To sum up, the Bjork-Shiley tilting disk heart valve was intended to overcome the intense requirement of anticoagulant and thrombosis which was the main problems of the caged-ball heart valves. There is no doubt that it highly reduced thrombosis effect but due to faulty design concept, flawed manufacturing practices and characteristics of patients it was accompanied by outlet strut fracture and claimed many lives.
Even if the Shiley company knew the occurrence of fracture, it implements the “Earn as you learn” policy and continued supplying the product while investigating the problem. It can be clearly seen that the medical devices regulatory requirements were not strong enough to enable the FDA to take action on the B.S. heart valve in time.
The Bjork-Shiley heart valve case presented ethical questions both for the system of regulation and for the individual responsibilities of bioengineer. In addition to withdrawal of the B.S. heart valve from the market in 1986, the case also enabled the FDA to ratify strong regulation requirements on medical devices. Finally the company incurred $20.75 million fine by the government and spent a lot of money to create a continuing fund for researches to follow up the B.S. valve integrity non-invasively.

To sum up, the majority of pre-service teachers performed positive responses towards EFL TPACK questionnaire. The first research question was answered that pre-service teachers’ technology integration towards TPACK implementation were on sufficient level. Although, there was some doubts on pre-service teachers’ comprehension of English text and speech accurately which indicated from their high responses on neutral scale. However, there were also a low number of disagree responses in PCK and TPK items. The second research question was answered by the interview result which discussed about the way of pre-service teachers’ technology device integration. The majority of them integrate technology in their language classroom used laptop and projector. Some of them also used cell phone and audio speaker. While a handy-cam that mentioned in the interview result, it was used by the students. However, there were also some pre-service teachers who did not integrate any technology on their language learning. Thus, they used traditional method. Meanwhile, several pre-service teachers did not integrate technology devices in the classroom but they were indicated using some devices for their teaching without involved it in the classroom setting such as printer, laptop and cell phone to support their conventional teaching media.
B. Suggestion
In accordance with this research finding, to promote the confidence of pre-service teachers in integrating technology into the classroom, here are some suggestions for the academic institution who held teacher education program.
1. Auditing pre-service teachers’ confidence on using technology in the classroom setting continuously and providing them digital technology update for teaching is needed in order to give the appropriate course for pre-service teachers.
2. Giving the pre-service teachers more practices on the skill of English comprehension both in speaking and writing to fulfil their necessary knowledge bases and sufficient comprehension.
3. Increasing the quality and quantity of technology devices should be done
4. Pre-service teachers should be brave conducting an experiment with new technology for teaching in the classroom.


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