Epistemology Is A Better Choice Over Traditional Epistemology

Epistemology can be split into two areas: one being traditional epistemology and the other being naturalized epistemology. The distinction between the two forms of epistemology is that traditional epistemologists accept what they think they know whereas natural epistemologists put what they think they know to empirical tests. The connotation of ‘empirical’ in this context refers to the methodologies of natural science; specifically, putting theories that we believe to know to scientific experimentation to find out if the theory is true. In this essay, I will establish the reasons why naturalized epistemology is a better choice over traditional epistemology. First, I will establish why traditional epistemology can be a potentially viable†¦show more content†¦A paradigm-shift is where a set of theoretical principles is replaced by another, for example: Special Relativity replaced Newtonian Mechanics. The problem with this is that theoretical paradigms have no common basis; hence, paradigm-shifts cannot work. Special Relativity and Newtonian Mechanics may seem to have the same theoretical meaning, but they do not because the terms of ‘mass’, ‘force’, and ‘duration’ all have a different meaning to different scientists. Science, in Kuhn’s opinion and from what is gathered on theoretical paradigms, does not provide concrete, epistemic, nor empirical assumptions. It does not work best empirically because matters dealing with science must happen with theoretical paradigms, where effectiveness is a problem. Epistemic thought executed in an empirical manner is better known as naturalized epis temology. Although, traditional epistemology, or sometimes referred to as normative epistemology, can help us further our understanding of philosophy. Jaegwon Kim expounds on this type of epistemology in his work, What is â€Å"Naturalized Epistemology†?, in which he states â€Å"that justification is a central concept of our epistemological tradition, that justification, as it is understood in this tradition, is a normative concept, and in consequence that epistemology itself is a normative inquiry whose principal aim is a systematic study of the conditions of justified belief† (Kim, 539). Epistemology can be

The Intersection of Race, Sexual Orientation and Religion...

Intersectionality is a relevant theory for some gay, lesbian or bisexual individuals. Intersectionality studies the relationships among multiple dimensions and modalities of social relationships and subject formations (McCall, 2005). The theory argues, pursues and considers how gender, race, sexual orientation and other categories of identity interact on many and often concurring levels of social relationships, therefore allowing discrimination and social inequity. Intersectionality explains how the notion of social injustice, such as racism, sexism, homophobia, and belief-based bigotry such as religion are not independent of one another; instead, they are interconnected, and thereby reflect â€Å"intersectionality† in regards to social†¦show more content†¦Every day in the United States, a young person, under the age of eighteen faces homelessness, and most often it’s because of others. In a report by The National Gay and Lesbian Task Force, it was noted that 26% of LGBTQ youth were kicked out of their homes when they came out (Ray, 2006). The Urban Justice League reports numbers as high as 78% of LGBTQ youth that â€Å"were removed from or left their foster care placements because they were un-welcoming or hostile towards their sexual orientation and/or gender identity † (Feinstein, Greenblatt, Hass, Kohn, Rana, 2001). The United States is an independent, individualistic country; we prize the freedom of expression, but do we really? One of the most significant, if not the most important, social structures is the family. Gay, lesbian and bisexual individuals who are aware of their sexuality, must create an alternative self to present to family and friends, especially if there is an understanding, verbalized or implicit, that homosexuality is not tolerated, or simply wrong. Many gay, lesbian and bisexual men and women would rather go with the flow, assimilate, not make waves, rather than to express their own gay identit y, and risk ostracism. When race is factored into the equation of homosexuality, it becomes more complicated. Taking a look at Black and Latino cultures over the past ten to twenty years, there was an emergence ofShow MoreRelatedThe Reasons behind Homosexual Discrimination1214 Words   |  5 Pageswhat you feel, because those who mind dont matter and those who matter dont mind. Essentially, this advice is applicable to any given individual, yet it seems that it is most suitable for homosexuals, and therefore why it lies within the heart of gay rights. It is inevitable, that as a minority group, homosexuals will find that they will encounter more people who â€Å"mind† than heterosexuals. 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Normal Birth Free Essays

research Do women’s ideas of ‘normal’ birth match those held by professionals? Abstract Aim: To explore the definitions of normal birth held by women who have not given birth, what influences that perspective, and compare it with those of health professionals. Background: Available evidence provides conflicting definitions of normal childbirth. The majority of available evidence encapsulates the views of the health professionals themselves or women who have experienced childbirth. We will write a custom essay sample on Normal Birth or any similar topic only for you Order Now Little evidence exists that reflects the views of women yet to experience childbirth. Method: Six participants were identified via purposive sampling to undertake a small exploratory qualitative study utilizing semi-structured interviews and thematic analysis. Ethical approval was obtained. Results: The definition of normal birth is individual and complex. The absence of complications and use of interventions influenced this definition, which in part agrees with health professionals’ current definitions. Birth was perceived as a scary prospect; a view largely constructed from negative stories from friends and family. Conclusions: The findings suggest that working within the confines of a definition of ‘normal’ childbirth is far from straightforward. It highlights a need to encourage women to view birth more positively. Expanding this research further would explore these issues in more detail, providing more conclusive evidence to support practice. thinking to happen, both parties need to agree on what a ‘normal’ birth actually is. With these thoughts in mind, this research study set out to explore the understanding of normal birth held by women who have yet to experience birth, what influenced that understanding, and how closely their responses matched the range of definitions and ideas held by health professionals. Background Childbirth is multidimensional and requires a definition that covers all aspects (Downe, 2006). However, differences of meaning are in use by various professions, and none of the definitions truly encapsulate all aspects of childbirth or provide a consistent definition (Gould, 2000). For some, childbirth without intervention is normal and optimal; for others, as long as the baby is born vaginally without assistance then this constitutes a normal birth. The term ‘normal childbirth’ has been used for decades as a way of differentiating between birth outcomes often for the purpose of producing statistical data. However, with continual scientific developments and an ever-changing society, the boundaries of what could be termed ‘normal’ have become blurred, particularly where interventions (and different degrees of interventions) are concerned. The World Health Organization (WHO) (1996) defined normal birth as: ‘Spontaneous in onset, low risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position, between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition’. Conversely, however—and only a year later— Beech (1997) argued that: ‘ the expectation that every pregnancy should end in a healthy mother and baby no matter what, has actually encouraged the justification for use of interventions’. British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 A Alison Edwards Senior Lecturer in Midwifery, Birmingham City University Jacky Conduit Lecturer in Nursing and Physiotherapy, University of Birmingham childbearing experience resulting in a healthy mother and baby is optimal. Finding agreement on the best way to achieve this, especially when considering the multifaceted nature of childbirth, is far more complex. Numerous articles and projects have shrouded childbirth in conflicting viewpoints and approaches, leaving even health professionals struggling to agree on a standard definition of normality. Childbirth has increasingly become the focus of reality TV shows, often cleverly edited to portray childbirth in a more ‘entertaining’ way; or to fit a storyline as opposed to reality (Savage, 2006). Alongside this the internet has further provided women with a plethora of new perspectives on childbirth and has possibly influenced their perceptions. With an identified goal to reduce the number of caesarean sections and aim towards birth without intervention (Department of Health (DH), 2007), it could be argued that women should to be able to work alongside health professionals towards achieving this goal of ‘normality’. It could also be suggested that to begin to enable this unity of 720 research The more recent consensus statement by the Maternity Care Working Party (MCWP) (2007), (which includes members of the National Childbirth Trust, ardent promoters of intervention-free birth), reflects some of the changes in their definition whereby some interventions such as augmentation of labour, the use of electronic monitoring and an active third stage, are acceptable. Interestingly, epidurals and episiotomy are excluded from the context of normality in this definition. A study by Downe et al (2001) also raised more questions than answers. Their study raised the issue of ‘commonality’ as a factor in ‘normality’, i. e. whether the rise in the caesarean rate has led to this becoming considered as a ‘normal’ birth. In turn, they concluded that when establishing a percentage rate for normal births, by discounting women who experienced the use of any interventions such as induction and episiotomy, then the percentage of actual ‘normal’ births drops considerably. Downe et al (2001) and Duff (2002) also question the use of terms such as ‘according to rule’ or ‘commonplace’ in definitions, as a caesarean could now be considered commonplace but arguably not ‘normal’. Gould (2000) and Crabtree (2008) concluded that some midwives considered birth to be normal if the woman saw it as normal; further developing the viewpoint that normality is individual to the woman and that every birth experience is unique. Anderson (2003) and McGuinness (2006) questioned the need for a definition at all and speculated about the impact of encouraging mothers to aim for normality, when the midwives themselves are not clear about what it is. However, Anderson’s work is based primarily on the findings of one author and despite a convoluted journey through the literature, merely demonstrates how complex an issue normal childbirth has become. DeClercq et al (2005) reported on a substantial study of new mothers who were asked to describe their birth stories. The majority of the American ethnic minority women interviewed had experienced some degree of medical intervention. Although most felt that interference was not wanted or required, only 10% refused it. Cronin and McCarthy (2003) explored the influences on women’s perceptions and concluded that the greatest influence came from family members. The sample used, however, consisted of predominantly teenage mothers, which may explain the reliance on the family for information. Phenomenological studies by Berg and Dahlberg (1998) and Gibbins and Thomson (2001), evaluated that the women they interviewed all felt that they wanted some control over their birth experiBritish Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 nce but there were gaps in their knowledge which were usually filled by family members or information from the media. These studies of women just after birth or during pregnancy further demonstrated that women didn’t really consider some interventions to be a problem. What was clear in many of the studies, however, was that a positive birth experience led to higher satisfaction rates in the overall childbirth experience; conclusions supported b y the comments found in a collection of births stories documented by McHugh (2001). A few quantitative studies were found by Hundley et al (2001) and Sandin-Bojo et al (2008). Despite using alternative methodology, their findings supported the links between positive views of pregnancy, women’s preferences and the outcome, and the potential for inappropriate use of interventions. Having performed an extensive search using Cochrane, CINAHL and MEDLINE alongside primary and secondary references and seminal texts, the majority of available studies were conducted during the antenatal and postnatal period. No evidence was found which studied women’s perspectives before they became pregnant. This study was therefore evolved to consider the aforementioned concepts and resulted in the research question, ‘Normal childbirth’: Do women’s definitions match those of health professionals? Study design The principal aim of the study was to explore the definitions of normal birth held by women who have yet to experience birth, what influences that perspective, and compare their views with those of health professionals. Objectives The main objectives of this study were to: l Gain insight into whether women who have yet to experience childbirth have similar definitions of normality o health professionals l Explore whether there is a need for improved education of women about childbirth l Gain insight into what influences these women’s perceptions of birth. As the main aim of this small explorative study was to explore women’s interpretation of ‘normal birth’, a qualitative approach was selected. A semistructured interview was selected a s the means of collecting data, as this is well suited for the exploration of the perceptions and opinions of respondents especially with complex and sensitive issues. This approach also enables probing and clarification of responses to take place at the time of the interview itself. This in turn enhances the validity of the find721 research ings (Parahoo, 1997). A semi-structured interview is particularly useful as it allow the participants to tell their own stories, in the way they choose, without the constraints of predetermined questions, as in a questionnaire (Rees, 2003). However, interviews can be time consuming, sometimes difficult to organize, and it can take time and practice to become an effective interviewer. description validity’ while maintaining rigour and trustworthiness (Savage, 2006), the interviews were audio-taped. The discs were destroyed on completion of the study, but until then were stored securely. To maintain confidentiality, each participant was provided with a pseudonym from the outset and only the researcher was aware of the participant’s true identity. Prior to the interviews taking place the participants were provided with an information sheet, outlining the research project and were asked to sign a consent form. Relevant demographic details were also collected. Clarification regarding meeting of the inclusion criteria was sought prior to each interview. The intention was for the interviews to last for up to 40 minutes. To aid focus and consistency, while providing room for flexibility, an interview schedule was drawn up using predominantly open-ended questions. A pilot run of the questions to be used was undertaken and any adjustments made before commencement of the study. This data was discarded and these participants were not involved in the study. The final open-ended questions included: l What has influenced the way you view childbirth? l How important would having a normal birth be to you? More probing questions were introduced as the interviews progressed, to develop the exploration of the individual issues raised by the participants. A small ‘Thank you’ gift consisting of a gift voucher was given to each participant of the main study on completion of the interviews. To ensure validity and rigour (Flick, 2009) purposive sampling, an audit trail, interview schedule and tape-recorded interviews were used. Trustworthiness or credibility was maintained through continued contact and discussion of data with the participants to review the interpretation of the findings. Sampling Purposive sampling was used to ensure the participants met the inclusion criteria. Unlike quantitative research, with qualitative studies small samples are accepted as the norm (Higginbottom, 2004). Inclusion criteria The criteria for inclusion in this study were for women to be of childbearing age between 18 and 45 years, not working in the field of health, and with no personal experience of pregnancy or childbirth. There were no restrictions on level of education, ethnicity, religion or culture. Those women who fell outside the age ranges or who had experienced any degree of childbirth including miscarriage would not be eligible to participate. Initial searches began with an email to female staff within the researcher’s workplace, i. e. an institute of higher education. Initially there was limited response to the first request, but further searching led to a total of six women volunteering to participate. Two volunteers, however, did not fulfil the criteria and were therefore not interviewed. The four women fulfilling the inclusion criteria were working as administrative staff and were between the ages of 22 and 29 years. Three were in stable relationships, although not married, and the fourth was currently single. Levels of education ranged from A levels to Bachelor degrees. Three were white British and one participant was white Irish. None of them had any history of or personal experience of childbearing. Time constraints unfortunately inhibited any further searches, which did lead to a limitation on the variety of women volunteering. The final group subsequently demonstrated a similar range of characteristics and demographics which may provide a more narrowed perspective. However, there is scope in future research to broaden the search to include women from other social backgrounds and ethnic groups. Ethical approval Ethical approval was sought from the research panel at the University and consent was obtained from line managers to approach staff and utilize the rooms for the interviews. As the research did not involve patients and was not undertaken within NHS premises, further ethical approval was not required. The ethics panel granted permission to proceed provided the aforementioned actions regarding confidentiality were adhered to. It was made clear to all participants at the outset that they could withdraw from the study at any point and that if any of them were upset at any stage during the interview it would be stopped and British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 Semi-structured interviews In order to put the participants at ease the interviews took place in private, within the participant’s workplace and with a female researcher. To aid transcription of the data and avoid ‘compromising 722 research support offered. In this case none of the women expressed any concerns or demonstrated any signs of distress. Much of the previous literature concentrated on the definition of ‘normality’ being related to whether interventions were used within the labour. Annabel felt that the definition of ‘normality’ had changed over the years but perceived that ‘commonality’ actually made birth normal. This perhaps contradicts Duff’s (2002) theory that terms such as ‘commonplace’ are not useful when defining normality. Annabel and Lucy both believed that if a lot of people used ‘gas and air’ for example, this made it the norm, but as epidurals were used less often they were not considered normal: ‘ †¦ the epidural and not as many women use that—they don’t have that, except when they have complications. (Lucy) These responses to some extent demonstrated a perceived link between the use of more ‘significant’ interventions and a normal or otherwise outcome; thus agreeing with some of the MCWP (2007) definition and much of the current evidence. In an attempt to explore the respondents’ definition of normal birth in more depth, questions were asked ab out the difference between the terms ‘natural’ and ‘normal’. Reassuringly the responses reflected what many health professionals would consider a difference. Annabel initially struggled to decide what the difference was, but then concluded that: ‘Natural would be not having all the drugs and what not †¦ It’s very normal to have drugs and pain relief and all those sorts of things’. Or as Jane said: ‘I think a natural birth would be naturally having a baby without any drugs, doing it like the normal animal way without having some help. ’ The use of pain relief figured highly in all of the transcriptions but there was not a consensus on whether their use deemed a birth ‘normal’ or otherwise. Despite further probing, limited data were obtained on the use of other interventions apart from drugs. Annabel and Victoria did suggest that having a forceps birth could be considered normal to them and indeed all of the participants expected to be in labour for a long time and have stitches, but other possible interventions were not mentioned. This may have been due to an expressed lack of knowledge about childbirth or British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 Analysis Once the interviews had been recorded and transcribed verbatim, a process of thematic analysis was used. Thematic analysis is a method for identifying, analyzing and reporting patterns (themes) within data. It minimally organizes and describes the data set in (rich) detail (Braun and Clarke, 2006). Various techniques are described here but are based on the process of familiarization with the transcribed data and identifying patterns or themes occurring within it. These are then coded line-by-line to aid further analysis. As part of the researcher’s audit trail and to achieve greater validity of the findings, the researcher’s interpretations of the data was discussed with the individual participants and clarity sought where required following the interviews (Flick, 2009). Findings Following analysis, three main themes emerged: birth without complications is normal, individual and important; birth is painful and scary; and the greatest source of knowledge is friends and family. Birth without complications is normal, individual and important When asked how they would define ‘normal’ birth, the women gave mixed and individual responses: ‘so a normal birth wouldn’t need any drugs or wouldn’t need any—what’s that help? †¦ an epidural or anything like that to help you—you’ve had the baby and you’ve had no problems. (Jane) Victoria felt that it was acceptable to have an epidural and still have a normal birth. She supported the suggestion that birth is individual: ‘It’s quite confusing really, because natural is what I’d see as normal but in society today, normal doesn’t mean natural because caesareans are quite normal umm †¦ to me all different types of c hildbirth are seen as normal. Every individual woman like—I know that for every individual woman no pregnancy is exactly the same so it is normal for some women to have a caesarean and some women not to and all different types of birth. 724 research due to the fact that they were not directly asked about it by the researcher in an effort to avoid influencing the responses. What did prove to be a significant concern for these individuals centred on having complicationfree labour rather than an intervention-free one. For example, when Annabel was asked what she would want from her birth experience, she spoke of: ‘†¦ just sort of a generally easy birth without the complications and what not, the long long labour and things like that. Jane spoke along similar lines: ‘I think my idea is that as long as the baby comes out healthy and there’s been no problem then it’s been a normal birth’. She continued further later in the interview when asked how important normal birth was: ‘I think it would be really important because it’s a massive event so you want to have it set up in your mind that that’s the way I want to do it †¦ if interventions have to happen you understand that these things have to come in. Jane stated her friends had been sharing their bad stories because they are ‘dramatic’; she was able to view the stories more objectively: ‘From the stories you hear about it being so painful but as well it being quite a nice experience and that you’ve got a child and you forget about all the pain. ’ Victoria had gained most of her information from the colleagues she worked with and felt that up until that point she knew very little about it; she reported that the stories she had heard ‘made me feel funny about it’. All of the participants were asked to consider the impact the media and television had on their perception of childbirth. Perhaps reassuringly these participants recognized that the way childbirth is portrayed is often far from realistic and all felt that the greatest influences continued to be family and friends. This compares favourably with the work of Savage (2006). Other common threads ran through all of the interviews, including the need for the absence of complications and that it was the norm to give birth in hospital. Both Jane and Victoria briefly mentioned home birth but would not consider it for themselves for fear of something going wrong. commented about their lack of knowledge about childbirth but when asked the source of their information, family and friends featured highly. Unfortunately, most of the stories the participants had heard were negative, further raising their anxieties about experiencing childbirth for themselves: ‘everyone that’s had a baby talks about it, it’s just not something I fancy doing at all—although some of my friends have had like the easiest birth ever, I tend to focus on the not-so-easy births and think ‘oh my god! hat would be me’. ’ (Annabel). Birth is painful and scary Not unexpectedly (although not directly asked about), all of the participants expressed fear of the unknown regarding childbirth, especially the degree of pain they expected to experience and the potential for, as Victoria expressed it, ‘to los e control’. Victoria also expressed a fear of her body and ‘how it works’ and how ‘it’s like a bit degrading’. In fact, none of the participants felt keen to undergo a pregnancy and birth for, as several expressed it, a ‘fear of something going wrong’. On a more positive note, however, the majority saw pain as a necessity and that the outcome of a new baby made it worthwhile, as Jane surmised: ‘It’s meant to be from what I’ve heard one of the most painful things you can do in life but then at the end it’s worth it. ’ Discussion This study had an identified research question with clear objectives, principally to compare women’s views of normal childbirth with prevalent views of health professionals as reported in existing literature. Three distinct themes were identified which reflect some of the evidence available from studies with women who had already experienced childbirth. Berg and Dahlberg (1998), for example evaluated that the women they interviewed all felt that they wanted some control over their birth experience but there were gaps in their knowledge which was filled usually by family members or British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 The greatest source of knowledge is friends and family This line of questioning resulted in the most discussion and volume of data produced. Throughout the interviews all of the participants repeatedly 726 research from reading in the media. Also in 2001, Downe et al explored the concept of the use of interventions, including caesarean section, becoming ‘commonplace’ and therefore the norm. Indeed some of the participants in this study thought along similar lines If direct comparisons are made to definitions provided in the available literature, then to some degree we can conclude that the definitions of women and health professionals match. Some of the interventions listed in the MCWP’s definition matched those expected by the participants. However, formulating a distinction between ‘normal’ and otherwise proved less straightforward. It is apparent that the women recognized childbirth as an individual concept, and that it was important to them to have a normal birth as they perceived it; studies by Gould (2000) and Crabtree (2008) reflect that health professionals widely acknowledge this. Perhaps controversially, it could be argued that the purpose of differentiating between types of birth lies with the generation of statistical data, supporting funding requests or even a professional need to justify one’s actions, rather than helping to achieve what appear to be the women’s aims of a healthy outcome irrespective of method. Without seeking to encourage an increase in operative birth, perhaps removal of a definition of normality which excludes or includes specified interventions may go some way in helping to ease the pressure on women to conform to an ideal. Crabtree (2008) describes how in New Zealand, the use of interventions has markedly altered the definition of normal birth and while midwives make efforts to protect their women by for example, encouraging home visits to women in early labour, birth is becoming increasingly medicalized with interventions being the norm. Clearly, achieving a birth without any interventions and complications is ideal, and midwives are trained to promote ‘normality’. However, the women who participated in this study feared the pain of childbirth and the possibility of any complications, such as a prolonged labour, far more than having any interventions such as an epidural or stitches. This is consistent with the conclusions drawn by Lawrence-Beech and Phipps (2008) that despite years of medicalization and increasing intervention, women’s hopes for a healthy baby and to feel ‘physically and mentally whole’ after the birth have remained consistent. The 2007 report from the MCWP goes some way toward recognizing that a shift may be needed in thinking about the issue of common interventions and ‘normality’. More extensive research is needed to provide further clarification. British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 For these women who had no experience of childbirth, what proved to be a significant concern was having a complication-free labour rather than an intervention-free one. Regarding the influences on women’s perceptions of normality, the majority of data indicated family and friends having the strongest influence. Unfortunately birth was often portrayed negatively which clearly discourages women. This perhaps presents a need to reconsider the approaches health professionals take when educating women about their ability to give birth. Reflection This was the researcher’s first attempt at utilizing this method of data collection and analysis and it is acknowledged that an effective interviewing technique takes time to develop. Initially the interviewing technique was quite stilted and potentially important leads may have been missed. However, by utilizing the interview schedule as an aid, the latter interviews were much more relaxed and a greater degree of exploration of the points raised was enabled. As highlighted by Green and Thorogood (2004), we needed to consider potential ‘issues of bias due to the influence of the researcher, particularly when they are in the powerful position of health professional’. To redress any imbalance of power and empower the participants to speak with ease (Holloway and Wheeler, 2002), the interviews were conducted within the participant’s workplace at a time convenient to them. There is also the possibility that the participants said what they thought the researcher wanted to hear (Rees, 2003). In this instance it was essential for the researcher to maintain a neutral stance during the interview. Only brief responses to 727 ISTOCKPHOTO research Key points Finding agreement on the best way to achieve a healthy birth can be complex l For health professionals to work with women to achieve the goal of ‘normality’ there needs to be agreement as to what a ‘normal’ birth is l In assessing what women thought about ‘normal’ birth, three main themes emerged: birth without complications is normal, individual and important; birth is painful and scary; and the greatest source of knowledge is friends and family l The resul ts demonstrated an overall limited knowledge of childbirth among women, but, as with health professionals there was confusion as to what constitutes normality articipants’ direct questions were provided and leading questions were avoided. It is also inevitable that to some extent the interviewer’s knowledge and experience would influence the process and possibly the interpretation of the data. To minimize this impact the researcher aimed to ‘bracket’ out her own views until the interviews were completed. This involved suspending the researcher’s feelings while accepting that her own values will impact to some degree on the study (Lavender et al, 2004). In this instance, however, the researcher’s knowledge proved beneficial during the interpretation process as it enabled direct comparison between a health professional’s view and that of the participant’s. Conclusions The findings of this small research project have only begun to scratch the surface of the initial enquiry. Much of the research undertaken prior to this was carried out on women who had experienced childbirth, therefore women who had yet to experience childbirth were selected for study. The results demonstrated an overall limited knowledge of childbirth, but, as with health professionals the same confusion over what constitutes normality prevailed. The opportunity for more extensive research presents itself as this was a limited sample size. With a much larger sample clearer conclusions may be generated, providing greater supporting evidence for a rethink over what constiBJM tutes normality in today’s society. Anderson G (2003) A concept analysis of ‘normal birth’. RCM Evidence-based Midwifery 1(2): 48–54 Beech BAL (1997) Normal birth – does it exist? AIMS Journal 9(2): 5–8 Berg M, Dahlberg K (1998) A phenomenological study 728 of women’s experiences of complicated childbirth. Midwifery 14(1): 23–9 Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3: 77–101 Crabtree S (2008) Midwives constructing ‘normal birth’. In: Downe S, ed. (2008) Normal Childbirth: Evidence and Debate. Churchill Livingstone, London Cronin C, McCarthy G (2003) First time mothers – identifying their needs, perception and experiences. J Clin Nurs 12(2): 260–7 DeClercq E, Sakala C, Corry MP, Applebaum S (2005) Listening to mothers II: Report of the Second National US Survey of Women’s Childbearing Experiences. J Perinat Educ 16(4): 9 Department of Health (2007) Maternity Matters: Choice, Access and Continuity of Care in a Safe Service. The Stationery Office, London Downe S (2006) Engaging with the concept of unique normality in childbirth. BJM 1(6): 352–6 Downe S, McCormick C, Lawrence Beech B (2001) Labour interventions associated with normal birth. BJM 9(10): 602–6 Duff E (2002) Normal birth: ‘commonplace’, ‘according to rule’ or ‘well adjusted’? MIDIRS Midwifery Digest 12(3): 313–4 Flick U (2009) An Introduction to Qualitative Research. 4th edn. Sage Publications Ltd, London Gibbins J, Thomson AM (2001) Women’s expectations and experiences of childbirth. Midwifery 17(4): 302–13 Gould D (2000) Normal labour: a concept analysis. J Adv Nurs 31(2): 418–27 Green J, Thorogood N (2004) Qualitative Methods for Health Research. Sage Publications Ltd, London Higginbottom G (2004) Sampling issues in qualitative research. Nurse Res 12(1): 7–19 Holloway I, Wheeler S (2002) Qualitative Research in Nursing. 2dn edn. Blackwell Publishing, Oxford Hundley V, Ryan M, Graham W (2001) Assessing women’s preferences for intrapartum care. Birth 28(4): 254–63 Lavender T, Edwards G, Alfirevic Z (2004) Demystifying Qualitative Research in Pregnancy and Childbirth. Quay Books, Wiltshire Lawrence -Beech BA, Phipps B (2008) Normal birth: women’s stories. In: Downe S, ed. Normal Childbirth: Evidence and Debate. Churchill Livingstone, London Maternity Care Working Party (2007) Making normal birth a reality. RCM, RCOG and NCT, London McGuiness F (2006) Defining normal birth would help midwives and mothers. BJM 14(6): 328 McHugh N (2001) Storytelling and its influence in passing birth culture through the generations. Midwifery Matters 89: 15–17 Parahoo K (1997) Nursing Research: Principles, Process and Issues. MacMillan Press Ltd, London Rees C (2003) An Introduction to Research for Midwives. 2nd edn. Books for Midwives Press, Cheshire Sandin-Bojo A, Wilde Larsson B, Hall-Lord M (2008) Women’s perception of intrapartal care in relation to WHO recommendations. J Clin Nurs 17(22): 2993–3003 Savage JS (2006) The lived experience of knowing childbirth. J Perinat Educ 15(3): 10–24 World Health Organization (1996) Care in Normal Birth: A Practical Guide. WHO, Geneva British Journal of Midwifery †¢ November 2011 †¢ Vol 19, No 11 How to cite Normal Birth, Essay examples

Macroeconomics Singapore Government Forecasts

Question: Describe about the Report for Macroeconomics of Singapore Government Forecasts. Answer: Summary of the Article: Singapore government forecasts the growth rate of economic performance of Singapore stays around 1 to 3 percent. However, there is a disagreement of economist regarding the proposed statistics of this economic performance. According to them, it is likely to be the lower than this. The growth rate of economic performance may be 1.5 to 2.5 percent. Monetary Authority of Singapore (MAS) and Ministry of Trade and Industry publish an annual report on July 25th. Central Bank keeps a close look at the exit of Britten from the European Union, the issue of decreasing pace of Chinas economic growth and quick recovery of UKs economy. However, according to MAS, the economy of Singapore is losing its pace of growth in the first six months, likely to increase its pace in the following half of the year. Economists take into account the issue of Brexit and Chinas low-pace economic performance (Room 2016); suggest the economic growth rate is around 1.5 percent to 2.5 percent. The economist of OCBC Ba nk suggests almost the same figure. MAS and economist of DBS even fear of fall of the growth rate even lower by this time. According to MAS, trade cluster is likely showing some improvement. There is improvement in certain sectors or industry like electronics, sea- transport and the wholesale. Manufacturing sector shows an improvement from 0.5 percent to 0.8 percent in the second quarter than the first quarter of the year. Construction and service sectors do not show that much of improvement. However, there is a requirement of improvement in these sectors. According to Ravi Menon, the managing director of MAS, if there is no such improvement; the growth rate may be lower than the previous year. This is a real concern of the government of Singapore (Leong, Ashokkumar and Kentish 2016). MAS recommend the policy for appreciation of zero in foreign exchange. Central Bank realizes a need of change in the existing monetary policies. MAS expectation is that gradually increasing inflation rate can cause to change in the decision of the Central Bank regarding the monetary policy. However, Central Bank clearly shows its intentions for an unchanged monetary policy. There is an interest of MAS to ensure the financial integrity of the Singapore economy. Central Bank takes some steps for the financial institution to manage the flows related to 1MDB. The statement of the Central Bank is far more comprehensible to the public than the usual one. There is a clear disappointment of MAS regarding a declining reputation of Singapore economy as a trustable center of finance. To decrease the activities of money laundering, MAS suggests active and strong regulatory framework, a corporation from the close boarder, strong supervision on a financial institution and proper enforcement of law s. Enforcement of proper rules and regulations can prevent various fraudulence and illegal activities of Singapore (Quah 2016). Economic Definition used in this analysis: Economic Growth: In case of Singapore, economist hopes that the growth of the economy or the economic performance of the Singapore economy is 1.5% to 2%. This figure of the rate of growth of the Singaporean economy is not convincing. To sustain its past brilliant performance of the economy, the policy makers should look forward, approve and implement the required changes to the existing policies, according to the needs of the economy (Harvie and Van 2016). Inflation: The expectation of MAS regarding the future or the inflation rate of 2016 is in between -0.1% to 0%. Monetary policy: The monetary authority of Singapore (MAS), manages all the monetary policies of Singapore. Central Bank of Singapore plays a crucial role in determining the various policies in the field of various monetary factors like rate of interest, rate of foreign exchange, inflation, and price stability. Volatility in the price can cause serious problem to the economy. Therefore, there should be price stability. Money laundering: The Central Bank of Singapore sets up a new body to prevent the act of money laundering. The rising case of money laundering is the main reason of deterioration in the trust on the Singaporean economy in any related financial flows (Jansen 2016). Economic Analysis: According to MAS, the expected growth rate of Singapore is not very impressive in 2016. The joint study of MAS and Ministry of trade and industry of Singapore publishes a report on the expected rate of growth of the economy. This report suggests that the future rate of growth of the economy stays between 1.5 to 2.5 percent. There may be several reasons behind this lower growth rate. The influential effects are the sudden exit of Britten from the European Union, the economic recovery of UK and slow growth rate of China. Adding to this context, there are some hopes arise for the performance of manufacturing, sea transport and the wholesale industry. However, the performances of the service sectors and construction sectors are not so impressive (www.mas.gov.sg. 2016). In recent day, to sustain a development of the emerging economy like Singapore, there is a requirement of sustained increase in a tertiary sector like transport and service sectors along with a healthy increase in primary and secondary sectors. However, the trends and performance of the economy of Singapore in the tertiary sector are not that remarkable. Along with this problem, the Central Bank does not make them ready to change their monetary policies. Its market policies are inconsistent with the ongoing economic situation in Singapore. Inflation rate gradually starts increasing. There are also various problems of money laundering and financial-flows related 1MDB. In the following diagram, there is a graph of the growth rate of GDP of Singapore (Room 2016). In figure 4, the horizontal axis measures the time and vertical axis measures the growth rate of GDP of Singapore. The following graph shows the rate of GDP of Singapore from 2011 to 2016. The measurement of the rate of GDP is on a quarter scales. The blue bars are showing the division of GDP from quarter-to- quarter scale. The red line indicates the variation of the rate of GDP from year to year scale. The year-to-year scale shows a sharp decline in the rate of GDP in the period of 2011, and then it is fluctuating. It stats increasing at mid-quarter of 2013 till the last quarter. Then again, it starts decreasing and after then showing a fluctuation and remains lower till the end of first quarter of 2016 (Schmoke et al. 2016). Quote from the given article, the central bank also said on Monday unless there was a marked deterioration in the global economy, or a significant shift in the inflation outlook, there is no need to change its current monetary policy stance----- this means that the central bank does not ready to change its monetary policies. The central bank changes its monetary policies if the inflation rate is significantly high or any urgent requirement arises. Figure 1, shows the demand for money and figure 2, represents the supply of money. In figure 3, first curve shows the short run equilibrium and the second graph shows the long run equilibrium of the money market. In short run aggregate supply curve is upward sloping and aggregate demand curve is downward sloping. As the demand increases relative to supply, price level rises. In long run, aggregate supply is fixed. Therefore, increase in money supply raises the aggregate demand and raises the level of price. The demand for money has a negati ve relation with rate of interest and fixed money supply for a given time. The equilibrium in money supply and demand decides the rate of interest. As there is no hike in inflation, there is no change in the monetary policy by the central bank. Figure 1: demand for money (Source: created by author) Figure 2: supply of money (Source: created by author) Figure 3: demand and supply of money in SR and LR (Source: created by author) Figure 1:The growth rate of GDP (Source: created by author) Economic implication: From the above discussion, it is clear that Singapore economy faces a serious problem. Singapore government needs to keep a close look on the issue related to prevention of money laundering activities. The government should maintain the earned- reputation of Singapore in related financial matters and rescue back its position in the global market. The government should enhance and maintain the internal and external financial integrity. The growth of tertiary sectors is very important for any economy. Singapore shows an improved performance in the manufacturing means secondary sectors. However, there is a requirement of improvement of all the sectors in a balanced way. Therefore, there is need of a strong regulatory framework, strong supervision on the financial institution, proper enforcement laws (He 2016). Conclusion: The economy of Singapore is an emerging economics. It shows a very impressive growth rate in the past. All the sectors show remarkable improvement in this regard in the past. However, due to some reasons the economy of Singapore faces some troubles in no time. There is a strong influence of certain external economic changes on the Singaporean economy. Keeping an eye on these external issues, there is a requirement of serious concern of Singapore government and Central Bank. There is a requirement of giving strong emphasis on the recommended policies of efficient policy makers and to the expert economist. Central Bank should modify its current monetary policies. Various events of money laundering and other illegal activities cause deterioration in the financial reliability of the Singapore in the global market. Therefore, to earn the reputation of the economy all over again, there is a need for coordination of all the sectors of the economy. The proposed recommendations and evaluation s of 2016 annual report of MAS are very important. Therefore, there is a need for strong concern and effective implementation of various policies to recover from the present positions. Reference: Harvie, C. and Van Hoa, T., 2016.The causes and impact of the Asian financial crisis. Springer. He, D., 2016. The Hidden Dangers and Risks to Chinas Currency Security. InFinancial Security in China(pp. 19-31). Springer Singapore. Jansen, K., 2016.External finance in Thailands development: An interpretation of Thailands growth boom. Springer. Leong, T., Ashokkumar, M. and Kentish, S., 2016. The Growth of Bubbles in an Acoustic Field by Rectified Diffusion.Handbook of Ultrasonics and Sonochemistry, pp.69-98. Quah, J.S., 2016. Development: The Singapore Case.Asian Development and Public Policy, p.1. Room, R. (2016). Macroeconomic Review Apr 2016. Mas.gov.sg. Available at: https://www.mas.gov.sg/News-and-Publications/MAS-Announcements/2016/Macroeconomic-Review-Apr-2016.aspx [Accessed 12 Aug. 2016]. Room, R. (2016). The Singapore Economy. [online] Sgs.gov.sg. Available at: https://www.sgs.gov.sg/The-SGS-Market/The-Singapore-Economy.aspx [Accessed 12 Aug. 2016]. Room, R. 2016. Monetary Policy Macroeconomic Review.Mas.gov.sg. Available at: https://www.mas.gov.sg/monetary-policy-and-economics/monetary-policy/macroeconomic-review.aspx [Accessed 12 Aug. 2016]. Room, R. 2016. The Singapore Economy Recent Economic Developments in Singapore. Mas.gov.sg. Available at: https://www.mas.gov.sg/monetary-policy-and-economics/the-singapore-economy/recent-economic-developments-in-singapore.aspx [Accessed 12 Aug. 2016]. Schmoker, C., Russo, F., Drillet, G., Trottet, A., Mahjoub, M.S., Hsiao, S.H., Larsen, O., Tun, K. and Calbet, A., 2016. Effects of eutrophication on the planktonic food web dynamics of marine coastal ecosystems: The case study of two tropical inlets.Marine Environmental Research,119, pp.176-188. www.mas.gov.sg. 2016. www.mas.gov.sg. Available at: https://www.mas.gov.sg/~/media/resource/publications/macro_review/2016/MR_April2016.pdf [Accessed 12 Aug. 2016].

Spina Bifida Essay Example

Spina Bifida Essay Approximately one in 1000 children born in North America is affected with spina bifida, which makes the latter one of the most common and disabling congenital defects. Due to advances in medicine and technology over the past 40 years, the predicted lifespan of a child born with this disability has improved considerably. The focus of treatment now lies in the ongoing medical and rehabilitative management of the disability, including multiple and complex neurological, surgical, orthopaedic, gastrointestinal, and urological surgical procedures, as well as long-term use of orthotic aids and mobility devices and ongoing physiotherapy regimens. Risk Factors Spina bifida is one of the most common, serious malformations of human structure. At birth, it tends to be more common in girls than in boys. Additionally, the prevalence of spina bifida varies across time, by region, and by both race and ethnicity. Since the early 1980s, estimation of the prevalence of spina bifida in many industrialized countries has been complicated by the availability of prenatal diagnosis and the elective termination of some affected fetuses (Chan et al, 1993). A recognized chromosomal, teratogenic, or Mendelian malformation syndrome can be identified in a small proportion of individuals with meningomyelocoeles (Kallen Harris, 1998). However, most affected individuals do not have an underlying malformation syndrome. The list of variables that have been implicated as risk factors for the non-syndromic form of spina bifida is long and varied, ranging from maternal consumption of blighted potatoes to a short inter-pregnancy interval. However, most of the associati ons that have been reported are weak and have not been replicated in subsequent studies. Consequently, only a few variables have been established, or are strongly suspected to be risk factors for spina bifida: history of previous affected pregnancy with same partner, inadequate maternal intake of folic acid, pregestational maternal diabetes, valproic acid and carbamazepine. We will write a custom essay sample on Spina Bifida specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Spina Bifida specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Spina Bifida specifically for you FOR ONLY $16.38 $13.9/page Hire Writer A family history of spina bifida or anencephaly is one of the strongest risk factors for these disorders. The risk for spina bifida or anencephaly, or both, in the siblings of affected individuals ranges from 3% to 8% and is consistently higher than that of the general population. An increase in the risk of spina bifida has also been reported for second and third degree relatives of affected individuals (Carter Evans, 1973). One study has suggested that the risk of having a child with spina bifida or another type of neural tube defect might be increased in couples who have had a child with Downs syndrome, and the risk of having a child with this syndrome might be increased in couples who have had a child with a neural tube defect (Barkai et al, 2003). It is apparently that additional investigation is needed to confirm or rule out any potential link between these two disorders. It is generally accepted that inadequate intake of natural folate, or its synthetic form, folic acid, before and during early pregnancy, is associated with an increased risk of spina bifida and anencephaly. Case-control studies, randomized clinical trials, and community-based interventions with vitamin supplements have shown that the failure to consume folic acid supplements or folic acid-containing multivitamins increases the risk of having an affected child by two-fold to eight-fold (Wald et al, 2001). Moreover, the risk of having a child affected by a neural tube defect is indirectly related to both maternal folate and folic acid intake (from dietary sources and supplements) and maternal folate status. The mechanism underlying the association between neural tube defects and folate has not been established. However, folate participates in two metabolic pathways that, if disrupted, could have an adverse effect on the development of the embryo. One of these pathways is important for nucleic acid synthesis, and the other for a range of methylation reactions. Disruptions in folate metabolism can also result in raised homocysteine concentrations, which are teratogenic to the neural tube in some animal models (Wald et al, 2001). Women with pregestational diabetes are at increased risk of having a child with spina bifida and other types of birth defects (e.g., diabetic embryopathy). In these women the risk of having a child with a malformation of the central nervous system, including spina bifida, is two-fold to tenfold higher than the risk in the general population. The mechanism underlying this teratogenic effect has not been established, but it is clearly related to the degree of maternal metabolic control. Indeed, there is evidence that the risk of congenital malformations in the offspring of diabetic women is associated with first-trimester blood glucose concentrations (assessed by glycosylated haemoglobin concentrations) (McLeod Ray, 2002). Whether raised glucose concentrations are directly teratogenic, or whether they serve as a marker for another teratogenic agent (e.g., ketone bodies, free oxygen radicals) is unclear. Many anticonvulsant drugs are known teratogens. However, different anticonvulsants are associated with different constellations of malformations. An increased risk of spina bifida is associated with in-utero exposure to valproic acid or carbamazepine alone, or in combination with each other or other anticonvulsants. In infants exposed to valproic acid or carbamazepine the risk of spina bifida might be as high as 1%-2%. Women who use these drugs for indications other than epilepsy (e.g., bipolar disease, migraine, chronic pain) are also at increased risk of having a child with spina bifida if they become pregnant while taking these drugs. The mechanisms by which valproic acid and carbamazepine increase the risk of spina bifida have not been established. Diagnosis Maternal serum ÃŽ ±-fetoprotein and ultrasound are now routinely used to identify fetuses that have or are likely to have either spina bifida or anencephaly. Positive findings from either of these two screens can be followed by amniocentesis or detailed sonography, or both. When amniocentesis is done, amniotic fluid ÃŽ ±-fetoprotein and acetylcholinesterase concentrations can be used to confirm the presence of an open fetal malformation and differentiate between open ventral wall defects (e.g., gastroschisis and omphalocoele) and open neural tube defects (Loft, 1990). Â  Additionally, the fetal karyotype can be examined to rule out chromosomal anomalies. However, sonography can also be used to differentiate between ventral wall and neural tube defects, and to identify additional structural malformations that are characteristic of fetuses with chromosomal abnormalities. When a diagnosis of spina bifida is confirmed, ultrasound is used to assess spontaneous leg and foot motion, leg an d spine deformities. Most fetuses with spina bifida that are not electively terminated receive no treatment until after birth. Several studies have investigated whether method of delivery influences the outcome for infants with the disorder. Anteby and Yagel (2003) concluded that, in general, there is no conclusive evidence that caesarean section improves the outcome in children with spina bifida relative to vaginal delivery. However, caesarean section might be justified for large lesions, to reduce the risk of trauma, and is done after in-utero treatment of spina bifida because the forces of labor are likely to produce a dehiscence. Treatment Closure of the spinal lesion is usually done within 48 hours of birth. However, there are data indicating that, with antibiotics, the risk of infection does not rise until a week after birth. Â  If there are overt signs of hydrocephalus, and imaging studies confirm the presence of ventriculomegaly, a shunt is usually placed at the same time as the lesion is closed (Charney, 1985). However, in most cases hydrocephalus is not manifest until a few days after surgical closure. Spina bifida is a disorder that might be suitable for in-utero treatment, since it is compatible with life, is associated with substantial morbidity, and is routinely detected before 20 weeks of gestation. Moreover, neurological deterioration of affected fetuses might occur during gestation. Specifically, leg movement can be seen on sonograms of some affected fetuses before 17 to 20 weeks, whereas later in gestation and in neonates there is typically some degree of deformity and paralysis (Korenromp, 1986). The lo wer limb movements noted early in gestation could be secondary to spinal are reflexes. However, such movements could be of cerebral origin and their absence in later gestation may be the result of neural tissue damage caused by exposure to amniotic fluid or trauma. Additionally, animal studies, in which a model for spina bifida is created by laminectomy and exposure of the spinal cord to amniotic fluid, show that function can be retained if the lesion is closed before birth (Meuli et al, 1995). The first cases of in-utero spina bifida repair were done in 1994 with an endoscopic technique (Bruner et al, 1999) that proved unsatisfactory and was abandoned. In 1998, in-utero repair of spina bifida by hysterotomy was reported. Early experience suggested that infants treated by hysterotomy had improvement in hindbrain herniation, and possibly a diminished need for shunting relative to infants treated postnatally. It might be that in-utero treatment reduces the need for shunting by eliminating the leakage of spinal fluid that puts back-pressure on the hindbrain, such treatment allows reduction of the hindbrain hernia and relieves the obstruction of the cerebrospinal fluid outflow from the fourth ventricle. Compared with historical controls, infants treated in utero have a lower incidence of moderate to severe hindbrain herniation and hydrocephalus requiring shunting. In a series of 50 spina bifida cases treated in utero at the Childrens Hospital of Philadelphia, reversal of hindbrain herniation was reported in all cases, and the proportion requiring shunting was less than that in historical controls (43% versus 85%) (Johnson et al, 1989). A similar proportion requiring shunting (54%) was also noted in a series of 116 spina bifida cases treated in utero at Vanderbilt University Medical Center (Bruner et al, 2004). Comparisons between infants with spina bifida who were treated in utero and historical controls are however subject to substantial bias. Infants treated in utero represent a highly selected subset of affected individuals. Additionally, the medical management of such infants might differ from that of historical controls for reasons unrelated to the in-utero repair. Prognosis Short-term and long-term survival of individuals with spina bifida has increased with improvements in medical and surgical management. The most recent population-based data indicate that 1-year survival is about 87%, and that roughly 78% of all individuals with spina bifida survive to the age of 17 years (Wong et al, 2001). Unfortunately, these individuals continue to be subject to excess morbidity and mortality into and throughout adulthood. Whether treated in utero or postnatally, individuals with spina bifida are at substantial risk for leg weakness and paralysis, sensory loss, bowel and bladder dysfunction, and orthopaedic abnormalities (e.g., clubfoot, contractures, hip dislocation, scoliosis, kyphosis). In general, the functional level of the defect corresponds to the anatomical level of the bony spinal defect as determined by radiology. However, a retrospective study published in 2002, noted that functional level was higher (worse) than the anatomic level in 48% of individuals with spina bifida, and lower than the anatomic level in 14% of individuals (Rintoul et al, 2002). Individuals with spina bifida are at risk for associated malformations of the nervous system, including hydrocephalus and Chiari II malformations. Process Neonates with spina bifida should have baseline imaging studies of the central nervous system and subsequent serial head measurements to assess the velocity of head growth and the need for shunting. Orthopaedic deformities should also be treated shortly after birth, and ultrasonography and urodynamic studies should be done to assess the status of the urinary tract and provide a baseline for continuing assessment. At this age, bowel function is usually not a substantial difficulty since affected infants have the gastrocolic reflex and pass stools with most feedings. Medical care and monitoring of individuals with spina bifida is best provided by regular assessments by a multidisciplinary team. This team should be under the direction of a skilled physician with training in the care of children who have multiple disabilities, and should include a coordinator who is responsible for patient follow-up. Additional team members should include a nurse specializing in the care of children with multiple handicaps, a paediatric neurosurgeon, urologist and orthopaedic surgeon, a physical therapist, and a social worker. Other sub-specialists should be available on an as needed basis. Team members should be in direct communication with each other and with the patient’s primary care physician, who should provide routine medical care (e.g., immunizations) and continuing emotional support for the family. Psycho-Social Implications As it is well known children with spina bifida have problems with perceptual and cognitive skills, particularly complex visual-spatial tasks involving figure-ground relations, form consistency, spatial memory, and the location of stimuli in space (Fletcher et al. 2000). It has been shown that children with spina bifida demonstrate preserved abilities on measures that include simple visual discrimination and simple spatial relations (Fletcher et al. 2000). For instance, Dennis et al. (2001) found that children aged 6 to 15 years with spina bifida were as adept as matched control individuals in the perception of visual illusions concerned with size, length, and area. Various studies indicate that parents of disabled patients express a need for greater support on psychosocial aspects of their adolescents’ condition, including a desire for more anticipatory guidance in the areas of vocational/educational training, sexuality, and daily living skills (Samuelson et al, 1992). Therefore, rehabilitation professionals who serve children with spina bifida and their families should help the family by nurturing the youth through stressful periods, and by teaching family members tangible ways to strengthen adaptive functioning. Thus, while the rehabilitation team can help with the important outcomes of functional status and medical management of the condition, effective, family-centered care must also attend to the crucial developmental skill building. Two major focuses are needed in supporting families that are coping with spina bifida: a lifelong focus and an adolescent-specific focus. In the former, rehabilitation team members must discuss autonomy skills and cognitive development early and continuously to encourage experience in decision-making appropriate for the developmental stage. In addition, it is recommended that rehabilitation professionals assess parents’ need for anticipatory guidance and resources on an ongoing basis. For optimal success, it is crucial that these interventions start early in a child’s life. For example, a toddler can be given options: which shirt to wear, what breakfast cereal to eat, or where to go for a walk. The focus on making appropriate decisions continues through the school years. Moreover, age-appropriate chores should be assigned for all children. Creativity may be needed to develop an appropriate chore for a child with mobility impairments, but the data suggest that this is cr itical to developing self-sufficiency (Sawin et al., 1999). Conclusion Giving the increasing incidence of spina bifida and diversity of its occurrence, the resolution to this dilemma requires two-fold approach. From the critical perspective, it is necessary to focus both on clinical research and simultaneously on the various sociological aspects of disabled patients, particularly their health status, functional status, and health-related quality of life. Simultaneously, the ability of healthcare providers to suggest preventive measures, anticipatory guidance, and wellness approaches to care for individuals with lifelong chronic illness and disability should be stimulated.

Al Capone Essays - Five Points Gang, Bootleggers, The Untouchables

Al Capone Essays - Five Points Gang, Bootleggers, The Untouchables Al Capone Al Capone is America's best known gangster and the single greatest symbol of the collapse of law and order in the United States during the 1920s Prohibition era. Capone had a leading role in the illegal activities that lent Chicago its reputation as a lawless city. Capone was born on January 17, 1899, in Brooklyn, New York. Baptized Alphonsus Capone, he grew up in a rough neighborhood and was a member of two kid gangs, the Brooklyn Rippers and the Forty Thieves Juniors. Although he was bright, Capone quit school in the sixth grade at age fourteen. Between scams he was a clerk in a candy store, a pinboy in a bowling alley, and a cutter in a book bindery. He became part of the notorious Five Points gang in Manhattan and worked in gangster Frankie Yale's Brooklyn dive, the Harvard Inn, as a bouncer and bartender. While working at the Inn, Capone received his infamous facial scars and the resulting nickname Scarface when he insulted a patron and was attacked by her brother. In 1918, Capone met an Irish girl named Mary Mae Coughlin at a dance. On December 4, 1918, Mae gave birth to their son, Albert Sonny Francis. Capone and Mae married that year on December 30. Capone's first arrest was on a disorderly conduct charge while he was working for Yale. He also murdered two men while in New York, early testimony to his willingness to kill. In accordance with gangland etiquette, no one admitted to hearing or seeing a thing so Capone was never tried for the murders. After Capone hospitalized a rival gang member, Yale sent him to Chicago to wait until things cooled off. Capone arrived in Chicago in 1919 and moved his family into a house at 7244 South Prairie Avenue. Capone went to work for Yale's old mentor, John Torrio. Torrio saw Capone's potential, his combination of physical strength and intelligence, and encouraged his prot g . Soon Capone was helping Torrio manage his bootlegging business. By mid-1922 Capone ranked as Torrio's number two man and eventually became a full partner in the saloons, gambling houses,and brothels. When Torrio was shot by rival gang members and consequently decided to leave Chicago, Capone inherited the outfit and became boss. The outfit's men liked, trusted, and obeyed Capone, calling him The Big Fellow. He quickly proved that he was even better at organization than syndicating and expanding the city's vice industry between 1925 and 1930. Capone controlled speakeasies, bookie joints, gambling houses, brothels, income of $100,000,000 a year. He even acquired a sizable interest in the largest cleaning and dyeing plant chain in Chicago. Although he had been doing business with Capone, the corrupt Chicago mayor William Big Bill Hale Thompson, Jr. decided that Capone was bad for his political image. Thompson hired a new police chief to run Capone out of Chicago. When Capone looked for a new place to live, he quickly discovered that he was unpopular in much of the country. He finally bought an estate at 93 Palm Island, Florida in 1928. Attempts on Capone's life were never successful. He had an extensive spy network in Chicago, from newspaper boys to policemen, so that any plots were quickly discovered. Capone, on the other hand, was skillful at isolating and killing his enemies when they became too powerful. A typical Capone murder consisted of men renting an apartment across the street from the victim's residence and gunning him down when he stepped outside. The operations were quick and complete and Capone always had an alibi. Capone's most notorious killing was the St. Valentine's Day Massacre. On February 14, 1929, four Capone men entered a garage at 2122 N. Clark Street. The building was the main liquor headquarters of bootlegger George Bugs Moran's North Side gang. Because two of Capone's men were dressed as police, the seven men in the garage thought it was a police raid. As a result, they dropped their guns and put their hands against the wall. Using two shotguns and two machine guns, the Capone men fired more than 150 bullets into the victims. Six of the seven killed were members of Moran's gang; the seventh was

Branding Assignment Example | Topics and Well Written Essays - 2000 words

Branding - Assignment Example The companies look at branding to create certain amount of awareness and reputation related to the product and the organization and places the firm at a better place in the market. The real value of brand comes from its ability to add values and delivering profit to the organization by creating loyalty among the customers. Branding is not only used in terms of marketing but also from the financial perspective. Getting the value recognition and image for the customers helps the organization to gain financial impact (Schatte, 2010; Clifton, 2010; Blackett and Boad, 1999; Franzen and Moriarty, 2008). This report focuses on the company Cinnabon Inc., that started its first operation in the year 1985 in the Sea Tac Mall. The company was specially known for its â€Å"world's best cinnamon roll†, which was prepared after the team found the best flavoured cinnamon in Indonesia and mastered the recipe (Cinnabon, Inc., 2012a). This company has grown into a world famous brand with its un matched craving appeal among the customers for their baked goods and various types of beverages. This report aims to design a branding strategy for Cinnabon Inc. Current branding strategy of Cinnabon Inc. Few decades ago Cinnabon Inc. ... bon to the distribution channel along with the varied range of products and at the same time making sure that the expanding brand of Cinnabon continuous to operate as an integrated and seamless whole (Fehrenbach, 2013; BusinessWire, 2013). Multi-Channel Operations Cinnabon Inc, does not operates as a one-dimensional brand that plays in just one segment or channel. They are into a multichannel business leading the brand across different channels and ensuring that every channel integrates with each other so that it can accelerate the brand image. Thus, the multichannel brand management successfully is the major challenge for the organization. The organization is currently operating in about 48 countries with over 900 franchises and is approaching towards the annual sales of about $1 billion (Fehrenbach, 2013; Goudreau, 2012). In recent years the organization has experienced a magnificent growth by creating and marketing new products that can looked through two new conduits such as lice nsed product that are sold by other outlets like fast-food restaurants and consumer packaged goods that are sold in grocery stores. Immediate consumption food services has been operating as the main channel through the franchise bakeries, which is the most common company’s face to the consumers; but now the company has planned to move towards few more newer channels like grocery retail and food service licensing (Thorn, 2013). Therefore, the main aim of Cinnabon Inc. at present to manage these multichannel operations such they mingle among themselves well and enhance the brand image of the organization. Protection of Brand Image Using multiple channels to make the products available to the consumer opens door to other challenges too like protecting the brand. According to Cole there are

Intermodal Transportation Research Paper Example | Topics and Well Written Essays - 1500 words

Intermodal Transportation - Research Paper Example However, recent findings and literature regarding intermodal transportation ports review a contradictory outcome of these measures. The following paper investigates and discusses the effects of actions taken to up security at ports. Actions taken to improve the security at ports has negatively affected throughput, increasing costs and reducing the quality of operations. In 2005, a research by Ronald W. Tarr, Vicki McGurk, and Carol Jones made the realization that there are dangers facing intermodal transport ports after 9/11 are volatile (Tarr, et al., 2005). This unpredictability arises from the likelihood that terrorists may use intermodal transport to deliver weapons and explosive material. Oversized significance of stepping up security measures in these ports. The article explores the effects of training through collaboration and decision-making and its support of the response of transit organizations in the course of the 9/11 attacks (Tarr, et al., 2005). These effects revealed the substandard quality of intermodal transportation during the attacks and the ways the harmed output during the implementation of the already established security measures. A recent research by Nil Kula Degirmenci and Gul Denktas Sakar recognized number of security-linked challenges the intermodal transportation sector has been dealing with for the past several years (Degirmenci and Sakar, 2012). Among these challenges are piracy and terrorism. The researchers noted that security measures alone could not address the many low-quality operations, equipment, and industry players. Degirmenci and Sakar proceed to propose a system for gaining a general insight of the current security concept in intermodal transportation ports. This system takes into account the legal, innovative, and economic aspects. Consequently, system identifies key elements of security in intermodal transport by concentrating on requirement

You may do two papers on one artist's Research Paper

You may do two papers on one artist's - Research Paper Example While his mother assisted him in appreciating art as a young boy of 12 years, working at his father’s barbershop opened him up to the business world and to social issues of his surroundings. Mentorship alone is not enough to develop and sharpen skills and thus Hunt went through schooling. The first formal training that Hunt attended was at Juniors School of Art Institute at Chicago and later he joined University of Illinois to further his studies. At this early age, Hunt began experimental sculptors from abstract though guided by the twentieth century’s artists. This made him impress the community around him and he joined several exhibitions like Artists of Chicago, Vicinity Show, and American Show. While in the American show, Museum of Modern Art purchased a piece for its collection. In 1962, he was the youngest artist to exhibit in Seattle World’s fair, which is an international survey exhibition. According to Richard Hunt as quoted in the Lubeznik centre, â€Å"My career in sculpture began in 1955. It was then, while still a student, I began to exhibit my sculpture around Chicago in all sorts of places-art fairs, small galleries, local art centres, and the like† (Lubeznik centre). Hunt describes his career in the next twelve years that followed this and how he grew in the area of sculptural development. In addition, his skills enabled him to develop as a private, independent studio based and self-generated artist. In 1974, Richard accepted to head the project of Thunderbird Park that had started in 1952 with his grandfather Mungo Martin. He later dropped the project and started his own studio to pursue his own career. According to Galleria Silecchia, â€Å"Among other public works, Richard was selected for a major installation at the Vancouver International Airport and was a part of a multi-artist commission to create the furnishings for the University of

Impact Of Woolf Reforms On Civil Justice System Law Essay

Impact Of Woolf Reforms On Civil Justice System Law Essay The Woolf reforms have successfully increased access to justice for litigants despite being confronted with extensive variables and multifaceted difficulties. However, the reforms have failed in some major aspects, ultimately falling victim to the notoriety and reality of legal reform. The civil justice system and the Woolf reforms will firstly be discussed, moving into an analysis of the prominent areas of the Civil Procedure Rules, with the essay concluding with an overall analysis of the reforms, exposing the reasons for its failures, in reference to the reality of the civil justice system. The Civil Justice System and the Emergence of the Woolf Reforms and Access to Justice The civil justice system has the dual function of serving the public good and acting as a private means. Its social purpose is to provide the machinery for giving effect to the rights of citizens, whilst contributing to the social and economic well being of the community and regulating the exercise of executive power under the democratic principle of the rule of law. For these purposes to be fulfilled, there must be effective access to justice with an awareness of every citizen of their rights, entitlements, obligations and responsibilities, and of the procedures for redress. The underlying basis of the Woolf reforms is therefore to ensure that the justice system provides opportunities for the public to make good their rights. An unambiguous aspiration to overhaul the justice system culminated in 1994, when the then Master of the Rolls, Lord Woolf, was appointed by the Lord Chancellor, Lord Mackay, to assess the practices and procedures of the civil courts in England and Wales. There was a four year, all-embracing inquiry and extensive consultation process that made over three hundred recommendations designed to improve the limitations of civil litigation. There were two reports, published in June 1995 and July 1996, that revealed the findings of the wide-ranging inquiry and provided the foundation for the subsequent Civil Procedure Rules 1998. It is widely accepted that the perceived deficiencies of the civil justice system were met by proposals of radical change and the Woolf reforms were far more than a modification or clarification of the justice system. This investigation into the countrys legal system was required to maintain the integrity and political legitimacy of the system, preventing it from being brought into disrepute. The impact that the competency of a nations justice system can have on considerations such as the economy and political presence in international affairs was also recognised. This is especially the case when identifying London as a prominent dispute resolution centre in the world, attracting litigants from across the globe. The reputation of England and Wales was assessed and the pre-Woolf litigation landscape was in need of reform if this historic justice system was to maintain its standing as one of the most competent providers of justice. Findings of the Woolf Reforms The perceived deficiencies revealed by Woolfs inquiries were readily agreed by the users of the civil justice system. In essence, litigation in England and Wales was too slow, too expensive and too uncertain. These injustices were predominantly identified to be the result of the English adversarial tradition and allowing parties to assume the proactive and dominant case management role, leaving the judiciary to perform simply a reactive role. Too Slow The pre-Woolf landscape contained too much delay that crippled the efficiency of the system and provided a disincentive to those seeking to enforce their rights. This introduced an additional cause of stress, such as through making it more difficult to establish the facts and leading parties to settle for inadequate compensation.  [1]  Lord Woolf identified delay to be the direct result of the adversarial culture of litigation that lawyers practised within and thrived upon. The time taken to progress a case from an initial claim to final hearing was a matter of concern, especially in making litigation expensive. Too Expensive The ever-increasing cost of litigation was found to limit access to justice. However, for some academics, high costs do not automatically entail that low income citizens are prevented from participating in the justice process because of the existence of what Michael E. Stamp  [2]  has named the fiscal illusion, where a belief arises that legal services are becoming unaffordable because they have increased in relative price. Stamp argues that society must alter the proportion of income devoted to different goods and services and rely upon increasing the productivity of legal services to match the increasing costs rather than solely aiming to decrease costs whilst maintaining current levels of efficiency. The Woolf reforms took on the dual approach of aspiring to increase the output of the justice system and endeavouring to strip away unnecessary costs. Stamps comment is an understatement of how low income citizens are being priced out of litigation and fails to stress the importan ce of access to justice for every citizen, irrelevant of social or financial status. Despite the above debate, it is accepted that the cost of a claim is a barrier to some and a problem for all litigants  [3]  and in more direct opposition to Stamp, Sir Thomas Bingham  [4]  robustly describes costs to be a cancer eating at the heart of the administration of justice. The system was too expensive with patterns of costs being higher than the claim was worth. High costs act as a deterrent to those making and defending claims and a number of businesses say that it is often cheaper to pay up, irrespective of the merits, than to defend an action. For individual litigants the unaffordable cost of litigation constitutes a denial of justice.  [5]  The primary intention to provide justice for individuals and businesses was being undermined by the inefficient cost of the machinery. This begins to expose the cruel reality of accessing justice that will run throughout this assessment of the Woolf reforms. Too Uncertain Uncertainty for litigants was a simple but significant limitation of accessing justice arising from unpredictable costs, timings and timetabling, and the uncertainty of judicial decisions. Uncertainty constituted a strong deterrent for litigants and must not be minimised as an issue. The English Adversarial Tradition There was a definitive intention to shift the litigation culture from that of adversarialism to compromise, co-operation and settlement. Woolf described the adversarial system as likely to encourage an adversarial culture and to degenerate into an environment in which the litigation process is too often seen as a battlefield where no rules apply.  [6]  There was a determination of lawyers to manipulate court procedures, delay and disrupt the opposition counsel, increase the costs of the litigation for personal profit and impose professional protectionalism. Woolf identified that main procedural tools for conducting litigation efficiently have each become subverted from their proper purpose  [7]  and the powers of the court have fallen behind the more sophisticated and aggressive tactics of some litigators.  [8]  Lawyers were accused of abusing the disclosure of information, disputing unquestionable points, making tactical appeals and deploying tactics to drag out litigati on, thereby driving up costs. Any analysis of this tradition identifies that the burden of this abuse falls on the client. Woolf disclaimed any potential shift towards an inquisitorial system and abandoning adversarialism in its entirety, in order to maintain its benefits, such as its impartiality compared to inquisitorial techniques. The proposed reform of case management (as set out below), was therefore created to be compatible with the adversarial tradition, establishing conditions where it could survive the transfer of control from the parties to the judiciary. Conclusion on the Findings of the Woolf Reports The justice system was essentially failing the litigant, on and for whom the whole system should, in principle, focus and deliver. Fairness, speed of process, reasonable results and the availability of appropriate procedures were all found to be lacking within a system which promised all these goals. The impression of litigation is a fragmented, inefficient and incomprehensible system failing to fulfil its function and its potential, to promptly distribute affordable and certain justice. It is difficult to take issue with Lord Woolfs findings and the principles of reform that emerge from his conclusions. The reliability and diligence of the access to justice reports are uncontested and the research element of the reforms will continue to act as a valuable identification of the positives and, importantly, limitations of the civil justice system. In this facet of investigation and assessment, Woolf was undoubtedly successful. However, the means and choice of initiatives that Woolf proposed to remedy the exposed limitations are open to debate and critique, particularly when commonly identified as being radical and controversial in their nature and the direction in which they attempt to guide the justice system. Objectives of the Woolf Reforms The aims of the reforms can be condensed into one overriding objective, set out in Civil Procedure Rules 1.1, which was to increase the competency of the civil justice system to decide and deal justly the cases set before it. This includes such considerations as reducing excessive costs, ensuring cases are dealt with expeditiously, honestly and in a manner that is proportionate to their nature. This would create equal footing for parties, guaranteeing that there is a reasonable allotment of resources per case by the court. The vision of Woolf and the principles of his report were reinforced in the Civil Procedure Rules (CPR) which came into force on 26th April 1999. The CPR established a common set of procedures and rules for both the county courts and High Court to follow and gave effect to the three hundred plus changes, amounting to the most radical change to procedure in the last one hundred years. The Woolf reforms did not tinker with the existing system; they rewrote it.  [9]  The CPR are extensive, but some elements are considered to be more prominent than others. It is these that I will focus on in my assessment of the CPR as the implementation of the Woolf reforms. The following six elements of the CPR were, and continue to be, considered to have had the most effect on the English civil procedure. Case Management Technique Lord Woolf believed case management to be vital in solving the key problems of cost, delay and complexity, identifying that the three are interrelated and stem from the uncontrolled nature of the litigation process. In particular, there is no clear judicial responsibility for managing individual cases or for the overall administration of the civil courts.  [10]  The transfer of control from the parties to the judge was designed to improve the pace and efficiency of litigation through imposing tighter timeframes and reducing case duration. Woolf recommended that in relation to case management, the complexity of rules should be eased through modernising terminology and eliminating the distinctions between procedure and practice. Woolf not only sought to change the legal culture of the parties and their counsel, but also the role of the judiciary within an organised court service. Case management was an interventionist approach, imposing a more dominant role for the courts whilst not dismissing the English adversarial tradition in its entirety. The judiciary were equipped with wide discretionary powers, for example, imposing early trial dates and refusing any plea to delay the start of a trial. The governing role of the judge is a common aspect of other continental legal systems and its introduction constituted a shift of the English legal system towards the majority.  [11]   Positives Case management has improved access to justice through increasing the speed of litigation. This initiative determined that it was the judges rather than the lawyers who dictate pace. No longer are the larger claims allowed to fester in the do not touch drawers of solicitors filing cabinets.  [12]  Lawyers were too often judged to slow down litigation, Woolf himself regarding that in the majority of cases the reasons for delay arise from failure (by the lawyers) to progress the case efficiently, wasting time on peripheral issues or procedural skirmishing to wear down an opponent or to excuse failure to get on with the case.  [13]  Many academics view the shift in management from the lawyers to the more responsible and non-partisan judiciary to be an effective reform. For example, 98% of respondents to the 2001 Woolf Network Third Survey considered that the newly introduced Case Management Conferences worked well in their case.  [14]  The increase of discretionary power and control has meant that time-wasting and tactical applications have not been tolerated, and breaches of judicial instruction in relation to the final hearing can result in claims being struck out. Limitations It is argued that a judge does not necessarily or automatically possess the skills or know-how to manage cases competently, reducing the predictability of a claim. The concern is that competency levels are suggested to decrease down the ranks of the judiciary whilst the levels of discretion are maintained. Case management has also been argued to constitute judicial over-involvement, where lawyers who have obtained a deeper knowledge of the case are prevented from deciding how the case should progress. This not only places the responsibility irrationally with the judge, who has only briefly assessed the claim, but also could be construed as reflecting a mistrust of the professionalism of counsel to the dispute. Case management is predicted to fail as a permanent solution because the institution of judicial case management represents a one-time productivity increase where the immediate effect may be lower costs of obtaining justice, but, over the long run, the cost savings will evaporate as a direct result of the cost disease.  [15]  This educated prediction of unavoidable failure of case management, and the Woolf reforms and CPR as a whole, must be treated with care, because it is in essence a prediction. However, this calculated forecast of the reform process suggests a negative outcome of case management that cannot be ignored. The necessary technological advances within the system have also been insufficient to support the implementation of case management. The increased judicial use of computers and telephone conferences, the acceptability of email correspondence in many courts and the advantage of claims beginning online, have all been beneficial, but this is the limit of any technological input. This is not due to the lack of technology available, but rather the justice system barely tapping into the phenomenal potential of technology. It is characteristically a lack of resources and allocated funds that have limited the use of technology, thereby failing to adequately complement the reforms. Conclusion It is apparent that there should not be an outright restoration of the responsibility to manage cases back to the parties and their lawyers. The wholesale rejection of judicial case management does not emanate from a fair evaluation of an initiative that has speeded up litigation and, as a direct result, decreased costs. There must be a reassessment of this reform, with the aim of improving the ability of the judiciary to effectively administer and control cases, essentially through a development of training judges in management techniques. In combination with this training, it is vital that there is an increase in the availability of technological support. This initiative seems to be a clear example of the dangers of such an interventionist approach. Pre-Action Protocols Pre-action protocols constitute strict procedures and sensible codes of practice which are dependent upon the facts and nature of a case, which parties when confronted with the prospect of litigation are expected to follow. The original two protocols in the CPR, for example, concerned personal injury and clinical negligence respectively. The aim overall was to encourage the early settlement of claims and avoid litigation, such as through an early exchange of full information of the dispute. The protocols follow a similar pattern as the encouragement to participate in alternative dispute resolution, in that compliance with the protocols is not compulsory, but an unreasonable refusal to participate will affect the awarding of costs. Positives The success of the pre-action protocols is clear from their expansion from the original two to the current ten, in March 2010. The protocols have increased the structure and organisation of claims, creating certainty for litigants of the pre-trial steps that they are expected to take, such as the effort to settle. This sequentially has stimulated increased levels of dispute resolution and early settlement through the improvement of the pre-action investigation, earlier exchange of information and the enhancement of the relationship and understanding between parties through more pre-action contact. The protocols have also been credited with ensuring that disputes which are litigated are done so on the foundation of detailed preparation and consideration. Further positives include the decrease of nuisance ill-founded claims and the success of the attached code, which categorises disputes which do not fall within the protocols. Limitations The protocols have been criticised solely for their burden and lengthy requirements. The obligation to perform tasks such as writing letters, disclosing information and exchanging expert reports all combine to duplicate the process of the claim to follow. A dispute is essentially fought twice, unnecessarily increasing time and costs. Conclusion The protocols were a strong success only falling foul in the adverse effect of the burden of administration. They represent the strength of the reforms and suggest that radical reform can be effective if implemented correctly. The Track System Under case management, a track system was proposed to assign different procedures to different cases that are separated on the merits of complexity and financial value. The CPR classifies cases into one of the three tracks of small claims, fast track and multi-track.  [16]  The small claims track is for cases of less than  £5,000 in value and the fast track including claims that are more valuable than  £5,000, but fall below  £15,000, or that fail to fit within the small claims criteria. Fast track cases are deemed to be simpler disputes, and on a slight variation, include landlord-tenant disputes and personal injury cases that are valued between  £1,000 and  £5,000. The multi-track includes all the cases over  £15,000 that fail to be placed in the fast track and small claims. Positives The fast track arrangements have been successful in having cases heard quicker, with it being claimed that this guarantees a final hearing within 30 weeks from soon after the defence has been sent to court.  [17]  The track system overall is merited for recognising that cases of different size and complexity should be dealt with in different ways with it having been noted that the criticism that such distinctions will condemn many claimants of small sums to second class justice is wholly misconceived.  [18]  This initiative has increased certainty of timetabling and improves efficiency by ensuring that judicial time is spent proportionately to the issues in claims. Limitations The track system is highly controversial because of its technique of the early classification and has struggled to contend with the extensive variables that determine the costs awarded to a party.  [19]  The most influential variable that has hindered success is the unpredictability of the length of a dispute.  [20]  In some cases it is close to impossible to balance and account for variables, such as complexity and financial value, in the early stages of a case. The track system must also contend with all the disadvantages of going to court, regardless of which track, including the common problems of cost and time. Conclusion The immediate defence of the track system that the analysis and clarification of costs is an ambitious and difficult task is not sufficient to excuse its failure. The system has fallen victim to the overload of variables and has failed to present itself as a competent antidote and controller of excessive costs. This initiative is a disappointment and current calls for its removal are justified. The concerns of the track system once again support the use of Alternate Dispute Resolution processes to reach a settlement, rather than proceed to trial. Costs Most of the descriptive guidelines of the overriding objective set out in the CPR concern the costs of litigation. High costs are often magnified by the issue of delay which acts as drag or friction upon the economy by reducing the ability of individuals and corporations to increase productivity and fully utilise capital.  [21]  At a minimum, costs must be more predictable and affordable, despite the difficulties of quantifying and identifying the sources of abstract costs not directly related to the litigation process. The objective must be reducing delay that creates excessive costs and constructing an initiative to reduce any influx in costs if a claim is inhibited by delay. The general rule of costs that the losing party must pay those of the successful party still remains. However, CPR 44.3 has modified this long-standing rule by introducing exceptions to it and giving the court discretion in the allocation of costs in certain cases. The rules of paying costs also can require the losing party to pay on account before the final sum of costs is decided by the court. This scheme, coupled with the ability to order costs or a proportion of costs which have been summarily assessed to be paid within fourteen days has established in todays litigation system a concept of what one learned commentator has described as pay as you go system for costs.  [22]  The early and continuous payment of costs promotes early settlement as the parties assess their cases earlier and can make calculations as to whether their costs will exceed their revenue. This scheme communicates the reality of a claim directly to the parties, encouraging them to rationally manage their fi nances and clarify and target their personal goals within the claim. Parties also have an incentive to adopt a more co-operative approach because of the threat of court imposed financial penalties for unreasonable conduct. This is an example of the court utilising a more forceful, realistic and arguably manipulative technique in the practical application of a reform through costs. Positives Michael Bacon identified that several long established principles relating to legal costs have either been modified or disappeared completely as a result of the Woolf reforms, and one or two totally new concepts and procedures have been introduced.  [23]  This dramatic reform has increased the predictability and certainty of costs and balanced unequal financial means between litigants through orders for the party with greater financial resources, but with the weaker case, to pay interim costs. There has also been increased enforcement of procedural rules, and action taken in respect of unreasonable conduct, by the court through automatic costs sanctions. Limitations The new costs regime has been criticised predominantly for failing to sufficiently reduce and control costs. Costs have been front loaded and perceived decreases in costs have been shown to be cancelled out by adverse effects of other reforms. In addition, cost sanctions have been criticised for being oppressive and punitive instead of preventing non-compliance with court convention. Conclusion Costs have not been successfully reduced and only minor reductions can be identified. The reasoning that costs are difficult to control because of their dependence upon a high number of variables, and the reality that there cannot be a sole recommendation targeting the financial burdens of litigation, are not justification for the failure of a multifaceted scheme designed to reduce costs. The only positive is that the emphasis on costs has raised the profile and importance of costs overall. This awareness has instigated a new outlook on reducing costs that may develop into a culture. The costs scheme constitutes the major criticism of the reforms overall. Alternative Dispute Resolution Reform of the justice system was required to promote more cases to an earlier, controlled settlement as opposed to an untidy, pressured one at the door of the court. The encouragement for early settlement follows Woolfs vision of litigation as the last resort for disputing parties, with the view that any settlement is better than proceeding to trial. This has allowed alternative dispute resolution (ADR) to take a fundamental role, and information on the sources of ADR is provided at all civil courts and legal aid funding is made available for ADR processes. ADR is the umbrella term for a group of techniques used to solve disputes other than through the traditional court adjudication. However, proceedings should not be issued or commenced if settlement is still being explored. The competency of the Centre for Dispute Resolution (CEDR) which nominates mediators, liaises with both parties and prepares the mediation agreement, also became relevant. In theory, ADR prevents the limitations of the court process from proceeding to fruition. If a claim is settled in mediation, the costs, complexity, adversarialism, time and ineffectiveness of the court procedure are all circumvented. The reduction of cases progressing to trial also reduces the burden on the courts, allows for a more efficient and better resourced procedure and, ultimately, better access to justice. The court was therefore equipped with the power to direct parties to attempt ADR under CPR 26.4 and to order a months postponement, facilitating parties to secure a settlement. In combination with ADR processes, offers to settle, known as Part 36 offers, provide yet another stimulus to settle before court action. Part 36 offers departed from the traditional structure of settlement, allowing both the claimant and defendant to make an offer to settle before the issuing of the claim or during the actual proceedings. If an offer has been made then this will be taken into consideration by the court when awarding costs. Positives There has been a clear cultural change and increased numbers of settlements through the vigorous promotion of ADR. There now exists a regime that encourages and obliges parties and their lawyers to consider settlement and utilise ADR processes. The largely aggressive adversarial behaviour associated with disputes has been softened with a more co-operative and collaborative approach. This culture immediately decreased the number of claims reaching court, with a 19.6% fall in the number of proceedings issued from 2000 to 2001 in the Queens Bench Division.  [24]  ADR has offered willing litigants the opportunity to participate in a quicker, cheaper and more specific and flexible technique for resolving their dispute. ADR also has many personal advantages for the participants as it can be creative, reduce stress and repair relationships. Limitations The essential limitation of ADR is its reliance upon the original participation in mediation. A settlement then relies upon the facts of a case and the parties approach to ADR. Many parties take a half-hearted approach to mediation and have no real intention to negotiate for a settlement. They intend instead to avoid the financial implications of unreasonably refusing to mediate. It is argued that as a result of both failed settlement attempts and indifferent participation in mediation, ADR does not necessarily reduce costs. Mandatory mediation is argued to constitute the greatest failure of ADR. Professor Dame Hazel Genn,  [25]  through the voluntary pilot mediation scheme of the Central London County Court (CLCC), identified that the Woolf reforms have motivated parties to mediate in order to avoid financial penalties for unreasonable refusal and create the appearance of following judicial direction. There was also the 2004 Automatic Referral to Mediation Scheme (ARMS) run at CLCC, where one hundred cases a month were selected at random and sent to mediation before any court hearing. Parties unwilling to partici