Standardization And Adaptation Of International Marketing

1.2 standardization vs adaptation Nowadays people always argue should we use the same standard for worldwide or using different strategies for different countries in the modern world. People who are using standardization strategy in international marketing. First of all, the development of the technology had made the world become a village, that means each country and their people are closer than ever before. (David A, 2013) Base on this opinion, the individual markets are not along isolated at all; globalization makes every individual market became a global market, every market can affect other markets. For instance, the U.S. subprime mortgage crisis can not only affect nearly countries like Mexico, Canada, but also affects the worldwide economy. Secondly, the popular culture makes a different country’s cultural mixing as one; because of the development of communication, different country’s culture can also affect each other. For example, you can find so many Chinese restaurants in the UK, but most of them are supplied non-traditional Chinese food which mixing Japanese flavor or Korean cooking method. In their opinion, that means people are easier to adapt new thing than ever before, so they can make a standardization for all markets. Thirdly, the global market had become more open than before. Most countries are opening up their markets, that means the political barriers are becoming lower for international companies which using standardization strategy. (Poulis andShow MoreRelatedStandardization Versus Adaptation in International Marketing2205 Words   |  9 PagesStandardization versus Adaptation in International Marketing Introduction The most challenging decision that a company may face in internationalization is the degree of standardization or adaptation in its operations. The question of standardization or adaptation affects all avenues of a business’ operations, such as RD, finance, production, organizational structure, procurement, and the marketing mix. Whether a company chooses to standardize or adapt its operations depends on its attitudesRead MoreStandardization Versus Adaptation in International Marketing2213 Words   |  9 PagesStandardization versus Adaptation in International Marketing Introduction The most challenging decision that a company may face in internationalization is the degree of standardization or adaptation in its operations. The question of standardization or adaptation affects all avenues of a business’ operations, such as RD, finance, production, organizational structure, procurement, and the marketing mix. Whether a company chooses to standardize or adapt its operations depends on its attitudesRead MoreCritical Analysis of Standardization and Adaptation in International Marketing2462 Words   |  10 Pagesdecision faced by the company to choose between standardization and adaptation in its operations, products or services. It has been one of the important and most popular research topics since 1960s to understand whether standardization is better or adaptation for marketing mix in international marketing. The increasing role of international expansion of business across the borders has also increased the focus of companies towards the international marketing strategies. It is also a biggest challenge forRead MoreInternational Standardization And Adaptation Of Shiseido s Marketing Strategy1944 Words   |  8 Pagesstandardisation and adaptation of Shiseido’s marketing strategy in Chinese and U.K market. The first part is literature review on the topic of international standardization and adaptation. The second part is the main body of the essay. Then last part will give companies some marketing recommendations according to the analysis of internal and external. 1. Literature Review The literature on international marketing tactics debates two significant points of view. Some researchers support the international standardizationRead MoreAdaptation vs. Standardization in International Marketing – the Country-of-Origin Effect9552 Words   |  39 PagesInnovative Marketing, Volume 3, Issue 4, 2007 Demetris Vrontis (Cyprus), Alkis Thrassou (Cyprus) Adaptation vs. standardization in international marketing – the country-of-origin effect Abstract The literature on international marketing presents a confrontation between two mainstream schools of thought regarding international marketing. The one supports the standardization approach and argues that multinational companies’ behavior should be uniform to minimize total costs and promote a globalRead MoreStandardization in International Marketing Strategy Is Doomed to Failure: Literature Review and Methodological Critique1577 Words   |  7 PagesStandardization in International Marketing Strategy is doomed to failure: Literature review and methodological critique. The literature on standardization of international marketing strategy has rapidly increased in amount since Levitt (1983) suggested the main concept that business strategies and their influences on firm performance should be universal through national markets which are very much alike culturally, economically and politically, in spite of limited empirical evidence focusedRead MoreAdvantages And Disadvantages Of Standardized Marketing1597 Words   |  7 Pages Overall, standardized marketing can reduce costs and facilitate the unified control and management of enterprises, which focus on brand development (Katsikeas, Samiee Theodosiou, 2006), while Zou, Andrus and Wayne Norvell (1997) believed that brand loyalty is different from the risk perception of products from different countries, which indicates the adaptation strategy of product and advertising. Both of them have their own advantages and disadvantages (Theodosiou Leonidou, 2003). Due to differentRead MoreInternational Advertising : Theory And Approach925 Words   |  4 PagesInternational Advertising: Theory Approach International advertising is becoming more complex due to the varieties in both the theoretical approach and application. is a complex concept that varies drastically in both theoretical approach and application. The emerging global consumer culture is affecting international marketing theories and in return, international promotional mix decisions. American culture is dominating the global markets due to the use and application of international advertisingRead MoreMarketing Communication Strategies For International Marketing Essay1531 Words   |  7 Pages Generally, two types of market approaches are considered to go for global marketing and those †¢ Global Approach †¢ Customized Approach QUESTION 9: Which strategy will you use for your product-standardization, extension, adaptation and invention? ANSWER: Some of the important product communication strategies used in international marketing are as follows: A product can be marketed abroad only with the help of a communication strategy, which is what conveys the promotional theme to consumersRead MoreInternational Marketing Strategy1738 Words   |  7 PagesMARKETING ESSAY In affluent societies, one observes a growing fragmentation of markets, buyers requesting more and more products adapted to their specific needs. How can we reconcile this fact with the objectives of global marketing that emphasises a strategy of standardisation of products and brands across the entire world? Executive Summary: Companies developing a global marketing strategy must consider its impact and influence on the company. Crucial for development of global marketing strategy

Essay on The General Features of Human Cells - 1736 Words

The adaptation of cells to their functions,their size, and shape 1.THE GENERAL FEATURES OF HUMAN CELLS The cell is the structural functional unit of all known living organisms it is the smallest unit of an organism that is classified as a living and is often called the building block of life .Like ourselves, the individual cell that forms our bodies can grow reproduce, process, information, respond to stimuli and carry out an amazing array of chemical reactions ,as the twenty first century opens we face an explosion of new data about components of cells what structures they contain how they touch and influence each other. The human body is composed of countless millions of units called cells .In an animal like a human there are†¦show more content†¦Granulocyte They are spherical shaped the most numerous of the white cells they destroy pathogens such as protozoan’s or helminths and they medicate allergy and other forms of inflammation. The cell contains many cytoplasmic granules, or secretary resides that labour potent chemicals important in the immune responses .They have a multi lobed nuclei and because of this they are often called polmorphonuclear cells. Granulocytes are subdivided into three categories neutrophils ,eosiophils and basophiles, making up to 50 to 80 percent of all white cells are neutrophils which are often one of the first cell types to arrive at the site of infection, where they engulf and destroy through a process called phagocytosis .Eosinophils and bisophils as well as the tissue cells(mast cells) arrive late .The granules of bisophils and mast cells contain a number of chemicals including histamine and leukotrines that are important in inducing allergic inflammatoryShow MoreRelatedDesigning A New Software Tool Essay1468 Words   |  6 PagesAbstract A new software tool, which aims to interactively discover the micro-organization of pyramidal neurons, has been developed recently. This tool is the PyramidalExplorer which makes possible the exploration of regional differences in the pyramidal cell morphology by integrating quantitative morphological information regarding the cell’s morphology with applied functional models. This tool is known for its navigation within the 3D dataset and for its unique filter and content-based retrieval operationsRead MoreThe Human Body Limits Iron Stores1287 Words   |  6 Pagesiron absorption and the it’s release from storage sites in the body (Haemochromatosis.org.au, 2014). The human body limits iron stores through the HFE protein, however hereditary haemochromatosis is caused by a mutation of the HFE protein in the DNA, means it cannot communicate with the transferrin receptor. As a result, when iron enters the body, the transferrin absorbs the mineral into the cells. Excess ir on is deposited into liver, heart pancreas, joints, sex organs and in the joints.DNA is a doubleRead MoreMobile Phones: Information and Communication Technology1492 Words   |  6 Pagesdevelopments in the telecommunication world. Initially, mobile phones or cellular phones (also known as cell phones) were only introduced as telephones that were portable and their use was not confined to ones premises. Over the years, the way cell phones began to be used diversified greatly when the world moved towards the GSM technology. The GSM was than further developed to incorporate services such as General Packet Radio Service. Then came the 4th generation mobile phones and it was when the concept ofRead MoreVisual Information Processing Paper1592 Words   |  7 PagesPSYCH/64 December 2, 2013 Holly Berry Perception Paper Humans have a unique and wonderful device in how one sees. The eye and brain work together to turn the world into visual data one’s brain can understand and use. There are some eye conditions that inhibit the sight or the recognition of the shapes one sees. Research continues to overcome these conditions as well as to further understand the biochemical reaction that gives humans the sight and understanding one has of visual data. IncludedRead MoreThe Stem Cell Therapy ( Iusct )1641 Words   |  7 PagesIntrauterine stem cell therapy (IUSCT) refers to treatment of a variety of fetal genetic disorders thought transplantation of either allogenic or genetically modified autologous stem cells. Stem cells become incorporated into the recipient tissue to start proliferation and differentiation through their pluripotent or multipotent potential to compensate for the missing or defective protein. This could be useful in treating fetal genetic disorders which are considered to be perin atally lethal or associatedRead MoreDarwin s Theory Of Natural Selection1638 Words   |  7 Pagessurvive longer and transmit more of their genetic characteristics to succeeding generations, than do those that are less well adapted. The following section will cover aspects on which Darwin’s theory was transformative on his society, and also the general feelings of his contemporaries towards his work. Joseph Hooker, a lifelong friend and contemporary of Charles Robert Darwin was the first person Darwin confided in about his discoveries and theories of natural selection. â€Å"Yet Hooker never hesitatedRead MoreA Machine Learning Approach For Emotions Classification1388 Words   |  6 Pagesor opinion mining is the computational study of opinions, sentiments and emotions expressed in text. Sentiment analysis refers to the general method to extract subjectivity and polarity from text.It uses a machine learning approach or a lexicon based approach to analyse human sentiments about a topic..The challenge for sentimental analysis lies in identifying human emotions expressed in these text. The classification of sentiment analysis goes as follows: Machine Learning is the field of study thatRead MoreThe world is going through great clinical developments in the field of medicine and treatment .800 Words   |  4 Pagesfind an end to many diseases And one of the Successful approaches is using originate cells to treat diseases for example Parkinsons and diabetes. So we can say that treatment utilizing stem tissues came to remedy the problem of diseases that medicine could not handle. Even though drugs deal with many illnesses, there is continue to a lot of conditions that treatment could not handle. I really believe that stem cell therapy as an effective alternative for the management of incurable ailments but exactlyRead MoreHow Spreadsheets Can Be Used For Solving Complex Problems1231 Words   |  5 PagesOnce a framework has been completed it doesn’t have to be made again because all of the formulae remain in place. A lot of the spreadsheet uses AutoSum which automatically changes totals when the cells that have been r eferenced change values. You can also use autofill to copy the same formula into the next cell, if a spreadsheet isn’t used then all calculations have be done manually which is not only tedious but time consuming. All information can also be converted into graphs at the click of a buttonRead MoreThe Benefits of Genetic Engineering Essay1108 Words   |  5 Pagesit is crucial to continue research in this field. Todays research in genetic engineering is bringing about new methods for curing and treating major medical illnesses. The Human Genome Project has allowed geneticists to map the genes of human beings. This project is far from complete, as the DNA sequence of humans is extremely long, yet it will eventually show geneticists which genes are responsible for certain inherited diseases. Identified genes could be repaired, resulting in the irradiation

The wilderness free essay sample

Reznor uses images of the Holocaust and World War II, events that people worldwide remember. These events allow Reznor to expand the meaning of his lyrics to people all around the world through universal memories. His lyrics tied to the images of the Holocaust create a deeper meaning and direct the viewer to remember the massacre inflicted on the world by the Nazis, which are memories that stir many a heart to sadness or anger. He talks about trying to forget memories and that the only thing he feels is pain, a vey universal feeling. When he says â€Å"Try to kill it all away, But I remember everything,† it conveys a feeling of desperateness and hopelessness, as a last resort turning to self-inflicted pain in a last attempt to forget the memories that plague him. At the end, the song goes â€Å"If I could start again,† both singers give this line meaning. We will write a custom essay sample on The wilderness or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page For Reznor, the images are tied to his longing to go back and change his use of drugs. For Cash, it was a longing to fix the fact that he focused more on his career than his family, a sentiment that he could not get rid of and that came back to haunt him. The first line of the chorus reads â€Å"What have I become?† For both men, they looked back and realized that they had become the very person that they would have scorned in their past. â€Å"I cannot repair†¦ I will let you down†¦.†

Never Give Up free essay sample

Never give up at anything you do. Giving up is one of, if not the biggest sign of a weak person. When you give up , and Just throw all of your dreams out of the window, and lust forget what all you have sacrificed trying to get where you are today, you are a weak person. I believe that no one should give up, but you need to know when to give up. Myself has actually gave up on one of my best loves I have ever had. Baseball. I was a freshman here at Central High School when It all started. I kept on having family problems, and my girlfriend and I were always fighting.Everything Just never seemed to go my way. Everybody, Including my family and friends, knew that something was wrong, but I Just kept It from them. I have always played baseball, ever since I could walk. We will write a custom essay sample on Never Give Up or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page My big brother would take me outside when I was at age and Just throw the ball back and forth. Rain, sleet, or snow, we were throwing some sort of ball around. Well, anyway as time went on, I got older, Into high school and It seemed Like everything went down hill from there. I had a lot more responsibility and a lot more on my mind.It seemed that everyday was a struggle. Talking to my parents wasnt easy: talking to my friends wasnt easy; I couldnt even talk to my girlfriend. And by the time baseball had came around, I was just exhausted. I signed up and went to tryouts and we did our same routine like we do all the time: jog four poles, do your sprints, and stretch. Well today, coach wanted to see how fast the whole entire team could run two miles. I was like, Oh Lord, I really dont want do this. But of coarse, I did anyway. Well, we started Jogging around the field. But I noticed something that is not normally the case; I was dead last. Everybody was ahead of me, and I was trailing behind them. I did not have one bit of urge to even attempt to catch them. I was being very lazy. The whole week goes by and I am still being the same lazy guy in the back. Finally, tryouts are over and I get to talk with the coach. He calls me out and I walk over there and he says that he had a spot for me in left field on varsity, and he noticed I was super lazy, and that he could tell I didnt have the love for the game that I used too. He handed me the pants and the jersey and the hat and everything that anybody needs to play baseball and told me to take them home. He told me that when I get home, talk with your parents about if you really want to play or not. So, I thought about what he said for a little bit and waited for my AMA to come and pick me up from the base field that I Just worked my butt off trying to clean up. I get in the car. The first thing she said to me was, Case, what Is wrong honey? I didnt really say anything to her at first until we got home. After I got home, I Just let her know that I didnt think I was ready to play baseball. My Mama and Daddy both could not believe It. Their Jaws dropped to the ground. Actually shocked myself. My daddy had to have a talk with me for Like eighteen hours about until he finally said, Well son, I dont want make you do anything that you dont want do. And, If youre serious about not playing, and dont think you will regret in the future, then hang me up. And that was that. I gathered up all of my stuff, my jersey, my pants, my hat and everything and took it all back to the coach the next day. He told me that I probably made the best choice. He also said that he would love to see me come out next year and tryout again after your time off. But, all playing baseball is one of my biggest regrets I have ever had in my life. I am a quitter and I do admit it. But I am strong enough to admit that. So to prevent from going through what all I have, never give up. Never give up free essay sample Never give up At some point In the various Journeys we embark on In our lives, we get to a part where we feel Like giving up. Sometimes we give up before we even start and other times we give up just before we are about to make that huge break-through that we have been putting so much effort in to achieve. I want to tell to all of you that the only valid excuse you have to give up is if you are dead. As long as you are alive you have the choice to keep trying until you finally succeed. Secondly you must be realistic and should know that the the chance of mastering something in the first time is almost on-existent.Everything takes time to learn and you will make mistakes. Learn from them. There Is a well saying that:- Dont be discouraged. Its often the last key In the bunch that opens the lock. We will write a custom essay sample on Never give up or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page I want to tell you that you are stronger than you think. One little setback is not enough to stop you from achieving your goals. Neither are 10 or 100 or 1000 setbacks. You dont want to be known as someone that is weak and gives up. Go out there and prove yourself to the world and to yourself. You CAN and WILL achieve what you set out to do. The only time you fail is when you give up.If someone else can do It then so can you. Even If It Is only one other person In the world that has achieved what you have set out to achieve, that should be reason enough for you to never give up. In life there are going to be many people who will try to bring you down and tell you what you want to achieve is not possible. Dont let anyone destroy your dreams and always believe in your dreams. Let the people you love and who mean the world to you be your inspiration to persist and persevere. I want to tell you that always keep In mind that there are people that are worse than you.Right now also there are many people who are In a worse situation and environment than you are right now. Are you thinking about giving up running 5 miles a week? Think about the people who are unable to even walk and how much they would give to be able to run 5 miles every day. There will always be haters. There will always be plenty of naysayer and people who try to tear you down. Dont pay attention to them and dont take what they say to heart. Let the haters hate and you keep believing in yourself. You deserve to be happy and you deserve to have success. Keep that mindset and never give up until you reach your destination! Ten you feel like you want to give up and you are about to give up when you are so close to making a huge break-thru. Seth Gooding has written an awesome book about this called The Dip that teaches that at any given time you are always Justas heartbeat away from success. If you think youre beaten, you are. If you think you dare not, you dont. If you think youre out-classed, you are; Youve got to think high to rise. Youve got to be sure of yourself, If you ever want to obtain a prize. Lifes battles does not always go, To the stronger or faster man. But, soon or late, the man who wins,

5 Great Tips for Business Writing - Proofeds Writing Tips

5 Great Tips for Business Writing - Proofeds Writing Tips 5 Great Tips for Business Writing Business writing includes everything from dry internal reports to snazzy website copy. But while different situations call for different writing styles, we have a few tips that apply to any type of business writing. Check them out below to find out how they could benefit your company! 1. Tailor Writing to an Audience As mentioned above, business writing is a broad category. This means you should always write for a specific audience. So whether it is a technical report for those in the know or a light-hearted press release for the public, think about who you are writing for and adapt the tone and language to suit. 2. Beware Buzzwords and Jargon Business buzzwords and jargon are not necessarily bad. Sometimes you need to use technical language to communicate something complicated. But take care not to go too far! Packing your writing with jargon will make it difficult to read, especially if you aren’t writing for a specialist audience. And buzzwords can be alienating. It is far better to keep things simple by using everyday language wherever possible. And if you need to use jargon, explain exactly what it means when you introduce the term. 3. Help Your Reader Find Key Details Life is busy. And sometimes that means you don’t have time to read the small print. If you want to make sure your readers don’t miss important information, then, you have to make it easy for them. If you are writing for an internal audience, you may want to include an executive summary. This lets you summarize key details in an easy-to-read fashion, while giving full information in the rest of the document. If writing for a wider audience, use formatting (e.g., bold or italics) and headings to help your readers find the most important information even while skim reading. 4. Keep It Short Write concisely wherever possible. After all, if time is money in the business world, you can’t assume everyone will read the entire 283-page report you sent. So keep it short where you can. If you are writing a longer document, though, always give the main points first. This will ensure that even busy readers see what you need them to. 5. Always Proofread! This is quite possibly the most important tip of all. And we’re not just saying that because we offer an outstanding business proofreading service. Whether or not you choose to work with us (you should), checking your business writing for errors is essential all of the time. Errors in business writing will give a bad impression to customers, clients, and colleagues alike. They can even cost a lot of money if you’re unlucky! And this makes proofreading worth the effort.

5 Reasons Teaching Might Not Be For You

5 Reasons Teaching Might Not Be For You Teaching can be immensely fulfilling work. The idea of shaping young minds and guiding kids toward their own futures (not to mention having summers off) leads a lot of people into the teaching field. However, not everyone is cut out for this kind of work. The last thing you want is to discover that you aren’t up to the task while standing in front of a class your first day on the job. It’s best to decide whether or not you’re teacher material before even pursuing a degree in education. Here are 5 issues that may make you decide that teaching is not for you.1. You’re not adaptable.One plus one will always equal two. The alphabet will always start with A and end with Z. World War II will always begin in 1939. The information you teach may never change, but the way you teach it certainly will. Perhaps your particular administration will demand you rewrite that lesson plan you submitted or the school’s curriculum has changed. Perhaps what works for a cl ass of well-behaved students will not work for an unruly one. A teacher must be able to adapt to any number of predictable and unpredictable situations. If you don’t think you’re sufficiently flexible, then teaching probably isn’t for you.2. You don’t like homework.Your students won’t be the only ones who’ll have tons of homework. A teacher’s workday rarely ends at the sound of the bell. There will be papers and tests to grade and lesson plans to prepare. Excited to have your summers off? Well, don’t get too excited, because your summers will be spent doing professional development work and getting ready for the next school year.3. You are not 100% comfortable with kids.As they say, kids can be cruel. And they don’t just pick on each other. Students may have it in for their teachers as well, and the monkey-see-monkey-do nature of the classroom may lead good kids to mimic the behavior of the bad ones. Before you know it, your class is out of control and it’s your job to rein it in. Some people have an innate ability to do this. They are natural-born teachers. However, if the thought of playing zookeeper to a room full of squealing, nasty (and perhaps even insulting) young people sounds terrible to you, you may want to choose another career path.4. You want to get rich.Do you want to make loads of money? Well, you aren’t going to get rich as a teacher. The average starting salary of a teacher in the U.S. is just $36,000, and teachers can spend hundreds of out-of-pocket dollars on class supplies. That isn’t to say that the job is not rewarding in countless other ways, or that the worth of a job is measured by the amount of a paycheck, but if making bank is your ultimate goal you’ll unfortunately have to look elsewhere.5. You can’t deal with parents.Maybe you love the kids†¦ but the parents? Not so much. This can be a real problem, since a teacher’s job of ten involves managing parents. When it comes to their children’s educations, parents can get pretty emotional or downright out of control. You might have a mom yelling at you or a dad breaking down in tears. Upping the â€Å"ick factor,† a parent might even hit on you. Such situations are tricky to navigate, and you never want to blame the student for a parent’s inappropriate behavior. If you become a teacher because you think kids are a dream and adults are a nightmare, you might be in for an unpleasant surprise when you have to deal with both on a regular basis.

In what sense does modernisation and post-modernity present a Essay

In what sense does modernisation and post-modernity present a challenge for identity and the self - Essay Example There is a great demarcation in identity constructs when comparing the post-modern era to the pre-modern era. The biggest difference is that the post-modern era has been marked with a great deal more impersonality then the pre-modern era. Whereas, in the pre-modern era, an individual could derive a sense of self and identity from their close connections – their neighbors, their churches, their family – in the post-modern era, this changed. Moreover, the role of the man has changed with the advent of the changes that have occurred in the post-modern era. Where he was the sole breadwinner in the pre-modern era, and this is where he derived his identity, in the post-modern era, the man has become less of a breadwinner and thus, according to some views, he became more of a consumer.Therefore, the male identity has changed substantially in this era. The following explains the broad nature of identity, then explains how individuals, in general, have been affected by the post- modern changes, then, finally, how men in particular have been affected by these changes. The nature of identity Identity is a dynamic social product, residing in psychological processes, which cannot be understood except in relation to its social context and historical perspective. (Breakwell, 1986, p. 9). It is a process that is developed over a person's entire life span.. Identity grows across time, but there is a nature of time that must be considered. Inner time is a duration, and is in tune with each person's cognitive rhythms. Martin (1987) references this time thusly - inner time is the realm of subjective consciousness of the individual. As we know from experience, the two may seem inconsistent, as when we talk of time flying or passing slowly. (Martin, 1987, p.199) This concept of time refers to our inner states. Intersubjective time is measured by face-to-face social interactions, by sharing experiences with others, thus moving through time conjointly. By sharing experien ces with others, the interactants come close to achieving a consensual appreciate of their conjoint movement through time. (Breakwell, 1986, p. 21). Biographical time refers to large chunks of time that are meaningful in one's life eras, such as adolescence, childhood, college years, married life, etc. There are also social and personal aspects to an identity. All humans have a division between self-identity and the performance of oneself that he puts out into the world, in specific social contexts (Giddens, 1991, p. 58). The personal identity, or real self, differs from one individual to another - some individuals' real self comes out when they act impulsively, other's real self is manifested when acting out social obligations. (Breakwell, 1986, p. 16). The real self may be looked at as being a person’s root core of who they are, and who they would be if there were not the influences of various social dynamics and constraints. (Tracy & Trethewey, 2005, p. 173). Another way o f looking at this concept is the private self, the self that known only to the individual, and the public self, the self that is known to others. These two aspects of identity both act in concert with one another and conflict with each other. Most individuals unconsciously deem one aspect more important than the other, and the favored aspect is the one that controls their behavior. (Brewer & Hewstone, 2004, p. 185). There is some theory that one's personal identity is only exposed when making moral decisions, as this exposes values, which are the cornerstone of presuppositions about the self. (Breakwell, 1986, p. 17). According to Anthony Giddens (1991), identity is a reflexive project. The premise of reflexive awareness is that an individual knows what they are doing, and why they are doing it. Humans monitor their circumstances, and are able to discursively explain why they are engaging in a certain behaviour. Discursive practices use reason or argument to explain something, as op posed to emotions and intuition. Practical consciousness is the

Late Roman, Early Christian and Byzantine Art Essay - 2

Late Roman, Early Christian and Byzantine Art - Essay Example On looking at its interior central upper walls, decorations denoting four pairs of apostles are well placed (Ricci 22). On careful scrutiny, one could not fail to recognize the St. Paul and St. Paul. In addition, this central upper walls in the bay have the apostles acclaiming a given giant cross right at the dome center against the sky blue appearance of the stars (Ricci 23). These apostles appear to be placed floating among clouds. The other bunch of apostles exists in the barrel vaults in the interior of that building (Ricci 24). A careful scrutiny of the lunette existing in the north entrance depicts Christ mosaic depicting a good shepherd taking care of his flock. In his arms, an imperial staff appears to be joined to the given Christian cross, supposing symbolizing a combination of heavenly and earthly domains (Ricci 25). Over the South wall, another lunette can be view, but this one depicting St. Lawrence standing close to a given flaming gridiron (Ricci 27). The gridiron has on its opposite side a bookcase which appears to contain four books. These books have inscribed names of evangelists (Ricci 28). The interior provides a serene atmosphere for Christians as they are made to have their hearts

South Carolina and Georgia Essay Example for Free

South Carolina and Georgia Essay When the American colonies rebelled against Great Britain, the rebels gave their reasons in the Declaration of Independence. According to the Declaration, people have unalienable rights to liberty. â€Å"The ideology of the revolutionary generation shaped the later American Bill of Rights. This revolutionary ideology combined and wove together both the natural rights of man and the historic rights of Englishmen†. The colonists emphasized natural rights and historic liberties as a result of their view of government. Government was potentially hostile to human liberty and happiness. Power was essentially aggressive. The rebellious colonists dealt with the problem of aggressive political power by several devices: separation of powers, an independent judiciary, the right of people to have a share in their own government by representatives chosen by themselves, and an insistence on the natural and historical rights and liberties of citizens reflected in revolutionary bills of rights of the several states. These concessions to slavery produced some protests. George Mason, delegate from Virginia and a leading advocate of a federal bill of rights, complained that delegates from South Carolina and Georgia were more interested in protecting the right to import slaves than in promoting the Liberty and Happiness of the people. Some framers rationalized the compromise with slavery on the assumption that the institution would soon die out. In truth, however, a compromise was made in the interest of the Union. While the framers compromised with slavery, they took steps to prevent its spread to new states. Particularly after the adoption of the Bill of Rights the Constitution reflected the Jekyll-and-Hyde character of the nation. The nation sought simultaneously to protect liberty and slavery. All in all, the Bill of Rights was adopted because of the fear of abuses of power by the federal government. It simply had no application to the states. The idea that the federal Bill of Rights protects liberty of speech and press, freedom of religion, and other basic rights from violations by the states has become commonplace, even for lawyers. Indeed, many Americans probably accepted this commonplace when careful lawyers knew it was not so. From 1833 to 1868 the Supreme Court held that none of the rights in the Bill of Rights limited the states. From 1868 to 1925 it found very few of these liberties protected from state action. Those the states were free to flout (so far as federal limitations were concerned) seemed to include free speech, press, religion, the right to jury trial, freedom from self-incrimination, from infliction of cruel and unusual punishments, and more. State constitutions, with their own bills of rights, were available to protect the individual, but too often they proved to be paper barriers. Most, but not all, scholars believe that the Supreme Court was right, at least as a matter of history, up to 1868. They believe, that is, that the founding fathers did not intend for the Bill of Rights to limit the states. In contrast to the English Bill of Rights of 1689, in which the powers of Parliament are protected against the encroachments of the monarch, the American Bill of Rights was created to protect the individual against the intrusions of the legislative and executive branches of the government. As James Madison expressed it, If we advert to the nature of Republican Government we shall find that censorial power is in the people over the Government, and not in the Government over the people. Nowhere in the Bill of Rights is this more sharply affirmed than in the words of the First Amendment: Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof; or abridging the freedom of speech or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. Although nine of the thirteen colonies had established churches, four did not (Rhode Island, Pennsylvania, New Jersey, and Delaware). By the time the First Amendment was adopted, however, only three states had an established church -Massachusetts, New Hampshire, and Connecticut. Of even greater significance is that no two states shared the same religious configuration with respect to its population. Not to be overlooked is that in the decade between the Declaration of Independence and the Constitutional Convention, numerous states had made declarations in support of religious freedom prior to the adoption of the Bill of Rights. In 1868 the Fourteenth Amendment was ratified. Beginning in the 1920s, the U. S. Supreme Court began to apply the Bill of Rights to states through a process now called the incorporation of the Bill of Rights into the Fourteenth Amendment. As originally passed, the Bill of Rights applied only to the federal government and not to state governments. The Fourteenth Amendments equal protection and due process clauses clearly applied to the states. Through a series of lengthy cases, the Court engaged in a piecemeal process of interpreting the Fourteenth Amendment clauses to include the various freedoms protected in the Bill of Rights. In Near v. Minnesota (1931) the Supreme Court applied freedom of the press to the states. In this case, the city of Minneapolis tried to suppress the publication of scandalous, malicious and defamatory material in newspapers. A newspaper publishers association, fearing censorship, challenged the Minnesota law on the grounds of violation of freedom of press. The Supreme Court struck down the law by contending that it represented prior restraint of future issues. The most important freedom given to the press is freedom from prior restraint, the freedom not to be censored. The process of nationalizing the Bill of Rights through the Fourteenth Amendment continued in the area of free exercise of religion. In Hamilton v. Board of Regents (1934), the Court held that freedom of religion was protected by the First Amendment against invasion by the national government and by the states. This decision was confirmed in Cantwell v. Connecticut (1940). This case questioned the constitutionality of a Connecticut law which banned solicitation of money for religious or charitable reasons unless approved by the secretary of the public welfare council. This particular official had the authority to decide whether a fund-raising cause was truly a religious one. In a unanimous decision, the Supreme Court ruled that the statute violated religious freedom and the due process clause of the Fourteenth Amendment. From the critical standpoint, the Bill of Rights not only constitutionally protects individual rights of citizens, such as freedom of religion, peaceable assembly, right to keep and bear arms, trial by jury, but it also secures the entire system of American democratic values and implementation of democracy in reality. For instance, freedom of press, declared of in the First Amendment, does not mean only that â€Å"Congress shall make no law†¦ abridging the freedom of†¦press. † Considering the fact independent media is one of the pillars of modern democracy, this constitutional guarantee aims to secure democratic principles of the country. Moreover, the freedom of press implies automatically the absence of any censorship limiting the execution of freedom of speech, which is too declared in the First Amendment and similarly is to protect democratic principles. The Bill of Rights has been created not only to protect freedoms and liberties of American citizens on individual levels, but also to secure the position of a person before the government. For example, the Fifth Amendment provides that no person shall be forced in any criminal case to be a witness against oneself. At the same time, from my personal viewpoint, the fundamental importance of the Bill of Rights is its long lasting effect and its tremendous influence on American legislative and judicial system. Firstly, the Bill triggered the adoption by the Congress of several important acts protecting civil liberties like Civil Rights Act. Secondly, because the Bill is an integral and vital part of US Constitution, and thus the ultimate legal power, legislative and judicial system have been continuously improving constitutional doctrine on individual rights. For example, one can notice during 1960-70s the constitutional rights of public employees to freedom of speech and association, procedural due process, and equal protection have also been vastly expanded. Historically the Constitution has retained its flexibility because interpretations of its meaning have changed. Choosing between two or more sets of competing values, the Supreme Court has played a major role in maintaining this flexibility. A significant trend has been the extension of civil rights to the previously powerless. For instance, the involvement of the U. S. Supreme Court in civil rights for blacks is long-standing, dating back to issues from the days of slavery. In the Dred Scott case (1857), Chief Justice Taney ruled that no blacks, slave or free, were citizens, and that blacks had no citizenship rights (Hall, 38). In 1883, two decades after the Civil War and the official end of slavery, the Court ruled on five separate suits affecting the rights of blacks, and collectively called the Civil Rights Cases (1883). These cases arose in response to the Civil Rights Act of 1875 which prohibited racial discrimination in jury selection and public accommodations. In these cases, the public accommodations portions of the 1875 act were challenged. The Court recognized that the Fourteenth Amendment forbade discrimination by states but it made no mention of discriminatory acts committed by individuals. Since the Civil Rights Act prohibited discrimination by individuals and private businesses, the Court ruled that the act had overstepped congressional authority and was therefore unconstitutional. By the end of World War II, the Supreme Court had become more supportive of civil rights for blacks. It struck down the all-white primary in Smith v. Allright (1944), arguing that the Democratic party was in essence an agent of the state and was therefore subject to the Fifteenth Amendment. During the late 1940s and the 1950s, the Court followed the trends begun earlier of moving away from the doctrine of separate but equal (Hall, 51). This may be seen in the cases of Sipuel v. Oklahoma (1948), Sweatt v. Painter (1950) and McLaurin v. Oklahoma State Regents (1950). In the Sipuel case, which was similar to the Gaines case, the Court ordered Oklahoma to provide a separate but equal law school for a black woman and stressed the need for equality in facilities. In Sweatt v. Painter, the state of Texas had established a separate black law school but it was inferior to the white law school at the University of Texas in the size of its faculty and the quality of its library and student body. The court ruled that the black law school had to be improved. The Court nearly overturned the separate but equal doctrine in the McLaurin case in which Oklahoma had allowed a black student to attend a white graduate school but had segregated him from the rest of the students by designating separate sections of the library, cafeteria and classrooms for him. The Court struck down these segregation provisions, claiming that they interfered with the ability of the black student to exchange ideas with other students, a requisite for a good education. Although these cases fell short of invalidating the separate but equal principle, they made segregation at the graduate school level more difficult to implement. Perhaps the most significant civil rights cases to aid blacks in the fight for equality were the two Brown cases in the 1950s. Brown v. Board of Education I (1954) arose as the result of a suit against Topeka, Kansas where Linda Brown, a black child, was not permitted to attend a segregated white school four blocks from her home. In Brown I, under the leadership of Supreme Court Chief Justice Earl Warren, the Court overturned the Plessy decision of separate but equal in the public schools by declaring that the separate but equal doctrine made black children feel inferior. In Brown v. Board of Education II (1955), the Court ruled on how to accomplish desegregation, concluding that local school boards should establish plans for desegregation under the supervision of federal district judges and with all deliberate speed. Despite these court rulings, southern school boards were slow to respond and avoided court orders by closing public schools and placing white children in private schools. Consequently, desegregation was only implemented very slowly. Women are not a minority but they have historically experienced legal discrimination based on their gender. The Supreme Court has played an important role in the expansion of rights for women. Overall the Court has been less important in the expansion of womens rights than it has been in the extension of rights to blacks and other racial minorities. A major reason for the less important role of the Court is that womens rights have mostly been broadened through legislation. Many womens rights cases addressed by the Supreme Court have been concerned with employment. Early court decisions followed a trend of protectionism and upheld restrictions on the nature and conditions of employment for women. In Bradwell v. Illinois (1873), the Supreme Court upheld a state law preventing women from practicing law. Not until the 1970s did U. S. Supreme Court rulings begin to move away from the restrictive, protectionist trend of the past. Reed v. Reed (1971) was the first instance of the Court striking down a state law which discriminated against women. Taylor v. Louisiana (1975) overturned the precedent set in Hoyt v. Florida. Phillips v. Martin-Marietta (1971) ruled that employers could not discriminate against mothers of preschool children, despite fears that they might often miss work to care for their children. In Stanton v. Stanton (1975) the Court struck down a Utah law which required divorced fathers to support sons until they were twenty-one under the assumption that they would need support while being educated, while daughters had to be supported only until they were eighteen under the assumption that they would get married and be supported by their husbands. Beginning in the 1920s, the U. S. Supreme Court began to apply the Bill of Rights to states through a process now called the incorporation of the Bill of Rights into the Fourteenth Amendment. As originally passed, the Bill of Rights applied only to the federal government and not to state governments. The Fourteenth Amendments equal protection and due process clauses clearly applied to the states. Through a series of lengthy cases, the Court engaged in a piecemeal process of interpreting the Fourteenth Amendment clauses to include the various freedoms protected in the Bill of Rights. In Near v. Minnesota (1931) the Supreme Court applied freedom of the press to the states. In this case, the city of Minneapolis tried to suppress the publication of scandalous, malicious and defamatory material in newspapers. A newspaper publishers association, fearing censorship, challenged the Minnesota law on the grounds of violation of freedom of press. The Supreme Court struck down the law by contending that it represented prior restraint of future issues. The most important freedom given to the press is freedom from prior restraint, the freedom not to be censored. In many cases the statements embedded in the Bill of Rights are impacted directly or indirectly through the process of governance in the United States. One of the most peculiar examples of this impact is adoption of the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001, commonly known as the Patriot Act. This act significantly expands the power of the federal government to investigate, detain, and deport those people who the government suspects are linked to terrorist activity and other crimes. The Fourth Amendment of the United States Constitution requires the government to prove to a judicial officer that it has probable cause of a crime before it conducts an invasive search to find evidence of that crime or in exact words, this Amendment declares that â€Å"the right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause†¦Ã¢â‚¬  Before the enactment of the Patriot Act, if the primary purpose was a criminal investigation, the law enforcement officials had to first prove the higher standard of probable cause. Investigating criminal activity cannot be the primary purpose of surveillance. Now American society witnesses how one of the most fundamental statements of the Bill of Rights, particularly that one protecting individual freedoms from the state, is challenged. The change made by Section 218 of the Patriot Act authorizes uncon stitutional activity by impinging on the Fourth Amendment protection that requires probable cause. Section 218 now provides law enforcement officials with a tool to avoid probable cause when conducting criminal investigation surveillance. The adoption of the Patriot Act has been triggered with the war the United States declared against terrorism. Interestingly, the same event, the war on terrorism, challenged another important element of the Bill of Rights, namely the due process clause of the Fifth Amendment, which states that â€Å"no person shall be deprived of life, liberty, or property, without due process of law. † Practically, this statement aims to secure individuals from unconstitutional exercise on the behalf of the government. Importantly, this article provides Americans with the right to be tried by unprejudiced courts with application of lawful procedures and laws. However, during the war in Afghanistan and Iraq, the US government intentionally deterred in prisons many prisoners of war (identifying them as terrorists) without court orders, indictments and further court hearings. Here one can notice the constitutional collision, in which the rights of the US government during wartime (including deterring of individuals without due process clause) challenges the statements embedded in the Bill of Rights. Works Cited Barnett, Randy E. ed. , 1989. Ninth Amendment. supra note 29, at 18 Bailyn, Bernard. 1967. Ideological Origins of the American Revolution. Cambridge, Mass. : Harvard University Press. Ely, J. 1980. Democracy and Distrust. Cambridge, MA: Harvard University Press. Hall, Kermit L. 1989. The Magic Mirror. Law in American History, New York: Oxford University Press. Levine, James P. 1992. Juries and Politics, Pacific Grove, CA: Brooks/Cole Publishing Company. Madison, James. November 27, 1794. Republicanism. Speech in Congress. Annals of Congress 934. Nelson, William E. 1988. The Fourteenth Amendment: From Political Principle to Judicial Doctrine. Cambridge, MA: Harvard University Press. Schwartz, B. 1971. The Bill of Rights. A Documentary History. pp. 222-226. Wiecek, W. 1976. The Sources of Antislavery Constitutionalism in America, 1760-1848. Ithaca: Cornell University Press. P. 74

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SET EDITION: U.S. INTERNATIONAL MÉXICO ARABIC TV: CNN CNNi CNN en Espaà ±ol HLN Sign up Log in Home TV & Video CNN Trends U.S. World Politics Justice Entertainment Tech Health Living Travel Opinion iReport Money Sports SHARE THIS Print Email More sharing Colin Powell Fast Facts By CNN Library updated 3:35 PM EDT, Tue August 20, 2013 (CNN) -- Here's a look at the life of Colin Powell, former Secretary of State and Chairman of the Joint Chiefs of Staff. Personal: Birth date: April 5, 1937 Birthplace: Harlem, New York Birth name: Colin Luther Powell Parents: Luther Powell, a shipping clerk Mother: Maud Ariel (McKoy) Powell, a seamstress Marriage: Alma Vivian (Johnson) Powell (August 25, 1962-present) Children: Annemarie Powell (May 1970); Linda Powell (April 1965); Michael Powell (March 1963) Education: City College of New York, B.S. in geology,1958; George Washington University, M.B.A.,1971; National War College, 1976 Military service: U.S. Army, 1958-1993, General Other Facts: Powell grew up in the South Bronx, the son of Jamaican immigrants. Powell participated in ROTC in college, leading the precision drill team and attaining the top rank offered by the corps, cadet colonel. Military awards include the Legion of Merit, Bronze Star, Air Medal, Soldier's Medal and two Purple Hearts. Civilian awards include the President's Citizens Medal, the Congressional Gold Medal, the Secretary of State Distinguished Service Medal, and the Secretary of Energy Distinguished Service Medal as well as receiving the Presidential Medal of Freedom twice. Powell was the youngest man and first African-American to be Chairman of t... ...ital firm of Kleiner, Perkins, Caufield & Byers as a "strategic limited partner." March 2006 - The National War College Foundation establishes the Colin Powell Chair for National Security, Leadership, Character and Ethics. Summer 2007 - Begins to speak out against the Bush administration's decision to go war against Iraq, the increase in troop strength in Iraq and the treatment of prisons at Guantanamo Bay. January 20, 2009 - Is one of the honorary co-chairs of President Barack Obama's inauguration. Powell had endorsed Obama during the 2008 presidential campaign. February 3, 2010 - Powell reverses his stance on gays and lesbians in the military; his opposition to homosexuals in the military helped lead to the original "Don't Ask, Don't Tell" policy of the 1990s. 2012 - Publishes a second memoir, "It Worked For Me: In Life and Leadership," with Tony Koltz.

Effect of Celebrity Endorsement on Consumer Behavior on the Youth of Pakistan Essay

In our research we have to just focus on the youth so our target area is â€Å"Lahore† because more than 75% are students are here. We chose Lahore as my population because it is well develop city and here large number of consumer’s are educated as compare to other many cities. More over people from all over Pakistan are living in Lahore. Sample size A sample of two hundred consumers was chosen on the basis of simple random sampling because the respondent are divided on the bases of demographic factor like age. We categories the sample of 200 respondents 160 males and 40 females because mostly females do not gave proper response. Sampling Technique The data has been collected from the respondent living in Lahore with the help of Mail questionnaires, consisting of 12 questions were developing to quantify my observation and give study a direction. we chose the probability based simple random sampling because the respondents are divided on the bases of demographic factor like age(16 to 30). Unit of analyses In this research paper we chose the individual person through the mail questionnaire because every individual have its own perception regarding buying so they individually can easily gave response that either celebrity endorsement effect on buying behavior or not. Research Instrument When we choosing a research instrument we focus on dimension of variable and also validity and reliability of variable so, we chose the scaling method as research instrument. Through scaling method we easily measure the idea, concept theme and document of research problem. We use likert scale in our questionnaire. Data collection method Basically in this paper two types of data have been used. Both are listed below: I. Primary data Primary data is the one which is collected from the scratch meaning that the data is collecting from the source and it has not changed hands. In this paper primary data has been collected from the respondents from Lahore via mail questionnaire that consist of 12 questions. The questions were structured, placed in a sequence to understand the consumer perception. The respondents were chosen randomly and the data obtained from their questionnaires was analyzed to come up with the findings. II. Secondary data Secondary data is the one which is collected from secondary source. This research study also contains secondary data .The secondary data was collected for the purpose of literature review. The secondary data was collected from different research journals and furthermore from different websites were used for this purpose. Data Organization Data organization is also called data washing. Data washing means separate the data of out layer and those respondents who just fill the questionnaires without any thinking. Reliability and Validity of Data In this step of research design check the data validity and reliability so, for checking the validity and reliability of data we focus on different test. We choose the t-test for checking the validity and reliability of our research study. Data analysis In this research paper for the analysis of data we focus on goodness of data, hypothesis testing and also focus on feel for data. In goodness of data we see the reliability and validity of data and in hypothesis testing we see that either my research study approve or disapprove. We analyze our data by regression and simple percentage method by using SPSS software.

Health Promotions Among Diverse Populations Essay

Marginalization of the Native American population is a result of colonialism; they were considered to be ignorant and hostiles by the â€Å"White† settlers, forced to live on reservations, lost their culture and values through assimilation and stripped of their rights in society. Segregation, Social Darwinism, and other discriminatory practices have led to the marginalization of Native Americans, resulting in the lowest standard of living in the United States, high rates of alcoholism, and a significant loss of heritage as they are cut off from native rituals and language and encouraged to meld into the cultural expectations of mainstream America. In this document of research, I will compare my findings on Native American Health with the general population at this time. I will also define what â€Å"health† means to this population. Also included in this research will be examples of three levels of preventative health promotion and health disparities for this unique min ority. Health Status among the Native American Population The prevalence of unemployment was much higher among blacks, Hispanics, and American Indian/ Alaska Natives than among whites in 2006 and 2010. In 2010, unemployed adults were much less likely than employed adults to report their health as excellent or very good. During 1999-2008, both life expectancy and expected years of life free of activity limitations caused by chronic conditions were signiï ¬ cantly greater for females than for males and for  whites than for blacks. The percentage of American Indians and Alaska Natives who lacked health insurance in 2013 was 26.9%. Although while some Native American Tribes may benefit financially because of the casinos, most have the worst standard of living in the United States. Between the poverty and unemployment, life on the reservations is unbearable for many tribe members. Marginalization of the Native Americans is a result of colonialism; they were considered to be ignorant and hostiles by the â€Å"White† settlers, forced to live on reservations, lost their culture and values through assimilation and stripped of their rights in society. Segregation, Social Darwinism, and other discriminatory practices have led to the marginalization of Native Americans, resulting in the lowest standard of living in the United States, high rates of alcoholism, and a significant loss of heritage as they are cut off from native rituals and language and encouraged to meld into the cultural expectations of mainstream America. Dominant Health Issues Their rate of alcoholism is much higher than the rest of the population and 1 in 10 Native American deaths is alcohol-related,† (Winkel, 2010). Consequently, alcohol has had a great influence on the Native American’s culture. Winkel also states, Researchers over the years have shown that the effects of alcohol on this culture are also due to genetics. Looking from the genetic level, certain ethnic groups have a gene mutation that causes adverse reactions to drinking large amounts of alcohol. Groups that possess this â€Å"protective gene† include Chinese and Japanese populations, and it causes them to feel rapid heartbeat, headache, nausea, and extreme drowsiness. Other groups, including Native Americans, do not possess this gene mutation, consequently reducing the side effects of heavy drinking. (Winkel, 2010) Besides genetics, the environment that one lives in will determine whether they will be an alcoholic or not. Alcoholism often co-exists in Native American communities with other problems like Depression, self-hate, and cultural shame. According to an article in the Las Cruces Sun News, in New Mexico, young people of Native decent commit suicide at twice the national rate. Suicide rates among indigenous Native youth are higher and somewhat triple the rates seen among Anglo youth. (Furlov, B. Paskus, L.) Mental Health is of the highest concern along with the following: Cancer, Heart Disease, and Diabetes are the top three galling afflictions. Unintentional injuries, Chronic Liver disease, chronic lower respiratory disease follow close. Stroke, Suicide, Nephrosis and chronic Nephrotic Syndrome are in the top ten. Unfortunately, Influenza and Pneumonia have to be figured into the mix as well. Perhaps since the time the Europeans first traded alcohol with the Native Americans, it began the downward spiral effect that they are feeling today. It has been said that alcoholism is an epidemic among the Native America. Alcohol is no longer sold on any Reservation due to the issue. The American Indian and Alaska Native people have long experienced lower health status  when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. Native traditional Health remedies and Health defined by Indigenous America They combine herbal medicine, spirituality, and rituals. In addition, there are many similarities in today societies and the Native American culture. Sage is held sacred by many Native American Indians, because of the effective purifying energies. They both use Native American medicine for example sage, which is use to protect you against bad spirits. It is also use today to treat stomach problems, kidney, and liver problems. On the other hand, Native American medicine is not the same today as modern medicine. Native American healing involves herbal remedies such as sage and tea. Modern medicines use sage and teas, too. Native Americans traditionally believe that illness comes from spiritual problems. They have a traditional shaman, or herbalist that are spiritual healers. A ritual that Native Americans use is the sweat lodges and stones for purifying the body, mind, and spirit. In addition, rituals that will last weeks or even longer, such as dancing, singing, and sand painting take place at the same time to bring harmony into the soul. Native American doctors also recommend a ritual purification. Purifications are intended to get rid of harmful toxins to the body. It is a holistic approach. There is a belief that violating tribal laws carries consequences to include mental and physical illness, ongoing bad luck, disability or trauma. Any violations must be made right in order for harmony and good health to be restored. Among Native Americans, the idea remains that the sickness and illness that one experiences is related to a spiritual cause, and in turn creates a disparity between mind, body and spirit. Health is defined by harmony between body, mind, and spirit. Disease Prevention and Health Promotion Prevention Focus Areas The best known system of measuring health in the U.S. is Healthy People 2010 (Healthy People 2020 is to be released soon), which contains a total of 467 separate indicators on the health of the country. A small subset of indicators, called Primary, can serve as the roadmap American Indian and Alaskan Native (AI/AN) communities need for assessing current health status, designing and implementing programs to improve health, and evaluating the effectiveness of these programs. What people eat has a powerful impact on their health. Nutrition plays an integral part in many of our most prevalent diseases, including diabetes mellitus, heart disease, stroke, obesity, hyperlipidemia, hypertension, certain cancers (breast and colon, e.g.), and osteoporosis. The Indian Health Service is working both to improve the health of patients with nutrition related diseases, and to prevent these illnesses in future generations through interventions in schools, community health programs and hospital and clinic based services. Immunizations are one of the most effective disease- prevention tools available today. Thanks to the routine immunization of children, the U.S. has seen a dramatic decrease in a number of vaccine-preventable diseases that used to cause significant illness and even death. In conclusion, education is the key to helping this populace. Obesity is a large part of the population and exercise promotion along with healthy eating is encouraged. Mental Health is a large affliction associated with Native health and must be recognized when children are young. As Health Care workers we must combine traditional medicine with modern medicine and holistic approach. References Centers for Disease Control and Prevention: Office of Minority Health and Health Equity November 26, 2014.Retrieved from http;//www.cdc.gov/minorityhealth/index.html Centers for Disease Control/National Center for Health Statistics: July 14, 2014. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/aian.html Centers for Disease Control 24/7: Saving Lives, protecting people. October 28, 2014. Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/hhispanic.html Center for Disease Control: Health Disparities and Inequalities Report- U.S. 2013. Retrieved from http://www.cdc.gov/minorityhealth/CHDIReport.html Edelman, Kudzman, and Mandle; Health Promotion throughout the Life Span, edition 8, 2014. Indian Health Services website: http://www.ihs.gov/injuryprevention http://www.ihs.gov/newsroom/factsheets/disparities Paskus, L., Furlov, B. â€Å"Suicide among very young Native Americans is alarming.† Las Cruces Sun News 5/27/2015 Native American Health: Medline Plus â€Å"Native Peoples concepts of health and illness.† http://www.nlm.nih.gov/medlineplus/nativeamericanhealth.html#cat51 National Vital Statistics Reports, Vol 62, No. 6, December 2013, Table 1, Page 31 Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2012. Vital Health Statistics. Series 10, Number 259, December 2013

Examine how Valvular heart valve disease has caused a major problem worldwide The WritePass Journal

Examine how Valvular heart valve disease has caused a major problem worldwide Introduction: Examine how Valvular heart valve disease has caused a major problem worldwide Introduction:Definition:Cellular sources:Biomaterials:Sterilization methods:Pre-clinical trials:Biomechanical culture:Commercialized products:Challenges:Conclusion:REFERENCES:Related Introduction: Valvular heart valve disease caused a major problem worldwide, result in increasing rate of morbidity and mortality (Rashid et al., 2004). Each of the four valves of heart can be affected by dysfunction (Mol et al., 2009). The common solution is the replacement of diseased valves either mechanical or bioprostheses. However, they are associated with shortcoming. Patients with mechanical valves are associated with long term of anticoagulation therapy which leads in higher risk of complications (Hjortnaes et al., 2009).   Bioprosthetic valves are less durable, enable to grow and repair and lead to calcification. Moreover, they are associated with reoperation especially with young patients. None of these valves are capable to restore native valves functions.   To overcome replacement shortage of heart valve, in the mid of 1980s in the USA, tissue engineering concept was proposed as alternative solution and has the capability to produce autologous heart valves (Matsumura, 2003). Definition: Tissue engineering of heart valves is manipulation of biological molecules and cells for the purpose of creating new structures capable of metabolic activity. (Vesely, 2005). Approaches: Worldwide, two main approaches have been used to achieve the desirable and clinical needs of heart valves; regeneration and repopulation (Vesely, 2005). In the first approach, decellularized xenograft (ECM proteins; collagen or fibrin) or allograft served as valve biological scaffold, mixed with autologous cells (myofibroblast and endothelial) has been seeded in vitro (Mendelson and Schoen, 2006), (Neuenschwander, 2004). However, limitations of this approach are; the construct lack the ability to grow, long term mechanical properties could alter physical properties of the native valves and a possibility of disease transmission (Neuenschwander, 2004). Moreover, inflammatory reaction due to ECM proteins used may deteriorate the scaffold result in biomechanical damage (Mendelson and Schoen, 2006). A biodegradable synthetic scaffold is the traditional approach in which cells of a specific phenotype are transplanted onto a bioresorbable scaffold in the shape of heart valves (Vesely, 2005).These biocompatible materials offer several advantages; Due to degradation products, they have neither side effects nor immunogenic reactions.   They are harmless and easy to handle. At the site of implantation, the remaining autologous living structures after complete biodegradation of the scaffolds have the ability to remodel, to adapt and to grow (Neuenschwander, 2004). The danger of the transmission of new infections and immunogenic reactions is minor as a result of utilization of autologous cells which lead to identical bioengineered tissues to host cells (Neuenschwander, 2004). Extracellular matrix material is formed by the cells after attachment and the polymer scaffold degrades (Fuchs et al., 2001). As shown in (Shinoka et al., 1995) mixed cell population of endothelial cells and from ovine arteries were isolated and separated from each other by fluorescence-activated cell sorting. An acetylated low-density lipoprotein marker was used to label endothelial cells. Myofibroblasts were seeded onto polyglycolic acid scaffolds which then seeded with endothelial cells. Before new tissues being regenerated, the degrading scaffold cannot tolerate pressures of the left ventricle (Vesely, 2005). Therefore, the constructs were implanted in sheep in place of the native right posterior leaflet of the pulmonary valve.   This approach results in trivial pulmonary regurgitation in autografts but moderate in allografts and doesn’t show stenosis (Shinoka et al., 1995). Repopulation is the less popular approach. Complex structure (collagen) is fabricated by manipulating biological molecules.   Prior to implanting, cleaning off the porcine aortic valve from cells is required, and leaving intact the connective tissue matrix. Then, the acellular matrix of the patients cells is repopulated, stimulated and thus result in creating a living tissue resemble to the native tissue (Vesely, 2005). Cellular sources: In tissue engineered valve applications, mesenchymal stem cells and differentiated tissue-specific cells (including circulating endothelial progenitor cells or smooth muscle cells) are the two main types used. They are harvested from either patients or experimental animals (Vesely, 2005). Stem cells along with the appropriate matrix are expected to provide a broader source of either autologous or allogenic cell lines once differentiated to the proper end point. Thus, they are beneficial for therapeutic use in the cardiovascular field (Vesely, 2005). Animals’ tissues such as canine and pigs are conducting in a research with variability in successful implantation.   Mesenchymal stem cells for TE of ECM scaffolds have been obtained from canine tissues. Also, due to presence of type 1 and IV collagen and fibronectin, ECM from pig’s tissues showed ability to grow to a single layer (Rashid et al., 2004). In most approaches, veins (saphenous vein) or peripheral arteries (radial artery, mammary artery) are efficient sources of cells. Mixed vascular cell populations give rise to myofibroblast and endothelial cells lines. myofibroplasts derived from arteries show decreased proliferation in monolayer culture and ECM formation when cultivated on three dimensional structure compared to cells obtained from veins (Neuenschwander, 2004). Another promising alternative source of heart valves can be derived from progenitor cells derived from peripheral blood and bone marrow cells (mesenchymal stem cells). MSC can be differentiated into different tissues, are easy to obtain, shows high proliferating capacity in vitro and faster growing than vascular derived cells. They produce well developed ECM after cultivation under bio-mimetic conditions (Neuenschwander, 2004). Biomaterials: There are two principal choices of scaffold; naturally or synthetic polymeric scaffolds. Exogenous ECM scaffolds are required to provide mechanical support until the target newly tissue is formed and become stable. Designing is based on the target cells population needed to implant at the injury or diseased sites. In vivo, they are degraded alongside the implanted functionally tissues grow and organize their matrix structure (Kim et al., 2010). Non-toxic, biodegradable and biocompatible scaffolds serve as a temporary matrix for the seeded cells due to their own a highly porous microstructure that supply nutrients required for growth and necessary for waste removal. They possess structural integrity to withstand in vitro and in vivo loading. The most widely used in HVE are polyglycolic acid (PGA), polylactic acid (PLA) and their copolymers (PGLA). PGA is highly resorbable, linear, a highly crystalline and have a high melting point. PLA reduce the rate of hydrolysis and have limited water uptake. In all of that, to facilitate tissue growth, growth factors are integrated in the scaffold. However, a number of disadvantages must be overcome; slow or incomplete degradation that cause inflammation, limited nutrients and oxygen delivery to deep cells and fibrosis (scar) occupied the space formed after scaffold degradation (Mendelson and Schoen, 2006). Natural scaffold composed of decellularized xenograft or allograft tissue or ECM components such as collagen or fibrin (Mendelson and Schoen, 2006). Fibrin gel scaffold can be designed into a valve structure to form a biodegradable, autologous scaffold.   Blood is the source of fibrin gel and mould into autologous manner to work against immunogenicity. Seeding cells into fibrin scaffold results in good tissue development with viable fibroblast. However, fibrin scaffold would lack mechanical strength (Knight, 2004). Furthermore, in a process similar to the contraction of a wound healing, cells entrapped in collagen gels compact the gel, improve their property and increase density (Mendelson and Schoen, 2006). But, any scaffold made from collagen alone would like to degenerate very quickly due to in vivo forces affected heart valves (Knight, 2004). Moreover, hyaluronan is a glycosaminoglycan polymer with a repeating disaccharide structure and being used as biocompatible material ECM scaffold. It imparts viscoelastic properties and applies pressure that gives tissues compressive resistance (Vesely, 2005). Sterilization methods: Several methods are used to sterile materials utilized in process of seeding and tissue harvesting. 1) Dry heat sterilization in which items are placed in an oven for one hour at 160T to be sterilized by dry heat. 2) Moist heat sterilization is used to autoclave objects and solutions not suitable for dry heat sterilization for 20 minutes at 121 T, 15 pounds per square inch (psi). 3) 0.2ptm filters are used to sterilize solutions not suitable for autoclaving (Knight, 2004). Pre-clinical trials: Animal model is an essential part of biomedical research to approve tissue engineered devices by FDA in order to carry on clinical trials. Using animal tissues as sources relies on many factors; cost, ethical considerations, availability and the nature of the tested tissue. In Zilla study (Zilla et al., 1994), baboons were used to study the proliferation of seeding (endothelial cells) EC on polytetrafluoroethylene (PTFE) grafts. Compared to the control of unseeded graft, seeded graft showed persistent confluent EC layer through time with the aid of fibrin glue enriched with RGD (Zilla et al., 1994). Due to similar anatomy and physiology to that of humans, pigs have been used widely for experimental study. Also, they are cooperative without general anesthesia. They are capable of rabid growth so limiting the time required for TE construct (Rashid et al., 2004). Biodegradable polyglycolic acid (PGA) scaffold was treated by sodium hydroxide and modified seeded bovine SMC and EC were used by Niklason and co-workers in after 24 days of implantation in swine model. Ovine and caprine are also models to study TE due to large size and easy access to the carotid artery in the long neck. They can be used for long term study because adult animal can’t grow (Rashid et al., 2004). In a number of researches, sheep model was used widely but ordained for failure as a result of exuberant fibrotic response to implants (Vesely, 2005). Compared to humans, implants grow rapidly with fibrotic tissue in sheep (Schoen, 2011). In preclinical testing, the choice of animal model is a challenge owing to immunologic considerations (Mendelson and Schoen, 2006). Biomechanical culture: Various parameters determine the optimal conditioning protocols; the scaffold, the magnitude and types of mechanical cues, the sensitivity of cell to the used scaffolds. Bioreactors in TEHV have been developed to improve tissue formation, organization and functions and to stimulate dynamic mechanical of the TEHV. Moreover, to mimic native excitation-contraction coupling, electrical stimulation has been used. Additionally, to mimic the diastolic phase of the cardiac cycle, a diastolic pulse duplicator bioreactor has been developed which result in dynamic tissue straining (Sacks et al., 2009). Commercialized products: In October 2000, CE Mark approved use of the CryoLife Synergraft. It was similar to decellularization matrix approach by removing cellular antigens using extraction and dissolution. It was expected to sound mechanically as acellular matrix. Unfortunately, complications related to stenosis, inflammation and valve rupture result in death and thus withdrew from the market (Vesely, 2005). Challenges: Till date, no EHV constructs have been commercialized. Before translation of the construct to patients, numerous steps must be considered and assured laboratory.   For example; ethical issues, safety, efficacy and quality of the product should be evaluated. Additionally, medical devices interactions results such as; thrombosis, infection and inflammation will have to be accepted. There is a need to develop tools to monitor the fate of transplanted and endogenous cells, biomarkers to evaluate the patients variability to implantation. in all of that, suitable approach is required that ensure efficiency and safety (Schoen, 2011). Conclusion: Three main issues determine the success of tissue engineered heart valve; 1) sources of cells, 2) the (matrix) scaffold that serves as a guiding structure and determines the three dimensional shapes of tissue development and cell attachment and 3) the optimal culturing condition for cell growth. State of art of TEHV today is still on research, significant challenges must be solved before start in clinical application. REFERENCES: FUCHS, J. R., NASSERI, B. A. VACANTI, J. P. 2001. Tissue engineering: a 21st century solution to surgical reconstruction. The Annals of thoracic surgery, 72, 577-591. HJORTNAES, J., BOUTEN, C. V. C., VAN HERWERDEN, L. A., GRUNDEMAN, P. F. KLUIN, J. 2009. Translating autologous heart valve tissue engineering from bench to bed. Tissue Engineering Part B: Reviews, 15, 307-317. KIM, B. S., PARK, I. K., HOSHIBA, T., JIANG, H. L., CHOI, Y. J., AKAIKE, T. CHO, C. S. 2010. Design of artificial extracellular matrices for tissue engineering. Progress in Polymer Science. KNIGHT, R. L. 2004. Development of methods for the tissue engineering of cardiac valves using mesenchymal stem cells. MATSUMURA, G. 2003. Successful application of tissue engineered vascular autografts: clinical experience. Biomaterials, 24, 2303-2308. MENDELSON, K. SCHOEN, F. J. 2006. Heart Valve Tissue Engineering: Concepts, Approaches, Progress, and Challenges. Annals of Biomedical Engineering, 34, 1799-1819. MOL, A., SMITS, A. I. P. M., BOUTEN, C. V. C. BAAIJENS, F. 2009. Tissue engineering of heart valves: advances and current challenges. Expert Review of Medical Devices, 6, 259-275. NEUENSCHWANDER, S. 2004. Heart valve tissue engineering. Transplant Immunology, 12, 359-365. RASHID, S. T., SALACINSKI, H. J., HAMILTON, G. SEIFALIAN, A. M. 2004. The use of animal models in developing the discipline of cardiovascular tissue engineering: a review. Biomaterials, 25, 1627-1637. SACKS, M. S., SCHOEN, F. J. MAYER JR, J. E. 2009. Bioengineering challenges for heart valve tissue engineering. Annual Review of Biomedical Engineering, 11, 289-313. SCHOEN, F. J. 2011. Heart valve tissue engineering: quo vadis? Current Opinion in Biotechnology. SHINOKA, T., BREUER, C. K., TANEL, R. E., ZUND, G., MIURA, T., MA, P. X., LANGER, R., VACANTI, J. P. MAYER, J. E. 1995. Tissue engineering heart valves: valve leaflet replacement study in a lamb model. The Annals of thoracic surgery, 60, S513-S516. VESELY, I. 2005. Heart valve tissue engineering. Circulation research, 97, 743. ZILLA, P., PREISS, P., GROSCURGH, P., Rà ¶SEMEIER, F., DEUTSCH, M., ODELL, J., HEIDINGER, C., FASOL, R. VON OPPELL, U. 1994. In vitro-lined endothelium: initial integrity and ultrastructural events. Surgery, 116, 524-534.

How to Figure Out If You Should Work for Yourself

How to Figure Out If You Should Work for Yourself Have you ever thought about whether or not you should work for yourself? Maybe you’re tired of the 9-5 grind. Maybe you feel underutilized by your boss. Maybe you’d like to fulfill yourself creatively. Or maybe you’d just like to make more money. Whatever the case may be, setting up something on your own is a big decision and you need to think very carefully about the pros and cons before you decide to take the plunge.  Source:[The Business Backer]

The Problem of Consumer Skepticism Case Study Example | Topics and Well Written Essays - 500 words

The Problem of Consumer Skepticism - Case Study Example However, there are many factors inhibiting development towards greener practices. One might think that any effort made by a company to be eco friendly is well received by those who are concerned about the environment. For example, Coca Cola’s effort towards greener practices has been faced by numerous setbacks. The bottles are still made of plastic and even though it is recyclable most consumers through them away leading to environmental pollution. Secondly, the green idea is no exception as it has been faced by a huge controversy inhibiting its progress. Although, the idea would have positive impacts on the environment, such as reducing rainwater runoff by 38 percent and minimize heat island impact by 26 percent, there are those who are against the idea. Critics state that the new by law behind the idea of green rooftops may dampen the efforts of the green movement, as it will limit developers’ options in constructing, as they will be concerned towards making the building eco-friendly thus increase the building costs. Consumer attitudes towards eco-friendly products limit greener practices since most of them are skeptical about paying a high price for these products.

A Critique of Plato's Just Society using the Notion of Fairness from Essay

A Critique of Plato's Just Society using the Notion of Fairness from John Rawls - Essay Example He viewed that there could be a harmony or just society, only when these inequalities were either factored in or eliminated, and this notion of 'fairness' will be presented as a fundamental critique of Plato. The most explicit discussion of the tripartite part of the soul, and the primacy of reason therein, occurs in the fourth book of the Republic (435b). One of the first preliminary aspects of the soul, is that although the parts of the soul are distinct in their virtues, Socrates also stresses that in the functioning of these parts, the soul must be considered as a â€Å"whole† [Plato, 1992, p. 436a]. What is implied by this, is as follows. If for example, one desired food, and this desire originated in the appetites, it would still require reason both to discern the means of satisfying this desire, but also it would require reason to know when one has had enough for the sake of health in which case, reason would act upon the ‘will’ to suppress desire, so to sp eak. This is a ‘chain of command’, so to speak, which will be explored both as it is outlined in this section of the Republic, but also in terms of how this is established in the three classes of the state [Haworth, 2004, p. 13]. Further, it is important to similarly stress that the appetites are as necessary for reason for the sake of surviving. In other words, someone who had no appetite would starve, just as someone who had no ‘will’ or ‘spirit’ would have no discipline to stop eating or drinking. Thus, Socrates stresses that although reason is given privilege within the scheme of the soul, he also stresses that all three aspects constitute the ‘whole’, and this ‘whole’ is necessary for surviving. In some ways, his position on the soul can be said to be a refutation of Thrasymachus' position from the beginning of the dialogue where he argues that the just society is the one ruled by the â€Å"stronger† [Adams and Dyson, 2003, p. 4]. Socrates defines this relation, using, for example, the compulsion to â€Å"drink† extending from the appetites or the â€Å"irrational† [Plato, 1992, p. 439d] part of the soul: â€Å"Doesn’t that which forbids in such cases come into play – if it comes into play at all – as a result of rational calculation, while what drives and drags them to drink is a result of feelings and diseases? Apparently† [Plato, 1992, p. 439c-d]. Although the surface appearance, suggests that there is a complete opposition between the appetites on the one hand, or, desire, impulse, etc.., and on the other hand, the rational component of the soul, it is as though there is a harmony of opposites which Socrates is arguing here. What is implied by this, is as follows. Even though reason and irrationality are opposed, they are united in the very functioning of the soul. While the appetites are controlled through the â€Å"spirit† or the will [Plato, 1992, p. 440a], it is reason which makes the decision concerning how much control, or when to control the appetites. Again, it is important that we have appetites, and that they are necessary for survival, which reason is aware of, for the same reasoning, that is, for the sake of surviving or health, they must also be controlled. In keeping with Socrates example of drinking, it is often the case that an alcoholic, who is overcome by their appetites, may end up dying or being sick at the very least. Thus, the relationship between the parts of the soul, can be described as created a

Feminist Art Review of Cindy Sherman Self-Portrait Essay

Feminist Art Review of Cindy Sherman Self-Portrait - Essay Example Perhaps the most seminal artist operating in this cultural milieu is Cindy Sherman. Sherman’s art presents a multitude of perspectives on the self, interrogating identity, experience, and femininity in the postmodern world. This essay examines Sherman’s self-portrait Untitled Film Still 53 arguing that it presents a comprehensive response to mainstream perspectives on identity and actively resists the male gaze. Analysis While Cindy Sherman’s work almost exclusively explores conceptual portraits, her most notable collection is the Untitled Film Stills, 1977–1980. Within the context of this collection critics have divided the portraits into a variety of themes, still it’s clear that are a number of concerns that underline all these modes of representation. One of the most emblematic portraits of this collection is Sherman’s Untitled Film Still #53. From a strictly literal perspective, this work is a photographic portrait of Sherman wearing a b londe wig. Her eyes are slanted indifferently to the left. She is standing in front of a concrete wall that is blurred from view by the brightness of a light and photographic development techniques. While this portraiture presentation is ostensibly simplistic in meaning, further analysis reveals a number of deeper meanings. In deconstructing traditional representations of identity Sherman’s Untitled Film Still #53 resorts to one of the most pervasive constructors of identity – the cinema. Indeed, it’s been noted that in the, â€Å"early work by Cindy Sherman†¦she reconstructs the codes of the representation of femininity in cinema† (Jones, pg. 90). Within the context of this portrait one witnesses the co-optation of many elements of film noir cinema. In these regards, the low-key lighting and blurred focus are much in-line with this genre. While the photograph represents a recreation of this 1940s and 1950s aesthetic, the nature of it being a second- order representation is such that it leads individuals to question the nature of these early and mid-20th century forms of gender and identity construction. It’s noted that, â€Å"The intellectual woman looks and analyzes, and in usurping the gaze she poses a threat to an entire system of representation† (Jones, pg. 67). Such an understanding reveals perhaps the central meaning behind this specific portrait and Sherman’s larger body of work, namely that the artist has implemented conceptual portraits in a post-modern paradigm to interrogate previously held notions of truth and reality. Another prominent investigation of identity in this portrait is through interrogation of the male gaze. Feminist theory contains a strong emphasis on the representation of women in television and film, with Laura Mulvey’s the gaze a prominent area of consideration. Within Sherman’s portrait it’s clear she is exploring this feminist concern in a variety of ways . One prominent understanding, as is characteristic of Sherman’s Untitled Film Stills, is that, â€Å"Sherman has posed herself as embodied object, photographically frozen within gendered positions of vulnerability† (Jones, pg. 323). When one examines this within the outward representation of the photographic image, one of the major considerations is the mid-20th century costume and body language. Sherman’

Violence Against Nurses In Psychiatric Health And Social Care Essay

Violence Against Nurses In Psychiatric Health And Social Care Essay Violence is currently prevalent in every sphere of social life. Nowadays, health care personnel are facing more harsh behaviours than ever before, here in Jordan. The rising rate of violence in health care settings has become a major problem for nurses. Nurses are at considerable risk of occupational (work-related) violence. Working primarily in psychiatric departments resulted in an increased risk for both physical assault and non-physical violence (Nachreiner, et al., 2007). Psychiatric health care providers have high rates of work place violence victimization, but yet little is known about the strategies used by them and their facilities to manage, reduce, and prevent violence (Peek-Asa, et al, 2009). Their presence in stressful situations such as incidents (violent incidents), suicide attempts, waiting to visit a doctor, or transfer of patients to another ward or another hospital exposes them to more abuse or harsh behaviour from patients, families, relatives and friends than oth er hospital staff (Kwak et al., 2006). The motivation of this paper stemmed from a recently news in the media reporting the increased incidents of violence and aggression faced by nurses in Jordanian hospitals. The media news prompted the author to reflect on current knowledge and understanding of these events in both in Jordan and around the world to make recommendations for managing reducing, and prevention of these events in the future. Recommendations for future research in this area were addressed also. Recommendations for future research will enable nurses to deepen their understanding of violence and aggression in psychiatric settings which in turn will lead to improved strategies, policy and practice leading to increased safety for nurses and patients. This paper was intended to be a commentary paper on the phenomena of violence in psychiatric settings; however, to comment on this phenomenon an extensive literature review was conducted and will be presented also. The paper design compared the violence with the cr ime. The perpetrator of this crime is the psychiatric or mentally ill patient, while the victim is the psychiatric/mental health nurse. The scene where the crime occurred is the psychiatric setting. The Aim This paper aims to provide a general understanding of the whole picture of violence against nurses in psychiatric settings. In order to achieve that, this paper addressed the following topics: (1) Recent epidemiology of episodes of violence in psychiatric words, (2) Defining violence and related concepts, types, and forms, (3) The perpetrator, (4) The victim, (5) Prevention of violent incidents, (6) Assessment of violence, (7) Management of violent episodes. Methods The following databases were searched: EBSCO host service databases (Academic Search complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), MEDLINE, Psychology and Behaviours Sciences Collection). These databases were searched for English language papers published between 1 January 2006 and 1 April 2011 using the key words violen* (violence or violent) and in-patient or psychiatric words or psychiatric settings. Limiters were used in each database to include and exclude certain studies. The search was limited to full text articles, available references articles , articles published between 1 January 2006 and 1 April 2011 in scholarly (peer reviewed) journals. Special limiters for Academic Search Complete were periodical publications, English language articles, and articles with PDF full text. Special limiters for CINAHL Plus were articles with available abstract, English language articles, research articles only, articles that considered humans only as research subjects, articles with at least one nurse author, studies conducted in inpatient settings only, and articles with PDF full text. Special limiters for MEDLINE were: articles with abstract available, English language articles, articles that considered humans only as research subjects, articles published in nursing Journals only. Only PDF full text articles were searched in psychology and Behavioural Sciences Collection. After completing search, 197 studies resulted. Most of them were included in this paper. However, some were not included because they did not respond to the objects of this paper. Some of studies in references lists of the resultant articles were also reviewed and included for epidemiological purposes even they are older than five years. Some of them were also used for critically reviewing the updated studies (à ¢Ãƒ ¢Ã¢â€š ¬Ã‚ °Ã‚ ¥5 years). Definitions Violence in the workplace can take various forms ranging from abusive language, threats, physical assaults, and even homicide (Wassell, 2009). There are many different definitions of violence. This section will define and differentiate between violence forms and forms. The world Health Organization (WHO) define violence as: The intentional use of physical force or power, threatened or actual, against oneself another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevlopment, or deprivation (WHO, 2005, p.5). Work-related violence is any activity or event occurred in the work environment involve the international use of physical or emotional abuse against an employee, resulting in negative physical and emotional consequences (Nachreiner, et al., 2007). A less restrictive definition was the definition of Baron and Neuman; they define workplace violence as direct attacks which occur in the work place itself or within an organization (Baron Neumann, 1998). Physical assault is hitting, slapping, kicking, pushing, grabbing, sexually assaulted, or any type of physical contact aimed to injury or harm (Nachreiner et al.). A threat occurred when someone used words, gestures, or actions for freighting another one without attempting harm or injury (Nachreiner et al.). Sexual harassment occurred when one is a subject for any type of unwanted sexual behaviour (words or actions). (Nachreiner et al.). Verbal abuse is calling another person -must be associated with the name- with unfavourable words for the purpose of hurting emotionally injuring. Jenkins (1996) believes that even threat of physical violence is considered physical violence (Jenkins, 1996). WHO determined three types of violent acts: physical, sexual, and psychological (WHO, 2005, p.6). Violence and aggression are two interrelated concepts extensively studied in nursing literature. Although, they are not the same, nursi ng literature widely used them interchangeably. In this paper, violence and aggression will be used interchangeably. Epidemiology The risk of being subjected to violence among health staff is 16 times higher than in other occupational groups in the service sector (Kingma, 2001). There is an escalating alarming trend of all forms and types of violence towards nurses in health care settings (Whelan, 2008). Nurses are at the highest rates of nonfatal workplace assault and violent victimization in all health care settings (Lanza, Zeiaa, Rierdan, 2006). There is a considerable difference in the prevalence and incidence of episodes of violence in mental health settings, depending on the countries in which the studies were carried out. A survey of 4.826 nurses conducted by the American Nurses Association, 17% reported that they have been physically assaulted, and 57% reported that they had been abused in the last year (Peek-Asa, et al., 2009). Also, only 20% reported that they felt safe in their current work environments. Psychiatric nurses are the highest subjects of violent victimization rates of all types of nurse s (Islam, Edla, Mujuru, Doyle, Ducatman, 2003). In an analysis of the results of the Assaulted Staff Action Programme (ASAP) that persists for 15 years; 1.123 mental health nurses (69.58%) were victims of violence by patients. They were the subjects of physical (85.32%), sexual (1.18%), nonverbal intimidation (1.67%), and (6.01%) assaults. 46.34% of injures were soft tissue bruises, 10.16% were head and back injuries, 5.76% were bone/tendon/ligament injures, 12.39% were open wounds, scratches, or spitting incidents, 1.8% were abdominal wounds, and 18.65% were psychological fright. 36.69% were mild injures, 31.52% were moderate, and 14.13% serious and intense (Flannery, Farley, Rego, Walker, 2007). A survey in psychiatric institutions in Switzerland reported that 70% percent of nurses reported being physically attacked at least once in their career (Needham, et al., 2004). A multiregional study of nursing staff members from acute psychiatric settings showed that 76% of the particip ants reported that they were assaulted at least once (Peek-Asa, et al., 2009). In a study in Iran, verbal abuse was experienced by 87.4% of nurses during a 6-month period, and physical violence by 27.6% during the same period of time (Shogi, Sanjari, Shirazi, Heidari, Salemi, Mirzabeigi, 2008). The most frequent and most severe forms of verbal abuse reported were judging and criticizing, accusing and blaming, and abusive anger (Kisa, 2008). In one Arabic study, a national cross sectional survey was conducted in Kuwait to document the prevalence and determinants of violence against nurses in healthcare facilities. 48% of nurses experienced verbal violence; and 7% only experienced physical harm over the previous six months (Adib, Al-Shatti, Kamal, El-Gerges, Al-Raqem, 2002). Another Arabic study in Bahrain, Hamadeh and colleagues found the average assault rate on nurses is 4.4%. (Hamadeh, Al Alaiwat, Al Ansari, 2003). No similar studies were conducted in Jordan. However, this high results may be an emergent indicator of the escalating trend in Jordan and other Arabic countries because of their similar Arabic culture to Kuwait and Bahrain. Epidemiological studies were recommended to conduct to determine the incidence and prevalence of this phenomenon in Jordanian health care settings and especially in mental ones. Despite the high prevalence of violence acts toward nurses, only 20% of violent incidents are reported by nurses. This is due to staff being accustomed to violence; peer pressure not to report; differential reporting based on gender of the victim, fear of blame; excessive paper work; and incomplete or invalid information on reports completed by persons not witness to the event (Crilly, Chaboyer, Creedy, 2004). This problem should also be addressed in future studies to investigate its causes and to solve it. The Victim Nurses are usually the subjects of violence victimization. However, Other mental health care professionals such as physicians and physiotherapists are also at a considerable of violent acts (Stubbs Dickens, 2009). This paper addressed nurses only as subjects of victimization from psychiatric and mentally ill patients. Psychiatric patients assaults on nurses victims are a worldwide occupational problem. There is remarkable consistency in victim characteristics over time (Flannery, Juliano, Cronin, Walker, 2006). Men nurses were exposed to more abuse than women (Shagi, et al., 2008). However, there is an inconsistent finding in the literature identifying whether males or females are more violence-prone (Camerino, Estryn-Behar, Conway, Der Heijden, Hasselhorn, 2008). The risk of experiencing abuse was higher in nurses with more job experience or who worked more hours (Shagi et al.). On the other hand, a longitudinal cohort study showed that younger nurses with less job experiences are at increased risk violence (Camerino et al., 2008). However, exposure to violence was not significantly associated with age, gender, duration of employment in nurses working in child and adolescent psychiatric units (Dean, Gibbon, McDermott, Davidson, Scott, 2010). Having a lower job title (air or practical nurse), b eing in closer contact with patients, having special personality traits, using drug or alcohol, reporting extreme fatigue , may lead to higher risks for aggression and harassment at the workplace (Cooper Swanson, 2002). Nachreiner et al, agree with Copper Swanson on that LPNs an increased risk for both physical assault and non-physical violence compared to RNs (Nachreiner et al, 2007). Violent incidents are often related to the low awareness of nurses about the adequate therapeutic communication skills in dealing with patients (Cooper Swanson, 2002). Perceptions attitudes of nurses on patients violent incidents in psychiatric settings are extensively studied in the literature. Psychiatric nurses attitudes are different across countries (Jansen, Middel, Dassen, Reijneveld, 2006). According to some nurses violence is perceived as dysfunctional/undesirable. Whereas in others, violence is perceived as a functional comprehensible phenomenon (Abderhalden et al., 2002). 97% of participants believed that dealing with aggressive behaviour was a part of work in mental health inpatient unit (Dean, Gibbon, McDermott, Davidson, Scott, 2010). In the same study, 69.7% of participants believed that the current level of physical aggression in the ward was unacceptable, whereas only 12% report that it was acceptable, and the others reported feelings of uncertainty (Dean et al, 2010). They rationalize that by recognize that staff with more positive attitudes exhibited lower state anxiety. There are negative attitudes of nursing students to violen t incidents, and these attitudes are deteriorated over time (Bowers, Alexander, Simpson, Ryan, Carr-Walker, 2007). The perception of aggression scale (POAS) is a newly developed attitude inventory assessing nurses attitude toward aggressive patients (Palmstierna Barredal, 2006). Consequences of violent incidents on nurses were also extensively investigated in the literature. Responses to violence encompassed three major categories relating to physical emotional and professional impact (Dean, et al., 2010). They found that physical injuries divided to: direct injuries from the violent incidents, injuries while implementing restrictive interventions, and physical symptoms such as headache and muscle tension (Dean, et al.). Major physical injuries were on the head, the trunk, the upper and lower extremities (Langsrud, Linakker, Morken, 2007). Ongoing mental fatigue, stress, shock, helplessness, anger, vulnerability, feelings of being emotionally drained, anxious, impaired sleep and concentration were all emotional responses of nurses as a result of being violent (Dean, et al.). Nurses also respond with the following emotions and behaviours: frustration, despair, hopelessness, substance abuse, absenteeism, retaliation and the development of I do not care attitu de (Bimenyimana, Poggenpoel, Myburgh, Niekerk, 2009). The results of verbal abuse or violence by patients, often result in a severe psychological impact in nurses (Inoue, Tsukano, Muraoka, Kaneko, and Okamara, 2006). The most common emotional reaction to violence was anger, followed by shame, humiliation and frustration (Kisa, 2008). The Perpetrator Violence is common among individuals entering mental substance abuse words. Episodes of violence on psychiatric wards have been extensively studied, with one of the main aims being to identify who is more likely to be violent during hospitalization. However, it is difficult to determine that, because violence is a complex behaviour links with a variety of biological, psychopathological, and social factors. 15-years study concludes that older male patients with schizophrenia and younger personality-disordered patients are high-risk assailants (Flannery, Juliano, Cronin Walker, 2006). Antisocial personality disorder poses a great risk for violence among women than men (Yang Coid, 2007). Anxiety disorders and any personality disorder are more severe among violent women; alcohol dependence and hazardous drinking are more severe among violent men (Yang Coid). In a recent literature, Cornaggia and colleagues found that the psychiatric diagnosis most frequently associated with aggressive behaviour is paranoid schizophrenia. As patients with paranoid schizophrenia retain sufficient ability to plan and commit acts of violence related to their delusions (Cornaggia, Beghi, Pavone, Barale, 2011). Higher levels of hostility-suspiciousness predict the worsening of the pattern of violence (Amore et al., 2008). Persecutory delusions appear to increase risk of violence in some patients; co-occurren ce of persecutory delusions and emotional distress may increase the risk of violence (Bjorkly, 2006). Lower social class of origin, offending behaviour in the parental generation loss of the father, a new partnership of the remaining parent, growing up in blended families promoted the development of offending behaviour in general (Stompe, et al., 2006). Past history of violence toward others, substance abuse disorders are risk factors for future violence (Flannery, Julliano, Cronin, Walker). Past history remains the most consistent and stable predictor of future violence (Amore et al., 2008). Dual diagnosed patients with substance abuse disorders and bipolar sample have more violent acts (Grunebaum, et al., 2006). Black and minority ethnic are more often perceived as potentially violent to others (Vinkers, Vries, Van Baars, Mulder, 2009). Internalizing symptoms and affective reactivity contributed to aggression severity more than impulsivity and demographics (Kolko, Baumann, Buks tein, Brown, 2007). Even the month of birth of patients is considered a risk factor of violent behaviour (Cailhol, et al., 2009). Repeatedly violent patients had a higher length of residency, a higher number of previous violent behaviours (Grassi, et al., 2006). A past history of head injury with loss of consciousness was more frequent among persistently physically aggressive patients (Amore, et al., 2007). Assessment Many studies also discussed high risk children in the literature. Aggression appears associated with a wide variety of commonly psychiatric disorders in children (Connor McLaughlin, 2006). Children of bipolar parents are at high risk of hostility, aggression, violence (Farchione, et al., 2007). Adolescent conduct disorder patients are more likelihood to be violent (Ilomak, Viilo, Hakko, Marttunen, Makkikyro, Rasanen, 2006). Children with learning disabilities who had a comorbid psychiatry diagnoses reported a significantly higher amount of peer victimization than children without a cormobid psychiatric disease (Baumeister, Sterch, Geffken, 2007). Many other results showed results opposed to what known. Foley and colleagues found that violence at presentation with first-episode psychosis is not associated with duration of untreated psychosis (Foley, Browne, Clarke, Kinsella, Larkin, O`Callagham, 2007). No substantial evidence support the relation between insight and violence risk (Bjorkly, 2006). The Scene The scene of violence victimization against the psychiatric nurses by psychiatric and mentally ill patients is the psychiatric settings. The structure of the setting can provoke the manifestation of violence (Steffgen, 2008). Also, environmental design have been demonstrated to deter violence (Wassell, 2009). Inadequate staffing levels and lack of opportunities for clients to participate in therapy may provoke violence behaviour (Sturrock, 2010). The role of uncertainty concerning job stability represent a casual factor Also, lack of job security may cause violent behaviour The absence of social support and co-workers increases the risk of nurses in this setting to physical and verbal violence (Steffgen). The occurrence of workplace violence may cause damage to both the individual and the institutions. Organizations may face increased absenteeism, sick leave, property damage, decreased performance and productivity, security costs, litigation, workers compensation, and increasing turn over rates (Jackson, Clare, Mannix, 2002). Prevention Previous nursing literature suggested a number of strategies that can be considered by nurses to prevent violence. There is limited research on effective interventions to prevent patient violence (Kling, Yassi, Smailes, Lovato, Koehoorn, 2010). However, failing to accept and implement preventive measures in psychiatric settings has an impact to reduce violence in these settings (Wassell, 2009). Improved reporting may be of big benefit of reducing physical violence (Nolan Citrome, 2007). This may be occur by early recognition and intervention of potentially occurring violent incidents in the future. After conducting the Violence Prevention Community Meeting (VPCM), a significant decrease in patients violence were found across day, evening and night shift for pre-treatment vs. treatment and pre-treatment vs. post treatment comparisons. VPCM is a semi-structured protocol for the purpose of violence prevention (Lanza, Rierdan, Forester, Zeiss, 2009). Early recognition has strong practical implications for psychiatric nurses by helping them to assist patients with the detection of early warning signs. Early recognition is pay special attention to the early social and interpersonal factors that may deteriorate the patient behaviour to violent one (Fluttert, Meijel, Webster, Nijman, Bartels, Grypdonck, 2008). Steffgen identified many preventative measures of workplace violence such as: measures concerning the physical environment, measures concerning the management of the organizations and the behaviours of the members in the organizations, policies, counselling and training measures (Steffgen, 2008). A 6-module program have been shown to be effective in reducing and preventing violent incidents in a 6-months evaluation period. The 6 modules were about violence risk assessment, theoretical models of violence, assertive training, ethical legal issues of violence management (Anderson, 2006). Dubin et al identified six gold recommendations to prevent violence incidents in psychiatric emergencies. Firstly, all newly admitted patients should be assessed for risk of violence; those who have risk factors should be continually assessed. Second, nurses should avoid evaluating and/or treating patients at risk for violence alone or in an isolated office. Third, nurses must remember that patients violence is a response to feelings of helplessness, passivity, and perceived or actual humiliation; therefore nurses should avoid becoming verbally or physically towards them. Fourth, nurses are supposed to use non-coercive methods such as de-escalation to prevent escalation of patients aggression. Fifth, limit setting should always offer the patient two options with one option being the preferred option. Sixth, an armed patient should not be threatened and the clinician should respond in a non-threatening manner offering help and understanding. Finally, evaluation of environment safety s hould occur periodically and changes should be implemented that will enhance safety (Dubin, Julius, Novitsky, William, 2009). Assessment The first step in mental nursing process and one of the most important duties in psychiatric settings is assessment. Psychiatric nurses are faced with a great number of situations in which risk assessment are needed. Risk assessment is a process concerned with a variety of issues à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬risk for what, when, where, and to whom-not just the were Prediction of future violence (Haggard-Grann, 2007). Predicting violence has been compared to forecasting the weather. Like a good weather forecaster, the nurse does not state with certainty that an event will occur. Instead, he/she estimates the likelihood that a future event will occur. Like weather forecasting, predictions of future violence will not always be correct (Scott Resnick, 2006). Three major types of violence risk assessment are extensively reviewed in the literature. The three types are: (1) Clinical violence risk assessment, (2) Structural risk assessment tools, (3) Functional assessment. The number of risk assessment instruments has increased in the recent years (Haggard-Grann). Risk assessment tools should include situational aspects, behavioural patterns, and predicted events or stressors (Haggard-Grann). The first step when determining which instrument to use for a specific risk assessment is to determine the purpose and context for which the instrument is needed (Haggard-Grann). Decision should be made regarding whether the assessment is for the first time (to separate the highly risk patients from others) or for continuous ongoing assessment (Haggard-Grann). If adopted in clinical practice with a professional way, these instruments will indeed aid in the assessment and early recognition of violent incidents. However, they are inescapable part in the clinical practice in psychiatric settings. (Haggard-Grann). Awareness of the limits and abilities of such instruments is required. Lurigio and Harris underscored the importance of performing more accurate assessment tools that can for example determine the upcoming type of violence, or the likelihood of weapons use (Lurigio Harris, 2009). A risk assessment tool mainly contains two types of factors: static and dynamic. Dynamic factors are of a great importance in a decision context whereas static factors are at less importance. Dynamic factors should be assessed regularly in a structured time schedule (ex. every 1 hr). (Haggard-Grann). Static variables are based on intrapersonal factors (ex., personal biological characteristics) that served as risks factors for a patient to be potentially violent in the future. (Haggad-Grann). Many violent risk assessment tools were developed for the aim to assess the violent incidents in psychiatric settings. Sexual Aggression scale is an effective assessment tool to record systematically the occurrence of sexually aggressive behaviours for patients who reside in psychiatric hospitals. (Jones, Sheitman, Hazelrigg, Camel, Williams, Paesler, 2007). It is a brief scale consists of 4 sub scales with a brief description of them. The Alert System is a system includes a risk assessment form used by nursing staff to assess patients upon admission to the psychiatric setting in order to identify these at an increased risk of violence (Kling, et al ., 2010). If identified as at risk for violence, a flag is placed on the patients chart and wristband to contain staff of a patients potential for violence (Kling et al). The warning is intended to allow workers to take precautions to prevent violent incidents in flagged patients. These precautions may include: wearing a personal alarm, being near a security personals, not having sharp objects in the patients room, and not entering the patients room alone (Kling et al). Study results indicate that the Alert System is effective in identifying potentially violent patients. However, the ultimate goal of implementing the Alert System is to reduce the risk of violent incidents (Kling et al). Risk for in-patient violence in acute psychiatric intensive unit can be a high degree be predicted by nurses using the Broset violence checklist (Bjorkdahl, Olsson, Palmstierna, 2006). The BVC is a method to predict risk for violence from patients within the coming 24 hrs in acute psychiatric inpatient settings (Bjorkdahl, Olsson, Palmstierna). BVC is used to assess the patient three times daily: in the morning, noon, and night shifts (Bjorkdahl, Olsson, Palmstierna). The BVC assess absence or presence of six behaviours: confusion, boisterousness, irritability, verbally, threatening, physically threatening and attacking object (Bjorkdahl, Olsson, Palmstierna). The HCR-20 is a structured professional checklist designed for the assessment of risk future violence in patients with violent history / or a major mental disorder or personality disorders. (De Vogel De Ruter, 2006). The HCR-20 consists of 20 items, divided into three subscales: historical scale, clinical scale, and risk management scale. The predictive validity of the HCR-20 was good (De Vogel De Ruiter). The Forensic Early Warning Signs of Aggression Inventory (FESA) was developed to assist nurses and patients in identifying and monitoring early warning signs of aggression in forensic patients (Fluttert, Meijel, Leeuwen, Bjorkly, Nijman, Grypdonck, 2011). The Maudsley Violence Questionnaire contains 56-items measure a number of cognition (including: beliefs, rules, distortions and attributions) that are related to violence (Warnock-Parkes, Gudjonsson, Walker, 2007). The Psychopathy Checklist (PCL) is a clinical rating scale designed to measure psychopathic attributes in mentally ill patients, Patients who score higher have higher rates of violent recidivism (Scott Resnick, 2006). The PCL uses a semi-structured interview, case-history information, and specific criteria to rate each of 20 items on a three- point scale (0, 1, 2). (Scott Resnick). Total scores (ranging from 0 to 40) reflect an estimate of the degree to which the patient matches psychopathy (Scott Resnick). The Violence Risk Appraisal Guide (VRAG) is a risk assessment instrument of 12 items. It is probably the most well-known assessment instrument aimed to assess dangerousness in high-risk mentally ill patients. It is used to appraise the violence risk in psychiatric and other health settings (Scott Resnick, 2006). It is constructed by taking variables known to predict violent behaviour among men with mental disorders who have records of previous violent behaviour then summarizing the variables into one scheme (Haggard-Grann, 2007). Interactive Classification Tree is a recent tool for assessing the violence risk of patients discharged from psychiatric facilities (Scott Resnick, 2006). This tool utilizes a sequence of questions related to risk factors for potential violence (Scott Resnick). According to the answers, another related question is posed, until the pt is classified into a category of high or low risk of future violence (Scott Resnick). Structured risk assessment tools have inherent limitation when used alone. Criticisms of instruments include the following: they provide only approximations of risks; their use is not generalizable beyond the studied populations: they are rigid, and they fail to inform violence prevention risk management (Scott Resnick, 2006). Functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of problem behaviours. This is achieved through assessment of the behaviour of interest, the individuals predisposing characteristics, and the antecedent events, considered important for the initiation of the behaviour, and the consequences of the behaviour, which maintain and direct its developmental course (Daffern, Howells, Ogloff, 2007). They identify 9 common functions of violent behaviour in psychiatric settings in the literature: demand avoidance, to force compliance, to express anger, to reduce tension, to obtain tangibles, social distance reduction (attention seeking), to enhance status or social approval, compliance with instruction, to observe suffering (Daffern, Howells, Ogloff). Functional assessment have many implications for the prediction and prevention of inpatient violence and for the treatment of violent patients. The distinction of functional assessment approaches and structured assessment tools is that the first emphasize the correct classification of the form of a particular behaviour and the other one emphasize the purpose of the behaviour (Daffern, Howells, Ogloff). The clinical risk assessment method is the oldest method of violence risk assessment. It is the classical method of expecting, predicting, and assessing of risk. This means that the nurse gathers the information that he or she believes to be useful and on the basis of that information makes a judgment of the risk (Haggad-Grann, 2007). Unfortunately, this method cannot predict future violence with high accuracy. The accuracy of a