Jacksonian era Essay Example | Topics and Well Written Essays - 750 words

Jacksonian era - Essay Example Worldwide, this time was a fairly peaceful one, taking into account various national movements and smaller wars; however, in 1848 there were mass revolutions of the lower classes in Europe. This key event had global implications which were played out over the next few decades, and vastly changed the nature of history after the Jacksonian era. What historical evidence was used by the author, Robert Remini, to write this book, and was the historical evidence accurate? The historical evidence on which this book is based is a large collection of secondary source material. Remini used a large number of texts in researching for this book – forty-three, to be precise – but it is difficult to ignore the fact that none of these appear to be primary sources. History is a field where interpretation of sources is key, and it is slightly worrying that the author would have only focused his interpretation on other interpretations rather than on any original source material. Any perso nal flaws and biases have been magnified in Remini's analysis of purely secondary sources. That said, the wide range of sources is somewhat reassuring, and without reading all forty-three books, it can only be hoped that his biases allowed him to take an accurate and fairly un-prejudiced view. How did slavery and Indian removal affect the United States during the Jacksonian era? Before Jackson's ascent to the presidency, slavery in the United States had started to come to its end. In 1822 a small group of black slaves revolted, causing the deaths and banishment of at least 72 slaves. Throughout the Jacksonian era, slave-owners â€Å"dreaded† (Remini, 59) the eventual uprising of their slaves, and an 1831 rebellion fuelled these flames. The Nat Turner Rebellion involved the murder of roughly sixty white people, but, Remini argues, had less of an influence on abolition than the example of other countries and states at the same time. The slow emancipation of the slaves caused mu ch cultural discourse, some of it constructive, some of it less so – â€Å"race riots became a regular occurrence in Jacksonian America† (61), even reaching Washington D.C. in 1835. It was feared that the abolition of slavery would shatter the Union, and indeed there was almost civil war over a slavery-related issue in the early 1830s, with threats of secession coming from several states. Ultimately the slavery issue did cause civil war, creating a stronger and more equal United States. Although the book calls it 'Indian removal', a less racist and euphemistic term would be Native American banishment or deportation. Like slavery, the banishment of Native Americans from their homes was a way in which the white leaders of society prioritized their own desires above the needs of others, to the detriment of North American society. Jackson â€Å"demanded† (46) that Native Americans concede their land to him. In 1830, a Removal Act was passed, in which Native American s were guaranteed land in the west, and transportation thereto, if they would give up their land in the east; the Cherokee tribe refused and took the matter to the Supreme Court, arguing that they were not subject to state laws. The ruling, that they were neither subject to state laws nor independent, set a dangerous precedent as Native Americans as â€Å"domestic dependents† (47). Again, like slavery, states and races were divided along fault-lines, with radicals on each side respectively supporting Native American protection or

Statement of purpose 5 Essay Example | Topics and Well Written Essays - 1000 words

Statement of purpose 5 - Essay Example This inspired me to get a course in college that would allow me to teach. In addition, I always valued studying a foreign language because I realized how important it is for a person to be globally competent especially at these times where the world is truly becoming smaller by the minute and those who are able to speak and understand several languages are always at an advantage. I graduated English Language and Literature in Arts College at Kuwait University in June, 2010 and have been employed at the Ministry of Education just a few months afterwards. I could say my dreams are coming true. However, when I started teaching, I have discovered that there are still a lot I need to learn. Of course I understand that it has been just a few months since I started working but taking a chance on the opportunities given me is a great factor I have been considering in enrolling to the postgraduate study. Young as I am, my passion to teach young people another language aside from their native tongue does not seem to be enough for me to be taken seriously both by my colleagues and students. This challenged me to equip myself with a good education that would not only put me in a pedestal to be respected but more so, to have the authority that most successful professionals have so that I could efficiently give what I want my students to have. Taking the opportunity of getting help from my parents while I am still young and able, I considered schools the United Kingdom because I am attracted to the beauty of the country. Getting into the internet, I truly appreciate most of the universities but I was exceptionally attracted to the University of Stirling. I have been reading about the testimonies of students who eventually confirmed this is the best university that fits my expectations in postgraduate study. One of the things I have been considering as someone who is aiming for excellence in the services I give to my students and employer is the quality of education. Hellenba ch and Stratikopolous, Stirling students whose testimonies are posted on the university’s internet profile mentioned that the university has a highly qualified teaching staff and with highly competitive academic level. Both are important to me and fill the top positions on my list of priorities in looking for a good school for me to enroll in. In addition, I also read about other students’ testimonies saying the school is a very multi-cultural place and people are used to foreigners, that students are made to feel totally welcome and comfortable regardless of nationality. As a Kuwaiti, these are factors I have been looking into as well because I know how environment could affect my learning process. I would like to learn as much as I can so that I have been looking for schools that would accommodate me as a human being and not just another student to add number to the many students around the world. I have observed that most universities talk about how great their univ ersity is and how welcome the students are but some of those which I have browsed over in the internet only claim to be without backing up their claims with what the students say about their school. For Stirling, I admire their effort of getting words from students because I believe no one can tell about a school better than the students who have experienced how it is to be in a certain school. I then look forward to working with competent professors and various students, sharing our ideas and experiences as we are moulded into the best

The emergence, opportunities and importance of mobile e-commerce using Essay

The emergence, opportunities and importance of mobile e-commerce using smartphone - Essay Example Businesses have the opportunity to grow big since they are having tremendous amounts of sales just through these smart phones. Taking Amazon for instance, it has been noticed that people all over the world has made â€Å"transactions worth $ 1 Billion through smart phone in the last 12 months† (Johnston, 2010). â€Å"A mobile e-commerce report was released in which it was shown that online shopping has tripled between 2008 and 2009† (Johnston, 2010). In addition, they predicted that there will be a quicker increase in 2010 (Jackie, 2010). It is important for business who does not accept online payments to get themselves online and get mobile compatible to accept mobile orders so that they can take the advantage of increased sales. As mobile usage is continuing to grow and is gaining popularity across the globe, so it is predicted that international E-commerce will also expand as a result. Not only businesses and companies can take advantage of mobile ecommerce, but it i s growing important among the farmers as well. If their tractor breaks down in the middle of the field, so they can always order the other part through mobile, which saves a lot of their time and money. However, some risks involved are that one cannot completely depend on this, as there can be viruses, which can stop the whole business. In addition, it is difficult for some people to view the entire page, as the screen of the smart phone is so small.

American Ideology Essay Example | Topics and Well Written Essays - 1250 words

American Ideology - Essay Example Politics, like diplomacy, is the art of the postponement of hostilities, in the way people try to resolve their political, economic, and ideological differences. However, it is a fact that people will still try to bicker and debate on their differences despite the best efforts, because some people have a hard set of ideas or ideologies which cannot be swayed. This is in effect the essence of democracy, in which various ideas are welcomed and tolerated. Ideology can range from the extreme left (very liberal) to the middle to the extreme right (conservative) and this brief essay is a position paper as it examines both these two ideologies. Discussion Ideas are rarely truly original or innovative, most of these ideas are either influenced by earlier ideas or mere improvements or adaptations of much earlier ideas in human history. In this regard, history works in only a one-way street, which means earlier ideas can influence later ideas, as people go through their lives and human history unfolds in a deterministic way. This philosophy postulates that every human idea, action, and decision is a consequence from prior events or antecedent state of affairs. Along this line, history and ideology works in the same way; nothing exists in a vacuum and both Hitler and Einstein were also influenced. Question No. 1 – socialism is an economic, political, and social principle which states that the general public (the common masses) should own and control public properties or the so-called commons (the natural resources open to everybody for exploitation and their use); it further advocates public ownership of the means of production in society, such that there will be no private ownership of these same means of production for goods and services. Socialism is an adverse reaction to excesses of a free-market capitalism which arose out of the Industrial Revolution in England back in the eighteenth century; it (the Industrial Revolution) changed the wealth paradigm from own ership of vast tracts of land to ownership of the means of production, namely the new factories and assembly lines. This is a new economic system but the new class of capitalists exploited the masses of laborers by hiring them at subsistence wages, working in unsafe or unsanitary conditions, no minimum working hours and no minimum or living wage, the widespread use of child labor, and the repression of progressive social ideas such as labor unions or in not letting the workers' voice be represented or heard. Socialism therefore is in opposition to the main and cherished ideals of capitalism that are centered on egoism and self-preservation through the so-called â€Å"invisible hand† of Adam Smith in which free markets are supposed to be self-regulating and all are to be supposedly benefited by the profit motive. But modern economics show this does not really always work out as envisioned because capitalism implies fierce competition in free markets and this leads to undue wea lth accumulation by a few individuals (the capitalists or new elites of society). Modern economics always struggle with issues of scarcity and socialism is the best way to solve it. Albert Einstein believed that humans are capable of going beyond Veblen’s so-called â€Å"predatory phase† in the collective human experience of social development, which is reason for socialism to be adopted as the best system for human society. Reason is the key to achieving the social-ethical

Walt Disney or “Uncle Walt” Essay Example for Free

Walt Disney or â€Å"Uncle Walt† Essay Have you ever seen a movie or a cartoon that was produced by Disney? Of course you have! That is because there are so many movies and cartoons that are produced by Disney. However, Disney wasn’t as popular in the 1920’s as it is today. It all started with an average man. His name was Walter Elias Disney, or better known as Walt Disney. Walt Elias Disney was born in Chicago, Illinois, on the date of December 5, 1901. Later in his life he lied about his age and joined the American Red Cross at the age of 16. He soon went home and got a full scholarship to the Kansas City Art Institute. There he met a fellow animator Ubbe Iwerks. Then the two set up their own company. They made a series of animated shorts that were called â€Å"Newman’s Laugh-o-grams†, but the business failed. The two soon went to Hollywood and created a cartoon series that is about a little girl named Alice that has adventures in the woods. That too, went bankrupt. After that, his brother and he made another small company named Disney Brother’s Studios. When Walt and his brother (Roy) made Disney Brother’s Studios that was when they started to reel in the big money. Their first distributor was a woman from New York named Margaret Winkler. Disney’s Alice cartoons sold for 1500 dollars a short. The same price was for his Oswald cartoons. A few years later, Margaret Winkler and her husband stole the rights to Disney’s Oswald cartoons and every other cartoon they made, but Disney retaliated because he made one of his biggest cartoons after that which was Mickey Mouse. It was an instant sensation. Then in 1929, he made all of Mickey Mouse’s friends. They were Goofy, Pluto, Minnie, and Donald. This was one of his biggest hits. A few years later, Disney made the movie, Snow White and the Seven Dwarfs. It made an unimaginable 1.5 million dollars. It later won an Oscar. So went on Disney’s career. He produced many of the movies that we know today like, Finding Nemo, Monsters Inc., Peter Pan, and many more. Walt died on December 15, 1966. As you can see, Walt Elias Disney was very important to the 1920’s. He was very important because he created a new hobby that people could do. This means that he changed mass media and American culture. It made a very large significance to the future. Without Walt Disney, Disney Studios would not have been created. In the future Disney made many movies. Millions of Americans have seen and still watch Disney movies. I guess that I’m trying to say that without Disney, all the movies that we loved as children wouldn’t have existed if Walt didn’t make Disney. That’s how it affected the future. Walt Disney also affected American history. It gave Americans something to do or watch in their free time. Many movies that are widely known today wouldn’t have been made if it wasn’t for Walt Disney. So it affected American history because it changed mass media and he made many movies that are still loved today by millions of people around the world. So in the end, Walt Elias Disney was a very important man. He made a multi-billion dollar industry. It was amazing what he did. After all his work was stolen, he kept on trying and succeeded. He retaliated and made one of the biggest movie making companies in the history of America. It shows you that anything is possible in the land of opportunities.

Crime And The Impact On Modern Society

Crime And The Impact On Modern Society The threat and fear of crime are constant concerns that impact many people in modern society. The safety of schools and communities are usually indicated by crime rates, and are justifiably major factors in choosing where to reside. Research denotes that juveniles are involved in numerous crimes each year, as perpetrators who are subjected to legal intervention for status offenses such as running away, school truancy and curfew violations and as victims (Regoli, Hewitt, Delisi, 2007). Literature review reveals that there are official measures of juvenile crime which include those by police, the courts, and corrections agencies; and unofficial measures of juvenile crime such as self-report and victim surveys, that try to give a more complete description of the true extent of juvenile crime (Schmalleger, Bartollas, 2008). This paper will discuss several methodologies of official and unofficial measurements of juvenile delinquency and the identifiable problems with these types of data collections. Keywords: Uniform Crime Report, National Incident-Based Reporting System, self-reporting Criminologists for years have recognized that there are major problems in defining and measuring juvenile delinquency. The first is the legal definition that applies to youth who have been officially labeled in juvenile court. Legal definitions vary by time and place, making comparisons difficult because they are not uniform in all jurisdictions with respect to age of the prosecution; thus they tend to provide an unrealistic picture of the extent and nature of delinquency since they deal only with youth who are caught and processed (Regoli et al., 2007). Behavioral definitions in contrast to the legal definition can sometimes provide a more accurate picture of the extent and nature of delinquency and the characteristics of the offenders and victims. By using behavioral definitions, juveniles who violate statutes are seen as delinquent whether or not they are officially labeled (Regoli et al., 2007). The results have the appearance of delinquency being evenly distributed across social class and more frequent than official statistics would lead us to believe; thus showing a highly noted problem of relying on self-reporting processes and the difficulties in collecting accurate data (Regoli et al., 2007; Schmalleger, 2009). Measurement is not new to the juvenile justice system. Too often data collected by juvenile justice agencies have been unrelated to outcomes, and seldom allowed the public to assess performance in a meaningful way (Schmalleger, Bartollas, 2008). I suggest that this one of the reasons information does not completely help juvenile justice systems and organizations determine impact or cost-effectiveness of their interventions. Data is most useful when it provides input to juvenile justice professionals regarding public awareness and support, and can provide citizens and other government stakeholders with a sense of what the juvenile justice systems and agencies are really accomplishing or trying to accomplish. Official Measuring of Juvenile Delinquency Even with all the debates about the methodology of juvenile delinquency measurement, official crime statistics are considered the most accurate measures of crime and are often used in the news media and by justice agencies. This data is usually compiled by police, courts, and corrections agencies. The Uniform Crime Report (UCR) a program which began in 1929 and provides this type of data on the national and local levels, and track occurrences of eight specific crimes including the locations and frequencies of each (Lynch, Jarvis, 2008). This useful information is collected by the Federal Bureau of Investigation (FBI) from law enforcement agencies across the country, and presents descriptive statistical, historical profile of violent juvenile crime in America based on the percentage of all arrests (Lynch, Jarvis, 2008). Another official measure for data collection of juvenile crime is the National Incident-Based Reporting System (NIBRS). This system was developed in 1988 by the federal government to address some of the shortcomings of the UCR, and is generated from the records management systems of federal, state and local agencies (Regoli, et al., 2007). The NIBRS which collects information on every arrest and incident was intended to be a broader crime reporting system in comparison to the UCR program; and it gives much greater details on specific crimes because it differentiates between crimes that are attempted and crimes that are completed (Schmalleger, 2009). Proponents for official measurements have recently argued that these measures show validity for certain crimes; any problems tend to be stable over time allowing trends and patterns to surface; there is easy to access to the data and relatively inexpensive; they allow for city and regional trend comparisons; and they provides detailed information on reporting patterns, who is arrested, and homicides (Lynch, Jarvis, 2008). In contrast, opponents have raised the issues that the reports do not capture unreported crime because under or over reporting by law enforcement often referred to as the dark figure of crime; and as it relates to juvenile crimes the number of arrests is not equal to the actual number of youths who committed crime, and group arrests overestimate juvenile crime (Lynch, Jarvis, 2008). Un-Official Measuring of Juvenile Delinquency Even though most of the fundamental problems with official crime statistics had been identified before the end of the nineteenth century, including the major problem of the dark figure of unknown crime, it was not until the mid-twentieth century that systematic attempts to unravel some of the mysteries of official statistics were initiated (Regoli, et al., 2007). Turning to data sources outside of the official agencies of criminal justice, unofficial crime statistics were generated in order to explore the dark figure of crime not known to the police, and to create measures of crime that were independent of the official registrars of crime and crime control, which many felt would address more validity and reliability issues in the measurement of crime (Doerner, Lab, 2005). One un-official data collecting measure used for juvenile delinquency is self-reporting. These reports are confidential questionnaires administered to samples of youth who voluntarily report on their own involvement in delinquent activities, which sometimes provide a more complete picture of juvenile delinquency (Webb, Katz, Decker, 2006). They however are not error free. These measures use population samples that arguably are small, and it has been suggested by some criminologists that they are not representative of juvenile offenders as a whole (Webb et al., 2006). Recently, it has been proposed by some researchers that victim surveys recognize the inadequacies of official measures of crime, particularly the apparently substantial volume of crime and victimization that remains unknown to, and therefore un-acted upon by, criminal justice authorities (Doerner, Lab, 2005). The National Crime Victimization Survey (NCVS), a survey sponsored by the federal government and has been collecting data on personal and household victimization since 1973 (Doerner, Lab, 2005). It was designed with four primary objectives: to develop detailed information about the victims and consequences of crime; to estimate the number and types of crimes not reported to the police; to provide uniform measures of selected types of crimes; and to permit comparisons over time and types of areas (Doerner, Lab, 2005). In general, victimization surveys have the same problems and threats to validity and reliability as any other social-science survey. Ironically, there is a double dark figure of hidden crime that is not reported to interviewers in victimization surveys designed to uncover crimes not reported to the police (Doerner, Lab, 2005). Such incomplete reporting of victimization means that victimization surveys, like official data sources, also underestimate the true amount of crime, and this then suggests that the discrepancy between the crime rate estimates of the victim surveys and the UCR may be even larger than reports indicate. A noted strength of victim surveys is that most crimes included in the questionnaire are F.B.I. index crimes; but research also reveals that two index crimes (murder and arson) are not included in the survey, though many other important crimes are measured in the victimization surveys (Doerner, Lab, 2005). It is fair to argue that many times the results from thi s type of data collection show that the victimization statistics are somewhat limited in their representativeness and generalizing ability. Conclusion Debates have been heated over the last few decades on the proper way to measure delinquency. Research reveals that there are three major sources of data that have been used, self-reports of delinquent behavior, victimization surveys, and official accounts (e.g., arrests, court records) (Regoli et al., 2007). These sources of data results do not always agree, and studies have shown that certain methodologies such as survey-reports show weaker associations between social status (e.g., poverty, race, gender) and delinquency than official records (Regoli et al., 2007). Proponents for methodological measurements argue that these sources of data yield reasonably similar patterns when the object of inquiry is serious and persistent delinquency (Schmalleger, 2009). I suggest there is still a need for more methodologies to aid in the challenges of prevention and recidivism juvenile crime.

Glasgow Coma and Glasgow Outcome Scales for Brain Injury

Glasgow Coma and Glasgow Outcome Scales for Brain Injury ABSTRACT Traumatic brain injury (TBI) is a leading cause of death in adults under the age of 45 and an estimated 7.7 million people in the European Union are living with a disability caused by TBI. The severities of these injuries are differentiated by the use of the Glasgow Coma Scale (GCS), and the outcome is assessed by the Glasgow Outcome Scale (GOS). These scales can be used to develop a prognosis for individuals with TBI’s in various ways. Primarily, the lower the GCS score the more severe the brain injury and therefore the worse the outcome for the patient. The GOS is applied 6 months after injury and provides a score of 1-5 with a lower score indicating the worse outcome, death. To conclude GCS by itself cannot be used to provide a long term prognosis for brain injuries. GCS can be used in addition to other factors such as presence of a midline shift on Computer Tomography and fixed pupil dilations are significant in determining prognosis. The presence of lesions on the brainst em correlates with the GCS and GOS scores allowing reliable and valid prognosis’ to be made. INTRODUCTION Traumatic brain injury (TBI) affects an estimated 1.4 million people every year in the United Kingdom (UK)[1], and is a leading cause of death in adults under the age of 45. [2] It is currently estimated that at least 7.7 million people in the European Union are living with disabilities caused by TBI’s. [3] TBI’s account for 6.6% of the Accident Emergency (AE) attendees. [4] 95% of all TBI’s presented at AE are mild, 5% severe and moderate injuries. [5] It is extremely important to determine the severity of the TBI as it has implications on the treatment and later rehabilitation of the patient. TBI can be open or closed injuries, with open TBI injuries being linked to worse functional outcomes and increased mortality. The most common method of assessing TBI is the Glasgow Coma Scale (GCS) and a common method for addressing the outcome of a patient is the Glasgow Outcome Scale (GOS). WHAT IS THE GLASGOW COMA SCALE? The GCS is a test to ascertain the consciousness of a patient after being subject to a TBI. The maximum score with this scale is 15 and the minimum 3, this is comprised of three sections: eye opening, verbal response and motor response. (Table 1). GCS is included in National Institute for Health and Clinical Excellence (NICE) guideline on head injury3 to provide information on survival rates for patients suffering different severities of TBI. The guideline also indicates that GCS is a measurement that should be taken at the scene of the injury by paramedics. If this is not possible it should be taken at admission to AE as early indication of TBI severity is imperative in the later treatment. The GCS differentiates between the severities of head injury by score ranges. A GCS of 13-15 indicates a mild head injury, 9-12 moderate and 3-8 severe. The GCS score can be affected by the time it is applied after injury, therefore in order to universalise this, GCS is often used once the patient has been stabilised.4 The GCS can be difficult to use in trauma cases, as localised trauma, swelling, sedation and intubation can affect testing the eye and verbal responses. [6] [7] In a survey performed by The European Brain Injury Consortium only 49% of patients could be tested fully against the scale after being stabilised in resuscitation.[8] Feature Response Score Total Eye Opening Spontaneously 4 To speech 3 To pain 2 No response 1 E: /4 Verbal Response Orientated 5 Confused 4 Inappropriate words 3 Incomprehensible words 2 No response 1 V: /5 Motor Response Obeys commands 6 Localises pain 5 Withdraws from pain 4 Flexion to pain 3 Extension t pain 2 No response 1 M:/6 Total Score GCS /15 Table 1- Glasgow Coma Scale Components of the GCS and how each section is scored individually Adapted from: Bethel J. 2012, Emergency care of children and adults with head injury, Nursing Standard, 26(43), 49-56 The GCS is considered by some to have acceptable inter-rater reliability[9] when used by experienced practitioners. However mistakes are made consistently by inexperienced users of up to 1 mark per section. Inter-rater reliability was shown to improve after exposure to a training video.[10] Reliability with scoring is imperative in making accurate TBI severity diagnosis, and then the relevant treatment associated with them. In severe TBI’s the motor component of the GCS is the best indicator of prognosis, this is due to verbal and eye scores not being able to be performed. [11] This has led to an adaption of the motor score of the GCS, called the simplified motor score (SMS). The SMS has 3 scores: 2 obey commands, 1 localises pain and 0 withdrawal to pain.[12] It was found that the SMS and GCS were useful in indicating whether neurosurgery was needed and also intubation. Overall GCS was better in predicting chance of death, however SMS was able to be used to assess patient involved in trauma more effectively as intubation and eye swelling would not be detrimental.12 This indicates that SMS may be better used in conjunction with GCS with patients who present to AE with severe head trauma. HOW CAN THE GLASGOW COMA SCALE BE USED IN BRAIN INJURY PROGNOSIS? A more severe TBI will lead to a worse 6-month functional outcome for the patient. 30% of patients with initial GCS [13] and 50% of patients with GCS ≠¤8 after being stabilized in resuscitation will die.6 Patients who have a GCS score of 3-5 have a 5% chance of survival 6 months after injury.[14] There is no direct correlation between GCS score and the patient’s ability to function in daily life afterwards. This is due to varied functional outcomes being linked to different scores on the GCS.[15] Patients with GCS ≠¥8 had 85% chance of favourable prognosis, if this score was obtained 24 hours post-admission.[16] The predictive value of GCS scores alter according to the time at which the score was obtained. GCS scores obtained at least 24 hours after trauma were linked to the grade the TBI was classified by MRI data. These grades are associated with brain stem lesions, grade 4 being the worst and grade 1 the best. The higher the GCS score the lower the grade of brainstem lesion and therefore the better prognosis in terms of functional outcome for the patient. 14 In a study performed by Utomo et al there were no patients with GCS 3-8 that were living independently 6 months after injury. In addition patients with this GCS score were 24 times more likely to die when compared to patients with GCS score 13-15.[17] GCS alone cannot accurately predict the brain injury prognosis for a patient. However, if GCS is applied with computer tomography (CT) evidence and pupil dilations, then a prognosis of possible functional outcome can be made for an individual patient.[18] WHAT IS THE GLASGOW OUTCOME SCALE? The GOS was developed to assess functional recovery of patients with brain injuries.[19] The GOS is based on a structured interview that assesses 7 areas: consciousness, independence at home, independence in the community, work, leisure and social events, relationship with family and friends and finally return to normal life.[20] The area in which the patient is living is not taken into account with the GOS but is taken note of separately. GOS is often split into two broad outcomes: favourable and unfavourable. Favourable outcome encompasses good recovery and moderately disabled. Unfavourable outcome includes: death, persistent vegetative state and severely disabled.9 The standard GOS has a 5 point scale (Table 2) but was extended after concerns were raised that it was not sensitive enough in detecting minor disabilities that may restrict the patient in returning to work. This led to the GOS extended (GOSE) being devised. Guidance has been published to increase the universal reliability of the GOSE[21], but there are still issues with its application. This is mainly due to the time period between the TBI and the GOSE being applied, this is normally taken at 6-12 months post injury. A GOS assessment at 12 months was more reliable than at 6 months[22], but it may increase the number of patients lost in follow up. 10% of patients who were moderately or severely disabled at the 6 month GOS test improved by one category. GOS GOS(extended) 1 Death 1 Death 2 Persistent Vegetative State 2 Persistent Vegetative State 3 Severely Disabled 3 Lower Severely Disabled 4 Upper Severely Disabled 4 Moderately Disabled 5 Lower Moderately Disabled 6 Upper Moderately Disabled 5 Good recovery 7 Lower Good Recovery 8 Upper Good Recovery Table 2 Glasgow Outcome Scale Shows on the left hand side the original GOS (5 point scale) and on the right the extended GOS (8 point scale) Adapted from: Nichol A, Higgins A, Gabbe B, Murray L, Cooper D, Cameron P. 2011, Measuring functional and quality of life outcomes following major head injury: Coma scales and checklists, Injury, 42(3), 281-287 The 5 sections of the GOS refer to the functional ability that will ultimately be achieved by the patient. Vegetative state refers to the patient being unable to respond; severely disabled patients cannot live on their own; moderately disabled patients can live by their selves but have reduced ability to work; good recovery infers that the patient returns to work fully.[23] It is also possible that the patient when interviewed presents a more positive outlook of their situation leading to the GOS score being faulty. In addition to this a patient may be given a GOS score of 5 indicating a good recovery, but this only refers to the patient being able to return to work. With a good recovery prognosis may still have changes in personality and an inability to cope in social situations.20 This leads to the GOS not fully indicating a good recovery, again highlighting the reason why the GOSE was devised. Under these circumstances a patient can be given a GOSE score of 7 indicating a lower good recovery. The GOS and the GOSE scores can be obtained via phone call increasing their practicality as a scale. This scale is reliable when performed over the phone due to the standardized interview which informs the score that the patient will receive.19 HOW CAN THE GLASGOW OUTCOME SCALE BE USED IN BRAIN INJURY PROGNOSIS? When applied to the GOS a patient with a severe TBI had 40% likelihood of death; 4% chance of being in a vegetative state; 16% severe disability; 19% moderate disability and 21% chance of a good recovery.6 This was a 40% likelihood of a favourable functional outcome at the 6-month GOS test. This is compared to mild brain injury that had 9% chance of dying; 0% of being in a vegetative state; 14% of severe disability; 24% of moderate disability and 53% of having a good recovery.6 This has a 77% overall prognosis of a favourable outcome for individuals with a mild brain injury. This shows that the GOS will make a differentiation in functional outcome for different severity of brain injury. This score is unlikely to change from an unfavourable to favourable outcome after this time period although some small improvements may be seen.18 Any further improvement is probably linked to rehabilitative treatment, and not the improvement of the patient’s TBI. There is a 94% chance of a good recovery with GCS >8.5 (9 +) and age ≠¤49.5 years. This is compared to an 81% chance of good recovery with GCS >8.5 (9 +) and age ≠¥49.5 years. This highlights how age can affect the probability of a patient achieving a good recovery from their brain injury.[24] Patient’s aged >75 years with a moderate or severe TBI were three times more likely to die from their TBI than patients aged 65-74 years. It was also less common for patients aged >75 years to be living independently 6 months post-injury than patients that were younger.15 The age of the patient and the severity of their TBI need to be taken into account when deciding on treatment. The prognoses for individuals in the 75+ age range are unfavourable according to the GOS. 15 Due to this treatment should be decided based on this factor. There is a correlation between the GOC score a patient is given and the grade of their brainstem lesion that is provided by MRI data. A higher grade of brainstem lesion correlates to a more unfavourable outcome for the patient.14 CONCLUSIONS Overall the GCS cannot by itself provide either long or short term brain injury prognosis. This is because there are too many variables that affect each GCS score, including the fluctuation of the GOS associated with these scores and the difference in reliability depending on who has applied the scale. The GCS is used to assess the severity of a brain injury and to allow medical professionals to constantly monitor the patient’s progress. GOS can be used to give prognosis 6 to 12 months after injury; if the scale is used before this time then the score will not indicate the full functional outcome of the patient. This time period of scoring is not beneficial for prognosis at such a time that it will be used to inform treatment of the patient. The GOS does not provide a long term prognosis for brain injury as over time and with rehabilitation improvements can be made past what is predicted. Due to the time period necessary for GOS to be more accurately applied, the GCS can be used for the interim on a general scale in order to infer the likely GOC score a patient may receive. This score will be linked to other factors such as age, pupil dilation and presence of a midline shift on computer tomography, in addition to initial GCS score.18 To conclude the GCS and GOS are vital in identifying the severity of brain injury and are still the most used scales for their purpose due to their simplicity and acceptable reliability. The use of these scales in brain injury prognosis helps direct treatment for individual patients, and allows realistic individual rehabilitation goals to be made for that individual. 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