Sterile versus non-sterile gloves

Sterile versus non-sterile gloves Sterile technique is generally used for laceration repair despite a lack of scientific evidence that this is necessary (Wilson, 2003). This study addresses whether there is a difference in the infection rate of lacerations randomised to receive repair using sterile versus nonsterile gloves. This will help to increase knowledge on the evidence of infection rates when nonsterile gloves are used. If it can be proven that the use of nonsterile gloves for laceration repair poses no risk, this could save time and have considerable financial savings. This may change clinical practise in the future. Research Question: Sterile versus non-sterile gloves: A safe alternative in the management of acute simple wounds in the pre-hospital environment? Sterile technique (including the use of sterile gloves) for acute simple wound or laceration management is traditional and the practise continues to be recommended (Wilson, 2003). However, there are few studies and little evidence to support this practise. Using clean nonsterile gloves rather than individually packaged sterile gloves for uncomplicated wound repair in the community may result in cost and time savings. Study objective: This proposal is for a prospective randomised controlled trial designed to determine whether there is a difference in the rate of infection, after suture repair of uncomplicated wounds and lacerations, using clean nonsterile gloves versus sterile gloves in a community setting. Justification: The research question separates this proposed study from in-hospital studies, and addresses the small data set available specific to community and pre-hospital environments (Perelman et al, 2004; Worral, 1987; Bodiwala George). Results will add to the body of evidence, broaden the knowledge base for the healthcare community and further the cause of science (Medical Research Council, 2010). This trial aims to provide quality data for publication, enabling informed re-use by others and thereby reducing the risk of data creation duplicity. Background: The Department of Health (DoH) (2005) paper Taking healthcare to the patient states that at least one million of the people taken to AE every year could be treated at the scene, in their homes or in the community. With the advent of the Emergency Care Practitioner (ECP) role, many simple wounds / lacerations are suitable for treatment and closure in the pre-hospital setting. During the year 2008 09, the National Health Service (NHS) reports that there were 663,475 Accident and Emergency attendances in England for lacerations, accounting for 8.5% of total attendances (NHS, 2010). Figures for the Ambulance service this trial will be run at show that over a six month period from April to September 2010, their ECPs attended 1555 calls for laceration / haemorrhage, 72.5% (n= 1127) of which were dealt with at the scene, negating a visit to an Accident and Emergency department. These wounds were cleansed, treated and closed where necessary using a variety of techniques from tissue adhesiv e to paper stitches or sutures. As sterile gloves are not available, the practitioner carrying out treatment of these wounds would have been using clean, non sterile gloves. This is in stark contrast to wound closure in the Accident and Emergency department where the use of sterile gloves is universal (NHS Clinical Knowledge Summaries, 2010). The question asked by this study is whether there is a difference in the rates of infection between wounds treated by practitioners wearing sterile versus non sterile gloves in the community. To answer this it is necessary to investigate what contributing factors to wound infection there are, how they are best managed and what, if any, difference gloves make to the control of infection. Pratt et al (2007) advise that best practice (in the absence of strong evidence) must be guided by expert opinion and national and international guidance; all of which should be integrated into local practice guidelines. In the case for use of sterile versus nonsterile gloves, there has been insufficient research to provide reliable evidence, therefore clinical tradition is followed and sterile gloves are the preferred choice. This dogmatic adherence to tradition is underlined by Flores (2008) who states Although ritualistic practice needs to be questioned, with the rising incidence of multi-resistant infections, it seems prudent to err on the side of caution when in doubt. Obviously then, it is important to remove the doubt by rigorous research into the area for concern, thereby adding quality data to the body of evidence and knowledge, and allowing this to steer best practise, however this is out of the scope of this study. Literature Review. A search of Cochrane Library gave 135 results, 1 of which directly answered the question (Perelman et al, 2004 see appendix one). A search of three other databases British Nursing Index (BNI), The U.S. National Library of Medicine premier life sciences database (PubMed) and Cumulative index to nursing and health literature Nursing allied health (CINAHL) revealed the same plus 2 others: Bodiwala George (1982) and Worral (1987) using the search term Infection OR Cross Infection OR Disease Transmission OR Infection Control AND Glove* OR Protective Device* OR Surgical Glove* OR Sterile Glove* OR Non Sterile Glove* AND Acute Traumatic Wound* OR Wound*.  LIMIT set to Human AND English. This shows there is little tangible research into the hypothesis suggested in this proposal. The prospective Randomized Control Trial (RCT) by Perelman et al (2004) in Canadian Emergency Departments compared sterile versus nonà ¢Ã¢â€š ¬Ã‚ sterile gloves (both latexà ¢Ã¢â€š ¬Ã‚ free) in sutured repair of lacerations. The study enrolled 816 patients (age à ¢Ã¢â‚¬ °Ã‚ ¥ 1) with blinding of patients and outcome assessors. Infection rates by 23 days were 4.3% in the nonà ¢Ã¢â€š ¬Ã‚ sterile group and 6% in the sterile group (no statistical difference), however credence was given to the possibility of skewing results due to the Hawthorne effect (Bowling, 2009) (As blinding the clinician in this type of study is impossible, it is possible that physicians using nonsterile gloves are simply more careful). This is the only RCT study of sterile versus nonsterile gloves. It is of high quality with a reasonable sample size, let down only by the non-standardised partially blind follow up. There are two older studies with significant limitations (comparing no gloves to sterile gloves) and questionable randomisation. Bodiwala George (1982) showed through their study of 408 patients that the difference in infection rates between gloved and ungloved suturing was not statistically significant. Worral (1987) found that infection rates were higher in the sterile gloved group, although the study group was small (n=50). Both these studies lend support to the idea that sterile gloves offer little in the way of reducing infection rates in the repair of simple lacerations, however suturing without any gloves is inappropriate and unsafe for practitioner and patient. Allan (2009) supports the findings of these earlier studies and concludes that present evidence indicates simple lacerations can be repaired with clean nonsterile gloves without an increased risk of infection. Acute traumatic wounds, in comparison to surgical incisions, are by their very nature already exposed to infective agents and the time delay between injury and treatment is longer (Forsch, 2008). Meticulous cleansing and where necessary, debridement is essential in reducing infection rates (Durham Hines, 2001). Moscati et al (1998) found that irrigation of acute traumatic wounds to remove grit, foreign bodies, dressing residue, excess exudates and other potential contaminants to be vitally important in preventing later complications of infection and tattooing. Generally it is agreed that wound cleansing by irrigation is preferable to swabbing or wiping (Dealey, 2005). Trott (2005) supports the old maxim The solution to pollution is dilution, stating that the most effective method for reducing bacterial load on wound surfaces and for removing debris and contaminants from within a laceration is through irrigation. This begs the question: if in the acute traumatic laceration a high bac terial load is already present, of what benefit are sterile gloves in their treatment and closure? Theoretical framework: This is a positivist paradigm (Parahoo, 2006), collecting scientific quantitative data. The research question is based on the empirical data from previous similar trials. It is acknowledged that empirical data is vulnerable to interpretation (Rubin Rubin, 2005) and this trial seeks to limit this by means of closed questions in the data gathering tool. The proposed study hypothesises that the use of clean nonsterile gloves when suturing acute simple lacerations in a community setting has little or no effect on post procedure wound infections. To refine the research question, guidance was taken from Lewith Little (2009) to ensure it is focused, is feasible and explicit. It is also a Statement of expectation relative to the variables investigated (Polit Beck, 2004). Research Methodology: This research will be a randomised controlled trial (RCT). This is chosen as there is a direct comparison between two variables; an RCT providing robust data. The RCT is the most appropriate method of study design, especially in the setting of wound repair, as suggestibility and patient expectations are potentially significant sources of bias (Jadad Cepeda, 2000). Although double blinding is impossible in this trial, the assessing clinician (data gatherer) will be blinded as to what gloves were used. However a weakness is acknowledged in that the patient may inform the assessing clinician and by so doing inject a risk of bias. To reduce the effect of other variables, ECP practise and equipment is standardised (Health Professions Council, 2010). All wound closure by the ECPs will comply with the most recent evidence based practise (NHS Clinical Knowledge Summaries, 2010). All cleaning materials, local anaesthetics and equipment are identical county wide, ensuring equality. Only mono-filament suture material will be used (no silks). Acknowledgement is given to the following variables over which this trial has no control: Individual client hygiene, poor compliance with wound care advice, further trauma to wound site post repair. The trial will be run over a six month period and utilise cluster randomisation by geographical area. For three months, sterile gloves will be used by ECPs in the west of the county whilst the east ECPs will use clean nonsterile gloves. At the three month point this will be reversed with west ECPs using clean nonsterile gloves and east ECPs using sterile gloves. Data will be collected by RW at the end of each week. Sampling: Randomised from the population area (east / west). Randomisation is automatic due to the nature of calls; assistance only being sought when needed by the public, therefore the study has no control over and cannot affect bias of patient, place, time etc. Only those calls attended by ECPs and deemed suitable for suture closure will be included. Limits: Inclusion: Patients over 18 years of age, who have sustained an acute, simple traumatic laceration which is less than six hours old requiring primary closure with simple, interrupted sutures. Exclusion: Patients with the following Very dirty / Tetanus prone wounds, immunocompromised, immunosuppressed, concomitant antibiotic use, deep wounds requiring layered suturing to eliminate dead space, puncture wounds, bite wounds (animal or human), any wound where there is suspicion of retained foreign body or damage to underlying structures, diabetes, wounds over 6 hours old. Data Collection: Data will be collected via post in the form of two clinician completed multi choice questionnaires at 3 days and at removal of sutures (ROS). The first interval gives a reasonable healing time for wound review and early identification of infection if present (patient safety). The second time interval was chosen as patients will need to re-present for this procedure and it gives reasonable opportunity for infection, dehiscence or other problems if present, to be apparent and acted upon as necessary. RW will be the dedicated researcher for collection of questionnaires, data analysis and telephone follow-up, (thus reducing response loss and attrition of data) at no cost to the trial. Patients will be supplied with 2 copies of the questionnaire as part of their discharge advice pack to facilitate continuity should they re-present at an earlier time for any reason, or at another facility. If the forms are not returned, telephone follow up will be done. As the patient should attend for wound review regardless of this research, completion of the questionnaire will cause minimal impact on clinician time, with little interference to departmental workloads. Questionnaires are designed to be simple and rapid to complete. All questionnaires will be supplied with a self-adhesive stamped self addressed envelope for ease of return. It is recognised that a limitation of this study is non return of questionnaires for whatever reason; this will be factored into the final statistical analysis. As it is impossible to blind the clinician as to whether the gloves are sterile or nonsterile in this trial, their input into it will be limited to indicating on the ECP form (See appendix 2) which group the patient fits into; A for sterile glove use, B for clean nonsterile. Randomisation and selection bias through allocation is avoided by the unpredictable nature of the emergency and unplanned workload covered by the clinicians (ECPs). This should help increase validity of findings (Bowling, 2009). As the division of the Ambulance service utilised for this trial is already divided into east and west areas, this will be used to control the intervention by allocation of sterile or nonsterile gloves. Initially, the west ECPs will use only sterile gloves for suturing wounds, with the east ECPs using clean nonsterile gloves. At the half way point in the trial, the researcher will reverse this. This allocation of gloves gives a reasonable control group from both sides of the county and acknowledges differences in individual ECP procedure, geography, demographics etc. Ethics: The four point biomedical ethics framework suggested by Beauchamp Childress (2001) has been considered in the design of this trial. This trial recognises autonomy for both patient and practitioner by seeking informed consent from participants. It promotes beneficence through its attempt to treat patients expeditiously, to high standards, without prejudice; and non-maleficence by reassuring participants that their data with be kept confidential. Justice is assured by equality of treatment for each participant. Ethical approval for the research will need to be sought from both the Ambulance service Clinical Review Group and University Ethics Committees prior to starting the research process. The researcher will be responsible for ensuring that the participants welfare is maintained. Consent will be sought by the attending ECP. Kimmel (2007) acknowledges that participants should come to no harm psychologically, physically or socially. By strict adherence to wound care guidelines (cleansing, dressing etc) in the acute assessment and treatment phase, and due regard for the patient during follow-up, this should be addressed. Consent: Prior to the study, education of ECPs through a micro-teach session (a 5 minute presentation) and poster campaign for those who cannot attend will be carried out. The ECPs will be asked if they will partake in the trial; there will be no expectation on them to do so and their inclusion will be purely voluntary. Informed consent will be sought from all patients although acknowledgement is given to the fact that the patient will be presenting in a post injury phase; they may be distressed, in pain and anxious. All patients participating in the trial will have a clear explanation given to them prior to discharge to ensure they fully understand their role and right to leave the trial at any point. Confidentiality: All data for publication, dissemination or public review will be purely statistical and numerical, having no personal details of the participants; there will be no breach of confidentiality. Participant safety: All prior research has concluded that there is statistically no difference in rate of infection when comparing glove use, adding support to the argument that there is little risk to the patient (Bodiwala, Worral, and Perelman). All gloves used will be latex free, reducing any risks of latex allergy / sensitivity to patient and clinician alike. All participants will have the opportunity to withdraw at any phase of the trial. Data Analysis and discussion: Data will be presented in a 22 contingency table (See appendix 4). As the research question is looking for a possible relationship between two variables, a bivariate statistical analysis will be used (See appendix 4). Specialist advice will be sought for the analysis of the statistical data. It is hoped that response rates will be very high as the respondent will be a medical professional (not the patient), the questionnaire is very short and straightforward, and is supplied with a self adhesive, stamped self addressed envelope. This scenario is similar to Perelamans experiment which achieved a 98% response. The patient, by the very nature of their injury, will need to attend for follow up / ROS. Calnan et al (2005) suggest a response rate of approximately 56% when reliant on the patient. Timeline: Year 2011 Initiate experiment 1st April Data collection Continuous and ongoing (RW) Complete fieldwork by 1st September Complete analysis by 1st October Give presentation on 8th October Complete final report by 1st November Conclusion: Sterile technique is generally used for laceration repair despite a lack of scientific evidence that this is necessary (Wilson, 2003). This study addresses whether there is a difference in the infection rate of lacerations randomised to receive repair using sterile versus nonsterile gloves. This will help to increase knowledge on the evidence of infection rates when nonsterile gloves are used. It is apparent that could it be proven that there is little evidence to support the continued use of sterile gloves; this could reflect a significant cost saving for the NHS (see appendix 5). This may change clinical practise in the future. References / Bibliography: Allan, M.G. (2009) Lacerations: Sterile Gloves Water? Tools for Practice. June 1, 2009. Beauchamp, T.L. Childress, J.F. ( 2001) Principles of Biomedical Ethics. New York: Oxford University Press. Bodiwala, G.G., George, T.K. (1982) Surgical Gloves During Wound Repair In The Accident And Emergency Department. The Lancet: July 10, 1982. pp 91-92. Bowling, A. (2009) Research Methods in Health (3rd ed), Maidenhead: Open University Press. Calnan, M., Wainwright, D., ONeill, C., Winterbottom, A. Watkins, A. (2005) Lay evaluation of health care: the case of upper limb pain. Health Expectations. 8(2):149-160. Dealey, C. (2005) The Care of Wounds (3rd ed). Oxford: Blackwell. Department of Health (2005) Taking Healthcare to the Patient: Transforming NHS Ambulance Services [online] Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4114269 Accessed 24/10/10. Durham C. Hines, S.E. (2001) Laceration assessment and management. Patient Care for the Nurse Practitioner. Jun; 4 (6): 17-20, 23. Flores, A. (2008) Sterile versus non-sterile glove use and aseptic technique. Nursing Standard. 23 (6) 35-39. Forsch,  R..  (2008). Essentials of Skin Laceration Repair.  American Family Physician.  78(8),  945-51.   Grava-Gubins, I., Scott, S. (2008) Effects of various methodologic strategies: survey response rates among Canadian physicians and physicians-in-training. Canadian Family Physician. Oct;54(10):1424-30. Hampton, S. (2003) Nurses inappropriate use of gloves in caring for patients. British Journal of Nursing 12(17):1024-7. Health Professions Council (2010) Standards of Proficiency. [Online] Available at http://www.hpc-uk.org/assets/documents/1000051CStandards_of_Proficiency_Paramedics.pdf Accessed 13/11/10 Jadad, A.R., Cepeda, M. (2000) Ten challenges at the intersection of clinical research, evidence-based medicine and pain relief. Annals of Emergency Medicine 2000;36:247-52. Kimmel A.J. (2007) Ethical Issues in Behavioural Research: Basic and applied Perspectives (2nd ed). Oxford: Blackwell. Lewith, G. Little, P. (2009) Randomised Controlled Trials in Saks, M. Allsop, J. (2009) Researching Health: Qualitative, Quanatitative and Mixed Methods. London: Sage. p 225. Medical Research Council (2010) Data Sharing Initiative: Aims. [Online] Available at www.mrc.ac.uk Accessed 09/11/10. Moscati, R.M., Reardon, R.F., Lerner, E.B., Mayrose, J. (1998) Wound irrigation with tap water. American Academy of Emergency Medicine. 1998; 5(11): 1076-80. National Health Service: Accident and Emergency Attendances in England (Experimental Statistics) 2008-09. Hospital Episode Statistics [online] Available at http://www.ic.nhs.uk/webfiles/publications/AandE/AandE0809/AE_Attendances_in_England%20_experimental_statistics_%202008_09_v2.pdf Accessed 24/10/10. National Health Service (2010) Clinical Knowledge Summaries: Lacerations Management. [Online] Available at http://www.cks.nhs.uk/lacerations/management Accessed 11/11/10. Parahoo, K. (2006) Nursing Research: Principles, Process and Issues. (2nd ed.) London: Palgrave-Macmillan. Perelman, V., Francis, G.J., Rutledge, T., Foote, J., Martino, F., Dranitsaris, G. (2004) Sterile versus Nonsterile Gloves for Repair of Uncomplicated Lacerations on the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine. 2004; 43(3): 362-370. Polit, D.F. Beck, C.T. (2004) Nursing research: Principles and methods. (7th ed.). Philadelphia: Lippincott, Williams Wilkins. Pratt, R.J., Pellowe, C.M., Wilson, J.A., Loveday, H.P., Harper, P.J., Jones, S.R.L.J., McDougall, C., Wilcox, M.H. (2007) epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infections 65(Supplement): S1S64. Royal Mail [Online] available at http://www.royalmail.com Accessed 11/11/10. Rubin, H. Rubin, I. (2005) Qualitative Interviewing: The Art of Hearing Data (2nd ed.) London: Sage. Trott, A.T.(2005) Wounds and Lacerations: Emergency Care and Closure (3rd ed.) USA: Mosby. Wilson, J. (2003) Infection Control in Clinical Practice. (2nd edn.) London: Balliere-Tindall. Worral, G.J. (1987) Repairing Skin Lacerations: Does Sterile Technique Matter? Canadian Family Physician 1987; 33:1185-1187. Appendix 1 Relevant Paper Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Perelman et al 2004 Canada 816 patients over the age of 1yr old with simple lacerations prospective randomised controlled trial Infection post repair Infection rate for sterile vs non-sterile gloves was 6.1% and 4.4% respectively with no significant statistical difference partially blind follow up looking for signs of infection was not standardised Appendix 2 ECP information form Questionnaire 1 ECP No: Group A / B Incident No. Name: Age M / F Contact Tel. No: Site of laceration: Number and size of sutures: Appendix 3 Follow up Questionnaire Name: Age M / F Contact Tel. No: Is there any erythema extending à ¢Ã¢â‚¬ °Ã‚ ¥ 1cm from the wound? Y / N Is the wound hot to touch? Y / N Is the wound inflamed or swollen? Y / N Is there any purulent discharge? Y / N Does the patient report any increase in pain? Y / N If yes to any/all of above, is the patient systemically well? If no, refer immediately.

Compare the Wars and All Quiet on the Western Front Essay

During World War I, many soldiers were impacted by the mental and physical effects that have changed their lives in positive, but mostly negative ways. There are two novels that talk about two men in World War I, however each tells a different story on their struggles on the battlefield. On one of the books, The Wars by Timothy Findley, focuses on the protagonist Robert Ross, a Canadian soldier that joined the war. Robert Ross mainly joined to war because it was his way of isolating himself after his sister’s death, while on the other book, All Quiet on The Western Front by Erich Maria Remarque, in which the story is about a teenager named Paul Baumer. Paul Baumer is a German soldier who was influenced from his teacher that going to war was a courageous decision. War focuses us to sacrifice our humanity in exchange for survival, which leads us to our self-destruction, where we become like animals for the sake of our survival. The meaning behind this is that wars take our feelings and human instincts thus replacing them to animal instincts to survive. In the end, life becomes difficult to come back to which leads to our own destruction. The aspect from both novels is about â€Å"men who were destroyed by war† (Remarque 12) even when they have escaped the horrors of the war. Both authors express that they do not want to tell us about the experiences in the war, at least not just the war, but rather the destructive impact on the soldier; such as the inability of young people to go back to their life exactly like before the war. There is no doubt that the entire generation has been ruined by war and were unable to function afterwards. Paul Baumer returns home on his seven day leave, and describes those seven days as unhappy personal experiences. He fails to see an old major on the street, he is forced by another officer to go back to the major and salute him according to the etiquette of military soldiers. Paul feels as though it is petty harassment. For Paul it’s already embarrassing for his father to tell him to wear his uniform so that he could proudly show it to all his acquaintances. Just to show his uniform to all his father’s acquaintances, Baumer finds it as though as they are getting the wrong idea of what the reality of war was. Paul’s father wants him to use his experiences of the war as a demonstration but insists that it is to â€Å"dangerous† to remind him of the war because he cannot manage as though he was on the front-lines like before. This goes the same as for The Wars; many soldiers were destroyed after seeing how the war was like. †¦frozen fingers of nameless rivers, heralded by stream and whirling snow, the train returned him to his heritage of farms†¦Ã¢â‚¬  (Findley 46) The steam from the train could have signified the anger from all the soldiers after witnessing the death from all their fellow troops and just leaving their corpse unburied, while they move on to the hopes of winning the war. The topic of destruction in the novels is also caused by the older generation. The younger generations believed that the eld er ones had greater insight and wisdom but was later on destroyed by the first sight of the war casualties. The sight of how they have been betrayed, the soldiers also notice that it is the older generation that declares war and never physically fight in it; however it is the younger soldiers that are risking their own lives for them. An example of betrayal is also seen in The Wars, when Robert is betrayed by Taffler, whom was seen as a manly strong soldier to follow; however after the incident, Roberts view of him immediately shattered. Robert states that all the soldiers have been raped by their so called leaders. It has to be there because it is my belief that Robert Ross and his generation of young men were raped, in effect, by the people who made the war. Basically, their fathers did it to them. † (Findley 150-151) â€Å"Fathers† would be the people that are in powers who controlled the younger generation but who were also told to slaughter their so called enemy. All Quiet on the Western Front also contradicts the older generation because Paul feels as though he was betra yed by his own teacher. â€Å"For us lads of eighteen they ought to have been mediators and guides to the world of maturity†¦ to the future†¦ in our hearts we trusted them. The idea of authority, which they represented, was associated in our minds with a greater insight and a more humane wisdom. But the first death we saw shattered this belief. We had to recognize that our generation was more to be trusted than theirs†¦ The first bombardment showed us our mistake, and under it the world as they had taught it to us broke in pieces. † (Remarque 78) In this quote Paul learns that the educators who were supposed to guide the younger generation to the â€Å"right† direction into the world have failed miserably. The older generation that is constantly mocking the younger generations for cowardice signs but even the older generation hasn’t actually experienced the reality of war and what the feeling of fighting is actually like. The younger generation need to make their own choices instead of always relying on the older ones between whether something is right or wrong whilst the older generation has been proved incapable of doing so. In the midst of wars many soldiers strive to survive and will do anything just for the sake of survival. Robert Ross does a good job on surviving the war on the battlefront; however, it is ironic to see the very same allies he fought with end up killing him. Robert doesn’t die in action but dies in a burning barn. He continuously sees destruction all around him wherever he goes and is always afraid that he may not live â€Å"On the far side he could see that the men and the wagons and the rest of the convoy were drawn up near fires and he just kept thinking: warm, I am going to be warm. † (Findley 82) This is desperation in order to remain alive. Similarly to The Wars, Paul and his friends also strive just to survive the war. In the first chapter Remarque jumps into the war action: â€Å"We were at rest five miles behind the front† (Remarque 3) He does not clearly specify whether or not the German army or Paul’s friends. Unlike The Wars where the main characters are athletic, strong like Robert and Taffler, Remarque doesn’t describe his characters as complete developed characters. Each of them is described as people who have regular human qualities. An example would be Tjaden who is the biggest eater and Westhus who continuously thinks about women. They feel as though, to survive they need to form a brotherhood that strives as much as possible to survive an arena of death. All other expressions they may show are unable to be shown as the only thing that you’re able to show is the sake for surviving the war. Hunger is a part of survival in All Quiet on The Western Front. Many soldiers that don’t come back to the camp receive the dead ones share of food from the first chapter. Because the soldiers were really happy to see the extra food and wasn’t sad or angry about the death of their comrades means that food was very uncommon. Dehumanizing is a necessary tool in order to survive the war. Dehumanizing is depicted in both The Wars and All Quiet on the Western Front, however, Robert is having trouble going to the stage of being dehumanized through the book, and isn’t until later he is to his limits and snaps making him do awful things; like shooting Captain Leather in the face. Referring back to All Quiet on The Western Front, Paul describes the psychological transformations that soldiers have when going into battle such as this quote. â€Å"We have become wild beasts. We do not fight, we defend ourselves against annihilation. It is not against men that we fling our bombs, what so we know of men in this moment when Death with hands and helmets is hunting us down†¦ We feel a mad anger. No longer do we lie helpless, waiting on the scaffold, we can destroy and kill, to save ourselves, to save ourselves and be revenged† (Remarque 113). The soldiers stop being good people and become beasts later on, so they may survive. It is necessary to sacrifice the thoughtful and logical part of their minds in order for them to become like animals to survive. However for Robert dehumanization becomes a problem. He is too sensitive for these sorts of things and this is seen through his thoughtfulness of the animals. Robert tries to find a role model to become manlier but doesn’t happen until he sees the horses being bombed, in which changes him. Robert has held in such anger to the point where he kills captain leather but the interesting thing is that Robert went to the point of becoming an animal himself in order to save animals. â€Å"His anger rose to such a pitch that he feared he was going to go over into madness. He stood where the gate has been and thought: ‘If an animal had done this – we would call it mad and shoot it’ and at that precise moment Captain Leather rose to his knees and began to struggle to his feet. Robert shot between the eyes. † (Findley 178) Wars had a huge impact to the younger generations and the physical involvement of war changes a person immediately. â€Å"I am young, I am twenty years old; yet I know nothing of life but despair, death, fear and fatuous superficiality cast over an abyss of sorrow. (Remarque 267) Soldiers such as Robert and Paul realize that they themselves have changed from the impact of the war experience, they are alienated, a feeling of no belonging, an inability to connect to the past. And feel as though they need to go back to the trenches because nothing else connects to them anymore. And so the broken soldiers, Paul and Robert, return to the frontlines and become an animal again, only this time, survival is short live d.

Humor Or A Is It All Just Common Anti-Feminist Stereotype

Humor or a is it all just common anti-feminist stereotype; Geoffrey Chaucer explores thought out the Canterbury tales- The Wife of Bath. The Canterbury tales is a group of 28 people that went on a pilgrim. Each telling their own stories (including Chaucer himself). Of all the people on the pilgrim, there were only two women. The first was the Prioress in which Chaucer explains to be the head of the nunnery; she was kind hearted (including to animals). The other woman was the Wife of Bath (whom we learn that her name was Allison), whom was the complete opposite of the Prioress. For she was a more open person in telling her tale (pg. 100). This paper will be addressing the Wife in more detail, firstly is does Chaucer follow the†¦show more content†¦Willfully the Wife continues her tale about how she views marriage as well as virginity. In her tales the Wife points out three points about marriage and the idea of marrying more than once is fine. Point one â€Å"for wel ye knowe a lord in his household he nath naht every vessel al of gold†. In which we learn that not all man uses their gold(virginity), but some women are better is wooden(married). The second point that she brings up is â€Å"virgintee is greet perfection, and continence eek with devocion, but crist that of perfeccion is welle, bad nat every wight she cholde go selle, al that he hadde and give it to the poor†¦Ã¢â‚¬  this point was interesting because is saying that there is nothing wrong with being a virgin however, if you are to follow the life of the lord than do not just do half of his ways. You must do all of his ways if you want to be prefect like him, that means giving up everything that you own to the poor. Then her final point on marriage is â€Å"telle me also, to what conclsion were members maad of generaction, and of so parfit wys wight ywtonght†(pg 21). This we learn that she is telling readers that first of all if we were all virgins that where would the nex t generation came from. Secondly way did the lord give use certain body parts (referring to sexual organs) if we are not to use them. These points can be seen as going back and forth thought out the tale. As we learn more about the Wife, we can see that she does at sometimes fall into theShow MoreRelatedWomen s Fight For Equality1617 Words   |  7 Pagesissues associated with women’s fight for equality and share a common purpose and audience, but they also differ in many ways. Text A, an opinion piece written by Amy Butcher and published in the Sunday Review was written in the same context as text B, a humorous cartoon created by Kate Beaton (as they are both written in the 21st century), yet their topics and approaches to their pieces vary greatly. 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Persuasive Essay Bigfoot - 2205 Words

English 102 21 Sep 2005 Bigfoot: Finally A Reasonable Scientific Inquiry? If you ask anyone on the street, they will almost always have an opinion. Does Bigfoot exist? That question has brought much laughter and skepticism in the last fifty years. throughout European history in this country Americans have been presented with eyewitness accounts of hairy wild men, roaming the deepest parts of the forest. Numerous foot and hand print castings have been made, and home movies shot. Unfortunately, the majority of the population chooses to not believe in Bigfoot. In reality, they choose to not look at the evidence. Media has been the real culprit in setting the tone for Bigfoot perceptions. In fact the name Bigfoot was coined by a†¦show more content†¦Science works hard to create a theory which is then accepted as a foundation for the next accepted theory, and so on. When some rebel comes along and offers an idea that refutes or replaces one of these cornerstones the whole wall has to be rebuilt. Science doesn’t like that. So in the interest of stability, some revolutionary and persuasive ideas are not allowed into the arena of scientific debate. (Krantz 238) Sasquatch is one of the victims of this mentality. Within the last 10 or 15 years there has emerged a core of scientists who have had the courage to consider the sasquatch as a real possibility. They have not only postulated hoaxing explanations but have tested them to see what is a plausible hoax. They have turned to primate evolution, natural history, animal physiology and even dermal ridge analysis to prove or refute the evidence and hypothesis of an undiscovered great primate in North America. The first and largest question is why don’t we have a body? In well over 100 years of modern sightings and a few attempts to shoot a sasquatch there has been no body produced. How can this be? Let’s take a quick look at what we know for sure: The animal’s home range is some of the most impenetrable forestland in North America. In Northern California alone there are roughly 35,000 square miles of rugged, remote, unpopulated wilderness. This land is full of steep sided mountains, canyons and thick forests. Liebigs Law of the Minimum showsShow MoreRelatedLogical Reasoning189930 Words   |  760 Pagesprobable good consequences of each action and the probable bad consequences while weighing the positive and negative impact of each consequence. It’s a kind of cost-benefit analysis. Exercises 1. Columbus Day is an American holiday. Write a short essay that weighs the pros and cons and then comes to a decision about whether there should be more or less public celebration (by Americans and their institutions) on Columbus Day, October 12. Here is some relevant background information to reduce your