Environmental Issue in China

Executive Summary Rapid growth in China is negatively affecting the environment. Air pollution in Beijing is now a major source of concern, while the Chinese government seems to be doing little to protect the environment. Thus, this paper presents an in-depth public diplomacy strategy based on building a network of influence to advocate for policy change in environmental laws and protection.Advertising We will write a custom proposal sample on Environmental Issue in China specifically for you for only $16.05 $11/page Learn More A network of influence will draw members from diverse sources and, therefore, present issues and solutions to influence change in policies from diverse perspectives. As such, it will perhaps make the government to take action and reform its inadequate measures to protect the public. Introduction China’s ranking on environmental degradation by global bodies such as the UNEP has placed it among the top ten countries with incr easing negative impacts on the environment. This could be linked to its vastness in the industrial sector and the lack of proper policies on environment degradation. Historically, especially during The Mao Regime, the willingness of China to take caution on environmental degradation had been questionable. However, due to mounting pressure from environmentalists and even Chinese themselves, the government is trying to salvage the seemingly out of hand situation. Nearly all types of pollution experienced in China are relatively higher than thresholds set for normal human environment. For instance, in air pollution, Beijing has surpassed the Environmental Protective Agency’s air quality scale of 300 to register above 500 scales. In January 12 2015, the reading reached 886. This is to say, air in Beijing, in some instances, has become unsafe for breathing. Deforestation is on high rates. The UNEP has listed Chinese forest cover as threatened and needing protection. Deforestation has gradually led to desertification, with alarming desertification annual rates of 950 square miles. These high rates of pollution have led to â€Å"cancer villages†, places with extremely high cancer risks to the dwellers. Specifically, people living near industrial complexes have reported extremely high numbers of nearly all types of cancer such as stomach, liver, and kidney and colon cancer, among others.Advertising Looking for proposal on diplomacy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Biodiversity drop resulting from deforestation, killing of wild animal in search of their products like ivory, horns, bones and skins is also major environmental issues witnessed in China. China also has an indirect connection with killing of wild animals in other parts of the world, especially Africa, since China provides market for wild animal products. Given these environmental issues in China, specifically the current level of air pol lution, this proposal presents a design of an in-depth public diplomacy strategy to deal with the issue. Major causes of air pollution in China The smog descending upon China in the recent past has a great link to industrial productions, gases emitted by vehicles, coal power plants, and construction activities. These statistics were given by China’s Ministry of Environment Protection citing contributions of 80%-90% of air pollution. The negative impact has been immense in Beijing and majority of Chinese cities. The release of sulfur dioxide and other harmful gases and the consequent acid rain in China has been reported as the highest in the world since the 1990s (Gao et al. 447). Pollution mitigation policies failure China has made some policies to conserve the environment. Nevertheless, the implementation process has been facing insurmountable challenges. First, the drastic economic growth and rural-urban migration witnessed in China over the past two decades alongside huge population have made it hard for the process of pollution mitigating. Second, most of the environmental policy institutions get less funding and attention relative to economic policy institutions. Therefore, the lack of effectiveness of environmental policy institution has made it difficult for implementation of environmental policies. Finally, the existence of many autonomous local networks and governments is another big obstacle in environmental policies implementation processes. Though the central government may be spearheading proper implementation of the set policies, the many autonomous local governments do not do the same (He et al. 34-35). China’s opportunities in pollution mitigation Political will and the government structures Pollution can easily be fought if the mitigation process gets proper political will from the government. The current Chinese government has expressed its intentions of fighting the menace. This is a good sign and can be a milestone in war agai nst pollution as opposed to government inaction. Furthermore, Chinese central government can make use of many autonomous local governments to reach all parts of the vast country. The already existing environmental policies and institutions can be of great use, especially if given enough funds.Advertising We will write a custom proposal sample on Environmental Issue in China specifically for you for only $16.05 $11/page Learn More People’s will Public outcry on the adverse effects of high pollution level has been reported all over China, especially North China and in major cities. The government can tap this and make it a useful tool for curbing the vices by mobilizing its citizenries in the war against pollution. Since the Chinese have experienced the severe effects of pollution first hand, they collaborate with the government to fight it, given proper sensitization and tools. International support The Chinese pollution issues could be in the end , global problem. Therefore, most of the countries and global bodies could give a lot of support in the process of pollution reduction. China should make use global assistances be it financial or technical support. For instance, China can make use of international bodies such as the UNEP in coming up with sustainable development policies. Funding The Chinese GDP has been on steady increase over the past two decades. Additionally, China has many trading partners who together with international financiers, would give loans and grants for environmental protection. Possible challenges faced in pollution mitigation The huge population and its consequent demands China’s huge population poses a major challenge for curbing and controlling pollution. For instance, the high demand for vehicles and other products has led increased industrial activities, which emit increased volume of harmful gases. The magnitude of the problem The magnitude of pollution may make the steps taken in curbi ng the menace to appear futile. The problem itself could also be facilitating the rate at which it is accelerating. For example, winters are made colder by pollution and as a result, people use more coal to warm their homes, further increasing the problem. Ambiguous policies and laws, development verses environment The Chinese government is not clear on policies on consumption of products that are hazardous to the environment. Confusion comes in especially when it comes to balancing economic growth and conserving the environment. It has advocated for policies in support of development without paying attention on the impact on the environment, and policies in support of sustainable development. In cases where people and firms contravene environmental policies, the laid down deterrents are not properly used. The challenge of source of energy To support big industries and the huge number of vehicles, China depends majorly on coal, which is a major source of pollution. The government of China has the will to reduce consumption levels of coal, but it is faced with the challenge of giving an alternative. The possible route out of this problem, which is converting coal to gas, needs a lot of fresh water. That is, by creating a solution to coal usage, more problems that pertain to water consumption will be created.Advertising Looking for proposal on diplomacy? Let's see if we can help you! Get your first paper with 15% OFF Learn More Use of economic resources and finances The process of cleaning up the environment is capital and labor-intensive. Therefore, adequate funds and time are needed to carry out cleaning activities. This may even include regulating the amount of coal consumption, further hurting the economy. Unreliable data There have been claims that the Chinese do manipulate the pollution statistics probably with the aim of reducing the shocking details on the ground. This can arguably be true since statistics released by the government have discrepancies with those given by the U.S. Embassy in Beijing. With unreliable data, it is even more difficult to come up with comprehensive strategic plans to mitigate pollution. The proposed in-depth public diplomacy strategy Advocacy and the network of influence Public policies reflect the ultimate outcomes of a government system to transform the public positively. Currently, it can be difficult to demonstrate the influence of Chinese government on environmental issues, specifically the quality of air in Beijing. Thus, interest groups should take initiatives to change the current situations because they too can hardly demonstrate their roles in air quality protection in China. As such, the environment and the public face critical technical issues that require advocacy intervention. Public diplomacy must always strive to influence policy change through more reliable tactics. For this proposal, the term public diplomacy strives to show how interest groups can apply advocacy as a public diplomacy strategy to shape and change thoughts and opinions while encouraging the formation of strong alliances with other like-minded groups in society irrespective of culture and geographical location. The influence of advocacy should have some effects on the government, at least in a manner that results in concrete initiatives to save the environment. Given the influence of the Chinese government on the public, it is proposed that a network of influence sh ould be created as a public diplomacy strategy to influence the government to take action on air pollution. It is believed that networks of influence would lead to more meaningful views and positions on how the government can tackle air pollution in China. The exact events The public diplomacy strategy, advocacy would involve the use of informational and educational materials to seek for the preferred outcomes by engaging a network of influence that can influence Chinese government to adopt new environmental policies. Advocacy would involve specific positions that support the needs of environmental activists. Hence, the network of influence will use specific tools or activities such as written opinions, editors’ point of view, political leaders’ support, and think tank analysts’ recommendations. In addition, other members of the network would take part in educational and professional exchange programs to learn more about China and its cultural practices, particu larly on environmental conservation. How a network of influence would work By developing and sustaining a network of influence and revamping the relations, the level of engagement at home and abroad with stakeholders, an interest group is most likely to achieve positive outcomes. A network of influence targets various stakeholders from diverse fields and regions. Literature has shown that collaboration between local individuals and other higher-level bodies is vital for environmental conservation. Further, the role of local stakeholders is viewed in terms of knowledge generation to enhance learning of the local context. In addition, several studies focusing on environmental management have often stressed the relevance of working together with various stakeholders and the relevance of networks that cut across several levels of social bodies. This approach ensures that an interest group can gain access to a diverse set of information, sustained learning and enhanced relationship with the external bodies. While building a network of influence is vital for public advocacy to protect the quality of air in China, academics point out that it is not clear whether knowledge obtained by external relations is internally relevant, distributed, accepted and adopted by interest groups. Further, it is also not self-evident whether relations between local stakeholders and higher-level actors lead to enhanced social learning and pro-environmental support. Notwithstanding these issues, both external and internal groups can create a strong network of influence with specific roles to protect the environment. It has been shown that in the past decades of the 20th century, several major regional environmental developments took place specifically in Africa and Latin America. These developments were inspired by critical issues and questions brought forward by experts from other regions (Lahsen et al. 14). However, contributions from within the regions were also noted as important thr oughout the stages. Funds and global cooperation reduced cases of isolated, few experts working alone on major environmental issues with global impacts. While China is not considered small or less wealthy, its investment in environmental research may not sufficiently meet the current levels of environmental threats and pollution witnessed. Nevertheless, a network of influence would ensure that the interest group could learn from others while positively contributing to determine the best solutions. In addition, the interest group is most likely to attain greater national and global recognition while pressing for changes at the local levels. A network of influence would allow the interest group in China to assess their air pollution levels and propose solutions that can be adopted to formulate national policies on air pollution. It is believed that when an interest group forms a strong network of influence, it is most likely to succeed. Through consolidating the comprehension of envir onmental pollution in China and focusing on support from various actors, it can achieve positive outcomes in influencing policies to support pro-environmental behaviors. Applicability and feasibility: how it fits and departs from normal practices A network of influence can be built and used for public advocacy effectively because it is shown that networks often go beyond the normal boundaries on influencing power and its distribution. Consequently, an influential interest group on air pollution can rapidly attain its goals. The built network of influence display elements of flexibility and agility to allow its reviews constituents and reconfigure for emerging issues. Ideas about air pollution and control would freely compete while actors who have robust ideas will receive support for policy change. A network of influence would reduce risks of isolated collective action and develop a big better group that can influence policies sufficiently well in China. The Chinese government has n ot yet come to acknowledge and appreciate the relevance of redistribution of power. Thus, it may oppose the rise of an influential network. An interest group must recognize this limitation and realize that the government is far much behind in addressing environmental issues relative to its global counterparts. It rarely accepts that curbing air pollution would ultimately improve the quality of life among Chinese. In addition, the government has also failed to recognize that state power of today should concentrate on effective policy formulation through sharing and promoting ideas and practices that work rather than projecting military might to neighboring states. Therefore, a network of influence consists of experts should aim to project positive environmental values, interests and then set clear goals for the government and the public to meet for environmental protection. It is imperative to recognize that public agencies, private actors and other global actors consisting of some c ivil society groups all require some levels of representation and influence in critical issues. Failure of representation of any organization can limit the possible contribution to policy formulation. If, for instance, the Chinese government, its environmental protection agencies and local civil society groups cannot argue for the best case to protect the environment and public health, then a strong network of influence is necessary to work together with Chinese institutions to address these issues. A network of influence will bring together a wider community of environmental experts to address the air pollution issue in China in a flexible manner that the government cannot. In this regard, the network of influence would show the inefficiency, ineffectiveness and irrelevancy of the government in addressing environment concerns. Meanwhile, the Chinese government should not abandon its role because of poor policies. Instead, the government must be accountable and should seize this opp ortunity to evaluate its performance, functions and reform areas with flaws in environmental protection. If the government wants to join the network of influence but cannot sufficiently take part in it across all levels, then it must identify specific aspects of environmental policies that require transform and present to the network of influence. Social media have been adopted in China in the recent past to push for changes in environmental policies based on how the state machinery has handled the issue of air pollution. The government and a section of the business communities, however, used the online media to advance their own narratives. For instance, corporations have seized business opportunities associated with the widespread air pollution to sell mask and filters specifically for PM2.5. For several decades, the government dismissed air pollution as a non-issue caused by dust and fog while failing to account for the presence of PM2.5 particles in its reports. However, the U.S . Embassy located in Beijing started to provide data on the quality of air through social media in the year 2008, Chinese began to realize how compound the issue was. Consequently, they also started to contribute on issue affecting the air quality, questioned the inadequacy of the government reports on PM 2.5, and a lack of intervention from the government. This section shows how social media can create a network of influence to promote public diplomacy on critical issues that affect the public. Social media were responsible for raising public awareness and led to some action from the Chinese government to improve the quality of air. Otherwise, without the network of influence, the Chinese government was going to do nothing. The infiltration of the network of influence by government officials and some members of the corporate world to shape discussions by advancing narrow views and profit-oriented agendas shows that not all members in a network of influence have the same interest. A ssets required Financial resources are required to facilitate advocacy while human capital, knowledge, and expertise on environmental advocacy issues would be critical success factors. Further, technological expertise to reach a global audience through the Internet will also be necessary. Possible approaches using a network of influence to impact air pollution policies A network of influence should strengthen the relations with major institutions and individuals to promote public diplomacy discourse with the aim of influencing the government and rogue business leaders. The network should strengthen the relationship with other supporting organizations such as civil society groups, environmental conservation bodies, and NGOs for a larger audience base and support. A global image, perhaps advanced by social media, would give the network of influence opportunities to share best practices in public diplomacy through idea sharing and policy formulation. It must also create strong links wi th the locals, young leaders, and emerging leaders through various communication channels. Evaluation of efforts The interest group will observe changes in policies, Chinese government participation in processes, provision of current data on environmental issues, engaging all stakeholders, adoption and implementation of new policies. The actual impact would be demonstrated when the air quality in Beijing improves after implementation of new policies. Feedback will be used to advance future advocacy programs. Conclusion The current state of air pollution and other environmental pollution issues in China has reached an alarming level. Thus, a public diplomacy strategy involving the use of a network of influence consisting of a broad membership drawn from various professions, regions and sectors is most likely to influence air pollution policy in China and bring about change to protect the environment and public health. Works Cited Gao, Cailing, Huagiang Yin, Nanshan Ai and Zhengwen Hu ang. â€Å"Historical Analysis of SO2 Pollution Control Policies in China.† Environmental Management 43 (2009): 447–457. Print. Grabmeier, Jeff. Fighting Air Pollution in China with Social Media. 2014. Web.. Grossmann, Matt. â€Å"Interest group influence on U.S. policy change: An assessment based on policy history.† Interest Groups Advocacy 1 (2012): 171–192. Print. Hays, Jeffrey. Facts and Details: Air Pollution in China. 2014. Web.. He, Guizhen, Yonglong Lu, Arthur P.J. Mol and Theo Beckers. â€Å"Changes andchallenges:China’senvironmentalmanagement in transition.† Environmental Development 3 (2012): 25–38. Print. Henrikson, Alan K. What Can Public Diplomacy Achieve? 2006. Web.. Lahsen, Myanna, Mercedes M.C. Bustamante, Robert Swap, Elizabeth McNie, Jean P.H.B. Ometto, Tatiana Schor, Holm Tiessen, Sandy Andelman and Harold Annegarn. â€Å"The contributions of regional knowledge networks researching environmental changes in Latin America and Africa: a synthesis of what they can do and why they can be policy relevant.† Ecology and Society 18.3 (2013): 14. Print. Matous, Petr. â€Å"Social networks and environmental management at multiple levels: soil conservation in Sumatra.† Ecology and Society 20.3 (2015): 37. Print. McClellan, Michael. Public Diplomacy in the Context of Traditional Diplomacy. 2004. Web.. Metzl, Jamie F. Network Diplomacy. Georgetown Journal of International Affairs. 1 Apr. 2001. Web. This proposal on Environmental Issue in China was written and submitted by user Travis Golden 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.

Georgia - Crime Victims Rights

Georgia - Crime Victims' Rights You Have The Right To Be Notified Of: Arrest of the accused.Availability of victim service programs.Availability of compensation for victims of violent crime.Any court hearings where release of the accused will be considered.Release of the accused.Court proceedings during prosecution of the case.Motion for new trial or appeal dates.Change of status of the defendant, if you request this in writing. You Have The Right To: Express your opinion on the release of the accused pending court proceedings.Express your views on the outcome of the case prior to plea negotiations or sentencing of the accused.Complete a Victim Impact Statement. Notification To Victims Of Crime The Office of Victim Services will notify registered victims when any of the following occurs: The inmate is released from prison having completed the court ordered incarceration.The inmate has been approved for transfer to a work release transition center.Removal from transition center to be returned to prisonEscape of an inmate from custody.Recapture of an escapee.The release from prison after completing the confinement portion of the sentence to begin a court ordered probation period.A scheduled parole release from prison.An offenders parole is revoked and the parolee is returned to the custody of the Department of Corrections.Transfer to the custody of another authority outside of the Georgia Department of Corrections.The death of the inmate while in the custody of the Georgia Department of Corrections Services to Victims of Crime A toll free number is available for crime victims to contact the Office of Victim ServicesRegistration of crime victims for notification of the release of their offender from the custody of the Georgia Department of Corrections.Notification of an inmates release or escape from the custody of the Georgia Department of Corrections.Advocacy on behalf of victims concerning their particular needs in the correctional process, including but not limited to: situations involving harassment by inmates, compliance with court mandated conditions, unwanted contact, etc.General information regarding the status of offenders in the custody of or under the supervision of the department of corrections.Referrals for crime victims to other state, federal and community based services.Notification of execution dates along with preparation and orientation for the survivors of homicide victims who choose to be present at an execution. Victim Information and Notification Every Day V.I.P. is an automated information and notification system used by the Georgia Department of Corrections to provide registered victims or their families with access to information about their offender 24 hours a day, everyday. V.I.P. Hotline: 1-800-593-9474. V.I.P. also functions as a notification system. Through computer generated telephone calls, victims who have registered with the Georgia Department of Corrections will automatically receive notification of the release of their offender from custody. The information and notification services of the V.I.P. system are available in both English and Spanish. How to Register with V.I.P. The V.I.P. hotline may be used to obtain updates on the following inmate information: The current location of incarceration.The parole status/eligibility.Maximum or scheduled release date.The system will advise you if the offender is not in custodyNotification Calls Registered victims will automatically begin receiving computer-generated telephone notification calls when any of the following occurs: The inmate is released from prison having served the court ordered term of incarceration.Release from prison after completing the confinement portion of the sentence to begin a court ordered probation period.Upon being paroled from prison.The escape and recapture of an inmate.The death of the inmate while in the custody of corrections.Notification calls will be placed to the registered phone number every hour. The calls will continue for a 24-hour period or until the victim enters the assigned PIN, confirming the notification process has been completed.

Organic Chemistry lab Determination of the Structure of a Natural Assignment

Organic Chemistry lab Determination of the Structure of a Natural Product in Anise Oil - Assignment Example The molecule’s index of hydrogen deficiency is 10. This implies that there are 5 rings or double bonds in the structure. Each one would then compensate for the two of the hydrogen atoms that are not there (Lehman, p.292-294). Upon catalytic hydrogenation of anise oil, a saturated compound with a chemical formula C10H20O, it points to the original structure to be containing four pibonds, since eight hydrogen atoms were added (Lehman, p.292-294). Aliquat 336 functions as phase transfer catalyst, it provides green chemistry procedures. If it was not added, the experiment would not have been environmentally friendly due to the hazardous wastes produced during the chemical reactions. B) The Ph 7 of the filtered reaction mixture indicates a neutral mixture. It points to addition of insufficient 6M HCL which was required to make the reaction mixture acidic. The reaction mixture ought to have turned brown after addition of anise oil and heat, which turns white in addition of

Total reward system proposal Coursework Example | Topics and Well Written Essays - 2000 words

Total reward system proposal - Coursework Example to the overview provided above, it is clear that Rational Holidays will only be capable of meeting its HR needs if it adequately accomplishes a number of crucial elements. According to WorldatWork (2007), the primary aims of a TR strategy are to communicate a unique value proposition that sufficiently meets the needs of current and potential employees in order to minimize unnecessary employee turnover. Secondly, the strategy aims to offer a framework for the design, administration and communication of rewards programs by employers. To achieve these objectives, Rational Holidays must conceive a suitable strategy involving the various elements: The first element is to lay out the company’s strategies. In other words, the firm must first articulate its core values together with its business strategies. Particularly, the firm must spell out how the proposed strategy will ensure that the business needs as well as aims are met. In addition to this, the company will need to stipulate exact timelines when goals are set to be achieved. The second vital element that be encompassed in the TR strategy is the statement of the firm’s overall objectives. It is well-known that multinational companies operate in an environment that is highly diverse, from a number of perspectives. Apart from the diverse legal requirements involved, multinationals have to respond to different customer needs, just the same way that it has to deal with the demands and conflicting opinions of numerous shareholders. As a result, the TR strategy for Rational Holidays will need to include distinctive statements that outline how the system will uphold these diverse needs. To accomplish this, the approach will need to clearly delineate the roles that will be played by every reward element. The third element is prominence. Every TR strategy ought to give a general description of the superiority of compensation rewards over other tools with an impact on actions as well as decisions. To achieve this

Compare and contrast Gandhi and Plato on the issue of appearance and Essay

Compare and contrast Gandhi and Plato on the issue of appearance and reality - Essay Example pularly known as Mahatma Gandhi, and in India as the Father of the Nation was that ‘great soul’ in human form who was able to mobilize millions of people towards nonviolence through principles of nonviolence and truth; he rose to lead the Congress in 1920, during British Imperialism in India, and successfully brought an end to the British rule in India through his basic yet revolutionary principles and radical politics (Dalton, p.27). Both Plato and Gandhi, considered as highly learned super souls, possessed an ability to mobilize masses through their principles and values. Plato was the first one to differentiate between appearance and reality through his views of the world as a pale reflection of different forms as they appeared to the eye; he philosophized that the world is actually changing constantly, and all impressions, as seen, are mere forms (Gelb, 29). Plato explained his ideology of ‘world of forms,’ and their reality, through parable of prisoners in a cave; he pointed at the ‘reality’ of prisoners’ view that is restricted to their own shadows seen on the walls of the cave from the light behind them. If these prisoners are not exposed to outside world, they will tend to believe that the shadows that are visible are the forms of the world. When they are exposed to the outside world, which is the truth, they will not be able to accept it immediately and will have difficul ty in understanding and adjusting to the light and other objects of truth in the world. Through this explanation, Plato explained the relationship between knowledge and reality that is connected through wisdom. A true philosopher is the one who is in constant search of wisdom that will enable him to identify the goodness, truth, and beauty of life. Quite different in approach was Gandhi’s perception of appearance and reality, in other words conceptualization of metaphysics; were based on the issues that pervaded India for many centuries. Although Gandhi fought

Pediatric Trauma Scoring System in Predicting Mortality

Pediatric Trauma Scoring System in Predicting Mortality PEDIATRIC TRAUMA SCORE AS PREDICTOR OF OUTCOME OF PATIENTS ADMITTED TO CENTRALIZED SURGICAL INTENSIVE CARE UNIT IN A GOVERNMENT TERTIARY HOSPITAL: A RETROSPECTIVE COHORT STUDY I. Justification of the Study Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness. Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity. In particular, scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking. Furthermore, there is considerable difference between clinicians prognostication estimates. Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use. Thus, this study will investigate the use of a simple Pediatric Trauma Scoring system in predicting mortality. II. Relationships of research objectives, data substrates, operationally-defined variables and data analyses. Objective Data Substrates Operationally-defined variables Analyses To compare the outcome of patients to pediatric trauma score Pediatric trauma score sheet Pediatric Trauma Score Mortality rate per category of Pediatric Trauma Score Rate of patients with Prolonged Hospital Stay per category of Pediatric Trauma Score Relationship of outcome of patient (mortality and prolonged hospital stay) to pediatric trauma score TOPIC BACKGROUND Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness.1 Quantitative observations of severity of illness in pediatric trauma using scoring systems has the potential to impact overall evaluation from baseline presentation to case endpoints.2 Scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking.1 Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use.1 A Pediatric Trauma Score (PTS) was developed with grading variables commonly seen in pediatric trauma accounting for the unique physiological and anatomical nature. The PTS consists of six variables. Each variable is scored +2 for minimal or no injury, +1 for minor or potentially major injury, or -1 for major or life-threatening injury. The total score ranges from +12 to -6 with increasing severity.3 Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity.4 Several studies revealed consistently the direct linear relationship between Pediatric Trauma Score and injury severity thereby confirming that P.T.S. is an effective predictor of both severity of injury and potential for mortality.5 REVIEW OF RELATED LITERATURE Most of the scoring systems are not appropriate for pediatric trauma patients. Variables such as respiratory rate, heart rate, and systolic blood pressure differ with infancy and childhood. In addition, the verbal response as used in GCS is not applicable for young children. For these reasons, Tepas and colleagues3 created the Pediatric Trauma Score (PTS). The authors stated that weight becomes a variable because pediatric patients had fewer physiologic reserve. Systolic blood pressure, patency of airway, level of consciousness, presence of wounds or fractures were variables included. 3 The presence of these injuries suggests severe energy transfer and positively correlates with concomitant visceral injury.10 Below is the Pediatric Trauma Score. Pediatric Trauma Score +2 +1 -1 Weight >20kg 10-20 kg Airway Patent Maintanable Unmaintainable Systolic B/P >90 mmHg 50-90 mmHg CNS Awake + LOC Unresponsive Fractures None Closed or suspected Multiple, closed or open Wounds None Minor Major, penetrating or burns The assessment of severity of illness as well as mortality predictive value of the Pediatric Trauma Score (P.T.S.) was evaluated in several studies with different conclusions. In a study by Tepas, three categories of patients with probability of mortality were identified. Pediatric trauma score of greater than 8 had a 0% mortality while pediatric trauma score between 0 and 8 had an increasing mortality related to their decreasing pediatric trauma score. Score of less than 0 had 100% mortality. This study documented the direct linear relationship between Pediatric Trauma Score and injury severity validating that P.T.S. is an effective predictor of both severity of injury and risk for mortality.5 Consistent with the findings of the latter, Ramenonofsky compared the evaluation of pediatric trauma patients by paramedic in the field versus the physician in the emergency room using the Pediatric Trauma Score. There was agreement between the scores of these two individuals 93.6% of the time, correlation coefficient 0.991, r2 = 0.982. The sensitivity and specificity of Pediatric Trauma Score was computed at 95.8% and 98.6%, respectively. He described Pediatric Tra uma Scoring System as a straightforward modality for assessing the severity of injury.6 Eichelberge examined the applicability of the PTS found significant correlations with survival, Injury Severity Score (ISS) and mortality. 8 On the other hand, the use of PTS as a predictor of mortality was found to be inadequate in a retrospective study by Balik. Size classification was noted to be overemphasized because of the low mortality (7.7%) in children less than 10 kg. Forty-nine of 71 surgically treated patients with intra-abdominal organ injuries had a PTS >8. The existing variables of PTS did not have equal relationships to mortality.7 Critics have also noted that the PTS suffers from scoring ambiguity leading to misinterpretation and inadequate scoring.11 Problem also arises due to a systematic bias in scoring. For example, the assessment of a patient’s consciousness can be done at the scene or on admission to the emergency department. 12 Despite exhaustive review of the literature on Pediatric Trauma Scoring, there has been no mention of the predictive value of Pediatric Trauma Scoring done on patients upon entry to an ICU. Conclusion of studies on Pediatric Trauma Score may be less generalizable due to possible variability in settings.9 RESEARCH QUESTION Among pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit in Davao Regional Hospital, what is the relationship of outcome of patients to pediatric trauma score using a retrospective cohort study? SIGNIFICANCE OF THE STUDY Investigating the reliability of Pediatric Trauma Scoring system in predicting mortality and prolonged hospital stay is important. The results of this study can be a validation of earlier studies made on this scoring system as a tool in objective measurement of severity of illness as well as an intensive care unit outcome and efficiency benchmarking. OBJECTIVES To determine the pediatric trauma score of all patients and classify as to pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the mortality rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the survival rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the rate of pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 among surviving patients To determine the risk for mortality or prolonged hospital stay among pediatric trauma patients per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 METHODOLOGY RESEARCH DESIGN A retrospective cohort study of all pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit between January 1, 2013 to December 31, 2013 in Davao Regional Hospital will be conducted. SETTING This study will be conducted in Davao Regional Hospital (DRH), a tertiary hospital with 250-bed capacity, in Tagum City. The Centralized Surgical Intensive Care Unit (CENSICU) is an intensive care unit for adult and pediatric surgical patients in Davao Regional Hospital. The Department of Surgery of Davao Regional Hospital is a member of the Mindanao Integrated Surgical Residency Training Program under the Department of Health, Region XI. PARTICIPANTS All pediatric trauma patients admitted to CENSICU in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be retrospectively included in the study. INCLUSION CRITERIA All patients admitted to Centralized Surgical Intensive Care Unit due to trauma All patients aged less than 14 years old EXCLUSION CRITERIA Patients discharged against medical advice Patients transferred to another hospital OPERATIONAL DEFINITION OF TERMS Traumaan injury to any site of the body described as multiple or single (neck, thorax, abdomen or extremeties) site caused by an extrinsic, blunt or penetrating agent Pediatric trauma patients-patients aged less than 14 years old admitted due to trauma Pediatric Non-Trauma patients- patients aged less than 14 years old admitted for surgical intervention of non-trauma cause (example: intestinal obstruction due to Hirschsprungs disease, massive pleural effusion due to malignancy) Prolonged Hospital Stay-length of hospital stay is more than 14 days with or without surgical intervention DATA GATHERING All pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit (CENSICU) in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be identified from the admission logbook in the CENSICU of Davao Regional Hospital. The patients will be identified using the inclusion and exclusion criteria . The list of patients will be submitted to Medical Records Section of Davao Regional Hospital for chart retrieval. The charts will be reviewed for the following data will be gathered from each patient: age in years, sex, length of hospital stay in days, weight in kilograms, systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds. After calculating the Pediatric Trauma Score of each patient, the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) can be determined. In addition, the outcome of the patient will be determined as to: Mortality With prolonged hospital stay among surviving patients MaIN OUTCOME MEASURES AND OTHER DEPENDENT VARIABLES The primary outcome is the mortality rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively. The secondary outcomes are the following: Number of pediatric trauma patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively Survival rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0 Rate of surviving pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 INDEPENDENT VARIABLE The identified independent variables include age, sex, weight in kilograms, length of hospital stay, patency of airway, systolic blood pressure in mmHg, level of consciousness, presence of fractures and minor or major wounds. SAMPLE SIZE COMPUTATION Sample size for this study was computed using Epi Info 7 StatCalc. Calculations were based on the assumptions that: 1) the ratio of patients unexposed to the risk factor (i.e., PTS greater than 8) to patients exposed to the risk factor (i.e., PTS 8 or less) is 3; and 2) the prevalence of the outcome (i.e., death) in the unexposed group is 15%. Estimations were done in order for the study to detect an odds ratio of 5 as statistically significant. In a computation for odds ratio carried out with 5% level of significance, a sample size of 79 patients will have 80% power of rejecting the null hypothesis (no significant increase or decrease in odds ratio) if the alternative holds. DATA HANDLING AND ANALYSIS Clinical characteristics (age in years, sex, weight in grams, length of hospital stay), systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds, and Pediatric Trauma scores of patients will be compared statistically. A p value will be computed to establish whether the difference in the values were significant or not. A p value The Pediatric Trauma Score of each patient will be calculated and the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) to which the patient belongs will be determined. The total number of patients in each category will be evaluated. Outcome (mortality rate or survival rate) of each patient belonging to a particular category will be tallied and each frequency computed. Among surviving patients, length of stay will be evaluated as to prolonged (>14 days) or not prolonged. Rate of surviving patients with prolonged hospital stay will be determined. Risk of mortality as well as prolonged hospital stay among surviving patients will be expressed in odds ratios (OR) with 95% confidence interval.

The Threat of Anne Hutchinson Essay -- essays research papers

The Threat of Anne Hutchinson   Ã‚  Ã‚  Ã‚  Ã‚  In Puritan led Massachusetts Bay Colony during the days of Anne Hutchinson was an intriguing place to have lived. It was designed ideally as a holy mission in the New World called the â€Å"city upon a hill,† a mission to provide a prime example of how protestant lives should have subsisted of. A key ingredient to the success of the Puritan community was the cohesion of the community as a whole, which was created by a high level of conformity in the colony. Puritan leaders provided leadership for all facets of life; socially, economically, religiously, and even politically. A certain hierarchy was very apparent in the Massachusetts Bay Colony, in which ministers always seemed to have gotten their way. Governor Winthrop got his way in 1637 by banishing a woman, Anne Hutchinson, whom he thought posed a threat to the structure of the colony. I believe that there is a legit rationale for her banishment, this being her religious ideas that were very close to tha t of the Antinomians who Governor Winthrop was not too fond of. I also think that this was not the primal reason. In my mind, Anne’s gender played a large role in determining whether or not she actually posed a serious threat to the solidarity of Massachusetts.   Ã‚  Ã‚  Ã‚  Ã‚  Upon her arrival to the Massachusetts Bay Colony in 1634, Anne Hutchinson was a much respected member of her community. As time went on, her dealings with the religion began to be...