Goal: To perform a review of scholarly information on a selected pediatric topic and describe the implications for nursing practice with the pediatric population.
Due Date: Hard copy to be submitted Feb 23, 2016, 09:30 am Rm 3213
Assignment:
• Select a topic of interest that you wish to explore (see Appendix A). You may choose to explore a topic that is not listed; however, you must get approval from your professor in writing prior to the start of this assignment.
• There may be a limitation to the number of students allowed to write about each topic.
• Research literature and theory should be utilized to support the paper. A minimum of 3 scholarly journal articles must be utilized to support the paper. At least 2 of the 3 articles must come from the nursing literature. One article must be a research article related to the topic. A Standard of Practice or Best Practice Guideline may be used as one of the articles.
• The body of the essay will be a maximum of five (5) pages in length, double spaced (12 font), excluding title page, reference list, and appendices.
Essay Components
• Title Page
• Introduction
o Clearly describe the topic/issue and its relevance to pediatric nursing. Develop and articulate clear thesis statement to explore within the paper.
• Discussion of scholarly articles
o Summarize and discuss the information from the selected articles as it relates to your thesis statement. Discuss the relevance to the topic.
• Nursing implications
o Discuss the implications of the evidence to nursing practice.
o Select three Bevis’ nursing tools: Caring, Communication, Problem-solving/decision-making, Teaching, Leadership/Planned Change, Research, or Advocacy. Using the three tools, discuss how the evidence from the three articles selected support the strategies used in nursing practice.
o Three Bevis’ tools must be discussed.
• Conclusion
o Provide a clear, concise summary of your findings and implications
• References
o Include all sources cited in the paper.
o APA 6th edition format (second print)
Essay Guidelines:
? A list of topics and a marking rubric (APPENDIX C) are attached as Appendices.
? All papers must be submitted in a sealed envelope. Include only your student number on the outside as your identification. Please also include the course title and the professor’s name.
? Mandatory elements to include with the essay: title page, reference list, Turnitin™ Originality Report, copies of abstract from reviewed articles
o Copies of the article abstract must be stapled and submitted with the assignment.
? All mandatory elements of the assignment must be included. Late penalties, as described, will be assigned to any incomplete assignment. It is the responsibility of the student to ensure that all requirements are met. Faculty will not check the envelopes at time of submission.
? The body of the essay will be a maximum of 5 pages, (double spaced, 12 font), excluding title page, and reference list.
? APA 6th edition (second printing) format must be followed.
? Grammar and spelling are important. One mark will be deducted for each grammatical or spelling error so please proof read and spell check your paper.
? A scholarly approach to referencing ideas and thoughts of others is required. For any information that is not general knowledge, cite a source both in the text and in your reference list.
? Please review the policies of St. Clair College and of the University of Windsor on plagiarism. Links to the websites are posted on Blackboard™. Plagiarized papers will be dealt with according to these policies.
? Assignments are due on the dates specified unless arrangements are made with the professor at least 5 days in advance of the due date. The professor reserves the right to ask individual students to produce work complete to date, and then decide whether or not it is appropriate to grant an extension.
? The penalty for a late assignment is a 5% deduction per day to a maximum of 25%. After 5 days, the assignment will receive a mark of zero.
o The Turnitin™ originality report is an essential element of the assignment. If it is not submitted, the assignment will be considered incomplete and late until received.
Turnitin™
? This course is using the plagiarism prevention software, Turnitin™. It is the responsibility of the student to turn their paper into www.turnitin.com. (See Appendix B for Turnitin guidelines)
o Class IDs and password information will be posted on Blackboard™.
o If you already have a profile with Turnitin, you can login with your email and click on enroll with this new class ID# 11397145 and password “intervention”. If you are new to this class you must enroll as a new user and then follow with the ID# and password. The course name is Nursing Care of Children and Youth.
o Please be sure to create your user profile by January 23, 2016. You will then have the opportunity to check for plagiarism and correct your paper.
o Each time you make changes to your paper you must re-submit to Turnitin™ so that your final copy matches your Turnitin™ report. Once you are satisfied with your report, you are to print off the results from ‘Turnitin’ and submit with your paper. This is to be submitted as an appendix.
o You must explain each of the percentages reported in the final originality report. Example: If your paper shows plagiarism related to references typed in exactly the same manner as a text, there is nothing you can do about this. You are to reflect that this is a reference in APA format and that it cannot be changed. • Your report may not be 0%. This is acceptable as long as you explain each of the % reported.
o NOTE: When you check for plagiarism, you are able to check in two ways (including references or not including references). Please do both. This will allow you to see the difference as many times the plagiarism results are due to APA references and there is nothing that needs be done with these. You are to hand in a copy with references.
APPENDIX A
Suggested Topics
Note: If there is a topic not shown below in the pre-approved list, that you have an interest in and want to explore, you must get approval from the professor in writing before beginning your paper.
Nursing Practice
• Pediatric Early Warning tools (PEW)
• Effects of hospitalization on [age group – infants, toddlers, …]
• Infection control on a pediatric unit
• Pain assessment in children
• Pain management in children
• Fever management in children
• Medication safety in pediatric nursing
• Atraumatic care
• Camp nursing
• Age-appropriate communication with [age group – infants, toddlers, …]
• Pediatric palliative care
• Cultural competence in pediatric care
• Pre-operative preparation
• School nursing
• Nursing in teen health clinics
Health Promotion
• Vaccination safety
• Anti Vaccine movement
• HPV immunizations
• Dental care for toddlers and young children
• Prevention of obesity
• Breast feeding promotion
• Dating violence
• Prevention of sports injuries (concussion)
• Playground safety
• Bicycle safety
• Pool safety, drowning
• Prevention of smoking initiation
• “Safe sex”
• Marijuana Use
Growth and Development
• Toilet training
• Development of trust in infancy
• Adolescent development – peer group influence
• Precocious puberty
• “Picky eating”
• Sibling rivalry and sibling violence
• Breast feeding promotion
• Children’s understanding of death
• Childhood fears
• School phobia/ school refusal behaviour
• Homosexuality
• Sexual risk behaviours in adolescence
• Separation anxiety
Health Disorders
• Type 1 diabetes – Supporting parents
• Type 1 diabetes – Adolescent issues
• Type 1 diabetes – Prevention of complications
• Type 2 diabetes in children
• ADHD – Medication Use
• ADHD – Behavioural approaches
• Asperger syndrome
• Asthma – Home management
• Sleep disorders in children
• Concussions – long-term risks
• Munchausen syndrome by proxy
• Nut allergies
• Precocious puberty
• Chronic illnesses – support for parents
• Siblings of children with life-threatening illnesses
• Anorexia and/or bulimia
• Obesity in children
• Cancer in children – coping strategies of children
• Ear infections – antibiotic use decision
• Deafness in children
• Blindness in children
• Vomiting and diarrhea in infancy – home management
• Marfan syndrome
• Growth hormone deficiency
• SIDS – Sudden Infant Death Syndrome
• Mental health issues – e.g. mood disorders, suicide
Social Issues
• Health needs of immigrant children
• Child abuse – prevention programs
• Informed consent in children
• Cyberbullying
• Family breakup – effect on children
• Daycare selection
• Toy safety
• Farm safety for children
• Health needs of aboriginal children
• Poverty – effects on children’s health
• Internet safety
• Cultural minority challenges
• Aboriginal children in remote communities
• Adopted children
• Car seat safety
• Water fluoridation
• Transition from pediatric to adult care
• Spanking / physical discipline
• Mainstreaming – special needs children in the school environment
• Shaken baby syndrome
• Children with Incarcerated Parent(s)
Appendix B: Turnitin Introduction
(A student video is also available at ‘turnitin.com’)
This quickstart will help you get started with Turnitin and will walk you through the steps for submitting your first paper. To begin, you need to first register with Turnitin and create a user profile.
! If you have received an e-mail from Turnitin with a temporary password, a user profile has already been created for you. To get started, log in to Turnitin with your e-mail address and password and proceed to Step 2 in this quickstart.
Step 1
To register and create a user profile, go to www.turnitin.com and click on the New Users at the top of the homepage 1.
The new user wizard will open and walk you through the profile creation process. To create a profile, you must have a class ID and an enrollment password. You can get this information from your instructor. Once you finish creating your profile, you will be logged in to Turnitin.
Step 2
Your class will show up on your homepage. Click on the name of your class to open your class portfolio 2.
Step 3
Your class portfolio shows the assignments your instructor has created and your submissions to the class. To submit a paper, click the submit button next to the paper’s assignment 3.
Step 4
The paper submission page will open. Enter a title for your paper. To select a paper for submission, click the browse button and locate the paper on your computer. We accept submissions in these formats:
• MS Word, WordPerfect, RTF, PDF, PostScript, HTML, and plain text (.txt)
After entering a title for your paper and selecting a file, click submit to upload your paper 4.
If your paper is in a format that we do not accept, you can submit it by cut and paste. To submit a paper this way, select cut & paste using the pulldown at the top of the form 5.
To submit a paper by cut and paste, copy the text of your paper from a word processing program and then paste it into the text box in the submission form. If you submit your paper using the cut and paste method,
Step 5
The paper you chose to submit will be shown on the next page. Look over all the information and make sure that it is correct. To confirm the submission, click the yes, submit button 6.
Step 6
After you confirm your submission, a digital receipt will be shown. This receipt will be e-mailed to you. To return to your portfolio and view your submission, click the portfolio button 7.
!By default, students cannot see their own Originality Reports. If you do not see an Originality Report icon in your portfolio and want to see your report, contact your instructor.
If you need further assistance with Turnitin or would like to learn about the advanced features our system offers, please download our student user manual, which is available at http://www.turnitin.com/static/pdf/tii_student_guide.pdf
(Taken from www.turnitin.co
APPENDIX C: RUBRIC FOR 63-277 W2014
Category Superior
100-80 Very Good
79.9-70 Acceptable
Average
69.9-63.0 Minimally Meets
Requirements
62.9-60 Does not meet requirements/
Failing grade
59.9-50 / 49.9-45 Score for Each Section
Topic
Response to the Assignment
Applicable, plausible
Sophisticated insight into concepts within current and future trends. Many new ideas expressed.
Describes new concepts accurately.
Some insight and originality demonstrated.
Uses familiar concepts, offers few new concepts. Response to the assignment is slightly more than adequate. Responds adequately to assignment but with minimal reference to concepts.
Unclear. Lack of comprehensive thought or structure.
/15
Discussion and analysis of scholarly resources
Examples of primary sources evident.
Critiques, analyzes, generates unanswered questions.
Excellent integration of quoted material into paper.
Analysis is fresh and exciting, poses new ways to view material and concepts. Provides rationale for outcomes appropriate for specific contexts using research based professional nursing or related literature.
Quotes well integrated.
Evidence related although points may not be clear. Some examples from the literature used to support points.
Quotes not well integrated.
Analysis offers nothing new, quotes do not relate to analysis
Minimal support from the literature used to support points.
Use of quotes meets minimal expectations for paper.
States concepts and ideas from text with weak attempt at analysis. No evidence of support from the literature referred to.
Quotes “plopped into the paper” Not integrated into sentences in a meaningful way.
No attempt to link evidence to argument.
/30
Implications for Practice – Integration of Bevis’ Tools Makes clear and definitive links to professional implications, related clearly to Bevis’ tools Application to practice described: fair degree of breadth / depth of argument. Explored Bevis’ tools adequately Surface level degree of application. Some effort to link to Bevis’ tools Does not demonstrate application beyond status quo, logic often fails. Weak connection to Bevis’ tools No application to practice demonstrated or inappropriate application.
Poor application of Bevis.
/30
Conclusion Clear concise summary of findings and implications Summarizes findings and implications briefly Some effort at forming conclusion Weak summary Summary very weak or lacking.
/15
Professional Writing Free of grammatical errors and APA errors, presents ideas clearly and professionally.
Excellence throughout and is creative and original in thought. Free of grammatical errors and APA errors.
Presents ideas clearly and professionally. Some grammatical or APA errors.
Presents ideas clearly. Meets minimal expectations for spelling, grammar and APA in paper.
Ideas are not always presented clearly. Writing clarity and flow is poor.
Many grammatical and APA errors.
/10
§ One mark will be deducted for each grammatical, spelling or APA error Final Grade
/ 100
Monday 18 January 2016
Examining the constraints of gender diversity in the corporate world in Britain
Paper details:
I can provide guidance as to what the dissertation is about and the aims and objectives of the dissertation. I want a literature review that mirrors the aims and objectives and taces into consideration that it is a secondary research paper with no primary research to be conducted. I want it to clearly identify and to analyse the strengths and weaknesses of the theories or schools of thought relevant to my topic. After the literature review I want to continue to do the discussion section (provided the literature review is in good order) to 'find things out from the research, rather than discovering “ready-made” results reported in the literature'.
My paper aims to examine the constraints of gender diversity in the corporate world in Britain and how this has effected female progression in the workplace to management and beyond in the corporate world.
I want it to look at the following (although this is not the final plan):
• What is Diversity (Stereotype, types, etc)
• Human Resources
o HR in Organisations
o Roles and responsibilities towards reducing disparity in female leaders at the corporate level in organization (coaching, mentoring,)
o Connection with organisational change
• Female leadership
o Statistics
o Relationship between gender board diversity and firm performance
o Benefits etc.
• Factors hindering women to climb up the corporate ladder
• Theoretical Framework
o Need to review the social science theories and choose the theory that can best explain the relationships between the key variables in your study.
o Need to also discuss the assumptions or propositions of this theory and point out their relevance to your research.
review to be 6000 words and to be completed in 7-10 days with room for revision and guidance...
I can provide guidance as to what the dissertation is about and the aims and objectives of the dissertation. I want a literature review that mirrors the aims and objectives and taces into consideration that it is a secondary research paper with no primary research to be conducted. I want it to clearly identify and to analyse the strengths and weaknesses of the theories or schools of thought relevant to my topic. After the literature review I want to continue to do the discussion section (provided the literature review is in good order) to 'find things out from the research, rather than discovering “ready-made” results reported in the literature'.
My paper aims to examine the constraints of gender diversity in the corporate world in Britain and how this has effected female progression in the workplace to management and beyond in the corporate world.
I want it to look at the following (although this is not the final plan):
• What is Diversity (Stereotype, types, etc)
• Human Resources
o HR in Organisations
o Roles and responsibilities towards reducing disparity in female leaders at the corporate level in organization (coaching, mentoring,)
o Connection with organisational change
• Female leadership
o Statistics
o Relationship between gender board diversity and firm performance
o Benefits etc.
• Factors hindering women to climb up the corporate ladder
• Theoretical Framework
o Need to review the social science theories and choose the theory that can best explain the relationships between the key variables in your study.
o Need to also discuss the assumptions or propositions of this theory and point out their relevance to your research.
review to be 6000 words and to be completed in 7-10 days with room for revision and guidance...
Women's & gender studies
Paper details:
2. Read the Introduction in Women Worldwide By Janet Lee & Susan M. Shaw
(pages 1 - 14).
3. Analyze Plate 34 (Debt) on pages 90 - 91 in the Penguin Atlas of Women in the World by Joni Seager. The Atlas provides a lot of information and statistics for various issues that affect the lives of women. You should find that the visual nature of the information helps you see regional and global patterns. In this case, you should be able to identify the relationship between colonialism, poverty, and economic globalization.
For this assignment you will need to pick one of these former British colonies - Bangladesh, Kenya or Malaysia - and do some research about how colonialism affected the status of women. Next, analyze current conditions for women in the country you chose. What has been the biggest impact of British rule on women?
Your answer should be approximately 200 words in length and edited for grammatical errors. If you use statistics or quotes, you must also use references.
2. Read the Introduction in Women Worldwide By Janet Lee & Susan M. Shaw
(pages 1 - 14).
3. Analyze Plate 34 (Debt) on pages 90 - 91 in the Penguin Atlas of Women in the World by Joni Seager. The Atlas provides a lot of information and statistics for various issues that affect the lives of women. You should find that the visual nature of the information helps you see regional and global patterns. In this case, you should be able to identify the relationship between colonialism, poverty, and economic globalization.
For this assignment you will need to pick one of these former British colonies - Bangladesh, Kenya or Malaysia - and do some research about how colonialism affected the status of women. Next, analyze current conditions for women in the country you chose. What has been the biggest impact of British rule on women?
Your answer should be approximately 200 words in length and edited for grammatical errors. If you use statistics or quotes, you must also use references.
Hayao Miyazaki: Female Archetypes within Studio Ghibli.
Paper details:
Looking at the role of female characters within the directors films and more of a focus on Archetypes. Focusing on films Nausicca, Spirited Away, Howls Moving Castle and Princess Mononoke. This is a feminist paper and requires theory to film, and various sources. - This is only an introduction.
Also personal knowledge of the animation films, and Japanese cultural backgrounds is a must with some insight into Studio Ghibli.
I would like to have plenty of varied sources, and would ask that some of the sources be taken from :
1. Jeremy Mark Robinson, The Cinema of Hayao Miyazaki (Crescent Moon Publishing, 2012)
2. Ashkenazi, Michael. Japanese Mythology. New York: Oxford U P, 2008.
3. Helene Cixous, “Ecriture feminine” (Feminine writing) in Toril Moi, Sexual-textual politics: feminist literary theory (1998)
4. Kawai, Hayao. Dreams, Myths and Fairy Tales in Japan. Einsiedeln, Switzerland: Daimon Verlag, 1995.
5. Kawai, Hayao. The Japanese Psyche: Major Motifs in the Fairy Tales of Japan. Woodstock: Spring Pub., 1996.
6. Knapp, Bettina L. Women in Twentieth-Century Literature: A Jungian View. University Park, Penn State Press: 1987.
7. Carl Gustav Jung, Four archetypes : mother, rebirth, spirit, trickster -London : Routledge, 2003.
Looking at the role of female characters within the directors films and more of a focus on Archetypes. Focusing on films Nausicca, Spirited Away, Howls Moving Castle and Princess Mononoke. This is a feminist paper and requires theory to film, and various sources. - This is only an introduction.
Also personal knowledge of the animation films, and Japanese cultural backgrounds is a must with some insight into Studio Ghibli.
I would like to have plenty of varied sources, and would ask that some of the sources be taken from :
1. Jeremy Mark Robinson, The Cinema of Hayao Miyazaki (Crescent Moon Publishing, 2012)
2. Ashkenazi, Michael. Japanese Mythology. New York: Oxford U P, 2008.
3. Helene Cixous, “Ecriture feminine” (Feminine writing) in Toril Moi, Sexual-textual politics: feminist literary theory (1998)
4. Kawai, Hayao. Dreams, Myths and Fairy Tales in Japan. Einsiedeln, Switzerland: Daimon Verlag, 1995.
5. Kawai, Hayao. The Japanese Psyche: Major Motifs in the Fairy Tales of Japan. Woodstock: Spring Pub., 1996.
6. Knapp, Bettina L. Women in Twentieth-Century Literature: A Jungian View. University Park, Penn State Press: 1987.
7. Carl Gustav Jung, Four archetypes : mother, rebirth, spirit, trickster -London : Routledge, 2003.
Ehics
Activity Description
Prepare a paper in which you evaluate the Tyco International case study provided in Kaplan (2009)and Stephen et al. (2012). Be sure to address the following in your paper:
Briefly summarize the historical scenario surrounding Tyco International.
How do you think the spending and the loans were able to go on for so long?
Evaluate the outcome of events.
Was the punishment justified? Why or why not?
Is it difficult for us to see ethical breaches that we ourselves commit?
Support your paper with a minimum of five (5) scholarly resources in addition to required resources. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.
Length: 5-7 pages not including title and reference pages
Your paper should demonstrate thoughtful consideration of the ideas and concepts that are presented in the course and provide new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards.
Introduction:
The Price of Unethical Behavior
We have learned that many argue if and to what degree that social responsibility should be considered in businesses. Unfortunately, there are many cases that clearly and definitively cross ethical (and legal) lines. In these cases, including the Tyco International case examined below, the price these CEOs, companies, and stakeholders pay can be quite high.
Review the resources listed in the Books and Resources area below to prepare for this week’s assignment(s).
Complete the following Spotlight on Skills if you need assistance with the tools used to complete your assignments.
Spotlight on Skills: Develop your Logical Thinking and Argumentative Skills
In this assignment, you will be called upon to present your ideas, make arguments, and defend a point of view. All of this calls for research based evidence, as well as logical thinking skills that provide the framework for presenting this evidence. To begin, develop your logical thinking skills through first considering the developmental stages of your own thinking: Developing as rational persons: Viewing our development in stages. Then, review the Jones, R, (2010) article to learn more about what constitutes a good argument.
Books and Resources for this Week:
Articles
Reference Instruction
Kaplan, D. A. (2009). Koz makes his case.
http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=45515650&site=ehost-live
Read Article
Stephens, W., Vance, C., & Pettegrew, L. (2012). Embracing ethics and morality.
http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ofs&AN=73784983&site=ehost-live
Prepare a paper in which you evaluate the Tyco International case study provided in Kaplan (2009)and Stephen et al. (2012). Be sure to address the following in your paper:
Briefly summarize the historical scenario surrounding Tyco International.
How do you think the spending and the loans were able to go on for so long?
Evaluate the outcome of events.
Was the punishment justified? Why or why not?
Is it difficult for us to see ethical breaches that we ourselves commit?
Support your paper with a minimum of five (5) scholarly resources in addition to required resources. In addition to these specified resources, other appropriate scholarly resources, including older articles, may be included.
Length: 5-7 pages not including title and reference pages
Your paper should demonstrate thoughtful consideration of the ideas and concepts that are presented in the course and provide new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards.
Introduction:
The Price of Unethical Behavior
We have learned that many argue if and to what degree that social responsibility should be considered in businesses. Unfortunately, there are many cases that clearly and definitively cross ethical (and legal) lines. In these cases, including the Tyco International case examined below, the price these CEOs, companies, and stakeholders pay can be quite high.
Review the resources listed in the Books and Resources area below to prepare for this week’s assignment(s).
Complete the following Spotlight on Skills if you need assistance with the tools used to complete your assignments.
Spotlight on Skills: Develop your Logical Thinking and Argumentative Skills
In this assignment, you will be called upon to present your ideas, make arguments, and defend a point of view. All of this calls for research based evidence, as well as logical thinking skills that provide the framework for presenting this evidence. To begin, develop your logical thinking skills through first considering the developmental stages of your own thinking: Developing as rational persons: Viewing our development in stages. Then, review the Jones, R, (2010) article to learn more about what constitutes a good argument.
Books and Resources for this Week:
Articles
Reference Instruction
Kaplan, D. A. (2009). Koz makes his case.
http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bth&AN=45515650&site=ehost-live
Read Article
Stephens, W., Vance, C., & Pettegrew, L. (2012). Embracing ethics and morality.
http://proxy1.ncu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ofs&AN=73784983&site=ehost-live
International Financial System
Order Description
A regional bank has decided to open an office overseas for serving those businesses that are expanding internationally. Choose a country with a large financial center that you believe would be helpful to your customer base.
•Discuss some of the challenges you may face in this new environment. ?What are the cultural, ethnic, social, and educational characteristics?
•Describe the political and legal systems.
•How much does the government intervene in the private sector? ?How will that affect your financial institution?
•What type of economic system does it have? ?What is the history of that economic system?
•How is the country involved in international trade? ?How does the government get involved in trade issues?
?Will that help or hurt your financial institution?
•Will your presence in this country be helpful in your attempts to invest in other developing countries?
•Is this country involved in any regional integration efforts? How so?
•Why did you choose this location for your bank?
•As a manager, what would be your overall assessment about whether you want to pursue opening an office there? ?Are the financial risks worth taking?
?Will it be beneficial to all of the stakeholders?
In pursuing this, what type of presence do you think would be best suited to your objectives?
•How should the plant be financed?
•Should they hedge foreign exchange or something else? Explain.
•Identify 3 foreign exchange instruments you would recommend?
•What, if any, government regulations that would affect earnings and cash flow should they be aware of?
•Include the need to be aware of inflation and interest rates and how it affects exchange rates.
•Keep in mind that the country that the plant is in does not necessarily have to be where the financing is done.
A regional bank has decided to open an office overseas for serving those businesses that are expanding internationally. Choose a country with a large financial center that you believe would be helpful to your customer base.
•Discuss some of the challenges you may face in this new environment. ?What are the cultural, ethnic, social, and educational characteristics?
•Describe the political and legal systems.
•How much does the government intervene in the private sector? ?How will that affect your financial institution?
•What type of economic system does it have? ?What is the history of that economic system?
•How is the country involved in international trade? ?How does the government get involved in trade issues?
?Will that help or hurt your financial institution?
•Will your presence in this country be helpful in your attempts to invest in other developing countries?
•Is this country involved in any regional integration efforts? How so?
•Why did you choose this location for your bank?
•As a manager, what would be your overall assessment about whether you want to pursue opening an office there? ?Are the financial risks worth taking?
?Will it be beneficial to all of the stakeholders?
In pursuing this, what type of presence do you think would be best suited to your objectives?
•How should the plant be financed?
•Should they hedge foreign exchange or something else? Explain.
•Identify 3 foreign exchange instruments you would recommend?
•What, if any, government regulations that would affect earnings and cash flow should they be aware of?
•Include the need to be aware of inflation and interest rates and how it affects exchange rates.
•Keep in mind that the country that the plant is in does not necessarily have to be where the financing is done.
Compare and Contrast Constructivism Learning theory to Behaviorism Learning theory
Order Description
Compare and Contrast Constructivism Learning theory to Behaviorism Learning theory. Include theorist, key concepts, application, etc.
Compare and Contrast Constructivism Learning theory to Behaviorism Learning theory. Include theorist, key concepts, application, etc.
Questions on Voting
1. Does the following family of preferences over the three alternatives X, Y, Z have the single-peak
property? Explain. There are four preference orderings, each represented by a column, and a
higher alternative is preferred to a lower one.
X Z Z Y
Z X Y Z
Y Y X X
2. Suppose that an odd number of individuals have single-peak preferences. Explain why the mostpreferred
alternative of the median voter will defeat every other proposal by a majority votes.
3. Consider majority rule with six people. Because there is an even number of individuals there is a
possibility of ties. We will say that a is a unique majority winner if there is no feasible alternative
that defeats a by a majority, and for every other feasible alternative ß there is at least one other
feasible alternative that defeats ß by some majority. Use Tables 1 and 2 to show that the rule
that selects the unique majority winner can be manipulated by a single individual.
Table 1
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
X X W Y Z Z
Y W Y Z X W
Z Y X W W Y
W Z Z X Y X
Table 2
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
X X Y Y Z Z
Y W Z Z X W
Z Y W W W Y
W Z X X Y X
property? Explain. There are four preference orderings, each represented by a column, and a
higher alternative is preferred to a lower one.
X Z Z Y
Z X Y Z
Y Y X X
2. Suppose that an odd number of individuals have single-peak preferences. Explain why the mostpreferred
alternative of the median voter will defeat every other proposal by a majority votes.
3. Consider majority rule with six people. Because there is an even number of individuals there is a
possibility of ties. We will say that a is a unique majority winner if there is no feasible alternative
that defeats a by a majority, and for every other feasible alternative ß there is at least one other
feasible alternative that defeats ß by some majority. Use Tables 1 and 2 to show that the rule
that selects the unique majority winner can be manipulated by a single individual.
Table 1
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
X X W Y Z Z
Y W Y Z X W
Z Y X W W Y
W Z Z X Y X
Table 2
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
X X Y Y Z Z
Y W Z Z X W
Z Y W W W Y
W Z X X Y X
Mathematics
For problems 1 6 evaluate the indicated limits, if they exist.
1. For evaluate,
(a) (b) (c)
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Article review
article review on the article: Cataract visual impairment and quality of life in a Kenyan population.
This is the assignment
1 A4 max
Aim of study
•What questions is this study trying to answer?
Method(s):Give a description of the population(s), measurements and method(s) that have been used?
Why do you think the author(s) used this method(s)?
Answer the following questions:
• Why this population?
• Why this sample size?
• Why these type of measurements?
• this type of data analysis?
Discussion (half A-4):
Answer the following questions:
• What are the advantages of the chosen method(s)?
• What are the possible drawbacks of the chosen method(s)?
• What do you think the reproducibility of the chosen method(s) is? Discuss bias and generalization.
• Do you think the chosen method(s) is valid?
• How can you increase the reliability of the chosen method(s)?
EXTENDED REPORT
Cataract visual impairment and quality of life in a Kenyan
population
Sarah Polack, Hannah Kuper, Wanjiku Mathenge, Astrid Fletcher, Allen Foster
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See end of article for
authors’ affiliations
. . . . . . . . . . . . . . . . . . . . . . . .
Correspondence to:
S Polack, London School of
Hygiene & Tropical
Medicine, Keppel Street,
London WC1E 7HT, UK;
sarah.polack@lshtm.ac.uk
Accepted 19 January 2007
Published Online First
31 January 2007
. . . . . . . . . . . . . . . . . . . . . . . .
Br J Ophthalmol 2007;91:927–932. doi: 10.1136/bjo.2006.110973
Aims: To evaluate the World Health Organization Prevention of Blindness and Deafness 20-item Visual
Functioning Questionnaire (WHO/PBD VF20), a vision-related quality of life scale, and to describe the
relationship between cataract visual impairment and vision- and generic health-related quality of life, in
people >50 years of age in Nakuru district, Kenya.
Methods: The WHO/PBD VF20 was pilot tested and modified. 196 patients with visual impairment from
cataract and 128 population-based controls without visual impairment from cataract were identified through
a district-wide survey. Additional cases were identified through case finding. Vision- and health-related
quality of life were assessed using the WHO/PBD VF20 scale and EuroQol generic health index (European
Quality of Life Questionnaire (EQ-5D)), respectively. WHO/PBD VF20 was evaluated using standard
psychometric tests, including factor analysis to determine item grouping for summary scores.
Results: The modified WHO/PBD VF20 demonstrated good psychometric properties. Two subscales (general
functioning and psychosocial) and one overall eyesight-rating item were appropriate for these data.
Increased severity of visual impairment in cases was associated with worsening general functioning,
psychosocial and overall eyesight scores (p for trend ,0.001). Cases were more likely to report problems
with EQ-5D descriptive dimensions than controls (p,0.001), and, among cases, increased severity of visual
impairment was associated with worsening self-rated health score.
Conclusion: The modified WHO/PBD VF20 is a valid and reliable scale to assess vision-related quality of life
associated with cataract visual impairment in this Kenyan population. The association between health-related
quality of life and visual impairment reflects the wider implications of cataract for health and well-being,
beyond visual acuity alone.
Cataract is the leading cause of blindness and low vision
worldwide, estimated to be responsible for at least 17.7 of
the 37 million cases of blindness in the world.1 Cataract
extraction is one of the most cost-effective medical interventions,
2 and yet coverage of cataract surgery in low-income
countries remains low.3
Visual impairment and outcomes from sight-restoring
surgery have traditionally been assessed using objective clinical
measures, such as visual acuity (VA). In recent years, however,
there has been increasing recognition of the importance of
assessing patients’ views regarding the impact of medical
conditions and interventions, and quality of life assessment has
gained increasing interest and acceptance.4
Vision-related (disease specific) quality of life (VRQOL)
scales assess patients’ experiences of visual acuity. By contrast,
generic health-related scales are designed to be applicable to a
range of conditions, interventions and populations. The
majority of studies assessing the association between cataract
and quality of life are from high-income countries.5–9 Many
well-validated scales exist for evaluating vision function (VF)
and VRQOL in these settings.10 Fewer scales and studies
exist for low-income settings, and in particular for Africa.11 12
No studies exploring the impact of cataract on wider healthrelated
quality of life in African countries were identified.
Recently, the World Health Organization recommended that
more attention be given to the assessment of VF and VRQOL
in people with visual impairment, and highlighted the
need for cross-cultural methods.13 Based on this, the Indian
VF33 questionnaire (INDVFQ33),14 which was developed
through focus group discussion and psychometric evaluation,
was reviewed to produce a 20-item visual functioning
questionnaire (WHO/PBD VFQ-20). It was recommended that
this scale be validated by field testing,13 but this has not
occurred to date.
This study aimed to evaluate the WHO/PBD VFQ20, a new
VRQOL instrument, and describe the relationship between
cataract visual impairment and vision- and health-related
quality of life, in people >50 years of age in Nakuru district,
Kenya.
METHODS
Study population
This study was conducted in Nakuru district between February
and June 2005 as part of a wider case–control study to evaluate
the impact of cataract surgery on quality of life and poverty. To
estimate the required number of cases (visually impaired from
cataract) and controls (with no visual impairment), sample size
calculations were based on previous findings of a difference of
at least one-third in mean VRQOL.14 15 The power to detect this
difference required a sample of 133 cases and 133 controls, with
an a of 0.01 and 80% power.
Cases were recruited via three methods: a population-based
survey of 3500 adults aged >50 years, using systematic cluster
sampling with probability proportionate to size (82 cases)16;
community-based case detection (65 cases) using the same
cluster sampling procedure; and the first 50 patients attending
the Rift Valley Hospital, Nakuru, Nakuru district, Kenya, who
Abbreviations: EQ-5D, European Quality of Life Questionnaire; EuroQol,
European quality of life; HRQOL, health-related quality of life; INDVFQ33,
Indian VF33 questionnaire; PCA, principal components analysis; QOL,
quality of life; SES, socioeconomic status; VA, visual acuity; VAS, visual
analogue scale; VF, vision function; VRQOL, vision-related quality of life;
WHO/PBD VFQ20, World Health Organization Prevention of Blindness
and Deafness 20-item Visual Functioning Questionnaire
927
www.bjophthalmol.com
met the case definition. This hospital is the main centre for
cataract surgery in Nakuru district and serves people from
across the district. Three different methods were employed
because of logistical and time constraints. Procedures for
ophthalmic examination, case selection criteria and consent
were the same in each.
Ophthalmic examination and case definition
The case definition was people aged >50 years with best
corrected VA ,6/24 in the better eye due to cataract, living in
Nakuru district. All clinical examinations and diagnoses were
made by ophthalmologists. VA was measured with available
correction using a tumbling ‘‘E’’ chart. For each case in the
survey, one or two age- and sex-matched control subjects (VA
>6/18) were randomly selected from the same cluster.
Vision-related quality of life
The WHO/PBD VFQ2013 was translated into Swahili and two
local languages (Kikuyu and Kalenjin), and back-translated by
independent translators, who were asked to comment on the
appropriateness of language used for the target population. A
review was held to discuss differences in the translations and to
modify them accordingly. The scale was pilot tested on 20
patients in the eye unit, Nakuru District Hospital, and small
modifications to the wording of some items were made to
ensure local understanding. One question, ‘‘how much difficulty
do you have in seeing because of glare from bright
lights?’’, caused difficulties for respondents from rural areas
where there was a lack of electricity or car lights. Following
consultation with an ophthalmologist, this question was
removed. For test–retest reliability assessment, the questionnaire
was administered to 20 patients at the eye unit, Nakuru
Hospital in the afternoon, and again the next morning by the
same interviewer.
Health-related quality of life
To assess health-related quality of life, items from the European
Quality of Life Questionnaire (EQ-5D) were used. This scale
was designed by the European quality of life (EuroQol) group to
be brief, simple and practical for use in surveys alongside
disease-specific measures.17 Evidence of validity and reliability
in high- and low-income settings has been shown.18–20 The EQ-
5D includes two components. The first consists of five
descriptive dimensions: mobility, self-care, usual activity,
pain/discomfort and anxiety/depression, each with three
response options: no problem, some problem or extreme
problem. The second is a visual analogue scale (VAS), with
scores ranging from 0 (‘‘worst imaginable health state’’) to 100
(‘‘best imaginable health state’’). Respondents are asked to
indicate on the scale where they rate their ‘‘own health state
today’’. For all study members this scale was described verbally,
enabling those members unable to see the scale to respond. The
same translation procedure described above was used to
translate the EQ-5D. However, due to time constraints, this
was carried out independently from the EuroQol group, and the
versions used in this study have therefore not been approved by
the EuroQol group.
Interviews
Six interviewers were trained for 1 week, and interviews were
observed periodically throughout the study.
Ethical considerations
Informed signed or thumb-printed consent was obtained from
all study subjects. All cases were offered free cataract surgery at
the district hospital. People with visual impairment, but not
eligible to be study cases, were examined and referred to the
district hospital accordingly. Ethical approval for this study was
obtained from the ethics committees of the London School of
Hygiene & Tropical Medicine, London, UK, and the Kenya
Medical Research Institute, Nairobi, Kenya.
Statistical analysis
Visual acuity
For analysis, presenting VA in the better eye with available
correction was grouped into the following categories: normal
vision (>6/18, controls only), moderate visual impairment (,6/
24, >6/60), severe visual impairment (,6/60, >3/60), blind
(,3/60, .PL) and perception of light (PL).
Vision-related quality of life
Validity and reliability of the WHO/PBD VF20 (minus one item)
were evaluated by standard psychometric methods, including
item acceptability, internal consistency, test–retest reliability,
within-scale analyses and analyses against external criteria,
and using thresholds specified by Lamping et al.21 Analyses were
conducted on data from cases only, except for testing the ability
Table 1 Characteristics of cases and controls
Cases,
n (%)
Controls,
n (%)
Age- and sexadjusted
OR (95% CI)
Age (years)
50–59 9 (4.6) 11 (8.6) Baseline
60–69 34 (17.4) 30 (23.4) 1.3 (0.5 to 3.8)
70–79 66 (33.7) 51 (39.8) 1.6 (0.6 to 4.1)
>80 87 (44.4) 36 (28.1) 2.9 (1.1 to 7.8)
Sex
Male 79 (40.3) 51 (39.8) Baseline
Female 117 (59.7) 77 (60.2) 1.0 (0.6 to 1.6)
Education
None 148 (76.7) 74 (58.7) Baseline
Some 45 (23.3) 52 (41.3) 0.4 (0.2 to 0.7)
Literacy
Cannot read 148 (75.9) 65 (50.8) Baseline
Can read 47 (24.1) 63 (49.2) 0.3 (0.1 to 0.5)
Marital status
Single/widowed 110 (56.7) 59 (46.8) Baseline
Married 84 (43.3) 67 (53.2) 0.7 (0.4 to 1.2)
Socioeconomic status
1 (poorest) 57 (29.8) 22 (17.9) Baseline
2 52 (27.2) 27 (22.0) 0.8 (0.4 to 1.6)
3 46 (24.1) 35 (28.5) 0.5 (0.3 to 1.0)
4 (least poor) 36 (18.9) 39 (31.7) 0.4 (0.2 to 0.8)
Visual acuity
>6/18 0 (0.0) 128 (100.0) N/A
,6/24, >6/60 78 (39.8) 0 (0.0)
,6/60, >3/60 41 (20.9) 0 (0.0)
,3/60, .PL 36 (18.4) 0 (0.0)
PL 41 (20.9) 0 (0.0)
Mean (95% CI) Mean (95% CI) p Value
Vision-related quality
of life*
Overall eyesight 3.9 (3.9 to 4.1) 2.1 (2.0–2.3) ,0.001
General
functioning
43.6 (41.5 to 45.8) 17.8 (16.6–19.1) ,0.001
Psychosocial 12.2 (11.4 to 12.9) 5.5 (5.0–6.0) ,0.001
Self-rated health 47.6 (45.1 to 50.1) 59.4 (56.3–62.5) ,0.001
PL, perception of light.
Some data were missing.
*Higher score denotes poorer quality of life.
Higher score denotes better self-rated health.
928 Polack, Kuper, Mathenge, et al
www.bjophthalmol.com
of the scale to differentiate between groups known to be
different, which compared cases and controls. Three subscales
were originally proposed: visual symptoms (3 items), general
functioning (12 items) and psychosocial (4 items), with one
overall eyesight-rating item. As modifications were made, a
rotated exploratory factor analysis was conducted to determine
how items should be grouped for summary scores. Maximum
likelihood estimation was used, and the number of distinct
factors in the scale were taken as those with eigenvalues .1.22
Covariates
Standard sociodemographic data and indicators of socioeconomic
status were collected, as they have been shown to
influence QOL.14 A socioeconomic status (SES) index was
calculated for each household using principal components
analysis (PCA) to determine weights for a list of assets and
wealth indicators using the method of Filmer and Pritchett.23
Variables entered into the PCA included building materials of
the house, ownership of household assets, animal ownership
and education of the head of the household. Assets and wealth
indicators included in the PCA were selected on the basis of
published literature and discussion with local key informants.
The index was created using STATA V.9 and was divided into
quartiles from poorest (lowest SES index) to least poor (highest
SES index).
The associations between QOL measures, VA and socioeconomic
variables were assessed initially using analysis of
variance (WHO/PBD VF20 subscales and EQ5D VAS score) and
x2 (EQ5D dimensions). Multivariate linear or logistic (as
appropriate) regression analyses were conducted using forward
selection of variables, forcing age and gender into the models.
All analyses were conducted using STATA V.9.
Table 2 Internal consistency and skewness values for World Health Organization Prevention
of Blindness and Deafness 20-item Visual Functioning Questionnaire summary scores
Interitem range
(mean)
Item-total range
(mean) Cronbach a Skewness
Overall eyesight – – – 20.59
General functioning 0.33–0.88 (0.70) 0.61–0.93 (0.85) 0.96 20.15
Psychosocial 0.62–0.80 (0.72) 0.82–0.92 (0.89) 0.91 20.28
Pain/discomfort in eye – – – 0.21
Table 3 Forward selection multivariate adjusted linear regression analyses of World Health
Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire
scores, presenting visual acuity and sociodemographic variables in cases visually impaired
from cataract
Model 1:
overall eyesight
Model 2:
general functioning
Model 3:
psychosocial
Mean (95% CI) Mean (95% CI) Mean (95% CI)
Presenting visual acuity
,6/24, >6/60 3.7 (3.6 to 3.9) 36.5 (33.7 to 39.3) 10.7 (9.4 to 11.8)
,6/60, >3/60 3.7 (3.7 to 4.1) 39.2 (33.6 to 39.3) 10.9 (9.3 to 12.6)
,3/60, .PL 4.0 (3.8 to 4.2) 47.2 (43.1 to 51.3) 14.2 (12.4 to 16.1)
PL 4.7 (4.5 to 4.9) 59.2 (55.3 to 63.1) 14.5 (12.9 to 16.1)
p for trend ,0.001 ,0.001 ,0.001
Age (years)
50–59 4.2 (3.9 to 4.1) 41 (32.2 to 49.8) 11.5 (7.8 to 15.3)
60–69 3.9 (3.7 to 4.1) 40.5 (36.3 to 44.7) 11.1 (9.3 to 12.9)
70–79 4.0 (3.8 to 4.1) 44.9 (41.8 to 47.9) 13.0 (11.7 to 14.3)
>80 4.0 (3.9 to 4.2) 44.4 (41.8 to 47.0) 12.0 (10.9 to 13.2)
p for trend 0.54 0.14 0.47
Sex
Male 3.9 (3.8 to 4.1) 43.8 (40.9–46.6) 12.3 (11.0 to 13.6)
Female 4.0 (3.9 to 4.1) 43.7 (41.4 to 46.0) 12.1 (11.0 to13.1)
SES
1 (poorest) 4.2 (4.0 to 4.4) 49.9 (46.6 to53.1)
2 4.0 (3.8 to 4.2) 43.3 (40.0 to 46.7) –
3 3.9 (3.8 to 4.2) 39.3 (35.7 to 42.9) –
4 (least poor) 3.7 (3.5 to 3.9) 40.1 (36.0 to 44.3) –
p for trend 0.001 ,0.001
Marital status
Married – – 10.6 (9.4 to 11.9)
Widowed/single – – 13.3 (12.2 to 14.4)
Amount of variance explained
by VA (full model)
23.5% (25.6%) 30.0% (37.6%) 7.8% (12.1%)
PL, perception of light; SES, socioeconomic status; VA, visual acuity.
Age and sex were always kept in the model and adjusted means are presented.
–Did not contribute significantly to the model.
Higher score denotes poorer vision-related quality of life..
Cataract visual impairment in a Kenyan population 929
www.bjophthalmol.com
RESULTS
In all, 196 cases and 128 controls were included. Controls were
younger, more likely to have had some education and were in
higher socioeconomic groups than cases (table 1).
Vision-related quality of life
The WHO/PBD VF20 fulfilled most standard psychometric
criteria. The proportion of missing data for each item was ,1%.
Floor and ceiling effects were ,80% for each item and for
summary scores (ie, ,80% people endorsed response categories
at the top and bottom of the scale for each item and for the
summary scores; table 2). Ten items in the general functioning
subscale had inter-item correlations (ie, correlations with other
items in the same subscale) above the maximum criteria of
0.75, which suggests some item redundancy. Two distinct
factors were identified from the factor analysis. All originally
proposed general functioning items, with one visual symptom
item loaded onto factor 1 and all proposed psychosocial items
loaded onto factor 2, suggesting that two subscales, general
functioning and psychosocial, are appropriate for these data.
One visual symptom item, ‘‘because of your eyesight how much
pain and discomfort do you have in your eyes’’, did not load
well onto either factor. As the pain/discomfort item did not
clearly belong to either of the subscales, it was analysed
separately. Good subscale internal consistency was demonstrated
by high Cronbach a and item-total correlations (table 2).
Test–retest correlations were above the acceptable level of 0.80.
Cases had significantly poorer general functioning, psychosocial,
overall eyesight and pain/discomfort scores than
controls, satisfying the known-group differences criteria
(table 1). The scale showed good convergent validity; poorer
VA was associated with poorer mean general functioning,
psychosocial and overall eyesight rating scores (test for trend
p,0.001). The exception was the pain/discomfort item, which
was not significantly associated with visual acuity.
Discriminant validity findings were mixed. Age was not
associated with mean VRQOL scores among cases. However,
cases in the lower SES group had poorer general functioning (p
for trend ,0.001) and self-rated eyesight scores (p=0.04).
Widowed/single cases had poorer psychosocial scores
(p=0.004). Women, widowed/single cases and cases with no
formal education reported poorer pain/discomfort scores. In
Table 4 Response distribution to European Quality of Life Questionnaire domains and
adjusted odds ratios in cases and controls
EQ-5D domain Cases n (%) Controls n (%) Adjusted OR* (95% CI) p Value
Mobility
No problem 65 (33.2) 93 (72.7) Baseline ,0.001
Some problem 118 (60.2) 35 (27.3) 5 (3.0 to 8.2)1
Confined to bed 13 (6.6) 0 (0.0) – –
Self-care
No problems 106 (54.1) 114 (89.1) Baseline ,0.001
Some problems 74 (37.8) 14 (10.9) 6.2 (3.3 to 11.7)1
Unable 16 (8.2) 0 (0.0) – –
Usual activities
No problems 44 (22.5) 93 (72.7) Baseline ,0.001
Some problems 103 (52.6) 33 (25.8) 8.9 (5.2 to 15.1)1
Unable 49 (25.0) 2 (1.6) – –
Pain/discomfort
None 30 (15.3) 47 (36.7) Baseline` ,0.001
Moderate 131 (66.8) 75 (58.6) 2.7 (1.5 to 4.8)
Extreme 35 (17.9) 6 (4.7) 6.8 (2.5 to 18.9)
Anxiety/depression
None 40 (20.4) 64 (50.0) Baseline` ,0.001
Moderate 96 (49.0) 57 (44.5) 2.8 (1.6–4.8)
Extreme 60 (30.6) 7 (5.5) 13.9 (5.4 to 35.9)
EQ-5D, European Quality of Life Questionnaire.
*Odds ratios (ORs) from forward selection logistic regression analysis, with age and sex always included in the model.
Adjusted for age, sex and location.
`Adjusted for age, sex, literacy and location.
1Owing to small cell sizes ‘‘some problem’’ and ‘‘severe problem’’ were combined to calculate ORs for ‘‘any problem’’.
Table 5 A forward selection multivariate linear regression
analysis of self-rated health (from visual analogue scale),
visual acuity and sociodemographic variables
Self-rated health score
Coefficient (95% CI)
Visual acuity
,6/24, >6/60 Baseline
,6/60, >3/60 0.5 (26.2 to 7.2)
,3/60, .PL 26.2 (213.2 to 0.8)
PL 29.6 (216.3 to 3.0)
p for trend 0.001
Age (years)
50–59 Baseline
60–69 4.5 (29.6 to 18.7)
70–79 12.9 (20.8 to 26.6)
>80 7.2 (26.4 to 20.8)
p for trend 0.66
Sex
Male Baseline
Female 1.4 (24.7 to 7.5)
Socioeconomic status
1 (poorest) Baseline
2 8.3 (1.7 to 14.8)
3 8.3 (1.7 to 14.9)
4 (least poor) 10.7 (3.3 to 18.1)
p for trend 0.009
Marital status
Single/widowed Baseline
Married 6.7 (0.4 to 12.8)
930 Polack, Kuper, Mathenge, et al
www.bjophthalmol.com
multivariate analyses (table 3) controlling for visual acuity,
overall eyesight and general functioning scores were worse in
poorer cases, and widowed/single cases were more likely to
have poorer psychosocial scores. There were no significant
multivariate predictors of pain/discomfort in the eyes of the
cases.
Health-related quality of life
All five EQ-5D dimensions discriminated between cases and
controls (table 4). Among cases, adjusting for covariates, poorer
VA was associated with higher odds of reporting any problem
with mobility (p for trend =0.003), self-care (p for trend
,0.001), usual activities (p for trend=0.008) and pain/
discomfort (p for trend =0.01). There was no significant
association with depression.
Self-rated health score was worse in cases than in controls
(p,0.001); (table 1), and mean health score worsened with
increasing severity of visual impairment in cases (table 5).
Widowed/single and cases in the lower SES groups had lower
mean health scores.
DISCUSSION
This study evaluated the WHO/PBD VF20, an instrument
recommended for measuring VRQOL in low-income settings,
in Nakuru district, Kenya. To our knowledge no other studies
have explored the association between visual impairment from
cataract and quality of life in Kenya.
The results show that the modified WHO/PBD VFQ20, with
one overall rating item and two subscales, (general functioning
and psychosocial) is a valid and reliable scale in this Kenyan
setting. One item about glare from glare from bright lights was
removed, but this might have more relevance in other settings.
The item about pain in the eye did not correlate well with other
items in the scale. Cases reported worse pain scores than
controls; however, among the cases, there was no significant
variation in pain score with VA. Pain and discomfort are not
typical symptoms of cataract, but this item might be more
relevant for other ocular morbidities. However, it was not
included in the original INDVFQ33 which was developed on the
basis of 46 focus group discussions exploring patient’s perceptions
about their eye conditions and associated impact on daily
living.24 There was some redundancy in items, suggesting that it
might be possible to shorten this questionnaire further,
although the full questionnaire should be evaluated in other
settings to confirm this.
Cases were more likely to report problems with the EQ-5D
dimensions than controls. Increasing severity of visual impairment
was associated with higher odds of reporting problems
with mobility, self-care, usual activities, and pain/discomfort
and with mean self-rated health score. These findings
correspond to studies from high-income settings,5 and highlight
an impact of visual impairment on wider well-being that is not
necessarily reflected by vision related scales.
Sociodemographic and economic variables influenced
response independently of VA. This is in accordance with other
studies,5 14 and suggests that experiences of visual impairment
may vary according to individual circumstances. In a study in
Hong Kong, Lau et al25 comment that, despite comparable VA
and using the same scale, mean VRQOL scores were better than
those in China and Nepal, and suggest that this may be due to
differences in modern household utilities which facilitate selfcare
activities. A similar reason may explain why cases in the
lower SES groups in Nakuru had worse general functioning
scores. Promotion of surgical services at early stages of cataract
in poor communities should remain a priority. Being widowed/
single increased the social and emotional burden of cataract
visual impairment, as reflected by poorer psychosocial scores
compared with married people. In contrast, but in accordance
with findings from the INDVFQ 33 in India,14 there was no
association between VRQOL scores and age or sex.
This study has its limitations. Three different case recruitment
methods were used. However, all cases were from the
same district and met the same case definition. According to
power calculations, 133 controls were required for the study,
but only 128 were identified. However, the power calculations
were based on very conservative estimates, so the effect of this
is probably minimal. The WHO/PBD VF20 was recommended as
an instrument to assess all ocular morbidities and we focused
only on cataract. Further, we focused only on people aged
>50 years, and the scale might perform differently in other age
groups. However, the original INDVFQ33 was also developed in
people aged >50 years, and, although other eye conditions
were included, was largely dominated by cataract, reflecting the
relative importance of this condition in the Indian setting. Our
results indicated that some items in the Kenyan setting were
not relevant or were redundant. Future studies should look at
the performance of the full WHO/PBD VF20 scale in other
populations or other disease groups. The translation of the EQ-
5D questionnaire was not validated by the EuroQol group,
although standard translation procedures were followed.
Multiple tests of statistical significance for correlated measures
were made using these data. However, analyses were repeated
using the Bonferroni correction and the multivariate analyses
were essentially unchanged.
In this study, evidence of the validity and reliability of a new
scale were shown, and the data suggest that this scale would be
suitable for assessing the outcome of cataract surgery. The
findings add weight to the evidence of disability and poorer
self-perception of own health associated with cataract visual
impairment among people in an African country.
ACKNOWLEDGEMENTS
We thank all the people from Nakuru district who participated in the
survey. We also thank the office manager (Redempta Muibu), the
ophthalmologists (Oscar Onyango, Godfrey Nyaga, Tina Eusebio), the
ophthalmic clinical officers (Maurice Oduoo, Flora Kosgey, Devina
Kisorio and Maina James), the interviewers (Philip Lumula, Nimmo
Gicheru, Marie Anne Cege, Emma Kamau, Mike Kepkembai, Agnes
Maingi and Rose Kagwe), the information officer (Irene Chelagat), the
drivers (Daniel Mutai, John and Sammy) and data entry clerks (Faith
Lumula and Terry). The Rift Valley Provincial Hospital kindly offered us
office space on their premises. The assistance of the Medical Officer of
Health, Nakuru, and the Electoral Commission Office in Nakuru is
acknowledged.
Authors’ affiliations
. . . . . . . . . . . . . . . . . . . . . . .
Sarah Polack, Hannah Kuper, Astrid Fletcher, Allen Foster, London School
of Hygiene & Tropical Medicine, London, UK
Wanjiku Mathenge, Rift Valley Provincial General Hospital, Nakuru Town,
Nakuru, Kenya
Funding: This study was funded by grants from Sight Savers International,
Christian Blind Mission and ORBIS International.
Competing interests: None.
REFERENCES
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13 WHO. Consultation on development of standards for characterization of vision
loss and visual functioning. Geneva: World Health Organization, 2003.
14 Gupta SK, Viswanath K, Thulasiraj RD, et al. The Development of the Indian
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16 Mathenge W, Kuper H, Polack S, et al. Rapid Assessment of Avoidable Blindness
in Nakuru District, Kenya. Ophthalmology 2007;114:599–605.
17 Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol
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18 Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and
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932 Polack, Kuper, Mathenge, et al
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This is the assignment
1 A4 max
Aim of study
•What questions is this study trying to answer?
Method(s):Give a description of the population(s), measurements and method(s) that have been used?
Why do you think the author(s) used this method(s)?
Answer the following questions:
• Why this population?
• Why this sample size?
• Why these type of measurements?
• this type of data analysis?
Discussion (half A-4):
Answer the following questions:
• What are the advantages of the chosen method(s)?
• What are the possible drawbacks of the chosen method(s)?
• What do you think the reproducibility of the chosen method(s) is? Discuss bias and generalization.
• Do you think the chosen method(s) is valid?
• How can you increase the reliability of the chosen method(s)?
EXTENDED REPORT
Cataract visual impairment and quality of life in a Kenyan
population
Sarah Polack, Hannah Kuper, Wanjiku Mathenge, Astrid Fletcher, Allen Foster
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
See end of article for
authors’ affiliations
. . . . . . . . . . . . . . . . . . . . . . . .
Correspondence to:
S Polack, London School of
Hygiene & Tropical
Medicine, Keppel Street,
London WC1E 7HT, UK;
sarah.polack@lshtm.ac.uk
Accepted 19 January 2007
Published Online First
31 January 2007
. . . . . . . . . . . . . . . . . . . . . . . .
Br J Ophthalmol 2007;91:927–932. doi: 10.1136/bjo.2006.110973
Aims: To evaluate the World Health Organization Prevention of Blindness and Deafness 20-item Visual
Functioning Questionnaire (WHO/PBD VF20), a vision-related quality of life scale, and to describe the
relationship between cataract visual impairment and vision- and generic health-related quality of life, in
people >50 years of age in Nakuru district, Kenya.
Methods: The WHO/PBD VF20 was pilot tested and modified. 196 patients with visual impairment from
cataract and 128 population-based controls without visual impairment from cataract were identified through
a district-wide survey. Additional cases were identified through case finding. Vision- and health-related
quality of life were assessed using the WHO/PBD VF20 scale and EuroQol generic health index (European
Quality of Life Questionnaire (EQ-5D)), respectively. WHO/PBD VF20 was evaluated using standard
psychometric tests, including factor analysis to determine item grouping for summary scores.
Results: The modified WHO/PBD VF20 demonstrated good psychometric properties. Two subscales (general
functioning and psychosocial) and one overall eyesight-rating item were appropriate for these data.
Increased severity of visual impairment in cases was associated with worsening general functioning,
psychosocial and overall eyesight scores (p for trend ,0.001). Cases were more likely to report problems
with EQ-5D descriptive dimensions than controls (p,0.001), and, among cases, increased severity of visual
impairment was associated with worsening self-rated health score.
Conclusion: The modified WHO/PBD VF20 is a valid and reliable scale to assess vision-related quality of life
associated with cataract visual impairment in this Kenyan population. The association between health-related
quality of life and visual impairment reflects the wider implications of cataract for health and well-being,
beyond visual acuity alone.
Cataract is the leading cause of blindness and low vision
worldwide, estimated to be responsible for at least 17.7 of
the 37 million cases of blindness in the world.1 Cataract
extraction is one of the most cost-effective medical interventions,
2 and yet coverage of cataract surgery in low-income
countries remains low.3
Visual impairment and outcomes from sight-restoring
surgery have traditionally been assessed using objective clinical
measures, such as visual acuity (VA). In recent years, however,
there has been increasing recognition of the importance of
assessing patients’ views regarding the impact of medical
conditions and interventions, and quality of life assessment has
gained increasing interest and acceptance.4
Vision-related (disease specific) quality of life (VRQOL)
scales assess patients’ experiences of visual acuity. By contrast,
generic health-related scales are designed to be applicable to a
range of conditions, interventions and populations. The
majority of studies assessing the association between cataract
and quality of life are from high-income countries.5–9 Many
well-validated scales exist for evaluating vision function (VF)
and VRQOL in these settings.10 Fewer scales and studies
exist for low-income settings, and in particular for Africa.11 12
No studies exploring the impact of cataract on wider healthrelated
quality of life in African countries were identified.
Recently, the World Health Organization recommended that
more attention be given to the assessment of VF and VRQOL
in people with visual impairment, and highlighted the
need for cross-cultural methods.13 Based on this, the Indian
VF33 questionnaire (INDVFQ33),14 which was developed
through focus group discussion and psychometric evaluation,
was reviewed to produce a 20-item visual functioning
questionnaire (WHO/PBD VFQ-20). It was recommended that
this scale be validated by field testing,13 but this has not
occurred to date.
This study aimed to evaluate the WHO/PBD VFQ20, a new
VRQOL instrument, and describe the relationship between
cataract visual impairment and vision- and health-related
quality of life, in people >50 years of age in Nakuru district,
Kenya.
METHODS
Study population
This study was conducted in Nakuru district between February
and June 2005 as part of a wider case–control study to evaluate
the impact of cataract surgery on quality of life and poverty. To
estimate the required number of cases (visually impaired from
cataract) and controls (with no visual impairment), sample size
calculations were based on previous findings of a difference of
at least one-third in mean VRQOL.14 15 The power to detect this
difference required a sample of 133 cases and 133 controls, with
an a of 0.01 and 80% power.
Cases were recruited via three methods: a population-based
survey of 3500 adults aged >50 years, using systematic cluster
sampling with probability proportionate to size (82 cases)16;
community-based case detection (65 cases) using the same
cluster sampling procedure; and the first 50 patients attending
the Rift Valley Hospital, Nakuru, Nakuru district, Kenya, who
Abbreviations: EQ-5D, European Quality of Life Questionnaire; EuroQol,
European quality of life; HRQOL, health-related quality of life; INDVFQ33,
Indian VF33 questionnaire; PCA, principal components analysis; QOL,
quality of life; SES, socioeconomic status; VA, visual acuity; VAS, visual
analogue scale; VF, vision function; VRQOL, vision-related quality of life;
WHO/PBD VFQ20, World Health Organization Prevention of Blindness
and Deafness 20-item Visual Functioning Questionnaire
927
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met the case definition. This hospital is the main centre for
cataract surgery in Nakuru district and serves people from
across the district. Three different methods were employed
because of logistical and time constraints. Procedures for
ophthalmic examination, case selection criteria and consent
were the same in each.
Ophthalmic examination and case definition
The case definition was people aged >50 years with best
corrected VA ,6/24 in the better eye due to cataract, living in
Nakuru district. All clinical examinations and diagnoses were
made by ophthalmologists. VA was measured with available
correction using a tumbling ‘‘E’’ chart. For each case in the
survey, one or two age- and sex-matched control subjects (VA
>6/18) were randomly selected from the same cluster.
Vision-related quality of life
The WHO/PBD VFQ2013 was translated into Swahili and two
local languages (Kikuyu and Kalenjin), and back-translated by
independent translators, who were asked to comment on the
appropriateness of language used for the target population. A
review was held to discuss differences in the translations and to
modify them accordingly. The scale was pilot tested on 20
patients in the eye unit, Nakuru District Hospital, and small
modifications to the wording of some items were made to
ensure local understanding. One question, ‘‘how much difficulty
do you have in seeing because of glare from bright
lights?’’, caused difficulties for respondents from rural areas
where there was a lack of electricity or car lights. Following
consultation with an ophthalmologist, this question was
removed. For test–retest reliability assessment, the questionnaire
was administered to 20 patients at the eye unit, Nakuru
Hospital in the afternoon, and again the next morning by the
same interviewer.
Health-related quality of life
To assess health-related quality of life, items from the European
Quality of Life Questionnaire (EQ-5D) were used. This scale
was designed by the European quality of life (EuroQol) group to
be brief, simple and practical for use in surveys alongside
disease-specific measures.17 Evidence of validity and reliability
in high- and low-income settings has been shown.18–20 The EQ-
5D includes two components. The first consists of five
descriptive dimensions: mobility, self-care, usual activity,
pain/discomfort and anxiety/depression, each with three
response options: no problem, some problem or extreme
problem. The second is a visual analogue scale (VAS), with
scores ranging from 0 (‘‘worst imaginable health state’’) to 100
(‘‘best imaginable health state’’). Respondents are asked to
indicate on the scale where they rate their ‘‘own health state
today’’. For all study members this scale was described verbally,
enabling those members unable to see the scale to respond. The
same translation procedure described above was used to
translate the EQ-5D. However, due to time constraints, this
was carried out independently from the EuroQol group, and the
versions used in this study have therefore not been approved by
the EuroQol group.
Interviews
Six interviewers were trained for 1 week, and interviews were
observed periodically throughout the study.
Ethical considerations
Informed signed or thumb-printed consent was obtained from
all study subjects. All cases were offered free cataract surgery at
the district hospital. People with visual impairment, but not
eligible to be study cases, were examined and referred to the
district hospital accordingly. Ethical approval for this study was
obtained from the ethics committees of the London School of
Hygiene & Tropical Medicine, London, UK, and the Kenya
Medical Research Institute, Nairobi, Kenya.
Statistical analysis
Visual acuity
For analysis, presenting VA in the better eye with available
correction was grouped into the following categories: normal
vision (>6/18, controls only), moderate visual impairment (,6/
24, >6/60), severe visual impairment (,6/60, >3/60), blind
(,3/60, .PL) and perception of light (PL).
Vision-related quality of life
Validity and reliability of the WHO/PBD VF20 (minus one item)
were evaluated by standard psychometric methods, including
item acceptability, internal consistency, test–retest reliability,
within-scale analyses and analyses against external criteria,
and using thresholds specified by Lamping et al.21 Analyses were
conducted on data from cases only, except for testing the ability
Table 1 Characteristics of cases and controls
Cases,
n (%)
Controls,
n (%)
Age- and sexadjusted
OR (95% CI)
Age (years)
50–59 9 (4.6) 11 (8.6) Baseline
60–69 34 (17.4) 30 (23.4) 1.3 (0.5 to 3.8)
70–79 66 (33.7) 51 (39.8) 1.6 (0.6 to 4.1)
>80 87 (44.4) 36 (28.1) 2.9 (1.1 to 7.8)
Sex
Male 79 (40.3) 51 (39.8) Baseline
Female 117 (59.7) 77 (60.2) 1.0 (0.6 to 1.6)
Education
None 148 (76.7) 74 (58.7) Baseline
Some 45 (23.3) 52 (41.3) 0.4 (0.2 to 0.7)
Literacy
Cannot read 148 (75.9) 65 (50.8) Baseline
Can read 47 (24.1) 63 (49.2) 0.3 (0.1 to 0.5)
Marital status
Single/widowed 110 (56.7) 59 (46.8) Baseline
Married 84 (43.3) 67 (53.2) 0.7 (0.4 to 1.2)
Socioeconomic status
1 (poorest) 57 (29.8) 22 (17.9) Baseline
2 52 (27.2) 27 (22.0) 0.8 (0.4 to 1.6)
3 46 (24.1) 35 (28.5) 0.5 (0.3 to 1.0)
4 (least poor) 36 (18.9) 39 (31.7) 0.4 (0.2 to 0.8)
Visual acuity
>6/18 0 (0.0) 128 (100.0) N/A
,6/24, >6/60 78 (39.8) 0 (0.0)
,6/60, >3/60 41 (20.9) 0 (0.0)
,3/60, .PL 36 (18.4) 0 (0.0)
PL 41 (20.9) 0 (0.0)
Mean (95% CI) Mean (95% CI) p Value
Vision-related quality
of life*
Overall eyesight 3.9 (3.9 to 4.1) 2.1 (2.0–2.3) ,0.001
General
functioning
43.6 (41.5 to 45.8) 17.8 (16.6–19.1) ,0.001
Psychosocial 12.2 (11.4 to 12.9) 5.5 (5.0–6.0) ,0.001
Self-rated health 47.6 (45.1 to 50.1) 59.4 (56.3–62.5) ,0.001
PL, perception of light.
Some data were missing.
*Higher score denotes poorer quality of life.
Higher score denotes better self-rated health.
928 Polack, Kuper, Mathenge, et al
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of the scale to differentiate between groups known to be
different, which compared cases and controls. Three subscales
were originally proposed: visual symptoms (3 items), general
functioning (12 items) and psychosocial (4 items), with one
overall eyesight-rating item. As modifications were made, a
rotated exploratory factor analysis was conducted to determine
how items should be grouped for summary scores. Maximum
likelihood estimation was used, and the number of distinct
factors in the scale were taken as those with eigenvalues .1.22
Covariates
Standard sociodemographic data and indicators of socioeconomic
status were collected, as they have been shown to
influence QOL.14 A socioeconomic status (SES) index was
calculated for each household using principal components
analysis (PCA) to determine weights for a list of assets and
wealth indicators using the method of Filmer and Pritchett.23
Variables entered into the PCA included building materials of
the house, ownership of household assets, animal ownership
and education of the head of the household. Assets and wealth
indicators included in the PCA were selected on the basis of
published literature and discussion with local key informants.
The index was created using STATA V.9 and was divided into
quartiles from poorest (lowest SES index) to least poor (highest
SES index).
The associations between QOL measures, VA and socioeconomic
variables were assessed initially using analysis of
variance (WHO/PBD VF20 subscales and EQ5D VAS score) and
x2 (EQ5D dimensions). Multivariate linear or logistic (as
appropriate) regression analyses were conducted using forward
selection of variables, forcing age and gender into the models.
All analyses were conducted using STATA V.9.
Table 2 Internal consistency and skewness values for World Health Organization Prevention
of Blindness and Deafness 20-item Visual Functioning Questionnaire summary scores
Interitem range
(mean)
Item-total range
(mean) Cronbach a Skewness
Overall eyesight – – – 20.59
General functioning 0.33–0.88 (0.70) 0.61–0.93 (0.85) 0.96 20.15
Psychosocial 0.62–0.80 (0.72) 0.82–0.92 (0.89) 0.91 20.28
Pain/discomfort in eye – – – 0.21
Table 3 Forward selection multivariate adjusted linear regression analyses of World Health
Organization Prevention of Blindness and Deafness 20-item Visual Functioning Questionnaire
scores, presenting visual acuity and sociodemographic variables in cases visually impaired
from cataract
Model 1:
overall eyesight
Model 2:
general functioning
Model 3:
psychosocial
Mean (95% CI) Mean (95% CI) Mean (95% CI)
Presenting visual acuity
,6/24, >6/60 3.7 (3.6 to 3.9) 36.5 (33.7 to 39.3) 10.7 (9.4 to 11.8)
,6/60, >3/60 3.7 (3.7 to 4.1) 39.2 (33.6 to 39.3) 10.9 (9.3 to 12.6)
,3/60, .PL 4.0 (3.8 to 4.2) 47.2 (43.1 to 51.3) 14.2 (12.4 to 16.1)
PL 4.7 (4.5 to 4.9) 59.2 (55.3 to 63.1) 14.5 (12.9 to 16.1)
p for trend ,0.001 ,0.001 ,0.001
Age (years)
50–59 4.2 (3.9 to 4.1) 41 (32.2 to 49.8) 11.5 (7.8 to 15.3)
60–69 3.9 (3.7 to 4.1) 40.5 (36.3 to 44.7) 11.1 (9.3 to 12.9)
70–79 4.0 (3.8 to 4.1) 44.9 (41.8 to 47.9) 13.0 (11.7 to 14.3)
>80 4.0 (3.9 to 4.2) 44.4 (41.8 to 47.0) 12.0 (10.9 to 13.2)
p for trend 0.54 0.14 0.47
Sex
Male 3.9 (3.8 to 4.1) 43.8 (40.9–46.6) 12.3 (11.0 to 13.6)
Female 4.0 (3.9 to 4.1) 43.7 (41.4 to 46.0) 12.1 (11.0 to13.1)
SES
1 (poorest) 4.2 (4.0 to 4.4) 49.9 (46.6 to53.1)
2 4.0 (3.8 to 4.2) 43.3 (40.0 to 46.7) –
3 3.9 (3.8 to 4.2) 39.3 (35.7 to 42.9) –
4 (least poor) 3.7 (3.5 to 3.9) 40.1 (36.0 to 44.3) –
p for trend 0.001 ,0.001
Marital status
Married – – 10.6 (9.4 to 11.9)
Widowed/single – – 13.3 (12.2 to 14.4)
Amount of variance explained
by VA (full model)
23.5% (25.6%) 30.0% (37.6%) 7.8% (12.1%)
PL, perception of light; SES, socioeconomic status; VA, visual acuity.
Age and sex were always kept in the model and adjusted means are presented.
–Did not contribute significantly to the model.
Higher score denotes poorer vision-related quality of life..
Cataract visual impairment in a Kenyan population 929
www.bjophthalmol.com
RESULTS
In all, 196 cases and 128 controls were included. Controls were
younger, more likely to have had some education and were in
higher socioeconomic groups than cases (table 1).
Vision-related quality of life
The WHO/PBD VF20 fulfilled most standard psychometric
criteria. The proportion of missing data for each item was ,1%.
Floor and ceiling effects were ,80% for each item and for
summary scores (ie, ,80% people endorsed response categories
at the top and bottom of the scale for each item and for the
summary scores; table 2). Ten items in the general functioning
subscale had inter-item correlations (ie, correlations with other
items in the same subscale) above the maximum criteria of
0.75, which suggests some item redundancy. Two distinct
factors were identified from the factor analysis. All originally
proposed general functioning items, with one visual symptom
item loaded onto factor 1 and all proposed psychosocial items
loaded onto factor 2, suggesting that two subscales, general
functioning and psychosocial, are appropriate for these data.
One visual symptom item, ‘‘because of your eyesight how much
pain and discomfort do you have in your eyes’’, did not load
well onto either factor. As the pain/discomfort item did not
clearly belong to either of the subscales, it was analysed
separately. Good subscale internal consistency was demonstrated
by high Cronbach a and item-total correlations (table 2).
Test–retest correlations were above the acceptable level of 0.80.
Cases had significantly poorer general functioning, psychosocial,
overall eyesight and pain/discomfort scores than
controls, satisfying the known-group differences criteria
(table 1). The scale showed good convergent validity; poorer
VA was associated with poorer mean general functioning,
psychosocial and overall eyesight rating scores (test for trend
p,0.001). The exception was the pain/discomfort item, which
was not significantly associated with visual acuity.
Discriminant validity findings were mixed. Age was not
associated with mean VRQOL scores among cases. However,
cases in the lower SES group had poorer general functioning (p
for trend ,0.001) and self-rated eyesight scores (p=0.04).
Widowed/single cases had poorer psychosocial scores
(p=0.004). Women, widowed/single cases and cases with no
formal education reported poorer pain/discomfort scores. In
Table 4 Response distribution to European Quality of Life Questionnaire domains and
adjusted odds ratios in cases and controls
EQ-5D domain Cases n (%) Controls n (%) Adjusted OR* (95% CI) p Value
Mobility
No problem 65 (33.2) 93 (72.7) Baseline ,0.001
Some problem 118 (60.2) 35 (27.3) 5 (3.0 to 8.2)1
Confined to bed 13 (6.6) 0 (0.0) – –
Self-care
No problems 106 (54.1) 114 (89.1) Baseline ,0.001
Some problems 74 (37.8) 14 (10.9) 6.2 (3.3 to 11.7)1
Unable 16 (8.2) 0 (0.0) – –
Usual activities
No problems 44 (22.5) 93 (72.7) Baseline ,0.001
Some problems 103 (52.6) 33 (25.8) 8.9 (5.2 to 15.1)1
Unable 49 (25.0) 2 (1.6) – –
Pain/discomfort
None 30 (15.3) 47 (36.7) Baseline` ,0.001
Moderate 131 (66.8) 75 (58.6) 2.7 (1.5 to 4.8)
Extreme 35 (17.9) 6 (4.7) 6.8 (2.5 to 18.9)
Anxiety/depression
None 40 (20.4) 64 (50.0) Baseline` ,0.001
Moderate 96 (49.0) 57 (44.5) 2.8 (1.6–4.8)
Extreme 60 (30.6) 7 (5.5) 13.9 (5.4 to 35.9)
EQ-5D, European Quality of Life Questionnaire.
*Odds ratios (ORs) from forward selection logistic regression analysis, with age and sex always included in the model.
Adjusted for age, sex and location.
`Adjusted for age, sex, literacy and location.
1Owing to small cell sizes ‘‘some problem’’ and ‘‘severe problem’’ were combined to calculate ORs for ‘‘any problem’’.
Table 5 A forward selection multivariate linear regression
analysis of self-rated health (from visual analogue scale),
visual acuity and sociodemographic variables
Self-rated health score
Coefficient (95% CI)
Visual acuity
,6/24, >6/60 Baseline
,6/60, >3/60 0.5 (26.2 to 7.2)
,3/60, .PL 26.2 (213.2 to 0.8)
PL 29.6 (216.3 to 3.0)
p for trend 0.001
Age (years)
50–59 Baseline
60–69 4.5 (29.6 to 18.7)
70–79 12.9 (20.8 to 26.6)
>80 7.2 (26.4 to 20.8)
p for trend 0.66
Sex
Male Baseline
Female 1.4 (24.7 to 7.5)
Socioeconomic status
1 (poorest) Baseline
2 8.3 (1.7 to 14.8)
3 8.3 (1.7 to 14.9)
4 (least poor) 10.7 (3.3 to 18.1)
p for trend 0.009
Marital status
Single/widowed Baseline
Married 6.7 (0.4 to 12.8)
930 Polack, Kuper, Mathenge, et al
www.bjophthalmol.com
multivariate analyses (table 3) controlling for visual acuity,
overall eyesight and general functioning scores were worse in
poorer cases, and widowed/single cases were more likely to
have poorer psychosocial scores. There were no significant
multivariate predictors of pain/discomfort in the eyes of the
cases.
Health-related quality of life
All five EQ-5D dimensions discriminated between cases and
controls (table 4). Among cases, adjusting for covariates, poorer
VA was associated with higher odds of reporting any problem
with mobility (p for trend =0.003), self-care (p for trend
,0.001), usual activities (p for trend=0.008) and pain/
discomfort (p for trend =0.01). There was no significant
association with depression.
Self-rated health score was worse in cases than in controls
(p,0.001); (table 1), and mean health score worsened with
increasing severity of visual impairment in cases (table 5).
Widowed/single and cases in the lower SES groups had lower
mean health scores.
DISCUSSION
This study evaluated the WHO/PBD VF20, an instrument
recommended for measuring VRQOL in low-income settings,
in Nakuru district, Kenya. To our knowledge no other studies
have explored the association between visual impairment from
cataract and quality of life in Kenya.
The results show that the modified WHO/PBD VFQ20, with
one overall rating item and two subscales, (general functioning
and psychosocial) is a valid and reliable scale in this Kenyan
setting. One item about glare from glare from bright lights was
removed, but this might have more relevance in other settings.
The item about pain in the eye did not correlate well with other
items in the scale. Cases reported worse pain scores than
controls; however, among the cases, there was no significant
variation in pain score with VA. Pain and discomfort are not
typical symptoms of cataract, but this item might be more
relevant for other ocular morbidities. However, it was not
included in the original INDVFQ33 which was developed on the
basis of 46 focus group discussions exploring patient’s perceptions
about their eye conditions and associated impact on daily
living.24 There was some redundancy in items, suggesting that it
might be possible to shorten this questionnaire further,
although the full questionnaire should be evaluated in other
settings to confirm this.
Cases were more likely to report problems with the EQ-5D
dimensions than controls. Increasing severity of visual impairment
was associated with higher odds of reporting problems
with mobility, self-care, usual activities, and pain/discomfort
and with mean self-rated health score. These findings
correspond to studies from high-income settings,5 and highlight
an impact of visual impairment on wider well-being that is not
necessarily reflected by vision related scales.
Sociodemographic and economic variables influenced
response independently of VA. This is in accordance with other
studies,5 14 and suggests that experiences of visual impairment
may vary according to individual circumstances. In a study in
Hong Kong, Lau et al25 comment that, despite comparable VA
and using the same scale, mean VRQOL scores were better than
those in China and Nepal, and suggest that this may be due to
differences in modern household utilities which facilitate selfcare
activities. A similar reason may explain why cases in the
lower SES groups in Nakuru had worse general functioning
scores. Promotion of surgical services at early stages of cataract
in poor communities should remain a priority. Being widowed/
single increased the social and emotional burden of cataract
visual impairment, as reflected by poorer psychosocial scores
compared with married people. In contrast, but in accordance
with findings from the INDVFQ 33 in India,14 there was no
association between VRQOL scores and age or sex.
This study has its limitations. Three different case recruitment
methods were used. However, all cases were from the
same district and met the same case definition. According to
power calculations, 133 controls were required for the study,
but only 128 were identified. However, the power calculations
were based on very conservative estimates, so the effect of this
is probably minimal. The WHO/PBD VF20 was recommended as
an instrument to assess all ocular morbidities and we focused
only on cataract. Further, we focused only on people aged
>50 years, and the scale might perform differently in other age
groups. However, the original INDVFQ33 was also developed in
people aged >50 years, and, although other eye conditions
were included, was largely dominated by cataract, reflecting the
relative importance of this condition in the Indian setting. Our
results indicated that some items in the Kenyan setting were
not relevant or were redundant. Future studies should look at
the performance of the full WHO/PBD VF20 scale in other
populations or other disease groups. The translation of the EQ-
5D questionnaire was not validated by the EuroQol group,
although standard translation procedures were followed.
Multiple tests of statistical significance for correlated measures
were made using these data. However, analyses were repeated
using the Bonferroni correction and the multivariate analyses
were essentially unchanged.
In this study, evidence of the validity and reliability of a new
scale were shown, and the data suggest that this scale would be
suitable for assessing the outcome of cataract surgery. The
findings add weight to the evidence of disability and poorer
self-perception of own health associated with cataract visual
impairment among people in an African country.
ACKNOWLEDGEMENTS
We thank all the people from Nakuru district who participated in the
survey. We also thank the office manager (Redempta Muibu), the
ophthalmologists (Oscar Onyango, Godfrey Nyaga, Tina Eusebio), the
ophthalmic clinical officers (Maurice Oduoo, Flora Kosgey, Devina
Kisorio and Maina James), the interviewers (Philip Lumula, Nimmo
Gicheru, Marie Anne Cege, Emma Kamau, Mike Kepkembai, Agnes
Maingi and Rose Kagwe), the information officer (Irene Chelagat), the
drivers (Daniel Mutai, John and Sammy) and data entry clerks (Faith
Lumula and Terry). The Rift Valley Provincial Hospital kindly offered us
office space on their premises. The assistance of the Medical Officer of
Health, Nakuru, and the Electoral Commission Office in Nakuru is
acknowledged.
Authors’ affiliations
. . . . . . . . . . . . . . . . . . . . . . .
Sarah Polack, Hannah Kuper, Astrid Fletcher, Allen Foster, London School
of Hygiene & Tropical Medicine, London, UK
Wanjiku Mathenge, Rift Valley Provincial General Hospital, Nakuru Town,
Nakuru, Kenya
Funding: This study was funded by grants from Sight Savers International,
Christian Blind Mission and ORBIS International.
Competing interests: None.
REFERENCES
1 Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in
the year 2002. Bull World Health Organ 2004;82:844–51.
2 Javitt J, Venkataswamy G, Sommer A. The economic and social aspect of
restoring sight. In: Henkind P, eds. ACTA:24th International Congress of
Ophthalmology. New York: Lippincott, 1983:1308–12.
3 Foster A. Vision 2020: the cataract challenge. J Community Eye Health
2000;13:17–19.
4 Ellwein LB, Fletcher A, Negrel AD, et al. Quality of life assessment in blindness
prevention interventions. Int Ophthalmol 1994;18:263–8.
5 Wang JJ, Mitchell P, Smith W. Vision and low self-rated health: the Blue
Mountains Eye Study. Invest Ophthalmol Vis Sci 2000;41:49–54.
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6 Crabtree HL, Hildreth AJ, O’Connell JE, et al. Measuring visual symptoms in
British cataract patients: the cataract symptom scale. Br J Ophthalmol
1999;83:519–23.
7 Chia EM, Mitchell P, Rochtchina E, et al. Unilateral visual impairment and health
related quality of life: the Blue Mountains Eye Study. Br J Ophthalmol
2003;87:392–5.
8 Chan CWN, Wong JCC, Chan KSK, et al. Evaluation of quality of life in patients
with cataract in Hong Kong. J Cataract Refract Surg 2003;29:1753–60.
9 Lee JE, Fos PJ, Zuniga MA, et al. Assessing quality of life in cataract patients: the
relationship between utility and health-related quality of life measurement. Qual
Life Res 2000;9:1127–35.
10 Massof RW, Rubin GS. Visual function assessment questionnaires. Surv
Ophthalmol 2001;45:531–48.
11 Schemann JF, Leplege A, Keita T, et al. From visual function deficiency to
handicap: measuring visual handicap in Mali. Ophthalmic Epidemiol
2002;9:133–48.
12 van Dijk K, Lewallen S, Chirambo M, et al. Creation and testing of a practical
visual function assessment for use in Africa: correlation with visual acuity,
contrast sensitivity, and near vision in Malawian adults. Br J Ophthalmol
1999;83:792–5.
13 WHO. Consultation on development of standards for characterization of vision
loss and visual functioning. Geneva: World Health Organization, 2003.
14 Gupta SK, Viswanath K, Thulasiraj RD, et al. The Development of the Indian
Vision Function Questionnaire (IND-VFQ): field testing and psychometric
evaluation. Br J Ophthalmol 2005;89:621–7.
15 Fletcher A, Vijaykumar V, Selvaraj S, et al. The Madurai Intraocular Lens Study.
III: Visual functioning and quality of life outcomes, Am J Ophthalmol
1998;125:26–35.
16 Mathenge W, Kuper H, Polack S, et al. Rapid Assessment of Avoidable Blindness
in Nakuru District, Kenya. Ophthalmology 2007;114:599–605.
17 Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol
Group. Ann Med 2001;33:337–43.
18 Brazier J, Jones N, Kind P. Testing the validity of the Euroqol and
comparing it with the SF-36 health survey questionnaire. Qual Life Res
1993;2:169–80.
19 Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in
rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D).
Br J Rheumatol 1997;36:551–9.
20 Tidermark J, Bergstrom G, Svensson O, et al. Responsiveness of the EuroQol (EQ
5-D) and the SF-36 in elderly patients with displaced femoral neck fractures.
Qual Life Res 2003;12:1069–79.
21 Lamping DL, Schroter S, Marquis P, et al. The community-acquired pneumonia
symptom questionnaire: a new, patient-based outcome measure to evaluate
symptoms in patients with community-acquired pneumonia. Chest
2002;122:920–9.
22 Hays RD, Fayers PM. Evaluating multi-item scales. In: Fayers PM, Hays RD, eds.
Assessing quality of life in clinical trials methods and practice. New York: Oxford
University Press, 2005:41–53.
23 Filmer D, Pritchett L. Estimating wealth effects without expenditure data—or tears.
An application to educational enrollment in states of India. Demography
2001;38:115–32.
24 Murthy GVS, Gupta SK, Thulasiraj RD, et al. The development of the Indian
Vision Function Questionnaire (IND-VFQ): questionnaire content. Br J Ophthalmol
2005;89:498–503.
25 Lau J, Michon JJ, Chan WS, et al. Visual acuity and quality of life outcomes in
cataract surgery patients in Hong Kong. Br J Ophthalmol 2002;86:12–17.
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Recruitment, Interviewing, and Candidate Selection
"React Presents Chicago" ( aMUSIC PRODUCTION COMPANY, you can google it,
the book we use is:• Noe, R.A. et al. (2015). Human Resource Management: Gaining a Competitive Advantage (9th edition). McGraw-Hill Irwin. ISBN: 978-0-07-811276-8
and this week's chapter and topic are: Performance Management
and Employee Development ( so choose one topic that you think you can come up with the best content)
Attached files are assignment example and a classmate's example, you have to follow it, for the "DISCCUSION QUESTIONS"
Background:
• There are approximately thirty-five unfilled positions at XXXXXXXXXXX and two of these openings are in the New Product Development team I have been a part of for the last year.
• Within the last month, I was asked to interview candidates to fill the senior level positions. HR provided me with each candidate's resume, job description, general questions, and a date/time for the interview.
• I have met with seven of the twelve candidates that have been brought in for either the first or second round of interviews. Each interviewer has individually interviewed each candidate for 30-60 minutes and the team of interviewers has been changed throughout the process.
• I have been forming my own questions and am not aware of what others are asking (including my manger and the HR representative). The provided questions are general and not specific to the job requirements or tasks. I have asked each candidate both situational and future-oriented questions based on situations I have been in (leading teams and working on technical problems).
• Within a week after the interviews, the team of interviewers met as a team and provided feedback to the HR talent acquisitions representative (she then provided the information to the hiring manager). During the meetings, I had been asked to start the discussion. We are not required to turn in notes from the interviews, so notes are not required. Most of the feedback provided is general and each interviewer is asked whether they would hire the candidate. I tried to provide specific examples to back-up
• Both positions have been open for approximately three to four months. Those employees who were previously in the role were either promoted within the company or moved to another open position in another team.
Problem/ Impact:
• Many of the candidates that were interviewed are better suited for other teams/roles within the company based on their experience and future goals (other teams are also currently hiring, but hiring managers are different)
• The current role of a New Product Development Engineer is both project management and technical. Some of the candidates have experience in one or the other -- unclear as to which skills are more desired.
• The interviewing team has changed throughout the process, so candidate ratings have been less useful. No standard interviewing practice or specific structure has been used throughout the process.
• The hiring manager is under pressure to fill the position, so his sentiments have changed throughout the process.
• The hiring manager has brought back candidates for a second round of interviews even if the outcome from the first round was overall negative.
• Many employee's time has been spent on this interviewing process for two positions that have not yet been filled (I have spent nine hours total).
Discussion Questions:
• Although I am not the hiring manager, what specific suggestions could I provide to the hiring manager or HR representative to positively affect the interviewing process?
• Along with the general questions that HR provides each interviewer, what other types of questions should and could be provided?
• What are some ways to increase the interview's utility (degree at which information provided enhances the effectiveness of personnel)?
• What are some suggestions for streamlining the interviewing process from the beginning instead of bringing in many candidates multiple times?
• What type of work-sample tests could be utilized by the company to understand if candidates are self-starters, team-oriented, and leaders as-well-as have technical skills?
• Since the positions discussed above opened due to employee movement within the company (due to promotions or job experience), how could Hollister have better planned for the situation (unfilled positions)?
Relevant Course Material:
• Improvements may include: (1) interviews that are more standardized, structured, and focused on goals and behaviors, (2) interviews that are quantitatively rated - instead of yes/no, (3) required notes that are structured - since meetings may occur a week after actual interviews, (4) situational interviewing questions
• Job requirements and behaviors should be known by interviewers prior to conducting interviews. Also, hiring managers should work closely with the HR talent acquisition representatives to determine the job description and behavior requirements.
• Instead of general interviews, use a combination of work-sample tests, structured interviews, and a measurement of general cognitive ability. Also, decrease the amount of interviewers and/or use the same interviewers throughout the process.
• XXXXXXXXX currently forecasts for HR planning three times a year (beginning, middle, and end). Due to planning, early stages of recruitment should be possible prior to promotions/movement and selection.
the book we use is:• Noe, R.A. et al. (2015). Human Resource Management: Gaining a Competitive Advantage (9th edition). McGraw-Hill Irwin. ISBN: 978-0-07-811276-8
and this week's chapter and topic are: Performance Management
and Employee Development ( so choose one topic that you think you can come up with the best content)
Attached files are assignment example and a classmate's example, you have to follow it, for the "DISCCUSION QUESTIONS"
Background:
• There are approximately thirty-five unfilled positions at XXXXXXXXXXX and two of these openings are in the New Product Development team I have been a part of for the last year.
• Within the last month, I was asked to interview candidates to fill the senior level positions. HR provided me with each candidate's resume, job description, general questions, and a date/time for the interview.
• I have met with seven of the twelve candidates that have been brought in for either the first or second round of interviews. Each interviewer has individually interviewed each candidate for 30-60 minutes and the team of interviewers has been changed throughout the process.
• I have been forming my own questions and am not aware of what others are asking (including my manger and the HR representative). The provided questions are general and not specific to the job requirements or tasks. I have asked each candidate both situational and future-oriented questions based on situations I have been in (leading teams and working on technical problems).
• Within a week after the interviews, the team of interviewers met as a team and provided feedback to the HR talent acquisitions representative (she then provided the information to the hiring manager). During the meetings, I had been asked to start the discussion. We are not required to turn in notes from the interviews, so notes are not required. Most of the feedback provided is general and each interviewer is asked whether they would hire the candidate. I tried to provide specific examples to back-up
• Both positions have been open for approximately three to four months. Those employees who were previously in the role were either promoted within the company or moved to another open position in another team.
Problem/ Impact:
• Many of the candidates that were interviewed are better suited for other teams/roles within the company based on their experience and future goals (other teams are also currently hiring, but hiring managers are different)
• The current role of a New Product Development Engineer is both project management and technical. Some of the candidates have experience in one or the other -- unclear as to which skills are more desired.
• The interviewing team has changed throughout the process, so candidate ratings have been less useful. No standard interviewing practice or specific structure has been used throughout the process.
• The hiring manager is under pressure to fill the position, so his sentiments have changed throughout the process.
• The hiring manager has brought back candidates for a second round of interviews even if the outcome from the first round was overall negative.
• Many employee's time has been spent on this interviewing process for two positions that have not yet been filled (I have spent nine hours total).
Discussion Questions:
• Although I am not the hiring manager, what specific suggestions could I provide to the hiring manager or HR representative to positively affect the interviewing process?
• Along with the general questions that HR provides each interviewer, what other types of questions should and could be provided?
• What are some ways to increase the interview's utility (degree at which information provided enhances the effectiveness of personnel)?
• What are some suggestions for streamlining the interviewing process from the beginning instead of bringing in many candidates multiple times?
• What type of work-sample tests could be utilized by the company to understand if candidates are self-starters, team-oriented, and leaders as-well-as have technical skills?
• Since the positions discussed above opened due to employee movement within the company (due to promotions or job experience), how could Hollister have better planned for the situation (unfilled positions)?
Relevant Course Material:
• Improvements may include: (1) interviews that are more standardized, structured, and focused on goals and behaviors, (2) interviews that are quantitatively rated - instead of yes/no, (3) required notes that are structured - since meetings may occur a week after actual interviews, (4) situational interviewing questions
• Job requirements and behaviors should be known by interviewers prior to conducting interviews. Also, hiring managers should work closely with the HR talent acquisition representatives to determine the job description and behavior requirements.
• Instead of general interviews, use a combination of work-sample tests, structured interviews, and a measurement of general cognitive ability. Also, decrease the amount of interviewers and/or use the same interviewers throughout the process.
• XXXXXXXXX currently forecasts for HR planning three times a year (beginning, middle, and end). Due to planning, early stages of recruitment should be possible prior to promotions/movement and selection.
JIHAD OR EXTREMISM
need to know the media represents the meaning of Jihad and how it differs from the muslim view of the word Jihad. I also need to know why is there a difference between the meanings. Also please define extremism
What claim does the author make in the introduction about how the idea of failure and Reconstruction was different fifty years after the event?
Questions
1. What claim does the author make in the introduction about how the idea of failure and Reconstruction was different fifty years after the event? [ 2pts]
2. What evidence does the author provide to support this idea of Reconstruction as a failure during that time period? Provide three examples (answer should be a paragraph) [6 pts]
3. According to the article, how did this view of Reconstruction impact African Americans? [2 pts]
4. How was Dubois' interpretation of Reconstruction different? [2 pts]
5. Why does the author use some “what if” questions towards the end of the article to explain the true failure of Reconstruction? (this answer should be a paragraph) [6 pts]
The words “tragic” and “tragedy” have long been linked to the Reconstruction era in the United States, but the reason for the association has shifted over time. In the first 50 years after the period ended, those words were most often used to lament post-Civil War attempts to change the racial balance of power in the defeated South. According to the zero-sum game white supremacists were playing, granting black citizenship—which required ending slavery, preventing discrimination based on race, and giving black males the right to vote and govern in Southern states—stripped white people of what they believed to be their God-given right to rule over black people. A whole school of literature and history sprang up to carry the message far and wide: Terrible, terrible things had been done to the good and innocent white people of the South during Reconstruction.
The most well-known purveyor [supporter] of this notion was D.W. Griffith, whose film,Birth of a Nation, depicted illiterate, uncouth, and lecherous-for-white-women black men who had supposedly taken the reins of power in Southern states during Reconstruction. The film portrayed black legislators as men with their bare feet up on their desks during sessions, eating chicken and watermelon while taking the occasional swig of alcohol. These caricatures of black legislators told the story: Reconstruction was a folly; black people were unfit for American citizenship. And millions of people took the message of Griffith’s grotesque masterpiece to heart.
Griffith’s contemporaries in American history departments echoed his sentiments, though they generally cloaked their contempt for black people; substituting faux [fake] scholarly detachment for the director’s cinematic pyrotechnics on the race question. In a blatant use of the discipline of history for reactionary ends, William A. Dunning of Columbia University created a school of historiography that seconded the notion that Reconstruction was a grievous error. Dunning and his protégés weren’t alone. In an era where scientific racism and hostility to blacks flourished openly, other historians, literary figures, and social commentators felt free to question blacks’ fitness for citizenship
In this view, President Andrew Johnson—who did everything he could to sabotage efforts on behalf of the formerly enslaved, and after his impeachment in the House of Representatives, escaped removal from office by one vote in the Senate—was portrayed as the hero who had valiantly attempted to save the country from the specter of “Negro Rule.” The men who opposed him were considered dangerous “radicals” aimed at upsetting the racial hierarchy and making inferior people citizens of the United States. Johnson, who was barely educated himself—he learned to read in his late teenage years and to write just a few years later—was held up as one of the country’s great presidents.
The urgency to limit black advancement and create doubts about the efficacy of black citizenship was derived from the doctrine of white supremacy. Blacks of the era saw Birth of a Nation for what it was, and organized protests in various venues where it was screened. But, as noted, it was not only that movie’s presentation of Reconstruction-as-horror-show that had to be confronted. The early written history of the era put the weight of academia behind crude formulations of racially based power politics; making the pronouncements of blacks’ unfitness for citizenship a matter of social science and, for some, pure science. These writings served late 19th-century and early 20th-century political and social arrangements—disfranchisement, Jim Crow, and, for extremists, lynching. Casting doubt on blacks’ innate capacities, they gave license to question whether African Americans should, or could ever, be successfully incorporated into the American polity. Very importantly, it was to be left to whites to decide the question when, and if, blacks would ever be eligible to exist with all the attributes of citizenship in the United States. Blacks resisted this idea in the streets and in scholarship.
In 1935, the eminent scholar W.E.B. Dubois produced Black Reconstruction, which offered a devastating corrective to Dunning and his cohort, detailing the ways in which they had distorted the record. Other historians, most notably Eric Foner, followed Dubois’s course with transformative works that made it clear that the real “tragedy” of Reconstruction was the determined and sustained opposition to the program that consequently kept the goals of the farsighted men in Congress from being achieved.
It was tragic that by the 1870s, white northerners, tired of dealing with the South’s racial problems and ready to move on, effectively abandoned Southern blacks to the mercies of people who had not long before thought of and treated them as chattel. Blacks’ status as outside of—or somehow “alien” to—the American republic continued, and continues today. That blacks have had to “fight” for the rights of citizenship, after the Fourteenth Amendment purportedly made them citizens, reveals the disconnect.
In the end, the opportunities for blacks, the South, and the country as a whole that were lost because of the resistance to and abandonment of Reconstruction stand as one of the great tragedies of American history. The subject naturally provokes a series of “what ifs.” What if plans for land reform had been effectuated during that time? Doing so would have helped the freedmen to become landowners, a status recognized since the country’s origins as a foundation for personal independence. But black independence was exactly what white southerners didn’t want. They preferred to bring things back as close to slavery as possible, ensnaring former enslaved people and their progeny in a system of share cropping and debt peonage that stymied the growth of black economic wealth for generations.
What if blacks’ voting rights had not been cut off through official shenanigans and outright violence? What different political course might the South have taken? Support for public education and public works would likely have been much stronger if blacks had been active in the electorate. This, in turn, might have brought more sustained economic development, infrastructural improvements, and a higher standard of living to all in the region.
What if American historians during the aftermath of Reconstruction had not been white supremacists? A different type of society, and a different type of education about that society, would have given young blacks and whites an opportunity to learn another narrative about black people’s place in America.
There is little reason to doubt that if the United States had started the process of rewriting the script on race relations during the late 19th century, instead of delaying it to the 1950s and 1960s, many problems that have their origins in the country’s troubled racial history might be closer to resolution. As Justice Thurgood Marshall noted in 1978 in the affirmative action case, The Regents of University of California v. Bakke, America has been dealing with the tragedy of Reconstruction’s failure and its aftermath for decades now. It appears that the country will likely be doing so for the foreseeable future.
1. What claim does the author make in the introduction about how the idea of failure and Reconstruction was different fifty years after the event? [ 2pts]
2. What evidence does the author provide to support this idea of Reconstruction as a failure during that time period? Provide three examples (answer should be a paragraph) [6 pts]
3. According to the article, how did this view of Reconstruction impact African Americans? [2 pts]
4. How was Dubois' interpretation of Reconstruction different? [2 pts]
5. Why does the author use some “what if” questions towards the end of the article to explain the true failure of Reconstruction? (this answer should be a paragraph) [6 pts]
The words “tragic” and “tragedy” have long been linked to the Reconstruction era in the United States, but the reason for the association has shifted over time. In the first 50 years after the period ended, those words were most often used to lament post-Civil War attempts to change the racial balance of power in the defeated South. According to the zero-sum game white supremacists were playing, granting black citizenship—which required ending slavery, preventing discrimination based on race, and giving black males the right to vote and govern in Southern states—stripped white people of what they believed to be their God-given right to rule over black people. A whole school of literature and history sprang up to carry the message far and wide: Terrible, terrible things had been done to the good and innocent white people of the South during Reconstruction.
The most well-known purveyor [supporter] of this notion was D.W. Griffith, whose film,Birth of a Nation, depicted illiterate, uncouth, and lecherous-for-white-women black men who had supposedly taken the reins of power in Southern states during Reconstruction. The film portrayed black legislators as men with their bare feet up on their desks during sessions, eating chicken and watermelon while taking the occasional swig of alcohol. These caricatures of black legislators told the story: Reconstruction was a folly; black people were unfit for American citizenship. And millions of people took the message of Griffith’s grotesque masterpiece to heart.
Griffith’s contemporaries in American history departments echoed his sentiments, though they generally cloaked their contempt for black people; substituting faux [fake] scholarly detachment for the director’s cinematic pyrotechnics on the race question. In a blatant use of the discipline of history for reactionary ends, William A. Dunning of Columbia University created a school of historiography that seconded the notion that Reconstruction was a grievous error. Dunning and his protégés weren’t alone. In an era where scientific racism and hostility to blacks flourished openly, other historians, literary figures, and social commentators felt free to question blacks’ fitness for citizenship
In this view, President Andrew Johnson—who did everything he could to sabotage efforts on behalf of the formerly enslaved, and after his impeachment in the House of Representatives, escaped removal from office by one vote in the Senate—was portrayed as the hero who had valiantly attempted to save the country from the specter of “Negro Rule.” The men who opposed him were considered dangerous “radicals” aimed at upsetting the racial hierarchy and making inferior people citizens of the United States. Johnson, who was barely educated himself—he learned to read in his late teenage years and to write just a few years later—was held up as one of the country’s great presidents.
The urgency to limit black advancement and create doubts about the efficacy of black citizenship was derived from the doctrine of white supremacy. Blacks of the era saw Birth of a Nation for what it was, and organized protests in various venues where it was screened. But, as noted, it was not only that movie’s presentation of Reconstruction-as-horror-show that had to be confronted. The early written history of the era put the weight of academia behind crude formulations of racially based power politics; making the pronouncements of blacks’ unfitness for citizenship a matter of social science and, for some, pure science. These writings served late 19th-century and early 20th-century political and social arrangements—disfranchisement, Jim Crow, and, for extremists, lynching. Casting doubt on blacks’ innate capacities, they gave license to question whether African Americans should, or could ever, be successfully incorporated into the American polity. Very importantly, it was to be left to whites to decide the question when, and if, blacks would ever be eligible to exist with all the attributes of citizenship in the United States. Blacks resisted this idea in the streets and in scholarship.
In 1935, the eminent scholar W.E.B. Dubois produced Black Reconstruction, which offered a devastating corrective to Dunning and his cohort, detailing the ways in which they had distorted the record. Other historians, most notably Eric Foner, followed Dubois’s course with transformative works that made it clear that the real “tragedy” of Reconstruction was the determined and sustained opposition to the program that consequently kept the goals of the farsighted men in Congress from being achieved.
It was tragic that by the 1870s, white northerners, tired of dealing with the South’s racial problems and ready to move on, effectively abandoned Southern blacks to the mercies of people who had not long before thought of and treated them as chattel. Blacks’ status as outside of—or somehow “alien” to—the American republic continued, and continues today. That blacks have had to “fight” for the rights of citizenship, after the Fourteenth Amendment purportedly made them citizens, reveals the disconnect.
In the end, the opportunities for blacks, the South, and the country as a whole that were lost because of the resistance to and abandonment of Reconstruction stand as one of the great tragedies of American history. The subject naturally provokes a series of “what ifs.” What if plans for land reform had been effectuated during that time? Doing so would have helped the freedmen to become landowners, a status recognized since the country’s origins as a foundation for personal independence. But black independence was exactly what white southerners didn’t want. They preferred to bring things back as close to slavery as possible, ensnaring former enslaved people and their progeny in a system of share cropping and debt peonage that stymied the growth of black economic wealth for generations.
What if blacks’ voting rights had not been cut off through official shenanigans and outright violence? What different political course might the South have taken? Support for public education and public works would likely have been much stronger if blacks had been active in the electorate. This, in turn, might have brought more sustained economic development, infrastructural improvements, and a higher standard of living to all in the region.
What if American historians during the aftermath of Reconstruction had not been white supremacists? A different type of society, and a different type of education about that society, would have given young blacks and whites an opportunity to learn another narrative about black people’s place in America.
There is little reason to doubt that if the United States had started the process of rewriting the script on race relations during the late 19th century, instead of delaying it to the 1950s and 1960s, many problems that have their origins in the country’s troubled racial history might be closer to resolution. As Justice Thurgood Marshall noted in 1978 in the affirmative action case, The Regents of University of California v. Bakke, America has been dealing with the tragedy of Reconstruction’s failure and its aftermath for decades now. It appears that the country will likely be doing so for the foreseeable future.
Evidence Based Practice and Applied Nursing Research
Introduction:
For this assessment, you will select a nursing admission/assessment or patient care/preparation process or procedure (e.g., routine shaving of the surgical site) that is commonly found in your practice setting that you and your colleagues question. You will gather evidence to determine the basis for this process or procedure, provide suggestions based on evidence on how this process or procedure should be changed, and determine possible barriers to implementation of a revised clinical practice guideline.
Requirements:
A. Describe a nursing admission/assessment or patient care/preparation process or procedure currently found in your practice setting.
Note: You must choose a process or procedure that was already in place and you can recommend changes to.
1. Discuss why the present process or procedure needs to be changed, based on the evidence you have gathered.
2. Based on your initial investigation of the situation, do the following:
Note: You may need to ask workplace personnel to complete the following.
a. Explain who determined the basis for the current process or procedure in your practice setting.
b. Explain the decision makers’ rationale for instituting or supporting the current process or procedure.
c. Explain why the decision makers decided to implement the current process or procedure.
3. Recommend a practice change for the process or procedure you selected.
a. List five relevant and credible sources to support your suggested practice change.
Note: Credible sources are less than five years old and may include professional journals, research reports, professional websites, governmental reports, current texts less than five years old, and presentations from professional meetings.
4. Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you listed in part A3a.
5. Explain the implications your recommended change might have on the practice setting, based on the relevant and credible sources you listed in part A3a.
6. Discuss how you would involve key stakeholders in the decision to change the process or procedure or to comply with the recommended change.
B. Write an essay (suggested length of 2–3 pages) in which you do the following:
1. Discuss the specific barriers you may encounter in applying research to processes and procedures in your practice setting.
Note: You should distinguish between difficulties you would have interpreting what the research says and synthesizing it into a practice guideline or procedure, rather than just the outside barriers to change.
2. Identify at least two strategies that you and your team could use to overcome the barriers you discussed in part B1.
3. Explain how you would implement your recommended process or procedure based on research findings.
C. When you use sources, include all in-text citations and references in APA format.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.
For this assessment, you will select a nursing admission/assessment or patient care/preparation process or procedure (e.g., routine shaving of the surgical site) that is commonly found in your practice setting that you and your colleagues question. You will gather evidence to determine the basis for this process or procedure, provide suggestions based on evidence on how this process or procedure should be changed, and determine possible barriers to implementation of a revised clinical practice guideline.
Requirements:
A. Describe a nursing admission/assessment or patient care/preparation process or procedure currently found in your practice setting.
Note: You must choose a process or procedure that was already in place and you can recommend changes to.
1. Discuss why the present process or procedure needs to be changed, based on the evidence you have gathered.
2. Based on your initial investigation of the situation, do the following:
Note: You may need to ask workplace personnel to complete the following.
a. Explain who determined the basis for the current process or procedure in your practice setting.
b. Explain the decision makers’ rationale for instituting or supporting the current process or procedure.
c. Explain why the decision makers decided to implement the current process or procedure.
3. Recommend a practice change for the process or procedure you selected.
a. List five relevant and credible sources to support your suggested practice change.
Note: Credible sources are less than five years old and may include professional journals, research reports, professional websites, governmental reports, current texts less than five years old, and presentations from professional meetings.
4. Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you listed in part A3a.
5. Explain the implications your recommended change might have on the practice setting, based on the relevant and credible sources you listed in part A3a.
6. Discuss how you would involve key stakeholders in the decision to change the process or procedure or to comply with the recommended change.
B. Write an essay (suggested length of 2–3 pages) in which you do the following:
1. Discuss the specific barriers you may encounter in applying research to processes and procedures in your practice setting.
Note: You should distinguish between difficulties you would have interpreting what the research says and synthesizing it into a practice guideline or procedure, rather than just the outside barriers to change.
2. Identify at least two strategies that you and your team could use to overcome the barriers you discussed in part B1.
3. Explain how you would implement your recommended process or procedure based on research findings.
C. When you use sources, include all in-text citations and references in APA format.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.
Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.
EH 102
Item #1: In 100-125 well-chosen words, answer Question #1 on p. 8 of CI.
Item #2: In equally well-chosen words, answer the following 3 questions about the sample essay on pp. 12-13. (Use your own wording and ideas, not what you see in the book.)
a. What is the author's overall claim or purpose in this essay? (Answer in one sentence.)
b. What do you think the author would say is his strongest reason in this essay, and why might he think this reason is so important? (Answer in 3-4 sentences.)
c. In your opinion, what is the weakest part of this essay and why is it weak? (Answer in 3-4 sentences.)
Item #2: In equally well-chosen words, answer the following 3 questions about the sample essay on pp. 12-13. (Use your own wording and ideas, not what you see in the book.)
a. What is the author's overall claim or purpose in this essay? (Answer in one sentence.)
b. What do you think the author would say is his strongest reason in this essay, and why might he think this reason is so important? (Answer in 3-4 sentences.)
c. In your opinion, what is the weakest part of this essay and why is it weak? (Answer in 3-4 sentences.)
Python Programming
You!will!be!adding!your!own!functions!to!the!program.!!There!must!not!be!any!variables!used!outside!any!
of!the!functions.!
!
!
If!you!do!not!complete!all!of!the!assignment,!the!marker!will!run!your!program!until!the!program!stops!
running!and!you!will!be!given!the!marks!for!the!parts!of!the!assignment!you!have!completed.!
!
THE)GAME)OF)DIGIT)MEMORY)
The!one!player!game!of!Memory!is!a!game!in!which!all!of!the!digit!pairs!are!laid!face!down!in!random!order!
on!a!surface!and,!each!turn,!the!player!selects!two!of!the!digits!which!are!then!displayed.!!If!the!two!digits!
selected!by!the!player!match,!the!pair!of!digits!remain!visible!and!the!player!continues!with!the!next!turn!
trying!to!match!another!pair!of!digits.!!If!the!digits!don't!match!the!digits!are!turned!over!and!the!player!
continues!with!the!next!turn.!The!object!of!the!game!is!to!turn!over!all!the!pairs!of!matching!digits!in!as!
few!turns!as!possible.!! !
Add!the!
functions!
required!to!
the!program.!
! 2!
THE)SKELETON)OF)THE)PROGRAM)
The!skeleton!of!the!program!for!the!game!of!Memory!is!shown!below.!!The!play_one_game()!function!
is!complete!and!should!not!be!changed!in!any!way.!!Copy!this!skeleton!into!your!program!file!and!complete!
the!missing!functions.!!Example!output!using!the!completed!program!is!shown!on!the!last!three!pages!of!
this!document.!
import random
#----------------------------------
# main part of the program
#----------------------------------
def main():
player_name = get_player_name()
display_title(player_name)
play_one_game(player_name)
#----------------------------------
# Play one game
#----------------------------------
def play_one_game(player_name):
hidden_symbol = "-"
digits = get_random_digits()
user_digits = hidden_symbol * len(digits)
cheating_is_on = get_cheating_on_off()
if cheating_is_on:
display_cheating(digits)
turns_so_far = 0
matched_so_far = 0
pairs_guessed = 0
while not user_digits == digits:
display_digits(user_digits, turns_so_far, pairs_guessed)
index1 = get_index_from_player()
digit1 = digits[index1]
display_first_digit(index1 + 1, digit1)
index2 = get_index_from_player()
digit2 = digits[index2]
previous_user_digits = user_digits
user_digits = get_adjusted_digits(user_digits, index1, index2,
digit1, digit2)
turns_so_far += 1
if digit1 == digit2:
pairs_guessed = get_pairs_guessed(user_digits)
else:
display_digits(user_digits, turns_so_far, pairs_guessed)
press_enter_to_continue()
user_digits = previous_user_digits
display_digits(user_digits, turns_so_far, pairs_guessed)
display_game_end_feedback(player_name, turns_so_far)
main()!
of!the!functions.!
!
!
If!you!do!not!complete!all!of!the!assignment,!the!marker!will!run!your!program!until!the!program!stops!
running!and!you!will!be!given!the!marks!for!the!parts!of!the!assignment!you!have!completed.!
!
THE)GAME)OF)DIGIT)MEMORY)
The!one!player!game!of!Memory!is!a!game!in!which!all!of!the!digit!pairs!are!laid!face!down!in!random!order!
on!a!surface!and,!each!turn,!the!player!selects!two!of!the!digits!which!are!then!displayed.!!If!the!two!digits!
selected!by!the!player!match,!the!pair!of!digits!remain!visible!and!the!player!continues!with!the!next!turn!
trying!to!match!another!pair!of!digits.!!If!the!digits!don't!match!the!digits!are!turned!over!and!the!player!
continues!with!the!next!turn.!The!object!of!the!game!is!to!turn!over!all!the!pairs!of!matching!digits!in!as!
few!turns!as!possible.!! !
Add!the!
functions!
required!to!
the!program.!
! 2!
THE)SKELETON)OF)THE)PROGRAM)
The!skeleton!of!the!program!for!the!game!of!Memory!is!shown!below.!!The!play_one_game()!function!
is!complete!and!should!not!be!changed!in!any!way.!!Copy!this!skeleton!into!your!program!file!and!complete!
the!missing!functions.!!Example!output!using!the!completed!program!is!shown!on!the!last!three!pages!of!
this!document.!
import random
#----------------------------------
# main part of the program
#----------------------------------
def main():
player_name = get_player_name()
display_title(player_name)
play_one_game(player_name)
#----------------------------------
# Play one game
#----------------------------------
def play_one_game(player_name):
hidden_symbol = "-"
digits = get_random_digits()
user_digits = hidden_symbol * len(digits)
cheating_is_on = get_cheating_on_off()
if cheating_is_on:
display_cheating(digits)
turns_so_far = 0
matched_so_far = 0
pairs_guessed = 0
while not user_digits == digits:
display_digits(user_digits, turns_so_far, pairs_guessed)
index1 = get_index_from_player()
digit1 = digits[index1]
display_first_digit(index1 + 1, digit1)
index2 = get_index_from_player()
digit2 = digits[index2]
previous_user_digits = user_digits
user_digits = get_adjusted_digits(user_digits, index1, index2,
digit1, digit2)
turns_so_far += 1
if digit1 == digit2:
pairs_guessed = get_pairs_guessed(user_digits)
else:
display_digits(user_digits, turns_so_far, pairs_guessed)
press_enter_to_continue()
user_digits = previous_user_digits
display_digits(user_digits, turns_so_far, pairs_guessed)
display_game_end_feedback(player_name, turns_so_far)
main()!
Discussion Recruting Problem
Before you enter this discussion, please complete your unit reading assignment. Please re-read the Case Study “Who Has a Recruiting Problem” on page 66 in Chapter 4 of your text and respond to the following questions in your original post:
“Considering the critical need for nursing help on evenings as well as weekends, what can Carrie and Jane tell this applicant?
If Jane has to adhere rigidly to her scheduling policy and the candidate refuses to accept the job, what problems might Jane face?
If Jane offers the applicant the position without requiring weekend hours, and without changing the department policy, what problems should Jane expect to encounter?
How can Carrie, as an HR professional, provide further help to Jane, a supervisor in nursing services, as she attempts to recruit sufficient staff for the nursing department? (Fallon, L, p.67, 2007)“
After closely examining the facts and conversation within case, please identify the law(s) that have a direct implication on the outcome of this case?
Provide justification for each of your opinions or explanations.
You will need to perform additional research beyond your textbook to address a few of these questions. Here is one additional source: www.findlaw.com.
Note: If you use resources, other than your textbook to support your positions, please be sure to cite your source(s). Wikipedia is not an acceptable source..
Fallon, L. F., & McConnel, C.R. (2007). Human Resource Management in Health Care Principles
and Practice (p.67). Sudbury, MA: Jones and Bartlett Publishers
“Considering the critical need for nursing help on evenings as well as weekends, what can Carrie and Jane tell this applicant?
If Jane has to adhere rigidly to her scheduling policy and the candidate refuses to accept the job, what problems might Jane face?
If Jane offers the applicant the position without requiring weekend hours, and without changing the department policy, what problems should Jane expect to encounter?
How can Carrie, as an HR professional, provide further help to Jane, a supervisor in nursing services, as she attempts to recruit sufficient staff for the nursing department? (Fallon, L, p.67, 2007)“
After closely examining the facts and conversation within case, please identify the law(s) that have a direct implication on the outcome of this case?
Provide justification for each of your opinions or explanations.
You will need to perform additional research beyond your textbook to address a few of these questions. Here is one additional source: www.findlaw.com.
Note: If you use resources, other than your textbook to support your positions, please be sure to cite your source(s). Wikipedia is not an acceptable source..
Fallon, L. F., & McConnel, C.R. (2007). Human Resource Management in Health Care Principles
and Practice (p.67). Sudbury, MA: Jones and Bartlett Publishers
categories of Human Resources activities
Your text identifies four categories of Human Resources activities, what are these categories? Identify and briefly explain the actions of each category.
Chapter Problems
This assignment reinforces information in your textbook and concepts presented in this unit. Your responses should be thorough, well-conceived college-level responses that are grammatically correct. Please write your answers in complete sentences. You must justify your responses with facts and details from the readings, with your opinions and with your conclusions and interpretations. It is recommended that you work through this assignment as you complete your reading assignment.
With specific reference to activities found within health care organizations, describe how three departments or functional areas other than Human Resources might have evolved in a manner similar to the evolution of HR. In each instance, describe the activities that might have initially existed and then accrued to form the basis of each activity as it is known today.
Your text identifies four categories of Human Resources activities, what are these categories? Identify and briefly explain the actions of each category.
Describe how a Human Resources department in a health care organization might evolve through one organizational model as a department grows and matures.
What are the primary shortcomings of reengineering as it is practiced in contemporary health care organizations? How does reengineering differ from minor modification of existing practices?
What appears to have been the primary intended purpose of the Employee Retirement Income Security Act? Why was this legislation deemed to be necessary?
Viewing the Family and Medical Leave Act from the perspective of a working department manager, describe the ways in which this legislation has affected a supervisor’s ability to manage.
Provide several reasons why a department manager should be familiar with the organization’s compensation scales?
Why is the department manager’s visibility and availability to employees considered to be important?
What law was implemented in 1970 concerning safety within the workplace? Briefly explain this law. In general, how does this law impact an HCA? In addition, how does it impact a Human Resources manager?
Grading Criteria
You will be graded on the accuracy and thoroughness of your responses.
Fallon, L. F., & McConnel, C.R. (2007). Human Resource Management in Health Care Principles
and Practice (p.). Sudbury, MA: Jones and Bartlett Publishers
Chapter Problems
This assignment reinforces information in your textbook and concepts presented in this unit. Your responses should be thorough, well-conceived college-level responses that are grammatically correct. Please write your answers in complete sentences. You must justify your responses with facts and details from the readings, with your opinions and with your conclusions and interpretations. It is recommended that you work through this assignment as you complete your reading assignment.
With specific reference to activities found within health care organizations, describe how three departments or functional areas other than Human Resources might have evolved in a manner similar to the evolution of HR. In each instance, describe the activities that might have initially existed and then accrued to form the basis of each activity as it is known today.
Your text identifies four categories of Human Resources activities, what are these categories? Identify and briefly explain the actions of each category.
Describe how a Human Resources department in a health care organization might evolve through one organizational model as a department grows and matures.
What are the primary shortcomings of reengineering as it is practiced in contemporary health care organizations? How does reengineering differ from minor modification of existing practices?
What appears to have been the primary intended purpose of the Employee Retirement Income Security Act? Why was this legislation deemed to be necessary?
Viewing the Family and Medical Leave Act from the perspective of a working department manager, describe the ways in which this legislation has affected a supervisor’s ability to manage.
Provide several reasons why a department manager should be familiar with the organization’s compensation scales?
Why is the department manager’s visibility and availability to employees considered to be important?
What law was implemented in 1970 concerning safety within the workplace? Briefly explain this law. In general, how does this law impact an HCA? In addition, how does it impact a Human Resources manager?
Grading Criteria
You will be graded on the accuracy and thoroughness of your responses.
Fallon, L. F., & McConnel, C.R. (2007). Human Resource Management in Health Care Principles
and Practice (p.). Sudbury, MA: Jones and Bartlett Publishers
This assignment is specific to special education ELL knowledge
Details:
Your required practicum/field experience hours for this course will be spent observing and being mentored by ELL instructors or administrators in a Title I setting.
For this assignment, observe and assess at least one lesson involving ELLs using the SIOP checklist from Appendix A in the textbook. Focus your observation on Strategies, Interactions, and Practice & Application.
Submit a copy of one of your completed checklists to your instructor in LoudCloud.
Log the time that you spend on-site in your Clinical Field Experience Verification Form.
Your required practicum/field experience hours for this course will be spent observing and being mentored by ELL instructors or administrators in a Title I setting.
For this assignment, observe and assess at least one lesson involving ELLs using the SIOP checklist from Appendix A in the textbook. Focus your observation on Strategies, Interactions, and Practice & Application.
Submit a copy of one of your completed checklists to your instructor in LoudCloud.
Log the time that you spend on-site in your Clinical Field Experience Verification Form.
Project management
Brainstorm to identify a common real world process in bank you have experienced and recall its details which include Brief description with process name,type,industry second,list with mini description of elements ,distinguishing resources and activities. third,List of(typical) inputs with type,quantity,and unit. fourth, list of outputs with type ,quantity and unit. fifth,list with mini description of rules distinguishing to which elements each applies.
it's basically what you see and the process you face while you visit a bank in your normal day.
prepare the following assignment and submit per course schedule:
Part 1: Process Narrative
Brainstorm to identify a common real-world process within business, transportation,
education, entertainment or another suitable industry that you have experienced and
recall its details. It could involve é.g. creating or providing goods or services.
It must have the following features to qualify as a valid process for this assignment:
0 Uncertainty: A non-zero / non-certain probability for more than one possible option,
status, or outcome must exist in one or several elements within the process;
Queuing: The productive or participating entities (i.e. resources) within the process
must face the possibility of sometimes having to wait under certain circumstances;
0 Constraints: A set of rules that defines the boundaries and governs the internal
workings, behaviors, and interactions must exist for all elements within the process.
“Important: It is not allowed to be from the construction industry (nor be a restaurant).
Submit your answer as a two-page memorandum describing your approach to solving
this assignment, any interesting observations or insights, and the following sections:
fl. Brief description with process name, type, industry, and at least one- actual example;
a List with mini description of elements, distinguishing resources versus activities;
7-0 List of (typical) inputs with type, quantity, and unit;
a... List of (typical) outputs with type, quantity, and unit;
-o List with mini description of rules, distinguishing to which element(s) each applies.
Develop a one-page narrative that describes all elements and behaviors in text form.
Part 2: Process Model
Draw a clear flowchart that shows the entire process graphically, so that somebody wh
has never experienced this process can easily participate and understand it. Put brief
descriptive labels into each step (box) and condition/decision (diamond) symbol.
Use the “Homework Guidelines” for information on how to prepare a quality submittal.
Reference all sources (except for the textbook) in the accepted ASCE referencing styl
at the end of your document. Contact the instructor with any questions. This assignme
is to be prepared in teamwork of 2-3 students. Graduate students have the option of
preparing this assignment in individual work.
it's basically what you see and the process you face while you visit a bank in your normal day.
prepare the following assignment and submit per course schedule:
Part 1: Process Narrative
Brainstorm to identify a common real-world process within business, transportation,
education, entertainment or another suitable industry that you have experienced and
recall its details. It could involve é.g. creating or providing goods or services.
It must have the following features to qualify as a valid process for this assignment:
0 Uncertainty: A non-zero / non-certain probability for more than one possible option,
status, or outcome must exist in one or several elements within the process;
Queuing: The productive or participating entities (i.e. resources) within the process
must face the possibility of sometimes having to wait under certain circumstances;
0 Constraints: A set of rules that defines the boundaries and governs the internal
workings, behaviors, and interactions must exist for all elements within the process.
“Important: It is not allowed to be from the construction industry (nor be a restaurant).
Submit your answer as a two-page memorandum describing your approach to solving
this assignment, any interesting observations or insights, and the following sections:
fl. Brief description with process name, type, industry, and at least one- actual example;
a List with mini description of elements, distinguishing resources versus activities;
7-0 List of (typical) inputs with type, quantity, and unit;
a... List of (typical) outputs with type, quantity, and unit;
-o List with mini description of rules, distinguishing to which element(s) each applies.
Develop a one-page narrative that describes all elements and behaviors in text form.
Part 2: Process Model
Draw a clear flowchart that shows the entire process graphically, so that somebody wh
has never experienced this process can easily participate and understand it. Put brief
descriptive labels into each step (box) and condition/decision (diamond) symbol.
Use the “Homework Guidelines” for information on how to prepare a quality submittal.
Reference all sources (except for the textbook) in the accepted ASCE referencing styl
at the end of your document. Contact the instructor with any questions. This assignme
is to be prepared in teamwork of 2-3 students. Graduate students have the option of
preparing this assignment in individual work.
significant economic organizational
Select a company that you have identified as having gone through significant economic organizational change due to the recent economic downturn our country has been experiencing. Write your own case study of this company. Tell the story of what happened to bring about the change, the type of change, the change process, etc. Evaluate the change process and comment on whether or not the process could have been improved. If you have experienced and taken part in an economic organizational change in a company where you have been employed, please share your experiences using the concepts provided in this course.
The introduction should describe the company, its industry or products, and its current status. Discuss how the company has used the economic concepts discussed in the course in their strategic reorganization. You should have a minimum of eight current references to support your paper. The paper should be 12 - 15 pages in length, APA format, typed double-spaced, 12-point font with one-inch margins. Remember to reference all work cited or quoted by the text authors. You should be doing this often in your responses.
The introduction should describe the company, its industry or products, and its current status. Discuss how the company has used the economic concepts discussed in the course in their strategic reorganization. You should have a minimum of eight current references to support your paper. The paper should be 12 - 15 pages in length, APA format, typed double-spaced, 12-point font with one-inch margins. Remember to reference all work cited or quoted by the text authors. You should be doing this often in your responses.
Homework
6. (TCO 1) Revise: Please send us a check for $45.95, plus tax. (Points : 5)
7. (TCO 1) Revise: In an effort to stimulate sales, Mallmart is lowering prices substantially on its line of consumer items. (Points : 5)
8. (TCO 1) Revise: Because of the degree of active employee participation, we are of the opinion that the
stock bonus plan will be successful. (Points : 5)
Question 9.9. (TCO 1) Revise: The evaluation was performed by us. (Points : 5)
10. (TCO 1) Revise: We cannot possibly send a repairman until next Monday. (Points : 5)
11. (TCO 1) Revise: We apologize for inconveniencing you during our remodeling. (Points : 5)
12. (TCO 1) List the instances of biased language in this report:
The finishing plant was the scene of a confrontation today when two ladies from the morning shift accused a foreman of sexual harassment. Marilyn Humphrey, a black inspector, and Margaret Sawyer, an assembly-line worker, accused Mr. Engerrand of making suggestive comments. Mr. Engerrand, who is 62 years old and an epileptic, denied the charges and said he thought the girls were trying to gyp the company with their demand for a cash award. (Points : 5)
13. (TCO 1) Revise: I think that we should proceed with this expansion for three reasons. (Points : 5)
14. (TCO 1) Revise this passage by inserting logical transition words.
Columbia is widening its lead over Kraft in the computer-magazine war.
Its revenues increased 27% last year, whereas Kraft’s increased only 16%.
Its audited paid circulation increased to 600,000, compared to 450,000 for Kraft.
Kraft was able to increase both the ad rate and the number of ad pages last year. (Points : 5)
15. (TCO 1) Revise: Our attorney made a recommendation that we take several steps to avoid litigation in regard to sexual harassment. The first step we should take involves establishing an unequivocal written statement prohibiting sexual harassment within our organization. The second thing we should do is make sure training sessions are held for supervisors regarding a proper work environment. Finally, some kind of procedure for employees to lodge complaints is necessary. This procedure should include investigation of complaints. (Points : 5)
7. (TCO 1) Revise: In an effort to stimulate sales, Mallmart is lowering prices substantially on its line of consumer items. (Points : 5)
8. (TCO 1) Revise: Because of the degree of active employee participation, we are of the opinion that the
stock bonus plan will be successful. (Points : 5)
Question 9.9. (TCO 1) Revise: The evaluation was performed by us. (Points : 5)
10. (TCO 1) Revise: We cannot possibly send a repairman until next Monday. (Points : 5)
11. (TCO 1) Revise: We apologize for inconveniencing you during our remodeling. (Points : 5)
12. (TCO 1) List the instances of biased language in this report:
The finishing plant was the scene of a confrontation today when two ladies from the morning shift accused a foreman of sexual harassment. Marilyn Humphrey, a black inspector, and Margaret Sawyer, an assembly-line worker, accused Mr. Engerrand of making suggestive comments. Mr. Engerrand, who is 62 years old and an epileptic, denied the charges and said he thought the girls were trying to gyp the company with their demand for a cash award. (Points : 5)
13. (TCO 1) Revise: I think that we should proceed with this expansion for three reasons. (Points : 5)
14. (TCO 1) Revise this passage by inserting logical transition words.
Columbia is widening its lead over Kraft in the computer-magazine war.
Its revenues increased 27% last year, whereas Kraft’s increased only 16%.
Its audited paid circulation increased to 600,000, compared to 450,000 for Kraft.
Kraft was able to increase both the ad rate and the number of ad pages last year. (Points : 5)
15. (TCO 1) Revise: Our attorney made a recommendation that we take several steps to avoid litigation in regard to sexual harassment. The first step we should take involves establishing an unequivocal written statement prohibiting sexual harassment within our organization. The second thing we should do is make sure training sessions are held for supervisors regarding a proper work environment. Finally, some kind of procedure for employees to lodge complaints is necessary. This procedure should include investigation of complaints. (Points : 5)
special education ELL knowledge
This assignment is specific to special education ELL knowledge
Details:
Your required practicum/field experience hours for this course will be spent observing and being mentored by ELL instructors or administrators in a Title I setting.
For this assignment, observe and assess at least one lesson involving ELLs using the SIOP checklist from Appendix A in the textbook.
Submit a copy of one of your completed checklists with a 250-word reflection on this experience. Address the following questions in your reflection:
Were the students aware of the class language and content objectives?
How did the teacher instruct the content and language objectives?
What types of strategies, interactions, applications, and assessments were implemented?
How did the teacher accommodate for different ELP levels?
Log the time that you spend on-site in your Clinical Field Experience Verification Form. Submit a copy of your completed log to your instructor in LoudCloud with this assignment.
You are required to submit this assignment to Turnitin.
Details:
Your required practicum/field experience hours for this course will be spent observing and being mentored by ELL instructors or administrators in a Title I setting.
For this assignment, observe and assess at least one lesson involving ELLs using the SIOP checklist from Appendix A in the textbook.
Submit a copy of one of your completed checklists with a 250-word reflection on this experience. Address the following questions in your reflection:
Were the students aware of the class language and content objectives?
How did the teacher instruct the content and language objectives?
What types of strategies, interactions, applications, and assessments were implemented?
How did the teacher accommodate for different ELP levels?
Log the time that you spend on-site in your Clinical Field Experience Verification Form. Submit a copy of your completed log to your instructor in LoudCloud with this assignment.
You are required to submit this assignment to Turnitin.
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