Monday, September 30, 2019

Environment and Global Warming Essay

Global warming has been a major problem for the last one decade or so all over the world. The climate is changing and the temperatures on the earth surface are warming up as a result of increase in amount of green house gases (GHGs) such as carbon dioxide emitted into the atmosphere. Global warming is defined as an increase in the average earth’s temperatures which as result leads to a change in the overall global climate. The impacts of global warming are quite diverse and they include ecosystem instability, a rise in sea level, increase in pests and diseases, health problems, loss of environmental beauty due to extreme weather conditions such as floods, hurricanes and so fourth (Abarbanel et al. , 2002, 22-23, 57-63). Global warming has been found to be mainly caused by human activities resulting from over reliance on fossil fuels as a source of energy which increase the green house gases emissions into the atmosphere. Research has also shown another side of global warming whereby, air pollutants emitted by fossil fuels are responsible for making clouds to reflect more sun’s rays back to the space. This effect is known as global dimming and it leads to less light reaching the earth surface. This global dimming is responsible for causing droughts due to lack of rain especially in the Northern Hemisphere and it also camouflages the actual effects of global warming leading to their underestimation (Abbot et al. , 2000, 159-176). The effects of global warming on the environment are very dangerous and expensive and all the governments in the world agree that something must be done. In this respect, the united nations have come up with a framework convention on climate change which is responsible for coming up with agreements such as the Kyoto protocol among others. The Kyoto protocol is an international agreement passed by the United Nations Framework Convention on Climate (UNFCCC) back in 1994 which was aimed at addressing global warming and climate change issues all over the world. This agreement sets targets for all the industrialised nations in the world which they are expected to abide by in order to reduce the amount of green house gases emitted by those industries located in the respective nations. This protocol is considered as the greatest agreement reached by members of the United Nations which is bound to protect the environment and ensure sustainable development. How a national policy can help to address a global problem. National policies have a great role to play in tackling major national and global challenges such as climate change, globalisation, sustainable energy needs and so forth. The solutions to such problems require innovations which are able to see beyond the problem awareness and come up with solutions aimed at lessening their environmental and economic impacts on a long term basis. Such issues more often than not require the implementation of a national policy which will address the problem both nationally and internationally. A policy is meant to ensure that the problem is addressed from a central point of view and that all the concerned parties are speaking in one voice. An example of a global problem which is currently causing major concerns in the whole world is global warming. Although its effects are largely felt in the industrialised countries, the overall effects of climate change are evident in all nations because the pollutions emitted in one part of the globe quickly disperse to all other parts of the globe (Hay 2002). With growing concern on this problem of global warming and carbon pollution, a national policy for sustainable development is essential to address this problem and come up with rules and regulations aimed at controlling the emission of carbon pollutants and other green house gases into the atmosphere. To effectively address the effects of global warming and climate changes, all the world governments must come up with national environmental policies, efficient technological strategies and invent new sources of energy which are cleaner and more sustainable. Unlike common environmental policies such as the ones set by the United Nations and other world organisations, national policies created by individual countries focused towards addressing a certain global problem are bound to be more effective because such measures are bound to achieve abatements which are in line with the national interests at the lowest national costs possible. For instance, to address the issue of global warming, Australia has come up with a three-pillar national policy aimed at reducing the amount of pollutants released to the atmosphere by its industries and as a result, the government has had to make some economic reforms which are favourable to its economic stability in order to accommodate this policy (Miller & Tyler, 1987, 19-23). Australia’s national policy in addressing global warming Australia has been vulnerable to climate changes and severe repercussions of problems associated with poorly designed policies aimed at addressing this issue. An intergovernmental Panel on Climate Change (IPCC) released a report in 2007 indicating that the Australia’s average climate is expected to change by about five degrees by the year 2070 due to the high rate of emission of GHGs in the country unless the government finds a quick and lasting solution to this global threat (Steger et al. , 2004, 33-46). Such a temperature change is bound to affect the ecosystems, energy resources, population health, agriculture, tourism as well as other sectors of the nation’s economy. Some of this effects to human beings and ecosystems are already being felt due to an increase of about 0. 9 degrees in the annual average temperatures. This effects prompted the government to facilitate the Garnaut climate change review in June and ratification of the Kyoto protocol on 3rd Dec 2007 as a way of demonstrating the government’s commitment to addressing the global warming and climate change all over the world. By agreeing to the Kyoto protocol, the Australian government has expressed willingness to pay the price for carbon reduction as a way of dealing with global warming. The Garnaut review focused on examining the climate change and its effect on the nation’s economy and has come up with policies and policy frameworks aimed at improving sustainable development. The draft report produced after this review presented a detailed examination of the climate change and its implications on Australia as a single nation. Following the Garnaut draft report indicating that the impacts of global warming and climate change in Australia are expected to be greater than those experienced in the other developed countries, the government has decided to come up with a climate change policy to ensure a safer society, a more stable economy and less climate changes in the future. This policy is focused on addressing three major issues. That is; †¢ Reducing the amount of green house gases emitted by industries in the country. †¢ Adapting to those impacts of climate changes which can not be reversed or changed. †¢ Contributing to the achievement of a global solution to the problem of global warming. (Milutin, 2003, 42-56) The Australian government using this policy has introduced an emission trading scheme and a framework for carbon reduction which will help to reduce the GHGs emission by up to 60 percent by the year 2050. A reduction in the national GHGs emission will put Australia in a better position to influence the international communities in working towards a low carbon environment (Julian, 2003, 495-503). In addition, the Australian government is committed to promoting an industrial policy aimed at facilitating investment in cleaner, greener and more sustainable energy resources and increasing the economic opportunities in the country. This industry policy has helped to develop comprehensive strategies which include local content rules and purchasing policies to provide long term solutions to climate change (Derek, 2002, 115-120). According to the environmental policies set by the Australian government, the environmental standards for its industries are set very high in order to restrict them from releasing pollutants to the atmosphere (Migeotte, 2002, 519-520). The Australia’s domestic policies are bound to affect the international credibility and the ability to acquire a global solution to global warming. The long term national target which is meant to reduce the emissions by about 60 percent before the year 2050 places the total global effort and carbon pollution schemes in a better position to achieving a solution to the worldwide problem and thus, this national policy is a step in the right direction. Conclusion Global warming presents a great environmental, social and economic challenge which requires urgent attention from governments all over the globe. The Australian government has done a lot to show that it is committed to eliminating this global problem through establishment of an environmental policy and ratification of the Kyoto protocols established by the United nations framework convention on climate change. This has greatly assisted the country to reduce the amount of GHGs emission and carbon pollutants into the atmosphere leading to a cleaner environment and it has helped to address the global problem at large. This shows that the use of well implemented comprehensive national policies can help to adequately address global problems such as global warming. References Abarbanel, Albert, and Thomas McCluskey (2002). â€Å"Is the World Getting Warmer? † Saturday Evening Post, 1 July, pp. 22-23, 57-63. Abbot, Charles G. , and F. E. Fowle, Jr. (2000). â€Å"Income and Outgo of Heat from the Earth, and the Dependence of Its Temperature Thereon. † Annals of the Astrophysical Observatory (Smithsonian Institution, Washington DC) 2: 159-176. Miller, G. Tyler Jr. , 1987. Living in the Environment. Belmont: Wadsworth Publishing Company, 19-23. Steger, Will and Bowermaster, Jon, 2004. Saving the Earth. New York: Bryon Preiss, 33-46. Adem, Julian (2003). â€Å"Experiments Aiming at Monthly and Seasonal Numerical Weather Prediction. † Monthly Weather Review 93: 495-503. Ager, Derek (2002). The New Catastrophism: The Importance of the Rare Event in Geological History. Cambridge: Cambridge University Press, 115-120. Migeotte, M. V. (2002). â€Å"Spectroscopic Evidence of Methane in the Earth’s Atmosphere. † Physical Review 73: 519-20. Milankovitch, Milutin (2003). Canon of Insolation and the Ice Age Problem. Belgrade: Koniglich Serbische Akademie, 42-56.

Sunday, September 29, 2019

Marketing – Converse Case Study

Converse Case Study Creating a marketing strategy isn’t always about taking a hands-on approach and facilitating how consumers should think of a certain brand. Converse All Stars took an alternative route, a â€Å"stand-back approach† giving its customers control over marketing its shoe brand. As a result, Converse delivered a customer-brand relationship where the needs, wants and demands of its customers were met by a pair of All Star Chucks.The needs, wants and demand of customers is a major customer and marketplace concept. Human â€Å"needs† are states of felt deprivation that could be of a physical need like for food and clothing, social need like for affection or individual needs like for learning or self-expression. Wants are forms of needs that are derived from cultures and individual personality (i. e. specific types of food like Asian, American or Mexican are specific wants for food).Demands of customers are also factored in when customers’ wants are supported by their ability to make purchases. Relating this to the Converse case study, Converse’s customers demonstrated a physical need for clothing or shoes in this case as well as an individual need for self-expression, and their wants were derived from Converse’s simple, affordable and classy style and â€Å"no-brand† brand, a specific culture and type of personality that consumers affiliated with Converse.Converse’s culture of self-expression became the reason why it was wanted and thereby demanded by consumers who had buying power. Converse understood this concept well as it was able to capture value from its customer by enabling them to customize and individualize their pair of Chucks, thus creating a market offering that became an integral part of Converse’s marketing success.

Saturday, September 28, 2019

Marketing Ethics of Mecca Cola Case Study Example | Topics and Well Written Essays - 2000 words

Marketing Ethics of Mecca Cola - Case Study Example Marketing plans and strategies would be incomplete without paying much consideration to the customers. Customers will and should always be a part of the agenda in any marketing plan of any company. Because of the implications for profitability and growth, customer retention is potentially one of the most powerful weapons that companies can employ in their fight to gain a strategic advantage and survive in today's ever increasing competitive environment (Lindenmann, 1999). Marketing involves the buying, selling, and trading of goods and services and the subsidiary activities that make these exchanges possible. It is a social process, as well as an economic activity and a collection of physical tasks. Marketing takes place only in societies. Even a rather large, primitive family unit may engage in extensive production and consumption on a self-sustaining basis without becoming involved in activities that can be described as marketing. In organized societies, marketing activities are themselves important features of the social milieu, and changes in marketing practices may carry implications extending throughout the social structure. For example, the location of trading centers affects the modes and routes of transportation (Kotler and Armstrong, 200); advertising affects popular conceptions of tastes and life styles; and changes in distribution channels create and eliminate employment opportunities and ways of life. Appraisals of the performance of marketing activities within our society are commonplace. Marketing is said to be inefficient because there are "too many" gasoline service stations. It is said to be unfair because some firms are "making it impossible" for others to continue to exist in the market place. It is said to be unproductive because "too much" money is spent on advertising (Lun and Gupta, 2001). Generally comes off very well indeed. Businessmen do not hesitate to spend large sums in marketing their wares, and consumers show no great reluctance to pay the resultant charges embodied in what they buy The fundamental economic criterion for appraising marketing activities is the efficiency with which they are performed. Efficiency, or productivity, involves a relationship between effort and effect, sacrifice and reward, input and output. Efficiency is a relative concept (Neumann and Sumser, 2002). When we describe an activity as "inefficient," we mean that too much effort is being expended with too little effect; in other words, that the ratio of effort to effect is higher than necessary. And when we describe an activity as "efficient," we mean that the ratio of effort to effect is about as low as can be achieved. In general, economic activities that are more efficient are preferred to those that are less efficient and for a very simple reason. If there are two methods of accomplishing the same task and one of them requires a smaller expenditure of time, effort, and resources than the other, then by using that method one can accomplish the task and have time and materials left over. One may then either use these surplus resources to accomplish the task another time, or in a superior fashion, or may transfer these resources into some entirely different activity (Ohmae, 1990). So long as one's time and resources are of some value in some use including their use in leisure or in saving for the future

Friday, September 27, 2019

Policing Functions Essay Example | Topics and Well Written Essays - 1000 words

Policing Functions - Essay Example On the other hand, under the function of taking charge to policing the world, police falls into different classifications: public, specialized and professionals. Sheriff, constable and watch are in-charge of crime control. However, even if one could highly associate these responsibilities with policing, police are not excuse from various controversies. One of them according to Walker and Katz is the political influence and corruption associated with power that police carry among themselves due to their highly diversified functions in the US Law Enforcement Industry. From Industry perspective for instance, police have substantial authority and power to give substantial opportunity for the third party to gain with illegal activities such as gambling, prostitution and drug trafficking. Furthermore, for some ordinary people according to Walker and Katz, police are under in any way of positive or negative stereotyping. Walker and Katz elaborate negative stereotypes for police as being une ducated, untrained, prejudiced, brutal and corrupt. The positive stereotype on the other hand points police officers as heroic saints. Although Walker and Katz also point that police are not entirely different from ordinary citizens, the negative or positive stereotypes at some point must have substantial evidence from actual perspective of the society on policing. On the other hand, another important perspective on policing is that it is unsuccessful. Police agencies are bureaucratic paramilitary organizations that have traditionally responded slowly to change (Jones, 2009). In this matter, Jones believes that administrators fail to understand the complexity of their environment... In this paper, the proponent tries to examine various perspectives of the policing function from local, state and federal organizational levels. By looking at the hierarchy presented in this essay and different classifications of police, one could actually say that policing in the United States is highly decentralized, fragmented and diversified. The researcher focuses on describing differences and similarities of their functions on each level. Policing may have potentially gained positive or negative image for a long period of time. Reforms may be necessary in order to correct major negative feedbacks which at some point may lead to inefficient function of policing. In conclusion, the researcher also tries to address possible future changes in laws and the overall impact that these changes will have on the field of policing, such as the use of technology in policing, that is very important in order to enhance more and fulfill the essential task or function of every police officer. I n this case, the judicial system and emancipation of law must ensure in its reform programs to give substantial opportunity for policing to gain remarkable advantage in exercising the following: crime prevention, policing the world, crime control and law enforcement. All of such changes are to ensure that the execution of policing would substantially meet the prevailing needs of the society. The researcher also hopes that in some way his suggestions could increase successful policing and address the potential correction of negative image of policing.

Thursday, September 26, 2019

Article summary Example | Topics and Well Written Essays - 1250 words - 3

Summary - Article Example ost common type of cardiovascular disease among aboriginal people is the coronary heart disease whose cause although largely unknown, several risk factors have been found to increase its chance of occurrence. These include high levels of cholesterol, hypertension, diabetes mellitus smoking and high density of lipoproteins; these risk factors are attributed to the lifestyles and the socio-economic status of the aboriginal people. For the last couple of decades, the aboriginal people have adopted a western lifestyle including their nutritional patterns and behaviour, which include eating foods rich in calories and adopting inactive lifestyles; this has led to increase in cardiovascular diseases. Type 2 diabetes, which is the most common among the aboriginal people is usually characterised by resistance to insulin, high blood glucose levels and reduction in insulin levels. This type of diabetes is most often found in adults and its risk is increased by obesity, lack of physical activity, stress, depression and poor nutritional habits. Since diabetes and severe obesity have been found to be linked, mainly through the adipose tissue, which has been found to trigger insulin resistance in sells, the appearance of obesity will in most cases lead to diabetes. For the last 50 years, prevalence of type 2 diabetes has been increasing among aboriginal populations with about 17.9 percent of all adult being diagnosed with the disease, the figure rises to 35 per cent among individuals 55 years or older. In some communities in northwestern Ontario, the prevalence has been found to be as high as 80 per cent among women between 50 and 64 years of age. However, this trend has not spared people much younger among the first nation communities with studies showing that 53 per cent of those living with diabetes are below 41 years of age and 65 per cent are below 45 years. This type of diabetes, although not observed in youths, it has been found in young children between 5 and 8 years in

Wednesday, September 25, 2019

China doing business in Venezuela Essay Example | Topics and Well Written Essays - 250 words

China doing business in Venezuela - Essay Example government has not made an official announcement, America feels threatened as an influence within the region. Currently, America is the largest importer of oil from Venezuela, and China will be taking away from this amount. 2) U.S. consumers may benefit from with deal through an increase in Venezuelan oil production. As of right now, Venezuela produces about 3 billion barrels of oil each day (James 2011). With help from the Chinese loans, oil production is expected to increase to increase massively. This, in turn, will benefit U.S. consumers because the oil price should hopefully come down. With more oil on the market, prices will be driven down. The cost of gas to U.S. consumers should reduce considerably. However, the United States government needs to be careful that there are not any deals going on between the Venezuelan government and their Chinese counterparts. Energy Minister Rafael Ramirez has said, â€Å"We don’t do discounts with anyone†¦We sell at international prices (James 2011). If the U.S. wants to remain competitive in the oil market, then it should hope that this is true. Associated Press. (2011, Nov. 25) Venezuela’s Chavez defends China ties as officials sign deals for $6 billion in loans. The Washington Post. Retrieved from

Tuesday, September 24, 2019

Building Lasting Customer Loyalty Essay Example | Topics and Well Written Essays - 1250 words

Building Lasting Customer Loyalty - Essay Example The variable that drives customer loyalty the most is price. A company that has been able to build tremendous customer loyalty because they offer better price than the competition is Wal-Mart. A lot of customer supports private label brands because they offer greater value than national brands. The quality of the product is another important variable when a company is trying to build customer loyalty. Customers are willing to pay more for products of higher quality. Three additional variables that drive customer loyalty are location, selection, and service. Companies that are able to achieve customer loyalty obtain lower customer switching, increased profitability, and great word of mouth advertising. Six key elements of customer loyalty are: a) build on the foundation of a brand; b) use price to communicate a fair value; c) engage customers with great customer experience; d) recognize good customers; e) reciprocate customer loyalty; f) build intimate relationship with best customers (Bradner, 2007). If your customer has a business that offers items that your company uses it is a good idea to purchase from them to support the business of a client that is providing you with revenues. Marketers must pay close attention to their top customers to ensure customer retention of these key clients. Four types of loyalty tactics are price, experience, programmatic, and relationship loyalty. In the airline industry a company that has had success by offering low fares is RyanAir. s. Programmatic loyalty provides companies with discount and tcalled BK rewards that offers its customers a 5% credit towards the purchase of future food items. In the service industry having a good brand experience is very important to achieve a higher level of customer retention. Chapter 21 Summary The business world has become more interconnected than ever due to faster communication, transportation, and financial flows. The story of Red Bull is a great example of a company that was able to suc ceed in the foreign markets. Today Red Bull has penetrated over 100 countries worldwide. Corporations hold most of the wealth of the world. There are 200 companies that have more money than a quarter of the world’s countries. In 2003 international trade accounted for one-quarter of the U.S. GDP. A global industry is an industry in which the strategic positions of competitors of major geographic or national markets are affected by the overall global position. An example of a global industry is petroleum due to the fact that the majority of the automobile worldwide are powered by gasoline. A global firm is a firm that operates in more than one country. Five major decisions in international marketing are: 1) deciding whether to go abroad; 2) deciding which markets to enter; 3) deciding how to enter the market; 4) deciding on the marketing program; 5) deciding on the marketing organization. Many international markets offer opportunities to achieve higher profitability than the do mestic market in which the companies operate. Expanding into international market allow companies to achieve economies of scale. It also helps companies reduce their dependency on one market. When a company gets attack by international competition a good strategic option is to counterattack by penetrating the domestic market of the international competition. Prior to penetrating a foreign location companies must identify the risk involved with the decision. The company might not understand the foreign nation business culture. The regulation of the country must be understood prior to establishing a presence in a location. For example the environmental laws of the country might impose additional cost the company was not incurring in its domestic marketplace. The four

Monday, September 23, 2019

Personal and Private Information Exposures and Opportunities Term Paper

Personal and Private Information Exposures and Opportunities - Term Paper Example It will discuss these concerns from the perspective of protecting personal rights. The rights of companies to share information will also be discussed and the rights to have private information protected shall also be considered in this discussion. How credit agencies often skate the thin lines in privacy shall be another aspect of this paper. Case studies and measures supporting the position taken will also be presented. This paper is being carried out in order to provide a clear and well-supported discussion on rights of privacy in the current age of pervasive socialization activities. Private and personal information are now available through various access points in the internet – via social networking sites, online sales transactions, and even membership in organizations (Boyd and Heer). However, private and personal information expose individuals to various illegal internet activities including internet fraud, identity theft, harassment, phishing and similar activities. Through social networking sites alone, personal information is often available to the public and to the user’s friends (Chiaramonte and Martinez, 6). ... Networking sites, especially Facebook have come under fire for its failure to protect the privacy of its users (Coppola, et.al., 95). At one point, Facebook founder Mark Zuckerberg was severely criticized for stating that ‘privacy was dead.’ This belief epitomizes Zuckerberg lackadaisical concern for user privacy in Facebookl this would also explain why features to protect user’s privacy were not immediately laid out from the very start (Public Policy and Management). It took years and a significant amount of pressure and backlash from the social networking community for Facebook to finally relent to the installation of tighter privacy options for users. At one point, Facebook even admitted that it made the email addresses of their users available to various organizations and corporations (Lampe, et.al., 167). This practice has since been stopped by the popular social networking site. Despite the privacy settings now made available to Facebook and social network u sers, there still are risks to the exposure of the privacy of these users (Hass, 30). For one, there is still no guarantee that the social networking sites are not releasing user information to corporations for the right price. Moreover, the failure of users in utilizing the privacy features is also an issue which does not guarantee privacy and protection of users (Stutzman). Some users in Facebook are not aware that their social activities and other internet activities are often being tracked and posted in Facebook. Many websites now ask users or readers whether they are reading as Facebook users, and not knowing the implications of agreeing to Yes/No dialogue boxes, these users often just tick Yes and from then, all the articles they read, the videos they watch, and the

Sunday, September 22, 2019

Analysis of two commercial brands of bleaching solution Essay Example for Free

Analysis of two commercial brands of bleaching solution Essay Objective To determine the concentrations of the active ingredients in 2 commercial bleaches. Introduction Sodium hypochlorite is usually found in bleaching solutions. It is the active ingredient of bleaching solutions. It bleaches by oxidation. When it is added to dye, the following reaction occurs: ClO- + dye - Cl- + (dye + O) If the oxidized form of the dye is colorless, then the color of the dye would fade away. In the presence of acid, the hypochlorite ions from the bleaching solution reacts with the iodine ions from potassium iodide in the following way: ClO- + 2I- + 2H+ I2 + H2O + Cl-. When sodium thiosulphate solution is added into this reacted solution, a further reaction occurs: I2 + 2S2O32- 2I- + S4O62- This reaction could be used in titration to find out the number of moles of thiosulphate ions, thus the concentration of hypochlorite ions in the bleaching solution. Procedure 1. 10 cm3 of Kao Bleach was pipette into a volumetric flask. Distilled water was added until the meniscus reaches the graduation point. 2. 25 cm3 of the titrated bleach was pipette into a conical flask. About 10 cm3 of potassium iodide and dilute sulphuric acid was added into the conical flask. 3. The solution was titrated with sodium thiosulphate solution until the brown colour of the iodine fades. 4. Starch solution was added into the conical flask, and the solution was further titrated until the dark-brown colour of the starch-iodine complex turns to colourless. The volume of sodium thiosulphate solution required to reach the end point was recorded. 5. Steps 1 to 4 were repeated 3 more times. 6. Steps 1 to 5 were repeated using Clorox Bleach. Data and Calculation Molarity of standard Na2S2O3 solution = 0. 05182M Brand A: Kao Price: $11. 9/ 1500ml Trial 1 2 3 Final reading/cm3 26. 8 23. 1 25. 7 26. 0 Initial reading/ cm3. 4. 1 0. 4 2. 9 3. 2 Volume of Na2S2O3 22. 7 22. 7 22. 8 22. 8 Average no. of moles of Na2S2O3 used in the titration: 0. 05182 X (22. 7 + 22. 8 X 2)/3 X 0. 001 = 1. 180 X 10-3 moles So, there are (1. 180 X 10-3 /2) =5. 90 X 10-4 moles of I2 in the reaction So, there are 5. 90 X 10-4 moles of ClO- ions in the diluted solution. Concentration of ClO- in Kao bleach = 5. 90 X 10-4 X 10 /10 X 1000 =0. 5899M Brand B: Clorox Price: $21. 9/ 2840ml Trial 1 2 3 Final reading/cm3 33. 5 32. 4 32. 0 33. 2 Initial reading/ cm3 2. 7 1. 3 0. 9 2. 3 Volume of Na2S2O3 30. 8 31. 1 31. 1 30. 9 Average no. of moles of Na2S2O3 used in the titration: 0. 05182 X (30. 9+ 31. 1 X 2)/3 X 0. 001 = 1. 608 X 10-3 mole So, there are (1. 608 X 10-3 /2) =8. 041 X 10-4 moles of I2 in the reaction So, there are 8. 041 X 10-4 moles of ClO- ions in the diluted solution. Concentration of ClO- in Kao bleach = 8. 041 X 10-4 X 10 /10 X 1000 =0. 8041M Conclusion The concentration of ClO- in Kao is 0. 5899M while that of Clorox is 0. 8041M. Discussion 1. When we add starch solution into the conical flask, the solution turns dark blue. After that, when we add a few drops of sodium thiosulphate, the colour of the solution would turn colourless. We must be careful when we are doing this step. This is because the starch-iodine complex does not show graduation of color change. We may get pass the end point easily. The readings would be inaccurate. 2. Dilute sulphuric acid is irritating. So we must be extra careful in using it. How did I use sulphuric acid more safely? I used a larger measuring cylinder to measure out the amount of sulphuric acid. The likeliness of spilling the acid would be lower. 3. After I had done all the experiments, I found out that the tip of the pipette was broken. When I asked Mr. Leung, he said that the pipette could not be used anymore. Why? I could think of 2 reasons. First, the broken tip of the pipette could cause danger when we are using the pipette. We would have a higher chance of getting our finger cut. Second, the broken tip of the pipette may cause the solution to be carried to leak. So, it is unreliable. Answers to Study Question 1. (a) Amount of active ingredient in Kao: 0. 5899 X (35. 5 + 16) = 30. 38 g /dm3 Amount of active ingredient in Clorox: 0. 8041 X (51. 5) = 41. 41 g/dm3 (b)Cost per gram of Kao: (11. 9 X 1000/1500) /30. 38 = $0. 2611 per gram Cost per gram of Clorox: (21. 9 X 1000/2840) / 41. 41 = $ 0. 186 per gram 2. As Clorox is of a lower price, it is the better buy. 3. Adding potassium iodide in excess ensures that all chlorate ions have reacted. Only when all the chlorate ions have been reacted that the amount of iodine formed can fully reflect the amount of chlorate ions in the solution. This ensures that the volume of sodium thiosulphate used in the titration can be used to determine the number of moles of chlorate ions in the solution. 4. When an acid is added into a solution of chlorate and iodine ions, iodine would be liberated. The iodine can then be used in titration to determine the amount of the chlorate ions. 5. The second way it may deteriorate is by decomposition by sunlight: 2H+ + 2ClO- - 2HCl + O2 The chlorate ions, under sunlight, decompose back to chlorine ions and the bleaching ability of the bleaching solution is reduced. 6. This is because before reaching the end point, starch solution will not show any signs of being close to the end point. Other indicators will. For example, if methyl orange is close to its end point, it will first change the color of the solution to orange. Then, the solution would turn back to its original colour. In this way, we will know that we are close to the end point and we would add the solution more slowly. However, similar characteristics could not be found when we use starch as an indicator. So, we may get pass the end point easily. This problem is solved by titrating the iodine solution without any indicator first. After the brown color of iodine vanishes, we know that we are very close to the end point. At this stage, adding starch solution can tell us whether there is still iodine in the solution. As we know that we are already very close to the end point, we would add the solution more slowly. It would be lees likely to shoot pass the end point.

Saturday, September 21, 2019

Personal Responsibility Essay Example for Free

Personal Responsibility Essay Define what personal responsibility means to you. Explain the relationship between personal responsibility and college success. Include a preliminary plan to practice personal responsibility in your education. This week, using the Center for Writing Excellence resources, provide the thesis statement and informal outline for your Personal Responsibility Essay assignment, due in Week Five. Thesis Statement: Personal Responsibility means taking accountability for my own actions, accepting whatever consequences come from my actions, and then understanding how to improve or make necessary changes. By staying organized, setting personal goals, keeping my stress level to a minimum, and staying focused, I can achieve college success. Informal Outline: I. Intro II. What personal responsibility means a. Accountability for my own actions b. Being organized c. Setting goals; both personal and academic III. Tools for personal responsibility d. Having time management skills e. Setting personal goals f. Keeping my stress level to a minimum g. Staying focused IV. What I will hold myself academically accountable for h. Attending all classes i. Reading all materials j. Doing all assignments and turning them in on time k. Studying for all exams V. Conclusion: In conclusion, although it is easier to blame others for my failures and my mistakes, it is because of my personal responsibility that I will be able to have college success. I will have a clear understanding of what I expect from my education as well as what I expect for my future. I will strive to accomplish every goal that I will set for myself in my personal life as well as the goal I will set for myself as a student. Personal responsibility determines how I choose to live my life and the things I choose to do and not to do. In turn, my college success is up to me.

Friday, September 20, 2019

Causes of Breast Cancer

Causes of Breast Cancer Breast Cancer About 40,610 women alone will die just this year from breast cancer. Everyone is at risk of breast cancer. Breast cancer is a cancer that starts in the breast. It is a big killer of women. The article breast cancer states that, breast cancer, cancer that originates in the breast. Breast cancer is the second leading cause of cancer death in women.(Breast cancer. The) Even though it has a high risk in women anyone can get breast cancer. The article mentioned above says, Although the vast majority of the cases occur in women, some men also get breast cancer.(Breast cancer. The) There has been some lead way in the prevention of breast cancer and less people dying. The article breast cancer says, Even allowing for improvements in detection (i.e., the introduction of routine mammography), there has been a long-term gradual increase in the incidence of breast cancer since the early 1970s, but because of the more effective treatment afforded by such early detection, overall mortality began to decrease by the mid-1990s. (Breast cancer. The) Certain things increase the risk of breast cancer. Howeve r, not everyone with breast cancer has these things, and not everyone who has these things has breast cancer. The article mentioned above says, Epidemiological study has identified certain risk factors that increase the possibility that a woman will get breast cancer, although not all women with breast cancer have these traits, and many women with all of these traits do not develop the disease. (Breast cancer. The) The risk goes up for older people, if it is in your blood, or if you have a history of breast disease. The article breast cancer says, Risk factors include age (the incidence of breast cancer is rare in women under 35-most cases occur in women over 60); a history of breast cancer in a close blood relative; and a history of breast cancer or benign proliferative breast disease. (Breast cancer. The) Other risk factors are hormones, not having children or waiting to have children, and weight. The article mentioned above states, A high cumulative exposure to female sex hormone s (estrogen and progesterone) appears to increase the risk of some breast cancers. Hormonally related risk factors include early menarch (before age 12), late menopause (after age 55), having no children or postponing childbirth, and obesity in women over 50. (Breast cancer. The) One way to stop breast cancer early on is to have regular mammograms. The advantage of mammography is that it can find the tumor in its early stages. People whose cancer is found with a mammogram have a higher chance of survival. The article Mammography says, Mammography is X-ray imaging of the breast to detect breast cancer. The advantage of mammography is that it can detect tumors while they are still small and are most easily treated. Studies have shown that women who received early medical treatment after their breast cancers were found through mammograms had a five-year survival rate approaching ninety percent (depending on the stage at which cancer is detected). By comparison, women whose cancers were not found by mammograms had a five-year survival rate of just sixty percent.(Mammography) Lots of women will have this disease at one point in their life, but mammograms can help to diagnose it. The article mentioned above says, The American Cancer Society has estimated that one o ut of every eight women will develop the disease at some point in her lifetime. Mammography is considered an important tool for diagnosing women at risk for developing breast cancer.(Mammography) Breast cancer was not always so widely accepted. The article Mammography says, By the 1960s, mammography was becoming a widely used diagnostic tool. Some critics claimed that the procedure exposed women to dangerous levels of radiation.(Mammography) This made them change the way they did it to satisfy the critics. The article mentioned above says, The amount of radiation needed to produce clear pictures of breast tissue was reduced significantly through the development of more sensitive film.(Mammography) The best way to tell if you have breast cancer is to feel for it. The article Breast Cancer says, The primary method of discovering the symptoms of breast cancer is self-examination. Doctors recommend that women learn how to properly examine their breasts and to do so on a regular basis. The purpose is to look for any changes in the breasts. (Breast Cancer Sick) What the patient should be looking for is a lump. If a lump is found then it should be reported to a doctor immediately. The article mentioned above states, One warning sign of breast cancer may be a lump in the breast or armpit area. The presence of a lump suggests that medical advice should be sought.(Breast Cancer Sick) The fact that a lump is there should not have you worried, because it is not always cancerous. The article Breast cancer says, A lump does not necessarily indicate breast cancer. In many cases, lumps are benign (not cancerous) and can be removed without any lasting harm to the patient.(Breast Cancer Sick) A nother test to see if you have cancer is a biopsy. The take a tissue sample off of the breast, and test it for cancer. The article mentioned above states, One test is a breast biopsy. The tissue removed during a biopsy can be studied under a microscope. The test allows a doctor to determine whether cells in the sample are cancerous or not. (Breast Cancer Sick) IF cancer is found then they can see if has spread to other parts of the body yet. The article Breast cancer says, If cancer is found, tests can also be used to determine if the cancer has metastasized (pronounced muh-TASS-tuh-sized). Metastasis (muh-TASS-tuh-sis) is the process of cancer cells spread to other parts of the body. Testing for metastasis involves removal of lymph nodes from the armpit. The presence of cancer cells in the lymph nodes suggests that the cancer has begun to spread. (Breast Cancer Sick) The easiest treatment is to remove the lump and some of the tissue around it with some lymph nodes. The article ment ioned above says, The simplest treatment is a lumpectomy, a procedure in which the cancerous lump is removed from the breast. The surgeon also removes some tissue around the lump and some of the lymph nodes under the arm. Removing healthy tissue around the lump ensures that all of the cancer has been removed. Removing the lymph nodes allows the doctor to test for metastasis. (Breast Cancer Sick) Diets can have an effect on you and cause breast cancer. The people with the most fat in their diet have lots of deaths from breast cancer. Cory Servaas writes, The highest incidence of deaths from breast cancer is found in the most highly developed countries, those in which peoples diets tend to be high in fats and low in fiber.(Servaas) The death rate from cancer in countries with low fat foods is lower, but as more countries develop a more American diet they are increasing in deaths. Servaas states, Traditionally, in Japan, only 20 percent of the calories in the daily diet comes from fat versus 40 percent of calories from fat in the United States. Note the chart on page 67 that shows the rate of deaths from breast cancer in Japan to be very low. (Men may be interested to know that the death rate from prostate cancer is also very low in Japan.) This chart, however, was compiled in 1976. It is interesting that the incidence of breast cancer in Japan has increased 250 percent since 1 966. During this period many Japanese have shifted to a higher-fat, Western type of diet. Within Japan, the risk of developing breast cancer has been found to be 8.5 times higher among wealthier women who eat meat daily than among poorer women. A similar increase in breast cancer was found in Iceland, where the national diet has shifted from predominantly fish and sheep to more Western fare.(Servaas) This is because the increase in fats has led to more obesity and it is increasingly harder to find the lumps on breast used to detect breast cancer. In conclusion breast cancer is caused by age hereditary traits, hormones, and health. An easy way to find it is with a self-examination or mammogram. The easiest way to deal with it is a lumpectomy. References Breast Cancer. Sick!, UXL, 2007. Research in Context, go.galegroup.com/ps/i.do?p=MSICsw=wu=j020902v=2.1id=GALE%7CCV2643900019it=rasid=15ef5ef0bdc2b526562335fb8657988f. Accessed 9 Feb. 2017. breast cancer. The Columbia Electronic Encyclopediaà ¢Ã¢â‚¬Å¾Ã‚ ¢, Columbia University Press, 2017. Research in Context, go.galegroup.com/ps/i.do?p=MSICsw=wu=j020902v=2.1id=GALE%7CA68486643it=rasid=607940fd249c5b4968321bc189f256b1. Accessed 3 Feb. 2017. Mammography. UXL Science, UXL, 2008. Research in Context, go.galegroup.com/ps/i.do?p=MSICsw=wu=j020902v=2.1id=GALE%7CCV2646000622it=rasid=da4238e50516f2702052bcad4af954c3. Accessed 6 Feb. 2017. SerVaas, Cory. Prevent breast cancer deaths. Saturday Evening Post, Mar. 1986, p. 68+. Research in Context, go.galegroup.com/ps/i.do?p=MSICsw=wu=j020902v=2.1id=GALE%7CA4151308it=rasid=deac5885b258ce7d6954f0f6396e4f6f. Accessed 3 Feb. 2017.

Thursday, September 19, 2019

Pro War in Iraq Essay -- War Wars Argumentative persuasive Essays

Pro War in Iraq I do not subscribe to the fashionable notion of moral equivalence between all deeply-held beliefs. I believe in the rights of the individual over the collective. I believe democracy is better than dictatorship, both morally and practically. Not necessarily democracy as we or the Americans or the French practice it, but the idea that in every possible practical way, you should let people make their own decisions, and if these decisions need to be circumscribed in any way, then you should only do it with the explicit approval of a majority of the people in question. And above all that a people must be able to change governments and leaders without resorting to force.   Ã‚  Ã‚  Ã‚  Ã‚  So my ongoing position is that I am not comfortable with a world in which there are prosperous democracies and failing dictatorships, and we are supposed not to notice because somehow it would be disrespectful of the people living under the dictatorships. I don’t buy it.   Ã‚  Ã‚  Ã‚  Ã‚  The problem, of course, is that many peoples currently living under dictatorships might, if asked right now, come up with some deeply unpleasant policy decisions. They might even vote against democracy, saying they don’t want it. This is the worry in many countries with an Islamic fundamentalism problem: if they can get a majority the fundamentalists are committed to democracy under the slogan â€Å"one man, one vote, just this once†. That is not democracy.   Ã‚  Ã‚  Ã‚  Ã‚  Democracy needs certain conditions to get started. It is an eco-system, not a single tree, you can’t just plant it and sit back in its shade. But once it is established, it is hard to uproot. People talk about democracy needing a democratic â€Å"culture†, but culture is the wrong word, it makes it sound subjective. What it really needs is a universal foundation based on respect for the individual: freedom of speech, freedom of association, primacy of the rule of law, relinquishing the use of political violence, the rights of women to participate fully in economic, social and political life. It may be the case that these values are most clearly held in Northern Europe, North America and the English-speaking world. But they are not western values: they are all founded in the primacy of the rights of the individual. Where these values have had a chance to become established in other cultures, they take root. Southern and Eastern Europe, Japan a... ... under any circumstances, is unequivocal.   Ã‚  Ã‚  Ã‚  Ã‚  Apart from the obvious point that all UN members are always selective about which resolutions they get involved in implementing, it is worth reading Resolution 242 itself. Sure enough, it requires â€Å"Withdrawal of Israeli armed forces from territories occupied in the recent conflict†. At the same time, however, it requires â€Å"Termination of all claims or states of belligerency and respect for and acknowledgement of the sovereignty, territorial peace within secure and recognized boundaries free from threats or acts of force.† The State referred to in the second part is, of course, Israel; the claims, threats, territorial incursions and violence are those visited on it by its neighbors since its creation and acknowledgement by the UN. The resolutions against Saddam Hussein were unilateral and unequivocal. They are materially different from resolutions that present a package of requirements that have to be carried out by both sides in a conflict, and whose implementation is going to require the cooperation of both sides.   Ã‚  Ã‚  Ã‚  Ã‚  And there you have it. I think the intervention is morally justified, practically required, and legally based.

Wednesday, September 18, 2019

jared :: essays research papers

†¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Can I buy you a drink, or do you just want the money. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  I may not be Fred Flintstone, but I bet I can make your bed rock. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do you believe in love at first sight, or should I walk by again? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Hi, my name is {name}, how do you like me so far? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Your body's name must be Visa, because it's everywhere I want to be. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  I may not be the best looking guy here, but I'm the only one talking to you. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Yo Baby, you be my Dairy Queen, I'll be your Burger King, you treat me right, and I'll do it your way. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Excuse me, do you have your phone number, I seem to have lost mine. I can't find my puppy, can you help me find him? I think he went into this cheap motel room. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  I'm new in town, could I have directions to your house. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  If you were a new hamburger at McDonald's, you would be McGorgeous. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Let's do breakfast tomorrow. Should I call you or nudge you? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  If I could rewrite the alphabet, I would put U and I together. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There must be something wrong with my eyes, I can't take them off you. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do you have a map? I just keep on getting lost in your eyes. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  You might not be the best looking girl here, but beauty is only a light switch away. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  That's a nice shirt. Can I talk you out of it? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There must be something wrong with my eyes, I can't take them off you. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Are you from Tennessee? Because you're the only ten I see! †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Was your father a thief? 'Cause someone stole the stars from the sky and put them in your eyes. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Your daddy must have been a baker, 'cause you've got a nice set of buns. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Excuse me, but I DO think it's time we met. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Shall we talk or continue flirting from a distance? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Is it cold in here, or are you just happy to see me. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do you sleep on your stomach? No. Can I? †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Be unique and different, say yes. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  You make me so nervous and flustered, I've completely forgotten my standard pick-up line. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Do you have a map? I just keep on getting lost in your eyes. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Is it that cold out or are you just smuggling tic-tac's. †¢Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Excuse me I lost my teddy bear will you sleep with me tonight.

Tuesday, September 17, 2019

External Factors Essay

External factors are a number of influencing factors which are not controlled by the company but will impact pricing decisions. It includes of legal, consumer trends, technological, and competitors. Our company focuses on technological and competitor as external factors that influencing price setting on matcha collagen biscuits. Competition factors can look into three areas which are monopoly competition, perfect competition and oligopoly competition. Monopolistic competition is a situation where a single company or group controls the entire output of the market for a given type of product or service with any buyers. Besides, a monopoly is protected from competition by high barriers to entry and the product it produces has no close substitutes. Example of monopolistic competition is water service which supplier of water has no substitutes. Perfect competition is a market structure where there are a large number of buyers and sellers. There are a perfect knowledge of market condition and the price which no individual firm has any influence on the market price. The products in perfect competition are homogeneous which they can be substituted easily. Therefore, the company can entry or exit the industry without affecting the market. An oligopoly competition is a situation in which a particular market or industry is dominated by a small number of firms which compete against each other. There is an element of interdependence in the decision-making of these firms. Example of oligopoly competition are newspaper industry, petrol stations, and airlines. Our product’s price is influence of external factors which is perfect competition. This is because there are many firms produce an identical and homogeneous biscuit in the biscuit market such as Munchy, Tiger, and Jacobs. Besides, they are many sellers in the biscuit market which are Kraft, Julie, and Munchy as well as there is no dominating firm. Therefore, our company is considered as price takers which accepts market price determined by the forces of market demand and supply. Furthermore, all buyers and sellers have perfect knowledge about the prices of biscuits in the market. Hence, our company cannot simply set the price of matcha collagen biscuits to maximize its profit, this will cause our product easily substitute with another brand of biscuits. Moreover, our company has complete freedom of entry into and exit from the biscuit market without affecting the entire market. Technology is a business enabler that has a revolutionary impact on the actual conduct of business. It contributes to achieving desired business productivity and efficiency. Under technological, our company using advanced technology on manufacturing operation to produce matcha collagen biscuits. Examples, our company used the latest techniques and machinery in order to increase the production as well as maximize capacity. Furthermore, the creation of databases and electronic communications in our company have enabled vast quantities of information to be shared and quickly distributed within the company. Moreover, our company’s customer service department used communication technology to talk to customer but will also have access to internal systems, such as technology to simplify credit control and stock control. Therefore, shifts in technology and advances may affect costs, quality and overall innovation of our product which becomes a major factor of setting the right price f or matcha collagen biscuits.

Monday, September 16, 2019

Banning whaling

Whales are the biggest animals that live on this planet, in the oceans. Depending on their species they can weigh up to 200 tons, the weight of around 12 elephants or 2000 people. It has also been studied that the brains of whales are developed which means they are intelligent creatures. Since centuries whales have been hunted down for their oil and meat. The process of killing whales for their meat and oil is called whaling. In the olden days only the slow moving whales were hunted.By the 17th entury the demand for whale 011 and meat rose and It wasnt until the 18th century when a new hunting weapon was invented. Since harpoons were invented, fast paced whales like blue whales could be killed but it is a very cruel way of hunting whales. Whales being the biggest animals of our planet and being driven to almost extinction, It becomes our duty to ban hunting whales and preserve them. Commercial whaling has driven so many whale species to near extinction. Not only that but other factor s like ocean noise, pollution, climate changes also threaten their existence.In 1 905, since whaler shifted to Antarctic waters, South Georgia became he Centre for whaling and between 1930-1931 30,000 blue whales were killed and processed 1 That nearly drove the blue whales Into extinction as they were hardly noticed ever Lohan 2 since. In 1986 the International Whaling Commission banned whaling all over the world to protect whales from being hunted but despite that, many countries still practice whaling either In disguise of research or to maintain the Industrial demand for whale meat and oil. Countries that still practice whaling are Japan, Iceland, Norway.Iceland has recently alone killed hundreds of whales and send tons of hale-meat to Japan whose market Is already so full of whale meat. In Japan whale meat Is a delicacy and on the pretext of scientific research It kills whales. Whales take time to mature and also reproduce slowly. They only have one young one in around 3 years and it takes time for a specie to recover after being hunted in masses. Hence its numbers decrease to extinction so easily that we don't realize the harm we do by killing whales that are so Important to our ecosystem.People all over the world consider commercial whaling to be cruel. Nowadays people all around the world love whales and whale watching trips have become opular. Many see whale watching as a better alternative to whale hunting -It Is a 1 OF3 whales popular amongst people2. â€Å"In the late 1980s, whale watching became popular outside the Ogasawara islands south east of Tokyo where they claim to have a 90% success rates for watching humpback whales by boats during the past few years. † Whale watching trips are offered there everyday at times for 2 hours or 6 hours.The types of Lohan 3 boats are diving boats, pleasure boats and commercial/sports fishing boats3. Humpback whales and right whales are making a comeback in their numbers due to protection organizations. This, being a success, shows that we should hold out more protection campaign for whales because many species are still fragile and cannot recover their numbers quickly. Many people consider that the method of killing whales is extremely cruel. â€Å"Although whaling fleets may be highly sophisticated, equipped with sonar, helicopters, long-range explosive harpoons and factory ships, the actual kill is horrific† 4.The way a whale is killed is through a harpoon, which is 90 kilograms in weight and is shot from a cannon. The head of the harpoon has a time fused grenade which when hits the whale, explodes and tears the internals of the hale apart. The whale still continues to suffer until hours of beating when it actually dies. Whales are smart creatures and it is not possible to find a humane way of killing them. People say killing whales is good because whales eat a lot of fish but what we don't realize is over-fishing is a bigger factor for decrease in fishes.Since whales hav e decreased in numbers fishes should have increased in their numbers but they haven't, hence we are only to blame for the diminishing of aquatic animals. Japan has killed hundred of whales even after the ban on whaling. They kill whales on the rounds of scientific research whereby when a whale is killed scientists recover parts of the whale, which helps them understand the age of the whale, its diet, Lohan 4 and birthing rate and the meat is packaged and sold in the market5.Japan's history has shown that it largely depends on whale meat for its source of protein and nutrition and thus still kills whales for food. â€Å"NRDC and over a dozen other conservation groups recently petitioned the Obama administration to take strong action against Iceland under the Pelly Amendment to the Fisherman's Protective Act† 6. Through this, the President can impose trade sanctions to a country that does not obey conservation agreements. The United States has been a leading global conservator for whaling.To sum everything up, Whales have been hunted for years to such an extent that many species of whales have been driven to extinction and it takes time for a specie to recover its numbers because of the slow rate of whale reproduction and maturity. It is more profitable to have whale watching than killing whales because whale watching serves as a source of income through tourism. Whale oil used to be in demand in the olden days but due to modernization and lternatives for whale oil , the profits from whaling has decreased because now a days whale oil is rarely used.The methods of killing whales are inhumane as they are When shot, they may take up to an hour to die but in the meantime suffer. Countries still practice whaling either through pretext of scientific research or commercial whaling. Consumptions of whale meat Lohan 5 can be harmful because the mercury content in them was found to be high as studied in Japan. Whales are significant to our ecosystem and without the m the marine ecosystem is vastly affected. Whales are magnificent creatures and are espected and loved all around the world.They are intelligent and also the biggest on our planet. Hunting them to extinction is Just another projection of how cruel and inhumane mankind can be. Banning whaling should be maintained all around the world but with stricter impositions.

Sunday, September 15, 2019

Ethics of care Essay

Introduction †¢ Care ethics [The ethics of care] originated among feminists who maintained, on the basis of Carol Gilligan’s work, A Different Voice , that women and girls approach moral issues with a strong concern for empathy and caring in interpersonal relationships. Care and Virtues †¢ Care ethics focuses on virtues associated with care as a moral sentiment and response in the context of particular relationships. †¢ The emphasis is on such traits as empathy, sympathy, compassion, loyalty, discernment and love in intimate relationships, rather than the abstract principles and rights of deontological and libertarian ethics. †¢ Like communitarian ethics, care ethics stresses the interdependence of persons and the importance of particular relationships, especially within the family and other communities Care Ethics †¢ Care ethics encourages altruism, which entails concern for others, their feelings and needs, but does not neglect care for oneself. †¢ Care ethics requires the moral agent to balance care of the self with care for others. Photo by Katerha Gilligan’s Ethics of Care †¢ Gilligan identifies levels and transition periods in the development of the ethics of care. †¢ (1) â€Å"From Selfishness to Responsibility† the conflict between what one would do vs. what one ought to do within their attachments and connections to others. Photo by Derek Bruff Ethics of Care †¢ (2) â€Å"Goodness as Self-Sacrifice† – concern for others, their feelings and the need to not inflict harm are major concerns. †¢ (3) â€Å"From Goodness to Truth† – the morality of care must include a care of the self as well as others, to be honest and real with oneself, an increased responsibility to one’s responsibility to the self, as well as others. †¢ Gilligan defines this as â€Å"mature care†. Photo by Ed Yourdon Ethics of Care †¢ (4) â€Å"The Morality of Nonviolence† – a moral equality between the self and others is achieved by applying an injunction against hurting; care becomes a universal obligation[1]. Harvard Educational Review: 481-517 Repr. 1986 as â€Å"A Different Voice†, In Pearsall, Women and Values: 309-339 [1] Gilligan, Carol 1977, â€Å"Concepts of the Self and of Morality† †¢ â€Å"Care ethics is based on [or â€Å"justified by† ] â€Å"lived experience,† especially that of women with intimate relations, trust and commitment. †¢ â€Å"Lived experience† is the accumulated subjective experience of individuals (2). Care Ethics Photo by Mary Ellen Mark †¢ (2) Pettersen, T. 2008. Comprehending Care . United Kingdom: Lexington Books:23 Care Ethics †¢ Care ethics appears most appropriate to intimate relations, but its advocates seek to extend it to communities, institutions and nation states Care ethics is intended to guide conduct and to provide an aspirational ideal of the virtuous life Photo by geek2nurse Affective and Cognitive Care Caring has both affective and cognitive dimensions. †¢ Cognition is necessary to understand the other’s needs, feelings and circumstances. But caring also involves a range of feelings associated with empathy, sympathy, compassion, and love. Care Ethics and Normative Ethics †¢ Care ethics provides normative guidance, but it does not prescribe specific actions by applying a set of abstract principles, rights and rules (found in normative ethics). †¢ With universalizing principles (normative ethics), the public domain has superiority over private-personal domains. . Emotion and Understanding †¢ In caring, moral thoughts are not separated from feelings as they are in many Western ethical philosophies from Plato to Kant. †¢ Gilligan challenges the idea that moral reasoning should be divorced from feelings and contexts. Emotion and Understanding †¢ Knowledge is gained through human connection to others when we try to take the perspectives of others in deciding morality and justice. Photo by rexquisite Co-Feeling and Empathy †¢ Caring involves understanding another’s feelings that seeks to go beyond mere understanding (empathy) to actually feeling what others experience. †¢ Petersen defines this as co-feeling which is more than empathy. †¢ Caring originates from the experience of caring for others. †¢ In caring for particular individuals, we learn to recognize the needs and vulnerabilities of human others everywhere; and to avoid harming them. Co-feeling and Empathy Co-feeling in care ethics comes from experiencing the complexities of a particular individual’s situation. A deep, detailed appreciation for the lives of others enriches our own self-understanding. Photo by Neys †¢ Co-feeling is one ability in mature care; how one should act and what actions constitute care. †¢ Caring involves participating in another’s feelings on his/her terms with an attitude of engagement, not of disinterested observation or judgment. †¢ It is an act of affective imagination. Photo by Quinn Anya Care Ethics and Moral Autonomy †¢ For care ethics, moral autonomy is construed as relational autonomy. †¢ In contrast with Kant’s isolated individual who rationally formulates universal principles by himself or herself, the relational autonomous agent takes account of her interdependence with others. †¢ Gilligan promotes a more nuanced and complex concept of moral autonomy with space for holding self-determination with consideration, reason with emotion, and independency with connectedness. Friend Wheel by Unlisted Sightings †¢ Care ethics replaces the detached respect for the autonomous decisions of others that is the legacy of principle-based ethics with attentiveness to the plight, special needs, and vulnerabilities of individuals, who might need help is deciding what to do †¢ Tensions continue to exist within care ethics between contextual sensitivity in moral decisionmaking and respect for principles that direct us to treat people equally, with justice and respect for autonomous choices. Justice and Moral Conflicts – Care Ethics †¢ Moral conflicts are still those that involve individuals with differing philosophies. They involve loyalty conflicts or divergent responsibilities and interests for individual professionals. Agents have different ideas of what is ethically relevant. Photo by xeeliz Steps to Convergence on Ethics of Care and Principle-based Ethics †¢ What actions are right or wrong according to some relevant norms or principles, fairness in particular. What is the effect of these principles on those involved – will they hurt individuals? †¢ Care ethics questions the over-reliance on principles and rules in ethics. †¢ Are we choosing to be detached and numb to feeling the impacts of the principle of justice on individuals and our relationship to them? Photo by Svenska Cellulosa Aktibolaget A THIRD WAY †¢ Care ethics encourages the moral agent to balance respect for individual autonomy with caring for individuals in relationships. †¢ A balance between relations and autonomy, between connection and integrity would create convergence of principles with care. †¢ An intermediate position between too much and too little would be needed. A THIRD WAY †¢ Care ethics requires morally mature agents to weight and balance principles with caring for individuals. †¢ In these moral conflicts, â€Å"listening† to others, is essential to decision-making. †¢ Interdependent leadership and communication may open up new possibilities – a third way. . References Beauchamp T. and J. Childress. 2009. Principles of Biomedical Ethics, New York: Oxford University Press, 6th ed Gilligan, Carol 1977, â€Å"Concepts of the Self and of Morality† Harvard Educational Review: 481-517 Repr. 1986 as â€Å"A Different Voice†, In Pearsall, Women and Values: 309-339 Munson, R. 2004. Intervention and Reflection: Basic Issues in Medical Ethics, 8th Ed Australia ; Belmont, CA : Thomson/Wadsworth, Pettersen’s T. 2008. , Comprehending Care . United Kingdom: Lexington Books:

Saturday, September 14, 2019

10 Things I Learned from Mgt-317

Organizational Behavior. 1. I learned that organizational culture is the shared values and beliefs that underlie a company’s identity. The organizational culture is passed through socialization to new employees and it influences how we behave at work. 2. I learned that different types of organizations have different types of cultures. For example, Badger Mining Corporation uses a clan culture, which resembles a family-like structure and the effectiveness is achieved through collaboration of all the employees. Apple uses an adhocracy culture and encourages innovation and creativity.Carmakers KIA uses a market culture and promotes competition inside the organization with the purpose of increasing market share and being profitable. Tech company Dell has a hierarchy culture, which promotes their employees to be efficient and reduce cost. 3. I learned that there are two types of conflicts in an organization, content or substantive based and personal or emotional based. The first on e can be solved by using creativity and innovation and can benefit the organization. The second one harms people involved because of their egos. 4.I learned that sometimes conflicts benefit the involved parties. There are two ways of stimulating functional conflict: (1) by being the devil’s advocate and (2) by using the dialectic method. The devil’s advocate works as a critic and tries to find flaws in the proposal and the dialectic method uses debate between proposals. 5. I learned that there are 5 was to resolve conflicts. (1) Competing is being assertive and not caring about other people’s concerns. (2) Accommodating is unassertive and cooperative, an individual neglects his own rights to satisfy the concerns of others. 3) Avoiding is unassertive and uncooperative. When avoiding, an individual does not immediately pursue either his or her own concerns or those of the other person. (4) Collaborating is assertive and cooperative. When collaborating, an individu al attempts to work with the other person to find a solution that fully satisfies the concerns of both. (5) Compromising is intermediate in both assertiveness and cooperativeness. When compromising the objective is to find an expedient, mutually acceptable solution that partially satisfies both parties. 6.I learned that I am more efficient when I work in teams. Throughout the semester we had to work in teams not only for our project but also in small class activities. I really enjoyed working with different people with different characteristics. 7. I learned that most of the time I am intrinsically motivated. I am at one point of my life where money is not a problem. My family is able to support me while I live here in Boston and go to school. I realized that I do with passion the things that I love and that there are no external rewards that can change that. 8.I learned that my decision making style was both directive and analytical. I am a person that likes facts and makes decisio ns based on logic. I like analyzing all the possible aspects of a situation and all possible outcomes before making a decision but sometimes I tend to overanalyze a situation. 9. I learned how to be an effective team member. How to interact with my teammates and how to contribute with my ideas in order to be part of a successful team. 10. I learned that my learning style is being an accommodator because I am very open to new experiences and I learn from them based on trial and error.

Friday, September 13, 2019

Assessment for learning Essay Example for Free (#9)

Assessment for learning Essay Learning is an innate capability of a person. People perceive things and learn through their experiences while they grow up and develop accordingly with their ages. Aside from the normal people who learn in the normal way, there are off course other people who are above normal, after which learn through special trainings and conditioning. People learn accordingly with their capacity to gain information and store it in their minds. It is not only by sending children to school that they are learning but also through their real life experiences that require not only for their intelligence but also for their emotional skills. In determining the learning rate of a certain group, it is very important that the surveyor is able to gather the information about the specific group such as age range, family background, nutrition of the students and other factors that actually affect the learning activity of a person, be it a cognitive or conditional learning. There are also specific tests that can be given to the students or the target learners to have written and documented results. Suppose I chose the pool of elementary students that includes children ranging from 10-11 years old. These children are already exposed to a large scope of media that portray the different roles and scenarios in the society. If I am to analyze their emotional intelligence, I would give them examinations that can determine how well they interact with other students such that they will be told to work on groups. Through the activity, students with good family background can actually have the bigger possibilities of leading the group thus causing peace whenever other children tend to fight for what they believe. Off course there will be passive kind of children and the best tool to give or offer them are group dynamics that can actually unleash their inner talents. That is also possible if the conductor of the test is encouraging and enthusiastic. In terms of academic assessments, children on this age range can be fed with lectures and practice activities such as solving math problems or subject and verb agreement. In my past experiences as a child, it is very effective for me that children will be given the chance to construct their own sentences and math problems. After that, children will be asked to solve and analyze what they do and have it in group discussions. Group discussions can help the children to gain other ways of solving such problems and understanding different sentences. It is also helpful that the teacher follows up the development of the understanding of a student. Assessing the strengths and weaknesses of the lesson is necessary thus providing them devices and strategies that can help them understand more the difficult points. Specific tools that can be used in assessing the ability of a person in Mathematics and English can be flash cards and reading literary pieces (stories, anecdotes) respectively. Both can add up to the expertise of a student to the subject matter. Every child deserves the right for education. For those who can’t afford it, there are still many ways to supply your children with it; either tutoring them every day or enrolling them a school that caters scholarships. It is vital to feed the children with knowledge while they are young and still can acquire and save them to their memories. The value of education is much more priceless than any treasure in this world: not fading but still growing through ages. QCA WEBSITE. Assessment for learning. Retrieved 1 May 2008 from http://www. qca. org. uk/qca_5067. aspx Assessment for learning. (2017, Jan 11).

Impact of the European Union on France Essay Example | Topics and Well Written Essays - 1750 words

Impact of the European Union on France - Essay Example From this discussion it is clear that  the European Union (EU) is a political and economic federation comprising 27 member countries, and all of them design same policies for different areas. In 1993 the EU was formed with the signing of the Maastricht Treaty, but later there was a great contribution from multiple European organizations, which led to the development of European Union. This represents an effort to bring forth unity in Europe encompassing various attempts of establishing unity through armed forces. France was one of the member nations involved in European Union. There were several criteria associated with joining the Union which were evaluated by the European Council country-wise.  This paper outlines that the major benefit of EU was that it focused on a stable democracy where one nation would not be unduly harmed by other nations. One European currency and economic integration proved to be primary goals of European Union. The research question for this particular study is – â€Å"what is the impact of Euro and EU on France in economical, social, political and cultural context.† This study will help to evaluate the positive and negative impacts created on France by European Union.  In the economic context the impact of EU and Euro on France would be analysed on the basis of GDP components, productivity, public finances, external trade and labour market. EU possessed GDP of 11,600 billion Euros and a total population of 500 million in 2006.

Thursday, September 12, 2019

Ethics in Business Summative Assignment Essay Example | Topics and Well Written Essays - 2000 words

Ethics in Business Summative Assignment - Essay Example However, Vin Diesel has recently become a vegetarian and no longer consumes the product. Amie feels disturbed by the ethical ramifications of the celebritys endorsement and is pondering how to proceed with the advertising project in the face of ethical concerns. Individuals in the advertising business, or even amongst general society, are often challenged when they consider ethics and legality to be similar; however ethics and the law are two very distinctly different things (Nickels et al, 2005). Amie, the copywriter for Laird & Laird, questions the ethical appropriateness of using recent vegetarian convert Vin Diesel as the spokesperson for Basils Best bacon. Because the celebrity no longer consumes the product, Amie feels that consumers may be unintentionally misled by the endorsement, since potential health issues are being intentionally omitted from Diesels promotion of the product. However, the Advertising Standards Association has established that so long as the endorser can accurately testify to verifiable personal use of a product, with no mention of strictly present usage, the celebrity endorsement is legally valid. I believe that Amie is engaged in such a dilemma to where she is ineffectively relating legalities with that of ethi cal issues, thus she is not able to separate the two very different viewpoints. The first step that Amie needs to take to satisfy her apprehension is to adequately measure her perceptions to determine whether an ethical situation actually exists. Marketing communications and advertising messages must consistently be accurate and truthful in order to meet appropriate standards (Gershon & Buerstatte, 2003). With this in mind, it has been clearly illustrated through both personal communications with Vin Diesel and in his legalised testament to his historical satisfaction with the consumption of Basils

Wednesday, September 11, 2019

HOMEWORK 6 Personal Statement Example | Topics and Well Written Essays - 250 words

HOMEWORK 6 - Personal Statement Example It can hence be noted that a variance may hence be considered as unfavorable or on the contrary be favorable. Viewing a prepared income statement budget report, one visualizes how the variance does affect the overall net income of that company. Hence one can hence make deductions on whether they are favorable or unfavorable. This occurs when actual net overall income is less than the expected then the variance would be considered to be unfavorable. Hence, higher revenues can cause a favorable variance. Nonetheless, extreme higher costs and expenses do result in causing an unfavorable form of variance in a company (Richards, 1995). Sales variances can be considered to be favorable when the real sales can be seen as greater than the expected or what would be termed as the targeted sales. They can be unfavorable when the expected sales are lower than the targeted sales. Cost variances are favorable when real costs happen to be lower than the targeted costs. In many a times at the production level, sales of a company may be affected. Lower control in the quality of the production process may result to sub-standard quality of the goods. This ultimately would translate to poor sales for the company hence making lower levels of expected income. Things involving delays in the production process could also affect the products being readily available in the market and hence deter volume of sales. Failures which happen to arise in the production department subjected in satisfying specifications of customers also inhibit sales. Hence, it can be observed that considerate investigation and thorough research on the importance of these sales volume variances can translate to identifying those responsible for the overall dismal sales performance for the company (Richards, 1995). Furthermore, the company has to use such vital information so as to manage the various anticipated costs to be incurred. For instance, to determine volume variances, one needs to compare a static

Tuesday, September 10, 2019

Democratic Peace Theory Essay Example | Topics and Well Written Essays - 2000 words

Democratic Peace Theory - Essay Example 5). In that context the democratic peace theory not only directly challenges the validity and efficacy of the alternate political systems, but also the existing accounts of international relations that lay emphasis on the concepts like the strategic common interests and balance of power machinations, while delving on the international relations between salient democratic powers (Newman & Rich 2004, p. 5). Democratic Peace Theory In a simplistic context, one could ascribe the democratic peace theory as a theory that upholds the fact that the democratic nations seldom engage in war with each other (Schraeder 2002, p. 17). There exist varied other terms aimed at explaining and grasping this theory like ‘inter-democracy non aggression hypothesis’ or ‘mutual democratic pacifism’. ... 17). The other hypothesis that is put forward in the support of the democratic peace theory is that the democratically elected leaders are conversant in resolving issues through negotiations, and hence they carry on with this attribute in their approach towards foreign relations (Schraeder 2002, p. 17). No wonder, there are many people who tend to deny or criticize the democratic peace theory. What is Democracy? To a great extent the validity and relevance of the democratic peace theory is dependent on as to how one tends to define or explain a democracy. Although there is no single paradigm that grasps a holistic definition of democracy, yet, experts have identified varied salient features that delineate an ideal democracy. On most important attribute of the democratic nations is that they do have a democratically elected constitutional form of government that is answerable to people. Besides, these constitutionally elected governments happen to be representative in their scope and nature, directly responsible to the public sentiments, beliefs and aspirations. A workable and pragmatic democracy is always subservient to the principle of the separation of powers, where the powers of the state are judiciously allocated between the varied pillars of democracy like the executive and the judiciary. All the worthwhile and true democracies do extend varied judicial and legal rights to their citizens, which are legally and ethically upheld by the constitution and the state. Last but not the least, democracies do believe in extending avenues for participation to varied sections and segments of the society. Hence, in the interest of practicality, while delving on the democratic peace theory; one does

Monday, September 9, 2019

Organizational Environment and Behavior of British Airways Research Paper

Organizational Environment and Behavior of British Airways - Research Paper Example This research will begin with the statement that in the modern era of globalization Aviation industry is growing rapidly. This industry has many players with a strong competition among themselves. British Airways is the largest airlines company in the United Kingdom. The company was founded in 1974. Its headquarters are in London. Based on the Fleet size British Airways is the largest airlines. In 1972 British Airways Board was established by the government of UK for managing two nationalized airlines company. British European Airways, British Overseas Airways Corporation, Northeast Airlines and Cambrian Airways are the four airlines companies who merged together and formed the aviation company British Airways. Initially, for thirteen years the company was owned by the state government. In 1987 the company was privatized. British Airways is the founding member of the third largest airline's alliance that is Oneworld. This company provides international flights to international destin ations. It has flight service around 550 destinations in all over the world. It gives the customers excellent food service along with many other options for like games, TV, music, etc for satisfying its customers. The company is registered in London Stock Exchange. British Airways has established a contract to combine itself with the Iberia Airlines. The company expanded its business through different acquisitions and mergers. Until 2008 this firm was the largest airline company by the number of passengers. The company has its strong presence in Gatwick Airport. BA CityFlyer is the subsidiary of British Airways and it is the largest operator in London. The success of the company depends largely on the commitment and motivation of its employees. British Airways is a large organization with a huge number of employees. It is one of the largest airline companies in the world. The company provides many benefits to its staffs which motivates them in their work. British Airways creates a s ense of value among its employees which enrich the working environment of the company.

Sunday, September 8, 2019

Benefits of Biomedical Research Using Animals Essay

Benefits of Biomedical Research Using Animals - Essay Example Breast cancer is the most common in American women (American Cancer Society). On the other hand, I went through the signs and symptoms to understand what my aunt was experiencing. The website listed symptoms like swelling in parts of the breast, irritation of the skin, pain in the breast or nipple, and sometimes discharge from the nipple (American Cancer Society). Moreover, I also learned of how cells of cancer grow in an uncontrollable manner and pose the risk of spreading to other parts of the body in what is known as metastasis. After a visit to the oncologist, my aunt level of cancer was said to be a stage that could not be controlled through surgical means. Therefore, the only option viable at the time was the use of chemotherapy. Chemotherapy helps in reducing the growth of cancer cells in the body (American Cancer Society). My aunt was placed on a combination of chemotherapy tamoxifen and Herceptin. However, chemotherapy has been associated with the side effects in human thanks to the recent development that has enabled development of drugs that mitigates side effects. One of such drugs that my aunt had to rely on was Herceptin. The drug acts by focusing on specific genetic alteration and hence has enabled in the reduction of side effects such as hair loss and nausea that is typical in another form of therapies (UCLA). The efficacies of these drugs that have been helpful to my aunt have been proved through animal research. The development of these drugs has been possible through intensive research that has been done on animals (rats) (Animal Research Info). It is the identification of estrogen receptor (ER) in the laboratory that has made it possible to describe the target site specificity of estrogen action in breast cancer (Jensen and Jordan 1). In the 1970s, there was consideration of the use of ER as a target for therapeutics.

Saturday, September 7, 2019

Summary on India Country Report Essay Example | Topics and Well Written Essays - 1000 words

Summary on India Country Report - Essay Example The financial year for India is April to March, and during the first quarter of the current financial year (2007-08), real GDP growth was 9.3%, estimated growth rate for the full year being 8.4%. This is on the back of an average annual growth rate of 8.83% in the past four years since 2003 – 04. The above 8% GDP growth performance is not likely to be sustained in the coming two years, forecasts being still healthy at 7.9 % and 7.4% successively. The overall GDP is estimated to cross one trillion US dollars land mark during the current year itself, by a good margin. Sector-wise, industrial and services sectors continue to outperform while the agricultural sector growth will be anemic, as in the past few years. During 2006-07, industry and services sectors accounted for 27.9% and 54.6% of the GDP respectively, the balance 17.5% being for the primary sector in which more than 700 million people are engaged in India. Thus, the bleak outlook for the rural economy stares in the face of Trade in goods and services, with continued political support for liberalization, is showing good performance. Imports are rising due to strong domestic demand for industrial and consumer goods. However, exports which averaged 26.5% growth in the past three years are expected to slow down to 17.2% in the current year, the main culprit being the weakening of the US dollar vis-Ã  -vis the Rupee. Rupee appreciated by over 12.5% in the past 12 months and the export oriented segments of the economy like software services, textiles, leather goods etc are hit by the Rupee appreciation. Rising cost of increased imports and crude oil are balanced somewhat by the rising exports of services along with remittances from non-residents, thus keeping the current account deficit under control, estimated at less than 2% of the GDP for 2008-09. The policy laid emphasis on increased spending on primary

Friday, September 6, 2019

Issue in Corporate Failure of Bank Essay Example for Free

Issue in Corporate Failure of Bank Essay It also raised millions of revenue by accounting techniques to show false profits and hided their losses which occur in trading and bad debt. The biggest bank fraud in history According to Manhattan District Attorney Robert M. Morgenthau, the BCCI scandal that came to light in 1991 was the largest bank fraud in world history. Perhaps no other criminal enterprise has involved or at least embarrassed so many prominent people, from billionaire Arab sheikhs to Third World dictators to present and former leading figures in the U. S. and British governments. Certainly none could match the international web of financial chicanery, political intrigue, and unsavoury figures with which BCCI was said to be associated. (Source: Encyclopaedia Encarta 2007) BCCI was engaged in four major frauds. One was a cover-up of $633m of losses on treasury trading. The second was the illegal acquisition through nominees of several banks in the US, in which it spend $346m. The third was a complex manipulation of accounts to prop up its largest borrower, the gulf shipping group of Pakistan, to which it lent more than $725m, which was over the limit set by banking regulations. The fourth was fundamental fraud by which BCCI allegedly acquire secret control of 56% of its own shares at a cost of over $500m. BCCI was a serpent eating its own tail. These sums add up to more than $2bn. But this is a minimum: it omits the enormous cost to BCCI of financing its secret losses. The manipulation to cover up the fraud involved another $2bn, bringing the grand total to well over $4bn. BCCI frauds were the main reasons for its corporate failure. The scale the fraud is breathtaking enough. But while most frauds involve the disappearance of real money, BCCI did the exact opposite. It manufactured billions of dollars out of nothing to conceal gaping holes in its balance sheet, like a giant game of ‘Double Your Money’. This involved extraordinary financial gymnastics and illegal loans on a huge scale. When BCCI finally came crashing down, it was not with a thud, but in a shower of paper. (Behind Closed Door: FT Publication) BCCI initiated every single route to excel its growth. In a first place its corporate structure was so complicated which involved uses of shell corporations frequently termed as satellites, bank confidentiality and secrecy. BCCI’s top management including nominees which also includes some famous personalities in politics were involved in corruption and made it a supreme atmosphere for crime. BCCI’s criminalities included, †¢Fraud by BCCI and BCCI customers involving billions of dollars; money laundering in Europe, Africa, Asia, and the Americas; †¢BCCIs bribery of officials in most of those locations, †¢Support of terrorism, arms trafficking, and the sale of nuclear technologies; †¢Management of prostitution; †¢The commission and facilitation of income tax evasion, smuggling, and illegal immigration; †¢Illicit purchases of banks and real estate. Source: Walker, L. 2001) Abdul Basir, head of BCCI Pakistan operation, says: â€Å"We looked after clients in the most efficient, personalised manner. † The diamond market which is home to Lahore’s famous dancing girls, Prostitutes, who for centuries have provided entertainment for emperors and their cour tiers – and latterly for politicians, Arab Sheikhs and bankers. BCCI used these girls to treat Arabs rich businessmen and major shareholders. BCCI’s Zafar Iqbal, former chief executive, was in charge of managing prostitutes. Corporate Failure of BCCI There were two main reasons of BCCI’s corporate failure apart from their criminal activities. These were high risk loans and trading. A bank’s treasury plays a key role in managing its financial affairs by trading large amounts of money and currencies. Some if this dealing is done on behalf of clients. But bank treasuries also speculate on whether currencies will rise or fall, using their own money. BCCI was no exception. According to Price Waterhouse, the bank combined these two activities by trading huge amounts of clients’ money – but in its own name, and without their knowledge.

Thursday, September 5, 2019

Factors Affecting Antipsychotic Medication Compliance

Factors Affecting Antipsychotic Medication Compliance INTRODUCTION The aim of this dissertation is to explore the factors affecting concordance with prescribed antipsychotic medications. The rationale for selecting this topic is derived from personal working experience with mental health service users. Having worked as a nursing assistant for the past eight years on acute admissions wards and as a student nurse for the past three years it was observed that a large proportion of compulsory re-hospitalisation under the Mental Health Act 1983 occurs due to relapse of mental illness as a result of non- concordance with medications, particularly service users with a diagnosis of schizophrenia. This led to believe that concordance with antipsychotic medications plays a crucial role in managing psychosis as it positively contributes towards the effective management of the illness in the community. In support to this view, Gray et al (2002a) assert that prophylactic use of antipsychotic medication reduces the risk of relapse among individuals with schizophr enia and non-concordance with medication has the potential for frequent re-hospitalisations. This has been recognised as the revolving door syndrome. During most mental health placements it was noted that non-concordance with medication has become significant, as this has been identified as a risk factor within the risk assessment checklist. Furthermore, despite the well-documented therapeutic effect of antipsychotic medications, some patients are reluctant to accept treatments and some may even wish to cease taking medications altogether. Therefore, this empirical knowledge has reinforced the desire to examine the factors associated with non-concordance with antipsychotic medications. According to Brimblecombe et al (2005) medication is one of the major therapeutic tools available to help people with schizophrenia. There is also growing evidence that schizophrenia can be treated effectively with a range of psychological and social interventions together with antipsychotic medications. Norman Ryrie (2004) emphasised that antipsychotic medication has been the mainstay of treatment for schizophrenia since the 1950s when it was discovered that the dopamine antagonist haloperidol and chlorpromazine exerted antipsychotic effects. The National Institute for Clinical Excellence (NICE) (2002) recommends that atypical antipsychotic drugs such as amisulpride, aripiprazole , olanzapine, quetiapine or risperidone must be considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia or to promote recovery for those who have experienced unacceptable side-effects on conventional antipsychotics, as atypical antipsychotics appear to have less extrapyramidal symptoms (side effects) than the conventional antipsychotics such as haloperidol and chlorpromazine. The care and treatment of individuals with schizophrenia have advanced considerably over the past ten years, since the introduction of atypical antipsychotics and medication continues to be the first line treatment for schizophrenia (Walker MacAulay, 2005). However, Gray et al (2002b) claim that despite the effectiveness of these atypical antipsychotic drugs, non- concordance with prescribed antipsychotic medications is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. In addition, Mitchell Selmes (2007) claim that over the course of a year, about 75% of patients will discontinue prescribed antipsychotic medications, often coming to the decision themselves and without informing a health professional. According to Gray et al (2006) relapse rates is five times higher among individuals with schizophrenia, who are non-concordance with medication compared with concordance. Non-concordance during acute treatment of psychosis le ads to chronic symptomswhereas non-concordance after remission increases the risk ofrelapse and both may have serious consequences; re-hospitalisation (Hamer Haddad, 2007). Furthermore, the impacts of non-concordance with medication not only affect the individuals with schizophrenia, as each relapse causes a stepping down of cognitive functioning which is rarely retrieved but also their carers and the costs of treatments (Institute, 2007). To facilitate this project as a literature review, an analysis of secondary sources only will be use. Secondary sources were mainly obtained from nursing journals such as Nursing-Standard, Nursing-Times, Advances in Psychiatric Treatment, Mental health practice, Schizophrenia Bulletin and The British Journal of Psychiatry, containing the key words: schizophrenia, oral antipsychotic, medication management and non-concordance. An Internet search of Google was also done with the same keywords to access any relevant documents. To address the factors affecting concordance with prescribed antipsychotic medications, these will be divided into patient-related factors, medication-related factors and clinician-related factors. LITERATURE REVIEW According to White (2007) schizophrenia is a debilitating psychiatric disorder characterised by a range of positive and negative symptoms and these symptoms were first described in detail by the British neurologist Hughlings-Jackson in the late 1800s. There is no physical test for schizophrenia rather it is diagnosed by the presence of certain positive and negative symptoms over a period of time (Brennan, 2001). According to Issacs (2006) the neurotransmitter hypothesis suggests that the dopamine over activity in the mesolimbic dopamine pathway, which is between the midbrain, is thought to cause the positive symptoms of schizophrenia and dopamine under activity in the mesocortical dopamine pathway is thought to result in the negative symptoms of schizophrenia. Positive symptoms represent a distortion of normal experience, such as delusions, hallucinations and thought disorder, whereas negative symptoms represent a loss or dimming of normal function and social norm, such as avoidance of social interactions (Baker, 2003). There are different types of schizophrenia such as paranoid, disorganised, catatonic, undifferentiated and residual (Issacs, 2006). However, Gillam (2002) claimed that the exact causes of schizophrenia remain unclear but genetic, environmental and social factors are all thought to influence its development. The risk for a child to develop schizophrenia is 46%, if both parents have the disorder (Kirk et al, 2006). Women who have certain viral illnesses during their pregnancy may be at a greater risk of giving birth to children who later develop schizophrenia and the 1957 influenza A2 epidemics in England resulted in an increase in schizophrenia in the offspring of women who developed this flu during their pregnancy (Frankenburg, 2007). 1 in 100 UK populations will develop schizophrenia in their lifetime and the world prevalence is about 2-4 in 1000, as it affects men and women equally (Rethink, 2008). However, the onset in men is about five years earlier than women with the peak age of incidence is between 16 and 25 and the presentation of the illness varies tremendously, not only between individuals, but also within the same individual at different stages of their illness (Magorrian, 2007). Schizophrenia seems to be more common in city areas and in some ethnic minority groups and premature mortality in people with schizophrenia is 2 to 3 times higher than that in the general population (Royal college of Psychiatrists 2008). The premature mortality might be due to poorer health care, physical health, unhealthy lifestyles and people with schizophrenia may be at greater risk of type 2 diabetes as a result of antipsychotic medications (Nash, 2005). Moreover, according to WHO (2008) schizophrenia is a treatable disorde r but many individuals remain untreated regardless of effective treatments. There has been an unresolved debate about how best to define patients engagement with medications and until the 1980s most work on patient engagement with medications regimes was described as compliance (Norman Ryrie, 2004). The term compliance is often used interchangeably with adherence or concordance (Snelgrove, 2005). According to Kikkert (2006) the term compliance has fallen out of favour in clinical practice because it carries an assumption that patients are the passive recipients of clinicians and implies unquestioning obedience with no opportunity for patients choice. To add to the complexity of this term, patients can be intentionally or unintentionally non-compliant such as a deliberate decision not to comply with treatment and patients may have misunderstood the guidance that they have been given or unable to open the medication container. Velligan et al (2006) claimed that in recent years there has been a shift from this paternalistic model of doctor-patient interactions with the consequent preference for the use of the term adherence. However, while adherence emphasises negotiation between clinician and patient, it still implies a degree of passivity and obedience (Snelgrove, 2005). Gray et al (2002b) assert that concordance may be a more acceptable term as it suggests a collaborative process of decision-making regarding medications regimes and acknowledges the importance of the two-way communication. The NHS Plan (2000) emphasises the importance of placing patients at the centre of services and the transformation of patients into consumers of the health service has changed the context of health care, as patients are expected to become more active and informed about their treatments (Jasper, 2006). Murray et al (2007) emphasise that shared decision-making between clinicians and patients has the potential to improve concordance with treatment plans. Furthermore, The Chief Nursing Officers review of mental health nursing (2006) recommends that building and maintaining positive interpersonal relationships with service users is essential to successful mental health nursing practice and person-centred values is helpful in building positive relationships. This indicates that by not agreeing to health professionals advice patients may be labelled as non-compliant. Nonetheless, compliance could also be problematic, for example if patients continue to take medication obediently, although it is causing adverse side effects. However, from the empirical knowledge the term compliance is still being used in clinical settings despite the paternalistic conception. Therefore, the term concordance is favoured here as it promotes the idea that medication treatment should be a collaborative process between clinicians and patients, which emphasises the patients rights. Ultimately, the term concordance corresponds with the current ethos of modern mental health care set out in the National Service Framework (1999), the NHS Plan (2000) and the Chief Nursing Officers review of mental health nursing (2006), which is concerned with working in partnership with patients and carers. However, according to the term concordance patients have the right to make t reatment decisions, for example, stopping medication even if health professionals do not agree with that decision. For decades researchers have worked to explain the causes of non-concordance with medication unfortunately there have been no valid way of measuring concordance (Velligan et al, 2006). Rates of concordance have been measured by using the subjective and objective methods. Subjective method includes patients` self report and direct interviews, although this method is less expensive, it tends to overestimate the degree of concordance, as patients may not admit non-concordance (Gray et al, 2002b). Snelgrove (2005) claims that objective method such as blood and urine analysis also pose problems as they do not account for individual metabolism and do not reflect inconsistencies in concordance over time. Moreover, from empirical knowledge blood test is effective in monitoring concordance with mood stabilisers such as lithium, but for schizophrenia it is the manifestation of symptoms can support the evidence of non-concordance. According to Gray et al (2002b) pill counts are more reliable, b ut it is impossible to tell whether patients have actually ingested the medication. Even expensive objective method such as electronic monitoring which records every occasion that a pill bottles is opened can also be problematic when patients choose not to swallow the medication that was removed or do not replace the caps and electronic prescribing is still fallible, just because medication is available does not mean that it is taken (Velligan et al, 2006). One of the major clinical problems in the treatment of people with schizophrenia is partial or complete non-concordance with medication and this limits the clinical effectiveness of the prescribed medications (Kikkert et al, 2006). Antipsychotics medication can only be effective if they are taken continuously over a sustained period of time (Norman Ryrie, 2004). Urquhart (2005) claims that partially concordant patients can be difficult to identify because they do not actively refuse to take their medication but the dosage deviations for different reasons and this may only be detected when psychotic symptoms re-emerge. Partial concordance creates significant problems for the treating physician as it creates difficulties in determining whether medications are working adequately, dosing is appropriate or concomitant medication is needed (Velligan et al, 2006). Therefore, this indicates that medication or dosage changes and the addition of concomitant medications are more likely to occu r among patients who are not fully concordant with prescribed medications. Non-concordance with prescribed medication is believed to be a significant factor to increasethe probability of relapse in patients with schizophrenia and relapse is one of the most costly aspects of schizophrenia (Almond et al, 2004). Knapp et al (2004) undertook a study of 658 patients receiving antipsychotics medication of whom 20% reported non-concordance with prescribed medication and concluded that non-concordance was one of the most significant factors in increasing service costs, predicting an excess annual cost per patient of  £2500 for inpatient services and an overall additional cost of  £5000 for total service use. In addition, Almond et al (2004) estimated that costs for relapse cases are four times higherthan those for non-relapse cases. Therefore, these two studies show that relapse in patients with schizophrenia as a result of non-concordance isa major factor in generating high hospitalisation rates and costs. This implies that patients who do not concord with the ir medication are likely to requiremore treatment and support from a range of services and given the high costs associated with relapse non-concordance is a key factor in the use ofin-patient and external services. Antipsychotic medication has proven efficacy in the treatment of schizophrenia and the prevention of relapse. In spite of vast evidence that antipsychotics can be effective in treating the symptoms of schizophrenia, almost 90% of patients will relapse within the first five years of treatment following an acute episode and in general the illness has a tendency to recur or become chronic (Velligan et al, 2006). According to White et al (2007) non-concordance with drug therapy is common in schizophrenia; approximately 50% of patients are non-concordant within one year and 75% within two years after being discharged from hospital. Such high rates of non-concordance with medication may initially seem alarming (Gray et al, 2002b). However, it is similar with other conditions such as asthma where maintenance treatment is required. A study of concordance with asthma medication conducted by Newell (2006) estimated that 70 % of asthma patients in the UK are non-concordant with medication and t he levels of non-concordance in long-term conditions, such as asthma are known to be high as many asthma sufferers will only take medicine when they feel they need it rather than as instructed by clinicians. Therefore, considering the Newell (2006) findings it can be argued that the rates of non-concordance with antipsychotics are not significantly different than those on non-psychiatric medications and the myth that non-concordance with medication is more common among mental disorders as compared to physical disorders needs to be dispelled. Several factors have been shown to increase the chance of relapse but probably the single most important cause of relapse is the discontinuation of effective antipsychotic medication regime. A large number of factors influence non-concordance with prescribed antipsychotic medications, however Gray et al (2002b) have identified the main factors as impaired judgement, negative beliefs about treatment, poor worker-user relationship and the side-effects of medication. Additionally, Kikkert et al (2006) conducted a study in four European countries exploring medication adherence in schizophrenia and identified insight, beliefs about treatment, side effects and treatment efficacy as factors that influence concordancewith medication in patients with schizophrenia. Urquhart (2005) suggests that the problem of non-concordance may be more prevalent among those with schizophrenia due to its nature, for example, lack of insight. Magorrian (2007) claimed that non-concordance with medication is often linked to the persons level of insight into his or her illness and lack of insight is a frequent concomitant of psychosis. In schizophrenia, insight has been defined as an awareness of illness and an ability to recognise symptoms as part of an illness (Gray et al, 2002b) According to Surguladze David (1999) between 50% and 80% of patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder and these individuals are often difficult to engage with treatments due to impaired insight. Recent conceptualisation has formulated insight as a continuum representing the combination of three factors; awareness of illness, need for treatment and attribution of symptoms. Lack of insight is continuously problematic but an emotional element can be associated with denial of symptoms or rejection of treatment at key points in the illness (Byrne, 2000). Mitchell Selmes (2007) claim that having a perception about the illness and the knowledge of medications are the key factors of concordance in mental health and patients who understand the purpose of the prescription are twice more likely to collect it than those who do not understand. A study by Cuesta et al (2000) reported that patients suffering from schizophreniashowed poorer insight than patients with affective disorders. Cuesta et al (2000) findings demonstrated that the severe disturbances of insight persisted over the time and the level of insight was not significantly improved in patients suffering from functional psychosis as between 29% to 49% of these patients continued to have fair to poor insight at the follow up assessment. This is consistent with the findings of Kikkert et al (2006), where poor insight was a strong predictor of non-concordance with medication. In contrast, Tait et al (2003) conducted a study to examine changes in insight and symptoms of psychosis on fifty participantswho met the ICD—10 diagnostic criteria for schizophrenia. The participants were interviewed and insight was measured duringacute psychosis using the Insight Scale with the score 0- 12 and all the participants were reinterviewed at 3 and6 months following the init ial interview. Tait et al (2003) findings indicated that duringthe acute episode, 48% of participants scored 9-12 on the InsightScale and the majority of participants (63%) werein the 9-12 range of scores. The study of Tait et al (2003) clearly indicated that level of insight was high among many participants. In considering the findings of both Cuesta et al (2000) and Tait et al (2003) it appears that some patients with psychosis are unaware of their illnesses and insight is a strong predictor of concordance with medications and a good indicator of prognosis. However, evidence for a relationship between insight and concordance with treatment is inconclusive as the discrepancies found between the two studies might be due to the methodological factors, such as selection of participants. In both studies all the participants had a diagnosis of schizophrenia and all of them gave informed consent to enter the study. According to Appelbaum (2006) several studies in America regarding the decisional-capacity of patients with schizophrenia to consent or participation to research have raise some concerns due to the cognitive impairments associated with schizophrenia and using the MacArthur Competence Assessment Tool for Clinical Research clearly indicated that patients with schizophrenia do lack und erstanding and reasoning of research ethics. McCann Clark (2005) emphasise that antipsychotic medications some of which have a sedating effect can also have an impact on the cognitive processes, such as illogical thinking and this can hinder the quality of responses. Moser et al (2005) argued that some studies have shown that a high percentage of individuals with schizophrenia have adequate decisional capacity to consent to research participation, however in a medication-free schizophrenia research, participants did not show a major decline in decisional capacity. In addition, Jeste et al (2006) claimed that there is a risk in assuming that decision-making capacity of individuals with schizophrenia is always impaired, when they are capable to make autonomous decisions and in considering their decision-making capacity as permanently impaired by virtue of their diagnosis. Consequently, in order to investigate factors associated with schizophrenia, it can be argued that only individuals with schizophrenia can provide the answers of their experiences and protecting vulnerable populations from research activity can also exclude them from its benefits. According to Gerrish Lacey (2006) there two key concepts that concern the quality of a research: validity and reliability. Roberts et al (2006) define reliability as how far a particular test will produce similar results in different circumstances, whereas validity is to ascertain the methods are actually measuring what is intended to measure. Both Cuesta et al (2000) and Tait et al (2003) had used structured interviews to gather the data and have chosen a quantitative approach. Structured interview provides the opportunities to change the words but not the meaning of the questions thus, Parahoo (2006) claimed that validity is enhanced because participants can be helped to understand the questions and interviewers can ask for clarifications and probe for further responses, if necessary and since all the questions are ideally asked in the same way, structured interview has a high degree of reliability. It seems that both Cuesta et al (2000) and Tait et al (2003) have adopted the appropriate approach to their research, as quantitative research is the conduct of investigations primarily using numerical methods. It infers that to examine correlations between insight and service engagement qualitative approach could not have produced the same data in this area of study. Moreover, in both studies purposive sampling were used as all the participants had a diagnosis of schizophrenia. According to Polit Beck (2006) all participants in a phenomenological study must have experienced the phenomenon under study and must be able to articulate what is like to have lived the experience. Johnson Orrell (1996 cited in Surguladze David, 1999 P 166) have argued that some patients may have their own explanations of their illnesses, such as religion or cultural beliefs which may not coincide with the Western medical model of mental disorders and this can be even more complicated if one tries directly to impose the models of insight on patients from non-Western cultures. Gamble Brennan (2006) claimed that different cultures in England perceive mental illness in different ways and this can have an impact on treatments as some cultures rather seek help from religious leaders than mental health services. Alternatively, religion or spiritual beliefs in the Western culture can have a positive impact on concordance with medication, as religious individuals with schizophrenia have a better social support compare to non-religious individuals with schizophrenia (Borras et al, 2007). Therefore, it can be put forward that awareness of illness is a crucial factor in the motivation to receive pharmacological treatment. Both cultures and religion can have a positive and negative influence on concordance with antipsychotics. Patients can have different levels of awareness into their illness and they may consciously or unconsciously avoid acknowledging that they are suffering from mental health problems because of their reluctance to bear the stigma of mentally ill (Surguladze David, 1999). Byrne (2000, p65) defined `stigma as a sign of disgrace or discredit, which sets a person apart from others and the stigma of mental illness although more often related to context than to a persons appearance, remains a powerful negative attribute in all-social relations`. Stigma of mental illness has become an indication for unpleasant experiences, such as bringing shame to the family or social exclusion. According to Phillips et al (2002), in some parts of china, schizophrenia is still considered as a punishmentfor an ancestors misbehaviour or for the familys currentmisconduct and the effect of stigmais greater if the patient had more prominent positive symptoms or highly educated. Moreover, a study by Lee et al (20 05) concluded that 60 % out of 320 patients with schizophrenia had experienced interpersonal stigma from p arents, siblings or close rel atives. This indicates that people with schizophrenia are more likely to experience stigma from family members than the general public. Having a diagnosis of schizophrenia does not only affect ones health but also carries all the prejudice, discrimination and social exclusion, for example many individuals are attacked on the streets, rejection in the society and denial of employments because they were known to have mental health problems (Gamble Brennan, 2006). According to Byrne (2000) in two identical UK public opinion surveys, 80% of participants claimed that most people are embarrassed by mentally ill people and about 30% agreeing `I am embarrassed by mentally ill persons`. There is also evidence that supports the concepts of stereotyping of mental illness. The power and influence of the media on mental illness has been a key issue of debate over many years as people with schizophrenia are frequently portrayed as violent and dangerous. In contrast, people with schizophrenia are more likely to be dangerous to themselves than to others, while the greater danger to the public is posed by people without mental health problems and people with mental health problems are six times more likely than the general public to be the victims of murder (Stickley Felton, 2006). Moreover, Gamble Brennan (2006) claimed that when the boxing champion Frank Bruno was admitted to hospital in 2003, one of the newspaper headlines was `Bonkers Bruno locked up`. This indicates that stigma has the grave potential to cause reluctance to seek treatments and this can be detrimental to the persons health. Therefore, as a mental health clinician, it will be vital to assist people wit h mental health problems to rebuild their lives and this requires moving beyond the traditional focus on symptoms and medication by exploring alternatives in reducing stigma of mental health that avert people from social inclusion. It has been predicted that families with high expressed emotion compared to low expressed emotion can contribute towards the relapse rate in symptoms of schizophrenia and this can also be a triggering factor for non-concordance with medication. High expressed emotion carers appear to perceive their caring situation as more stressful and this could be conceptualised as a catastrophic appraisal of the role of caring (Raune et al 2004). Kuipers et al (2006) identifies the components of expressed emotion as emotional over-involvement, hostility, critical comments, warmth and positive remarks. A study by Kuipers et al (2006) indicates that patients whose carers showed high expressed emotion had considerably higher levels of anxiety and lower self-esteem due to the components of expressed emotion. However, a significant amount of data from western cultures suggests that high expressed emotion subjects who were not on medication are three times likely to relapse than those who were on medic ation (Bhugra McKenzie, 2003). This clearly signifies that despite being concordant, high expressed emotion subjects are vulnerable to relapse. The interactions between patient and the carers are crucial, especially cross-culturally as in some cultures for example, in some parts of India, emotional over-involvement is the norm and if carers do not show emotional over-involvement, this can be seen as lack of care (Bhugra McKenzie, 2003). Hashemi Cochrane (1999) conducted a study in UK on expressed emotion and they observed that 80% of the British Pakistani, 45% of the White and 30% of the British Sikh families exhibited high levels of expressed emotion and emotional over-involvement was notably higher among the British Pakistani group. The findings concluded that White patients with high expressed emotion relatives were significantly more likely to relapse than those from low expressed emotion families, whereas for both Asian groups high expressed emotion did not predict relapse. The study of Hashemi Cochrane (1999) also indicated that that Pakistani families in the UK were more likely to be rated as high expressed emotion than White families, indicating that components such as emotional over-involvement may be cultural rather than pathogenic traits. Conversely, low expressed emotion families who are not over-anxious in their response to the patients illness may tend to perceive stigma in less threatening ways whereas, families with high expressed emotion, who respond to the patients illness in a highly anxious may experience stigma more intensely (Phillips et al 2002). Therefore, it appears that family members levels of expressed emotion could influence their perception and response to stigma of mental health and concordance with medication is essential for patients irrespective of the expressed emotion status in the family. Thus, family interventions need to improve in order to lower the levels of anxiety and to increase self-esteem among families with hig h expressed emotion. As a clinician it will be vital to acknowledge the cultural aspect of expressed emotion status in the family to facilitate concordance with medication. There is overwhelming evidence for patients with schizophrenia, who misuse illicit drugs and alcohol to have an increased rate of re-hospitalisation (Sokya, 2000). According to Barnes et al (2006) the higher relapse rate in people with established schizophrenia who usesubstances may be partially explained by non-concordant tothe medication regimen. Evidence suggests that the substance used most frequently by people with schizophrenia is cannabis (Gamble Brennan, 2006). Arseneault et al (2004) emphasise that rates of cannabis use in UK are higher among people with schizophrenia than among the general population and patients detained under the MHA (1983) have even higher rates of lifetime use of cannabis. Substance misuse in schizophrenia may be explained as a form of self-medication to alleviate the symptoms of schizophrenia, to improve the side effects of antipsychotics and to respond to social pressures (Sokya, 2000). There has been little evidence to support the self-medication hypothesis despite its popularity with users and in contrast, substance misuse can aggravate the symptoms of schizophrenia and can also trigger psychotic episode particularly in people with a pre-exis Factors Affecting Antipsychotic Medication Compliance Factors Affecting Antipsychotic Medication Compliance INTRODUCTION The aim of this dissertation is to explore the factors affecting concordance with prescribed antipsychotic medications. The rationale for selecting this topic is derived from personal working experience with mental health service users. Having worked as a nursing assistant for the past eight years on acute admissions wards and as a student nurse for the past three years it was observed that a large proportion of compulsory re-hospitalisation under the Mental Health Act 1983 occurs due to relapse of mental illness as a result of non- concordance with medications, particularly service users with a diagnosis of schizophrenia. This led to believe that concordance with antipsychotic medications plays a crucial role in managing psychosis as it positively contributes towards the effective management of the illness in the community. In support to this view, Gray et al (2002a) assert that prophylactic use of antipsychotic medication reduces the risk of relapse among individuals with schizophr enia and non-concordance with medication has the potential for frequent re-hospitalisations. This has been recognised as the revolving door syndrome. During most mental health placements it was noted that non-concordance with medication has become significant, as this has been identified as a risk factor within the risk assessment checklist. Furthermore, despite the well-documented therapeutic effect of antipsychotic medications, some patients are reluctant to accept treatments and some may even wish to cease taking medications altogether. Therefore, this empirical knowledge has reinforced the desire to examine the factors associated with non-concordance with antipsychotic medications. According to Brimblecombe et al (2005) medication is one of the major therapeutic tools available to help people with schizophrenia. There is also growing evidence that schizophrenia can be treated effectively with a range of psychological and social interventions together with antipsychotic medications. Norman Ryrie (2004) emphasised that antipsychotic medication has been the mainstay of treatment for schizophrenia since the 1950s when it was discovered that the dopamine antagonist haloperidol and chlorpromazine exerted antipsychotic effects. The National Institute for Clinical Excellence (NICE) (2002) recommends that atypical antipsychotic drugs such as amisulpride, aripiprazole , olanzapine, quetiapine or risperidone must be considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia or to promote recovery for those who have experienced unacceptable side-effects on conventional antipsychotics, as atypical antipsychotics appear to have less extrapyramidal symptoms (side effects) than the conventional antipsychotics such as haloperidol and chlorpromazine. The care and treatment of individuals with schizophrenia have advanced considerably over the past ten years, since the introduction of atypical antipsychotics and medication continues to be the first line treatment for schizophrenia (Walker MacAulay, 2005). However, Gray et al (2002b) claim that despite the effectiveness of these atypical antipsychotic drugs, non- concordance with prescribed antipsychotic medications is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. In addition, Mitchell Selmes (2007) claim that over the course of a year, about 75% of patients will discontinue prescribed antipsychotic medications, often coming to the decision themselves and without informing a health professional. According to Gray et al (2006) relapse rates is five times higher among individuals with schizophrenia, who are non-concordance with medication compared with concordance. Non-concordance during acute treatment of psychosis le ads to chronic symptomswhereas non-concordance after remission increases the risk ofrelapse and both may have serious consequences; re-hospitalisation (Hamer Haddad, 2007). Furthermore, the impacts of non-concordance with medication not only affect the individuals with schizophrenia, as each relapse causes a stepping down of cognitive functioning which is rarely retrieved but also their carers and the costs of treatments (Institute, 2007). To facilitate this project as a literature review, an analysis of secondary sources only will be use. Secondary sources were mainly obtained from nursing journals such as Nursing-Standard, Nursing-Times, Advances in Psychiatric Treatment, Mental health practice, Schizophrenia Bulletin and The British Journal of Psychiatry, containing the key words: schizophrenia, oral antipsychotic, medication management and non-concordance. An Internet search of Google was also done with the same keywords to access any relevant documents. To address the factors affecting concordance with prescribed antipsychotic medications, these will be divided into patient-related factors, medication-related factors and clinician-related factors. LITERATURE REVIEW According to White (2007) schizophrenia is a debilitating psychiatric disorder characterised by a range of positive and negative symptoms and these symptoms were first described in detail by the British neurologist Hughlings-Jackson in the late 1800s. There is no physical test for schizophrenia rather it is diagnosed by the presence of certain positive and negative symptoms over a period of time (Brennan, 2001). According to Issacs (2006) the neurotransmitter hypothesis suggests that the dopamine over activity in the mesolimbic dopamine pathway, which is between the midbrain, is thought to cause the positive symptoms of schizophrenia and dopamine under activity in the mesocortical dopamine pathway is thought to result in the negative symptoms of schizophrenia. Positive symptoms represent a distortion of normal experience, such as delusions, hallucinations and thought disorder, whereas negative symptoms represent a loss or dimming of normal function and social norm, such as avoidance of social interactions (Baker, 2003). There are different types of schizophrenia such as paranoid, disorganised, catatonic, undifferentiated and residual (Issacs, 2006). However, Gillam (2002) claimed that the exact causes of schizophrenia remain unclear but genetic, environmental and social factors are all thought to influence its development. The risk for a child to develop schizophrenia is 46%, if both parents have the disorder (Kirk et al, 2006). Women who have certain viral illnesses during their pregnancy may be at a greater risk of giving birth to children who later develop schizophrenia and the 1957 influenza A2 epidemics in England resulted in an increase in schizophrenia in the offspring of women who developed this flu during their pregnancy (Frankenburg, 2007). 1 in 100 UK populations will develop schizophrenia in their lifetime and the world prevalence is about 2-4 in 1000, as it affects men and women equally (Rethink, 2008). However, the onset in men is about five years earlier than women with the peak age of incidence is between 16 and 25 and the presentation of the illness varies tremendously, not only between individuals, but also within the same individual at different stages of their illness (Magorrian, 2007). Schizophrenia seems to be more common in city areas and in some ethnic minority groups and premature mortality in people with schizophrenia is 2 to 3 times higher than that in the general population (Royal college of Psychiatrists 2008). The premature mortality might be due to poorer health care, physical health, unhealthy lifestyles and people with schizophrenia may be at greater risk of type 2 diabetes as a result of antipsychotic medications (Nash, 2005). Moreover, according to WHO (2008) schizophrenia is a treatable disorde r but many individuals remain untreated regardless of effective treatments. There has been an unresolved debate about how best to define patients engagement with medications and until the 1980s most work on patient engagement with medications regimes was described as compliance (Norman Ryrie, 2004). The term compliance is often used interchangeably with adherence or concordance (Snelgrove, 2005). According to Kikkert (2006) the term compliance has fallen out of favour in clinical practice because it carries an assumption that patients are the passive recipients of clinicians and implies unquestioning obedience with no opportunity for patients choice. To add to the complexity of this term, patients can be intentionally or unintentionally non-compliant such as a deliberate decision not to comply with treatment and patients may have misunderstood the guidance that they have been given or unable to open the medication container. Velligan et al (2006) claimed that in recent years there has been a shift from this paternalistic model of doctor-patient interactions with the consequent preference for the use of the term adherence. However, while adherence emphasises negotiation between clinician and patient, it still implies a degree of passivity and obedience (Snelgrove, 2005). Gray et al (2002b) assert that concordance may be a more acceptable term as it suggests a collaborative process of decision-making regarding medications regimes and acknowledges the importance of the two-way communication. The NHS Plan (2000) emphasises the importance of placing patients at the centre of services and the transformation of patients into consumers of the health service has changed the context of health care, as patients are expected to become more active and informed about their treatments (Jasper, 2006). Murray et al (2007) emphasise that shared decision-making between clinicians and patients has the potential to improve concordance with treatment plans. Furthermore, The Chief Nursing Officers review of mental health nursing (2006) recommends that building and maintaining positive interpersonal relationships with service users is essential to successful mental health nursing practice and person-centred values is helpful in building positive relationships. This indicates that by not agreeing to health professionals advice patients may be labelled as non-compliant. Nonetheless, compliance could also be problematic, for example if patients continue to take medication obediently, although it is causing adverse side effects. However, from the empirical knowledge the term compliance is still being used in clinical settings despite the paternalistic conception. Therefore, the term concordance is favoured here as it promotes the idea that medication treatment should be a collaborative process between clinicians and patients, which emphasises the patients rights. Ultimately, the term concordance corresponds with the current ethos of modern mental health care set out in the National Service Framework (1999), the NHS Plan (2000) and the Chief Nursing Officers review of mental health nursing (2006), which is concerned with working in partnership with patients and carers. However, according to the term concordance patients have the right to make t reatment decisions, for example, stopping medication even if health professionals do not agree with that decision. For decades researchers have worked to explain the causes of non-concordance with medication unfortunately there have been no valid way of measuring concordance (Velligan et al, 2006). Rates of concordance have been measured by using the subjective and objective methods. Subjective method includes patients` self report and direct interviews, although this method is less expensive, it tends to overestimate the degree of concordance, as patients may not admit non-concordance (Gray et al, 2002b). Snelgrove (2005) claims that objective method such as blood and urine analysis also pose problems as they do not account for individual metabolism and do not reflect inconsistencies in concordance over time. Moreover, from empirical knowledge blood test is effective in monitoring concordance with mood stabilisers such as lithium, but for schizophrenia it is the manifestation of symptoms can support the evidence of non-concordance. According to Gray et al (2002b) pill counts are more reliable, b ut it is impossible to tell whether patients have actually ingested the medication. Even expensive objective method such as electronic monitoring which records every occasion that a pill bottles is opened can also be problematic when patients choose not to swallow the medication that was removed or do not replace the caps and electronic prescribing is still fallible, just because medication is available does not mean that it is taken (Velligan et al, 2006). One of the major clinical problems in the treatment of people with schizophrenia is partial or complete non-concordance with medication and this limits the clinical effectiveness of the prescribed medications (Kikkert et al, 2006). Antipsychotics medication can only be effective if they are taken continuously over a sustained period of time (Norman Ryrie, 2004). Urquhart (2005) claims that partially concordant patients can be difficult to identify because they do not actively refuse to take their medication but the dosage deviations for different reasons and this may only be detected when psychotic symptoms re-emerge. Partial concordance creates significant problems for the treating physician as it creates difficulties in determining whether medications are working adequately, dosing is appropriate or concomitant medication is needed (Velligan et al, 2006). Therefore, this indicates that medication or dosage changes and the addition of concomitant medications are more likely to occu r among patients who are not fully concordant with prescribed medications. Non-concordance with prescribed medication is believed to be a significant factor to increasethe probability of relapse in patients with schizophrenia and relapse is one of the most costly aspects of schizophrenia (Almond et al, 2004). Knapp et al (2004) undertook a study of 658 patients receiving antipsychotics medication of whom 20% reported non-concordance with prescribed medication and concluded that non-concordance was one of the most significant factors in increasing service costs, predicting an excess annual cost per patient of  £2500 for inpatient services and an overall additional cost of  £5000 for total service use. In addition, Almond et al (2004) estimated that costs for relapse cases are four times higherthan those for non-relapse cases. Therefore, these two studies show that relapse in patients with schizophrenia as a result of non-concordance isa major factor in generating high hospitalisation rates and costs. This implies that patients who do not concord with the ir medication are likely to requiremore treatment and support from a range of services and given the high costs associated with relapse non-concordance is a key factor in the use ofin-patient and external services. Antipsychotic medication has proven efficacy in the treatment of schizophrenia and the prevention of relapse. In spite of vast evidence that antipsychotics can be effective in treating the symptoms of schizophrenia, almost 90% of patients will relapse within the first five years of treatment following an acute episode and in general the illness has a tendency to recur or become chronic (Velligan et al, 2006). According to White et al (2007) non-concordance with drug therapy is common in schizophrenia; approximately 50% of patients are non-concordant within one year and 75% within two years after being discharged from hospital. Such high rates of non-concordance with medication may initially seem alarming (Gray et al, 2002b). However, it is similar with other conditions such as asthma where maintenance treatment is required. A study of concordance with asthma medication conducted by Newell (2006) estimated that 70 % of asthma patients in the UK are non-concordant with medication and t he levels of non-concordance in long-term conditions, such as asthma are known to be high as many asthma sufferers will only take medicine when they feel they need it rather than as instructed by clinicians. Therefore, considering the Newell (2006) findings it can be argued that the rates of non-concordance with antipsychotics are not significantly different than those on non-psychiatric medications and the myth that non-concordance with medication is more common among mental disorders as compared to physical disorders needs to be dispelled. Several factors have been shown to increase the chance of relapse but probably the single most important cause of relapse is the discontinuation of effective antipsychotic medication regime. A large number of factors influence non-concordance with prescribed antipsychotic medications, however Gray et al (2002b) have identified the main factors as impaired judgement, negative beliefs about treatment, poor worker-user relationship and the side-effects of medication. Additionally, Kikkert et al (2006) conducted a study in four European countries exploring medication adherence in schizophrenia and identified insight, beliefs about treatment, side effects and treatment efficacy as factors that influence concordancewith medication in patients with schizophrenia. Urquhart (2005) suggests that the problem of non-concordance may be more prevalent among those with schizophrenia due to its nature, for example, lack of insight. Magorrian (2007) claimed that non-concordance with medication is often linked to the persons level of insight into his or her illness and lack of insight is a frequent concomitant of psychosis. In schizophrenia, insight has been defined as an awareness of illness and an ability to recognise symptoms as part of an illness (Gray et al, 2002b) According to Surguladze David (1999) between 50% and 80% of patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder and these individuals are often difficult to engage with treatments due to impaired insight. Recent conceptualisation has formulated insight as a continuum representing the combination of three factors; awareness of illness, need for treatment and attribution of symptoms. Lack of insight is continuously problematic but an emotional element can be associated with denial of symptoms or rejection of treatment at key points in the illness (Byrne, 2000). Mitchell Selmes (2007) claim that having a perception about the illness and the knowledge of medications are the key factors of concordance in mental health and patients who understand the purpose of the prescription are twice more likely to collect it than those who do not understand. A study by Cuesta et al (2000) reported that patients suffering from schizophreniashowed poorer insight than patients with affective disorders. Cuesta et al (2000) findings demonstrated that the severe disturbances of insight persisted over the time and the level of insight was not significantly improved in patients suffering from functional psychosis as between 29% to 49% of these patients continued to have fair to poor insight at the follow up assessment. This is consistent with the findings of Kikkert et al (2006), where poor insight was a strong predictor of non-concordance with medication. In contrast, Tait et al (2003) conducted a study to examine changes in insight and symptoms of psychosis on fifty participantswho met the ICD—10 diagnostic criteria for schizophrenia. The participants were interviewed and insight was measured duringacute psychosis using the Insight Scale with the score 0- 12 and all the participants were reinterviewed at 3 and6 months following the init ial interview. Tait et al (2003) findings indicated that duringthe acute episode, 48% of participants scored 9-12 on the InsightScale and the majority of participants (63%) werein the 9-12 range of scores. The study of Tait et al (2003) clearly indicated that level of insight was high among many participants. In considering the findings of both Cuesta et al (2000) and Tait et al (2003) it appears that some patients with psychosis are unaware of their illnesses and insight is a strong predictor of concordance with medications and a good indicator of prognosis. However, evidence for a relationship between insight and concordance with treatment is inconclusive as the discrepancies found between the two studies might be due to the methodological factors, such as selection of participants. In both studies all the participants had a diagnosis of schizophrenia and all of them gave informed consent to enter the study. According to Appelbaum (2006) several studies in America regarding the decisional-capacity of patients with schizophrenia to consent or participation to research have raise some concerns due to the cognitive impairments associated with schizophrenia and using the MacArthur Competence Assessment Tool for Clinical Research clearly indicated that patients with schizophrenia do lack und erstanding and reasoning of research ethics. McCann Clark (2005) emphasise that antipsychotic medications some of which have a sedating effect can also have an impact on the cognitive processes, such as illogical thinking and this can hinder the quality of responses. Moser et al (2005) argued that some studies have shown that a high percentage of individuals with schizophrenia have adequate decisional capacity to consent to research participation, however in a medication-free schizophrenia research, participants did not show a major decline in decisional capacity. In addition, Jeste et al (2006) claimed that there is a risk in assuming that decision-making capacity of individuals with schizophrenia is always impaired, when they are capable to make autonomous decisions and in considering their decision-making capacity as permanently impaired by virtue of their diagnosis. Consequently, in order to investigate factors associated with schizophrenia, it can be argued that only individuals with schizophrenia can provide the answers of their experiences and protecting vulnerable populations from research activity can also exclude them from its benefits. According to Gerrish Lacey (2006) there two key concepts that concern the quality of a research: validity and reliability. Roberts et al (2006) define reliability as how far a particular test will produce similar results in different circumstances, whereas validity is to ascertain the methods are actually measuring what is intended to measure. Both Cuesta et al (2000) and Tait et al (2003) had used structured interviews to gather the data and have chosen a quantitative approach. Structured interview provides the opportunities to change the words but not the meaning of the questions thus, Parahoo (2006) claimed that validity is enhanced because participants can be helped to understand the questions and interviewers can ask for clarifications and probe for further responses, if necessary and since all the questions are ideally asked in the same way, structured interview has a high degree of reliability. It seems that both Cuesta et al (2000) and Tait et al (2003) have adopted the appropriate approach to their research, as quantitative research is the conduct of investigations primarily using numerical methods. It infers that to examine correlations between insight and service engagement qualitative approach could not have produced the same data in this area of study. Moreover, in both studies purposive sampling were used as all the participants had a diagnosis of schizophrenia. According to Polit Beck (2006) all participants in a phenomenological study must have experienced the phenomenon under study and must be able to articulate what is like to have lived the experience. Johnson Orrell (1996 cited in Surguladze David, 1999 P 166) have argued that some patients may have their own explanations of their illnesses, such as religion or cultural beliefs which may not coincide with the Western medical model of mental disorders and this can be even more complicated if one tries directly to impose the models of insight on patients from non-Western cultures. Gamble Brennan (2006) claimed that different cultures in England perceive mental illness in different ways and this can have an impact on treatments as some cultures rather seek help from religious leaders than mental health services. Alternatively, religion or spiritual beliefs in the Western culture can have a positive impact on concordance with medication, as religious individuals with schizophrenia have a better social support compare to non-religious individuals with schizophrenia (Borras et al, 2007). Therefore, it can be put forward that awareness of illness is a crucial factor in the motivation to receive pharmacological treatment. Both cultures and religion can have a positive and negative influence on concordance with antipsychotics. Patients can have different levels of awareness into their illness and they may consciously or unconsciously avoid acknowledging that they are suffering from mental health problems because of their reluctance to bear the stigma of mentally ill (Surguladze David, 1999). Byrne (2000, p65) defined `stigma as a sign of disgrace or discredit, which sets a person apart from others and the stigma of mental illness although more often related to context than to a persons appearance, remains a powerful negative attribute in all-social relations`. Stigma of mental illness has become an indication for unpleasant experiences, such as bringing shame to the family or social exclusion. According to Phillips et al (2002), in some parts of china, schizophrenia is still considered as a punishmentfor an ancestors misbehaviour or for the familys currentmisconduct and the effect of stigmais greater if the patient had more prominent positive symptoms or highly educated. Moreover, a study by Lee et al (20 05) concluded that 60 % out of 320 patients with schizophrenia had experienced interpersonal stigma from p arents, siblings or close rel atives. This indicates that people with schizophrenia are more likely to experience stigma from family members than the general public. Having a diagnosis of schizophrenia does not only affect ones health but also carries all the prejudice, discrimination and social exclusion, for example many individuals are attacked on the streets, rejection in the society and denial of employments because they were known to have mental health problems (Gamble Brennan, 2006). According to Byrne (2000) in two identical UK public opinion surveys, 80% of participants claimed that most people are embarrassed by mentally ill people and about 30% agreeing `I am embarrassed by mentally ill persons`. There is also evidence that supports the concepts of stereotyping of mental illness. The power and influence of the media on mental illness has been a key issue of debate over many years as people with schizophrenia are frequently portrayed as violent and dangerous. In contrast, people with schizophrenia are more likely to be dangerous to themselves than to others, while the greater danger to the public is posed by people without mental health problems and people with mental health problems are six times more likely than the general public to be the victims of murder (Stickley Felton, 2006). Moreover, Gamble Brennan (2006) claimed that when the boxing champion Frank Bruno was admitted to hospital in 2003, one of the newspaper headlines was `Bonkers Bruno locked up`. This indicates that stigma has the grave potential to cause reluctance to seek treatments and this can be detrimental to the persons health. Therefore, as a mental health clinician, it will be vital to assist people wit h mental health problems to rebuild their lives and this requires moving beyond the traditional focus on symptoms and medication by exploring alternatives in reducing stigma of mental health that avert people from social inclusion. It has been predicted that families with high expressed emotion compared to low expressed emotion can contribute towards the relapse rate in symptoms of schizophrenia and this can also be a triggering factor for non-concordance with medication. High expressed emotion carers appear to perceive their caring situation as more stressful and this could be conceptualised as a catastrophic appraisal of the role of caring (Raune et al 2004). Kuipers et al (2006) identifies the components of expressed emotion as emotional over-involvement, hostility, critical comments, warmth and positive remarks. A study by Kuipers et al (2006) indicates that patients whose carers showed high expressed emotion had considerably higher levels of anxiety and lower self-esteem due to the components of expressed emotion. However, a significant amount of data from western cultures suggests that high expressed emotion subjects who were not on medication are three times likely to relapse than those who were on medic ation (Bhugra McKenzie, 2003). This clearly signifies that despite being concordant, high expressed emotion subjects are vulnerable to relapse. The interactions between patient and the carers are crucial, especially cross-culturally as in some cultures for example, in some parts of India, emotional over-involvement is the norm and if carers do not show emotional over-involvement, this can be seen as lack of care (Bhugra McKenzie, 2003). Hashemi Cochrane (1999) conducted a study in UK on expressed emotion and they observed that 80% of the British Pakistani, 45% of the White and 30% of the British Sikh families exhibited high levels of expressed emotion and emotional over-involvement was notably higher among the British Pakistani group. The findings concluded that White patients with high expressed emotion relatives were significantly more likely to relapse than those from low expressed emotion families, whereas for both Asian groups high expressed emotion did not predict relapse. The study of Hashemi Cochrane (1999) also indicated that that Pakistani families in the UK were more likely to be rated as high expressed emotion than White families, indicating that components such as emotional over-involvement may be cultural rather than pathogenic traits. Conversely, low expressed emotion families who are not over-anxious in their response to the patients illness may tend to perceive stigma in less threatening ways whereas, families with high expressed emotion, who respond to the patients illness in a highly anxious may experience stigma more intensely (Phillips et al 2002). Therefore, it appears that family members levels of expressed emotion could influence their perception and response to stigma of mental health and concordance with medication is essential for patients irrespective of the expressed emotion status in the family. Thus, family interventions need to improve in order to lower the levels of anxiety and to increase self-esteem among families with hig h expressed emotion. As a clinician it will be vital to acknowledge the cultural aspect of expressed emotion status in the family to facilitate concordance with medication. There is overwhelming evidence for patients with schizophrenia, who misuse illicit drugs and alcohol to have an increased rate of re-hospitalisation (Sokya, 2000). According to Barnes et al (2006) the higher relapse rate in people with established schizophrenia who usesubstances may be partially explained by non-concordant tothe medication regimen. Evidence suggests that the substance used most frequently by people with schizophrenia is cannabis (Gamble Brennan, 2006). Arseneault et al (2004) emphasise that rates of cannabis use in UK are higher among people with schizophrenia than among the general population and patients detained under the MHA (1983) have even higher rates of lifetime use of cannabis. Substance misuse in schizophrenia may be explained as a form of self-medication to alleviate the symptoms of schizophrenia, to improve the side effects of antipsychotics and to respond to social pressures (Sokya, 2000). There has been little evidence to support the self-medication hypothesis despite its popularity with users and in contrast, substance misuse can aggravate the symptoms of schizophrenia and can also trigger psychotic episode particularly in people with a pre-exis