Reaction Paper to McFerson's African Women Essay

Reaction Paper to McFerson's African Women - Essay Example These women are the nomad community’s architects. They construct and are the owners of the nomadic houses. The construction of these houses is a form of wedding ritual and is one of the events women perform collectively. In some areas, women in Somalia work collectively to fetch water, collect firewood, make food and take care of the children. Pre-nuptial gifts are from the groom’s family or himself to the girl she wants to marry or bride. In a number of cases, pre-nuptial gifts together with dowry are given by the husband as a fraction of the total wealth for the new household (McFerson 443). The nature of the pre-nuptial gifts depends on the events that occur in the marriage union, for example, if the marriage union collapses without the wife’s fault or if the head of the household dies, the pre-nuptial gift is used to support the wife. Similarly, in Western cultures, there are a number of gifts that bypass amid the groom and bride and their respective relatives during marriage. There are rules that regard the nature of these in the occasion of divorce or death, and they vary with area or time (McFerson 444). The traditional Ashanti society has a high regard for ancestors, ancestor worship and matriliny. They use ancestors as an element of worship. The ancestors are perceived to be superior and powerful to human beings. Additionally, they honor and acknowledge the presence of the ancestors (McFerson 446). The poem presume the dead or ancestors are immortal and appear in the form of wailing children, the firebrands, the grass, dying fire, whimpering rocks, forest, and in the house. This community feels the presence of the ancestors. That is why the poem insists the dead are not dead. The poem highlights matriliny in the form of inheritance. That is why ancestors or the dead are in the form of wailing

Health Policy Delivery Essay Example | Topics and Well Written Essays - 2250 words

Health Policy Delivery - Essay Example Stakeholders include the government, private healthcare providers such as hospitals, health plans, office-based clinicians, industry groups or the pharmaceutical, biotechnology, and medical device manufacturers and marketers, professional associations, industry and trade associations, advocacy groups, and consumers (Donaldson and Gerard, 1993). In the policy process, UK health policy encompass knowledge and effects on the networks between national government systems, arm's length bodies, the NHS, patient groups and charities, as well as information and processes in the Demand-side reform, Supply side reform, Transactional reform, Regulation or the Healthcare Commission, NICE, Therapy knowledge of gastroenterology, dermatology, cardiovascular medicine, anti-infective, sleep medicine, pain management, palliative care, oncology and neurology, identifying and utilising opportunities arising from non-medical prescribing, effective collaboration with patient groups, medical societies and Royal Colleges, managing national and regional guideline programmes producing timely responses and positive outcomes, knowledge of controlled drugs legislation, implications for commercial teams and preparation of submissions for Home Office consultations, knowledge of the NHS changing environment and incorporation into business plans and strate gic marketing, Parliamentary lobbying - understanding the process, networking and influencing, submissions to Government organisations including the Home Office and Health Select Committee (Donaldson and Gerard, 1993). A policy is a deliberate plan of action that guide decision-makers in order to achieve rational outcomes that apply to governments, the private sector, organisations and groups as well as individuals (Jenkins, 1978). Policy could also refer to the process of making important organizational decisions, such as the identification of different alternative programs or spending priorities, or choosing among a list on the basis of the impact or result they will have. These can be political, management, financial, and administrative mechanisms arranged to reach explicit goals and objectives (Birkland, 2001). Birkland (1995) have pointed out that while "the study of politics has a long history, the systematic study of public policy, on the other hand, can be said to be a twentieth century creation. It dates, according to Daniel McCool, to 1922, when political scientist Charles Merriam sought to connect the theory and practices of politics to understanding the actual activities of government, that is public policy," (p.4). In most instances, according to Bridgman and Davis (2004), the eight step policy cycle includes: 1. Issue identification - In this process, emerging problems are identified, although

Classification and Format in the Income Statement Essay Example for Free

Classification and Format in the Income Statement Essay Investors commonly assess a firm’s value based on the firm’s expected future sustainable earnings stream. To inform analysts and other financial statement users about sustainable earnings, firms often report income from recurring business activities separately from income effects from unusual or nonrecurring activities (such as asset impairments, restructuring, discontinued business segments, and extraordinary events). To provide more useful information for prediction, U.S. GAAP (Generally Accepted Accounting Principles) requires that the income statement include some or all of the following sections or categories depending on the nature of the firm’s income for a period: †¢Income from Continuing Operations. Reports the revenues and expenses of activities in which a firm anticipates an ongoing involvement. When a firm does not have items in the second and third categories of income in a particular year, all of its income items are related to continuing operations; so it does not need to use the continuing operations label. Firms report their expenses in various ways. Most firms in the United States report expenses by their function: cost of goods sold for manufacturing, selling expenses for marketing, administrative expenses for administrative management, and interest expense for financing. Other firms, particularly those in the European Community, tend to report expenses by their nature: raw materials, compensation, advertising, and research and development. †¢Income from Discontinued Operations. A firm that intends to remain in a line of business but decides to sell or close down some portion of that line (such as closing a single plant or dropping a line of products) generally will report any income, gain, or loss from such an action under continuing operations. On the other hand, if a firm decides to terminate its involvement in a line of business (such as selling or shuttering an entire division or subsidiary), it will report the income, gain, or loss in the second section of the income statement, labeled â€Å"Income, Gains, and Losses from Discontinued Operations.† †¢Extraordinary Gains and Losses. Extraordinary gains and losses arise from events that are (1) unusual given the nature of a firm’s activities, (2) nonrecurring, and (3) material in amount. Corporate annual reports rarely disclose such items. Many firms have reported restructuring charges and impairment losses in their income statements in recent years. Such items often reflect the write-down of assets or the recognition of liabilities arising from changes in economic conditions and corporate strategies. Because restructuring charges and impairment losses do not usually satisfy the criteria for discontinued operations or extraordinary items, firms report them in the continuing operations section of the income statement. If the amounts are material, they appear on a separate line to distinguish them from recurring income items. Income, gains, and losses from discontinued operations and extraordinary gains and losses appear in the income statement net of any income tax effects. The majority of published income statements include only the first section because discontinued operations and extraordinary gains and losses occur infrequently.

Febrile Neutropenia Case Study

Febrile Neutropenia Case Study Consent: The patient consented for the use of the details of the illness in this report. 2.1 Patient History 2.1.1 History of disease Mr DW is a 50yr old male who was admitted to hospital on the 12th of February after suffering from nausea, vomiting and diarrhoea the previous day. He reported vomiting about 3-4 times during the day but only very small amounts of vomitus as he felt too unwell to eat anything but very small amounts of food. This was on a background of a 5-month history of multiple myeloma (MM), as well as chemotherapy induced pancytopenia. He received a Melphalan peripheral blood stem cell transplant on the 8th of February 4 days prior to his current admission His symptoms were managed by medication, but on the 15th of February he had a spike in temperature overnight. His mucous membranes became mildly erythematous on the 14th of February. He has experienced no other symptoms and overall his symptoms have gradually improved during his stay. 2.1.2 Past Medical History Relevant past medical history includes multiple myeloma which was diagnosed on the 9th of September 2016 which he has been undergoing chemotherapy for. He also received an autologous stem cell transplant on the 8th of February 2017. At the time of the diagnoses, Mr DW presented with vertebral fractures and symptomatic anaemia. Mr DW also has pancytopenia which is a consequence of his chemotherapy. Aside from hospital admissions related to the aforementioned conditions, Mr DW has never been to hospital and has no other relevant past medical history. 2.1.3 Medications       Drug Name Dose Indication Aztreonam 2g, IV, 8 hourly Antibacterial Prophylaxis Fentanyl 25mcg/hr (transdermal modified release patch) 1 patch, every 3 days Pain Fluconazole 200mg, 1 capsule, Oral, Daily Antifungal prophylaxis Metoclopramide 10mg, 2mL, IV, 8 hourly Nausea, vomiting Nystatin 1 tab, Oral, BD (twice a week) Antifungal prophylaxis Ondansetron 4-8mg, IV, 8 hourly Nausea, vomiting Pantoprazole 40mg, Oral, night Ulceration of oesophagus valaciclovir 10mg, Oral, bedtime Herpes Prophylaxis 2.1.4 Drug Allergies Penicillin Leaves the patient with a full body erythematous rash 2.1.5 Family History The patient had no family history of any conditions 2.1.6 Psychosocial History and Functional Status Mr DW is currently employed as a cinematographer and regularly has to travel around and to different states due to his line of work. He is a non-smoker, drinks approximately 1 or 2 standards in a fortnight and denies recreational drug use. He lives with his wife and 2 of his 5 children at his house and describes himself as feeling very well supported by his family. The diagnosis of multiple myeloma was a big shock for him and his family and he is quite concerned about his current prognosis. He stated that he has accepted it and is trying to stay positive and to continue living life as normally as possible. 2.2 Physical Examination Observation revealed a middle-aged man who was very bright, alert and sitting upright in a chair. Within the room there was a lot of flowers and cards. His vitals were normal (RR 18, SPO2 98% on RA, BP 115/75, HR 80, afrebile 37.4oC) On general inspection there was no visible bruising, scars, masses or other abnormalities except for some slight erythema around a PICC line on his right arm. His hands had no nicotine stains, nail changes or palmar erythema but there was palmar crease pallor. There was good dentition, mucous membranes were moist. 2.2.1 Cardiovascular Exam Pulse was palpable bilaterally and of normal rate and rhythm.Carotid pulse was strong in character. JVP was not elevated.Heart sounds dual no murmur.No audible bruits nor palpable thrills or heaves.No signs of peripheral oedema. 2.2.2 Respiratory Exam Trachea was midline.Chest expansion symmetrical and not reduced.Clear lung sounds throughout as well as normal percussion and vocal resonance.No signs of peripheral or central cyanosis. 2.2.3 Gastrointestinal Exam Abdomen was soft and non-tender.Spleen and kidneys not palpable.Liver of normal span (10cm)Bowel sounds were present. 2.3 Investigations X-ray Skeletal Survey Lungs and pleural spaces clear. Mediastinal contour and heart size are normal. Mild multi-level degenerative disc disease at the thoracic level. Normal everywhere else. Multiple small lytic lesions involving calvarium, proximal humeri and proximal femora bilaterally in keeping with MM Blood Cultures Results had not yet returned. Blood Test: Haematology WCC: 0.93*109/L (Low) Hb: 98 g/L (Low) PLT: 84*109/L (Low) HCT: 0.276 L/L (Low) MCV: 85.2 fL (Normal) RCC: 3.24*1012/L (Low) MCH: 29.9pg (Normal) MCHC: 351 g/L (Normal) Neutrophils: 0.89*109/L (Low) Lymphocytes: 0.03*109/L (Low) Monocytes: 0.00*109/L (Low) Eosinophils: 0.01*109/L (Low) *Non-listed results were within normal ranges 2.4 Diagnoses Based on his initial presentation and considering his recent stem cell transplant his treating team suspected his symptoms were likely to be due to side effects of his treatment as opposed to infection. Following the spike in temperature he was considered to have febrile neutropenia and was treated according to the guidelines (with a slight modification that shall be discussed later in report) and based on his symptoms as well as the mildly erythematous mouth Mr DW was considered to have mucositis. He is currently being managed with anti-emetics as well as prophylactic treatment considering his vulnerable state. They are also awaiting the results of blood cultures to ensure that he does not have any severe opportunistic infections. 3.1 Part A: Physiology Pancytopenia is an important entity encountered in regular clinical practice. It is not a disease but is instead a finding and can have multiple causes most of which primarily involve the bone marrow. Pancytopenia consists of a low haemoglobin count, low white cell count, and platelet count (Gayathri Rao, 2011). In Mr DWs case, his pancytopenia was caused by bone marrow suppression due to his chemotherapy treatment. 3.1.1 Platelet production and Megakaryocytopoiesis Currently the physiology of platelet production from megakaryocytes (MKs) are not perfectly understood. MKs are a type of nucleated bone marrow cells that studies have shown develop into polypoid structure via a process that is known as endomiosis followed by a maturation process before producing platelets in circulation (Machlus Italiano, 2013). Figure 1: Haematopoietic lineage(Deutsch Tomer, 2013) MKs are derived from haematopoietic stem cells (HSCs) which are the precursors to all other blood cells (see Figure 1) and they themselves are derived from haemangioblasts. HSCs progress into becoming common myeloid progenitor cells (CMPs) that mature into either monocytes or granulocytes, or they can continue developing into MK-erythroid progenitor cells (MEPs) which go on to produce MKs (Deutsch Tomer, 2013). Figure 2: Platelet Production Pathway(Machlus Italiano, 2013) In the first phase of maturation MKs undergo nuclear proliferation and enlargement of their cytoplasm which is filled with platelet-specific granules as well as sufficient membrane to complete the platelet production process. The second phase involves MKs remodelling their cytoplasm into proplatelets and then into preplatelets which go on to release platelets through fission events (see Figure 2) (Machlus Italiano, 2013). There are a number of growth factors and interleukins that regulate the development of MKs but the primary and most potent one is thrombopoietin (a glycoprotein produced in the liver). It is crucial in the development and proliferations of HSCs as it stimulates the MKs to undergo hyperplasia and hypertrophy as well as stimulating the formation of the platelet projections from which release platelets into the circulation (Deutsch Tomer, 2013). 3.1.2 Erythropoiesis Erythrocytes are vital to the functioning of the human body as they transport oxygen to the tissues. As such the complex developmental process known as erythropoiesis has to be carefully regulated and managed (Luo et al., 2017). The process mainly occurs within bone marrow and begins with the differentiation of HSCs into burst-forming-unit erythroid (BFU-E) cells which are the earliest erythroid progenitors (see Figure 3). These cells then go onto become the colony-forming-unit erythroid (CFU-E) cells which undergo further differentiation and maturation to become mature erythrocytes (Luo et al., 2017). Figure 3: Overview of Erythropoiesis(Hattangadi, Wong, Zhang, Flygare, Lodish, 2011) Erythropoietin is produced in the kidneys and acts as one of the most important physiological regulators of erythropoiesis. It is produced primarily in response to hypoxic conditions detected by specialised interstitial cells in the outer medulla and inner cortex of the kidneys. Erythropoietin regulates erythrocyte production, prevents apoptosis and controls the rate of release. It also acts on CFU-Es (see Figure 3) which then go on to become proerythroblasts (Hattangadi et al., 2011). These cells undergo maturation to eventually become polychromatic, basophilic, and orthochromatic erythroblasts. The orthochromatic erythroblasts differentiate to reticulocytes and become mature erythrocytes (Luo et al., 2017). Mr DWs pancytopenia is consistent with myelosuppression and is a common side effect of chemotherapy treatment. Normally HSCs from which blood cells develop are capable of self-renewal but chemotherapy affects cells within the bone marrow and greater numbers of HSCs are needed to be activated. Unfortunately, with the diminished capability production of the myeloid cell lines is unable to keep up and leads to low counts which is reflected in Mr DWs blood tests (see investigations) as he has low amounts of white cells, red cells and platelets. Unlike other conditions where there may be infiltration of bone marrow he still makes normal cells but just in a diminished amount, consequently, he has normal mean cell volume, mean platelet volume and mean corpuscular haemoglobin. 3.2 Part B: Health Policies Fever in neutropenic patients occurs frequently early in a course of chemotherapy and in diseases which disrupt the bone marrow. In these cases fever could be considered a medical emergency as it requires immediate evaluation as well as the use empiric broad-spectrum antibiotics (Lyman Rolston, 2010). Patients with febrile neutropenia have mortality rates ranging from 5% 20% and mortality rates can be greater than 50% in patients who develop septic shock or pneumonia even with the use of antibiotic treatment (Kuderer, Dale, Crawford, Cosler, Lyman, 2006). The importance of managing febrile neutropenia swiftly and as effectively as possible cannot be understated and as such the guidelines around this area are extremely important. 3.2.1 Prince of Wales Febrile Neutropenia Guidelines Figure 4: Prince of Wales Initial Management of Febrile Neutropenia Guidelines(Health, 2015) The Prince of Wales hospital where Mr DW presented has a specific guideline for initial management of febrile neutropenia. Since he has a severe penicillin allergy he was treated following the guidelines with Aztreonam but his treating team chose to differ from the guidelines and gave him Vancomycin immediately. Mr DW did not have any of the indicators for the use of vancomycin (see Figure 4) but during a discussion with the treating team it became apparent that they believed it was safer and resulted in overall better outcomes to begin patients on vancomycin immediately. As such they believed that vancomycin should be used immediately in cases with any penicillin allergy and used following the dosing guidelines when theres no penicillin allergy. 3.2.2 Use of Empiric Antimicrobial Therapy In terms of the use of empiric antimicrobial therapy in the initial management of febrile neutropenia the Prince of Wales guidelines essentially perfectly follow the national recommendations. The changes that Mr DWs treating team wished to make to the guidelines is at odds with the current literature and guidelines (Freifeld et al., 2011; Paul, Dickstein, Borok, Vidal, Leibovici, 2014). Based on most studies into this topic, non-selective use of vancomycin reduced relative risk of mortality but was not found to be significant and there also was no significant difference in overall 30-day patient mortality (Lugtenberg, Burgers, Westert, 2009; Paul et al., 2014). 3.2.3 Recommendations The Prince of Wales guidelines closely adhere to the national guidelines and what the current literature deems as the most effective (Freifeld et al., 2011; Paul et al., 2014). Even so, its clear that the treating team for Mr DW felt that the current guidelines were inaccurate. It is difficult to assess which version is more effective specifically for the population they are dealing with at the Prince of Wales hospital but based on current research following the current guidelines (as opposed to modifying them) appears to be the best course of action (Lugtenberg et al., 2009). That being said, in specific cases where the specialists in this area strongly feel that they should act differently it may be best to defer to their experience and expertise. This assignment has been an interesting and thought-provoking experience. The most surprising thing I found was how the views of the treating team differed from the guidelines. I realised I place a lot of value upon their views and thus was very surprised when looking at the literature as it seemed to be contradict what they told me. Its clear that I was biased at the beginning but even after researching this topic Im still unsure if there is a correct view or side. Although, what this whole process has taught me is that more research, consultation, and evaluation in regards to current treatment guidelines and policies still can and should be done. This time around when doing the assignment again I tried to ensure that I took the advice and feedback on my previous assignment seriously. Finding a patient was difficult and I ended up with a patient that had similar aspects to a previous assignment but I tried to explore different aspects and it also allowed me to incorporate things that I did not include previously. There have been issues and difficulties with writing this assignment but I feel that overall, its been quite rewarding and that I hope to maintain a higher level of quality in my work going into the future. References             Deutsch, V. R., Tomer, A. (2013). Advances in megakaryocytopoiesis and thrombopoiesis: from bench to bedside. British Journal of Haematology, 161(6), 778-793. doi:10.1111/bjh.12328 Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., Boeckh, M. J., Ito, J. I., Mullen, C. A., . . . Wingard, J. R. (2011). Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical infectious diseases, 52(4), e56-e93. Gayathri, B. N., Rao, K. S. (2011). Pancytopenia: A Clinico Hematological Study. Journal of Laboratory Physicians, 3(1), 15-20. doi:10.4103/0974-2727.78555 Hattangadi, S. M., Wong, P., Zhang, L., Flygare, J., Lodish, H. F. (2011). From stem cell to red cell: regulation of erythropoiesis at multiple levels by multiple proteins, RNAs, and chromatin modifications. Blood, 118(24), 6258. Health, N. (2015). Initial Management of Febrile Neutropenia. Retrieved from Http://www.seslhnweb/powh/policies/default.asp Kuderer, N. M., Dale, D. C., Crawford, J., Cosler, L. E., Lyman, G. H. (2006). Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer, 106(10), 2258-2266. doi:10.1002/cncr.21847 Lugtenberg, M., Burgers, J. S., Westert, G. P. (2009). Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Quality and Safety in Health Care, 18(5), 385. Luo, S.-T., Zhang, D.-M., Qin, Q., Lu, L., Luo, M., Guo, F.-C., . . . Wei, Y.-Q. (2017). The Promotion of Erythropoiesis via the Regulation of Reactive Oxygen Species by Lactic Acid. Scientific Reports, 7, 38105. doi:10.1038/srep38105 http://www.nature.com/articles/srep38105#supplementary-information Lyman, G. H., Rolston, K. V. I. (2010). How We Treat Febrile Neutropenia in Patients Receiving Cancer Chemotherapy. Journal of Oncology Practice, 6(3), 149-152. doi:10.1200/JOP.091092 Machlus, K. R., Italiano, J. E. (2013). The incredible journey: From megakaryocyte development to platelet formation. The Journal of Cell Biology, 201(6), 785. Paul, M., Dickstein, Y., Borok, S., Vidal, L., Leibovici, L. (2014). Empirical antibiotics targeting Gramà ¢Ã¢â€š ¬Ã‚ positive bacteria for the treatment of febrile neutropenic patients with cancer. The Cochrane Library.

Generation What? An Outcast of Generation X :: Essays Papers

Generation What? An Outcast of Generation X Reflecting upon my writing is one of the most difficult tasks I have ever been asked to do. Looking back upon my work, I realize that this is one of the most important papers I have written. Not only was this piece the first paper I have written for a writing studio, it also enabled me to release some of the frustrations I have with my generation. Generation X. Slackers. Twentysomethings. There has been so much written about this group. There have been countless attempts by the media to analyze them. The media panders to and laughs at them, almost in the same breath. They discuss the group's alienation and disaffection, and their pride in multiculturalism. The media mocks their seemingly constant depression and applauds their tolerance and open-mindedness. Movies such as Reality Bites and Singles show this group in all its glory. Most people in this age group watch these movies and feel a connec tion with them. The backdrops of these characters' lives, and the experiences these characters face are similar to their own. However, I, as well as many of my peers, cannot relate to any of the so-called "Gen eration X" movies, TV shows, music, etc. While we are all in the correct age group, these forms of entertain ment are for the products of a white, middle-class, suburban upbringing. This category leaves out a con siderable amount of young Americans. The whole concept of a Generation X reminds me of junior high school, where knowing the right people, wearing the right clothes, and listening to the right music means status and popularity. Back in junior high, there was the popular crowdrich kids, ath letes, and beautiful people. These popular people had one thing in common conformity. They all wore the same type of clothes with the same brand names. They went to all the socially key functionsparties, dances, etc. As much as twentysomethings would like to think they have progressed beyond this point, they have not. Generation X also has a popular crowd. Instead of going to the socially key parties, they attend concert events like Lollapalooza and Woodstock '94. Instead of going out of their way to look like everyone else, they go out of their way not to look like everyone elseand end up looking like everyone else in the process. The audience at a Lollapalooza concert is a study in nonconformist conformity.

The American Dream: The Essence of America Essay examples -- Essays on

From the birth of America, to America today, the driving force and the heart of America has always been the â€Å"American Dream.† The â€Å"American Dream† is a goal for many of people who live in the realms of the Americanized world. I believe that the â€Å"American Dream† is controlling my own destiny, becoming successful, and living free. Examples of this dream are things like television, automobiles, supermarkets, malls, Internet, planes, trains, etc. The â€Å"American Dream† is success, freedom, and being able to control your own destiny.   Ã‚  Ã‚  Ã‚  Ã‚  Becoming successful has been the dreams of many people of the past and present and I think that it is one the most important things that a person must accomplish. Anyone and everyone can develop into a successful person, permitting that the person believes i...

Ethical Issues in Accounting Essay

â€Å"Accountants and the accountancy profession exist as a means of public service; the distinction which separates a profession from a mere means of livelihood is that the profession is accountable to standards of the public interest, and beyond the compensation paid by clients.† —Robert H. Montgomery, describing ethics in accounting. Accounting ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to accountancy. It is an example of professional ethics. Accounting ethics were first introduced by Luca Pacioli, and later expanded by government groups, professional organizations, and independent companies. Ethics are taught in accounting courses at higher education institutions as well as by companies training accountants and auditors. Due to the diverse range of accounting services and recent corporate collapses, attention has been drawn to ethical standards accepted within the accounting profession. These collapses have resulted in a widespread disregard for the reputation of the accounting profession. To combat the criticism and prevent fraudulent accounting, various accounting organizations and governments have developed regulations and remedies for improved ethics among the accounting profession. Importance of Ethics in Accounting The nature of the work carried out by accountants and auditors requires a high level of ethics. Shareholders, potential shareholders, and other users of the financial statements rely heavily on the yearly financial statements of a company as they can use this information to make an informed decision about investment. They rely on the opinion of the accountants who prepared the statements, as well as the auditors that verified it, to present a true and fair view of the company. Knowledge of ethics can help accountants and auditors to overcome ethical dilemmas, allowing for the right choice that, although it may not benefit the company, will benefit the public who relies on the accountant/auditor’s reporting. History Luca Pacioli, the â€Å"Father of Accounting†, wrote on accounting ethics in his first book Summa de arithmetica, geometria, proportioni, et proportionalita, published in 1494. Ethical standards have since then been developed through government groups, professional organizations, and independent companies. These various groups have led accountants to follow several codes of ethics to perform their duties in a professional work environment. Accountants must follow the code of ethics set out by the professional body of which they are a member. United States accounting societies such as the Association of Government Accountants, Institute of Internal Auditors, and the National Association of Accountants all have codes of ethics, and many accountants are members of one or more of these societies. In 1887, the American Association of Public Accountants (AAPA) was created; it was the first step in developing professionalism in the United States accounting industry. By 1905, the AAPA’s first ethical codes were formulated to educate its members. During its twentieth anniversary meeting in October 1907, ethics was a major topic of the conference among its members. As a result of discussions, a list of professional ethics was incorporated into the organization’s bylaws. However, because membership to the organization was voluntary, the association could not require individuals to conform to the suggested behaviors. Other accounting organizations, such as the Illinois Institute of Accountants, also pursued discussion on the importance of ethics for the field. The AAPA was renamed several times throughout its history, before becoming the American Institute of Certified Public Accountants (AICPA) as its named today. The AICPA developed five divisions of ethical principles that its members should follow: â€Å"independence, integrity, and objectivity†; â€Å"competence and technical standards†; â€Å"responsibilities to clients†; â€Å"responsibilities to colleagues†; as well as â€Å"other responsibilities and practices†. Each of these divisions provided guidelines on how a Certified Public Accountant (CPA) should act as a professional. Failure to comply with the guidelines could have caused an accountant to be barred from practicing. When developing the ethical principles, the AICPA also considered how the profession would be viewed by those outside of the accounting industry. Teaching Ethics Universities began teaching business ethics in the 1980s. Courses on this subject have grown significantly in the last couple of decades. Teaching accountants about ethics can involve role playing, lectures, case studies, guest lectures, as well as other mediums. Recent studies indicate that nearly all accounting textbooks touch on ethics in some way. In 1993, the first United States center that focused on the study of ethics in the accounting profession opened at State University of New York at Binghamton. Starting in 1999, several U.S. states began requiring ethics classes prior to taking the CPA exam. Seven goals of accounting ethics education †¢ Relate accounting education to moral issues. †¢ Recognize issues in accounting that have ethical implications. †¢ Develop â€Å"a sense of moral obligation† or responsibility. †¢ Develop the abilities needed to deal with ethical conflicts or dilemmas. †¢ Learn to deal with the uncertainties of the accounting profession. †¢ â€Å"Set the stage for† a change in ethical behavior. †¢ Appreciate and understand the history and composition of all aspects of accounting ethics and their relationship to the general field of ethics. —Stephen E. Loeb In 1988, Stephen E. Loeb proposed that accounting ethics education should include seven goals (adapted from a list by Daniel Callahan). To implement these goals, he pointed out that accounting ethics could be taught throughout accounting curriculum or in an individual class tailored to the subject. Requiring it be taught throughout the curriculum would necessitate all accounting teachers to have knowledge on the subject (which may require training). A single course has issues as to where to include the course in a student’s education (for example, before preliminary accounting classes or near the end of a student’s degree requirements), whether there is enough material to cover in a semester class, and whether most universities have room in a four-year curriculum for a single class on the subject. There has been debate on whether ethics should be taught in a university setting. Supporters point out that ethics are important to the profession, and should be taught to accountants entering the field.[18] In addition, the education would help to reinforce students’ ethical values and inspire them to prevent others from making unethical decisions. Critics argue that an individual is ethical or not, and that teaching an ethics course would serve no purpose. Despite opposition, instruction on accounting ethics by universities and conferences, has been encouraged by professional organizations and accounting firms. The Accounting Education Change Commission (AECC) has called for students to â€Å"know and understand the ethics of the profession and be able to make value-based judgments.† Phillip G. Cottel argued that in order to uphold strong ethics, an accountant â€Å"must have a strong sense of values, the ability to reflect on a situation to determine the ethical implications, and a commitment to the well-being of others.† Iris Stuart recommends an ethics model consisting of four steps: the accountant must recognize that an ethical dilemma is occurring; identify the parties that would be interested in the outcome of the dilemma; determine alternatives and evaluate its effect on each alternative on the interested parties; and then select the best alternative. Accounting Scandals Accounting ethics has been deemed difficult to control as accountants and auditors must consider the interest of the public (which relies on the information gathered in audits) while ensuring that they remained employed by the company they are auditing. They must consider how to best apply accounting standards even when faced with issues that could cause a company to face a significant loss or even be discontinued. Due to several accounting scandals within the profession, critics of accountants have stated that when asked by a client â€Å"what does two plus two equal?† the accountant would be likely to respond â€Å"what would you like it to be?† This thought process along with other criticisms of the profession’s issues with conflict of interest, have led to various increased standards of professionalism while stressing ethics in the work environment. The role of accountants is critical to society. Accountants serve as financial reporters and intermediaries in the capital markets and owe their primary obligation to the public interest. The information they provide is crucial in aiding managers, investors and others in making critical economic decisions. Accordingly, ethical improprieties by accountants can be detrimental to society, resulting in distrust by the public and disruption of efficient capital market operations. â€Å"Every company in the country is fiddling its profits. Every set of published accounts is based on books which have been gently cooked or completely roasted. The figures which are fed twice a year to the investing public have all been changed in order to protect the guilty. It is the biggest con trick since the Trojan horse. †¦ In fact this deception is all in perfectly good taste. It is totally legitimate. It is creative accounting.† —Ian Griffiths in 1986, describing creative accounting From the 1980s to the present there have been multiple accounting scandals that were widely reported on by the media and resulted in fraud charges, bankruptcy protection requests, and the closure of companies and accounting firms. The scandals were the result of creative accounting, misleading financial analysis, as well as bribery. Various companies had issues with fraudulent accounting practices, including Nugan Hand Bank, Phar-Mor, WorldCom, and AIG. One of the most widely-reported violation of accounting ethics involved Enron, a multinational company, that for several years had not shown a true or fair view of their financial statements. Their auditor Arthur Andersen, an accounting firm considered one of the â€Å"Big Five†, signed off on the validity of the accounts despite the inaccuracies in the financial statements. When the unethical activities were reported, not only did Enron dissolve but Arthur Andersen also went out of business. Enron’s shareholders lost $25 billion as a result of the company’s bankruptcy. Although only a fraction of Arthur Anderson’s employees were involved with the scandal, the closure of the firm resulted in the loss of 85,000 jobs. Causes Fraudulent accounting can arise from a variety of issues. These problems usually come to light eventually and could ruin not only the company but also the auditors for not discovering or revealing the misstatements. Several studies have proposed that a firm’s corporate culture as well as the values it stresses may negatively alter an accountant’s behavior. This environment could contribute to the degradation of ethical values that were learned from universities. Until 1977, ethics rules prevented accounting and auditing firms from advertising to clients. When the rules were lifted, spending by the largest CPA firms on advertisements rose from US$4 million in the 1980s to more than $100 million in the 2000s. Critics claimed that, by allowing the firms to advertise, the business side overstepped the professional side of the profession, which led to a conflict of interest. This focus allowed for occurrences of fraud, and caused the firms, according to Arthur Bowman, â€Å"†¦ to offer services that made them more consultants and business advisers than auditors.† As accounting firms became less interested in the lower-paying audits due to more focus on higher earning services such as consulting, problems arose. This disregard for the lack of time spent on audits resulted in a lack of attention to catching creative and fraudulent accounting. A 2007 article in Managerial Auditing Journal determined the top nine factors that contributed to ethical failures for accountants based on a survey of 66 members of the International Federation of Accountants. The factors include (in order of most significant): â€Å"self-interest, failure to maintain objectivity and independence, inappropriate professional judgment, lack of ethical sensitivity, improper leadership and ill-culture, failure to withstand advocacy threats, lack of competence, lack of organizational and peer support, and lack of professional body support.† The main factor, self-interest, is the motivation by an accountant to act in his/her best interest or when facing a conflict of interest. For example, if an auditor has an issue with an account he/she is auditing, but is receiving financial incentives to ignore these issues, the auditor may act unethically. Principles- vs. rules-based â€Å"When people need a doctor, or a lawyer, or a certified public accountant, they seek someone whom they can trust to do a good job — not for himself, but for them. They have to trust him, since they cannot appraise the quality of his ‘product’. To trust him they must believe that he is competent, and that his primary motive is to help them.† —John L. Carey, describing ethics in accounting The International Financial Reporting Standards (IFRS) are standards and interpretations developed by the International Accounting Standards Board, which are principle-based. IFRS are used by over 115 countries including the European Union, Australia, and Hong Kong. The United States Generally Accepted Accounting Principles (GAAP), the standard framework of guidelines for financial accounting, is largely rule-based. Critics have stated that the rules-based GAAP is partly responsible for the number of scandals that the United States has suffered. The principles-based approach to monitoring requires more professional judgment than the rules-based approach. There are many stakeholders in many countries such as The United States who report several concerns in the usage of rules-based accounting. According to recent studies, many believe that the principles-based approach in financial reporting would not only improve but would also support an auditor upon dealing with client’s pressure. As a result, financial reports could be viewed with fairness and transparency. When the U.S. switched to International accounting standards, they are composed that this would bring change. However, as a new chairperson of the SEC takes over the system, the transition brings a stronger review about the pros and cons of rules- based accounting. While the move towards international standards progresses, there are small amount of research that examines the effect of principle- based standards in an auditor’s decision- making process. According to 114 auditing experts, most are willing to allow clients to manage their net income based on rules- ba sed standards. These results offers insight to the SEC, IASB and FASB in weighing the arguments in the debate of principles- vs. rules based- accounting. IFRS is based on â€Å"understandability, relevance, materiality, reliability, and comparability†. Since IFRS has not been adopted by all countries, these practices do not make the international standards viable in the world domain. In particular, the United States has not yet conformed and still uses GAAP which makes comparing principles and rules difficult. In August 2008, the Securities and Exchange Commission (SEC) proposed that the United States switch from GAAP to IFRS, starting in 2014. Responses to scandals Since the major accounting scandals, new reforms, regulations, and calls for increased higher education have been introduced to combat the dangers of unethical behavior. By educating accountants on ethics before entering the workforce, such as through higher education or initial training at companies, it is believed it will help to improve the credibility of the accounting profession. Companies and accounting organizations have expanded their assistance with educators by providing education materials to assist professors in educating students. New regulations in response to the scandals include the Corporate Law Economic Reform Program Act 2004 in Australia as well as the Sarbanes-Oxley Act of 2002, developed by the United States. Sarbanes-Oxley limits the level of work which can be carried out by accounting firms. In addition, the Act put a limit on the fee which a firm can receive from one client as a percentage of their total fees. This ensures that companies are not wholly reliant on one firm for its income, in the hope that they do not need to act unethically to keep a steady income. The act also protects whistleblowers and requires senior management in public companies to sign off on the accuracy of its company’s accounting records. In 2002, the five members of the Public Oversight Board (POB), which oversaw ethics within the accounting profession, resigned after critics deemed the board ineffective and the SEC proposed developing a new panel, the Public Company Accounting Oversight Board (PCAOB). The PCAOB wa s developed through the Act, and replaced the POB. In 2003, the International Federation of Accountants (IFAC) released a report entitled Rebuilding Public Confidence in Financial Reporting: An International Perspective. By studying the international company collapses as a result of accounting issues, it determined areas for improvement within organizations as well as recommendations for companies to develop more effective ethics codes. The report also recommended that companies pursue options that would improve training and support so accountants could better handle ethical dilemmas. A collaborative effort by members of the international financial regulatory community led by Michel Prada, Chairman of the French Financial Markets Authority, resulting in establishment of the Public Interest Oversight Board (PIOB) on 1 March 2005. The PIOB provides oversight of the IFAC standards-setting boards: the International Auditing and Assurance Standards Board (IAASB), the International Accounting Education Standards Board (IAESB) and the Inter national Ethics Standards Board for Accountants(IESBA). The most recent reform came into effect in July 2010 when President Obama signed â€Å"The Dodd-Frank Wall Street Reform and Consumer Protection Act†. The act covers a broad range of changes. The highlights of the legislation are consumer protections with authority and independence, ends too big to fail bail outs, advance warning system, transparency and accountability for exotic instruments, executive compensation and corporate governance, protects investors, and enforces regulations on the books. The legislation also resulted in the Office of the Whistleblower, which was established to administer the SEC’s whistleblower program. Congress authorized the SEC to provide monetary awards to whistleblowers who come forward with information that results in a minimum of a $1,000,000 sanction. The rewards are between 10% and 30% of the dollar amount collected. Whistleblowers help identify fraud and other unethical behaviors early on. The result is less harm to investors, quick ly holding offenders responsible, and to maintain the integrity of the U.S. markets.