Radiographer Abnormality Detection Schemes

Radiographer Abnormality Detection Schemes Maariyah Iqbal   INTRODUCTION In this chapter, the background of the problem will be presented. This will be followed by the research problem as well as the particular purpose and question, specifically highlighting why the topic area chosen is of great interest. 1.1 Background The National Health Service (NHS) provides healthcare for all citizens within the United Kingdom (UK) and it is funded by taxes; the core principles of the NHS are to meet the needs of everyone and it is based on a patients clinical need(s) and not on their ability to pay (Slee et al., 2008). The National Institute for Health and Care Excellence (NICE) 2017 provides guidance on how to promote good health as well as prevention and treatment of health. The NHS in England receives over 1 million patients approximately every 36 hours, and this organisation employs over an estimated of 1.5 million people making it to one of the top five worlds largest workforces (NHS Choices, 2016). Despite the success of the services of the NHS there is more work needed to continue to improve services and deliver care (NHS Improvement, 2015). Therefore, the NHS continues to remain under pressure as there are further increases in demand for care (NHS Improvement, 2015). This means an increased demand for all health care practitioners, including Radiographers. The demand for services means increased waiting times, may lead to increased work pressure. To improve services the department of health set an ongoing standard for the NHS where the patient spends four hours or less in the Accident and Emergency (AE) from arrival to admission or discharge (House of commons, 2005). However, a report from the Kings Fund (2016) shows that AE departments are soaring to six million patients attending, this is placing a huge strain on services making it difficult to meet this target. Data from the briefing paper from Houses of Parliament (Appendix 1) show that in some areas such as; Greater London and Manchester there was 26-32% of patients that waited for more than four hours. Increased demands of work continue to leave the NHS under pressure as there are further increases in demand for care, and issues with being able to discharge medically fit patients (NHS Improvement, 2015). Extracted from the quarterly data summary issue (2008), in England one of the main issues surrounding discharging of patients is that they are still awaiting results of tests and discharge forms are not being complete in time (NHS England, 2015). Good planning in regards to discharging is imperative as it will improve patient flow and satisfactory, and can also decrease the chances of patients being readmitted again (Family Caregiver Alliance, 2016). The department of health puts forward ten operating principles in regards to discharging, one of which is the multidisciplinary team working together to plan care, and make decisions on the process and timing of discharging (Nursing Standard, 2010). Professionals can extend their roles beyond their scope of practice, and can be further trained to contribute to discharging of patients which can ease pressures of other staff in the AE department such as; doctors. Research also taken from (Graysons, no date) showed that a search search by the NHS Litigation Authority for descriptions of failure/delay diagnosis or incorrect diagnosis in 2014/15. The results of the response showed, 183 mentions of fractures. This highlighted that misinterpretation of images was also one of the factors of delayed discharge. In the context of clinical imaging, radiographers reporting on images is well established in the UK and it makes a major contribution to clinical imaging services and contribution to multidisciplinary care (The Society of Radiographers, 2017). A study was carried out by Snaith (2007) whereby three reporting radiographers were trained to discharge patients or refer to AE (Accident Emergency) for further assessment. The results were significant and showed that that 1760 examinations were reviews, 5% of these were discharged and 2% were referred. However, the number of patients recalled due to incorrect interpretation was decreased by 52% in those 4 months compared with the previous 3 years data (The College of Radiographers, 2017). This shows that Radiographers can extend their role not just within clinical imaging services, but also outside of their department by contributing to the management of patients and decreasing the risk of radiographic misinterpretation. Initially, radiographers produce high quality images of the body, screen for abnormalities and take part in surgical examinations to identify and diagnose injury and disease (The National Careers Service, 2016). Thus, being able to distinguish between normal and abnormal appearances that are evident on images is one of the standards that should be met by a radiographer (HCPC, 2017). The red dot system is implemented by radiographers in emergency departments to highlight acute abnormalities. Radiography Abnormality Detection Schemes (RADS) is one of the ways in which radiographers interpret images produced. They are able to make an initial interpretation on images obtained which gives them a proactive role in the diagnostic process, and assists doctors in the correct interpretation of radiographic images (SoR, no date). However, despite there being a set standard for radiographers to meet. Clinical imaging services are under increasing pressure year on year as radiographers are required to enhance the quality of the image, productivity, which is difficult due to staffing levels (Beardmore, 2013). In addition, these problematic areas can have a knock-on effect on other significant areas within the NHS; such as supervision of newly qualified and students that are training there. After research, the author has found that there is a variation in of training in hospitals and university, as the time that students spend on clinical placement has found to be different. The University of Leeds (2017) 50% of the course is in clinical placement, however, students at the Birmingham City University (2017) spend 35% of their course on clinical placement. This highlights there is a variation in clinical placement and this could affect the new registrants that may not be equally competent once qualified or even mee t a certain threshold. Ultimately, all students must meet specific standards in order to receive their Health and care professions council (HCPC) registration to be able to become and work as a newly qualified radiographer (the Society and College of Radiographers, 2017). The HCPC is an independent regulator, it regulates 15 other professions besides radiographers, they are established to protect the public by maintaining a register of all those that hold the protected title of social worker, so that registrants practice safely, legally and effectively (University of Bedfordshire, 2017). The HCPC set standards, approve courses that meet those standards, register those who pass the courses and clinical competencies, and hold them to their standards. In relation to diagnostic radiography, they set standards of proficiency for all radiographers which set out safe and effective practice, it covers areas in depth; so, all radiographers should be able to maintain fitness and practice (Health and Care Professions Council, 2013), this is elaborated on further from on section 3 to 3.3 (Appendix 2). It is vital that all standards that are discussed and mentioned, are met in order to be able to receive the registration. Additionally, once qualified and registered under the HCPC; a newly qualified radiographer is supported on their job role by a period of preceptorship. Although there is no defined period of preceptorship it is support for those that have newly qualified. It is a period of adaptation to a job role, consolidating knowledge and skills till he or she is able to work as an autonomous radiographer. (The Society and College of Radiographers, 2017). Moreover, as there is a shortage of staff as the NHS staff survey conducted in 2013 that showed that the staff stated that they felt under pressure and over worked, as they were working extra hours increasing from 69.7% to 70.5% from the previous year (UNISON, 2014). This highlights that training students, or even supporting staff within an organisation can be difficult as staff can be difficult due to staffing issues and work pressures. However, from research the author has found that an increase of patients will mean an increase in the range and capability of clinical images which will consequent needs of training radiographers to safely extend their roles. Moreover, initial training whereby it leads to either role extension, or continuing professional development are integral to radiographic practice (The Society of Radiographers, 2017). Radiographers are expected to build on their postgraduate qualifications and clinical managers are encouraged to embed this use of learning tool in radiographers personal development reviews (The Society of Radiographers, 2017). In context, of this radiographer are able to extend their roles by Radiographer Abnormality Detection Schemes (RADS). RADS allows radiographers to red dot images which put a mark on the image suggesting there is an abnormality present (Carver and Carver, 2012). Thus, making it easier for the clinician/referrer to look at when reporting on it. Being able to implement RADS can help to reduce errors and improve accuracy (Chan, 2007). The aim of this system is to assist emergency departments, especially when there is a shortage of staff such as; radiologists that do the reporting w hich helps location of the abnormality to be commented on sooner (Coelho and Rodrigues, no date). The basis of the problem around RADS will now be further discussed, which will be able to give an insight of the purpose of this research. 1.1 Research Problem RADS has become an accepted norm for radiographers (Carver and Carver, 2012). Before implementing RADS, it is essential that radiographers are able to evaluate and manipulate images for quality purposes which allows them to the be able to understand the image to implement RADS. A study carried out by Brearly et al., 2005 which looked at the accuracy of radiographers use of the red dot system with and without training on this area, and whether or not they can assess how a normal image would be presented. There was a significant improvement found in the sensitivity for detecting abnormalities, however, there was no change in the actual specificity. This highlights that, after training took place radiographers were able to red dot more images than before the training took place, however, the number of radiographs that radiographers selected as being normal there was no change found. Therefore, the validity of this study is limited as it not clear on whether the sample of radiographs before and after training were comparable. However, Hardy and Culpan (2007) carried out a study whereby they assessed radiographers before and after training in their ability to red dot images. They introduced a training programme for 10 weeks, the results showed that their accurac y as a group increased for 89.9% to 93% and their sensitivity (number of abnormal images) however, the specificity (number of normal images) decreased slightly from 96.4% to 96.1%. The study highlights, that although the results are not statistically significant, with appropriate training it can have an overall positive effect on the use of radiographer abnormality detection schemes. Despite there being a significant amount of research on this topic area, there is no clear evidence whether or not training improves the implementation of red dotting. 1.1 Research purpose and question The purpose of this research is to give an insight on whether training improves newly qualified radiographers in implementing RADS in practice or not. This case will be further developed with the use of a literature review. References Birmingham City University. (2017). Diagnostic Radiography: BSc (Hons). Available: http://www.bcu.ac.uk/courses/diagnostic-radiography-2017-18. Last accessed 9th Feb 2017 Net Doctor. (2017). What is the NHS?. Available: http://www.netdoctor.co.uk/health-services/nhs/a4489/what-is-the-nhs/. Last accessed 9th Feb 2017. NHS Choices . (2016). The NHS in England. Available: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx. Last accessed 9th Feb 2017. NHS Improvement. (2015). NHS providers working hard, but still under pressure . Available: https://improvement.nhs.uk/news-alerts/nhs-providers-working-hard-still-under-pressure/. Last accessed 9th Feb 2017. Teesside University. (2017). BSc (Hons) Diagnostic Radiography. Available: https://www.tees.ac.uk/undergraduate_courses/Health__Social_Care/BSc_(Hons)_Diagnostic_Radiography.cfm. Last accessed 9th Feb 2017. The Kings Fund. (2017). Demand for NHS services soars to record levels. Available: https://www.kingsfund.org.uk/press/press-releases/demand-nhs-services-soars-record-levels. Last accessed 9th Feb 2017. The National Careers Service. (2016). Radiographer. Available: https://nationalcareersservice.direct.gov.uk/job-profiles/radiographer. Last accessed 9th Feb 2017. UNISON. (2014). Running on empty NHS staff stretched to the limit. Available: https://www.unison.org.uk/content/uploads/2014/04/On-line-Catalogue222452.pdf. Last accessed 9th Feb 2017. Parliamentary. (no date). Accident and Emergency Statistics: Demand, performance and pressure. Available: http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN06964. Last accessed 9th Feb 2017. The Health and Care Professions Council. (2017). Standards of Proficiency. Available: http://www.hpc-uk.org/assets/documents/10000DBDStandards_of_Proficiency_Radiographers.pdf. Last accessed 9th Feb 2017. The Society of Radiographers. (no date). Radiographer abnormality detection schemes in the trauma environment. Available: http://www.sor.org/system/files/article/201109/ab_detection_clinical_260607.pdf. Last accessed 9th Feb 2017. https://books.google.co.uk/books?id=j8vohIcgiiACpg=PA264dq=what+is+red+dotting+in+radiographyhl=ensa=Xved=0ahUKEwia0cm_h4vSAhVTF8AKHXsnDu0Q6AEIQDAG#v=onepageq=what%20is%20red%20dotting%20in%20radiographyf=false https://books.google.co.uk/books?id=_W0RhyluKncCpg=PT33dq=why+is+the+red+dot+system+importanthl=ensa=Xved=0ahUKEwimt62ak4vSAhVpJ8AKHUm6DPoQ6AEIGjAA#v=onepageq=why%20is%20the%20red%20dot%20system%20importantf=false http://repositorio.chporto.pt/bitstream/10400.16/842/1/CR11a.pdf https://www.researchgate.net/publication/6998900_Accuracy_of_radiographers_red_dot_or_triage_of_accident_and_emergency_radiographs_in_clinical_practice_A_systematic_review https://books.google.co.uk/books?id=5Hf4xWVXwxoCpg=PA376dq=The+National+Health+Service+(NHS)+provides+healthcare+for+all+citizens+within+the+United+Kingdom+(UK)+and+it+is+funded+by+taxes.hl=ensa=Xved=0ahUKEwjm3tWB-Y3SAhWKD8AKHbTzAtcQ6AEIGjAA#v=onepageq=The%20National%20Health%20Service%20(NHS)%20provides%20healthcare%20for%20all%20citizens%20within%20the%20United%20Kingdom%20(UK)%20and%20it%20is%20funded%20by%20taxes.f=false https://www.publications.parliament.uk/pa/cm200405/cmselect/cmpubacc/445/445.pdf http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59854 http://www.radiographyonline.com/article/S1078-8174(05)00159-8/abstract http://www.graysons.co.uk/advice/the-top-misdiagnosed-conditions-in-nhs-hospitals/#misdiagnosed https://www.caregiver.org/hospital-discharge-planning-guide-families-and-caregivers http://journals.rcni.com/userimages/ContentEditor/1373367855606/Discharge-planning.pdf http://www.radiographyonline.com/article/S1078-8174(03)00069-5/abstract https://www.beds.ac.uk/howtoapply/departments/appliedsocialstudies/reforms-in-social-work-education/the-health-and-care-professions-council-hcpc http://www.radiographyonline.com/article/S1078-8174(05)00159-8/abstract Appendices Appendix 1: AE waiting times in England: Patients spending over 4 hours in major AE departments (Parliamentary, no date) Appendix 2 (Health and Care Professions Council, 2013). Further websites could be used https://www.researchgate.net/publication/232221820_Evaluating_the_true_clinical_utility_of_the_red_dot_system_in_radiograph_interpretation could be used for intro and literature review http://shura.shu.ac.uk/9450/1/Naylor_PhD.pdf

Co-education Female Essay

The debatable issue on Co-education is continually progressing through the State and convincing parents and teachers that sex-separation will reveal a sign of improvement in student’s lives. In the United States, teamwork is a massive aspect in people’s lives where both girls and boys work together in order to achieve their goal , however, both articles provide informative proves that co-education could result in failure because of the different stereotypes in society. The debate mainly focuses on the separation of both sexes in school since â€Å"there is no extra cost. The debate also catches the reader’s attention by the different research that many scientists did in order to prove a fair result that will satisfy the parents and teachers. The separation of sexes in school could result in improvement of education and behavior with boys and girls. Based on Jennifer Medina’s article, teachers will face less problems if both sexes are separated since the boys will tend to focus more on learning than on girls, in addition, girls will tend to feel more comfortable participating in class. Co-education will also result in good teamwork especially in the outside community because both girls and boys will learn to communicate. However, from the boy’s point of view, they will tend to be more comfortable in expressing themselves and learn about â€Å"being a man† in their own bodies. In addition to those articles, the media will affect the parents and the teachers around the state because of highly known and educative people in society. For example, Leonard Sax who is a best seller author of Why Gender Matters and Michael Sax argues about single sex with a huge audience in order to prove their facts about the separation and the importance of it. In contrast, both sex educations could also result in improvement around the state and in schools because boys and girls will learn to communicate together and work hard as one community. In addition, many authors and scientist were seeking for evidence in order to prove that Co-education could be for the good of their community. For example, a research on Bronx’s Eagle school stated that both sexes’ classes tend to have higher test scores around the state and tend to receive high percentages in their community. Both sexes will also learn and appreciate that both sexes are important in everyone’s lives since they communicate and work together outside of the learning community. Researchers also proved that working together as both sexes will also result a sign improvement in teamwork because many girls tend to be left out in single-sex schools in teamwork projects. Comparatively, Co-Education and single education also have their problems in society because of their lack of certain teachings in schools. For example , a study showed that girls tend to be smarter than boys and tend to solve math and science faster and more accurate since there are different brains and each person have a different sign of knowledge and personality. However, since girls are smarter, they tend to ask for more detailed teachings and writing scripts since they will have more things to explain in their writing assignment. When in contrast, boys have to write about a simple sport or a job they seek for in order to prepare them for the future. Although, teachers who support single education tend to have other opinions toward their ways of teaching. For example, Mr. Napolitano claims that he is more comfortable in expressing his feelings and thoughts while teaching to single sex classrooms because the boys will tend to have the same situation. In addition he also shows a book called Patrol Boy in order to show boys that having a tattoo is not a material they should use in co-ed class. In conclusion, this debate tends to prove that single education will show more improvements since the media tend to support it and also the teachers. The reasons that parents should choose single education is because they will improve economically and also their students will face less behavior problems and more school focused. However, co-ed schools tend to have higher scores and will teach the students to work together in order to improve their speech especially outside in society since they will be working together as one team. Both articles prove that both educations will result in bonding together as students and as teachers in this society because at the end of this debate both classrooms will be teaching and learning in the states.

Prejudice and Discrimination Essay

Analytical Factsheet on Prejudice & Discrimination on Class Inequality Section 1: Executive Summary This essay is about prejudice and discrimination occurring in Singapore context to address Class discrimination. This essay will also show reasons to why prejudice and discrimination occurs and the effects of such inequity can cause to the society. In this case studies possible measures and solutions will be highlighted and suggested. Section 2: The issues and who are involved. This essay will discuss the discrimination against foreign workers working in Singapore. I will be elaborating on how class discrimination has adverse impacts on society on economic level and social levels. I define foreign workers as a group of minority that come from different countries to work in Singapore. According to the 2009 Singapore Yearbook of Manpower Statistics, 37. 6% of Singapore’s population are made up of foreign workers (1. 1 million %). This proves that foreign workers are an important component of our labour force. (Construction (70. 7%), followed by manufacturing (46. 8%) and service (28. 9%) sectors. ) The reason why I chose this topic is that knowing that this group of people had contributed to the country’s growth, yet they still suffer from social inequality and it is an important to address such issues and to understand what leads to such prejudice and discrimination against them. The common stereotypes of foreign workers are they are dirty, have weird body odour, lack of proper hygiene, creates disturbance in housing areas. They tend to speak loudly, creating a lot of noise and being responsible for the crime rates in Singapore. (The Straits Times Nov 2007 they eat, litter, get drunk, urinate, sleep and even fight,) They are also classified as poor people, cheap labour, being lecherous and not very well educated, and people with ill intension. These stereotypes then evolve into prejudices and discrimination and people tend to believe such information because it is consistent with their stereotypes while dismissing contradictory information. Having such stereotypes, people will tend to avoid and be unwilling to mingle with this group of people. For example in the case of the dormitory being setup for a group of foreign workers near the Serragoon gardens issue, it has brought about a big fiasco. Residences were worried about the safety and security in the neighbourhood. Working in a foreign country somehow shows that they are poor, in need of money and thus creating an impression that they wouldn’t hesitant to break in into houses to steal. (CNA October 3rd 2008 Dormitory decision upsets some Sera goon Gardens residents) It clearly shows how they are being mistreated by allocating their living quarters next to the cemetery to prevent any social conflict between the locals and these foreigners. (The Online Citizen Nov 2009 Social isolation – left among the dead) Many of them are being deprived of proper housing conditions where many need to be squeeze into a small room. Dormitories provided were usually poorly facilitated and has very low hygiene standards and others stay at worksite which can be dangerous. (The Online Citizen Sept 2009 Special Feature Is Singapore Slum Free? ) Unsafe transportations were used to ferry these workers to the worksites. Due to these factors, resulting in cases where foreign workers’ lives were lost because their welfare and safety weren’t factor in as priority. (Asia One News the New paper June 2010 3 death 14 hurt in latest crash) This group of people are commonly discriminated by the derogatory name( chinaman, bangala) given to them and being viewed a ‘2nd class citizen’ due to the low paid jobs they have thus having low social status. And because of this they are often being disrespected, taken for granted and exploited in the labour market. (The Online Citizen October 5th 2009 Chinese worker issued with receipt containing vulgarities) Section 3: Why it is important for us to talk about it? Currently there are laws and regulation in Singapore to protect these foreign workers but much can be done to improve on the current situation. According to civil society organisation Transient Workers Count Too, Ministry of Manpower hands out booklets to foreign workers upon their arrival in Singapore. These booklets regarding the employment act are available in different languages, hotline number is also provided for workers to report abuses. But employers and agents, in many cases, confiscate these leaflets and brochures, thus such informations are unable to reach them. Public endorsement of the exploitation of foreign workers seems to be allow for businesses and ports in Singapore to run 24 hours a day, 7 days a week, 365 days a year on foreigners because the economic market have created an industrial and work culture that requires them to accepting conditions that local workers would not agree to. Thus businesses are allowed to cut corners by squeezing foreign workers dry. The restrictive work permit system, which ties foreign workers to a single employer, makes it difficult for them to negotiate for better working conditions let alone higher wages. Many were afraid to speak up fearing that they might lose their jobs. Returning to their countries is not what they are looking forward to as many have taken out loans of up to $9000 just to work in Singapore. These workers have to work for long hours to support their families and to re-pay their debt. Contracts that are written are usually not made clear to the workers. Employers made the contracts solely to protect their own needs, rather than creating an unbiased relationship between themselves and their workers. Unions on the other hand are limited to how much they can do to assist and help demand for better working conditions. When workers are poor and lack legal protection, they are often willing to work longer hours for lower wages. Hence, the reason employers are willing to hire foreign workers in favour of local workers is because working conditions of all low wage workers in general are poor to start with. With such social inequality present in a multi racial country, it is important to address these issues in order to uphold the country’s goal to foster good relationship between different groups of people and to maintain a presentable image in the global world. Most importantly is to educate and ensure growth of such sectors should not be made at the expense of these workers’ rights. Being a small country, the effects if a strike will to occur will affect the country drastically, it will only tell foreign investors that we are not strong enough to provide a stable policies for business dealing and human rights are being abuse thus reflecting badly on Singapore’s reputation. Hence it is important to make sure fair treatment is giving to them. Negative effects will surface if they decided to vacant these jobs and it will definitely crumble the industries that which employments of foreign workers are high. Section 4: Where can we start to fix the problem? To tackle the problems of such inequality, by raising awareness and creating opportunities for interaction is ideal. Giving foreign workers a medium to voice out their opinions is necessary for human rights and the Government should initiate sharing sessions with foreign workers where translators could be brought in to break down language barriers. To help ease the problem of exploitation, laws which work against bad lodging can be further enforce with stricter consequences. For example, improve living conditions so as basic necessities are provided. Reduce discriminatory behaviours acted towards this minority group, the media can also play a part to show that what dangerous or risky jobs are taken up by them to make our living lifestyle better and to address and give credit to their contributions. In addition, subjects such as civics and moral education can be used to reach out to educate students about discrimination at a younger age. References: 1. The Online Citizen Nov 2009 Social isolation – left among the dead http://theonlinecitizen. com/2009/11/social-isolation-left-among-the-dead/ 2. Asia One News the New paper June 2010 3 death 14 hurt in latest crash http://news. asiaone. com/News/The+New+Paper/Story/A1Story20100623-223657. html 3. The Online Citizen Sept 2009 Special Feature Is Singapore Slum Free? http://theonlinecitizen. com/2009/09/toc-special-feature-is-singapore-really-slum-free/ 4. Transient Worker Count too http://www. twc2. org. sg/site/newsletters/2008-sept-oct. html 5. The Straits Times Nov 2007 they eat, litter, get drunk, urinate, sleep and even fight, http://www. straitstimes. com/print/Free/Story/STIStory_180230. html 6. The Online Citizen October 5th 2009 Chinese worker issued with receipt containing vulgarities http://theonlinecitizen.com/2009/10/chinese-worker-issued-with-receipt-containing-vulgarities/ 7. Fit to Post June 24th 2010 Recognizing the work and sacrifice of foreign workers http://sg. yfittopostblog. com/2010/06/24/recognising-the-work-and-sacrifice-of-foreign-workers/ 8. The Online Citizen March 6th 2010 Foreign Workers Contract http://theonlinecitizen. com/2010/03/foreign-worker-contracts/ 9. Ministry of Manpower http://www. mom. gov. sg/Pages/default. aspx 10. CNA October 3rd 2008 Dormitory decision upsets some Serragoon Gardens residents http://www. channelnewsasia. com/stories/singaporelocalnews/view/380077/1/. html.

Essay about Napoleons Farwell Address Speech Analysis

Napoleon’s Farewell Address To The Old Guard A truly dramatic moment in history occurred on April 20, 1814, as Napoleon Bonaparte, Emperor of France and would-be ruler of Europe said goodbye to the Old Guard after his failed invasion of Russia and defeat by the Allies. By that time, Napoleon had ruled France and surrounding countries for twenty years. Originally an officer in the French Army, he had risen to become Emperor among the political chaos following the French Revolution in which the old ruling French kings and nobility had been destroyed. Napoleon built a 500,000 strong Army, which used modern tactics and improvisation in battle to sweep across Europe and acquire an Empire for France. But in 1812, the seemingly invincible†¦show more content†¦Ã¢â‚¬Å"Soldiers of my Old Guard: I bid you farewell. For twenty years I have constantly accompanied you on the road to honor and glory. In these latter times, as in the days of our prosperity, you have invariably been models of courage and fidelity. With men such as you our cause could not be lost; but the war would have been interminable; it would have been civil war, and that would have entailed deeper misfortunes on France. I have sacrificed all of my interests to those of the country. I go, but you, my friends, will continue to serve France. Her happiness was my only thought. It will still be the object of my wishes. Do not regret my fate; if I have consented to survive, it is to serve your glory. I intend to write the history of the great achievements we have performed together. Adieu, my friends. Would I could press you all to my heart.† Napoleon Bonaparte - April 20, 1814 Following this, Napoleon was sent into exile on the little island of Elba off the coast of Italy. But ten months later, in March of 1815, he escaped back into France. Accompanied by a thousand men from his Old Guard he marched toward Paris and gathered an army of supporters along the way. Once again, Napoleon assumed the position of Emperor, but it lasted only 100 days until the battle of Waterloo and was defeated by the English and Prussian Armies on June 18, 1815. A month later he was sent into exile on the island of St. Helena off the coast of Africa. On May 5, 1821, the