An Evaluation of Emergency Plan for Hurricanes and Natural Disasters Research Paper - 1

An Evaluation of Emergency Plan for Hurricanes and Natural Disasters - Research Paper Example rs, it has been seen that these progressions have been happening very more frequently in today’s world because of air and climatic irregular characteristics that show up in various catastrophic events, for example, volcanoes, tremors, typhoons, tornadoes and most as of late the torrent that have broken the lives of numerous in recent years and most as of late in Japan. It has been seen that with each danger that happen, it turns out to be exceptionally significant for the state to respond and take unconstrained measures to handle the circumstance promptly for getting increasingly grave and to drop down the force of the circumstance by actualizing a careful technique that plots the speediest most aid ventures on quick premise to support the people in question and the affectees of the debacle. For countering such major circumstances, it is significant for the legislatures around the globe to take solid measures and to have a crisis plan or an arrangement that characterizes all t he stages required for early help and recuperation of the areas hit by the calamity. It is profoundly basic to comprehend the essentialness of the debacle the executives plan and the entire procedure that is engaged with help activity during the hour of calamity and it is likewise imperative to comprehend that how the achievement of the arrangement can be procured through its usage. Debacle the executives is a technique that is concocted if there should be an occurrence of any characteristic catastrophe occurs. It has additionally been named as the fiasco recuperation the executives that can be planned and get operational during the hour of any calamity or a significant disaster that can influence the human populace for a huge scope. Around the globe in lion's share of the nations where catastrophic events become a piece of their lives, governments plan such fiasco or crisis plans for speedy alleviation quantifies so as to reestablish the typical tasks or the standard life in the regions hit by fiascos. The calamity the board strategy or plan relies upon certain fund amental components. However, one of the

Assignment #3 Petty v. Metropolitan Govt of Nashville & Davidson Research Paper

Task #3 Petty v. Metropolitan Govt of Nashville and Davidson County - Research Paper Example As is indicated by Mollica (2008), at the core of this, the chief question for this situation is whether Metro had disregarded USERRA, in its dealing with or treatment of Petty. Negligible had left the division for deployment ready with the United States Army and looked for redeployment with the office after the fulfillment of his military help. There are four key capacities that USERRA performs. These include: the ensuring returning veterans the privilege of re-work after military assistance; keeping businesses from victimizing returning veterans, according to their military help; recommending the situation to which armed force veterans are entitled upon their arrival; and keeping bosses from terminating returning veterans self-assertively, inside a time of reemployment. Considering the four capacities, it is on the right track to express that USERRA exists to unite the privileges of returning veterans who are looking for reemployment upon come back from administration. Be that as it may, even considering the previous, Metro postponed re-recruiting Petty by oppressing her through the whole come back to-work process. Besides, Metro damaged the reemployment arrangements of USERRA by not concurring Petty the position he had been equipped for. The Court made an end that Petty’s guarantee for segregation under USERRA was genuine and established on truth since he had fulfilled all the specifications for the reestablishment. Once more, the court proceeded with that Petty’s request for reemployment was made in an opportune way, and his release done respectably. In the USERRA claim, Petty had fittingly contended that the office had unlawfully postponed his reemployment and declined to reestablish him [Petty] to his watch sergeant’s position. This was unfair against Petty, by temperance of his military assistance record. The contention by the office that it was simply watching uniform qualification for obligation strategies which Nashville and the encompassing district didn't get the job done in the court. Metro

MIT Alum Helps the Red Sox Keith Foulke

MIT Alum Helps the Red Sox Keith Foulke Every Sunday ESPN nationally televises one baseball game, and last night they showed the final game of the three-game set between the archrivals Boston Red Sox and New York Yankees. The Red Sox won the rubber game of the series 7-2, thanks to a strong pitching performance from David Wells, who pitched 8 1/3 solid innings. After a Gary Sheffield single in the ninth inning, Red Sox manager replaced Wells with relief pitcher Keith Foulke, who has been struggling greatly this year. The announcers said that Foulke had flown to Birmingham, Alabama, last week to see Dr. Glenn Fleisig. That was a name that caught my ear. At left, Red Sox relief pitcher Keith Foulke; at right, biomechanics researcher and MIT alum Glenn Fleisig. Glenn Fleisig, along with his wife Clara, serves as our head alumni interviewer in the Birmingham area. Dr. Fleisig is the Smith + Nephew Chair of Research at the American Sports Medicine Institute, and graduated from MIT with a degree in Mechanical Engineering in 1984. Clara is a Medical Doctor with a Biology degree, MIT Class of 1985. For more information, I went to ESPNs Peter Gammons, who wrote: Keith Foulke took last Mondays off-day to go see Dr. Glen Fleisig and the staff at ASMI in Birmingham for an evaluation of his delivery. Because ASMI is in conjunction with Dr. James Andrews, there were reports that Foulke was having shoulder problems. Foulke would not discuss it. Every player has the right to privacy, said one Sox official. Most of our pitchers go there at some point each year. Why not? Fleisig might be one of the best practicioners of pitching biomechanics in the world. Wanting to know more, I turned to my friend Google. I found: A nice video story about Fleisig and pitching biomechanics from This Week in Baseball, entitled The As pitchers uses cutting edge biomechanics. A two-part interview by Baseball Prospectus with Fleisig. Part 1 Part 2 A CNN story: Technology Takes the Mound The Baseball Prospectus interview asked Fleisig how he got his start: Like many people out there, I had dreams of being a major league player as a kid. After a while it became apparent that I was stronger in the classroom than on the baseball field. I went to MIT, majored in mechanical engineering, and figured Id devote my life to being a mechanical engineer, building cars and playing softball on the weekend with friends. This was 1983, and at that time MIT had a biomechanics lab in the mechanical engineering department. I had to do my senior engineering project, and my friends were working on fluid dynamics, heat transfer, things like that. So I walk into the biomechanics lab, and I see someone working on breaking down a golf swing. I didnt know you could use these principles to apply to sports and peoples movements playing sports. So for my senior paper I worked on the mechanics of the golf swing. I told the professor in charge of the lab that I wanted to get a job in this field; he laughed and said there werent any. An intern from MIT had gone out to the Olympic training center in Colorado to do some biomechanical work, so I decided to do the same thing. When I got there, I was just some college kid whod walked off campus, right into the center of media attention for the 84 Olympics. We were testing rowers, archersUSA Today, CBS, newspaper people would show up every dayit was quite exciting obviously. From there, I approached Dr. Chuck Dillmanhe was the director of the biomechanics lab and my first mentorand said: I like the idea of looking at sports through biomechanics, but my particular interest is baseball. What can I do to do this for a living? He said Id have to meet this up-and-coming young doctor named James Andrews. The Olympic committee and Andrews had put together a joint effort, a course called Injuries in Baseball, and Dr. Dillman suggested there might be some po tential there. And hows Foulke doing? In three appearances since his consultation with Fleisig, he has not allowed a baserunner. Keep it up!

Co-morbidity in Substance use and Psychosis - Free Essay Example

Sample details Pages: 24 Words: 7236 Downloads: 4 Date added: 2017/06/26 Category Health Essay Type Analytical essay Did you like this example? What do the following have in common: alcoholism, obesity, smoking, drug abuse and compulsive gambling? Until recently, there were thought of as relatively independent and separate problem areas. Psychologists, psychiatrists, social workers, and other mental health professionals have previously specialised in the treatment of one of these behaviours, but few had attempted to extend their therapy and research efforts to cover more than one or two of these disorders. As well as their expertise, specialists in these areas have not worked in concert with one another, or communicated with each other about treatment and research issues. Don’t waste time! Our writers will create an original "Co-morbidity in Substance use and Psychosis" essay for you Create order However, several changes have been induced in recent times with the concept of addictive behaviours, and this has led to possible commonalities among these seemingly diverse problems. There is also the increased awareness that workers in each of these areas have much to learn from one another, and that there may be significant and instructive similarities in aetiology, process and treatment. The interesting similarity among the above mentioned problems has collectively come to be known as additive behaviours. According to Miller (1980) addictive behaviours involve some form of indulgence for short-term pleasure of satisfaction at the expense of longer-term adverse effects. The various substance abuse disorders all involve significant health risks as various chronic diseases. There are enormous social costs of addictive behaviours, both in personal expenditures as non-essentials and costs to the public as health care, crime control etc. The following essay aims to critically review DSM-IV guidelines for diagnosing co morbid substance use disorders (SUDs), the factors that undermine definitive diagnosis of co morbid disorders, and the potential diagnostic changes that could address these issues. In particular this essay shall examine alcoholism which is one form of substance abuse. Attempts shall also be made to investigate the types of research that would act as a support for the criteria and guidelines for diagnosing SUDs and psychosis. Substance use disorder is caused due to psychoactive drug use and may be referred to as a condition arising from the abuse of alcohol and psychoactive drugs. Alcohol and other substances can have varied physiological and psychological effects. Although the effects of alcohol and drug consumption may appear as desirable, prolonged and heavy usage may result in physical harm, dependency and withdrawal problems and long term psychological damage or social harm. For the diagnosis of patients with co morbid psychotic symptoms a nd substance use disorders (SUDs) the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV), makes clear distinctions between independent psychotic disorders (bipolar disorder, schizophrenia) and substance-induced syndromes (delirium, dementia etc.). Most substance-induced psychotic symptoms are considered to be short lived and that it subsides with sustained abstinence along with other symptoms of substance intoxication and withdrawal. One of the most frequent situations in psychiatric diagnosis are challenges posed by patients who experience the onset of psychotic symptoms during episodes of current or recent psychoactive substance use (Rosenthal Miner, 1997). All major categories of non-organic psychotic disorders in DSM-IV have an exclusion criterion for symptoms that are not caused due to the direct physiological effects of a substance. For patients with SUDs, psychotic disorders can be diagnosed as either independent or having one of the many substance-ind uced mental disorders. Psychosis forms a feature of this categorisation. When changes occur relating to the pharmacological effects of different categories of substances, the symptoms include à ¢Ã¢â€š ¬Ã¢â‚¬Å" acute intoxication, intoxication delirium, withdrawal, substance-induced psychotic disorder with hallucinations etc (caused due to the use of substances such as, alcohol, stimulants etc.). The only exception is for alcohol-induced pathological dementia. All other substance-induced psychotic mental disorders are considered as time limited (Rounsaville, 2007). Alcohol dependence syndrome according to DSM-IV (APA,1994), is characterised by the presence of three or more of the following symptoms à ¢Ã¢â€š ¬Ã¢â‚¬Å" a strong compulsion to drink; difficulty in controlling either the onset or termination of drinking or the levels of alcohol use; a physiological withdrawal state on the stopping of alcohol consumption or the use of alcohol to avoid withdrawal symptoms; increasing toler ance to alcohol (i.e. the need to consume larger quantities of alcohol to achieve a similar effect as produced originally from smaller amounts); digressive neglect of other interests; and persisting use of alcohol despite awareness of the harmful effects from consumption. Alcohol-related psychosis is a secondary psychosis with hallucinations occurring as the predominating feature in many alcohol-related conditions. These include but are not limited to acute intoxication; withdrawal, after a major decrease in alcohol consumption, and alcohol idiosyncratic intoxication. According to Larson (2008), alcohol is a neurotoxin that affects the brain in a complex manner through prolonged exposure and repeated withdrawal. This results in significant morbidity and mortality. Larson further argues that, alcohol-related psychosis is often an indication of chronic alcoholism. As such, it is associated with medical, neurological, and psychosocial complications. The discontinuation of alcohol ra pidly clears alcohol-related psychosis but may continue on later alcohol related exposure. Although distinguishing alcohol-related psychosis from schizophrenia through clinical presentation often is difficult, the general consensus is that alcohol-related psychosis suspends with abstinence, unlike schizophrenia. Larson (2008) has also noted that, alcohol-related psychosis lacks the in-depth research needed to understand its pathophysiology, demographics, characteristics, and treatment when compared to alcoholism. According to Rassool (2006) psychoactive drugs are substances which have an effect on the central nervous, as they alter mood, cognitive processes and behaviour. Rassool (2006), states that, the uses of psychoactive drugs are considered illegitimate depending on the social customs and laws of different cultures and societies. In most societies, no adjustments are made in the interest of the use and misuse of tranquilisers, heroine, volatile substances, and stimulants suc h as amphetamines and cocaine. Legal drugs such as alcohol, caffeine and nicotine are used as a social lubricant and as self-medication, as a means to relieve tensions and anxieties of everyday life. They are also used as a mechanism to ease social intercourse. He further agues that, although there is an increased risk of morbidity and morality, alcohol is actively encouraged and socially reinforced in some societies. There have also been observations that consumption levels are on the rise in most countries and hence, statistics have been obtained for the UK to demonstrate this fact below. According to the NHS Information Centre (2009), an estimated 863,000 alcohol related admission in hospital in 2007/08. This is an increase of 69% since 2002/03 when the alcohol related admission was at 510,200. The statistics bulletin further states that, in England in 2007, the number of individuals who were on prescription items for the treatment of alcohol dependency were 134,429. These wer e prescriptions that were dispensed in primary care settings or NHS hospitals and those dispensed in the community. This shows a marked difference since 2003 when there were 102,741 prescription items (an increase by 31%). Further findings from the bulletin indicate that, there were 6,541 deaths in England in 2007, and these were directly related to alcohol (an increase by 19% since 2001). Of these alcohol related deaths, majority of the individuals died from alcoholic liver disease (estimate of 4,249). Alcohol misuse related harm is estimated to cost the NHS in England approx.  £2.7 billion in 2006/07. As an attempt to ensure a moderately even account of the statistics on alcohol misuse in UK, the Audit Scotland report has been reviewed and provides further evidence of Scotlands growing problem with drug and alcohol misuse. The Audit Scotland (2009) report presents that Scotland has a higher level of drug and alcohol misuse compared to the rest of the UK. According to the report, the levels of alcohol dependency are three times higher than that of England. The report states that estimating the size of Scotlands alcohol problem is not accurate due to lack of national data and under-reporting of consumption. Based from findings from the Office of National Statistics (2002), an estimated 4.9% of the population in Scotland aged 16 and over are dependant of alcohol. The higher prevalence of alcohol dependency is Scotland has been argued to be found due to high rates of alcohol dependency in Scottish women. There were 42,430 discharges from acute general hospitals with an alcohol-related diagnosis in 2007/08. When compared to statistics from the past five years, there has been an increase by 5% in discharge rates (Alcohol Statistics Scotland, 2008). In Scotland, 11% of all accident and emergency attendances are considered to be as a result of alcohol. The busiest time of alcohol-related attendances are recorded as Friday night of Saturday morning rangi ng between midnight and four in the morning (NHS Quality Improvement Scotland, 2006). Scotland has the highest alcohol-related death rate in the UK with 1,399 alcohol-related deaths in 2007. This is a 75% increase over ten years and over 100% increase over fifteen years (General Register Office for Scotland, 2009). A report from Strathclyde Police in 2007 showed that between April 2006 and March 2007, two-thirds of those in custody at three Glasgow police stations were for violent offending under the influence of alcohol. The reasons for highlighting the statistics on alcohol misuse in UK as well detailed statistics from Scotland is not just to emphasise the ever growing alcohol and drug consumption in the country, but also to understand the common co-occurring psychiatric disorders related with the misuse of these substances. The recent recognition of this co morbidity can be attributed to a number of reasons. Abou-Saleh Janac (2004), state that, the development of drug abuse s ervices was separate from that of the development of general psychiatric services, with little interference between them. Furthermore, the move from hospitals to community care of individuals with severe mental disorders has exposed these individuals to the risk of developing alcohol and drug problems, thereby merely heightening their psychopathology and disability. There is also the high risk of self-harm not just to individuals who are within general psychiatric services, but also those with severe personality disorders within addiction services. A number of etiological models for co morbidity have been introduced in research. These include à ¢Ã¢â€š ¬Ã¢â‚¬Å" common factor models, secondary substance misuse models, and secondary psychiatric illness models (Mueser, Bellack Blanchard, 1998). According to Mueser et al (1998), the common factors models include common genetic factors and antisocial personality disorder. However, Abou-Saleh Janac (2004) argue that studies have not supported the existence of a common genetic factor in the causation of substance misuse and psychiatric disorders. At the same time, the presence of antisocial personality disorder was shown to be a common factor in substance misuse. They further go on to argue that, patients with sever mental illness and antisocial personality disorder are morel likely to have substance misuse than those with no antisocial personality disorder. Adversity in childhood can seem omnipresent in patients with alcohol misuse who are co morbid with psychiatric conditions. A study conducted by Langeland, Dralijer Van der Brink (2004), found that childhood detrimental influences such as early loss of a parent, witnessing domestic violence and parental alcoholism, exemplified as variations in types of co morbid psychiatric disorders in men with alcohol dependence. A further study by Mueser et al (2000), in a cohort study involving 325 patients with co morbid psychiatric disorder and substance misuse disting uished the predictors of co morbidity as male, young age, lacking education, involved in criminal activity, conduct disorder, and antisocial personality disorder. Secondary substance misuse models include those of self-medication, alleviation of depression, and super sensitivity. Abou-Saleh Janac (2004), further state that the self-medication model depict psychiatric patients as using specific substances to alleviate specific symptoms. However, this argument has not been supported and psychiatric patients who use alcohol or drugs have worse outcomes. As depression can be associated with a general proneness to addiction and not the use of a specific substance, the alleviation of depression model is more acceptable. According to the super sensitivity model, patients with severe mental illnesses react in a highly sensitive manner to low doses of alcohol and drugs, in particular amphetamines leading to a hasty relapse in the individuals illness. The secondary psychiatric illness mo del alcohol and drug use disorders are viewed as causing the co morbid mental disorder (Abou-Saleh Janac, 2004). An interesting note about the above stated models is that, causality is one-directional. In clinical practice, substance abuse may form both a cause and a consequence of another mental disorder. A mental disorder at the same time may be both a cause and a consequence of substance abuse, thereby creating a vicious circle. In individual cases, multiple pathways of association between substance abuse and other mental disorders may act simultaneously in both directions. A review of certain factors (bio physiological and genetic, socio cultural and psychodynamic) as well as a detailed review of other models (social learning and behavioural) which all put together helps formulate what is known and thought about why human beings come to abuse themselves by abusing alcohol. When split apart, each model explains a part of every abusers problem, together they provide a comprehe nsive etiological perspective. According to Miller (1980), one of the most obstinate theories of the bio physiological model of alcoholism is that alcoholics and non-alcoholics differ in the rate at which they metabolise alcohol. Identifying such a difference would suggest that the etiological factor resides in the rate-limiting mechanisms involved in the metabolism of ethanol. However, no metabolic studies of alcoholism indicate the existence of such a rate difference (given that the alcohol consumption is kept constant) (Mello Mendelson, 1978). Charles Lieber, claims that alcoholics have two metabolic routes by which they break down alcohol while non-alcoholics have one (Korsten Lieber, 1979). According to this theory, alcoholics metabolise alcohol differently from non-alcoholics and thus gain the capacity to consume larger amounts of alcohol for longer periods of time than non-alcoholics. Even if such proof were available, there still lie the important roles of environmental, b ehavioural and socio-cultural factors in alcoholism. Numerous studies have been carried out, suggesting that alcoholism runs in families (Goodwin, 1979). Evidence that genetic factors play an important role in the development of alcoholism has been derived from twin studies, family studies, adoption studies, observations of ethnic differences, and studies of biological risk factors (Goodwin 1979, 1985). Studies of monozygotic (identical) and dizygotic (fraternal) twins generally suggest that there is some degree of heritability in the frequency and quantity of alcohol consumed (Schuckit 1987). Monozygotic twin pairs also tend to show a significantly higher level of concordance compared with dizygotic twin pairs (Schuckit 1987; Agarwal and Goedde 1990). Family studies indicate that approximately 40% of alcoholics have an alcoholic parent (Institute of Medicine 1987), and that the alcoholism rate is significantly higher in relatives of alcoholics than in relatives of non alcoholics (Cotton, 1979; Guze et al, 1986). Alcoholics with a family history of alcoholism tend to begin drinking earlier in life. They also tend to have more alcohol-related problems than those alcoholics without a family history of alcoholism (Cloninger et al. 1981). These data, taken together, suggest that there may well be a genetic component to alcoholism, though its extent and influence of inheritance is not a simple one, as both genetic and environmental factors may be involved (McNeece DiNitto, 2005). The pharmacology and physiology of physical dependence and tolerance to the drugs of abuse continue to be explored, but this model alone cannot adequately define alcoholism. As mentioned earlier, cultural patterns have a profound impact on drinking and rates of alcoholism. Miller (1980), states that although cultural influences can predispose a person to alcoholism, social variables play a major role in translating that predisposition to actual addiction. He further states that cult ural influences can operate to maintain alcoholic drinking. For e.g. peer pressure, has a powerful influence on the development of deviant drinking among adolescents (Jessor Jessor, 1975). Social historians have argued that the pervasiveness of social setting-related influences on persons to drink heavily (Zinberg Fraser, 1979). Psychoanalysts explain alcoholism in several ways. Alcoholism is seen by some psychoanalysts as fundamentally suicidal, trying to destroy bad, depriving mothers with whom the person has identified with. Others claim that alcoholics are defining themselves against underlying depression by drinking to oblivion (Williams, 1976). Critics of the psychoanalytic approach to alcoholism, argue that there is no empirical data to support these hypotheses. They also argue that psychoanalysis does not help alcoholics who seek treatment (Schuckit Haglund, 1977). Dynamic theories of drug addiction, describe the addict as a person whose habit represents a return to th e oral stage of psychosexual development. As such, dependency needs being paramount, the addict is frustrated with their inability to derive satisfaction of these needs. Inability to meet their oral dependency needs in more appropriate ways, leads the addicts to use drugs or alcohol to obtain gratification. Although the complex psychoanalytic theory has been simplified to a great extent, it has relatively little impact on the prevailing views of aetiology and treatment. The cognitive behavioural approach views any type of psychopathology as a maladaptive learning process. As such, the central goal of cognitive behavioural approaches is to design techniques through which maladaptive responses can be disentangled and replaced with adaptive responses. The first behavioural explanation for alcoholism was that of tension-reduction. Tension-reduction is based on the hypothesis that, alcohol appears to reduce anxiety. Hence, alcohol is presumed to reinforce drinking by alcoholics. Empir ical support for the theory came from earlier studies of experimentally-induced conflict in animals (Conger, 1951, 1956; Masserman Yum, 1946). However, tension reduction has not received universal support (Cappell Herman, 1972; Brown Crowell, 1974). The behavioural effects of alcohol involve a complex interaction of factors. The expectations an individual holds about alcohol effects their behaviour (Pliner Cappell, 1974). Expectancies themselves are complex because it is based on belief systems, prior drinking experiences, the immediate social and physical setting of drinking, dosage levels etc. Such complexity suggests that the potential reinforcing capabilities of alcohol remain uncertain. The social learning model views alcohol and drug abuse as socially acquired, learned behaviour patters that are maintained by numerous anticipatory causes (classical conditioning) and consequent reinforces (operant conditioning). The causes and reinforces may be of a psychological, sociol ogical or physiological nature (Miller Eisler, 1975). The relationship between SUDs and psychiatric disorders pose commonplace diagnostic challenges for both clinicians in treatment settings and researchers in community settings. This is because both SUDs and psychiatric disorders are intermeshed with resemblance of intoxication and withdrawal effects to the symptoms of psychiatric disorders in most patients who come for treatment. Research findings suggests that there are high rates of SUDs amongst individuals with schizophrenia (Regier et al 1990), and even higher rates were reported among samples with first episode psychosis (FEP) (Sevy et al, 2001; Kavanagh et al, 2004; Wade et al, 2004). Addressing co morbidity is clinically relevant because SUD in schizophrenic patients is associated with poorer clinical outcomes (Swofford et al, 1996) and contributes significantly to their morbidity and morality (Rosen et la, 2008). The reasons for high co morbidity between SUD and schiz ophrenia although poorly understood, are considered to be an involvement of brain pathways and is likely to be a shared feature in co morbidity that is common to all drugs of abuse (Volkow et al, 2007). The co morbidity of SUD and schizophrenia could also be a direct consequence of the underlying neuropathology of schizophrenia. This may contribute to enhanced addiction vulnerability in individuals by disrupting the neural substrates that mediate positive reinforcement (Chambers, Krystal Self, 2001). The challenge has been to design measures to differentiate three conditions. Firstly, differentiating between expected intoxication and withdrawal symptoms; secondly, being able to distinguish between psychiatric disorders occurring during periods of active substance use. The third measure includes being able to differentiate between psychiatric disorders that are clearly independent from substance use. Prior to the publication of DSM-Iv, there existed no specific criteria for makin g these differentiations in substance abusers. This gave rise to a number of reliability and validity problems, including low levels of agreement between study groups, even when the same measures were used (Hasin, Samet, Nunes, Meydan, Matseoane Waxman, 2006). Eventually, DSM-IV clarified the guidelines to a considerable extent for differentiating independent and substance-induced disorders. According to DSM-IV, if a psychiatric episode occurs when substance use is insufficient to produce persistent intoxication or withdrawal, it would be diagnosed as primary (independent). Subsequently, substance-induced psychiatric disorders are defined as those that occur during periods of heavy substance use (or remitting shortly thereafter) and that have symptoms that exceed the expected effects of intoxication or withdrawal listed in DSM-IV. Hasin et al (2006), also argue that no study has yet addressed the reliability of the DSM-IV system of differentiating between intoxication/withdrawal sy mptoms. Disorders whose symptoms exceed intoxication/withdrawal effects and psychiatric disorders that is temporally independent from periods of substance use. In order to create a diagnostic instrument that was reliable and valid for assessment of psychiatric disorders in substance abusers, the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was developed (Hasin, Trautman, Miele, Samet, Smith Endicott, 1996). The pre-DSM-IV PRISM included standardised guidelines and probes to differentiate between organic and non organic syndromes and was administered by experienced clinical interviewers. Hasin et al (1996) conducted a study involving 172 dual-diagnosis or substance abuse patients. The result showed good to excellent reliability for many diagnoses, including SUDs, primary affective disorders, eating disorders, some anxiety disorders, and psychotic symptoms. The need to incorporate the new DSM-IV criteria (including the criteria for substance-induced disorders), to shorten and simplify the interview, and to add assessment of specific psychotic disorders led to the development of the PRISM-IV (Hasin et al, 2006). The PRISM-IV is a semi structured interview. The covers the diagnosis for current and lifetime time frames. These include abuse and dependence (by substance), major depressive disorder, mania, schizophrenia, mood disorder with psychotic features, delusional disorder, brief psychotic disorder, personality disorders etc. The most fascinating feature of the PRISM-IV is that, diagnostic modules can be selected to suit specific research needs. Apart from this, substance use disorders that are unimportant to the research question can be omitted as well. Other than PRISM-IV and DSM-IV, there are various other assessment tools that can be used for the assessment of psychiatric disorders in substance abusers. One such tool is the International Classification of Diseases Diagnostic Criteria (ICD-10). ICD-10 provides specific c riteria to differentiate between primary disorders and disorders resulting from psychoactive substance use, but only for psychotic disorders. ICD-10 excludes psychotic episodes attributed to psychoactive substance use from a primary classification similar to DSM-IV. Unlike DSM-IV, ICS-10 does not provide a separate psychoactive substance-related category for any other type of psychiatric disorder. In ICS-10, organic mental disorders exclude alcohol or other psychoactive substance-related disorders. Furthermore, organic mood disorders and organic delusional disorders cannot be used to diagnose episodes co-occurring with heavy psychoactive substance use (Torrens, Matrin-Santos Samet, 2006). Different interviews for psychiatric diagnosis based on DSM-IV or ICD-10 criteria are available for clinical and research studies. These include Structured Clinical Interviews for Axis I disorders (SCID-I) for DSM-IV (First et al, 1997). There exists the Schedule for Clinical Assessment in Neur opsychiatry (SCAN) (Janca et al, 1994) and the Composite International Diagnostic Interview (CIDI) (WHO, 1998). The SCID-IV is a semi-structured interview that allows diagnosis of primary or substance-induced disorders. However, it does not provide any specific guidelines other than those stated in the criteria. The differentiation of primary and substance induced disorders is made on a syndrome level in SCID-IV (Torrens, Matrin-Santos Samet, 2006). A range of clinical phenomena can be assessed by SCAN. A core instrument of the SCAN is the Present State Examination (PSE-10). PSE ratings are coded on score sheets and based on these ratings, a computer program generates ICD-10 and DSM-IV diagnoses. The PSE is a semi-structured clinical examination. The interviewer uses clinical judgment to attribute specified definitions to clinical phenomena using the SCAN Glossary. The glossary consists of a list of definitions of clinical symptoms and experiences (Torrens, Matrin-Santos Samet, 20 06). Finally, the CIDI is a fully structured interview design. The interviewers read the questions as written without interpretation (Robins et al, 1988). CIDI relies heavily on the subjects opinion for primary substance-induced differentiation. The CIDI generates ICD-10 and DSM-IV diagnoses. Symptoms attributed to alcohol, drugs, or physical illnesses are eliminated for consideration when making psychiatric diagnoses in CIDI. The method of evaluation used in CIDI is very varied in comparison to SCID-IV, SCAN or PRISM-IV. Torrens et al (2006) argues that, currently, most DSM-IV psychiatric disorders can be assessed in substance-abusing subjects with acceptable to excellent reliability and validity by specifically using the PRISM assessment tool. Having reviewed the statistics, aetiology and assessment of co morbidity in alcohol abuse, the next section is going to analyse the different treatment approaches. One of the biggest problems in the treatment of SUDs is preventing a re lapse after abstinence or controlled substance use has been achieved. Whilst there is no general theory of relapse, Marlatt Gordons approach to treatment is based principles of social learning theory, and draws heavily on the concepts of self-efficacy (Bandura, 1977). The approach emphasises on the methods to enhance confidence in individuals to enable them to perform activities leading to an effective outcome. According to self-efficacy theory, individuals who possess a high self-efficacy on their ability to perform a particular task are more likely to initiate and maintain that behaviour (Wilson, 1996). Wilson (1996) argues that the self-efficacy theory has been criticised on a number of conceptual grounds including difficulty in distinguishing between response-outcome expectancies and performance self-efficacy (Lee, 1989). The Stages of change model by Prochaska DiClemente (1983), suggest four stages in the process of change. These include: pre-contemplation (not thinking ab out cessation); contemplation; action (attempting to engage in cessation); and maintenance (stopped using drug, and attempting to remain abstinent). Wilson (1996) argues that, although this model cannot be considered to be a general theory of relapse, there are opportunities different types of interventions for different individuals. He further argues that theory helps make specific and testable predictions about the matching of individuals for treatments. Other than the theoretical explanations for prevention of replace in individuals with alcohol abuse, there also exists medical treatment and social treatment approaches. Detoxification is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to offset the withdrawal symptoms. Detoxification treats only the physical effects of prolonged use of alcohol, but does not actually treat alcoholism. There is a high chance of relapse without further treatment. Various forms of group therapy or p sychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as providing relapse prevention skills. Miller (1980) states that when problem drinkers are treated, approximately one-third become abstinent and an additional one-third show substantial improvement without abstinence. He has based his findings from short-term studies; however, data from long-term studies suggest that on average only 26% of those treated remain abstinent or improved after one year. A few other treatment strategies for alcohol addiction include aversion therapies, family therapies, controlled drinking therapies etc. To conclude, while progress is apparent in the study of substance abuse; more research is needed on the commonalities and differences among the addictions. Numerous theories have been developed to help explain the causes of addiction, but it is important not to lose sight of essential differences among substances and their effects. In dividuals with recurrent or severe and enduring mental illness and co morbidity with substance-misuse have complex needs. This requires the continuing care of specialist mental health services and substance-misuse services. It has been reported that around 30% of those seeking help for mental health problems have current substance misuse problems, and of individuals seeking help for substance misuse, more than half have had a mental disorder in the previous six months (Department of Health, 1998). According to Appleby (1999), individuals with substance-misuse and psychiatric disorders find it hard to engage with appropriate services. He further states that suicide is a high risk factor amongst this group. The different assessment tools that have been devised by DSM-IV for the diagnosis of co morbidity in SUDs, whether in primary or specialist care should consider how to access appropriate specialist input. Recent studies have examined the relationships between alcohol dependence and psychiatric illness as having a combination of contributors. These include childhood trauma, having parents with substance dependence and genetic factors influence the development of alcohol and co morbid psychiatric disorders. There is still much to be learned about the details of alcohol misuse co morbid with psychiatric disorders in order to evolve strategies to manage these difficult disorders. Ideally, rather than adopting treatments from successful treatment strategies for singular disorders, new pharmacological and psychological treatments need to be generated specifically for the co morbid patient with alcohol misuse (Rassool, 2006; Miller, 1980; Volkow, 2009). Reference: Abou-Saleh, M.T. Janca, A. (2004). The epidemiology of substance misuse and co morbid psychiatric disorders. Acta Neuropsychiatrica. 16, pp. 3-8. Agarwal, D.P., Goedde, H.W. (1990). Alcohol Metabolism, Alcohol Intolerance and Alcoholism. New York: Springer Verlag. Alcohol Stastistics Scotland (2008). ISD Scotland, 2009. Taken From: Audit Scotland (2009) Drug and Alcohol Services in Scotland. Online Source: https://www.audit-scotland.gov.uk/media/article.php?id=103. Accessed (15/08/09). American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association. APA (American Psychiatric Association) (1994) DSM- IV: Diagnostic and Statistical Manual of Mental Disorders. (4th ed.) pp. 75-90. American Psychiatric Association, Washington, DC. Taken From: Rassool, G.H. (2006). Dual Diagnosis Nursing. Oxford: Blackwell Publishing Ltd. Appleby, L. (1999). Safer Services: National Confidential Inq uiry into Suicide and Homicide by People with Mental Illness. Department of Health, London. Taken from: Rassool, G.H. (2006). Dual Diagnosis Nursing. Oxford: Blackwell Publishing Ltd. Audit Scotland (2009) Drug and Alcohol Services in Scotland. Online Source: https://www.audit-scotland.gov.uk/media/article.php?id=103. Accessed (15/08/09). Baigent, M.F. (2005). Understanding Alcohol Misuse and Co morbid Psychiatric Disorders. Current Option in Psychiatry. Medscape CME. Online Source: https://cme.medscape.com/viewpunlication/30060. Accessed (15/08/09). Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 84, pp. 191-215. Taken from: Wilson, P.H. (1996). Relapse Prevention: Overview of research findings in the treatment of Problem Drinking, Smoking, Obesity and Depression. Clinical Psychology and Psychotherapy. 3[4], pp. 231-248. Brown, J.S., Crowell, C.R. (1974). Alcohol and conflict resolution, a theoretical analysis. Qu arterly Journal of Studies of Alcohol, 35, pp. 66-85. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Cappell, H., Herman, C.P. (1972). Alcohol and tension reduction à ¢Ã¢â€š ¬Ã¢â‚¬Å" a review. Quarterly Journal of Studies on Alcohol, 33, pp. 33-64. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Chambers, R.A., Krystal, J.H., Self, D.W. (2001). A neurobiological basis for substance abuse co morbidity in schizophrenia. Biological Psychiatry. Vol. 50, 71à ¢Ã¢â€š ¬Ã¢â‚¬Å"83. Taken From: Volkow, N.D. (2009). Substance Use Disorders in Schizophrenia à ¢Ã¢â€š ¬Ã¢â‚¬Å" Clinical Implications of Co morbidity. Schizophrenia Bulletin. Vol. 35. Cloninger, C.R., Bohman, M., Sigvardsson, S. (1981). Inheritance of alcohol abuse: Cross-fostering analysis of adopted men. Archives of General Psychiatry. Vol. 38 (8), pp. 861-868. Conger, J.J. (1951). The effects of alcohol on conflict behaviour in the albino rat. Quarterly Journal of Studies on Alcohol, 12, pp. 1-29. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Cotton, N.S. (1979). The familial incidence of alcoholism: A review. Journal of Studies on Alcohol. Vol. 40, pp. 89-116. Department of Health (1998). Expert Seminar on Dual Diagnosis and the management of Complex Needs. Department of Health, London. Taken from: Rassool, G.H. (2006). Dual Diagnosis Nursing. Oxford: Blackwell Publishing Ltd. First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). (American Psychiatric Press:Washington DC). Taken from: Torrens, M., Martin-Santos, R., Samet, S. (2006). Importance of Clinical Diagnoses for Como rbidity Studies in Substance Use Disorders. Neurotoxicity Research. 10[3,4]. pp. 253-261. General Register Office for Scotland (2009). Deaths: Information and Statistics. Online Source: https://www.gro-scotland.gov.uk/statistics/deaths/alcohol-related-deaths/index.html. Accessed (15/08/09). General Register Office for Scotland (2009). Deaths: Information and Statistics. Online Source: https://www.gro-scotland.gov.uk/statistics/deaths/alcohol-related-deaths/index.html. Accessed (15/08/09). Goodwin, D.W. (1979). Genetic determinants of alcoholism. In J.J. Medelson N.K. Mello, (Eds.) The diagnosis and treatment of alcoholism. New York: McGraw-Hill. Taken From: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Goodwin, D.W. (1985). Alcoholism and genetics: The sins of the fathers. Archives of General Psychiatry. Vol. 42 (2), pp. 171-174. Guze, S.E., Cloninger, C.R., Martin, R ., Clayton, P.J. (1986). Alcoholism as a medical disorder. Comprehensive Psychiatry. Vol. 27 (6), pp. 501-510. Hasin, D., Samet, S., Nunes, E., Meydan, J., Matseoane,K., Waxman, R. (2006). Diagnosis of Comorbid Psychiatric Disorders in Substance Users Assessed With the Psychiatric Research Interview for Substance and Mental Disorders for DSM-I. American Journal of Psychiatry. 163, pp. 689-696. Hasin, D., Trautman, K., Miele, G., Samet, S., Smith, M., Endicott, J. (1996). Psychiatric Research Interview for Substance and Mental Disorders (PRISM): reliability for substance abusers. American Journal of Psychiatry. 153, pp. 1195à ¢Ã¢â€š ¬Ã¢â‚¬Å"1201. Taken from: Hasin, D., Samet, S., Nunes, E., Meydan, J., Matseoane,K., Waxman, R. (2006). Diagnosis of Comorbid Psychiatric Disorders in Substance Users Assessed With the Psychiatric Research Interview for Substance and Mental Disorders for DSM-I. American Journal of Psychiatry. 163, pp. 689-696. Institute of Medicine (1987). He ritable determinants of risk. Taken From: Causes and Consequences of Alcohol Problems: An Agenda for Research. Division of Health Sciences Policy. Washington, DC: National Academy Press. Janca, A., Ustun, T.B., Sartorius, N. (1994). New versions of World Health Organization instruments for the assessment of mental disorders. ACTA Psychiatrica Scandinavica. 90, pp. 73-83. Taken from: Torrens, M., Martin-Santos, R., Samet, S. (2006). Importance of Clinical Diagnoses for Comorbidity Studies in Substance Use Disorders. Neurotoxicity Research. Vol. 10 (3,4), 253-261. Jessor, R., Jessor, S.L. (1975). Adolescent development and the onset of drinking: A longitudinal study. Journal of Studies on Alcohol, 36, pp. 27-51. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Kavanagh, D.J., Waghorn, G., Jenner, L., et al(2004). Demographic and clinical correlates of co-morbid sub stance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophr Res. 66, pp. 115à ¢Ã¢â€š ¬Ã¢â‚¬Å"124. Taken from: Lambert, M., Conus, P., Lubman, D.I., Wade, D., et al (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. ACTA psychiatrica scandinavica. 112, pp. 141-148. Korsten, M.A. Lieber, C.S. (1979). Hepatic and gastrointestinal complications of alcoholism. In J.H. Mandelson N.K. Mello (Eds.), The diagnosis and treatment of alcoholism. New York: McGraw-Hill. Taken From: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Lambert, M., Conus, P., Lubman, D., I., Wade, D., et al (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. ACTA psychiatrica scandinavica. 112, pp. 141-148. Langeland, W. Dralijer, N. Van der Brink, W. ( 2004). Psychiatric co morbidity in treatment-seeking alcoholics: the role of childhood trauma and perceived parental dysfunction. Alcoholism Clinical Experimental Research. Vol. 28, pp. 441-447. Taken From: Baigent, M.F. (2005). Understanding Alcohol Misuse and Co morbid Psychiatric Disorders. Current Option in Psychiatry. Medscape CME. Online Source: https://cme.medscape.com/viewpunlication/30060. Accessed (15/08/09). Larson, M. (2008). Alcohol-related psychosis: Differential diagnoses Workup. Department of Child and Adolescent Psychiatry, Harvard University. Online resource: https://emedicine.medscape.com/article/289848-overview Accessed (14/08/2009). Lee, C. (1989). Theoretical weaknesses lead to practical problems. Journal of Behavior Therapy and Experimental psychiatry. 20, pp. 115-123. Taken from: Wilson, P.H. (1996). Relapse Prevention: Overview of research findings in the treatment of Problem Drinking, Smoking, Obesity and Depression. Clinical Psychology and Psychoth erapy. 3[4], pp. 231-248. Lessa, N. Scanlon, W.F. (2006). Substance use disorders. Wiley Concise Guides to Mental Health. Hoboken, NJ: John Wiley Sons. Masserman, J.H., Yum, K.S. (1946). An analysis of the influence of alcohol and experimental neurosis in cats. Psychosomatic Medicine, 8, pp. 36-52. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. McNeece, C.A. DiNitto, D.M. (2005). Chemical Dependency. A Systems Approach. (3rd Ed.) Englewood Cliffs, NJ: Prentice Hall. Taken From: Lessa, N. Scanlon, W.F. (2006). Substance use disorders. Wiley Concise Guides to Mental Health. Hoboken, NJ: John Wiley Sons. Mello, N.K. Mendelson, J.H. (1978). Alcohol and Human Behaviour. In L.L. Iversen, S. D. Iversen, S.H. Snyder (Eds.), Handbook of psychopharmacology. New York: Plenum Press. Taken From: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Miller, P.M., Eisler, R.M. (1975). Alcohol and drug abuse. In W. E. Craighead, A. E. Kazdin, Mahoney (Eds.), Behavior modification principles, issues, and applications. Boston, Massachusetts: Houghton Mifflin. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Mueser, K.T., Bellack , A.S. Blanchard, J.J. (1998). Co morbidity of schizophrenia and substance abuse: implications for treatment. Journal of Consulting and Clinical Psychology. Vol. 60, 845-856. Taken From: Abou-Saleh, M.T. Janca, A. (2004). The epidemiology of substance misuse and co morbid psychiatric disorders. Acta Neuropsychiatrica. 16, pp. 3-8. Mueser, K.T., Yarnold, P.R., Rosen berg, S.D., Swett, C.J., Miles, K.M. Hill, D. (2000). Substance Use Disorders in Hospitalised Severely Mentally Ill Psychiatric Patients: Prevalence, Correlates and Subgroups. Schizophrenic Bulletin. 26, pp. 179-192. Taken From: Abou-Saleh, M.T. Janca, A. (2004). The epidemiology of substance misuse and co morbid psychiatric disorders. Acta Neuropsychiatrica. 16, pp. 3-8. Newcastle University (2007). Medical Student Teaching Resource. Online Source: https://www.ncl.ac.uk/nnp/teaching/disorders/substance/index.html. Accessed (14/08/09). NHS Information Centre (2009). Statistics on Alcohol: England. The Health and Social Care Information Centre. Online Source: https://www.dh.gov.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/DH_085391 Accessed (15/08/09). NHS Quality Improvement Scotland (2006). Findings from randomly selected ten day period in 2005 in then AE departments in Harmful Drinking: The size of the problem. Taken From: Taken From: Audit Scotland (2009) Drug an d Alcohol Services in Scotland. Online Source: https://www.audit-scotland.gov.uk/media/article.php?id=103. Accessed (15/08/09). Office of National Stastistics (2002). Psychiatric morbidity among adults living in private households 2000. Taken From: Audit Scotland (2009) Drug and Alcohol Services in Scotland. Online Source: https://www.audit-scotland.gov.uk/media/article.php?id=103. Accessed (15/08/09). Pliner, P., Cappell, H. (1974). Modification of affective consequences of alcohol: A comparison of social and solitary drinking. Journal of Abnormal Psychology, 83, pp. 418-425. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Prochaska, J.O., DiClemente, C.C. (1983). States and processes of self-change and smoking: Towards an integrative model of Change. Journal of Consulting and Clinical Psychology. 51, pp. 390-395. Taken from: Wilson, P.H. (1996). Relapse Prevent ion: Overview of research findings in the treatment of Problem Drinking, Smoking, Obesity and Depression. Clinical Psychology and Psychotherapy. 3[4], pp. 231-248. Rassool, G.H. (2006). Dual Diagnosis Nursing. Oxford: Blackwell Publishing Ltd. Regier, D.A., Farmer, M.E., Rae, D.S., et al (1990). Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiological Catchment Area (ECA) Study. JAMA, 264, pp. 2511à ¢Ã¢â€š ¬Ã¢â‚¬Å"2518. Taken from: Rounsaville, B.J. (2007). DSM-V Research Agenda: Substance Abuse/Psychosis Co morbidity. Schizophrenia Bulletin, 33 [4], pp. 947-952. Robins, L.N., Wing, J., Wittchen, H.U., Helzer, J.E., Babor, T.F., Burke, J., Farmer, A., Jablenski, A., Pickens, R., Regier, D.A., et al. (1988) The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch. Gen. Psychiatry . 45, pp. 1069-1077. Taken from: To rrens, M., Martin-Santos, R., Samet, S. (2006). Importance of Clinical Diagnoses for Comorbidity Studies in Substance Use Disorders. Neurotoxicity Research. 10[3,4]. pp. 253-261. Rosen, C.S., Kuhn, E., Greenbaum, M.A., Drescher, K.D. (2008). Substance abuse-related mortality among middle-aged male VA psychiatric patients. Psychiatric Services. Vol. 59, 290à ¢Ã¢â€š ¬Ã¢â‚¬Å"296. Taken From: Volkow, N.D. (2009). Substance Use Disorders in Schizophrenia à ¢Ã¢â€š ¬Ã¢â‚¬Å" Clinical Implications of Co morbidity. Schizophrenia Bulletin. Vol. 35. Rosenthal, R.N. Miner, C.R. (1997). Differential diagnosis of substance-induced psychosis and schizophrenia in patients with substance use disorders. Schizophrenia Bulletin. 23, pp. 187à ¢Ã¢â€š ¬Ã¢â‚¬Å"193. Rounsaville, B., J. (2007). DSM-V Research Agenda: Substance Abuse/Psychosis Co morbidity. Schizophrenia Bulletin, 33 [4], pp. 947-952. Schuckit, M.A. (1987). Biological vulnerability to alcoholism. Journal of Consulting and Cli nical Psychology. 55 (3), pp. 301-309. Schukit, M., A., Haglund, R., M., J. (1977). An overview of the etiological theories on alcoholism. In N. J. Estes M. E. Heinemann (Eds.), Alcoholism: Development, consequences, and interventions. Saint Louis: Mosby. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Sevy, S., Robinson, D.,G., Holloway, S., et al (2001). Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. ACTA psychiatrica scandinavica. 104, pp. 367à ¢Ã¢â€š ¬Ã¢â‚¬Å"374. Taken from: Lambert, M., Conus, P., Lubman, D., I., Wade, D., et al (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. ACTA psychiatrica scandinavica. 112, pp. 141-148. Strathclyde Police (2007). Unpublished data supplied to the Scottish Government. Taken From: Audit Scotland (2009 ) Drug and Alcohol Services in Scotland. Online Source: https://www.audit-scotland.gov.uk/media/article.php?id=103. Accessed (15/08/09). Swofford, C.D., Kasckow, J.W., Scheller-Gilkey, G., Inderbitzin, L.B. (1996) Substance use: a powerful predictor of relapse in schizophrenia. Schizophrenia Resource Centre. 20, pp. 145à ¢Ã¢â€š ¬Ã¢â‚¬Å"151. Taken From: Volkow, N.D. (2009). Substance Use Disorders in Schizophrenia à ¢Ã¢â€š ¬Ã¢â‚¬Å" Clinical Implications of Co morbidity. Schizophrenia Bulletin. Vol. 35. Swofford, C.,D., Kasckow, J.,W., Scheller-Gilkey, G., Inderbitzin, L.,B. (1996). Substance use: a powerful predictor of relapse in schizophrenia. Schizophr Res. 20, pp. 145à ¢Ã¢â€š ¬Ã¢â‚¬Å"151. Taken from: Lambert, M., Conus, P., Lubman, D., I., Wade, D., et al (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. ACTA psychiatrica scandinavica. 112, pp. 141-148. Torrens, M., Martin-Santos, R., Samet, S. (2006). I mportance of Clinical Diagnoses for Comorbidity Studies in Substance Use Disorders. Neurotoxicity Research. 10[3,4]. pp. 253-261. Wade, D., Harrigan, S., Whelan, G., Burgess, P., McGorry, P. (2004). The impact of substance use disorders on clinical outcome in first-episode psychosis. Schizophr Res. 67 (Suppl. 1):B172. Taken from: Lambert, M., Conus, P., Lubman, D., I., Wade, D., et al (2005). The impact of substance use disorders on clinical outcome in 643 patients with first-episode psychosis. ACTA psychiatrica scandinavica. 112, pp. 141-148. Williams, A.F. (1976). The Alcoholic personality. In B. Kissin H. Begleiter (Eds.), The biology of alcoholism, Volume 4. New York: Plenum Press. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press. Wilson, P.H. (1996). Relapse Prevention: Overview of research findings in the treatment of Problem Drinking, Smoking, Obesity and De pression. Clinical Psychology and Psychotherapy. 3[4], pp. 231-248. World Health Organization (1998) Composite International Diagnostic Interview (CIDI): Core, Version 2.1 (WHO, Geneva). Taken from: Torrens, M., Martin-Santos, R., Samet, S. (2006). Importance of Clinical Diagnoses for Comorbidity Studies in Substance Use Disorders. Neurotoxicity Research. 10[3,4]. pp. 253-261. Volkow, N.D. (2009). Substance Use Disorders in Schizophrenia à ¢Ã¢â€š ¬Ã¢â‚¬Å" Clinical Implications of Co morbidity. Schizophrenia Bulletin. Vol. 35. Volkow, N.D., Wang, G.J., Telang, F., et al (2007). Profound decreases in dopamine release in striatum in detoxified alcoholics: possible orbitofrontal involvement. Journal of Neurosciences. Vol. 27, 12700à ¢Ã¢â€š ¬Ã¢â‚¬Å"12706. Taken From: Volkow, N.D. (2009). Substance Use Disorders in Schizophrenia à ¢Ã¢â€š ¬Ã¢â‚¬Å" Clinical Implications of Co morbidity. Schizophrenia Bulletin. Vol. 35. Zinberg, N.E., Fraser, K.M. (1979). The role of the soc ial setting in the prevention and treatment of alcoholism. In J.H. Mendelson N.K. Mellow (Eds), The diagnoses and treatment of alcoholism. New York: McGraw-Hill. Taken from: Miller, W.R. (1980). The Addictive Behaviours. Treatment of Alcoholism, Drug Abuse, Smoking, and Obesity. GB: Wheaton Co. Ltds., Prergamon Press.

Destructive Leadership the Cause, Effect, and Aftermath

Destructive Leadership: The Cause, Effect, and Aftermath Snehal Kavi University of Maryland, University College Abstract This paper explores the behaviors of a destructive leader, and how this negativity affected the leader’s subordinates. Several peer-reviewed articles support the ideas that decision-making, influence tactics, power, and emotional intelligence create a successful leader. However, these traits were non-existent in a particular leaders case, which led to undesirable behaviors throughout the organization. The operational manager at a pain management company incessantly belittled and humiliated her subordinates, exerting power in the incorrect manner. This leader had little knowledge and expertise in her field, did not†¦show more content†¦Freed (2011) defines a leader as a strong, wise, emotional, and intelligent person who can help those who are weaker. Britni also provided direction and motivation to site managers to excel the efforts of their teams every week, month, or year. This however, made it easy for Britni to ridicule managers who were at the bottom of t he list. Pollach Kerbler (2011) define a leader as someone whose â€Å"strong charisma, reputation, and symbolic power can have a positive effect on corporate reputation, corporate performance, [and] organizational effectiveness† (p. 355). Through these definitions and various others, it is a common thread that a leader should be likeable, able to motivate and influence, and powerful. A leader should hold some power over the individuals being led, to allow the leader to gain a sense of authority. With this power, the individuals, being led, begin to respect, listen, and follow what their leader asks of them (Colquitt et al, 2013). Power also allows the leader to reward and punish individuals based on their performance (Colquitt et al, 2013). A major task of the operational manager at Kure is to determine what value of the quarterly bonus would be given to each individual site manager, based on performance. Freed (2011) states, â€Å"the motivational philosophy of carr ots (rewards) andShow MoreRelated Hurricane Katrina: A Man-made Disaster Essay1364 Words   |  6 PagesEDT on August 29, 2005 Hurricane Katrina made landfall, etching lasting memories of those living in and around the New Orleans, Louisiana. It was this day that Hurricane Katrina came ashore and caused what was to be thought as one of the â€Å"most destructive storm in terms of economic losses† (Hurricane Katrina —, 2007) of all times. Who was to be blamed for the failure in emergence management response and preparation, no one seemed to know or understand. Those left in the wake of this disasterRead MoreThe Effects Of Stress On The Body s Normal State1402 Words   |  6 PagesStress is the body’s reaction to internal or external stimuli that upset the body’s normal state. A stimulus that causes stress that can physical, mental, or emotional. The term stress is used to refer to both the body’s reaction and the stimuli that caused it. The bo dy’s reaction to highly stressful situations is known as the flight or fight response. Under stressful circumstances, quantities of adrenaline, a hormone produced by the adrenal glands that are released into the bloodstream. This stimulatesRead MoreA New Paradigm Of Terrorism1537 Words   |  7 Pagesthe pursuit of political change.’ (2001:3) However, in his own article he offers only a systematic clarification of terrorism in stating their aim to ‘undermine confidence in government and leadership’ (2002:313), which remains unchanged despite the context. Hoffman’s central argument focuses on the aftermath of 9/11 and therefore his definition holds the purpose of rethinking counterterrorism measures and merely as a byproduct in showing potential modern threats. To accurately analyse whether ‘NewRead MoreCan Weapons Of Mass Destruction Be Justified?1618 Words   |  7 Pagesjustified because it follows the rules of the Just war theory. WMD’s can’t be justified WMD’s cannot be justified as they cause mass destruction and kill the innocent. It will never be just to kill so many people and harm the environment. There are massive side effects when nuclear weapons are used, both economic and environmental; these problems can cause long term effects. WMD’s are also very expensive to make and maintain, it costs countries billions of pounds each year to maintain their weaponsRead MoreThe Disaster Planning Or Management1847 Words   |  8 PagesMorris, Fitzgerald, and Milanes, 2009, p306). By early September, people were forcibly evacuated and the storm displaced more than 1.5 million people (Lalwani, et al., 2007, p10). According to Lalwani, et al. (2007, p10), â€Å"Katrina was the most destructive and costliest natural disaster in the history of the United States,† with an estimated $75 billion worth of damage. Months after the hurricane, 3,200 people were unaccounted for and many of the low-lying areas, most of which were poor and minorityRead MoreThe Impact Of Organizational Activity On The Performance Of A Large Scale Organization Like The State And Its Patterns Of Response2183 Words   |  9 Pagespriori was ambiguous. Lastly, in accordance with the organizational model, major crisis in government’s behavior reflects the lack of coordination of its parts, which in turn causes interdependent outputs. The failure to launch the warnings effectively could be seen as a result of miscommunication and of lack of leadership in order to ensure that common repertoires were fulfilled under high pressure. OECD Model: the importance of having the flexibility and capacity of innovate under pressure AccordingRead MoreEssay On Revolutionary War1760 Words   |  8 PagesAmerican Colonists, should be the ones paying for the Army through the form of taxes. The American who had a history of â€Å"salutary neglect,† in which the Thirteen Colonies really never had to deal with the British government collecting taxes until the aftermath of the French and Indian War. This is what started a lot of talk of the colonies wanting independence, just paying for taxes to pay for the army that the Colonies wanted to protect themselves from further French and or Indian threats. Colonist consistentlyRead MoreTerrorism, State Terror And Terrorism Essay2005 Words   |  9 Pagesthese events are ambiguous and unreliable. The earliest accounts of genocide can be found in some of the world’s oldest literary works such as The Illiad and The Bible. However, a concise definition or understanding of genocide did occur until the aftermath of the Holocaust in 1945. After the Holocaust, the United Nations sought to codify genocide during The Convention of the Prevention and Punishment of the Crime of Genocide. The Convention defined genocide as â€Å"acts committed with the intent toRead MoreThe Battle Of Fort Fisher2012 Words   |  9 Pagesmasonry retaining its shape form the slopes given to the parapets, scarp, and counterscarp, with the aid of gabions and other temporary expedients. Our knowledge of it is imperfect, but enough is known to enable us to form as correct a judgment of the effects of the proposed explosion in the open air in front of it, as though we possessed as much detail as in the preceding case of Fort Caswell. The light-house situated in this fort or immediately adjacent thereto, was at the date of our last survey (1856)Read MoreEssay on National Missile Defense4089 Words   |  17 Pagesballistic missiles that are increasingly accurate and powerful. In fact, the Soviets has the ability to overwhelm the United States missiles on the ground should a conflict ever occur. Arms race is a vicious cycle in itself and will not contribute to the cause of world peace. Therefore, to render this advantage impotent and obsolete, President Reagan directs the nation’s talented and government agencies to begin exploring and researching programs that will achieve the ultimate goal of eliminating threats

Police Brutality A Law Enforcement Officer - 4738 Words

When you take oath to become a law enforcement officer you are supposed to stand by the area that you work within and serve and protect. While working officers are put in thousands of different scenarios. While growing up you are taught proper ethics and values and should know the difference between what is right, and what is wrong. However; many officers break down and realize that being a law enforcement officer doesn’t pay as much as they like. They fall fortune to being greedy, stealing money, and even getting into the drug trade while they are in uniform. In the end these men and women that put on the uniform are just as bad as the drug dealers who sling dope on the corner. Police brutality is another big issue within law enforcement. At times police overuse the necessary amount of force that is needed and end up injuring and even at times killing another individual. These officers are also just as guilty as the ones that they have been placing under arrest. Police departments were began approximately 350 years ago, and the first police department was established in the city of Boston. As soon as colonists had arrived there in 1630, confined regulations had allowed for constables to be prearranged. Soon after, in April 1631, the townspeople formed a watch made up of six watchmen, one constable, and several volunteers who patrolled at night, walking the rounds (Johnson, 2012). From 1630 until now a lot of things have changed within police departments.Show MoreRelatedThe Violence Of Police Officers Essay1431 Words   |  6 Pagesmotivated police brutality and societal discrimination. Though his efforts were not in vain, today’s media representation of law enforcement impacts the societal cultivation of police officers in a negative way. Media outlets, in the forms of television, radio, or social websites, create a cynical view of police officers, which influences societal beliefs and creates negative connotations. These days, police are often stereotyped as aggressive, corrupt beings. The growing hatred for police officers widensRead MorePolice Brutality Today s Media1626 Words   |  7 PagesPolice Brutality What do most people think of the topic of police brutality? More than once, images and stories of minorities civil rights being taken away become the topic of conversation. It is heart wrenching to see these videos and hear these stories of police brutality in today’s media. Every day there seems to be another headlining case on the topic of police brutality. Police brutality isn’t just law enforcement officers abusing the power granted to them; however, it is a much larger issueRead MorePolice Brutality Based On Racial Profiling1682 Words   |  7 Pagesviews law enforcement officers as heroic and honorable individuals, whose main purpose is to protect and serve the community. For many officers, this description is accurate, however for others; violence and brutality against innocent citizens is the key to getting the job done. For years, minorities have fallen victim to police brutality based on racial profiling, stereotypes and other unjustifiable reasons that has cost several innocent lives. The involvement of officers in police brutality againstRead MorePolice Brutality And The Law Enforcement846 Words   |  4 Pagesdemonstrating the brutality of law enforcement has been becoming more frequent over the past couple of years. When you hear about these cases of police brutality, how often is it that law enforcement officials are punished for the crime they have perpetrated? Most of the time the law enforcement officials, who are very well in the wrong do not get any kind of punishment whatsoever for the crimes that they have committed and it all comes back to the power that they have. Police brutality cases have beenRead MorePolice And Police Brutality1331 Words   |  6 Pagesrace. Police brutality is an everyday case and there has yet nothing to be done to help reduce nor stop the violence. Often people critic the duty and the responsibilities that a police officer has in this county. Their duty is far from just eating donuts and drinking coffee. The first thing someone does when they feel like their life or someone’s life is in danger, is call 911 expecting that the law enforcement appears on the scene in .0 seconds. Even then a certain percentage of the law enforcementRead MoreThe Effects Of Police Brutality On Minority Communities1152 Words   |  5 PagesThe Effects of Police Brutality on Minority Communities Police brutality thrives in the inner city regions where minority communities live and work. Police brutality is a crime punishable by law and is often instigated by law enforcement officers who are either racially biased or prone to authority abuse and violent (re)actions. Allegations abound concerning police brutality with police officers using unnecessary or excessive force, committing battery, conducting illegal body searches and bullyingRead MorePolice Brutality And The Civil Rights Movement1738 Words   |  7 PagesWhile combating police brutality everyday, what really does matter? Despite, the increased attention and actions to remedy police brutality, police brutality is still a prevalent issue in today’s American society. It has sent critics on both sides of the issue into their corners, as no one really seems to have the answer. Maybe, the reason why police brutality has been so troublesome to alter is because the people trying to alter it are only targeting only th e symptoms instead of the infection itselfRead MorePolice Brutality1569 Words   |  7 PagesPersuasive/Policy/Problem/Cause/Solution Central Idea/Thesis: Police brutality should be regulated with greater strength and objectivity. INTRODUCTION I. Police brutality is constantly made known to us all through mass media, but I hadn’t ever taken the time to truly grasp the severity of it until it hit close to home. A. Three weeks ago, a close family friend was brutally beaten in front of his children at a family gathering by the police. B. My purpose is to persuade my audience that police brutality should be regulated with greaterRead MorePolice Brutality And The Civil Rights Movement1522 Words   |  7 PagesPolice brutality is defined as â€Å"excessive and/or unnecessary force by police when dealing with civilians,† and this has become more prominent within the United States throughout the years (Danilina). There has many cases where police brutality has been seen via news channels, and it has dismantled the unity of trust between the civilians of the United States and the law enforcement who are supposed to protect the everyday people from harm. The issue is if the law enforcement is actually right withinRead MorePolice Brutality And The United States1630 Words   |  7 Pages Police Brutality is an ongoing problem and existent concern in the United States and should be resolved immediately. Law enforcement must function as an element that consists of organized and civilized officers. The presence of police brutality is becoming more of an issue as society grows. The problem posed by the illegal exercise of police power is an ongoing reality for individuals of a disfavored race, class, or sexual orientation. Police brutality must be stopped so that police do not forget

American Revolution free essay sample

Before the formation of the United States, the European colonies in the Americas had an insatiable demand for cheap, exploitable labor. Despite myths to the contrary, the land was not untamed nor virginal. Native Americans were seen as the ideal choice for wealthy Europeans seeking cheap labor, however many could not survive contact with diseases carried over the Atlantic by the colonialists. Local labor was out of the question. The next option was to bring over workers from England, Ireland, Germany, and other European countries, where a glut of low-skill workers had resulted in a growing impoverished class. For many early European immigrants, life in the American colonies was sold as a fresh start. Pamphlets were distributed to all classes of life selling the bountiful riches of the colonies in an effort to sustain functioning population levels. Wealthy merchants established businesses profiting from the regions rich natural resources, politicians used their favor with royalty to acquire huge swaths of untamed land, and mercenaries gained massive fortunes establishing white, European superiority in North America. In Document 5, the abolition of slavery was a dramatic change but slavery still occur after the Civil War. Every other states besides the 13th colonies still had slaves around.The south were force to give up slave and the federal government in Northwest ordinate did not want slaves. Document 6 Is a speech written In 1819, 30 years after the Revolution was made by a young African American who was valedictorian of his New York free school. The young man was wondering how he will use his knowledge and skills after graduating high school without being push away by the color of his skin. In his speech he said No one will employ me; white boys wont work with me and White clerks wont associate with me. He felt that his only option were normal labor services, which is not much different from slavery. Color was still an issue to the society. My fall reason why I think the American Revolution was not Revolutionary Is because of Poverty Among the People. In Document 4, the Economic status of the Representatives in six colonial state legislatures shows that in the North, the percentage for the wealthy before the Revolution was 36% and after the war, it dramatically drop to 12%. Then for the South, before the Revolution the percentage for the wealthy was 52% and dropped to 28%.Not as many wealthy people were In he legislature after the war. This shows that many wealthy people became poor for economic reasons and the aftermath of the American Revolution. It caused destruction damage. At the end of it, the poor felt more equal to the rich. I believe that the American Revolution was not a Revolutionary because changes didnt occur till a decade later after the war. Things were being influence but it wasnt a Jump to another.

Rtyuiop free essay sample

There are three problems from the textbook for this assignment. I suggest that you work on the problems on your own before you meet with your team. When you do meet with your team, you can discuss your answers and choose the best one or a combination of the best ones for your submission. Please attach each team member’s work to your submission. Your team submission can be hand-written or computer generated or a combination of the two but it must be legible. Don’t worry about making your submission pretty – there are no marks for pretty. Make your team submission legible. Here are my estimates of how long it should take you to complete this assignment Then based on the results of your calculations, write a memo evaluating the relative performance of the three operating divisions. Assume the role of a Swan financial analyst and address the memo to the CEO of the company. We will write a custom essay sample on Rtyuiop or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Your memo should tell the CEO which division performed the best and which performed the worst. 2. Problem 6-21, page 285, Spa Ariana (35 marks) Required If you find any inaccuracies, uncertainties or contradictions, simply state your assumptions and proceed with the requirements.

A video game characters résumé stacked with relevant usable keywords

A video game characters rà ©sumà © stacked with relevant usable keywords The beginningsHave you ever played the game Getting Over It? It’s a terrible, terrible game created by Bennett Foddy where you play as a man sitting in a cauldron, and the entire purpose is to climb up a very large hill with a hammer. Sounds simple in theory, but in the words of the creator, this game is made to hurt people. And it does that well.We used to play this game on our breaks. I say used to, because after falling off the cliff so many times and having to start over, Michael (the owner of the company) uninstalled it from Steam in a fit of climbing rage (or moment of clarity, depending on how you want to see it). And all was well in the land of Full Stack Talent.A few days after The Great Uninstallationâ„ ¢, we were all working quietly at our desks and Michael turned to us and said â€Å"Wouldn’t it be funny if we made a rà ©sumà © for a climber, but like, we put a bunch of developer keywords in there and see if any recruiters reach out to us?†And th us, Django Ovrette was born.We created a doc file on our shared Google drive and off we went writing a rà ©sumà © for a professional climber, stacking it with as many dev keywords as we could. My personal favorite is â€Å"pretty huge python, or php, as I like to call him.† We spent a couple of hours perfecting the rà ©sume (stopping to cry-laugh a few times), creating a google voice number and a new email address, and when we were done, off Django went to the internet! We then searched for a few of the keywords (like php, yii, django, etc) and there he was in all his glory.Django, in all his glory. Can you catch all the references? Hint: there are a LOT.  hbspt.cta.load(2785852, '9e52c197-5b5b-45e6-af34-d56403f973c5', {});We went back to work, and waited for the calls and emails to roll in – and it didn’t take long. We posted the rà ©sumà © on January 26th (a Friday, for reference) in the afternoon and had emails when we came in on Monday morning.Being t hat I’m a huge data nerd, I took the liberty of compiling some information on the recruiters who reached out to Django.As of January 26th (keep in mind, this is less than a month), Django has received:110 emails50% (roughly) were form letters – these came mostly from big recruiting agencies50% (roughly) were personalized for Django15 phone calls8 voicemailsOf these communiquà ©s, 2 voicemails stood out. One was a recruiter from a small, local firm stating that she wasn’t sure what Django’s role at Dick’s was, but she wanted to speak to him about his experience, because â€Å"clearly you have some dev knowledge, but I can’t tell if this is a joke or not.† She ended up calling Django twice and emailing once.The second voicemail came from a senior recruiter at a mid-sized recruiting company, and it started with her laughing and saying this was the best thing she had seen in 17 years as a recruiter. She continued by saying she printed it out and passed it around the office, and asked for a call back because she wanted to know who was â€Å"really behind this.† We saved that voicemail.Our takeawayWhat we learned from Django’s foray into job searching is that, unfortunately, most big recruiting firms frankly don’t seem to actually spend any time on you. Form letters, keyword searching rather than actually reading your rà ©sumà ©, emails only with no call follow up, etc. Django saw much better communication with the folks who came from small recruiting agencies – they reached out with personalized emails and followed up with calls. Being that we are a small recruiting agency ourselves, we really appreciated seeing the parallels, and it reinforced that we’re doing it right by going for quality over quantity.Words of adviceBig guys, don’t forget your candidates are people. Spend the time to actually read their rà ©sumà ©s and see if the qualifications actually match instead of running their CV through a keyword search. We know your time is limited (trust us, we do) but so is the candidate’s – and they deserve to have someone who is dedicated to finding them the best career match possible.Small guys, keep it up. Your personal touch and solid, constant communication and follow-ups are immensely appreciated, and probably make the difference on whether a candidate/client will want to work with you or not.- About the authorThis article was written by Roxanne Williams, who works at Full Stack Talent, a technology recruiting agency in Tampa, FL.

12 Steps Programs - Help or Hinder Essay Example | Topics and Well Written Essays - 500 words

12 Steps Programs - Help or Hinder - Essay Example The aroma of good, strong coffee vied with the scent of some expensive perfumes, but the tobacco won. I was surprised at the mix of people, there a man in denim, here an impeccably suited businessman of middle age. Three older women had placed themselves in neighboring chairs, their body language signaling support and sisterhood. Designer chic and thrift shop dowdy, all seemed to have abandoned one addiction and were now desperately pursuing another, nicotine. Except for one small, dumpy woman, nervously polishing, replacing, then polishing again, her tinted eyeglasses, and a skinny guy with big ears, which he kept pulling at.What followed was awful to observe. The little woman stood up, shook and stuttered and exposed her heart, life and soul in painful, gut-wrenching honesty to these complete strangers. She had just taken Step 1. Everybody applauded, several approached her and hugged her. She was crying and smiling at the same time, but no longer shook or twitched with nerves, she seemed more peaceful, as if relieved of a big burden. It was clear she felt better, cherished and a part of things. Poor John could only mutter his name, hanging his head as he labeled himself an alcoholic, then collapsing in tears into his chair.individual perceptions of Him, would make it all better.

Counterfeit Merchandise Essay Example | Topics and Well Written Essays - 1500 words

Counterfeit Merchandise - Essay Example The global market for counterfeit goods has been increasing rapidly. Counterfeited goods accounted for 3-4% of the global trade in the past while according to recent estimates of the International Chamber of Commerce it has increased to 7% and is worth around US$350million (Vagg & Harris, 2000, p.108). The problem is extensive in proportions with the US and EU confiscating around US$94million worth goods and 85million counterfeit products respectively in the years 2002-2003(Hilton, Choi & Chen, 2004, p.345). Counterfeiting is prevalent in many sectors such as software, video, music, toys, aircraft spare parts, medicines, perfumes and fashion merchandise such as handbags, watches, textiles (Vithlani, 1998, p.8). Counterfeiting in the software, music and motion picture industry has been on the increase over the years due to technological innovations, reduced costs of counterfeiting and the ease with which the products can be counterfeited (Vithlani, 1997, p.10). Counterfeit spare parts in the aviation industry and fake medicines have serious and far reaching consequences on the health and safety of the people (Vithlani, 1998, p.15). The fashion industry has been plagued by the problem of counterfeit products for many years now. Replicating designs and trademark infringements have become a routine occurrence in the industry causing substantial losses in profits and loss of reputation for the original manufacturers. Fashion counterfeiting is especially rampant in UK and Italy. Counterfeits in perfumes are also common and perfume manufacturers spend around 1-2% of their annual revenues to combat counterfeiting. Many reasons can be cited for the prevalence of counterfeits in the fashion industry. One of the main reasons is that in many countries the trademarks are protected against counterfeiting however, the designs are not protected and don’t come

Influencing Practice For Service Improvement In Primary Care Nursing Essay

Influencing Practice For Service Improvement In Primary Care Nursing Essay Innovation and change are currently seen as an integral part of the NHS, and nurses have an increasing responsibility in the delivery of healthcare (DOH 2004). With the introduction of clinical governance many NHS Trusts are examining the standard of care being given and are implementing new initiatives to bring the care up to standard. This essay will aim to discuss and explore the implementation of an initiative to change practice in a clinical area of a primary care setting within an NHS trust. The proposed change is that of an orientation pack for new staff. This change can be linked to one aspect of clinical governance, staff and staff management, as it was felt that this was an area that needed developing. It will explore the reasoning for the change and the leadership style that was utilised for to implement a change. It will analyse the change theory developed by Kurt Lewin (1951) and how it will influence the implementation. Key strategies for effective clinical governance involves effective teamwork, leadership, ownership, openness and, most importantly, communication. The additional recurring theme is that the public and patients need to be involved in all aspects of the planning, organisation and environment of care. Since 1999, it has been at the top of the agenda for the NHS (Sale 2005). Scally and Donaldson (1998) define clinical governance as: A system through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish (p61). There are many key elements in clinical governance these have divided into seven pillars. The pillar that will be focussed on in this particular instance will be pillar 4: Staff and staff managing, it has many crucial elements essential to the structure of a trust, specifically workforce planning. Without planning there will be a lack of staff skills, knowledge and empowerment which could threaten the provision of quality clinical care (Sale 2005). An orientation pack is vital in any organisation setting. It can be overwhelming when starting a new role, and people can experience many emotions therefore there needs to be a structure in place to aid with this transition. Ward (2009) explains an orientation pack may impact retention within the nursing profession as well as increasing self confidence it will also impact staff with greater productivity and sense of direction in the work group. This is due to new employees getting to know the alignment between their role and the organisation expectations of them (Brown 2000). The primary care trust was having difficulty in retaining their staff, and had been experiencing a high turnover; there had also been some difficulties in filling the vacancies. Recruitment is ongoing, and costly the official cost is 32% of nurses annual salary, but including the building up of new staff and productivity deficit in the process it can be four times this (Foster cited by Agnew 2004). He goes on to explain in the first year if the new employee has a sense of belonging by being effectively bonded to the setting then this significantly reduces turnover. Despite these obvious advantages, it was found that there was only a general induction to the trust which every employee has within the first three months of their new employment; however no formal structure had been developed in the specific clinical area. By not having a formal orientation to the clinical area made it makes it difficult to establish the roles of the already existing team. The team is split into clusters; these clusters cover different general practices around the area, however trying to establish which cluster covered which practice was confusing. There was also found to be a lack of clarity when it came to the caseload, it was difficult to identify client groups and information was limited, this in turn was also putting possible risk to patient care. Furthermore there was no opportunity for new staff to ident ity their objectives and how to develop themselves within their role. When an initiative is being introduced to staff, they need to be aware of the reasons for the implementation. To enable successful integration into a new work place there needs to be a structured form of induction to alleviate barriers in communication and to enable a smooth transition. The proposed idea of a staff orientation pack (appendix 1) was the result of planned change. Planned change is a deliberate application of knowledge and skills by a leader, to bring about a change requires the leader to have the skills of problem solving, decision making and interpersonal and communication skills (Marquis and Huston 2006). Warrilow (2009) and Oliver (2006) both recognise that transformational leadership is focussed on, and embraces change, as it involves both the leaders and followers engaging on a common aim. They also recognise the leader to be a key element of successful strategies for managing change. Transformational leadership would be the most appropriate style to utilise when introducing the orientation pack as the underlying goal of transformational leadership is to bring about some type of change (Grimm, 2010, p76). The leaders who use this style are also regarded as change agents. A change agent should be a person skilled in the theory and implementation of planned change to be able to deal appropriately with the very real human emotions, including resistance that planned change can bring about (Marquis and Huston 2006). They can achieve this by using qualities such as charisma to motivate their followers to be able to achieve their goals, share visions and empower them (Grimm 2010). Change can be an intricate process which can have barriers which can threaten a successful implementation (McCrery and Pearce 2002). Sullivan and Decker recognise that Nurse Leaders must initiate the changes they believe are necessary to strengthen nursing practice, provide quality care, and create a better system (2005, p.217). In an organisation, to implement change they would need to follow a change theory.   There are many theorists who have developed processes of change, but Lewins theory is perhaps the one that is most recognised, user friendly and uncomplicated. The aid of a change model can be beneficial in overcoming certain obstacles. His theory of change provides the structure for understanding nurses behaviour during times of change and ways to improve the behaviour when introducing change into the workplace (Bozak 2003 p83). The model encompasses a three strep process this can be found in appendix 2. Lewins normative model of change is based on team participation, including all staff that will be affected by this change. This then increases their approval and implementation of change through a bottom-up method (Murphy 2006), furthermore identifying that achieving durable and efficient change entails the collaboration and involvement of the whole team not isolated individuals. Nevertheless, before any change is considered a plan is required that identifies the need. Baulcomb (2003) suggests guidance from Lewins (1951) force field analysis (FFA) demonstrates the complexities of the change process and how driving and resisting forces were incorporated within the planning and implementation phases'(p275). It is pertinent that the driving and restraining forces must be analyzed before implementing a planned change. Cork (2005) further explains that when implementing any change there are a number of factors that help to achieve change, this would be the driving concept for example the aim to improve orientation to the work place. Conversely, a restraining factor could be unwillingness to change or poor staff morale. Change can then only occur when one force outweighs the other, ideally for positive change the drivers must outweigh the restraining forces. The FFA for the proposed change can be found in appendix 3. The focus of the unfreeze stage is to change the status quo of the existing practice. The change agent needs to prepare the staff by identifying and challenging the need for change. The identification is necessary because changing for the sake of changes sake can cause unnecessary stress and the feel of manipulation (Marquis and Huston 2006). Involvement of colleagues from the very beginning empowers staff and makes them feel more valued. Sale (2005) identifies that staff are empowered when an environment has been created which encourages them to be actively involved in the decision making processes. However it is inevitable that there will be resistance when trying to implement a change especially when involving humans. Emotions can run high and change can be held as threatening. Conflict can also arise as it is making something different to what was (Sullivan and Decker 2005). To be able to start to overcome resistance the change agent needs to start to utilise their qualities as a leader and focus on valuing creativity and innovation form their staff (Marquis and Huston 2006). Informal discussions took place with different members of staff at various levels to explain problem had been identified and that there was a need for change. This allowed for the change agent to find common ground and start having a sense of connection with the staff (Tyrrell 1994). Staff appeared quite unsatisfied with the current status quo, however it was found that time was a resisting factor due to busy workloads. An issue that the change agent could bring to the attention of the staff is that the in the current climate workloads would not improve if there is low retention in staff, which in turn can be caused by not feeling integrated into the team properly. Part of this stage may involve making people feel uncomfortable. Another factor that would need to be considered would be a possible cost implication and who would carry it, management may feel reluctant to participate in fu nding. In the clinical setting the change agent could start to communicate their desired change via email which all staff have access to. This can give the staff the opportunity to convey their opinions on the change, which can then be reinforced with a formal team meeting which will allow the change agent to convey their purpose for change and give the staff a sense of direction, and also allowed for them to be open and honest within the team (Grimm 2010). It can also give the change agent an idea of how change may be perceived by the whole team, and possible resistance. Once the need for change has been perceived by others and the status quo has been disrupted then the change agent can go on to the next stage in the change model (Marquis and Huston 2006). Marquis and Huston (2006) states that In movement, the change agent identifies, plan and implements appropriate strategies, ensuring that driving forces exceed restraining forces (p173). It also allows for problems to be undertaken and for goals and objectives to be set, and opportunity to scope out for alternative solutions. This stage can take time as there are many factors to take into account. In appendix 2 the FFA for the proposed change identifies that restraining forces appear to have an undercurrent of human behaviour. This can be extremely difficult to overcome especially when nurses have always done something in a particular way and are reluctant to make change. As previously mentioned communication is the key to successful change and the change agent needs to keep an open line of communication when implementing the plan. A transformational leader uses effective communication to increase the motivation, morale and performance of their staff members as opposed to the usual c ommand and control staff supervision style (Lorraine 2010). Trust is also a key issue; it arises from a mutual understanding that the change would not be detrimental to the staff (Hein 1995). Hence the change agent will require the ability to communicate effectively and encourage motivation amongst the staff. According to Clark (2009) a leader needs to develop a high degree of emotional intelligence. This allows for an understanding of the emotions of their staff and manages them in a positive way to achieve the best possible outcome. Hein (2007) then continues and says it enforces the problem solving and decision making skills of the change agent allowing for staff to become more relaxed, less stressed and more open for change. If there is a continuation of motivational struggles and unwillingness to change motivational interviewing would be a preference to over overcome this. This looks at encouraging and supporting people in adopting new behaviours. The change agent would support the staff member whom is struggling with ambivalence about change. Encouragement is used so that there is recognition of the alternatives to the status quo (Bundy 2004). However, Bundy (2004) does go on to say this can be seen as quite challenging and can have elements of being confrontational. This process needs to be executed wisely. For a successful implementation education would also be a key factor. The change agent would need to educate staff on the new pack and clarify the expectations of the staff for the pack to continually be used and developed. Spencer (2001) suggests that this will give staff the confidence that they are doing the right thing and that practice is successful and sustainable. Once the plan has been established and implemented into practice, leaders need to ensure that there is maintained equilibrium. By including staff in the change, the change agent has invited them to become more attached to organisation, which leads to greater commitment, willingness and motivation (Hein 1995). Additionally it is imperative that continual support and guidance is given so that acknowledgments that all staff has embrace and understood it. Nevertheless no change should ever be frozen solid there needs to be scope for re-thawing to allow for continual changes to improve practice, however initially stabilization needs to occur for staff to reap the benefits. Refreezing actions include defining standards, documentation, training, processes and so on. The change agent would need to continue to monitor over a period of time as it can take three to six months for a change to be to be accepted (Marquis and Huston 2006). There will also be the need to make sure that people are no t pulled back to the previous stage. Ways of doing this is removing any method by which people can return, so there is nothing to return to (Straker 2010). The change agent can try to do this is by making it part of everyday practice. Once a norm is developed and there have been significant signs that it has had a positive impact such as greater staff retention then people are more inclined to use it. If the change was found to be successful then a possible scope for development would be to start to look on a wider scale and try to implement the pack into other clinical practices within the PCT. Again there will be barriers to overcome, although from the experience that the change agent had encountered in the clinical area, these barriers could seem less daunting. There would have also been greater development in their leadership skills allowing for the growth of confidence in implementing change. Change is an essential dynamic in positive growth and development; although some may be resistant to it others may embrace it and feel empowered. A recurrent theme that has appeared through the here may change process is that of communication. Excellent communication skills allow those affected by change to have their say, thus allowing barriers and resistance to be overcome. Although it may not be possible to fully eliminate barriers there may be ways to move the barriers to make them a positive. Saver (2009) also states that constant communication helps new and current staff feel valued (p19). In conclusion nurses in the present working climate have to accept necessary changes with an open mind and motivation arms. Not only should they accept changes as they take place, but should also be constantly reviewing working practices and being proactive in implementing changes as and when necessary. Change is not always welcomed, however it will allow for eradication of stagnation within the working environment (Ootim, 1997). References Agnew, T (2004) Support for staff reduces cost of recruitment. Nursing Standard. May 2004 18(35) p7 [online]: Available from Ovid URL [Accessed 11th November 2010]. Baulcomb, J (2003) Management of change through force field analysis. Journal of nursing management. Jul 2003 11(4) 275-80 [online]: Available from: EBSCO URL [Accessed 10th November 2010]. Bozak, M (2003) Using Lewins Force Field Analysis in Implementing a Nursing Information System. CIN: Computers, Informatics, Nursing. 21(2):80-85, Mar-Apr 2003. [online] Available from: Ovid URL [Accessed 30 October 2010] Brown, J. (2000) Employee Orientation: Keeping New Employees on Board. [online] Available from: http://humanresources.about.com/lr/new_employee_orientation/189518/1/. [Accessed on 30th October 2010] Bundy, C. (2004) Changing behaviour: using motivational interviewing techniques. Journal of The Royal Society of Medicine. 97 (44):43-47, 2004. [online] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1308798/pdf/15239293.pdf [Accessed 30 October 2010] Clark Chambers, C (2009) Creative nursing leadership and management. London: Jones and Barttlett Publishers International. Cork, A. (2005) A model for successful change management Nursing Standard Mar 2-8 19(25):40-42 [online]: Available from EBSCO URL [Accessed on 30th October 2010]. Department of Health (2004) Standards For a Better Health. London: DOH Grimm, J. (2010) Effective Leadership: Making the Difference. Journal of Emergency Nursing. January 2010 36(1):74-77, [online]. Available from: Ovid URL [Accessed 29 October 2010] Hein, E. (1995) Contemporary leadership behaviour. 5th ed Philadelphia: Lippincott Company. Hein, S. (2007) Emotional Intelligence. [online] Available from: www.http://eqi.org. [Accessed 14th November 2010] Lorraine, C (2010). Nurse Leaders Effective Communication. [online] Available from: Nurse Leaders Effective Communication | eHow.co.uk http://www.ehow.co.uk/about_6677338_nurse-leaders-effective-communication.html#ixzz15Cdizzvg. [Accessed on 14th November 2010] Marquis, B and Huston, C (2006) Leadership roles and management functions in nursing: theory and application. 5th ed. Philadelphia, Lippincott Williams Wilkins. Mullins, J (2007) Management and organisational behaviour. UK: Pearson Education Murphy F (2006) Using change in practice: a case study approach. Nursing Management. May 2006 13(2): 22-25. [online]. Available from: Ovid URL [Accessed on 30th October 2010] Oliver, S (2006) Leadership in health care. Musculoskeletal Care. 2006 4(1): 38-47 [online] Available from: www.interscience.wiley.com. [Accessed on 30th October 2010] Ootim, B (1997) Effective change. Nursing Management. May  1997 4(2):10. [online] Available from: Ovid URL [Accessed on 30th October 2010] Sale, D. (2005) Understanding Clinical Governance and Quality Assurance: making it happen. Basingstoke: Palgrave: Macmillan. Saver, C (2009) Closing the revolving door for OR staff. OR Manager. Mar 2009 25(3):18-19 [online] Available from: EBSCO URL [Accessed on 30th October 2010] Scally G and Donaldson LJ. (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317(7150) 4 July pp.61-65 [online]. Available from: Ovid [Accessed 29 October 2010]. Spencer, S, (2001). Education for change, in: Spencer, S, Unsworth, J and Burke, W. (eds) Developing community nursing practice. Buckingham: Open University Press, pp.116-113. Straker, D. (2010). Lewin Push and Pull. [online] Available from http://www.syque.com/quality_tools/tools/Tools54.htm [Accessed 14th November 2010] Sullivan, E Decker, P (2005) Effective leadership management in nursing. 6th ed. New Jersey: Pearson Prentice Hall. Tyrrell, R (1994) Visioning: an important management tool. Nursing economics. Mar-Apr 1994 12(2): 93-94. [online]. Available from: EBSCO URL [Accessed on 10th November 2010] Unsworth, J (2001). Managing the development of practice, in: Spencer, S, Unsworth, J and Burke, W. (eds) Developing community nursing practice. Buckingham: Open University Press, pp. 69-92. Ward, CW (2009) Enhancing orientation and retention: one units success story. Journal of continuing education in nursing. Feb 2009 40(2):87-90 [online]. Available from: EBSCO URL [Accessed on 30th October 2010] Warrilow, S. (2009) Transformational Leadership Theory The 4 Key Components in Leading Change Managing Change. [online] Available from: http://ezinearticles.com/?Transformational-Leadership-TheoryThe-4-Key-Components-in-Leading-Change-and-Managing-Changeid=2755277. [Accessed on 5th November 2010]. Appendix 1 Proposed Induction pack guidelines Appendix 2 Kurt Lewins Change theory Unfreezing reducing those forces which maintain behaviour in its present form, recognition of the need for change and improvement to occur Movement development of new attitudes or behaviour and the implementation of change Refreeze stabilising change at the new level and reinforcement through supporting mechanisms, for example policies, structures or norms Mullins (2007 p736)