting strategy use at several proficiency levels work with interactive or transactional listening work with cognitive and metacognitive strategies work consi dering the relation of strategy use to text, task, and setting.Chapter 3 Studies in listening difficulties of L2 listeners in foreign countriesTauroza and Allisons ( )studyspeech rateGriffiths suggests that different language have different customary rates and the rates defined in studies using English can not be applied exactly to studies of other languages. Most research quotes a normal speech rate of 165 to 180 words per minutes for native speakers of English. On the other hand, while Foulke reports a threshold (the rate at which comprehension begins to decrease rapidly) level between 250-275 w.p.m., others states that comprehension decreases as a function of mental aptitude and difficulty level. Tauroza and Allison compare normal speed of British speakers for four types of speech. They found that while the mean for radio and interview speech events lies within the range of 160 to 190 w.p.m., the means for conversation and lecture categories are outside this range. The mean rate for conversation in words per minute was 210, while for lectures, 140. They note further that thirty-three percent of their lecture data was slower than cxxx w.p.m. and twenty-three percent of the conversation data was faster than 220 w.p.m. The issue of normal speech rate is one that still needs a great sell more research that takes into account all of the variables mentioned above. (Rubin, 1994)Boyles (1984) studyfactors most frequently mentioned in listeningIn Boyles (1984) study, 30 teachers and 60 students in Hong Kong were asked to list the sextet factors which they considered the most important in aiding or hampering the effectiveness of listening comprehension. It was interesting to know that the students gave much more importance to vocabulary than teachers did. It was surprising that the students mentioned two factors, memory and concentration, barely mentioned by the teachers. In addition, the students considered that there was a possible relationship between their re ading habits and their listening comprehension, which was not mentioned by the teachers. On the other hand, the teacher seemed to specify the linguistic factors more sophisticatedly. The teacher would specify the factors as ability to pick up clues, complex syntactical structures, stress and intonation and interference from Chinese. On the contrary, the students just indicated that the lack of general language ability or the difficulties in English listening comprehension.Lynchs (1997) studya case study of an intermediate-level learners progressLynch (1997) conducted an ethnographic study of a Japanese student who attended English language courses at the Institute for Applied Language Studies, the only one pickings an undergraduate course in economics at the University of Edinburgh. His scores on the listening tests were relatively low in comparison with his reading and grammar scores with the other students in class. A number of possible reasons were found to explain his difficulti es in listening comprehension. First, he was the youngest member in his class so that he was unwilling to engage in negotiation with his seniors. Second, he was the only undergraduate student with an economic background in his English class so that he viewed himself as insufficient in some general background knowledge. Third, he joined Course 3 in the EAP program, skipping the basic class, Course 1 and 2. Therefore, he approximation he needed more time to get used to negotiate with others in English. Fourth, his lowest listening score disappointed him greatly. The perceptions of the subject had made a substantial influence on his English learning.Gohs (2000) studylistening comprehension problemsGoh (2000) investigated the comprehension problems of second language listeners in a cognitive perspective. She identified real-time listening difficulties faced by 40 Chinese undergraduates and examined their difficulties within the three-phase model of language comprehension proposed by Anderson. (1995). The data were collected from learners self-reports in their diaries, semi-structure interviews and immediate retrospective verbalizations. The data revealed 10 problems that occurred during the cognitive process phases of perception, parsing, and utilization. She also, made a comprehension between two multitudes, high ability listeners and low ability listeners. Each group consisted of eight students selected according to their grades in a post-instruction standardized proficiency test, the SLEP test of Educational Testing Service 1991. She found that listeners with highly ability and low ability both had a perception problem with recognizing words they knew. Another problem they both shared was parsing problem that they quickly forgot what they thought they had understood. In addition to these two problems, high ability listeners reported a utilization problem that they were often unable to extract the meaning out of the message even if they had understood all th e words. On the other hand, low ability listeners reported another perception problem that they often did not hear the next part of a text because they spent too much time thinking about what they had just heard.REFERENCESBoyle, J.P. (1984). Factors affecting listening comprehension. ELT Journal, 38 (1), 34-38Chiang, C.S. Dunkel, P. (1992). The effect of speech modification, prior knowledge, and listening proficiency in EFL lecture learning. TESOL Quarterly, 26(2), 345-374Goh, C.C.M. (2000). A cognitive perspective on language learners listening comprehension problem. System, 28(1), 55-75.Lynch. (1997). Life in the slow lane Observations of a limited L2 listener. System, 25 (3), 385-398Oxford, R. (1993). Research update in L2 listening. System, 21(2), 205-211.Rost, M. (1994). Introducing listening. London Penguin.Rubin, J. (1994). A review of second language listening comprehension research. Modern language Journal, 78(2), 199-217Rubin, J. Thompson, I. (1994) How to be a more succ essful language learner Toward learning autonomy. MA Heinle Heinle Publishers.Underwood, M. (1994). Teaching listening. Longman Handbooks for Language Teachers.Yagang, F. (1993).Listening problems and solutions. English Teaching Forum, 31 (2), 16-19

War and Peace Essay -- European History Germany France War Essays

War and Peace The greater threat to world peace in the 20s, 30s, and 40s is a point that could be argued and debated upon for essays on piles of essays. The true threats of world peace were those who were nave enough to believe that a people can be totally humiliated as the Germans were in the Treaty of Versailles following World War I and not be subject to promises of regained glory. Throughout the 1920s, the world was relatively peacefulsave perhaps the Italian revolution by Mussolini who had his Fascist government set up fully by the year 1926 and the Beer Hall Putsch led by Adolf Hitler in 1923. With the stifling of the revolution by the Bavarian government (which was completely riddled full of Nazi sympathizers), Hitler was sentenced to the minimum five years in prison at Landsberg fortress in Munich where he had a Martha Stewart-esque term of hard-time. Even at his trial, he spoke as if it were a political rally Hitlers book was elysian from the en couragement of other members of the Nazi party, Emile Maurice his chauffeur being the original writer until young Rudolf Hess took over shortly after Hitler began to dictate the book. Hitler originally titled his archives Four Years of Struggle Against Lies, Stupidity, and Cowardice (http//www.spartacus.schoolnet.co.uk/GERmein.htm). The publishers thought the title to be too long and instead changed it to Mein Kampf which translates to My Struggle. After H...

Dawn by Elie Wiesel Essay -- Dawn Elie Wiesel Essays

Dawn by Elie Wiesel In this report you will see the comparisons a middle the novel Dawn and the life of Elie Wiesel, its author. The comparisons are very visible once you learn about Elie Wiesels life. Elie Wiesel was born on September28,1928 in the town of Hungary. Wiesel went with a lot of hard times as a youngster. In 1944, Wiesel was deported by the nazis and taken to the submerging camps. His family was sent to the town of Auschwitz. The father, mother, and sister of Wiesel died in the concentration camps. His older sister and himself were the only to survive in his family. After surviving the concentration camps, Wiesel moved to Paris, where he studied literature at the Sorbonne from 1948-1951. Since 1949 he has worked as a foreign correspondant and journalist at various times for the French, Jewish, periodical, LArche, Tel-Aviv newspaper Yediot Ahronot, and the Jewish daily forward in New York City. Francois mauriac the Roman Catholic Nobelest and Nobel Laureate convinced W iesel to speak about the Holocaust. Wiesel wrote an 800 page memoir which he later edited into a smaller version called Night. In the mid 60s Wiesel spoke out a lot about the Holocaust. Later on Wiesel emerged on as an important moral voice on Religious Issues and the Human Rights. Since 1988 Wiesel has been a professor at Boston University. Some of Wiesels greatest novels has been Night, Dawn, The Accident, The Town Beyond The border, The Gates Of The Forest, The Fifth Son...

The Influence Of CAD On Society Essay -- essays research papers

Before computers there were hands and tools. Before hands and tools there were just hands. human being keep back always been designing and throughout human history drafting is what became of it. With new technology in building during the earlier years drafting demand to be changed to accommodate it. Humans have always been able to find better ways to accomplish things. Drafting is no different.Before people apply tools to draw something they went to what we call now a General Contractor with an idea and he had to come up with the rest. After a while the contractors wanted more. retributive an idea wasnt enough for them. Their clients sometimes wouldnt like what they had built for them. So eventually the contractors asked the clients to tell them exactly what they wanted. Since it was hard to sketch accurately, tools were developed to serve them in drawing. This enabled the client to show the contractor exactly what he wanted.As the population grew rapidly the demands for faste r and more accurate plans did also. Once again drafters looked for a new way to draw. They decided to turn to the computer. In the 1950s MIT discovered the capability to display a computer-generated image on the screen (Zandi, 5). Up until the middle to late 1970s drafters used this technology just for mathematical calculations (Goetsch, 23). Then they discovered that the computer could be used to display more than just numbers. They institute that they could use it to draw on. It wasnt until the early 1980s that this new technology caught on (Goetsch, 23). Drafters found that using computers was much quicker, more accurate, and much neater than hand cadaverous plans. They had found their solution, Computer Aided Drafting and Design or CADD.Now that CADD has found it way into drafting it has been improving upon drafting greatly over the erstwhile(prenominal) 20 years. Today nearly all firms use CAD (Friedman). It has changed the way people go about their drawing and designing pr ocess. The variety of new programs has make everything more accurate, there are umteen more ways to think towards a problem, and the process of fast tracking has come about. It has changed the society in many ways.Whether using CADD or drawing a project traditionally, drafters always start off with a sketch. When brainstorming ideas i... ... in the office (Friedman). People sometimes have conflicting ways to go about something but in the end it all looks the same (Friedman).The human beings inherent slowness and inaccuracy in performing manual drafting tasks such as lettering, line work, and scale work, coupled with the ever increasing demands for higher levels of productivity, led to the wide scaled development of CADD (Zandi, 4). Drafting has been square off by CADD over the years and so has technology. The more we rotter do by drafting the more we can accomplish technologically. CADD has allowed us to accomplish these things. It devises a different way of thought process. ( Friedman) And like the railroad, electric light, or the car it will eventually alter our economic structures, our social systems, and our daily living. IBMs best thinking on this matter is that the computer did not turn out to be primarily a computational mechanism but is for many different things (Zandi, 22). CADD allowed us to design something as complex as a skyscraper and it allows us to create many other complex things. (Grad, 17) Many things are still to come of CADD can we can only await to see how it will change or society and our drafters more.

Essay --

Mara SalvatruchaMara Salvatrucha, otherwise known as MS-13, is quite possibly one of the most wellspring known and most notorious street face packs in the existence. Beginning in the poor immigrant streets of Los Angeles in the 1980s, the gang has spread like wild fire across not only the United States, but across the world, from Alaska to Spain (Tkach & Parker, 2006). Originating in Los Angeles, California, MS-13 was founded by refugees from El Salvador. Mara is a Central American term for gang salva refers to El Salvador, trucha, meaning trout in English, for something that is clever, or sharp. MS-13 is also known as the Salvadoran Army Ants. After MS-13 spread from their birthplace in Los Angeles across countries, their activities helped make the disreputable Northern Triangle Guatemala, El Salvador, and Honduras, as the most violent place in the world that is not at war (Dudley, 2013). Mara Salvatrucha has been named one of the worlds most dangerous gangs due to their origin s, growing population of the gang, the brutality of their crimes, the signs and famous tattoos Mara Salvatrucha is known for, the prison life hiding the leaders, and the evolution into nonionic crime. Starting with civil wars of El Salvador, Guatemala, and Nicaragua, refugees traveled northbound to Los Angeles. In 2012, the United States Treasury segment named MS-13 as a transnational criminal organization. The Treasury Department gave insight on details about how truly powerful MS-13 is, including that the gang is involved with drug trafficking, kidnapping, human smuggling, sex trafficking, murder, assassinations, racketeering, blackmail, extortion, and immigration offenses (Dudley, 2013). Mara Salvatrucha has been placed with the Zetas from Mexico, ... ... from Mexico, Italys Camorra, and the Japanese Yakuza, confirming that Mara Salvatrucha is one of the most dangerous gangs. When a member is sentenced to prison, it is beneficial for the member because they learn criminal and gang knowledge by the veterans of MS-13 that reside in prison. Learning the graffiti, the hand signals and stacking, the tattoos and their meanings, obtaining information from different cliques can all be obtained due to members of MS-13 going to prison. While America sits and continuously deports MS-13 gang members away from the States, they are spreading the terror to other countries. Now, in El Salvador, this country is seeing more rage now due to the gang violence than they did when they were going through civil war. Ironically, the civil war is what drove refugees up to Los Angeles and what became the birth place of Mara Salvatrucha.

Technology and the Media Essay -- social issues

Technology and the MediaIn this essay, British historian and broadcaster Asa Briggs looks at how technological advances made in recent decades have created a revolution in the media, allowing people to communicate in shipway they had never dreamed of. Briggs notes that although these sunrise(prenominal) modes of communicationincluding the television, the personal computer, the Internet, and other digital technologiesare available by dint ofout many parts of the universe, these media may be used in different ways depending upon the prevailing political and social circumstances. Briggs also raises questions about the future of the media and how the unfolding media revolution pass on affect peoples lives.Technology and the MediaThe sense that the world is in the middle of a continuing communications revolution has been strong since the 1960s when television made its great breakthrough. It was then that the Canadian writer on communications, Marshall McLuhan, made his memorable stat ements that the medium is the message and that the world was becoming a global village. It was then too that the word media became part of daily speech, finishing not only electronic media, live television, but older print media, particularly the press.Comparisons were drawn between the progress and the development of television in the twentieth century and the advent and diffusion of printing in the 15th and 16th centuries. Yet much had happened between. It was not until the 19th century that the newspaper became the dominant pre-electronic medium, future(a) in the wake of the pamphlet and the book and in the company of the periodical. It was during the 19th century also that the communications revolution speeded up, beginning with transport, the railway, and leading on through the telegraph, the telephone, radio, and motion pictures into the 20th-century world of the motor car and the airplane. Not everyone sees that process in perspective. It is important to do so.It is general ly recognized, however, that the introduction of the computer in the 20th century, followed by the invention of the integrated circuit during the 1960s, radically changed the process, although its impact on the media was not immediately apparent. It now became possible to combine thousands, later millions, of individual transistors on a single chip. Computers became smaller and more powerful. They became personal... ...iafrom books to motion pictures and from cable to satelliteendanger individual freedom? Will the opportunity of choice, clefted to individuals, mean that the field of choice will be genuinely widened? May we not have more and more of the same thing?It is logical to separate out questions relating to technological developments from questions relating to ownership and control, but, in practice, visions of the future world involve bringing them together. It is difficult in present circumstances to avoid the blurring of image (seeing the world as it is presented to us o r as we present it to ourselves) and reality. Can truth survive? The media in their mediation can create what has come to be called virtual reality and Internet can offer fantasy ways of escaping from the restraints of life as it is lived to a world of cyberspace. Cyber words have multiplied during the 1980s and 1990sfrom cybernaut to cyborg through a entire new vocabulary.It may well be that through an effort to chart the words that we use, and the dates when they were first used, we can achieve a greater understanding of a continuing historical process that encompasses the future as well as the past.