Public and private spaces Essay Example | Topics and Well Written Essays - 750 words

Public and private spaces - Essay Example However, this also meant that some people who were unaware on the streets took him literally. In fact, it was not shocking that one of the captured individual has sued him. In one instance, Borat, using a voice heavy with accent, greets a man and introduces himself, to which the man runs off, scared and, apparently, showing that he is xenophobic (Stowe & Stump, 2007: p55). While Borat did not obtain his consent to put him in the film or trailer, he could claim that he was investigating the manner in which Americans behave towards foreigners, which is guaranteed under freedom of the press. Since the reaction by the man is newsworthy, as well as in public interest, Borat is able to exploit the First Amendment to the benefit of his film. This part is especially shocking due to the total disgust on the man’s face at being approached by a foreign man who is shabbily dressed. The film, while embarrassing to those captured showing the worst in them, is socially responsible, at least compared to what really happens in the real world. The freedom of speech is also humiliated in some ways; for example, the designer Jean Paul Gaultier in his Brooklyn Museum exhibition. The exhibition is shocking to say the least and sometimes seems like a scene one would expect to see in a strip club or, at best, in the bedroom. Latching onto the notion of the First Amendment, the designer decided to exhibit articles of clothing that border on the subversive, especially when it comes to his depictions of sex. In fact, the infamous Madonna cone bra seems mild compared to some of the revealing clothing on show (Murphy, 2013: p1). The brochure accompanying the exhibition claims that humans have an intimate relationship with what they wear and that clothes are with us in private and public (Murphy, 2013: p1). While this is a logical view, what he goes on to exhibit blurs the line between what should be shown in public and what he should show in private exhibitions. In seeking to bring what people normally associate with intimacy and privacy into a public exhibition, Jean Paul Gaultier exploits and humiliates the freedoms under the First Amendment. While he does have protection under the first amendment, what the exhibition stands for should be a private affair not a public one in a public institution. At some point, it almost seems that, instead of exploring the theme of sex, which is not a bad thing in itself, he is moving towards an exhibition of how prostitution looks like. Social responsibility is totally lacking in this exhibition. Finally, there are also some instances in which the freedom of speech is celebrated, such as in the film â€Å"The Yes Men Fix the World†. In this film, the filmmakers make mock advertisements and press releases. A particularly striking one, which was quite hilarious and revealing, was the one about the US Chamber of Commerce. They were the subject of a mock press conference captured in the film, which claimed that they had altered their stance on the legislation regarding global warming and climate change (Russell & Cohn, 2013: p32). In addition, they also posted what seemed like the media center page on the website run by the Chamber of Commerc

Medical Law Coursework Example | Topics and Well Written Essays - 6500 words

Medical Law - Coursework Example In this regard, an individual’s right to self-determination is based on the individual’s capacity to exercise that right. In other words, autonomy and the right to self-determination are the ethical factors underlying what UK law accepts as capacity or competency.5 The law assumes outright that individuals have the capacity to consent to medical treatment. Under Section 1(2) of the Mental Capacity Act 2005, â€Å"a person must be assumed to have capacity unless it is established that he lacks capacity.†6 In other words, the capacity to consent is a rebuttable presumption, although healthcare professionals are required to start out with the presumption that all patients have the capacity to consent to medical treatment. The presumption of capacity to consent is not automatically denied minors. ... s it would be if he were of full age; and where a minor has by virtue of this section given an effective consent to any treatment it shall not be necessary to obtain any consent for it from his parent or guardian.7 It would therefore appear that the age of majority has been lowered to 16 in terms of determining the legal capacity to consent to or refuse medical treatment. However, Section 8(3) of the 1969 Act goes on to provide that Section 8 â€Å"shall not be construed as making ineffective any consent which would have been effective† in the event â€Å"this section had not been enacted†.8 It therefore follows that common law considerations relative to assessing capacity on the basis of the patient’s ability to process and understand information relative to medical treatment in a rational manner may be applied to all minors. Lord Scarman noted in Gillick v West Norfolk and Wisbech Area Health Authorit that fixing the age of minority at 16 was undesirable as it: Brings with it an inflexibility and a rigidity which in some branches of the law can obstruct justice, impede the law’s development and stamp on the law the mark of obsolescence where what is needed is the capacity for development.9 In other words, Lord Scarman felt that it was unrealistic to fix the age of development when many factors influenced a child’s level of maturity and thus the issue of whether or not a minor was in a position to understand the medical treatment proposed and thus make a rational decision about accepting or refusing to accept it. It therefore follows that capacity to consent to or refuse to submit to medical treatment is a subjective issue. Legal capacity to consent to medical treatment or medicine is not determined or fixed on the basis of the individual’s status. Therefore

Literature Review Strategy for Evidence Based Practice (EBP)

Literature Review Strategy for Evidence Based Practice (EBP) Introduction Evidence based practice (EBP) is an approach to health care in which health professionals use the most appropriate information available to make clinical decision for providing high quality patient care (McKibbon, 1998). EBP has shifted the focus of health care professionals from a traditional approach on authoritative opinions to a stress on facts extracted from previous research and studies (Sackett et al, 1997). It has been suggested by that nursing practice based on evidence enhances patient care, as compared to traditional practices (Majid et al, 2011). In addition, as nurses are increasingly more involved in clinical decision making, it is becoming essential for them to make use of the best evidence in order to make effective and justifiable decisions (Majid et al, 2011). To discuss the evidence for a clinical skill, this essay will investigate the antiseptic preparations for surgical site antisepsis. The rationale for selection of this topic is its significance for the clinical nursing practice as nurses are frequently involved in the surgical site preparation (Dizer et al, 2009). Surgical site infection (SSI) is a type of healthcare-associated infection in which a wound infection occurs following an invasive (surgical) procedure. It has been suggested by National Institute of Health and Care (NICE, 2004) that surgical site infections account for almost 20% of all of healthcare-associated infections. It has been further highlighted that nearly 5% of patients undergoing a surgical procedure develop a surgical site infection antiseptic preparations. NICE (2008) has recommended that aqueous or alcohol based solution with chlorhexidine or iodine can be used for prevention of SSI. However, it does not favour or recommend one solution over the other. This essay will explore the literature for evidence about efficacy of these preparation in comparison to one another. It is important for the nurses to be aware of the best available evidence regarding antiseptic preparations to minimise the risk of surgical site infection. Research Question and Literature Search The research question for the current essay will be formulated on the PICO framework as suggested by Sackett et al (1997): P Population or problem Clean-contaminated surgical procedures I Intervention Chlorhexidine gluconate C Comparison or comparator Povidone-iodine O Outcome Surgical site infection The question formulated for the current essay using PICO framework would therefore be: In surgical procedures, is chlorhexidine gluconate more effective in comparison to povidone-iodine in reducing surgical infections? To answer the question, literature search for the available evidence for was done. The author identified a list of key search terms and synonyms that can result in a large number of hits and combined these with Boolean terms AND/OR. Terms made up of of two words were looked for by making use of speech marks so that they were are not searched for separately, and truncation was used for terms identified to have multiple endings. The key words used were surgical site infection anti-septic preparations iodine and chlorhexidine. In order to make sure that an in-depth search was done, which would elicit the largest number of studies more than one academic search engines were searched by the researcher. Cinahal: Contains an index of nursing and allied health literature and is helpful for use in a thorough search (Glazsiou, 2001). Medline: Suggested to be used in healthcare systematic reviews (Glazsiou, 2001). NHS Information Resources and NHS Evidence: Is a widely used database resource containing evidence-based reviews and specialist research from reliable sources. NHS evidence was searched separately. Cochrane Library: Provides a list of systematic reviews and RCTS that have been published or are in a process of publishing (Glazsiou, 2010). Pubmed: It is a commonly used internet resource for healthcare professionals with a large international coverage. The results of the search generated a large number of article however these had to be reduced in order to generate an appropriate research article which can answer the question formulated. Therefore, an inclusion and exclusion criteria was set to narrow down the large number of articles generated. The guidelines from NICE (2008) in which both preparation have been recommended in 2008 hence the research was done for studies published after that. Only randomised controlled trials (RCTs) have been included as they provide the best evidence. The articles which were not in English and published before 2009 were therefore excluded. Also, the studies in which preparations for a particular type of surgical procedure were studied were also excluded as the evidence for general surgical procedures was being looked for. Abstracts of the studies generated from the search of different data bases engines were thus read so that the articles which do not satisfy the inclusion criteria of this essay can be excluded. This resulted in selection of one article which satisfied the inclusion and exclusion criteria of the current work. The study by Darouiche et al (2010) is a RCT which compared the efficacy of two surgical preparations i.e. chlorhexidine–alcohol with that of povidone–iodine for preventing surgical site infections. In order to achieve this, preoperative skin preparation was done for adults undergoing clean-contaminated surgery in six hospitals with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint in a random way. The primary outcome was any surgical-site infection within 30 days after surgery. This study will be critically analysed to identify its strengths and weaknesses. It has been suggested by Burls (2009) that critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. The critical skills appraisal programme (CASP) tool (Appendix 1) for randomised controlled trials (RCTs) will be used as the selected study is a randomised controlled trial. Screening questions 1. Did the trial address a clearly focused issue? Yes, the study addressed a clearly focused issue with clear problem to be explored, comparison groups and outcomes being investigated using a PICO framework to formulate the research question thereby increasing the rigour of the study (Huang et al, 2006). 2. Was the assignment of patients to treatments randomised? Yes, the assignment to treatment and placebo group was carried out randomly in a ratio of 2:1. This will increase the validity of the study. Literature suggests that random allocation of patients to study groups help to minimize both the selection bias as well as the impact of any confounder present (Cormack, 2000). It has also been observed in the study that in order to match the two groups and deal with possible inter-hospital differences, randomization was stratified by hospital by using computer-generated randomization numbers without blocking. This is a strength of the study as stratified randomisation can help to attain maximum balance of significant characteristics without compromising the benefits of randomisation (Altman and Bland, 1999). 3. Were all of the patients who entered the trial properly accounted for at its conclusion? Yes, the trial was not stopped early and the patients were analysed in the groups to which they were randomised. The study has done both intention-to-treat analysis for both groups as well as per protocol analysis. This accounts for the drop outs in the study an also been reported thus accounting for these drop-outs which may decrease the internal validity of the study. According to the Cochrane Collaboration (2014) intention-to-treat analysis minimised the presence of bias which may exist due to loss of participants, thus upsetting the baseline similarity attained by randomisation. Detailed Questions The study by Darouiche et al (2010) does not explicitly mention whether the personnel involved in the study were blind to the treatment groups. However, it has been mentioned in the study that the operating surgeon became aware of which intervention had been assigned only after the patient was brought to the operating room. In addition, both the patients and the site investigators who diagnosed surgical-site infection on the basis of standard criteria stayed unaware of the group assignments. This minimises the bias in the study and increases its validity as differential treatment or evaluation of participants can possibly introduce bias in the study at any phase of a trial (Karanicolas et al, 2010). Hence, it is a strength of the study. According to Berger (2006), in addition to randomisation, it is important to keep the baseline variables of the study groups similar at the commencement of the trial as it is essential for a RCT to compare groups that differ only with reference to the treatment they receive. The baseline characteristics of both groups have been reported in the study and did not show any significant difference between the two intervention groups reflected by their insignificant p values. It appears from the study that both chlorhexidine and iodine groups were treated the same way other then intervention. In order to determine the treatment effect, clear pre-defined primary end point has been given by Darouiche et al (2010). The primary outcome was defined on the basis of a standard criteria given by the CDC hence it increases the reliability of study. The results of the study found that the overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P = 0.004). In order to find the results, the study undertook multiple statistical considerations and tests. The study increased its statistical power by increasing the sample size in each group which gives the study 90% power to identify a significant difference in the frequency of surgical-site infection between the two groups, at a significance level of 0.05 or less. In addition, as mentioned above intention-to-treat and per protocol analyses were performed which further increases study validity. The study also carried out a pre-specified Breslow–Day test for homogeneity to find whether the results were consistent across the six participating hospitals. This was also a strength of the study as literature suggests that involvement of multi-centre patients can compromise the external validity of the RCTs (Rothwell, 2010). This is due to potential effect of differences between health-care systemswhich result in different treatment affects, values and confidence intervals have also been reported where required. Regarding the application of the results in the settings in UK, it has been highlighted by that the study by Darouiche et al (2010) was done in the US and used an aqueous solution of iodine. However, in the UK, the most widely used skin preparations are alcohol-based solutions of 0.5% chlorhexidine or 10% iodine (Tanner, 2012). This is because aqueous-based solutions are thought to be less effective than alcohol-based solutions. Hence, to make the study applicable to the UK settings, 2% chlorhexidine in alcohol should have been compared with 0.5% chlorhexidine in alcohol or 10% povidone iodine in alcohol. The benefits of the study are definitely superior to the harms as SSI not only causes significant unwanted outcomes and distress for the patient but also results in increased costs for the patient, the healthcare and the wider economy (Tanner, 2012). Thus, a number of factors increase the external validity and internal validity of the study including stratified randomisation, blinding of study personnel, intention-to-treat analysis, keep the baseline variables of the study group’s similar, sample size and a number of statistical tests. In addition, clear pre-defined primary end point increased the reliability of the study. The study thus has very low risk of bias and can be therefore rated as 1++ according to NICE hierarchy of evience (NICE, 2004). Hence, alcoholic chlorhexidine solution is significantly more effective in reducing SSIs than povidone iodine. However, the results should be applied to UK settings with caution. References: Altman, D.G. and Bland, J.M. (1999) How to randomise BMJ. 11;319(7211), pp. 703-4. Berger VW. (2006) A review of methods for ensuring the comparability of comparison groups in randomized clinical trials. Rev Recent Clin Trials. 1(1), pp. 81-6. Burls, A. (2009) What is critical appraisal? London, Hayward Group. Cochrane Collaboration (2014) Glossary, [Online] Available from: http://www.cochrane.org/glossary [Accessed 29 January 2014] Cormack, D. (2000) The research process in nursing, 4th ed., Wiley-Blackwell: Oxford. Crookes, P.A. Davies, S. (1998) Research into Practice. London: Balliere Tindall. Darouiche, R.O., Wall, M.J. Jr, Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., Miller, H.J., Awad, S.S., Crosby, C.T., Mosier MC, Alsharif A, Berger DH. (2010) Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. . N Engl J Med. 362(1), pp. 18-26. Dizer B, Hatipoglu S, Kaymakcioglu N, Tufan T, Yava A, Iyigun E, Senses Z. (2009) The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery. J Clin Nurs. 18(23), pp. 3325-32. Glasziou, P. (2001) Systematic reviews in health care: a practical guide, Cambridge; Cambridge University Press. Huang, X., Lin, J. and Demmer-Fishman, D. (2006) Evaluation of PICO as a knowledge representation for clinical questions. AMIA Annu Symp Proc, pp. 359-63 Karanicolas, P.J., Farrokhyar, F., Bhandari, M. (2010) Practical tips for surgical research: blinding: who, what, when, why, how? Can J Surg. 53(5), pp. 345-8. Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y.L., Chang, Y.K., Mokhtar, I.A. (2011) Adopting evidence-based practice in clinical decision making: nurses perceptions, knowledge, and barriers. J Med Libr Assoc. 99(3), pp. 229-36. McKibbon, K.A. (1998) Evidence-based practice, Bull Med Libr Assoc. 86(3), pp. 396–401. NICE (2004) Reviewing and grading the evidence [Online] Available from: http://www.nice.org.uk/niceMedia/pdf/GDM_Chapter7_0305.pdf [Accessed 9 February 2014] NICE (2008) Surgical site infection Prevention and treatment of surgical site infection, London: NICE. Rothwell, P.M. (2006) Factors That Can Affect the External Validity of Randomised Controlled Trials, PLoS Clin Trials. 1(1): e9. Sackett D.L, Richardson W.S, Rosenberg W.M.C, Haynes R.B.(1997) Evidence-based medicine: how to practice and teach EBM.Edinburgh, UK: Churchill Livingstone. Tanner J (2012) Methods of skin antisepsis for preventing SSIs. Nursing Times; 108: 37, 20-22.

The Importance of Setting in Please Stop Laughing at Me :: essays research papers

Please Stop Laughing at Me, an autobiography by Jodee Blanco, is one woman’s inspirational story about the fight against bullying. This real-life account is proof of the disturbing results of what happens at school. Jodee Blanco holds nothing back when she describes the horrifying events that occurred to her at several different schools. In the beginning of the book, as the reader, we find ourselves inside Jodee’s head as she is debating whether she should actually walk in and attend her high school reunion or not. Jodee dazzles us with all she has accomplished in life, and convinces us that she has nothing to fear. But, in all actuality, she is still nervous when it comes to facing her former classmates. This beginning scene plays a major role in the books central plot, and allows us to foreshadow some of the upcoming events. Next, we are placed in Jodee’s stable home as she is getting ready for her first day of high school. We see how truly desperate Jodee really is as she describes how her new shoes should make her popular. Throughout the story we see that Jodee is not poor, stupid, cubby, or socially awkward. She is simply prude, and is hated by the classmates of every school she attended in the attempt to become accepted. This explains how loving parents can be so wrong, schools cannot prevent disaster, and children in general can be just plain mean. Jodee goes back and forth through her entire school life explaining all her horrible experiences. We follow her through therapy, and watch as she is misunderstood by all adults. She explicitly depicts her suffering as she relives the torture. Shedding a shell, she lets us have full access of the shunning, teasing, and shocking physical abuse inflicted upon her by her classmates. This sets the atmosphere and attitude of the book, so we may accurately see what happens when no one is watching. This book is timeless, bullying is ongoing. The setting of the 1970s and 80s makes the experience for the reader really see how timeless this book is.

To Kill a Mockingbird Article

The Tale of the Boo Jem Scout Maycomb County – In the small neighborhood on my block lives a house that may or may not contain a malevolent phantom. This is the Radley’s place. Dill, Scout, and I know the tale of this evil Boo Radley, and during the summer we share the tale of him to tell people of the tales. It started with one summer, when Dill dared me to go touch the Radley’s house. Usually , we play out scenes of the stories of Arthur. As Dill says, â€Å"I played old Mr.Arthur and walked up and down the sidewalked. Coughed when Jem, who played as Boo, talked to me. He went under the front steps and shrieked and howled from time to time. † {Reference to page 51-52} Atticus claims that we are tormenting Boo Radley, and says, â€Å"You never really understand a person until you consider things from his point of view – until you climb into his skin and walk around in it. † {Chapter 3: TKAM} This time though, Dill took my book, The Gray, and I needed it back.He said he would give me my book back afterwards if I touched the Radley’s house. When I went to touch the house though, â€Å"the house was the same, droopy and sick, but as we stared down the street we saw an inside shutter move. Flick. A tiny, almost invisible movement, and the house was still. † {page 19, TKAM} Another time, there was a fire at Miss Maudie’s house. Scout and I had to stay by the Radley’s home, and we didn’t even notice who put the blanket on Scout. Atticus says, â€Å"Boo Radley.You were so busy looking at the fire, you didn't notice when he put the blanket around you. † {Page 96, TKAM} Miss Maudie says, â€Å"His name is Arthur and he’s alive. † {Page 57, TKAM} I don’t believe it, I think he’s been dead and was stuffed up the chimney. And even if he is alive, why would he be cooped up in the Radley’s house? Dill said this: â€Å"Why do you reckon Boo Radley's never r un off? † †¦ â€Å"Maybe he doesn't have anywhere to run off to†¦ † {Page†¦ 163? TKAM} Whether Boo Radley is alive or dead, he is here.

Is the belief in God rational? Essay

â€Å"The fool hath said in his heart, There is no God† (Psalm 14:1, KJV ) â€Å" He that believeth on me, as the scripture hath said, out of his belly shall flow rivers of living water† (John 7:38, KJV) As per Holy Bible, in the beginning, when there was no form, God had worked for six days in creating heaven and earth, â€Å"God saw every thing that he had made, and behold, it was very good† (Genesis 1:31 KJV). On seventh day, God ended his work and took rest. The very existence of earth, sun, moon, sky and stars are the resemblances of God’s work which are working without the intervention of human science which produces a fact there is a supernatural strength of spirit beyond the recognition of human knowledge and understanding. Accepting the fact that who believe in God is a theist and a non-believer is an atheist, each must have own justification of epistemic beliefs or non-beliefs on God with supportive arguments, irrespective of religion whether it is Buddhism, Hinduism, Islam or Christianity. Theists are fundamental believers on God and atheists draw scientific conclusions and explanations that God is unnecessary. Buddhism and Hinduism have a unique identity in explaining about atheism and also about the rationality about belief in God and so also the religion of Islam. Christianity as a religion, propagates Jesus Christ as God with a strong evidence of empty tomb and also taking the evidence of miracles performed and teachings quoted in four gospels of New Testament. According to Apostle Paul Jesus was â€Å" declared the son of God with power by the resurrection from the dead†. (Romans 1:4). The above concludes an opinion that God is a supreme being who is omnipotent and omnipresent, creator and ruler of the whole universe for Christianity scriptures are the proof of God. Belief or non-belief on God is based on a personal life experiences and the interaction with inner soul and God. A view at Old Testament of Holy Bible reveals some of the facts that God did communicate with Adam, Eve, Abraham, Isaac and Jacob. Moses was commanded by God to divide the red sea and to lead the Israel out of bondage from Pharaoh. The rationality behind the above, produces a strong evidence that the presence of God always surrounds the earth and this supernatural force controls the entire universe. This is a fact for those who believe and who listen to the voice of God. According to the Holy Bible, the seed of disbelief on the existence of God is none other than evil force which transforms the human minds who get carried away into material facts of the world and become the cause of self-fall. Conclusion Belief on God is good and is rational, as it is stated in Psalms â€Å"The fear of the Lord is the beginning of wisdom†. Human knowledge, development and wisdom are the gifts of God who is an embodiment of kindness, mercy and wisdom. If King Solomon asked for wisdom to lead kingdom, Moses asked for accuracy in speech to communicate with people, each according to the wants and desires, were offered gifts by God. This was made possible only by God and for believers the history of past glories of God is the holy grail to carry and move on. Reference Gregory Kouki (2001), It is rational to believe in God? Accessed on 21 February, 2007