Research Utilization Project - Fecal Transplantation Essay Example for Free

Research Utilization Project Fecal Transplantation Essay Clostridium difficile (C-difficile) is a common bacterium that is a frequent cause of infection in the colon and effects numerous patients. Clostridium difficile increases the hospital costs associated with inpatient care, including identification of the organism as well as treatment. The most common cause of C-difficile infection is the elimination of normal intestinal flora caused by antibiotic use. Standard treatment of C-difficile infection includes the use of oral (Flagyl) and intravenous (Vancomycin) antibiotic therapy. The use of fecal transplantation to treat C-difficile infection is increasing in popularity. Research regarding fecal transplantation dates back to 1958; however, the efficacy of fecal transplant for the treatment of C-difficile are rapidly emerging with noted benefits for patients. The mere thought of presenting fecal transplantation for the treatment of a C-difficile infection is often dismissed because of limited available evidence and the concerns about using someone else’s stool to treat the infection. The necessity to educate patients with C-difficile is an additional challenge. Potential donors and recipients need to be assured of minimal risks associated with the screening and transplantation process. The ability to educate society on the results of evidence-based practice regarding the treatment of C-difficile with fecal transplantation should minimize concerns and enhance patient outcomes. The creation of a patient education programs is increasingly beneficial when multiple health care professionals and interdisciplinary teams are involved. Thus, a project objective in implementing an educational patient program for fecal transplantation is the creation of an informative brochure for potential use in the Endoscopy Department at Sharp Memorial Hospital by December 2014. The treatment regimen for initial and chronic C-difficile with fecal transplantation is inexpensive and noted as extremely effective. The articles reviewed consistently reveal efficacy rates greater than 85%. Fecal transplantation for the treatment of C-difficile continues to illicit multiple verbal and non-verbal responses and is not considered a standard of care for patients, families, communities, and hospital staff. The implementation of an informative educational brochure will minimize fears, hesitations, and reluctance for the treatment of C-difficile with fecal transplantation. The central theme of transplanting feces from a selected healthy donor to the recipient with C-difficile is often met with resistance. The fecal transplantation brochure will encompass aspects of fecal transplantation with the expectation of educating patients, families, and communities. Additionally, the brochure would enhance awareness of hospital staff providing an opportunity to educate units or departments. The application of Kurt Lewin’s change model for the implementation of an educational brochure for fecal transplantation will be employed. The current treatment modalities for C-difficile and the methods of transmission are increasingly becoming expensive for health care organizations. The financial goals of the organization are to decrease the rates of C-difficile and possibly entertain the concept of fecal transplantation. A dichotomous survey will be used to measure awareness and use of fecal transplantation for the treatment of C-difficile. The interdisciplinary team employed to create the brochure would prove beneficial in developing standardized procedures in performing fecal transplantations. The Southern California Society of Gastroenterology Nurses and Associates is an excellent venue for potentially validating and communicating the results. The two possible grant funding sources for the fecal transplantation brochure is the American Gastroenterological Association (AGA) and the American Society of Gastroenterology Nurses and Associates (SGNA). The creation and implementation of an educational brochure for patients considered for fecal transplantation would enhance community education and minimize fears in treating C-difficile with fecal transplantation. Keywords: fecal transplantation, clostridium difficile, fecal micobiota transplantation Problem Identification The traditional treatments for patients diagnosed with infections of the colon are antibiotics. However, many antibiotics kill the normal healthy bacteria of the colon. This results in an overwhelming increase in the risk for developing a C-difficile infection. Medicine. Net (2012) stated, â€Å"Patients taking antibiotics are at risk of becoming infected with C. difficile as antibiotics can disrupt the normal bacteria of the bowel, allowing C. ifficile to become established in the colon† (para. 1). The potential for implementing the use of fecal transplantations for the treatment of C-difficile among the general population is questionable. The mere thought of presenting fecal transplantation for the treatment of a C-difficile infection is often dismissed because of limited available evidence and the concerns about using someone else’s stool to treat the infect ion. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple enters. Transplantation [fecal] can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract† (p. 403). An additional consideration is the perception of fecal transplantation within the community. The necessity to educate patients with C-difficile is an additional challenge. Potential donors and recipients need to be assured of minimal risks associated with the screening and transplantation process. Current research supports and discusses a comprehensive approach to identification and screening for potential fecal donors, donor preparation, and transplantation procedures. The procedure for donor selection and screening is comprehensive to prevent the transmission of infection. According to Hamilton, Weingarden, Sadowsky, and Khoruts (2012), â€Å"The [donor] history includes assessment of infectious risk, including identification of known risk factors for HIV and Hepatitis, current communicable diseases, and recent travel to areas of the world with a higher prevalence of diarrheal illnesses† (p. 3). In educating patients, families, and the community at large, the rigor associated with the screening process must be emphasized to reduce fear. The project objective in implementing an educational patient program for fecal transplantation is the creation of an informative brochure for potential use in the Endoscopy Department at Sharp Memorial Hospital by December 2014. The brochure will be created using a collaborative approach by employing endoscopic nursing champions. The goal is for the brochure to be patient specific and encompass appropriate information to decrease fears and answer questions associated with fecal transplantation. Additionally, the development of a patient posttest associated with the brochure will be created to evaluate the effectiveness of content delivery and adjusted accordingly to meet patient needs and desired outcomes. The proposed solution will minimize the ambiguity and fears associated with fecal transplantation for the treatment of C-difficile. Solution Description The proposed solution for teaching potential recipients and donors about fecal transplantation for the treatment of C-difficile is to diminish infection rates. By creating and implementing a comprehensive nursing educational approach patients and donors can be well informed on this innovative treatment modality. â€Å"In many areas of clinical decision making, research has demonstrated that â€Å"tried and true† practices taught in basic nursing education are not always best† (Polit Beck, 2012, p. 25). The ability to educate society on the results of evidence-based practice regarding the treatment of C-difficile with fecal transplantation should minimize concerns and enhance patient outcomes. The creation of a patient education program is increasingly beneficial when multiple health care professionals and interdisciplinary teams are involved. The importance of evidence-based practice is to ensure the evidence about fecal transplants has been collected, evaluated, and implemented to establish the best practice and approach. The main premise for patient safety is to ensure donors have been thoroughly screened to minimize the potential for the transmission of other diseases with feces. According to Rohlke and Stollman (2012) on donor selection, â€Å"There have not yet been any adverse events reported that can be conclusively or directly attributed to [fecal microbiota transplantation] FMT, and proper donor screening is essential to avoid transmitting communicable diseases from donor to recipient† (p. 406). Individuals with recurrent C-difficile infections are moderately self-educated regarding treatment modalities and are receptive to the idea of fecal transplantation. The emphasis on educating patients, families, and communities regarding fecal transplantation as the initial treatment regimen is the focus. Hospital and individual associated costs in administering antibiotic therapy for the treatment of C-difficile could be drastically reduced by using fecal transplantation as the initial therapy. Brandt (2012) stated in reply, â€Å"Do patients typically accept fecal transplantation as a treatment option? Yes †¦patients typically respond with interest, and they are generally positive about trying it and they do not typically react with disgust† (para. ). The current research base associated with fecal transplantation demonstrates high cure rates while minimizing the reoccurrence of C-difficile. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple centers† (p. 403). The review of current literature demonstrates that patient education for fecal transplantation is performed by a gastroenterologist and not the gastrointestinal (GI) nurse. Patient education provided to patients from physicians typically entails a one-way communication style. In this scenario, the gastroenterologist sends the information to the patient, and there is little discussion with the receiver. Thus, patients commonly seek out more information from the registered nurse. The ability to educate patients regarding fecal transplantation using the proposed brochure would facilitate a commonality and minimize fears. The feasibility of implementing the brochure into endoscopic departments would be perplexing and centered on nursing knowledge of fecal transplantation. Brodine and Kellogg (2013) stated, â€Å"All patients infected or colonized with C. ifficile must be educated about this bacterium, proper disease management, and transmission prevention. The nurse should use patient-centered communication—free of jargon and appropriate to the patient’s health-literacy level† (para. 13). The health care organization must employ educational programs specific to the needs of the patients and desired outcomes. â€Å"The Joint Commission recommends using the â€Å"teach-back† and â€Å"show-back† methods to educate patients; that is, ask the patient to â€Å"teach back† the information provided or demonstrate understanding by â€Å"showing† a skill†¦Ã¢â‚¬  (Brodline Kellogg, 2013, para. 3). The organizational culture at Sharp Memorial Hospital for nursing is centered on the American Nurses Credentialing Center (ANCC) Magnet Recognition Program ®. The nursing strategic plan is developed by nursing leaders with input from nursing staff based on the hospital strategic plan. Additionally, nurse leaders emphasize that innovation is a core value and part of the nursing process. Nurse leaders encourage innovation through training, resources, and role modeling (Beyond Excellence, 2013). The roposed solution of implementing patient education for fecal transplantation is supported by Sharp Memorial Hospital because it involves introducing new knowledge regarding innovative, evidence-based treatment modalities. Research Report Clostridium difficile infection remains a constant struggle for hospitals. The standard treatment regimen of antibiotics commonly results in relapses. Research on fecal transplantation is continuing to emerge as a promising alternative approach in treating chronic C-difficile infections. Numerous studies demonstrate positive outcomes with the administration of fecal transplant in the treatment of C-difficile (Rohlke Stollman, 2012). Fecal transplantation has shown through research studies to be a useful treatment for C-difficile infection via the restoration of intestinal normal flora (Brandt, 2012). The most common sign reported by patients diagnosed with C-difficile is chronic diarrhea. Johnson (2012) stated, â€Å"The administration of antibiotics can alter the balance of normal colonic flora to permit the overgrowth of pathogenic C. ifficile strains that produce toxins which cause diarrhea and associated symptoms† (para. 5). In an article published in the Alimentary Pharmacology and Therapeutics, the authors reported 17 of 22 fecal transplantations for the treatment of C-difficile were effective (Landy, Al-Hassi, MLaughlin, Walker, Nicholls, Clark, Hart, 2011). The substantiated results of the review article highlighted major differences in patients, donors, screening, methods of administration, and the definition of treatment responses (Landy et al. , 2011). The multiple factors highlighted in this review of treating C-difficile with fecal transplantation review across the spectrum using a standard approach is essential to supporting increased use of this treatment modality. Landy et al. (2011) stated, â€Å"Standardized controlled studies are necessary to ascertain the most effective treatment regimen as well as the most acceptable method of treatment† (p. 414). Grehen, Borody, Leis, Campbell, Mitchell, and Wettstein (2010) published a study, â€Å"to demonstrate the benefits of fecal biotherapy and the role of new therapeutic strategies for the treatment of gastrointestinal conditions† (p. 51). The study included 10 patients treated with fecal transplantation and monitored the progress of bacterial population of the colon pre and post transplantation for a 24 week period. Grehen et al. (2010) found the following: At intervals of 4, 8, and 24 weeks after the procedure, the bacterial populations in the patients’ fecal samples consisted predominantly of bacteria derived from the health donor samples. Comparisons of similarity at 4, 8, and 24 week samples to the donor-infused sample were made and each recipient’s baseline sample was statistically significant with Friedmen test. p. 551) Rohlke and Stollman (2012) noted that C-difficile rates continue to rise with greater intensity and severity. The treatment of C-difficile with fecal transplantation is an emerging and accepted intervention in patients with recurrent C-difficile. Rohlke and Stollman (2012) stated, â€Å"Cure rates of 90% are being consistently reported from multiple centers. Transplantation can be provided through a variety of methodologies, either to the lower proximal, lower distal, or upper gastrointestinal tract† (p. 403). The review by Rohlke and Stollman (2012) analyzed reports validating the factors of â€Å"donor selection, appropriate patient criteria, and the preparations and mechanisms of fecal microbiota transplant delivery available to clinicians and patients† (p. 403). The internal validity of the research articles reviewed demonstrates moderate samples were randomly selected. The current literature validated the need for more randomized controlled studies to determine established guidelines for the implementation of fecal transplantation. Additionally, the treatment regimen for initial and chronic C-difficile with fecal transplantation is inexpensive and noted as extremely effective. The independent variable of the effectiveness of fecal transplantation for the treatment of C-difficile remained a consistent theme. The articles reviewed consistently reveal efficacy rates greater than 85%. The external validity of the study articles revealed fecal transplantation processes are varied in the process of which patients are treated, the donor selection criteria, donor screening protocols, and the methods of delivery. The outcomes of the results reported are moderately consistent; however, the ability to generalize a standardized treatment pathway is ambiguous and larger multi-organizational and multi-disciplinary studies are essential. Rex (2012) found the following: Several studies of fecal transplantation have demonstrated high cure rates. The latest and largest to date is a retrospective case series involving 70 patients in Finland (mean age, 73; 86% outpatients). Overall, 94% of these patients had symptom resolution during the first 12 weeks after transplantation, including 32 of the 36 infected with the O27 strain of C. ifficile and all 34 of those infected with other strains. No immediate complications occurred. (para. 1) Fecal transplantation in the treatment for C-difficile has proven to be highly successful in a limited number of studies. In determining if fecal transplantation should be the standard of treatment for C-difficile infection, larger controlled studies are required. Additionally, a standard process related to donor screening, implantation techniques, transplant follow-up, and regularly documenting patient outcomes are essential in establishing standardized fecal transplantation protocols.

Censoring Our Students :: Argumentative, Legal Issues, Social Issues

â€Å"Students do not shed their constitutional rights to freedom of speech or expression at the schoolhouse gates.† --Justice William Brennan For many years it has been debated whether students have the same amendment rights as any other person in the world. Many would say that they do not. They would say that by taking away those state given rights they are protecting the students from being exposed to negative things. Unfortunately the only thing that is being accomplished by this overprotection is the lack of understanding of the world they will soon be facing. â€Å"Why not stand firm as a public institution that expresses and explores the complex range of human experiences? Why be diplomatic and apologetic about the fact that we do not shy away from difficult, challenging, and complex topics? (Durbin)† There isn’t a more appropriate statement. Why not stand firm? Prepare students for the real world. Teach them how to survive. By censoring out issues or only allowing limited discussions of high profile topics, students are not being exposed to life skills that are crucial to the real world. Therefore setting them up for failure.   Ã‚  Ã‚  Ã‚  Ã‚  The American public schools, for many years, have been faced with the problem of censorship. Many such problems have been fostered by groups who question the use of instructional materials that do not meet their moral, religious, political, cultural, or ethic values (Sherrow 38). By censoring topics such as homosexuality, religion, sex, racial issues, and other taboo topics it is not allowing the growth and expansion of student’s minds.

Narrative and Group Essay

Objectives: R6 Authorial perspective, R13 Evaluate own reading, R18 Prose text, S&L10 Group organisation 2 3 4 5 *Ask questions *Speculate *Relate to prior reading *Inference and deduction *Visualisation *Empathy *Reread *Relate to time and place *Interpret patterns *Summarise *Interpret patterns *Interpret patterns *Ask questions *Establish relationship with author *Interpret patterns *Ask questions Group reading: pages 7–22 Group activity: narrative hooks – group card SC2 What makes an effective narrative hook? Each group shares one example of inference Narrative hooks sheet Character, inference and deduction Group reading: pages 23–38 Group activity: explicit/inferred development of character – group card SC3 Group reading: pages 39–49 Group activity: in-depth exploration of character – group card SC4 Teacher with guided group – guided card SC1 Group reading: pages 50–63 Group activity: mind-mapping of plot and links between characters – group card SC5 Group reading: pages 64–77 Group activity: in pairs, author interrogation – group card SC6 Strategy checkcard Prompts sheet Photocopies of pp. 9–44 Structure: mind-mapping, seeing patterns Identifying and tracking themes Author’s viewpoint and intentions Two pupils to give feedback on what reading strategy helped most this lesson Refer to SC5 None 6 Select one group to demonstrate. What new insights has this given into the book? Refer to SC7. Each group reports on one language feature and its effect Read pages 70–86 Access to the Internet 7 Narrative style at word, sentence and text level 8 9 10 11 *Hear a voice as Authorial voice. How is read author ‘heard’ in novel? Ask questions *Interpret patterns *Reread/reinterpret Endings and how they link Group reading: pages 94–100 *Summarise back to the beginning Group activity: endings and resolutions – *Pass judgements group card SC9 Outline expectations for group presentations. Preparation of presentations Group presentations: 10 minutes per text Group reading: rereading pages 64–70 Group activity: groups choose one plot event and explore how the language features work within this – group card SC7 Teacher with guided group – guided card SC2 Group reading: pages 87–94 Group activity: find examples of author’s voice – group card SC8 Photocopies of pp. 64–70 Each group to give an None example of a) authorial and b) narrative voice Each group to consider None what is effective about ending in their book Homework: Preparation/rehearsal Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 1 Robert Swindells Group card SC1 Objectives: R4 Versatile reading R12 Independent reading Resources: Strategy check-card As a whole group we have: †¢ established the ground rules for group and guided reading; †¢ looked at effective strategies for reading (starter activity and Strategy check-card). Now you are going to: †¢ read up to page 7. Group task 1. Discuss how you think the author ‘hooks’ or interests the reader, making them want to read on. 2. Be prepared to share your findings in the plenary. Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 2 Robert Swindells Group card SC2 Objectives: R13 Evaluate own reading R18 Prose text Resources: Narrative hooks sheet As a whole group we have: †¢ revised the range of reading strategies you have available to you. Now you are going to: †¢ look at the narrative hooks used by the author. Whilst you are reading: †¢ think about the strategies you are using (look at the Strategy check-card); †¢ think about the evidence you may use to support your ideas. Group reading Read together pages 7–22 (see group task first! ). Group task 1. One pupil recaps on pages 1–6. 2. Divide yourselves into two groups of three and label yourselves Group A and Group B. Group A – using the Guide to guided reading prompts sheet, what have you discovered about the main character in your book? Prepare to share your findings with Group B. Group B – using the Narrative hooks sheet, which narrative hooks has the writer used to entice the reader? Prepare to share your findings with Group A. 3. Share your findings with the whole group, using supporting evidence. Why does this make an effective opening to Stone Cold? Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 3 Robert Swindells Group card SC3 Objectives: R13 Evaluate own reading R18 Prose text Resources: Strategy check-card, Prompts sheet As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks. Now we will: †¢ explore how the characters are developing. Group reading Read pages 23–38 together. Whilst you are reading: †¢ think about the strategies you are using, especially those of inference and deduction (look at the Strategy check-card); †¢ think about the evidence you may use to support your ideas. Group task In pairs, using the Prompts sheet on Character, what have you discovered about the main character(s) in the book? What is explicitly stated and what is inferred? Be prepared to give evidence and jot down notes in your reading journal. Link’s character Evidence Explicit/Inferred Shelter’s character Evidence Explicit/Inferred Share your findings around the group and add examples that you did not have. How effective is Robert Swindells’ development of his main characters? What techniques does he use? Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 4 Robert Swindells Group card SC4 Objectives: R13 Evaluate own reading R18 Prose text Resources: Photocopies of pp. 9–44, highlighter pens As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks; †¢ explored the developing relationships between character and place. Now you are going to: †¢ explore the characterisation in more depth. Group reading Read pages 39–49 together. Group task 1. In discussion, recap on what we have learned about Link so far. 2. Give out photocopies of pp. 39–44 a nd highlighting pens. Working in pairs, agree responsibility for highlighting one of the following areas. What is learned about: i. unters and predators (how people perceive the homeless)? ii. pain and problems (physical pain and mental strain)? iii. partnership and poverty (what Link is learning from Ginger, proof that things are getting worse and worse)? 3. Share findings with the others in the group – what can we infer and deduce about: i. how Link seems to feel about his new life? ii. whether he will be tough enough to survive? iii. what the future might hold for him? Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 5 Robert Swindells Group card SC5 Objectives: R13 Evaluate own reading R18 Prose text Resources: None As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks; †¢ explored the developing relationships between character and place; †¢ begun to explore themes and how the characters contribute towards them. Now you are going to: †¢ continue to trace developments, including themes. Group reading Read pages 50–63 (see instructions 3 and 6 below first! ). Group task 1. One pupil to recap on the story so far, key characters and situation. 2. As a group discuss the central themes you have identified in Stone Cold so far. Make a map of them. ) 3. Up until page 56 the narrator is still heavily reliant upon Ginger to show him all the tricks he will need in order to survive. He seems surprised by people’s attitudes towards the homeless. In pairs discuss and make another mind-map in your journals on what you think Link really learns from: i. his encounter with Captain Hook and time on the boat; ii. his walk through Camden Lock market and feelings when Ginger meets his friends; iii. hearing about Doggy Bag’s way of life and thinking about his disappearance. You should try to point towards textual evidence to support your ideas. . Share findings as a whole group. Discuss the following comment from the author: ‘I am dedicated to the idea that we are all responsible for one another, and that we ought to conduct ourselves accordingly, doing no harm to any being. ’ (Robert Swindells – Introduction to Stone Cold). For discussion: i. Is it possible to live such a life in our modern times? ii. Do we have a duty to care for our poorest, weakest and most needy? Captain Hook sees such people as targets to be exploited. Is he wrong? iii. Is the treatment Link receives unfair? iv. Should he have toughed it out at home? Should he join the army? . How do you think we should solve the problems of homelessness and begging on the streets of Britain? Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 6 Robert Swindells Group card SC6 Objectives: R6 Authorial perspective R13 Evaluate own reading R18 Prose text Resources: Access to the Internet As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks; †¢ explored the developing relationships between character and place; †¢ explored themes and how the characters contribute towards them. Now you are going to: †¢ explore the role of the author. Group reading Read pages 64–77 together. Group task The characters are not the only ones that have a voice in a story. Readers are often given a strong impression of the author, the teller of the tale, and this can influence your experience of the story. 1. In pairs, write down five questions that you would like to ask Robert Swindells about Stone Cold and his ideas in the book. One member of the group should take on the role of the author and be interviewed as the author. 2. When you have done this read the interview given by Robert Swindells about his reasons for writing at www. mystworld. com (a more detailed one can be found at www. achuka. co. uk). List the similarities and differences in your ideas about Robert Swindells with those presented in the interview. How close was your group’s impression of the author given in Stone Cold to that given in the interview? Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 7 Robert Swindells Group card SC7 Objectives: R13 Evaluate own reading R18 Prose text Resources: Photocopies of pp. 64–70 As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks, character, setting and mood, relationships between character and place, and emerging themes. Now we will: †¢ explore the author’s narrative style. Group reading Paired rereading of pages 64–70. Group task 1. Recap on the story so far. How has Link’s situation altered? How has his character developed since arriving in London? 2. The pages you have just read could be summarised in flow chart form as follows: A) B) C) Link’s initial desperation>meeting paper seller>Link can’t sleep> The all-night caff>meeting Toya>Link’s resolution (the New Me)> Arrival of new girl>forgetting Ginger>Link’s new partner. You are going to discuss together the following questions. What techniques does the author use in these pages to: i. build up tension? ii. make us feel closer to Link? iii. show the vulnerability of those on the streets? Split yourselves into three pairs, A, B and C. Each pair will focus on its given line in the flow chart above and try to answer the questions. Focus on textual evidence to support your ideas. 3. Share your findings with the group in discussion. Homework Read pages 70–86. Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 8 Robert Swindells Group card SC8 Objectives: R6 Authorial perspective R13 Evaluate own reading R18 Prose text Resources: None As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks, character, setting and mood, relationships between character and place, emerging themes. Now we will look at: †¢ authorial voice – ‘I am dedicated to the idea that we are all responsible for one another, and that we ought to conduct ourselves accordingly, doing no harm to any being. ’ (Robert Swindells – Introduction to Stone Cold) Group reading Read together pages 87–94. Group task Sometimes adults tell children scary stories in order to stop them doing something, i. e. the more frightened the children are, the less likely they are to go into the woods, or play by the river. In Stone Cold, Robert Swindells shows us the brutal reality of life on the streets. To make things worse, his homeless youngsters are being stalked by a serial killer. If the book is to succeed, his villain must be realistic and disturbing. 1. Do you think the author wants to scare us? Does he succeed? If so, how and why? If not, why not? 2. Discuss your ideas with a partner and then make notes on the following: i. what we learn about Link and his fears in these pages; ii. how the tension slowly builds; iii. how successful Robert Swindells is in creating a frightening villain. 3. Share your findings on these questions with others in the group. 4. Write 50 words about the character of Shelter and how you feel about him. Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 9 Robert Swindells Group card SC9 Objectives: R6 Authorial perspective R13 Evaluate own reading R18 Prose text Resources: None As a whole group we have: †¢ revised the range of reading strategies you have available to you; †¢ explored narrative hooks, character, setting and mood, relationships between character and place, emerging themes and narrative style. Now we will look at: †¢ the resolution. Group reading 1. In pairs, discuss the questions left unanswered by the story so far. Compile a list of three things you’d like to know and three things you’d like to happen by the end of the story. Record them in your books. Share your findings with the others in the group. 2. Read pages 94–100 (see task 3). Group task 1. Discuss how your ideas matched up with those of the author, Robert Swindells. 2. As a group discuss why the author chose to let Gail go off with Gavin at the end and leave Link all alone. Would a ‘happy ending’ have been more suitable? 3. Consider what the future might hold for Link. . Will he ever get off the streets? Has he got a future of any kind? ii. Was the author making a point when writing Stone Cold? iii. What might it have been? Did you enjoy the story? Why or why not? Homework Write a detailed reflection on the ending of the story and the points you made in response to question 3 in the group task. Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 4 Teaching objective(s): Robert Swindells Guided card SC1 R13 Evaluate own reading R18 Prose text Resources: Strategy check-card Photocopies pp. 9–44 Highlighter pens Stone Cold by Robert Swindells, pages 39–44: developing relationships between character and place Teacher distributes Strategy check-card, clarifies the objectives and identifies the reading strategies to be used in this session, i. e. scanning for, identifying and summarising specific points made by the author. Model these strategies based on the first full page of the novel, with a focus on the problems at home that are described by the narrator. Give pupils photocopies of pp. 39–44 and highlighting pens. Explain that they will be asked to text-mark for certain features. Pupils read pp. 9–44 independently. Individual pupils are asked to highlight what is learned about each of the following: †¢ Punters – begging and how it makes you feel; †¢ Pain – the physical damage sleeping rough can do; †¢ Predators – the dangers faced by the homeless; †¢ Problems – the mind games played at night; †¢ Partnership – Link’s gratitude towards his pal; †¢ Poverty – proof that Link is plunging lower and lower. Ask each pupil to share their findings with the rest of the group and then ask the group to comment on the skilful way the writer uses the voice of Link to alert us to the reality of life on the streets in modern Britain. What are we meant to infer and deduce about the future Link now faces? I. e. is he tough enough to survive the life he describes so vividly? Review reading strategies used in this session and, if they are keeping them, ask pupils to make brief notes in journals to record key points brought out in reading and discussion today. Homework: Read pages 44–49. Text focus: Teaching sequence: Introduction to text: Strategy check: Independent reading and related task: Return to text: developing response Review (reading target and next steps): Evaluation: Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3 Stone Cold Lesson 7 Teaching objective(s): Robert Swindells Guided card SC2 R6 Authorial perspective R13 Evaluate own reading R18 Prose text Resources: Strategy check-card Photocopies pp. 64–70 Text focus: Stone Cold by Robert Swindells, pages 64–70: narrative style and authorial attitudes, with a focus on word, sentence and text level features Teacher clarifies objectives and asks a pupil to recap on the story so far – how has Link’s situation altered? How has his character developed since arriving in London? Distribute Strategy check-card and outline expectations for developing the specific active reading skills targeted in this session. Model aloud the skills of inference and deduction on a section of the Daily Routine Orders chapters, showing how the writer implies a sense of menace. Stress that these strategies are essential skills for engaging with, and enjoying, texts and improving as a reader. Ask pupils to explain/illustrate when they have used these strategies recently. Give pupils photocopies of pages 64–70 and ask them in pairs to consider the techniques the author has used in order to imply: †¢ a growing tension; †¢ that Link deserves the reader’s sympathy; †¢ the vulnerability of those on the streets. Ask pupils to share their initial thoughts on key features at word, sentence and text level and then text-mark onto the sheets the evidence supporting their ideas. Teaching sequence: Introduction to text: Strategy check: Independent reading and related task: Return to text – developing response Whole-group discussion (teacher leads at first and then hands over questioning to pupils). Ask pupils to focus on textual evidence to support their findings. Why has the author chosen to remove a major character from Link’s environment and bring in another at this point in the story? What will this add or take away? Focus on inference and deduction and where the story may move next. Ask pupils to update their journals, if they are keeping them, listing their discoveries and speculations resulting from today’s session. Homework: Read pages 78–86. Review (reading target and next steps): Evaluation: Key Stage 3 National Stratagy NATE  © Crown copyright 2003 Group reading at Key Stage 3

Essay on The Coorelation between Drug Tolerance and the...

The Coorelation between Drug Tolerance and the Environment When considering the dynamics of brain and behavior, another component that enters the equation is environment. If brain equals behavior then changes to either should result in an altercation to the other component. The question that arises is whether a change in the environment produces change in brain chemistry and therefore, behavior. A connection between brain, behavior and environment may be observed in the context of drug tolerance. There are a collection of questions that seem essential to consider when attempting to correlate the brains development of an observable drug tolerance and the environment. †¢ Does the environment affect drug tolerance? How? †¢ What†¦show more content†¦A delayed recovery to the initial stimuli would be expected if the receptors were numerically or physically altered. However, after terminating a drug treatment, a delayed recovery to the initial stimuli has not been observed. Instead, the body readapts to the drug-free state (2). Furthermore, reactions that are almost directly opposite to the desired effect of the drug are observed. These reactions are termed withdrawal symptoms and are observed when no drugs are administered and compensatory processes operate unopposed (2). If the nervous system provides compensatory responses, then the question arises as to whether environmental cues initiate the response. Environmental cues that initiate responses were observed by the Russian physiologist, Ivan Pavlov (1849-1936). Pavlov made initial observations pertaining to classical conditioning. Pavlov correlated environmental cues and physiological changes as he observed dogs salivating in response to a collection of cues that signaled feeding time. Without the stimulus of food present, there was an observable response to the anticipated stimuli as the dogs salivated in preparation for the emanate arrival of food (3). Siegel et al. (1982) applied Pavlovs model of classical conditioning to the administration of drugs (4). Siegel et al. observed that the anticipated stimuli signaled by environmental cues provided an additional drug tolerance. An experiment was designed with