Genie Wiley, the Feral Child

Genie Wiley (born April 1957) was a severely neglected and abused child who was discovered and taken into custody by authorities when she was 13 years old. While her circumstances until that point were undeniably tragic, they also presented an opportunity for psychologists, linguists, and other researchers to study psychosocial, emotional, and cognitive development in an individual who had suffered from severe social isolation and deprivation. In particular, the discovery of Genie presented an opportunity to study whether a child who was past the so-called critical period for language acquisition could learn to speak a first language. Key Takeaways: Genie Wiley Genie Wiley was abused and neglected for over a decade until she was discovered in 1970 when she was 13 years old.Known as the feral child, Genie became an important subject of research. Of special interest was whether she could acquire language, as she was no longer within the critical period for language development.Genies case presented an ethical dilemma between prioritizing her care or prioritizing research on her development. Early Life and Discovery The case of Genie Wiley came to light on November 4, 1970. Genie was discovered by a social worker when her mother, who was partially blind, went to apply for social services. Genie had been isolated in a small room starting at the age of 20 months until her discovery at 13 years and 9 months old. She spent most of her time naked and tied to a potty chair where she was given limited use of her hands and feet. She was completely cut off from any kind of stimulation. The windows were curtained and the door was kept closed. She was only fed cereal and baby food and wasn’t spoken to. Although she lived with her father, mother, and brother, her father and brother would only bark or growl at her and her mother was only permitted very brief interactions. Genie’s father was intolerant of noise, so no TV or radio was played in the house. If Genie made any noise, she was physically beaten. Portrait of Genie Wiley. Bettmann / Getty Images Upon her discovery, Genie was admitted to Children’s Hospital of Los Angeles for evaluation. She was severely underdeveloped. She was thin and looked like a child of six or seven. She couldn’t stand up straight and could only walk with a hunched â€Å"bunny walk.† She was unable to chew, had trouble swallowing, and spat frequently. She was incontinent and mute. At first, the only words she recognized were her name and â€Å"sorry.† Testing shortly after she came to the hospital revealed that her social maturity and mental abilities were at the level of a one-year-old. Genie didn’t walk at a normal age, so her father came to believe she was developmentally disabled. However, the researchers brought onto the case after Genie’s discovery found little evidence of this in her early history. It appeared she never suffered from brain damage, mental disability, or autism. Therefore, the impairments and developmental delays Genie exhibited upon being assessed were the result of the isolation and deprivation she was subjected to. Both of Genie’s parents were charged with abuse, but Genie’s 70-year-old father committed suicide the day he was supposed to appear in court. The note he left said, â€Å"The world will never understand.† The Rush to Research Genie’s case drew media attention as well as great interest from the research community, which considered it a rare opportunity to discover whether it was possible for Genie to mentally develop after such severe deprivation. Researchers would never deliberately conduct deprivation experiments with people on moral grounds. So, Genie’s sad case was ripe for study. Genie was not the child’s real name, but the name given to the case in order to protect her privacy. The National Institute of Mental Health (NIMH) provided funding for research and a team was assembled whose goal was to rehabilitate and study Genie’s progress. Genie soon learned basic social skills like using the toilet and dressing herself. She was fascinated by her environment and would study it intensely. She especially enjoyed visiting places outside the hospital. She was talented at nonverbal communication, but her ability to use language did not proceed rapidly. As a result, psychologist David Rigler decided to focus the research on Genies language acquisition. Language Acquisition The discovery of Genie coincided with a debate about language acquisition in the scholarly community. Linguist Noam Chomsky, from the Massachusetts Institute of Technology, claimed humans are born with an innate ability to develop language. He believed language isn’t acquired because we learn it, but because it’s part of our genetic inheritance. Then, neuropsychologist Eric Lenneberg added a caveat to Chomsky’s ideas. Lenneberg agreed that humans are born with the ability to develop language, but suggested that if a language wasn’t acquired by puberty, it might never be. Lenneberg’s proposal was called the â€Å"critical period hypothesis.† Yet, there was no ability to test the theory until Genie came along. Within the first seven months after her discovery, Genie learned many new words. She had even begun to speak but only in single words. By July 1971, Genie could put two words together and by November she could put together three. Despite  signs of progress, Genie never learned to ask questions and she didn’t seem to understand the rules of grammar. After beginning to speak in two-word phrases, normal children experience a language â€Å"explosion† a few weeks later in which speech develops quickly. Genie never experienced such an explosion. Her speech seemed to plateau at creating two to three-word strings, despite four years of additional work and research with her. Genie demonstrated that it’s possible for an individual to learn some language after the critical period. Yet, her inability to learn grammar, which Chomsky believed was key to human language, indicated that passing the critical period was detrimental to the complete acquisition of a first language. Arguments and Ethical Considerations During Genie’s treatment, there  were disputes amongst the members of her team. In the early days after her discovery, she entered her first foster home with her teacher Jean Butler. Butler claimed she felt that Genie was being subject to too many tests and attempted to make changes to Genie’s treatment. She wouldn’t allow the linguist Susan Curtiss or the psychologist James Kent into her house to see Genie. Other team members claimed Butler thought she could become famous through her work with Genie and didn’t want anyone else to get credit. Butler’s application to become Genie’s permanent foster parent was rejected about a month later. Psychologist David Rigler and his wife Marilyn stepped in and fostered Genie for the next four years. They continued to work with her and let others continue their research throughout that time. However, Genie left the Riglers’ home after NIMH stopped funding the project due to problems with data collection. Throughout the four years in which Genie was being tested and studied, there was debate about whether she could be a research subject and a rehabilitation patient at the same time. The ethics of the situation were murky. In 1975, Genie’s mother regained custody after being acquitted of all charges of child abuse. Genie’s care quickly became too much for her to handle, though, so Genie began to bounce from foster home to foster home. She was once again subjected to abuse in those homes. Soon, she stopped talking and refused to open her mouth entirely. Meanwhile, Genie’s mother filed a lawsuit against Genie’s team and the Childrens Hospital alleging that the researchers prioritized testing Genie over her welfare. She contended that they pushed Genie to the point of exhaustion. The case was eventually settled but the debate continues. Some believe the researchers exploited Genie, and therefore, didn’t help her as much as they could have. However, the researchers say they treated Genie to the best of their ability. Historian and psychologist Harlan Lane points out that â€Å"theres an ethical dilemma in this kind of research. If you want to do rigorous science, then Genies interests are going to come second some of the time. If you only care about helping Genie, then you wouldnt do a lot of the scientific research. So, what are you going to do?† Genie Today Genie is believed to be alive and living in an adult foster home as a ward of the state of California. While the linguist who worked with Genie, Susan Curtiss, has attempted to get in touch with her, she’s been repeatedly rebuffed. However, she said that when she calls the authorities, they inform her that Genie is well. Yet, when journalist Russ Rymer saw Genie at her 27th birthday party, he painted a much bleaker picture. Similarly, psychiatrist Jay Shurley, who was at Genie’s 27th and 29th birthdays, claimed Genie was depressed and had withdrawn into herself. Sources Cherry, Kendra. â€Å"Overview of Feral Child Genie Wiley.† Verywell Mind, 9 March 2019. https://www.verywellmind.com/genie-the-story-of-the-wild-child-2795241Pines, Maya. The Civilizing of Genie. Teaching English Through the Disciplines: Psychology, edited by Loretta F. Kasper. Whittier Publications, 1997. http://kccesl.tripod.com/genie.htmlNOVA. Secret of the Wild Child. PBS, 4 March, 1997. https://www.pbs.org/wgbh/nova/transcripts/2112gchild.htmlFromkin, Victoria, Krashen, Stephen, Curtiss, Susan, Rigler, David, and Rigler, Marilyn. The Development of Language in Genie: A Case of Language Acquisition Beyond the Critical Period Brain and Language, vol. 1, no. 1, 1974, pp. 81-107. http://dx.doi.org/10.1016/0093-934X(74)90027-3Carroll, Rory. Starved, Tortured, Forgotten: Genie, the Feral Child Who Left a Mark on Researchers. The Guardian, 14 July 2016. https://www.theguardian.com/society/2016/jul/14/genie-feral-child-los-angeles-researchers

To Kill A Mockingbird Character Analysis - 733 Words

In the story To Kill a Mockingbird it follows the life of Jem and Scout as they grow up in a time of inequality and injustice. In the beginning of the story Scout does not understand Atticus’ life lessons, but as she matures she will. The author tells the story from an older and more mature Scout’s perspective. Harper Lee also uses the voice of Jem to portray the internal and external conflicts in the book. Using Jem’s voice, Lee reveals how a young man can rise above ignorance in their community. This story portrays literary elements such as character, setting, and conflict, this affects the theme that you can not judge people by rumors but by getting to know them. The Mrs. Dubose conflict with Jem is one of the coming-of-age†¦show more content†¦This scene shows how mature Jem is now, his punishment was more of torture in his eyes but he persists throughout the agony. Another coming of age experience was toward the climax of Boo’s story, Scout s tarts to see Boo as a person, not just as a rumor from Miss Stephanie Crawford, the neighborhood gossip. She sees him as an ordinary person and cares for him, unlike most Maycomb civilians. In the end, Scout realizes Atticus was right. â€Å"One time he said you never really know a man until you stand in his shoes and walk around in them. Just standing on the Radley porch was enough† (374). One night, she talks about Boo â€Å"Atticus, when they finally saw him, why he hadn’t done any of those things†¦Atticus, he was real nice†¦Ã¢â‚¬  (376). People view Boo Radley as things that he is not and held responsible for things he never did, but when Scout finally meets Boo, she finally realizes that all those rumors are lies and they must respect others as people. And lastly, Mr. Dolphus Raymond is a character who is known by the citizens of Maycomb for what he appears, but Scout recognizes that he is not what he seems. Mr. Raymond is a white man who has children with his black wife, and hangs around Negros. He says â€Å"it helps folks if they can latch...a reason† (268). He believes that blacks should get more respect and to treat them like people. Raymond is one of â€Å"the handful of people with enough humility to think when they look at a Negro† (316). Scout starts toShow MoreRelatedTo Kill a Mockingbird Character Analysis Essay763 Words   |  4 PagesEssay Prompt: In a 1-2 page character analysis, explain what makes Atticus such a good parent, using quotes and evidence from the text to back up your claims. The Most Memorial Parent In 2003, the American Film Institute chose Atticus Finch, a respectful, dignity attorney from To Kill a Mockingbird, as the greatest hero in 100 years of film history. Harper Lee published To Kill a Mockingbird in the 1960s and it immediately received huge acclaims from readers throughout the world. In the novelRead MoreTo Kill A Mockingbird Character Analysis783 Words   |  4 PagesMockingbird Characters A mockingbird is someone or something that does no harm to others. In the story To Kill A Mockingbird, there are three characters that symbolize a mockingbird. They are Boo Radley, Atticus Finch, and Tom Robinson. These characters are innocent and do good to others. They also deserve no harm to be done to them. Boo Radley is a character the symbolizes a mockingbird. People like Mrs. Crawford spread rumors about Boo. â€Å"As Mr. Radley passed by, Boo drove the scissorsRead MoreTo Kill A Mockingbird Character Analysis721 Words   |  3 Pagesclass 6th Period English ll December 21 To Kill a Mockingbird is written by Harper Lee. It is the story of a black man’s struggle for justice. The protagonists Atticus Finch and his daughter Scout and other characters such as Tom Robinson and Bob Ewell, the author reveals her themes showing the evils of racism and the need in humans for respect. heroism is found in this novel, characters who show both physical and moral courage. Three characters to start are Atticus Finch, Mrs. Dubose, andRead MoreTo Kill A Mockingbird Character Analysis903 Words   |  4 Pages To Kill a Mockingbird, a novel written by Harper Lee, takes place during the Great Depression in the fictional town of Maycomb County, Alabama. The novel is narrated by Scout Finch looking back upon events within her childhood in Maycomb. She retells the various adventures she’s had with her brother, Jem, and father, Atticus. Scout and Jem are often getting themselves into trouble whether it is because they are pestering their reclusive neighbors the Radleys, or are destroying the gardens of anotherRead MoreTo Kill A Mockingbird Character Analysis1557 Words   |  7 PagesThis quotation shows that to have courage isn’t always when you are being brave but when you finish something that you start. In the book â€Å"To Kill a Mockingbird† By Harper Lee,   Many characters show the trait of courage throughout the book. It also s hows many important parts of the book through these quotes that are shown. In the novel To Kill a Mockingbird by Harper lee Atticus shows the trait of courage a lot in the book.   The next two quotes are ones that show that Jen is a person in the novelRead MoreTo Kill A Mockingbird Character Analysis924 Words   |  4 PagesThe novel To Kill a Mockingbird is based on the passed experienced from Harper Lees childhood. The character of Atticus resembles the author’s father, and the character of Scout resembles herself. To Kill a Mockingbird is a novel written by the well known author, Harper Lee. This book is written in Scouts perspective to portray her life. The main character, Scout, who is also the narrator is portrayed as a young girl who is still learning the rules of life. Her father, her brother Jem, and nannyRead MoreTo Kill A Mockingbird Character Analysis956 Words   |  4 PagesEmpathetic Development in To Kill a Mockingbird Developing genuine empathy is one of life’s greatest challenges. In To Kill a Mockingbird, author Harper Lee uses unhypocritical, more experienced characters like Atticus to expose Jem and Scout to adult knowledge. Their adult influence is what brings about the empathetic growth and maturity of Jem and Scout. Atticus is one of these adults. After Scout is upset by her teacher’s inability to understand Maycomb County’s culture, Atticus delivers theRead MoreTo Kill A Mockingbird Character Analysis1033 Words   |  5 Pagespsychology. Children are molded by the milieu they are raised in, as apparent throughout the story of To Kill a Mockingbird by Harper Lee. Countless times we are exposed to children who are raised in different environments, from the Finchs to Ewells to even the Cunninghams. While we follow Scout, a 6 year old girl, and Jem, a 10 year old boy, through the story, we get to see their characters’ personalities evolve and change due to when and where they grew up at. We also get to experience how theyRead MoreTo Kill A Mockingbird Character Analysis1244 Words   |  5 PagesWas Atticus Finch was the true hero of To Kill A Mockingbird? Harper Lee’s To Kill A Mockingbird narrates the journey of Scout Finch from an immature, feisty, close minded young girl, to a strong, brave and courageous girl that now knows the truth about Boo Radley the towns ‘freak’. Boo Radley is middle aged man who is known as a creep but by the end of the novel they realise that he is a nice man. Scout is the daughter of Maycombs brave and courageous lawyer, Atticus Finch who defends Tom RobinsonRead MoreTo Kill A Mockingbird Character Analysis756 Words   |  4 Pagesso that she could end the aggression her father gave her. Mayella is powerful due to the fact that she is white, her family is the poorest family out there, but because of her color she will always be preferred over African-Americans. In â€Å"To Kill A Mockingbird,† Harper Lee uses class, race, and gender to determine if Mayella has power after all. In this case, power brought her down to be on a negative side. She may be white but because of the way she lives she will never earn the trust of others

Infection Prevention and Control Level

Question: Discuss about theInfection Prevention and Control Level. Answer: Introduction: This essay aims to analyze critically a qualitative and a quantitative research literature for supporting research development. The method of research critique will be utilized for analyzing the different components of the two articles and determining their significance in the research field. At first, the analysis of the two research articles will be done followed by a critical analysis. The essay will first define research critique and will make the readers understand regarding the research findings. For analyzing every section of a literature, an appropriate framework is needed (Parahoo, 2014).A summary will be provided after critically analyzing the two articles. Subsequently, this essay will critique a compulsory section of this article along with the other three sections for evaluating the findings of the research. The reviewing of the other parts includes introduction, literature review and discussion. The essay will critique the two research articles by considering the framew ork of research. Research Critique A research critique is concerned with the evaluation of content of the research papers. It involves the identification of problem, finding out specific questions, studying the theoretical and analytical approaches of the study and evaluating the findings along with the significance. The summary of a research critique involves the personal study and evaluation of the research articles by the authors. The arrangement cannot be similar that a research critique includes only errors in a report; comparatively it may be principally positive. It helps for analysing the weakness and strength of a specific research article. It also assists to identify repetitions, unrelated information and grammatical errors and overall writing style. It is carried out for a number of reasons, for example, when a research paper is all set to be published and for commenting on the research wok prior to publication. In some cases, it helps the emerging scholars in gaining experience, learning and developing the research skills (Fitzgerald, 2012). Summary of the First Article The first article titled Barriers to nurses adherence to central venous catheter guidelines by Jeffrey Picker (2014) is a qualitative research study which has included a descriptive method. This study has involved then participants and the collection of data has been carried out through interview. The analysis of data was performed with the help of Coloaizzis method. This study has aimed to explore the perceived barriers of nurses for adhering to the standard care practice s of Central Venous Catheters (CVCs). The key findings of this study have suggested that the barriers of adherence are potentially able to produce errors and restrict the nurses to provide a high-quality care to the patients. Critique The key findings of this study have suggested that the barriers of adherence are potentially able to produce errors and restrict the nurses to provide a high-quality care to the patients. The researchers with the logical development of the rationale and understanding of the study have done a detailed review of the cited articles. There has been an integrated assessment of all the articles and the researchers have identified the gaps between the knowledge and practice of the nursing professionals. By making a comparison with the other studies, it has been discovered by the researchers that this study has a minor susceptibility to predisposition because it is more rigorous and hence, it the current knowledge has been extended with the basis for less significant deviation. The method of research utilized by the researchers together with exploration of general credibility has highlighted the apparent barriers of the nurses explicitly. Justification These signify the logic, which has been maintained by the researchers throughout the study to provide a reliable understanding regarding the aim of the research with the purpose of the interventions to establish the hypothesis of the research. The researcher has discussed the discussion regarding post-insertion bleeding as a side effect, though no intervention has been suggested to reduce or avoid this bleeding that could have made this study more practical and safety oriented. A clear demonstration regarding the infections associated with the catheters and the significance of CVCs in managing the severely ill patients has been given by the introduction of this article. Summary of the Second Article The second research article titled A comparative evaluation of antimicrobial-coated versus non-antimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial by Storey et al. (2016) is a quantitative study. The sample populations of this study comprised the patients who were randomly selected and placed with PICC line in the body. The study involved 167 patients from the three high-risk units and was allocated to receive either a non-CHG or a CHG impregnated line. The collection of data was carried out in the form of laboratory and the patients were reviewed regularly. The study was designed to compare the effects of non-CHG and CHG lines on the development of CLABSI and VTE. The findings of the study revealed that no major differences were observed in the development of CLABSI and VTE by using both the lines. Critique The researchers have developed a coherent development regarding the understanding of the topic with respect to the existing knowledge. This is apparent from the fact that a challenge is presented by the PICC lines in the clinical practice because of the development of complications. Hence, it is necessary for identifying the impact of CHG and non-CHG groups on the development of complications and their successive prevention (Sandrucci Mussa, 2014).It relates the review with the research problem directly and after reviewing, the identification of gaps has been done by summarizing the publications of the research. The development of VTE, CLABSI and post-insertion bleeding has been discussed by the researchers. This provided a thorough assessment regarding the findings of the study and associated them with the findings from another study for gaining knowledge. Justification The findings of this have reflected the different factors that have emerged in the form of contextual factors and cognitive barriers, which were later, associated with the main subject of this study. It can be affirmed form the study that the authors could have underlined some additional things regarding the role of the healthcare organizations to facilitate the barriers that are faced by the nurses as it could have presented a clear image about the issue. In addition to this, the study carried out in this research article is logical and well-linked. It has been exhibited by the introduction of this study that every year several patients die because of medical errors and the need for the nurses to adhere to the guidelines of the practices of standard care along with their responsibility for minimizing the errors. General Credibility (Compulsory Section) The general credibility of the research method can be stated in the way that the research method clearly explored the aim of the research in the study. It is apparent from the fact that the researchers have established an apparent and consistent association between the research aim and findings of the study. The study intended to investigate the impact of both the PICC lines on the arising of problems and the findings advocated no major variations mong both the lines resulting in the development of problems. These signify the logic, which has been maintained by the researchers throughout the study to provide a reliable understanding regarding the aim of the research with the purpose of the interventions to establish the hypothesis of the research. Optional Sections Introduction The first article titled Barriers to nurses adherence to central venous catheter guidelines by Jeffrey Picker (2014) is a qualitative research study which has included a descriptive method. This study has involved then participants and the collection of data has been carried out through interview. The analysis of data was performed with the help of Coloaizzis method. This study has aimed to explore the perceived barriers of nurses for adhering to the standard care practice s of Central Venous Catheters (CVCs). The second research article titled A comparative evaluation of antimicrobial-coated versus non-antimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial by Storey et al. (2016) is a quantitative study. The sample populations of this study comprised the patients who were randomly selected and placed with PICC line in the body. Literature Review The literature review systematically reviewed the articles to demonstrate the factors of risk that leads to infection and identifying the patients who are prone to develop infections. A coherent development regarding the understanding of the topic with respect to the existing knowledge has been developed by the researchers. This is apparent from the fact that a challenge is presented by the PICC lines in the clinical practice because of the development of complications. Hence, it is necessary for identifying the impact of CHG and non-CHG groups on the development of complications and their successive prevention (Sandrucci Mussa, 2014).It relates the review with the research problem directly and after reviewing, the identification of gaps has been done by summarizing the publications of the research. Discussion of the Study The results of the study along with their implications and limitations has been analysed by the discussion of the study. It has been associated with the other studies that have been reviewed in the in the background section which assisted in the identification of variables such as resource availability, staffing and documentation. It has been identified that the nurses have an awareness regarding the barriers to standard care practices. Besides the strength, the found weakness was the limitation of the study, which has been recognized properly with recommendations for future research. The discussion regarding the implications of the study has been done that enhanced the validity of the study and they have been proposed by keeping in consideration the complex environments of healthcare. Application to New Zealand Context The two articles involved Central Venous Catheter (CVC), while one of them is concerned with the guidelines by the nurses along with the development of complications such as VTE and CLABSI because of the utilization of PICC lines. The rationales for future research in this area have been provided by these studies. The significant international experiences have been used for reducing the infections that are acquired by healthcare by the Health Quality and Safety Commission of New Zealand (Sturm Antonakis, 2015). The information for helping the healthcare professionals in preventing the infections that re associated with CVC has been provided by this commission. It is clear that in New Zealand; evidence-based guidelines are not followed that brings about differences in the clinical practices. As a result, it is necessary that the nurses along with the other professionals of healthcare should assess the guidelines to ensure the availability of the best evidence (Taylor et al., 2014). T he barriers that are perceived by the nurses in their daily practices must be reduced to facilitate them for adhering to the standard practices of care to minimize the complications associated with CVC (LoBiondo-Wood Haber, 2014).The awareness and knowledge of the nurses can be enhanced by the upgrading of the consistency by developing a model to ensure than evidence-based interventions are received by the patients (Vasudevan, Oddie McGuire, 2016). The healthcare organizations can utilize the findings of these quantitative and qualitative studies for enhancing the quality of care offered to the patients. In order to adhere with the guidelines of management of CVCs, the nurses need to work hard since they are aware regarding the barriers for implementing an evidence-based protocol (Taylor et al., 2014). Conclusion (Compulsory Section) To conclude, by critically analysing the two research articles, it is apparent that in healthcare settings, safe delivery of care is a priority and the main role of the nursing professionals. Negligence in the care of the patients can result in the development bloodstream infections. In order to prevent this from taking place, the orientation of the healthcare organizations together with an official training will play a significant role to provide the essential tools that are needed for carrying out safe practices. They should identify and eliminate the barriers for ensuring the safety of the patient in an efficient manner. References Diggery, R. C. (2012).Catheters: Types, applications and potential complicationsNova Science Publishers, Inc. Dougherty, L., Lister, S. (2015).The Royal Marsden manual of clinical nursing procedures. John Wiley Sons. Fawcett, J. Garity, J. (2009). Evaluating research for evidence-based nursing practice. Philadelphia, PA: F.A. Davis Company. Fitzgerald, L. (2012). Using research evidence in S. Borbasi D. Jackson. Navigating the maze of research: enhancing nursing and midwifery practice (3rd ed., pp193-213). Chatswood, Sydney: Mosby Elsvier Jeffery, A. D., Pickler, R. H. (2014). Barriers to nurses adherence to central venous catheter guidelines.Journal of Nursing Administration,44(7/8), 429-435. Lapp, H., Krakau, I. (2014).Cardiac catheter book(1st ed.). New York: Thieme. LoBiondo-Wood, G., Haber, J. (2014).Nursing research: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences. Parahoo, K. (2014).Nursing research: principles, process and issues. Palgrave Macmillan. Polit, D. F., Beck, C. T. (2013).Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams Wilkins. Sandrucci, S., Mussa, B. (Eds.). (2014).Peripherally Inserted Central Venous Catheters. Springer Milan. Storey, S., Brown, J., Foley, A., Newkirk, E., Powers, J., Barger, J., Paige, K. (2016). A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial.American journal of infection control,44(6), 636-641. Sturm, R. E., Antonakis, J. (2015). Interpersonal Power A Review, Critique, and Research Agenda.Journal of Management,41(1), 136-163. Taylor, J. E., McDonald, S. J., Tan, K. (2014). A survey of central venous catheter practices in Australian and New Zealand tertiary neonatal units.Australian Critical Care,27(1), 36-42. Valentin, A., Capuzzo, M., Guidet, B., Moreno, R.P., Dolanski, L, Baure, P. Metnitz, P.G.H. (2006). Patient safety in intensive care: Results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Medicine, 32 1591-1598. Vasudevan, C., Oddie, S. J., McGuire, W. (2016). Early removal versus expectant management of central venous catheters in neonates with bloodstream infection.The Cochrane Library. Worth, L. J., Spelman, T., Bull, A. L., Brett, J. A., Richards, M. J. (2015). Central line-associated bloodstream infections in Australian intensive care units: Time-trends in infection rates, etiology, and antimicrobial resistance using a comprehensive Victorian surveillance program, 2009-2013.American journal of infection control,43(8), 848-852.

Bilingual Education Essay Research Paper Bilingual Education 2 free essay sample

Bilingual Education Essay, Research Paper Bilingual Education = Unilingual Education Bilingual instruction in America is a sound thought, but it is non genuinely bilingual instruction, it is merely bilingual for those who do non already speak English. America is a state with more and more civilizations blending together with different countries of America talking different linguistic communications. In California, Spanish is the dominant linguistic communication following to English, and in provinces such as Maine, French is spoken. Other civilizations should non be assimilated into mainstream America wholly, but America shouldn? Ts have to flex over backwards to do life easier for aliens. In order to go more culturally tolerant, everyone should larn a 2nd linguistic communication, non merely immigrants. Americans should do bilingual instruction genuinely bilingual. The first ground is to extinguish the consequence bilingual instruction has on hapless, non-English speech production kids. In Richard Bernstein? s, ? A War of Words? he says, ? Advocates of bilingual instruction believe that it represents the best opportunity for non-English speech production kids # 8212 ; who, non so coincidently, frequently come from lower-income groups? to bask the profusion and chances of American life? , but he besides writes, ? ? Bilingual instruction is a failure, a tactic that in the terminal will harm the opportunities of the by and large hapless, non-English speech production kids of all time holding a equal portion in the promise of American life. ? By merely holding everyone learn a 2nd linguistic communication eliminates the lines of income, and cultural background. Truly bilingual instruction would besides extinguish the psychological effects it has on non-English speech production kids. When they are in a schoolroom filled with people who do non talk the same linguistic communication they do, they are forced to experience entirely because they can non execute at the same degree as their equals, they feel there is something incorrect with them, lower than everyone else. ? ? Empowering Minority Students? does non reason that a kid? s inability to talk English is what leads him to neglect if he is put into an English schoolroom. Children fail? because they are made to experience? shame? for belonging to a minority group, for non being a portion of the dominant group. The lone manner to? authorise? such kids? is for the instructors to? consciously challenge the power construction both in their schoolrooms and schools and in the society at big? Bilingual instruction? is an? authorization pedagogy. ? It is an act of rebellion against white, Anglo Do mination ( Bernstein 2 ) . Truly bilingual instruction would forestall any one kid from experiencing lower than the other since they would wholly be sharing the same experience of larning another linguistic communication. In California for illustration, immigrants would be larning to talk English, while kids who already speak English would be larning another linguistic communication besides. Most likely the? dominant minority linguistic communication? in the country. In this instance Spanish, but of class Spanish would non be the lone linguistic communication available. The pick would be up to the parents. Entire submergence in a foreign linguistic communication is a necessity. Non-English speech production kids must be wholly immersed in English, and the same for the native English talkers, they must be immersed wholly in, for illustration, Italian. ? Under the dominant method of bilingual instruction used throughout this state, non-English speech production pupils are taught all academic topics such as math, scientific discipline, and history entirely in their native linguistic communication. English is a separate topic. The job with this method is that there is no nonsubjective manner to mensurate whether a kid has learn ed plenty English to be placed in categories where academic direction is wholly in English. As a consequence, some kids have been kept in native linguistic communication categories for six old ages? ( Hayakawa 3 ) . There are many people who will hold that seeking to larn a linguistic communication is non something a individual does in a hr everyday. That individual must be wholly immersed in the linguistic communication, they must be talking that linguistic communication all of the clip, or at least more than they speak their native linguistic communication. If the people in the current bilingual instruction classs were wholly immersed in English, they would hold no pick, but to accommodate and larn the linguistic communication in order to map. It does non take a kid six old ages to larn a linguistic communication when they are forced to make so. Children learn at an exceptionally fast rate, if they are immersed in one linguistic communication, it would non be really long until they are fluid in that linguistic communication. If kids started larning a 2nd linguistic communication in the 3rd class, they would most probably be fluent by fifth or 6th class, which leaves plentifulness of clip to possibly larn a 3rd? With all of these kids larning all different types of linguistic communications, there will finally be a dislocation in communicating. Sooner or subsequently person who prefers to talk Spanish is traveling to run into person who prefers to talk Russian. This is precisely the ground many people believe that English should be made the official linguistic communication of the United States. ? Because we are a state of immigrants, we do non portion the features of race, faith, ethnicity, or native linguistic communication which form the common bonds of society on other states. However, by holding to larn and utilize a ind ividual, universally spoken linguistic communication, we have been able to hammer a incorporate people from an incredibly diverse population? ( Hayakawa 2 ) This is a good thought, but it would merely be required if everyone knew more than one linguistic communication. Most Americans today merely know English. Until this fact changes, there is no demand to do English the official linguistic communication of the US, but even if it were a job now, English should be made the? default? linguistic communication. Meaning that it is to be used merely in the event of a communications dislocation. The adult male who prefers to talk Spanish attempts to talk to a adult male who prefers to talk Russian, they both result to the? default? linguistic communication of English so they can pass on. When they are finished, they can travel back to talking their preferable linguistic communication to everyone who understands them. Which would propose that these two thoughts should travel manus in manus. In order for a truly bilingual instruction system to work is to do certain that all instructors are fluid in both English and the linguistic communication they will be learning. Which means that there will be a demand for instructors that can talk either German, Italian, Russian, Chinese, Nipponese, Gallic, Spanish. Then there will be the demand to those who can talk the local linguistic communications. For illustration, Lakota is widely used on most Sioux reserves in the US, so many parents may desire their kids to larn Lakota alternatively of Chinese. More money will be needed to fund all of these linguistic communication plans, since there will stop up being class listings as: Third Grade English, Third Grade Spanish, Third Grade Italian etc? There will besides be uneven schoolroom sizes because many parents in California will desire their kids to larn Spanish ensuing in a big Spanish category and a little Russian category, if any at all. The thought of a truly bilingual instructi on system is still a batch more productive and beneficiary than the current bilingual system, but the genuinely bilingual system is, truthfully, Utopian in nature.

The Role of Word and Sacrament in the Life of Catholics

Catholics in the United States are the representatives of one of the largest religious groups, and Catholicism has deep roots in the country’s history. That is why, the Catholic tradition and the views of Catholics on Word and sacraments can be discussed as reflecting the visions of the majority of Americans.Advertising We will write a custom essay sample on The Role of Word and Sacrament in the Life of Catholics specifically for you for only $16.05 $11/page Learn More The role of Word and Sacrament in the life of those Catholics who follow their religious tradition strictly is significant because Word of God is associated with main religious doctrines and principles of Catholicism, and sacraments can be discussed as the main rites of passage which determine the major stages in the human life and accentuate the connection of an individual with the faith. Catholics focus on belonging to the community and church while following the fundamental relig ious principles and doctrines. The everyday life of Catholics should be based on spirituality, faith, and religious tradition. Moreover, Catholicism provides people with a set of moral norms and rules which are necessary to follow and live according to God’s laws (Allitt, 2003). The principles of Catholicism are meaningful for Americans because they depend on the aspects of the historic development (Hemeyer, 2010). According to Corbett and Hemeyer, â€Å"Catholics were among the first, if not the first, Europeans to set foot upon the shores of America† that is why it is quite usual for Americans to share the Catholic tradition (Corbett Hemeyer, 1997, p. 89). As a result, â€Å"the majority of people in the United States consider Catholics to be a part of consensus religion. Catholicism is not viewed as ‘out-of-the-ordinary’ religion† (Corbett Hemeyer, 1997, p. 92). From this point, the main tendencies of the American society’s development a re formed within the Catholic communities which can influence the life of a lot of Americans considerably. Thus, Catholics’ visions of Word and Sacrament become especially significant for discussing the Americans’ religious tradition and spirituality in relation to Christianity. The guidelines to find the principles of religion and rules to follow can be reached with references to Word of God presented in the Bible. Catholics are inclined to discuss Word of God as God’s will or even as the equivalent of God. Thus, God’s will make Catholics act according to this will and according to the specific doctrines and codes presented in relation to the dogmas of Catholicism (Hemeyer, 2010).Advertising Looking for essay on religion theology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Catholics follow Word of God because it can be discussed as the single truth presented directly by God. From this perspective, following Word, people have to provide the definite response to this will. Catholics react to Word of God with following the religious principles and building their life according to the Catholic tradition. God’s truth is reflected in Word that is why people can grow spiritually basing on the visions provided in the Bible (Allitt, 2003). Furthermore, Catholics can draw conclusions about the aspects of religion only referring to Word of God. However, to build the life according to Word of God and main Catholic principles, it is necessary to follow definite religious procedures known as sacraments. Thus, Word of God and Sacrament are the basic aspects of the Catholic worship. The American Catholic Church provides people with the opportunity to attend it as the centers for worship and for developing the community life (Hemeyer, 2010). Church is significant during the periods of trouble and when people experience crises in their life. Those Catholics who cannot find the answer to the quest ions of spirituality with the help of interpreting Word of God are inclined to act and follow sacraments which reflect the main stages or passages in the human life such as the process of adopting the religion or marriage (Corbett Hemeyer, 1997). Sacraments are the meaningful rituals which can deepen the individual’s faith and connect the person with God more closely, developing one’s spirituality. Thus, to accept God’s will and to participate in Sacrament, Catholics should follow a range of rituals. Moreover, the role of sacraments is incomparable because they help determine the main aspects of the life and accentuate the sacred fields of the human existence. Catholics determine seven main sacraments which are Baptism, Confirmation, Reconciliation, Marriage, Eucharist, Holy Orders, and Anointing of the Sick. According to Hemeyer, the first and the main sacrament that Catholics participate in is Baptism. Thus, Catholics believe that â€Å"baptism is necessary for the removal of the inborn sin that is a part of all persons simply because they are human† (Hemeyer, 2010, p. 99).Advertising We will write a custom essay sample on The Role of Word and Sacrament in the Life of Catholics specifically for you for only $16.05 $11/page Learn More To become a Catholic, it is necessary to be baptized according to the principles of this religion. Baptism is an important stage of cleaning the soul and body from the sins, and it is a kind of protection for a human provided by the religion. Baptized Catholics begin to celebrate God and his will fully. Eucharist is a ritual when Catholics share Christ’s Body and Blood in the form of bread and wine. It is an important stage of becoming closer to Christ spiritually. Sacraments are significant to teach Catholics the basics of religion according to God’s Word. Thus, God forgives the people’s sins, and Catholics are taught to forgive during the sacrament of Reconciliation (Hemeyer, 2010). To develop the mature spirituality, Catholics are expected to follow the ritual of Confirmation. Holy Orders help Catholics join Church and share the basic religious doctrines. Anointing of the Sick is a specific sacrament in which a priest usually uses oil to anoint a person â€Å"who is ill or in danger of dying from accident or old age†, and this sacrament is a way of â€Å"mediating the concern of Christ and the Church for the suffering person† (Hemeyer, 2010, p. 103). Marriage is one more Catholic sacrament. Getting married in front of God, Catholics state their belonging to their spouses and accentuate the religious power of the union of persons who love each other. Sacraments in the form of definite rituals and ceremonies help Catholics share the love of Christ and follow God’s will reflected in Word. Moreover, Word of God can be regarded as the single source of God’s will available for Catholics’ understa nding. The interpretation of Word of God presented in the Bible is the Catholics’ way to deepening their faith and spirituality. Furthermore, the Bible is the source of ethical rules and codes for the Christians.Advertising Looking for essay on religion theology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Thus, Catholics receive the knowledge of God with references to Word of God provided in the Bible. Sacraments are extremely significant for Catholics because these acts help people connect their lives with God. According to the religious visions, Catholics can feel God’s grace and love while following these sacraments. References Allitt, P. (2003). Religion in America. USA: Columbia University Press. Corbett, J. M., Hemeyer, J. C. (1997). Religion in America. USA: Prentice Hall. Hemeyer, J. C. (2010). Religion in America. USA: Prentice Hall. This essay on The Role of Word and Sacrament in the Life of Catholics was written and submitted by user Kaliyah S. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Medical Esthetics Essays

Medical Esthetics Essays Medical Esthetics Paper Medical Esthetics Paper Essay Topic: Medical Medical esthetics is an evolving field in the therapeutic and medical sphere. It specializes in the use of advanced cosmetic lasers and other treatments to treat a full spectrum of both cosmetic and medical conditions that range from vascular and pigmented skin imperfections, hair removal, skin rejuvenation, and collagen regeneration, to more physically and emotionally debilitating conditions such as cystic acne and acne scarring, Rosacea removal and scar reduction to name just a few. Medical estheticians adopt holistic approaches in treating their patients’ conditions. They look at the cause of a condition rather than just the symptoms to formulate an effective treatment plan. According to the American Medical Aesthetics (AMA) corporation, this concept is vital in order to deliver exceptional results for which medical esthetics have come to be known, with little or no downtime. The AMA Corporation says further, â€Å"Lasers are unique in their ability to specifically target tissues below the surface of the skin and transfer energy to the root cause. By understanding each laser’s purpose, we can treat the condition with just enough energy from the right combination of laser frequencies to precisely affect the tissue. We look for what is called the ‘therapeutic threshold,’ which is the exact amount of energy needed to get a desired result – eliminating the downtime that is associated with over treating an area. † Esthetics is a rapidly emerging profession which specializes in skin and body care. There has evolved two types of practice in relation to esthetics. One is cosmetic esthetics and medical esthetics. Though both are concerned with enhancing the beauty of a client’s skin, cosmetic esthetics is limited to using make-up/cosmetic ingredients, their chemistry and use, and some skin care treatments offered in salons. The procedures that cosmetic estheticians perform include the following: organic, European and American facials; waxing and exfoliation; face, hand arm massage; cleansing and toning techniques; enzymes, ampoules, finishing masks; makeup/cosmetic ingredients, their chemistry and use; the basic anatomy and physiology of the skin; skin analysis and special treatments; and use of electrical current and esthetics equipment. While career opportunities for cosmetic estheticians may be any one of the following: Commercial Makeup Artist; Skin Technician; Cosmetic Merchandising; Cosmetics Sales; Cosmetic Buyer; Product Promotion; Skin Care Salon Owner; Teacher of Esthetics; Cruise Ship Esthetician. Medical esthetics, on the other hand, is concerned about the effects of time, lifestyle stressors, and even environmental stresses that can harm the skin. Therefore, maintenance treatments are necessary to prolong and enhance healthier more beautiful skin. The Medical Aestheticians are licensed skin care practitioners who perform the critical function of performing extractions and skin nourishing treatments as well as designing a home care regimen for each patient that assists the patient in remaining engaged in long term care and maintenance. These medical estheticians also perform customized facials so treatment results are better. And with these, patients are handled with TLC or tender love and care. As patients are under the long-term care of medical estheticians, they are able to maximize the results achieved by laser procedures. Medical estheticians are considered specialists who invest heavily in the tools of their trade. They invest in multiple lasers, as well as the most advanced, state-of-the-art lasers for the purpose of treating a wide variety of conditions and skin types. Their approach in treating various skin conditions is holistic, meaning to be a medical esthetician is to be interested in getting to the root cause of a condition to treat it at the source, rather than just treating surface conditions that are often a temporary solution. And for them, education is an ongoing process for the benefit of their patients. They continually educate themselves about the latest modalities in skin care in order to deliver consistent results time and again. The medical estheticians also educate their patients so they may better understand how their treatment interacts with their whole body and thereby help them achieve significant results. The job market for medical estheticians is extensive. Medical estheticians may launch and build a medical esthetics practice by setting up their own clinics, manage a clinic, teach in the field of medical esthetics, become a patient coordinator; go into marketing management, and more. Due to expanded clinical responsibilities in plastic surgeons and dermatologists practices expert esthetic clinicians with broad educational backgrounds and the appropriate credentials are urgently needed and are in great demand. According to the Victoria L. Rayner’s Center for Appearance and Esteem, the critical deficiency in supply of properly trained medical estheticians for health care services is widely recognized as a serious problem by practicing physicians. This is because physicians tend to complain often of the limited competence of inadequately trained personnel. Hence, accredited estheticians that have been properly trained and certified are being sought and hired. Medical estheticians may perform various procedures and some of these are the following: HBOT or Hyperbaric Oxygen Therapy; computer complexion analysis; laser facelift; laser surgery procedure for pigmented discoloration of the skin such as color blending and age or sun spot removal; laser procedure for vascular discoloration like defined veins, broken capillaries, cherry angioma, generalized redness and microvasculature, and rosacea. They may also offer laser procedure for deep collagen regeneration and remodeling; laser procedure for â€Å"peel and resurfacing† or accelerated epidermal regeneration; and laser procedure for amber led photo-modulation. Other procedures performed include but are not limited to: pigmented lesion removal; age spot removal; age spot reduction; melasma reduction; cystic acne reduction / removal; spider vein laser removal (varicose vein removal / reduction); epidermal laser peel; dermal collagen remodeling procedures to remove surgical scars, acne scars, and stretch marks; permanent hair removal; dermal rejuvenation to treat wrinkles; Botox treatment; Restylane, an FDA-approved dermal filler; medical spas; and wrinkle reduction. Medical estheticians have more edge when it comes to knowledge and practice of esthetics. They may know what the cosmetic estheticians know and practice plus more. This is because medical estheticians become experts through training in cosmetically camouflaging and normalizing the appearance of disfigured patients aside from being knowledgeable in all aspects of camouflage therapy; they are also well equipped when it comes to dermatologic diagnosis and treatment methods, commonly prescribed medications for skin conditions (topical systemic), including the investigation of OTC medications. Other areas of expertise to medical estheticians which can be of more profit to them are the following: acne management; cellular rejuvenation; allergies and inflammatory disorders commonly seen by dermatologists; eczema and the medical estheticians role in its management; erythema and telangiectasia; positive and negative aspects of facial treatments; age associated skin changes, exploration of the causes of aging and how to minimize its effects; photosensitivity; pre-cancers of the skin; laser therapy; reactions to cosmetics; categorizing standard cosmetic formulations; the difference between drugs and cosmetics; facts about cleansing preparation; exploring micropigmentation; and indications of hormonal dysfunctions.

Marketing 4050 Essay Example | Topics and Well Written Essays - 250 words - 1

Marketing 4050 - Essay Example Marketing strategy aims for advertisers to maintain and increase customers for their product. The media on its part aim to be the advertisers and consumers favorite in covering the advert. The advert of alcohol promotion is essential and should be done regularly to keep consumers loyal. Many more consumers will prefer that drink to other liquor brands in the market. The ad quality influences the effectiveness it will have on the market (Ware, Baron and Edge). An ad structured in a persuasive, and credible manner will most certainly be more convincing to consumers. Ads have some consistent features that appeal to customers or discourage them. These include alcohol content percentage and drinking age limit. The alcohol content appeals to consumers according to their preference while the warning on age will limit those who are underage. The leading title article relates to the ad as it is on tax increase mostly on alcoholic drinks. This ad focuses on alcoholic consumers and those interested in the drink. It also targets at investors. The ad influences the reader to pledge its loyalty to it. There are many competitive ads competing both for space in the magazine and consumers. This is a smart investment because it does not only market the company’s product but also its image in

Was Ford Ethically Right in Its Decision to Design Improvements and Th Assignment

Was Ford Ethically Right in Its Decision to Design Improvements and Thereby Risk the Lives of Its Consumers - Assignment Example Ford was ethically wrong in its decision to forego the improvements and thereby risk the lives of its consumers. In any case, it certainly appears that Ford was rushing against time to capture the market and overcome its competitors in the compact car industry. On ethical and moral judgments, a decision informed by material benefits at the expense of human lives is certainly wrong and misguided. Worse still, the cost-benefit analysis conducted by Ford amounted to involving its consumers in a deal of which they were totally oblivious. For such a decision to qualify on ethical grounds, the automaker would have made public its decisions on the faults of the vehicle and the subsequent cost-benefit analysis so as to inform the potential buyers of Pinto. In such a case, the company would be exonerated from the faults that came as a consequence of the defect in the vehicle. Moral conduct regards human lives as totally absolute and should never be quantified with other material products.Huma n beings are generally risk-averse and would not really partake into evitable instances where their lives are put to risk. The passing on of the $11 to the customers comes after the maintenance has been made and the vehicle is devoid of the risk. In this case, the rationality of the customer does not, therefore, come in. their decision to buy the car is therefore pegged upon another thing like cost and taste but not a risk. It is therefore certainly much different from the case of the airbags which are optional and the consumer has to make a decision.

Workplace Discrimination Research Paper Example | Topics and Well Written Essays - 1000 words

Workplace Discrimination - Research Paper Example Humans have always developed ways of stereotyping their fellow human beings using age, race, gender, religion, or ethnicity as their basis. It is only in current days that individuals have taken the trouble to look at discrimination as a challenge instead of looking at it as a solution. For example, segregation on the basis of race was at one point taken to be part of the natural order. Moreover, the right to vote was withdrawn from people belonging to the members of the female population to protect the different communities, solely because females, by virtue of their appearance, were presumed not to posses the survival characteristics. In addition, there is no society which escaped the negative components presented by discrimination. Also, there is no society which can claim that it does not have elements of discrimination in its different structures today. Racial discrimination also has a long history, with a number of people seeing racial discrimination as a faultlessly natural fe ature of life. Nonetheless, in recent times, racial discrimination in the work place has become a more significant subject. Its increased presence may be the result of the opposition of different elements; the workforce that is still continuing to be racist, and a recession that places jobs at a premium and makes employers to be particularly choosy during employment (Feagin, 2006). This paper will look at racial discrimination in the modern workplace. The paper will accomplish this by analyzing a current case of workplace discrimination in drawing conclusions regarding the effects of discrimination on organizational productivity. In America, it is constitutionally unlawful to engage in any form of discrimination against employees based on any reason, but the cases and evidences of workplace discrimination seem to be increasing with every passing day. In today’s world of competition, it has become extremely important for organizations to stop workplace discrimination because i t is a factor that not only results in decreasing organizational productivity but also affects the quality of business processes. Although the government of the United States has implemented effective laws, such as, Title VII of the Civil Rights Act 1964 to stop workplace discrimination, there is still a lot more that needs to be done to keep this negative element out of the workplace. Nevertheless, the basic federal laws that deal with racial discrimination in the workplace can all be found in Title VII of the Civil Rights Act 1964. By and large, Title VII of the Civil Rights Act 1964 disallows employers from engaging in the following activities: refusing or failing to sign up an employee on the basis of their race; providing workers lesser benefits or paying a worker less because of the racial orientation; failing to give promotions, opportunities, or benefits to a worker because of their race; and segregating or not properly classifying applicants or workers by race (Memmi, 2000) . In addition, employment agencies are not allowed to reach decisions on work assignments on the basis of a person’s race. Also, labor representatives and unions cannot expel people or refuse membership to individuals because of their race. Discrimination on the basis of race in the workplace can be illustrated in a number of ways, some of which can be obvious or blatant. Nonetheless, racial discrimination can frequently be restrained and more difficult to notice, for example, an employer failing to promote an employee or higher an applicant because of their racial makeup. Therefore, it may be asserted that a worker who experiences unfavorable treatment because of his race is a victim of racial discrimination. Additionally, racial discrimina

Emerging Threat of Invasive Fungal Infections

Emerging Threat of Invasive Fungal Infections Introduction Emerging threat of Invasive Fungal Infections Invasive fungal infection continues to be a major problem associated with high morbidity and mortality mainly to immunocompromised patients as well as to immunocomptent patients but to a much lower extent. (1) Invasive fungal infection and fungemia are caused by a variety of fungal pathogens. The most commonly isolated yeasts are Candida species (spp.) and Cryptococcus spp. Aspergillus species remains the most common mould however, Fusarium spp., Scedosporium spp., Penicillium spp. and Zygomycetes are increasingly isolated.(2) Patients mostly become colonized during hospitalization however, very few patients who become colonized develop sever infection. Nosocomial fungal infections can represent up to 15% of all nosocomial infections.(3) The spectrum of opportunistic invasive fungal infections has increased substantially owing to the rapidly growing population of immunocompromised patients.(4) Due to lack of specificity of symptoms diagnosis of fungal infections can be challenging.(3 ) Candida infections are mostly prevalent in critically ill patients in intensive care units (ICUs) and very low birth weight infants. Candidaemia is highly fatal with a reported mortality in the range from 36% to 63%.(5) In the recent years, mortality rates in ICU patients have decreased substantially probably due to earlier initiation of antifungal therapy.(6) Conversely, aspergillosis is the most common fungal infection in immunocompromised most specifically in haematological malignancy and haematopoietic stem cell transplantation (HSCT) patients. Incidence of aspergillosis has increased considerably but mortality has decreased owing to better diagnosis and treatment.(7) Treatment of Invasive Fungal Infections Treatment and prophylaxis of invasive fungal infections involves systemic antifungal therapy. Historically amphotericin B and Flucytosine have been the only available antifungals; these were followed by the development of the older triazole antifungals; fluconazole and itraconazole in the late 1980s. More recent advances have led to the release of amphotericin lipid formulas, newer broad spectrum triazoles (voriconazole, posaconazole) and the newest class of echinocandins.(8) Amphotericin B either as a deoxycholate or in lipid formulations has been the backbone of antifungal therapy for many years. The triazole antifungals have also emerged as front-line treatment and prophylaxis for many systemic fungal infections. Triazole antifungals used systemically include fluconazole, itraconazole, posaconazole and voriconazole. Fluconazole has a major role in prophylaxis and treatment of both invasive and superficial fungal infection. Voriconazole is the drug of choice in invasive aspergillosis of the lung. Posaconazole is used as a salvage therapy for invasive aspergillosis as well as a prophylaxis in HSCT and neutropenic patients.(9) Itraconazole is active against most fungi except for Zygomycetes.(10) Terbinafine which is widely used in skin infections is also effective against systemic candidiasis including vulvovaginal candidiasis although less effective than fluconazole and itraconazole.(11,12) Flucytosine is used in combination with amphotericin B for treat ment of severe systemic mycoses and has also in combination with other antifungals for treatment of colorectal carcinoma.(13) Echinocandins Introduced Despite the advantages in medical practice and introduction of newer agents, mortality due to fungal infections remained high with mortality due to Aspergillus approaching 100% in HSCT patients.(14,15) There has also been a change in epidemiology of fungal infections with non-albicans species reaching up to 50% with no significant change in mortality in spite of these newer agents in two studies conducted 15 years apart.(16,17) Echinocandins is a newer class of systemic antifungals introduced after almost 15 years of no new agents. They work by inhibiting ÃŽ ²-D glucan in fungal cell wall. Echinocandins have favourable kinetics which allows their once daily dosing. (18) The first echinocandin product to be licensed is caspofungin (FDA approved in 2001), that was followed by micafungin (FDA approved in 2005), and anidulafungin (FDA approved in 2006). (19)The discovery of the echinocandin antifungals has provided a new alternative for patients with equal if not higher efficacy relative to older agents and apparently lower toxicity.(20,21) Echinocandins are extensively used in the treatment of invasive fungal infections mainly invasive candidiasis in neutropenic and critically ill patients.(22)They are also approved as a salvage treatment for invasive aspergillosis.(23) The major advantage of the echinocandins members is their higher efficacy against many candida species including C. glabrata and C. krusei res istant to fluconazole added to their lower toxicity rates compared to older antifungals.(20,21,24) The Infectious Diseases Society of America (IDSA) recommends echinocandins as first line treatment of Candidaemia while caspofungin is offered as an alternative to voriconazole for treatment of invasive aspergillosis.(22,23) Echinocandins showed equal efficacy to triazole antifungals and even superior efficacy in subgroup analysis since it demonstrates superior efficacy for prophylaxis in patients with hematologic malignancies and undergoing HSCT.(25) Echinocandins Safety Treatment of fungal infections is challenging and riddled with adverse events. (26,27) Echinocandins showed no difference in drug related adverse events and all-cause mortality as compared to triazole antifungals where both groups have shown to be generally well tolerated, nevertheless, echinocandins has significantly decreased adverse event related mortality compared to triazole antifungals.(25) Echinocandins have revealed hepatic toxicity in clinical trials yet the incidence is considered low.(28) The most commonly reported toxicities associated with echinocandins in clinical trials are rash, phlebitis, and nausea. The renal profile of this class appears to be superior to that of older agents.(29,30) Serious adverse events reported with echinocandins in the context of clinical trials are very few with atrial fibrillation and seizures in two cases treated with anidulafungin and disseminated intravascular coagulation in another one treated with micafungin.(31,32) Unfortunately, till now there is insufficient data on the frequency of hepatic and renal toxicities in normal clinical settings although they have already been reported in context of clinical trials. Moreover, as these agents became more widely used outside clinical trials, new adverse reactions are surfacing. Anidulafungin has been reported to be associated with alopecia in a female patient after several months of treatment.(33) Anidulafungin has also been associated with life-threatening haemodynamic stability in another patient during administration.(34) Three cases has shown a considerable drop in their cardiac index or a worsening of the mean arterial pressure, one following caspofungin administration and the other two post anidulafungin administration.(35) Echinocandins has also been associated with a decrease in cardiac contractility in few case reports and in vitro studies which warrant further investigations.(36,37) Further studies seem to be mandatory to investigate this po tential risk. Limitations on Detecting Risk Pre-marketing studies are incapable of detecting rare events. In addition due to their short duration they are also unable to detect delayed toxicities. It’s worth noting that to detect doubling of a 0.1% event with 80% power; more than 50,000 subjects need to be studied. This leads to drugs being authorized without serious rare events are adequately studied. One cannot also be sure that the safety profile demonstrated in the pre-marketing clinical trials with limited number of subjects remains unchanged when used by millions of patients in normal settings. This difference in safety profile demonstrated is not only attributed to difference in number of users but may also be due to choosing of healthier subjects to participate in clinical trials, providing better care to clinical trials participants in addition to shorter duration of exposure in clinical trials as compared to normal settings. This difference in safety profile may as well be attributed to the fact that participa nts in clinical trials are rarely representative to the general patient population. (38,39) Post Marketing Risk Detection Pharmacovigilance is defined as the continuous process of detecting, evaluating, communicating and improving safety of medicines under normal conditions.(40) Post marketing data on adverse events include spontaneous case reports, medical record databases, and data collected in prospective postmarketing studies.(41) Spontaneous reports are unsolicited reports of clinical observations originating outside of a formal clinical trial and that are submitted to regulatory agencies or drug manufacturers.(42) The report is considered important if it involves an ADR that is new, rare, serious or occurring at a higher frequency than expected.(43) Spontaneous reporting systems have a potential for detecting or ‘signalling’ new ADRS that have not been previously recognized in clinical trials.(38) The most crucial factor that determines the value of spontaneous reports is the quality of submitted reports and whether it has a complete description of the ADR, patient demographics, baseline characteristics other confounding factors or medication and temporal relation.(42) Signal detection using large postmarketing ADRs databases is the first step in detecting unknown and unexpected associations between drug exposure and adverse events which has to be followed by qualitative case-by-case analysis to identify signals that may be of value or warrant further investigation.(44,45) Safety evaluators usually look at common trends or patterns or and potential causal relations. (42) Advantages and Limitations of Spontaneous Reporting In all countries, the nation pharmacovigilance system relies on spontaneous reporting by healthcare practitioners, patients and manufacturers to the national coordinating center.(46) Spontaneous reporting is the only source of pharmacovigilance that provides the highest volume of data at the lowest cost.(47) The most important function of spontaneous reporting is early detection of signals which helps in hypothesis formulation that may lead to initiation of confirmatory investigations or regulatory actions that may end up with warnings, label changes or product withdrawal.(48,49) Large postmarketing databases are the most important source for mining of drug safety data, however, analysing data from these databases is very challenging owing to the limitations of these unsolicited reporting systems.(50) One of the most important limitations of spontaneous reporting is the quality of data since cases are mostly poorly documented with no follow up data which necessitates contacting the reporter for more data.(42) Another limitation is under-reporting whose extent is very hard to estimate and which depends on many factors including the severity of the reported ADR among many other factors.(51,52) Reporting rate also undergoes fluctuation along the drug life cycle with higher rates noticed when the drug is newly introduced to the market (weber effect). Higher reporting rates are also noticed for serious medical events or after negative publicity. (53) It’s estimated that FDA receives only 1% of ADRs in one study and 8% in another of all occurring ADRs which affects is reflected on the inability of spontaneous reporting system to estimate incidence of a specified ADR. (54,55) Role of Data mining in Pharmacovigilance The role of data mining in the field of pharmacovigilance is evolving. At the outset, it’s worth noting that data mining methods involve identifying the observed relation between a drug and a certain ADR. These relation identification methods are based totally on the frequency with which the drug and event are reported. The relations identified using these data mining techniques cannot be used to prove or negate a causal relation.(50) Data mining methods can elucidate complex drug issues such as concomitant medications or conditions that may not be investigated using traditional methods. However, this is usually confronted by the non-systematic attainment of background rates of adverse events and drug exposure data which hinder estimation of risk based on spontaneous reporting databases.(56,57) In the context of data mining, the term ‘signal’ is used to refer to a quantitative association between a drug and an event which exceeds a certain threshold set by the investigator that warrant further evaluation. The ‘signal score’ is the number reflecting the strength of the quantitative association which reflects how much the observed frequency differs from that expected.(50,56,58) The application of computational and statistical methods to large drug safety databases for identifying drug-event pairs disproportionately reported at higher frequency than expected by a statistical independence model is referred to as ‘Safety data mining’ and ‘disproportionality analysis’. Many data-mining methods are applied to pharmacovigilance; the ones that are most commonly reported in the literature are the proportional reporting ratio (PRR) and the reporting odds ratio (ROR) in addition to the Bayesian and empirical Bayesian methods.(59–62) Signal Detection Methods Disproportionality analysis is the main concept behind computerized pharmacovigilance methods. Disproportionality analysis is dependent on the construction of a 22 contingency table as shown in table (1). (63) Disproportionality methods differ in how they are calculated and how they account for low counts. They are generally classified into Frequentist and Bayesian approaches. Drug of interestOther drugs Event of interestab Other event cd Table 1: Statistical significance in spontaneous reporting is calculated using the frequencies in the table above Frequentist approaches Frequentist approach usually accompanied by hypothesis testing of independence using chi-square or Fisher’s exact test.(64) Proportional reporting rate (PRR) or Case/Non-case design PRR can be considered as an approximation of conditional probability and is calculated using the following equation: PRR= = a/(a+c) à · b/(b+d). Where a/(a+c) can be perceived as the probability of developing the event of interest given that the drug of interest is taken and an event in turn, b/(b+d) can also be perceived as the probability of developing the event of interest given that another drug is received given that any other drug is taken and an event occurred.(63) PRR is a valuable aid to signal generation which is easy to calculate and interpret with various refinements made possible.(59) Reporting Odds Ratio ROR is a ratio of two ratios and is calculated according to the equation: ROR= a/bà ·c/d where a/b is the ratio of the patients who had the event of interest a divided by the number of patients who had the event while taking other medications. This ratio in turn is divided by c/d which is calculated by dividing all patients who had the drug of interest but did not have the event of interest by all other patients who did not have the event of interest given that they took any other drugs. (63) ROR is not affected by general under reporting for a specific drug or as specific event.(65) It has been proposed that ROR may be less biased than other disproportionality methods being considered as the case-control studies analysis.(66) Nevertheless, others believe that in practice there is no difference in performance between ROR and PRR.(60,67) Bayesian approaches Bayesian approaches tries to account for uncertainty in disproportionality measure calculated from small samples by shrinking the disproportionality measure towards baseline case of no association. This shrinking is a reduction of spurious associations when there are not enough data to support it and is proportional to the variability in the disproportionality statistics.(64) The Bayesian approaches include Multi-item Gamma Poisson Shrinker (MGPS) which is currently used by the FDA.(68,69) MGPS is based on an empirical Bayes framework and its computed measure is called empirical Bayes geometric mean (EBGM) which is the Bayesian version of the Relative Reporting Ratio (RRR). RRR is the ratio of the incidence of the observed incidence rate of a drug-event pair to its expected rate under the assumption that the drug and event are independent.(70) Another Bayesian approach adopted by the WHO is called Bayesian Confidence Propagation Neural Network (BCPNN), which estimates a Bayesian version of the Information Component (IC). A positive IC indicates that based on all reports in the database the drug-event pair is reported more often than expected. (61) Postmarketing Safety Databases for Signal Detection Databases utilized in drug safety data mining are postmarketing databases maintained by manufactures, regulators and different consortia. These databases are different in their reporting guidelines, coding dictionaries and rules for data entry. These databases vary in size and may reach millions of reports. The analysis of these databases may yield different results and so a single database available to all stakeholders is needed. Ideally this database will not have duplicate reports or missing data and is consistently coded for drug and event name. A number of databases are commonly available for signal detection activities, however; they differ in accessibility. These include the database of the WHO International Drug Monitoring Programme and the FDA’s public release safety database (AERS).(50) WHO Safety Database The WHO safety database is a large database receiving AEs from the national collaborating centers participating in the WHO Drug monitoring program.(71) It has the advantage of having the drug names coded according to the Anatomical Therapeutic Chemical (ATC) classification and ADRS are coded using the WHO Adverse Reaction Terminology. However, data is accessible by subscription only.(68) European Medicines Agency EudraVigilance database The EMEA pharmacovigilance system is called the EudraVigilance. It has 2 modules one for clinical trials and another for post marketing surveillance. It has analytical capabilities and performs signal detection in terms of PRR and ROR. It has restricted access even to manufacturers who can only see reports that they have submitted to the EMEA.(72) US FDA Adverse Event Reporting System (AERS) AERS is the FDA’s postmarketing safety database. AERS database is intended to support the FDAs post-marketing safety surveillance program for drugs. It relies on unsolicited reports submitted by healthcare professionals and patients on adverse events and medication error reports as well as required reports by manufacturers and so represents a useful resource for investigating drug safety.(73) The public-release version of AERS is available beginning with January 2004 as quarterly data directly downloadable from the FDA website. The new FDA FAERS was launched in the 10th September, 2012, and replaced the Adverse Event Reporting System (also known as Legacy AERS).(74) The main aim of the current study is to: Map the safety profile of echinocandins antifungals.as compared to other drugs. Compare the safety profile of echinocandins to that of other systemic antifungals. Assess the effect of changing the reference group on the top signals identified. To achieve these aims data mining methods and disproportionality analysis will be employed to the FDA AERS to achieve these aims. This study will therefore add to the knowledge on the safety profile of this newer class of antifungals.

Hermann Hesse: A Classic Take on the Modern Age Essay -- Biography Bio

Hermann Hesse: A Classic Take on the Modern Age Hermann Hesse, writing in the twentieth century, extolled many of the virtues of the past. His unique style, dependent upon German Romanticism, adapted the issues of the modern age. Using subject matter from various sources, Hesse built fictional worlds that mirrored reality. In the novel Siddhartha, Hesse deals specifically with the spiritual quest. Although writing about the spiritual landscape of India, this work addresses the desire for meaning that the entire world felt after the events of World War I. Born in Germany in 1877, Hesse would live through the complete change in existence that occurred in the twentieth century. Coming from a family of devout Protestants, Hesse had been exposed to the traditional Christian existence. He began to write while still in his teens. A lifelong pacifist, Hesse would continue to fight against the violence of his age. The works of Hesse were always tinged with the notion of the outsider (The Steppenwolf) or the search for meaning (Siddhartha). Utilizing a higher artistic style than many of his colleagues, Hesse acknowledged Romanticism in his work. His subject matter could be highly simple in the case of Gertrude or extremely complex like Magister Ludi:The Glass Bead Game, for which he would win the Noble Prize in the year 1946. Until his death in 1962, Hesse would struggle to find meaning in the horrible events in his lifetime. Although Hesse concerns himself with the same issues of isolation and meaninglessness that Franz Kafka addresses, he utilizes a poetic writing style to bring out the beauty of his subject. The lofty style helps "with the construction of an ideal as an escape from his emotional crisis of the war years" (Ziolk... ...ction of the previous paths. Humanity could no longer be content with religion or with consumer needs. A spiritual truth had to be found, but it would require a long journey and many failures along the way. Mankind could learn as much about the beliefs of the past in order to discover "the condition of the present world and a revelation of the relationship of all things to one another" (Ziolkowski 154), the lesson that all things are interconnected. All of the past, present and future are inextricably linked as part of a continuous flow. Works Cited Freedman, Ralph. Hermann Hesse: Pilgrim of Crisis. New York: Pantheon Books, 1978. Hesse, Hermann. Siddhartha. New York: New Directions Publishing Corporation And Bantam Books, 1951. Ziolkowski, Theodore. The Novels of Hermann Hesse: A Study in Theme and Structure. Princeton: Princeton University Press, 1965.

Corporate Governance Mechanism Essay

Executive Summary This paper will reviews the extent to which corporate governance acts as efficient tool to protect investors against corporate fraud, thus contributing to summarize the literatures on role of corporate governance on preventing occurrence of corporate fraud. In a more recent study, corporate fraud is part of earnings manipulation done outside the law and standards. Whereas, the activities covered by the terms earnings management (such as income smoothing and big bath) and creative accounting (or window dressing) normally remain within the regulations. In this regard, corporate governance mechanism, particularly effective boards, audit committees, and auditors, decrease the likelihood of corporate fraud occurs. At very last contemplation, vigilant structure within corporation as holding stakeholders interests with shift in ethics and values will likely stop greedy executives to take personal advantages. Keywords: Corporate fraud, earnings management, corporate governance, board effectiveness, audit committee effectiveness and auditor effectiveness. 1. Introduction There are a number of legal cases involving the accounting manipulation in leading companies in the United States of America (USA) and also other countries, such as Enron and WorldCom in USA, and HIH Insurance and One.Tel in Australia. These have led investors, regulators, and academics to focus on improving dimension of corporate governance to unveil that unethical financial reporting practice. Scholars commonly attribute that poor corporate governance in such companies caused their earnings manipulation. For instance, Lavelle (2002) asserts that Enron’s bankruptcy was caused by the audit committee’s lack of independence, which determined from poor governance, which is part of corporate governance mechanism. This paper will reviews the extent to which corporate governance acts as efficient tool to protect investors against corporate fraud, thus contributing to summarize the literatures on role of corporate governance on preventing occurrence of corporate fraud. In addition, from the practical point of view, this paper is expected to provide information on how board and audit committee, auditor and regulator indicate and anticipate which firm’s corporate governance mechanism that cause the likelihood to fail to prevent commit corporate fraud and loose stakeholders. In general discussion, corporate governance mechanism assures a crucial role in improving the efficiency of capital market through its impact on corporate operating efficiency and effectiveness, sustainable growth, and integrity and quality of financial report. Blue Ribbon Committee (1999) asserts good governance promotes relationship of accountability among primary corporation participants to enhance corporate performance. This mechanism holds management accountable to the board and the board accountable to stockholders. The key element of board oversight is working with corporation management to achieve corporate legal and ethical compliance. Board oversight mechanism can be taken in place to deter fraud, anticipate financial risk, and promote high quality, accurate, and timely disclosure to the board, to the public market and to the shareholders. This paper is organized as follows. In the next section, it will be presented the literature review regarding the corporate fraud and earnings management. It is continued by discussing the effectiveness of board oversight and audit committee, role of external auditor and closing thoughts at curbing fraud. 2. Fraud and Earnings Management In this section, it will be distinguished between corporate frauds from earnings management. Existing literatures seem no clear agreement on differentiating both those two event in corporate reporting. 2.1 What is Corporate Fraud? In the beginning of 2000s, US investors has been hit by intentionally falsify of financial reporting in the biggest and prominent public company. The companies such as Enron, Worldcom, HIH Insurance and One.Tel, to name but a few, has perpetrated and resulted a monumental losses for the investing public. For instance, Enron that recorded as the seventh largest corporation by its market capitalization in US, averaging $90 per share and worth US$70 billion in 2000, was suddenly collapsed in late 2001. Morrison (2004) asserts that the cause of the collapse is the largest corporate fraud and audit failure. Then, it can be understood that the massive corporate fraud caused by fraudulent financial reporting have contributed to a very sharp decline in the US stock market. Many of these corporate scandals include such as action of account manipulation, earnings management, restatement and other failing to report the significant events to investing public. Then, what corporate fraud does really mean? One of the answers, corporate fraud is defined as an intentional or reckless conduct, whether by act or omission, that results in materially misleading financial statements (National Comission on Fraudulent Financial Reporting of the United States, 1987). Many prior studies (Persons, 2006; BÃ ©dard, Chtourou & Courteau 2004; Uzun, Szewczyk & Varma, 2004; Abbott, Parker & Peters, 2000; Beasley, 1996) have found that corporate fraud generally involves the accounting irregularities notion, such as: * Manipulation, falsification or alteration of accounting records or supporting documents from which financial statements are prepared. * Misrepresentation in or intentional omission from, the financial statements of events, transactions, or other significant information. * Misapplication of accounting principles relating to amounts, classification, manner of presentation, or disclosure. Stolowy and Breton (2004) proposed the framework to understand the classification of account manipulation. They classify the manipulation that is outside the law and standards constitutes as fraud (known as corporate fraud, financial fraud, and accounting irregularities, interchangeability). Whereas, the activities covered by the terms earnings management (such as income smoothing and big bath) and creative accounting (or window dressing) normally remain within the regulations. Figure 1 presents that framework for understanding account manipulation (adopted from Stolowy and Breton 2004). Figure 1 Framework for Understanding Account Manipulation Fraud, in large extent, occurs when somebody commits an illegal act. In accounting notion, for example, fabricating false invoice to increase revenue number is fraud, while interpreting consignment sales as ordinary sales is errors. This different sometime does not clear to everyone, particularly who does not really understand how accounting treatment is. In short, it can be conclude that fraud exists when the account manipulation done outside the limit of the regulations (law and standards). 2.2 Earnings Management It is always hard to frame a useful definition to such a broad subject ‘earnings management’. Account manipulation done within law and standard is categorized into earnings management and creative accounting. The objective of this type account manipulation is to alter the wealth transfer mechanism: earnings per share (EPS on income statement side) and debt to equity ratio (balance sheet side). Based on figure 1, earnings management is a reporting activity done by manipulating the income statement into two ways: first, by presenting item before or after the profit used to calculate EPS and second, by removing or adding particular revenues or expenses (modification of total net income). In addition, ‘creative accounting’ term has been developed mainly by practitioners and commentators on market activity. The chartist concern comes from observing the market, not from any fundamental analysis. Windows dressing activities are done by manipulating structural risk to influence the level of firm’s debt to equity ratio. For example, interpretation at off balance sheet transaction such as leasing. Earnings management can be beneficial, neutral, and pernicious (Ronen & Yaari 2006). It is beneficial since it signals long term value. Managers take advantage of flexibility in the choice of accounting methods to signal internal information on future company’s cash flows. Then, it can be neutral when it reveals short-term true firm value. Managers can chose the accounting treatment either economically efficient or opportunistic behaviours. On the contrary, it is pernicious since it conceals short- or long term performance. This practice usually involves tricks to mislead or reduce the transparency of the financial information. Since the last decade, US Securities and Exchange Commission (SEC) had stated its concern about earnings management (Levitt 1998) and other scholar wonders the condition of the audit committees’ incapacity to deal with earning management which using accounting tricks to camouflage a firm’s true operating performance (Warrick 1999). As account manipulation is done outside law and standards, indeed it constitutes fraudulent financial reporting (Stolowy & Breton 2004). In this regard, scholars commonly find association between less fraudulent financial reporting and good corporate governance mechanism (Beasley 1996; Abbott, Parker and Peters 2000). 3. Governance Mechanism in Preventing Fraud In this section, it will be reviewed role of corporate governance in describing and preventing such as occurrence of corporate fraud. A vast number of previous literature reveal that company in default (fraud) have less effective boards, audit committees, and external auditors. 3.1. Board and Audit Committee Oversight Effectiveness The board of directors and its audit committee play a prominent role in corporate governance particularly in controlling top management. Back in 1983, Fama and Jansen argue that the board as a corporation’s highest level of control mechanism with ultimate responsibility over the way company is run. The literature review on fraudulent financial statement, restatement and financial reporting quality commonly indicates that characteristic and composition of the board do influence its effectiveness. A vast number of study examining proxies for the board’s power, independence and competence by: * The presence of financial expert; this characteristic of boardroom prevent the accounting fraud and minimize their seriousness (Farber 2005). * Proportion of independence directors on the board; the percentage of independent directors in fraudulent firms is likely to be smaller than in compliant firm. In the same way, the presence of non-affiliated block holder on the board will be negatively associated with the level of non-compliance of accounting manipulation outside law and regulation (fraud) (Beasley 1996, Beasley et al. 2000 and Abbott et al. 2004). * The number of seats directors; board size increases the likelihood of corporate fraud increases. The rational of this finding is a smaller board provide more of controlling function than do a larger board (Beasley 1996 and Jensen 1993). * Low board of director tenure; when turnover is high, so there will be a few employees (senior staff) who are still work with the company can memorize the corporation’s fraudulent activity. Few new employees are likely to join the line of power elite and therefore it will more foster insider power (senior staff) to institutionalize their position of power within corporation (Dunn 2004). * Separation of the CEO position and chairman of the board. Dunn (2004) argues that structural power, when managers also sit as key person in the board negates the advantages of a division of labour and can lead to adverse corporation outcomes. These above characteristics show that excessive power of board, percentage of unrelated directors and presence of financial experts will likely determine the level of company’s compliance with law and regulations. Indeed, this governance mechanism has been incorporated into corporate governance guideline in some prominent organisation and regulators (OECD 2004 and ASX 2008). For instance, in second edition ASX under principle 2 ‘the structure the board to add value’ requires that ‘the roles of chair and chief executive officer should not be exercised by the same individual’. In some extent this empirical finding has been taken into account by some market self regulatory such as ASX. It is important to note that audit committee effectiveness is negatively associated with the occurrence of corporate fraud (Farber 2005; Abbott et al 2004; and Agrawal and Chadha 2005). Its committee’s effectiveness commonly is measured by number of outside directors and number of financial expert on firm audit committee. In addition, ASX 2008 states the importance of independence and competence of audit committee. International practice is moving towards an audit committee only comprised of independent directors. Regarding technical expertise, audit committee should include members who are all financially literate (able to read and understand financial statements), which at least one have accounting qualification and one who understand the industry practise which corporation operates. 3.2. Auditor Effectiveness Many previous studies argue that external auditor plays a crucial role in preventing and detecting accounting fraud (Farber 2005, Piot and Janin 2005, Myers et al. 2003, and Johnson et al. (2002). Farber (2005) finds that firms audited by one of Big 4 (PricewaterhouseCoopers, Ernst & Young, KPMG and Deloitte Touche Tohmatsu) are less often announcing fraudulent financial reporting compared to firms audited by non Big 4. Moreover, Piot and Janin (2005) states that the occurrence of restatement (low level of fraudulent financial reporting) is often proceeded by a change of external auditor. Then, it may be considered that auditor effectiveness can be measured by engaging Big 4 as external auditor and no suddenly change of auditor before their rotation period. In addition, there is debate over the benefit of rotation period. Myer et al. (2003) find that longer auditor tenure constrains management’s discretion with accounting accruals, which suggests high audit quality. This is consistent with Johnson et al. (2002) that also find accruals are larger and less persistent for firms with short auditor tenure relative to those with medium or long tenure. They argue that longer tenure can improve auditor expertise from superior client-specific knowledge. However, proponent of mandatory auditor rotation argues that lengthy auditor tenure erodes independence, which in turn impairs audit quality. Since independence is an abstract thing, regulators, practitioners, and academics often rely on the appearance dimension to operationalize the auditor independence (Dupuch et al. 2003). In common sense, auditor will be perceived less independence when provide such material amount of particular kinds of non-audit service to audit clients. Ladakis (2005) describes that in the year of 2000 alone, Enron as detected fraudulent corporation paid Andersen audit fees of US$25 million, and non-audit fees of US$27 million. 4. Closing Thoughts There are so many regulatory efforts aiming to curb corporate fraud and any other accounting irregularities within company, then people will find inconclusive answer that all regulation is not enough to deter the fraud in the future. Dishonest people inside corporation will insist to commit fraud and other type of crimes within or outside standards and regulations. Those who have no commitment to firms and society may always find a way to do fraud for personal advantages. They will override the regulations in even new creative practice to hide theft. Then, last hope to stop this is only good structure as holding between economic and social goal, individual and communal goal incorporated with shift in ethics and value. People must always remember that greedy executive who wants to acquire the personal benefit cannot be stopped by even best controls and regulations. Companies would be perform better by addressing the fraud issues specific to their own firm, and then developing an ethical corporate values that will hold them well in the long run. Corporate governance compliance within company and proactive fraud prevention effort by professional can decrease the corporation’s likelihood of being victimized by fraud. 5. List of References ABBOTT, L., PARK, Y. & PARKER, S. (2000) The Effect of Audit Committee Activity and Independence on Corporate Fraud. Managerial Finance, 26, 55-67. ABBOTT, L., PARKER, S. & PETER, G. (2004) Audit Committee Characteristics and Restatements. Auditing: A Journal of Practice and Theory, 23, 69-87. AGRAWAL, A. & CHADHA, S. (2005) Corporate Governance and Accounting Scandals. Journal of Law and Economics, 48, 371-390. 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The Review of Accounting and Finance, 3, 5-65. UZUN, H., SZEWCZYK, S. H. & VARMA, R. (2004) Board Composition and Corporate Fraud. Financial Analysts Journal, 60 (3), 33-43. WARRICK, W. W. (1999) Post-Blue Ribbon Committee thoughts on developing the audit committee’s charter and annual report. Directorship, 25, 6.