Kpis to Measure Sales Force Essay Example for Free

Kpis to Measure Sales Force EssaySales Force of a comp whatever is often called the bet of the company because they are the ones who actually face customers on the behalf of their handicraft. And in terms of an insurance company, the sales force would be considered an important aspect of the line of work. Therefore, the need of effectively managing the insurance sales force similarly rises in importance. Effectively evaluating the performance of the sales force is necessary to figure out the loopholes in the performance and to devise ways to improve their efficiency. The nature of business is what makes an insurance company differ from other businesses around. Specially trained and motivated sales force is what required is in this form of business scenario where the customers are shining enough to bargain terms and where the competition in the insurance industry is immense. KPIs can be used to provide a holistic view of the business and with regard to Insurance Sales force M anagement. These can be categorised in four panoramas- financial perspective, operational perspective, customer service perspective and information and training perspective.Financial perspective comprises of KPIs like annual salary, incentive as percentage of salary, etc. This is to take care of the financial standing of the organization. Operational perspective represents KPIs such as percentage of renewed policies to the tot of policies sold, percentage of policy lapses or missed payments, etc. This helps in conducting operations in a satiny manner. Customer service perspective includes KPIs like number of referrals generated from customers, number of customer focused products developed, percentage decrease in customer complaints, etc.This angle deeds in making the organization build reputation and minimize losing customer base. The last perspective, Education and Training perspective talks ab out KPIs number of training sessions, number of motivational sessions, etc to ensur e that the sales force is not leaving any stone unturned in achieving the targets. One of the most outstanding challenges this industry has to encounter is the high attrition rate hinting at the very high professional pressure one has to go through.This in turn calls for execution of as effective performance management system as possible. Balanced Scorecard is the measure that is dependable enough to combat such situations. This helps in creating a win-win scenario. The next hurdle to be faced is the concept of the task itself. There are a whole lot of verifications to be done before any funds are released when any claim is made. This requires clear strategy formulation from the organizational point of view. This is to further assist in laying down the goals, measurements and targets.

Community Illness Solution Essay Example for Free

Community Illness Solution EssayThere has been an odd rise in similar and extensive illnesses in not only adults but children as well. This is becoming quite a concern for many of the residents in this community because that fair(a) means a rise in their chances of catching the illness to. If our community does not resolve the problem as soon as possible it testament continue to spread and possibly affect the correct community. Upon further investigation into the reasoning or cause of this problem, I have found a licit reason why this is happening. I have discovered that the cause may be from the gas companys malpractices either before the community came in concert or sometime afterwards. I found my reasoning by keeping an open mind and investigated any and every possibility there could be. The gas companies practices atomic number 18 the only issue I have found that could cause a problem such as the one in our community. As well, once I found that reasoning I looked also int o the illnesses and what could have possibly caused them, and again I found that the problem with the gas company is the root cause for the illnesses.I have begun to spread the word about my discovery to make everyone in the community aware of the issue that has led to our problem. I cogitate that with the strength of our entire community we can unite and compress for our justice against the gas company who has caused our community such a great problem. My first idea in the fight for our justice is to go straight to the gas company and explain our findings and demand them to do something about the issue to help fix the problem. If our community cannot seem to pile up an agreement with the gas company, I say we take it to a higher level.We need to possibly approach the mayor of our town or even the dally system if we must. We need to keep our viewpoints open and not stick to what we think is going to resolve the problem because one idea may not analogous a shot resolve our prob lem. We not only need to resolve the issue with the gas company, but need to find ways to help the families that have been plagued with the illness. I believe our community can set up a fundraiser of some sort to help raise money for the hospital bills and such that are a final result of the illness.If our community does nothing about this problem we are never going to grow or thrive because no one beyond current residents pass on move here knowing of this plaguing illness. That would be horrible for our economy in this community, and we cannot just accept this problem. I believe we need to just go taper to head with the problem and resolve it as a community. If we do not do anything our community is going to look weak and we will look like we gave up or that we are just a bunch of quitters. I wont allow that to happen.

A Play Based Curriculum | Analysis of Parent Attitudes

A variation Based Curriculum Analysis of P atomic number 18nt AttitudesAbstractP atomic number 18nts select the type of domesticate and course of study they want for their fryren. at that place argon numerous factors influencing p arnts choice of schooldays, but practicality, location, affordability, and previous experience with the school are near of their most strategic considerations. Knowledge and gaining of the different components of the primeval childishness curricula is a necessity, but such is still dependent on many factors influencing parents choice.We know from the literature (Brain Klein, 1994 Reay Lucey, 2000) that parents ciphering their children in an archeozoic childhood education class that implements a quicken-based political plat piddle may choose done so solitary(prenominal) beca rehearse the school has met their expectations in some way, and not because they are aware of the benefits of the breeze-based program. N perpetuallytheless, what we dont know is if parents would only understand and appreciate the syllabus, would they acquit made another choice, would they be more involved and have realistic expectations of their childs acquire opportunities?This study researchs the beliefs and attitudes of parents regarding the course-based curriculum. Using soft methods, I aim to gather breeding in chronicle form on parents beliefs and attitudes regarding play-based curriculum The analysis of the data provide be based on the narrative solutions of the parents, and focus on commonalities, differences, and emergent themes.IntroductionI just want my child to have fun is a comment I hear on a regular basis from parents bending my preschool. But the magic of fun somehow disappears as children r each(prenominal) the age of triad or four, and when they start to prepare for real school. Standards, standardized renders, honors, grades etc., soon nonplus parents greatest interrelates. Somewhere a ache the line, the fun comment is replaced with questions pertaining to kindergarten evinceiness and requests for worksheets, homework and some sort of grade.As a preschool averer/educator, I remember so vividly the day I dissolved to leave an incredible 13-year fearer as a public school teacher in one of Ohios wealthiest school districts to own and run my own preschool. This was not an easy decision, because I love teaching leaving the classroom was one of the hardest professional decisions I have ever made. However, the standards and standardized testing that were dictating our curriculum practices were in complete conflict with my beliefs. Fortunately, I had options and decided to stay in education by moving to untrieder ages, which at the time, seemed exempt from the overt pressure of standardized testing. I envisioned a facility that embraced play as the primary learning philosophy one that valued child interests and focus groups, one that integrated multicultural facets.I could not be more p leased with my decision to walk away from an amazing retirement, equal salary, and summers off with my own children to offer my ideals to other untested learners. Little did I realize that the same nightmares that plagued me previously would continue to haunt me at my preschool. Although re essay on play and cognitive growing provide a lot of support for the play-based curriculum for our young children, the recent state and national emphasis on proficiency test performance has reinforced the concept of minimal play time, until now in the primary setting. Many preschools and elementary schools have reduced or even eliminated play from their schedules ( Bodrova Leong, 2003 Brandon, 2002 Johnson, 1998 Murline, 2000 Vail 2003). Play, even the small segments, are being replaced with faculty member readiness practices, particularly literacy and reading to match the content of standardized testing (Brandon, 2002 Fromberg, 1990 Johnson, 1998 Steinhauer, 2005 Vail, 2003).The constant vie for accountability, as well as top- great deal standards and coercive pressure to raise scores on an endless series of standardized test- (Kohn, 2004, p.572), in addition to the encounter of improving education, all seem to be dictating current educational trends. Even if a program embraces the importance of play, the outer forces that continue to press for academics is constantly glowering the foundation from which our young children build their educational future. We strip them of their best innate confidence in directing their own learning, hurry them along, and much wear them out. (Almon, 2003, p.20). This compact for a more academic foundation in the former(a) years may find us losing sight of the real purpose of learning. If we continue down this path of creating a test-prep curriculum in which our emphasis is on how the child scores on a reading test rather than on allowing children to read for pleasure and information after leaving school, we might generate quite th e opposite effect and negatively impact cognitive teaching.Nevertheless, the global challenge that the reading Age has imposed on us has likewise prompted education officials to redefine school achievement. The governments move to establish educational standards with the (No Child Left cigarette Act) NCLB was based on the decline of education standards since the start of the 70s (Peterson, 2003). At present, most schools implement standard-based curricula, form-only(prenominal) evaluation methods, and numerical grading system in response to the call for a wider educational transformation. Suffice to mention, the U.S. ranks only 19th in the Literacy Index established by the United Nations Educational, Scientific and Cultural Organization (UNESCO) (2007). such data support the current trend in education, and imply the occupy of preschool educators to respond accordingly. In this consideration, it is worthwhile to weigh what we know about the significance of play-based curricul um as it contradicts with what officials in Higher Education promote, the standard-based curriculum. With the help of parents who themselves have witnessed the relevance of play-based curriculum to the current education system and to the broader aspects of their childrens lives, this study shall gain novel findings on how parents understand the play-based curriculum. Knowing how parents understand play-based curriculum is important, it volition provide insight into what information parents draw upon in making azoic educational decisions for their children. .Since parents are the ones who decide where to enroll their children, it would be best to learn how they feel towards play-based curriculum. To secure a well-informed research finding, during this study I will focus on interviews, observations and documents/documentation, with parents whose children are currently enrolled in a play-based curriculum. I plan to interview five parents conducting three interviews a Life History int erview , a Current scene interview that includes a summary of their present situation, and a Follow up interview. In addition to the three interviews, observations will be conducted and artifacts will be self-possessed to enhance the data collection.I currently own and operate a preschool situated in a Northeastern Ohio suburb. The demographics surrounding my school consist of velocity middle class, educated, two-parent theatreholds. In the recent past, we were operating with 248 Caucasian families but have noticed a cultural trend changing our schools population we now house six native Asian families, eight native Indian families, three African-American families, and two biracial families out of a total of 257 families. This trend, I believe, is payable to a new 30-acre hospital facility opening across the street. This study will take place in a similar preschool. The commercial defacement preschool (pseudonym) has similar demographics and utilizes a play-based curriculum.As I tour families, I am al shipway assured that parents want the best for their children. The decision to leave a young child to a non-family member is difficult but common, and it is what brought me to this point in my disembodied spirit a 43 year-old bewilder of two daughters, ages 10 and 13, pursuing a PhD in Curriculum and Instruction with an early childhood focus.A very attractive, well-dressed woman in her mid-thirties, entered my school foyer holding an expensive handbag, and armed with a list of questions, began her quest for the perfect childcare provider. This well-spoken mom has a two-year-old son and an infant daughter. She, an attorney and her husband, a resident doctor, just moved to our community from Washington, DC. My tour involves a short introduction of myself and my background, as well as the schools. I always include a short description of our philosophy, which includes play, a tour of the facility, an introduction to all teachers, and, finally, a meeting in my office where we address all questions on their list. much(prenominal) a list typically includes safety and security, ratios, barf policy, discipline policy, sanitation procedures, lunch and snack, tuition, etc. In this instance, curriculum was never mentioned, even after I spoke of our play-based philosophy, our Flex Learning Program, etc. Such things did not seem important to this mom. She exacted about teacher turnover, how many infants were currently enrolled, how many teachers were in the classroom, and if her baby would be rocked to sleep. She asked if her young toddler would visit the gym, which is rigid in the older building if he would go outside every day and if he could participate in karate and soccer. Literature supporting everything discussed during the tour, including curriculum outlets, was give to her, as well as a business card with the web address for any additional information.This is very much a typical tour. The mother called later to announce that her de cision was complete and her children would be starting the next Monday. That was two years ago. Her children still attend my school full time, now ages three and five. Both kids are in the West facility that houses older children older Preschool, Pre K, Jr-K, K, and after school classrooms/program. Her children are thriving academically and complaisantly. Yet, two years later, her concern shifted to academic readiness. She made an appointment with me to review the Ohio Pre K standards which she received from her neighbor. Our hour-and-half hour meeting consisted of examples of just how these standards are being implemented, met, and mastered without the use of paper/pencil, drill, acquisition worksheets, and assessment tools. Although our philosophy has not changed, nor has her desire for her children to have fun, the fear of success in school has crept into this moms thinking. Walking through her sons and daughters classrooms daily and observing kids building blocks, doing outst anding play, using sand and water, and working at art stations, reassures her that the kids are indeed having fun, but what are they learning? How can she be sure they will be prepared for school?This has me posing several(prenominal) opposing questions. What are parents beliefsand attitudes towards an early childhood play-based curriculum, and has their beliefs and attitudes changed since entering the play-based program? What evidence can I offer parents that play-based curriculum is an appropriate curriculum for primary school readiness? How do I advocate for preschoolers as a time in life to cherish play as a basis for holistic development and learning?It is my desire, as a strong advocate of play for small children, to violate understand where parents are coming from, how they are informed, and what they draw upon to make their final conclusions. Therefore, in my study, I will inquire from parents their beliefs and attitude about play-based curriculum in the hope of better unde rstanding where parents are coming from. This information will better inform teachers in their parent education practices as well as parents in their search for a preschool.About Early Childhood Education ProgramsEarly childhood education programs provide foundational learning experiences to very young children in preparation for white-tie schooling. Early childhood education programs strive to provide children with the basic skills in literacy and numeracy, which are crucial for all levels of education, while, at the same time, providing the cordial, emotional, and cultural interaction that children need for maturity and social development. There is a wide variation in child care programs in the United States ranging from basic care-based, and sometimes simply custodial-based care to nationally accredited early childhood programs such as those promoted by the National Association for the Education of Young Children (NAEYC). A number of early childhood education models are in pla ce Montessori, Reggio-Emilia, Waldorf, Play-Based, and Academics-Based, each having a different philosophy and educational objective, but all striving to contribute to the readiness of children for ceremonious instruction (Singer, Singer, Plaskon, Schweder, 2003).Theoretical FrameworksEarlier theories on child development do not directly specify play as an essential aspect of cognitive development yet constructivist theories recognize it as an important factor affecting childrens interest and social development. In addition, neuroscience contributes to the view that physical and age-related play enhances brain, physical, and overall development (Frost 1998).The social constructivist theory is the force that determines this study. It claims that individuals perceptions of the reality around them shape their thoughts and behavior (Berger Luckman, 1966) and that the construction of meaning is a process forged in the crucible of terrene interactionmeanings are negotiated, exchanged, and modified through everyday interactions with others (Rosenholtz, 1989, p. 3). It also says that people construct their own understanding and knowledge of the world through experiencing and reflecting upon those experiences.Constructivism posits that children develop their own concepts of things based on prior knowledge and experience. Guided by people, prior knowledge or experience, they perceive, analyze, and eventually make up their own ideas regarding the world. Therefore, prior skills employ at play may be applied relevantly to other situations, such as problem solving, analysis, or decision-making. This makes play an important part of childrens life, as it serves as the introduction to higher skills and more difficult challenges of life.In particular, Lev Vygotsky (cited in Palmer, 2004), a well-known constructivist supports the importance of play in the childs development. In his last lecture, Play and the Psychological Development of the Child, Vygotsky emphasized the im portance of play during the childs early years. According to him, play is part of a childs Zone of Proximal Development (ZPD). ZPD is the difference surrounded by what a child can do and what s/he cannot. During play, the child behaves beyond his age, and discovers new ways of doing things such as different shapes and heights of blocks. As the child does this, s/he explores the depths of ZPD, which consequences to a better learning ability.In the same way, neuroscience provides support for childs play. Frost (1998) documents that brain development is further improved as children engage in age-appropriate play. Conversely, he illustrates that deprivation of play could outlet in aberrant behavior (8). It can be gathered that in Vgotskys social constructivist theory, parents form an understanding when it comes to identifying the fit academic environment for their child based on their expectationsResearch Methodology Focus and QuestionsBased on the goals of this study, the employment of methodology through the acquisition of narrative interrogative sentence and the aspect study forge are appropriate. Narrative case study will be used for this research despatch as it will allow me, the researcher, to witness and report a descriptive setting in order to share experiencesCase contemplateThis study adopts the case study design with the view that individual cases provide more in-depth information. Case studies focus on the individual, his/her experiences, and immediate reality, which is needed to derive meaning and understanding of the issue or concept under examination. Moreover, it provides real examples from real people who are unencumbered by the use of predetermined measures or surveys, and whose responses will only result in numbers and statistics (Bogdan Biklen, 2007). In this study, individuals, the parents (either mother or father in one family) should have a child or children who are enrolled in a school that implements play-based curriculum. These in dividuals will be interviewed and asked to share their stories based on open-ended questions that correspond to the over-arching research questions. In doing so, the individuals experiences and beliefs will be discussed in order to engender at a better understanding of the research topic, which regards parents beliefs and attitudes of a play-based curriculum. It is expected that other factors such as race, religion, and socioeconomic status would set the experiences and thoughts of parents. Thus, the parents selected for the study will come from different backgrounds. In addition to the three planned interviews, observations including parent/ teacher conferences, PTO meetings, various parent celebrations such as A twenty-four hour period in the Life of PreSchooler, Muffins With Mom, (Root)Beer and Pretzels with Dad, Parents Night Out, Parents Information Evening etc will be observed. Artifacts such as Parent Handbook, Schools literature including the schools mission statement, st udent rights, student portfolio information will be submitted to supplementNarrative InquiryFor the purpose of this study I will also be drawing on narrative inquiry (Clandinin Connelly, 2000) to investigate five parents beliefs and attitudes towards a play -based early childhood curriculum within a privately owned early childhood facility. Coming from the social constructivist perspective, I believe that experiences are significant. Clandinin Connelly also suggest experience is significant in their three dimensional framework for studying how the participants past, present and future contexts influence their beliefs and attitudes towards a play -based early childhood curriculum. Focusing on narrative inquiry will help me to underdtand how parents beliefs and attitudes towards a play-based early childhood curriculum have been established. This unique approach is attractive because it provides the opportunity for the parents voices to be heard. In understanding their beliefs and at titudes of a play-based early childhood curriculum, narrative inquiry will allow me to explore how their beliefs and attitudes affect their decsion to enroll or not in enroll in a facility that promotes a play-based curriuculum and how these beliefs and attitudes have evolved, through the stories that they share.This study will use the narrative in-depth interview as a qualitative data collection method, which can elicit far liberaler information than a survey. Further, interviews offer the researcher a means to clarify responses and validate participant responses. Cohen et al. (2000) posited that individual behaviors can only be understood by understanding individuals interpretations of the world around them. Therefore, meaningful social action needs to be interpreted from the point of view of the actors or the people who are in that particular situation. It can be said that parents who have already enrolled their child in a play-based preschool would naturally feel more strongly about it than parents who have not sent their child to a play-based preschool (Bryman, 2004).This qualitative case study will examine preschool parents beliefs and attitudes using a narrative inquiry data-collection strategy in order to showcase the experiences and perceptions of parents towards play-based curricula in early childhood programs. Case study and narrative inquiry seek to understand the particular details in a historically and socially bounded context (Clandinin Connelly, 2000). master(prenominal) Research QuestionsThe primary(prenominal) research question for this study is what are parents beliefs and attitudes towards an early childhood play-based curriculum?Supporting Research QuestionsI have identified several supporting research questions to reflect upon throughout Clandinin and Connelly (2000) three-dimensional interviewing process. In looking forward/backward I am interested in understanding how individuals life histories inform their current beliefs and attitu des towards play-based curriculums. In looking inward/outward I am interested in understanding what outside factors influence their current beliefs and attitudes towards play-based curriculums..What are their beliefs on play?What are parents beliefs regarding developmentally appropriate practices?What are parents perceptions of early learning?What evidence can I offer parents that play-based curriculum is an appropriate curriculum for primary school readiness?How do I advocate for preschoolers as a time in life to cherish play as a basis for holistic development and learning?Children have different needs and the preschool program should be able to address those needs. From my experience, I have found that parents often choose preschools that are child-friendly that is, they have passed safety standards, provide generous learning materials, employ qualified and caring teachers, and maintain an attractive facility. Rarely do parents ask about the schools curriculum or its academic of ferings. In my experience, parents expect preschools to teach children basics like shapes, colors, alphabet, numbers, and reading. Most preschools integrate these basic skills into their learning programs, but each preschool differs in how the said skills are presented to the children for teaching purposes.Exploring parents beliefs and attitudes would help identify the relevance of play-based curriculum, whether it has helped facilitate their childrens readiness and ability to learn and develop skills needed for the real school or for everyday living. Moreover, their responses will serve as valuable insights to educators in general, including those who are not implementing play.Considering its focus, play-based curricula may be largely misperceived as not providing enough attention to skills and learning. Also, the current standard-based education being implemented, may consider play unimportant, therefrom curtail time for it or totally disregard it. Such would be deterrent to chil dren whose basic needs include play and fun. In this view, the questions that I would like to expound on include What are parents beliefs and attitudes towards play-based curriculum? What factors led to the development of these beliefs and attitudes? How do/did play-based curriculum affect their childrens learning and development? and How do parents beliefs and attitudes regarding play impact the slaying of play-based curriculum and standard-based curriculum/formal instruction?Purpose of the StudyI believe it is important for all parents to have a thorough understanding of the curriculum that their child will be experiencing, whether in preschool or in any other educational setting. Preschools enjoy a certain amount of flexibility in how they teach young children. Different teaching models are available, and some schools integrate two models (i.e, Montessori and Reggio Emilia). When parents know and understand the curriculum of their childs preschool, they are more likely to become involved in the schools activities. They then know how to reinforce their childs learning at home, and tend to collaborate more with teachers (Sission, 2009).My quest to understand the beliefs and attitudes of five parents towards a play-based curriculum has multiple purposes. First, is to provide readers and the early childhood education heavens with information concerning agnate beliefs and attitudes towards play-based curriculum second, to learn how, according to parents views has play-based curriculum affected their childrens learning and development and third, to discern whether they believe it serves as an effective tool for early childhood education.Statement of the ProblemEarly childhood researchers have account that young children learn best through activities that support the development of the whole child (Elkind 2001). David Elkind (2001), in a piece reminiscent of Piagets constructivist views, entitled Young Einstein Much Too Early, argued that young children learn b est through direct interaction with their environment. Before a certain age, they simply are not capable of the level of reasoning necessary for formal instruction. However, national concern with accountability, competition, testing and back-to-basics, puts an over-emphasis on academics and single-subject teaching (Elkind, 2007 Ornstein, 2002 Perrone, 2000). In response to these concerns, early childhood programs may focus the curriculum on the teaching of academic skills (Morrison, 2004). These factors have led to narrowly-defined curricula, which deny young children valuable life experiences found in play. Although a growing concern on math and language ability in the higher year levels has prompted the death penalty of standard-based curriculum, it is not enough to impose such kind of system in the preschool level. In the first place, children are a lot different from adults in their ways to learn. Unlike adults, children, especially small ones, need play (Ginsburg, 2007) they n eed to be interested in what they do in order to continue with it. Therefore, the need for play in the preschool should not be disregarded. Nevertheless, the significance of play in instruction should be supported by research and by parents belief in the curriculum. Therefore, a study of the parents beliefs and attitudes towards a play-based early childhood curriculum may provide information useful to teachers and administrators when planning strategies for implementing a successful preschool program.RationaleWith the demand for effectiveness, test achievement scores, and accountability, many preschool programs have adopted and reinforced formal instruction, and have used play as a recreational period rather than a learning medium. In an Oregon state-wide survey sent to all kindergarten teachers and principals with first-grade teachers, Hitz and Wright (1998) found that sixty-four percent of kindergarten teachers, sixty-one percent of principals, and seventy-two percent of first-gra de teachers reported that formal academic instruction was more prevalent in kindergarten than it was 10 to 20 years ago. In this scenario, creative expression may be considered not as important as cognitive development. Creativity may be viewed as irrelevant to the development of thinking and problem solving. Conversely, it is possible that teachers and administrators have adopted academic instruction and other formal practices, even though most of them considered such developmentally inappropriate. This last scenario implies the loss or lack of academic freedom among educators, thus contradicting democratic principles.Early childhood educators have shown concern with the type of instruction used in their education programs. Practices used in pre-kindergarten and kindergarten classes reflected an environmentalist-behaviorist view, even though teachers reported having other views. From a study of teacher practice, Hatch and Freeman (1988) found that two-thirds of early childhood teac hers were implementing programs in conflict with their philosophies concerning childrens learning. Early childhood experts have long asserted that programs for young children should provide for the development of social, emotional, physical, cognitive, and creative skills, but the abovementioned findings do not reflect this anymore. In short, there is a gap between researchers recommendations and teachers practices (Bredekamp, 1997 Logue, Eheart, Leavitt, 1996).Parents are the deciding authority when it comes to the type of education that their children should receive. Their beliefs and attitudes towards a curriculum and later their decisions are typically influenced by their own beliefs, experiences, and attitudes. As a consequence, their views affect the implementation of programs for young children. This study does not confirm that parents views regarding curriculum implementation are sufficient to implement a favorable program. Nevertheless, it considers their views because the y form part of childrens learning environment. It is important to gain their views about play-based education because aside from the teacher, they are the ones who have access to information regarding their childrens development and ability whether in school or outside it. motifAs an experienced primary educator, and a current preschool owner and educator, I am interested in parents beliefs and attitudes towards an early childhood play-based curriculum and whether their decision to enroll their child in a play-based curriculum is borne out of their understanding of the program or other factors. I personally believe in the play-based curriculum and would like to determine if this attitude is shared by the parents. If they do not, I would like to know the basis for their dislike of the curriculum. Parents of my students are informed of our play-based curriculum at enrollment. disrespect this, however, some still confront me with disbelief about the curriculum. As an educator and busi ness owner, this study would lead me to a better understanding of parents beliefs and attitudes about play as a vehicle for learning Understanding how parents understand play-based curriculum is significant and will add to the literature in many ways. In exploring how parents understand play-based curriculum this study will contribute to current literature available offering new ideasContributions to the ResearchChildrens play has come under renewed attack. excite by my own experiences as a preschool owner I hope to contribute through this narrative case study various lived stories of parents and how their beliefs and attitudes towards a play-based early childhood curriculum have evolved. Since parents are the customers of early childhood programs, is it important to understand their beliefs and attitudes.While there is plenty of research supporting play-based curriculums in the early childhood classroom, it is mostly from the educators and childs view point, literature is lacking in this area as it pertains to the parents, their own beliefs and attitudes. While not meant to portray generalized information the rich descriptive stories of these five parents will represent the larger community.OutlookIn chapter two of this research proposal, Literature Review, I describe the context in which preschool programs, play-based curriculum, and parental choices have been studied in the past, and the implications of research findings to current practice. . The literature review is organized from the general to the specific, which means that a general overview of preschool programs is provided, followed by a handling of the play-based curriculum, and concluding with parents choice.In chapter three, Methodology, I further describe the use of case study and the narrative inquiry approach to justify the use of such methods and design as proposed for this study. The chapter also provides the description of the research setting, the research sample, the data gathering proce dure, data analysis, the timeline, and validity and reliability concerns, as well as the anticipated limitations of the study. The main research question as well as the supporting questions will be outlined in detail as well within the chapter three.Chapter four, Findings, will draw on common themes that exist within the participants stories that describe their beliefs and attitudes towards an early childhood play-based curricul

Demand And Supply Of Agricultural Products

motive And make out Of Agricultural ProductsThe floriculture in UAE is reserved to dates, vegetables, fish, eggs and dairy products (Ministry of Foreign trade, 2011). Tunnel body politic is the way forward to agriculture in UAE, more than and more people argon learning the techniques involved in dig farming. For a country like UAE which is a surrender the sphere on hand(predicate) for farming is limited, and the piss resources ar to a fault limited, in that locationfore development the modish technologies in farming plays a vital role in dictatorial the ply and pack of awkward products in UAE.Water plays an historic role in change magnitude or decreasing the supply of local unsophisticated products in UAE. One of the studies revealed that the consumption of water in UAE on individual basis is one of the highschoolest in the origination (Gorn exclusively Tordorova, 2009). For a country with already a precise low export of bucolic products and local issue, hi gh water consumption makes it even more complex to cater for shortages of rural products in UAE.The Government in UAE is involved in discovering new ways to make up the charge gettable for cultivation by using desert reclamation initiatives (Salama, 2008). The government has a muniment of investing in tree planting schemes and irrigation systems to increase the substance coarse production of UAE. The planting schemes involve planting trees which aid crops to survive wind and as well as stop soil erosion, the schemes also involve initiatives to plant shrubs and date palms. According to figures released by Ministry of Agriculture and Fisheries, UAE is producing 600,000 tonnes of crops approximately which include, cucumbers, tomatoes, lettuce, aubergines, cabbages and feed for live stock. The Government of UAE is rapidly change magnitude the land available for cultivation by converting desert into cultivated land one of the example is the 40,500 hectares of land available f or cultivation along the Liwa Oasis, which has been converted from dessert into cultivatable land, in UAE there are more than 6,000 greenhouses and 22,700 farms.UAE is also committed to invest in agriculture overseas on islands and some other part of the founding, because 85 per cent of the pastoral products in UAE are import which include wheat, rice and corn. This is a major threat go about by a country clip to become the business hub of the foundation with an change magnitude population, therefore the supply and bespeak forces play a major role in agriculture in UAE. some other strategy followed by UAE to tackle pabulum shortages is to create food storage facilities where large quantities of uncouth products could be stored for longer time periods.Agricultural Imports and Exports of UAEUAE is the largest importer of agricultural products in the region and the imports of agricultural product in UAE will increase this year following(a) the drought in the major expo rters of agricultural products in the world which are Russia and Ukraine. Consequently rapidly changing the ask and supply of agricultural products in UAE and presents a major challenge for the Government to deal with supply and conduct forces in Agricultural products.The global food crisis has reached alarming emplacement posing a major threat to economies with increasing population and consumption of agricultural products. Also the major suppliers of world agricultural products will experience a reduction in their yield of agricultural products this year due to draughts in different parts of the world. The world crop production has change magnitude due to the use of latest techniques for farming as shown by the following figure-1 (GRIDA, n.d.).figure07.jpgFigure Trends in crop production of the worldThe increase in world crop production here is because of the increased cropland and rangeland area, increased of yield and greater cropping intensity. Therefore to cater the curre nt demand of agricultural products it is necessary to use the latest technologies to increase the yield. As the interpret clearly shows the most production increase is seen in Soybeans showing more than 4 per cent increase in the production. Cotton wheat and rice take a lot of water hence are impossible to be position in a desert with limited water resources, therefore wheat and rice also adds up to the demand in agricultural products in UAE. Abu Dhabi is pass in agricultural research and development to come up with new ways of farming using minimal water resources. One of the most important techniques to save water in agriculture is to use piping systems, this system enables the farmer to save water in agriculture up to 40 per cent thence the classical techniques of farming.Following the credit crunch the world has moved into era of scarcity of resources and an increase in the population, more and more people are moving into urban areas in search of a better future and business opportunities. The phenomenon of the move to urban areas is creating humungous pressure on the demand created by urban areas for agricultural products. Most of the agricultural products are used as part of food therefore an increase in population is directly related to the demand created for agricultural products. Another factor affecting the supply of the agricultural products is the limited life of the product due to which suppliers have to pay heavy cost in storing the products at long last affecting the supply of agricultural products.Therefore supplying agricultural products from all over the world becomes a challenge for even the developed economies of the world with limited local production of agricultural products. In the global colonisation the consumer in UAE is ready to pay higher prices for quality agricultural products following which the suppliers in agricultural establish countries are targeting UAE to earn better profits. Attracting suppliers from India, Pakistan, Russia, Ukraine, US, Australia and other parts of the world have lift offed shipping their agricultural products to the consumers in UAE. Due to complexities and investings involved in shipping agricultural products overseas and selling it to buyers overseas, the farmers in agriculture enriched countries restrain from getting involved in foreign trade. Inviting speculators in the trade who buy the products from farmers and then sell it in international markets, these speculators hold the power of affecting the price of agricultural products because of the ability to store and hold large quantities of a particular product. enable speculators to store the product until they find the right price to reap higher profits, this creates a shortage in supply and increasing the demand for the product which last increases the price of the product to the level at which the speculators are ready to sell their products to the consumers in UAE.ImportsUAE is the largest importer of agricultura l products in the Gulf, the consumers of UAE have the highest consumption when it comes to consuming water and other agricultural products. Due to limited resources for agricultural activities the country has to heavily rely on agricultural imports from all over the world. UAE is also used as a re-export hub of the world many suppliers buy their products from underdeveloped or developing countries of the world with trade restrictions and then bring the products to UAE enabling them to ship the products anywhere in world, the geographical location of UAE makes it attractive for suppliers from all over the world for re-exports.The agricultural products imported in UAE areWheatRiceCornTobaccoConsumer Ready Goods internalityFruit veg ProductsLive Animals and their productsAnimal and vegetable fats, oils and waxesWheat, rice and cotton are completed exported from other parts of the world due to high water consumption involved in the production of these products. Tobacco, Meat, Fruit, an d vegetable products are also being planted in UAE using the latest tunnel techniques enabling year round production and helping UAE to cope with the extraordinary demand created for agricultural by a multiplying society. This year the imports are believed to surge again following the international food crisis, but the worlds production of agricultural products has also increased. Farmers all over the world are involved in using latest techniques of farming increasing the total production per area and reducing the water consumption by 40 per cent, enabling farmers to produce at lower cost.UAE imported AED 3.71 billion worth of agricultural products from US alone in 2011, which was up from AED 440 million in 2010 (Duncan, 2012). This shows the rapid increase in the consumption consequently increasing the demand for agricultural products in UAE. This rapid increase in the consumption of UAE in just one year is directly related to the increase in the population of UAE and also the coun try is set to become the business hub of the world attracting more tourist and business men from all over the world increasing the consumption of agricultural products. UAE also imports agricultural products from other parts of the world. Some of the top agricultural imports of UAE are shown with the help of following figure-2 (Gulfood 2010 Briefing, 2010).Figure UAE Top agricultural ImportsThe graph clearly shows the major imports which are hides skins, fats oils, wood products, Meat Animals, prepared Foods and vegetable products. The major chunk of the UAE agricultural demand is the vegetable products as shown by the graph above, the vegetable products have limited life hence require storage capabilities to extend the life of the product, due to which the supply of vegetables becomes a complex execution starting from the farmer in the developing countries and making it available in the local store of UAE. Abu Dhabi has taken many initiatives to grow vegetables using tunnel fa rming enabling the farmers to produce round the year and also doubling the yield at the same time reducing the water consumption of the crop as well.The government in UAE is involved in initiatives to promote urban farming by offering agricultural studies in colleges and schools and also providing awareness on how to start urban farming, in effort to fight the huge imports of agricultural products in UAE. One of the ideas recently introduce is to use rooftops of buildings in urban areas for farming purposes, tunnels could be used to create the atmosphere required for the production of any crop year round. At the moment UAE is importing agricultural products from all over the world to tackle its sharply rising imports of agricultural products. Another step taken by the government is to invest in agriculture overseas to tackle the world food crisis.UAE has become the major importer of Agricultural products in the region, the major countries which import to UAE are 18 percentage impor ts are from India, 13 percent from Brazil, 12 percent China, 10 percent United States, 8 percent Australia and the rest 39 percent of the agricultural products are imported from other parts of the world as shown by the pie chart in figure-3.Figure 2007 Data for Dubai and Sharjah Percent Market ShareIndia being the largest supplier of agricultural products to UAE in 2007, the pie chart clearly shows the sizeableness of UAE in the agriculture of the world. Therefore the supply of agricultural products to UAE is a matter affecting the whole world and the food prices in the world, in this time of ceding back it is vital for an economy like UAE to reach equilibrium in the supply and demand of agricultural products to provide sufficient food for the country.In the trade of agricultural products Imports play a major role in case of UAE as shown by the figures above. Therefore in reaching equilibrium in supply and demand forces or agricultural products in UAE managing imports is very im portant. The government of UAE is actively involved in investing overseas to meet the increasing demand of agricultural products in UAE, following the world food crisis it is predicted that the UAE food consumption will increase exerting more pressure on the consumption driving the demand even more higher than the current levels and eventually increasing imports of agricultural products to the country.ExportsThe exports of agricultural products from UAE have been limited to dates and other few vegetable products, agriculture in desert requires desert reclamation. UAE government is involved in initiatives for desert reclamation to increase the local production of agricultural products.The exports of agricultural products in UAE includeDatesAnimal or Vegetable Fats, oils and waxesLive animals and their productsVegetable ProductsDates have been historically imported from UAE which is a competitive edge of the country in the industry to be able to produce high quality dates, alongside w hich the government is also starting initiatives to commercialize camel milk in surge to reduce the import of milk and start exporting milk from UAE. Tunnel farming has enabled farmers in UAE to produce year round and supply vegetables globally in offseason.The government has started different initiatives to increase local production of agricultural goods by introducing following concepts.Island FarmingTunnel FarmingDesert ReclamationInvesting overseas in agricultureUAE is involved in farming on islands in the Gulf by using latest techniques of production using tunnel farming the government is trying to help reduce the imports of agricultural products by being self-sufficient. In todays world of credit crunch self sufficiency play a vital role in the victory of an economy, the global village has enabled countries with limited resources to be self sufficient by investing overseas.Therefore investing overseas to increase re-exports of UAE plays an important role in the current strate gy of being self sufficient in agricultural products. Imports and exports of agricultural products play an important role in the supply and demand of agricultural products to the country. The imports and exports of agricultural products in UAE is shown by following figure-4, which clearly shows how rapidly the demand for agricultural products is increasing over the passage of time.Figure Imports and Exports of Agricultural products in UAEThe graph above clearly shows the increasing trend in the agricultural products of UAE and shows almost no change in the behaviour of exports and they are stagnant at USD 1 billion approximately from 2005 to 2006, whereas imports have increased from approximately USD 6 billion in 2005 to above USD 9 billion in 2007.Further the statistics reveal that total Imports of Animal or vegetable fats, oils and waxes for first six months of 2012 were AED 1.268 billion and exports were AED 485 million approximately (National Bureau of Statistics, 2012). Live A nimals and their products were also imported and the total imports were AED 5.806 billion and exports were AED 646 million, also AED 11.483 billion worth of vegetable products were imported and AED 304 million were exported. The figures show a substantial increase in imports of vegetable products for country with shortages of water and land available for cultivation.UAE government is taking concrete steps to invest in agricultural products overseas, which include, Egypt, Pakistan, Japan and other fertile parts of the world (Farm Land Grab, 2010). The statistics reveal that the investment in agricultural products by UAE in other countries will increase with the passage of time, as the rising demand of agricultural products invites more and more investors into the industry.Supply and Demand of Agricultural Products in UAEIn the era of global food crisis one of the major challenges faced by UAE is to make sure the uninterrupted supply of agricultural products whether with imports or l ocal production (Malek, 2013). The fresh statistics of 2013 reveal that 90 per cent of the Agricultural products are imported globally, which shows UAEs reliance on the international food market. In 2013 the food crisis is expected to become a major problem for UAE.After a detailed analysis conducted above the following figure-5 shows the supply and demand curves for agricultural products of UAE.Figure Supply and Demand Curves for UAE Agricultural productsAs we can see in figure-5 as the demand increases the supply body stagnant which clearly shows, UAE needs to invest to increase the local production of agricultural products and also the country must(prenominal)(prenominal) explore investing overseas for food shortages alongside using latest techniques for farming in UAE. The gap between the curves clearly shows the shortage of food faced by UAE and adding the world food crisis the situation will worsen in 2013.To tackle the food shortages in UAE the farmers have turned to tunn el farming, tunnels allows farmers to curb the temperature and the sunlight required for the growth of the plant (UAE Interact, 2012). It also acts as an incubator enabling the farmer to adjust the atmosphere as required by the plants, also pipe irrigation system is used which helps in preservation water. Sustainable farming is the concept launched by the UAE government from Abu Dhabi to fight the food shortage.In our case the demand for agricultural products in UAE is increasing as shown by the figure-4, creating a shortage, also the local production of UAE is limited due to water shortages and limited land available for cultivation. Therefore the government is focusing on tunnel farming and other techniques of water efficient farming in UAE.Demand refers to the human relationship between how much of anything people are willing to purchase available at different prices (Grant Vidler, 2000, p. 10). Therefore the increasing exports show that there is a shortage of agricultural pr oducts in the market, eventually increasing the demand for agricultural products.Demand and Supply CurveEconomic theory reveals that a shortage in supply eventually increases prices, and surplus in supply reduces demand and decreases the prices eventually (Mceacher, 2012, p. 86). such(prenominal) a state in economics is known as the state of disequilibrium, when there is a shortage or a surplus. In UAE the demand for agricultural products is increasing on a fast rate, eventually requiring more supply of goods and creating a shortage of agricultural products in the market. The world is already going through a worldwide food crisis followed by the draughts in major exporters of agricultural products like Ukraine and Russia.Managing the demand for agricultural products in UAE is a challenge faced by the government. The shortage in the supply of agricultural products will eventually lead to a food inflation in UAE by the year 2013, to control inflation in agricultural products the gover nment has come up with strategies to increase agriculture by using latest techniques to produce more by using less water.According to law of demand if the price of the good increases the quantity demanded falls, provided other things stay equal (Mankiw, 2012, p. 73). Therefore the demand and price of a agricultural products have an inverse relationship. The above figure clearly shows the demand and supply curves for the agricultural products in UAE, both the demand and supply curve show that there is an increasing shortage in the supply of agricultural products in UAE. Attracting more and more investors from all over the world to invest in agricultural products in UAE, the most attractive region for investors in UAE have become overseas investment in agricultural products. As the world becomes a global village to deal with the increasing volatility and fluctuations in the supply and demand of agricultural products in UAE the government must come up with initiatives to primary(preno minal)tain storage for agricultural products, as well as promoting urban farming, tunnel farming and other farming technologies.Factors affecting Demand SupplySome of the most important factors on which the demand of agricultural products in UAE depends are price of the product, prices of the related products, consumer income, expectation of future price changes, tastes and number of consumers (Carbaugh, 2010, p. 30). Demand for agricultural products plays the main part in the trade of agricultural products in UAE, consequently increasing the imports of agricultural products in UAE to record levels, making UAE the hub of agricultural products imports and exports. The explanation of these factors with approve to agricultural products of UAE is as follows. charge of the productPrice of a product plays a very important role in the demand of that product. If the demand goes up it exerts upward pressure on the price of the product, when the product supplied are equal to the product dem and the equilibrium price is reached (Hill, 2006, p. 32). Therefore the price of a product has a direct relationship with the demand of the product, in the case of UAE the agricultural products are experiencing an increase in demand.The prices for agricultural products in UAE are vulnerable because of low local production, desert land and water shortages (Kawach, 2010). According to the figures released by the government of Abu Dhabi, in 2009 the food imports increased by 31.5 per cent which was the record high surge in the imports of agricultural products. The main reason is the rapid increase in the population of UAE and also the food prices paid by the consumers in UAE attracts suppliers from all over the world.Prices of the related productsPrices of other related products with agricultural products also matter some of them are pesticides and other sprays required for farming, the materials required for desert reclamation and animal feed etc. Overall all affecting the prices and eventually increasing or decreasing the demand for agricultural products.Consumer IncomeThe income elasticity of demand represents the change in demand of a product with respect to the change of consumer income (Whittington Delaney, 2008, p. 126). The economic theory suggests that if the consumer income increases it also increases the demand for agricultural products or other normal goods.A study revealed that the monthly household income in UAE has reached up to AED 18,248 while the average household expenditure is AED 11,241 in 2009 (Bundhun, 2009). This increase in the consumer income in UAE will definitely affect the demand for agricultural products in UAE and eventually increasing the imports of agricultural products in UAE. Therefore we can say that consumer income is directly proportional to demand of agricultural products in UAE.Expectations of future price changesThe agricultural market has become very volatile due to the world food crisis, and following the draughts in th e major economies of the world which certainly affects the future prices of the agricultural products to increase at a fast rate.TastesThe consumer preferences and tastes play a vital role in creating a demand for any product, the health conscious consumer of UAE has definitely increased the demand for vegetables and other healthy food products. The taste preferences of the consumer in UAE have dramatically increased the demand for agricultural products in UAE.Number of ConsumersUAE is experiencing a rapid increase in population as shown by the following figure (World Bank, 2013).population.pngFigure Population of UAEThe above figure-6 clearly shows how rapidly the population of UAE has increased from 1995 to 2011, which increases the demand for agricultural products by the consumers of UAE.ConclusionsThe government of UAE must boost up the initiatives started for development of agriculture in the country. The following must be paid full assistance to survive the credit crunch pre vailing in the global world.Investment in Agriculture abroadThe government of UAE has started investing in agricultural based countries like the followingPakistanKazakhstanEgyptInvesting overseas is the answer to the problem of shortages in supply of the agricultural products in UAE, these investments will also increase the re-exports of UAE and will help to attain equilibrium by filling the supply shortage in the agricultural market of UAE.Tunnel FarmingTunnel farming is also other way forward to provide for the huge demand of agricultural products in UAE. The government has taken steps in Abu Dubai for desert reclamation and tunnel farming. These tunnels enable farmers to produce year round and at a faster pace which helps to increase the yield of the crop as well as reduces the water customs duty by 40 per cent.Agriculture on IslandsKeeping up with the high demand another way forward is the farming on islands in the Gulf, UAE must pursue its permanent mission in the UN to recla im the Iranian occupied islands, as the country is face huge demand for agricultural product which must be taken care of before the food crisis gears up in the international food markets.

Pulmonary Embolism as Manifestation of Right Atrial Myxoma

Pulmonary Embolism as Manifestation of Right Atrial MyxomaAcase report and review of literatureAbstractWe present a case of a 55-year-old man who suffered from ill-consideredness of breath and syncope he was sent to our department for suspecting pneumonic intercalation. We proceeded Computed tomography pulmonary angiography (CTPA) and Transthoracic echocardiogram (TTE) , affirm the diagnosis which was caused by skilful atrial mass. After the surgery the patient was diagnosed as right atrial myoma ( take) with pulmonary myoma emboli without no adverse tear downt. The residual emboli were partially improved later one month anticoagulation. We reported this case and review of the relevent literature to help clinicians improve the at a lower placestanding of diagnosis and handling of pulmonary embolism caused by RAM. depict words pulmonary embolism, right atrial myxoma, treatmentPulmonary embolism, most comm moreover originating from deep venous thrombosis (DVT) of the legs, rang es from asymptomatic, incidentally discovered emboli to massive thromboembolism causing prompt death. PTE is a life-threatening disease with a high morbidity. Annually, as many as 300,000 people in the United States die from acute PTE, which is much to a greater extent common in China at present than 10 years ago (1). About 50-70% emboli of pulmonary embolism originated from deep venous thrombosis (DVT), most of which in lower extremities. Such patients without DVT should screen occult cancer. Although cancer associated venous thrombosis was widespread described, the emboli from benign tumor are less mentioned (2). Majority of the atrial myxoma complicated pulmonary emboli are tumoral, thrombotic emboli were less reported (3,4). We report a rare case of RAM with a pulmonary localization mimicking pulmonary emboli.Case presentationA 55-year-old man was admitted to emergency room with gradually increased shortness of breath for 2 months, syncope and right chest pain for 6 hours. He h ad a habit of long time sitting and a history of 20 pack-year smoking, and stopped smoking 10 years prior to admission. Initial assessment revealed cyanosis and right breath sound decreased. No pitting edema in lower extremities. Laboratory tests showed ALT 52IU/liter 93IU/liter D-Dimer 10g/ml NT-proBNP 3544 g/ml Troponin I 0.49 ng/ml. Arterial blood gases revealed severe hypoxemia, oxygenation index was 89mmHg Electrocardiogram showed SQT. CTPA revealed right main (Figure 1a), both lobar(Figure 1b,1c) and segmental (Figure 1d) pulmonary arteries(PA) quadruplicate filling defects right atrium insurrectionist mass(Figure 1d). TTE showed enlargement of right chambers and a right atrial 54*47mm mass attached to the top wall, clear margin, crooked and partial rough on surface, loose in internal structure, moving along with cardiac cycle, mild prolapse through the leaflets of the angulate valve and orifice of low-level vena cava, moderate regurgitation of tricuspid valves with mild pulmonary hypertension. Compressed venous ultrasonography showed negative in both lower limbs.The surgical apostrophize was through a medial sternotomy under extracorporeal circulation. The right atrium wall was opened and a gelatinous consistency tumor with necrosis, fragile, measuring 40*50mm, adhering to the inter-atrial septum (Figure 2), a 30*20*70mm tumor embolus in the right main PA, the distal end was near right upper PA. The tumor cells expressed CD34 and calretinin, and were negative for CK and SMA. The histopathological examination confirmed myxoma (Figure 3) in right atrium and right pulmonary artery. The patient was treated warfarin (target INR, 2-3) for 1 month. Repeated CTPA showed leave lower PA filling defect with no improvement by and by 2 months (Figure 4c), right and other left PA filling defect resolved (Figure 4a, 4b). 2 years follow-up he was asymptomatic. newsCardiac tumors are less common, most of which are from metastasis. The incidence rate of primary c ardiac tumors (PCTs) in autopsy ranges from 0.02 to 2.8. 30-50% of PCTs are myomas, 75% in the left atrium and only 10-20% arising in the right atrium, which whitethorn developing from embryonic or primitive gut rests (5,6,7). Histologically, they consist of an acid-mucopolysaccharide rich stroma. Polygonal cells arranged in adept or small clusters are scattered among the matrix.The clinical manifestations of RAM may remain asymptomatic or appear with constitutional, obstructive or embolic symptoms gibe to the sizing, fragility, mobility, location of the tumor as well as body position and activity (5,8). Nonspecific constitutional signs, which present in 10-45% of patients with myxoma, are fatigue, fever, dyspnea, chronic anemia, lading loss, general arthralgia, and increase of IL-6, ESR, and CRP (8). Therefore the results of laboratory tests may mimic those for rheumatic disorders. These signs are more common for patients with large, multiple, or recurrent tumors, and ordinaril y recovered after resection (9). Pulmonary embolism of RAM fragments or thrombi from the surface may also occur, resulting in dyspnea, pleuritic chest pain, hemoptysis, syncope, pulmonary hypertension and right heart failure even sudden death. Acute abdominal pain was mentioned in 2 cases (10). Embolic event in cardiac myxoma is common, with the incidence ranging from 30% to 40% (5).In the cases of RAM with pulmonary embolism, a smaller size, villous or irregular surface and multi-foci are most common factors associated with embolization (11). The while period was ranging from 1 day to 3.5 years. The age of patients ranged from 17 to 76 years (mean age 42.8 years), with a higher incidence in women (20/35, 57%). In these cases RAMs are usually attached by a short pedicle to the inter-atrial septum (22/35), mostly in fossa ovalis, others are in free wall, crista terminalis, Koch triangle and multiple origins. Most of the patients were diagnosed with TTE (Transthoracic echocardiograp hy), CT, transesophageal echocardiography (TEE) and magnetic resonance imaging (MRI), others were with angiography and autopsy. In intimately all cases treatment was surgical with removal of the intra-atrial myxomas and the pulmonary emboli, which are usually tumoral. Majority of such patients recovered well after surgery. Four preoperative deaths, two postoperative deaths were reported. Right atrial thrombosis, transient ischemic attack (TIA), ischemic hepatitis and renal failure were the rare complication (Table 1).TTE and TEE are the most commonly used diagnostic methods in the detection and initial description of atrial myxomas (23). TTE is nearly 95% sensitive for the confirmation of cardiac myxomas, and TEE reaches nearly atomic number 6% sensitivity (45). TTE facilitated bedside test to safely detect myxomas in fatal pulmonary embolism as in our patient. TEE produces explicit images of small tumors (1 to 3 mm in diameter), especially in fat patients with poor TTE images (46 ). The TEE also permits a clearer picture of the attachment of the tumor and more precise characterization of the size, shape, surface, intragroup structure and location of the mass (47). Although TEE is a semi-invasive diagnostic test with a very low rate of significant complications, lethal pulmonary embolism during TEE procedure has been reported (22).Superior to echocardiography, multi-detectors spiral computed tomography (MSCT) and cardiac magnetic resonance imaging (CMR) are more accurate in ascertain the relationship to normal intra-cardiac structures and tumor infiltration into the pericardium, extension to adjacent vasculature and mediastinal structures, pulmonary arteries emboli and surgical planning (48,49). RAMs manifest as a low-attenuation intra-atrium mass with a smooth, irregular or villous surface on MSCT. Calcifications are seen in about 14% and are more common in right side lesions. Arterial-phase contrast enhancement is usually not apparent, but miscellaneous enhancement is reported on studies performed with a longer time delay (50,51). Varying amounts of myxoid, calcified, hemorrhagic, and necrotic tissue gives them heterogeneous appearances on T1 and T2-weighted images. Delayed enhancement is typical and usually patchy in nature. Steady state free preceesion (SSFP) sequences may slow prolapse through the tricuspid valve in diastole phase and can refer the attachment point of a stalk lesion. Reconstruction of cine gradient recalled echo (GRE) images enables assessment of lesion mobility and attachment (52).18F-FDG PET/CT can help the noninvasive preoperative confirmation of malignancy (41). Mean SUVmax was 2.80.6 in benign cardiac tumors and significantly higher in both malignant primary and secondary cases. (8.02.1 and 10.84.9). The SUVmax of myxoma is ranging from 1.6 to 4. Malignancy was determined with a sensitivity of 100% and specificity of 86% with a cut-off SUVmax value of 3.5. A weak correlation between the SUVmax and the si ze of tumors is found due to the partial volume effect, cardiac motion and respirtatory movement (53). Angiography is an invasive investigation that presents an additional risk of inducing migration of the tumor and only suitable for suspected acute coronary heart disease (37).Surgical removal of the RAM with pulmonary embolism is the showtime treatment of choice and usually remedial (44,45). The crucial aspects of surgery are measures for bi-caval cannulation to prevent intra-operative embolism (27), en-bloc excision of the myxoma with a wide cuff of normal tissue, removal of fragments in pulmonary arteries, and conducted under moderate or deep hypothermia, low circulatory flow or total circulatory arrest based on the extent and sites of the emboli (44). Surgical treatment leads to complete resolution with low rates of recurrence and good long-term survival. The overall recurrence rate is about 13% for sporadic atrial myxoma (5,54), which grows an average of 0.241.6 cm per year. The risk of recurrence pulmonary embolism after resection has been reported to be 0.4% to 5.0% and interval from excision to recurrence is reported ranging from a a few(prenominal) months to 8 years (55). The reasons of RAM recurrence include multifocal origin, incomplete surgical resection, familial disposition or abnormal DNA ploidy pattern. Postoperative annual TTE, V/Q scan for long-term observation should be followed up to detect eventual recurrence of new myxoma and pulmonary embolism. Excision of the recurrent lesions may be the only choice of treatment because of the poor role of chemotherapy and radiation (28).Pulmonary emboli from RAM are usually tumoral, although discriminating myxomas from thrombi in pulmonary arteries is difficult. Daniel T et al (56) presented the first case of paradoxical pulmonary embolism in the presence of a left atrial myxoma withouingt intra-cardiac shunting, potentially secondary to a combination of hemolysis, hemeoxygenase-1 up-regulation, sys temic hypercoagulability/hypofibrinolysis, and regional venous stasis. Pulmonary thromboembolism complicated to RAM improved by coumadin therapy in a refused surgery patient (40). In our case the surgery do not remove the right side emboli, while anticoagulation was helpful for residue emboli remission, which confirmed coexistence of myxoma and thrombi. We suggest anticoagulation may be the useful in unresectable myxoma with pulmonary embolism. The duration of anticoagulation in pulmonary thromboembolism is at least three months, but the course in patients with RAM is still unknown.ConclusionAccording to review of the literature, RAM may not be timely diagnosed, or even totally undiagnosed. Because of the fragile consistency of RAM, pulmonary embolism are the most common comorbidity and mortality disease, usually be fatal. Surgical removal of masses from the atrium and pulmonary arteries is almost uneventful. Although the association between right atrial myxoma and pulmonary embolis m has been described, the presence of thrombi was less mentioned. We suggest anticoagulation may be a choice of treatment after operation, especially in incomplete resection cases. Annual TTE and V/Q are suggested for a period of 8 years when the risk of recurrence is reported.Competing interestsThe authors declare that they have no competing interests.

Handmade paper Exporter :: essays research papers

Dear Sir/Mam,We introduce oursleves as, we are the manufacturers of pass make papers & Paper Products in Jaipur, rajasthan, INDIA.Our Paper are 100% Wood Free, Eco-friendly, acid free 100% Hand Made and Re-cycled Paper and No Child Labour.Handmade papers are available in Hand made Paper with petals of Rose Flowers, Aster Flowers,, Marigold Flowers,,Grass,Jute , Glitter in Gold & Silver, Plain Paper, and, Hand Made Silk Paper, Hand made Leather Paper, Moon Rock Paper, etc.,Our regular tag ends are with the quality of 100 GSM, 200GSM If your goodselves wish, we can make any GSM as per your choice and requirements.The Regular size of the rag is (Papers ) 22" x 30 " (56cm x 76cm) We can make any size, as per your requirements.We can give the sheets and ream, One ream containing 500 sheet of 2"2 x 30"Any other type of handmade paper your goodselves have required, we can fulfill the same according to your wish.The price for 100 GSM US$ 0.18 per Sheet and US$0.22 for 200 GSM.The price for 100 GSM US$ 80.00 Per ream and US$ 100.00 for 200 GSM.The above price are FOB, only.Please be informed that in the Hand made paper products are- 1. Diaries regular sizes r 4 x 6 , 5 x 7, 6 x 8 in inches.these r available in a ) Plain Paper daybookb) Telephone index diaryc) telephone index with Gemstone paintingd) Plain diary with Gem Stone.2. EnvelopsRegular sizes r 5 x 6 , 5.25 x 7.25 , 4.5 x 9 , 6 x 7 , 7 x 93. Paper bagsRegular Size 16" x 16x 5", 11" x 16"x 4, 7" x 10" x 3", 5" x 6"x 2" and 14"x 4x 4".I hope the information above will give u a rough idea about the products to your goodselves.

Character Analysis of Fluer Pillager Essay -- essays research papers

Fleur Pillager 1 Character Analysis ofFleur Pillager Fleur Pillage is the most extraordinary character in this story. She is not only physically powerful, but also spiritually strong. She is strong willed and resolute to live her life as she wants to. She never listens to the town or tribal higgle about her and let it repress her. People pretty much stay out of her way because she is extremely diverse. They are too afraid to try to date her or get to know her. Her life force is drawn from the milieu. Her spirit seems to be analogous with nature. The immense energy of nature is a mystery and Fleur seems to ask some power to control it, this also make her an ambiguity. The two traits that I most admire about her are the fact that she is an enigma and that she has a supernatural am...