An Analysis Of Effective Listening Skills

An Analysis Of Effective Listening Skills Communication is the key to personal, financial, and entrepreneurial success. Seminars constantly tout the importance and crucial role of effective communication, especially in order to succeed at business. However, one aspect of communication skills that is often overlooked is the effective use of non-verbal communication. Non-verbal communication can be summed up as all the other parts of language that give us visual and non-audible clues in order to correctly interpret the meaning and intent of the speaker in a conversation. Non-verbal communication can be communicated through gestures and touch also known as Haptic communication by body language or posture, by facial expression and eye contact. Non-verbal communication can even be communicated through objects such as clothing, hairstyles or even architecture, symbols and graphics. For example, when one goes to a job interview, khaki pants can convey a range of meaning anywhere from oh, Im here to the well-dressed and ready to conquer, all based on the style, quality, cut, and fit of the pant. Simplistic yes, but tried and proven as well. By the same token, wearing blue jeans to a job interview, no matter how dressy the pants are, it sends an underlying message of casualness that may not be the chord to strike, depending on the position and industry. Also, speech contains nonverbal elements known as paralanguage, which include factors like voice quality, emotion and speaking style, as well as the spoken rhythm, word intonation or inflection and stress. Dance is also regarded as a nonverbal communication. Likewise, written texts have nonverbal elements such as handwriting style, spatial arrangement of words, graphical or design arrangements or the use of emoticons. However, much of the study of nonverbal communication has focused on face-to-face interaction, whe re it can be classified into three main focuses: environmental conditions where communication takes place, the physical characteristics of the speakers, and behaviors of the speakers during interaction. While not a traditionally defined form of non-verbal communication, effective listening skills are arguably the most prized set of communication skills for any businessperson to develop in order to achieve success. Furthermore, effective listening skills impact not only the professional sphere, but also the personal and emotional health and overall well being of a person. Many experts disagree on the number of specific components that encompass an effective listener, yet there are certain key elements that are generally accepted as guidelines to make a listener more effective and serve to enhance the quality of communication between the involved parties. Listening is one of those special skills that, because we can hear, we tend to believe that we can automatically listen. Yet for many people hoping to facilitate, listening is the most difficult skill to master. As I write this I am remembering one of todays well-worn clichà ©s, often used by those who arent listening: I hear what y ou are saying, but So says Mr. Trevor Bentley, who has developed a very specific set of criteria to define an effective listener. In his article, The special skills of listening, he states that specific situations require specific responses or set of listening skills. According to Bentley, one can narrow these instances to six main groups, which consist of monologue, dialogue, conversation, discussion, debate, and argument. Websters defines a monologue to be an extended uninterrupted speech by a character in a drama. The character may be speaking his or her thoughts aloud, directly addressing another character, or speaking to the audience, especially the former. Monologues are common across the range of dramatic media (plays, films, animation, etc.). In daily life, a monologue refers to that one individual who talks incessantly upon all subjects, often without pause to consider the effect of any of their utterances upon those in their immediate vicinity. On the other hand, dialogue is an interaction of sorts, its everyday basis and counterpart is a conversational exchange between two or more people. Now, a conv ersation is by definition communication between multiple people. It is a social skill that can be accomplished by the average individual. Conversations are the ideal form of communication in some respects, since they allow people with different views on a topic to learn from one another. For a successful conversation, the partners must achieve a workable balance of contributions. A successful conversation includes repeating, answering, creating and countering connections between the speakers or things and topics that the speakers know. For this to happen, those engaging in conversation must find a topic on which they both can relate to in some sense. They speak or from personal experience or from others observations and knowledge. Those engaging in conversation naturally tend to relate the other speakers statements to himself or herself. They may insert aspects of their lives into their replies, to relate to the other persons opinions or points of conversation. Again, all these are examples of different forms of listening. Finally there are discussions, debates, and arguments. While one can argue that these are all escalating forms of the same condition, the general meaning and reference of these three words is an explanation of an issue or a topic, compared and contrasted according to logical rules, and factually affirmed by persuasion and logic to declare one viewpoint in better standing than the other. Bentley recommends that in order to maximize communication in each of these situations one should chose a level on which to listen again, based upon the situation and to use a combination of directive, facilitative and active listening to have the most effective communication occur. His eight stages of listening cover non-listening, passive listening, judgmental listening, attentive listening, visual listening, reflective listening, active/creative listening, and directive listening. While the Bentley system has very logical and effective solutions to many communication dilemmas and situations, othe r experts take a more instinctive and generalized view of effective listening and non-verbal communication. In the article Turn listening into a powerful presence, Richard Harris states that Better-than-average listeners are keenly aware of the following important issues: partnership, reviewing systematically, effort, star events, empathy, neutralizing snap judgments, and tenacity. Listening is not by any stretch of the imagination a passive endeavor if practiced correctly or effectively. As a listener, one is always trying to receive or understand the meaning of the conversation, while dealing with all the non-verbal communicational clues on a subconscious level. If you are blindfolded in a room with some friends, you could participate in conversation actively. However, your responses and understanding could range from a little bit off to very misdirected, depending on how many visual cues and gestures you miss due to the blindfold. Active listening is not just generating responses to sounds or answering the question. It requires the listeners to understand, interpret, and analyze what is heard. Today, the ability to listen is an invaluable skill in interpersonal commun ication. It improves personal relationships by reducing conflicts, strengthening cooperation, as well as fostering understanding. Harris stresses the importance of practicing the issues that arise when holding a conversation, fully confident that a normal person can adapt and learn these techniques in order to become a more effective communicator. Sometimes effective listening is simply making sure that one is completely engaged in the conversation, suspending judgment, and making evaluations after all the issues have been discussed. However, it is not natural for humans to listen in this form, and patience and practice are key aspects to developing natural listening skills, which will eventually feel like a normal part of the mental acrobatics exercised on a daily basis by anyone who must communicate in any form. Effective listening is essential for anyone who wants to perform at his or her best, work easily and gracefully, and learn effectively. Few people realize that the art of listening has everything to do with intuition and little to do with the mental gymnastics of trying to concentrate on the words themselves. As you begin to see listening as an art and conversation as something that creates beauty, you will begin to understand how your own thoughts interfere with the experience. One expert argues that the less thinki ng that goes on during a conversation, the more effective the listener is, because more of the actual conversation is retained and absorbed. (Gunn) This particular expert states that in his personal research, the more open and clear a person is when engaged in conversation, the more recall is available after the conversation. Intuition and feelings are also very important to this particular theorist. For effective listening, this theory requires one to be very aware of the feelings that are being inspired throughout the course of the conversation, to be stored in the memory and analyzed after the conversation is over, which one presumably will have more recall thereof since one did not get mentally distracted by emotions or thoughts during the conversation. Effective listening is also closely related to non-verbal communicational forms such as gestures. Gestures are another tool that can be used to maximize a listeners input on the conversation and its outcome. While this specific tool is very culture based, it can be very effective when interpreted and practiced correctly. One of the most common cultures to use gestures in the United States is the Latin Americans. Gestures allow individuals to communicate a variety of feelings and thoughts, often together with body language in addition to words when they speak. For example, in the Cuban culture there is quite an amount of hand gesturing that leads throughout a conversation. Depending on the speed of the gesture shows the mental or emotional state of the person doing the speaking; if smooth motions are made with the hands, the words being said are meant to pacify or to be taken calmly, regardless of their content. Though gestures are not part of syntactic language, their processing take s place in the same areas of the brain used by speech and sign language. Another simple form of listening is reflective listening. Reflective listening is a communication strategy that involves two key steps: to comprehend a speakers thought, then offering the idea back to the speaker, to verify the idea has been understood correctly. It attempts to reconstruct what the client is thinking and feeling and to relay this understanding back to the client. Reflective listening is a more specific strategy than the more general methods of active listening. It arose from Carl Rogers school of client-centered therapy in counseling theory. (Hughes) It is important to observe the other persons actions and body language. Having the ability to interpret anyones body language allows the listener to develop a more accurate understanding of the speakers words and possibly even the intent of the conversation, which may or may not be audibly stated. Having heard, the listener may restate or paraphrase what the speaker is saying. This is a technique for reassuring the speak er of ones undivided attention. It really does not imply understanding or agreement. In emotional conversations, a good listener may intuit or sense underlying feelings and emotions. For example, when in an argument, one would say, I sense you are angry. Can you tell me why? Again, the interplay between the non-verbal clues and tools such as gestures and reflection all play a role in maximizing the effectiveness of the listener. While one cannot make a judgment call about the best way to listen, it is clear that the most definitive way to become an effective listener is to be mentally ready and to challenge oneself to practice skills that lead to naturally recalling and understanding everything that is said and intimated in conversation. While listening has much to do with the physical ability of the person, the intellectual application for effectiveness is more of a mental and psychological exercise that can only improve with constant practice. Not to trash the visually impaired, but the eyes are consistently the best source for all the cues that guide effective listeners. For many in the business world, the time spent becoming an effective listener will be priceless in terms of communication that can open doors and opportunities. Furthermore, an effective listener that applies their professional success to their personal life can also ensure a very productive and emotionally satisfying life, because all of us have something to say, and everyone wants to be heard. In the words of Bishop TD Jakes, Listen with your ears. The ears work better when windpipes are closed. Listen with your mind. Many times words are based on a point of reference that you may not be aware of. Listen with your heart. Many times words do not convey whats in the heart; so when you listen, hear what is said but also what is meant. Compassion is a critical part of understanding. It is difficult to love people without understanding them. Love seeks to understand. Listening with your heart will take away your natural propensity to be selfish. Listen with your heart. Many times words do not convey whats in the heart; so when you listen, hear what is said but also what is meant. Compassion is a critical part of understanding. It is difficult to love people without understanding them. Love seeks to understand. Listening with your heart will take away your natural propensity to be selfish. Sound words to guide the spiri tual health of his parishioners, but also very applicable to any successful individual in todays world.

Industrial Hygiene and Toxicology

Thermal radiation also known as infrared which is a form of light that can not be seen, we can only see visible light. Infrared gives us information that we would not be able to get from visible light. Because all object gives off some type of heat, yes, all objects even if the of cold or frozen. Cold or frozen objects only gives off a very small amount of heat, but this heat can be detected by infrared. We can you use infrared to gather information about the heat and temperature an object has. Anything that has a temperature whether it is cold or hot will give off will give off infrared light or heat. When looking at these objects the hotter they are the brighter they are. The less bright they appear they cooler the object is. For example if you used infrared to look at a cold or frozen object you would notice the object does not appear bright at all, but the further away from that object you move it will start to get brighter because the area is warmer than the object. The opposite is true for a hotter object the further you move from the heat the less bright the area appears. It was discovered in an 1800 experiment by William Herschel, the same astronomer that discovered Uranus. He used a cut-glass object to separate the sunlight into a spectrum of colors. While taking the temperature of the visual colors, he noticed when he placed the thermometer bulb just beyond the red colors the temperature would raise, this was the birth of thermal radiation. There are types of radiations in the electromagnetic spectrum, a lot of which we can not see. The little portion that we can see is called light. This spectrum is identified by either short or long wavelength, infrared is non-ionizing radiation found in the long wavelength between microwaves and visible light. Infrared radiation (IR) has wavelengths ranging from 780 nm to 1 mm. Following the classification by the International Commission on Illumination (CIE), this band is subdivided into IRA (from 780 nm to 1. 4 ?m), IRB (from 1. 4 ?m to 3 ?m) and IRC (from 3 ?m to 1 mm). This subdivision approximately follows the wavelength-dependent absorption characteristics of IR in tissue and the resulting different biologica l effects (Matthes & Stellman, 2011). † Infrared is being used by the government, private industry, and some research activities. The fire department uses infrared or thermal imaging to see through smoke during fires to help find personnel that may injured or trapped in the fire and find hot spots after a fire has been put out. The military uses it to help support in night surveillance and missions. The police department uses it for ground and aerial search, for example a thief hiding or running from the police at night The workplace is host to a variety of IR hazards, including both short-and long-term exposures that represent real health risks. Examples of operations that produce infrared radiation include welding, cutting, brazing, furnace operations, pouring, casting, hot dipping, glassblowing, lasers and high-intensity light sources (Sankpill, 2009)†. Working in the sun can cause sunburn from the rays of the sun. Infrared exposure has been know to cause cataracts. Two occupations that are most know for this is glass-blowers and furnace operators. Infrared exposure can also cause a loss of site. When it absorb in the eye, the area of the retina is damaged which cause you to loss site in that area. The American Conference of Governmental Industrial Hygienists (ACGIH) guideline for IR-A exposure of the anterior of the eye is a time-weighted total irradiance of 100watts per square meter for exposure durations exceeding 1,000 seconds (ACGIH 1992 and 1995) (Sankpill, 2009)†. All employees should try and engineer these hazards out or find a way to protect the employees by shielding them from the hazards. If this is unable to be accomplished then personal protective equipment (PPE) should be used as a last result. OSHA has stet standards to protect the worker from these hazards: 29 CFR 1926. 102(b)(1) for construction, 29 CFR 1910. 133(a)(5) for general industry, and 29 CFR1910. 153(a)(4( for maritime industry. There is a variety of protective eyewear that is coated with a IR-absorbing lenses that are shade at different level depending on the job being conducted. You can buy them in either: goggles, glasses, or face shields. Be sure not confuse tinted lenses with the protected shaded lenses. Also due to the new technologies plastic and polycarbonate lenses have been developed to absorb infrared across the entire lens at a consistent level. â€Å"Concerns have been raised about a possible link between some types of non-ionizing radiation and cancer. The way in which it might do this isn't clear. Non-ionizing radiation doesn't damage DNA directly, but it may be able to affect cells in other ways. The possible links between some of types of non-ionizing radiation and cancer are discussed below. But at this time, non-ionizing radiation has not been established as being able to cause cancer† (Society, 2010). In conclusion, infrared there are still a mixed opinions about the effect it has on the body. So it is best as always to take the proper steps to keep you safe. That means wearing the proper personal protective equipment when it is required. Also if you have to work with or around infrared you should always take it a pond yourself to learn the limitations of any type of radiations so that you will know how to protect yourself. Reference Page Matthes, R., & Stellman, J. M. (2011). Infrared Radiation. Retrieved May 25, 2013, from ILO Encyclopaedia of Occupational Health & Safety: http://www.ilo.org/oshenc/part-vi/radiation-non-ionizing/item/654-infrared-radiation Sankpill, J. P. (2009, October). U.S. Safety. Retrieved May 28, 2013, from U.S. Safety Web site: http://www.ussafety.com/media_vault/documents/1258397660.pdf Society, A. C. (2010, March 29). Radiation Exposure and Cancer. Retrieved May 28, 2013, from American Cancer Society web site: http://www.cancer.org/cancer/cancercauses/othercarcinogens/medicaltreatments/radiation-exposure-and-cancer

Brady Handgun Violence Protection Act Essay - 4860 Words

TABLE OF CONTENTS:_______________________________________________________ 1. Executive Summary ...†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 2. Thesis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 3. History and Analyzing the Problem †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦... 4 4. Methods †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.......... 6 5. Evidence †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.†¦.... 9 6. Recommendations †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 7. Evaluation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 17 8. Bibliography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 20 EXECUTIVE SUMMARY:______________________________________________________ The Brady Handgun Violence Protection Act, in short: The Brady Act, was United States legislation that was passed by Congress in 1993. The Brady Act required a five-day waiting period and criminal background check, performed by state and local law enforcement, for the purchase of a handgun. The Brady Act was instituted to curtail handgun violence and decrease the probability of a handgun ending up in a criminal’s hands. The legislation was heavily pushed by Senator James Brady and his wife, Sarah Brady, after Sen. Brady was seriously injured by a gunshot wound during the attempted assassination of President Ronald Reagan in 1981. The five-day waiting period went into effect on February 28, 1994, and was strongly opposed by theShow MoreRelatedBrady Handgun Violence Protection Act Essay2679 Words   |  11 Pages_____ The Brady Handgun Violence Protection Act, in short: The Brady Act, was United States legislation that was passed by Congress in 1993. The Brady Act required a five-day waiting period and criminal background check, performed by state and local law enforcement, for the purchase of a handgun. The Brady Act was instituted to curtail handgun violence and decrease the probability of a handgun ending up in a criminal’s hands. The legislation was heavily pushed by Senator James Brady and his wifeRead MoreThe Gun Control Debate Continues Essay1762 Words   |  8 Pagesstated that in February 28, 1994, the Brady Handgun Violence Prevention Law (the Brady Act) required a five-day waiting period for all handgun purchases from dealers. Whenever there is the sale of a handgun, shotgun, or long rifle to a prospective buyer, a background check must be performed on that person to decide whether that person is forbidden from owning a firearm due to past criminal actions. According to justfac ts.com between the implementation of the Brady Bill in March 1994 and year-end 1997Read MoreGun Control3838 Words   |  16 Pagesrather than regulations on guns. Guns don’t kill people, people kill people. Gun Control: Tragedies Throughout the years since guns have existed in the United States, there have been many mass killings. However, throughout recent years, gun violence has become much more prevalent in school settings. Three of the most well known massacres occurred in Colorado, Virginia, and Connecticut. These three horrific events have become synonymous with the word gun control. On April 20th of the yearRead MoreThe Free Range Of Interpretation Of The Constitution1648 Words   |  7 Pagesbetween citizen and state. The issue in the forefront of this is the Second amendment and the right that is described that a citizen under proper regulation can join a militia for the security of their free state as well have the right to bear arms (Brady). This amendment is open to interpretation as if much of the other Amendments has been the under controversy in to whether citizens should have the right to arm themselves with firearms. The branches of government whom are at the front of this issueRead MoreGun Control Research Paper2015 Words   |  9 PagesGuns In The United States In today’s society of political turmoil, violence, and economic tragedies, many gun control advocates are pushing for more gun regulations from the government. Guns have been a part of America’s way of life for centuries. However, it was not until the 20th century that the government enacted it’s first gun control act. The National Firearms Act was enacted in 1934, as stated in â€Å"Firearm Laws, Regulations, and Ordinances,† edited by Sandra Alters, in response to theRead MoreBackground Checks Are The Most Effective Way Of Preventing Gun Crimes1484 Words   |  6 Pagesmost effective way of preventing gun crimes. There are multiple cases of school and community shootings and how it could be prevented if there were some sort of system to catch perpetrators. Gun violence has been an issue since the 1970s and started to peak in the 1980s and 1990s. Gun Violence is violence committed with the use of a gun and recently there has been an increase in gun c rimes, but due to background checks they have decreased. A background check is the process of looking up and compilingRead MorePersuasive Essay On Gun Control1806 Words   |  8 Pagesthe National Firearms Act of 1938, the Gun Control Act of 1968, and the Arms Export Control Act of 1976. These three major legislations plus the rights given to the people by the constitution are the guidelines that the state governments follow and cannot contradict when they made state mandated gun regulations. One of the first major federal gun control related acts to be passed was the National Firearms Act was passed in 1934, which was followed by the Federal Firearms Act of 1938 (Vizzard, 2015Read MoreThe Issue Of Gun Control1199 Words   |  5 Pagesmany years. Several Supreme Court cases spoke about gun control during the late 1800s and first half of the 1900s, but were not a major issue until the 1960s. After the assassination of President John F. Kennedy, Congress passed the 1968 gun control act which banned mail-order gun sales. Congress has debated gun control since the attempted assassination of President Ronald Reagan on March 30, 1981. At that time there was not enough support for stricter gun control. Throughout the 1990s the controversyRead MoreGun control1657 Words   |  7 Pagesto background checks have been heavily discussed by both emotion and logic, by both gun supporters and gun control activists, and it seems like there is no middle ground for both parties to agree on. Crime rates influence guns demanded for self-protection, and guns demanded by criminals depend upon guns held by law-abiding citizens. Comparative-static analysis is used to investigate the effects of crime and gun control policies. The results show that i ncreases in crime control policies may reduceRead MoreU.s. Gun Legislation On The Rights Of A Free State1253 Words   |  6 Pagesand Gen. George Wingate. 1934: The National Firearms Act passes in response to gangster culture during Prohibition. The law implements a tax on the making and transfer of automatic-fire guns, shotguns and rifles. 1939: Supreme Court upholds a federal ban on sawed-off shotguns, implying that the Founding Fathers adopted the amendment to ensure the then-new federal government could not disarm state militias. 1968: Congress passes the Gun Control Act. The law calls for better control of interstate traffic

Osteoarthritis - Free Essay Example

Sample details Pages: 27 Words: 8222 Downloads: 4 Date added: 2017/06/26 Category Health Essay Type Research paper Did you like this example? The relative effectiveness of full kinetic chain manipulative therapy and full kinetic chain rehabilitation in the treatment of osteoarthritis of the knee. Brief Synopsis of the Research Therefore in this study we aim to establish the effect of the KFC manipulative therapy alone, FKC rehabilitation alone and the combination of the two interventions on osteoarthritis of the knee. This will be done by means of a quantitative randomised comparative clinical trial. Don’t waste time! Our writers will create an original "Osteoarthritis" essay for you Create order 60 patients will have been diagnosed with osteoarthritis of the knee according to the inclusion and exclusion criteria, and will be randomly divided into 3 groups. The first group will receive 6 treatments using FKC manipulative therapy alone, the second will receive 6 treatments using FKC rehabilitation alone, and the third group will receive 6 treatments using FKC manipulative therapy combined with FKC rehabilitation. Subjective (Beck Depression Inventory, McMaster Overall Therapy Effectiveness Tool, Western Ontario and McMaster Universities Osteoarthritis Index and Berg Balance Scale) and objective (Inclinometer) measures will be taken at baseline, 1 week and 1 month follow up. These results will be recorded and the data analysed using SPSS statistical package at a 95% confidence interval. Section B: To be typed in Arial 12-point font in one and half line spacing (expand sections to fit contents, but keep within the specified maximum lengths) 1. Field of Research and Provisional Title The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. 2. Context of the Research 1. Osteoarthritis is a very common condition, affects 9.6% of men and 18% of women aged 60 years worldwide (Woolf and Pfleger, 2003). 2. Although multi-factorial, falls cause nearly two-thirds of all non-intentional injury related deaths in older adults (Hawk et al., 2006). One of the causative factors is loss of hip and knee proprioception secondary to increased joint degeneration, thus by addressing these problems with the rehabilitation and/or adjustment there may be a decreased risk of fall. 3. There is research to suggest that applying manipulative therapy and rehabilitation to the full kinetic chain yields greater benefits for KOA patients than at home rehabilitation alone (Deyle et al., 2005), however this combination of treatments has never been compared against full kinetic chain manipulative therapy alone. 4. KOA stiffness, pain and dysfunction was shown by Deyle et al., (2000) and Deyle et al., (2005) to improve better when adding manipulative therapy to a rehab ilitation program as compared to placebo and exercise alone, respectively. 3. Research Problem and Aims Aim: The relative effectiveness of full kinetic chain manipulative therapy and rehabilitation in the treatment of osteoarthritis of the knee. Objectives: i) To determine whether manipulative therapy alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. ii) To determine whether manipulative therapy alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. iii) To determine whether rehabilitation alone is effective in the short term treatment of KOA in terms of subjective and objective measurements. iv) To determine whether rehabilitation alone is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. v) To determine whether manipulative therapy combined with rehabilitation is effective in the short term treatment of KOA in terms of subjective and objective measurements. vi) To determine whether manipulative therapy combined with rehabilitation is effective in the intermediate term treatment of KOA in terms of subjective and objective measurements. vii) To compare sh ort term results and intermediate results, respectively. viii) To determine whether manipulative therapy combined with rehabilitation is effective in decreasing the risk of fall according to the Berg Balance Scale. ix) To determine whether rehabilitation alone is effective in decreasing the risk of fall according to the Berg Balance Scale. x) To determine which treatment method is more effective in decreasing the risk of fall according to the Berg Balance Scale. 4. Literature review Osteoarthritis is a chronic degenerative disorder with a complex aetiology (Felson, 2000). It is characterized by focal loss of articular cartilage within synovial joints, associated with hypertrophy of bone (osteophytes and subchondral bone sclerosis) and thickening of the capsule, resulting in alterations in biomechanical properties (Woolf and Pfleger, 2003). It is a very common joint disorder, affecting mostly those above the age of 60 and can occur in any joint but is most common in the hip; knee; and the joints of the hand, foot, and spine (Symmons, Mathers and Pfleger, 2003). As many as 40% of people over the age of 65 suffering symptoms associated with knee or hip OA (Zhang et al., 2008), resulting in OA becoming the fourth leading cause of disability in the years 2000 (Symmons, Mathers and Pfleger, 2003). Although no cure exists, a number of treatment options exist to provide symptomatic relief as well as improvement of joint function. Amongst these are non-pharmacological interventions, such as rehabilitation, manual therapies, acupuncture and electromodalities, as well as pharmacological measures such as oral medication and intra-articular injections. In severe cases, where nonsurgical interventions have failed, more invasive approaches may be needed (Scher and Pillinger, 2007). McCarthy (2004) compared the effectiveness of an at home exercise program on its own or when supplemented with a class-based exercise program. There was found to be a greater improvement in WOMAC score in the class-based exercise group (20.6%) than the at home group (8.8%). These relatively modest effects may be owed to inability of exercise to address a number of factors that prevent patients from maximising results from their exercise program. Fitzgerald (2005) identified quadriceps inhibition or activation failure, obesity, passive knee laxity, knee misalignment, fear or physical activity and self-efficacy as examples of such factors. The necessity for additional inter ventions to address these factors therefore becomes apparent. Tucker et al. (2003) compared the relative effectiveness of knee joint manipulation versus a non-steroidal anti-inflammatory drug (NSAID), and found manipulation to be just as effective as NSAIDs in the treatment on KOA. Fish et al., (2008) had similar results when comparing the effectiveness of knee joint mobilisation against Topical Capsaicin Cream. Capsaicin has been previously demonstrated superior to placebo in many painful disorders including knee and general osteoarthritis. Pollard, Ward, Hoskins and Hardy (2008) applied a manipulative therapy protocol, consisting of soft tissue mobilisation and an impulse thrust to the symptomatic knee joint complex. This was found to have a statistically significant improvement in knee pain, mobility, crepitus and function when compared to the control group (interferential current set at zero). Pollard et al. (2008) also noted that knee treatment had a significant improvement in hip movement of those in the intervention group compared to the control group. This may be owing to the effect that treatment to a single joint may have on the full kinetic chain (hereafter FKC). A number of studies have been conducted on various joints of the full kinetic chain of the lower extremity to determine their effect on the knee. Cliborne et al., (2004) aimed to determine the short-term effect of hip mobilization on pain and range of motion (ROM) measurement in patient with knee osteoarthritis (OA). It was demonstrated that the presence of hip pain and pain on squatting, restricted hip flexion and/or a positive scouring test predicts a better knee OA outcome. Currier et al., (2007) suggest that pain over the hip, groin or anterior thigh; limitations in passive knee flexion and internal rotation of the hip; as well as pain with hip distraction predicts a favourable short-term response to hip mobilizations. In fact it was found that, based on the presence of one variab le, the probability of a successful response was 92% at 48-hour follow-up, which increased to 97% if 2 variables were present. Iverson et al., (2008) suggest that the strongest predictor of whether adjusting the lumbopelvic spine will decrease knee pain (in patellofemoral pain syndrome) is if there is a side-to-side difference in hip internal rotation greater than 14 °. The presence of this variable increased the likelihood of a successful outcome from 45% to 80%. These studies collectively show that correcting the various dysfunctions within the kinetic chain will have a favourable effect on knee joint dysfunction. However, there has yet to be a study that seeks to improve knee osteoarthritis by treating all indicated joints in the full kinetic chain. Few studies have looked at what effect combining manipulation and rehabilitation would have in the treatment of KOA. Deyle et al., (2000) applied manual therapy to the knee as well as to the lumber spine, hip and ankle as require d. Additionally patients where given to knee exercise program to perform in the clinic on treatment days and at home. WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores are used to detect changes in the patients perception of function and quality of life, specifically related to the disease process. In this study, there was a 55.8% improvement in the treatment group as compared to a 14.6% improvement in those patients receiving placebo (subtherapeutic ultrasound), thus proving the effectiveness of combining manipulation and rehabilitation. Using similar methodologies, Deyle et al., (2005) compared an at home versus in clinic physical therapy program. Those being treated in clinic received supervised exercise, manual therapy to the FKC and a home exercise program, while a second group received at home exercise only. Significant improvements where seen in both groups, however the clinic treatment group had an improvement in WOMAC scores of 52% and only a 26% improvement was seen in the home exercise group. The author attributed this difference between groups to the application of manual therapy to the full kinetic chain. However, the clinic group performed the exercises under supervision and where corrected where necessary while the home group were largely unsupervised and may have performed the exercises incorrectly as a result, thus decreasing the benefit such exercises would have. One should therefore not consider the difference in group performance to be solely due to the addition of manual therapy. To date there is no study which compares the effect of manual therapy alone versus the above mentioned treatment combinations. Therefore there is a need for a study to determine whether FKC manual therapy combined with a standardised rehabilitation program is more effective than either intervention alone in the treatment of osteoarthritis of the knee. 5. Research Methodology Design type: Quantitative comparative clinical trial conducted at the Durban University of Technology Chiropractic Day Clinic (hereafter DUT CDC). Advertising: [Appendix A] Old age homes and retirement villages throughout the greater Durban region will be approached, as well as advertisements placed on notice boards of DUT, community halls, shopping centres and places of worship. Sampling procedure: A sample size of 60 (n=60) will be selected by means of convenience sampling (Brink, 2006). Those individuals responding to the advertisements will be screened and accepted based on the inclusion and exclusion criteria. Telephonic interview: Patients are required to contact the DUT CDC telephonically to determine whether they meet the requirements of the study. This will be determined by asking the patient the following questions; * Are you between the ages of 38 and 80? * Have you had knee pain for longer than 1 year? * Do you have a history of trauma or surgery to the lumbar spine or lower limb? * Are you able to stand and walk on your own, with minimal need and/or without significant dependence on canes and walkers? * Do you suffer from a chronic medical condition that would require you to take regular medication? * Would you be prepared to have radiographs taken of your lower limb? If the patient meets the criteria for the study, a consultation will be made, at which they will be presented with a letter of information and informed consent form [Appendix B], which they will be required to sign. The following inclusion and exclusion criteria will be assess using a case history [Appendix C]; physi cal exam [Appendix D]; lumbar and pelvis [Appendix E]; hip [Appendix F]; knee[Appendix G] and; ankle and foot [Appendix H] regional examinations. Inclusion Criteria: A. Criteria, as developed by Altman (1991), requires a minimum of one of the first three clinical criteria below (#1, 2 or 3) for diagnosis of KOA (sensitivity 89 % and specificity 88%). 1. Knee pain and crepitus with active motion and morning stiffness ? 30 min (with age 38 ? 80 years of age). 2. Knee pain and crepitus with active motion and morning stiffness 30 minutes and bony enlargement (with age 38 ? 80 years of age). 3. Knee pain and no crepitus and bony enlargement (with age 38 ? 80 years of age). B. The following 4 criteria are all required: 4. Knee pain of ? 1 year duration and able to stand and walk without severe varus/valgus deformity and/or severe instability (Kellgren and Lawrence, 1957). 5. Diagnosis of concurrent subluxation/or joint dysfunction (S/JD) complex: a. Diagnosis of S/JD will be supported throughout using the PART(S) system. 6. A patient must have a score of ?720 mm (?30%) on the WOMAC scale to be included (Tubach et al., 2005). 7. No history of meniscal or other knee surgery in the past 6 months (Pollard et al., 2008). 8. A diary will be kept to monitor whether medication consumption is increased, decreased or stays the same. Exclusion Criteria: 1. Significant visual disorders, severe vestibular disorders, neurological and peripheral sensory disorders which may be a contra-indication to exercise 2. History of knee or hip joint replacement, severe varus or valgus deformity, instability, fracture and severe osteoporosis, Rheumatoid arthritis, or frank avascular necrosis with or without moderate or severe deformity, 3. History of significant lumbar herniated disc injury with sequela, 4. Severe balance and proprioception problems (i.e. inability to stand with and/or without marked spinal or hip deformity) 5. Symptoms of moderate to severe osteoarthritis in both knees and/or hips: Note: both knees can be treated if there is KOA or joint dysfunction in the opposite knee and otherwise no other severe complications as noted above. However, only data collected from the worst knee will be used for the purpose of the study. 6. Long term chronicity combined with multiple treatment failure especially multiple failur e with previous physical treatment (? 3), with and/or long term severe pain, and/or a severely complicated or complex disorder (such as multiple co-morbidities combined with KOA such as a mix of: knee, hip and lumbosacral OA, and/or cardiovascular and/or auto-immune disease), or a severely disabled and/or a patient with severe and decreased functional ability and/or a severe clinical depression, may lead on a case by case basis, to exclusion. A basic guide for #6 to be used on a case by case basis: I. Pain: The patient gives a history that can be interpreted as having stayed constantly or chronically at a high level of an estimated verbal analogue score (VAS) of ? 7 or WOMAC score of 1680-1920mm (70-80%) (out of a maximum worst score of 2400mm) for 3 to 5 years or longer. II. Complicated or complex: 3 or more disorders at one time in the same patient (with KOA) as listed from #1-5 above. III. Severely disabled: dependent on a cane, brace or walker 75 to 100% of the time when ambulating; severe cardiovascular disease; severe instability in the knee or other joints or possibly less than, or markedly less than half the normal ROM. IV. Clinically depressed: determined by history and use the Beck Depression Inventory (BDI). The BDI has been validated for measuring depression in clinical and nonclinical settings (Beck et al., 1961). Radiological analysis: Although diagnosis of KOA will be made primarily through clinical examination, knee x-rays will be taken on patients who qualify and consent to participate in the clinical trial. The purpose is to determine the grade of osteoarthritic change (according to the Kellgren-Lawrence scale (reference)), to confirm suspicions of contra-indications to treatment, or to rule out a pathology outside of OA. Additionally, the subjects history and physical examination may indicate the need for lumbosacral/pelvic, hip, ankle and/or foot x-rays (see exclusion criteria below). Procedure: Time Baseline 2 weeks 4 weeks 6 weeks 1 week F/U 1 month F/U # Rx 2 2 2 Outcome measurement WOMAC ROM BBS BDI WOMAC OTE ROM BBS BDI WOMAC OTE ROM BBS BDI Once accepted into the study, patients will be randomly allocated into 3 (three) groups using a randomised allocation chart (reference). Interventions: Group A will be treated with only manipulative therapy of the FKC. Group B will be treated with only rehabilitation of the FKC. Group C will be treated with manipulative therapy combined with rehabilitation of the FKC. Manipulative therapy: [Appendix I] FKC manipulative therapy (manipulative therapy to the knee, and any indicated axial or appendicular joint dysfunction, such as to the spine, hip, ankle, and foot) for KOA has been hypothesized as superior to localised manipulative therapy (Deyle et al., 2005). Treatment will focus on carefully restoring knee flexion and extension by lesser grades of mobilization as recommended by Deyle et al., (2005) and Fish et al., (2008), and patellar mobilization as per Pollard et al., (2008), along with careful high velocity low amplitude axial elongation of the knee joint as per Fish et al., (2008). Additionally, manipulative therapy will be applied where needed to the full kinetic chain using other diversified techniques, such as HVLA manipulation or mobilization as outlined in Shafer and Faye (1990), and/or Peterson and Bergman (2002). Also, the hip technique, as outlined by Hoeksma et al., (2004) and the use of HVLA knee manipulation methods from Tucker et al., (2005) will also be utili zed when indicated. The particular joint dysfunction also known as the subluxation complex or manipulable lesion will be chosen based upon findings in the regional examinations. Rehabilitation: [Appendix J] Rehabilitative therapy will include exercises, focused soft tissue treatment and stretch to the knee and elsewhere along the full kinetic chain where needed based upon functional assessment (Deyle et al., 2005). Also included in rehabilitation will be patient advice, education and home exercise recommendations for managing their KOA. The rehabilitation protocol will be standardised across groups B and C, with minor case by case variations. Intervention frequency: All patient will receive: 6 treatments in the first three (3) weeks (2x treatments/week). Training in a rehabilitation program, to be completed daily. Regular telephonic communication (every 1-2 weeks) following the completion of the 6th treatment. All groups will be required to return to the clinic no more than one (1) week after the 6th treatment and at the one (1) month follow up to have readings taken. Measurement Tools: All data will be collected previsit 1, no more than 1 week after 6th treatment and at 1 month follow up, with the exception of OTE which will not be collected at previsit 1. Subjective data will b obtained by means of; Beck Depression Inventory [Appendix K] The McMaster Overall Therapy Effectiveness (OTE) Tool [Appendix L] will be used to assess patient satisfaction and general improvement. o The OTE is a valid and reliable questionnaire that allows the patient to classify the change in their health status: whether their KOA symptoms, or overall quality of life has improved, remained the same, or worsened since the last visit (Chan et al., 2006) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Appendix M] detects change in function and quality of life in patients suffering from KOA using multiple questions with the visual analogy scale (VAS). o The WOMAC is valid and reliable for KOA, and has a long history of being broadly and freque ntly utilized to assess knee and hip OA, thus allowing comparison to a large number of studies and trials (Bellamy et al., 1988). Berg Balance Scale (BBS) questionnaire [Appendix N] is a predictor of fall risk and will be delivered if the one legged standing test is failed (Hawk et al., 2006)). KOA patients who are +ve for the Berg Balance Scale (BBS) will be monitored as a subgroup (with a + OLST and BBS) at all clinic assessments Objective data will be obtained by means of: Inclinometer [Appendix O] readings for knee flexion and extension only to evaluate the patients range of motion (ROM) (reference). Statistics: The latest version of SPSS will be used to analyse the data. 6. Plan of Research Activities Provide a summarised work plan for each year of the project giving information for each research activity per year, under the following headings: Activity Timeframes (target dates for the duration of the project) 7. Structure of Dissertation / Thesis Chapters 1. Introduction 2. Review of the related literature 3. Subjects and methods 4. Results 5. Discussion 6. Recommendations and conclusions 7. References 8. Potential Outputs  § Provide details on envisaged measurable outputs (e.g. publications, patents, students, etc.);  § Expected national and/or international acclaim for the research and contribution of research outputs to building the knowledge base;  § Exploitability of outputs, e.g. applicability to community development, improved products, processes, services in SA, region and/or continent;  § Expected effects of research results. 9. Key References Brink, H. 2006. Fundamentals of research methodologies for health care professional. 2nd edition. Juta and co. Cape Town. Cliborne, A., Wainner, R., Rhon, D., Judd, C., Fee, T., Matekel, R., and Whiteman, J. 2004. Clinical hip tests and a functional squat test in patients with knee osteoarthritis: reliability, prevalence of positive test findings, and short-term response to hip mobilization. Journal of Orthopaedic Sports Physical Therapy, November; 34(11): 676-685. Currier, L., Froehlich, P., Carow, S., McAndrew, R., Cliborne, A, Boyles, R., Mansfield, L., and Wainner, R. 2007. Development of a clinical prediction rule to identify patients with knee pain and clinical evidence of knee osteoarthritis who demonstrate a favourable short-term response to hip mobilization. Physical Therapy, September; 87(9): 1106-1119. Deyle, G., Allison, S., Matekel, R., Ryder, M., Stang, J., Gohdes,D., Hutton, J., Henderson, N., and Garber, M. 2005. Physical Therapy Treatment Effectiveness fo r Osteoarthritis of the Knee: A Randomised Comparison of Supervised Clinical Exercise and Manual Therapy Procedures versus a Home Exercise Program. Physical Therapy, 85(12): 1301-1317. Deyle, G., Henderson, N., Matekel, R., Ryder, M., Garber, M., and Allison, S. 2000. Effectiveness of Manual Physical Therapies and Exercise in Osteoarthritis of the Knee. Annals of Internal Medicine, 132(3): 173-181. Felson, D. 2000.Osteoarthritis: New Insights Part 2: Treatment Approaches. In: National Iinstitute of Health Conference, Annals of Internal Medicine; 133: 726-737. Hawk, C., Hyland, J.K., Rupert, R., Colonvega, M. and Hall, S. 2006. Assessment of balance and risk for falls in a sample of community-dwelling adults aged 65 and older. Chiropractic and Osteopathy, 14(3). Haynes, S. and Gemmell, H. 2007. Topical treatments for osteoarthritis of the knee. Clinical Chiropractic; 10: 126-138. Iverson. C., Sutlive, T., Crowell, M., Morrell, R., Perkins, M., Garber, M., Moore, J., an d Wainner, R. 2008. Lumbopelvic manipulation for the treatment of patients with patellofemoral pain syndrome: development of a clinical prediction rule. Journal of Orthopaedic Sports Physical Therapy, June; 38(6): 297-312. McCarthy, C., Mills, P., Pullen, R., Roberts, C., Silman, A., and Oldman, J. 2004. Supplementing a home exercise programme with a class-based exercise programme is more effective than home exercise alone in the treatment of knee osteoarthritis. Rheumatology; 43: 880-886. Pollard, H., Ward, G., Hoskins, W. and Hardy, K. 2008. The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. Journal of the Canadian Chiropractic Association, December; 52(4): 229-242. Symmons D, Mathers C, Pfleger B. 2003. Global burden of osteoarthritis in the year 2000 [online]. Geneva: World Health Organization. Available at: URL: https://www3.who.int/whosis/menu.cfm?path=evidence,burden,burden_gbd2000docslanguage=english Tucker, M., Brantingham, J., Myburg, C. 2003. Relative effectiveness of a non-steroidal anti-inflammatory medication (Meloxicam) versus manipulation in the treatment of osteo-arthritis of the knee. European Journal of Chiropractic, 50: 163-183. Woolf, A.D. and Pfleger, B. 2003. Burden of major musculoskeletal conditions. Bulletin of the World Health Organization, 81 (9). Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., Bierma-Zeinstra, S., Brandt, K. D., Croft, P., Doherty, M., Dougados, M., Hochberg, M., Hunter, D. J., Kwoh, K., Lohmander, L. S. and Tugwell, P. 2008. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis and Cartilage, 16:137-162. Appendix L The McMaster Overall Therapy Effectiveness (OTE) Tool (for general improvement and patient satisfaction) Patient No. Visit No. Page No. . Overall Treatment Evaluation KOA We would like to find out if there are any changes in the way you have been feeling since treatment started: after 6 treatments, and also at the 1st week and 1st month follow ups. Since treatment started, has there been any change in your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS related to your knee osteoarthritis? Please indicate if there has been any change by checking ONE of the three boxes below (Better/About the same/Worse): Better About the Same Worse ? ? If you have checked ABOUT THE SAME, ? Please stop here. ? If you have checked the box If you have checked the box BETTER: WORSE: How much BETTER would you say How much WORSE would you say your ACTIVITY LIMITATION, your ACTIVITY LIMITATION, SYMPTOMS AND/OR FEELINGS SYMPTOMS AND/OR FEELINGS have been since treatment started? Have been since treatment started? Please choose ONE of the options Please choose ONE of the options below: below: Almost the same, hardly better at all Almost the same, hardly worse at all A little better A little worse Somewhat better Somewhat worse Moderately better Moderately worse A good deal better A good deal worse A great deal better A great deal worse A very great deal better A very great deal worse Patient No. Visit No. Page No. . Overall Treatment Effect CHF, continued Answer the following question whether or not you answered BETTER or WORSE and what your response was. Note if you have improved, the change will be important since you likely will be able to carry out your responsibilities with greater ease and comfort compared to before the study. If on the other hand you are worse, then you will have more difficulty carrying out your responsibilities; this will also be important for you as you have more difficulty with your activities. Is this change (BETTER/WORSE) important to you in carrying out your daily activities? Not important Slightly important Somewhat important Moderately important Important Very important Extremely important THANKS FOR YOUR COOPERATION! Description of scales and how they will be assessed: * Pages one and two are graded separately. * Page one is graded on a 15 point scale. Scored from +7 to -7 * If the answer to the first question is Better then you have a + integer * If the answer to the first question is About the Same the score is 0 * If the answer to the first question is Worse then you have a integer * With a + or integer, the answers below the better or worse response are numbered sequentially from top to bottom. Almost the same, hardly better is a 1 and A very great deal better is a 7. * Page two is graded on a 7 point scale. Scored from 1 to 7 * The answers are numbered sequentially from top to bottom. Not important is a 1 and Extremely important is a 7 Later we will dichotomize the scores on page one between scores 1 (improved) and 0 (not improved). Appendix M The WOMAC Western Ontario and McMaster Universities osteoarthritis index KNEE OSTEOARTHRITIS Name:_________________________________________________ Date:___/___/______DOB:___/___/_____ In Sections A, B and C questions will be asked in the following format and you should give your answers by putting a straight vertical (up-and-down) mark on the horizontal line. Note: 1. If make a straight vertical (up-and-down) mark on the line, at the left-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have no pain. Note: 2. If make a straight vertical (up-and-down) mark on the line, at the Right-hand end of the line, i.e. NO PAIN EXTREME PAIN Then you are indicating that you have extreme pain. 3. Please Note: a) that the further to the right-hand end you place your straight vertical (up-and-down) mark on the line, the more pain you are experiencing b) that the further to the left-hand end you place your str aight vertical (up-and-down) mark on the line, the less pain you are experiencing c) Please do not place your straight vertical (up-and-down) mark on the line outside the markers. You will be asked to indicate on this type of scale the amount of pain, stiffness, or disability you are experiencing. Please remember the further you place your straight vertical (up-and-down) mark on the line to the right, the more pain, stiffness, or disability you are indicating that you experience. Section A Instructions to Patients The following questions concern the amount of pain you are currently experiencing in your Knee. For each situation please enter the amount of pain recently experienced. (Please mark your answers with a straight vertical {up-and-down} mark on the line). 1. Walking on a flat surface NO PAIN EXTREME PAIN 2. Going up or down stairs NO PAIN EXTREME PAIN 3. At night while in bed NO PAIN EXTREME PAIN 4. Sitting or lying NO PAIN EXTREME PAIN 5. Standing upright NO PAIN EXTREME PAIN Section B Instructions to Patients The following questions concern the amount of joint stiffness (not pain) you are currently experiencing in your knee. Stiffness is a sensation of restriction or slowness in the case with which you move your joints. (Please mark your answers with a straight vertical {up-and-down} mark on the line). 1. How severe is your stiffness after first wakening in the morning? NO STIFFNESS EXTREME STIFFNESS 2. How severe is your stiffness after sitting, lying or resting later in the day? NO STIFFNESS EXTREME STIFFNESS Question: What degree of difficulty do you have with: 1. Descending stairs. NO DIFFICULTY EXTREME DIFFICULTY 2. Ascending stairs NO DIFFICULTY EXTREME DIFFICULTY 3. Rising from sitting NO DIFFICULTY EXTREME DIFFICULTY 4. Standing NO DIFFICULTY EXTREME DIFFICULTY 5. Bending to floor NO DIFFICULTY EXTREME DIFFICULTY 6. Walking on a flat surface NO DIFFICULTY EXTREME DIFFICULTY 7. G etting in/out of car NO DIFFICULTY EXTREME DIFFICULTY 8. Going shopping NO DIFFICULTY EXTREME DIFFICULTY 9. Putting on socks/stockings NO DIFFICULTY EXTREME DIFFICULTY 10. Rising from bed NO DIFFICULTY EXTREME DIFFICULTY 11. Taking off socks/stockings NO DIFFICULTY EXTREME DIFFICULTY 12. Lying in bed NO DIFFICULTY EXTREME DIFFICULTY 13. Getting in/out of bath NO DIFFICULTY EXTREME DIFFICULTY 14. Sitting NO DIFFICULTY EXTREME DIFFICULTY 15. Getting on/off toilet NO DIFFICULTY EXTREME DIFFICULTY 16. Heavy domestic duties NO DIFFICULTY EXTREME DIFFICULTY 17. Light domestic duties NO DIFFICULTY EXTREME DIFFICULTY Below is a ten-centimeter line that begins with 0 and ends with 10. On this scale 0 stands for â€Å"no pain†. 10 stands for pain â€Å"as bad as it can be.† The first scale is for your usual (daily or typical) level of knee pain. The second scale is for your knee pain level when it is at its worst. Please think about your usual knee pain. On the line below, make a straight vertical (up-and-down) mark on the line to show how you usually feel. NO PAIN WORST PAIN IMAGINABLE Please think about your knee pain when it is at its worst. On the line below, make a straight vertical (up-and-down) mark on the line to show how you feel when you knee pain is at its worst. NO PAIN WORST PAIN IMAGINABLE Appendix N Berg Balance Scale The Berg Balance Scale (BBS) was developed to measure balance among older people with impairment in balance function by assessing the performance of functional tasks. It is a valid instrument used for evaluation of the effectiveness of interventions and for quantitative descriptions of function in clinical practice and research. The BBS has been evaluated in several reliability studies. A recent study of the BBS, which was completed in Finland, indicates that a change of eight (8) BBS points is required to reveal a genuine change in function between two assessments among older people who are dependent in ADL and living in residential care facilities. Description: 14-item scale designed to measure balance of the older adult in a clinical setting. Equipment needed: Ruler, two standard chairs (one with arm rests, one without), footstool or step, stopwatch or wristwatch, 15 ft walkway Completion: Time: 15-20 minutes Scoring: A five-point scale, ranging from 0-4. â€Å"0† indicates the lowest level of function and â€Å"4† the highest level of function. Total Score = 56 Interpretation: 41-56 = low fall risk 21-40 = medium fall risk 0 -20 = high fall risk A change of 8 points is required to reveal a genuine change in function between 2 assessments. BERG BALANCE SCALE Name: __________________________________ Date: ___________________ Location: ________________________________ Rater: ___________________ ITEM DESCRIPTION SCORE (0-4) 1. Sitting to standing ________ 2. Standing unsupported ________ 3. Sitting unsupported ________ 4. Standing to sitting ________ 5. Transfers ________ 6. Standing with eyes closed ________ 7. Standing with feet together ________ 8. Reaching forward with outstretched arm ________ 9. Retrieving object from floor ________ 10. Turning to look behind ________ 11. Turning 360 degrees ________ 12. Placing alternate foot on stool ________ 13. Standing with one foot in front ________ 14. Standing on one foot ________ Total ________ GENERAL INSTRUCTIONS Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item. In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if: †¢ The time or distance requirements are not met †¢ The subjects performance warrants supervision †¢ The subject touches an external support or receives assistance from the examiner Subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring. Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12. 1. SITTING TO STANDING INSTRUCTIONS: Please stand up. Try not to use your hand for support. ( ) 4 able to stand without using hands and stabilize independently ( ) 3 able to stand independently using hands ( ) 2 able to stand using hands after several tries ( ) 1 needs minimal aid to stand or stabilize ( ) 0 needs moderate or maximal assist to stand 2. STANDING UNSUPPORTED INSTRUCTIONS: Please stand for two minutes without holding on. ( ) 4 able to stand safely for 2 minutes ( ) 3 able to stand 2 minutes with supervision ( ) 2 able to stand 30 seconds unsupported ( ) 1 needs several tries to stand 30 seconds unsupported ( ) 0 unable to stand 30 seconds unsupported If a subject is able to stand 2 minutes unsupported, score full points for sitting unsupported. Proceed to item #4. 3. SITTING WITH BACK UNSUPPORTED BUT FEET SUPPORTED ON FLOOR OR ON A STOOL INSTRUCTIONS: Please sit with arms folded for 2 minutes. ( ) 4 able to sit safely and securely for 2 minutes ( ) 3 able to sit 2 minutes under supervision ( ) 2 able to able to sit 30 seconds ( ) 1 able to sit 10 seconds ( ) 0 unable to sit without support 10 seconds 4. STANDING TO SITTING INSTRUCTIONS: Please sit down. ( ) 4 sits safely with minimal use of hands ( ) 3 controls descent by using hands ( ) 2 uses back of legs against chair to control descent ( ) 1 sits independently but has uncontrolled descent ( ) 0 needs assist to sit 5. TRANSFERS INSTRUCTIONS: Arrange chair(s) for pivot transfer. Ask subject to transfer one way toward a seat with armrests and one way toward a seat without armrests. You may use two chairs (one with and one without armrests) or a bed and a chair. ( ) 4 able to transfer safely with minor use of hands ( ) 3 able to transfer safely definite need of hands ( ) 2 able to transfer with verbal cuing and/or supervision ( ) 1 needs one person to assist ( ) 0 needs two people to assist or supervise to be safe 6. STANDING UNSUPPORTED WITH EYES CLOSED INSTRUCTIONS: Please close your eyes and stand still for 10 seconds. ( ) 4 able to stand 10 seconds safely ( ) 3 able to stand 10 seconds with supervision ( ) 2 able to stand 3 seconds ( ) 1 unable to keep eyes closed 3 seconds but stays safely ( ) 0 needs help to keep from falling 7. STANDING UNSUPPORTED WITH FEET TOGETHER INSTRUCTIONS: Place your feet together and stand without holding on. ( ) 4 able to place feet together independently and stand 1 minute safely ( ) 3 able to place feet together independently and stand 1 minute with supervision ( ) 2 able to place feet together independently but unable to hold for 30 seconds ( ) 1 needs help to attain position but able to stand 15 seconds feet together ( ) 0 needs help to attain position and unable to hold for 15 seconds 8. REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.) ( ) 4 can reach forward confidently 25 cm (10 inches) ( ) 3 can reach forward 12 cm (5 inches) ( ) 2 can reach forward 5 cm (2 inches) ( ) 1 reaches forward but needs supervision ( ) 0 loses balance while trying/requires external support 9. PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet. ( ) 4 able to pick up slipper safely and easily ( ) 3 able to pick up slipper but needs supervision ( ) 2 unable to pick up but reaches 2-5 cm (1-2 inches) from slipper and keeps balance independently ( ) 1 unable to pick up and needs supervision while trying ( ) 0 unable to try/needs assist to keep from losing balance or falling 10. TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.) ( ) 4 looks behind from both sides and weight shifts well ( ) 3 looks behind one side only other side shows less weight shift ( ) 2 turns sideways only but maintains balance ( ) 1 needs supervision when turning ( ) 0 needs assist to keep from losing balance or falling 11. TURN 360 DEGREES INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction. ( ) 4 able to turn 360 degrees safely in 4 seconds or less ( ) 3 able to turn 360 degrees safely one side only 4 seconds or less ( ) 2 able to turn 360 degrees safely but slowly ( ) 1 needs close supervision or verbal cuing ( ) 0 needs assistance while turning 12. PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool four times. ( ) 4 able to stand independently and safely and complete 8 steps in 20 seconds ( ) 3 able to stand independently and complete 8 steps in 20 seconds ( ) 2 able to complete 4 steps without aid with supervision ( ) 1 able to complete 2 steps needs minimal assist ( ) 0 needs assistance to keep from falling/unable to try 13. STANDING UNSUPPORTED ONE FOOT IN FRONT INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subjects normal stride width.) ( ) 4 able to place foot tandem independently and hold 30 seconds ( ) 3 able to place foot ahead independently and hold 30 seconds ( ) 2 able to take small step independently and hold 30 seconds ( ) 1 needs help to step but can hold 15 seconds ( ) 0 loses balance while stepping or standing 14. STANDING ON ONE LEG INSTRUCTIONS: Stand on one leg as long as you can without holding on. ( ) 4 able to lift leg independently and hold 10 seconds ( ) 3 able to lift leg independently and hold 5-10 seconds ( ) 2 able to lift leg independently and hold L 3 seconds ( ) 1 tries to lift leg unable to hold 3 seconds but remains standing independently. ( ) 0 unable to try of needs assist to prevent fall ( ) TOTAL SCORE (Maximum = 56) Section C: Ethics Note: Ethics requirements are faculty specific. Kindly ensure that you are aware of and have complied with the relevant ethics requirements. Tick as appropriate: Humans Organisations Animals Environment Yes à ¼ No Yes No Yes No Yes No Indicate Category (X) 1. Exempt from Ethics and Biosafety Research Committee Review (straightforward research without ethical problems) 2. Expedited review (minimal risk to humans, animals or environment) 3. Full Ethics and Biosafety Research Committee review recommended (possible risk to humans, animals, environment, or a sensitive research area) 4. Full Ethics and Biosafety Research Committee review required (risk to humans, animals, environment, or a sensitive research area) Attach Addendums (if any) ETHICAL ISSUES CHECKLIST FOR RESEARCH APPROVAL To be completed by all people wishing to conduct research under the auspices of Durban University of Technology. 1. Use the Durban University of Technologys Research Ethics Policy and Guidelines to ensure that ethical issues have been identified and addressed in the most appropriate manner, before finalising and submitting your research proposal. 2. Please indicate [by an X as appropriate] which of the following ethical issues could impact on your research. 3. Please type the motivations/further explanations where required in the cell headed COMMENTS. 4. The highlighted response cells indicate those responses which are of particular interest to the Ethics Committee NO. QUESTION YES NO N/A DECEPTION 1. Is deception of any kind to be used? and if so provide a motivation for acceptability. O COMMENTS: NO. QUESTION YES NO N/A 2. Will the research involve the use of no-treatment or placebo control conditions? If yes, explain h ow subjects interests will be protected. O COMMENTS CONFIDENTIALITY 3. Does the data collection process involve access to confidential personal data (including access to data for purposes other than this particular research project) without prior consent of subjects? If yes, motivate the necessity O COMMENTS 4. Will the data be collected and disseminated in a manner that will ensure confidentiality of the data and the identity of the participants? Explain your answer O COMMENTS 5. Will the materials obtained be stored and ultimately disposed of in a manner that will ensure confidentiality of the participants? If no, explain. If yes specify how long the confidential data will be retained after the study and how it will be disposed of. O COMMENTS 6. Will the research involve access to data banks that are subject to privacy legislation? If yes, specify and explain the necessity. COMMENTS RECRUITMENT 7 Does recruitment involve direct personal approach from the researchers to the potential subjects? Explain the recruitment process O COMMENTS 8 Are participants linked to the researcher in a particular relationship, for example employees, students, family? If yes, specify how. O COMMENTS 9 If yes to 8, is there any pressure from researchers or others that might influence the potential subjects to enrol? Elaborate. O COMMENTS 10 Does recruitment involve the circulation/publication of an advertisement, circular, letter etc? Specify O COMMENTS: advertisement 11 Will subjects receive any financial or other benefits as a result of participation? If yes, explain the nature of the reward, and safeguards O COMMENTS 12 Is the research targeting any particular ethnic or community group? If yes, motivate why it is necessary/acceptable. If you have not consulted a representative of this group, give a reason. In addition explain any consultative processes, identifying participants. Should consultation not take place, give a motivation. COMMENTS INFORMED CONSENT 13 Does the research fulfil the criteria for informed consent? [See guidelines]. If yes, no further answer is needed. If no, please specify how and why. O COMMENTS 14 Does consent need to be obtained from special and vulnerable groups (see guidelines). If yes, describe the nature of the group and the procedures used to obtain permission. COMMENTS 15 Will a Subject Information Letter be provided and a written consent be obtained? If no, explain. If yes, attach copies to proposal. In the case of subjects who are not familiar with English (e.g it is a second language), explain what arrangements will be made to ensure comprehension of the Subject Information Letter, Informed Consent Form and other questionnaires/documents. O COMMENTS 16 Will results of the study be made available to those interested? If no, explain why. If yes, explain how COMMENTS RISKS TO SUBJECTS 17 Will participants be asked to perform any acts or make statements which might be expected to cause discomfort, compromise them, diminish self esteem or cause them to experience embarrassment or regret? If yes, explain. O COMMENTS 18 Might any aspect of your study reasonably be expected to place the participant at risk of criminal or civil liability? If yes, explain. O COMMENTS 19 Might any aspect of your study reasonably be expected to place the participant at risk of damage to their financial standing or social standing or employability? If yes, explain. O COMMENTS 20 Does the protocol require any physically invasive, or potentially harmful procedures [e.g. drug administration, needle insertion, rectal probe, pharyngeal foreign body, electrical or electromagnetic stimulation, etc?] If yes, please outline below the procedures and what safety precautions will be used. O COMMENTS 21 Will any treatment be used with potentially unpleasant or harmful side effects? If yes, explain the nature of the side-effects and how they will be minimised. COMMENTS 22 Does the research involve any questions, stimuli, tasks, investigations or procedures which may be experienced by participants as stressful, anxiety producing, noxious, aversive or unpleasant during or after the research procedures? If yes, explain. COMMENTS 23 Will any samples of body fluid or body tissues be required specifically for the research which would not be required in the case of ordinary treatment? If yes, explain and list such procedures and techniques. COMMENTS 24 Are any drugs/devices to be administered? If yes, list any drugs/devices to be used and their approved status. O COMMENTS GENETIC CONSIDERATIONS 25 Will participants be fingerprinted or DNA fingerprinted? If yes, motivate why necessary and state how such is to be managed and controlled. O COMMENTS 26 Does the project involve genetic research e.g. somatic cell gene therapy, DNA techniques etc? If yes, list the procedures involved O COMMENTS BENEFITS 27 Is this research expected to benefit the subjects directly or indirectly? Explain any such benefits. COMMENTS 28 Does the researcher expect to obtain any direct or indirect financial or other benefits from conducting the research? If yes, explain. O COMMENTS SPONSORS: INTERESTS AND INDEMNITY 29 Will this research be undertaken on the behalf of or at the request of a pharmaceutical company, or other commercial entity or any other sponsor? If yes, identify the entity. O COMMENTS 30 If yes to 29, will that entity undertake in writing to abide by Durban University of Technologys Research Committees Research Ethics Policy and Guidelines? If yes, do not explain further. If no, explain. O COMMENTS 31 If yes to 30, will that entity undertake in writing to indemnify the institution and the researchers? If yes, do not explain further. If no, explain. O COMMENTS 32 Does permission need to be obtained in terms of the location of the study? If yes indicate how permission is to be obtained. O COMMENTS 33 Does the researcher have indemnity cover relating to research activities? If yes, specify. If no, explain why not. COMMENTS 34 Does the researcher have any affiliation with, or financial involvement in, any organisation or entity with direct or indirect interests in the subject matter or materials of this research? If yes, specify. O COMMENTS The undersigned declare that the above questions have been answered truthfully and accurately STUDENT NAME SIGNATURE- DATE SUPERVISOR NAME SIGNATURE DATE Please initial alongside if the project is to be registered as secret Guidelines for the Preparation of a Research Proposal (To be read in conjunction with the Postgraduate Student Guidelines) Please ensure that you have completed, in every respect, all of the following prior to submission of your Research Proposal. Students are advised to use the electronic version of the PG 4 form which is available from the DUT website or from the Faculty Officer. Please complete ALL SECTIONS, using Arial 12-point font, one and half line spacing in MS Word. Where sections are not applicable please adapt the form accordingly. 1. Proof-read your hard copy, ensure correct referencing, edit rigorously and then submit to your Supervisor(s). 2. Number all pages and show correct author source references both in the tex t proper and in the References at the end using the Harvard referencing method (IEEE for Engineering students). 3. Complete the Ethics Section, the Work Plan and the Budget correctly in every respect and again engage in a thorough spell check prior to submission to your Supervisor/Co- Supervisor(s)/ Promoter/Co-Promoter(s). 4. Please note carefully the closing dates, as outlined in the Academic Calendar, contained in the Rule Book for Students, the registration dates as well the expected duration for the completion of the project. 5. It is imperative that you adhere to your specified guidelines for completion of your research and institutional/faculty deadlines as published on the DUT website. Reviewer / Review Panel Chair Title Tel (W) Tel (H) Cell Fax e-Mail Yes No Un- clear Recommendations Signed: __________________________Date: _______________________ (Reviewer) Signed: __________________________Date: _______________________ (HoD) ETHICS CLEARANCE CERTIFICATE Student Name Student No Ethics Reference Number Date of FRC Approval Qualification Research Title: In terms of the ethical considerations for the conduct of research in the Faculty of Health Sciences, Durban University of Technology, this proposal meets with Institutional requirements and confirms the following ethical obligations: 1. The researcher has read and understood the research ethics policy and procedures as endorsed by the Durban University of Technology, has sufficiently answered all questions pertaining to ethics in the DUT 186 and agrees to comply with them. 2. The researcher will report any serious adverse events pertaining to the research to the Faculty of Health Sciences Research Ethics Committee. 3. The researcher will submit any major additions or changes to the research proposal after approval has been granted to the Faculty of Health Sciences Research Committee for consideration. 4. The researcher, with the supervisor and co-researchers will take full responsibility in ensuring that the protocol is adhered to. 5. The following section must be c ompleted if the research involves human participants: YES NO N/A v Provision has been made to obtain informed consent of the participants v Potential psychological and physical risks have been considered and minimised v Provision has been made to avoid undue intrusion with regard to participants and community v Rights of participants will be safe-guarded in relation to: Measures for the protection of anonymity and the maintenance of Confidentiality. Access to research information and findings. Termination of involvement without compromise Misleading promises regarding benefits of the research