World War II Debates Essay Example for Free

World War II Debates Essay Even though the 1920’s began with a favorable outlook for peace, towards the end of the decade and throughout the 1930’s the clouds of war were forming. Dictators arose in countries that were dissatisfied with the results of World War I. Germany, Italy, and Japan took aggressive actions, and neither the League of Nations nor the democratic countries were able or willing to stop them. British Prime Minister Chamberlain suggested the best way to deal with Hitler was the policy of appeasement. Actions were taken that moved Europe toward war. The debate over the causes of World War II provides different perspectives. There were several factors as to why the world was plunged into World War II in 1939. At the end of WWI, the Treaty of Versailles was established. This being one of those issues having aggravated many nations. In example, reparations often ad to be paid for things like war damages as well as being forced to lessen their militaries. Both Italy and Japan were promised land- they never got the land- so ultimately this led to feeling of revenge for their anger over the situation. The Great Depression had a huge effect on Germany’s economic trouble. This caused the people to desire a leader who was not only strong but who would also be an authoritative figure for their nation. Being that authoritative figure, both Hitler and Mussolini rose to power. This triggered the beginning of WWII. Especially with the force that Hitler was willing to use when saying that Germany needed to unite all its people under one government- the Reich- to do this, he believed that they needed to fight to get what the need accomplished. This force being the â€Å"sword† (AS SEEN IN DOCUMENT 1) Appeasement is giving into an aggressors demands so peace will be had. European countries often thought that this was the proper actions to take. Appeasement is far from an effective way to dealing with aggressions. Appeasement has to do with the aggression of the axis nations in World War II. This took place when Italy invaded Ethiopia. Eventually to conquer and avenge the loss to Ethiopians in 1896. Haile Selassie, Ethiopian king, appeals to the League of Nations. To no avail. Which was led by Britain and France, to aid in fighting off Mussolini’s forces. The League of Nations proved ineffective. This proves that Britain and France disliked any fight. Haile wanted to stop the Italian aggression. If the aggression was not stopped, he, the aggressor, would attack others. Aggressors should not be appeased (AS SEEN IN DOCUMENT 2). As seen by Winston Churchill, the aggressor must be stopped, Britain, France, and the other countries must join together in a collective security to stop aggression. They should have stopped Hitler when he seized Austria or threatened Czechoslovakia, which was later taken over. The British government is to blame, as it weakened the League of Nations and did not build up their defenses leaving the state in a disaster. The British government also didn’t stop Germany from rebuilding the army. It is pointed out to us that Winston believed that Britain lost the chance to increase Nazi Germany. (AS SEEN IN DOCUMENT 6). (AS SEEN IN EXCERPT 7), Kennan offers his belief that appeasement was unnecessary because Czechoslovakia was strong enough to save itself. And German officials were about to overthrow Hitler. (AS SEEN IN DOCUMENT 8), Historian Taylor defend appeasement. He also states that there was little basis for suggesting that Germans would reject Hitler since they had put him in power and supported him. Other countries were also worried about Russian expansion into Europe. Also, (AS SEEN IN DOCUMENT 5) Chamberlain suggested appeasement because he believed â€Å"good will and determination: could solve differences among countries peacefully. He said they could not fight to save Czechoslovakia because it is a small country, But he is willing to fight over big issues, Specifically, he says he will fight to stop a country that is using force to take over the world , but he does not want war and rather prefers appeasement. Another factor includes a violation of the Treaty of Versailles, by Hitler, when sending German troops into the Rhineland as he said it was time for Germany to be treated as an equal to the rest of the countries of Europe and no longer as a defeated, punished nation. France however went to the League of Nations and asked that Germany be removed from the Rhineland diplomatically or by a stronger force if seen necessary. Western democracies were adopted with the appeasement to keep the peace. The League of Nations did not take action to terminate these attacks (AS SEEN IN DOCUMENT 3). The Munich agreement also proves that appeasement is not the answer for peace. During the Munich Conference, Germans got the OK to occupy Sudetenland, Czechoslovakia only if to promise not to invade more countries (AS SEEN IN DOCUMENT 4). (AS SEEN IN DOCUMENT 9) Keith Eubank claims that the countries of Europe, including Britain and France, were not willing to fight because Hitler had done nothing to warrant their returning to the conditions they had suffered in WWI. All the countries had other interests and they were not willing to unite to stop Hitler. Collective security was not the route to take at this time. Stalin, Roosevelt and Churchill demanded Germany split into factions to be controlled by their respective countries and France, but Hitler refused. Allied forces and the Red Army invaded Berlin and Hitler committed suicide. America quickly ended the war in the Pacific with two nuclear weapons dropped on Japan. The War ended in the Summer of 1945. It is estimated that 50 million people lost their lives during World War 2.

The IFAC code of ethics for profession accountants

The IFAC code of ethics for profession accountants Introduction Nowadays, independence is major issues to attain highest level of performances to meet the public interest requirement. (Messier et al, 2006) Therefore, International Federation of Accountants (IFAC) has its mission to provide consistently high quality of service in the public interest by continues establish and strengthen the worldwide economic development and enhancement the accountancy profession with harmonized standards. (ICEAW ¹, 2005)[Online].An IFAC Ethics Committee which also known as The International Ethics Standards Board for Accountants (IESBA) has been established by IFAC Board to develop the issues of the mission and therefore published the Code of Ethics for professional accountants to emphasize the independences and principle-based approach to its professional ethics. (IFAC ¹, 2010)[Online] The Code of Ethics for Professional Accountants (The Code) is guidance for professional accountants identify, evaluate and respond to threats in providing independent audit and assurance service. Independence in assurances services are always being discussed in the Code in terms of a principles-based approach which takes into account threats to independence, accepted safeguards and the public interest.(Rick Hayes et al,2005) It is very important since they implicitly set limit for unethical behaviour and provide guidance in auditing.( Gary Pflugrath,2007) IFAC code always focuses on the issues of independent. Auditing is virtually worthless without independent as it is referred as cornerstone of auditing. An auditors should unbiased, and unaffected by conflict of interest in their viewpoint to provide a true and fair view of the entitys audit report. (Brenda Porter, 2008) It is important to independent to avoid possible threats and access to confidential and sensitive information when carry out their work with professional and due care. Public always rely on the auditors knowledge, skills and expertise in order to form an independent opinion when providing assurance engagement. (ACCA ¹, no date)[Online] Main Report 2.1 The role of IFACs code of ethics is strengthening the independent of external auditors to provide reasonable assurance service. With comply with fundamental principles and the conceptual of framework, the Code can provides information that is more confidential and reliable in public practise while maintaining professional competence and independence. (Graham W.Cosserat, 2009) .These fundamental principles fulfil their obligation for public interest and achieve objective of accounting profession. The conceptual framework of professional conduct and ethics also provided to identify evaluate and respond to threats with compliance with the fundamental principles are not compromised. (ICAEW ¹, 2005)[Online]. The Code also prohibiting members from incompatible activities like allowing commission or brokerage that soliciting clients or encroaching upon other members work. (Emmanouil Dedoulis, 2006) For positive aspect, the code of ethics provides high quality standards and strong professional accounting to serve public interest in a transparent, efficient, and effective manner. Independence plays a vital role for truthfulness and confidentiality financial reporting to investor to serve public interest. (IFAC ², 2004) [Online]. As the public interest continually increase in demand, the revised Code of Ethics has been issued and maintain in principles-based approach to strengthen independent requirement. The revised code is regarding the ethical responsibilities of the auditors who encounter illegal acts and fraud by developing additional guidance. Newer safeguard also has been applied into the revised safeguard to provide guidance for more quality framework from professional accountants. (IFAC ³, 2008)[Online] The revised code is addressing relationships and previous and current interest which related to new entity that may affect independence. Relationship and interest may create significant threats that objectivity could be compromised. (IFACà ¢Ã‚ Ã‚ ´, 2009)[Online] Apart from that, Mr. George has point out that the Code also helps in facilitate the global harmonisations. (IFACà ¢Ã‚ Ã‚ µ, 2010)[Online].Global harmonisation is important because it is to reduce complexity and provides decisive strategic for future global capitals market. It provides greater confidence and sensitive in reliable and transparent information for individual companies. Therefore, it needs high quality accounting framework to develop the truly global set of the standards.(PWC,2007)[Online] Independence helps to provide high quality work which are meeting the information needs for capital market to allow the market operate efficiency, smoothly and effectively. This has improves the ability for investor and stakeholders to global basis to achieves substantial benefits from capitals market and lowers their risk and error of judgement. (ACCA ², 2006) [Online] On the other hand, the revised code of ethics has its negative side. It takes times to adopt the revised Code of ethics as all the professional accountants needs to absorb new information, knowledge, technical and skills in order to strengthen up the requirement of independent. It is also need to incur extra costs to provide training and preparation to adopt the newer information and requirement. Besides that, it needs to have extra communication for clearly understood all the requirement involving in revised Code of Ethics to minimise uncertainty and confusion. (ACCA ², 2006) [Online] The practice of professional accounting may create loopholes activities which may discredit the profession. Independent of profession accountants will hard to resolve this situation because the code is difficult enforcing by legally. (ACCA P1, 2008) [Online] Because the IFAC is not in a legislative position, the Code of Ethics contains no formal sanctions. (Hansrudi Lenz, 2008). Therefore, the auditors can choose to accept and comply with such a code without coercion. In such situation, the Code will fail to comply because they appear out-of-touch on ethics as they are unwilling or too busy to take the responsibility. (ACCA P1, 2008) Other than that, the code of ethics consists moral norm in provides guidance to strengthen up independence. Unfortunately, it has been fundamentally questioned about the moral base of the profession. It is neither a pure-lip-service nor a strict self-binding agreement in the sense of the Code of ethics. The independence may fail to maintain via the Code as there are self-binding that create opportunity to transgress a moral norm since independence of mind are difficult to observe. (Hansrudi Lenz, 2008)There is empirical evidence that shows moral norm are useless if the human natural are neither truly altruistic nor truly egoistic of the human behaviour. A selfish person will leave no rooms for moral obligations and maximise self-interest in decisions making which creates the ethical conflict of interest. (Sara Ann Reiter, 2000) 2.2 The IFAC code of ethics for profession accountants is essentially to maintain the principles-based approach in applying the fundamental ethics principles and conceptual framework. The IESBA have highlighted the principles-based approach as vital roles in auditing which gives guidance to resolving conflicts of interest. (ACCA P7, 2007). IFAC are more preferable to principles-based approach rather than rules-based approach as rules-based approach professional conduct and ethics cannot provide for all circumstances. There may result in inappropriate or inadequate safeguards for fundamental principles of ethics when the rules-based approach lead to unquestioning compliance to rules. (Philomena Leung, 2009) In positive aspect, the IFAC code with accordance with principles-based approach provides numerous set of specific rules for each ethical situation that had been identified. There are varied in the nature of engagement and work environment to professional accountants. (Messier, 2006)Therefore, the code with principles-based approach provides suitable guidance for every possible identified situation that involves ethical consideration with compliance with the fundamental principles that are not compromised. It is therefore the principles-based approach is acts as a driver to provide high quality work of audit. (IFACà ¢Ã‚ Ã‚ ¶, 2004) [Online] According to IFAC, external auditors independences are more preferable to principles-based approach because it creates the robust structures and applied to varied and diverse circumstances faced by professional accountants as it is continues to applicable in the rapid change of environment. (IFACà ¢Ã‚ Ã‚ µ, 2010) [Online] As it is applicable to global environment, it helps professional accountants to avoid technical evasion of detailed rules. The Code is more robust and capable of more consistent application as the IFAC code clarifies the absolute restrictions or prohibition. (IFACà ¢Ã‚ Ã‚ ·, 2009) [Online] The principles-based of the Code are potentially very flexible because it provides flexible framework for multi-culture, multi-lingual, and multi-jurisdictional environment. (IFACà ¢Ã‚ Ã‚ ¶, 2004) [Online] This approach also provides best suited to the rapid change in business environment which allows multitude circumstances that may arise in practise. As such, the standards of the Code can be responsive to the changing needs of the public interest and serves better for the requirement and interests for both user and financial markets. (Intosai, no date) [Online] Conversely, principles-based approach in the Code of ethics may have potential drawbacks. Although the Code provides basic principles to guidance, it is however that a lack of precise guidelines may create inconsistencies. (IVSC, 2007) [Online] As there are many similar circumstances to follows, the illustrative examples can be mistakenly interpreted.(ACCA P1,2008) The professional accountants may covey the false impression in descriptions of situation where it may be misguide the work in practise. Hence, they may not establish any basic principles or essential procedures to be followed in audit review, other assurance and related services engagement. (IFACà ¢Ã‚ Ã‚ ¸, 2009) [Online] The Code with principles-based approach does not and cannot capture all ethical circumstances and dilemma unless the professional accountants have very good and clear understanding in the underlying principles. (ACCA P1, 2008) Ethical dilemma can be inevitably occurring when the code cannot be honoured without apparent breach of another. (FIG, 2007) [Online] As there are argue in the regional variations in cultural, social and ethical norms, the IFAC code cannot capture important differences in emphasis in some part of the world. In additional, the Code of ethics is not technically enforceable in any legal manner although there are sanctions exists in breach of the code in some jurisdiction. Therefore, the voluntary and perhaps for the ethical code is less effective. (ACCA ³, no date) [Online] Principles-based approaches are required auditors to exercise or apply judgement because specific audit may apply laws and regulations that impact on the audit objectives. However, it is depends in the ethical conduct of the auditors. (Gary Pflugrath, 2007) Fairness expression are necessary require in the audit opinion which limits of the consistent application. Auditor may not to be able to express unqualified opinion and judgement if there are uncertainties affecting in the financial statement. Materiality by nature or by context may found in consideration. (Intosai ², no date) [Online] 2.3 Other recommendations Apart from Code of ethics, there is support evidence that shows positive relationship between audit committees and auditors independence which means that audit committee can enhance auditors independence. (Nur Barizah Abu Bakar, 2005) Audit Committee is a committee of independent non-executive directors that provide independent point of reference to auditors with view of a companys affairs other than executive directors. By providing additional channel of communication, the audit committee are strengthening the independence of external auditors. (United Nations, 2006) [Online] The audit committee might provide an impartial body for auditors to consult conflict of interest. Audit committee will also lead to increasing public confidence in the credibility and objectivity of financial report. (ACCA P7, 2009) Besides that, audit effectiveness and independently can be raised through audit quality control process. The international Standard on Quality Control (ISQC) further enhancing confidence in independent audit by encourage stakeholders work together with open and constructive dialogue in order to contribute the work of government and regulators by generating practical ideas. (ICEAW ², 2006) [Online]. ISQC also provides guidance for auditor to acquire required capabilities and competences by impose quality control in perform audit and reviews financial statement and other assurance and services engagement. The ISQC require all professional accountants perform all professional responsibilities with integrity and maintain objectivity which gain the publics confidence in the credibility of their work. (Brenda Porter, 2008) In additionally, IFAC also issued the Continuing Professional Education programme (CPE) to enhancing the professional technical skills and competences which help to develop independent of professional accountants. CPE provides high level of training to helps it members acquire the knowledge they need to face the contemporary rigors and challenges of the professional. (MIA, 2007).CPE provides rapid development in legislation, accounting standards and guidelines, technology development and increase public expectations of the services to maintain professional competence and ensure due care at all times. (MIA, 2005) [Online] By developing the higher professional standards and fostering greater sharing information between member and expert of the industry, it geared enhancing the quality of the profession. (MIA, 2007) Conclusion IFAC code of ethics plays an important element for professional accountants to serve public interest. The Code has emphasize the important for external auditors to be independent in provide reasonable assurance engagement. With guidance by the Code, the professional accountants can provide high-quality standards works with access of truthfulness and confidentiality financial reporting. From positive view, the independence can be strengthen up by the code of ethics with comply with the fundamental principles and conceptual of framework which allow professional accounting achieve their objective of accounting profession and maintain competences in practices. Besides that, the code of ethics had been revised in order to strengthen independences requirement. The code also helps in facilitate harmonisation. The code always based on principles-based approach to provide flexible for professional accountants. Principles-based approach in the Code also provides numerous set of guidance for every possible situation. Apart from that, the principles-based approach of IFAC code provides robust structure to many different circumstances. It is also suitable for business environment that rapid in changing to allows multitude circumstances. Whereas from negative view, the Code needs time consuming and cost incurred to absorb the new information, new technologies and knowledge and skills. The Code also creates loopholes from professional accountants which will possible discredit the profession. Independent cannot be strengthening because of pure-lip-service and self-binding agreement that transgress moral norm. The principles-based approach of IFAC Code has some deficiencies. The guidances examples may mistakenly interpret as it is lack of precise guidelines. IFAC Code also does not and cannot capture all ethical circumstances and dilemma. The principles-based approach also requires the professional accountants provides too many judgement which may brings to uncertainties of financial statement. Thus, besides the IFAC code of ethics, the professional accountants are advices to further develop other international standards or regulated body such as audit committee, ISQC and provide CPE to strengthen independent of auditors in providing assurance service.

Sterile versus non-sterile gloves

Sterile versus non-sterile gloves Sterile technique is generally used for laceration repair despite a lack of scientific evidence that this is necessary (Wilson, 2003). This study addresses whether there is a difference in the infection rate of lacerations randomised to receive repair using sterile versus nonsterile gloves. This will help to increase knowledge on the evidence of infection rates when nonsterile gloves are used. If it can be proven that the use of nonsterile gloves for laceration repair poses no risk, this could save time and have considerable financial savings. This may change clinical practise in the future. Research Question: Sterile versus non-sterile gloves: A safe alternative in the management of acute simple wounds in the pre-hospital environment? Sterile technique (including the use of sterile gloves) for acute simple wound or laceration management is traditional and the practise continues to be recommended (Wilson, 2003). However, there are few studies and little evidence to support this practise. Using clean nonsterile gloves rather than individually packaged sterile gloves for uncomplicated wound repair in the community may result in cost and time savings. Study objective: This proposal is for a prospective randomised controlled trial designed to determine whether there is a difference in the rate of infection, after suture repair of uncomplicated wounds and lacerations, using clean nonsterile gloves versus sterile gloves in a community setting. Justification: The research question separates this proposed study from in-hospital studies, and addresses the small data set available specific to community and pre-hospital environments (Perelman et al, 2004; Worral, 1987; Bodiwala George). Results will add to the body of evidence, broaden the knowledge base for the healthcare community and further the cause of science (Medical Research Council, 2010). This trial aims to provide quality data for publication, enabling informed re-use by others and thereby reducing the risk of data creation duplicity. Background: The Department of Health (DoH) (2005) paper Taking healthcare to the patient states that at least one million of the people taken to AE every year could be treated at the scene, in their homes or in the community. With the advent of the Emergency Care Practitioner (ECP) role, many simple wounds / lacerations are suitable for treatment and closure in the pre-hospital setting. During the year 2008 09, the National Health Service (NHS) reports that there were 663,475 Accident and Emergency attendances in England for lacerations, accounting for 8.5% of total attendances (NHS, 2010). Figures for the Ambulance service this trial will be run at show that over a six month period from April to September 2010, their ECPs attended 1555 calls for laceration / haemorrhage, 72.5% (n= 1127) of which were dealt with at the scene, negating a visit to an Accident and Emergency department. These wounds were cleansed, treated and closed where necessary using a variety of techniques from tissue adhesiv e to paper stitches or sutures. As sterile gloves are not available, the practitioner carrying out treatment of these wounds would have been using clean, non sterile gloves. This is in stark contrast to wound closure in the Accident and Emergency department where the use of sterile gloves is universal (NHS Clinical Knowledge Summaries, 2010). The question asked by this study is whether there is a difference in the rates of infection between wounds treated by practitioners wearing sterile versus non sterile gloves in the community. To answer this it is necessary to investigate what contributing factors to wound infection there are, how they are best managed and what, if any, difference gloves make to the control of infection. Pratt et al (2007) advise that best practice (in the absence of strong evidence) must be guided by expert opinion and national and international guidance; all of which should be integrated into local practice guidelines. In the case for use of sterile versus nonsterile gloves, there has been insufficient research to provide reliable evidence, therefore clinical tradition is followed and sterile gloves are the preferred choice. This dogmatic adherence to tradition is underlined by Flores (2008) who states Although ritualistic practice needs to be questioned, with the rising incidence of multi-resistant infections, it seems prudent to err on the side of caution when in doubt. Obviously then, it is important to remove the doubt by rigorous research into the area for concern, thereby adding quality data to the body of evidence and knowledge, and allowing this to steer best practise, however this is out of the scope of this study. Literature Review. A search of Cochrane Library gave 135 results, 1 of which directly answered the question (Perelman et al, 2004 see appendix one). A search of three other databases British Nursing Index (BNI), The U.S. National Library of Medicine premier life sciences database (PubMed) and Cumulative index to nursing and health literature Nursing allied health (CINAHL) revealed the same plus 2 others: Bodiwala George (1982) and Worral (1987) using the search term Infection OR Cross Infection OR Disease Transmission OR Infection Control AND Glove* OR Protective Device* OR Surgical Glove* OR Sterile Glove* OR Non Sterile Glove* AND Acute Traumatic Wound* OR Wound*.  LIMIT set to Human AND English. This shows there is little tangible research into the hypothesis suggested in this proposal. The prospective Randomized Control Trial (RCT) by Perelman et al (2004) in Canadian Emergency Departments compared sterile versus nonà ¢Ã¢â€š ¬Ã‚ sterile gloves (both latexà ¢Ã¢â€š ¬Ã‚ free) in sutured repair of lacerations. The study enrolled 816 patients (age à ¢Ã¢â‚¬ °Ã‚ ¥ 1) with blinding of patients and outcome assessors. Infection rates by 23 days were 4.3% in the nonà ¢Ã¢â€š ¬Ã‚ sterile group and 6% in the sterile group (no statistical difference), however credence was given to the possibility of skewing results due to the Hawthorne effect (Bowling, 2009) (As blinding the clinician in this type of study is impossible, it is possible that physicians using nonsterile gloves are simply more careful). This is the only RCT study of sterile versus nonsterile gloves. It is of high quality with a reasonable sample size, let down only by the non-standardised partially blind follow up. There are two older studies with significant limitations (comparing no gloves to sterile gloves) and questionable randomisation. Bodiwala George (1982) showed through their study of 408 patients that the difference in infection rates between gloved and ungloved suturing was not statistically significant. Worral (1987) found that infection rates were higher in the sterile gloved group, although the study group was small (n=50). Both these studies lend support to the idea that sterile gloves offer little in the way of reducing infection rates in the repair of simple lacerations, however suturing without any gloves is inappropriate and unsafe for practitioner and patient. Allan (2009) supports the findings of these earlier studies and concludes that present evidence indicates simple lacerations can be repaired with clean nonsterile gloves without an increased risk of infection. Acute traumatic wounds, in comparison to surgical incisions, are by their very nature already exposed to infective agents and the time delay between injury and treatment is longer (Forsch, 2008). Meticulous cleansing and where necessary, debridement is essential in reducing infection rates (Durham Hines, 2001). Moscati et al (1998) found that irrigation of acute traumatic wounds to remove grit, foreign bodies, dressing residue, excess exudates and other potential contaminants to be vitally important in preventing later complications of infection and tattooing. Generally it is agreed that wound cleansing by irrigation is preferable to swabbing or wiping (Dealey, 2005). Trott (2005) supports the old maxim The solution to pollution is dilution, stating that the most effective method for reducing bacterial load on wound surfaces and for removing debris and contaminants from within a laceration is through irrigation. This begs the question: if in the acute traumatic laceration a high bac terial load is already present, of what benefit are sterile gloves in their treatment and closure? Theoretical framework: This is a positivist paradigm (Parahoo, 2006), collecting scientific quantitative data. The research question is based on the empirical data from previous similar trials. It is acknowledged that empirical data is vulnerable to interpretation (Rubin Rubin, 2005) and this trial seeks to limit this by means of closed questions in the data gathering tool. The proposed study hypothesises that the use of clean nonsterile gloves when suturing acute simple lacerations in a community setting has little or no effect on post procedure wound infections. To refine the research question, guidance was taken from Lewith Little (2009) to ensure it is focused, is feasible and explicit. It is also a Statement of expectation relative to the variables investigated (Polit Beck, 2004). Research Methodology: This research will be a randomised controlled trial (RCT). This is chosen as there is a direct comparison between two variables; an RCT providing robust data. The RCT is the most appropriate method of study design, especially in the setting of wound repair, as suggestibility and patient expectations are potentially significant sources of bias (Jadad Cepeda, 2000). Although double blinding is impossible in this trial, the assessing clinician (data gatherer) will be blinded as to what gloves were used. However a weakness is acknowledged in that the patient may inform the assessing clinician and by so doing inject a risk of bias. To reduce the effect of other variables, ECP practise and equipment is standardised (Health Professions Council, 2010). All wound closure by the ECPs will comply with the most recent evidence based practise (NHS Clinical Knowledge Summaries, 2010). All cleaning materials, local anaesthetics and equipment are identical county wide, ensuring equality. Only mono-filament suture material will be used (no silks). Acknowledgement is given to the following variables over which this trial has no control: Individual client hygiene, poor compliance with wound care advice, further trauma to wound site post repair. The trial will be run over a six month period and utilise cluster randomisation by geographical area. For three months, sterile gloves will be used by ECPs in the west of the county whilst the east ECPs will use clean nonsterile gloves. At the three month point this will be reversed with west ECPs using clean nonsterile gloves and east ECPs using sterile gloves. Data will be collected by RW at the end of each week. Sampling: Randomised from the population area (east / west). Randomisation is automatic due to the nature of calls; assistance only being sought when needed by the public, therefore the study has no control over and cannot affect bias of patient, place, time etc. Only those calls attended by ECPs and deemed suitable for suture closure will be included. Limits: Inclusion: Patients over 18 years of age, who have sustained an acute, simple traumatic laceration which is less than six hours old requiring primary closure with simple, interrupted sutures. Exclusion: Patients with the following Very dirty / Tetanus prone wounds, immunocompromised, immunosuppressed, concomitant antibiotic use, deep wounds requiring layered suturing to eliminate dead space, puncture wounds, bite wounds (animal or human), any wound where there is suspicion of retained foreign body or damage to underlying structures, diabetes, wounds over 6 hours old. Data Collection: Data will be collected via post in the form of two clinician completed multi choice questionnaires at 3 days and at removal of sutures (ROS). The first interval gives a reasonable healing time for wound review and early identification of infection if present (patient safety). The second time interval was chosen as patients will need to re-present for this procedure and it gives reasonable opportunity for infection, dehiscence or other problems if present, to be apparent and acted upon as necessary. RW will be the dedicated researcher for collection of questionnaires, data analysis and telephone follow-up, (thus reducing response loss and attrition of data) at no cost to the trial. Patients will be supplied with 2 copies of the questionnaire as part of their discharge advice pack to facilitate continuity should they re-present at an earlier time for any reason, or at another facility. If the forms are not returned, telephone follow up will be done. As the patient should attend for wound review regardless of this research, completion of the questionnaire will cause minimal impact on clinician time, with little interference to departmental workloads. Questionnaires are designed to be simple and rapid to complete. All questionnaires will be supplied with a self-adhesive stamped self addressed envelope for ease of return. It is recognised that a limitation of this study is non return of questionnaires for whatever reason; this will be factored into the final statistical analysis. As it is impossible to blind the clinician as to whether the gloves are sterile or nonsterile in this trial, their input into it will be limited to indicating on the ECP form (See appendix 2) which group the patient fits into; A for sterile glove use, B for clean nonsterile. Randomisation and selection bias through allocation is avoided by the unpredictable nature of the emergency and unplanned workload covered by the clinicians (ECPs). This should help increase validity of findings (Bowling, 2009). As the division of the Ambulance service utilised for this trial is already divided into east and west areas, this will be used to control the intervention by allocation of sterile or nonsterile gloves. Initially, the west ECPs will use only sterile gloves for suturing wounds, with the east ECPs using clean nonsterile gloves. At the half way point in the trial, the researcher will reverse this. This allocation of gloves gives a reasonable control group from both sides of the county and acknowledges differences in individual ECP procedure, geography, demographics etc. Ethics: The four point biomedical ethics framework suggested by Beauchamp Childress (2001) has been considered in the design of this trial. This trial recognises autonomy for both patient and practitioner by seeking informed consent from participants. It promotes beneficence through its attempt to treat patients expeditiously, to high standards, without prejudice; and non-maleficence by reassuring participants that their data with be kept confidential. Justice is assured by equality of treatment for each participant. Ethical approval for the research will need to be sought from both the Ambulance service Clinical Review Group and University Ethics Committees prior to starting the research process. The researcher will be responsible for ensuring that the participants welfare is maintained. Consent will be sought by the attending ECP. Kimmel (2007) acknowledges that participants should come to no harm psychologically, physically or socially. By strict adherence to wound care guidelines (cleansing, dressing etc) in the acute assessment and treatment phase, and due regard for the patient during follow-up, this should be addressed. Consent: Prior to the study, education of ECPs through a micro-teach session (a 5 minute presentation) and poster campaign for those who cannot attend will be carried out. The ECPs will be asked if they will partake in the trial; there will be no expectation on them to do so and their inclusion will be purely voluntary. Informed consent will be sought from all patients although acknowledgement is given to the fact that the patient will be presenting in a post injury phase; they may be distressed, in pain and anxious. All patients participating in the trial will have a clear explanation given to them prior to discharge to ensure they fully understand their role and right to leave the trial at any point. Confidentiality: All data for publication, dissemination or public review will be purely statistical and numerical, having no personal details of the participants; there will be no breach of confidentiality. Participant safety: All prior research has concluded that there is statistically no difference in rate of infection when comparing glove use, adding support to the argument that there is little risk to the patient (Bodiwala, Worral, and Perelman). All gloves used will be latex free, reducing any risks of latex allergy / sensitivity to patient and clinician alike. All participants will have the opportunity to withdraw at any phase of the trial. Data Analysis and discussion: Data will be presented in a 22 contingency table (See appendix 4). As the research question is looking for a possible relationship between two variables, a bivariate statistical analysis will be used (See appendix 4). Specialist advice will be sought for the analysis of the statistical data. It is hoped that response rates will be very high as the respondent will be a medical professional (not the patient), the questionnaire is very short and straightforward, and is supplied with a self adhesive, stamped self addressed envelope. This scenario is similar to Perelamans experiment which achieved a 98% response. The patient, by the very nature of their injury, will need to attend for follow up / ROS. Calnan et al (2005) suggest a response rate of approximately 56% when reliant on the patient. Timeline: Year 2011 Initiate experiment 1st April Data collection Continuous and ongoing (RW) Complete fieldwork by 1st September Complete analysis by 1st October Give presentation on 8th October Complete final report by 1st November Conclusion: Sterile technique is generally used for laceration repair despite a lack of scientific evidence that this is necessary (Wilson, 2003). This study addresses whether there is a difference in the infection rate of lacerations randomised to receive repair using sterile versus nonsterile gloves. This will help to increase knowledge on the evidence of infection rates when nonsterile gloves are used. It is apparent that could it be proven that there is little evidence to support the continued use of sterile gloves; this could reflect a significant cost saving for the NHS (see appendix 5). This may change clinical practise in the future. References / Bibliography: Allan, M.G. (2009) Lacerations: Sterile Gloves Water? Tools for Practice. June 1, 2009. Beauchamp, T.L. Childress, J.F. ( 2001) Principles of Biomedical Ethics. New York: Oxford University Press. Bodiwala, G.G., George, T.K. (1982) Surgical Gloves During Wound Repair In The Accident And Emergency Department. The Lancet: July 10, 1982. pp 91-92. Bowling, A. (2009) Research Methods in Health (3rd ed), Maidenhead: Open University Press. Calnan, M., Wainwright, D., ONeill, C., Winterbottom, A. Watkins, A. (2005) Lay evaluation of health care: the case of upper limb pain. Health Expectations. 8(2):149-160. Dealey, C. (2005) The Care of Wounds (3rd ed). Oxford: Blackwell. Department of Health (2005) Taking Healthcare to the Patient: Transforming NHS Ambulance Services [online] Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269 Accessed 24/10/10. Durham C. Hines, S.E. (2001) Laceration assessment and management. Patient Care for the Nurse Practitioner. Jun; 4 (6): 17-20, 23. Flores, A. (2008) Sterile versus non-sterile glove use and aseptic technique. Nursing Standard. 23 (6) 35-39. Forsch,  R..  (2008). Essentials of Skin Laceration Repair.  American Family Physician.  78(8),  945-51.   Grava-Gubins, I., Scott, S. (2008) Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training. Canadian Family Physician. Oct;54(10):1424-30. Hampton, S. (2003) Nurses inappropriate use of gloves in caring for patients. British Journal of Nursing 12(17):1024-7. Health Professions Council (2010) Standards of Proficiency. [Online] Available at http://www.hpc-uk.org/assets/documents/1000051CStandards_of_Proficiency_Paramedics.pdf Accessed 13/11/10 Jadad, A.R., Cepeda, M. (2000) Ten challenges at the intersection of clinical research, evidence-based medicine and pain relief. Annals of Emergency Medicine 2000;36:247-52. Kimmel A.J. (2007) Ethical Issues in Behavioural Research: Basic and applied Perspectives (2nd ed). Oxford: Blackwell. Lewith, G. Little, P. (2009) Randomised Controlled Trials in Saks, M. Allsop, J. (2009) Researching Health: Qualitative, Quanatitative and Mixed Methods. London: Sage. p 225. Medical Research Council (2010) Data Sharing Initiative: Aims. [Online] Available at www.mrc.ac.uk Accessed 09/11/10. Moscati, R.M., Reardon, R.F., Lerner, E.B., Mayrose, J. (1998) Wound irrigation with tap water. American Academy of Emergency Medicine. 1998; 5(11): 1076-80. National Health Service: Accident and Emergency Attendances in England (Experimental Statistics) 2008-09. Hospital Episode Statistics [online] Available at http://www.ic.nhs.uk/webfiles/publications/AandE/AandE0809/AE_Attendances_in_England%20_experimental_statistics_%202008_09_v2.pdf Accessed 24/10/10. National Health Service (2010) Clinical Knowledge Summaries: Lacerations Management. [Online] Available at http://www.cks.nhs.uk/lacerations/management Accessed 11/11/10. Parahoo, K. (2006) Nursing Research: Principles, Process and Issues. (2nd ed.) London: Palgrave-Macmillan. Perelman, V., Francis, G.J., Rutledge, T., Foote, J., Martino, F., Dranitsaris, G. (2004) Sterile versus Nonsterile Gloves for Repair of Uncomplicated Lacerations on the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine. 2004; 43(3): 362-370. Polit, D.F. Beck, C.T. (2004) Nursing research: Principles and methods. (7th ed.). Philadelphia: Lippincott, Williams Wilkins. Pratt, R.J., Pellowe, C.M., Wilson, J.A., Loveday, H.P., Harper, P.J., Jones, S.R.L.J., McDougall, C., Wilcox, M.H. (2007) epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infections 65(Supplement): S1S64. Royal Mail [Online] available at http://www.royalmail.com Accessed 11/11/10. Rubin, H. Rubin, I. (2005) Qualitative Interviewing: The Art of Hearing Data (2nd ed.) London: Sage. Trott, A.T.(2005) Wounds and Lacerations: Emergency Care and Closure (3rd ed.) USA: Mosby. Wilson, J. (2003) Infection Control in Clinical Practice. (2nd edn.) London: Balliere-Tindall. Worral, G.J. (1987) Repairing Skin Lacerations: Does Sterile Technique Matter? Canadian Family Physician 1987; 33:1185-1187. Appendix 1 Relevant Paper Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Perelman et al 2004 Canada 816 patients over the age of 1yr old with simple lacerations prospective randomised controlled trial Infection post repair Infection rate for sterile vs non-sterile gloves was 6.1% and 4.4% respectively with no significant statistical difference partially blind follow up looking for signs of infection was not standardised Appendix 2 ECP information form Questionnaire 1 ECP No: Group A / B Incident No. Name: Age M / F Contact Tel. No: Site of laceration: Number and size of sutures: Appendix 3 Follow up Questionnaire Name: Age M / F Contact Tel. No: Is there any erythema extending à ¢Ã¢â‚¬ °Ã‚ ¥ 1cm from the wound? Y / N Is the wound hot to touch? Y / N Is the wound inflamed or swollen? Y / N Is there any purulent discharge? Y / N Does the patient report any increase in pain? Y / N If yes to any/all of above, is the patient systemically well? If no, refer immediately.

The Assessment of Society in Jonathan Swifts Gullivers Travels :: Gullivers Travels Essays

  Ã‚  Ã‚   "In its most serious function, satire is a mediator between two perceptions-the unillusioned perception of man as he actually is, and the ideal perception, or vision, of man as he ought ot be," (Bullitt, 3). Likewise, "misanthropy" can be understood as being the product of one of two world views: 1) The Pure Cynic or Misanthropist has no faith in human nature and has given up on any notion of ideals. This type lies and manipulates as a matter of course and these are the types that tend to run the world. 2) The "Burned" or Disillusioned Idealist's misanthropy arises out of disappointment in humankind. In many ways, the second type exhibits more bile as he is constantly frustrated by what men do as opposed to what they ought to do. Jonathon Swift is the second type of misanthropist and Gulliver's Travels is arguably his greatest satiric attempt to "shame men out of their vices" (Ibid., 14) by constantly distinguishing between how man behaves and how he thinks about or just ifies his behavior in a variety of situations. Pride, in particular, is what enables man to "deceive himself into the belief that he is rational and virtuous when, in reality, he has not developed his reason, and his virtue is merely appearance," (Ibid., 66). This satire works on so many levels that a paper such as this allows me to deal with only three elements, and in a necessarily superficial way: the ways in which the structure and choice of metaphor serve Swift's purpose, a discussion of some of his most salient attacks on politics, religion, and other elements of society, and his critique on the essence and flaws of human nature. Swift's purpose was to stir his readers to view themselves as he viewed humankind, as creatures who were not fulfilling their potential to be truly great but were simply flaunting the trappings of greatness. Gulliver's Travels succeeds in this goal brilliantly. The form and structure of the whole work enhanced Swift's purpose, as did the specific metaphors in each of the four voyages. Firstly, Swift went to great pains to present Gulliver's Travels in the genuine, standard form of the popular travelogues of the time. Gulliver, the reader is told, was a seaman, first in the capacity of a ship's surgeon, then as the captain of several ships. Swift creates a realistic framework by incorporating nautical jargon, descriptive detail that is related in a "factual, ship's-log" style, and repeated claims by Gulliver, in his narrative, "to relate plain matter(s) of fact in the simplest manner and style.

Parked Cars Can Be Death Traps for Kids :: Safety Death Children Essays

Parked Cars Can Be Death Traps for Kids Imagine sitting in a hospital waiting room anticipating the results of the tests being run on your only child. You were lucky though; at least he is alive. You had no idea that he was in your car. You can not imagine how traumatic it could have been for him to be trapped in his own car. Finally the doctors come to tell you the news. He has brain damage, and he will never fully recover. He may never walk again and he will never live the life of a normal child. These events occurred because you did not make the effort to assure your child was not unattended in your vehicle. â€Å"At least 19 children died during the summer of 1999 because they were trapped in hot cars, according to data being released by a children’s safety group† ( O’Donnel 1). Some parents run in the post office, pay for gas, buy a pack of cigarettes, or even go shopping while their children sit in a hot vehicle. â€Å"A National Safe Kids Campaign survey shows that 10% of parents believe that children can be unattended in a car. That number increases to 20% for parents 18 to 24 years old. And 50% of parents report that they don’t lock their vehicles† ( O’Donnel 5). Children should not be left unattended in a car for any reason. A child left unattended in a car could die. The extreme temperatures cause the child to overheat, which leads to death. The child could have severe brain damage. The heat could not be so extreme it causes death, but brain damage can be just as traumatic. The child could climb into the car if left unlocked. Many parents are not aware that their children are in their vehicles. The results of leaving a child unattended in a car can be fetal. Many parents don’t understand the severity of leaving a child alone in a vehicle. Assuring that your child is never unattended in a vehicle is very important during hot weather when temperatures inside a parked car can soar to deadly levels in minutes. â€Å"John McDonnel put a thermometer, which was set at about 98 – degrees, and let it sit in a car in the hot sun for several hours.

Recognise and Immediate Action to Deal with Any Bullying, Harassment or Oppressive Behaviour According to Thepolicies and Procedures of the Setting

Unit 334 Support Children and Young People’s Health and Safety Task 2 After looking at my schools health and safety policy the school makes reference’s to current legislation and complies with Leicester city council legislation. To show that we understand the health and safety policy and that we will comply with it we have to sign a document. So if we use a chair instead of a ladder to put up a display and fall off the chair and hurt yourself you can’t sue the school or HCC. Task 3 Case Study 1 This would be a good place to visit as some of the children have never been but there are concerns about health and safety and the risk of being in a big open space but to minimise the risk a risk assessment will be done. This will identify the hazards and the control measures to reduce the risk. You would discuss this as a year group to ensure that all staff understand their roles on the trip. A letter will be sent home with the children in your year group to get parental consent if the school doesn’t have a parent signature the child will not be allowed to go on the trip. This letter also has all the information the parents will need to know like places they will be visiting e. g. a museum, butterfly gardens. Also in the letter it will have information such as 1. date the trip will take place 2. What clothing and shoes the children will need to wear. 3. Arrangement for packed lunch and free school meals and what drinks are suitable to take 4. The cost of the trip if any 5. When the trip will return back to school. They will be a slip at the bottom of the letter to return back to the school. For all staff and governors going on the trip they will be given a timetable with what will be happen during the day at set times and where to meet. This will also have the focus of the day. There will be a group list with the timetable which has the name of all staff that are going on the trip and the children they will be looking after and any one on one requirement’s. In the school office there are two lists, one which has all staff and governors going on the trip, there contact details, there emergency contact details, and the other list has all the children going on the trip and there emergency contact details. The school uses a ratio of 1:6 in years 1 &2 and a ratio of 1. 4 in year R against the national recommendation of 1. 8 for an infant school on a trip. All children are given name tags to wear with the schools details just in case they get lost or separated from their group with their names are facing down. Before going on the trip the children are talk to about stranger danger this not done intrusive with the children there are told never to lose sight the adult in there group so their will not need to talk to strangers when on the trip. This is done couple of times during the week as a class and in small groups. Case study 2 Amiria should say to the group of children let’s let the men get on with their work and engage them in an activity away from the fence, if there is enough space, if not she should take them inside. Because she doesn’t know if the men are CRB checked and following the schools child protection policy. Within my work place I support a child with physical needs so I have to be aware of where he is and what he is doing and point out potential risks to make him aware, such as walking across a classroom with toys in his path. In this case I stopped him and asked why that route was not a safe way to walk, I then discussed what could happen and together we chose a safer way to cross the room.

Civilization and Medicinal Uses

1. How is the discovery of beer linked to the emergence of the first civilization?A: The discovery of beer is linked to the emergence of the first civilizations because, a change happened around 12,000 years ago when the nomads deserted there migratory ways, settled down and took up farming. When they began to farm and collect grains that’s when beer was discovered. Therefore beer is linked to the first civilizations emergence by the sudden adoption of farming.2. How is the production of beer an example of plant domestication?A: For something to be domesticated it has to be grown or breed for a specific purpose. Well the plants/grains used to make beer were given just that, a purpose to be grown.3. What sources does Standage use to gather his information on beer?A: Ballinger, Clint. â€Å"Beer Production in the Ancient Near East.† Unpublished paper,   personal communication.Baron, Stanley. Brewed in America: A History of Beer and Ale in the United States.  Boston: L ittle, Brown, 19624. What were some of the uses for beer?A: Beer was as a currency but it was also used medicinally. The workers that built the pyramids were paid in beer and bread, the standard amount each worker got was three or four loafs of bread and two jugs (contains eight liters). Tablets from the Egyptian records that date back to 2100 BCE contains list that different medicinal uses for beer.â€Å"The Ebers Papyrus† yet another medical text for the uses of beer that dates around 1550 BCE , contains many recipes for the medicinal uses of beer but combined with other  ingredients . Half an onion mixed with beer was said to cure constipation.5. How did beer civilize man according to Standage?A: â€Å"Beer permeated the lives of Egyptians and Mesopotamians from the cradle to the grave. Their enthusiasm for it was almost inevitable because of the emergence of complex societies, the need to keep written records, and the popularity of beer all from surplus of grain.† (Standage, 39)What he is saying here is that no one could over look or avoid there excitement for the beer because it brought out more civilized societies, made them keep up with written records to pass down the process to make the beer, and that beer became so popular and so available because of the numerous counts of grains that they had access to know that they had taken up farming and gathering.6. Explain the relationship between beer writing, commerce, and health?A: Beer and writings relationship is that in order for the process of making beer to not only be remembered but also passed down generations, the Egyptians and the Mesopotamians had to make clay tablets. These had the processes, medicinal uses, and ingredients written on their faces. Beer and commerce’s relationship was created when both civilizations used beer as a currency.They used this beverage as means of payment for the builders of the Great Pyramids. On that note this is why the builders on the third Gi za pyramid were known as the â€Å"Drunkards of Menkaure†. Lastly, Beer and healthy relationships come from both civilizations use of this beverage for medicinal purposes. They used ingredients mixed with beer to cure a wide variety of illnesses or discomforts.WINE1. How did the use of wine differ from the use of that in ancient Greece and Rome?A: Wine was seen as a symbol of wealth, he chose not the usual Mesopotamian culture beverage but the elegant wine. Carved stone shows him drinking wine from a bowl not beer. Beer was not used that much for gathering and fest  although it was provided, guest would choose the new drink over there native beer. It was regarded as an exotic drink and it high price and sacristy made it worthy of the gods themselves.2. What did drinking wine symbolize in ancient Greece and Rome?A: Drinking wine in ancient Rome and Greece was an emblem of power, prosperity, and privilege.3. How was wine consumed? Is this similar to or different from beer con sumption in Mesopotamia/Egypt?A: The Pharaohs tasted the wine and made their own vineyards near the deltas of the Nile, for this was a place with rich soil. They made it to where the production outside of their own vineyards was limited. However in Mesopotamia the elegant yet powerful wine was restricted only to that of the wealthy because of the lands incapability to support larger surpluses of the wine.4. How did the use of wine differ in the