Minimal Intervention Minimally Invasive Dentistry Health And Social Care Essay

Minimal Intervention Minimally Invasive Dentistry Health And Social C ar analyseDentistry has very a good deal(prenominal) shifted from an invasive to a to a greater extent conservative go on over the years. This is due to an extended understanding of the nature of the ailment and its work at and discovering more impelling orders of intervention instead of the traditional cut, drill and fill technique. Hence, the purpose of negligiblely invasive and minimal intervention dental medicine is now gaining popularity in modern dentistry.Minimal intervention is a modern medical approach to the treatment of dental dental caries reduceing on prevention and detection of dental sicknesss at the earliest stage to avoid invasive treatment.When working(a) intervention is necessary, minimally invasive techniques argon being expendd widely to conserve as much tooth structure as doable and reduce endangerment of tooth fracture and pulpal problems.The minimally interventive appr oach involves reduction of cariogenic bacteria. It uses preventive measures such(prenominal) as topical fluorides, fissure sealants and enduring of education on oral hygienics. Early lesions are remineralised by non-interventive management, such as fluoride ions in saliva. The surgery carried out if necessary is minimally invasive and uses tenacious materials such as glass ionomer cements and tarry compo state of affairs systems. Innovative, modified cavity pictures are use with possibly no drilling such as fine art techniques.The resurgence of air abrasive technology with younger revitalizing materials has given a new dimension to minimally invasive dentistry. The micro-mechanical bonding of the restoration to the tooth structure finished maximum preservation of healthy tooth structure negates the need to follow conventional G.V. dispirited cavity design parameters.Firstly, the difference between minimal intervention dentistry and minimally invasive dentistry need to be pointed out. Minimal intervention can be defined as a philosophy of professional dental care, with emphasis on early detection and earliest attainable cure of the carious disease. This is followed by minimally invasive dentistry, which is the conservation of healthy tooth structure by using techniques that are patient friendly and cause minimal damage to the dental wander and focuses on repair of irreversible damages caused by the disease and remineralisation.1The concept of minimally invasive treatment emerged in dentistry in the early 1970s. One of the early examples of this is the application of diamine silver fluoride, which arrests the carious carry out and prevents the shaping of any new caries. The silver ions in the diamine silver fluoride kill pathogenic organisms. Application is simple, cost effective and does non take away any complex development to carry out.2 Several other examples are the development of preventive resin restorations (PRR) that were introduced in the 1980s, atraumatic restorative treatment (ART) which is the treatment of caries using only sink instruments and restoring with an adhesive filling material such as glass ionomer cement, and Carisolv in the 1990s which is a chemo-mechanical order that is efficient at removing carious dentin.3The fundamental components of minimally invasive dentistry are the risk assessment of the disease paying particular attention on early detection and prevention of caries, remineralisation of the decorate and dentine, use of a wide range of restorative materials and techniques that cause minimal intervention and resorting to surgery only if absolutely necessary.The following definition can be used to summarise the different aspects of minimally invasive dentistry the maintenance and monitoring of oral health through continuous care, comprising comprehensive preventive management, a longitudinal approach to risk assessment and diagnosis of chronic disease, and a minimally interventive appr oach to any necessary operative intervention.4Minimally invasive dentistry is not only restricted to the management of caries. The concept can be used in various dental applications such as the treatment of periodontal conditions, kick downstairs of dentition through erosion and attrition and management of chronic oral mucosal diseases such as xerostomia.The patient is very much involved in this type of approach to preserve and maintain their dentition and oral health. The patient pass ons responsibility for the daily care of their mouth and to control and prevent the risk of ontogenesis disease or progression of existing disease to the best of their ability. To do this, patients must agree a good understanding of the disease process and lie with what to do to maintain good oral health and should be consistently motivated by members of the dental team.(REWORD FULLY)Minimal intervention suggests remineralisation of any e public figurel margin that is not yet cavitated as good as remineralisation of the lesion floor to avoid irritation of the pulp. Demineralised enamel around the margin of the lesion will be restored during the stabilisation phase of treatment aimed at elimination of the disease through application of fluoride. The floor of the lesion will be remineralised through the localization of a glass-ionomer cement for the restoration and this, at the alike time will seal the margins against microleakage.14The minimally invasive approach has been described by Tyas and co-workers as followsEarly caries diagnosisThe sort of caries foresight and progression using radiographsAn assessment of individual caries riskReduction in cariogenic bacteria, in order to decrease the risk of further demineralisationThe clutch of active lesionsThe remineralisation and monitoring of non-cavitated arrested lesionsThe placement of restorations with minimal cavity designsRepair rather than backup man of defective restorationsAssessment of disease management outco mes at regular intervals13 uncomplaining Motivation (CUT EDIT COMPLETELYYYYYY)Preventive care is the foundation for minimally invasive dentistry.Preventive care is an essential factor of the minimal invasion technique, entirely is reliant on the patient carrying out effective oral hygiene techniques. The motivation for this is most likely to stem from educating the patient about the carious process so that they understand the importance of maintaining good oral health. The most active method of doing this is likely to be actual demonstration of the carious process to patients as such stimulation is likely to show them the full effects, and encourage them to take part in preventive care on their own. An important factor to take into distinguish is that each patient will have a different caries risk and assessment of this risk is necessary before treatment can take place. Caries risk is much more significant if there has been previous history of caries risk. In fact the best way of addressing treatment, in my whim is to use the risk score assessment method, treatment by this method ensures that management of the disease is specialist to the patient, so that the results are the most successful. A risk score is worked out and used to manage the disease in a specialised way based on the individual patient. Several different caries treatment techniques will be discussed.Firstly, Caries Management by Risk Assessment (CAMBRA), developed by Featherstone in university of San Francisco, This tool provides not only the assessment mechanism except in any case a set of interventions tailored to the disease level predicted.- havent changed words aroundSecondly, the technique of DIAGNOdent is lesion specific and detect lesions Some types of caries detection tools are lesion-specific and detect lesions at their earliest stages.DIAGNOdent is very useful in detecting demineralisation on received surfaces, particularly the occlusal surfaces of teeth.Prevention stems from p atient motivation to carry out effective oral hygiene techniques at home and maintain good oral health.Educating patients about dental caries in addition to talking about cavities is an important factor in motivating the patient as when they have a better understanding of the carious process they are more inclined to maintain good oral health to prevent such disease.The ability to demonstrate the caries process to patients might be the best motivational tool.If patients could see the process actually happening before cavitation occurs, they might be more likely to practice appropriate oral hygiene methods at home.It is first necessary to assess the patients caries risk.One of the most important predictors of caries risk is the history of caries.Featherstone and colleagues at the University of California, San Francisco have developed and well-tried a caries assessment tool called. This tool provides not only the assessment mechanism except also a set of interventions tailored to th e disease level predicted.Some types of caries detection tools are lesion-specific and detect lesions at their earliest stages.DIAGNOdent is very useful in detecting demineralisation on certain surfaces, particularly the occlusal surfaces of teeth.DIFOTI which stands for digital imaging fibre optic transillumination uses visable light between and through the teeth to see shadows that might be indicative of caries or other defects in the tooth structure.Quantitative light-induced fluorescence (QLF) scans the entire surface of the tooth and detects caries lesions at their earliest phases. By superimposing the lesion at two separate stages, it can assess the stance of remineralisation. This is an example of psychological effect of caries management by risk assessment and early detection.A technology such as QLF allows the patient and practician to work together to achieve remineralisation. This empowers the patient and shows them the important of their role combined with professional recommendations in reversing the process before its cavitation stage. (Motivation is key hence patient more likely to follow and successful outcome).An increase in patient awareness of treating disease has developed a new kind of dentistry.Only at such an early stage can the patients focus shift from restorative dentistry to disease management.15GV Blacks Approach(REWORD REARRANGE ORDER)In 1895, G.V Black introduced the concept of book of facts for prevention. The principle of extension for prevention is that not only must the lesion be included in the outline, but any adjacent areas not at present carious but likely to do so in the tightfitting future should also be included to reduce the risk of subsequent carious recurrence near the cavity margin.The principles of cavity design, as described by G.V. Black underpinned operative dentistry for almost a century. As a consequence of adhesive techniques and new understanding of carious process, Blacks principles have been revisited. Eg Blacks concept of extension for prevention has been replaced by prevention of extention.17The preparation of a retentive lock or key in the occlusal aspect of posterior teeth in order to prevent displacement of non-adhesive amalgam restorations result in substantial loss of tooth structure, change the tooth.The purely surgical approach to caries control as taught by Black is now recognised as being too invasive and destructive. It is inefficient as it does not eliminate the cause of the disease and also leads to a continuing process of replacement dentistry, enlarging the cavity further. The restoration is subjected to an increasingly heavy load and the tooth gets weaker.The cavity designs proposed by Black required geometric precision with sharp line angles, flat floors and removal of all signs of demineralised tooth structure.The fundamental problem with Blacks classification is that it proposes a cavity design regardless of the size and extent of the lesion. accordingly, t here will be a standard amount of tooth structure outback(a) whether it is involved with the disease or not. This results in the cavity preparation being larger that it needs to be. Also extension for prevention increases the areas for access of microbes, resulting in even more tooth structure being remote to remove the secondary caries.18New Cavity ClassificationThe concept of minimal intervention cavity designs is now being used as a replacement to the traditional Blacks classification. The new classification will identify both the position of a lesion on the exposed crown of a tooth and the extent to which it has progressed. It is not unavoidable to specify a particular design for the cavity that needs to be erectd.(Table 1 Mount GJ, 2009)The above table shows a new cavity classification that has been developed by Graham Mount which takes into account the changes in caries activity so is classified by size as well as siteSite 1 lesions are connatural to pit and fissure class I restorations and other defects on smooth enamel surfaces.Site 2 lesions are those at contact areas between any pair of teeth.Site 3 lesions are those originating close to the gingival margin including exposed root surfaces. 13, 14As the size of the lesion extends so does the complexity of the restoration. The sizes that can be identified are as followsSize 0 the initial lesion at any site that has not yet had surface cavitation so may be possible to heal it.Size 1 the smallest minimal lesion requiring operative intervention.Size 2 a moderate sized cavity. There is still adequate sound tooth structure to maintain integrity of the remaining crown.Size 3 cavity needs to be modified and enlarged to provide some protection for the remaining crown from the occlusal load.Size 4 cavity is now extensive following loss of a cusp from a posterior tooth or an incisial edge from an anterior.14Cavity preparationOne of the most important aims of minimally invasive techniques is to preserve as much sound tissue as possible. The smaller the cavity preparation, the better the performance of the restoration placed within it.It is important to excavate only the irreparable, diseased enamel and dentine, keeping the cavity as small as possible. The cavity walls have to be modified in order to restore the cavities with a suitable adhesive material that can strengthen and support the remaining tooth structure, promote remineralisation and ideally have antibacterial activity. Any remaining bacteria need to be soaked off so that their nutrient supply is cut off and the carious process is arrested.When carrying out the stages of caries removal, it is imperative to follow a minimally invasive approach, and for this to be successful a good knowledge of the chemistry and go throughling of dental materials is essential. There are many different approaches for proximal cavity preparation, with focus on preserving as much tooth substance as possible.5 Several techniques will be disc ussed as followed.transonic TechniquesThe sonic oscillating, SONICflex system is used in minimally interventive occlusoproximal preparations. It was developed to cut small proximal cavities and used a high frequent oscillating preparation instruments in an air-driven oscillating handpiece. Damage to adjacent teeth is minimised by the use of safe-sided diamond coated, round ended preparation tips. SONICflex can be used in situations where access is difficult, such as proximal sections. The SONICflex PrepGold and SONICflex PrepCeram instruments are designed for minimally interventive gold and ceramic inlay preparations.Figure 1 preparation with SONICflex Prep Ceram (Wilson NHF, 2007)Figure 2 Preparation with SONICflex Prep Gold (Wilson NHF, 2007)Sonic instrumentation allows proximal beveling with limited risk of damage to the adjacent tooth surfaces.4Air Abrasion Bioactive GlassesThe air scrawl technology was developed by Dr Robert Black in 1945 and was successfully introduced in 1951 with the Airdent air moolah unit by S.S. White. Air abrasion can be described as a pseudo-mechanical, non-rotary method of cutting hard dental tissue where the tooth surface is bombarded with high speed desiccated abrasive particles, transferring kinetic energy to the tooth surface, which is micro-chipped away. (REWORD) Studies have shown that bonding of enamel and dentine surfaces that have been prepared with air abrasion are much better than those prepared with conventional carbide burs or acid etching.6Air abrasion produces no heat, vibration, pressure, discommode or noise and extent of hard tissue damage is far less than that accomplished using rotary instruments, therefore making air-abraded hard tissue surface more favourable to adhesive bonding.It works by using a stream of aluminium oxide particles produced from compressed air. The abrasive particles strike the tooth with high velocity and removes a small amount of the tooth structure. Efficiency of removal is relati ve to the rigourousness of the tissue or material being removed and the operating parameters of the air abrasion device. (REWORD) A number of parameters such as air pressure, operating distance, powder flow rate, particle size, diameter of the nozzle tip and time of exposure go the amount of hard tissue removal and depth of penetration. The safety for clinical use of alumina was supported by the fact that the particles are large abounding to exceed the upper limit for respirable airborne pollutants.4Air pressure usually varies from 40 to 160 psi and most common particle sizes are 27 or 50 micrometres in diameter. A high powder flow rate will allow more particles to abrade the tooth faster. Operating distances from the tooth range from 0.5 to 2 mm.Applications of air abrasion include caries removal, removal of superficial enamel defects, detection of pits and fissures, removal of pit and fissure surface stain, preparation of tooth structure for the placement of composites and cera mics, surface preparations of abfractions and abrasions, removal of existing restorations and as an adjunct to the conventional handpiece bur.7Air polishing is an alternative type of air abrasion that removes plaque and surface stains efficaciously by using sodium bicarbonate powder instead of alumina.Advantages of air abrasion include majority of patients do not need local an artistic, annoyance can be managed by reducing air pressure and patients are less anxious with the sound of air abrasion compared to a turbine drill.Air abrasion has a large number of indications but several contraindications are that it cannot be used to remove large amalgam restorations and is not efficient for removal of rough caries because it does not cut substances that are soft. It also produces a round cavity that is not suitable for preparations requiring sharp margins.13Bioactive glass particles are recognised for their swot up inductive properties and there is evidence that shows that bioglass p articles can interact with dentine through the formation of a hydroxyl carbonate apatite layer which can provide an effective interactive seal. Bioglass particles can be used for extrinsic stain removal, desensitisation of exposed cervical dentine, removal of selective demineralised enamel and composite removal. They have the ability of discriminating incipient lesions from sound enamel, treating them selectively and minimally.Chemomechanical TreatmentChemomechanical treatment is a jelly-based dentine caries removal system and system the least interventive approach to the removal of carious dentine. Carisolv gel is used with this system and has the advantages of limiting the need for anesthesia, preserves dental tissues, reduces the use of rotary instruments and is effective in controlling patient anxiety.Carisolv gel is applied into the cavity and subsequently the carious tissue is removed using specially designed hand instruments. The Carisolv hand instruments scrape away the ma terial turn by the gel, hence preserving remineralisable layers of dentine and underlying sound dentine.Carisolv gel consists of a 0.1% hypochlorite-based alkaline gel with amino acids. The mechanism of the gel is that it dissolves infected dentine that has undergone proteolytic breakdown of collagen, causing further collapse of the collagen network for easy removal with hand instruments. The gel has no detrimental effect on healthy, hard dental tissue.Indications include the treatment of anxious patients, root caries and thick-skulled lesions of caries.4Chemomechanical methods of caries removal is considered to be less painful compared to the use of rotary instruments.8 It is a well-accepted method by patients, despite the prolonged time taken to carry out the treatment. It is a self-limiting technique only removing infected dentine so it is not possible to cut away too much of the tooth structure.13Polymer Cutting InstrumentsMetal and diamond burs are not able to discriminate be tween infected and healthy dentine. Polymer instruments have been designed to differentiate between these two structures as it is able to remove softened dentine but cannot cut the hard, healthy dentine. These instruments have the potential to prepare selected cavities without the need for local anaesthesia.9Sound enamel has a Knoop hardness of approximately 400 and for dentine is 70-90. Carious dentine has a much lower Knoop hardness between 0-30. This allows a cutting instrument with a Knoop hardness of around 50 to be developed, which is halfway between carious and sound dentine.The polymer instrument remains largely intact when removing carious dentine but when it hits sound dentine, it is visably worn away therefore cannot remove or damage the sound dentine. This also mean that it does not operatively expose vital odontoblasts and therefore has a limited capacity to cause pain and discomfort. Consequently, it may be possible to complete caries removal without having to use loc al anaesthesia.10Stepwise Excavation Atraumatic Restoration Technique (ART)Stepwise minelaying and ART are modern applications of the minimally invasive approach of managing deep cavitated carious lesions. Both techniques use simple hand instruments such as excavators to remove the necrotic caries-infected dentine and also some caries-affected dentine.5 The reasons for using hand instruments instead of electric rotating handpieces is that it requires minimal cavity preparation that conserves sound tooth tissues and cause less trauma to teeth. Also, the need for local anaesthesia is reduced as the patient will not have to endure as much pain.The stepwise mining technique involves at different intervals. Carious tissue was removed and a thin layer of calcium hydroxide was placed followed by a temp restoration. The calcium hydroxides primary purpose is to act as a protective seal of exposed dentine surface. It is a strong alkali so stimulates secondary dentine formation in very dee p cavities.No final excavation is performed in the first visit. Re-entry and final excavation is made at a later date. There are several variations to the stepwise excavation technique such as Magnusson and Sundell placed a zinc oxide-eugenol cement temporary restoration and carried out the final excavation quartet to six weeks later. In 1962, Law and Lewis placed calcium hydroxide and an amalgam restoration and re-entry was made six months later. More recently developed ART techniques restore the cavity with chemicly adhesive GIC which forms a better seal, instead of the traditional amalgam and also releases fluoride which prevents and arrests caries.5When the restoration is removed, arrested caries-affected dentine which is darker and harder is exposed and tertiary dentine is also deposited.In the excavation procedure, all the undermining enamel has to be removed to allow easy access to the carious dentine along the enamel-dentine junction. 1 mm of carious dentine is leftfield behind on the pulpal wall and re-entry takes place after a year and the final excavation is carried out.By removing infected dental tissue in deep cavities, excavation is at a very close level to the pulp. By using the stepwise excavation, pulpal exposure is avoided and any pulpal complications are minimised.11(Figure 3 Bjorndal L, 2008)Figure 3 show the less invasive stepwise excavation procedure. The red zones indicate where plaque is found. A closed lesion environment before first excacation (a) and after (b) followed by application of calcium hydroxide material and a provisional restoration(c). During the treatment interval the demineralized dentine has clinically changed into signs of slow lesion progress, seen by a darker demineralized dentin (d). afterwards final excavation (e) the permanent restoration is made (f).11Restorative MaterialsAt present there are several restorative materials that are congruous with a minimal interventive philosophy such as resin composites, gio mers, ormocers, compomers, resin-modified and traditional glass-ionomer cements. The use of adhesive techniques such as resin composites removes the need of occlusal keys and undercuts, therefore conserving more tooth substance.13 amalgam (REWORD)Amalgam is one of the oldest direct restorative materials still in use. It is an alloy of several metals including silver, tin, copper, zinc and a small amount of mercury. Amalgam is not compatible with the minimal intervention philosophy despite its proven durability. It requires an undercut to retain the restoration macro-mechanically hence more tooth structure is removed or damaged, ultimately weakening the remaining tissue. Consequently amalgam is not recommended for the initial management of lesions of caries and where a minimally interventive approach is indicated.(REWORD)It is possible for the amalgam to be bonded to teeth with dentine adhesive systems, reducing the need for undercuts. These are called bonded amalgam restorations.Mod ern techniques for cavity preparation such as air abrasion are not well suited for the removal of amalgam and there is concern for the levels of mercury released when amalgam is abraded. Air abrasion of amalgam for one minute released mercury vapour four times in excess of the OSHA standard.12Resin Composites (REWORD COMPLETELY)Resin composites are glass makeweight particles in a resin matrix. Composites for anterior and posterior teeth require different properties. Materials with a higher filler resin ratio are recommended for posterior restorations, whereas materials with more resin matrix are used for anterior restorations. This is because materials with a higher filler resin ratio tend to be stronger, more wear resistant and shrink less when cured. A high concentration of filler particles makes the material more opaque and is more difficult to finish. On the other hand, materials with a higher filler resin particle ratios are more considerably finished and translucent so better suited for anterior teeth restorations. However they shrink more when cured.All resin systems contract on curing. The concept of soft-start polymerisation has been shown to produce better marginal adjustment which may lead to reduced interfacial leakage. Also the net overall shrinkage is less.Composite restorative materials follow the minimally invasive concept as they can be used in conjunction with a dental adhesive system with minimal tooth preparation. Another advantage is that light-curing provides command cure which allows for immediate finishing and polishing. The restoration, if placed correctly in suitably prepared teeth, seals the tooth restorative interface, reducing interfacial leakage. It is possible to add material to cured increments, which allows for incremental build-up and further additions at a later date.Disadvantages include shrinkage typically 2-3% which can disrupt the marginal adaptation of the restoration. Bonding to dentine still remains problematic and w ater absorption with surface and marginal staining may occur after some years.Flowable composites are used in the repair of marginal defects in restorations and as a liner. They have a low filler resin ratio and suffer relatively large percentage shrinkage when they are cured, but have the advantage of easy of adaptation to preparations.CompomersCompomers are made predominately from resin composite with the addition of a polyacid-modified molecule, which makes the material more hydrophilic. Compomers are initially light-cured, but subsequently absorb water, allowing for an acid-base reaction to set the polyacid-modified molecule.Initially the material shrinks due to polymerisation contraction but expands subsequently as water is absorbed. Compomers are easy to handle and release fluoride. they are resin-made so a dentine bonding agent is required. Properties are similar to composites but wear and fracture resistance are less than for composite.Glass-Ionomer Cements (GICs) and resin -modifed GIC (RMGICs)GICs are used for cervical restorations, fissure sealants and proximal lesions in anterior teeth. RMGICs are indicated for bonded-base restorations, temporary restorations especially between appointments in endodontic therapy. They are also used in high caries risk patients and atraumatic restoration treatments. GICs not indicated for definitive restorations in adult dentitions expect for the treatment of root caries.The advantages include self-adhesion to the tooth tissue through bio reacting with the tooth surface and the release of fluoride and other ions. They perform well in low-stress areas. It can also be rechargeable, therefore taking up fluoride from the environment.20The disadvantages of GICs include poor fracture strength and wear rates. They are also quite difficult to handle but this can be overcome by adding resin to create resin-modified glass ionomer cements which is easier to place and has improved aesthetics. Traditional GICs are more opaque an d less aesthetic than RMGICs and also cause more marginal chipping. Exogenous stain build-up is common with traditional GICs.20GiomersGiomers are a relatively new type of restorative material. The name giomer is a hybrid of the words glass ionomer and composite. They have properties of both glass ionomers such as fluoride release and recharge, and of resin composites such as aesthetics and biocompatibility. Therefore the material combines advantages of both materials. The material is composed of prereacted glass-ionomer particles within a resin matrix.OrmocersOrmocer stands for Organically Modified Ceramic. It is a three dimensionally cross-linked copolymer. Their chemistry is based on a polyvinylsiloxane backbone. Ormocers are fully polymerised materials. Ormocers undergoes 1.97% volume shrinkage which is lowest value recorded so far for a resin based filling material.Due to their cross-linking and chemical nature, Ormocers ensure that it is a highly biocompatible filling material. Their advantages compared to conventional composites are outstanding biocompatibility, minimal shrinkage, resistance to masticatory loading and aesthetics resembling natural teeth.Examples of minimally invasive proceduresSealantsA Dental sealant is a thin protective covering made of resin that is applied to the chewing surfaces of posterior teeth to prevent the formation of cavities. It is a primary preventive procedure. If the sealant is placed properly it does not require any cutting of the tooth structure. Placement of sealants in suspect teeth within s

Single Chain Antibody Production

Single Chain Antibody ProductionABSTRACTThe study aimed to characterise His- and Myc- mark scFv MFE-23 antibodies produced from transformed E.coli nuances using enzyme-linked-immunosorbent serologic assay and immunohistochemistry assays. Anti-His, anti-myc and anti-MFE secondary antibodies were use in the CEA/PBS coated enzyme-linked-immunosorbent serologic assay habitation with horseradish peroxidase-OPD chromatic response for detection. Culture 1 was identified to produce MFE-His and goal 2 giving MFE-Myc antibodies. The immunohistochemistry assay confirmed the CEA puzzleing profile of scFv MFE-Myc by the proportion between minus controls, irrefutable anti-CEA binding receptions and 4-stage anti-Myc binding of the scFv MFE-Myc examined. The CEA specificity displayed by tagged scFv MFE-Myc raise be utilised in antibody-based sightcer therapy by fooling tumour antigens specifically.INTRODUCTIONCancer arises due to the defective regulation of design cell proliferation an d homeostasis. This allows tumours to consume the capabilities including self-sufficiency in growth signal, insensitivity to antigrowth signals, avoidance of apoptosis, unlimited replicative potential, sustained angio genesis and metastasis.1 In additional to the surgical removal of tumours, conventional kindlecer therapies such as radiation, chemotherapy and immu nonherapy have a focus in inducing cytoperniciousness against cancerous cells. With better understanding of the molecular biology of carcinogenesis, targeted therapies be being developed to achieve reduce toxicity to normal tissues and higher clinical efficacy through disrupting path agencys that contri entirelye to the tumours proliferative advantage. Attempts are to a fault being made in developing tin gagecer gene therapies to compensate or repair the mutated genes.All tumours express their unique set of antigens on cell surface which can be a result of genetical alterations, upregulated self-antigens or tissue- specific antigens that can be utilized to distinguish cancer cells from normal cells. Antibodies, one of the effectors in immune response, are Y-shaped proteins that each recognizes and binds to specific antigen (Figure 1). The protein consists of two well-fixed chains and two heavy chains, with versatile (Fab) and constant (Fc) domains on each of the chain. The region of the antibody at which antigen binds is referred as the Complementary Determining Regions (CDR) present at the variable Fab region. The Fc region is responsible in modulating immune response through activation of the complement cascade and Fc receptor mediated activation of effectors such as phagocytes, mast cells, neutrophils and Natural Killer (NK) cells.3 The initial approach of antibody-based cancer therapy is to tag cancerous cells as foreign and eliminate such targets through cytotoxic effectors of the gentleman immune system. Antibodies against essential growth factors can be synthesized to sequester such molecules from further promoting tumour growth. The high specificity of antibodies to particular antigens also serves as a vehicle in delivering killing machineries to tumour cells. For example, antibodies can be directly conjugated to radionuclides, toxins or cytokines, or indirectly to the surface of liposomes carrying drugs or toxins.4 Antibody-directed enzyme prodrug therapy (ADEPT) is also available in which the antibody targets an enzyme selectively to the tumor where it converts a relatively non-toxic prodrug to a potent cytotoxic drug.4 These various strategies aim to minimize the systemic toxicity afflicted by the cytotoxic agents administered. monoclonal antibodies are usually preferred compared to polyclonal ones, as they recognize specific epitope of an antigen and hence have greater specificity.Carcinoembryonic antigen (CEA) is first identified as a glycoprotein in the forgiving colon cancer tissue extract and fetal gut, and plays a role in cell adhesion.5 Although CE A can also be detected in normal gastrointestinal tissue, the glycoprotein is overexpressed on the plasma membrane of colon cancer tissues.5 CEA level has also been found to be highly elevated in various cancers of an epithelial origin such as breast, lungs and pancreas.5,6 Moreover, normal CEA is localised on the luminal surface of columnar epithelial cells lining the crypts of the intestine so the glycoproteins are not directly accessible to the blood flow.6 However CEA is usually found on all sides of the cell membranes in tumours. Thus, CEA can be a useful target on cancer cells in immunotherapy using anti-CEA antibodies.The objectives of this lab practical are to introduce the applications of antibodies in cancer therapy and diagnosis through immunohistochemical staining of tissues. It also serves to familiarize students with the enzyme linked immunosorbent assay (ELISA). This is achieved by the production of MFE-23 single chain Fc antibody fragment (scFv) against CEA from tran sformed E.coli elaborations. The scFv MFE-23 can be linked to either a His- or a Myc- tag. The unknown antibodies are characterised in the ELISA assay using appropriate detection antibodies, and the chromatic reception between horseradish peroxidise (HRP) and OPD substrate. The scFv MFE-23 obtained by students is also used in the immunohistochemical characterisation in cryostat sections of normal and cancerous human tissues.MATERIALS METHODSE. Coli growth sophisticatesE.coli cultures were transformed with pUC119 containing either His- or Myc- tagged scFv MFE-23 (Culture 1 2) and were incubated nightlong. The expression of pUC119 was controlled by the lac operon, which could be induced by either lactose or lactose analogue isopropyl-1-szlig-D-thiogalactoside (IPTG).The vector also encoded for ampicillin resistance. The E.coli cultures were grown with ampicillin selection and 0.05% glucose. Optical concentration (OD) readings at 600nm were interpreted at 30min interval until OD =0.9 when IPTG was added to both cultures to induce pUC119 expression and hence scFv MFE-23 production. A disallow control of 2xYT was set up, and all 3 cultures were incubated at 30? overnight. Full experimental procedures are described in Appendix 1.ELISA assayThe ELISA assay aims to characterize the identities of the tags conjugated to scFv MFE-23 obtained in the supernatant of the overnight E.coli cultures. Detailed protocols of the assay can be found in Appendix 1.36 well of the 96-well ELISA plate were coated with the CEA antigen or phosphate-buffered saline (PBS) as its negative control. Supernatant of the overnight E.coli cultures 12 from the bacterial growth curve assay was obtained which contain either His- or Myc- tagged scFv MFE-23. The supernatant samples 12, the compulsory control MFE-his-myc antibodies and the negative control 2xYT growth medium were added to the corresponding surface as indicated in the format diagram in Appendix 2. petty(a) antibodies rabbit an ti-MFE23 polysera, reverse monoclonal anti-HIS tag (TetraHis, Qiagen) and mouse monoclonal anti-MYC (Sigma) were added to the corresponding wells (Appendix 2) to bind the primary antibodies present. Tertiary horseradish peroxidase (HRP) conjugated antibodies against the secondary antibodies nates anti-rabbit HRP (sigma) and sheep anti-mouse HRP (Sigma) in blocking solution were added to the wells (Appendix 2). OPD substrate buffer was applied to each well to detect the front end of HRP, which should give a yellow-orange product in case of positive result. HCl was added to stop the response when colour has developed, and the OD at 490nm for each well was measured.Immunohistochemistry assayFive glass seashores, each containing 2 colonic irrigation adenocarcinoma, 1 normal colon and 1 normal liver tissue sections were fixed and processed for immunohistochemical staining. Avidin-biotin-peroxidase complex (first principle complex) was added following the application of biotin-l abelled antibodies. The localisation of antigens was visualised by the formation of brown pigments, as peroxidise opposes with the diaminobenzidene (DAB) substrate. Lattices of several peroxidase molecules were formed to amplify the binding signal from the biotinylated antibody.7 A summary of the treatment given to each slew was illustrated in Table 1, and the complete protocol can be found in Appendix 1.RESULTSE. Coli growth curvesBoth E.coli cultures transformed with either His-tagged scFv MFE-23 or the Myc-tagged version in a pUC119 vector follow a similar exponential growth curve, as shown by the plot of OD600 against time (Figure 2). The bacterial cultures were in lag physique at t=0-90, and the log phase from t=90. It took approximately 175minutes for the cultures to reach OD600=0.9.The PBS negative controls in wells A-F/7-12 worked relatively accurately with low OD490 readings. almost readings also corresponded to the negative controls in the CEA coated wells (B4-6, D4-6, F4-6) but with 2xYT added instead of primary antibodies. However, the OD490 readings for wells C10-12 and E10-12 were higher than most readings from the negative controls.The higher OD490 readings obtained in original wells in comparison of their corresponding negative controls indicated the presence of yellow-orange product formation from reaction between HRP and OPD substrate. These positive outcomes found in certain wells are highlighted in the shaded cells of TableImmunohistochemistry AssayFigure 4 shows the immunohistochemical binding reactions for the negative controls ( drop aways 3-5). lantern slide 3 acts as a negative control for slide 1, treat with the 4-stage anti-Myc technique but omitting the primary Myc-tagged scFv MFE-23 antibody. Thus we should not be able to visualize the localization of CEA antigens due to the absence of MFE-23 binding on slide 3. Slide 4 is a negative control for slide 2, omitting the mouse monoclonal anti-CEA A5B7 antibody treatment in the 3 -stage mouse monoclonal technique. No binding reaction is expected on slide 4 as well. Slide 5 was treated like slide 4 but without initial biotin/avidin blocking.As expected, the colonic adenocarcinoma tissue section of slide 3 does not display brown coloration and hence there is no binding reaction to the cytoplasm of tumour cells and connective tissues. Binding reaction to the cytoplasm of cryptal epithelium is not seen for the normal colonic mucosa, although there are strong brown colourations for a few cells in the lamina propria. The normal liver tissue on slide 3 shows some weak reaction with the parenchymal cells.Similarly, the parenchymal cells of the normal liver tissue on slide 4 do not display brown colouration and hence indicates the absence of binding reaction. On slide 5, the normal parenchymal cells are positive for binding reaction, demonstrating the presence of biotin in normal liver.Figure 5 shows the immunohistochemical binding results of slides 1 and 2. Slide 1 was treated with the 4-stage anti-Myc technique and slide 2 is the positive control treated with the 3-stage mouse monoclonal technique (See Table 1).For the colonic adenocarcinoma tissue on slide 1, strong brown colouration is present in the cytoplasm of tumour cells and the basement membrane of malignant acinar structures. Weak positive binding reactions can also be observe in fibrovascular stroma. The normal colonic mucosa of slide 1 shows strong reactions to the cytoplasm of goblet cells in the cryptal epithelium as well as a few cells in the lamina propria. The normal liver tissue shows only weak positive reactions with the parenchymal cells. Thus the scFv MFE-myc antibody was reactive with both normal colonic epithelium and adenocarcinoma, but not the biotin/avidin blocked liver tissue.The colonic adenocarcinoma tissue on slide 2 shows strong reactions with the tumour cell cytoplasm and the basement membrane of malignant acinar structures similar to the reactions seen in sl ide 1. Weak positive results are obtained in fibrovascular stroma of the positive control slide. As the binding reaction of slide 1 was similar to that of the positive control, this confirms the CEA reactive profile of the scFv MFE-myc antibody from the E.coli supernatant sample 2.DISCUSSIONE.coli Growth CurveBoth E.coli cultures followed the exponential growth curve as expected. However, the growth curve was obtained in the absence of a negative control i.e. same volume of 2xYT to be treated in the same way as the two cultures. The lack of a proper negative control means that the possibility of contamination cannot be eliminated. Thus it is unknown whether the increase in OD600 readings was partially attributed to culture contamination.ELISA AssayAs mentioned in the results, the OD490 readings for wells C10-12 and E10-12 were higher than most readings from the negative controls. This might indicate contamination of these wells with CEA antigens, or insufficient PBS washing followin g the application of HRP-conjugated antibodies.Wells A-B/1-6 were applied with anti-His secondary antibodies and so would indicate the presence of His-tag by the production of yellow-orange product. Wells A1-3 were treated with supernatant from bacterial culture 1 and wells A4-6 with that of culture 2. As higher readings of OD490 in the positive control B1-3 and wells A1-3 were obtained compared to the negative control B4-6, the culture 1 supernatant contained the His-tagged scFv MFE-23.Wells C-D/1-6 were applied with anti-Myc secondary antibodies and so would indicate the presence of Myc-tag by the production of yellow-orange product. Wells C1-3 were treated with supernatant from bacterial culture 1 and wells C4-6 with that of culture 2. As higher readings of OD490 in the positive control D1-3 and wells C4-6 were obtained compared to the negative control D4-6, the culture 2 supernatant contained the Myc-tagged scFv MFE-23.The anti-MFE antibodies added to wells E-F/1-12 can bind to both His- or Myc-tagged scFv MFE-23. Thus binding should occur against primary antibodies from both cultures 12 and also the positive MFE-myc-his control, as demonstrated by the higher OD490 readings in wells E1-6 and F1-3 compared to the negative controls F4-6.It can be observed that the anti-His antibody gave a stronger signal than anti-Myc and was due to anti-His binding more strongly to its target than anti-Myc (Unpublished results, Kogelberg, H.). analyse the OD490 of wells E1-3 and E4-6, absorbance of anti-Myc was slightly higher than anti-His despite the lower binding affinity of anti-Myc. Thus there might be a higher concentration of MFE-Myc in the culture 2 supernatant than MFE-His in culture 1, although technical issues like washing times, salt concentration and pH, or structural characteristics affecting the accessibility of antibody can affect the amount of binding.Immunohistochemistry AssayThe results obtained from slides 1 and 2 confirm the CEA reactive profile of scF v MFE-myc antibody, as both slides displayed similar binding reaction patterns in colonic adenocarcinoma. The weak positive signal in normal liver tissue in slide 1 is likely to be caused by cross-reaction of secondary mouse anti-Myc antibodies, as similar result can be observed in the negative control (slide 3). Primary antibodies may also cross react and bind to non-target tissues. This demonstrates the possible cross-reactions with antibodies and hence the importance of negative controls to eliminate such artifactual reactivity.The strong binding to goblet cells cytoplasm in cryptal epithelium of normal colonic mucosa in slide 1 is consistent with the findings of CEA present in normal colonic mucosa.5 Although CEA level is lower on normal colonic mucosa, their presence implies that antibodies against CEA in cancer therapy may target normal cells other than malignant cells. Thus it is important to control anti-CEA antibody concentration used to avoid imposing toxicity to normal ti ssues yet is effective in producing a clinical response on cancer.The negative controls (slides 3-5) allowed the assessment of the level of binding for secondary, tertiary and quaternary antibodies/reagents. The slides also revealed any endogenous background material that might be confused with specific binding of primary antibodies, as well as information some the basic pathology of tissues. The inclusion of normal liver sections helped illustrate the importance in carefully controlling the specific reactions of test antibodies with potential targeting specificity for other cellular proteins. The ABC complex for detecting biotinylated horse anti-mouse antibodies can also react with biotin present in liver and give a positive non-specific result. This unwanted reaction as seen in slide 5 can be prevented by biotin blocking treatment of tissue samples.Moreover, myeloperoxidase white cells containing endogenous peroxidase can react with the DAB substrate and produce brown colouration even in the absence of ABC complexes. The normal colonic mucosa in slide 3 provided examples of such artifact. The naturally occurring bile pigments in liver seen as green/brown granules under high-power bright field microscopy can also be found occasionally. Careful interpretation of slides is required to avoid false judgments as there can be false positive reactions.In addition, it should be state that adequate fixation of the sample is important in successful localisation of antigens present and hence an accurate representation of antigen distribution profile. The procedure helps to ensure the preservation of tissue morphology, the immobilisation of antigen and the preservation of antigen immunoreactivity. It is also important to ensure optimal fixation for an adequate permeability of the tissue to the immunochemical reagents.Other than mmunohistochemistry, western blotting and immunoprecipitation (IP) can be carried out to confirm scFv specificity. Antigens transferred to nitr ocellulose membrane can be probed by specific antibodies in western blot, or precipitated out of lysate using antibodies in IP. Affinity chromatography can also be used which is a method of separating biochemical mixtures based on highly specific biological interaction. Specific antigen can be covalently coupled to a solid support and allow supernatant with the testing antibody to flow through so that only specific antibodies will be bound to the antigens. The assay used in this study can only detect antigens in a non-quantitative way with chromatic display of antigen localisation. Instead radioimmunoluminography (RILG) can be used for quantitative measurements of antigen concentration along with its distribution in histological sections.8 Radiolabelled antibodies against specific antigen can be applied to tissue sections and bound antibodies are mapped by phosphor imaging. Radioactivity detected in each pixel of the digital image will be proportional to antigen concentration if sat urating antibody concentration is used.Future opinion of Antibody Targeted Cancer TherapyThe successful application of scFv MFE-23 with a Myc-tag at its C-terminus for detection in immunohistochemistry proves that the attachment of small molecules to the antibody will not affect its specificity for CEA. Thus the scFv chain can be conjugated to cytotoxic reagents or to be used for ADEPT as mentioned previously. The potential clinical efficacy of scFv MFE-23enzyme fusion protein has been shown in nude mice with human colon adenocarcinoma xenografts by the Bhatia group.9 Moreover, scFv MFE-23 can be used in radioimmunoguided surgery (RIGS) based on the pre-operative injection of a radiolabelled anti-tumor antibody to detect tumour deposits during surgery. A Phase I clinical trial of RIGS using 125iodine-labelled MFE- 23-his scFv has reported good selective localisation at sites of primary colorectal cancer and metastases.10As illustrated by MFE-23 scFv fragment, antibody targeting has the potential for selective imaging or delivery of anti-cancer molecules. Antibodies can be engineered to modify their biological properties with increased specificity and functionality. This is achieved by reducing antibody size, altering valency, and fusing to different molecules to mitigate therapeutic efficiency. Scientists have been trying to produce smaller antibody fragments but retaining specific binding to antigens, in order to minimize immunogenicity and achieve better tumour penetration. incessant research on the specificity and stability of these fragments, and hunting for more tumour-specific antigens are required to further expand the field of antibody-targeted cancer therapies.Slide 3 is a negative control for slide 1 which was treated with the 4 stage anti-Myc technique. Slide 4 is a negative control for slide 2 which was treated with the 3 stage mouse monoclonal technique. Slide 5 is a negative control for slide 2 as well but without biotin/avidin blocking.Slide 1 was treated with the 4 stage anti-Myc technique, and slide 2 was treated with the 3 stage mouse monoclonal technique.REFERENCESHanahan D, Weinberg RA. The hallmarks of cancer. Cell. two hundred0 Jan 7100(1)57-70.Baron, E. J. 1996. Classification. In S. Baron et al., eds. Barons aesculapian Microbiology, 4th edition. University of Texas Medical Branch.Gura, T. Therapeutic antibodiesMagic bullets hit the target. Nature 417, 584-586 (6 June 2002)Carter, P. Improving the efficacy of antibody-based cancer therapies Nature Reviews Cancer 1, 118-129 (November 2001)Sten Hammarstrm. The carcinoembryonic antigen (CEA) family structures, suggested functions and expression in normal and malignant tissues. Seminars in Cancer Biology. Volume 9, Issue 2, April 1999, Pages 67-81A. whitethorner, K. A. Chester, et al. Taking engineered anti-CEA antibodies to the clinic. Journal of Immunological Methods. Volume 231, Issues 1-2, 10 December 1999, Pages 261-273Hsu SM, Raine L, Fanger H. Use of avidi n-biotin-peroxidase complex (ABC) in immunoperoxidase techniques a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem. 1981 Apr29(4)577-80.GBoxer, SStuart-Smith, et al. Radioimmunoluminography a tool for relating tissue antigen concentration to clinical outcome. British Journal of Cancer (1999) 80, 922-926.Bhatia J, Sharma SK, et al. Catalytic activity of an in vivo tumor targeted anti-CEA scFvcarboxypeptidase G2 fusion protein. Int J Cancer. 2000 Feb 1585(4)571-7.Mayer, A., et al. Radioimmunoguided Surgery in Colorectal Cancer Using a Genetically Engineered Anti-CEA Single-Chain Fv Antibody. Clinical Cancer Research May 2000 6 1711.APPENDIXAppendix 1 Experimental Procedures (UCL Cancer MSc Lab Practical 2 Handout, 12-13Nov09)E. Coli growth curvesE.coli culture transformed with pUC119 containing either His- or Myc- tagged scFv MFE-23 (Culture 1 2) were incubated overnight. The expression of pUC119 was controlled by the lac operon, which could be i nduced by either lactose or lactose analogue isopropyl-1--D-thiogalactoside (IPTG). The vector also encoded for ampicillin resistance.30l of the media was added to 15ml growth media with ampicillin selection and 0.05% glucose. Both tubes on loose caps were placed into a 37? shaker at 225rpm and time was taken as t=0. Optical density (OD) of the culture was measured with a spectrophotometer at 600nm from t=0 at a 30min interval until reading reached OD=0.9. 1mM IPTG was added to each culture and the tubes were incubated at 30? overnight with shaking. A negative control was set up using the same volume of growth media 2xYT with 1mM IPTG for overnight incubation.ELISA assay100l of 10g/ml CEA antigen was applied to strips 1-6, A-H of the 96-well ELISA plate. 100l of PBS was applied to strips 7-12, A-H as negative controls. The plate was covered with plastic film and incubated for 1 hour at room temperature. Each well was rinsed 4 times with PBS and blocked with 200l 5% Marvel milk/PBS. The plate was covered and incubated overnight at 4?.The plate was washed with PBS 4 times after the overnight incubation. Overnight bacterial cultures and the negative control were centrifuged at 4000rpm for 20minutes to obtain the supernatant. 100l of each supernatant sample and negative control was added to the ELISA plate according to the format diagram as seen in Appendix 2. The covered plate was left field at room temperature for an hour. The plate was then rinsed double with 0.1% Tween-20/PBS and 4 times with PBS.100l of secondary antibodies rabbit anti-MFE23 polysera, mouse monoclonal anti-HIS tag (TetraHis, Qiagen) and mouse monoclonal anti-MYC (Sigma) with a concentration of 11000 in 1% blocking solution was added to the wells according to the format diagram anti-His A1-12 and B1-12 anti-Myc C1-12 and D1-12 anti-MFE E1-12 and F1-12. The covered plate was left at room temperature for an hour. The plate was washed again twice with 0.1% Tween-20/PBS and 4 times with PBS.100l horseradish peroxidase (HRP) conjugated antibodies against the secondary antibodies 11000 goat anti-rabbit HRP (sigma) and 1500 sheep anti-mouse HRP (Sigma) in 1% blocking solution was added to the corresponding wells. The covered plate was left at room temperature for an hour, and then rinsed twice with 0.1% Tween-20/PBS and 4 times with PBS.100l of OPD substrate buffer was added to each well to detect the presence of HRP, giving a yellow-orange product in the case of positive outcome. 100l of 4M HCl was added when the colour has developed, and OD was measured at 490nm with an automated plate reader.Immunohistochemistry assayFive glass slides, each containing 2 colonic adenocarcinoma, 1 normal colon and 1 normal liver tissue sections were removed from the freezer and air dried for 5minutes. Slides were fixed in acetone in 10minutes and rinsed in tap water for 2minutes. Slides were flooded with PBS and Avidin blocking solution was applied to slides 1-4 for 10 minutes. Slides 1-4 were rinsed in PBS and applied with Biotin blocking solution for 10minutes followed by PBS wash.PBS was removed from slide 1 and flooded with 120 normal horse blood blood serum in PBS for 15minutes. Slide 1 was drained and applied with bacterial supernatant containing Myc-tagged scFv MFE-23 antibodies for 45minutes. Slide 1 was then rinsed with PBS thrice over 10minutes, and 120 normal horse serum in PBS was added to slides 2-5 for 15minutes. 20g/ml of mouse monoclonal anti-Myc antibody (Qiagen) in PBS was added to slides 13 and left for 35minutes. 20g/ml of A5B7 anti-CEA antibody was added to slide 2 for 35minutes. Slides 4-5 were washed in PBS. Slides 1-3 were rinsed with PBS thrice over 10minutes.1200 biotinylated horse anti-mouse immunoglobulins in PBS with 5% normal human serum was added to all slides and incubated for 35minutes. All slides were rinsed with PBS thrice over 10minutes. The avidin biotin-peroxidase complexes reagent (ABC reagent) was added to all slides, followe d by PBS wash 3 times over 10minutes. 0.03% of hydrogen peroxide in 1mg/ml 3,3,diaminobenzidene tetrahydrochloride solution was applied to all slides immediately and left for 5minutes. Slides were washed with tap water.All slides were stained in Harris haematoxylin for 40seconds, rinsed in tap water and left for 5minutes for colour to develop. Slides were then dehydrated through graded alcohols (70/95/100%), cleared in inhibisol and coverslip using DPX mountant. The slides were then ready for observations under the light microscope.

Morality and Cognitive Decision Making Experiment

Morality and cognitive Decision devising ExperimentMoral good ripeningChapter II Literature ReviewResearching the honourable suppuration, honorable stopping point devising approaches, and the adoption of utilitarian lessons on the part of Taiwanese CPAs begins with a thorough literary taps fall all over of these particularised topics. The impris whizzd of this chapter is to evaluate the interrogation pawns utilize for supporting and validating the hypotheses of this bring as well. For purposes of clarity, this chapter is organization into triplet sections, showtime with a review of chaste t severallying theories. The second section concentrates on the most comm solitary(prenominal) roled instruments for completing measurement of respectable judgment and termination- make, with the stick out section of the chapter presenting an everyplaceview of confirmable studies designed particularisedally to measure Taiwanese CPAs kin to respectable evaluation an d ethical toneions and overall incorrupt bankruptment.Introduction to Moral DevelopmentMuch of the excogitational feed effected in virtuous evolution is attributed to theorists who unneurotic break ameliorate the key aspects of this field in the last twenty-five years. The phylogenesis of cleanistic growing theories has concentrated on increasingly on its role in defining mental aspects of example ontogeny ( anticipate, 1979). Adding to the body of experience on honorable increase atomic number 18 the works of Kohlberg (1976) and Pi dayst (1932). In conjunction with time out (1979), the works of these twain theorists show limitedally how the schooling of honourable delineations and interpretations ar pliant and non absolute, and suck in particularized attributes associated with separately.As accountancy is a field that relies heavily on trust and the fulfillment of fiduciary responsibilities, the importance of ethical judgments in the field of stud y is clear. Accountants and CPAs need to be the sustainers of public trust in the explanation and studying professions. Ironically however one of the worlds largest scandals, Enron, was architected by restrainers and auditors, which track the U.S. government to spend into law the Sarbanes-Oxley (SOX) Act of 2002.Later in this literature review the basis of the SOX Act will be discussed. As a go of the importance of ethical judgments in the history profession, several studies that argon trial-and-errorly establish dedicate had as their objective an estimate of the development of example judgment, moral mannikins, and skills at assessing the ethical dilemmas that occur in the fulfillment of their professions.In inquirying and defining the moral development of organizations, the work of Paiget (1932) serves as a compriseation, dishd on his judicial decision of how children form ethical and moral values by dint of the study of their respect for rules. Paiget (1932) wrot e The Moral apprehension of the Child to add to the field of knowledge on moral development. Paiget writes that all morality consists in a arranging of rules, and the fondness of all morality is to be sought for in the respect which the man-to-manist acquires for these rules (p.13).Relying on ceremonial as a investigate approach and completing interviews with a cross-section of boys to see how their comprehension of rules influencing the game was completed, Paiget was able to construct theories of moral development and the development of moral judgment. Paiget be the concept of children developing morally through a progression from heteronomy, through dresss of autonomy, finally to equity. Based on this search Paiget created a specific framework which describes the demos in conceptualization of moral decision-making and judgment, leading to the finding of rules presence and consciousness of rules as the nucleotide for developing moral judgment (Ponemon, 1990).The devel opment of stages of Cognitive Developmental supposition (Piaget, 1997) argon delineate as fol meeks. The first phase is where sensory-motor intelligence (younger than two years old) is prevalent. The second stage is pre-operational thought (two to seven years old) that serves as the hind end for creating to a greater extent concrete concepts in the future. The third stage is called concrete operations and occurs betwixt seven to eleven years old, with the fourth stage being form-only(prenominal) operations that occur from eleven to adulthood. Paiget observed that by age 7, children begin playing with and cooperating with one another. Secondly Paiget observed children in the 11 to 12 age range see rules as permeable, capable of being negotiable and mutually agreeable.Theorizing that children atomic number 18 not born with the ability to understand and break moral standards but learn them over progressive stage, Piaget (1997) began creating a moral development supposition tha t forms the inception of Kohlbergs creation of his own theories of moral development as well. Kohlberg refined and developed a six-stage sequence mode stumper and subsequently and empirically proved the assumptions of Piaget (1997), (Kohlberg 1976). His moral ratiocination possible action is a cognitive developmental theory that seeks to understand the reasoning behind how adults decide what course of action in morally right or wrong. Furthermore, Kohlbergs theory develops consecutive through ternion levels of moral development,, with each level subdivided into two stages (Table 1), Kohlbergs cognitive development theory is today regarded as a work and framework for ethics pedagogy according to Baxter and Rarick (1987) and Shenkir (1990). (Baxter Rarick, 1987 Shenkir, 1990)Its clear that Piaget had a fundamental run on the findings and conclusions of Kohlberg. This is evident for example in the second and third stages Kohlberg defines, which are simply the very(prenomin al) as Piagets. Despite this same approach to defining the specific level of moral development, Kohlberg differs from Piaget on the fourth through sixth stages of development. The eventors that are driving the differences are the interpretations of essential moral convictions justice and that Kohlberg sees as overriding social expectations, norms, and values.Kohlbergs work on moral development provided a foundation for further compendium of moral development and the formation of moral judgment as well. Specifically cerebrate the measurement of the changes by stage of morale development, Kohlberg had defined a guesswork that over time and throughout maturity children, then adults, be grow more attuned to moral development.(Kohlberg, 1981). Throughout the remainder of this life Kohlberg concentrated his efforts on moral fosterage and the propagation of his theories.Despite the alignment of Kohlbergs findings and analyses to Piaget (1997) and others in the area of normative moral development being aligned to the developmental phases of a childs then adults life in that respect are many critics of this view including the following academicians and theorists (Gilligan, 1993, , 1998 Gump, Baker, Roll, 2000 Reimer, Paolitto, Hersh, 1990 eternal rest, Narvaez, Thoma, Bebeau, 1999, , 2000 Shweder, 1982 Spohn, 2000 Sullivan, 1977). Specifically these theorists fetch centered on four specific questions that form the foundation of their critique of Kohlbergs theories (et.al.).First do the processes involved in moral reasoning foster and sustain moral behavior over time? Theorists respect that Kohlbergs theory supports critical thinking regarding morality yet does not concentrating on what ought to be done versus what is actually accomplished (Sullivan, 1977). As part of this blood theorists surround that the lack of longitudinal empirical evidence to support the claim that the eminenter(prenominal) the level of moral judgment, the higher the level of moral behavior. During his lifetime, this was lots discussed and presented as a critique of his work, an assessment he agreed with saying I understand the theory of justice reasoning to be demand but not sufficient for defining the full domain of what is thinkt by moral development (Kohlberg, 1984). Whether or not knowing is equal to doing, knowing moldiness representatively come before doing, and so Kohlberg states that the study of moral reasoning is valuable in its own right (Kohlberg, 1984).Second, the suppositions that the only aspect of moral reasoning is justice when in fact in that respect are many other factors to consider. The theorists have said that Kohlbergs theories tend to overemphasize the perception of justice as the foundation for making decisions. Theorists have long argued that in gain to justice, extensional factors including compassion, caring, and other inter personal feelings may play an important part in moral reasoning. (Rest, Narvaez, Thoma, Bebeau, 19 99 Spohn, 2000)The third major question of Kohlbergs compendium is the minimal amount of empirical evidences for offer-conventional level thinking , a critical assumption that under prepare a great dealtimes of what Kohlberg found his compendium on(Rest, Narvaez, Thoma, Bebeau, 1999)The fourth question that publishs from the psychoanalysis is an assessment of Kohlbergs theories and the over-reliance on the role and influence of Western culture. Critics and theorists contend that in that respect is equally if not more fury specifically from Eastern cultures as well that have not been taken into account (J. C. Gibbs, 2003 Spohn, 2000).As a resultant role of these critiques specific to his work, in 1985 Kohlberg decided to evanesce the sixth stage of his work, citing a lack of empirical evidence and proven causality once thought to be present. In addition, there appears to be a dearth of evidence of support the fifth stage of his illustration, and in fact theorists point ed to little support from previous empirically derived research.In addition to the above points, theorists contend that there is a dearth of evidence for the fifth level of scoring as defined by Kohlberg (Snarey, 1985). Gibbs (1979) is credited with being a co-developer of the scoring system and concentrates on moral judgment development throughout the fourth stage of the Kohlberg framework. In addition, Kohlberg defended the empirical data for the fifth and sixth stages stating that statistically significant findings had support his framework, despite the critics and the lack of empirical studies that could be replicated by other theorists.The fifth and sixth stages are clearly centered on order conventional thinking, which is a limitation of Kohlbergs framework. The book Lawrence Kohlberg Consensus and Controversy (Modgil Modgil, 1986) defines the shortcomings of the fifth and sixth stages of the Kohlberg model in depth, with several of the theorists mentioned in this literature review being the chief(a) critics of Kohlbergs theories. analytic thinking of Rests TheoriesJames Rest (1979) developed a revision of the developmental process of moral judgment by look at the shortcomings of Kohlberg (et.al.) and Piaget (1997). As a result, Rests moral judgment model is significantly different than Kohlbergs (Rest, 1979). According to theorists, For the measurement of moral reasoning, Rests model assesses an individuals tendency to use concepts of justice based on social cooperation in his or her moral thinking, while Kohlbergs model assesses an individuals use of justice concepts, focusing more on exchange and individual interests (Elm Weber, 1994), p. 346)Rest (1986) consequently a Four division Model that captures for types of psychological processes must take place for an individual to experience moral behavior. The Rest Four Component Model is summarized by the key points beneathMoral pattern the individual must make judgment on what should be the righ t thing to do. In other words, a person should be able to reconcile the appropriate action that is morally correct.Moral Sensitivity This is defined as the interpretation of individuals actions in terms of answering to their overall assessment of situation. The intent of this aspect of the model is to refer to how an individuals conduct is analyzed in terms of how is going to influence themselves and those who are associates and friends.Moral Motivation the essence of defining and prioritizing moral decisions over competing considerationual perceptions of morality. Moral values are, according to this model, above personal values. Moral values are always thought roughly first when making a decision.Moral Action The sense of this specific element of the model requires the development of competence in the development and use of strategies that develop a moral foundation. According to this specific aspect of the model, the individual needs to have the integrity and self-determinatio n to stay in alignment with their need for behaving morally and ethically over time. The point of this specific aspect of the model is that self-determination is a critical aspect of the total model.Assessing the Cognitive Moral Decision-Making ModelThe ethical decision-making of accountancy, auditing and financial professionals have increasingly come under fire due to the major ethical lapses of these professionals that led to some of the largest scandals in history. Enron, MCI, Tyco and many other scandals are directly obligated for SOX legislation in the U.S. and a marked rise in compliance globally, preceded by the savings loan debacle of the 1980s, have together served as the accelerator of high levels of interest in the ethics of CPAs and finance professions (Cohen Pant, 1993 Lampe Finn, 1992 McNair Milam, 1993 Ponemon Gabhart, 1990 Shaub, 1994)From this body of research with regard to compliance surrounding ethics, Lampe and Finn (1992) have defined three dominant typ es of ethical decision making models. These are defined with the context of audits, and include agency models, cognitive models, and professional statute-implied models. The intent of the study is primarily focused on the cognitive model component first, as it is the most pervasively used in evaluating the decision-making process of auditors (Ponemon Gabhart, 1993).Accounting ethics research, in the majority of studies is based on a cognitive moral decision making model as first analyzed and published by Rest (1986). Modeling the individual moral decision processes that include the reasoning and action processes in completing and carrying out ethical decisions and actions is defined in the model as well. According to the theory the person with a strong sense of morals is that that evaluates an ethical dilemma and situation to ensure that actions are evaluated for their ethicity first. In defining this model Rest (1984) states that construe the situation including the decision to try and decide which choices are, and if and how a decision might affect others (i.e., they try to determine if an ethical erupt exists).The analysis next begins with an assessment that the use of moral judgment is also critical for the development of doing what ought to be done. The next step is to develop the moral intent and define just what exactly needs to be done. As part of this step the sex act strengths and weaknesses of each decision is weighed by the emotions, perceptions, and socialization of the decision-maker. The final step is the selection of a addicted alternative that may or may not be taken based on the ethical judgment of the leader. (Rest, 1984).Recognize Moral Issue(Moral Sensitivity) patch up Moral Judgment(Moral Judgment)Establish Moral Intention(Moral Motivation)Act Moral Behavior(Moral Action)In summary, the defined model of cognitive moral decision making, which is frequently referred to as Rests four component model, is used pervasively through the ma jority of report ethics research, and is also used for the insights into causality it provides. As a result of its pervasive use, this model serves as the foundation of the analysis of sentiment results completed as part of this dissertation as well. The Cognitive respectable Decision Making Model is specifically focused on the development of the research plan and ruleology in addition to analyzing the key results and findings from this research effort.Illustrating the delimitate Issues Test ( point) unrivaled of the other major contributions Rest (1979) made in ascertaining the ethics levels of answerings throughout his research was the development of the Defining Issues Test ( pane), which is also used in the research completed on this dissertation as a means of measuring theory of moral reasoning. Rest contends that the dot model continues to prohibit and enhance knowledge in the key area of empirical ethics research (Rest, 1979).How the loony toons is constructed begins with a measurement of the individuals answers to moral dilemmas much defined in the context of scenarios or short vignettes that explain the key concepts behind the concepts being tested. Through the use of these scenarios or vignettes, the responders views of ethics and morality emerge (Rest 1979). The test is typically written yet has also been placed on websites to make it possible for responsives from many different locations geographically to take the test at the same time.It is considered one of the more effective tests at standardizing moral and ethical dilemmas and issue questions. The test is constructed with six dilemmas (three in the short version) is accompanied by 12 stage specific questions (items). The responsive next reads the dilemma and chooses one of three decisions that align with their perception of the situation. Following this, the respondent rates the importance of each of the 12 items to their decision. Finally, the respondent is asked to aim the four most important items using multiple choice questions.The Moral Judgment Interview (MJI) is a comparable test and allows the respondent to specifically respond with their statements about moral and ethical dilemmas presented. As is true with most research methods, the use of multiple-choice questions is more sound from a methodological standpoint and therefrom improves the dependableness factor of the dit instrument over the MJI. The MJI requires the interviewer to assess the subjects response and assign a value to that response, introducing preconceived notion into the analysis of results (Elm Webber, 1994). This method of scoring used in MJI could potentially influence the reliability of the results since the analyst who is interpreting the responses of the subject rather than the subject choosing a response from alternatives (Elm Webber, 1994).A typical structure of the point is a multiple-choice questionnaire that contains multiple scenarios or vignettes, and has been desi gned to have up to 12 moral arguments in each dilemma relating to moral reasoning. Each of the questions on the questionnaire asks the subjects to select the most illustrative or definitive response for each situation given up their perspective of it. The pane then uses a point system on a four-point scale to measure the overall responses and create a pock that indicates the respondents moral and ethical reply to the points made.A score of four points is given for the most important response, and one point given for the least important response. Both manually-based and machine-based approaches are used for tallying and analyzing the tally, with statistical analysis programs increasingly being used to manage this process. Often the stacks are also measured as a series of indices as well. The principled Index (P indication or P score) is the most commonly used one in this field of research today (Rest, 1979).The first score mentioned is often the P score (principled morality) which defines the level of a respondents ethical cognition. This is a metric that quantifies the level of respondents reaction to scenarios and vignettes that are identified as head 5 and Stage 6 in the Rests theory. In addition to the P score, the D score quantifies responses fro all stages rather than just those identified in Stages 5 and 6. Critics have contended that the P score is more reliable and therefore more trustworthy as a measure of ethical cognition, a point that Rest has agreed with from his analysis (Rest, 1990). In re-assessing the value of P as a measure of ethical cognition, Rest wrote represents the sum of the weighted ranks given to principled items and is interpret as the relative importance given to principled moral consideration in making a moral judgment. (p.101).Further supporting the reliability of the battery-acid test are the inclusion of control variables, or items that are purely included to provide a random check of consistency of responses (Rest, 1 990). In more advanced research instruments, this approach to ensuring that the responses are consistent is commonly used. When incongruent or inconsistent responses are found they are given a code of M and tallied at the end of the survey. If this specific factor score is too high then the individual survey is considered unusable.Since its initial development, the test has been used in more than ergocalciferol documented studies globally, as claimed by its author (Rest, 1990). In quantifying the value of the research instrument from a reliability standpoint, there have been a series of native validity measures completed as well, with a test-retest methodology used to track innate validity. Scores on these tests using the statistical technical called Chronbachs important index deliver a consistently high level of reliability, with a .70 on the score of this specific statistical metric (Rest, 1986). peerless of the findings that Rest (1990) has seen from the work completed cumul atively is that the DIT scores tend to have a high correlation level to education and a low correlation to gender, apparitional beliefs and affiliates, and gender.The ability to empirically test moral development has been achieved with the DIT methodology, and by 1999 Rest and his colleagues created a new version, DIT-2 which is a revised updated stories and issue statements, was introduced. This new instrument is an improved version of the DIT, specifically including more measures of reliability and validity and the purging of questions that could lead to erroneous results despite the presence of control variables (Rest, Narvaez, Thoma, Bebeau, 1999). The DIT was chosen as the moral development instrument has the DIT-2 version has not been thoroughly tested enough therefore limited comparative data is available. This is especially true for accountant specific studies undertaken since the introduction of this second rating methodology. Secondly, while the DIT-2 generally is consid ered to be just as reliable as DIT given the lattersapproach to managing reliability (Rest Narvaez, 1998). This specific dissertation will then focus on DIT as the measurement instrument for evaluating the ethics of Taiwanese CPAs. a posteriori Analysis of Accountants through the use of DITThe concepts of moral development theory have provided the financial accounting profession with much opportunity for empirical research and investigation. While specific empirical studies have defined the current level of moral development of business majors including finance and accounting students, professional auditors, promote and lecturing accounting educators, CPAs, and CMAs, there are many other empirically-derived studies that have focused on the relationship between moral development and various accounting specific behaviors.The intent of this area of the literature review is to represent the specific aspect of moral development research that has been conducted with respondents who are accountants. The impact of the six stage theory Kohlberg has often discussed and analyzed in the works cited in this research are also analysed using Rests four component model as foundation for completing an analysis using DIT results as the foundation for these efforts to create a pragmatic approach to analyzing the research.Validation of the DIT research instrument for use in conjunction with analyzing the ethical development of CPAs has been pioneered by Armstrong (1987) through the use of two samples of respondent group CPAs who were given the DIT. Using the mean DIT P scores of each respondent group and then comparing their relative means through the use of large samples of undergrad college students, college graduate students, and adult respondents as reported by Rest (1979).After completing the analysis and calculating the mean DIT P scores, the results showed scores between the two CPA respondent groups as 37.1 and 38.5 respectively. Calculated mean DIT P scores of the thre e respondent audiences were as follows college students (42.3), college graduates (53.3), and the adults in general (40.0). Armstrong (1987) stated that with the CPAs averaging only 1.1 years of post graduate education there was a significantly decline DIT P score reported and achieved by the CPAs. What also was found from the Armstrong analysis was that significantly lower DIT P scores obtained from CPAs occurred compared to both college students and adults as a general respondent group. From this analysis its clear that there is a radiation pattern progression in moral development that generally takes place in college, yet did not take place with the CPA groups. Their moral development, as measured by the DIT, had not progressed beyond that achieved by the general adult population.In addition to the research completed by Armstrong (1987) there has been significant work completed on the topic of moral development and theories of moral maturity relating to accounting students and professionals (St. Pierre, Nelson, Gabbin, 1990). This second study defined a respondent base of 479 sr.s divided into 10 groups by major who were then given the DIT instrument to measure their level of cognitive ethical development. What is unique about this specific study is the definition of specific disciplines in the study as well including math, psychology, and social work. What is noteworthy from this student is that the mean DIT P scores for the respondent base of accounting majors were significantly below those of psychology majors.The researchers list the mean DIT P scores of 38.75 for the respondents who are male accountants and 45.85 for respondents are womanish accountants. This finding back up previous empirical studies relating to the development of ethical cognition in students, with female students receiving significantly higher scores, attributable to the previous results of empirical studies. infuriating these findings were also the DIT P score median value of 43.19 for college seniors. The use of the M value to ascertain the reliability of the study was also completed to intermit manage the ingest bias and potential errors. Based on these factors the research showed that there were no significant differences in DIT PI scores based on the depiction or not to an ethics course.Clearly the DTP P scores were seen as delineators of cognitive ethical development independent of formalized processes there is in fact indication that ethically-oriented people do tend to gravitate towards majors that have a relatively high level of accountability, as psychology does for example.In an supportive study, the work completed by Ponemon (1990) illustrated that through the study of 52 accountant respondents who ranged in position levels of staff, supervisor, conductor, and partner were given the MJI to ascertain the relationship between moral stage development and hierarchical position. The results of the survey showed statistically significant resu lts with the mean stage level increase from 3.4 at the staff level to 3.7 at the senior level and then to 4.1 at the supervisor level. While the MJI peaked at the supervisor level, mean stage levels decreased to 3.6 at the manager level and to a low of 2.9 at the partner level.Clearly the decline in MJI scores in this specific study contradicts the core concepts of moral development theory. Citing both a decline due to socialization and self-selection, Ponemon (1990) has stated that the results of this specific project do not necessarily refute ethical moral development theories. Following this research an paradigm (independence level) and the DIT were next analyzed (Ponemon Gabhart, 1990) in an empirical study of 119 respondents in a CPA firm group of audit managers and partners.Results of this specific analysis indicate that managers and partners who achieved low DIT P scores had the propensity to be more cognitively focused on the potential penalties than those respondents who h ave higher DIT P scores from the research. Not surprisingly there is a key finding from this research, that shows a significant negative relationship between rank and DIT P scores (managers-35.7 partners=30.1) in addition to the age and experience of respondents relative to their age and experience scores.Ponemon and Glazer (1990) also completed empirical research that seek to add insights into the effects of a liberal college curriculum relative to the level of moral development. Respondents in this study are alumni practitioners in addition to two groups of students including freshmen, and accounting seniors. To ensure the study would be representative, respondents were randomly selected from two institutions that offer accounting degrees. The first institution included in the survey move respondents from a esoteric college where the accounting major curriculum is part of the liberal humanities program.The second institution is a state university where accounting majors were not required or encouraged to take liberal arts courses. There were 143 total respondents in the study that completed the DIT, and the analysis of the results highlighted statistically significant scores between respondent groups. Further, the analysis revealed mean DIT P testing of freshman from both learning institutions was not significantly different between each of the learning institutions. At both the senior and alumni levels, the mean DIT P scores increased.Paradoxically the institution that had accounting as part of the liberal arts program had the higher DIT P scores than the institution that specifically focused on accounting as a core curriculum. In analyzing the results of the survey differences the researchers stated that to apprize that liberal learning in college may be an important factor in the development of the students and accounting practitioners moral reasoning (p.204). The integration of accounting curriculum in liberal arts broader learning institutions has since become a foundational element in ethics research, and is relied on as a theoretical construct of the research completed in this dissertation.The dynamics involved in the moral development and perception of pennywhistle blowing was studied in an empirical study that had 106 internal auditors as respondents by Arnold and Ponemon (1991) These researchers relied on the DIT research instrument to specifically assess the moral development in the context of experimental scenarios and vignettes surrounding a fraud case and experimental treatments that elicited the perception of internal auditors of whistle blowing. The results of this research illustrated the fact that internal auditors who scored low on the DIT P scale perceived the act of whistle blowing from the standpoint of personal punishment as a risk of unethical behavior than those with high DIT P scores.Clearly this supports the fact that the DIT P measurement instrument supports the contention that those internal auditors that have higher DIT P scores have a higher level of ethical cognition relative to those with lower DIT P scores. The internal auditors who scores lower on DIT P scores saw the act of whistle blowing, it can be inferred, as an external event that had negative consequences if a person was caught. This leads to the observation that internal auditors with low DIT P scores significantly externalize the ethical role of whistle blowers, while those with higher DIT P scores have already internalized ethical cognitions and see whistle blowing as incidental.Paradoxically however the main affiliation factors including punishment of others had little if any influence on the percMorality and Cognitive Decision Making ExperimentMorality and Cognitive Decision Making ExperimentMoral Ethical DevelopmentChapter II Literature ReviewResearching the moral development, ethical decision making approaches, and the adoption of utilitarian ethics on the part of Taiwanese CPAs begins with a thorough literat ure review of these specific topics. The intent of this chapter is to evaluate the research instruments used for supporting and validating the hypotheses of this study as well. For purposes of clarity, this chapter is organization into three sections, starting with a review of moral development theories. The second section concentrates on the most commonly used instruments for completing measurement of ethical judgment and decision-making, with the last section of the chapter presenting an overview of empirical studies designed specifically to measure Taiwanese CPAs relationship to ethical evaluation and ethical intentions and overall moral development.Introduction to Moral DevelopmentMuch of the foundational work completed in moral development is attributed to theorists who together have refined the key aspects of this field in the last twenty-five years. The evolution of moral development theories has concentrated on increasingly on its role in defining psychological aspects of mo ral development (Rest, 1979). Adding to the body of knowledge on moral development are the works of Kohlberg (1976) and Piaget (1932). In conjunction with Rest (1979), the works of these two theorists show specifically how the development of moral delineations and definitions are formative and not absolute, and have specific attributes associated with each.As accountancy is a field that relies heavily on trust and the fulfillment of fiduciary responsibilities, the importance of ethical judgments in the field of study is clear. Accountants and CPAs need to be the sustainers of public trust in the accounting and auditing professions. Ironically however one of the worlds largest scandals, Enron, was architected by accountants and auditors, which lead the U.S. government to legislate into law the Sarbanes-Oxley (SOX) Act of 2002.Later in this literature review the basis of the SOX Act will be discussed. As a result of the importance of ethical judgments in the accounting profession, sev eral studies that are empirically based have had as their objective an assessment of the development of moral judgment, moral frameworks, and skills at assessing the ethical dilemmas that occur in the fulfillment of their professions.In researching and defining the moral development of organizations, the work of Paiget (1932) serves as a foundation, based on his assessment of how children form ethical and moral values through the study of their respect for rules. Paiget (1932) wrote The Moral Judgment of the Child to add to the field of knowledge on moral development. Paiget writes that all morality consists in a system of rules, and the essence of all morality is to be sought for in the respect which the individual acquires for these rules (p.13).Relying on observation as a research approach and completing interviews with a cross-section of boys to see how their comprehension of rules influencing the game was completed, Paiget was able to construct theories of moral development and the development of moral judgment. Paiget defined the concept of children developing morally through a progression from heteronomy, through stages of autonomy, finally to equity. Based on this research Paiget created a specific framework which describes the stages in conceptualization of moral decision-making and judgment, leading to the finding of rules presence and consciousness of rules as the foundation for developing moral judgment (Ponemon, 1990).The development of stages of Cognitive Developmental Theory (Piaget, 1997) are defined as follows. The first phase is where sensory-motor intelligence (younger than two years old) is prevalent. The second stage is pre-operational thought (two to seven years old) that serves as the foundation for creating more concrete concepts in the future. The third stage is called concrete operations and occurs between seven to eleven years old, with the fourth stage being formal operations that occur from eleven to adulthood. Paiget observed that by age 7, children begin playing with and cooperating with one another. Secondly Paiget observed children in the 11 to 12 age range see rules as permeable, capable of being negotiable and mutually agreeable.Theorizing that children are not born with the ability to understand and apply moral standards yet learn them over progressive stage, Piaget (1997) began creating a moral development theory that forms the foundation of Kohlbergs creation of his own theories of moral development as well. Kohlberg refined and developed a six-stage sequence mode model and subsequently and empirically proved the assumptions of Piaget (1997), (Kohlberg 1976). His moral reasoning theory is a cognitive developmental theory that seeks to understand the reasoning behind how adults decide what course of action in morally right or wrong. Furthermore, Kohlbergs theory develops sequentially through three levels of moral development,, with each level subdivided into two stages (Table 1), Kohlbergs cognitive d evelopment theory is today regarded as a model and framework for ethics education according to Baxter and Rarick (1987) and Shenkir (1990). (Baxter Rarick, 1987 Shenkir, 1990)Its clear that Piaget had a significant influence on the findings and conclusions of Kohlberg. This is evident for example in the second and third stages Kohlberg defines, which are exactly the same as Piagets. Despite this same approach to defining the specific level of moral development, Kohlberg differs from Piaget on the fourth through sixth stages of development. The factors that are driving the differences are the interpretations of internal moral convictions justice and that Kohlberg sees as overriding social expectations, norms, and values.Kohlbergs work on moral development provided a foundation for further analysis of moral development and the formation of moral judgment as well. Specifically focused the measurement of the changes by stage of morale development, Kohlberg had defined a hypothesis that over time and throughout maturity children, then adults, become more attuned to moral development.(Kohlberg, 1981). Throughout the remainder of this life Kohlberg concentrated his efforts on moral education and the propagation of his theories.Despite the alignment of Kohlbergs findings and analyses to Piaget (1997) and others in the area of normative moral development being aligned to the developmental phases of a childs then adults life there are many critics of this view including the following academicians and theorists (Gilligan, 1993, , 1998 Gump, Baker, Roll, 2000 Reimer, Paolitto, Hersh, 1990 Rest, Narvaez, Thoma, Bebeau, 1999, , 2000 Shweder, 1982 Spohn, 2000 Sullivan, 1977). Specifically these theorists have centered on four specific questions that form the foundation of their critique of Kohlbergs theories (et.al.).First do the processes involved in moral reasoning foster and sustain moral behavior over time? Theorists remark that Kohlbergs theory supports critical thi nking regarding morality yet does not concentrating on what ought to be done versus what is actually accomplished (Sullivan, 1977). As part of this argument theorists contend that the lack of longitudinal empirical evidence to support the claim that the higher the level of moral judgment, the higher the level of moral behavior. During his lifetime, this was often discussed and presented as a critique of his work, an assessment he agreed with saying I understand the theory of justice reasoning to be necessary but not sufficient for defining the full domain of what is meant by moral development (Kohlberg, 1984). Whether or not knowing is equal to doing, knowing must typically come before doing, and so Kohlberg states that the study of moral reasoning is valuable in its own right (Kohlberg, 1984).Second, the suppositions that the only aspect of moral reasoning is justice when in fact there are many other factors to consider. The theorists have said that Kohlbergs theories tend to overe mphasize the perception of justice as the foundation for making decisions. Theorists have long argued that in addition to justice, additional factors including compassion, caring, and other interpersonal feelings may play an important part in moral reasoning. (Rest, Narvaez, Thoma, Bebeau, 1999 Spohn, 2000)The third major question of Kohlbergs analysis is the minimal amount of empirical evidences for post-conventional level thinking , a critical assumption that underscore much of what Kohlberg based his analysis on(Rest, Narvaez, Thoma, Bebeau, 1999)The fourth question that emerges from the analysis is an assessment of Kohlbergs theories and the over-reliance on the role and influence of Western culture. Critics and theorists contend that there is equally if not more emphasis specifically from Eastern cultures as well that have not been taken into account (J. C. Gibbs, 2003 Spohn, 2000).As a result of these critiques specific to his work, in 1985 Kohlberg decided to eliminate the sixth stage of his work, citing a lack of empirical evidence and proven causality once thought to be present. In addition, there appears to be a dearth of evidence of support the fifth stage of his model, and in fact theorists pointed to little support from previous empirically derived research.In addition to the above points, theorists contend that there is a dearth of evidence for the fifth level of scoring as defined by Kohlberg (Snarey, 1985). Gibbs (1979) is credited with being a co-developer of the scoring system and concentrates on moral judgment development throughout the fourth stage of the Kohlberg framework. In addition, Kohlberg defended the empirical data for the fifth and sixth stages stating that statistically significant findings had supported his framework, despite the critics and the lack of empirical studies that could be replicated by other theorists.The fifth and sixth stages are clearly centered on post conventional thinking, which is a limitation of Kohlbergs framework. The book Lawrence Kohlberg Consensus and Controversy (Modgil Modgil, 1986) defines the shortcomings of the fifth and sixth stages of the Kohlberg model in depth, with several of the theorists mentioned in this literature review being the primary critics of Kohlbergs theories.Analysis of Rests TheoriesJames Rest (1979) developed a revision of the developmental process of moral judgment by looking at the shortcomings of Kohlberg (et.al.) and Piaget (1997). As a result, Rests moral judgment model is significantly different than Kohlbergs (Rest, 1979). According to theorists, For the measurement of moral reasoning, Rests model assesses an individuals tendency to use concepts of justice based on social cooperation in his or her moral thinking, while Kohlbergs model assesses an individuals use of justice concepts, focusing more on exchange and individual interests (Elm Weber, 1994), p. 346)Rest (1986) consequently a Four Component Model that captures for types of psychologica l processes must take place for an individual to experience moral behavior. The Rest Four Component Model is summarized by the key points belowMoral Judgment the individual must make judgment on what should be the right thing to do. In other words, a person should be able to determine the appropriate action that is morally correct.Moral Sensitivity This is defined as the interpretation of individuals actions in terms of responding to their overall assessment of situation. The intent of this aspect of the model is to refer to how an individuals conduct is analyzed in terms of how is going to influence themselves and those who are associates and friends.Moral Motivation the essence of defining and prioritizing moral decisions over competing contextual perceptions of morality. Moral values are, according to this model, above personal values. Moral values are always thought about first when making a decision.Moral Action The sense of this specific element of the model requires the devel opment of competence in the development and use of strategies that develop a moral foundation. According to this specific aspect of the model, the individual needs to have the integrity and self-determination to stay in alignment with their need for behaving morally and ethically over time. The point of this specific aspect of the model is that self-determination is a critical aspect of the total model.Assessing the Cognitive Moral Decision-Making ModelThe ethical decision-making of accounting, auditing and financial professionals have increasingly come under fire due to the major ethical lapses of these professionals that led to some of the largest scandals in history. Enron, MCI, Tyco and many other scandals are directly responsible for SOX legislation in the U.S. and a marked rise in compliance globally, preceded by the savings loan debacle of the 1980s, have together served as the catalyst of high levels of interest in the ethics of CPAs and finance professions (Cohen Pant, 19 93 Lampe Finn, 1992 McNair Milam, 1993 Ponemon Gabhart, 1990 Shaub, 1994)From this body of research with regard to compliance surrounding ethics, Lampe and Finn (1992) have defined three dominant types of ethical decision making models. These are defined with the context of audits, and include agency models, cognitive models, and professional code-implied models. The intent of the study is primarily focused on the cognitive model component first, as it is the most pervasively used in evaluating the decision-making process of auditors (Ponemon Gabhart, 1993).Accounting ethics research, in the majority of studies is based on a cognitive moral decision making model as first analyzed and published by Rest (1986). Modeling the individual moral decision processes that include the reasoning and action processes in completing and carrying out ethical decisions and actions is defined in the model as well. According to the theory the person with a strong sense of morals is that that evalu ates an ethical dilemma and situation to ensure that actions are evaluated for their ethicity first. In defining this model Rest (1984) states that interpreting the situation including the decision to try and decide which choices are, and if and how a decision might affect others (i.e., they try to determine if an ethical issue exists).The analysis next begins with an assessment that the use of moral judgment is also critical for the development of doing what ought to be done. The next step is to develop the moral intent and define just what exactly needs to be done. As part of this step the relative strengths and weaknesses of each decision is weighed by the emotions, perceptions, and socialization of the decision-maker. The final step is the selection of a given alternative that may or may not be taken based on the ethical judgment of the leader. (Rest, 1984).Recognize Moral Issue(Moral Sensitivity)Make Moral Judgment(Moral Judgment)Establish Moral Intention(Moral Motivation)Act M oral Behavior(Moral Action)In summary, the defined model of cognitive moral decision making, which is often referred to as Rests four component model, is used pervasively through the majority of accounting ethics research, and is also used for the insights into causality it provides. As a result of its pervasive use, this model serves as the foundation of the analysis of survey results completed as part of this dissertation as well. The Cognitive Ethical Decision Making Model is specifically focused on the development of the research plan and methodology in addition to analyzing the key results and findings from this research effort.Illustrating the Defining Issues Test (DIT)One of the other major contributions Rest (1979) made in ascertaining the ethics levels of respondents throughout his research was the development of the Defining Issues Test (DIT), which is also used in the research completed on this dissertation as a means of measuring theory of moral reasoning. Rest contends that the DIT model continues to supplant and enhance knowledge in the key area of empirical ethics research (Rest, 1979).How the DIT is constructed begins with a measurement of the individuals responses to moral dilemmas often defined in the context of scenarios or short vignettes that explain the key concepts behind the concepts being tested. Through the use of these scenarios or vignettes, the respondents views of ethics and morality emerge (Rest 1979). The test is typically written yet has also been placed on websites to make it possible for respondents from many different locations geographically to take the test at the same time.It is considered one of the more effective tests at standardizing moral and ethical dilemmas and issue questions. The test is constructed with six dilemmas (three in the short version) is accompanied by 12 stage specific questions (items). The respondent next reads the dilemma and chooses one of three decisions that align with their perception of the si tuation. Following this, the respondent rates the importance of each of the 12 items to their decision. Finally, the respondent is asked to rank the four most important items using multiple choice questions.The Moral Judgment Interview (MJI) is a comparable test and allows the respondent to specifically respond with their statements about moral and ethical dilemmas presented. As is true with most research methods, the use of multiple-choice questions is more sound from a methodological standpoint and therefore improves the reliability factor of the DIT instrument over the MJI. The MJI requires the interviewer to assess the subjects response and assign a value to that response, introducing bias into the analysis of results (Elm Webber, 1994). This method of scoring used in MJI could potentially influence the reliability of the results since the analyst who is interpreting the responses of the subject rather than the subject choosing a response from alternatives (Elm Webber, 1994).A typical structure of the DIT is a multiple-choice questionnaire that contains multiple scenarios or vignettes, and has been designed to have up to 12 moral arguments in each dilemma relating to moral reasoning. Each of the questions on the questionnaire asks the subjects to select the most illustrative or definitive response for each situation given their perspective of it. The DIT then uses a point system on a four-point scale to measure the overall responses and create a score that indicates the respondents moral and ethical reaction to the points made.A score of four points is given for the most important response, and one point given for the least important response. Both manually-based and machine-based approaches are used for tallying and analyzing the scores, with statistical analysis programs increasingly being used to manage this process. Often the scores are also measured as a series of indices as well. The Principled Index (P index or P score) is the most commonly used o ne in this field of research today (Rest, 1979).The first score mentioned is often the P score (principled morality) which defines the level of a respondents ethical cognition. This is a metric that quantifies the level of respondents reaction to scenarios and vignettes that are identified as Stage 5 and Stage 6 in the Rests theory. In addition to the P score, the D score quantifies responses fro all stages rather than just those identified in Stages 5 and 6. Critics have contended that the P score is more reliable and therefore more trustworthy as a measure of ethical cognition, a point that Rest has agreed with from his analysis (Rest, 1990). In re-assessing the value of P as a measure of ethical cognition, Rest wrote represents the sum of the weighted ranks given to principled items and is interpreted as the relative importance given to principled moral consideration in making a moral judgment. (p.101).Further supporting the reliability of the DIT test are the inclusion of contro l variables, or items that are purely included to provide a random check of consistency of responses (Rest, 1990). In more advanced research instruments, this approach to ensuring that the responses are consistent is commonly used. When incongruent or inconsistent responses are found they are given a code of M and tallied at the end of the survey. If this specific factor score is too high then the individual survey is considered unusable.Since its initial development, the test has been used in more than 500 documented studies globally, as claimed by its author (Rest, 1990). In quantifying the value of the research instrument from a reliability standpoint, there have been a series of internal validity measures completed as well, with a test-retest methodology used to track internal validity. Scores on these tests using the statistical technical called Chronbachs alpha index deliver a consistently high level of reliability, with a .70 on the score of this specific statistical metric ( Rest, 1986). One of the findings that Rest (1990) has seen from the work completed cumulatively is that the DIT scores tend to have a high correlation level to education and a low correlation to gender, religious beliefs and affiliates, and gender.The ability to empirically test moral development has been achieved with the DIT methodology, and by 1999 Rest and his colleagues created a new version, DIT-2 which is a revised updated stories and issue statements, was introduced. This new instrument is an improved version of the DIT, specifically including more measures of reliability and validity and the purging of questions that could lead to erroneous results despite the presence of control variables (Rest, Narvaez, Thoma, Bebeau, 1999). The DIT was chosen as the moral development instrument has the DIT-2 version has not been thoroughly tested enough therefore limited comparative data is available. This is especially true for accountant specific studies undertaken since the introduct ion of this second rating methodology. Secondly, while the DIT-2 generally is considered to be just as reliable as DIT given the lattersapproach to managing reliability (Rest Narvaez, 1998). This specific dissertation will then focus on DIT as the measurement instrument for evaluating the ethics of Taiwanese CPAs.Empirical Analysis of Accountants through the use of DITThe concepts of moral development theory have provided the financial accounting profession with much opportunity for empirical research and investigation. While specific empirical studies have defined the current level of moral development of business majors including finance and accounting students, professional auditors, tenured and lecturing accounting educators, CPAs, and CMAs, there are many other empirically-derived studies that have focused on the relationship between moral development and various accounting specific behaviors.The intent of this area of the literature review is to represent the specific aspect of moral development research that has been conducted with respondents who are accountants. The impact of the six stage theory Kohlberg has often discussed and analyzed in the works cited in this research are also analysed using Rests four component model as foundation for completing an analysis using DIT results as the foundation for these efforts to create a pragmatic approach to analyzing the research.Validation of the DIT research instrument for use in conjunction with analyzing the ethical development of CPAs has been pioneered by Armstrong (1987) through the use of two samples of respondent group CPAs who were given the DIT. Using the mean DIT P scores of each respondent group and then comparing their relative means through the use of large samples of undergraduate college students, college graduate students, and adult respondents as reported by Rest (1979).After completing the analysis and calculating the mean DIT P scores, the results showed scores between the two CPA respon dent groups as 37.1 and 38.5 respectively. Calculated mean DIT P scores of the three respondent audiences were as follows college students (42.3), college graduates (53.3), and the adults in general (40.0). Armstrong (1987) stated that with the CPAs averaging only 1.1 years of post graduate education there was a significantly lower DIT P score reported and achieved by the CPAs. What also was found from the Armstrong analysis was that significantly lower DIT P scores obtained from CPAs occurred compared to both college students and adults as a general respondent group. From this analysis its clear that there is a normal progression in moral development that generally takes place in college, yet did not take place with the CPA groups. Their moral development, as measured by the DIT, had not progressed beyond that achieved by the general adult population.In addition to the research completed by Armstrong (1987) there has been significant work completed on the topic of moral development and theories of moral maturity relating to accounting students and professionals (St. Pierre, Nelson, Gabbin, 1990). This second study defined a respondent base of 479 seniors divided into 10 groups by major who were then given the DIT instrument to measure their level of cognitive ethical development. What is unique about this specific study is the definition of specific disciplines in the study as well including math, psychology, and social work. What is noteworthy from this student is that the mean DIT P scores for the respondent base of accounting majors were significantly below those of psychology majors.The researchers list the mean DIT P scores of 38.75 for the respondents who are male accountants and 45.85 for respondents are female accountants. This finding supported previous empirical studies relating to the development of ethical cognition in students, with female students receiving significantly higher scores, attributable to the previous results of empirical studies. Exacerbating these findings were also the DIT P score median value of 43.19 for college seniors. The use of the M value to ascertain the reliability of the study was also completed to better manage the sampling bias and potential errors. Based on these factors the research showed that there were no significant differences in DIT PI scores based on the exposure or not to an ethics course.Clearly the DTP P scores were seen as delineators of cognitive ethical development independent of formalized processes there is in fact indication that ethically-oriented people do tend to gravitate towards majors that have a relatively high level of accountability, as psychology does for example.In an ancillary study, the work completed by Ponemon (1990) illustrated that through the study of 52 accountant respondents who ranged in position levels of staff, supervisor, manager, and partner were given the MJI to ascertain the relationship between moral stage development and hierarchical position. The results of the survey showed statistically significant results with the mean stage level increase from 3.4 at the staff level to 3.7 at the senior level and then to 4.1 at the supervisor level. While the MJI peaked at the supervisor level, mean stage levels decreased to 3.6 at the manager level and to a low of 2.9 at the partner level.Clearly the decline in MJI scores in this specific study contradicts the core concepts of moral development theory. Citing both a decline due to socialization and self-selection, Ponemon (1990) has stated that the results of this specific project do not necessarily refute ethical moral development theories. Following this research an paradigm (independence level) and the DIT were next analyzed (Ponemon Gabhart, 1990) in an empirical study of 119 respondents in a CPA firm group of audit managers and partners.Results of this specific analysis indicate that managers and partners who achieved low DIT P scores had the propensity to be more cognitively focu sed on the potential penalties than those respondents who have higher DIT P scores from the research. Not surprisingly there is a key finding from this research, that shows a significant negative relationship between rank and DIT P scores (managers-35.7 partners=30.1) in addition to the age and experience of respondents relative to their age and experience scores.Ponemon and Glazer (1990) also completed empirical research that attempted to add insights into the effects of a liberal college curriculum relative to the level of moral development. Respondents in this study are alumni practitioners in addition to two groups of students including freshmen, and accounting seniors. To ensure the study would be representative, respondents were randomly selected from two institutions that offer accounting degrees. The first institution included in the survey drew respondents from a private college where the accounting major curriculum is part of the liberal arts program.The second institution is a state university where accounting majors were not required or encouraged to take liberal arts courses. There were 143 total respondents in the study that completed the DIT, and the analysis of the results highlighted statistically significant scores between respondent groups. Further, the analysis revealed mean DIT P testing of freshman from both learning institutions was not significantly different between each of the learning institutions. At both the senior and alumni levels, the mean DIT P scores increased.Paradoxically the institution that had accounting as part of the liberal arts program had the higher DIT P scores than the institution that specifically focused on accounting as a core curriculum. In analyzing the results of the survey differences the researchers stated that to suggest that liberal learning in college may be an important factor in the development of the students and accounting practitioners moral reasoning (p.204). The integration of accounting curriculu m in liberal arts broader learning institutions has since become a foundational element in ethics research, and is relied on as a theoretical construct of the research completed in this dissertation.The dynamics involved in the moral development and perception of whistle blowing was studied in an empirical study that had 106 internal auditors as respondents by Arnold and Ponemon (1991) These researchers relied on the DIT research instrument to specifically assess the moral development in the context of experimental scenarios and vignettes surrounding a fraud case and experimental treatments that elicited the perception of internal auditors of whistle blowing. The results of this research illustrated the fact that internal auditors who scored low on the DIT P scale perceived the act of whistle blowing from the standpoint of personal punishment as a risk of unethical behavior than those with high DIT P scores.Clearly this supports the fact that the DIT P measurement instrument support s the contention that those internal auditors that have higher DIT P scores have a higher level of ethical cognition relative to those with lower DIT P scores. The internal auditors who scores lower on DIT P scores saw the act of whistle blowing, it can be inferred, as an external event that had negative consequences if a person was caught. This leads to the observation that internal auditors with low DIT P scores significantly externalize the ethical role of whistle blowers, while those with higher DIT P scores have already internalized ethical cognitions and see whistle blowing as incidental.Paradoxically however the main affiliation factors including punishment of others had little if any influence on the perc

Cinematography In Macbeth :: essays research papers

Cinematography In MacBethWhen I first watched the two episodes of MacBeth I noticed several differences in the was the two directors portrayed the settings and characters in witch image. In the first movie I found the witch scene to be very dark and somber which made it easy to tell what the witches were doing and the fogand lightning gave me the impression that bad things were yet to come. This atmosphere is totally differentfrom the second video though because the second virtuoso takes place on a clear beautiful beach which seemsto be very peaceful. They way the second video locomoteed out it was kind of difficult to keep an eye on what wasgoing on, but as the scene progressed it became easier to understand what was going on. By the was this scene was shot the viewer really has to postdate because it seems really strange. It does not follow the typical stereotype of most witches and it is very irregular. The first movie just had a way creepier image to it withthe scary music, the witches weird voices and the lightning and stuff going on in the background. At the beginning of the second movie scene Im given the impression that the witches are almost regular people until they start pulling out the arm and rope and stuff. I enjoyed the second movie scene more becauseit seemed more casual and it really caught my eye because you dont know what is going to happen next.I also liked it because it was simple and it didnt follow the trends of most witch scenes. When I first watched the beach scene I can honestly say that I dislike it, but as I watched it over and over and over and over again I began to notice the little things that made the scene creepy like the squawking seagulls and the mysterious arrival and depart of the witches. The beach seemed like an unlikely place to cast a spell which is why I enjoyed the second movie scene more.

If I Were George Bush Essay example -- essays research papers

If I Was George BushIf I was George Bush I would follow the exact same path he is following right now. His plans for our countries learning and health Care plan live up to their promises. These plans also benefit the country greatly as a whole. Yet, if I was President Bush, I would make the corroboratory effects of these plans to prove themselves more immediate than they have been. This would urge the States to follow my, or Bushs, plans to make America a better place.The Education Plan the Bush has produced is almost perfect. It contains six key points that I totally agree with. The first part of the plan says that Ameri stool will provide maintain grants to recruit and train teachers. The second part of the plan being that America will be recruiting high quality Individuals to become teachers. The third part says that America will be expanding programs to train teachers in specific subject areas. The fourth part suggests that America will implement the Teachers Protection Act. The fifth part says that a new teachers tax deduction will be implemented. Lastly, the sixth part of the plan says that America will be providing expanded student loan forgiveness for teachers. All of these goals lead to one key plan. This plan is to put a quality teacher in every room. If this feat can be accomplished, I would follow the exact same plan Bush is following right now. Bush basically has this plan covere...