Break Free Product Life Cycle

Most firms build their marketing strategies around the concept of the product life cycle–the idea that after introduction, products inevitably follow a course of growth, maturity, and decline. It doesn't have to be that way, says Harvard Business School marketing professor Youngme Moon. By positioning their products in unexpected ways, companies can change how customers mentally categorize them. In doing so, they can shift products lodged in the maturity phase back–and catapult new products forward–into the growth phase. The author describes three positioning strategies that marketers use to shift consumers' thinking. Reverse positioning strips away â€Å"sacred† product attributes while adding new ones (JetBlue, for example, withheld the expected first-class seating and in-flight meals on its planes while offering surprising perks like leather seats and extra legroom). Breakaway positioning associates the product with a radically different category (Swatch chose not to associate itself with fine jewelry and instead entered the fashion accessory category). And stealth positioning acclimates leery consumers to a new offering by cloaking the product's true nature (Sony positioned its less-than-perfect household robot as a quirky pet). Clayton Christensen described how new, simple technologies can upend a market. In an analogous way, these positioning strategies can exploit the vulnerability of established categories to new positioning. A company can use these techniques to go on the offensive and transform a category by demolishing its traditional boundaries. Companies that disrupt a category through positioning create a lucrative place to ply their wares–and can leave category incumbents scrambling.

Baltimore (Maryland) As A Transportation Network And Sea Port

Baltimore is located in North central part of Maryland state, on the Patapsco River, 40 miles (60 Km) North East of Washington D. C. and 75 miles (125 km) South West of Philadelphia (Holcomb, 2005). The city lies in a humid sub-tropical climate zone and experiences very high humid summers around July and warm winters around January (Ogle, 1996). Baltimore towns were founded in the 17th Century as commercial ports. The town was established on July 30, 1729 and was named after the first proprietary governor of Maryland province Lord Baltimore (Holcomb, 2005).Baltimore grew rapidly from â€Å"mid to late 18th century as a granary for sugar-producing colonies in the Caribbean† (Ibid, 2005). Since the distance of Baltimore from the Caribbean is shorter as compared to other large ports such as New York City port and Boston, it was popularly used because it reduced transportation time as well as reduced spoilage of goods (Starr, 1991). After the British forces had burnt down Washingt on DC, they invaded Baltimore in 1812 but the US forces won in that war (Ogle, 1996).Afterwards, development grew explosively due to increase commerce in America and abroad. This lead to construction of federally-funded National road, privately-funded Baltimore and Ohio railroad (Oslon, 1997). This boasted Baltimore as a major shipping and manufacturing centre (Ibid, 1997). On February 7, 1904, great Baltimore fire gutted down more than 1,500 buildings in about 30 year and brought down city to ruin (Ogle, 1996). But two years later, through the help of city council the buildings were set back. The city grew in area as more suburbs were founded (Higham, 2004).From late 1970s, the Inner Harbor was revitalized in a bid to modernize the port to increase the capacity and make it more competitive (Ogle, 1996). In 1979 the Baltimore convention centre was opened (Higham, 2004). In 1990s it was revamped and expanded as it became a major tourist destination. In the 21st century there has been development of Inner Harbor with sites like sport centre, ESPN Zone and Baltimore World Trade Centre (Martin, 2003). During the 19th and 20th centuries, Baltimore served as a ship building and transportation hub for the Mid Atlantic states due to its large natural harbor.In the 20th century, the city competed vigorously with New York and Philadelphia in developing and maintaining large port facilities to attract merchants (Oslon, 1997). Baltimore port which was originally developed to â€Å"transport crops, today the port moves more than 30. 6 million tons of cargo annually from automobiles to zinc† (Anuta, 1983). This port has a major economic impact on Maryland state and neighboring states like Virginia, Washington DC and New York (Starr, 1991).The state is an industrious town with motor manufacturing and steel processing forming its economic base and backbone (Ogle, 1996). Nevertheless, shipping and transportation is a major economic engagement due to its strategic locati on as well as its developed and networked transportation system. Baltimore city has a number of interstate highways. These federally-funded state highways link Baltimore with other states (Robert, 2005). There are also two tunnels that pass through Baltimore harbor within the city. These are the four bore Fort McHenry Tunnel and two-bore Harbor tunnel (Ibid, 2005).Baltimore is well served with passenger rail. Amtruk’s trains serve between Baltimore and major cities in US, for example, just outside the city Baltimore/Washington International Thurgood Marshall Airport Rails Station is a renowned traveler’s stop (Oslon, 1997). Besides, MARC commuter rail services connect Baltimore’s two intercity rail stations; the Camden Station and Penn Station with Washington DC’s Union station and stops in between (Robert, 2005). Maryland Transit Administration provides people in Baltimore city with public transit.The bus network in the city is comprehensive and efficien t. Baltimore-Washington International Thurgood Marshall Airport (BWI) and Martin State airport serves Baltimore with air transport services (Anuta, 1983). Baltimore is a preferred transport hub and sea port that is very important to Maryland State as well as neighboring states like New York and Virginia (Higham, 2004). This is because it has a well-defined road network that gives it great comparative advantage. Its deep water port facilities are modernized and handle bulk goods conveniently.There are various advantages of Baltimore port as compared to other ports around that region. These include geographical advantage. Baltimore has interconnected multi-model system of transport and it offers one of the low cost shipping and transportation services (Starr, 1991). It also has well-maintained state roads connect Baltimore to the rest of the US. Baltimore Beltway surrounds the city and other interstate highways connect Baltimore to all directions (Robert, 2005). People can easily make across Baltimore metropolitan area through the city’s extensive local road system.Due to its central location in the densely populated North West corridor of US, Maryland state and Baltimore in particular has geographical advantage over other ports as a distribution centre (Holcomb, 2005). Baltimore can be accessed by overnight tracks that haul goods to major markets of North East, South East and Mid West due to the strategic location (Ibid, 2005). According to Maryland Distribution Council (http://www. mdc. org) the consumer market that is within overnight reach of Maryland state represents a whooping 80 million people (32% of US population), $1.2 trillion in effective buying income (35% of the US total) and $566. 2 billion in retail sales (33% of US total) (Anuta, 1983). According to MDC the private haulers number over 5,000, common and contract carriers that serve within Maryland and its environ (Ogle, 1996). Baltimore port handles in the ranges of 30. 6 million tons of c argo every year and it is ranked number one in Poll-on Roll off cargo in the East coast (Starr, 1991). Another comparative advantage is the technological advances in the port that has computerized its operations.The port boasts the use of Electronic Data Interchange (EDI), hand held computers, computerized gate computers and scanners which in a great way have had a positive impact on the efficiency and effectiveness of the port (Ogle, 1996). Economically, Baltimore has large skilled labor force that is important in running of its vibrant economy. It has large tracks of warehouses, that is, over 23 million square feet and cold storage space (Starr, 1991). It has developed in service industry and has comprehensive international banking services (Robert, 2005).Baltimore still has other comparative advantages over other ports surrounding it. These include excellent inter-model connections by water, rail and tunnel, rail service that is on-dock at all terminals provided by CSX and Norfol k Southern, is rated as one of the safest and most secure ports in the world, presence of advanced and electronic cargo data system which makes the process of clearing and forwarding efficient and time-saving, cargo consolidation, export parking and crating services. It also has excellent tracking services whether it is a local dray or a long haul (Robert, 2005).Baltimore harbor’s importance to neighboring states like New York City and Virginia are numerous. With the well-maintained interstate highways one can drive to Baltimore from New York City for only two hours, and less than one hour from Washington DC (Higham, 2004). There are also options to use trains or fly into the city. The city offers exciting tourist destination. Ellicott City is a charming village with restored historical sites with art galleries, quaint shops, gift shops and restaurants (Ibid, 2004). Baltimore offers a great investment destiny for businessmen and businessmen have identified the city for invest ment.Investors from New York and neighboring states are investing in hotels, transport and other services (Ogle, 1996). The Baltimore port ahs become a magnet for development that has spread outside the city to nearby states like Virginia (Oslon, 1997). This is because of the ability to handle large bulk of goods that are shipped into these states for development and also serving as exporting port to these states economies (Starr, 1991). The Baltimore port has contributed to growth of nearby regions such as Virginia and Philadelphia through provision of jobs.Direct related jobs, induced and indirect jobs have increased due to increased cargo movement in the port (Holcomb, 2005). Out of these 16,500 are direct jobs and about 34,000 induced and indirect jobs and other jobs that are directly related to activities at the port in nearby states are in hundreds of thousands (Anuta, 1983). Through taxes paid by businesses that engage in shipping, handling, transporting, importing and export ing goods, Maryland State and neighboring regional states, get tax revenues that greatly help them fund their budgets (Higham, 2004).Baltimore port has enabled growth of service sectors in Maryland state and other states (Oslon, 1997). These sectors that developed include banking, insurance, admiralty, law, maritime services, consignee service and surface transport (Ibid, 1997). This has impacted an increased business income of participants like national trucking firms, freight forwarders and bankers. The value of the port of Baltimore to neighboring states has increased due to increased due to increased cargo moving via the port into these states (Martin, 2003).Through the port goods are exported and imported into these states that generate about $50 billion of their economic activities in 2007 (Ibid, 2003). Some of the challenges that Baltimore port faces is environment degradation due to material waste disposal (Starr, 1991). However, legislation was passed to control waste of dr edge materials. Environment Trust Fund was set up to fund building of a site for the disposal of the material dredged from the shipping channels leading to Baltimore harbor (Anuta, 1983).Environment impact statement was prepared after public hearing, where citizens proposed provision of commercial shipping by maintaining channels approaching Baltimore port, which in turn saw an outright prohibition to open water disposal and recycling of waste for agricultural and other purposes (Robert, 2005). Traffic congestion is another challenge that faces the city and Maryland state in general. There was a bill that proposed state local and regional transportation plans to reduce vehicle mileage by at least 10% by 2020; however the US senate rejected the proposal (Holcomb, 2005).The assembly has approved removal of the annual state sidewalk funding capital which amounts to about 2 million dollars which will see increased funding of state in sidewalks that will manage transport in the city stre ets (Oslon, 1997). Crime situation in the state is a major challenge to this city port (Anuta, 1983). The crime statistics for 2005 revealed approximately 269 homicides which is about seven times the normal rate (Starr, 1991). Generally overall crime rate have worked hard to reduce crime activities and give the city a safe environment (Martin, 2003).Conclusion Baltimore port is a very important not only to the Maryland state but to the whole region. This port serves as a major entry and exit point of goods and people from Atlantic to Mid West and the whole of United State. Its strategic geographic location has given it a comparative advantage over rival ports. Many of businesses around the region use these ports to export or import their goods as it is cheaper considering the short distance to the coast. Increased activities this port has translated to economic growth in the region.The impact of the use of the Baltimore ports on the regional economies can be identified in sectors su ch as, tourism sectors, transport and haulage sectors, banking and other financial service sectors as well as public sector. More service industries are developed in Maryland and nearby estates to support the growth brought by enhanced use of this port. Despite these positive influences the use of ports has on the region there are some negative impacts that can be identified as having came out of the use of the ports.Drug importation through these ports has been a challenge not only to this state but to the whole nation. Drug barons use this as sea entry point to US market. They disguise their consignment as legal trade goods to get clearance and access to their intended markets. Maryland Port Authority has stepped up and taken measures like use of scanners to scan contents in containers and use of drug detectors. The state security forces together with federal security agents should help reduce crime in the city.Insecurity has been recognized as a major force that can greatly decel erate the rate of development in the city. Investors flee areas that they know their investments are not safe. Maryland Port Authority should implement ways of improving harbor management and services for instance, ensuring that there is sufficient safety from hazards like fire, theft, accidents in the work place as well as ensuring that information technology system is up-to-date and fully functioning.In turn, this will radically enhance Baltimore harbor transportation network, thus reducing obstacles such as delayed transportation, drug trafficking and traffic congestion. References Anuta, Michael J. (1983). Ships of our Ancestors. Baltimore: Genealogical Publishing Co. , Inc. Higham, Eileen. (2004). Tuscany-Canterbury: A Baltimore Neighborhood History. Baltimore: Maryland Historical Society. Holcomb, Eric L. (2005). The City as Suburb: A History of Northeast Baltimore since 1660. Santa Fe, N. M. : Center for American Places. Martin L. Millspaugh.(2003). The Inner Harbor Story. Th e Urban Land Institute. Washington, D. C. Ogle, Maureen. (1996). All the Modern Civilization Baltimore. Johns Hopkins University Press. Olson, Sherry H. (1997). Baltimore: The Building of an American City. Baltimore: Johns Hopkins University Press. Robert C. Keith (2005). Baltimore Harbor: A Pictorial History. Third Edition. The Johns Hopkins University Press. Baltimore and London. Starr, J. (1991). The Port of Baltimore: Off the Beaten Track? Maritime Policy and Management 18, 171-181. http://www. mdc. org

Russia Essay Example | Topics and Well Written Essays - 250 words - 4

Russia - Essay Example Mingst and Ivan, however, argue that the use of conflicting prices was a scapegoat. The actual conflict was due to Ukrainians electing a government in 2005 that was against Russia. The cutting of the gas supply was an indirect way of enacting a sanction to the Ukrainians. Realism best explains Putins behavior. According to Mingst and Ivan, realism is defined as selfish, fearful, and power seeking (79). The main agenda of the realists is to increase their power by either through balance or war. The main agenda of attacking Ukraine was to show Russia’s superiority. Russia aimed to impact into the Ukrainians’ that they should comply with Russia’s demand. Mingst and Ivan argue that Putin uses aggressive and forceful diplomatic measures to other countries as a way to undermine them. With the state of Russia as a superpower, the best way to involve it would be through diplomatic negotiations based on fairness and understanding. If negotiations fail, the international community may seek arbitration. Military support to Ukraine may also be necessary if the former efforts

WConference Question Essay Example | Topics and Well Written Essays - 250 words

WConference Question - Essay Example As such, there is a close relationship between human being and the art and hence the art always has a personal appealing to human. The art mostly reveals, through creativity, the side of the world that is interesting but we cannot see or experience in any other way except through art. Plato agrees with me by stating that it is ill advised for people to indulge in both mimetic and narrative representations in the place of art. As such, he demonstrated that arts are the best way that communicates a message from its originality. I am of the opinion that the art is an inseparable characteristic of the society. It is through art that the voiceless in the society can get a voice. Creativities that is demonstrated by the art explain the type of society the people are living. Every person in th society requires to study humanity and the art. This is because the only way to understand the norms and traditions of a given community is by embracing their arts and culture. A good example of how important the art is is the Nkisi sculpture that unites people in DRC. These arts are integral part of the society and hence humanities should be taught in school ion order to safeguard our

Societal Effects of the War in Iraq Essay Example | Topics and Well Written Essays - 500 words

Societal Effects of the War in Iraq - Essay Example This is a deep cause for concern because the worst people affected by war are people who are directly involved in it like soldiers and their families. It is these individuals which create a society. When they see their environment changing so dramatically, they react to it in very unpredictable ways. In the case of the Iraqi civilians, they will develop a deep rooted hatred for any American. American civilians and indeed the rest of the world have seen this situation as an inhumane attempt by their president to capture oil reserves from Iraq. To make a quantitative understanding of these problems, we can use the attitude measurement technique. Used to measure the change of an object's attitude towards another, this therefore will help us state the factors which have caused a change in the minds of the Iraqi civilians towards Americans and especially George Bush (Farris, 2002). On the other hand, it will also help us determine the causes for the American and global sympathy for the Iraqi civilians. The simple fact of the matter is that the Iraqi civilians have been through a very traumatic experience. Families have been torn apart and children and women have been murdered in huge numbers. This has created an immense form of hatred in the minds of the Iraqis. The Americans on the other hand, being a very well aware and well educated society, value human life.

Ancient Egyptian Art, Painting, and Sculpture Research Paper

Ancient Egyptian Art, Painting, and Sculpture - Research Paper Example Source: http://www.crystalinks.com/egyptart.html Being that ancient Egypt was a religious nation, most of the paintings and sculptures during civilization encompass the goddesses, gods, and Pharaohs.3 These were religious leaders who were considered as divine and they were accorded much respect as they determined individual fate. The ancient arts were characterized by idea according to the outlined order. The arts consisted of clear and precise lines that combined with simple shapes and colors to create some manners of order and top bring balance in the Egyptian nation. Source: http://www.crystalinks.com/egyptart.html Similarly, ancient Egyptian arts had horizontal and vertical lines, which they used in maintaining proportions in the artistic works. The artists maintained both religious and political orders, as they were involved in their artistic works. They also drew figures into sizes not considering the painter’s point of view as it was meant to define the social hierarchy of situations. A good example of this can be depicted by drawing the figure of pharaoh to be bigger in the painting paying no respect to its location.4 It also applies to greater gods and lesser gods. Egyptian sculptures were made of clay, wood, metal and stones. These materials were readily available during the period and they were regarded precious in making sculptors at the time. The use of stones in making sculpture was the most plentiful as it was considered permanent because it is hard and was available in different colors which provided a wide choices. The ancient Egyptian sculptors were very distinctive in its nature in two different ways: it is characterized as cubic and frontal. This is because it takes the form of the cubes or the... This paper stresses that ancient Egyptians arts resembled the actual life situations and nature. They conformed to strict rules which represented their three dimensional forms. Most of the paintings if not all portrayed the figures and images of real life and nature as it was easily noticeable with keen observation. The drawings and paintings were very complete and pretty and they also represented real life situations. ancient Egyptian arts had horizontal and vertical lines, which they used in maintaining proportions in the artistic works. The artists maintained both religious and political orders, as they were involved in their artistic works. They also drew figures into sizes not considering the painter’s point of view as it was meant to define the social hierarchy of situations. A good example of this can be depicted by drawing the figure of pharaoh to be bigger in the painting paying no respect to its location. It also applies to greater gods and lesser gods. Egyptian scul ptures were made of clay, wood, metal and stones. These materials were readily available during the period and they were regarded precious in making sculptors at the time. The use of stones in making sculpture was the most plentiful as it was considered permanent because it is hard and was available in different colors which provided a wide choices. The ancient Egyptian sculptors were very distinctive in its nature in two different ways: it is characterized as cubic and frontal. This report makes a conclusion that the ancient Egyptian arts, paintings, and sculpture play an important role in the life of the Egyptian. The ancient arts have certain characters which makes them distinctive from other forms of arts of other countries. This has made them stand over period and preserve their arts.

Rent Control is Out of Control Essay Example | Topics and Well Written Essays - 500 words

Rent Control is Out of Control - Essay Example Rent control has had the opposite effect of its original intention, to provide affordable housing. Rent control should be abolished in cities where rent control exists, and politicians should be proactive and lift controls with an eye on the economics involved and a deaf ear to the activist hysteria. Rent control results in higher prices for available housing by reducing the supply. Landlords are offered little incentive to build new units that will fall under price control. Tenants have no incentive to move from a low rent situation. Elderly parents whose children have moved away may continue to live in a 4 bedroom unit to maintain the current rental rate long after the space is needed. As the supply shrinks, would-be renters turn to the shadow rental market. This market, which may account for as much as 30 percent of the available housing market, exists outside the rent control laws due to special exemptions or the government's desire to maintain a relief valve for excess demand. However, due to the short supply and high demand, these units may be priced several times higher than the market value. Housing quality also suffers under rent control. Landlords faced with limited rental income are reluctant to make improvements or even do minimum repairs.

A Brief History of Noise Music Essay Example | Topics and Well Written Essays - 1000 words

A Brief History of Noise Music - Essay Example Understanding the truth behind noise music is indeed a practical sense of understanding the roots of music as it is and the connection that it has upon the development of modern music that entertains, informs and establishes the cultural and the traditional evolution of music from then until now. Referred to as atonality and dissonance, noise music is simply the collection of different ‘noise’ created through the plucking, the strumming or the picking of different instruments. Without the sounds created by the said instruments, music could not be given birth to at all. Yes, ‘noise’ is the raw production of sound from the different procedures of utilizing the different instruments that are available for use. Basically, the process of creating the said sound craft paves the way towards a more innovative sense of producing music. Of course, music when first produced is basically a raw compilation of meaningless sounds that could not be directly used by the creators or that of the listeners yet. The innovative ways by which the creators add in the arrangement of the ‘noise music’ and the lyrics that could jive with the rhythm m and the notes of the produced noise music are then recreated along with the said collection of sounds. It is through this that an entire music presentation is completed. The birth of noise music has given birth to a different genre of musical arrangement that is far more different from that of the traditional creations and presentations of sound such as Jazz and classical music. Basically, listeners could actually see through the imposed consideration on the existence of noise music as a particular separation of old music from that of the new genres of music. Noise music are usually more lively, more emotionally provocative and matters as such in comparison with that of the traditional music creations. The pop

A Biography of Kathleen Kenyon, the Renowned Biblical Archaeologist Research Paper

A Biography of Kathleen Kenyon, the Renowned Biblical Archaeologist - Research Paper Example In a recent, somewhat quirky biography, she is described as â€Å"a modest woman who had confidence in her own judgement, a kind woman who did not suffer fools easily, and a pioneer in her discipline who many found insufficiently ‘academic’. She was known for her love of dogs, pink gin, and digging.†1 Kathleen Kenyon was certainly unconventional by the standards of her Edwardian youth, and it is this determination to step aside from the restrictions of convention in her work as much as in her private life which made her such a significant contributor to the field of biblical archaeology. Birth, Education, and Youth It seems that from the moment of her birth, Kathleen Kenyon was destined to follow a career in the field of biblical archaeology. She was born on the 5th of January, 1906, as the eldest daughter of the eminent but rather shy biblical scholar, Sir Frederic Kenyon. The family was an ancient one, with lands in Shropshire; the Greek and Latin scholar Freder ic and his wife had a family home in Harrow-on- the-Hill near London.2 This was an academic household with many books and an expectation that all members of the family would take an interest in things to do with history and the Christian faith. Kathleen’s father went on to take up a post of a director of the British Museum in London, giving the family a connection with all the greatest treasures in British archaeological history. The young Kathleen and her younger sister, Nora, had a conventional upper class childhood with governesses coming to teach them at home at first, followed by attendance at exclusive girls’ schools: first a provincial one during the war, and then the highly academic Saint Paul’s Girls’ School where Greek and Latin were taught to prepare the students for entry into Oxford and Cambridge Universities.3 This was in many ways a charmed early life, so that, despite the events of the First World War, Kathleen Kenyon enjoyed an idyllic ch ildhood and access to some of the best education that money could buy. The moral and religious values of this family along with a tendency towards studious activities remained with Kathleen as she grew into adulthood, and she was a churchgoer throughout her later life. The schooling that Kathleen received and her own hard work at her studies ensured that she was accepted at Somerville College Oxford to study history. This was, as was typical at that time, a segregated institution which looked after the lodgings and welfare of its all-female student population, although students also attended mixed lectures across the whole of the university. The value of such a high status family upbringing was to prove critical in other ways also, because the young Kathleen came to know various eminent scholars and researchers through family connections. This key advantage led to her first experience of actual fieldwork, because she used these connections to get to know expedition leaders and acqui re junior positions on their trips. Excavations In her early twenties, Kathleen participated in an archaeological excavation in what was then Rhodesia (today’s Zimbabwe), and then became part of a team led by the renowned British archaeologists couple, Mortimer and Tessa Wheeler, which was excavating ancient Roman remains at St. Albans in the South of England. The man, Mortimer Wheeler, taught her his methods and became a mentor for her, guiding her to take up the latest scientific methods. This activity was broken off by the advent of the Second World War, in which Kathleen performed the duties as an administrator of the London Institute of Archaeology affiliated to the University of London; she also participated in volunteer activities with the Red Cross

Database Modeling Essay Example | Topics and Well Written Essays - 500 words

Database Modeling - Essay Example It might be important to have alternative contact addresses for students in case of unexpected situations. Therefore, in order to cater for such a situation, we need to create additional tables to handle the addresses. One table named email-address will contain the following fields: id, email address and student-id. Likewise, another table named phone-number will be created containing the following fields: id, phone number, and student-id. Finally, another table will be street-details. This table will have the following fields: id, street-name, city-name, state, and student-id. The four tables created to satisfy the requirements of 1NF. They are also in 2NF since they do not contain any partial dependencies. All fields in each table are uniquely reliant on the respective primary key as 2NF requires (Buxton, 2009). The four tables also fulfill the requirements of 3Nf since all fields present depend on the primary key for their values. The next table that requires normalization is named course-information. This table contains the following fields: Course-Id, course-title, and course credit. This table is already in first normal form since it does not contain multi-valued fields. This table also fulfills the requirements of 2NF since all fields in the table rely uniquely on the primary key. This table also fulfills the requirements of 3NF since each field in that table is dependent on the primary key. The last thing now is to create a relationship between a student and the courses that they take. This can be done by employing a many to many relationships between student-information table and course-information table. In order to accomplish this relationship, another table is required.  

Eulogy Case Essay Example for Free

Eulogy Case Essay The obituary is a section that most newspapers have and despite being buried in the back of the newspaper, is a section of the paper that most people read, at least in passing. Older people read it to see if they can find anyone that they know. Younger people might read it to see how old somebody was when they died or if they are aware of history, to see what famous person might have died. There are also people who are fascinated by others and wish to read what one has accomplished in their life. It is amazing that an entire life can be summed up in a few paragraphs. What else is amazing is exactly who receives an obituary in the paper at all. The small town papers will memorialize anyone whose information they receive from a family member or other source. That person would pass unnoticed except for the kind remembrance of their family members still living. This is not the case in the larger newspapers. The Chicago Tribune, with a readership estimated at just fewer than three million, has limited space and therefore, can only print the obituaries of people who have distinguished themselves in a way that society deems worthy. For the week of February 18th to February 23rd, the obituaries were studied to see exactly who was receiving the posthumous honor of having their name in one of the largest newspapers in the country. The first eulogy is that of Jack Kipp. (1923-2007) (Kates, 2007) The man had humble beginnings in Chicago. His mental and physical deficiencies left him out of service for WWII but yet he found his way onto the Midwest Stock Exchange in Chicago, second only to the New York Stock Exchange in size and influence. Mr. Kipp was a man who straddled both financial classes. Since he worked for the Chicago Stock Exchange, he would accurately be considered among the upper class. This would continue as he helped form another financial firm in the 1970’s and made a good deal of money at this venture. But when he retired, he remembered the people who were not given a chance to reach the heights that he had attained and spend the last 16 years of his life tutoring individuals into earning their GEDs. His son said that he had a desire to help his fellow man and saw this as his chance to do so. So his social status helps him get into the Tribune? He lived a long life 84 years, all of them in Chicago. This is a helpful contributing factor and the fact that he formed his own investment firm was probably the factor which helped to secure his place in the Tribune. Only in the byline does it talk about his volunteer work. This would lead the reader to believe that if he were just a volunteer and did rise to the financial levels that he had, his obituary would not have been found in the Chicago Tribune but perhaps a local newspaper since the Chicago land area is able to support dozens of smaller though, significant newspapers. Another notable obituary is that of Dr. Joan Swift. (1919-2007) Dr. Swift was hired as the coordinator of the child development program at Wilson Junior College. In only three short years, she was promoted to the Dean of Directors in 1968 which is a position that she held until 1983. She grew up in New York but spent the last 55 years in Hyde Park, a suburb of Chicago. Here are two examples where an individual has lived a long life, most of it in and around Chicago and rose to a moderate level of success to which that success was met by a notable duration. The article did not specify her financial background and even though she did rise to a high level within the teaching profession. The headline and byline of the obituary makes the reader believe that simply a teacher would not have been given so many inches of column space unless the duration of his/her tenure was to the length that it was noteworthy. The third and last obituary is of Dr. Kenneth Rehage. (1910-2007) (Jensen, 2007) He was from the area as a professor at the University of Chicago in the 1960’s. This fact alone, on a slow news day would ensure his placement within the obituary section of The Chicago Tribune along with his long life. But what made his life even more noteworthy was the fact that he spent the last half of his life setting up secondary schools in Pakistan. Not only did he set up schools there but traveled there hundreds of times in order to help train the instructors there. Dr. Rehange spoke the language and left his home open to students from Pakistan to stay and consider his home and place away from home. He is remembered fondly by his former students even though he stopped teaching in the 1970’s. Dr. Rehange was not a man of great wealth and the headline of his obituary talks only about his development of schools in Pakistan. In this respect, his social class was a contributing factor but if he was just another rich man who had died, it does not seem probable that his life would have made the obituary section. He was a humanitarian to a degree that is not seen in a day to day basis and that is why he made the Tribune. The Chicago Tribune, reaching a population of millions, has a great deal of space restraint that they have to follow. There has to be a selection process in order to place the obituaries of people who have established their life as one whose death will serve as an impediment to some aspect of Chicago and its surrounding area. The kindly neighbor down the street will not be a likely selection to make the Tribune but would rather be a better fit in any of the local papers in the area. Each of the three obituaries that were described had a 1 inch by 2 inch picture along with roughly 300-400 words used to describe their life. It is impossible for the obituary section to follow this format for every person who dies in Chicago on a given day. So unfortunately, a father who is extremely important to his family as well as his co workers and wife of 50 years, will not be seen as â€Å"important enough† to make the Tribune. He has no great wealth, made no special discovery or contribution to science nor did he hit 500 home runs. But if his family wants him to be remembered in print, most towns will have the space available to detail their loved ones life in print in a way that would honor their humble, though important, achievements. LITERATURE CITED Kates, Joan. Longtime Securities Trader. Chicago Tribune February 19, 2007 Section 3 p. 9 Jensen, Trevor. Helped Develop Schools in Pakistan. Chicago Tribune February 21, 2007 Section 3 p. 11

Diagnosing Co-Morbid Substance Use Disorders (SUDs)

Diagnosing Co-Morbid Substance Use Disorders (SUDs) What do the following have in common: alcoholism, obesity, smoking, drug abuse and compulsive gambling? Until recently, there were thought of as relatively independent and separate problem areas. Psychologists, psychiatrists, social workers, and other mental health professionals have previously specialised in the treatment of one of these behaviours, but few had attempted to extend their therapy and research efforts to cover more than one or two of these disorders. As well as their expertise, specialists in these areas have not worked in concert with one another, or communicated with each other about treatment and research issues. However, several changes have been induced in recent times with the concept of addictive behaviours, and this has led to possible commonalities among these seemingly diverse problems. There is also the increased awareness that workers in each of these areas have much to learn from one another, and that there may be significant and instructive similarities i n aetiology, process and treatment. The interesting similarity among the above mentioned problems has collectively come to be known as additive behaviours. According to Miller (1980) addictive behaviours involve some form of indulgence for short-term pleasure of satisfaction at the expense of longer-term adverse effects. The various substance abuse disorders all involve significant health risks as various chronic diseases. There are enormous social costs of addictive behaviours, both in personal expenditures as non-essentials and costs to the public as health care, crime control etc. The following essay aims to critically review DSM-IV guidelines for diagnosing co morbid substance use disorders (SUDs), the factors that undermine definitive diagnosis of co morbid disorders, and the potential diagnostic changes that could address these issues. In particular this essay shall examine alcoholism which is one form of substance abuse. Attempts shall also be made to investigate the types of research that would act as a support for the criteria and guidelines for diagnosing SUDs and psychosis. Substance use disorder is caused due to psychoactive drug use and may be referred to as a condition arising from the abuse of alcohol and psychoactive drugs. Alcohol and other substances can have varied physiological and psychological effects. Although the effects of alcohol and drug consumption may appear as desirable, prolonged and heavy usage may result in physical harm, dependency and withdrawal problems and long term psychological damage or social harm. For the diagnosis of patients with co morbid psychotic symptoms and substance use disorders (SUDs) the Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV), makes clear distinctions between independent psychotic disorders (bipolar disorder, schizophrenia) and substance-induced syndromes (delirium, dementia etc.). Most substance-induced psychotic symptoms are considered to be short lived and that it subsides with sustained abstinence along with other symptoms of substance intoxication and withdrawal. One of the m ost frequent situations in psychiatric diagnosis are challenges posed by patients who experience the onset of psychotic symptoms during episodes of current or recent psychoactive substance use (Rosenthal Miner, 1997). All major categories of non-organic psychotic disorders in DSM-IV have an exclusion criterion for symptoms that are not caused due to the direct physiological effects of a substance. For patients with SUDs, psychotic disorders can be diagnosed as either independent or having one of the many substance-induced mental disorders. Psychosis forms a feature of this categorisation. When changes occur relating to the pharmacological effects of different categories of substances, the symptoms include – acute intoxication, intoxication delirium, withdrawal, substance-induced psychotic disorder with hallucinations etc (caused due to the use of substances such as, alcohol, stimulants etc.). The only exception is for alcohol-induced pathological dementia. All other substance-induced psychotic mental disorders are considered as time limited (Rounsaville, 2007). Alcohol dependence syndrome according to DSM-IV (APA,1994), is characterised by the presence of three or more of the following symptoms – a strong compulsion to drink; difficulty in controlling either the onset or termination of drinking or the levels of alcohol use; a physiological withdrawal state on the stopping of alcohol consumption or the use of alcohol to avoid withdrawal symptoms; increasing tolerance to alcohol (i.e. the need to consume larger quantities of alcohol to achieve a similar effect as produced originally from smaller amounts); digressive neglect of other interests; and persisting use of alcohol despite awareness of the harmful effects from consumption. Alcohol-related psychosis is a secondary psychosis with hallucinations occurring as the predominating feature in many alcohol-related conditions. These include but are not limited to acute intoxication; withdrawal, after a major decrease in alcohol consumption, and alcohol idiosyncratic intoxication. According to Larson (2008), alcohol is a neurotoxin that affects the brain in a complex manner through prolonged exposure and repeated withdrawal. This results in significant morbidity and mortality. Larson further argues that, alcohol-related psychosis is often an indication of chronic alcoholism. As such, it is associated with medical, neurological, and psychosocial complications. The discontinuation of alcohol rapidly clears alcohol-related psychosis but may continue on later alcohol related exposure. Although distinguishing alcohol-related psychosis from schizophrenia through clinical presentation often is difficult, the general consensus is that alcohol-related psychosis suspends wi th abstinence, unlike schizophrenia. Larson (2008) has also noted that, alcohol-related psychosis lacks the in-depth research needed to understand its pathophysiology, demographics, characteristics, and treatment when compared to alcoholism. According to Rassool (2006) psychoactive drugs are substances which have an effect on the central nervous, as they alter mood, cognitive processes and behaviour. Rassool (2006), states that, the uses of psychoactive drugs are considered illegitimate depending on the social customs and laws of different cultures and societies. In most societies, no adjustments are made in the interest of the use and misuse of tranquilisers, heroine, volatile substances, and stimulants such as amphetamines and cocaine. Legal drugs such as alcohol, caffeine and nicotine are used as a social lubricant and as self-medication, as a means to relieve tensions and anxieties of everyday life. They are also used as a mechanism to ease social intercourse. He further agues that, although there is an increased risk of morbidity and morality, alcohol is actively encouraged and socially reinforced in some societies. There have also been observations that consumption levels are on the rise in most countries and hence , statistics have been obtained for the UK to demonstrate this fact below. According to the NHS Information Centre (2009), an estimated 863,000 alcohol related admission in hospital in 2007/08. This is an increase of 69% since 2002/03 when the alcohol related admission was at 510,200. The statistics bulletin further states that, in England in 2007, the number of individuals who were on prescription items for the treatment of alcohol dependency were 134,429. These were prescriptions that were dispensed in primary care settings or NHS hospitals and those dispensed in the community. This shows a marked difference since 2003 when there were 102,741 prescription items (an increase by 31%). Further findings from the bulletin indicate that, there were 6,541 deaths in England in 2007, and these were directly related to alcohol (an increase by 19% since 2001). Of these alcohol related deaths, majority of the individuals died from alcoholic liver disease (estimate of 4,249). Alcohol misuse related harm is estimated to cost the NHS in England approx. Â £2.7 billion i n 2006/07. As an attempt to ensure a moderately even account of the statistics on alcohol misuse in UK, the Audit Scotland report has been reviewed and provides further evidence of Scotlands growing problem with drug and alcohol misuse. The Audit Scotland (2009) report presents that Scotland has a higher level of drug and alcohol misuse compared to the rest of the UK. According to the report, the levels of alcohol dependency are three times higher than that of England. The report states that estimating the size of Scotlands alcohol problem is not accurate due to lack of national data and under-reporting of consumption. Based from findings from the Office of National Statistics (2002), an estimated 4.9% of the population in Scotland aged 16 and over are dependant of alcohol. The higher prevalence of alcohol dependency is Scotland has been argued to be found due to high rates of alcohol dependency in Scottish women. There were 42,430 discharges from acute general hospitals with an alcohol-related diagnosis in 2007/08. When compared to statistics from the past five years, there has been an increase by 5% in discharge rates (Alcohol Statistics Scotland, 2008). In Scotland, 11% of all accident and emergency attendances are considered to be as a result of alcohol. The busiest time of alcohol-related attendances are recorded as Friday night of Saturday morning ranging between midnight and four in the morning (NHS Quality Improvement Scotland, 2006). Scotland has the highest alcohol-related death rate in the UK with 1,399 alcohol-related deaths in 2007. This is a 75% increase over ten years and over 100% increase over fifteen years (General Register Office for Scotland, 2009). A report from Strathclyde Police in 2007 showed that between April 2006 and March 2007, two-thirds of those in custody at three Glasgow police stations were for violent offending under the influence of alcohol. The reasons for highlighting the statistics on alcohol misuse in UK as well detailed statistics from Scotland is not just to emphasise the ever growing alcohol and drug consumption in the country, but also to understand the common co-occurring psychiatric disorders related with the misuse of these substances. The recent recognition of this co morbidity can be attributed to a number of reasons. Abou-Saleh Janac (2004), state that, the development of drug abuse services was separate from that of the development of general psychiatric services, with little interference between them. Furthermore, the move from hospitals to community care of individuals with severe mental disorders has exposed these individuals to the risk of developing alcohol and drug problems, thereby merely heightening their psychopathology and disability. There is also the high risk of self-harm not just to individuals who are within general psychiatric services, but also those with severe personality disorders with in addiction services. A number of etiological models for co morbidity have been introduced in research. These include – common factor models, secondary substance misuse models, and secondary psychiatric illness models (Mueser, Bellack Blanchard, 1998). According to Mueser et al (1998), the common factors models include common genetic factors and antisocial personality disorder. However, Abou-Saleh Janac (2004) argue that studies have not supported the existence of a common genetic factor in the causation of substance misuse and psychiatric disorders. At the same time, the presence of antisocial personality disorder was shown to be a common factor in substance misuse. They further go on to argue that, patients with sever mental illness and antisocial personality disorder are morel likely to have substance misuse than those with no antisocial personality disorder. Adversity in childhood can seem omnipresent in patients with alcohol misuse who are co morbid with psychiatric conditions. A study condu cted by Langeland, Dralijer Van der Brink (2004), found that childhood detrimental influences such as early loss of a parent, witnessing domestic violence and parental alcoholism, exemplified as variations in types of co morbid psychiatric disorders in men with alcohol dependence. A further study by Mueser et al (2000), in a cohort study involving 325 patients with co morbid psychiatric disorder and substance misuse distinguished the predictors of co morbidity as male, young age, lacking education, involved in criminal activity, conduct disorder, and antisocial personality disorder. Secondary substance misuse models include those of self-medication, alleviation of depression, and super sensitivity. Abou-Saleh Janac (2004), further state that the self-medication model depict psychiatric patients as using specific substances to alleviate specific symptoms. However, this argument has not been supported and psychiatric patients who use alcohol or drugs have worse outcomes. As depression can be associated with a general proneness to addiction and not the use of a specific substance, the alleviation of depression model is more acceptable. According to the super sensitivity model, patients with severe mental illnesses react in a highly sensitive manner to low doses of alcohol and drugs, in particular amphetamines leading to a hasty relapse in the individuals illness. The secondary psychiatric illness model alcohol and drug use disorders are viewed as causing the co morbid mental disorder (Abou-Saleh Janac, 2004). An interesting note about the above stated models is t hat, causality is one-directional. In clinical practice, substance abuse may form both a cause and a consequence of another mental disorder. A mental disorder at the same time may be both a cause and a consequence of substance abuse, thereby creating a vicious circle. In individual cases, multiple pathways of association between substance abuse and other mental disorders may act simultaneously in both directions. A review of certain factors (bio physiological and genetic, socio cultural and psychodynamic) as well as a detailed review of other models (social learning and behavioural) which all put together helps formulate what is known and thought about why human beings come to abuse themselves by abusing alcohol. When split apart, each model explains a part of every abusers problem, together they provide a comprehensive etiological perspective. According to Miller (1980), one of the most obstinate theories of the bio physiological model of alcoholism is that alcoholics and non-alcoholics differ in the rate at which they metabolise alcohol. Identifying such a difference would suggest that the etiological factor resides in the rate-limiting mechanisms involved in the metabolism of ethanol. However, no metabolic studies of alcoholism indicate the existence of such a rate difference (given that the alcohol consumption is kept constant) (Mello Mendelson, 1978). Charles Lieber, claims that alcohol ics have two metabolic routes by which they break down alcohol while non-alcoholics have one (Korsten Lieber, 1979). According to this theory, alcoholics metabolise alcohol differently from non-alcoholics and thus gain the capacity to consume larger amounts of alcohol for longer periods of time than non-alcoholics. Even if such proof were available, there still lie the important roles of environmental, behavioural and socio-cultural factors in alcoholism. Numerous studies have been carried out, suggesting that alcoholism runs in families (Goodwin, 1979). Evidence that genetic factors play an important role in the development of alcoholism has been derived from twin studies, family studies, adoption studies, observations of ethnic differences, and studies of biological risk factors (Goodwin 1979, 1985). Studies of monozygotic (identical) and dizygotic (fraternal) twins generally suggest that there is some degree of heritability in the frequency and quantity of alcohol consumed (Schuckit 1987). Monozygotic twin pairs also tend to show a significantly higher level of concordance compared with dizygotic twin pairs (Schuckit 1987; Agarwal and Goedde 1990). Family studies indicate that approximately 40% of alcoholics have an alcoholic parent (Institute of Medicine 1987), and that the alcoholism rate is significantly higher in relatives of alcoholics than in relatives of non alcoholics (Cotton, 1979; Guze et al, 1986). Alcoholics with a fami ly history of alcoholism tend to begin drinking earlier in life. They also tend to have more alcohol-related problems than those alcoholics without a family history of alcoholism (Cloninger et al. 1981). These data, taken together, suggest that there may well be a genetic component to alcoholism, though its extent and influence of inheritance is not a simple one, as both genetic and environmental factors may be involved (McNeece DiNitto, 2005). The pharmacology and physiology of physical dependence and tolerance to the drugs of abuse continue to be explored, but this model alone cannot adequately define alcoholism. As mentioned earlier, cultural patterns have a profound impact on drinking and rates of alcoholism. Miller (1980), states that although cultural influences can predispose a person to alcoholism, social variables play a major role in translating that predisposition to actual addiction. He further states that cultural influences can operate to maintain alcoholic drinking. For e.g. peer pressure, has a powerful influence on the development of deviant drinking among adolescents (Jessor Jessor, 1975). Social historians have argued that the pervasiveness of social setting-related influences on persons to drink heavily (Zinberg Fraser, 1979). Psychoanalysts explain alcoholism in several ways. Alcoholism is seen by some psychoanalysts as fundamentally suicidal, trying to destroy bad, depriving mothers with whom the person has identified with. Others claim that alcoholics are defining themselves against underlying depression by drinking to oblivion (Williams, 1976). Critics of the psychoanalytic approach to alcoholism, argue that there is no empirical data to support these hypotheses. They also argue that psychoanalysis does not help alcoholics who seek treatment (Schuckit Haglund, 1977). Dynamic theories of drug addiction, describe the addict as a person whose habit represents a return to the oral stage of psychosexual development. As such, dependency needs being paramount, the addict is frustrated with their inability to derive satisfaction of these needs. Inability to meet their oral dependency needs in more appropriate ways, leads the addicts to use drugs or alcohol to obtain gratification. Although the complex psychoa nalytic theory has been simplified to a great extent, it has relatively little impact on the prevailing views of aetiology and treatment. The cognitive behavioural approach views any type of psychopathology as a maladaptive learning process. As such, the central goal of cognitive behavioural approaches is to design techniques through which maladaptive responses can be disentangled and replaced with adaptive responses. The first behavioural explanation for alcoholism was that of tension-reduction. Tension-reduction is based on the hypothesis that, alcohol appears to reduce anxiety. Hence, alcohol is presumed to reinforce drinking by alcoholics. Empirical support for the theory came from earlier studies of experimentally-induced conflict in animals (Conger, 1951, 1956; Masserman Yum, 1946). However, tension reduction has not received universal support (Cappell Herman, 1972; Brown Crowell, 1974). The behavioural effects of alcohol involve a complex interaction of factors. The expectations an individual holds about alcohol effects their behaviour (Pliner Cappell, 1974). Expectancies themselves are complex because it is based on belief systems, prior drinking experiences, the immediate social and physical setting of drinking, dosage levels etc. Such complexity suggests that the potential reinforcing capabilities of alcohol remain uncertain. The social learning model views alcohol and drug abuse as socially acquired, learned behaviour patters that are maintained by numerous anticipatory causes (classical conditioning) and consequent reinforces (operant conditioning). The causes and reinforces may be of a psychological, sociological or physiological nature (Miller Eisler, 1975). The relationship between SUDs and psychiatric disorders pose commonplace diagnostic challenges for both clinicians in treatment settings and researchers in community settings. This is because both SUDs and psychiatric disorders are intermeshed with resemblance of intoxication and withdrawal effects to the symptoms of psychiatric disorders in most patients who come for treatment. Research findings suggests that there are high rates of SUDs amongst individuals with schizophrenia (Regier et al 1990), and even higher rates were reported among samples with first episode psychosis (FEP) (Sevy et al, 2001; Kavanagh et al, 2004; Wade et al, 2004). Addressing co morbidity is clinically relevant because SUD in schizophrenic patients is associated with poorer clinical outcomes (Swofford et al, 1996) and contributes significantly to their morbidity and morality (Rosen et la, 2008). The reasons for high co morbidity between SUD and schizophrenia although poorly understood, are considered to be a n involvement of brain pathways and is likely to be a shared feature in co morbidity that is common to all drugs of abuse (Volkow et al, 2007). The co morbidity of SUD and schizophrenia could also be a direct consequence of the underlying neuropathology of schizophrenia. This may contribute to enhanced addiction vulnerability in individuals by disrupting the neural substrates that mediate positive reinforcement (Chambers, Krystal Self, 2001). The challenge has been to design measures to differentiate three conditions. Firstly, differentiating between expected intoxication and withdrawal symptoms; secondly, being able to distinguish between psychiatric disorders occurring during periods of active substance use. The third measure includes being able to differentiate between psychiatric disorders that are clearly independent from substance use. Prior to the publication of DSM-Iv, there existed no specific criteria for making these differentiations in substance abusers. This gave rise to a number of reliability and validity problems, including low levels of agreement between study groups, even when the same measures were used (Hasin, Samet, Nunes, Meydan, Matseoane Waxman, 2006). Eventually, DSM-IV clarified the guidelines to a considerable extent for differentiating independent and substance-induced disorders. According to DSM-IV, if a psychiatric episode occurs when substance use is insufficient to produce persistent intox ication or withdrawal, it would be diagnosed as primary (independent). Subsequently, substance-induced psychiatric disorders are defined as those that occur during periods of heavy substance use (or remitting shortly thereafter) and that have symptoms that exceed the expected effects of intoxication or withdrawal listed in DSM-IV. Hasin et al (2006), also argue that no study has yet addressed the reliability of the DSM-IV system of differentiating between intoxication/withdrawal symptoms. Disorders whose symptoms exceed intoxication/withdrawal effects and psychiatric disorders that is temporally independent from periods of substance use. In order to create a diagnostic instrument that was reliable and valid for assessment of psychiatric disorders in substance abusers, the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was developed (Hasin, Trautman, Miele, Samet, Smith Endicott, 1996). The pre-DSM-IV PRISM included standardised guidelines and probes to differentiate between organic and non organic syndromes and was administered by experienced clinical interviewers. Hasin et al (1996) conducted a study involving 172 dual-diagnosis or substance abuse patients. The result showed good to excellent reliability for many diagnoses, including SUDs, primary affective disorders, eating disorders, some anxiety disorders, and psychotic symptoms. The need to incorporate the new DSM-IV criteria (including the criteria for substance-induced disorders), to shorten and simplify the interview, and to add assessment of specific psychotic disorders led to the development of the PRISM-IV (Hasin et al, 2006). The PRISM-IV is a semi structured interview. The covers the diagnosis for current and lifetime time frames. These include abuse and dependence (by substance), major depressive disorder, mania, schizophrenia, mood disorder with psychotic features, delusional disorder, brief psychotic disorder, personality disorders etc. The most fascinating feature of the PRISM-IV is that, diagnostic modules can be selected to suit specific research needs. Apart from this, substance use disorders that are unimportant to the research question can be omitted as well. Other than PRISM-IV and DSM-IV, there are various other assessment tools that can be used for the assessment of psychiatric disorders in substance abusers. One such tool is the International Classification of Diseases Diagnostic Criteria (ICD-10). ICD-10 provides specific criteria to differentiate between primary disorders and disorders resulting from psychoactive substance use, but only for psychotic disorders. ICD-10 excludes psychotic episodes attributed to psychoactive substance use from a primary classification similar to DSM-IV. Unlike DSM-IV, ICS-10 does not provide a separate psychoactive substance-related category for any other type of psychiatric disorder. In ICS-10, organic mental disorders exclude alcohol or other psychoactive substance-related disorders. Furthermore, organic mood disorders and organic delusional disorders cannot be used to diagnose episodes co-occurring with heavy psychoactive substance use (Torrens, Matrin-Santos Samet, 2006). Different interviews for psychiatric diagnosis based on DSM-IV or ICD-10 criteria are available for clinical and research studies. These include Structured Clinical Interviews for Axis I disorders (SCID-I) for DSM-IV (First et al, 1997). There exists the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) (Janca et al, 1994) and the Composite International Diagnostic Interview (CIDI) (WHO, 1998). The SCID-IV is a semi-structured interview that allows diagnosis of primary or substance-induced disorders. However, it does not provide any specific guidelines other than those stated in the criteria. The differentiation of primary and substance induced disorders is made on a syndrome level in SCID-IV (Torrens, Matrin-Santos Samet, 2006). A range of clinical phenomena can be assessed by SCAN. A core instrument of the SCAN is the Present State Examination (PSE-10). PSE ratings are coded on score sheets and based on these ratings, a computer program generates ICD-10 and DSM-IV diagnos es. The PSE is a semi-structured clinical examination. The interviewer uses clinical judgment to attribute specified definitions to clinical phenomena using the SCAN Glossary. The glossary consists of a list of definitions of clinical symptoms and experiences (Torrens, Matrin-Santos Samet, 2006). Finally, the CIDI is a fully structured interview design. The interviewers read the questions as written without interpretation (Robins et al, 1988). CIDI relies heavily on the subjects opinion for primary substance-induced differentiation. The CIDI generates ICD-10 and DSM-IV diagnoses. Symptoms attributed to alcohol, drugs, or physical illnesses are eliminated for consideration when making psychiatric diagnoses in CIDI. The method of evaluation used in CIDI is very varied in comparison to SCID-IV, SCAN or PRISM-IV. Torrens et al (2006) argues that, currently, most DSM-IV psychiatric disorders can be assessed in substance-abusing subjects with acceptable to excellent reliability and validity by specifically using the PRISM assessment tool. Having reviewed the statistics, aetiology and assessment of co morbidity in alcohol abuse, the next section is going to analyse the different treatment approaches. One of the biggest problems in the treatment of SUDs is preventing a relapse after abstinence or controlled substance use has been achieved. Whilst there is no general theory of relapse, Marlatt Gordons approach to treatment is based principles of social learning theory, and draws heavily on the concepts of self-efficacy (Bandura, 1977). The approach emphasises on the methods to enhance confidence in individuals to enable them to perform activities leading to an effective outcome. According to self-efficacy theory, individuals who possess a high self-efficacy on their ability to perform a particular task are more likely to initiate and maintain that behaviour (Wilson, 1996). Wilson (1996) argues that the self-efficacy theory has been criticised on a number of conceptual grounds including difficulty in distinguishing betwe en response-outcome expectancies and performance self-efficacy (Lee, 1989). The Stages of change model by Prochaska DiClemente (1983), suggest four stages in the process of change. These include: pre-contemplation (not thinking about cessation); contemplation; action (attempting to engage in cessation); and maintenance (stopped using drug, and attempting to remain abstinent). Wilson (1996) argues that, although this model cannot be considered to be a general theory of relapse, there are opportunities different types of interventions for different individuals. He further argues that theory helps make specific and testable predictions about the matching of individuals for treatments. Other than the theoretical explanations for prevention of replace in individuals with alcohol abuse, there also exists medical treatment and social treatment approaches. Detoxification is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects to offset the withdrawal symptoms. Detoxification treats only the physical effects of prolonge d use of alcohol, but does not actually treat alcoholism. There is a high chance of relapse without further treatment. Various forms of group therapy or psychotherapy can be used to deal with underlying psychological issues that are related to alcohol addiction, as well as providing relapse prevention skills. Miller (1980) states that when problem drinkers are treated, approximately one-third become abstinent and an additional one-third show substantial improvement without abstinence. He has based his findings from short-term studies; however, data from long-term studies suggest that on average only 26% of those treated remain abstinent or improved after one year. A few other treatment strategies for alcohol addiction include aversion therapies, family therapies, controlled drinking therapies etc. To conclude, while progress is apparent in the study of substance abuse; more research is needed on the commonalities and differences among the addictions. Numerous theories have been developed to help explain the causes of addiction, but it is important not to lose sight of essential differences among substances and their effects. Individuals with recurrent or severe and enduring mental illness and co morbidity with substance-misuse have complex needs. This requires the continuing care of specialist mental health services and substance-misuse services. It has been reported that around 30% of those seeking help for mental health problems have current substance misuse problems, and of individuals seeking help for substance misuse, more than half have had a mental disorder in the previous six months (Department of Health, 1998). According to Appleby (1999), individuals with substance-misuse and psychiatric disorders find it hard to engage with appropriate services. He further states th at suicide is a high risk factor amongst this group. The different assessment tools that have been devised by DSM-IV for the diagnosis of co morbidity in SUDs, whether in primary or specialist care should consider how to access appropriate specialist input. Recent studies have examined the relationship

Theories of Third World Development

Theories of Third World Development Post-development calls for development of theories based on the culture and struggles of the people from the Third World countries. Discuss whether or not theories derived from the culture of Third World countries could be free from the problems affecting the universal theories of development and if so how? To begin the discussion on whether or not theories derived from the culture of Third World countries as propagated by post-development could be free from the problems affecting the universal theories of development, it is imperative to understand the concepts of ‘development’ and ‘post-development’. The following table provides a basic overview in the form of comparison, between the two concepts: Development has increasingly become an unsettled concept. From the initial decades of the development era providing a clear agreement on the need for some sort of development, despite an array of positions, we have come to a decade where the status of development has become difficult to ascertain. What makes development knotty is the tension between the universe of those who study the Third World and the universe of those who inhabit this world. Development is touted to be a pervasive cultural discourse with intense consequences for the production of social reality in the so-called Third World. This has been largely due to the problems that are associated with universal theories of development: Authoritarian and specification of goal and processes: Development, by virtue of a universal scale on which it can be measured, leading to the identification of â€Å"developed† and â€Å"less developed† (or â€Å"underdeveloped† or â€Å"developing†) units, specifies the existence of a particular goal (development itself) and dictates the processes needed to achieve that goal, i.e. economic growth, industrialisation, and modernisation through the transfer of capital, technology, and knowledge from the North/West. The fact that these theories are based on one particular conception, which is then assumed to be universal (while ignoring/subordinating other conceptions) they make development authoritarian as they prescribe interventions in people’s lives that these people themselves may disapprove of. Ethnocentrism: Universal development theories entail emulating Western History and are synonymous with Westernization. These theories give a ready-made development recipe from the west and at their heart is the idea that economic growth can be stimulated in any country, by following a US/European model. This recipe was driven by behaviorist, positivist and empiricist approaches in the mould of â€Å"scientific model† that prevailed in western universities and Research Centres and assumes that Western societies as ideal models and are complete in contrast to other societies of the Third World countries, the â€Å"less developed† ones. These theories have been accused for viewing Third world countries as inferior versions of the European countries, because the standards of a good society are assumed to be both universal and identical with particular (European) standards. It is also believed that colonial tutelage gave way to diffusion of development (development aid/proje cts, etc.), but retained the purpose by providing Europe’s past formula for development as the only workable one. In other words, development is like a phoenix rising from the ashes of imperialism. Decontextualisation and Generalization: Another problem with universalization is that it groups all Third World countries into one category and ignores differences among them in an attempt to overgeneralize. Indians, Kenyans, Mexicans, etc. are not seen as being diverse and non-comparable, but as somehow lacking in terms of what has been achieved by the advanced countries. It assumes that all Third World countries have the same problems linked to a lack of capital, knowledge, technology, productivity, institutions, etc. which can be solved with technocratic solutions, unconcerned with politics, relations of power and conflicts of interest, solutions that are rational and that no one can object to. It also neglects the differences between the supposed beneficiaries such as farmers and landless labourers, rural and urban poor, men and women, wage labourers and company owners, ruling elites and marginalised groups, etc. Universal development theories also do not take into account that t he underdevelopment in the Third World is a result of Western Capitalist Explanation. Thus, when their starting points and journeys aren’t the same, how can the future discourse of the Third World ape the past of the First World? The ‘a priori’ approach of development for the developing and underdeveloped make it infeasible as the decision of the route is based on circumstances that are no longer there. For formulating bankable processes of upliftment, it is important that these nations be viewed as very different constructions of societal, economic, political, and cultural structures. Their progress into democratization or economic success will not come from mirroring the histories of the First World but must instead be unique to the needs, cultures, traditions, and prior establishments of each individual country. Exogenous Nature: The theories were developed by a body of so called experts who merely drew from their own personal thinking in their task of changing the Third World countries, making it external. Can a theory or method be forced upon people without first engaging in a conversation with the subject? If so, is the â€Å"product† created from this exercise of value? Can years of lived experience be erased through a series of strategic planning sessions, or campaigns not rooted in any significant way to the reality of the subject being trained or required to participate in the activity? These are the question that the paradigm of post-development answers in the negative. Theories derived from the culture of Third World countries could be free from the problems affecting the universal theories of development because of the following features of post development and thus of these theories: Non-authoritarian with flexible goals and processes: The primary concern of post-development is to look for alternatives to development through an interest in culture and local knowledge by promotion of localized, pluralistic grassroots movements and its strength is in its anti-authoritarian sensibility. It also believes that there are numerous ways of living a good life and every society is free to invent its own and involves responses given by a group of people to particular problems or direct instances of power. Thus, post development is neither imposing a goal nor a process and distances itself from technocratically pre-defined standards and universal models. Therefore, the theories emanating from the Third World within the ambit of post development respect alterity and anonymity in the construction of subjectivities, with each society asserting its right to define its own path. These theories allow the subjects to use their own tools, and to go alone to not only develop answers, but also its own questions. Cultural Relativism: Since these theories are based on the struggles and cultures of the people of the third world countries, local culture, artistic aspects and communal aspirations are often important concerns. These theories are generally deeply interested in the history of their communities and the place they occupy in regional or national contexts. Post-development takes into account people’s self-definitions as a crucial part in its inquiry and tends to create a new awareness of cultural difference, which contributes to the breakdown of ethnocentrism and universal values. Therefore, these theories entail discourses on difference, particularly cultural difference. Contextualisation: Post-development is related to the visibility of the grassroots and entails local contexts. It situates itself within the context of local struggles and the linkages of local people in the world systems, lending it relevance and usability to people of the Third World in their daily lives and struggles. It encompasses a plurality of collective actors and revolutions at the micro level, with their own spheres of autonomy. The theories emerging from the Third World with applicability to the Third World presuppose an adequate understanding of the different social, political and economic structures of these countries and their respective histories. Endogenous Nature: Post-development heavily relies on the knowledge of the Third World countries and this knowledge occupies an important role in the creation of theories for them and the decision making processes. It involves intellectuals from the Third World, alongside grassroots activists. Post-development counters the problems of universalization of development theories by instating faith in theories based on the culture and struggles of the people from the Third World countries, taking into account their needs, wants, desires, histories, structures, etc. An example of a theory arising from indigenous knowledge is presented in Jane C. Horan’s (2002) study of indigenous economic development. In this, female textile producers in the Kingdom of Tonga received money as part of a ‘Women in Development’ aid-funded credit scheme. Though it was anticipated that the loans would be used to produce textiles for the local tourist economy, the women produced indigenous koloa textiles for the Tongan ceremonial economy which, according to Horan, enabled a â€Å"greater range of ideological, spiritual and material gains including cash† (2002, p.206). Though â€Å"the default rate on the loans was low, and the women were engaged in a Tongan notion of development known as fakalakalaka, the funders and the critics of the schemes were either unable to or would not recognise development taking place† (Horan, 2002, p.210). The study acknowledges what people are doing vis-à  -vis what development doctrines expect them to d o. Other instances are indigenous movements originating from the south of Mexico, the south of Colombia, Ecuador and Bolivia, picking up also in Peru because of anti-mining protests. These are social movements in which the indigenous component is stark, but there is also a black, Afro-Latin American component in several countries, and also a peasant one represented by those connected to Via Campesina, a federation of peasant movements who are opposing free trade and the privatisation of seeds. What one needs to understand is that since development and post-development are at the extreme ends of the spectrum, therefore the problems of universalization as seen in development are not seen in the paradigm of post-development due to its highly localized nature. However, post-development (thus by extension the theories propagated by it) has its own set of problems, even though it forces us to confront the failures of the development agenda. Critiques of post-development believe that it overstates its case and neglects all the possibilities of positive development interventions, such as techniques of modern medicine raising health and life expectancy of people, by taking an extremely homogenized view of development. Further, it romanticizes local communities and at times, legitimizes oppressive traditions, and becomes just as paternalistic as the chastised development paradigm. It ignores the local forms of oppression and violence and is accused for being indifferent to the viola tion of human rights. While the movement towards cultural sensibilities that accompanies post development is a welcome shift, the plea for people‘sculture, indigenous culture, local knowledge and culture, can lead if not to ethno-chauvinism, to reification of both culture and locality or people. Furthermore, by propagating thinking local and acting local, it tends to avoid global structures of inequality. Though, the second wave of post-development counters a few of the aforementioned shortcomings by suggesting alternatives like the conception of communal solidarity, direct democracy, social movements, indigenous knowledge, etc. and state that the it is not the aim of post-development to offer a normative, new solution, the loopholes aren’t still completely plugged and will not be till the time a viable alternative to development is proposed by this school of thought. In the absence of a feasible solution put for by it, post-development remains merely deconstructive of an existing paradigm. In today’s world, what is needed is a middle way, something between development and post-development that can incorporate the positives of universalization as well as localization. Till the time such an approach is developed, the choice pertains to choosing the lesser evil of the two. References: Horan, J.C. (2002) Indigenous wealth and development: micro-credit schemes in Tonga, Asia Pacific Viewpoint, 43(2), 205-221.

Margaret Fell Fox Essays -- essays research papers

Margaret Askew Fell Fox In the seventeenth century, a commanding female public minister emerged during the radical religious movement of Quakerism. Margaret Askew Fell Fox was one of the founding members of the Religious Society of Friends, and was popularly known as the "Mother of Quakerism". She has been known less as a minister and more as a founder and provider of financial support then other young women. Throughout this paper I will refer to her as Fell Fox, name she acquired through marriages during her lifetime. Through her struggles and triumphs, radical actions and beliefs, and her desire to worship God, Fell Fox had a significant impact on the world around her. In this essay, I hope to share how Fell Fox’s life, writings, and actions contributed to her radical contribution to life in seventeenth century England. In 1614, Fell Fox was born in Lancashire, England. She was born into the landed gentry, a level of society with both good education and breeding. In her late teens, she married an older man, a highly respected judge, by the name of Thomas Fell. Fell was politically involved in the society and several times was a member of Parliament. During their marriage, Fell inherited a house from his father and he and Margaret lived at the estate. The estate had been named Swarthmoor Hall by Fell’s father. During that time, Fell was often away from home on court circuits. Fell was well known in the region for his hospitality to travelers, and accordingly, the Hall was open to travelers. Fell Fox followed her husband’s desire for hospitality. In June 1652, George Fox came to Swarthmoor while Fell was away on a circuit. (Fox was later credited with being the founder of the Quakers.) When Fell returned home, Fell Fox and their nine children were no longer attending their community Anglican Church. Instead, Fell Fox had deeply involved her family and herself in the â€Å"Principle and Persuasion† that was introduced to her through Fox. We have later learned that the moment Fell Fox met Fox, she changed her religious alliance. According to a analysis of Fell Fox’s works, her conversion from the Anglican Church to Quakerism revealed â€Å"none of the traditional Puritan obsession with self-doubt and self-introspection, while going through a gradual faith-awakening proc... ...aking. Wallingford: Pendle Hill Publishers, 1976. First Feminists: British Women Writers 1578 – 1799. ed. Moria Ferguson. Bloomington: Indiana University Press, 1985. Kunze, Bonnelyn Young. Margaret Fell and the Rise of Quakerism. Stanford: Stanford University Press, 1994. _____. â€Å"An Unpublished Work of Margaret Fell.† Proceedings of the American Philosophical Society. 1986. Ross, Isabel. Margaret Fell, Mother of Quakerism. London: Longman, 1984. Primary:  ¬Fell, Margaret. Margaret Fells Answer to Allan Smallwood Dr. Priest of Grastock in Cumberland. London: 1668 _____. Margaret Fell to John Rouse (her son in law) and Wife, 1st of 8th Month, 1664. London: 1664. _____. A Paper Concerning Such as are Made Ministers. H.W., 1659. _____. A True Testimony from the People of God. London: Robert Wilson, 1660. _____. Women’s Speaking Justified, Proved, and Allowed by the Scriptures. Augustan Reprint Society. Fox, George. A Journal of George Fox. London: 1694. Fox, Margaret Fell. The Testimony of Margaret Fox, Concerning her Late Husband, George Fox; Together with a Brief Account of Some of his Travels, Sufferings, and Hardships Endured for the Truth’s Sake. London: 1964.

Nature and Nurture in Crime and Punishment Essay -- Crime and Punishmen

Nature and Nurture in Crime and Punishment       In the news today there is an article about a high-school boy who brought guns to school and shot several students. The parents of the victims are suing various computer game companies saying that the violent games present shooting and killing people as pleasurable and fail to portray realistic consequences. A representative of one of the companies released a statement saying that this is another example of individuals seeking to elude responsibility that has become so common in our society. This case is not about software. What is on trial is the age-old debate between nature and nurture, which also lies at the center of Fyodor Dostoevsky's Crime and Punishment.    In his dream about the gray nag, Raskolnikov as an unshaped child is innately compassionate; he weeps for horses being cruelly beaten, but already society, in the form of his parents, begins to shape him, to train him, to numb his compassionate feelings for those in pain. His mother draws him away from the window when he sees such a horse pass and his father tells him when the men kill the nag "They're drunk, they're playing pranks, it's none of our business, come along" (59). Already Raskolnikov is being taught to rationalize murder, for all those people who watched and did not interfere are partly to blame as they rationalize that "it's none of our business."    Mikolka, the horse's murderer, also rationalizes his role; first, he defines the mare as property, not as life. Repeatedly he says "It's my goods" (57) while those who object refer to the horse not as an neuter object but as "her." Secondly, he attempts to justify the act through cold reasoning: "I might as well kill her, she's not worth her ... .... Even today as we scan the news we can still find the nature versus nurture issue addressed by Dostoevky still prevalent in our court cases and legal system.    Works Cited and Consulted:    Bloom, Harold. Modern Critical Interpretations. New York, New York: Chelsea House Publishers, 1988.    Dostoevsky, Fyodor. Crime and Punishment. New York: Random House, 1992.    Gale Research Co. Nineteenth Century Literature Criticism. Detroit, MI 1984, Vol. 7.    Kjetsaa, Geir. Fyodor Dostoyevsky, A Writer's Life. New York, New York: Viking Penguin Inc., 1987,    Magill, Frank. Masterplots. Englewood Cliffs, NJ: Salem Press, 1976.    Terras, Victor. Handbook of Russian Literature. New Haven, CT; Yale University Press, 1985.    Timoney, John. Speech on Crime and Punishment. Mt. Holyoke College, November 10, 1994.   

Frederick Douglass Essay examples -- Biography Biographies Bio

In Frederick Douglass' autobiography, Narrative of the Life of Frederick Douglass, An American Slave, he writes about the inhumanity and brutality of slavery, with the intention of informing white, American colonists. Douglass is thought to be one of the greatest leaders of the abolition, which radically and dramatically changed the American way of life, thus revolutionizing America. Douglass changed America, and accomplished this through writing simply and to the point about the "reality" of slavery, told through the point of view of a slave. In a preface of Douglass' autobiography, William Lloyd Garrison writes, "I am confident that it is essentially true in all its statements; that nothing has been set down in malice, nothing exaggerated, nothing drawn from the imagination; that it comes short of reality, rather than overstates a single fact in regard to slavery as it is" (Douglass, 6). This statement authenticates and guarantees Douglass' words being nothing but the truth. Douglass' enslaved life was not an accurate representation of the common and assumed life of a slave. He, actually, often wished that he was not so different and had the same painful, but simpler ignorance that the other slaves had. It was his difference, his striving to learn and be free that made his life so complicated and made him struggle so indefinitely. Douglass expresses this in writing, "I envied my fellow-slaves for their stupidity. I have often wished myself a beastÂ…It was this everlasting thinking of my condition that tormented me" (Douglass, 53). In his narrative, Douglass does generalize to relate his experience to that of other slaves, creating a parallel between his life and the life of any other slave. He writes about the brutality, physi... ...edge. In his narrative, Douglass layers the many brutal, cruel, inhumane, and true components of slavery in his life, underlying each story with a political motive and relation. This method of writing was for his audience removed from slavery, those ignorant of slavery, uninformed, misunderstood, and those who were fortunate to have freedom. Douglass illustrates living conditions, experiences, tragedies, and struggles to great depths. Everywhere, African Americans escaped the binds of slavery due to Frederick Douglass' determination. He revolutionized America, being one of the greatest leaders of the abolition, being the reason for so many freed lives, and leading to the complete abolition and illegality of slavery in America. Works Cited Douglass, Frederick. Narrative of the Life of Frederick Douglass, An American Slave. Boston: The Anti-Slavery Office, 1845.

Medical Tourism : Introduction

During the past four years, the market grew at a whopping rate of 20-30% and is expected to grow further. Considering this growth the current market size is estimated to be $100 billion. Medical Tourism industry offers tremendous potential for the developing countries because of their low-cost advantage. The advantages of medical tourism include improvement in export earnings and healthcare infrastructure. Many people in westernised world are accustomed to visit other nations which can offer medical treatment and very economy rates.In other words high quality health care treatments can be best available abroad at a very affordable prices (Herrick, 2007). Medical tourism has been very popular among the nations like Thailand, Philippines, Malaysia, India, Cuba, South Africa, Singapore etc (Bookman, 2007). In order to realize the full potential of the industry, it is imperative for these countries to develop a strategic plan for coordinating various industry players –the medical practitioners, private hospitals, policy makers, hotels, trans portation services and tour operators.This report presents the strategy that needs to be implemented by India, one of the key destinations for Medical tourism, in order to achieve industry-leadership. The reason for rapid growth of the medical tourism may be attributed to long waiting lists, opened channels for a high quality treatments etc (Carrera and Percivil, 2008). The Medical Tourism Industry in India is poised to be the next big success story after software. With a great information technology (IT) hub in India, it has got great potential for medical tourism (Connell, 2006).According to a Mckinsey-CII study the market size is estimated to be Rs. 5000-10000 Crores by 2012. The key concerns facing the industry include: absence of government initiative, lack of a coordinated effort to promote the industry, no accreditation mechanism for hospitals and the lack of uniform pricing policies and standards across hospitals . 2. 0 Aims To analyse business strategies of medical tourism industry and based on the data analysed necessary recommendations are provided in order to develop the efficacy of the this industry in India. . 1 Objectives * To explore the field of medical tourism and different business strategic approaches followed by other developing nations * To analyse the current position of Medical Tourism in India * To evaluate business strategies thrusts for the future * To provide necessary conclusion and recommendation. 2. 2 Scope of the study: There has been a considerable improvement in medical tourism all over the world. However, the developing nation like India needs to develop its own areas to contribute more towards medical tourism.The research had found suitable hypothesis for this study which will be helpful to be tested and effectively practiced in India. The conclusion may provide additional plans for the sustainability of medical tourism in the state. 3. 0 Reasearch Methodology Res earch helps in exploring the new things in certain area of interest and enhances the knowledge (Jenkowicz, 2003). It helps in analysing the conflicts in that particular area and tries out in finding some solutions for a particular conflict. It is the logical and systematic exploration of particular area of interest (Collins, 2003).These acts as template for carry out research. This further enhances the quality of the research (Malhotra, Birks, 2005). Research design can be classified as follows: Figure 3. 1: research design (Malhotra and Birks, 2005) The current study primarily focuses on the business strategies medical tourism in India. An exploratory research is adopted for this current study whereby the key problematic area is not yet identified. On the other hand the conclusive design has only very confined or specific hypothesis. This is a complex study which will have a small sample size.Hence the data thus collected can be quantifiable. The questionnaires in case of the descr iptive study are pre-formulated. Of all the different types of studies the cross sectional studies are considered to be the commonest approach. In case of simple cross sectional studies the respondents will be interviewed only one time where as in case of multiple cross sectional studies the two or more respondents will be interviewed at one time. Cohort analysis, which will be categorised under the multiple cross sectional studies, group of individuals will be exposed to equal traits at given time period.There has been a significant difference between longitudinal and cross sectional research however, longitudinal sample remains same unlike of cross sectional research. The size of the smaple will always remain same if both the researches such as casual and descriptive research are equal in representation (Malhotra, 2006). Research methods According to Blaxter (2006), the research skills constituting selection, analytics and presentation of data explore facts through some distortion s of any interested subject. The research methods have been broadly classified.However, critically evaluating the data through further research would be carried out with help of previous research validation. The methods could be in mixed approach such as quantitative and qualitative methods. The researcher understood that there should be a deep understanding of the tools before incorporating it into the research (Grix, 2004). The researcher finds interpretivism as best approach to explore the subject and to identify the data using qualitative research techniques. There are two different types of approaches commonly used such as inductive and eductive approach. The research is purely based on the end result which is much similar to inductive approach so, the deductive approach is eliminated from this research. The researcher is very keen on identifying suitable tools and techniques to derive appropriate research methods and data collections for which a proper research strategy is to be used which would be critically analysed and confirmed through case studies (Punch, et al, 2004). 3. 1 Data collection: It is the important aspect in the research process.All the research tools and techniques used to collect data is performed with subject to personal interaction, focus groups, observation and artefacts. All the data collection are identified with two segments such as primary data collection and secondary data collection. 3. 1. 1 Primary data: All the data related to qualitative and quantitative methods are observed through this technique. In this primary research, questionnaires and semi-structured interviews are considered as important. The researcher chosen closed ended questionnaire which will be more suitable for the research undertaken (Naoum, 2006).Based on the qualitative type, interviews were performed to derive data required for this research. The researcher had chosen telephonic interview which could be more reliable and can provide deep insight data rel evant to research study. All the interviews are preceded with questionnaire to probe the participants based on the response to previous questions (Collins, 2003). 3. 1. 2 Secondary data: The researcher had gone through a rigorous study based on books, journals, online articles and newspapers. Most of research related journals are derived from science direct and EBSC host websites.However, there is a considerable amount of vagueness found by the researcher during the collection of secondary data. The researcher had followed probability sampling technique to use in the current study which could produce accurate results needed for this research (Breweton, 2001).