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How to write a good argumentative essay Geneva School of Diplomacy

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Annual Accomplishment Report Essay. The Alternative Learning System, since its implementation, saw the great success of its programs. A Good School? As an writing a newspaper alternative way of learning, it provides a viable alternative to the existing formal educational system. Its two major programs the argumentative essay Accreditation and Equivalency Program (AE) and the Basic Literacy Program (BLP) become the how to a good literary University new hope for our out-of-school youths and adults in fulfilling their dreams since some of them haven#8217;t been in school for such a long time. Another program of ALS, the Informal Education (InfEd), is a lifelong process of learning by which every person acquires or accumulates knowledge, skills, attitudes and insights from daily experiences at home, at work, at play and from life itself. Alternative Learning System has been a very important component of our educational system to achieve quality and access to education as envisioned in the Education For All 2015 (EFA). How To Argumentative Essay School Of Diplomacy? Its main goal focuses on the eradication of illiteracy and poverty alleviation and among its key functions are: to promote, improve, monitor and write a good Ruskin University (Navitas) evaluate alternative learning interventions for functional literacy of out-of-school youth and a good essay of Diplomacy adults. II.

ALTERNATIVE LEARNING SYSTEM GOALS, MISSION VISION: Sustainable human resource development through quality basic education. Empowerment of learners for a literacy learning who can contribute for how to write about yourself, the social, economic, cultural and values development resulting to how to write a good improved quality of life. It is envision in Pangasinan II that every ALS learner will become functionally literate, productive, and write an autobiography essay University effective members of the society, useful, caring and patriotic citizens. As a newly-hired mobile teacher, I started to lay out my plans for how to a good argumentative Geneva, the ALS program in articles American the month of June. I went to different barangay of Natividad especially in identified areas where most of the residents belong to marginalized group of learners and are underprivileged. I coordinated with community leaders and conducted advocacy campaign to identify potential learners. I recruited learners for the AE and BLP Programs.

I also conducted the Functional Literacy Test to assess the learner’s level of a good argumentative essay Geneva School learning and competency. I coordinated with the school ALS coordinators in identifying in-school overaged learners by how to essay about yourself Dulwich the middle of June. I assisted my learners to fill up their ILA and prepared for them an individual portfolio. I encouraged them to register for Geneva School of Diplomacy, the AE Examination. I assisted in the consolidation of Literacy Mapping in July and in the succeeding months. In celebration of Nutrition Month, we were able to put up a vegetable garden around the CLC. I also prepared the MIS and LIS of essay Concord my learners. By the end of July, I assisted in the AE registration. I also provided my learners with individual copy of write argumentative Geneva of Diplomacy AE reviewer at my own expense. For the month of August and September, I accomplished the Learner’s Reference Number through online encoding.

I attended the three-day Municipal-Based Kalusugan Pangkalahatan Training Seminar at Batchelor East, Natividad, Pangasinan in creative School October, and also a three-day seminar of Gender and Development at Urdaneta City in November. From July to November, I conducted a regular learning and write a good Geneva School review sessions to my learners in preparation for the AE Test. By December, I was able to assist my learners to take the AE Test at Binalonan, Pangasinan. Also, I was able to accomplish all the reports and requirements to be submitted to the Division Office on time. IV. STRATEGIES, INTERVENTIONS AND ACTIVITIES FOR IMPROVEMENT: Varied forms of teaching strategies were employed during the implementation of the how to essay Griffith program. Implementer used interactive modules and applied various approaches and mode of delivery such as face-to-face, group session, individual tutorial, guidance and counseling and Geneva of Diplomacy the learning session approach. V. IMPROVEMENT IN EDUCATIONAL METHODS, PROCESSESS BETTER ASSESSMENT METHODS: To hasten the process of learning, I shouldered the reproduction of some of the modules and review materials for our learners. I also provided all of them with necessary school supplies facilitate the learning session process. VI. INSTRUCTIONAL MATERIALS AND KITS: ALS Learning Modules.

Accreditation and Equivalency Reviewers. Mobile Teacher Tool Kit. ALS Core Competencies. Functional Literacy Test Sheet. Creative Thinking Skill Preparatory? Basic Literacy Program Learning Modules. Reference books, booklets and pamphlets. White board marker. VII. PHYSICAL INPUTS – (Community Learning Center): Natividad District is very lucky enough to have a Community Learning Center intended for how to School, ALS Learning Session at Natividad Central School. In other barangay, we seek the permission and assistance of school head or barangay official for us to utilize vacant classroom or barangay hall where we could conduct our learning sessions. In some instances especially in areas where school or community hall is not available, we occupy any space where session can be conducted.

VIII. PROBLEMS ENCOUNTERED ACTIONS TAKEN: Some of the learner especially adult learners are affected with their life problems and insecurities. They have their minds on so many things about their family life. The fact that they belong to indigent population attending classes at their age is no longer their top priority considering their economic status. Adult learners are often worried since they haven#8217;t been in school for such a long time. Being the ALS Implementer, counseling, individualized attention, and how to write an autobiography Griffith University plenty of how to encouragement help a lot in such situation. Other problems encountered during the implementation of the Griffith University (Navitas) program are the sustainability of the program with regards to its contact hours, absenteeism and laziness.

The learners also come in the learning center according to their own flexible time that’s why Instructional Manager makes continuous repetition of the how to write a good argumentative essay of Diplomacy lesson. With regards to these problems, home visitation, tutorial, giving assignments and encouragement through relating personal experiences were the how to literary essay Anglia University (Navitas) actions applied. How To A Good Geneva Of Diplomacy? I therefore conclude that the ALS workforce in Natividad District Local Government Unit should work hand in thinking skill Сollege School hand to promote the welfare of write essay Geneva our learners in the implementation of its programs and projects. Every member of the community plays an important role for a wider coverage of the program. To facilitate the smooth implementation of the program implementers must have the necessary training and write yourself Dulwich orientation before taking the post. How To Write A Good Essay Geneva? The agency or agencies concerned must provide complete set of learning modules, reviewers and all other necessary learning materials for the course.

Multi-media based learning session must also be encouraged to upgrade the teaching and learning process. University/College: University of Arkansas System. Type of paper: Thesis/Dissertation Chapter. Date: 16 August 2016. Let us write you a custom essay sample on Annual Accomplishment Report. for only $16.38 $13.9/page. Thinking Chaminade Сollege? Haven't found the write a good argumentative Geneva School Essay You Want? Get your custom essay sample. For Only $13.90/page.

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How to Write an how to write a good essay School of Diplomacy eCommerce Business Plan for Your Startup. So you’ve decided that you want to quit your day job and thinking skill Chaminade, start your very own e-commerce empire. That’s great! But before you become the next Jeff Bezos (and definitely before you quit your job!), it’s worth spending some time to write argumentative School, think about a business plan. In this article, we’ll dive into the key elements of an e-commerce business plan, which is very different than writing a traditional business plan. Why You Should Take the Time to writing a newspaper Griffith, Write a Business Plan. We know that starting an e-commerce business is how to a good argumentative essay School of Diplomacy, exciting and it can be tempting to jump right in, without constructing a business plan. READ: PLEASE DON’T DO THIS.

If you haven’t put your ideas, questions and concerns on paper, then you haven’t given your business model enough thought. Taking the time to write a business plan might seem like a lot of work but it can save you a lot of time and money in the long-run by how to about yourself College, better preparing you for potential challenges and opportunities that you’ll face as a first time entrepreneur. When writing a business plan, YOU are your target audience! The point of a business plan is to help you get your ideas down on paper – so don’t worry about making it fancy or excessively long. So what should one hope to get out of a good essay Geneva School of Diplomacy, a business plan? Knowledge. Writing A Newspaper Griffith University! A better sense of what you know and more importantly, what you don’t know.

Resources. The resources you’ll need to make your business successful (e.g. money, partners, employees). Road map. Write A Good School! Helping you set clear goals for your business from the outset. Viability. Probably the most important thing – once you write your business plan, you should have a better sense of the viability of the opportunity. Now that you know you need a business plan lets jump into the sections you need to think about. Download our FREE list of 32 profitable e-commerce niche ideas. Complete with our proprietary ranking system comprised of easy-to-read scores for Customer Lifetime Value, Gross Margins, Content Popularity, and about Dulwich College, Search Marketing Opportunity.

Creating a short, crisp value proposition is a good gauge for how clear your idea is. Write Argumentative Essay! Write this section as if you had one minute to write about yourself Dulwich College, explain your business to a potential investor or customer. Argumentative Geneva Of Diplomacy! Then practice it over write a good Anglia and over and over again until you feel really confident in explaining it to someone. Once you write this and how to argumentative essay Geneva School, are happy with it, use it on your website as your company description. Let’s say you’re looking to Сollege Preparatory, start a hiking company, called Atlas Hiking Co., which sells premium performance hiking shirts. A possible company description could be the following: Atlas Hiking Co. is a lifestyle hiking company that produces high performance hiking shirts for outdoor lovers. Our proprietary SPF40 fabric is one of the lightest fabrics on the market, providing mountain lovers with maximum comfort, both from a breathability and sun-protection standpoint. Our product is made in the U.S.A. and how to write a good essay of Diplomacy, a portion of our profits are donated to creative thinking skill Chaminade Preparatory School, preserve national parks around the country. Before you start diving into the weeds, it’s a good idea to first develop a framework for how to write essay your business model.

Once you go through the different sections of the business plan and conducted extensive research, you will definitely want to make some tweaks to your business model so no need to conclusion to an, make this perfect. There are a number of ways to write argumentative Geneva School, sell a product on the internet and several different business models one could employ. Depending on what you intend to sell, it’s important to think through which business model makes the most sense for your product. Physical products: Clothing, shoes, home goods Digital products: Software as a Service products, ecourses, ebooks Services: Consulting services, home cleaning. Business to Business (B2B): You are selling to organizations, corporations and non-profits rather than individual customers Business to Consumer (B2C): This means you are selling to individual consumers rather than businesses Marketplace: You are acting as a middleman by bringing businesses and how to write a narrative essay Dulwich, (B2B or B2C) customers to a good School, one website. How are you sourcing your product? Manufacture In-house: You make your product or service in-house Third party manufacturer: You outsource manufacturing of argumentative essay, your product or service to a third party manufacturer Dropship: You partner with a dropship manufacturer. Basically this means that they make your product, package it and ship it directly to how to a good argumentative of Diplomacy, your customer while your company handles the entire customer relationship Wholesale:You buy goods or services from other companies in bulk and re-sell those products on thinking Chaminade Сollege Preparatory your website.

Here’s a fact you can bank on: there has never been a successful e-commerce entrepreneur that didn’t understand his/her market, cold. That’s why this section is one of the most important in the entire business plan. It will force you to understand the industry in which you operate, the overall industry outlook, the how to write a good Geneva existing competition, and write an autobiography University (Navitas), your target customer demographic. Before you even get started in writing this section, you need to spend several hours researching the market. Here are some of the most efficient ways to research a particular market: Google is your best friend. How To! Look for any recent industry reports on your market of how to write Anglia Ruskin University, choice.

This will give you a good sense of how much growth the industry is write a good essay, experiencing, why this growth is happening and what are the largest customer segments. In our example of Atlas Hiking Co., we should research the outdoor apparel market. Let’s say that through our research of the outdoor apparel industry, we discovered that there was a huge boom in youth hiking apparel. How To Essay College! Perhaps parents were increasingly concerned of their kids’ exposure to UV rays while hiking so began to spend more money on write argumentative Geneva of Diplomacy their kids. We could use this valuable information to guide our business strategy. There’s only how to write an autobiography essay Griffith University (Navitas), so much you can read online. Argumentative Of Diplomacy! Go to a nearby store that sells similar products to yours and a newspaper article for kids University (Navitas), interview the store representative. Write A Good Geneva School! The store rep has interacted with hundreds of write a good literary essay, interested customers which can lead to essay School of Diplomacy, thousands of valuable insights!

It’s amazing how these insights can translate into a meaningful business opportunity. Here’s an travel articles American University Washington example: If I was going into how to write of Diplomacy, a Billy’s Outdoor Store to research the outdoor apparel market, I would probably ask Billy the following: What are your best selling products? What are your worst selling products? Find products similar to yours and ask the representative his/her favorite features on products similar to yours. University (Navitas)! How much are customers generally willing to spend for these types of products? Do customers make repeat orders of any of these products? Do you get a lot of customers that are looking to buy last minute hiking gear before they go on a hike? Create an excel spreadsheet of all of your competitors.

In your excel spreadsheet, you should have the following columns: Competitor Name Website Price point Product Description Key Features (e.g. Write A Good Essay School! fabric, waterproof, slimfit, etc.) What is the competition missing? Is there a gap in the offering? Where you can add some additional value? After conducting the competitor analysis, Atlas Hiking Co. might find that the competition’s hiking shirts offer very few features at write literary essay University a low price point, but no one offers a luxury hiking shirt with additional features at a higher price point. This is just an example of the types of insights one can gain from market research which can drastically alter your business model. By using Google’s keyword planner and trends pages, you can get a good sense of how in demand your product is and whether it’s trending upward, or downward.

Google is great for a general idea, just don’t bank on how to write argumentative Geneva it. The video below is a good guide on how to use Google Trends and Google Keywords. Are there nearby trade shows that you can go to? Again, creating connections with other people in your industry is a sure-fire short-cut to countless hours of reading on the internet. Trade shows are also a great opportunity to argumentative essay Concord College, talk to competitors, meet manufacturers, and better understand where things are heading in write a good argumentative Geneva your industry. Once you finish researching the relevant industry, you should summarize your findings by how to write an autobiography, answering the write essay Geneva School of Diplomacy following questions:

How big is the overall industry? How big is the specific sub-industry in which you intend to operate? Where has most of the historic growth in the market come from? Why is this the right time to enter this market? What are the how to an autobiography Griffith University (Navitas) sub-segments that are poised for future growth (e.g. youth apparel)? How crowded is the product category with competition? How is your competition distributing their product (online, retail, wholesale etc.)? What’s missing from the competition’s product offering? Who is your target customer (population size, age, geography, education, ethnicity, income level)?

Are consumers comfortable with buying your product category online? So, now you’ve concluded that you have a great business idea and Geneva School, it’s in a growing market. That’s great – but how are you going to drive traffic to your website and to an argumentative, get customers buy it? And how much can you afford to spend on your product? In order to come up with a marketing strategy, you need to first know your customer inside out. You should be able to answer such questions as: How old is your customer? Where does your customer live? What is the population of how to argumentative of Diplomacy, your customer base? What is how to Griffith, their education level?

What is how to write argumentative School, their income level? What are your customers’ pain points? With so many channels to reach your customer, which one is best for you? Once we know pretty much everything there is to know about our target customer, we can shift focus to our marketing strategy. What channels should you use to grab the attention of your customer demographic? Some of the key marketing channels include:

Pay-per-click – this typically involves using Google Shopping campaigns and managing a product data feed. Affiliate sale networks – Allowing other blogs and websites to sell your product for a cut of the a good literary Anglia Ruskin revenue. List the different affiliate sale networks that you plan to promote through. Social media (Facebook, Instagram, Pinterest etc.): Which is your strategy for social media and where will you dedicate your attention? Search Engine Optimization – Create and argumentative essay Geneva, promote awesome content so people find your product organically through search. Write An Autobiography Essay Griffith (Navitas)! What is write argumentative, your content marketing strategy? Come up with a content roadmap that lists the next 10-15 articles you want created as well as your strategy for creating such content (in-house vs. outsource). Writing University Washington! How will you persuade people to buy your product once they get to your site? Blogger networks – could be organic or paid through affiliate sale programs. Develop a list of the key bloggers in your product category.

For Atlas Hiking Co., this might be an influencer that blogs about the best hiking trails in America. Finding the optimal mix of these advertising tools depends 100% on your customer segment as well as your product type. For example, a SaaS product targeting millennials will require an entirely different marketing strategy than an e-commerce physical product targeting baby boomers. Perhaps that should be a post on its own for another day! How much should you spend to acquire a customer? In order to understand this, we need to first discuss a concept known as Lifetime Value of a good, Customer or LTV. Write An Autobiography Griffith University (Navitas)! In essence, this is a formula that helps you better understand how much an average customer will spend over time.

Here’s a good read on how to calculate LTV. It’s important to remember that for new businesses, you don’t have a lot of data on customer purchase habits so it’s a good idea to be more conservative with your assumptions in calculating LTV. Let’s say, for Atlas Hiking Co., I determine that the average LTV per customer is $300. This means that over time, the average customer will spend $300. Argumentative School Of Diplomacy! Let’s say on average, if I receive $300 in revenue, $100 of that will translate to to an essay Concord College, gross profit before I factor in my marketing costs (basically I’m just subtracting out the how to essay Geneva of Diplomacy cost making the shirts). Knowing that my gross profit is $100 per how to write Griffith University (Navitas) shirt is a critical piece of information because it tells me that I can spend up to $100 in how to write argumentative School of Diplomacy marketing to creative thinking Chaminade Сollege, acquire a customer and still be profitable! With so much technology and SaaS products out there, it’s important to understand the various moving parts and a good essay Geneva of Diplomacy, diagram how they all integrate with one another. Some of the different elements include: Come up with a detailed list of the different products and services you need to to an argumentative Concord College, run your business as well as the monthly and per how to write essay Geneva transaction cost of each of them.

This will be important in understanding the impact of these services to your margins. So we know we want to sell hiking shirts, that’s great! But for some of thinking Сollege School, us, we’re not quite sure as to what we should sell. To succeed in online retail, you need a product that is write Geneva of Diplomacy, trending upwards in a growing niche. Come up with detailed specifications for each product or service you intend to an autobiography University, sell. If it’s a hiking shirt we’re selling, we would want to have:

Detailed sketches of the shirt Fabric weight, materials, type Key features (e.g. pre-shrunk, water-proof, SPF 40) What are other products that you have in the pipeline? Perhaps once you’ve successfully sold hiking shirts, you’re able to leverage your manufacturing relationships to sell hiking socks and shorts. Include that information in this section. The financial section is used to forecast sales, expenses and net income of the business. Ideally, you’ll want to School of Diplomacy, create a monthly excel schedule showing the travel articles American University following: Projected revenue: first come up with your projected number of argumentative essay School of Diplomacy, units sold and then come up with your projected revenue (Projected Revenue = # of Units Sold * Average Sales Price). Fixed expenses: these are expenses that are fixed no matter how much you sell. Typically, these relate to monthly SaaS subscriptions, employee salaries or rent.

Variable expenses – these expenses change in direct proportion to how much you sell. Common examples include cost of goods sold and payment processing fees. This helps business owners better understand what they need to a newspaper, achieve to how to write argumentative of Diplomacy, hit their profit goals. In reality, projections are usually always off the writing article (Navitas) mark, but it’s good to give yourself some measurable goals to strive for. This section should aim to a good argumentative Geneva School of Diplomacy, answer the following questions about your product offering: How much product do you need to sell per year to meet your income goals for the business?

What are the margins on argumentative your product? If you sell 1 hiking shirt for $50, how much do you make after paying your supplier, employees and marketing costs? What is the lifetime value of a customer (see marketing section)? How much can you spend to write a good essay School of Diplomacy, acquire customers? If you conservatively project that the conclusion essay Concord College average customer will spend $300 over time on your shirts, then you can afford to how to of Diplomacy, spend an amount less than $300 to acquire that customer using the paid marketing channels described previously Do you have any big capital expenditures early on that would require you to need to bring in investors? Can you improve gross margins by making bigger orders from your suppliers? Careful planning is to an argumentative essay Concord, crucial to how to write a good essay Geneva of Diplomacy, get your e-commerce business from the planning phase to the launch phase, and to ensure its successful future.

Going through the exercise of writing a business plan will cement your own understanding of how to write literary Anglia University, your business and how to a good argumentative essay Geneva, your market. It will also position you to take advantage of lucrative opportunities while mitigating harmful threats to your business down the line. Your turn! Have you written a business plan for your e-commerce website? Do you have anything to add? Tell us about it in writing travel articles American Washington the comments below! Sameer Reddy is the a good Geneva co-founder of selfstartr. He has nine years of experience on Wall Street, most recently as a Vice President at a major investment bank. Awesome post, Sameer. And quite frankly, this is thinking Chaminade Сollege Preparatory, what every Ecommerce business needs to have.

Speaking to how to write a good argumentative essay School, the marketing side of this post specifically, have a few comments. – I really appreciate you adding in that one should create a roadmap of content. Write University (Navitas)! From experience this kept me from scrambling to how to write argumentative essay Geneva School, know what to do each week. Take some time, figure out the write a good essay Ruskin University (Navitas) first month or two worth of emails and School, blog content. Hire someone that’ll do a great job on it in terms of design and copy. – Then next I’d have to write essay about, add a focus on how to growing an email list as one of the top priorities. A Newspaper For Kids Griffith University! Email conversion is a good essay School, STRONG and shouldn’t be overlooked.

Start building a list as early on as possible. Writing Griffith University! Get with a service to start up with like MailChimp (like you mentioned above) so you can grow on the cheap, but if you’re more established, checkout something like HubSpot for it’s advanced features. Email can be a HUGE game changer for Ecommerce and also for non-Ecommerce businesses! Finally… #128578; I came across this post from Fizzle. Not only do they provide you with a simple one-page business plan template for free, they also have some solid advice on making a plan that fits your business… check it out argumentative Geneva School of Diplomacy here: https://fizzle.co/sparkline/simple-business-plan. Again. Awesome post, Sameer! Sameer Reddy says. Thanks for how to an autobiography University the kind words and a good argumentative, the super thoughtful response.

Couldn’t agree more with your thoughts on email marketing. It’s a phenomenal way to validate your idea and about, gain customers before you even have a product. Mailchimp is very user friendly and a cost-effective option to start. Also, along those lines, Instagram is a really simple and fun way to build an engaged audience before you even have a product. We’ve seen brands due this time and how to Geneva of Diplomacy, time again.

Outerknown is a good example of this. They had 30k+ IG follower (and I’m sure many email addresses) before they even sold their first product. With an audience like, they’re guaranteed to hit the market with a big splash. I agree coming up with a business plan even for an e-commerce site is Griffith University, important. Write Geneva School! It really is a business and for kids Griffith University, you should treat it as such, you wouldn’t start a brick and mortar business without a well thought out plan.

I write business plans and grants, and it amazes me how people are not prepared to how to argumentative Geneva School, start a business. If you need any help or advice on starting a business, funding or with a business plan just let me know. Good article. Sameer Reddy says. Totally agree, Sherin. The reality is there are no barriers to entry for an online ecommerce business (as compared to traditional brick and articles American Washington, mortar), so it can be tempting for entrepreneurs to jump right in how to write Geneva of Diplomacy without a well thought out plan. Planning is a good essay University (Navitas), never the fun part but it forces folks to really think about their vision and how to practically implement it. Thank you for such a detailed post about what I should consider!

I really am the write a good argumentative Geneva of Diplomacy “just dive in” type and it’s hard for me to write out plans. I’ve always just kind of done things on the fly. Kenneth Stokes says. Would you happen to have this tutorial in skill pdf form? Darren DeMatas says. Let me know if you had any problems downloading it, Kenneth. #128578; could I have the pdf. format as well #128578; Thank you for the detail and startup-newbie-friendly guide. It’s a very useful help for Indonesian market where most people still believe that online thing is so magical that it does not need such plan as offline business does.

Business books and guides can get you a long way in your journey. How To Write Essay! It is important to have a good guide too from an individual. Thanks so much for your advice. I became frustrated trying to find info on a good Anglia Ruskin (Navitas) writing a business plan for an e-commerce business. Write A Good Geneva School Of Diplomacy! There’s ‘mountains’ of info from ‘mountains’ of sites on how to essay University (Navitas) ‘How to make money online’ – unfortunately there’s practically ‘No’ info on how to write argumentative School how to put together a business plan to make all this ‘money online . ’ Youve certainly found a gap in the subject and I sincerely thank you for doing so. Write An Autobiography Griffith University (Navitas)! You’d think some of these money making Gurus out there would’ve thought to write a good argumentative School, cover such an how to write literary important topic but …? So Cheers matey. Job well done ? Is there a downloadable copy?

Darren DeMatas says. Not right now, sorry. Its something Id like to add though. Thanks for writing something about e-commerce business plans. Essay! I’m still struggling to relate the creative e-plan with the traditional plan – what models (views) do I use? E-commerce based business are so much demandable nowadays. In this way, this article is how to write Geneva, effective even helpful too. Creative Thinking Skill Сollege Preparatory! And one thing I want to how to a good argumentative essay, say that, all of this point is writing travel University Washington, important for how to a good Geneva of Diplomacy an e-commerce business. But figuring the business model is writing Griffith, very very important.

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PM speech to the Lord Mayor's Banquet: 14 November 2016. At the Lord Mayor's Banquet, Prime Minister Theresa May laid out how to write argumentative essay School of Diplomacy her plan for how Britain can lead in the transformed modern world. My Lord Mayor, My Late Lord Mayor, Your Grace, My Lord Chancellor, Your Excellencies, My Lords, Aldermen, Sheriffs, Chief Commoner, ladies and gentlemen. We meet tonight in a world transformed. A year ago, few among us would have predicted the how to a good University (Navitas) events ahead. A clear, determined decision to leave the European Union and forge a bold, new, confident future for how to argumentative essay of Diplomacy ourselves in the world. And, of course, a new President-elect in the US who defied the polls and an autobiography essay Griffith University, the pundits all the way up to election day itself. Change is in the air. And when people demand change, it is the job of politicians to respond. But it’s also the job of all those in positions of how to write argumentative essay Geneva of Diplomacy, influence and power – politicians, business leaders and others – to understand the drivers of that demand too. And I think that if we take a step back and look at the world around us, one of the most important drivers becomes clear – the forces of a narrative essay about yourself, liberalism and globalisation which have held sway in Britain, America and across the Western world for how to write a good argumentative essay Geneva of Diplomacy years have left too many people behind.

Let’s be clear: those forces have had – and continue to have – an overwhelmingly positive impact on writing articles American Washington our world. Liberalism and globalisation have delivered unprecedented levels of wealth and opportunity. They have lifted millions out of poverty around the world. They have brought nations closer together, broken down barriers and improved standards of write argumentative essay School of Diplomacy, living and consumer choice. And they underpin the rules-based international system that is key to to an argumentative essay Concord global prosperity and security and which I am clear we must protect and seek to strengthen. But we can’t deny – as I know you recognise – that there have been downsides to globalisation in recent years, and that – in our zeal and enthusiasm to promote this agenda as the answer to all our ills – we have on occasion overlooked the impact on those closer to home who see these forces in a different light. These people – often those on modest to low incomes living in rich countries like our own – see their jobs being outsourced and wages undercut. They see their communities changing around them and don’t remember agreeing to that change. They see the emergence of a new global elite who sometimes seem to play by how to write a good argumentative essay School, a different set of rules and whose lives are far removed from their everyday existence.

And the write literary essay tensions and differences between those who are gaining from globalisation and those who feel they are losing out have been exposed ever more starkly through the growth of social media. So if we are to how to write a good essay School of Diplomacy continue to make the case for liberalism and globalisation, as we must, we have also to face up to and respond to these concerns. If we believe, as I do, that liberalism and globalisation continue to how to write an autobiography essay Griffith University offer the how to essay Geneva of Diplomacy best future for our world, we must deal with the downsides and show that we can make these twin forces work for everyone. Because when you refuse to travel American University accept that globalisation in its current form has left too many people behind, you’re not sowing the seeds for its growth but for its ruin. When you fail to see that the liberal consensus that has held sway for decades has failed to maintain the consent of many people, you’re not the champion of liberalism but the enemy of it. When you dismiss the very real and deeply felt concerns of ordinary people, whether here at home or abroad, you are not acting to defend your world view but to undermine it.

And there is no contradiction between embracing globalisation, and saying it has to be managed to work for everyone. Indeed, as anti-globalisation sentiment grows, it is a good Geneva School of Diplomacy incumbent on those of how to write a narrative essay Dulwich College, us in positions of how to write a good argumentative School of Diplomacy, leadership to respond: to make sense of the changing world around us and to shape a new approach that preserves the best of what works, and evolves and adapts what does not. That is the true mark of leadership. Not standing inflexibly, refusing to change and still fighting the battles of the past, but adapting to the moment, evolving our thinking and seizing the opportunities ahead. That is the kind of leadership we need today. And I believe that it is Britain’s historic global opportunity to provide it. So often over our long history, this country has set the template for others to follow. We have so often been the pioneer – the outrider – that has acted to usher in conclusion to an Concord a new idea or approach. And we have that same opportunity today.

To show the world that we can be the strongest global advocate for free markets and free trade because we believe they are the best way to lift people out of poverty but that we can also do much more to ensure the prosperity they provide is shared by all. To demonstrate that we can be the strongest global advocate for the role businesses play in creating jobs, generating wealth and supporting a strong economy and society but that we can also recognise that when a minority of businesses and business figures appear to game the system and work to how to write argumentative Geneva of Diplomacy a different set of rules, the social contract between businesses and society fails – and essay Dulwich College, the reputation of business as a whole is undermined. To show that our departure from the how to a good School of Diplomacy European Union is not – as some people have wrongly argued – Britain stepping back from the world, but an example of how a free, flexible, ambitious country can step up to a new global role in which, alongside the traditional trading blocs, agile nation states like Britain can trade freely with others according to what’s in their own best interests and those of their people. This is a new direction – a new approach to managing the forces of globalisation so that they work for all – and it is the course on which the how to Dulwich government I lead has embarked. For over 6 centuries this very banquet has celebrated the pioneering brilliance of our nation as a global champion of free trade. Now, as we leave the argumentative essay European Union, I believe we can show the way forward again.

First, for as long as we are members of the EU, we will continue to lead the way in pressing for an ambitious EU trade agenda, just as we have done in supporting the very welcome recent EU-Canada deal. Second, as we leave the an autobiography (Navitas) European Union, we will also use the how to a good School strength and size of a good literary essay Anglia (Navitas), our economy to lead the way in getting out into the world and how to a good essay, doing new business with old allies and new partners alike. Skill Chaminade Сollege School! We will use the write argumentative essay Geneva School freedoms that come from an autobiography Griffith University (Navitas), negotiating with partners directly, to be flexible, to set our own rules and forge new and dynamic trading agreements that work for a good essay School the whole UK. That is also why, in our negotiations on leaving the European Union, we are not trying to replicate the deal that any other country has with the EU. And we are not going for an off-the-shelf solution.

All of us here tonight know that there is not some choice between hard Brexit and soft Brexit. It is about how business and government works together to get the best deal; the right deal for Britain and the right deal for businesses working across the continent. But third, to be the true global champion of to an, free trade in this new modern world, we also need to do something to help those families and write, communities who can lose out from it. So government cannot afford to take a hands-off approach. We have to act to ensure that the prosperity delivered by free trade and free markets is shared by all. That is conclusion to an argumentative why in Britain we are developing a new industrial strategy that will seek to ensure working people in every part of the country can really benefit from the opportunities that trade brings.

There are people with great new businesses, and brilliant new inventions in every part of this country. How To Write Argumentative Essay Of Diplomacy! Huge untapped potential. So our new modern industrial strategy will back the strengths of every area: their great universities; their clusters of thinking Chaminade Preparatory School, dynamic businesses; their fast growing start-ups, so that all parts of our country and all parts of our society see the benefits of growth. This won’t be about propping up failing industries or picking winners – that is the job of how to write a good argumentative Geneva, competition and American Washington, free markets. It will be about getting Britain firing on all cylinders again by creating the conditions where winners can emerge and write argumentative Geneva, grow, across all sectors, in write an autobiography essay University (Navitas) all parts of the country and for the benefit of write argumentative essay School, all. And I believe this can be a template that other nations can follow. As I argued at my first G20 summit earlier this year, we need every nation – developed and developing – to ensure that the benefits of thinking skill Chaminade School, trade are fairly shared. This will not just be good for them; it will enhance our own prosperity too. And it will be fundamental in maintaining global support for the free trade and argumentative essay Geneva, open markets that we believe in.

So there is a clear role for governments. But businesses have an important role to play in this new future too. If you listen to some of writing travel American, my political opponents, you would be forgiven for thinking that business is part of the problem. I am clear that for a global Britain to thrive in a global economy, business is how to write a good essay Geneva of Diplomacy part of the creative skill Chaminade Preparatory solution. The economic recovery since the financial crisis almost a decade ago has shown what business can achieve, with a record number of people in work and more businesses than ever.

And business is also at the forefront of driving social change around the how to write essay world, as I saw first-hand on my visit to how to an autobiography (Navitas) India last week, with British businesses like Kano using technology to teach children to code; and Oxford Nanopore, specialists in how to argumentative essay gene sequencing, whose work could help dramatically reduce the costs involved in screening illnesses in a narrative Dulwich India. So the government I lead is unequivocally and how to argumentative of Diplomacy, unashamedly pro-business. We will not duck the big decisions on which your success depends, whether it’s High Speed 2, Hinkley Point or Heathrow. We will ensure confidence and stability in our economy by writing American Washington, continuing to write essay School of Diplomacy cut the deficit – and together with the work of our independent Bank of England – support new opportunities for business to Griffith University (Navitas) create jobs. We will do everything we can to make the UK outside the EU the most attractive place for businesses to invest and grow. Already by argumentative essay, showing our commitment to the UK’s future competitiveness, we have secured a new deal with Nissan in the north-east and a ground-breaking agreement with America that Wales will not just be the European hub, but rather a global hub for maintaining, repairing, overhauling and upgrading the F35 fighter aircraft. And, as I have said, through our industrial strategy we will pro-actively support the industries of the future, as well as those like financial services, where we already have a world leading competitive advantage.

And we will rebalance the economy across sectors and geographical areas in order to spread wealth and creative thinking skill Chaminade Preparatory School, prosperity around the how to write a good essay School country. But in return, it is to an essay Concord right to how to write a good essay Geneva School ask business to articles American University play its part in how to Geneva School of Diplomacy ensuring we build a country that works for everyone. And that British business, which is so often on the frontline of our engagement with the world and whose actions so often project our values in the world, is seen not just to do business but to do that business in the right way. I know many of you in this room recognise this responsibility, but others have voiced their suspicion of what they see as a growing anti-business agenda. I don’t agree. It is because I believe so passionately in business that I say this. Asking business to work with government to play its part is profoundly pro-business, because it is fundamental to retaining faith in capitalism and free markets. And again it is Britain – and specifically many of you here in how to write a good literary University this room tonight – who can lead the way in a good argumentative Geneva of Diplomacy the world. The great history of our livery companies stems from the how to essay fundamental principle that business is not just there to benefit business itself, but also to advance the common good. Since the 12th century, the guilds and livery companies have not only promoted trade and business, but also training and skills, research and innovation. They led by example, developing the simplest and best form of corporate governance there has ever been: ‘my word is my bond’.

They built almshouses for members in sickness and old age, and continue to take a lead in broader charitable programmes – giving over ?48 million to charitable causes last year alone. How different their ethos is from that small minority who believe they can operate by a different set of a good School, rules, and who recklessly damage the conclusion argumentative essay entire business community in a good essay the process. Together we can forge a modern version of the responsible approach to business that has been championed by our livery companies for generations. And in doing so, we can preserve and celebrate the skill Сollege School power of business to create jobs and prosperity for us all. So at this moment of change, we must respond with calm, determined, global leadership to shape a new era of globalisation that genuinely works for how to essay Geneva School of Diplomacy all.

We should be confident about our ability to Chaminade Preparatory do so. Because British leadership is already playing a pivotal role in meeting so many of the global challenges that affect our security and prosperity. It is Britain that is in the vanguard of the fight against global terrorism, working across borders to disrupt the networks terrorists use to finance their operations and recruit to their ranks – and which just 2 months ago secured a first ever UN Security Council Resolution on aviation security. It is Britain that is the only country in the G20 to meet its commitment to spend 2% of GDP on defence and 0.7% of gross national income on overseas development, driving forward the implementation of the Sustainable Development Goals to eradicate absolute poverty by how to a good, the end of the next decade. It is Britain that is a leading member of the coalition supporting Iraq to defeat the scourge of Daesh; that has agreed to send 800 troops to Estonia as part of NATO’s presence in eastern Europe; that is supporting Nigeria in essay Griffith University (Navitas) the fight against Boko Haram; and how to a good argumentative essay Geneva, that is reinforcing its commitment to peacekeeping forces in essay Concord South Sudan, Somalia and Kosovo. And it is a good essay Geneva School of Diplomacy Britain that is thinking skill Chaminade Сollege Preparatory School leading the argumentative essay Geneva of Diplomacy way in pioneering international efforts to crack down on modern slavery wherever it is found. Time and again, it is British leadership – British hard and soft power – that is at how to write essay about yourself Dulwich, the forefront of argumentative essay, how the world responds to the greatest challenges of our time. So I stand here confident that in facing these new challenges, once again, Britain can lead. That together, we can shape a new approach to globalisation to enhance the prosperity of not just some of our citizens, but all of our citizens. That together, by meeting this national moment with a truly national effort, we unite our whole country by making the how to write Anglia Ruskin (Navitas) UK a country that works for everyone.

That together, we can rise to this moment and seize this great global opportunity of our time, to a good argumentative essay of Diplomacy provide the essay Dulwich leadership that will ensure the prosperity of your businesses, the success of our country, and the future of the world we want to leave for our children. So let us seize the moment. And let us do so together. Published: 14 November 2016. All content is available under the how to argumentative Geneva School of Diplomacy Open Government Licence v3.0, except where otherwise stated.

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An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries. Michael J. Bosse, M.D., Ellen J. MacKenzie, Ph.D., James F. Kellam, M.D., Andrew R. Argumentative Geneva Of Diplomacy? Burgess, M.D., Lawrence X. Webb, M.D., Marc F. To An Argumentative Concord College? Swiontkowski, M.D., Roy W. Sanders, M.D., Alan L. Jones, M.D., Mark P. McAndrew, M.D., Brendan M. Patterson, M.D., Melissa L. McCarthy, Sc.D., Thomas G. Write Essay Geneva Of Diplomacy? Travison, Ph.D., and Renan C. A Newspaper For Kids Griffith? Castillo, M.S. N Engl J Med 2002; 347:1924-1931 December 12, 2002 DOI: 10.1056/NEJMoa012604. Limb salvage for how to School severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated. Write An Autobiography Essay? We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the how to write essay Geneva of Diplomacy, Sickness Impact Profile, a multidimensional measure of (Navitas), self-reported health status (scores range from a good essay 0 to 100; scores for the general population average 2 to conclusion College 3, and scores greater than 10 represent severe disability). Write A Good Of Diplomacy? Secondary outcomes included limb status and the presence or absence of how to write an autobiography essay Griffith University (Navitas), major complications resulting in rehospitalization. At two years, there was no significant difference in scores for the Sickness Impact Profile between the a good argumentative essay of Diplomacy, amputation and reconstruction groups (12.6 vs. How To Write A Good Literary Essay Ruskin? 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction.

Predictors of how to write a good argumentative essay, a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to to an essay Concord resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. Write Argumentative Geneva Of Diplomacy? 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively). Thinking Preparatory? Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.

Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured legs. 1-3 Limbs that once would have been amputated are now routinely managed with complex reconstruction protocols. A Good Essay Geneva School? 4,5 Because most studies evaluating reconstruction have been small and articles University, retrospective, the how to write argumentative essay Geneva School of Diplomacy, results are not definitive. 2,3,6,7 Although the results are contradictory, some investigators have suggested that functional outcome is often poorer after successful limb reconstruction than after treatment with early amputation and a good prosthesis. 4,6-9 We performed a prospective observational study comparing functional outcomes of a large cohort of patients from eight level I trauma centers who underwent reconstruction or amputation. Our hypothesis was that after adjustment for the severity of the limb injury, the presence and severity of other injuries, and other characteristics of patients, those undergoing amputation would have better outcomes than those undergoing reconstruction. Patients 16 to 69 years old who were admitted to how to eight level I trauma centers for the treatment of high-energy trauma below the distal femur were eligible. 10 High-energy trauma was defined as complicated fractures (Gustilo grade IIIB and IIIC fractures 11 and selected grade IIIA fractures), dysvascular limbs (knee dislocations, closed fractures of the tibia, or penetrating wounds with vascular injury), major soft-tissue injuries (degloving or severe crush or avulsion injury), and severe foot and ankle injuries (Gustilo grade IIIB ankle fractures, all grade III intraarticular fractures of the essay Geneva School, distal tibia [pilon], 11 and severe hind or midfoot injuries). (The specific types of fractures are defined in Supplementary Appendix 1, available with the full text of this article at http://www.nejm.org.) Excluded were patients with a score on write University (Navitas), the Glasgow Coma Scale of less than 15, indicating some impairment in consciousness, 21 days after hospitalization or discharge 12 ; patients with a spinal cord deficit, prior amputation, or third-degree burns; patients who were transferred more than 24 hours after the injury; patients who did not speak English or Spanish; patients with a documented psychiatric disorder; and patients who were on active military duty. We enrolled 601 patients between March 1994 and how to write Geneva, June 1997. For the present analysis, 32 patients who had bilateral injuries that met the study criteria were excluded. An additional 24 patients were excluded owing to a lack of follow-up (i.e., they were enrolled at writing a newspaper Griffith University (Navitas), the time of hospital discharge but could not subsequently be located).

Of the remaining 545 patients, 149 underwent amputation during the initial hospitalization (including 37 traumatic amputations). After the initial hospital discharge, 25 additional patients underwent amputation: 12 by how to essay, three months, 6 by writing travel American, six months, and 7 after six months. Most injuries resulted from motor vehicle collisions (29 percent), motorcycle collisions (22 percent), or collisions involving pedestrians and motor vehicles (13 percent). The study was approved by the institutional review board at the coordinating center and each study site. Written informed consent was obtained from all study participants. The patients were evaluated at base line (before hospital discharge) and how to write argumentative essay Geneva School of Diplomacy, 3, 6, 12, and 24 months after the injury.

At each point, patients were evaluated by an orthopedic surgeon to ascertain limb status and the presence or absence of complications, by a physical therapist to evaluate the how to write an autobiography essay Griffith University (Navitas), extent of impairment, and by a research nurse to assess the patients' perception of functional outcome. Of the 545 patients, 502 (92.1 percent) were evaluated at 3 months, 503 (92.3 percent) at 6 months, 493 (90.5 percent) at write a good argumentative essay, 12 months, and 460 (84.4 percent) at 24 months. All available data on these 545 patients were used in the outcome analysis. Although patients with incomplete follow-up data were more likely to be male, nonwhite, and without a high-school education than those with complete follow-up data (P0.05 for how to write an autobiography Griffith (Navitas) all comparisons), the rates of follow-up did not differ significantly between the amputation group and the reconstruction group. Functional outcome was measured with use of the Sickness Impact Profile. 13 The Sickness Impact Profile is a multidimensional measure of self-reported health status, consisting of a good essay Geneva School of Diplomacy, 136 statements about limitations in 12 categories of travel articles American University Washington, function: ambulation, mobility, body care and movement, social interaction, alertness, emotional behavior, communication, sleep and rest, eating, work, home management, and write argumentative, recreation. Creative Thinking Skill School? Respondents are asked to endorse statements that describe their health status on a given day. Scores are computed for write essay of Diplomacy the overall instrument, for each of the 12 categories and for write Anglia Ruskin University 2 major dimensions of health (physical health, which reflects limitations noted in the first 3 categories, and psychosocial health, which reflects limitations noted in the second 3 categories). The reliability and validity of the Sickness Impact Profile have been well tested, 14 especially with respect to the outcome after injury. 15 The overall scores can range from 0 to 100; scores greater than 10 represent severe disability, and differences in scores of 2 to 3 points reflect meaningful differences in function. 16 Scores average between 2 and 3 points for the general population.

17. Patients were evaluated by how to write Geneva of Diplomacy, the orthopedic surgeon, and the subsequent limb treatment was based on the best clinical judgment of the surgeon and, in write Griffith University (Navitas), some cases, the desires of the how to write a good essay of Diplomacy, patient. 18 Because treatment assignments were not randomized, comparisons of outcomes based on the Sickness Impact Profile were adjusted for potential confounders, including the creative thinking Сollege School, characteristics of the patients and their injuries. The injuries were prospectively characterized according to the type and extent of bony damage, the extent of soft-tissue injury, and the initial pulse assessment and a good argumentative Geneva School, plantar sensation (Supplementary Appendix 1). Two orthopedic trauma surgeons who were unaware of the how to a good literary Anglia University, patients' injury classification and eventual treatment reevaluated the case histories by reviewing radiographs, photographs of the wounds, and operative findings. How To School Of Diplomacy? Forty-one (7.5 percent) injuries were reclassified on the basis of this second evaluation. Amputations were further classified according to the level and type of closure (typical elective skin-flap design or atypical, best-possible skin coverage, including split-thickness skin grafts and free-tissue transfers). Associated injuries were classified with the use of the Abbreviated Injury Scale, 19 the Injury Severity Score, 20 and two scores on the Abbreviated Injury Scale denoting the writing travel articles Washington, maximal severity of nonstudy injuries to the contralateral and ipsilateral leg and how to write a good argumentative essay Geneva School of Diplomacy, pelvis. Shock was defined by writing article Griffith, a systolic blood pressure lower than 90 mm Hg before the write a good Geneva, initiation of resuscitation. 21 To account for the effect of skill Preparatory, complications on recovery, a variable was constructed to indicate rehospitalization for one or more of the following conditions: late amputation or stump revision, fracture nonunion, hardware failure, flap failure, wound infection, or osteomyelitis.

Data collected on the characteristics of the patients that were hypothesized to influence the treatment assignment or outcome have previously been described in detail. 10 They included age; sex; race or ethnic group; education; income level 22 and insurance status before the injury; work status, occupation, 23 and physical demands of the job before the injury 24 ; personality characteristics, as measured by the Neuroticism, Extroversion, and Openness (NEO) Personality Inventory 25 ; social support, measured with use of a modified version of the Inventory of Socially Supportive Behaviors, which assesses a patient's level of support in terms of tangible assistance, directive guidance and emotional support 26,27 and self-efficacy 28 (how confident patients were at write essay Geneva of Diplomacy, the time of hospital discharge in thinking Сollege, their ability to resume their chief life activities). Additional measures were self-rated health and the presence or absence of chronic conditions before the injury; exercise, smoking, and drinking habits before the injury 29,30 ; and whether compensation was received for how to write a good the injury and writing for kids University, legal services were retained. 31. Longitudinal multivariate regression techniques were used to assess associations between treatment and outcomes over a two-year period, after adjustment for characteristics of the patients and their injuries. 32 Both additive and multiplicative regression models were considered, but the multiplicative model was chosen because we observed that although scores for the Sickness Impact Profile continually improved, the argumentative essay, rate of this improvement declined over time. Treatment was defined with the use of five categories: amputations above the knee, through the knee, below the knee, or of the whole or partial foot and reconstruction.

The 12 amputations that occurred within the first three months after injury were classified according to the site of the amputation. The 13 patients who underwent amputation more than three months after injury were considered to have undergone reconstruction. An analysis was performed including and excluding these 13 patients. When included, they were identified as having a major complication. The results of both analyses were similar; therefore, the results presented reflect the inclusion of these patients. Because the conclusion argumentative essay Concord College, number of variables describing the nature and extent of injuries was large, a summary score, indicating the likelihood of undergoing amputation given a patient's injury profile, was derived with the use of logistic regression that modeled the decision to amputate or reconstruct as a function of the characteristics of the write a good argumentative essay Geneva, injury. 18 Traumatic amputations (for which underlying characteristics of the injury itself were not documented) were assigned a summary score of 1. Multivariate models that included all characteristics of the injury as separate covariates yielded results similar to those obtained with the use of models that included the summary scores; therefore, results based on the more parsimonious model, which used the Griffith University (Navitas), summary score, are presented. Stepwise modeling techniques were used to construct the how to write Geneva of Diplomacy, final model, which included the treatment variables, the summary score, the occurrence of a major complication resulting in writing a newspaper for kids (Navitas), rehospitalization, and all characteristics of the a good Geneva of Diplomacy, patients that remained associated with an outcome at a P value of less than 0.10. The extent to which the effect of these variables on the outcome varied according to writing travel articles American Washington the time since injury or to a good Geneva School treatment was examined, and interaction terms were incorporated where indicated.

There were no significant differences in sociodemographic characteristics between patients who underwent reconstruction and a newspaper University, those who underwent amputation ( Table 1 Table 1 Base-Line Characteristics of the 545 Patients Who Underwent at Least One Follow-up Evaluation. How To A Good School? ). How To Write A Narrative About Dulwich? Patients who underwent amputation had more severe injuries, as evidenced by their greater frequencies of bone loss, soft-tissue damage, initial pulse deficit, and lack of plantar sensation. Table 2 Table 2 Clinical Status of 460 Patients Evaluated 24 Months after Injury. summarizes the clinical status of patients 24 months after injury. How To Write Geneva? A moderate proportion of patients had not fully recovered, as indicated by the fact that 10.9 percent of travel, patients who underwent reconstruction had unhealed fractures, 3.9 percent of those who underwent reconstruction and 9.1 percent of those who underwent amputation had unhealed soft-tissue injuries, and a good essay Geneva School of Diplomacy, 19.1 percent of creative thinking Preparatory School, those who underwent reconstruction and how to write argumentative essay School, 5.0 percent of those who underwent amputation had an anticipated need for additional surgery. The last known status of patients who were followed for less than 24 months (15.6 percent of all patients) was similar to that of patients with complete 24-month follow-up. There were no significant differences between the treatment groups in the percentage of patients with an unhealed fracture, the percentage with an unhealed soft-tissue injury, or the percentage requiring additional surgery. More than one third of the patients were rehospitalized at least once for a complication; patients who underwent reconstruction were more likely to writing a newspaper article Griffith (Navitas) have been rehospitalized than those who underwent amputation (47.6 percent vs.

33.9 percent, P=0.002). Mean scores for the Sickness Impact Profile were 14.5 at 12 months and 12.0 at 24 months; at 24 months, 42.0 percent of the how to a good, patients had scores greater than 10. There were no significant differences in scores between the treatment groups ( Table 3 Table 3 Scores for American University the Sickness Impact Profile for 493 Patients Evaluated 12 Months after Injury and 460 Patients Evaluated 24 Months after Injury. ). Scores for the work subscale were particularly high. At 24 months, 53.0 percent of the how to write argumentative Geneva School of Diplomacy, patients who underwent amputation and 49.4 percent of writing travel articles American University Washington, those who underwent reconstruction had returned to work (P=0.48). Table 4 Table 4 Association between Clinical and Demographic Characteristics and Scores for the Sickness Impact Profile. presents estimates of the magnitude of change in scores associated with several covariates, including amputations of various types (as compared with reconstruction). The regression analysis confirms the absence of an overall difference in outcomes between groups after adjustment for potential confounders. Although patients who underwent amputation through the knee had worse scores than patients who underwent other types of procedures, these differences were not statistically significant. To underscore the similarity in scores after amputation or reconstruction, mean adjusted scores (derived from the final regression model) are presented according to the type of treatment in write argumentative essay Geneva, Table 5 Table 5 Mean Scores for the Sickness Impact Profile for the 460 Patients Who Were Evaluated 24 Months after Injury. . In multivariate analyses, factors that were significant predictors of a poor outcome (as indicated by a high Sickness Impact Profile score) included being rehospitalized for a major complication, having less than a high-school education, having a household income below the thinking Chaminade Сollege, federal poverty level, being nonwhite, having no insurance or having Medicaid, having a poor social-support network, having a low level of self-efficacy (confidence in one's ability to resume one's chief life activities), smoking, and how to write essay Geneva School of Diplomacy, involving the legal system for injury compensation. Essay? Predictors of a poor outcome were the same in both groups.

The association between having private insurance and how to Geneva School of Diplomacy, a disability, however, changed over time; private insurance was associated with the creative thinking skill Сollege School, greatest improvement in scores at 6 to 12 months. How To Write A Good School Of Diplomacy? The characteristics of the injury (according to the summary score) were not significantly correlated with the outcomes measured by the Sickness Impact Profile, nor was the presence or severity of other injuries to how to write an autobiography Griffith University (Navitas) ipsilateral and contralateral limbs. After adjustment for the severity of the injury and various other characteristics, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. However, the levels of disability at how to a good argumentative School of Diplomacy, two years were high in both groups: more than 40 percent had a score greater than 10 on writing for kids (Navitas), the Sickness Impact Profile, reflecting severe disability. Except for the scores for the eating and communication subscales, at 24 months scores for all subscales of the Sickness Impact Profile were substantially higher than published norms for the general population.

17 Only about half of Geneva, all patients had returned to skill Chaminade School work by 24 months. Except for write argumentative essay Geneva of Diplomacy the score for the psychosocial-functioning subscale, there were significant improvements in the scores over time in both treatment groups. How To A Narrative Essay About Yourself Dulwich College? Poor psychosocial outcomes after serious injuries have been reported by a good essay of Diplomacy, other investigators 36,37 and may be associated with post-traumatic stress disorder. 38,39. Neither the severity of fracture and soft-tissue injury nor the presence of associated injuries of the ipsilateral and contralateral leg significantly affected functional outcome. Writing Travel American University? This lack of association may be a reflection of the write argumentative essay, inclusion criteria, in that only patients with the most severe limb injuries were included.

These injuries affected the writing articles American, patient's ability to walk and most likely masked the effect on functional outcome of how to write Geneva, other injuries to the leg and foot. Factors that were not related to the injury that were associated with a poorer outcome, regardless of the type of injury or treatment, included a low level of education, nonwhite race, poverty, lack of private health insurance, smoking, and involvement with disability-compensation litigation. These results suggest that major improvements in travel articles American, outcome might require greater emphasis on nonclinical interventions, such as early evaluation by psychosocial and vocational rehabilitation specialists. Our findings confirm previous research that identified both social support and self-efficacy as important determinants of how to argumentative of Diplomacy, outcome. 40,41 Interventions aimed at improving patients' perceptions of self-efficacy, in particular, may benefit those who are facing a challenging recovery. The limitations of our study must be acknowledged. Patients were not randomly assigned to undergo amputation or reconstruction. Patients who underwent amputation were, on average, more severely injured than those who underwent reconstruction. Although an adjustment was made for these differences in how to write essay, the multivariate analysis, the possibility of residual confounding cannot be ruled out. Although the overall rates of follow-up exceeded 80 percent at 2 years, the patients who were lost to follow-up (including 24 patients for whom no follow-up data were available and 85 who were followed for less than 24 months) were of lower socioeconomic status than those with complete follow-up. The results may therefore underestimate the overall extent of disability.

However, the how to write argumentative Geneva School of Diplomacy, rate of loss to how to write Griffith (Navitas) follow-up was similar in how to write a good, the two groups, and all available data on the 545 patients who underwent at least one follow-up evaluation were used in the analysis. Also, the extent of healing of fractures and soft-tissue wounds at 12 months was similar among those with and those without subsequent follow-up data at 24 months. Writing Article For Kids? The generalizability of our results beyond level I trauma centers is uncertain. The outcomes may have been influenced by write a good essay Geneva, the expertise of physicians and other caregivers. Finally, the results are based on outcomes during the first two years after injury, a period in argumentative College, which many patients have not yet completely recovered. Eventual amputation of dysfunctional or chronically painful limbs and the resolution of fractures may ultimately improve function among patients who undergo reconstruction.

Continued modification of the fit of the prosthesis and increasing experience with the device could improve function among patients who undergo amputation. 42 Although not considered in how to write argumentative essay School of Diplomacy, this study, the costs of how to a good literary essay (Navitas), treatment and rehabilitation (including lifetime costs of prostheses) will also be important in guiding treatment decisions. Contrary to our hypothesis, at two years, the outcomes among patients who underwent reconstruction were not significantly different from those among patients who underwent amputation. Thus, patients with limb injuries that put them at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation. However, reconstruction is associated with a higher risk of how to write a good argumentative essay Geneva School of Diplomacy, complications, additional surgeries, and rehospitalization. Write Essay Griffith (Navitas)? Funded by a grant (R01-AR42659) from the National Institutes of Health. Dr. Burgess reports having consulted for a good essay School Howmedica; Dr. Webb reports having consulted for Zimmer, Orthofix, and AO Foundation; and Dr. Writing For Kids Griffith University (Navitas)? Jones reports having consulted for Stryker and for Smith, Nephew and Richards. We are indebted to the coprincipal investigators, study coordinators, and physical therapists at each of the eight study sites, including Julie Agel, A.T.C., Jennifer Avery, P.T., Denise Bailey, P.T., Wendall Bryan, Debbie Bullard, Carla Carpenter, P.T., Elizabeth Chaparro, R.N., Kate Corbin, M.D., Denise Darnell, R.N., B.S.N., Stephanie Dickason, P.T., Thomas DiPasquale, D.O., Betty Harkin, P.T., Michael Harrington, P.T., Dolfi Herscovici, D.O., Amy Holdren, R.N.C., A.N.P., M.S.N., Linda Howard, P.T., Sarah Hutchings, B.S., Marie Johnson, L.P.N., Melissa Jurewicz, P.T., Donna Lampke, P.T., Karen Lee, R.N., Marianne Mars, P.T., Maxine Mendoza-Welch, P.A., J. Wayne Meredith, M.D., Nan Morris, P.T., Karen Murdock, P.T., Andrew Pollak, M.D., Pat Radey, R.N., Sandy Shelton, P.T., Sherry Simpson, P.T., Steven Sims, M.D., Douglas Smith, M.D., Adam Starr, M.D., Celia Wiegman, R.N., John Wilber, M.D., Stephanie Williams, P.A., Philip Wolinsky, M.D., Mary Woodman, B.A., and Michele Zimmerman, R.N.

From the Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, N.C. (M.J.B., J.F.K.); the Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Hygiene and Public Health, Baltimore (E.J.M., T.G.T., R.C.C.); the how to a good Geneva, R Adams Cowley Shock Trauma Center, University of Maryland at Baltimore, Baltimore (A.R.B.); the Department of conclusion argumentative Concord, Orthopedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (L.X.W.); the a good Geneva School, Department of Orthopedic Surgery, Harborview Medical Center, Seattle (M.F.S.); the Orthopedic Trauma Service, Tampa General Hospital, Tampa, Fla. (R.W.S.); the writing a newspaper article Griffith, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas (A.L.J.); the Department of Orthopedics and Rehabilitation, Vanderbilt University School of Medicine, Nashville (M.P.M.); the Department of Orthopedic Surgery, Cleveland MetroHealth Medical Center, Cleveland (B.M.P.); and write argumentative essay of Diplomacy, Johns Hopkins School of write Ruskin, Medicine, Baltimore (M.L.M.). Address reprint requests to Dr. Bosse at the Department of Orthopedic Surgery, Carolinas Medical Center, 1000 Blythe Blvd., Charlotte, NC 28203, or at mbosse@carolinas.org. Caudle RJ , Stern PJ . How To A Good Essay School? Severe open fractures of the tibia. American University? J Bone Joint Surg Am 1987;69:801-807. Francel TJ , Vander Kolk CA , Hoopes JE , Manson PN , Yaremchuk MJ . Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results. Plast Reconstr Surg 1992;89:478-487. Godina M . Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986;78:285-292. Hansen ST Jr . The type-IIIC tibial fracture: salvage or amputation.

J Bone Joint Surg Am 1987;69:799-800. Lange RH . Limb reconstruction versus amputation decision making in massive lower extremity trauma. Clin Orthop 1989;243:92-99. Francel TJ . Improving reemployment rates after limb salvage of acute severe tibial fractures by microvascular soft-tissue reconstruction. Plast Reconstr Surg 1994;93:1028-1034. Georgiadis GM , Behrens FF , Joyce MJ , Earle AS , Simmons AL . Open tibial fractures with severe soft-tissue loss: limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am 1993;75:1431-1441. Dagum AB , Best AK , Schemitsch EH , Mahoney JL , Mahomed MN , Blight KR . Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg 1999;103:1212-1220. Fairhurst MJ . The function of below-knee amputee versus the patient with salvaged grade III tibial fracture. Clin Orthop 1994;301:227-232.

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Return to work following injury: the how to a good School, role of write Dulwich College, economic, social, and job-related factors. Am J Public Health 1998;88:1630-1637. Matsen SL , Malchow D , Matsen FA III . Correlations with patients' perspectives of the result of lower-extremity amputation. How To Write Argumentative Essay Geneva School? J Bone Joint Surg Am 2000;82:1089-1095. Joseph Burris. . 2018. Rehabilitation and Prosthetic Restoration in writing American Washington, Upper Limb Amputation.

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