Monday, January 27, 2020

Case Study: Pre Eclampsia | Essay

Case Study: Pre Eclampsia | Essay This essay is based on a case study and will discuss the underlying pathophysiology, management and psychosocial aspects a patient faces when diagnosed with pre-eclampsia. Information was obtained through the patient and from their medical notes. Section A: Case History JB is a 38-year-old, gravida 4, para 0, Caucasian female who presented in hospital at 36 weeks plus 5 days gestation with sudden development of oedema in the face and upper and lower extremities along with a severe headache. On examination her blood pressure (BP) was elevated at 171/107 mmHg. Her pulse 81 beats per minute (bpm), respiratory rate 15 breaths per minutes, and temperature was 36.4  °C. Her urine sample showed ++ 2 proteinuria. There was evidence of oedema in her face and upper and lower extremities and her lower deep tendon reflexes were brisk but without any clonus. JB denied any visual disturbances and epigastric pain. On palpitation of the abdomen, the symphysio-fundal height was 38cm. The fetal lie was longitudinal and the back appeared to be on the right. The presentation appeared to be cephalic and the head was 3/5 engaged. Electronic fetal monitoring showed fetal heart rate at 135 bpm, with reassuring variability. There was no deceleration and acceleration was normal. It was also noted that contractions were absent. Her antenatal care had been shared between the hospital and her general practitioner and was uneventful until she was admitted to hospital on this occasion. On briefly reviewing JBs past medical history she has seasonal allergies as well as long standing asthma in which she uses salbutamol inhaler to relieve her symptoms. JB also has a history of depression. In her family history her father suffers from hypertension as well as cirrhosis and her mother has a remarkable medical history of extensive medical conditions such as hypertension, angina, and transient ischemic accidents. Both her maternal grandparents had a history of type 2 diabetes. With regards to her social history, JB works as a customer assistant and lives with her partner. JB has never smoked, and has not taken alcohol since finding out she was pregnant. Her past obstetric history is remarkable for recurrent miscarriages. She had two miscarriages at 6-8 weeks and one ectopic pregnancy a year and a half ago which miscarried naturally at 10 weeks. The initial investigations showed; a normal full blood count, liver enzymes and creatinine. However urate (0.37 mmol/l) and the protein: creatinine ratio (44 mg/mmol) levels were elevated. JB is demonstrating key cardinal symptoms of pre-eclampsia including hypertension, proteinuria, oedema, and increased reflexes.1 A diagnosis of severe pre-eclamptic toxaemia was made, JB was admitted and treatment was commenced with 10mg nifedipine. With JB being admitted onto the ward, there was continuous monitoring of BP and fetal monitoring using cardiotocography (CTG). The next morning JBs BP stabilised to 128/74 mm Hg and she reported feeling better. With the BP stable and a reassuring CTG a decision to induce delivery was made and she was given Prostaglandin E2 (PGE2) over three days. However there was poor response and the cervix remained obstinately unchanged and so it was decided the baby would need to be delivered via caesarean section. Section B: Pathophysiology Pre-eclampsia is part of a range of conditions known as the hypertensive disorders of pregnancy.2 It is defined as a multisystem disorder characterised by the new onset of raised BP (≠¥140/90 mm Hg) and proteinuria (at least 1 + on dipstick or ≠¥0.3 g/24 hours) after 20 weeks of gestation.3-5 Although the triggering event initiating the syndrome is unknown, a two stage model of pre-eclampsia has been proposed (figure 1).1,6-9 The primary asymptomatic stage, characterised by inadequate remodelling of the placental vasculature during the first trimester results in reduced placental perfusion leading to placental ischemia and release of placental products into the maternal circulation.1,6,7 Consequently this initiates the second symptomatic stage, the maternal syndrome in which endothelial dysfunction precedes the clinical manifestations of the disease including characteristic hypertension, proteinuria, and glomerular endotheliosis.1,6,7 There is also risk for developing the H ELLP syndrome (haemolysis, elevated liver enzymes and low platelets), progression to eclampsia, and end-organ damage.1,6,7 Stage 1 In normal pregnancy, following implantation, the surface trophoblast cells of the adhering blastocyst differentiate into an inner cellular layer, the cytotrophoblast, and an outer syncytiotrophoblast.10,11 The undifferentiated cytotrophoblasts found in the inner layer can develop into hormonally active villous syncytiotrophoblasts, extravillous anchoring trophoblastic cell columns, and invasive intermediate trophoblasts.10 The extravillous trophoblastic cells proliferate from the tips of anchoring chorionic villi to form the cytotrophoblast shell which line the uterine cavity.10,11 Cytotrophoblasts continue to migrate through the uterine endometrium until they reach the spiral arteries, by which time they have differentiated into an endothelial-like cell type.10,11 Endovascular trophoblast cells begin to remodel the spiral arteries by replacing the endothelium and smooth muscle cells resulting in the destruction of medial elastic, muscular and neural tissue.10-12 These physiological changes result in an increased vessel diameter leading to the creation of a low-resistance arteriolar system with the absence of maternal vasomotor control, and therefore allowing a notable increase in blood supply to the developing fetus.7,10 In pre-eclampsia this physiological dilatation does not occur adequately thus resulting in placental hypoperfusion and ischemia.1,8,10 The ischemic placenta may lead to the production of cytokines and growth factors as well as simulate placental apoptosis or necrosis, resulting in release of humoral or particulate materials into maternal systemic circulation that promote generalised maternal vascular endothelium dysfunction, culminating in the clinical manifestations of pre-eclampsia.1,8,10 The invasion of trophoblast cells is regulated by factors expressed by the decidual barrier.7,10 These factors include cell adhesion molecules, extracellular matrix, proteinases, growth factors and cytokines.7,10 Malfunctions in any these factors may lead to poor trophoblast invasion and subsequently pre-eclampsia.7,10 Immunological factors play a main factor in pre-eclampsia.7,10,11 Abnormal placentation may be the result of maternal immune rejection of paternal antigens expressed by the fetus. Normally HLA-G, a class 1B MHC antigen, expressed by the extravillous trophoblasts protects from natural killer cell lysis.11-13 Women who develop pre-eclampsia do not appear to express this HLA-G and therefore are not protected.7,10 Stage 2 The clinical manifestations of pre-eclampsia can be linked to the pathophysiological changes that occur including vasoconstriction, activation of coagulation cascade and reduced plasma volume.14 Development of hypertension is a key feature of pre-eclampsia.1,8,14 During normal pregnancy, although through maternal physiological adaptations there is a 30-50 % increase in cardiac output, the decrease in peripheral vascular resistance results in decreased arterial BP.14 However, those who develop pre-eclampsia experience widespread vasoconstriction, increased peripheral vascular resistance, and decreased cardiac output.1,13 Evidence shows there to be an exaggerated sensitivity of the vasculature of women with pre-eclampsia to all vasopressors hormones, best known is the increased responsiveness to angiotensin II.1,13 This increase in vascular reactivity is thought to be due to an alteration in the balance of prostaglandins as a result to the damage to vascular endothelial damage.1 JBs BP when she presented was 171/107 mm Hg. This is a considerably elevated and can be defined as severe pre-eclampsia (≠¥160 / ≠¥110 mm Hg).2-4 Although fluid retention and oedema occurs in patients with pre-eclampsia they are also a feature of normal pregnancy.1 Plasma volume increases by approximately 50% in uncomplicated gestations and normal gravidas sometimes experience oedema.1 However in pre-eclampsia plasma volume is decreased by 15-20% and in these cases women experience rapid weight gain and generalised oedema as a result of an abnormal shift of extracellular fluid (ECF) from the vascular to the extravascular compartment hence maintaining a low plasma volume and an increased interstitial fluid volume.1,14,17 With excessive accumulation of interstitial ECF, the presence of peripheral oedema particularly in the face and hands is seen. JB haemoglobulin was 130g/l, reflecting the haemoconcentration seen in pre-eclampsia as a consequence of the reduced intravascular volume.1 Women with pre-eclampsia also have noticeably reduced renal plasma flow (RPF) and glomerular filtration rate (GFR).1 The decline in RPF is attributed to vasoconstriction, whereas the fall in GFR is related both to the decline in RPF as well as to the morphological changes in the kidney.1 These characteristic pathological changes of pre-eclampsia are known as glomerular endotheliosis and comprise mainly of diffuse glomerular endothelial cell swelling, enough to obstruct the capillary lumen.1,7,8,13,15 The morphologic lesion is accompanied by functional changes in renal hemodynamics which correlates best with the magnitude of hyperuricemia and proteinuria.1,5 Early to middle pregnancy serum uric acid usually falls well below 0.24 mmol/l, in patients with pre-eclampsia levels often rise >0.27 mmol/l as seen in the case of JB (0.37 mmol/l).14 A number of studies have correlated the rise in serum uric acid with the severity of pre-eclampsia and with the extent of glomerular injury.5,8 JBs PCR levels was also measured to estimate the extent of proteinuria. The result recorded 44 mg/mmol predicts significant proteinuria, the threshold being >30mg/mmol.17 Left untreated, pre-eclampsia can proceed to life threatening convulsions termed eclampsia.18 Another specific complication that can arise from pre-eclampsia is the HELLP syndrome, which is illustrated by the sudden appearance of a microangiopathic haemolytic anaemia, elevation of liver enzymes and a rapidly falling platelet count.18 In these cases rapid interruption of pregnancy is required to avoid hepatic or renal failure, sepsis, or even death.1,6,7,15,18 Section C: Management Treatment for hypertension in pregnancy raises a series of challenges to the healthcare team.17 An in-depth knowledge of the adaptive physiological, psychological and social processes is required in order to choose the optimal management for the mother and her fetus.17,19 Incomplete understanding of the aetiology in pre-eclampsia has hindered attempts at prevention.12,17 However effective and adequate prenatal care management of pre-eclampsia has led to the reduced mortality related to this disorder.15,16 This includes early detection and referral of women at high risk, careful monitoring with prevention and treatment of complications, and a decision regarding timely delivery.15,16 Delivery remains the definitive treatment for pre-eclampsia even though the disease progression may not resolve immediately.8 Following diagnosis of pre-eclampsia, management relies on the initial observations recorded of both mother and fetus.4,16 The central goal of management of pre-eclampsia is ultimately to protect the wellbeing of the mother and prevent progression to eclampsia and then the delivery of a healthy newborn.4,16 While delivery is always suitable for the mother, it might not be appropriate for a premature fetus.4,16 Therefore the decision to deliver is influenced by the mothers condition, gestational age and status of fetus at the time of assessment.4,16 JBs management was given in accordance to guidelines from Royal College of Obstetricians and Gynaecologists.5,17 Based on JB diagnosis at 36.5 weeks she was admitted to hospital with the decision to induce labour and allow a vaginal delivery. Observations of vital signs including BP, heart rate, oxygen saturations, and respiratory rate were recorded every 15 minutes along with continuous CTG monitoring.5,15 A 10 mg dose of oral anti-hypertensive nifedipine was given to stabilize her BP before she could be induced. The sole need to treat is to prevent the hemorrhagic squeal of hypertension, in particular cerebral haemorrhage, rather than alter the progression of the disease process.2 Antihypertensive drug therapy is advised for pregnant women with systolic BP of ≠¥ 160 or diastolic BP ≠¥ 110 mm Hg.2,5,17 The goal of treatment is to lower systolic pressure to 130-150 mmHg and diastolic pressure to 80-100 mmHg.5,17 It is also important that BP is lowered gradually to prevent hypotension as placental perfusion can be adversely affected and compromise the fetus15. With a conservative management plan in place and JB stable, the BP was measured every four hours during the day. Full blood count, renal and liver function tests, were all carried out daily.5,17 There are many possible choices of antihypertensives that are appropriate in pregnancy.8 Methyldopa and labetalol are first line antihypertensive drugs used in treatment of pre-eclampsia.4,5 Methyldopa is a centrally acting alpha2 agonist that reduces sympathetic outflow activity.15,20 Although it has a long track safety record, due to the common drug side effects of depression, in the case of JB with a history of depression it was agreed an alternative should be used.14,15 The use of labetalol was also contraindicated in JB case as she is asthmatic.5 Labetalol is a non selective beta blocker and a selective alpha blocker.15,21 As both of these were contraindicated in JB case, nifedipine was prescribed instead. Nifedipine is a type 2 calcium channel blocker which is usually used as a second line agent in cases where BP is noncompliant to treatment with methyldopa and beta blockers.15,20,21 It acts by inhibiting the inward transfer of calcium ions from extracellular space and by the inhibition of uptake by smooth muscle cells.15,20,21 Its primary effect is to cause smooth muscles relaxation.15,20,21 Nifedipine has become a widely used antihypertensive, owing to its ability to vasodilate the vasculature with rapid onset and its full reversibility on discontinuing the drug.15,20,21 With respect to use of drugs in pregnancy, nifedipine has been rated as a Category C drug.21 This means that its use is recommended only when likely maternal benefits are seen to outweigh possible fetal effects, as the teratogenic effect of the drug on the fetus is uncertain.21 Once the BP was stabilized, induction of labour commenced. It is recommended that women in presence of severe pre-eclampsia at or beyond 34 weeks gestation to be induced to prevent the progression of the disease to eclampsia.5 Induction of labour was stimulated via PGE2, which contains dinoprostone. Its mechanisms of action are similar to the natural cervical ripening process.22,23 It is administered intravaginally to induce cervical ripening by directly softening the cervix, relaxing the cervical smooth muscle, and producing uterine contractions.22,23 There has been some debate of the use of dinoprostone in women with a history of asthma; however PGE2 is a bronchodilator, thus not contraindicated to use, in JB case. 23 For women whom there is a concern about the risk of eclampsia, it is recommended they receive magnesium sulphate as a prophylactic to protect against seizures, however in JBs case it was held off. The MAGPIE study demonstrates that the risk of eclampsia is more than halved in these women.5,8,24 However, it is also worth noting that only 1-2 % of pre-eclamptic women in the UK had fitted in the absence of anticonvulsant treatment.24 After magnesium sulphate is administered, extra caution is needed due to the potency of the drug which can lead to respiratory depression especially where nifedipine has previously been taken.21 When magnesium sulphate has been prescribed, it should be continued at least 24 hours post partum, as the risk of eclampsia does not resolve immediately after delivery. 5,14,15,24 The majority of women following deliver with severe pre-eclampsia will require inpatient care for four days or more.5 JB was discharged on the forth day after careful review of her clinical signs. She was continued on her anti hypertensive treatment, and was to be reviewed as an outpatient. JB was also offered a postnatal follow up to discuss the events of the pregnancy as well as preconception counselling.5 Section D: Psychological and Social Aspects Epidemiology Pre-eclampsia complicates about 2-8 % of pregnancies and may have serious effects on the mother and child, which makes it important threat to pubic health in both developed and developing countries. 2,24,25 Worldwide maternal mortality and morbidity from pre-eclampsia and eclampsia remains high, it is estimated to be responsible for approximately 12 % of maternal deaths per year. 24 It is estimated that pre-eclampsia is accountable for 67% of the referrals to day care assessment units, 20% of antenatal admission and 25% of obstetric admissions to intensive care units in the UK .26 The cost of treating pre-eclampsia varies between  £500- £10000 including the sum of hospital stay, induction costs, mode of birth, and pre-admission costs.17 Due to improvements in antenatal care in the UK, syndrome of eclampsia and development of HELLP syndrome is now rare.17 Eclampsia is reported in 1 in 2000 pregnancies.8,15,25 Also perinatal mortality rates are gradually improving, due to advances in antenatal care, early detection, improved anaesthesia, early delivery and expert neonatal paediatric care.15 Factors associated with an increase risk of pre-eclampsia include nullparity, African-American ethnic background, multiple gestations, obesity, chronic hypertension, molar pregnancy, family history of pre-eclampsia and a previous history of pre-eclampsia.4,8 Psychosocial Women who experience pre-eclampsia are exposed to significant amount of psychological and social stress.27 These stress disturbances in turn may have a significant impact on the mother and baby during the important early months following delivery.27,28 Pre-eclampsia is a disease which develops without warning therefore as JB reported, she found herself having to deal with the unexpected and dramatic changes in fetal health risk as well as her own all of a sudden. The diagnosis of pre-eclampsia initiates feelings of fear, shock, and sometimes even disbelief particularly to those experiencing it well before term. Shock comes from the fact that they were being hospitalised and felt unprepared for delivery.27,28 JB was very nervous after being admitted to hospital as she and her baby were regularly monitored and the realisation of the serious consequences the disease possess.28,29 There was also a sense of frustration as well as disempowerment as JB felt she had no control over the situation, and it was no longer just a personal responsibility. These feelings were amplified through the lack of sufficient information given on the disease, not completely informed about her actual situation, and on the medical decisions being made.27,28 JB was very emotional as she felt responsible for developing pre-eclampsia and worried about the risks she may have propelled on her child. Other psychological stresses were requirement of bed rest, boredom and being separated from her partner during hospitalisation.28 For those women who are diagnosed well before term, there is a greater risk of prematurity.28 These women being unprepared for the experience of delivering a premature baby can be a major component of shock and fear experienced. When progression of disease leads to complications, an emergency caesarean section which is usually performed can be very traumatic experience and life can suddenly be thrown into chaos. 27,28 These women usually have less early contact with there baby and are less likely to breast feed as they are recovering from surgery.27,28 For those who unfortunately loose their baby, they will be faced with the complex and traumatic events of grieving. This grieving process can be coupled to relationship problems as partners usually grieve differently.28 Women with pre-eclampsia are at increased risk of reoccurrence with subsequent pregnancies; therefore it is important they are advised of this if they wish to conceive again.28,30 The experience of severe pre-eclampsia may be overwhelmingly stressful. There is little time to adjust to new realities. Women may blame themselves adding the burden of guilt to the acute emotional chaos that follows diagnosis. Conclusion In conclusion, pre-eclampsia remains a global problem and a clinical challenge. It is a significant cause of maternal and perinatal mortality and morbidity. As the triggering factors remain unknown, prevention of the disease becomes difficult. At present, the only treatment option for pre-eclampsia is delivery, but this is not always simple and usually involves a risk-benefit balance between health of mother and the maturity of the fetus.

Saturday, January 18, 2020

Differences between Herbert Hoover and Franklin D. Roosevelt Essay

In reflection there are many differences between the United States’ 31st president Herbert C. Hoover and it’s 32nd president Franklin D. Roosevelt, so much so that their administrations and thoughts on how to run the country existed on two completely different paradigms in relation to their views on the governments role in society. To begin with, the Grand old man and the New dealer start out with a difference in the very foundation of their political standpoints. Herbert Hoover was affiliated with the Republican Party while Franklin D. Roosevelt was a member of the democrat party and their administrations are but a reflection of their affiliations. Herbert Hoover was appointed to office on March 4th of 1933 and Franklin Roosevelt was appointed April 12th of 1945. Hoover ended up serving four years in office as he lost his reelection to Roosevelt himself who later came to serve a total of three terms in office resulting in twelve years of presidency before his death in office. In the administrations of Hoover and Roosevelt it is clear that Roosevelt was more for government involvement than was Hoover however, Hoover had served as the secretary of commerce under the administrations of president Harding and president Coolidge and even in those administrations he believed that the government did not have to be passive and he backed the concept of â€Å"associationalism† that envisioned the creation of national organizations of businessmen in particular industries. This was meant to stabilize industries and promote efficiency in production and marketing but he never truly had an opportunity to implement his plans because less than a year after his inauguration the United States plunged into the Great Depression, sidelining previous ambitions and goals. In new light of his presidency Herbert Hoover implements government economic recovery that granted limited success such as the Smoot-Hawley tariff which hurt his administration and the economy rather than help it. And much of his doctrine for governing the American people was to have the least amount of direct government involvement in the people’s everyday lives. On the other hand Roosevelt was elected into the Great Depression and in his first 100 days in office he implemented a flurry of economic legislation that was part of his â€Å"New Deal† domestic program in attempt to alleviate (immediately yet not completely) the crisis looming over the United States. During his presidency Roosevelt implemented many acts that dealt with the Economy/Jobs, Financing/Banking, Defense/Foreign  Affairs, Social issues, Housing and even Environment and even got the nation’s unemployment rate down from 25% to 2%( The Agricultural Adjustment Acts, Emergency Relief Appropriation Act, Fair Labor Standards Act, Farm Credit Act, Federal Emergency Relief Act (FERA), Gold Reserve Act, National Industry Recovery Act (NIRA), National Labor Relations Act, Tennessee Valley Act, The Federal Farm Bankruptcy Act, Glass-Steagall Act, Corporate Bankruptcy Act, Emergency Banking Act, Federal Securities Act, Securities Exchange Act, Veterans Administration Act, Lend-Lease Act, Neutrality Acts, Selective Training and Service Act, Revenue Act of 1932, Revenue Act of 1941, Social Security Act, Farm Mortgage Refinancing Act, Home Owners Loan Act, National Housing Act, and the Reforestation Relief Act). Roosevelt’s new economic programs brought jobs to hundreds of thousands of men during the Great Depression through rural and agricultural projects that allowed them to once again get a paycheck, which also alleviated the congestion of large urban areas, a feat which overshadows president Hoover’s rural projects such as the Hoover dam. Roosevelt may have implemented many acts such as the Conservation Corps (CCC), Works Progress Administration (WPA) and Tennessee Valley Authority but it wasn’t just his economic reform that allowed for alleviation of the crisis, it was also his cheerful personality. Franklin D. Roosevelt used his optimism to bring trust and public confidence to his administration. And some of the ways he did this was through the â€Å"Fireside Chats† which were radio chats which he would use to communicate his programs and plans with the people. Roosevelt’s personality was even shown in his inaugural address where he stated â€Å"we h ave nothing to fear but fear itself† and it was often unknown that he was paralyzed in both of his legs. Herbert Hoover in contrast was not as outspoken and forth going and he lost the trust of the American people. More radical programs of relief were presented to him but he insisted that his policies were working. Hoover’s popularity began to decline due to his perceived political failures and many Americans thought him personally responsible for the conditions that they were in which led them to begin calling the shantytowns (housing for the unemployed) that they lived in on the outskirts of town, â€Å"Hoovervilles† But not only are Hoover and Roosevelt different in their domestic services but they were also different in their foreign affairs as Hoover didn’t have much direct involvement in foreign affairs but he did  pass the Hoover-Stimson doctrine which refused to recognize Japan’s conquer of Manchuria and even mediated on behalf of Peru and chile to settle a land dispute as well as sending ships to shanghai in order to protect U.S citizens. Hoover simply did not have the same pressing issues in foreign affairs as Roosevelt did because WWII occupied a lot of the time that Roosevelt was in office. Initially Roosevelt attempted to keep America out of the war and simply implemented ways to aid in the war effort while still on the home front such as the cash and carry act where munitions had to be bought and picked up from the United States instead of being shipped to the buyer and this improved the economy as European demand for war goods increased. And even though Roosevelt attempted to keep America out of the war, entry was inevitable after the Japanese bombing of Pearl Harbor that Americans themselves wanted revenge for. This led to more foreign intervention and direct involvement that president Hoover didn’t have to endure as president although he did assist in the war effort under president Wilson by supplying the troops with food as well as organizing a large return of Americans from Europe. In conclusion, President Herbert C. Hoover and Franklin D. Roosevelt are two president who lived on different sides of the political spectrum. President Hoover was a hands off type of president and was not big on large reform and radical change but rather little government involvement in the affairs of the American people whereas president Roosevelt had more of a direct approach. President Roosevelt believed that the government should have direct involvement in the affairs of the people and it was evident in his administration due to all of the economic legislation that was passed during his terms. In the end they were both presidents who stuck to their respective presidential strategies.

Friday, January 10, 2020

Employee motivation in Apple corpotation

This essay was written on Employee motivation in Apple company. I pointed out couple motivation theories that were developed in order to show people the ways of motivating. First and base theory is Maslow’s hierarchy pyramid then there are Equity theories and Two factor theory. The most popular and efficient motivation theory is goal seeking motivation theory. This theory was made in order to motivate staff to seek new opportunities how to solve a problems or reach their goals. In the second part I introduced the apple company and their motivation standards and behaviour.I applied the rest of theories that i picked for this essay and company. Some motivation strategies were already a part of this company but some were not. As far as some motivations are part of ourselves. How do we react and what do we do to make ourselves better. Apple Inc. is one of the most developing company in human resources and management. In the first part of my essay I would like to point out couple t heories that are often mentioned by many people as a main motivation at work.In second part I will apply theese mentioned theories to an Apple company in order to compare and evaulate the difference of their processing motivation standards and theories of employee and human motivation. Employee motivation is one of the main concernes of corporations theese days because of the main focus of employees on what can employer offer for my hard and efficient work. How do they motivate in order to reach higher standards and profits. What if I create a great added value for the company and they treat me the same without any bonus or raised wage? Same questions but in different ways has our future employer.Company theese days need mature, efficient, motivated and high-performance employees. Since the business has taken place on our planet. Came up a question? How do I motivate people? So now I am going to mention couple theories that are most likely often used by companies to motivate their e mployees. Motivation forces within the individual forces that account for the direction, level, and persistence of a person’s effort expended at work. Direction is the way where you channel your motivation. How do you apply the motivation. Then there is a level of motivation that meassures how much effort someone puts in motivating staff.Motivating persistence is the length of time a person or manager sticks with a given action. How long does it take to reach a goal. Types of motivation theories Content theories Maslow’s hierarchy of needs theory Abraham Maslow first inctroduction of his theory took place in 1943 paper „A Theory of Human Motivationâ€Å". There are basically five levels of what humans need. Some are more important than others but basically follows a flow of certain needs that needs to be satisfied first before you can worry about other needs. The Maslow’s theory is often displayed as a Pyramid of needs.The bottom of the pyramid are the pr imary human needs (Psychological) such as breathing, eating, sleeping, drinking water, sexual needs. Second floor of the pyramid also known as secondary needs are safety needs which means security of our body, health, the family or our employment. Third floor is named Love or belonging this floor includes friendship, family and sexual intimacy. Fourth floor of pyramid is called Esteem it covers self esteem, confidence,achievemtn, respect of others. Fifth floor is self actualization, this top of the pyramid is made of morality, creativity,spontaneity,problem solving.Another theory is Acquired need theory. Need for achievement. The desire to do something better or more efficiently, to solve problems, or to master complex tasks. Need for affiliation. The desire to estamblish and maintain friendly and warm relations with others. Need for power. The desire to control others, to influence their behaviour or to be responsible for others. Two factor theory also known as Herzberg’s mo tivation-hygiene theory and dual-factor theory was developed by Frederick Herzberg in 1959. Herzberg in study of individual needs and motivation developed this theory.The theory identifies two different factors as primary causes of job satisfaction and job dissatisfaction. Hygiene factors Sources of job dissatisfaction that can be found in context of our job or in the work we got set. Job dissatisfaction occurs when hygiene factors are poor. Improving the hygiene factors only decreases job dissatisfaction doesn‘t make profit in sales or financial sphere. Motivator factors Sources of job satisfaction to job content. Presence or absence of satisfiers or motivators in people’s jobs is the key to satisfaction, motivation, and performance.If we want to build more motivator factors in the job content we call it a job enrichment. Equity theory was developed by John Stacey Adams in 1963 this theory means that any percieved inequity becomes a motivating state of mind. Foundation of equity is based on social comparison. People are motivated to behave in ways that restore or maintain equity in situations. Individual outcomes and individual efforts must be equal to other’s outcomes and other’s efforts then equity is in place once the equality comes outbounced then inequity can occur. Equity theory prediction: Felt negative inequityIndividual feels thath he has recieved relatively less than others in proportion to work inputs. Felt positive inequity Individual feels that he has recieved relatively more than others have. Equity restoration behaviours. Reduce work inputs Change the outcomes reciever Leave the situation Change the comparison points Psychologically distort things Try to change the efforts of the comparison person Organizational justice How fairly and equitably people see the practices of their workplace at the time. Every employees motivation is a multiplicative function of valence, expectancy and instrumentality.Goal seeking theory motivation was developed by Edwin A. Locke in the middle of 1960’s. Goal setting The process of developing, negotiating, and formalizing the targets or objectives that a person is responsible for accomplishing. Difficult goals are leading to more efficient and lasting performance than low goals. Specific goals are leading to a slightly raising performance than vague or giving ourselves a general goal. Feedback more likely task feedback is motivating people to produce a higher performance by setting of higher performance and more sophisticated goals.Goals are leading to higher performance when people have the abilities and the feelings of self-efficacy required to accomplish them. Goals are motivating people toward higher performance when they are accepted by the individual, and there is commitment ot them. Management by objectives (MBO) Process of joint goal setting between a supervisor and a subordinate. Firstly I would like to briefly introduce the Apple company and then th eir standards in staff motivation in progress. Apple was founded by Steve Jobs, Steve Wozniak and Ronald Wayne in 1976 in order to develop and sell PC’s.Steve Jobs died in 2011. He was the main engine of Apple Inc. and he showed them the way they should go in the future. Even though he had a cancer he was a fighter and solver. Apple Inc. and employee motivation and relationships. Apple shows the world its greatness for a period of time now. They are leading electronics market worldwide. And firstly I might want to point out the negative part of suppliers behaviour. Since the supplier’s employees are not an Apple’s employees they dont care about unethical behaviour in their suppliers factories in China or India.Particulary in China-Chenzen there is a supplier of many electronic selling brands called Foxconn. Foxconn employs about 500. 000 employees. And the suicide rate is about 60 employees per year. That is alarming number. But for worldwide leading companies t hat sells electronics it’s just a good business of low cost makeing of their product and high profit by selling it to consumer. This is the main issues of almost every corporation that founds it’s place or cooperates with already existing factories with employee base. While the economy is flowishing they expand to other socialy low parts of China or India.Employees at Foxconn for example are 12 old children that work from 12 to 16 hours a day. So in 2013 Apple Inc. which was making almost 70% of their devices in Foxconn in Chenzen China has made a statement and showed the world their suppliers. Foxconn was mentioned as an problem facility that has to take steps forward to eliminate unethical behaviour. Apple wants his suppliers to set the working hours to 60 hours in 6 days that makes maximum of 10 hours a day. Only 38% of suppliers commited to this. Foxconn wasn’t one of those companies.So that was the negative experience I have with Apple impact on ethical beh aviour of the coutrnies of third world. I studied Apple Inc. since middleschool. I made many eassays and reports about their business and internal functions like staff motivation, appreciation, development. Mainly Apple was built and carried through the rough times by legendary messiah Steve Jobs. Now its Tim Cooks turn to take over the vessel and head for the goals of the number one company in the world. If you look at apples employee motivation culture you can see that the theory of goal seeking took place here as a main push factor.The pull factor was the internal share sale for employees. Employees could buy shares for the lowest price given by apple. They couldn‘t participate on meeting or participate on strategical and main decisions of the headquarters. This is ment as a kind of benefit, bonus, incentive. Apple is mainly working on the management by objectives management and goal seeking theory. They give their employees the feeling of higher good. They give them a purp ose to proceed to better performance. Often in Apple Inc. employees were scared to walk in hall ways because they could meet Steve Jobs.When someone met with him, he always asked couple questions and sometimes he fired someone spontaneously that was called „to get Steveâ€Å". So employees even though they didnt know Steve but only their supervisors were scared of him, because of his changing behaviour. There are many operating teams that are working on the same things without knowing it. Thats the main advantage of motivating them. They solve the problem, but other team solved it in a better way. Their motivation rises because of competition made betweens those teams. They are doing alot of brainstorming with their supervisors even Steve was attending those.That gives employees a chance to present their ideas and even to protest the changes or procedures taking place. If I would implement the equity theory in Apple Inc. I would say that this motivating factor is always hidde n. It’s individual need but most people do care if another person gets a higher bonus for the same work with better effort or performance. So it’s highly motivating and won’t affect the other methods of motivation. Maslow’s needs theory is already in everybody. Every person has his needs. We have the same primary needs like sleeping, eating and drinking.But others have higher goals to improve themselves for themselves and their environs. This is also very individual basic employee has different needs than a manager or owner. Another theory that i mentioned in the first part of my eassay was goal seeking motivation theory that is already in text above. Apple Inc. esxists on this type of motivation since it was developed. Even though Steve Jobs died. And the last theory mentioned is Herzbergs two factor theory based on measuring the satisfaction or dissatisfaction of employee in their workplace also know as motivator-hygiene theory.I would like to say somet hing negative about apple’s motivation procedures but I can’t because it is just brilliant. The two factor is also part of the company management. Apple Inc. is recruiting only the best of best and they benefit those people and take care of them. Those people don’t need to change employers or sell the information to media. They are satisfied and often they are strongly commited to the company. Apple is like a big happy family that profits out of its shares and company salaries.Apple Inc.  is strong company that has strict rules and motivates their staff to improve their skills and inovative thinking. They grow their own profesionals in electronics and management. Apple deserves the main position on worldwide market of electronics. They have the best design and marketing in the world. They employ thousands of people all over the world. The key strategy of Apple was always to maintain on path that Steve Jobs showed them. I hope that in the future Apple will set a standard even for their suppliers of how to behave to their employees in ethical and fair way that should be human being treated. Figure 1. 1 Employee Motivation in Apple Corpotation AbstractThis essay was written on Employee motivation in Apple company. I pointed out couple motivation theories that were developed in order to show people the ways of motivating. First and base theory is Maslow’s hierarchy pyramid then there are Equity theories and Two factor theory. The most popular and efficient motivation theory is goal seeking motivation theory. This theory was made in order to motivate staff to seek new opportunities how to solve a problems or reach their goals.In the second part I introduced the apple company and their motivation standards and behaviour. I applied the rest of theories that i picked for this essay and company. Some motivation strategies were already a part of this company but some were not. As far as some motivations are part of ourselves.How do we react and what do we do to make ourselves better. Apple Inc. is one of the most developing company in human resources and management. In the first part of my essay I would like to point out c ouple theories that are often mentioned by many people as a main motivation at work.In second part I will apply theese mentioned theories to an Apple company in order to compare and evaulate the difference of their processing motivation standards and theories of employee and human motivation.Employee motivation is one of the main concernes of corporations theese days because of the main focus of employees on what can employer offer for my hard and efficient work. How do they motivate in order to reach higher standards and profits. What if I create a great added value for the company and they treat me the same without any bonus or raised wage? Same questions but in different ways has our future employer.Company theese days need mature, efficient, motivated and high-performance employees. Since the business has taken place on our planet. Came up a question? How do I motivate people? So now I am going to mention couple theories that are most likely often used by companies to motivate t heir employees.Motivation forces within the individual forces that account for the direction, level, and persistence of a person’s effort expended at work. Direction is the way where you channel your motivation. How do you apply the motivation. Then there is a level of motivation that meassures how much effort someone puts in motivating staff.Motivating persistence is the length of time a person or manager sticks with a given action. How long does it take to reach a goal. Types of motivation theories Content theories Maslow’s hierarchy of needs theory Abraham Maslow first inctroduction of his theory took place in 1943 paper „A Theory of Human Motivationâ€Å".There are basically five levels of what humans need. Some are more important than others but basically follows a flow of certain needs that needs to be satisfied first before you can worry about other needs. The Maslow’s theory is often displayed as a Pyramid of needs.The bottom of the pyramid are th e primary human needs (Psychological) such as breathing, eating, sleeping, drinking water, sexual needs. Second floor of the pyramid also known as secondary needs are safety needs which means security of our body, health, the family or our employment.Third floor is named Love or belonging this floor includes friendship, family and sexual intimacy. Fourth floor of pyramid is called Esteem it covers self esteem, confidence,achievemtn, respect of others. Fifth floor is self actualization, this top of the pyramid is made of morality, creativity,spontaneity,problem solving.Another theory is Acquired need theory. Need for achievement. The desire to do something better or more efficiently, to solve problems, or to master complex tasks. Need for affiliation. The desire to estamblish and maintain friendly and warm relations with others. Need for power.The desire to control others, to influence their behaviour or to be responsible for others. Two factor theory also known as Herzberg’s motivation-hygiene theory and dual-factor theory was developed by Frederick Herzberg in 1959. Herzberg in study of individual needs and motivation developed this theory.The theory identifies two different factors as primary causes of job satisfaction and job dissatisfaction. Hygiene factors Sources of job dissatisfaction that can be found in context of our job or in the work we got set. Job dissatisfaction occurs when hygiene factors are poor.Improving the hygiene factors only decreases job dissatisfaction doesn‘t make profit in sales or financial sphere. Motivator factors Sources of job satisfaction to job content. Presence or absence of satisfiers or motivators in people’s jobs is the key to satisfaction, motivation, and performance.If we want to build more motivator factors in the job content we call it a job enrichment. Equity theory was developed by John Stacey Adams in 1963 this theory means that any percieved inequity becomes a motivating state of mind. Foundatio n of equity is based on social comparison.People are motivated to behave in ways that restore or maintain equity in situations. Individual outcomes and individual efforts must be equal to other’s outcomes and other’s efforts then equity is in place once the equality comes outbounced then inequity can occur. Equity theory prediction: Felt negative inequityIndividual feels thath he has recieved relatively less than others in proportion to work inputs. Felt positive inequity Individual feels that he has recieved relatively more than others have. Equity restoration behaviours. Reduce work inputs:Change the outcomes reciever.Leave the situation.Change the comparison points.Psychologically distort things.Try to change the efforts of the comparison person.Organizational justice.How fairly and equitably people see the practices of their workplace at the time. Every employees motivation is a multiplicative function of valence, expectancy and instrumentality.Goal seeking theory motivation was developed by Edwin A. Locke in the middle of 1960’s. Goal setting The process of developing, negotiating, and formalizing the targets or objectives that a person is responsible for accomplishing. Difficult goals are leading to more efficient and lasting performance than low goals.Specific goals are leading to a slightly raising performance than vague or giving ourselves a general goal. Feedback more likely task feedback is motivating people to produce a higher performance by setting of higher performance and more sophisticated goals.Goals are leading to higher performance when people have the abilities and the feelings of self-efficacy required to accomplish them. Goals are motivating people toward higher performance when they are accepted by the individual, and there is commitment ot them. Management by objectives (MBO) Process of joint goal setting between a supervisor and a subordinate. Firstly I would like to briefly introduce the Apple company and then the ir standards in staff motivation in progress. Apple was founded by Steve Jobs, Steve Wozniak and Ronald Wayne in 1976 in order to develop and sell PC’s.Steve Jobs died in 2011. He was the main engine of Apple Inc. and he showed them the way they should go in the future. Even though he had a cancer he was a fighter and solver. Apple Inc. and employee motivation and relationships. Apple shows the world its greatness for a period of time now.They are leading electronics market worldwide. And firstly I might want to point out the negative part of suppliers behaviour. Since the supplier’s employees are not an Apple’s employees they dont care about unethical behaviour in their suppliers factories in China or India.Particulary in China-Chenzen there is a supplier of many electronic selling brands called Foxconn. Foxconn employs about 500. 000 employees. And the suicide rate is about 60 employees per year. That is alarming number. But for worldwide leading companies tha t sells electronics it’s just a good business of low cost makeing of their product and high profit by selling it to consumer.This is the main issues of almost every corporation that founds it’s place or cooperates with already existing factories with employee base. While the economy is flowishing they expand to other socialy low parts of China or India.Employees at Foxconn for example are 12 old children that work from 12 to 16 hours a day. So in 2013 Apple Inc. which was making almost 70% of their devices in Foxconn in Chenzen China has made a statement and showed the world their suppliers. Foxconn was mentioned as an problem facility that has to take steps forward to eliminate unethical behaviour. Apple wants his suppliers to set the working hours to 60 hours in 6 days that makes maximum of 10 hours a day. Only 38% of suppliers commited to this. Foxconn wasn’t one of those companies.So that was the negative experience I have with Apple impact on ethical behavi our of the coutrnies of third world. I studied Apple Inc. since middleschool. I made many eassays and reports about their business and internal functions like staff motivation, appreciation, development.Mainly Apple was built and carried through the rough times by legendary messiah Steve Jobs. Now its Tim Cooks turn to take over the vessel and head for the goals of the number one company in the world. If you look at apples employee motivation culture you can see that the theory of goal seeking took place here as a main push factor.The pull factor was the internal share sale for employees. Employees could buy shares for the lowest price given by apple. They couldn‘t participate on meeting or participate on strategical and main decisions of the headquarters. This is ment as a kind of benefit, bonus, incentive.Apple is mainly working on the management by objectives management and goal seeking theory. They give their employees the feeling of higher good. They give them a purpose t o proceed to better performance. Often in Apple Inc. employees were scared to walk in hall ways because they could meet Steve Jobs.When someone met with him, he always asked couple questions and sometimes he fired someone spontaneously that was called „to get Steveâ€Å". So employees even though they didnt know Steve but only their supervisors were scared of him, because of his changing behaviour.There are many operating teams that are working on the same things without knowing it. Thats the main advantage of motivating them. They solve the problem, but other team solved it in a better way. Their motivation rises because of competition made betweens those teams. They are doing alot of brainstorming with their supervisors even Steve was attending those.That gives employees a chance to present their ideas and even to protest the changes or procedures taking place. If I would implement the equity theory in Apple Inc. I would say that this motivating factor is always hidden. Ità ¢â‚¬â„¢s individual need but most people do care if another person gets a higher bonus for the same work with better effort or performance.So it’s highly motivating and won’t affect the other methods of motivation. Maslow’s needs theory is already in everybody. Every person has his needs. We have the same primary needs like sleeping, eating and drinking.But others have higher goals to improve themselves for themselves and their environs. This is also very individual basic employee has different needs than a manager or owner. Another theory that i mentioned in the first part of my eassay was goal seeking motivation theory that is already in text above.Apple Inc. esxists on this type of motivation since it was developed. Even though Steve Jobs died. And the last theory mentioned is Herzbergs two factor theory based on measuring the satisfaction or dissatisfaction of employee in their workplace also know as motivator-hygiene theory.I would like to say something neg ative about apple’s motivation procedures but I can’t because it is just brilliant. The two factor is also part of the company management. Apple Inc. is recruiting only the best of best and they benefit those people and take care of them.Those people don’t need to change employers or sell the information to media. They are satisfied and often they are strongly commited to the company. Apple is like a big happy family that profits out of its shares and company salaries. Apple Inc. is strong company that has strict rules and motivates their staff to improve their skills and inovative thinking.They grow their own profesionals in electronics and management. Apple deserves the main position on worldwide market of electronics. They have the best design and marketing in the world. They employ thousands of people all over the world.The key strategy of Apple was always to maintain on path that Steve Jobs showed them. I hope that in the future Apple will set a standard ev en for their suppliers of how to behave to their employees in ethical and fair way that should be human being treated.

Thursday, January 2, 2020

Feasibility Study - 3740 Words

Presented by Barerra, Jan Paul Cajayon, Natalia Nigel Collado, Daniel Joseph De Leon, Philip Enriquez, Manuel Lozano, Arvin Umali, Anthony FEBRUARY 22, 2013 TURON DELUXE Muralla St. Intramuros, Manila Chapter I – Introduction This study looks at how a food cart business will flourish and how it will operate as a business, as well as being an entrepreneur. Food cart businesses are successful in the market nowadays with proper study and all. Such businesses popped like mushrooms. In order to obtain pure success, this paper will show all necessary data to win in the business world. Managing a business is not easy as one, two, and three. Lots of time and effort is needed to have a successful business, brain and heart is the key to prosper.†¦show more content†¦Equipments for cooking, storage and display is also needed, such as Refrigerator, Deep Fryer, and Glass rack and Gulaman 2.5 Estimated Project Cost The total of the initial capital needed for set-up and operation of the business for its first month is Php. 129,425.00 . The said amount includes all the budget for the operation of business; such as permits, license equipments, and ingredients and laborers salary. Chapter III – Benefits to the Consumers and Producers 3.1 Benefits to the Consumers 3.1.1. Homemade Unlike any other similar products, Turon Deluxe products would be prepared at home. The main ingredient, Banana, would come from different places, not in a stored cold refrigerator. The products are made preferrable fresh and made to order process. 3.1.2. Clean The products are made in a clean manner, it does not venture in anything that is wise made anywhere in the location of the business. The products are handly made before shifting to the location and produce with a good perspective manner in the eyes of the consumers. Using recyclable paper for the packaing 3.1.3. Accessible Location The Turon Deluxe is about to locate itself at the Walls of Intramuros. Knowing that this location is one of the most visited places in the Philippines due to its historic relations. At a very visible location, visitor and guest of the fortifications can drop by to taste and experience our prod uct. Giving the consumers to a whole new level ofShow MoreRelatedFeasibility Study778 Words   |  4 Pagesproperty development. We start out by arming ourselves with all the information needed to determine which locations have the potential to make money or not. In this phase we evaluate potential suburbs, neighbourhoods and sites, do a preliminary market study, put together a preliminary budget, carry out a preliminary financial analysis, prepare a timing analysis and review the political climate and the council approval process. Here are the steps we will evaluate in detail during the course: a) BecomeRead MoreFeasibility Study2369 Words   |  10 PagesWhat to Include in your Feasibility Study March 30, 2010, 3:32 am In starting a new business venture, it is important to conduct a feasibility study to ensure that your business will be successful. Some things to be included are plan, cost, and sources of funding, manpower and personnel requirements, market and profitability. In the plan section of your feasibility study, State clearly the objectives and description of the project. Duration to complete the project is also included. It is usuallyRead MoreFeasibility Study5785 Words   |  24 PagesFeasibility Study In T.L.E Submitted by: Christel Ann P. Gabarda IV-Dignity Submitted to: Mrs.Dalisay Buenconsejo 2013 Logo Table of Contents Introduction Background of the Study†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦1 Objectives†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦.....2 Methodology†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦.3 Definition of Terms†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..6 Market Sudy Market Study Market Environment†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.....8 Survey†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.9 Survey Analysis.............................................Read MoreFeasibility Study4402 Words   |  18 Pagessupporting recycling of waste materials. 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It is located between 11th Avenue and McKinley Parkway, Bonifacio Global City, Makati City Serendra is a 12-hectare garden community with European architecture style derived from Tegel Harbor and Germany Berliner Strasse master plans combined with the stone style house or bahay na bato architecture of the Philippines