Motivation Essay

1. Define and discuss motivation. Which theory of motivation offers the best chance, if handled properly, of increasing productivity in your workplace? Motivation can be described as a process that accounts for an individuals intensity, direction and persisitence of efforts towards attaining a goal (Robbins, 2004). While general motivation is concerned with motivation towards the achievement of any goal, this paper will be discussing motivation in relation to organizational goals, as the focus is on work related behavior (Robbins, 2004). With regards to the definition, there are 3 key elements related to motivation. Intensity is concerned with how hard a person tries to achieve a goal. But in order for intensity to trnaslate into better performance it has to be channeled in the right direction. So, the quality of the intensity is very essential. Persistence is another dimension to motivation. It is a measure of how long a person can maintain his or her efforts. There have been numerous theories on motivation, devised and tested multiple times. But the theory I find most relevant and important to a workplace, the work be of any nature, is the expectacy theory, put forward by Victor Vroom (Robbins, 2004). Expectancy theory focuses on three main relationships. The effort-performance relationship, performance-reward relationship and the reward-personal goal relationship. In more practical terms, expectancy theory says that when an employee puts in effort o his job it is partly because he believes his effort will translate into better performance, but this performance alone would be useless to him, until and unless there are obvious benefits attached to better performance, i.e. rewards. These rewrds may be monetary or non-monetary and may vary from a promotion or pay increment to a pat on the back from the boss and a word or two of appreciation from the supervisor. This would motivate the workforce, as every individual will perceive that with this job he would be able accomplish his personal goals. 2. Define and discuss leadership. Which style is presently used in your own workplace? Which style is needed, or which style do you believe should be used to increase productivity? Leadership theories have great applications in business settings. For example, some organizations look for leadership traits when choosing a candidate for a leadership position.   Most organizations that we normally encounter look for specific personality traits of individuals such as their openness to experience, social behavior, extraversion etc. These are the traits that are associated with good leaders. Extraversion is a trait that is mostly associated with leadership emergence because extraverted people are quick to establish contacts, have usually good communication skills and are emotionally aware of others. Similarly, openness to experience is a good indicator of a leader’s ability to encounter and deal with new situations. Contemporary theories of leadership such as Charismatic leadership and Transformational leadership fit very well in the dynamic situation of the contemporary world. Contemporary leadership theories view leaders as individuals who inspire their followers through their words, ideas and behaviors. And this is so true of today’s successful leaders (Kotter, 1995).   Charismatic leadership theory can be applied to leaders such as New York mayor Rudy Guiliani, African President Nelson Mandela, and African-American leader Martin Luther King. Through his rhetoric, Martin Luther king was able to consolidate the civil rights movement and became one of the most inspiring leaders (Kotter, 1995). Contemporary leadership theories are forward looking as they emphasize on leader’s vision. A clear vision is described as one of the qualities of charismatic leaders because it is their vision that binds their followers and becomes the impetus for change. Moreover, contemporary leadership theories put emphasis on leader-follower relationship as in Leader Exchange Theory (Robbins, 2004). As employees become more empowered, leader-follower relationship becomes even more important and contemporary leadership theories provide valuable information in this regard. So, in essence, leadership has a huge role to play when it comes to the employees’ attitude towards work. Because, if a leader can inspire and motivate his or her followers, it may help bring out a more positive attitude from them, and ultimately this would have a positive impact on the productivity of the company.

Genetic Testing For Haemophilia Health And Social Care Essay

MFA presented to the day care of the Paediatric section with left mortise joint swelling for one twenty-four hours after hitting his mortise joint on a rock while playing in the flushing one twenty-four hours prior to admittance. There was hurting and bruising seen at the mortise joint articulation after the injury. The swelling increased in size and became more painful throughout the dark. His parents so brought him to the day care early the following forenoon. Physical scrutiny revealed swelling and tenderness at the left ankle joint every bit good as decreased scope of motion on both inactive and active motion due to trouble. There were besides multiple ecchymosis in different phases seen at the upper and lower limbs. A diagnosing of haemarthroses of the left mortise joint articulation was made. MFA was transfused with 200IU of Factor VIII. The hurting and puffiness were reduced in badness but persisted throughout the twenty-four hours. MFA returned to the day care the following twenty-four hours for more Factor VIII. He was given Factor VIII transfusion 200 IU twice daily for the following two yearss. The hurting and puffiness subsided after 3 yearss. MFA was diagnosed with terrible Haemophilia Angstrom when he was eight months of age. The diagnosing was made at the national blood bank. Familial testing besides done at the national blood bank revealed that his female parent was a haemophilia cistron bearer. MFA receives transfusion of Factor VIII when he develops haemarthroses or shed blooding due to trauma. He requires factor transfusion on an norm of one time every three months. He has had repeated hospital admittances with an mean continuance of stay for three to four yearss. MFA has good household support and is a member of the haemophilia society. He and his household have adapted good to his unwellness. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: PediatricssPATIENT ‘S DETAILSI/C NUMBER: ( B ) 630902-01-6092 Age: 9 old ages old Sexual activity: Male DATE OF ADMISSION: 23/04/09 R/N NUMBER: N/A2 ) CLINICAL HISTORYChief ailment: MFA is a nine twelvemonth old male child who was diagnosed with haemophilia A since eight months old. He presented with swelling in the left mortise joint for one twenty-four hours. History of present unwellness: MFA was running in the field at school when he knocked his mortise joint against a big rock in the land on the eventide of the twenty-four hours prior to showing at the day care. There was hurting after he hit his mortise joint but he was able to bear weight and walk. There was some bruising but no hemorrhage at the site of hurt. The joint became more painful towards the dark and there was some puffiness, heat and inflammation which increasingly increased. The hurting increased in badness so much so that MFA was unable to bear weight and used a wheelchair belonging to his brother to travel about the house. The hurting caused him some uncomfortableness but he was able to kip. He did non take any analgesia for the hurting. The following twenty-four hours, MFA ‘s parents brought him to the day care of the pediatric section for a factor transfusion. Systemic reappraisal was everyday. MFA was foremost diagnosed with haemophilia A when he was 8 months of age. His parents noticed that he developed contusions at his custodies and articulatio genuss. This occurred when he was tilting to creep. A blood trial was done in the national blood bank, and his parents were told that MFA had terrible hemophilia A. His immediate household underwent testing and his female parent was found to be a bearer of the haemophilia cistron. MFA receives factor VIII transfusion on an norm of one time every three months. The transfusions are required when he develops haemarthroses or gum hemorrhage due to tooth decay. The joint most normally affected is his right articulatio genus articulation. He has non developed any contractures. He does non normally seek medical intervention for contusions which are a common happening. He has non had mucosal shed blooding as nosebleed or hematuria. MFA would sometimes necessitate hospital admittance for factor VIII transfusion. This is normally when he has hemorrhage or terrible hurting due to a haemarthroses or a hematoma. At other times he would have the transfusion at the day care and return place. His parents would convey him once more to the infirmary for the following dosage till the hurting and puffiness in the joint resolutenesss. If a transfusion were required at dark when the day care is non unfastened, MFA would travel to the pediatric ward where the medical officer would be able to administrate the factor VIII. His symptoms would better with the factor VIII transfusion. MFA is an active male child who likes playing and running about. However his instructors in school restrict his physical activity to non-contact athleticss such as badminton and running. He is besides discouraged from unsmooth drama with his classmates. He wears elastic guards around his cubituss and articulatio genuss to protect them from hurt. However the elastic guards do non assist much as he still develops haemarthroses at those articulations. MFA is presently casting his decidual dentition. As such he requires factor VIII transfusion screen prior to tooth extraction. MFA is under followup at the pediatric clinic of Batu Pahat. He has defaulted the followup as his parents feel that nil much was done during the visits. He merely presents to the day care when necessitating factor VIII transfusion. MFA has besides been referred for physical therapy after episodes of haemarthroses which limit motion in the articulations. He has attended a few Sessionss of physical therapy in order to forestall contracture at articulations which have haemarthroses. He does non hold regular assignments. MFA is a member of the haemophilia society. His parents on a regular basis attend meetings where negotiations are given to educate parents on caring for haemophiliac kids. The members besides relate their experiences and promote one another. MFA has a medic qui vive necklace which says that he has haemophilia A. However, he rarely wears the medic qui vive. Past medical history MFA has non had any other infirmary admittances other than those due to haemophilia. Family history MFA is the youngest of three siblings. His senior sister is twenty old ages old and is good. His senior brother is 15 old ages old and has a bone cyst. He has undergone eight surgeries to mend the bone cyst every bit good as due to complications such as refractures. The wheelchair which MFA used at place was bought for his brother ‘s usage. MFA ‘s parents are good. There is no household history of hemophilia on his maternal side even though she is a bearer. MFA ‘s female parent has 3 brothers but all of them are good and do non hold hemophilias. There is no history of shed blooding upsets in the household. Social history MFA ‘s parents are both instructors. However they have to lose traveling to work frequently due to MFA ‘s status which necessitates frequent visits to the infirmary. As such, MFA ‘s female parent has a particular agreement with her schoolmaster which allows her to learn from 11 to 4 autopsy. As such, she is free in the forenoon to convey MFA to the infirmary when he needs it. His parents besides provide good support for MFA in that they frequently attend haemophilia meetings to update themselves on agencies to outdo attention for their kid. Birth history MFA was born at term in Hospital Batu Pahat. He was delivered through an elected cesarean delivery subdivision due to a breech presentation. There were no prenatal abnormalcies detected during everyday prenatal medical examination. There were no perinatal or station natal complications. He was nursed with his female parent after birth and discharged uneventfully. Developmental history MFA is presently in primary three of a spiritual school. He is an above mean pupil who finishes in the top 10 of his category. His instructors have no ailments about his school assignment. Developmental mileposts prior to this were all achieved at the appropriate times. Dietary history MFA is on an grownup diet now. He eats balanced repasts which are normally prepared by his female parent. He was breastfed till the age of seven months. Weaning was with porridge at the age of five months. Immunization history MFA has been immunized harmonizing to the immunisation agenda. After he was diagnosed with hemophilia A, his immunisations were done at the pediatric clinic under factor VIII screen. His last immunisation was at seven old ages of age. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss3 ) Findings ON CLINICAL EXAMINATIONOn general scrutiny, MFA was friendly and communicative. He was sitting in a wheelchair with a patch around his left mortise joint. There were some ecchymosis seen at his weaponries and thighs. He looked good nourished. He was non in terrible hurting. Anthropometric measurings: Weight: 24kg ( 10th to 25th centile ) Height:130cm ( 25th to 50th centile ) His critical marks were normal: Pulsation: 82 beats per minute Respiratory rate: 18 breaths per minute Blood force per unit area: 108/72 Temperature: 37 grades Celsius Examination of the lower limbs: There were ecchymosis seen on both lower limbs at the thigh every bit good as at the shin and calf. The left mortise joint was swollen and there was a contusion seen on it. It was stamp on tactual exploration but there was no addition in temperature. There was reduced motion of the left mortise joint articulation due to trouble. The right mortise joint articulation every bit good as both the left and right articulatio genus articulations were normal. There were no contractures seen. Examination of the upper limbs: There was besides some contusions seen on both the upper limbs. The cubitus and wrist articulations were normal on both custodies. The scope of motion for all the articulations on both upper limbs were normal. Examination of the cardiovascular and respiratory systems every bit good as scrutiny of the venters was normal. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss4 ) PROVISIONAL AND DIFFERENTIAL DIAGNOSES WITH REASONINGProbationary diagnosing: Haemarthroses of the left mortise joint articulation — — Evidence for: MFA has been diagnosed with hemophilia since the age of eight months. The articulations are a common site of shed blooding for hemophiliac. In add-on, MFA has had anterior episodes of hurting and puffiness in the joint similar to this episode. The hurting reduced when he was given factor VIII transfusion which farther supports this diagnosing. He besides has multiple contusions on his weaponries and legs which indicate that he has a hemorrhage upset. Differential diagnosing: 1 ) Juvenile Rheumatoid Arthritis The pauciarticular type of juvenile rheumatoid arthritis nowadayss with hurting and puffiness in the big articulations such as articulatio genuss, mortise joints and carpuss. It may show as symmetrical arthralgia or may merely impact one articulation. Evidence against: Juvenile rheumatoid arthritis normally nowadayss during childhood while MFA has been holding episodes of joint hurting and puffiness since he was an baby at eight months of age. Juvenile arthritic arthritis is besides associated with forenoon stiffness which MFA does non hold. MFA besides has easy contusing which is non a characteristic of juvenile rheumatoid arthritis 2 ) Septic arthritis Patients with damaged articulations are predisposed to infected arthritis. As such, a haemophiliac patient who has repeated haemarthroses may hold damaged articulations which are susceptible to infection. Evidence against: Patients with infected arthritis normally have fever while MFA did non. They are besides more common in patients who are immunocompromised. On physical scrutiny, there was no increased heat in the joint which would be more declarative of infected arthritis. 3 ) Ankle ligament hurt A sudden turn of the mortise joint may do a wrenching of the soft tissue and ligaments around the mortise joint doing hurting and puffiness. Evidence against: Master of fine arts did non writhe his mortise joint while playing. He simply knocked it against a stone. As such the mechanism of hurt does non propose that the ligaments were strained. He was besides able to bear weight after hitting his mortise joint and the puffiness and hurting bit by bit developed. This is contrary to what is expected in a sprained mortise joint where there would be immediate puffiness and hurting around the mortise joint. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss5 ) IDENTIFY AND PRIORITISE THE PROBLEMS1. Swelling at the left mortise joint MFA has hurting and puffiness at the left mortise joint articulation. He was in moderate hurting which he rates as 6 out of 10 on the hurting mark. Analgesics such as acetylsalicylic acid and NSAIDS are non recommended for him as they cause shed blooding in hemophiliac. As such the best agencies for rapid alleviation of the hurting and the swelling would be Factor VIII transfusion. 2. Hazard of joint devastation MFA is presently eight old ages old and is an active male child who enjoys playing with his friends. As such he is prone to injury from even mild injury. He has developed haemarthroses on an norm of every 3 months. Perennial haemarthroses at the same articulation could do devastation of his articulations taking to osteoarthritis, restriction in motion and development of contractures. A hold in intervention could besides do harm to the joint. As such, prompt and equal factor VIII transfusion is indispensable for MFA. He should besides be referred to the physical therapy section when the hurting has subsided. Physiotherapy would assist in forestalling the development of joint contractures 3. Hazard of shed blooding Due to his active nature, MFA is besides at hazard of terrible hemorrhage if he injures himself. He was last admitted to the infirmary for one hebdomad due to shed blooding when he fell while playing. There was terrible hemorrhage from his oral cavity and gums when he hit his face on a tabular array. MFA is besides presently casting his decidual dentition. As such, he is at hazard of gum hemorrhage from the site of tooth extraction. The most unsafe hazard is that of an intracranial bleeding 4. Hazard of perennial factor transfusions MFA requires frequent factor transfusion. As the factor VIII used in Batu Pahat is derived from human plasma, there is a hazard that MFA may acquire Hepatitis B, Hepatitis C or HIV infections. In add-on, MFA has non been screened for any of these infections. As such it is necessary for MFA to be screened as recommended by the Malaysian protocol for the direction of hemophilia. 5. Consequence of unwellness on school assignment and day-to-day activity MFA misses school for about a hebdomad on an norm of one time every three months. This may impact his public presentation in school. In add-on there is an addition demand for him to acquire good academic consequences as he would necessitate to believe about a hereafter with a calling that does non necessitate heavy physical activity due to his status. Trouble faced by caretakers MFA ‘s male parent and female parent are both working and frequently are forced to lose work in order to take attention of MFA when he develops episodes of hemorrhage. Both the parents are instructors who have understanding schoolmasters who sympathize with them and give them much leeway in order to care for their kid. However the uninterrupted emphasis of taking attention of a inveterate sick kid demands to be addressed. Support groups such as the haemophillia society would be able to assist the parents by giving them entree to other parents who face similar troubles. These parents would be able to promote one another and portion tips on caring for haemophilliac kids Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss6 ) Plan OF INVESTIGATION, JUSTIFICATIONS FOR THE SELECTION OF TESTS OR PROCEDURES, AND INTERPRETATION OF RESULTSProbes done at 8 months of age by the national blood bank: 1. Curdling profile Justification: MFA presented with peliosis at his limbs which indicates that might hold a hemorrhage upset. As such a curdling profile would be utile to see if the curdling tracts are affected. Consequences: APTT prolonged. More than 90 seconds Interpretation: The drawn-out APTT indicates that the intrinsic tract is affected and that one of the factors in the intrinsic tract may be deficient. 2. Serum factor VIII degree Justification: To determine which specific factor that is lacking doing the hemorrhage upset. Consequences: Factor VIII degree: 0.6 % ( No inhibitors detected ) Interpretation: MFA has severe haemophilia A due to his Factor VIII degree being less than 1 % . He will react to factor VIII transfusion as there are no inhibitors to factor VIII detected. No probes were done for this presentation at the day care. I would propose the undermentioned probes: 1 ) A field radiogram of the ankle articulation AP and sidelong position Justification: In order to govern out other causes of the joint hurting such as infected arthritis or break at the joint. Possible grounds why it was non done: The clinical presentation of the patient did non propose that he has infected arthritis as he did non hold a febrility and the articulation was non ruddy. As the clinical image was typically implicative of a haemarthroses given that he is a hemophiliac, it would be unjust to the patient to subject him to an ten beam as this would intend he would be exposed to radiation every three months. 2 ) Full blood count Justification: A full blood count would be utile to see if there is an increased white cell count which may bespeak an infection. Possible grounds why it was non done: MFA is clinically good with no symptoms of infection such as febrility. As such a full blood count may non be necessary as it would likely be normal. There is besides a hazard of shed blooding or hematoma from venepuncture. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss7 ) Working DIAGNOSIS AND PLAN OF MANAGEMENT ON ADMISSIONWorking diagnosing: Haemarthroses of the left mortise joint due to Haemophilia A My proposed program of direction: I ) Factor VIII transfusion with a mark serum factor degree of 30 % eight hourly till the puffiness and hurting resolutenesss two ) Elastic patch and ice battalion around the left mortise joint three ) To rest the mortise joint articulation by non-weight bearing boulder clay swelling and hurting reduces four ) To analyze patient for joint malformation or contractures prior to dispatch from day care V ) Refer the patient to physiotherapy for joint rehabilitation of the affected articulation. six ) To educate the parents on attention for their kid and protective steps to forestall hurt. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss8 ) Summary OF INPATIENT PROGRESS ( INCLUDING MAJOR EVENTS, CHANGE OF DIAGNOSIS OR MANAGEMENT AND OUTCOMES )MFA was given 200 IU of Factor VIII transfusion. He was so asked to return the following twenty-four hours to be reviewed by the medical officer in charge. Merely one transfusion was deficient for the puffiness and MFA had to digest much uncomfortableness and hurting throughout the dark. This is despite the Malayan Paediatrics protocol recommendation that factor VIII is given every 8 to 12 hours. The ground for this could be the prohibitory cost of the factor. The following twenty-four hours MFA was given another 200 IU of Factor VIII transfusion in the forenoon and once more in the eventide, 12 hours apart. He was given two more transfusions on the 3rd twenty-four hours. The transfusions were given at the day care in the forenoons and at the pediatric ward at dark by the medical officer who was on call. The hurting and swelling resolved on the 4th twenty-four hours post hurt. He was examined by the medical officer and was told to merely return to the day care if he had another episode of joint puffiness or open hemorrhage. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss9 ) DISCHARGE PLAN, COUNSELLING AND MOCK PRESCRIPTIONDischarge program: I ) MFA was asked to rest him left mortise joint and to partly bear weight till it was wholly pain free. two ) Referral to the physical therapist for joint rehabilitation to be done Guidance: I ) MFA was advised to avoid athleticss which involve physical contact as the even minimum injury may do a bleed. two ) MFA ‘s parents were told to convey him back to the day care if there were any longer episodes of shed blooding into the articulations or self-generated hemorrhage. They were given a eventuality program to travel straight to the pediatric ward and see the medical officer on call if any hemorrhage were to go on when the day care is closed. three ) MFA and his parents were besides educated on complications that they need to look out for such as intracranial bleeding. They were taught about the marks and symptoms that they should be wary of. four ) MFA was encouraged to travel for physical therapy which he had antecedently defaulted. He was told about the dangers of joint devastation due to recurrent haemarthroses and how physical therapy may help in forestalling contractures. Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss10 ) REFERRAL LETTER ( MANDATORY )Dr Tan Hai Liang, Paediatric Department, Hospital Batu Pahat Physical therapist, Physiotherapy section, Hospital Batu Pahat 27 May 2009 Dear sir, Patient ‘s name: Mohammad Faiz Affizuddin Patient ‘s I/c figure: ( B ) 630902-01-6092 Problem: Haemarthroses of the left mortise joint articulation Thank you for seeing this nine twelvemonth old male child who was diagnosed with Haemophilia A for the past eight old ages. He has had recurrent episodes of shed blooding into the articulations. The articulations most normally affected are the articulatio genus articulations and elbow articulations. His current presentation is for a haemarthroses of the left mortise joint articulation. Physical scrutiny: Inflammation and puffiness of the left mortise joint articulation. Tenderness on tactual exploration. Reduced scope of motion both active and inactive. He has been given Factor VIII transfusion which has reduced the puffiness and hurting. Kindly reexamine the patient and execute joint rehabilitation for him. He has good household support and his household could besides be taught exercisings to forestall joint contractures that can be done at place in position of his recurrent shed blooding into the articulations. Thank you. Yours genuinely,______________( Dr Tan Hai Liang ) Student Name: Tan Hai Liang ID NO: M0409146 Name OF SUPERVISOR: Dr Kyin ROTATION: Pediatricss11 ) Learning ISSUES IN THE 8 IMU OUTCOMES1 ) Family and community issues in health careHow are parents affected by holding a hemophiliac kid? I had the chance to speak to MFA ‘s parents and inquire them about the challenges faced when caring for him. They related many of their experiences and confided that many alterations to the life style of the household were done in order to accommodate to populating with and caring for a hemophiliac. Both parents have had to lose work on a regular basis due to MFA ‘s frequent infirmary admittances. Family activities besides are limited to light physical activity with minimum hazard of hurt. Furthermore MFA ‘s female parent admitted to ab initio experiencing guilty as she was the bearer of the cistron that leads to his status. As such, I wondered if hemophilia had an impact on parent ‘s quality of life in visible radiation of the many accommodations that they had to do to their life style. A survey by Beeton et al [ 1 ] involved 12 parents of kids with hemophilias whose age ranged from 18 months to 16 old ages of age. The parents were interviewed and qualitatively assessed on their experiences in caring for a kid with hemophilia. It found that medical direction often focused on assisting the hemophiliac adjust to his or her status with small accent on the wider household web. The early old ages of the kid ‘s life after diagnosing were characterized by the parents missing experience and feeling uncertain. This is coupled with the frequent demand of factor transfusion and the associated trouble in venous entree in babies and immature kids. Quality of life at the early old ages post diagnosing was found to be hapless due to parents experiencing ‘out of control ‘ . Parents caring for a hemophiliac kid besides reported that the manner in which they engaged with the people around them had changed. There was a necessity in being more self-asserting in order to protect their kid. This was confirmed by MFA ‘s female parent who relates that she had statements with the infirmary manager and schoolmaster of MFA ‘s school in order to take a firm stand on particular steps to be put into topographic point to better MFA ‘s quality of life. The survey besides found that female parents normally took up a greater duty in caring for the kid. Fathers who were at work during the twenty-four hours did non hold the same degree of experience and this could be a beginning of struggle between parents. Parents were besides found to hold higher degrees of emphasis and anxiousness. However the degree of the emphasis and anxiousness was dependent upon on the phase that parents had achieved in pull offing the status every bit good as successful version. Another survey by Bullinger et al [ 2 ] showed that the quality of life for patients and households with hemophilia was higher when compared to patients with other chronic unwellnesss such as asthma. This shows that households with hemophiliac are able to populate a comparatively normal life with good quality of life if certain stairss were taken to accomplish successful version. The survey found that betterment in quality of life can be attained by supplying an environment in which patients and parents experience understood and good informed. In decision, I learned that hemophilia has a profound consequence, non merely on the kid who has the disease but besides on his primary caretakers which are his parents. As such I need to besides ask about how parents are get bying and offer professional aid such as reding if necessary.2 ) Critical thought and researchIs coagulating factor dressed ore prophylaxis effectual in the direction of patients with hemophilias?A paper by Ljung [ 3 ] proposed that direction of a patient with hemophilia should travel off from concentrating on the upset itself and alternatively look towards keeping a healthy kid. This means that patient ‘s should non be repeatedly managed with factor transfusions when they present with shed blooding but alternatively be kept healthy by forestalling the hemorrhage from go oning in the first topographic point. As such the writer proposed that primary contraceptive therapy should be the gilded criterion in the direction of patients with hemophilias. However is coagulating factor dressed ore prophylaxis effectual in pull offing patients with hemophilias, and what are the associated factors which prevent this direction from being a practical option? I looked at a Cochranre reappraisal by Stobart et Al [ 4 ] which analysed four separate surveies affecting 37 patients. The consequences of the reappraisal showed that there was a statistically important difference in the decrease of shed blooding episodes in patients who were given standard prophylaxis when compared to a placebo. It besides found that secondary results such as clip loss to school and employment due to the unwellness was statistically significantly reduced among those having primary prophylaxis compared to a placebo. The reappraisal besides quoted one survey which showed that a twice hebdomadal extract of higher dosage of factor dressed ore had a statistically important advantage in cut downing the figure of bleeds a twelvemonth when compared to a lower dosage and less frequent disposal of transfusion. However the writers concluded that there was deficient grounds from randomized control tests to urge the usage of primary contraceptive factor extract in the direction of patients with hemophilias. An independent retrospective survey by Khoriaty [ 5 ] showed that primary prophylaxis has some promise. The survey recruited 133 patients with Haemophilia A and B with a average age of 27.93. It compared the 91 patients who were on primary prophylaxis and the staying 42 patients having on-demand intervention when they developed shed blooding. The survey found that there was a statistically important decrease in the figure of self-generated shed blooding per twelvemonth. Patients on primary prophylaxis were found to hold 3.2 bleeds per twelvemonth while those who received on-demand therapy bled 5.7 times per twelvemonth. It found no statistical difference between the two groups in footings of hemorrhage after injury. However the consequences for this survey needs to be read with attention due to the big age scope. Further surveies need to be done for the pediatric age group due to differences such as a higher leaning for injury and hurt in active kids compared to grownups who are better at caring for themselves. One ground why primary prophylaxis is non used in the intervention of haemophiliacs despite its promise is the high cost of the factor VIII. One phial of 200 IU costs in the part of RM 800. As such it may non be cost effectual for primary prophylaxis to be carried out particularly in the context of the Malaysian health care system with its limited budget. A cost effectivity analysis by Miners et al [ 6 ] in England showed that it would be & amp ; lb ; 547 to forestall one episode of shed blooding from go oning. This cost is mostly prohibitory in the Malayan context. In decision I found that there is grounds that primary prophylaxis has much promise in the bar of shed blooding among haemophilia patients but extra surveies need to be carried out particularly in the local environment in order to determine the cost-effectiveness of primary prophylaxis.3 ) Self directed life long larningWhat is the hereafter in footings of direction of hemophilia? The direction of hemophilia is presently with factor transfusions which aim to halt hemorrhage when it has already happened. The other option is primary prophylaxis with regular factor extracts to forestall hemorrhage. However this attack is dearly-won and does non cover with the job of patients developing inhibitors which make transfusions uneffective. As such, research workers are looking into a agency for a remedy of hemophilia. This remedy is by utilizing cistron therapy. The aim of cistron therapy is to redact a faulty cistron sequence to accomplish complete reversion of disease phenotype in the life-time of the patient. Haemophilia is seen as the ideal campaigner for cistron transportation therapy as foremost there are many cell types which are able to synthesise biologically active coagulating factor. Second, there is a broad remedy window which makes it unneeded to hold rigorous cistron look. Third there are big and little animate being theoretical accounts that permit the survey of safety and efficaciousness prior to induction of human tests. [ 7 ] Phase 1 clinical tests are presently being done utilizing largely viral vectors to infix the cistron. Retroviruss have shown promise in this therapy. The cistrons are inserted via developing hepatocytes or hematopoietic root cells. Presently safe long term look of coagulating factors has been successfully achieved in big carnal theoretical accounts of hemophilias utilizing multiple cistron transportations. [ 8 ] Gene transportation therapy nevertheless still faces many obstructions before it can be seen as a feasible therapy for hemophilia. There is hazard of experimentation in worlds in order to formalize this therapy. Many inquiries besides remain unreciprocated such as inhibitor development after the interpolation of the cistron and besides the transmittal of the extra cistron to the kids of the patient who receives the cistron therapy. One paper suggested a generous timeline of at least 20 to 30 old ages before the potency of cistron therapy can even be considered. These issues are ‘merely medical ‘ issues. Religious and ethical issues besides have to be taken into consideration before prosecuting this direction. In decision, I learned that though there is much potency in this field of cistron therapy, much research still has to be undertaken to determine its safety every bit good as efficaciousness. However it has been a valuable experience in larning about new modes of intervention and to catch a glance of what the hereafter holds. This has taught me to go on larning as there are ever new sentiments and therapies available in the direction of any unwellness. 4 ) Professionalism, moralss and personal development What are the ethical deductions of familial proving for haemophilia? After MFA was diagnosed with haemophilia, his immediate household underwent familial testing. The proving revealed that his female parent was a bearer and that his senior brother and senior sister were normal. The familial testing was done voluntarily. There is no recommendation in the Malayan Paediatric protocol for familial testing to be done. Familial testing is normally done in patients with no clear household history in order to determine which parent is a bearer so that farther stairss of direction can be carried out. These farther stairss may include offering familial testing to the siblings of the bearer parent and besides reding about hazard of holding extra kids. However familial testing besides raises many ethical inquiries. First there is guilt, heartache and ego incrimination when a female parent with no known household history of hemophilia discoveries that she was the cistron bearer that passed it on to her kid. A paper by Thomas et al [ 9 ] on attitudes towards familial proving in an Australian community found that female parents who were ‘sporadic ‘ bearers ( no known household history of hemophilia ) were had feelings of guilt. Performing familial testing to determine that a female parent of a haemophiliac kid is a bearer would merely be of value if extra stairss were taken such as offering familial testing to the female parent ‘s siblings. This in itself would raise inquiries of confidentiality and revelation since offering the testing would necessitate the physician to unwrap to the other household members that the female parent is a bearer. This revelation could so take to stigmatisation. In this specific instance, MFA ‘s female parent was found to be a bearer. She related that she felt anguished at ‘causing ‘ her boy to endure much hurting. The cognition that the female parent was the bearer who had passed on the cistron to her boy did non change the direction of MFA. As such there was small virtue in executing the familial testing in this instance. A 2nd consideration of familial testing is the deductions that it has on a individual ‘s determination of whether or non to hold kids. This is once more more relevant for female bearers. Carriers should be counseled that there is a 50 per centum opportunity that their kid would hold hemophilias if he were a male child. However the ethical issue arises when there is no agency of correlating between the genotype and phenotype. [ 10 ] Just because the kid may hold hemophilia does non foretell the grade of badness of the hemophilia. The lone means to cognize for certain about the position of a foetus in footings of whether he would hold hemophilias and the grade of badness is by making antenatal familial proving such as chorionic villi sampling. Prenatal familial proving itself is associated with many ethical issues such as the deductions of transporting out such a trial. Would the foetus be terminated? There is legal leeway for expiration if it can be proven that the kid ‘s unwellness would convey about mental hurt to the female parent. Where do we pull the line to make up one's mind that such a foetus has excessively terrible a haemophilia so as to justify expiration? Who makes the determination? In the instance of MFA, the parents decided non to hold any more kids due to the hazard of holding another hemophiliac kid. It ca be seen that the familial testing had a profound impact on their determination. However proper and thorough familial guidance was non given to the parents. In decision I learned that familial proving for hemophilia is fraught with many ethical considerations. It should merely be offered when proper followup such as guidance, support and options can be offered to those undergoing the trial. In the absence of proper model of support, it may be better to keep back familial testing.

Class Actions Essay Example | Topics and Well Written Essays - 250 words

Class Actions - Essay Example wsuit on behalf of several thousand or a larger group of unnamed plaintiffs who share common grievances caused by similar actions, products or defects such as consumer products, pharmaceutical drugs, medical devices and motor vehicles. People have also submitted class actions with regards to corporate misconduct, employment practices, consumer fraud and securities fraud. A class action is the best way of handling cases with similarly situated and multiple plaintiffs. This is so because, many a times, there are many people who have suffered similar or same injuries, and their individual injuries are minor, as such, they might not independently pursue legal redress. However, there are instances in which it may be impractical to submit individual lawsuits, especially when the numbers of those affected by defective products or conduct of actions is high (Hensler, 2001). As a result, class actions have become an efficient way of bringing together and disposing off thousands of claims that would otherwise be impractical to be individually litigated. Class actions still remain the most viable way of handling thousands of similar claims since it aggregates small claims, thereby lowering the cost of litigation. Class actions also ensure that all plaintiffs, both unnamed and named, receive some compensation (Backhaus et al., 2012). Backhaus, J. G., Cassone, A., & Ramello, G. B. (2012). The Law and Economics of Class Actions in Europe: Lessons from America. (J. G. Backhaus, A. Cassone, & G. B. Ramello, Eds.). Northampton, Massachusetts: Edward Elgar

Speech-language pathology Personal Statement Example | Topics and Well Written Essays - 750 words

Speech-language pathology - Personal Statement Example I realized that he was not paying attention to what I was telling him and had mixed feelings of shock and surprise to his response. I kept wondering about it only to learn later that the child was suffering from autism and his response is termed as echolalia, a typical characteristic found in autistic kids. Autistic children who exhibit this characteristic communicate by simply repeating songs or words which they have heard during a previous activity or everyday life. Such children are unable to engage in the right form of communication and in most cases would not understand what they are saying. This experience provided the impetus for my interest in communication disorders and more specifically with autistic children. It was in that moment of silence that I realized the importance of effective communication especially with children with special needs. In order to widen my knowledge, skills and experience in communication I am applying for the Master’s program in speech-langu age pathology at the University of Utah and I believe that this course will help me pursue my long-term goal. I strongly believe that communication is a vital requirement that drives the existence of mankind. Over the years I have collected considerable resources, self-contained units on communication disorders and my current experience as a speech-language pathology aide has enabled me to understand human communications in greater detail. My first bachelor’s degree is not related to communications and the GPA is a reflection of the lack of interest for that course. It was only later that I developed a keen interest for communications and hence I pursued a second bachelor’s degree and graduated from the Utah State University in Communication Disorders in August 2012 with a GPA of 3.8. I believe that this GPA is reflective of the passion and determination I have for communications and speech-language pathology in particular. This course helped me gain a clear focus and a vision for

A problem of statement in Science Education Research Paper

A problem of statement in Science Education - Research Paper Example Several researches about the RET programs have indicated variations in changes and drastic improvement concerning the teachers that, a lot of research skills and teaching based practices can be adopted through inquiry based processes. For this reason, there is a bit of conformity that, RET are good for the instructors as it expands the mind during study and equips the teachers with adequate knowledge on how to carry out research (Sarah &Wise, 2003). It has been realized that the adaptation of Next Generation Science Standards (NGSS) within the teaching fraternity as one of the major elements in RET has replaced the test. This method has for decades entrenched science education, which could not give relevant effects about the students understanding. The NGSS practices has been proven best to the educators and the students since it enhances learning through students engagements as such, enabling them to explore actively the science that was meant to have been learnt in class together w ith the actual engineering practices (NGSS Lead States, 2013). Most of the findings argue that, science teachers’ require comprehensive assessment to determine how best they have embraced research as an important role in adding the teaching practices. This is because most teachers are conversant with class tests as in contrasts to research practices which are perceived to expose many skills needed during actual professional exploration (Goreham, 2010). Research experience for teachers mainly focuses on instructive issues that may affect teaching of sciences and how to deliver learning of science at all levels of teaching and this would in turn helps in the professional development of teaching skills to the instructors. Through the involvement of quite a number research, discussion groups and may be seminars, teachers are able to get the best strategies and adequate resources which they further implement in classrooms. According to National Science Education Standards (NRC, 20 00), the effect of RET practices amongst the teachers has not been explored to its best therefore, this research is meant find in-depth analysis on how positively this can be implemented in other areas where the effect has no so much been felt (Russell, 2006). II. Background on RET programs Research Experiences for Teachers (RET) has stirred up professional development amongst the teachers and the students themselves, this grate importance of significant effect has improved the teaching moderation and learning in classroom. Several researches have indicated how teachers gain a lot of confidence after conducting numerous researches. With respect to this, they view themselves as learners and this further enhances the development of closer ties with their students and the colleagues at work (Cahn, 2008). RET programs vary considerably depending on the specialization of the teachers. For instance, some teachers may develop journals concerning the experiences they have achieved after fie ldwork observations to be used for later discussions in the classes. In this case, the records can be used to redefine the mentality of an instructor on how the programs are delivered. Moreover, other research methods such as discussions, observations and interviews are targeted at

Examine the ways in which attempts are being made to address the Essay

Examine the ways in which attempts are being made to address the problem of cyber bullying in the criminal justice system of England and Wales - Essay Example There are various criminological theories that have been proposed to help in understanding the mind of the criminal. Some of these theories suggest that the society is to blame for creating criminals while other theories base their arguments on the view that criminals are born and not made. With Face book and Twitter being the most popular social networking sites in the UK, cybercrime is on the increase. In England and Wales, cyber bulling is considered an offence under law. The choice theory helps in explaining the way a criminal’s mind operates in leading him to commit a crime. The bully’s reasoning is thereafter transferred on to the victim who believes whatever the bully says. The insufficient regulation of social networking sites has led to more cases of cybercrime in the UK. Children have committed suicide following the cyber bully’s opinion about the child. This essay seeks to examine how the rational choice theory can help the justice system in England an d Wales against cybercrime. Every victim of crime wonders why people commit crime. Studying criminology helps an individual understand why people commit crime. This helps in understanding how the criminal thinks and come up with ways in how to assimilate the criminal while controlling crime. There are several theories of why people commit crime. Others propose that the individual decides to commit crime consciously while some believe that the community is responsible for crimes committed. With all the varied theories of crime available, an agreement are made that, fairness should be available in any society. In this essay, the rational choice theory will guide in understanding a criminal’s mind and ways of combating crime in England and Wales using this theory. The rational choice theory proposes that an individual chooses to commit crime once the pain and punishment

EXPRESSION ON B CELLS IN HEALTHY INDIVIDUALS AND IN CHRONIC Literature review

EXPRESSION ON B CELLS IN HEALTHY INDIVIDUALS AND IN CHRONIC LYMPHOCYTIC LEUKIMIA - Literature review Example Components of the immune system such as the white blood cells protect the body through the creation of specific antigens. However, in some cases, the immune system itself can be a source of problems, such as in autoimmune diseases, where the immune system recognizes cells of the host body as invaders and attacks these. The cells that form an important part of the immune system can also function incorrectly. Chronic lymphocytic leukemia (CLL) is one example of a disorder where the cells of the immune system are functioning incorrectly. This is a cancer where the B cells of the immune system are highly activated, show increased levels of proliferation and decreased rates of apoptosis. This results in the accumulation of affected cells, which prevents the immune system functioning normally. This review considers the role that Toll-like receptors (TLRs) have on immune system functioning, with a specific focus on CD180 (also known as RP105) and its role on CLL. Toll-like Receptors The imm une system plays a crucial role in protecting the body against pathogens and allows the body to effectively defend itself. One class of molecules that have been shown to have an important role in the effectiveness of the immune system is Toll-like receptors (TLRs). ... Image from Akira et al. (2001) However, while the TLR pathway has been shown to be crucial for the defense and protection of the body, it also can have a significant role in immune system diseases and allergies. This can be due to high levels of signaling or deficiencies of molecules that are involved in the signaling pathway . Thus, TLRs play a significant role in the immune system and related diseases. Understanding their functions both collectively and individual is important to understand the occurrence and progression of many different diseases, as well as looking for treatment for these. Studies have revealed that one potentially important TLR in many immune system diseases is CD180, also known as RP105. This molecule is expressed on the outer membrane of B cells that is known to be a leucine-rich repeat (LLR). LLRs are known to be important in the way in which pathogens within the immune system are recognized. A homolog of the protein has been found on mouse B cells, and has b een associated with a decreased rate of cell death. Experimental evidence shows that cells that were negative for CD180 were susceptible to apoptosis induced by corticosteroids, while those that expressed CD108 were not . In mice, almost all mature B cells expressed CD180; however, this is not true in humans. For example, in individuals suffering from systemic lupus erythematosus (SLE) almost 16% of patients tested were not expressing CD180 in a significant quantity. Individuals who did not have SLE had a significantly lower average level of CD180 expression than those who were affected with SLE . In humans, CD180 is involved in the recognition of B cells and signaling of lipopolysaccharides. However, little more is known about its function . In mice, almost all

Formosa Plastic Cops. USA Term Paper Example | Topics and Well Written Essays - 1500 words

Formosa Plastic Cops. USA - Term Paper Example ed nearly the whole of the reactor facility and the adjacent warehouse igniting Vinyl chloride resins stored in a warehouse with smoke drifting over the local community who were then evacuated and the facility remains shut down. The initial fire was caused and fuelled by Vinyl chloride monomer, raw material for Vinyl chloride manufacture, which is highly flammable and a known carcinogen. The explosion occurred when the bottom valve of an operating reactor was opened spilling its highly flammable contents. The next section discusses the specific sections of 29 CFR 1910.146 that Formosa Plastics Corporation neglected. According to the Occupational Safety and Health Administration, Formosa Plastics Corporation did not comply with the Permit Required Confined Spaces 29CFR 1910.146. The sections of Permit Required Confined Spaces that were neglected are Training and Rescue and Emergency operations. Under the section of Training, Permit Required Confined Spaces requires that an employer provides training for the employees to understand, and acquire knowledge and skills vital for the safe performance and execution of duties within the confined space. It also requires training to be provided to the employee before being assigned duties, when duties are changed, when permit space operations are changed that are hazardous for which the employee has not been trained on, and if the employee feels that the permit space entry procedures have been deviated from or the employee has little knowledge of the procedures. The training is designed to establish employee proficiency in execution of the duties and new or revised procedures. After all the training has been done, certification should be made available with the name of the employee, trainers signature and the respective training dates. Formosa Plastics Corporation also neglected the Rescue and Emergency services regulations for confined space. The rescue and emergency operations require that the employer provides and trains

Asian Americans have faced from 1965 to today Essay

Asian Americans have faced from 1965 to today - Essay Example They also believe that the affirmative action has affected them in a negative way in regard to admissions to the best universities. For instance, in 1978, the United States Supreme Court gave a ruling that stated that the universities could consider the student’s race during admissions. Majority of the universities adopted this diversity policy in order to attain a student body that was more diverse. However, this diversity policy led to the admission of fewer Asian Americans into universities (Lee 33). Participation in politics is also another issue or problem faced by the Asian Americans. They have attempted to participate in politics in many ways and one of them is through donating money. However, the donations have been viewed as means through which the Asians are attempting to influence Americans politics to their benefits. For instance, in 1996, the Democratic Party was looking for funds for the reelection of President Clinton. Much later the Democrats were blamed for illegally accepting money from the foreigners; these foreigners as identified by the Congressional Republicans and the media were Asians. From this scenario, it is evident that the Asian Americans affected by racial profiling and prejudice regardless of their political affiliations. Their attempts to succeed both in the political and civic leadership are met with strong allegations that they have evil plans to dominate the world (Le 1). Another issue facing the Asians Americans is the great disparity in terms of socioeconomic status, occupation, and education among the subgroups. Some of the Asian subgroups like the Cambodians and the Laotians do not possess a high school diploma. Previously, education has been linked to high-income levels and professional skills but it is also linked to access to health care services. Majority of the Asian Americans are either poor or working for minimum wage and they have no access to

Management Finance Essay Example | Topics and Well Written Essays - 2500 words

Management Finance - Essay Example Behavioral issues of standard costing include planning and operational variances which further includes materials, sales and labor variances. Planning and operational variances mean when plans or standards of a budget are normally depending on the expected environment where targets are decided. But in reality if the environment is not same as the expected one then the actual performance is compared with the standard performance to measure the changed conditions. In planning variance, we compare the set up standard with the revised standard and in operational variance we compare the actual output with the revised standard. The other important behavioral issues of standard costing involve Variable overhead variance and fixed overhead variance. Variable overhead variance can be defined as the difference between the standard or planned variable overhead cost which is allowed for the actual output and the variable overhead cost that has actually occurred. The variance is also called as ex penditure variance as the variable overhead cost can vary with change in production thus a change in expenses amount can also be the reason of such variance (Drury, 2008, p.432). It can be expressed as follows- Fixed overhead is the portion of total overhead cost variance which can be occurred due to the difference between the standard cost of fixed overhead allowed for the output which is produced in actual. And the actual fixed overhead cost incurred. Fixed overhead variance can be derived as- Fixed overhead further expands itself as a. Budget or Expenditure Variance and b. Volume variance. Budget or expenditure variance is known as that portion of fixed overhead variance which occurs because of difference between actual fixed overheads and planned or budgeted fixed overheads during a particular period of time. It can be derived as follows- Volume Variance is the portion of fixed overhead variance which happens due to the difference between standard costs of fixed overhead which i s allowed for the actual output and the planned fixed overheads for the particular period in which the actual out has been produced (Drury, 2008, p.438). Volume variance can derived as follows- Apart from measuring the variance analysis, we should also focus on the relationship between variance analysis and behavioral issues that occurs in an organization. Variance analysis measures the performance ability of the managers (Izhar, 2001, p.294). Managers know that their performing ability is judged by the variance analysis and their risk and reward depend either on adverse or on favorable result of variance analysis. Thus they have two ways, either they will work hard to achieve the standard amounts or they can manipulate the planned amounts. For this reason the organization should distinguish between controllable cost and uncontrollable cost. Controllable cost can be defined as those cost which can be controlled by the managers if they are efficient enough like cost of labor. It is a controllable cost and if management is efficient then they can reduce the labor cost by reducing number of the inefficient labors. They will hire only those labors that are skilled and efficient in the production line. Uncontrollable costs are those costs which cannot be controlled by management like cost of raw materials. Management cannot influence the cost of raw materials in the market (Bhattacharyya, 2011, pp. 539-540). Thus if the managers are judged by planning variance then they will be discouraged and de-motivated. It

Law and Real Estate Essay Example for Free

Law and Real Estate Essay Executive Summary Pacific Grove Spice started as a small specialty grocer on the Monterey Peninsula of California in the early 1980s. Within 10 years they were the â€Å"place† to find spices in Central California and now have a widespread reach covering all 50 states. The spice industry that it is in has been growing steadily because of how important a role spices are getting in the kitchens and in cooking. The growing concern about obesity and diet has also left a positive impact because of the health conscious people that desire healthier meals that are still favorable. The demand for spices is at an all-time high and although multinational firms like McCormick Company dominate the industry, many small firms are competing successfully, Pacific Grove spice being one of them. The problem that Debra Peterson and Fletcher Hodges are having is that they have three choices to make. They have to decide whether they should accept an offer from a cable-cooking network to produce and sponsor a new program, raise new equity by selling shares of common stock, and/or acquire High Country Seasonings-a privately owned spice company. While making their decision they have to keep in mind that the bank financing their company wants them to reduce interest-bearing debt to less than 55% of total assets and the equity multiplier to less than 2.7 times by June 2012. We recommend that Introduction Debra Peterson is currently the Chief Executive Officer of the Pacific Grove Spice Company. The Chief Financial Officer, Fletcher Hodges, and she are trying to figure out what strategy to take to meet the demands of the bank that finances their company. The recent financial crisis had made the credit committee uneasy and they now want Pacific Grove Spice to reduce interest-bearing debt to less than 55% of total assets and the equity multiplier to less than 2.7 times by June 2012. They have three options they are currently considering and this case study illustrates the financial forecasts for the next few years and showcases what we feel is the best decision for them regarding their options and the banks demands. Analysis Pacific Grove Spice’s operations are not profitable enough to quickly bring  it into compliance with the bank’s requirements. It’ll take about four years with just the regular operations.

Criminal Justice Issues in Democratic Society

Criminal Justice Issues in Democratic Society What are the major crime control or major criminal justice issues that face advanced democracies? Advanced democracies are mainly based around the liberal social democratic model which places a high value on the idea of human rights and freedom of choice across a wide spectrum of human activities (Bevir, M. (2005) 1-10) (Choongh, S. (1997) Ch. 1) (Fennell, P., Harding, C., Jà ¶rg, N. and Swart, B. (1995) Chap. 1). This emphasis on human rights extends into the field of criminal justice which is an essential component of any advanced democracy (Coates, R., Davis, G., Messmer, H. and Umbreit, M. (1992) 1-5) (Cochrane, J., Marsh, I. and Melville, G. (2004) 1-5). This typically involves a concept of crime control which aims to protect society from violence and violent offenders as well as punishing criminals for infringing the law (Ashworth, A. (2006) 1-5) (Bean, P. (2004) Ch. 1) (Fielding, N. (1995) Ch. 1). However, this focus creates problems because the rights of the victim will also have to be counterbalanced against the rights of the defendant. Often there are conflicting interests at stake and it is often the rights that the rights of the criminal are resolved at the detriment of the victim of the crime, or vice versa (Allan, T. (1994) 1-5) (Ashworth, A. (2006) 1-5) (Bean, P. (2004) Ch. 1). A good starting point for a discussion of the major issues which affect criminal justice is a discussion of what the purpose of a criminal justice system is in advanced democracies. The criminal justice system imposes sanctions on people who are deemed to have broken the law. It is based on independent principles, and there is a mechanism which involves an independent tribunal of enquiry into whether or not a person broke the law. The test of whether a person has broken the law usually involves whether or not a prosecuting authority can prove beyond a reasonable doubt that the person concerned infringed the law. Therefore the purpose of the criminal justice system is twofold; it involves the identification of criminals, and it operates to impose fair and consistent sanctions on those who have broken the law, in an effort to protect society form criminal activity and to give the victim a measure of peace of mind and sense that justice has been served in the measure of punishment which has been imposed. However, in a sense the abstracted concept of the purpose and functionality of the criminal justice system is quite far apart from the actual translation of these principles ‘on the ground’ so to speak. This difficulty has led many to question to approaches which have been taken to criminal justice issues within various advanced democracies. This has given rise to a body of debate as to which approach is better and for what reasons. The main crime control and criminal justice issues which are tied up within a complex lexis of sociological, political and legal factors (Dixon, J. and Macarov, D. (1998) Chap. 1) (McLaughlin, Ferguson, Hughes and Westmarland (2003-2004) Chap. 1), which emanate from this political background (Bevir, M. (2005) 1-10) (Choo, A. (1993) 1-5) (Choongh, S. (1997) Ch. 1). There are issues such as deprivation, social exclusion, poverty, drug addiction, prostitution, rising population, youth deprivation, violence and unemployment which all have a role to play in influencing the criminal justice system (Coxall, B. and Robins, L. (1998) Chap 1 and 2) (Denver, D., King, A., McLean, I., Norris, P., Norton, P., Sanders, D. and Seyd, P. (1998) 1-5) and the issues which form part of its application within advanced democracies (Allan, T. (1994) 1-5) (Ashworth, A. (2006) 1-5) (Bean, P. (2004) Ch. 1). This essay will attempt to extract themes from this background and discuss them with reference to the q uestion. So how is it possible to extract themes from this background, and to identify them as major criminal justice issues? Perhaps it is important to emphasis that this is a subjective exercise and any list of major criminal justice issues will necessarily not be an exhaustive list. Nevertheless it is possible to surmise what the most important themes would be. The purpose and function of punishment is a major criminal justice issue. What may be achieved through the punishment of the offender?; should the law have a pragmatic approach which aims to find the best possible solution in this regard for society at large?; or should the focus be more microcosmic and focus on the individual needs of the victim, and how they feel in relation to their experience of the results of crime? These are all questions which must be addressed in addressing this as a major criminal justice theme in relation to criminal justice in advanced democracies. The issue of crime control is also a major theme for the purpose of criminal justice in advanced democracies. How should one approach the detection of crime; should one have a utilitarian or a deontological perspective on how terrorism should be detected and prevented? and how important are human rights within the process? Should human rights be sacrificed for the purposes of preventing further terrorist attacks ? These are all very important questions which will be explored in examining this issue. One major theme which affects societies in advanced democracies is the debate as to whether punishment should be aimed more at retribution, or rehabilitation of the offender (Bevir, M. (2005) 1-10) (Singer, P. (1990) 1-20) (Marshall, T. (1999) 1). This is a difficult question to approach. It is clear that the UK for example has taken an approach which comes down firmly in favour of the rehabilitation of the offender (Allan, T. (1994) 1-5) (Ashworth, A. (2006) 1-5). It is difficult to speculate as to why this is the case, however if we are to draw perspective from the current sociological climate it is correct to tie this rationale to the fact that prison populations are expanding beyond control in the UK, and the government have had to impose strategies which reduce this problem. As Cochrane, J., Marsh, I. and Melville, G. (2004) surmise: ‘†¦.newer, harsher initiatives have similarly had little effect on the size of the prison population or on rates of recidivism. Without going into great detail, some overall figures will help illustrate the pressures on the prison system in Britain and provide a context for considering the different philosophies of punishment. The prison population in Britain has continued to rise pretty steadily over the past few decades, with over 71,000 people in Prison Service establishments in 2002 (Home Office data, Social Trends 33, 2003). The number of people given immediate custodial sentences in 1999 was over 105,000 compared to just under 80,000 four years previously (Home Office data, Annual Abstract of Statistics, 2002)†¦ (Cochrane, J., Marsh, I. and Melville, G. (2004) 4)’. One strategy therefore is to impose more community based penalties on offenders, such as tagging of offenders, curfews, drugs and alcohol addiction programmes and suspended sentences on criminals rather than prison based sentences, which are often regarded as the last resort (Singer, P. (1990) 1-20) (Marshall, T. (1999) 1). Contrast this approach with the approach taken in America where crime control is probably more retributionist than the UK system. The presence of the death penalty in some states in America evidences this contrast. Proponents of each system offer various justifications for their favoured approach. Proponents of the American system would argue that stiffer penalties deter criminals from engaging in repetitive patterns of criminal activity. Conversely, proponents of the approach taken in the UK would argue that the prison system simply perpetuates the problems associated with repeat offending (Cohen, M. (2005) 1-5) (Davies, M., Croall, H. and Tyrer, J. (2005) Chap.1) since in this system a person is more likely to be sent to prison for relatively minor offences. When in the prison population these individuals are exposed to more hardened criminals from whom they can become associated with or learn more sinister patterns of criminal activity. For this reason, it is argued that the system which focuses less on retribution and more on offender rehabilitation is more effective at reducing levels of crime in society since criminals are kept away from these situations where more hardened patterns of cr iminal propensity can be formed. Another problem which faces advanced democracies are problems associated with terrorism, and how the criminal justice system should handle the detection of and the punishment of crimes associated with extreme forms of terrorism. The impact of the September 11th attacks in America, and the London underground attacks launched on the West by Al Qaeda have become benchmarks for a renewed terrorist campaign against advanced democracies in the West, and extreme Muslim terrorist groups. The approach to terrorism in the UK has been focused simultaneously on the detection of crime, greater public awareness of the problems of terrorism and an appeal to moderate sectors of the Muslim community, whereas most of the measures which we have seen formulated as the Patriot Act in America have focused on bolstering the security services with more powers to detect terrorist related crime. An example which highlights this contrast between the two systems can be found by looking at the development of powers relating to the control of terrorism in advanced democracies. In the UK for example, the approach may be characterised colloquially as ‘softly, softly’. There was a huge public outcry when an innocent man was shot dead on the underground system shortly after the July attacks on the Underground system. This can be contrasted with the system in America which allows law enforcement officials to carry guns and where armed clashes are more likely to occur as a result. In the UK new powers are being debated which extend the powers of police officers to question suspects of terrorism. The system as it stands does not permit officers to question a suspect after charges have been brought. This is seen as the end of the matter. However, police are to be allowed in future to question terrorism suspects long after charges have been brought. These new powers are seen as useful particularly in complex cases where large amounts of evidence have been gathered in the investigation. This new law also reflects the growing sophistication of terrorism which now can be aided through laptops and sophisticated technology which stores information in an encrypted form. The laws in England have also controversially been extended to extend the amount of time a terrorism suspect can be detained without charge. The government’s efforts to secure 90 days for the police to hold terrorism suspects without charge were defeated in the Commons. This can be sharply contrasted with the American system, which has secured powers to hold detainees in Guantanamo Bay without charge and indefinitely. The strength of feeing about 9/11 in America has given this more oppressive system germination and propelled it now, even when more than three years have passed since the attacks on the twin towers. Therefore we can see a dichotomy emerging also which highlights a disconnect between these two examples of how criminal justices themes have emerged as divergent within the spectrum of advanced democracies. To turn now to further examples of criminal justice issues in advanced democracies, these have in many ways highlighted similar issues. Major criminal justice themes have been approached differently in other advanced democracies such as those in continental Europe. Many European countries for example have seen their foreign policy as linked with their efforts to structure the criminal justice system. The troop withdrawal from Iraq and the effects which were projected in relation to this have influenced what is important within these criminal justice systems. Advanced democracies such as India have also had their criminal justice systems influenced by the issues of terrorism and associated crime control. The Indian system sees the shape of their criminal justice system with respect to the detection of terrorism as having a considerable impact upon their ability to forge relationships with actors in the West with whom a political alliance can be economically advantageous. In conclusion this essay has examined the criminal justice system issues which have moved to the forefront of the political and legal agenda in advanced democracies. The issues of social exclusion, the debate about whether retribution or rehabilitation should be the focus of the efforts of the criminal justice system and the approaches taken to terrorism and the new brand of terrorism which has been seen recently have all been evaluated. The diversity which is involved in assessing the contributions and effects of criminal justice issues across different advanced democratic systems shows us how difficult it is to make generalisations about what issues are major in the area of criminal justice. This essay has attempted to extrapolate what themes may be important generally within different advanced democracies. The difference in how each issue develops and manifests itself has been highlighted in the essay. Bibliography Books Allan, T. (1994) Law, Liberty, and Justice: The Legal Foundations of British Constitutionalism. Publisher: Oxford University. Place of Publication: Oxford. Ashworth, A. (2006) Principles of Criminal Law. Publisher: Oxford University Press. Place of Publication: Oxford. Bean, P. (2004) Drugs and Crime. Publisher: Willan Publishing. Place of Publication: UK. Bevir, M. (2005). New Labour: A Critique. Publisher: Routledge. Place of Publication: London. Choo, A. (1993) Abuse of Process and Judicial Stays of Criminal Proceedings. Publisher: Oxford University. Place of Publication: Oxford. Choongh, S. (1997) Policing as Social Discipline. Publisher: Clarendon Press Oxford. Place of Publication: Oxford. Christie, N. (2004) A Suitable Amount of Crime. Publisher: Routledge. Place of Publication: New York. Coates, R., Davis, G., Messmer, H. and Umbreit, M. (1992) Making Amends: Mediation and Reparation in Criminal Justice. Publisher: Routledge. Place of Publication: New York. Cochrane, J., Marsh, I. and Melville, G. (2004) Criminal Justice: An Introduction to Philosophies, Theories and Practice. Publisher: Routledge. Place of Publication: London. Cohen, M. (2005) The Costs of Crime and Justice. Publisher: Routledge. Place of Publication: New York. Coxall, B. and Robins, L. (1998) British Politics Since the War. Palgrave. London. Davies, M., Croall, H. and Tyrer, J. (2005) An Introduction to The Criminal Justice System in England and Wales. Publisher: Longman: Place of Publication: London. Denver, D., King, A., McLean, I., Norris, P., Norton, P., Sanders, D. and Seyd, P. (1998) New Labour Triumphs: Britain at the Polls. Publisher: Chatham House Publishers. Place of Publication: Chatham, NJ. Dixon, J. and Macarov, D. (1998) Poverty: A Persistent Global Reality. Publisher: Routledge. Place of Publication: London. Fennell, P., Harding, C., Jà ¶rg, N. and Swart, B. (1995) Criminal Justice in Europe: A Comparative Study. Publisher: Clarendon Press. Place of Publication: Oxford. Fielding, N. (1995). Community Policing. Publisher: Clarendon Press. Place of Publication: Oxford. McLaughlin, Ferguson, Hughes and Westmarland (2003-2004) Restorative Justice critical issues. Publisher: Sage Publications. Place of publication: UK. Singer, P. (1990) A companion to ethics. Publisher: Blackwell. Place of publication: Oxford. Articles Marshall, T. (1999) Restorative justice: an overview. Publisher: The Home Office Research Development and Statistics Directorate. Place of publication: UK. Websites Used http://www.restorativejustice.org.uk/?Glossary

An Essay on Foraging Societies

An Essay on Foraging Societies Foraging society forms the oldest and the more basic political system of people- the band societies. For more than 1 million years, these people from hunter-gathering societies sustain their living doing this. The contemporary hunter/ gatherers form a small group or population of people with little density and nomadic type of living. Foragers remain egalitarian because they live in close kinship relations with others. They were tied with relations and they formed groups of unity. That is the reason why they exchange commodities or services among each other. The wealth circulated among themselves. This created an egalitarian group, where there were no great differences between people. An example of a foraging society, residing in the Kalahari Desert, is the society of King San or the Bushmen. They gather fruits, berries, melons, and nuts. It is estimated that women gather the food and the overall time spend on gathering is 2 or 3 days out of one week. Men from the tribe spend their spare time in performing rituals, resting or entertaining. They reside in Namibia, Botswana, and South Africa. An example of a foraging society in the tropical rain forests is the Mbuti Pygmies. In the gathering process everyone of the group is involved, even children- male pick up elephants, wild pigs and other animals, while females gather the vegetation. The third group of foragers dwells in the arctic regions where vegetation was scarce. Eskimos, the local people, hunt sea mammals (whales, seals) and value a lot the undigested vegetation. For that reason, female did not specialize in gathering food. In the summer both males and females gathered larvae and maggots. Fissioning among foraging people eccurs, when under certain conditions( like overpopulation) there is a need of migration of some people, and their fragmentation into smaller groups of people. Sometimes the subsistence food can become scarce, and not enough for the entire population. Infanticide occurs when a mother deliberately kills a newly born child. The reason is that sometimes, woman cannot afford to meet the needs of the baby, or because the baby has some deformed physical features. The fertility rate among foraging people is very low. There may be several reasons for this. Females from the San people are for example very slim and they do not weight more than 80 pounds. This can postpone the menstruation. Their puberty comes later, the average age is 16 years-old, compared to the average age in the US- 12years-old. Most of the foraging groups do not differ in their economic state. They share the same economic system based on reciprocity, the exchange and sharing of goods, food, and services. It is called a Reciprocal Economic system. Most commonly, families exchange their food with other families from the group. It is defined that there are three types of reciprocity. The first one is called Generalized Reciprocity, which is based on the assumptions that there is no return in the exchange. In other words, people do not expect to have a return for they favor, or exchange of goods or services. For example, it is even insulting among some foraging group to say thank you, after they have given you food. We also have in our societies Generalized Reciprocity- when your parents buy you clothes or give you pocket money, they do not expect you to return anything to them back. This system creates more mutual trust and bounds better kin and relations. It also strengthens the egalitarian status of people. The second type of Reciprocity is the Balanced Reciprocity. It involves an exchange with immediate return. This system is more like bargain and trade. It is used by groups of people who in a far distance between them. In modern foraging groups this reciprocity is not very common, because most of them exchange values and goods among kin groups only. The third type is the Negative Reciprocity, which involves no reciprocity of all. It is an attempt to get an exchange or a deal without returning anything. According to Lee and DeVores work, foraging people like the San are affluent in terms of their allocated time spent on finding subsistence. They estimated that foraging people easily find food enough for a couple of days, and that foraging people have adequate and well balanced diet. They called them Leisure and Affluent people. They found that the average death rate is not high and the average age of people from those societies is the same as people from more developed industrialized societies. According to another anthropologist Sahlins, foraging people did not accumulate goods and food, because of their nomadic living, and that makes them not so materially obsessed. However, recent studies challenged the hypothesis mentioned above. They found that these facts to not apply to every forage group. For example in the rain forests people could not easily find some certain type of food immediately and spend more than 30 , 40 hours a week, searching for it. Furthermore, it is estimated that other activities, such as making weapons or preparing the food also involves much time. Those recent studies do not challenge entirely the previous hypothesis, but expand the relativity that comes from the geographic locations of people. The social organization of foraging people is based on kinship, marriage, family, gender and age. The family can be Nuclear, which includes parents and their immediate offspring. Band includes several Nuclear Families. A band can include from 20 to 100 individuals, depending on the environment capacity of subsistence of those people. Cross cousin marriage appears when a male is married to the fathers sisters daughter or his mothers brothers daughter. Patrilocal residence- when the married couple resides with the males father. Restricted marital exchange is the combination of patrilocal residence and cross cousin marriage, where two groups exchange the females to tight the kinship alliances. Brideservice is when male resides in a females band for a period of time. Matrilocal residence- the husband lives with the brides family. Inuit tradition is the wife exchange where male individuals have sexual intercourse with each others wives. Egalitarian status of men is more common than the equal status of females in foraging group, compared to people from other societies. Patriarchal- when male dominates in political and social aspects. Gender and Age are important factors in evaluating the labor division. They vary between societies to societie and determine the social stratification and hierarchy. The warfare and violence in modern foraging societies differ from the past foraging socities. There are now lower at rate. Most of the problems that individual resolves are connected to relations between adultery.

Chlamydia Essay -- essays research papers

Chlamydia trachomatis is the most widespread and infamous bacterial infection affecting the genital tract. Not only is it quite common in developed countries but an increase in cases has sprung up in developing countries as well. In the United States, there is a 4 million per year case rate of chlamydia which costs the US approximately $2 billion dollars in consequences and treatments. Persons who suffer from chlamydia in underdeveloped countries and have no means of seeking treatment may become blind because chlamydia has the potential of causing trachoma. It is becoming a global interest to control and restrain this budding disease. In order to do so it is essential to recognize the symptoms of chlamydia, diagnose the victim, and provide treatment immediately.   Ã‚  Ã‚  Ã‚  Ã‚  Observing symptoms of chlamydia is often a difficult process considering that 75% of females and 50% of males are asymptomatic; for those who are infected and do show symptoms, there are obvious signs directly connected to the chlamydia bacterium. In infected females, purulent discharge and a burning sensation while urinating are common indicators. The irregular discharge can be mistaken for normal vaginal discharge making this indicator slightly less conspicuous. These signs are caused by the bacterium’s concentration on the cervix and urethra and is classified as an acute endocervical infection. Other signs in the female are spotting between menstrual periods, fever, and severe back and abdominal pain. In males, burning sensation and discharge from the penis also occur. In addition, pain around the opening of the penis as well as soreness of the testicles can be observed. These symptoms occur from epididymitis. The contraction of chlamydia through anal pe netration can lead to rectal discharge, bleeding, and pain. If symptoms appear the next stage is to verify that the symptoms are directly related to the chlamydia bacterium. There are a number of methods in the process of diagnosing a potential case of the chlamydia trachomatis bacteria. Classic methods of diagnosis have been centered on cell culture; the â€Å"culture era† began in the 1970s and proceeded into the late 1980s. Cell culture â€Å"was the inoculation of clinical material into animals, embryonated hens eggs or tissue culture cells and the demonstration of characteristic chlamydial inclusions.† Minor complication... ...s were tested for chlamydia through IgG antibodies and the PCR process. The study concluded that IgG antibodies in males were associated with lower pregnancy rates and a higher IgG antibodies count in the woman. There is a higher occurrence of IgG antibodies in the infertile couples than in fertile couples. After some treatment, the odds ratio of not successfully completing pregnancy with the male being chlamydia trachomatis positive is 2.6. In those couples that were not treated, the odds ratio is much higher at about 3.9. The study deems it â€Å"cost-beneficial† to screen infertile couples by means of the PCR tests because it is been deemed â€Å"cost-effective† in places where the chlamydia bacteria was very common. The chlamydia trachomatis disease is on the rise so further studies and research is quite necessary to maintain a tight grip on this epidemic. Innovative diagnosis will assist persons infected with chlamydia to identify the disease in early stages to help reduce further complications and cost concerns. Advancement in treatments will evidently be beneficial for those with acute and chronic stages of chlamydia which will also reduce costs as well as grief to those infected.

Comparing Coming of Age in The Chocolate War and Boys Life :: comparison compare contrast essays

Coming of Age in The Chocolate War and Boy's Life Cory in Boy's Life and Jerry in The Chocolate War are examples of characters in a bildungsroman Many high school students read coming of age novels, or bildungsromans such as: Kidnapped, The Outsiders, To Kill a Mocking Bird, and many others. What these students, however, do not realize while reading these novels is that the protagonist of the story is growing and changing throughout the novel in many ways. Many of these changes are results of conflicts, which most teens face throughout their lives. In Boys Life, by Robert McCammon, and The Chocolate War, by Robert Cormier, the male protagonist encounter many conflicts, in which most teens can relate to in everyday life. These two books are examples of bildungsromans because both, Cory and Jerry change throughout the novel because of their mental tests and physical abuses. The male protagonist, Cory and Jerry, encounter many mental tests, which affect the boy's views on life. The most obvious test which shows this is the dealing with a close one's death. In Boy's Life, Cory shows this best the way he completely changes his views on life and especially faith, when his best friend Davy Ray dies. A good example is when Cory says "I wasn't sure of anything anymore: not life, not afterlife, not God, not goodness." (p454). Cory begins to understand that he must have faith. In The Chocolate War, when Jerry's mother dies he begins to look at life in a new way wondering if he is wasting away his life. He wonders if he is a part of anything special, or if he is "sleepwalking" through life (p20). He later thinks of this often when he thinks about disturbing the universe. He also shares very little intimacy with his father after his mother's death and looks at him in a different way. When Jerry looks at his father one night, he wonders if his father is wasting away his life with everyday ordinary routines, and if he is turning out to be like his father (p52). The deaths involved in these two books challenge Cory and Jerry's beliefs and help them to grow and to mature into young adults. Because of the boy's determination, they are challenged in many ways. This is best shown in The Chocolate War with Jerry's decision not to sell the chocolates.

Inconsistent Roles Essay -- essays papers

Inconsistent Roles The Colonial era spans nearly two hundred years with each settlement in the New World containing distinctive characteristics. Location in the new world is one factor that shaped women’s lives but religion and economics also played a massive role. These roles however were constantly changing and often contradicting. Since there is numerous factors that contributed to the shaping of women’s private and public roles in the seventeenth and eighteenth century it is impossible to categories all colonial woman in one group. Some historians refer to this period as the golden age of women; however, I tend to see this period as oppressive, with only few examples of women exercising social and public powers. The vast amount of women who came to the New World in the earliest days of colonial settlement came as indentured servants to the Chesapeake region. The New World was underdeveloped and sparsely populated; therefore, the women were expected to not only perform their traditional female work but also engage hard manual labor. Early colonial women in some respects were allotted more freedom than women of latter generations; yet, this was not a product of ideology, but rather necessity. European men did not support the idea of equality and saw women as their inferior; however, female inferiority was minimized due to the harsh conditions affecting the entire populous of the New World. The women who lived out the duration of their contract or who were bought out of servitude were quickly married and just as quickly widowed. This factor granted women more power and access to land. Some widows would assert power through courts to guarantee claims to their deceased husbands land. Lois Green Carr and Lorena S. Walsh in The Planters Wife describe how many husbands left their entire estate to their widows entrusting them with the responsibility of managing his estate and dividing the land between their children. â€Å"A husband made his wife his executor and thus responsible for paying his debts and preserving the estate.† By today’s standards the practice of leaving property to a wife is the norm; yet, prior to seventeenth century this practice was virtually nonexistent. Carr and Walsh continue by stating, â€Å"Evidently, in the politics of family life women enjoyed great respect.† Therefore, while the Chesapeake colonies remained underdeveloped women ... ... been more emotionally pleasing but still the women remained distant from the outside public realm. The Quakers shared in an exceptional amount of equally that was never adopted or accepted by the dominant classes in the colonies. The last years of the colonial era did allow for increased rights and autonomy for women but it still was tangled with contradictions and in no respect could be deemed as the golden age of women. Bibliography: Lois Green Carr and Lorena Walsh, The Planter’s Wife: The Experience of White Women in Seventeenth-Century Maryland. The William and Mary Quarterly, October 1977, 556-557. Ibid. 557. Laurel Ulrich, Good wives, The Ways of her Household (Oxford University Press, 1983), 22. Ibid. 32. Nancy F. Cott, Roots of Bitterness: Documents of the Social History of American Woman, Examination Of Anne Hutchinson (Northeastern U. Press. Boston 1996), 3-10 Carol Karlsen, The Devil in the shape of a woman: Witchcraft in colonial New England (New York: W. W. Norton, 1987), 116 Linda K. Kerber, women of the Republic: Intellect and Ideology in Revolutionary America (Chapel Hill: Univ. of North Carolina Press, 1980), 38 Ibid. Chap. 4

Advance Directive Essay

The purpose of advance directives is so that you are making it your right to make decisions about your own medical care. This phrase applies to a wide range of instructions that one might make orally or written about actions that one would or would not want to be taken if one were somehow incapacitated and unable to join in making decisions (Corr et al, 2009). An advance directive is a topic that resonates strongly in my heart. Less than two weeks ago my husband and I had a family crisis and had to make some really difficult healthcare decisions regarding our family member. These decisions were less difficult for us because our loved one had previously given us power-of-attorney. So we knew her wishes prior to her illness and were able to make the correct decisions as a family. Unfortunately, most families don’t realize the importance of this legal document until an emergency occurs. Authors of _Death & Dying, Life & Living_ identify six goals of death education. It is the third goal that will be the focus of my paper. According to Corr et al the third goal of death education is to prepare individuals for their public roles as citizens. In this way, death education helps to clarify important social issues that face society and its representatives, such as advance directives in health care (Corr et al, 2009). We each have the right and responsibility to make healthcare decisions for ourselves. There may be a time, whether from accident or illness, when you are no longer able to make important and necessary medical  decisions. This is an opportunity for you to express your wishes and direct your healthcare decisions in advance before they may be needed. We’re living in an age of medical miracles. Tiny babies born months too early can often be saved. Hearts, lungs kidneys and lives can all e transplanted. There are life support machines and devices for almost every purpose. Ventilators to help people breath, cardiac assist devices to take over for the heart, feeding tubes to nourish patients who can’t eat, and dialysis to support people with failing kidneys. My husband and I know this all too well with the recent diagnosis of his mother. Medical advances have saved many lives. But with these advances have come questions about using machines to prolong the natural dying process. Kentucky laws recognize the right of individual’s to make choices about their medical care. We have the right to request or refuse treatment and to ask that life prolonging treatment be stopped. We also have the right to make out an advance directive. An advance directive is a legal paper which lets an individual to state their wishes about the use of life support machines and medical treatment. It can also be used to name someone else to make medical choices for them if they become unable to speak for themselves (ccky.org, 2010; Jasper 2007). According to David Kelly author of _Medical Care at the End of Life: A Catholic Perspective_ claims that treatment can be morally extraordinary only when the person’s death is imminent, regardless of whether the treatment is given, is to give biological life itself an absolute value that supersedes all other values.† (Kelly, 2006).The decision to make an advance directive is personal one and should only be made after careful consideration. My mother-in-law is currently on full life support and the hospital social worker told us that because she is at a Catholic hospital their philosophy there is that withholding or withdrawing treatment does not cause death, but merely allows the natural process of dying to take place. They further stated that they will not do anything to intentionally cause her death. This was an impromptu interview, but I was able to ask the social worker a few questions regarding advance directives. HOSPITAL SOCIAL WORKER INTERVIEW: Q: What is an advance directive? A: Advance directive states in writing your choices about medical care or names someone to make medical choices for you if you become unable to speak for yourself. It is called an advance directive, because it is signed in advance to let your family and doctor know your wishes regarding medical treatment. Kentucky law recognizes many types of advances directives, including living wills, healthcare surrogate designations, and durable power of attorney for healthcare. Q: Do my mother-in-law or anyone else have to have an advance directive before treatment here at this hospital? (Keep in mind it’s a catholic hospital) A: No. You cannot be required to make any advance directives in orders to get medical treatment, and for that matter health insurance or any other reason. It s purely a matter of personal choice. Q: Can anyone in my mother-in-law’s family make healthcare choices for her if she unable to do so and we do not have an advance directive or do you all go by the oldest child? A: If she cannot speak for herself and there is not an advance directive, then according to the state of Kentucky laws its first the court appointed guardian; her spouse; her adult child and if there is more than one then it’s the majority of the adult children available at the time; her parents; and then the nearest living relative and if there is more than one then it’s the majority of them (unnamed social worker, 2010). According to the state of Kentucky adults (ages 18 or older) who are mentally competent have the right to make healthcare decisions in advance. Advance directives state your choices for medical treatment, especially in regard to  life-sustaining procedures. You can also use advance directives to name a healthcare agent, who is any person you choose, to make your healthcare decisions if you are unable to do so. Advance Directives only apply if you are unable to make personal medical decisions, unless you indicate you want your healthcare agent’s authority to begin when the document is signed. You cannot be refused medical care because you do not have advance directives (Jasper, 2007). Any time you have a healthcare need; your doctor should discuss your situation with you and obtain your consent before giving you care. Patients have the right to refuse treatment or to choose among different kinds of treatment. Patients may further leave the hospital or seek treatment and opinions from other healthcare providers. Making a responsible choice does not always mean you accept your doctor’s advice, but it does mean you understand the consequences of your choice. This right to decide to say yes or no to treatment includes consenting to, or refusing treatments needed to sustain life (Shannon, 2006). I use to believe that once you signed the back of the driver’s license then you were giving consent for hospitals to not give you the true care that you deserved. This was a myth that I always believed until I became adult. I think that it was based on those old horror movies like COMA back in the 1970s. From a recent lecture on donation I learned the real value of signing the back of the driver’s licenses and giving consent to organ donation. Organ transplants are truly a miracle of modern medicine. Thousands of organ transplants occur in the United States each year, yet thousands of people also die each year while waiting for an organ. The generous gift of one’s organs or tissues can allow other seriously ill individuals to live. During this lecture I learned that anyone could become an organ donor and age did not mean that you can’t necessary donate. Most importantly was that signing a donor card was not going to affect my care that I received from the hospital. Patients are given the same quality care, whether or not a donor card was signed and that donation proceedings only begin after all efforts to save my life had been done and my death had been declared. Now I feel  confident that signing my driver’s license will not enhance my death. The Kentucky Cabinet for Health and Family Services’ Long-Term Care Ombudsman (LTCO), along with other national, state and community organizations, is leading an effort to highlight the importance of advance healthcare decision-making an effort that has culminated in the formal designation of April 16th as the inaugural National Healthcare Decisions Day (NHDD) (http://www.nationalhealthcaredecisionsday.org, 2010). Despite the fact that the importance and benefits of advance directives have been proven repeatedly for many years, only a small minority of Americans have executed an advance directive, according to information on the National Healthcare Decisions Day (NHDD) website. NHDD seeks to address this issue by focusing attention on advance healthcare planning from a variety of directions simultaneously across the United States. Any number of professionals such as healthcare providers, chaplains, attorneys, and long-term care ombudsmen can provide clear, concise, and consistent information and tools for executing written advance directives about healthcare power of attorney and/or living will in accordance with state laws (http://www.nationalhealthcaredecisionsday.org, 2010). In closing, most people can’t read your mind when you’re healthy, let alone try to figure out your wishes during a major health crisis while under additional stress. Be kind to your loved ones; make those decisions in advance; and have them legally documented. NATIONAL HEALTHCARE DECISION DAY PRESS RELEASE DO YOU HAVE AN ADVANCE DIRECTIVE? Do you know what healthcare treatments you would and would not want if you could not speak for yourself? Do other people know what your wishes are? The 2nd Annual National Healthcare Decision Day will be held on Friday, April  16, 2010, a day for all people regardless of age or current health to be reminded of the importance of making their healthcare wishes known to loved ones and their care providers. Everyone is encouraged to voice their wishes and take steps to ensure that their choices are known and protected. An Advance Directive is a legal document that tells healthcare providers who it is that you wish to make medical decisions for you and what treatments you would want or not want, if you are ever not able to tell care providers what you would want in a medical emergency or life-limiting illness. The simple act of creating an Advance Directive can turn out to be an incredible gift for loved ones in the event of an accident or severe illness. Advance Directives are written instructions about your future medical care. They do not go into effect until you are no longer able to make decisions. Adults can benefit from thinking about what their healthcare choices would be if they were unable to speak for themselves. ADVANCE DIRECTIVES COME IN TWO MAIN FORMS: A _†HEALTHCARE POWER OF ATTORNEY†_ (or â€Å"proxy† or â€Å"agent† or â€Å"surrogate†) documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself. Your â€Å"healthcare power of attorney† will make medical decisions based on your wishes identified in your Advance Directive. In states that recognize these documents, families and healthcare providers cannot override your living will or your agent’s decision. It is a good idea to discuss your wishes with your friends, family members, and your doctor, now, while you still can. YOUR HEALTHCARE AGENT HAS TO MEET THE FOLLOWING REQUIREMENTS: †¢ Anyone over the age of 18 †¢ Can be a family member, loved one, or close friend †¢ Someone who: you trust, knows you well, will advocate on your behalf, and will honor  your wishes A _†LIVING WILL†_ documents what kinds of medical treatments you would or would not want at the end of life. A living will is a type of advance directive called a healthcare treatment directive. A living will spells out the measures you do and do not wish to have taken to extend your life when you are clearly dying. You may decide whether or not you would want breathing machines, feeding tubes, oxygen, IV fluids, or medicines to be used. A living will needs to be signed in front of a witness. A witness cannot be a relative, creditors and heirs to your estate, or your doctor. It is important that a living will cover decisions about your healthcare only when you have a terminal illness. It is better to prepare a living will when you are healthy, not when you have been ill or in the hospital. Make sure your Advance Directive reflects your wishes. If you plan on moving to another state make sure you update your Advance Directive, because it may not be valid in the state that you move to. Some states do not recognize living wills that have been drafted in other states. Your Advance Directive does not expire and can be updated as needed. It is important for your family members to know your wishes in case of an emergency. Also, you should take a copy of your Advance Directive to the hospital whenever you are admitted so that it can become a permanent part of your medical record. REFERENCE LIST Catholic Conference of Kentucky. (2010). Catholic conference of Kentucky. Retrieved from http://ccky.org/ Corr, C. A., Nabe, C.M., & Corr, D. M. (2009). Death and Dying: Life and Living (6th Ed.). Belmont, CA: Cengage Learning Jasper, M. C. (2007). Health care directives. Dobbs Ferry, NY: Oceana Publications Kelly, D. F. (2006). Medical care at the end of life: A Catholic perspective. Washington, DC: Georgetown University Press National Healthcare Decision Day. (2010). Fact Sheet retrieved November 29, 2010 from http://www.nationalhealthcaredecisionsday.org/ Shannon, J. B. (2006). Death and dying sourcebook: Basic consumer health information about end-of-life care and related perspectives and ethical issues, including end-of-life symptoms and treatments, pain management, quality-of-life concerns, the use of life support, patients’ rights and privacy issues, advance directives, physician-assisted suicide, caregiving, organ and tissue donation, autopsies, funeral arrangements, and grief ; along with statistical data, information about the leading causes of death, a glossary, and directories of support groups and other resources. Detroit, MI: Omnigraphics.