Recommendation Letter Manager for Part-Time Employee

Suggestion Letter Manager for Part-Time Employee SAT/ACT Prep Online Guides and Tips Not the entirety of the up-and-comers requesting a suggestion letter are full-time or long haul workers. Regardless of whether you're composing for low maintenance or brief laborer, you can in any case give incredible understanding into his work execution and qualities. In the example letter underneath, a café chief suggests a server who worked during summers off from school. The up-and-comer's hoping to move into his first all day work after graduation. Peruse on to realize what this eatery director needs to state. Test Letter #3: Written by a Manager for a Part-Time Employee Ms. Talia RichardsonRestaurant ManagerTapea Restaurant Group56 Main St.Centreville, VA 20122 Dear Ms. Richardson, It’s my pleasure to give this letter of suggestion to Charlie, who functioned as a server at Solera Restaurant for as far back as two summers. As Charlie’s direct chief who worked intimately with him all through his time here, I was intrigued with his hard working attitude, benevolent character, and capacity to function admirably under tension. As he moves on from Johnson Wales with a degree in Hospitality Management, I’m certain that he has what it takes to do well as an Assistant Restaurant Manager with Tapea Restaurant Group. As a server at Solera, Charlie exhibited standout client support. Our customer base is a blend of long haul benefactors and visiting vacationers, and Charlie was friendly and expert toward all. In any event, when things got wild during top business hours, Charlie kept up his vitality level and tender loving care. I review one example when the kitchen was upheld up and a table griped about to what extent they needed to hang tight for their food. Charlie tuned in to their interests and offered them free treats to guarantee that they left inclination positive about their eating experience. Charlie is careful, neighborly, and accommodating, all characteristics that made him a fantastic expansion to our staff. To get familiar with friendliness the board, Charlie set up gatherings with me all through the mid year to talk about my duties as Restaurant Manager. We discussed staff preparing and oversight, spending the board, authorizing, wellbeing rules, authoritative records, and business advancement, among other key pieces of the activity. Charlie carried a great deal of information to the table and immediately got new subtle strategies. Between his classes at Johnson Wales and reasonable encounters, he has an away from of the obligations of dealing with an eatery. The previous summer, Charlie went far in excess of what was required to assist us with facilitating enormous capacities. Specifically, he helped with arranging a graduation celebration for more than 60 individuals and a bat mitzvah for 75. Charlie gave his contribution on menus and help with requesting supplies and supervising stock levels before the occasions. Charlie likewise filled in as a server, dealing with a huge volume of solicitations during a definitely coordinated occasion. He demonstrated himself to be a key resource in arranging the capacities and ensuring everything ran easily. In the event that we had any right hand administrative positions accessible at Solera, Charlie would be the main individual I would call. Charlie has my most elevated proposal for the situation of Assistant Restaurant Manager. He reliably dazzled me and the remainder of the staff with his hard working attitude, client assistance, and expanding administrative aptitudes. If it's not too much trouble don’t dither to get in touch with me for any additional data. Much obliged to you for your time. Genuinely, Janet ChildRestaurant ManagerSolera Restaurantjchild@solera.com(866) 811-5546 Need to give a solid proposal to your representative, however don't have the opportunity to create the ideal letter? PrepScholar's new proposal device, SimpleRec, takes you from well meaning goals and a clear page to a completely composed and arranged letter of suggestion in less than 5 minutes. You should simply give us some basic snippets of data about your representative and your experience working with them, and we'll wrap up. Give a shot SimpleRec chance free today: Will this proposal letter help Charlie line up a vocation for after graduation? Suggestion Letter #3: The Breakdown This letter speaks to one composed by an administrator for low maintenance representative. For this situation, the low maintenance worker is going to move on from school and is going after his first job in quite a while picked field. The proposal letter assumes a significant job, consequently, in indicating that he’s prepared to take on this new position. As a café supervisor herself, Janet Child is an extraordinary hotspot for Charlie’s proposal letter. She begins by portraying his client support aptitudes as a server at Solera. At that point she centers around the manners by which he’s qualified to turn into an Assistant Restaurant Manager. Janet depicts how Charlie advanced his instruction by meeting with her to find out about the duties in café the board. She likewise talks about his off camera help in arranging and facilitating enormous capacities, an obligation that he would need to take on as Assistant Manager with Tapea. Janet utilizes profoundly positive language, just as explicit models, to show Charlie’s aptitudes in the field of accommodation the executives. She makes her suggestion letter particularly solid by expressing that she would employ him herself if Solera had any positions accessible. Her letter will positively be a help to Charlie’s application as his analysts decide if he’s prepared to step into the situation of Assistant Restaurant Manager. What's Next? Is it true that you are prepared for another example proposal letter? Snap here to peruse a supervisor's reference letter for an independent website specialist! Is it true that you are searching for our full guide on proposal letters? Look at our reference letter manual for find out about what goes into a decent letter and discover eight additional examples. Need to give a solid suggestion to your worker, yet don't have the opportunity to create the ideal letter? PrepScholar's new proposal device, SimpleRec, takes you from well meaning goals and a clear page to a completely composed and organized letter of suggestion in less than 5 minutes. You should simply give us some straightforward snippets of data about your worker and your experience working with them, and we'll wrap up. Give a shot SimpleRec chance free today:

Matthew Hale and the Creativity Research Paper Example | Topics and Well Written Essays - 1500 words

Matthew Hale and the Creativity - Research Paper Example Sound was just 2 years of age when the Church of the Creator was established. He was the most youthful among 4 kin made out of young men. At the early age of 11, Hale claimed that â€Å"white individuals had been answerable for most by far of progress on the planet, and thusly, the possibility that the races were 'equivalent' to each other appeared incorrect.† This was the year when the future Pontifex Maximus or most noteworthy minister of Creativity had his racial arousing. During his university life, Hale composed publications for the college paper and there he upheld and advocated suppositions towards White Separatism. The 80s was the time that ought to have begun grasping equity and started to take out prejudice yet there are still individuals who did the inverse and further segregate other people who are not white.3 Klassen expressed in his book that â€Å"the dark man is in actuality the most perilous animal on the substance of the earth to the further endurance of the White Race. He is a threat that matches that of the Jew himself, in spite of the fact that for various reasons. In all actuality, the Jew is by a long shot the more noteworthy by and large peril in controlling and devastating the White Race.†4 The author of the WCOTC is one of the individuals who affected the philosophies of Hale during his university days. ... There were occasions that followed that Hitler and his different friends didn't affirmed of. Hitler and the others thought of the goes about as a selling out from the moralities that they were battling for. This was the start of Hitler’s contempt towards others who have contradicting conclusions towards his perspectives.5 Klassen thought about Germany, Adolf Hitler and National Socialism as warriors for salvation. It was not simply Hale who has been affected by Hitler yet additionally the organizer of the WCOTC himself. It would not be an amazement with respect to why the Creativity Movement are loaded with outrage and contempt to the individuals who are not White as well as to the individuals who are White however Jews. Klassen even celebrated Hitler’s unfeeling activities by expressing the accompanying, â€Å"Well, he has done a lot. First and foremost he has gotten us time. As we expressed beforehand, without a doubt before the finish of the 1930's everything of Eur ope and in all likelihood the entire world would lie squashed and gutted, falling down at the feet of the merciless Jewish beast †socialist Marxism. Adolf Hitler didn't bite the dust futile. He kicked the bucket for his darling White Race, including you and me. He got us in any event 50 years of time in which we could revitalize ourselves and put forth an incredible Final attempt to successfully pound the beast that is currently as yet gripping at our throat.†6 There are two or three things that Klassen and Hitler had faith in that supplemented the contemplations and perspectives of Hale; this would be despise and bigotry. Something else in like manner between the 2 individuals who affected Hale was both Klassen and Hitler submitted suicide.7 8 When Hale was broadcasted as the Pontifex Maximus in 1996, he turned into the most noticeable and best pioneer of the WCOTC. The World

Learn the Different Types of Harassment in the Workplace

Learn the Different Types of Harassment in the Workplace Everyone is entitled to a safe and healthy working environment. This means that, in addition to the work environment being free from any hazards that might cause physical harm, it should also allow you to work freely, without any kind of harassment from anyone. Different states even have in place laws to safeguard employees against workplace harassment. In spite of this, workplace harassment is still a very common occurrence. To make matters worse, many people are not aware of what qualifies as harassment, and as a result, many instances of harassment go unreported, leading to toxic and unproductive working environments. Workplace harassment is so rampant that, according to a poll by Washington Post and ABC News, more than 33 million women in the US have experienced an instance of sexual harassment in a work environment, which is only one type of workplace harassment.Workplace harassment can be defined as any unwelcome verbal or physical behavior directed towards someone that makes t he working environment abusive, hostile or intimidating for the victim. Harassment also includes situations where the victim has to endure hostile behavior as a prerequisite for continued employment. To make it easier for you to identify and therefore report instances of harassment, we are going to take a look at some of the most common types of workplace harassment. SEXUAL HARASSMENTHave you ever been in a situation where a colleague made a sexual remark about you or requested for sexual favors? You might have let it slide as normal behavior, but if it made you uncomfortable, that was an instance of sexual harassment, and you should have taken action against it. Sexual harassment is one of the most common forms of workplace harassment. For most people, sexual harassment is what comes to mind when workplace harassment is mentioned. Sexual harassment can be defined as harassment that involves sexual conduct, behavior or advances. Is there a colleague that shares unsolicited sexual ma terial (pornography) or views such material at work? Does a colleague make sexual jokes or comments about you or other colleagues? Does he or she ask sexual questions, make sexual gestures, touch others inappropriately or invade personal space in a sexual manner? All these are forms of sexual harassment. Another form of sexual harassment is what is known as quid pro quo sexual harassment. This is where some type of benefit is offered to someone in exchange for some form of sexual activity. This is predominant between senior level and junior level employees, where the senior level employee solicits for sexual activity in exchange for some favors. For instance, your boss asking you to perform a sexual act on them in exchange for a promotion or preferential treatment is an example of quid pro quo sexual harassment. Quid pro quo sexual harassment can also be used for blackmail. According to a survey by CNBC, 19% of adults in America have reportedly experienced sexual harassment at work, with the figure being higher for women compared to men.If you find yourself being harassed sexually, the first thing you should do is to speak up and let the harasser know that their behavior is offensive to you. If they do not put a stop to their behavior, you should report the behavior to your immediate supervisor, or in accordance with your company’s policy for handling sexual harassment claims. If the company is unable to put a stop to the behavior, you should file an administrative charge with the Equal Employment Opportunities Commission (EEOC), who will then investigate the claim and either attempt to resolve the issue or advise you to sue. DISCRIMINATORY HARASSMENTMost types of workplace harassment fall under this category. Discriminatory harassment involves situations where you are harassed because you belong to a certain minority group within the workplace. Discriminatory harassment is defined not by how it is carried out, but rather by the reason behind the harassment. In the United States, Majority of the types of workplace harassment in this category are prohibited by Title VII of the Civil Rights Act of 1964. Below are some common types of discriminatory harassment.Gender HarassmentThis is a type of discriminatory harassment where you are treated in a discriminatory manner because of your gender. While gender harassment is often confused with sexual harassment, the two are different. Gender harassment can happen without any sexual innuendo. For instance, situations where another job applicant is chosen over you because of their gender, despite the two of you being equally qualified and experienced can be termed as gender harassment. Situations where you are denied promotion opportunities because of your gender also constitute gender harassment. Gender harassment might also involve displaying or sharing material (pictures, posters, comics and videos) that are degrading to one gender, as well as making degrading comments or jokes about one gende r’s ability to perform a certain task. Gender harassment is especially predominant in male dominated industries. Gender harassment is so common that 42% of women say they faced gender discrimination at work.Racial HarassmentIf you have worked in an environment where there are people from different races, you have probably witnessed this kind of workplace harassment. Racial harassment occurs in situations where someone is treated differently because they belong to a different race, or because they look different. This usually occurs when the race of the victim is a minority at the workplace compared. Racial harassment takes the form of racial slurs, racial jokes about the victim’s looks, accents, customs, beliefs or ancestry, racial insults, racial intolerance, disgust and degrading or stereotypical comments. Racial harassment creates a hostile working environment for members of the affected race.Religious HarassmentPicture this: the newly hired employee comes to her first day we aring a hijab, only for her to be told that she should not wear hijabs at work. She is also informed that she is expected to be back at her desk by 2 every day, including Fridays, which are her prayer days. While this might seem like normal behavior in the corporate world, it amounts to religious harassment. Religious harassment is closely linked with racial harassment, owing to the fact that different races often have different religious beliefs. However, religious harassment specifically involves showing discriminatory behavior towards someone because of their religious beliefs. This usually occurs in environments where the victim has a different religion from the majority of other employees. Religious harassment takes the form of cruel jokes about one’s religion, pressures to convert from one’s religion, and degrading comments about one’s religion. It also involves intolerance towards the victim’s religious holidays, customs and traditions. Situations where the employer r efuses to accommodate dress codes or prayer observance schedules dictated by the employee’s religion, like in our example above, also constitute religious harassment. If you notice this kind of behavior at work, you should speak up, even if you might not be the victim. Disability HarassmentThis is a type of discriminatory harassment that occurs because of a certain disability. This type of harassment is usually shown towards people suffering from a disability, as well as to people who are acquainted with a disabled person or those who take advantage of disability benefits. Disability harassment may take the form of segregating the victim, failure to accommodate their disability, lack of disability awareness, making jokes about the victim’s disability or making degrading comments about the victim. Failure to give opportunities to someone because of their disability is also a form of disability harassment. For instance, if you are experienced and qualified enough for a promotion b ut get passed over for reasons you believe are related to your disability, you should report it as a case of disability harassment.Sexual Orientation HarassmentDo you identify as gay, bisexual, transgender, or queer? Has someone at work ever said something demeaning or made a crude joke about your sexual orientation? If you answered yes to these questions, then you should have reported that as a case of workplace harassment. This type of discriminatory harassment has not been very common. However, as different sexual orientations are gaining acceptance in society and more people opening up about their sexual orientations, this type of harassment is becoming more prevalent. Sexual orientation harassment is directed to members of the LGBTQ community (Lesbians, gays, bisexuals, transgender and queer people). Sexual orientation harassment takes the form of offensive comments and jokes about a person’s sexual orientation, or even directing physically threatening/abusive actions to a pe rson because of their sexual orientation. For instance, a homosexual man might experience this type of harassment when working in the military.Citizenship HarassmentThis is a type of workplace harassment where the victim is harassed because of their citizenship status or because of their nation of origin. For instance, as a migrant, you might be treated unfairly or discriminated against despite being authorized to work within the country. Citizenship harassment might take the form of name calling and stereotyping, making jokes and derogatory comments about a person’s nationality, or unequal treatment when it comes to getting hired, job assignments, or work benefits. In extreme cases, citizenship harassment can even lead to termination of work. In the United States, victims of citizenship harassment are protected by The Immigration and Nationality Act, which makes it illegal for employers to discriminate against employees based on their nation of origin or citizenship status, provi ded they are authorized to work in the United States. Age Based HarassmentThis involves situations where a person is treated in a discriminatory manner because they are within a certain age bracket. This kind of harassment is usually common to workers who are above 40 years. It also happens sometimes to workers who are too young. This type of harassment might take the form of stereotyping the victim, directing insults and teasing statements at them, criticizing them unfairly or even leaving them out of important workplace activities. For people within the 40+ bracket, the aim of this kind of harassment is usually to push the victim into early retirement. For instance, referring to a 40+ male worker as “grandpa” or repeatedly asking him when he is going to retire can be viewed as age harassment. PHYSICAL HARASSMENTThis is a type of workplace harassment that involves threats of physical harm towards the victim. In extreme cases, it might even get to actual physical attacks. Physic al harassment is also referred to as workplace violence. It might be hard to believe that this kind of workplace harassment takes place in today’s modern society, yet it is something that happens commonly. Physical harassment includes behaviors such as making threatening gestures â€" such as shaking your fists angrily at someone â€" physically attacking someone by punching, shoving, slapping or kicking someone, or even destroying property with the aim of intimidating someone. Making gestures that are meant to be offensive, threateningly invading someone’s personal space or playing music with derogatory or offensive language are also forms of physical harassment. Such behaviors don’t have to be directed towards someone in order to be considered as harassment. For instance, playing music with offensive language is considered as a form of physical harassment even if the music is directed at anyone in particular. Similarly, if two employees make offensive gesture while joking with each other, a third employee who sees their gestures can complain of physical harassment. POWER HARASSMENTYou have probably witnessed situations where a boss has used their power to intimidate or coerce low level employees to do something. This is abusive behavior and should be reported as an instance of power harassment. Power harassment occurs in situations where the harasser and the victim hold different levels of power within the organization. Power harassment can be defined as a kind of behavior where someone in a superior position takes advantage of his position to cause physical or emotional distress to employees in a lower position in the office hierarchy. Power harassment can take many forms. Does your supervisor yell at you or criticize you harshly in front of others? Does he belittle your intelligence with the aim of embarrassing you? All these are examples of power harassment. Power harassment also involves situations where bosses provide no work to their subordinates o r work that is below their level, assigning unnecessary work or work that is impossible to do, creating challenging schedules for subordinates, as well as situations where superiors try to intrude into someone’s personal life. PERSONAL HARASSMENTThis is a form of workplace harassment that is based on the personal relationship between the harasser and the victim. Unlike other forms of harassment, personal harassment does not happen because of the victim’s gender, sexual orientation, race, nationality, religion, position in the office hierarchy, or anything else that might be a cause of harassment. Instead, it occurs because the harasser is a bully who picks on the victim for any reason. Examples of personal harassment include making offensive jokes and inappropriate comments about someone, personal humiliation, intimidation, performing actions that are meant to get the other person in trouble, gossiping, and so on. The worst part about personal bullying is that it can be very har d to prove, which makes it hard for action to be taken against the harasser. VERBAL/WRITTEN HARASSMENTPeople have different personalities, and in a situation people have to interact with others constantly, it is inevitable that there will be conflicts that result in a mean word being thrown here or there. However, if this becomes a regular thing, then it becomes a form of harassment. Verbal and written harassment is very common at the workplaces and can be very easy to recognize. However, many forms of verbal/written harassment are not illegal, which makes it harder to report or stop the behavior. However, when directed at someone within a protected class, then it becomes illegal. Verbal/written harassment includes actions such as using curse words, shouting or yelling at someone, making demeaning jokes about someone, sending emails, texts or letters with rude slurs, sending emails with offensive content, mimicking someone’s accent in a manner meant to embarrass them, or making di sparaging comments about someone. While you cannot take legal action against some forms of verbal harassment (such as yelling, cursing or making offensive jokes and remarks), you should still make a report to HR if someone is verbally harassing you to the point that the work environment becomes hostile to you.VISUAL HARASSMENTIn many cases, visual harassment does not get reported because it is not directed at anyone in particular. However, it still counts as a form of harassment if it makes another person feel uncomfortable. Examples of visual harassment include viewing pornographic or violent images and videos at work, displaying posters with inappropriate messages, wearing clothes with offensive messages, indecently exposing oneself to colleagues, drawing or showing images with violent, derogatory or sexual undertones, and so on. It’s good to note that sometimes, someone might display or share something without any intention of causing any harassment. Even if majority of workers find the material to be funny or interesting, it still counts as harassment if it makes another worker uncomfortable. PSYCHOLOGICAL HARASSMENTThis is a type of workplace harassment that negatively affects someone’s psychological integrity. Psychological harassment, which is a form of emotional abuse, affects an employee’s dignity and makes them feel undervalued at a professional or personal level. It is often humiliating and is aimed at lowering the victim’s self-esteem. Psychological harassment can be highly damaging. Undermining someone’s psychological integrity can affect other areas of their life, such as their work life, their social life, and in some cases, their physical health. Psychological harassment may make the victim nervous every time they think about coming to work. There even cases where people have committed suicide as a result of psychological harassment. Some examples of psychological harassment include dismissing the victim’s ideas as senseless, denyin g the victim any attention, spreading rumors about the victim, discrediting their achievements or giving no appreciation for their efforts, using harsh words, going against the victim at every possible moment, and so on. ONLINE HARASSMENTToday’s world has become increasingly digital, and businesses have been at the forefront of adopting new technology in order to make operations more efficient. Today, email is the standard means of communication in the corporate world. Departments and groups working on common projects use messaging applications like Slack, Telegram and Whatsapp Groups to easily communicate with each other. Marketing departments rely on social media to create awareness about products. Despite all these advantages, technology has also provided a new platform for workplace harassment. Online harassment refers to situations where the internet and other digital media are used to harass, threaten or maliciously embarrass an employee. Some examples of online harassment i nclude:Spreading rumors or gossip about someone through email, group chats and social media.Sending emails, texts or instant messages with unpleasant undertones to the victim. Spreading viruses to sabotage the victim’s work.Sending threatening emails or messages.Impersonating the victim in online channels and sending messages that would cause a negative response from colleagues. Creating fake online content with the aim of depicting the victim negatively.Sharing offensive or graphic material online. The problem with online harassment is that it can sometimes be hard to catch. For instance, if the harasser has impersonated the victim in online channels, it might be difficult to prove that it was the harasser posting the messages and not the victim. Sometimes, the harasser might also use a medium that the victim seldom uses, thereby spreading false information about the victim without the victim’s knowledge. This means that people need to be very careful in order to spot instances of online harassment. RETALIATION HARASSMENTRetaliation harassment occurs in situations where someone is harassed as a punishment for reporting or standing up to another type of harassment. For instance, if you file a complaint for sexual harassment by your boss and they find a non-existent reason to fire you after you file your complaint, that is an instance of retaliation harassment. Unlike the other forms of harassment, many workers are not aware that the law protects them from retaliation harassment. Retaliation harassment can occur as a result of an employee filing or acting as a witness to an harassment investigation, voicing his voice against ongoing harassment, defying orders they feel are discriminatory, refusing the sexual advances of a colleague or superior, asking to be have a disability or religious practice accommodated, and so on. According to this study, 75% of victims who spoke up experienced retaliation harassment.Examples of retaliation harassment include getting excluded from some activities, getting shifted to a less desirable position or shift, being reprimanded, getting passed over for raises or promotions, having your salary reduced, being subjected to excessive scrutiny, being given lower ratings in performance evaluations, or even termination from work. Therefore, if you find your employer taking any of these actions after you file a complaint for harassment or act as witness in a harassment investigation, this could be retaliation harassment, which you are protected against by law. THIRD PARTY HARASSMENTMany forms of workplace harassment take place between people working within the same organization. The victim is usually harassed by a colleague, a supervisor or a manager. However, there is another form of workplace harassment where the hostile behavior is carried out by a ‘third party’, someone who does not work within the organization but still interacts with employees. The third party could be a supplier, a vendor, a client, or a customer. In most cases, the victims of third party harassment are usually low level employees, such as sales people, cashiers, and so on. Examples of third party harassment include a client constantly flirting with an employee, a customer asking a salesperson who works on commission basis for sexual favors in exchange for business, a customer refusing to work with a certain employee because of the employee’s religious belief or nationality, and so on. Since third party harassment is perpetrated by outsiders, it can be very difficult to spot or stop. However, it is still the employer’s responsibility to stop this kind of harassment against employees.WHAT TO DO IF YOU EXPERIENCE HARASSMENT AT WORKSometimes, you will experience one of the types of harassment discussed above or more. How do you handle it? Below are some steps on how to deal with workplace harassment:The first thing you should do is to speak up and make it clear to the harasser that what they are doing is offen sive and you will not tolerate it. Below are some examples of how to speak up to your harasser:“Don’t touch me.”“I am Sophie. Please avoid calling me sweetie.”“That makes me feel uncomfortable. Don’t do it again.”The second thing you should do is to start documenting the incidences of harassment, however minor they might be. Keep a journal of every time the harasser has done something offensive to you. If they have sent offensive texts or emails, keep copies of these. Documenting makes it easier for you in case you decide to report.Have a support system of people you trust and tell them about your ordeal. This way, you will have someone to back you up once you decide to report.If the abusive behavior does not stop even after you speak up, you should consider reporting it to your employer. When reporting, follow your company’s harassment complaint procedure to the letter. Keep copies of your complaint letter and any response you get from the company. If your company does not have any policy on such matters, make a report to HR or to your immediate supervisor.If the behavior continues, consider filing a complaint with the EEOC. The EEOC will investigate your claim and try to get your employer to put an end to the abusive behavior. If they are unable to stop it, the EEOC will then advice you to sue your employer.WRAPPING UPWorkplace harassment is illegal, and it is the responsibility of every employer to ensure that the working environment is safe, healthy and conducive for all employees. As an employee, you should also be ready to take action against any kind of harassment you might face while at work. The first step is to know how to identify situations that constitute harassment. Having read this article, you will hopefully be able recognize different kinds of workplace harassment that might be directed towards you or a colleague. If you notice any of the situations discussed above, you have the right to request your employer to make changes that will put a stop to the behavior. If the employer does not take any action, you should seek legal advice from an employment lawyer, since your right to work in a safe and conducive environment is protected by law.

How School And Education Affects The Lives Of African...

School and education happens to be one of the main things affected in the lives of both African American males and females living in single parent households. Parents tend to become less involved in the childs academics and social activities in school from the stress of being a single parent and having so much responsibility on them. It seemingly gets worse by the time the child reaches high school. One survey asked high school students whether their parents helped them with their school work and supervised their social activities. Students whose parents separated between the sophomore and senior years reported a loss of involvement and supervision compared to students whose parents stayed together (Mclanahan, n.d.). This usually leads to the child performing poorly in the classroom and on assignments. The child becomes less motivated to attend school, which leads to poor attendance. Poor attendance and lack of motivation sometimes results in the child dropping out of school. If the parents live apart, the probability that their children will drop out of high school rises by 11 percentage points. And for every child who actually drops out of school, there are likely to be three or four more whose performance is affected even though they manage to graduate (Mclanahan, n.d). Children born to unmarried parents are slightly more likely to drop out of school and become teen mothers than children born to married parents who divorce. But the difference is small compared to theShow MoreRelatedImpact Of Academic Excellence On African American Communities934 Words   |  4 PagesThis scholarly article gives a detailed analysis of academic disidentification, its significance and causes in the African American community especially amongst African American males. It is highly important to understand the meaning of academic disidentification and why it is so concentrated in African American males. 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Beloved A Reconstruction Of Our Past - 1705 Words

Karla Ximena Leyte Professor John Crossley Short Close Reading Paper #2 November 20, 2015 Beloved: A reconstruction of our past Beloved by Toni Morrison is a reconstruction of history told by the African American perspective, a perspective that is often shadowed or absent in literature. Her novel presents a cruel demonstration of the horrors endured by slaves and the emotional and psychological effects it created for the African American community. It unmasks the realities of slavery, in which we are presented with the history of each of the characters lives and the memories they are trying to conceal. By looking at the suppression of memory from the members of 124, we can see Morrison creates a metaphor to the way America’s future is dependent on understanding the haunting of the past. Through an analysis of these memories and their consequences, we can comparatively relate it to our engrained past in slavery and how the former speaks for the ladder. Iyunolu Osagie discusses Morrison’s narrative as a product in â€Å"historical mythmaking† in her review Is Morrison Also Among the Prophets?: â€Å"Psychoanalytic† Strategies in Beloved. She incorporates Du Bois’s idea of â€Å"double consciousness†, the divided identity of African Americans as the way they see themselves and the way society sees them, as a strategy Morrison incorporates to re-narrate the history of slavery (Osagie). Through this double consciousness, Morrison creates a new narrative of what slavery means to the blackShow MoreRelatedPostmodernism in American Literature Essay1390 Words   |  6 PagesPostmodernism in American literature The novel Beloved by Toni Morrison often makes us question the credibility of what is being told, and uses many striking, sudden shifts between the past and present, making it difficult to distinguish between reality and fiction. This blurring of the truth is a common element of postmodern fiction. 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Say No to the Death Penalty Free Essays

Counting the seconds and minutes to your death. Inhaling your last breath. The next thing you know, the prison doctor has just injected a lethal drug into you. We will write a custom essay sample on Say No to the Death Penalty or any similar topic only for you Order Now How do you not feel pain, empathy or sadness? But, you know that the doctor brushes it off as if it nothing happened. All because of something we call ‘The Death Penalty.† The death penalty affects people who are wrongly convicted, the positive affect because there isn’t a death penalty in our society and human morality. How do you feel about innocent people dying? Innocent people are wrongly convicted on a daily bases, so why put these people in jail. Those who opposed this argument say †the people who commit a crime, deserve to die. ‘Six Canadian prisoners were convicted of a dangerous crime and later released due to their innocent. The six Canadians were condemned for the first degree murder and if there were death penalty then these six innocent people would have died. Another reason is that the prisoners should have the time to prove their innocence. I say this because after the trial. If new evidence is found then it’s very difficult to start another trial. It’s a life of a person in your hands and nothing should be neglected. Such as David Milgaard who was sentenced to life in prison. He was the suspected killer for the murder of Gail Miller. He spent 22 years in prison and was freed by DNA evidence. Once you go to prison, it makes a profound impact on your life. Have you read the human rights from the United Nations? In the third law it states †Any person right to life, liberty and security of person.† If Canada, reinstates the death penalty that’s violating the human rights. It would be a very embarrassing moment for Canada for all we stand for and worked for. We are a country that is highly respected and is known for fighting for our rights. We have all the right to life. Do you think the death penalty affects things in our society? First reason is that there are fewer murders because there is not the death penalty. Since, there is no death penalty in Canada; the murder rate has decreased since 1970’s. In 2009, the murder rate in Canada was 1.81 homicides per 100.000 populations. If we compare the static between Brazil is a big difference. Canada was 1.81 homicides and Brazil at 25.2homicide rates. Also, Brazil has no death penalty since 1988. How to cite Say No to the Death Penalty, Essay examples

Pediatric Dengue Shock Syndrome Essay Example

Pediatric Dengue Shock Syndrome Essay SYSTEMATIC REVIEW The Use of Colloids and Crystalloids in Pediatric Dengue Shock Syndrome: a Systematic Review and Meta-analysis* Sharon Lyn R. Jalac,1 M. D. , Michelle de Vera,1 M. D. , and Marissa M. Alejandria,2 M. D. ABSTRACT Background: The cornerstone of therapy for dengue shock syndrome (DSS) remains to be the prompt and aggressive restoration of circulating plasma volume. Two common types of intravenous uids currently used in DSS are crystalloids and colloids. The debate is ongoing on whether one is superior to the other in critically ill patients. Objective: This systematic review aims to compare the therapeutic effects of colloids versus crystalloids in reducing the recurrence of shock, the requirement for rescue uids, the need for diuretics, the total volume of intravenous uids given, the hematocrit level and pulse rates, and mortality rates of children with DSS. Search strategy: We searched Medline 1966 to August 2008, the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2008), and the Philippines Herdin database 1964 to 2008. Local journals were handsearched and reference lists were examined. Researchers and experts in the eld were contacted for unpublished or ongoing trials. Selection criteria: The studies included were randomized controlled trials comparing colloids versus crystalloids in children less than 18 years with a diagnosis of DSS. Data collection and analysis: Two reviewers independently did trial selection and assessment of methodologic quality using the Cochrane Infectious Diseases Group criteria. Two reviewers independently extracted the data and analyzed it using Review Manager Version 5. We will write a custom essay sample on Pediatric Dengue Shock Syndrome specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Pediatric Dengue Shock Syndrome specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Pediatric Dengue Shock Syndrome specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Results: Of eight studies initially reviewed, four studies ful lled the selection criteria (N=694, colloids=410, crystalloids=284). Colloids and crystalloids did not differ signi cantly in decreasing the risk for recurrence of shock (RR 0. 92, 95% CI 0. 62 to 1. 38), the need for rescue uids (RR 0. 90, 95% CI 0. 70 to 1. 16), total volume of intravenous uids given (WMD 0. 80, 95% CI -1. 68 to 3. 28) and the need for diuretics (RR=1. 17, 95% CI 0. 84 to 1. 64). However, there were signi cant improvements from baseline in the hematocrit levels (WMD -3. 37, 95% CI -5. 94 to -0. 0) and pulse rates (WMD -3. 37, 95% CI -5. 94 to -0. 8) of patients who were given colloids. Tests for heterogeneity were not signi cant. Allergic type reactions were seen in patients given colloids. One child died in the colloid group. Conclusion: Colloids decreased the hematocrit and pulse rates of children with DSS after the rst two hours of uid resuscitation. However, no signi cant advantage was found over cr ystalloids in reducing the recurrence of shock, the need for rescue colloids, the total amount of uids, the need for diuretics, and in reducing mortality. KEYWORDS: Meta-analysis, Crystalloids, Colloids, Pediatric, Dengue shock syndrome Department of Pediatrics, The Medical City Department of Clinical Epidemiology, UP College of Medicine 1 2 *Best Paper, The Medical City Interdepartmental Research Forum, 2008 14 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids of lifesaving F luid resuscitation is oneshock thecritically ill cornerstones in managing in patients. Physicians have an array of intravenous uids to choose from, however, the debate continues on which type of uid would be most bene cial. One condition that would bene t most from smart uid choice is dengue shock syndrome (DSS). DSS is the most serious manifestation of dengue hemorrhagic fever (DHF). The burden of disease is greatest in Asia, where in many countries dengue is a leading cause of pediatric hospitalization. An estimated 500,000 patients with severe dengue require hospitalization each year, a large proportion of which are children. At least 2. 5% of patients die, although case fatality could be twice as high. 1 The major pathophysiological event seen in DSS is the acute increase in vascular permeability leading to the loss of plasma from the vascular compartment. Thus, the key to its management is the rapid restoration of the circulating intravenous blood volume. Two common types of intravenous uids currently used in DSS are crystalloids and colloids. Crystalloids are uids based on a solution of sterile water incorporated with electrolytes that are formulated to be hypertonic, hypotonic, or isotonic in com parison to the human plasma. The most common formulations include 0. 9% isotonic saline which is designed to approximate closely the human plasma, and lactated Ringer’s solution, almost similar to isotonic saline, but with the addition of lactate. Colloidal uids are also water- and electrolytecontaining solutions, but with the addition of a substance that does not easily diffuse through a semipermeable membrane owing to its high molecular weight. Albumin preparations contain human serum albumin, the largest component of colloid osmotic pressure in the human blood. The hetastarches, which are 6% hetastarch and 10% pentastarch, are derived from a polysaccharide that is incorporated in a uid with different molecular weights. Dextran solutions use synthetically derived dextran proteins. Gelatin solutions have true gelatin component designed to be biologically compatible. 3 The current guidelines in the management of DSS include administration of crystalloid intravenous uids at a rate of 10-20mL/kg over an hour upon presentation of unstable vital signs or manifestations of shock. Shifting to colloidal solution is warranted if there is evidence of hemoconcentration despite administration of about 1 liter of initial intravenous uids, as shown in Appendix 1. Once improvement is seen, colloids should be shifted back to crystalloids. The increased vascular permeability in DSS, combined with the capability of crystalloid uids to seep through easily, predisposes a patient to receive massive volumes until hemodynamic stability is achieved. This led to the belief that colloids, with their higher molecular weight and ability to maintain or improve the colloid osmotic pressure, will require less amount to achieve improvement, and can thus be a better alternative to crystalloids during the early resuscitative phase in DSS. The studies that have investigated the bene ts of colloids over crystalloids in patients with shock are limited. The large, multi-center, double-blind, randomized controlled trial Saline vs Albumin Fluid Evaluation conducted in 2004 compared the colloid albumin and the crystalloid isotonic saline for uid resuscitation in 6,997 intensive care unit patients. In the said trial, albumin and saline were comparable in terms of 28-day all cause mortality. 4 Likewise, a systematic review of the use of colloids and crystalloids for uid resuscitation in critically ill patients found no evidence that colloids, compared with crystalloids, reduced the risk of dying. Despite the increasing numbers of patients with DSS who are mostly children, there are only a few studies that compared the use of colloids and crystalloids in these patients. 6-9 OBJECTIVES The purpose of this systematic review is to synthesize the available data from clinical trials comparing colloids and crystalloids in resuscitating children with DSS. It aims to estimate the effects of colloids compared to crystalloids on the following param eters in children with DSS: †¢ Recurrence of shock. Requirement for rescue intravenous uids. †¢ Mortality. †¢ Total volume of intravenous uid given. 15 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids †¢ Need for diuretics. †¢ Change in hematocrit level. †¢ Change in pulse rate. This systematic review aims to compare the adverse effects associated with the administration of colloids versus crystalloids in children with DSS. experts, and researchers in the eld for additional information on unpublished and ongoing trials. There was no language restriction. Methods of the review: Two reviewers independently assessed the eligibility of potentially relevant trials based on the selection criteria. The reviewers independently assessed the methodologic quality of each trial using the Cochrane Infectious Diseases Group criteria. Studies were assessed as â€Å"high quality† if randomization and allocation concealment were adequate, blinding maneuvers were performed, and intent-to-treat analysis was done. Studies were assessed as â€Å"fair quality† if any subtle biases were present: unclear allocation concealment; absence of blinding; and no intent-to-treat analysis. Studies were considered â€Å"low-quality† if any of the following biases was seen: inadequate randomization and allocation concealment and/or signi cant differences between the treatment group and control group in terms of known predictors of outcome; obvious differences in the general quality of care received by subjects in both groups; marked difference in drop-out rates; and outcome detection methods were different for both groups. Two reviewers independently abstracted data from the studies including baseline characteristics of patients, inclusion and exclusion criteria, types of intervention or study uids, and dosing regimen. The information on each outcome measure and the number of affected patients were also obtained. Data were analyzed using the Review Manager (RevMan) Version 5. 0. For dichotomous data, the risk ratio, or the probability that an event will occur, was determined for each comparison. The need for diuretics, need for rescue uid, and recurrence of shock were all considered dichotomous outcomes. For continuous data, the weighted mean differences were determined. The decrease in hematocrit and pulse rate from baseline and the total volume of intravenous uids administered were all analyzed as continuous data. Missing data such as standard deviations were derived using the 95% con dence intervals provided. SEARCH METHODOLOGY Criteria for considering studies for this review: Studies included in this review were randomized controlled trials in which children less than 18 years of age were given either colloid or crystalloid intravenous uid within the rst 2 hours after being diagnosed with DSS. The diagnosis of DSS was based on the World Health Organization (WHO) criteria, as shown in Appendix 2, which included hemoconcentration associated with the characteristic plasma leakage, presence of circulatory compromise as evidenced by narrowing of pulse pressure, hypotension, decreased perfusion, and decreased urine output. The primary outcome measures included the number of episodes of shock, the requirement for rescue intravenous uids, and mortality. The secondary outcome measures included the change from the baseline in pulse rate, the change from the baseline of hematocrit, the need for diuretics, the total volume of intravenous uid given, and adverse effects. Search strategy: We searched the following databases for relevant studies: Medline 1966 to June 2008; the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2008); and the Herdin database of the Philippines 1964-2008. The search strategy combined the terms â€Å"pediatrics†, â€Å"child†, â€Å"children†, â€Å"dengue†, â€Å"dengue hemorrhagic fever†, â€Å"dengue shock†, and â€Å"intravenous uids† with the Cochrane Highly Sensitive Search Strategy phases one and two as contained in the Cochrane Reviewer’s Handbook, as shown in Appendix 3. Conference proceedings and local journals were handsearched for potentially relevant trials. The reference lists of articles were examined to identify additional relevant studies. We also searched institutional libraries, including libraries in universities, hospitals, and pharmaceutical companies. We contacted colleagues, 16 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Study Flow Diagram Potentially relevant randomized controlled trials identified through Medline, Herdin, and CENTRAL searches (n=4) Trials excluded (n=2) Included patients with septic shock (n=1) Assessed difference between clinical and laboratory diagnosis of dengue (n=1) Articles obtained from colleagues (n=2) Trial excluded (n=1) Used both colloids and crystalloids in a single patient (n=1) Links to related articles and other references examined (n=2) Trial excluded (n=1) Compared colloid with blood plasma (n=1) Randomized controlled trials comparing colloids and crystalloids in pediatric dengue shock (n=4) The formula for grouping data and imputing group means and group standard deviations were obtained from the Cochrane Handbook of Systematic Reviews. 0 We assessed heterogeneity using the chi-square test for heterogeneity (P value 50% indicated moderate degree of heterogeneity; a value of 75% indicated large degree of heterogeneity across trials. For outcome measures with signi cant heterogeneity, the sources of heterogeneity were explored by doing sensitivity analysis according to methodologic quality. excluded two trials: one trial was on the assessment of the differences between the clinical and laboratory diagnosis of dengue, and the other trial included patients with septic shock. On review of the reference lists of relevant articles, two more trials were identi ed: one ful lled the selection criteria while the other was excluded since it used both colloids and crystalloids for each study participant. We obtained two additional studies from colleagues. One trial was excluded because it compared a colloid with blood plasma. Included studies: Four randomized controlled trials on the use of colloids and crystalloids in children with DSS were included with a combined sample size of 694 (colloids=410, crystalloids=284). -9 All the trials used WHO criteria for the diagnosis of DSS. 2 Participants: The patients were under 18 years old, with ages ranging from 1-15 years. All patients were Asians: 655 were Vietnamese and 39 were Indonesian. In all the studies, none of the patients received any intravenous uids prior to the study. 17 RESULTS Search results: As shown in the study ow diagram, we identi ed four potentially relevant randomized controlled trials on the use o f colloids and crystalloids through Medline and CENTRAL searches. We Philippine Journal of Microbiology and Infectious Diseases Vol. 9, Issue 1, January-June 2010 Colloids Table 1. Characteristics of Included Studies Author, Year Nhan 2001 7 Study Population 230 Vietnamese children clinically diagnosed DHF DHF grade III = 222 DHF grade IV = 8 1-15 years old Intervention Study uids Lactated Ringer’s solution, isotonic saline, dextran, gelatin Fluid rate DHF grade III: 20mL/kg for 1 hr DHF grade IV: 20ml/kg for 15min, then 20mL/kg over the following hour Study uids Lactated Ringer’s solution, starch, dextran Fluid rate 15mL/kg for 1 hr, then 10mL/kg for the 2nd hr Outcomes Data presented are those of DHF grade III patients only: PPRT, reshock rate, time to 1st episode of reshock, change from baseline of hematocrit and pulse rate, volume of uid infused, requirement for rescue uid, volume of rescue uid used, requirement for diuretic, mortality Change from baseline of hematocrit; total volume of rescue uid used after initial resuscitation, total volume of uid given, requirement for further uid resuscitation, requirement for diuretic, mortality, length of hospital stay; depth of pleural effusion, new bleeding after study entry, clinical uid overload, volume of ascites Change from baseline of hematocrit, cardiac index, pulse rate and pulse pressure, requirement for further uid resuscitation, requirement for diuretic, duration of shock, episodes of reshock, mortality Change from the baseline of hematocrit, hemoglobin, pulse rate and pulse pressure; total volume of uid given, episodes of reshock, mortality Adverse Reactions None stated Wills 20056 51 2 Vietnamese children with clinical DSS Moderate shock = 383 Severe shock = 129 2-15 years old Allergic type reactions, transient high fever and rigors without cardio-respiratory compromise; urticarial rashes Dung 19998 50 Vietnamese children with clinical DSS 5-15 years old Study uids Lactated Ringer’s solution, isotonic saline, dextran, gelatin Fluid rate 20mL/kg for 1 hr, then 10mL/kg for the 2nd hr Study uids Lactated Ringer’s solution, gelatin Fluid rate 20mL/kg as initial volume of uid resuscitation None stated Prasetyo20089 39 Indonesian children with clinical DSS 1-13 years Adverse reactions in coagulation, liver and renal functions and acid-base equilibrium; severe allergic type reactions DHF: dengue hemorrhagic fever DSS: dengue shock syndrome PPRT: pulse pressure recovery time One study included both DHF grades III and IV patients9, while two studies presented data on DHF grade III patients only. 7-8 The study by Wills (2005) grouped patients into those with moderate and severe shock. The subset of patients with severe shock was not given the chance to receive crystalloid uids and was not included in this review. Children were excluded in the study if they had severe hemorrhagic manifestation for which transfusion was likely7, chronic disorders7, malnutrition9, and heart, renal, liver, and lung diseases. 9 Interventions: The colloids used were dextran 706-8, gelatin7-8, and hydroxyethyl starch. 6,9 The crystalloids used were lactated Ringer’s solution69 and isotonic saline. 7-8 In three studies6-8, the study uids were administered initially at 20mL/kg for 1 hr for DHF grade III patients and 20ml/kg for 15min. Subsequently, uids were given depending on each study’s protocol: 20mL/kg over the following hour for DHF grade IV patients7; 15mL/kg for 1 hour, then 10mL/kg for the 2nd hour6; and 20mL/kg for 1 hour, then 10mL/kg for the 2nd hour. The study by Prasetyo9 administered an initial volume of 20mL/kg to all patients. Table 2. Characteristics of Excluded Studies Author, Year Hung 2006 Martinez-Vega 2006 Tatura 2008 Upadhyay 2005 Reason for Exclusion The study used both colloids and crystalloids in all patients with DSS. The study did not compare colloids and crystalloids; it was based on the assessment of the difference between clinical and laboratory diagnosis of dengue. The study compared gelatin solution with blood plasma. The study participants were children with septic shock. 18 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Table 3. Methodological Quality of Included Studies Author Year Dung 19998 Randomization Adequate Allocation Concealment Adequate-treatment pack numbers contained in opaque envelopes Adequate-treatment pack numbers contained in opaque envelopes Computer generated random numbers, treatment packs prepared by independent staff Not stated Blinding Double-blind each treatment bottle covered in black tape Double-blind Double-blind Intent-to-treat Analysis Not stated Nhan 20017 Wills 20056 Sequential randomization Adequate, strati ed by pulse pressure Random assignment, strati ed to DHF 3 or 4 Yes Yes Prasetyo 20089 Not stated Not stated Outcomes: The outcomes measured included the following: changes from baseline of hematocrit6-9 and pulse rate7-9; total volume of rescue uid used after initial resuscitation6,7 and requirement for further uid resuscitation6-8; total volume of intravenous uids given6,7,9; requirement for diuretics6-8; and number of patients with recurrences of shock. -9 Other parameters evaluated were the following: change in hemoglobin9, pulse pressure8,9 and pulse pressure recovery time7; cardiac index8; duration of shock8; time to rst episode of reshock7; length of hospital stay in days6; and mortality. 6-9 The study by Prasetyo further determined disorders of blood coagulation, liver and renal function parameters, and acid-base equilibrium. 9 The study by Wills reported depth of pleural effusion, new bleeding after study entry, clinical uid overload, and volume of ascites. 6 Two studies determined severe allergic type reactions after intravenous uid infusion. 6,9 The characteristics of the included studies are summarized in Table 1. Excluded studies: Trials that did not compare rystalloids and colloids or were not used on pediatric patients with DSS were excluded from this review. 11-14 The characteristics of the excluded studies are summarized in Table 2. Methodological quality of included studies: Two studies were assessed as â€Å"high quality. †6. 7 The study by Prasetyo had unclear alloc ation concealment and did not mention blinding or intent-to-treat analysis, as shown in Table 3. The study by Dung also did not state whether intent-to-treat analysis was done. Both were rated as fair quality. Despite randomization, the study of Nhan had unequal distribution of more severely ill patients: dextran group had fewer patients with very low pulse pressure, but had patients with lowest mean pulse rate at presentation. Primary outcomes: The meta-analysis of the trials showed no statistically signi cant difference in reducing the risk for recurrence of shock (3 trials, RR 0. 92, 95% CI 0. 62 to 1. 38) and the need for rescue colloids (2 trials, RR 0. 90, 95% CI 0. 70 to 1. 16) after the initial resuscitation. Test for heterogeneity was not signi cant for both outcomes, as shown in Figures 1 and 2. Figure 1. Number of Patients Who Had Recurrence of Shock After the Initial Fluid Resuscitation Study or Subgroup Dung 1999 Nhan 2001 Prasetyo 2008 Total (95% CI) Colloid Crystalloid Risk Ratio Events Total Events Total Weight M-H, Fixed, 95% CI 2 31 1 25 111 19 155 2 32 3 25 5. 4% 111 86. 7% 20 7. 9% 156 100. 0% 1. 00 [0. 15, 6. 55] 0. 97 [0. 64, 1. 47] 0. 35 [0. 04, 3. 09] 0. 92 [0. 62, 1. 38] Risk Ratio M-H, Fixed, 95% CI Total events 34 37 Heterogeneity: Chi? = 0. 82, df = 2 (P = 0. 66); I? = 0% Test for overall effect: Z = 0. 40 (P = 0. 69) 0. 005 0. 1 1 10 200 Favours colloids Favours crystalloids Favours experimental Favours control 19 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Figure 2. Number of Patients Who Needed Rescue Colloids After the Initial Fluid Resuscitation Study or Subgroup Nhan 2001 Wills 2005 Total (95% CI) colloid crystalloid Risk Ratio Events Total Events Total Weight M-H, Fixed, 95% CI 32 74 111 255 366 37 40 111 41. 0% 128 59. 0% 239 100. 0% 0. 86 [0. 58, 1. 28] 0. 93 [0. 7, 1. 28] 0. 90 [0. 70, 1. 16] Risk Ratio M-H, Fixed, 95% CI 77 Total events 106 Heterogeneity: Chi? = 0. 08, df = 1 (P = 0. 78); I? = 0% Test for overall effect: Z = 0. 81 (P = 0. 42) 0. 01 0. 1 1 10 100 Favours colloids Favours crystalloids Favours experimental Favours control All study participants recovered fully, ex cept for one child in the colloid group (starch) who died of profound shock and gastrointestinal bleeding. 6 Secondary outcomes: There was no signi cant difference between patients who received colloids and crystalloids in terms of the total volume of intravenous uids given during resuscitation (WMD 0. 80 ml/kg, 95% CI -1. 68 to 3. 8) and the need for diuretics (RR=1. 17, 95% CI 0. 84 to 1. 64). The test for heterogeneity was not signi cant, as shown in Figures 3 and 4. Hemodynamic variables: On the other hand, there was a signi cant improvement in hematocrit levels from the baseline after the rst two hours of uid resuscitation (WMD -7. 87, 95% CI -8. 52 to 7. 22), but with a large degree of heterogeneity, as shown in Figure 5. Sensitivity analysis removing the study of Wills (2005), which used median instead of mean, removed the heterogeneity and a statistically signi cant reduction in hematocrit levels remained (WMD -3. 37, 95% CI -5. 94 to -0. 80), as shown in Figure 5a. The study of Wills (2005) also showed a signi cant reduction in the median hematocrit levels two hours after the initial resuscitation (25% for the dextran group versus 9% for the Ringer’s lactate group, p 35% Improvement IV therapy by crystalloid, successively reducing the ow from 10 to 6, 6 to 3ml/kg/hr Discontinue after 24-48 hrs Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 25 Colloids Appendix 2. World Health Organization Criteria for the Diagnosis of Dengue Fever and Dengue Hemorrhagic Fever DF/DHF DF Grade* Symptoms Fever with two or more of the following signs, headache, retro-orbital pain, myalgia, arthralgia I Above signs plus positive tourniquet test Above signs plus spontaneous bleeding Laboratory Leukopenia occasionally. Thrombocytopenia, may be present, no evidence of plasma loss Thrombocytopenia 100,000, Hct rise 20% Thrombocytopenia 100,000, Hct rise 20% Thrombocytopenia 100,000, Hct rise 20% DHF DHF II DHF III Above signs plus circulatory failure (weak pulse, hypotension, restlessness) Profound shock with undetectable blood pressure and pulse DHF IV Thrombocytopenia 100,000, Hct rise 20% *DHF Grade III and IV are also called as Dengue Shock Syndrome (DSS) 26 Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 Colloids Appendix 3. Search Strategy Philippine Journal of Microbiology and Infectious Diseases Vol. 39, Issue 1, January-June 2010 27