International Relations - International Development (Proposal Outline) Essay

Global Relations - International Development (Proposal Outline) - Essay Example In actuality, ladies as a rule are kept at lower than auxiliary level and in a large portion of the social orders in spite of her administrations chiefly to families that are additionally unpaid. Taking all things together, ladies has been given less benefits on social, political, and financial force than they merit as contrast with men with one and only explanation of being Woman. Also the bias has fortified itself and ladies, in numerous pieces of the world particularly creating nations, are growingly denied of the crucial rights as individual. Financial minimization of ladies alludes to the burden and hardship that lady is represented against man on the monetary fronts. Monetary minimization incorporate all viewpoints, for example, neediness, hardship from dynamic rights and positions as for financial issues and all the more critically access to monetary assets. The danger of persecuting individual with sex disparity, as a rule and monetary mistreatment in explicit, additionally d idn’t permit further developed segments of the countries that guarantee to be pioneers being developed. For example, just 12 organizations from fortune 500 are driven by ladies; down from the tally of 15 than earlier year (CNN, 2011). Nations that are accepting driving places of development as rising countries for example China with a normal development pace of above 8% in worldwide monetary emergencies time; powerlessness and minimization of ladies has expanded with increment in movement from country to urban regions for their financial development. These ladies, however, got opportunity from low compensation paid employment at ranch yet faces in urban areas progressively troublesome circumstance of imbalance, for example, provocation and other city-variant of underestimation including work segregation, pay hole and opportunity disparities and so on (Tam, 2006). Confirmations from created and rising countries when hold such circumstances it at that point gets clear as crysta l the condition winning in creating countries, for example, India and Pakistan. The two nations being the social center point of the South East Asia hold all the more firmly those old uninformed qualities that supported the strength of men even in most instructed areas of society; denying ladies of social, social, open and monetary procuring too dynamic (Nelasco, 2012). As of late in two gatherings, ladies have affirmed regardless of exchange progression and globalization, ladies are becoming turning into the survivor of joblessness, underemployment, relocation for vocation to urban and abroad and so on. All these have put increased effect on ladies imbalance with breaking down food instability; work serious ventures exploiting modest work with convergence of enormous number of ladies fundamentally with their families for employments and thus, presenting high frailty thinking the colossal work pool. Given beneath are a few insights that presents start real factors of victimization l adies (Nelasco, 2012) Importance of the ladies strengthening â€Å"When we enable ladies, we enable networks, countries and the whole human family.† â€UN secretary-general Ban Ki-Moon (UN Women, 2011) For exertion identified with lessen this imbalance sociologies has introduced tremendous writing; be that as it may, the affectivity has just picked up progress to the point that UN segments understood the significance of actuality that world will currently create mindfulness in regards to ladies strengthening and year 2011 UN stamped debut of formal endeavors for ladies strengthening (UN Women, 2011). Chief of UN (Women Empowerment segment of UN) has vision of this segment to have future

Consumer Guarantees Law and Legal Services

Question: Talk about the Consumer Guarantees Law and Legal Services. Answer: Presentation: Purchaser security law is a path accessible to individual to retaliate against the strategic policies which are oppressive. These laws are planned at worldwide level to give assurance to customers and forestall the injurious acts of venders of merchandise and enterprises. Purchaser insurance laws are pertinent on dealers when they look to procure benefit by giving incorrectly data or doesn't give total data to buyers. In Australia, purchaser security laws exists at both government and state level. They are upheld by organizations of government, workplaces of lawyers officers, and other government bodies. This paper contains the conversation on customers assurances, brief note on authentic improvement of shopper insurance law in Australia, and how purchasers security laws work at both government and state level in Australia. In this paper, we additionally talk about the procedure of insurance of customers when buyers are not happy with the item or administration they get. Customer assurance and authentic improvement of shopper insurance in Australia: Segment 3 of ACL characterizes the shopper as an individual or business who bought products and ventures which doesn't surpass measure of $40000, merchandise and enterprises surpass the measure of $40000 yet they are of such nature which usually utilized for residential, family unit or individual utilization, and furthermore spread the products identified with business street vehicle (Competition and Consumer Act 2010, n.d.). The fundamental reason for buyer security laws is to ensure the shoppers against out of line practices of exchange directed by merchants for looking for benefit. Generally, all the business associations are overseen and controlled by the economic situation which put them in ruling situation from their clients and associations utilize this situation to abuse their purchasers. Buyer Protection Law in Australia gives the point by point application and impact of law identified with customer assurance and risk of item in Australia. The customer assurance law was created in Australia by the understanding marked by Council of Australian Governments. The arrangements of this law are the reflection of the arrangements indicated in Trade Practices Act 1974, and some extra insurances are additionally added to the purchasers. For the most part, this law mirrors the arrangements of buyer assurance of reasonable exchanging enactment which appropriate in both state and region (Bruce, 2013). In 1980, a fruitful endeavor was made by administration of Australia to execute the buyer law through an enactment presented under Part V of the Trade Practices Act 1974. The advantages of this law are for the brief time frame, and governments at singular level included Australian government take activities at their own for the improvement of shopper laws which bring about difference, duplication and multifaceted nature. Activities of government brings about disarray in the brain of purchasers identified with their privileges and furthermore business associations can't comprehend their commitments under law. Every one of these disarrays bring about loss of cost, time and endeavors. Around then broad buyer laws in Australia was characterized by 13 Acts which nearly covers a similar issue identified with purchaser security, it additionally incorporates two national laws that is Trade Practices Act 1974 and the ASIC Act 2001, and 8 state and region Fair Trading Acts. Three additional locales are there in which three additional laws are instituted for buyer security. There are additionally some broad shopper arrangements identified with offer of products in eight state and regions of Australia. These laws are intricate and mistaking for shoppers and organizations. In the wake of considering this issue the new Act is presented by the administration of Australia that is Australian Consumer Law. This new Act replaces very nearly 850 Sections in previously mentioned Acts, and does exclude number of auxiliary requirement and different guidelines that help them. The Australian Consumer Law (ACL) is the national law, and the principle motivation behind this law is purchaser assurance and reasonable exchanging. On first January 2011, ACL is started and it is a helpful change of the Australian government and the States and Territories through the Legislative and Governance Forum on Consumer Affairs (CAF). Organization of ACL is led by Australian Competition and Consumer Commission (ACCC), and some other shopper security offices worked in the states and domains. Australian Securities and Investments Commission (ASIC) additionally show their association on applicable issues (ACL, n.d.). Australian Consumer Law covers following issues: Law identified with national uncalled for contract terms which spread standard type of shoppers and business contracts little in nature. National law likewise ensuring privileges of customers while managing in the products and ventures. National law identified with wellbeing of item and requirement of laws. National law identified with spontaneous customer understandings which manages entryway to entryway deals and furthermore phone deals. National guidelines identified with lay-by understandings. Punishments, intensity of authorization, and customer change choices. The ACL applies at national level, in all the states and regions of Australia and to all organizations led in Australia. Every one of those exchanges which are happened before first January 2011, all the past national and state laws are applied. This law is regulated by ACCC and authorized by all courts and councils in Australia, and furthermore incorporate the councils and courts of the states and domains. Each one of those insurances which are given in ACL are like the assurances gave in the arrangements of Australian Securities and Investments Commission Act 2001 (ASIC Act). Thusly, all the items and administrations identified with account are treated in comparative manner. Committee of Australian Governments consents to the Intergovernmental Arrangement which brings about foundation of ACL. In 2008, profitability commission of Australia gives the proposal of ACL, and this commission likewise found that ACL give somewhere in the range of $1.5 and $4.5 billion advantage to the Australian people group (ACL, n.d.). Upper leg tendon is characterized under Schedule 2 of the Competition and Consumer Act 2010 which is recently known as the Trade Practices Act 1974 (TPA). Following are a few parts of ACL which are characterized beneath: Part 1: in this section there are set of definitions, and furthermore a few arrangements identified with shopper law, and this area additionally incorporates meaning of customer. Part 2: this section characterizes the general securities, and these general assurances help in makes gauges identified with business in the market. These general assurances incorporate after bans: General limitation on misdirecting conduct and misleading behavior in business. General limitation on unconscionable lead and explicit limitation on unconscionable direct in the event of purchaser and some specific business exchanges. There are a few arrangements which make out of line contract terms in customer contracts void. This section incorporates some particular assurances which manage the specific types of business lead, and it incorporates: Limitation on some particular practices which are out of line in organizations. It additionally manages shopper exchanges identified with merchandise and ventures. Spread risk of maker in the event of wellbeing absconds in products. Section 4: it manages criminal offenses identified with specific issue secured by part 3. Part 5: this section incorporates intensity of requirement and cures. Upper leg tendon guidelines are set out to a limited extent 6 and 7 of the Competition and Consumer Regulations 2010, and it gives commonsense impact to the arrangements of (ACL, n.d., ACCC, n.d.). Cures accessible to shoppers: Shopper ensures are characterized as set of rules which manages the sell and buy exchanges of customers, and these standards are given under ACL. Rules identified with purchaser ensures characterize the circumstances under which business is at risk towards their buyers and give solution for them. This assurance naturally applied to the products and enterprises gave by vender or maker. Organizations that give products or administrations to buyers must agree to the purchaser ensures, makers, and shippers must consent to the shopper ensure. Products must comprise following certifications: Merchandise must be of worthy quality. Merchandise must satisfy the reason for which they are made. All the fundamental data identified with products must be given to purchaser. Products must be liberated from shrouded protections and charges. Merchandise must sell with undisputed belonging. Fix office must be accessible for sensible timeframe. Merchandise must be liberated from abandons (ACCC, n.d.; Queensland Government). Cures gave by ACL to customers are separated into four sections, and these cures are identified with provider and producer of items. Following cures are accessible to purchaser when customers are not happy with the products: Cures which are identified with ensures gave by provider of products. Cures which are identified with ensures against producer of merchandise. Cures which are identified with ensures against provider of administrations. Cures which are identified with ensures against provider and credit suppliers (Find law, n.d.). Cures accessible to shoppers are dictated by the inability to agree to the buyer ensure. These disappointments are part into two sections that is significant disappointment or non significant disappointment. Inability to agree to customer ensure is considered as significant disappointment if provider neglected to conform to following assurances: Assurance under area 51 that is title of merchandise, segment 52 that is undisturbed belonging, segment 53 that is undisclosed protections, segment 54 that is satisfactory quality, Section 55 that is qualification for any undisclosed reason, Section 56 that is flexibly by depiction, an

Hollow Men Explication :: English Literature

Empty Men Explication We are the empty men We are the stuffed men Empty and full. Considering the speaker of this club of logical inconsistencies is a solitary being (it very well may be a human, or even a stone) speaking to the a large number of its sort, it takes after any semblance of a scarecrow or maybe a mannequin along the lines of those seen on CNN speaking to a Bush with an immensely enormous nose put on flares. An alarm crow with straw. Stuffed to the edges. A substance lacking generosity. The straw is the substance, however each singular straw is empty, light, one subtlety of shading yet together they make a reason one of either being a joke of what the U.N. places in its record books of the main super force in the start of the 21st century or frightening crows off. There is a reason among empty grounds, a reason for the straw to be compacted together. Also, oh, that design is cultivated when a we is accomplished not an I. Inclining together Headpiece loaded up with straw. Oh! This reconfirms my doubts of fluttering together to accomplish a rule of social endorsement, of a status that decides the reason to be one of those playing with the positive. And they should simply lean their heads, even the heads that are loaded with straw, in a practically neuron epitomized skull. Hang over, and take a toast to their beverages a negligible tink of the tumblers even scotch couldn't have a additional delightful too bad flagging an irrevocability of limited help. Our dried voices, when We murmur together Are calm and good for nothing As wind in dry grass Or on the other hand rodents' feet over broken glass In our dry basement Hollow voices, less the dew of dampness. However this express is a finished direct opposite of my quickly drawn hypothesis inside the time span of to what extent my eye covers can wander off as those decided asses to abstain from fluttering down (yes Mr. Little, my own special confirmation of 2 o' clock wanderings into Bless Men turn over a few empty stones themselves, however I'm not whining, appreciate). Very actually, as I'm taking this allegory less the implications I firmly suspect this sonnet to have (maybe even borrowed???), gathering among themselves delivers no pace of progress, for the gathering bears no essential result. Yet, whom is to guarantee that it is an indispensable outcome which infers a achievement, is what out scarecrow is attempting to vouch after? Elliot brushes out a dejected state of mind on canvas, apparently a sketch of shadows as a forerunner to more feet sliding across shards of glass. With respect to the consequence of a meeting, it can likewise highlight the non-presence of

Learning organization Essay Example for Free

Learning association Essay Marquardt (2002, p. 211) introduced 16 stages important to assemble a learning association. A more intensive glance at our association uncovered that there is still such a long way to go and change. Utilizing Marquardt’s illustration, our association is still in the caterpillar stage, â€Å"earthbound† and â€Å"nonlearning† (p. 235). The significant test staying with our in this status can be connected to just two things, disposition of representatives and initiative style. Shockingly, the 16 stages proposed by Marquardt come down to these two things. Workers have negative view about change. They are not ready to leave their customary ranges of familiarity, face challenges or focus on changing the organization. They come up short on the inspiration to teach, improve and create themselves expertly. The old, tried method of doing things remains the standard. Nonetheless, the all the more upsetting certainty is the absence of exertion from the pioneers. In light of Marquardt’s conversation, the primary exertion for change should originate from the top, from the pioneers. By and by, the administration style in the organization doesn't oblige the necessities of a learning association. The authoritative culture doesn't enable the empoyees to communicate their imagination or investigate their possibilities. To put it plainly, our association is 16 stages from change. In view of the rules, to impact change, the pioneers need to perceive their job as the operators of progress. As per Marquardt’s book, â€Å"The initial step is for authority to subscribe to changing the organization into a learning organization† (p. 210). Before that could occur, pioneers should above all else need to perceive the need to change our caterpillar approaches to that of a butterfly. This progression relates to the making of a hierarchical vision. The organization needs a progressively powerful, fascinating, motivating vision to keep the two heads and workers animated into changing and improving the organization just as making a domain for continious learning.

Neo Nazis :: essays research papers fc

â€Å"Two Neo-Nazis have been sentenced for killing Black young person Benjamin Hermansen. A third litigant has been sentenced for being an accomplice to the assault. The slaughtering of 15-year-old Benjamin Hermansen while he was meeting a companion close to his home in Oslo started shock. A huge number of Norwegians rioted a couple of days after the demise to challenge bigotry and viciousness. Oslo City Court indicted Joe Erling Jahr, 20, and Ole Nicolai (Kvisler), 22, both connected to the Boot Boys neo-Nazi gathering, of homicide. Jahr was condemned to 16 years in jail and (Nicolai) Kvisler 15 years. Veronica Andreassen, 18, was indicted as an assistant to the attack and imprisoned for a long time. The court said the homicide was arranged, racially spurred and submitted by individuals from a Neo-Nazi gathering halfway to spread dread. It likewise found that Jahr and (Nicolai) Kvisler had each cut Hermansen with various blades. "Benjamin Hermansen would not have been assaulted if his skin had been a similar shading as the defendants," the court's decision said. The court said Jahr and (Nicolai) Kvisler had gone out that night with the aim of "getting a foreigner" and had brought blades. It said that while Andreassen didn't take part in the assault, she went with them in spite of realizing they arranged viciousness. Hermansen, who was dynamic in his school and sports, was brought up in Norway. He additionally had revolted against prejudice on national TV a couple of months before his passing after he was ambushed by neo-Nazi adolescents during a soccer competition in Denmark. â€Å" (fare.net) That was a news story I found on a Norwegian enemy of bigot site. It happened just a couple of days back on January 21st in Norway. This shows the pervasiveness of bigotry despite everything going on today. The gathering answerable for the homicide had a place with an association that considers themselves the Neo-Nazis. One of the inquiries I’ve constantly posed in my history classes, is â€Å"Why do we have to think pretty much so much stuff that happened for such a long time ago?† Last year, my history educator, Mr. Slater, offered me a response. He said we have to find out about history, or we will be destined to rehash our past slip-ups. All things considered, I’ll talk about how Nazism began. At the outset, there was Adolf Hitler. He carried on with a to some degree uninteresting life as a kid. His dad was a traditions official at the fringe isolating Austria and Germany. Neo Nazis :: articles look into papers fc â€Å"Two Neo-Nazis have been indicted for killing Black youngster Benjamin Hermansen. A third litigant has been sentenced for being an assistant to the assault. The slaughtering of 15-year-old Benjamin Hermansen while he was meeting a companion close to his home in Oslo started shock. A huge number of Norwegians rampaged a couple of days after the passing to challenge bigotry and viciousness. Oslo City Court sentenced Joe Erling Jahr, 20, and Ole Nicolai (Kvisler), 22, both connected to the Boot Boys neo-Nazi gathering, of homicide. Jahr was condemned to 16 years in jail and (Nicolai) Kvisler 15 years. Veronica Andreassen, 18, was indicted as an accomplice to the ambush and imprisoned for a long time. The court said the homicide was arranged, racially persuaded and submitted by individuals from a Neo-Nazi gathering incompletely to spread dread. It likewise found that Jahr and (Nicolai) Kvisler had each cut Hermansen with various blades. "Benjamin Hermansen would not have been assaulted if his skin had been a similar shading as the defendants," the court's decision said. The court said Jahr and (Nicolai) Kvisler had gone out that night with the expectation of "getting a foreigner" and had brought blades. It said that while Andreassen didn't take an interest in the assault, she went with them regardless of realizing they arranged savagery. Hermansen, who was dynamic in his school and sports, was brought up in Norway. He likewise had taken a stand in opposition to bigotry on national TV a couple of months before his passing after he was ambushed by neo-Nazi adolescents during a soccer competition in Denmark. â€Å" (fare.net) That was a news story I found on a Norwegian enemy of supremacist site. It happened just a couple of days back on January 21st in Norway. This shows the commonness of bigotry despite everything going on today. The gathering answerable for the homicide had a place with an association that considers themselves the Neo-Nazis. One of the inquiries I’ve constantly posed in my history classes, is â€Å"Why do we have to think pretty much so much stuff that happened for such a long time ago?† Last year, my history instructor, Mr. Slater, furnished me a response. He said we have to find out about history, or we will be destined to rehash our past mix-ups. All things considered, I’ll talk about how Nazism began. First and foremost, there was Adolf Hitler. He carried on with a fairly uninteresting life as a kid. His dad was a traditions official at the fringe isolating Austria and Germany.

3 Medications for Alcoholism Treatment

3 Medications for Alcoholism Treatment September 24, 2019  zoranm/Getty Images More in Addiction Coping and Recovery Overcoming Addiction Methods and Support Personal Stories Alcohol Use Addictive Behaviors Drug Use Nicotine Use Currently, there are only three medications approved by the U.S. Food and Drug Administration  for the treatment of alcohol abuse  and alcohol dependence. None of these medications are prescribed to people who are still drinking alcohol. They are only for those who have already stopped drinking and are trying to maintain abstinence.?? There are no medications on the market that are prescribed for people who are still drinking alcohol that will cause them to stop drinking. Antabuse (Disulfiram) as a Drinking Deterrent Antabuse (disulfiram) was the first medicine approved for the treatment of alcohol abuse and alcohol dependence. It works by causing a severe adverse reaction when someone taking the medication consumes alcohol. Most people who take it will vomit after a drink of alcohol. This, in turn, is thought to create a deterrent to drinking.?? Disulfiram was first developed in the 1920s for use in manufacturing processes. The  alcohol-aversive effects of Antabuse  were first recorded in the 1930s. Workers in the vulcanized rubber industry who were exposed to tetraethylthiuram disulfide became ill after drinking alcohol.?? In 1948, Danish researchers trying to find treatments for parasitic stomach infections discovered the alcohol-related effects of disulfiram when they too became ill after drinking alcohol. The researchers began a new set of studies on using disulfiram to treat alcohol dependence.?? Shortly thereafter, the U.S. FDA approved disulfiram to treat alcoholism. It was first manufactured by Wyeth-Ayerst Laboratories under the brand name Antabuse. Initially, disulfiram was given in larger dosages to produce aversion conditioning to alcohol by making the patients very sick if they drank. Later, after many reported severe reactions (including some deaths), Antabuse was administered in smaller dosages to support alcohol abstinence.?? Naltrexone for Alcohol Cravings Naltrexone is sold under the brand names Revia and Depade. An extended-release, monthly injectable form of naltrexone is marketed under the trade name Vivitrol. It works by blocking in the brain the high that people experience when they drink alcohol or take opioids like heroin and cocaine.?? Naltrexone was first developed in 1963 to treat addiction to opioids. In 1984, it was approved by the FDA for the treatment of drugs such as heroin, morphine, and oxycodone. At the time, it was marketed by DuPont under the brand name Trexan. In the 1980s, animal studies discovered that naltrexone also reduced alcohol consumption. Human clinical trials followed in the late 80s and early 90s. These showed that when combined with psychosocial therapy, naltrexone could reduce alcohol cravings  and decrease relapse rates in alcoholics.?? The FDA approved the use of naltrexone to treat alcohol use disorders in 1994. DuPont then renamed the drug Revia. Campral (Acamprosate) for Discomfort Campral (acamprosate), is the most recent medication approved for the treatment of alcohol dependence or alcoholism in the U.S. It works by reducing the physical distress and emotional discomfort people usually experience when they quit drinking. In 1982, the French company Laboratoires Meram developed acamprosate for the treatment of alcohol dependence. It was tested for safety and efficacy from 1982 until 1988 when it was authorized for use by the French government to treat alcoholism. It was first marketed under the name Aotal.?? For more than 20 years, acamprosate was widely used throughout Europe for treating alcoholics. It was not approved for use in the U.S. by the FDA until July 2004. It was first marketed in the United States in January 2005 under the brand name Campral.?? Campral is currently marketed in the United States by Forest Pharmaceuticals.

Future of Leadership - 2475 Words

Future of Leadership (Research Paper Sample) Content: What is the Future of Leadership? Name of the student Institution affiliation What is the Future of Leadership? The art of leadership has evolved over the years, making the institution more competitive than ever before. In retrospect, many challenges have come with this revolution, many leaders having the responsibility to determine courses of action at critical moments. Amidst the challenges, there has been an increasing need to assess leadership in the context of sustainability in order to determine how present models, values and principles may contribute to the leadership in the future. Owing to the fact that good leadership liberates the society from many challenges and introduces paths of success, it would be important to determine how leadership will be shaped for the future. Requisite values in leadership relevant in the future Marching into the future of leadership requires an understanding of the critical values that are expected from the modern leaders. As vital pace setters and the vision holders of the society, the leadership is supposed to have key qualities that shape the institution of leadership in the modern day. Besides being approachable, leaders are expected to exhibit traits of fairness and the ability to listen and discern between various opposing perspectives (Morrison it evolves depending on the changing needs and demands of the society (Riggio, 2003, p. 68). In the future, this discipline will be viewed from the context of a changing society; one driven by demands of better identities and performance. In this respect, the modern views of an institution of static traits called leadership are bound to change, and depart from the tendencies that seek to embody the qualities of leadership in individual persons (Karp & Helgo, 2008, p. 33). It then emerges that the role of leadership will be formulating courses of action, and pursuing those that show where the organization should face at a given time in accordance with the needs of the society at the designated instant. The changing views on the origins of leadership capability Most literature has continued debates on the emergence of leadership qualities and mainly the main foundations on which leadership thrives. It would be important to note that the future of leadership will be focused on the identities that are witnessed in the cumulative experiences of a leader, as opposed to the characteristics that a leader portrays (Karp & Helgo, 2008, p. 34). This subject is mainly analyzed in the context of whether leaders are born with their characters or are formed by the experiences they face and the skills they face as they tackle the challenges that face modern organizations. In this context, the future leadership will tend to rely more on dynamic tendencies that are the results of the identity of the organizations or leader, as opposed to static traits that have been inculcated into the individual by nature (Riggio, 2003, p. 49 ). The concept of relationships in future leadership It is important to note that the future leadership will thrive on the formation of relationships, a two-way process that involves the interlink between the leaders and their followers (Earley, Weibling, Bubb, & Glenn, 2009, p. 305). This dictum lies within the rubric that human beings form and develop certain patterns of behavior when they are together or in the same environment (Karp & Helgo, 2008, p. 34). The human brain in hence analyzed in the context of a social organ, developing into patterns that are shaped by the course of the society. The concept of relationships is analyzed mainly in the contexts of cognitive, dynamic and social perspectives, being the results of research and studies that have been developed into the concept of leadership and external influence. As a key to developing the best trends in future leadership, there is a need for emotional intelligence, a trait that would dictate the success of both personal and professional success (Riggio, 2003, p. 45). In this perspective, having the ability to influence positive relationships will be critical to the future of leadership, majorly prescribing the routes that organizations will take and their performance. Future leadership in the psychological perspective The leader in the future should handle to handle the trends and of the psychological processes of workers and be able to manipulate the different tools that enhance positive coordination, participation and reasoning in the workplace. Such tools are given in the context of motivation, having the ability to communicate, building teams as well as the interlink of cultures in the workplace (Karp & Helgo, 2008, p. 34). It would be important to note that the trends of behavior emerge within teams of employees as a result of proper modes of communication and their motivation. Using the tools of psychological influence that guide the feelings, reactions and emotions of teams, the future lea ders will be in a better position to determine the responses of people, and formulate initiatives that determine the courses of action to be taken. The extent of the relevance and use of the tools will determine the influence of the leader of the team or group of people. Leadership by action The modern leadership has often employed technical means to define the courses of action as well as complex systems as the courses of action. Although the creation of courses of action in a sophisticated manner may not be criticized based on performance, it would be important for analyses future leadership in the true context of leadership. By virtue of being the leader, contemporary reasoning would argue that the leader should set the pace, be exemplary and active in the affairs of the organization. Experience proves that effective leadership is one that is exemplary, directing teams through paths that are dictated by the leader (Karp & Helgo, 2008, p. 35). This entails a leadership model that is flexible to analyze the concept of one’s own self and replicating actions in a way that influences course of action in the team. However, this type of leadership places the bar at a very high point, limiting the eligibility of most people for future leadership (Bennis, & Spreitzer, 2001, p. 103). In this perspective, therefore, leaders aspiring for relevance in the future must therefore frame their practices in a way that allows their followers to see them as active participants of the organization, and not just passive onlookers that demand work to be done. In this scenario, the demands of the leader will be more and their experiences in the workplace will be a determining factor for their continued success in the workplace. Leadership models and the future expectations Authentic leadership This is one of the most interesting forms of modern leadership, arising from the need to transform groups of people into teams that can be harnessed to produce a given result. This model is built on the foundations of a leader who portrays transparency in leadership, an aspect that facilitates a culture of openness and leads to positive behavior in the organization (Avolio, Walumbwa, & Weber, 2009, p. 423). This type draws major insights f...

William Shakespeare s Macbeth - Macbeth s Quest For Glory

Evilness itself is a betrayal of the habitual human nature of any person. The natural tendency of a person is morality; however, that inclination can be corrupted and influenced into twisted malevolence. A common image in the play representing this evil is the serpent, shown to be a conniving, wicked tempter. This symbol takes many forms throughout the story, beginning as a comparison of the ideal character Macbeth should strive to be and finishing as yet another threat to Macbeth’s quest for glory. In Shakespeare’s play Macbeth, both Macbeth and Lady Macbeth have to defy their own human nature to accomplish their desires, namely murdering King Duncan. This action forever changes their mentalities and morals by its test to the strength of their ethics and the loyalty of the relationships to which they belong. Several main betrayals of faith occurred throughout the play, such as Macbeth’s attempt on Banquo and his son’s lives showing his infidelity to his l ongstanding friendship with Banquo. Lady Macbeth was not free from this trend of disloyalty, either. She took part in tempting Macbeth into killing Duncan, the main betrayal of the entire play, which demonstrated her favoring power over her love for her husband. Each of these evil acts was of complete opposition to the natural acts of humanity. Extreme immorality does not come from simply human thought; the idea must be planted into the mind of a human and grown through temptation. The witches’ prophecy for Macbeth, asShow MoreRelatedBlood Imagery in Macbeth Essay1451 Words   |  6 PagesMacbeth is the ultimate story of a fight between the forces of good and evil. It tells the tale of a tragic hero whose quest for power leads to his ultimate downfall. Macbeth starts out as an honorable warrior but changes when his ambition becomes uncontrollable. As he becomes increasingly paranoid, Macbeth uses violent means to eliminate threats to his Scottish throne. As the play progr esses, blood continuously plays a part in the events as the murders become more frequent. William ShakespeareRead More Shakespeares Macbeth - The Transformation of Macbeth and Lady Macbeth2861 Words   |  12 PagesThe Transformation of Macbeth and Lady Macbeth      Ã‚   In the play Macbeth, by William Shakespeare, the characters  Macbeth and Lady Macbeth decide, in a great fit of ambition, to kill King Duncan.   Later in the play we see the same two characters undergo a transformation in their personalities after murdering the King.   Macbeth begins the play as a noble soldier and gradually changes into an ambitious and murdering tyrant.   Lady Macbeth begins as a strong, ambitious woman who dominates her husbandRead Moreshakespeare influences16068 Words   |  65 Pagesï » ¿ RESEARCH TOPIC An Analytic Review Of Shakespearean Influence On Faulkner s Tragedy RESEARCH QUESTION How Shakespeare tragic patterns influenced on William Faulkner s writings? NAME: SYEDA AMBREEN FATIMA FATHER’S NAME: SYED HASAN AKHTER SEAT NO: 1315793 ENROLMENT NO: 2013/ENG/M.A(LIT)/15681 DATE OF SUBMISSION: 28TH NOV 2013 SUBMITTED TO: MISS SAMREENRead MoreLooking for Richard Transcript11989 Words   |  48 Pagesand all the doughnuts we can eat. Shakespeare? What the fuck do you know about Shakespeare? Arise, fair sun... ...and kill the envious moon. Like eager droppings into milk, it doth posset and curd. Some are born great, some achieve greatness... ...and some have greatness thrust upon them. Intelligence is hooked with language. When we speak with no feeling, we get nothing out of our society. We should speak like Shakespeare. We should introduce Shakespeare into the academics. You know why

Causes of The American Revolution Essay - 983 Words

The period before the American Revolution was characterized by a series of social as well as political shifts that occurred in American society as new republican principles took hold in the gentry of the colonies. That time era distinguished the sharp political debates between radicals and moderates over the role that democracy should play in a government. This broad new American shift to republicanism and a newfound support of democracy was a catastrophe to the traditional social hierarchy, which characterized an old mixed government in the Americas. This new republican ethic forced in a new age of American political values. By 1775, republicanism had become a widespread philosophy in the colonies. It incorporated federalist ideals†¦show more content†¦The acts also instituted the need to enforce mercantilist policies in the Americas. The Sugar Act was passed to place a regulation on trade in the colonies to indirectly tax tea (one of the most demanded products in the A mericas). Another act that passed was the Stamp Act. This was the first direct tax on colonial peoples. They responded to this with the plea no taxation without representation. This was a saying that meant the British could not rightfully institute taxes on the colonists because they did not have any political say in whether or not they wanted to be taxed. Practically there was no way that a semi-independent nation 3,000 miles away from Britain could be represented in their government. This was a ploy by the radicals used to market and spark the idea of American independence and formulate more radical ideas. Radical societies were formed to fight against the new acts being instituted by the British. The Sons of Liberty were formed in every colony, and used propaganda, intimidation, and mob violence to prevent the enforcement of the acts. This was a radical group that was formed because of the Revolution in America. American independence in and of itself was a radical idea. The colonies had been established as a money making scheme for great Britain; no one ever guessed they would spark war with their mother country and become their own sovereign nation. Many Radical propaganda writers were influenced by the American Revolution. ThomasShow MoreRelatedThe Revolution : The Cause Of The American Revolution1898 Words   |  8 Pages The American Revolution was the turning point for the colonies that made up the United States today. It was the war that freed the colonists from British control. But what actually caused the American Revolution? Well, there’s no simple answer to that question. In fact, most of the causes acted as if they were dominoes. These events can be categorized in four periods of time or setting. These groups are, Salutary neglect, Mercantilism, Boston, and Unity of protests. Salutary neglect was the ideaRead MoreCauses Of The American Revolution1202 Words   |  5 PagesThroughout history many revolutions took place, ranging from the unremarkable to a truly memorable, as the French revolution, the American Revolution, and the Bolshevik Revolution, but American revolution took place in 1775-1783. The revolution was different from other revolution because of growing tensions between residents of Great Britain’s 13 North American colonies and the colonial government because American revolution was not like the others. This revolution was not like the others becauseRead MoreCauses Of The American Revolution738 Words   |  3 Pagesas the American Revolution, or the Revolutionary War. The American Revolution was a war between the colonists of America and Great Britain and they were fighting over the independence of America from Britain. This war lasted until 1781, when the British surrendered to the Americans, As a result, America is a fully independent country and it has stayed that way since that day. There were many causes of the war, The Stamp Act, the Boston Tea Party, and Lexington and Concord . The first cause of theRead MoreCauses Of The American Revolution913 Words   |  4 Pages While the american revolution was caused from taxes, it was also formed from the effects of a corrupt system of government. The effects of britains rule was a much bigger flame for the revolution then the taxes placed upon citizens. The american revolution was an event that will forever shape us as a country. It was a tough war filled with blood and brutal acts of violence, but it was also an awakening for the colonies that will later become the United States, it showed that while under a governmentRead MoreCauses Of The American Revolution880 Words   |  4 Pages The American Revolution is the most important time in all of American history. This brought the birth of a new country and the treasured constitution. In the beginning, colonists were proud to be British. In the years to come, there were small occurrences that bothered the colonists and led to the Revolution. Other countries contributed to the start of a crueller British control. The French and Indian War caused King George III to introduce expensive taxes (Pavao). These taxes came about becauseRead MoreCauses Of The American Revolution1335 Words   |  6 Pageswere multiple causes for the American Revolution, but the most important was the violation and deprivation of rights from the American People. The American people were faced with multiple acts and taxes that violated and took away their rights. Americans were continuously being taxed after the French and Indian War by acts like the sugar act, the stamp act, the Townshend acts,the tea act, and many more(Hedtke, et al., The Ame rican Saga). Despite all the taxes being placed on the Americans and the thingsRead MoreCauses of the American Revolution953 Words   |  4 PagesEmily Thou Mr. G./ Period 1 September 14, 2012 Causes of the American Revolution The American Revolution began in 1755 as an open conflict between the thirteen colonies and Great Britain. The Treaty of Paris had ended that war in 1783, giving the colonies their own independence. There are many factors contributing to the start of the Revolution, but the war began as the way The Great Britain treated the colonies versus the way the colonies felt they should be treated. For example, the FrenchRead MoreCauses Of The American Revolution886 Words   |  4 PagesThe American Revolution began on April 19, 1775. It was the war between Great Britain and its colonies located in the New World. The colonists, as many historians put it, were like children rebelling against the motherland; however, they had many valid reasons for this revolt, including their desire for freedom and independence. My World History textbook says freedom was falsely promised when the colonists had settled (Krull 868). The more direct causes of this widely known rebellion include taxesRead MoreCaus es Of The American Revolution1344 Words   |  6 PagesAmerican Revolution The causes of the American Revolution go back to the beginning of salutary neglect and the French and Indian War, as well as changes in the thinking of society. The effects of these events and other factors led to pressure within the colonies, ultimately resulting in rebellion. There were five factors to the nature of the American Revolution: The Environment, The Enlightenment, Self-Government, Economic Independence and Colonial Unity. The first factor that led to the AmericanRead MoreCauses Of The American Revolution813 Words   |  4 PagesCauses Before the American Revolution, any imports from England from us had to come in ships owned by the British. Also, we could only sell tobacco and sugar to England. The British took French territory in Canada, east of the Mississippi River, and Spanish Florida which led to the American Revolution. Due to the war, Britain went in debt so, the British government placed taxes on goods so they could make more money. But that’s not all that led to the American Revolution, both the us and the French

Ethical Issues Involved, And Identify Stakeholders

1) Steps one through three in the decision making process include the following: Determine the facts, identify the ethical issues involved, and identify stakeholders. Beginning with the facts of the case Ms. Adams is the sole proprietor of her small successful structural engineering firm with a MBA. She has 15 employees working for her firm in renovation of major historic commercial buildings. One of her largest clients Charles A. Smith owns the Inverness Bank an old, well-recognized seven-story granite faced building. Smith is in the final stages of negotiations to sell the Inverness Bank to a group of foreign investors represented by Sam Goldworthy a local attorney. Mr. Goldworthy requested a structural survey of specific building elements, including outdated window casements, among others to wrap up the deal. Mr. Smith agrees to have the structural survey completed and hires Ms. Adams’ firm to compete the survey. The contract stated a clause saying â€Å"all information discovered by the engineer shall become the property of the client (Smith) and shall not be released to others without the clients’ express written consent.† Adams assigns Brock Williams, one her most experienced engineers to complete the survey. Brock dismantles three units at random for a more precise determination. He dismantles one unit to see how the windows are attached, and discovers a steel strap for anchoring the windows. Brock discovers that the three-inch exterior granite veneer is attached toShow MoreRelatedAssignment B1 1 Essay examples860 Words   |  4 Pages(12%) This assignment gives you an opportunity to analyze a key IT-related organizational ethical privacy issue subject to relevant laws, regulations, and policies. Both of the following sites provide sources and an excellent backdrop for issues relating to privacy protection and the law. See EPIC Report  Ã¢â‚¬â€œ at:  Ã‚  http://epic.org/reports/  Ã‚  See List on left:  Ã‚  HOT POLICY ISSUES and/or:   https://www.eff.org/issues/privacy   [see list at right on this page] This includes sub-topics discussing informationRead MoreCorporate Social Responsibility and Single Strongest Argument1106 Words   |  5 PagesIdentify and explain the major factors in the social environment that create an atmosphere in which business criticism takes place and prospers. dasdasdassadasdasdadadasdadsdadasdasdassssssssssssssssssssss- ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss- ssssssssssssssssssssssscourse? Or is it still a vital reality? 4. Give an example of each of the four levels of power discussed in this chapter. Also, give an example of each of the spheres of business power. 5. Explain in yourRead MoreEthical Conflicts : Teleological, Deontological And Contemporary Theories Essay1270 Words   |  6 PagesAnalysis of ethical conflicts is mainly based on teleological, deontological and contemporary theories. ANALYSIS OF ETHICAL ISSUES Teleological theory is based on the consequence of an action and not about the action itself. It mainly focuses on the outcome an action will produce even though the action is unethical. If the outcome is ethical even when actions leading to it are unethical, then this theory is technological theory. It looks into the future if an action done. For example, a businessmanRead MoreEthics Game1353 Words   |  6 Pages2012 Barbara Scheibe, RNC, MSN Ethics Game Simulation Reflective Journal This journal contains my reflections of the Ethics Game simulation assignment. The purpose of this assignment is to help me understand how to make ethical decisions using a decision model. Ethical Issue #1-Presented during my shift We have a 16 year old pregnant patient (RB), in her tenth hour of labor. Her parents are present and have been with her the entire time. They have chosen to limit medication and assistance availableRead MoreResolving Ethical Dilemmas767 Words   |  4 PagesResolving Ethical Dilemmas Calvin L Harris Jr. ETH 316 15 November 2012 Marlon Spencer Resolving Ethical Dilemmas Ethical issues are inevitable because we live in a world of diversity. Diversity brings many beliefs, attitudes and personalities. As a result, ethical issues are common. They come in many shapes, sizes, and favors. Even though ethical issues cannot be prevented, ethical issues can be resolved because sound decisions can by considering ethical lenses to address andRead MoreProfessional Ethics : My Professional Ethical Model1388 Words   |  6 PagesProfessional Ethical Model Heather Youngs Eastern Washington University My Professional Ethical Model I have reviewed a few ethical models in formulating my own for my professional counseling practice. I first checked the American Counseling Association (ACA) Ethical Model, as well as the American Mental Health Counselor’s Association. I found the ACA’s model to be very helpful in determining what facets and perspectives a counselor would utilize to examine an ethical dilemma withRead MoreStakeholder Analysis1018 Words   |  5 Pagesï » ¿Overview of Stakeholder Analysis on City Harvest Church Financial Irregularities As listed in a table, potential stakeholders will be reviewed according to their interests in City Harvest Church. Issues like benefits of the project to the stakeholders or activities that might cause damage or conflict to the stakeholders will be included. Each stakeholder will be listed in one column. Individual stakeholder’s interest will be reviewed on its importance to the success of the project. To ensureRead MoreThe Mysterious Roses and Cold Feet1056 Words   |  5 Pagesexercise we were required to address the issues in the simulation and identify the best decision for all parties involved. This summary will review what ethical issues were presented in the simulation, the decision making steps to ethically address the issues, the perspectives and lenses that were used to make the decision, influences in the decision making and concepts that relate to my work place. The first simulation â€Å"The Mysterious Roses† presented an issue that could have potentially been aRead MoreA Few Good Men Summary938 Words   |  4 PagesA Few Good Men Summary A few Good Men is a movie that presents strong a strong ethical dilemma. The story is about two Marines Pfc Downey( James Marshall), and Lanc Cpl. Dawson (Wolfgang Bodison) who are charged with the murder of another marine PFC Santiago. The legal team representing is comprised of Lt Kaffee (Tom Cruise) who seems to be more interested in playing baseball, his friend LTJG Sam Weinberg (Kevin Pollack), and Cmdr Galloway (Demi Moore), who believes there is more to the story behindRead MoreEngineering At Scientific Engineering Corporation1609 Words   |  7 Pagesthe new material, in order to meet its delivery schedule with NASA. Unfortunately for Gary, his lack of project management and business process knowledge will result in numerous technical, contractual, ethical and legal issues throughout the term of the project. Technical and Contractual Issues When STI issued its request for proposal for the Orion Shield project, STI did so under the assumption that subcontractors would be responding to the request based upon their current tested technical solutions

Analysis Of Shakespeare s The Midsummer Night s Dream...

SHAKESPEARES PLAYS-SHAKESPEARE Interpretations of greek mythology in shakespeare: mention main focus on ovid and reasons—most popular at time --can briefly mention other sources One of the ways Shakespeare incorporated classical allusion into his work was simply by description. He would reference a character or place, in place of an adjective, so as not to have to go into too much detail as his audience at the time would have understood that point he was trying to get across due to their education. These references would have little effect on the actual plot of the play. These references would be used to describe appearance, personality, mood or occupation. Theseus’s monologue in A Midsummer Night’s Dream, about the insanity of lovers shows this clearly when it describes how the lover in question perceives his love as having ‘Helen’s beauty’, even without being objectively unattractive. This reference was clear and would definitely be understood by Shakespeare’s intended audience. Even in modern art and literature Helen of Troy from the Trojan horse myths is seen as the epitome of beauty. --Mythological names can also be used to represent a mood or state of mind. In A Midsummer Night’s Dream, Hermia uses a range of references in association with Lysander. These ranged from Venus, the goddess of love, Cupids Golden arrows, to Queen Dido. Queen Dido was abandoned by her Trojan lover, Aeneas, and burned herself alive. These references were used to convey the passion feltShow MoreRelatedWilliam Shakespeare s A Midsummer Night s Dream And Fool1401 Words   |  6 PagesWilliam Shakespeare. While their individual personalities and functions differ from play to play, the reoccurrence of the Shakespearean fool suggests that fools serve as an important institution of the Shakespearean stage. But what is the role of the Shakespeare’s fools in his works? And how do particular characteristics about these fools help them achieve this purpose? Through an in-depth analysis of Shakespeare’s arguably two most famous fools, Puck (Robin Goodfellow) from A Midsummer Night’s DreamRead MoreWhy Did Freud Use Oedipis As Basis?1355 Words   |  6 PagesSHAKESPEARES PLAY-FREUD WHY DID FREUD USE OEDIPIS AS BASIS!! HAMLET Freudian theories are most prominent in Hamlet out of all Shakespeare’s plays. The most common repressed desire is that of Oedipus. In the myth Oedipus killed his father, and went on to marry his mother, without knowing who each of them were. In this myth the feelings are brought to light however in Hamlet they stay repressed. We only learn of it through the effects it causes. Hamlet is all about incest. After his father’s deathRead MorePerfect Idealism In Shakespeares Hamlet1631 Words   |  7 PagesIntroduction The play Hamlet is a fable of how the ghost of a slain king comes to haunt the living with disastrous consequences. A rancorous ghost and a brother s murder, lead the gloomy setting of Hamlet s Denmark. Hamlet story opens with an encounter between young Hamlet, his dad s ghost as well as the prince of Denmark. The ghost reveals to Hamlet that its murderer was his brother Claudius, who then rapidly wedded his widowed queen, Gertrude. As a result, the ghost presses Hamlet to seek vengeanceRead MoreEssay on A Midsummer Nights Dream: Critical Analysis3103 Words   |  13 PagesCritical Analysis of quot;A Midsummer Nights Dreamquot; William Shakespeare, born in 1594, is one of the greatest writers in literature. He dies in 1616 after completing many sonnets and plays. One of which is quot;A Midsummer Nights Dream.quot; They say that this play is the most purely romantic of Shakespeares comedies. The themes of the play are dreams and reality, love and magic. This extraordinary play is a p lay-with-in-a-play, which master writers only write successfully. Shakespeare provesRead MoreWilliam Shakespeare s Romeo And Juliet1231 Words   |  5 PagesWilliam Shakespeare is certainly one of the best known playwrighters of the theater history for having written plays such as Romeo and Juliet or Macbeth. A feature of Shakespearean theater is so-called â€Å"theatre within a theatre†, â€Å"drama within a drama† or more generallyâ€Å"a play within a play†, i.e a play where the author stagged, at some time, an other theater play inside this one. Many of his plays can be qualified as â€Å"plays within plays† and espacially Hamlet and A Midsummer Night s Dream. ThereforeRead MoreSatire : The Fundamental Function Of Satire1644 Words   |  7 Pageslaughing at the misfortune of others, who we perceive as being inferior to us in some way or who we view as being set in their ways and incapable of changing their circumstances. [3] World famous Austrian neurologist Sigmund Freud and founder of psycho-analysis published a book entitled ‘Jokes and Their Relation to the Unconscious’ which deals with the perennial themes of comedy and laughter. He analyses three laughter situations: der Witz (translated as â€Å"joking†), â€Å"the comic† and â€Å"humour†. Firstly, derRead MoreThe Theme Of Homo Eroticism Within The Play As You Like It And How It Differs From Various Other3688 Words   |  15 Pages Within this analysis, I will inquire into the theme of homo-eroticism within the play As You Like It and how it differs from various other plays written by Shakespeare and elaborate on how ground-breaking this play was during the time it was written and when it was performed, the differences in social constructs between then and now the differing views of society in the time it was written and the present day. As You Like Its first performance was in London in 1740, a time when popular literatureRead MoreAnalysis Of Shakespeare s The Tempest 2603 Words   |  11 PagesMalouin 11 Measuring a Life in a Drama When many people think of William Shakespeare, they think of plays like Romeo and Juliet, Macbeth or Hamlet. One of the most influential plays written by Shakespeare is not one listed above. The play that reflects the life and all of Shakespeare?s plays is The Tempest. This work was and still is influential in both America, Britain and around the world. Although William Shakespeare was an influential writer in American and British literature, The TempestRead MoreRhetorical Devices3007 Words   |  13 Pagesis part of classical rhetoric and a number of rhetorical devices are worth considering in any analysis of style. For the analysis of literature a knowledge of rhetorical devices is indispensable, since there is often a considerable density of rhetorical figures and tropes which are important generators and qualifiers of meaning and effect. This is particularly the case in poetry. Especially the analysis of the use of imagery is important for any kind of literary text. (For furt her details see AnalysingRead MoreShakespeare As A Midsummer Nights Dream Essay1922 Words   |  8 PagesWilliam Shakespeare is a well know writer in the English time. William Shakespeare was a poet but he was also a play writer and actor. According to The Longman Anthology British Literature, Volume 1b, The Early Modern Period pgs. 1199-1203. William Shakespeare was the greatest writer in the English language, he wrote poems that incorporated plays of histories, tragedies, comedies. Shakespeare was the third child of John and Mary Shakespeare, born in Stratford-upon-Avon on April 23, 1564, and at

Counseling Psychology Free Essays

A fuller understanding of clients’ problems within the province of psychological counseling involves not only the cogency of the framework employed but also how it applies in practice. Mindful of the fact that there is no single intervention or explanation that can possibly apply to all cases; there is a pressing need for counseling psychologists to take into consideration the client’s point of view; that is, how the client understands, appropriates and integrates for his/herself his/her current situation. If we are to characterize the past two decades, we may say that it is noted for an increased emphasis on methodological diversity, not only in approaches but also, and more importantly, in terms of alternative research methods in counseling psychology (Goldman, 1976; Howard, 1983). We will write a custom essay sample on Counseling Psychology or any similar topic only for you Order Now In this aspect, the emergence of pragmatism allowed for diverse approaches in counseling psychology which values both objective and subjective knowledge (Hanson, 2005, p. 226). Mindful of this significant shift in theorizing and research, this paper seeks to articulate the underpinnings of the generalist approach to counseling psychology, their problems and limitations so as to provide feasible solutions for a more pragmatic approach that is beneficial not only for the clients but for the practitioner as well. The dominant approach in the profession of counseling psychology is the generalist model of intervention. The generalist approach is essentially a problem-solving approach which operates on the assumption that as experts, psychologists know best, since they have the necessary knowledge, skills and training in handling clients’ problems. Six interrelated steps/stages are involved in the generalist intervention model: (1) assessment, (2) planning, (3) intervention, (4) evaluation, (5) termination, and (6) follow up. The essential difference between the generalist and the person-centered approach in terms of intervention is that the generalist sees the relationship in the â€Å"expert-client† kind of way, whereas, it is not necessarily the case for the person-centered approach. The counseling psychologist who employs the person-centered approach knows the value of emphatic listening and applies it to his/her clients for this will be of great help in addressing the client’s need for positive regard from others. If the client feels comfortable with the counseling psychologist because the latter knows how to listen, then this will be of great help in boosting the client’s self-worth. The person-centered approach was developed from the client-centered approach by Carl Rogers. Regarding the impact of the person-centered approach, Krebs and Blackman (1988) wrote: â€Å"The person-centered approach has had impact on domains outside of therapy such as family life, education, leadership, conflict resolution, politics and community health. † On a preliminary note, it may be said that for Krebs and Blackman, the person-centered approach has many interesting and fruitful applications. As was noted earlier, Roger’s person-centered therapy is a modification of his client-centered therapy, the foundation of which is a phenomenological and existential framework on construing a theory of personality. An adequate theory of personality, as Roger sees it, must take into account the core notions of (1) human nature and (2) the human condition and the reason for improving the aforementioned condition. He writes: â€Å"the core of man’s nature is essentially positive† (1961, p. 73). He adopts an organismic view of the person in a positive way. It is positive in the sense that the person, as an organism, is driven by an actualizing tendency. This idea is actuallly not something new and may be compared to the ancient Greeks idea of the telos which is the Greek term for end or purpose. In Aristotle’s view, for instance, man’s telos involves the actualization of the distinctive human function. It is, in this direction then that human beings ought to move [that is, the actualization of the human potentials]. â€Å"The good life is a process not a state of being. It is a direction, not a destination (Rogers, 1961, p. 186)†. The Self then for Rogers, is driven by the said actualizing tendency. A fully-functioning person for Rogers is a person who is developing, or if I may use Aristotle’s word â€Å"flourishing†. The fully-functioning person flourishes, so to speak, that is, geared towards development. Development in this sense, would involve personality development. Since man’s nature, as Rogers claims, is positive then he/she will seek personality development. If the person-centered approach to counseling psychology is more appropriate in terms of producing successful outcomes, then perhaps we may consider juxtaposing such an approach with the constructivist framework. According to Neimeyer (1995) constructivism represents a meta-theory and epistemologic stance that emphasises self-conceiving, self-organising, and proactive features of human knowing (cited in Savickas, 2000, p. 60). Moreover, by juxtaposing the person-centered approach with constructivism, both the client and the counseling psychologist may continuously review, revise and re-orient themselves with the things that they know and how they live their lives. This is to say that there is no monopoly in terms of the learning process that takes place since both the client and the counseling psychologist takes an active part in the meaning-making process. This way, psychology becomes humanistic. Rogers’ person-centered approach is of this type. Humanistic psychology, as a reaction to positivistic psychology, sheds light on important questions that matter, not only for the client and practitioner, learner and teacher. Schneider, et. al, summarized these questions as follows: â€Å"What does it mean to be fully experientially human? † and â€Å"How does that understanding illuminate the fulfilled or vital life? † (Schneider, et. al, 2001, p. xx). These questions are questions of universal concern and have been framed in different ways by different thinkers in different periods in the history of ideas. In the final analysis, we may take refuge in the thought that developing humanistic psychology brings us closer to understanding our human condition, our situatedness. In so doing, it also gives us a fuller understanding of our very own humanity. For it is by knowing who we are and where we stand can we chart the rightful path towards a just and humane society. References Goldman, L. (1976). â€Å"A Revolution in Counseling Psychology. † Journal of Counseling Psychology. 23: 543-552. Hanson, W. E. (2005). â€Å"Mixed Methods Research Designs in Counseling Psychology. † Journal of Counseling Psychology. 52: 224-235. Howard, G. S. (1983). â€Å"Toward Methodological Pluralism. † Journal of Counseling Psychology. 30: 19-21. Krebs, D. , Blackman, R. (1988). Psychology: A First Encounter. Toronto: Harcourt Brace Jovanovich. Rogers, C. R. (1965). â€Å"A Humanistic Conception of Man†. In R. E. Farson (ed. ) Science and Human Affairs: Science and Behavior Books, Inc. ___. (1961). On Becoming a Person. Houghton Mifflin. Savickas, M. L. (2000). â€Å"Renovating the Psychology of Careers for the Twenty First Century. † The Future of Career. Cambridge University Press. Schneider, K. J. , et. al. (2001). The Handbook of Humanistic Psychology: Leading Edges in Theory, Research and Practice. Sage. How to cite Counseling Psychology, Papers

Spiritual Assessment free essay sample

For this assignment I was ask to develop a spiritual assessment tool, interview a patient using this tool, summarize my findings, analyze my results, identify areas of improvement and describe the spiritual experience that this spiritual assessment offered to better meet the needs of my patient. Research indicates a close connection between spiritual needs and physical needs. Integrating spiritual assessment into patient care has become vital for hospital and other health care settings. Spiritual assessment in the hospital setting is also mandated by joint Commission on accreditation of Healthcare organizations (JCAHO). Spiritual, 2009). I developed this tool using criteria from the HOPE assessment tool. This tool was originally created by Gowri Anadarajah and Ellen Hight from the department of family medicine at Brown University. The HOPE assessment lets nurses or other health care providers collect information in a non-threatening manner, it is brief and goes over critical areas. It also allows patients to tell their own story about important spiritual issues that might affect the patient’s physical health needs. â€Å"H=Sources of hope, meaning, comfort, strength, peace, love and connection. O= Organized religion. Personal spirituality and practices and E= effects on medical care or end-of-life decisions† (Galek, Flannely, Vane, Galek, 2006). When completing a spiritual assessment tool it is important to always respect our patient’s spirituals beliefs and to be open minded. There is a lot we can learn by exploring our patient’s spirituality and a lot of modification we can make in their plan of care to meet their overall needs. Summary of assessment findings Mrs. B. F. is a 52 yr old Hispanic female. Post surgical patient, who states God and the support of her family, gives her hope and strength in difficult times. She labels herself as â€Å"halfway catholic† and does not belong to a particular church. She attends church about once every two months. She feels that when she goes to church she finds peace and is able to communicate with God better. She likes it better when there is not a lot of people in church. Mrs. B. F. believes she has a good relationship with God, but she does regret not dedicating more time to God and also regrets not teaching her children about God. She thinks her children are worried about her now that she is in the hospital and they need God’s support to deal with her illness. She plans to teach her children how to get closer to God when she is discharge from the hospital. She likes to pray to God and the Virgin Mary. Mrs. B. F. believes her deceased grandmother and deceased father are her guardian angels. She also believes in Karma â€Å"if you are a good person, good things will happen to you†. All her spiritual and religious beliefs are important to her. She also indicated her wishes to see a priest and to visit the hospital’s chapel. (F. B. 2011) Significant discoveries When I evaluated Mrs. B. F. I made the following discoveries: At first she gave me the Impression that she did not want to answer my questions, but quickly she became really involved in the conversation. She opened up to me and was willing to discuss her spiritual needs. She sounded honest when answering the questions and pleased that I took the time to hear her concerns. She admitted feeling guilty about not teaching her children her religious beliefs and voiced concern about her children not having God in their lives. She also showed interest in meeting with a priest which I arranged after the Interview. What went well? I am pleased that my interview went well. At first I did not feel confident that I had the skills necessary to lead a spiritual assessment. In the past the only thing I did was to ask my patients if they belonged to a church or religion and asked if they needed to see a chaplain/ priest or spiritual leader. This time I felt that Mrs. B. F. was engaged in the conversation. I was able to ask open ended questions that encouraged the assessment to flow naturally and I was able to meet some of her spiritual needs. What would I do differently in the future? When interviewing Mrs. B. F. I noticed we had a few unnecessary interruptions that disrupted the low of my interview. In the future I will post a sign at the door indicating interview in process and I will notify the patient’s primary nurse and the unit secretary about what I am doing in order to minimize the interruptions. Barriers or Challenges One of the challenges that I encountered was not having enough experience to have the appropriate answers to the patient’s responds without sharing my own religious or personal beliefs. I had a hard time letting the interview continue without me sounding like I was giving advices that reflected my religious beliefs. I can see how it an be challenging to conduct this interview with a patient that has a different faith or different spiritual beliefs than mine. I also had to modify my questions to more open ended questions instead of yes or no questions. Example question #8 and question #9. Description of Spiritual experience Using this spiritual assessment tool helped me developed a special relationship with my patient deeper that when I am just focusing on my patient’s physical needs. I am now more comfortable exploring the spiritual side of my patients without immediately relying on a chaplain or a priest. My patient seemed so grateful with me for taking the time to listen to her that the next day I made sure somebody took her to the hospital’s chapel. I did not personally go with her. Perhaps the next time, I will have the courage to accompany one of my patient’s to the chapel. This tool not only help me better meet the needs of my patient, but also helped me understand my own spiritual beliefs. I learned that I am a very private person when it comes to expressing my religious beliefs. I also learned that I don’t feel comfortable taking a patient to the hospital chapel. It is important for health are providers to understand and be clear about their own spiritual beliefs to be able to remain patient-centered and non-judgmental when addressing patient’s religious and spiritual concerns. (Anandarajah, hight, 2008). Conclusion From this assignment, I have learned how much closer a nurse or other health care provider can get to their patients by evaluating the patient’s spiritual needs. Also how important it is for all nurses to promote spiritual health into their practice in order to develop their patient’s trust and provide quality care in a holistic approach.

The Fraser River Gold Rush of 1858 free essay sample

I live in Fort Victoria. The region changed awfully with the Fraser River  . gold rush of 1858. In that year, as many as 30,000 people arrived in the region. Therefor, the population of Fort Victoria rose. There was such an entrance of people, in fact, the Britain established the colony of  British Columbia  on the mainland, in order to strengthen its control over the area. The gold rush brought With it, different people of many ethnic backgrounds. For example, like Hispanic and Chinese. People came from the United States and from other parts of British North America. Until the gold rush of 1858, fur trading had been the dominant industry, controlled by the Hudson Bay Company. With the rush, gold mining  became the absolute economic activity. Coal mining, as well as forestry and fishing, also emerged during this period, but none rivalled gold in importance. The period of prosperity was short-lived. By the mid-1860s the gold rush had collapsed, sinking British Columbia into a painful trouble. We will write a custom essay sample on The Fraser River Gold Rush of 1858 or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The British Colonies were interested in forming a Federal Union or a Confederation. Although not all colonies wanted to do so. While Canada and the Maritime provinces were negotiating Confederation in the mid 1860s, British Columbia and Vancouver Island were consider a union of their own. In this time of trouble that followed the gold rush, separate colonial administrations was a wrong financial burden. The union of the two colonies became official in 1866. In 1867, the reformers convinced the governer to allow British Columbia into Confederation. But a major catch was the thousands of kilometres of HBC-owned land separating British Columbia from Canada. That land, known as  Ruperts Land and the North-west Territories. , would have to be accomplished before Canada could stretch from sea to sea. In May of 1868 De Cosmos helped to found the  Confederation Legue. In July 1868, the Canadian government had passed the  Ruperts Land Act. This was to purchase all land that belonged to HBC. With this purchase Canada controlled territory all the way to the Pacific Ocean. So basically, I support confederation because simply put, It brought all the colonies together and also formed a law biding government. By: Khadheeja Sally

Utilitarianism And Euthanasia Essay Example For Students

Utilitarianism And Euthanasia Essay Today there are five to ten thousand comatose patients in long term care facilities (Wheeler A1). There are countless elderly people in care facilities that have repeatedly expressed a desire to die. There are countless terminally ill patients that have also begged for death. Should these people be allowed to die, or should they be forced to keep on living? This question has plagued ethicists and physicians throughout the years. In the Netherlands, courts have begun to permit the administration of lethal injections to terminally ill patients (Jacoby 101). To many people, this is a barbaric practice. To others, it is the only humane thing to do. When a person is dying of a terminal illness with no hope of recovery, that person should be allowed to die if they wish. Deliberately keeping them alive to endure the pain and suffering of their illness is the barbaric practice. If they wish death, death should be given to them. Activists for the Right to Life dont stop to consider the right to die. I believe that the Right to Die is as sacred a right as the Right to Life. People who believe in the Right to Die are not alone. The Hemlock Society, which advocates the right to die for terminally ill patients claims to have 28,000 members in forty chapters nationwide (Derr 3). We will write a custom essay on Utilitarianism And Euthanasia specifically for you for only $16.38 $13.9/page Order now One of the controversies over the right to die is: who should choose? If the patient is comatose or is unable to make rational judgements, should the doctor or a family member be permitted to make the final decision? If family members were allowed to make the decision Right to Life advocates claim, a family member could get away with the murder of a relative just because that person cant make up their own mind. Right to Death advocates have a simple answer to this problem. Every person should have a Living Will which simply states that that person wishes death if they are fatally injured or become terminally ill. A Living Will would permit people to make their own decisions about life and death with no possibility of being misunderstood. Today, Holland has legal euthanasia where an estimate for the figures for deaths from active euthanasia would be in the range of six to eighteen thousand deaths (Moody 712). This number may seem horrible to some, but to others, it simply means another six to eighteen thousand people who are no longer suffering. I do not know why the Advocates for the Right to Life insist on keeping people who are suffering alive, but I do know that they have no right to dictate to a person whether or not they have the right to die. I can understand the concern of these people that euthanasia might be used for unethical killings, such as the Nazis did in World War II, but if euthanasia were strictly regulated to include only those who had specifically asked for euthanasia, or those who had asked for it in living wills, then what happened in Germany could be prevented. When someone is suffering extreme pain from an injury or a terrible disease, do we deny them drugs to make them more comfortable? Of course not. I see no reason to deny the same suffering and dying people the comfort of death. WORKS CITED* Derr, Patrick. Euthanasia and the Future of Medicine. Hastings Center Report December 1988: 2-3* Jacoby, Tamar. I Helped Her on Her Way' Newsweek November 7, 1988: 101* Moody, Harry R. Legal and Ethical Issues in Elder Care: The Right to Die Gerontologist October 1988: 711-712* Wheeler, David L. Euthanasia: an Increasingly Pressing Issue for Ethicists and Physicians Chronicle of Higher Education November 9, 1988: A1, A6

Data Models of Accounting Information Systems Essay Example

Data Models of Accounting Information Systems Essay Example Data Models of Accounting Information Systems Essay Data Models of Accounting Information Systems Essay In Accounting Information Systems, the object is the economic entrepreneur and the information store which is needed in a structural way so the data may be consistent and integrated. Reality modeling of the components around the economic unit is very important for building an obedient system which stores the information ABA the economic unit. In the beginning of Accounting Information Systems modeling of the data was made by materializing the processes of the economic unit into process which the computer may process fast and with fewer errors than humans. This model didnt take into consideration the Truckee of traditional data of the discipline of accounting. They stored the model intact as it was described by Bacilli during Renaissance. The Conservatism really the half accounting profession. So the the change from a stable model and hashishs appendicitis in use numeration millennium in a new model would not be easy accepted from the community unless the new model wasnt clear enough and usable. The Traditional Model uses statements to prevent errors and repetitions in computing. As the computers do the calculations very fast and without error there is no need for these statements. So the statements are just converted virtual views that contains the information processed and is viewed as man times as the user need. Beginning from the years 1975 until the beginning of 80 a number of change happened in the Celled of data modeling in general and in the modeling of data in Accounting Information Systems. AREA Model In 1979 William E. McCarthy on his thesis An entity-Relationship View of Accounting Models introduced a model which is now implemented in the most famous ASS and ERP. Etc. Importance can be given to the Clinician information system (e. G. ERP) which doesnt eve anything from traditional system. The procedure which is recommended to be taken while building an ASS model is: His suppose was based on the postulate: ASS may be naturally simulated on a relational database which contains real world entity and relations between these entities. In his thesis he emphasized the need to not be focused on the model: Transaction Table + Double Entry Principle which restraint the 3. . Identification of classified entities in Agents, Events and Resources. The building of an E-R diagram which will expose the meaning of these entities and relations between them. Definition of entities characteristics and of the relationships between them, classified by the demands of the different PDF Double Entry Principle -? which restraint the information of the entrepreneur in only one as- sided by the demands Of the different level users. 423 Data Models of Accounting Information Systems AREA vs.. IAC Sigil Hexagram, Aimed Faith Errors 4. Organization of results from the preview- process as the only way of his enhancement. Us Steps in the tables and identification AREA presents the fundamental change in the of their unique characteristics (Keys). Tat modeling of ASS, so it presents ASS itself. AREA model is the base of all other models of Information Identity]action and protection in ASS and there have been a lot of his versions, this 1 . Model is done by following these steps: Event 2. Sources which are consumed or added by this event 3. Internal Agents 4. External Agents for example: AREA-L which. Adds the entity: Locations to the AREA -model, The main rules are: 1. Every Event is connected to at least one Source from which it differ 2. Every Event is connected to at least one other Event. 3. Every Event is connected to at least two Double Entry Principle Consistency Agents (The economic duality principle). McCarthy is being thanked in a lot of books about ASS as the person who had the courage to think different from the others. Double Entry Principle seems that it makes a lot of information redundancy, but in fact this doesnt happen. This principle means that we have to register at the same time the taking or letting of a good or service with the corresponding balanced amount In money or credit of the taking or letting. There isnt redundancy; these arent different actions but complementary ones. Figure 1: Process example A schematic presentation of the above rules for a process example. Basing on the AREA cycles model of ASS, they would be presented in this way.

Impact of Media on Society Essay Example | Topics and Well Written Essays - 750 words

Impact of Media on Society - Essay Example The media can affect women negatively through their desire to want to look â€Å"beautiful† like models and presenters on television. In different forms of media, women are shown as having an ideal body type (Sands, n.d.). Over a long period of time after continually seeing thin and beautiful women, it has to have an effect on the average woman in society. This can be seen from when little girls get their first Barbie doll; why is every Barbie doll sexy, slim, and are revealing? (Sands, n.d.). The reason is that the media fuels this desire by promoting it as normal. Young girls are susceptible to these types of media because they do not know how to differentiate between the truth and exaggerated truth. Going a little further, the media often plays up the sexualisation of women. This can be shown in many movies, where women are shown to be sexy and powerful. This inadvertently has an effect on women who watch these movies because they then feel like they need to act in the same way. The average model in the fashion industry is young, tall, and slim (Sands, n.d.). This can often lead to anorexia among young girls because they feel like they have to look exactly like those models that they see on fashion catwalks around the world. Another group of society that the media negatively affects is young people, namely teenagers. ... MTV is the most obvious example of this. Research shows that teenagers who watch a considerable amount of MTV have very relaxed attitudes about sex (Williams, 2004). This shows that there is a direct link between teenagers’ behaviors and what they watch on television. The last group in society that the media affects negatively is children. Violence is one of the key issues with children and the media. Research shows that children who play video games reguarly are more likely to be violent later on in life (Tompkins, 2003). Besides this, violence is often displayed on programs that children tend to watch. While this does not have the same effect on children as video games, it can still affect their behaviors when they reach adulthood. Violent behavior will often lead to prison or will affect them socially. Parents need to censor everything that their children watch on television because it may cause them to show violence towards others. The media can be used to benefit society if it is done in the right way. It is not likely that the media’s impact on society will diminish anytime soon, so it is important that the message is changed to only have a positive effect on a society’s citizens. The media can increase society’s knowledge as long as it remains unbiased and presents information that does not negatively affect three groups: women, teenagers, and children. References Sands, B. (n.d.). Mass Media Has a Negative Impact on Women. Retrieved from Teen Ink: http://www.teenink.com/opinion/pop_culture_trends/article/225891/Mass-Media-Has-a-Negative-Impact-on-Women/ Tompkins, A. (2003, December 14). The Psychological Effects of Violent Media on Children. Retrieved from AllPsych Online:

Relevance of Portfolio Theory and Capital Asset Pricing Model Essay

Relevance of Portfolio Theory and Capital Asset Pricing Model - Essay Example In fact risk taking is directly linked to larger amount of earnings. In order to lure investors, risky investments must offer greater returns. Actually risk and returns go hand in hand. It is the belief of investors to distribute their risks and so they diversify their investments as well. They always like to make their investments in a portfolio of assets as they never like to stack all their eggs in one basket. Hence what really matters is not the risk and returns alone, but the risk and return on a portfolio of assets on the whole. According to James Bradfield (2007, p167) an assortment of securities is known as a portfolio. Portfolio theory is a conventional scrutiny of the relationship between risk and return on the risky securities. The rate of returns is particularly measured through alpha, beta, and R-squared. A random variant denotes the rate of return from a portfolio. The computation of the probability distribution generating the returns rate of the security contained in the portfolio depends on the probability distribution creating the value for the portfolio. The hypothesis is helpful for a patron. It helps them to decide and allocate their funds in risky securities thus creating a portfolio. This investment indicates the preferences with regard to the combination of risk and anticipated returns of the investors. The CAPM is a link between the risks and returns on the investments. After (Sharpe, William F.1964, pp. 425-442) developed the CAPM theory several other researchers have developed the theory with giving importance to the diversifiable and non-diversifiable risks of different investments. Previously the CAPM had only a single risk factor which was the risk of the entire movement of the market. This risk is denoted as "market risk" and the formula for CAPM is as follows: E (Ri) = Rf +i [E (RM) - Rf] Where E (RM) = expected return on a "market portfolio" i = measure of methodical risk of asset i comparative to "market portfolio". "The expected return for an asset i according to CAPM is equal risk free rate plus a risk premium" (Frank J. Fabozzi and Harry Markowitz, 2002, p.67). Later on research was conducted and the creators of CAPM theory related diversifiable which are unsystematic risks and non-diversifiable which are systematic risks for all the securities in the portfolio. Some management individuals conceived that CAPM is not genuine as it dominates participating management and investment study. Frank J. Fabozzi and Harry Markowitz states "even though the idea is not true it does not mean that the constructs introduced by the theory are not important. Constructs introduc

Research into Rational Drug Prescribing in Yemen

Research into Rational Drug Prescribing in Yemen CHAPTER 1 1.0 Introduction In Yemen as well as in many other developing countries the quality of health services which constitute social indicators of justice and equity is far from being satisfactory. Inappropriate, ineffective, and inefficient use of drugs commonly occurs at different health facilities (Abdo-Rabbo, 1993; Abdo-Rabbo, 1997). Irrational prescribing is a habit, which is difficult to cure. This may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasteful of resources and needless expenditure. According to the Yemeni constitution, â€Å"patients have the right to health care and treatment† i.e. appropriate care, consent to treatment and acceptable safety. Therefore, health workers should concentrate on making patients better and patients should concentrate on geting better. Health care in general and particularly the drug situation in any country is influenced by the availability, affordability, and accessibility of drugs as well as the prescribing practices. There are many individuals or factors influence the irrational prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug information and misinformation (Geest S. V. et al, 1991; Hogerzeil H. V., 1995).Improving rational use of drugs (RUD) is a very complex task worldwide because changing behavior is very difficult. The 1985 Nairobi conference on the rational use of drugs marked the start of a global effort to promote rational prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug use had been properly tested in developing countries (Laing et al., 2001). The selection of drugs to satisfy the health needs of the population is an important component of a national drug policy. The selected drugs are called essential drugs which are the most needed for the health care of the majority of the population in a given locality, and in a proper dosage forms. The national list of essential drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and quality, cost- effectiveness and allocated financial resources. WHOs mission in essential drugs and medicines policy is to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor and disadvantaged medicines are unavailable, unaffordable, unsafe or improperly used. The organization works to fulfill its mission in essential drugs and medicines policy by providing global guidance on essential drugs and medicines, and working with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs. Development and implementation of national drug policies are carried out within the overall national health policy context, with care taken to ensure that their goals are consistent with broader health objectives. All these activities ultimately contribute to all four WHO strategic directions to: reduce the excess mortality of poor and marginalized populations reduce the leading risk factors to human health develop sustainable health systems,and develop an enabling policy and institutional environment for securing health gains. The greatest impact of WHO medicines activities is, and will continue to be, on reducing excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems. The people of our world do not need to bear the present burden of illness. Most of the severe illness that affects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care — including essential medicines, vaccines and technologies. Millions cannot — they cannot get the help they need, when they need it. As a result they suffer unnecessarily, become poorer and may die young. A countrys health service cannot respond to peoples needs unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice. (Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on Investigation of Medicines, Brasilia, 4 April 2000). 1.1 Background 1.1.1 Brief history of antibiotics According to the original definition by Waksman, antibiotics substances which are produced by microorganisms and which exhibit either an inhibitory or destructive effect on other microorganisms. In a wider, though not universally accepted definition; antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth processes (Reiner, 1982). Up to now, more than 4,000 antibiotics have been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only about 100 are used clinically as the therapeutic utility not only depends on a high antibiotic activity but also on other important properties such as good tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are therefore used a large extent and constitute the largest class of medicaments with respect to turnover value. Today, antibiotics are also used in veterinary medicine and as additives to animal feed. In the past they were used addition, as plant protection agents and as food preservatives. In this review we have confined ourselves to a brief description clinicallyuseful antibiotics. These belong to various classes of chemical compounds, differ in origin, mechanism of action and spectrum activity, and are thus important and representative examples of known antibiotics. 1.1.2 Problem Statement This study examines drug use in Yemen and factors leading to inappropriate use of medicines particularly antibiotics and the prescribing pattern. It defines rational drug use and describes policy developments, which aim to encourage appropriate use. In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on making patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that meets their own requirements for an adequate period of time and at the lowest cost to them and their community (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It involves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient length of time according to standard treatment. Furthermore, it involves monitoring the effect of the drug both on the patient and on the illness. There is plentiful evidence of the inappropriate use of drugs, not through self-medication or unauthorized prescribing, but inadequate medical prescribing and dispensing. Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and with expectations about the care they typically receive; they typically leave with a package of drugs or with a prescription to obtain them in a private market. In previous study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported quantity and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the community and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in some shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs. 1.1.2.1 Inappropriate Drug Use Increasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as improving health, can lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992; WHO, 1988). Inappropriate drug use may include under-use, over-use, over-supply, non-compliance, adverse drug reactions and accidental and therapeutic poisoning (DHHCS, 1992). It also includes medicating where there is no need for drug use, the use of newer, more expensive drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985). 1.1.2.2 Quality Use of Medicines In an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The stated aim of the policy is: to optimise medicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are often required for prevention, control and treatment of illness†. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a price people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 ; DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and duration of drug therapy and the inadequate review of drug therapy once it has been initiated. 1.1.2.3 The Requirement of Drug Information for Quality Use of Medicines A medicine has been described as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been two of the factors consistently identified as necessary for rational drug use (Naismith, 1988; Soumerai, 1988; Carson et al, 1991; Dowden, 1991; Henry and Bochner, 1991; Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use: Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the basis for appropriate prescribing decisions by medical practitioners. Medical practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is avai lable to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines. 1.1.2.4 Problem with antibiotic use The concerns regarding inappropriate antibiotic use can be divided into four areas: efficacy, toxicity, cost, and resistance. Inappropriate use of antibiotic can be due to: Antibiotic use where no infection is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery. Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection. The wrong drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia. The wrong dose or duration of therapy. Such inappropriate use has a measurable effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were used (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria. Inappropriate antibiotic use exposes patients to the risk of drug toxicity, while giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and yet direct and indirect side effects of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognized and have been described in reaction to antibiotic residues in food (Barragry, 1994). Life threatening side effects may be occur from the use of antibiotics for apparently simple infections, it is estimated, for example, that eight people per year in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked: especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993). The medical benefit of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolate of Staphylococcus aureus was described only two years after the introduction of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so rapidly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The vast quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to eme rgence of infection due to virtually untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has recently caused outbreaks in hospitals in London (Hiramatsu et al., 1997). Anti-infective are vital drugs, but they are over prescribed and overused in treatment of minor disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria become resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999). Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule. How does one ensure that good drug are not badly used, misused, or even abused? How can drugs be used rationally as intended? What is rational use of drugs? What does rational mean? 1.1.3 Rational Use of Drug Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994). These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis); in defining effective and safe treatments (drugs and non-drugs); in selecting appropriate drugs, dosage, and duration; in writing a prescription; in giving patients adequate information; and in planning to evaluate treatment responses. The definition implies that rational use of drugs; especially rational prescribing should meet certain criteria as follows (Ross et al., 1992): Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment. Appropriate drug.The selection of drugs is based on efficacy, safety, suitability, and considerations. Appropriate patient. No contraindications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient. Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed. Appropriate monitoring. The anticipated and unexpected effects of medications should be: appropriately monitored (Vance and Millington, 1986). Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. Irrational prescribing may be regarded as pathological prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following forms: The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections, The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS, The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhea, The use of drugs of uncertain safety status, e.g., use of dipyrone, Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhea, The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate. The use of unnecessarily expensive drugs, e.g., the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated. Some examples of commonly encountered inappropriate prescribing practices in many health care settings include: (Avorn et al., 1982). Overuse of antibiotics and antidiarrheals for non-specific childhood diarrhea, Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment, Drugs already prescribed, and Excessive use of antibiotics in treating minor respiratory tract infection. The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter. Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines. 1.1.3.1 Factors Underlying Irrational Use of Drugs There are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving from patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992). Table 1.1: Factors affecting irrational use of drug Impact of Inappropriate Use of Drugs The impact of this irrational use of drugs can be seen in many ways: (Avorn et al., 1982). Reduction in the quality of drug therapy leading to increased morbidity and mortality, Waste of resources leading to reduced availability of other vital drugs and increased costs, Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis, Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs. 1.1.3.2 The Rational Prescription (i.e. the right to prescribe) The rights to prescription writing must be ensuring the patients five rights: the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full name and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not abbreviated, using approved titles only. Dose and dose frequency should be stated; in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998). 1.2 Overview on Essential Drug Concept (EDC) Essential drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year published the first model list of essential drug and WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE [that mean safety , availability, need efficacy] (John, 1997). The essential drug concept is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost (New Straits Times, 1997a). In support of this concept, the WHOissued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Yemen to focus on becoming self-reliant where generic equivalents of essenti al drugs can be manufactured and popularized to meet the health needs of the majority of the people. The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug Policy was to: Prepare a list of essential drugs to meet the health of needs of the people. Assure that the essential drugs made available to the public are of good quality Improve prescribing and dispensing practices Promote rational use of drug by the public Lower cost of the drugs to the government and public Reduce foreign exchange expenditure 1.3 Yemen Essential Drug List and Drug Policy in Yemen The Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system. The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price; that these drugs are safe and effective; and that they are prescribed and used rationally. The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries; but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and implemented this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The second edition of the Yemen Drugs list and the Yemen Standard Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996); MoPHP/NSTG, (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same booklet (Mo PHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated. Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994). The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the recognition of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs remain in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences remain unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals. The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as â€Å"new† are minor variations of existing drug preparations and do not always represent a significant treatment improvement. In addition, the vast number brand names products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world. The regular supply of drugs to treat the most common diseases was a major problem for governments in low-income countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients involved in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other interested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country. The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has n Research into Rational Drug Prescribing in Yemen Research into Rational Drug Prescribing in Yemen CHAPTER 1 1.0 Introduction In Yemen as well as in many other developing countries the quality of health services which constitute social indicators of justice and equity is far from being satisfactory. Inappropriate, ineffective, and inefficient use of drugs commonly occurs at different health facilities (Abdo-Rabbo, 1993; Abdo-Rabbo, 1997). Irrational prescribing is a habit, which is difficult to cure. This may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasteful of resources and needless expenditure. According to the Yemeni constitution, â€Å"patients have the right to health care and treatment† i.e. appropriate care, consent to treatment and acceptable safety. Therefore, health workers should concentrate on making patients better and patients should concentrate on geting better. Health care in general and particularly the drug situation in any country is influenced by the availability, affordability, and accessibility of drugs as well as the prescribing practices. There are many individuals or factors influence the irrational prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug information and misinformation (Geest S. V. et al, 1991; Hogerzeil H. V., 1995).Improving rational use of drugs (RUD) is a very complex task worldwide because changing behavior is very difficult. The 1985 Nairobi conference on the rational use of drugs marked the start of a global effort to promote rational prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug use had been properly tested in developing countries (Laing et al., 2001). The selection of drugs to satisfy the health needs of the population is an important component of a national drug policy. The selected drugs are called essential drugs which are the most needed for the health care of the majority of the population in a given locality, and in a proper dosage forms. The national list of essential drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and quality, cost- effectiveness and allocated financial resources. WHOs mission in essential drugs and medicines policy is to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor and disadvantaged medicines are unavailable, unaffordable, unsafe or improperly used. The organization works to fulfill its mission in essential drugs and medicines policy by providing global guidance on essential drugs and medicines, and working with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs. Development and implementation of national drug policies are carried out within the overall national health policy context, with care taken to ensure that their goals are consistent with broader health objectives. All these activities ultimately contribute to all four WHO strategic directions to: reduce the excess mortality of poor and marginalized populations reduce the leading risk factors to human health develop sustainable health systems,and develop an enabling policy and institutional environment for securing health gains. The greatest impact of WHO medicines activities is, and will continue to be, on reducing excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems. The people of our world do not need to bear the present burden of illness. Most of the severe illness that affects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care — including essential medicines, vaccines and technologies. Millions cannot — they cannot get the help they need, when they need it. As a result they suffer unnecessarily, become poorer and may die young. A countrys health service cannot respond to peoples needs unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice. (Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on Investigation of Medicines, Brasilia, 4 April 2000). 1.1 Background 1.1.1 Brief history of antibiotics According to the original definition by Waksman, antibiotics substances which are produced by microorganisms and which exhibit either an inhibitory or destructive effect on other microorganisms. In a wider, though not universally accepted definition; antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth processes (Reiner, 1982). Up to now, more than 4,000 antibiotics have been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only about 100 are used clinically as the therapeutic utility not only depends on a high antibiotic activity but also on other important properties such as good tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are therefore used a large extent and constitute the largest class of medicaments with respect to turnover value. Today, antibiotics are also used in veterinary medicine and as additives to animal feed. In the past they were used addition, as plant protection agents and as food preservatives. In this review we have confined ourselves to a brief description clinicallyuseful antibiotics. These belong to various classes of chemical compounds, differ in origin, mechanism of action and spectrum activity, and are thus important and representative examples of known antibiotics. 1.1.2 Problem Statement This study examines drug use in Yemen and factors leading to inappropriate use of medicines particularly antibiotics and the prescribing pattern. It defines rational drug use and describes policy developments, which aim to encourage appropriate use. In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on making patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that meets their own requirements for an adequate period of time and at the lowest cost to them and their community (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It involves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient length of time according to standard treatment. Furthermore, it involves monitoring the effect of the drug both on the patient and on the illness. There is plentiful evidence of the inappropriate use of drugs, not through self-medication or unauthorized prescribing, but inadequate medical prescribing and dispensing. Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and with expectations about the care they typically receive; they typically leave with a package of drugs or with a prescription to obtain them in a private market. In previous study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported quantity and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the community and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in some shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs. 1.1.2.1 Inappropriate Drug Use Increasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as improving health, can lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992; WHO, 1988). Inappropriate drug use may include under-use, over-use, over-supply, non-compliance, adverse drug reactions and accidental and therapeutic poisoning (DHHCS, 1992). It also includes medicating where there is no need for drug use, the use of newer, more expensive drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985). 1.1.2.2 Quality Use of Medicines In an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The stated aim of the policy is: to optimise medicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are often required for prevention, control and treatment of illness†. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a price people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 ; DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and duration of drug therapy and the inadequate review of drug therapy once it has been initiated. 1.1.2.3 The Requirement of Drug Information for Quality Use of Medicines A medicine has been described as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been two of the factors consistently identified as necessary for rational drug use (Naismith, 1988; Soumerai, 1988; Carson et al, 1991; Dowden, 1991; Henry and Bochner, 1991; Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use: Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the basis for appropriate prescribing decisions by medical practitioners. Medical practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is avai lable to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines. 1.1.2.4 Problem with antibiotic use The concerns regarding inappropriate antibiotic use can be divided into four areas: efficacy, toxicity, cost, and resistance. Inappropriate use of antibiotic can be due to: Antibiotic use where no infection is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery. Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection. The wrong drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia. The wrong dose or duration of therapy. Such inappropriate use has a measurable effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were used (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria. Inappropriate antibiotic use exposes patients to the risk of drug toxicity, while giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and yet direct and indirect side effects of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognized and have been described in reaction to antibiotic residues in food (Barragry, 1994). Life threatening side effects may be occur from the use of antibiotics for apparently simple infections, it is estimated, for example, that eight people per year in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked: especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993). The medical benefit of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolate of Staphylococcus aureus was described only two years after the introduction of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so rapidly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The vast quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to eme rgence of infection due to virtually untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has recently caused outbreaks in hospitals in London (Hiramatsu et al., 1997). Anti-infective are vital drugs, but they are over prescribed and overused in treatment of minor disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria become resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999). Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule. How does one ensure that good drug are not badly used, misused, or even abused? How can drugs be used rationally as intended? What is rational use of drugs? What does rational mean? 1.1.3 Rational Use of Drug Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994). These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis); in defining effective and safe treatments (drugs and non-drugs); in selecting appropriate drugs, dosage, and duration; in writing a prescription; in giving patients adequate information; and in planning to evaluate treatment responses. The definition implies that rational use of drugs; especially rational prescribing should meet certain criteria as follows (Ross et al., 1992): Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment. Appropriate drug.The selection of drugs is based on efficacy, safety, suitability, and considerations. Appropriate patient. No contraindications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient. Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed. Appropriate monitoring. The anticipated and unexpected effects of medications should be: appropriately monitored (Vance and Millington, 1986). Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. Irrational prescribing may be regarded as pathological prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following forms: The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections, The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS, The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhea, The use of drugs of uncertain safety status, e.g., use of dipyrone, Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhea, The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate. The use of unnecessarily expensive drugs, e.g., the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated. Some examples of commonly encountered inappropriate prescribing practices in many health care settings include: (Avorn et al., 1982). Overuse of antibiotics and antidiarrheals for non-specific childhood diarrhea, Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment, Drugs already prescribed, and Excessive use of antibiotics in treating minor respiratory tract infection. The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter. Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines. 1.1.3.1 Factors Underlying Irrational Use of Drugs There are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving from patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992). Table 1.1: Factors affecting irrational use of drug Impact of Inappropriate Use of Drugs The impact of this irrational use of drugs can be seen in many ways: (Avorn et al., 1982). Reduction in the quality of drug therapy leading to increased morbidity and mortality, Waste of resources leading to reduced availability of other vital drugs and increased costs, Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis, Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs. 1.1.3.2 The Rational Prescription (i.e. the right to prescribe) The rights to prescription writing must be ensuring the patients five rights: the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full name and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not abbreviated, using approved titles only. Dose and dose frequency should be stated; in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998). 1.2 Overview on Essential Drug Concept (EDC) Essential drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year published the first model list of essential drug and WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE [that mean safety , availability, need efficacy] (John, 1997). The essential drug concept is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost (New Straits Times, 1997a). In support of this concept, the WHOissued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Yemen to focus on becoming self-reliant where generic equivalents of essenti al drugs can be manufactured and popularized to meet the health needs of the majority of the people. The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug Policy was to: Prepare a list of essential drugs to meet the health of needs of the people. Assure that the essential drugs made available to the public are of good quality Improve prescribing and dispensing practices Promote rational use of drug by the public Lower cost of the drugs to the government and public Reduce foreign exchange expenditure 1.3 Yemen Essential Drug List and Drug Policy in Yemen The Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system. The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price; that these drugs are safe and effective; and that they are prescribed and used rationally. The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries; but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and implemented this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The second edition of the Yemen Drugs list and the Yemen Standard Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996); MoPHP/NSTG, (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same booklet (Mo PHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated. Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994). The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the recognition of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs remain in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences remain unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals. The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as â€Å"new† are minor variations of existing drug preparations and do not always represent a significant treatment improvement. In addition, the vast number brand names products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world. The regular supply of drugs to treat the most common diseases was a major problem for governments in low-income countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients involved in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other interested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country. The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has n