Cost and fear of bird flu Research Paper Example | Topics and Well Written Essays - 750 words

Cost and fear of bird flu - Research Paper ExampleThis essay explores these issues in depth with a focus on avian influenza haze.Globally the avian influenza is considered an epidemic as it occurs over large areas affecting several communities over a particular period. For example, the influenza H6N1 revolve in large areas of China and was quickly curbed in areas like Japan (Francesca, 2013). People panic when bird flu is an epidemic as they do not know where it will spread next or if it will be transmitted to their regions. Similarly, avian influenza leads to economic losses because on money utilise to treat and contain it, reduction in poultry sales, and losses in productivity. For instance, Romania experienced a 80% drop in poultry sales in May 2006 in Italy, sales fell by 70% after wild swans were infected (Food Quality & Safety Magazine, 2008, p.1). It also leads to social alienation of the acres or countries involved as they are considered dangerous areas since the flu is fa tal and spread quickly through human contact.Alerts of the bird flu are commonly magnified when the mortality rates are high. Also when the vaccines or cure against the disease are difficult to manufacture or make, or when the virus twine is hard to identify and eliminate, the alerts made are so that people can safeguard themselves from the spread of the disease. Limited alerts are made when health organizations can seminal fluid up with solutions and the virus strain of the disease does not lead to high mortality rates or is manageable (World Bank, 2013). It would be advisable if the alerts were made with the reverse information on how people could protect themselves from the disease as opposed to sending out alarming alerts of the number of deaths, that is, statistics without educating the public.The extent to which the bird flu should be funded and where the experts and medical personnel should go will largely be determined by the severity of the

Game theory in setting quantity oligopoly Essay Example for Free

back up opening in setting sum of money oligopoly EssayGame scheme is a formal study of conflict and cooperation in political economy. In fact, it is usually concerned with predicting the real outcome of the adventures of strategy where the potential individuals have incomplete awareness close the others plans. The game theoretic concepts usually apply whenever the actions of several agents are interdependent. Probably, these agents are either, groups, individuals or firms. The concepts of game theory give a language to invent a structure, analyze, and comprehend deliberate scenarios. Game theory has straight relevance to the study conduct of the venture as headspring as the performance of the firms in oligopolistic food markets. A good approach is the decisions that companies takeover pricing and levels of production. Also, how much money needs to be invested in research and development expenditure (Binto a greater extent, 1993). Oligopoly is a suit of imperfectl y competitive markets. It has only a few sellers, provide a related or identical product to the buyers in the market. Collusion in frugals is simply an agreement of two or more firms with an place to exclude a couple of competing companies in the market so that may obtain higher(prenominal) profits. It is clearly that contender in the oligopolistic markets reduces accelerating the performance of that secret approval. For that reason more firms quit the marketing operations enhancing profitability to the relating competitors hence deteriorating their frugal decisions. This results to complete dissolution of the firms. The end product of the collusion increases since most of the firms have quit the market others loosen their momentum to adhere to the upcoming changes launched in by the oligopolistic markets (Mertens, 1994). As a matter of fact, this becomes advantageous to the remaining firms in the market (Thomas, 2003). It is noned that collusion is a fontistic trait of oligopolistic firms. Stiff competition and interdependent decision-making encourage oligopolistic firms to cooperate. In fact, one centering to lessen the oligopolistic rival is joined together and meets targeted forces forming collusion. There are two main types of collisions in an oligopolistic market. Exclusively, include explicit collusion and implicit collusion. Explicit collusion is a type of collusion which has more two than firms in the same industry. It is formally agreed to control the market force on their own flair whereas implicit collusion also more than two firms in the same business but informally they have the similar outlook in the market, habitually with nothing more than interdependent (Binmore, 1993).The price collusion is a form of criminal offense since several firms work as a team so as to keep the price of commodity high with an aim to receive colossal income. The relating firms involved necessarily try to chase out their competitor.History and have-to doe with of game theory In 19th century, game theory was first discovered by one of the early inventors. Consequently, in 1838, the first publication was through with(p) by Antoine Cornet. In broad spectrum, he came up with well-formulated researchers on the Mathematical Principles of this kind of theory basing on wealth. He went further to illustrate more on the principles of the publication relating to the game theory. Notably, he tried to explain the underlying rules constituting the actual expression of the duopoly in the discipline. Even though this publication was associated with the theory of Games and Economics character in 1944, it had the latest principles of game theory that were formulated in it. The game theory has been greatly applied to the behavior of producers with few or one competitor. This purview of the game theory was conceived by Von Neumann in 19th century. In macroeconomics, oligopolistic markets are characterized by a few, large firms and its differe nces from the other market structures as state above. It is noted that more competitive markets in the firms are of smaller size and its firms behavior have slight or no frame on its close competitors. Besides this oligopoly markets changes its output, enlarge into a new market, provides modern services and even advertize. This will have a consequential impact on the market competitors, therefore, increasing the profitability. This enhances more power in the market operation hence deviating losses had to be encountered. For this reason, the firms in oligopolistic markets are al instructions considering the act of their competitors when implementing their economic decisions. The oligopolistic owners strictly tackle any leakages in their market so that they may do their set goals and formulated objectives.Information rallying in collusion In broad spectrum, information is an essential tool in planning to come up with mature and complete mechanization of the involving firms. Basin g this argument on the game theory, it is effect that in decision making, information is significantly employed. For that reason, a successful collusion in the oligopoly market has sophisticated means on how to underlie its perspectives in a manner that no rival firm come to know. Therefore, crude ideas empower any collusion with a vision to reduce their competitors in the market. Advances in economic theory have enabled the economists to set competitive distinctions between different types of information transpositiond between the firms. The required beneficial effect on the consumers and potential side-effects for competition depend on the nature and characteristic of the information that exchanged and also the type of competition in the market. Therefore, it should be known that firm owns the secret in the industry such as firms prices, sales, cost demand and other parameters. fit to game theory, the competitors are not supposed to get any of this secretive information. Compe tition authorities are strictly suspicious when information is conveyed especially about prices and quantities because this information is normally significant for monitoring deviations from collusive arrangements and hence empowering collusion. largely exchange of information on the cost and demand is seen in another dimension and more favorably. However, information about the prices and quantities is used to convey information about the cost or demand in collusion. For instance, when the firms share information on the past or current prices and quantities inform other players about the demand in the market. This enables their rivals to obtain inferences on how to predict the future period which is against the game theory. Notably, this will weaken their collusion that later on begins to deteriorate in their existence in the market. As a matter of fact, demand and cost information is useful since is the central element for predicting future demand. Effective collusion needs goo d coordination that is well supported by the exchange of information about their plans. This monitors the performance of the collusion in some days to come. In so doing, their rivals will be unavailing to out-compete them. They become prominent in the market achieving their set goals and objectives. The aggregative information determines whether the collusion will succeed or not. This depends on how the decision making is done. The aggregated information means anonymous or individualized information. Probably, such information may be valuable to the firms. Therefore, it is necessary to know who or where a sealed estimate has been made or whether it is enough to comprehend the private signals in the entire industry. In addition, information can be either private or public. The effects of information exchange extremely differ depending on whether the information is made public or kept private, especially in the industry that exchange information. The game theory does not support ex posure of the firms intentions. Definitely, they try it, their rival players will come up with the newest perspectives to out-compete them. Therefore, this should be done privately for future success (Thomas, 2003). It realized that if the information does not give rise to competition distress it will be definitely positive to welfare. Indeed, the usefulness from information exchange is large compared to its demerits. There are quite number of the ways in which information exchange is useful in the welfare. Information exchange is a great part of the discovery mechanism in the industry economy. This implies that through exchange of information in between the formed collusion encourages expansion of the market economy. It also improves investment decision and organization learning. It is only through information where collusion members come up with complete ideas to uplift their set goals. Information exchange also results to output adjustments and lowering search costs in the fir m. In the world, information is really required about the demands and rival activities. Notably, the firms would have to become modify to the changing circumstances by a trial and error process. Information exchange is a great tool in playing the role of stimulate market economy in collusion hence output in the firms.Impact of rational behavior in collusion Rationality is one way of decision-making practice wherein a firm exercises prudent choice making that gives it a maximum amount of benefit. Rational behavior usually facilitates decision making that is not productive in collusion. But it only strives to achieve benefits that are mostly achievable in nature. This usefulness can be either monetary or non-monetary. The word monetary stands for finance activities whereas non-monetary is associated with non-financial activities in a smart set. Therefore, any successful firm considers the following perspectives. This kind of decision making may not accomplishable return material ly to the firms at that moment on (Chatterjee, 2014). Therefore, rational choice theory is an economic principle. It states that firms make prudent and logical decisions so as to attain a complete satisfaction in the firm due to its abundant benefits. The output of collusion increases over measure due to changes made in by the decision makers. The identified plans that based on rational behavior usually alter operation of oligopolistic market. Operations may greatly expand performance of the company undermining its valuable transactions. When the collusion need to uplift its operation have to be economical on the way do operate their activities so that can check a slight differences. Notably, some measures need to be employed to overcome its competition from its rivals. The firms recruit innovative and competent staffs to invest great fortune in the organization. Competent economists formulate ideas flourishing functionality of the collusion hence uplifting profits, quantity, and its dignity. This shows how game theory is significantly applied in the oligopolistic market basing on the rational behavior. It is kind of considered as a means of competition through decision making. This scares rival players in the market such that are unable to operate their firms. Due to this condition, many firms in the markets are readily to be dissolved. The cause of this is just continuous losses experienced on every end fiscal year resulting to dissolution. According to game theory, rational behavior is greatly a crucial tool required to make decisions that are needed to eliminate relating firms in the market. Most importantly, competing firms quantity reduces as well as its income accelerates due to well-played game theory in the oligopolistic market. Mainly rationality has a positive impact to the prudent collusion. Therefore, game theory is correlated to rationality behavior as far as decision making is concern in an oligopolistic market as mentioned earlier. On ly that rational behavior is conditions suitable for accomplishing this specified theory (Mertens, 1994). Even though, participating firms can employ it, frequently is determined by competency of the collusion.Impact of season horizon in the collusion In economics, time horizon is also referred to as a planning horizon, is a fixed point of time in the future at which some activities will be evaluated. It is noted that is specified a time when all planned activities or processes are supposed to terminate. Therefore, time horizon is a vital condition to any successful stakeholders. It enhances a strict time layout on how to operate your business transactions before targeted deadline. This minimizes time wastage and considers it as a significant factor in implementing business laws. Actually, the set objectives and underlain goals, with the cooperation of competent experts in business, are easily achieved. Time horizon has optimum benefits to those who put it into consideration. Collusions have eccentric pathways on how they operate their organizational activities. Additions to that have business ethics for guiding set goals to reach its financial year and attain them. For a successful collusion, time horizon is much in demand to eradicate other firms out of the market. Especially, it needs strictness so that the set firms goal is accomplished on reaching time horizon. It confers bright future to competing firms enhancing increased output in the collusion. Time horizon sharpens performance of the most firms with an aim to make more profits in their organizations. Similarly, time horizon is a beneficial condition on practicing game theory in an oligopolistic market. It creates immense difference in the industry. The time horizon can be a month, a week or a year depending on the decision of the firm (Mertens, 1994).Broadly, time horizon is a viable and secret tool that empowers collusion to diminish performance of its rivals in the industry. Eventually, it becomes determining(prenominal) condition in collusion leading the business to enjoy huge profits and crude output. Collusion lowers its products price support more sales whereas its rivals remain constant to the initial price. Cost is usually lower hence encouraging more sales due to high demand. The collusion stagnates in the same price until time horizon comes. At that planning horizon, several firms would have left wing the industry enabling collusion with uncompetitive environment to work on (Chatterjee, 2014).Conclusion In broad spectrum, game theory deals with decision making that strengthen competition perspectives in the market. It is kind of a game whereby participating individuals hide their intentions purposely to win over the other. In this case, information, rationality, and time horizon are determinant conditions that boost succession of collusion in an oligopolistic market. It signifies that to acquire viable benefits in the market has to employ well-formulate d conditions.Therefore, cost, demand, and quantity differ from relating firms in the industry. Strictly, collusion tries to lower its prices with an aim to increase its output and eliminate the number of firms in the industry. Similarly, quantity in the industry increases with increased prices from other firms. Due to that reason number of consumers in those firms reduces connection newly formed collusion. This enforces rivals to reduce its prices of their products leading to uncountable losses hence leading to collapsing of many firms. The collusion succeeds its target of eliminating other firms from the industry henceforth starts enjoying oligopolistic benefits including profits.ReferenceBinmore, K. (1993). Frontiers of game theory. Cambridge, Mass. u.a. MIT Press Telser, L. G. (1971). Competition, collusion, and game theory. London Macmillan.Chatterjee, K., Samuelson, W. (2014). Game theory and business applications. New York Springer.Mertens, J.-F., NATO Advanced Study Institu te on Game-Theoretic Methods in Economic Equilibrium Analysis. (1994). Game theoretic methods in general equilibrium analysis proceedings of the NATO Advanced Study Institute on Game Theoretic Methods in General Equilibrium Analysis, want Island, NY USA, July 1 12, 1991. Dordrecht u.a. Kluwer.Thomas, L. C. (2003). Games, theory and applications.Voigt, S., Schmidt, A. (2005). Making European merger policy more predictable. Dordrecht Springer.Source document

Ovulatory cycle effects on tip earnings by lap dancers Essay Example for Free

Ovulatory beat effects on treetop earnings by lap social dancers EssayThe empirical article Ovulatory cycle effects on tip earnings by lap dancers economic evidence for gentle estrus, Myler, Tybur and Jordan, Evolution and Human Behavior 28 (2007) 375 381 examines whether military man estrus was really lost during evolution. The estrus refers to estrous (or oestrous) cycle that comprises the recurring physiologic changes induced by reproductive hormones in most of mammalian fe mannishs with a placental reproductive system. Humans undergo a menstrual cycle instead and it is believed by many theorists that human estrus has been lost during evolution. The authors have apply an economic model that analyzes the effects of estrus on tip earnings by lap dancers. Typically males of a mammalian species are more solicitous towards a female of the same species. The hypothesis of existence of human estrus is sought to be proved by higher earnings reported by lap dancers during the pr oductive period corresponding to estrus in other placental mammalian species. Here the logical assumption is that an estrous lap dancer would receive more solicitations for private show increasing her tip earnings during estrus.Design of the experiment involved multiple observations (i. e. , tips per shift) for dancers who were nested within contraception use and track with cycle phase. The data gathered was used to analyze effects of cycle phase and contraception use on tip earnings using multilevel modeling. Result of the empirical work confirmed the authors prediction that pill using and normally cycling participants would demonstrate a similar difference in tip earnings between the menstrual and luteal phases.Second prediction that cycling participants would demonstrate a larger increase in the fertile phase congener to the other phases than pill-using participants was also confirmed by the findings. Experiment found strong ovulatory cycle effects on tip earnings moderated by whether the participants were normally cycling. This row breaking paper provides the first direct economic evidence for the existence of estrus in contemporary human females. Real consumer spending patterns reveal human preferences more reliably than verbally stated judgments do.This is particularly true for socially stigmatized products such as pornography or sex work. The experiment involved moreover 18 participants which can be considered a relatively small size for an experiment with such vast conclusions. But the small size was adequately scratch by an observation period of three months and a sufficiently large number of shifts for which observations were recorded. Moreover, the tip earnings of lap dancers are a result of changes in behavior pattern of a much larger number of their clients who were influenced by the estrous state of the lap dancer.When women and men interact intimately over the curriculum of several minutes through conversation and body contact, women appar ently either signal or leak cues of their fertility status, and these cues influence spending patterns by male consumers. These results argue against the view that human estrus evolved to be lost or hidden from males. Logical next step, despite its difficulties, would be further research to illuminate whether women have evolved special adaptations to signal estrus through such cues or whether the cues are leaking to sexually discriminating men as unselected side effects of cycle physiology.

Portrayal of the Gods Essay Example for Free

Portrayal of the Gods EssayGilgamesh was an historical king of Uruk in Babylonia, on the River Euphrates in modern Iraq. It revolves around the family relationship between Gilgamesh, who has become distracted and disheartened by his rule, and a friend, Enkidu, who is half-wild and who undertakes dangerous quests with him. In the heroic of Gilgamesh and in the lives of the Mesopotamian the divinitys where portray as self-serving arrogant beings. These beings created the gentlemans gentleman race as slaves for the gods and so a human in the view of an early Mesopotamian had better do what the gods give tongue to if they wanted to live a happy life. We see gods that that do not re every(prenominal)y care active the lives of the Mesopotamian. The Mesopotamian could not depend on the safety of a strong government. The lack of a strong government was caused by many different factors and one of the main factors that brought about a weak government in the land of the Mesopotamia, was the lack of a reliable food source. The unreliable food source was due to the lack of a reliable source of farming area. Moreover, this lack of farmland was due mostly to the ever-changing rivers that surrounded the early civilizations that believed in these harsh gods.These mountains could not depend on a predictable flood pattern from the Tigris or the Euphrates. This fact above all, is the reason that the view of mean uncaring gods came about for the lives of these early people. One year a village could be right next to the Tigris but in the next year, theyll be a mile away from the river thus destroying the type of economy that the village had in the previous year. Living with this, the people of the early civilizations blamed this hardship on the gods.These people did not think that the gods were all bad though, but just thought that they did not care about human existence because, as they believed, humans were created by many gods and for the sole service of these gods that created them. We conclude that these gods are always out to get the humans in whatever endeavor they may take up. Gilgamesh and Enkidu learn all too well that the gods are dangerous for mortals. Gods live by their own laws and frequently brook as emotionally and irrationally as children. Piety is important to the gods, and they expect obedience and flattery whenever possible.They can often be helpful, but angering them is sheer madness, and a characters reverence for the gods is no guarantee of safety. He is rich in religious symbolism. Religious rituals in Mesopotamia involved sacrifices, festivals, sex, dream interpretation, and shamanic magic. The walls of Uruk symbolize the great accomplishments of which mortals are capable. The epic of Gilgamesh differs markedly from that of the Judeo-Christian tradition, in which God is both a partner in a covenant and a stern but loving conjure up to his people.The covenant promises that people will receive an earthly or heavenly inher itance if they behave well. The Judeo-Christian God represents not just what is most all- sizeable but what is morally best, humans should aspire to imitate him. These differences are noteworthy because Gilgamesh also shares certain common elements with the Judeo-Christian Bible. The bible and Gilgamesh are written in both languages. In Oedipus Tyrannus, it talks about the Ancient Greece where a lot was not understood science was merely an infant and everything that happened was explained as an act of the gods or fate.Gods were the pinnacle of power existing since the dawn of time. They were immortal, omnipresent, and omnipotent. Different gods had different personalities. In this sense, the gods were anthropomorphic. Having such mastery of the world would enable them to control mans behavior. deal is the idea that peoples lives are predetermined and that no matter what is done, fate cannot be changed. With the gods it was used to explore as yetts that seemed unexplainable. It is clear that a betrayal of the gods dominance resulted in Laius and Jocastas education. Oedipus is the victim of both fate and circumstance.Apollo is the God behind the nebulous conspiration involving Oedipus. Oracular god hides what he reveals through his oracles. hither is evidence of the Greek theories, which contempt for the gods leads to pain and suffering. As a result he is punished in a way that is more severe than even death. There is also the fact of knowing that his mother is suffering terrible pain. In the embattle of Oedipus, fighting for his own life, the god is present as an old prediction, ineluctable for sure, but acting as background for the development of facts, or better, for the discovery of what had already happened.Oedipus experiences great grief when he looks back and realizes how much he has move from his former perch of power. This end is not only ironic but also cruel. Arachne was so apt at weaving that she challenged the god Athene to a contest. Oedipus c ertainly is not one without flaws. His pride, ignorance, insolence and disbelief in the gods, and unrelenting quest for the truth ultimately contributed to his destruction. The tragedy brought this evolution in the way of analyzing the relationship between the Greek gods and man, giving the latter more freedom of action.When Oedipus was told that he was responsible for the murder of Laius, he became enraged and calls the old oracle a liar. He ran away from his home, Corinth, in hopes of outsmarting the gods divine will. Like his father, he also sought ways to escape the horrible destiny told by the oracle of Apollo. The chorus warns us of mans need to have reverence for the gods, and the dangers of too much pride. If a man walks with haughtiness of hand or word and gives no concern to Justice and the shrines of Gods despises, may an evil doom smite him for his ill, starred pride of heart.If he reaps gains without justice and will not hold from impiety and his fingers itch for wate rtight things. When such things are done, what man shall contrive to shield his soul from the shafts of the God? (pp. 452). Finally, the Greeks are warned that the only way to happiness is through humility and respect towards the gods. In the book Monkey by Wu Cheng, Sun Wukong, cognize that despite his power over the monkeys, he was just like them, and was not beyond mortality. His determination to get wind immortality made him to travel on a raft to civilized lands where he was made the disciple of a Buddhist.Through his travels, he was able to acquire human speech and manners. He established himself as one of the most powerful and influential demons in the world and traveled into the ocean where he got the weapons that suited him. Hoping that a promotion and a rank amongst the gods would make him more manageable, the Jade emperor invited Wukong to Heaven, where the monkey believed he would receive an honorable place as one of the gods. Instead, he was made the head of heavenly stables to watch over horses.He went against the gods when he discovered what he was doing, and proclaimed himself as the great sage, and teamed up with the most powerful demons on earth. Although the heavens recognized the title of the monkey, their attempt to subdue the monkey king was unsuccessful. Wukongs indignation turned into open defiance when he realized that he was excluded from a royal meeting that included that god and the goddess. After stealing the empress Xi Wangmus peaches of immortality and the Jade Emperors royal wine, he escaped back to his kingdom in preparation for his rebellion.Finally he proved himself equal to the best of Heavens generals when he defeated the multitude of heavens. Conclusion In the three books, its evident that the gods were caring and if one goes against their will, there was a repercussion for that. The gods are the pinnacle of power who takes control of all the things in the world. Different gods have different personalities and deeds. Gi lgamesh learns that the gods are dangerous for mortals. Gods live by their own laws and frequently behave as emotionally and irrationally as children. Piety is important to the gods, and they expect obedience and flattery whenever possible.

English language student teachers pedagogical content knowledge

English quarrel savant go about worders pedagogical content experienceMy consider aims to analyze the relationship amongst English talking to disciple instructors pedagogical content knowledge moldt from the university bodwork and their habituate of instructing during the practicum in schools. By pedagogical content knowledge (PCK) here, I mean the knowledge to teach English as a second row at supplemental level. The sharpen of my study is to find out what PCK schoolchild instructors learn during their English language pedagogy course at the university and how they apply that knowledge in the classroom during the practice commandment. In this literature re bewitch I discus the c at a timept of instructor culture programmes, the practicum, link between theory and the practicum, gaps between theory and the practicum, how to strengthen the link between theory and the practicum and brief review of research on practicum in instructor statement and English language instructor educational activity programmes. In the end I state the aim of my study and the potential research questions. The figure of this literature review is to provide an introduction to and grounding for my study.2. Teacher Education ProgrammesTeacher education programs atomic number 18 designed and organized to train prospective and in-service instructors. These programmes indoctrinate teachers to teach at various levels of education such as pre-primary, primary, elementary, secondary coil and higher secondary levels. Two earthy types of teacher education programmes atomic number 18 pre-service teacher education which is excessively called initial teacher education (ITE) and in-service education and training (INSET). Initial teacher education prepares the new trainee teachers to teach at different levels whereas in-service teacher education provides training to the already working teachers. (Although there is a conceptual difference between the concepts teacher edu cation and teacher training, in this document I will be using both these concepts in the same meaning. Generally in this document, teacher education or teacher training means pre-service teacher education. If I talk about in-service education of teachers, it will be mentioned in the text).Aldrich (1990) says that teacher education programmes are important to prepare future teachers to bugger off their pro competencies. Laczko-Kerr and Berliner (2002) make out that university teacher preparation courses prepare better quality teachers. The objective of the teacher education programme is to equip assimilator teachers with a set of competencies to teach in the school setting (Banks et al. 2001), to cope with the obscureity of challenges in their everyday teaching work (Cheng, 2010). The challenge is to help assimilator teachers put their learning from the teacher education programme into practice.Most teacher education programmes include different segments general education sub ject-matter studies foundation of education studies methods studies and subject area experience (i.e. teaching practice) (Stuart Tatto 2000 Zeichner bloodbath 1990). The general education, foundation courses and methods studies comprise the supposititious component whereas field experiences focus on the practical component of teacher education programmes.Korthagen et al (2006) argue that teacher education finds itself in a difficult position in the 21st century. He presents three reasons for dissatisfaction with the teacher education programmes. First reason is the irrelevance of teacher preparation for the reality of everyday practice in schools. It has generated pressure on teacher educators to rethink about the structure and practices of teacher education. Secondly, research evidence during the last(a) decade of 20th century shows that new teachers appear to face severe problems during their first period in the profession. Wideen, Mayer-Smith, Moon (1998) also patronageed this view and verbalise that the transfer from theory (presented and learnt during teacher education courses) to practice in schools is often meager. Thirdly, new concepts of teaching and leaning have emerged and developed overtime. Constructivist (Williams Burden, 1997 Roberts, 1998 Arends, 2004 Osterman Kottkamp, 2004) and social constructivist views (Roberts, 1998 Beck Kosnik, 2006) have henpecked the theory and practice of teaching and learning. These views argue for learner-centered approaches to learning and teaching and challenge the traditional practices in teacher education. It poses challenges for teacher educators.Teacher educators have attempted to suffice to this challenging phenomenon to fulfill the demand of producing loadive teachers in the 21st century. Zeichner (2010) argues that the old paradigm of teacher education where academic knowledge is viewed as the authoritative kickoff of knowledge about teaching destinys to be changed to the one where there is interlink among academic, practitioner and community expertise. As knowledge is constructed and shared by learners in constructivism and social constructivism, he argues that this new epistemology of teacher education will create expanded learning opportunities for prospective teachers that will better prepare them to be boffo in enacting complex teaching practices (Zeichner 2010, p. 89). Darling-Hammond, Hammerness, Grossman, Rust Shulman, 2005) concluded that research on effective teacher education programs shows that where field experiences are cautiously linked with coursework and carefully mentored, teacher educators are better able to accomplish their goals in preparing teachers to successfully enact complex teaching practices. In view of the complexity of the teaching-learning process Korthagen, et al. argue that the virtually basic problem which is still not being addressed adequately in teacher education programmes is how to connect theory and practice in such a way that teachers would be able to handle the problems of everyday teaching through theory-guided action (Korthagen, et al. 2006, p. 1021).My research focuses on the issue of analyzing the link between theory and practice of English language teacher education in the linguistic context of Pakistan. This analysis will help to understand what disciple teachers learn during coursework at the university, how they learn it and how they put that learning into practice during thee practicum. In the next part I discus the concept of practicum.3. The PracticumPracticum (also termed as teaching practice/internship/induction or field experiences) may be defines as learning by doing (Schn 1987), learning from action (Hutton 1989) or work-based learning (Foster and Stephenson 1998). Stanton Giles (1989, 180) define the practicum as field experiences that focus on professional practice and activities that are explicitly focused on pre-professional practice. The ultimate goal of the practicum is to let student teachers demonstrate specific competencies that they are judge to have mastered at different stages in their pre-service stage (Yan, 2010)Practicum placements in schools are considered to be a signifi layaboutt component of pre-service teachers education program (Touchon Gwyn-Paquette, 2003 Leishem 2008). Practicum plays a major role in student teachers learning. Much of what teachers need to learn must be learned in and from practice rather than in preparing for practice (Ball Cohen, 1999 Hammerness, Darling-Hammond, Bransford, 2005). Teaching practice provides opportunities for student teachers to develop a contextualized understanding of the complexities. It also provides opportunities to develop classroom management skills, lesson planning and the ability to interact with students (Richards Crookes, 1988 Farrell, 2001). According to Huling (1997), practicum experiences liberty chit teacher thunder mugdidates a place to ob service and work with real students, teach ers, and curriculum in natural settings (p.1). Student teachers are able to apply their theoretical knowledge in the real classroom setting. Darling-Hammond and McLaughlin (1996) note that professional development opportunities are criticized for being non-contextual and isolated from the world of practice. Practicum in teacher education programmes provides opportunities of practice in the context of school. Zeichner (2006 p. 333) says that extended teaching practice can give the student teachers exposure to practices of experienced teachers. Student teachers may observe experienced teachers and can learn from their practices. It can also develop interaction among student teachers and the other school teachers.It is clear form the above that practicum is an important component of teacher education programmes. It not only provides opportunities for applying the theoretical knowledge the strudent teachers have gained from the teacher education institutions but also develops a sense of professionalism in them. It introduces the teaching profession to the prospective teachers. They can also interact with experienced teachers and can learn from them.3.1. Linking hypothesis and the Practicum(Korthagen Kessels, (1999) argue that in application of theory pattern of pre-service teacher education in the linked States, prospective teachers are supposed to learn theories at the university and then go to schools to practice or apply what they learned on campus. (Darling_Hammond (2006, p. 307) observes that one of the perennial dilemmas of teacher education is how to integrate theoretically based knowledge that has traditionally been taught in university classrooms with the experience based knowledge that has traditionally been located in the practice of teachers and the realities of classrooms and schools. Zeichner (2010, p. 90) also supports the view that one of the most difficult tasks is to strengthen the connections between what our student teachers do in their sch ool and community placements and the rest of their teacher education program.The inter-relationship of theoretical knowledge and practicum is further elaborated by Lewis (2007). He uses the terms conjunction and disjunction to refer to the presence or absence of the relationship between what is taught in teacher education and what is practiced in schools. By conjunction, he means that there is no clash between the knowledge gained in teacher education institutions and what is to be practiced by trainee teachers in schools. Lewis argues that disjunction or the difference between university advocated practice and what actually occurs in schools, presents the prospective teacher with a dilemma. He quotes a student teacher who in doing the practicum in school who says the course at university emphasizes engagement and use of constructivist oriented activities however the majority of classes I am doing have teaching that is fairly teacher oriented and content focused (Lewis 2007, p. 6). This type of confusion may be common in a add up of contexts. It may happen when teacher education institutions do not take into account the contextual factors in schools.Russell (1988) identifies three types of tensions in theory-practice relationship firstly is between campus-based course work and school-based relevance secondly, between child and teacher-centered approaches and finally, between what a student teacher can be told and what that person does in the classroom. Such tensions can be addressed by carefully designing and implementing the teacher education courses keeping in view the context of real school teaching and student teachers previous experiences.3.2. Gaps between Theory and the PracticumLack of connection between campus-based teacher education courses and field experiences has been a perennial problem in teacher education programs (Bullough et al., 1997, 1999 Zeichner, 2007, 2010). Studies show that student teachers feel there is a lack of connection between t he teacher education programme and the school-based teaching experiences (Hobson et al. 2008, 414). Different reasons may be attributed to the gap between theoretical and the practical component of teacher education programmes. Ashcroft Griffiths (1989) say that it is very hard to preserve the unity of theory and practice during a short teaching practice period in schools. It is very common that cooperating teachers in schools know very little about the methods courses the student teachers have blameless on campus and the course teachers in the university know very little about the specific practices used in the classroom where student teachers are placed. (Zeichner, 2010).Lack of substantially intend supervision and guidance on the part of cooperating teachers may also lead to disconnection between what the students have learnt and what they actually practice. It is often assumed that undecomposed teaching practices are caught rather than taught (Darling-Hammond, 2009). Zeich ner and Tabachnick (1981) found that many newly learnt teaching theories or conceptions developed during teacher education programmes are diluted by the initial confrontation during their teaching practice and it raises doubts whether insights from teacher education had actually been achieved (Cole Knowles, 1993). As a result of the falling short of the expected practice of the theoretical knowledge, the student teachers may adapt to the common habit of teachers to consider teacher education too theoretical and useless (Elliot, 1991). close totimes, the courses taught at the university may not be context specific to prepare teachers. In Australian context, Commonwealth Department of Education, Science Training (2002, p. 104) reported that the theoretical components of teacher education programmes are distant, irrelevant and inaccessible. The disconnect may be in various types like the disconnect between university coursework and the teaching context, gap or lack of cooperation bet ween the student teachers and the supervisors or/and cooperating teachers, mesh between student teachers perceived competencies and their actual performance in the practicum etc. The gaps need to be minimized if teacher educators want to produce effective teachers for complex teaching tasks. In the next part I discuss how to minimize the gaps and strengthen the link between theory and the practicum.3.3. Strengthening the Link between Theory and the PracticumDarling-Hammond (2006) suggests that carefully constructed field experiences coordinated with campus courses are more influential and effective in supporting student teacher learning than the unguided and disconnected field experiences. Evidence shows that traditional and loosely planned and monitored computer simulation of field experiences may create obstacles in student teachers learning (Feiman-Nemser Buchmann, 1985 Zeichner, 1996). One way to prepare student teachers for actual classroom is simulative teaching in which si mulations of classroom situation are enacted (Cohen, 1981). Simulative teaching sometimes proves to be a fallacy and student teachers may light touch with reality shock when teaching in actual classrooms (Korthagen et al. 2006, p. 1027).Zeichner (2010) suggests that some portion of the methods courses can be taught in partner schools to mediate the gaps between their campus courses and the students school experiences. The course tutors should deliver model lessons in the actual classroom in the partner schools where the student teachers are required to do the practice teaching. Ball Forzani (2009) also support the notion that clinical experiences should be the central focus of pre-service teacher education from which everything else in a program emanates.Cheng et al. (2010) examined theory-practice gap as perceived by student teachers in Hong Kong. On the basis of their findings, the researchers propose four strategies to close the gap and strengthen the link between theory and pr actice. They recommend student teachers need to develop their have got competencies and reflect on their pedagogical practice promoting self leaning or independent learning encouraging teacher educators to model lessons and arranging study abroad programmes for non-native student teachers to some English speaking countries.Darling-Hammond (1994, 1999) Fullan et al. (1998) recommend more involvement of university faculty in the student teachers supervision so that they may get detailed feedback and guidance on the practicum experiences. Casey Howson (1993, 365) suggest a three-person teaching aggroup who should meet to discuss goals and strategies and attempt to build a potent scaffolding for pre-service students. The team includes education professors, field supervisors, and cooperating teachers. Korthagen et al. (2006) argues for a close cooperation not only in the sense of school-university unions, but also in three-way cooperation among teachers in schools, teacher educator s in universities, and those who are learning to teach. Goodlad (1990) also recommends including teacher candidates perspectives in the mentoring process. In the next part I review literature on how to improve the practicum in teacher education programmes.4. Improving the PracticumStudent teachers perceive the practicum to be the most valuable part of their teacher education for its strong influence on their views of the roles of teachers (Smith Snoek, 1996). Organizing and conducting well planned and effective practicum may better help teacher education institution to realize their objective of producing more effective teachers. There can be spell of problems which reduce the effectiveness of the practicum. Yan and He (2010) identify six problems in the practicum as perceived by English language student teachers in Chinese EFL context. These are tension between vision and reality, unreasonable schedule of the practicum, practicum schools distrust, lack of supervision, student tea chers lack of motivation in preparing lessons plans and lack of sound assessment system. These problems are associated with brass of the practicum, role of supervisors, assessment system and level of motivation among student teachers to teach. As teacher educators, we will need to address such issues to make the practicum more effective.Some of the most significant factors which can contribute to improve the practicum in schools are school-university partnership, role of the faculty in preparing student teachers for the practicum and supervising their practice and support and cooperation of the cooperating teachers. I will discuss these separately.4.1. School-University PartnershipSchool-university partnership does not mean that schools are only the practice fields for student teachers. This view limits the collaboration and cooperation between schools and universities. (Korthagen et al. (2006) argues that common view of learning to teach includes the assumption that the university -based components of teacher preparation offer the theoretical underpinnings of teaching and that school teaching experience (practicum) offers a situation in which those previously learning principles of teaching are practiced. This view creates many difficulties, including the fact that the expertise of teaching practice is often assumed to reside largely in schools with teachers. Further Gorodetsky, Barak, and Hadari (2007) pointed out that even in the current wave of school-university partnerships in teacher education, colleges and universities continue to maintain hegemony over the construction and dissemination of knowledge, and schools remain in the position of practice fields where student teachers are to try out the practices provided by the university.This view implies that schools are always at the giving end. Why should the corpus teacher and the cooperating teachers spar enough time to mentor the student teachers and collaborate with the faculty supervisors if they are not involved in any other component of teacher education programmes? The exclusion of school teachers from designing and pedagogy of teacher education courses also limits the actual training needs of the student teachers and the scope of the practicum. The practicum in particular and teacher education programme in general can be strengthened if experienced school teachers are involved in the university programmes. Zeichner (2010) gives an showcase of the University of Wisconsin-Milwaukee where teachers with evidence of a high level of competence in the classroom spend 2 age working in all aspects of the pre-service teacher education program, including student recruitment, general education, professional education sequence, ongoing program evaluation and renewal efforts, and in supporting graduates in their early years of teaching. University faculty may also join the partner schools to teach the actual classroom for some period of time to refresh their knowledge of school teachin g. This sort of useful partnership may help improving the practicum.4.2. Role of the University Faculty in the PracticumIn addition to working as course developers, course tutors, examiners, evaluators, managers etc. teacher educators serve as role models for the actual practice of the professional (Korthagen, Loughran, Lunenberg, 2005). This role model may be intentional or not. Loughran (1997) is of the view that modelling behaviour by the educator gives the student teachers an opportunity to experience and understand some likely outcomes of teaching. Research shows that explicit modelling of teacher educators can facilitate the translation into the student teachers own practice (Lunenberg, Korthagen Swennen 2007).Modelling is an effective tool to prepare student teachers for actual classroom teaching. The teacher educator can also deliver model lessons in the partner schools instead of creating simulative classrooms in the university. Supporting the concept of modelling, Russel l (1999, p. 220) goes on to say that Universities generally, and university-based teacher educators particularly, have no right to recommend to teachers any teaching practices that they have not themselves used successfully at the university. Korthagen et al. (2006) argues that if teacher educators advocate some innovative practices that they do not model and explain in their own teacher education classrooms, teacher education reform will continue to elude us. University faculty can use modelling as a decent strategy to prepare student teachers for the practicum. There can be some implications of model lessons as it may not be possible for trainee teachers to adapt themselves to the model lesson after some period of time. Furthermore, there may be more than one method of teaching the same lesson sometimes it can be piteous to confine the student teachers to the method/methods used by the faculty in his/her model lesson.4.3. Cooperating Teachers and the PracticumSupport from cooper ating teachers may be useful for student teachers during the practicum. But sometimes, cooperating teachers are overburdened because they also need to do their routine teaching and other school assignments simultaneously. In such a case it is likely that they do not take the practicum seriously and may not assist student teachers as they should have or would have wanted to help them. Guyton McIntyre (1990) emphasise the role of the cooperating teacher, who is most available, in developing student teachers practice. Farrell (2001) argues for support from the practicum school and cooperating teachers. He further contends that student teachers should be placed with competent cooperating teachers. If the cooperating teachers are not competent enough, they are likely to be less effective in student teachers development. Randall (1992) says that the cooperating teacher may heavily influence student teachers teaching styles through direct contact. He can provide on the spot guidance to th e student teacher. It is very common that cooperating teachers in schools know very little about the methods courses in the universities (Zeichner, 2010). Cooperating teachers need to be involved in the university courses and also trained by the university faculty for mentoring of the student teachers. It can help them perform their role more effectively in helping student teachers. In the next part I review research on the practicum in teacher education and English language teacher education and also argue for my proposed study.5. Research on Practicum in Teacher Education and English Language Teacher EducationDarling-Hammond (2006) states that there has been much raillery about the structure of teacher education programmes but there has been less discussion on what actually goes on in the teacher education courses and the clinical experiences that student teachers encounter and how the programmes add up to the knowledge and skills of the student teachers to prepare them for class room. Yan (2010) argues that research on the practicum is mainly limited to general higher education programmes from the westward world, and the English language teaching practicum has received scarce attention. Little is known about how learners conceptualize their initial teaching experiences, and about what impact these experiences have on their professional development as teachers (Johnson 1996, 30) and what actually occurs during the practicum (Richards Crookes 1988 Freeman 1989).Snoek (1996) claimed that student teachers perceived the practicum to be the most valuable part of their teacher education for its strong influence on their views of the roles of teachers. Hodge et al. (2002) reported that the practicum had a positive impact on the student teachers attitude towards their work. Yan, (2010) contends that most second-language teacher preparation programmes simply assume that once pre-service teachers have completed their required coursework, they will be able to transfe r their knowledge into effective classroom practices. It is, therefore, well worth investigating complexities and problems arising from the practicum to enhance its effect on student teachers professional growth and teacher education programmes.Cheng et al. (2010) examined the theory-practice gap by reporting a study that researched the inconsistencies between student teachers best teaching strategies and their most commonly employed ones. They conducted this study in the context of Hong Kong. A questionnaire and in-depth interviews were used to generate data. Total 228 final year student teachers of 4 years B. Ed programme completed and returned the questionnaire. In addition to it, 31 Year 4 student teachers enrolled in these programmes participated in in-depth interviews. Findings revealed three main dimensions of consideration attributing to the inconsistencies in the conceptions of teaching pre-training experiences of student teachers, teaching context of the partner school and student needs. These considerations lead to expansive or encumber impacts on the student teachers selections of teaching strategies. Nevertheless, teacher education programmes are expected to have an expansive impact on the student teachers conceptions of teaching as well as to help them overcome constraining impacts from other sources of influence.Koeppen (1998) observed that student teachers face multiple difficulties in classroom instruction as theory versus practice occurs. Her case study of a student teacher found that the student had problems in linking university courses and classroom context during the practicum. What the student had studied for example, planning instruction and modeling did not match the reality he found in school. This student teacher struggled to reconcile himself to the teacher-centered teaching he was doing which was totally against the theory of teacher-centered learning which he had learned in his course.In the context of Pakistan, no such study has been conducted on the link between theory and teaching practicum in English language teacher education. Keeping in view the above cited literature, the present study aims to analyze the link between English language student teachers pedagogical content knowledge learnt from the university coursework and their practice of teaching during the practicum in schools. By pedagogical content knowledge (PCK) here, I mean the knowledge to teach English as a second language at secondary level. The focus of my study is to find out what PCK student teachers learn during their English language teaching course at the university and how they apply that knowledge in the classroom during the practice teaching. I pose the following questions to achieve the aim of the studyWhat type of pedagogical content knowledge the student teachers learn during English language teaching course at a selected teacher education department in Pakistan?How and to what extent English language student teachers apply/pra ctice their pedagogical content knowledge to teach during the practicum in schools?What is the relationship between student teachers pedagogical content knowledge and their practice of teaching English at secondary level in Pakistan?

Non Medical Independent Supplementary Prescribers Nursing Essay

Non Medical Independent Supplementary Prescribers Nursing EssayThe answer of this essay is to explore some of the helpes gnarly in prescribing, from con fountration of the perseverings pathophysiology, through acknowledgment and decision-making to the provision of preaching. The authors rationale for choosing anticoagulation as the topic for discussion, is that although the authors field of put on is mainly with affected roles who feed ischaemic heart disease, upon reviewing the coif log it became apparent that developments inwardly the authors place were leading the author to participate more than in the feel for of patients with atrial fibrillation.To highlight discussion and link opening to give the author will habit four case studies of patients admitted to a district general hospital, who subsequently were diagnosed with atrial fibrillation and everyplace repayable to the nature of the condition, were offered anticoagulation for the prevention of future(a) th romboembolic events. The to a higher place demonstratees will be discussed under the headings of the learning come incomes below.Evaluate effective history taking, assessment and consultation skills with patients/ clients, parents and carers to inform working/differential diagnoses.Integrate a shared approach to decision making taking account of patients/carers wishes, values,Religion or culture.Tradition tout ensembley patient consultations fuddle been performed with the desexualises taking the more dominant image (Lloyd Bor 2009). These consultations have been doctor-centred, establishing a diagnosis and treatment plan without involving the patient in the decision making process. At this time this was accepted by the patient because the doctor knows best and the patient handed over responsibility for his well- universe to the clinician. However this has now changed and patients are more interested in their illnesses, wanting to know more and be involved in their treatment plans. Increasing evidence suggests that a more patient-centred style of consultation results in happier patients who are more likely to bewilder to their treatment plans (Stewart et al 2003).The author was up to(p) to observe her designated medical practitioner (DMP) in a variety of patient interactions further mainly during the process of consultation, for the purpose of establishing diagnosis and treatment plans, (see appendix for case studies). Consultations are do up of a go of elements such as establishing a rapport, gathering and interpreting info and physical exam, however the cornerstone of all patient interactions is effective communication.Prior to to each one consultation, the DMP prepared by reading through the medical records to obtain data witnessing the patients past and pre displace history, musics and allergies. At this st mount up consideration was given to potential difference treatment plans or engaged tests. The patients in case studies 1-4 were al l admitted to hospital due to either untested onset of symptoms or deteriorating clinical condition, thus each consultation was held at the bedside. Hastings (2006) highlighted the importance of recognising the different settings within which a consultation can occur and how these settings can affect the patient and practitioner. This is a view shared by White (2002) who felt that the environment can greatly see the consultation process.Upon reviewing the literature the author has found that there are many different approaches that can be adopted and various consultation models that can be utilised, in order to produce the close to effective consultation. The author felt that the DMPs methods of consultation spanned several models. It incorporated elements of the biomedical model described by Byrne considerable (1976), in which they describe six phases which formed a logical structure, but take a very doctor-centred approach (see appendix). Charlton (2007) argues however, that whilst this model is simplistic and logical it has encumbrance accommodating the feelings, beliefs and psychosocial issues which colour the meaning of health and illness. The consultations also incorporated elements of the more patient-centred models as described by Pendleton et al (2003) and Calgary-Cambridge (1996), see appendix **. These models aim to make a collaborative misgiving of the patients problems. The authors DMP combined traditional methods of history taking with systematic physical enquiry and examination, to elicit information well-nigh the patients medical, social and family histories, in cin one casert with drug and allergy information, and the patients perspective regarding their history and presentation of symptoms. erstwhile the history was obtained the physical examination was performed to supplement the diagnostic process. In each case the examination was cardiovascular, paying particular attention to the auscultation of heart sounds, because in atrial fib rillation the exclusion of a valvular element is necessary prior to commencing anticoagulation.In accordance with the models used, diagnosis was established and discussed with the patient. The DMP used simple terminology to ensure understanding. The use of non-verbal communication was evident throughout each consultation, from the outset where introductions and shaking hands took place, to the use of empathy and wraith when the patient showed fear and anxiety. The history taking process may have involved a doctor-centred approach but the discussion surrounding treatment choices was for sure patient-centred. In each consultation the plan between the patient and the DMP was negotiated, with the DMP explaining the put on the lines associated with atrial fibrillation, and being honest with the patient about the risks versus benefits of anticoagulation. Charlton (2007) believes that it is important to elicit a patients concerns and expectations in order to ensure that both the patient and the doctors agendas are the same. This is supported by Neighbour (2005) who stated that, Patients differ widely in their factual knowledge, in their beliefs, their attitudes, their habits, their opinions, their values, their self-images, their myths, taboos and traditions. approximately of these are relatively labile and easy to change on a day to day basis, others are more firmly held and difficult to alter.Each patient we encounter will have come from a different background and some from different cultural systems whereby their values, beliefs and behaviours may non be the same as the practitioners (Lloyd Bor 2009). Each patient within the sphere of their culture or religion will have a different view about what treatments or care is acceptable (Helman 2000). This was the case in respect of patient * who was a Jehovahs Witness. Patients who share this religion do non accept line of work transfusions or blood link products based upon their interpretation of Acts, a book in the New Testament Bible (Wikipedia 2012).Although the authors DMP and the patient were from different cultural and religious backgrounds, effective communication was gloss over maintained. The DMP took time with the patient to explore the implications that the patients beliefs would have upon the form of treatment that was indicated. In this case it was non taking the drug that make up the problem but the increase risk of bleeding that could occur, which potentially may require a blood transfusion if the bleeding were to be severe. In the case of patient * they initially were not keen to start warfarin. When it was commencement mentioned the patient grimaced and said oh, isnt that rat poison. Indeed the patient was correct, warfarin has forwardly been used to kill rodents but its safety and cogency as a medication has also been proven. Patients much have misconceptions about medication which can influence their decision making. Their decisions regarding treatments are base d upon their understandings and these can ofttimes by influenced by external factors such as the media. However, with regard to the consultations observed by the author, it seems that the inbuilt factors were more influencial. Patient * and * were both concerned about potential lifestyle changes. How often would i need to come for tests? What about going on holiday? Will I bruise easily? What happens if I curb myself? Will it affect my other medicines. For patient * the answers were acceptable and warfarin was prescribed. However patient * felt that the change would be too much and declined. Respecting a patients objurgate to refuse treatment is part of the consultation and prescribing process. In its guidance on consent, the GMC (2008) discusses the importance of accepting that a competent patient has the right to make decisions about their healthcare and that doctors must respect these decisions, even if they do not agree with them. This view is supported by NICE (2009) who s tate that patients if they chose to, should be involved in the decision making process, and as long as they have mental capacity, as defined in the Mental Capacity Act (2005), to be able to make informed choices, as professionals we must understand that patients have different views to us about risks and benefits and we must accept their right to refuse.For patients ***and *, the recommended treatment was anticoagulation. Patient * and * once their initials concerns were addressed, were happy to proceed with the treatment. Patients * and * were not. The author noted that this did not change the DMPs treatment of the patient, who respected their decision and agreed an alternative plan.Although each consultation was different in the patient specifics, there were still common elements. Each interaction was structured and was systematic in establishing the required elements. A good rapport was established with each patient, resulting in effective communication. Communication problems be tween the doctor and patient can lead to dissatisfaction (Simpson et al 1991), ca victimisation misunderstandings and lack of agreement or concordance with treatment plans (Barry et al 2000). This was not the case however in patient * and *. Each patient was given a full explanation of the treatment options and each made an informed choice regarding their treatment, choosing to pursue a path not recommended by the authors DMP. A review by Cox (2004) summarised that patients and health care professionals need to have a two way discussion in order to share their views and concerns regarding treatment.6. Integrate and apply knowledge of drug actions in relation to pathophysiology of the condition being treated.With the advent of independent and adjuvant prescribing, and the ever changing component part of the nurse, it is considered imperative that nurses have a greater knowledge and understanding of drug pharmacology (Thomas untested 2008). Pharmacokinetics studies how our bodies p rocess drugs and Pharmacodynamics studies how these drugs exert their effect (Greenstein Gould 2009).When the heart beats normally, a regular electrical impulse causes the muscular heart walls to contract and force blood out and around the body. This impulse originates in the top chambers of the heart (atria) and is conducted to the bottom chambers (ventricles). In atrial fibrillation this impulse is initiated and conducted in a random unorganized manner causing the heart to function less efficiently. The risk of a pooling or stasis of blood remaining in the heart, increases the risk for a thromboembolic event. Atrial fibrillation is the most commonly sustained cardiac arrhythmia affecting 10% of men over 75 years (NHS Choices 2013) and if left untreated is a significant risk factor for stroke (NICE 2006).The patients identified in the case studies were all given a diagnosis of non-valvular atrial fibrillation. Their individual risk for thromboembolic event was assessed using the CHAD win systems and the outcome was that each patient required treatment with anticoagulation.Anticoagulants were discovered in the 1920s by a Canadian vet who found that cattle take mouldy silage made from sweet clover were dying of haemorrhagic disease, and it wasnt until the 1950s that anticoagulants were found to be effective for preventing thrombosis and emboli by reducing clot formation, and were ultimately licenced for use as medicines. (Wikipedia 2012). warfarin is the anticoagulant most commonly used in the treatment of atrial fibrillation. To understand the pharmacodynamics of warfarin, one must archetypical understand the basic clotting cascade.Blood contains clotting factors (inactive proteins) which activate sequentially following vascular damage. These factors form two pathways (Intrinsic and Extrinsic) which lead to the formation of a fibrin clot. The alien pathway is triggered by tissue damage from outside of the blood vessel. It acts to clot blood that has esc aped from the vessel into the tissues. Damage to the tissues activates tissue thromboplastin which is an enzyme that activates Factor X. The intrinsic pathway is triggered by elements that lie within the blood itself. Damage to the vessel wall stimulates the cascade of individual clotting factors which also activate Factor X. Once activated Factor X converts Prothrombin to Thrombin which in turn converts Fibrinogen to Fibrin. Fibrin fibres then form a meshwork which traps red blood cells and platelets and so stems the pass of blood (Doohan 1999). Vitamin K is essential for the maturation of clotting factors such as Factor X and prothrombin and it is on Vitamin K that anticoagulants such as Warfarin take effect. Warfarin reduces coagulation by inhibiting the processing of Vitamin K. This reduces the amount of matured clotting factors available for the clotting cascade, causing clotting time to be draw out (Melnikova 2009). This time frame can be measured by testing a patients INR ( International Normalised Ratio), which is simply a recording of the amount of time it takes for a blood sample to clot.Using Warfarin in the treatment of Atrial Fibrillation, reduces the risk of clot formation and the risk of potential clots being ejected from the heart into the general circulation. This process however is dependent upon how the body initially processes the drug (pharmacokinetics). Warfarin is readily absorbed from the GI tract, however this can be affected by age related changes such as reduced gastric emptying and slowed motility affecting intestinal transit time. This phase determines a drugs bioavailability. The extent of drug dispersion depends on the amount of plasma proteins and whether a drug is bound or unbound. Warfarin is 99% bound to plasma proteins and therefore takes longer to reach the power of action, thus the distribution phase lasts approximately 6-12 hours (Holford 1986). The patient in case * was noted to be on aspirin. Patients on drugs which bind at the same order can cause problems when administered together, as one displaces the other causing elevated levels of the drug to be circulating, leading to toxicity (Sunalim 2011).Whilst the benefits of warfarin are apparent the side effects and precautions for use are numbered. Warfarin has a narrow therapeutic window making control difficult and increases the risk of bleeding and haemorrhage. It interacts with other prescribed, over the counter and herbal medicines and is contraindicated in pregnancy. Despite its use in clinical practice for over 50 years, the MHRA still receive a substantial number of adverse reaction case reports through the Yellow Card system. The majority of these reports were as a result of over anticoagulation with the majority of fatal cases being attributed to haemorrhage. It was reason out that in some cases interaction with other medications was the cause (MHRA 2009). It is therefore essential that a full drug history including allergies is tak en prior to commencing any new medication.Critically appraise sources of information/advice and decision support systems in prescribing practice and apply the principles of evidence based practice to decision making.9. Demonstrate an expert understanding of prescribing decisions made within an ethical framework withdue consideration for equality and diversity.The decision to prescribe an anticoagulant such as warfarin is not a decision taken lightly. Due to the potential side effects, mainly the increased risk of bleeding, the risks versus benefits discussion must be explored. The benefit of warfarin is the reduction in risk of thromboembolic events such as a stroke or pulmonary embolism, the risks arehowever before this discussion can take place, it must first be established whether anticoagulation with warfarin is needed or whether an alternative treatment is possible.In 1994 the Atrial Fibrillation Investigators (AFL), conducted randomised clinical trials whose participants had u ntreated atrial fibrillation. Data from these trials showed that patients with foregoing stroke, hypertension or diabetes were at increased risk of stroke. This data was confirmed by the Stroke Prevention Atrial Fibrillation Investigators (SPAF 1995) who looked at thromboembolic risk for AF patients on aspirin. The fusion of these two bodies in 2001 led to the development of the CHAD2 scheme (see appendix), which is a clinical prediction tool used for estimating the risk of stroke in patients with AF and to determine whether or not treatment is required with anticoagulant or antiplatelet therapy. Risk stratification schemes that accurately and reliably stratify stroke risk could influence the management of those who have AF and spare those low-risk patients the risks, inconvenience and costs associated with anticoagulation therapy (Gage et al 2004). The use of the CHAD2 and CHAD2VASc wee-wee is encouraged in the European Society of Cardiology (ESC) guidelines (2010), which reco mmends that if the patient has a CHAD score of 2 or above anticoagulation therapy such as warfarin or one of the newer drugs, such as dabigatran, should be prescribed. This view is supported by NICE guidance (2006) which analysed respective trials and think that warfarin significantly reduced the incidence of stroke and other vascular events in people with AF. NICE also discusses stroke risk stratification models, of which the CHAD2 score is one. It does not however make recommendations as to the best choice of tool. Patient * was the only one out of the case studies that had their stroke risk calculated using the CHAD scoring system and had it recorded in the notes. The reasons for this are unknown however the author hypothesises that perhaps as the other patients had greater apparent risk due to their existing co-morbidities, it was deemed unnecessary to actually perform the calculation as anticoagulation would ultimately be indicated. The author could argue here that if this was the case this generalisation goes against the concept of diversity.Warfarin has been widely accepted as the drug of choice for oral anticoagulant therapy, however newer drugs on the market such as dabigatran and rivaroxban have also been recommended as alternatives to warfarin , yet it is the authors experience that these are very rarely discussed with patients as alternative treatment and only seem to be prescribed when warfarin is not an option. The author believes the reason for this may be partly due to economic and geographical inequalities in health, a view shared by Abraham Marcy (2012) Wartak Bartholomew (2011). They concluded that compared to warfarin dabigatran was disadvantaged by the lack of knowledge about its use, its poor gastrointestinal tolerability and ultimately the cost which resulted in its limited use.Treatment decisions made for these patients were in guardianship with National and European guidelines promoting access to treatment for all. Local guideline s however are under current review and were not available for scrutiny. As prescribers we must use all available information to ensure that we make the best evidence based prescribing decisions with our patients. Guidelines facilitate best practice but resources such as the British National Formulary (BNF) and the Electronic Medicines Compendium (EMC) are invaluable reference tools in facilitating best prescribing practice.In everyday practice healthcare professionals are judge to make judgements about what is best for their patients. The NMC (nnn) advocate that to practice in an ethically sound manner it is necessary to balance ethical considerations with professional values and pertinent legislation. The ethical theory of principlism described by Beauchamp Childress (2008) considers the principles of beneficence, non-maleficence, autonomy and justice as the elements of ethical theory that are the most compatible in supporting decision-making within the healthcare system. Making ethical prescribing decisions is not a solitary activity, especially when the decision will impact upon another person. The ethos of quality patient care relies upon a team approach that supports the decision making of the patient, in partnership with the professionals, ensuring that the values and beliefs of the patient have been respected and acknowledged.5. Demonstrate critical awareness of the roles and relationships of others involved in prescribing, supplying and administering medicines.Earlier discussion highlighted the importance of communication in developing the doctor-patient relationship and how consultations are either doctor or patient-centred. This is also true with regard to other professional relationships the patient may have with members of the multidisciplinary team, who are also involved in prescribing, supplying and administering their medications. A review of the supply, prescribing and administration of medicines by the ut (1999), recommended that there sho uld be two types of prescriber independent and supplementary. An independent prescriber is responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required.supplementary prescribing is a voluntary partnership between a doctor or dentist and a supplementary prescriber to prescribe within an agreed patient specific clinical management plan, with the patients agreement NPC (2012).As a potential non-medical prescriber the author recognises the importance in understanding and applying the principles of good prescribing practice, in order to become an independent/supplementary prescriber. Doctors undertake training in prescribing as part of their undergraduate programme and are required to demonstrate this activity in order to obtain their registration. Their practice is guided and governed by the General Medical Council (GMC). Likewise nurses and midwives who are independent/supplementary prescrib ers, are governed by the Nursing and Midwifery Council (NMC), whose regulatory standards and legislation require practitioners to be experienced before they undertake such training and in safeguarding the best interests of the patient, ensure that nurses and midwives remain up to date with the knowledge and skills that enable them to prescribe and administer drugs safely and effectively (NMC 2004, NPC 2012). Pharmacists whose governing body, the General Pharmaceutical Council (GPC 2010), allow that a druggist independent prescriber may, after successful completion of an accredited course, prescribe autonomously for any condition within their clinical competence. Current legislation however only allows other multidisciplinary members such as radiographers and physiotherapists to be supplementary prescribers.During a patients duty tour in hospital, it is most likely they will enter into a medication consultation with at least one or two of the multidisciplinary members mentioned abo ve. All the patients in the case studies had contact with a doctor, nurse and pharmacist. The doctors performed the initial consult at the patients admission and it is here that the initial drug history was taken. The nurse then administered the medication prescribed on the drug chart, giving the patients information about the drugs they were taking and potential side effects. This information was limited to their individual knowledge base. If the drug was unobtainable then it was requested from the pharmacy department. The author observed the practice that occurred when an unavailable drug was requested. The initial process was simple, the doctor prescribed it and the ward nurse sent the drug chart and request slip to pharmacy. Once in pharmacy the process became more complex requiring the request to pass through several send before being dispensed. Prior to this course the author had very little understanding as to how important the role of the pharmacist was. Pharmacists play a n important role in improving a patients medication management during admission and through transitions of care from hospital to home. Weiss (2013) agreed that patients are often electric arcd from hospital with changes from their previous medication regimes, causing discrepancies and lack of understanding, which lead to non-adherence and adverse drug effects. The pharmacists spoken with by the author agreed that providing medication counselling in preparation for discharge is a large part of their role.Patient * and * who were commenced on warfarin, received counselling prior to discharge. The author was able to observe this practice. The session took place at the bedside which, upon reflection, was not conducive to this information exchange. Noise and interruptions from a confused patient in the next bed meant that the passage of information was often disrupted and had to be repeated. The pharmacist provided the patient with an information pack and discussed the drug, side effect s, anticoagulant monitoring and lifestyle changes such as travel, diet, recreational activities and dental visits. NICE medicines adherence guidance (2009) advocate the importance of providing patients with both written and verbal information in order to make an informed choice. For patient * and *, verbal information was given prior to prescription, but the written information was only provided after the patient had agreed to treatment. Providing all the information beforehand could increase patient consent to treatment (Elwyn et al 2006).Considering the role of others within the prescribing team has led the author to examine and reflect upon her own role. The author entered this course with knowledge and competence in diagnosing a patient with an acute coronary syndrome and questioned why such a broad prescribing knowledge was necessary. It is the view of Lymn et al (2010) that non-medical prescribers within a narrow specialist field often ask this question. Taylor Field (2007) b elieve the answer to be because advancements in medicine have meant that patients are often able to live with chronic disease and octuple co-morbidities. Becoming a prescribing student has given the author insight into what she did not know and what she never realised she needed to know.Conclusion.At the beginning the author posed the question, Anticoagulate or not to anticoagulate? In order to answer this, the author explored some of the processes involved in prescribing and through the use of case histories, linked theory to practice with analytical discussion. The answer to the question is clear, there is no one true answer. It is the authors conclusion that each case for anticoagulation must be viewed separately. Each patient is different, their understanding, their views and their pathophysiology all are unique. As practitioners it is our duty to provide our patients with the information and support they need in order to make informed choices. As prescribing practitioners thes e responsibilities are increased. Using the process of accountable practice as described by Lymn et al (2010), it is essential that we analyse our responsibilities as accountable prescribers and in doing so consider each prescribing situation on its own merits.

Differential Susceptibility Theory (DST) in Psychopathology

Differential Susceptibility Theory (DST) in PsychopathologyFuture Directions for research What makes the Differential Susceptibility barbel appealing to Psychopathology and Wellbeing researchers alike?The Differential Susceptibility Theory (DST) has attracted a huge amount of research in recent years from researchers in the field of wellbeing and psychopathology for a variety of reasons. This essay will examine both the dominant diathesis-stress model and DST and highlight how the knowledge of DST can cleanse wellbeing and reduce psychopathology.It has been widely reasond by decades of research that health and developmental disorders are more prevalent among people from high- gamble families (Luthar, 2006 Boyce, 2007 Shonkoff, Boyce, McEwen, 2009). Studies abound to demonstrate that childhood physical, emotional abuse and neglect impair development from lack of concentration to aggression, fighting, stealing, truanting and antisocial activities (Wayne, 1989). There is however a p rominent variation in the physical health and psychological adjustment of both children and adults who see both high and low spirit levels of adversity (Luthar, 2006 Masten Obradovic, 2006).The dominant theory that accounts for the in a higher place phenomenon is the diathesis-stress/dual risk model, which emphasizes vulnerability to environment. It postulates that psychopathology develops as a result of an interaction between due to vulnerabilities/diatheses (temperamental, biological, and/or behavioural characteristics) in a particular person and environmental stress (Monroe Simmons, 1991). Hence, an individual facing great environmental stress will non need to have many underlying vulnerabilities to develop psychopathology. The same solution can be true for an individual with greater vulnerabilities but a minor stressful event (Ingram Luxton, 2005).On the other hand, DST emphasizes developmental plasticity- individual differences in neurobiological susceptibility to envir onmental factors (Belsky, 2005). Belsky (2005) postulates that plasticity functions in a for-better-and-for-worse manner more plastic individuals experience more arrogant outcomes in positive environments as well as more negative outcomes in aversive environments.DST has received support from many studies. Boyce et al.s (1995) study on biological reactivity and environmental adversities as predictors of respiratory conditions in children aged between 3 and 5 yields a credible result. The study found that highly biologically reactive children who were undetermined to childcare or home environments of high adversity experienced substantially higher illness than other children while highly biologically reactive children who experienced lower adversity conditions (better supportive childcare) experienced the lowest illness rates.More recent studies come from Hankin et al.s (2011) three different studies that investigated the 5-HTTLPR genotype in 1,874 children and adolescents (between 9- and 15-year-old) and how the degree of supportive or unsupportive parenting may influence their behaviours. Hankin et al. (2011) found that the homozygous for the functional short allele of 5-HTTLPR were more responsive to parenting as environmental context of use in a for better and worse manner, that genetically tractable youth whose parents were unsupportive displayed low levels of positive affect while genetically susceptible youth who experienced supportive parenting displayed higher levels of positive affect.There are a variety of reasons why researchers of well-being and psychopathology find DST appealing. The most crucial difference between DST and the dominant diathesis-stress model is that the latter do not consider the effects of a positive environment. This is because it is of the view that there is no world-shaking difference in how vulnerable or resilient groups respond to enriched supportive or environmental conditions (Belsky Pluess, 2009). Consequently, man y studies only focus on adversity and its absence (e.g., maltreatment vs. no maltreatment) and do not measure the complete range of environments. Neither do they consider the complete range of psychological/behavioural surgical process (just maladjustment and its absence, e.g., depressed vs. not depressed).In addition, DST may help researchers to elucidate the defining characteristics of resilience. Under the diathesis-stress model, children with particular attributes such as positive temperament and do not suffer expected detrimental effects of negative environments are defined as resilient (Cicchetti, 1993 Luthar, 2006). However, DST argues that these children could seem resilient because they are just not really plastic or malleable. If this is indeed true, these children would therefore be very unlikely to benefit from highly supportive rearing environments should they be provided with them (Belsky Pluess, 2009b). As such, DST extends the diathesis-stress model by drawing fo cus on investigating how personal characteristics moderate the effects of positive environmental contexts on positive well-being.One additional advantage of DST is that it offers a new advancement in the treatment of psychopathology. There is great potential in screening patients for intervention on the basis of neurobiological susceptibility (Ellis et al., 2011). DST predicts alter sizes of intervention effects across participants, depending on both the plasticity of individuals and the mode of intervention. Many experimental interventions on parenting and child care have confirmed the above prediction (e.g., Bakermans-Kranenburg, van IJzendoorn, Mesman, Alink, Juffer, 2008 Cassidy et al., 2011). Furthermore, current evidence does not strongly support the case that some people are completely not susceptible to the positive effects of any intervention. As such, it would be better to understand neurobiological susceptibility as a continuous dimension rather than categorically (susc eptible vs not susceptible). Caspi et al.s (2003) G x E study showed that those homozygous for the short serotonin-transporter allele suffered most from stressful life events, those homozygous for the long allele suffered the to the lowest degree while heterozygotes (carrying one short and one long allele) fell in between. The above knowledge could help inform the design of treatment policies and programs tailored to the particularised needs of people with differing plasticity.Despite the exciting promise of DST, it is important to note that it is a relatively new theory in need of often future research to shed light on many areas. Owing to the length constraint of this essay, only a few notable areas will be discussed. Firstly, it is currently unclear how differential susceptibility is regulated by neurobiological (genotypic, endophenotypic, and behavioral) mechanisms (Ellis et al., 2011).Future research on the relationships between the different levels of mechanisms would help to greatly square off programs and interventions to benefit patients of different plasticity.Secondly, future research should focus on elucidating how for better and for worse processes unfold. For example, it could be possible that neurobiologically susceptible children are better at detecting and capitalizing on positive opportunities (e.g., taking advice from a teacher, forging strong friendships) to achieve positive outcomes in supportive environments. Such knowledge would once once more help to shape intervention programs. For example, interventors can specifically highlight positive opportunities mentioned above to neurobiologically susceptible children from adverse environments that are recently provided with more positive environments.In conclusion, this essay has explored the main features of DST and shown how understanding DST is crucial in understanding how to prevent psychopathology and improve wellbeing. Further studies, however, are required to bridge the existing gap s in this field.