Alcohol and Family Violence Essay Example for Free

Alcohol and Family Violence Essay Alcohol and family Violence has been an issues with families for many years, these are two demons that some just can’t break, families have been experiencing the traumatic of one’s physical uncontrollable actions. Alcohol has become one’s stress reliever in all views that it began to take over one’s way of thinking and reaction, this is ways individuals express their evil thoughts and the sad thing it that the abuse of alcohol has a domino effect on their children’s as they become adults and parents later in life. If community members understand violence differently, their responses may be inconsistent and even harmful to victims. (Advocate. Minnesota, (2003)). Almost 6,500 children across the world have been a victim of family violence which leads up to being in a single parent home, One in three children globally (30%) said as leader of their country; they would tackle violence by improving law and order. For children in developing countries, improving education (17%) was the next priority (compared with just 6% of children in developed countries). (2003). Child Fund.) Finally, a 1991 study in the United States found that the average amount of alcohol consumed prior to the use of violence was only a few drinks, which â€Å"suggests that the act of drinking may be more related to woman abuse than the effect of alcohol.† Two other studies indicate that drug use is more strongly correlated to domestic violence than is alcohol. (2003). Child Fund.) Improving their self-esteem, they abuse the victim physically, emotionally, and sometimes, sexually. Another key factor in wife abuse is alcohol. When the man is stressed, he turns to alcohol to relieve it. Little does he know that the alcohol makes him more irritable? He started really drinking excessively and that is when the abuse started. He had been drinking I sat down to read the paper and he wanted his supper . . . he kicked the c at to the ceiling, he started slapping my face with both hands, (Berger, 1990, pg. 42). So, if youre in an abusive relationship what is the best way to get out and stop of the battering abuse? After notorious acts of abuse, usually, the woman will finally realize that the situation will never get better. Basically there  are three basic reasons why women leave a violent relationship: Educated themselves about the necessary available help, being faced with the impact on their children (mentally, physical, sexually and courage to know when enough is enough) and women having a tolerance level of abuse. (Berger, 1990, pg. 48). Family Violence is Willfully or knowingly placing, or attempting to place, a family member in fear of hurt, causing hurt, wrongful confinement or restraint against the family member’s will or continual harassment which causes anguish.. A family member can be your spouse or ex-spouse, child (including adopted and step child), sibling, parent or in-law. Now there are many factors that contribute to family violence, the most commonly seen are th e characteristics of the abused and the abuser. There is no one specific country or culture that is more abusive than another, abuse is spread across countries, cultures, socio-economic statuses, races, religion and ethnic groups (Goldman, Salus, Wolcott Kennedy, 2009). For example, one may be very educated and well-kept but if unable to control behavior caused by emotions, he may be abusive. While if one may be poor and lowly educated, if he is well controlled in his behaviors and emotions, he will then not be abusive. More often, in cases of child abuse, the abuser usually a parent, father or mother, could be one who may be in situations of stress or someone who simply cannot control their emotions, anger. In a paper written by Professor Harry J. Gaynor (1998), in 1,356 cases of child abuse reported by National Burn Victim Foundation, there were 176 spontaneous cases, of which 97% of them are parents that are known to have aggressive response behavior. There are two kinds of aggressive response, active and passive. Active aggressive behaviors do not have concern over the impact that anger will have to the abused, this translates to actions of hurting the abused verbally, could be hurling hurtful words, humiliating, and physically, hitting the abused. While the passive aggressive response behaviors are those that have cooped up, suppressing negative emotions of a length of time and a blow up or breakdown can be expected, this translates to behavior of neglect and not paying attention to the abused (Gaynor, 1998). Children are victims of adult’s uncontrollable behavior of anger. As much as we blame abusers, and we should look at their background and past, that when they were children were tormented as well. Baltimore County, Maryland Police Department (2012),  shared some facts about child abusing inmates, that 84% of them were abused as children, families with more than four children have higher rates of abused and neglect, more than 80% of the abusers are parent or someone the child is close to and parents on drugs is physically abused regularly. There are parental histories and the cycle of abuse that we have to factor into the characteristics of the abuser. Many of these individuals who are maltreating their own children were victims of abuse and neglect themselves. (Goldman et al., 2003). There is no major difference in percentage of perpetrators being female or male. An apparent close percentage of 50% and 58% of mothers and fathers are found to abuse their own children. However, while single mothers are accused of child neglect, many fathers who abandon the child are almost never considered in the neglect (Newton, 2001). Abuse often happen in environment or family situation where it is overcrowded, usually happens with families with more than four children. If the living conditions are cramped and isolated and parents do not hold proper stable jobs, the chances of abuse in those families, whether parent-child or sibling abuse may occur (Baltimore County, Maryland Police Department, 2012). From the Encyclopedia of Mental Disorders (n.d.), some causes of abuse at times are simply due to parent’s ignorance of developmental stages. This ignorance can lead to frustration and eventually aggressive behaviors. They are under stress because their child has issues with toilet training or not meeting their expectations. Understanding developmental stages can help parents to understand their child’s learning curve better and they will learn to cope with their expectation. Another cause is mental disorders, parent with depression, personality disorders or anxiety disorder etc., can affect their ability to care for their children. The abused, children as the focus, can contribute toward family violence toward themselves and they may never know it. Disabled children, children with mental disorders, children with development disorders, hyperactive children are all at a higher risk compared to a healthy child in receiving abuse. These children have needs that are special, if they do not attain required needs, manner of communication from them can be highly distressing. According to Sullivan (1996) from the Boys Town National Research Hospital, children with disabilities are found to be at greater risk of abuse and neglect compared to children without disabilities (Official Journal of the American Academy  of Pediatrics, 2001). Children with disabilities of any form may be unable to retort, have no understanding that they are abused or cannot communicate the happenings of the abuse may have issues because adults know that they can get away with it because their abuses will not be reported. Knowing one can get away with it makes it easier to push through the abuse compared to risking the child complaining to others about the abuse. Children although still the ultimate victims whether or not they are the cause of the abuse and abused children and the abuser may have much effect in the society. There are long term effects surrounding family violence and any forms of family violence have effects to both the abused and the abuser. Some of the effects are physical and neurobiological, cognitive and emotional and social and educational. First, physical and neurological damages are the visible effects on a child, direct trauma from physical abuse can cause ruptured organs and even possible brain deformity or retardation. Neglect will cause the child to be underfed and/or nutritional deficit, the child will have slow growth rate and development of the physical and brain would be unhealthy. This makes deficient in mental growth as well. Repeated trauma produces changes in the neurochemistry of the brain that affects memory formation. This causes the person to will time to time continually getting flashbacks of fragmented memories of emotions throughout their life. Cognitive and emotional damages are relative unseen. Some children resort into extreme methods to deal with the trauma tic experiences. Some lash out at people around them and themselves. Some become depressed and do things that make them feel better, example by taking drugs and alcohol, some even go to the extent of attempting suicide. Bonding and attachments with their parents or people in general may cease and understanding of the abusing behavior might become permanent if assistance does not come. Children that have been abused also show no concern when someone else is under distress, they may even result to behave in ways like hitting the other child the same way their abuser did to them (Sigelman Rider, (2012). A social and educational effect becomes obvious when the child become less sociable or not sociable at all, isolating himself. The child may also become distrustful toward people in general making them unable to properly have a normal relationship. Due to this, the child will grow up having issues with self-esteem, have low level of confidence. Behaviorally, some children may  grow up to become abusive or they become isolated (Encyclopedia of Mental Disorders, n.d.). Some of the children who do not seek and have support to recovery may consider what they have been through has normal and appropriate. This is how the cycle of abuse goes on. Abused children are often emotionally and physically in pain at school; hence they are unable to concentrate at what they have to do, leading to them falling behind their grades. They find it hard to make friends and hence either become a bully or get bullied at school as well. Because of this, teachers at school might see them as a problematic child if they are not aware of the happenings that are going on at home. With society (school) labeling them as problematic and being abused at home by parents they are likely to feel rejected by everyone. Intervention as a Human Services Professional I would suggest that all family members seek counseling to express all issues and get to the root cause of the problem. When children are involved seeing a therapist with the family and without the parents would be one of my intervention to help their family, I would also have the parents go to parenting classes. Resource: Advocate. Minnesota, (2003).Alcohol and Domestic Violence. www.umn.edu/hutments/svaw/ domestic/link/alcohol.htm Attorney-General’s Chambers (31 October 2009). Interpretation of this Part. In Women’s Charter (Chapter 353, Section 64). Retrieved from http://statutes.agc.gov.sg Baltimore County, Maryland. (2 January 2013). Facts About Child Abuse. Retrieved from http://www.baltimorecountymd.gov/Agencies/police/community/abuse.html (2003). Child Fund. www.childfund.org.av/publication/new-childfund-survey-fines-assive-kids-blame-alcohol-number-one-cause-violence Gaynor, H. J. (1998). The Root of Child Abuse: Anger. Retrieved from http://www.aaets.org/article63.htm Goldman, J., Salus, M. K., Wolcott, D., Kennedy, K. Y. (2003). A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice. Retrieved from https://www.childwelfare.gov/pubs/usermanuals/foundation/foundatione.cfm

Chronic Low Back Pain (CLBP) Literature Review on Treatment

Chronic Low Back Pain (CLBP) Literature Review on Treatment INTRODUCTION Chronic low back pain (CLBP) is a major health issue in the western world and is a significant burden on health care; Americans spend $37 billion annually with a further $19.8 billion lost in absenteeism [1]. There is 58% life time prevalence of back pain in the UK, a 22-65% 1-year prevalence and 6-7% of all adults have constant back problems [2]. Although CLBP is usually benign ( Modern (Verum) acupuncture originates in ancient Chinese philosophy which claims pain and disease manifest because of imbalances in bodies forces of Yin and Yang. It is believed these forces flow through specific courses (meridians) and can be manipulated using specific acupuncture points to regain the balance. Acupuncture has evolved from the traditional Chinese application and some styles incorporating adjuncts such as electrical stimulation of the acupuncture needle [4], A recent systematic review of articles published between 1966 and February 2003 [4] concluded that the efficacy of acupuncture on CLBP was inconclusive due to the low methodological quality of selected studies. They found acupuncture had some short-term improvements in pain and function compared to control or sham but due to low methodological quality they concluded a need for higher quality studies. This review updates that study [4] by including articles published after February 2003 or studies that were published prior but were of high relevance and methodological quality. The objective is to provide firm conclusions about the efficacy of acupuncture therapy for CLBP. METHODS Study Selection Criteria Only randomised controlled trials (RCTs) available in English and available free of charge were included. Search Strategy In October 2009 the MEDLINE database (period 1950 to date) was searched for RCTs published after February 2003 and matching the search string Chronic low back pain AND acupuncture OR dry needling OR Sham OR Placebo AND randomised controlled trial OR randomized controlled trial. Further searches using PEDro, Web of Science (using ISI Web of Knowledge) and Cinahl (period 1982 to date) (see appendix A). Each articles reference list was also used as a source of relevant publications. Participants For inclusion the studies participants needed to be =18-years old with non-specific CLBP. Non-specific CLBP was defined as pain between the 12th costal margin and the inferior gluteal folds =12-weeks. If radiating leg pain was present this must be secondary to the lumbosacral region pain. RCTs that included participants with specific pathologies as the root cause of their CLBP, such as malignancy, prolapse of =1 inter-vertebral disc or spinal fracture were excluded. Interventions Studies that investigated the effects of traditional (Verum) acupuncture, trigger-point acupuncture and dry needling were reviewed. RCTs were included regardless of hand of electro-stimulation. Studies investigating non-needle based acupuncture, such as laser acupuncture, were excluded. Control interventions included sham, usual care, Transcutaneous Electrical Nerve Stimulation (TENS) or conservative orthopaedic therapy. Outcome measures There are four outcome measures considered to be important when assessing CLBP Pain intensity (e.g. visual analogue scale (VAS-P), numerical rating scale (NRS-P)) A global measure (e.g. Overall improvement, proportional recovery of patients) A back specific functional status measure (e.g. Roland-Morris Disability Questionnaire (RMDQ)) Return to work (absenteeism, speed of return) RCTs must include =1 of the above. The primary outcomes were pain and function. Study selection A total of 544 studies were found through the searches with 17 potentially eligible RCTs identified. Of these 5 were excluded due to study duplication (n=1), sole inclusion of participants with specific CLBP (n=2) or use of non-needle based acupuncture (n=2). The remaining 12 articles were reviewed using the Critical Appraisal Skills Programme (CASP) to determine their methodological quality. CASP enables the systematic review of an RCT for validity, design, execution and reasoning. Assessment criteria included randomization and allocation of participants, blinding of participants and assessors, identification of potential observer bias, participant numbers at RCT start and conclusion, presentation and accuracy of results, and any identified limitations. Results were recorded and documented (Appendix B). RCT commonalities: Participants were excluded: if they exhibited contraindications to acupuncture, had received acupuncture for their CLBP previously, previous spinal surgery, infectious spondylopathy, malignancy, congenital spine deformity, compression fracture due to osteoporosis or spinal stenosis. No differences in demographic variables or baseline levels of pain and disability were detected between the groups at baseline (P >0.05). Randomization was computer-generated with random number tables. All participants gave informed consent. Each RCT received ethical approval Usual care is defined as a combination of drugs, physiotherapy and exercise. RESULTS [5] 298 participants with CLBP =6-months randomised to 12 sessions of acupuncture (n=146) or sham acupuncture (n=73) over 8-weeks, administering therapists had =140 hours training and 3-years experience, with a third delayed acupuncture group (n=79) who received no acupuncture for the initial 8-weeks followed by the acupuncture groups protocol. Outcome measures were VAS-P and back function using the validated German Funktionsfragebogen Hannover-RÃ ¼cken (FFbH-R) questionnaire. At 8-weeks VAS-P decreased from baseline in all groups; after 26 and 52-weeks the acupuncture groups results were better than sham however differences were not significant. Results from the delayed acupuncture group followed the acupuncture groups pattern. The trial had good methodological quality: outcome measures were assessed independently with participants completing questionnaires, attrition was reasonable (18%) but the acupuncture group was double the size of the others which may have influenced results. [6] 638 participants with CLBP =3-months randomised to standard acupuncture (n=185), individualised acupuncture (n=157), sham acupuncture (n=162) or usual care (161) groups. Acupuncture groups received 10 treatments over 7-weeks by acupuncturists with =3 training. The Primary outcome measure was RMDQ. Compared to baseline all groups showed improved function and pain at 8-weeks. Mean values for RMDQ were consistent up to 52-weeks with the usual care group having greater dysfunction than all acupuncture groups (P=.001). There was no significant difference between real and sham acupuncture groups (P>0.05). All forms of acupuncture had beneficial and persisting effects over usual care for CLBP treatment with clinically meaningful functional improvements. There were no significant differences between acupuncture groups. Outcome measures were gathered by blinded telephone interviewers and attrition was low (6%) resulting in good trial internal validity [7] 1162 participants with CLBP =6-months randomised to 5-weeks of twice-weekly acupuncture (n=387) or sham acupuncture (n=387), performed by acupuncturists with =140 hours training. A third group received usual care (n=387). Outcome measures were Von Korff Chronic Pain Grade Scale (GCPS) and Hanover Functional Ability Questionnaire (HFAQ). Results were presented as a percentage of improvement in function and pain at 6-month follow-up. At 6-months both acupuncture groups had significant improvements in pain and function compared to baseline and usual treatment. There was no difference between acupuncture groups (p=0.39). The trial was methodologically strong with good internal validity: the control group was an active multimodal conventional therapy, had high power with stated calculation, follow-ups at 1.5, 3 and 6-months, low attrition (4%) and balanced dynamic randomisation. This was a good, highly relevant, large, rigorous trial. [8] 35 participants, =65-years, with CLBP =6-months randomised to 1 of 3 groups receiving 2 3-week phases of 30-minute acupuncture sessions, with a 3-week interval between. Group A (n=12) received standard acupuncture, Group B (n=10) superficial trigger-point acupuncture and Group C (n=13) deep trigger-point acupuncture. Outcome measures were VAS-P and RMDQ score. Group C showed a statistically significant VAS-P and RMDQ reductions from baseline after phase 1 with VAS-P reduction persisting over 12-weeks. There was no significant reduction in VAS-P or RMDQ for either other groups. The RCTs methods are described well however small sample size, high dropout (27%), short-term follow-up and potential bias limited internal validity [9] 26 participants, =65-years, with CLBP =6-months randomised to 2 groups. Over 12-weeks each group received 1 phase of trigger-point acupuncture and 1 phase of sham acupuncture with a 3-week break between. Group A (n=13) received trigger-point phase first followed by sham, Group B (n=13) vice-versa. Acupuncturist had =4-years training and =7-years clinical experience. Outcome measures were VAS-P and RMDQ score. After phase 1 Group A had significantly lower VAS-P (P [10] 60 participants with CLBP =6-months randomised them to 6-weeks of 30-minute weekly sessions of either acupuncture (n=30) or placebo TENS (n=30). No details of administering therapists were given. The primary outcome measure was VAS-P. Although acupuncture showed highly significant differences in all the outcome measures between pre- and post-treatment, the differences between the 2 groups were not statistically significant. Generally the RCT was poor: therapists were not blinded, high noncompliance (23.3%), cointerventions might have influenced results, the dropout rate was not explained and there was no intention-to-treat analysis. [11] 131 participants 18-65 years old with CLBP =6-months were randomised to groups receiving 20 30-minute sessions of traditional and auricular acupuncture (n=40), physiotherapy (n=46) or sham acupuncture and physiotherapy (n=45), over 12-weeks. Outcome measures were VAS-P and pain disability index (PDI). After 12-weeks of treatment the acupuncture group showed significantly reduced pain and disability compared to the physiotherapy group but not compared to the sham group. At 9-months the acupuncture group was more effective than physiotherapy in reducing disability only and not different to sham. The trial was methodologically strong but short-term dropout was 24% and long-term 37%. The treatment scheduled was five-a-week for 2-weeks then weekly for 10-weeks which may not be clinically practical. [12] 55 participants =60 yrs, with CLBP =12-weeks were randomised to 2-weeks of twice-weekly acupuncture and electrical stimulation alongside usual care (n=31) or usual care alone (n=24). Primary outcome was RMDQ. At 6-weeks results indicate clinically and statistically significant improvements in the acupuncture group for pain and disability compared to control. Effects remained and only diminished slightly at 9-weeks follow-up. The trial was methodologically strong: balanced randomisation, clear methods, low attrition (14%). Participant inclusion criteria included prior imaging limiting generalisability. [13] 186 participants aged between 20 and 60 with CLBP =6-week were randomised to 4-weeks of usual care alone (n=60) or with either acupuncture (n=65) or sham acupuncture (n=61). Acupuncturists were experienced doctors trained in Beijing. Primary outcome measure was VAS-P. Immediately after treatment 65% of the acupuncture group reported a =50% reduction in VAS-P compared to 34% of the sham group and 43% of the usual care group. At 3-months 79% of the acupuncture group, 29% of the sham group and 14% of the usual care group reported a =50% VAS-P reduction. Methodological quality was high: balanced (stratified) randomisation and excellently described methods however there was 30% attrition at 3-month follow-up and data collection was from general practitioners leading to potential performance bias. [14] 241 participants, aged 18-65, with CLBP for 4 to 52-weeks were randomised to 10 sessions of acupuncture (n=160) or to usual care (n=81) over 3-months. Acupuncturists were training for =3-years and =12.8-years clinical practice. Outcome measures were SF-36 pain scores and Oswestry low back pain disability questionnaire (ODI) taken at baseline, 3, 12 and 24-months. A power calculation stated a required 100 participants per group to detect a 10-point difference on SF-36 (90% power and 5% significance level). A 5 point difference in SF-36 was deemed significant. The number of participants in the acupuncture group was increased to 160 to allow for between-acupuncturist effect, usual care group decreased to 80 participants without power loss. Results were presented as point differences between randomisation, 12 and 24-months. At 12-months a 5.6 point intervention effect difference in SF-36 pain was found and 8 point at 24-months. No treatment effect was found for any other dimension o f SF-36 or ODI. Participants were representative of UK population, randomisation was balanced, methods were thoroughly documented and acupuncture treatments were individualised resulting in high methodological quality and generalisability. However 25% of participants were unaccounted for at conclusion reducing internal validity. [15] 11630 participants with CLBP =6-months were allocated to three groups. Group A were received 15 individualised acupuncture sessions with usual care as needed (n=1549). Group B received delayed acupuncture with usual care as needed (n=1544). Group C declined to be randomised but received 15 individualised acupuncture sessions with usual care (n=8004). Treatment was over 3-months. Outcome measures were FFbH-R and SF-36 pain scores. At 6-months the acupuncture group showed significant improvements in FFbH-R and SF-36 pain compared to routine care alone. The large sample size and broad inclusion criteria meant results were generalisable however groups were different at baseline and findings identified a degree of randomisation selection. [16] 52 participants with CLBP =6-months were randomised to 4-weeks of physiotherapy with daily 1-hour electro-acupuncture sessions (n=26) or standard physiotherapy (n=26). Outcome measures were pain (NRS-P) and function using the Aberdeen-LBP. There was a significant reduction in NRS-P and Aberdeen-LBP scores in the acupuncture group immediately after treatment and at 1 and 3-months follow-up. Methodological quality was limited by possible breach of blinding integrity due to lack of patient blinding and subjective outcome measures. DISCUSSION Acupuncture vs. no treatment Two high quality studies (11928 people) [5] and [15] found acupuncture more effective in short-term pain reduction and functional improvements than no (delayed) treatment. However both studies were weakened by insufficient blinding and participants were recruited from newspaper adverts [5] or an insurance company [15] limiting generalisability; both of which reduce results confidence. Acupuncture vs. sham Studies comparing acupuncture and sham acupuncture (2460 people) ([5], [6], [7], [11] and [13]) found both effective at reducing pain and increasing function compared to baseline measures; however no study found a clinically significant difference between groups With five methodologically sound trials all reporting similar results clinicians can have confidence in the effectiveness of acupuncture or sham-acupuncture in pain and functional improvements. However with no clinically significant difference between groups, placebo effect seems to be a substantial contributing factor. Acupuncture vs. usual care Five RCTs comparing acupuncture and usual care (12164 people) ([12], [13], [14], [15] and [16]) concluded that acupuncture was more effective at reducing pain. Increased function in the acupuncture group compared to control was reported in 1 RCT [12] at 6- and 9-weeks, [15] at 6-month and another [16] investigated effect immediately after treatment and 1- and 3-months follow-up; however 1 RCT [14] found no significant improvement in function in their longer-term study at 12 or 24-month. Unlike other papers reviewed, Thomas and colleagues used UK based participants who received treatments in private or GP clinics adding confidence to their conclusions when applied to the general UK population. From study findings clinicians can have confidence that the addition of acupuncture to their treatment of CLBP will be more effective than usual care alone. Acupuncture vs. deep and superficial trigger-point acupuncture One study ([8] 35 people) found greatest improvements in pain and function using deep trigger-point-acupuncture. However this study, while being methodologically thorough and having patient and assessor blinding, was limited by small size, high dropout (23%), short-term follow-up and possible centre bias leading to reduced clinical confidence. Acupuncture vs. TENS One RCT ([10] 60 people) found significant improvements using both TENS and acupuncture but no significant intergroup difference over 6-months. However, confidence in results are limited because participants also received usual care and exercise so may have improved regardless; furthermore the study had no therapists blinding, high noncompliance (23.3%), unexplained dropouts and no intention-to-treat analysis. Trigger-point acupuncture vs. sham In 1 cross-over trial ([9] 26 people) trigger-point acupuncture was found to be more effective than sham however small sample size, high attrition (23%), restricted to short-term follow-up and possible bias due to centre location (Department of Orthopaedic Surgery, Meiji University of Oriental Medicine) limit confidence in findings. LIMITATIONS Studies were commonly limited by being unrepresentative: of the 12 studies 2 were UK based ([10], [14]), six restricted participants by age ([8], [9], [11] [12], [13], [14]), 2 used participant recruitment methods which may have introduced expectation bias (newspaper adverts, [5], insurance company [15]) and five had underpowered sample sizes or non-stated power calculations ([8], [9], [11], [12], [13]). Without representative sample groups the outcome measures cannot be applied to the general population with any reliability. Discrepancies were noted in treatment frequency with control group participants receiving less attention than intervention participants [16]. Blinding was inconsistent across studies: 1 study ([5]) blinded participants in the acupuncture groups but not the delayed group, 1 study ([6]) blinded participants only, four ([7], [8], [9], [13]) blinded assessors and participant, 1 ([10]) blinded assessors only, 1 ([11]) blinded assessors and participants but not acupuncturists, three ([12], [14], [15]) had no blinding and 1 ([16]) blinded assessors but not participants. CONCLUSIONS There is some evidence for the efficacy of acupuncture for CLBP; compared to no treatment there was short-term ([5] 8-week and [15] 3-month) pain reduction and functional improvements. Compared to sham therapy both showed similar improvements in pain and function at short-term ([5] 8-week, [6] 8-week, [11] 12-week and [13] 3-month) and mid-term ([5] 6-month and 1-year, [7] 6-month, [11] 9-month) follow-up but no significant difference was detected between groups. Compared to usual care acupuncture showed significant improvements in primary outcome measures at treatment, short- ([12]6- and 9-week, [13]3-month, [16]1- and 3-month) and long-term ([15]6-month, [14]1- and 2-year) follow-up. Compared to superficial and deep trigger-point all treatments showed improvements but none were significantly different from each other. Both acupuncture and TENS were found to produce long-term ([10] 6-month) improvements but no significant difference was found between interventions. Comparing trigger -point therapy to sham, trigger-point was found to be more effective although benefits were not sustained. There is evidence that acupuncture alongside other treatments relieves pain and increases function better than individual therapies alone. Further research needs to be conducted to determine treatment frequencies and sustainability of treatment effects. Effective sham treatments need to be developed to establish placebo effect compared to acupuncture and other therapy types. Additional Resources Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA;290(18):2443-2454. Maniadakis, N. and Gray, A. (2000) The economic burden of back pain in the UK. Pain, 84, 95-103. Koes BW, van Tulder MW and Thomas S (2006). Diagnosis and treatment of low back pain. BMJ; 332, p1430-1434 Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. (2005). Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration. Spine 2005;30:944-963 Reviewed Journals Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN. (2006) Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of internal medicine. 166: 450-457. Cherkin et al (2009) A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Haake M, Muller H, Schade-Brittinger C, Basler HD, Schafer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. (2007). German Acupuncture Trials (GERAC) for chronic low back pain- randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 167(17):1892-1898. Itoh E, Katsumi Y, Hirota S, Kitakoji H. (2006). Effects of trigger point acupuncture on chronic low back pain in elderly patients a sham-controlled randomised trial. Acupuncture in Medicine. 24(1):5-12 ItohK. Katsumi Y. Kitakoji H. Acupuncture in Medicine. (2004) Trigger point acupuncture treatment of chronic low back pain in elderly patients: a blinded RCT. 22(4):170-7, Kerr DP, Walsh DM, Baxter D. (2003) Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The clinical journal of pain. 19: 364-370 Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. (2001). Acupuncture treatment of chronic low-back pain a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain 96 (2002) 189-196 Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. (2003). Acupuncture for chronic lower back pain in older patients: a randomized, controlled trial. Rheumatology. 42:1508-1517 Molsberger AF, Mau J, Pawelec DB, Winkler J (2002). Does acupuncture improve the orthopedic management of chronic low back pain a randomized, blinded, controlled trial with3 months follow up. Pain 99 (2002) 579-587 Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M J , Roman M, Walters S J, Nicholl J. (2006). Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal.doi:10.1136/bmj.38878.907361.7C Witt CM, Jena S, Selim D, Brinkhaus B, Reinhold T, Wruck K, Liecker B, Linde K, Wegscheider K, Willich SN. (2006). Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain. American Journal of Epidemiology 2006;164:487-496 Yeung CKN, Leung MCP, Chow DHK. (2003). The Use of Electro-Acupuncture in Conjunction with Exercise for the Treatment of Chronic Low-Back Pain. The Journal Of Alternative And Complementary Medicine..2003:9:4:479-490

Economic Business Strategies of Ryanair

Economic Business Strategies of Ryanair Ryanair Introduction The economics of business vary, both depending upon the industry where they operate and the style and strategy adopted by the management. Within this paper it is intended to assess those economic factors as they relate to the â€Å"low-cost† airlines. To assist with this assessment Ryanair, one of the leading â€Å"low-cost† airline operators in Europe, will be used as an example. Existing Corporate Strategy Following the liberalisation of the airline industry, the consumer demand for air travel began to increase. However, when operators such as Ryanair, an Irish based company, was one of the â€Å"first-movers† (Faulkner and Campbell 2006). in adopting a â€Å"low-cost† strategy for Europe, similar to the model successfully introduced by Southwest Airlines (2007) in the US, the levels of demand increased dramatically. As can be seen from the numbers of passengers using UK airports (see table 1). Table 1 Airline passengers Year Passengers (m) 1980 50 1990 90 2000 180 The demand for airline seats is also forecast to more than treble by 2030 to around five hundred million UK passengers. Ryanair is an Irish airline operator that commenced business in the mid 1980’s with one 15-seater aircraft, has grown to a business that now has a fleet of over 150 aircraft and carrying over two million passengers (About Us 2007). Since the beginning of the century, the company’s growth rate has improved substantially, to a position where it is now supplying air travel to around forty million passengers (see figure 1), with an expectation of this rising to seventy million within the next few years (Ryanair 2007). The company has achieved this growth by supplying consumers with consistently low prices. It maintained these low fares by creating a â€Å"no frills† price advantage (Pettigrew et al 2002), which differentiated its service from the established airline competitors (Porter 2004, p.207 and Kotler et al 2004, p.407). In other words Ryanair offered cheap fares with lower levels of service. For example, free in-flight meals were eliminated. At one stage the no-frills policy included not providing ice for in-flight drinks (Creaton 2004, p.169), although this was reintroduced following complaints. However, to sustain this position, as Lynch (2006) and Faulkner and Campbell (2005), who submitted that to achieve and maintain low price in the market place, the business itself had to be structured in a way that provided a limited cost base. Ryanair has achieved this situation by taking a number of measures, which include: Maximising use of resources by using one aricraft type, increasing employee roles and reducing airpot turnaround times. Ticketless and direct selling via the Internet or phone, which served to reduce administrative costs. Use of secondary rather than main airports. This move enabled the business to negotiate lower airport fees. Single class travel, elimatiion of free inflight services and seat reservation helped reduce business costs. All of these measure have given Ryanair the flexibility to be able to maintain a flexibility of price, from 99p owards, and service and helped it to react effectively to industry changes. In terms of profit and the financial contribution that Ryanair’s strategy has achieved, as can be seen from the following financial data taken from the relevant company’s website, shows how successful Ryanairs appraach was in 2003, when compared with its main competitors (See table 2 below). Table 2Net profit percentages Company Percentage Ryanair 17.81% Easyjet 7.98% British Airways 7.28% Challenges There are significant future challenges facing the low-cost airline industry in general, and Ryanair in particular, which will need to be addressed. Amongst these are the following: Competition It increased regional and global harmonisation and development of air travel; Ryanair is bound to face increasing competition within the next five years. This could materialise from developing nations within Europe, where there is significant scope for new entrants (see figure 2) It could also result from the recently signed â€Å"open skies† agreement between the EU and US (Milmo and Gow 2007). Both of these actions could result in loss of market share to new entrants, which would impact adversely upon Ryanair’s current level of success and financial results. Similarly, Ryanair’s own growth predictions could reduce its profitability levels. Whilst growth brings economies of scale, it can increase management costs, which is counter-productive to efficiency (Creaton 2004, p.250). Taxation At present the airline industry is heavily subsidised. As identified with the Bized (2004) report, this benefits the industry players by around  £6 billion annually. These benefits include zero VAT, capped landing charges and fuel tax exemption. It is anticipated the removal of these benefits, by introducing the relevant takes could reduce passenger levels by over 22% as a result of the increase in prices. Whilst it is not expected that all these subsidies will be eliminated at once, there is little doubt that for political, treasury and environmental reasons some adjustments will be seen in these areas will be seen within the next five years. Environment The major challenge facing Ryanair relates to its impact on climate change. Following recent IPCC, the EU are becoming increasingly concerned with the airline industries contribution to this global issue. As a result, these organisations have developed industry targets that are expected to be met within the next 5 years and beyond (see table 3). Unless Ryanair adapts its corporate strategy to take into account these targets, the result addition costs, or reduction in service will impact severely upon its ability to remain cost efficient and to maintain its present levels of profitability. Future Strategy As has been advised by a number of researchers (Lynch (2006) and Faulkner and Campbell (2006)) every business needs to review its corporate strategy to address future challenges. There are two ways that Ryanair can address the challenges that have been outlined in the previous section of this paper In terms of reducing the impact of competition, and making it more difficult for new entrants, the business needs to continue to seek ways to sustain its cost reduction programme. This not only means that it has to ensure that the internal management structure efficiency of the business needs to be as efficient as it has been in the past, but also that the business needs to seek new measures of cost reductions. For example, expanding its automatic check-in processes through all its locations would greatly reduce the business human resource cost. It can also sustain its lower price policy by transferring the cost of flying from ticket cost to other aspects of the travel, for example luggage. This specific action could also offset any potential airport cost increases. However, the most effective strategy to adopt in order to address all of the challenges is to develop a plan that increases the supply to meet anticipated demand, whilst at the same time reducing the cost of that supply and the effects of increased taxations and meeting its environmental commitment. The most effective plan for this achievement is the conversion of the current fleet to higher passenger capacity aircraft. For example, the introduction of a significant number of Airbus models would double capacity on those flights. From an economic viewpoint it would also reduce costs. For example the maintenance and servicing costs would remain the same because aircraft numbers have not been increased, but will reduce as a percentage of the ticket cost. Similarly, airport costs and other taxes, such as fuel tax would also be reduced per passenger capita. Finally, because of the increased load, and higher efficiency of these aircraft, the emissions level per passenger km would also see a reduction, thus helping the business to meet its environmental targets. Conclusion As has been seen from this research, over the past two decades the business economic strategies that Ryanair has employed have been successful in helping it maintain competitive advantage, achieve passenger growth and fulfil its objective of increasing business value. However, with the future challenges facing the business from increased competition, rising taxation and environmental concerns, the business will need to adopt a that is flexible to change, whilst at the same time enabling it to continue to sustain and achieve the successes of the past. This will mean combining cost reduction with a production and supply system that reduces the impact of potential tax increases, whilst at the same time enabling Ryanair to meet the increasing demands of reducing its environmental impact. Bibliography Bized (2004). Low Flying Fares: An End to Cheap, No Frills? Retrieved 27 July 2007 from http://www.bized.co.uk/current/leisure/2003_4/010304.htm Brassington Frances and Pettitt, Stephen (2006). Principles of Marketing, 4th edition, Pearson Education Ltd. London, UK Channel 4 News (2007). If you care about the environment, you should fly Easyjet. Really? Retrieved 16 May 2007 from http://www.channel4.com/news/articles/society/environment/factcheck+how+green+is+easyjet/509642 Creaton, Siobhan (2004). Ryanair: How a Small Irish Airline Conquered Europe. Aurum Press Ltd. London, UK. Faulkner, David and Campbell, Andrew (2006). The Oxford Book of Strategy: A Strategy Overview and Competitive Strategy. New ed. Oxford University Press. Oxford, UK. De Groote, P.D (2005). The Success Story of European Low-Cost Carriers in a Changing Airworld. GaWC Research Bulletin 174. Retrieved 27 July 2007 from http://www.lboro.ac.uk/gawc/rb/rb174.html Kotler, Philip. Wong, Veronica., Saunders John A and Armstrong, Gary (2004). Principles of Marketing, 4th European edition, Pearson Education Ltd. London, UK. Lynch Richard (2006). Corporate Strategy. 4th edition. Financial Times Prentice Hall. Harlow, UK. Milmo Dan and Gow David (2007). EU Open skies deal. The Guardian. London, UK. Pettigrew, Andrew M. Thomas, Howard and Whittington, Richard (2002). The Handbook of Strategy and Management. Sage Publications Ltd. London, UK. Porter, Michael E (2004). Competitive Strategy: Techniques for Analysing Industries and Competitors. The Free Press. New ed. The Free Press. New York, US. Report (2007). The Environmental Effects of Civil Aircraft in Flight. Royal Commission of Environmental Pollution. Retrieved 29 July 2007 from http://www.rcep.org.uk/avreport.htm Ryanair (2007). About us. Retrieved 14 May 2007 from http://www.ryanair.com Southwest Airlines (2007). About SWA. Retrieved 28 July 2007 from http://www.southwest.com/about_swa/airborne.html

The Crucible: Insight Of Hale, Elizabeth And John :: Essay on The Crucible

The Crucible, a container that resists hear or the hollow at the bottom of an ore furnace. However its connotations include melting pot, in the symbolic sense, and the bearing of a cross. Elizabeth, John Proctor’s wife; a cold, childless woman who is an upright character who cannot forgive her husband’s adultery until just before he died: she is accused of being a witch. Reverend Hale, a self-proclaimed expert on witchcraft; at the play’s end tries to save the accused. John Proctor, a good man with human failures and a hidden secret, a affair with Abigail, he is often the voice of reason in the play; accused of witchcraft.â€Å"I do not judge you. The magistrate that sits in your heart judges you.† This is where Elizabeth suspects that John has committed adultery, but knows how good of man he is and tries to look over it. â€Å"Adultery, John.† This is where John tells her and she makes it sound like it is news to her even though she has known for awhile. She is trying to have John have a â€Å"good† name and not be a name that everyone discards. â€Å"No, sir.† Here she is protecting his name but she doesn’t know that John has just came out and said that he committed lechery. She thought that she was saving him but she was actually making it worse for him.â€Å"I mean to crush him utterly if he has shown his face.† Here he is talking about if he ever encountered the Devil that he would literally kick his ass. This shows how he is a hippercrite against being a Puritan. Even though he is a religious man he still has the human character of having an evil side to himself.â€Å"But I will cut off my hand before I ever reach for you again.† John is talking to Abigail and how he is finished with seeing her and that he doesn’t want any part of her. John goes through from being amoral to immoral and then to moral, then back to amoral at the end. â€Å"It’s winter in here yet.† Elizabeth and John were talking about how he was working all day seeding even though he was at Salem to see what the fuss was all about. Here he shows his character toward Elizabeth by lying to her and she can’t trust him. â€Å"Let Rebecca go like a saint, for me it is a fraud.

The Role of Power in Obedience Essay -- Political Science Law Politics

To Obey or Disobey: The Role of Power in Obedience People’s decision to obey or disobey the law is based on how much power (in its various forms) they perceive the law to have behind it. The power of coercion is one maintained by every government in human history: the power to punish. The power of legitimacy is a much more subtle power: the power to appear as an authority and let others presume that you know best. While enforcing law, authorities will exercise both these powers. Both powers underscore government and society’s ability to control us and to get us to obey. Why do we obey? Stanley Milgram’s Obedience to Authority, a series of experiments in which subjects were told to administer what they believed to be high-voltage electric shocks to people who they thought were experimental subjects, shows us the disturbing extent of people’s obedience in the face of power. Whereas it was hypothesized that few of the subjects would actually shock their supposed experimental subjects, the actual experiments showed a â€Å"disturbingly high level of compliance with authority figures despite the apparent pain evinced by the false experimental subjects.† (Cover 223) Even when the false experimental subjects (actually just a tape recording of responses) screamed with supposed agony, the vast majority of the subjects, although showing some hesitation and concern for their â€Å"victims†, still nevertheless shocked them again and again at the behest of the authority, even after the â€Å"victims† had gone silent. (Cover 223) The almost blind obedience of these subjects was due to the power of legitimacy and expertise they perceived the authority figures behind the experiment to have. The 2 authorities were able to impose their will ... ...human, we will always retain our freedom of thought and our decision to obey or disobey. 5 Works Cited Cover, Robert M. â€Å"The Violence of Legal Acts.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 223. King, Martin Luther. â€Å"Letter from Birmingham Jail.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 158-162. Kropotkin, Peter. â€Å"Law and Authority.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 158-162. Tyler, Tom. â€Å"Why do People Obey the Law?† Introduction to Legal Studies: A Reader. Ed. Thomas Hilbink. Amherst: Collective Copies. 475-495. The Role of Power in Obedience Essay -- Political Science Law Politics To Obey or Disobey: The Role of Power in Obedience People’s decision to obey or disobey the law is based on how much power (in its various forms) they perceive the law to have behind it. The power of coercion is one maintained by every government in human history: the power to punish. The power of legitimacy is a much more subtle power: the power to appear as an authority and let others presume that you know best. While enforcing law, authorities will exercise both these powers. Both powers underscore government and society’s ability to control us and to get us to obey. Why do we obey? Stanley Milgram’s Obedience to Authority, a series of experiments in which subjects were told to administer what they believed to be high-voltage electric shocks to people who they thought were experimental subjects, shows us the disturbing extent of people’s obedience in the face of power. Whereas it was hypothesized that few of the subjects would actually shock their supposed experimental subjects, the actual experiments showed a â€Å"disturbingly high level of compliance with authority figures despite the apparent pain evinced by the false experimental subjects.† (Cover 223) Even when the false experimental subjects (actually just a tape recording of responses) screamed with supposed agony, the vast majority of the subjects, although showing some hesitation and concern for their â€Å"victims†, still nevertheless shocked them again and again at the behest of the authority, even after the â€Å"victims† had gone silent. (Cover 223) The almost blind obedience of these subjects was due to the power of legitimacy and expertise they perceived the authority figures behind the experiment to have. The 2 authorities were able to impose their will ... ...human, we will always retain our freedom of thought and our decision to obey or disobey. 5 Works Cited Cover, Robert M. â€Å"The Violence of Legal Acts.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 223. King, Martin Luther. â€Å"Letter from Birmingham Jail.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 158-162. Kropotkin, Peter. â€Å"Law and Authority.† Before the Law: An Introduction to the Legal Process. Eds. Bonsignore, Katsh, d’Errico, Pipkin, Arons, Rifkin. Boston: Houghton Mifflin Company, 2002. 158-162. Tyler, Tom. â€Å"Why do People Obey the Law?† Introduction to Legal Studies: A Reader. Ed. Thomas Hilbink. Amherst: Collective Copies. 475-495.

The Great Depression :: American History Economy Essays

The Great Depression There had been financial panics before, and there have been some since, but never did a collapse in the market have such a devastating and long-term effect. Like a snowball, it formed and swept away the whole economy before it. Businesses closed, putting millions out of work. Banks failed by the hundreds. Wages for those who were fortunate enough to still have work fell drastically. The value of money decreased as the demand for goods declined. The international structure of world trade collapsed, and each nation sought to protect its own industrial base by imposing high tariffs on imported goods. This only made matters worse. By the fall of 1931, the international gold standard had collapsed, further damaging any hope for the recovery of trade. This started a series of currency devaluations in several countries, because these nations realized that a devalued currency posed at least a temporary advantage in the struggle to find markets for their goods. This was the start of the Great Depression of 1929 to 1940, which began and centered in the United States but spread quickly throughout the industrial world. By 1932, United States industrial output had been cut in half. One fourth of the labor force (about 15 million people) was out of work, and there was no such thing as unemployment insurance. Hourly wages had dropped by about 50 percent. Prices for agricultural products dropped to their lowest level since the Civil War. More than 90,000 businesses failed completely. For nearly every unemployed person, their were dependents who needed to be fed and housed. This massive poverty and hunger had never before been known in the United States. Former millionaires stood on street corners trying to sell apples at 5 cents apeice. Hundreds of pitiful shantytowns, called Hoovervilles in honor of the unfortunate Republican president who presided over the disaster, sprang up all over the country to shelter the homeless. People slept under "Hoover blankets" (old newspapers) in the out-of-doors. People waited in bread lines in every city, hoping for something to eat. In 1931 alone, more than 20,000 Americans committed suicide. The theme song of the time was "Brother, Can You Spare a Dime?" For anyone who did have money, depression America was a shopper's paradise. A new home could be bought for less than $3,000. A man's suit costed about $10, a shirt about 50 cents, and a pair of shoes about $4.

The Characteristics Of Adult Learners Education Essay

Adult pupils in the procedure of ELT construct the particular group of people socially accepted as mature and who are in a learning procedure. Education of grownups has long been perceived as different from instruction of kids in both theory and pattern. The field of big instruction was pioneered by Malcom Knowles who claimed that andragogy should be distinguished from teaching method. Andragogy consists of larning schemes focused on grownups while teaching method is concerned on kids. Knowles ‘ theory of andragogy is an effort to develop a theory specifically for grownup acquisition. Adults bring life experience and a degree of adulthood into the schoolroom that kids and striplings do non. Probably the individual most of import concern for the instructor of grownups is a thorough apprehension of the scholar. Through such an apprehension it is possible to direct your learning to the specific demands and involvements of the grownup. Adults are autonomous and expect to take duty for determinations. Adult larning plans must suit this cardinal facet. In practical footings, it means that direction for grownups demands to concentrate more on the procedure and less on the content being taught. It is of import to utilize schemes such as function playing, simulations, undertaking work and treatments rather frequently because they are most utile for big pupils who are job -centred, goal- oriented and practical. Teacher adopts a function of facilitator or resource instead than lector or grader. Furthermore, another facet of grownup instruction is motive because merely when pupils are motivated they can larn. The best manner is to heighten studentsA? ground for larning. Teachers must be after their motivation scheme which is considered to be successful if it includes demoing grownup pupils the relationship between developing an expected publicity. Finally, we do non hold to bury another built-in portion of grownups larning which proper feedback is. We should cognize when and have to give feedback because good feedback is one of the basic wagess of acquisition. Teaching English to grownups is different from learning kids and teens and involves a considerable sum of planning and accomplishment to do it apprehensible and adaptable to all scholars.1. Features of Adult LearnersCompared to kids and teens, grownups have particular demands and demands as scholars. Adults are people who have the position of adulthood in their ain and other peopleA?s eyes, but in the instruction procedure they come in the low-level place of the scholars. It could be really hard at the beginning and it depends on persons how to cover with this state of affairs. A batch of grownups can go dying because they are so disquieted about traveling back to school and are afraid of their failure and may believe that they are unable to larn. â€Å" The struggle is that as grownups we already have certain well-developed thoughts about life along with our ain system of thoughts and beliefs. To acknowledge that we need to larn something new is to acknowledge that there is something incorrect with our present system. â€Å"[ 1 ] On the other manus, they have outlook about the acquisition procedure and they are able to accept duty for their ain acquisition. They are independent and self – directed, they are non dependent on other people for way. Adults as scholars are goal-oriented and results-oriented. They normally know what end they want to accomplish and they besides have specific consequences in head for instruction. They must see a ground why to larn something. Learning has to be valuable for them ; it should be related to their demands and eventually suit to their work. In other words, grownups seek instruction which is appropriate for their current lives. They are practical and are focused on the facets of the lessons ; it means they want to cognize how the lessons will be utile to them on the occupation. We must non bury that grownups have a batch of experience and a wealth of cognition and they expect to be treated consequently. They require larning that makes sense and is connected to their cognition and experience. They can be critical of learning methods ; they will non execute a learning activity merely because the instructor said to make it. Furthermore, we can anticipate that grownups are more disciplined that some kids and adolescents and are able to prolong a degree of motive. Compared to kids, grownups have more developed abstract idea ; it means we have to take appropriate activities adapted to utilize their minds to larn consciously. To sum it up, there are a batch of specific characteristics of grownup scholars which we have to bear in head in the procedure of learning. Compared to kids and adolescents, grownups have particular demands and demands as scholars. Of class, these are generalisations and there can look some exclusions in each group of scholars.2. Learner DifferencesAll pupils have different rational abilities. They think and learn otherwise. Learner differences are related to different thought manners and larning manners of pupils. Some of them use more than one manner, but by and large each individual has a preferable manner. We can separate brooding minds, originative minds, practical minds and conceptual minds. Brooding minds perceive new information subjectively, associate it to past experience and analyze their feelings about larning. On the contrary, originative minds like to play with new information, really frequently ask â€Å" why? † and make their ain solutions. Practical minds need factual information and attempt to happen the simplest and besides efficient manner to make something. In other words, they want to use their new accomplishments to their occupation. The last group consists of conceptual minds who are interested in how things work, non merely in the concluding result. They like seeing images and want to cognize the related constructs.[ 2 ] Equally of import are larning manners. Students normally tend to one acquisition manner because they associate it with larning success. There are three general larning manners: ocular, audile, and kinesthetic. Ocular scholars process new information when they can see it. They like artworks, illustrations, diagrams, images and presentations. Their slogan is â€Å" Show me. â€Å" Auditory scholars rely on sounds and voices ; they remember new information when it is spoken. They love talks and treatments. Their slogan is â€Å" Tell me. † Kinesthetic scholars need to make something to understand it. They want to touch the new information or manipulate it. They prefer written assignments, taking notes and scrutiny of objects. Their slogan is â€Å" Let me make it. †3. Motivation for Adult LearningMotivation is some sort of internal thrust which pushes person to make things in order to accomplish something. A cognitive position of motive includes factors such as the deman d for geographic expedition, activity, stimulation, new cognition and self-importance sweetening. Students come to education for many grounds. All grounds are acceptable because any motive is better than none. Unless you are motivated, you will non and can non larn. Most big pupils are at the schoolroom because they want to be. There are called â€Å" want to † scholars. Some of them are at that place because they need it for their occupation. They are â€Å" have to † scholars. There are a batch of motive factors. Some of the most common are: Promotion- depends on go throughing an test or making a class. Personal promotion – people want to acquire higher position at work. Social relationships – people want to do new friends. Escape/Stimulation – people want to avoid ennui, larning can disrupt the day-to-day modus operandi at place or at work. External outlooks – people try to carry through the outlooks of person with formal authorization. More money – after go throughing a class or successful graduation you can anticipate to gain more money. Social public assistance – attempt to better ability to be good to mankind and take part in community work Cognitive involvement – people who are interested in larning, they want to have new information and seek cognition for its ain interest There are Four Foundational Principles that motivate grownups to larn ( Wlodkowski, 2009 ) : Inclusion is the consciousness of scholars that they are a portion of an environment, they respect each other, and they have no fright of menace or humiliation. It is related to positive societal clime. Inclusion Fosters engagement. Attitude is a combination of constructs, information, and emotions. Attitude consequences in a sensitivity that can take to favorable or unfavorable response. Attitude causes a powerful consequence on human behavior and acquisition because they help people make sense of their universe. ( E.g. Negative larning experience can impact our attitude, engagement and outlooks. ) Meaning – devising, apprehension, and altering significance is a cardinal facet of grownup instruction. Deep significance causes that the experience or thought is connected to an of import end. Meaning comes from disputing larning experience in an piquant format about a relevant subject. Meaning sustains engagement. Competence is an attempt to effectual interaction with the universe. Adults have a strong innate temperament to be competent. They need to use what they have learned to the existent universe. Competence allows a pupil to experience confident when they know that they are expert at what they are larning. Assurance once more supports and motivates more extended acquisition. This can ensue in a spiralling moral force of competency and assurance. Increasing and directing pupil motive is one of a teacherA?s undertakings. We should form the indispensable motivational conditions. If we want to set up inclusion, we need to make a acquisition ambiance in which scholars and instructors feel respected and connected to one another. Following undertaking is to develop attitude, it means making a favorable temperament to larning through personal relevancy and pick. To heighten significance is of import to make ambitious and thoughtful acquisition experiences which include learnersA? positions and values. Furthermore we should breed competency by making an apprehension of scholar effectivity. And how do we cognize if scholars are motivated? There are some discernible indexs of intrinsic motive: Learners do activities without opposition. Learners spontaneously relate acquisition. Learners ask inquiries. Learners go beyond required work. Learners are proud of their acquisition and its effects. Unlike kids and adolescents, grownups have many duties that they must equilibrate. These duties can take to the barriers against take parting in larning. The most common jobs are deficiency of clip, money, assurance, involvement, deficiency of information, programming job and jobs with kid attention and transit. The best manner how to actuate grownup scholars is to heighten their ground for acquisition and diminish the barriers. As instructors of grownups we have to be after actuating schemes which show learners the relationship between preparation and an expected publicity.4. Giving Feedbackâ€Å" The old expression that pattern makes perfect is non true. But it is true to state that it is pattern the consequences of which are known which makes perfect. † ( F.C. Barlett ) Feedback, unfavorable judgment, praising and noticing are really of import in the instruction procedure. Teaching grownups is complicated because of the trouble of knocking. There are two unsafe: giving feedback in the incorrect manner and non giving plenty. Without proper feedback the learner public presentation can non better. If public presentation can non better, all scholars rapidly loose their involvement. Good feedback is one of the basic wagess of acquisition and critical portion of the learning rhythm goes like this: In comparing with kids and teens, grownups find it harder to acknowledge that they have made a error, and it is harder for them to unlearn it. The same error can be repeated once more hence is of import to give feedback instantly or every bit shortly as possible. The job is non merely to rectify mistakes made on the topographic point, but to happen out some basic misinterpretations from the yesteryear, e.g. when we teach grammar, pupils sometimes have no thought what parts of address are. Until all the misinterpretation from the yesteryear are identified, no advancement can be made. A batch of pupils seem it hard to larn the regulations of English spelling decently. It can be a combination of mechanical and psychological grounds. It is peculiarly difficult to rectify once more perennial errors. The solution how to avoid it is bar ; it means make certain that on first juncture of a new piece of larning the grownup gets the right reply – â€Å" right first clip † .[ 3 ] It is frequently said that people learn by doing errors. It is true but we should recognize when measuring that prise make us experience confident, whereas negative unfavorable judgment makes us self-doubting. Good feedback is given quickly, contains encouraging words, gives elaborate remark on each public presentation, praises the good points before knocking the bed, is focused on knocking the public presentation, non the individual, is concentrated on merely a few errors at a clip and is clear. Giving feedback demands accomplishments every bit good as tact. We should make a friendly ambiance for constructive feedback. After giving feedback, we should look into that the scholar has understood the message by inquiring open-ended inquiries. Avoid closed ( yes, no ) inquiries, e.g. Have you understood? It is better to get down inquiries with â€Å" State me † , â€Å" How † , or â€Å" Why † . Finally, a batch of instructors overestimate the measure of feedback they give. To avoid it, seek to happen ways to offer every scholar some feedback in every lesson. As instructors of grownups we should understate the bed consequence of unfavorable judgment although there are a batch of possibilities for misinterpretation because without feedback pupils can non larn and instructors do non learn.5. Function of the Teacherâ€Å" When the pupil is ready, the instructor appears † ( a Buddhist adage ) As we said in one of old chapter, a batch of big pupils can experience dying when they go back to school after a few old ages being out of the schoolroom. Our occupation as a instructor of grownup pupils is to be positive, friendly and encouraging. Patients help excessively. It is sometimes of import to cognize that older pupils need more clip to react if we ask a inquiry. Promote your pupils to utilize their ain life experience in the acquisition procedure excessively. As instructor we should understate the carnival of failure and the bad consequence of past acquisition experiences by offering activities which are accomplishable for our pupils and correspond to their degree. Not merely pupils can hold some concerns. There can be a job for some instructors and it is age. School instructors are ever older than their students and have the advantages of longer instruction. Not so instructors of grownups. They can be younger than their pupils and may even be less intelligent. It is right to hold some concerns about a new group of pupils, but both the job and the solution are in our ain custodies. What makes a good instructor? Effective instructor have these features ( Rogers, 1989 ) : A warm personality – accept all pupils and understand them, be helpful Social skill – ability to link the group together without being dominate Forming ability – disposal is swimmingly handled Skill in descrying and deciding scholar jobs Enthusiasm – a batch of oculus contact, varied voice inflection. Not merely can the personality of a instructor but the leading manner lead to the success or failure of larning. We can separate three different types of leading: dictator, where the leader is rigorous, autocratic, encourages fight and makes all of import determinations himself ; laissez-faire, where the instructor does virtually nil unless he is straight asked a inquiry ; and democratic, where the scholars decide what they will make and the instructor is person who can impact single solutions of jobs. In the group where the instructor behaves magisterially the scholars are submissive and good behaved, but frequently mishear instructions, are competitory, reciprocally belittling and demo marks of aggression and tend to abandon work when the instructor leaves the room. On the contrary, the individualistic group does about nil whether or non the instructor is present. Under democratic leading the scholars work good together without carnival of one surpassing the other. There occur smal l tenseness or aggression and the impermanent absence of the instructor make no alterations in the sum of work the scholars do.[ 4 ] It is clear that creativeness is more bucked up in groups where the instructor does non rule. There can develop pleasant societal relationships, more pupils talk to one another and esteem each other. On the other manus, dominant, aloof, autocratic instructors tend to bring forth either really hostile or subdued group of scholars who are individualists and do non desire to co-operate.6. Teaching SchemesAny activity that gets pupils involved is really utile and makes the learning experimental. This includes e.g. little group treatments, function drama, composing or pulling something specific, skits etc. Activities that involve acquiring up and traveling approximately can besides maintain pupils energized. Try to utilize a assortment of learning stuffs and methods and do non bury single differences of your pupils ( differences in manner, clip, types and gait of larning ) . It is known that single differences addition with age. Take into history that your pupils have a batch of life expe rience which they can convey to the schoolroom, supply them every bit much chances for duologue as possible and ask open-ended inquiries so that they can utilize their cognition and experience. Treat all inquiries and remarks with regard. State your pupils the outlooks of the instruction procedure and familiarise them with the course of study, but do non be disappointed when they do non wholly agree with your program. You can discourse it together and do some alterations in conformity with the demands of your pupils. They can assist you to plan the acquisition procedure. Because grownup pupils are jobs centred, allow them cognize how the freshly acquired cognition can be applied to current jobs or state of affairss. As a instructor you should equilibrate between presentation of new stuff, treatment and engagement among pupils and your class program. Teaching schemes for grownups are more effectual if it is learner-centred than instructor-centred.[ 5 ] By utilizing combinations of grownup scholar techniques and schemes, Extension pedagogues can make preparation experiences that will heighten the acquisition of participants. When grownups participate in a positive acquisition experience, they are more likely to retain what they have learned and use it in their work environment.6.1. Lectures and PresentationsLectures and presentations are the most common instruction methods in big instruction. They are sometimes referred to as an economic manner of learning because they do non necessitate about any technician or administrative support. As a instructor usage these methods exhaustively. First, maintain them short. Lectures should take 15 or 20 proceedingss and bound for presentation is even shorter, five proceedingss. Second, your talk should hold a clear beginning, center and terminal ; it means that it is clear to your pupils and if it is clear defined, it can assist pupils to cognize what the aims are before get downing. This techni ques has o batch of possibilities how to be used. You can present short intensive presentation which is followed by practising. You can instantly see if your pupils understood your talk. Adults learn best through engagement and activity, so your talk or presentation can be interspersed with group treatment, single undertakings, and audio-visual stuff. In the talks or presentations try to maintain to simple chief points. A batch of grownup pupils need to hold a written support of a new piece of larning but it is known that grownups do non take notes really frequently. Making notes during presentation can be a recreation from understanding therefore it is better to teach your pupils non to compose merely listen to you. Fix well-designed printed press releases for them, non really long because it could deter your pupils from reading it. It is better to administer press releases after a talk than earlier ; it is less deflecting. If you are showing, be certain that all scholars are able to see from your point of position. If the presentations are seen from the forepart, the pupil must mentally change by reversal all the procedures. In general, talks and presentations are likely best used in short subdivisions, with frequent resort to treatment, single pattern, undertaking work etc.6.2. Role – drama, Simulation and GamesSimulation, role- drama and games play similar functions in linguistic communication instruction. They are seen as ways of bridging the spread between the schoolroom and the existent word. These activities offer a assortment of ways how to do the acquisition procedure more interesting, disputing and lively. As we said in earlier chapters, grownups need to avoid being told how to make something, they need to seek it out for themselves. Role-playing refers to the changing of one ‘s behavior to presume a function. It is any speech production activity when you either set yourself into person else ‘s places ( The President, a millionaire, a dad star etc. ) , or when you stay in your ain places but set yourself into an fanciful state of affairs ( ‘At the eating house ‘ , ‘Checking in at the airdrome ‘ etc. ) Role-playing is proposed as an ideal technique to learn linguistic communication because it prepares scholars for the unpredictable nature of real-life communicating, Teachs appropriate linguistic communication usage, and boosts assurance. Learning takes topographic point when activities are prosecuting and memorable. It is ever better to convey state of affairss to life and maintain them existent and relevant. We should utilize the role-play for the undermentioned grounds ( Harmer, 1989 ) : It ‘s merriment and motivation. Quieter pupils get the opportunity to show themselves in a more blunt manner. The universe of the schoolroom is broadened to include the outside universe – therefore offering a much wider scope of linguistic communication chances. Some function playing is simple and does non necessitate any particular readying. It is a normal extension of work done rehearsing duologues and drills ; on the other manus, function drama can be prepared in advanced when the instructor sets up the scene. The stuff must be relevant, brief and believable. Once you have selected a suited function drama, predict the linguistic communication needed for it. It is recommended to present any new vocabulary before the function drama. After the function drama is finished, pass some clip on debriefing. This does non intend indicating out and rectifying errors. It is the procedure of debriefing which helps do the acquisition points. After the function drama, the pupils are satisfied with themselves ; they feel that they have used their cognition of the linguistic communication for something utile. This feeling of satisfaction will vanish if every error is analyzed. It might besides do the pupils less confident and less willing to make the other function dramas. Ask your pupils sentiment about the role-play, e.g. : What did you believe of the manner you handled X? How did it compare with the manner you deal with this in existent life? The purpose is to discourse what has happened in the function and what they have learned. Finally, do non bury to thank and praise the participants for their attempts. Example of function drama: We can play the picture where the characters are making something. The pupils watch it and so can reiterate some duologues. Then the instructor divides pupils into groups and they play the characters from the film dawdler, but extend the duologues harmonizing to their ain phantasy. After rectification and treatment they play the same scene once more. Simulation is defined as a world of map in a fake and structured environment. A simulation has three features: A world of map which means the participants in a simulation must step inside the function they have accepted and act consequently. A fake environment where there is no contact with the existent universe. A structured environment where the participants have all the facts and information provided for them.[ 6 ] Simulations have been used in many countries of preparation and instruction, such as the ground forces or in concern surveies. But in whatever country, linguistic communication is the tool used for communicating and Jones claim that simulation and linguistic communication are â€Å" virtually inseparable † . Simulation in ELT motivates scholars because simulation activities give them a opportunity to be involved in linguistic communication usage. It allows everyone to take part and even when errors are made, the instructor does non interfere. It gives chance for meaningful pattern of linguistic communication because most simulations involve interaction, either verbal or non-verbal, in spoken or written signifier. Well – planned simulations that are relevant to the scholars will surely promote earners to desire to finish the undertakings. The realistic ambiance in simulation is achieved through the careful readying of the stimulus stuff. Students take functions where the y behave as people in a wider assortment state of affairss which are close to existent life. Simulation encourages creativeness although it begins with information given to scholars. They need to be clever to bring forth the thought and to finish the simulation. Example of simulation: Title: To do a command 5 participants ( each pupil is given a function card with some information about a function and with counsel what to make: Finance Manager, Factory Manager, Gross saless Manager, Office Manager, and Director ) Situation: The company is doing available RM 10A 000 for upgrading merely one of the four sections. Each section is under the leading of a director ( as in the above ) . Each section is allowed to do a command for the amount of money saying the ground the money is needed. The Director will so make up one's mind the successful bidder. Language maps: Explaining, justifying, supporting, opposing. Time: 1 hr lesson Students are divided in groups of 5. At the terminal of the lesson, the Director studies on the determination for each group.GamesNot merely do many grownups enjoy games, but linguistic communication games really accelerate larning in a figure of ways. It is perfectly critical that big pupils know why they are utilizing a peculiar game, what specific mark grammar or vocabulary are they rehearsing, or what accomplishment are they reenforcing by utilizing the game. If pupils know and understand why they are making a peculiar activity they will be much more inclined to collaborate and bask the acquisition. Learning through merriment activities relaxes pupils and makes the schoolroom atmosphere much more supportive for scholars. Using adequate assortment in the type of activity or game will convey all four acquisition manners into drama: auditory, ocular and kinesthetic. Using games allows your pupils to acquire the most out of lesson clip, by passing it talking English. There are some links where you can happen a batch of games for grownup English scholars: www.teachingenglishgames.com www.ELTgames.com The of import advantage of all above mentioned activities is that they are wholly active methods of larning. Another benefit is that their existent value is frequently in the societal accomplishments they teach.6.3. Undertaking Workâ€Å" State me and I forget. Show me and I remember. Involve me and I understand † ( Chinese adage ) Undertaking work is a agency of communicating and enjoyment based on the combination of theory and pattern. A undertaking is an drawn-out piece of work on a peculiar subject where the content and the presentation are determined chiefly by the scholars. Students work in groups to work out disputing jobs that are reliable and frequently interdisciplinary. Learners decide how to near a job and what activities to prosecute. It can be used at every degree from absolute novice to progress. There can be involved all scholars mixed in ability, assurance and experience. The undertakings are really originative. The writers of the undertakings gather information from a assortment of beginnings and synthesise, analyze, and derive cognition from it and so set all the parts together to organize a consistent presentation. It is based on studentsA? demands and involvements. The instructor ‘s function is to steer and rede, instead than to direct and pull off pupil work. How to get down? Teach your pupils how to make undertaking work. Get down with concrete, small-scale activities. Decide the presentation signifier and the standards for its rating. Undertakings need to be seen or read so be after the last undertaking session as a presentation. Types of undertakings: Production undertaking Performance undertaking Collection undertakings Informational undertakings Orientation undertakings Social public assistance undertakings. Each undertaking needs to be evaluated. You can utilize a simple undertaking rating study, which remarks on facets of the undertaking such as content, design, linguistic communication work and besides evaluates the unwritten presentation phase of the undertaking. It can be discussed with all pupils from the category or group. Advantages of undertaking work are: It increases motive because all scholars are personally involved All four accomplishments – reading, composing, listening and talking are integrated Learning outcome – pupils have an concluding merchandise Undertaking is an reliable undertaking and therefore the linguistic communication input is more reliable There are developed interpersonal dealingss through working in a group It is learner centred – contend and methodological analysis can be decided between the scholars and the instructor A interruption from everyday.[ 7 ]6.4. DiscussionDiscussion is the prototypic learning method for active acquisition because it encourages pupils to detect solutions and develop critical thought abilities. . Discussion allows scholars to be active and experience personal contact. During treatment all participants speak to each other, explore, exchange positions, and larn from each other, pupils from instructor, instructor from pupils. Discussion is a state of affairs where pupils and instructor can and make do an unfastened, equal and personal response to a book, current societal job, manner, movies, political relations etc. which needs reading to take it beyond a factual statement. In a good treatment most members of the group experience willing able to talk when appropriate. Even in group where everybody contributes, there will be people who talk more than others. Dominant members of groups are frequently able and energetic people, whose enterprise can be used for other group membe rs, either in the thoughts they contribute to general treatment, or in some particular assignments, excess research or short talks they can set about. Silent member or people who speak seldom in a treatment can be soundless as a manner of demoing disapproval of what the remainder of group are stating or they can be diffident, diffident or lazy or because they prefer to listen to other people instead than to speak themselves. Problems of over-dominant and excessively soundless pupils can be solved by dividing the group into smaller groups for some portion of the category clip. Peoples who ne'er speak in the big group can state a batch in the smaller 1. Before treatment you can promote your pupil to fix for it. They can believe about a subject, read some stuffs and write notes and remarks. It is normal that for the first twosome of proceedingss the treatment is slow and hard to pull off, but if your pupils are prepared for it and you create a friendly atmosphere it can shortly warm up. If your purpose is a treatment which involves everyone, it is of import to run chairs in a circle, as that is the lone manner people can see or turn to each other easy than in sitting lecture- manner in consecutive lines.[ 8 ]DecisionIn decision, learning grownups should be different from learning kids and striplings. As we said, instructors of grownups should utilize a different manner of learning which is based on the theory of andragogy which suggest that grownups expect learner – centred scenes where they can find their ain ends and form their acquisition harmonizing to their present life demands. The learning techniques should be chosen wi th respect to demands of all scholars. We should see what attack and methods seem to be appropriate for our pupils. We have to esteem our pupils different larning manners, we should promote them, actuate them and give them a proper feedback. When our pupils know that the instruction procedure benefits them pragmatically, they will execute better, and the benefits will be longer enduring. Good instructors of grownups take all of these factors into history. Beyond learning your topic, you have the chance to animate assurance and passion in another human being. This is your challenge as a instructor of grownups.