Pediatric Trauma Scoring System in Predicting Mortality

Pediatric Trauma Scoring System in Predicting Mortality PEDIATRIC TRAUMA SCORE AS PREDICTOR OF OUTCOME OF PATIENTS ADMITTED TO CENTRALIZED SURGICAL INTENSIVE CARE UNIT IN A GOVERNMENT TERTIARY HOSPITAL: A RETROSPECTIVE COHORT STUDY I. Justification of the Study Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness. Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity. In particular, scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking. Furthermore, there is considerable difference between clinicians prognostication estimates. Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use. Thus, this study will investigate the use of a simple Pediatric Trauma Scoring system in predicting mortality. II. Relationships of research objectives, data substrates, operationally-defined variables and data analyses. Objective Data Substrates Operationally-defined variables Analyses To compare the outcome of patients to pediatric trauma score Pediatric trauma score sheet Pediatric Trauma Score Mortality rate per category of Pediatric Trauma Score Rate of patients with Prolonged Hospital Stay per category of Pediatric Trauma Score Relationship of outcome of patient (mortality and prolonged hospital stay) to pediatric trauma score TOPIC BACKGROUND Intensive trauma care of pediatric patients is faced with many issues such as quality of care, efficiency and cost-effectiveness.1 Quantitative observations of severity of illness in pediatric trauma using scoring systems has the potential to impact overall evaluation from baseline presentation to case endpoints.2 Scoring systems have become the standard for intensive care unit outcome and efficiency benchmarking.1 Early identification of patients with high probability of mortality can help families with difficult decisions, prevent unnecessary suffering and help direct limited resources to a more practical use.1 A Pediatric Trauma Score (PTS) was developed with grading variables commonly seen in pediatric trauma accounting for the unique physiological and anatomical nature. The PTS consists of six variables. Each variable is scored +2 for minimal or no injury, +1 for minor or potentially major injury, or -1 for major or life-threatening injury. The total score ranges from +12 to -6 with increasing severity.3 Scoring systems such as the Pediatric Trauma Score can aid in clinical decision making through objective measurement of severity of illness in relation to a particular outcome such as mortality or morbidity.4 Several studies revealed consistently the direct linear relationship between Pediatric Trauma Score and injury severity thereby confirming that P.T.S. is an effective predictor of both severity of injury and potential for mortality.5 REVIEW OF RELATED LITERATURE Most of the scoring systems are not appropriate for pediatric trauma patients. Variables such as respiratory rate, heart rate, and systolic blood pressure differ with infancy and childhood. In addition, the verbal response as used in GCS is not applicable for young children. For these reasons, Tepas and colleagues3 created the Pediatric Trauma Score (PTS). The authors stated that weight becomes a variable because pediatric patients had fewer physiologic reserve. Systolic blood pressure, patency of airway, level of consciousness, presence of wounds or fractures were variables included. 3 The presence of these injuries suggests severe energy transfer and positively correlates with concomitant visceral injury.10 Below is the Pediatric Trauma Score. Pediatric Trauma Score +2 +1 -1 Weight >20kg 10-20 kg Airway Patent Maintanable Unmaintainable Systolic B/P >90 mmHg 50-90 mmHg CNS Awake + LOC Unresponsive Fractures None Closed or suspected Multiple, closed or open Wounds None Minor Major, penetrating or burns The assessment of severity of illness as well as mortality predictive value of the Pediatric Trauma Score (P.T.S.) was evaluated in several studies with different conclusions. In a study by Tepas, three categories of patients with probability of mortality were identified. Pediatric trauma score of greater than 8 had a 0% mortality while pediatric trauma score between 0 and 8 had an increasing mortality related to their decreasing pediatric trauma score. Score of less than 0 had 100% mortality. This study documented the direct linear relationship between Pediatric Trauma Score and injury severity validating that P.T.S. is an effective predictor of both severity of injury and risk for mortality.5 Consistent with the findings of the latter, Ramenonofsky compared the evaluation of pediatric trauma patients by paramedic in the field versus the physician in the emergency room using the Pediatric Trauma Score. There was agreement between the scores of these two individuals 93.6% of the time, correlation coefficient 0.991, r2 = 0.982. The sensitivity and specificity of Pediatric Trauma Score was computed at 95.8% and 98.6%, respectively. He described Pediatric Tra uma Scoring System as a straightforward modality for assessing the severity of injury.6 Eichelberge examined the applicability of the PTS found significant correlations with survival, Injury Severity Score (ISS) and mortality. 8 On the other hand, the use of PTS as a predictor of mortality was found to be inadequate in a retrospective study by Balik. Size classification was noted to be overemphasized because of the low mortality (7.7%) in children less than 10 kg. Forty-nine of 71 surgically treated patients with intra-abdominal organ injuries had a PTS >8. The existing variables of PTS did not have equal relationships to mortality.7 Critics have also noted that the PTS suffers from scoring ambiguity leading to misinterpretation and inadequate scoring.11 Problem also arises due to a systematic bias in scoring. For example, the assessment of a patient’s consciousness can be done at the scene or on admission to the emergency department. 12 Despite exhaustive review of the literature on Pediatric Trauma Scoring, there has been no mention of the predictive value of Pediatric Trauma Scoring done on patients upon entry to an ICU. Conclusion of studies on Pediatric Trauma Score may be less generalizable due to possible variability in settings.9 RESEARCH QUESTION Among pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit in Davao Regional Hospital, what is the relationship of outcome of patients to pediatric trauma score using a retrospective cohort study? SIGNIFICANCE OF THE STUDY Investigating the reliability of Pediatric Trauma Scoring system in predicting mortality and prolonged hospital stay is important. The results of this study can be a validation of earlier studies made on this scoring system as a tool in objective measurement of severity of illness as well as an intensive care unit outcome and efficiency benchmarking. OBJECTIVES To determine the pediatric trauma score of all patients and classify as to pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the mortality rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the survival rate per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 To determine the rate of pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 among surviving patients To determine the risk for mortality or prolonged hospital stay among pediatric trauma patients per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 METHODOLOGY RESEARCH DESIGN A retrospective cohort study of all pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit between January 1, 2013 to December 31, 2013 in Davao Regional Hospital will be conducted. SETTING This study will be conducted in Davao Regional Hospital (DRH), a tertiary hospital with 250-bed capacity, in Tagum City. The Centralized Surgical Intensive Care Unit (CENSICU) is an intensive care unit for adult and pediatric surgical patients in Davao Regional Hospital. The Department of Surgery of Davao Regional Hospital is a member of the Mindanao Integrated Surgical Residency Training Program under the Department of Health, Region XI. PARTICIPANTS All pediatric trauma patients admitted to CENSICU in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be retrospectively included in the study. INCLUSION CRITERIA All patients admitted to Centralized Surgical Intensive Care Unit due to trauma All patients aged less than 14 years old EXCLUSION CRITERIA Patients discharged against medical advice Patients transferred to another hospital OPERATIONAL DEFINITION OF TERMS Traumaan injury to any site of the body described as multiple or single (neck, thorax, abdomen or extremeties) site caused by an extrinsic, blunt or penetrating agent Pediatric trauma patients-patients aged less than 14 years old admitted due to trauma Pediatric Non-Trauma patients- patients aged less than 14 years old admitted for surgical intervention of non-trauma cause (example: intestinal obstruction due to Hirschsprungs disease, massive pleural effusion due to malignancy) Prolonged Hospital Stay-length of hospital stay is more than 14 days with or without surgical intervention DATA GATHERING All pediatric trauma patients admitted to Centralized Surgical Intensive Care Unit (CENSICU) in Davao Regional Hospital between January 1, 2013 to December 31, 2013 will be identified from the admission logbook in the CENSICU of Davao Regional Hospital. The patients will be identified using the inclusion and exclusion criteria . The list of patients will be submitted to Medical Records Section of Davao Regional Hospital for chart retrieval. The charts will be reviewed for the following data will be gathered from each patient: age in years, sex, length of hospital stay in days, weight in kilograms, systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds. After calculating the Pediatric Trauma Score of each patient, the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) can be determined. In addition, the outcome of the patient will be determined as to: Mortality With prolonged hospital stay among surviving patients MaIN OUTCOME MEASURES AND OTHER DEPENDENT VARIABLES The primary outcome is the mortality rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively. The secondary outcomes are the following: Number of pediatric trauma patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0, respectively Survival rate of admitted patients categorized per pediatric trauma score of greater than 8, pediatric trauma score of 0 to 8 and pediatric score of less than 0 Rate of surviving pediatric trauma patients with prolonged hospital stay per pediatric trauma score category of greater than 8, 0 to 8 and less than 0 INDEPENDENT VARIABLE The identified independent variables include age, sex, weight in kilograms, length of hospital stay, patency of airway, systolic blood pressure in mmHg, level of consciousness, presence of fractures and minor or major wounds. SAMPLE SIZE COMPUTATION Sample size for this study was computed using Epi Info 7 StatCalc. Calculations were based on the assumptions that: 1) the ratio of patients unexposed to the risk factor (i.e., PTS greater than 8) to patients exposed to the risk factor (i.e., PTS 8 or less) is 3; and 2) the prevalence of the outcome (i.e., death) in the unexposed group is 15%. Estimations were done in order for the study to detect an odds ratio of 5 as statistically significant. In a computation for odds ratio carried out with 5% level of significance, a sample size of 79 patients will have 80% power of rejecting the null hypothesis (no significant increase or decrease in odds ratio) if the alternative holds. DATA HANDLING AND ANALYSIS Clinical characteristics (age in years, sex, weight in grams, length of hospital stay), systolic blood pressure in mmHg, patency of airway, loss of consciousness, presence of fractures and wounds, and Pediatric Trauma scores of patients will be compared statistically. A p value will be computed to establish whether the difference in the values were significant or not. A p value The Pediatric Trauma Score of each patient will be calculated and the category of Pediatric Trauma Score (PTS greater than 8, PTS between 0 to 8, or PTS less than 0) to which the patient belongs will be determined. The total number of patients in each category will be evaluated. Outcome (mortality rate or survival rate) of each patient belonging to a particular category will be tallied and each frequency computed. Among surviving patients, length of stay will be evaluated as to prolonged (>14 days) or not prolonged. Rate of surviving patients with prolonged hospital stay will be determined. Risk of mortality as well as prolonged hospital stay among surviving patients will be expressed in odds ratios (OR) with 95% confidence interval.

Critique of The Law of Apostasy in Islam Essay

In 1924 Samuel Zwemer wrote The Law of Apostasy in Islam as a response to several books and articles that claimed there is no punishment in Islam for apostate Muslims. Zwemer quotes Khwajah Kemal-ud-Din who wrote in his book India in the Balance, â€Å"in Islam there is no penalty for apostasy† and Mohammed Ali’s English translation of The Koran â€Å"neither here nor anywhere else in the Holy Koran is there even a hint of the infliction of capital or any other punishment on the apostate. † Zwemer disputes these claims and tries to prove his contention that there is a long history of punishing apostates throughout the Muslim world (Zwemer 8-9). Zwemer was a missionary for the Christian Dutch Reformed church in the Middle East during the latter part of the nineteenth and early twentieth century. The people he worked with and tried to convert to Christianity were Muslims. Zwemer begins his argument in the chapter â€Å"Why so Few Moslem Converts† by citing numerous cases where Muslims practiced punishment and ostracism against apostate Muslims, that is, Muslims who had converted to Christianity. The incidents described are anecdotal and deal with specific examples where apostate Muslims underwent punishment or discrimination at the hands of practicing Muslims. Assuming, for the sake of argument, Zwemer is correct and such practices occurred, Zwemer still does not disprove either of the statements quoted above. What Zwemer â€Å"proves† is that some Muslims were punished, nothing more. He has not proven the Koran supports such practices. The title of this chapter must give the reader pause; it does not seem to be the title of an intellectual argument, but more like a defense of his and other missionaries efforts while working among Muslims. Apparently he had concluded the reason for his lack of success was due to fear of punishment by other Muslims, not because he was a bad missionary, or because the tenets of Islam were more convincing to people in the region than the principles in Christianity (Zwemer 15-29). In the chapter two â€Å"The Law of Apostasy† Zwemer quotes three passages of the Koran that he claims indicate an official sanctioning of punishment of apostates. Zwemer is unconvincing. The phrase â€Å"take from them [apostate Muslims] neither patron or help (IV. 90, 91) and alleges that the standard commentary of Baidhawi, whoever that is, means â€Å"take and kill him wheresoever you find ye find him, like any other infidel (Zwemer 33). It appears Baidhawi has chosen an interpretation that is not justified from the original text. He treats the other passages in a similar fashion, interpreting them to mean apostates should be killed or punished, when a more straightforward interpretation does not imply his conclusion. Zwemer errs in at least two fashions. First he appears to equate evidence that indicates punishment has been administered against apostates indicates the sanction of such actions by the teaching of Islam. This is not the case. Throughout history there are far too many examples where common practices were either directly prohibited by official policies or were not addressed by these policies. This does not indicate official policies authorized such actions. Secondly, Zwemer’s evidence is largely either anecdotal or demand such contrived interpretations of the Koran as to unconvincing. Consequently The Law of Apostasy in Islam does not prove that punishment for apostate Muslims is a tenant of Islam. Works Cited Zwemer, Samuel M. The Law of Apostasy. London: Marshall Brothers Ltd, n. d.

Populist Party’s Platform

The Populist Party commonly refereed to as the peoples party was a relatively short lived political party within the United States during the 19th century. It was particularly popular within western farmers since it was directly opposed to the gold standard system of international trade. However the party did not last long in United States politics. Regardless of this fact the party’s ideas or manifestos have been employed in United States politics even to date. In essence the party grew out of an agrarian uprising especially after the collapse of agricultural prices in 1873. It arose from a farmer’s alliance of farmers who had an economic target of collective action against merchants, brokers and rail roads as well as an integrated nation wide policy. Most importantly the driving force towards the creation of the party arose from the refusal of both the democrats and the republicans to accept the farmers’ alliance idea of the use of silver as the national model of coinage. SHORT HISTORY: The Populist Party or the people’s party was formed by the farmers’ alliance in collaboration with the knights of labor. This initial formation took place between the years 1899 and 1890. The actual realization of their dreams was in 1892 when the party held its annual convention in Nebraska. This is the time that the party actually nominated members for the first time for national elections. In 1896 the democrats incorporated ideas of the people’s party 1892 platform and this negatively impacted on the party’s progress. In addition the ensuing collaboration between the democrats and the Populist Party did not auger well with the already existing relation between the populists and the republicans in the south. This marked the onset of the party’s decline in United States politics. THE 1892 PARTY PLATFORM: The Populist Party’s 1892 platform was commonly refereed to as the Omaha platform since it w3as held in Omaha Nebraska. In this platform the Populist Party demanded the following; Complete overhaul of all national banks. This was aimed at reducing the risk to citizens of excessive exploitation by these corporations. Immediate Imposition of direct election of senators within the United States was demanded as well. This was directed at reducing the prevalence of corruption and bribery in the voting system. It was also aimed at increasing public participation in the electoral process, as well as to reduce instances of insider trading within the big parties. The platform also sought immediate introduction of civil service reforms. In the preamble of the manifesto the party claimed that the time had come for the railroads to own the people or the people to own the railroads. For the later to happen there was need to introduce constitutional amendments to make sure that the government would not use the power of the employees to intimidate the people. Thus civil service reforms and regulations had to be introduced to prevent this. The platform also demanded the introduction of a national wide graduated income tax system. The introduction of a legal eight hours working day and the introduction of government control of all railroads. The platform also demanded the introduction of unlimited coinage of silver and gold at the existing ratio of 16 to 1. The platform also demanded that the state introduce postal savings banks for the interest of all citizens in order to facilitate foreign exchange. The platform also claimed that land and any other natural sources of enrichment remains the people’s heritage and thus should not be monopolized or misused and further alien ownership of this should not be entertained. ANALYSIS: The Omaha platform was well received throughout the United States. This was mainly due to the fact that most of the party’s ideas were overly practical and implemental. In addition the party was trying to prevent a scenario of continued dominance by the democrats and republicans for what the party called political power and plunder. The party also sought to return power to the people by reducing the vices inflicted by the capitalists on laborers by reducing the dominance of gold in trade. The Omaha platform also sought to return the powers of the government to the â€Å"plain people† from where the powers actually originated. The purposes of the platform the party claimed were to be identical to the purposes of the national constitution. Despite its decline in popularity in United States politics, some of its ideas have come to be endorsed in mainstream governance and politics. A good example of this is the abolition of the gold standard. In this field the party’s 1892 platform highly demanded the abolition of this sys tem but it was not until the 1970s that the gold-standard was actually abolished as the common exchange system. In earnest we can thus argue that the demands put forward by the party were not only progressive in nature but also widely visionary, since it has taken more than a generation for the other political party’s to adopt/implement these policies. In addition the party’s platform could be described as having been Progressive in the sense that the introduction to the manifesto detailed splendidly the causes that made their demands justifiable. Among these issues included; the fact that the party claimed that there was widespread corruption compounded by political and moral degradation within the American public. CONCLUSION: Although the people’s party 1892 manifesto contained quite progressive ideas the party was quite short-lived in American politics. By 1896 during the next national elections, the Democratic Party took most of the people’s party ideas and incorporated them in their platform. In addition the party nominated a democrat (William Jennings) as their presidential candidate. After this scenario the party started to decline in popularity within national politics. In the year 1984 plans were already underway to revive the Populist Party. These efforts did not bear fruit due to internal party conflicts. In 2002 a new group emerged â€Å"the populist party of America† emerged. It is actively opposed to the bush administration especially on the issue of the war in Iraq. It also advocates for strict adherence to the bill of rights as well as direct democracy. It has yet to field presidential candidates. REFERENCE: http://www2.wwnorton.com/college/history/eamerica/media/ch22/resources/documents/populist.htm   

Apology And Aristophanes The Clouds - 982 Words

What worries many great intellectuals is the thought of being represented. The scholar Socrates was know as a calculated man who tried to delve into and honestly answer all of his quagmires about life and the universe. While this may be true, when comparing many of the contemporary Athenians who quote him there are countless inconsistencies. Not only do these irregularities intrigue present day students of classical works, they raise questions about the veracity of his quoted works. There are some works which shed a positive light on the scholar while others convey the contrary. One such comparison is that of Plato’s book, Apology and Aristophanes’ play The Clouds. Throughout both masterpieces there are connotations that they both disagreed and presumably misrepresented Socrates’ methods, beliefs and overall views. Misrepresenting Socrates has inevitably created an only partial representation of the real, truth seeking man that he was and has forced the present d ay scholar to accept the inconsistencies as part of the mysteries of Ancient Greece. The interactions that the two authors had with Socrates created a motive for each’s objectives and thus modeled their works differently. The playwright Aristophanes was much old than Plato and his work, The Clouds, was released when Plato was very young. At that period many â€Å"average† less sophisticated older citizen scoffed at Sophists’ allegedly perverted and warped logic. Aristophanes work fits that genre. Aristophanes had littleShow MoreRelatedEssay Clouds vs. The Apology1649 Words   |  7 Pages Clouds vs. The Apology In Aristophanes Clouds and in Platos Apology we see extensive fictional representations of the historical figure, Socrates, who left us no literary works under his own name. When comparing these two representations, readers often assume, as a result of the nature of the comedic genre, that Aristophanes portrayal of Socrates is exaggerated and fallacious. On the other hand, Platos account is often taken more seriously as a result of the philosophical genre and theRead MoreClassical Essay780 Words   |  4 Pages Second Paper Assignment Shonell Maynard In the books; The Clouds written by Aristophanes, and The Apology, written by Plato, the philosopher Socrates is portrayed in two different ways. Plato, being a loyal follower of Socrates, portrays him as being a very simple man who is always open to learning new wisdom. However, Aristophanes portrays him as an atheist who practices sophistry along with a number of different crimes. People question whetherRead MoreAristophanes’ Clouds a Satyr Play Written in 419 BCE1161 Words   |  5 PagesAristophanes’ Clouds, if read hastily, can be interpreted as a mindless satyr play written in 419 BCE. Yet the chorus warns the reader not to expect the play to have farcical ploys like â€Å"a hanging phallus stitched on† the actors to evoke a laugh, but to take note of underlying seriousness as â€Å"she [the play] comes in trusting only her words† (Clouds 538-44). Even if the play does use some low devices, the play’s message is sophisticated and can be read as a warning to Socrates. Aristophanes isRead MoreAnalysis of Socrates in Aristhphane ´s Clouds and Plato ´s Apology1081 Words   |  5 Pagesclaimed to know anything that he questioned. In Plato’s text â€Å"Apology† Socrates is depicted as a man who was arrogant, hypercritical of others, and fixed on his ways no matter the consequences. He had the qualities of a man who saw no error in what he was doing because he thought he was above average men, and thought he was a benefit to society against what others claimed. In contrast Socrates’ portrayal in Aristophanes’ play â€Å"Clouds† is more positive, his character was written wanting men to beRead MoreSocrates’ Speech in Apology975 Words   |  4 PagesAristophanes’ Clouds, if read hastily, can be interpreted as a mindless satyr play written in 419 BCE. Yet the chorus warns the reader not to expect the play to have farcical ploys like â€Å"a hanging phallus stitched o n† the actors to evoke a laugh, but has underlying seriousness as â€Å"she [the play] comes in trusting only her words† (Clouds 538-44). Even if the play does use some low devices, the play’s message is sophisticated and can be read as a warning to Socrates. Aristophanes is a â€Å"friendlyRead MoreSocrates: The Dichotomy between Aristophanes and Plato’s Depictions1489 Words   |  6 Pagesbetween Aristophanes and Plato’s Depictions Ignorance: the condition of being uninformed or uneducated; this basic definition is crucial to understanding one of the most controversial figures in ancient Athenian society: the philosopher Socrates. The man’s entire life was devoted to proving the fact that no one actually knew what they thought they did; that everyone lived in ignorance. This viewpoint earned Socrates many enemies, so many that even a renowned playwright, Aristophanes, decidedRead More The Clouds by Aristophanes Essay1678 Words   |  7 PagesThe Clouds by Aristophanes - Relevant in Todays World The Clouds by Aristophanes, is a play centrally concerned with education. Aristophanes employs satire to illustrate his conservative beliefs. It is intended to show readers that in the tendency to philosophical subtleties lies the neglection of the real needs of the Athenians. According to Aristophanes, philosophical speculation only acts to shake the established foundations of accepted religion, gods, and ideals of morality. Read MorePoli Sci Midterm1155 Words   |  5 Pagesguided reason and language. 2. Is Socrates against nature, or following it? Please draw examples from Aristophanes’ The Clouds and the relevant Platonic Dialogues. In the four dialogues, Socrates professes that he is for nature in different ways. He describes nature and human nature. He believed that human nature involves reasoning and consisted of metaphysical concepts. In Aristophanes’ â€Å"The Clouds,† Socrates states that he believes that the Gods are not the ones who produce rain and thunder butRead MoreSocrates : The Father Of Western Philosophy747 Words   |  3 Pagesonly one of the most influential intellectual to have ever lived, but also one of the most controversial. His ideology, teachings, and beliefs are still discussed, debated, and quoted to this day. Using one of his students, Plato and looking at Aristophanes work, one can draw concluding thoughts on why Socrates brought so much controversy to the table and how both perspectives seem to tell a different story. Socrates was a Greek philosopher between 470BC to 399BC. He is remembered as the father ofRead More Socrates Essay1087 Words   |  5 Pagesof absolutes. This alternative is not without its faults. Socratic philosophy is plagued by a destructive element. It reduces the authoritative opinions about political life but replaces it with nothing. This is the vital stem from which the quot;Apology of Socratesquot; is written. Because of the stinging attack on Athenian life, and the opinions which they revere so highly, Socrates is placed on trial for his life. The question now becomes why and in what manner did Socrates refute the gods and