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for Critical Analysis of the Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients Study

1. MAARIE Questions for Week 2 Assignment: This document contains the questions you will be answering for this week’s assignment, as well as instructions for how to complete it. MAARIE Questions for Week 2 Assignment.docx 2-4: These documents are supplements to the study we are looking at this week. Sometimes the supplemental content will be where you find the answers (or parts of answers) to some MAARIE questions. NOTE: You still need to follow the instructions located in the Week Two assignment document to find the STUDY. These items are just supplements to the study. Disclosures Nonsedation or light sedation study.pdf Study Protocol Nonsedation or light sedation.pdf Supplementary Appendix Nonsedation or light sedation study.pdf Page 1 of 2 WEEK TWO HOMEWORK: MAARIE Questions for Critical Analysis of the Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients StudyNOTE: Make sure you are analyzing the Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients StudyInstructions:1. Open this document and save a copy to your computer or flash drive. 2. Next, enter your answers to the questions as you analyze the study.3. Save the document with your answers.4. Look for the submission link titled “Use this link to Submit Your Answers for your analysis of the Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients” study on Blackboard and cut and paste your answers to the selected questions from your homework document into the “quiz”.Method- The purpose and population for the investigation1. Evaluate for conflict of interest. Who conducted the study? A group of researchers based at a reputable university or research institution, or an individual without clear affiliations? Be particularly cautious about accepting claims about treatment effectiveness in articles by people who intend to sell the treatment. Who funded the study? If a researcher received funding from an independent granting agency that uses a peer-review process for evaluating and awarding funds, the findings might be more credible and less subject to bias than if the funding agency has a vested interest in the results. If a commercial entity sponsors a study, this should be disclosed. But although sponsorship may influence the authors’ conclusions in some instances, this is not always the case. There are many research partnerships among industry, university-based researchers, and institutes, so this can be a difficult issue to assess. Make sure you include an answer to the question and your evidence for that answer; for example “I believe a conflict of interest may exist because . . .” or “I believe a COI is unlikely because . . .”2. Study hypothesis What is the study question being investigated? 3. Study population What specific population is being investigated? What are the inclusion and exclusion criteria for the subjects of the investigation? Some of this information may be in the supplementary material. 4. Sample size and statistical powerHow many individuals are included in the study and the control group(s)? What is the stated study power? Are the participant numbers adequate to sufficiently power the study? Your answer should include a statement about the study being powered sufficiently or not and your evidence. Assignment- Selection of participants for the study and control groups5. ProcessWhat specific method(s) is/are used to randomize participants to study and control groups (computer generated in 1 to 1 allocation or were blocks used, etc.? Are the numbers of participants in the treatment and groups similar? 6. Confounding variablesLook at the baseline characteristics, are there differences between the baseline characteristics for study and control groups that may affect the outcome of the investigation? Offer of at least one confounding variable that the authors hadn’t included in the baseline characteristics or the inclusion and exclusion criteria that might affect the measured outcome(s)? 7. Masking or blindingAre the participants and the investigators aware of the participants’ assignment to a particular study or control group? If patients are not aware but investigators were the study is single blind. If the patients and the researchers don’t know, then the study is double-blinded. If an independent/impartial group was used to evaluate the data and this group didn’t know about the participant’s assignment then report this information. Assessment-Measurement of outcomes or endpoints in the study and control groups8. AppropriateWhat primary (and secondary) outcomes did the authors choose to measure. Are the outcomes selected appropriate when you consider the hypothesis for the study? 9. Accurate and preciseHow will the outcomes (primary and secondary) that were selected be accurately and precisely measured? Remember to answer the question as well as provide your evidence of this. 10. Complete and unaffected by observationIs the follow-up of participants nearly 100% complete (did the same number of participants who started the study end the study—or did the authors tell you what happened to them) and is it affected by the participants’ or the investigators’ knowledge of the study or control group assignment?

Radiation Protection in Dentistry

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Radiation protection in dentistry-do we practice what we learn? Abstract. Aim: Easy availability, overuse and lack of reinforcement of the radiation hazards facts have unknowingly resulted in overlooking of ALARA among many dentists . The aim of the present study was to assess the awareness, concern and practice of radiation protection in general dental practice. Materials and methods:The study was conducted among 156 private dental practitioners in West Bengal India. A cross-sectional self-administered questionnaire consisting of a total of 28 items was employed. The obtained data was compiled systemically and was analyzed by using SPSS 17. Results: Bisecting angle technique and use of E speed films with manual processing was the most common. Majority of the participants had no idea about the type of cone used (37.2% ), tube current (37.8%), kvp56.4% (88). Exposure time was equally variable with maximum variability in case of digital radiographs. Use of lead barriers and aprons were poor . Conclusion :The knowledge and practice of radiation protection is not satisfactory. Repeated reinforcement and training and the most importantly change in attitude to follow ALARA is required. key words: Radiation, questionnaire survey, safety measures, dentists Introduction: X-ray is invisible but its effects are not. Radiological investigations are first modality of diagnosis in most oral and maxillofacial disorders nevertheless its detrimental effects cannot be ignored. Easy availability, overuse without proper knowledge and lack of reinforcement of the radiation hazards facts have unknowingly resulted in overlooking of ALARA principles in many cases. [1, 2 ] The aim of the present study was to assess the awareness, concern and practice of radiation protection in general dental practice in the state of west Bengal in India. Materials and methods: The present study was conducted among private dental practitioners in west Bengal India. Ethical clearance was obtained from the Institutional Review Board, Haldia College of Dental Sciences, Haldia. The investigators visited 250 private dental practices in west Bengal, India but only 156 dentists were part of the study, all of those who had a radiographic machine were included in the study. The purpose of the study was explained to the dental practitioners and their consent was subsequently obtained. A cross-sectional self-administered questionnaire consisting of a total of 28 items was employed in the present study. Information pertaining to demographic data such as age, gender, educational qualification, and type and duration of practice was also collected. The obtained data was compiled systemically and was analyzed by using SPSS (statistical package for social sciences) Chicago III software version 17. Mean was calculated for demographic variables. For all variables frequency and percentage were calculated. The significance of difference between two independent groups was determined using Chi-squared test. Level of significance was set at 0.05. Results Questionnaires were distributed to 250 dentists but only 156(62.4%) were considered as study subject as they possessed radiographic unit. Of 156 dentists134 were male and 22 female dentists. 75.6% (118) were university graduates (BDS) and 24.4% (38) were post graduates (MDS) involved in general practice. 34.6% (54) had 25yrs of experience. (Fig-1) 61.5 %( 96) had either intraoral x-ray unit or extra oral unit or both. Majority of the dentists 85.3% advised for radiographs only after clinical examinations. IOPAR was a common radiograph advised (44.2 % advised at least 30-49 iopar /week) followed by opg ( 39.7% advised for at least 1opg/week. Bitewing /occlusal were not very commonly advised. Majority of the participants had no idea about the type of cone used (37.2% i.e. 58), tube current (37.8% (59). 56.4% (88) dentists said that kvp of dental x-ray machine should be within60-80kvp and 50% used cylindrical collimation. Though about half of them kept the exposure time 0.5sec to 0.8secs about 20% used a longer exposure 1.2 secs. 62.2 % (97) of the respondents used films, mostly E speed films. Among 8.9 %( 14) who used digital sensors 50% had no idea about the type used. In case of extraoral radiography 60.3% had no idea of the type of receptor being used. 49.4%(77) preferred bisecting angle technique, only a mere 3.2% used film holders, 55%(86)used patients finger, 7.8% assistant used to hold film and remaining 34% of the dentist used to hold the film themselves. 87.3% used manual processing or both, only 3.8% automatic processing rest used digital imaging. 35.9% changed processing solutions every week. A shocking fact was noticed that 83.3% of those using manual processing threw the processing solutions in sewage drains and lead foils in dustbins. Around 40.3 %( 63) of the responders did not stand behind any barriers during exposure. Many of the dentists were completely unaware of the position distance rule to be followed in case of lack of barrier. Only 59%of the responders knew correctly where to stand during exposure (>6ft), 10.9% had no idea while 30.1% answered it wrongly. Similarly 45.7% did not know the correct angulations to stand. 46.2% (72) of the dentists never made their patients wear lead apron 60.9% (95) did not use thyroid collar, 42.3% (66) of the dentists never wore the lead apron during exposure. More than half 51.3% (80) did not have any idea of the correct thickness of lead apron. 93.6% (146) did not have any form of dose monitoring and 45.5% (71) did not know of radiographic machine periodic calibration. Awareness of radiation protection and pregnancy was good. 51.3% (80) said x-ray should only be done in emergency, 57% (89) considered 2nd trimester to be safest for radiographs but 16.7 %( 26) considered it can be done in any trimester. Discussion The respondents’ knowledge concerning the technical details of their equipment was limited, with 82.3% not being aware about the kilovoltage peak of their machine. With respect to radiation protection of the patients, a radiographic unit with a voltage capacity between 60Kvp to 70Kvp is recommended.[3] Up to 10.8% dentists were not aware about the speed of film. 94.1% dentists preferred technique was bisecting angle technique for periapical radiography, silmilar to study by Sheikh et al.[4] Higher qualifications (MDS) showed a significant difference only in the type of radiographic machine (p=0.026), number of radiographs taken(p=0.049) and preferred periapical technique )p=0.037).this was in contrast to the findings by other studies [5] where MDS had a better attitude score probably due to better exposure to relevant scientific literature and continuing dental education programs. This indicates that the prevailing attitude towards radiation protection is very casual in west Bengal dentists. Use of rectangular collimator reduces the dose about 5 times in comparison to circular cone.[6] In our study only 27% of the dentists used rectangular collimator, the results were slightly higher than other studies Math et al(7%),[6] Belgium (6%), [7] Turkey5.5%. [3] About 50% of the study population thought 0.5-0.8 sec as the ideal exposure time. But with increased use of handheld portable x-ray devices with lesser kvp (most uses 60kvp) the duration of exposure used is often longer.[8 ] In good agreement with another study [6] 62.2 % of the dentists used E speed films. Interestingly survey showed 5.1% used self processing films. Since self processing films are not commonly available in West Bengal does it reflect social desirability bias? Only 8.9 %( 14) used digital radiography which is less than the results of Ilguy et al,[3] Kaviani et al[9]. Dentist should be encouraged to use faster films and digital radiography as it requires only half the exposure of E speed films.[6] Only a mere 3.2% used film holders, in others patient, dentist or assistant used to hold the film. Use of bisecting angle technique is more common than paralleling in consistent with results of other studies. [3, 6, 7 ]Another interesting finding was that those using digital sensors rarely used a film holder. This is completely paradoxical practice. Use of paralleling cone technique along with film holder reduces unnecessary exposures- ALARA[6] is followed. 87.3% used manual processing or both, only 3.8% automatic processing rest used digital imaging. Results are in good agreement with Math et al[6] (92%), Ilguy et al [3](85%). 83.3% of those using manual processing threw the processing solutions in sewage drains and lead foils in dustbins indicating that the set guidelines of biomedical waste management are equally not followed. Handheld portable x-ray devices are increasingly used for intraoral radiography. There are no set guidelines for duration of exposure, position -distance rule is not followed, radiation safety of operator is in question as the unit is hand held, set angulations for exposures intraoral periapical radiographs cannot be met especially for lowers as the x-ray unit is obstructed by the patients upper thorax and shoulders. The authors are in agreement Berkhout et al [10] for an international set guidelines for hand held digital x-ray. In contrast to the study Binnal A[5] where respondents with ›11 years of experience in practice had better radiation protection practices we found younger dentists had better radiation protection practice probably attributed to training in undergraduate course. Most dentists do not take radiographs irrespective of the necessity if the patient is pregnant due to the fear of exposure of radiation to fetus. However a study by Kusama et al[11] indicated that the fetus does not directly receive radiation doses during head and chest diagnostic exposures and that the absorbed dose was estimated at less than 0.01 mGy. Threshold radiation dose for pregnancy termination is only above 25 rads or 250 mGy.[12] Radiations threshold for the development of congenital defects during the most sensitive period is 0.2 Gy and the threshold for growth retardation and abortion is much higher.[12] The first semester is the most sensitive period during pregnancy[13] and exposure threshold for the development of definitive defects increases after main organogenesis period.[12] Nonetheless, no radiography procedure should be carried out on pregnant women unless there is an absolute necessity. When such procedures are undertaken, all the precautions should be exercised to minimize the radiation dose.[14] Dentists had an acceptable level of awareness (51.3%) regarding pregnancy and radiation exposure. Only 16.7% (27) considered diagnostic radiation can be done in any trimester (with all precautions), 57%considered 2nd trimester to be safest. Given that the practice of holding the film by fingers and use of portable dental unit were high around 40.3 %( 63) of the dentist did not stand behind any barriers during exposure rather stood beside the patient. Many of the dentists were completely unaware of the position distance rule to be followed in case of lack of barrier. Only 59%of the responders knew correct distance to stand during exposure (>6ft), similarly only 55.8% knew the correct angulation to stand to avoid being in direction of primary and secondary radiation. 93.6% did not have any dose monitoring and 45.5% did not know of radiographic machine periodic calibration. The negative response in this survey on dosimetry is far higher than that reported by math et al only 40%.[6] A large group of dentists never used lead apron and thyroid collars. This is irrespective of years of experience or qualification and gender which is unlike other studies.[6,7] This brings forward the gaping difference in clinical practice and theoretical knowledge imbibed in undergraduate courses. Perhaps the fact that there was no recognition of dento-maxillofacial radiology as a specialty in West Bengal until 2009 shows the poor level of response. The result of the study should alert the dental professional societies that more attention to be given to the negligent attitude towards dental radiology practice. There are few limitations of this study. Study sample was localized to particular region were there was no undergraduate radiation protection training. Questionnaires based studies are susceptible to acquiescence (yea-saying) bias, deviation (faking bad) bias, and social desirability (faking good) bias.[5] Conclusion At the age of CBCT we are still striving to follow minimal radiation protection measures. Government and dental authority should make it mandatory for all dentists to attend at regular intervals continuing dental education programs on basic imaging in dentistry and radiation protection. Set guidelines for hand held x-ray machine is must. Repeated reinforcement and training and the most significant factor- attitude in each dental professional to follow ALARA will certainly make a great difference in radiation protection for individual and the mass. Share this: Facebook Twitter Reddit LinkedIn WhatsApp

SPD200 GCU Classroom Management and the Inclusive Classroom

custom writing service SPD200 GCU Classroom Management and the Inclusive Classroom.

Disruptive behavior and misbehavior can occur in any classroom. While
it is important to identify these behaviors, it is even more important
to observe them and try to determine why the behavior happened in the
classroom. Teachers must be social detectives and observe behaviors to
determine why a behavior is occurring if they are to plan effective
interventions. If a teacher understands the needs of the student, the
effect of the environment on the student, and identifies patterns
(when the behaviors occur over time), it is easier to find ways to
provide support, reinforce other behaviors, redirect behavior, and
often even prevent a behavior from occurring in the future.Complete the “Classroom Management and the Inclusive Classroom
Matrix.” Include causes and strategies for addressing
misbehavior or disruptive behavior in the inclusive classroom.Support your findings with 2-3 scholarly resources.
SPD200 GCU Classroom Management and the Inclusive Classroom

Residential Proximity to Airports and Health Impacts Essay (Critical Writing)

Lin et al. (2008) sought to understand whether living close to airports raises the chances of being hospitalized from respiratory conditions as opposed to residing farther away. To realize this objective the authors conducted a cross-sectional study among residents who resided near “Rochester, LaGuardia and MacArthur” airports, all of which are in different cities in New York. The data comprised of hospital admissions of patients with respiratory conditions from the period between 1995 and 2000. The sample included children aged between 0-4 years among other members of the population. While the target population was to be located within 12 miles from the airports, the exposure to air pollutants was determined basing on whether individuals lived in areas within or beyond 5 miles. Moreover, Lin et al (2008) considered wind-flow patterns i.e. within or beyond 75 percentiles. The combined effect of wind-flow pattern and proximity to the airports was also determined. After calculating for hospital admission rates related to respiratory illnesses putting into consideration the exposure indicators for each airport, the authors found out that there were higher admission rates for residents who lived no more than 5 miles from all the airports as opposed to those who lived farther. The rates were highest for residents who lived near LaGuardia and least for residents who lived near MacArthur airport. The authors also noted that there was no positive relationship between hospital admissions from respiratory conditions and wind-flow patterns. Lin et al. (2008) therefore came into a conclusion that closeness to certain airports can lead to increased respiratory conditions and hospitalizations thereof. This is due to exposure to air pollutants such as nitrogen oxides and volatile organic compounds. The authors were cautious to advise that further research should be conducted to expound on factors leading to respiratory conditions related to proximity to airports since many factors contribute to this. Reference Lin, S. J., Munsie, J. P., Losavio-Herdt, M., Hwang, S. A. and Civerolo, K. et al., (2008). Residential proximity to large airports and potential health impacts in New York State. International Archives of Occupational and Environmental Health, 81:797–804.

CJUS 620 LU Human Trafficking and Prostitution Spreading Awareness Discussion

CJUS 620 LU Human Trafficking and Prostitution Spreading Awareness Discussion.

PLEASE RESPOND TO EACH DISCUSSION QUESTION WITH 250 WORDS AS WELL AS A REFERNCE: RESPOND AS IF HAVING A CONVERSATION WITH THE WRITER OF THE POST!!!!1)The crime of human trafficking can happen anywhere. Therefore, officers must be aware of the signs and evidence that indicate that trafficking may be occurring in their communities.Human trafficking, at its most basic level, is defined by the Trafficking Victims Protection Act of 2000 as (a) the recruitment, harboring, transporting, supplying, or obtaining a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude or slavery; or (b) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform sex acts are under 18 years of age (Logan, Walker, & Hunt, 2009) Although most news accounts of human trafficking focus on the sex trade, the violence endured by the victims of human servitude, the powerful effects of psychological coercion play a key role in entrapment and continued enslavement (Mcdonald, 2014).In comparison to prostitution, human trafficking involves the use of force, fraud, or coercion for the purpose of involuntary servitude or sex trafficking. Trafficking, though variously defined, covers coercion, forced labor, and slavery. Prostitution describes the sale of sex, by no means necessarily without consent or with coercion (Butcher, 2003). One of the barriers to identifying victims of trafficking is the societal view of prostitution, and the view that prostitution is an occupation, and a choice, making it a victimless crime with no visible harm to any one person (Linebach, & Kovacsiss, 2016).Trafficking laws are among the most difficult laws to enforce. The difficulties vary by type of crime. For sexual exploitation, the victims are often viewed by police, prosecutors, judges, and juries not as legitimate victims but rather as criminals engaged in prostitution and of being illegally in the country. Prosecutors dread these cases because proof depends upon the testimony of a credible, convincing victim/witness, brave enough to testify and patient enough to wait months for a trial. But, sex trafficking victims/witnesses are rarely of that kind and often disappear and abandon the case. Prosecutors blame the failure of the public to report cases and the fact that the police had not identified any cases with clear evidence that victims had in fact been coerced, defrauded, or forced to do labor (Mcdonald, 2014). Mcdonald continues relating local police typically leave labor cases to the federal government because the cases tended to involve unauthorized migrants (2014).In May 2014, the U.S. Department of Homeland Security’s Blue Campaign, the department’s unified effort to combat human trafficking, released a new web-based training course for law enforcement that concentrates on signs and indicators of both labor trafficking and sex trafficking (Mcdonald, 2014) . The training focuses on how to detect human trafficking, how to begin an investigation and the unique dynamics of interviewing trafficking victims (Mcdonald, 2014).This distinction between human trafficking and prostitution is critical for the general public, law enforcement, and adjudicators to realize. Communities in general accept prostitution as just another criminal activity plaguing their streets. If communities were aware that labor trafficking was prolific in the United States, and that it involves the use of force, fraud, or coercion for the purpose of involuntary, modern-day slavery, there may be a larger focus to report, investigate, and prosecute cases of forced labor. We see on a regular basis, campaigns to reduce drug abuse and gun violence. Rarely are public service announcements directed at human trafficking and the 600,000 to 800,000 individuals trafficked internationally every year (Linebach, & Kovacsiss, 2016).Butcher, K. (2003). Confusion between prostitution and sex trafficking. The Lancet, 361(9373), 1983-1983. Linebach, J. & Kovacsiss, L. (2016). Psychology in the justice system. Scotts Valley, CA: CreateSpace Independent Publishing Platform.Logan, T. K., Walker, R., & Hunt, G. (2009). Understanding Human Trafficking in the United States. Trauma, Violence, & Abuse, 10(1), 3–30.Mcdonald, W. F. (2014). Explaining the under-performance of the anti-human-trafficking campaign: Experience from the united states and europe. Crime, Law and Social Change, 61(2), 125-138.2)Understanding and differentiating between members complicit with human trafficking and those forced into it for sex labor trade is extremely difficult. Many times, individuals being smuggled cooperate completely with smugglers in order to achieve entry into another country illegally (Linebach & Kovacsiss, 2016). It is not uncommon for those who are caught to claim they are taken against their will in an effort to have a suitable defense to protect themselves from being prosecuted. This becomes even more of a problem for local law enforcement, because they need to be able to effectively perform their jobs in the manner which best fits the situation. Another issue local enforcement faces with battling prostitution stems from the issue that the people driving the industry are out of reach of the local municipalities making it impossible for them to combat it effectively on their own. It requires a great deal of coordination with other agencies to stop the problem at it’s root. Otherwise local law enforcement agencies will just arrest the lower level prostitutes.There should definitely be a difference between prostitution and human trafficking. Anytime crimes are grouped together it can lead to convoluted outcomes which may benefit the true predators in these cases. Additionally, it is important to distinguish between those forced into prostitution/sex trafficking and those who are willing participants in human trafficking. I believe the general public would like to think they care about what is going on, but they probably do not see it clearly on a day-to-day basis. Most people care to the extent that they think it is bad, but they are not directly exposed to the reality of it and may not know the signs to report any suspicious activity to the proper authorities. I believe informing the public on the signs of human/sex trafficking and the types of occupations commonly associated with these illegal activities are the best ways to inform the public.The justice system can do a better job of communicating/coordinating with lower levels of government in an effort to identify and expose the networks in place which power the sex trafficking machine. These organizations are quite vast and stretch across the continents in an impressive manner. Making the connections and links will ultimately help reduce the number of overall victims of the trade. As for the current and future victims, ensuring mandated treatment and help for the victims during and after the legal process should be provided for the victims. Linebach and Kovacsiss state, “researchers have begun to investigate the adverse psychological effects of prostitution, as more and more evidence surfaces that prostitutes are presenting symptoms of severe psychological disorders, including PTSD and dissociative disorders” (p. 29). These are concerning leaving it vital to provide the help needed to those suffering as a result of the trade.ReferenceLinebach, J., & Kovacsiss, L. (2016). Psychology in the Justice System. Rome, GA: Floyd County Superior Court.
CJUS 620 LU Human Trafficking and Prostitution Spreading Awareness Discussion

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