Attitudes to Language Essay Example for Free

Attitudes to Language Essay Language clearly plays a major role in all aspects of society. The most obvious is its social role of allowing people to relate to each other in all facets of their lives: to share information, emotions and ways of life. We use language as a means of navigating our daily lives and it plays an integral role in most of our interactions. Perhaps for this reason, French is regarded as an elegant and romantic language, while German is considered to be guttural. Additionally, ever since mankind evolved into different language communities, it is commonplace for people to adopt various attitudes towards the language(s) spoken by others, as well as towards the dialects of the language they speak. These attitudes are motivated by different factors, including pride in or shame regarding one’s own language, confidence or embarrassment about how one sounds, nationalism and a sense of personal dignity, one’s status and values as well as the prestige some languages are given in international interactions. A well known attitude is the desire for foreign speech patterns; another is the rejection of certain dialects. People form impressions of your personality, emotional state, geographic origin, education, experiences, age or socioeconomic status from the language you use and the way you use it. We often witness the amusement of an audience when someone speaks in the creole, for not only does the system of sound evoke laughter, but the assumption that the speaker is an uneducated serf is then made. Ridicule and contempt for the vernacular, creoles and dialects are common responses from some members of society, even within the Caribbean society, where dialects are rich, strong and the first language. Dialects develop under various circumstances as well as geographical locations and are varieties of languages. A creole could be a dialect within a language. Because of our history, people of the region tend to place a high premium on the standard languages (the language of power and economic might). Many  people believe that upward mobility is largely dependent on one’s ability to fit in with the predominant socioeconomic class, and language is the main signifier of this fit. Many Caribbean writers have described scenarios of people who went overseas, were generally expected to return with a new command of the target language and often demonstrated their new found ‘status’ by emphasizing their foreign accent of ‘twang’. While some might be impress ed by the ‘twang’, others view such pretensions with derision. Attitudes to language may vary from one sector of the society to another and some people demonstrate self-conscious behavior when speaking the standard language. This is largely a result of the fact that in most societies one is often judged on the basis of the variety of language that one speaks. This is even more prevalent in societies with a colonial legacy, like the Caribbean, where certain dialects are associated with the institution of slavery or conquest. Increasingly, educators are becoming aware that a person’s native language is an integral part of who that person is and marginalizing the language can have severe damaging effects on that person’s psyche. Many linguists consistently make a case for teaching native languages alongside the target languages so that children can clearly differentiate among the codes ( a term used synonymously with language or dialect but generally refers to a linguistic system of communication. A code can also be non-linguistic such as a dress code or code of conduct) and hence be less likely to mix the two. This approach has been adopted in Haiti, where schools teach both Standard French and French Creole (Haitian) and children are expected to be fluent in both. Additional prominence has been given to Caribbean Creoles with the publication of Creole dictionaries and with the translation of the New Testament from the Christian Bible into French Creole in St. Lucia. A similar project is under way in Jamaica. While attitudes to local dialects have been slowly changing, many people still associate the use of Creole with negative images and believe that its use should be relegated to specific circumstances and occasions. However, the fact that non-standard language varieties are the most widely spoken in the Caribbean makes them the choice of persons trying to get information to large sections of the society. For example, many advertisers use the Creole language to ensure that their message appeals to most people. At the same time, because of the prestige attached to the standard language, it tends to be the language of choice on formal occasions, like church services. A language variety is usually chosen because of its perceived social functions. You may have noticed that, the more formal the occasion, the more likely the use of the standard language, while for everyday interaction, popular music or emotional appeals, people tend to gravitate towards the non-standard varieties. You would have noticed that, even in a formal situation, non-standard dialect might be used for anecdotes, to inject humour or in a quotation. In the Caribbean, people switching from one code of language to another, often without thinking. However, there are times when the use of standard langue would seem totally out of place and would even interfere with semantics. For example, folk stories, folk songs and proverbs seem to lose a certain essence when translated into standard. The role of language as a vehicle for sharing culture is indisputable. Caribbean writers, singers and oral poets have played a major part in fostering acceptance of the Creole languages of the region, by incorporating them into their work and exposing them to the world. Nonetheless, negative attitudes to these languages persist in the minds of many.

Are Video Games Good For Children Children And Young People Essay

Are Video Games Good For Children Children And Young People Essay For that matter, are video games good for adults. Has anyone ever seen the effects of prolonged exposure to video games and the effects it has on someones family or the community? As a father, I have dealt with negative effects of video games first hand. There have been numerous studies and debates on the subject of video games and the effects, whether positive or negative, they have on children. Video games are not good for children because of the negative effects to a childs behavior and overall health. Violent tendencies Children that play violent orientated video games have displayed violent tendencies toward others. There have been numerous studies and research conducted, on violent video games played by children, which suggest that children may become more aggressive after playing (Harvard Mental Health Letter, 2010) those types of games and the conclusion behind this reasoning, are three traits of the personality, which are high neuroticism, disagreeableness, and low levels of conscientiousness (Harvard Mental Health Letter, 2010). Playing violent orientated video games cause children to act and think aggressively (Harvard Mental Health Letter, 2010). These conditions may cause children to commit violent acts or behavior. Violent Behavior In addition to increased aggression, children who play violent video games are associated with increased violent behavior (Souccar, 2012). Because of this behavior, there have been multiple despicable acts such as the Virginia Tech shootings where a gunman killed over thirty people in 2007(Lee, Finley, 2011). In 1999, another devastating act in Columbine, Colorado, two teenage gunmen entered a school with weapons, killed twelve students and a teacher, before taking their own lives (Belanger, Wagner, 2011). Eric Harris and Dylan Kiebold were frequent players and program contributors to a violent video game called Doom (Lee, Finley, 2011). Children or teens, that do not commit violent acts, may still display pathologic behavior. Pathologic Behavior Children that play video games exhibit pathologic behavior. There are many warning signs of pathologic behavior, such as lying about or hiding how much time is spent playing or disobeying parental limits; losing interest in sports and hobbies; choosing the game over time with friends; and continuing to play despite plummeting grades(Wagner, 2008). This is a very touchy subject in my household. My thirteen year old step-son has exhibited pathologic behavior because of video games. When the neighbors kids come to ask him to play outside, he refuses and has continued playing his games. His grades at school have suffered because he does not concentrate on doing his homework and worries more about playing video games. He has told a few lies, thrown tantrums, kicked walls and our washing machine, and is constantly disrespectful to his siblings, my wife and myself. My step-son has also exhibits signs of video game addiction. Video Game Addictions Children with video game addictions, if left untreated, could have disastrous effects as adults. There are millions of people all over the world who love to play video games, either on game systems or online social media, but that love for the video games turns into tragedy for those with video game addictions. According to Lee and Finley (2011), a couple in Korea went to a local establishment to feed their video game addiction, only to return home over five hours later to find their four month old baby girl dead because she was left alone. Also according to Lee and Finley (2011), parents in Reno, Nevada were arrested after their obsession with video games caused them to neglect to feed their two young children. Increase of Video Game Addictions The increase of video games addictions has prompted the opening of clinics in countries such as the Netherlands, United States, China, and other countries around the world, to help combat the effects of video game addiction (Belanger, Wagner, 2011). Also stated, by Belanger and Wagner (2011), the Council on Science and Public Health recently proposed adding video gaming addiction to a list of formal disorders, such as drug addiction. Video game addictions and its symptoms mirror other addictions so closely, that it was almost classified as an official psychiatric disorder (Lee, Finley, 2011) by the American Medical Association (AMA) in 2007. With all of the negative effects of video games, such as addictions, there are good video games children can play. Good Video Games There are many video games that are good for children. Over the past few years, there have been many advances in good video games and game systems, such as the Wii from Nintendo and the EyeToy Kinetic from Sony, which engage the players with the game (Barros, et al, 2012). I and my family have played games on both systems, The Wii system controller is held by the player which controls the actions of the avatar on the screen. The Kinetic system is similar, but the player controls the movement of the avatar with his/her body movements through the use of a camera. One game that is used to induce physical activity, with both gaming systems, is a game called Dance, Dance, Dance (Barros, et al, 2012). The players are actively involved in the games that they are playing and are increasing their heart rate and physical activity. These Exergames (Barros, et al, 2012) are promoting exercise and physical fitness. Even though there are good video games, there are still other negative effects, su ch as inactivity from playing non-active games, which may induce childhood obesity. Childhood Obesity For children that do not have access to those types of games, cant afford the games, or just dont care to play them, often play the games that they have, for long periods of time, which leads to the lack of physical activity, and the onset of childhood obesity (Childhood Obesity, n.d.). A report, issued by the U.S. Department of Health Human Services, mentions a few reasons children may play video games for long periods of time. It may be the lack of parental control, being left alone by their parents for hours at a time, or just having to stay inside because of safety concerns (Childhood Obesity, n.d.). There is a growing concern, from parents such as myself, that children are becoming lazy from the lack of exercise because of video games. This lack of exercise contributes to weight gain and obesity. I have a personal connection with this subject because a member of my family was constantly playing video games, not getting any physical exercise, became a social outcast, and over a short period of time became obese. Video Games Are Not Good Video games are not good for children because some children exhibit too many pathologic behaviors and display violent tendencies because of video games. Children become addicted to video games which may carry over into their adulthood; they may lose all sense of reality, and their addiction to video games may become so severe, that tragedies happen because of that addiction. For other children, they may become obese because of the lack of physical activity. There are an abundance of good video games for children to play, but as a parent, I have been a witness to most of these negative effects for over 10 years and I am not going to let my step-son or any of my children play video games excessively. I will control how much time is spent playing video games; make sure that they take extended periods away from video games to get their homework completed and to get daily exercise.

Embryo Research :: Science Arguemtative Argument Papers

Embryo Research as a Paradigm of Ethical Pragmatics Research on the human embryo is one of the most obstinately controversial issues of international bioethical debate. There has not been enough of a consensus on this issue to allow for more than a formal compromise within Europe. I argue in this paper for a pragmatic approach to the problem which accords priority to "want-regarding" considerations but does not fail, as most utilitarian approaches do, to give due weight to the "morality-dependent harms" caused by the practice of embryo research to those rejecting it from other than want-regarding principles. I suggest that in deeply controversial bioethical issues a consistent want-regarding perspective should be prepared, under certain narrow conditions, to make pragmatic trade-offs between the inherent merits of the practice in question and the averse emotions of the public. These conditions are that the averse emotions are widespread, felt to be of existential importance, and stable under additional information, and that the costs in terms of reduced freedom and foregone humane progress do not seem excessive. Research on the human embryo is one of the most obstinately controversial issues of international bioethical debate. There has been not enough of a consensus on this issue to allow for more than a formal compromise even within Europe. In Germany, embryo research has been strictly prohibited since the Embryo Protection Act came into force in 1990. In other countries, such as Great Britain, research on the human embryo is permitted under certain narrowly defined conditions. But even in the countries with a ban on embryo research so much political pressure is exercised for a less rigid policy especially by medical and biological researchers that there is reason to doubt whether the ban on embryo research will be maintained in the long run. What is interesting about the debate from a philosophical point of view is the remarkable absence, for most of the time, of clear and stringent principles. Thus, there is some kind of consensus, at least in Europe, that human embryos should not be produced for research purposes. If embryos are made the objects of research at all they should be "supernumerary" embryos coming from in vitro fertilisations which have aimed at implantation in the maternal womb but which, for some reason or other, have not been used for this purpose. Even if there is an obvious moral difference between, one the one

Shakespeares Macbeth - Why does Macbeth Murder Duncan? :: GCSE English Literature Coursework

Why does Macbeth Murder Duncan? In Shakespeare’s play Macbeth, the lead character of the same name is not sufficiently happy with the high social position he occupies and the honored status he has acquired. Viewing the play simplistically, one may conclude that Duncan is murdered due to the ambition of Macbeth. Ambition is a sin, of course, and therefore Macbeth is punished for his sins. If one does not care to probe more deeply, this evaluation of the play is almost entirely satisfactory, because it is very simple and neat. Yet, this approach converts the work from an extraordinarily complex study of evil into a straightforward morality play and closes off discussion of the most interesting aspects of the play.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Now, there is some evidence for the charge of ambition. Macbeth does want to become king, and he refers to that desire as ambition ("I have no spur/ To prick the sides of my intent, but only/ Vaulting ambition which o'erleaps itself/ And falls on th'other" (1.7.25-28). But we need to be careful here not automatically to take a character's own estimate of his motivation for the truth, or at least for a completely adequate summary statement of all that needs to be said. We need to "unpack" just what that concept of ambition contains in the character to whom we apply it.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   For a fascinating aspect of Macbeth's motivation is that he is in the grip of something which he does not fully understand and which a part of him certainly does not approve of. This makes him very unlike Richard Gloucester, who announces his plans with glee and shows no scruples about what he has to do (quite the reverse: he looks forward to doing away with his next victim and invites us to share his delight). Clearly a part of Macbeth is fascinated with the possibility of being king. It's not entirely clear where this desire comes from. The witches (whom we will discuss later) put the suggestion into the play, but there is a strong hint from Lady Macbeth that she and her husband have already talked about the matter well before the play begins ("What beast was't then/ That made you break this enterprise to me?" (1.7.48-49). In that case, the appearance of the witches may be, in part, a response to some desire in Macbeth.

Problems Facing United States Today Essay

It is now year 2008, and after Bush administration’s destructive decisions to humanity, America is now facing tremendous problems at home and abroad.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   I consider moral standard as the problem which should be taken most seriously. Why? Because it has been in question since the Bush administration declared war against Iraq and violated not just the human rights but also the rights of the country and the rules of war. Justice was not given. Though there were a number of Americans that opposed these attacks, the effects violence has resulted to confusion on moral standards of most Americans.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Next is, the problem arising now in medical and social security aspects. It is a problem that should be dealt with as soon as possible for the reason that the government is spending large amount of money and that health is considered a high priority for the benefits of the citizens. There are also issues regarding the inequalities in the medicare system. The government should protect its citizens through improving this type of services. The third problem I consider to be taken with high importance are issues between the Republicans and the Democrats which constitutes the political controversies covering all other problems America is facing. There are far more important issues than the rivalries between the two parties. With this, the politicians tend to focus on such issues and controversies, rather than solving the state’s problems regarding the government’s inefficient services. Following this is the failing value of dollar. As a result of this, the economy of US is under a critical condition. If not solved, this may affect their domestic and international trades. The prices of services and goods may also increase, that may result to revolutions or the failure of the standard of living of the Americans. When this happens, it may cause the less competitiveness of their market to foreign trade.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The fifth problem I considered is the lack of preparedness and actions for natural disasters. The whole planet is under climate change and the people are not aware of what is it all about. The natural disasters now and stronger and are not detected and reported accurately. One example is the typhoon that hit a state in US wherein hundreds of people died and the government was unprepared, so the rescue operation and the services were of low quality. Not only that, the spread of information and educating the people about natural disasters is very minimal. Next is the poor control of government spending. Like the war in Iraq which cost them millions of dollars, but they failed to give justice to both sides. Also the funds they provide for space exploration in order to compete with other countries that are advancing in that field like Russia. Another is the fund for war weapons which are not rationally used, and gives high risk to the citizens security and health.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The seventh problem on my list is the human rights violation abroad brought by the wars launched during Bush’ administration. The war violated the human rights of almost all the population consisting Iraq. Its effects are long term because it has caused and American citizens residing in Middle East can be in danger for attacks as the result of the war.   Next is the lack of help in restoring the environment which is I think is connected with the issue on lack of preparedness. This is a problem because the whole planet is experiencing climate change, and given that US is a first world country and has a high contribution in the world’s pollution, I think they should launch programs and lead other countries in restoring mother nature. The ninth on my list is the problem within family relations. There is an increase in the number of partners getting a divorce, though they have institutions to help these families, still it makes their moral standards low since children of broken families are the victims. The last problem is the illegal aliens inside their territory that may cheat taxes and commit crimes causing another set of problems to the nation. References The Real Problem Facing America. January 18, 2008 retrieved from http://gopublius.com/the-  Ã‚   real-problem-facing-america/ Some More Information on the National Healthcare Plan– How It Can Be Done. January 18, 2008 retrieved from http://www.blogs4me.com/johnnyangel/ Importance of Your Family History to Your Marriage. January 18, 2008 retrieved from http://marriage.about.com/od/familyoforigin/a/familyhistory.htm Top Ten US Natural Disasters. January 18, 2008 retrieved from http://www.livescience.com/environment/top10_naturaldisasterthreats_us.html

Vacant Chapter 17 Family

The last five years have been unbelievable in more ways than one. It's been a long, difficult road, no doubt about it. There's fighting†¦and making up, money problems and tears, but we always make it through, and we make it through together. We are, however, about to experience three of the biggest changes in our lives thus far. Margie is retiring and a new manager will take her place. I'm pretty sure I know a candidate who is a shoe-in. Ethan has taken his duties as assistant manager very seriously. Margie confided to me that it would be a proud moment to see Ethan take her place. The salary increase was nothing to joke about either, and this promotion was enabling us to finally buy our own home. It wouldn't be fancy or lavish, but it would be ours. Margie has been an enormous support system for both Ethan and me. She's stepped in as the mother figure we both needed as we transitioned to new parts of our lives. One could say that I should have been bitter about a â€Å"stand-in† mother, but I never saw it that way. She has been my savior more than once, but when I first met Margie, I wasn't sure what to think. â€Å"Can I help you?† â€Å"Well, I was looking for Ethan.† The woman was small, but spoke with assurance. â€Å"Does he still live here?† I hadn't known what to tell her. It flashed through my mind when I answered the door that perhaps this was the landlord and someone had reported us. Ethan wasn't supposed to have anyone living with him. I shouldn't have cared if he got in trouble after the way he up and left me after I spilled my guts to him, but I just couldn't be angry with him – no matter how hard I tried. â€Å"I'm Margie, Ethan's boss.† I stalled in answering her, debating whether I should invite her in. â€Å"Dear†¦?† â€Å"Oh, sorry – I'm uh†¦Ã¢â‚¬  I didn't know whether to give my real name. My gut told me that this woman was harmless. â€Å"It's Emily.† My mother taught me to never give more information than necessary. â€Å"Well, Emily, it's a pleasure to meet you.† That day, Margie invited herself into the duplex and into my life. She was there to comfort me as I cried my eyes out and told her the events leading up to Ethan leaving. She hugged me and gave soothing words of encouragement; above all else, she assured me Ethan would return and that I just had to be patient. She spoke about Ethan that afternoon as if he were her own son. There was never a disapproving word, only compliments and work anecdotes from the years she'd known him. She was also there to support me through school. She insisted, along with Ethan, that I take full advantage of the scholarship I was given. She also wanted me to develop my interests and not just major in something so I could get a job. She told me to pursue what I loved; something I was passionate about. â€Å"I think I know what I want to major in,† I told Margie, the excitement of my revelation radiating in my tone. â€Å"That's great, sweetie. Tell me.† â€Å"This lady came in today with a little boy with autism, and it was so fascinating to watch her interact with him. I think I want to learn more about children and disabilities.† I was nervous about Margie's answer. Maybe she thought I was a little too ambitious or crazy even in regards to my career path. â€Å"What do you think?† â€Å"I think we are lucky to have you, one of God's angels here on earth. You warm an old woman's heart, Emily. I can't think of a better career choice.† I finished school three years later with a degree in Early Childhood Special Education. Margie was there with Ethan on graduation day, and I think she was the loudest cheerleader in the auditorium. â€Å"So, you really want to do this?† I used to be the one that was so unsure of everything and looked to Ethan to be the decision maker. Now, it seems, the tables have turned. He's always looking to me for reassurance. â€Å"I do. I know there will be a lot of work to be done on it, but I have the summer off. There is a lot I can do during that time.† I'd yet to tell him he'd be doing all the painting, but I think – all things considered – he'll be just fine with the tradeoff. â€Å"This house is in a better neighborhood and is a bit bigger. There is room for us to have a home office and a couple spare bedrooms.† The realtor was anxious to make a deal. The house had been on the market for several months due to the â€Å"as is† sale. She's hovering, not wanting this potential sale to slip away. â€Å"Do you have any questions, Mr. and Mrs. Parker?† Despite hearing Mrs. Parker every day, hearing it still brings a smile to my face. I grabbed Ethan's hand and led him back down the hallway. â€Å"I think we'll take another look around and meet you back out front.† I answer, desperate to get a few moments alone with my husband and away from the hovering realtor. â€Å"Will you marry me?† Those were the first words out of Ethan's mouth. Not, â€Å"Good morning, Emily. How did you sleep?† Stunned didn't even begin to capture what I was feeling. My brain wasn't fully awake, and I hadn't registered the small diamond on my left hand. Ethan had placed it there in my sleep and had yet to bring it to my attention. The two years before Ethan's proposal had been perfect. Our new apartment was a dream come true, and we'd even made friends with our neighbors Garth and Kim. The guys loved to barbecue, and Kim loved to talk about kids and literature, two of my favorite things. â€Å"Emily? Come on! You're killing me here!† His desperation made me giggle a bit, as if I'd ever tell him no. â€Å"Yes!† â€Å"Thank God! I was so nervous.† Three weeks later found us at Powell Gardens in the Marjorie Powell Allen Chapel. We had the ceremony on Friday evening, then a picnic in the nearby fountain courtyard. It was small, just Margie and her husband, Garth and Kim, and me and Ethan. We didn't have a honeymoon, but that was okay. Someday, we'd get there. â€Å"So what are you thinking we can do with this room?† Easy, Emily, don't rush it. Make it perfect, I tell myself. â€Å"I'm sure you'll want a place to set up shop at home to work on your lesson plans and stuff.† Ethan walks into the room and steps to the large bow window. â€Å"This window will give you a lot of natural light to work by,† he finishes. â€Å"Yeah, but I think the smaller room down the hall will be good for an office space.† Deep breath, this is it. â€Å"I think this room would be perfect as a nursery since it's right next to the master and has its own quarter bath.† Wait for it†¦. It takes longer than I think it should for it to sink in. I've counted to thirty before he turns around and stares at me blankly. I move my hand down to rest on my still flat stomach. His eyes widen and his mouth falls open. After a long pause, I give him a nod of confirmation and my eyes flutter closed for a couple seconds. â€Å"You're†¦?† I simply nod again. â€Å"Seriously?† â€Å"Seriously.† I don't even think my reply is completely out of my mouth before he's crossed the room and picks me up. He swings me around, hugging me tight. He's mumbling, â€Å"Oh my God, oh my God!† over and over into my breasts. I half expect him to sneak a motorboat in there while he's at it. I just grip his head tighter, relishing the moment. He finally sets me down and kisses me. This is the happiest I've ever seen this man†¦the man I love and worship and would do anything for. â€Å"Thank you, Emily. Thank you for giving me everything I've always wanted, a family.†

A Letter of Advice to Nhs Litigation Authority on Clinical Neglgence Case of Missed Fractured Scaphoid Bone

To: NHS Litigation Authority, Re: Chandler Bing v Friends Health NHS Foundation Trust Dear Sir/ Madam, Thank you for your referral of the case concerning Mr. Chandler Bing’s missed fracture scaphoid bone received on 31 August 2010. The following is the Letter of Advice to the NHSLA concerning the above-mentioned case. The Claimant: 1. The Claimant was born on 8 April 1969. As a result of the events referred to in their particulars of claim the claimant is now represented by Bloomingdale Solicitors to launch to launch a civil action against Friends Health NHS Foundation Trust on 31 August 2010. The Defendant: 2. The Defendant was at all relevant times responsible for the management control, and administration of Friends Health NHS Foundation Trust, and for the employment of doctors, nurses, and other medical specialist s including emergency medicine, radiology and orthopaedic surgeons at and for the purpose of the said hospital. Duty of care: 3. Each of the doctors, nurses, and other staff employed at the hospital who treated the Claimant at the hospital owed the Claimant a duty of care. This duty included a duty in respect of: a. The advice given to the Claimant; . The diagnosis made in respect of the condition of the Claimant; c. The treatment prescribed for the Claimant and advice as to the effect of the treatment; d. The monitoring of the Claimant whilst treatment was given to the Claimant. 4. The Defendant is vicariously liable for any such breach of duty on behalf of any of its employees. Procedural Steps: 1. Protocol Steps: a. Obtaining health records: to provide suf ficient information to alert the Healthcare provider where an adverse outcome has been serious; to request for specific medical records involving the case. . Request for copies of patient’s clinical records with approved standard forms. c. Make sure the copy records to be provided within 40 days of the request and for a cost not exceeding changes permissible under the Access to Health Records Act 1990. d. If the Healthcare provider fails to provide health records within 40 days, their advisers can then apply to Court for an order for pre-action disclosure. e. If Healthcare provider considers additional health records are required from a third party, these should be requested through the patient. Third party Healthcare providers are expected to co-operate. 2. The response: Letter of response: a. Provide requested records and invoice for copying. b. Comments on events and/or chronology. c. If breach of duty and causation are accepted, suggestions for resolving the claims and request for further information offer to settle. d. If breach of duty and/or causation are denied, outline explanations for what happened by Healthcare provider suggests further steps like further investigations, obtaining expert evidence, meetings, negotiations or mediation, or an invitation to issue proceedings. e. Healthcare provider should acknowledge receipt of letter of claim within 14 days of receipt. f. Healthcare provider should, within 3 months of letter of claim, provide a reasoned answer. g. If claim is admitted, then the Healthcare provider says so. h. If any part of claim is admitted, then Healthcare provider makes clear which issues of breach of duty and/or causation are admitted and which are denied and why. i. If claim is denied, include specific comments on allegation of negligence, and if synopsis or chronology of relevant events provided and is disputed, Healthcare provider’s version of events provided. . Additional documents, for instance, internal protocol, copies provided. k. If patient made an offer to settle at this stage as a counter-offer by supporting medical evidence, and/or other evidence in addition to claim in healthcare provider’s possession. l. If parties reach agreement on liability, but time is needed to resolve claim, then aim to agree a reasonab le period. Witness Evidence: The witnesses concerned in this case include: 1. Claimant’s family members and colleagues concerning the accused loss of function in daily activities of living. . Healthcare providers beside the medical doctor in Accident and Emergency Department, including accident and emergency doctors and consultants, radiologists, orthopaedic specialists, nurses, family doctors, etc, who have treated the Claimant. 3. The Claimant himself. Where a witness statement or a witness summary is not served, the party will not be able to call that witness to give oral evidence unless the Court allows it. Matters to be covered in the witness’s statement will include: 1. Occupation and working ability of the Claimant, if this has changed, since the injury, previous occupation of the Claimant. 2. Brief description of marital and family circumstances including dates of birth of all the family members of the Claimant. 3. The Claimant’s amount of the sequence of events relating to the treatment in question. Care should be taken to avoid importing text and phraseology from medical records or reports that the Claimant would not use in the normal course of discussing the case. 4. If the witness’s factual recollection of events differs in any important respect from the medical records, or from the version of facts set out in the Defendant, the statement should acknowledge this and comment upon these differences. 5. The witness should describe the effects of the injury; this will include the effects on his physical condition, emotional condition, the practicalities of everyday life, the Claimant’s financial affairs, family life, and future plans and projects. Additional witnesses should state their relationship to the Claimant. If a amily member is providing a statement which is collaborative of the Claimant’s amount of events, the witness should confirm that he or she has read the Claimant’s statement and state that he or she agrees with its contents, insofar as those within his or her knowledge. The statement should then deal with issues of which the witness can give primary evidence. Where a party is required to serve a witness st atement and he is unable to obtain such a statement, for example because the witness refuses to communicate with the Defendant’s solicitor, he may apply to the Court for the permission to serve only a witness summary instead. This application should be made without notice. The witness summary is a summary of the evidence which would otherwise go into a witness statement, or if the evidence is not known, matters about which the party serving the witness summary will question the witness. Expert Evidence: 1. In clinical negligence disputes, expert opinions may be needed: a. On breach of duty and causation. b. On the patient’s condition and prognosis. c. To assist in valuing aspects of the Claims. The main expert witnesses to be considered include: a. Orthopaedic specialists. b. Accident and Emergency specialists. c. Radiology specialists. 2. The new Civil Procedure Rules will encourage economy in the use of experts and a less adversarial expert culture. It is recognized that in clinical negligence disputes, the parties and their advisers will require flexibility in their approach to expert evidence. Decisions on whether experts should be instructed jointly; and on whether reports might be disclosed sequentially or by exchange, should rest with the parties and their advisers. Sharing expert evidence may be appropriate on issues relating to the value of the Claim. However, this protocol does not attempt to be prescriptive on issues in relation to expert evidence. 3. Obtaining expert evidence will often be an expensive step and may take time, especially in specialized areas of medicine, where there are limited numbers of suitable experts. Patients and Healthcare providers, and their advisers, will therefore need to consider carefully how best to obtain any necessary expert help quickly and cost effectively. . Assistance in locating a suitable expert is available from a number of sources. Here the NHSLA has already supplied a number of experts for this case. 5. This is a case of missed fracture of the waist of the scaphoid, for a patient initially seen in the Accident and Emergency Department, is often a clinical diagnosis rather than a radiological diagnosis, because this fracture may not become apparent on an X-Ray until often a period of 10 days, and some times konger, has elapsed. . Tenderness in the anatomical snuffbox at the base of the dorsal aspect of the thumb, or pain produced by proximal pressuring on the wrist joint in radial deviation by comparison to the unaffected side, together with diminished power of grip, is an indication for the forearm to be put into a scaphoid plaster of Paris. 7. The patient must have the plaster checked the following day and will need to be X-Rayed again in 10 to 14 days if a fracture line was not initially visible. 8. When a fracture of the scaphoid is suspected, â€Å"scaphoid views† should be asked for. 9. The doctor at Accident and Emergency Department must ensure that 4 views have been carried out: Anterior-Posterior, Lateral, Supination oblique, and Pronation oblique. 10. If there is doubt about the diagnosis or the fracture is displaced, then a more senior or orthopaedic opinion must be sought forthwith, otherwise a scaphoid plaster must be applied, and the patient referred to the next Accident and Emergency review clinic or fracture clinic. 11. There is a component of contributory negligence by the Claimant who insists to remove the plaster in the follow up clinic despite he was strongly advised not to do so. The effect of this contributory negligence on the Claims should be further explored and evaluated. Quantum of damages: The means to calculate the quantum of damages made in this case of clinical negligence include various heads of the following damage: 1. Pain, suffering and loss of amenity; 2. Loss of earnings; 3. Care and assistance; 4. Travel and parking; 5. Miscellaneous expenses. The Claims on items (1), (3), (4) and (5) are measured quite subjectively by the patient affected. The calculation of loss of earning could be done by using the Ogden tables, which are involving a set of statistical tables for use in Court case in the United Kingdom. Beside the age of this patient (Date of Birth=08/04/1969) being 41 years old on the date of claim (that is 12-11-2010) is known, we still need to know about the patient’s earning per annum, what is his occupation, whether he had any disability resulted, his qualifications, and his planned age for retirement. In case where the period of loss of earnings will continue for many years into the future, it is particular important to ensure that amount is taken of likely periodic changes to the Claimant’s income. The Claimant will want to point to anticipated career progression. In such cases, the Court will either: 1. Determine the average multiplicand, based upon the likely earnings throughout the period of loss, which will be applied to the full period of the loss, or; 2. Use stepped multiplicands for each stage of the Claimants career. Generally, this will result in a lower multiplicand at the beginning and possibly at the very end of the period of loss, with one or more higher multiplicands to represent the likely career progression that would have been followed. There is a need to interview the Claimant in more details to decide these uncertainties for a more comprehensive evaluation. Last but not least, the importance of expert evidence in such a case is vital. Medical evidence can provide an indication as to what work the Claimant will be capable of undertaking, both at present and in the future. This, together with evidence of the Claimant’s employment prospective, will assist the Court in determining what will happen to the Claimant in the future. Another means to calculate for the approximate quantum of the damage in this patient is to look into common laws and journals for similar cases for comparison and a rough estimation of quantification of similar claims. In Johns v Greater Glasgow Health Board1, a 44 years old lady broke her scaphoid bones in both wrists in a fall. The fractures were only diagnosed three months later. As a result the fractures would not unit, causing continuous incapacity and pain. Bone grafting was contemplated, despite an earlier unsuccessful attempt. Held, that solatium was properly valued at 11,000 pounds with wage loss to date and for a further 4 years. In W v Ministry of Defence2, which is a case of failure to diagnose fractured scaphoid from Clinical Risk 2010; Volume 16: p. 198 (by Collier et al). The case was settled concerning damages awarded to the Claimant pursuant to the delay in the diagnosis of the fracture of his hand, without which the Claimant could have avoided undergoing surgery and regained his complete and normal wrist function. W made an offer to settle in the sum of 15,000 pounds. The amount awarded to the Claimant was reduced to 9,000 pounds after further negotiation. 1. Johns v Greater Glasgow Health Board (1990) SLT 459. 2. W v Ministry of Defence (2009) MLC 1652 In B v Norfolk & Norwich University Hospital3, the Claimant, a male nurse aged 29 years, had attended the Norfolk & Norwich University Hospital NHS Trust after falling off his bike in July 2004. His left fractured scaphoid bone wad missed and a non-united scaphoid fracture with humpback deformity and associated ligament damage had occurred. The Claimant thus made a Part 36 Offer for the sum of 14,000 pounds that was agreed with the Defendants in March 2006. In N v Pontypridd & Rhona NHS Trust4, the Claimant injured his right wrist in a fall whilst ice-skating on March 14, 1998. He attended the Hospital’s Accident and Emergency Department and was noted as having a tender scaphoid. An X-Ray of the wrist was taken which was interpreted as disclosing no fracture. Nonetheless the wrist was set in plaster of Paris and the Claimant released. On March 19, 1998, the Claimant re-attended the Hospital’s Accident and Emergency Department still in pain. The cast was removed; no X-Ray was repeated. The Claimant was given tubi-grip dressing and told to exercise the wrist. On April 29, 1998, the Claimant attended a different Hospital complaining pain and swelling over scaphoid region. X-Ray showed a fracture of scaphoid bone in his right dominant hand. On May 29, 1998, the fracture showed sign of delayed union. As a result, a settlement of total damage of 12,500 pounds; general damage of 8,000 pounds, and special damage for income loss and care of 4,500 pounds were awarded. In P v United Bristol Healthcare NHS Trust5, the Claimant was involved in a fracas at nightclub in Bristol and arrested for punching security camera. The Claimant attended Accident and Emergency Department at the Bristol Royal Infirmary on 27 May 2000 and he experienced problems relating to his right wrist. The SHO treated the injury as being a sprain and no X-Ray was taken. The Claimant’s GP then identified tenderness in anatomical snuffbox. An X-Ray confirmed fracture through scaphoid being missed by Accident and Emergency Department. The Claim was finally settled for 40,000 pounds with causation proved. 3. B v Norfolk & Norwich University Hospital (2006) MLC 1350 4. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031 5. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD Settlement Where a Claimant has received State Benefits as a result of a disease and is subsequently awarded compensation, the Department for Work and Pension (DWP) will seek to recover these benefits from the Defendant via a system operated by the Compensation Recover Unit (CRU). The CRU is also responsible for collecting from a Defendant the cost of any NHS treatment that a Claimant has received following a clinical negligence. Notifying the DWP: Section 4 of the 1997 Act requires the compensator to inform the DWP not later than 14 days after receiving the Claim. The Notification should be made on Form CR1 which is sent to the DWP. On receipt of Form CRU1, the CRU will send Form CRU4 to the Defendant. The Claim then progresses to the settlement stage. When ready to make an offer of compensator, the compensator submits form CRU4 to obtain a Certificate. The CRU acknowledges receipt of form CRU4 within 14 days. The CRU sends the Certificate to the compensator- a copy will also be sent to the Claimant’s solicitor. The compensator will then settle the compensation claim and pay the relevant amount to the DWP within 14 days of the settlement. The compensator will also complete and send to the DWP Form CRU102 detailing the outcome of the Claim. The rules relating to recovery of benefit apply to clinical negligence claims. Due to their complexity, especially relating to causation, the CRU has set up a specialist group to deal with the claims, and makes a special request their compensators inform the CRU about clinical negligence claims as soon as the pre-action correspondence is received. Part 36 Offer: A party who wishes to make a Part 36 Offer must first apply for a Certificate of Recoverable Benefit from the CRU. Although Part 36 does not spell it out , guidance from case law suggests that the offer should therefore particularize the various heads of damage, and indicate the amount of benefits to be deducted against each head. Mediation: The parties should consider whether some form of Alternative Dispute Resolution Procedure would be more suitable than litigation, and if so, endeavour to agree which form to adopt. Both the Claimant and Defendant may be required by the Court to provide evidence that alternative means of resolving their dispute were considered. The Courts take the view that litigation should be a last resort, and that claims should not be issued prematurely when a settlement is still actively being explored. Parties are warned that if the protocol is not followed, then the Court must have regard to such conduct when determining costs. Mediation is one option for resolving disputes without litigation: it is a form of facilitated negotiation assisted by an independent neutral party. The Clinical Disputes Forum has published a guide to mediation which will assist, available at www. clinicaldisputesforum. org. uk The Legal Services Commission has published a booklet on â€Å"Alternatives to Courts†, CLS Direct Information Leaflets 23, which lists a number of organizations that provide ADR services. It is expressly recognized that no party can or should be forced to mediate or enter into any form of ADR. (Total: 3000 words) Bibliography: 1. Lewis: Clinical Negligence: A Practical Guide, 6th edition, Tottel Publishing. . Khan M, Robson M, Clinical Negligence, 2nd edition, Cavendish Publishing. 3. Powers and Harris: Clinical Negligence, 3rd edition, Butterworths. 4. Woolf S (1995) Access to Justice – Interim Report HMSO. 5. Woolf S (1996) Access to Justice – Final Report HMSO. 6. (1999) The Civil Procedure Rules HMSO. 7. â€Å"Making Amends†, at www. dh. gov. uk 8. †NHS Redress Bill† at www. publications. parliment. uk 9. Civil Litigation Handbook by Woolf, Lord Justice; Burn, Suzanne; Peysner John (2001), The Law Society. 10. A. A. S. Zuckerman, Ross Cranston (1995), Reform of Civil Procedure- Essays on â€Å"Access to justice†, Oxford University Press. 11. The Judicial Studies Board, Guidelines for the Assessment of General Damages in Personal Injury Cases, 9th edition, Oxford University Press. 12. Personal Injury & Clinical Negligence: Tough Conditions – The Lawyer 10/10/05, www. lexisnexis. com 13. Opinion: Edwina Rawson: The Lawyer 26/09/05, www. lexisnexis. com 14. Butterworths: â€Å"Risk Assessment in Litigation: Conditional Fee Agreements, Insurance and Funding†, David Chalk 15. The Law Society: â€Å"Conditional Fees: A survival Guide†, Napier and Bawdon 16. The Law Society: â€Å"Civil Litigation Handbook†, Peysner. 17. â€Å"Mediating Clinical Negligence Claims†, Roger Wicks, www. medneg. com articles 18. â€Å"Guide to Mediation†, www. clinical-disputes-forum. org. uk 19. â€Å"Guide to Mediating Clinical Negligence Claims†, www. clinical-disputes-forum. org. uk 20. Kemp and Kemp The Quantum of Damages, Sweet and Maxwell. 21. Medical Litigation Online, www. medneg. com 22. AvMA Medical and Legal Journal 23. â€Å"General Damages – the NHS Case†, Philip Havers Q. C. and Mary O’Rourke, Quantum, Sweet & Maxwell (2000) 24. Practice Direction at www. justice. gov. uk 25. NHSLA website www. nhsla. com 26. Civil Procedure Rules at www. justice. gov. uk 27. Pre-action Protocol for the Resolution of Clinical Disputes and Practice Direction – Protocols, www. justice. gov. uk 28. â€Å"Guidelines on Experts’ Discussions in the Context of Clinical Disputes†, Clinical Risk (2000) 6, 149-152 29. The â€Å"Draft Guidelines On Experts’ Discussions in the Context of Clinical Disputes† (published by the Clinical Disputes Forum) 30. Part 36 and its Practice Direction, www. justice. gov. uk. 31. The NHS Redress Act 2006 can be found online at www. legislation. gov. uk/ukpga/2006/44 32. Johns vs Greater Glasgow Health Board, (1990) SLT 459, www. medneg. com 33. W v Ministry of Defence, (2009) MLC 1652, www. medneg. com 34. B v Norfolk & Norwich University Hospital (2006) MLC 1350, www. medneg. com 35. N v Pontypridd & Rhona NHS Trust (2003) MLC 1031, www. medneg. com 36. P v United Bristol Healthcare NHS Trust (2004) MLC 1159 QBD, www. medneg. com