Assignemt Essay Example | Topics and Well Written Essays - 500 words

Assignemt - Essay Example The major challenge affecting prognosis, however, has been on the imaging of partial tears. Oblique imaging planes, including oblique axial, oblique coronal and oblique sagittal, would improve on the accuracy of diagnosis and detection of any partial tears in the ACL. It would also aid in assessing individual bundle tears. This approach has been noted to be more useful than the standard MRI in cases where ACL tear is anticipated. The protocol could also benefit from 3D sequences such as the 3D-DESS, known to be isotropic acquisition having the potential of reducing partial volume averaging through acquisition of thin and continuous slices from the joints. Additionally, this could be used to come up with multiplanar reformat images, MPR, which would make the evaluation of ACL possible from any orientation or oblique planes through a single acquisition. This creation of the MPR could be sourced as part of PACS system or through dependent workstations. The MPR images in this context would be useful for acquisition of the oblique planes, including the oblique axial, coronal and sagittal, to better assess the ACL tears. Finally, the 3D-DEES sequences play a crucial role of enhancing the image’s T2* weighting and also increases synovial fluid and cartilage signal intensities. This 3D-DEES technique is beneficial in the sense that it provides moderate accuracy with regards to early cartilage delineation and high accuracy when detecting advanced cartilage lesions. As such, this sequence can only be employed when dealing with cartilage structures. Replacing this ACL imaging sequence with subtraction-DESS technique would result in its optimisation. The MRI technology has been beneficial in supporting chronic and acute ligament injuries diagnosis and, even more importantly, in assessing problems that arise after the reconstruction of ligament. Even so, the short T2-relaxation time associated with tendon tissue (4), the standard MRI having echo times, TE,

Answer 4 discussion questions as instructed below Assignment

Answer 4 discussion questions as instructed below - Assignment Example The advantages of placing the C-arm fluoroscopy at different angles with regards to the patient, for example, either under/over/lateral, is that it offers an appropriate way to facilitate minimal exposure to the radio waves. The level of success in any C-arm fluoroscopy procedure performed is contingent on the proficiency of the doctor involved and the pathoanatomic characteristics of the patient. The benefit is that it offers minimally invasive procedures for the treatment being carried out. Reducing occupational exposure is achieved via the use of garments having components of lead metallic elements. Lead metal is known to be effective in shielding from radioactive components, for instance, like in this case x-rays. The TV monitors and control cart are utilized for cross sectional examination of two images to provide a comparison for the technologist. The equipment are flexible in hardware structure and can be rotated or flipped to provide a preferred view. Mobile fluoroscopy with supported digital imaging which offers still images is essential for therapists to analyze and compare data collected. The foot pedal allows the physician or any approved equipment operator to have hands-free operation of the C-arm machine. A completely equipped and automatic foot pedal has added functionality to offer flexible operations and movement within the examination room. Radiation safety is essential for all the individuals involved or affiliated to the operations of the portable x-ray machines. It is advisable for all the persons and staff who remain in the radiography room to wear a lead apron. A minimum distance of 6 feet (approximately 2m) is suitable for all operators involved to minimize the exposure that comes with the procedures. Delicate organs like the gonads ought to be protected from the radioactive elements. The level of exposure is greatly dependent on the distance from exposure point, thus,

Energy Society Essay Example for Free

Energy Society Essay The Kyoto Protocol The official name of the Protocol is The Kyoto Protocol to the United Nations Framework Convention on Climate Change. It is an agreement by 165 countries for mandatory targets for the reduction of the world’s greenhouse gas emissions. These gases—carbon dioxide, methane, nitrous oxide, and several fluorinated gases are believed to contribute significantly to global warming. The targets of the Protocol are primarily industrialized countries, which are expected to reduce their combined emissions to 95% of 1990 emission levels between 2008 and 2012. The Protocol was agreed on in 1997, although it only took effect in 2005. Between the years 1990 and 2000, the overall emissions of industrialized countries have been reduced by 3%, but largely because of the drastic reduction of emissions from former Soviet countries because of their failing economies. Other industrialized countries overall had an increase of 8% emissions. It is estmated that emissions from industrialized countries will be 10% above 1990 emission levels by the year 2010. For industrialized countries, the emission reduction target of the Kyoto Protocol is only around 5%, and many climate scientists are concerned that this is not enough to curb the effects of global warming. They believe that in order for the agreement to actually help solve the problem, the emission rates would be cut down by 60%. This has led to the opinion that the agreement lacks real value, more so without US backing. However, advocates believe that the Protocol lays out the groundwork for future negotiations. Emission reduction laws were already signed in many countries and would continue to take effect even when the Protocol itself has ceased to exist. â€Å"Happy Kyoto Day† – http://www.worldchanging.com/archives/002119.html This site has an unusual approach to the problem of determining the Kyoto protocol’s merit. According to the author, â€Å"In and of itself, the Kyoto treaty wont solve global warming or avert disastrous climate disruption.† The author states that the protocol is essentially a catalyst. It will put the world in an environmentally aware mindset—even if the Kyoto protocol fails, it will force the world to come up with something better. It will also encourage economic changes that strive towards greater efficiency and sustainability. Lastly, the protocol â€Å"is a symbol, a conscious step in the right direction for the planet. â€Å"Kyoto global warming: good stuff or part of a dark conspiracy to dominate the world?† – http://uspolitics.tribe.net/thread/e4978f31-0439-4b70-bbf3-f0ce93a09a42 According to this site, â€Å"global warming alarmism† is indeed the â€Å"mother of all environmental scares.† The author states that it is definitely not settled whether human activity has had any significant effect on global warming; global warming is a theory, not a fact. Some effects of the Kyoto protocol would include â€Å"impoverishing the USA and creating intense disaffection within the ranks of the working classes.† Basic necessities would become very expensive. â€Å"Electricity would double in cost, fuel would skyrocket.† Lastly, the author claims that the Kyoto protocol is a political â€Å"device to lead the Social Communists closer to world dominion.† One of the worst effects that global warming could have would be the rise of sea levels, due to the melting of ice caps and to thermal expansion of the world’s waters. A hundred years from now, if the worst global warming predictions come true, millions of people will be displaced from their homes, which will be submerged. This will have drastic economic and cultural impacts. The effects of the mass displacement on the economy could reach far into the future. The loss of farmland, of business districts, etc. may spawn another (much worse) Great Depression in many areas. Forced cultural dispersion will be commonplace, making the ubiquitous problem of the generation gap much more considerable. Many people who would call themselves environmentalists would not necessarily have good knowledge of environmental issues. They may pay lip service to the environmentalist cause without inconveniencing themselves in any respect to protect it. But I would venture to say that a majority of those who call themselves environmentalists would be willing to go out of their way to ‘serve’ the world. However, it is certain that, as in other controversial issues, there would be much hypocrisy. If by ‘environmentalists’ we mean those who are—or claim to be—‘concerned’ about the environment, then certainly most of them would just be claiming belief in the cause, but be too lazy. In them would be an awareness of an ideal—the preservation of the environment—but a lack of initiative, probably because of the lack of any immediate incentives. References    Kyoto Protocol, 2006, Department of the Environment and Heritage, Australian Greenhouse Office, Available at: http://www.greenhouse.gov.au/international/kyoto/index.html The Kyoto Protocol, New Zealand Ministry for the Environment, Available at: http://www. climatechange.govt.nz/about/kyoto.html Cascio, Jamais, 2006, Happy Kyoto Day, Available at: http://www.worldchanging.com/archives/002119.html Kyoto global warming: good stuff or part of a dark conspiracy to dominate the world?, 2006, Available at: http://uspolitics.tribe.net/thread/e4978f31-0439-4b70-bbf3-f0ce93a09a42 QA: The Kyoto Protocol, 2005, BBC News, Available at: http://news.bbc.co.uk/1/hi/sci/tech/ 4269921.stm The Kyoto Protocol A brief summary, 2006, European Union, Available at: http://ec.europa.eu/ environment/climat/kyoto.htm Kyoto Protocol, 2006, Wikipedia, Wikimedia Foundation, Inc., Available at: http://en.wikipedia. org/w/index.php?title=Kyoto_Protocololdid=80236719 Kyoto Protocol comes into force, 2005, BBC News, Available at: http://news.bbc.co.uk/2/hi/ science/nature/4267245.stm

Vulnerable Subjects Research

Vulnerable Subjects Research PROTECTION OF VULNERABLE SUBJECTS IN CLINICAL TRIALS BACKGROUND Aim: To throw light on the state of vulnerable subjects in Clinical Research. Objective: To understand current provisions and legislations available to protect the rights of vulnerable subjects with special emphasis on plight of sex workers enrolled in anti-HIV trials. VULNERABLE SUBJECTS IN CLINICAL RESEARCH Individuals who are comparatively or entirely inept of defending their own wellbeing are termed as vulnerable research participants. When study includes such subjects additional care has to be taken to protect their rights. It is the investigator and his research team’s responsibility to ensure that these subjects are not exploited in the name of research. The study design team, sponsor, investigator must be aware of the special requirements needed for vulnerable subjects and they should develop the study protocol, informed consent form and the confidentiality agreement keeping the vulnerable subjects’ needs in mind. The different types of vulnerable subjects included in clinical trials are classified on basis of their vulnerability. Some examples are as follows: 1. Cognitive and Communicative vulnerability: This includes children and adolescents. Patient’s suffering from mental retardation, dementia and other kinds of mental illness. Enrollment of people with educational deficits and unfamiliarity with language. Stressful emergency: conditions that do not permit otherwise capable adults to implement their capabilities efficiently. 2. Juridical or institutional vulnerability: Person who is under the official authority of others (egs. Parents, guardians, warders, officers and judges) who may have their own benefits in whether the individual agrees to enroll in the study. 3. Deferential vulnerability: Influence of other people in subjects life, determine their decision to enter the trial. Existence of an informal hierarchy (egs. Relatives, friends, masters, physician) 4. Medical vulnerability: Prospective patients who have a severe medical condition, for which there are no existing efficient or satisfactory regular cure (examples: very aggressive and malignant forms of cancer, last stage AIDS and some uncommon ailments) owing to their unusual medically tricky state, misuse of these patients throughout their hope for remission or improvement is not unusual. 5. Economic vulnerability: Prospective subjects with low economic background may join trial with hope of getting income, housing and healthcare facilities. Payment for participation or free access to healthcare services might constitute unfair inducements to enroll through exploitation of these subjects. 6. Infrastructural vulnerability: Patient is tempted to enroll in trials, as they pre-suppose the availability to them of resources or facilities (egs. a rapid communication system, a reliable dietary intake, skilled healthcare professionals) 7. Social vulnerability: Refers to individuals belonging to undervalued social groups or communities.(sex workers)[R. Colombo, The Most Vulnerable Subjects Of Biomedical Research IX General Assembly PAV – publications] EXPLOITATION OF VULNERABLE SUBJECTS THROUGH HISTORY Exploitation was rampant in the absence of regulations, laws, guidelines and codes. Escalating physician to god-like position with immense faith in them and failure to recognize vulnerable subjects has resulted in horrific incidents in history of research. These major mishaps have convinced the medical fraternity the need for developing ethical guidelines and code for research specifically for the vulnerable populations. The Nuremberg trial The 20th century will always be remembered due to the shocking and upsetting experimentation performed by Nazi doctors. During the World War II, the Nazi physicians took advantage of the prisoners of war; they carried out experiments unparalleled in their range and the level of anguish and harm. Appalling studies such as injecting the poor prisoners with gasoline and live viruses, immersing people in ice water, and forcing them to ingest poisons have gone down in the history books as the most inhuman experiments. The physicians in order to satisfy their scientific curiosity have performed these experiments which were of no use to the participants. These experiments usually resulted in the death of the participants. After the war ended, there was a huge public outburst against these experiments and 23 physicians were indicted at Nuremberg for their willing participation in these experiments. Sixteen were found guilty and sentenced while seven were hanged to death. This resulted in the origin of the Nuremberg Code, which made informed consent mandatory. The Willowbrook study The Nuremberg Code unfortunately did not put to end unethical research as not every researcher honored the Code. The three year long Willowbrook study is another example where vulnerable patients were exploited. Willowbrook State School, an institution for mentally defective children were intentionally infect with the hepatitis virus, by being fed stools from infected persons or later by being injecting with purified virus preparations, to observe the natural history of this disease and then to test the effects o gamma globulin in preventing the disease. Researchers defended the deliberate infection of these children by stating that the bulk of them acquired the infection in any case while at Willowbrook, and possibly it would be better for them to be infected under restricted research settings. What was worse was that during the course of these studies, new inmates were admitted only if they agreed to participate in the hepatitis program! There was obviously no full disclosure ad clearly coercion and undue pressure was used to enroll vulnerable subjects like children and mentally challenged. Jewish Chronic Disease Hospital Study At the other end of life’s spectrum, came the Jewish Chronic Disease Hospital Study where live cancer cells were infused into continually ailing and incapacitated patients. These patients had been told that they were getting a skin examination. The patients were provided oral information about the test but no consent was documented. Syphilis study The most notorious example of prolonged infringement of human rights of a vulnerable faction of research participants was the long-term study of black males performed at Tuskegee by the United States Public Health Service. Initiated in the 1930s to examine the natural history of untreated syphilis, continuing until 1972, this study recruited more than 400 black men suffering from syphilis. These participants were recruited without informed consent and were mislead that a few of the measures taken in the interest of research were essentially â€Å"special complimentary treatment†. Although along the way antibiotics become available, these were not given to the patients and the study resulted in 28 deaths, 100 cases of disability, and 19 cases of congenital syphilis. The Belmont report published by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research on April 18, 1979 was one of the outcomes of the public outcry that resulted when the story of the Tuskegee study broke.[Urmila Thatte, Etical issues in clinical Research chapter 4, of Basic principles of clinical research and methodology by S K Gupta] Guidelines for ethical conduct of research in human subjects that have came into picture: Nuremberg Code, 1947 Declaration of Helsinki, 1964 The Belmont Report, 1979 International Ethical Guidelines for Biomedical Research Involving Human Subjects, 1982, 1993, 2002 The Ethics of Research related to Healthcare in Developing Countries, Nuffield council, 2002 Indian council for Medical Research Ethical Guidelines for Biomedical Research on Human subjects SPECIAL CONSIDERATIONS FOR CHILDREN Regulations that protect children, so as to prevent their exploitation are: OHRP 45 CFR 46 Subpart D FDA 21 CFR 50 Subpart D Special Considerations for Children are: Research that involves no more than minimal risk can be approved with adequate provisions for obtaining the assent of the child and permission from their parents/guardians. 45 CFR 46.404 The combination of assent by the minor subject and permission (consent) from the parents is deemed appropriate to enroll the child subject in the trial. In case of life threatening events only consent from parents would suffice, as there is expectation of direct benefit. However the child must be given full explanation of the trial. If the research presents an opening to comprehend, avoid or lessen a grave predicament affecting the health or welfare of children, but does NOT provide direct benefit to the subject or societal (indirect) benefit, than the research cannot be approved by the IRB unless HHS Secretary Approval is granted. 45 CFR 46.407 . Extremely rare- both Parent consent + child assent. When parents of the child are deceased, unknown or incompetent then the legal guardian must give is consent. Step parents, Grandparents, Adult siblings, adult Aunts or Uncles may not consent a child to research. SPECIAL CONSIDERATIONS FOR WOMEN Regulations that protect women, so as to prevent their exploitation are: OHRP 45 CFR 46 Subpart B Research studies involving pregnant women and fetuses must satisfy the following requirements to obtain IRB approval: Preclinical studies have been conducted, including studies on pregnant animals; clinical studies, that include non-pregnant women and provide data for assessing potential risks to pregnant women and fetuses 46.204(a) Risk to fetus is caused solely by interventions or procedures that hold prospect of direct benefit for the woman or the fetus or, 46.204(b) If no benefit, risk to the fetus is not greater than minimal and the research develops important biomedical knowledge not obtainable by any other means. 46.204(b) SPECIAL CONSIDERATIONS FOR PRISONERS The voluntary choice of the prisoners must not influenced by any potential advantages entailed to them due to the study, which outweighs the risks. For example, Parole decisions must not be affected for prisoners participating in the trial. The study is ethical, when the risk of participation is acceptable even to a non prisoner subject. Selections of subjects are carried out in a fair manner. When spoilt for choice, randomization techniques must be used. If necessary, adequate follow-up care must be provided to the volunteers. SPECIAL CONSIDERATIONS FOR DECISIONALLY IMPAIRED A combination of assent from the subject and permission from the concerned legal authorities constitute for the informed consent. The risk of participation would be agreeable to general volunteers too. Selection is fair and unbiased Adequate follow up is provided SPECIAL CONSIDERATIONS FOR SEX WORKERS Enrolling Sex workers in HIV vaccine trials that are ethical, valid and are not exploitative is a challenge that must be faced. Due to their nature of work, they require additional support. Sex workers are generally from the downtrodden community, they are illiterate and understanding the language in the informed consent is a major issue for them. Hence the informed consent must be in the local language and should be easily understood. The informed-consent must be prepared in such a way that it is in consultation with the community advisory and counsel board to ensure social sensitivity. Confidentiality is an important issue. These women may face physical abuse and abandonment from their clients, if they enter these trials. Supportive counseling should be provided before, during and after the test. Sex workers must not only be given male condoms but along with that they should be provided with female condoms. Proper guidance on safe sex must be dispensed. Clinical trial study team should increase awareness among the sex workers about AIDS. They should provide proper guidance to them, for prevention. Sex workers should be treated equally as general women would have been treated in a clinical trials. Study team should be sensitive towards them and not discriminate and look down upon them. CASE STUDY Health Minister, Urbain Olangnena Awono of the Cameroon government has decided that they may have to put a stop to the Tenofovir trials taking place in the port city of Douala due to various allegations by AIDS activists. The health minister had scheduled an audit for the same. The Tenofovir trial began in September 2004, Tenofovir is a established drug used for treatment of AIDS, manufactured by Gilead pharmaceuticals U.S. This trial was to determine whether Tenofovir can work as a prophylactic to prevent AIDS. The study recruited 400 sex workers free of infection. Half the women took a Tenofovir pill daily and the other half took a placebo. The study is conducted by Family Health and Insurance (FHI) with the support of U.S $ 6.5 million dollars from Bill and Melinda Gates Foundation. AIDS activists have demanded that this study be completely suspended on ethical grounds. They have said that the volunteers are vulnerable subjects and their rights have been exploited. Activists claim that the subjects have received inadequate counseling and healthcare. They have brought to notice that the sex workers are not fully informed about the risks involved in the trial. They also argue that the Study team has not promised to guarantee free healthcare if the workers become infected, which ideally every volunteer must receive. The FHI have counter attacked and cleared their stand by assuring that free medical checkups and tests have been carried out. Various tests like gynecological, medical care, HIV, pregnancy have been carried out for free. However various Activists have disregarded this claim and said that these are all false promises and haven’t been materialized. Another important issue that has been brought to notice was that, most of these sex workers were illiterate didn’t understand English and very little French, in spite of that the informed consent form were in English. However later it seen that the ICF shown to PlusNews was in French. The study team had provided 96 male condoms to sex workers. However imparting knowledge to prevent the infection of disease would be like a conflict of interest for the researchers. As the trial would be a success only if the women were exposed, become infected. The sex workers are misinformed and they feel that by taking this pill they are now vaccinated against the disease. In order to get their point across, so that the concerned authority would wake up to this injustice, AIDS activists in Paris staged a demonstration in front of the Cameroonian embassy in Paris. This demonstration got full coverage on the French T.V. This resulted in a public outcry against the trials. CRITIQUE The Tenofovir trial case study is an excellent example highlighting the profound impact media can have on the progress of the trial. The complete discontinuations of the trials prove that activists and non- governmental organizations with the help of the media can bring about change. These same activists are also involved in promoting research to combat the disease, but they can hinder the progress too. Hence researchers must be more aware about the ethical issues surrounding enrollment of sex workers. Engaging in discussion and consulting with the participant’s community before the trial begins can avoid such media spectacle. The case study rightly brings to one’s notice that lack of consultation with the support groups and community network was the biggest error on the part of the research team. Extensive discussion with community networks and a good flow of communication would bridge the gap and increase the trust of sex workers in the trials. The activists have rightly questioned why no subjects from general population have been enrolled to test safety of the drug. They have expressed concern and raised another important issue that the same trial would have provided women from Europe and U.S better benefits and adequate healthcare. The burning issue against this trial has been that since the primary outcome is HIV infection, researchers will provide inadequatecounseling to prevent infection. Since there exits a conflict of interest, sex workers will not be encouraged to have safe sex. Another important drawback of the trial has been its failure to provide sex workers with female condoms. They were provided with male condoms but negotiating for the same with their clients does not go down well with their trade. It is shocking that the sex workers were completely ignorant about the drug. They were misguided that the drug is a vaccine for AIDS, which made them more careless and prone to the disease. On the other hand, Tenofovir trials aimed at providing a prophylactic for AIDS, which would be a major breakthrough in combating this deadly disease and would definitely be of great benefit to the sex workers. Such uncontrolled and extreme protest has led to the complete discontinuation of the trial which in turn is bad news for the sex workers. The sponsor company had also promised to market this drug in Cameroon for much reduced prices. The validity of the media reports is doubtful as all the allegations made against the research team have been without any evidence. Activists instead of creating media backlash against the trial should have engaged in constructive dialogue with the research team stating their demands. CONCLUSION Clinical research has given millions of patients’ worldwide assurity that the medicine they purchase and consume, has been completely validated for its safety and efficacy. It ensures that these patients worldwide are getting the best medicine with utmost safety parameters. Investigators along with their research team bear the ultimate responsibility for their work with human subjects. They have the privilege of using human subject to advance scientific research, in turn society expects that investigators will show respect for their research subjects. Unfortunately as history has shown some scientists still continue to value their quest for knowledge and potential for personal fame and financial gain more highly then respect for basic human rights. Hence, various guidelines, regulations, codes and law have come into picture to protect the human subject. Special care and provisions must be made for subjects who are shunned from society. Sex workers live on the fringe of society and can rarely ask for their rights or support from public. In the interest of general health, to conduct trials for AIDS, this section of society must not be used as mere guinea pigs. Particular guidelines and ethical code of conduct for researchers must be drawn in order to protect these oppressed subjects. Providing them information on AIDS is not enough, they must be given free health care and female condoms. They need compassion and justice from us. REFERENCES Deanna Kerrigan et al, Environmental structural factors significantly associated with consistent condom use among female sex workers in the Dominican Republic, AIDS 2003 17:415-423 , Lippincott Williams and Wilkins. Arnaud L Fontanet et al, Protection against sexually transmitted diseases by granting sex workers in Thailand the choice of using the male or female condom: results from a randomized controlled trial, AIDS 1998, 12: 1851-1859, Lippincott Williams and Wilkins. Edward Mills et al, Media reporting of Tenofovir trials in Cambodia and Cameroon, 24 August 2005, BMC International Health and Human Rights. Edward J Mills and Sonal Singh, Health, human rights and the conduct of clinical research within oppressed populations, Globalization and health 2007, 3:10, BioMed Central Ltd. Peter H. Kilmarx et al, Protection of Human Subjects’ Rights HIV- preventive clinical trials in Africa and Asia: Experiences and Recommendations, AIDS 2001, 15 (suppl 5) : S73-S79, Lippincott Williams and Wilkins Geeta Yadav et al, Associations of sexual risk taking among Kenyan female sex workers after enrollment in an HIV – 1 prevention trial, J Acquir Immune Defic Syndr 2005; 38:329-334, Lippincott Williams and Wilkins Gielen AC, Fogarty L, OCampo P, Anderson J, Keller J, et al, Women living with HIV: Disclosure, violence, and social support, 2000, J Urban Health 77:480–491 R. Colombo, The Most Vulnerable Subjects Of Biomedical Research IX General Assembly PAV – publications. Urmila Thatte, Ethical issues in clinical Research chapter 4, of Basic principles of clinical research and methodology by S K Gupta Cynthia McGuire Dunn and Gary L. Chadwick, Protecting study volunteers in research, Third edition. Thomson Centerwatch. Ezekiel J. Emanuel, MD, PhD; David Wendler, PhD; Christine Grady, PhD, What Makes Clinical Research Ethical? , JAMA.2000;283:2701-2711. Cohen J. Cameroon Suspends AIDS Study. Science, Science Now 2005 Feb: 4. Singh JA, Mills EJ. The abandoned trials of pre-exposure prophylaxis for HIV: what went wrong? PLoS Med 2005;2: e234 Atatah C. Douala AIDS drug controversy: medical council says trials violated ethical norms. Post News Line 2005. www.postnewsline.com/2005/02/strongdouala_ai.html (accessed 15 Jan 2008). http://www.actupparis.org/article1734.html?var_recherche=tenofovir (accessed 15 Jan 2008) http://medicine.plosjournals.org/perlserv/?request=get-documentdoi=10.1371%2Fjournal.pmed.0020234ct=1SESSID=3b4fdb3c51bc2ee0983c4abb37ad4ffa (accessed 15 Jan 2008) KIPNIS K., Vulnerability in research subjects: a bioethical taxonomy, in NATIONAL BIOETHICS ADVISORY COMMISSION, Ethical and Policy Issues in Research Involving Human Participants, op. cit., vol. 2, pp. G1-G13, p. G5. http://www.academiavita.org/template.jsp?sez=Pubblicazionipag=testo/et_ricbiom/colombo/colombolang=english (accessed 15 Jan 2008) www.medscape.com/viewarticle/408956_3

DeVere or William Shakespeare? Essay -- Biography Biographies Essays

DeVere or Shakespeare?      Ã‚  Ã‚  Ã‚  Ã‚   Abstract:   The debate over the legitimacy of the authorship of Shakespearean works has been disputed for centuries. While many scholars have held beliefs that Shakespeare's works have been written by figures such as Christopher Marlowe, Francis Bacon, William Stanley, and others, the most heated debate today is between William Shakespeare and Edward DeVere, the Earl of Oxford. Each side of this debate has many followers, the Stratfordians, or those who claim Shakespeare to be the true author, and the Oxfordians who believe that true credit should go to DeVere. My paper, far from being a complete analysis of the possibilities of Shakespearean authorship, attempts to summarize and rationalize the arguments of these two groups. It would be impossible to include all arguments and evidence in a paper such as this. Full books have been written on aspects of the debate I will not even mention, or may just barely touch on. Hopefully after reading this paper, however, you will have a little better understanding of the debate of authorship. As I am not in any respect a scholar on the subject I shall not attempt to make a conclusion as to which of these men is the author, but rather to inform and explain the many arguments on both sides of this debate in the hopes that the reader can learn a little more about the ongoing debate and form an opinion of his or her own.    In countries all over the globe the name William Shakespeare brings to mind literary genius, a character so famed in eloquence and creativity that none other comes close to him in prestige. Yet for centuries scholars, students and readers have argued a very fundamental question: whether or not the plays and poems attribute to William... ...rpose-to designate a penname without confusion (Whalen 32). * Principal actors in the plays of Shakespeare's First Folio included Jon Heminge,Henry Condell and Richard Burbage, the same three who were in the late edition to Shakesperes will (Whalen 51). * Oxford was said to be an excellent playwright, yet no plays written under his name were ever found (Whalen 127).      Works Cited "A Beginners Guide to the Shakespeare Authorship Problem." Online. 31 October 1999. Available http: www.shakespeare-oxford.com/guide/htm. Kathman, Dave and Tom Reedy. "How we know the Shakespeare wrote Shakespeare: The Historical Facts." Online. 2 November 1999. Available http: www.clark.net/pub/tross/ws/howdowe.html. Michell, John. Who Wrote Shakespeare? London: Thames and Hudson, 1996. Whalen, Richard F. Shakespeare-Who Was He? Westport:Praeger, 1994.

Howards End by E. M. Forster Essay -- Howards Howard End EM Forster E

Howard's End by E. M. Forster Howards End by E. M. Forster deals with the conflict of class distinctions and human relationships. The quintessence of the main theme of this lovely novel is: "Only connect!†¦Only connect the prose and passion†¦and human love will be seen at its height. Live in fragments no longer." This excerpt represents the main idea that Forster carries through the book: relationships, not social status, are--or at least should be--the most important thing for people.Howards End was written in 1910. That explains the naivete and idealism that permeate the atmosphere of the novel. Written in the beginning of the twentieth century in England about the beginning of the twentieth century in England it reflects the mood that existed in England at that time. It was a time of prosperity. The industrial revolution that started in the previous century made the British Empire a world power. Everyone had a job and the conditions for the workers significantly improved as compared to the past century. Trade unions that never existed before had just begun to form to protect the rights of the working people, and poor children didn't have to work in mines anymore. A bloody and seemingly meaningless war hadn't yet begun to destroy bodies and devastate souls of people. Generally speaking, the times were good, and the future was viewed in an optimistic way. The atmosphere of the book is filled with romance and hope, even though the author is very far from writing an utopian type of description of English society.In fact, the book is very truthful in the description of class problems of the country. In Howards End Forster talks about two classes and two ideologies that are separated by the thick wall of social prejudices and misunderstandings. The two social groups are represented by the cultured, idealistic Schlegels and the pragmatic, business-oriented Wilcoxes. The Schlegel Sisters, who aren't 'pure' English, but people of German origin, personify Forster's dream about what people's philosophy of life should be. They used to think about the class differences as obstacles that do not allow people to fully understand each other. The hope is that if everybody thinks that way, people will just forget about class differences--that's what Forster's dream is. Margaret and Helen Schlegels partly think this way because being part of minority group i... ...ccur. Unfortunately, there was nothing in English society at the beginning of the twentieth century that could have given a hope of such an ending, and there is not too much now.But who cares?We have to be optimistic sometimes and hope for a better future. Too much of Hemingway's "things end badly" approach will make us all sick, tired, incorrigible pessimists. We need novels, movies, cartoons that end happily to bring some hope to our world where--Hemingway was right--too many things end too badly. This lovely and romantic book is worth reading, for it's an excellent candy in the world of our bitter reality. The idea of being comrades and 'only connecting' suits any place in the world at any time. Why not follow it, why not pay attention to personality only instead of making a big fuss about a person's social status or the amount of money an individual has? This book is too romantic, but the ability of being romantic is, after all, our strength. Who knows, maybe things that seem too idealistic to us today will become the fundamental society principles tomorrow. Who knows, maybe in the future people all over the world will "only connect" and be happy. At least, one may hope.

Case Study Crescent Pure Essay

Due to Crescent being Portland Drake Beverages’ (PDB) first entry into the U.S. sport/energy beverage market, there are some issues that PDB should consider with regard to Crescent’s impending launch. These issues consist of determining what customers want, being discussion-worthy and being transparent. Before launching Crescent it is essential to make sure that there is a place for Crescent in the market. Sarah Ryan, Vice President of Marketing for PDB, is doing this by trying to specify whether Crescent fits in the market better as an energy drink, a sport drink or a healthy organic beverage. Being discussion-worthy is another important issue to consider because it is important to make sure Crescent’s product stands out against the various other energy/sport beverage companies that are coming out with their own products. By captivating your consumers with something discussion-worthy, you’ll foster organic word-of-mouth about your brand. Being transparent is also a vital issue to consider because consumers have so many options on where to spend their money for sport/energy drinks. By being transparent and showing consumers exactly where their money is going, Crescent’s product will attract consumers. Letting consumers know where Crescent’s products are coming from and why they are priced they way they are gives power to the consumer, and helps them feel confident about their purchases. The factors that should influence the position of Crescent are competitors, market segmentation and market size. The market segmentation for sport drinks and energy drinks are distinguished through levels of hydration provided, energy provided, nutrition provided and favorable taste provided. Most energy drinks have higher energy, lower nutrition, lower hydration and  lower favorable taste compared to sports drinks. Additionally, the largest group of energy drink consumers were males between the ages of 18-34. Also parents of children were more likely to consume energy drinks and the highest volume of drinks consumed was by respondents with a household income below $25,000 per year. For sport drinks, roughly half of men consumed them, while only a third of women did. Furthermore, although 40% of men found sports drinks refreshing, only 27% of females did. Sports drinks appealed to younger consumers, 62% of those between the ages of 18 to 24. Crescent’s best target is males a nd females between the ages of 18-35. PDB must decide whether or not to position Crescent as an energy drink, a sport drink, or a healthy organic beverage. The advantages for positioning Crescent as an energy drink is that the market size for energy drinks has grown 40% between 2010 and 2012. Energy drinks were estimated to be $8.5 billion in the United States in 2013; forecasts projected that figure to reach $13.5 billion by 2015. Another advantage is that Crescent is a beverage that consists of organic ingredients that are a healthier option than most energy drinks. This is an advantage because sales of energy drinks with lower levels of caffeine and purer ingredients are rising due to consumer demand for healthier food and beverage choices. A disadvantage for positioning Crescent as an energy drink is that many potential consumers view energy drinks as unhealthy and might not see past that when PDB launches their new Crescent energy drink. Due to news stories highlighting the alleged health risks from energy drinks, 32% of consumers over 18 indicated they drank an energy drink in the last six months, 11% of who were drinking fewer energy drinks than they had a year earlier. The advantages of positioning Crescent as a sport drink is that the market size is also increasing. The market increased 9% between 2007 and 2012. In 2012, sports drinks reached $6.3 billion in the United States and are expected to grow to $9.58 billion by 2017. Another advantage of positioning Crescent as a sports drink is that diet and low-sugar beverages, which did not exist before 2009, had grown by 33% between 2010 and 2012. The market size for diet and low-sugar sports drinks is expected to increase from $1.4 billion in 2012 to $2.97 billion in 2017. This is perfect for PDB because  the Crescent beverage is based on being a diet, low-sugar, and overall healthy option. The disadvantage of PDB positioning Crescent as a sports drink is the concern regarding rising childhood obesity rates resulting in government-mandated guidelines to remove high-calorie sugary drinks and snacks, including sports drinks, from school vending machines. This could be a negative impact on the amount of sports drinks young consumers buy, who make up a large portion of the sports drinks that are consumed. The advantages of positioning Crescent as a healthy organic beverage is due to consumers currently moving towards healthier food and beverage options, as mentioned earlier. It is a market that is currently growing and will continue to grow. The disadvantage of positioning Crescent as a healthy organic beverage is that it lacks the energy that is provided by other energy drinks due to its use of organic ingredients. A focus group feedback found that some young consumers noted that Crescent had less energy than they had hoped. The positioning strategy that I would select would be a healthy organic beverage. It is important to find what draws you apart from the competition and then advertise based on that. The target market that Crescent wants to attract are people who are health conscious and consumers who buy sugary energy and sport drinks aren’t going to be as health conscious. Other implications that this will have for other elements of the marketing mix is that PDB could potentially raise the price for a Crescent beverage because some consumers from the focus group questioned PDB’s ability to deliver quality organic ingredients at $2.75, when most healthy organic beverages are above $3.00. Another implication this will have for other elements of the marketing mix is where this product is going to be sold. If Crescent is being sold as a healthy organic beverage then it must be sold in a store that sells other healthy and organic products in order to provide for the right target market. Lastly, Crescent will have to be advertised as a healthy organic beverage through packaging, commercials and other forms of advertisement showing that this product is healthy and only organic ingredients are used to make it.