PowerPoint Presentation

TEACH-VIP

T rainin= g,

E ducating,

A dvancing

C ollaboration in

H ealth on

V iolence and

I njury

P revention =

Core curriculum

Lesson 8

= The materials in this lesson are based on an injury prevention and control curriculum originally = developed by the World Health = Organization and a global network = of injury experts.

Gen= eral lesson description

This l= ecture focuses on basic ethical principles of public health practice and applies them to= the study of injuries and violence prevention.

It exp= lores the importance of concepts such as respect for individuals and the principles= of beneficence and justice as expressed in the Belmont Report or other simil= ar national and international agreements.

Ethica= l principles in relation to surveillance reporting, privacy and research are also addressed. In research activities, the concept of the institutional ethics review board is explained.

The le= sson also explores wider ethical issues concerning unequal access to services, structural, economic, age and gender inequalities.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0001_image002.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhqgAzAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAACo ADEAhgAAAAAAAADMmQDMmgPMmgfMmgvMmgvMmwvMnAzMnA3MnA/MnA/MnQ/MnhDMnhHMnhLMnhLM nxLMoBPMoBTMoRXMoRbMohfMohfMoxjMpBnMpRnMphrMpxvMqBzMqBzMqR3Mqh7Mqh/Mqx/MrB/M rSDMriHMriHMryLMryLMsCPMsSPMsiTMsyXMtCXMtSbMtSbMtifMtifMtyjMuCjMuSnMuirMuyrM vCvMvSzMvizMvyzMwC3MwC3MwS3Mwi7Mwy7MxC/MxS/MxjDMxjDMxzHMyDHMyTLMyTLMyjLMyzLM zDPMzAECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwEC AwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwECAwf/gAGCg4SFhoeI iYqLjI2Oj5CRjwKUAgOXAwQFBgYHnp+eCAkKCwsMDA0NDg8QEBEREhITFBW1FRYXFxgYGRq+Ghsc HB0eHh8fICEhIiIjJCQlJSYnKCkqKivZLCwtLi8wMTEyMjM0NDU1Nuo37Dg4OTk6Ojs7PDw9Pvk+ P/xA/kFBhAgcMoSIwSIIERpZeKQhkocQkSSZSLFiEiUYl2gMUMkSJk2cQIESRcoUKlWsXMGSRcsW Ll28fgETRswYMmXMnEGTRs0aNm3cvIETR84cOnU22N1wB08ePXv49PH74Q8IQIFCCBokklAhQ4cR H1oci1GJxiUcK2HKtKmTyFCj/0qdSrWq1atYs2zdyrWr169gw4odS7as2bNo06pdy7ZiW7dv4caV O5duXbt38ebVu6dvX79/AQcWPNh1oZGGR8KKHVux7Nm0lNaCdPuWpNyTdVXibVnrZV+ZgGsOxml4 Z2KfjB0LjVyUMlKlTDM/5Sz1s9XQWUdzLf01tWrWrTNu7Ci77Vu4JeeitLsyr0u+Mf/SFHyzsE7E PRcDfTxUstHKSV3WlGZQdTZVVVeJtlVXRZiGmmoSgTeRa+Op9ZF559lmEl0p3cWSXr7F50tw9BGW 02E8KfZTY0FBRtRkR1m2FGZObRZVPgeChpVWpCXkIFhhSTiheGiRd2FIGca14f96un34Hkx+jTif TSYWh5+KybXYX3MxBjjjgNPd6BlVOirYo1enARmRkBcRCZtHl8x23gEaqpebh+71Bl+UMwVGJXH3 pYjcfsu9+N9zAkpno4HWJZjdgtyl6V2QQlJYpIVxYlibknZ22B5ve0EJ3JTD2YficfqxyB9zMAII HY0EUodjo9jxuJ2P3UHIpqVvlofkpunh5uluIO45qp+lnmhcfisq56J/zskYXY0FVkfmdTtqx+CP k65ZqZtGZvqrSHUKyx6xT/4mH7L1KXvloKoWCm2Xr4K5qLUI1qptpA9+961ZFcZ2JG3kcmpuk3mG qq6U7FYZKKrNasnqodLCGib/o9c6auu2uforIa/hsjXuSAZzeK6Teoq6rnDtWiloqs5u2SqiXypa 7awZ6wsprpLq+u9rIcuZZLAmIwxqiHyS+Kepy2JJ6LNcupootbKOmW+2O6PZL6Ufg4upyASTTDST eB5t7MolAnoqs1muami0Xk4bq5g5YmvmrVqrCdGuXgssbtiflFt02cWqzDDLDq/tdLxQz1yxvTdb XeajZzbYMdfggfy10MDeNvinhS/cJ+JqNw1vzBPDXa/NVdet8b48b+1t1wBf6jfYcwpONujpijh6 2ky/C7PEb9M79dwYX303xz17nHnfcOI+tOe7o5uy6Eon6zLEbcsbNc1yX4zv/+Qb86v3arQDvbmm BY99J+/X+559yw+z/bTMFMdt8b04K0853pZrHuZYo7nbca591Huf9RQmP1LRT3GnI968pFYzqtGN VlirHLd8lr6ARe+AYkvgsFDGwKQ5MHGmG57bJgi+/UXOdTrT4OVm97za9WpguStZ9UiItGORLngv i9gKv/c41l0wZxkE4AadR0Do+Qpw6BHhyRLWQ7QtzV1B7F7j8rc6CyaPfLDLW7f29jMPPjGH7hsh Fc92OOBhkXv3S53xKoi88dntf8yTHRk7aLsPsi+ES1IgD9n4uytuz36Mw5/qjie+/oExawHUI/pq qD4D/jFwOhTkGg1XSO3Vb/9xqCseBcPHP8ndsXyxO1+E+HjDv6FRikYLXQMbVjrhCdF7jtMf5FqH weWZb4yTbKINg3bJKAZSjWbj5PxQaEstKnKOpHxhL/H4Sw5S0ow4nN4xp5hM7J2wllmMoyhbuMsj +g+VYrSmMCvpx5FhMo3clKUJaQlEOCZSjqN0IS+R6MtUAnOV1+zjGbXZqXj2bp4/fCMiQ8nCInrR jq+D5BIHSBYnZrNz24zlQX3oxkOCUoJE1KURv3jKMEZSlXwb5vrcacyCajR+CO3oJyM4xFx2sY6O LKlEZ7jHgLZSehh1KeE2akVPQlCFuOQiI0sJwyTmEaVlFOhFEZjRocKUo4b/nClSt7hIOjbSlBGV oQBpuE5supKgB7NqCbFq1BTekqvQ1Kc5HylWSQK0rFI9a1DTCr+1FvWBbnUmPsk5UojGUIk8DWZF VWpJltIpk8iUJ1sB20xxNlSkD81pWBE71p7i9acgfCcs1VrFNmb1qG99Zj7LSdLNPvWfKWXnQPf6 uQWWtpOUDec9x+lQnIL1sK9V52JlO1VACrWvt10mOO3J0JDe9KtN7Wc6mThcswKVqse1LSGVW8+F gtSmS5UmP6npT+FapIDthOJj4flSv5q2rZXd7WWfy9RpovOksI0qaIu53tEid7vf7O5Ha6pUr9Z3 vPedKFmrm9frGpev2lVmNoAVOuCkdjWa+zynSRXsWQbv17G602Q3Z5lQj9LUwnFlrWGdWk3qntdN koixjGdM4xrbeMaBAAA7 ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0021.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Ethical issues related to injuries in terms of surveillance, research, care and access to services, and wider social ethical implications

Ethical issues in the injury field

Sessi= on time: 60 minutes

= Secti= on IV. Ethical issues involved in injury preve= ntion and control, and safety promo= tion

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0021_image003.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhuAGJAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAAC2 AYgAgQAAAAAAANnZ2fLy8gL/jI+py+0Po5y02ouz3rz7D4aIQJbmiabqyrbuC8fyTNf2jbNBzvf+ D6wZgsSi8YhMKku7pfMJnQ2j1Kr1ihU0s9yub+oNi8dkbfmMNoHT7LYbt33Lreu5/T6P4/fHOv8P yKUXSAg3WIiYaHSo2KjD6BgpGQM5Kelnmal5UrmZiOkZeilqCUp6WtiJyme66oqn+mrXKlvbFmvr RpvLO4bbi7YLPIz1S+xrfKyslLws2OwcDQQtXSVcjf1Dnf10zf1tsw2e5D1u/iJ+XlSu3o6S7q4N Hw8+T5/Dft9urx/O3x/tH0AZ+QbWM0ilIMJsAhe2UOhQWsOIKiBSXDbxIqeM/xpdceyo5SNIUiI1 WhzZq+TFkyhzqaTIsmWtlxFjynxF06HNm6tyLtzJ85RPhECDihpqsKhRT0gHKl2qqSnAp1BLVTV0 FZvUflSzOtqqr6tXRWDviR2LqCy9s2gJqY3Hti2gt+7iymV1F4bdvHfo7vPLNwzgc3sDyxlsrrBh XYtXKG6cBvG4x5DPSK53uTKUzNwoa/b1WQ3n0ORIk/BsWlBq1KmLrRYBO7bs2bRr276NO7fuCAN6 +/4NPLjw4cSLGz+OPLny5cybO38OPbr06dSrW7+OfYCB7Ny7e/8OPrz48eTLmy++/bz69ezbu38P Pz709PLr27+PP7/+/PT3+///D2CAAg4YXH8EHohgggouaJ2BDD4IYYQSHujghBZeiGGG5VWoYYce fghichyGSGKJJl444okqrsgigCm2CGOMMq734ow23ohjgwHkyGOPPkZX449CDsljkEQeiSSLRibJ ZJMeLulklFJCCOWUVl4pYJVYbsmlfVp2CWaY6n0pZplmekfmmWquKV2abL4JJ3Juxklnnb7NaWee b+KpZ59m8ulnoF0CKmihVhJqaKJNIqpoo0Qy6mikPUIqaaU27oZppppuymmnnn7qQWuiHjXaqKb2 wNqpqpJT6qquEtTqq7I+FOustr5T6626hrRrr7rk6qusqQZLbEXAFqvqsMh5Lssrs87Sceyzr0lL bTfRVvuZstjqqu22tnbrrbDXhrsYuOSuau65p6ar7qjsttvau/CaJu+8odVrr2b45gvZvvyWO+6/ WfkrMF8EF3zXwQi3pfDCYzXs8MABR8wTxBRDZfHFRmWsccUTdzwSqCKPTHLJJp+M8gEFAAA7 ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0022.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Main objective of this lesson
To address important ethical issues t= hat should help define guiding principles for the practice on injury prevention a= nd control, and safety promotion activities. <= /span>

Core competencies that students= should attain by the end of the session

To gain an understanding of:

1. the principles of ethical conduct = in public health;

their application in research and practice including:

respect for autonomy (voluntaries, privacy)

justice

informed consent

information

comprehension

2. assessment of risks and benefits (non-malfeasance, beneficence);

3. different cultural perspectives and ethical approaches to health;

4. the institutional review board pro= cess and an awareness of international agreements

    that address the relationship of injuries and violence to human rights;

5. by means of examples, the importan= ce of ethical responsibilities in injury prevention

    and control (e.g. iss= ues related to children and the elderly, labour, building and
    planning, consumer products, sports and recreation, customs, agriculture,

    transportation); =

6. the concept of the right to safety= (the Delhi Declaration).

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0016.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Ethical issues in injuries

TEACH-VIP

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0016_image004.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhmwEsAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAACZ ASoAgQAAAAAAADPMzAECAwL8jI6py+0Po5y02ouz3rz7D4ZCYIjmiabqyrbui5LwTNf2jec6JO/+ DwwKh7Qe8YhMKpdCI/MJjUqnFif1is1qg9at9wsOg7risvmMHpXS7LZ7Sn7L53RcvI7P60X3vf8P GNEXSFj4N2iYqPiGuOj4GNYIOUkJt1aJmUklqdnpqcP5KTrqEkp6ihpimsraerHqGivbADtrO1t7 q8uau+s72vsrrBk8bDxZfKysmLzsHNj8LK0XPW09V32tzZa97V3W/S3uFT5uflV+rg6Vvu6e1P4u 33Q5b28Wf69/Q9Lv/w8woMCBBAsaPIgwocKFDBs6fAgxosSJFCta/FcAADs= ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0013.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Historical aspects

Public health <= /span>

<= span style=3D'font-family:Arial;font-size:117%'>• Earlier notions =

   - Hippocratic Corpus

   - Qur’an <= /div>
   - Vinaya

<= span style=3D'font-family:Arial;font-size:117%'>• Disease and disease control in the middle ages

and renaissance

•

<= span style=3D'font-family:Arial;font-size:117%'>• Modern ethical approaches

Early = notions of ethics can be found in multiple writings from different cultures and regi= ons of the world. Concepts and principles of ethics and health can be found in the Hippocratic Corpus, in the Qur’an and in the Buddhist scripture= s of the Vinaya to name some examples. Many of the concepts discussed in these writings refer to the protection of human life and the avoidance of harm.=

During= the Middle Ages, concerns about public health and disease mainly involved infectious conditions and activities were related mostly towards the application of quarantine. In the 16th century, some social concepts about disease emerg= ed such as the relationship between inequality, poverty and disease.<= br>

In the= 19th century, governmental interventions and activities were first applied and addressed multiple ethical issues such as child labour and sanitary conditions of workers. With the Industrial Revolution, public health activities were institutionalized and consolidated within government structures. Many of these activities developed simultaneously with an overall approach that increasingly valued the dignity of individuals.

In the= early 20th century, concepts related to ethics and consent appeared. But it was not until after the Nuremberg trials, following the Second world war, that ethical issues relating to research and public health became part of the mainstream.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0013_image005.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhjwAhAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAACO ACAAgQAAAAAAADPMzAECAwKGjI+py+0Po5x0iYuz3rz7D4biSJaZYabqyrYu6sbyTI9wjef6eu/+ D8T0gsSibGhMKknIpfOpaUKnSyn1SrRitzst90vzgsctMflsMqPXITX7zXHD5xc5HW6/s/N6NL9P 9gcIJjjIVWiIhZhItcgI5fjoFCmpRFlpdImZBVDh+QkaKjoaUAAAOw== ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0017.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Ethical approaches= and theories

=

<= span style=3D'font-family:Arial;font-size:117%'>• Relativistic approaches

=

<= span style=3D'font-family:Arial;font-size:117%'>• Consequentialism (e.g. utilitarianism)

=

<= span style=3D'font-family:Arial;font-size:117%'>• Deontological (Kantian) approach&#= 13;

=

<= span style=3D'font-family:Arial;font-size:117%'>• Other approaches

General issues

Moral = relativism refers to the notion that universal concepts cannot be applied given the large cultural variability that exists in the world. These arguments have sometimes been supported by the notion of using culturally sensitive standards. While indeed there are differences in interpretations about morality, standards are usually universal. An example of this is the use = of informed consent. Relativists often argue informed consent is not necessa= ry in some settings because it is culturally insensitive, potential subjects= are not competent enough, or the importance of a health problem supersedes, t= he informed consent process. Each of these points is not sufficient to avoid= the use of informed consent because in most cases relativism of standards is = confused with relativism of judgements about a situation. As will be seen later, in most cultures some universal moral standards exist which can help guide t= he best way to ethically practise injury prevention (1).

Apart = from the relativistic approaches, there are some theories that approach the problem from different perspectives. Consequentialist theories (e.g. utilitariani= sm) for example, are focused on the idea that specific actions or practices a= re acceptable if they yield more benefits to people when compared with other similarly oriented actions or practices.

Kantia= n (or deontological) theories, state that action is only moral when performed b= y a person or agent who possesses good will. This good will by itself is base= d on the existence of universal rules. Such rules are guiding principles for a= ll.

Some a= pproaches contend that moral and ethical dilemmas are best handled by virtuous peop= le who better understand the nature of a problem. Finally, other approaches focus on the use of precedents or previous cases to dictate what is ethic= ally appropriate rather than focusing on universal rules.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Some general moral principles

<= span style=3D'font-family:Arial'>• Be truthful

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• Respect privacy/prote= ct confidentiality

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• Obtain consent

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• Be loyal <= /span>

<= span style=3D'font-family:Arial'>• Be just/fair/equitabl= e

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• Do not kill

<= span style=3D'font-family:Arial;visibility:hidden'>•

<= span style=3D'font-family:Arial'>• Do not cause pain

There = are some universally accepted moral principles that can serve as the basis for eth= ical standards. While these standards might follow different interpretations a= nd applications among different people, according to Beauchamp (1), some universally accepted principles or precepts can be defined: These include= :

be tru= thful

respec= t privacy and protect confidentiality

obtain= consent

be loy= al

do not= kill

do not= cause pain (continued on next slide).

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0019.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Some general moral principles

• Do not incapacitate&#= 13;

•

• Do not cause offence =

•

• Do not deprive of goods

•

• Protect and defend others’ rights

•

• Prevent harm from occ= urring to others

•

<= span style=3D'font-family:Arial'>• Remove conditions tha= t will cause harm to others

•

• Help persons with disabilities

•

• Rescue persons in dan= ger

The ru= les mentioned here are neither absolute nor exhaustive and some have partial applicatio= ns. Their specific interpretation will in many cases depend on contextual situations and specific cultural perspectives. Many of these rules provide guidance for professional morality and, in turn, for the creation of code= s of conduct, within the framework of specific activities (1).

Do not= incapacitate.

Do not= cause offence.

Do not= deprive of goods.

Protec= t and defend others’ rights.

Preven= t harm from occurring to others.

Remove= conditions that will cause harm to others.

Help p= ersons with disabilities.

Rescue= persons in danger.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Ethics and practices

Ethics:

=

<= span style=3D'font-family:Arial;font-size:117%'>• relationship with morality and religion

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• relationship with the law and human rights

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• relationship with policy

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• relationship with public health

Based = on the principles mentioned before one can understand the relationship between ethics and religion. Most religions state some basic premises about human behaviour and frequently express them as moral obligations.

In the= same manner, such premises that are socially acceptable in different contexts can be translated into laws that determine, modulate, and enforce social and individual behaviour. The implementation of policies is usually based on existing legal frameworks = that determine what is permissible, and what is not, within a specific society, nation or group of nations. Many of these premises have a close relations= hip with current definitions of human rights and national or international standards of conduct.

Public= health by definition promotes and protects the health of the population and therefo= re should be developed within these ethical standards of conduct. Public hea= lth contributes to the enhancement and protection of people through actions a= imed at improving health while respecting the rights of individuals and communities.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0010.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Some general moral principles

How do they relate to

injuries and violence prevention?

How do= ethical principles relate to injuries and violence prevention? There are many way= s in which ethics is related to injuries and violence prevention activities.

Some o= f the most important themes include the use and application of internationally agreed codes of conduct for research and practice, specific issues related to populations or injuries, and the overall relationship of injury preventio= n to human rights.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0010_image006.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhhgFBAHcAMSH+GlNvZnR3YXJlOiBNaWNyb3NvZnQgT2ZmaWNlACH5BAEAAAAALAAAAACE AT8AgQAAAAAAAADMmQECAwL/lI+py+0Po5y02ouz3rz73wTgSJbmiabqynJiC8fyTNe2/d76zvf+ n8oBh8Si8VgTIpfMpvPJUEKn1KpVJr1qt9wuJesNi8dWMPmMTv/M6rb7rWLD5/T6RW7P6/cGPP8P qOYXSFjINWiYqOiEuOj4CNQIOUlJI1mJmYlyqdnp6fIZKnrCOWp6mlCKujqqyvra6Qo7SylLe7to i7tLqMv7u+cLPEwnTHzcZoy8TKbM/NzlDD1dRm3NJ32tvZS97U3U/S3eEz5ujnOe7lWu3r7C7h5v Ai9f/0Fvn6+Br99fwe8vIASAAgsuIGgwYR+FDGEgbCjwIUR/Eifqq2jRHsaMQfI2cnTn8aO6kCLP kSw57iTKbypXbmvp8hrMmNRm0oQWIKfOnTx7+vwJNKjQoUSLGj2KNKnSpUybOn0KNapUoQUAADs= ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Standards of conduct

Responsibilities t= o: =

=

<= span style=3D'font-family:Arial;font-size:117%'>• society

=

<= span style=3D'font-family:Arial;font-size:117%'>• research subjects

=

<= span style=3D'font-family:Arial;font-size:117%'>• employers and funding sources =

=

<= span style=3D'font-family:Arial;font-size:117%'>• professional colleagues

At the= professional level, there are some clear responsibilities related to the practice of public health. As suggested by Beauchamp, in the specific case of epidemiology, these include:

respon= sibilities to society: defined as the provision of benefits, creation of public trust, avoidance of conflicts of interest, and promotion and practice of impartiality;

respon= sibilities to research subjects: these include protecting the welfare of research subje= cts, ensuring informed consent and respect for privacy/confidentiality. Institutional review/ethics committees exist to ensure that research is undertaken in accordance with these principles;

respon= sibilities to employers and funding sources: these include the formulation of actual professional responsibilities for practice and the protection of privileg= ed information;

respon= sibilities to professional colleagues: these include accurate reporting of methods and results used for research and compulsory reporting of unacceptable condit= ions and behaviours.

Overal= l these responsibilities encompass the whole spectrum of activities and approache= s a professional working in public health and injury prevention should be awa= re of and practice.

Such responsibilities have actually been translated into specific codes of con= duct for professional practice.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0002.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Cultural/religi= ous ethical systems:

•<= /span> Aboriginal bioethics

• Islamic code of medical ethics = ;

•<= /span> Hindu bioethics =

•<= /span> Chinese bioethics

•<= /span> Jewish bioethics

•<= /span> Christian bioethics

Professional codes:

•<= /span> Nuremberg Code <= /div>
•<= /span> Declaration of Helsinki

•<= /span> International Guidelines for Ethic= al Review of

Epidemiological Studies (CIOMS/WHO)

•<= /span> professional associations (IEA, IE= F, CMA)

Codes of conduct

Ethica= l principles stemming from religious perspectives should be acknowledged and understoo= d. In very general terms some specific characteristics can be identified.

Multip= le aboriginal cultures emphasize holism, pluralism and community or family decision-mak= ing with the maintenance of quality of life (2).

Islami= c codes are linked to ethical teachings from the Qur’an (3) and strive for virt= uous behaviour.

Hindu = traditions favour holism, the importance of family and support a duty-based rather t= han rights-based approach (4).

Chines= e codes of bioethics emphasize interdependence, and family and community decision-ma= king (5).

Jewish= traditions also favour duty-based approaches over rights-based models (6).

Christ= ian traditions focus on the value of autonomy and rights-based approaches (7, 8).=

There = are multiple codes of conduct for professional research and practice in public health. Selections of these are included below.

The Nu= remberg Code created as a consequence of the human experiments carried out by Nazis du= ring WW II. It contains 10 principles of which the first one refers to volunta= ry consent of human subjects. Other concepts refer to principles of benefice= nce and risks to human subjects.

In 196= 4 the World Medical Association enhanced the code through the Declaration of Helsinki. This declaration addresses issues related to research in human subjects, disclosure of information, consent, privacy, risks and benefits of resear= ch and voluntariness.

Furthe= r development of codes of conduct in research have been produced through:

the In= ternational Guidelines for Ethical Review of Biomedical Studies developed by t= he Council for International Organizations of the Medical Sciences (CIOMS) (= 9);

a fram= ework for practice applicable worldwide, provided by WHO.

Finall= y, other more specific codes stem from international agreements of professional associations such as:

the In= ternational Epidemiological Association (IEA), Industrial Epidemiology Forum (IEF) and Chemical Manufacturer’s Association (CMA) that have activities rela= ted to injury prevention, control and safety promotion (1).

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0003.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Practical aspects

<= span style=3D'font-family:Arial;font-size:117%'>• Research

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>• =

<= span style=3D'font-family:Arial;font-size:117%'>• Specific injuries or violence problems

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>• =

<= span style=3D'font-family:Arial;font-size:117%'>• Other social aspects

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>• =

<= span style=3D'font-family:Arial;font-size:117%'>• Human rights approach

Some p= ractical aspects related to the application of these codes of conduct can be understood through the development of research, through dealing with spec= ific injury issues, through overall social conditions that can prevent, or promote, the occurrence of injuries, or by following a human rights appro= ach.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0011.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

<= span style=3D'font-family:Arial;font-size:150%'>• Informed consent

•<= /span> =

• Privacy

•<= /span> =

• Confidentiality =

•<= /span> =

• Risks and benefits

Research aspects

In the= area of research, seven basic concepts can be discussed. These refer to informed consent, privacy, confidentiality, risks and benefits, information, comprehension and voluntariness.

Inform= ed consent refers to the respect for autonomy of individuals. Research subjects shou= ld not only be informed, but clearly understand the implications, of participating in specific procedures.

Privac= y refers to the assurance that sensitive information pertaining to the health of individuals will not be disclosed or shared without specific approval of subjects. This concept is intimately associated with confidentiality and = the way health or research information is handled and protected.

The di= sclosure and understanding of the risks and benefits of research procedures is crucial= . It not only involves the research subject but also the researchers and the committees evaluating the research process as a whole. These actors must = be well aware of the correct balance between risks and benefits of conducting research and be able to communicate it to participants so that they understand it. This balance assures the application of the principle of beneficence that states that actions taken must produce a good or better outcome for an individual or societies as a whole.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0020.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

<= span style=3D'font-family:Arial;font-size:150%'>• Information <= /div>
<= span style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:133%'>• Comprehension
<= span style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:133%'>• Voluntariness

Research aspects

All of= these concepts, in one way or another, are discussed or included in the most wi= dely used codes of conduct and are specifically addressed in areas of research. When conducting research, many institutions closely follow guidelines that comply with these principles.

Inform= ation refers to the appropriate communication of the research process and disclosure of all information necessary for subjects to be able to make informed consen= t or dissent.

Resear= ch subjects must fully understand the process and implications of research in order to provide informed consent. Full comprehension of the risks and benefits of= the research thus enable individuals to exercise their will in relation to participating, or not, as research subjects.

Volunt= ariness refers to the will of individuals to become, or cease to be research subjects, w= hen they consider it appropriate. It also precludes researchers from coercing individuals into research.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0018.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Research aspects

<= span style=3D'font-family:Arial;font-size:150%'>• Institutional Review Board

   - objectives

   - members

The re= search ethics committee is also known as in some countries as an Institutional Review Board.

The pu= rpose of the research ethics committee is to guide researchers and promote the applica= tion of adequate codes of conduct when doing research. It should be a specially appointed committee independent of the investigator and sponsors. In many countries this committee involves other scientists with competencies necessary to judge the scientific merits of the research and the methodological procedures involved. However some of these committees also include non-scientists such as lawyers, ethicists or persons belonging to= the clergy. Individuals outside of institutions should also be part of these committees (1).

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Injury-related aspects

<= span style=3D'font-family:Arial;font-size:117%'>• Vulnerable populations:

- children

= - elderly

=

<= span style=3D'font-family:Arial;font-size:117%'>• Suicide

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• Traffic injuries, traumatic brain injuries

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• Occupational injuries <= /span>

<= span style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:117%'>• Safety for informants and research= ers

Some s= pecific ethical issues that arise in research concern the conduct of studies involving vulnerable populations such as children, the disabled or elderl= y. In many circumstances of child abuse, for example, dealing with issues of treatment or rehabilitation forces external agents to act on behalf of the child when the caretakers are causing harm. The risk of psychological distress when answering questions relating to intentional injuries is potentially high especially in children and adolescents. In these cases, special considerations of risks and benefits should be taken into account. Other issues arise when dealing with older persons, for example, especial= ly when they have a cognitive impairment.

Anothe= r example of a vulnerable population is victims of violence. WHO (10) has developed guidelines for research on domestic violence against women.

Other = examples of ethical issues that come to light in selected injury-related settings are described below.

In reg= ards to suicide, many social taboos or community beliefs imply that the handling = of information related to suicide be confidential and respectful of the priv= acy both for persons who have attempted suicide and for the families of victi= ms of suicide.

Person= s that have suffered severe trauma to the brain and have cognitive impairments are sub-populations where special considerations must be taken for example wh= en addressing issues of life support and death.

Victim= s of sexual violence need significant psychological support and respect for privacy a= nd confidentiality.

Other = ethical issues might involve the rights that workers have to conduct their labour activi= ties in safe environments. In the research environment, this involves the safe= ty of informants and researchers especially in subjects related to violence.=

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/slide0008.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation

Human rights and injuries

<= span style=3D'font-family:Arial;font-size:133%'>• Human rights and injuries

<= span style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:133%'>• Human rights and public health = ;

<= span style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<= /span> =

<= span style=3D'font-family:Arial;font-size:133%'>• The right to safety<= /div>

Many o= f the previous examples relate to the respect of human rights. The integration of human rights approaches to public health and injuries is important. From the hu= man rights perspective, nations have an obligation to respect, protect and fu= lfil human rights that are related to injuries and violence (11).

The co= ncept of the right to safety developed through this approach has been addressed in multiple venues. The clearest example is the Delhi Declaration. This declaration was adopted in New Delhi on 8 March 2000 after the Fifth World Conference on Injury Prevention and Control (12). It basically states that injuries represent a huge burden of disease in the world and that safety = is a condition where as many hazards that can be controlled should be controll= ed. Freedom from such hazards is imperative for effective injury and violence prevention. Sharing information on risks, controlling them, and allocating more resources for injury prevention can lead to a higher degree of safet= y. Efforts to encourage institutions to adopt and implement this declaration= are currently under way.

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/master01.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"
‹header›

‹date/time›= =

Click to edit Master text styles

Second level

Third level

Fourth level

Fifth level

‹footer›

‹#› =

General lesson description
This lecture focus= es on basic ethical principles of public health practice and applies them to the study of injuries a= nd violence prevention. It explores the importance of concepts such as respect for individu= als and the principl= es of beneficence and justice as expressed in the Belmont Report or other similar national and international agreements. Ethical principles in relation to surveillance reporting, privacy a= nd research are also addressed. In research activities, the concept of the institutional ethics review board is explained. = The lesson also explores wider ethical issues concerning unequal access to services, structural, economic, age and gender inequalities.=

Early notions of ethics can be found in multiple writings from different cultures and regions of the world. Concepts and principles of ethics and health can be found in the Hippocratic Corpus, in the Qur’an and in the Buddhist scriptures of the Vinaya to na= me some examples. Many of the concepts discussed in these writings refer to the protection of hum= an life and the avoidance of harm. During the Middle Ages, concerns about public health and disease ma= inly involved infectious conditions and activities were related mostly towards the application of quarantine. In the 16th century, some social concepts about disease emerged such as the relationship between inequality, poverty and disease. = 3;In the 19th century, governmental interventions and activities were first applied and addressed multiple ethical issues such as child labour and sanitary conditions of workers. With the Industrial Revolution, pub= lic health activities w= ere institutionalized and consolidated within government structures. Many of these activities developed simultaneously with an overall approach that increasingly valued the dignity of individuals. In the early 20th century, concepts related to ethics and consent appeared. But it was n= ot until after the Nuremberg trials, following the Second world war, that ethical issues relating to research and public health became part of the mainstream.

Moral relativism refers to the notion that universal concepts canno= t be applied given the large cultur= al variability that exists in the world. These arguments have sometimes been = supported by the notion of using cultur= ally sensitive standards. While indeed there are differences in interpretations about morality, standards are usually universal. An example of this is the use of informed consent. Relativists often argue informed consent is not necessary in some settings because it is culturally insensitive, potential subjects are not competent enough, or the importance of a health problem supersedes, the informed consent process. Each of these points is not sufficient to avoid the use of informed consent because in most cases relativis= m of standards is confused with relativism of judgements about a situation. As will be seen later, in most cultures some universal moral standards exist which can help gu= ide the best way to ethically practise injury prevention (1). Apart from the relativistic approaches, there are some theories that approach the problem from different perspectives. Consequentialist theories (e.g. utilitarianism) for example, are focused on the idea that specific actions or practices are acceptable if they yield more benefits to people when comp= ared with other similarly oriented actions or practices. Kantian (or deontological) theories, st= ate that action is only moral when performed by a person or agent who possesses good will. This good will by itself is based on the existence of universal rules. Such rules are guiding principles for all. Some approaches contend that moral and ethical dilemmas are best handled by virtuous people who better understand the nature of a problem. Finally, other approaches focus on the use of precedents or previous cases to dictate what is ethically appropriate rath= er than focusing on universal rules.

There are some universally accepted moral principles that can serve= as the basis for ethical standards. While these standards might follow different interpretations and applications among different people, according to Beauchamp (1), some universally accepted principles or precepts can= be defined: These include:
be truthful

respect privacy and protect confidentiality

obtain consent = ;

be loyal

do not kill

do not cause pain (continued on next slide).

The rules mentioned here are neither absolute nor exhaustive and so= me have partial applications. Their specif= ic interpretation will in many cases depend on contextual situations and specific cultural perspectives. Many of these rules provide guidance for professional morality and, in turn, for the creation of codes of conduct, within the framework of specific activities (1).
Do not incapacitate.

Do not cause offen= ce.

Do not deprive of goods.

Protect and defend others’ rights.

Prevent harm from occurring to others.

Remove conditions = that will cause harm to others.

Help persons with disabilities.

Rescue persons in danger.

Based on the principles mentioned before one can understand the relationship between ethics and religio= n. Most religions state some basic premises about human behaviour and frequently express them as moral= obligations. In the same manner, such premises that = are socially acceptable in different contexts can be translated into laws that determine, modulate, and enforce social and individual behaviour. The implementation of policies is usually based on existing legal frameworks that determine what is permissible, and what is not, within a specific society, nation or group of nations. Many of these premis= es have a close relationship with current definitions of human rights and national or international standards of conduct. Public health by definition promotes and protects the health of the= population and therefore should be developed within these ethical standards of conduct. Public health contributes to the enhancement and protection of people through actions aimed at improving health while respecting t= he rights of individua= ls and communities.

How do ethical principles relate to injuries and violence preventio= n? There are many way= s in which ethics is related to injuries and violence prevention activities. Some of the most important themes inclu= de the use and application of internationally agreed codes of conduct for research and practice, specific issues relat= ed to populations or injuries, and the overall relationship of injury = prevention to human rights.

At the professional level, there are some clear responsibilities related to the practice of public health. As suggested by Beauchamp, in the specific case of epidemiology, these include: responsibilities to society: defined as= the provision of benefits, creation of public trust, avoidance of conflicts of interest, and promotion and practice of impartiality= ; responsibilities to research subjects: these include protecting the welfare of research subjects, ensuring informed consent and respect for privacy/confidentiality. Institutional review/ethics committees exi= st to ensure that research is undertaken in accordance with these principles; responsibilities to employers and fundi= ng sources: these include the formulation of actual professional responsibilities for practice and the protection of privileged information; responsibilities to professional colleagues: these include accurate reporting of methods a= nd results used for research and compulsory reporting of unacceptable conditions and behaviours. Overall these responsibilities encompass the whole spectrum of activities and approaches a professional working in public health and injury prevention should be aware of and practice. Such responsibilities have actually been translated into specific codes of conduct for professional practice.

Ethical principles stemming from religious perspectiv= es should be acknowledged and understood. In very general terms some specif= ic characteristics can be identified. Multiple aboriginal cultu= res emphasize holism, pluralism and community or family decision-making with t= he maintenance of quality of life (2).
Isla= mic codes are linked to ethical teachings from the Qur’an (3) and strive= for virtuous behaviour.
Hindu traditions favour holism, the importance of family and support a duty-based rather than rights-based approach (4).
Chin= ese codes of bioethics emphasize interdependence, and family and community decision-making (5).

Jewi= sh traditions also favour duty-based approaches over rights-based models (6).

Chri= stian traditions focus on the value of autonomy and rights-based approaches (7, 8).
There are multiple codes of conduct for professional research and practice in pu= blic health. Selections of these are included below. The Nuremberg Code create= d as a consequence of the human experiments carried out by Nazis during WW II. = It contains 10 principles of which the first one refers to voluntary consent of human subjects. Other concepts refer In 1964 the World Medical Association enhanced the code through the Declaration of Helsinki. This declaration benefits of research and voluntariness.
Furt= her development of codes of conduct in research have been produced through:= 3;
the International Guidelines for Ethical Review of Biomedical Studies developed by the Council for International Organizations of the Medical Sciences (CIOMS) (9);= 3;
a framework for practice applicable worldwide, provided by WHO. <= /div>
Fina= lly, other more specific codes stem from international agreements of profession= al associations such as:
the International Epidemiological Association (IEA), Industrial Epidemiology F= orum (IEF) and Chemical Manufacturer’s Association (CMA) that have activities related to injury prevention, control and safety promotion (1).

Some practical aspects related to the application of these codes of= conduct can be understood through the development of research, through dealing with specific injury issues, through overall social conditi= ons that can prevent,= or promote, the occurrence of injuries, or by following a human rights approach.

In the area of research, seven basic concepts can be discussed. The= se refer to informed consent, privacy, confidentiality, risks and benefits, information, comprehension and voluntariness. Informed consent refers to the respect = for autonomy of individuals. Research subjects should not only be informed, but clearly understa= nd the implications= , of participating in specific procedures. Privacy refers to the assurance that sensitive information pertaining to the health of individuals will not be discl= osed or shared without specific approval of subjects. This concept is intimately associated with confidentiality and the way health or research information is handled and protected. The disclosure and understanding of the risks and benefits of resea= rch procedures is crucial. It not only invo= lves the research subject but also the researchers and the committees evaluating the research process as a= whole. These actors must be well aware = of the correct balance between risks and benefits of conducting research and be able to communicat= e it to participants so that they understand it. This balance assures the application of the principle of benefic= ence that states that actions taken must produce a good or better outcome for an individual or societie= s as a whole.

All of these concepts, in one way or another, are discussed or incl= uded in the most wid= ely used codes of conduct and are specifically addressed in areas of research. When conducting research, many institutions closely follow guidelines that comply with these principles. Information refers to the appropriate communication of the research process and disclosure of all information necessary for subjects to= be able to make informed consent or dissent. Research subjects must fully understand the process and implications of research in order to provide informed consent. Full comprehension of the risks and benefits of the research thus enable individuals to exerc= ise their will in relation to participating= , or not, as research subjects. Voluntariness refers to the will of individuals to become, or cease= to be research subjects, when they consider it appropriate. It also precludes researchers from coercing individuals i= nto research.

The research ethics committee is also known as in some countries as= an Institutional Review Board. The purpose of the research ethics committee is to guide researchers and promote the application of adequate cod= es of conduct when doing research. It should be a specially appointed committee independent = of the investigator= and sponsors. In many countries this committee involves other scientists with competencies necessary to judge the scientific merits of the research and the methodological procedures involved. However some of these committees also include non-scientists such as lawyer= s, ethicists or persons belonging to the clergy. Individuals outside of institutions should also be part of these committees (1).
Some specific ethical issues that arise in research concern the conduct of studies involving vulnerable populations such as child= ren, the disabled or elderly. In many circumstances of child abuse, for = example, dealing with iss= ues of treatment or rehabilitation forces external agents to act on behalf of = the child when the careta= kers are causing harm. The risk of psychological distress when answering questions relating to intentional injuries is potentially high especially in children and adolescents. In arise when dealing with older persons, for example, especially when they have a cognitive impairment. Another example of a vulnerable population is victims of violence. WHO (10) has developed guidelines Other examples of ethical issues that come to light in selected injury-related settings are describe= d below. In regards to suicide, ma= ny social taboos or community beliefs imply that the handling of information = related to suicide be confidential and respectful of the privacy both for persons who have attem= pted suic= ide and for the families of victims of suicide. Persons that have suffered severe trauma to the brain and have cognitive impairments are sub-<= span lang=3DEN-GB style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bi= di-font-family: Arial;mso-hansi-font-family:Arial;font-size:83%'>populations where special considerations must be taken for example when addressing issues of life support and death. Victims of sexual violence need significant psychological support and respect for privacy and = confidentiality. Other ethical issues might involve the rights that workers have to conduct their labour activities in safe
Many of the previous examples relate to the respect of human rights. The integration = of human rights approaches to public health and injuries is important. From the human rights perspective, nations have an obligation to respect, protect and fulfil human rights that are related to injuries and violence (11). The concept of the right to safety developed through this approach has been addressed in multiple venues. The clear= est example is the Delhi Declaration. This declaration was adopted in New Delhi on 8 March 2000 after the Fifth World Confer= ence on Injury Prevention and Control (12). It basically states that injuries represent a huge burden of disease in the world and that safety is a condition where as many hazards that = can be controlled should be controlled. Freedom from such hazards is imperative for effective injury and violence prevention. Sharing information on risks, controlling them, and allocating more resources for injury prevention can lead to a higher degree of safety. Efforts to encourage institutio= ns to adopt and implement this declaration are currently under way.
------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/master03_stylesheet.css Content-Transfer-Encoding: base64 Content-Type: text/css Ym9keQ0KCXt3aWR0aDo1MzRweDsNCgloZWlnaHQ6NDAwcHg7fQ0KLlRCDQoJe21zby1zcGVjaWFs LWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5UDQoJe2ZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9t YW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5CQg0K CXttc28tc3BlY2lhbC1mb3JtYXQ6YnVsbGV0XDIwMjI7fQ0KLkINCgl7dGV4dC1hbGlnbjpsZWZ0 Ow0KCWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCWNvbG9yOmJsYWNrOw0KCW1zby1j b2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZToxNTIlOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28t a2luc29rdS1vdmVyZmxvdzoxO30NCi5CMUINCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1bGxldFwy MDEzO30NCi5CMQ0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hhci13 cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQjJCDQoJe21zby1zcGVjaWFsLWZv cm1hdDpidWxsZXRcMjAyMjt9DQouQjINCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7 DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLkIzQg0KCXtt c28tc3BlY2lhbC1mb3JtYXQ6YnVsbGV0XDIwMTM7fQ0KLkIzDQoJe2ZvbnQtZmFtaWx5OiJUaW1l cyBOZXcgUm9tYW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzox O30NCi5CNEINCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1bGxldFwwMEJCO30NCi5CNA0KCXtmb250 LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNv a3Utb3ZlcmZsb3c6MTt9DQouTkINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMjI7 fQ0KLk4NCgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4i Ow0KCWNvbG9yOmJsYWNrOw0KCW1zby1jb2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo1NyU7DQoJ bXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLk4xQg0KCXttc28t c3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouTjENCgl7dGV4dC1hbGlnbjpsZWZ0Ow0K CWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCWNvbG9yOmJsYWNrOw0KCW1zby1jb2xv ci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo1NyU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5z b2t1LW92ZXJmbG93OjE7fQ0KLk4yQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAy Mjt9DQouTjINCgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9t YW4iOw0KCWNvbG9yOmJsYWNrOw0KCW1zby1jb2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo1NyU7 DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLk4zQg0KCXtt c28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouTjMNCgl7dGV4dC1hbGlnbjpsZWZ0 Ow0KCWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCWNvbG9yOmJsYWNrOw0KCW1zby1j b2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo1NyU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1r aW5zb2t1LW92ZXJmbG93OjE7fQ0KLk40Tg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRc MjAyMjt9DQouTjQNCgl7dGV4dC1hbGlnbjpsZWZ0Ow0KCWZvbnQtZmFtaWx5OiJUaW1lcyBOZXcg Um9tYW4iOw0KCWNvbG9yOmJsYWNrOw0KCW1zby1jb2xvci1pbmRleDoxOw0KCWZvbnQtc2l6ZTo1 NyU7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLk9CDQoJ e21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5PDQoJe3RleHQtYWxpZ246bGVm dDsNCglmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgljb2xvcjpibGFjazsNCgltc28t Y29sb3ItaW5kZXg6MTsNCglmb250LXNpemU6MTE0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNv LWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTzFCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxl dFwyMDIyO30NCi5PMQ0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglmb250LXNp emU6MTE0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQou TzJCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5PMg0KCXtmb250LWZh bWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglmb250LXNpemU6MTE0JTsNCgltc28tY2hhci13cmFw OjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouTzNCDQoJe21zby1zcGVjaWFsLWZvcm1h dDpub2J1bGxldFwyMDIyO30NCi5PMw0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsN Cglmb250LXNpemU6MTE0JTsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZs b3c6MTt9DQouTzRCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5PNA0K CXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCglmb250LXNpemU6MTE0JTsNCgltc28t Y2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQ0JCDQoJe21zby1zcGVj aWFsLWZvcm1hdDpub2J1bGxldFwyMDIyO30NCi5DQg0KCXtmb250LWZhbWlseToiVGltZXMgTmV3 IFJvbWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQou Q0IxQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAxMzt9DQouQ0IxDQoJe2ZvbnQt ZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29r dS1vdmVyZmxvdzoxO30NCi5DQjJCDQoJe21zby1zcGVjaWFsLWZvcm1hdDpub2J1bGxldFwyMDIy O30NCi5DQjINCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWNoYXItd3Jh cDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLkNCM0INCgl7bXNvLXNwZWNpYWwtZm9y bWF0Om5vYnVsbGV0XDIwMTM7fQ0KLkNCMw0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFu IjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouQ0I0Qg0K CXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMDBCQjt9DQouQ0I0DQoJe2ZvbnQtZmFtaWx5 OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVy ZmxvdzoxO30NCi5DVEINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMjI7fQ0KLkNU DQoJe2ZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9tYW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCglt c28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5IQkINCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1bGxl dFwyMDIyO30NCi5IQg0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hh ci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouSEIxQg0KCXttc28tc3BlY2lh bC1mb3JtYXQ6YnVsbGV0XDIwMTM7fQ0KLkhCMQ0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJv bWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouSEIy Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6YnVsbGV0XDIwMjI7fQ0KLkhCMg0KCXtmb250LWZhbWls eToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3Zl cmZsb3c6MTt9DQouSEIzQg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6YnVsbGV0XDIwMTM7fQ0KLkhC Mw0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJ bXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouSEI0Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6YnVs bGV0XDAwQkI7fQ0KLkhCNA0KCXtmb250LWZhbWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28t Y2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZsb3c6MTt9DQouUUJCDQoJe21zby1zcGVj aWFsLWZvcm1hdDpidWxsZXRcMjAyMjt9DQouUUINCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBS b21hbiI7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlFC MUINCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1bGxldFwyMDEzO30NCi5RQjENCgl7Zm9udC1mYW1p bHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92 ZXJmbG93OjE7fQ0KLlFCMkINCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1bGxldFwyMDIyO30NCi5R QjINCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWNoYXItd3JhcDoxOw0K CW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlFCM0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0OmJ1 bGxldFwyMDEzO30NCi5RQjMNCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNv LWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlFCNEINCgl7bXNvLXNw ZWNpYWwtZm9ybWF0OmJ1bGxldFwwMEJCO30NCi5RQjQNCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5l dyBSb21hbiI7DQoJbXNvLWNoYXItd3JhcDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0K LlRibEINCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMjI7fQ0KLlRibA0KCXt0ZXh0 LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJY29sb3I6Ymxh Y2s7DQoJbXNvLWNvbG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjEzMyU7DQoJbXNvLWNoYXItd3Jh cDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlRibDFCDQoJe21zby1zcGVjaWFsLWZv cm1hdDpub2J1bGxldFwyMDEzO30NCi5UYmwxDQoJe2ZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9t YW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5UYmwy Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouVGJsMg0KCXtmb250LWZh bWlseToiVGltZXMgTmV3IFJvbWFuIjsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Ut b3ZlcmZsb3c6MTt9DQouVGJsM0INCgl7bXNvLXNwZWNpYWwtZm9ybWF0Om5vYnVsbGV0XDIwMTM7 fQ0KLlRibDMNCgl7Zm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJbXNvLWNoYXItd3Jh cDoxOw0KCW1zby1raW5zb2t1LW92ZXJmbG93OjE7fQ0KLlRibDRCDQoJe21zby1zcGVjaWFsLWZv cm1hdDpub2J1bGxldFwwMEJCO30NCi5UYmw0DQoJe2ZvbnQtZmFtaWx5OiJUaW1lcyBOZXcgUm9t YW4iOw0KCW1zby1jaGFyLXdyYXA6MTsNCgltc28ta2luc29rdS1vdmVyZmxvdzoxO30NCi5kZWZh dWx0Qg0KCXttc28tc3BlY2lhbC1mb3JtYXQ6bm9idWxsZXRcMjAyMjt9DQouZGVmYXVsdA0KCXt0 ZXh0LWFsaWduOmxlZnQ7DQoJZm9udC1mYW1pbHk6IlRpbWVzIE5ldyBSb21hbiI7DQoJZm9udC13 ZWlnaHQ6bm9ybWFsOw0KCWZvbnQtc3R5bGU6bm9ybWFsOw0KCXRleHQtZGVjb3JhdGlvbjpub25l Ow0KCXRleHQtc2hhZG93Om5vbmU7DQoJdGV4dC1lZmZlY3Q6bm9uZTsNCgltc28tZmFyZWFzdC1o aW50Om5vOw0KCWxheW91dC1mbG93Omhvcml6b250YWw7DQoJY29sb3I6YmxhY2s7DQoJbXNvLWNv bG9yLWluZGV4OjE7DQoJZm9udC1zaXplOjExNCU7DQoJbXNvLXRleHQtcmFpc2U6MCU7DQoJbXNv LWxpbmUtc3BhY2luZzoiMTAwIDAgMCI7DQoJbXNvLW1hcmdpbi1sZWZ0LWFsdDowOw0KCW1zby10 ZXh0LWluZGVudC1hbHQ6MDsNCgltc28tY2hhci13cmFwOjE7DQoJbXNvLWtpbnNva3Utb3ZlcmZs b3c6MTsNCglkaXJlY3Rpb246bHRyOw0KCW1zby13b3JkLXdyYXA6MTsNCgltc28tdmVydGljYWwt YWxpZ24tc3BlY2lhbDpiYXNlbGluZTsNCgltc28tYW5zaS1sYW5ndWFnZTpFTi1VUzt9DQphOmxp bmsNCgl7Y29sb3I6I0NDQ0NGRiAhaW1wb3J0YW50O30NCmE6YWN0aXZlDQoJe2NvbG9yOiMzMzMz Q0MgIWltcG9ydGFudDt9DQphOnZpc2l0ZWQNCgl7Y29sb3I6I0IyQjJCMiAhaW1wb3J0YW50O30N Cn== ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/script.js Content-Transfer-Encoding: quoted-printable Content-Type: application/javascript; charset="us-ascii" function LoadSld() { var sld=3DGetObj("SlideObj") if( !g_supportsPPTHTML ) { =09 sld.style.visibility=3D"visible" return } if( MakeNotesVis() ) return runAnimations =3D _InitAnimations(); =09 if( IsWin("PPTSld") ) parent.SldUpdated(GetSldId()) g_origSz=3DparseInt(SlideObj.style.fontSize) g_origH=3Dsld.style.posHeight g_origW=3Dsld.style.posWidth g_scaleHyperlinks=3D(document.all.tags("AREA").length>0) if( g_scaleHyperlinks ) InitHLinkArray() if( g_scaleInFrame||(IsWin("PPTSld") && parent.IsFullScrMode() ) ) document.body.scroll=3D"no" _RSW() if( IsWin("PPTSld") && parent.IsFullScrMode() ) FullScrInit(); =09 MakeSldVis(); ChkAutoAdv() if( runAnimations ) { if( document.all("NSPlay") ) document.all("NSPlay").autoStart =3D false; if( sld.filters && sld.filters.revealtrans ) setTimeout( "document.body.start()", sld.filters.revealtrans.duration * = 1000 ); else document.body.start(); } } function MakeSldVis()=20 { var fTrans=3Dg_showAnimation && SldHasTrans() if( fTrans )=09 { if( g_bgSound ) { idx=3Dg_bgSound.indexOf(","); pptSound.src=3Dg_bgSound.substr( 0, idx ); pptSound.loop=3D -(parseInt(g_bgSound.substr(idx+1))); } SlideObj.filters.revealtrans.Apply()=09 } SlideObj.style.visibility=3D"visible" if( fTrans ) SlideObj.filters.revealtrans.Play() } function MakeNotesVis()=20 { if( !IsNts() ) return false=20 SlideObj.style.display=3D"none" nObj =3D document.all.item("NotesObj") parent.SetHasNts(0) if( nObj ) {=20 nObj.style.display=3D"" parent.SetHasNts(1) } return 1 } function ChkAutoAdv() { if(SldHasTrans()) SlideObj.onfilterchange=3DAutoAdv else AutoAdv() } function AutoAdv() { if(!IsWin("PPTSld") || !gUseSldTimings )return var sld=3DGetCurSld() if( (sld.mAdvDelay>0) && !parent.IsFramesMode() ) setTimeout("parent.GoToNextSld()",sld.mAdvDelay) } function GetObj(id) { if(g_supportsPPTHTML) return document.all(id); else return document.getElementById(id); } function SldHasTrans() { return SlideObj.style.filter !=3D ""; } function GetSldId()=20 { var regExp =3D /file:\/\/\//i var pos =3D location.href.search(regExp) if (MHTMLPrefix !=3D "" && pos !=3D -1) sId =3D location.href.substring(pos) else { sId =3D RemoveFilePrefixFromHref(location.href); var regExp =3D /\// var fixedHref =3D sId var pos =3D -1 =09 pos =3D fixedHref.search(regExp) while (pos !=3D -1) { fixedHref =3D fixedHref.replace(regExp, "\\") pos =3D fixedHref.search(regExp) } =09 if (g_fBaseHyperlink =3D=3D true) sId =3D "file:///" + fixedHref; else sId =3D fixedHref.substring(fixedHref.lastIndexOf('\\') + 1) } =09 return sId } function HideMenu() { if( frames["PPTSld"] && PPTSld.document.all.item("ctx= tmenu") && PPTSld.ctxtmenu.style.display!=3D"none" ) { PPTSld.ctxtmenu.styl= e.display=3D'none'; return true } return false } function IsWin( name ) { return window.name =3D=3D name } function IsNts() { return IsWin("PPTNts") } function IsSldOrNts() { return( IsWin("PPTSld")||IsWin("PPTNts") ) } function SupportsPPTAnimation() { return( navigator.platform =3D=3D "Win32"= && navigator.appVersion.indexOf("Windows")>0 ) } function SupportsPPTHTML() { var appVer=3Dnavigator.appVersion, msie=3DappVer.indexOf("MSIE "), ver=3D0 if( msie >=3D 0 ) ver=3DparseFloat( appVer.substring( msie+5, appVer.indexOf(";",msie) ) ) else ver=3DparseInt(appVer) return( ver >=3D 4 && msie >=3D 0 ) } function _RSW() { if( !g_supportsPPTHTML || IsNts() || ( !g_scaleInFrame && (!IsWin("PPTSld") || !parent.IsFullScrMode()) ) ) return var padding=3D0; if( IsWin("PPTSld") && parent.IsFramesMode() ) padding=3D6 cltWidth=3Ddocument.body.clientWidth-padding cltHeight=3Ddocument.body.clientHeight-padding factor=3D(1.0*cltWidth)/g_origW if( cltHeight < g_origH*factor ) factor=3D(1.0*cltHeight)/g_origH newSize =3D g_origSz * factor if( newSize < 1 ) newSize=3D1 s=3DSlideObj.style s.fontSize=3DnewSize+"px" s.posWidth=3Dg_origW*factor s.posHeight=3Dg_origH*factor s.posLeft=3D(cltWidth-s.posWidth+padding)/2 s.posTop=3D(cltHeight-s.posHeight+padding)/2 if( g_scaleHyperlinks ) ScaleHyperlinks( factor ) } function _InitAnimations() { animRuntimeInstalled =3D ''+document.body.localTime !=3D 'undefined'; isFullScreen =3D (window.name =3D=3D "PPTSld") && !parent.IsFramesMode(); g_animUseRuntime =3D g_showAnimation && animRuntimeInstalled && !(isFullSc= reen && parent.IsSldVisited()); if( g_animUseRuntime ) { collSeq =3D document.all.tags("seq"); if( collSeq !=3D null ) { for(ii=3D0;ii numSlds ) gSldJumpIdx =3D numSlds; if ( gSldJumpIdx >=3D 0 ) { if ( gSldJumpIdx =3D=3D 0 ) gSldJumpIdx =3D 1; var jumpTo =3D parseInt(gSldJumpIdx); gSldJump =3D 0; gSldJumpIdx =3D ""; win.GoToSld( parent.GetSldList().mList[jumpTo-1].mSldHref ) } } } function _KDH() { if( event.keyCode =3D=3D 8 ) { event.returnValue =3D 0; parent.GoToPrevSld(); } } function DocumentOnClick() { if( IsNts() || parent.HideMenu() ) return; if( ( g_allowAdvOnClick && !parent.IsFramesMode() ) || (event && (event.keyCode=3D=3D32) ) ) parent.GoToNextSld(); } var g_supportsPPTHTML =3D SupportsPPTHTML(), g_scaleInFrame =3D 1, gId=3D""= , g_bgSound=3D"", g_scaleHyperlinks =3D false, g_allowAdvOnClick =3D 1, g_showInBrowser = =3D 0, gLoopCont =3D 0, gUseSldTimings =3D 1; var g_showAnimation =3D g_supportsPPTHTML && SupportsPPTAnimation() && ( (w= indow.name=3D=3D"PPTSld" && !parent.IsFramesMode()) || g_showInBrowser );va= r g_animManager =3D null; var g_animUseRuntime =3D false; var g_animItemsToHide, g_animInteractiveItems, g_animSlideTime; var g_animMainSequence =3D null; var ENDSHOW_MESG=3D"End of slide show, click to exit.", SCREEN_MODE=3D"Fram= es", gIsEndShow=3D0, NUM_VIS_SLDS=3D18, SCRIPT_HREF=3D"script.js", FULLSCR_= HREF=3D"fullscreen.htm"; var gCurSld =3D gPrevSld =3D 1, g_offset =3D 0, gNtsOpen =3D gHasNts =3D gO= tlTxtExp =3D 0, gHasNarration =3D 0, gOtlOpen =3D true window.gPPTHTML=3DSupportsPPTHTML() var g_fBaseHyperlink =3D false; var gMainDoc=3Dnew Array(new hrefList("slide0001.htm",1,-1,1),new hrefList(= "slide0021.htm",1,-1,1),new hrefList("slide0022.htm",1,-1,1),new hrefList("= slide0016.htm",1,-1,1),new hrefList("slide0013.htm",1,-1,1),new hrefList("s= lide0017.htm",1,-1,1),new hrefList("slide0007.htm",1,-1,1),new hrefList("sl= ide0019.htm",1,-1,1),new hrefList("slide0004.htm",1,-1,1),new hrefList("sli= de0010.htm",1,-1,1),new hrefList("slide0005.htm",1,-1,1),new hrefList("slid= e0002.htm",1,-1,1),new hrefList("slide0003.htm",1,-1,1),new hrefList("slide= 0011.htm",1,-1,1),new hrefList("slide0020.htm",1,-1,1),new hrefList("slide0= 018.htm",1,-1,1),new hrefList("slide0006.htm",1,-1,1),new hrefList("slide00= 08.htm",1,-1,1)); /********************************************* Frameset functions These functions control slide navigation and state of the frameset. **********************************************/ function RemoveFilePrefixFromHref(href) { var regExp =3D /^file:\/\/\//i; return href.replace(regExp, "") } function FullScrInit() { g_allowAdvOnClick =3D GetCurSld().mAdvOnClk document.body.style.backgroundColor=3D"black" document.oncontextmenu=3Dparent._CM; document.onkeydown =3D _KDH; document.ondragstart=3DCancel document.onselectstart=3DCancel self.focus() } function Redirect( frmId ) {=09 var str=3Ddocument.location.hash,idx=3Dstr.indexOf('#'), sId=3DGetSldId() if(idx>=3D0) str=3Dstr.substr(1); if( window.name !=3D frmId && ( sId !=3D str) ) { obj =3D GetObj("Main-File") window.location.href=3Dobj.href+"#"+sId return 1 } return 0 } var MHTMLPrefix =3D CalculateMHTMLPrefix();=20 function CalculateMHTMLPrefix() { if ( document.location.protocol =3D=3D 'mhtml:') {=20 href=3Dnew String(document.location.href)=20 Start=3Dhref.indexOf('!')+1=20 End=3Dhref.lastIndexOf('/')+1=20 if (End < Start)=20 return href.substring(0, Start)=20 else=20 return href.substring(0, End)=20 } return ''; } function GetTags(base,tag) { if(g_supportsPPTHTML) return base.all.tags(tag); else return base.getElementsByTagName(tag); } function UpdNtsPane(){ if(frames["PPTNts"]) PPTNts.location.replace( MHTMLP= refix+GetHrefObj( gCurSld ).mNtsHref ) } function UpdNavPane( sldIndex ){ if(gNavLoaded) PPTNav.UpdNav() } function UpdOtNavPane(){ if(gOtlNavLoaded) PPTOtlNav.UpdOtlNav() } function UpdOtlPane(){ if(gOtlLoaded) PPTOtl.UpdOtl() } function SetHasNts( fVal ) { if( gHasNts !=3D fVal ) { gHasNts=3DfVal UpdNavPane() } } function ToggleOtlText() { gOtlTxtExp=3D!gOtlTxtExp UpdOtlPane() } function ClearMedia() { // Clear any sounds playing before launching another browser window. Other= wise, // in fullscreen mode, you'll continue to hear the sound in the frames mod= e. if (PPTSld.pptSound) PPTSld.pptSound.loop =3D 0; } function FullScreen() {=20 if ( PPTSld.g_animUseRuntime ) PPTSld.document.body.pause(); ClearMedia(); var href =3D ( document.location.protocol =3D=3D 'mhtml:') ? FULLSCR_HREF = : FULLSCR_HREF+"#"+GetHrefObj(gCurSld).mSldHref; if (MHTMLPrefix !=3D "") href =3D RemoveFilePrefixFromHref(href) if(PPTNav.event.ctrlKey) { var w =3D (window.screen.availWidth * 1.0) / 2.0 var h =3D w * (PPTSld.g_origH * 1.0) / PPTSld.g_origW win =3D window.open( MHTMLPrefix+href,null,"toolbar=3D0,resizable=3D1,top= =3D0,left=3D0," + "width=3D"+ w + ",height=3D" + h ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } else { win =3D window.open( MHTMLPrefix+href,null,"fullscreen=3Dyes" ); if( win.document.body && PPTSld.g_animUseRuntime ) win.document.body.PPTSldFrameset=3Dwindow; } } function ToggleVNarration() { rObj=3DPPTSld.document.all("NSPlay") if( rObj && !PPTSld.g_animUseRuntime ) { if( (rObj.playState =3D=3D 1)||(rObj.playState =3D=3D 0) ) rObj.Play() else if( rObj.playState =3D=3D 2 ) rObj.Pause() else return; } else if( PPTSld.g_animUseRuntime ) { narObj =3D PPTSld.document.all("narrationID") if( narObj ) narObj.togglePause() } } function GetCurSldNum() { =20 obj=3DGetHrefObj(gCurSld) if( obj.mOrigVis =3D=3D 1 ) return obj.mSldIdx else =20 return gCurSld } function GetNumSlds() { =20 if( GetHrefObj(gCurSld).mOrigVis =3D=3D 1 ) return GetSldList().mNumVisSlds; else return GetSldList().mList.length } function GetSldNum( href ) { for(ii=3D0; ii 1 ) PopSldList(); else if( !IsFramesMode() ) { if( gLoopCont ) GoToFirst() else EndShow() } } function GoToPrevSld() { ii=3DgCurSld-1 if( ii > 0 ) { obj=3DGetHrefObj(ii) while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) ) obj=3DGetHrefObj(--ii) if( ii =3D=3D 0 ) ii=3D1 GoToSldNum(ii) } } function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) } function GoToLast() { ii=3DGetSldList().mList.length if( ii !=3D gCurSld ) GoToSld( GetHrefObj(ii).mSldHref ) } function GoToSldNum( num ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue obj =3D GetHrefObj( num ) obj.mVis=3D1 gPrevSld=3DgCurSld gCurSld =3D num; =09 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(obj.mSldHref= )) else PPTSld.location.replace(obj.mSldHref) =09 if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function GoToSld( href ) { if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue GetHrefObj( GetSldNum(href) ).mVis=3D1 if (MHTMLPrefix !=3D "") PPTSld.location.replace(MHTMLPrefix+RemoveFilePrefixFromHref(href)) else PPTSld.location.replace(href) } function SldUpdated( id ) { if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return gPrevSld=3DgCurSld gCurSld=3DGetSldNum(id) if( IsFramesMode() ) { UpdNavPane(); UpdOtlPane(); UpdNtsPane() } } function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) } function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO= bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) } function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) } function CloseWindow() { if( HideMenu() ) return; =09 var event =3D PPTSld.event; if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D= =3D32 || event.type=3D=3D"click" ) ) window.close( self ); CatchNumKeys( self, event ); } function Unload() { gIsEndShow=3D0; } function SetupEndShow() { gIsEndShow=3D1; PPTSld.document.body.scroll=3D"no"; PPTSld.document.onkeypress=3DCloseWindow; PPTSld.document.onclick=3DCloseWindow; PPTSld.document.oncontextmenu=3D_CM; } function EndShow() { if( IsFramesMode() ) return if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue doc=3DPPTSld.document var dir =3D doc.body.dir if( dir !=3D "rtl" ) dir =3D "ltr"; doc.open() doc.writeln('

' + ENDSHOW_MESG + '
') doc.close() } function SetSldVisited(){ GetSldList().mList[gCurSld-1].mVisited=3Dtrue } function IsSldVisited(){ return GetSldList().mList[gCurSld-1].mVisited } function hrefList( sldHref, visible, advDelay, advClk ) { this.mSldHref=3D this.mNtsHref =3D sldHref this.mOrigVis=3D this.mVis =3D visible this.mVisited=3D false this.mAdvDelay=3D advDelay this.mAdvOnClk=3D advClk } function SldList(arr,curSld,fEnd) { this.mCurSld =3D curSld; this.mList =3D new Array(); var idx =3D 1; for(ii=3D0;ii 0) { PushSldList(sldList,fEnd); gCurSld =3D 1; } else if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue } function PushSldList(arr,fEnd) { var ii =3D gSldStack.length; gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd); GoToSld( gSldStack[ii].mList[0].mSldHref ); } function PopSldList() { if (gSldStack[gSldStack.length-1].fEndShow) EndShow() else { gCurSld =3D gSldStack[gSldStack.length-1].mCurSld; gSldStack[gSldStack.length-1] =3D null; gSldStack.length--; var sldList =3D gSldStack[gSldStack.length-1]; GoToSld( sldList.mList[gCurSld - 1].mSldHref ); } } var custShowList=3Dnew Array(); /********************************************* Navigation button implementation There are 2 types of buttons: ImgBtn, TxtBtn implemented as function objects. They share a similiar interface so the event handlers can call SetActive, for example, on a button=20 object without needing to know exactly=20 what type of button it is. **********************************************/ //---------------------------------- function ImgBtn( oId,bId,w,action ) //---------------------------------- { var t=3Dthis t.Perform =3D _IBP t.SetActive =3D _IBSetA t.SetInactive=3D _IBSetI t.SetPressed =3D _IBSetP t.SetDisabled=3D _IBSetD t.Enabled =3D _IBSetE t.ChangeIcon =3D null t.UserAction =3D action t.ChgState =3D _IBUI t.mObjId =3D oId t.mBorderId=3D bId t.mWidth =3D w t.mIsOn =3D t.mCurState =3D 0 } function _IBSetA() { if( this.mIsOn ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _IBSetI() { if( this.mIsOn ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0=20 } } function _IBSetP() { if( this.mIsOn ) { obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 ) obj.style.posLeft+=3D1; obj.style.posTop+=3D1 } } function _IBSetD() { =20 obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 ) obj.style.posTop=3D0=20 } function _IBSetE( state ) { var t=3Dthis GetObj( t.mBorderId ).style.visibility=3D"visible" if( state !=3D t.mIsOn ) { t.mIsOn=3Dstate if( state ) t.SetInactive() else t.SetDisabled() } } function _IBP() { var t=3Dthis if( t.mIsOn ) { if( t.UserAction !=3D null ) t.UserAction() if( t.ChangeIcon ) { obj=3DGetObj(t.mObjId) if( t.ChangeIcon() ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth else obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth } t.SetActive() } =20 } function _IBUI( clr1,clr2,nextState ) { var t=3Dthis SetBorder( GetObj( t.mBorderId ),clr1,clr2 ) obj=3DGetObj( t.mObjId ) obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj= .style.posTop t.mCurState=3DnextState return obj } //----------------------------------------- function TxtBtn( oId,oeId,action,chkState ) //----------------------------------------- { var t=3Dthis t.Perform =3D _TBP t.SetActive =3D _TBSetA t.SetInactive=3D _TBSetI t.SetPressed =3D _TBSetP t.SetDisabled=3D _TBSetD t.SetEnabled =3D _TBSetE t.GetState =3D chkState t.UserAction =3D action t.ChgState =3D _TBUI t.mObjId =3D oId t.m_elementsId=3D oeId t.mIsOn =3D 1 } function _TBSetA() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gHiliteClr,gShadowClr,0,0 ) } function _TBSetI() { var t=3Dthis if( t.mIsOn && !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) } function _TBSetP() { if( this.mIsOn ) this.ChgState( gShadowClr,gHiliteClr,1,1 ) } function _TBSetD() { =20 this.ChgState( gFaceClr,gFaceClr,0,0 ) this.mIsOn =3D 0 } function _TBSetE() { var t=3Dthis if( !t.GetState() ) t.ChgState( gFaceClr,gFaceClr,0,0 ) else t.ChgState( gShadowClr,gHiliteClr,1,1 ) t.mIsOn =3D 1 } function _TBP() { var t=3Dthis if( t.mIsOn ) {=20 if( t.UserAction !=3D null ) t.UserAction() if( !t.GetState ) return if( t.GetState() ) t.SetPressed() else t.SetActive() } =20 } function _TBUI( clr1,clr2,lOffset,tOffset ) { SetBorder( GetObj( this.mObjId ),clr1,clr2 ) Offset( GetObj( this.m_elementsId ),lOffset,tOffset ) } function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle= ft } function SetBorder( obj, upperLeft, lowerRight ) { s=3Dobj.style; s.borderStyle =3D "solid" s.borderWidth =3D 1=20 s.borderLeftColor =3D s.borderTopColor =3D upperLeft s.borderBottomColor=3D s.borderRightColor =3D lowerRight } function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] } function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() } function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() } function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() } function BtnOnUp() { b=3DGetBtnObj() if( b !=3D null ) b.Perform() else Upd() } function GetNtsState(){ return parent.gNtsOpen } function GetOtlState(){ return parent.gOtlOpen } function GetOtlTxtState(){ return parent.gOtlTxtExp } function NtsBtnSetFlag( fVal ) { s=3Ddocument.all.item( this.m_flagId ).style s.display=3D"none" if( fVal ) s.display=3D"" else s.display=3D"none" } function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etActive() } function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etInactive() } function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S= etPressed() } function _BSetA_BorderImg() {=20 b =3D gBtnArr[this.mBorderId]=20 if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 ) obj.style.posTop=3D0 } } function _BSetI_BorderImg() {=20 b =3D gBtnArr[this.mBorderId] if( b !=3D null && this.mIsOn && !b.GetState() ) { obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 ) obj.style.posTop=3D0 } } var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"= THREEDFACE" var gBtnArr =3D new Array() gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan= e,GetOtlState ) gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt= lPane,GetOtlState ) gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN= tsPane ) gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg; gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg; gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.= ToggleNtsPane,GetNtsState ) gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To= ggleNtsPane,GetNtsState ) gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n= b_prevBorder",30,parent.GoToPrevSld ) gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n= b_nextBorder",30,parent.GoToNextSld ) gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent= .FullScreen ) gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa= rent.FullScreen,null ) gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border; gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent= .FullScreen,null ) gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border; gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border; gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice= ","nb_voiceBorder",18,parent.ToggleVNarration ) gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT= xt","nb_otlTxtBorder",23,parent.ToggleOtlText ) gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts" gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState /********************************************* Context menu implementation _CM() is the function that's hooked up to the oncontextmenu event. Once we're asked to show the menu, we first build it by creating DIVs on-the-fly. Then we position it=20 within the screen area so it doesn't get clipped. Creating the DIVs using createElement() means we don't have to write out any extra HTML into the slide HTML files. **********************************************/ var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr= row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval" function ShowMenu() { BuildMenu(); var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y= =3DPPTSld.event.clientY+doc.scrollTop m =3D PPTSld.document.all.item("ctxtmenu") m.style.pixelLeft=3Dx if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) ) m.style.pixelLeft=3Dx-m.scrollWidth m.style.pixelTop=3Dy if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) ) m.style.pixelTop=3Dy-m.scrollHeight m.style.display=3D"" } function _CM() { if( !parent.IsFullScrMode() ) return; if(!PPTSld.event.ctrlKey) { ShowMenu() return false } else HideMenu() } function BuildMenu() { if( PPTSld.document.all.item("ctxtmenu") ) return var mObj=3DCreateItem( PPTSld.document.body ) mObj.id=3D"ctxtmenu" mObj.style.visibility=3D"hidden" var s=3DmObj.style s.position=3D"absolute" s.cursor=3D"default" s.width=3D"120px" SetCMBorder(mObj,"menu","black") var iObj=3DCreateItem( mObj ) SetCMBorder( iObj, "threedhighlight","threedshadow" ) iObj.style.padding=3D2 CreateMenuItem( iObj,sNext,M_GoNextSld,M_True ) CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld ) =09 CreateSeparator( iObj ) CreateMenuItem( iObj,sEnd,M_End,M_True ) mObj.style.visibility=3D"visible" } function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa= lue=3Dfalse } function Highlight() { ChangeClr("activecaption","threedhighlight") } function Deselect() { ChangeClr("threedface","menutext") } function Perform() { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) e.Action() else PPTSld.event.cancelBubble=3Dtrue } function ChangeClr( bg,clr ) { e=3DPPTSld.event.srcElement if( e.type=3D=3D"menuitem" && e.IsActive() ) { e.style.backgroundColor=3Dbg e.style.color=3Dclr } } function M_HasPrevSld() { return( parent.HasPrevSld() ) } function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() } function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();= PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() } function M_True() { return true } function M_End() { window.close( self ) } function CreateMenuItem( node,text,action,eval ) { var e=3DCreateItem( node ) e.type=3D"menuitem" e.Action=3Daction e.IsActive=3Deval e.innerHTML=3Dtext if( !e.IsActive() ) e.style.color=3D"threedshadow" e.onclick=3DPerform e.onmouseover=3DHighlight e.onmouseout=3DDeselect s=3De.style; s.fontFamily=3DsFont s.fontSize=3D"9pt" s.paddingLeft=3D2 } function CreateSeparator( node ) { var sObj=3DCreateItem( node ) SetCMBorder(sObj,"menu","menu") var s=3DsObj.style s.borderTopColor=3D"threedshadow" s.borderBottomColor=3D"threedhighlight" s.height=3D1 s.fontSize=3D"0px" } function CreateItem( node ) { var elem=3DPPTSld.document.createElement("DIV") node.insertBefore( elem ) return elem } function SetCMBorder( o,ltClr,rbClr ) { var s=3Do.style s.backgroundColor=3D"menu" s.borderStyle=3D"solid" s.borderWidth=3D1 s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr } ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/fullscreen.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/notes_flag.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhCgAKAPcAAAAAAIAAAACAAICAAAAAgIAAgACAgICAgMwENMTExPz8/AAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAMDAwP8AAAD/AP//AAAA//8A/wD//////ywAAAAACgAKAEAIKgDx4UNA sKDAgQUTJiCogGHDhBAfFlRAMSFCiAguTozYUGJEiAk0EhQYEAA7 ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/buttons.gif Content-Transfer-Encoding: base64 Content-Type: image/gif R0lGODlhWAESAPf4AAAAAIAAAACAAICAAAAAgIAAgACAgICAgAQEBISEBASEBISEhAQEhMTExAQE /KTM9Pz8/ERERPz8BAT8/KSkpGRkhMTcxCRkxAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAMDAwP8AAAD/AP//AAAA//8A/wD//////yH5BAEAAPgALAAAAABYARIA QAj/APEJHEiwoMGDCBMqXMiwocOHECNKnEixosWLGCEiQKCRo8YDIEHig2DxAD4LKD1avDDhgUuV GUOGbHBR5QGYFBG4fHAB58EKECJEwCfUYAWPFGAygLCRKQIIUKM6WAohKUGgCikcFWh1INWoYKVS 7SrQ41GbIhGYLAuVQVOoC+IyXUuUAkG1HE3KFDhAwkgJc5/qDZmxsOHDiBMrXsy4sePDGyP7lChT 5MULmDPnlDw5YmW6FTNrfgi0aNGEZPEtbfo2bNTUpYeeRph69dPWrqvCNFuBIGG1A59CYPAVQtwF cw0OxWdTIOiBCQAjaAB17fOFII8voGmRc+eOkilm/z9OvTtnjN4hYk1YoT3H2rnBOphPAB9skgq3 2lcaX/5YnJVt9BloAar12UEIRGCZdQghMABI1Tn32IQUVthYexhmqGGGMBHAgIfEhSiiiATAtOGJ GnYI4ogsEldicAYOGNJGZaml3Y0L3NTZUBz1xlB0PUoUI0jlVWRSVN89xBKSGB1YU1TMoRfVBEle hR9HQs1GEHxQ3RZZbveZthxt/LEmXHyp5XWABSCpaRJwbM13gAACPHVccgJFgF+NEhqUAEkQSCfc ddhVhh5dVTaEAEsTUNlkZUWKN9BNGDE6QU8OrSdbllzpxyVTTrU21Uj3scfhp7nNpyoDaTIEJ3P9 If8J2kbLNYegg9JRBwGhFvbq66+ZUiDssMQWK2yHxiZLrInKNotss8l+B5yBrr5p2UIJvortANoC 6+234IbLla/elRtZjeamh5CC3Sb0YLvixivvYkDFGlZqBNh7r4n6goVvv6/ZlCicN+kL71ALTnpQ dCIZp7CihkLA3UQmoWRBogyxtBPGCTnZncVR1rSTo5nuydC/Eo8kUH+lOoTyyvjoCuZu+PjYIKLD rZybtrM1d10C0QXKEVz48GrQkEeWdFJKlbb0UmEeV0SzyC6RvNB646LWIVjUNeC1zAFb+RDKXksM 9r531bwmpQW9+hQDDsx5pqwDRWBXcFES2hc+gEn/wJGdEEWdE6LoWcoxQweaTNmkhydkKaYMYY2Q p1unbLl/pPKbn3v7EZRvrKvqlja2ONvrtoIw9tn2g32/tQBlhtYkU+MNikZ7QYlPDPuMldpOmuJX nVo5VF3HjI+q89mteX5IDd/fVFClma5kiE4f2XUJhlz09gj2NbTDRifkmu7zXjR++RVJ/lPznuvr QH2iD6S+UewP9Dnon6d2NLwN8n90BB6hC68cFMCHoe+ACASP9c4DowUyEF0OPFcDI0ij/VXPaAKC UfhS95AKGoQ7IBRICI1HwhGaUIQoLGEKT6jCFrLwhSuMoQtlCMMZ2rCGOKShDm+4wxzy8Ic+DGIP B4cIRCKGMCAAOy== ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/frame.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" PowerPoint Presentation ------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/outline.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii"

No= tes

Slide Show

Outline

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

------=_NextPart_01C8328C.C17B6980 Content-Location: file:///C:/2D693CD8/CoreLesson8_files/filelist.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C8328C.C17B6980--


	Gen= eral lesson description
	This l= ecture focuses on basic ethical principles of public health practice and applies them to= the study of injuries and violence prevention.
	It exp= lores the importance of concepts such as respect for individuals and the principles= of beneficence and justice as expressed in the Belmont Report or other simil= ar national and international agreements.
	Ethica= l principles in relation to surveillance reporting, privacy and research are also addressed. In research activities, the concept of the institutional ethics review board is explained.
	The le= sson also explores wider ethical issues concerning unequal access to services, structural, economic, age and gender inequalities.


	Early = notions of ethics can be found in multiple writings from different cultures and regi= ons of the world. Concepts and principles of ethics and health can be found in the Hippocratic Corpus, in the Qur’an and in the Buddhist scripture= s of the Vinaya to name some examples. Many of the concepts discussed in these writings refer to the protection of human life and the avoidance of harm.=
	During= the Middle Ages, concerns about public health and disease mainly involved infectious conditions and activities were related mostly towards the application of quarantine. In the 16th century, some social concepts about disease emerg= ed such as the relationship between inequality, poverty and disease.<= br>
	In the= 19th century, governmental interventions and activities were first applied and addressed multiple ethical issues such as child labour and sanitary conditions of workers. With the Industrial Revolution, public health activities were institutionalized and consolidated within government structures. Many of these activities developed simultaneously with an overall approach that increasingly valued the dignity of individuals.
	In the= early 20th century, concepts related to ethics and consent appeared. But it was not until after the Nuremberg trials, following the Second world war, that ethical issues relating to research and public health became part of the mainstream.


	Moral = relativism refers to the notion that universal concepts cannot be applied given the large cultural variability that exists in the world. These arguments have sometimes been supported by the notion of using culturally sensitive standards. While indeed there are differences in interpretations about morality, standards are usually universal. An example of this is the use = of informed consent. Relativists often argue informed consent is not necessa= ry in some settings because it is culturally insensitive, potential subjects= are not competent enough, or the importance of a health problem supersedes, t= he informed consent process. Each of these points is not sufficient to avoid= the use of informed consent because in most cases relativism of standards is = confused with relativism of judgements about a situation. As will be seen later, in most cultures some universal moral standards exist which can help guide t= he best way to ethically practise injury prevention (1).
	Apart = from the relativistic approaches, there are some theories that approach the problem from different perspectives. Consequentialist theories (e.g. utilitariani= sm) for example, are focused on the idea that specific actions or practices a= re acceptable if they yield more benefits to people when compared with other similarly oriented actions or practices.
	Kantia= n (or deontological) theories, state that action is only moral when performed b= y a person or agent who possesses good will. This good will by itself is base= d on the existence of universal rules. Such rules are guiding principles for a= ll.
	Some a= pproaches contend that moral and ethical dilemmas are best handled by virtuous peop= le who better understand the nature of a problem. Finally, other approaches focus on the use of precedents or previous cases to dictate what is ethic= ally appropriate rather than focusing on universal rules.


	There = are some universally accepted moral principles that can serve as the basis for eth= ical standards. While these standards might follow different interpretations a= nd applications among different people, according to Beauchamp (1), some universally accepted principles or precepts can be defined: These include= :
	be tru= thful
	respec= t privacy and protect confidentiality
	obtain= consent
	be loy= al
	do not= kill
	do not= cause pain (continued on next slide).


	The ru= les mentioned here are neither absolute nor exhaustive and some have partial applicatio= ns. Their specific interpretation will in many cases depend on contextual situations and specific cultural perspectives. Many of these rules provide guidance for professional morality and, in turn, for the creation of code= s of conduct, within the framework of specific activities (1).
	Do not= incapacitate.
	Do not= cause offence.
	Do not= deprive of goods.
	Protec= t and defend others’ rights.
	Preven= t harm from occurring to others.
	Remove= conditions that will cause harm to others.
	Help p= ersons with disabilities.
	Rescue= persons in danger.


	Based = on the principles mentioned before one can understand the relationship between ethics and religion. Most religions state some basic premises about human behaviour and frequently express them as moral obligations.
	In the= same manner, such premises that are socially acceptable in different contexts can be translated into laws that determine, modulate, and enforce social and individual behaviour. The implementation of policies is usually based on existing legal frameworks = that determine what is permissible, and what is not, within a specific society, nation or group of nations. Many of these premises have a close relations= hip with current definitions of human rights and national or international standards of conduct.
	Public= health by definition promotes and protects the health of the population and therefo= re should be developed within these ethical standards of conduct. Public hea= lth contributes to the enhancement and protection of people through actions a= imed at improving health while respecting the rights of individuals and communities.


	How do= ethical principles relate to injuries and violence prevention? There are many way= s in which ethics is related to injuries and violence prevention activities.
	Some o= f the most important themes include the use and application of internationally agreed codes of conduct for research and practice, specific issues related to populations or injuries, and the overall relationship of injury preventio= n to human rights.


	At the= professional level, there are some clear responsibilities related to the practice of public health. As suggested by Beauchamp, in the specific case of epidemiology, these include:
	respon= sibilities to society: defined as the provision of benefits, creation of public trust, avoidance of conflicts of interest, and promotion and practice of impartiality;
	respon= sibilities to research subjects: these include protecting the welfare of research subje= cts, ensuring informed consent and respect for privacy/confidentiality. Institutional review/ethics committees exist to ensure that research is undertaken in accordance with these principles;
	respon= sibilities to employers and funding sources: these include the formulation of actual professional responsibilities for practice and the protection of privileg= ed information;
	respon= sibilities to professional colleagues: these include accurate reporting of methods and results used for research and compulsory reporting of unacceptable condit= ions and behaviours.
	Overal= l these responsibilities encompass the whole spectrum of activities and approache= s a professional working in public health and injury prevention should be awa= re of and practice.
	Such responsibilities have actually been translated into specific codes of con= duct for professional practice.


	Ethica= l principles stemming from religious perspectives should be acknowledged and understoo= d. In very general terms some specific characteristics can be identified.
	Multip= le aboriginal cultures emphasize holism, pluralism and community or family decision-mak= ing with the maintenance of quality of life (2).
	Islami= c codes are linked to ethical teachings from the Qur’an (3) and strive for virt= uous behaviour.
	Hindu = traditions favour holism, the importance of family and support a duty-based rather t= han rights-based approach (4).
	Chines= e codes of bioethics emphasize interdependence, and family and community decision-ma= king (5).
	Jewish= traditions also favour duty-based approaches over rights-based models (6).
	Christ= ian traditions focus on the value of autonomy and rights-based approaches (7, 8).=
	There = are multiple codes of conduct for professional research and practice in public health. Selections of these are included below.
	The Nu= remberg Code created as a consequence of the human experiments carried out by Nazis du= ring WW II. It contains 10 principles of which the first one refers to volunta= ry consent of human subjects. Other concepts refer to principles of benefice= nce and risks to human subjects.
	In 196= 4 the World Medical Association enhanced the code through the Declaration of Helsinki. This declaration addresses issues related to research in human subjects, disclosure of information, consent, privacy, risks and benefits of resear= ch and voluntariness.
	Furthe= r development of codes of conduct in research have been produced through:
	the In= ternational Guidelines for Ethical Review of Biomedical Studies developed by t= he Council for International Organizations of the Medical Sciences (CIOMS) (= 9);
	a fram= ework for practice applicable worldwide, provided by WHO.
	Finall= y, other more specific codes stem from international agreements of professional associations such as:
	the In= ternational Epidemiological Association (IEA), Industrial Epidemiology Forum (IEF) and Chemical Manufacturer’s Association (CMA) that have activities rela= ted to injury prevention, control and safety promotion (1).


	Some p= ractical aspects related to the application of these codes of conduct can be understood through the development of research, through dealing with spec= ific injury issues, through overall social conditions that can prevent, or promote, the occurrence of injuries, or by following a human rights appro= ach.


	In the= area of research, seven basic concepts can be discussed. These refer to informed consent, privacy, confidentiality, risks and benefits, information, comprehension and voluntariness.
	Inform= ed consent refers to the respect for autonomy of individuals. Research subjects shou= ld not only be informed, but clearly understand the implications, of participating in specific procedures.
	Privac= y refers to the assurance that sensitive information pertaining to the health of individuals will not be disclosed or shared without specific approval of subjects. This concept is intimately associated with confidentiality and = the way health or research information is handled and protected.
	The di= sclosure and understanding of the risks and benefits of research procedures is crucial= . It not only involves the research subject but also the researchers and the committees evaluating the research process as a whole. These actors must = be well aware of the correct balance between risks and benefits of conducting research and be able to communicate it to participants so that they understand it. This balance assures the application of the principle of beneficence that states that actions taken must produce a good or better outcome for an individual or societies as a whole.


	All of= these concepts, in one way or another, are discussed or included in the most wi= dely used codes of conduct and are specifically addressed in areas of research. When conducting research, many institutions closely follow guidelines that comply with these principles.
	Inform= ation refers to the appropriate communication of the research process and disclosure of all information necessary for subjects to be able to make informed consen= t or dissent.
	Resear= ch subjects must fully understand the process and implications of research in order to provide informed consent. Full comprehension of the risks and benefits of= the research thus enable individuals to exercise their will in relation to participating, or not, as research subjects.
	Volunt= ariness refers to the will of individuals to become, or cease to be research subjects, w= hen they consider it appropriate. It also precludes researchers from coercing individuals into research.


	The re= search ethics committee is also known as in some countries as an Institutional Review Board.
	The pu= rpose of the research ethics committee is to guide researchers and promote the applica= tion of adequate codes of conduct when doing research. It should be a specially appointed committee independent of the investigator and sponsors. In many countries this committee involves other scientists with competencies necessary to judge the scientific merits of the research and the methodological procedures involved. However some of these committees also include non-scientists such as lawyers, ethicists or persons belonging to= the clergy. Individuals outside of institutions should also be part of these committees (1).


	Some s= pecific ethical issues that arise in research concern the conduct of studies involving vulnerable populations such as children, the disabled or elderl= y. In many circumstances of child abuse, for example, dealing with issues of treatment or rehabilitation forces external agents to act on behalf of the child when the caretakers are causing harm. The risk of psychological distress when answering questions relating to intentional injuries is potentially high especially in children and adolescents. In these cases, special considerations of risks and benefits should be taken into account. Other issues arise when dealing with older persons, for example, especial= ly when they have a cognitive impairment.
	Anothe= r example of a vulnerable population is victims of violence. WHO (10) has developed guidelines for research on domestic violence against women.
	Other = examples of ethical issues that come to light in selected injury-related settings are described below.
	In reg= ards to suicide, many social taboos or community beliefs imply that the handling = of information related to suicide be confidential and respectful of the priv= acy both for persons who have attempted suicide and for the families of victi= ms of suicide.
	Person= s that have suffered severe trauma to the brain and have cognitive impairments are sub-populations where special considerations must be taken for example wh= en addressing issues of life support and death.
	Victim= s of sexual violence need significant psychological support and respect for privacy a= nd confidentiality.
	Other = ethical issues might involve the rights that workers have to conduct their labour activi= ties in safe environments. In the research environment, this involves the safe= ty of informants and researchers especially in subjects related to violence.=


	Many o= f the previous examples relate to the respect of human rights. The integration of human rights approaches to public health and injuries is important. From the hu= man rights perspective, nations have an obligation to respect, protect and fu= lfil human rights that are related to injuries and violence (11).
	The co= ncept of the right to safety developed through this approach has been addressed in multiple venues. The clearest example is the Delhi Declaration. This declaration was adopted in New Delhi on 8 March 2000 after the Fifth World Conference on Injury Prevention and Control (12). It basically states that injuries represent a huge burden of disease in the world and that safety = is a condition where as many hazards that can be controlled should be controll= ed. Freedom from such hazards is imperative for effective injury and violence prevention. Sharing information on risks, controlling them, and allocating more resources for injury prevention can lead to a higher degree of safet= y. Efforts to encourage institutions to adopt and implement this declaration= are currently under way.