Effectiveness of Risk Assessment in Preventing Pressure Ulcer Research Paper

Effectiveness of Risk Assessment in Preventing Pressure Ulcer - Research Paper Example The objective of the study will be as follows: To assess whether incorporating risk assessment in nursing practice can reduce the prevalence of pressure ulcers; Establish whether risk assessment can reduce the overall preventive measures used on a patient Investigate whether the detection of pressure ulcers in its early stages could reduce its severity and prevent other illnesses from developing. Background Pressure ulcers are local injuries to skin and/or underlying tissues due to pressure from an object pressing and/or rubbing against the skin. Pressure usually leads in insufficient blood flow and occurs mostly in bony areas such as the sacrum, coccyx, hips, and heels. Insufficient blood supply can lead to death of skin cells leading to the formation of an ulcer. In the US, the prevalence of pressure ulcers varies among states widely, with some states such as Ontario recording incidence rates of 53% in poorly managed healthcare institutions (Clarke, Bradley, & Whytock, 2005).... The staff will also be trained on early detection of the injuries. c) Comparison Data on patients at risk from developing pressure ulcer will be collected before and after training. The data will also include the number of patients who will develop ulcers over a four-week period before and after the training intervention. Data collected after nursing staff have undergone training will be compared to that collected before the training using various statistical analyses to determine whether there was a significant decline in the number of patients at risk of developing ulcers. d) Outcome Results of the analysis will also indicate whether training of nursing personnel in the assessment of pressure ulcer risk is effective in reducing the number of patients developing pressure ulcers. e) Time The study will run for a period of three months. Data on the number of patients developing ulcers and those at risk will be collected for a period of four weeks followed by training of personnel. Dat a will be collected again after training for a period of four weeks. Critique of Literature Clinical studies have shown that development of pressure ulcer during hospitalization can be alleviated by adopting appropriate mitigation measures (Severens, Hobraken, Duivenvoorden, & Frederiks, 2002; Vanderwee, Clark, Dealey, Gunningberg, & Defloor, 2007). These measures can include the development of methods and ways of determining risk factors. Early action can alleviate pain and improve quality of life among persons at risk or those already affected. Healthcare institutions can also benefit from early detection of pressure ulcers by reducing fiscal and time expenditure on the care and treatment of patients. Clarke et al. (2005) mention that pressure ulcers directly kill at least

Gender and subject choice Essay Example for Free

Gender and subject choice Essay To carry out these interviews, I would take a sample of 20 sixth-formers, preferably within my own sixth-form to allow easier, speedier access and consisting equally of both males and females. In order to do this I would use quota sampling, this is a way in which variables can be controlled and the participants with similar characteristics are chosen, hence the overall sample can reflect the characteristics of the population as a whole. These samples would also preferably include students that had chosen to study any of the sciences, however particularly focusing on Biology. This sample would also take into account ethnic and class differences in order to allow me to differentiate between males and females according to different variables, providing sufficient extra data to measure gender against class roles and the intersections. Whilst this will provide qualitative clues as to subject choices by gender it will be limited in illustrating the impact of the learning environment and gender roles, as this would demand more qualitative analysis such as that of Anne Colleys. However, I would expect the results to be generalisable to a wider population. I will anchor these questions in previous research such as that of Anne Colley. Within the interviews, I am going to focus on Biology in particular when asking about the science/favourite subjects, etc. My reasons for doing this arise from the evidence that Science at GCSE level is more popular with males whereas at A-level it is more commonly chosen by females. I would begin the interviews with a number of open-ended questions, so as to give the participant a chance to provide me with worthy feedback, eg. Why did you choose Biology? , and What did you think of it ?(in comparison to GCSE level), etc. I would record the answers to these open questions as it would be time-consuming to write down many long answers, etc. This would enable me to extract a varied viewpoint on many different students perspectives of subject choice and preference. Then I would ask a series of closed-ended questions which will generally be more appropriate to achieve a table of results for clear comparisons to be made. These closed-ended questions would include similar questions to: Do you think Biology is a girls subject? and Do you think Physics is a boys subject? , etc. Questions would be piloted on a small group of males and females to ensure its adequacy. This is in fact a small-scale preliminary study which will allow me to check that things will run smoothly during the interviews and also allow improvements to be made to the design of the research, should there be any faults. (471 words) Potential Problems As this is a such a small piece of research, it would a problem to generalise from it, especially to schools and pupils different from the sample, eg.ethnic minorities, private education, etc. It would give an idea of the reasons in which a particular small group of students chose their A level subjects and their own individual reasons for doing so. However it could give a fair impression of reasons for subject choice in other cases, eg. similar circumstances to other pupils studying the same subjects etc. The usage of quota sampling does have both theoretical and practical drawbacks in some circumstances. It isnt truly random as each person within the population doesnt have an equal chance of being chosen. The lack of this genuine randomness may have a significant effect on the results. For example, the quota sample within my study would be only those illustrated on the biology class register, however the results may have more of an impact if a quota sample had been taken from all those who achieved a high grade at GCSE biology and were in fact considering going on to study it at a higher level, etc. There is of course, with my research an interviewer bias. As my opinions on the topic are set by doing the research, participants may be influenced by my asking of the questions and will therefore respond by giving a respectable answer as they may find the real truth embarrassing, eg. I fancied a lad who was taking the course. However I am similar in status to my chosen sample group, therefore they may wish to impress or please me by giving me answers that they think I want to hear. Another problem may be the reliability of the interviewees memory, they arent currently making their choice and might not remember their thoughts on it at the time. Also during interviews, a crucial factor as a way of achieving a reliable outcome of the research is to not put ideas into the students head before having asked open-ended questions. For example, closed-ended questions especially may put forward ideas that werent there before and therefore mislead me about their thoughts on the matter, etc.

Modern Hot Metal Desulfurization

Modern Hot Metal Desulfurization Modern Hot Metal Desulfurization And Dephosphorization Technologies Introduction The purpose of phosphorus and sulfur removal is to decrease the concentration of these particles along with the undesired inclusions (oxides, borides, nitrides, carbides, and chlorides) to accomplish the final product quality requirements [5]. Dephosphorization involves low temperature, high slag basicity (CaO/ SiO2 ratio) and high oxygen activity whereas desulphurization entails high temperature, high slag basicity (CaO/ SiO2 ratio) and low oxygen activity. Initially, dephosphorization was performed by the addition of iron ores in the blast furnace runner. Soda ash (Na2CO3) was used in the blast furnace house during desulphurization. Subsequently, dephosphorization was improved by the subsurface injection of reagents in vessels, such as torpedo or submarine cars. Desulfurization was enhanced by co-injection of lime and magnesium into the hot metal transfer ladles [6]. The following dephosphorization and desulphurization technologies are reviewed: 1. Dephosphorization by the multirefining converter (MURC) process 2. Dephosphorization using CaO aggregates 3. Desulfurization by Magnesium 4. Desulfurization by flux injection using a new kinetic model 5. Desulfurization by the CFD modeling 1. Dephosphorization By The Murc Process The multirefining converter (MURC) process claims to improve the efficiency of the dephosphorization procedure by reducing the cost and minimizing the slag volume. It is a new hot metal pretreatment in which dephosphorization and decarburization processes are developed in the same converter for further reduction of the decarburization slag. The MURC process reduces the amount of slag by 50 % in comparison to the conventional pretreatment processes (30 %). The decarburization slag is continuously recycled (Figure 1). A low basicity dephosphorization slag is discharged from the MURC due to the high amount of total iron in the slag (T Fe) and no desiliconization treatment of the hot metal. This results into a valuable utilization of the dephosphorization slag in the steelmaking process. 2. Dephosphorization Using Cao Aggregates The multiphase dephosphorization slag is analyzed through the addition of calcium ferrite flux powder into hot metal. It is observed that high [Si] content (0.15 %) shows a similar CaO efficiency for dephosphorization than low [Si] content (0.00 %). The low [Si] content exhibits calcium phosphate (3CaO.P2O5) whereas high [Si] content shows a combination of calcium silicate (2CaO.SiO2), and calcium phosphate. The formation of these solid phases explains a similar CaO efficiency under different [Si] content. 3. Desulfurization By Magnesium Desulfurization is enhanced by the stirring effect of Mg bubbles in the hot metal. The reaction speeds up by the addition of lime and CaC2. These desulfurization reagents were tested in ArcelorMital Indiana Harbor. The typical inclusions before reagent injection were TiC and MnS. TiO2 is added to protect the graphite lining in the blast furnace. MgS + TiC and MgS were the most frequent inclusions after the reagent injection. MnS inclusions were not observed after this stage. This means, most of these inclusions floated up at the end of desulphurization. Further improvement of desulfurization can be achieved by Al addition. The latter reacts with lime to form lower melting point calcium aluminates. 4. Desulfurization By Flux Injection Using A New Kinetic Model Desulfurization is performed by introducing powder reagents (CaO, calcium carbonate, calcium diamide carbonate) into the hot metal using either core wired or a carrier gas (nitrogen). This creates a complex variety of interfaces in torpedo ladles (Figure 2) [7]. There are two reaction modes that are present in the heterogeneous/ immiscible phases. The first mode is related to the transitory reaction between the liquid steel and powder particles. The second mode is the permanent reaction between the slag on the surface and the molten steel. Desulfurization in torpedo ladles. The interfaces are: (1) Jet zone; (2) bubbles and particles rise in the plume zone; (3) bubbles emerge in the breakthrough zone; (4) slag zone; (5) gas-slag-metal emulsion forms in the dispersion zone; (6) metal reacts with lining in the lining zone; (7) lowest stirring intensity in the intermediate zone Several parameters influence the desulfurization of hot metal and are predicted by a new model of submerged powder injection. The total amount of the flux is considered to be liquid at steelmaking temperature and the injection rate along with the time lapse can be determined. The total sulfur removal rate for both the permanent contact (top slag) and transitory (injection powder) mode is obtained by the following equation, The right hand side of the reaction is related to the transitory reaction. This equation is only useful during the powder injection. After that, the right hand side becomes worthless. Sulfide solubility in slag is restricted. Once the sulfide solubility limit is reached, a pure sulfide phase grows within the slag to absorb the excess of sulfur. Sulfide saturation may occur before the slag and metal reach equilibrium. The speed of the reaction is reduced until the sulfur content is dropped. Excess of sulfur in permanent reactions produces a reversion reaction and further desulphurization cannot occur. The transitory reaction removes the excess of sulfur by the continuously addition of fresh powder into the torpedo ladle. It is also recommended to deslag after powder injection. Figure 3 is divided into [% S] wt % and reaction rate. The experimental results are obtained from the 20 CaO-60CaF2-20Al2O3 (by weight) powder injection under an argon atmosphere into 3.4-3.8 kg cast iron at 1310 Â °C. Once the slag (permanent-contact reaction) experiences an excess of sulfur at 420 s, the sulfur concentration decreases continuously until 950 s. The contributions of the permanent and transitory reactions are also displayed. The permanent reaction increases with time until it is saturated. The transitory reaction never approaches to saturation conditions. The difference between these two reactions is not significant large. Therefore, the contribution of these both reactions is generally equal. 5. Desulfurization By CFD Modeling Synthetic slag is used on the desulfurization process due to its reuse in several treatments. The sulfur is transferred to the synthetic slag followed by slag regeneration. Slag regeneration is performed by the oxygen injection to produce gaseous sulfur dioxide (Equation 3). The sulfur distribution also differs from the slag and the metal once desulfurization begins (Figure 4). A porous plug at the bottom of the vessel is used to inject nitrogen in the hot metal. The fluid velocity is increased to optimize the desulfurization rate to improve sulfur transport. Therefore, CFD analyzes the desulfurization and slag regeneration processes to optimize the plug position and calculate the drift velocity of gas bubbles, desulfurization rate, among other parameters, for future design of desulphurization processes. Conclusions Multirefining converter (MURC) (1) Dephosphorization and decarburization are carried out in the same converter, reducing the slag volume for better industrial, economical and environmental purposes (2) The dephosphorization efficiency is increased by greater amounts of CaO to produce solid phases, such as 3CaOP2O5 and 2CaSiO2 Desulfurization by Mg (1) TiC particles are nucleation sites for MnS and MgS (2) MgS inclusions are the most frequent particles after the reagent injection Desulfurization by flux injection using a new kinetic model (1) A new model is developed to evaluate and identify separately the transitory and permanent reactions (2) This model helps to predict the excess of sulfur to avoid reversion of it in the hot metal (3) The contributions of the transitory and permanent contact reactions are observed to be in a similar proportion, concluding equal influence in the powder injection technique CFD Modelling (1) The desulfurization and slag regeneration are successfully modeled using thermal and transport mechanisms References [1] S.Y. Kitamura, K. Yonezawa, Y. Ogawa, N. Sasaki (2002). Improvement of reaction efficiency in hot metal dephosphorization, 29 (2), 121-124 [2] Q. Liu, H. Pielet, P. Kaushik B. Chukwulebe (2009). AISTech 2009 Proceedings. An investigation of hot metal desulfurization by Mg, 1, 821-827 [3] S. Ohguchi and D.G.C. Robertson (1984). Kinetic model for refining by submerged powder injection: Part 1 Transitory and permanent contact reactions, 11(5), 261-274 [4] S. Pirker, P. Gittler, H. Pirker J. Lehner (2002). Elsevier. CFD, a design tool for a new hot metal desulfurization technology, 26, 337-350 [5] X. LV and L. Zhang (2008). Removal of impurity elements from molten aluminum: part 1. A review. 1, 1-35 [6] R.J. Fruehan (Ed.) (1998). The making, shaping and treating of steel (11th ed.). Pittsburgh: The AISE Steel Foundation [7] M. Sadmi S. Ashhab (2007). Jordan Journal of Mechanical and Industrial Engineering. Application of neural net modeling and inverse control to the desulfurization of hot metal process, 1 (2), 79-84

Jane Campions The Piano - A Metaphor for European Domination Essay

Jane Campion's The Piano - A Metaphor for European Domination The exact nature of the encounters between Captain James Cook and the Polynesian natives of Hawaii as well as all interactions and exchanges between Europeans and native Polynesian peoples of the Pacific while Cook was exploring the islands of Hawaii and after has been investigated by anthropologists and historians for many years. Captain Cook died at the hand of Polynesian natives while he was at Hawaii in 1779. Marshall Sahlins stated that Cook was seen as the god Lono during the celebration of the Makahiki festival taking place at the time of Cook’s visit. Gananath Obeyesekere, in his noted work, The Apotheosis of Captain Cook: European Mythmaking in the Pacific, argues that Sahlins is incorrect in his conclusions about Cook and his myth models, which are defined as indigenous people not using rationality in the same way as Europeans. They underestimate the flexibility and pragmatism of indigenous cultures and cosmology. Obeyesekere argues that the Prospero myth and the Kur tz myth are evident in the works of Sahlins and other historians as well. The Prospero myth that is of the European explorer who brings forth peace and a "civilized" culture to the native peoples of the lands he or she explores. The name "Prospero" is taken from a character in Shakespeare’s play, The Tempest. The Kurtz myth is that of the explorer, who witnesses the raw nature and "uncivilized" culture and ideology of the native peoples and becomes himself "savage". The name "Kurtz" originated from Joseph Conrad’s novel Heart of Darkness and is adopted in Francis Ford Coppola’s cinematic masterpiece Apocalypse Now. Obeyesekere’s ideas are prevalent in The Piano, a feature film involving a lov... ...rts Obeyesekere’s arguments by having the savage element awakened, then subdued with force in the supposedly civilized Europeans, as opposed to Sahlin’s denial of European savagery in the explorations of Cook and the denial that Cook was a savage and bloodthirsty male seeking to kill, using "civilization" as an excuse for killing. This idea is seen in the domination of Ada by both Stewart and Baines, and the males’ violence and sexual aggression toward the innocent and mute Ada. The inability to speak on Ada’s part is a metaphor for her domination by the males, a trait of european culture in the ninteenth century. The piano is the means by which she is able to communicate, embodying both the Kurtz persona in the raw, beautiful sound that flows from the piano, and the Prospero persona in the intricate and ordered melody and harmony with that a skilled pianist plays.

Examining Government Regulations

The current government regulations I researched pertain to the clinical guidelines and the civil rights of persons living with HIV/AIDS in Portland, Oregon. Many people living with HIV/AIDS, at some point during their illness, find themselves in need of housing assistance and support services. Stable housing promotes improved health, sobriety or decreased use of alcohol and illegal drugs, and, for some, a return to paid employment and productive social activities. As the number of people living with HIV/AIDS continues to grow in both urban and rural areas throughout the United States, stakeholders must find new ways to address their needs to promote the health and well-being of these individuals and their families. Increasingly, maximizing the resources available to people who need them requires partnering across mainstream housing and human services systems to ensure continuity of care, program efficiency, and that there is â€Å"no wrong door† to assistance for clients at risk. The United States Department of Health and Human Services recommended public health law reform as part of its Healthy People 2010 initiative. Public health law in many states is ripe for reform. Oregon state legislature has suggested that existing state statutes are ineffective in responding to contemporary health threats for many reasons. These statutes pre-date modern scientific and constitutional developments and lack adequate standards of privacy, due process, and risk assessment. Forty percent of Oregonians with HIV need housing assistance, and a survey of Oregon service agency representatives cited the lack of affordable housing as the number-one barrier to stability for Oregonians living with HIV/AIDS. Critical issues were identified and recommendations developed to improve the ability of these systems to cooperatively meet the housing and services needs of people living with HIV/AIDS in Oregon. The obstacles that would prevent me from meeting the needs of people living with HIV/AIDS are 1. Limited Awareness of Resources Dedicated to People Living with HIV/AIDS Many potential housing and services partners lack awareness or accurate knowledge of existing resources dedicated to, or which can be used to serve, people living with HIV/AIDS, and that lack of awareness may limit partnerships. 2. Confidentiality Concerns The need to maintain client confidentiality restricts the ways that OHOP housing coordinators and other organizations and individuals can publicize their activities and resources. . Limited Staff Capacity and Knowledge HIV Care and Treatment staff may lack familiarity with aspects of partner systems, including affordable housing, and have limited resources and time to conduct marketing and outreach to potential partners and planning bodies. Discrimination adds to the daily struggles faced by the growing number of people living with HIV/AIDS in the United States – people who are predominantly poor and disproportionately African American or Latino. Every agency’s biggest problems facing their clients involve meeting basic needs – coping with poverty, hunger, illiteracy, inadequate medical care, lack of transportation, and homelessness. In addition to those basic needs issues, people with HIV face a series of critical civil rights problems. Individuals living with HIV/AIDS need to know their rights and need the resources to advocate for themselves when their rights are threatened. They also need national legal organizations like the ACLU AIDS Project to enforce their civil rights and civil liberties through litigation, public education and legislative advocacy. Recommendations: †¢ Develop simple, discreet material to publicize OHOP and related services and opportunities, and distribute it widely. †¢ Present to current and potential partners, including faith-based and community-based grass roots organizations with information tailored to their interests. †¢ Engage provider agency staff, clients, and other regional participants in publicizing the need, opportunity, and benefits of investing in housing and services for people living with HIV/AIDS. †¢ Focus attention on improving coordination with planning, data, and other elements of homeless systems. †¢ Promote Shelter Care and other bonus projects through agreements to streamline or share sponsor administrative costs. †¢ Conduct outreach and seek partnerships with landlords and property managers. Oregon Housing and Opportunities in Partnership (OHOP) Program Many people living with HIV/AIDS find themselves in need of housing assistance and support services at so me point during their illness. As many as 60 percent of all persons living with HIV/AIDS report a lifetime experience of homelessness or housing instability. Stable housing promotes improved health, sobriety or decreased use of alcohol and illegal drugs, and, for some people living with HIV/AIDS, a return to paid employment and productive social activities. The federal Housing Opportunities for Persons with AIDS (HOPWA) program provides funding, distributed by both formula and competition, dedicated to the housing needs of people living with HIV/AIDS and their families. This funding is not only necessary but critical to have the needs of people living with HIV/AIDS met adequately. Examining Government Regulations The current government regulations I researched pertain to the clinical guidelines and the civil rights of persons living with HIV/AIDS in Portland, Oregon. Many people living with HIV/AIDS, at some point during their illness, find themselves in need of housing assistance and support services. Stable housing promotes improved health, sobriety or decreased use of alcohol and illegal drugs, and, for some, a return to paid employment and productive social activities. As the number of people living with HIV/AIDS continues to grow in both urban and rural areas throughout the United States, stakeholders must find new ways to address their needs to promote the health and well-being of these individuals and their families. Increasingly, maximizing the resources available to people who need them requires partnering across mainstream housing and human services systems to ensure continuity of care, program efficiency, and that there is â€Å"no wrong door† to assistance for clients at risk. The United States Department of Health and Human Services recommended public health law reform as part of its Healthy People 2010 initiative. Public health law in many states is ripe for reform. Oregon state legislature has suggested that existing state statutes are ineffective in responding to contemporary health threats for many reasons. These statutes pre-date modern scientific and constitutional developments and lack adequate standards of privacy, due process, and risk assessment. Forty percent of Oregonians with HIV need housing assistance, and a survey of Oregon service agency representatives cited the lack of affordable housing as the number-one barrier to stability for Oregonians living with HIV/AIDS. Critical issues were identified and recommendations developed to improve the ability of these systems to cooperatively meet the housing and services needs of people living with HIV/AIDS in Oregon. The obstacles that would prevent me from meeting the needs of people living with HIV/AIDS are 1. Limited Awareness of Resources Dedicated to People Living with HIV/AIDS Many potential housing and services partners lack awareness or accurate knowledge of existing resources dedicated to, or which can be used to serve, people living with HIV/AIDS, and that lack of awareness may limit partnerships. 2. Confidentiality Concerns The need to maintain client confidentiality restricts the ways that OHOP housing coordinators and other organizations and individuals can publicize their activities and resources. . Limited Staff Capacity and Knowledge HIV Care and Treatment staff may lack familiarity with aspects of partner systems, including affordable housing, and have limited resources and time to conduct marketing and outreach to potential partners and planning bodies. Discrimination adds to the daily struggles faced by the growing number of people living with HIV/AIDS in the United States – people who are predominantly poor and disproportionately African American or Latino. Every agency’s biggest problems facing their clients involve meeting basic needs – coping with poverty, hunger, illiteracy, inadequate medical care, lack of transportation, and homelessness. In addition to those basic needs issues, people with HIV face a series of critical civil rights problems. Individuals living with HIV/AIDS need to know their rights and need the resources to advocate for themselves when their rights are threatened. They also need national legal organizations like the ACLU AIDS Project to enforce their civil rights and civil liberties through litigation, public education and legislative advocacy. Recommendations: †¢ Develop simple, discreet material to publicize OHOP and related services and opportunities, and distribute it widely. †¢ Present to current and potential partners, including faith-based and community-based grass roots organizations with information tailored to their interests. †¢ Engage provider agency staff, clients, and other regional participants in publicizing the need, opportunity, and benefits of investing in housing and services for people living with HIV/AIDS. †¢ Focus attention on improving coordination with planning, data, and other elements of homeless systems. †¢ Promote Shelter Care and other bonus projects through agreements to streamline or share sponsor administrative costs. †¢ Conduct outreach and seek partnerships with landlords and property managers. Oregon Housing and Opportunities in Partnership (OHOP) Program Many people living with HIV/AIDS find themselves in need of housing assistance and support services at so me point during their illness. As many as 60 percent of all persons living with HIV/AIDS report a lifetime experience of homelessness or housing instability. Stable housing promotes improved health, sobriety or decreased use of alcohol and illegal drugs, and, for some people living with HIV/AIDS, a return to paid employment and productive social activities. The federal Housing Opportunities for Persons with AIDS (HOPWA) program provides funding, distributed by both formula and competition, dedicated to the housing needs of people living with HIV/AIDS and their families. This funding is not only necessary but critical to have the needs of people living with HIV/AIDS met adequately.

Choosing Disability

Exceptionally: Disability and Giftedness Dry. Stuart Sameness's Parents all over the world have one great thing In common, wanting the best for their children and giving them great opportunities to pursue their dreams. Children are considered special blessings from God, especially for couples that were bestowed with this blessing after much patience. Furthermore, women who could not conceive were known to be cursed and inferior to other fertile women.Although, there are still any couples whose attempts to conceive a child naturally go vain, medical science has allowed these problems to be resolved through various interventions, such as; infertility treatments, intrauterine insemination, in vitro fertilization, surrogacy or even sperm donor clinics. There are many things to be considered when it comes to family planning, before a couple decides to bring a child Into this world. For some, It may to Walt until they are financially well off, moving to a family friendlier neighborhood, or possibly visiting a fertility clan to weigh out their options.Fertility lining are also beneficial If the couple Is Interesting In knowing the probably of passing a disease with a family history or a disability off to their offspring. Moreover, possess preferential characteristics such as; eye color, hair color, height, race, and/or education. As one might say, conceiving through sperm donors is the safest alternative precisely because donors with congenital disabilities are screened out long before they would ever make the catalogue, as the sperm banks are aware that the probability of such a withdrawal is very low.But as strange as deliberately assign a disability to an unborn child may seem, there are many advocating for the allowance of such services. Some parents have taken steps to ensure that they have children with a desired disability. What is meant by ‘disability is subject for considerable debate, however. For many, disability is something undesirable, as it signif icantly reduces the individual's quality of life and social opportunities. This scenario is particularly relevant to the Deaf Culture who consider themselves a part of a minority group.This paper intends to explore the controversy regarding the ethics of deliberately choosing a disability and implementing it on the case study of James Kittle and wife and discussing why they should not be allowed to deliberately select an embryo with a disability via the use of pre-implantation diagnosis. James Kittle is a congenital deaf married to a wife of 5 years. James and wife are both belonging to the Deaf Culture and seem very content with their ‘disability.Their main mode of communication is American Sign Language and do not consider their condition as a defect or a disability, rather a different viewpoint of life that differs only slightly from the norm. Both James and his wife were raised in a typical nuclear family with hearing parents and siblings. Once they learned that they were expecting their first child, they were thrilled. This excitement, however was short-lived as they soon found out that he was born hearing with no signs of partial deafness.They were hoping for a deaf child like themselves so that he could easily be integrated into their culture and so they could set a new generation of the Deaf in the family. As Jimmy, their son, turned four, they started fearing that they would eventually lose their son, o the hearing world. They decided to consult their family doctor who referred them to an ideologist with whom they could discuss the possibility of surgically deafening their son by removing his cochleae from both of his ears.As this was illegal in America, James took it upon himself to take Jimmy to Brazil where this type of surgery is permissible. Jimmy refused once he learned of his parents' intention but was told that he would have no problem adjusting and was not given much of an option. The surgery was successful and James and his wife now co nsider Jimmy a ‘special blessing. They are now ready for their second child, but instead of simply hoping for that child to be deaf, they are considering the possibility of conceiving through pre- implantation diagnosis, since they do not want to take their chances as they did with Jimmy.This case study raises many ethical issues about deliberately choosing deafness over normality and why it should never be permissible to do so on the basis of fundamental human rights. The choice to seek deaf children cuts across the grain of virtually all discussion in bioethics about prenatal interventions involving the traits of children. It is not prenatal interventions regarding producing super kids, with superior qualities not commonly observed in their peers of the same age.These qualities usually exceed their peers and even parents in sight, hearing, intelligence, athletic skills, immunity to disease, strength and many more among the list of desirable traits. If options to select these enhanced traits were available, why would the parents not want these for their children? There seems to be no logical reasoning behind limiting their children of these beneficial traits. In addition, these traits should be equal to everyone and not Just the wealthy that already have the most advantages many people lack.From time to time, bioethics forums are flooded with such debatable issues and concerns when it comes to ‘designing' babies through the use of medical interventions. By contrast, however, parents going through the extra mile to ensure their children are born with a congenital disability, particularly deafness, take the debates and the controversies surrounding these issues in an entirely different direction. Two contrasting views of deafness exist in today's society.Most people insider deafness as a pathological condition resulting in profound hearing loss, followed by the viewpoint that deafness is a sensory deficit. People diagnosed with this condition are se en to be at a great disadvantage and strongly deviant from the norm. Moreover, the minority viewpoint regards deaf people as belonging to a culture paralleling themselves with racial groups such as Blacks, Hispanic and others who are bonded together by shared values, and a common language (Wagner, 2008).Those that belong to this culture consider the property of being deaf to be a highly ascribable characteristic and a unique cultural identity. The couple mentioned above takes great pride in being a part of such a culture and feel their motives of wanting deaf children through various means to be misunderstood. James and his wife wanted children like themselves and did not see their preferences as a moral offence. In addition, James felt so strongly connected with this culture that he wanted to see in his children the deafness that was so central to his identity.While the decision of this couple to want a deaf child grew out of their own moral intuition, Teresa Burke is amongst the m any commentators that as offered a defense of such a practice, as long as certain conditions are met. Teresa Burke (2005) argues that parents may be allowed to have deaf children only if they are deaf themselves and are able to work on offering language or some means of communication to their children. She argues that deafness is compatible with the ability to pursue a rewarding life.Furthermore, she feels that eliminating many environmental issues, such as stigma and discrimination can offset its disadvantages and a society where the deaf and the hearing live alongside one another, coexisting peacefully is not entirely unattainable (Burke, 2011). The counterparts of this argument, which is much more relatable to the norm suggest that parents have an obligation to enhance the capacities of their children to the extent that is within their power.Julian Cupules (2001) feels that there is a certain obligatory force to treat and prevent diseases and that we have an obligation to try to manipulate these characteristics to give an individual the best opportunity of the best life, not the other way around. To fail to treat our children's disease is to harm them. In general, he mental, and psychological capacities. Failing to do so is harming them, Just as it is to elaborately reduce these capacities and limiting them of a state of well being, regardless of how it is done (Cupules, 2001).From a perspective like this, it is evident that prevention of suffering is central to anyone's moral belief. James and his wife were definitely not selfless, as they disregarded Jimmy's refusal and went ahead with the surgery anyway. Despite the fact that deafness does not disable the possibility of a meaningful life, moral considerations suggest that parents should not be choosing this alternative intentionally. All in all, deafness is a disability in the ensue that it represents an inhibition in a major life function and James committed a strong moral transgression by making a choi ce for his son that cannot be undone.Typically, the search for genes that cause or contribute to an undesirable medical condition is followed by the hope of finding a cure for that condition, or eradicating it in general (Wagner, 2008). Deafness differs from most disabilities precisely because it is not universally viewed as an undesirable medical condition, and according to many advocating this point; there is no need to even find a cure, since it is not a problem. This is not to say that deaf people deny their tautological status but it illustrates their importance of culture over pathology.The current popularity of cochlear implant surgery today among hearing parents of deaf children with its post rehabilitation oral skills, has led to a reduction in the number of deaf children attending special residential school for the deaf at an early age. When the FDA announced its proposal in 1990 to provide children with cochlear implants, the members of the deaf community reacted negative ly and even referred to it as ‘cultural genocide' (Sculls, 2011).Now, many years later, the ethical issues of cochlear implant surgery seem to not be a problem anymore because of the advances in genetic engineering that has allowed people from this community to genetically ‘design' their babies to their preferences. Although this technology is meant to eradicate any form of disability altogether, it has recently been used to Just do the opposite. Many of these deaf community members have been shifting their focus to prenatal genetic diagnosis (PIG) in tandem with in vitro fertilization (IVY) for embryo screening.A study released in 2008 found that 3 percent of in vitro fertilization-PIG lining in the United States have provided PIG to select for a disability (Wagner, 2008). In addition to PIG, other technologies may soon be available to people wanting to have deaf children, such as gene replacement therapy. In other words, deafness could be ‘created' by deliberatel y inserting a deaf gene. This goes back to the topic discussed earlier regarding genetically creating a super kid, with extraordinary characteristics.PIG is an expensive procedure currently offered only to couples at risk of having a child suffering from a serious genetic disease, but there is nothing inherent in the technology that limits it to such uses. This means couples wealthy enough to afford such practices will be given full freedom to genetically create babies with preferable qualities whereas their less fortunate counterparts, who will not be able to afford these types of procedures, will always be at a disadvantage (Murphy, 2009). This leads to an entirely broad debate regarding eugenics and why it should not be practiced.Authors such as John Harris (2000) argue that intentionally selecting into this world who has a disability using technology in ways that it was not meant or, it significantly violates the child's right to an open future (Harris, 2000). It is a known fact , which neither the deaf community itself cannot deny, that people suffering from a hearing loss lead more difficult lives than hearing counterparts, partly because there will always be more hearing people in this world than deaf and there will never be enough accommodations.Loss of hearing, therefore, in such a linguistic society can become dangerous when a deaf person is unable to detect nearby hazards thereby affecting their sense of independence and security and limiting social opportunities. Alternative viewpoints proposed by Albany Lucas (2012) contend that selection for a particular disability is as problematic as selection against, since both are based on the assumption that a single genetic characteristic should be the determining factor in the decision to have a child (Lucas, 2012).Opponents of this point assert that although they value the existence of living disabled individuals and believe in giving these individuals equal respect and opportunities as any other human be ing, it is morally wrong to knowingly bring a disabled child into the world and limiting their opportunities. In addition, the harm of genetically harming children can be clearly seen when considering how the same harm without genetics involved would be viewed. Genetics, reproductive technologies and techniques such as PIG are simply tools.Tools are used to accomplish things; whether the use of the tool is ethical depends on what it is that we are trying to accomplish. If something is morally wrong, it does not matter what tools or what method is used to accomplish that, it still remains wrong. In the case of James, who deliberately deafened his first hearing child, by racially removing his cochlea so he could become a part of their culture, now wants to create a second deaf baby using genetic engineering techniques.Preventing a child from hearing harms the child; it limits and disadvantages the child and therefore should not be permissible for medical personnel to carry on with thi s kind of procedure, especially for Jimmy and his wife, who are evidently putting their own happiness ahead of their children's since they disregarded their son's refusal. Jimmy was 4 years old when he was forced into such an irrational decision, which means he ad experienced the hearing world and had therefore chosen to stay in it. All the facts are the same and lets say, via PIG with in vitro fertilization Jimmy and his wife have their congenital deaf child.But now a cure for this deafness is discovered, it is risk free with no side effects, which leads us to think, would the parents, in this case, be right to withhold this cure for deafness from their child? Would the child have any legitimate complaint if they did not cure his deafness? Could this child complain to his parents dismissing him the possibility of being able to listen to music, the sound f trees, the wind, the rain, the waves on the shore, or hearing a spoken word or even learning spoken language?There is no imagini ng to how the child would feel when it discovers that it lacked these experiences only because of his/her parent's deliberate denial. Furthermore, it is not plausible to say that all these things that the child could have had, but because of it's parents decision, are unimportant, so much so that their loss or absence of it is not even considered a disability to them. Different groups. Similarly, deaf community is bonded together via a signed language,American Sign Language (SSL). Although this characteristic is not the sole criterion, it is viewed as a strong distinction between them and the non-deaf community (Singleton & Title, 2000). Furthermore, the deaf community includes members with hearing losses at both levels of extreme, from those who are profoundly deaf to those normal hearing children of the deaf community. There are also people who are hard of hearing individuals that identify themselves as part of the deaf community.Therefore, acceptance and integration into the deaf community is depended upon he attitude and the use of SSL, which means that in order to belong to the deaf community, one does not need to be born deaf. Furthermore, hearing children born to deaf parents are considered bilingual and bicameral since they potentially share the language and culture of their deaf parents and they are inevitably members of the hearing community (Singleton & Title, 2000).Although there has been some concern regarding signs of spoken language delay observed in hearing children of non-hearing parents, there is not much evidence to support this claim. Therefore, elaborately removing Jimmy's cochleae was unnecessary since he did not need to be deaf to belong to the Deaf community. Many deaf parents, occasionally have the misguided notion that they should not sign with their child simply because the child is hearing. Signing with the hearing child, from its birth, not only teaches the hearing child to be fluent in SSL, but also it ensures stronger communicati on between the parents and the child.Moreover, turning normal hearing children to a deaf child overcomes the possibility of having hearing children that are bilingual and bicameral. Shift-Myers (2004) asserts that many hearing children of deaf parents evidently develop speech and language normally provided that they have some exposure to normal hearing speakers and if their family life is otherwise normal. In addition, Jimmy and his wife both belong to hearing families, which means there would be enough exposure to normal hearing from the grandparents, and the child would consequently not develop any language delay.In any case, if a hearing child of deaf parents does show signs of spoken language delay, then an appropriate practical Lana to enhance the child's spoken language input would be in order (Shift-Myers, 2004). James and his wife ought to use the best mode of communication to ensure effective parenting, and to promote natural language acquisition for the child, whether it i s spoken or signed language. â€Å"It is a simple fact that it is better to have five senses than four† Nanette Winters). Who can argue against that? Yet, what Winters calls, a ‘simple fact' may not be so simple for everyone as clearly illustrated in this paper.This is especially not a simple fact when it comes to the Deaf community. Many facts arise from those who live the oaf lives. One such fact is that they believe being Deaf should be viewed as parallel to being Black, or Hispanic. Another fact is that these Deaf community members feel no objection expanding their community by wanting deaf children, whether it may be through prenatal medical interventions or postnatal surgical procedures. This paper explored the question of whether it is morally Justifiable to use genetic technology to here is not about being supportive of people who are deaf or otherwise disabled.The basic issue is whether or not there are ethical limits to what parents can impose on a hill. Pro-c hoice campaigners and reproductive freedom supports argue that it should be the couple's choice or wish on how they want to raise their child, but through negative enhancement and achieving outcomes that are socially not preferred affects everyone in the community in general (Carping, 2008). Morally speaking, parents have a duty to use assisted technology to give their children the best opportunity of the best life, not deliberately reducing the child's welfare.