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Testimonial and non-testimonial statements
Testimonial and non-testimonial statements: While the appellant did not attend the trial, she was able to transmit a photograph and some text, which in any case does not warrant to be used as evidence against the defendant. However, it was presented as evidence of the linkages between the appellant and her ex-husband. The scripture states that one person cannot be used as sufficient evidence to criminalize a person’s wrongdoing. Instead, Deuteronomy 19:15 asserts that at least two witnesses can provide sufficient evidence against a case in a court of law (Jonakait, 2005).
The defendant can dismiss the litigant’s claim asserting that presenting a photograph and text without affording him the opportunity to cross-examine the defendant violates his Sixth Amendment right to challenge the plaintiff as defined by the U.S. Supreme Court in Adrian Martell Davis v. Washington. In this circumstance, the court can dismiss the case arguing that the photograph and text cannot be used as testimony.
In short, the Confrontation Clause of the 6th Amendment does not approve non-testimonial statements and does not therefore qualify to be used as evidence at trial. The photograph and the text provided to 911 were intended to help the police determine an ongoing emergency, as opposed to being used as testimony to a past crime (Lininger, 2005).
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The bench can, therefore, uphold the view that under this backdrop, the content cannot act as testimony. While her not appearing at trial was warranted by the Sixth Amendment, the content was insufficient to prosecute the defendant because the motives may be crooked. The photograph and text were prohibited. The Adrian Martell Davis v. Washington altered hostility analysis. Its existing effect was immediate and substantial in the justice system on the evidence termed as irrelevant (Raeder, 2007).
Jonakait, R. N. (2005). ‘Witnesses’ in the Confrontation Clause: Crawford v. Washington, Noah Webster, and Compulsory Process. NYLS Legal Studies Research Paper, (05/06), 2.
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The process of preparing and performing speech
Share insights you gained from the process of preparing and performing speech. What do you think you did well? What area do you think you need to improve on?
The process of preparing and performing speech presents one with the opportunity to strengthen their interpersonal, group, public speaking and literacy ability. In this process, I gained various insights, for example, the importance of communication in my life. In addition, there is a relationship between daily communication and public speaking. Again, people take turns in public speaking and certain cases they are silent.
They do this throughout the day and learn nothing from it. During this process, I was the center of attention from friends, and this did not make me uneasy. On the stage, nonetheless, some individuals perceive that things are different. That is not the case. During long presentations for instance, there is need for the speaker to engage with the audience.
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Individuals can communicate their feedback while the speaker will negotiate his/her turn like in everyday conversation. The variance is how the speaker perceives the context. When it comes to doing what I did well, I was informed of the audience expectations, as such I was clear and eloquent in my speech. People believe that the degree of hope; precision or idealistic attributes recognized in an eloquent speaker are necessary but then concentrate on insufficiencies, fear and the likelihood of failing to fulfill requirements.
In bid to overlook such ideal, I was able to present the speech with a rational disposition effectively. The guidelines I use with ease in a dialogue daily are similar to a larger discussion in the perspective of public speaking. This standpoint provided an optional as I addressed my apprehension that assisted me to ignore optimistic expectations. By and large, I need to improve a few things such as understanding that public dialogue should not be a fright experience; rather it may be related to holding a friendly discussion. This is particularly true with a good preparation and organization of a presentation before time.
References
Wood, J. (2014). Communication Mosaics: An introduction to the field of communication. Cengage Learning.
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Merchandise Operations
Merchandise Operations: Inventory consists of finished goods, partially finished goods, and raw materials. A manufacturing firm might have raw materials and partially finished goods that require further processing while retail might have finished goods that are awaiting shipment at the end of the financial period. The method used for inventory costing directly affects the cost of good which affects the gross profit and net income.
The periodic inventory costing system uses the physical inventory counts the estimates for the cost of goods for closing inventory balance since it does not track inventory daily. Moreover, the perpetual inventory costing method updates each sale and purchase thereby continually updating the inventory and cost of goods balance. First-in-first-out, last-in-last-out, specific identification and weighed average costing are the most common valuation methods (Michael 2012). Costs of inventory include but not limited to shipping, acquisition, and direct costs.
During inflation, FIFO costing flow method is likely to give high ending inventory. If the inventory is high, the net income is also expected to be high. FIFO method uses the assumption that the first purchased inventory item becomes the first one to be used in production or sold (Chirantan 2016). Therefore, when there is inflation in the market, the cost of goods in the income statement consists of the less expensive items. However, the ending inventory includes the most expensive items. As a result, the amounts of ending inventory and net income are high.
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It is, therefore, impeccable that a company applies different inventory costing methods to counter inflation and deflation. Under LIFO method, ending inventory and net income is lower than under FIFO method. When weighted average costing method is used, inventory cost is high and net income is low during inflation (Michael 2016). Specific identification method provides net income that is dependent on acquisition costs of inventory. Therefore, FIFO is the only costing method that produces high inventory and high-income amounts during inflation.
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Inventory Costing
Inventory consists of finished goods, partially finished goods, and raw materials. A manufacturing firm might have raw materials and partially finished goods that require further processing while retail might have finished goods that are awaiting shipment at the end of the financial period. The method used for inventory costing directly affects the cost of good which affects the gross profit and net income.
The periodic inventory costing system uses the physical inventory counts the estimates for the cost of goods for closing inventory balance since it does not track inventory daily. Moreover, the perpetual inventory costing method updates each sale and purchase thereby continually updating the inventory and cost of goods balance. First-in-first-out, last-in-last-out, specific identification and weighed average costing are the most common valuation methods (Michael 2012). Costs of inventory include but not limited to shipping, acquisition, and direct costs.
During inflation, FIFO costing flow method is likely to give high ending inventory. If the inventory is high, the net income is also expected to be high. FIFO method uses the assumption that the first purchased inventory item becomes the first one to be used in production or sold (Chirantan 2016). Therefore, when there is inflation in the market, the cost of goods in the income statement consists of the less expensive items. However, the ending inventory includes the most expensive items. As a result, the amounts of ending inventory and net income are high.
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It is, therefore, impeccable that a company applies different inventory costing methods to counter inflation and deflation. Under LIFO method, ending inventory and net income is lower than under FIFO method. When weighted average costing method is used, inventory cost is high and net income is low during inflation (Michael 2016). Specific identification method provides net income that is dependent on acquisition costs of inventory. Therefore, FIFO is the only costing method that produces high inventory and high-income amounts during inflation.
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FIFO, First-in-first-out Costing Method
Inventory consists of finished goods, partially finished goods, and raw materials. A manufacturing firm might have raw materials and partially finished goods that require further processing while retail might have finished goods that are awaiting shipment at the end of the financial period. The method used for inventory costing directly affects the cost of good which affects the gross profit and net income.
The periodic inventory costing system uses the physical inventory counts the estimates for the cost of goods for closing inventory balance since it does not track inventory daily. Moreover, the perpetual inventory costing method updates each sale and purchase thereby continually updating the inventory and cost of goods balance. First-in-first-out, last-in-last-out, specific identification and weighed average costing are the most common valuation methods (Michael 2012). Costs of inventory include but not limited to shipping, acquisition, and direct costs.
During inflation, FIFO costing flow method is likely to give high ending inventory. If the inventory is high, the net income is also expected to be high. FIFO method uses the assumption that the first purchased inventory item becomes the first one to be used in production or sold (Chirantan 2016). Therefore, when there is inflation in the market, the cost of goods in the income statement consists of the less expensive items. However, the ending inventory includes the most expensive items. As a result, the amounts of ending inventory and net income are high.
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It is, therefore, impeccable that a company applies different inventory costing methods to counter inflation and deflation. Under LIFO method, ending inventory and net income is lower than under FIFO method. When weighted average costing method is used, inventory cost is high and net income is low during inflation (Michael 2016). Specific identification method provides net income that is dependent on acquisition costs of inventory. Therefore, FIFO is the only costing method that produces high inventory and high-income amounts during inflation.
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The Sarbanes-Oxley act
The Sarbanes-Oxley act was given a node by the congress. The decision to bring this law into action was to protect the individuals who had interest in various firms from being duped. The congress was afraid of situations where shareholders and other citizens lost act was The Sarbanes-Oxley act was developed to help in reducing the mis-use of investors by fraudulent firms. This act was put into action to ensure that all those who invest do not fall prey of those fraudulent persons. It became evident to the authorities that many investors were being harassed by the several fraudsters who had entered the sector.
The governance principles of regulatory compliance requirements related to Sarbanes-Oxley Act
The Sarbanes-Oxley Act is based on several regulatory compliance requirements. The compliance requirements have been put in place to ensure that the act is well understood by ll the users. The users are presented with such guidelines to ensure that they do not stray from what the act advocates for. One of the regulatory compliance requirements gives guidelines on disclosure controls. The section that hands the control of disclosures is 302.
This section advocates that all liable officers should ensure that they state their role on coming up and maintaining internal control in a firm. Secondly, this section guides on how all responsible officers should indicate that the firm’s information has been passed to the relevant stakeholders. This section also provides that all responsible officers should carry out analysis a of firm’s internal controls before making their reports.
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The other governance principle of regulatory compliance requirements related to Sarbanes-Oxley is improper influence on conduct of audits. This guideline is under section 303 of the Sarbanes Act. This section of the Sarbanes-Oxley act was aimed at ensuring that the accountants and auditors did their job in the recommended manner. This means that the auditors were supposed to start shedding the bad professional habits that used to make shareholders lose their investments in companies.
According to the Sarbanes-Oxley act, the accountants were supposed to ensure that the reports produced were as the true and fair view in a company. This means that the accountants were supposed to report business operations as they truly were. Regarding auditors, the Sarbanes-Oxley act stated that the auditors were supposed to ensure that their opinions are not compromised.
Section 404 of the Sarbanes act is the other regulatory guideline. This section states that the management should be able to produce a report that explains the level of internal controls in an organisation. This section is usually titled as the Sarbanes-Oxley act, section 404; the assessment of internal controls. Just like the requirement in section 302 for all signing officers to state their role in internal controls, section 404 stipulates that the management should state its responsibility when it comes to the internal controls of an organisation.
Under this section of the act, the management should be able to give a report that shows their assessment of the internal controls for all fiscal years.
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The role of the SEC and how Sarbanes-Oxley affected the agency
SEC refers to Securities and Exchange Commission. According to Kohn, Kohn and Colapinto, (2014), this is an agency in the United States f America which deals with companies whose shares are to be taken over by new owners. This commission ensures that there exists a smooth transition whenever there are takeovers of organisations. The smooth transition is usually aimed at ensuring that nobody ends up becoming aggrieved in the process of takeover. Basically, the introduction of the Sarbanes-Oxley Act was an added advantage to the SEC. This is because it brought about legislation that strengthened the policies SEC.
The Sarbanes-Oxley Act strengthened the enforcement of securities fraud and helped in the implementation of accounting reform. This was as a result of the Sarbanes-Oxley Act stating it clearly how all the officers in an organisation should be held liable regarding their actions. The guidelines brought about by the Sarbanes-Oxley Act have made all the professionals in audit and accountancy upholds high levels of integrity towards their work (Greg, 2015). The act has also made the management of organisations be in the forefront in ensuring that all the stakeholders are taken care of; most of all the shareholders.
Conclusion
Investors should always be protected by the authorities. This is why the congress came up with the Sarbanes-Oxley Act which was aimed at offering such protection. All the professional bodies should be able to monitor its members. This monitoring will be able to identify the rogue members and remove them from their recognition. This will be a move that will take all professionals towards discipline that protects corporate and the shareholders. It is advisable for the authorities to keep on improving the guidelines and principles that this act is based on.
This will be able to tighten any loose ends that might start developing as the targeted individuals discover new tricks. The review of the guidelines and principles will enable the act capture contemporary issues related to business operations and securities in general. According to Thompson (2014), shareholder protection strategies should always be incorporated in all legislation during reviews.
References
Greg, F. (2015). “America Robbed Blind.” Wizard Academy Press.
Kohn, S., Kohn, M. & Colapinto, D. (2014). Whistleblower Law: A Guide to Legal Protections for Corporate Employees. Praeger Publishers.
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The impact that pediatric medical devices have on the world of healthcare
Pediatric medical devices are used in treating or diagnosing conditions and illnesses from birth to the age of twenty-one. There is an extensive range of pediatric devices ranging from imaging machines to tongue blades. While a number of products are designed particularly for children, other products are borrowed from adult applications or are made for more general utilization (Samuels-Reid & Blake, 2014).
This paper provides an exhaustive evaluation of the way in which pediatric medical devices in health care have changed over time. The paper also provides an analysis of the extent to which pediatric medical devices have affected the diagnoses in healthcare. Furthermore, this paper provides an assessment of how target markets have changed with pediatric medical devices.
Medical devices essentially include the items which are utilized in diagnosing, curing, mitigating, treating, or preventing a disease. There is an extensive assortment of medical devices ranging from simple tools such as surgical clamps and bandages to complex ones such as pacemakers. Pediatric patients are amongst those a medical device is designed to treat and include persons aged from birth to not more than 21 years (United States Government Accountability Office, 2016).
Designing medical devices for paediatrics could be difficult. This is because children are by and large smaller and more active compared to adults, their functions and body structures change during childhood, and children might actually be long-term users of medical devices which brings new concerns with regard to longevity of device and lasting exposure to implanted materials (Field & Tilson, 2015).
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Pediatric medical devices in healthcare have changed over time
The history of pediatric medical devices in healthcare is fascinating in terms of how advancements have been made over time to address the unmet needs of paediatrics. As more children continued to suffer from illnesses, medical device manufactures started to make pediatric medical devices that are tailored to youngsters and babies. These devices were vital for improving not just health, but also the quality of life for babies and young people (Zimmerman & Strauss, 2010).
From the 1930s through to the 1940s and 50s, adult respiratory intensive care units (ICUs) were set up for the purpose of battling the blight of the polio outbreak with iron lung ventilators. These respiratory intensive care units, out of necessity, also cared for pediatric patients who had the polio disease (Epstein & Brill, 2012).
In their newly created neonatal ICUs, neonatologists developed procedures for environmental and nutritional support for premature toddlers and sick babies along with ventilation methods and monitoring for the treatment of respiratory distress syndrome, which is also commonly called the hyaline membrane disease. It is worth mentioning that the understanding and utilization of the surfactant and continuous positive airway pressure mechanical ventilation improved to a great extent the survival of babies with hyaline membrane disease (Downes, 2013).
In the 1960s, advancements in pediatric congenital heart surgery resulted in a need of developing intensive care units and devices for providing complex postoperative care. This need was accelerated by the introduction of cardiopulmonary bypass for repairing congenital heart lesions. The first pediatric ICU medical devices were developed by Goran Haglund in the year 1955 and utilized in Europe at Children’s Hospital of Gotenburg in the northern European nation of Sweden (Samuels-Reid & Blake, 2014).
In 1967, John Downes opened a pediatric Intensive Care Unit at Children’s Hospital of Philadelphia, which had a few pediatric ICU devices. Over the next 4 decades, hundreds of pediatric Intensive Care Units were established in many community hospitals, children’s hospitals, and academic institutions across Europe and North America. By 1995 for instance, there were about 306 general pediatric intensive care units in America with pediatric medical devices and that number rose to 349 in the year 2001 (Waugh & Granger, 2011).
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John Gibbon at the Jefferson Medical College Hospital in the state of Philadelphia in the year 1953 carried out the world’s first open heart surgical operation on an infant using the total cardiopulmonary bypass machine that he had designed and developed. Prior to that surgery, adolescents and babies who had congenital heart disease were considered inoperable or they were treated with closed heart surgery (Epstin & Brill, 2012).
In 1938 at Children’s Hospital in Boston, Robert Gross carried out the very first ligation of a patent ductus arteriosus in a young child aged 7 and in 1944, he repaired an aortic coarctation. Still in the year 1944, Swedish professionals Nylin and Craafort carried out a repair of an aortic coarctation (Downes, 2013). In the year 1945 at Johns Hopkins Hospital, Vivien Thomas and Alfred Blalock conducted an extracardiac shunt between the ipsilateral pulmonary artery and the subclavian artery in an infant girl aged fifteen months with tetralogy of Fallot (Epstin & Brill, 2012).
These procedures, in addition to the introduction of cardiopulmonary bypass, served to revolutionize the treatment of heart disease in children and in fact stimulated the development of pediatric cardiac ICUs and medical devices, and helped to improve perioperative care. Noninvasive Mechanical Ventilation was initially introduced during the late 1980s for pediatric patients who had nocturnal hypoventilation (Cheifetz, 2013).
Noninvasive Mechanical Ventilation uses a mask placed over the mouth and/or nose or prongs which are inserted into the nares in order to provide positive pressure ventilator assistance. Either continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) which produces differing expiratory and inspiratory positive airway pressures might be utilized (Epstin & Brill, 2012).
Noninvasive Mechanical Ventilation is utilized in augmenting impaired respiratory effort in various illnesses and conditions such as congestive heart failure, asthma, neuromuscular disorders, and cystic fibrosis. In treating adolescents and babies who have hypoxemic respiratory failure with Noninvasive Mechanical Ventilation, professionals have found low incidence of intubation and improvement in dyspnea, ventilation, and oxygenation (Cheifetz, 2013).
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The other respiratory-assist, noninvasive pediatric medical device which has become more and more popular lately is the humidified, high-flow gas that is delivered to the infant through a nasal cannula. In essence, 1 unit of the Vapotherm 2000i delivers about 40 L/min of gas flow with over ninety-five percent humidity (Waugh & Granger, 2011). The high humidity serves to increase comfort at the higher levels of gas and prevent nasal mucosal drying.
In principle, the high-flow system generates continuous positive airway pressure. It is worth mentioning that this device – the high-flow nasal cannula – has been utilized in babies who are premature in order to prevent apnea of prematurity and generates the same distending pressures as nasal continuous positive airway pressure. This pediatric medical device became highly popular owing to its anecdotal success as well as comfort because of subjective improvement of respiratory distress and prevention of intubation of teenagers, children and babies who have respiratory difficulties (Sreenan et al., 2011).
Many children and infants who are severely sick require mechanical ventilation and endotracheal intubation for cardiorespiratory failure or postoperative care. The first mechanical ventilation was designed and developed in the year 1910 by Sievers and Lawen. This ventilator provided negative and positive pressure through a piston cylinder. Iron lungs were the next mechanical ventilators. They were negative-pressure, electrically powered body tanks which were utilized widely for polio pediatric patients in the 1920s, 30s, 40s and even 50s (Downes, 2013).
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Modern mechanical ventilators utilize computers in providing various ventilation modes – volume versus pressure –, to synchronize with the ventilator effort of the patient, and to adjust patterns of inspiratory flow in order to improve gas flow distribution. Initially conceptualized in the year 1972, High-Frequency Oscillatory Ventilation (HFOV) is popular in the treatment of refractory to conventional ventilation in children and babies (Lunkenheimer et al., 2011).
This pediatric device basically delivers a tidal volume not more than the dead space volume at a rate of over a hundred-and-fifty breaths every minute and a higher mean airway pressure (Cheifetz, 2013). High-Frequency Oscillatory Ventilation maintains an open lung but avoids large pressure changes and phasic volume, which minimizes the cyclical stretch of the pediatric patient’s lungs and ventilator-induced lung injury.
Researchers have reported that using High-Frequency Oscillatory Ventilation in the first twenty-four hours of mechanical ventilation decreases the mortality by 47 percent compared with its use after twenty-four hours of mechanical ventilation (Fedora et al., 2010). Moreover, using High-Frequency Oscillatory Ventilation has been shown to improve oxygenation and survival by eighty-nine percent in children without increasing the risk of air leaks and pneumothorax. On the whole, the HFOV pediatric medical device has helped to improve mortality in children and babies, although its efficacy has not been proved in premature babies.
Ventricular Assist Devices (VADs) are utilized in pediatric patients with heart failure. Matsuda and Matsumiya (2012) noted that ventricular assist devices are utilized in patients who have cardiomyopathy with heart failure or severe cardiogenic shock as a bridge to recovery or to heart transplantation. These devices are attached surgically to the failing ventricle with an implantable or extracorporeal pneumatic or electric pump which brings about improved blood flow.
In essence, Ventricular Assist Devices allow for improved quality of life and mobility in adolescents and babies who have failed medical management for their heart failure (Goldman et al., 2013).
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Extracorporeal Life Support (ECLS) pediatric medical device was first employed in the year 1976 in children and babies who had postoperative cardiac failure, persistent fetal circulation, massive meconium aspiration and infant respiratory distress syndrome (Bartlett et al., 2010). This device supports a pediatric patient in circumstances in which the respiratory and/or cardiac disease cannot be medically managed through conventional means and ensures sufficient tissue oxygen delivery for supporting end-organ function.
It is notable that Extracorporeal Life Support involves surgical placement of cannulae into a main artery or vein for veno-arterial Extracorporeal Life Support, or only a main vein for veno-venous Extracorporeal Life Support (Bartlett et al., 2010). In children and older babies, Extracorporeal Life Support has been utilized for support during very serious sepsis, Acute Respiratory Distress Syndrome, or cardiac failure because of cardiomyopathy/myocarditis, hemodynamic instability following congenital heart surgery palliations/repairs, and at times as a bridge to heart transplant (Walker, Liddell & Davis, 2014).
The survival rates for Extracorporeal Life Support pediatric medical device for patients who require cardiopulmonary resuscitation is sixty-four percent in youngsters who have cardiac arrest following open-heart surgery and sixty-one percent in newborns without congenital heart disease (Chen et al., 2011).
Pediatric patients are of many different sizes, ranging from over 100 kilograms to less than 1 kilogram. This creates the need for a wide range of bronchoscopes, endotracheal tubes, catheter sizes, in addition to other pediatric medical devices. Pediatric critical care would today not be possible without the development of size-appropriate pediatric medical devices.
Prior to the 1950s, Shann, Duncan and Brandstater (2013) noted that endotracheal tubes were made with the use of rubber or metal material. Introduced during the ‘50s, plastic polyvinyl chloride endotracheal tubes become less rigid at body temperature and they soften. They are also less probable to bring about subglottic stenosis. When smaller-sized uncuffed and cuffed endotracheal tubes were developed and introduced into the marketplace, prolonged intubation of adolescents and babies was actually made possible (Shann, Duncan & Brandstater, 2013).
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Likewise, intravenous access is of great importance for the administration of medicines and fluids to pediatric patients who are severely sick. During the mid-1940s, plastic catheters replaced metal needles which were rigid thereby making long-term intravenous access possible. In the late 1950s, the current flexible, intravenous catheter-around-the-needle pediatric medical device was developed by George Doherty (Zimmerman & Strauss, 2010).
During the ‘60s and ‘70s, percutaneous central venous access developed. It is notable that the launch of pediatric-sized equipment facilitated monitoring of central venous pressures, placement of catheters for parenteral nutrition, as well as placement of pulmonary artery catheters for measuring hemodynamic variables including pulmonary artery pressure, vascular resistance, and cardiac output (Zimmerman & Strauss, 2010).
When designing the pediatric medical devices which could be implanted into the body of a child, the key factors that have been taken into consideration by medical device manufacturers over the years are as follows: (i) how the pediatric medical device would fit the body of the child as he or she grows; (ii) how the pediatric medical device is absorbed by the child’s body; and (iii) the durability of the medical device (Cheifetz, 2013).
When a medical device manufacturer designs a respiratory medical device for adult patients, the manufacturer could focus on the particular physiologic condition of the patient. However, when the manufacturer designs a respiratory device for the youngest infants, the manufacturer has to think holistically. The manufacturer should think about the baby’s entire body since everything is actually interrelated.
In addition, each aspect of an infant’s growing body has been taken into account over the years in developing effective medical devices for this population. When using surgical tape for instance, the fragile skin of the child is of particular importance. Materials utilized in developing these products are made without detrimental toxins and are gentle on the child’s skin (Shann, Duncan & Brandstater, 2013).
On the whole, in the area of pediatric medical devices, a substantial amount of progress has been made over the years. In making this progress, medical device manufacturers have ensured that they develop products which are tailored to accommodate the lifestyle, activities and growth of a child. Chen et al. (2011) reported that long-term pediatric medical devices are today designed to fit within the lifestyle of children as much as possible and not forcing the children to fit to the medical devices as it used to be the case in the first half of the 20th century when children were forced to fit into medical equipment for adult patients.
Even with chronic diseases, children should be allowed to be children. Over the years, professionals have exploited the opportunity for growth and development in pediatric biomedical engineering as they do their best to create innovative medical devices which improve the quality of pediatric care for children and babies.
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Pediatric medical devices have affected the diagnoses in healthcare
The pediatric medical industry is a very fragmented industry that comprises giant corporations and start-up companies. The Food and Drug Administration regulates many different diagnostic medical devices under specified procedures. It is notable that diagnostic medical devices for pediatric patients range from items such as cardiac monitors, vision evaluation instruments, and blood pressure cuffs to complex imaging equipment.
Basing upon their complicatedness, pediatric diagnostic medical devices are usually assigned to one of 3 classifications – Class I, Class II and Class III – and regulated by the Food and Drug Administration accordingly (Food and Drug Administration, 2016). In addition, diagnostic medical devices for pediatric patients comprise a diverse range of products commonly referred to as in-vitro diagnostic devices: they are essentially systems, instruments, and reagents used in the diagnosis of illness or other conditions.
The Food and Drug Administration regulates pediatric in-vitro diagnostic medical devices in the United States which are manufactured and sold by medical device manufacturers and other tests which are vital in diagnosing a number of uncommon conditions and illnesses (Food and Drug Administration, 2016).
An oxygen machine helps the pediatric patient to breath and a heart pump helps in bringing blood from the heart of the child to the rest of his or her body. These and other pediatric medical devices have helped to save so many children lives. According to the Food and Drug Administration (2016), pediatric medical devices are crucial in treating sick children and infants who are affected by various diseases, including uncommon illnesses.
Pediatric medical devices are helpful in the prevention of premature death and each year, they greatly improve the quality of life for numerous youngsters and infants. Some medical devices are developed particularly for children and infants and some are developed specifically for patients who are above a particular age. Many times however, healthcare providers modify medical devices meant for adult patients for usage in pediatric patients (Samuels-Reid & Blake, 2014).
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Pediatric medical devices are crucial in treating adolescents and infants who have heart disease. Modern examples include ventricular assist medical devices, atrial septal defect occluders, defibrillators, balloon catheters, pacemakers, prosthetic heart valves, endovascular stents.
Epstein and Brill (2012) stated that together with improvements in medical and surgical practice over the last 2 decades, pediatric medical devices have contributed very much to decreasing the overall burden of mortality and morbidity seen in adolescents and babies who have heart disease. Almond (2013) reported that the majority of cardiac medical devices utilized in adolescents and infants nowadays are utilized off-label in which the risk-benefit of those medical devices has not been characterized properly.
In essence, medical devices designed for pediatric patients face a number of challenges to Food and Drug Administration approval linked largely to ethical considerations of device testing in adolescents and babies, heterogeneity of the patient population, and the small target population. Even though comparatively few cardiovascular medical devices have actually been approved by the Food and Drug Administration for use in children, the number of pediatric medical devices that are successfully being approved by the FDA is on the rise (Food and Drug Administration, 2016).
Many FDA approvals of pediatric medical devices are being given via the Humanitarian Device Exemption pathway, which is in fact designed for uncommon conditions which make it appropriate for medical devices that treat pediatric congenital heart disease.
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One major pediatric medical device used by medical professionals and organizations for diagnosis and which has been very helpful in saving the lives of very many babies and children is the Vertical Expandable Prosthetic Titanium Rib (VEPTR). This pediatric medical device has actually been influential in saving the lives of over 320 young children and babies who would have otherwise died due to the lack of breathe considering that they suffered from thoracic insufficiency syndrome (TIS) – a rather rare disease (Shann, Duncan & Brandstater, 2013).
The VEPTR pediatric medical device is basically curved like a ribcage. Moreover, it has holes which allow the surgeon to expand this pediatric medical device in outpatient surgery each 6 months. This device is implanted in adolescents and babies – who could be as young as six months of age – until skeletal maturity, often 16 years in boys and 14 years in girls.
VEPTR was invented by Dr. Robert Campbell and it actually took him thirteen years to obtain approval from the federal drug administration given that it took a very long period of time in accumulating many pediatric patients with rare sicknesses. The VEPTR is intended for a number of purposes which include: treating scoliosis, which refers to a sideways curve within the spine; stabilizing the ribs and spine in adolescents and infants who have serious chest wall deformities to allow these children to breathe better; reconstructing the chest when a number of ribs need to be taken out for some kinds of cancer surgical operation (United States Government Accountability Office, 2011).
On the whole, VEPTR is used in treating adolescents and babies with a group of conditions commonly referred to as thoracic insufficiency syndrome. In this thoracic insufficiency syndrome, the thorax of the pediatric patient – which consists of breastbone, rib cage and spine – are not able to support normal breathing. One of the treatment options entails the placement of a titanium rib. A number of other medical devices have been developed or are currently being developed for use in the diagnosis of pediatric patients in healthcare. Some of these pediatric medical devices are illustrated in the table below (United States Government Accountability Office, 2011):
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Pediatric Medical Device
Condition diagnosed, treated or use
1
Biodegradable valve ring for infants and adolescents
Utilized for repairing cardiac valve
2
PediVAS pediatric circulatory assist device
Utilized in temporary and acute life support for small children and babies
3
Septal cincher
Utilized in reducing the gap of a cardiac valve
4
Pediatric ultrasound imaging for surgical planning and diagnostics
Utilized to perform cardiac imaging
5
Antiseptic and nonthrombogenic catheters for babies
Utilized in treating infection and clotting problems with catheters in infants
6
Bowel lengthening device
Utilized for treating the short bowel syndrome
7
Catheter for peripheral nerve blocks
Utilized for securing catheter placement during pediatric pain management
8
Neurosurgical articulated tools
Utilized during pediatric brain surgical procedure
9
Pyloromyotomy surgical tool
Utilized to make laparoscopic pyloromyotomy easier and safer
10
NICU dashboard
Utilized for monitoring and synthesizing multiple pediatric vital sign inputs
11
Esophageal atresia surgical tool
Used to treat esophageal atresia
12
RoboImplant for scoliosis: a bionic ortho implant that is remotely operated
Used to treat acquired and congenital spine disorders for instance early onset scoliosis
13
Magnetic Mini-Mover for pectus excavatum
Used to treat sunken chest or pectus excavatum.
14
Melody Transcatheter Pulmonary Valve
Utilized in repairing a leaky or blocked pulmonary heart valve which has formerly been replaced to rectify heart defects. This pediatric medical device is inserted without the use of open heart surgical operation and while the child’s heart is beating. It could delay the need for more invasive open heart surgical operation.
15
Debakey VAD Child left ventricular assist system
Used for pediatric heart transplantation. Also used for youngsters aged five to sixteen with BSA 1.5 to 0.7 with class 4 heart failure refractory to medical therapy
16
Shelhigh Pulmonic Valve Conduit Model NR-4000
Used in infants and youngsters aged from 0 to four years who require replacement of an absent or dysfunctional artery
17
Contegra Pulmonary Valve Conduit
Used in youngsters below the age of eighteen years who require reconstruction of RVOT because of pulmonary stenosis, Pulmonary Atresia, and Truncus Arteriosus.
18
Berlin Heart EXCOR pediatric ventricular assist device
Used in youngsters aged sixteen years and below who have class 4 cardiac failure and listed for transplantation
19
CardioSEAL Septal Occlusion System
Used to treat adult and pediatric patients who have complex single ventricle physiology
Target markets have changed with pediatric medical devices
Target markets have changed considerably since medical device manufacturers now have to focus also on pediatric medical devices to satisfy the unmet needs and not focus solely on medical devices for the adult patient population. Even so, the development of pediatric medical devices lags five to ten years behind the development of medical devices for adult patients (Food and Drug Administration, 2016).
As is true for manufacturers of biologics and medicines, medical device manufacturers naturally look for business opportunities in markets of adequate profitability and size in order to merit the investment risk. In particular, if the Food and Drug Administration demands far-reaching clinical data for approval of the medical device, manufacturers might be discouraged from making medical devices for small markets such as pediatric patients by the practical and expense challenges of carrying out satisfactory trials to show efficacy and safety of the device.
Even so, the Safe Medical Devices Act 1990 allowed the Humanitarian Device Exemption (HDE) to promote both the development and introduction of sophisticated medical device technologies to satisfy the unmet needs of small patient populations including adolescents, neonates and infants (Food and Drug Administration, 2016).
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A Humanitarian Device Exemption application contains a sufficient amount of information for the Food and Drug Administration to establish that the medical device does not create a significant or unreasonable risk of injury or sickness, and that the likely benefit to health of the targeted patient population really outweighs the risk of disease or injury from its utilization.
To qualify for a Humanitarian Device Exemption, medical device manufacturers should initially request that the medical device must be designated as a Humanitarian Use Device by the Office of Orphan Products Development. A Humanitarian Use Device refers to a medical device that is designed to benefit patients in diagnosing or treating a condition or illness which is manifested in or affects less than four-thousand people annually in America (Fedora et al., 2010).
If a medical device is to be utilized for diagnosis of diseases, the documentation in a Humanitarian Device Exemption application should show that less than four-thousand patients annually would be subjected to diagnosis by that particular medical device in America.
The Humanitarian Device Exemption provides various incentives for start-ups to manufacture pediatric medical devices which have enabled a number of companies to focus on the pediatric patient target market. For instance, unlike companies that make other products such as drugs and biologics, pediatric device makers are not required to provide clinical evidence that demonstrates the efficacy or effectiveness of their devices (Food and Drug Administration, 2016).
This is a major incentive that has allowed device makers and start-ups to focus on the pediatric patient target market since clinical trials to support efficacy claims often take a number of years to carry out and are costly. Furthermore, the period of time specified for regulatory review of an application is often shorter for Humanitarian Device Exemptions compared to the time period for other premarket approval applications.
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The other incentive for pediatric device manufacturers is certainly the waiver of filing fees often demanded as per the Medical Device User Act, which is more than $200,000 (Food and Drug Administration, 2016). Partly because of these incentives, entrepreneurs at a number of small start-up firms are now developing several ground-breaking and inventive medical devices, focusing on the target market that comprises children aged <21 and these device makers and start-ups seek to address the unmet needs of small patient populations particularly pediatric patients.
Certainly, medical device makers have changed the focus of their target market somehow, from focusing on medical devices for the adult patients to making devices for adolescents, infants and neonates to take advantage of the HDE incentives.
Today, manufacturers of pediatric medical devices are largely entrepreneurs at small, start-up firms. These start-up firms design and produce a number of revolutionary medical devices including medical devices which address the medical needs of small population of patients. Field and Tilson (2015) reported that there are a number of motivations for companies to make pediatric medical devices for small patient populations.
Some start-up firms focus on addressing unmet needs in the society and contribute to the society without the need to navigate the processes of decision-making common with complex, big medical device manufacturers. In other cases, the projected business opportunity is extremely risky or extremely small to be worth attention from current large companies though is still lucrative enough to attract small groups of entrepreneurs or venture capitalists.
It is notable that in exchange for partial ownership of the start-up firm, most venture capitalists and angel investors usually offer the required funding aimed at bringing promising and ground-breaking innovations into the marketplace (Goldman et al., 2013). Besides infusions of capital, venture capitalists and angel investors who have previously worked with other new firms might offer strategic advice and management expertise to guide managers of start-up medical device companies.
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In healthcare, technological innovations could save lives of patients and even increase the quality of life. Artificial hips and knees allow patients to be able to get back to their feet, stents prop open weak arteries, and pacemakers help in restoring rhythm to the patient’s heart. Nonetheless, these medical devices have largely been meant only for adult patients, not children.
For a lot of years, Downes (2013) reported that pediatric patients have been dealing with ill-fitting medical devices which were designed for adults. Healthcare providers were forced to adapt medical devices made for adults to adolescents and babies and the resultant improvisations have usually been far from ideal, not just in terms of safety, but also in terms of efficacy.
However, over the past few years, target markets have changed with more professionals and medical device makers being more willing to produce devices that are particularly customized for infants and children. More and more focus is now being put on the designing and making of appropriate state-of-the-art pediatric medical devices. For instance, the consortium Southern California Centre for Technology and Innovation in Pediatrics (CTIP) was formed in the year 2011 for the purpose of bringing together the best experts to accelerate the development of pediatric medical equipment – a path, which, as Almond (2013) pointed out, has not been lucrative or simple to tread.
In essence, these experts give advice to aspiring developers of medical devices on the process of manufacturing, protection of intellectual property, funding opportunities, regulatory oversight, commercial partnerships, as well as clinical trial design. The CTIP is basically a consortium between Children’s Hospital Los Angeles and the University of Southern California (Children’s Hospital Los Angeles, 2016). It is of major importance to have best advisers given that there are a number of intrinsic challenges in commercializing medical equipment and devices for paediatrics – a field which is typified by usually vulnerable and small patient populations.
There are also a number of contests organized in order to foster innovation which would advance pediatric healthcare and address the unmet medical and surgical device needs for babies and adolescents. For example, there is the yearly contest held by the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National Health System in Washington, DC (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
This contest is part of the institute’s 3rd yearly symposium and from 8 finalists, 2 pediatric medical innovators, Prospiria from Texas and AventaMed from Ireland were selected to get a fifty-thousand dollar award. Acknowledging that pediatric ear tube surgical operation is the main reason that youngsters and babies undergo surgical procedure which necessitates general anesthesia, AventaMed designed and created a hand-held ear tube pediatric medical device which does not necessitate full general anesthesia.
On the other hand, Prospiria presented to the contest a non-invasive pediatric medical device utilizing optoacoustic imaging for monitoring endotracheal tube positioning for pediatric life support patients (Sheikh Zayed Institute for Pediatric Surgical Innovation, 2016).
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Conclusion
To sum up, pediatric medical devices consist of the items which are employed in diagnosing, curing, mitigating, treating, or preventing a disease in adolescents, babies and neonates. In healthcare, the history of pediatric medical devices is quite exciting in terms of how progress has been made over the years aimed at addressing the unmet needs of paediatric populations. As more youngsters and infants continued to suffer from various ailments, medical device makers began developing medical devices specifically designed for pediatric patients.
Today, these pediatric medical devices are crucial for improving both the health as well as the quality of life for youngsters comprising adolescents, infants and neonates/newborns. Pediatric medical devices are critical in diagnosing and treating ailing adolescents and babies who are affected by many ailments, including rare ailments. These devices are useful in the prevention of premature death in children.
References
Almond, C. S. (2013). The FDA review process for cardiac medical devices in children: A review for the clinician. Prog Pediatr Cardiol, 33(2): 105-109
Bartlett, R. H., Gazzaniga, A. B., Jefferies, M. R., Huxtable, R. F., Haiduc, N. J., & Fong, S. W. (2010). Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 22:80–93
Cheifetz, I. M. (2013). Invasive and noninvasive pediatric mechanical ventilation. Respir Care48:442–458
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Children’s Hospital Los Angeles. (2016). A better fit: State-of-the-art medical devices are finally being customized for pediatric patients. Retrieved from http://www.chla.org/publication/better-fit
Downes, J. J. (2013). The historical evolution, current status, and prospective development of pediatric critical care. Crit Care Clin 8:1–22
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Fedora, M., Klimovic, M., Seda, M., Dominik, P., & Nekvasil, R. (2010). Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome. Bratisl Lek Listy 101:8–13
Field, M., & Tilson, H. (2015). Safe Medical Devices for Children Executive Summary. Institute Of Medicine.
Goldman, A. P., Cassidy, J., de Leval, M., Haynes, S., Brown, K., Whitmore, P., Cohen, G., Tsang, V., Elliott, M., Davison, A., Hamilton, L., Bolton, D., Wray, J., Hasan, A., Radley-Smith, R., Macrae, D., & Smith, J. (2013). The waiting game: bridging to paediatric heart transplantation. Lancet 362:1967–1970
Lunkenheimer, P. P., Rafflenbeul, W., Keller, H., Frank, I., Dickhut, H. H., & Fuhrmann, C. (2011). Application of transtracheal pressure oscillations as a modification of “diffusing respiration”. Br J Anaesth 44:627
Matsuda, H., & Matsumiya, G. (2012). Current status of left ventricular assist devices: the role in bridge to heart transplantation and future perspectives. J Artif Organs 6:157–161.
Samuels-Reid, J. H., & Blake, E. D. (2014). Pediatric medical needs: A look at significant US legislation to address unmet needs. Expert Rev Med Devices, 11(2): 169-174
Shann, F. A., Duncan, A. W., & Brandstater, B. (2013). Prolonged per-laryngeal endotracheal intubation in children: 40 years on. Anaesth Intensive Care 31:663–666
Sheikh Zayed Institute for Pediatric Surgical Innovation. (2016). 2015 Highlights: 2015 Sheikh Zayed Prize for Pediatric Device Innovation. Retrieved from http://www.pediatric-surgery-symposium.org/
Sreenan, C., Lemke, R. P., Hudson-Mason, A., & Osiovich, H. (2011). High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics 107:1081–1083
United States Government Accountability Office. (2011). Pediatric medical devices: Provisions support development, but better data needed for required reporting. GAO
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Waugh, J. B & Granger, W. M. (2011). An evaluation of 2 new devices for nasal high-flow gas therapy. Respir Care 49:902–906
Zimmerman, J. J., & Strauss, R. H. (2010). History and current application of intravenous therapy in children. Pediatr Emerg Care 5:120–127
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Euthanasia
Incorporating a Theory
Management of terminally ill patients is pretty demanding. Clinicians taking care of these patients are always passed with several questions. How can I be most helpful to this patient? What is the most appropriate manner of delivering news of a terminal diagnosis? However, the most important of all these questions that they ask themselves is how they can develop a thoughtful and reasonable plan for end of life care? It is for this reason that I chose the Lewis’s theory of change as the most crucial theory of euthanasia.
Despite proposing that euthanasia is the best approach for patients nearing their end of life, I strongly believe that health officials should equip themselves with necessary skills for managing these patients before they may request for euthanasia.
In today’s world, hospital settings are receiving a high number of patients who are put under palliative care. Most of these patients tend to engage in poly-pharmacy where they are prescribed more than four drugs. The probability of medical errors to occur in such hospital settings is high. Such errors usually lead to disturbing consequences not only on the patient but also on the nurse.
The occurrence of such errors can however be minimized significantly through the incorporation of technology that promotes patient care and saves time for the busy nurses. An example of an approach that can be used is the Bar-Coded Medication Administration (BCMA). This technology entails the use of scanning devices to contrast bar codes installed in patients with codes that display the prescribed drugs, electronically identifying the possible errors against the medical records, hence decreasing the occurrence of medication errors drastically.
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However, implementation of change in practice is usually associated with production of anxiety or fear of failure in nurses resulting in resistance to this change process. It is for this reason that Kurt Lewis’s theory of change comes in handy. Most healthcare institutions have used this model to study human behavior and how it is related to change as well as the patterns of resistance to the change.
The model determines forces that inhibit change implementation and factors that drive the change process. By identifying these two forces, health care organizations can then work towards strengthening the positive driving forces and find solutions to the impeding forces.
Kurt Lewis Theory Incorporation
This theory is made up of three stages; unfreezing phase, moving phase, and the refreezing phase.
Unfreezing phase
During this stage, round table discussions can be conducted with the aim of teasing out the supporting and impeding forces. This will be essential particularly in identifying the challenges that should be overcome. Some restraining forces in this facility may include; lack of computer experience, staff resistance against the use of computerized devices, dislike of the new system, and the cases of workarounds. BCMA is implemented successfully without instances of dangerous workarounds with maximum investment in the results.
On the other hand, the driving forces may include; enough financial investment, proper time management, support from top level managers, and potential ease of use.
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Moving Phase
This phase involves the actual change including planning and implementation of the project. Bar code implementation may require corporation from various teams such as the clinical information services, information technology (IT), pharmacy, clinical nurse educators, program managers, and administrators. A project leader should also be chosen to oversee and assess all phases of this project. Some of the challenges that can be encountered during this stage include the rediscovery of workarounds. However, they can be solved through provision of further education.
Refreeze Phase
This is the final stage. Here the there should be ongoing support of the clinicians on the frontline. All stakeholders should also be accorded technological support to a point where the change is deemed complete and all users have familiarized themselves with the technology and are comfortable with it. Once the process is fully functional, an analysis and summary of the challenges encountered, successes met, and problems encountered should be done for future reference. Any project of this magnitude can realize massive success once the Kurt Lewis theory of change is implemented.
Review of Literature
Euthanasia is a clinical practice that is carried out usually in terminally ill patients such as cancer patients who are suffering severe pain. Thienpont enlightens that, it can be conducted either through administration of a lethal injection or blocking a patient’s feeding tube (Thienpont et al, 2015). However, this subject of euthanasia has raised heated debates on whether it should be conducted or not. Math and Chaturvedi conducted a research to seek views on whether it should be executed or not.
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From their study, they learned that some proponents of euthanasia argued that terminally ill patients occupy valuable space in hospital beds. They also argued that the long term palliative care accorded to the patients is a huge waste on medical resources. However, others opposed these views saying that it is not fair to kill someone just on petty grounds that hospital beds are needed by others.
Terminally ill patients can be provided other avenues such as special hospices or homes where they can be taken care of. They even went further and stressed that if caring for the terminally ill is a waste then it would be just for the medical practitioners to deny medication to the elderly who are nearing the end of their life as well. To them, the description of hospice care as a waste of medical resources was rather harsh and families of terminally ill patients cannot agree to this statement.
According to Bauman and Dang, the best approach of managing patients with chronic diseases such as cancer or dementia is through hospice and palliative care (Bauman and Dang, 2012). Hospice care involves cooperation among several health officials from nurses, mental health professionals, clergy men, and to social workers all of whom act towards achieving a common goal, that is, providing the needs of chronically ill patients. Furthermore, they help in assisting family members who are constantly involved in the patient care process.
These officials work around the clock including weekends and holidays to offer their patients with a 24/7 care and assistance which they require desperately. According to Shah and Mushtaq, these specialists listen to and address the complaints of not only the patients but also the patient families (Shah and Mushtaq, 2014). They also provide counseling services and use advanced medical procedures and technology.
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According to Compas, et al, majority of these hospice and palliative care specialists help patients in patients’ homes so that these patients can spend the remaining time of their life with their loved ones and friends (Compas, et al, 2010). They can also assist patients at nursing homes, hospitals, and assisted living centers. These specialists are typically registered nurses (RNs) most of which hold a bachelor’s or a master’s of science degree in nursing. Their training involves
Carrying for terminally ill patients is accompanied with emotional circumstances that physicians usually find difficult to respond to (Leiva, 2010). Clinicians should therefore before be assisted from all specialties in attending their patients. Research has proven that even the most thoughtful health officials struggle with issues that arise when managing dying patients. This does not necessarily refer to assisted suicide of the patients under palliative care but rather to the overall emotional climate that encompasses this process whereby all that can be done medically has been done.
The most important attribute for such clinicians is being a straight shooter. Usually, patients and their families request that clinicians should be straight shooter. This actually means that they should use the truth when the patients and the families require it most. This may not cure or bring any form of happiness. However, being honest signifies that the clinician can be counted on to describe exactly the difficult times to be faced and offer solutions to these challenges.
Omipidam emphasized that it is important for physicians to understand that ethnicity and culture play a crucial role in management of patients in some communities (Omipidam, 2013). Therefore, physicians are advised to enquire from patients if they would like to receive information and make decisions or if the family wants to take care of the issues.
Moreover, physicians should maintain routine hospital calls. Just as it is crucial not to desert a patient to a consultant, it is equally important to ensure that regular visits to the terminally ill patients are maintained. The family as well as the patient should be well informed acutely of the frequency and the duration of the visits. The research conducted by Boudreau proved that physicians have a tendency of changing their schedules and shorten visits once the patients enter the last stages of illness (Boudreau, 2011).
One does not need to be a practitioner to correctly understand what this distance behavior has on the family and the patient. Maintaining frequency and duration of the visits will increase the understanding of the family, patient, and the physician.
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Most terminally ill patients suffer from depression (Katon, 2011). As a result, physicians should be well skilled in managing such psychological issues. Stuck and Nobel implied in their study that engagement of creative arts such as music engagement, expressive writing, and visual arts can be used to improve health outcomes (Stuckey and Nobel, 2010). This is because they help in enhancing an individual’s emotions, moods, and other psychological states.
Some of the countries that have legalized the proposed change- euthanasia include Netherlands and Belgium. Pereira ascertains that one of the main reasons for undertaking this policy was to relieve pain and suffering among terminally ill patients. However, Ncayiyana opposes this practice citing reasons that it does not show dignity and respect to human life (Ncayiyana, 2012).
The author offers alternative solutions saying that improvements on medication have been done to promote patients quality of life and ensure that their deaths are as humane as possible. The scholar argues that a person in sedation state still is still biologically alive and has the right to live until his/her natural death.
In some cases, patients request for euthanasia. However, Schüklenk, confirms that several organizations such as the European Court for Human Rights have since ruled that no one has a recognized right to die whether with the aid of a third person or a public authority (Schüklenk, et al, 2011). He debates that if people were given the right to take their life, then people that are critically injured or the very old would have been compelled to request their death.
Hickman and Douglas oppose the idea that relatives can call for euthanasia to spare themselves the miseries of watching their loved ones go through agony and severe pain (Hickman and Douglas, 2010). Nevertheless, they have no right whatsoever to end life of the patients despite them being relatives.
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A survey conducted by Bennett et al on 200 doctors and 400 nurses, indicated that almost 94% of the nurses and 95% of the doctors viewed hospice care to be very important for patients with life-threatening conditions. Almost all these doctors and nurses wanted hospice care to be made readily accessible. They also agreed that the general public should have more information regarding hospice palliative care and end-of-life care training should be fundamental in medical and nursing education (Bennett et al, 2010).
However, the surprising fact from this survey was that 72% of the doctors and 28% of the nurses revealed that medical professionals do not enough concerning palliative care. This indicated the existing gap of knowledge that is used in support terminally ill patients. According to Bennett et al, basic medical education is not sufficient for hospice care training.
The environment, values, and culture in clinical settings and other places of care should encourage and promote greater openness and discussions about end of life. Policy makers in the field of healthcare should also seek ways of supporting and creating more opportunities and avenues for nurses to employ in their practice of hospice care in whichever specialty they are in.
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Bennett, H. D., Coleman, E. A., Parry, C., Bodenheimer, T., & Chen, E. H. (2010). Health coaching for patients with chronic illnesses. Fam Pract Manag, 17(5), 24-29.
Boudreau, J. D. (2011). Physician-assisted suicide and euthanasia: Can you even imagine teaching medical students how to end their patients’ lives? The Permanente Journal, 15(4), 79–84.
Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. (2012). Coping with chronic illness in childhood and adolescence. Annual Review of Clinical Psychology, 8, 455–480.
J. Katon, W. (2011). Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues in Clinical Neuroscience, 13(1), 7–23.
Leiva, R. A. (2010). Death, suffering, and euthanasia. Canadian Family Physician, 56(6), 528–530.
Math, S. B., & Chaturvedi, S. K. (2012). Euthanasia: Right to life vs right to die. The Indian Journal of Medical Research, 136(6), 899–902.
Ncayiyana, D. (2012). Euthanasia: No dignity in death in absence of an ethos of respect for human life. The South African Medical Journal, 102(6), n.p.
Omipidam, B. A. (2013). Palliative care: An alternative to euthanasia. BMJ Supportive and Palliative Care, 3(2), 229.
Pereira, J. (2011). Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Current Oncology, 18(2), 38–45.
Schüklenk, U., Delden, J. J. M., Downie, J., Mclean, S. A. M., Upshur, R., & Weinstock, D. (2011). End-of-life decision-making in Canada: The report by the Royal Society of Canada Expert Panel on end-of-life decision-making. Bioethics, 25(1), 1–4.
Shah, A., & Mushtaq, A. (2014). The right to live or die? A perspective on voluntary euthanasia. Pakistan Journal of Medical Sciences, 30(5), 1159–1160.
Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing, and public health: A review of current literature. American Journal of Public Health, 100(2), 254–263.
Thienpont, L. Verhofstadt, N., Loon, T., Distelmans, W., Audenaert, K., & Deyn, P. (2015). Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: A retrospective, descriptive study. BMJ Open, 5(7), n.p.
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Rehabilitation of Prisoners
Prison like any other institution plays a correctional role in society. They offer correctional services to inmates to make them better members of the society. Prison is supposed to rehabilitate the inmate and ensure that they leave prison as corrected members of the society as law-abiding citizens. This is the role of prison and the reason prisons were set up.
However, rehabilitation of prisoners is the biggest burden that the society has experienced from history. Prison is a hard life for inmates since they are segregated from the society and forced to lead a life that they have never led before. Prison is not just buildings but is an institution with facilities that help the prisoner to change their lives and lead a normal life.
According to the Crime Museum (2015), rehabilitation should make the prisoner not to admire crime or anything that can lead them to prison. However shows that the time prisoners spend in prison does not help the inmates to change but rather they acquire new skills in crime.
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Lack of prisoners non-complying to the resources offered
Without proper rehabilitation strategy, the prisoners may be easily pushed back to crime due to the kind of life they lead while in prison. This has led to the increasing number of criminals with some prisoners being second or third offenders. To analysts, this only challenges the role that rehabilitation is playing to the general society.
Prisons of today are characterised by strict sentences limited resources and punishments that make prison life a nightmare to all the prisoners who live in. The prisoners face hard life in prison and adjusting back to society when they are released becomes almost impossible to them. To improve rehabilitation, many prisons are currently recruiting professionals in particular fields that can help improve the rehabilitation process (Crime Museum, 2010).
These professionals offer specific rehabilitation services to prisoners during their life in prison. However despite this many prisons are faced with rehabilitation challenges that appear when the prisoners are released. The challenges range from lack of Substance abuse recovery, lack of inmates none complying to the resources offered and lack of support system of individual prisoner when released back into society.
Lack of Substance Abuse Rehabilitation
According to the department of correctional services of South, Australia research has shown that use of appropriate programs that have effective methods that help to bring change in prisoners by changing their perception of society may lower the rate of crime in society. These services are called offense specific programs are offered to prisoners together with other interventions increase the rehabilitation rate of the prisoner. Further the departments suggest that the rehabilitation programs should be integrated with case related services to give a cohesive service to the prisoner.
Hammond (2013) argues that drug and substance abuse fight is the role of the criminal justice and public health. It is a battle between different factions of the society from those who are pro-imprisonment conservatives to progressive sentiments that insist on finding solutions that will provide a permanent solution to the menace. In America, this has been a fight between the conservative politicians and the Congress.
Substance abuse is one of the reasons why people get arrested or go to jail. Some people are either drug traffickers or they are either user of the same substances. When these people are detained and taken to prison, life becomes so unbearable to them since they are not like any other normal criminal. Apart from the disciplinary process that every prisoner goes through. There is a need to provide substance rehabilitation to prisoners who were on drugs before the arrest.
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According to WHO dependence on drugs is a disorder that can be treated effectively by governments. However many states have not made an effort to ensure that they put in place structures that can help rehabilitate people. For prisoners, it is worse since they a thrown in prison and left to survive on their own. This does not change the prisoner’s habits but rather drives them deeper into drugs. This is because the prison does not adequately rehabilitate the prisoners but rather they are released back to the society with the same substance abuse problem.
Many prisons lack rehabilitation services due to inadequate personnel to handle the prisoners. This makes the prison administration to appear to be doing nothing to address the issues (Siegel, 2011). Further the challenge of rehabilitating the prisoners are linked to the resource burden that it brings to society. Many countries fail to have appropriate rehabilitation programmes because of the cost of rehabilitation.
In US residential substance abuse treatment for state prisoner programmes have been established to help solve the substance abuse problem. The role is to help the governments’ agencies to come with up substance abuse strategies that are used in local facilities to help solve substance abuse. The services are supposed to extend further to community-based after care services that are used by the probation department. The approach is based on the module of “thinking for change” Which is a balanced curriculum that is integrated to provide solutions to social problems.
McNeill (2012) argues that due to the cost of substance rehab in prisons and the poor segregation of prisoners according to their needs the government can come up with community-based centres that can treat the addicts. Diverting the drug users to community centres rather than prison could reduce the rate of crime. The government can resort to different approaches to forming of cognitive groups that apply empirical approaches to problem solving.
Therefore, we need to treat the causes of substance abuse through the use of community interventions that can help to reduce the problem. Countries are supposed to develop a drug rehabilitation programme that is based on the government policy and strategic pans so that they fit in the national drug policy o the country
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Lack of prisoners non-complying to the resources offered
Some prisoners do not comply with the resources offered to them. A prison is a place where freedom and guaranteed right of the prisoner are denied while other restricted are injected into the life the prisoner. This is supposed to ensure that the individual accepts the mistakes they made and were ready to move on to a changed life. According to the United Nations, this should end up with a rehabilitated individual
Some prisoners fail to comply with the resources offered to them since they are victims of an inefficient justice system that is full of untrained officers who are extremely corrupt. This makes the prisoner feel uncomfortable making rehabilitation ineffective to them. In many instances, peoples have been incarcerated due to the mistakes of others. The prisoner ends up being mentally disturbed since they are suffering from the mistakes of another person (Fitzpatrick, 2011).
To such a prisoner life becomes so unbearable by realizing that their rights have been grabbed and replaced with new strict conditions that the prisoner has to adapt to. No amount of resources in a correction facility can make such an individual to comply.
Furthermore, many of the staff employed in the prison are underpaid by the government and end up extending their frustrations to the prisoners. Other staff may be poorly trained or lack specific training in prison management. The staffs are only trained in paramilitary and lack knowledge in prison management. This makes the managers incompetent and unable to run the prison guidelines.
This makes the prison difficult and the resources channelled by the government to these facilities to be wasted. Furthermore many governments have made no effort in training those employed in prisons on specific prison rehabilitation approaches.
Further, the prisoners are mistreated by officials who are supposed to help them to adjust to better members of the society. In many cases, abusive authorities will intimidate or abuse prisoners as a way of gaining control over them. Mostly these are occasioned by the lack of relevant tools and capacity by the police to investigate cases. The police, therefore, resort torture as the only way of ensuring that they get information from the prisoners.
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Lack of support system of individual prisoner when released back into society
Rehabilitation has also been ineffective due to lack of support system of an individual prisoner when released back into society. Life after prison is the worst nightmare that every prisoner thinks of before being released (Shapland & Bottoms, 2011). Despite the joy that comes with the freedom, the burden of life after prison haunts every prisoner. Some prisoners have been jailed for over thirty years and have spent all their adulthood in prison.
What happens when such an individual leaves prison? How or where does such a person start from in the outside world? Life becomes unbearable and pushes such an individual to extreme ends where they are left with very little options.
According to the United Nations prison management handbook Prison, life affects people and when they are released to the society they face so many problems. Majority suffers from not only psychological but also physical health due to the conditions that they have been exposed to while some of them abuse substances in prison.
On the other hand, some prisoners find it difficult to get employment and housing. Some of them will depend on relatives while others will live on the streets as beggars until they can find a job that can pay for accommodation. With this, many temptations can make the prisoner fall back to crime and find themselves in prison again. This has become the major reason there are many second offenders in prison.
The way the prisoner leaves the prison and settles into the society depends on how long they have been behind bars. Some have been in for long to the extent that when they come out the whole society has changed, and they have to learn life and new skills a fresh. This is disturbing since detention offers several factors to prisoners apart from just being a correctional facility. It helps them to practise restraint from drugs and thus part of rehabilitation.
Drug addiction for abuse offenders depends on how the life of a prisoner unfolds after their release from prison. When the prisoner is exposed to situations of drug related substances, then the person can easily fall back to drug addiction.
In many cases, prisoners are released into the society with no support centres that they can attach themselves as they try to settle in society. The prisoners are left to struggle for themselves and to find a way of integrating into the society. However, factors like employment, family support, stabilization of mental illness and financial stability help the individual to integrate easily into the society. These factors, therefore, focus on psychological, social and material support f the offender when out of prison.
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Recommendations
Governments and communities should develop effective ways of reintegrating these offenders into the society. The offenders need to find something constructive that they can do in their lives which make them desist from crime. The offenders need to find social groups that they can attach themselves to as they try to make their live meaningful. According to Peters (2011), these groups range from work, family and peer influences. Helping the individual understand influences that can make their life meaningful that makes them desist from crime and falling back.
Support groups will accept the individual and help the individual to feel appreciated and give a chance for a second life. Social and structural features of the community that the prisoners find themselves in after release affect each and every individual. In most cases the released offenders find themselves in towns or cities where the neighbourhood is concentrated with other released offenders may make the individual to fall back to crime.
However, the most important factor that makes people to either fall back to crime or stays off is the ability to get a source of income. The majority of the offenders who are in prison were engaged in an activity that was supposed to add an extra coin to their pocket. Thus, the financial hardship that the prisoner goes through may increase their chances of engaging in a similar crime or a different crime. From the above arguments the recommendations that the state needs to adopt is to develop adequate policies that ensure prison is made a correctional facility and not just an institution.
Many prisons need to be rehabilitated before they can be used to rehabilitate people. The government has to invest enough resources in prisons by training the staff and having adequate resources that can be used to segregate prisoners and deal with them according to their needs prisoners should be treated depending on the class or category of the crime committed. . Therefore, each case has to be treated as unique, and the individual assisted through the rehabilitation process.
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Further the society needs to be empowered to be able to combat crime and fight crime related elements through different groups. Support groups within the society reduce crime by providing a social association to the members of the society. Furthermore, the community needs to play a centre role in reintegrating and accepting released offenders into the society. Stigma and discrimination push crime gangs to regroup and commit further crimes.
Finally, the prison has to be like a second home to offender where they get to know their mistakes and accept to change. It is important for the staff who work in prisons to ensure that they help the prisoners to be able to accept change and desist crime. Desisting from crime is a psychological and exemplary process that the prisoner needs to be taken through and given time to change.
Conclusion
Government policy is the most important factor that can help in rehabilitating any criminal. The transition of an individual from the prison to the community is a process that the prisoner needs to be prepared in advance before they leave the society. The governments need to develop policies that give room for correctional centres to develop and support the prisoners morally as they prepare themselves for the outside world. People are jailed or imprisoned because the state has passed that law. Therefore, the state needs t have recommendations that will ensure prison is a correctional facility and not punishment centre.
On the other hand support centres need to exist in a society that focuses on preventing crime and delinquency among the citizens. The role of fighting crime should not a state issue but rather a community problem. The communities need to be empowered and have appropriate support centres that can take people who have committed a minor crime on parole or probation. When the offenders are doing community work, they need to be supported and taken through therapy that will help them realise the need to desist from crime (Ekunwe, Jones & Mullin, 2010).
When the whole community fights crimes, then prison will not be relevant to the offenders since crime will be reduced. However the need to empower the community with alternatives to livelihood will contribute to reducing poverty among the members and decrease the rate of crime proportionally. Poverty is the biggest problem affecting many people. Hardcore criminals engage in crime to make a living and not to terrorize the society. What happens to these people when they leave prison and stay in the society determines the kind of person they become in future?
Furthermore, some criminal activities have been characterized as inborn and thus passed down from generation to generation. What support is given to the family both moral and psychological to ensure the young ones in the family do not pick up those traits? The family of the offender is left desperate in trying t find an alternative to livelihood.
This may force them to engage in crime and thus the culture of crime revolving in the family. Therefore, the society has to support the offenders in ensuring that they can adapt and integrate into the society. Rehabilitation is not fighting crime but crime can be combated within the community and outside prison.
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The crime museum offers a variety services that range from rehabilitation to training of inmates. It’s a resource centre for training and correctional facilities to government
Ekunwe, I., Jones, R. S., & Mullin, K. (2010). Public attitudes toward crime and incarceration in Finland. Researcher: An Interdisciplinary Journal, 23(1), 1-21.
The researchers are scholars of criminology with a passion in crime related activities. The article focuses on how the public perceives crime and incarceration and whether people who have committed crimes can be integrated and taken back into the society. The research involved the prisoners and the public in determining their perception.
Fitzpatrick, C. (2011) what is the Difference between ‘Desistance’ and ‘Resilience’? Exploring the Relationship between Two Key Concepts. Youth Justice 11 (3)
The article analyses resistance and resilience as a way of rehabilitation by an individual. Each under rehabilitation is faced with the two choices and if the offender does not fall for any. Then the individual ends up falling back to crime or becoming a second offender.
Glaze, L.E.; and Herberman, E.J. Correctional Populations in the United States, 2012. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2013. Available at Office of National Drug Control Policy. Answers to frequently asked questions about marijuana. WhiteHouse.gov. Accessed 20 April 2014. Available at http://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana#prison
The article is a government document from the department of justice the National Drug Control Policy office. The study entailed the study focussed mostly on marijuana and the questions that were asked by visitors to the website. The document is a research document on the use of marijuana and how it relates to crime within the country. Its main focus was on how the correction process of rehabilitating prisoners works and why some of them fall back to crime.
Lisa M. Hammond (2011) Drug War Policy and The Prison Industrial Complex
Hammond is a researcher and scholar of criminology. The document is based on the study of drug abuse in the society and how the policies that exist can be used to fight the problem. It focussed on how government policies are not effective in the drug war and why there is need to change and improve on the correctional laws.
McNeill, F. (2012) Four forms of ‘offender’ rehabilitation: Towards an interdisciplinary perspective. Legal and Criminological Psychology 17(1): 18–36.
The article studies the four types of offenses that criminal will engage in that can lead them to prison. These offenses characterise the level that the criminal is and will determine the kind of punishment that may be judged upon the offender. It shows how individuals get into crime and the level and magnitude of the offence they commit.
Peters, C. (2011) Social Work and Juvenile Probation: Historical Tensions and Contemporary Convergences. Social Work.
Peters writes on the role that professionals play in rehabilitation. The book looks at the history of crime and probation and the contemporary convergences that have developed since then. Since the onset of probation, many scholars have advanced different methodologies and therapies that can be used to correct juveniles and prisoners.
Siegel, L. (2011) Criminology. Theories, Patterns & Typologies. USA: Wadsworth.
These are theories of crime involvement on how people engage in criminal activities. The theories explain how the individual falls back to crime by lacking social and moral support from the society. Through lack of support, the criminal gangs regroup and start new criminal activities. Individuals also learn new crimes from their fellow inmates which they may practise when released.
Shapland, J., & Bottoms, A. (2011) Reflections on social values, offending and resistance among young adult recidivists. Punishment & Society 13(3): 256–282.
The article is about the social value in a society that supports the activities done by the young people. It looks at how punishment in society can help the young to avoid crime or continue with a crime. It highlights the pitfalls of society that contribute to crime and how these crimes can be tackled.
United Nations (2013) Prison Management Handbook. New York.
The handbook by the UN is a management guide that is a toolkit used internationally according to the UN standards. It shows the basics managing the prison and prisoners. Prison involves both the prisoners and the facilities within the institution. Each element in the prison plays a correctional role that helps in ensuring that the whole system runs.
United Nations (2010). Handbook for prison leaders. A basic training tool and curriculum for prison managers based on international standards and norms.
This is a tool kit for prison managers that can be used for training staff within the prison. It contains international standards and norms that are applied internationally and the way the prisons should be run.
Ekunwe, I., Jones, R. S., & Mullin, K. (2010). Public attitudes toward crime and incarceration in Finland. Researcher: An Interdisciplinary Journal, 23(1), 1-21.
Fitzpatrick, C. (2011) what is the Difference between ‘Desistance’ and ‘Resilience’? Exploring the Relationship between Two Key Concepts. Youth Justice 11 (3)
Glaze, L.E.; and Herberman, E.J. Correctional Populations in the United States, 2012. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2013. Available at Office of National Drug Control Policy. Answers to frequently asked questions about marijuana. WhiteHouse.gov. Accessed 20 April 2014. Available at http://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana#prison
Lisa M. Hammond (2011) Drug War Policy and The Prison Industrial Complex
McNeill, F. (2012) Four forms of ‘offender’ rehabilitation: Towards an interdisciplinary perspective. Legal and Criminological Psychology 17(1): 18–36.
Peters, C. (2011) Social Work and Juvenile Probation: Historical Tensions and Contemporary Convergences. Social Work.
Siegel, L. (2011) Criminology. Theories, Patterns & Typologies. USA: Wadsworth.Shapland, J., & Bottoms, A. (2011) Reflections on social values, offending and desistance among young adult recidivists. Punishment & Society 13(3): 256–282.
United Nations (2013) Prison Management Hand book. New York.
United Nations (2010). Handbook for prison leaders. A basic training tool and curriculum for prison managers based on international standards and norms.
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