Outline and Evaluate Biological Therapies as Treatments of Depression

Outline and evaluate biological therapies as treatments of depression.There many forms of treatment to cure depression, many of which are biological. These target the physical and chemical side of the body.Anti-depressants and other drugs are the most common forms of treating depression. They work by boosting levels of insufficient neurotransmitters such as serotonin and nor-adrenaline. They will either reduce the amount of re-absorption or block the enzyme that is trying to break down neurotransmitters. Allowing to increase the amount of neurotransmitter available , so that neighbouring cells become excited.Tricyclics are used to block the transporter mechanism that re-absorbs both serotonin and nor-adrenaline into the pre-synaptic cell after it has fired. As a result to this there are more neurotransmitters left in the synapse making the transmission of the next impulse easier.The treatment of depression has three phases which it is to go through, the first being acute in which the treatment of current symptoms takes place. Then it goes into the continuation phase in which the treatment is continued for six months where the medication is gradually withdrawn to prevent relapse. Lastly the maintenance phase which is recommended for individuals who have a reccurent depressive episode.One of the most common anti-depressant drugs used are Selective Serotonin Re-uptake Inhibitors (SSRI's), these are associated with serotonin which have been found to be involved in depression. The SSRI's will work by stopping the nerve cells from re-absorbing serotonin that has been released into the synapse, which in turn will increase the amount of serotonin available.However SSRI anti-depressants may not be able to treat all forms of depression. Kirsch et al (2008) found that only in the most severe cases of depression there was a significant advantage of using the SSRI. Therefore showing that anti-depressants may not be able to help those with mild or moderate depression.Another type of anti-depressants are mono amine oxidise inhibitors (MAOIs) that work with nor-adrenaline in the synapses. These block the enzyme mono amine oxidise from taking apart noradrenaline, and thus increase the amount of noradrenaline that is available at the synapse. Low levels of noradrenaline in certain areas of the brain has been linked with depression, and so MAOIs are an effective antidepressant.Nonetheless in the case of children and adolescents anti-depressants may fail to work altogether. Hammen (1997) found that anti-depressants appeared to be less useful with children and adolescents than with adults. This could be due to the fact that there are varied developmental differences in their brain neurochemistry and thus equaling to children not being as effected by the anti-depressants. Which may mean that other forms of treatment may need to be considered when treating a depressed child but could and but could also question the overall effectiveness of anti-depressants.Ther e are also safety concerns to do with SSRI's such as an increased use of them may lead to an increase in suicidal thoughts within vulnerable people. Ferguson er al (2005) did a review of studies that found that those in a SSRI condition compared to a placebo condition, are twice as more likely to attempt suicide.This risk however has been found higher amoung adolescents than adults. Suggesting that anti-depressants may in fact be more harmful than beneficial to a depressive individual.Another issue with the treatment of depression is that there may be a misdiagnosis in treatment due to age. Benek-Higgins et al (2008) found that because of the symptoms of depression are masked over by the natural changes in the elderly and their lifestyles. Therefore anti-depressant medication is less likely to be prescribed to them, which may lead to depression in the elderly not being treated at all.It has been found to be harder to treat the elderly also, this is because they are less likely to se ek professional help as they feel that there is a social stigma attached to being â€Å"mentally ill† and do not wish to lose their independence if they are diagnosed. This equals to them not being diagnosed and in turn equalling to them not being treated of their depression.However using a placebo during an experimental treatment may be an ethical issue. As lying to a depressed individual, that they are taking medication to make them better could psychologically make them worse upon learning that they have been lied to. Therefore a thorough debriefing and regular follow-ups will be needed for the individuals.There is also the risk of a publication bias, Turner et al (2008) found as authors have suggested that there is selective publication made to emphasise the positive outcomes of anti-depressant treatments. Drug companies may try to present their drugs as positive even if they aren't. Therefore biased conclusion may lead to inappropriate treatment decisions.Many therapies such as drug therapy are conducted regularly to treat depression but there is no answer on how to measure the effectiveness of them. As how are we meant to know when the patient has been â€Å"cured†, as there is no particular destination that one is trying to get towards. So there is no particular time to measure the effectiveness, whether that be during the therapy or 6 or so months after. Therefore the use of drugs etc may not be as effective as we think, because they do not lead us to a clear cure.Electroconclusive therapy (ECT) involves applying electrodes to a patient's head and passing an electric current through their brain. This will then cause a seizure to occur for a few seconds, but it is not clear as to why ECT works and how. Oxygen is given to the patient during the treatment to compensate for their inability to breathe, and the treatment will be given to the patient three times per week depending on the severity of their depression.It is used in the most severe cases, where a patient is at danger of harming themselves or is extremely suicidal, and anti-depressants and therapy are not having any effect on the the patient. The seizure from the ECT is said to regulate the mood of the patients, which will decrease their depressive episode.Yet there are many side effects to the use of ECT, for example when ECT was first introduced it resulted in injuries such as broken bones, however due to the modern change in treatment and the use of muscle relaxants and the therapy being taken place under anesthetic has decreased the likelihood of injuries. Although memory loss is very likely to follow prior to ECT, it isn't said how long the memory loss may last. Although ECT has been found to be effective to those who have depression the negatives may outweigh the positives to some extent.There is much evidence that supports the effectiveness of ECT, for example Gregory et al (1985) found that in comparison to sham ECT , which is when the patient is not a naesthetised during ECT, have been found to have a significant difference in outcome in favour of the real ECT. Therefore showing that within ECT itself it may be very effective for people with depression.In contrast to anti-depressants, ECT have been shown to be more efficient that anti-depressants, Scott (2004) found that in the short term treatment ECT was better than drug therapy. Which again supports the effectiveness of ECT and how it should be used more often.One way of minimising the cognitive problems that are associated with ECT, which is to use unilateral ECT, where the electrodes are placed only on one side of the skull, rather than the bilateral ECT where the electrodes are placed on both sides of the skull. Studies found that the unilateral is less likely to cause cognitive problems than the bilateral. This shows that to use unilateral ECT would be much more effective than bilateral ECT, and could cause less side effects.A concern with ECT is the consent of the patient s receiving the treatment, the DOH report (1999) found that 59% of 700 patients whom had received ECT admitted to not giving consent to treatment. Even when the patients volunteer to reicieving the treatment there was still an issue with fully informed consent about the side effects. Therefore ECT may not be given to all patients with fully informed consent and could be seen as ethically incorrect.

Managing your professional performance Essay

1.0 INTRODUCTION Personal development planning (PDP) is a process undertaken by an individual to reflect upon their own development in a purposeful way through learning and experience. (Jackson, 2001) Everyone has desires and aspirations in life. To go about achieving goals and success in one’s life, it is vital to jump start and implement a very own personal and professional development plan. Every individual will have their own interpretation of personal development. For me, it is a lifelong personal growth and learning progress not only in building on self awareness and enhancing on skills and professions but also to achieve spiritual growth. 2.0 ANALYSE PERCEIVED DEVELOPMENT NEEDS AT THE BEGINNING OF THE MODULE 2.1 Personal Vision and Mission Vision Statement: â€Å"To become an effective and respected General Manager in the hospitality industry; helping to enhance the performance and continuous improvement within the business and extending excellence service to the customers.† Mission Statement: â€Å"I will strive hard to work my way up the ladder with continuous learning and development of knowledge, skills and experiences and at the same time, maintaining good work ethics and relationships with people around me.† MANAGING YOUR PROFESSIONAL PERFORMANCE Philosophy: I always believe that if one does not have the passion towards something, one won’t achieve success in it. We may be inspired to do something, but to be successful in what we are doing requires great effort and determination. Just like the saying from Thomas Alva Edison (1929 cited in Sommers 2012, p184) – â€Å"Genius is 1% inspiration and 99% perspiration†. If no effort is put in, there’s just no way that we can achieve success in life. 2.2 Status When I have chosen hospitality as my career, I knew it is a field that differs from the others which it requires not only basic hospitality knowledge and skills but also industry experience. Therefore, along with my studies I have held several part time positions as a waitress, promoter, sale executive and even a part time tuition teacher to gain career-related experience. As soon as I completed my diploma studies, I undergo my industrial training and continue on as a full time employee working as a guest experience executive with Le Meridien Hotel before I further my degree in order to gain broader knowledge and real-world experiences. Throughout these years so much has happened. Everyday I’m facing with new challenges and obstacles in work, with many ups and downs. I have learned to be patient; looking at things from different perspective and creatively dealing with different types of human being. All these working experiences have developed me a sense of competence and build up my self-esteem. Also, I’m more aware of the attitudes, skills and experiences that required for further career development and seizing the opportunity to gain insight and learn more about myself. MANAGING YOUR PROFESSIONAL PERFORMANCE 2.3 Self Assessment I have made an assessment of my own personality and capabilities in certain key skill areas in order to anlayse my strengths and weaknesses as well as to review on the gaps that I could further enhance for my long-term career prospects. (a) Personality Personality test is vital in helping me to understand my inner self and review on areas that could be improved for better self development to achieve future career success. I have taken the big five personality tests which could review on my level of sociability, friendliness, work ethic, calmness and creativity. (Please refer to appendix 1 – The Big Five Model of Personality) The result indicated that I am a person who is well organised, relatively social and tends to consider the feelings of others. However, weak in handling emotions and tend to be conventional. (b) Career Motivation According to Robbins (2001 cited in Tan and Amna 2011, pp73-94), motivation is a needs-satisfying process, which means individuals will strive to achieve goals when their needs are satisfied by certain factors. It is highly important for me to understand my career motivation in order to achieve a more fulfilling and productive career. And based on the career motivation test that I have taken, I realized for me to ensure a long term job satisfaction; my career motivational needs are recognition and long-term reward. (Please see appendix 2 – Career Motivation Test) This enables me to reflect and decide on the type of organisation My ex-manager exercises a range of leadership approaches as shown in the table above and deploys them appropriately according to different situations. Instead of practicing only one or few of the leadership approaches, her way of leading and levels of control towards the team is moving along the continuum which from being an autocratic leader to a democratic leader. MANAGING YOUR PROFESSIONAL PERFORMANCE 3.1.4 Different Styles and Different Stages When I first joined in the organisation, I was really not used to her way of managing as I was being ordered and instructed on things to do without having the freedom to do according to my way. Whenever I questioned on the task that I was performing, her reply is always the same – â€Å"Just follow and do whatever I told you, soon you will understand why.† Until a period where I saw other teams were doing the same tasks as mine but different way of performing; and they ended up screwing up the tasks made me realized her intention was to train me on the right way of doing things. After gaining some period of working experience, she presented a list of suggestions and solutions; and allowed me decide on my own based on my analysis and past experience. And as soon as she had faith on me and the team and having confidence in our abilities, she allowed us to develop ideas and decide on action to be taken. As in overall, when the team is immature or new, she will practice the styles more towards to the left-hand side of the spectrum. By contrast, when the team is skilled and motivated, she will practice the styles that are more towards to the right-hand side of the spectrum. Her shifting in leadership styles from being autocratic to democratic at different stages has inspired me and made me understand that a great leadership is not necessary to be consistent with the forms of leadership, but being able to apply the right style at the right situation. ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE and influence followers’ perceptions, and eventually smooth the path in achieving common goals. 3.1.6 Conclusion I truly believe that there is no one â€Å"best† style of leadership. Different leaders will have their own interpretation of what is called a good leader and with different approaches to leadership. To me, to be a good leader, first is to become a good follower, which I truly agree with the saying from Mark Wagner (2010) – â€Å"Great Followers make the Best Leaders†. In my opinion, a great leader needs to be developed through experience and learning; learned from observation, listening, hearing and doing. A leader may be is naturally born, but a great leader is definitely made. Page 21 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE 3.2 COMMUNICATION (Activity 4) Communication is a simple yet complex activity in which can be defined as a twoway process of reaching mutual understanding through verbal or nonverbal means. (Business Dictionary, n.d.) It is an important facet of life which plays a vital role not only in personal interactions but also in business communication. 3.2.1 Importance of Effective Communication In the daily personal interactions, effective communication could help oneself to deliver the information along and get the desired respond or need. It could also help to build up good relationships with the people around through better understanding and avoiding from arguments and misunderstandings. Effective communication could also build up individual’s’ self-esteem as they are able to present themselves well and express their thoughts and feelings. Effective communication is also a key to success for every organisation, leader, manager, and employee. It is vital for an organisation to build or strengthen the relations with internal and external stakeholders and ultimately, achieving business goals and missions. Following table highlights the importance of effective communication in business: Consideration Understands human nature Emphasize positive pleasant facts, visualizing reader or listener’s problems, desires, emotions and responses. ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE Courtesy Strengthen relations Not only thinks about receiver but also valuing his or her feelings. Use polite word and gestures, being appreciative, thoughtful, tactful, showing respect. Source: Managementstudyguide.com, 2012 3.2.3 Reflection Throughout this activity, I found out that it wasn’t easy to get everyone to be in the same level of understanding of the information that I have been delivered. Different people tend to have different interpretation and understanding towards my explanation of the visual ‘poster’. I was struggling in expressing my own thoughts and ideas effectively towards the entire class. Also, I realized the same scenario happened in my previous workplace when I was expressing or explaining something to different people. My words are often misinterpreted or misunderstood; and eventually lead to ineffective job performance. My weakness in delivering message is causing me great difficulty to communicate effectively especially in the workplace. Out of the 7C’s above, I realized I am somehow lack of the 2 C’s – completeness and concreteness. I often simplify my expressed thoughts and ideas without any further explanation and supporting facts. Perhaps this is the issue which leads to the misinterpretations due to having an unclear and ineffective communication. Therefore, it is essential for me to look into how I could craft effective communications and further develop on my communication skills. Page 24 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE 3.2.4 Communication Skills The act of communicating involves verbal and nonverbal components. (Rod and Suzanne, n.d.) Both of these components are interrelated which are vital to deliver clear and concise messages; and receive correct and understand messages sent by the others. Therefore, these two aspects of communication skills should be enhanced as a whole to ensure effective communication. (a) Verbal Verbal communication includes both oral and written communications. (Rod and Suzanne, n.d.) There are numerous verbal communication skills such as speak with confidence, think before you speak, don’t talk too much and so on. And, I found it that there are certain verbal skills that I could enhance and worth mastering based on my communication weaknesses, which are: (i) Learn the art of listening Listening someone effectively enable us to gain valuable information and greater understanding of the others’ point of view. One of the key improvements that I would require is to stay focus or pay attention on the message delivered to gain a deeper understanding of another’s thoughts. Remain clearheaded is also another key area that I need to further enhance by truly listen to someone’s perception and controlling emotions when it comes to sensitive and emotional topic. (ii) Be clear and concise I should avoid wordy expressions and learn to choose my words; state out my point of views as clear as possible and as briefly and succinctly as possible. I Page 25 of ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE should train on this daily while communicating with family members, friends, colleagues and relatives; and gain feedbacks from them for better improvement. (b) Nonverbal Nonverbal communication can be described using body languages which involve facial expression, body movement, gestures, eye contact, voice, space and more. (Rod and Suzanne, n.d.) Following are the list of tips that could help me in enhancing my nonverbal communication skills: Always make eye contact while communicating with people. Exhibit appropriate facial expressions and affirmative head nods. Avoid distracting gestures and actions. Be mindful of personal space while communicating. Do not invade personal space by getting too close or confuse communication by being too far away. Source: IILM, 2012, p90 3.2.5 Conclusion Communication is not just a simple daily activity but it comes together with skills and techniques where individuals need to learn and acquire them in order to perform daily tasks and work effectively. To me, it is the most highly valued skill out of all professional skills as it plays a vital role in all aspects of personal and professional lives that would last for a lifetime. (Word Counts: 1436 Words) ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE 4.0 DEVELOP AN ACTION PLAN FOR FUTURE DEVELOPMENT A personal action plan is a detailed schedule of key activities which set by an individual in order to accomplish personal goals. (Carnes, 2010) Based on my vision and mission statements as well as the identified development needs, I have set a list of goals to be achieved into short-medium terms in the next fifteen years; starting from year 2013 till 2027. 4.1 FIVE-YEAR ACTION PLAN Plan period: From 2013 to 2017 (Age 22 to 26) Goals to be achieved: 1. To be a Front Office Manager I have got two years working experience as a guest experience executive in the hotel industry and several part time working experiences in the related fields. My next stage will be looking forward to be a front office supervisor; and then strive hard to work my way up to the next level which is to be a front office manager within these five years. 2. To travel every year Ever since I finished primary school, I have not been to anywhere out of the country, as I am committed to my study and work. And to be frank, I can’t really remember when is the last time I traveled, most probably is when I was in the age of 12. I want to turn this around; and I want to go on vacation or travel abroad every year to gain a different perspective of the world. Lifetime ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE ï‚ · From industry expertise, managers, supervisors and colleagues through sharing of industry knowledge and experiences. Personal Observations and Experiences ï‚ · The daily working experiences also known as the firsthand experiences enable me to gain awareness and up-todate hospitality-related service and knowledge. Year 1 – 2013 (Age 22) Basically my plan in 2013 is to return to my previous workplace right after I finished my degree course in between April to May. I have been offered a position by my ex-manager, working as a guest experience supervisor or called it as a front office supervisor starting in June. Throughout the whole year, I have planned to take different training programmes or courses to overcome my weaknesses, enhance my professional skills, gain additional knowledge, build up self esteem and develop self competencies. The examples of training programmes include the â€Å"360-Degree Leadership Skills† training course, â€Å"Creativity, Critical Thinking, Problem Solving and Decision Making† training course, and â€Å"Personal and Professional Effectiveness† training workshop. Also, I am seeking for work-life balance, and I will plan for at least an oversea trip probably in the year-end; which it is also one of my personal goals.ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE Year 2 to 5 – 2014 – 2017 (Age 23 to 26 ) These four years are going to be hectic years as I will be striving hard to work my way up to the next position level. I will apply for Starwood Leadership Development Programme which is a hands-on-three-year training programme to prepare myself to be a future leader; enhancing every aspect of my personal and professional skills, knowledge and experiences. From time to time, I will also keep myself up-to-date of the hospitality or related industry knowledge through a wide variety of resources as listed in the action plan. I will also constantly look up for courses or training programmes to help me to further improving my professional skills and knowledge. And hopefully by 2017, I could achieve my first career goal which is to be a front office manager; utilizing my skills, knowledge and experiences gained to help the organisation in enhancing the performance and continuous improvement within the business. Page 31 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE 4.2 TEN-YEAR ACTION PLAN Plan Period: From 2018 to 2027 (Age 27-36) Goals to be achieved: 1. To be a Director of Rooms Division (By Year 2022, Age 31) My next goal to be achieved after being a Front Office Manager is to be a Director of Rooms Division after five years. I planned to apply for cross training or internal transfer programme to the housekeeping department for at least two years to learn and get more exposure about the overall rooms operation. 2. To be a Hotel Manager (By Year 2027, 36) My next goal to be achieved after being a Director of Rooms Division is to be a Hotel Manager after five years; before moving forward to the next position level which is the General Manager. I planned to gain experience and exposure to all hotel departments and different functions to gain more in-depth knowledge and integrated experience of how the entire hotel operates. 3. To get a Master’s Degree (By Year 2019, Age 28) Also, one of my ten-year goals is to earn a Master’s Degree on a part-time basis to acquire broader knowledge and skills to keep myself a competitive edge over the others. Keeping me on the edge of developments with constant professional skills improvement and keeping industry knowledge up to date is also one of my life time plans. Personal Observations and Experiences The daily working experiences also known as the firsthand experiences enable me to gain awareness and up-todate hospitality-related service and knowledge. Cross Training Programme – Housekeeping Department ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE Year 1 to 5 – 2018 – 2022 (Age 27 to 31) Basically my plan after achieving my first career goal is to get a Master’s Degree major in hospitality management on a part-time basis over two years duration. This enables me to stay competitive in the industry as there is a growing in demand for higher education qualifications in the hospitality industry especially for the higher level positions. Also, I will participate in certain soft skills training programmes or courses to further improve and enrich myself such as stress management and emotional intelligence training workshops. Constantly updating the industry knowledge through a variety of sources is also one of my to-do-lists to keep myself stay alert about the industry changes, spot threats and opportunities early on, and make better business decisions. After planning to work for two years as a front office manager, I plan to get myself involved in cross training programme in housekeeping department to gain integrated experience and knowledge on how the entire room division operates. This can be an important stepping stone for me to move onto the next career level. Besides, I will also take up the Certified Professional Coach (CPC) Programme to enhance my mentoring and coaching skills to elevate myself to become a better leader. This programme not only able to help me to become better coaches in my own professional and personal lives but at the same time also improving better cross functional interaction and efficiency in the organisation. And expecting by 2022; all the plans, efforts and determination that I have put in could help me in achieving my second career goal in life which is to be a Director of Rooms Division. Page 36 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE Year 6 to 10 – 2023 – 2027 (Age 32 to 36) Gaining integrated experience in all hotel departments through cross training programme is going to be my next plan after being a Director of Rooms Division. This cross training is going to take about three years duration to six different departments with six months each which include food and beverage, security, engineering, sales and marketing, finance and revenue, and human resource departments. This programme is extremely important for me in achieving my next career goal as it enables me to expose, learn and gain an in-depth knowledge and experience on how the entire hotel runs. And expecting by 2027, I could achieve my third career goal in life which is to be a Hotel Manager. Other than just focusing on maximizing my career achievement, I also aim to buy a home latest by 2024 in the age of 33 and build up a happy and healthy family. Not to forget also to ensure a balance of my work life; go on vacation or travel abroad probably in every year-end to relax and gain a different perspective of the world. 4.3 Contingency Plan Reviewing on the action plans regularly is essential to keep track of my progress in achieving my personal and professional goals. However, situations may change at times due to sudden or unexpected circumstances or perhaps desires may change as time goes by. Therefore, adjusting goals and plans are necessary when the situation calls for it. Following are the contingency plans of the five and ten years development plans by identifying the possible breakdowns: Page 37 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE 1. Extension of Timeframe An extension of time is essential when the goals are unable to be achieved within the timeframe perhaps due to unexpected circumstances. For example, my aim to purchase a house by the age of 33 might need to be extended in the case that I am facing financial difficulties at that moment. The cross training programme to all hotel departments might also need to be extended from three years to four years if I can’t gain my desired result and knowledge from all the departments within the targeted timeframe. 2. Seek consultation from industry expertise Seeking advice and consultation from industry expertise such as managers and directors is required if I don’t gain the desired or enough skills and knowledge from the training programmes and workshops. Often the view, opinion, experience and knowledge share by the expertise could help me to gain a better insight into the required skills development. 3. Online Professional Development Taking up online development courses are my backup plan instead of attending training programmes or workshops during the case of having limited time in completing a thousand of tasks in daily life; causing me couldn’t fulfill my development plans within the targeted timeframe. This backup plan would be more flexible and convenient for me especially in a hectic working environment. However, I would still prefer participating in training workshops as I will get the chance to get involved in a variety of activities such as role plays, group Page 38 of 41 ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE dynamics, games and more; which could help me in gaining a better understanding and insight of the professional skills development. 4.4 Future Plan My next career aim after being a Hotel Manager for about five years length of duration is looking forward to become an effective and respected General Manager in the hospitality industry which is also my vision in life. My career development will not just stop at this stage after achieving my vision; but will continue on to set another vision and goals to be accomplished in the rest of my life. I will continue to emphasize on maximizing my career potential and achievement through ongoing development of professional skills, knowledge and experience. Besides taking up different skills training courses and participating in training programmes to further enhance and enrich myself, I will also seek advice from the industry experts to achieve a better result in career achievement. Not to forget also to constantly reviewing and evaluating the action plan and self development; and look for ways to further enhance personal and professional performance. Besides, one of my future plans is also to contribute to the best of my ability towards the community not only on behalf of the organisation but also for my own sake. Example of contributions include participating or working with the local or international charities and adopting green approaches such as choosing more Page 39 of ILP 333 MANAGING YOUR PROFESSIONAL PERFORMANCE environmentally viable alternative power supplies, integrating the consideration of environmental concerns into decision makings, promote environmental awareness, reducing waste through reuse and recycling activities and more. Conclusion To me, personal and professional development is a journey that never ends. It is a lifetime and ongoing process in developing professional skills, knowledge and experience as well as in achieving personal and spiritual growth. I truly believe that personal growth and development is completely within my hands which requires not only strong determination and self discipline but also having a positive, can-do attitude and thought that are vital in driving me to success. And based on my philosophy of success, I will definitely put in great effort and determination in everything I do; strive hard to achieve every single goal that I have set in life. (Word Counts: 1869 Words) (Total Word Counts: 4184 Words) Page 40 of 41

Process Work Essay

Module 1: Contexts: Unit 1: Purposes of the school curriculum |Unit 1 Activity 1: Changing curriculum principles | |I have made appropriate entries in my commonplace book |√ | |Unit 1 Activity 2: The hidden curriculum | |I have made appropriate entries in my commonplace book |√ | | Unit 1 Activity 3: Ivan Illich | |I have made appropriate entries in my commonplace book |√ | |Unit 1 Activity 4: What should the education system aim to achieve? | |I have made appropriate entries in my commonplace book |√ | |To what extent do you agree that ‘schools should be inculcating knowledge relevant to modern society such as the ability to live | |healthily, to manage money and to find fulfilment’ (Bloom, 2008: para 2). In the space below, write a piece for your tutor, in no more | |than 500 words, as a response to this question. | |A school is an institution designed for the teaching of students (or â€Å"pupils†) under the direction of teachers. Curriculum which is the | |frame work of the school has been broadly def ined as all the experiences learners have under the guidance of the school, and all planned | |learning for which the school is responsible Marsh C.J and Willis (http/coefaculty.aldosta.edu/grubbs/ definitions).Curriculum is | |structured to be flexible, and always reflect goals of the nation. | |( It is important to be clear about the correct meaning of terms but these definitions do not focus the reader immediately on the | |required subject.) | |Prof. John white ( White) a professor in the Institute of Education University of London is of ( the) opinion that schools should be | |inculcating knowledge relevant to modern day societal needs like ability to live healthy, manage money and find fulfilment ( new | |sentence?) in his published work â€Å"What schools are for and Why† White(2007).He is also of opinion that the existing curriculum with its | |emphasis on discrete subjects is a relic of the 19th century attitudes to school and he argues that such values no longer apply to the | |21st century. This writing is aimed at showing my extent of agreement with his opinion. | |Health is defined as feeling sound, well, vigorous and physically able to do things that most people ordinarily can do.J.Mirowsky and | |Ross (2003). Research shows that healthy eating can improve childrens’ concentration and help them do better in school says paediatric | |behavioural nutritionist Janice Baronowski from Baylor University in Houston.http://www.livestrong.com/article/192724. It was also | |observed in China that exercise which is part of the daily activities in schools kept the pupils mind and body alert, and helped their | |performance. Since the well-being of an individual including his emotional balance cannot be separated from his ability to succeed in the| |pursuit of his individual and societal interest at large, I agree that schools inculcate knowledge of the ability to live healthily. This| |will include regular exercise and healthy eating. However, some physical exercises done to keep fit could pose a threat to the health of | |some children. | |John white in his published work is also of opinion that money managing skills be taught children. Trilling and hood ( Hood) (2001) | |suggest that we are moving from the industrial age to the knowledge age where knowledge becomes manpower. As the world is growing and | |economic policies changing, I agree that children be taught how to spend and save but any attitude attached to spending is somewhat | |related to the level of income and needs of the individual which is very dynamic. On the other hand, a general principle on spending can | |be taught to guide children as they grow to fit into a larger society. Inculcating values like kindness, trust is also relevant as this | |are values that promote integrity and efficiency in the  way things are done in the society. | |Personal fulfilment however is a broader term to consider. It is encouraged that children learn to discover and live their dreams, but to| |what extent can we measure one’s fulfilment, and how relevant is an individual’s fulfilment ( fulfilment?) to the needs of the society? | |The school curriculum is a reflection of the needs of the society, therefore knowledge to be inculcated in schools should be aimed at | |achieving societal goals, not just individuals finding fufillment in what they do. | |( You are beginning to develop some interesting arguments here. I was interested , especially, in how you related health to effective | |learning and identified the possible contradiction between individual fulfilment and societal needs. You have the potential here to | |take a more critical , and questioning, view of White’s theory although this is not developed. | |You weaken your argument by not keeping a clear focus on the required task as well as through having unnecessary errors in writing. To | |present work at Masters level requires more careful proof reading. ) | |Unit 1 Activity 5: Overall curriculum aims | |I have made appropriate entries in my commonplace book |√ | |I have watched and listened to the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |Unit 1 Activity 6: The purposes of one curriculum subject | |I have made appropriate entries in my commonplace book |√ | |I have posted a contribution to the discussion board |√ | |Please paste the text of your initial discussion board entry below: | |Language study is as important as the essence of language itself which is basically communication.Communication is a necessary tool | |required for human  beings to co-exist, and language is a dominant means of communication.Language is all emcompassing,it ( It) is the | |identity of any tribe and nation at large, ( ?) it is the medium for interaction between teachers and pupils for all subjects,and also | |necessary for internationa l relations. | |English and French are two languages widely spoken in countries all over the world.English is the Lingua Franca of most British colonized| |nations,Nigeria inclusive,among over 250 languages spoken in the country.It is also important to be competent in the use of English as | |the Lingua franca of the nation.Asides effective communication,competence builds confidence which is a necessary quality children should | |imbibe.In Nigeria English is taught as a core subject from nursery to secondary school level,and in the University it is compulsorily | |studied as a general course. | | | |( You present a reasoned case. Again, watch sentence structure and the use of capital letters) | |Unit 1 Activity 7: Education and the knowledge age | |I have made appropriate entries in my commonplace book |√ | |I have read the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | PGCE International – Process work record form Module 1: Contexts: Unit 2: Understanding educational systems |Unit 2 Activity 1: Crossing cultures | |I have made appropriate entries in my commonplace book |√ | |I have watched and listened to the feedback provided at the end of the activity  |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |Unit 2 Activity 2: Key issues in your own educational system | |I have made appropriate entries in my commonplace book |√ | |What might your tutor need to understand about your own educational contexts (both teaching and learning)? In the space below, write an | |analysis, in no more than 500 words, of the main issues which she or he will need to take into consideration when responding to your work| |on this course: | | KEY EDUCATIONAL ISSUES IN MY COUNTRY | |In discussing major issues in the Nigerian Education system where I practice,it is important to note that there is no uniformity of | |standard and practice.While Government schools run with a standard and curriculum,the private schools adopt standards and curriculum in | |line with the vision of their owners so we have the British,Turkish,Lebanese,American and even a blend of more than one curriculum in | |practice by different schools.This disuniformity ( I do not think this is a correct word, though I understand what you are saying. You | |would need to state â€Å"This lack of uniformity†¦Ã¢â‚¬ ) in standard in itsself ( itself?) is a major issue.For this reason the dominant issues | |in the public schools like poor infrastructure,fewer learning and teaching aids, might not be very ( ?) present in the private | |schools. This is as a result of fund mismanagement and poor maintenance of existing facilities in public schools. ( Are you arguing that | |it is the lack of Government standard and curriculum that leads to better facilities and learning in private schools? I am not clear of | |your argument.) | |Poor power supply affects the use of electronic teaching and learning aids such as the interactive white board,computers,etc. and | |facilities that enhance a comfortable learning environment like the air conditioners and fans.Though this is a challenge faced by both | |the public and private schools at large,it is largely overcome by the private schools that use alternative power  supply.This | |however,means extra cost to these schools and is shared by the children as they have to pay higher school fees thus making very good | |quality education expensive and hardly affordable for those below average class. | |Teachers’ welfare in the past was very poor as they were not well renumerated an d in most schools both public and private,they are | |still poorly paid and priced.This has led to a negative approach towards the profession and demotivated people from going into practice.A| |high turnover of teachers also exists in schools as existing teachers leave the profession for more â€Å"promising professions†.Some teachers| |are not motivated enough to give their best to the profession and are most times absent from the classroom as a result of this poor | |treatment especially in government schools. The country is however in the process of improving teachers welfare. | |Educational policies for some time, have not been relatively stable so we have a policy implemented today and discarded tomorrow, for | |instance the 6-3-3-4 system of six years in primary school,three years in a vocational training school for those who can not go further | |to secondary education,three years in senior secondary school and four years in university was changed to a 9-3-4 education system which | |was kicked against by many technocrats in the field.shortly ( start a sentence with a capital letter) after it was changed back to the | |6-3-3-4 system.This instability has greatly challenged the Nigerian Educational system,considering the cost of training teachers to | |reflect policy aims,and cost of adopting and implementing the policies. | |The Multi ethnicity of the country has an effect on the country’s education policies.What may be acceptable as a practice in one state or| |culture might n ot be in another.For instance, in the Northern part of Nigeria, culture places more restriction on the females unlike | |other parts of the country, thereby making it difficult for some policies to be implemented.This is especially as regards curriculum and | |professional practice. | | | |( You raise many interesting issues in this response. You still need to proof read with  greater care and check the clarity of every | |argument.) | | | | | | | |Unit 2 Activity 3: Exploring Teachers TV | |I have watched at least three of the Teachers TV videos and made appropriate notes | |in my commonplace book |√ | |Unit 2 Activity 4: Comparing approaches | |I have made appropriate entries in my commonplace book |√ | |Unit 2 Activity 5: Improving approaches | |I have made appropriate entries in my commonplace book |√ | |I have listened to the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |I have posted a contribution to the discussion board |√ | |Please paste the text of your initial discussion board contribution below: | |I agree that some elements of the practices in the educational system of other countries have been adopted into the Nigerian educational | |system and will like to add that failure of the 6-3-3-4 system is not in its inability to produce competent graduates who can fit into | |the larger society, but in the fact that its aim of six years compulsory primary education accompanied with three years vocational | |training in vocational schools was not fully achieved.This is seen in the existence of fewer vocational schools for science,wood, | |furniture and textile making in the country. | |On mathematics I suppose the difference between the practice in Hungary and  Nigeria lies more in the method employed in teaching the | |subject. Maths teaching in Nigeria is more abstract and most teachers,especially in government schools, use less attractive manipulatives | |in teaching concepts compared to the Hungarian practice.In Nigeria focus seems to be on the cognitive with less emphasis on process which| |i ( I) believe amounts to the reason why at age 8 children can recite multiplication tables to 12. I also observed that students | |performance in the subject in Nigeria seems to be poorer compared to their counterparts in Hungary.In the external examination conducted | |in my secondary school which is owned by the Federal Government in 2005, over 50% failure in maths was recorded. | |Although there is current record of improvement in the subject,I believe if we adopt the Hungarian method of teaching the subject | |practically with more attractive manipulatives especially in early education stage, and organize periodic seminars for teachers | |irrespective of the sector which they belong to on improved strategies for teaching the subject, there will be improved performance in | |mathematics among students in Nigeria. | |( You demonstrate that you have engaged with the materials   on the course and are relating them to your own experience in Nigerian | |schools.) | |Unit 2 Activity 6: Exploring links | |I have made appropriate entries in my commonplace book |√ | |Unit 2 Activity 7: British Council Schools Online | |I have made appropriate entries in my commonplace book |√ | PGCE International – Process work record form Module 1: Contexts: Unit 3: Understanding the classroom |Unit 3 Activity 1: The value of observation | |I have made appropriate entries in my commonplace book |√ | |I have listened to the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |Unit 3 Activity 2: The ethics of classroom observation | |I have made appropriate entries in my commonplace book |√ | |I have read the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |Unit 3 Activity 3: Observing two pupils | |I have made appropriate entries in my commonplace book |√ | |Unit 3 Activity 4: Three further influential factors | |I have made appropriate entries in my commonplace book |√ | |I have read the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback |√ | |Unit 3 Activity 5: Creating a positive classroom ethos | |I have made ap propriate entries in my commonplace book |√ | |Unit 3 Activity 6: Social and emotional aspects of learning | |I have made appropriate entries in my commonplace book |√ | |I have read the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light  of this feedback |√ | |Unit 3 Activity 7: Pupil grouping and the learning environment | |I have made appropriate entries in my commonplace book |√ | |I have posted a contribution to the discussion board |√ | |Please paste the text of your initial discussion board contribution below: | |I will prefer grouping pupils based on mixed ability. This is to enhance exchange of not only ideas, but also to encourage character and | |learning strategy influence between the high and low ability. If learning is to be child centred, then I believe children should be given| |a chance to learn from each other, not only from their teachers. However grouping based on ability will be encouraged in core subjects | |like Mathematics to help those struggling in the subject recieve ( receive) more attention from teachers in their areas of challenge, but| |learning would not be restricted to this setting alone, ( New sentence?) grouping will vary based on topic taught and needs of the | |learner. | |Language classes will be more beneficial if there is mixed ability grouping because Language theorist ( Are you referring to someone | |specific? If so state this.) have proven that Language is better learnt through association especially between the more competent and the| |less competent ones. | |( You present some good arguments here. Do writers like Kutnick raise any other issues that you think are important? Are there | |circumstances in the classroom when you would not use mixed ability grouping but , instead, base grouping on other factors?) | |Unit 3 Activity 8: Multimodal semiotic analysis | |I have made appropriate entries in my commonplace book |√ | |I have watched/listened to the feedback provided at the end of the activity |√ | |I have added to/amended my commonplace book entries in the light of this feedback  |√ | |Unit 3 Activity 9: Classroom observation | |I have made appropriate entries in my commonplace book |√ | |In the light of your classroo m observation, think about any new understandings which you feel that this approach has provided for you. | |Have you been surprised by any of the ways in which meanings can be constructed in classrooms? Write a critical account of multimodal | |semiotic analysis as a methodology. What are its strengths and limitations? | |In the space below, write a summary of your responses to these questions (in no more than 500 words) for your tutor: | |Multimodal semiotics is deriving meaning from different modes employed by the teacher in the classroom. Semiotics refers to meaning of | |all kinds, with sign as its central focus that is meaning derived not only from words spoken, but in other symbols. Modes refer to the | |many means by which meaning is made. Kress et al (2005). Modes described by Kress et al include classroom layout, voice quality, visual | |display, gesture, gaze, movement of teacher. Multi means various or different kinds. Multimodal semiotics as a concept looks at meaning | |not derived from only one mode in the classroom, but from an interaction between different modes, just as how much is said, written and | |read. | |In observing an English lesson on traditional tale for year 2 pupils, I took note of the modes employed by the teacher during the lesson | |which includes voice quality, movement and seating arrangement of the pupils, in the cassroom ( classroom).The teacher started on a calm | |low pitched yet confident tone.This tone created a rather friendly and relaxed environment for the children. As the lesson progressed, | |her tone also rose in a clear progression,without loosing its calmness,or sounding too loud.The key words in the | |lesson;tale,traditional,story,villain,happyending,etc. were stressed as she pronounced them. She was also very audible and spoke with | |such clarity that showed great confidence and captivated the attention of the children. I observed that this tone of confidence, | |influenced the behaviour of the children.She did not have to deal so much with inappropraite  behaviour in the classroom, her voice tone | |simply gave an atmosphere of discipline. | |The pupils all sat in twos on tables arranged in traditional setting of three rows, facing the teacher who was majorly( mainly?) standing| |before them, with her table at the side in front of the classroom. Her table position was such that she could monitor the children from | |all angles without necessarily seating in front of them. Seating arrangement was changed to group seating when a task was given. The | |pupils were asked to use WOW words to describe a picture on the interactive white board and were placed in groups of four on each table, | |facing each other which I observed encouraged participation between all the children in the classroom. After performing the task, the | |pupils went back to their former positions. For another task, pupils sat in twos on different tables to form mnemonics to remember | |spellings of different words. Her movement was however restricted as she scarcely moved around to see what the pupils were doing, but | |only gave instructions vocally. Sh e had someone from each table stand and read out what was on a worksheet. This made the lesson look | |teacher centered. | |The teacher’s restricted movement did not really reflect a participatory class environment but a teacher centred one, contrary to the | |seating arrangement. The tone of the teacher however influenced the lesson style; it was very confident, quite firm and created a | |friendly environment. The rising and falling tone captivated the pupils’ interest and I observed that this made the lesson interesting. | |( You show good understanding of this theory of communication in the classroom and how it can be used to support deeper observation of | |what is taking place. You show good observation and identify many interesting aspects of the lesson. I also found interesting how the | |teacher proved more effective in different parts of the lesson. Well answered.) | | |

Hydrogen as alternative energy Essay Example | Topics and Well Written Essays - 1000 words

Hydrogen as alternative energy - Essay Example Apart from the abundance in the universe, hydrogen gas is in much less quantity in our planet. The reason for this difference is the less density of earth and low weight of hydrogen that aids it in excavating itself away from the earth’s atmosphere. It exists on earth in the form of hydrocarbons and in the water ( 2/3rd ratio of the earth), making H2 the 3rd largest found an element on earth. Hydrogen sources are methane and some bacteria and algae.According to an approximation, each 9/10 atoms in this universe are hydrogen. Hydrogen was discovered by a British fellow, Henry Cavendish in 1766, where he also proved hydrogen to be an integral part of water. Hydrogen combines with nearly every element of the periodic table, existing in nature in the form of sugars, alcohols, acids, fuels, carbonates, phenols, etc. The necessary element for fuel cells is hydrogen. Due its abundance and combinations with nearly every compound, hydrogen can be extracted from any of such compounds an d has the ability to provide as a source of green energy. The reason lies in the manufacturing process of hydrogen and its chemistry that enables green service. Now the question is where we can find hydrogen to run the fuel cells?Fuel cells usually come up with reformers or the hydrogen generators. The ultimate and everlasting solution of the problems lies in solar powered fuel stations. Methane producers and natural gas production can store hydrogen after it is formed as a raw product during extractions.

Medical Intervention with the Disease of Osteoarthritis Essay

Medical Intervention with the Disease of Osteoarthritis - Essay Example Scientific investigations have clarified that the disease of osteoarthritis is common in older people following years of wear-and-tear that thin the cartilage and the bones (Davis 1988). Osteoarthritis can also result from diseases in which there is softening of the bone, like Puget's disease in which the long bones of the body curve like a bow, or osteoporosis with its bowing of the shoulder called "dowager's hump," or other bone degeneration (Hammerman 1989). Other forms of arthritis can also cause a secondary osteoarthritis. Despite what many have been told, osteoarthritis is not an inevitable problem of aging. Those who don't suffer from it may have their heredity and possibly the strength of their immune systems to thank. Medical science is not quite sure of all the factors that come into play in deciding who gets osteoarthritis and who doesn't. As was mentioned, osteoarthritis creates a formation of spurs of bone to form in the locations where the disease is most prevalent, oft en in the back of the neck, spinal column, and knees but in various other locations as well; as the research will continue to point out (Brandt 1988). This ultimately leads to restricted movement due to the destruction of the cartilage and causes inflammation and pain in the areas the disease targets. Arthritis alone is simply medically known as a swellin... d by the inflammation and the breakdown of cartilage around the joints which makes it far more complex than the basic form of arthritis itself (Hammerman 1989). Cartilage is the shock absorbing material between joints. The weight-bearing joints such as the knees, hips, and spine, as well as the hands, are the joints most often affected by osteoarthritis. These joints are under much greater stress because of additional weight and continuous use (lifting, sports, support, and movement). The concern that too much physical activity may lead to osteoarthritis is on the rise also (Davis 1988). Specialists who work with patients who have this disease now claim that too much physical activity can lead to osteoarthritis since "the continuous stress that physical activity places on the joints can result in micro trauma and degeneration of the articular cartilage" (Davis 1988). Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritic conditions, os teoarthritis is the most common, affecting over 15 million people in the United States (Hammerman 1989). Before age 45, osteoarthritis occurs more frequently in males. After age 55 years, it occurs more frequently in females. Most cases of osteoarthritis have no known cause, and are called primary osteoarthritis (Brandt 1988). When the cause of the osteoarthritis is known, the condition is called secondary osteoarthritis. Primary osteoarthritis is mostly related to aging. After prolonged use of joints, the cartilage begins to degenerate by flaking or forming tiny crevasses. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and minimized movement of the

Starbucks External and Internal Environment Essay

Starbucks External and Internal Environment - Essay Example Business of Starbucks is complemented by three operating segments such as International division, United States division and Global Consumer Products division. The study has selected UK in order to analyze critical success factor and resource capability of Starbucks. Impact of external environment on business policy of Starbucks will be measured by using PESTLE and Porter’s Five Force analysis. SWOT, value chain analysis and VRIO framework will be used to understand internal strength of Starbucks. Critical success factor (CSF) analysis will be important part of the study. Starbucks Corporation was established by Jerry Baldwin, Gordon Bowker and Zev Siegl in the year 1971. In the initial years Starbucks operated business with single store located in Pike Place Market of Seattle. The company is headquartered at Seattle, Washington, U.S. Distribution network of the company is complemented by 6700 owned stores and 4080 licensed stores in USA. Starbucks has established their presence in more than sixty countries with the help of 20,000 stores. The company offers hot drinks, food items, various coffee drinks and other retail merchandise. As of 2011, market capitalization of the company is US$37.84 billion while sales revenue was more than US$ 13 billion. The company is facing competitions from various big players such as Dunkin' Brands, Nestle, McDonalds, and Wendy's International, Inc. Strategic Group map for Coffee industry can be explained in the following manner: (Source: Brown, 2011) Task A (1) Analysis of Starbucks External Environment Macro Environme nt Analysis PESTLE will be used to analyze macro environment condition of UK. Political UK is one of the most influential countries in the world and plays crucial role on deciding business policy in North Atlantic Treaty Organization. Government in the country has taken stern steps such as 24% budget cut for department of media, sports and culture in order to reduce overall financial deficit in the country. Government in the country has planned to reduce corporate tax by 22% within next two years and raise income tax bar ?8,200 to ?9,205. Economic Economic recession has contracted GDP growth by 0.2% while industry growth rate of the country has slumped to 0.8% last year. Economists forecasted unemployment of UK will touch 8.4% by the end of 2012 and more than 2.5 million people will get unemployed within next one year Social Budget deficit of Government has created challenge for people of the country to maintain standard living style while "managed migration" police government has f urther deteriorated the situation. Working age population in the country is growing at a rate of 7.7% for last two years. Technology Retailers are using latest technologies such as RFID, ERP and

Policy brief Essay Example | Topics and Well Written Essays - 1000 words

Policy brief - Essay Example Notably, the affordable care act requires states to establish their independent insurance exchanges. In other words, they want states to default to the federal exchange. Nonetheless, it should be noted that the joint federal state programs were initiated to fund the medical services in the United States. This is a long term project that was initiated to provide care to the moderate income families. Moreover, it is worth noting that Medicaid is among the largest federal funded budgets and it has had a rapidly growing cost, but with unsustainable rates (Rosen, 1988). The huge cost of this program to the federal government’s budget calls substantial overhaul towards reducing the taxpayers from huge funding burden. Nearly all states including Vermont usually receive Medicaid with an open ended funding from the federal government (Kaiser Commission Medicaid, 2012). The expansion of the state budget along with their expanded benefits usually leaves the taxpayers with no option but to pay additional costs. It should be noted that the current funding structure provides a room for overexpansion that in turn provides the states with limited incentive t o control extensive waste and fraud programs. Moreover, program is designed in a top down regulatory structure thereby creating distortions within the health care markets. However, the Medicaid intra governmental grants have proven to be effective and efficient for the funding mechanisms within the United States funding systems. Notably, they have created conditions that match the states’ funding considerably. In essence, the program allows the federal government to share specific expenditures that are attached to the program. These programs attached to the Medicaid services are known as the federal medical assistance percentage (FMAP). The FMAP was initiated for the government to have a larger percentage in the Medicaid costs in states. However, the highly targeted states are those with low