Audit of Syphilis Screening in Pregnancy

Audit of Syphilis Screening in Pregnancy Tables Table 1:Syphilis confirmatory test results for forty nine  pregnant woman 18 Table 2:Syphilis screening results of eleven new-borns of  positive syphilis mother 24 Table 3: Positive syphilis confirmatory test results for sixteen  pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening  for mothers 28 Figure 2: The laboratory turnaround time of syphilis screening  for new-borns 28 Tables Table 1: Syphilis confirmatory test results for forty nine pregnant woman 18 Table 2: Syphilis screening results of eleven new-borns of positive syphilis mothers 24 Table 3: Positive syphilis confirmatory test results for sixteen pregnant woman 30 Figures Figure 1: The laboratory turnaround time of syphilis screening for mothers Figure 2: The laboratory turnaround time of syphilis screening for new-borns ABSTRACT Objective: A re-audit of syphilis screening in pregnancy was carried out to ensure that the improvements in laboratory and clinical aspects of management for the antenatalof pregnant women with positive syphilis screening and their new-born babies fully met were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). Methods: Patients’ data were collected via query of the three databases: Clinisys Labcentre, Telepath and EuroKing. The n the data were analysed using Microsoft Access 2013. Results: Samples from Forty nine49 pregnant woman with positive syphilis results serology were referred to a reference laboratory laboratory were sent to MRI for syphilis serological confirmatory testing. Sixteen pregnant woman with of these women were confirmed to have had had positive syphilis were identified. Ten pregnant woman were re-tested screened at least twice during their pregnancy and six pregnant woman were only screened tested once during pregnancy. Over-testing of for treponemal IgM were seen in nineteen patients[h1] with non-reactive RPR titre. Only eleven babies born to mothers with syphilis were followed-up with serial serological tests for syphilis. Only four new-borns were fully screened. Some of the new-borns were not tested with treponemal IgM due to sample insufficiency. Conclusion: There were some improvements seen since the first audit which includes the changes of the confirmatory testing schedule in MRI, lower screening false positive rate, and increased follow-up of the new-borns. There were also things to improve in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of syphilis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h2]. In-house confirmatory testing should be considered to allow reduction of test turnaround time’s thereby aiding patient management.Improvements[h3] should be made in the management of syphilis in pregnancy and the new-borns of positive syphilis mothers. Treponemal IgM test should be performed only when the RPR test were reactive to prevent over-testing of patients. The test algorithm for screening of sy philis in new-borns should give priority to RPR test and treponemal IgM to prevent under-testing[h4]. 1.0  INTRODUCTION 1.1  Syphilis Syphilis is an infectious disease caused by Treponema pallidum (T.pallidum) subspecies pallidum. The disease is transmitted from human to human, and humans are its only known natural host (Woods 2005). Epidemiologically, in the UK, cases of syphilis have increased in England since 1997 led by a series of outbreaks reported from Manchester, London and Brighton (Health Protection Agency 2009). Since 1999, diagnoses of infectious syphilis have been made in heterosexuals where the outbreaks are linked to sex work, students and young people. But, there was a changing pattern of infection between 1999 and 2008, when seventy three percent of new diagnoses of infectious syphilis were reported in men who have sex with men (Health Protection Agency 2009). The transmission is primarily by sexual activity (Zeltser Kurban 2004) (vaginal and anal intercourse) and by direct contact with active primary or secondary lesions (Lafond Lukehart 2006) for example through oral sex and kissing at or near an infectious lesion (Kent Romanelli 2008). T.pallidum may invade the host through normal mucosal membranes and also through minor abrasions in the skin (Zeltser Kurban 2004) such as from sexual trauma, causing an inflammation, ulcer and then spreading through the blood stream to other parts of the body (Goh 2005). 1.2  Syphilis in Pregnancy Mothers with untreated syphilis may seriously complicate their pregnancy. Vertical transmission of T.pallidum across the placenta (Singh Romanowski 1999) can occur at any time during pregnancy (Vaules et al., 2000; Oswal Lyons 2008), this leads to wide dissemination of the spirochete in the fetus (Woods 2005). Fetal infection resulting in spontaneous abortion, still-birth, premature delivery, non-immune hydrops fetalis and also congenital infection (Singh Romanowski 1999; Vaules et al., 2000; Ledger 2000). Vertical transmission may occur at any stage of syphilis infection. However, the transmission is more common in mothers with primary and secondary stage of syphilis (Singh Romanowski 1999; Vaules et al., 2000; Oswal Lyons 2008) as the risk of transmission depends on the levels of spirochaetemia which are higher in these stages compared to other stages (Vaules et al., 2000). Syphilis may also be transmitted during birth by contact of the new born with the mother’s genita l lesion (Ledger 2000; Berman 2004). 1.3  Congenital Syphilis Signs of infection for early congenital syphilis may appear within the first two years of the infant’s life with clinical manifestations include hepatosplenomegaly, rash, fever, and signs of neurosyphilis, especially bulging fontanel, seizures, and cranial nerve palsies (Mattei et al., 2012; De Santis et al., 2012). As for late congenital syphilis, the sign of infection may only be seen over the first two decades with clinical manifestations such as frontal bossing, nasal cartilage destruction, and dental abnormalities (Mattei et al., 2012; De Santis et al., 2012). Congenital syphilis leads to multiple organ infection because of the widespread haematogenous dissemination (De Santis et al., 2012) that will further cause death in the fetus or new born. However, the disease is almost preventable if mothers with syphilis are treated early in pregnancy (Walker Walker 2007). 1.4  Serologic Test Diagnosis of syphilis is made based on clinical signs and symptoms, microscopic examination and serologic tests (Little 2005). Two types of serologic testing were available; non-treponemal specific tests and treponemal specific tests (Clyne Jerrard 2000). Non-treponemal tests are widely used for testing and screening for syphilis as they are rapid, simple and inexpensive (Ratnam 2005). The example of  non-treponemal tests include the Venereal Disease Research Laboratory (VDRL) test and the rapid plasma reagin (RPR) test (Kent Romanelli 2008). Due to the rate of false-positive results which present in about one to two percent for these tests, the positive results have to be confirmed by sets of treponemal-specific tests such as the T.pallidum particle agglutination (TPPA) test, T.pallidum haemagglutination (TPHA) test and treponemal enzyme immunoassay (EIA) test (Kent Romanelli 2008). 1.4.1  Antenatal Screening The detection and treatment of infectious syphilis are extremely important in preventing congenital syphilis (Chakraborty Luck 2007; Simms Broutet 2008). An effective antenatal screening programme can have a huge impact in the way of managing both mother and baby. All pregnant women should be screened for syphilis at their first antenatal appointment (French et al., 2009) and the test should be repeated early in the third trimester (Goh Thornton 2007). Also, all infants born to seropositive mothers should be examined at birth and at monthly intervals for three months until it is confirmed that serological tests are and remain negative (Oswal Lyons 2008). The primary screening tests recommended (Kingston et al., 2008) are either treponemal EIA or TPPA/TPHA. If the screening test is positive, it must be confirmed by either one of the opposite tests. VDRL or RPR will be performed when the confirmatory test gives positive results (Kingston et al., 2008). 1.5  Audit on Diagnostics of Syphilis in Pregnancy The diagnosis of infectious syphilis in women in the UK increased between 1999 and 2007. The increase of syphilis cases in women has also led to the re-emergence of congenital syphilis in the UK which may suggest sub-optimal management of patients with syphilis (Health Protection Agency 2009). In 2011, an audit on diagnosis of syphilis in pregnancy was performed at the Pennine Acute NHS Trust (PAHT) to ensure the syphilis screening in pregnant women and also the serological diagnostic of their new-born babies followed the UK standard for Microbiology Investigations in Serological Diagnosis of Syphilis which were introduced by Public Health England in 2007 (Public Health England 2014b). The purpose of introducing the standard was to assure equivalence in the investigation strategies in different laboratories across the UK (Public Health England 2014b). The audit reveals the concerns about the delays in syphilis confirmations and insufficient follow-up for new-borns of positive syphilis mothers. At least eighteen percent of positive syphilis cases took more than one month for confirmation and the turnaround time for eleven percent of the syphilis screening cases out of forty five cases took more than one week. It is also found that there was inconsistency in performing treponemal IgM test where fifty three percent of cases (twenty four cases out of forty five cases) were not tested for treponemal IgM. For the management of neonates, only four new-borns were followed-up and among four new-borns, only one have been followed up according to the guidelines. Recommendations made from the audit includes the improvement of time to confirmation of specimens, changes of confirmation test by using treponemal IgM to all pregnant woman, referral of all pregnant woman with inconclusive syphilis confirmation to Genitourinary Medicine (GUM) clinic and management of new-borns where follow-up should be completed according to the guidelines provided (Vladana et al., 2011). 1.6  Re-audit of Syphilis Screening in Pregnancy A re-audit of syphilis screening in pregnancy at the PAHT was performed to discover if changes made after the first audit recommendations have led to the improvement of services. The re-audit was carried out three years after the first audit done in 2011. The re-audit aimed to ensure that the improvements in laboratory and clinical aspects of management for the antenatal women with positive syphilis screening and their new-born babies were in accordance with the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) and the Guidelines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013). 2.0  METHODOLOGY 2.1  Background The PAHT comprises four major district general hospitals; North Manchester General, Fairfield General Hospital, Rochdale Infirmary and The Royal Oldham. Some 12,000 women annually present for antenatal care. Women usually attend for antenatal care at one of three antenatal clinics or one of several General Practice Clinics within the community. In the UK antenatal infectious disease screening is usually performed at three months gestation (http://www.screening.nhs.uk/). Women are offered screening for rubella immunity, hepatitis B virus infection, human immunodeficiency virus infection and T.pallidum (syphilis) infection. Among 12,000 women screened within the PAHT in the period 1st January 2013 to 31st December 2013, a series of forty nine pregnant woman with positive syphilis serology were identified. To determine whether syphilis screening and follow up care of babies born to these mothers followed the UK Guidelines of the Management of Syphilis (Kingston et al., 2008) and the Gui delines for the Management of Syphilis in Pregnancy and the Neonatal Period (Stringer et al., 2013), a retrospective study was performed. 2.2  Diagnosis of Syphilis Pathway Patients’ blood sample was collected with informed consent at the antenatal clinic and laboratory test requests were made. The patients’ information was recorded in the maternity information system database; â€Å"EuroKing† (Euroking, Chertsey, Surrey, UK). Samples were transported to The Royal Oldham Hospital (TROH) microbiology laboratory via the hospital transport system to be tested. Patient demographic information was recorded in the laboratory data system Clinisys Labcentre (Clinisys, Chertsey, Surrey, UK). If the syphilis screening test was negative, a report was generated and then posted to the antenatal clinics where the sample came from. If the syphilis screening test was positive, the sample was sent to a reference laboratory, Manchester Medical Microbiology Partnership Laboratory at Manchester Royal Infirmary (MRI) for confirmatory testing. Testing at the MRI comprises two treponemal enzyme immunoassay tests for total treponemal antibody; a T.pallidum specific assay (EIA); the T.pallidum particle agglutination assay (TPPA); the reagin precipitin assay (RPR) and where appropriate a T.pallidum specific IgM enzyme immunoassay (IgM) in accordance with national guidelines (Kingston et al., 2008). These results were recorded in the MRI laboratory database system, (Telepath; CSC Healthcare, Banbury, Oxfordshire, UK) and a printed copy of the patient test results was sent back to TROH microbiology laboratory. The reference laboratory report was transcribed onto the Clinisys Labcentre system and a printed report was generated to be to the antenatal clinics. Finally, the patients’ report received by the antenatal clinics was recorded in the patients’ notes and updated in the EuroKing system. 2.3  Data Collection Data collection for the study was accomplished via query of the three databases: the PAHT laboratory database system, Clinisys Labcentre, the MRI database system, Telepath and the maternity information system database, EuroKing. The data gathered including the patients’ hospital number, NHS number and specimen number, date of birth, the date of sample collection and report, and also the syphilis serology data which includes the patients’ treponemal EIA, TPPA, RPR and treponemal IgM results. The sample collection and sample reported data were obtained to investigate the turnaround time taken for the diagnosis within the laboratory. 2.4  Analysis of Data The laboratory system data was presented as Microsoft Excel spreadsheets (Microsoft Corporation, Seattle, USA). All the patients’ data were then imported and assembled in Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). The data for the forty nine pregnant woman with positive syphilis serology were analysed using Microsoft Access 2013 (Microsoft Corporation, Seattle, USA). 2.5  Clinical Audit This was conducted under the Clinical Audit provision of the NHS National Research Ethics Committee (National Research Ethics Service 2008). The work was registered and approved as a Clinical Audit with the Clinical Audit Department of the PAHT. Data analysed was anonymised before release from the Trust to comply with Data Protection Guidelines (Caldicott Committee 1997). The clinical audit used the UK National Guidelines on the Management of Syphilis (Kingston et al., 2008) as a standard. 3.0  RESULTS Fifty positive syphilis serology results were identified from forty nine pregnant woman undergoing routine antenatal infectious disease screening at TROH microbiology laboratory. All specimens were screened with Chemiluminescent Microparticle Immunoassay test using the Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA). The fifty specimens were also sent to the Manchester Medical Microbiology Partnership Laboratory, MRI which acts as a reference laboratory for syphilis serological confirmatory testing. 3.1  Confirmation Methods by MRI The reference laboratory confirms syphilis screening with two treponemal EIAs, a semi-quantitative TPPA, a semi-quantitative RPR, and where appropriate a T.pallidum specific EIA for IgM antibody in accordance with national guidelines (Kingston et al. 2008). The first treponemal EIA test was the same Abbott Architect Syphilis TP Assay (Abbott Diagnostics, Chicago, USA) used at TROH for syphilis serological testing; the second treponemal EIA test used the DiaSorin Liaison XL System (DiaSorin S.p.A, Saluggia, Italy), the semi-quantitative TPPA was the Serodia TPPA Assay (Fujirebio Diagnostics, Inc., Tokyo, Japan), the semi-quantitative RPR was the Abbott Syfacard – RR card test (Abbott Diagnostics, Chicago, USA), and the T.pallidum specific EIA for IgM were run using CAPTIA Syphilis-IgM Assay (Trinity Biotech, Ireland, UK). Where necessary, further testing using T.pallidum specific immunoblotting and/or T.pallidum specific polymerase chain reaction testing are also used in confir mation testing. All specimens were confirmed using treponemal EIA, TPPA and RPR but only about twenty nine specimen out of fifty specimen were tested using treponemal IgM. There were seventeen positive screening with syphilis and thirty three negative screening with syphilis. Negative screening was defined by having negative results for either one or both treponemal EIA, TPPA titres of less than 1:80 and RPR titre of less than 1:2; positive results were defined by having positive results for both treponemal EIAs, a TPPA titre of greater than or equal to 1:160, RPR titre greater than or equal to 1:2 and positive results of treponemal IgM (Table 1). Table 1: Syphilis confirmatory test results for forty nine pregnant woman. Patient numbers with symbol â€Å"*† are pregnant woman with positive syphilis results. Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA InterpretationResult 1 1 Positive Negative Negative Negative Not Done Negative *2 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:320 Negative Negative 3 1 Positive Negative Negative Negative Not Done Negative 4 1 Positive Negative Negative Negative Not Done Negative *5 1 Positive Positive 1:5120 1:64 Not Done Positive 2 Positive Positive 1:5120 1:64 Not Done 3 Positive Positive 1:2560 1:8 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 6 1 Positive Negative Negative Negative Negative Negative *7 1 Positive Positive 1:640 Negative Not Done Positive *8 1 Positive Positive 1:1280 Negative Not Done Positive 2 Positive Positive 1:2560 1:1 Not Done 9 1 Negative Negative Negative Negative Not Done Negative 10 1 Positive Negative Negative Negative Negative Negative 11 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *12 1 Positive Positive 1:5120 1:4 Negative Positive 2 Positive Positive 1:5120 1:4 Not Done Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Interpretation *13 1 Positive Positive 1:640 1:64 Not Done Positive 14 1 Positive Negative Negative Negative Negative Negative 15 1 Positive Negative Negative Negative Not Done Negative 16 1 Positive Negative Negative Negative Not Done Negative 17 1 Positive Negative Negative Negative Negative Negative 18 1 Positive Negative Negative Negative Not Done Negative 2 Positive Negative Negative Negative Not Done *19 1 Positive Positive 1:640 Negative Not Done Positive 2 Positive Positive 1:1280 Negative Not Done 20 1 Positive Negative Negative Negative Not Done Negative Patient Test TEIA1 TEIA2 TPPA RPR IgM EIA Result 21 1 Positive Negative Negative Negative Not Done Negative *22 1 Positive Positive 1:640 1:4 Not Done Positive 2 Positive Positive 1:1280 1:4 Not Done 23 1 Positive Negative Negative Negative Not Done Negative 24 1 Positive Negative Negative Negative Not Done

Birth And Eleven Months Children And Young People Essay

Birth And Eleven Months Children And Young People Essay The control that people have over their bodies is quite remarkable, and yet most people take it completely for granted. Watch a young baby struggling to pass a rattle from one hand to another and you will soon see how skilled you have become. Physical development like many other areas of development is a journey, but interestingly it is a relatively fast one, and by the age of 5 years most children have a good level of control over their bodies. Physical development looks principally at the skills that children acquire, but it is important to understand that there is a link here to growth and maturation. For example, young babies can suck their toes, but this becomes difficult as the bodys proportions change. In the same way some physical development cannot take place until some maturation processes have occurred. Physical development builds childrens confidence when children can do things for themselves, they are more likely to gain in confidence, and they can do things how and when they want. It allows children to express themselves, physical movements are one in which babies and young children can express themselves. Babies may signal with their arms if they wish to be listed .Physical development is also linked to cognitive development, in childrens early stages , a significant amount of learning is practical and requires physical movements, early physical movements also help to develop the brain. To gain control over their movements, children need to master different types of movement and Michelle howorth NC39964 Assignment 1 Page 2 Skills. These types of movements are fine motor skills and gross motor skills. Fine motor skills cover small movements that are usually made using the hand, fine manipulative skills are movements that require the fingers and thumbs to carry out co-ordinated small tasks, fine motor skills are movements that involve the wrists and hands. According to Arnold Gessel an American paediatrician the central nervous system underpinned development with stimulation not necessarily having a significant role. He suggested that they are 3principles of physical development 1. Development follows a sequence, as children develop and grow a sequence emerges and certain things have to be in place before others can follow. 2. Development begins at the top at the head and moves downwards, babies gain control of their head and top of the spine before any other part of the body. This is a survival mechanism which allows the baby to feed. 3. development begins with motor movements which are uncontrolled which then become refined and precise, they have uncontrolled arm and leg movements but most control is quickly gained, by 6 months most babies can take an offered toy relatively easily . The first year of life is amazing in terms of physical development, babies begin with a range of reflexes, the reflexes are actions that happen without the baby thinking about them, these are swallowing and sucking reflex -these ensure the babies can feed and swallow milk. Rooting reflex -the baby will move its head to look for a nipple or teat if its cheek or mouth is touched, this helps the baby to find milk. Grasp reflex- babies will automatically put their fingers round an object that has touched the palm of their hand. Startle reflex when babies hear a sudden sound or see a sudden bright light, they will react by moving their arms outwards and clenching their fist. Walking and standing reflex- when babies are Michelle howorth NC36694 Assignment 1 Page 3 Held upright with their feet on a firm surface they usually make stepping movements. Falling reflex- this is known as the Moro reflex babies will stretch out their arms suddenly and then clasp them inwards in any situations in which they feel they are over falling. Over the first few months some of these reflexes begin to disappear and instead babies learn to control their movements, muscle tone also increases and the body grows stronger. By the time babies are one month old they have changed already, they appear less curled up and more relaxed. Babies at one month old have usually started to settle into a pattern, they sleep quite a lot of the time but will gradually try to spend longer time awake. They cry to communicate their needs and parents are beginning to understand the different kind of crys , they start to learn more about their parents : they may stop crying when they hear their voice ; they also try hard to focus on the face of who is holding them (they can focus at a di stance of 20-25cms ).When they get to 3 months they have grown in height and weight , they have grown out of all their early clothes and have changed in many ways, Some babies have learnt the difference between day and night and are able to sleep through the night . They are likely to cry less and most parents are getting better at knowing what their cry means, they are also starting to sleep a little less and are far more alert .They may smile quite often and show that they know the sound of their parents voices and movements .Babies bodies are also developing, they are able to lift their head up and look about when put on their tummies. As a child reaches 6-8 months they have learnt many skills, they are very alert and move their head to see what is happening, they enjoy playing and show it by squalling in delight .They can now reach out and grab a toy and move it from one hand to another, they are able to focus on an object and explore it if it seems interesting .They also start to show that they understand a little of what is being said to them and they try to communicate. They usually enjoy their food and are beginning to feed themselves by grabbing a spoon .They are also getting stronger they can sit up with support in a highchair and are able to roll Michelle howorth NC36694 Assignment1 Page 4 over from their backs to their fronts, they can push themselves up on their hands if they lie on their fronts and hold this position for a while .As they reach 9 month Babys physical development is now very noticeable, many babies will be crawling or finding other ways of being mobile, they are able to sit up without any support; these new movements mean babies can explore more. Children at this age spend a lot of time sitting and playing, when they are mobile they can move quite fast .As well as large objects babies are also picking up objects handling them and becoming more skilled at touching things. Objects still get popped into the mouth. 1.2. Summarise the intellectual development of a child aged eight to twenty months. At this age your childs attention span is beginning to lengthen, he is beginning to develop memory through repeated activity; touching objects made of different textures and materials to see what they feel like provide him to explore different ways of using his hands. He explores and experiments by touching different substances and textures such as different fabrics like velvet and felt which provide soft and hard textures. Babys begin to say there first words such as mamma and dada which are evidence of his cognitive development and the beginning of a fantastic new stage where communication develops into verbal language. As this age he might be able to say a few words such as mamma and dada or simple words which they recognise from parents communication with them but children are quite different, some pick up language fast and others dont, some children dont talk until later into their development. By 20 months they can understand simple requests like pass your bottle. His developin g language may still be restricted to one word at a time and he hasnt quite established putting 2 words together and he may just point at things when he wants them and his vocabulary may vary between 50-100 words. Language development and memory are closely linked and memory are closely linked he will soon begin to realise that language will help him in the world around him, by communicating he will start to learn a few concepts , like tidying up after playing , this helps him take care of his possessions . Michelle howorth NC39964 Assignment 1 Page 5 There are different theories of how he gets to these stages theories that look at the way children think and learn are extremely important as they can be applied to so many situations in everyday life .This also means that when Studying other aspects of child development , such as language behaviour management, or aggression you will find that the same terms and theories keep reappearing .Currently learning theories can be grouped into 3 bands The behaviourist approach suggests that learning is influenced by rewards, punishments and environmental factors .The term conditioning is often used by behaviourists, it means that you learn to act in a certain way because past experiences have taught you to do or not to do something. B.F Skinner is recognised as being a key figure in developing the behaviourist approach by learning theory. Skinner suggested that most humans learn through exploring the environment and then drawing conclusions based on the consequences of their behaviour. Jean Piaget was a zoologist who became interested in childrens cognitive development as a result of working on intelligence tests. He noticed that children consistently gave similar wrong answers to some questions and began to consider why this was. Piaget used his own children to make detailed observations and gradually developed a theory that has been very influential. His theory of learning is sometimes referred to as constructive approach because he suggested that children constructed or built up their thoughts according to their experiences of the world around them. He felt that learning was an on-going process with children needing to adapt (hence piagets term adaption).For example a child aged 15 month may come to believe that milk is served in blue beakers , because their experience of having milk is linked with it being served in a blue beaker. If one day they are given juice in the blue beaker instead of milk they will reconsider the theory and thus come to the conclusion that milk and other drinks come in blue beakers. Piaget used specific vocabulary to describe the process of children learning in this way. Assimilation- the child constructs a theory. (Schema). Equilibrium the childs Michelle howorth NC39964 Assignment 1 Page 6 Experiences seem to fit the schema (everything balances). Disequilibrium An experience occurs that casts doubts on the effectiveness of the schema. (Things dont add up anymore). Accommodation the child changes the original schema to fit the new piece of experience or information; he grouped child development into 4 broad stages Sensori-motor, pre-operational, concrete operational, formal operational. Although Piagets work is well known there are 2 other approaches which are in some ways similar to Piagets, Vygotsky Jerome bruners work was influenced by Piaget but particular by Vygotskys work. Bruners is not a stage theory as such but he suggests that children gradually acquire cognitive skills and he refers to these as modes of thinking. Enactive-0-1 years, iconic 1-7 years, symbolic 7+ years. Bruner believed that cognitive development can be speeded up if stimulated, he also believed that adults had a very important role in developing childrens cognitive skills by working alongsid e them and asking questions helping children to vocalise their thoughts. 1.3 Summarise the language and communication development of a child aged 16-26 months. Much of an 18 months old toddlers speech is jargon is unrecognisable but with emotional content. A child at 18 months should be able to use 5-20 words most of which will be nouns. Examples include mamma, dada bath, and nana. At this age when he learns a new word he will repeat it over and over. 20-25 percent of an 18 month olds vocabulary should be intelligible to outsiders; they are learning every object has a name. A babys vocabulary includes things like names of food, animals, family members, clothing and toys. 18 months may be able to point at parts of the body when a parent names it. A childs vocabulary explodes between the 18-24 month marks, maybe 2/3 of what he says is intelligible and his vocabulary may contain 150-300 words. He should be able to name lots of objects in his surroundings like, chair, bottle, and cup Michelle howorth NC36694 Assignment 1 Page 7 He should be able to form small sentences like want cup he will be able to understand the words my and mine. There are quite a few theories as to explain how children Learn language. Theories of language development fall into 1 of 2 camps; empiricist and nativist. Empiricist believes language is a learned behaviour. Nativists on the other hand believe we are born with some innate language ability. Empirical researchers focus on learning theories to understand how children acquire language skills while nativists look for biological components responsible for the universe rules underlying all of the language spoken by people. Lev vygotsky a Russian psychology researcher who began developing his empirical theories of cognitive development after the Russian revolution in the early 20th century. Children learn by solving puzzles with the help of other people such as parents or siblings. Language develops a tool for helping them solve problems more effectively. They learn the skill by prac ticing or modelling language behaviours they hear being used around them.in his theory, language development is closely tied to social behaviour putting him in the empiricist camp. B.F Skinner, an American psychologist best known for his work in behaviourism, proposed behaviourism as the basis for language development in a book published in 1957. The core behaviourism is learning through reinforcement. the reinforcement takes different forms ,for example if the parent says to the child can you say mummy? and the child responds accordingly the parent provides positive reinforcement . If the child uses language to make demands such as asking for a cookie and the demand is granted, the child receives positive reinforcement for using language. This approach places skinner in the empiricist camp of language development. According to empiricist Jean Piaget, a Swiss psychologist known for studying how knowledge develops in children and adults during the first half of the 20th century, la nguage Michelle howorth NC39964 Assignment 1 Page 8 Development is connected to a childs cognitive development. As the child moves through the different stages of cognitive development. For example, during the pre-operational stage children can grasp the existence of things even when cannot see those things, likewise they can use language to think about those non- present things. Naom Chomsky , an American linguist and cognitive scientist believes children are born with innate knowledge of the rules governing language. This makes him a nativist, his research during the late 20th century also suggest that the rules are universal among the known human languages. For example Japanese and English seem very different, but both languages include verbs and in both languages verbs take an object. The difference is where the object of the verb is placed in the sentence. According to Chomsky the reason the children learn language so quickly is because they already know the rules. Jerome Bruner, a nativist and American cognitive psychologist bel ieved language development comes easier to most children because of a combination of innate biological endowments and social encouragement. Bruners research on the subject began in the 1960s. Bruners notes that even children who cannot distinguish between their thoughts and things attempt to use language suggesting they are born with an inclination towards communication. The role of encouragement is to provide necessary support as the child develops linguistically. 1.4 summarise the emotional development of a child aged between 30 and 50 months. A childs emotional development is hard to monitor because self-concept, gender identity and social status are developing as well. The Michelle howorth NC39964 Assignment 1 Page 9 Way they behave is usually a clear indicator of what they are dealing with on an emotional level. At this age lessons are being learnt which will form a childs personality, the childs personality as influences on emotional development. Children who are more adaptable will progress a lot faster than children who are far less adaptable, things like meeting new people and being in new environment will be more daunting for them. During this age childrens emotional needs are shown through their behaviour, understanding their needs and dealing with them as necessary will help the childs emotional health as the child progresses. Also during this time every experience the child encounters helps to develop the childs self-concept, spending time with parents and other children will give the child a sense of who he is by emotional interactions and will start to develop his independence. Parents are the best role models the help the child develop his sense of gender identity, as a result of the child studying the parent, emotional characteristics of the parent become a part of the childs gender identity. Frustrations and tantrums in a child this age are very apparent; tantrums occur for no apparent reason but are often due to insecurities and not being able to get what they want. By 3 years old this behaviour will have calmed down and he will be beginning to develop interests in feelings towards other people and is starting to feel a lot more secure in his environment , he can keep his frustrations under control , by the time he reaches 4 he will have developed a definite personality and loves to explore everything new , he has excitement for adventures and can show sympathy and concern towards other children his behaviour might start to become erratic , for example he will like things and hate things in the space of a few minutes , he will exaggerate things and become extremely bossy and may begin to start telling lies. Theorist erik erikkson proposed that emotional devel opment consisted of 8 crisis and that each crisis consisted of a specific window in a childs individual development for example the crisis for this specific age according to Erickson is initiative versus guilt according to errikkson a child should develop a sense of purpose by being able to do things on his own , such as dressing himself , if a child is not allowed to do this the child may become afraid to try new things and develop a fear of disapproval. 1.5 Summarise the social development of a child aged between 40 and 60 months. At this age a child interacts with other children very easily but only usually in a small group or with familiar adults. they are beginning to make massive leaps in socialisation which helps them develop a lot more friends .they dont need as much attention from adults because they understand that attention is there when needed. They will show friendship preferences but mainly based on play interests. Children will also now be aware of their own social backgrounds and strive to be accepted for who they are. They understand the difference in culture and gender and enjoy making friends and love being in the company of others. there confidence is building and they begin to understand the concept of sharing and taking turns and also begin to understand the difference between right and wrong. Lev vygotsky proposed that children thrive through interactions with their surrounding culture is theory is known as the cultural perspective in this theory it states that cognitive development of ch ildren is enhanced when they work in their zone of proximal development (zpd). Children need help off adults to support them as they learn new things to reach (zpd). According to vygotskys theory children can do more with the help and guidance of an adult than they can do themselves. In conclusion vygotskys theory of cognitive development states that interactions with other people are essential for maximum cognitive development to occur. 1.6 Analyse treasure baskets and discuss importance of child development. Michelle howorth NC39964 Assignment 1 Page 12 Treasure baskets an idea originally created by Elinor Goldschmeid. A treasure basket is a shallow sturdy basket containing a selection of everyday items, none of which are plastic. Most of the objects are in everyday use by adults and are made of natural materials. The item in the basket vary in weight, size and texture, colour, taste temperature and sound and all the items are chosen to stimulate one or more of 5 senses. Children explore the treasure basket using their senses to discover what an object is, what it is like and perhaps what it does when shaken or manipulated. Children learn by exploration and experience a treasure basket brings many items within reach that a child may not have had the opportunity to handle. A child can feel items with their hands, feet, fingers and mouth, by having this opportunity a child discovers weight, texture and size. Does it have a smell? Can you taste it? Wave it does it make a noise? Drop it and what happens? Can I put it inside another obje ct? Can I join 2 items together? What happens when I bang one item against the other? Elinor Goldschmeid spent time observing children and their parents she looked at how children gain knowledge of the world around them and how parents often give children objects to explore. For example, if when out, a child or baby gets upset, we often give them something to play with that is to hand a makes a noise or can be fiddled with, such as a bunch of keys. When we are busy in the kitchen a child sitting on a floor will often reach for the spoon we have dropped or the pots and pans in the cupboard. These observations led Elinor goldschmeid to the development of the treasure basket as a way of helping children to learn, explore Michelle howorth NC39964 Assignment 1 Page 13 And have fun. Treasure basket ideas were originally designed for babies who were sitting but not yet on the move. The basket is a good exploratory resource for babies and children who are not yet independently mobile babies given safe, Stimulating and supportive opportunities will use their senses to learn about objects they encounter. In doing so they will enter into a world of discovery puzzlement, social encounter and communication. As babies suck, grasp, touch and feel objects they rehearse behaviours which foster their earliest learning (Goldschmeid E 1989). The reason they dont use plastic in the treasure baskets is that many objects made of plastic are similar in many ways , they are often all smooth, have no smell and no taste. In our manufactured world adults and babies use plastic objects every day and a child gains experience of these objects through handling bottles, cups, toys and rattles. By offering a whole range of objects which are not plastic we increase the opportu nities for a child to explore and learn. The items contained in the baskets fall fewer than six headings. Natural objects e.g. pumice stone, a lemon and a natural loofah Natural materials e.g. little basket, wooden nail brush and a paint brush. Wooden objects e.g. curtain rings, clothes pegs and egg cups Metal objects e.g. spoons, bunch of keys, and bunch of bells. Leather, rubber, textiles e.g. leather purse, bath plug and chain, ribbon and lace. Paper/cardboard greaseproof paper, boxes, tubes. More objects that can be put in the basket are objects that rattle, objects that fit inside one another, such as boxes and pegs or graded measuring spoons, Michelle howorth NC39964 Assignment 1 Page 14 building and demolition articles which fit together and take apart, such a wooden blocks, zipped leather purse, a box with a lid, also objects to follow such as wooden eggs, balls and tubes that roll. When choosing a treasure basket there are plenty of points to consider, such as the safety of the basket, you need to make sure that you choose a basket which is strong and durable, without jagged edges and the objects should be washable, disposable and replaceable. For example pieces of fabric. Each object should be clean and safe, always check the basket regularly and be watchful of painted and varnished items, check they are non-toxic and if any doubts do not include them. you may also need to maximise play opportunities you need to aim for a variety of textures ,weight and colour and also be wary of including soft toys as their information and interest value can be limited . Also needed to be considered is where to place the basket in relation to the child. For example would the chi ld find it easier to reach in front or at the side? The child needs to be observed how he interacts with the basket. Do you need to offer more objects for him to explore. How can you make it more interesting? Is there an object the child doesnt like? Children all develop at different rates with regard to exploration be aware of the stage the child is at. Treasure basket ideas can also be adapted for children who are not sitting. Items can be put in a be active box or a little room or suspended from a play gym. The little room is an idea developed by Lilli Neilson for children with sensory difficulties. You can make a little room from a cardboard box, place the box down on its side with the child lied just inside the opening, line the sides with textured materials and suspend objects from the ceiling so that they hang down within the childs reach. 1. 7 Explain what is meant by holistic development Michelle howorth NC39964 Assignment 1 Page 15 Holistic development is when all areas of development e.g social, emotional, physical and intellectual and communication development, work as a whole to develop the childs overall development. Holistic development sees the child as a whole person thats why its important when you observe a childs development so you can observe it as a whole so you can see what progress is being made (or not being made). A good example of this is to observe a child playing hopscotch as this uses all areas of development combined together. Children must be able to understand to take their turn and must cope with their feelings if they do not win. This is personal, social and emotional development. The child must also be able to understand what is happening and understand the rules of the game and be able to count, this is cognitive development. The child must be able to throw a stone, have strength in their legs to support their weight and also be able to balance and have sufficient coordination, this i s physical development and finally the child needs to be able to say numbers out loud, arrange turns and be able to chat whilst waiting for their turn, this is communication and language development. If a child lacks in one of these areas of development he may struggle to play hopscotch, so observing the child as a whole can help practitioners or parents give the child support in the areas he lacks ability.

Personality and Personal Growth Essay -- Psychology Research Papers

Personality and Personal Growth â€Å"An integral being knows without going, sees without looking and accomplishes without doing† – Lao Tzu The text book definition of Personality is an individual’s unique pattern of thoughts, feelings and behaviors that persist over time and across situations. I agree with this idea that a personality is what makes all of us who we are. I believe that a personality is a combination of innate characteristics that everyone is born with and the sum of total life experiences. I believe that a personality is a portrayal of an individual’s reality. The way that an individual walks, talks, speaks and even the career path that they choose to go on is all a reflection of their personality. I believe that each individual is put on this earth to influence every person that they come in contact with; it is the responsibility of every individual to learn as well as teach each other. I strongly believe that you are born with a unique, distinct personality. I remember when both my nieces and my nephew were born each one of them had a specific personality that has transformed and made them each as they are today. My oldest niece, since the young age has always had this older wisdom about her like she was a reincarnated older spirit. This wisdom always comes out in her personality; she is continuously teaching us (older folk) and making us look at life in a different manner than what we would originally look at something. She has made us look out o...

King Philip Essay -- essays research papers fc

King Philip’s War was a disturbing war fought in America in 1675, almost certainly as a result of the early contact between the English Colonists and the Native Americans. The Natives were, and had always been fighting for their freedom and land, as well as their culture unharmed. Though the Natives had their own religious beliefs, the Colonists felt that they were the greater man, and that God would play a part by remaining on their side. The Natives did not trust the English with their multiple cheated promises and such, and it was only expected that the Natives would not believe in the English. There is no one established reason for this war, like many wars, but it is only probable that it be a result of the many differences between the Native way of life, and the English way. The Wampanoag Indians were a tribe that settled in the area of current day Rhode Island and Massachusetts. It is estimated that the number of tribe members was somewhere over ten thousand before the English arrived and brought along sickness and disease that the Natives were not accustomed to. By around 1675 it is imagined that the Wampanoag population plummeted to around only one thousand members. At first, the Wampanoag were accepting of the English because there appeared to be no immediate threat of endangerment of the Natives. The Natives actually became appreciative and dependent on the English in a sense, because they had been introduced to the various types of food, clothing, and most importantly, weapons. Massasoit, the Chief of the Wampanoag Indians at the time, signed a treaty of peace with the English that promised not to give up their land to anybody without the knowledge and consent of the Plymouth government first. It wasn’t until 1630 when the situation reversed with the increasing amount of settlers moving to The Massachusetts Bay Colony known as â€Å"The Great Migration†, that the Natives became angered. The new settlers, the Puritans, were in desperate need of land and would do anything to get it. They wiped the Pequoit Indians out in the Pequoit War of 1637, and other than those who chose to convert to the Puritan religion and way of life, the Pequoit had vanished. Many of the Indian tribes were in trouble with the threat of loss of land, as well as loss of lives. It was time to strike back and defend what was theirs. After Massasoit had passed on, Alexander would... ...sold into slavery in the West Indies, while others faced disease, cultural disruption, and the loss of their lands. Works Cited Bodge, George. Soldiers in King Philips War. NEHG Register many vol's 1886-1887. Bourne, Russell. The Red King’s Rebellion. Oxford University Press, New York, 1990. Church, Benjamin. Diary of King Philip's War, 1675-76. Chester, Conn. : Published for The Little Compton Historical Society [by] Pequot Press, 1975. Leach, Douglas. Flintlock and Tomahawk. Parnassus Imprints Inc., Hyannis, Massachusetts, 1995. Lepore, Jill. The Name of War : King Philip's War and the Origins of American Identity. New York : Knopf, 1998. Narrative of the Captivity and Restoration of Mrs. Rowlandson. New England Chronology NEHG Register vol 7 October 1853. Schultz, Eric B. King Philip's War : The History and Legacy of America's Forgotten Conflict. Woodstock, Vt. : Countryman Press ; New York : Distributed by W.W. Norton, c1999. Shroeder, Betty. The True Lineage of King Philip (Sachem Metacomb). NEHG Register vol 144 July 1990. Webb, Stephen Saunders. 1676, The End of American Independence. New York : Knopf, 1984.

Ballroom Dancing :: essays research papers

Ballroom Dancing: The Development of Two Techniques   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚   It is a fact that emotion stimulates the body into movement. It has been said that â€Å"dancing is older than anything except eating, drinking and love†. Civilization and conditioning has taught people to suppress this natural response but the primitive desire still remains. Prehistoric man expressed his emotions by movement. When speech was just developing, even primitive cave drawings depict men dancing. As time went on and language was developed, the expressive movements of early man continued but transformed from spontaneous, formal and lastly traditional aspects. These dances were adapted as parts a social custom. This became the foundation of folk dances.   Ã‚  Ã‚  Ã‚  Ã‚  Throughout the earlier dark ages, dancing was found in every country in the form of traditional folk dances. Dancing was a regular feature of the church festival days in Italy, France and England. Showing as long as people exist, the desire to move will survive. This instinct for movement enabled crude folk dance to survive the dull dark ages. Dances from this period were drawn from the Christian Era and by the 15th century dance records became popular, documenting the actual dances then in â€Å"vogue†. This is when the earliest ballroom dances were documented. One documenter, Thoimot Arbeau published ‘Orchesographie’ in 1588. Arbeau lived in a time of transition where solemn dance was giving way to a livelier dance form. Even in the days of Arbeau, technique was slowly being formed by the dancing masters of the period, but it was not until the latter half of the 17th century, after Louis XIV that the hard and fast rules for execution of the every dance were laid down by the members of the Academy and the five positions of the feet were formulated for the first time.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  The ballets presented in these days were spectacular based on technique. The first intertwining of the ballet and ballroom came when professional dancers appeared in ballets and the ballets left the court and went to the stage. When the ballet moved to the stage its technique became considerably enriched. Such changes went on also in ballroom dancing, in 1812, the modern hold made its appearance in ballroom waltzes. And the next advance towards what we call modern dancing was made in the 1840’s when several dances made their appearances in the ballroom. These included the Polka, Mazurka and the Schottische. There was also a trend to drop all decorative steps in ballroom.

An audience’s responce to Hedda gabler Essay

Hedda Gabler is a dramatic, exciting, confusing and at times unpleasant character, who is frustrated by a lack a freedom where she cannot be the wild and unstable free spirit that she wishes and this shines through throughout the play. From this frustration comes immense boredom which is in her case very deadly. She embodies some of the typical Aristotelian qualities of a tragic protagonist but Ibsen has put a strange twist on it. For example she is a woman of fortune. It has been made clear in the book that she was born into this high class lifestyle and has this fortune by no endeavour of her own. Therefore, by being placed at the top of the hierarchy, she has further to fall and there is more at risk than the average person. However, she is not really someone that people can identify or can have sympathy for, as neither generous nor courageous. Also, as is common her fatal flaw is her snobbery or pride. However, Aristotle’s notion of hamarita states that it is a ‘ matter of action’ not the character themselves. I don’t believe this applies her and agree with the 20th century interpretation. This is not brought about by the unfortunate circumstances more than the character themselves. This applies very much to Hedda as her ‘conflicted individual moral psychology which brings about the opposite of what the character intends’. The Norwegian playwright, Henrik Ibsen was very specific about the time when he set Hedda Gabler. The late 19th century was a time where woman were secluded and deluded into an oppressive and subjugate lifestyle. Ibsen puts Hedda in this male dominated were she challenges the conventional middle class bourgeois housewife by acting in a dictating and manly way witch were to shock the 19th century audience at this truly outrageous and outspoken character. The audience can therefore not identify with Hedda because in more ways than one she brings about her own demise. The local newspapers and media were disgraced; such as the daily telegraph which said ‘What a horrible story! What a hideous play! †¦ The play is simply a bad escape of moral sewage-gas’ Describing Hedda’s feelings as ‘the foulest passions in humanity’. This shows that the most tragic thing to me is that there are people her in this world. The play is started off with the stage layout, witch Ibsen perceptibly and carefully layout, giving a very bourgeois atmosphere each object has a lot of meaning to show the tragic nature of the play and Hedda. For example there are a lot of dark and dull colours hinting to things; such as saying ‘autumn colours’. Ibsen is using pathetic fallacy to show Hedda’s state of mind. Autumn is a time were everything around us is dying, dead leaves on the floor and animals hibernating. A time were there seems to be a deafening silence in the air following the summer which is usually buzzing with life. This could mean that maybe Hedda has passed the summer time in her life. A time when she was herself bloom perhaps and a time when she was also buzzing with colourful life. It is mentioned that Hedda used to go to parties and be a socialite. Then we see her state of mind at the present which is autumn. This already sets the scene of this play as pessimistic and cold. This is unusual for Ibsen’s targeted audience as they were used to cheerful and uplifting entertainment. Something to bewitch them into thinking their lifestyle was perfect as it was, which Hedda Gabler does not do in the slightest. Another thing that might have stunned the audience is Hedda’s awkwardness towards Miss Tesman and Mrs Elvsted. At a time were woman only socialized with woman it is interesting to see how she treats her fellow females in such a horrible manner. This is shown towards the beginning of Act1 were she call’s Miss Tesman’s hat to be servants hat. As Miss Tesman is Mr Tesman’s mother figure she should also traditionally be Hedda’s too, so by disrespecting like that would cause the audience to empathise with Miss Tesman and detest Hedda and her behaviour. Hedda also has a very unusual characteristics she presented by Ibsen in a very masculine way. By doing this she is emasculating George Tesman. To begin with he does this himself with Mrs Tesman, the keyword for the first is claustrophobic for Hedda; witch, with me, causes some sympathy for Hedda. With a combination of the childish nicknames (like Georgie and aunty juju) and the dreaded flowers make it as much cringe worthy to the audience as it was to Hedda, which is shown when they leave when The most prominent way that this is done is through the pistols, General Gabler’s pistols.

Human Resources and Industrial Relations in the Public Sector Essay

INTRODUCTION Industrial relations is concerned with the relationship between management and workers and the role of the regulatory mechanism in resolving any industrial dispute. It covers areas such as collective bargaining, trade unions and the government. Human resource management (HRM), which has a soft approach (people friendly) and a hard approach (people as a resource to be used as seen fit by the organization), could be summarized as a strategic approach to managing employees. The role of industrial relations has been diminished to some extent in Trinidad and Tobago with the implementation of human resource management practices and policies. However some of the aspects of the traditional public sector model and the environment it was planted in has survived till now, which affects the implementation and success of new public management. LITERATURE REVIEW â€Å"Comparative Industrial Relations: An Introduction to Cross National Perspectives† by Bean 1994 states, Dunlops prescription of the advancement of knowledge in IR is the need to break away from the restrictive and myopic confines of problem solving, institutional studies with individual countries- what has been termed ‘ethno-centric’ bias- in favor of border comparisons over the course of time and across countries. He postulated that the systems theory was applicable to study comparative industrial relations. Haworth 1991 however states that the systems theory fails to explain how the pattern of industrial relations has developed in Third World countries. The industrial relations system responds to social political and economic change  whereby actors (mainly management) usually have a number of responses they can make, therefore there is the existence of discretion in decision making which will in turn affect industrial relations. Kochan et al 1984. Zeitlin 1987 states, industrial relations can best be explained not by the social and economic structure but by historical divergences in institutional development resulting from the strategies and organizations of the state, trade unions and employers. This book basically deals with comparative industrial relations where research is done on similar phenomena taking place in different countries. Poole 1986 highlights four principles for this research to be done, 1. Focus on environmental influences coming from the societal processes and structures. 2. Multi-disciplinary perspectives incorporating social, political and economic aspects. 3. Explanatory variables as opposed to descriptive categories. 4. Utilizing the historical as well as contemporary dimension. Trade unions are institutional representatives of worker interests within the labour market and the society. It is collective rather than individual â€Å"concerted behavior is the essence of modern trade uni onism†, (Ulman 1990) He also spoke of the ‘individualizing’ of industrial relations into human resource management. Industrial Relations and Globalization: Challenges for Employers and their Organizations†, a document prepared by David Macdonald (1997) states that during the period of the 1990’s there were new demands of international competition and dramatic advances in technology. Globalization had also changed the nature and operation of the ‘market place’ and production in many countries across the world. Considerable demands were placed on employers and enterprises thus new structures, processes and strategies were required to be implemented. Within the enterprise, industrial Relations (IR) plays a very strategic role and many changes much be made to the traditional practices and human resource Management (HRM). This new approach attempts to improve flexibility and skills of the workforce which would seek to improve various aspects within the workplace such as trust and communication between managers and workers etc. David’s paper focuses on industrial relations trends and developments in Asia and the Pacific with special attention paid to the challenges organizations and employers are to be faced with. The paper also observes the changing nature of industrial relations and its development as influenced by the forces of globalization, liberalization as  well as the historical and current factors which influence the relations in the region. He defines industrial relations as the means by which various interests in the labour market are accommodated, primarily for the purpose of regulating employment relationships. Industrial relations are therefore concerned with relationships within the workplace and in the organization at all levels. These relationships are expressed through collective bargaining, involvement of workers in decision making etc. Traditionally, industrial relations was to achieve collective outcomes at a national and/or sector/industry levels which are then applied to each enterprise. Human Resource Management is different as it focuses directly at the level of the enterprise seeking to align interests of workers both individually and in groups, managers for the purpose of corporate objectives, seeking to accomplish a competitive advantage in the marketplace. In the book ‘Understanding Work and Employment: Industrial relations in Transition’ looked at the contribution and challenges of human resource management to industrial relations. Due to ‘high commitment management’, human resource management (HRM) is seen to be replacing trade unions. Traditionally, personnel was seen as a subset of IR but in the 1980’s, employee relations evolved to IR being a part of HRM. Eight main issues of HRM to IR were identified as being a change of focus from a sociology perspective to a psychology perspective, a move from pluralism to unitarism, a stress on management as the main actors in the industrial relations system, an emphasis on business strategy and ‘fit’ between policies, the application of the resource based view of the firm to employee relations, the influence of high commitment management and the challenge of the psychological contract view to the understanding of employment contract. Industrial relations had its share of hardship as it journeyed to succession. Historians and novelists acknowledged the drastic changed made in the British society which came about during the industrial revolution. Karl Polanyi described the excruciating changes which took place as feudal societies transformed to an industrialized state. He identified that â€Å"the effects on the lives of people were awful beyond description† (Polanyi 1957, 76). Also stated was: In disposing of a man’s labor power the system would, incidentally, dispose of the physical, psychological, and moral entity â€Å"man† attached to the tag. Robbed of the protective covering of cultural institutions, human beings would perish from the effects of social exposure; they would die as the victims of acute social dislocation through vice, perversion, crime and starvation†¦. No society could stand the effects of such a system of crude fictions even for the shortest stretch of time unless human and natural substances, as well as its business organization, were protected against the ravages of this satanic mill. (Polanyi 1957, 73). Polanyi stated that the negativity that the industrial revolution faces was not much of poor conditions under which individuals live or worked but rather the displacements faced by employees whom are no longer under the protection of cultural institutions. Employment relations and the social sciences by Hills revealed that there is a link between industrial relations and the discipline of social sciences. Steven M. Hills also extended the search of systems analysis by Dunlop where he established a structure to put in order the variety of concepts, of which many never was fully known, which comprise the study of industrial relations. Hills, in his explanation for choosing the employment relationship rather than labor union as his reference point, are because his attention was focused on the controls that govern employer-employee relationships. Understanding these controls is an important aspect in order to express appreciation toward the underlying forces of industrial relations systems according to Hills. He also shows the closeness these controls impose by the government, labor unions and social classes. In Hills analysis, he showed the difficulties faced in all employment relationships, whether they are well-thought-out as pre-industrial, industrial or alleged â€Å"post-industrial† citizens where unions are strong, weak or nonexistent. TRADITIONAL IR SYSTEM INCLUDING DISCUSSION OF THE TRADITIONAL PUBLIC SECTOR MODEL Industrial relations produces and organizes knowledge, it is unique and has its own theories, concepts, techniques, practices and ideological commitments. Industrial relations was born in the United Stated in the 1910’s. It was a reaction to the waste, human suffering, the social injustice as well as the employer- power in the nineteenth and early  twentieth century capitalism. It also arose because it was viewed that relations between bosses and workers could be improved. Industrial relations in terms of academia is the study of labor problems but gave priority to specific areas like a strategy or institution for solving problems for example the trade unions or collective bargaining. The early version of industrial relations emphasized inherent conflict of interest which exist between the employer and employee, that there is superior bargaining power of the employer and the autocratic nature of workplace governance in the traditional firm. With the globalization of industrial relations there was the spread of industrialism, market economics, trade union movements, protection of human rights and political democracy. There was a decline in industrial relations because of the decrease in trade union density, major forma of labour unrest, political power in many countries, the rise in human resource management, the rise in neo-liberalism, national and world politics etc. Industrial relations is centered around fostering stability, efficiency cooperation, peace and positivity. In the 1960’s there began to be a slow decline in industrial relations. There was a narrowing of the intellectual domain and the field was becoming marginalized. Numerous universities in the 1990’s dropped the term ‘Industrial Relations’ and adopted ‘employment relations’ or ‘human resources’. Over the years industrial relations had made attempts to establish itself as a self- contained academic dis cipline but continued to fail (Kaufman 2004). There was the shrinking role of collective bargaining as well. The traditional industrial relations model is concerned with a particular set of phenomena associated with regulating the human activity of employment. It focuses on the implementation of rules within the work place and factors outside of the work place which influences the process. It is concerned with collective bargaining, trade unions, employers, managers and payments. John Dunlop originated the systems approach to industrial relations which is basically an integrative model which seeks to provide tools of analysis to interpret and gain an understanding and how and why particular rules are established in particular Industrial Relations systems and how and why they change in response to changes which affect the system. John Dunlop (1991) applied the systems theory which embodies a set of actors, rules, context and ideology. Flanders (1979) and the Oxford Approach defined industrial relations as the  study of institutions of job regulation. Flanders states that the institution and job regulation can be categorized into the internal and external factors; he insists that collective bargaining is central to the industrial relations system. Flanders agreed with Dunlop (1958) that rules are also essential but continued that rules are only a generic description which can be given to these various instruments of regulation. Heyman (1957) a critic of industrial relations scholars agrees that rules are a mandatory aspect as well. He however, criticizes the Oxford school and Dunlop for not acknowledging the importance of informal rules in the industrial relations system. Heyman (1975) takes the view of the Marxist perspective and views industrial relations as the process of control over work relations, or as the political economy of waged labour. The three perspectives of industrial relations are as follows: the Marxist perspective, the unitary perspective and the pluralist perspective. Fox agrees that industrial relations provided the foundation for Human Resource Management. Concepts and practice of industrial relations are as follows, collective bargaining, trade unions, models of trade unions, the voluntarist tradition, compulsory system and the adversary system. The first four decades of the 1930’s in the English- speaking Caribbean was dominated by political unionism. The shift was largely influenced by globalization. There was rapid expansion of enterprises in almost all aspects. The three phases which affects the Caribbean’s history were, the colonial phase and the colonial administrator, the post- colonial phase and the globalization phase. There was a social division between labour and capital in Trinidad and Tobago. During the 1930’s Trinidad and Tobago suffered the effects of the worldwide depression. There were unjust labour practices and the wages were exceptionally low. The colonial era in Trinidad and Tobago was basically one in where there was unilateralism in rule making by employers, voluntarism and non-involvement of the state and there was the social and economic exploitation of the people. During the post-colonial eras, there was the adversarial system, state control, it was pluralist to a certain extent and was unitary. ANALYSIS AND FINDINGS The globalization period brought drastic changes to the public sector and  industrial relations. There were structural adjustment programs, free trade, foreign aid, investment as well as reforms in the labour market. Gray (1998) describes globalization as the worldwide spread of modern technologies of industrial production and communication of all kinds. The consequence was that solutions for the contemporary Caribbean were no longer the same as the ones in the past. There was a missing link and a burning need for a Human resource management approach to step in. It was the approach where â€Å"a human workplace† menaing â€Å"the company looks after their employees and the employees look after their company. The human resource management function was now an integral part of management. It can be said that the role of industrial relations, policies and practices have diminished in comparison to the earlier years under the traditional model after human resource management was introduced. During the 1930’s in Trinidad and Tobago, the industrial relations paradigm was quite dominant. There was a severity in struggle with respect to the working class as the country had experienced periods of enslavement and indentureship, workers had no rights and there was no place for grievances. This period was controlling and dominant and there was the Royal Commission of Lord Moyne (1938) which was to investigate the labour and social conditions in the British West Indian Colonies. In Trinidad and Tobago there was hardly any political representation and all power and responsibility was centered on the governor. Trade unions had to fight for political and social status, industrial politics political unionism and trade unions- based political parties are rooted in the tradition of Caribbean societies. This legacy has continued even until today in the Trinidad and Tobago public sector. However, it is safe to say that the implementation of human resource management policies and practice has reduced the influence and popularity of industrial relations to the public sector and society as a whole. With the implementation of various departments in organizations, including human resource departments, managers are taking are not only reducing the need for certain aspects of industrial relations but also deal with problems. Therefore the connection between employee and the trade union or government organizations are being wiped out. This may be because it fosters an environment that shows the employee that the organization cares, but may also reduce the chance of negative stories or problem leaking outside of the organization, preventing bad  reputations from being created. Human Resource Management includes conducting job analyses, planning personnel needs, recruiting the right people for the job, orienting and training, managing wages and salaries, providing benefits and incentives, evaluating performance, resolving disputes, and communicating with all employees at all levels. Examples of core qualities of HR management are extensive knowledge of the industry, leadership, and effective negotiation skills. Human resource management is formerly called personnel management. Although ‘high commitment’ as stated by some scholars, it reaps the most rewards for the organization itself. CONCLUSION Human resource management is seen as the new way forward. Industrial relations still has a connotation of trade union struggles and equality battles. Industrial relations still play a major role in organizations in Trinidad and Tobago. While human resource management is increasingly dealing with the issues and concerns of employees, there is still a need for government intervention. At the conciliation unit of the Ministry of Labour, Small and Micro Enterprise Development Limited, there are a thousand trade disputes reported on average per year. When management may be the problem, industrial relations and its components are of use. However, HRM is still a developing concept in Trinidad and Tobago. HRM could be seen as a developed country’s take on employee relations and Trinidad and Tobago is still developing. Aspects of the traditional public sector still exist. Since industrial relations still play a major role in Trinidad and Tobago society, it would be wise to adopt a more employee relations approach. In the past, HRM was not entirely successful in Trinidad and Tobago. It is still a relatively new concept and field to the developing world. Due to the circumstances and nature of Trinidad and Tobago, HRM may not be the best policy to implement in society at this time. Human Resource Management can also pose as a challenge for Industrial relations as it can undermine the role of trade unions at enterprise level. Realistically however, human resource management and industrial relations policies and practices can be harmonized to benefit each other. As society changes and more are demanded from employer, employee and the  organization, adopting the more common soft approach to human resource management shows development on the part of the industrial relations system. There is a need for industrial relations in society, but by adding more roles that may have diminished due to human resource manage, it ensures not only survival but the ability to survive in a society where west is viewed as better, and human resource management is the way of the west. References Ackers, Peter, and Adrian Wilkinson. Understanding work and employment: industrial relations in transition. Oxford: Oxford University Press, 2003. Bean, Ron. Comparative industrial relations: an introduction to cross-national perspectives. 2nd ed. London: International Thomson, 1999. Collings, David G., and Geoffrey T. Wood. Human resource management: a critical approach. London: Routledge, 2009. â€Å"Employment Relations and the Social Sciences.† Google Books. https://encrypted.google.com/books?id=lTIS5L5JbD0C&printsec=frontcover#v=onepage&q&f=false (accessed November 21, 2013). Mac Donald, David. INDUSTRIAL RELATIONS AND GLOBALIZATION: CHALLENGES FOR EMPLOYERS AND THEIR ORGANIZATIONS . Asia-Pacific in the Twenty-First Century Turin, Italy: ILO Workshop on Employers’ Organizations, 1997.