Secret Life of Bees Research Paper

Jackie Yets 3/21/11 Per. 6, English H2/SP Secret Life of Bees Research Paper While one reads the Sue Monk Kidd novel, The Secret Life of Bees, an enigma acquainted with the book is why the Black Madonna of Breznichar in Bohemia is used as opposed to a white Virgin Mary. With the story taking place in the racist south of 1964 it would be reasonable to assume that a black Mary wouldn’t be common, or readily accepted; however she still occupies a large area of the women’s lives. For the Boatwright’s, the Daughters of Mary, and quickly for Lily and Rosaleen, the black Virgin Mary is placed in the book as a source of strength, and maternal comfort. The most obvious symbolism of the Black Madonna of Breznichar in Bohemia is that it is featured in the novel to give the characters a religious strength. In the story of ‘Our Lady of Chains’ August tells how the statue was such an inspiration to the slaves, and how â€Å"Our Lady filled their hearts with fearlessness†¦ And if it ever grew weak, they would only have to touch her heart again,† (109-110). ‘Our Lady of Chains’, another Divine black figure in the book besides the Madonna of Breznichar, does that same thing for all of the women. Along with ‘Our Lady’ the Bohemian Black Madonna has the same effect on the Daughters of Mary, because it showed them that â€Å"what’s divine can come in dark skin. You see, everybody needs a God who looks like them,† (141). In the real world however, there is no such thing as the Black Madonna of Breznichar in Bohemia. The historical region of Bohemia was located in the same area as modern Poland, and Poland is home to a well known Black Madonna, Our Lady of Czestochowa, who shares many similarities with the Madonna of Breznichar in Bohemia. These similarities, including features and elements of the pictures, strongly suggest that the Madonna of Breznichar in Bohemia is based on Our Lady of Czestochowa. Our Lady of Czestochowa is well known for her ‘miracle working’, mostly involving scaring away foreign invaders and assisting small groups of defenders in defeating powerful armies (Similar to Lily, Rosaleen, the Boatwrights, and the Daughters of Mary gaining the strength to convince an angry T-Ray to leave Lily with them? ). The Black Madonna is also historically known to have been at the foundation of rebellions and revolutions, and leading to freedom; which can again be connected to Lily leaving and becoming free of her father. However the Black Madonna of Breznichar in Bohemia also has another role. Another component of the Bohemian Madonna’s role is her place as a ‘mother of thousands’. In a reflection on The Secret Life of Bees by the author, Sue Monk Kidd said that the Black Virgin Mary existed in the novel to be a symbol of comfort. She also planned for Lily to have a coming home to herself, and a discovery of a mother within to take place with the help of a divine female presence, the Black Mary. Along with the strong connections between the Mary and a mother-like role to the characters, in a religious perspective she is of course a symbol of motherhood, and giving life. In general, the Virgin Mary is known for giving birth to Christ. There is also another connection concerning the Black Mary, which is that she is the ancient earth-goddess that was altered for use in Christianity. Many other goddesses were pictured as black, most importantly Ceres the Roman goddess of agricultural fertility. Keeping in mind the theory that the Black Madonna is an ancient earth-goddess, agriculturally the best fertile soil is characterized by a black color. The blacker the soil, the more becoming it is for farming. Good farming leads to more food, which keeps humans alive. Summing it up, the black earth gives life. This is another strong connection to a life giving maternal role. There’s also another spiritual connection to the comfort brought by the presence of Our Lady of Czestochowa. This connection regards the hidden meaning of the colors present in the images of the Mother; first is the blue-green background, which symbolizes hope. Foremost, the brown skin color is more important, subtly indicating the human element as well as the long history seen by the Madonna. With all of these characteristics related to the Black Virgin Mary, it is clear why Kidd would create this divine figure to inspire her cast of characters. The insurgence nurtured in the history of Black Madonna created the perfect symbol to guide Lily in her search for a home and a connection to both her literal mother, as well as the mother within herself. Works Cited Duricy, Michael P. â€Å"Black Madonnas: Our Lady of Czestochowa. † Black Madonnas. The Marian Library/International Marian Research Institute. , 26 March 2008. Web. 13 March 2011. Jozwik, Ziemowit. A Treasury of Europe. Europe and Me Magazine. N. p. 4 January 2010. Web. 13 March 2011. < http://www. europeandme. eu/8heart/455-the-black-madonna> Kidd, Sue Monk. Secret Life of Bees- The Black Madonna in the Novel. Sue Monk Kidd. LUX Interactive, LLC. , n. d. Web. 13 March 2011. Duricy, Michael P. Black Madonnas. The Marian Library/International Marian Research Institute, 6 October 2009. Web. 13 March 2011. Cahoy, Nate. Comparing Madonnas. The Black Madonnas. PB Works. n. d. Web. 13 March 2011. Our Lady of CzestochowaBlack Madonna of Breznichar in Bohemia

The Disputations Preacher

Known by the name, Girolamo Savonarola, he was born in 1452 Italy, however, different sources give varied accounts of his native town, some say it is Ferrara while others say it is in Occhiobello, which is 7 km from Ferrara. A man whose life was controversial, dramatic as well as tragic. Savonarola left a mark as a man who cared nothing for dictatorial protocol and official pretense. At Ferrara University, he took his undergraduate studies in Arts. He initially portrayed his feeling on morally corruption among the clergy, at the age of twenty, when he took them head on in his poem titled De Ruina Mundi (on the fall of the world). hich bespoke the destruction of the world. Hot on its heels came another poem in 1475 named, De Ruina Ecclesiae (on the downfall of the church). It is here that he portrayed his contempt of the Roman curia by defining it as ‘a false whore'. Savonarola went on to join the Dominican congregation in the year 1475, where he entered the San Domenico convent at Bologna. This coincided with the Italian Renaissance . Savonarola immersed himself in his studies with zeal, this saw him transfer to the Convent of Santa Maria Degli Angeli in 1479. In 1482 he was deployed by the oder to what came later to be known as, the city of his destiny- Florence. People bemoaned his ungainly character and poor oratory skills. The impression he made of himself on the people of Florence was so dismal that, they never noticed his eventual departure in1487. This took him back to Bologna, where he went on to become the master of studies. Savonarola went on to preach on prophesies he had, such as the occupation of Florence by the French. He went on to become more, outspoken and took a hard stance that sometimes ended making him some kind of a misfit among the people. He believed in the classification of issues and actions in only two categories: the good and the bad. Savonarola, was later to fall into bad books with the orders of the catholic church. This led to he excommunication by the pope ,who was later to authorize his arrest. All this was later followed his arrest, torture, prosecution and eventual execution,on grounds of heresy sedition and for proclaiming prophetic statements. His execution took place in 1498 where he was burnt at the stake alongside his two ardent disciples. It is important to note that Savonarola remained defiant onto death. This is attested to by the fact that even though he wrote a confession, he followed it with a meditation, where he pleaded with God to forgive him for pleading to sins he did not commit. Different schools of thought view Savonarola differently, however all agree that Savonarola is one big disputation theme for all and sundry. Savonarola's thinking later on came to be known as not only a way of thought but also a guiding light for both conservatism thinkers and reformists. cholars have look at the Savonarola way of thought, as a linchpin for serous revolutionary discourse as well as a reason for serous research and study into the history of disputation theory. Either way it is looked at, the Savonarola way of thought can serve any of the above purposes depending on the interest of the one examining it. (Polizzotto, 1995) describes how followers of Savonarola had influence that permeated every facet of Florentine life . This was during the important happenings that saw the transition of the city on from republic to principate. In his words, their ideology and activities offer the key to demystifying both the political happenings of the latter years of the Florentine Republic, as well as the nature of contemporary political debate. It also gives an insight into the characteristics of the merging Medicean Principate. DISPUTATION This was a preaching method commonly utilized by the Dominicans. It employed a system of thesis, antithesis and synthesis. It was manly distinguishable from methods by its clashing of ideas. This was the academic background from which Savonarola emanated. (Hazel,n. d. p. -17) puts it ‘like his Dominican contemporaries, the young Savonarola was trained in the disputation method, and it has a marked influence on his style of preaching'. In examining the Rhetorical influences that surrounded Savonarola in his formative days, we can form a good idea of the facets of a good renaissance discourse. For Savonarola the summon was the most effective tool of bringing about moral reform. H is tendency to rely on the summon for moral reform can be attributed to the fact that he was a Dominican. Dominicans have gone down in history as strong believes in rhetoric and disputation Savonarola though came to believe in his oratory skill almost by pure accident He initially experimented with rhetoric, to very successful results much to his own consternation. (Hazel, n. d, p. 4-17) one incident confirmed his power to him. While traveling the seas on a boat, he noticed a bunch of soldiers gambling using dice and cards. He so furiously denounced this activity with such bitterness that they stooped the gambling, much to his own surprise. This vitriolic manner would be the benchmark of his future preaching. Savonarola derived most of his rhetoric effectiveness from the fact that he was perceived as a prophet by many. He was more of what could today be regarded as a doom sayer. His passionate way of preaching eventually earned him very ardent supporters, who later came to play a very pivotal role in determining the success of his campaigns. Savonarola followers were compelled to develop a way by which to survive the turbulent times and be able to carry on their campaign of trying to fight what they believed to be moral decadence. SAVONAROLA AS AN EXAMPLE OF RESISTANCE TO ORGANIZATIONAL CHANGE IN CONTEMPORARY ORGANIZATIONS. Savonarola came into the picture in the immediate post renaissance period. his was a time marked by reduced enforcement of the doctrines. It was a period of widespread immorality and more so, among the proletariat. The church orders were also not spared the widespread liberalism in the church at the time. The church was going through a period when it had relaxed its stand on the usage of disguises, jewelery and other such adornments. He got a huge following of a group that he ca lled the weepers. This group went through the city, raiding houses for paintings, jewelry, mirrors, combs and all that they considered unbecoming of good followers of the religion. The passion with which he defended his views was infectious and convincing enough to earn hims the attention of the masses. He further utilized his rhetoric to have people convinced that whatever he was speaking was bound to happen. since the first instance when he convinced the soldiers of the illegitimacy and the immorality of the act they were engaging in, he got convinced of the ability to sway peoples thoughts. The benchmark of the rhetoric of Savonarola is the ability to draw parallelism, between the acts people are engaged in, and prophecies or documentation, or practices of hither. During his mission to return the people into the accepted practices, or the practices he viewed as acceptable, he had to use rhetoric effectively. Rhetoric served as such a powerful and effective too since as it is stated that it went a long way into attracting meaningful attention. Savonarola viewed the pope as a big failure in allowing the insurgence of renaissance. This was the foundation of his thinking that the pope, was a major hurdle in his efforts to marshal people, back to the accepted and traditionally practiced doctrines. Kreis, 2000) Savonarola viewed himself as an instrument of God, and and did not believe in anything deterring him– not even Lorenzo the Magnificent, could stand in his way. He envisioned the reconstruction Florence as a â€Å"respublica Christiana,† a Christian republic, a republic in where allegiance was to the true sovereign God and God alone. This resentment to the establishment was particularly informed by the fact that, Pope Alexander I V had two illegitimate children, which were an obvious testimony of his wayward behavior. All the sane this was not the only informing idea behind Savonarola's vehemence. The commitment of the Pope to renaissance gave him a curious mix of both the earthly and the religious. To the conservatism this was a clear and sure show of moral rot and if condoned was bound to bring doom to all and sundry. The biggest challenge that was facing the conservative was in trying to turn people around to their way of thinking, and to fuel sufficient phobia of doom in the people. This activity was also faced by another challenged in that, the church and the ruling powers of the society were so much intertwined. Therefore for the conservatives to effectively combat the newly adapted and overwhelmingly accepted way of life, they had to wage a battle and sustain in long enough to sway a good following. Both the religious (Pope) and the social (Medici) authorities therefore fell in the bad books of the conservatives. The question of the most effective method of achieving this was then the only answer he had to seek out. Here rhetoric through preaching became the way out and as (Hazel,n. d p. 4-17) puts it Savonarola was opposed to both the Medici and the Pope. He used his rhetoric though preaching to stir up resentment to both the Medici and the Pope. The two were a very then powerful ruling coalition. The question that is likely to arise is: how was this possible?. Savonarola painted such a grim picture of the impeding damnation and the inferno of hell. He used his rhetoric so effectively that he painted a picture, grim enough to sway even the staunchest of souls. However for the Medici he was to be viewed with suspicion as a man preaching the return to the morality of the medieval times that they were trying to move people from. This unprecedented opposition of the ruling coalition earned him many supporters In contemporary organizations these days, rhetoric can be a very effective in resisting change. However there are some very basic requirements that must be met in remaining true to the Savonarola example. First and most important, the originators and the propagators of the rhetoric must be fully convinced of the philosophies that inform their rhetoric. This is attested top by the Savonarola example, in that, in as much as there was very stiff opposition to his stance in issues of morality and the tenets of religious beliefs, he stood his ground. This is despite the fact, that he was fighting what could be correctly termed as, a David versus Goliath battle against the powerful ruling coalition, comprising of the Medici and the Pope. The perpetrators of modern day rhetoric who desire to attain any meaningful success in fighting changes in institutional structures also ought to stand their ground. They also ought to be fully aware of the exact parameters within which their arguments and their expectations lie. This is shown in Savonarola's depiction of authority as put in the words of ( Hazel,n. Savonarola draws parallelism between the sinners of those days and the merchants who Jesus whipped while they were trading in the temple. In as much as the traders had permission from the Jewish leadership, Jesus on his side was heeding a higher decree from the father. Savonarola therefore advises his followers to act like Jesus and defy the regulations from the rulers since they do not augur well with the biblical teachings. The convic tion with which you defend you arguments is perhaps defined by the manner in which Savonarola defended his. Savonarola is known to have defended his stand all the way to grave, this is evident in the way he wrote down meditations to the effect that, he prayed to God for forgiveness. He sought forgiveness for confessing to sins he felt he wasn't guilty of. The disputations of Savonarola are very vital in highlighting the effectiveness of rhetoric which is backed by conviction. The passion that is a key requirement especially in such contradictory situations plays a key role in the swaying of the peoples way of thinking. Many are the times, when very passionate public, speakers who are actually trying to sell ideas, that could otherwise have been viewed as vague, have been accepted instead of their more informed yet less passionate counterparts. A good example of passionate public rhetorician is one catholic priest by the name of Charles Coughlin of the 1930. He spoke co passionately about the occurrences of the time on public radio that he gained a very wide public audience. This is not withstanding the fact that he was talking about the normal happenings. It is however important to note that he used to approach these arguments with passion and controversy. The rhetoric however is always effective if ,and only if it is directed. This was a real highpoint of Savonarola. He directed the gall of his rhetoric towards the failing of the ruling elite and the church leadership. The modern times rhetorics especially those opposed to institutional changes normally make informed attacks of specific institutions, people, or activities in trying to give ground to their rhetoric. This has been demonstrated in most cases in instances when the perpetrators of rhetoric have painted grim pictures of doom in the peoples minds, if the organizations do not remain the way they are. However this directed criticism has to be informed by facts that cannot be easily disputed. This was the case in the instance when the followers of Savonarola knew for a fact that the deeds they were fighting against were realities that could not be contested. The other key reason for any rhetoric to be effective is its being backed by action. In any resistance to organizational changes. Actions can always play a key role in swaying people into thinking your way. This is actually a very vital display of conviction and commitment to the cause. In as much as power of rhetoric delivery is likely to earn one good following, resistance to institutional change is actually a major challenge. Savonarola backed his rhetoric with radical actions and these were both bold and rampant. The adherents of his rhetoric alongside him, attacked all that they thought represented the rot in the church. They also attacked and burned all that was associated with the laxity that came with the renaissance, This was the hallmark and the culmination of his disputation rhetoric. Groups of youths that were drawing inspiration from him roamed the city in vigilante groups, they collected all that was associated with the demeaning change and burnt them at what later came to be called the fire of vanity. This eventually convinced the people that the disputationist had a case, they therefore swayed their stand and started following him in larger numbers. However it is of importance to note that, any action taken in the efforts to resist the advent of change should be taken with a lot of moderation. This is due to the fact that the extreme tends to shock people into resting the efforts directed at resisting the change. This can be justified by the case of what eventually happened to Savonarola. The activities of people being held at ransom by marauding youths led to resentment amongst the people. This was also due to the fact that the people felt that they were denied the pleasures of the changing times. The other failure was due to lack of moderation in public displays of allegiance to the French. Savonarola sided with the French in their occupation of the city of Florence, this landed him inn bad books with the populace. It is therefore of essence that in passion in resisting organizational change ought to be metered and moderated. In modern times leaders who try to resist change using rhetoric should be guided by the principle of moderation and public acceptability of pronouncements and deeds. This can enhance a steady yet acceptable and successful resistance. The people following Savonarola also required to have regulations, this was however a major failing of the Friar which eventually was instrumental in occasioning his downfall. THE DISPUTATION PREACHER AS A CATALYST FOR ORGANIZATIONAL CHANGE. Savonarola has widely been depicted as big resistance and a conservatist. He was known for resisting the changes that the proletariat were introducing into the thinking of the people and the church. Much as all this is true, he can as well be observed as a person who played a pivotal role in awakening peoples thinking and perception of hierarchy and stipulations. Savonarola came into the picture during a time when the Pope and the Medici had such a cordial and strong relationship. It was during the time when a decree from the pope was treated as law. Great lessons on effective change can be learnt from the preacher. First he openly opposed the moral rot in the religious orders at that time. The eventual reformation that took place in the orders of the church, that eventually led to the protestant movement, were not a mere accident. We can not also, exclusively say that they, emanated from the Ninety five theses that were authored Martin Luther. They started all the way with the public denunciation of the proletariat by Savonarola. It ought not to escape our attention that such deeds as these call for guts and conviction. Therefore Savonarola was key in starting the reformists thinking that saw major changes in the church. Similarly the contemporary leaders of the day could borrow a leaf from the stance of Savonarola and stand their ground in the face of such daunting tasks. This can point people in the right direction if the strong and vitriolic rhetoric is to be used effectively. If such tactics are used then much can possibly be accomplished. his will all be a catalytic role since just like Savonarola accomplices will be essential for the wider goal to be achieved. The use of rhetoric to instigate social change also ought to be well informed and guided by the need for general good of the involved society. It is in this respect that Savonarola was able to obtain a good following. In the first instance, he painted a very gr im picture of the realities facing the people. Painted a very dull picture of what awaited the people in in future. With this clearly understood, he prodded people into following him into a revolution that was to same people from the inevitable eternal damnation. People followed his advice since they felt that by so doing they could evade the oncoming apocalypse. It is in this light that, the contemporary leaders in the current day organizations, ought to inform people of the doom awaiting them in the future if the present is not well dispensed with. They need to match the rhetoric so stated with words leads the people to revitalize and energize their need to do good. The driving force behind this need to do good is the underlying fact that the good is like a boomerang. The thinking and speech of Savonarola was clearly against the grain and the activities of the time. He brought to the fore the failings of a papacy which very many revered till then. True to form, the contemporary leaders of these days are supposed to give room for fresh, radical and new ways of thought. This can be a vital way of energizing peoples thoughts. not all that is radical or new is bad. this was clearly shown in Savonarola's time. In as much as Savonarola fell into bad books and was eventually hanged, he was right in several claims. For example he argued that the Vatican had turned into a den of prostitution, this was right due to the fact that the pope was outright promiscuous. Therefore people ought to be allowed free reign of thought and encouraged into offering new ideas. Rhetoric is good tool of encouraging and enhancing involvement of the masses into peoples activity. This is shown in how effectively Savonarola was able to cajole the people of Florence into feeling a s part of his vision. (Hazel, n. d) he reverts to his analogy of Christ driving money changers out of the temple with ropes. He sees his tongue as the major ropes and then asks people to be the other smaller ropes with which to drive out the church officials. In this way he manges to fit the people into the picture. hey now feel like they are part of the battle against the moral rot. They therefore are given the feeling that they have a role to play in driving the agenda forward. The contemporary organization leaders these days ought to adopt the same attitude, if their rhetoric is going to be effective. There is need to orient people into feeling that they belong to the wider picture. The ability to integrate the people in the people into the picture helps in creating a progressive force . The ability to have people working in tandem for a common goal as well helps in increasing the peoples resolve to do things together and do them well. The protests that Savonarola mounted were three pronged, they addressed the three major issues of the society. He addressed the love for splendor and money, hence the economy. He addressed the prophetic revelations he had, hence religion. Finally he addressed the failure of the Medici hence he addressed the political administration. Therefore for any modern rhetoric to be effective, if Savonarola is to be used as a benchmark, the modern leaders ought to address and effectively so, the above three major issues. The effective handling of these three makes a wholesome and effective approach in any Rhetoric. CONCLUSION Modern users of rhetoric ought to put in mind and effectively integrate the Savonarola approach. this is a sure way of ensuring efficiency. little has been said about the good that was raised by the rhetoric of Savonarola, however a lot can be learnt from his approach. His approach was very much in line with the accepted and very much utilized approaches to rhetoric. In modern times the approach to the rhetoric always uses the same reasoning as the guiding light. Effective address of the issues at hand ought to be a key consideration in the delivery of rhetoric. Zeal and passion are also key in the delivery. The interplay between such delivery and well planned out actions increases the effectiveness. Disputation also serves as a good way of engaging the thinking of all and sundry. Disputation though tends to be more of and elitist approach which can be a major impediment to the engagement of masses in a discourse. However it is more effective since it is more mind engaging and provokes more insightful thinking. Many a times different people have used rhetoric effectively. This has always produced wide mass following and public acclaim. The key lies in following Savonarola's example, and like he did, appealing to the emotions. Rhetoric and disputation world over have been very effective in instigating radical changes to any systems that are publicly accepted and acclaimed. For one to effectively utilize the same, it is essential to familiarize with the users of yesteryears and know how effectively they did so. To say that Savonarola was simply effectively with his rhetoric would be an understatement.

Arguing an Opinion †Invention List Essay

In the last twenty years technology has changed society and our culture. We now live in a world that couldn’t have been imagined fifty years ago. Many of these changes have come through computers and connectivity. The Internet is changing the way we live and date. It has made finding your soul mate just a quick click away. By using online dating services you can peruse profiles from the comfort, and security of your home. You can read thousands of profiles , view pictures of people in your area or around the world ,, and then decide whether to move forward with conversations and dating or move on to the next pond. Having the ability to get to know someone via email and messaging is far superior to meeting someone in a hot sticky bar. Online dating allows you the ability to get to know the other person before going to the first date. Since some people tend to be more comfortable expressing themselves through written communication, they tend to open up more during the initial interaction When using an online dating service there isn’t any guesswork about the person you are getting to know. You can be very specific when listing your wants and it is easier to find someone that shares yourvalues.. Setting up a profile unique to your needs and interests helps attract others with similar hobbies and morals. When viewing your matches you already are being connected with others that meet the specific criteria listed in the questionnaire you filled out when completed your personal profile. If there is any question about what a match listed it can be cleared up easily before meeting, via messaging or phone conversations. With the accessibility that the internet provides, online dating can alleviate the jitters associated with meeting someone for the first time. You can talk to someone via email, text message, or on the phone until you are comfortable with meeting your soul mate for the first date. When you meet for the first time it is a welcomed event. You are able to get the awkward introductions and small talk out of the way, and your first date doesn’t have to result in a ‘drink fest’ to rid yourself of the nerves from being in an uncomfortable situation. Technology has changed the face of dating indefinitely and gives you the ability to meet people you would never have the opportunity to meet in your day to day life. While others may still be on the hamster wheel of dating, you can end the monotony and find your soul mate in just a few short clicks.

Human resouces function Essay Example | Topics and Well Written Essays - 1500 words

Human resouces function - Essay Example This made me spend much of my time looking for another computer with the appropriate program. Once through we were given question papers with question, we were supposed to answer within thirty minutes. The questions were particularly tough involving calculations and grammar. We were taken to the firms’ clinic for blood samples to test for drugs upon completing the tests. I tried to object but was informed that it was a requirement according to the organizational policy and this would be conducted upon suspicion and applies to all employees. When the test results were out I was ranked the second best, but laboratory drug test were not given to us in the group. This marked the start of the panel interview. The first person got in, and I was truly nervous as I waited outside. After twenty, minutes, he emerged from the room, but I did not get an opportunity to ask him the possible question I was likely to be asked. I was called in, and when I stepped in and closed the door and I m anaged to greet the panelists with a smile and waited to be assigned a seat. I was shown to my seat which I responded with "thank you." When we were all seated formal introductions followed with all panelists introducing themselves. I was requested to hand over my resume. The human resource manager asked me: â€Å"So you are (name)? â€Å"Yes sir† â€Å"Tell us more about yourself† â€Å"I am a third year students pursuing a human resource management degree. In high school, I attained a GPA of 2.1. I'm from a family of three and am the only child. I have served as a class leader and a team leader in various groups within the classroom set up. I also actively participate in other co-curricular activities such as swimming, helping the needy in the society and making social friends†. â€Å"What do you think are your major contributions to this company?† Though we have other people interested in this same position who have similar qualifications, I believe I have a personal drive that enables me to work beyond the expected limits. I also pay attention to details a factor I believe is highly significant in managing human resources. With these qualities, I believe I can manage to help the organization move towards the attainment of their set goals and objectives. â€Å"What is your greatest weakness?† â€Å"In one instance during our class lessons the teacher asked my views about equal employment opportunities. I responded that the physically challenged and people of other races should only be given jobs once the whites and the physically fit have already gotten jobs. I felt that they were not able to perform just like the white. However, I have tried to change this perception by interacting with the physically challenged and people of other races that have enabled me to realize that they have capabilities and potential that lack in some of the physically fit and white individuals.† After a series of other questions in rela tion to discrimination, employee rights, and job analysis, I was requested to leave the room and wait for the results outside. I stood up, thanked all of them and left the room. When the results were out I emerged the best. Objective II During the interviewers sought to understand my level of understanding and expertise in the field of human resource management. For any organization to be able to select the right

Critically analyse the extent to which the courts rely on policy Essay

Critically analyse the extent to which the courts rely on policy considerations when determining international trade cases - Essay Example This aspect has been the most significant hindrance to solving international trade cases. However, with globalization being on the increased, this notion can be easily changed. Major international bodies have come up with common policies, rules and regulation that create equality in the international market. According to Economist1 (2008) equality in the international market can only be achieved through creation of common international trade policies. This move has gone a long way in ensuring even small countries get the maximum market exposure as the market heavyweights. International market policies did not favor such countries. As much as these policies have been formulated, the courts and the judicial systems have the obligation of ensuring that these policies are adhered to. Just like any other court or justice system, the law governing international trade cases has an extent that a court may alter when need be. This has been a source of debate from many analysts who argue that international trade policies should not be altered regardless of the situation in question. Should there be an extent at which a court should adhere to international trade policies? What conditions should a case have in order to have the international laws stretched? What are the positive and negative effects of stretching the international trade polices? . According to Ahn, Fukao & Ito2 (2005) the reliance of the courts to international policies has enabled justice to prevail in the international market. The extent of the court reliance on the international policies is stipulated by the law. These laws are formulated in regards to the norms of the international market. These laws are a formulated by the joint opinion of major financial regions. This enables the laws formulated to be efficient and considerate to all requirements of these zones. After these laws are formulated the courts are given the responsibility of ensuring that the laws are practiced in full force. Major laws an d policies involved in the international market are based on licensing and legality. In licensing the courts only require to adhere to the requirements of the international law. In the international market, licensing involves legalizing business enterprises to export and import goods and services across the globe. Legalizing of business enterprises is based on their mode of operation and organization structure. The operations an organization carries out should be in line with the legal and international market requirements. For instance, the trade of illegal goods is strictly prohibited in all market regions across the globe. In ruling on a case involving the trade of illegal goods, the courts need to pass judgment regarding the requirements of the international policies. However, in this scenario there may exceptions which are due to different policies in different nations. For instance, with the legalization of the marijuana in a state in the United States, international law prohi biting the trade of marijuana should not govern this particular state. In this case, the court is forced to consider the law governing the trade of a particular product in a particular region. It is in such a scenario that the court needs to alter the international trade policies. From this scenario, one could argue that the court may alter the international trade policies to a certain extent. For instance, if two countries in different

Security Solution Essay Example | Topics and Well Written Essays - 750 words

Security Solution - Essay Example The critical point of the matter is that some of the company’s key competitors have already hacked the company’s strategies and that they are already using their techniques. No one knows anything about the source of the attack. However, the management is suspicious that some greedy employees could be associated with the attack and that they reveal vital information to its competitors. The network administrator of the ABC Company has limited understanding of attack methodologies while the company lacks valid security measures. Information regarding the company’s products, the raw materials available, quantity of finished goods, and their prices has been disclosed through a database which has been open for users from across the company. All company’s information has been easily accessible and modifiable by every user in the organization. This has been the key problem to the company security and has resulted to the attack and has lead to leaking and hacking o f data on their laptops. In order to protect the internal data of the company, adequate security measures should be taken with critical observation of the laid down strategies to ensure success in the attainment of security within the company (Essaaidi et al., 2006). The storage of data should be structured in an appendix whereby each department can have an access only to its information. A specific file saver should contain folders which contain specific information for each department with a ‘login’ option while personnel from a particular department should not be able to access information from another department’s folder. The encryption mechanism should be devised to ensure that data belonging to a particular user is accessible to that user only. The installed OS in the company computers should be updated with the latest patches and fixes while modification on information on each database should only be done by the head of department. Not even the network adm inistrator should have the right to modify information on the database but should, however, access the information in a ‘read only’ mode. In order to ensure that the computers are not accessed from outside the organization, which has greatly contributed to the hacking, the available OS in the computers should be updated and configured. The outdated OS present in the computers need to be updated to ensure that no outsider can access the computers. The company should also consider installing an anti-spyware tool. This tool monitors all activities on the computer. The tool can be accidentally installed within program downloads and other files while their use is often cruel. They can capture passwords credit card details as well as banking credentials and relay them back to cheaters. Anti-spyware will help in monitoring and protecting the computers from spyware threats and is free to update and use (Stamatellos, 2007).   On the implementation of the solutions, the organiz ation will require to inform all employees on the changes and possibly train the relevant authorities on how to operate the installed devices in their computers. The organization should also give briefings to all employees, department heads and the network administrators on the need to have such amendments at such a time. The briefings should be meant to declare the attack an organizational disaster which calls for responsibilities from all partners for its termination. The solutions would ensure that the c

DESCRIPTION Essay Example | Topics and Well Written Essays - 750 words

DESCRIPTION - Essay Example As a representation of that faith in mankind and the belief in a higher power the building I have chosen to observe is a church. The church itself is non-denominational and it is called the Christ Fellowship. It is set slightly off the main road which makes it accessible yet offers the peace and quiet which is a requirement for meditation and contemplation. While the typical church may exalt in the beauty of architecture with high roofs, steeples and a narrow structure this building is rather squat since it only has two floors but it looks very modern since it is a beige structure and makes liberal use of glass in its construction. The entrance is covered with an overhang that is supported by four white pillars and which put a person at rest soon as one lays eyes on them. Evenly spaced windows all around the building not only let the sun in they also give a beautiful well-lit outlook from the inside. Looking at it one would think it is a school building or another utilitarian office since there is no stained glass or much Christian imagery around the building. That certainly helps the purpose of the church since it is supposed to be a centre of learning and holds quite a lot of utility for us. While there are a number of trees which run around the building perimeter, there is also a significantly large car park attached to the building which is large enough to hold a hundred cars or more. Behind the building there are several open fields where a person can take a walk or children can use as play grounds. I have been told that once enough funds are generated, the empty space behind the church will be utilized for further development. On a typical Sunday morning you would find the car park almost filled to capacity and people of all races coming into the church. Most of the people who are coming in are in SUVs or family sedans and looking at them you would be able to guess that they are middle class or upper middle class

Western history Essay Example | Topics and Well Written Essays - 3500 words

Western history - Essay Example Principia or The Mathematical Principles of Natural Knowledge is a book that was published by Isaac Newton in 1687. It contained a principle he formulated now known as the law of universal attraction or gravitation. The law simply states: â€Å"Every particle of matter in the universe attracts every other particle with a force varying inversely as the square of the distance between them and directly proportional to the product of their masses.† 1. Condorcet and the future of humanity. Marquis de Condorcet, French mathematician and philosophe, had three hopes: one, that all nations will be one day equal to each other; two, that there will be equality in each of the nations themselves, and; three, that mankind will be perfect. Condorcet’s basis for believing that one day, all these will happen is the fact that based on the historical past, men and states were set free and liberated from ignorance and superstition by the emergence of enlightened men who saw reason as their only master. 2. a) The painting implies that all people of all classes are influenced by the books of enlightenment because everyone included in the scene seem to be holding one or near one. The poor couple on the right lower portion, one sitting down on some really huge ones and the woman bending over to him with books strewn all over her feet. On the left side lower portion, a clergyman with a book tucked under an arm is talking to some men, perhaps about the book he is holding. A woman holding a book can be seen gaily conversing with a traveler resting in front of the bookstore and all over its facade are probably advertisements of books on sale in the bookstore. b) The clergy is obviously an important and authoritative figure in the community, even beyond the pulpit. Everything that he says, people listen and the fact that the clergy in the picture is holding a book implies that his exposure to the ideas in the book will most likely be communicated to the community which

Group Interviews Essay Example | Topics and Well Written Essays - 750 words

Group Interviews - Essay Example Also called as focus groups and panel interviews, group interviewing has, still, its own share of advantages and disadvantages. Several suppositions on its advantages as a research method has made group interviewing an extensively used technique (Robinson, 1993). Comparing this technique with individual or one-on-one interview, group interviewing is presumed to generate a wider variety of response, which in turn, is highly valuable in marketing and social researches. Companies use this technique in job screenings as well, to see leadership and character of the candidates in an open discussion. In this way, they could spot the strong and competent ones who are suitable for their open positions. In terms of time, group interviewing is an efficient technique in social researches to meet deadlines yet still generate sufficient and reasonable data set. With these share of positive attributes, the charisma of group interviewing has come to be equated with â€Å"qualitative research† (Robinson, 1993). In most cases, the effect of group interviewing on interview space and environment is treated as an advantage. As most people feel tension when set for an individual interview, the setting of several interviewees at one session somehow relieves the pressure of the situation. The intimidating feel of the one-on-one interview is also lessened during a group interviews as interviewees get the comfortable feeling along with the each other, rather than alone with a respectable moderator. In this case, the apparent view of the moderator or researcher as an authority, which makes the situation intimidating, is avoided. Interaction among the interviewees is also seen as an advantage in many cases, as it not only creates a comfortable environment but rather an opportunity for a sensible discussion and data set. It is in this lively interaction and rich discussion that the data emerges (Cohen & Manion, 1994). Thus, group

Entry 2 Essay Example | Topics and Well Written Essays - 500 words

Entry 2 - Essay Example In both qualitative and quantitative research designs, data would be collected from the responses on research questions hence the need for questions motivated by up-to-date literature, suiting the study, focused on the objectives and have a logical layout. The research questions could be answered in researcher’s own words or from selected optional responses, referred to as open or closed responses respectively, and could be combined in a data collection instrument, including a questionnaire and interview. This learning helps appreciate research design as an important tool in answering the research questions appropriately. This has been achieved through the application of the two major research designs including the true experimental design where subjects would be randomly assigned, and in cases where the researcher needs to focus on an intact group from a population, referred to as quasi experimental design. Their strengths lie in pre-test confirmation of equivalence on linguistic form, post-test examination on development of linguistic form being targeted and control group that solves logical

United Nations Global Compact Research Paper Example | Topics and Well Written Essays - 1000 words

United Nations Global Compact - Research Paper Example Two principles which will be discussed in this memo are principle 1 and 10 i.e. dealing with human rights as well as the corruption. Principle 1 of the Initiative basically indicates that the firms should support and protect the internationally proclaimed human rights. Principle 10 however deals with the corruption and makes it important for the firms not to engage in any kind of corruption including bribery and extortion.1 Considering the above principles, our firm therefore is willing to offer its sincere recommendations and suggestions in this regard. We therefore propose that the corporate members of this local network group must evolve a clear understanding of what are some of the expectations from members while following the initiative besides ensuring that all the firms comply with the regulations at various levels rather than ignoring them at one stage and complying with them on the other. This would ensure that the principles are followed in their true spirit by all. Our firm strongly believes in these principles and has endeavored to inculcate them into our organizational culture in a manner that will ensure the compliance with all the principles. Our experience however, also suggests that the firms or partners whom we work with may not be in complete compliance with the principles outlined in Global Compact Initiative. As such it becomes our implied responsibility to ensure that all the stakeholders truly understand the relative significance of these principles. Further, the business implications for compliance of these principles can be relatively difficult because companies cannot effectively influence their partners who may be involved in violation of any of the above principles. Our experience with our partners in countries like Bangladesh also indicates that our suppliers engage into activities such as paying low wage rates, offering bribes to officials for getting approvals, having poor

Are the Differences Between Management and Leadership Essay Example for Free

Are the Differences Between Management and Leadership Essay What are the Differences Between Management and Leadership? † Management and leadership are closely related but is not the same thing. They are both necessary and complementary to each other. In the corporate world, there are vastly different jobs that require different skills. There are similarities with the two and you can hardly become a great manager without good leadership capabilities. Being a manger does not always mean that the person has the natural ability to lead. And being a good leader does not always make for the best manager. Leaders can be found in all departments of the workplace. A person can be called a leader if he can successfully influence and encourage colleagues to work toward and objective in which the goal is beneficial to the group. The leader’s job is basically to inspire and motivate. Leadership is an ability that is difficult for some people to learn. However, they may not be able to handle difficult business related issues that a manager might have to handle. A manager is considered a leader by definition of the position. Employees are required to follow this individual as required in their job descriptions. Managers offer stability and confidence in organization. Managers are good at delegating tasks and achieving results, but may not be the first person employees look to for guidance. Management may be described as doing things right, while leadership is doing the right thing. Managers have subordinates, while leaders have followers. Employees may not feel a sense of loyalty to a manager, but will stick with the leader because they have a greater sense of belief in them. Managers who don’t have true leadership skills lack certain qualities that are attractive to followers, such as charisma. Being able to blend the styles of a leader and a manager represents a distinguished skills set. That’s why people with the ability to be leaders and mangers are found at the top of all successful companies. The most successful businesses and teams have strong leaders who know how to motivate employees and managers to the results needed to achieve success. I personally think businesses should carefully review applicants for management positions to make sure they have the abilities to lead as well as manage. If the applicant does not possess all of the qualities needed to be a great manager then perhaps they are not the right person for the job. I would not want a manager who you could not depend on in times of crisis and conflict. http://guides. wsj. com/management/developing-a-leadership-style/what -is-the-difference-between-management-and-leadership.

Hyundai Motors: An Evaluation

Hyundai Motors: An Evaluation Around the world, there were about 806 million cars and light trucks on the road in 2007. The numbers were increasing rapidly, especially in China. In 2008, with rapidly rising oil prices, however, industries such as the automotive industry are experiencing a combination of pricing pressure from raw material costs and changes in consumer buying habits. The industry is also facing increasing external competition from the public transport sector, as consumers re-evaluate their private vehicle usage. We have discussed how Hyundai Motor would expand business in global automotive environment which has been changed and exceeded demands. Company overview Hyundai Motor Company, a division of the Hyundai Kia Automotive Group, is the worlds largest automaker by profit, the worlds fourth largest automaker by units sold and the worlds fastest growing automaker. Headquartered in Seoul, South Korea, Hyundai operates the worlds largest integrated automobile manufacturing facility in Ulsan, which is capable of producing 1.6 million units annually. Chung Ju-Yung founded the Hyundai Engineering and Construction Company in 1947. Hyundai Motor Company was later established in 1967. The companys first model, the Cortina, was released in cooperation with Ford Motor Company in 1968. In 1975, the Pony, the first Korean car, was released, with styling by Giorgio Giugiaro of ItalDesign and powertrain technology provided by Japans Mitsubishi Motors. Exports began in the following year to Ecuador and soon thereafter to the Benelux countries. In 1991, the company succeeded in developing its first proprietary gasoline engine, the four-cylinder Alpha, and transmission, thus paving the way for technological independence. In 1983, Hyundai exported the Pony to Canada, but not to the United States because the Pony didnt pass emissions standards there. Canadian sales greatly exceeded expectations, and it was at one point the top-selling car on the Canadian market. The Pony afforded a much higher degree of quality and refinement in the lowest pric e auto segment than the Eastern-bloc imports of the period then available. In 1986, Hyundai began to sell cars in the United States, and the Excel was nominated as Best Product #10 by Fortune magazine, largely because of its affordability. The company began to produce models with its own technology in 1988, beginning with the midsize Sonata. In 1996, Hyundai Motors India Limited was established with a production plant in Irrungattukotai near Chennai, India. In 1998, Hyundai began to overhaul its image in an attempt to establish itself as a world-class brand. Chung Ju Yung transferred leadership of Hyundai Motor to his son, Chung Mong Koo, in 1999. Hyundais parent company, Hyundai Motor Group, invested heavily in the quality, design, manufacturing, and long-term research of its vehicles. It added a 10-year or 100,000-mile (160,000 km) warranty to cars sold in the United States and launched an aggressive marketing campaign. In 2004, Hyundai was ranked second in initial quality in a su rvey/study by J.D. Power and Associates. Hyundai is now one of the top 100 most valuable brands worldwide. Since 2002, Hyundai has also been one of the worldwide official sponsors of the FIFA World Cup. In 2006, the South Korean government initiated an investigation of Chung Mong Koos practices as head of Hyundai, suspecting him of corruption. On April 28, 2006, Chung was arrested, and charged for embezzlement of 100 billion South Korean won (US$106 million). As a result, Hyundai Vice Chairman and CEO, Kim Dong-jin, replaced him as head of the company. After a shake-up in the Korean auto industry caused by overambitious expansion and the Asian financial crisis, Hyundai acquired rival Kia Motors In 1998. In 2000, the company established a strategic alliance with DaimlerChrysler and severed its partnership with the Hyundai Group. In 2001, the Daimler-Hyundai Truck Corporation was formed. In 2004, however, DaimlerChrysler divested its interest in the company by selling its 10.5% stake for $900 million. Hyundai Motor has been expanding globally, starting with its plant in Turkey in 1997, India in 1998, China in 2002, and in 2005, it built a plant in the U.S., the worlds biggest auto market. In 2007, a decade after it began building plants overseas, Hyundai Motor began construction for plants in the Czech Republic and Russia, creating a strategic network of production facilities spanning over six countries. With its 12 CKD plants, Hyundai Motor is boosting sales every year and cementing its position as a global automaker. The company pl ans to raise the ratio of overseas production to 50 percent by 2010, to produce 3 million units outside Korea. Hyundai Motor is present in 196 countries and has 6,000 dealerships all over the world. It is maintaining a strong position in developed regions such as the U.S. and Europe. Furthermore, it has been successfully winning orders for taxis and government vehicles in emerging markets such as Central Latin America, the Middle East and Southeast Asia, boosting sales and the companys brand image. After reaching the 2 million unit sales mark in 2006, Hyundai Motor sold 2.6 million units worldwide in 2009. Through its strategy of local production and sales, the company is contributing to the local economies.(Exhibit1) [Exhibit1] Annual Unit Sales 2009 2008 2007 2006 2005 Sales in unit 1,611,991 1,668,745 1,700,297 1,611,062 1,700,843 Domestic 701,469 570,116 624,227 580,288 569,721 Export excluding CDK 910,522 1,098,629 1,076,070 1,030,774 1,131,122 Hyundai Motor Companys brand power continues to rise as it was ranked 72nd in the 2007 Best Global Brands by Interbrand and Business Week survey. brand value estimated at $4.5 billion. Public perception of the Hyundai brand has been transformed as a result of dramatic improvements in the quality of Hyundai vehicles. The Company produces and markets passenger cars under the brand names of Equus, Genesis, Genesis Coupe, Azera, Sonata, Elantra, Accent, Getz, i30, i30cw, i20 and i10; recreational vehicles under the brand names of Veracruz, Santa Fe, Tucson, Matrix and H-1, and commercial vehicles, which include medium and heavy duty trucks, and buses. Analysis of Global Automobile Market Environment Current Automotive industry Market In 2007, a total of 79.9 million new automobiles were sold worldwide: 22.9 million in Europe, 21.4 million in Asia-Pacific, 19.4 million in USA and Canada, 4.4 million in Latin America, 2.4 million in the Middle East and 1.4 million in Africa. The markets in North America and Japan were stagnant, while those in South America and other parts of Asia grew strongly. Of the major markets, China, Russia, Brazil and India saw the most rapid growth, and China became both the largest automobile producer and market in the world after experiencing massive growth in 2009. In the first 4 months of 2010, the total sales of automobile were 6.17 millions in China (3.52 millions in US), and the total sales were expected to be around 17 millions (13.65 millions in 2009) for the year of 2010, nearly twice as much as USA. [Exhibit 2] International Car Sales by Global Auto Report The automotive industry crisis of 2008-2010 was a part of a global financial downturn. The crisis affected European and Asian automobile manufacturers, but it was primarily felt in the American automobile manufacturing industry. The automotive industry was weakened by a substantial increase in the prices of automotive fuels linked to the 2003-2008 energy crisis which discouraged purchases of sport utility vehicles (SUVs) and pickup trucks which have low fuel economy. The popularity and relatively high profit margins of these vehicles had encouraged the American Big Three automakers, General Motors, Ford, and Chrysler to make them their primary focus. With fewer fuel-efficient models to offer to consumers, sales began to slide. By 2008, the situation had turned critical as the credit crunch placed pressure on the prices of raw materials. Car companies from Asia, Europe, North America, and elsewhere have implemented creative marketing strategies to entice reluctant consumers as most experienced double-digit percentage declines in sales. Major manufacturers, including the Big Three and Toyota offered substantial discounts across their lineups. The Big Three faced criticism for their lineups, which were seen to be irresponsible in light of rising fuel prices. North American consumers turned to higher-quality and more fuel-efficient product of Japanese and European automakers. However, many of the vehicles perceived to be foreign were actually transplants, foreign cars manufactured or assembled in the United States, at lower cost than true imports. [Exhibit 3] Major global automotive company analysis Competitors Globalization Strategy Toyota Toyota Motor Corporation, commonly known simply as Toyota, is a multinational corporation headquartered in Japan. At its peak, Toyota employed approximately 320,000 people worldwide. It is the worlds largest automobile maker by sales. The company was founded by Kiichiro Toyoda in 1937 as a spinoff from his fathers company Toyota Industries to create automobiles. Three years earlier, in 1934, while still a department of Toyota Industries, it created its first product, the Type A engine, and, in 1936, its first passenger car, the Toyota AA. Toyota also owns and operates Lexus and Scion brands and has a majority shareholding stake in Daihatsu and Hino Motors, and minority shareholdings in Fuji Heavy Industries, Isuzu Motors, Yamaha Motors, and Mitsubishi Aircraft Corporation. The company includes 522 subsidiaries. Toyota is headquartered in Toyota City, Aichi and in Tokyo. In addition to manufacturing automobiles, Toyota provides financial services through its Toyota Financial Services division and also builds robots. Toyota Motor Corporation (including Toyota Financial Services) and Toyota Industries form the bulk of the Toyota Group, one of the largest conglomerates in the world. Toyotas marketing efforts have focused on emphasizing the positive experiences of ownership and vehicle quality. The ownership experience has been targeted in slogans such as Oh, what a feeling! (1978-1985, in the U.S.), Who could ask for anything more (1986-1989), I love what you do for me, Toyota! (1990-1997), Everyday (1997-2000), Get the feeling! (2001-2004), and Moving Forward (2004-present). Toyota introduced a new worldwide logo in 1989 in conjunction with and to differentiate it from the newly released luxury Lexus brand. There are three ovals in the new logo that combine to for the letter T, which stands for Toyota. The overlapping of the two perpendicular ovals inside the larger oval represent the mutually beneficial relationship and trust that is placed between the customer and the company while the larger oval that surrounds both of these inner ovals represent the global expansion of Toyotas technology and unlimited potential for the future.[30] Toyota has factories in most parts of the world, manufacturing or assembling vehicles for local markets. Toyota has manufacturing or assembly plants in Japan, Australia, India, Sri Lanka, Canada, Indonesia, Poland, South Africa, Turkey, Colombia, the United Kingdom, the United States, UAE, France, Brazil, Portugal, and more recently, Argentina, Czech Republic, Mexico, Malaysia, Thailand, Pakistan, Egypt, China, Vietnam, Venezuela, the Philippines, and Russia. Recently, Toyota announced it was recalling up to 1.8 million cars across Europe, including about 220,000 in the UK, following problems with defective accelerator pedals. Many Toyota models were involved, covering the 2007-2010 model years. Toyota subsequently recalled the Prius model for reprogramming of its ABS system. The U.S. Sales Chief, James Lentz, was questioned by the United States Congress committees on Oversight and Investigations on February 23, 2010, as a result of recent recalls. On 26 March Toyota said it would halt production in France and Britain for 12 days because of poor sales following the recalls. On 6 April 2010, The US government sought a record penalty of US$16.375 million from Toyota for its delayed response in notifying the National Highway Traffic Safety Administration regarding the defective accelerator pedals, and on 19 April Toyota said that it would pay the fine. The company said the recalls could cost the company up to US$2 billion (GBÂ £1.25 billion ) in lost output and sales. General Motors General Motors Company, also known as GM, is a United States-based automaker with headquarters in Detroit, Michigan. GM manufactures cars and a truck in 34 countries, recently employed 244,500 people around the world, and sells and services vehicles in some 140 countries. By sales, GM ranked as the largest US automaker and the worlds second largest for 2008, having the third highest 2008 global revenues among automakers on the Fortune Global 500. On June 1, 2009, General Motors filed for Chapter 11 bankruptcy proceedings, which were completed on July 10 of the same year, and it was thereafter reorganized once a new entity acquired the most valuable assets. GM is now temporarily majority owned by the United States Treasury and, to a smaller extent, the Canada Development Investment Corporation a Canadian Crown corporation and the Ontario government, with the US government investing a total of US$57.6 billion under the Troubled Asset Relief Program. On April 21, 2010, GM CEO Ed Whitacre Jr. announced that the company had paid back the entire amount of the US and Canadian government loans, with interest, a total of $8.1 billion. The company expects to repurchase a sizable portion of the remaining equity stake with funds earned via a public stock offering. While no GM shares are currently available to the public, the companys plans as of 2009 were to initiate an initial public stock offering (IPO) in 2010. GM plans to focus its business on its four core North American brands: Chevrolet, Buick, GMC, and Cadillac. In Europe, following a period of negotiation to sell a majority stake in its Opel and Vauxhall brands, the company decided to retain full ownership of these operations. However, on February 23, 2010, GM sold Saab Automobile to Spyker Cars NV and is winding down its Hummer, Pontiac, and Saturn brands, the latter two remaining under the old GM, now known as Motors Liquidation Company In 2009, General Motors employs approximately 244,500 people around the world. The Renaissance Center located in Detroit, Michigan, United States, is the global headquarters of General Motors. In 2008, GM sold 8.35 million cars and trucks globally. GM is the majority shareholder in GM Daewoo Auto Technology Co. of South Korea and has collaborations with Shanghai Automotive Industry Corporation of China, AvtoVAZ of Russia, and most recently, UzAvtoSanoat of Uzbekistan. GM has had collaborations with various automakers including Fiat and Ford Motor Company.GM retains various stakes in different automakers. General Motors best success internationally has unquestionably been its performance in China, GM sales rose 66.9% in 2009, selling 1,830,000 vehicles and accounting for 13.4% of the market. Volkswagen Group Volkswagen is a German automobile manufacturing group; and according to figures published by economic research firm Global Insight in November 2009, is the largest automobile maker in the world by vehicle production.[7] Its parent company Volkswagen Aktiengesellschaft, develops vehicles and components for all marques of the whole Group, and also manufactures complete vehicles for the Volkswagen Passenger Cars and Volkswagen Commercial Vehicles marques. Volkswagen Group is divided into two primary divisions: the Automotive Division, and the Financial Services Division. The Group consists of 342 Group companies, which are involved in either vehicle production or other related automotive services. Although it operates worldwide, Volkswagen Groups core market is primarily Europe. Of its automobile brands, Volkswagen Passenger Cars is its mainstream marque, and the Groups major subsidiaries also include well-known car marques like SEAT, Ã…Â  koda, and the prestige marques of Audi, Lam borghini, Bentley, and Bugatti. The Group also has operations in commercial vehicles, owning Volkswagen Commercial Vehicles, along with a controlling stake in Swedish truck and diesel engine maker Scania AB, and a 29.9% stake in MAN SE. Volkswagens second-largest market is China, where its subsidiary, Volkswagen Group China, is the largest joint venture automaker, selling more than one million vehicles in 2008. The Volkswagen Golf is the third bestselling automobile in the world, selling over 26 million units through 2008. In 2009, Volkswagen Group sold 6.31 million vehicles, claiming over 11% of the world passenger car market. Volkswagen AG is heavily involved in sports sponsorship, with investments having included the 2008 Summer Olympics and the 2014 Winter Games, as well as the David Beckham Academy. The company also wholly owns the Bundesliga football side VfL Wolfsburg. The company is also the shirt sponsor of Major League Soccer club, D.C. United. In August 2009, Porsche SE and Volkswagen Group reached an agreement that Volkswagen AG and Porsche AG would merge in 2011. Ford Motor Company The Ford Motor Company is an American multinational corporation based in Dearborn, Michigan, a suburb of Detroit. The automaker was founded by Henry Ford and incorporated on June 16, 1903. In addition to the Ford, Lincoln, and Mercury brands, Ford also owns Volvo Cars in Sweden, and a small stake in Mazda in Japan and Aston Martin in the UK. Fords former UK subsidiaries Jaguar and Land Rover were sold to Tata Motors of India in March 2008. Ford has agreed to sell Volvo to Geely Automobile in a deal expected to be completed in the third quarter of 2010. Ford introduced methods for large-scale manufacturing of cars and large-scale management of an industrial workforce using elaborately engineered manufacturing sequences typified by moving assembly lines. Henry Fords methods came to be known around the world as Fordism by 1914. Ford is currently the second largest automaker in the U.S. and the fourth-largest in the world based on number of vehicles sold annually, directly behind Volkswagen. In 2007, Ford fell from second to third in US annual vehicle sales for the first time in 56 years, behind only General Motors and Toyota. However, Ford occasionally outsells Toyota in shorter periods (most recently, during the summer months of 2009). By the end of 2009, Ford was the third largest automaker in Europe (behind Volkswagen and PSA). Ford is the seventh-ranked overall American-based company in the 2008 Fortune 500 list, based on global revenues in 2008 of $146.3 billion. In 2008, Ford produced 5.532 million automobiles and employed about 213,000 employees at around 90 plants and facilities worldwide. Starting in 2007, Ford received more initial quality survey awards from J. D. Power and Associates than any other automaker. Five of Fords vehicles ranked at the top of their categories and fourteen vehicles ranke d in the top three. During the mid to late 1990s, Ford sold large numbers of vehicles, in a booming American economy with soaring stock market and low fuel prices. With the dawn of the new century, legacy healthcare costs, higher fuel prices, and a faltering economy led to falling market shares, declining sales, and sliding profit margins. Most of the corporate profits came from financing consumer automobile loans through Ford Motor Credit Company. In the face of demand for higher fuel efficiency and falling sales of minivans, Ford moved to introduce a range of new vehicles, including Crossover SUVs built on unibody car platforms, rather than more body-on-frame chassis. In developing the hybrid electric power train technologies for the Ford Escape Hybrid SUV, Ford licensed similar Toyota hybrid technologies to avoid patent infringements. Ford announced that it will team up with electricity supply company Southern California Edison to examine the future of plug-in hybrids in terms of how home and vehicle energy systems will work with the electrical grid. Under the multi-million-dollar, multi-year project, Ford will convert a demonstration fleet of Ford Escape Hybrids into plug-in hybrids, and SCE will evaluate how the vehicles might interact with the home and the utilitys electrical grid. Some of the vehicles will be evaluated in typical customer settings, according to Ford. In 2006, the company raised its borrowing capacity to about $25 billion, placing substantially all corporate assets as collateral to secure the line of credit. Chairman Bill Ford has stated that bankruptcy is not an option. In order to control its skyrocketing labor costs (the most expensive in the world), the company and the United Auto Workers, representing approximately 46,000 hourly workers in North America, agreed to a historic contract settlement in November 2007 giving the company a substantial break in terms of its ongoing retiree health care costs and other economic issues. The agreement includes the establishment of a company-funded, independently-run Voluntary Employee Beneficiary Association (more commonly known as a VEBA) trust to shift the burden of retiree health care from the companys books, thereby improving its balance sheet. This arrangement took effect on January 1, 2010. As a sign of its currently strong cash position, Ford contributed its entire current liabilit y (estimated at approximately USD$5.5 Billion as of December 31, 2009) to the VEBA in cash, and also pre-paid USD$500 Million of its future liabilities to the fund. The agreement also gives hourly workers the job security they were seeking by having the company commits to substantial investments in most of its factories. During November 2008, Ford, together with Chrysler and General Motors, sought financial aid at Congressional hearings in Washington D.C. in the face of worsening conditions caused by the automotive industry crisis. The three companies presented action plans for the sustainability of the industry. The Detroit based automakers were unsuccessful at obtaining assistance through Congressional legislation. GM and Chrysler later received assistance through the Executive Branch from the T.A.R.P. funding provisions. On December 19, the cost of credit default swaps to insure the debt of Ford was 68 percent the sum insured for five years in addition to annual payments of 5 percent. That means it costs $6.8 million paid upfront to insure $10 million in debt, in addition to payments of $500,000 per year. In January 2009, Ford announced a $14.6 billion loss in the preceding year, making 2008 its worst year in history. Still, the company claimed to have sufficient liquidity to fund its business pla ns and thus, did not ask for government aid. Through April 2009, Fords strategy of debt for equity exchanges, erased $9.9 B in liabilities (28% of its total), in order to leverage its cash position. These actions yielded Ford a $2.7 billion profit in fiscal year 2009, the companys first full-year profit in four years. Honda Honda Motor Company, Ltd., Honda Technology Research Institute Company, Limiteds a Japanese multinational corporation primarily known as a manufacturer of automobiles and motorcycles. Honda is the worlds largest manufacturer of motorcycles as well as the worlds largest manufacturer of internal combustion engines measured by volume, producing more than 14 million internal combustion engines each year. Honda surpassed Nissan in 2001 to become the second-largest Japanese automobile manufacturer. As of August 2008[update], Honda surpassed Chrysler as the fourth largest automobile manufacturer in the United States. Honda is the sixth largest automobile manufacturer in the world. Honda was the first Japanese automobile manufacturer to release a dedicated luxury brand, Acura in 1986. Aside from their core automobile and motorcycle businesses, Honda also manufactures garden equipment, marine engines, personal watercraft and power generators, amongst others. Since 1986, Honda has been involved with artificial intelligence/robotics research and released their ASIMO robot in 2000. They have also ventured into aerospace with the establishment of GE Honda Aero Engines in 2004 and the Honda HA-420 HondaJet, scheduled to be released in 2011. Honda spends about 5% of its revenues into RD. Nissan Motor Nissan Motor Company, Ltd., shortened to Nissan, is a multinational automaker headquartered in Japan. It was formerly a core member of the Nissan Group, but has become more independent after its restructuring under Carlos Ghosn (CEO). It formerly marketed vehicles under the Datsun brand name and is one of the largest car manufacturers. As of August 2009, the companys global headquarters are located in Nishi-ku, Yokohama. In 1999, Nissan entered a two way alliance with Renault S.A. of France, which owns 44.4% of Nissan while Nissan holds 15% of Renault shares, as of 2008. Nissan is among the top three Asian (also known as the Japanese Big 3 Automakers) rivals of the Big Three in the U.S. Currently it is the third largest Japanese car manufacturer. It also manufactures the Infiniti luxury brand. The Nissan VQ engines, of V6 configuration, have featured among Wards 10 Best Engines for 14 straight years, since the awards inception. III. Analysis of Hyundai Motors Hyundai Motors Globalization Strategy Process of Growth Since the companys foundation in 1967, Hyundai Motor Company became the first automaker producing manufacture facilities itself. The first model Pony, manufactured and started to export, was very favorable not only into Korean market but also into global market, which elevating Hyundai Motor into one of the global automobile companies. In 1976, Hyundai had started the first export business with Africa, North America and middle Asia and expanded into European market. In overseas market, especially in North America, Hyundai achieved the big success and had an opportunity to become into the global automaker in worldwide. Possessing 10 manufacturing plants, 11 research centers, and more than 6,000 sales networks throughout the world, Hyundai Motor also helps to keep sales growth across the world and maintain to the top leading global company. Furthermore, Now, Hyundai as Global corporate citizen makes every effort to fulfill its economic responsibility, most principal in corporate activities throughout the world. (http://www.hyundai.com) The Hyundai Motors Global Business Strategy In the process of globalization, the major global strategy for Hyundai Motor can be focusing on exporting in the global market which was very successful. From the inception of the foundation, the Hyundai management team always recognized the importance of exporting to overseas which the key factor to growth global business and manufactured most exports from single Ulsan plants. In other words, Hyundai has been involved in independent management strategy. In addition, striving to face with country specific regulation and rapid market changes, Hyundai has been implemented transnational strategy like the joint-venture strategy in China, Turkey and Malaysia in order to expand global market share. Hyundai Motor Company further strengthened its presence as a global automaker by promoting sustainable development worldwide, accelerating global management initiatives and creating the second construction of manufacturing plants in China and India, thereby increasing its production capacity all the more. At the same time, it also achieved qualitative growth by successfully generating sales of its strategic model targeting the European market. In 2007, a decade after it began building plants overseas, Hyundai Motor began construction for plants in the Czech Republic and USA, creating a strategic network of production facilities spanning over six countries. (http://www.hyundai.com) [Exhibit 4] Hyundai Motor Companys International Entry Mode (sourced by http://www.hyundai.com) Country Partner Hyundais Share Start Yr To produce Entry Mode India HMI 100 98. 9 Ownership USA HMMA 100 05. 5 Ownership Czech HMMC 100 06. 7 Ownership China BHMC 50 02. 1 Joint Venture WuHan Qi Che 21 96. 7 Joint Venture Turkey HAOS 85 97. 7 Joint Venture Malaysia INOCOM 15 99. 9 Joint Venture The organizational structure of international business for Hyundai Motor Company is International Division Structure which is like many Korean companies fit well with Korean culture and lean toward centralization. That is, it has risk of demotivating local manager in host countries. By that, the Hyundai Motor Company has struggled to recruit local manager who can manage, coordinate and control worldwide regional operations underutilized allowing diversity as strategic task. US subsidiaries show [Exhibit 5] Example of International Division Structure The Hyundai Motors Global Business Efforts International Site Selection The Site Selection implies that the company does spell out all possible locations to decide which site/market to be targeted and determined by content and goal with its limited human resource, technology, and capital. (Sourced by Professor Lee, JR, Shin, MS / International Business) Market Size and infrastructure: consider for purchasing power and production Market attractiveness: competitors and market structure Important to consider potential international market expansion which cover all countries/regions in the world for the further The major variable factor for site selection is market attractiveness, competitors, and the strategic goal for a company. The good example for International Site Selection in Hyundai Motor Company can be expanding the global business to Canada region. With the success of exporting Excel, Hyundai Motor Company had made decision to expand the international business into Canada as below factors as detour entrance strategy to USA. Of course, Hyundai Motor Company cannot overlook the competitors such as Toyota, Honda. etc. Market accessibility: to avoid Trade barrier by NAFTA, Market proximity , Cost Reduction and Price competiveness by Local Manufacture Government Aid: tax, financing support by construction of manufacture plant Regional Advantage : close to locate associated company Political Risk Avoid: to avoid lack of exports by Korean labor strike in 1988 Likewise, the variable factors to expand the Hyundais global business to other countries can be considered as reduction of transportation cost risk, avoid currency exchange risk, cost reduction by hiring local resources, government aid and etc, International Entry Mode Prior to change into the globalization, the process of growt

Case Summary Hypertension In Pregnancy Health And Social Care Essay

Case Summary Hypertension In Pregnancy Health And Social Care Essay Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is at 37 weeks and 5 days of gestation. She was diagnosed to have hypertension in pregnancy during antenatal routine follow-up in Klinik Kesihatan Simpang Renggam at 36 weeks and preeclampsia (blood pressure 160/100mmHg, urine dipstick albumin 1+) 3 days before admission. She was admitted to Hospital Kluang and started on Tab. Methyldopa 250mg TDS. She was advised for induction of labour in view of preeclampsia at term and she requested to be transferred to Hospital Batu Pahat (HBP). She did not have any signs and symptoms suggestive of severe preeclampsia or labour. During admission to HBP, tablet prostin 1.5mg was inserted into the posterior fornix twice to induce labour but there was no change in cervical os and symptoms of labour. Decision was made to try artifical rupture of membranes. However, following the procedure, internal monitoring detected fetal distress and as spontaneous delivery was not imminent, Mdm. S M was agreeable for emergency lower section caesarean section under general anaesthesia. A healthy infant boy was delivered (weight 2.9kg, Apgar score 91105) and there were no intra or post-operative complications. Following the surgery, both mother and infant were well in the ward. Mdm. SM was ambulating and tolerating orally and by the 2nd post-op day, both had passed urine and motion. Wound inspection on day 2 showed clean, non-gaping wound. As she was well, decision was made to discharge her and she was given appointment to review her blood pressure and operative wound at the postnatal clinic at KKSR. On discharge, her blood pressure was 140/70mmHg (without medication) and urine dipstick albumin was trace. Analgesia given on discharge were mefenemic acid and paracetamol. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology PATIENTS DETAILS I/C NUMBER: 800318015794 AGE: 30 SEX: Female DATE OF ADMISSION: 20/6/2010 R/N: 1358593 2) CLINICAL HISTORY Chief Complaint Elevated blood pressure detected in pregnancy at 36 weeks of gestation. History of Present Illness Mdm. SM is a 30-year-old Malay female of gravida 5 parity 3+1 who is currently at 37 weeks and 5 days of gestation. She was referred to Hospital Kluang from Klinik Kesihatan Simpang Renggam (KKSR) for elevated blood pressure detected on routine antenatal follow-up and subsequently transferred to Hospital Batu Pahat (HBP) for induction of labour in view of her development of high blood pressure in pregnancy. Her elevated blood pressure was first detected during her routine antenatal follow-up at Klinik Kesihatan Simpang Renggam 10 days before admission to HBP. During this visit, her blood pressure was recorded as 150/90mmHg and she also complained of slight bilateral swelling of her feet but otherwise had no other complaints. The feet swelling resolved after 3 days. Throughout the next 7 days, she went to KKSR every alternate day for monitoring and 3 days before admission to HBP, her blood pressure was noted to be 160/100mmHg with presence of albumin 1+ on urine dipstick that was prev iously not present. She was immediately given tablet labetolol 100mg and admitted to Hospital Kluang where she was subsequently started on tablet methyldopa 250mg 8-hourly. Three days after admission to Hospital Kluang, she was advised by the doctor to undergo induction of labour and she thus requested to be transferred to HBP so her family members in Batu Pahat could take care of her. During the course of these events, she did not experience shortness of breath, headache, blurring of vision, epigastric pain, seizures, abdominal pain, vaginal bleeding, nausea, vomiting, palpitations, or recurrence of the foot swelling. At time of admission, she did not experience contraction pain, show, leaking of liquor. Fetal movements were good. Systemic Review Mdm. SM did not have fever. Her appetite was good and her urinary and bowel habits were normal. Her sleep was unaffected. Antenatal History This was an unplanned but wanted pregnancy. Mdm. SM realized she was pregnant when she missed her period, of which the last was 28/12/09. She bought a pregnancy test kit and it tested positive. She subsequently did her booking at KKSR at 7 weeks of period of amenorrhoea. At booking, her blood pressure was 120/80mmHg, hemoglobin 13.4g/dL, sugar undetected, and urine albumin negative. Infective screening was negative and blood type O positive. Her expected due date was given as 14/8/10. During follow-up 1 month later, she had her first ultrasound scan which found her uterus to be larger than dates. Her due date was revised to 6/7/10. Modified glucose tolerance test done twice during pregnancy were negative. She experienced morning sickness and vomiting during the first 3 months of pregnancy but it was not severe and she could cope without medication. Throughout the pregnancy, she was diagnosed to have urinary tract infection twice and was treated with antibiotics. A further 3 ultrasoun d scans were done and all were normal. She was also compliant to the supplements given throughout pregnancy. There were no other problems during the antenatal follow-up until the detection of elevated blood pressure 10 days before admission to HBP. Past Obstetric History This is her fifth pregnancy and her last childbirth was in 2008. She has 3 children, 2 boys and a girl, of whom all were born via vaginal delivery at postdate after induction of labour. Birth weights ranged from 2.7 to 3.0kg, all are healthy with no complications and were breastfed. However, during her 3rd pregnancy, she suffered a miscarriage during the 12th week and dilatation and curettage was performed during that admission. Gynae Menstrual History Mdm. SM achieved menarche at the age of 12. Her menstrual cycles have always been regular with 28 days per cycle and 5 to 7 days of flow. She does not experience menorrhagia or dysmenorrhoea. She has never had a cervical smear done and has never used oral contraceptive pills. She has not required medical attention for any gynaecological problem. Past Medical History Mdm. SM has never been diagnosed with any chronic disease such as diabetes, hypertension, and asthma before. She has also never been admitted for non-pregnancy related reasons. She also does not have any known food or drug allergies. Family History Mdm. SM is the eldest of three siblings. Her youngest sister also had gestational hypertension. Her father has hypertension and her mother had diabetes, but passed away 2 years ago due to tuberculosis. All family members have been screened and all tested negative for tuberculosis. Social History Mdm. SM is now a housewife. She formerly worked in a factory but decided against returning to work following her last pregnancy in 2008 for her childrens benefit. She is a non-smoker and does not consume alcohol. Her husband is a short-haul lorry driver and smokes, but only outside their home. They live slightly off Kluang, and it takes them slightly over an hour to reach HBP, and 15 minutes to reach KKSR. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 3) FINDINGS ON CLINICAL EXAMINATION (Mdm. SM was examined by me on the 2nd day of admission) Mdm. SM was alert, conscious and cooperative. She was not in any pain or distress. She was sitting comfortably on her bed. On examination, there was no pallor, jaundice or pedal edema. Her reflexes were not brisk. Her clinical parameters are: Blood Pressure : 124/80 mmHg Heart Rate : 95 beats per minute. Regular rhythm Respiratory Rate : 20 breaths per minute Temperature : 37 °C Examination of the cardiovascular system, respiratory system, fundus, thyroid and breasts were normal. On examination of the abdomen, it was distended with gravid uterus as evidenced by linea nigra, and striae albicans. There was no striae gravidarum, scars, or pulsations noted. On palpations, the abdomen was soft and non-tender, uterus non-irritable, and fetal parts felt. The symphysio-fundal height was 36cm, which corresponds to dates. On examination, this is a singleton fetus at longitudinal lie with cephalic presentation, with the fetal back on the maternal left. The fetal head was four fifths palpable. Estimated fetal weight is 2.8 to 3.0kg. Liquor is adequate. Fetal heart was heard and the rate was 142 beats per minute. Vaginal examination (by medical officer on admission) revealed no perineal, vulval or vaginal abnormalities. Cervical os was 1 cm with cervix tubular, soft and axial, station high and membrane intact. Bishops score was 3/10. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 4) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONING Provisional Diagnosis Preeclampsia in pregnancy Mdm. SM developed new onset elevated blood pressure of 160/100mmHg at 36 weeks of gestation and urine dipstick albumin of 1+ (300mg/L). This fits the minimum requirement of preeclampsia among the hypertensive diseases in pregnancy. However, Mdm. SM did not experience any symptoms to suggest a severe preeclampsia or impending eclampsia such as headache, visual disturbances, epigastric pain, vomiting, liver tenderness. The urine dipstick for albumin is not the best way to detect proteinuria required for the diagnosis of preeclampsia 3 and is usually only used for screening, but as the blood pressure and urine albumin were persistently elevated, it is better to err on the side of caution and treat Mdm. SM as such since patients with relatively mild preeclampsia can rapidly progress into severe disease 1. Following the repeated positive detection of urine albumin of only 1+, more definitive tests should be performed to better quantify her proteinuria 2,3. Differential Diagnosis Pregnancy-induced hypertension, late onset As Mdm. SM has been compliant to her antenatal follow-ups and did not have elevated blood pressure detected at any time before 36 weeks of gestation, it is likely that she has developed the onset of a hypertensive disease in pregnancy and it appears to be of late onset as it developed only after 32 weeks gestation. However, as subsequent visits showed urine dipstick albumin of 1+, indicating the onset of proteinuria (although poor predictive value and not as significant as 2+) 3, it might prove wiser to be more vigilant and assume that Mdm. SM does indeed have preeclampsia as it would be foolish to dismiss these warning features despite the fact that she does not demonstrate any suggestive symptoms because it is possible that even patients with no prodromal signs may suddenly progress into eclampsia 1,3. Essential hypertension in pregnancy with superimposed preeclampsia Another possibility that we may entertain is that Mdm. SM has had previously undiagnosed essential hypertension with currently superimposed preeclampsia. However, this seems rather unlikely. Firstly, Mdm. SM is young at the age of 30 and unlikely to suffer from essential hypertension as this disease common presents after the age of 40. Secondly, at no time throughout antenatal follow-up did she have elevated blood pressure recorded before that particular visit at 36 weeks of gestation. However, following delivery of her infant, she should have her blood pressure rechecked during postnatal follow-up care at 6 to 12 weeks post-delivery. If her blood pressure if still elevated at that time, then it will be more likely that she has essential hypertension. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 5) IDENTIFY AND PRIORITISE THE PROBLEMS 1. Elevated blood pressure and its implications in pregnancy Mdm. SM has newly discovered elevated blood pressure at 36 weeks of gestation. This is considered late onset but is not uncommon, and gives rise to a spectrum of hypertensive disorders in pregnancy. While it seems that at first she has gestational hypertension, the mildest of the disease spectrum, she demonstrated proteinuria on her subsequent antenatal visit, therefore concluding that she has preeclampsia. Hypertensive disorders in pregnancy have the potential to put both mother and infant at increased risk of mortality. Its complications are elaborated below. During admission, Mdm. SM should be monitored for any change in her condition as she may quickly progress into severe disease states and this would require urgent intervention, the most definitive being the delivery of the infant. Ward management includes close observation of both mother and infant, and medication to control the elevated blood pressure. 2. Induction of labour in view of preeclampsia at term Termination of the pregnancy is the only definitive sure for preeclampsia. On presentation, Mdm. SM has features categorized as mild preeclampsia. Normally, severe preeclampsia would dictate the need for antihypertensive and anticonvulsive therapy followed by subsequent delivery and symptoms such as headache, epigastric pain, and visual disturbances may indicate this. The fetal age is usually an important deciding factor when it comes to inducing labour as the treatment goals seek the best outcome for both mother and infant. As Mdm. SM is already at term and there have been no issues previously detected regarding the health of her fetus, it should be safe to proceed with induction of labour. There is also no reason to prolong the pregnancy as the risk of eclampsia increases. If for any reason an obstetric reason arises e.g. fetal distress, delivery should proceed via caesaren section. 3. Impending eclampsia and other potential complications Warning signs and symptoms of impending eclampsia or severe preeclampsia include headache, visual disturbances, epigastric pain, reduced urine output, edema and ultimately, convulsions. These symptoms should be recognized early so the necessary intervention can take place. Seizures increase the risk of maternal and perinatal morbidity and mortality rates. Some maternal complications are placenta abruption, neurological deficits, aspiration pneumonia, pulmonary edema, cardiopulmonary arrest, and acute renal failure. Other major complications that may occur as a result of severe preeclampsia are HELLP syndrome, pulmonary embolism and stroke. Fetal complications include growth restriction, fetal distress, and death. 4. Risk of post-partum eclampsia It is possible for eclampsia to occur in the postpartum period especially when the patient has reached term. In such cases, up to 44% of eclampsia occurs postpartum 3. As the risk is quite high, Mdm. SM should continue to be monitored in the ward for the development of any signs and symptoms. As she is comfortable and relatively symptom free while in the ward, it appears unlikely that she may worsen into an eclamptic state but the risk should not be afforded. As there are no guidelines to suggest an optimum postpartum inward observation period, it would depend on her clinical situation during the subsequent days following her delivery. 5. Hypertension in pregnancy and its long term implications As Mdm. SM has developed preeclampsia during this pregnancy, she is at increased risk to develop hypertensive or metabolic complications in future pregnancies. The risk of recurrence is generally higher in earlier onset preeclampsia. At the same time, she should be evaluated in the postpartum period for the possibility of essential hypertension at the 6 week postnatal review. Also, women with preeclampsia are at an increased risk for developing hypertension, diabetes, hyperlipidemia, chronic renal disease, stroke and ischemic heart disease. Mdm. SM should be made aware of all these implications and should be educated on how she can prevent these via the modification of her lifestyle. She should also be advised to attend preconceptual counseling in the event of a future pregnancy and to come early for booking. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 6) PLAN OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTS 1. Urine Dipstick for Albumin To look for the presence of albumin in the urine firstly, to confirm proteinuria, and secondly, to evaluate the severity of the preeclampsia. Urine dipstick for albumin should be repeated daily in the ward. Also, if in doubt, further investigation to quantify proteinuria can be done e.g. urine protein/creatinine spot test 2,3. Results: Urine dipstick albumin on admission was trace. Results at KKSR showed 1+. Interpretation: This result could be due to the fact that the blood pressure has lowered as Mdm. SM has been started on methyldopa and her blood pressure is under control. This does not mean that she no longer has preeclampsia. She should be checked daily for any changes in both blood pressure and proteinuria. 2. Full Blood Count To look for anemia which may require correction, haemoconcentration which may indicate severe preeclampsia 1, and platelet levels as HELLP syndrome is a complication that may arise in preeclampsia. This may also serve as baseline in case operative procedures are required. Result: TWBC 12.0 x109/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ (neutrophils 8.20, lymphocytes 2.70) Hemoglobin 10.7 g/dL à ¢Ã¢â‚¬  Ã¢â‚¬Å" Hematocrit 32.3% à ¢Ã¢â‚¬  Ã¢â‚¬Å" Platelets 354 x 109/L Interpretation: The total white cell count is slightly raised, but this is to be expected in pregnancy. The hemoglobin is slightly low but this is also expected in pregnancy and should be monitored especially if the patient requires surgery or experiences anemic symptoms. There is no haemoconcentration and the platelets are normal. 3. Prothrombin Time, INR, Activated Partial Thromboplastin Time (PT/INR/APTT) To obtain a baseline of the coagulation profile in case operative procedures are required and also to look for potential coagulopathy as it is a possible complication of preeclampsia. Result: PT 12.3s INR 1.05 APTT 39.6s Interpretation: PT/INR/APTT is within normal range. Coagulopathy appears unlikely in Mdm. SM given that her platelets are also normal and her preeclampsia is not severe. 4. Renal Profile To assess renal functions to look for elevation of creatinine as that would indicate severe preeclampsia and also to detect acute renal failure which is associated with increased risk of HELLP syndrome, placenta abruption and postpartum hemorrhage 1. Result: Urea 1.3mmol/L Sodium 140mmol/L Potassium 3.7mmol/L Creatinine 51 µmol/L Interpretation: Mdm. SM renal profile is normal and creatinine is not elevated, adding to the indicators that her preeclampsia is of the mild category. Low urea levels and good urine output also rules out acute renal failure. 5. Liver Functions Test To assess liver functions and its components such as liver enzymes and bilirubin which would be raised in severe preeclampsia or HELLP syndrome in which there is hemolytic anemia and elevated liver enzymes. Result: Total protein 73g/L Albumin 33g/L Globulin 40g/L Total bilirubin 0.5mg/ml Direct bilirubin 0.2mg/ml Indirect bilirubin 0.3mg/ml ALP 121U/L à ¢Ã¢â‚¬  Ã¢â‚¬Ëœ ALT 7 U/L GGT 7 U/L Interpretation: Liver enzymes (ALT) and bilirubin levels are not elevated, indicating a mild preeclampsia and no biochemical evidence of HELLP syndrome. The ALP is slightly elevated, but this could be due to compression of the gravid uterus on the hepatobiliary tree. 6. Serum Uric Acid Elevated serum uric acid is an early biochemical sign of preeclampsia 1 and may help to predict maternal complications in preeclampsia 4. Results: Serum uric acid 103 µmol/L à ¢Ã¢â‚¬  Ã¢â‚¬Å" Interpretation: Serum uric acid levels are not elevated and are in fact, slightly lowered. This result indicates low likelihood of severe preeclampsia or maternal complications. 7. Serum Lactate Dehydrogenase To check for elevated levels which should indicate hemolytic anemia, a component of HELLP syndrome. Results: Not done during this admission. 8. Cardiotocograph (CTG) Done on admission as a baseline for fetal monitoring. Results: Baseline fetal heart rate was 130 beats per minute, baseline variability was 5 10, accelerations present with no decelerations. Interpretation: CTG is reactive with no signs of any fetal compromise. CTG should be repeated following each procedure e.g. prostin insertion, AROM or if fetal compromise is suspected. 9. Transabdominal Ultrasonography This should be done to confirm fetal age, as confirmation of fetal age is important when it comes to deciding whether or not to induce labour in preeclampsia. Also to check for fetal well-being and growth restriction, but these requires repeated scans and plotting of growth chart over a period of time. Result: No ultrasonography was done during this admission. The last scan was done in Hospital Kluang before patient was transferred to HBP. The last scan reports fetal age corresponding to dates, AFI of 9, and no abnormalities detected with no mention of other findings. Interpretaion: As fetal age is corresponding to dates and there is no suggestion of fetal compromise or restriction, it is safe to proceed with induction of labour. 10. Urinalysis (UFEME) To check the levels of proteinuria which may be more quantitative than urine dipstick. Results: Leukocytes, nitrite, protein, glucose, ketone, urobilinogen, and bilirubin were not detected. Interpretation: No proteinuria was detected. This could mean that the patient does not have preeclampsia but rather gestational hypertension, or it could be undetected as the blood pressure has also become well controlled with medication. However, no risks should be taken and Mdm. SM should be closely observed in the ward. Either way, induction of labour and delivery would still be ideal for her as she has already reached term. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 7) WORKING DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSION Working Diagnosis Induction of labour at term in view of mild preeclampsia in pregnancy Comment: As Mdm. SM has elevated blood pressure and urine dipstick albumin 1+ but has no physical or biochemical features suggestive of severe preeclampsia, the working diagnosis is mild preeclampsia. However, she should be monitored closely in the ward for any symptoms indicative of disease progression. As she has reach term, it would also be wise to induce labour in her, especially given her history of postdates as delivery would be the only definitive management in such cases. Plan of management on admission Continue T. Methyldopa 250mg 8-hourly Daily urine albumin dipstick Vital signs monitoring 4-hourly Baseline cardiotocograph on admission Fetal kick charting and Labour progress charting To notify immediately if spontaneous rupture of membranes To notify immediately if strong contractions commence Encourage orally For induction of labour with T. Prostin 1.5mg as Bishops score unfavourable To notify immediately if any symptoms occur STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 8) SUMMARY OF INPATIENT PROGRESS (INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES) Throughout the first two days of admission, Mdm. SM was comfortable in the ward with no development of any symptoms of severe preeclampsia, eclampsia, or labour. Her vital signs were stable with blood pressure ranging 122-138/70-84. On the morning of the 2nd day, tablet prostin 1.5mg was inserted into her posterior fornix under aseptic technique. Cardiotocograph was reactive and vaginal examination 6 hours post-insertion showed cervical os 3cm, cervix 2cm, soft and axial, and high station. Therefore, a 2nd tablet of prostin was inserted on the morning of the 3rd day. Once again, post-insertion cardiotocograph was reactive and vaginal examination 6 hours later showed no changes to before. Mdm. SM still did not experience any signs and symptoms of labour. She also did not have any symptoms indicating progression of her preeclampsia. On the morning of the 4th day, it was decided that Mdm. SM should undergo artifical rupture of membranes (AROM) rather than have a 3rd prostin tablet inser ted. Cardiotocograph monitoring had been difficult so decision was made to insert fetal scalp electrode at the same time for internal monitoring. Following the AROM, internal monitoring revealed a drop of fetal heart rate from 130 to 100 beats per minute with no accelerations. Cervical os was still 3cm with no symptoms of labour. Decision was made to proceed with emergency lower section caesarean section (ELSCS) under general anaesthesia and Mdm. SM gave her consent. Via ELSCS, a healthy baby boy was delivered weighing 2.9kg with Apgar score of 91105. There were no intra or post-operative complications. Post-operative medications given include IV ampicillin 500mg QID, subcutaneous heparin 5000 units BD, IV pitocin 40 units QID, IM pethidine 50mg PRN, Tab. paracetamol 1g QID and Tab. Mefenemic acid 500mg TDS. Throughout the next 2 days, Mdm. SM was comfortable in the ward and had mild operative site pain with no other symptoms and vital signs were stable. All medications except analg esia were stopped. She was ambulating well, tolerating orally and had passed urine and motion by the 5th day. As for the baby, breastfeeding had commenced and he had also passed urine and motion. The uterus was well contracted at 22 weeks size and dressing was not soaked. Inspection of the wound on the 6th day revealed a clean and non-gaping wound. She was counseled on contraception and indicated a preference for intrauterine contraceptive device. As she was well, she was discharged with appointment to return to postnatal clinic at KKSR to review her blood pressure and operative wound in 1 weeks time. On discharge, her blood pressure was 140/70mmHg and urine dipstick albumin was trace. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 9) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTION Discharge Plan Tab. Mefenemic acid 500mg TDS PRN Tab. Paracetamol 1g QID PRN Follow-up appointment at Klinik Kesihatan Simpang Renggam (KKSR) Postnatal clinic in 1 week to review blood pressure and operative wound. Follow-up appointment at KKSR in 6 weeks for review, cervical smear, and contraception. Counseling Advised to return immediately to the hospital if Mdm. SM has problems with the caesarean wound e.g. pain, discharge or if she develops any new or worrying symptoms. Advised on the need to be compliant to postnatal follow-up to review Mdm. SMs condition. Advised for cervical smear during postnatal follow-up as previously never done. Counseling regarding breastfeeding and contraception. Explain about the nature of pregnancy-related hypertensive disorders and its long term implications. Advised to attend antenatal clinic for preconceptual counseling if future pregnancy is desired, or to come for booking immediately once discovered to be pregnant. Advised to observe a healthy lifestyle in order to prevent development of conditions such as hypertension and diabetes. Mock Prescription Tab. Paracetamol 1g QID PRN x 1/52 Tab. Mefenemic acid 500mg TDS x 1/52 STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 10) REFERRAL LETTER (IF APPLICABLE) Medical Officer, Postnatal Clinic, Klinik Kesihatan Simpang Renggam, 86200, Simpang Renggam. 20th June 2010 Mdm. SM (IC.800318015794) Date of admission: 20th June 2010, Date of discharge: 25th June 2010 Problem: Late onset hypertensive disease in pregnancy Dear medical officer, Mdm. SM is a 30-year-old Malay lady of parity 4+1 who was diagnosed to have preeclampsia at 36 weeks of gestation during routine antenatal follow-up at your centre. During admission to our ward, she underwent induction of labour with tablet prostin and artificial rupture of membranes. However, fetal distress developed, picked up on internal monitoring and Mdm. SM underwent emergency lower section caesarean section under general anaesthesia. She delivered a healthy baby boy (2.9kg, Apgar 91105) with no complications intra- and post-operatively. We are discharging her into your care. Please review her blood pressure as scheduled and also offer contraception and cervical smear as previously never done. She has indicated preference for intrauterine contraceptive device. Do not hesitate to contact us immediately should the need arise. Thank you very much for your attention. Yours sincerely, Paul Kong Fu-Xiang (Final year medical student, IMU), Department of Obstetrics Gynaecology, Hospital Batu Pahat. STUDENT NAME: Paul Kong Fu-Xiang ID NO: M0508129 NAME OF SUPERVISOR: Dr. Sharifah Sulaiha ROTATION: Obstetrics Gynaecology 11) LEARNING ISSUES IN THE 8 IMU OUTCOMES 1. Disease prevention and health promotion Hypertensive disorders in pregnancy are one of the most common antenatal problems and eclampsia is a major source of maternal mortality. What are the ways in which some element of prevention can be instituted or to decrease the severity of preeclampsia? There haven been certain strategies touted to prevent or modify the severity of preeclampsia. These are categorized as dietary supplements, antihypertensive medications, antioxidants, and antithrombotic agents 5. As low salt diet is one of the recommended dietary changes for hypertensive patients, De Snoo et al 1 was one of the earliest researchers to study the effects of low salt diet in preventing preeclampsia but this practice was discarded as it yielded no significant change. Knuist et al performed a randomized controlled trial in 1998 and they reported that despite helping control blood pressure in non-pregnant individuals, a sodium-restricted diet was ineffective in 361 women in terms of prevention of preeclampsia 6. The dietary supplementation of calcium of at least 1 gram per day is recommended as class I-A evidence 2. Several studies showed that women with low calcium diets were at significantly increased risk of gestational hypertension 7,8,9. Levine et al performed a large , randomized-controlled trial and they found that there was no significant difference in outcome with calcium supplements versus placebos 10. This suggests that unless a pregnant woman has a low calcium intake, calcium supplements may have no added benefit 5. With regards to fish oil supplements and its cardioprotective fatty a