Five Generation Models Free Essay Example, 2000 words

The paper tells that each of the first five generation models seemed to focus mainly on one part of the innovation process and yet for success to be achieved, one has to incorporate the full cycle without preference. Key elements to put into consideration in the journey to exploit the whole cycle is aiming at boosting competitiveness and financial security. The First Generation Model (Technological Push) describes innovation as being pulled by technological needs. Innovation in the technological field has to be a continuous process. This is the bit that makes all the difference as there are companies that can keep up and those that cannot. A form of discontinuity in innovation may destroy a company s competitiveness, Hamel. He describes innovation capability as a means by which inventive productions can be facilitated. Consistency is therefore very essential in this model, a company needs to have proactive innovators to fuel the novelty. Time is an important factor to consider in th e whole process. Decision making is therefore put on a timeline. Exploitation of knowledge is what defines innovation capability, utilization of knowledge in a particular technological field leads to the perfect execution of an idea. We will write a custom essay sample on Five Generation Models or any topic specifically for you Only $17.96 $11.86/page These two aspects combined effect is often underestimated and it may lead to the representation of different bases for the same delivering value. For example, telegraphy versus the telephone.

Theme Of Redemption And Good Country People By Flannery O...

Flannery O Connor s stories â€Å"A Good Man Is Hard to Find†, and â€Å"Good Country People† both present very similar themes. Within these stories is the theme of redemption, and the way relationships affect the way people interact with each other seem to be a core issue she struggles with. Both stories have a protagonist that have to deal with some type of villain who has little to no belief, while their presence of faith that there is good in people gets them into the horrible situations that they find themselves in. She uses some of the same aspects in both stories in very different ways. The characters are a big part of her stories, the conflicts that arise in the story, and the symbolism that is used. This paper will explore how faith can lead us to have false hope and why it is important to remain aware. In both stories there are seemingly different protagonist. First there is Hulga. She is someone that rude, harsh, with Doctorate in Philosophy, and is appalled by the idea of love. Then you have a grandmother, who is always looking back on the old days and a slight sense of wonder. From what O Connor gives the reader in their descriptions, there is not much similarities happening. However, under the surface of these characters the reader can see that both characters are somewhat shallow and do not see this about themselves. Hulga, even though she is highly educated she is a believer in nothing, all she knows is what to say and when to say it. This becomes obvious whenShow MoreRelatedA Good Man By Flannery O Connor1795 Words   |  8 PagesJada Brandon 11-26-2015 English 261 Final exam A Good Man is Hard to find in this Story Considered as one of the best short story authors in her era, Flannery O Connor wrote many short stories before her death in 1964. A faithful Catholic, religion was a primary theme in her works; she wrote mostly about southern life with religious themes recurring in her work. One of her most famous stories was the 1955 short story A Good Man Is Hard to Find. The story depicts the heartless execution ofRead MoreEliot s The Love Song Of J. Alfred Prufrock1777 Words   |  8 Pagesthe character T.S. Eliot creates in â€Å"Prufrock.† What aspects of early twentieth-century society does the speaker of T.S. Eliot’s â€Å"The Love Song of J. Alfred Prufrock† represent? â€Å"The Love Song of J. Alfred Prufrock† by T.S. Eliot is a poem about a man who is extremely insecure with himself. Prufrock, the main character, obviously has major insecurity issues especially when it comes to women. He is very awkward and does connect well with anyone in society. He is a very lonely character that shows

Where Women Lead The Show †Renoir’s Acrobats At The Cirque Fernando, 1879 Free Essays

Pierre-Auguste Renoir’s Acrobats At The Cirque Fernando, 1879 shows two young girls, most probably between twelve and fifteen years of age, taking turns to perform their act at the circus. One of the young girls is carrying balls around her chest while the other is communicating with the audience as part of her act. The girl who is communicating with the audience has a questioning, innocent expression on her face. We will write a custom essay sample on Where Women Lead The Show – Renoir’s Acrobats At The Cirque Fernando, 1879 or any similar topic only for you Order Now The one who is carrying balls is possibly waiting for her turn to perform. She, too, is innocent and fresh in appearance as the other. However, she seems to be dwelling on her new experiences of semi-adulthood. Perhaps she is musing on the boys in her life – the young men who admire her very much. The audience depicted in the painting, behind the bodies of the two young girls, appears to consist of men alone after all. The men appear like judges, in their black coats, giving them the semblance of uniformed officers. Only one of the men has his face visible through the painting, and the face is hard enough for the girls to display their innocence in all its glory with the assumption that the counterpart of a harsh and doubtful attitude must be softness. Although the girl carrying the balls has her back turned toward the hard faced man, she knows that she too would have to perform. The expressions of the male and the females in Renoir’s Acrobats At The Cirque Fernando, 1879 are rather similar to the expressions of the two sexes depicted in many of the artist’s works of the time. The woman is seen as the adored and innocent object that performs, even though the man is hard faced, perhaps weary of the work that he performs to fend for his family day after day. The woman is the amuser, the muse, and the object of entertainment to fend for. After all, she is beautiful. The only beautiful facet of the man is that he is strong – in Renoir’s paintings, at least. What is more, the man is always staring at the woman in Renoir’s works. He fondles her whenever he has the chance. The woman remains faithful to him – this is depicted through the innocence on her face. If she becomes unfaithful she knows that the hard faced man would discontinue supporting her. The French word for ‘thank you’ is merci, which, if used in English, perfectly describes the attitude of the woman in late nineteenth century Paris. Although Paris was one of the first places in the west where women were generally believed to have been liberated, Renoir’s painting reveals that the women were definitely not liberated through promiscuity or debauchery. Rather, the urban Parisian women in the late nineteenth century seem to have been given permission by their men to be out and about, entertaining them, while remaining faithful to their innocence as well as their marital vows. As the facial expression of the young girl carrying the balls in Renoir’s Acrobats At The Cirque Fernando, 1879 reveals – women understood their position in Parisian society even as they were aware that men and women are equally dependent on each other. Perhaps they also knew that men could turn violent against the woman – the epitome of mercy – and that their partners may very well become harsh and cruel if they were not obeyed according to divine laws that are believed to demand that they become subservient unto men. Although these beliefs continue to be nurtured in many parts of the world, Renoir’s Acrobats At The Cirque Fernando, 1879 is a reminder that divine laws may have been misconstrued as well! How to cite Where Women Lead The Show – Renoir’s Acrobats At The Cirque Fernando, 1879, Papers

Professional Development

Question: Discuss about the Professional Development. Answer: Introduction In todays more complex and challenging business environment, personal and professional development is essential in order to accomplish the goals and objectives of the business organizations in an effective and a more comprehensive manner. On the other hand, in current, each and every organization is focusing on the professionalism in the organization. Moreover, most of the organizations are also conducting personal and professional development training programs for the overall development of their employees. In addition to this, in current, healthcare organizations are mainly focusing on professional development training programs in order to enhance quality of healthcare and professionalism of nurses within the organizations. Apart from this, this research paper would be helpful to argue the relevance of professional development to enhance quality of healthcare and professionalism of nurses. Moreover, this paper would also be beneficial to describe the major factors that drive person al and professional development relevant to the field of work. Along with this, the paper would also be advantageous to describe the importance of personal and professional development to provide quality healthcare and nursing cares. As well, the paper would be helpful to explore the local, national and global influences that have an impact on professional development in both positive and negative way. Furthermore, the paper would also be useful to explain the impact of professional development on current health care organization and service delivery. On the whole, this research paper would be valuable to explore the importance of professionalism within the healthcare organizations. Exploring Professionalism in their Own Organization Professional Development to Enhance Quality of Healthcare and Professionalism of Nurses Giri, Frankel, Tulenko, Puckett, Bailey, and Ross (2012) describe that, nowadays, professional development has become a major factor of success for the healthcare organizations. It is because of professional development plays a significant role to improve the learning power and to enhance the knowledge and skills of employees that are essential in order to deliver professional services to the patients and clients. Along with this, professional development also plays an important role to ensure that the workers of the organizations are continued to be competent in their profession (Giri, Frankel, Tulenko, Puckett, Bailey, and Ross, 2012). Moreover, professional development is also helpful to ensure that capabilities and skills of the employees keep pace with the current standards of the organizations. In addition, professional development is also important to make sure that knowledge of employees is up to date and relevant as per the requirements of healthcare organizations. And so, i t can be said that, professional development plays a critical role in order to improve the quality of health care as well as nursing care in an effective and a significant manner (Motacki, and Burke, 2016). In the view of Bose, Oliveras, and Edson (2001), professional development also plays a vital role in order to enhance professionalism on nurses. It is true that, professionalism in nursing is an important component in order to accomplish a healthy work environment or workplace. In other words, it also can be said that, professionalism has become a critical quality for nurses to possess. Professionalism has need of honesty, integrity, concern, a commitment to keep medical advances, an aptitude to communicate with patients effectively, and esteem for patient autonomy. Moreover, in recent years, due to changes in health care delivery and technological advances, nursing professionalism has received increased attention (Bose, Oliveras, and Edson, 2001). Alidina (2013) states that professional development plays a major role in order to deliver a deeper considerate of what it means to be a professional within the healthcare organizations. Professional development also provides the changing trends and directions that are essential to nurses in their profession. Moreover, professional development also plays a significant role to make the nurses social in order to perform their roles, responsibilities, and practices in an effective way. Professional development also develops the knowledge, skills, and advanced technologies within the profession of nurses (Alidina, 2013). As a result, it can be said that, professional development plays a significant role to enhance quality of healthcare and professionalism of nurses. Major Factors That Drive Personal and Professional Development Relevant To Field of Work Betancourt, Green, and Carrillo (2002) describe that there are a lot of important factors that drive personal and professional development relevant to the field of work. In the context of healthcare, personal factors and environmental factors are the major factors that drive personal as well as professional development within the healthcare organizations. These factors are described as below: Personal Factors: There are lots of personal factors that drive personal and professional development within the field of work. For case, personal well-being (quality of life, balance between personal professional life, stress, depression), individual characteristics (motivation, integrity, work ethics, personality traits), and interpersonal qualities skills (communication skills, cynicism, compassion) are the major personal factors that compel personal and professional development within the field of work. The main reason behind it is that personal and professional development improves the knowledge, skills, and abilities of the employees and also motivates them to work according the ethics and standards of the healthcare organizations (Campbell, Silver, Sherbino, Cate, and Holmboe, 2010). Moreover, personal and professional development also plays a significant role in order to maintain balance between personal and professional life of people and to reduce the level of stress in a n effective and a more comprehensive manner. Environmental Factors: There are numerous environmental factors that also oblige personal and professional development within the field of work. For case, organizational culture (focus on need of patient, organizational relationships with industry, relative value placed on patient care), formal/informal curricula on professionalism (mentoring, training, organizational policies), and practice characteristics (specialty, autonomy, work content, workload, patient characteristics environment) are the major environmental factors that drive personal and professional development within the healthcare organizations (Betancourt, Green, and Carrillo, 2002). These environment factors play a major role in order to provide proper training to the employees and also motivate to work as per the pre-determined value of the organizations. In this way, it can be said that personal factors and environment factors are the major factors in the area of health care that coerce personal as well as professio nal development relevant to field of work. Also, these factors create a difference between the personal and professional life of people, so they can be alive their personal life accordingly and can perform their professional duties or responsibilities without any stress or depression (McCaffrey, 2012). Importance of Personal and Professional Development Importance of Personal and Professional Development to Provide Quality Healthcare and Nursing Cares Encourage (2012) says that, in current, professionalism and personal professional development plays an important role to provide quality healthcare and nursing cares in an effective and an appropriate manner. The personal and professional development plays an important role to make sure that doctor and nurses are able to performing as per the medical competence and clinical performance. Along with this, with the help of the professionalism, they become able to perform their ethical as well as professional responsibilities and also provide surety that the medical care they are providing to patients is protected and totally based on the valid scientific evidence. In support of this, Davys, and Jones (2007) state that personal and professional development plays a critical role to improve the performance of the people. For case, with the help of professionalism, people become more sincere and professional in their relevant field of word. Moreover, personal and professional development a lso plays an important role to offer more innovative ways to work and consequently, it improves the quality of healthcare in an automatic manner. Filipe, Silva, Stulting, and Golnik, (2014) describe that personal and professional development plays a significant role in order to improve the quality of nursing cares. As it is well known that nurses plays a significant role in order to deliver safe quality care to patients. In this situation professionalism and professional development motivates nurses to take part in ongoing competence, continuous education, and development activities in order to improve the safety as well as quality of care that they offer to the patients. In this way, it can be said that personal and professional development play a crucial role in order to provide the quality healthcare as well as nursing cares in an effective and a more comprehensive manner (Chism, 2010). Local, National and Global Influences That Have an Impact on Professional Development Brown, Belfield, and Field (2002) describe that, in todays more complex era, the local, national and global influences have an impact on professional development. For case, political, cultural, religious, etc. are the major local, national and global influences that have an impact on professional development in both positive and negative way. Health care policies and professional development training programs that are made at global, national and local levels are easily understandable by all the people of the organizations. As a result; doctors and nurses become able to follow all the instructions in an effective way and also provide safe as well as quality care to the patients. According to Geissinger, and Lloyd (2001), cultural and religious factors or influences have negative impact on professional development. It is because of an organizations consists people of different culture and religion. In this situation, it is very difficult for the people to be agreed on a common thing. In that case, health policies or decisions that are developed at global, national, and local levels often become a matter of debate for the healthcare organizations. In this way, these cultural and religious factors influence the professional development in a negative way. Impact of Professional Development on Current Health Care Organization and Service Delivery In current, professionalism and professional development is considered a key of success for the business organizations. Along with this, professional development also plays a significant role in order to accomplish the personal goals in a pre-determined time period. Professional development has become a major component of all the health care organizations (Porch, 2007). In other words, it can be said that, professional development has numerous positive impact on current health care organization and service delivery. For case, professional development plays a significant role in order to motivate doctors and nurses to upgrade their knowledge, improve patient care, and develop professional relationships to provide safe care to patients. On the other hand, professional development also plays a critical role in order to develop mutual trust between the healthcare providers and patients. Moreover, professional development also improves practices as well as self-esteem within nursing cares so they can provide quality services to the customers. In addition to this, professional development describes all the activities (formal and informal) that are essential to health care providers in order to develop, maintain, update, and improve their professional proficiencies, attitudes, and knowledge in an effective and an appropriate manner (Hinchliff, Norman, and Schober, 2008). Along with this, professional development also plays a critical role in order to expand knowledge as well as skills and to enhance personal professional efficiency of healthcare providers. In this way, it can be said that, in current professional development has changed the overall structures of the healthcare organizations. In current, with the help of professional development, the healthcare organizations have become able to provide safe as well quality care and service delivery to patients on time (Rebeiro, Jack, Scully, and Wilson, 2014). Consequently, it can be said that, professional development has been provided a new path of success to the health care organizations. Conclusion On the basis of the above discussion, it can be said that, in current, professional development has played a significant role in order to improve quality of healthcare and professionalism of nurses in an appropriate way. Moreover, it should also be noted down that, professional development has positive impact on current health care organization as well as service delivery. Along with this, it can also be observed that, professional development has been improved the nursing practices, skills, aptitudes, and knowledge in order to improve the quality of care and service of the healthcare organizations in an effective and a significant manner. References Alidina, K. 2013. Professionalism in post-licensure nurses in developed countries. Journal of Nursing Education and Practice, 3(5), p.128-137. Betancourt, J.R., Green, A.R. and Carrillo, J.E. 2002. Cultural competence in health care: Emerging frameworks and practical approaches (Vol. 576). New York: Commonwealth Fund, Quality of Care for Underserved Populations. Bose, S., Oliveras, E. and Edson, W.N. 2001. How can self-assessment improve the quality of healthcare. Operations Research Issue Paper, 2(4), pp.1-27. Brown, C.A., Belfield, C.R. and Field, S.J. 2002. Cost effectiveness of continuing professional development in health care: a critical review of the evidence. Bmj, 324(7338), pp.652-655. Campbell, C., Silver, I., Sherbino, J., Cate, O.T. and Holmboe, E.S. 2010. Competency-based continuing professional development. Medical Teacher, 32(8), pp.657-662. Chism, L.A. 2010. The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues. Jones Bartlett Publishers. Davys, D. and Jones, V. 2007. Peer observation: a tool for continuing professional development. International Journal of Therapy and Rehabilitation, 14(11), pp.489-493. Encourage, I.I.D. 2012. Quality improvement training for healthcare professionals. Health Foundation, p.1-52. Filipe, H.P., Silva, E.D., Stulting, A.A. and Golnik, K.C. 2014. Continuing professional development: Best practices. Middle East African journal of ophthalmology, 21(2), p.134-141. Geissinger, H. and Lloyd, P. 2001. Continuing professional development for rural and remote health care practitioners. In 6th National Rural Health Conference Good Health-Good Country from Conception to Completion (pp. 4-7). Giri, K., Frankel, N., Tulenko, K., Puckett, A., Bailey, R. and Ross, H. 2012. Keeping up to date: Continuing professional development for health workers in developing Countries. Intra Health International. Hinchliff, S., Norman, S., and Schober, J. 2008. Nursing Practice and Health Care 5E: A Foundation Text. CRC Press. McCaffrey, R. 2012. Doctor of Nursing Practice: Enhancing Professional Development. F.A. Davis. Motacki, K., and Burke, K. 2016. Nursing Delegation and Management of Patient Care. Elsevier Health Sciences. Porch, R.A. 2007. Must-have Information for Nurses about Quality and Patient Safety. Joint Commission Resources. Rebeiro, G., Jack, L., Scully, N., and Wilson, D. 2014. Fundamentals of Nursing: Clinical Skills Workbook. Elsevier Health Sciences.

“Words that Wound” Summary and Reaction Essay Example

â€Å"Words that Wound†: Summary and Reaction Paper â€Å"Words that Wound† by Kathleen Vail Words that Wound by Kathleen Vail is an essay about the effects of bullying on students in American schools. The essay starts with a re-enactment of Brian Heads public suicide. Brian was apparently being bullied in school and resolved into committing suicide to escape the torture. Statistics of how many students are bullied are then showed afterwards, claiming that the performance in class of a staggering number of students is affected by bullying. Despite the statistics, authorities have not paid much attention to bullying, prompting William Head, the father of Brian, to start an advocacy against bullying. However, even with Mr. Heads efforts, bullying continues in their area. Teachers often ignore the abuse that is going on in campus, and some of them even think it is part of the learning that the school provides. As a result of the fatal bullying incidents in Georgia, the state has passed an anti-bullying law. Reactions My first reaction to the essay based on the opening paragraph is that it reminds me a lot of the Pearl Jam music video Jeremy. We will write a custom essay sample on â€Å"Words that Wound†: Summary and Reaction specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on â€Å"Words that Wound†: Summary and Reaction specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on â€Å"Words that Wound†: Summary and Reaction specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Jeremy in the music video also committed suicide in front of his classmates. There is reason to believe that the video is partly inspired by the incident mentioned in this essay, although it is not really clear. My second reaction is that I am surprised that there are people who would take their own lives just because of bullying. I know kids can undergo physical and emotional suffering, but I dont think it is enough reason to commit suicide; I believe that there is no reason in the world to commit suicide. I may be just saying this either because I never experienced bullying or I am just really optimistic in life. At any rate, I agree with one of the teachers in the essay that bullying is partly the victims’ fault. Bullied students should not allow themselves to be bullied. They should stand up for themselves even if the bullies are physically superior. Resistance, no matter how futile, can have some positive effects. Reference Vail, K. (1999). Words that Wound. American School Board Journal, 186 (9), 37–40.

Review of Pans Travail essays

Review of Pan's Travail essays J. Donald Hughes, Pans Travail, (Baltimore, 1994), 277 pp. Oddly enough, there is little biographical information available on J. Donald Hughes. His special interest in the Mediterranean and sacred groves is evidenced by the numerous books and articles he has published on the subject. He is multilingual, fluent in German, Greek, and Spanish with basic skills in French and Russian as well. He received his doctorate in History from Boston University and then taught at several different colleges. He is currently a History professor at the University of Denver, and the author of eight other books and articles about environmental history. The first four chapters (out of eleven total) are dedicated to providing the reader with background information. Hughes gives an overview of environmental history and ecology as a whole, preparing the reader to narrow the focus of these concepts to a single area: the Mediterranean Basin. He also describes this region and discusses why it is such a unique ecosystem. Not only are climate, land, and sea addressed, but a charming section on the different winds of each section of the region is also included. Pre-history is touched upon, and Hughes examines Egyptian and Mesopotamian societies and their relationships with nature. By showing how each city dealt differently with the flooding of their respective rivers, Hughes illustrates two opposing views towards nature. Literary evidence shows how Greek and Roman religion viewed the world as a sacred place. This contrasts with the view eventually offered by such philosophers as Aristotle which placed nature in hierarchical order, with plants exist[ing] for the sake of animals, animals for the sake of man, and...inferior men [as] natural slaves of the superior (60). These four chapters effectively give the reader enough information about the basis of Greek and Roman society to understand the following arguments regarding the...

Learning Style Essay Example | Topics and Well Written Essays - 500 words

Learning Style - Essay Example Learning styles are unique aspect of a learner’s initiative to gain new knowledge and are important as basis for the mode of instruction that should be used. Learning Styles and Kinesthetic Learner Experiences The VARK questionnaire is a multiple choice type of test which provides questions about normal day-to-day activities which aims to identify the test taker’s learning style. Learning styles are â€Å"biological and developmental set of personal characteristics that make the identical instruction effective for some students and ineffective for others† (Dunn & Dunn, 1993, as cited in Dunn & Griggs, 1998). All answers are to be evaluated which would be the basis of the type of learning style the test taker prefers. There were items in the questionnaires in which I have to check two choices, but most of the time, I choose the answers similar or close to what I usually do. The answers are mostly involving body movements and actual involvement of the activity. In other words, I usually prefer to learn by doing it myself or with the guidance of others. As expected, I came about with the result â€Å"kinesthetic learner† which I think is very true according to my previous learning experiences.

American Architecture in the Gilded Age Essay Example | Topics and Well Written Essays - 1000 words

American Architecture in the Gilded Age - Essay Example The researcher of this essay focuses on the discussion of The Gilded Age, that is a term that came to reflect the time of the greatest economic, territorial, industrial, and population expansion in American history. It was Mark Twain who gave us the Gilded Age, a novel that humored this period and most importantly portrayed its people , the time and the structures that can only be measured in the standards of opulence and fast transformations. The researcher states that although there are two sides on this term as it was coined as a satire, the period, which started from 1876, indeed, marked an epoch whose achievements are felt in the great men it has produced and the monuments that would influence what is to be the modern American architecture. Thus, it is not surprising to know that the â€Å"Gilded Age† provided a period of dynamism in the area of American architecture, that is a main focus of this essay. Firstly, the researcher discusses the Chicago World Fair of 1893 or m ore popularly known as the Columbian Exposition, that brought together the brightest minds of the â€Å"Gilded Age† in the field of architecture. Seconsly, the researcher discusses The Central Park, also called as â€Å"the Greensward,† designed by Frederick Law Olmstead and Calvert Vaux and was build in the 19th century. The researcher then concluds that architecture provides us not only an unparalleled insight if we are to study a society, but also an era or history as a whole and a sphere that will shape the history and the public.

The Level of Empathy in Waste Land Essay Example | Topics and Well Written Essays - 750 words

The Level of Empathy in Waste Land - Essay Example The task of having to go through the process of capturing events on film without instigation to preserve objectivity is one that is an integral part of the entire process. At the same time, to be able to keep in mind that they are working with people yields the necessity of participating. The fact that Muniz was already involved and is in charge of the process gives the filmmakers the chance to encapsulate the interaction between the world-renowned Brazilian contemporary artist and his advocacy to help. As the director herself has pointed out, â€Å"There’s no limit to the responsibility you have as a documentary filmmaker to portray ordinary people. I think it’s fantastic that in the film, you see Vik arguing with his wife about whether to bring to London or not for the auction† (Steinberg, n.p.). This scene actually built the most tension and a thought-provoking one in fact as both sides have equally persuasive arguments. The level of empathy that was instilled throughout the documentary set out the emotional flow that enabled to send its message across. Near the end of the film, the audience sees Muniz in a pensive mood contemplating how his life could easily have been in the same direction as the garbage-pickers. â€Å"Vik Muniz diligently cleared a trail for himself, which he studied, expanded, and further elaborated, until gleefully setting a distinctive course for his work† (Amaral, par.2). This may have been the case but his life has been one of amazement from the cause which led him to New York to his success as a modern artist. Halfway through the film, any viewer would realize that the story is not about him and how he helped the poor people of Brazil. No, right after Isis’ posing for the camera one immediately realizes that there is more than charity that fuels it.

Ganglioneuroblastoma During Pregnancy †Case Report

Ganglioneuroblastoma During Pregnancy – Case Report Rare case of ganglioneuroblastoma during pregnancy – case report Abstract Ganglioneuroblastoma is a very rare tumor, especially in pregnancy. So far the association between this tumor and pregnancy has not been reported. We present a case of ganglioneuroblastoma relapse at a 3rd trimester pregnant woman. Neurological symptoms developed late, increased by the effects of pregnancy on the brain tumor. Therapeutic management in this case represents a medical dilemma regarding mode setting and timing of delivery, taking into account the maternal-fetal risk-benefit. In this case caesarean section under general anesthesia was settled, with the need of postpartum brain tumor excision. Keywords: ganglioneuroblastoma, pregnancy, treatment, caesarean section Introduction Ganglioneuroblastoma is a neuroblastic tumor containing malignant elements characteristic to neuroblastoma and benign elements found in ganglioneurinoma (1). Intracranial tumors are extremely rare in pregnancy (2). By their rarity and their diagnosis in the last trimester of pregnancy, intracranial tumors have an increased risk of maternal and fetal morbidity and mortality. Cranial tumors tend to increase and become symptomatic in the last trimester of pregnancy, the causes not being entirely known. Therefore any woman with an existing neurological condition should consult her obstetrician and her neurologist before she becomes pregnant (3). Management of these cases should evaluate whether the mothers and the fetuss lives are threatened. A multidisciplinary team recommends the optimal timing for the termination of pregnancy, as determined by the fetus maturity and mothers neurological condition (4). The present study reports one case of pregnant women in the third trimester with ganglioneuroblastoma. The patient underwent caesarean section under general anesthesia at 36 weeks gestation with favorable postoperative evolution. So far, there are no well-established protocols regarding the management of intracranial tumors (especially ganglioneuroblastoma) in pregnant women. Case report I.A., 20-year-old woman, G1P1L0, was admitted to our hospital due to weak, irregular uterine contractions in her 36th week of gestation. Patient’s history: in 2005 the patient was diagnosed with right parietal lobe ganglioneuroblastoma. She had undergone surgery followed by radiochemotherapy and anticonvulsive therapy with phenytoin for about one year with favorable outcome. Six years following resection, the patient had no radiologic recurrence. The pregnant woman was taken out by a gynecologist in the first trimester of pregnancy, with the usual analyzes of pregnancy, ultrasound and regular prenatal checkups without objective neurological signs until the 3rd trimester of pregnancy. Therapeutic attitude assumed identification of neurological symptoms in order to determine the optimal treatment, maintaining a low fetal risk and continuing uncomplicated pregnancy until birth. Methods Investigation protocol included routine tests and imaging tests. Neurological examination revealed vestibular syndrome and nystagmus which recommended contrast MRI. MRI conclusions: In the right parietal lobe, postcentral, viewed a well-shaped image of 32mm in diameter, nongadolinium-enhanced, sequel looking. An area of oedema with irregular outline in white matter was surrounding it. In the right temporal lobe, adjacent to the sylvian seizure, in hyposignal T2 image showed a nodular-shaped tumor of about 7mm in diameter with discrete central heterogenity (gadolinium-enhanced). No perilesional oedema. Ventricular system located on the midline. MRI based neurosurgical consultation has determined that the tumor was operable and stated the need of postpartum surgery (excision of the brain tumor). All fetal biometric parameters studied were below the 10th percentile for gestational age, showing a linear decrease with gestation until the end of pregnancy. The difference between menstrual age and gestational age determined by ultrasound was 3 weeks and 3 days. Estimated fetal weight was 2420 g, which placed the infant in the 6th percentile. The amniotic fluid index was 7.5 cm, confirming the diagnosis of IUGR. The patient had received dexamethasone treatment with double purpose: fetal lung maturation and reduced perilesional cerebral oedema in order to decrease focal neurological symptoms. The association between IUGR, repeated variable cardiotocography decelerations and brain tumor recurrence with emphasized neurological symptoms imposed urgent caesarean section. Medical committee composed of obstetrician, anesthesiologist, neurosurgeon and neonatologist decided caesarean section under general anesthesia, which was performed 5 days after the admission of the patient. Results A 20 year-old patient, I.A., known with operated and radiochemotreated ganglioneuroblastoma eight years earliar, with ongoing pregnancy (36 weeks) was admitted to our clinic for weak uterine contractions and associated neurological symptoms (vestibular syndrome, nystagmus, slightly right motor deficit). She followed a protocol of blood tests, imaging and interdisciplinary consultations establishing the diagnosis of brain tumor, possible relapse of old pathology. Fetal biometry measurements and fetal biological parameters objectified the existence of fetal distress risk of premature birth or miscarriage. Those set the need for preoperative corticosteroid therapy (Dexamethasone) for lung maturation and perilesional brain oedema control and emergency caesarean under general anesthesia. Caesarean section was performed 5 days after admission, without early nor late intraoperative and postoperative complications. It resulted an unique live female newborn, weighing 2670g, 9 Apgar, with physiological vital functions, not requiring special follow-up. Recovery of the mother was complication-free with persistent, constant postoperative neurological symptoms. When discharged, the patient was recommended ambulatory neurosurgical exam to establish the opportunity of surgery targeting the brain tumor. Discussions Ganglioneuroblastoma is a tumor of the sympathetic nervous system that arises from primitive sympathogonia and is composed of both mature gangliocytes and immature neuroblasts and has intermediate malignant potential (5). These tumors are rare. They occur in fewer than five out of one million children each year (6). Ganglioneuroblastomas are extremely rare in adults, with only about 50 cases documented in people over the age of 20, and only five cases observed in the adult brain (7). There are no reports of ganglioneuroblastoma presenting during pregnancy in medical literature (8). Objectification of brain tumor by contrast MRI was necessary to establish the subsequent therapeutic management, although in literature there are â€Å"not enough studies to determine the safe use of contrast in pregnancy (9). MRI is probably the imaging diagnostic procedure of choice and should be performed when a brain tumor is suspected (10). Before pregnancy the patient was declared cured, as no clinical nor radiological tumor relapse existed for six years. It is likely that pregnancy-induced changes have a tumorigenic effect, due to several factors such as fluid retention, increased blood volume and hormonal changes (11). Pregnancy is an aggravating factor for brain tumours on which it acts by three mechanisms: acceleration of tumor growth, increase of peritumoral oedema and the immunotolerance to foreign tissue antigens that is proper to pregnancy (12). Normal physiological changes during the pregnancy, such as increased levels of gonadotropins and augmented fluid volume status may accelerate the growth of some types of brain tumors (13). The combination of oligohydramnios and IUGR portends a less favorable outcome, and early delivery should be considered (14). Treatment of brain tumor in pregnancy requires an integrated multidisciplinary approach, which includes neurosurgery, ophthalmology, radiology, obstetrics, neonatal pediatrics (15). Indication for type of delivery is controversial. The best moment to recommend the craniotomy and the neurosurgical removal of the tumor will depend of the mothers neurological condition, the histological tumor type as well as the gestational age. In a study published in 2011, performed on 10 patients with brain tumors diagnosed during pregnancy, prior to craniotomy, five patients had caesarean sections, two others had vaginal deliveries, in three patients the delivery took place after the brain tumor treatment(16). The caesarean section was made under general anesthesia. Studies have shown that general anesthesia remains safe and dependable for operative delivery in parturients with intracranial tumor. Tracheal intubation allows maternal hyperventilation thereby controlling raised intracranial pressure. Hemodynamic stability is readily achieved to maintain cerebral perfusion (17). Conclusions Ganglioneuroblastoma is a rare brain tumor in childhood, and appears exceptionally in pregnant women. Pregnancy and brain tumor have mutual negative effect on the patient. Brain tumors that develop in pregnant women have to be diagnosed and assessed through MRI, although the effect of gadolinium contrast on the pregnancy is yet unknown and needs further medical studies. The order of obstetrical an neurosurgical treatment of pregnant women with brain tumors requires an integrated multidisciplinary approach, including neurosurgery, radiology, obstetrics, neonatal pediatrics which have to assess all maternal-fetal risks and benefits. Lack of brain tumor reccurence 6 years after currative neurosurgical treatment was not enough to establish that the patient was cured. The patient suffered a brain tumor relapse 8 years after brain surgery probably due to metabolic and hormonal changes induced by pregnancy. References 1.Robertson H.E. Das Ganglioneuroblastom ein besonederer Typus im System der Neurome. Virchows Arch [Pathol Anat]. 1915;63: 147-168 2. Pavlidis NA. Coexistence of pregnancy and malignancy. The Oncologist 2002;7: 279-87. 3. Carmel Armon, Stephen A Berman. Neurologic Disease and Pregnancy. Medscape reference; 8 nov 2012 4. Ducray F, Colin P, Cartalat-Carel S, et al. Management of malignant gliomas diagnosed during pregnancy. Rev Neurol (Paris) 2006;162: 322–9. 5. Lonergan GJ, Schwab CM, Suarez ES, Carlson CL. Neuroblastoma, ganglioneuroblastoma, and ganglioneuroma: radiologic-pathologic correlation. Radiographics 2002; 22: 911-34. 6. Linda J., Vorvick, MD and Yi-Bin Chen, MD. Also reviewed by David Zieve, MD. A.D.A.M. Medical Encyclopedia. Ganglioneuroblastoma; Last reviewed: February 7, 2012. 7. Schipper MH, van Duinen SG, Taphoorn MJ, Kloet A, Walchenbach R, Wiggenraad RG, Vecht CJ. Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands. Cerebral ganglioneuroblastoma of adult onset: two patients and a review of the literature. Clin Neurol Neurosurg. 2012 Jul;114(6):529-34. 8. Manjusha Sanjay Rathi. Ganglioneuroblastoma: First presentation during pregnancy; Program: Abstracts Orals, Featured Poster Presentations, and Posters Monday, June 17, 2013; Kings Mill Hospital, Sutton in Ashfield, United Kingdom 9. Black P, Morokoff A, Zauberman J, Claus E, Carroll R. Meningiomas: science and surgery. Clin Neurosurg. 2007;54:91-9. 10. Awada A, Watson T, Obeid T. Cavernous angioma presenting as pregnancy-related seizures. Epilepsia, 38 (7): 844-6, 1997. 11. Wlody D: Neurosurgery in the pregnant patient. Newfield P, Cottrell J, editors. Philadelphia: WW Lippincott; 1999. 12. Depret-Mosser S, Jomin M, Monnier JC, Vinatier D, Bouthors-Ducloy AS, Christiaens JL, Krivosic-Horber R. Cerebral tumors and pregnancy. Apropos of 8 cases. J Gynecol Obstet Biol Reprod (Paris). 1993; 22(1):71-80. 13. Poisson M, Pertuiset BF, Hauw JJ, Philippon J, Buge A, Moguilewsky M, et al. Steroid hormone receptors in human meningiomas, gliomas and brain metastases. J Neurooncol 1983;1:179-89. 14. Golan A, Lin G, Evron S, Arieli S, Niv D, David MP. Oligohydramnios: maternal complications and fetal outcome in 145 cases. Gynecol Obstet Invest. 1994;37:91–5. 15. Khalil E Rajab, FRCOG, FFFP Nouf Behzad N, MD, Arab Board. Brain Tumor in Pregnancy. Bahrain Medical Bulletin, Vol 35, No 1, March 2013. 16. Lynch JC, Gouvà ªa F, Emmerich JC, Kokinovrachos G, Pereira C, Welling L, Kislanov S. Management strategy for brain tumour diagnosed during pregnancy. Br J Neurosurg. 2011 Apr;25(2):225-30. doi: 10.3109/02688697.2010.508846. Epub 2010 Sep 8. 17. Lily Chang, Lian Looi-Lyons, Lydia Bartosik, Simon Tindal; Anesthesia for cesarean section in two patients with brain tumours. Canadian Journal of Anesthesia. January 1999, Volume 46, Issue 1, pp 61-65 1

student :: essays research papers

Organizations have long sought to provide employees with consolidated desktop access to the various applications, business processes, and sources (both technology and human) required to perform knowledge-based work. But as recently as five years ago, the desktop environment was still woefully inadequate to this task. The ability to access aggregated enterprise information on-demand required a more reflective, process-centric model of desktop computing-that is, if someone were to look over your shoulder as you work, would their view of your desktop reflect the nature of the work (i.e., the business processes) in which you're engaged? The classic desktop computing interface did not allow this kind of on-demand access-much of the integration between information, enterprise apps, and business process still occurred in the "gray matter" between the ears of knowledge workers. The enterprise information portal (EIP) addresses this need.. At their core functional level, EIPs are all about access-a single point of personalized, on-line access to business information and knowledge sources, as well as, increasingly, real-time access to core applications and processes. Key enabling technologies here include advances in security (including sophisticated directory/authentication services), the proliferation of "portlets" or "gadgets" (API-like chunks of code for plugging enterprise apps into the portal), as well as the maturation and widespread adoption of XML (for "active" or "intelligent" content). As the technology behind portals evolves, so do the ways in which enterprises are using enterprise portals to achieve their business goals. Originally adopted by small departments and subsets of employees, the portal concept has expanded to encompass virtually all employees as well as the extended organization's partners and su ppliers. Enterprise portals are reaching all the way out to individual customers, providing them with a personalized view of the organization or enterprise.