Student Management System Essay Example for Free

Student Management System Essay The student management suite from Applane allows you to automate the processes around student needs from admission to their transportation while ensuring seamless communication between the school, students and their parents. It has been developed keeping in mind the need to bring in efficiency in student management while providing a sense of security and safety in the minds of students and their parents or guardians. The key modules in the Applane Student Management suite include: Student Information System. Applane provides a completely integrated Student Information System that maintains a comprehensive profile of the student which acts as the core of Student Management. This enables all supporting student management processes to connect seamlessly with each other. Using this fully automated, on-cloud solution †¢Maintain a detailed student profile along with information such parents/guardians profile, sibling details, personal ID details such as passport and visa details, etc. †¢Categorize and manage all student documents submitted in scanned form using a pre-populated mandatory check-list. †¢Input detailed course and subject information for every student that acts as a base or core for the Education Delivery suite. †¢Request section change through the system with an in-built approval workflow . †¢Request and append personal information such as address change and contact number with ease and maintain in a central database for all future communication. †¢Students parents can login at school website to view profile and place request for change in contact details and section change. Student Admissions For a school, student admissions is the most important process at the start of an academic session and one that requires a very efficient and seamless operation. Applane brings in the much needed clarity and reliability to the process while helping in conducting it in a fast and fair manner. Using Applane, †¢Parents and students can submit Online/Offline admission enquiries and get a response instantly. †¢The School can open admissions to various courses and send invitations in an automated way. †¢School can sell application forms online. †¢School can manage the admission applications by filtering and categorizing them as per their scoring criteria. †¢School can announce and confirm the admissions online on the school website. †¢School can also auto-email to successful applicants. †¢As an additional function, student promotions and Re-registration can also be done seamlessly on the Applane system. Student Transportation A key part of student management requires providing safe and timely transportation to students from their boarding station to the school and back. Applane provides a fully automated system for managing this crucial requirement for schools where they have to manage the routes of hundreds of students travelling on their school buses daily. Applane allows †¢Students or their parents to request availing/withdrawing/change of transport facility online. †¢Schools to create and plan routes, assigning bus stops. †¢Schools to manage vehicles with maintenance schedule and papers schedule. †¢School to send auto reminders/email to the transport in-charge for maintenance and taxation/insurance dues. †¢Schools to monitoring vehicle movement to ensure complete safety of students. †¢Schools to maintain a fuel log book to ensure that there is no over invoicing by the drivers. †¢Schools to generate reports including route report, vehicle report, maintenance schedules, fuel log-book, etc. †¢Schools to send SMS to the student of a route/all routes for bus delays/changed timings, etc. Information Flow Communication A seamless and timely information flow between the school, students and their parents/guardians is not only an important function to keep everyone updated on various school matters but also a critical function to ensure safety and compliance of the students as per school rules and regulations. Using Applane, the school can communicate with students and their parents using auto generated Email and SMS facility on various matters such as †¢Attendance of the student. †¢Fee reminders. †¢Notices/circulars regarding Parent Teacher meetings, events, holidays, etc. †¢Examination results of the student. †¢Transport delay/change. †¢Library overdue books. †¢Confirmation of requests regarding address change, section change, etc. †¢Festival greetings

Integrated Treatment for Substance Use and Depression

Integrated Treatment for Substance Use and Depression Mental Health: Simone Case Scenario Dual diagnosis, co morbidity and co-occurring disorders are terms often used interchangeably to describe mental ill health and substance abuse (drugs and/or alcohol) in various combinations. These disorders may occur at the same time or one may follow the other. Even though the diseases of mental illness and drug abuse are comorbid, causality is not implied and either condition may precede the other (Fortinash and Holoday Worret, 2012). The symptoms of one condition may mask or conceal the symptoms of the other, with either condition assuming priority at any given time. Alcohol is the most widely used drug. The National Institute for Clinical Excellence (NICE) estimated in 2011 over 24% of people in England consume alcohol levels that are potentially or actually detrimental to health. The co morbidity of depression and alcohol dependence are two of the most prevalent psychiatric disorders affecting the general population. Evidence suggests that alcohol use disorders are linked to depressive symptoms and that alcohol dependence and depressive disorders co-occur to a larger degree than expected by chance. However, it is not clear whether the depression causes alcohol problems, whether the alcohol consumption or alcohol problems caused depression, or whether both could be attributed to a third cause (Royal College of Psychiatrists, 2015). This assignment will consider the case scenario of Simone part time social worker, aged 43 with depression and alcohol abuse. Simone lives with her three children and the intervention of choice is Cognitive Behavioural Therapy (CBT). This section will define CBT and its uses and adopt the Critical Appraisal Skills Programme (CASP) toolkit (2013) to critically evaluate and discuss two CBT research articles in treating depression and alcohol abuse to evidence why this is an appropriate intervention for Simone. CBT is defined as a talking therapy that can help individuals manage their problems by changing the way they think and behave (Frances and Robson, 1997). Commonly used to treat a range of mental health issues including depression, anxiety disorders, phobias, but also deemed valuable in treating alcohol misuse, especially as part of an overall programme of recovery. The goal of cognitive behavioural therapy is to teach the person to become aware of incidences and situations which trigger the need to drink, to learn to avoid putting themselves in these situations and to develop coping strategies to deal with other problems and behaviours which may lead to drinking. Until recently the effectiveness of CBT for comorbid alcohol had not been studied, however, the first of two research articles will now be critically evaluated and discussed below. Developing an Integrated Treatment for Substance Use and Depression Using Cognitive Behavioural Therapy (Osilla et al, 2009) is an American qualitative research article. The research goal was to design and develop a treatment programme for delivery by substance abuse counsellors in outpatient mental health settings. This was thought to be important because earlier research had indicated the effectiveness of CBT in depression and alcoholism separately. The research developed a group based integrated 18 session treatment plan involving 3 modules (thoughts, activities and people interactions) linking mood and alcohol use and provided strategies for identifying and modifying harmful thoughts and activities. Drawing on previous studies (Hepner, Watkins, Woo and Wiseman, 2006) they involved a treatment development team including researchers, clinicians, stakeholders and CBT experts. Recruited participants (N=7; 4 male, 3 female) were already enrolled in outpatient substance misuse treatmen t who had met the criteria for mild depression using the 9 item Patient Health Questionnaire with scores of 5 or > (no indication given whether other people had chosen not to take part as this sample is small). Client focus groups were conducted following the group treatment sessions led by two clinical psychologists who had observed the group sessions from behind a one way mirror, thus the methodology used is entirely appropriate for addressing the research goal. The article states that the clients provided informed consent but there is no information regarding how the research was explained to participants, whether ethical approval was sought or whether ethical standards were maintained. The data analyses consisted of the researchers reviewing notes and transcripts independently from the client focus groups to select, group and label salient issues that point to the acceptability of integrated CBT. Notable points with similar concepts were categorised if different participants had said the same things on a number of occasions over a given time frame e.g. comments which stated that alcohol and mood influenced each other. Underlying themes were generated from the data and quotes were analysed and identified that fitted each of the relevant themes. Each researcher independently sorted quotes by theme and together they reached a consensus on any discrepancies. Findings indicated that treatment was widely accepted by clients and counsellors. Clients stated that applying CBT skills help to treat both their depression and alcohol misuse whilst positively affecting other areas in their lives. Clients felt the treatment had built their confidence and the group process was helpful in learning from each other. The article produced no evidence of triangulation but stated that there were limitations to the study that affect the generalization of the results. The study evaluated a single case implementation, so future studies would be necessary to examine client views in several clinics over time with different treatment sessions in order to judge whether integrated treatment is truly acceptable and feasible given funding constraints. Clearly, integrated CBT for depression and alcohol misuse evaluated as being useful and beneficial but the research concluded that there is a need to develop more web based training or other innovative ways that effect ively train substance abuse counsellors to a reasonable standard with minimal costs to provide a unified CBT approach to manage comorbid depression and alcohol misuse. A Randomized Controlled Trial of Cognitive Behavioural Treatment for Depression versus Relaxation Training for Alcohol – Dependent Individuals with Elevated Depressive Symptoms (Brown et al, 2011). The goal of this Rhode Island trial was to evaluate the efficacy of adding CBT versus relaxing training to partial hospital treatment for individuals misusing alcohol with elevated levels of depressive symptoms. This was deemed important because it was expected that the addition of CBT would result in reduced levels of depressive symptoms and in decreased quantity and regularity of alcohol use.166 men and women were recruited (aged 16 65 years) from an alcohol and drug treatment unit provided they met the Diagnostic and Statistical Manual of Disorders, Fourth Edition (2000) criteria for alcohol dependence and had a Beck Depression Inventory of 15 or more. Participants were informed about the study, consent was obtained and they were randomly assigned to receive 8 individual session s of CBT (n = 81) or relaxation training (n = 84). The article didnt mention whether the personnel were blinded. Treatment conditions did not differ on demographics, individual alcohol consumption or depression related variables. Results indicated significant improvement in depressive and alcohol use over time for all participants. Compared with the relaxation training, the CBT group had significantly reduced levels of depressive symptoms at the 6 week follow up as measured by the Beck Depression Inventory. This effect was found to be inconsistent because there was no difference in the Modified Hamilton Rating Scale (MHRD) for Depression between conditions at that point in time or at any subsequent follow up. There was no significant in alcohol use between groups. The researchers were clearly disappointed that this study did not replicate the results of an earlier pilot study in 2007. However, plausible reasons given included the average length of hospital stay had reduced from 21.2 days to 3.9 resulting in treatment sessions being conducted in an outpatient setting making it difficult to compare results. The setting for this study was a private hospital with educated Caucasian patients and caution should be used in generalizing findings to populations with different characteristics. Interview data and treatment adherence had not been subject to reliability ratings. The need for the trial was clearly documented and further studies evaluating the efficacy of CBT in individuals with alcohol misuse and elevated depressive symptoms is required. Overall, the benefits outweighed the harm. Depressed people with alcohol misuse like Simone have complex needs which pervade every aspect of daily life including psychiatric, psychological, education, employment and social care. Supporting someone with depression and alcohol misuse is one of the biggest challenges facing mental health services (DH, 2006).Traditionally, substance misuse and mental health services developed separately but a national drug and alcohol dependence strategy was published in December 2010 (HMG, 2010), and a mental health strategy a few months later (HMG, 2011). Both strategies acknowledge the association between mental health problems and drug and alcohol problems. Successful outcomes for both problems need early intervention and effective joint working between drug and alcohol treatment and mental health services in integrated, recovery-oriented local systems. Furthermore, a NICE guideline (2011) includes principles of care, identification and assessment in all assessment areas and principles for in terventions, underpinned by best available evidence (due for review in 2015). Regarding impact on future practice, co morbidity requires nurses to adapt multiple roles in order to achieve a comprehensive level of care. A primary diagnosis isnt necessary as both depression and alcohol misuse can be treated simultaneously. A non judgemental, person centred approach recognising that treatment will be long term is required. Good communication skills with multiple professionals and services are essential. Clinical skills include specialist alcohol misuse assessments, mental health and risk assessments, the provision of specialist advice on reduction and harm minimisation, appropriate interventions, treatment advice to other care professionals and the ability to work in a multidisciplinary team. In practice, it is not possible for nurses to be an expert in all of the skills required, however they should have a working knowledge of some. Training is required to deliver comprehensive alcohol programmes through developing skills particularly in cognitive behavioural th erapy which seems to produce beneficial effects on both depression and alcohol outcomes. Bibliography Brown, A.B., Ramsey, S.E., Kahler, C.W., Palm, K.M., Monti, P.M., Abrams, D., Dubreuli,.M., Gordon,.A. and Miller.I.W. (2011) A Randomized Controlled Trial of Cognitive Behavioural Treatment for Depression versus Relaxation Training for Alcohol – Dependent Individuals with Elevated Depressive Symptoms. Journal of Studies on Alcohol and Drugs 72(2): 286-296 Critical Appraisal Skills Programme (2013) Qualitative Research Check List. Oxford UK. Critical Appraisal Skills Programme (2013) Randomised Control Trial Check List. Oxford UK. Department of Health (2006) The Dual Diagnosis Good Practice. Diagnostic and Statistical Manual of Disorders (2000), 4th Edition, Text Revision (DSM-IV-TR). American Psychiatric Association.Washington DC. Fortinash, K.M and Holoday Worret,P.A (2012) Psychiatric Mental Health Nursing, 5th edition. Australia, Mosby. Frances, R. and Robson, M (1997) Cognitive Behavioural Therapy in Primary Care. Jessica Kingsley Publishers. London. Hepner, K.A, Watkins, K.E., Woo, S. and Wiseman, S. (2006) Group Cognitive Behavioural Therapy for Depression in Substance Abusers: Substance Abuse and your Mood. Treatment Manual for non traditional providers. HM Government (2010). Drug Strategy 2010 Reducing Demand, Restricting Supply, Building Recovery: Supporting People to live a Drug Free life. HM Government (2011). No Health without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of all Ages. National Institute of Clinical Excellence (2011) Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: National Institute for Health and Clinical Excellence. Osilla, K.C., Hepner, K.A, Munoz, R.F, Woos. S and Watkins, K. (2009) Developing and Integrated Treatment for Substance Use and Depressing Using Cognitive Behavioural Therapy. Journal of Substance Abuse Treatment 37(4);412-420 Royal College of Psychiatrists (2015) Improving the Lives of People with Mental Illness (online) available from:  http://www.rcpsych.ac.uk/healthadvice/problemsdisorders/alcoholdepression.aspx  (Accessed 13th April 2015) Lynskey,M.T.(1998 ) The comorbidity of alcohol dependence and affective disorders: treatment implications. Drug and Alcohol Dependence 52:201- 209 Miller, I.W.,Bishop,S.,Norman,W.H. and Maddever,H.(1995) The Modified Hamilton Rating Scale for Depression;reliability and validity. Psychiatry Research 14: 131-142 Mitcheson, L., Maslin, J., Meynen, T., Morrison, T., Hill, R. and Wanigaratne, S. (2010). Applied Cognitive and Behavioural Approaches to the Treatment of Addiction: A Practical Treatment Guide. Chichester: Wiley-Blackwell. NHS Information Centre for Health and Social Care (2011), Statistics on Alcohol: England 2011. The Health and Social Care Information Centre. NICE (2007). NICE clinical guideline 51. Drug Misuse: Psychosocial Interventions. London: National Institute for Health and Clinical Excellence. Raistrick, D.,Heather, N and Godfrey. ,C (2006) Review of the effectiveness of treatment for alcohol problems. The National Treatment Agency for Substance Misuse. Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P., Barnes, T., Bench, C., Middleton, H., Wright, N., Paterson, S., Shanahan, W., Seivewright, N and Ford, C. (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry, 183, 304-313.

Complications Of Skeletal Traction Health And Social Care Essay

Complications Of Skeletal Traction Health And Social Care Essay In the last two decades, there have been major changes in the management of lower limb long bone fractures, surgical management has become the norm. Skeletal traction is now rarely used as the definitive form of management. Most of the patients admitted to our hospitals have skeletal injuries, and these patients have prolonged length of stay as they are initially managed non- operatively. Complications of traction have been looked at since 1947 and have been published but literature from the developing countries is lacking. This study is being conducted to evaluate the prevalence of complications associated with skeletal traction with lower extremity fractures. Objective : To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. Study Design:- This is a Hospital based Prospective Descriptive study, that will be carried out from December 2010 to March 2011. Study Setting :- The study will be carried out at the KNH orthopaedic wards. Materials and Methods :- Patients who are put on lower limb skeletal traction will be recruited into the study, They will be reviewed weekly for complications namely pin tract infection, pressure sores, venous thrombo-embolism, orthostatic pneumonia and knee stiffness, until upto the point they are taken off traction. The data will be collected using pre-designed questionnaires. INTRODUCTION Fractures of the femur are almost always the result of great violence and are sometime a threat to the patients life, not only because of the immediate complications such as bleeding or associated injuries but also because of subsequent complications related either to the treatment of the fracture or to the complications of the associated injuries. Immobilization of the fracture was recognised as essential for union. The development of splints, such as the Thomas splint and the subsequent combinations of the splints with traction methods either fixed or balanced, allowed for better control of the fracture, patients never the less had to remain in traction for three months or longer before the fracture was sufficiently stable to allow ambulation. Skeletal traction is seldom used in modern practice, usually it is only a temporary mode of treatment. Internal Fixation is still the treatment of choice for most closed injuries, this is because of higher union rates, lower rates of complications, earlier weight bearing, shorter hospital stays and early return to daily activites. In KNH majority of the patients admitted with femoral fractures are managed initially on skeletal traction. Patients with proximal femoral fractures are on Russel Hamiltons traction while patients with femoral shaft fractures are on Perkins traction. When the patient is managed on skeletal traction the patient is on prolonged bed rest and hospital stay increases also nursing care is difficult and the patient is at risk of developing morbidities due to the skeletal traction and prolonged immobilisation. The cost of care is increased and as seen in our setting most of the patients we manage come from a low socio-economic background who have difficulties in financing their healthcare. The prolonged confinements of the patients on traction is associated with certain complications, such as pin tract infections, decubitus ulcers, which can be overcome by better nursing care, but the complications of prolonged bed rest such as bladder and bowel derangements, deep venous thrombosis, osteoporosis, muscle wasting, to mention only a few cannot be prevented hence the need for early internal fixation. Literature Review Motor vehicle crashes are the leading cause of death in adolescents and young adults (1,2,3,4) and of the estimated 856 000 road deaths occurring annually worldwide, 74% are in developing countries (5). In both Nigeria (6,7) and Kenya (8), for example, a fivefold increase in traffic-related fatalities was observed over the last 30 years. Injuries cause profound morbidity and are one of top 10 causes of death and disability in both developing and developed economies (9). Kenya, like other developing countries, lacks organised efforts to reduce the burden of injuries. Although there is debate as to whether trauma systems in high-income countries are transferable to developing economies, baseline studies providing accounts of injury and injury trends in least developed countries are scanty.(10) Media reports have raised concern over rising road accident injuries in Kenya. Most of these occur in the capital city, Nairobi (11). Those injured mainly receive treatment at the Kenyatta National Hospital (KNH) the citys main hospital. The city lacks a systematic pre-hospital care and the patients arrive at the institution at any time and unannounced. As demonstrated in Saidis study, the injured are transported to hospital by private vehicles in the majority of cases. Ninety two per cent of the casualties arrive at KNH without any pre-hospital optimisation. (10) Saidi et al (12)found 31.0% of all admissions at KNH are due to injury indicating that a large volume of trauma admissions is handled at this public hospital. The average length of hospital stay of 14 days is from Saidis study is much longer than in reports from established trauma facilities. At the Vancouver General and Teaching Hospital, Canada, the length in 1997 was 9.14 days despite caring for patients with severer injuries (24% with ISS > 16) than in Saidis (12) cohort of patients (13.4% with ISS > 15) [12,13]. The excess length of hospital stay at KNH is caused by the predominance of skeletal injuries. Long bone fracture fixation is usually performed late, a practice occasioned by the local economic environment and a limiting factor for external validity of this outcome measure. An initial period of nonoperative care, which may last up to 4 weeks, is inevitable. The delay is caused by time spent to raise funds for desired implants. Many patients (90%) pay for the services out of their pockets [14]. If a policy of early fracture treatment incorporating a care reimbursement system that does not delay the operative intervention is introduced, the average length of stay may improve. This early fixation would additionally prevent pulmonary failure state, alleviate pain, ease nursing care, reduce complications [15], and allow early rehabilitation and return to work. The principles of traction are a pulling force that is applied to part of the body i.e. the limbs, the pelvis or spine and another force applied in the opposite direction called counter traction. The forces involved in traction are based on Newtons third law of motion, which states for every action there has to be an equal and opposite reaction. Malgaigne characterized as the greatest surgical historian, and author of the 1st comprehensive work on the diagnosis and the treatment of fractures (18), credits Guy de Chauliac with the introduction of continuous, isotonic traction in the treatment of fractures of the femur. This was accomplished by suspending a weight, attached to the leg by a cord over a pulley at the foot of the bed. The use of traction dates as far back as 3000 yrs. The Aztecs and the ancient Egyptians used manual traction and made splints out of tree branches and bark. (19) In 1847, Malgaigne introduced the first effective device which grasped the bone itself, these hooks were designed for the Rx of displaced patella fractures, the hooks were pressed through the skin and subcutaneous tissue to engage the proximal and distal fragment of the patella.(18) During World War One there was a rapid spread of the use of skeletal traction by application of tongs to the femoral condyles. After the war the tongs were extensively used in the United States but their popularity gradually decreased because of the complications, particularly infection associated with their use, tongs are now mainly reserved for skull traction.(21,22,23,24,25) Skeletal traction by means of the Steinman pin was popularized by Bohler and his students. Isotonic traction still remains an essential element in the closed treatment of many fractures. In many places worldwide it is standard practice to apply skeletal or skin traction to the injured limb following acute fractures prior to surgery Billsten 1996; Brink, 2005 (41). Traction may be either skin or skeletal. The main theoretical advantages of traction are that it will reduce pain at the fracture site and assist the reduction of the fracture thereby making the subsequent operation easier to perform. For intracapsular fractures reduction in circulatory complications has been proposed as traction may reduce any tamponade effect (Pressure caused by build up of excess fluid) which will compress blood vessels and block blood flow within the joint. Traction however has potential disadvantages, it makes nursing of the patients more difficult for e.g. use of a bed pan by the patient, pressure area care prior to surgery. Other adverse effects especially of skeletal traction include complications of sepsis at the pin site, pulmonary complications and knee stiffness because of the prolonged immobilization. In the last two decades there have been major changes in the management of lower limb long bone fractures, where resources permit, surgical management of open closed femoral tibial fractures has become routine.(26) Traction should now be rarely used as the definitive form of management. Orthopaedic surgeons have come to appreciate that there are 4 main treatment goals for fracture management (27). These goals were created by the ASIF (association for the study of internal fixation) and are: Anatomic reduction of the number fragments, ensuring alignment, length, and angulation and rotation are corrected as required. Stable internal fixation to fulfil bio-mechanical demands Preservation of blood supply to the injured area of the extremity. Active pain free mobilization of adjacent muscles and joints to prevent the development of fracture disease There are several studies done to determine the usefulness of pre-op traction, (32,33,34,,35,36,37,38,39), though these studies are mainly looking at proximal femoral fractures. Traction prior to surgery is standard practise in some hospitals, a survey of 78 hospitals in Sweden (40) showed that a quarter of those, routinely applied skin traction to all patients with hip fractures, while another survey done by Brink et al in 2005(41) found that pre-op traction was standard practise in 20% of trauma departments in the Netherlands. These studies have shortfalls in that the type of traction used is mainly skin fraction, and the maximum duration patients are on traction is 2.3 days Brink 2005(41), while in our setting patients are on traction for minimum one week prior to internal fixation . In this study only 4 patients were put on skeletal traction of the total patients put on traction, reasons for the difference are not given. From the Cochrane review article on the pre-op benefits of traction, not many studies have looked at the complications of patients put on skeletal traction. The main outcome measures in these studies (32,33,34,35,36,37,38,39,40,41) were degree of pain, analgesia use, length of surgery, ease of fracture reduction, and it seems like incidence of pressure sores and other complications were secondary objectives. One of the earliest accounts of complications of skeletal traction is from 1946, by Kirby Fills (42) they mainly looked at complications associated with trans-fixation pins and wires in skeletal traction, from a series of 305 fractures of long bones, complications occurred in 12, of these only 3 were related with Steinman pin use one of the patients had pin tract infection (PTI), and 2 had peroneal nerve palsy, however the author clearly states many patients who had a little drainage from the pin but no signs of inflammation were not regarded as pin tract infection . Pin tract infection is defined as an abnormal condition associated with skeletal traction or external fixation devices and is characterized by infection of superficial, deeper or soft tissues or by osteomyelitis. These infections may develop at skeletal traction pin sites. Some of the signs of pin tract infection are erythema at the pin sites, drainage, pin loosening, elevated temperature, and pain. The bone pin construct is not a sterile interface, but it is a pathway between the surface of the skin, which is normally colonized by bacteria, and the medullary cavity which is sterile (43). Factors which predispose to pin tract infection are thermal necrosis (44) and accumulation of fluid around the pin (45). Regular pin care prevents crusting around the pins, thus minimizing fluid accumulation and hence transmission of bacteria, within the underlying tissues (45). Pin insertion using a hammer leads to splintering of the cortex (46). Insertion of the pin using power tools has been indicated as the main cause of thermal necrosis (44) hence hand drills are preferable for insertion. Necrosis of osteophytes and tissues due to the temperature elevation provide a fertile bed for any pathogenic bacteria. Patients who are put on skeletal traction suffer from morbidities associated with prolonged bed rest. A feature peculiar to these patients is morbidities associated with pin tract infections, which results in pain, pin loosening and subsequently need for removal of the pin. Neglect in these cases can lead to abscess formation and osteomyelitis (43). Similar morbidity of pin tract infection is associated with pins used in external fixators. Reported incidence in the world literature on pin tract infection is 5-10% (47,48,49,50). This incidence increases in cases of transfixation pins upto about 80% (51). The prevalence of pin tract infection varies dramatically in the literature from a 1% prevalence of major infections to an 80% prevalence of minor infections (52). Even in the study identified by the Cochrane review (53) the prevalence of pin tract infection varied, based on the treatment of pin sites, from 8-25% (54). A common factor in most studies of pin site complication is the lack of a standard definition of what constitutes a PTI is it inflammation around the pin site as reported in upto 41.6% in one series (55), or is it cellulitis around the pins or pin sites with draining sero-purulent discharge or is it pin loosening. Therefore this study is being done to establish what the rates of pin tract infection are when all the signs of inflammation will be used to diagnose pin tract infection. Looking at studies done closer to home in 1962 procter reported his series of 41 patients in SA (56), he was looking at use of perkins traction in femoral fracture management. PTI was found in 15% of the patients, while all the patients had full knee ROM at a period of 10 weeks. A few years later Usdin reported his own series of 58 patients, managed by perkins traction, and 5 of these patients 8.6% developed pin tract infections, and 2 cases had residual knee stiffness (57). More recently Gosselin in his series of 53 patients from Sierra Leone in 2005 reported that 23 patients (42.6%) of his patients had a pin tract infection and at an average 29 days after being put on traction.(59) Therefore it is noted incidence of PTI varies from centre to centre and is dependent on several factors , it is the purpose of this study to establish what proportion of patients on skeletal traction develop a PTI. Other complications associated with skeletal traction are decubitus ulcers, venous thromboembolism, Knee stiffness and pneumonia. There is sparse literature which reports on the occurrence of these complications in association with skeletal traction. Butt et al in his RCT of operative versus non-operative treatment of distal femoral fractures found that in the non-operative arm, a total of 26 patients developed complications. 3 of these patients had DVT, 4 had chest infections, 4 had pressure sores, 4 had UTIs (58) and 5 out of 26 patients developed pin tract infection. When critically ill patients are under our care it is important to protect them from further deterioration or delays in recovery, especially due to complications that are not related to the underlying pathophysiology that brought the patient to hospital. Immobility is associated with increased risk of VTE, decubitus ulcers and pulmonary insufficiency. Bed rest is a highly un-physiologic form of therapy and can lead to a number of complications (table1). Immobility-Associated Complications System Complications Respiratory Atelectasis Pneumonia Pulmonary embolus Cardiovascular Hypovolemia Dampened carotid baroreceptor response Orthostatic hypotension Deep venous thrombosis Gastrointestinal Constipation Ileus Renal Renal calculi Urinary stasis Endocrine Hyperglycemia Insulin resistance Musculoskeletal Muscular atrophy and deconditioning Bone demineralization Joint contractures Skin Decubitus ulcers Psychosocial Depression Decreased functional capacity Decreased respiratory excursion and stasis of secretions leads to atelectasis and pneumonia, lesser muscle contractions of the lower limbs results in reduced venous return, venous stasis and VTE. Reconditioning, loss of skeletal muscle mass and strength, is often seen because of immobilization. Bone demineralization due to absence of weight bearing stress on the skeleton, joint contraction occurs because of muscle atrophy. Pressure sores develop because of prolonged pressure on bony prominences. DVT and PE have long been recognized as major causes of morbidity and mortality in patients undergoing both elective and emergency orthopedic surgery. Numerous studies have investigated the incidence of DVT PE associated with hip and total knee arthroplasty, also the role of prophylactic anti-coagulation has been extremely investigated. When considering orthopedic trauma patients extrapolation from the arthroplasty literature is not appropriate. The incidence of DVT PE in association with hip and pelvic fracture has been looked at extensively, however there is insufficient information on patients with femoral fractures managed with skeletal traction, so as to allow the orthopedic surgeon to determine the risk or benefit rational of anti coagulation. In a prospective study done in Canada a co-host of 349 following major trauma was studied, and DVT cross found in 126 of the 182 with lower extremity orthopedic injuries, 61% of patients with pelvic fractures, 80% of patients with femoral fractures, 77% of patients with tibia fractures had confirmed DVT using venographic studies. Patients with fracture of tibia, femur are known to be at almost a 5 times more risk to have DVT as compared to patients without fractures. Geerts et al also found that only 3 of the 201 patients with confirmed DVT (ODS 1.5%) had clinical characteristics suggestive of DVT, therefore it is questionable whether clinical characteristics are adequate to make a diagnosis of DVT. Although it is well known that elderly patients have an increased risk of thrombosis. Geerts et al also found that younger patients with trauma those that are under 30years had a 46% incidence of DVT. The incidence of DVT in patients with femoral fractures on skeletal traction is unknown. The purpose of this study is to determine the incidence of DVT with positive clinical characteristics and confirmed by Doppler U/S in patients on skeletal traction for femoral fractures. Respiratory problems are common after long bone fractures, The main common complication of long bone fracture is fat embolism syndrome (FES),(60) followed by respiratory dysfunction and insufficiency.(61,62) Despite the development of medical and anesthetic management, evidence indicates that early treatment of the fractures in a multiply injured patient has a profound effect in reducing the risk of subsequent respiratory complications. (61,63,64,65,66) There are numerous studies showing that early fixation of femoral fractures can decrease the incidence of ARDS and multiple organ failure (MOF).(67,68,69,70,71,65) Over the last decade the beneficial effects of early stabilization of femoral shaft fractures by intramedullary nailing have been challenged. The association between early femoral fixation with reamed nailing and a higher risk of ARDS/MOF has been suggested.(56,64,60,61,65,66,) The first prospective study on this subject showed that among 178 patients, the incidence of pulmonary complications was significantly higher in those with late stabilized fracture.(71) In patients with single fracture, the complication rate after late fixation was 22% in comparison with 4% after early stabilization. In multiple fractures, these rates the traction were100% and 32%, respectively.(69,70) Early fixation can lead to the prevention of thrombosis, subsequent bed ulcers, and decreases the needs for analgesics.(65,74) Furthermore, early stabilization eliminates the need for supine position for skeletal traction, it improves pulmonary function and prevents atelectasis.(63,65,67,74,75) This study is aimed to determine the incidence of respiratory problems in patients who have single femoral or multiple fractures, and are awaiting operative stabilization. Severely restricted knee motion is a recognized complication of operative procedures or trauma around the knee. This is a significant problem in underdeveloped countries where the initial management of many of these injuries is suboptimal. The reported rate (76,77,78,79) of significant knee stiffness after various injuries and procedures around the knee is as high as 11% in the western literature, but may be much higher in underdeveloped countries, where ideal management of trauma is not readily available (80). A large percentage of these cases present with adhesions inside as well as outside the knee, and the management of these cases then becomes complex. Loss of extension is labelled more debilitating in western cultures, with small extension deficits impeding normal walking ; restricted flexion however is a serious problem in the Asian countries, where social and religious mores make sitting on the ground a normal requirement of everyday life. Flexion loss is mostly due to intra-articular fibrosis and scarring in the quadriceps-femoral mechanism. Anterior adhesions involve the quadriceps expansion in the lateral and medial recesses, the suprapatellar bursa, muscle adhesions to the femur, patella , or even shortening of the rectus femoris (77). A number of studies have described the complications of traction however no study from the region where patients are primarily managed on skeletal traction have looked at the complications due to skeletal traction and those associated with prolonged immobilization. STUDY JUSTIFICATION:- American College of Surgeons Committee on Trauma has recommended that femoral shaft fractures in polytrauma patients be treated within 2-12 hours after injury, provided they are hemodynamically stable.(81,82) Studies have also shown the significant benefit of intervention within the first 24 hours. Immediate fixation has been shown to decrease fatalities, respiratory complications, multisystem organ failure, and the length of ICU stays in most patients. The type of early fixation used can be debated, but the timing appears to be what makes the difference (83,84). World over fracture fixation has evolved whereby early fixation is advocated for. In the resource-poor local setting with large volumes of patients occasioned by persistently high RTA, the primary management modality is skeletal traction. There is lack of skilled personnel (surgeons/traumatologists) in most peripheral hospitals and hence most patients who have sustained fractures of the lower limb are put on skeletal traction as ORIF cannot be done therefore it is important to establish what are the common complications suffered by these patients. There is a large volume of patients who are seen at KNH, this is mainly because of the poor infrastructure at peripheral hospitals in managing major orthopaedic injuries hence most patients are referred to KNH causing a strain on its resources and ultimately leading to substandard orthopaedic care. The complications associated with skeletal traction and prolonged immobilization have been reported by several authors however most of the numbers of patients who are managed on skeletal traction in these studies are few. In our setup most of the patients with femoral fractures are put on skeletal traction while awaiting operative management therefore it is important to know what the incidence of these complications in our setting are. The incidence of pin tract infection in most studies is not adequately reported as there is no standardized definition of pin tract infection therefore this study will look at pin tract infection broadly . In KNH patients with femoral fractures are put on skeletal traction while awaiting fixation, this is mostly done on an elective operating list and it is not known what duration these patients are on traction, from this study we will establish what the mean waiting time is for a patient with femoral fracture to be internally fixed. It is not known what number of patients with femoral fractures who are put on traction in our setting develop complications hence this study is being done to establish the proportion of patients who get pin tract infections, and other complications associated with skeletal traction. BROAD OBJECTIVE:- To determine the proportion of patients with Lower Extremity fractures who develop complications associated with skeletal traction. SPECIFIC OBJECTIVE:- To determine the proportion of patients on skeletal traction for LE fracture who develop pin tract infections venous thrombo-embolism knee stiffness pressure sores orthostatic pneumonia 2. Determine the proportion of those who recover from the complications 3. To determine the duration patients are on traction 4. Proportion of those with adverse outcomes following complications PATIENTS AND METHODS STUDY DESIGN This is a Hospital based Prospective Descriptive study. STUDY SETTING:- The study will be carried out at the KNH orthopaedic wards. STUDY PERIOD:- The study will be carried out over a period of four months or?until the sample size is achieved SELECTION CRITERIA :- All patients eligible to the study will be enrolled until the sample size is obtained. INCLUSION CRITERIA:- All skeletally-mature pts with lower extremity fractures put on skeletal traction as a definitive or temporary treatment option Those consenting to be recruited in to the study. EXCLUSION CRITERIA:- Skeletal immaturity determined radiologically. Pre existing disease: pneumonia, VTE, pressure sores SAMPLE SIZE CALCULATION:- The sample size will be determined by the use of the following formulae to achieve an adequate sample to accurately estimate the prevalence of complications in pin tract infection in the study population. n = Z2ÃŽÂ ±/2 X P (1-P) D2 Where n = required sample size P = prevalence of pin tract infection (42.6%, 24%  [1]  , 26%  [2]  ), based on the estimated prevalence from a similar study in Sierra Leon by Gosselin. This is the only study in the developing country performed in a similar setting. D = Precision with which to measure prevalence, set at plus or minus 1%. The ZÃŽÂ ±/2 is the cut off points along the x-axis of the standard normal probability distribution that represents probability matching the 95% confidence interval (1.96). Substituting the above in the formulae we get; n à ¢Ã¢â‚¬ °Ã‹â€  93.9 = 94 patients DEFINITIONS OF COMPLICATIONS AS WILL BE USED IN DATA COLLECTION :- Pin Tract Infection :- will be defined by signs of hyperemia,pain,crusts,seropurulent discharge around the pin site or pin loosening. Venous Thrombo-embolism :- Patients with unilateral leg swelling, calf pain, will be subjected to doppler u/s to confirm presence of a thrombus. Pressure sores : Trochanteric,sacral,calcaneal regions of the body will be examined and the use of the pressure sore grading system will be used to record presence of pressure sores :- Grade 1 :- non blanchable erythema of intact skin Grade 2:- Partial thickness skin loss involving epidermis,dermis or both Grade 3:- Full thickness skin loss involving damage o or necrosis of subcuataneous tissues that may extend down to but not through underlying fascia Grade 4 :- Full thickness skin losswith extensive destruction, tissue necrosis or damage to muscle or bone. Knee Stiffness :- Patients have a reduced range of motion of the knee of the injured limb and will determined by range of motion of less than 30 degrees, less than or equal to 90 degrees or more than 90 degrees. Pneumonia :- Patients who have recorded high temperatures, respiratory distress, cough, chest pain will be used to make a diagnosis of pneumonia. DATA COLLECTION:- Patients will be recruited into the study Consecutively Use of a questionnaire to gather data, including demographics, cause of fracture, traction system and its duration, incidence of complications and their outcome. Data will be collected as pertains to the date of commencement of traction up to the date patient undergoes operative management or is taken off traction. Patients will be recruited into the study as they are put on traction, and will be followed upto the time they are taken off traction. DATA ANALYSIS:- The data will be collected using a structured questionnaire. The questionnaires will be coded to make the data entry easy. The filled questionnaires will be kept in a safe place ready for the data entry and for the confidentiality of the patients details. After cross checking the questionnaires for any missing entries a data base will be designed in MS Access which will allow the researcher to set controls and validation of the variables. On completion of the data entry exercise the data will be exported in a Statistical Package (SPSS Version 15.0 Chicago , Illinois) for analysis. The data will be presented in tables and figures where applicable. Non- Parametric tests (Mann Whitney U test) will be used to examine whether there is any significant association between the continuous variables e.g. age and duration count, while chi-square will be used to establish the significant associations between the categorical variables. Odds Ratios (OR) and associated 95%C

Biography of Frederick Douglass Essay examples -- Informative Essay, B

Frederick Douglass was a combative African American slave born the year of 1818 in Tuckahoe, Maryland who fought his slave breaker during an unfair dispute and beat him. He demonstrated how a man was turned into a slave since birth then how a slave was turned into a man. As a rebellious runaway slave that later became known as the greatest abolitionists in history believed in his liberty more than his own life. Not only was he one of the most scholarly and effective orators but he also became revolutionary. As one of the best-known black leaders in the nineteenth-century he was asked to deliver a speech, â€Å"What to the Slave is the Fourth of July† to celebrate America’s independence from Britain. As an American slave he delivered this speech with an emotional content against America. His speech was seen as hypocrisy by not keeping up with the Declaration of Independence. However, as a former slave he was deprived from liberty for many years, which, makes America hypo critical by asking him to speak about liberty to the United States. Douglass rhetorically tells America, â€Å"Who so stolid and selfish that would not give his voice to swell the hallelujahs of a nation’s jubilee, when the chains of servitude had been torn from his limbs? I am not that man† (Douglass, 255) to make them see his point of view as a former slave talking about liberty. On July 5, 1852 Frederick Douglass was orating to America where he proclaimed â€Å"July fourth to be the bitterest reminder of America’s failed promise† (Douglass, 247). During this time the 1850 compromise was passed through congress where the Mason and Dixon line was established because of the controversy between the North and South. Some important parts were the 3/5th compromise in which a ... ...y,† demonstrates that they do not follow what they worship to the fullest. He is using the religious aspect of African Diaspora to demonstrate his point that liberty should be extended to all citizens including African American. Another part of African Diaspora is the study of back to Africa, which was mentioned by Martin Robinson Delany. Delany and Douglass had two opposing view of Africans living in the U.S. Frederick Douglass believed in mainstream ideas and that America can one day end slavery and welcome them as citizens. On the other hand, Delany believed that was not possible because they needed a county of their own. Both views were part of African Diaspora as well as religion which all unite to make one movement for people of African Descent dispersed all over the world. Works Cited "what to the slave, is the fourth of July" (1852), pp. 246-268

Poem Comparison of Mr bleaney by Philip Larkin and In Memory of My Gran

Poem Comparison of Mr bleaney by Philip Larkin and In Memory of My Grandfather by Edward Storey The two poems that will be conveyed and compared will be 'Mr Bleaney' (by Philip Larkin) & 'In Memory of My Grandfather' (by Edward Storey). Both verses describe the character of the poem. The character in the poem on the Grandfather has admiration, but Mr Bleaney is disturbed. In this essay I will compare the character, poets feelings and attitude to each man. Furthermore, the similarities and differences in structure, language and image between the two poems will be compared and lastly my preference and emotional responses. To begin with what each poem is about. Mr Bleaney is a descriptive and narrative verse. There are two voices the landlady's and the poets, Mr Bleaney is given in the view of the depressed lyricist. Mr Bleaney is given the life of the writer through his lonely years. It is about a man named Mr Bleaney who lives through a lacklustre yet ordinary life, but the place he lives in is shown through a kitsch light. On the other hand the Grandfather is compared to a tree and the whole poem has the description of his appearance through the grandson's observation. Now I shall move on to the characters. Mr Bleaney has a sad life because he lives in a place called 'The Bodies.' The word body is used when someone is departed. So this means who ever lives in this house is nobody. They are metaphorically deceased. The poet describes Mr Bleaney using environments and surroundings. He suggests Mr Bleaney is not intellectual, 'sixty watt bulb' very dim, has a restricted life. Additionally he has no possessions of his own, 'behind ... ...uthor achieved his expectations of the character by evaluating him with a tree, 'his voice rough as the bark of his cracked hands.' So both artists have achieved their prospect to an extent. The reactions and images that I received from this poem vary from the writer. My preference is that I had learnt a lesson from the Mr Bleaney's poem is 'we treat ourselves the way we tell other people to treat us.' The grandfather poem did not give me many lessons except that he is the most respected character in the lyric and the whole sonnet is personified, with the tree. Additionally I blemished many disparity and distinction between the poems. There weren't numerous resemblances though. In conclusion the Mr Bleaney has told me he was a lonely and a middle class man, but the grandfather was a free sprit and lived life his way.

Examples of Discipleship Essay

I believe that Dietrich Bonhoeffer and Christian Aid are two prime examples of discipleship in this century, Bonhoeffer as an individual and Christian Aid as an organisation. Bonhoeffer was a German preacher born in 1906 to a medical professor and his wife in Breslau, a small town. From an early age he wanted to serve God, and so he studied theology at university and taught and preached in both Germany and America. He returned to his homeland in 1933 to protest against the newly elected Nazi party, and joined the new Confessing Church, having rejected his previous Protestant church for bowing to Hitler’s demands. He worked in a secret training centre for new pastors, run by the confessing church, for four years, as the Gestapo closed it down in 1937. After that, and with the signs of the oppression soon to be felt by the German people becoming clearer, Bonhoeffer took a more active role in his campaigning against the Nazis, eventually leading him to a cell in a prison and the hangman’s noose in 1945. One of the main tenants of Christian discipleship is Jesus’ teaching on the mountain: pacifism and love for enemies. Bonhoeffer was an avid believer in these ideals, and wrote his still-relevant book, The Cost of Discipleship, based around those thoughts. He interpreted the maxim of â€Å"If someone strikes you on one cheek, turn to him the other also† as a call for pacifism and working out disagreements by reasoning rather than force. But Bonhoeffer was forced to challenge his own morals when the news of the violent anti-Semitism ignited by Hitler spread and several of his friends joined the German resistance. Most of those opposed to the Nazis saw that the only way to end the suffering caused by Hitler was to kill him. Public meetings were banned, and the press were heavily censored. The huge propaganda departments of the government would not allow any attempt by Bonhoeffer to spread his Christian teaching. So Bonhoeffer felt that he could be quiet, and wait until the war finished, and congratulate those that ended it, or he could play an active role in a plot to kill Hitler. Firstly he helped smuggle Jews out of Germany, but was caught and forced to give up any legitimate teaching. Forsaking any hope of reaching a peaceful end to the conflict, Bonhoeffer helped the bomb plot to assassinate Hitler. When it failed he was incarcerated, and he contemplated his deviance from Christian law. Bonhoffer had to make, on his own, one of the main questions that hangs over all belief systems: Whether the moment dictates what a person should do, or if people should always keep constant what they believe in. In his case it was between fighting evil and helping those in need or staying true to his pacifist roots. He chose to take a drastic step against some of Christ’s teachings to implement others, leading to his arrest and execution. This inevitable question still hangs over the church, and a viable answer has yet to be suggested. Christian Aid is a charity funded by numerous churches in the UK and Ireland. Although it is funded and staffed by Christians, Christian Aid will support any people in need, regardless of religion or race, and does not attempt to convert those it helps to Christianity. Although it combats poverty and need immediately and continually in global trouble areas, it also tries too stop poverty at it’s root, and was a large part of the ‘Jubilee 2000†² campaign to abolish third world debt. Christian aid has interpreted Jesus’ teaching on Discipleship and concentrated on the aid and help parts of his teaching. It would look to examples from his life: â€Å"When the sun was setting, the people brought to Jesus all who had various kinds of sickness, and laying hands on each one, he healed them† (Luke 4:40) This sort of passage, frequent in the gospels, shows that Jesus cared greatly for the needy, rejecting the idea that they somehow ‘deserved’ their punishment, and was not afraid to get dirty and ritually ‘unclean’ to help. In the same way, Christian Aid was set up by Christians who do not judge those they help, and will go to any lengths to re-enact Christ’s good work. They also follow the teaching laid down by Jesus in his parables, such as the parable of the Good Samaritan: â€Å"He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own Donkey, brought him to an Inn and took care of him.† (Luke 10:34) The idea of this parable, where one man steps in where others fear to tread, inspires Christian Aid a lot, as they are physically helping the needy of the world while other members of society just stand back and watch, sometimes nodding approvingly. They see this following of Jesus as being true to one of Jesus’ main teachings, â€Å"Love your neighbour as yourself† And seek to harmonise the lot of people around the world by abolishing suffering through war, poverty and disasters. As Christian Aids motto goes; â€Å"We believe in life before Death†, Christian Aid is rejecting the traditional view of the churches preaching yet not acting, and are playing an active role in the reduction of suffering. They see Jesus’ message not just as an instruction to put up with life until you die, but also as a chance to help the needy, and prove before God their faith as Christians.

Bretton Woods Essay

Bretton Woods Conference The Background During the World War I and World War II the international monetary system is split into several competing currency blocs, the fierce trade war between the global recession and nation. In the post-World War II, at the end of World War II, the U. S. dollar has enjoyed a unique and powerful position in international trade and also because British and American governments for consideration of national interests, ideas and design of post-war international monetary system, proposed separately by the â€Å"White Plan† and â€Å"the Keynes plan. Huai-held plans† and â€Å"Keynes Plan† with is the establishment of international financial institutions, stabilize the exchange rate, the expansion of international trade, and promoting world economic development for the purpose, but the way they operate. Because the United States boarded the supreme world leader of the capitalist world economic crisis and after World War II, the dollar's international status because of its strength of the international gold reserves to get a solid, the two sides reached in April 1944, reflects the White Plan on the establishment of the GB currency experts of the Fund a joint statement. What is â€Å"Bretton woods conference†? The United Nations Monetary and Financial Conference, commonly known as the Bretton Woods conference, Bretton woods system or Bretton woods agreements. It was a gathering of 730 delegates from all 44 Allied nations at the Mount Washington Hotel, situated in Bretton Woods, New Hampshire, to regulate the international monetary and financial order after the conclusion of World War II.The conference was held from 1-22 July 1944, when the agreements were signed to set up the International Bank for Reconstruction and Development (IBRD), the General Agreement on Tariffs and Trade (GATT), and the International Monetary Fund (IMF). It established the rules for commercial and financial relations among the world's major industrial states in the mid 20th century and also was the first example of a fully negotiated onetary order intended to govern monetary relations among independent nation-states. As a result of the conference, the Bretton Woods system of exchange rate management was set up, which remained in place until itself collapsed in 1971, when President Richard Nixon severed the link between the dollar and gold. What they agreed: * Formation of the IMF and the IBRD (World Bank) Adjustably secured foreign exchange market rate system: * Exchange rate were fixed, with the provision of changing them if necessary * Currencies were required to be convertible for trade related and other current account transactions * All member countries were required to subscribe to the IMF’s capital * if exchange rate might not be favorable to a country’s balance of payments position, the governments had the power to revise them by up to 10% Who’s involved? Delegation from around the w orldAustralia|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  India|   Ã‚  Ã‚  Ã‚  Belgium|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Iran|   Ã‚  Ã‚  Ã‚  Bolivia|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Iraq|   Ã‚  Ã‚  Ã‚  Brazil|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Liberia|   Ã‚  Ã‚  Ã‚  Canada|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Luxembourg|   Ã‚  Ã‚  Ã‚  Chile|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Mexico|   Ã‚  Ã‚  Ã‚  China|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Netherlands|   Ã‚  Ã‚  Ã‚  Colombia|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  New Zealand|   Ã‚  Ã‚  Ã‚  Costa Rica|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Nicaragua|   Ã‚  Ã‚  Ã‚  Cuba|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Norway|   Ã‚  Ã‚  Ã‚  Czechoslovakia|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Panama|   Ã‚  Ã‚  Ã‚  Dominican Republic|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Paraguay|   Ã‚  Ã‚  Ã‚  Ecuador|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Peru|   Ã‚  Ã‚  Ã‚  Egypt|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Philippines|   Ã‚  Ã‚  Ã‚  El Salvador|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Poland|   Ã‚  Ã‚  Ã‚  Ethiopia|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Union of South Africa|   Ã‚  Ã‚  Ã‚  France|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Union of Soviet Socialist Republics (USSR)|   Ã‚  Ã‚  Ã‚  Greece|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  United Kingdom|   Ã‚  Ã‚  Ã‚  Guatemala|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  United States|   Ã‚  Ã‚  Ã‚  Haiti|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Uruguay|   Ã‚  Ã‚  Ã‚  Honduras|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Venezuela|   Ã‚  Ã‚  Ã‚  Iceland|   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Yugoslavia| The United States, having the largest delegation, brought a wide spectrum of economists and politicians to the Bretton Woods Conference. China, represented by the Nationalist government of Chiang Kai-shek, played an active role and was granted the fifth largest quota among the original members of the IMF.Cuba, governed by Ramon Raul San Martin, sent a delegation that represented the interests of small agr icultural economies. Delegates from many Latin American nations were deeply involved in the negotiations. The democratic process at Bretton Woods ensured that concerns of all countries were addressed. Though the delegation from the Soviet Union was active at the Conference and signed the draft Articles, the Soviet government later decided not to join the Fund or the Bank. The cooperation of the U. S. and USSR delegations was a positive moment before the onset of the Cold War. In 1944, the Indian delegation to Bretton Woods included both British citizens as well as Indian nationals, as India was still part of the British Empire.Alexander Argyropulos (at right in photo), a member of the Greek delegation, arrived in New York on June 21. Argyropulos had been a prisoner of war for a year. His arrival in the United States culminated in the reunion with his wife and daughter, who had escaped Greece when Axis forces invaded. Camille Gutt one of the Belgian delegation. Once the Fund was esta blished, Gutt was elected as its first Managing Director, a post he held until 1951. Outcomes: The Conference led to the creation of three organizations in order to lead the world economy in the right direction. The International Monetary Fund (IMF), the General Agreement on Tariff and Trade (GATT) and the World Bank.The IMF was intended for keeping track of the monetary policy, to balance the exchange rates, reduce restrictions on the foreign exchange rate, and provide loans to invest in the infrastructure of developing countries and countries that had debts. The number of votes a country for the IMF board depends on its contribution factor towards the reserve. The U. S, U. K, Japan, Germany have 40% of the votes. Out of that percentage, the U. S has 17% of the votes, making them the majority power in the IMF. The GATT encouraged â€Å"laissez-faire system†, to make trade without government intervention, to reduce taxes when two countries are trading with each other and make it fair. It is known now as the World Trade Organization.The World Bank main idea and purpose was to help third world countries and reduce poverty, and to corporations who want to aid the developing countries. The World Bank would offer loans to rebuild roads and utilities. These were the organizations that emerged from the Bretton Woods Agreement. Another outcome for the United States was the Dollar being a â€Å"World Reserve Currency† and that all trade and business will be done in American dollars. Even trade between two different nations that do not use the American dollar as their currency; will do business with each other using the dollar. For example the price of oil from Saudi Arabia will not be in Saudi Rials, but in American dollars. Then those dollars would be redeemable through gold from the U.S at a fixed price of 35$ per ounce. All the countries that signed the Bretton Woods Agreement agreed to fix their currency with the same value as the value of gold. The s upply of money a country had went hand in hand with its gold reserves. The countries that were not rich in gold, would have to borrow money in order to finance their investments and development. The system performed trade through stable and adjustable exchange rates. However there was an increase in demand for dollars which lead to an increase in trade deficits, and the value of the dollar remained high. The United states couldn’t fix the exchange rate between itself and other urrencies. It became known as the â€Å"n’th currency problem†. All the countries currencies were at par with the US dollar. The United States worth of gold was $26 billion by 1964. The world’s worth of gold was $33 billion. Many countries held the U. S dollar as their main reserve asset. Because of that, the French President, De Gaulle said the U. S had a privilege of unlimited financing, because of the majority of countries having dollar assets. The U. S was unable to eliminate it s deficits. The ways in which the balance payment deficits could be corrected include deflating the economy by using a monetary policy, which means raising interest rates.Another policy to use is the Fiscal Policy that includes reducing government spending in order to reduce demand. The U. S could have also devalued its currency, which meant foreign currency prices are higher. This would reduce exports from foreign currencies, and more exports from the U. S. The Bretton Woods system was successful until 1971, August 15th. A few measures were taken to avoid the system going to fail. They included imposing an â€Å"interest equalization tax† to reduce the outflow of investments and private capital. However this lead to more loans from foreign borrowers. A lot of the funds went to financial institutions in places lke Europe and Japan. The United States President Nixon said the amount of gold that was sent out of the U.S for the 27 years since the agreement was unsustainable. He announced a 90-day freeze on wages and prices, a 10% import surcharge on imports and suspended converting dollars into gold. The value of gold had increased, yet the price of $35 per ounce remained. Even though many countries still owed money to the U. S and were in debt. References: http://weber. ucsd. edu/~jlbroz/Courses/Lund/handouts/Lecture12%20_Bretton_%20Woods. pdf http://id. wikipedia. org/wiki/Sistem_Bretton_Woods http://www2. econ. iastate. edu/classes/econ355/choi/bre. htm http://en. wikipedia. org/wiki/Bretton_Woods_system http://en. wikipedia. org/wiki/International_Monetary_Fund http://en. wikipedia. org/wiki/Gold_standard