Reproductive Tract Infections (RTI): Symptoms and Causes

Reproductive Tract Infections (RTI): Symptoms and Causes Reproductive tract infections (RTI) are recognized as a public health problem and ranking second after maternal morbidity and mortality as the cause of loss of healthy life among women of reproductive age in developing countries (Jindal et al, 2009.). Infections of the reproductive tract causes serious health problem worldwide, with an impact on individual women and men, their families and communities (Adler et al., 1998). Are RTI infections which affect the reproductive tract, part of the reproductive system. For females, the reproductive tract infections may be much higher in the reproductive tract (fallopian tubes, ovaries and uterus) and lower reproductive tract (vagina, cervix and vulva). The global burden of reproductive tract infections (RTI) is a huge and a serious public health problem, especially in developing countries, where ITR are endemic . They can have serious consequences including infertility, ectopic pregnancy, chronic pelvic pain, abortion, cervical cancer, menstrual disorders, pregnancy loss, babies with low birth weight and increased risk of HIV transmission. The presence of the ITR (especially ulcer causing sexually transmitted infections) can promote the acquisition and transmission of human immunodeficiency virus (Rabiu et al., 2010). Reproductive tract infections include endogenous infections, iatrogenic infections and sexually transmittedinfections (STDs) (Muula et al., 2006) . Reproductive tract infections (RTI) refers to three different types of infections affecting the reproductive tract : 1. Endogenous infections are probably the most common RTI worldwide. They result from an overgrowth of organisms normally present in the vagina. Endogenous infections include candidiasis and bacterial vaginosis. These infections can be easily treated and cured . 2. Iatrogenic infections occur when the cause of infection (bacteria or other microorganism) is introduced into the reproductive tract via a medical procedure, such as menstrual regulation, abortion, insertion of an IUD or during childbirth. This can happen if the surgical instruments used during the procedure has not been properly sterilized, or an infection, which was already present in the lower reproductive tract is pushed through the cervix into the upper reproductive tract . 3. Sexually transmitted diseases (STDs) are caused by viruses, bacteria or parasites microorganisms that are transmitted through sexual activity with an infected partner. About 30 different sexually transmitted infections have been identified, some of which are easily treatable, many of which are not. HIV, the virus that causes AIDS, is perhaps the most serious sexually transmitted infection, since it eventually leads to death. STDs affect men and women, and can also be transmitted from mother to child during pregnancy and childbirth. (Germain et al. 1992). Female RTI usually originate in the lower genital tract, such as vaginitis or cervicitis and can produce symptoms such as : abnormal vaginal discharge , genital pain itching burning feeling with urination abdominal pain irregular mensural cycle blood stained discharge However, a high prevalence of asymptomatic disease occurs, which is a barrier to effective control (Elias et al., 1993). Such as: Infertility Fibroid Polyps Prolaps Uterus / Vaginal Endomitrosis Even when symptoms occur, their presence may overlap with and be misdiagnosed as a normal physiological change and normal physiological discharge can be diagnosed as RTI. (Trollope Kumar, 1999). The presence of ulcers, especially RTI causing STI may increase the acquisition and transmission of human immunodeficiency virus (Fleming et al. 1999). Infertility is a health problem in Africa, particularly in sub-Saharan Africa, where 20-30 % of couples are unable to conceive (Sciarrha, 1994). Most health advocates consider infertility as the most important reproductive health and social issues confronting the Nigerian women and gynecologists often report that infertility is 60 % 70 % of your queries at higher education institutions (Okonofua et al, 1997.). In Nigeria, most cases of infertility RTI following (Snow et al. 1997) Ectopic pregnancy is a large percentage of acute gynecological emergencies in Nigeria and is a major cause of maternal mortality [ 11-13 ]. A study in Lagos, Nigeria found previous STI and pelvic inflammatory disease as the main risk factors for ectopic pregnancy (Anorlu et al., 2005) Cervical cancer is usually the result of a sexually transmitted infection, and human papilloma virus is the causative agent. It is the most common malignancy of the reproductive system and a leading cause of death from cancer in Nigerian women (Thomas, 2000). In contrast to most other types of cancer, it is common below the age of 50, and is therefore a leading cause of premature death (Dey et al. 1996). Sites of Reproductive Tract Infections : Reproductive tract infections can affect the outer genitals and reproductive organs. Infections in the area of the vulva, vagina, cervix or are referred to as the lower reproductive tract infections. Infections in the uterus, fallopian tubes and ovaries are considered upper reproductive tract infections. (Bulut et al. 1995) Minor infections of the reproductive tract : . Vaginitis : RTI affecting the external genital area and lower reproductive tract in women is often referred to as vulvo vaginitis, vaginitis or simply indicating that the vulva and / or vagina become inflamed and sometimes itchy or painful. Vaginitis is most commonly caused by endogenous infections such as candida (thrush, yeast) or bacterial vaginosis, sexually transmitted infections despite certain as trichomoniasis, can also commonly cause these symptoms and signs. Pelvic infections can have consequences far more dangerous than the initial vaginitis, such as ectopic pregnancy or infertility. (Bulut et al. 1995) 2. Infection of the cervix Infection of the cervix can be caused by a variety of pathogens, particularly sexually transmitted infections, such as gonorrhea, chlamydia and Human Papillomavirus transmitted. Infections of the cervix are considered more serious than vaginitis because more commonly result in infection of the upper reproductive tract, with its serious consequences. Unfortunately, they are also more difficult to detect and are often asymptomatic. (Bulut et al. 1995) Upper Reproductive Tract Infections : The migration of infection in the upper reproductive tract, including the uterus, fallopian tubes, ovaries, and tends to be more severe than infections of the lower reproductive tract. Infections of the upper reproductive tract are often a direct complication of infections, especially sexually transmitted lower reproductive tract. (Bulut et al. 1995) Pelvic inflammatory disease (PID), for example, is one of the most serious problems of gonorrhea or chlamydia. This can result in chronic abdominal pain, ectopic pregnancy, menstrual irregularities, infertility and as a result of scarring of the fallopian tubes . Ectopic pregnancy, which can cause death, is a particularly serious complication, since it requires emergency interventions that are not available in many resource-poor settings. Iatrogenic infections -. Caused by the introduction of bacteria in normally sterile environment of the womb through a medical procedure such as insertion of an IUD can also result in serious, and reproductive tract infections, occasionally life -threatening upper (Bulut et al .., 1995) ADHD in Classroom Strategies: Literature Review ADHD in Classroom Strategies: Literature Review To what extent can teachers make provisions for pupils with ADHD (Attention-Deficit Hyperactivity‑Disorder) in the mainstream classroom? CONTENTS (JUMP TO) Section 1: Referenced Extracts Section 2a Part One: Analysis and Critical Evaluation of the Issue Section 2b Part Two: Examination of the Practical Implications for Primary School Teachers Section 3: Copies of Extracts Section 4: Bibliography Sources and Further Reading Section 1: Referenced Extracts (1) Quarmby, K. (Tuesday 6 December, 2004) Rebels without a Cause: Children with Behaviour Problem are Increasingly Diagnosed with ADHD, in, Education Guardian, pp.1-3 (2) The Disorder named AD/HD: What we know (2004) National Resource Centre for AD/HD: Children and Adults with Attention-Deficit Hyperactivity‑Disorder (CHADD; http://www.help4adhd.org/en/about/what/WWK1.pdf , p.2 (3) Rafolovich, A. (2005), Exploring Clinician Uncertainty in the Diagnosis and Treatment of Attention-Deficit Hyperactivity-Disorder, in, Journal of Sociology of Health and Illness, Volume 27, Number 3 London: Blackwell, pp.306‑310 (4) Northen, S. (Friday 26 November, 2004), Feed your Head, in, The Times Educational Supplement, p.3 (5) Spencer, T. et al (1995), A Double-Blind Cross‑Over Comparison of Methylphenidate and Placebo in Adults with Childhood Onset Attention-Deficit Hyperactivity-Disorder, in, Archives of General Psychiatry, Volume 52, pp.434-443 (6) Education Guardian Opinion (Tuesday 10 October, 2006), p.4 (7) Handy, C. and Aitken, R. (1986) Understanding Schools as Organisations London: Penguin, p.13 (8) Chowdhury, U. (2004) Tics and Tourette’s Syndrome: a Handbook for Parents and Professionals London and New York: Jessica Kingsley, p.115 (9) Raphael Reed, L. (1995) Reconceptualisng Equal Opportunities, in, Griffiths, M. and Troyna, B. (Eds.), Antiracism, Culture and Social Justice in Education Stoke‑on‑Trent: Trentham, p.88 (10) Guiding Principles for the Diagnosis and Treatment of Attention‑Deficit Hyperactivity‑Disorder (2006), Presented by the Attention Deficit Disorder Association (ADDA); http://www.add.org/pdf/GuidingPrinciples021206Rev[1].pdf , p.2 (11) Jones, A. (August 2004) Clinical Psychology Publishes Critique of ADHD Diagnosis and Use of Medication on Children, in, Psychminded Website; http://www.psychminded.co.uk/news/news2004/august2004/Clinicalpsycholgy (12) Swanson, J.M. and Castellanos, F.X. (2002) Biological Bases of ADHD – Neuroanatomy, Genetics and Pathophysiology, in, Jensen, P.D. and Cooper, J.R. (Eds.), Attention Deficit Hyperactivity Disorder: State of the Science Kingston: New Jersey, pp.71-72 (13) ADHD: Strategies for Primary School Teachers; http://premium.netdoktor.com/uk/adhd/living/school/article.jsp?articleIdent=uk.adhd.living.school.uk_adhd_xmlarticle_004691 (14) ADHD in the Classroom – What Helps; http://www.adhd.com/educators/educator_communication_difficulties.jsp (15) Selikowitz, M. (2004) ADHD: the Facts Oxford: Oxford University Press, p.154 (16) Stein, D.B. (1999) Ritalin is not the Answer: a Drug-Free, Practical Programme for Children Diagnosed with ADD or ADHD New York: Jossey Bass Wiley, Preface Section 2a Part One: Analysis and Critical Evaluation of the Issue The issue of ADHD is one of the most pressing contemporary concerns within the broader educational sphere of making adequate provisions for children with learning difficulties. With the help of scientists and the media, ADHD has been transformed from a relatively unknown illness of the brain to a well known national problem for thousands of schoolchildren. The increase in awareness has been accompanied by a steep rise in the number of children being diagnosed with the disease. â€Å"The National Institute for Clinical Excellence (NICE) estimates that as many as 500000 children in the UK may have ADHD and, of these, as many as 100000 may be seriously affected.†(1) Unbelievably, this figure amounts to approximately one in twenty of all British schoolchildren. With figures constantly on the rise and awareness increasing in tandem, it is clear that ADHD is, at the beginning of the twenty first century, a highly important concern for any mainstream primary school teacher. In comparison to other behavioural problems experienced by young people, the illness is relatively new (at least in terms of its recognition from psychiatrists and general practitioners) and, as such, often causes confusion and misunderstanding when the issue is raised in the classroom. Tourette’s syndrome, for example, has a ten year advantage over ADHD in terms of public awareness and forthright medical opinion. Moreover, the illness is also notoriously difficult to accurately quantify with rather ambiguous symptoms like ‘inattentiveness’ and ‘a lack of concentration’ used as precursors to a diagnosis of attention‑deficit hyperactivity‑disorder. ADHD is consequently considered to be a highly controversial illness that has the medical community split over whether it is a disability in the traditional sense or whether it is a neurological malfunctioning on the part of the child or individual in question. This is not an easy problem to so lve not least because of the scarcity of medical facts. Indeed, the medical facts that are known are somewhat ambiguous and rely heavily on subjectivity rather than objectivity, which would bequeath an improved perspective for scientists and teachers alike. It has, however, been concluded that the illness begins no later than the age of seven and patients who are first diagnosed as ADHD sufferers in adulthood must have displayed the core symptoms from the age of seven to receive treatment for attention‑deficit hyperactivity‑disorder this places the issue directly within the realm of the primary (as opposed to the secondary) school teacher as the first tell-tale signs must be evident before the age of seven (year three). It is therefore prudent to detail these core symptoms of the disease so that the primary school teacher may be in a position to offer better advice to parents and doctors as to the condition to one of their pupils. For this, analysis must turn towards the USA, which is the leading country in terms of diagnosing, treating and including children with the illness in national classrooms. Thus, according to the American National Resource Centre for AD/HD, symptoms can be split into two separate categories (2). The first category comes under the heading of ‘inattention’. The chief features of this are: Making careless mistakes in homework, in class and in other related activities. Failing to pay close attention. Difficulty maintaining attention during work or play. Appearing as if not listening when clearly being spoken to. Failing to follow simple instructions in class. Have difficulties with organisation. Avoiding work with a sustained amount of mental excursion, such as homework or tests. Loses things. Easily distracted. Forgetful in daily activities. The second category used for ascertaining the most visible symptoms of ADHD comes under the heading of ‘hyperactivity-impulsive behaviour’. The core features of this particular behavioural manifestation are: Constant ‘fidgeting’ in class with hands or feet. ‘Squirming’ in chairs. Running or climbing at inappropriate times. Has difficulty remaining seated. Difficulties in maintaining silence during quiet play times. Failing to wait for turn in class. Interrupting teachers and fellow pupils at inappropriate times. Act as if they are on a ‘motor’. It is immediately evident from just a brief overview of the symptoms that ADHD is open to a wide variety of claims of inaccuracy with regards to diagnosis as well as excessive interference on the part of parents, teachers and the state, which has made the cause of children with learning difficulties a chief domestic policy since the end of the twentieth century. Sceptics naturally point to the many years before ADHD became a well known disorder (during the 1980s’) as evidence that the illness has been blown out of proportion (help groups, on the other hand, say this is merely evidence of the way in which the illness has been avoided by education professionals for so long.) Furthermore, according to an empirical study compiled by Adam Rafolovich (3), even doctors retain strong reservations about diagnosing a child with ADHD on the grounds of the fertile ground for misconception that exists with concerns to the symptoms highlighted above. For instance, there can be little doubt that there is a very fine line between defining a child as ‘clinically inattentive’ and simply viewing that same child as lazy and disinterested in the subject matter at hand. Likewise, the same problem persists with any variety of the core symptoms of ADHD, which are often too close to everyday behavioural disorders that should be expected in children as young as seven or eight. Once again, it is not difficult to understand the sceptic’s point of view, especially when considering that the modern variation of schooling is a lot more pupil friendly than was the case forty or fifty years ago. Psychiatric experts and doctors are likewise divided over the best means of treatment available to children who have been satisfactorily diagnosed with ADHD. In the 1990’s, medication was seen as by far the most viable route to inclusion in the classroom with the ‘wonder drugs’ Ritalin and Concerta witnessing an explosion in sales at this time. Prescriptions for these two drugs have leapt from 6000 in 1994 to around 345000 by 2003. This marked increase is testimony to the way in which ADHD has become a serious problem for all mainstream teachers, particularly those who work in primary schools. In addition, there have been grave concerns voiced by doctors, parents and teachers regarding the moral aspect of prescribing a child as young as five or six a powerful, sophisticated neurological drug that alters the way the brain perceives key data. Young people’s brains do not fully develop until well into adolescence and often beyond; thus, the risks in having chi ldren become dependent on medication at such a young age should be obvious to all concerned. Moreover, as Stephanie Northen (4) points out, the fact that ADHD is seen as a biochemical imbalance in the brain requiring a pharmaceutical treatment while, at the same time, dyslexia is seen as a solely educational problem that has no connection with the brain, severely tests the rationale behind the way that the illness is currently being classified and treated. In many cases the difference between the two is only the opinion of a teacher, doctor or mental health observer. On the whole, however, medication has proved to be a success in young children with ADHD at least in terms of lessening the tendency for public outbursts and school time tantrums. Research conducted by the MTA Co‑Operative Group at the end of the twentieth century discovered that approximately 70 to 80% of school children with ADHD reacted positively to psycho stimulant medications. Significant academic improvement has likewise been noted with an increase in attentiveness in the classroom, compliance on group related tasks and a greater accuracy evident in homework, coupled with a decrease in activity levels, impulsivity, negative social behaviours in groups and verbal hostility (5). The implications of medication and the effects that this can have on a child who displays the key symptoms of inattention, impulsivity and hyperactivity will be discussed in greater detail in Part Two of the discussion, but, at this point, the important point to note is the relatively high level o f success of prescription drugs in the effort to minimise the negative The other major option with regards to effective treatment is the option of psychotherapy involving a mental health expert and groups of child sufferers of ADHD. Utilising a form of cognitive behaviour therapy, qualified experts are able – over time – to challenge the way in which children react to certain environments and situations – those situations that had previously led to evidence of what are considered to be the core symptoms. ADHD ‘coaches’ also help the child to prioritise, organise and develop interactive skills that will lessen the chances of that child experiencing a sense of social exclusion. There are also a number of problems with this kind of therapy not least the obstacle concerning the considerable costs incurred via employing a mental health professional in the current NHS climate. Theory and practice therefore still stand some way apart when it comes to the ideal means of treating children with ADHD faced with the reality of NHS staff shortages and a scarcity of private sector mental health experts who concentrate solely on children with learning difficulties. There is also the significant problem of stigmatisation when a child is diagnosed and then treated for ADHD or, indeed, any other mental health problem. To understand the severity of the issue, one need only look at the way that the adult labour force in the UK discriminates against employees who have a mental health issue in order to understand the way in which playgrounds can become a source of intensive bullying, especially below the age of eight according to the Guardian Education Opinion in October 2006 (6). When one considers the fact that schools are, according to Charles Handy and Robert Aitken (7), not at all dissimilar to adult commercial organisations, it becomes even more clear that bullying and peer pressure are significant issues when it comes to schooling children with learning difficulties and behavioural problems, which ADHD obviously entails. As Uttom Chowdhury declares, the more a child stands out as different from his or her classmates â€Å"because of associated behaviours such as impulsivity, poor handwriting and academic difficulties† (8) the greater the likelihood of bullying and social exclusion. Primary school teachers would have a pivotal role to play in the cessation of bullying on the grounds of a mental illness, in addition to maintaining an effective social balance within the classroom. Furthermore, a pupil who suffers from ADHD is bound to display signs of low self esteem, regardless of bullying in the playground or peer pressure within the classroom. Low self esteem combined with the unpredictable side effects of the medication as well as mitigating factors that may be occurring at home, means that the task of a mainstream primary school teacher is made all the more time consuming. It can be seen that attention‑deficit hyperactivity‑disorder is not only a highly topical issue that is bound to increase in significance in the coming decades, but that it is also a highly problematic area of debate for public education and child welfare due to the ambiguity that resides at the heart of the diagnosis of the condition. While there are a number of tell‑tale signs that a child may be suffering from ADHD there are also any number of alternative reasons as to why a student appears to be veering away from the carefully constructed consensus of a primary school classroom. Ultimately, some children would just prefer not to be in school at all. With this in mind, it is prudent to turn attention towards the implications for teachers who wish to advance the governmental policy of social inclusion in the classroom by understanding how ADHD can be married with an award for Quality Teacher Status. Section 2b Part Two: Examination of the Practical Implications for Primary School Teachers Section 3.2.4 of the Standards for the Award of Qualified Teacher Status declares that teacher should, â€Å"identify and support more able pupils, those who are working below age-related expectations, those who are failing to achieve their potential in learning, and those who experience behavioural, emotional and social difficulties.† Clearly, therefore, with regards to pupils with ADHD, the most pressing concern for primary school teachers is the need to maintain a healthy social balance within the classroom without ostracising the child with the learning difficulty. Inclusiveness must consequently be the teacher’s main priority if they are to fulfil the most basic precept of the QTS. â€Å"All children need someone to mediate their learning, but sometimes this feels especially true for children with special educational needs.† (9) This is a tried and tested educational tightrope that cannot be replicated in a college classroom, in an academic book or in an education‑specific journal. Rather, this challenge can only be met through experience. This is, of course, not to state that there are not certain features and attributes that the teacher can learn so as to be in a more advantageous position to deal with potential sufferers of ADHD. The most obvious place to begin would be the acquisition of help from a more experienced teacher – one who hopefully has coped with the demands of teaching children with learning difficulties beforehand, even if the difficulty in question is not ADHD. This would equip the recently qualified primary school teacher with the ability to deal more efficiently with children in the classroom who have already been diagnosed with the illness as well as those pupils that have yet to be diagnosed but who are nonetheless showing a variety of signs of ADHD. This is an important point because, according to the ‘guiding principles for the diagnosis and treatment of attention-deficit hyperactivity‑disorder’, ADHD should be â€Å"suspected but never presumed.† (10) Section 2.4.1 of the Standards for the Award of Qualified Teacher Status states that: â€Å"they [the qualified teacher] understand how pupils’ learning can be affected by their physical, intellectual, linguistic, social, cultural and emotional development.† With regards to pupils with ADHD, this would involve the ability to liaise with the child’s parents. This has two obvious benefits. The first is to better understand the child’s home life, which experts agree is a vital factor in the formation of the disease, especially if said home life is noticeably chaotic, abusive or violent. â€Å"More regard should be given to a child’s social circumstances, experience and history in understanding their behaviour.†(11) Secondly, research has indicated that there are certain generic attributes of ADHD that run through families, which makes the issue of maintaining an effective, coherent working dialogue with the parents of ADHD sufferers all the more imperative (12). Although the illness is inherently complex, involving a cross‑over of many genes, there is a strong likelihood that one of the parents will also show signs of ADHD, making empathy with the child easier in the process. The Standards for the Award of Qualified Teacher Status also require the primary school teacher to be able to effectively plan lessons for all pupils in the class. Moreover, as of January 2002, a revised SEN code of practice dictated that â€Å"all teachers are SEN teachers.†(13) Clearly, children with learning difficulties pose unique problems for the planning of lessons, none more so than those pupils with ADHD, which is an inherently disruptive and anti‑social illness. Communication between the teacher and the student (not to mention communication between the student and his classmates) is therefore a major problem. Fortunately, there are a number of study aids that are available for teachers to consult. For instance, the official ADHD website in the US offers invaluable advice on how best to manage children with the illness in a classroom setting (14). The following constitutes a small extract of what the organisation considers to be useful information for educators . It should be interpreted as an Individual Education Plan (IEP): Refrain from ‘popping’ a question which requires a speedy answer. Give the student extra time to answer questions. For example, use up time by writing on the blackboard. Speak slowly and provide information in small units. This is especially helpful in the classroom. Reinforce verbal instructions and lessons with written materials, or by writing on the blackboard. Work closely with the student to determine and accommodate his or her individual needs. There are likewise a number of books that have been published in recent years that are a source of encouragement for primary school teachers. Mark Selikowitz, for example, gives advice on the structural planning of the classroom for students with ADHD: â€Å"the child with ADHD should be seated at the front of the class near to the teacher’s desk. The old idea of putting the ‘naughty’ child at the back of the class†¦is totally inappropriate if the child has ADHD.† (15) Teachers must also be constantly aware of the dangers inherent in educating children who are prescribed powerful doses of medicine. In his critique of the culture of prescription drugs prevalent in the USA and the UK, David Stein warns of the side‑effects of Ritalin, which include insomnia, tearfulness, rebound irritability, personality change, nervousness, anorexia, nausea, dizziness, headaches, heart palpitations, and cardiac arrhythmia. (16) Finally, in accordance with Section 3.3.1.4, tutoring a child with ADHD allows the qualified teacher to test their ability to effectively manage instances of bullying and harassment. Where a child with ADHD is concerned, bullying is especially relevant due to the potentially volatile outbursts of the child in question as well as taking into account the reaction of those classmates who do not understand ADHD. As is the case when constructing an IEP, the primary school teacher must be able to use common sense in order to properly tailor classroom and playground management for the specific needs of the child in question. No two ADHD sufferers are likely to display the same characteristics of the disease. Section 3: Copies of Extracts (1) (4) Rebels without a cause Children with behaviour problems are increasingly diagnosed with ADHD. But their parents often struggle to get them the education they need. By Katharine Quarmby Tuesday December 6, 2005 The Guardian James Steele, aged 10, from Bermondsey, south London, has seven doses of Ritalin a day to control his behaviour. On one of his first days at Southwark Park primary school, he stripped off naked and was chased round the school by two teachers. His mother, Julie Clapp, had to give up work to cope with him. Its been a nightmare, she says. He would crawl over desks, start climbing on equipment in the classroom, says Angie Sharma, acting headteacher. Then at one point he opened the window and stood on the ledge. The whole school was in a panic. We seriously thought we might have to exclude James. It was extremely difficult for the teacher to teach to the national curriculum when James was running out of class, refusing to co-operate. Before he joined the school, he had already been kicked out of nursery. The school begged Southwark council for help and, at the age of seven, James was diagnosed with attention deficit hyperactivity disorder (ADHD) and given a statement of special educational need. A team of experts assessed James, including the schools special educational needs co-ordinator, an

Disaster Preparedness Essay

A disaster is generally defined as an event in which illness or injuries surpass resource capabilities of a community or medical facility (Ignatavicius & Workman, 2010). Disaster preparedness is a process of ensuring that an organization has complied with the preventive measures and is in a state of readiness to contain the effects of a predicted disastrous event to minimize loss of life, injury, and damage to property. see more:essay on disaster management in english Disaster preparedness can also provide rescue, relief, rehabilitation, and other services in the aftermath of the disaster, as well as have the capability and resources to continue to sustain its essential functions without being overwhelmed by the demand placed on them. The American Nursing Association is helping to ensure that disaster preparedness and response is robust in this country to be personally and professionally prepared for a disaster. Being in a prepared profession can help cope and help the communities recover from disaster better, faster and stronger (Brewer, 2010). According to the Maricopa Integrated Health System (MIHS) at Maricopa Medical Center, they have a specialized disaster preparedness plan to fit their current top three hazards. Maricopa Medical Center conducts a Hazard Vulnerability Assessment (HVA) annually. The current top three hazards K. F. , Manager of Fire Safety and Disaster Preparedness, at Maricopa Medical Center has identified include: Mass Causality Incidents (trauma, burns, pandemic, etc. ), Small Casualty Hazardous Materials Response (less than five patients), and Severe Weather Incidents (monsoonal action, thunderstorms, and haboobs). This organization has a comprehensive Emergency Operations Plan that addresses the top three current hazards in the organization’s region. Maricopa Medical Center is also further developing their business continuity and recovery plans into stand-alone plans (K. F. , personal interview, February 13, 2012). In order to evaluate and determine the effectiveness of the disaster preparedness plan, Maricopa Medical Center annually conducts a minimum of two operational exercises, in addition to various discussion based exercises. The organization’s exercises follow the Homeland Security Exercise Evaluation Program (HSEEP), which includes an after action report process with an improvement plan and corrective action plan sections. According to the Agency for Healthcare Research and Quality, many studies have showed that disaster drills have been an effective way to improve staffs knowledge of hospital disaster procedures (Catlett, 2004). Additionally, exercise objectives are developed in such a way to exercise pieces of the plan that have been identified as opportunities for continual improvement and/or grant deliverables. Once opportunities for improvement of the disaster plan are identified, these improvements are remedied by being given corrective actions with specific time frames and the status is reported to senior management. Some recent corrective actions that have occurred within recent years include the development of position-specific training to further build comfort for those that are activated in the Hospital Command Center, plan changes regarding Casualty Care Areas during a response to a Mass Casualty Incident, and Standard Operating Procedure enhancement for the Hospital Emergency Response Team (K. F. personal interview, February 13, 2012). The representation that is present on the disaster preparedness committee for Maricopa Medical Center does not include nursing management. The emergency management committee includes a cross-sectional representation from the entire health system. This includes Acute Care, Behavioral Health, Ancillary Services, and Outpatient Services. K. F. , stated, â€Å"Bedside nursing has been extremely instrumental within the various task groups that focus on plan changes. In fact, the task groups associated with Casualty Care, Fatality Management, and HERT development are chaired by bedside nursing staff. There is also a Steering Committee for guidance that includes the Chief Operating Officer, Chief Medical Officer, Chief Information Officer, Chief Compliance Officer and the Vice President of Hospital Operations (K. F. , personal interview, February 13, 2012). † The established relationships that are within the community to help implement the organization’s disaster preparedness plan are that K. F. is currently the Chair-Elect for the Az Coalition for Healthcare Emergency Response (AzCHER-Central), which brings hospitals, clinics, skilled nursing acilities, fire & Emergency Medical Services (EMS), public health, emergency management, and other community stakeholders together for planning. Maricopa Medical Center currently has three to four members on the general body of this group, including bedside nursing representatives. There are a number of governmental agencies that are involved in the organization’s disaster preparedness planning. K. F. is an active member with Coyote Crisis Collaborative, which includes some of those from AzCHER, but also universities and community colleges, utilities, private business, faith-based and other volunteer groups, etc. The Chief Information Officer is currently the Chairman of the Board for Coyote Crisis Collaborative. Additionally, they participate in the Hospital Preparedness Program (HPP) Grant which is administered by Arizona Department of Health Services. All of these opportunities provide environments for collaboration, plan sharing, and developing solutions to issues that face all of those included (K. F. , personal interview, February 13, 2012). In order to implement this plan, staff has received adequate training. The National Incident Management System and Incident Command System training is required for all identified Hospital Command Center staff. They have a â€Å"3-Deep† list for all identified positions. Required training includes Incident System-100, Incident System-200, Incident System-700, and Incident System-800 as a minimum. Incident System-300 and Incident System-400 are required for section chiefs and incident commanders. An overview of the Hospital Incident Command System is shared with all employees at New Employee Orientation. The Hospital Emergency Response Team (HERT) members receive additional Hospital Incident Command System (HICS) training within the HERT course and must take Incident System-100, Incident System-200, and Incident System-800 as pre-requisites for HERT. At Maricopa Medical Center, HERT training is now the standard for the Emergency Department first-year residents during their orientation process. K. Fehr stated, â€Å"Additionally, position-specific training has been identified in a recent exercise as an opportunity for improvement. That training has been developed and is scheduled to be administered over the next 90 days (K. F. personal interview, February 13, 2012). † Maricopa Medical Center has an automated system for the Hospital Command Center that is based upon Hospital Incident Command System IV. This system allows for â€Å"virtual† command and has the ability to send status updates, as well as provide real-time status to the HCC Team. They have also just been given access to a Mass Notification program from Arizona Department of Health Services that can be used internally to ensure that communication during incidents is sent to every employee. HICS IV is the current model that is used, which is National Incident Management System compliant (K.  F. , personal interview, February 13, 2012). The standards that nurses are held to concerning their ethical obligations to their organization and community would be handled by the Incident Commander with guidance of wither a Legal Specialist or Medical Ethicist. Any issues that are specific to standards of care would be approved by the Incident Commander and forwarded to the staff during the event based upon available resources, etc. If the question is specific as to the nurses’ duty to respond to work during a disaster, they do not require them to respond. They hope that they would stay or be willing to come in. The planning includes the set-up of child/elder care areas and sleeping areas for the staff to remove barriers that would take them away from their station. Planning does include the idea that at least 40 % of the staff will not remain or come in during an incident. Maricopa Medical Center has a Memorandum of Understanding and a Memorandum of Agreement with other regional hospitals and formal request processes at the county and state levels for additional staff. When asked whether staff buy-in was a coveted aspect in Maricopa Medical Center’s disaster plan, K. F. tates, â€Å"Staff is absolutely buy-in coveted for this organization’s disaster preparedness plan. The best method that we have found for involvement includes the expansion of the HERT Program, covering the program during Health Fairs and Nursing Skills Fairs, and involving staff in exercises as mock patients (K. F. , personal interview, February 13, 2012). † After my interview with K. F. , I was really intrigued into what all goes on with a disaster preparedness plan. I knew that disaster plans were in effect for many organizations, but I did not realize the actual extent of what goes n with the planning of it. I learned a lot through the interview and was very pleased with the information that I received about Maricopa Medical Center and their disaster preparedness plan. I feel that what is involved in their plan is very relevant to the location of the organization, as well as how they every year they have two operational exercises, as well as discussion based exercises, to help test their plan and determine its effectiveness. I think this is a very important aspect to any organization because without testing the plan, it is unclear how effective it really it. After these annual exercises, I think it is great that the organization has an after report with ideas for improvement to help make their disaster plan stronger and more effective. All in all, I believe that Maricopa Medical Center has a very effective and sufficient disaster preparedness plan for their organization and that they are consistently looking for areas of where they can improve and better their plan to help the community recover from disaster as it occurs (K. F. , personal interview, February 13, 2012).

Final Year Project: Project Report

Final Year Project Review Tutorials 5. Project Profile Document Part 2 Preparation This tutorial will take place in the week beginning 25th February 2013. Check your on-line timetable for details. Before the tutorial, you should prepare and print out a draft copy of Part 2 of your Project Profile Document. This part of the document is all about the context of your project. Think of it as the sort of thing you might use to help you prepare for a job interview to show that you have an awareness of the industries closely related to your project and the professional requirements made on engineers working in them.It should include: †¢ †¢ For your project: o Environmental and sustainability limitations o Customer and user needs and aesthetics o Cost drivers o Fitness for purpose in terms of production, operation, maintenance and disposal For companies and organisations working in fields relating to your project, (you may choose a single company or organisation, or describe activi ty in the sector as a whole): o Opportunities and threats faced by the company/sector o The general management techniques used to control quality and ensure that engineering objectives are met The ways in which sustainable development is promoted in the sector o Legal requirements governing engineering activities in the sector o Particular requirements for professional and ethical conduct Peer Review & Feedback 1. 2. 3. Swap your draft section with another member of the class. Using the form provided, prepare a review of the document you have been given to read including some suggestions for changes/improvements. Go through your review with the report’s author and then get feedback on your own report from your reviewer.Write an action plan to update your Project Profile Document Final Year Project Review Tutorials Progress Report 1. 2. Using the form provided, write and hand in a summary of your progress to date. Hand your review and progress report to the tutor, to be scanne d and then returned to you. Copies of all documents will be made available to all academic staff. 5. Project Profile Document Part 2 1 Final Year Project Review Tutorials Review – Project Profile Document Part 2 Student ID Student Name Author ReviewerThe following sections should be completed by the reviewer and discussed with the author. Comment on how well you think the student has presented broader design Project context considerations of the project Industry context As a reader, comment on how you think that the author has helped you to understand the economic, social and environmental context of the industries that work in the project’s field Following discussion with the reviewer, the author should write a summary of the changes that will be made in the next draft of this section 5. Project Profile Document Part 2 2

Genetic Engineering Technology - 1689 Words

Modern genetic engineering technologies are advancing, and genetically modifying a genome is becoming a reality. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and CRISPR-associated system (CAS9) genome editing system is the most advanced in use. CRISPR can edit a genome more accurately and with higher precision than any other system. The intended use of the CRISPR/CAS9 system is to insert a gene, delete a gene, or silence a gene, leading to powerful applications (Christensen and Choy 2017a). For example, scientists plan to use this technology to change the genome and resulting phenotype in the efforts to eliminate potentially lethal diseases. One such disease is Human Immunodeficiency Virus (HIV) and Acquired†¦show more content†¦CRISPR was first exploited in 2007, by a food ingredient company. Their focus was on applications of the system to fermented milk bacteria (Streptococcus thermophilus) in the production of yogurt and cheese. By utilizing the CRISPR system, the company was able to vaccinate the bacteria used in their product against unwanted bacteriophages (Stachler and Marchfelder 2016a). Since then, the greater applications of the system have been realized. CRISPR is an adaptive natural immune system used by bacteria to protect against bacteriophages that replicate within the bacterium. It starts when a bacteriophage lands on the membrane of a bacterium cell, where it injects its DNA into the cell. Shortly after the DNA is injected, the infected bacterium detects the presence of bacteriophage DNA, leading to a production of a complex. The complex consists of the CAS9 nuclease and a twenty-base sequence short guide RNA known as sgRNA. The complex wraps around the bacteriophage DNA, and travels along until it reaches a targeted sequence indicated by the RNA. The sgRNA searches for complementary bases, only attaching at that region of the genome, ensuring the proper location. Upon reaching the location, the CAS9 enzyme will proceed to make a double stranded cleave through the DNA, disabling the bacteriophage and protecting the bacteria (Richter et al. 2012a). Bioengineers have generated a custom sgRNA within a CAS9 nuclease to search for a specific gene location within theShow MoreRelatedGenetic Engineering : An Unnatural Cell Invasion Technology2277 Words   |  10 PagesGenetic engineering is a complex environmental health issue that presents several benefits and risks to both consumers and the environment. Genetic engineering is a technique used to produce genetically modified organisms (GMOs), which are genetically altered in a way that does not occur naturally by mating or natural recombination (WHO, 2014). In other words, genetic engineering is an unnatural cell invasion technology. This technology is used to grow genetically modified (GM) plants, which areRead MoreGenetic Engineering : A New Technology1311 Words   |  6 PagesGenetic Engineering Genetic engineering is a new technology that is not utilized to its full potential. Often called modern biotechnology, genetic engineering can bring humanity into a better medical and agricultural age. Genetic engineering is an important scientific breakthrough because by altering DNA, scientists can improve food, create organs for transplant, and prevent certain diseases and birth defects. The field of genetic engineering has developed very quickly due to the greater understandingRead MoreGenetic Engineering : Technology, Equipment, And Experimentation Essay1678 Words   |  7 Pagesdoesn’t seem realistic in this day and age, but this is what our world is heading towards due to enhancements in scientific knowledge, technology, equipment and experimentation. This enables these scientists to undergo the delicate process used to enhance the characteristics of the individual. This process is known as genetic engineering. The aim of genetic engineering is to add new genes that have not been found in the individual. This could involve changing a base pair A-T or C-G in the DNA. In orderRead MoreReaction Paper On Genetic Engineering Technology741 Words   |  3 PagesWhat is I told you I could take your eyes and make them green, blue, even hazel?What if I said that all this could be done with a genetic engineering technology called CRISPR. CRISPR is a relatively new technology that can do just that and more†¦Now when I say CRISPR most people automatically think about the area in the fridge where vegetables are stored, but its more than that and its going to change the world right before our changing eyes. 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This innovative technology paved ways for medical breakthroughs, along with the expansion of human understanding towards the mechanismsRead MoreThe case for and against genetic engineering Essay examples640 Words   |  3 Pages The case for and against genetic engineering I will look at the case for and against the use of genetic engineering and make a conclusion on whether or not I believe that it is right. As I believe in genetic engineering, I will start buy looking at the reasons that support it. The main reason that I support genetic engineering is that this technology has dramatically improved our ability to treat and even cure diseases and gentic disorders. If mRNA is isolated andRead MoreDesigner Babies Essay905 Words   |  4 PagesAdolf Hitler. Designer Babies, a form of human genetic engineering, should be banned. When a human is created with a different embryo in a lab that child can feel a lost sense of identity; also, genetic engineering can lead to a loss of human diversity and an imbalance between the social classes; and the procedure for testing and creating genetically engineered children destroys embryos that had the potential of becoming a child. Genetic engineering is a field that is growing rapidly every singleRead MoreGenetic Engineering: Brave New World1012 Words   |  5 PagesGenetic engineering has been around for many years and is widely used all over the planet. Many people don’t realize that genetic engineering is part of their daily lives and diet. Today, almost 70 percent of processed foods from a grocery store were genetically engineered. Genetic engineering can be in plants, foods, animals, and even humans. Although debates about genetic engineering still exist, many people have accepted due to the health benefits of gene therapy. The lack of knowledge has always

Cyber Crimes Reflected Through Television Programs

Cyber Crimes Reflected Through Television Programs Cybercrimes are a culture which has facilitated technological criminal efforts to undermine government and private organizations in order to create disruption and panic on a large scale. Today’s television programming takes a series of intelligence type action roles, which prove the impact of post 9/11. Computer crimes have increased nationwide fears. The television series 24 is an action drama featuring a make believe personality known as Jack Bauer. During the show, Bauer has been frequently on the move to give- up various plots. (U.S. Department of State, National Strategy for Combating Terrorism, January 2001-2009). Bauer is a counter-terrorist agent who works out of a Counter†¦show more content†¦Computer crimes are perpetrated against thousands of Americans daily. The retail giant Target experienced several major computer crimes during the Black Friday’s discounted sales promotions, when thousands of their customer’s personal and financial information were stolen via the internet using computers. This is just one of many crimes involving information processing systems and the internet. This single act in its entirety encompassed all of the cyber crimes addressed previously. Account holders will not incur any financial burden from the breach, but the financial institutions, or merchant who issued he card(s), acquire the cost amid situation like this (By CNNMoney Staff @CNNMoney December 19, 2013: 4:41 PM ET). As technology changes every day, you can always expect many more new offenders, offenses, and victims simply based on the caliber of knowledge someone possesses, and by the role of the technology they are able to access. Computers can be used in the different ways to perpetrate these offenses. 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Health Care Reform Patient Protection And Affordable...

Health Care Reform The health care reform of 2010, Patient Protection and Affordable Care Act (PPACA), signed by the President Barrack Obama marked a significant landmark on the health care system that needed to be changed in order to provide health to the millions of uninsured in the United States. Nurses play an important role in the Affordable Care Act. According to Nickitas (2015), â€Å"nurses need deep understanding of the cost of care, health economics, and policy. Understanding the impact of the cost of care on society at large is an ethical imperative, particularly because nurses are consistently rated by society as the most trusted professionals† (p.158). The purpose of this paper is to discuss the financial factors that influence the health care today. Topics like cost containment, reimbursement methods, economic factors, funding sources, and business influences will also be explored. Socioeconomic Status and Health Outcome In general, individuals with higher socioeconomic status have better health, hence, lower mortality rate. â€Å"Individuals who occupy the lower ranks in the social and economic hierarchies†¦ experience worse health status and higher levels of mortalities† (Palloni Yonker, 2014, p. 15). Socioeconomic status encompasses the individual’s education, income and occupation. All of those factors can have an impact on an individual’s health. Families with higher income can provide greater quality food choices, have good healthcare, afford living in a safeShow MoreRelatedAffordable Care Act And Small Business1662 Words   |  7 PagesAffordable Care Act and Small Business Many people have a lot of questions when it comes to the new healthcare reform law. First off Obamacare is formally called the Patient Protection and Affordable Care Act. 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Importance of Being Earnest Essay Example For Students

Importance of Being Earnest Essay Title: The Importance of Being Earnest Author: Oscar Wilde Setting: Begins in a flat in London then proceeds to a manor house in the countryside in the late 1800s. Plot: Two men, John Jack Earnest Worthing and Algernon Moncrieff, use the deception a Bunbury that both their names were Ernest, in order to secure marriage to the women they love, Gwendolen Fairfax and Cecily Cardew. Then there is the ultimate unraveling of their lies, which still ends in their impending nuptials. Cast of Key Characters John Jack Ernest Worthing Bon-vivant Jack to Algernon 2 Algernon is asking Jack what brought him to town. Jack has come to town to get away from his responsibilities in the country, his ward Cecily, and to see Gwendolen, whom he wishes to propose marriage. In order to do this he has committed the Bunbury that he has come to see his brother, Ernest, who doesnt exist. He wishes to enjoy the pleasures before attending to his guardian duties. Quote: When one is in town one amuses oneself. When one is in the country one amuses other people. It is excessively boring. Curmudgeon Jack to Algernon 3 Jack has come to propose to Gwendolen. Which is the express reason behind his lying about his name being Ernest. Algy feels that is business not pleasure. Jack thinks it is utterly unromantic. Algernon says he will forget about romance when he is married. Though Algy doesnt know it yet when he sees Cecily he will shed this view. Jack feels that the view Algernon has, others do also and that is what causes the dissolution process to be born. Jack is generalizing his cynical view of unromantic people. Quote: The divorce court was specially invented for people whose memories are so curiously constituted. Architect Jack to Algy 3 Algy has said it is distasteful the way Gwendolen and Jack flirt with each other. This prompts Jack to state his romantic intentions toward Gwendolen. Jack has a specific goal, which is to marry Gwendolen. This is his sole purpose for coming to town. Jack is so intent on marrying Gwendolen he has created a bunbury, the phantom brother Ernest, in order to see her. He also lies that his name is Ernest. Quote: I am in love with Gwendolen. I have come to town expressly to propose to her. Conniver Jack to Algernon 4 Algernon is trying to found why there is an inscription of the name Cecily on Jacks lighter. Jack creates the lie that Cecily is his aunt when in actuality she is his ward. The lie beings to unravel here because Algernon continues to question Jack. This is Jacks Bunbury to Algy and there are many more to come. Jack hopes that this lie will discourage any further pursuit of his true relation, guardian, to Cecily. Quote: Well if you want to know Cecily happens to be my aunt. Critic Jack to Algernon 6 Jack has been trying to satisfy Algys fanatic questioning for the explanation of the inscription on Jacks cigarette case. Jack has said that he is Ernest in town and Jack in the country. Jack is not named Ernest. It is a phantom brothe r he has invented. Jack is going to explain his reason for lying in order to come to town, but he doesnt believe Algernon has a somber personality to comprehend his reasons. Quote: My dear Algy, I dont know whether you will be able to understand my real motives. You are hardly serious enough. Martyr Jack to Algy 6 Algy has returned the cigarette case to Jack; now, he wishes to hear the reason Jack is Ernest in town and Jack in the country. Jack shows his bunbury to Algy. Jack is Cecilys guardian that is why he is Jack in the country. In order to come to town he has invented a wayward brother named Ernest. Jack explains his reasons for lying about who Cecily really is and who he is to Cecily. He is essentially her immediate forebear and must keep up social standards. It is his responsibility to guard against any degrading of her values. Jack makes sacrifices to be Cecilys protector. One of his sacrifices is that he must lie in order to see Gwendolen, whom he doesnt see as often as he would like. Quote: When one is placed in the position of guardian, one has to adopt a very high moral tone on all subjects. Its ones duty. Dreamer Jack to Gwendolen 10 Jack is attempting to ask for Gwendolens hand in marriage. Gwendolen declares her passion for him and her wishes that he had shown more of his adore in public. When Jack remembers the day he met Gwendolen and he is telling her of his adore for her, he stammers through his declaration with awe of her. You can picture the star struck look in his eyes. Jack is dreaming of the time Gwendolen will be his ownest, which occurs at the end of the play. Quote: Miss Fairfax, ever since I met you I have admired you more than any girlI have ever met sinceI met you. Caregiver Jack to Lady Bracknell 14 Lady Bracknell has been questioning Jack about his background in order to determine his worthiness to marry Gwendolen. It has come out that Jack was found in a handbag in a train station cloakroom. Lady Bracknell will not allow the m arriage unless Jack can find his parentage. It would be below social standards and not very profitable for Gwendolen to marry someone of such origins. Jack is questioning Lady Bracknell of what to do, because he yearns to make Gwendolen full of zeal and must do so for his sake. Quote: May I ask you then what you would advise me to do? I need hardly say I would do anything in the world to ensure Gwendolens happiness. Judge Jack to Lady Bracknell 48 Lady Bracknell has just learned that Algy is engaged to Cecily. Cecily meets all of Lady Bracknells criteria, especially the money. Jack wont allow Algy to marry Cecily unless Lady Bracknell allows him to marry him. Jack is talking to Lady Bracknell about Algernons request to marry Cecily. He states that this will not happen because he finds that Algernon is a lyre and lacks any scruples. He judges Algy unfit as a match for Cecily because of Algys Bunbury. Quote: It pains me very much to have to speak frankly to you, Lady Bracknell, about your nephew, but the fact is that I do not approve at all of his moral character. I suspect him of being untruthful. Algernon Moncrieff Curmudgeon Algernon to Lane 2 Algernon is talking with Lane about the amount of wine consumed at his last dinner party. The comment that the wine at a bachelors house is better than a married household is made by Lane. And Lane infers his ideas of marriage to Algy. Algy feels that the social inferiors should hold up a better moral standard for the upper crust about marriage. And if they do not then they are worthless. After all it is their job to do so. It is ironic that Algy should speak of lower class morals when he has none of his own. His life is full of bunburying for entertainment. Quote: Lanes views on marriageReally, if the lower orders dont set us a good example, what on earth is the use of them? They seem, as a class, to have absolutely no sense of moral responsibility. Judge Algy to Jack 2 Jack finds out that Gwendolen is due to arrive wi th her mother, Lady Bracknell. This fits perfectly with his plan to purpose to Gwendolen. He wishes to recruit Algy to help by getting Lady Bracknell out of the way. Algernon talks to Jack of his conduct around Gwendolen and the lusty looks exchanged between the two of them. Their conduct is unbecoming of Ladies and Gentlemen. Pg. 2 My dear fellow, the way you flirt with Gwendolen is perfectly disgraceful. It is almost as bad as the way Gwendolen flirts with you. Avant-garde Algy to Jack 4 The last time Jack was at Algys house he left his cigarette case. Algy is reading the inscription and says the case must not be Jacks, because his name is Ernest. This indicates Jacks Bunbury. Algernon wants Jack to explain who Cecily is. He demands that the cigarette case inscription is explained and he is the first to mention it. Jack has been missing it for a while now. This is the first time Jack gets caught in his lies. Quote: Bring me that cigarette case Mr. Worthing left in the smoking-room the last time he dined here. Fanatic Algy to Jack 5 Algy bombards Jack on every lie he is telling about the inscription on the cigarette case. Cecily cant be his aunt when she calls him her Uncle Jack. Jack is really her guardian. Algy tells Jack that his name must be Ernest. Jack explains he is Jack in the country and Ernest in town. Ernest is really Jacks phantom brother. Algernon is quite persistent about the true explanation of the inscription on the cigarette case. For every little bit of reason he is given he continually pursues more and wont let the subject drop. He advances on Jack from every angle about the meaning of the words. Quote: Yes. But why does your aunt call you her uncle? From little Cecily, with her fondest love to her dear Uncle Jack. There is no objection, I admit, to an aunt being a small aunt, but why an aunt, no matter what her size may be, should call her own nephew her uncle, I cant quite make out. Besides, your name isnt Jack at all; it is Ernest. Conni ver Algy to Lane 8 Lady Bracknell and Gwendolen have arrived at Algys to find Jack there. Lady Bracknell is not pleased. Lady Bracknell apologizes for being late. Lady Bracknell wishes to have some tea and cucumber sandwiches, but Algy ate them all. Instead of telling her that he ate them, he makes an acquisition to Lane about where they are seeing he was to prepare them. This sets Lane up to lie and cover Algys indiscretion. Algy doesnt have to commit the bunbury some one else does. Quote: Good Heavens! Lane! Why are there no cucumber sandwiches? I ordered them specially Jester Algy to Jack18 Jack is proclaiming his love for Gwendolen when Algy interrupts with a giggle. Jack wants to know why. Algy is thinking of Bunbury. Algy has been listening in on Jack and Gwendolens conversation. Through the conversation he has found out where Jack lives in the country. He has secretly written down the address. The Bunbury he is thinking about is that he is going to the country house as Ernest to meet Cecily. Quote: Oh, Im a little anxious about Bunbury. Bon-vivant Algy to Lane 18 Lane presents Algy with a stack of bills and Algy destroys them and wishes to indulge in some spirits instead of tending to his responsibilities. Quote: Lane presents several letters on a salver to Algernon. It is to be surmised that they are bills, as Algernon, after looking at the envelopes tears them up Algernon says A glass of sherry, Lane Architect Algy to Jack 40 Jack admits to Gwendolen and Cecily that he has no brother at all and never did. The fact is Algy is really his brother, as he will find out later. Algy and Jack have both pretended to be named Ernest to marry the ladies. Now the lies have unraveled. The ladys figured out that neither of them will marry a man named Ernest and they are both quite mad. The women leave the men alone in the garden. Jack says this must be Algernons idea of a Bunbury and Algernon feels this is the epitome of bunburying. This is Algernons greatest legac y. Quote: yes, and a perfectly wonderful Bunbury it is. The most wonderful Bunbury I have ever had in my life. Visionary Algy to Jack 16 Algy wants to know if Gwendolen has accepted Jacks proposal. Gwendolen accepted, but Lady Bracknell is forbidding it due to Jacks origins. Jack badmouths Lady Bracknell. Algy is unwaivered by it. Algy implies that Gwendolen will turn out like Lady Bracknell. Jack sarcastically wonders is Algy believes he is being clever. Algy is showing conceit in that he is quite sure it is clever and true. Quote: It is perfectly phrased! And quite as true as any observation in civilized life should be. Lady Augusta Bracknell Director Lady Bracknell to Gwendolen 8 Lady Bracknell and Gwendolen arrive at Algys. Lady Bracknell sees Jack and gives him an icy bow. She does not approve of Jack and Gwendolen together it puts disorder to her plans for Gwendolens life. Lady Augusta doesnt like that her daughter has sat next to Jack and wishes to put order back to the situa tion. Quote: Wont you come and sit here, Gwendolen Oppressor Lady Bracknell to Gwendolen 12 Jack has just purposed to Gwendolen and Lady Bracknell comes in and interrupts. Gwendolen informs her mother that she is interrupting Mr. Worthing and that she and Mr. Worthing are engaged. Lady Bracknell brings Gwendolen back down to size with the firm reply that this is not so until she, her mother decides it to occur. Lady Bracknell wants Gwendolen to fear and respect her authority as her mother. Quote: Pardon meYou are not engaged to any one. When you do become engaged to some one, I, or your father, should his health permit him, will inform you of the fact Traditionalist Lady Bracknell to Gwendolen 12 Lady Bracknell has just been informed of Gwendolens engagement to Jack. She tells Gwendolen that this is not in line with tradition. She then explains the tradition. Lady Bracknell is a firm believer in the tradition of the time for marriages to be arranged by the family and not by the indi viduals. This is the only proper way for a lady to acquire wealth and keep her innocence from being tarnished. Quote: An engagement should come on a young girl as a surprise, pleasant or unpleasant, as the case may be. It is hardly a matter that she could be allowed to arrange for herself Critic Lady Bracknell to Jack 12 Lady Bracknell takes out a notebook and looks at it. The list she has is the same one the Duchess of Bolton has. Lady Bracknell is trying to give herself higher social status by association. Lady Bracknell is speaking to Jack about his status as a worthy suitor for her Gwendolen. He just doesnt make the cut of the upper class bachelors. He isnt on the roster of the best choice for mothers to make for their daughters. Quote: I feel bound to tell you that you are not on my list of eligible young men Curmudgeon Lady Bracknell to jack 13 Lady Bracknell is interviewing Jack. She asked him what he knows. He knows nothing. She is glad to hear that. Lady Bracknell is speaki ng to Jack of her view of education. She thinks it would hurt the upper class for there to be intellectual people and that it might possibly cause a riot on the royal family, but that problem wont occur in England because even educating people doesnt come first, social status does. Quote: The whole theory of modern education is radically unsound. Fortunately in England, at any rate, education produces no effect whatsoever. If it did, it would prove a serious danger to the upper classes, and probably lead to acts of violence in Grosvenor Square. Caregiver Lady Bracknell to Jack 15 Jack has told Lady Bracknell of his origins, found in a handbag at a train station in a cloakroom. In order for her to allow Jack to marry Gwendolen he must produce a parent. Jack can produce the handbag. Lady Bracknell needs to make sure her daughter is chosen the proper man for marriage. She feels Gwendolen needs her to make the choice for her, because they have done so most of her life. Quote: You can ha rdly imagine that I and Lord Bracknell would dream of allowing our only daughter-a girl brought up with the utmost care- to marry into a cloak-room and form an alliance with a parcel? Hon. Gwendolen Fairfax Architect Gwendolen to Jack 10 Jack is telling Gwendolen about how much he admires her since he first saw her. Gwendolen says she knows and that she too has admired him because of his name. She has always known she would marry an Ernest because it is fashionable. Gwendolen is a fraud about being honorable, because the only reason she is in love with Jack is that she thinks his name is Ernest. This is Gwendolens Bunbury, the pretense of love. It has been her goal since the day she met him. Quote: and my ideal has always been to love some one of the name Ernest. There is something in that name that inspires absolute confidence. The moment Algernon first mentioned to me that he had a friend called Ernest, I knew I was destined to love you. Conniver Gwendolen to Jack 10 Jack asks if Gwendolen would not love him if his name were not Ernest. Gwendolen starts speaking deliberately smooth and calculated almost too much so to be believable. She is telling him it is of no matter because his name is Ernest; therefore, she dances around the question. She is trying to cover up the fact that if his name were not Ernest she would not even take a second look at him. Quote: Glibly. Ah! That is clearly a metaphysical speculation, and like most metaphysical speculation has very little reference at all to the actual facts of real life, as we know them. Oppressor Gwendolen to Lady Bracknell 12 After Jack has proposed to Gwendolen, her mother returns to the room and instead of allowing Jack to stand Gwendolen does so and informs her mother of their engagement. Gwendolen takes control of the situation first. Gwendolen is physically restraining to Jack. She is verbally leashing to her mother, Lady Bracknell. Quote: Mamma! He tries to rise; she restrains him. I must beg you to reti re. This is no place for you. Besides, Mr. Worthing has not quite finished yet. Critic Gwendolen to Cecily 37 Gwendolen has come to the country house to surprise Jack. She meets Cecily first. They are exchanging polite insults to each other. Cecily is basically saying; if it looks like a duck and walks like a duck, it must be a duck. Cecily believes that Gwendolen has tricked Ernest to marry her. The fact is Algy is pretending to be Ernest and is whom Cecily is engaged. Jack is whom Gwendolen is engaged to and Jack is also pretending to be named Ernest. Gwendolen has just learned of the engagement between Ernest and Cecily and they are becoming engaged in a polite grit your teeth argument. Gwendolen lets Cecily know she obviously was raised in an improper style. Quote: I am glad to say that I have never seen a spade. It is obvious that our social spheres have been widely different. Caregiver Gwendolen to Cecily 39 Jack has told the ladies he doesnt have a brother named Ernest. Cecil y tells Gwendolen; her Ernest is Uncle Jack. That means that neither of the women is engaged to man named Ernest. Ironically after all the jealousy between the women they now have a common cause and unit. After Gwendolen and Cecily find out they has been lied to, they embrace and Gwendolen tells Cecily she will care for her like a big sister. Quote: You will call me sister, will you not? Cecily Cardew Deviant Cecily to Miss Prism 21 Miss Prism has just called for Cecily to come over and do her lessons. Cecily is talking with Miss Prism about her lessons. She tells Miss Prism that she doesnt want to do her German for she will look ordinary. She doesnt want to look like everybody else. She is being vain about her looks. Quote: But I dont like German. It isnt at all a becoming language. I know perfectly well that I look quite plain after my German lesson. Loner Cecily to Miss Prism 22 Cecily thinks Miss Prism could reform Jacks brother, Ernest. Cecily begins writing about Ernest in her diary. Cecily uses her Diary as her Bunbury. Cecilys sole companion is her diary she puts everything in it she lives her life in the pages. She wishes to remember her every detail of existence. Quote: I keep a diary in order to enter the wonderful secrets of my life. If I didnt write them down I should probably forget all about them. Dreamer Cecily to Algernon 32 Jack has demanded Algernon leave, but he has no intention of leaving. Algernon has asked Cecily to marry him. She begins to tell him they are already engaged and have been for some three months. She gives him the account of their lives thus far as lived in her dairy a far cry from reality. She has lived out their relationship in her diary. She has dreamed up the man that now stands in front of her. The only problem is that Algy is pretending to be named Ernest. Quote: On the 14th of February last. Worn out by your entire ignorance of my existence, I determined to end the matter one way or the other, and after a long strugg le with myself I accepted you under this dear old tree here Conformist Cecily to Gwendolen and then Algernon 43 Gwendolen and Cecily have learned that neither of them is engaged to a man named Ernest. Gwendolen and Cecily enter the house they are waiting for the men, Algernon and Jack, to enter. Gwendolen tells Cecily what to do and she follows her cue. The men finally enter. They have agreed not to speak first but Gwendolen does so and Cecily praises her then addresses Algernon also. Quote: Gwendolen, your common sense is invaluable. Mr. Moncrieff, kindly answer me the following question: Why did you pretend to be my guardians brother? Miss Laetitia Prism Traditionalist Miss Prism to Cecily 21 Cecily is watering the flowers. Miss Prism calls Cecily in to do her lessons. Miss Prism feels Cecily should not do manual labor that is not for ladies to do but for servants. Quote: Cecily, Cecily! Surely such a utilitarian occupation as the watering of flowers is rather Moultons duty than y ours? Director Miss Prism to Cecily 21 Cecily has just been tending to the flowers. Once Miss Prism has gotten Cecily to come over and sit down, she puts Cecily in order to do her lessons. Miss Prism tells Cecily what she is to do in her studies. As her teacher she must direct her education. Quote: Your German grammar is on the table. Pray open it at page fifteen. We will repeat yesterdays lesson. Curmudgeon Miss Prism to Cecily 22 Cecily is saying she thinks Miss Prism can reform Jacks brother. Miss Prism thinks the idea of turning over a new leaf is absurd. She is skeptical that it can be done. Quote: I am not in favour of this modern mania for turning bad people into good people at a moments notice. As a man sows so let him reap. Critic Miss Prism to Cecily 22 Miss Prism has written a novel herself. Later we find out that her novel is the key to Jacks true identity. When Miss Prism was younger she was caring for an infant, when she accidentally switched the baby with the book. Sh e placed the infant in her handbag and the novel in the baby carrier. The infant was Jack, whose real name is Ernest. Miss Prism sees no reason for Cecily to have a diary; she has nothing good enough to write about. Quote: You must put away your diary, Cecily. I really dont see why you should keep a dairy at all. Rev. Frederick Canon Chausable Caregiver Chausable to Jack 26 Jack comes in dressed in funeral garb. Jack is using the dress as a lie to eliminate his brother, Ernest. After Jack tells everyone his brother is dead, Chausable as a priest gives comfort to Jack. This is a need for priest to allow others to unburden their grief on them. Quote: Mr. Worthing, I offer you my sincere condolence. You have at least the consolation of knowing that you were always the most generous and forgiving of brothers. Critic Chausable to Jack 27 Jack says his brother will be buried in Paris. Chausable is horrified and feels that Jacks brother was crazy. The Victorian attitude toward Paris is tha t it is a place of ill repute. Algy is pretending to be Jacks brother Ernest to deceive Cecily. Quote: In Paris! Shakes his head} I fear that hardly points to any very serious state of mind at the last Deviant Chausable to Lady Bracknell 50 Lady Bracknell accuses Chausable and Miss Prism of having more than a platonic relationship. She thinks that there are more intimate issues. Chausable is outraged by the implications. He declares that he is a traditional man of God. Chausable shows his unique individuality to Lady Bracknell. Quote: I am a celibate, madame. Theme The Importance of Being Earnest is encompassed in the keeping up of social morals at all costs. The characters continually lie to keep an indignant moral high ground. They feel that without lying they would be unable to achieve their pleasures of life. Two men, John Jack Earnest Worthing and Algernon Moncrieff, use the deception a Bunbury that both their names were Ernest, in order to secure marriage to the women they lov e, Gwendolen Fairfax and Cecily Cardew. Then there is the ultimate unraveling of their lies, which still ends in their impending nuptials. John Jack Ernest Worthing comes to town to get away from his responsibilities in the country, his ward Cecily Cardew, and to see Gwendolen Fairfax, whom he wishes to propose marriage. In order to come to town he has invented a wayward brother named Ernest. He has committed the Bunbury that he has come to see his brother, Ernest, who doesnt exist. He wishes to enjoy the pleasures before attending to his guardian duties. Jack is proclaiming his love for Gwendolen when Algy interrupts with a giggle. Jack wants to know why. Algy is thinking of Bunbury. Algy has been listening in on Jack and Gwendolens conversation. Through the conversation he has found out where Jack lives in the country. He has secretly written down the address. The Bunbury he is thinking about is that he is going to the country house as Ernest to meet Cecily. Algernon has asked Cec ily to marry him. Cecily tells him they are already engaged and that it is written in her diary. Cecily uses her Diary as her Bunbury. She has dreamed up the man that now stands in front of her. The only problem is that Algy is pretending to be named Ernest. Jack admits to Gwendolen and Cecily that he has no brother at all and never did. The fact is Algy is really his brother, as he will find out later. Algy and Jack have both pretended to be named Ernest to marry the ladies. Now the lies have unraveled. The ladys figured out that neither of them will marry a man named Ernest and they are both quite mad. The women leave the men alone in the garden. Jack says this must be Algernons idea of a Bunbury and Algernon feels this is the epitome of bunburying. This is Algernons greatest legacy. Quote: yes, and a perfectly wonderful Bunbury it is. The most wonderful Bunbury I have ever had in my life. In the end, it is shown that there is more truth in many of the characters lies than they kn ew. When Cecily tells Algy that she and he are already engaged and have been for some three months. She gives him the account of their lives thus far as lived in her dairy. She has lived out their relationship in her diary. She has dreamed up the man that now stands in front of her. Miss Prism has written a novel herself. Later we find out that her novel is the key to Jacks true identity. When Miss Prism was younger she was caring for an infant, when she accidentally switched the baby with the book. She placed the infant in her handbag and the novel in the baby carrier. The infant was Jack, whose real name is Ernest. Jacks parents are really Algernons parents also. This means that every time Jack came to town to see Algy he really was seeing his wayward brother. With the truth exposed it also means that Algernon was only lying to Cecily about being named Ernest, because he truly is John Jack Ernest Worthings brother. Being earnest is being truthful. The quote that entails this ideal is on pg. 40 Algernon to Jack Well, one must be serious about something, if one wants to have any amusement in life. I happen to be serious about Bunburying Childhood Depression Essay