Psycholinguistics: Linguistics and Language Production Essay

Psycholinguistics studies the relationship between language and mind. It studies how are language and speech acquired, produced, comprehended, and lost. Language acquisition and language dissolution happen over time or diachronically. While language production and comprehension happen at a certain point of time or synchronically. Firstly, this paper will talk about language acquisition. Children are a focus of attention and affection in all societies. They go through many stages in language acquisition such as crying, cooing, babbling, first word, birth of grammar and childish creativity. During the very first few weeks of a child’s life, crying is his only way to show what he needs. Crying is unaffected by intentional control from the nervous system, which is responsible for human behavior. At the very beginning, baby’s crying is completely iconic. For example, when the child is hungry, his or her crying becomes louder and louder, it also increases in pitch. During the first two months of the child’s life, his or her crying becomes more symbolic. At these early stages, babies cannot depend on themselves. They depend completely on their caretakers for several years. This creates on enormous degree of early bonding and socialization. As a result of the extensive interaction between the children and their caretakers, children start to coo, making soft gurgling sounds, to express satisfaction. The cooing stage emerges at two months. When the child is about six months old, he or she starts to babble. This babbling stage refers to the natural tendency of children to create strings of consonant-vowel syllable clusters as a kind of vocalic play. Psycholinguists distinguished between marginal babbling and canonical babbling. Marginal babbling is an early stage similar to cooing where the child produce few and random consonants. While canonical babbling emerges at eight months when the child’s vocalization narrow down to syllables that similar of caretaker’s language. Then, the child enters the first-word stage. It starts after crying, cooing, and babbling. It emerges at about one year old. Children use idiomorphs. They are words which children invent when they first catch on to the magical notion that certainly sounds have a unique reference. For example, when the child sounds†milk†, he or she says â€Å"kaka†. By using these idiomorphs, children transform from an iconic creature to a symbolic one. During this stage, children use egocentric speech. They want to talk about the objects which surround them. After this previous stage, the child starts to use grammatical forms. Children start to use one word as a sentence, request or an exclamation. It is referred to as the holophrastic stage. Psycholinguists believe that the intentional, gestural and contextual clues which accompany holophrases make it clear those children are using single word sentence, exactly as adults do in conversations. The child starts to make sentences by a grammatical form. They can develop they use of grammar by imitating their caretakers. For example, when the father says â€Å"backwards†, his daughter imitated him by saying â€Å"rightwards†. They start to create sentences after the holophrastic stage, first with two words and subsequently with more. Childish creativity is an important stage during the child’s life. Children’s language is determined for their mother tongue. For example, children who rose up in china, they speak Chinese. Children are creative. They come up with new words and expressions which are not in their native language or not heard in their bilingual environments. Children are a bit more like well-programmed computers, who make creative, but often inaccurate guesses about the rulers and patterns of the language they are acquiring. They create to construct or reconstruct their mother tongue. Secondly, this paper will talk about language production. We fail sometimes to appreciate our gifts underlying so many of our everyday activities, such as writers and artists. We realize how much we take our actions for granted only through loss of injury. Language production is very important for us. Psycholinguists divided language production into four stages, conceptualization, formulation, articulation and self-monitoring. Conceptualization is the first step in language production. It means how to conceptualize the speech in our mind. The theory of the American psycholinguist, David McNeill , says that primitive linguistic concepts are formed as two modes of thought. These are syntactic thinking, which creates the sequence of words which we typically think of when we talk about how language is initiated, and imagistic thinking, which creates a visual mode of communication. Syntactic thinking and imagistic thinking collaborate together to conceptualize conversation. Formulation is the second step in language production. It is the eventual output of the process. It is easier to formulate than to conceptualize. The psycholinguist , Karl lashely, published an essay focused on the psychology of language. It concentrated on how speakers produce words, sound, sentences and phrases together so rapidly and accurately. He talked about how common it is to commit spelling errors when one is typing. These slips of the tongue or the pen are not linguistic loss during brain damage. They are normal mistakes occurs in everyday speaking and writing. We can make back-track and correct it. Slips of the tongue happen between two constants or two vowels. It has a certain pattern. There is the planning of higher level of speech. It is to analyze the steps we have to take and the decisions we have in order to produce an intended utterance. For example, there is a conversation between you and your friend about a certain situation. You decided that something is not important. You can choose to formulate it by some factors as politeness. It could be stated in an affirmative of negative response such as, â€Å"it is nothing† or † it is trivial†. Articulation is the third step in language production. What happens in our mind is very similar to what happens in the computer when I want to print some information. The conceptualization stage perceive itself as the primary and ultimate composer of communication, and the formulation stage pride itself as the conductor of speech sounds, but without the instrument of articulation, the music of our voices remain unheard and unappreciated. Like the operation of the printer which connected with the computer to produce what I wrote. Human larynx’s position plays an important role in speaking. It gives the human the ability to articulate speech. Its lower position gives humans the ability to articulate speech sounds. Self- monitoring if the final step in language production. All speakers and writers of any language, regardless of their degree of native fluency, commit linguistic blunders. Here, we have errors and mistakes. For native speakers, they do not commit errors, but they commit mistakes. They can self-correct immediately. While for non-native speakers, they commit errors and they are not able to notice it or correct it. Thirdly, this paper will talk about language comprehension. Understanding language is an automatic task which happens very quickly. Sounds or letters strike our ears or eyes creating words which form phrases, clauses and sentences. Understanding language was divided into four stages, comprehension of sounds, comprehension of words, comprehension of sentences and comprehension of texts. In the comprehension of sounds, psycholinguists did an experiment on a group of people. They gave them four sentences and each sentence has a missing word. They gave them the last syllable of each missing word and asked them to write down each word. For example, (1) it was found that the †¦eel was on the axle, (2) it was found that the †¦eel was on the shoe , (3) it was found that the †¦eel was on the orange, (3) it was found that the †¦eel was on the table. This insertion of different missing sounds to create a separate and appropriate word in each sentence is called the phoneme restoration effect. From the comprehension of the other words in the sentence, they can expect the missing word. Comprehension of words is more complex than the comprehension of sounds. Each word has many sounds. Even in short and one syllable words, we can find that they composed of many sounds. Each language has thousands of words where we can find some similar words which make us confuse in the meaning. One model that psycholinguists have adopted to account for this complexity is Parallel Distributed Processing (PDP). Its perspective argues that we use several separate and parallel processes when we understand spoken or written language. When someone hear or see a word, he or she can stimulate an individual logogen (verve cells) or lexical detection device for that word. These logogens link to individual neurons in neuronal network. Then, they activate themselves and work in parallel with many other logogens to create comprehension. There are comprehension of high frequency words and comprehensions of low frequency words. High frequency words are rapidly and frequently comprehended like â€Å"boy† and â€Å"orange†. While low frequency words take a long time to be comprehended like â€Å"exotic† and â€Å"logogen†. Psycholinguists divided the comprehension of words into several ways, in term of their spelling, on the basis of their pronunciation, and in terms of grammatical functions. In term of their spelling, like the homophones, the words pronounced alike but spelled differently, for example ; â€Å"threw† and â€Å"through†. On the basis of their pronunciation, like homographs, words spelled alike but pronounced differently, for example; â€Å"lead†noun and â€Å"lead† verb. In terms of grammatical functions, the word may be function as a verb and a noun or either of them only. There is another example of the uselessness of (PDP) approach to the comprehension of words most of us encounter during our daily life. It is what psycholinguists named as the Tip of the Tongue (TOT) phenomenon. This phenomenon occurs when we know a word but we cannot remember it to pronounce it. It is on the tip of the tongue. The word is not completely forgotten, but we can remember usually the first syllable of this word. This means that our long term memory storage is better for recognition than for recall. Comprehension of sentences is more complex than comprehension of sounds and words. Psycholinguists based their researches to examine the comprehension of sentences on the model of sentence grammar which proposed by Chomsky in 1950s. Chomsky model claimed that all sentences were generated from a phrase structure skeleton has a series of transformational rules which is named as (Transformational Generative Grammar). These transformations are very powerful. They could create many verities of sentences by rearranging, adding, deleting or substituting words in the original sentence. Psycholinguists examine these transformations on a group of native listeners to notice their level of comprehension. Example number one is : the dog is chasing the cat. While example number two is : Is not the cat chased by the dog?. Example number one is easier than example number two, because it has three transformational changes; it has been transformed into a negative, passive and interrogative sentence. Psycholinguists called this process as Derivational Theory of Complexity (DTC), because difficulty in comprehension was derived from number of transformations that were added to the original and simple sentence. Psycholinguists made experiments to test (DTC). They gave a group of listeners a number of sentences and asked them to recall both the sentence they had just heard and a string of words. They found that when the sentence becomes more complicated than the previous sentence and the number of sentences becomes more than one or two, the listener remembers fewer and fewer words. They also confuse by additional transformations in each sentence. Comprehension of texts is more complex than the others. When someone read or hear a text, he or she can remember the content but not typically the grammar of each sentence. The presence or absence of our background information can affect dramatically the way we remember a piece of discourse. Grammatically, we can remember simple sentences not complicated ones, for example we can remember active sentences than passive ones. Finally, this paper will talk about language dissolution or language loss. Language dissolution can be caused by unhappy accident which violates the language area of the brain, a traumatic event in our personal life, or genetic disorders. Psycholinguists found that the dissolution of language whether due to accident or age, is a rich source of information about how the human mind controls our attempt to communicate. Neurolinguistics and language loss have two things which are the evidence from aphasia and the surgical evidence. Neurolinguistics is an offspring of psycholinguistics, investigates how the human brain creates and processes speech and language. Firstly, we will talk about the loss of language due to brain damage. To understand how this happens, we need to clear up some misunderstandings about the human brain and how it functions. Anatomically, the brain has two separate and virtually identical cerebral hemispheres. There are millions of associations’ pathways which connect the left and the right hemispheres together, so any information in either hemisphere is shared with the other. Our central interest is in language not in the anatomical mapping of human neurology, so we concerned with the location of the control of speech organs and the sensation of speech. If I take the left hand and cup it over the left ear so that the palm of the hand is clapped over the ear hole. I can find that the left hand covers most of the left side of the head. If I opened the skull, I will find under the first two fingers, two vertical strips of brain tissues running down from the top of the head. They have the same size of the two fingers. It is the area of the brain which is responsible for the production and comprehension of human language. Under the middle finger, there is the motor cortex which responsible for muscular movements. While under the index finger, there is the sensory cortex. The top of the motor cortex and sensory cortex take care of the movement and sensation of the feet. While the bottom of these two strips are responsible for the head, mouth and throat. We can find that the top of the brain controls the lower part of the body and the vice versa. The left side of the brain is responsible for the right side of the brain and the vice versa. The top parts of the motor and sensory cortexes are responsible for the movement and sensation of the feet. While the bottom parts of them are responsible for the head. Humans are susceptible to injury in the central nervous system. The damage could arise from a loss of blood supply to the location of the central nervous system due to stroke, or invasive injury like an automobile accident or gunshot wound. There are two consequences that make the central nervous system unique in relation to any part of your body. Firstly, there is no pain receptor in the brain that is why a stroke, unlike a heart attack, is not a painful experience. The second thing is that the central nervous system does not regenerate. Once it is damaged, it does not grow back. Now, let us speak about the surgical evidence. There are two kinds of surgical operation have a particular bearing on questions of language dissolution. The first operation is hemispherectomy and the second one is split-brain operation. In rare cases, when the neurosurgeons find that either the left or right hemisphere of a patient was hardly affected, he or she opens this affected side of the skull and remove the entire left or right hemisphere. This operation performs on adults or children under the age of ten. For an adult, this operation causes a dramatic effect on them. When an adult undergoes a left hemispherectomy, he or she becomes completely aphasic, except for a few words of automatic speech. While, if this operation performed on children, it does not lead to loss of speech. The factor here for these causes is the age of the brain. During the first decades of human life, the human brain is continuously evolving and growing. Linguistic functions have not yet localized to specific areas of the brain. This gives a neuroplasticity of the still maturing brain. When a young brain encounters traumatic injury, even to the extent of losing an entire cerebral hemisphere, because it is still maturing, and because the primary areas of cognitive and linguistic functioning have not established, a child does not suffer the functional loss that an adult does. Children aphasia exists and stem from neurological abnormalities such as autism. The second operation is the split-brain operation which was developed in 1970s to treat specific cases of severe epilepsy. This operation was developed to spare sufferers from the terrible trauma of major seizures, because there are certain severe and singular forms of epilepsy which remain unaffected by pharmacological treatment. Epilepsy is caused by discharges in the motor cortex in one hemisphere that are transmitted to the corresponding cortex of the other hemisphere via the corpus callosum. There are a few negative consequences to the operation, and this rests largely on the fact that our senses are bilaterally represented. After the corpus callosum is cut, in normal, everyday situations, information from either eye goes to both hemispheres. Speech and language disorders are divided into dissolution from non-damaged brains and language loss through aging. There are two examples of disorders which causes dissolution from non-damage brain. These two examples are stuttering and autism. Stuttering is one of the most common articulation problems. It occurs, most frequently on the initial word of a clause, the first syllable of a word, the initial consonant of a syllable, and on stop consonants. There is a theory represents the extreme behavioral view and claims that stuttering originates from traumatic events occurring in early childhood when sensitive parents and primary school teachers are too assiduous in attempting to ensure that the child speaks fluently. There is another theory states that stammering is caused by the absence of unambiguous lateralization of speech to the left hemisphere. There another disorder which is autism. The first signs of this disorder are apparent in infants, before speech has really developed. Autism is referred to as childhood schizophrenia. An autistic infant exhibits a disregard for human interaction and ignores eye and face contact. This condition creates a lack of social interaction. At the end, the reduction in physical and mental abilities does accompany the aging process. When we become older, the language may be lost quickly.

Chapter 13 Gryffindor Versus Ravenclaw

It looked like the end of Ron and Hermione's friendship. Each was so angry with the other that Harry couldn't see how they'd ever make up. Ron was enraged that Hermione had never taken Crookshanks's attempts to eat Scabbers seriously, hadn't bothered to keep a close enough watch on him, and was still trying to pretend that Crookshanks was innocent by suggesting that Ron look for Scabbers under all the boys' beds. Hermione, meanwhile, maintained fiercely that Ron had no proof that Crookshanks had eaten Scabbers, that the ginger hairs might have been there since Christmas, and that Ron had been prejudiced against her cat ever since Crookshanks had landed on Ron's head in the Magical Menagerie. Personally, Harry was sure that Crookshanks had eaten Scabbers, and when he tried to point out to Hermione that the evidence all pointed that way, she lost her temper with Harry too. â€Å"Okay, side with Ron, I knew you would!† she said shrilly. â€Å"First the Firebolt, now Scabbers, everything's my fault, isn't it! Just leave me alone, Harry, I've got a lot of work to do!† Ron had taken the loss of his rat very hard indeed. â€Å"Come on, Ron, you were always saying how boring Scabbers was,† said Fred bracingly. â€Å"And he's been off-color for ages, he was wasting away. It was probably better for him to snuff it quickly — one swallow — he probably didn't feel a thing.† â€Å"Fred!† said Ginny indignantly. â€Å"All he did was eat and sleep, Ron, you said it yourself,† said George. â€Å"He bit Goyle for us once!† Ron said miserably. â€Å"Remember, Harry?† â€Å"Yeah, that's true,† said Harry. â€Å"His finest hour,† said Fred, unable to keep a straight face. â€Å"Let the scar on Goyle's finger stand as a lasting tribute to his memory. Oh, come on, Ron, get yourself down to Hogsmeade and buy a new rat, what's the point of moaning?† In a last-ditch attempt to cheer Ron up, Harry persuaded him to come along to the Gryffindor team's final practice before the Ravenclaw match, so that he could have a ride on the Firebolt after they'd finished. This did seem to take Ron's mind off Scabbers for a moment (â€Å"Great! Can I try and shoot a few goals on it?†) so they set off for the Quidditch field together. Madam Hooch, who was still overseeing Gryffindor practices to keep an eye on Harry, was just as impressed with the Firebolt as everyone else had been. She took it in her hands before takeoff and gave them the benefit of her professional opinion. â€Å"Look at the balance on it! If the Nimbus series has a fault, it's a slight list to the tail end — you often find they develop a drag after a few years. They've updated the handle too, a bit slimmer than the Cleansweeps, reminds me of the old Silver Arrows — a pity they've stopped making them. I learned to fly on one, and a very fine old broom it was too†¦Ã¢â‚¬  She continued in this vein for some time, until Wood said, â€Å"Er — Madam Hooch? Is it okay if Harry has the Firebolt back? We need to practice†¦Ã¢â‚¬  â€Å"Oh — right — here you are, then, Potter,† said Madam Hooch. â€Å"I'll sit over here with Weasley†¦Ã¢â‚¬  She and Ron left the field to sit in the stadium, and the Gryffindor team gathered around Wood for his final instructions for tomorrow's match. â€Å"Harry, I've just found out who Ravenclaw is playing as Seeker. It's Cho Chang. She's a fourth year, and she's pretty good†¦I really hoped she wouldn't be fit, she's had some problems with injuries†¦Ã¢â‚¬  Wood scowled his displeasure that Cho Chang had made a full recovery, then said, â€Å"On the other hand, she rides a Comet Two Sixty, which is going to look like a joke next to the Firebolt.† He gave Harry's broom a look of fervent admiration, then said, â€Å"Okay, everyone, let's go –â€Å" And at long last, Harry mounted his Firebolt, and kicked off from the ground. It was better than he'd ever dreamed. The Firebolt turned with the lightest touch; it seemed to obey his thoughts rather than his grip; it sped across the field at such speed that the stadium turned into a green-and-gray blur; Harry turned it so sharply that Alicia Spinnet screamed, then he went into a perfectly controlled dive, brushing the grassy field with his toes before rising thirty, forty, fifty feet into the air again — â€Å"Harry, I'm letting the Snitch out!† Wood called. Harry turned and raced a Bludger toward the goal posts; he outstripped it easily, saw the Snitch dart out from behind Wood, and within ten seconds had caught it tightly in his hand. The team cheered madly. Harry let the Snitch go again, gave it a minute's head start, then tore after it, weaving in and out of the others; he spotted it lurking near Katie Bell's knee, looped her easily, and caught it again. It was the best practice ever; the team, inspired by the presence of the Firebolt in their midst, performed their best moves faultlessly, and by the time they hit the ground again, Wood didn't have a single criticism to make, which, as George Weasley pointed out, was a first. â€Å"I can't see what's going to stop us tomorrow!† said Wood. â€Å"Not unless — Harry, you've sorted out your Dementor problem, haven't you?† â€Å"Yeah,† said Harry, thinking of his feeble Patronus and wishing it were stronger. â€Å"The Dementors won't turn up again, Oliver. Dumbledore'd go ballistic,† said Fred confidently. â€Å"Well, let's hope not,† said Wood. â€Å"Anyway — good work, everyone. Let's get back to the tower†¦turn in early†¦Ã¢â‚¬  â€Å"I'm staying out for a bit; Ron wants a go on the Firebolt,† Harry told Wood, and while the rest of the team headed off to the locker rooms, Harry strode over to Ron, who vaulted the barrier to the stands and came to meet him. Madam Hooch had fallen asleep in her seat. â€Å"Here you go,† said Harry, handing Ron the Firebolt. Ron, an expression of ecstasy on his face, mounted the broom and zoomed off into the gathering darkness while Harry walked around the edge of the field, watching him. Night had fallen before Madam Hooch awoke with a start, told Harry and Ron off for not waking her, and insisted that they go back to the castle. Harry shouldered the Firebolt and he and Ron walked out of the shadowy stadium, discussing the Firebolt's superbly smooth action, its phenomenal acceleration, and its pinpoint turning. They were halfway toward the castle when Harry, glancing to his left, saw something that made his heart turn over — a pair of eyes, gleaming out of the darkness. Harry stopped dead, his heart banging against his ribs. â€Å"What's the matter?† said Ron. Harry pointed. Ron pulled out his wand and muttered, â€Å"Lumos!† A beam of light fell across the grass, hit the bottom of a tree, and illuminated its branches; there, crouching among the budding leaves, was Crookshanks. â€Å"Get out of here!† Ron roared, and he stooped down and seized a stone lying on the grass, but before he could do anything else, Crookshanks had vanished with one swish of his long ginger tail. â€Å"See?† Ron said furiously, chucking the stone down again. â€Å"She's still letting him wander about wherever he wants — probably washing down Scabbers with a couple of birds now†¦.† Harry didn't say anything. He took a deep breath as relief seeped through him; he had been sure for a moment that those eyes had belonged to the Grim. They set off for the castle once more. slightly ashamed of his moment of panic, Harry didn't say anything to Ron — nor did he look left or right until they had reached the well lit entrance hall. Harry went down to breakfast the next morning with the rest of the boys in his dormitory, all of whom seemed to think the Firebolt deserved a sort of guard of honor. As Harry entered the Great Hall, heads turned in the direction of the Firebolt, and there was a good deal of excited muttering. Harry saw, with enormous satisfaction, that the Slytherin team were all looking thunderstruck. â€Å"Did you see his face?† said Ron gleefully, looking back at Malfoy. â€Å"He can't believe it! This is brilliant!† Wood, too, was basking in the reflected glory of the Firebolt. â€Å"Put it here, Harry,† he said, laying the broom in the middle of the table and carefully turning it so that its name faced upward. People from the Ravenclaw and Hufflepuff tables were soon coming over to look. Cedric Diggory came over to congratulate Harry on having acquired such a superb replacement for his Nimbus, and Percy's Ravenclaw girlfriend, Penelope Clearwater, asked if she could actually hold the Firebolt. â€Å"Now, now, Penny, no sabotage!† said Percy heartily as she examined the Firebolt closely. â€Å"Penelope and I have got a bet on,† he told the team. â€Å"Ten Galleons on the outcome of the match!† Penelope put the Firebolt down again, thanked Harry, and went back to her table. â€Å"Harry — make sure you win,† said Percy, in an urgent whisper. â€Å"I haven't got ten Galleons. Yes, I'm coming, Penny!† And he bustled off to join her in a piece of toast. â€Å"Sure you can manage that broom, Potter?† said a cold, drawling voice. Draco Malfoy had arrived for a closer look, Crabbe and Goyle right behind him. â€Å"Yeah, reckon so,† said Harry casually. â€Å"Got plenty of special features, hasn't it?† said Malfoy, eyes glittering maliciously. â€Å"Shame it doesn't come with a parachute — in case you get too near a Dementor.† Crabbe and Goyle sniggered. â€Å"Pity you can't attach an extra arm to yours, Malfoy,† said Harry. â€Å"Then it could catch the Snitch for you.† The Gryffindor team laughed loudly. Malfoy's pale eyes narrowed, and he stalked away. They watched him rejoin the rest of the Slytherin team, who put their heads together, no doubt asking Malfoy whether Harry's broom really was a Firebolt. At a quarter to eleven, the Gryffindor team set off for the locker rooms. The weather couldn't have been more different from their match against Hufflepuff. It was a clear, cool day with a very light breeze; there would be no visibility problems this time, and Harry, though nervous, was starting to feel the excitement only a Quidditch match could bring. They could hear the rest of the school moving into the stadium beyond. Harry took off his black school robes, removed his wand from his pocket, and stuck it inside the T-shirt he was going to wear under his Quidditch robes. He only hoped he wouldn't need it. He wondered suddenly whether Professor Lupin was in the crowd, watching. â€Å"You know what we've got to do,† said Wood as they prepared to leave the locker rooms. â€Å"If we lose this match, we're out of the running. just — just fly like you did in practice yesterday, and we'll be okay!† They walked out onto the field to tumultuous applause. The Ravenclaw team, dressed in blue, were already standing in the middle of the field. Their Seeker, Cho Chang, was the only girl on their team. She was shorter than Harry by about a head, and Harry couldn't help noticing, nervous as he was, that she was extremely pretty. She smiled at Harry as the teams faced each other behind their captains, and he felt a slight lurch in the region of his stomach that he didn't think had anything to do with nerves. â€Å"Wood, Davies, shake hands,† Madam Hooch said briskly, and Wood shook hands with the Ravenclaw Captain. â€Å"Mount your brooms †¦ on my whistle †¦ three — two — one –â€Å" Harry kicked off into the air and the Firebolt zoomed higher and faster than any other broom; he soared around the stadium and began squinting around for the Snitch, listening all the while to the commentary, which was being provided by the Weasley twins' friend Lee Jordan. â€Å"They're off, and the big excitement this match is the Firebolt that Harry Potter is flying for Gryffindor. According to Which Broomstick, the Firebolt's going to be the broom of choice for the national teams at this year's World Championship –â€Å" â€Å"Jordan, would you mind telling us what's going on in the match?† interrupted Professor McGonagall's voice. â€Å"Right you are, Professor — just giving a bit of background information — the Firebolt, incidentally, has a built-in auto-brake and –â€Å" â€Å"Jordan!† â€Å"Okay, okay, Gryffindor in possession, Katie Bell of Gryffindor, heading for goal†¦Ã¢â‚¬  Harry streaked past Katie in the opposite direction, gazing around for a glint of gold and noticing that Cho Chang was tailing him closely. She was undoubtedly a very good flier — she kept cutting across him, forcing him to change direction. â€Å"Show her your acceleration, Harry!† Fred yelled as he whooshed past in pursuit of a Bludger that was aiming for Alicia. Harry urged the Firebolt forward as they rounded the Ravenclaw goal posts and Cho fell behind. Just as Katie succeeded in scoring the first goal of the match, and the Gryffindor end of the field went wild, he saw it — the Snitch was close to the ground, flitting near one of the barriers. Harry dived; Cho saw what he was doing and tore after him — Harry was speeding up, excitement flooding him; dives were his specialty, he was ten feet away — Then a Bludger, hit by one of the Ravenclaw Beaters, came pelting out of nowhere; Harry veered off course, avoiding it by an inch, and in those few, crucial seconds, the Snitch had vanished. There was a great â€Å"Ooooooh† of disappointment from the Gryffindor supporters, but much applause for their Beater from the Ravenclaw end. George Weasley vented his feelings by hitting the second Bludger directly at the offending Beater, who was forced to roll right over in midair to avoid it. â€Å"Gryffindor leads by eighty points to zero, and look at that Firebolt go! Potter's really putting it through its paces now, see it turn — Chang's Comet is just no match for it, the Firebolt's precision — balance is really noticeable in these long –â€Å" â€Å"JORDAN! ARE YOU BEING PAID TO ADVERTISE FIREBOLTS? GET ON WITH THE COMMENTARY!† Ravenclaw was pulling back; they had now scored three goals, which put Gryffindor only fifty points ahead — if Cho got the Snitch before him, Ravenclaw would win. Harry dropped lower, narrowly avoiding a Ravenclaw Chaser, scanning the field frantically — a glint of gold, a flutter of tiny wings — the Snitch was circling the Gryffindor goal post†¦ Harry accelerated, eyes fixed on the speck of gold ahead — but just then, Cho appeared out of thin air, blocking him — â€Å"HARRY, THIS IS NO TIME TO BE A GENTLEMAN!† Wood roared as Harry swerved to avoid a collision. â€Å"KNOCK HER OFF HER BROOM IF YOU HAVE TO!† Harry turned and caught sight of Cho; she was grinning. The Snitch had vanished again. Harry turned his Firebolt upward and was soon twenty feet above the game. Out of the corner of his eye, he saw Cho following him †¦She'd decided to mark him rather than search for the Snitch herself†¦All right, then†¦if she wanted to tail him, she'd have to take the consequences†¦ He dived again, and Cho, thinking he'd seen the Snitch, tried to follow; Harry pulled out of the dive very sharply; she hurtled downward; he rose fast as a bullet once more, and then saw it, for the third time — the Snitch was glittering way above the field at the Ravenclaw end. He accelerated; so, many feet below, did Cho. He was winning, gaining on the Snitch with every second — then — â€Å"Oh!† screamed Cho, pointing. Distracted, Harry looked down. Three Dementors, three tall, black, hooded Dementors, were looking up at him. He didn't stop to think. Plunging a hand down the neck of his robes, he whipped out his wand and roared, â€Å"Expecto patronum!† Something silver-white, something enormous, erupted from the end of his wand. He knew it had shot directly at the Dementors but didn't pause to watch; his mind still miraculously clear, he looked ahead — he was nearly there. He stretched out the hand still grasping his wand and just managed to close his fingers over the small, struggling Snitch. Madam Hooch's whistle sounded. Harry turned around in midair and saw six scarlet blurs bearing down on him; next moment, the whole team was hugging him so hard he was nearly pulled off his broom. Down below he could hear the roars of the Gryffindors in the crowd. â€Å"That's my boy!† Wood kept yelling. Alicia, Angelina, and Katie had all kissed Harry; Fred had him in a grip so tight Harry felt as though his head would come off In complete disarray, the team managed to make its way back to the ground. Harry got off his broom and looked up to see a gaggle of Gryffindor supporters sprinting onto the field, Ron in the lead. Before he knew it, he had been engulfed by the cheering crowd. â€Å"Yes!† Ron yelled, yanking Harry's arm into the air. â€Å"Yes! Yes!† â€Å"Well done, Harry!† said Percy, looking delighted. â€Å"Ten Galleons to me! Must find Penelope, excuse me –â€Å" â€Å"Good for you, Harry!† roared Seamus Finnigan. â€Å"Ruddy brilliant!† boomed Hagrid over the heads of the milling Gryffindors. â€Å"That was quite some Patronus,† said a voice in Harry's ear. Harry turned around to see Professor Lupin, who looked both shaken and pleased. â€Å"The Dementors didn't affect me at all!† Harry said excitedly. â€Å"I didn't feel a thing!† â€Å"That would be because they — er — weren't Dementors,† said Professor Lupin. â€Å"Come and see — â€Å" He led Harry out of the crowd until they were able to see the edge of the field. â€Å"You gave Mr. Malfoy quite a fright,† said Lupin. Harry stared. Lying in a crumpled heap on the ground were Malfoy, Crabbe, Goyle, and Marcus Flint, the Slytherin team Captain, all struggling to remove themselves from long, black, hooded robes. It looked as though Malfoy had been standing on Goyle's shoulders. Standing over them, with an expression of the utmost fury on her face, was Professor McGonagall. â€Å"An unworthy trick!† she was shouting. â€Å"A low and cowardly attempt to sabotage the Gryffindor Seeker! Detention for all of you, and fifty points from Slytherin! I shall be speaking to Professor Dumbledore about this, make no mistake! Ah, here he comes now!† If anything could have set the seal on Gryffindor's victory, it was this. Ron, who had fought his way through to Harry's side, doubled up with laughter as they watched Malfoy fighting to extricate himself from the robe, Goyle's head still stuck inside it. â€Å"Come on, Harry!† said George, fighting his way over. â€Å"Party! Gryffindor common room, now!† â€Å"Right,† said Harry, and feeling happier than he had in ages, he and the rest of the team led the way, still in their scarlet robes, out of the stadium and back up to the castle. It felt as though they had already won the Quidditch Cup; the party went on all day and well into the night. Fred and George Weasley disappeared for a couple of hours and returned with armfuls of bottles of butterbeer, pumpkin fizz, and several bags full of Honeydukes sweets. â€Å"How did you do that?† squealed Angelina Johnson as George started throwing Peppermint Toads into the crowd. â€Å"With a little help from Moony, Wormtail, Padfoot, and Prongs,† Fred muttered in Harry's ear. Only one person wasn't joining in the festivities. Hermione, incredibly, was sitting in a corner, attempting to read an enormous book entitled Home Life and Social Habits of British Muggles. Harry broke away from the table where Fred and George had started juggling butterbeer bottles and went over to her. â€Å"Did you even come to the match?† he asked her. â€Å"Of course I did,† said Hermione in a strangely high-pitched voice, not looking up. â€Å"And I'm very glad we won, and I think you did really well, but I need to read this by Monday.† â€Å"Come on, Hermione, come and have some food,† Harry said, looking over at Ron and wondering whether he was in a good enough mood to bury the hatchet. â€Å"I can't, Harry. I've still got four hundred and twenty-two pages to read!† said Hermione, now sounding slightly hysterical. â€Å"Anyway†¦Ã¢â‚¬  She glanced over at Ron too. â€Å"He doesn't want me to join in.† There was no arguing with this, as Ron chose that moment to say loudly, â€Å"If Scabbers hadn't just been eaten, he could have had some of those Fudge Flies. He used to really like them –â€Å" Hermione burst into tears. Before Harry could say or do anything, she tucked the enormous book under her arm, and, still sobbing, ran toward the staircase to the girls' dormitories and out of sight. â€Å"Can't you give her a break?† Harry asked Ron quietly. â€Å"No,† said Ron flatly. â€Å"If she just acted like she was sorry — but she'll never admit she's wrong, Hermione. She's still acting like Scabbers has gone on vacation or something.† The Gryffindor party ended only when Professor McGonagall turned up in her tartan dressing gown and hair net at one in the morning, to insist that they all go to bed. Harry and Ron climbed the stairs to their dormitory, still discussing the match. At last, exhausted, Harry climbed into bed, twitched the hangings of his four-poster shut to block out a ray of moonlight, lay back, and felt himself almost instantly drifting off to sleep†¦ He had a very strange dream. He was walking through a forest, his Firebolt over his shoulder, following something silvery-white. It was winding its way through the trees ahead, and he could only catch glimpses of it between the leaves. Anxious to catch up with it, he sped up, but as he moved faster, so did his quarry. Harry broke into a run, and ahead he heard hooves gathering speed. Now he was running flat out, and ahead he could hear galloping. Then he turned a corner into a clearing and — â€Å"AAAAAAAAAAAAAARRRRRRRRRRRRGGGHHHHHHH! NOOOOOOOOOOOOOOOOOOOOOOO!† Harry woke as suddenly as though he'd been hit in the face. Disoriented in the total darkness, he fumbled with his hangings, he could hear movements around him, and Seamus Finnigan's voice from the other side of the room. â€Å"What's going on?† Harry thought he heard the dormitory door slam. At last finding the divide in his curtains, he ripped them back, and at the same moment, Dean Thomas lit his lamp. Ron was sitting up in bed, the hangings torn from one side, a look of utmost terror on his face. â€Å"Black! Sirius Black! With a knife!† â€Å"What?† â€Å"Here! Just now! Slashed the curtains! Woke me up!† â€Å"You sure you weren't dreaming, Ron?† said Dean. â€Å"Look at the curtains! I tell you, he was here!† They all scrambled out of bed; Harry reached the dormitory door first, and they sprinted back down the staircase. Doors opened behind them, and sleepy voices called after them. â€Å"Who shouted?† â€Å"What're you doing?† The common room was lit with the glow of the dying fire, still littered with the debris from the party. It was deserted. â€Å"Are you sure you weren't dreaming, Ron?† â€Å"I'm telling you, I saw him!† â€Å"What's all the noise?† â€Å"Professor McGonagall told us to go to bed!† A few of the girls had come down their staircase, pulling on dressing gowns and yawning. Boys, too, were reappearing. â€Å"Excellent, are we carrying on?† said Fred Weasley brightly. â€Å"Everyone back upstairs!† said Percy, hurrying into the common room and pinning his Head Boy badge to his pajamas as he spoke. â€Å"Perce — Sirius Black!† said Ron faintly. â€Å"In our dormitory! With a knife! Woke me up!† The common room went very still. â€Å"Nonsense!† said Percy, looking startled. â€Å"You had too much to eat, Ron — had a nightmare –â€Å" â€Å"I'm telling you –â€Å" â€Å"Now, really, enough's enough!† Professor McGonagall was back. She slammed the portrait behind her as she entered the common room and stared furiously around. â€Å"I am delighted that Gryffindor won the match, but this is getting ridiculous! Percy, I expected better of you!† â€Å"I certainly didn't authorize this, Professor!† said Percy, puffing himself up indignantly. â€Å"I was just telling them all t o get back to bed! My brother Ron here had a nightmare –â€Å" â€Å"IT WASN'T A NIGHTMARE!† Ron yelled. â€Å"PROFESSOR, I WOKE UP, AND SIRIUS BLACK WAS STANDING OVER ME, HOLDING A KNIFE!† Professor McGonagall stared at him. â€Å"Don't be ridiculous, Weasley, how could he possibly have gotten through the portrait hole?† â€Å"Ask him!† said Ron, pointing a shaking finger at the back of Sir Cadogan's picture. â€Å"Ask him if he saw –â€Å" Glaring suspiciously at Ron, Professor McGonagall pushed the portrait back open and went outside. The whole common room listened with bated breath. â€Å"Sir Cadogan, did you just let a man enter Gryffindor Tower?† â€Å"Certainly, good lady!† cried Sir Cadogan. There was a stunned silence, both inside and outside the common room. â€Å"You — you did?† said Professor McGonagall. â€Å"But — but the password!† â€Å"He had 'em!† said Sir Cadogan proudly. â€Å"Had the whole week's, my lady! Read 'em off a little piece of paper!† Professor McGonagall pulled herself back through the portrait hole to face the stunned crowd. She was white as chalk. â€Å"Which person,† she said, her voice shaking, â€Å"which abysmally foolish person wrote down this week's passwords and left them lying around?† There was utter silence, broken by the smallest of terrified squeaks. Neville Longbottom, trembling from head to fluffy slippered toes, raised his hand slowly into the air.

A Critical Regulatory Issue in Health Care Essay

Health care legal issues today are an uphill climb due to not having a full understanding of case laws and why we have them. One of the most controversial issues today is prescribed marijuana for the terminally ill. This has been a legal battle for years in the health care industry, especially for those who suffer from chronic illnesses such as cancer. Marijuana is an illegal drug that many physicians and patients believe it aids in relieving pain and side effects of chemotherapy and radiation treatments, which is very debilitating for many patients and cause many more issues for the patient. The states of California and Oregon have investigated the medicinal uses of marijuana closely. The differences in states approval or disapproval can be seen clearly with these two states. California for example views marijuana as a â€Å"Schedule I drug, meaning it can be possed and used to aid in survival and pain reduction for terminally ill patients. Yet, Oregon can legally permit physicians to prescribe the drug under Schedule II and patients can use the drug to end their lives.† (George J. Annas, J.D., M.P.H. 2006) The real question is whether or not the U. S. Congress had authority constitutionally and the autonomy to make a decision, since this would fall under the Commerce Clause. U. S. Supreme Court ruled that the clause gave them the power, the right, and the ability to regulate marijuana grown at home for personal medically related uses as it had â€Å"to regulate the amount of wheat a farmer grew on his farm for personal consumption.† (George J. Annas, J. D., M.P.H. 2006) The fact of the matter is this, it could have been prescribed legally by a physician was irrelevant. This is a very slippery area for the health care industry and all those who prescribe medical marijuana are under the Controlled Substance Act (CSA) of 1970. The CSA set standards and regulations for controlled substances in one of a five schedules that is based on the potential for  dependence and abuse. Also it puts our legal system at a crossroad when considering; what is possession of an illegal drug and tho se who distribute or deal illegal drugs. This places the system in an area for a litany of legal battles which have included the health care system on what is considered legal and what is not legal. Of course this opens the can of worms on assisted suicides. The ruling of that would have to come from the U. S. Attorney General to determine whether prescribing drugs for suicide was not a â€Å"legitimate medical practice†, â€Å"As required by the CSA and writing such a prescription could therefore result in revocation of one’s registration certificate with the Drug Enforcement Administration (DEA) and federal criminal prosecution.† (George J.Annas, J.D., M.P.H. 2006) Supreme Court rulings in cases of assisted suicide are an issue because they try and keep a general consensus at state level. The state court officials who are part of the executive branch are responsible for administering specific statues and are allowed to interrupt the meanings of cases involving the CSA. Therefore, it is very important to learn and know the statues and laws of the state in which the individual resides since the laws vary from state to state. The question of what constitutes a legitimate medical practice is open to interpretation and can be argued that the CSA prohibits doctor assisted suicide with the use of controlled substances. The use of Schedule II drugs is not a â€Å"legitimate practice†, thus causing the ruling in the state of California but, not in Oregon. This decision was reached because states have the right under federalism basic principle to regulate the practice of medicine and it is a state-regulated activity. The U. S. Congress does not have authority to make it federally regulated under the CSA. However, 20 states in the U. S. allow medical marijuana usage for terminally ill patients. This number is expected to grow, although, 20 states ruled it legal for medical purposes; it is still illegal under Federal Law. The issue of assisted suicide controlled substance abuse and medical marijuana have some interesting outcomes because the laws of the land take a strong stance to decriminalize marijuana as some state have already; it will reduce the number of prisoners in the prison population. From a medical stand point the benefit of prescribing the drug far outweighs not prescribing it because of the fear physicians have about being prosecuted and having their medical licenses revoked. However, the street  pharmacist would be able to have the same benefit of protection under the CSA, since we give longer sentences for drug dealing than we do murder. All things considered, the objective behind medical marijuana and the benefits it provides to the terminally ill or a person who suffers chronic pain shows a positive sign that it helps to relieve and aid in pain management. It’s time for public health officials, state regulators, and health scientist to bring (make) changes in health care when it concerns medical marijuana. Medical marijuana can be manufactured as a controlled substance and regulated to meet the standards in quality care and quality control. The standards can be met by establishing and monitoring results through follow ups and collection of clinical evidence. Medical marijuana has been a hot topic for years and will continue to be a hot topic in the years to come, yet it still benefits the people who need it. In many cases, people will continue to self-medicate to help with pain relief. Marijuana is an herb that is natural and in many cases safer than pain killers offered by large pharmaceutical companies. It has been proven that marijuana slows down response and gives the person the munchies. Yet the drugs from pharmaceutical companies can cause much worse damage from liver and kidney malfunctions as well as heart problems. So, which is better? George J. Annas, J. D., M. P. H. (2006) Congress Controlled Substances and Physician Assisted Suicide—Elephants in Mouse Holes, The New England Journal of Medicine

Gudie to employability Coursework Example | Topics and Well Written Essays - 250 words

Gudie to employability - Coursework Example Employers anticipate these employability skills while the graduates enter a profession of their choice (â€Å"Learning and information†). Resources and activities are often linked to such initiatives as institutional employability awards. These awards are offered to provide students with an opportunity to experience the added value of learning from the extra-curricular activities (Lantz 9). Some of these experiences include involvement with student societies, recognition of volunteering, and skills developed through work-based placements. Universities nowadays take a lot of measures in order to guide their students to employability. Such measures include but are not limited to deciding minimum working hours for the students, providing students with opportunities to work and earn at campus, teaching students how to present and prepare for the interviews, and allowing students more flexibility of learning by providing them with the choice of virtual education (â€Å"Careers and employability†). Guide to employability is a very special and necessary service ever university and college must provide its students with in the present age in order to increase their eligibility and competitiveness for

Uses Cases Assignment Example | Topics and Well Written Essays - 1250 words

Uses Cases - Assignment Example The withdrawal transaction begins by a customer inserting his or her Bank Card into the card slot of the ATM. Then a user validation process is performed on the basis of the card ID and the customer’s PIN. After validation, the a display screen is provided containing the available set of operations. In this scenario, the customer has directly selects â€Å"Withdraw Cash†. The ATM screen displays prompts for an account type. The selects the desired account type from the available Menu. This is immediately followed by screen for the user to input the required amount of money. All this information falls under the withdrawal use case. That is, the Bankcard ID, PIN (Personal Identification Number), account type and amount, which is then sent to the Bank as a requested transaction. The Bank then replies with a go-ahead or not reply. Upon successful approval the customer’s money is made available by the dispenser. The ATM then ejects the card and Prints a receipt. It is essential to indicate that this use case is based on the assumption that a user makes a direct and successful withdrawal. However, there are some alternative flows caused by conditions such as Wrong PIN, Invalid or Expired Card, Invalid Account type and Excess withdrawal Amount. The second diagram is a use case dependency for making an account deposit. As indicated in the use case diagram below, this is another highly technical procedure in the design of an ATM service machine. The preconditions are same as for withdrawal, which is a customer and Bank. The following is involved in the execution of an account deposit transaction. The transaction initiates by a Bank Customer inserting his or her card. This is then followed a provision of display screen by the ATM prompting a user PIN, which is integrated as the validation use case. It uses the card ID and PIN to authenticate its use. The machine displays a screen

Discussion Board 6-1 Assignment Example | Topics and Well Written Essays - 250 words - 2

Discussion Board 6-1 - Assignment Example the trend of masturbation and orgasm in children and adolescent, and puberty in adolescents is important to counselors as they are able to understand certain sexual anomalies that may appear in children and adolescents as they grow. According to Rathus, Nevid and Fitchner-Rathus (2014), human beings tend to begin masturbating at early stage of development. The practice tends to continue through adolescence to adulthood. Depending on the response of the immediate society to a masturbating child, adolescents or adults may exhibit sexual passiveness or activeness. If parents of a masturbating child punished, scolded or warned the given child against masturbating, the child may grow knowing that the practice is bad and may end up not exploiting their sexual abilities. This may lead to sexually inactive adolescents with retarded sexual interest or desire. Having such knowledge may help a counselor track the beginning of particular sexual abnormalities. Rathus, Nevid and Fitchner-Rathus (2014) report that human begins begin to experience orgasm as early as during infancy to childhood, adolescence and to adulthood. Having this background knowledge is important to help a counselor dealing with clients experiencing abnormal orgasmic response trace, identify possible historical causes, and find appropriate solutions. Understanding puberty and related processes as happens among adolescents is a special issue that a counselor needs to know about human sexual development. As mentioned by Rathus, Nevid and Fitchner-Rathus (2014), puberty defines the basic onset of adolescence. Adolescence prepares individuals for adulthood encounters. Puberty and adolescence usually trigger impulsive sexual feelings that may lead to inappropriate sexual behaviors. Counselors need to understand the process of puberty during adolescence to be able to help troubled adolescents face and overcome problems and embarrassments that usually characterize the

Strategic Analysis Essay Example | Topics and Well Written Essays - 3000 words - 1

Strategic Analysis - Essay Example It also launched cars of different varieties and also targeted all the segments mainly the huge middle class segment present in India. It has huge manufacturing units in different parts of the country and also has a good supply chain. The company is always been known because of its high quality and also good after sales service that the company has always provided to the customers (Maruti Suzuki. 2014). The company has not only concentrated in the market of India but it has also expanded itself in other parts of world by exporting its vehicles across to different countries like UK, Srilanka, Nepal, Egypt, Italy, Germany etc. The automobile industry in India has grown at a very rapid pace and it is very difficult for all the companies to maintain their market share. Customers are looking to get better quality and high performance cars more as they have got a lot of variety. In this report it can be seen how a company like Maruti does face problems related to a particular car model that is been launched in the market. The specific strategy that the company needs to implement to get over the current issue is also been analysed and certain recommendations are been given to the company based on the study from various reports, theories and concepts. In the recent times with the increasing competition in the growing automobile industry in the global world and especially in the developing countries customers have got lot more choice to make between varieties, quality , performance and other factors which does affect the purchase decision of the customers. Because of this high competitive environment it has become very important for all the companies to maintain a good quality for their products and also provide high performance cars to the customers (Fitzroy and Herbert, 2007, pp. 34-38). The chances of launching a defective product in the market does create a lot of problem for the company as the company loses all its

Moral Dilemmas Essay Example | Topics and Well Written Essays - 500 words - 2

Moral Dilemmas - Essay Example In stating about this problem, Russ Shafer-Landau argues that various moral principles tend to be effectively independently to how an individual perceives them. Kant’s moral theory is slightly different especially how people perceive it. In defining moral dilemmas, the Kant moral theory is seen as deontological whereby a person’s actions are morally upright in terms of virtues of individual’s motives. In this case, they must derive from a certain duty than inclination (Timmons 27). The determination to act according to his/her duty mostly overcomes the self-interest evidence or the desire to do otherwise. Moreover, Kant argues the aspect of moral values of an individual’s actions with the fact that they only reside in maxim or formal principle. Alternatively, it explains about the general commitment of a person to engage in a certain act because it is his/her duty to do so (Timmons 35). This therefore means that, duty remains the necessity for a person to act out of vengeance for the law. Rigorous application of similar methods towards this reasoning would result in an equal success while dealing with moral philo sophy problems. This therefore means that the eventual principle of morality must always be a moral law that happens abstractly and has the ability of guiding an individual towards a right action. In as much as the Kant’s theory seems effective and applies to real life events, this theory of ethics has its own flaws and ineffectiveness when used literary (Timmons 32). Generally, the theory fails to tell people what they should do especially when their moral responsibilities are conflicting. Kant’s theory of ethics is entirely general especially on some of the common happening in terms of moral ethics and dilemmas. However, the theory is not detailed and effective enough to guide people on how to

Energy efficiency rating Math Problem Example | Topics and Well Written Essays - 500 words

Energy efficiency rating - Math Problem Example In comparing the means for both groups, using a 1% significance level, the two-tailed P value, at a 99% confidence interval, equals 0.6543. Thus, there is a 65.43% probability that the observed difference between the salaries between private and GOH nurses are actually more extreme than their true differences. At a 1% level of significance, this implies that there is not enough statistical evidence to indicate that the salaries in private hospitals are greater than those in GOH. b. Comparing the means between the previous and current salaries, the previous salaries' mean is higher than the current salaries. At a 99% confidence interval, the two-tailed p-value equal to 0.4699 indicates that there is no reason to conclude that the means have a significant difference. In addition, the lower confidence limit of -3739.9893 indicates a large decrease in the lower limit coupled with a large increase in the upper confidence limit of 2033.3093. Thus, there is no conclusive evidence that the previous salaries are significantly lower than current ones.

Critique of Quantitative Methods Journal Paper Essay - 1

Critique of Quantitative Methods Journal Paper - Essay Example d in this regard that motivation is one of the key factors, which facilitates people to perform better for attaining their respective desired targets. Besides, modern organisations, in order to withstand in this competitive business world, are viewed to remain continuously engaged in making substantial changes in their policies, which lead towards raising the issue of distress amid the employees. In this respect, the article mainly drawn the framework of ‘transactional stress theory’ in order to evaluate the effectiveness of ‘affect-based model’ of ‘developmental job experience’ (DJE) through which both positive as well as negative outcomes of an individual could be measured (Dong & et. al., 2014). Correspondingly, the essay will critically interpret and evaluate the provided quantitative article, which is mainly concerned about determining the significance of an ‘affect-based model’ of ‘developmental job experience’ as well as the buffering effects of emotional intelligence. DJE refers to the experiences that an individual needs to carry for meeting the demands of the changing working assignment. This will certain provide them a significant opportunity of learning and enriching their inhaled competency of leadership in respect of knowledge, decision making skills, insightfulness and most vitally interpersonal capability (McCauley & Brutus, 2008). This particular approach i.e. DJE has been used by certain renowned organisations including IBM and NASA among others with the aim of developing on-the-job learning procedure of their respective employees. Based on this notion, it can be asserted that the approach aids in advancing the potential skills of the employees, which eventually result in making them high productive. In order to develop overall organisational competency, enhancing the employees’ skills and reducing the unwanted costs are quite important for any organisation in order to gain long-term success. It is often observed that most

View of the World Essay Example for Free

View of the World Essay The fact that more and more people have been holding a cynical view of today’s world can be explained by their deep disillusion with the existing social order, conventions, and values. To some extent, by embracing cynicism those people try to psychologically protect themselves against injustices and unpleasantness of this world. Contemporary cynics refuse to believe in the noble values promoted by modern society as they have plenty of bitter evidence attesting that those values are usually empty words and beliefs while most people do things only for their own advantage. Instead of concentrating on what today’s world should be, cynics accept it as it is now and try to adapt themselves to its realities. Cynics justify their position by the fact that they do not want to be victims of self-deception and disappointment as it often happens, for example, to idealists or optimists. If the latter believe in this world’s good virtues and ideals and have positive expectations from it, cynics know that such expectations often turn into disappointment, dissatisfaction, and sufferings. Today’s world is far from being perfect, cynics emphasize, and it is wrong and even harmful to expect something good from it. What disillusion is for others, it is reality for cynics, and in this philosophy they simply seek self-protection (Bayan). Apart from moral and psychological protection against today’s imperfect world, cynics also see certain important practical advantages resulting from their doctrine. Idealists and optimists expect success from whatever they do while cynics do not exclude failure and, therefore, work harder in order to reduce the possible negative effects of their failure. This approach motivates them to be more careful and attentive, and calculate everything they do to the last detail. And, unlike idealists and optimists, cynics are prepared to deal with their failure when it occurs, since they anticipated it from the very beginning. However, it often happens that their anticipation of failure and hard work unexpectedly turn out to be success, or at least their failure is far from being as serious as they expected it to be. And for cynics, this is another proof that their doctrine does not only insulate them against today’s world’s imperfection, but also occasionally contributes to their success (Nussbaum, 2009). References Bayan, R. Positive Cynicism. Retrieved February 20, 2009 from the World Wide Web: http://www. i-cynic. com/positive. asp Nussbaum, N. (2009, February 10). Glass Half Empty. The Cornwell Daily Sun on the web. Retrieved February 20, 2009 from the World Wide Web: http://cornellsun. com/node/34901

History of Database Technology and Data Models Essay Example for Free

History of Database Technology and Data Models Essay Imagine that you own bank and along with that, you own your bank’s credibility to your 100,000 clients. Just writing down each client’s information in a piece of paper would not be very secure and practical nowadays. That’s how an electronic database system comes in the picture. In this fast growing world, a technology like a database system is very necessary for establishments that hold a huge amount of data. However, the development of the current database technology and database models underwent an intricate process before it comes to a full bloom. In 1964, the word â€Å"database† technically denoted collections of data shared by end-users of time sharing computer systems and was coined by workers in a military information system. In addition, around 1960s, private companies started to own computers because of their increasing storage capabilities. Two data models were introduced: network (CODASYL) and hierarchical (IMS) model. During that time, database management systems were unsystematic. There no actual theoretical model about data organization. There was more emphasis on the processing of the records rather than the overall structure of the database system. During the 1970s, many astonishing breakthroughs on databases were witnessed. It was about the 1970 that E. F. Codd proposed a relational model for databases. The presented a system that separates the logical organization (schema) of a database from the physical storages and since that, it has been a standard in the field of computing. The term Relational Database Management System (RDBMS) was coined during this period. Theories about databases had finally made its way to the mainstream research projects. Two main prototypes for RDBMS were created: Ingres that was developed at UCB and this system used QUEL as query language and System R that was developed at IBM San Jose and this system used SEQUEL as query language. Meanwhile, in 1976, P. Chen suggested the Entity-Relationship (ER) model for database design which was proved to be vital in conceptual data models. This proposal enabled the designers to focus more on the data usage rather than its logical table structure. Commercialization of database systems for businesses began during the 1980s as demands for computers boomed. In addition, Structured Query Language (SQL) became a standard for database systems during these periods. DB2 became IBM’s flagship and development of IBM PC paved the way for more database companies and products like Dbase III and IV, Database Manager, OS/2 and Watcom SQL. The network and hierarchical models for database also started to disappear in the background. When the 1990s came, only a few surviving companies began to offer complex products at higher prices. Developments on database systems were more focused on client tool applications such as PowerBuilder (Sybase), Oracle Developer and VB (Microsoft). Some personal productivity tools related to database management were also created such as Microsoft Access and Excel. Some prototypes of Object Database Management System (ODBMS) also arose in the 1990s. It was also during the 1990s that the World Wide Web appeared. Large investments were made by Internet-related companies on Web and database connectors. Examples of these connectors are Active Server Pages (ASP), Java Servlets, JDBC, ColdFusion, Dream Weaver and Oracle Developer 2000. A solid growth of database applications was still observed in the early 21st century. Three companies continually dominate the database market: Oracle, IBM and Microsoft. In the near future, it is generally seen that databases management will be more sophisticated since huge systems (systems with storage measured in terabytes) are currently existing today. Most of these systems are used by most projects with science databases (genome projects, space exploration data). However, the â€Å"next great thing† on is the usage of XML with Java and other emerging technologies as a way to store data.

Research into Rational Drug Prescribing in Yemen

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