Effectiveness of Guidelines in Improving Patient Care

Effectiveness of Guidelines in Improving Patient Care This brief considers the empirical literature on the use of clinical guidelines in patient care. It is argued that negative guideline characteristics and justified concerns amongst doctors negate satisfactory adherence. Clinical guidelines have been part of the UK landscape for many decades, as a means of improving health care for patients (Woolf et al, 1999). Research evidence suggests that a significant proportion of physicians do not adhere to clinical guidelines in patient care (e.g. Grol et al, 1998; Forsythe et al, 1999; Sherr et al, 2001; White, 2001; Thomas et al, 2003). Sherr et al (2001) investigated adherence of Obstetric Units in the UK and Eire to antenatal HIV testing policies. The Department of Health and Royal College of Obstetricians have both issued specified guidelines, which require that antenatal HIV testing be offered to all pregnant women, and adherence to these benchmarks has generated some debate. Data from 89% of antenatal units was analysed. Only 10% of units offered testing to all presenting women, and these units were concentrated in areas of high HIV prevalence (i.e. London). Other units operated selective screening policies (offering antenatal testing to some women, identified on the basis of clinical criteria) or ‘on request’ screening. Forsythe et al (1999) studied adherence of senior NHS staff (consultants, general practitioners) towards BMA guidelines on the ethical responsibilities doctors have towards themselves and their families. The Academy of Royal Medical Colleges, and the General Medical Council both endorse these guidelines, which generally require that doctors do not assume responsibility for their own personal (or family’s) health care. Questionnaire data was collected from four randomly chosen NHS Trusts and three local medical communities in the London (South Thames) area. Personal use of health services was the outcome measure. Results showed that although most doctors (96%) were registered with a GP, the majority (63% of GPs and 59% of consultants) had not consulted their GP in the past year. Almost a quarter (24%) of consultants stated they would never see a GP before obtaining consultant advice. The majority (71% of GPs and 76% of consultants) self-prescribed drugs ‘usually’ or ‘sometimes’. Forsythe et al (1999) concluded â€Å"senior doctors are not following the BMA guidelines on looking after their own and their families health† (p.608). Clinical guidelines are thought to have significant benefits for patient care (Woolf et al, 1999). However, research findings on the impact of guidelines are mixed (Morrison et al, 2001; Bennewith et al, 2002; Bousquet et al, 2003). Bousquet et al (2003) conducted a randomised controlled trial assessing the value of guidelines of the International Consensus on Rhinitis (ICR) in caring for patients with seasonal allergic rhinitis. GPs were randomised into two groups: one group followed ICR guidelines (patients received an oral anti-histamine, a topical corticosteroid, and/or a topical ocular cromone) while the other group were free to choose appropriate treatment for patients. Outcome measures were degree of impairment[1] and symptom medication scores. Patients treated by the guidelines strategy GPs generated lower symptom scores over a three-week period compared with patients assigned to free-choice GPs. Furthermore, patients in the guideline group reported greater reductions in their degree of impairment compared to the free choice group. This trial clearly demonstrated the benefits for patients of implementing clinical guidelines. Diggory et al (2003) reviewed the results of five audits relating to cardiovascular-pulmonary resuscitation (CPR) at the Mayday University Hospital. At least one audit focused on doctors’ adherence to elderly care policy and guidelines recommended by the Royal College of Physicians. Documentation of a CPR decision, review of all patients, and documentation of any changes to the CPR decision became policy in the emergency department. CPR decisions were documented by both trainee doctors and consultants for >91% of cases. Consultants reviewed 93% of patients within 24hours, and documented a CPR decision in 81% of cases. Benefits for patients seemed to present in a reduction in DNAR[2] orders. Other research suggests that the benefits of guideline adherence for patients may be more limited. Morrison et al (2001; Bennewith et al, 2002) assessed the impact of clinical guidelines for the management of infertility, in both primary and secondary care settings. . Figure 1 Clinical investigations completed for intervention and control practices (Morrison et al, 2001) Over 200 general practices and NHS hospitals accepting referrals for infertility in Greater Glasgow were randomised to a control or intervention condition. The intervention group received clinical guidelines. No group differences were found in referral rates, albeit referrals from intervention practices were more complete, incorporating all essential clinical investigations (e.g. semen analysis, rubella immunity) (see Figure 1). No group differences emerged in the percentage of referrals in which a management plan was achieved within one year, in the mean duration between first appointment and date of management plan, and costs of referrals. On the whole, this study demonstrates a differential effect of guideline adherence across different criteria of patient care. Despite the (modest) increase in the number of recommended clinical investigations performed prior to referral, clinical guidelines were no more cost effective than having no guidelines. Overall, research findings are mixed regarding the benefits of guideline adherence for patient. Nevertheless, improvements in some aspects of care have been demonstrated. What guideline characteristics are pertinent to adherence? Michie et al (2004) assessed the reasons why GPs do not always conform to guidelines. The focus was on guidelines set by the UKs National Service Framework (NSF) for Coronary Heart Disease (CHD). London based GPs, who were classified as either ‘high implementers’ (adhered to five or more of 6 CHD standards) or ‘low implementers’ (adhered to 1 or 2 guidelines), were interviewed on their beliefs, self-reported behaviours, and organisational context. Several issues differentiated the two groups: views about evidence based practice; control over clinical practice; and the repercussions of adhering to guidelines. Low implementers were more sceptical about evidence-based practice, more worried about the lack of control over the development and implementation of guidelines, and their own professional duties as doctors, and adverse consequences for GPs/patients that outweigh any benefits. This study highlights the importance of GP attitudes towards guideline adherence. Irani et al (2003) emphasised the methodological characteristics of the guidelines themselves. They assessed the quality of national clinical practice guidelines (CPGs) on benign prostatic hyperplasia, and lower urinary tract symptoms. Two independent assessors appraised methodological quality of the CPGs using the St.Georges Hospital Medical School Health Care Evaluation Unit Appraisal Instrument. This tool incorporates items gauging three criteria: rigour of development (e.g. ‘Is there a description of the sources of information used to select the evidence on which the recommendations are based?’), context and content (e.g. ‘Is there a satisfactory description of the patients to which the guidelines are meant to apply?’), and clinical application (‘Does the guideline document suggest possible methods for dissemination and implementation?’). Analysis revealed substantial variability in quality across CPGs. Grol et al (1998) found an association between guideline characteristics and adherence. An observation design was used to study 47 specific recommendations from 10 clinical guidelines in relation to 12 different guideline characteristics. For example, evidence base, clinical experience, concerned with daily practice, and ambiguity. Regression analysis revealed three key characteristics that predicted most of the variance in compliance rate: ‘the recommendation is vague and not precisely defined’, ‘the recommendation demands change of fixed routines’, and ‘the recommendation is controversial and not compatible with current values’. Figure 2 Rates of compliance across guideline attributes (present or absent) (Grol et al, 1998) Figure 2 illustrates differentials in adherence rates as a function of the presence or absence of different guideline attributes. In general practitioners were more likely to comply in the presence of an evidence base, capacity to solve clinical problems, precisely described, and media publicity. Compliance was also more probable in the absence of capacity to provoke patients, requiring change to clinical routines, significant consequences for management, demanding new skills/training, controversy, complexity, and ambiguity. Clinical guidelines in the UK have historically been prescribed by a multiplicity of agencies, notably the Department of Health, and profession-specific bodies, such as the Royal College or Surgeons, Royal College of Nursing, and British Medical Association. The National Centre for Clinical Excellence (NICE) currently sets clinical guidelines. This body continually publishes benchmarks for most areas of clinical practice. The Department of Health has also established Essence of Care standards, which have a more generic focus (DOH, 2003). Guidelines are purportedly based on empirical evidence, notably randomised control trials, hence satisfying the requirement for evidence-based practice. However, reservations amongst GPs about the notion of evidence-based guidelines, which often fall outside their clinical experience, has been identified as one reason for low adherence amongst doctors (The BRIDGE Study Group, 2002; Michie et al, 2004). GP scepticism is partly justified. Morice and Parry-Billings (2006) discuss the validity of such ‘evidence’, identifying several important important issues. Firstly, NICE, the DOH, and other relevant prescribing bodies rely on clinical trials, many of which select patient groups â€Å"to give the trial treatment maximum scope to show an effect†. Then there is publication bias –studies showing positive or dramatic effects are more likely to be published than studies showing no difference/effect. Guidelines are often linked to meta-analyses, which by definition will be ‘infected’ by the research biases already mentioned. What is worrying is that many national guidelines are adapted locally, in the form of hospital policy (e.g. Sherr et al, 2001; Diggory et al, 2003), and these adaptations may have an even weaker evidence base than the national benchmarks set by NICE, DOH, and other prescribers. None of this is likely to improve GPs attitudes towards guideline adherence. Do doctors need guidelines? In a discussion of heart disease regulations in the UK, Petch (2002) argued that the specification of treatment criteria has not been very successful in the USA and other countries. Adherence to guidelines is criticised on three grounds. Firstly, guidelines imply universal health care, an ideal most nations cannot afford, least of all the UK, which relies on rationing (i.e. waiting) due to limited health resources. Attempting to implement similar standards for every single patient is expensive. Secondly, recommended treatments can often have complications/side effects, so that certain treatments may be inappropriate for certain patients, but yet be a mandatory therapy, which the doctor is compelled to follow regardless. Thirdly, administering the same treatment to all patients is not cost-effective. The treatment may not benefit every patient. It is usually not clear â€Å"which patients will benefit from which drugs and hence the victim of a heart attack will be recommended to take aspirin, a statin, a ÃŽ ² blocker, and an angiotensin converting inhibitor, in addition to other drugs†¦Ã¢â‚¬  (p.474). Nevertheless, guidelines remain an integral element of patient care. This raises an important question: what kind of support do GPs require in order to adhere to guidelines? Marshall et al (2001) investigated factors that facilitate guideline acceptance in health professionals. Representatives from general practices in the NHS Northern and Yorkshire region were interviewed. Thematic analysis highlighted several issues including the need for training (staff often lacked the requisite clinical expertise to implement some guidelines), a conflict between responsibility and control (nurses/doctors are responsible for implementing criteria, but have no say over resource allocation), the and ‘cul-de-sac’ of patient non-compliance (e.g. little can be done if patients refuse treatment, and this is interpreted as failure of staff to adhere to guidelines). CONCLUSION Several key issues have emerged from this review. Firstly, research findings are mixed regarding the benefits of clinical guidelines for patient care. There is clearly a need for more randomised controlled trials. The benefits for patients probably vary across disease types, clinical setting, and doctor and patient characteristics. Doctors have serious concerns about the use of guidelines in patient care, and these reservations are mostly justified. Perhaps the most defensible concerns relate to questionable evidence base, the need to account for differences in how individual patients respond to treatment, and poor guideline characteristics, such as ambiguity. Unsatisfactory guideline implementation by doctors will probably persist until these problems are fully addressed by NICE and the Department of Health. BIBLIOGRAPHY Bennewith, O., Stocks, N., Gunnell, D., Peters, T.J., Evans, M.O. Sharp, D.J. (2002) General practice based intervention to prevent repeat episodes of deliberate self harm: cluster randomised controlled trial. British Medical  Journal, 324, p.1254. Bousquet, J., Lund, V.J., van Cauwenberge, P., Bremard-Oury, C., Mounedi, N., Stevens, M.T. El-Akkad, T. (2003) Implementation of guidelines for seasonal allergic rhinitis: a randomised controlled trial. Allergy, 58, pp.733-741. Diggory, P., Cauchi, L., Griffith, D., Jones, V., Lawrence, E., Mehta, A., O’Mahony, P. Vigus, J. (2003) The influence of new guidelines on cardiopulmonary resuscitation (CPR) decisions. Five cycles of audit of a clerk proforma which included a resuscitation decision. Resuscitation, 56, pp.159-165. Forsythe, M., Calnan, M. Wall, B. (1999) Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.  British Medical Journal, 319, pp.605-608. Grol, R., Dalhuijsen, J., Thomas, S., Veld, C.I., Rutten, G. Mokkink, H. (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. British Medical Journal, 317, pp.858-861. Irani, J., Brown, C.T., van der Meulen, J. Emberton, M. (2003) A review of guidelines on benign prostatic hyperplasia and lower urinary tract symptoms: are all guidelines the same? British Journal of Urology, 92, pp.937-942. Marshall, J.L., Mead, P., Jones, K., Kaba, E. Roberts, A.P. (2001) The implementation of venous leg ulcer guidelines: process analysis of the intervention used in a multi-centre, pragmatic, randomised, controlled trial.  Journal of Clinical Nursing, 10, pp.758-766. Michie, S., Hendy, J., Smith, J. Adshead, F. (2004) Evidence into practice: a theory based study of achieving national health targets in primary care. Journal of  Evaluation in Clinical Practice, 10, pp.447-456. Morice, A.H. Parry-Billings, M. (2006) Evidence based guidelines – a step too far?  Pulmonary Pharmacology and Therapeutics, 19, pp.230-232. Morrison, J., Carroll, L., Twaddle, S., Cameron, I., Grimshaw, J., Leyland, A., Baillie, H. Watt, G. (2001) Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface. British Medical Journal, 322, pp.1-5. Petch, M.C. (2002) Heart disease guidelines, regulations, and the law. Heart, 87, pp.472-479. Sherr, L., Bergenstrom, A., Bell, E., McCann, E. Hudson, C.N. (2001) Adherence to policy guidelines – a review of HIV ante-natal screening policies in the UK and Eire. Psychology, Health and Medicine, 6, pp.463-471. The BRIDGE Study Group (2002) Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions. Journal of Evaluation in Clinical Practice, 8, pp.319-325. Thomas, A.N., Pilkington, C.E. Greer, R. (2003) Critical incident reporting in UK intensive care units: a postal survey. Journal of Evaluation in Clinical Practice, 9, pp.59-68. White, S.M. (2001) An audit of audit and continued educational and professional development. Anaesthesia, 56, pp.1003-1004. Woolf, S.H., Grol, R., Hutchinson, A., Eccles, M. Grimshaw, J. (1999) Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines.  British Medical Journal, 318, pp.527-530. Footnotes [1] Using the Standardised Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). [2] ‘Do not attempt resuscitation’

The Odyssey Homer characterizes the Kyklops in such a way as to reveal :: Classics

The Odyssey Homer characterizes the Kyklops in such a way as to reveal the birth of Odysseus’s well profound strengths as well as his inability to exercise restraint.In this essay I will analyze the significance of the one eyed Kyklops The Odyssey Homer characterizes the Kyklops in such a way as to reveal the birth of Odysseus’s well profound strengths as well as his inability to exercise restraint. In this essay I will analyze the significance of the one eyed Kyklops Polyphemos as an attempt to study Homer’s characterizing of the main character Odysseus. I will analyze the Kyklops’s interaction with Odysseus and will identify the various literary techniques used by Homer while simultaneously explaining the significance and effectiveness of these methods to the plot development of this epic poem. In order to present this pre-eminent epic of action to a more striking effect, Homer uses two devices of characterization, the epithet and the simile in book IX when he describes the scene involving Polyphemos and Odysseus. Both techniques were used to provide additional information about the two characters and to reveal different aspects of Homer’s development of Odyssey’s state of mind. After the war of Troy Odysseus and his crew attempted to find their way back to Odysseus’s home Ithaca, but due to their lack of responsibility they were met with some resistance and choose to rest on a strange island inhabited by a Kyklops. Upon arriving on the island Odysseus and his men naively feasted on readily abundant food found in a secluded cave without first exploring the island to see whether any threats lay near. Then curious Odysseus suggested that they explore and seek knowledge about the native people of the unconquered lands in order to decipher whether they were â€Å"wild savages †¦ or hospitable†¦ god fearing men† (188 -189). This is the first instance amidst a series of others where Odysseus neglects his role as leader and causes the fate of his crew and the journey to become jeopardized. His decision to explore the island of is what caused his main goal of returning home to Ithaca to become destined for failure. Odysseus stumbles onto a prodigious giant; this giant was Polyphemos, son of Poseidon, Greek God and ruler of the seas. When Polyphemos returns to his cave (the same cave where Odysseus and his men feasted) he realizes that his unannounced guests were expecting a warm welcome despite the fact that they had just finished raiding his cattle. The giant understandably refuses to show them any hospitality and begins to devour them one by one. Through this chaotic encounter the consequences of Odysseus’s bad leadership skills materialize, and we The Odyssey Homer characterizes the Kyklops in such a way as to reveal :: Classics The Odyssey Homer characterizes the Kyklops in such a way as to reveal the birth of Odysseus’s well profound strengths as well as his inability to exercise restraint.In this essay I will analyze the significance of the one eyed Kyklops The Odyssey Homer characterizes the Kyklops in such a way as to reveal the birth of Odysseus’s well profound strengths as well as his inability to exercise restraint. In this essay I will analyze the significance of the one eyed Kyklops Polyphemos as an attempt to study Homer’s characterizing of the main character Odysseus. I will analyze the Kyklops’s interaction with Odysseus and will identify the various literary techniques used by Homer while simultaneously explaining the significance and effectiveness of these methods to the plot development of this epic poem. In order to present this pre-eminent epic of action to a more striking effect, Homer uses two devices of characterization, the epithet and the simile in book IX when he describes the scene involving Polyphemos and Odysseus. Both techniques were used to provide additional information about the two characters and to reveal different aspects of Homer’s development of Odyssey’s state of mind. After the war of Troy Odysseus and his crew attempted to find their way back to Odysseus’s home Ithaca, but due to their lack of responsibility they were met with some resistance and choose to rest on a strange island inhabited by a Kyklops. Upon arriving on the island Odysseus and his men naively feasted on readily abundant food found in a secluded cave without first exploring the island to see whether any threats lay near. Then curious Odysseus suggested that they explore and seek knowledge about the native people of the unconquered lands in order to decipher whether they were â€Å"wild savages †¦ or hospitable†¦ god fearing men† (188 -189). This is the first instance amidst a series of others where Odysseus neglects his role as leader and causes the fate of his crew and the journey to become jeopardized. His decision to explore the island of is what caused his main goal of returning home to Ithaca to become destined for failure. Odysseus stumbles onto a prodigious giant; this giant was Polyphemos, son of Poseidon, Greek God and ruler of the seas. When Polyphemos returns to his cave (the same cave where Odysseus and his men feasted) he realizes that his unannounced guests were expecting a warm welcome despite the fact that they had just finished raiding his cattle. The giant understandably refuses to show them any hospitality and begins to devour them one by one. Through this chaotic encounter the consequences of Odysseus’s bad leadership skills materialize, and we

Agricultural Revolution Essay

Back in the early years, people have their very own way to survive in this world. They went for hunting edible animals in the juggle or gather in a village or place so that they could obtain food supplies. Could we imagine how tough it was for these people merely to get food for living, so that they could continue their life and preserve the continuation of human being? But thankfully it changed in 1700s when people started to make agricultural revolution, by that means people domesticated plants and animals so that they could sustain their life by having food stocks that they preserved. Although there were group of hunters that still hunting during that time, the agricultural revolution has impacted many or should I say most of the people in this world. They started to make their own land into agriculture field where they could use it for farming and animal’s production. During this stage, usually the production of food supply and the crops yield just adequate for their own f amily supplies and it was not for commercial purpose. When it came to another stage of Agricultural revolution, where this revolution brought a very significant impact in civilization and economic development; in which the era was called by the dawn of civilization. The Agricultural Revolution resulted in a food surplus, not unlike the original agricultural revolution which allowed civilization to develop. The agricultural revolution was a period of agricultural development between the 18th century and the end of the 19th century, which we could describe as one of vast and rapid increase in agricultural productivity and drastic improvements in farm technology. This idea of Agricultural revolution can be proved, as more experimental farmers has developed good and healthy seeds, cross breeding animals that potentially increase their life and prevent any diseases, nutritious soil or dirt, effective fertilizers, a good and efficient system of drainage and fencing. In addition, these enhancements of science have reasonably produced an effici ent fertilizer thus it was one of major factors that increased the productivity of soil. Lastly, there were also multitude of great inventions such as seed drills, plow, moldboard and many more. These machines or inventions have made the farmer’s work became easier than it ever was and it also increased the productivity of crops and animals. I found a quote from  one of my readings and it effectively related to agricultural revolution, â€Å"Thus not only will the same amount of land be able to feed more people; but each of them, with less labor, will be employed more productively and will be able to satisfy his needs better.† (Condorcet, 1793) There were a number of the factors that triggered the idea of agricultural revolution and new farming method in that particular of time, in which obviously because the lack of food supplies while at the same time they also were facing overpopulation. Furthermore, people were desperately trying to overcome this deficient issue and came up with the ideas to increase the production of food by planting on their own. Apart from that, the industrial revolution also played a crucial role for agricultural revolution to rise. B oth of these revolutions were closely related because of the idea of having better living and civilization. In fact, it is impossible for industrial revolution to take place without agricultural revolution. Besides, agricultural revolution also was triggered by the improvement of transportation method such as roads, railroads, refrigerated railroad, cars and trucks. By using this improvement of transportation technology, the farmer could increase the quantity of crops yield being brought to the market hence maximize their profit. According to my professor, Deborah Symonds has stated â€Å"the changes in farming that made fortunes for some, and left others anxious and evicted from their farms.† Based on that statement, we can tell that there were possibility of pros and cons from the agricultural revolution phenomenon. However, I strongly believe that the pros outweigh the cons as the impact of agricultural revolution towards the society highly important. As we know, the development of science has created an improved quality of fertilizer that eventually impacted more productive land . As we know, productive land would produce vast productions of crops and animals. This would lead to an even and stable population growth and contribution of food supplies, in which it became a key factor to the overcoming of famine problem. Apart from that, the increased of the population had produced a greater demand from the people for goods such as clothing. It is said that agricultural revolution had been the stepping stone to the Industrial Revolution. This has resulted in more construction of industrial factories hence increased the work opportunity for the people. On the other hand, the cons of agricultural revolution was that it included the reallocation of land ownership. When the  land happened to be more productive, it increased in value. It attracted these capitalists to be investors for food plantation and domestic farmers to buy the land in a large scale so that they could utilize it to produce large crops and vast production of animals. The consequence affected those small farm owners, or people who started with small area of land found themselves left out. It led to the eviction of small farming family from their own land for example the Highland Clearance in Scotland. In conclusion, Agricultural revolution had played a very significant role in shaping our modern day. I personally believe that we could not live as modern as it should be without agricultural revolution in fact I imagine that we could still go for hunting for food supplies just for the matter of survival. It made me think that this revolution has overcome world’s greatest problem, the deficient food and kept us away from famine. The Agricultural revolution was indeed a crucial phenomenon that ever happened in development of civilization.

Essay on The Zodiac Killer - 2094 Words

The Zodiac Killer The late 1960’s and early 1970’s were a time of great change in America. The Vietnam War, the civil rights movement and the sexual revolution were just some of the issues on the evening news in American households. For citizens of the San Francisco Bay area, as well as the rest of California, the late 60’s early 70’represented terror, fear and death. â€Å"The bizarre and theatrical and still unresolved serial murders by real-life ghoul who called himself Zodiac, who claimed in letters to have killed 37 people (though police have focused on five homicides and two attempted murders in the greater Bay Area in 1968 and 1969† (Booth,2) have intrigued people for nearly four decades. How has Zodiac remained so elusive? What†¦show more content†¦Ã¢â‚¬Å"The shot made a deafening blast, as the bullet entered David’s head blowing it apart† (Wark, 5). With David out of the way, the killer turned his attention back to Betty. â€Å"He pursued her through the woods, his gun drawn and shot her five times in the back from less than ten feet away†(Wark,5). David was still alive, but Betty was dead. In the ambulance David was able to give the police an account of the events that had taken place, but he died shortly after from his wounds. Upon investigation, the police came up with nothing, and ruled the murder a random homicide. Darlene Ferrin, a close friend of the first two victims, was the next victim of the Zodiac. On Friday, July 4th, 1969, Darlene made arrangements with friend Michael Mageau to go to the movies. Darlene picked Michael up from his apartment that evening, and from the beginning it was apparent that they were being followed. Darlene took many country back roads and traveled at very high speeds to try to lose the pursuing vehicle, but with no success. The vehicle forced Darlene’s car off of the road and into the parking lot of the Blue Rock Springs Golf cours e. Once the pursuer had sufficiently blocked them from any further movement in the car, he stepped out of his vehicle with a lantern in his hand. â€Å"Mike could feel intense heat throughout his body. He had been shot. The bullets were still being fired as Darlene slumped over theShow MoreRelatedThe Zodiac Killer1732 Words   |  7 PagesLucas Kelleher/ Street Law 10/3/08 The Zodiac Killer The Zodiac Killer is a serial killer who operated in Northern California in the late 1960s. His identity to this day still remains unknown. The Zodiac coined his name in a series of taunting letters he sent to the press. His letters included four cryptograms (or ciphers), three of which have yet to be solved. The Zodiac murdered five known victims in Benicia, Vallejo, Lake Berryessa, and San Francisco between December 1968 and October 1969.Read MoreEssay on The Zodiac Killer2341 Words   |  10 PagesThe Zodiac Killer Works Cited Not Included In the late sixties and early seventies, California was haunted by dozens of unsolved murders. The offender remains unknown to this day. The murderer, who referred to himself as the Zodiac, made contact with the police and area newspapers throughout his reign of terror through a series of menacing notes. Although the police were never able to apprehend Zodiac, they were able to gather information about him via the letters. Zodiac boasted of killingRead More The Zodiac Killer Essay2809 Words   |  12 Pagesear. The shot made a deafening blast, as the bullet entered David’s head at a horizontal angle, blowing it apart (Tina 3). With David out of his way, the killer turned his attention back to Betty. He pursued her through the woods, his gun drawn, and shot her five times in the back from less than ten feet away. (Tina 3). The killer then got back into his car, and drove away as quickly as he had appeared. David, amazingly, was still alive, and bleeding profusely from his wounds, but Betty wasRead MoreThe Zodiac Killer Project2069 Words   |  9 PagesThe Zodiac Killer Project The crime spree murders of the Zodiac killer is one of the greatest unsolved murdered cases of all time. The Zodiac’s murders took place from later 1960s, through to about 1972. Most of The Zodiac’s murders took place in Northern California. Some main areas where murders took place are Benicia, Vallejo, Lake Berryessa, and San Francisco, California. Two out of the four men that were attacked lived and three women out of the three were killed. The ages of the victims goesRead MoreEssay On The Zodiac Killer1734 Words   |  7 PagesThis is the Zodiac Speaking â€Å"I like killing people, because it is fun. It is more fun than killing wild game in the forest, because man is the most dangerous animal of all.† These are the words spoken by a man who terrorized the area of San Francisco, California for two years, lurking in the shadows killing five people, but taking credit for 37 different murders. This man taunted police, seeing his murders as one giant game, sending cryptic messages to the newspapers, forcing them to publish themRead More The Elusive Zodiac Killer Essays2062 Words   |  9 PagesThe Elusive Zodiac Killer Serial killers almost without exception enjoy playing games. Whether played with their victims’, or the police forces trying to track them down, the game of the kill is almost as essential as the murder itself. In most instances this need to draw out the experience leads to the downfall of the culprit. This was not the case with the elusive Zodiac Killer of the San Francisco Bay Area. Zodiac’s career, which would become the most cerebral murder case ofRead MoreEssay On The Zodiac Killer3047 Words   |  13 PagesLaw enforcement officers meet in San Francisco in 1969 to compare notes on the Zodiac Killer, who is believed to have killed five people in 1968 and 1969. The killer gained notoriety by writing several letters to police boasting of the slayings. He claimed to have killed as many as 37 people and has never been caught..Zodiac kill up to 45 people and more that they dont know about because he kill people in a different way in the different town that he was in but he word the same thing every timeRead MoreTaking a Look at the Zodiac Killer1610 Words   |  6 Pages The Zodiac Killer is one of the greatest unsolved serial killer mysteries, after Jack the Ripper. There were 2,500 suspects, but the case was never solved. The Zodiac’s first known victim is Cheri Jo Bates. His first letter, Confession, mentioned Cheri and said, â€Å" she is not the first and she will not be the last†. Six months after Cheri’s death, the killer sent copies of the letters to the Riverside Press, the police, and her dad. Since the killer knew her dad, the police thought that CheriRead MoreThe Zodiac Killer Case Revisited1231 Words   |  5 PagesThe Zodiac Killer Case Revisited I. List of crimes The horrors in California began on Friday, December 20, 1968 in the city of Vallejo when sixteen-year-old Betty Lou Jensen and seventeen-year-old David Faraday were killed while out on a date. At the time, according to Haugen (2011), they had driven to a remote lover’s lane on Lake Herman Road. It was while they were there that a vehicle stopped nearby and the driver got out, shot out the rear passenger window of David Faraday’s station wagonRead More The Zodiac Killer Essay examples1229 Words   |  5 Pages Much is unknown about the Zodiac killer, but given what is known about serial killers in general, this man was probably born between 1938 and 1943. That would make his age between 25 and 30 years old at the time of his first murder in Vallejo, California, in 1968. Also, that age estimate works with witness statements and its supported by Zodiacs references to his victims in younger terms in his letters of 1969. Zodiac wasnt an attractive character from what we kn ow. He may have had to wear glasses

An Evaluation Of A Democratic Republic - 1935 Words

Democracy is a multi-dimensional complex system of which the sum is greater than its individual parts. Another perspective that can be used to better understand the conceptual framework of democracy is its identity as a contrast of communism. In the recent century, there have been periods of revolution where regimes have fallen and a democratic system replaced the oppressive communist system. The purpose of this paper is to examine and analyze Hungary’s attempt to function as a democratic republic beginning with the preceding factors that lead to the transition from communism to democracy followed by the transition process itself from 1990 to 1991. An evaluation of the political system fifteen years after the transition will be included in†¦show more content†¦Preceding Factors In order for a society to progressively function, regardless of what type of political system it adheres to, the quintessential factor determining its success in this regard requires a stable economy. The dismal state of the economy in the late 1980’s sealed the fate of communism in Hungary by delegitimizing both Kadar’s regime in addition to the communist system as a political and economic conceptual framework all together (Bigler, 1992). As a result, the loss of faith from the Hungarian public set the tone for a peaceful political revolution that differed from the prior attempts, historically known to have been riddled with violence. Firstly, the oppressive political grip of the Soviet Union known to the Hungarians for the previous four decades was not just absent, it was replaced with encouragement. Secondly, this newfound encouragement was accompanied with a lack of suppression; a sharp contrast of the 1956 revolution where the bloody retaliation of the occupying So viet Troops successfully suppressed the uprising (Bigler, 1992). The end of Kadar’s rule (1988) was followed by a critical change in political and ideological pace beginning with the removal and banishment of Kadar and within a year, the complete abandonment of the communist party’s monopoly on power all together. The party itself was renamed from the Communist Party to the Hungarian Socialist Party and was headed by Karoly Grosz who was the leader behind the coup that overthrew

Stereotypes And Stereotypes Of Senior Citizens - 1765 Words

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Commercial and Corporation Law Tom - Jane and Company

Question: Discuss about the Commercial and Corporation Law for Tom, Jane and Company. Answer: Introduction: The case scenario is based on a Chartered accountant firm of Sydney named, Tom, Jane Co (TJC) and a public company named Sunflower Bank Ltd (Sunflower). To expand the business, TJC offered its clients for free service in the initial year of the contract period i.e. four years, which also agreed by Sunflower. Due to the rapid business success, TJC incorporated cut-price expansion strategy, but it was lethal for the client and TJC. The accountant firm was unable to highlight the flaws of Sunflowers financials and failed to detect a fraud of $65 million. As a result, the submitted financial report of Sunflower to Australian Stock Exchange was incorrect and included huge fraud. After revealing the actual scenario, the share prices of Sunflower fell by $50 million. According to the present situation, the identified issues are stated below: Problem in audit program Fraud in financial department of Sunflower Sunflowers shares fall in market Based on these issues, TJC needs to rectify the flaws accordingly and recommend to mitigate financial frauds from Sunflowers financial environment along with evading its future bankruptcy. Explanation of Rules Resembled with the Case Scenario According to the Trade Practice Act 1974 under the Australian Tort Law, cooperation between two companies that are under contractual agreement should not mislead or engage in deceptive practice in business. In the provided case study, the scenario clearly depicts mislead in audit that resulted towards huge financial loss of a company (Sadler, 2009). In this regard, the Section 103 of Sarbanes Oxley Act also allied with the negligence in corporate environment specifically in the audit field. The act illustrates the areas of quality control standards, which resembled with employees liability and responsibility towards the organization. In this case study, fraud of Sunflower perpetrated by its Chief Financial Officer and assistant, which indicates the presence of material weakness within the internal control system under the Sarbanes Oxley Act (Sarbanes Oxley Compliance Professionals Association, 2015). According to the case scenario, it is quite clear that TJC, the accountant firm, had a professional fault during the auditing program in Sunflower. In accordance with the stated fact, another criterion of law associated with auditors liability resembled with the scenario. In this regard, it is therefore stated that the issue of this case is related with professional liability of auditors under the Australians corporate governance framework along with the efficiency towards the capital market (Australian Government, 2016). In addition, the case scenario also depicts about the economic loss and negligence in duty of care, which is under the auditors liability law. In relation to the auditors liability, the Civil Liability Act 2002 defines the claim for damages, which can be applied for the Sunflowers stakeholders and for the company itself as well (New South Wales, 2011). According to the Civil Liability Act 2002, Sunflowers stakeholders can claim monetary compensation for the damages that they faced due to the fall in share prices. Apart from this, Sunflower can also claim compensation against the chartered accountant firm for the huge loss under the Civil Liability Act 2002. Concerning the stated rules, the Corporation Law 2001 indicates that Sunflower is able to take internal security step to eliminate the fraudulent by suing the companys Chief Financial Officer and her assistant along with the demand of monetary fine (NSW Young Lawyers Business Law Committee, 2007). Application Based on the previous section, it is evaluated that there are several legal regulative actions that can be initiated by the organization for such fraudulent against the audit company. However, there are certain acts that also depict about the necessity actions against the company as well. With the support of certain relevant case examples, the study can further illustrate the case scenario to identify the most suitable approach for the company. In this context, Securities and Exchange Commission v. WorldCom Inc., Civil Action No. 02-CV-4963 (SDNY) (JSR) is one of the case includes financial fraudulent and bankruptcy (U.S. Securities and Exchange Commission, 2016). WorldCom Inc. suffered from an internal fraudulent through which the company faced a stagnancy in growth and experienced loss due to fall in share price after revealing the fraudulent news. The financial loss made the scenario of bankruptcy and reported a financial fraudulent case according to the Sarbanes-Oxley Act 2002 under the Section 308. The WorldCom Inc. has taken actions against the employees, who were involved with the fraudulent according the Corporation Law 2001. On the other hand, the scenarios of the case also integrated with the Civil Liability Act 2002, which sincerely indicates that the stakeholders claimed for their huge losses to the company and the company was entirely liable for it (Kennedy, 2012). In the year 1999, Australian High Court delivered the result of Perre vs. Apand Pty Ltd HCA 36, wherein the presence of negligence in duty of care, economic loss and damages of reputation are largely illustrated. As per this case study, Civil Liability Act 2002 and Corporation Law 2001 both legislative scenario is allied accordingly. Moreover, reasonable foresee-ability, vulnerability of the plaintiff, indeterminacy of liability along with the unreasonable burden on individual autonomy in the market highlight the areas, wherein effective legislations have been incorporated accordingly (Advice Guidance Advocacy, 2014). From the above discussed case scenario and case examples, few points are illustrated thoroughly. According to these highlighted points, it can be affirmed that auditors liability, negligence of duty both are lethal for corporate environment and can be devastative for companys reputation as well as cause of financial losses. Conclusion Concerning the Sunflower and TJC case study, TJC is accounted for negligence in duty of care along with economic and reputation damages of Sunflower. From this instance, Sunflower can file a lawsuit against TJC under the Civil Liability Act 2002 and the Corporation Law 2001. In addition to this, as per the Corporation Law 2001, Sunflower can also sue the employees, who are associated with the internal financial fraudulent. Concentrating on the case study, it can also be stated that TJC was unable to identify the misstatement of the reports due to which it resulted as huge scandal. Thus, in accordance with the stated scenario, Sunflower can file lawsuit against TJC on the basis of auditors liability. This can be a potential point in this case in the favor of Sunflower. On the other hand, stakeholders of the company can suit a case against Sunflower according the Civil Liability Act 2002 in order to manage their damages. Apart from all these actions, TJC needs to reexamine their polici es and legislative scenarios accordingly to mitigate similar type of problems in future practices as well. References Advice Guidance Advocacy 2014, Legal help desk, Perre vs. Apand Pty Ltd HCA 36, viewed 14 September 2016, https://legalhelpdesklawyers.com.au/2014/08/12/perre-v-apand-pty-ltd-high-court-of-australia-12-august-1999/ Australian Government 2016, Part 5: Auditor liability, Strengthening the financial reporting framework, viewed 14 September 2016, https://archive.treasury.gov.au/documents/403/HTML/docshell.asp?URL=Ch5.asp Kennedy, K. A 2012, An analysis of fraud: Causes, prevention, and notable cases, Honors Theses, paper 100, pp. 6-35. New South Wales 2011, Preliminary, Civil Liability Act 2002 No 22, pp. 2-6. NSW Young Lawyers Business Law Committee 2007, A project of the NSW young lawyers business law committee, A Guide to Basic Procedures of Corporate Law for Young Lawyers, pp. 1-68. Sadler, P 2009, Liability for negligent misrepresentation in the finance industry, The Finance Industry, vol. 11, pp. 17-25. Sarbanes Oxley Compliance Professionals Association 2015, Sarbanes Oxley Act Section 103, Auditing, Quality Control, and Independence Standards and Rules, viewed 14 September 2016, https://www.sarbanes-oxley-act.biz/SarbanesOxleySection103.htm U.S. Securities and Exchange Commission, 2016, U.S. Securities and Exchange Commission, Securities and Exchange Commission v. WorldCom Inc., Civil Action No. 02-CV-4963 (SDNY) (JSR), viewed 14 September 2016, https://www.sec.gov/litigation/litreleases/lr18147.htm