Haemolytic Disease of the Fetus and Newborn (HDFN)

Haemolytic Disease of the Fetus and Newborn (HDFN) List and briefly describe three clinical signs for Haemolytic Disease of the Fetus and Newborn (HDFN) Haemolytic disease of the fetus and newborn (HDFN) is a rare disease that occurs when maternal alloantibodies cross the placenta during pregnancy and cause the destruction of fetal red blood cells (RBCs) (Delaney and Matthews, 2015; Haas et al., 2015). HDFN can result in fetal anaemia with progression to severe morbidities, such as ascites, hydrops fetalis, heart failure, kernicterus, and death (Delaney and Matthews, 2015). The clinical presentation of HDFN is variable, in which there are several manifestations that may occur (Murray and Roberts, 2007). Three of the most prevalent clinical signs that allows for neonatal paediatricians to suspect HDFN includes splenomegaly, oedema, and jaundice. HDFN is characterised by the accelerated destruction of RBCs, which results in differing rates of haemolysis and fetal anaemia (Urbaniak and Greiss, 2000). The continuous and rapid process of haemolysis causes extramedullary haematopoiesis, a result of erythropoiesis failing in the bone marrow, in the fetal liver and spleen (Dean, 2005). Organs, such as the liver and spleen, that are involved in the synthesis of RBCs increase the production to combat the rate of destruction and counteract the overall loss (Dean, 2005). The increased workload of the spleen results in its enlargement, termed splenomegaly (Bowman, 1997; Dunn, 1963).          Oedema is an important clinical sign of HDFN that is also associated with the degree of haemolysis and anaemia (Delaney and Matthews, 2015). Oedema can occur due to low levels of serum albumin through a decrease in osmotic pressure (Dean, 2005). Moreover, as the body compensates for fetal anaemia, the fetus can develop a hyperdynamic circulation (Haas et al., 2015). This can result in hydrops fetalis, a severe and life-threatening condition in which there is widespread oedema in the fetal and skin and serous cavities (Haas et al., 2015). A further clinical sign of HDFN is jaundice. Jaunice may occur as a result of haemolysis, in which there is an increase in the level of bilirubin within the body (Urbaniak and Greiss, 2000). Throughout pregnancy, bilirubin is removed via the maternal circulation by the placenta (Dean, 2005). Therefore, a high level of haemolysis may be present with a low level of bilirubin (Murray and Roberts, 2007). However, after birth the haemolytic process continues. At this stage of development, the liver of the neonate is immature and unable to conjugate the excess bilirubin (Urbaniak and Greiss, 2000). The unconjugated bilirubin begins to build and accumulate in the blood of the neonate, causing the skin and whites of the eyes to turn yellow (Dean, 2005). Within 24 to 48 hours after delivery, the level of bilirubin may increase substantially (Urbaniak and Greiss, 2000). Left untreated, this can lead to the development of kernicterus, a condition in which bilirubin deposits form in the basal ga nglia and brain stem nuclei (Haas et al., 2015). Describe the progression of HDFN, from sensitisation to fetal red cell destruction, in a D negative mother carrying a D positive fetus that has not received RhIg. Throughout pregnancy, antibodies from the maternal circulation play a vital role in providing protection for neonates; crossing the placenta from the maternal to the fetal circulation (Dean, 2005). This is essential for the fetus, as by delivery newborns have a relatively immature immune system (Murray and Roberts, 2007). Although the presence of maternal antibodies provides protection, the active transporting of antibodies across the placenta can result in HDFN (Dean, 2005). HDFN is triggered by a sensitisation event. This most often occurs during the first pregnancy; however, it can also arise from a blood transfusion or organ transplant (Delaney and Matthews, 2015). During the course of pregnancy, the maternal and fetal circulations gradually mix with each trimester (Delaney and Matthews, 2015). This results in maternal alloimmunisation, as the maternal circulation has been exposed to foreign RBCs (Haas et al., 2015). Despite the relatively small amount of fetal blood that passes into the maternal circulation, only a small amount is needed for sensitisation to occur (Dean, 2005). This is typical for an RhD negative mother carrying an RhD positive fetus. Sensitisation frequently transpires during the birth of the firstborn RhD positive child, where fetal maternal haemorrhage (FMH) is common (Delaney and Matthews, 2015). However, the risk of sensitisation increases in complicated and extensive labours (Dean, 2005). Sensitisation can also occur through earlier  events in pregnancy, such as a prenatal bleed, trauma, termination of pregnancy, chronic villus sampling, and miscarriage (Sebring and Polesky, 1990). The greatest risk of developing FMH is during the process of labour (Murray and Roberts, 2007). Subsequently, alloantibodies are most likely to form after delivery (Delaney and Matthews, 2015). After sensitisation of an RhD negative mother carrying an RhD positive fetus, the mothers serum will contain anti-D (Dean, 2005). Importantly, the maternal anti-D that is formed is of the IgM class and unable to effectively cross the placenta (Delaney and Matthews, 2015). As a result, HDFN is rare in first-born children and unlikely to have any clinical consequence or significance (Dean, 2005). However, once the maternal circulation has been exposed to the fetal circulation the maternal immune system has the potential to respond to foreign red cell antigens (Delaney and Matthews, 2015). Through extensive research and cohort studies, it has been established that HDFN is most likely to effect subsequent pregnancies (Dean, 2005). Maternal alloantibodies of the IgG1 and IgG class cause significant haemolysis, thus the most clinically significant forms of HDFN (Roberts, 2008). In the event that an RhD negative mother becomes pregnant for a second time, interaction with the RhD antigen stimulates the production of IgG type anti-D, which can be transported across the placenta into the fetal circulation (Delaney and Matthews, 2015). Once anti-D has entered the fetal circulation, it binds to the RhD antigens found on fetal RBCs and labels them to be destroyed (Delaney and Matthews, 2015). From here, the pathophysiology of the disease ensues, as illustrated in figure 4. Explain the action of RhIg in a D negative mother that has a D positive fetal bleed. Rh immunoglobulin (RhIg) is routinely used in clinical practice to prevent HDFN. RhIg is prepared from human plasma that has been immunised to the D antigen and functions by targeting RBCs that are positive for the D antigen (Brinc and Lazarus, 2009). The use of prophylactic anti-D remains the gold standard approach of antibody-mediated immunosuppression, having been used for several decades (Giancarlo et al., 2010). However, the mechanism of action of RhIg is not fully understood and there are three key hypotheses that have been proposed to explain its method of action. Antigen Clearance Hypothesis The first hypothesis is the antigen clearance hypothesis and is considered the main mechanism of action. Here, IgG is understood to prevent an antibody response by increasing the rate of phagocytosis and the removal of RBCs from circulation via the mononuclear phagocytic system, prior to recognition by the immune system (Brinc and Lazarus, 2009). IgG opsonised RBCs are believed to engage in the activation of IgG receptors (FcÃŽÂ ³Rs) on effector cells, stimulating phagocytosis. IgG is also suspected to increase the clearance of RBCs through the stimulation of complement activation on the RBC surface. Anti-D does not activate complement and therefore it is believed that FcÃŽÂ ³R-mediated phagocytosis is the mechanism by which anti-D is cleared (Brinc and Lazarus, 2009). FcÃŽÂ ³RIIB mediated B-cell inhibition hypothesis This mechanism is the most recently proposed and came about through the discovery of increased levels of transforming growth factor-ÃŽÂ ² and prostaglandin E2 in a number of pregnant women who were given RhIG. This mechanism proposes that RBCs and IgG form a complex in which a negative signal is delivered to inactivate antigen-specific B cells. However, mice models deficient in FcÃŽÂ ³RIIBhave shown that the involvement of FcÃŽÂ ³RIIB is not needed to induce antibody-mediated immune suppression. Furthermore, FcR-like molecules have been discovered in both mice and humans. It is believed that the FCRLs mediate the B-cell inhibition, however, this has yet to be demonstrated (Brinc and Lazarus, 2009). Steric Hindrance Hypothesis The Steric hindrance hypothesis proposes IgG binds the antigen, preventing the B-cell receptor from recognising the corresponding epitopes. Most anti-D epitopes are not blocked by RhIg. This allows free D epitopes to be detected after administration of RhIg. Monoclonal anti-D has been shown to prevent antibody responses by binding 10-15% of epitopes. This pathway has not been studied in detail and therefore knowledge of the immunobiology is limited. However, it is believed that IgG binding of D epitopes allows a formation between RBCs and B cells, in which this prevents B-cell activation (Brinc and Lazarus, 2009). The established methodology in the UK for the Quantification of a D positive fetal bleed is via flow cytometry with FITC-anti-D (FITC-BRAD3). Name and describe 3 alternative methods used worldwide to detect fetal bleeds In addition to the use of flow cytometry, several alternative screening methods are available to determine and quantify FMH (Kim and Makar, 2011). Three screening methods that are used worldwide include the rosette screen, Kleihauer-Betke acid elution test, and flow cytometry using anti-fetal haemoglobin antibodies. The rosette test is a screening method that is used to qualitatively detect fetal bleeds equal to or greater than 10 mL and 0.2% of fetal cells present in the maternal circulation (Kim and Makar, 2011). The rosette test works by indirectly identifying the presence of D positive fetal RBCs in D negative mothers (Solomonia et al., 2012). To perform this test, a maternal blood sample is collected, incubated with exogenous anti-D, and washed. D positive RBCs are added and are key as they act as an indicator. The sample is examined using a light microscope. In the presence of fetal D positive cells, the indicator RBCs form aggregates or rosettes around the coated fetal RBCs (Solomonia et al., 2012). A positive result is indicative of an FMH greater than 10 mL and requires quantification by Kleihauer-Betke acid elution test or flow cytometry to determine the dose of RhIg to administer (Kim and Makar, 2011). This test can encounter and produce false-positive results. This largely occurs if the mother of fetus is weak D. Furthermore, in the presence of a direct antiglobulin test (DAT), the rosette test may produce a false-negative result. This can be attributed to crosslinking and agglutination of the mothers antibody coated cells (Kim and Makar, 2011). The Kleihauer-Betke acid elution test is a screening method that differentiates between fetal haemoglobin (HbF) RBCs and adult Hb (Bromilow and Duguid, 1997). The underlying notion of this test is fetal RBCs largely contain HbF and are resistant to acid elution, whereas in contrast, adult Hb is acid-sensitive (Kim and Makar, 2011). To perform this test, a maternal blood sample is taken to prepare a thin peripheral smear. The peripheral smear is dried, immersed in fixative, exposed to and incubated with an acid buffer, and stained with eosin. Under a microscope, the test reveals fetal cells to be stained a dark pink-red colour, whilst adult red cells appear pale or as uncoloured ghost outlines (Kim and Makar, 2011). Under a microscope, the fetal cells are counted and reported as a percentage of adult cells (Kim and Makar, 2011). Flow cytometry using anti-fetal haemoglobin antibodies is a variant of flow cytometry that detects RhD positive fetal cells (Kim and Makar, 2011). In this method, monoclonal antibodies are directed against HbF (Davis, 2007). A maternal blood sample is collected and an RBC count is performed (Davis, 2007). Cells are then fixed and permeabilised with detergent to enable antibodies to enter the cellular membrane and bind HbF (Davis, 2007). A flow cytometer is used to analysed the antibody stained cells (Davis, 2007). This method uses positive and negative controls simultaneously to differentiation between fluorescence from fetal RBCs and non-specific background staining (Kim and Makar, 2011). The positive control is also highly important in setting out the parameters for gating a sample (Kim and Makar, 2011). Rosette test Kleihauer-Betke acid elution test Flow cytometry using anti-fetal haemoglobin antibodies Advantages: Commercial kits Widley available Simple to use Fast Inexpensive Advantages: Not dependent on presence of RhD antigen Requires only basic laboratory equipment Inexpensive Can be used to assess fetal welfare in RhD positive patients Advantages: Quantitative Automated good precisions, sensitivity, accuracy, and reproducibility Cost-effective Less labour intense Disadvantages: Only applicable to RhD negative mothers carrying RhD positive fetus Qualitative only not quantitative Disadvantages: Laborious to perform Accuracy and precision limited due to variation in test characteristics Poor reproducibility Subjective Disadvantages: If mother and fetus have the same RhD type or mother is RhD positive cannot be used to determine FMH False positives due to hereditary persistence of fetal Hb, increased levels of Hb in pregnancy and certain disease states a) A >2mL bleed is detected via acid elution test in a sample taken from a D negative mother. Quantification via anti-D flow cytometry results in a zero bleed. Explain two possible reasons for the opposing results. The differing results of the acid elution test and anti-D flow cytometry may be explained by the RhD status of the mother and fetus. If the mother is not RhD negative and is carrying an RhD positive fetus, this test would not reproduce the results of the acid elution test. Additionally, if the fetus has an RhD negative status, this would also cause the test to fail and detect a zero bleed. Furthermore, flow cytometry cannot accurately detect weak and partial D variants, resulting in a false negative result. Therefore, if the mother or fetus has either of these D variants, FMH would not be detected via flow cytometry. An alternative reason for the differing results between the two tests could be attributed to haemoglobinopathies, in which the flow cytometer detects HbF. Lastly, there could be a mistake in the tube, such that the antibody was not detected, causing an incorrect result. b) Suggest a suitable test alternative to those already conducted to investigate the sample further and explain your reasoning for the alternative test. The use of flow cytometry using anti-fetal haemoglobin antibodies would be a beneficial test to implement in order to clarify the results and detect if a bleed is present. This is important to ensure the appropriate and correct dose of RhIg is administered. Testing the sample using HbF flow cytometry would be useful as flow cytometry using anti-D failed to reproduce the results of the acid elution test. There is a possibility that the acid-elution test produced a false positive result. The acid-elution test is limited in that is has poor accuracy and is prone to variations. The false positive may arise as a result of adult hereditary persistence of HbF, which is known in 1 to 2% of the population. Furthermore, during pregnancy the level of HbF rises by 25%. Therefore, the use of HbF flow cytometry would be able to detect if this is what caused the result. The following bleeds were detected via anti-D flow cytometry in a D negative woman. Using the Mollison calculation work out: The bleed volume in mL The total RhIg dose in each case to the nearest 500 IU The top up RhIg dose required in each case to the nearest 500 IU The Mollison calculation is used to calculate the volume of bleed. To do this, the background of the isotope matched control is subtracted from the number of events obtained in the D positive region, as recommended in the BCSH guidelines. The Mollison equation is as follows: D (+) events D (-) events1800FMH = X -ml X 1.22 Total number of events 1 The equation can be simplified to the following: FMH = % of D positive events x 18 x 1.22 0.81% x 18 x 1.22 = 17.79 mL 18 ml bleed* = 18 x 125 = 2250 IU Rounded to nearest 500 = 2500 IU 2500 IU 500 IU = 2000 IU 0.45 x 18 x 1.22 = 9.88 mL 10 mL bleed = 10 x 125 = 1250 IU Rounded to nearest 500 = 1500 IU 1500 IU 500 IU = 1000 IU 0.091 x 18 x 1.22 = 1.99 mL 2 mL bleed = 2 x 125 = 250 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. 1.09 x 18 x 1.22 = 23.94 mL 24 mL bleed = 24 x 125 = 3000 IU Rounded to nearest 500 = 3500 IU 3500 IU 500 IU = 3000 IU 0.02 x 18 x 1.2 = 0.43 1 mL bleed = 1 x 125 = 125 IU Rounded to nearest 500 = 500 IU 500 IU 500 IU = 0 IU This bleed is under 4 mL and therefore no top up is required as 500 IU is routinely administered for a bleed of up to 4 mL. References Brinc, D. and Lazarus, A. (2009). Mechanisms of anti-D action in the prevention of hemolytic disease of the fetus and newborn. Hematology, [online] 2009(1), pp.185-191. Available at: http://asheducationbook.hematologylibrary.org/content/2009/1/185.long [Accessed 6 Mar. 2017]. de Haas, M., Thurik, F., Koelewijn, J. and van der Schoot, C. (2015). Haemolytic disease of the fetus and newborn. Vox Sanguinis, [online] 109(2), pp.99-113. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25899660 [Accessed 6 Mar. 2017]. Dean, L. (2005). Blood groups and red cell antigens. 1st ed. [Bethesda, Md.]: NCBI. Delaney, M. and Matthews, D. (2015). Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn. Hematology, [online] 2015(1), pp.146-151. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26637714 [Accessed 6 Mar. 2017]. Giancarlo Maria Liumbruno, Angelo DAlessandro, Federica Rea, Vanessa Piccinini, Liviana Catalano, Gabriele Calizzani, Simonetta Pupella, Giuliano Grazzini (2010). Blood Transfus. 2010 Jan; 8(1): 8-16. doi: 10.2450/2009.0108-09 Kim, Y. and Makar, R. (2012). Detection of fetomaternal hemorrhage. American Journal of Hematology, [online] 87(4), pp.417-423. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22231030 [Accessed 6 Mar. 2017]. Murray, N. and Roberts, I. (2007). Haemolytic disease of the newborn. Archives of Disease in Childhood Fetal and Neonatal Edition, [online] 92(2), pp.F83-F88. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675453/ [Accessed 6 Mar. 2017]. Roberts, I. (2008). The changing face of haemolytic disease of the newborn. Early Human Development, [online] 84(8), pp.515-523. Available at: https://www.ncbi.nlm.nih.gov/pubmed/18621490 [Accessed 6 Mar. 2017]. Urbaniak, S. and Greiss, M. (2000). RhD haemolytic disease of the fetus and the newborn. Blood Reviews, [online] 14(1), pp.44-61. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10805260 [Accessed 6 Mar. 2017].      Ã‚  

How to Run a Successful Meeting

How to Run a Meeting Like Google As one of the most successful companies in the world, Google is obviously doing something right when it comes to how they manage their time. In general, meetings are known for being a waste of time where complaining occurs, but no real solutions are found. Of course this isn't always the case, especially at Google. In this article, Google's Vice-president of search products, Marissa Mayer, outlines how meetings are scheduled and conducted in an effort to eliminate wasted time and maximize results.On average, Mayer holds around 70 meetings a week. With so much precious time at stake, Mayer has developed a few keys to running a successful meeting. The first being to set a firm agenda. An outline is required beforehand which helps to streamline discussions and keep focused. Next, notes are always made, no matter how insignificant the meeting might be. It is important to Google that everyone is able to look back and see the final decision, but more import antly, the progression of the discussion.Google is all about being current, and note taking enables the company to keep all employees up to date. Mayer also emphasizes using data in the approval process. This is to ensure that employees know that ideas or designs are chosen based on merit and results, not favoritism. All of these have proven successful for Google in order to reach optimum results during any meetings held. However, I think it is how Google decides to organize their time that makes their meetings successful.Every week, Mayer designates large amounts of time to meet with people. She organizes these large blocks of time into smaller â€Å"slices†. Think: mini meetings. Why schedule a 30 minute meeting when it will only take 10? Mayer is much more productive and efficient with her time because of these micro-meetings. Mayer also suggests the use office hours. She was inspired to do this after her work as a professor at Stanford University.In this informal approach , not only is efficiency wildly improved (5 or more â€Å"meetings† can potentially occur within 30 minutes), but some of Google’s best ideas have come out of office hours. After all, sometimes someone only needs approval to move forward on a project which would not take up anywhere near 30 minutes time (the shortest block of time that her calendar allows). And finally, Google keeps things on time with a giant 4 foot clock that is projected on the wall. This adds pressure to keep on task, but gives every assembly structure.

Book Review †English as an International Language Essay

The blurb of this contribution to the scientific research of English states that this language does not only matter in the context of linguistics but also in other subcategories of science like â€Å"sociocultural, political and pedagogical† fields. The reason is seen in the matter of English being a lingua franca that is used in all areas of these studies and therefore the book’s goal is to take a closer look into the complexity of the international usage of English. The book is kept in a light tone of brown on the outside. On the cover there is a picture of a globe published in Digital Shock in 1997, obviously underlining the focus on inter-nationality. Title and Editor are kept in white. The book spine gives a short introduction about the focus and provides the reader with some quotes of well-known scholars like Janina Brutt-Griffler and Ryuko Kubota. At the beginning of the book, the lists of acknowledgments, contributors and abbreviations are located, followed by an overview by the editor Farzard Sharifian. The work is split into four parts namely: 1. Native/ Non native Divide: Politics, Policies and Practices; 2. EIL, Attitudes and Identity(ies); 3. EIL, Teacher Education and Language Testing: Gaps and Challenges; 4. The Scope of EIL: Widening, Tightening and Emerging Themes. All of the parts contain 3 essays, except the fourth chapter that provides five different endings. In order to give a brought overview, I will summarize each essay in short and name the convincing and the missing points. The introduction states that the focus of this book is â€Å"on communication rather than on the speakers’ nationality† (p. 5). The reason for this focus lies within the critique that English language teachers express while looking at the results of such a research. This reveals a unilateral measure, excluding the scientific field of English language teaching and underlining the focus on more political issues. However, it already gives a certain sense to the difference between English as an international language (EIL) and English as it is taught in school. This overview deepens on the following pages dealing with the difference of â€Å"politics, policies and practices† (p. 6) and the more precise definition of EIL. By looking closer on attitudes and identities, the author takes position in recent debates and controversies e. g. based on the â€Å"NS-NNS accent†. Even though he declares an assumption stating that â€Å"English native speakers have no difficulty understanding each other† (p. 8) to be wrong, he at the same time provides the readers with the pro and contra arguments in such a debate. Due to the fact of his entry being more or less an introduction, Sharifian succeeds in not going to far into detail but giving hints of what will be dealt with in the following. The starting chapter is mainly concerned with the politics influencing English as an international language. The first essay is contributed by Adrian Holliday, professor for linguistics at the Canterbury Christ Church University in the UK. He argues that English as a lingua franca cannot be dealt with on sociolinguistic grounds alone but must be seen as phenomenon of changing ownership. With this statement he does not question the lingua franca movement but rather points out possible problems resolving from this point of view (p. 21). After providing the reader with background knowledge of the movement establishes a distinction of native and non-native speakers based on the question whether or not this is a distinction to be made on linguistic or political foundation. In the end he comes to the conclusion that due to their distance to the language, non-native speakers are more critical about English as a lingua franca. With the combination of political and linguistic approaches, Holliday provides the reader with a real sense connection of the two fields and therefore this entry is an appropriate contribution to the subject of the book. The next essay is written by Sadia Ali, anthropological linguist from Zayet University. Her focus lies within the field of EIL in the Gulf Corporation Council (GCC) (p. 34). In order to do so she reflects upon the experience of English teachers within this council. This is a major contrast o the focus that Sharifian declared in the beginning of the work. However, by finding out that the employed people in this field are usually native speakers, Ali continues by analyzing their experiences within the alien culture (pp. 40-42). Through the research on the students perceptions, she also enlightens the flip side of the issue and comes to the conclusion that even though the qualification of a teacher does not depend on his/her being a native speaker, hiring processes are still unfair and not adjusted to the actual needs. Additionally, she proposes to give up older convictions of regarding correct English as an attribute of native speaker (pp. 51-52). Marko Modiano from the University of Stockholm takes the same line with the slight adjustment of rather concentrating on European language teaching which in his opinion failed. By providing the reader with tables that reveal the multilingualism in Europe and its state, he claims that the policy of staying with this system causes the failure of English language teaching (pp. 70-76). Even though the arguments seem convincing, Modiano totally neglects the opposite view of English being just used in order to simplify international economical or cultural processes. The second part of the book deals with the characteristics of EIL in particular. The first contribution by David Li, Associate Professor at the University of Hong Kong, aims to research the views of non- native speakers towards intelligibility and identity. In short the discussion whether native speaker based pedagogical models are useful or if pluricentricity should be the norm. Based on a combination of quantitative and qualitative data using a semi-structured questionnaire he comes to the conclusion that teachers should raise the awareness of their students for other varieties of English rather than sticking to a native-speaker based model in order to â€Å"encourage the learners’ confidences in their own English varieties† (p. 110). The sixth chapter is published by Enric Llurda is a Professor Applied Linguistics at the University of Lleida, Spain. His scrutiny is located within the fields of native models among second language users and teachers and their pervasiveness. He establishes a connection between non-native English speakers and the phenomenon of the Stockholm Syndrom (p. 119). He claims that non-native speaking English teachers are accepting proposals and formulation â€Å"that relegate to mere spectators and at times executioners of native speaker norms† (p. 119). After establishing a connection between these teacher and EIL, he further describes the attitudes between the two and comes to the conclusion that there is a â€Å"need to overcome non-native English speaking teachers and their subordination to native speakers models† (p. 28). Additionally, he provides possible solutions e. g. to gibe teachers more opportunities to develop their language skills. (pp. 130-131). EIL migrant teacher identities is the field of investigation of Bojana Petric, a lecturer at the Department of Language and Linguistics at the University of Essex. Taking into consideration the mobility of English language educators, she wants to give an overv iew into the role of a migrant teacher within his/hers classroom. Her results are based on interviews with four English teachers in Hungary. These interviews brought her to the conclusion that various factors have an influence on the teachers’ constructions of identities. However by admitting that e. g. gender, race or class have also impact to a certain extend she reveals that the research on this field is just one out of many to tackle the issue of migrant teachers (pp. 148-149). The third part of the entire book already gives an impression of more future oriented essays, aiming to improve backward conditions. The first essay subscribe to that and is written by Vaidehi Ramanathan, a Professor for Socio/Applied linguistics at the university of California, and Brian Morgan from the the York University in Toronto. From a more critical point of view the two argue that globalization makes the problem of classes and their inequality more complex than before and has therefore also an influence on teaching English to speakers of other Languages (TESOL). The interesting thing about this article is the structure of it. Both authors engage in some kind of dialogue and thus the arguments add up and reflect upon each other. Be that as it may they come to the conclusion that that globalization results in significant challenges for â€Å"new scholars and practitioners in TESOL† (p. 166-167) which at the same time help lead to new possibilites in ways of approach. While all preceding chapters deal with whole parts of the globe e. g. the Eastern bloc, chapter 9 focuses on preparation programs in Japan for English teachers. Aya Matsuda, Assistant Professor at Arizona State University, takes a stand in the debate about the Japanese action plan â€Å"to ‘cultivate Japanese with English abilities. (p. 169) and in how far World English and EIL are incorporated into such a program. In order to do so, she used a questionnaire for Universities having an accredited teacher preparation program to collect the information needed. After the evaluation she draws to a close that the current preparation programs are â€Å"attempting to increase their students’ awareness of the sociolinguistic complexi ty† (p. 87). However, it will take more time to further improve these programs and to make them a good instrument to change the teaching methods and hence our society. The test that almost every student of English has encountered during his studies is the TOEFL. For this reason, Sarah Zafar Khan, director of the Effat English Academy at Effat College in Saudi Arabia, puts tests like this in comparison to the notion of English as an international language. She basically questions the dominance of standard American variety of English and the parts of the TOEFL test. In short is there a hegemony or not. To provide a practical example she integrates a case study from Saudi Arabia (pp. 195-197). Through her research, she sums up that students are able to use English for communicative reasons, still, they are not explicitly acquainted to the standardized American English occurring in the TOEFL. Thus she demands a change in the system of English testing for non-native speakers (p. 204). In the fourth part of the book, Paul Roberts and Suresh Canagarajah (the first is a publisher of ELT books and worked as an English teacher in 8 countries, the other Professor for Language Learning at Pennsylvania State University) open up with a glance spoken English in an international encounter. In order to do so, they concentrate on a conversation between five non-native speaking persons, all of them with a different nationality. Through this procedure they find out that â€Å"ELF 2 speakers have the capacity to negotiate English when the context demands it. † (p. 224). Due to the fact that capacities like this have been left out of linguistic literature so far, the assumption may come up that this is just possible because of the special circumstances both authors created. Be that as it may, it reveals that the strategies of communication are based on the circumstances and not on capability of the speakers themselves. The twelfth chapter is written by Sandra Lee McKay, Professor for English at the University of San Francisco. She concentrates on the pragmatics and EIL pedagogy. The author desires more attention to the teaching of pragmatics in English as an EIL. Mainly paying attention to L2/L2 interactions, the foundation for her argument is built upon the hybridity of modern interactions in English (pp. 127-128). The outcome of her research is that non-native speakers of English are more likely to use constructions or words of their L1 systems. In cases such as this, she proposes the working out of a specific communicative strategy to clarify certain concepts of English (p. 251). The final chapter fourteenth chapter with scholarships and the role of English connected to it. Andy Kirkpatrick, Head of the English Department at the Hong Kong Institute for Education, considers â€Å"the implications of the rise of English as the international language of scholarship for the dissemination of indigenous knowledge. †(p. 255). The main source of his investigation is Chinese medicine and its international transition. With this he proves that a cultural property such as traditional medical procedures, are widely spread across the globe through the help of English language. Still he thinks that this is not a thread to the Chinese tradition because the medical procedures still vary even if they claim to be Chinese. In brief the change in Chinese medicine would have sooner or later anyway (pp. 266-268). The final chapter is contributed by Eric Anchimbe, assistant Professor of English Linguistics at the University of Bayreuth. He analyzes the differences of local and international standards. Therfore he concentrates on Indigenized Varieties of English that have spread in the recent decades and are also referred to as New Englishes. In the following he underlines the differences e. g. to non-native Englishes (pp275-277). Anchimbe proves that the variation of English is not only based on misconception but â€Å"asymmetrical power relations as well as social constructs sustained through colonially-inherited discourses† (p. 84). Also, to him it is inevitable that the language of English changes like everything in the progress of globalization. All in all the contributions to the book are more than satisfactory concerning the actual goal announced by Sharifian in the introduction. However, it is sometimes hard for the reader to draw the connection between goal and entry of the book. The single texts are easy to approach and combine statistical research with comprehensible conclusions. Another point that is well done, is the fact that all texts are written from different authors from different parts of the world. This is of course necessary for a book that researches international facts in English, still the range of countries taken into consideration is remarkable. One point that does not succeed is the division into different chapters and parts. First of all it really confusing regarding the fact that there are so many texts. Also the division does not make sense because many texts have similar approaches and goals and are still not part of the same chapter. In comparison to other linguisitic books of research the topic is rather detailed. Therefore some entries appear to repeat many facts from each other. Still, by taking a closer look to the chapters, it becomes clear that every author uses the points for different ways of arguing in favor or against his topic. I think this book would make a great contribution to every language class. It shows that English is not only substantial in English speaking countries, but all over the world due to economy and culture and the influences of globalization.

Globalization Is An Inexorable Integration Of Markets

Globalization has been a contentious buzzword for a long time in our society, but there are two sides to every coin. For some it is a luminous path towards progress and the key to a better world. To others it is a cruel, soulless monster that will destroy cultures and enslave millions. Apparently, Most of the world benefitted from the beginnings of globalization. However, Ellwood and Legrain suggest that corporations might link the world more closely with shrinking supply chain. As trade becomes more globalized, people are more mobile now. Accessible and quick worldwide transportation has made the world seem smaller. In this assignment, several segments from readings will be used to show that globalization has more advantages than it does disadvantages. According to Legrain, globalization is an inexorable integration of markets. Globalization enables individuals, corporations and countries to reach round the world faster, deeper, cheaper and farther than ever before. On the contrary, Ellwood argues in â€Å"Globalization then and now†, that the embryonic form of globalization began with a navigational discovery five centuries ago and then turned into a deliberate project of economy based on a political choice. Personally, I would say that I am benefit from globalization. As an international student from China, I have easy access to Chinese groceries and authentic Chinese restaurants here in Toronto. To some degree, globalization eliminates the barriers between countries andShow MoreRelatedThe Cold War And The World War II872 Words   |  4 PagesDuring the World War II through the present, the Cold War and the Globalization impacted a lot both positive and negative sides for the national world. The Cold War was a remarkable time for not only Germany and Globalization was a big shift for the world. From that, people defined Cold War as a division and Globalization as integration. So why do people define two events like that? 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