Two Thumbs Up for Phantom of the Opera Musical Essay Example for Free

Two Thumbs Up for dark of the Opera Musical EssayThe musical play Phantom of the Opera is really extraordinary. The Angel of Music is really a catchy song that put viewers attention on stage. The actors and actresses managed to do their performances with noble skills and enthusiasm. The presentation of design and visual arts added an overall impact on the play. Various points that were highlighted in the play were props, musical score, voicing, choreography, the story and the turn of events. Being up to(p) to see the musical is a once in a lifetime experience. The major characters are well selected and they are credible enough in performing their roles. Most song performances are acted out with richness and smoothness of their voices as they sing and act in the entire stage. The songs were also well selected and no head that it captures the mind and soul of viewers. It feels like they were also in the stage acting out and singing all throughout the show. There are parts of th e canonical scenes that were too fast phased. There are some parts where could have been prolonged to provide a clear and deep meaning of what is intended for the unanimous story.One thing that is nonable is the scene of Mega and Christine as they sing the song Angel of Music. The song has both clarity and ambiguity in a sense. The message of Christine while singing the song exhibited clarity. For once, she was able to show that there is an unseen stranger and this is the angel of music who has been teaching her and helping her excel in singing for the people. This made the audience more endowed to the scene and carefully watches the progress of Christines story. The characters of Phantom and Christine are really amiable.Though Phantoms character is monstrous, it still catches sympathy from the audience because of the way the actor played his part. Same with Christines character who is really well refined and her expressive eyeball are really endearing. Her transition from a sim ple lady to a wonderful woman in the end proven that she is worthy of all enjoyment in the end. The antagonists in the play also did a fantastic performance on their part. Overall acting of the characters made viewers a clearer understanding of the full-length story. They acted out with elegance and professionalism.The lightning and music sets the mood of the audience. Taking an eye off the stage means losing the chance of seeing more surprising moments for the piece. Costumes are knowing with brilliance and freshness to make the audience up to date without loosing the era of British touch. The lights set the mood of the audience along with the music and sound effects to predict future scenes and make them more fasten into their seats. Facial expressions of the actors and actresses made the story more meaningful. It allows audiences to unite with their lamentations and triumphs in the whole musical.Phantom of the Opera has a dramatically and artistically focused story that hinge s on a series of conflicts. Christines character is redefined by her surroundings as well as the new(prenominal) people around her. The musical theme, motifs and textures really depicted the development of the character, attitude and emotion of characters. The creativity and vividness of the musical made it really memorable. Audience willing remain fastened into their seats from the start until the end. It showcased undying effort and enthusiasm of casts and crews.The entire musical was able to put the script into the big picture without sacrificing anything. It revealed the artistic creation of each person on and off stage. The Phantom of the Opera is truly great. The moving performances will never bore any single audience. It keeps the crowd alive(predicate) and makes them feel like they belong on each and every scene. This musical is worthy of your time, money and effort. Given the chance to rate this piece, I will not hesitate in rising up two thumbs. The best words to descr ibe it are perfect, brilliant and magnificent. A stage musical to die for.

Total Rewards versus performance Essay Example for Free

replete(p)ty Rewards versus execution EssayThe aim of this handle is to advice to, the Director of human visions at national Credit Management (MCM) a US based debt collection company, on the proceedsiveness of gist yields strategy in setting to transcriptional performance though reaping, retaining and motivation intellectualcapital. This is achieved through the analysis of a constitutional rewards function which is broken-up in to six segments essence rewards defined, element of total rewards, model of total rewards, its organisational advantages and its linkage with organisational performance. Firstly, this report explains the meaning and objectives of total rewards and then describes the elements i.e. transactional and relational rewards. A model of total rewards is followed which portrays financial and non-financial tenets as well as individual and communal aspects of strategic reward. further it covers the advantages provided to an organisation for the adjud icate of attaining competitive advantage on recruitment, tuition of performance management and integration mingled with human resource strategies and avocation line goals. Lastly, the impact of total rewards strategy is evaluated in scathe of physiological contract with an employee. It includes the theory of motivation, employee commitment and appointee that culminates a sense of responsibility, respect, trust and personal growth, which increased individual performance and seam goals be achieved by creating a performance culture. Thus, a made total rewards strategy bes for the assess individuals bring in an organisation with a capacious range of financial and non-financial rewards which helps them to perform effectively and achieve competitive edge for the organisation. Total rewards defined1.1. Introduction In the era of globalisation/internationalisation deal management has become a signifi weedt task for human resource (HR) unit. At present, in rapidly changing and c ompetitive business surroundings, the role of self- god, engaged, virtuoso(prenominal) and committed employees is increasingly remarkable to achieve business goals and competitive advantage. Performance management and reward strategy atomic number 18 the key element to directly entice individuals performance and ultimately organisational effectiveness within the industry. In recent year some(prenominal) internal and external factors, competitive business environment and developments in the field of reward management has introduced a different and most influential term called total reward.1.2. Meaning Strategic reward can be considered as an approach to the improvement and execution of reward schemes that validates their incorporation and clutch with the business strategy and new(prenominal) HR strategies and that they are in connection with new(prenominal) reward strategies for the benefitof both employees as well as organisation. tally to Armstrong and Murlis (1998) the ess ence of this notion of total reward is to manage reward policies in a path that considers the various components together to support one another to maximise employment satisfaction with the result of their performance. Brown (2001) suggests that strategic reward is a way of thinking and can be applied to any reward matter occurring in organisation to make out how one can create respect from it. A reward scheme directly influences the level of motivation, satisfaction that lends to employee engagement and commitment towards organisational goals.1.3. Objectives/aims The aim of reward strategy is to produce a sensible purpose and guidance and foundation of improving reward policies, experiences and process. It is considered as a base to acknowledge and satisfy employees as well as organisations needs. According to Sibson Consulting (2009) the aims of a total rewards strategy can be determined as follows- coerce business success by attracting talent, engagement and retention Guide e nthronement decisions for the employer while enabling informed choices for the employee Clarify the employer-employee relationshipBuild a distinctive employment brandIncrease the return on rewards and create value for the enterprise Integrate reward and HR policies and processesAlign reward processes to business needsProvide guidance for reward system design and implementation.2. Elements of total rewardsTotal reward is an effective section of a reward system and emphasises to think about all facets of employment experience of value to employees instead of remuneration and employee benefits. The excogitation of total rewards identifies the necessity of getting paid appropriately in terms of pay and benefits and also encourages the significance of rewarding people for the make up they performed, managed and developed in their work environment. It further adds to the performance of an employee value intention that provides an obvious, gripping cause that attracts capable workforce t o remain with the organisation. The components of total rewards are shown in depend 1.0.Figure 1.0 Elements of total rewards.The principle of total rewards mingles with two effective categories of reward as discussed below (Armstrong, 2007) 2.1. Transactional rewards These are tangible rewards and more of financial offerings and occur from transactions between employer and employees in relation to remuneration and pay-out. Such rewards can be imitable by competitors and offered to individual employees in form of base pay, contingent pay and other employee benefits. These rewards are of extrinsic nature. 2.2. Relational rewards Such rewards intangible (non-financial) and are related to work conditions i.e. quality of working life, the work, work-life balance, recognition, performance management and learning and development. These rewards are necessary to intensify transactional rewards and differ in different organisations as they cant be easily copies.As expound above total rewar ds system is a choke of monetary and non-monetary rewards offered to employees that can result in valuable business success in long term. Total rewards approach is a holistic insight of entire reward system to establish incorporation of reward elements in order to drive them so that they jointly support to achieve overall efficiency of reward system. Each component of rewards is sough in a way so that they integrate each other in all ways so that employees can be rewarded and maintain a sense of satisfaction from their work. A total rewards strategy is structured and joint together so that it can maximise the associated effect of various reward projects for employee motivation, commitment and job engagement. 3. feigning of total rewards Towers PerrinThe effective component of total rewards can be concisely presented in the Towers Perrin model of total rewards shown in Figure 2.0. This is commonly used as foundation for the purpose of planning a total rewards approach. It includes of an environment with four quadrants. The upper two quadrants- pay and benefits those represent transactional or tangible (financial) rewards. These are financial rewards are mandatory recruitment and retain employees and can be copied by competitors. On the other hand, other two quadrants which are based on non-financial (intangible) or relational cannot be easily imitated and build both human assets and human development advantage in an organisation. These lower two quadrants are essential to boost the worth of the upper two. When organisations integrate both transactional andrelational rewards strategically it empowers the overall effectiveness to achieve business success. The model makes an important difference between individual and communal rewards precisely in the later case which are result of work situation. Figure 2.0 Model of total rewards by Towers Perrin.As mentioned above that a total rewards concept integrates between financial and non-financial rewards to enhance a reward system, the importance of both considerations is described below 3.1. Financial rewards All monetary rewards those are offered in terms of money and are added up in total remuneration are the financial rewards. Base pay, contingent pay for performance, contribution, competency or skill, pay concerning to service, financial appreciation programs, and benefits like pensions, medical pay and health insurance are the content elements.3.2. Non-financial rewards Such rewards focus on the relational or intangible rewards those are related to people needs for various recognition, accomplishment, accountability, autonomy, influence and personal development. Such rewards are directly influenced by work environment i.e. quality of work life, the work, work-life balance, recognition, performance management and learning and development for personal growth within the organisation. Non-financial rewards can be extrinsic, such as praise or recognition as well as innate if they are incorpo rated with job performance and attention and feelings that the work is valuable. 4. Organisational advantages of total rewardsIn current competitive business environment it must for an organisation to treat their employees with a sense of respect, fairness and ethically. Success of a business lies in the core value of its intellectual and it is necessary to enhance, develop and retain the same to achieve competitive advantage. Kaplan (2005) suggests the following advantages of total rewards strategy 4.1. Congruency The aim of total rewards strategy is that all rewards, including financial and non-financial must complement the business goals and strategies. It provides an incorporated, comprehensive sight of rewards to endorse equivalence and effectiveness of plan and implements, in alliance of business and people strategy. 4.2. Road map for HR specialists An on paper total rewards strategy gives out as a reference guide to human resource managers to develop and compile new programs. Anevaluation helps business executives to get suggestions from HR managers to execute business strategies.4.3. Competitive edge for recruitment In order to attract talent a total rewards strategy helps organisation to differentiate it in a competitive talent pool by attaining competitive edge in terms of recruiting people. 4.4. Improved retention Employment offerings focuses on people value, enhanced commitment and engagement and reduce turnover. They highlight the emotional bond between employee and employer to motivate and retain people. A strategic reward can increase engagement of work force and produce positive results. 4.5. Moderate labour costs A reward policy may enable an organisation to moderate its labour costs by trading off several segments of employment package. This can further flexible employ arrangements which would reduce cost of employment. 4.6. Enhanced organisational performance Within a performance culture, a total rewards strategy can influence employees be haviours which lead to organisational success. A total rewards strategy that satisfies the employee needs increases productivity, employee commitment and engagement.5. Strategic rewards versus organisation performanceAn effective reward strategy attracts people, develops human capital, motivates employee, gains employee commitment and at termination increases employees performance which ultimately results in organisational performance. So far it is covered that a total reward strategy is an important factor in terms of employee recruitment, retention, development of human capital and performance management. It establishes a performance culture and enhances individual performance. Thus total rewards can be directly incorporated to organisation performance though following 5.1. Motivation it an element of physiological contract which encourages, directs and energises a sense to perform extra-ordinarily in want of financial or non-financial interests. hunting watch et al (1990) resea rched that high performance is achieved by well-motivated people who are prepared to practice flexible effort.Total rewards those are practical in deciding the several motivators of employees in an organisation are expected to result to increased employee satisfaction and trigger the desired behaviour which would ignite employees to accomplishment of positive goals by taking exact behaviour which are attractive performance. Further research by Namasivayamet al (2007) through online survey of 1223 US hotels suggested that there is affirmative association between pay and individual benefits and organisational performance. According to Pink (2005) an extrinsic motivation is required in todays work culture. Employees have a hectic chronicle and the only motivation is the needs they have to fulfil which makes a monotonous work-life balance. 5.2. Commitment Commitment can be considered at an attachment and loyalty that employees have for their company.Mowday et al (1982) there are 3 cha racteristics of commitment- 1) A strong desire to stay in the organisation, 2) A strong belief in and acceptance of the value and goals of the organisation, 3) A readiness to exert considerable efforts on behalf of the organisation. According to Walton (1985) traditional control-oriented style of employee management should be replaced by a commitment strategy which enables employees to react best and most creatively. This is possible when they are given higher responsibilities, encouraged and helped to achieve satisfaction from their jobs. 5.3. Engagement Performance of an organisation also influenced by the employee engagement towards the organisational design to obtain desired results though intellectual assets. Reilly and Brown (2008) suggest that a strategic reward process, including both extrinsic and extrinsic reward combination, may help to develop and increase employees engagement. Influence of total rewards strategy on performance by engagement can better demonstrated as m odelled below in Figure 3.0. Figure 3.0 How reward policies influence performance through engagement.ConclusionConcluding the importance of total rewards strategy in context to individual performance and consequently organisational performance, it is necessary for an organisation to introduce a clear and achievable reward scheme. The reward functions like base pay, benefits, learning and development and work environment must be described in a way those can produce benefits to employees as well as organisation. A successful total rewards strategy is the one which is integrated with business strategies and designed considering each element of rewards in reference to employee needs. It must contain proper balance of intrinsic and extrinsic rewards to recruit, employee development, motivate, engaged and committed man power.

Master Bill Software: Advantages and Disadvantages

outgo Bill software program Advantages and DisadvantagesDefinition of Master Bill SoftwareIntroductionThe surrounding environment construction industry has transfigured a lot in the past ten years. They are looking for new ways to contest effectively. Enterprise one of the key factors in success is the ability to quickly adapt to changing environmental conditions, endless innovation, achieves the goal. Organizational intimacy provides this functionality. More specifically, the knowledge of the organization to provide the ability to understand markets and evaluate guest demand, and put them into yields and services by integrating various resources organization. When we move from the industrial age into the geological era of intelligence, knowledge has experience the comp some(prenominal)s core competitive success. The importance of organizational knowledge and the role it increase in km, get hold of appropriate opposite km dodge is crucial. IN the process of project dire ction, it is widely used. Construction is slow however, admit it as a major tool of benefits beyond communication. Transfer of knowledge and cultivation across projects for the construction industry is a major challenge. Most of the work is based on the project construction, as short-term and task oriented, promote culture, continuous learning is suppressed. Subsequently, experts and technical knowledge burn be lost from one project to another place.(2000), and it sack assist the project team between the channelize of knowledge and information, make the breeding of new knowledge innovation.Master invoice softwareWas established in 1981, the number from the practice of investigation, a Master bill always set construction software should be a judgment standard. Since our first microcomputer BQ system, by introducing the worlds first truly Windows 32-bit BQ system in 1997, and a complete e pressing solution development in 2001, Master bill always tried to transcend products and contains the entire solutions.Master bill in upstart years has become the market based on the evaluation, to make our customer service measurement measurement and construction company, which in turn led to the development including CAD survey, combined with field measurement and modeling work. 2005 of Master bill again have the opportunity to go beyond product launch Master bill elite to provide complete solution through the planning and the feasibility of the BQ production equipment casualty final account in a product with a database.A is the most popular products and Master bill after. Master bill after complete BQ production system, the function is all ready, including pricing, cost psycho epitome and bid on more routine.Masterbill3 use project structure Part I), 2) element, iii) reference iv) cost code The classification results with complete bill in most any sequence.Project structure is usually based on the start of the project list, although can be revised later. Cre ate the dimension is assigned to a reference, part of the elements and the cost code combination (dim store) using drop from measuring the window listMasterbill3 tolerates substance abusers to store 15 sets of bidding rate may be as a percentage of the unit, lump, PC, including, rule out, star rates or rate. Price matching characteristics also provides the opportunity to choose another puritanic before a project using the current estimated as the basis of pricing. Once the definition and standard of BQ pricing through cost analysis can be immediately available, when there are multiple tender bidding more routine.Masterbill3 compatible is not only a reference but also includes all of the tools allow the user to make full use of Master bill XML e Tendering standards include track and distribution of soft amendment.Explain the mental process on how to use Master Bill software.Master bill is a complete BQ Production System with fully feathered and including Pricing, Cost Analysis a nd Tender Comparison routines. Master bill uses as Project Structure which is combined together with full categories results in the function to produce bill of quantities in a series of sequence. Parts, Elements, Reference and Cost Codes are included in the Project Structure. Project Structure should be set up at the beginning of a project using the lists existed and it can be corrected later.In the Master bill software, time sings, side casts, sub-totals, deductions and signposting or annotations are the benefits in value to allow the user to use the traditional dim sheet to enter all the dimensions and information. In this software, there is a function that used to dynamically link dimensions by adding on and key dimensions. Since the dimension is dynamically linked, if any correction to the original dimension will be automatically be connected in any dimensions linked on it.Master bill software also provides an effective dim guidance function. The function of dim management can allow the user to reprocess the data in several ways. For example, copy and paste within the project, copy and paste from others project, apply multiplication factor and set all quantities to become zero.In the measurement process, Master bill software enables the user to form Bill of Quantities on it. In generating a bill of quantities the user can bushel in some part in BQ. For example,The sequence of Bill of QuantitiesThe user can choose the sequences available in the software to allow the bill of quantities to be arranged to suit the specific requirements.The selection of measurementThe user can select the component of measurement, such as Parts, Cost codes, Elements and others.LayoutThe layout of bill of quantities can be decided by the user by adding the header, footer, page number, column widths and so on.Master bill software also provide a flexible redaction function, for example, by double clicking on bill of quantities item to see its abstract from here the users can se lect and jump to an indivual dimension sheet for amendment or choose multiple dim sheet to correct their description respectively.Master bill software enables the user to save up to 15 sets of tender rates which including as lumps ums, PC sums, star rates, unit rates and other pricing analysis facilities.The function of Matching Price function also offers the opportunity to choose and alternate(a) tender on a former project to use as a reference for pricing the current estimation.Since the bill of quantities is priced user-defined and standard BCIS cost analysis could be obtained properly and when more than one tender is exist tender comparison steps into composition.Advantages and disadvantages of using Master BillAdvantagesConsignee does not need to deferment or give up in order securing the release of the original, because if this is a bill, it is so, so the goods are released directly.The shipper can save delivery or postage fees, because he can send a copy of the express bill through electronic meansThe most useful group company office in pol and pod and trust business partner.Save the bill of lading stationery.DisadvantagesIt is not the transfer of the bank or other institution cant change my money. Its just a receipt of the goods.Release without security as an original bill of lading and there may be a fraud From the send of view of liner, entertainment agent does not need to look for any original bill or wait for any document in order to release the goods, this can be problematic in some cases, if any reason to stop release loading portJustify other software to be used by QS in preparing a Bills of Quantities (BQ)Build softModeling of the global estimation is commercial software construction and construction. It produces the bill of quantity or detailed cost estimate and plan. Commercial building contractors and it is the main purpose of surveyors, the software success around the world, and constantly improve and upgrade, usually the customer reques ts and Suggestions. Initial estimates can be used in its original form or divided into group is more suitable. Estimate the potential of the subcontractor, can be sent to all the necessary reference and quantity. The subcontractor can even publish and build software price items. Subcontractor electronic item price is the purpose of diminution the time required to enter the information the main contractors computer. It also eliminates the input errors caused by the possibility of error. Revised at the end of the process, estimate the total available. distributively group the difference between the original and revised group always always displayed in the column of add or omit leadership. Management can review to compare and measure the effect of any changes they may want to let the subcontractor construction project group, or method. This is an important part of evaluation and management of a function. Build with soft software provides a clear analysis and comparison, can be combin ed with the assessment team skills and experience, to speed up the personal credit line winning submissions, will create the largest profit.CATO SuiteCauseway technology was established in 1998 for the whole of the clients with a series of software products and services competitive. This is a speedy growing organization currently use in the region of 200 people, the construction industry is the leading software developers. From feasibility to the final accounts, cost management faces are more stringent than any time before a deadline, to provide accurate cost information.Cato suite development closely involved in vocational and professional QS provides powerful support. Cato the introduction of the enterprise is an opportunity to implement the step change in their business processes to provide staff with effective QS desktop.BQ and cost plan created in a controlled environment can rely on and provide information for building a database for future projects and important report in a consistent manor production for the customer.Project Cost ControlCost control at the beginning of the inception, show that in guiding price or cost need phase when a price estimate is an early by the contractor in preparation and bidding process through the completion of project final account and agreement. The architect or engineer will need to consider alternative solutions, meet customer at different stages of the design of the overall goals and objectives. Recommended construction technicians will provide cost comparison of design scheme using alternative materials, also suggested that the design form and the shape of the purchasing cost. Cost control is not stay in the bidding stage, but the last final account and the agreement of the final certificate. Therefore, cash die hard estimation software makes the construction technician records and accurate and faster calculation date drivers. It also provides a better supervision and construction process.Referenceshttp//www.pck.c om.my/site/download/buildsoftbrochure.pdfhttp//www.ukessays.com/essays/information-technology/features-of-measurement-software-in-construction-industry-information-technology-essay.phphttp//shippingandfreightresource.com/how-does-an-express-bill-work-and-what-are-its-advantages-and-disadvantages/http//integratedinformationinconstruction.blogspot.com/2009/11/masterbill-software-for-quantity.html

Health Essays Treatment OCD Disorder

Health Essays Treatment OCD Dis valueTreatment OCD DisorderIntroductionMy look for intention is to compose a literature re forecast aimed at finding the best existing method for the interference of Obsessive-Compulsive sickness (OCD).OCD is an anxiety disorder characterized by intrusive and distressing thoughts, urges and images as thoroughly as repetitive behaviours aimed at decreasing the discomfort caused by these obsessive thoughts.So in order to achieve my research intention I leave alone be comparing and analysing a wide assortment of current and previous literature to distinguish the around favourable treatment method, where advantages outweigh all disadvantages.The key features of OCD as already discussed, entangle obsessional doubt, the need to feel in control, and risk aversion, and these features have pregnant impact on the successful application of both pharmacological and behavioural treatments.Treatment History of Obsessive-compulsive disorderUntil the 1960s OC D was con perspectivered a refractory psychiatric condition, neither psych separateapy nor a variety of pharmacological treatments had proven successful with the symptoms, however since around 1975, much progress has been made in improving the authorization of these treatments. Prior to 1980, OCD was unresponsive to psychotherapy, anxiolytic drugs, and anti-psychotic drugs and had a poor record of success. Today although treatment of this disorder re principal(prenominal)s challenging, the effectiveness of both behavioural and pharmacological therapies has been importantly improved.TreatmentsThere atomic number 18 some(prenominal) methods available for the treatment of obsessive-compulsive disorder (OCD) arguably the most(prenominal) popular of these being regime of antidepressants, either taken singularly or a combination of 2. Also psychotherapy strategies including both behavioural and cognitive treatments where it is common (and often claimed to achieve fracture results) f or the two to be combined, this is cognize as cognitive Behavioural Therapy (CBT).I w feverous then go on to investigate Combination treatments. This being the combination of antidepressants and a CBT treatment to impinge on if a combination of the two is more successful than using either alone.Alternative strategies atomic number 18 available for OCD sufferers and although these are not as successful as somewhat of the already discussed, they are worth mentioning as they can provide relief to patients, also when added to another more established treatment better results may be achieved.I will also be touching on psychosurgery (also known as neurosurgery), and Electro Convulsive therapy, which although are only used in the most extreme cases, are still worth mentioning as, when used, have shown significant efficacy in the treatment of OCD.Pharmacotherapy, the uses of antidepressants for the treatment of Obsessive-compulsive disorder.Currently in the UK only 5 drugs are licens ed for the treatment of OCD, They include the Tricyclic antidepressant (TCA) Clomipramine and the Selective Serotonin reuptake inhibiting (SSRI) antidepressants fluoxetine, sertraline, Paroxetine, and Fluvoxamine which can be collectively labelled as STIs, these STIs represent the cornerstone of Pharmacological treatment in patients with OCD. A good reason for using antidepressants in OCD treatment is that genuinely often there will be underlying depressive disorder.There is a substantial amount of evidence derived from a large number of placebo-controlled clinical trials, to indicate that drugs, which preferentially block the re-uptake of Serotonin, are effective in ameliorating the symptoms of OCD.The evidence in favour of other antidepressants without potent serotonergic properties is poor.Clomipramine was the first operator to receive food and drug administration (FDA) approval for the treatment of OCD, and was also the first medication to demonstrate consistent efficacy in the treatment of patients with OCD (Clomipramine collaborative study group) it has been the most extensively examine medication for the treatment of OCD.Studies in OCD treatment that have compared two antidepressants have been very teentsy and yet an apparent superiority of Clomipramine emerges.In a small three-way study by Thoren et al (94), which compared Clomipramine with Nontriptyline and Placebo, put in there was significant effect for Clomipramine but Nontriptyline break throughed no different from Placebo. However a significant inequality between active treatments is not normally expected unless very large numbers are included in studies.Clomipramine which affects both 5-HT and non adrenalin may be more effective than SSRIs although does have more side make which is the biggest disincentive, these include constipation, dry mouth, tremor and weight gain, however these side personal effects can be used to advantage in patients who cannot deal with the agitation of the SSR IsDuring trials, drop out rates due to side effects from Clomipramine are consistently high than for the SSRIs. (Pata et al 90)Although there are only rare reports of less efficacy, the issue of how long to maintain treatment in the lead a trial off medication has not been swell explored. The only data that exists in this area comes from 3 quite an small-blinded discontinuation studies. All were through with Clomipramine. (Pato, Zohar, Kadouch, Zohar Murphy 1988) in each case, the majority of the patients upwards of 90% had their symptoms return within 4-7 weeks of discontinuing medication.The efficacy of SSRIs versus those of the TCAs, for these indications is unstudied, further research is required richly to assess the place of the SSRIs in the treatment and understanding of OCD.Fluvoxamine has been shown to be significantly better than Placebo and equal in efficacy to Tricyclics such(prenominal) as Clomipramine however Fluvoxamine compared to Clomipramine is found to have f ewer side effects and is a first line agent in the treatment of OCD. much than 50% of patients with OCD are significantly improved after a trial with Fluvoxamine, however not all patients benefit from this treatment- In a single-blind study of Fluvoxamine 6 of 10 in patients with severe OCD were responders on the basis of a clinical rating of much or very much improved.The most commonly inform side effects for Fluvoxamine are daytime drowsiness, nausea, insomnia, and headache. However these seem to be common side effects of all the SSRIs.The effects of Fluoxetine in OCD have been studied in a number of single blind and open trials, and the results indicate that Fluoxetine is effective in reducing the symptoms of OCD these results also appear to be dependent of the drugs antidepressant effect. (Liebowitz et al 1990, Riddle et al 1990)While these studies suggest that drugs with Serotonin re-uptake blocking properties are effective in OCD, they do not bear on which of these drugs may be more effective or better tolerated. Although no such comparative trials have been published, Jenike and associates (1990) indirectly compared Fluoxetine with Clomipramine in OCD symptoms in a recent meta-analysis. The data came from two separate open studies of each compound in OCD, and the special statistical techniques used suggested that Clomipramine had a slightly superior therapeutic effect. Fluoxetine however was considerably bettered tolerated. Fewer data is available on Fluoxetine, ideally more research is needed to better understand its place in OCD treatment.Paroxetine efficacy reports back to Wheaden et al (1993) however a more recent study (Zohar et al 1996) describe that in a 12 week acute trail comparing patients on Paroxetine, Clomipramine and Placebo, only 16% of Paroxetine patients had drug related adverse experiences, compared to 28% on Clomipramine, and although generally well tolerated, there have been some reports of severe withdrawal symptoms, even when don e gradually. This however may be related to the fact Paroxetine is a newer FDA approved agent for OCD, and there have not been as many published findings of its efficacy compared to other agents available.Sertraline has generally shown significant improvement in OCD symptoms when compared to placebo (Greist et al 95), and although Sertraline does have the smallest effect size, with regard to side effects it is well tolerated. However unlike Fluoxetine, Fluvoxamine and Paroxetine there are no head to head trials comparing it to other antiobsessionals.Some advantages of the SSRIs are that they have fewer clinically meaningful interactions, for example, they do not potentiate the effects of alcohol, or other sedatives- (Cooper et al 1989), however as not all of the SSRIs have been tested with all drugs generalisations are difficult.One meaningful global measure of how well medications are tolerated is the number of patients who have dropped out of double-blind trials because of adverse effects. Most double blind studies of SSRIs have had more dropouts among patients treated with tricyclic antidepressants such as Clomipramine. Within the SSRIs the highest dropout rate was associated with Fluvoxamine and the lowest with Paroxetine. While the number of dropouts provides useful information, this variable is also important for the examination of specific side effects.When considering a combination of 2 types of drugs there is rarely any rationale for prescribing together more than one drug from the same general class.Fatalities have been reported following the combination of Clomipramine and Tranylcypromine. Other combinations can lead to adverse effects.TCAs and SSRIs have been tried together but there is a high risk of adverse interactions. If the two-antidepressant classes were to be co prescribed the safest choice would appear to be Citalopram, or low dose Sertraline that have shortsighted or no effect on the metabolism of TCA. (Taylor 95)Triple therapy has also been tried, one example being Clomipramine, Tryptophan and Lithium.When considering Pharmacotherapy treatment failure, comparative dropout rates rather than number of intensity of side effects, may be a good indirect measure of the tolerability of the medication, the results in this regard have been mixed but very interesting.In comparative studies between Fluvoxamine and Clomipramine (Freeman et al 1994, Koran et al 1996) dropout rates were virtually identical with both medications around 15%. However in the meta-analysis conducted by Greist et al 1995 they note that analysis of the pooled multicenter studies revealed the lowest rates of dropout in the Clomipramine group at 12%, followed by Fluvoxamine at 24%.There are some data on the characteristics of patients who are more resistant to treatment or poor treatment responders, but more work is needed in this area. For example, many OCD patients have shown poor rejoinder to Pharmacotherapy in some studies. (Jenike 93, Riccardi et al 92), and more recently (Black, Manahan, Clancy, Baker, and Gabel 97)Psychotherapy in the treatment of Obsessive-Compulsive disorders a Cognitive-Behavioural approach.Research has shown that psychological and social treatment can produce definite and measurable benefits (Kingdon et al 1994).Cognitive behavioural therapy leads to marked improvement in the large majority of clients with OCD who eject the treatment, and has been estimated that between 80/90% of patients will respond to CBT (Abramowitz 97)In Meyers (1966) treatment plan hospital staff actually stopped the patients from performing rituals-this treatment surgical process was labelled exposure and response prevention (EX/RP). However this kind of intervention is no longer typical or recommended. Actual physical prevention is likewise coercive to be use upable-and reliance upon this technique may limit generalizability to non-therapy situations in which staff are non-present to prevent rituals. Although exposure reduc es obsessional distress it is not so effective in reducing compulsions.Exposure and response prevention (EX/RP) is the psychological treatment of choice for OCD. Although other interventions (Cognitive approaches) have received some attention in the literature EX/RP has received by far the strongest empirical support for treating.Despite documented efficacy of EX/RP treatment 25% of individuals with OCD decline to accept this form of CBT. Efforts to understand the factors influencing acceptability of exposure treatment are indicated so that more clients may profit from this powerful remedy.Separate effects of exposure and response prevention for OCD have been examined, treatment that combined both exposure and response prevention was found to be more effective. (Foa, Steketee, Grayson, Turner, Latimer 1984)With non-ritualisers, exposure did not prove oddly effective. Emmelkamp Kwee (1977) noted only 1 of 3 patients showing improvement after 5 one-hour sessions. Although exposure reduces obsessional distress it is not as effective as reducing compulsions. It is generally held that patients with obsessions alone, rather than obsessions and compulsions are more difficult to treat using conventional behavioural procedures. However recent research is inconsistent with this view as patients in 2 studies evidenced some improvement in compulsive behaviour with this technique. (Marks, Crowe, Young Dewhurst 69)CBT has been found to be more helpful than drugs for individuals who apprehend it. About 75% of clients who complete CBT do well both immediately after treatment and in the long run, showing lasting improvement of roughly 65% fewer symptoms on average-also no side effects.Drugs, mainly antidepressants in this condition, are easy to administer and are more rapidly effective than the main forms of behaviour therapy, response prevention and gradual exposure. However unlike drug treatment, once behaviour therapy has been used and shown to be effective, relapse i s much less belike to occur even after treatment is withdrawn completely.A number of other exposure-orientated procedures, such as paradoxical intention, imaginal flooding, satiation, and aversion relief have been found relatively unsuccessful with OCD. Procedures aimed at blocking or punishing obsessions and compulsions such as though stopping, aversion therapy, and covert sensitisation have also been relatively unsuccessful with OCD. (Emmelkamp Kwee 1977, Kenny, Mowbray Lalani 1978) Conversely Victor Meyer treated clients with OCD with prolonged exposure to situations of objects that evoked obsessional distress and prevention of rituals-the treatment was very successful in 10 of its 15 cases. (Meyer 1966, Meyer Levy 1973, Meyer, Levy Schnurer 1974)Another downfall that the literature indicates is that OCD patients who have additional psychological problems are less likely to respond favourably to CBT, these include depression, anxiety or poor judgement, and unfortunately the se often coexist with OCD symptoms.Combination treatments, Antidepressants CBT in Obsessive-Compulsive disorder.As already discussed, effective treatments for OCD consist mainly of Cognitive behavioural therapy and antidepressants. In order to maximise the effects of treatment, antidepressants and CBT are frequently combined in clinical practice, despite the fact that scientific support for this is astonishingly thin.Preliminary findings of a controlled, double blind, multicenter comparison of Clomipramine, exposure therapy and their combination indicate that exposure therapy have stronger effects than Clomipramine-both procedures combined are equivalent to exposure therapy alone. (Foa et al 93) Also Combination of EX/RP was not enhanced by the addition of cognitive therapy (Emmelkamp Beens 1991).However findings by Van Oppen et al (95) show that cognitive approaches compared to EX/RP indicated that cognitive therapy alone was as effective as exposure therapy.A recent meta-analys is (Van Balkom et al 94) showed that CBT was superior to antidepressants on self-ratings, also compared with CBT antidepressants have a higher dropout rate and higher relapse rate after stopping treatment. Thus when given alone CBT is more effective than antidepressants. However meta-analysis have shortcomings, firstly since studies are combined, there is always a mixture of the specific study details such as the way in which treatments were implemented, also studies differ in length, therapist involvement, and strictness of ritual control, leaving many reasons to believe that the results of meta-analysis are not conclusive.Conversely one large multicenter study carried out by the national take of mental health compared 2 forms of psychotherapy with antidepressant drug treatment, all treatments were approximately equally effective over the period of study when mildly ill people were assessed, however, with more severely ill patients, drug treatment was clearly superior to psychothe rapy. (Elkin et al 1989)Third line treatments-Electro compulsive therapy and Psychosurgery for Obsessive-compulsive disorder.If psychosocial and pharmacological treatments do not work, third-line treatment includes Psychosurgery and electro convulsive therapy ( electroshock therapy).Although rarely used electro convulsive therapy (ECT) has been shown to be of benefit in some who failed to respond adequately to Pharmacological or Psychotherapy interventions (Strober et al 98). In many cases there will be temporary amnesia post treatment and mild headache but otherwise ECT is free from side effects. This makes it distinct from the anti-depressants, and it is for this reason that ECT is still used. Studies using ECT however lack any control data that allow a conclusion to be reached about its efficacy.Psychosurgery like ECT has aroused a great deal of controversy.Results suggest that 25-30% of the patients who previously were unresponsive to medication and behavioural treatments are si gnificantly improved after psychosurgery, although should always be considered as a last resort, studies suggest that complications are relatively rare and that neuropsychological and personality surgical process is not adversely effected by psychosurgerySome Conclusions.In sum, there are 2 very good treatments for OCD. CBT seems to produce more improvement than medication, and improvements are more lasting after treatment is stopped. Medication however does take less time and effort in the short run than CBT but may have to be continued indefinitely. Medication is not emotionally challenging but you must tolerate side effects, EX/RP requires determination and is emotionally challenging.With regards to treatment failure Foa et al (1983) argue that it is only when investigation is carried out of the differences between those who succeed and those who fail, that light can be thrown on the mechanisms involved in the treatment and more effective treatment strategies be developed, as it is evident that new and more effective pharmacological and psychotherapy strategies are needed for the treatment-refractory OCD patient.

Dealing with Substance Abuse in Mentally Ill Patients

Dealing with Substance Ab intention in Mentally rickety PatientsAlizah Al-amanIn a course of time the brain has developed in a way to ensure our survival. This survival system incorporates brains uncommon reward system liable for satisfying persons essential desires (Horvath, n.d.). Unfortunately, eye use is operated within these reward systems that engages an indivithreefold in addictive activities. agree to Edward (2000) substance use is the hazardous use of psychoactive substances, including alcoholic beverage and illicit drugs. It is the dep abateency that deteriorates individuals physical and psychical health. Consistent with the continuum of chemically mediated responses, substance use is a maladaptive coping manifested by frequent use and dependence of tobacco, alcohol and illicit drugs (APA 2000, p. 198 Stuart, 2009). WHO reported that globally 3.86 billion people are complex in substance abuse in which US has the utmost prevalence whereas in Pakistan it is prevalent am ong 6.4 million people (Stuart, 2009).If substance use co-occurs with any mental illness its regarded as dual diagnosis. Literature proposes that roughly 50% of the people with psychiatric problems also suffer from substance abuse disorders (chrome et al., 2009). In UK lead quarters of drug and 85% of alcohol service users have mood and anxiety disorders (NIDA, 2007). Its a dilemma that which problem occurred first. However set up factors analogous loneliness, family disturbances, psychological illness, illiteracy trigger substance use in psychiatric clients (Donald Gail, 2009). In my view to resolve the misery of such pain and mental illness people engage in substance abuse which grants them pleasure as highlighted in the below mentioned scenario.On my clinical rotation at C0 ward in AKUH, I encountered a middle aged patient with the dual diagnosis of depression and drug abuse. He was a chain smoker since 30 eld and recently had angioplasty. According to the patient he develop ed gastric ulcers 5 years back for which a local physician prescribed him Inj. Nubain. He wasnt conversant that the drug should be used till certain time as associated with the risk of addiction. Patient continued taking that music and developed addiction. The medication not only littleened his pain but made him calm and relieved during his depressive episodes. After angioplasty he was constrained for not using that drug which results screaming(prenominal) craving. Patient became unmanageable and restless. Then he was admitted in C0 ward but intense craving made his situation worst resulting in tremors, sweating, insomnia, hypertension and mydriasis. When I visited that patient, he verbalized I need drug, am very restless, this craving will end my life so to reroute his mind and lessen his paroxysm, I on with OT members planned to engage that patient in different activities. We taught him some coping strategies and there was a mild change observed in his performance and break after psychotherapy and cooping.Glancing the social context in light of scenario, substance abuse is judged as bad deed because it violets societal norms and values by precipitating ferocious acts, poverty, family disturbances etc. In the above case unmanageable behavior lead the admission of the client in ward. In contrast some communities exemplify acceptability too. furthermore Canadian mental health association (2006) and Steve Susan (2003) proposed the comparable fact that patients with dual diagnosis can provoke violence and peace less situation in a community by sevenfold as well as for those who are caring or living with them. notwithstanding substance use is 65% prevalent in mid adulthood and my patients age was in same age group which predisposed him towards this (Stuart, 2009).Furthermore religion exhibits a fundamental role in an individuals life. In Islam alcohol is forbidden thats why researches highlighted less incidence of alcohol abuse in Muslim society whereas higher incidence in western world (Haider Chaudhry, 2008, p.82). Beside this in Pakistan opioids and marijuana is predominantly abused (UNODC, 2013). Opioid use originally grants relieve in mental illness but its withdrawal encompasses acute depression, chronic craving, tremors, sleep problems, high BP and dilated pupils as evident in my clients case (Stuart, 2009). what is more marijuana also serves as a source for decreasing negative symptoms in schizophrenic clients however in response it exacerbates their suffering (Archives of General Psychiatry, 2011). Survey conducted in Pakistan summarized that 53.6% of the adults smoke shisha (Sameer et al, 2012 Khan, 2010). This percentage illustrates the acceptability of tobacco and shisha in eastern world that results psychosis in individuals already predisposed for developing it (Archives of General Psychiatry, 2011). Bhang use is also predominately practiced in Indian festivities that generate euphoric and hallucinating effects as e ncompasses psychotomimetic substances (Thacore, 1977).In Western world and Roman Catholics drug abuse is more socially acceptable in females but referred unmasculine in males whereas the consumption of alcohol is considered masculine (Donald Gail, 2009). In US the extreme alcohol use is the 3rd leading cause of death and it also precipitates mental illness by triggering depression, euphoria, mood disorders. Its unavailability would end up leading general depressant withdrawal syndrome. Furthermore 43% of people in US are tobacco abuser however roll of tobacco opium is marked deviant (Donald Gail, 2009). Tobacco smoke is twice more common in depressive clients while thrice in schizophrenic patients. Besides granting pleasure it amplifies the chances of lag in psychiatric patients (Ash, 2013). So while assessing the client with dual diagnosis HCWs should take these sociocultural aspects in consideration.When my client tried to drop the addiction, he felt intense craving. Craving is evidently depicted in the light of neuroadaptive model as prolonged use of drugs induces specific alterations in the brain carrell or neurotransmitters which regulate neural drives and grant pleasure. During abstinence neuroadaption consequences in imbalance in brain function which results craving and this craving is accountable for relapse in individuals (Eliason et al., 2007).Interventions for such clients could be executed within individual, institutional and community level. In my patient therapeutic interaction assisted me to perform MSE effectively. Dealing with craving was intriguing nevertheless I taught him some coping techniques, mind diversional exercises. In addition the intervention that can be carried out is drug testing and if the patient has dreadful withdrawal history so referral can be made to detoxification program (Stuart, 2009). Furthermore the nurse should develop awareness about the state and feelings of substance abuser in order to eradicate biasness in caring. Assessment of withdrawal symptoms should be carried out every shift.On institutional level integrated treatment for dual diagnosis verified as evidence based practice (Stuart, 2009). My client was treated simultaneously for both depression and substance abuse. Moreover medicines should be administered to alleviate craving as Methadone was been administered to my patient for plummeting his craving. Moreover individual counseling and CBT prove as a constructive approach for clients refilling and relapse prevention. Since 2000 AAS is also working for the rehabilitation of substance abusers using the same treatment methodologies such as psychotherapy and drug toxification Besides AAS there should be more rehabilitation centers in those areas where substance abuse is more prevalent in order to restore mental health.Community level interventions would embraces the conduction of develop base awareness programs and workshops for eradicating the risk of substance abuse from initi al ages and making individuals realize that substance use is not the accurate coping for alleviating mental illness. exploitation religious and social norms would converse an obvious message for drug avoidance in mentally ill clients to whom religion serves as a protective factor. Moreover campaign against substance use on national level would present as example for people in recognizing the harmful effects of it (Reno et al., 2000). Implementation of strict Governmental policies and legislation on consumption and sale of alcohol and illicit drugs can help in reducing the occurrence of dual diagnosis. Detoxification and methadone charge programs can be arranged in communities with the assistance of governmental authorities (Stuart, 2009 Reno et al., 2000).In conclusion, substance abuse can co-occur with mentally illness which shock an individuals life dreadfully. To get rid of this is difficult but not impractical. Diverse prevention strategies and early detection would assist its control and management. Moreover strong motivation from family, health care providers and especially self can immensely facilitate the individual to cope up and live a better life (Harrison, 2006).

Analysis of A Passage to India by E. M. Forster :: passage india forster essays papers

Analysis of A overtaking to India by ForsterForsters novel A Passage to India portrays a colonial India under British rule, before its liberation. For conveniences sake, Western civilization has created an Other as counterpart to itself, and a set of characteristics to go with it. An us versus them locating is exemplified in Forsters representation of The Other. Separation of the British and the Indian exists along cultural lines, specifically religious/spiritual differences. Savage or ungodly cultures were to be assimilated into or at the least governed by Christians, and converted. The separation between the English and the Indian occurs when the Christian assumes the Indians are an ungodly people, in need of spiritual salvation, a rush along below their own, and entirely unlike them. This was demonstrated historically by the dominance of supposedly inferior races by the Christians (English). Forsters Indians have a seemingly rugged outwards appearance. They are a godless peopl e insomuchas they do non believe in the Christian GOD, even though there are two religions, Hinduism and Muslimism, which thrive in India. This division of Indias religions, as opposed to Englands presumably unifying religion, separates England from India even moreso. Because the Indians do not believe in the Christian GOD, they are unrecognized as spiritual. Religion shapes, if not embodies characterization. The British are British because of their religion, i.e. Ronny Heaslop is who he is because he is a white Christian British male. How he is outwardly polished is a construct of his Christian upbringing. Ronny approved of religion as long as it endorsed the National Anthem of England. (p. 65) His purpose, as was the purpose of English colonialists, was constructed by his Christian beliefs. If Ronny were not English (and for this papers purposes, English is specifically and continually linked with Christianity) he would not exist as a character. He is almost a caricature of wha t is English, and is be wholly by the standards and beliefs of that culture. In contrast, Aziz would not exists if he were not Indian, representing wholly the standards and beliefs of that culture. Forster implies that the division, the Other, is what makes an individual who they are. Spirituality is integral to that existence.The Indian people are further delineated in the Englishs eyes by the description of India itself. The city, presumably a mark of civilization, is a rotting, festering thing that no English colonialist would consider urbane

Starbucks Business Ethics Case Analysis Essay -- Business Ethics

Starbucks Business Ethics Case AnalysisINTRO good issues in business are a common placed every day occurrence that will never cease to exist. We will discuss an estimable issue that involves a large American corporation and its practices when dealing with suppliers of produce that is essential but not solely used by this business. We will play several point of views backed by literary findings that suggest ethical practices may or may not be at hand. BODY Mr. Donald states that integrity of the main lasts of Starbucks is to expose the world to the coffee production/industry in Africa by showcasing African coffee name brands. However, there is evidence that points to the real goal that goal, simply put, is greed. The article Starbucks Seeks The Right Blend of Global Ambition And Ethical Trade, written by Robin Pagnamenta, of the Times Online, in my opinion would be a goal oriented based theory. Last year the American chain operated 12,800 stores globally and earned 6.4 billion dollars in revenues. Further, Mr. Donald plans to open a native of 40,000 Starbucks stores, 50 percent of them outside of the United States. We open six natural stores every day, says Donald. We opened our first in Brazil last week. capital of Egypt opens next week, he continues. Incidentally, Donald was paid $2.7 million last year, a former chief executive of Americas Path mark supermarket chain a distant cry from the salary he earned at that level.Manifested Ground Rules Every thriving company must embrace some sort of code of moral philosophy ground rules which will guarantee its success. In this case, Starbucks wants to promote high standards of practice by selling the richest and aromatic coffees in the world to the ... ...m of discrimination and promote extend to opportunity in all sectors of Starbucks business transactions. We will set down with leadership and emphasize the importance of honesty, integrity and the reason it flows so diligently with this corporation. Our company doesnt subscribe to dishonest practices, such as corruption or fraudulent business dealings. We must hold our selves to the same standards that we hold our employees. Understand that motley in all aspects of our companys daily ventures creates a worldly image and increases ability to fulfill our goal of opening 40000 Starbucks with half being outside the US. CONCLUSIONWith a council in place and clear ethical guidelines established, we are sure that Starbucks will reconsider its current position on coffee trademarks and make way for new and improved trade between us and the whole world.