The pulley system investigation Essay Example for Free

The pulley system investigation Essay My aim is to create a pulley system which must consist of one, two or three pulley systems so that the results are recorded. I will also investigate and find the difference in the value of the force obtained for the three different pulley systems. Hypothesis I should be able to pick up 500g with one pulley but to make this easier I will use a pulley system, if I use one pulley that the force needed to lift this amount of weight should decrease by 25%. Off course this is my hypothesis Apparatus   Nylon Rope (3 Metres long Rope) Three pulley systems.   500g mass load force meter. (Newton Meter)   Clamp, Boss, Retort Stand. Loop and Weights. Safety Points The first thing that you must always be concerned about should be the safety of yourself and people around you. Safety should always be looked at seriously as this could alter the results and the test could turn unequal and unfair. You must always be concerned about Safety as this could always make the test more equal and Fair. Make sure that you put a bad underneath the pulleys in case they drop. A tension should always be readily available on the strings so that the whole pulley system does not collapse. Counter Balancing Masses could be an affective way to improve rather than a Newton Meter (optional). Method 1) The pulley must be firstly fixed together with a loop to a retort stand. 2) A string which has looped ends is then placed on top of the pulley 3) Weights can then be attached to one end of the string using its loop. A Newton Meter is than attached to the other side of the string. 4) By pulling down the Newton Meter you are able to raise the weight which sets the height and the effort is recorded on the Newton Meter. 5) You can now attach more pulleys and compare the force required to raise the weights. I have observed that you will not get the required result if you skip weight increasing from one number to another. You must go up step by step to see the trend. This is so that you can take real measurements and make observations correctly. 6) Adaptations To help make the experiment more efficient, the stand was were unstable; I got a friend to hold down the experiment whilst i was pulling the Newton meter. May I also mention that standard procedure may be different to the procedures which conclude in a Science Based Service. Science Based Services have much more detailed and quality instructions as well as equipment which give much more accurate readings. These accurate data include materials such as a digital Newton Meter which gives you an accurate reading to three decimal places. A Service which uses this equipment includes a building company which has to pick up a lot of weight. Diagram Result Test Number of Pulley Systems Force Needed to lift 500g load off the floor 1 0 3N 2 1 4N 3 2 3N 4 3 2N A surprising result has been achieved. The trend is very unusual. I have seen that the more the pulley is added the less force is required. But through observation i can see that without a pulley at all is better that has 1 pulley or 3 pulleys. The device is not very good as it was very unstable and people had to be aware of it. It was probably able to fall but did not due to the care that was taken. The performance of the system as a whole has not really attracted me. This is because the machine we used was insecure and unsafe to use. The first three tests were also very bad as they were better of not to be done. We contained results which were very unexpecting. If you were to add more pulleys the machine would get too complicated and may also not be able to handle it. As you know i had wished to add more pulleys but there were not any more to go around in the class. Conclusion I found out as the number of pulleys increased from 1 to 3 the amount of force needed to lift goes down. Evaluation I could improve my experiment if I repeat the test a few times to cancel any human errors such as wrong measurements which may occur during the measurement of the rope. Other measurements such as the weights may have been misunderstood due to their sizes which will vary accordingly. We also required adding more pulleys to get a more accurate result as more pulleys would have given us a more appropriate result. In the Industry In a laboratory you would use a pulley system simply to get the over all picture. It would be very small machine and the results taken would not be accurate. In a real world industry people have to move very large heavy items and materials. In an industry there are special separate companies which have the business of just moving items with huge pulley like machines. They take accurate reading of all there uses and determine through past experience of how much weight will be picked up and take on a job with the appropriate amount of pulleys. They have also got more stable and secure equipment which is checked regularly. The difference is our equipment is low graded and has not been specified for any specific weight criteria like there. We are also taking experiments before any real work can be taken up. But they have already got all the information required and choose there machine depending on the weight intended. Pulleys are found usually on cranes which help pick loads vertically but they use ropes, wires and chains!

A Critical Appraisal Of A Qualitative Journal Article Nursing Essay

A Critical Appraisal Of A Qualitative Journal Article Nursing Essay Research is a significant element in all professions, but perhaps more so in healthcare. It forms the basis of development and adaptation in the healthcare world, and allows professions to merely observe change (Griffiths, 2009). This essay critically appraises a research article, Using CASP (critical appraisal skills programme, 2006) and individual sections of Bellini Rumrill: guidelines for critiquing research articles (Bellini Rumrill, 1999). The title of this article is; Clinical handover in the trauma setting: A qualitative study of paramedics and trauma team members. (Evans, Murray, Patrick, Fitzgerald, Smith, Cameron, 2010). Many research articles are appraised due to the sheer degree of information obtainable in health care settings. Critically appraising articles allows one to filter out the low quality studies and distinguish misleading information (Cormack, Gerrish Lacey, 2010). The article title clearly explains the research, without being too extensive, using extraneous words or explaining the results found. It is able to inform the reader of the research aim without becoming uninteresting. The basic concept of a title should provide a summary of the content. A good title should be straight forward; a poorly written title will defer readers (Centre for research writing resources, 2012). Key words serve as key elements in the article, including handover, trauma and paramedics. Again allowing the reader to know precisely what the article consists of. The abstract of this article elucidates the purpose of the research, its results and reasonings. It also briefly articulates the method, highlighting key factors necessary. Everything declared in the article is present in the central text; all statistics and findings are indistinguishable. The abstract enables the reader to decipher if the article is of interest. This article clearly identifies the aims of the research in the abstract and main text. By using aims, the results and discussion are simply interpreted and flow effortlessly. Aims should be written plainly, in non-technical language and state the concepts the research is addressing (Stommel Wills, 2004). By using comprehensible and concise aims, the reader can simply understand what the researcher is setting out to obtain, giving the research a focus. In the background of the article, the researcher clearly identifies the relevance of the research aims and why the research is required, including medical mishaps and misinterpretation of trauma handovers. This allows one to understand the concepts behind the research, give the aims credibility and support incorporation into the results. Background information suggests that the topic has been thoroughly researched and aids construction of research methods and aims (Blaxter, Hughes Tight, 2006). This research uses qualitative methods, which deem appropriate for this type of research, as the researcher is trying to highlight the attitudes, experiences and emotions of participants concerning handovers. The research does not use statistics, rather participants responses and their subjective experiences around the topic. Qualitative research looks at the essence of social phenomena, giving people the opportunity to understand what people do and why (Williams, 2010). In the abstract, the researcher articulates using grounded theory and thematic analysis. Grounded theory is used to develop theories that can be used in practice (Oktay, 2012), suggesting this is a desired method for this research. The article is well set out, permitting the research design to be effortlessly recognisable and easily read. Although the researcher states that grounded theory was used, one may say that it was used incorrectly. Grounded theory is used to create theories that can be applied in real life situations (Oktay, 2012) and although this study does create a theory, (effective and ineffective handovers) it is building on an already established theory (MIST Mechanism-Injuries-Signs-treatment). The use of grounded theory is very ambiguous in this research; it could be argued that is has been applied correctly, due to using current research to guide the study. Whether it was applied accurately or not, the researcher has not explained how they used grounded theory or i ntegrated the theories into the research. The researcher does not disclose how they determined the exact method used. This would be beneficial as the research question, method of data collection and data analysis all depend on each other, and therefore these paramount decisions need to be made continually throughout the research process (Willig, 2008). The participants were selected through purposive convenience sampling, with no incentives. Although this is convenient for the researchers, it may mean the respondents are not the most appropriate to the task itself (Burnard Newell, 2011). In this case, all the participants were Paramedics or part of a trauma team and all had understanding with trauma cases. As the researcher states in the limitations, the conclusion may be different for less experienced participants or those who were trained differently. There is no explanation as to why the participants chose to take part in the study, nor why others chose to decline the opportunity. This would be valuable information as there may be a specific group of people that decide to volunteer for research studies, therefore the research may not be applicable for all paramedics and trauma staff. One may find it difficult to consider how all of the volunteers happened to be experienced, this may lead to the suggestion that the researchers f iltered through the respondents and chose the most suitable, still using convenience sampling. The article is also unclear about how the volunteers came to know about the research and what they were told before the research commenced. Convenience sampling is most commonly used in larger- scale studies (Sim Wright, 2000) and therefore seems an outlandish method to use, as only 27 participants were used in this study. In this article, the researcher does not disclose the setting in which data was collected. This may well have an impact on the results, as it could influence the participants emotions, how comfortable they feel and how much information they are willing to provide (Shi, 2008). Also, they do not specify which researcher conducted the interviews. By the interviewer being a Paramedic, part of a trauma team or neither may have an interviewer affect (Alder Clark, 2011). This in turn may change the results of the study, make it bias or unreliable. There is an obvious section in the article relating to how the data was collected. All participants were interviewed face to face, but the researcher does not specify if these were in groups or individual. By interviewing as a group some people may conform to others responses. Using a semi-structured face to face interview allows the interviewer to observe non-verbal communication techniques, as well as how the participants give their responses ( Flick, 2009). The interview consisted of pre-determined questions, using a topic guide. It is not discussed who wrote the topic guide, this again could have an effect on the results or the way in which certain questions are worded. The paramedics were given a somewhat different question format to those of the trauma team, allowing the researchers to gain full potential of questions given. The topic guide was integrated into the article, so readers are fully aware of questions asked. The participants were given a copy of MIST and asked to comment on how it could be enhanced. This was modified and presented at the specialties clinical meetings and opinions were given to the researchers by email or telephone. The researcher does not specify who was present at the clinical meetings, and whether the Paramedics were given the opportunity to see the modified version. It also does not disclose how long participants were given to respond and if they were given a chance to confer with any oth er people. If the participants were able to discuss the modified MIST before replying, the results may be inaccurate; some responses may be influenced by other professions with different experiences. The article is very vague about who was interviewed on the minimum dataset for handovers, as only the speciality groups were declared. This could cause a bias result, if only one profession was interviewed on specific aim. The researcher has not commented on their rationale for using any of these methods; supplying a rationale can help ensure validity in the research process and results (Piekkari Welch, 2004).There is no mention of any changes made throughout the study, therefore one can assume the original plan was followed through the majority of the study. The researcher has not mentioned how the data was recorded; this could have a detrimental effect on the results, because if they are noted from the researchers memory, mistakes could be made. Grounded theory usually records data u sing audio and video tapes, allowing the researcher to carefully examine responses given (Schreiber Stern, 2001). At no stage in the article does the researcher comment on their own role and any bias they may cause in the study. Researchers are said to be bias when they do not take an objective approach to research (Powers Knapp, 2006). From the article itself one can see that the research team consists of 1 Ambulance service employee, 1 trauma team member and 4 people from the research centre of excellence, suggesting there is minimal bias from researchers, but this is not documented. One may say bias was reduced as the participants were not given MIST until after they had been asked some of the questions; therefore it had no influence on previous responses. There is no research question used in this study, but there are four clear aims that were derived from the extensive background and initial research. Ethical issues have been considered by the research team as the study was approved by an ethics committee, but there is no justification of ethical issues taken into consideration concerning the participants. Although there are no ethical issues relating to the welfare of the participants, the researchers do not explain confidentiality and informed consent. One can presume that informed consent was gained from each respondent as they volunteered for the research. Informed consent requires the participants to have adequate information regarding the research (Surrena,2011). During this study, the data was sufficiently analysed, using thematic analysis. Thematic analysis uses coding to identify the recurrent or main themes in research results. It is most often used in qualitative research as it emphasises recurrent ideas and feelings (Mays, Popay Pope, 2007). By using a coding programme to categorise responses from participants, the researchers were able to find recurrent themes and were capable of placing responses into three nodes that were directed by the initial aims. This was independently checked for consistency and in some cases a third researcher was used to decipher any discrepancies, again reducing bias. In the main text, the researcher does not mention the use of thematic analysis, only the coding process, although it is mentioned in the abstract; one can assume this method was used throughout. It is not explained why the responses shown in the article were chosen to be published, but there is a descriptive table shown that entails several re sponses. It is exceedingly supportive to the results given, as it concurs with the results and highlights how the paramedics and trauma team share equivalent experiences with trauma handovers. The data analysis materialized no contradictory responses; there was a general consensus between all participants, emphasizing the need for further research and handover training and frameworks. There is a clear consensus that countless handovers are ineffective and several participants agreed on reasons for this. This was evidently stated by the researcher, along with the need for paramedics to obtain training in effective, concise handovers. There is no evidence for argument as all participants agreed that handovers needed to be enhanced in order to improve patient outcome and quick treatment. The researchers were not trying to settle argument, merely emphasise the experiences of professionals in the emergency setting. The researcher considers triangulation, but declares it should be used with caution in other hospitals, not mentioning the studys use in other ambulance services. Triangulation refers to approaching data from various perspectives (Flick, Kardorff Steinke, 2004).The discussion is flawlessly set out as the aims the researcher set out to justify. This makes it easier to alternate between the method, results and discussion with ease. The researcher discusses how the study can be the basis to further development with trauma handovers and illuminates the need for further research and application. It does mention the need for further paramedic training, but as a lone piece of research, it is unable to act upon this. The research has not highlighted any new areas that need investigation or further research, but has merely emphasised the awareness of poor trauma handovers. There is also no mention of transferability in this study, other than using it cautiously in other hospitals. Transferability refers to the probability that the study has meaning or use in other situations (Surrena, H 2011). In addition, there is a short time period between the article being written and it being published; meaning the information in this study is relevant and up to date. In conclusion, this research study is well designed with meaningful and useful results. The aims and background information are impeccable, giving the researcher ample reasons to conduct the study. The results are well analysed and supported by the discussion. The only downfall to this article is the minimal justification of choices made throughout the study. There are various limitations, that the researchers have identified themselves, allowing further researchers to replicate the study, modifying the limitations noted in this article. Due to the researcher identifying the need for further research, the reader may not consider changing their current practice based on this article alone. However it would be exceptionally useful in further research.

Gifted Children †Blessing or Curse? Essay -- Exploratory Essays Resea

Largely ignored by the social sciences, the study of gifted students is of utmost importance. Though there are varying degrees of giftedness, it is widely recognized that those with intelligence quotients of over 130 are "gifted", as these IQ’s place them in the top five percent of the population. Gifted children have an insatiable desire to learn, to explore. They learn with very little help from adults. They are also marked by their persistence, energy, and obsessive interests. Most of them can read by age four, some even earlier, for gifted children are endowed with prodigious memories for verbal and mathematical information. They not only excel at logical and abstract reasoning; they are also interested in philosophical issues. Blessed with some many positive qualities, gifted children are often overlooked even when they’re plagued by problems. As gifted children represent only a small percentage of the student population, the public neglects many of their needs. Faced with pressures from their families, schools, peers, and themselves, gifted students become socially challenged. Thus, it is necessary for society to learn more about the stresses endured by gifted students, so that someday many of these problems can be eliminated. The independent variables include pressures from family, school, and peers. The dependent variables are the socially challenged gifted children. The intervening variables include family support, the economic status of the family, the skills of the teachers, the student’s learning style, the age of the gifted children and their peers, and the motivational level of the gifted student. Primary research was conducted through two interviews and 50 surveys. A teacher of gifted student was interviewe... ...y Relationships and the Gifted.Washington, DC. Available http://www.nagc.org/CounGuide/family.html 1998 Orange, Carolyn. "Gifted students and perfectionism." Roeper Review 20, 1 (Sept-Oct 1997) Silverman, Linda Krega."How Parents Can Support Gifted Children." ERIC Digests 16 Apr 2000 Silverman, Linda Krega. "Through the lens of giftedness" Roeper Review 20, 3 (Feb 1998) Tolan, Stephanie S. "The Lemming Condition" Roeper Review 20, 3 (Feb 1998) Webb, James T. "Nurturing Social Emtional Development of Gifted Children" ERIC Clearinghouse on Disabilities and Gifted Education Reston, VA. Available http://www.ed.gov/databases/ERIC_Disgests/ed372554.html June 1994 Weber, Patricia. "Mental Models and the Identification of Young Gifted Students: A Tale of Two Boys" Roeper Review 32, 3 (Feb 1999) Winner, Ellen. Gifted Children New York: Basic Books, 1996.

Nazi Use of Darwinism Essay -- History, Politics, The Treaty of Versa

After the Great War in the nineteenth century, European nations had a difficult time finding economic stability. Germany took full responsibility for starting World War I and by signing the Treaty of Versailles, Germany agreed to give up huge portions of territory and pay reparation to victorious allies. The harsh principles which were outlined by the Treaty of Versailles made economic stability in Germany difficult to achieve and caused Germany to suffer from inflation and the Great Depression. Unemployment and the fear of communism allowed Adolf Hitler to rise to power in 1933. Before Hitler came to power, he spent nine months in jail where he wrote his autobiography Mein Kampf (My Struggle), where he mentions how Darwin’s theory of evolution was the only basis for a successful Germany. He sets forth a number of evolutionary ideas such as; struggle, survival of the fittest, and extermination of the weak to create a better society (Bergman.) Unable to accept Germanys defeat i n the Great War, Adolf Hitler convinced the German people they had been defeated from within-or stabbed in the back by Communist, Socialists, liberals, and the Jews. These â€Å"races† became scapegoats in Germany, and that is how they were constructed as the â€Å"inferior race.† These groups of people, especially the Jews, were not even considered human. With the belief of an inferior race, came the belief of a superior race, which were the self-proclaimed Germans. Concentration camps were created in Germany to separate the inferior race, or the non-Germans from the Germans. It was believed that the inferior race was contaminating the German gene pool. Social Darwinism is a term used to describe ideologies which compare Darwin’s ideas of evolution to social scienc... ...lf was an atheist, although Bergman cannot speak for a group of people who believed what Hitler said to be true. If Hitler was an atheist it further validates the point I am trying to make, Hitler indeed used Darwin’s ideas to justify his actions along with creationist ideas. Bergman unable to acknowledge the fact Hitler used manipulation and propaganda to encourage Nazism, was quick to attack the ideas of evolution. Now I shall ask, is it fair to say Hitler was a creationists because he used god in his speech, thus creationism is equivalent to Nazism? Better yet, if the Nazis did not believe in a god, would the holocaust have occurred? Now, do not be fooled by my last statement, I do not believe creationism is the cause of the holocaust. However, I am trying to prove that Bergman’s argument about Darwinism is just as foolish as my previous statement. Nazi Use of Darwinism Essay -- History, Politics, The Treaty of Versa After the Great War in the nineteenth century, European nations had a difficult time finding economic stability. Germany took full responsibility for starting World War I and by signing the Treaty of Versailles, Germany agreed to give up huge portions of territory and pay reparation to victorious allies. The harsh principles which were outlined by the Treaty of Versailles made economic stability in Germany difficult to achieve and caused Germany to suffer from inflation and the Great Depression. Unemployment and the fear of communism allowed Adolf Hitler to rise to power in 1933. Before Hitler came to power, he spent nine months in jail where he wrote his autobiography Mein Kampf (My Struggle), where he mentions how Darwin’s theory of evolution was the only basis for a successful Germany. He sets forth a number of evolutionary ideas such as; struggle, survival of the fittest, and extermination of the weak to create a better society (Bergman.) Unable to accept Germanys defeat i n the Great War, Adolf Hitler convinced the German people they had been defeated from within-or stabbed in the back by Communist, Socialists, liberals, and the Jews. These â€Å"races† became scapegoats in Germany, and that is how they were constructed as the â€Å"inferior race.† These groups of people, especially the Jews, were not even considered human. With the belief of an inferior race, came the belief of a superior race, which were the self-proclaimed Germans. Concentration camps were created in Germany to separate the inferior race, or the non-Germans from the Germans. It was believed that the inferior race was contaminating the German gene pool. Social Darwinism is a term used to describe ideologies which compare Darwin’s ideas of evolution to social scienc... ...lf was an atheist, although Bergman cannot speak for a group of people who believed what Hitler said to be true. If Hitler was an atheist it further validates the point I am trying to make, Hitler indeed used Darwin’s ideas to justify his actions along with creationist ideas. Bergman unable to acknowledge the fact Hitler used manipulation and propaganda to encourage Nazism, was quick to attack the ideas of evolution. Now I shall ask, is it fair to say Hitler was a creationists because he used god in his speech, thus creationism is equivalent to Nazism? Better yet, if the Nazis did not believe in a god, would the holocaust have occurred? Now, do not be fooled by my last statement, I do not believe creationism is the cause of the holocaust. However, I am trying to prove that Bergman’s argument about Darwinism is just as foolish as my previous statement.

DISCUSS HOW FAR JOHN PROCTOR, ELIZABETH PROCTOR AND REVEREND HALE CAN :: English Literature

DISCUSS HOW FAR JOHN PROCTOR, ELIZABETH PROCTOR AND REVEREND HALE CAN BE SAID TO REMAIN TRUE TO HIS OR HER BELIEFS The Crucible is a container that resists hear or the hollow at the bottom of an ore furnace. However its connotations include melting pot, in the symbolic sense, and the bearing of a cross. Elizabeth, John Proctor's wife; a cold, childless woman who is an upright character who cannot forgive her husband's adultery until just before he died: she is accused of being a witch. Reverend Hale, a self-proclaimed expert on witchcraft; at the play's end tries to save the accused. John Proctor, a good man with human failures and a hidden secret, a affair with Abigail, he is often the voice of reason in the play; accused of witchcraft. "I do not judge you. The magistrate that sits in your heart judges you." This is where Elizabeth suspects that John has committed adultery, but knows how good of man he is and tries to look over it. "Adultery, John." This is where John tells her and she makes it sound like it is news to her even though she has known for a while. She is trying to have John have a "good" name and not be a name that everyone discards. "No, sir." Here she is protecting his name but she doesn't know that John has just come out and said that he committed lechery. She thought that she was saving him but she was actually making it worse for him. "I mean to crush him utterly if he has shown his face." Here he is talking about if he ever encountered the Devil that he would literally kick his ass. This shows how he is a hipper rite against being a Puritan. Even though he is a religious man he still has the human character of having an evil side to himself. "But I will cut off my hand before I ever reach for you again." John is talking to Abigail and how he is finished with seeing her and that he doesn't want any part of her. John goes through from being amoral to immoral and then to moral, then back to amoral at the end. "It's winter in here yet." Elizabeth and John were talking about how he was working all day seeding even though he was at Salem to see what the fuss was all about. Here he shows his character toward Elizabeth by lying to her and she can't trust him. "Let Rebecca go like a saint, for me it is a fraud." This shows how he changes and starts to take

Otitis

Otitis is a general term for inflammation or infection of the ear, in both humans and other animals. It is subdivided into the following: Otitis externa, external otitis, or â€Å"swimmer's ear† involves the outer ear and ear canal. In external otitis, the ear hurts when touched or pulled. Otitis media or middle ear infection involves the middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space. This very common childhood infection sometimes requires a surgical procedure called â€Å"myringotomy and tube insertion†.Otitis interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, vertigo is a common symptom. An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that contains the tiny vibrating bones of the ear. C hildren are more likely than adults to get ear infections. Ear infections are often painful because of inflammation and buildup of fluids in the middle ear.Because ear infections often clear up on their own, treatment often begins with managing pain and monitoring the problem. Ear infection in infants and severe cases in general require antibiotic medications. Long-term problems related to ear infections — persistent fluids in the middle ear, persistent infections or frequent infections — can cause hearing problems and other serious complications. The onset of signs and symptoms of ear infection is usually rapid. Children Signs and symptoms common in children include: Ear pain, especially when lying down Tugging or pulling at an ear Difficulty sleepingCrying more than usual Acting more irritable than usual Difficulty hearing or responding to sounds Loss of balance Headache Fever of 100 F (38 C) or higher Drainage of fluid from the ear Loss of appetite Vomiting Diarrhea Adults Common signs and symptoms in adults include: Ear pain Drainage of fluid from the ear Diminished hearing Sore throat When to see a doctor Signs and symptoms of an ear infection can indicate a number of different conditions. It's important to get an accurate diagnosis and prompt treatment. Call your child's doctor if: Symptoms last for more than a day Ear pain is severeYour infant or toddler is sleepless or irritable after a cold or other upper respiratory infection You observe a discharge of fluid, pus or bloody discharge from the ear An adult with ear pain or discharge should see a doctor as soon as possible. An ear infection is caused by a bacterium or virus in the middle ear. This infection often results from another illness — cold, flu or allergy — that causes congestion and swelling of the nasal passages, throat and eustachian tubes. Role of eustachian tubes The eustachian tubes are a pair of narrow tubes than run from each middle ear to high in the back of the throat, behind the nasal passages.The throat end of the tubes open and close to: Regulate air pressure in the middle ear Refresh air in the ear Drain normal secretions from the middle ear Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block them, causing the accumulation of fluids in the middle ear. A bacterial or viral infection of this fluid is usually what produces the symptoms of an ear infection. Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.Role of adenoids Adenoids are two small pads of tissues high in the back of the throat believed to play a role in immune system activity. This function may make them particularly vulnerable to infection and inflammation. Because adenoids are located near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have more active and relatively larger adenoids. Related conditionsConditions of the middle ear that may be related to an ear infection or result in similar middle ear problems include the following: Otitis media with effusion is inflammation and fluid buildup (effusion) in the middle ear without bacterial or viral infection. This may occur because the fluid buildup persists even after an ear infection has resolved. It may also occur because of some dysfunction or noninfectious blockage of the eustachian tubes. Chronic suppurative otitis media is a persistent ear infection that results in tearing or perforation of the eardrum. Risk factorsSymptoms Age. Children between the ages of 6 months and 2 years are more susceptible to ear infections because of the size and shape of the eustachian tubes and becaus e of their poorly developed immune systems. Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home, because they're exposed to more infections, such as the common cold. Infant feeding. Babies who drink from a bottle, especially while lying down, tend to have more ear infections than do babies who are breast-fed. Seasonal factors.Ear infections are most common during the fall and winter when colds and flu are prevalent. People with seasonal allergies may have a greater risk of ear infections during seasonal high pollen counts. Poor air quality. Exposure to tobacco smoke or high levels of air pollution can increase the risk of ear infection. Family history. A child's risk of ear infections increases if another member of the family has had ear infections. Ethnicity. American Indians and Inuits of Alaska and Canada have an increased risk of ear infections Tests and diagnosis By Mayo Clinic staffYour doctor c an usually diagnose an ear infection or another condition based on the symptoms you describe and a relatively simple office exam. The doctor will likely use a lighted instrument to look at the ears, throat and nasal passage. He or she will also listen to your child breathe with a stethoscope. Pneumatic otoscope An instrument called a pneumatic otoscope is often the only specialized tool that a doctor needs to make a diagnosis of an ear infection. This instrument enables the doctor to look in the ear and judge how much fluid may be behind the eardrum.With the pneumatic otoscope, the doctor gently puffs air against the eardrum. Normally, this puff of air would cause the eardrum to move. If the middle ear is filled with fluid, your doctor will observe little to no movement of the eardrum. Additional tests Your doctor may perform other diagnostic tests if there is any doubt about a diagnosis, if the condition hasn't responded to previous treatments, or if there are other persistent or s erious problems. Tympanometry. This test measures the movement of the eardrum. The device, which seals off the ear canal, adjusts air pressure in the canal, thereby causing the eardrum to move.The device quantifies how well the eardrum moves and provides an indirect measure of pressure within the middle ear. Acoustic reflectometry. This test measures how much sound emitted from a device is reflected back from the eardrum — an indirect measure of fluids in the middle ear. Normally, the eardrum absorbs most of the sound. However, the more pressure there is from fluid in the middle ear, the more sound the eardrum will reflect. Tympanocentesis. Rarely, a doctor may use a tiny tube that pierces the eardrum to drain fluid from the middle ear — a procedure called tympanocentesis.Tests to determine the infectious agent in the fluid may be beneficial if an infection hasn't responded well to previous treatments. Other tests. If your child has had persistent ear infections or per sistent fluid buildup in the middle ear, your doctor may refer you to a hearing specialist (audiologist), speech therapist or developmental therapist for tests of hearing, speech skills, language comprehension or developmental abilities. What a diagnosis means Acute otitis media. The diagnosis of â€Å"ear infection† is generally shorthand for acute otitis media.Your doctor likely makes this diagnosis if he or she observes signs of fluid in the middle ear, if there are signs or symptoms of an infection, and if the onset of symptoms was relatively sudden. Otitis media with effusion. If the diagnosis is otitis media with effusion, the doctor has found evidence of fluid in the middle ear, but there are presently no signs or symptoms of infection. Chronic suppurative otitis media. If the doctor makes a diagnosis of chronic suppurative otitis media, he or she has found that a persistent ear infection has resulted in tearing or perforation of the eardrum.Treatments and drugs By May o Clinic staff Most ear infections don't need treatment with antibiotics. What's best for your child depends on many factors, including your child's age and the severity of symptoms. A wait-and-see approach Symptoms of ear infections usually improve with the first couple of days, and most infections clear up on their own within one to two weeks without any treatment. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 48 to 72 hours for anyone who is otherwise healthy and who is:Six months to 2 years of age with mild symptoms and an uncertain diagnosis More than 2 years old with mild symptoms or an uncertain diagnosis Treating pain Your doctor will advise you on treatments to lessen pain from an ear infection. These may include the following: A warm compress. Placing a warm, moist washcloth over the affected ear may lessen pain. Pain medication. Your doctor may advise the use of over-the-counter acetaminoph en (Tylenol, others) or ibuprofen (Motrin, Advil, others) to relieve pain. Use the drugs as directed on the label.Because aspirin has been linked with Reye's syndrome, use caution when giving aspirin to children or teenagers. Although aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns. Eardrops. Prescription eardrops such as antipyrine-benzocaine (Aurodex) may provide additional pain relief. To administer drops to your child, warm the bottle by placing it in warm water. Put the recommended dose in your child's ear while he or she lies on a flat surface with the infected ear facing up.Benzocaine has been linked to a rare but serious, sometimes deadly, condition that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, as this age gro up has been the most affected. If you're an adult, never use more than the recommended dose of benzocaine and consider talking with your doctor. Antibiotic therapy Your doctor may recommend antibiotic treatment for an ear infection in the following situations:Children under 6 months old with a probable diagnosis of ear infection Children 6 months to 2 years old with a certain diagnosis of ear infection Anyone with a probable ear infection and moderate to severe ear pain Anyone with a probable ear infection and a fever over 102. 2 F (39 C) or higher Even after symptoms have improved, be sure to use all of the antibiotic pills as directed. Failing to do so can result in recurring infection and resistance of bacteria to antibiotic medications. Talk to your doctor or pharmacist about what to do if you accidentally skip a dose. Ear tubesIf your child has otitis media with effusion — persistent fluid buildup in the ear after an infection has cleared up or in the absence of any infe ction — your doctor may recommend a procedure to drain fluid from the middle ear. During an outpatient surgical procedure called a myringotomy, a surgeon creates a tiny hole in the eardrum that enables him or her to suction fluids out of the middle ear. A tiny tube is placed in the opening to help ventilate the middle ear and prevent the accumulation of more fluids. Some tubes are intended to stay in place for six months to a year and then fall out on their own.Other tubes are designed to stay in longer and may need to be surgically removed. The eardrum closes up again after the tube falls out or is removed. Treatment for chronic suppurative otitis media Chronic infection that results in perforation of the eardrum — chronic suppurative otitis media — is difficult to treat. It's often treated with antibiotics administered as drops. You'll receive instructions on how to suction fluids out through the ear canal before administering drops. Monitoring Children with f requent or persistent infections or with persistent fluid in the middle ear will need to be monitored closely.Talk to your doctor about how often you should schedule follow-up appointments. Your doctor may recommend regular hearing and language tests. Prevention Tests and diagnosis Prevention By Mayo Clinic staff The following tips may reduce the risk of developing ear infections: Prevent common colds and other illnesses. Teach your child to wash his or her hands frequently and thoroughly, and teach your child not to share eating and drinking utensils. If possible, limit the time your child spends in group child care. A child care setting with fewer children may help. Avoid secondhand smoke.Make sure that no one smokes in your home. Away from home, stay in smoke-free environments. Breast-feed your baby. If possible, breast-feed your baby for at least six months. Breast milk contains antibodies that may offer protection from ear infections. If you bottle-feed, hold your baby in an up right position. Avoid propping a bottle in your baby's mouth while he or she is lying down. Talk to your doctor about vaccinations. Ask your doctor about what vaccinations are appropriate for your child. Seasonal flu shots and pneumococcal vaccines may help prevent ear infections.

Accountability Memo

MEMORANDUM Subject: Increasing of public scrutiny on not-for-profit reporting requirements The purpose of this memo is to explain why increasing scrutiny and demand for accountability by the public has influenced reporting for not-for-profit and governmental entities. State and federal regulators are reviewing, audit reports of agencies like ours that receive federal grants and loan monies. Their purpose is to â€Å"ensure that independent audit firms are in compliance with Generally Accepted Audit Standards (GAAS) and recently added requirements under Generally Accepted Government Auditing Standards (GAGAS) or yellow book standards†.The reporting requirements that the auditor's require to be able to prepare a statement of understanding of internal control structure is of particular interest. Because we are a not-for-profit company, the auditors have to report what certain members have the clearance to report cash donations and make deposits directly to the companies bank acco unt. The auditors also need to evaluate the internal controls we have in place to prevent theft, and report the strengths and weaknesses of our system. As a result, we need to provide the auditors with access to our computer transactions for all finance members.Your cooperation is greatly appreciated in this matter and being in compliance will the auditors will help protect our interest in continuing to receive federal monies as part of our operating budget. Sincerely, References: Williams , J L (Summer 1992 . New audit standards for audits of entities receiving federal financial help . Outlook , 60 , n2 .. 51 (1 . Retrieved August 5, 2012 General One via Gale : HYPERLINK http /find . galegroup . com /ips /start . do ? prodId IPS http /find . galegroup . com /ips /start . do ? prodId IPS Steinberg , R M Johnson , R N (August 1991 . Implementing SAS no . 55