Anne Frank. Essay example -- essays research papers

Anne Frank The journal of a little youngster Anne was a 13 years Jewish young lady that lived in Neatherlands in the time world war 2 was occurring; with an awful temper, it helped work with what she needed. That’s why she didn’t manage everything well with her sister, her mom, and every other person. The main diverse one was her father, he comprehended what was befalling her, ( pubescence), and helped her with all that she needed. On her birthday she got a journal, Anne named it Kitty, and Kitty was her closest companion from that point onward. From the principal day she had it, she would compose all the considerations, sentiments and wishes she had. Her folks were salesmen, that idea, that in Neatherlands they may be sheltered from the nazis. Her life changed, when in July of 1942, the nazis came there scanning for jewish individuals. So the Frank’s took a hard choice: avoid the nazis, living in the house mystery room. They were shearing this stay with the Van Daan family, dear companions to their family. Since that day an alternate life began, an actual existence they didn’t envisioned, and didn’t comprehend what street would take. Living in the mystery room wasn’t simple; concealing frightened each day and night, and running consistently with a compromising life. More awful, living with the Van Daanâ's, a family Anne didn’t like, with their little underhanded girl. Anyway, they were ensured by individuals that gave them food and took great consideration of them. The Van Daanâ's were turning out to be increasingly more inconsiderate consistently that passed, cause the weight ...

Bullying and Harassment Among the Lgbtq Youth Essay Example for Free

Tormenting and Harassment Among the Lgbtq Youth Essay Youth is a troublesome stage in life since it is a period for some when economic wellbeing is viewed as significant and confidence can be delicate. One’s economic wellbeing can legitimately influence one’s confidence and by and large bliss. Sadly, huge numbers of the individuals who have a higher economic wellbeing in center and secondary school use it against the individuals who are esteemed socially substandard compared to them, regardless of whether that is because of race, engaging quality, knowledge or sexuality. At the end of the day, the young people at the base of the social pyramid are frequently exposed to tormenting and provocation from their socially â€Å"superior† schoolmates. Tormenting and badgering have become an across the board issue in schools all around the United States and have demonstrated to have genuine ramifications, for example, issues in scholastics for the individuals who are deceived by menaces. Exploitation from tormenting and provocation can be connected to brought down confidence, tension, despondency, shirking of school, and self destruction (Hawker Boulton, 2000). Tragically, one of the most defrauded gatherings of understudies exposed to tormenting and badgering is the lesbian, gay, promiscuous, transgendered and strange youth. As indicated by the National Youth Association, 9 out of 10 LGBT understudies have encountered provocation while at school. It likewise expresses that LGBT adolescents are harassed a few fold the amount of as straight youngsters. These high paces of harassing may clarify why more than 33% of LGBT kids have endeavored self destruction (Hawker Boulton, 2000). Explicit mischief pointed towards LGBTQ people group, known as gay slamming and gay tormenting can be characterized as verbal or physical maltreatment against an individual who is seen by the opponent to be gay, lesbian, promiscuous or transgendered. This additionally incorporates the individuals who are really hetero yet may seem, by all accounts, to be non-hetero because of generalizations. The three primary sorts of tormenting the LGBTQ youth is most exposed to a re verbal badgering, physical attack, and digital harassing. The principal fundamental sort of tormenting, verbal badgering might be difficult to distinguish in light of the fact that it leaves no physical verification, but instead mental and passionate injury. Be that as it may, it is as yet a mainstream and harming strategy utilized by menaces to hurt the LGBTQ youth ordinary. Truth be told, as indicated by River’s concentrate in 1996, it is the most well known strategy among menaces. Additionally, as per bullyingstatistics.org, numerous casualties of verbal harassing experience brought down mental self view, and can have enduring impacts in passionate and mental manners. This sort of harassing can prompt low confidence, just as sadness and different issues (Hawker Boulton, 2000). As indicated by River’s concentrate in 2001, numerous LGBTQ teenagers report being presented to verbal badgering and demonization. River’s ongoing review shows that 82% of the LGBTQ youth in schools are exposed to verbal slurs (Rivers 2001). As per another investigation from the Mental Health of America in 1998 on obnoxious attack, understudies hear hostile to gay slurs, for example, â€Å"homo†, â€Å"faggot† and â€Å"sissy† around 26 times each day, which would be about once like clockwork all through their school day. Hostile to gay language utilized all the time in school settings is making a disagreeable and unwelcoming air for the LGTBQ understudies, which might be making them be disconnected and socially pulled back (Swearer, Turner, Givens, Pollack, 2008). In spite of the fact that not all enemy of gay slurs heard in school are intended to be vindictive, it is as yet destructive for the gay youth to hear. Numerous youths who utilize gay slurs may not be homophobic, yet increasingly uninformed to LGBTQ issues. Clearly not all homophobic verbally abusing is aimed at youthful gay and lesbians. For instance, analysts found that terms, for example, ‘‘gay’’ and â€Å"homo† are frequently used to allude to anything unmasculine or ‘‘uncool’’ (Duncan, 1999). Despite goal, the consistent corruption of these words causes an unfriendly and awkward condition for the LGBTQ youth (Thurlow, 2001). Homophobic slurs, for example, â€Å"That’s s o gay,† or â€Å"no homo,† are mainstream among youths and regularly go unpunished because of the heteronormative climate overwhelming schools (Thurlow, 2001). Numerous understudies may feel reluctant to take a stand in opposition to against gay slurs out of dread of being abused themselves. In the U.K. a progression of reviews dispatched by Stonewall detailed that upwards of 93 percent of youthful gay, lesbian and swinger individuals who are ‘‘out’’ at school endure obnoxious attack (Thurlow, 2001). It is obvious that it's anything but a happenstance the LGBTQ youth face the most badgering of any minority at school. Alongside obnoxious attack, LGBTQ youth likewise experience physical savagery in schools the nation over regular. Thinking back to the 1980’s and 1990’s sociologists, for example, Joyce Hunter respected the physical maltreatment occurring towards the LGBTQ populace originated from the disgrace and dread that originated from the AIDS scourge that was spreading quickly among the gay network in that time. In an investigation as later as 2003, 60% of LGBTQ youth had revealed being attacked tr uly because of their sexual direction (Chesir-Taran, 2003) These physical activities towards the gay and lesbian youth has made many dread going to class. Truth be told, numerous LGBTQ understudies dodge school so as to get away from the physical badgering. This drop in participation effectsly affects the student’s scholastics (American Educational Research Association). As indicated by StopBullying.gov, since LGBTQ understudies are bound to maintain a strategic distance from school they are at a higher hazard for diminished scholastic accomplishment, including lower GPA and state administered test scoresâ€and school interest. They are bound to miss, skip, or drop out of school too. LGBTQ youth that have been exposed to physical provocation, or youth perceived†¨as lesbian, gay, swinger, or transgender, are more are additionally almost certain smoke, use liquor and sedates, or participate in other dangerous practices (Rivers 2001). This likewise causes lesbians, gays or bisexuals to be twice as likely as their companions to be discouraged and consider or endeavor self destruction (Russell Joyner, 2001). This high rate is physical maltreatment might be one reason why the American Educational Research Association announced that LGBT adolescents are 3.3 occasions bound to consider ending it all than hetero young people, just as multiple times bou nd to really end it all. These casualties of physical maltreatment likewise have higher paces of unexcused nonappearances from school (American Educational Research Association). As indicated by the social examination hypothesis, against gay savagery, for example, abhors violations will in general happen because of heteros needing to make a qualification among themselves and gay people. Implying that the harassers are not following up on their own, yet in a gathering. Some exploration infers that heteros preform savagery upon gay people to make an adverse assessment of LGBTQ’s, which consequently makes a bigger partition among gay people and heteros. As it were, heteros needs to make an understood qualification among themselves and gay people, and in this way viciousness is utilized to make this separation (American Educational Research Association). Since the LGBTQ is such a little minority bunch in many schools it is simple for heteros to make the gay people the out-gathering, though different heter os advantage from in-bunch inclinations and treatment (Herek, Berrill, 1992). What is so significant about the social examination hypothesis and gay brutality is that savagery is one of the best and evident approach to make a separation between the in and out-gatherings. Strikingly, Herek Berill found that most wrongdoing related brutal acts generally just included one casualty and one culprit, anyway when these savage demonstrations were viewed as despise violations, particularly among gays and lesbians, the quantity of culprits arrived at the midpoint of around four. Herek Berill likewise found in their exploration that young men are at a high hazard for being both the culprit and casualty, in all probability because of menaces needing to state their sexual prevalence and manliness over gay young men (Herek Berill, 1992). Rather than being driven into storage spaces or being called homophobic slurs while strolling down the passage to class, LGBTQ understudies are exposed to another type of provocation these days, which happens outside of the homeroom, and all the more explicitly on the Internet. As per stop bullying.gov, Cyberbullying is tormenting that happens by means of electronic innovation. This incorporates gadgets, for example, mobile phones , PCs, web based life destinations, instant messages, web talk, and sites. One explanation that this sort of tormenting is on the ascent is on the grounds that as innovation progresses, teenagers become increasingly presented to it, while grown-ups become progressively disengaged. This error in culture among grown-ups and young people makes numerous guardians become ignorant of what their youngsters are doing on the Internet, which may put them at a hazard for being bothered, or in any event, preforming the badgering (Keith Martin, 2005). One of the latest and notable instances of hostile to gay digital tormenting is the tale of Tyler Clementi, a gay Rutgers University understudy. Clementi was a survivor of digital tormenting on the grounds that his flat mate, Dharun Ravi, kept an eye on his make-out meetings with a concealed webcam and outed him on the web. This caused Tyler Clementi to murder himself by bouncing off the George Washington Bridge in 2010.Studies show that LGBTQ youth who are harassed online were bound to have played hooky, to have confinements or suspensions, or to convey a weapon to class (Ybarra, Diener-West, Leaf, 2007). In this equivalent examination, most of the members who confessed to being the culprits of digital tormenting ascribed se crecy for feeling increasingly good badgering oth

Manufacturing strategy and operations Essay Example | Topics and Well Written Essays - 3000 words

Assembling methodology and activities - Essay Example The reception of this methodology has various advantages to an association and the general buyer fulfillment. In investigating this alternative of creation, the paper will give a contextual investigation of Nike, an organization that has worked sweatshops in different pieces of the world including Asia and South America. The advantages of this geologically inaccessible assembling methodology received by the organization will be assessed in accordance with the standards of this methodology. Geologically far off ease producing impacts on worldwide client care desire The current pine for with topographically inaccessible low assembling area has prompted the rise of assembling units in china and different nations. This is ascribed to the minimal effort of work and materials in these nations, which lead to creation of ease products. Through this methodology of assembling, various associations have essentially expanded creation of ease merchandise and ventures, which has influenced emphati cally on the general expenses of the item (Tengstam, 2008). Nike through its units in Asia and different pieces of the existence where the expense of work and materials are low, have expanded its creation of ease footwear. As perhaps the biggest producer of sports footwear on the planet, the organization has improved its worldwide consumer loyalty through 100% redistributing of its creation forms. Through this procedure, the organization centers around innovative work and leaves the connecting with procedures of assembling and enormous scope creation to seaward redistributed organizations. This guarantees the organization presents all around structured and customer taste based footwear, which improves the organisation’s advertise impact (Kumar, 2001). One of the open expenses of significant distance fabricating procedures to clients is the minimal effort of merchandise created because of the low creation expenses and crude materials. As an organization that utilizes crude mat erials from china, Indonesia and India, Nike has expanded its market control because of the moderately low expenses of its items. The escalated cost of introducing and keeping up a creation unit expands the general expense of creation and this is answerable for expanded expense of items in various multinationals. This doesn't anyway happen with Nike as it centers around innovative work forms which results into creation of excellent minimal effort merchandise. The capital expenses of introducing more creation hardware are along these lines circumvent and this empowers the business to deliver low beds footwear and other game extras (Harzing, 2005). Nike’s calculated and fabricating system The assembling methodology of Nike has remained its center quality and purpose behind predominance in the worldwide market as it has upgraded its center competiveness. As a methodology that tries to dispose of introductory capital and the need to oversee creation cost, Nike built up the utiliz ation of seaward sweatshops worked in Asia and southern America. These contracted organizations have the ability to create top notch footwear and sports extras, which upgrades its serious quality in the market. Inside these sweatshops in Asia and South America, Nike screens the creation quality and sends exiles to these manufacturing plants to deal with their creation proces

Osteoarthritis - Free Essay Example

The relative effectiveness of full kinetic chain manipulative therapy and full kinetic chain rehabilitation in the treatment of osteoarthritis of the knee. Brief Synopsis of the Research Therefore in this study we aim to establish the effect of the KFC manipulative therapy alone, FKC rehabilitation alone and the combination of the two interventions on osteoarthritis of the knee. This will be done by means of a quantitative randomised comparative clinical trial. 60 patients will have been diagnosed with osteoarthritis of the knee according to the inclusion and exclusion criteria, and will be randomly divided into 3 groups. The first group will receive 6 treatments using FKC manipulative therapy alone, the second will receive 6 treatments using FKC rehabilitation alone, and the third group will receive 6 treatments using FKC manipulative therapy combined with FKC rehabilitation. Subjective (Beck Depression Inventory, McMaster Overall Therapy Effectiveness Tool, Western Ontario and McMaster Universities Osteoarthritis Index and Berg Balance Scale) and objective (Inclinometer) measures will be taken at baseline, 1 week and 1 month follow up. These results will be recorded and the data analysed using SPSS statistical package at a 95% confidence interval. Section B: To be typed in Arial 12-point font in one and half line spacing (expand sections to fit contents, but keep within the specified maximum lengths) 1. Field of Research and Provisional Title The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. 2. Context of the Research 1. Osteoarthritis is a very common condition, affects 9.6% of men and 18% of women aged 60 years worldwide (Woolf and Pfleger, 2003). 2. Although multi-factorial, falls cause nearly two-thirds of all non-intentional injury related deaths in older adults (Hawk et al., 2006). One of the causative factors is loss of hip and knee proprioception secondary to increased joint degeneration, thus by addressing these problems with the rehabilitation and/or adjustment there may be a decreased risk of fall. 3. There is research to suggest that applying manipulative therapy and rehabilitation to the full kinetic chain yields greater benefits for KOA patients than at home rehabilitation alone (Deyle et al., 2005), however this combination of treatments has never been compared against full kinetic chain manipulative therapy alone. 4. KOA stiffness, pain and dysfunction was shown by Deyle et al., (2000) and Deyle et al., (2005) to improve better when adding manipulative therapy to a rehab ilitation program as compared to placebo and exercise alone, respectively. 3. Research Problem and Aims Aim: The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. Objectives: i) To determine whether manipulative therapy alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. ii) To determine whether manipulative therapy alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. iii) To determine whether rehabilitation alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. iv) To determine whether rehabilitation alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. v) To determine whether manipulative therapy combined with rehabilitation is effective in the short term treatment of KOA in terms of subjective and objective measurements. vi) To determine whether manipulative therapy combined with rehabilitation is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. vii) To compare sh ort term results and intermediate results, respectively. viii) To determine whether manipulative therapy combined with rehabilitation is effective in decreasing the risk of fall according to the Berg Balance Scale. ix) To determine whether rehabilitation alone is effective in decreasing the risk of fall according to the Berg Balance Scale. x) To determine which treatment method is more effective in decreasing the risk of fall according to the Berg Balance Scale. 4. Literature review Osteoarthritis is a chronic degenerative disorder with a complex aetiology (Felson, 2000). It is characterized by focal loss of articular cartilage within synovial joints, associated with hypertrophy of bone (osteophytes and subchondral bone sclerosis) and thickening of the capsule, resulting in alterations in biomechanical properties (Woolf and Pfleger, 2003). It is a very common joint disorder, affecting mostly those above the age of 60 and can occur in any joint but is most common in the hip; knee; and the joints of the hand, foot, and spine (Symmons, Mathers and Pfleger, 2003). As many as 40% of people over the age of 65 suffering symptoms associated with knee or hip OA (Zhang et al., 2008), resulting in OA becoming the fourth leading cause of disability in the years 2000 (Symmons, Mathers and Pfleger, 2003). Although no cure exists, a number of treatment options exist to provide symptomatic relief as well as improvement of joint function. Amongst these are non-pharmacological interventions, such as rehabilitation, manual therapies, acupuncture and electromodalities, as well as pharmacological measures such as oral medication and intra-articular injections. In severe cases, where nonsurgical interventions have failed, more invasive approaches may be needed (Scher and Pillinger, 2007). McCarthy (2004) compared the effectiveness of an at home exercise program on its own or when supplemented with a class-based exercise program. There was found to be a greater improvement in WOMAC score in the class-based exercise group (20.6%) than the at home group (8.8%). These relatively modest effects may be owed to inability of exercise to address a number of factors that prevent patients from maximising results from their exercise program. Fitzgerald (2005) identified quadriceps inhibition or activation failure, obesity, passive knee laxity, knee misalignment, fear or physical activity and self-efficacy as examples of such factors. The necessity for additional inter ventions to address these factors therefore becomes apparent. Tucker et al. (2003) compared the relative effectiveness of knee joint manipulation versus a non-steroidal anti-inflammatory drug (NSAID), and found manipulation to be just as effective as NSAIDs in the treatment on KOA. Fish et al., (2008) had similar results when comparing the effectiveness of knee joint mobilisation against Topical Capsaicin Cream. Capsaicin has been previously demonstrated superior to placebo in many painful disorders including knee and general osteoarthritis. Pollard, Ward, Hoskins and Hardy (2008) applied a manipulative therapy protocol, consisting of soft tissue mobilisation and an impulse thrust to the symptomatic knee joint complex. This was found to have a statistically significant improvement in knee pain, mobility, crepitus and function when compared to the control group (interferential current set at zero). Pollard et al. (2008) also noted that knee treatment had a significant improvement in hip movement of those in the intervention group compared to the control group. This may be owing to the effect that treatment to a single joint may have on the full kinetic chain (hereafter FKC). A number of studies have been conducted on various joints of the full kinetic chain of the lower extremity to determine their effect on the knee. Cliborne et al., (2004) aimed to determine the short-term effect of hip mobilization on pain and range of motion (ROM) measurement in patient with knee osteoarthritis (OA). It was demonstrated that the presence of hip pain and pain on squatting, restricted hip flexion and/or a positive scouring test predicts a better knee OA outcome. Currier et al., (2007) suggest that pain over the hip, groin or anterior thigh; limitations in passive knee flexion and internal rotation of the hip; as well as pain with hip distraction predicts a favourable short-term response to hip mobilizations. In fact it was found that, based on the presence of one variab le, the probability of a successful response was 92% at 48-hour follow-up, which increased to 97% if 2 variables were present. Iverson et al., (2008) suggest that the strongest predictor of whether adjusting the lumbopelvic spine will decrease knee pain (in patellofemoral pain syndrome) is if there is a side-to-side difference in hip internal rotation greater than 14 °. The presence of this variable increased the likelihood of a successful outcome from 45% to 80%. These studies collectively show that correcting the various dysfunctions within the kinetic chain will have a favourable effect on knee joint dysfunction. However, there has yet to be a study that seeks to improve knee osteoarthritis by treating all indicated joints in the full kinetic chain. Few studies have looked at what effect combining manipulation and rehabilitation would have in the treatment of KOA. Deyle et al., (2000) applied manual therapy to the knee as well as to the lumber spine, hip and ankle as require d. Additionally patients where given to knee exercise program to perform in the clinic on treatment days and at home. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores are used to detect changes in the patients perception of function and quality of life, specifically related to the disease process. In this study, there was a 55.8% improvement in the treatment group as compared to a 14.6% improvement in those patients receiving placebo (subtherapeutic ultrasound), thus proving the effectiveness of combining manipulation and rehabilitation. Using similar methodologies, Deyle et al., (2005) compared an at home versus in clinic physical therapy program. Those being treated in clinic received supervised exercise, manual therapy to the FKC and a home exercise program, while a second group received at home exercise only. Significant improvements where seen in both groups, however the clinic treatment group had an improvement in WOMAC scores of 52% and only a 26% improvement was seen in the home exercise group. The author attributed this difference between groups to the application of manual therapy to the full kinetic chain. However, the clinic group performed the exercises under supervision and where corrected where necessary while the home group were largely unsupervised and may have performed the exercises incorrectly as a result, thus decreasing the benefit such exercises would have. One should therefore not consider the difference in group performance to be solely due to the addition of manual therapy. To date there is no study which compares the effect of manual therapy alone versus the above mentioned treatment combinations. Therefore there is a need for a study to determine whether FKC manual therapy combined with a standardised rehabilitation program is more effective than either intervention alone in the treatment of osteoarthritis of the knee. 5. Research Methodology Design type: Quantitative comparative clinical trial conducted at the Durban University of Technology Chiropractic Day Clinic (hereafter DUT CDC). Advertising: [Appendix A] Old age homes and retirement villages throughout the greater Durban region will be approached, as well as advertisements placed on notice boards of DUT, community halls, shopping centres and places of worship. Sampling procedure: A sample size of 60 (n=60) will be selected by means of convenience sampling (Brink, 2006). Those individuals responding to the advertisements will be screened and accepted based on the inclusion and exclusion criteria. Telephonic interview: Patients are required to contact the DUT CDC telephonically to determine whether they meet the requirements of the study. This will be determined by asking the patient the following questions; * Are you between the ages of 38 and 80? * Have you had knee pain for longer than 1 year? * Do you have a history of trauma or surgery to the lumbar spine or lower limb? * Are you able to stand and walk on your own, with minimal need and/or without significant dependence on canes and walkers? * Do you suffer from a chronic medical condition that would require you to take regular medication? * Would you be prepared to have radiographs taken of your lower limb? If the patient meets the criteria for the study, a consultation will be made, at which they will be presented with a letter of information and informed consent form [Appendix B], which they will be required to sign. The following inclusion and exclusion criteria will be assess using a case history [Appendix C]; physi cal exam [Appendix D]; lumbar and pelvis [Appendix E]; hip [Appendix F]; knee[Appendix G] and; ankle and foot [Appendix H] regional examinations. Inclusion Criteria: A. Criteria, as developed by Altman (1991), requires a minimum of one of the first three clinical criteria below (#1, 2 or 3) for diagnosis of KOA (sensitivity 89 % and specificity 88%). 1. Knee pain and crepitus with active motion and morning stiffness ? 30 min (with age 38 ? 80 years of age). 2. Knee pain and crepitus with active motion and morning stiffness 30 minutes and bony enlargement (with age 38 ? 80 years of age). 3. Knee pain and no crepitus and bony enlargement (with age 38 ? 80 years of age). B. The following 4 criteria are all required: 4. Knee pain of ? 1 year duration and able to stand and walk without severe varus/valgus deformity and/or severe instability (Kellgren and Lawrence, 1957). 5. Diagnosis of concurrent subluxation/or joint dysfunction (S/JD) complex: a. Diagnosis of S/JD will be supported throughout using the PART(S) system. 6. A patient must have a score of ?720 mm (?30%) on the WOMAC scale to be included (Tubach et al., 2005). 7. No history of meniscal or other knee surgery in the past 6 months (Pollard et al., 2008). 8. A diary will be kept to monitor whether medication consumption is increased, decreased or stays the same. Exclusion Criteria: 1. Significant visual disorders, severe vestibular disorders, neurological and peripheral sensory disorders which may be a contra-indication to exercise 2. History of knee or hip joint replacement, severe varus or valgus deformity, instability, fracture and severe osteoporosis, Rheumatoid arthritis, or frank avascular necrosis with or without moderate or severe deformity, 3. History of significant lumbar herniated disc injury with sequela, 4. Severe balance and proprioception problems (i.e. inability to stand with and/or without marked spinal or hip deformity) 5. Symptoms of moderate to severe osteoarthritis in both knees and/or hips: Note: both knees can be treated if there is KOA or joint dysfunction in the opposite knee and otherwise no other severe complications as noted above. However, only data collected from the worst knee will be used for the purpose of the study. 6. Long term chronicity combined with multiple treatment failure especially multiple failur e with previous physical treatment (? 3), with and/or long term severe pain, and/or a severely complicated or complex disorder (such as multiple co-morbidities combined with KOA such as a mix of: knee, hip and lumbosacral OA, and/or cardiovascular and/or auto-immune disease), or a severely disabled and/or a patient with severe and decreased functional ability and/or a severe clinical depression, may lead on a case by case basis, to exclusion. A basic guide for #6 to be used on a case by case basis: I. Pain: The patient gives a history that can be interpreted as having stayed constantly or chronically at a high level of an estimated verbal analogue score (VAS) of ? 7 or WOMAC score of 1680-1920mm (70-80%) (out of a maximum worst score of 2400mm) for 3 to 5 years or longer. II. Complicated or complex: 3 or more disorders at one time in the same patient (with KOA) as listed from #1-5 above. III. Severely disabled: dependent on a cane, brace or walker 75 to 100% of the time when ambulating; severe cardiovascular disease; severe instability in the knee or other joints or possibly less than, or markedly less than half the normal ROM. IV. Clinically depressed: determined by history and use the Beck Depression Inventory (BDI). The BDI has been validated for measuring depression in clinical and nonclinical settings (Beck et al., 1961). Radiological analysis: Although diagnosis of KOA will be made primarily through clinical examination, knee x-rays will be taken on patients who qualify and consent to participate in the clinical trial. The purpose is to determine the grade of osteoarthritic change (according to the Kellgren-Lawrence scale (reference)), to confirm suspicions of contra-indications to treatment, or to rule out a pathology outside of OA. Additionally, the subjects history and physical examination may indicate the need for lumbosacral/pelvic, hip, ankle and/or foot x-rays (see exclusion criteria below). Procedure: Time Baseline 2 weeks 4 weeks 6 weeks 1 week F/U 1 month F/U # Rx 2 2 2 Outcome measurement WOMAC ROM BBS BDI WOMAC OTE ROM BBS BDI WOMAC OTE ROM BBS BDI Once accepted into the study, patients will be randomly allocated into 3 (three) groups using a randomised allocation chart (reference). Interventions: Group A will be treated with only manipulative therapy of the FKC. Group B will be treated with only rehabilitation of the FKC. Group C will be treated with manipulative therapy combined with rehabilitation of the FKC. Manipulative therapy: [Appendix I] FKC manipulative therapy (manipulative therapy to the knee, and any indicated axial or appendicular joint dysfunction, such as to the spine, hip, ankle, and foot) for KOA has been hypothesized as superior to localised manipulative therapy (Deyle et al., 2005). Treatment will focus on carefully restoring knee flexion and extension by lesser grades of mobilization as recommended by Deyle et al., (2005) and Fish et al., (2008), and patellar mobilization as per Pollard et al., (2008), along with careful high velocity low amplitude axial elongation of the knee joint as per Fish et al., (2008). Additionally, manipulative therapy will be applied where needed to the full kinetic chain using other diversified techniques, such as HVLA manipulation or mobilization as outlined in Shafer and Faye (1990), and/or Peterson and Bergman (2002). Also, the hip technique, as outlined by Hoeksma et al., (2004) and the use of HVLA knee manipulation methods from Tucker et al., (2005) will also be utili zed when indicated. The particular joint dysfunction also known as the subluxation complex or manipulable lesion will be chosen based upon findings in the regional examinations. Rehabilitation: [Appendix J] Rehabilitative therapy will include exercises, focused soft tissue treatment and stretch to the knee and elsewhere along the full kinetic chain where needed based upon functional assessment (Deyle et al., 2005). Also included in rehabilitation will be patient advice, education and home exercise recommendations for managing their KOA. The rehabilitation protocol will be standardised across groups B and C, with minor case by case variations. Intervention frequency: All patient will receive: 6 treatments in the first three (3) weeks (2x treatments/week). Training in a rehabilitation program, to be completed daily. Regular telephonic communication (every 1-2 weeks) following the completion of the 6th treatment. All groups will be required to return to the clinic no more than one (1) week after the 6th treatment and at the one (1) month follow up to have readings taken. Measurement Tools: All data will be collected previsit 1, no more than 1 week after 6th treatment and at 1 month follow up, with the exception of OTE which will not be collected at previsit 1. Subjective data will b obtained by means of; Beck Depression Inventory [Appendix K] The McMaster Overall Therapy Effectiveness (OTE) Tool [Appendix L] will be used to assess patient satisfaction and general improvement. o The OTE is a valid and reliable questionnaire that allows the patient to classify the change in their health status: whether their KOA symptoms, or overall quality of life has improved, remained the same, or worsened since the last visit (Chan et al., 2006) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Appendix M] detects change in function and quality of life in patients suffering from KOA using multiple questions with the visual analogy scale (VAS). o The WOMAC is valid and reliable for KOA, and has a long history of being broadly and freque ntly utilized to assess knee and hip OA, thus allowing comparison to a large number of studies and trials (Bellamy et al., 1988). Berg Balance Scale (BBS) questionnaire [Appendix N] is a predictor of fall risk and will be delivered if the one legged standing test is failed (Hawk et al., 2006)). KOA patients who are +ve for the Berg Balance Scale (BBS) will be monitored as a subgroup (with a + OLST and BBS) at all clinic assessments Objective data will be obtained by means of: Inclinometer [Appendix O] readings for knee flexion and extension only to evaluate the patients range of motion (ROM) (reference). Statistics: The latest version of SPSS will be used to analyse the data. 6. Plan of Research Activities Provide a summarised work plan for each year of the project giving information for each research activity per year, under the following headings: Activity Timeframes (target dates for the duration of the project) 7. Structure of Dissertation / Thesis Chapters 1. Introduction 2. Review of the related literature 3. Subjects and methods 4. Results 5. Discussion 6. Recommendations and conclusions 7. References 8. Potential Outputs  § Provide details on envisaged measurable outputs (e.g. publications, patents, students, etc.);  § Expected national and/or international acclaim for the research and contribution of research outputs to building the knowledge base;  § Exploitability of outputs, e.g. applicability to community development, improved products, processes, services in SA, region and/or continent;  § Expected effects of research results. 9. Key References Brink, H. 2006. Fundamentals of research methodologies for health care professional. 2nd edition. Juta and co. Cape Town. Cliborne, A., Wainner, R., Rhon, D., Judd, C., Fee, T., Matekel, R., and Whiteman, J. 2004. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. Journal of Orthopaedic Sports Physical Therapy, November; 34(11): 676-685. Currier, L., Froehlich, P., Carow, S., McAndrew, R., Cliborne, A, Boyles, R., Mansfield, L., and Wainner, R. 2007. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favourable short-term response to hip mobilization. Physical Therapy, September; 87(9): 1106-1119. Deyle, G., Allison, S., Matekel, R., Ryder, M., Stang, J., Gohdes,D., Hutton, J., Henderson, N., and Garber, M. 2005. Physical Therapy Treatment Effectiveness fo r Osteoarthritis of the Knee: A Randomised Comparison of Supervised Clinical Exercise and Manual Therapy Procedures versus a Home Exercise Program. Physical Therapy, 85(12): 1301-1317. Deyle, G., Henderson, N., Matekel, R., Ryder, M., Garber, M., and Allison, S. 2000. Effectiveness of Manual Physical Therapies and Exercise in Osteoarthritis of the Knee. Annals of Internal Medicine, 132(3): 173-181. Felson, D. 2000.Osteoarthritis: New Insights Part 2: Treatment Approaches. In: National Iinstitute of Health Conference, Annals of Internal Medicine; 133: 726-737. Hawk, C., Hyland, J.K., Rupert, R., Colonvega, M. and Hall, S. 2006. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropractic and Osteopathy, 14(3). Haynes, S. and Gemmell, H. 2007. Topical treatments for osteoarthritis of the knee. Clinical Chiropractic; 10: 126-138. Iverson. C., Sutlive, T., Crowell, M., Morrell, R., Perkins, M., Garber, M., Moore, J., an d Wainner, R. 2008. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. Journal of Orthopaedic Sports Physical Therapy, June; 38(6): 297-312. McCarthy, C., Mills, P., Pullen, R., Roberts, C., Silman, A., and Oldman, J. 2004. Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology; 43: 880-886. Pollard, H., Ward, G., Hoskins, W. and Hardy, K. 2008. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Journal of the Canadian Chiropractic Association, December; 52(4): 229-242. Symmons D, Mathers C, Pfleger B. 2003. Global burden of osteoarthritis in the year 2000 [online]. Geneva: World Health Organization. Available at: URL: https://www3.who.int/whosis/menu.cfm?path=evidence,burden,burden_gbd2000docslanguage=english Tucker, M., Brantingham, J., Myburg, C. 2003. Relative effectiveness of a non-steroidal anti-inflammatory medication (Meloxicam) versus manipulation in the treatment of osteo-arthritis of the knee. European Journal of Chiropractic, 50: 163-183. Woolf, A.D. and Pfleger, B. 2003. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81 (9). Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D. J., Kwoh, K., Lohmander, L. S. and Tugwell, P. 2008. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16:137-162. Appendix L The McMaster Overall Therapy Effectiveness (OTE) Tool (for general improvement and patient satisfaction) Patient No. Visit No. Page No. . Overall Treatment Evaluation KOA We would like to find out if there are any changes in the way you have been feeling since treatment started: after 6 treatments, and also at the 1st week and 1st month follow ups. Since treatment started, has there been any change in your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS related to your knee osteoarthritis? Please indicate if there has been any change by checking ONE of the three boxes below (Better/About the same/Worse): Better About the Same Worse ? ? If you have checked ABOUT THE SAME, ? Please stop here. ? If you have checked the box If you have checked the box BETTER: WORSE: How much BETTER would you say How much WORSE would you say your ACTIVITY LIMITATION, your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS SYMPTOMS AND/OR FEELINGS have been since treatment started? Have been since treatment started? Please choose ONE of the options Please choose ONE of the options below: below: Almost the same, hardly better at all Almost the same, hardly worse at all A little better A little worse Somewhat better Somewhat worse Moderately better Moderately worse A good deal better A good deal worse A great deal better A great deal worse A very great deal better A very great deal worse Patient No. Visit No. Page No. . Overall Treatment Effect CHF, continued Answer the following question whether or not you answered BETTER or WORSE and what your response was. Note if you have improved, the change will be important since you likely will be able to carry out your responsibilities with greater ease and comfort compared to before the study. If on the other hand you are worse, then you will have more difficulty carrying out your responsibilities; this will also be important for you as you have more difficulty with your activities. Is this change (BETTER/WORSE) important to you in carrying out your daily activities? Not important Slightly important Somewhat important Moderately important Important Very important Extremely important THANKS FOR YOUR COOPERATION! Description of scales and how they will be assessed: * Pages one and two are graded separately. * Page one is graded on a 15 point scale. Scored from +7 to -7 * If the answer to the first question is Better then you have a + integer * If the answer to the first question is About the Same the score is 0 * If the answer to the first question is Worse then you have a integer * With a + or integer, the answers below the better or worse response are numbered sequentially from top to bottom. Almost the same, hardly better is a 1 and A very great deal better is a 7. * Page two is graded on a 7 point scale. Scored from 1 to 7 * The answers are numbered sequentially from top to bottom. Not important is a 1 and Extremely important is a 7 Later we will dichotomize the scores on page one between scores 1 (improved) and 0 (not improved). Appendix M The WOMAC Western Ontario and McMaster Universities osteoarthritis index KNEE OSTEOARTHRITIS Name:_________________________________________________ Date:___/___/______DOB:___/___/_____ In Sections A, B and C questions will be asked in the following format and you should give your answers by putting a straight vertical (up-and-down) mark on the horizontal line. Note: 1. If make a straight vertical (up-and-down) mark on the line, at the left-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have no pain. Note: 2. If make a straight vertical (up-and-down) mark on the line, at the Right-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have extreme pain. 3. Please Note: a) that the further to the right-hand end you place your straight vertical (up-and-down) mark on the line, the more pain you are experiencing b) that the further to the left-hand end you place your str aight vertical (up-and-down) mark on the line, the less pain you are experiencing c) Please do not place your straight vertical (up-and-down) mark on the line outside the markers. You will be asked to indicate on this type of scale the amount of pain, stiffness, or disability you are experiencing. Please remember the further you place your straight vertical (up-and-down) mark on the line to the right, the more pain, stiffness, or disability you are indicating that you experience. Section A Instructions to Patients The following questions concern the amount of pain you are currently experiencing in your Knee. For each situation please enter the amount of pain recently experienced. (Please mark your answers with a straight vertical {up-and-down} mark on the line). 1. Walking on a flat surface NO PAIN EXTREME PAIN 2. Going up or down stairs NO PAIN EXTREME PAIN 3. At night while in bed NO PAIN EXTREME PAIN 4. Sitting or lying NO PAIN EXTREME PAIN 5. Standing upright NO PAIN EXTREME PAIN Section B Instructions to Patients The following questions concern the amount of joint stiffness (not pain) you are currently experiencing in your knee. Stiffness is a sensation of restriction or slowness in the case with which you move your joints. (Please mark your answers with a straight vertical {up-and-down} mark on the line). 1. How severe is your stiffness after first wakening in the morning? NO STIFFNESS EXTREME STIFFNESS 2. How severe is your stiffness after sitting, lying or resting later in the day? NO STIFFNESS EXTREME STIFFNESS Question: What degree of difficulty do you have with: 1. Descending stairs. NO DIFFICULTY EXTREME DIFFICULTY 2. Ascending stairs NO DIFFICULTY EXTREME DIFFICULTY 3. Rising from sitting NO DIFFICULTY EXTREME DIFFICULTY 4. Standing NO DIFFICULTY EXTREME DIFFICULTY 5. Bending to floor NO DIFFICULTY EXTREME DIFFICULTY 6. Walking on a flat surface NO DIFFICULTY EXTREME DIFFICULTY 7. G etting in/out of car NO DIFFICULTY EXTREME DIFFICULTY 8. Going shopping NO DIFFICULTY EXTREME DIFFICULTY 9. Putting on socks/stockings NO DIFFICULTY EXTREME DIFFICULTY 10. Rising from bed NO DIFFICULTY EXTREME DIFFICULTY 11. Taking off socks/stockings NO DIFFICULTY EXTREME DIFFICULTY 12. Lying in bed NO DIFFICULTY EXTREME DIFFICULTY 13. Getting in/out of bath NO DIFFICULTY EXTREME DIFFICULTY 14. Sitting NO DIFFICULTY EXTREME DIFFICULTY 15. Getting on/off toilet NO DIFFICULTY EXTREME DIFFICULTY 16. Heavy domestic duties NO DIFFICULTY EXTREME DIFFICULTY 17. Light domestic duties NO DIFFICULTY EXTREME DIFFICULTY Below is a ten-centimeter line that begins with 0 and ends with 10. On this scale 0 stands for â€Å"no pain†. 10 stands for pain â€Å"as bad as it can be.† The first scale is for your usual (daily or typical) level of knee pain. The second scale is for your knee pain level when it is at its worst. Please think about your usual knee pain. On the line below, make a straight vertical (up-and-down) mark on the line to show how you usually feel. NO PAIN WORST PAIN IMAGINABLE Please think about your knee pain when it is at its worst. On the line below, make a straight vertical (up-and-down) mark on the line to show how you feel when you knee pain is at its worst. NO PAIN WORST PAIN IMAGINABLE Appendix N Berg Balance Scale The Berg Balance Scale (BBS) was developed to measure balance among older people with impairment in balance function by assessing the performance of functional tasks. It is a valid instrument used for evaluation of the effectiveness of interventions and for quantitative descriptions of function in clinical practice and research. The BBS has been evaluated in several reliability studies. A recent study of the BBS, which was completed in Finland, indicates that a change of eight (8) BBS points is required to reveal a genuine change in function between two assessments among older people who are dependent in ADL and living in residential care facilities. Description: 14-item scale designed to measure balance of the older adult in a clinical setting. Equipment needed: Ruler, two standard chairs (one with arm rests, one without), footstool or step, stopwatch or wristwatch, 15 ft walkway Completion: Time: 15-20 minutes Scoring: A five-point scale, ranging from 0-4. â€Å"0† indicates the lowest level of function and â€Å"4† the highest level of function. Total Score = 56 Interpretation: 41-56 = low fall risk 21-40 = medium fall risk 0 -20 = high fall risk A change of 8 points is required to reveal a genuine change in function between 2 assessments. BERG BALANCE SCALE Name: __________________________________ Date: ___________________ Location: ________________________________ Rater: ___________________ ITEM DESCRIPTION SCORE (0-4) 1. Sitting to standing ________ 2. Standing unsupported ________ 3. Sitting unsupported ________ 4. Standing to sitting ________ 5. Transfers ________ 6. Standing with eyes closed ________ 7. Standing with feet together ________ 8. Reaching forward with outstretched arm ________ 9. Retrieving object from floor ________ 10. Turning to look behind ________ 11. Turning 360 degrees ________ 12. Placing alternate foot on stool ________ 13. Standing with one foot in front ________ 14. Standing on one foot ________ Total ________ GENERAL INSTRUCTIONS Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item. In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if: †¢ The time or distance requirements are not met †¢ The subjects performance warrants supervision †¢ The subject touches an external support or receives assistance from the examiner Subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring. Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12. 1. SITTING TO STANDING INSTRUCTIONS: Please stand up. Try not to use your hand for support. ( ) 4 able to stand without using hands and stabilize independently ( ) 3 able to stand independently using hands ( ) 2 able to stand using hands after several tries ( ) 1 needs minimal aid to stand or stabilize ( ) 0 needs moderate or maximal assist to stand 2. STANDING UNSUPPORTED INSTRUCTIONS: Please stand for two minutes without holding on. ( ) 4 able to stand safely for 2 minutes ( ) 3 able to stand 2 minutes with supervision ( ) 2 able to stand 30 seconds unsupported ( ) 1 needs several tries to stand 30 seconds unsupported ( ) 0 unable to stand 30 seconds unsupported If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4. 3. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL INSTRUCTIONS: Please sit with arms folded for 2 minutes. ( ) 4 able to sit safely and securely for 2 minutes ( ) 3 able to sit 2 minutes under supervision ( ) 2 able to able to sit 30 seconds ( ) 1 able to sit 10 seconds ( ) 0 unable to sit without support 10 seconds 4. STANDING TO SITTING INSTRUCTIONS: Please sit down. ( ) 4 sits safely with minimal use of hands ( ) 3 controls descent by using hands ( ) 2 uses back of legs against chair to control descent ( ) 1 sits independently but has uncontrolled descent ( ) 0 needs assist to sit 5. TRANSFERS INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair. ( ) 4 able to transfer safely with minor use of hands ( ) 3 able to transfer safely definite need of hands ( ) 2 able to transfer with verbal cuing and/or supervision ( ) 1 needs one person to assist ( ) 0 needs two people to assist or supervise to be safe 6. STANDING UNSUPPORTED WITH EYES CLOSED INSTRUCTIONS: Please close your eyes and stand still for 10 seconds. ( ) 4 able to stand 10 seconds safely ( ) 3 able to stand 10 seconds with supervision ( ) 2 able to stand 3 seconds ( ) 1 unable to keep eyes closed 3 seconds but stays safely ( ) 0 needs help to keep from falling 7. STANDING UNSUPPORTED WITH FEET TOGETHER INSTRUCTIONS: Place your feet together and stand without holding on. ( ) 4 able to place feet together independently and stand 1 minute safely ( ) 3 able to place feet together independently and stand 1 minute with supervision ( ) 2 able to place feet together independently but unable to hold for 30 seconds ( ) 1 needs help to attain position but able to stand 15 seconds feet together ( ) 0 needs help to attain position and unable to hold for 15 seconds 8. REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.) ( ) 4 can reach forward confidently 25 cm (10 inches) ( ) 3 can reach forward 12 cm (5 inches) ( ) 2 can reach forward 5 cm (2 inches) ( ) 1 reaches forward but needs supervision ( ) 0 loses balance while trying/requires external support 9. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet. ( ) 4 able to pick up slipper safely and easily ( ) 3 able to pick up slipper but needs supervision ( ) 2 unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently ( ) 1 unable to pick up and needs supervision while trying ( ) 0 unable to try/needs assist to keep from losing balance or falling 10. TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.) ( ) 4 looks behind from both sides and weight shifts well ( ) 3 looks behind one side only other side shows less weight shift ( ) 2 turns sideways only but maintains balance ( ) 1 needs supervision when turning ( ) 0 needs assist to keep from losing balance or falling 11. TURN 360 DEGREES INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction. ( ) 4 able to turn 360 degrees safely in 4 seconds or less ( ) 3 able to turn 360 degrees safely one side only 4 seconds or less ( ) 2 able to turn 360 degrees safely but slowly ( ) 1 needs close supervision or verbal cuing ( ) 0 needs assistance while turning 12. PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool four times. ( ) 4 able to stand independently and safely and complete 8 steps in 20 seconds ( ) 3 able to stand independently and complete 8 steps in 20 seconds ( ) 2 able to complete 4 steps without aid with supervision ( ) 1 able to complete 2 steps needs minimal assist ( ) 0 needs assistance to keep from falling/unable to try 13. STANDING UNSUPPORTED ONE FOOT IN FRONT INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subjects normal stride width.) ( ) 4 able to place foot tandem independently and hold 30 seconds ( ) 3 able to place foot ahead independently and hold 30 seconds ( ) 2 able to take small step independently and hold 30 seconds ( ) 1 needs help to step but can hold 15 seconds ( ) 0 loses balance while stepping or standing 14. STANDING ON ONE LEG INSTRUCTIONS: Stand on one leg as long as you can without holding on. ( ) 4 able to lift leg independently and hold 10 seconds ( ) 3 able to lift leg independently and hold 5-10 seconds ( ) 2 able to lift leg independently and hold L 3 seconds ( ) 1 tries to lift leg unable to hold 3 seconds but remains standing independently. ( ) 0 unable to try of needs assist to prevent fall ( ) TOTAL SCORE (Maximum = 56) Section C: Ethics Note: Ethics requirements are faculty specific. Kindly ensure that you are aware of and have complied with the relevant ethics requirements. Tick as appropriate: Humans Organisations Animals Environment Yes à ¼ No Yes No Yes No Yes No Indicate Category (X) 1. Exempt from Ethics and Biosafety Research Committee Review (straightforward research without ethical problems) 2. Expedited review (minimal risk to humans, animals or environment) 3. Full Ethics and Biosafety Research Committee review recommended (possible risk to humans, animals, environment, or a sensitive research area) 4. Full Ethics and Biosafety Research Committee review required (risk to humans, animals, environment, or a sensitive research area) Attach Addendums (if any) ETHICAL ISSUES CHECKLIST FOR RESEARCH APPROVAL To be completed by all people wishing to conduct research under the auspices of Durban University of Technology. 1. Use the Durban University of Technologys Research Ethics Policy and Guidelines to ensure that ethical issues have been identified and addressed in the most appropriate manner, before finalising and submitting your research proposal. 2. Please indicate [by an X as appropriate] which of the following ethical issues could impact on your research. 3. Please type the motivations/further explanations where required in the cell headed COMMENTS. 4. The highlighted response cells indicate those responses which are of particular interest to the Ethics Committee NO. QUESTION YES NO N/A DECEPTION 1. Is deception of any kind to be used? and if so provide a motivation for acceptability. O COMMENTS: NO. QUESTION YES NO N/A 2. Will the research involve the use of no-treatment or placebo control conditions? If yes, explain h ow subjects interests will be protected. O COMMENTS CONFIDENTIALITY 3. Does the data collection process involve access to confidential personal data (including access to data for purposes other than this particular research project) without prior consent of subjects? If yes, motivate the necessity O COMMENTS 4. Will the data be collected and disseminated in a manner that will ensure confidentiality of the data and the identity of the participants? Explain your answer O COMMENTS 5. Will the materials obtained be stored and ultimately disposed of in a manner that will ensure confidentiality of the participants? If no, explain. If yes specify how long the confidential data will be retained after the study and how it will be disposed of. O COMMENTS 6. Will the research involve access to data banks that are subject to privacy legislation? If yes, specify and explain the necessity. COMMENTS RECRUITMENT 7 Does recruitment involve direct personal approach from the researchers to the potential subjects? Explain the recruitment process O COMMENTS 8 Are participants linked to the researcher in a particular relationship, for example employees, students, family? If yes, specify how. O COMMENTS 9 If yes to 8, is there any pressure from researchers or others that might influence the potential subjects to enrol? Elaborate. O COMMENTS 10 Does recruitment involve the circulation/publication of an advertisement, circular, letter etc? Specify O COMMENTS: advertisement 11 Will subjects receive any financial or other benefits as a result of participation? If yes, explain the nature of the reward, and safeguards O COMMENTS 12 Is the research targeting any particular ethnic or community group? If yes, motivate why it is necessary/acceptable. If you have not consulted a representative of this group, give a reason. In addition explain any consultative processes, identifying participants. Should consultation not take place, give a motivation. COMMENTS INFORMED CONSENT 13 Does the research fulfil the criteria for informed consent? [See guidelines]. If yes, no further answer is needed. If no, please specify how and why. O COMMENTS 14 Does consent need to be obtained from special and vulnerable groups (see guidelines). If yes, describe the nature of the group and the procedures used to obtain permission. COMMENTS 15 Will a Subject Information Letter be provided and a written consent be obtained? If no, explain. If yes, attach copies to proposal. In the case of subjects who are not familiar with English (e.g it is a second language), explain what arrangements will be made to ensure comprehension of the Subject Information Letter, Informed Consent Form and other questionnaires/documents. O COMMENTS 16 Will results of the study be made available to those interested? If no, explain why. If yes, explain how COMMENTS RISKS TO SUBJECTS 17 Will participants be asked to perform any acts or make statements which might be expected to cause discomfort, compromise them, diminish self esteem or cause them to experience embarrassment or regret? If yes, explain. O COMMENTS 18 Might any aspect of your study reasonably be expected to place the participant at risk of criminal or civil liability? If yes, explain. O COMMENTS 19 Might any aspect of your study reasonably be expected to place the participant at risk of damage to their financial standing or social standing or employability? If yes, explain. O COMMENTS 20 Does the protocol require any physically invasive, or potentially harmful procedures [e.g. drug administration, needle insertion, rectal probe, pharyngeal foreign body, electrical or electromagnetic stimulation, etc?] If yes, please outline below the procedures and what safety precautions will be used. O COMMENTS 21 Will any treatment be used with potentially unpleasant or harmful side effects? If yes, explain the nature of the side-effects and how they will be minimised. COMMENTS 22 Does the research involve any questions, stimuli, tasks, investigations or procedures which may be experienced by participants as stressful, anxiety producing, noxious, aversive or unpleasant during or after the research procedures? If yes, explain. COMMENTS 23 Will any samples of body fluid or body tissues be required specifically for the research which would not be required in the case of ordinary treatment? If yes, explain and list such procedures and techniques. COMMENTS 24 Are any drugs/devices to be administered? If yes, list any drugs/devices to be used and their approved status. O COMMENTS GENETIC CONSIDERATIONS 25 Will participants be fingerprinted or DNA fingerprinted? If yes, motivate why necessary and state how such is to be managed and controlled. O COMMENTS 26 Does the project involve genetic research e.g. somatic cell gene therapy, DNA techniques etc? If yes, list the procedures involved O COMMENTS BENEFITS 27 Is this research expected to benefit the subjects directly or indirectly? Explain any such benefits. COMMENTS 28 Does the researcher expect to obtain any direct or indirect financial or other benefits from conducting the research? If yes, explain. O COMMENTS SPONSORS: INTERESTS AND INDEMNITY 29 Will this research be undertaken on the behalf of or at the request of a pharmaceutical company, or other commercial entity or any other sponsor? If yes, identify the entity. O COMMENTS 30 If yes to 29, will that entity undertake in writing to abide by Durban University of Technologys Research Committees Research Ethics Policy and Guidelines? If yes, do not explain further. If no, explain. O COMMENTS 31 If yes to 30, will that entity undertake in writing to indemnify the institution and the researchers? If yes, do not explain further. If no, explain. O COMMENTS 32 Does permission need to be obtained in terms of the location of the study? If yes indicate how permission is to be obtained. O COMMENTS 33 Does the researcher have indemnity cover relating to research activities? If yes, specify. If no, explain why not. COMMENTS 34 Does the researcher have any affiliation with, or financial involvement in, any organisation or entity with direct or indirect interests in the subject matter or materials of this research? If yes, specify. O COMMENTS The undersigned declare that the above questions have been answered truthfully and accurately STUDENT NAME SIGNATURE- DATE SUPERVISOR NAME SIGNATURE DATE Please initial alongside if the project is to be registered as secret Guidelines for the Preparation of a Research Proposal (To be read in conjunction with the Postgraduate Student Guidelines) Please ensure that you have completed, in every respect, all of the following prior to submission of your Research Proposal. Students are advised to use the electronic version of the PG 4 form which is available from the DUT website or from the Faculty Officer. Please complete ALL SECTIONS, using Arial 12-point font, one and half line spacing in MS Word. Where sections are not applicable please adapt the form accordingly. 1. Proof-read your hard copy, ensure correct referencing, edit rigorously and then submit to your Supervisor(s). 2. Number all pages and show correct author source references both in the tex t proper and in the References at the end using the Harvard referencing method (IEEE for Engineering students). 3. Complete the Ethics Section, the Work Plan and the Budget correctly in every respect and again engage in a thorough spell check prior to submission to your Supervisor/Co- Supervisor(s)/ Promoter/Co-Promoter(s). 4. Please note carefully the closing dates, as outlined in the Academic Calendar, contained in the Rule Book for Students, the registration dates as well the expected duration for the completion of the project. 5. It is imperative that you adhere to your specified guidelines for completion of your research and institutional/faculty deadlines as published on the DUT website. Reviewer / Review Panel Chair Title Tel (W) Tel (H) Cell Fax e-Mail Yes No Un- clear Recommendations Signed: __________________________Date: _______________________ (Reviewer) Signed: __________________________Date: _______________________ (HoD) ETHICS CLEARANCE CERTIFICATE Student Name Student No Ethics Reference Number Date of FRC Approval Qualification Research Title: In terms of the ethical considerations for the conduct of research in the Faculty of Health Sciences, Durban University of Technology, this proposal meets with Institutional requirements and confirms the following ethical obligations: 1. The researcher has read and understood the research ethics policy and procedures as endorsed by the Durban University of Technology, has sufficiently answered all questions pertaining to ethics in the DUT 186 and agrees to comply with them. 2. The researcher will report any serious adverse events pertaining to the research to the Faculty of Health Sciences Research Ethics Committee. 3. The researcher will submit any major additions or changes to the research proposal after approval has been granted to the Faculty of Health Sciences Research Committee for consideration. 4. The researcher, with the supervisor and co-researchers will take full responsibility in ensuring that the protocol is adhered to. 5. The following section must be c ompleted if the research involves human participants: YES NO N/A v Provision has been made to obtain informed consent of the participants v Potential psychological and physical risks have been considered and minimised v Provision has been made to avoid undue intrusion with regard to participants and community v Rights of participants will be safe-guarded in relation to: Measures for the protection of anonymity and the maintenance of Confidentiality. Access to research information and findings. Termination of involvement without compromise Misleading promises regarding benefits of the research

The Problem Of Human Trafficking - 1328 Words

Slavery has been abolished for the past 150 years and yet, there are still men, women, and children being taken from their homes and put into human trafficking. Every individual is supposed to be given the opportunity to a long and happy life but, with human trafficking standing in the way, millions of people are subjected to illnesses, diseases, and unhappiness. Human trafficking has taken over the lives of many, especially in Bangladesh. A country that is subjected to filth, poverty, and sex trafficking. Bangladesh is one of the top countries for human trafficking. The people of Bangladesh are in need of assistance, they need to be provided with health care for each and every individual exposed to the epidemic, sex trafficking. The issue is that the men, women, and children are told they will have a job interview for a good, well-paying job, or that they will be left with someone to marry and start a family, but they are lied to. We are proposing that human trafficking victims in Bangladesh are provided with the health care they need in order remain safe and disease free. Some may say that there is no real threat with human trafficking, for it is not something that is often talked about. Occasionally one can hear on the news or radio of a bust but, many choose to disregard that human trafficking is happening in their very own backyard. One way that human trafficking is publicized is by celebrities. Celebrities take their given power and take a stand on the contagiousShow MoreRelatedThe Problem Of Human Trafficking1498 Words   |  6 Pagesthese problems. Taking a closer look at an ongoing issue highly prevalent in our world today, it is easy to see that other issues feed off it, and can contribute to the issue at hand. The issue I want to focus on is human trafficking. This type of criminalization is often one that is overlooked, most people believing that it is some sort of â€Å"myth,† or that this type of action happens to very few, and is only pa rt of developing countries. However, the truth of the matter is that human trafficking occursRead MoreThe Problem Of Human Trafficking1283 Words   |  6 PagesWhen it comes to the topic human trafficking, mostly everyone knows that it has a lot of history to its name. According to ben skinner, â€Å" there are more slaves in the world today then ever before†(E. Benjamin pg. xi). There have been many incidents and cases with human trafficking such as, sex trade, smuggling, violence, etc. Today, one can show how real is Human Trafficking. This paper details the big enigma exist todays date, that Human Trafficking is real. Trafficking can happen in almost everyRead MoreThe Problem Of Human Trafficking1439 Words   |  6 Pages Though it may be receiving more attention in recent years, it could be argued that the complete magnitude of human trafficking is still not fully comprehended. Professor of Epidemiology, Rezaeian Mohsen, has stated that, â€Å"The ultimate intention of human trafficking is to give illegitimate power to a human being in order to force another human being to be a subject of modern slavery i.e. prostitution, sexual exploitation, forced labor, slavery, etc.† (Mohsen, 2016, p.36). This type of illegitimateRead MoreThe Problem Of Human Trafficking1080 Words   |  5 Pagesinevitable. The thought of writing my essay was frightening enough but deciding on a topic and searching for sources was a completely different story. After a few sleepless nights, I finally decided on my topic, human trafficking. I chose this topic because I believe human trafficking is a problem not only in America but worldwide and needs to be taken seriously. My strong dislike for research papers is not someth ing to hide but I am hoping for the best for this essay and the class. As I began researchingRead MoreThe Problem Of Human Trafficking883 Words   |  4 Pagesinterest in ending human trafficking, a complex and multi-faceted phenomenon, has been slow and selective. The inner reason for the poor success is the prevailing conception of the problem. 2. This paper argues that the limited success in fighting human trafficking is to a large extent the result of framing the existing debate of human trafficking as predominantly a matter of prevention and protection rather than addressing the global market conditions within which human trafficking thrives . UnlikeRead MoreThe Problem Of Human Trafficking Essay1623 Words   |  7 PagesIntroduction- A million of women children are trafficking worldwide every year it is problem of developed and developing and under developing country, issue found that across the nation are can say that trafficking is flowing to underdeveloped country to developing country or developing country to develop country. It has been made big market of human trafficking. Human trafficking is the third big benefitted industry in the world. At least million of children using in the prostitution for-profitRead MoreThe Problem Of Human Trafficking1387 Words   |  6 Pagesyears’ human trafficking has recogn ized as major illegal and problematic activity within the criminal justice system throughout the United States and a majority of the world. Although much attention has been paid to the worldwide aspect of human trafficking it is important to realize its domestic prevalence. According to ------------------ and estimated 200,0000 to 300,000 immigrants are trafficked illegally within the United States from impoverished countries. The topic of human trafficking has provedRead MoreThe Problem Of Human Trafficking1168 Words   |  5 Pagesa form of what we know today as human trafficking. The trafficking in persons is a form of modern day slavery, and exploits it’s victims into a slavery type setting such as manual labor or for commercial sex purposes. Many adults and elderly make up a great number of the humans that are trafficked each year, but the general population is children since they are usually helpless and are easier to manipulate since they are still in the ages of lear ning. Trafficking people is a very serious crime andRead MoreThe Problem Of Human Trafficking2103 Words   |  9 PagesHuman Trafficking Introduction The problem of human trafficking affects many countries around the world. In practice, it is a transnational organized crime in which participants have networks in different countries where they source and sell their victims. Human trafficking has adverse effects on the victims as well as the entire society. Accordingly, many countries have implemented different policies in an effort to combat this social concern. Despite these policies and intervention measures, humanRead MoreHuman Trafficking. Human Trafficking Has Been A Problem1487 Words   |  6 PagesHuman Trafficking Human trafficking has been a problem for too long. It affects many people at a time. There are many stories about different people who had been taken. The traffickers have different strategies in order to pull in different people. Human trafficking is not only in America, but in every part of the world. Around 4.5 million victims get stuck in sex trafficking. There are many ways to help stop human trafficking that are not hard to do and do not cost any money. If everybody could

Summary Orlando - 1642 Words

ORLANDO, Fla. — On a sweltering afternoon in late August, Stephanie Murphy, a Democrat running for Congress against a longtime Republican incumbent, stole a half-hour from a crammed schedule for something that grieving residents of this metropolitan area still routinely do: She visited Pulse nightclub, where a gunman ended 49 lives in June. The club itself has been closed since then, but a patch of the property in front brims with flowers, photographs and rainbow flags, which signal that Pulse was a place where many gay people gathered and many gay people died. It’s an eye-catching, heart-stopping memorial. Could it also be an omen of political change? Prominent among the issues that Murphy, 37, is campaigning on is her 73-year-old†¦show more content†¦people into an advantage. Public opinion polls leave no doubt that a significant majority of Americans support laws protecting L.G.B.T. people from discrimination and approve of same-sex marriage. But that doesn’t mean that they prioritize the issue and punish politicians with contrary views. The results of many elections suggest that they don’t. Continue reading the main story Advertisement Continue reading the main story I think that’s changing, and 2016 could be the proof of it. In several closely fought races around the country, candidates’ actions and comments regarding gay people have come to the fore and come to define them. Murphy’s contest against John Mica, now in his 12th term, is only one of them. The outcomes of two of the most competitive gubernatorial contests — in Indiana and North Carolina — could be affected by voters’ feelings about how the candidates have handled L.G.B.T. rights. That’s especially true in North Carolina, where Gov. Pat McCrory is being hammered for a shockingly regressive measure that he signed into law last March. It hallucinated some grave public danger in transgender people’s using public restrooms that correspond to their gender identity, banned them from doing so, and then went even further, nullifying local ordinances that outlawed employment and housing discrimination against gay and lesbian people. â€Å"I believe that he started this in order to stir up hisShow MoreRelatedMedia Influences On Our Perception, Knowledge, Attitudes, And Beliefs1650 Words   |  7 PagesMedia informs and influences us, as well as it impacts our perception, knowledge, attitudes, and beliefs about certain things that take place. June 12, 2016 was a tragic night at Pulse, a gay nightclub in Orlando, Florida. Omar Mateen, a 29-year-old security guard, initiated a terrorist attack, killing 49 people and wounding 53. He used an AR-15-style rifle and a handgun to carry out the attack. The hate crime took place just shortly before the club was supposed to close. When people started hearingRead MoreSummary Of The Death Of Seaworld Orlando s Trainer Dawn Brancheau 842 Words   |  4 PagesEmily Kalantar Professor John Swanson HCOM 213 ROUGH DRAFT Orcas in Captivity Create an image of being taken from a parent at a young age and being pitched into a barred pool, no way out and imperceptibly enough room to swim. Visualize seldom being let out to be engaged in nonsensical tricks in front of people cannot comprehend the uninhabited area you are forced to cope with behind closed doors. For the 141 killer whales held in captivity, this is the crude reality they face every single day. (CNN)Read MoreFlorida: History and Modern Attractions of the 27th State in America885 Words   |  4 Pagesprior to this Florida was on of the most popular state in the country thanks to a man named Walt Disney. Walt Disney opened up a theme park called Disney World in 1971 in Orlando Florida. People from all over the world came to Florida and marveled at the brand new park. About twenty years later a brand new park opened in Orlando Florida and it is called Universal Studios. This theme park is unlike any other because the theme changes with the new movies that co me out each year. On opening day peopleRead MoreAnalysis Of Seaworld And San Diego1215 Words   |  5 PagesSummary SeaWorld in San Diego, California recently announced its facility has plans to phase out its killer whale shows. This decision is what PETA and other oppositions of SeaWorld has been seeking, but there is no news of ending these shows at their Orlando and San Antonio locations. There is Federal legislation in the works to ban orca breeding, importing and exporting them for public display. This legislation is called the Orca Act and is still in its early stages of proposal. Passing ofRead MoreUniversal Car Rental Pricing Simulation (Havard Busines School Pricing Simulations)1215 Words   |  5 PagesRental Pricing Simulation July 2012 Universal Car Rental Pricing Simulation Background: The objective of the simulation was to maximise profits of Universal Car Rental Company. The simulation was run across three cities in Florida; Tampa, Orlando and Miami. Overall strategy: We adopted a strategy of offering the highest price achievable whilst maintaining 100% capacity utilisation irrespective of market share. In the context of the scenario, where growth in demand outstripped supplyRead MoreA Holistic And Spiritual Treatment Essay1473 Words   |  6 Pagesa student nurse through philosophical and nursing theories and relate these as to how nurses could perceive patients as human beings. In the view of Plato, through Dualism, humans have both immaterial and material components: the body and soul (Summary of Plato s Theory of Human Nature, 2014). In other words, there is more to a person that just mere physicality, which is a deeper and spiritual being (Croonenburg). Even nurses view patients as more than his or her body. Jean Watson, in her nursingRead MoreAnalysis Of The Movie Hot Seat 1270 Words   |  6 Pagesrevenge. The opening sets the tone and nice plants foreshadow information with satisfying payoffs during the script. There’s strong anticipation and dramatic irony when the audience knows about the bomb and waits for Orlando to discover it. There’s a solid inciting event when Orlando finally realizes he’s sitting on a bomb and is forced to commit acts of hacking. The second act is driven by the goal to figure a way out of his impossible situation. He’s proactive with trying and failing. There’s aRead MoreWireless World1411 Words   |  6 PagesProposal For 2010-2015 BUSN-278 Fall 2010 Professor Rebecca Boling Annie Hogan DeVry University ------------------------------------------------- Table of Contents Section | Title | Subsection | Title | Page Number | 1.0 | Executive summary | | | 3 | 2.0 | Sales Forecast | | | 3 | | | 2.1 | Sales Forecast | 3 | | | 2.2 | Methods and Assumptions | 3 | 3.0 | Capital Expenditure Budget | | | 4 | 4.0 | Investment Analysis | | | 4 | | | 4.1 | Cash flows | 4 | Read MoreVenetian High Renassaince929 Words   |  4 Pagesamazing poems of only four very influential poets of this time. I will discuss how Veronica Franco intelligently transforms courtly love into sexual metaphor. I will identify the missing elements of chivalry and courtly love in Ludovico Aristo’s â€Å"Orlando Furioso†, and I will compare Lucretia Marinellas views in â€Å"The Nobility and Excellence of Women† to those of Laura Cereta’s. Veronica Franco, being chief among the courtesans, is the most impressive with her use of a rather satiric approachRead MorePersonal Nursing Philosophy : My Personal Philosophy Of Nursing1190 Words   |  5 Pages(Faust et al., 2014, Major Dimensions, para. 3). Beliefs and Values Ones beliefs and values will affect the way the see each person, the environment they’re in, as well as the care they provide. My personal philosophies closely relate to Ida Jean Orlando: Nursing Process Theory as I try to assess the â€Å"problem† in my patient and find appropriate interventions to alleviate this discomfort. According to Petiprin (2016), this theory helps nurses find out the nature of the patient’s distress and provide

Fundamentals of Managerial Economics Learning

Question: Discuss about the Fundamentals of Managerial Economics Learning. Answer: Introduction: In this report an adamantine study has been prepared on the cost and profit structure of Food master Pasta product line. Cost and profit structure of Food master Pasta product line reflects that there is decrease of $ .30 it the retail price of foods which has resulted into increase of 50% in overall turnover of the Food master Pasta product line. In addition to this, net profit of company will also increased by 90% due to less price and increase turnover. In the proposed plan it is observed that the cost per unit of Food master Pasta product line has increased by .84 % which shows that company had made more investment in its fixed assets which resulted into high level of increment in overall cost of capital. After observing the budgeted plan of Food master Pasta product line, it is observed that company has increased its overall fixed cost. In addition to this, it is evaluated that company has failed to increase its total turnover and decreased its total sales by 50%. Total cost of company has also increased by .84% which is not good indicator for the business functioning of organization. References Healy, P.M. Palepu, K.G. (2012).Business Analysis Valuation: Using Financial Statements. Cengage Learning. Hirschey, M. 2008.Fundamentals of Managerial Economics.9thed. Mason: Cengage Learning.