Virtual communities Article Example | Topics and Well Written Essays - 500 words

Virtual communities - Article Example t block or the other side of planet of any individual who is a part of a computer-mediated social group, as well as the potential benefits for personal or societal wellbeing of belonging to such communities. From virtual discussion blogs, networking communities and play-station networks to virtual shops, jobs, and even virtual classrooms, this widespread medium is phenomenal for bringing about such a greater sense of community. This concept/term has become so pervasive in its use that there is a propensity to blend all social activity into a sole concept and disregard the diversity of virtual frameworks (Renninger 2002, p.293). The World Wide Web has made it simpler for individuals to form virtual communities. Geographically dispersed, these communities are used for multiple social and professional groups to hold discussions, share activities, and build strong ties among members; they have become central to motivating people to get wired. There are many examples of virtual communities that serve different purposes and target different segments. For instance, for independent contractors and consultants, About.com is a key example of a virtual community that can be utilized to assist a distributed workforce. This community provides discussion platforms, online training, and other resource areas for assistance. Moreover, another example of a virtual community is BlackPlanet.com, which specifically caters to the African American society. It allows the Black minority to interact, by offering email, free personal pages, chat rooms, forums, news, instant messaging, and Internet telephony, as well as online events and special promotions. Furthermore, this community features online channels which cover a variety of topics, like career, health, money, politics, news, music, beauty, love, sex, and spirituality etc.; it also has a ‘Black Expressions’ book club (McKay 2000, p.157). Virtual communities go far and beyond to cover all segments, for example, for gaming and

Mark Twain Case Essay Example for Free

Mark Twain Case Essay Mark Twain was an extremely productive author in his lifetime.   He wrote many famous books, articles and stories.   He was also a world traveler.   He visited five continents and crossed the Atlantic Ocean 29 times.   In general, he is notarized for his fiction works.   However, he also composed many successful non-fiction manuscripts as well. Many of Twain’s non-fiction works were written on his travels.   In his travels to the Old City, Twain took photographs to correspond with his written work.   He described the Old City, highlighting the methods and manners in which the Jewish people of the city worshipped and interacted with one another.    While doing this, he provided names to many of the places that he visited.   Many of these names have stuck, and have become the common names of landmarks (Journey to the Holy City, 2).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Most readers are already familiar with the broad brushstrokes of Mark Twain’s life.   Many interviews, however, were conducted in order to present a totally new facet of the Twain story, unfictionalized and in fascinating detail. These interviews appeared in a great diversity of American and international newspapers during the long course of his creative adult life (Nash).   The interviews provide information to the volumes and volumes of Twain’s imaginative and satirical capabilities.   Most famous of the non-fiction works written by Twain is his adult biography.   The biography tells the compelling story, from his own perspective, of life and the inspirations behind his works. Countless books have been written about Twain’s life.   One book, written by Ron Powers, has been hailed by critics as serving as a â€Å"biography but much more†¦Powers uses Twain’s life to tell us what America was like then and, tangentially, why were what we are today† (Spiegel, 2).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Twain’s world travels began in 1867, when a California newspaper sent him on a five-month trip to Europe and the Middle East.   There, he wrote many letters that were later put together to form the book The Innocents Abroad (Twain’s Travels, 1).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Mark Twain is considered to be one of the world’s greatest humorists.   His witty phrases and observations filled the pages of his non fiction works (WordPlay, 1).   Twain was also one of the first persons in his town in Hartford, Connecticut to have a telephone.   An example of his humorous use of satire to describe a situation occurred in 1880.  Ã‚   Twain was amused by his new device, as it enabled persons who enjoyed eavesdropping to hear only one side of a conversation.   As a result, he wrote an amusing description of listening to his wife talk on the telephone (Twain, 1).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Twain composed many of his non-fiction works under his pen name.   His legal name was Samuel Clemens.   While often engaged in travel, Twain spent over 17 years at his beloved Hartford home.   While living there, he published six books.   These include: The Adventures of Tom Sawyer, A Tramp Abroad, The Prince and the Pauper, Life on the Mississippi, Adventures of Huckleberry Finn, and A Connecticut Yankee in King Arthurs Court (Allen).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Literature critics have paid significant attention to Twain’s twang in his nonfiction writings, stating that â€Å"he pours forth a flood of most graphic word painting. He talks slowly and extracts each of his vowels with a corkscrew twist that would make even the announcement of a funeral sound like a joke† (Mark’s Twang, 1). Critics have also spent significant amounts of time dissecting Twain’s life as well as books written about his life.   In an article by Middlekauff, the author describes Twain as an inspiration to biographers, historians and literary critics alike.   Middlekauff elaborates on this by concluding, â€Å"Mark Twain, in all of his fascination, will never exhaust the interest of his readers† (1).   It seems as though Middlekauff hit it right on. In the past decade, in particular, Twain’s name has been used publicly to highlight achievement.   Schools have been named after him.   Additionally, many literary awards have been named after the famous author.   For example, in 2006, playwright Neil Simon was presented with the Ninth Annual Mark Twain Prize for American Humor (Awards and Prizes, 1). Works Cited Allen, Daniel.   Mark Twain.   Yankee.   November 2006.   Vol 70(9).   1 pg. Awards and Prizes.   American Theatre.   September 2006.   Vol 23(7).   1 pg. Journey to the Holy City in the Footsteps of Mark Twain.   PSA Journal.   October 2006. Volume 72(10).   2 pg. Mark’s Twang.   Harper’s Magazine.   September 2006.   Vol 313(1876).   1 pg. Middlekauff, Robert.   Mark Twain: A Life.   Journal of American History.   September Vol 93(2). 1 pg. Nash, Charles.   Mark Twain: The Complete Interviews.   Library Journal.   October 1, Vol. 131(16). 2 pg. Spiegel, Pamela.   Leaders as Readers.   American Libraries.   May 2006.   Vol 37(5), 4 pg. Twain, Mark.   A Telephonic Conversation.   Atlantic.   September 2006.   Vol 298(2).   1 pg. Twain’s Travels: Letters from home; from France, Morocco, Egypt and Russia.   Read. November 3, 2006.   Vol 56(6).   2 pg. Wordplay.   Read.   November 3, 2006.   Vol 56(6).   1 pg.

The Sarbanes Oxley Act Dealt With Four Major Issues Accounting Essay

The Sarbanes Oxley Act Dealt With Four Major Issues Accounting Essay What responsibilities did David Duncan owe to Arthur Andersen? To Enrons management? To Enrons stockholders? To the accounting profession? David Duncan owed Arthur Anderson the responsibility to do what a reasonable employee would do in any situation to include a duty to work with reasonable care and skill. Not to disrupt business, not to compete in business against Arthur Anderson while still working for them as an employee or conduct acts of corporate espionage, nor to disclose Arthur Anderson?s confidential information. Duncan had the duty and responsibility to be honest, and carry out and follow the orders of Arthur Anderson, so long as they were legal, and if not to disclose the wrongdoing, even if this will incriminate him. As a professional accountant, David Duncan had an obligation to record, provide, and attest to information regarding the economic affairs of Enron. Because investors and creditors place great reliance on financial statements in making their investment and credit decisions, it is imperative that the financial reporting process be truthful and dependable. Thus, the responsibility Duncan owed to Enron?s management and Enron?s Stockholders was to exercise the general duty of performance, skill and care of the ordinarily prudent accountant in the same circumstances and observe a standard of ethical or social responsibility. This duty is not only morally right, but it is required by law, and arises from the law of negligence, contract, and fiduciaries; required by those in professional services, such as accountants. David Duncan owed a responsibility to the accounting profession to uphold and adhere to the ethical code of the profession. These codes of ethics are established throughout the professional associations of accountants such as The American Institute of Certified Public Accountants, The Institute of Management Accountants and the Institute of Internal Auditors. These codes provide guidelines for responsible behavior by accounting professionals, and emphasize integrity, objectivity, confidentiality, and competency. Duncan failed in his responsibilities to Arthur Anderson, Enron?s management and stockholders, and the accounting profession. He did not maintain his integrity, objectivity, confidentiality, and competency. He did not properly follow Generally Accepted Accounting Principles and disclose Enron?s true financial status, resulting in an adverse impact to Arthur Anderson employees and Enron?s stockholders and employees. When he suspected Enron of unethical behavior, he failed to inform management at Enron or Arthur Anderson, his silence was a passive permissiveness to their behavior. The American Institute of Certified Public Accountants code of ethics suggests that the best interest of the client is served when accountants fulfill their responsibility to the public, once again Duncan failed. What are the ethical responsibilities of a corporate attorney, such as Nancy Temple, who works for an aggressive client wishing to push the envelope of legality? The professional duties of an attorney, who represents or advises auditors, as was the case with Nancy Temple and Arthur Anderson, must incorporate an awareness of the auditors professional responsibilities. Nancy Temple ultimately owes her duty to Arthur Andersen as in-house counsel and was ethically bound to pursue the interests of her client and in doing so serves the public interest best by representing Arthur Andersen?s interests. As an attorney admitted to the Illinois bar, Nancy Temple was subject to the Illinois Rules of Professional Conduct. These rules impose professional obligations of competence, diligence, communication, and confidentiality. Under both the Illinois Rules and the Model Rules, if a lawyer representing an organization knows that an officer, employee, or other person associated with the organization is violating the law in a manner that is likely to result in substantial injury to the organization, the lawyer shall respond by taking reasonably necessary measures that are in the best interest of the organization. Such measures may ultimately result in the lawyers resignation, but shall be designed to minimize the risk of revealing confidential information. Nancy Temple, although not be required to disclose Arthur Andersen?s confidential information, she could have elected to discontinue representation of Arthur Anderson?s due to their involvement in fraud and illegal acts. Under what conditions should an employee such as Sherron Watkins blow the whistle to outside authorities? To whom did she owe loyalty? Although touted as the Enron whistle-blower Sherron Watkins never really blew a whistle. Whistle-blowing is the release of information by a member or past member of an organization who has evidence of illegal or immoral conduct in the organization, or conduct in the organization that is not in the public interest. Whistle-blowing reveals information that would not be ordinarily revealed in everyday context. In almost every case whistle-blowing involves an actual or at least a declared intention to prevent something bad that would otherwise occur (Beauchamp, Bowie, Arnold, 2008; Boatright, 2000). Sharron Watkins, as a whistle-blower should have written the letter to the Houston Chronicle; Watkins wrote it to Ken Lay, stating Were such a crooked company and warned him of potential whistle-blowers lurking among them, and recommended actions to downplay, or minimize the damage (Time Magazine; Beauchamp, Bowie, Arnold, 2008). In the determination and under which conditions an employee should blow the whistle to outside authorities there are two theories, DE Georges? Standard theory and Davis?s Complicity theory. According to DE Georges? Standard Theory, whistle-blowing is permissible when the company will do serious harm, the whistle-blower has reported the threat to her superior but concludes it will not be fixed, and the whistle-blower has exhausted other internal reporting procedures. Furthermore, whistle-blowing is required when there is convincing evidence to an impartial observer, and a good reason to think revealing the threat will prevent the harm at reasonable cost (Beauchamp, Bowie, Arnold, 2008). According to Davis?s Complicity Theory, whistle-blowing is morally required when the information derives from the individuals work at the organization and not obtained through illegal means, such as spying. That the individual is a voluntary member of the organization and are not being held against their will or coerced. The individual believes there is serious moral wrong-doing, not a harm. The individual believes their work will contribute or in some way be supportive to the moral wrong if they do not go public (Beauchamp, Bowie, Arnold, 2008). Sharon Watkins, Vice President and a certified public accountant, knew the information was damaging, both harmful and morally wrong, to investors, stockholders, and employees alike. She did informed her supervisor CEO Ken Lay of perceived irregularities in the accounting practices of Fastow?s Special Purpose entities. Therefore, within the context of both theories, she was justified to alert outside authorizes. To whom did Sharron Watkins owe loyalty? Ronald Duska argues that the employee does not have an obligation of loyalty to a company, and that whistle-blowing is permissible, especially when a company is harming society (Beauchamp, Bowie, Arnold, 2008). Additionally, since Sharron Watkins was a member of a professional organization as a Certified Public Accountant, she was required by their professional code of ethics to report unethical behavior on the part of her fellow professionals in order to regulate their profession, therefore she owed loyalty to the public, her profession and herself. To whom does the board of directors owe their primary responsibility? Can you think of any law or regulations that would help ensure that boards meet their primary responsibilities? In the United States, corporate law dictates that a board of directors must monitor the leadership of the firm to ensure that the corporation is run correctly and effectively in the long-term interest of shareholders. Thus, the board of directors owes their primary responsibility to investors; they owe both the duty of care, or due diligence, and the duty of loyalty, or putting the investors first in their decision-making. Boards of directors are generally recognized as having five key charges. First, and most important, they must select, monitor, evaluate, and when necessary replace the CEO of the firm, with a key underlying duty of engaging in careful, advance succession planning. Second, the board is responsible for ratifying the company?s overarching vision and strategic plan, once it is developed by the CEO and his or her staff. Advising and counseling the CEO and other top managers as needed is a third function of the board, underscoring the importance of a board?s diversity of expertise. The board?s fourth responsibility is to locate and nominate high-quality board members and to evaluate the processes of the board and the performance of both the board and its members. Finally, the board is responsible for ensuring the adequacy of the firm?s internal control systems, a duty that is now reinforced by the Sarbanes-Oxley Act. The Sarbanes-Oxley Act of 2002 act was designed to protect shareholder value and the general public from corporate wrongdoing. The Sarbanes-Oxley Act dealt with four major issues in corporate governance of public corporations. First, the act created an oversight board to set and enforce auditing standards and discipline public company auditors. Second, the act intended to foster auditor independence. Third, the act increased corporate responsibility, by requiring that CEOs and CFOs certify all periodic reports containing the company?s financial results. Having knowledge of the certification of false statements is subject to criminal liability. Finally, the act enhanced financial disclosure with regard to the off-balance-sheet transactions and obligations with consolidated entities and individuals. These key provisions of the Sarbanes-Oxley Act have significantly strengthened the role of the board of directors and have made managements more accountable. What responsibilities do government regulators owe to business? To the market? To the general public? One of the principal responsibilities of government regulators is to ensure that the laws they enforce are regularly reviewed, and occasionally adjusted, to take account of changing conditions in the world.? Federal Trade Commission Government regulators, such as the U.S. Securities and Exchange Commission, are responsible for administering laws written to provide protection for investors. The responsibility government regulators owe to businesses is to ensure they are in compliance with the laws in effect. With regard to the market, the responsibility to ensures markets are fair and honest, and if necessary, enforce the laws through the appropriate sanctions. To the public, regulators owe the responsibility of trust, to provide the confidence to the public that the market and business are conducting operations in a fair, and legal manner and to provide for informed investment analysis and decision making by the public investors, principally by ensuring adequate disclosure of material information Are accounting and law professions or businesses? What is the difference? A business is a legally recognized organization designed to provide goods, services, or both to consumers or other business in exchange for money. Whereas a profession is a vocation that is to supply disinterested counsel and service to others for a direct and definite compensation without expectation of other business gains. In that the primary motive of business is to make a profit, and in doing so may fail, a professional is comparatively safe as he earns fees for his services and there cannot be negative fees. In establishing a business, no special educational or technical qualifications are required, other than providing a need, service, or commodity to the market, a professional is required to acquire a particular degree or qualification prescribed by a particular professional body. Most importantly, in a business upon completion of the transaction there is no assumption or implied contract of any sort, but in a profession their actions, deeds, or services do accompany an impli ed contract, a contract which provides that the service or information provided is truthful, complete, and verifiable. A professionals good reputation is one of his or her most important possessions People need to have confidence in the quality of the complex services provided by professionals. Because of these high expectations, professions have adopted codes of ethics, also known as codes of professional conduct. Codes of professional conduct are of utmost importance to professionals and those who rely on their services. These ethical codes call for their members to maintain a level of self-discipline that goes beyond the requirements of laws and regulations. Professionals know that people who use their services, especially decision makers, expect them to be highly competent, reliable, and objective. Those who work in a professional field must not only be well qualified but must also possess a high degree of professional integrity. Both accountants and attorneys are professions, in that they both must supply disinterested counsel for a set fee, they are hired or contracted to perform a service and in doing that service, are to provided an honest assessment or truthful information. Thus they have a professional responsibility to their clients, to the government, and to the public.

Essay --

Although the European Union consists of a large variety of institutions, the most important institution is the European Commission. Established in 1958 and based in Luxemburg and Brussels, this hybrid institution (executive and bureaucratic) â€Å"epitomizes supranationalism and lies at the center of the EU political system† (Dinan, 2010, p. 171). It has a substantial bulk of responsibilities and carries out these responsibilities with a vast number of constituents, acting as the executive for the EU. These responsibilities include anything from drafting and initiating policy to managing the financial framework of the EU, and can have a large impact on the other institutions of the EU. In order to â€Å"promote the general interests of the Union,† the Commission strives to unify the interests of the member states and is continually working for implementation and harmonization of EU law (Dinan, 2010, p. 191). Although not the most popular, in the sense that â€Å"Europeans generally view the Commission as power-hungry, insensitive to their concerns, and subversive of national political systems,† the Commission carries out responsibilities that play a key role in EU policy on a daily basis (Dinan, 2010, p. 171-172). These responsibilities include drafting and initiating policy, supervising the enforcement of the acquis communautaire and other legislation, managing the budget, and representing the interests of the EU internationally. Given its core position within the structure of the EU (kind of as an overseer of the EU as a whole), the Commission has developed active relations with the other institutions in order to carry out these responsibilities. Although other institutions also play an active role in the implementation of EU policy, no othe... ...itiate policy, supervise the enforcement of the acquis communautaire and other legislation, manage the budget, and represent the interests of the EU internationally. Although it may not have the final say in arbiting law, it has quite a lot of influence on the Council and ECJ due to its knowledge on the acquis communautaire and EU law. Due to its high volume of responsibilities, the Commission must have a large number of experts in order to fulfill them. If anything about drafting or initiating law is in question, there will always be an expert that can answer it, whether it is a DG or advisory committee. Through this network of responsibilities and experts, the Commission has become the most important institution by being able to effectively â€Å"implement a range of EU policies and programs;† one of the most prominent goals of the European Union (Dinan, 2010, p. 202).

Symbolism – “My Antonia”

Literary device – Symbolism Symbolism is the use of symbols to represent ideas or qualities: symbolic meaning attributed to natural objects or facts. â€Å"There seemed to be nothing to see; no fences, no creeks or trees, no hills or fields. If there was a road, I could not make it out in the faint starlight. There was nothing but land: not a country at all, but the material out of which countries are made† (10). â€Å"In all that country it was the spot most dear to me† because when all of the land has been cleared for farming, this â€Å"island† where two roads meet is the only place where the tall prairie grass still grows undisturbed† (62). Even while we whispered about it, our vision disappeared; the ball dropped and dropped until the red tip went beneath the earth. The fields below us were dark, the sky was growing pale, and that forgotten plough had sunk back to its own littleness somewhere on the prairie† (50-51). Willa Cather My Antoni a In the book, My Antonia, Jim Burden finds himself an orphan leaving his beloved home to a new, stranger place. When he first arrives he observes the country and how different the surroundings are. Throughout the story Jim finally settles in and has a new friend, Antonia. Many things happen and soon we are mourning over the death of Mr.Shimerda. His death was a big event and effected Antonia and her family. Her family was forced to work three times harder to keep themselves alive. As you transition into book two, more conflicts are invited and new symbols. There are three main types of symbolism that are appealing to the eye. The first quote uses the prairie as a symbol of Jim’s friendship with Antonia during his childhood. It may also symbolize the immigrants and the vast size of the prairie. Which may suggest both the opportunity for a new life and the overwhelming fear that goes with trying to create a new life.The third quote is usually missed as a sign of symbolism. The gravesite is a remnant of the prairie in its purest form, and it symbolizes Antonia’s and Jim’s longing for the past. It is also unwelcoming and â€Å"the  sky cries as if in sorrow, and the elements in the new land are not friendly, just as they have not been welcoming to  Mr. Shimerda† (61). In the final quote the symbol is the plough. It symbolizes man’s â€Å"beautiful and harmonious† connection to the land. The imagery suggests Jim’s impending separation from Antonia and while Antonia remains on the prairie, Jim leaves for good. Willa Cather uses many examples of symbolism.The lighting is one that is seen in many books, such as Of Mice and Men and more. A vivid description of light shows every major change that occurs in the novel. For example, at the end of the novel, after Jim leaves Antonia for the last time, he stands alone on the prairie roads in â€Å"the slanting sunlight† and reflects on the â€Å"incommunicableâ₠¬  past he shared with Antonia. The light from the sun is setting and at this time Cather uses the light to show the ending to Jim and Antonia’s relationship. Symbolism in this novel is important in deciding the lives, actions, and moods of the characters.

Competition in Healthcare

In the U. S. economy, when companies or organizations compete for consumers’ business, consumers usually win with lower prices and better quality product (Stossel, 2007). This idea has spread to the healthcare industry and is being encouraged as a way to increase value for patients (Rivers, 2008). With the healthcare industry being a very diverse industry, there are many different forms of competitions as well as benefits and shortfalls for competition in the healthcare market.Traditional competition in healthcare involves one more elements of price, quality, convenience, superior products or services, new technology and innovations (Rivers, 2008). There are different forms of healthcare competition. One form of healthcare competition is the competition that exists between individuals who provide healthcare such as physicians and other healthcare practitioners (Rivers, 2008). These entities compete for patients who are able to pay on their own, or who have their own health ins urance (Rivers, 2008). They also compete off of a non-price basis (Rivers, 2008).This means they are competing with their location, their colleague referrals, and their reputations (Rivers, 2008). Physicians and other healthcare practitioners may also compete in the medical market by reducing competition from non-physicians like psychologist (Rivers, 2008). The benefits for this type of competition are that it forces the healthcare practitioner and physicians to be more patient-orientated. It also encourages prices to competitive since some of these individuals are paying for the services out of their own pocket and is price conscious (Stossel, 2007).Another form of competition in the healthcare industry is healthcare organizations, such as hospitals (Rivers, 2008). These entities compete for physicians, third-party payers and patients (Rivers, 2008). They compete for patients by providing more services, better amenities and discounted prices (Rivers, 2008). They also compete for ph ysicians by trying to maintain a cutting edge of competition with their technology and new medical discoveries (Rivers, 2008). The final form of competition in the healthcare industry is between organizations that provide healthcare financing, insurance and plans.These entities compete with access, premiums, benefits, quality and different degrees of freedom in choosing a provider and the benefits or coverage services. The pitfall for this type of competition is that it can often be confusing for consumers who are comparing different insurance or financing plan. Competition in the healthcare industry is being encouraged to help better the quality of care patients receive as well as reduce medical costs. When patients have the choice of where they receive medical care, competition and having a competitive edge on opponents is important.Since the healthcare industry is so large and diverse, there are different forms of competition between healthcare entities. Ultimately competition is supposed to benefit the consumer and patients. resources: Rivers, P. (2008). Healthcare competition, strategic mission and patietn satisfaction:research models and propositions. Retrieved on October 13, 2012 from www. ncbi. nlm. nib/gov/pmc/articles/PMC2865678 Stossel, J (2007). The Competitive Advantage. http://abcnews. go. com/2020/story? id=36026262&page=1

Bering Strait - Geographic Overview

Bering Strait - Geographic Overview The Bering Land Bridge, also known as the Bering Strait, was a land bridge connecting present-day eastern Siberia and the United States state of Alaska during Earths historic ice ages. For reference, Beringia is another name used to describe the Bering Land Bridge and it was coined in the mid-20th century by Eric Hulten, a Swedish botanist, who was studying plants in Alaska and northeastern Siberia. At the time of his study, he began using the word Beringia as a geographic description of the area. Beringia was about 1,000 miles (1,600 km) north to south at its widest point and was present at different times during the Pleistocene Epochs ice ages from 2.5 million to 12,000 years before the present (BP). It is significant to the study of geography because it is believed that humans migrated from the Asian continent to North America via the Bering Land Bridge during the last glaciation about 13,000-10,000 years BP. Much of what we know about the Bering Land Bridge today aside from its physical presence comes from biogeographical data showing connections between species on the Asian and North American continents. For example, there is evidence that saber tooth cats, woolly mammoths, various ungulates, and plants were on both continents around the last ice age and there would have been little way for them to appear on both without the presence of a land bridge. In addition, modern technology has been able to use this biogeographical evidence, as well as modeling of climate, sea levels, and mapping of the sea floor between present-day Siberia and Alaska to visually depict the Bering Land Bridge. Formation and Climate During the ice ages of the Pleistocene Epoch, global sea levels fell significantly in many areas around the world as the Earths water and precipitation became frozen in large continental ice sheets and glaciers. As these ice sheets and glaciers grew, global sea levels fell and in several places across the planet different land bridges became exposed. The Bering Land Bridge between eastern Siberia and Alaska was one of these. The Bering Land Bridge is believed to have existed through numerous ice ages from earlier ones around 35,000 years ago to more recent ice ages around 22,000-7,000 years ago. Most recently, it is believed that the strait between Siberia and Alaska became dry land about 15,500 years before the present, but by 6,000 years before the present, the strait was again closed due to a warming climate and rising sea levels. During the latter period, the coastlines of eastern Siberia and Alaska developed roughly the same shapes they have today. During the time of the Bering Land Bridge, it should be noted that the area between Siberia and Alaska was not glaciated like the surrounding continents because snowfall was very light in the region. This is because the wind blowing into the area from the Pacific Ocean lost its moisture before reaching Beringia when it was forced to rise over the Alaska Range in central Alaska. However, because of its very high latitude, the region would have had a similar cold and harsh climate as is in northwestern Alaska and eastern Siberia today. Flora and Fauna Because the Bering Land Bridge was not glaciated and precipitation was light, grasslands were most common on the Bering Land Bridge itself and for hundreds of miles into the Asian and North American continents. It is believed that there were very few trees and all vegetation consisted of grasses and low-lying plants and shrubs. Today, the region surrounding what remains of Beringia in northwestern Alaska and eastern Siberia still features grasslands with very few trees. The fauna of the Bering Land Bridge consisted mainly of large and small ungulates adapted to grassland environments. In addition, fossils indicate that species such as saber-toothed cats, woolly mammoths, and other large and small mammals were present on the Bering Land Bridge as well. It is also believed that when the Bering Land Bridge began to flood with rising sea levels during the end of the last ice age, these animals moved south into what is today the main North American continent. Human Evolution One of the most important things about the Bering Land Bridge is that it enabled humans to cross the Bering Sea and enter North America during the last ice age about 12,000 years ago. It is believed that these early settlers were following migrating mammals across the Bering Land Bridge and for a time may have settled on the bridge itself. As the Bering Land Bridge began to flood once again with the end of the ice age, however, humans and the animals they were following moved south along coastal North America. To learn more about the Bering Land Bridge and its status as a national preserve park today, visit the National Park Services website. References National Park Service. (2010, February 1). Bering Land Bridge National Preserve (U.S. National Park Service. Retrieved from: https://www.nps.gov/bela/index.htm Wikipedia. (2010, March 24). Beringia - Wikipedia, the Free Encyclopedia. Retrieved from: https://en.wikipedia.org/wiki/Beringia

Art Fakes and Forgeries Essay Example

Art Fakes and Forgeries Essay Example Art Fakes and Forgeries Paper Art Fakes and Forgeries Paper Essay Topic: F for Fake The two essays, â€Å"What is Wrong with a Forgery,† by Alfred Lessing and â€Å"Artistic Crimes,† by Denis Dutton, explore the different reasons that they give negative connotation to the concept of an artistic forgery. Each author concludes that a forgery is indeed wrongful, however their reasons for this conclusion differ in several distinct ways. This essay will summarize both authors’ main points and compare and contrast the fundamental differences of their arguments. Lessing begins â€Å"What is Wrong with a Forgery† by establishing that forgeries are not void of aesthetic value. In fact, he states that a clear distinction must be made between the qualities that make a piece of art aesthetically pleasing and the non-aesthetic qualities that art critics consider when analyzing a piece. The concept of a forgery, he says, is purely non-aesthetic and should not be used to describe the beauty of a piece. To further illustrate this point and later points in his essay, Lessing introduces the case of the Johannes Vermeer fakes done by Hans van Meegeren. The painting The Disciples was thought to be a Vermeer masterpiece for 7 years until van Meegeren revealed that he had actually done the painting and misrepresented it as Vermeer’s. Lessing says, â€Å"The fact that The Disciples is a forgery is just that, a fact. It is a fact about the painting which stands entirely apart from it as an object for aesthetic contemplation. The knowledge of this fact can neither add anything to nor subtract anything from the aesthetic experience. Here Lessing establishes that his problem with the forgery does not lie within the aesthetic value of the art, so he introduces what he believes to be the real problem with a forgery: that it is an offense against what he calls â€Å"the spirit of the art,† and he contends that a forgery, such as The Disciples, â€Å"lacks artistic integrity. † To further illustrate this he considers that the concept of forgery cannot be applied to the performing arts, a concept which Dutton refuses to ac cept in his essay, which we will explore later. Lessing uses this concept to draw a distinction between creativity or originality and reproduction or technique. Technique, he says is public, it is something anyone can possess or learn, while originality or creativity is a deeper concept to explore. Both qualities in perfect balance, he asserts, are necessary to create a great work of art. Lessing says forgery is in the concept of originality and not technique stating, â€Å"forgery is a concept that can be made meaningful only by reference to the concept of originality, and hence only to art viewed as a creative, not as a reproductive or technical, activity. The element of performance or technique in art cannot be an object for forgery because technique is not the kind of thing that can be forged. Technique is, as it were, public. † In the Vermeer case, it is not the technique that was forged but his discovery of it; his originality in its use. Lessing further defines his view of artistic originality and its importance. He contends that true artistic originality comes from the impact on the history and progression of art. Vermeer, he says was a great artist because he brought new and original technique and style to the artistic community and profoundly impacted art history. The ability to produce aesthetically beautiful pieces of art is not all that makes a great artist, but it is this originality or â€Å"the fact that [Vermeer] painted certain pictures in a certain manner at a certain time in the history and development of art. † Van Meegeren did not possess this, he only had the technique to reproduce Vermeer’s originality. Lessing concludes with the assertion that since van Meegeren’s painting is aesthetically beautiful it is actually shows what a great artist Vermeer was. It is a testament to the original genius of Vermeer’s style and technique brought about in the 17th century. In Dutton’s essay, â€Å"Artistic Crimes† he, like Lessing, agrees that the intrinsic aesthetic properties of a work of art are not changed by the revelation that the piece is actually a forgery. Dutton’s stance on the issue of why a forgery is wrong differs most from Lessing’s in that he argues that there can be no distinction between creative and performing art. In Dutton’s opinion, every work of art involves some element of performance. The difference is whether we perceive the moment of performance or if we only see the end product of the performance. Regardless, this performance must be considered in appreciating a work of art. A performance he says represents a sense of accomplishment or achievement. Dutton states, â€Å"As performances, works of art represent the ways in which artists solve problems, overcome obstacles, make do with available materials. † This is an aspect of a piece that cannot be ignored when fully appreciating its artistic value. Dutton’s main problem with forgery then is not the lack of originality that Lessing speaks of, but that a forgery misrepresents achievement. In the van Meegeren case, for example, the problem is in that it was a much greater achievement for Vermeer to paint his masterpieces during the 17th century with the resources and technology at that time, than it is for van Meegeren to paint the same way in the 20th century with many more resources available. Another difference between Lessing and Dutton’s argument is that Dutton believes that a forgery does have originality and this is not its problem. Lessing believes that this lack of originality is the fundamental problem with the forgery, but Dutton states, â€Å"even forgeries – those putative paradigm cases of unoriginal effort – can have strikingly original aspects. † He goes on further to say that the van Meegerens are actually original van Meegerens, an original performance by van Meegeren was misrepresented as a Vermeer performance. Here, he asserts, is the misrepresentation of achievement that is the problem with a forgery. Dutton reiterates that the knowledge of the origin of a work and the artistic achievement that the piece represents is crucial to appreciating a work of art. The â€Å"aesthetic experience† that Lessing speaks of in his essay, Dutton discredits stating, â€Å"The encounter with a work of art does not consist in merely hearing a succession of pretty sounds or seeing an assemblage of pleasing shapes and colors. † The artistic experience he asserts is much more complex than that and when the performance that led to a piece of art is misrepresented the achievement that the art represents is misrepresented. To learn this fact changes the entire artistic experience when appreciating all aspects of the piece including the performance that led to its existence. Both Lessing and Dutton agree that the aesthetics of a piece are not altered by the acquired knowledge that it is a forgery. Where the two authors differ is in their concept of experiencing art. Dutton discredits Lessing’s belief in a purely aesthetic experience, believing that there are many more aspects involved in the artistic experience than pure aesthetics. The authors’ other key disagreement is in Lessing’s distinction between performing and creative art, saying that a forgery only exists in the creative aspect and the lack of originality in style and technique is where the forgery is wrong. However, Dutton disagrees, asserting that every piece of art involves a performance and this misrepresented performance misrepresents achievement. This is Lessing’s problem with a forgery because the achievement of the artist must be considered during any artistic experience.

Legalities related to sexual harassment policies for the workplace Research Paper

Legalities related to sexual harassment policies for the workplace - Research Paper Example Before filing a case against the offender, a victim must remember the place, date, and time of the sexual harassment besides any witness if possible. The harasser needs to be blatantly made clear by the victim to behave and mend ways. If there is no sign of amending ways, a warning needs to be made of the repercussions in legal terms through filing a case at EEOC (Equal Employment Opportunity Commotion), which can help the victim. An employer cannot be held responsible if no such policy is in practice at the workplace to tame the bad conduct but once a complaint has been made, taking action against the offender becomes mandatory for the employer to save the employer’s skin (Bhatnagar, 2007). Employees at state and federal level are also protected under the sexual harassment law. Title VII of the Civil Rights Act of 1964 under the federal law provides remedy for workplace harassment. This law is applicable to firms with fifteen or more employees. Where employee strength is less than fifteen the state anti-discrimination law comes to the aid of discriminated employees. Regarding single-gender harassment, there is provision to file a case against the employer whereas there is no unanimity over single-gender harassment in state laws (Larson, 2003). Basically, there are two simple types of workplace sexual harassment, Quid Pro Quo Harassment and Hostile Work Environment Harassment. In Quid Pro Quo type, the employee has to bear the gender based discrimination to remain in the job, avail routine benefit, salary hike or promotion. A hostile work environment affects the job performance of the employee by making the environment abusive. For inquiring into the workplace environment, we need to analyze the factors responsible for the conduct of the offender. It is crucial to confirm whether the offender’s behavior is verbally or physically wrong, how random the occurrence of the offence is, whether the behavior is just unfriendly or undoubtedly objectionable , what is the rank of the offender, whether the offence is committed taking along others by the offender in the league of perpetuators’ aiming at the victim singularly or including others as targets (Larson, 2003). Sexual harassment of verbal type can be judged on the overall happenings, depending on factors such as: The type, frequency, context, and specific aim of the remarks; Whether the comments were unfriendly and mean; Whether the alleged harasser pointed towards the victim while making a hostile comment; Whether the victim reacted by participated through return comments; and The level of kinship between the victim and the alleged harasser. To initiate action for sexual harassment, the plaintiff must prove that: 1. The plaintiff found the behavior to be hostile, abusive or offensive; and 2. Any person of balanced attitude in the same situation would consider the behavior hostile, abusive or offensive. It is to be noted that the plaintiff need not be necessarily a victim of the ordeal to file a claim against workplace sexual harassment. As stated above the federal cases can be filed with the EEOC, but it first requires case filing against the behavior of an administrative agency; state and local bodies also listen to such complaints under the state law. There is possibility that a state

Essay writting critical thinking A written Critique of a given Article

Essay writting critical thinking A written Critique of a given . 1200 words. Worth 50% of the overall grade - Article Example My findings indicate that most people especially parents, teachers, and religious leaders reject Harry’s works. Their argument is plain and clear. There is no compromise especially when it comes to raising children in the right way in this dynamic world. Harry Porters works have sparked a lot of speculation with many people viewing his works as satanic. However, some people view Harry Porters work as simple magic that replicate in real life. Harry porter writes mostly to children and most of schools and religious groups have banned his books in their institutions. Most people relate his books to fairy tales and Cinderella books, which never received much criticism as his books, are receiving. According to some people, Harry Porter is a Christian though his works are simply illusions considered satanic by some people. Despite the religion attack, most of Harry Porters work avoids religion in its context. Harry Porter argues that his works avoid introducing certain religion to the targeted audience. There has been intense debate about banning the books from US schools though the public view that as intimidation considering that witchcraft is a licensed business in the US. Other countries like United Arab Emirates consider the books il legal in their schools. The books contain positive aspects of good over evil embedded in witchcraft. The books portray the culture of love and courage in witchcraft, which Christian and other religion denounces. However, a critical perception of Harry Porters works indicate that the magic and illusions can be done in real life unlike works such as Lord of Rings which cannot be practiced in real life. Others view works of Harry Porter as stemming from Wicca religion, which usually incorporates witchcraft work. Wicca is gender polarized and the religion worships the moon Goddess and Horned God. It is also important to mention that Wicca contains magic ranging from folk culture magic and low magic, which is greatly, expressed in

Identify and discuss the relative importance of the major influences Essay

Identify and discuss the relative importance of the major influences on a tourist's purchasing decision - Essay Example Again, the paper on Japanese tourism demand for U.K outlines the visiting capability of both adult and children. Several factors affect the tourism of Japanese tourism to the U.K and further, it is pertinent to note that young children do frequent the U.K. the following is the summary of the book demand in tourism for the U.K. The book impact of demand in tourism for Japanese in the U.K argues that experts have concentrated on the study of tourism behaviors among Japanese forgetting the relationship of travel and motivational culture to Japan. Further, the difference between older and the younger is discussed. Therefore the article on Japanese tourism to the UK does not only analyze but also reveals the push and constraints as well as the cultural demand of Japanese’s choice on holiday outbound. Due to economic growth and increased expenditure in the Japanese nation, it is pertinent to note that the market on international tourism has gradually grown. Despite of the recent rec ession in economy, the outbound tours for Japanese has not been affected negatively; this is evident with the wide popularized overseas travel. It follows that the UK language, culture and novelty are the core values that act as pull factors to its tourism industry. Japan government has actively participated in the overseas visit since 1964, the Tokyo Olympic year. The article insinuates that the years after Olympic Games the government had to intervene in order to increase the Japanese overseas travelers to almost 10 million in the year 1991. According to the Japanese governmental report, it is acceptable that Japan did face economical recession although it did not hinder the Japanese from traveling outbound. The government concluded the above after analysis of the number of people who choose to enjoy leisure abroad, which was increasing despite of the recession in Japans’ economy. After several researches by experts, it is evident that both groups the older and younger pref er to take a yearly holiday. The frequency of travel varies for instance the younger tent to travel twice a year contrary to older age that travels less. Amusingly, the overseas travel is regarded as more luxurious and that is why, young Japanese are very much attracted to the UK touring. The book evaluates three factors that is the pull, push and constraints. It follows that the above brings out the understanding of the Japanese travel propensities to the UK. Constraints are factors that hinder or rather oppose the overseas travel by the Japanese. Thus, the book illustrates several categories of constraints as below. First, it is wise to analyze the constraint part. According to the research, it is evident that Japanese believe time is one of the constraints for the abroad travel on holiday. Even though it contradicts the study by JTB, who concluded that only 14 percent of the japans feel that time is a hindrance. This clash can be because of cultural differences. Since the japans are workaholics, they tent to feel it unfair to take off when others are working. In addition, the above further bears its evidence from the scholar by the name Bayton who made assumptions on the need of classification. It is argued that in the struggle to satisfy the ego-defensive and affection needs the Japanese do avoid holidays on regular basis. Another constraint to a

Liberation Theologies In The United States Term Paper - 1

Liberation Theologies In The United States - Term Paper Example The authors explain how in the 20th century, so many of these theologies came up with the aim of bringing about liberation for different oppressed groups or simply transforming their social existence. These theologies have a religious commitment but their organization is purely political. The goal of these theologies was to bring about full citizenship and equality in the social and political spheres of the lives of people in United States. This discussion is a term paper the book Liberation Theologies in the United States by Stacey Floyd-Thomas and Anthony Pinn. The authors provide an in-depth discussion about the origin and development of the liberation theologies in the United States. The book contains 10 liberation theologies which are all discussed in detail to the benefit of the reader. In this book each liberation theology is discussed in an exposition that displays its development, purpose and activities (Floyd-Thomas & Pinn 6). Immediately before the first chapter, the authors provide a very informative discussion that delves into the beginning of the cultural and social disorganization that that came to characterize the US in the 20th century when most of the liberations came up. Through this introduction, they lay a very solid background of things that led to the emergence of liberation movements. In this section, the authors show how the Europeans came to America and triggered destruction of cultures and worldviews and the rearrangement of the same. They go on to explain the cause of the diversity of the US people in terms of culture. Part of the diversity they say, was caused by immigrations in the 18th century. The existence of diverse cultures resulted in oppression especially for the minority groups. Through this book, the authors are able to show the true colors of the United States in the past two centuries and how religion has been used by different groups of people to fight for their freedom. For along time, oppression has been

Hellenistic Art Personal Statement Example | Topics and Well Written Essays - 500 words

Hellenistic Art - Personal Statement Example Each of these generals co-opted the art of the time to display the unique influences that their particular kingdoms engendered. However, the unifying mark that united these differing pieces is the gigantism and baroque nature that the art oftentimes entails. However, this was taken to such an unbelievable extreme that the art lost a great deal of its appeal and became overtly tacky. As a result, gone was the era of the muted and reserved art forms of the classical era. As previously stated, the art form of the Hellenistic period was anything but restrained. Rather than showing the ideals of human and godly actions/virtues, Hellenistic art focused on the very extreme. As such the art oftentimes showed individuals in the throes of mortal combat, characters prostrating themselves in various poses, defeated warriors downing poison, men overcome by fear, the loss of honor in death, and many other such expressive/explosive emotions. In this way details such as the forcefulness of the action or circumstances and the violence of the movements associated with these are amplified. Interestingly, although the same can be said for the mosaics other art forms, the pottery and other earthen rare remained largely unchanged and muted. One could reasonably expect that this was the result of the fact that the artists were attempting to extol the highest degrees of grandeur in the public displays of Hellenistic art; whereas the more muted domestic settings required art forms that did not necessarily need to be so bold and overbearing.

Managing Buiness Organization Essay Example | Topics and Well Written Essays - 2500 words

Managing Buiness Organization - Essay Example For instance, professionals are gaining more say in the running of organizations. Even where governance is by people who own the majority stakes, their own positions and the respect, they command are contingent upon their competence rather than ownership (Ahuja, 2005 880). "Management is the art of getting things done through other people. Management is the dynamic, life-giving element in every business. Without it the resources of production remain resources and never become production." (Sharma, 2004 11) This definition emphasizes that the managers achieve organizational objectives getting things done through the employees. Human resource Management is very essential for successful running of an enterprise. It ensures proper use of physical and human resources by deriving the best results. It leads to efficient performance and higher productivity. Human Resource Management is very essential for every organization to make productive use of human physical and financial resources or the achievement of the organizational goals. It helps in determination of objectives. No organization can succeed in tits mission unless its objectives an identified and well denied. Management helps in achieving these objectives by the efficient use of resources. In management, the term 'manager' means overseeing the subordinates at work by their superiors. It is the function of leading, co-coordinating and directing the work of others to accomplish designated objectives. It refers to the direct and immediate guidance and control of subordinates in the performance of their task (Sharma, 204, p.110). Role of manager in an Organization from the Onset of the Industrial Revolution The role of a manager in an organization has been shown below: Fig. Role of manager (Sharma, 204, p.111) (a) As Mediator- Manager acts as a mediator between higher-level management and the workers. (b) As Medium of Communication - manager acts as a medium of communication between higher-level managers and workers. He explains management policies to the workers and conveys the workers' attitudes, opinions, grievances and problems to higher-level management (Silbiger, p.103). In other words, he communicates (i) To the workers what the management expects from them and (ii) To the management what the workers want. Thus, manager bridges the gap between the expectations of management and demands of operatives and workers. (c) As Convertor - Manager acts as a convertor in the sense that he occupies such a key position which turns plans and policies into actual results through the efforts of workers. (d) As Inspirer - manager acts as an inspirer in the sense that he inspires workers to cooperate and contribute to the best of their capability for the achievement of organizational objectives. (e) As Leader - Manager acts as a leader in the sense that he influences the workers to work with team spirit for the achievement of organizational objectives. He also provides a cohesive force, which holds the group intact and develops a spirit of cooperation and discipline among the employees. (f) As Guide and Friend - Manager acts as a guide and friend in the sense that he educates and trains the workers, creates friendly environment and solves the disputes of the workers. In this way, he ensures team spirit, co-operation and discipline amongst the members (Sharma, 2004, p.115) Thus, the Manager is expected to secure not only the efficiency of operations but also the team spirit, co-o

Liberation Theologies In The United States Term Paper - 1

Liberation Theologies In The United States - Term Paper Example The authors explain how in the 20th century, so many of these theologies came up with the aim of bringing about liberation for different oppressed groups or simply transforming their social existence. These theologies have a religious commitment but their organization is purely political. The goal of these theologies was to bring about full citizenship and equality in the social and political spheres of the lives of people in United States. This discussion is a term paper the book Liberation Theologies in the United States by Stacey Floyd-Thomas and Anthony Pinn. The authors provide an in-depth discussion about the origin and development of the liberation theologies in the United States. The book contains 10 liberation theologies which are all discussed in detail to the benefit of the reader. In this book each liberation theology is discussed in an exposition that displays its development, purpose and activities (Floyd-Thomas & Pinn 6). Immediately before the first chapter, the authors provide a very informative discussion that delves into the beginning of the cultural and social disorganization that that came to characterize the US in the 20th century when most of the liberations came up. Through this introduction, they lay a very solid background of things that led to the emergence of liberation movements. In this section, the authors show how the Europeans came to America and triggered destruction of cultures and worldviews and the rearrangement of the same. They go on to explain the cause of the diversity of the US people in terms of culture. Part of the diversity they say, was caused by immigrations in the 18th century. The existence of diverse cultures resulted in oppression especially for the minority groups. Through this book, the authors are able to show the true colors of the United States in the past two centuries and how religion has been used by different groups of people to fight for their freedom. For along time, oppression has been

Managing Buiness Organization Essay Example | Topics and Well Written Essays - 2500 words

Managing Buiness Organization - Essay Example For instance, professionals are gaining more say in the running of organizations. Even where governance is by people who own the majority stakes, their own positions and the respect, they command are contingent upon their competence rather than ownership (Ahuja, 2005 880). "Management is the art of getting things done through other people. Management is the dynamic, life-giving element in every business. Without it the resources of production remain resources and never become production." (Sharma, 2004 11) This definition emphasizes that the managers achieve organizational objectives getting things done through the employees. Human resource Management is very essential for successful running of an enterprise. It ensures proper use of physical and human resources by deriving the best results. It leads to efficient performance and higher productivity. Human Resource Management is very essential for every organization to make productive use of human physical and financial resources or the achievement of the organizational goals. It helps in determination of objectives. No organization can succeed in tits mission unless its objectives an identified and well denied. Management helps in achieving these objectives by the efficient use of resources. In management, the term 'manager' means overseeing the subordinates at work by their superiors. It is the function of leading, co-coordinating and directing the work of others to accomplish designated objectives. It refers to the direct and immediate guidance and control of subordinates in the performance of their task (Sharma, 204, p.110). Role of manager in an Organization from the Onset of the Industrial Revolution The role of a manager in an organization has been shown below: Fig. Role of manager (Sharma, 204, p.111) (a) As Mediator- Manager acts as a mediator between higher-level management and the workers. (b) As Medium of Communication - manager acts as a medium of communication between higher-level managers and workers. He explains management policies to the workers and conveys the workers' attitudes, opinions, grievances and problems to higher-level management (Silbiger, p.103). In other words, he communicates (i) To the workers what the management expects from them and (ii) To the management what the workers want. Thus, manager bridges the gap between the expectations of management and demands of operatives and workers. (c) As Convertor - Manager acts as a convertor in the sense that he occupies such a key position which turns plans and policies into actual results through the efforts of workers. (d) As Inspirer - manager acts as an inspirer in the sense that he inspires workers to cooperate and contribute to the best of their capability for the achievement of organizational objectives. (e) As Leader - Manager acts as a leader in the sense that he influences the workers to work with team spirit for the achievement of organizational objectives. He also provides a cohesive force, which holds the group intact and develops a spirit of cooperation and discipline among the employees. (f) As Guide and Friend - Manager acts as a guide and friend in the sense that he educates and trains the workers, creates friendly environment and solves the disputes of the workers. In this way, he ensures team spirit, co-operation and discipline amongst the members (Sharma, 2004, p.115) Thus, the Manager is expected to secure not only the efficiency of operations but also the team spirit, co-o

Song of Myself Essay Example for Free

Song of Myself Essay Walt Whitman’s poetry often relies on lists to convey multiple aspects of the world. Indeed, through the catalogues of people, places and things that he uses in his poetry, Whitman is able to display and touch on a breadth of aspects of life that make his poetry applicable to more people and also demonstrate his commitment to showcasing different perspectives. Because he’s able to include so many different things, cataloguing becomes important in not limiting the scope of his poems, and it also provides a unique rhythm to Whitman’s poems that few poets effectively replicate. This cataloguing system is significantly present in his â€Å"Song of Myself,† which features numerous lists and tackles significant themes such as individuality and how people navigate living in the world. Because the nature of the cataloguing poetic device allows the speaker to use multiple things to explain a phenomenon, lists in â€Å"Song of Myself† allow Whitman to explore the complexity of identity and how individuals are formed from social forces and from within. Indeed, the list that I will explore demonstrates that both the body and the soul are important factors for identity development, and that any â€Å"Song of Myself† relies on a variety of things to truly demonstrate identity: influences from others, physicality, spirituality, and a holistic collection of factors from all aspects of the world. It is quite common for Whitman to use the listing poetic device, and he uses it effectively to demonstrate a breadth of subject. For example, in his poem â€Å"I Hear America Singing,† he discusses the â€Å"varied carols I hear; / Those of mechanics – each one singing his, as it should be, blithe and strong; / The carpenter singing his, as he measures his plank or beam / The mason singing his, as he makes ready for work, or leaves off work† (lines 1-4). The poem goes on to include the shoemaker, the mother, and other people who live in America and how exactly each one sings. Indeed, in this poem, Whitman lists numerous different experiences that different faces of the American workforce might have, using their job titles and the common theme of music to illuminate different aspects of American life. Whitman demonstrates how â€Å"Each [is] singing what belongs to her, and to none else; / The day what belongs to the day—At night, the party of young fellows, robust, friendly, / Singing, with open mouths, their strong melodious songs† (lines 8-10), showing that everyone in this list of people each has their own stake on identity and their own voice in the song of America, allowing this list to demonstrate a multifaceted perspective on what identity means and what the actual makeup of a community is. Indeed, this poem is the perfect representation of the Whitman list: not only does it use this list of individuals to make a point about America and individuality at the same time, but the poem relies on the repetitive but varied rhythm that the list provides through its consistent use of a pattern of listing people. This rhythm demonstrates the broader purpose of the list – it provides a consistency and pattern for the poem to base itself off of, thereby showing the interconnectedness of the people discussed in the poem, but also allows each person a large amount of individuality through the poem as well. In particular, Whitman’s â€Å"Song of Myself† is emblematic both of his work in general, especially his most famous Leaves of Grass, and the way in which he uses lists as a poetic device. â€Å"Song of Myself† explores individuality simply through its title, and looks at the numerous ways in which an individual is able to define oneself. Obviously, one can pick oneself apart as an individual and start there: â€Å"My tongue, every atom of my blood, formd from this soil, this air, / Born here of parents born here from parents the same, and their parents the same, / I, now thirty-seven years old in perfect health begin, / Hoping to cease not till death† (Section I). Here, we see the atoms of the speaker of this poem, their origins, and their age, clearly placing an individual at the center of the identity of this speaker. Other forces are at play in this poem, however: Whitman also uses lists to show other forces on identity. He states, â€Å"Trippers and askers surround me, / People I meet, the effect upon me of my early life or the ward and city I live in, or the nation, / The latest dates, discoveries, inventions, societies, authors old and new, / My dinner, dress, associates, looks, compliments, dues, / The real or fancied indifference of some man or woman I love,† (Section IV), demonstrating how a variety of others have also impacted the speaker’s identity and show that any â€Å"Song of Myself† also necessarily includes the voices of others. This poem embodies why Whitman uses lists because it allows him to send a variety of messages that all point back to the individuality of the speaker, even though the lists themselves may or may not be about him. Because of this, Whitman is able to demonstrate a more complicated perspective on identity and also show a number of different factors that can affect it. Indeed, the lists in â€Å"Song of Myself† demonstrate a broad interpretation of identity and the depth of which different identities are connected to one another. Section five of the poem explores the speaker’s relationship with his soul, saying, â€Å"I believe in you my soul, the other I am must not abase itself to you, / And you must not be abased to the other† (Section V). This section of the poem deals directly with the self’s relationship with the soul, and how this aspect of identity is closely related to a larger spiritual realm. The speaker asks the other to â€Å"Swiftly arose and spread around me the peace and knowledge that pass all the argument of the earth,† demonstrating a much broader connection to the world through the soul. Indeed, as the rest of the poem has shown, identity is connected to many different factors such as other people and internal thoughts, but in this section of the poem, Whitman clearly separates the soul from the body and demonstrates that identity is connected to both. The lists in â€Å"Song of Myself† and other Whitman poems allow the poet to depict the interconnectedness of various aspects of identity and life, and also the complexity with which identity is formed. The list itself in Section V also shows how complex the relationship between the body and the soul. Whitman states that the speaker knows â€Å"that the hand of God is the promise of my own, / And I know that the spirit of God is the brother of my own, / And that all the men ever born are also my brothers, and the women my sisters and lovers, / And that a kelson of the creation is love,† (Section V), showing that identity is wrapped up in many different forces. Indeed, the soul is clearly a part of identity, as well as the hand and spirit of God, â€Å"all the men and women ever† are to be considered siblings, and that creation as a larger concept is essential to this speaker and his identity. The list itself continues to compound upon these complexities as the speaker states, â€Å"And limitless are leaves stiff or drooping in the fields, / And brown ants in the little wells beneath them, / And mossy scabs of the worm fence, heapd stones, elder, mullein and poke-weed† (Section V). This natural imagery demonstrates yet another complex relationship with the self’s identity: here, the conversation that the self has with the soul is complicated through its connection with the physical earth and nature, showing yet another aspect of identity that the speaker and â€Å"Song of Myself† must grapple with. This list shows the essential mind/body disconnect present in identity, and also the widespread influences that the world and other people have on oneself. In addition to this one, many of the lists in this poem show how complex identity can be and show how many things constantly affect it. For example, the speaker states, â€Å"The big doors of the country barn stand open and ready, / The dried grass of the harvest-time loads the slow-drawn wagon, / The clear light plays on the brown gray and green intertinged, / The armfuls are packd to the sagging mow. / I am there,† (Section IX), again showing a broad connection to the world and the self’s constant and close relationship with the earth. Not only does this show the world’s relationship with the self, but also the self’s relationship with the natural and the soul. Again, though, it’s not simply spiritual and personal selfhood that dominates the speaker’s mind. Whitman shows other members of society, stating, â€Å"The married and unmarried children ride home to their Thanksgiving dinner, / The pilot seizes the king-pin, he heaves down with a strong arm, / The mate stands braced in the whale-boat, lance and harpoon are ready, / The duck-shooter walks by silent and cautious stretches, / The deacons are ordaind with crossd hands at the altar,† (Section XV), showcasing other ordinary members of society’s interaction with the world. Lists in â€Å"Song of Myself† consistently demonstrate the multiple communities that individuals are involved with. Walt Whitman uses the poetic device of cataloguing consistently in his poetry to demonstrate the multifaceted forces that influence identity formation and the complicated realities of life in the real world. Indeed, throughout all of his different poems, Whitman uses the list to show different perspectives on the world, different types of people, and the many different things that can affect a person’s self. In his â€Å"Song of Myself,† Whitman demonstrates just how complicated a person’s identity is, and how it interacts with the rest of society. Through his lists, he reinforces exactly this: by being able to give notice to many different people, places, things and ideas, Whitman is able to more aptly describe the complexity of the world and, moreover, the difficulty in pinning down identity. These lists show just how difficult it can be to â€Å"sing oneself,† and just how much can go into it – not only do other people, one’s own soul, a connection to nature and the more psychological aspects of selfhood affect someone’s identity, but the holistic aspects of the world and its interactions with people further complicate the speaker’s identity in this poem. Indeed, in a poem all about identity and one’s interactions with the world, lists serve a great role to shed light on the complexities of identity and the ways in which multiple factors influence people.

Research into Rational Drug Prescribing in Yemen

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