Sociology and Values Escape Barriers free essay sample

Simmel contends that the tumult of the city (refered to in Frisby 1989, p. 80) makes inward boundaries among individuals and that amiability (Giulianotti 2007, p. 295) can rise above this issue. Talk about The social communication between individuals is chiefly decided on the individuals that we need to know and wan to interface with. This can come down to similar interests of that individual in which they are pulled in to, for example, area of where they live, leisure activities, the kinds of garments they wear, the music that they like tuning in to. These interests can make boundaries to the individuals who are distinctive where people become less social to the individuals around them and just spotlight on the things that they need to concentrate on. Frisby (1989) contends this point through the discoveries of Simmel yet it is just through the perusing of Giulianotti (2005) that the friendliness of the â€Å"tartan army† can separate interests from regular day to day existence to frame one gathering that expels all obstructions for that specific occasion. We will compose a custom paper test on Humanism and Values Escape Barriers or on the other hand any comparable subject explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page Friendliness can be characterized as the social communication between individuals, where the lively collaboration through discussion makes an association. Boundaries which are shaped that keep friendliness from happening are to a great extent controlled by the commercialization of the specific individual and the specific status in which they need to acquire. The absence of friendliness is being determined by major businsess and organizations as they target people who need a style that will make them the most well known in the public arena. Nonetheless, others have decided not to follow this as What is amiability Social connections between individuals Form without substance Sociability-the unadulterated type of what is viewed as society and which fulfills us Playful communication Conversation What is its pertinence Overstimulation of the faculties Overstimulation through industrialism of makers and administrations Materialistic qualities Escape hindrances How dos the plaid armed force reflect friendliness No progressive system equivalent clothing standard No viciousness neighborly exchange drinks Cant talk abou employments/cash just football

Capital Maintenance Doctrine and Securities

Question: Examine about the Capital Maintenance Doctrine and Securities. Answer: Presentation The convention of capital support orders an organization to securely keep up its capital to assist lenders and permit the courts to guarantee check in the event that it has been legally spent (Saidul, 2013). It is a significant rule in organization law that requires the organization to get a legitimate thought fro all the offers that it might look to issues. The primary rules that support this precept incorporate the disallowance of an organization buying its own offers and the installment of profits to investors (Saidul, 2013). As indicated by the convention, the benefit that is made by the organization isn't to be perceives except if the measure of the net resources claimed by the organization is kept up. Birthplace and Rationale of the Doctrine Note that the regulation has been created as result legal translation. In Flitcrofts Case (1882) the court featured two parts of the convention; that the loan bosses reserve the option to check and guarantee that the capital of the organization isn't utilized or shared unlawfully and that the capital of the organization ought not be unintelligibly shared to the individuals from the organization by method of offers. On account of Trevor v Whitworth (1887) an organization purchased its very own lot shares from the organization. It was held that such an activity would prompt the decrease of the capital possessed by the organization and along these lines the organization was first committed to pay the investor the measure of his commitment upon liquidation. As per usual, it was held in Aveling Barford Ltd. V. Perion Ltd (1989) that the investors of an organization are qualified for their commitment to the capital upon liquidation, yet the loan bosses will be given need during the install ment. It bears taking note of that the precept of capital upkeep has for the most part begun from the advancement of English case laws. The method of reasoning for the presence of the tenet is to a great extent two overlay. First it looks to secure the enthusiasm of the banks and also it guarantees that the capital of the organization is legitimately utilized. The courts have been cautious in ensuring the capital of the organization with the goal that it stays flawless for the leasers (Zahir, 2000 p 50). Use of the Doctrine in Australia The capital upkeep principle is a debilitating marvel in Australia. This has been exhibited by the way that the vast majority of the budgetary organizations, for example, banks don't keep up an unblemished capital that will keep them from the unfriendly impacts of a money related emergency (Gluyas, 2014 p 23). As indicated by Roman (2016) there has been constrained guideline on the utilization of capital in Australia. Australia has recorded an upsurge in adaptability in the opportunity of utilization of capital however a similar time the security of the leasers has additionally been a top need (Roman, 2016). It would thus be able to be yielded that the principle of capital support is weakening in Australia and its application is losing importance in many organizations and monetary establishments. References Aveling Barford Ltd. V. Perion Ltd (1989) BCLC 626 at p. 630-3. Flitcrofts Case (1882) 21 Ch. D. 519. Gluyas, R (2014) Capital seizes Murray request as controllers put soundness before credit creation, The Australian, Roman, T (2016) The Rise and Fall of the Capital Maintenance Doctrine in Australian Corporate Law, Commercial Law in the Twenty-first Century Forum, Tsinghua University, Beijing Saidul, I. ( 2013) The Doctrine of Capital Maintenance and its Statutory Developments: An Analysis , The Northern University Journal of Law Trevor v Whitworth (1887) 12 App. Cas. 409. Zahir, M. (2000) Company and Securities Laws, , The University Press Limited, Dhaka

Blog Archive Admissions Myths Destroyed Yikes, a TypoI Am Done!

Blog Archive Admissions Myths Destroyed Yikes, a Typoâ€"I Am Done! You have worked painstakingly on your application. You have checked and rechecked your work. You finally press the Submit button, and then you discoverâ€"to your horrorâ€"that you are missing a comma and you inadvertently used “too” instead of “to.” The admissions committee is just going to throw your application out, right? Wrong. There is a fine line between a typo and pervasive sloppiness. If you have typos and grammatical errors everywhere, you send a negative message about your sense of professionalism and your desire to represent yourselfâ€"and thus the target schoolâ€"in a positive way going forward. If you have a minor mistake or too (oops, we meant “mistake or two”) in your text, you have an unfortunate but not devastating situation on your hands. Admissions committees understand that you are only human and, if you are a strong candidate, the entirety of your professional, community, personal, and academic endeavors will outweigh these blips. Do not dwell on the mistakes. Do not send new essays. Just accept your own fallibility and move on. Share ThisTweet Admissions Myths Destroyed

Bullying Is An Old Age Problem Essay - 1680 Words

Bullying has been an old age problem since the beginning of time, which is still a problem till this day in age. No matter what stage someone might be in life, there is a possibility that you may have been in the position of a victim, bully, and/or bully-victim? An aggressive behavior of bullying might be seen as an act that begins in early childhood and decreases around late adolescence years, but that isn’t the case. Regrettably, being harassed or tormented by aggressor can continue in a higher institution. Oddly enough, there is a misconception that once you’re in college, bullying cease to exist. Although this notion is understandable since there is this view about college being a place reinvent or find yourself, it’s like a blank slate in your life. You’re a new person, experiencing new thing, and meeting new people. This impression may stemmed from television shows and/or movies showing characters leaving there past behind and embracing the new adven tures to come. But that’s not the case, if you were once bullied before; it may happen again. Those same bullies grow up as you and the position may have changed where they are the ones getting bullied or they’re the same tyrant they were before. Bullying does change, it just evolves in different ways. The types of bullying can vary from physical, verbal, cyberbullying, sexual, and prejudicial bullying. While, there are programs to assist people dealing with bullying, it doesn’t completely eliminate the problem. DoesShow MoreRelatedThe Effects Of Bullying On Children s Adult Life1594 Words   |  7 PagesThe Effects of Bullying All throughout the world, there are many people being bullied at this very moment. While bullying is considered as a rite of passage to some people, it is becoming more and more harmful and destructive to its many victims. Bullying is known as â€Å"unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance† (â€Å"Bullying Definition† 1). This can be seen through both boys and girls, young and old. Bullying has no age limit or qualityRead MorePersuasive Essay On Cyber Bullying1524 Words   |  7 PagesMany children in school bully others for various reasons. Bullying is when you are intimidated or victimized repeatedly over time with negative actions from a more powerful peer. It can lead victims to go through serious problems in early childhood and adulthood. In many cases, aggressors do not receive the punishment I believe they should. I believe if they passed stricter bullying laws, it will reduce bullying in many pla ces. According to the National Center for Education Statistics in 2015, atRead MoreBullying in Schools Essay1644 Words   |  7 PagesBullying in Schools: Every second and minute of the day a kid is bullied. Bullying is something that is not only happening here in the U.S. but all over the world. We need to put a stop to! As parents, school educators, and a community we need to stand up to bullies and give kids who are being bullied an outlet to reach out for help. According to No Bully.com bullying is defined as a form of repeated aggression that is directed by one or more people towards another person. One of the biggestRead MoreBullying on the Rise Essay1058 Words   |  5 PagesBullying on the Rise Bullying comes in many forms, from teasing to harassment to physical aspects. When people talk about bullying, it seems to get swept under the rug, like it’s not a big deal. However, bullying is an epidemic. I believe the number one reason a child, or adult, is bullied has to do with being different. I think bullying is starting entirely too young in children, these days. I feel there is a difference between harmless teasing and bullying, but harmless teasing can turn intoRead MoreBullying Is A Real Problem1065 Words   |  5 PagesBullying In this paper I will be talking about how bullying is a real problem in our world and in our schools today. There are so many ways of bullying now a days. Now that there is new technology people can use cyberbullying because they can say whatever they want, but they don t have to say it too there faces. They can just go online and use their words to hurt people. people. Then, there is the old school bullying like you see in the movies. The victim that is getting bullied is two afraidRead MoreBullying And Its Effect On Children1109 Words   |  5 Pages Bullying is an abuse that hurts someone, either emotionally or physically. 3-4 year old children repeat some actions again and again intentionally to hurt someone and irritate other people through those actions or hit someone again and again for the same purpose (McIntyre Franks, n.d.). In 3-4 year olds, bullying is considered intentional. There are three to four kinds of bullying in early childhood we can identify (physical, verbal, and cyberbullying). There are also some steps through whichRead MoreCyber Bullying : A Consistent Problem For Young People Attending School1383 Words   |  6 PagesCyber-Bullying For decades, physical bullying has been a consistent problem for young people attending school. Yet the growth of the Internet has redefined how students pick on one another. Cyber-bullying has become one of the most difficult issues to resolve in our society. Cyber-bullying can come in many forms. Cyber harassment, for example, refers to repeated hurtful emails, text messages or instant messages. Another form of cyberbullying is impersonation, in which cyber-bullies pretend to beRead MoreAdvertising And Peer Pressure : Advertising1564 Words   |  7 Pagesthe first large-scale study of its kind has found.† Two thirds of 13-year-old girls are afraid of putting on weight and as a result, more than half of them avoid certain foods, according to the study by the National Institute for Health Research.† It is also notable that those who practice unhealthy weight control methods were 40% more likely than other children to be overweight and 90% more likely to be obese, by the age of 15 (Dixon). Teens are becoming very self-conscious of their body image andRead MoreBullying And Emotional Abuse Among School Children888 Words   |  4 PagesResearch Summary of Bullying and Emotional Abuse Among School Children Bullying is a social phenomenon that goes beyond gender, age, and culture. There are wide ranges in the definition of the term, bullying it is essentially characterized by one or more individuals primarily to assert control or power. Bullying is a common thing now a day’s on school playgrounds, neighborhood, social media also called â€Å"cyber bullying†, and at homes. Bullying among children brings a variety of negative acts carriedRead MoreBullying in Todays Society Essay1252 Words   |  6 PagesBullying In Today#8217;s World. Approximately 12, 8-10 year old children commit suicide every year because they are victims of bullying. Whereas 1.3 million children a year bully others. What is bullying? As defined in the Merriam-Webster dictionary, one who hurts or intimidates others. This assault may occur in two principle forms, verbal or physical. There are specific reasons why bullying happens and specific solutions that could help save as many as 12 lives a year. Bullying

Virtue is a Necessary Feature of Friendship - 871 Words

Friendship offers a basic good that is necessary in human life. But to what extent, if any, is virtue a necessary feature of a true friendship? A popular view, and one I agree with, is the highly moralized view, according to Cocking and Kennett, â€Å"friendship is an essential vehicle for moral development and improvement † (Cocking and Kennett, 280). In order to argue my view that virtue is a necessary feature, I will discuss Aristotle’s view of the best kind of friendship, reconstruct Cocking Kennett’s conception of the value of friendship and provide an example to show the difference in argument. In â€Å" The Nicomachean Ethics† Aristotle identifies three types of friendships: utility, pleasure, and virtue. He adopts a highly moralized view of friendship, believing the best type of friendship is one of virtue. These friendships arise between two good men with similar virtues. Friendships of utility form because of a good or benefit offered in the relationship. A Friendship of pleasure is established due characteristics, such as wit, which makes it pleasurable to be around one another. In both cases the â€Å"loved person is loved, but as providing some good or pleasure. Such friendships are easily dissolved, if the parties do not remain like themselves†¦ the love ceases† (144). These friendships of utility and pleasure are short lived, and therefore not the best type of friendship. Friendship formed out of virtue posses the qualities of utility, pleasure, but also of good. TheseShow MoreRelatedAristotle on Friendship1069 Words   |  4 Pagesof friendshi ps that exist in the Greek word philia (a broader definition of friendship than one might think), which are based off usefulness, pleasure, or goodness, the three reasons for liking something: friendships of utility, friendships of pleasure and complete friendships. In the beginning, Aristotle says that friendship is a virtue or at least involves virtue. It is necessary to life, since no one would choose to live without friends even if he had all other material goods. Friendships serveRead MoreFriendship Between Friendship And Friendship1405 Words   |  6 PagesFriendship is a form of virtue and is indispensable for human life since man is a social being. There are three conditions necessary for friendship to exist: mutual goodwill, awareness of the other’s feelings in their connection, and awareness of their goodwill and attitude toward the other. According to Aristotle there are three types of friendships corresponding to the three objects of love. The first two types are similar and interconnected; they are friendship based on mutual utility and friendshipRead MoreThe Issue Of Animal Cruelty1023 Words   |  5 Pagesdolphin. Both sources focus on the idea of the defining feature of man, and questions what is it that makes us human? Society is constantly abusing the idea of human superiority. Although humans have a distinctive feature, what gives one the right to be cruel to the other beings of the world, no matter what their function or their purpose in the world is? One must be careful not to abuse their power. One must use their practical and intellectual virtue to instill good moral values in other humans and otherRead MoreAristotle s Theory Of Virtue Ethics2060 Words   |  9 PagesWhy does Aristotle think friendship is a good? Is he right? Aristotle outlined a guide to ethics that sought, first and foremost, a degree of applicability that does not falter in its representations of humankind. Perhaps this is the reason that Aristotle plays close attention to one of humankinds most treasured and hard-wearing concepts - friendship. It would be fair to say that friendship has cemented a position as one of the most fundamental constituents that contribute to the phenomenon of dailyRead MoreThe Characteristics Of Characters In Crash By Paul Haggis709 Words   |  3 Pagesthat the divisions are only in the human heads. Besides, he is trying to prove that people are not good or bad; they just act according to the situation. Thus, all of the characters described in the movie have both good and bad features. The only example of moral virtues is a little girl, who wanted to sacrifice her life for the sake of her father. Believing in a magic power of an invisible bullet proof cloak, she became the miracle herself. Thus, undoubtedl y, she is the character for which viewersRead MoreEssay about Epic Conventions Applied in The Faerie Queene1711 Words   |  7 PagesThe Shepheardes Calender, as if a poet wants to be master in poetry, s/he has to abandon writing the basic forms of poetry such as pastoral and has to write an epic then his/her name will be written in the sky. Spenser deeply believed that it was necessary to construct an English, Christian Epic. The reason for this can be found within Sir Philip, An Apologie for Poetrie. It is Sydney’s desire to prove that the art of poetry is not a waste of time to Elizabethan society. By legitimizing poetry as aRead MoreFive MaAm, By Michelle Obama1002 Words   |  5 PagesYou’re on in five Ma’am,† the chairman of the Democratic National Committee whispers, covertly to the well-dressed woman quietly sitting next to him. The occupant grimly nods her careworn features, the embodiment of disinterest; Her mind, a grey mist that obscure her i nnermost thoughts like a sweeping, sullen, shroud. Michelle Obama, the senator’s wife would soon be known as Michelle Obama, the orator. The thought of delivering a requiem for her husband’s political career elicits such cynical mirthRead MoreAristotle on Justice2000 Words   |  8 Pagesgolden mean doctrine with respect to virtue. Without the identification of the deficient vice with respect to justice, then justice must not be a virtue of character. Due to considerations of time and length of this paper, I shall confine myself to addressing the initial criticism. I address both criticisms at length in Chapter 2 of my dissertation, entitled Just Friends: anInvestigation into the Social Theories of Aristotle and Epicurus on Friendship and Justice. Also,an extended versionRead MoreConfucianism And Its Positive And Negative Sides1908 Words   |  8 PagesKongzi, Mengzi, and Xunzi their beliefs and their ways of moral self-cultivation. I would also like to contrast Mengzi and Xunzi’s view on human nature. For the conclusion, I will explain my position on whether I agree or disagree with the central feature of Confucianism. There are three notable figures in Confucianism Kongzi, Mengzi and Xunzi. Kongzi better known as Confucius is the founder of Confucianism. Confucianism also known as Ruism, is a way of life taught by Confucius in the 6th-5th centuryRead MorePaper on Aristotle and Relationships at Work2275 Words   |  10 Pagesand contented with what they have. In particular, Aristotle explains his concepts on real happiness, virtue, deliberation, justice, and friendship which are the most important variables of civic relations. According to Aristotle, real happiness is not in pleasure, amusement, and entertainment, but it is in action that can be associated with virtue and highly moral way of living, since only virtue has true value for an individual and for those around him or her (Ostwald 25). The thinker also associates

The Impact Of Technology On The Digital Age - 2073 Words

This essay will explore the role of teaching, the purpose of schooling and the use of technology in the Digital Age with a focus on the implications the Digital Age has on teachers, teaching and the use of technology in schools. The Digital Age signifies the period since the 1970’s, which saw the change in the way we interact based on information computerization and saw the prevalence of the high-tech global economy that surrounds a knowledge-based society (Wikipedia, 2014). This period saw the rapid increase of the technological capacity to store information (Wikipedia, 2014). Traditionally, schooling is defined as the transferring of knowledge and skills in a school environment (Merriam Webster, n.d.). Schooling additionally includes the social and cultural structures such as the organisation of time reflected in the school timetable, the role people assume within the school and the knowledge that makes up the curriculum (Selwyn, 2012). Along with the obvious processes of te aching, learning and communication, the processes of socialisation and regulation should also be considered when thinking about schooling (Selwyn, 2012). A person who teachers or instructs, especially in a school environment is referred to as a teacher (Merriam Webster, n.d.). The priority of the teacher should be to seize the opportunity for learning experiences (Creighton Dickson, 1969). Society has always had high expectations of teachers as protectors, inspirers and critics (Creighton Dickson,Show MoreRelatedDesigning A Technology Plan Based On The School Needs1169 Words   |  5 PagesTechnology is ubiquitous in the 21st century, providing students with resources and help them become equipped with skills about the technology innovation; these are essential goals for educational institutions. Also, technology both can enhance effectiveness in administration and instruction (Gà ¼lbahar, 2007). Designing a technology plan based on the school needs becomes a fundamental part of technology leadership. According to Overbay, Mollette, Vasu (2011), â€Å"Good planning mandates that each principalRead MoreThe Digital Divide Between Younger And Older Users1002 Words   |  5 PagesIntroduction Due to the international triumph of Facebook (FB) and other social networking sites (SNS), studying the digital divide between younger and older adults is popular amongst researchers. Further, researchers attempt to discover and inform professionals on how to bridge the gap. The purpose of this research is to understand the influence of age on FB users. FB was selected for this study due its popularity, having a membership population of 1.23 billion monthly users, including 12 millionRead MoreThe Digital Of Digital Privacy1380 Words   |  6 Pages The term digital privacy can be defined as or explain as by using digital means protecting information of private citizens or business, In these days when people try to explain what is digital privacy mostly they refer to usage of internet or relate with it. This is the technology era, digital privacy is being discussed in related areas, and addressing related issues according in right direction drive towards solution and help to secure more data. Digital privacy focuses and depends on the mediumRead MoreThe Institute Of Museum And Library Services1490 Words   |  6 PagesComprehensive Exam Question 2: The Institute of Museum and Library Services (IMLS) promotes evidence-based evaluation. For a type of library of your choice discuss the use of outcomes and impact measures to develop sound evaluation practices. Use IMLS and association tools to craft your answer. The Institute of Museum and Library Services (IMLS) within the National Foundation of the Arts and Humanities. The two programs were combined and established in September 30, 1996. The program has been inRead MoreCause/Effect How Technology Influences Personal Relationships1095 Words   |  5 Pagesnegative impacts of digital technology on society. Technology has been evolving for hundreds of years. As it has become more advanced, the more it has taken a hold of the community. Digital technology is universal and there is no way to avoid it, but people need to start using it more responsibly. Everything gets taken for granted now that there are so many technological sources. Although there are a moderate amount of positive effects, the negative aspects outweigh them substantially. Technology useRead MoreThe Negative Impact Of Digital Technology On The Film Industry1594 Words   |  7 Pages Digital Technology has taken over the world. We are now in the era where the access of digita l technology is used at a frequent rate. As a result, digital technology has developed a major impact on the film industry. The transformation of the use of digital films has created a result of new advancement within technology, such as HD, 4K, 8K, and 3D films. With the birth of these visual technologies, it has created an eye-catching experience for the entertainment of the audience. Although the developmentRead MoreInformation Literacy And Digital Literacy1473 Words   |  6 PagesInformation and digital literacy play vital roles in our society and are necessary tools for citizens to have in this growing information age. Information literacy is â€Å"the ability to recognize the extent and nature of an information need, then to locate, evaluate, and effectively use the needed information.† (â€Å"Information Literacy Definition†, n.d.) Digital literacy is â€Å"the ability to find, evaluate, utilize, share, and create content using information technologies and th e Internet.† (â€Å"What is Digital LiteracyRead MoreEffects Of The Digital Divide On Children987 Words   |  4 Pagesschools to provide the faculty, students and families with access to and operation knowledge of computers. The results are expansive and may provide a means of â€Å"bridging the digital divide†. In possession of a Ph.D. and with over 15 years in the school setting, Mary Ann Harlan provides a unique look at the effects of the Digital Divide on children in rural communities. She suggests there is a â€Å"participation gap† along with a few potential interventions to bridge the gap while meeting the students’Read MoreThe Effects Of Digital And Traditional On The Classroom1586 Words   |  7 PagesMany adults think that because children and young adults have immersed in technology at a young age, they are naturally literate or skilled in using technology. Younger generations have been labeled as â€Å"digital native† or â€Å"tech savvy† individuals. Unfortunately, this labeling is not as true as most believe. Today’s students are no more literate with digital devices than their parents are. Digital literacy requires a much broader spectrum of skills than traditional reading requires. Skills that mustRead MoreHow Computer Technology Changed I ndividuals Lifestyles For The Better?1505 Words   |  7 Pagessociety is becoming increasingly computerized. The fundamental cause is computer technology is conceived globally to have brought conveniences to individuals’ lifestyle, including at work places and social life. Computer technology is the creation and development of computers to aid individuals in daily life and at work. Examples of computer technology include Internet and social media applications. So has computer technology changed individual’s lifestyles for the better? It is necessary to consider

The All Wars Memorial To Colored Soldiers And Sailors Essay Sample free essay sample

Great work forces live for the interest of their ain state. Many colored soldiers specifically Afro-american soldiers sacrificed their ain lives during the conflicts in several wars engaged in by the United States of America. Likewise. several of them leave their households behind and put aside their personal duties to give their whole individualism in functioning their state for its protection and for the accomplishment of its ends. Consequently. the state gave a testimonial to the gallantry and brave plants that these soldiers offered during their service in their state. The All Wars Memorial to Colored Soldiers and Sailors commemorate the heroic workss and undying love of these people. who obviously showed their altruistic dedication in carry throughing their duty in functioning their place state for its security. This commemorating memorial in recognition of the coloured soldiers and crewmans was sculpted by J. Otto Schweizer. The contribution of the commemoration was commissioned by the Commonwealth of Pennsylvania. We will write a custom essay sample on The All Wars Memorial To Colored Soldiers And Sailors Essay Sample or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Furthermore. Samuel Beecher Hart. Pennsylvania’s African- American Legislator administered the commemoration in 1927. It was originally situated in Fairmount Park but finally moved in November 1994 by the Philadelphia Arts Jury and by the appointed functionaries of the commission to reconstruct and to relocate. Nowadays. the commemoration is located in its celebrated location in Logan Square. 20Thursdaystreet and Benjamin Franklin Parkway. The United States created an ageless record for these unselfish brave workss of the coloured soldiers and crewmans. This will function as a permanent inspiration to the future coevals of the state. Furthermore. the memorial symbolizes the award and the wages that they received for their achievements. Their gallantry will stay in the Black Marias of every concerned citizens of the state. the memories about their heroics workss will function as a theoretical account for draw a bead oning soldiers and crewmans who wanted to offer their egos in service of their place state. Plants cited ( â€Å"The All wars Memorial to Colored Soldiers and Sailors† . 1999-2006 ) hypertext transfer protocol: //www. homeandabroad. com/c/25/Site/38517_All_Wars_Memorial_To_Colored_Soldiers_and_Sailors_visit. hypertext markup language

Beyond The Writers Market Seven Ways to Find New Magazines

Beyond The Writers Market Seven Ways to Find New Magazines Feel like you’re out of ideas to pitch the magazines you know? Then find new magazines. There are more magazines out there than you can imagine. Despite what you may have heard, new titles continue to evolve (over 130 in 2017 alone,  Statista reports).You’ve dogs include Modern Materials Handling and Industrial Heating. Due to their more specialized target audiences, trades tend to pay well.Another little-known but great-paying type of glossy are company magazines, known in the mag trade as custom pubs. The best-known of these is  Costco Connection  magazine, along with all the airlines’ in-flight mags, but there are more. Find more at the  Custom Content Council’s  site with its handy members’ directory search tab to sort

The Geographic Adventures of Captain James Cook

The Geographic Adventures of Captain James Cook James Cook was born in 1728 in Marton, England. His father was a Scottish migrant farm worker who allowed James to apprentice on coal carrying boats at the age of eighteen. While working in the North Sea, Cook spent his free time learning math and navigation. This led to his appointment as mate. Searching for something more adventurous, in 1755 he volunteered for the British Royal Navy and took part in the Seven Years War and was an instrumental part of the surveying of the St. Lawrence River, which helped in the capture of Quebec from the French. Cook'sFirst Voyage Following the war, Cooks skill at navigation and interest in astronomy made him the perfect candidate to lead an expedition planned by the Royal Society and Royal Navy to Tahiti to observe the infrequent passage of Venus across the face of the sun. Precise measurements of this event were needed worldwide in order to determine the accurate distance between the earth and sun. Cook set sail from England in August, 1768 on the Endeavor. His first stop was Rio de Janeiro, then the Endeavor proceeded west to Tahiti where camp was established and the transit of Venus was measured. After the stop in Tahiti, Cook had orders to explore and claim possessions for Britain. He charted New Zealand and the east coast of Australia (known as New Holland at the time). From there he proceeded to the East Indies (Indonesia) and across the Indian Ocean to the Cape of Good Hope at the southern tip of Africa. It was an easy voyage between Africa and home; arriving in July, 1771. Cook's Second Voyage The Royal Navy promoted James Cook to Captain following his return and had a new mission for him, to find Terra Australis Incognita, the unknown southern land. In the 18th century, it was believed that there was much more land south of the equator than had already been discovered. Cooks first voyage did not disprove claims of a huge landmass near the South Pole between New Zealand and South America. Two ships, the Resolution and the Adventure left in July, 1772 and headed to Cape Town just in time for the southern summer. Captain James Cook proceeded south from Africa and turned around after encountering large amounts of floating pack ice (he came within 75 miles of Antarctica). He then sailed to New Zealand for the winter and in summer proceeded south again past the Antarctic Circle (66.5 ° South). By circumnavigating the southern waters around Antarctica, he indisputably determined that there was no habitable southern continent. During this voyage, he also discovered several island chains in the Pacific Ocean. After Captain Cook arrived back in Britain in July, 1775, he was elected a Fellow of the Royal Society and received their highest honor for his geographic exploration. Soon Cooks skills would again be put to use. Cook's Third Voyage The Navy wanted Cook to determine if there was a Northwest Passage, a mythical waterway which would allow sailing between Europe and Asia across the top of North America. Cook set out in July of 1776 and rounded the southern tip of Africa and headed east across the Indian Ocean. He passed between the North and South islands of New Zealand (through Cook Strait) and towards the coast of North America. He sailed along the coast of what would become Oregon, British Columbia, and Alaska and proceeded through the Bering Straight. His navigation of the Bering Sea was halted by the impassible Arctic ice. Upon yet again discovering that something did not exist, he continued his voyage. Captain James Cooks  last stop was in February, 1779 at the Sandwich Islands (Hawaii) where he was killed in a fight with islanders over the theft of a boat. Cooks explorations dramatically increased European knowledge of the world. As a ship captain and skilled cartographer, he filled in many gaps on world maps. His contributions to eighteenth century science helped propel further exploration and discovery for many generations.

The Battle of Midway - One of the Critical Events in World War II Essay

The Battle of Midway - One of the Critical Events in World War II - Essay Example The military confrontation between the United States of America and the Japanese Empire escalated in the early months of 1942, as strategic territories located in and around the Pacific Ocean saw unprecedented levels of attritional warfare. The following passages will analyze the unfolding of events during the Battle of Midway from various authors’ viewpoints and place this battle in the wider context of the Second World War and the then-emergent new world order. To begin with, let us consider the book written by Jonathan Parshall and Anthony Tully titled Shattered Sword: The Untold Story of the Battle of Midway. The most remarkable aspect of this book is the fact that the authors try to present the political and military developments from the point of view of the Japanese. American and British documentations of the Battle of Midway can at times be biased in favour of the Allied forces. So, this change in perspective offered by Parshall and Tully comes across as refreshing and different. This is not to say that their account of the story lacks objectivity and balance. We learn that Admiral Yamamoto’s planned to keep Japanese forces in the Midway and western Aleutian Islands as a way of gaining the advantage over the Naval Fleet of the United States1. In contrast with the commonly available literature on the Japanese plan, Parshall and Tully explicate in detail its technological, doctrinal and historical aspects spanning the early decad es of the twentieth century. The authors also allude to the contrasting motives and modus operandi of the Japanese and American air strategies. The following passage from the book illustrates the range of references and attention to detail exhibited by the authors: â€Å"The Akagi, Kaga, Soryu, and Hiryu, the four aircraft carriers of "Kido Butai," the First Mobile Striking Force formed the offensive core of Japans fleet. Commanded by Admiral Nagumo, "Kido Butai" planned to attack Midway and then destroy any elements of the U.S. Pacific Fleet that tried to intervene.     

What are management techniques. Which ones are effective Research Paper

What are management techniques. Which ones are effective - Research Paper Example The Balanced Scorecard Technique is a performance-based technique that is structured in a way that enables a sequential check and evaluation of processes in order to determine the level of conformity with the expected outcomes (Armstrong 46). The popularity of the Balanced Scorecard has been witnessed largely in western countries. Studies have also found out a significant level of preference of this management tool in Scandinavian countries, the Middle East and Spain. Over the times, theorists and management experts have managed to develop related techniques and concepts of management basing on the structural foundation of the Balanced Scorecard. Some of the related techniques are Results Based Management and the Performance Prism technique. The fundamental feature in these techniques is the linking of all actions towards some specific outcomes. The balanced Scorecard operates through the creation of ‘target values’ that are used to measure the progress and specific outcomes of various processes within the organization. Essentially, the units of measurement are designed in ways that provide the most relevant information about the nature of performance of a given measure. Both financial and non-financial units of performance are assessed against these target values, which act as safeguards to the nature of performance (Armstrong 50). For instance, the volume of sales could be assigned to some specific target value so that all subsequent actions and results regarding the trends of sales are measured against this target value. On this score, it becomes necessary to consider the fact that other matters such as employee performance are regulated and observed through these values. Such measures could involve appraisal processes in which the performance of employees is measured against definite goals in order to deter mine the levels of progress in relation to certain

Feasibility Study Essay Example for Free

Feasibility Study Essay 1. 1 Tourism Profile Long Meadows is located in Mahabang Parang , Sta. Maria, Bulacan. Mahabang Parang is1. 0466 squared kilometer and as we saw the ranking of barangays in Sta. Maria we saw that Mahabang Parang is in the 19th place. First it was owned by Mrs. Luzviminda Aguirre. When Mrs. Luzviminda Aguirre past away, her husband Mr. Bonifacio Aguirre and their children Armine Aguirre Garcia and Jayson Adlai Aguirre manage the resort. Established in 1988, Long Meadows Country Resort started as a private Guest’s house and opened to the public as a resort. It is less than 30 minutes away from Balintawak toll Entry going to North It sits on a 3-hectare property, more than a hectare of which is properly developed. The resort features two (2) adult Pools, two (2) kiddie Pools, a private Pool with Villa, 17 air-conditioned rooms and open cottages, Bowling Center and Restaurant and Praderas Garden Pavillion The place exudes that rustic yet charming appeal of a countryside resort complete with quality service and facilities. Long Meadows Country Resort is also Affiliated with Bulacan Association of Resort Owners ( BARO ), Sta. Maria Business Association ( SMBA ) and Tourism Projects.. 1. 2 Geography Mahabang Parang is generally flat. The source of living here in Mahabang Parang are agriculture and sewing or tailoring. And also this is the best place to build a resort. CLIMATE Santa Maria has a climate â€Å"first type† which is defined as having two pronounced seasons: Dry from November to April and wet during the rest of the year. During the dry months, precipitation is less because of the prevailing easterly wind blow to produce rainfall in its leeward side. Santa Marias most perceptible months start from May and may have its maximum in August, which gradually decreases until December. During these most months, thunderstorms and rain showers causes precipitation in May and June while the rest is primarily due to the southeast monsoon that prevails on this particular part of the year. Others which occur in November and December are caused by tropical cyclones that pass through the area. Temperature The annual mean temperature in the area is 27. 7  °C. The warmest month is May with mean temperature of 29. 9 0 C while the coldest is January at 25. 2  °C. 1. 3Demographics Language As it is part of the Tagalog cultural sphere (katagalugan), Tagalog is the predominant language of Bulacan so in Mahabang Parang we used Tagalog. Population During the census year of 2010, there were 3,411 people residing in Mahabang Parang and grew to 3,628 in 2013. CHAPTER II: OBJECTIVE SETTING To rehabilitate Long Meadows Country Resort because we want this to be on the popular tourism spot located in Sta. Maria and to grow the economics of the town. Also to set up and develop new amenities of this resort and meet customer needs. To construct recreational resort to gain more guest. We construct new and relaxing amenities to provide relaxation and recreation to the guest. To rehabilitate recreation and leisure because we want to develop new amenities and meet customers need. Also to construct resort and gain more guest, visiting the resort. Having the marketing strategies to increase the sales of recreational activities and accommodation of the resort and to be as one of the competitors here in Bulacan. Lastly, to become â€Å"catchy† in terms of different new trending activities and known the resort through this. CHAPTER IV: FINANCIAL CONSIDERATION (Including 30% labor) Pool 2 Slide concrete stair 150,000 Wall Climbing 50ft. 120,000 Bowling Center 1,500,000 Gate 2 26,000 ______________ Total Amount:1,796,000 CHAPTER V: APPENDICES MAIN GATE ENTRANCE ONE OF THE COTTAGES POOL 1 PRIVATE POOL JACCUZI VACANT LOT FOR WALL CLIMBING POOL SLIDE POOL STAIR GATE 2 BOWLING CENTER INSIDE BOWLNG CENTER.

The Moonstone Essay -- essays research papers fc

Alexandra Lloyd What role did 19th Century popular serial novels such as Wilkie Collins’ The Moonstone play in British understandings of India? When Wilkie Collins first wrote The Moonstone in 1868, it was not published in the form available today, but was published in instalments in a popular Victorian magazine, All the Year Round. Upon its first publication it was eagerly read by the general British public, for its readership not only included the ruling and upper classes, but the cost and availability meant that a copy would have a wide circulation amongst all members of a household. The tale’s images and ideas of India thus reached many social groups in British culture. To Wilkie Collins, the gem, part of whose history we follow in The Moonstone, the novel of the same name, is the signifier of all things that humanity strives for, material and spiritual. He begins the novel by demonstrating that the history of the Moonstone gem is a history of thefts. In having his initial narrator state "that crime brings its own fatality with it" (p.6 Ch. IV of the prologue), Collins underscores the fact that nemesis attends every worldly expropriator of the Moonstone, which to its temporary European possessors is a bauble and a commodity but which to its faithful guardians, the Brahmins, is a sacred artefact beyond price. The Moonstone is never really English or England's, for the novel begins with an account of its various thefts. It opens in India with Rachel Verinder’s Uncle Herncastle's purloining the gem in battle (the opening lines are specifically "written in India"(p.1)) and closes with Murthwaite, the famed fictional explorer's, account (dated 1850) of the restoration of the gleaming "yellow Diamond"(p.466) to the forehead of the Hindu deity of the Moon "after the lapse of eight centuries"(p.466, "The Statement of Mr. Murthwaite"). The date of Murthwaite's account of the restoration of the diamond may be ironic, for in 1850 a Sikh maharajah, exiled from Indian after the Anglo-Sikh War of 1848-9, presented a gem, which is thought to be the ... ...l conciliation and transcendent faith if India were to arise from bloody, mutually destructive, strife and take her rightful place in the society of nations. Today, Collins's The Moonstone may be viewed not as a response to a national insurgency and/or European determination to keep the native in his place, but rather as a love story between two people who only come to see each other for what they are after misjudgements, misunderstandings, accidental and intended deceptions, and considerable self-sacrifice. Bibliography Page references to passages from The Moonstone come from the Oxford University Press, 1999 edition of the novel. Collins, Wilkie. The Moonstone. Oxford, Oxford University Press, 1999. Sutherland, John. â€Å"Introduction and A Note on the Composition† Wilkie Collins’ The Moonstone. Oxford, Oxford University Press, 1999. Stewart, J. I. M. â€Å"A Note on Sources.† Wilkie Collins' The Moonstone. Harmondsworth, Penguin, 1966, rpt. 1973. Pp. 527-8. Fraser, Antonia, ed. The Lives of the Kings and Queens of England. New York, Alfred A. Knopf, 1975. Peters, Catherine. The King of the Inventors: A Life of Wilkie Collins. London, Minerva, 1991.

School Life: What I Learned

As I look back, there are multiple reason I am who I am today, but when I think about it changing to a public school my junior year really had a huge impact on my life and who I am today. It has made me independent and trust of myself, become more involved in school and learned how to balance my time. Also, switch schools, I have experienced a huge diversity of people. My first two years of high school, I attended St.Pius X, there I had gone to school ith all the same people I had known my whole life. Pius was a very small school and very easy to adapt to. After my sophomore year, I just knew something wasn’t right with me. I felt very sheltered and I felt like I wasn’t my own person, I felt myself being like everyone else. Knowing myself and what I wanted in life, I knew St. Pius was no longer the school for me. My Junior year, I switched to North Kansas City, knowing few people going in. Going through something like that, I had no friends and no one to trust myself.I had no fear going in. Being able to start completely over with no friends and no one to trust or go to I developed so much confidence in myself and knew I would adapt quickly. Still to this day, even with the close relationships I have made with people, I am still very independent. I make sure no matter what goes on in my life to take care of all of my responsibilities and this quality will come in handy in college with everything I will experience and will continue to stay successful. To help myself adapt to the change, I became as involved as I possibly could.I joined clubs, did volunteer work and also played three sports all while maintaining a job. Being this involved I was nervous I would become overwhelmed and thought it would be easy to loose my focus with academics but I knew that I couldn’t let that happen. My grades really improved and I was able to manage all of my activities and always get my school work done. This will definitely benefit me in college because I k now that I will be as involved as possible and that i will still maintain the motivation to get ll my work done and take care of every single of my responsibilities I develop in college. North Kansas City is not only a bigger school that I am used to, but also a very diverse school. We represent people from about thirty six different countries. I have developed close relationships with people from places I have never even heard of. At North Kansas City high school there are so many opportunities, every individual person seems like they have found comfort there. I know I have found many things to be involved in.When I get in college I know there will be people all over the world and for most it will be a huge culture shock. Being surrounded by people with different backgrounds and all walks of life and my experience with going to one of the most diverse schools in the country will help me understand people and where they are all coming from. As much as I miss my old friends and old l ife, in the end I am so happy with the change. The self trusting, time management skills and experience to a very diverse school is what is best for me in the future, not only in college but in my career after college as well.

Physiology Dissertations - Third Stage Labour - Free Essay Example

Sample details Pages: 31 Words: 9412 Downloads: 2 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Introduction Don’t waste time! Our writers will create an original "Physiology Dissertations Third Stage Labour" essay for you Create order This dissertation is primarily concerned with the arguments that are currently active in relation to the benefits and disadvantages of having either an active or passive third stage of labour. We shall examine this issue from several angles including the currently accepted medical opinions as expressed in the peer reviewed press, the perspective of various opinions expressed by women in labour and theevidence base to support these opinions. It is a generally accepted truism that if there is controversy surrounding a subject, then this implies that there is not a sufficiently strong evidence base to settle the argument one way or the other. (De Martino B et al. 2006). In the case of this particular subject, this is possibly not true, as the evidence base is quite robust (and we shall examine this in due course). Midwifery deals with situations that are steeped in layers of strongly felt emotion, and this has a great tendency to colour rational argument. Blind belief in one area often appears to stem from total disbelief in another (Baines D. 2001) and in consideration of some of the literature in this area this would certainly appear to be true. Let us try to examine the basic facts of the arguments together with the evidence base that supports them. In the civilised world it is estimated that approximately 515,000 currently die annually from problems directly related to pregnancy. (extrapolated from Hill K et al. 2001). The largest single category of such deaths occur within 4 hrs. of delivery, most commonly from post partum haemorrhage and its complications (AbouZahr C 1998), the most common factor in such cases being uterine atony. (Ripley D L 1999). Depending on the area of the world (as this tends to determine the standard of care and resources available), post partum haemorrhage deaths constitutes between 10-60% of all maternal deaths (AbouZahr C 1998). Statistically, the majority of such maternal deaths occur in the developing countries where women may receive inappropriate, unskilled or inadequate care during labour or the post partum period. (PATH 2001). In developed countries the vast majority of these deaths could be (and largely are) avoided with effective obstetric intervention. (WHO 1994). One of the central argumen ts that we shall deploy in favour of the active management of the third stage of labour is the fact that relying on the identification of risk factors for women at risk of haemorrhage does not appear to decrease the overall figures for post partum haemorrhage morbidity or mortality as more than 70% of such cases of post partum haemorrhage occur in women with no identifiable risk factors. (Atkins S 1994). Prendiville, in his recently published Cochrane review (Prendiville W J et al. 2000) states that: where maternal mortality from haemorrhage is high, evidence-based practices that reduce haemorrhage incidence, such as active management of the third stage of labour, should always be followed It is hard to rationally counter such an argument, particularly in view of the strength of the evidence base presented in the review, although we shall finish this dissertation with a discussion of a paper by Stevenson which attempts to provide a rational counter argument in this area. It could be argued that the management of the third stage of labour, as far as formal teaching and published literature is concerned, is eclipsed by the other two stages (Baskett T F 1999). Cunningham agrees with this viewpoint with the observation that a current standard textbook of obstetrics (unnamed) devotes only 4 of its 1,500 pages to the third stage of labour but a huge amount more to the complications that can arise directly after the delivery of the baby (Cunningham, 2001). Donald makes the comment This indeed is the unforgiving stage of labour, and in it there lurks more unheralded treachery than in both the other stages combined. The normal case can, within a minute, become abnormal and successful delivery can turn swiftly to disaster. (Donald, 1979). chapter 1:define third stage of labour, The definition of the third stage of labour varies between authorities in terms of wording, but in functional terms there is general agreement that it is the part of labour that starts directly after the birth of the baby and concludes with the successful delivery of the placenta and the foetal membranes. Functionally, it is during the third stage of labour that the myometrium contracts dramatically and causes the placenta to separate from the uterine wall and then subsequently expelled from the uterine cavity. This stage can be managed actively or observed passively. Practically, it is the speed with which this stage is accomplished which effectively dictates the volume of blood that is eventually lost. It follows that if anything interferes with this process then the risk of increased blood loss gets greater. If the uterus becomes atonic, the placenta does not separate efficiently and the blood vessels that had formally supplied it are not actively constricted. (Chamberlain G et al. 1999). We shall discuss this process in greater detail shortly. Proponents of passive management of the third stage of labour rely on the normal physiological processes to shut down the bleeding from the placental site and to expel the placenta. Those who favour active management use three elements of management. One is the use of an ecbolic drug given in the minute after delivery of the baby and before the placenta is delivered. The second element is early clamping and cutting of the cord and the third is the use of controlled cord traction to facilitate the delivery of the placenta. We shall discuss each of these elements in greater detail in due course. The rationale behind active management of the third stage of labour is basically that by speeding up the natural delivery of the placenta, one can allow the uterus to contract more efficiently thereby reducing the total blood loss and minimising the risk of post partum haemorrhage. (ODriscoll K 1994) discuss optimal practice, Let us start our consideration of optimal practice with a critical analysis of the paper by Cherine (Cherine M et al. 2004) which takes a collective overview of the literature on the subject. The authors point to the fact that there have been a number of large scale randomised controlled studies which have compared the outcomes of labours which have been either actively or passively managed. One of the biggest difficulties that they experienced was the inconsistency of terminology on the subject, as a number of healthcare professionals had reported management as passive when there had been elements of active management such as controlled cord traction and early cord clamping. As an overview, they were able to conclude that actively managed women had a lower prevalence of post partum haemorrhage, a shorter third stage of labour, reduced post partum anaemia, less need for blood transfusion or therapeutic oxytocics (Prendiville W J et al. 2001). Other factors derived from the paper include the observation that the administration of oxytocin before delivery of the placenta (rather than afterwards), was shown to decrease the overall incidence of post partum haemorrhage, the overall amount of blood loss, the need for additional uterotonic drugs, the need for blood transfusions when compared to deliveries with similar duration of the third stage of labour as a control. In addition to all of this they noted that there was no increased incidence of the condition of retained placenta. (Elbourne D R et al. 2001). The evidence base for these comments is both robust and strong. On the face of it, there seems therefore little to recommend the adoption of passive manage ment of the third stage of labour. Earlier we noted the difficulties in definition of active management of the third stage of labour. In consideration of any individual paper where interpretation of the figures are required, great care must therefore be taken in assessing exactly what is being measured and compared. Cherine points to the fact that some respondents categorised their management as passive management of the third stage of labour when, in reality they had used some aspect of active management. They may not have used ecbolic drugs (this was found to be the case in 19% of the deliveries considered). This point is worth considering further as oxytocin was given to 98% of the 148 women in the trial who received ecbolic. In terms of optimum management 34% received the ecbolic at the appropriate time (as specified in the management protocols as being before the delivery of the placenta and within one minute of the delivery of the baby). For the remaining 66%, it was given incorrectly, either after the delivery of the placenta or, in one case, later than one minute after the delivery of the baby. Further analysis of the practices reported that where uterotonic drugs were given, cord traction was not done in 49%, and early cord clamping not done in 7% of the deliveries observed where the optimum active management of the third stage of labour protocols were not followed. From an analytical point of view, we should cite the evidence base to suggest the degree to which these two practices are associated with morbidity. Walter P et al. 1999 state that their analysis of their data shows that early cord clamping and controlled cord traction are shown to be associated with a shorter third stage and lower mean blood loss, whereas Mitchelle (G G et al. 2005) found them to be associated with a lower incidence of retained placenta. Other considerations relating to the practice of early cord clamping are that it reduces the degree of mother to baby blood transfusion. It is clear that giving uterotonic drugs without early clamping will cause the myometrium to contract and physically squeeze the placenta, thereby accelerating the both the speed and the total quantity of the transfusion. This has the effect of upsetting the physiological balance of the blood volume between baby and placenta, and can cause a number of undesirable effects in the baby including an increased tendency to jaundice. (Rogers J et al. 1998) The major features that are commonly accepted as being characteristic of active management and passive management of the third stage of labour are set out below. Physiological Versus Active Management . . Physiological Management Active Management Uterotonic None or after placenta delivered With delivery of anterior shoulder or baby Uterus Assessment of size and tone Assessment of size and tone Cord traction None Application of controlled cord traction* when uterus contracted Cord clamping Variable Early (After Smith J R et al. 1999) physiology of third stage The physiology of the third stage can only be realistically considered in relation to some of the elements which occur in the preceding months of pregnancy. The first significant consideration are the changes in haemodynamics as the pregnancy progresses. The maternal blood volume increases by a factor of about 50% (from about 4 litres to about 6litres). (Abouzahr C 1998) This is due to a disproportionate increase in the plasma volume over the RBC volume which is seen clinically with a physiological fall in both Hb and Heamatocrit values. Supplemental iron can reduce this fall particularly if the woman concerned has poor iron reserves or was anaemic before the pregnancy began. The evolutionary physiology behind this change revolves around the fact that the placenta (or more accurately the utero-placental unit) has low resistance perfusion demands which are better served by a high circulating blood volume and it also provides a buffer for the inevitable blood loss that occurs at the time of delivery. (Dansereau J et al. 1999). The high progesterone levels encountered in pregnancy are also relevant insofar as they tend to reduce the general vascular tone thereby increase venous pooling. This, in turn, reduces the venous return to the heart and this would (if not compensated for by the increased blood volume) lead to hypotension which would contribute to reductions in levels of foetal oxygenation. (Baskett T F 1999). Coincident and concurrent with these heamodynamic changes are a number of physiological changes in the coagulation system. There is seen to be a sharp increase in the quantity of most of the clotting factors in the blood and a functional decrease in the fibrinolytic activity. (Carroli G et al. 2002). Platelet levels are observed to fall. This is thought to be due to a combination of factors. Haemodilution is one and a low level increase in platelet utilisation is also thought to be relevant. The overall functioning of the platelet system is rarely affected. All of these changes are mediated by the dramatic increase in the levels of circulating oestrogen. The relevance of these considerations is clear when we consider that one of the main hazards facing the mother during the third stage of labour is that of haemorrhage. (Soltani H et al. 2005) and the changes in the haemodynamics are largely germinal to this fact. The other major factor in our considerations is the efficiency of the haemostasis produced by the uterine contraction in the third stage of labour. The prime agent in the immediate control of blood loss after separation of the placenta, is uterine contraction which can exert a physical pressure on the arterioles to reduce immediate blood loss. Clot formation and the resultant fibrin deposition, although they occur rapidly, only become functional after the coagulation cascade has triggered off and progressed. Once operative however, this secondary mechanism becomes dominant in securing haemostasis in the days following delivery. (Sleep, 1993). The uterus both grows and enlarges as pregnancy progresses under the primary influence of oestrogen. The organ itself changes from a non-gravid weight of about 70g and cavity volume of about 10 ml. to a fully gravid weight of about 1.1 kg. and a cavity capacity of about 5 litres. This growth, together with the subsequent growth of the feto-placental unit is fed by the increased blood volume and blood flow through the uterus which, at term, is estimated to be about 5-800 ml/min or approximately 10-15% of the total cardiac output (Thilaganathan B et al. 1993). It can therefore be appreciated why haemorrhage is a significant potential danger in the third stage of labour with potentially 15% of the cardiac output being directed towards a raw placental bed. The physiology of the third stage of labour also involves the mechanism of placental expulsion. After the baby has been delivered, the uterus continues to contract rhythmically and this reduction in size causes a shear line to form at the utero-placental junction. This is thought to be mainly a physical phenomenon as the uterus is capable of contraction, whereas the placenta (being devoid of muscular tissue) is not. We should note the characteristic of the myometrium which is unique in the animal kingdom, and this is the ability of the myometrial fibres to maintain its shortened length after each contraction and then to be able to contract further with subsequent contractions. This characteristic results in a progressive and (normally) fairy rapid reduction in the overall surface area of the placental site. (Sanborn B M et al. 1998) In the words of Rogers (J et al. 1998), by this mechanism the placenta is undermined, detached, and propelled into the lower uterine segment. Other physiological mechanisms also come into play in this stage of labour. Placental separation also occurs by virtue of the physical separation engendered by the formation of a sub-placental haematoma. This is brought about by the dual mechanisms of venous occlusion and vascular rupture of the arterioles and capillaries in the placental bed and is secondary to the uterine contractions (Sharma J B et al. 2005). The physiology of the normal control of this phenomenon is both unique and complex. The structure of the uterine side of the placental bed is a latticework of arterioles that spiral around and inbetween the meshwork of interlacing and interlocking myometrial fibrils. As the myometrial fibres progressively shorten, they effectively actively constrict the arterioles by kinking them . Baskett (T F 1999) refers to this action and structure as the living ligatures and physiologic sutures of the uterus. These dramatic effects are triggered and mediated by a number of mechanisms. The actual definitive trigger for labour is still a matter of active debate, but we can observe that the myometrium becomes significantly more sensitive to oxytocin towards the end of the pregnancy and the amounts of oxytocin produced by the posterior pituitary glad increase dramatically just before the onset of labour. (GÃÆ'Â ¼lmezoglu A M et al. 2001) It is known that the F-series, and some other) prostaglandins are equally active and may have a role to play in the genesis of labour. (Gulmezoglu A M et al. 2004) From an interventional point of view, we note that a number of synthetic ergot alkaloids are also capable of causing sustained uterine contractions. (Elbourne D R et al. 2002) chapter 2 discuss active management, criteria, implications for mother and fetus. This dissertation is asking us to consider the essential differences between active management and passive management of the third stage of labour. In this segment we shall discuss the principles of active management and contrast them with the principles of passive management. Those clinicians who practice the passive management of the third stage of labour put forward arguments that mothers have been giving birth without the assistance of the trained healthcare professionals for millennia and, to a degree, the human body is the product of evolutionary forces which have focussed upon the perpetuation of the species as their prime driving force. Whilst accepting that both of these concepts are manifestly true, such arguments do not take account of the natural wastage that drives such evolutionary adaptations. In human terms such natural wastage is simply not ethically or morally acceptable in modern society. (Sugarman J et al. 2001) There may be some validity in the arguments that natural processes will achieve normal separation and delivery of the placenta and may lead to fewer complications and if the patient should suffer from post partum haemorrhage then there are techniques, medications and equipment that can be utilised to contain and control the clinical situation. Additional arguments are invoked that controlled cord traction can increase the risk of uterine inversion and ecbolic drugs can increase the risks of other complications such as retained placenta and difficulties in delivering an undiagnosed twin. (El-Refaey H et al. 2003) The proponents of active management counter these arguments by suggesting that the use of ecbolic agents reduces the risks of post partum haemorrhage, faster separation of the placenta, reduction of maternal blood loss. Inversion of the uterus can be avoided by using only gentle controlled cord traction when the uterus is well contracted together with the controlling of the uterus by the Brandt-Andrews manoeuvre. The arguments relating to the undiagnosed second twin are loosing ground as this eventuality is becoming progressively more rare. The advent of ultrasound together with the advent of protocols which call for the mandatory examination of the uterus after the birth and before the administration of the ecbolic agent effectively minimise this possibility. (Prendiville, 2002). If we consider the works of Prendiville (referred to above) we note the meta-analyses done of the various trials on the comparison of active management against the passive management of the third stage of labour and find that active management consistently leads to several benefits when compared to passive management. The most significant of which are set out below. Benefits of Active Management Versus Physiological Management Outcome Control Rate, % Relative Risk 95% CI* NNT 95% CI PPH 500 mL 14 0.38 0.32-0.46 12 10-14 PPH 1000 mL 2.6 0.33 0.21-0.51 55 42-91 Hemoglobin 9 g/dL 6.1 0.4 0.29-0.55 27 20-40 Blood transfusion 2.3 0.44 0.22-0.53 67 48-111 Therapeutic uterotonics 17 0.2 0.17-0.25 7 6-8 *95% confidence interval Number needed to treat (After Prendiville, 2002). The statistics obtained make interesting consideration. In these figures we can deduce that for every 12 patients receiving active management (rather than passive management) one post partum haemorrhage is avoided and further extrapolation suggests that for every 67 patients managed actively one blood transfusion is avoided. With regard to the assertions relating to problems with a retained placenta, there was no evidence to support it, indeed the figures showed that there was no increase in the incidence of retained placenta. Equally it was noted that the third stage of labour was significantly shorter in the actively managed group. In terms of significance for the mother there were negative findings in relation to active management and these included a higher incidence of raised blood pressure post delivery (the criteria used being 100 mm Hg). Higher incidences of reported nausea and vomiting were also found although these were apparently related to the use of ergot ecbolic and not with oxytocin. This is possibly a reflection of the fact that ergot acts on all smooth muscle (including the gut) whereas the oxytocin derivatives act only on uterine muscle. (Dansereau, 1999). None of the trials included in the meta-analysis reported and incidence of either uterine inversions or undiagnosed second twins. Critical analysis of these findings would have to consider that one would have to envisage truly enormous study cohorts in order to obtain statistical significance with these very rare events. (Concato, J et al. 2000) With specific regard to the mother and baby we note some authors recommend the use of early suckling as nipple stimulation is thought to increase uterine contractions and thereby reduce the likelihood of post partum haemorrhage. Studies have shown that this does not appear to be the case (Bullough, 1989), although the authors suggest that it should still be recommended as it promotes both bonding and breastfeeding. The most important element of active management of the third stage of labour is the administration of an ecbolic agent directly after the delivery of the anterior shoulder or within a minute of the complete delivery of the baby. The significance of the anterior shoulder delivery is that if the ecbolic is given prior to delivery of the anterior shoulder then there is a significantly increased risk of shoulder dystocia which, with a strongly contracting uterus, can be technically very difficult to reduce and will have significant detrimental effects on the baby by reducing its oxygen supply from the placenta still further. The fundal height should be assessed immediately after delivery to exclude the possibility of an undiagnosed second twin. (Sandler L C et al. 2000) There are a number of different (but widely accepted) protocols for ecbolic administration. Commonly, 10 IU of oxytocin is given intramuscularly or occasionally a 5 IU IV bolus. Ergot compounds should be avoided in patients who have raised blood pressure, migraine and Raynauds phenomenon. (Pierre, 1992). The issue of early clamping of the cord is complex and, of the three components of the active management of the third stage of labour this, arguably, gives rise to the least demonstrable benefits in terms of the evidence base in the literature. We have already discussed the increased incidence of postnatal jaundice in the newborn infant if cord clamping is delayed but this has to be offset against both the occasional need for the invoking of prompt resuscitation measures (i.e. cord around the neck) or the reduction in the incidence of childhood anaemia and higher iron stores (Gupta, 2002). In a very recent paper, Mercer also points to the lower rates of neonatal intraventricular haemorrhage although it has to be said that the evidence base is less secure in this area. (Mercer J S et al. 2006) Other foetal issues are seldom encountered in this regard except for the comparatively rare occurrence when some form of dystocia occurs and the infant had to be manipulated and represented (viz. the Zavanelli procedure). If the cord has already been divided then this effectively deprives the infant of any possibility of placental support while the manoeuvre is being carried out with consequences that clearly could be fatal. (Thornton J G et al. 1999) In the recent past, the emergence of the practice of harvesting foetal stem cells from the cord blood may also have an influence on the timing of the clamping but this should not interfere with issues relating to the clinical management of the third stage. (Lavender T et al. 2006) There are some references in the literature to the practice of allowing the placenta to exsanguinate after clamping of the distal portion as some authorities suggest that this may aid in both separation (Soltani H et al. 2005) and delivery (Sharma J P et al. 2005). of the placenta. It has to be noted that such references are limited in their value to the evidence base and perhaps it would be wiser to consider this point unproven. We have searched the literature for trials that consider the effect of controlled cord traction without the administration of embolic drugs. The only published trial on the issue suggested that controlled cord traction, when used alone to deliver the placenta, had no positive effect on the incidence of post partum haemorrhage (Jackson, 2001). The same author also considered the results of the administration of ecbolic agents directly after placental delivery and found that the results (in terms of post partum haemorrhage at least), were similar to those obtained with ecbolics given with the anterior shoulder delivery, although an earlier trial (Zamora, 1999) showed that active management (as above) did result in a statistically significant reduction in the incidence of post partum haemorrhage when compared to controlled cord traction and ecbolics at the time of placental delivery. In this segment we should also consider the situation where the atonic uterus (in passive management of the third stage of labour) can result in the placenta becoming detached but remaining at the level of the internal os. This can be clinically manifest by a lengthening of the cord but no subsequent delivery of the placenta. In these circumstances the placental site can continue to bleed and the uterus can fill with blood, which distends the uterus and thereby increases the tendency for the placental site to bleed further. This clearly has very significant implications for the mother. (Neilson J et al. 2003) There are other issues which impact on the foetal and maternal wellbeing in this stage of the delivery but these are generally not a feature issues relating to the active or passive management of the third stage of labour and therefore will not be considered further. There are a number of other factors which can influence the progress of the third stage of labour and these can be iatrogenic. Concurrent administration of some drugs can affect the physiology of the body in such a way as to change the way it responds to normal physiological processes. On a first principles basis, one could suggest that, from what we have already discussed, any agent that causes relaxation of the myometrium or a reduction in uterine tone could potentially interfere with the efficient contraction of the uterine musculature in the third stage and thereby potentially increase the incidence of post partum haemorrhage. Beta-agonists (the sympathomimetic group) work by relaxing smooth muscle via the beta-2 pathway. The commonest of these is salbutamol. When given in its usual form of an inhaler for asthma, the blood levels are very small indeed and therefore scarcely clinically significant but higher doses may well exert a negative effect in this respect. (Steer P et al. 1999) The NSAIA group have two potential modes of action that can interfere with the third stage. Firstly they have an action on the platelet function and can impair the clotting process which potentially could interfere with the bodys ability to achieve haemostasis after placental delivery. (Li D-K et al. 2003) Secondly their main mode of therapeutic action is via the prostaglandin pathway (inhibitory action) and, as such they are often used for the treatment of both uterine cramping, dysmenorrhoea and post delivery afterpains. (Nielsen G L et al. 2001) They achieve their effect by reducing the ability of the myometrium to contract and, as such, clearly are contraindicated when strong uterine contractions are required, both in the immediate post partum period and if any degree of post partum haemorrhage has occurred. Other commonly used medications can also interfere with the ability of the myometrium to contract. The calcium antagonist group (e.g. nifedipine) are able to do this (Pittrof R et al. 1996) and therefore are changed for an alternative medication if their cardiovascular effects need to be maintained. (Khan R K et al. 1998) We should also note that some anaesthetic agents can inhibit myometrium contractility. Although they are usually of rapid onset of action, and therefore rapid elimination from the body, they may still be clinically significant if given at the time of childbirth for some form of operative vaginal delivery. (GÃÆ'Â ¼lmezoglu A et al. 2003) relevant legal and ethical issues related to topic and midwife, Many of the legal and ethical issues in this area revolve around issues of consent, which we shall discuss in detail shortly, and competence. Professional competence is an area which is difficult to define and is evolving as the status of the midwife, together with the technical expectations expected of her, increase with the advance of technology. In general terms the areas of professional competence are defined in both legal and ethical terms. These two areas commonly overlap but they do differ in a number of ways. The ethical duty of non-malificence is essentially an obligation not to do harm to the patient. The legal consideration of this point is rather broader insofar as the law requires that not only do you (as a midwife) have to ensure that you do no harm to the patient but that you also have a duty to ensure that no harm comes to the patient by other means. This essentially means that the healthcare professionals concerned must speak out if they are aware of the possibility of potential harm to the patient. (Halpern S D 2005) In the context of this dissertation we could cite the hypothetical example of an obstetrician who was practicing passive management of the third stage of labour in direct conflict with the evidence base in the area. This would require a professional midwife to voice her concerns on the matter and she would be held legally liable if she simply acquiesced in silence. (Dimond. B. 2001). Another example (and supported by legal precedent would be the liability of a midwife who did not speak as the patients advocate if the obstetrician was incapacitated by illness or (for example) alcohol. (Re C 1994) In broad terms, the issues enshrined in the area of professional competence are encapsulated in the Bolam Principle. (Hunt T 1994). This states that a healthcare professional should not be held as negligent if he or she acts in accordance with the practice accepted at the time by a reasonable body of medical opinion. in effect, this principle is saying that it is neither reasonable nor practical to expect every professional to achieve expert status in every field of their clinical practice. When acting in a clinical sphere, the healthcare professional should effectively go to lengths that another reasonable practitioner would go to then they would not be considered negligent. (Clarke J E et al 1997). This principle effectively allows common sense to prevail. It is of particular importance in the next section where we shall consider issues of informed consent. A balance must be drawn between what is possible and what is necessary. There is no merit in covering ones self by explaining all possible eventualities to a patient if the net result is that the patient is going to be unrealistically terrified of the potential hazards of a procedure. We shall discuss this in detail shortly. We can conclude this section on negligence with the overview that it has been accepted that if a healthcare professional can point to or cite evidence that has been published in a reputable peer reviewed journal with a secure evidence base, then it is unlikely to be successfully challenged. The greater the evidence base for a specific course of action, the less likely it is that it can be disputed. (Hewison, A. 2004) informed choice and informed consent, Healthcare professionals in general, and midwives in particular, are constantly confronted with the issue of consent. Some situations are tacitly taken for granted simply because there is a general understanding that if the patient allows contact, such as having their face washed, then there is the implication of consent. At the other end of the clinical spectrum, if a patient needs a LSCS and has arrived in the anaesthetic room, they are not realistically in a position to leave if they so choose. Given these circumstances it is vital that the patient has been in a position to have given informed consent which means that it should have been carefully and considerately explained to them beforehand. Consent is the difference between therapy and assault (Veitch RM 2002). This comment is essentially at the forefront of our considerations here. Even in antiquity there was general agreement that consent was necessary. There are surviving texts from the days of Hippocrates which suggest that although the healthcare professionals of the day had an obligation to do their best for the patient there was no formal obligation on the part of the patient to have to accept what was advised. In reality, we can reflect on the fact that many of the treatments of those days were clearly gross and the issue of consent would actually have been less of a matter of contention simply by virtue of the fact that the patient would clearly have had to have made up their mind to accept the treatment if they turned up to see the physician at all. (Carrick P 2000). The realities of today mean that there are a great many more subtleties to consider and we now have the benefit and guidance of the advice given by the Good Practice in Consent Initiative Group which was a direct result of the requirements of the NHS Plan that proper consent must be sought from all NHS patients and research subjects. (DOH 2000). It was set up under the auspices of the National Institute for Clinical Excellence which noted an area of ambiguity in current practice and felt that definitive guidance was needed. (Brechin A et al 2000). Their advice is considered to be perhaps currently the definitive guide on the subject. (Say R E et al 2003). The group use the term proper consent which is not just casual phrase but does have a very precise definition. We note that the definition however, is different in ethical and legal contexts. The ethical connotation is that the adult is always considered to be competent to give proper consent unless it is proved to be not the case. (Kuhse Singer 2001). The legal connotation was summed up by Lord Donaldson (Donaldson 1993) who ruled that The test that they should apply is Can this patient understand and weigh up the information needed to make this decision? (DOH 2000). If they can, then the clinician has judged them to be competent and the consent is Proper. In the converse case then clearly it is not. The whole area of childbirth is one which is invested with a high emotional content. It is therefore incumbent on the midwife (and all healthcare professionals) that they should not let their own personal values influence the decision that the patient eventually makes. (Mason T et al. 2003). If the patient should make a decision that appears to be completely out of character or irrational, one should not immediately assume that they are incompetent. it is actually probably more rational to conclude that they may not have clearly understood the explanations given to them by the professionals and as Mezirow comments, it may also therefore be a consequence of the fact that inadequate opportunity has been given for the patient to reflect, consider and to ask questions. (Mezirow, J 1991). The issue of competence is complicated further with the recognition of the fact that the legal definition of being competent to give consent is not necessarily universal. Winter (R et al. 1999) gives the example of a patient who can be judged competent to decide whether they have a flu vaccination or nor yet may not be competent to make a complex decision relating to investment strategy. Problems arise not so often in the every-day circumstances of professional practice, but at the margins where situations are encountered which are perhaps not met very often. The midwife may find herself in a situation where the patient cannot, either by virtue of sudden emergency of perhaps being under the influence of sedation or anaesthetic, give competent informed consent. The question then arises as to who is able to give consent for any particular procedure? It is a common situation for relatives to be present and they may wish to give consent on behalf of their relative. Both the Good Practice in Consent Initiative and the professional guidelines on the subject drawn up by the Royal College of Midwives give unequivocal guidance on the subject. Both these authorities concur with the ruling by Lord Donaldson (Donaldson 1993) who ruled that if a patient is considered incompetent to give consent, for any reason at all, then others cannot give that consent for them. It is entirely appropriate for the clinician to listen to the points of view of all interested parties and may appropriately ask them to sign a form stating that this is their opinion or that they are happy with a proposed procedure, but they cannot give vicarious consent for that procedure on behalf of the patient. In short, the responsibility lies with the clinician involved to make a considered judgement on what they consider the patient would have said when they were competen t and the responsibility for that decision is theirs. This is clearly a decision that has to take into consideration issues that have a range and scope that is far wider than simply the clinical issues to be considered. Douglas sums up the situation by commenting that the clinician must try to come to an opinion as to just how it would be thought likely that the patient would have reacted in the circumstances. (Douglas C 2002) One other area of clinical importance where the law gives clear guidance, is the area where the patient has given instructions or perhaps expressed a wish as to how they wised to be treated in any specific situation even though they may not be able to give that opinion at the time in question and the clinician must abide by these wishes in the absence of any other factors. (Sugarman J Sulmasy 2001) The ethical debate about a patients choice revolves around the issue of autonomy. (Coulter A. 2002). Healthcare professionals have to allow the individual patient the right, Gillon would suggest the responsibility, (Gillon R 1997) of each patient to determine how they wish to advance their own welfare. The key issue in this regard is enunciated by Dimond (B 1999) who we cite verbatim: In the context of medical consent, this right and responsibility is exercised by freely and voluntarily consenting or refusing to consent to recommended procedures or treatments when in possession of a sufficient knowledge of the benefits .. and risks involved. It is this last phrase which encapsulates the difficulty in this area. How does a healthcare professional ensure that a patient has sufficient knowledge to make the decision they are being asked to make without either frightening them inordinately with excesses of information or attempting to sway or influence their decision by making a conscious decision to restrict the amount of information given. To illustrate this with an example. If a patient decides that they do not want to have ecbolic drugs the healthcare professional is faced with a dilemma. If they know that the evidence base is considerably in favour of the use of such drugs, to what extent should they invade the potential autonomy of the patient in seeking to persuade them to change their mind to what may be seen as a more rational choice? Yura helps us with an analytical assessment of this point. (Yura H et al. 1998). The authors suggest that the judgement as to whether the patient is making a proper decision should be based on consideration of four criteria, namely: 1) Adequate disclosure of information 2) Patient freedom of choice 3) Patient comprehension of information 4) Patient capacity for decision-making If these criteria are met then one must assume that the decision is proper and should not seek to change it further. Yura then goes on to suggest that if these criteria are all met then one can also say that three further necessary requirements for proper consent are also met. 1) That the individuals decision is voluntary 2) That this decision is made with an appropriate understanding of the circumstances 3) That the patients choice is deliberate insofar as the patient has carefully considered all of the expected benefits, burdens and risks and reasonable alternatives. If we look at the current recommendations of the Royal College of Midwives advice on the subject, we can point to the fact that they currently require four specific areas to be addressed. They clearly cannot determine to what depth these areas have to be covered, as this has to be left to the professional judgement of the individual clinician involved. They suggest that if: 1) Diagnosis 2) Nature and purpose of treatment 3) Risks of treatment 4) Treatment alternatives. (cited in Hogston, R et al 2002). have all been covered, then the consent process can be considered proper and adequate These arguments can be encapsulated in a comment by Lewars who, although he was actually writing about consent in the area of radiographic imaging, finds that his comments are equally valid in this respect. The thrust of this discussion, in essence, revolves around the fact that a consenting competent adult has the right to either agree or disagree with any form of treatment or investigation and that there is no compulsion or necessity for them to justify that decision to anyone else. The problem for the profession is just how to quantify and to educate the patient sufficiently for that consent to be valid. (Lewars M 2004) implications for future practice, Putting all of these considerations together, we approached this topic with an open and enquiring mind. It is clearly important, when trying to come to a decision on issues such as these to try to embrace the principles of evidence based practice. In each area of clinical activity, the conscientious practitioner should endeavour to assimilate their own personal evidence base. This should ideally be done by a personal and critical assessment of the available literature. (Taylor. B. J 2000). We note that simply by reading the literature one is not likely to come to a rational conclusion as some papers (particularly the older ones) are little more than an exposition of the personal opinions of experienced clinicians. Although this may have some value, it is graded at Level IV in the scale of evidence Classification of evidence levels Ia Evidence obtained from meta-analysis of randomised controlled trials. Ib Evidence obtained from at least one randomised controlled trial. IIa Evidence obtained from at least one well-designed controlled study without randomisation. IIb Evidence obtained from at least one other type of well-designed quasi-experimental study. III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies. IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities. ( After Tanenbaum S. 1999) Of far greater gravity and legitimate weight are the papers which are categorised as Level I (a + b) which are derived from meta-analyses or properly conducted randomised controlled trials. In researching this discussion we have tried to restrict the papers presented in support of the arguments discussed to be at least Level IIb and above. This helps to give legitimacy to the arguments put forward. There appears to be little doubt, from the evidence presented here, that the passive management of the third stage of labour does appear to have a number of rational arguments to support it and there are demonstrable benefits to be obtained from such passive management. We can cite the absence of the side effects of some of the ecbolic drugs as a simple example. If the drugs are not given then the patient will not experience the possible side effects such as nausea, headache and hypertension to name but a few. The corollary of this line of action is that, in sparing the patient such possible side effects it would appear that they are also spared the protective and beneficial aspects of such drugs. We have set out unassailable evidence that the use of ecbolic drugs reduces the number of post partum haemorrhages and therefore the associated morbidity (and mortality) that goes with it. Proponents of passive management of the third stage point to drawbacks with the use of ecbolics (as indeed do some of the balanced papers that discuss active management of the third stage). There is no doubt that if used unwisely or inappropriately, there are drawbacks to their use. The issue of the undiagnosed twin is frequently cited as a possible contraindication. In real terms however, in the developed countries, such eventualities are extremely rare, as the advent of commonplace ultrasound investigations of pregnancy has made the diagnosis of multiple pregnancy comparatively easy. The significance for future practice would appear to be that there is little evidence to support the overall efficacy of passive management of the third stage of labour. As a concluding comment we will consider the article by Stevenson (Stevenson J 2005) which makes comment on the Bristol third stage trial. It makes interesting reading as a commentary on the presentation of the trial. We have not included it in the main body of discussion as it cannot be considered a balanced argument being essentially the opinions of the writer Stevenson opens his paper with the comments: But the trial, based on false premises, is completely misleading, and numerous criteria are mistaken, misunderstood or misinterpreted. The reason that we have included this in the consideration of the overall issue is his premise about the trial structure in which he comments: The obvious alternative to active management is passive management, to see whether a womans body can cope without assistance; that should settle the matter conclusively. Here is a very common blunder in logic: to go from the sublime to the ridiculous, to justify one inordinate extreme by ridiculing the opposite inordinate extreme. The thrust of Stevensons logic is clear and he effectively and coherently argues for a middle course of partial management and active intervention only when needed. The difficulty with this course is that it is dependent on both circumstance and individual clinician preference, and as such, it is virtually impossible to construct a protocol for a controlled trial. The corollary of this is that, although Mr Stevenson can freely express his opinions it is unlikely that there will ever be a randomised controlled trial which will allow him to assemble a secure evidence base for his assertions. Sadly, after a careful and erudite exposition of his argument, Stevenson rather diminishes the validity of his paper by ending with the unflattering comment: The statistician, nowadays retitled epidemiologist, without noticing the abysmal flaws in the structure of this trial, has dressed it in jargon, giving it an air of respectability and credibility. Debate and disagreement is healthy and will promote further research. There is no doubt that further research is needed in this area. 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