Marketing Course Evaluation Essay Example | Topics and Well Written Essays - 1500 words

Marketing Course Evaluation - Essay Example Likewise, I have learnt that firms should emulate appropriate brand names and pricing strategies in order to enhance the perception, motivation and product awareness that play a significant role in the consumer buying process. In its effort to attain a competitive edge, Lockheed Martin Aeronautics Company has embarked on merging with other companies in its effort to market products such as C-5, C-130 and C-141. In the same way, the company emulates horizontal market system for example at one time it replaced F-117 with F-22 based on the consumers feedback. Actions that I intend to take to stay current in my field includes, post graduate course in Project Management, Six Sigma Black Belt Certification (CSSBB) as well as masters degree. In order to improve the value of this course to the working adults, it is essential for lecturers to allocate adequate time for theory lessons as well as practical sessions. In addition, marketers should be trained on how to use web 2.0 as a major marke ting tool. Introduction In the contemporary world, firms have emulated a number of strategies to remain competitive and retain their customers. Through the guidance of the marketing managers, companies have emulated aspects such as proper branding, effective product positioning and pricing as well as promotional strategies. ... that I have gained Target Markets One of the skills that I have gained from the course is that for a company to be successful, it has to aim at particular customers. Being one of the major marketing strategy, target marketing in collaboration with the marketing mix that include price, product, promotion and price is essential especially when firms are aimed at expanding their customer base. Market positioning and segmentation The course has also exposed me to product positioning. This entails the process through which marketers create an image or the identity of their products on the minds of their consumers. One of the vital objectives of an effective product positioning is that it creates a strong customer awareness thus generating repeated purchases leading to high sales. On the other hand, market segmentation involves classification of the customers based on one or more characteristics (Kotler et al, 2010). In this way, firms are able to identify groups of customers with similar needs. Examples of market segmentation that this course introduced me into include geographic segmentation, demographic segmentation, psychographic segmentation, segmentation according to benefits and occasions as well as behavioral segmentation. Connecting with customers Building customer value, satisfaction, and loyalty Through the course, I was able to gain adequate skills on how to build customer value by enhancing a positive relationship especially by ensuring that organisations address the problems faced by the consumers in a timely manner. In addition, to ensure that the consumers are satisfied, it is imperative to provide quality products that meet their needs (Paliwoda et al, 2009). One of the major ways of enhancing customer loyalty is by creating a positive company-customer

Strategic Planning Dissertation Example | Topics and Well Written Essays - 5000 words

Strategic Planning - Dissertation Example Introduction Strategic planning within organizations is one of the most essential aspects of both sustainability and growth. Without the ability to meet the needs of strategic planning, there is the inability to move forward with specific needs and to reach the full potential of the organization. While strategic planning is required for the development of a company, the implementation and the end goals are often not met. The problems which arise are based on the various aspects of the organization and how it associates with the needs of each of the goals. Leadership capacities, communication tools, participation and the ability to reach smaller and larger goals through various initiatives are some of the several areas in which strategic planning is not implemented in the correct manner. This is followed with complexities which arise from the organizational culture and the expectations which are associated with meeting change or resistance to the workforce that is a part of the organi zation (Rothwell, 2010). ... The research will also examine specific areas in which strategic planning can alter, specifically with associations such as getting more employees available for participation, building milestones and metrics to incorporate the strategic plans with and altering the approaches toward the vision so it becomes tangible within the company. By investigating how these can be used, there is the ability to create and develop more alternatives with the required strategic plans and how these can alter into a form of action. Problem Statement While strategic plans are developed within corporations, they are often not implemented and end goals are not met. Literature Review (ADD 10 PAGES TO THIS LIT REVIEW SECTIONOFTHE PAPER) The approach which is taken toward strategic planning and implementation is one which is based on the understanding of taking action within a corporation. Without the correct strategies, there is the inability to provide higher amounts of sustainability and growth within a c ompany. However, there are often problems and difficulties with creating the required changes. This literature review will examine the various aspects of strategic planning and implementation as well as how it alters according to the difficulties which are in the organizational culture. The review will examine the various dimensions that are associated with strategic planning. It will further define the obstacles that do not allow the plans to be implemented at various levels within an organization. There will also be reference to theories which are created to alter the strategic planning so it becomes one that is associated with constructive

Multi Disciplinary Team

Multi Disciplinary Team Introduction This discussion opens with a definition of a therapeutic relationship and the key elements that impact on this. The discussion will focus on the different types of communication and explain the importance. I will also refer to the Multi Disciplinary Team (MDT) in a patients care and how this can strengthen the relationship. The discussion will end with reference to the Nursing and Midwifery Council (NMC) guidelines and the impact on the relationship. Self awareness will also be discussed. A therapeutic relationship is defined as A partnership between clients and nurses, both working together to improve the clients health status (Balzer Riley, 1986). This relationship allows both the nurse and the patient to gain satisfaction, the patient feels supported and listened to and the nurse feels valued in his/her role. One of the significant points in the relationship is that if the patient feels they are being listened to by the healthcare provider they will recover at a much faster rate. The key elements are, attending, hearing, understanding and remembering. Attending is the physical part with both the nurse and the patient being present and keeping up to date with what is being said. Hearing is the part that pays the attention to the patient. Understanding, this is reassuring the patient that what they have said has been understood. This can be done by paraphrasing. Remembering can be very difficult, if the nurse has understood what the patient has said this does become easier. In order to do this the nurse needs to fully attend to the patient, listen to them and then respond to them. According to Barker (1971), the listening process consists of four different elements listed above. By actioning the concepts the nurse can start to empathise with the patient. Empathy is an important aspect of this relationship, Empathy is the act of communicating to our fellow human beings that we understand how they are feeling and what makes them feel that way (Hogan, 1969) Empathy can be shown both verbally and non verbally, the verbal part is to reflect on how the patient is feeling and the reasons why and the goal should be to meet an accurate verbal reflection. The non verbal features of empathy are as much important as the verbal part; the non verbal part should show features of warmth and genuineness does the true caring for your patient come across. To do this verbal and non verbal communication must be used. Summary Questioning is a way of verbal communication between the nurse and the patient, some would say that questioning is a way of helping others to think about their problems (Alder and Rodman, 1982). There are two types of questions that may be asked to patients, open questions and closed questions, Open questions are asking for a more verbal response from the patient whereas closed questions is only encouraging the patient to give a short simple response. Along with questioning there are many other ways of verbal communication, establishing guidelines, acknowledgement, reflecting, paraphrasing, seeking clarification, summarising and planning .Clearly verbal communication is very important as are non verbal skills. Non verbal communication has various components; some of these include Posture, gesture, eye contact, touch, facial expression, appearance, head nods, silence, proxemics and other body language. Egan ( 1977) S.O.L.E.R framework has an important part to play in a therapeutic relationship, all of the points should make both the nurse and the patient is comfortable and in control of the situation, here is a bit of information to elaborate on the soler framework- S Sit squarely this means sit face to face with the patient this does not mean the nurse has to sit directly opposite the patient, the nurse should sit upright not slouching, this will show the patient the nurse has a caring posture. O Open posture this means sit with both arms and legs uncrossed, if both arms and legs are crossed it is said to show an element of defence from the nurse. L Lean slightly forward although this does depend on the conversation, leaning forward without leaning away will lead the nurse into the intimate zone of the patient. E Eye contact is recommended to be constant although this shouldnt be a constant stare as this can be very uncomfortable for the patient. R Relax -the nurse must be relaxed in order to gain the confidence in the patient. This framework can also be used by other healthcare professionals. Professionals other than nurses can strengthen the relationship; this can be another member of the health care team that needs to take part in the patients care. The professionals could include physicians, pharmacists, dieticians, occupational therapists these professionals are known as the MDT. A member of the MDT might need to be involved in the patients care, For example if the patient had concerns about their diet you could introduce the dietician to help. By introducing a member of the MDT it will strengthen the relationship with the patient. The patient however must consent to the involvement of other disciplines. Consent within a therapeutic relationship is very important, obtaining consent is a process and not a one off event. The patient must be told in a sensitive manner and the patient must then make the decision on whether to accept or decline the proposal being offered. The NMC (2008) states that you must respect and support peoples rights to accept or decline treatment and care (NMC code May 2008). Usually the professional who is going to perform the procedure will gain the consent although it is possible this task could be delegated to another professional who has the capability of meeting the required standards, Consent maybe obtained in a number of different ways, Verbal consent this is explaining everything verbally to the patient and the patient replying with a verbal answer, written consent this is normally obtained if the procedure has any risk or is lengthy and complex, the written consent is a record of what has taken place or could be of what has been offered and not taken p lace as the patient decline the opportunity. The NMC is the code that should be adhered to all times, some of the guidelines under the code includes Privacy, dignity and confidentiality, as part of the NMC code of conduct nurses are to work within their limitations. This is about the nurse being self aware. Self awareness is about recognising, accepting, challenging who we are, what we feel, and what we can and can not do (Rungapadiachy, 1998). In a therapeutic relationship it is also important to be in control of your own self awareness, be aware of your own values and beliefs. According to Rokeach (1968),a value is an important life goal or societal condition which is despired by a person. Beliefs are subjective statements used by individuals to describe something they believe as being true. Values are seen as the central core that reflects on ones attitude this is also know to affect ones attitude. Fishben and Ajzen (1975) define beliefs as statements which indicate a persons subjective probability that an object has a particular characteristic. Conclusion The Johari window is a model that is used to explore and develop self awareness; this model concentrates on interpersonal skills that are applied to interaction, it deals with awareness in the human behaviour (Luft 1969). There are four aspects to the Johari window, open, blind, hidden and unknown. The open part is the part that is known to self and others, the blind is the area that is unknown to self but know to others, the hidden part is the area that is known to self but unknown to others and the unknown is the area that is unknown to self and unknown to others. Through communication the open self is made more accessible. This strengthens the therapeutic relationship. This Essay has defined what a therapeutic relationship is and the key elements that impact on this. Different types of communication have been discussed and explanation given to show their importance. The role of the MDT in a patients care and how this can strengthen the relationship has also been discussed. NMC guidelines have an impact on the relationship and discussed a key issue from the guidelines, with special reference to consent. This essay has also explained why self awareness is important within a therapeutic relationship

Destiny, Fate, Free Will and Free Choice in Oedipus the King - Oedipus and Fate :: Oedipus the King Oedipus Rex

Oedipus the King and Fate D.T. Suzuki, a renowned expert on Zen Buddhism, called attention to the topic of free will in one of his lectures by stating that it was the battle of "God versus Man, Man versus God, God versus Nature, Nature versus God, Man versus Nature, Nature versus Man1." These six battles constitute an ultimately greater battle: the battle of free will versus determinism. Free will is that ability for a human being to make decisions as to what life he or she would like to lead and have the freedom to live according to their own means and thus choose their own destiny; determinism is the circumstance of a higher being ordaining a man's life from the day he was born until the day he dies. Free will is in itself a far-reaching ideal that exemplifies the essence of what mankind could be when he determines his own fate. But with determinism, a man has a predetermined destiny and fate that absolutely cannot be altered by the man himself. Yet, it has been the desire of man to avoid the perils that his fate ho lds andthus he unceasingly attempts to thwart fate and the will of the divine.. Within the principle of determinism, this outright contention to divine mandate is blasphemous and considered sin. This ideal itself, and the whole concept of determinism, is quite common in the workings of Greek and Classical literature. A manifest example of this was the infamous Oedipus of The Theban Plays, a man who tried to defy fate, and therefore sinned. The logic of Oedipus' transgression is actually quite obvious, and Oedipus' father, King Laius, also has an analogous methodology and transgression. They both had unfortunate destinies: Laius was destined to be killed by his own son, and Oedipus was destined to kill his father and marry his mother. This was the ominous decree from the divinatory Oracle at Delphi. King Laius feared the Oracle's proclamation and had his son, the one and only Oedipus, abandoned on a mountain with iron spikes as nails so that he would remain there to eventually die. And yet, his attempt to obstruct fate was a failure, for a kindly shepherd

Customer Relationship Management in Bahrain Investment Banking Arena Essay

The banking industry has undergone widespread changes within the operating environment and this involves globalization of markets and technological improvements. These two factors have influenced and encouraged innovative practices within the banking industry that has served to enhance its operational efficiency. The introduction of ATMs and e-banking facilities are some of the major milestones in the banking industry that have revolutionized business operations. The global markets have intensified the competitive environment of the banking industry that has created the need for increased efficiency in operations and increasing customer satisfaction. Customers are the lifeblood of any organization and the banking business too depends on the acquisition and retention of consumers for its profitability. Customer relationship management forms a vital aspect of business strategy driving the company’s market shares and market leadership position. Customer relationship management (CRM) has been defined as a business strategy that â€Å"is a fusion of a series of functions, skills, processes, and technologies which together allow companies to more profitably manage (acquire and retain) customers as tangible assets† (Shanmugasundaram, 2008:98). It is viewed as an interactive process that creates a balance between corporate objectives and customer satisfaction to increase the profitability of the business. Acquisition and retention of customers is one of the vital requirements of business and the effectiveness of strategies driven towards this goal determines the success of business enterprises. The past few years have witnessed growing application of CRM in retail banking and investment banking sectors. The key objective behind such initiatives is to ensure the delivery of superior customer service and to fulfil the needs of consumers. Such practices are effective in enabling organizations to meet the needs of the consumers and provide improved services in comparison to other players in the industry. Competitive advantage and business gains are driven by a proactive approach that focuses on consumer needs and expectations, provision of consistently high quality service, looking into consumer convenience and an effective follow up service to ensure consumer loyalty. A vital aspect of investment banking and any other financial services is the changing consumer mindsets. Owing to the abundance of information easily accessible over the Internet the consumers today are more knowledgeable of the wide range of choices and alternatives available to them. The consumers are equipped with more knowledge related to the banking options available and hence their banking decisions are guided by their well-researched study. This fact holds true for all economic sectors and business operations but forms a critical aspect of banking industries since it caters to a diverse segment of consumers. In nearly all business to business markets in which clients are as large as, or as in this case, often much larger than their suppliers, the latter must respond quickly to pressures from their clients to improve client management processes and systems† (Foss & Stone, 2002: 211). CRM in Investment banking sector The short term objective of the marketing department is to acquire customers while the long term objective translates to retaining the old customers through effective customer relationship management (CRM) strategies. Reaching and acquiring a new customer is one thing, keeping the relationship healthy and strong over a long period of time is the mark of the true marketing professional concerned with long term health of the organization† (Dolak, 2009). The increasing competitive market makes it difficult to retain customers over a longer period of time owing to the constant influx of new and substitute alternatives invading the shelf spaces at the local retail shop. This makes the task of CRM increasingly challenging and organizations adopt various strategies to attract old customers back. Retention strategies often employ measures such as consumer behaviour research and product surveys that enable the organizations to assess the needs and expectations of the consumer and enable them to serve better. Customers always appreciate the personal touch that results in building strong relationships. The net today provides numerous effective communication channels that are being used to keep the customer happy. Web based customer relationship management has effectively integrated all modes of communication – web, email, chat, video, voice to serve and support the customers to enhance the total customer experience. Investment banking differs from other forms of banking in the role a few major clients play on the bank’s performance and productivity (Foss & Stone, 2002). This form of banking targets a fixed client segment that drives the sales of investment products and services. The efficiency of the banking sector is determined by the types of products and services sold to customers in response to their investment needs and expectations. Customization of products and services are the key to deriving client satisfaction. Identification of the client segment is a vital factor in targeting and reaching out to the desired client population and this process is driven by market research. The changing demographics and intense competitive pressures from global industry players have however made a significant impact on the business strategies of investment banks worldwide. The challenges faced by investment bankers lie in reaching out to target consumers and providing them with increased ease of banking services that serve to retain clients over a longer period of time. Moreover, the increasing demands of consumers and growing expectations have driven the banking sector to adopt technology based innovative applications for meeting consumer needs and expectations. Online banking services and mobile banking applications are some of the innovative means that are being used by investment bankers to reach out to their target consumers. Such applications have served to improve banking services and efficiencies in resolving customer queries and needs promptly through the click of the mouse button. The anytime and anywhere access to banking services have defined new trends in serving consumers. â€Å"Online customization is one useful customer relationship management strategy adopted by e-business to add value and improve sales of their products and services using the Internet† (Khosla et al. , 2003). Investment banking in Bahrain The banking sector in Bahrain is one of the key sectors influencing economic growth and development in the region. The contribution of the financial services and banking sector is second only to the oil and natural gas industry in the country. The country has experienced an economic boom and an upward trend in economic growth and development over the past few decades on account of globalisation influences and opening of trade channels. The banking sector has also opened to multinational corporations establishing their operations in the country to tap the growing number of high net worth individuals in the country. Despite the globalisation of banking operations and increased de-regulation of the financial services sector in the area the country continues to have a significant control and supervision over the regulatory environment. The Central Bank of Bahrain continues to be monitor and control the banking environment in the country. The modernisation of banking services and strategic approaches made by investment bankers in other parts of the globe have not produced much impact in this region owing to the constraints applied by the existing cultural influence. The retail banking scenario in Bahrain is to a considerable extent driven by the culture of the country. The cultural impacts are realised in the conservative approach of consumers towards banking and investment. Various research studies have concluded that while the region is an emerging market for technology applications and innovative practices, user attitudes have limited the scope of technology based business models in the banking sector. The conservative market environment and user attitudes towards the CRM strategies adopted by investment bankers in Bahrain forms the focal point of the research study. The research study will analyse the various perspectives involved in CRM approach by investment bankers through the study of Unicorn Investment Bank in Bahrain. The bank was founded in the year 2004 and has its headquarters in Bahrain. It is an Islamic financial services group that has an international presence in various locations such as Malaysia, Turkey, Saudi Arabia and United States. The bank currently has six distinctive business service categories that include asset management and real estate, capital markets, corporate finance, private equity, strategic mergers and acquisitions and treasury. Among the various services offered by the bank the key approach is to deliver the customers with a comprehensive range of investment solutions that are customised to meet client needs and expectations. Unicorn’s integrated product offering and financial engineering skills are closely intertwined with a strong capacity to distribute the Bank’s products and services to a broad client base across the GCC region, the wider Middle East region, Southeast Asia, the USA and the Europe† (Unicorn, 2010). The target customers of the bank include high net worth individuals, business enterprises, financial institutions, corporations, and government agencies and departments. The products offered by the bank are Shari’ah compliant and conforms to the international financial practices (Unicorn, 2010). Issues and challenges â€Å"All major banks have invested heavily in technology and infrastructure over the last 5 and 10 years in this area, but hardly any of them have been successful in actually getting it effective† (Infosys, 2009). The failure of CRM initiatives within the investment banking sector have provided a new ground for research into increasing the effectiveness of CRM applications. There are many strategic implications related to the application of CRM within investment banking sector. This involves the adaptation of normal banking processes and systems to integrate with innovative use of technology based applications and automated query processing systems that require efficient management and handling of issues. Such issues pertain to the efficient use of CRM systems to meet operational goals and integrating the different banking functions to provide a structured application that can be used easily by consumers. Ease of use and convenience are some of the key parameters involved in the development of CRM based banking system. A key challenge facing these areas involves the security and privacy issues that form a major source of concern for consumers using the technology based applications. Technology based business models and CRM strategies enable investment bankers to provide the customers with efficiency in delivery of services, access to relevant information, product details and ease of transactions. Mobile banking and e-banking facilitates the customers of investment banking to a host of facilities that range from product enquiry; access updated rates of interest and market values of the investment products chosen and conducts investment transactions online. Investment portfolios can also be accessed and manipulated according to user convenience from the comforts of their home or office. However, widespread usage of such systems has been restricted on account of user reservations related to security issues and privacy of vital user data and information. Mobile banking and online transactions raise security and privacy concerns among most of the consumers (Barati & Mohammadi, 2009). The transfer of sensitive financial and personal information across mobile networks is found to be the prime reason behind the psychological barriers created among potential mobile banking customers (Laukkanen, 2007).

Robotics

Introduction Robotics has revolutionized the way industries operate, the way items are built, and the way society lives. Robotics is a fairly new technological advance that has made lives easier, and has provided a breakthrough for many operations and businesses. In a way, robotics is the future for businesses as well as the future of mankind. Like any other type of technology, robotics can be used in various industries, has advantages and disadvantages, and has a long history of how it came about.There are many aspects of robotics to be considered which include educational fields that one can choose, and the types of applications and industries robotics is found in. Safety is an important concept and part of robotics, especially because of its complexity. Being well educated in the field of robotics can play an important role on safety as well. This field can greatly reduce the workload and can increase the productivity in many companies, no matter how big or small. Robotics is the future, and embracing it will help in the future success of businesses.History of Robotics The actual word robot was made popular by an author in his 1921 play. This author claims that his brother was the inventor of the word, which comes from the Czech word â€Å"robota† meaning servitude. Robots were first used in factories such as industrial companies, where these would fix machines in order to handle manufacturing tasks that facilitated the production and assisted humans in their everyday tasks. Robots such as industrial robots that used artificial intelligence have actually been around since the 60’s.After the 1950’s computers along with robotics started to increase in popularity as well as complexity and numbers as technology also began to advance. In 1961, the first industrial robot was built to work on the General Motors assembly line, and this machine was conceived in 1954 by George Devol and was called Unimate. The name was given because the robot was manufactured by a company called Unimation. Unimate is to this day remembered as the first industrial robot ever built. After the first robot was built, many others started to come around, and in 1971 the first icroprocessor called 4004 was created by Ted Hoff at Intel. Many other creations began to follow such as programming language called Prolog, which became the basic language in the field of artificial intelligence, then came the first industrial robot with six electromechanic axes, then the silver arm, capable of replicating human hands. Currently, robots are used to monitor outer space. In April of 2001, the Canadarm2, which was attached to the space station, was launched into orbit. This robot was a much larger and more capable version of a previously used arm.Another break though in the robotics field made it to stores in 2002. The Roomba, a robotic vacuum cleaner manufactured by the company iRobot became quite popular during this time. The most recent robotic creation was the Robonaut 2, which is the latest generation of astronaut helpers that was launched into the space station on the STS-133 mission. This is the first humanoid robot in space. Some of its features included showing engineers how robots actually behave in space so they could work on upgrades and possible advances that would assist spacewalkers perform their scientific work.Google also came out with robotic vehicles, called Google driveless cars, which became famous in 2010. These robotic vehicles had drivers behind the wheels in case of an emergency, and drove to various places while taking pictures of their surroundings. Unimate Google Images4004 Google Images Canadarm2 Google ImagesThe Roomba Google Images Robonaut 2 – Google ImagesGoogle’s Driveless Car Google Images Advantages Robotics as any other industry and profession has advantages and disadvantages. Business decisions usually come with pros and cons especially when it coms to automating the rocess of production by using industrial robots. Companies need to first take time and consider all the facts before deciding to add robots to their departments, especially when these can bring advantages and disadvantages in the process. Some of the advantages that robots can bring to companies is the fact that the quality of work is excellent. Industrial robots have the capabilities to improve the quality of production. Some of the applications performed by robots are more precise than those performed by humans and are more consistent in their quality as well. This igh level of quality and consistency is harder to obtain in any other way besides using robots. In production of products by using robots the speed of their outputs has a dramatic impact in the overall production of products. Robots are built to work at constant speeds without needing sleep, vacations, breaks, and they even produce more than any human worker. Safety is one of the other advantages found in the use of robots. Robots increase the safety in the workplace as these can perform in dangerous environments and hazardous settings, giving the opportunity to umans to move the supervisory roles and away from hazardous environments. Robots also have the advantage of proving savings for companies. Being able to provide a safe workplace, robots can bring financial savings to companies as these will incur less worker compensation fees, no healthcare or insurance payments, and robots also perform at higher levels with a fraction of the effort. Disadvantages Robots also have disadvantages that need to be considered. Investing in a robot can be costly, especially if the business owner has a budget to work with. The cost of automating the roduction by using robots needs to be calculated into the business’ financial budget. The maintenance of the robot should also be calculated to avoid future surprises or bills. When it comes to robots, programming and interaction are required, as with new employees hiring and trai ning is also a requirement. This programming and interaction can become costly depending on the time invested. Robots can also provide a safe work setting for employees, as they take the place of them in hazardous settings, but they can also bring safety problems. Their only presence can be the cause of hazard for workers as well. Advantages |Disadvantages | |You can send them to very dangerous places |You need to get people trained to fix them if anything wrong | | |happens | |You can make them do you're job for you |Need a very intelligent crew | |They are more accurate than humans Eg no shaking when in a |They can ruin peoples lives Eg Take their job away from them | |very important surgery, puts every screw in fabricating a car| | |etc. | |Can do jobs 24/7 |They are very expensive to make | |Can guard without being tired just keep doing the same thing |You need the right materials to make them, that could be very| |24/7 |rare | |No need of nutrients |If you make a very amazi ng robot with amazing quality and it | | |brakes, it might be very hard to fix | |You can program them to make them do exactly what you want |They can be very hard to program | |them to do | | |They can not harm you unless they are programmed to |They can reproduce but it could cost money for the materials | |Can work with out doubts Eg when you think â€Å"what do i do |They can reproduce but it could cost money for the materials | |now†? | |They can lift very heavy things |You need highly trained people to make them | | |They can not recharge themselves | (â€Å"Advantages and disadvantages,† ). Industries Robotics falls into three major industries including manufacturing, service and defense. These industries will also generate jobs such as technical engineering, software, testing and many others. Because robotics is such a complex field, and no one person can manage knowing every aspect of it, this is known to be a collaborative field. Basically, robotics requi res a lot of team work and discipline to achieve all the required tasks in providing a successful product. This is a great advantage as segments of robotics seem to be growing fast. One industry in particular as been the service industry, which has seen tremendous growth over the last decade. Robots are being used more frequently in manufacturing, where these help create jobs. Robots also help control quality of products and maintain that quality high. Currently, the highest percentage of robotics is seen in the United States, where about 60 percent of the service industry and 80 percent of the military industry are located. The largest manufacturers of robotics, however, are still in Germany and Japan. Service Industry Google ImagesMilitary Industry Google Images Robotics and Education Currently the robotics industry is growing rapidly, and if people do not already own a robot, they will very soon.This industry is growing in various ways such as size and sales, as well as creating growth around itself. It has been found in recent research that the robotics industry is expected to generate over one million new jobs over the next five years. One great way to get involved in the field of robotics is to sign up for the First Robotics Competition. This is a good first step, especially for those under 18 years of age. By getting involved in the competition, you can learn every aspect of robotics, the different product life cycles, and also gain experience in the field. College is another great way to learn about robotics, as many institutions offer classes and degrees in robotics.Robotics is a very complex field, and it as multiple industries that it’s a part of. The robotics industry can offer employment to a wide range of people, even if their specialties do not include a degree in this field. Many people who have science degrees, physics, or even electronics degrees are employed in the field of robotics. Software is a part of robots that is not usually vi sible, yet engineers that design these software are very important and there are many jobs available for them. The future will be driven by software designers, and those who specialize in computer science. If one is passionate about robotics, it is recommended to take a course in a robotics elated field to learn more, and to find the different paths you can take in this field. By doing so, one can meet other people interested in robotics and share ideas and interests. Some universities do not offer specific robotics courses, but you can learn about robotics by taking engineering classes as well. Some of the subjects that will allow you to learn more about robotics include computer science, mechanical engineering, and electronics engineering. It is always a good idea to spend time taking small courses to see if this field is the right career path, instead of diving into a three to four year degree without being sure it’s the right choice. Careers in Robotics | |Robot Service Engineer | |As a service engineer you would be responsible for installing, maintaining and fixing any faults with the robots. | |Qualifications: Often offered as a modern apprenticeship (Requiring GCSEs), a BTEC in electronics or an A-level in an engineering related | |subject. | |Product Consultant / Demonstrator | |If you are confident in presenting in front of a group then this job may be perfect for you. You would be required to learn everything | |about a companies and demonstrate it to a group of potential customers. | |Qualifications: This would depend on the specific company. If presenting is the primary role, an A-level in English would be beneficial. | | |Research Assistant | |If you are passionate about developing new robot technology and can demonstrate good analytical and practical skills you may be ideal for | |research. | |Qualifications: A-level, Higher education certificate, Degree or Masters in an engineering related subject. | Safety Working with robots will bec ome more and more common, whether at home or in the workplace. With new developments in the robotics field, one of the problems that engineers are facing is safety. Safety is a concern that every industry has with their employees, and is now becoming a concern with robotics as well. One of the solutions that have arise regarding safety has been to prevent the user from coming into contact with the robot by using physical barriers to do so.While studying robot-human interaction, which is known as HRI, it has been found that removing these barriers will allow people to and robots to work together and cooperate in order to perform the required tasks. Robot systems that are able to perform HRI tasks will be considered as being safety-critical complex systems because of their size, behavior, functionality, and can even cause damage to their surroundings and to their operators. One of the objective when it comes to designing robots is to have the engineers work to achieve safety. Even if engineers design a safe robot, it an be hard to prove its safety by merely testing it. The Future of RoboticsOne aspect in which robotics has revolutionized the way we live has been the invention of the mobil phone. This invention changed the communication industry when it was introduced in the early 90’s. This simple device has sparked demand for wireless communication as well as portability in other devices. Knowing how robotics has changed the way we communicate, it can be predicted that robotics will have a great impact on the future as way especially in the areas of battery life and weight, artificial intelligence, and swarm robotics. Battery life is essential for mobil devices, and it can be seen as it is the largest part of the device, and the heaviest. In the uture, power sources will be reduced to allow a smaller device with longer battery life. The second area in which robotics will impact is artificial intelligence, or AI. So far many advances have been made in thi s field, but there is still much to be done. Currently, AI systems have been created to generate logic routines at basic levels. In the future, AI software may be able to think or even act like humans. Swarm robotics is the last important area, and it refers to controlling multiple cooperating robots. This basically means that multiple robots will be able to do various tasks and at the same time be cooperating directly or indirectly to complete that task.This will help in employee a large amount of robots to complete one major task. Mobil Devices Google Images Artificial Intelligence Google Images Swarm Robotics Google Images Robots vs. Humans Robots are known to have skills that cannot be matched by humans. In some cases, robots perform one function, but in others robots can take on various tasks that will take the place of several employees. One good example is how electric shavers used to be assembled in the old days, by using hundreds of factory workers who perform this task by using only their hands. Now, these same tasks are performed by robot hands. These robots can perform the work at igher speeds than humans can, three sifts a day, 365 days a year, and without vacation, breaks, or sick days. The future of business is in robotics. Companies are now wanting to work with the robotics systems that electronics giants such as Apple are currently using. Because robots are coming down in price, and at the same time growing in sophistication, it is believed that jobs will be lost. The success of robotics has jeopardized many jobs as so many tasks can be performed at a fraction of the time, higher quality, and at a fraction of the price. Even robot manufacturers have stated that in several applications robots are already more cost-effective than people. One ay to show this was seen in a company where a $250,000 robot replaced two machine operators, making $50,000 per year, and over the 15-year life of the system, the machines yielded $3. 5 million in labor and productivity savings. Robots are known for being a faster assembly line, and this is one of the main reasons they have been replacing so many factory workers, and giving companies more of a competitive advantage and savings. Conclusion Robotics has become a great part of society’s lives, and has even become essential in developing specialized tasks that need the constancy and preciseness of robots. Handling certain tasks could take excess amount of money and time that if performed by humans alone could ruin ompanies as they would not be competitive in the market. Robots provide us with the assistance needed to get the job done faster, and in a more productive way. This is the future and being a part of it makes it definitely better. References Wikipedia. (n. d. ). History of robots. Retrieved from http://en. wikipedia. org/wiki/History_of_robots Robotics careers and education. (n. d. ). Retrieved from http://www. razorrobotics. com/careers-and-education/ Future of robotics. ( n. d. ). Retrieved from http://www. razorrobotics. com/future-of-robotics/ Robot safety. (n. d. ). Retrieved from http://www. razorrobotics. com/safety/ PLATT , J. R. (n. d. ).The real steel: Robotics careers ready to boom. Retrieved from http://www. todaysengineer. org/2012/Feb/career-focus. asp Advantages and disadvantages of robotics. (n. d. ). Retrieved from http:// 14wo. qataracademy. wikispaces. net/Advantages and disadvantages of robotics Advantages and disadvantages of automating with industrial robots. (n. d. ). Retrieved from http://www. robots. com/blog/viewing/advantages-and-disadvantages-of-automating-with- industrial-robots MARKOFF, J. (n. d. ). Skilled work, without the worker. Retrieved from http://www. nytimes. com/ 2012/08/19/business/new-wave-of-adept-robots-is-changing-global-industry. html? pagewanted=all=0

William ShakespeareS Tragedies Essays - Love Stories, Free Essays

William Shakespeare'S Tragedies Essays - Love Stories, Free Essays William Shakespeare'S Tragedies Shakespeare is not our poet but the worlds, stated by W. S. Landor in 1846 (Lamb 340). William Shakespeare has given the world a whole new perspective on poetry. Usually the pieces he has written are either hated or loved. He has written comedies, romances, and tragedies. All of his pieces have been wonderful but the ones that stand out the most are his tragedies. The elements he uses in his tragedies set them above all the rest. All the tragedies, which include Romeo and Juliet; Hamlet; King Lear; Othello; MacBeth, all share similar characteristics. Most people think that the main element in Shakespeares tragedies is death, but this is untrue. William Shakespeare has written many tragedies that share similar elements to make his pieces of literature attractive to the audience. William Shakespeare uses the feeling of sorrow in all his tragedies he has written to make the audience admire the character who faces adversity . One of the many miracles of his pieces are how people learn to love the man is disliked when he suffers (Jorgensen 8). All of Shakespeares protagonists learn as the play goes on how to react from the ordeal (Jorgensen 1). This element of his writing is more important than the deaths or who wins or loses. The suffering in Shakespearean plays really shows what a tough world is mainly about. Jealousy in Othello, lust in Antony, revenge in Titus and Hamlet, and hatred in Coriolanus gives the tragedies most of their dynamics, but the deeper feelings come from sorrow (Jorgensen 8). One of lifes major paradoxes is love through suffering. As people suffer, they learn to love the things that are most important to them. The betterment of humans comes from suffering. In the tragedy of King Lear, the character of Kent says, Almost sees miracles, but m isery (Jorgensen 8). This exemplifies the suffering the Shakespeare uses in his works. The quote means that many events that you think are miracles can turn out to be miseries. Another tragedy in which Shakespeare uses sorrow is in Hamlet. Hamlet says, But I have within which passeth show; These but the trappings and the suits of woe (Lamb 261). Hamlet is sorrowing for the death of his father. No one cares about Hamlets personality, but the audience endures how the character suffers. Also in the play of As You Like It, Duke Senior gives a speech in which it shows the impact of pain of feelings. The Duke and his companions benefit from the cold weather rather than suffer (Jorgensen 9). Shakespeare considers the sorrow worse than any death. The pain of feelings really gets the audience into the play. People would rather like to watch characters suffer than be in a good mood. Shakespeare capitalizes on the feeling of sorrow to make his tragedies better than any others. Another great element that Shakespeare includes in most of his tragedies is the ordeal of the hero and heroine. The hero and heroine in the tragedies have a special passion between them (Jorgensen 1). The play of Romeo and Juliet indicates how well Shakespeare uses the hero-heroine theme. Everybody loves the characters of the charming Romeo and the beautiful Juliet. In Romeo and Juliet, the passion between the two is so strong that they go against their family values and marry each other. Passion in the tragedies gives the audience something to admire. This play is suited for love. Romeo and Juliet show youthful, tragic love (Kirsch 505). Passion is used in the never forgetting balcony scene. Romeo speaks, Th exchange of thy loves faithful vow for mine (Lamb 165). The passion here is so magnificent that the audience can not help to be amazed. Unlike Romeo and Juliet, the play of Antony and Cleopatra differs. Shakespeare describes the hero-heroine element in Romeo and Juliet as death marked while he describes Antony and Cleopatra as having a grander passion (Kirsch 506). In the play of Antony and Cleopatra, Antony says to Cleopatra, Theres beggary in the love that can be reckoned (Lamb 164). This shows the passion between the hero and heroine. The hero-heroine ordeal in most of Shakespeares tragedies along with passion is one element

Enzymes †Proteins Amino Acids

Enzymes – Proteins Amino Acids Free Online Research Papers Enzymes are proteins produced by all living organisms. These proteins consist of amino acids but what makes them different is how they behave in our body. (Felice) Enzymes are catalysts that make biochemical reactions take place within our bodies take place quickly and efficiently. These reactions would otherwise happen very slowly and or not occur at all. (SYMBIOSIS p59) These enzymes are highly specific in their functionality and work in different ways. They are the basic elements that activate all functions in the body. They facilitate reactions that build compounds from raw materials within the body, transport elements throughout the body, break down substances and eliminate the waste and unwanted chemicals within our bodies. Simply, enzymes carry out all the body’s biochemical functions. (Felice) Since enzymes are proteins, each consists of a specific sequence of amino acids. (WORTHINGTON) Weak hydrogen bonds that form between some of the amino acids help to determine the shape of the enzyme. It is this shape that allows the enzyme to fit onto a specific substrate molecule. Figuratively speaking, the enzyme and substrate molecule must fit together like a lock and key. (SYMBIOSIS p60) The material with which catalysts react is the enzyme’s substrate, which fits into a region of the enzyme called the active site. These enzymes are specific due to their active site. This active site will bind with the substrate to form the enzyme-substrate complex. (BIOLOGY p84) This is where the catalysis takes place. When the catalyst is complete the complex dissociates into enzyme and products. Enzymes lower the energy of activation needed for reactions to take place, they accelerate the rate of reactions. However, they do not determine the direction in which a reaction will go. (SYMBIOSIS p59) Enzyme activity is influenced by many factors such as varying environmental conditions, such as pH or temperature. Enzymes have a unique three-dimensional shape which determines which reaction the enzyme catalyzes. (BIOLOGY p84) Changes in the body’s temperature or the pH level may alter the three-dimensional shape of the enzyme or alter its rate of activity. When the shape of an enzyme is changed, this process is called denaturing. Purpose An enzyme is inactivated by a change in its shape, which can be altered by anything that disrupts the pattern of hydrogen bonding. Many enzymes function best within a narrow range of temperature or pH level. Substantial changes in either can disrupt their hydrogen bonds and alter their shape. It is the unique bonding pattern that determines the sensitivity of each enzyme to changes in temperature and pH. (SYMBIOSIS p61) For the purpose of this lab, we will perform three separate experiments to determine how certain enzymes are affected by changes in temperature and pH. Experiment I: The Influence of Enzyme Concentration on the Rate of Starch Digestion Amylase is an enzyme found in the saliva of many animals, including humans. Amylase utilizes starch as a source of food. Amylase is responsible for the preliminary digestion of starch by breaking up the chains of glucose molecules in starch into maltose, which is a two-glucose-unit compound. (SYMBIOSIS p62) Materials and Methods In this experiment, we will investigate the influence of enzyme concentration on the activity of the enzyme amylase. To help us follow the digestion of starch into maltose by salivary amylase, we will take advantage that starch, but not maltose, turns a dark purple color when treated with a solution of Iâ‚‚KI, which is normally yellow-amber in color. (SYMBIOSIS p62) We will vary the concentration of the enzyme amylase to determine that affect, if any, the variation will have on the rate of the reaction. The rate of disappearance of starch in these different concentrations allows a quantitative measurement of reaction rate. (SYMBIOSIS p62) We will begin the experiment by preparing the Amylase dilution. We will number five test tubes. Using the 5ml graduated pipette, we will add 5ml of distilled water to each tube. Using the graduated cylinders, we will then make serial dilutions. To do this we will add 5ml Amylase to tube #1 and mix by rolling the tube between our hands. In tube #2, we will add 5ml of Amylase from tube#1 and mix; then in tube #3, we will add 5ml of Amylase from tube#2 and mix; then in tube #4, we will add 5ml of Amylase from tube#3 and mix; and finally in tube #3, we will add 5ml of Amylase from tube#4 and mix. Then we will rinse the graduated cylinder thoroughly. (SYMBIOSIS p63) Next, we will prepare the experimental test tubes. We will begin by numbering the test tubes 1-5. Beginning with test tube #5 of the first set, we will transfer 2ml of the dilution into tube 5 of the second set using a 5ml pipette. We will rinse the pipette thoroughly with distilled water and repeat the procedure for tubes 4, 3, 2 and 1. After the transfers have been carried out, the first test tube set will not be used again in the experiment. (SYMBIOSIS p63) Now, we will add 1 or 2 drops of Iâ‚‚KI to each compartment of four rows of a spot plate. We will use a separate row for each concentration of Amylase. Using the second set of tubes, we will proceed with the tests beginning with tube 5. Using a clean pipette, one lab partner will add 1ml of the 1% starch solution to tube #5 and mix by rolling the tube between their hands, while the other partner immediately records the time. This time is 0. Then we will remove 21 drop of the mixture with a disposable Pasteur pipette, and add it to a drop of the Iâ‚‚KI in the first compartment on the test plate. Then we will sample the reaction mixture at 10 second intervals, each time using a new compartment of the test plate. We will continue this process until the blue color is no longer produced and the Iâ‚‚KI solution remains its original color (yellow-amber) indicating that all of the starch has been digested. We will repeat the same procedure for tubes 4, 3, 2 and 1. We will finish by recording our findings. (SYMBIOSIS p63-64) Results Experiment II: The Effect of pH on Catalase Activity Catalase is an enzyme that speeds the breakdown of hydrogen peroxide to water and oxygen. Cells of almost all living organisms use Catalase to remove Hydrogen Peroxide, which is a toxic byproduct of metabolism. (SYMBIOSIS p65) In this experiment we will examine the activity of Catalase at three different pH levels. The reaction between Hydrogen peroxide and Catalase products produces tiny bubbles. The more bubbles, the higher the activity. Materials and Methods For this experiment, we will add 1ml of Catalase to three test tubes numbered 1-3. Then we will add 2ml of pH2 buffer to test tube #1; 2ml of pH7 buffer to test tube #2; and 2ml of pH10 buffer to test tube #3. After adding the buffers, we will swirl each test tube and then add a drop of soap to each test tube. Then we will add 2ml of Hydrogen peroxide to each tube and wait 20 seconds. After 20 seconds, we will measure the height of the bubble column. (SYMBIOSIS p66) The research hypothesis is that the pH level of the solutions will affect the height of the bubble column. For the lower pH level, there should be little or no reaction; and as we go higher on the pH scale, the more bubbles we will see. This is due to the enzyme will have been denatured by the lower pH level. Results In test tube #1, there is no reaction within the solution. In test tube #2, the height of the bubbles is 5cm indicating that there is a reaction within the solution. In test tube #3, the height of the bubbles in 15cm, showing that this solution has the highest reaction within the solution. Experiment III: The Effect of Temperature on Rennin Activity Rennin is a protein digesting enzyme found in the lining of the stomachs of young mammals. Newborn babies and infants produce rennin but it is undetectable in adults. The reason is because the purpose of Rennin is to help solidify milk so that it will stay in the stomach and digestive system as a solid long enough to be digested and absorbed. (SYMBIOSIS p68) Chemical reactions, as explained above, accelerate as temperature rises. This is partly due to increased temperatures speeding up the motion of molecules causing the substrates to collide more frequently with enzyme active sites. A 10⠁ ° rise in temperature results in a two to three fold increase in the rate of a particular reaction. However, at higher temperatures, the integrity of proteins can be irreversible denatured. The optimum temperature for activity may vary depending on the structure of the enzyme. (SYMBIOSIS p68) Materials and Methods For this experiment, we will number three test tubes 1-3 and then measure and mark each tube 2 cm from the bottom of each tube with a wax pencil. To tube #1, we will add 4ml of refrigerated milk; however we will add 4ml of warm milk to tube numbers 2 and 3. Then we will add Rennin in different temperatures to each tube. For test tube #1, we will add 3 drops of refrigerated Rennin; for test tube #2 we will add 3 drops of warmed Rennin; and to test tube #3 we will add 3 drops of boiled Rennin. After adding the Rennin, we will place each tube in different temperatures for a total of 15 minutes. We will place test tube #1 in the refrigerator; test tube numbers 2 and 3 will both be placed in a warm water bath. After the 15 minutes have elapsed we will observe any changes in the solutions. (SYMBIOSIS p68-69) The research hypothesis is that the Rennin will react by causing the milk solutions to solidify as they would in the stomachs of infants and small mammals. I hypothesize that the refrigerated Rennin and milk solution will have little, if no, reaction; The warmer Rennin and milk solution will be more solidified than the refrigerated solution; and finally I hypothesize that the solution in which the Rennin was boiled and the milk was warmed will have the highest solidity of the three. (SYMBIOSIS p68-69) Results In test tube #1, we find the milk solution is barely solidified, almost not affected at all. This is due to the fact that the temperature was significantly lower than that of the other solutions causing little reaction with the Rennin. In test tube #2, the milk solution is slightly more solidified than the refrigerated solution. This is due to the fact that the temperature of the milk and Rennin was warmer in temperature causing the solution to react by solidifying. However, giving the solution a warmer environment by being placed in a warm water bath also aided in causing the solution to further solidify. In test tube #3, the milk solution was warm and the Rennin was boiling, therefore causing an almost instant reaction in the solution. However, after being given a warm water bath for 15 minutes it was almost completely solid. Therefore, my hypothesis regarding the affect of temperature on the enzymes is proved correct. Pearson Custom Publishing. SYMBIOSIS: the Benjamin Cummings custom laboratory program for the biological sciences. Boston, Massachusetts 2008. Pearson Education, Inc. BIOLOGY: Concepts Connections. San Francisco, California 2009. What is an Enzyme. Karen DeFelice. 15 April 2006. enzymestuff.com/ Introduction to Enzymes. Worthington Biochemical Corporation. February 2009. worthington-biochem.com/IntroBiochem/default.html Research Papers on Enzymes - Proteins Project Management 101Gap Analysis: Lester ElectronicsMRSA Staph BacteriaDeontological Teleological TheoriesCash or Card?Distance Learning Survival Guide

Should You Get an Early Childhood Education Degree

Should You Get an Early Childhood Education Degree SAT / ACT Prep Online Guides and Tips If you love working with kids, an early childhood education degree might be for you. In this growing field, a bachelor’s degree in early childhood education is becoming more and more necessary to get the job you want. Read on to learn what an early childhood education degree entails, the main differences between an early childhood education associate degree and a bachelor’s degree, and whether you actually need a graduate degree in the field. We’ll also look at the seven best schools offering an early childhood education degree online. What Is an Early Childhood Education Degree? A subset of education theory, the field of early childhood education concerns specifically the education of children from birth to the age of 8, or around third grade. An early childhood education degree could be an associate, bachelor’s, or graduate degree. Its main focus is how to educate young children,with an emphasis on cultural sensitivity, child-centered practices, ethics, inclusivity, community, and family. The overall purpose of an early childhood education degree is to prepare you for a career in early childhood education, whichnormally comprises the following types of jobs: Teacher (preschool, kindergarten, or elementary school) Teacher assistant Daycare provider Childcare center worker or director Nanny Special education teacher English Language Learner (ELL) teacher Child life specialist Education consultant Be aware that for some jobs, especially teaching ones, you might be required by your state toget additional certification or licensure. Below is an overview of the median incomes, job outlooks, and typical minimum required degrees for various jobs in the field of early childhood education. Jobs are arranged from highest salary to lowest. According to the Bureau of Labor Statistics (BLS), the average growth rate for all jobs for the years 2016-2026 is 7%, so any percentage higher than this means the job's growing faster than average. Job Title Minimum Degree Required 2017 Median Salary Job Outlook (2016-2026) Child life specialist Bachelor’s degree $60,380 7% Special education teachers Bachelor’s degree $58,980 8% Kindergarten and elementary school teachers Bachelor’s degree $56,900 7% Social workers Bachelor’s degree $47,980 16% Preschool and childcare center directors Bachelor’s degree $46,890 11% Preschool teachers Associate degree $28,990 10% Teacher assistants Some college, no degree $26,260 8% Childcare workers High school diploma $22,290 7% As you can see from this chart, there’s a clear connection between what kind of early childhood education degree one has and their salary. In general, the more advanced a degree you have, the higher the wages you’re likely to earn. Also of note is that all of the above jobs in early childhood education are seeing average or faster-than-average growth. This indicates that this field is a good one to get into since there will likely be many jobs available over the next decade. Must ... keep ... smiling ... for graduation pictures. Early Childhood Education: Associate Degree vs Bachelor's How does anearly childhood education associate degree differ from a bachelor’s degree in early childhood education? The following table presents a brief overview of the main differences between the two types of degreesin terms of the time it takes to complete each degree, what types of jobs are available to each degree holder, and what the highest median earning potential is (based on BLS data). Time to Complete Degree Options Jobs Available Earning Potential Bachelor’s degree 4 years (regular); 2-3 years (online) BA, BS, BAS, BSE Teacher (special education, kindergarten, elementary school); childcare center director; social worker; child life specialist $60,380 Associate degree 1.5-2 years AA, AS, AAS Preschool teacher; teacher assistant; nanny or other childcare worker $28,990 Since an early childhood education associate degree program is about two years shorter than a bachelor’s degree program, you’ll typically earn half as many credits doing an associate program than you would doing a bachelor's program. Although there's often lots of overlap in the courses required for associate and bachelor’s degree programs, the latter typically requires a lotmore courses that dive deeper into topics such as psychology, human growth and development, and creativity. Do You Need a Graduate Degree in Early Childhood Education? We've gone over the differences and similarities between an early childhood education associate degree and a bachelor’s degree in early childhood education. But is a master’s or doctorate in childhood education necessary for a great job? As you probably noticed with the first table, most jobs in early childhood education don’t require more than a bachelor’s degree. That said, having a master’s or doctoral degree in this or a related field can increase the job opportunities available to you by equipping you with high-level skills, practical experience, and leadership potential. This difference is reflected in wages, too. According to 2013 BLS data, preschool and kindergarten teachers who have a master’s degree can expect to earn about $13,000 more per year than those with only a bachelor’s degree. Here’s what US News says about the value of getting a master’s degree (bold emphasis mine): "Along with an increase in pay, earning a master’s degree in early childhood education can make it possible to pursue high-level occupations in the field, such as elementary school principal or instructional coordinator." So what kinds of graduate degrees in early childhood education are out there? Many, as it turns out. UM-Dearborn offers an MA in Early Childhood Education program, whose three program options are tailored toward "teachers, administrators, other service providers and educators who wish to learn how to serve young children and their families." Meanwhile, BU’s MEd in Early Childhood Education primarily targets aspiring teachers and "is recognized in the field for maintaining high standards for teacher preparation." With a doctorate (usually a PhD or EdD) in early childhood education, your job prospects will extend even further to fields such as postsecondary teaching, policy-making, and research- most of which typically come with higher salaries as well. Noteworthy doctoral programs include Columbia’s EdD in Early Childhood Education, NYU’s PhD in Teaching and Learning with a focus on Early Childhood and Childhood Education, and Vanderbilt’s PhD in Early Childhood Special Education. Ultimately, whether or not you decide to pursue a graduate degree in early childhood education will depend on the type of career you want and how much time and money you’re willing to put toward your education. Getting an Early Childhood Education Degree Online: Top 7 Schools These days, you can earn an early childhood education degree online, making it cheaper and more convenient than getting your degree the traditional way. Here, we introduce, in no particular order, the seven best schoolswhere you can earna bachelor's degree in early childhood education entirely online. University of Nebraska at Kearney The University of Nebraska at Kearney offers an online BA in Early Childhood Inclusive program. This program features not just instruction in early childhood education but also the opportunity for students to gain real work experience and a teaching endorsement. The program focuses on learning about children from birth through the age of 8. Upon completion of this online bachelor’s program, you’ll be able to teach special education to children aged 0-5 and regular education to children through the third grade. University of Massachusetts Amherst UMassOnline offers not one but two online bachelor’s degree programs in early childhood education: a BA in Children’s Learning and Development and a BA in Early Care and Education. In the former, students learn the skills they need to launch a career in education, child advocacy, administration, or youth and family programming. Studentsalso have the option to design their curriculum and bring in credits from prior coursework. The latter is more focused on career advancement within the field of early childhood education, including how to open your own childcare center. University of Cincinnati Through the University of Cincinnati’s College of Education, Criminal Justice, and Human Services, students can earn a BS in Early Childhood Education (Birth to Age 5) completely online. This program mainly prepares students to become teachers at places including preschools, public schools, and childcare centers. By completing this program and student teaching, students should be eligible for faculty recommendation for an Ohio pre-K teaching license. Cincinnati also offers an onlineAAS in Early Childhood Care and Education. This associate degree program provides students with a background in education theory, curriculum development, and early language development. University of Washington Ranked in the top 60 universities by US News, UW offers a fairly flexible online BA in Early Care and Education program. This program- originally called the BA in Early Childhood and Family Studies- is offered both full- and part-time and takes two to three years to complete. You’ll learn about innovative research and educational strategies, and acquire the skills necessary for establishing a career in various related fields, such as teaching, early childhood administration, early learning coaching, and family support. What's more, through the program’s use of the Intentional Teaching Framework, you’ll gain tons of practical experience by observing and working with real early childhood professionals. The only drawback with getting a degree online? You don't get to see the beautiful cherry blossoms on the UW campus. (Joe Mabel/Flickr) Kansas State University Approved by the Kansas State Department of Education, K-State’s online BS in Early Childhood Education program makes students eligible for licensure in early childhood unified (birth through kindergarten). Thecurriculum consists of courses in human development, teaching, family relationships, language development, and early childhood. In addition, the program boasts above-average starting salaries for graduates and a 99% pass rate on licensure exams. University of Dayton At the University of Dayton’s School of Education and Health Sciences, students can earn an online (non-licensure) BSE in Early Childhood Leadership and Advocacy. Unlike the degree programs listed above, which welcome newcomers to the childhood education field, this part-time program caters specifically to experienced early childhood professionals who wish to continue their work in advocating for children and their families. Applicants should have an associate degree in early childhood education or a related field. Courses cover adiverse array of topics, such as American education, how to educate diverse student populations, and early childhood program management. University of Missouri Through Mizzou Online, you can earn a BS in Human Development and Family Science with an emphasis in Early Childhood Education. With this program, students learn how to understand young children’s needs; create supportive, intellectually stimulating educational environments; and promote positive growth. Course topics include curricula-making, classroom environments, and child development. Conclusion: Getting an Early Childhood Education Degree Early childhood education is a growing field, so it’s important that you have the knowledge and credentials needed to get the job you want, whether that’s teaching, coaching, administration, etc. One way of getting credentials is to earn an early childhood education associate degree, which will help you get entry-level jobs and prepare you for a bachelor’s or even a master’s degree in the field should you want to expand your knowledge in the future. Another option is togeta bachelor’s degree in early childhood education.Nowadays, you can earn your early childhood education degree online without having to go anywhere, which can be super helpful if getting to a campus poses a challenge for you. Some online programs evenoffer licensure and teaching certification. There are many online early childhood education degree programs available, but we’ve narrowed down your options to give you a list of seven top schools offering an online bachelor’s degree in early childhood education. Here are the schools again, in no particular order: University of Nebraska at Kearney University of Massachusetts Amherst University of Cincinnati University of Washington Kansas State University University of Dayton University of Missouri Overall, if you want to have a career that involves teaching and helping young children, an early childhood education degree might be the best choice for you! What’s Next? Dreaming of becoming an elementary, middle, or high school teacher? Then check out our career guide to learn how you can prepare for a career in teaching while still in high school. Maybe you already have a bachelor's degree andare now considering grad school. Our expert guide can help you figure out whether amaster's degree is right for you (coming soon). 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Explain the central ideas of the text, paying particular attention to Research Paper

Explain the central ideas of the text, paying particular attention to how the author explores the relationship between film and - Research Paper Example It is no wonder that the issue of racism and colonialism has been covered in cinema numerous times with a further criticism expounded in different literary works. Sundry authors tried to display the problem of racism expressing own attitude to its consequences and influence on political and social sphere of life. Among a long list of such examples, there are Daniel Leab, Donald Bogle, Richard Maynard, Ralph Friar, Lester Friedman and many others who made an attempt to research the rate of veracity in the representation of colonial aspects in cinematography. Despite the fact demonstration of colonised nations contains a high level of distortion and it hardly can be compared to the real events, Stam and Spence (2009) consider that the biggest mistake of all critics is that they tend to forget that films in most cases are invention, fable and fiction. While numerous researchers focus on plot and characters analysing ‘positive images’, it has been found that frequently such images may be accepted as subversive leading to counterproductive effect and spreading racism in spite of their favourable representation and good intentions. The research of Stam and Spence takes into account the effect of sexism and anti-Semitism to provide a study on methodology and analysis on representations of texts. The authors explain the most important definitions such as colonialism, the Third World and racism. Hence, it has been concluded that historically racism evolved from the colonisation process and representatives of racism became those people who suffered from colonisation. Racism by its nature is not only the process of putting standards on values, asserting benefits of some nations and disparaging of other people, but it is a powerful source of scorn, violence, discrimination and crime. The idea to depict colonialism firstly started in literature where subjection of nations was considered as a way to eliminate overall ignorance and tyranny. Glorification of colon ialism can be met in the works of Daniel Defoe, Montaigne and even Shakespeare. The depiction of racism in the films that more often occurred in the beginning of twentieth century showed colonised nations from negative sides, which was not an unpredicted action of European film-makers. According to the research of Stam and Spence (2009), the history has been misinterpreted and falsely represented by cinematography that used to put cliches and unfair images on oppressed people. Numerous errors have been made in Hollywood films that misinform their viewers and change the real events. Hence, the representation of safari as a jungle with beasts of prey or the depiction of the period right after the Second World War without the existence of one single black person can be a good example of such blunders. Due to the conclusions of the authors, the most significant error of films is not the picture of changed stereotypes but the lack of oppressed groups as it happened with the exclusion of blacks on the screen. At the same time, the American musicals with the participations of only black actors were made by white film-makers especially for black audience and also could be accepted as racism since there was a total absence of white actors for saving the fabrication of existed stereotypes. Another wrong tendency that can be noticed in the European and American films is the usage of incorrect language when

SCOTS LAW - commercial law Essay Example | Topics and Well Written Essays - 1250 words

SCOTS LAW - commercial law - Essay Example In the development of Scots law roman principles were used. Law of the roman people gave individuals the right to enjoy certain privileges; in return, the people had a variety of obligations to fulfil. These principles find applications to help solve a variety of court cases in modern day Scotland unlike in England where court decisions are based on past rulings by judges in given cases, often known as common law. Some of the laws in Scotland find their origin from various courts. These could be in England, Scotland and from other courts across Europe. Courts are of great importance in the Scottish legal system as they can amend the law. Another source of Scottish law is lawyers who flourished in the seventeen and eighteen centuries. These lawyers wrote books that set out the precedence on which the Scottish law is based. Most of the principles were originally from the roman laws. Various lawyers who practice law today in Scotland follow and apply these principles to modern day law. The legislature in the United Kingdom makes laws through ‘acts of parliament.’ The laws are taken through the process of legislation; here they are first introduced as bills. From bills, they undergo further amendments until they finally signed into by the queen. Scotland established its own parliament. The government of the United Kingdom delegated some power to the Scottish parliament to make laws. The parliament in Scotland is, however, a minor player as the United Kingdom parliament is still supreme when it comes to legislation function. The right of humans are a fundamental part of life and it is important that they be protected by the law. These rights include the right to private life and the right to express oneself freely. The European Commission on Human Rights put these laws to ensure protection of human rights. Human right law is a significant source of law as all laws made must conform to it. The rights of humans

Personal and Organizational Ethics Essay Example | Topics and Well Written Essays - 2000 words - 2

Personal and Organizational Ethics - Essay Example Values can range from the ordinary places, such as the belief in hard work and  punctuality, to the more psychological, such as self-reliance,  concern for others, and harmony of purpose (Velasquez, 2002). Every human being has personal values that they uphold and maintain as they grow up. These values are quite important in the life cycle of human beings as they define who we grow up to become and they define our future. They also help us develop a relationship with the people around us and in our places of work. The values that we uphold define our character and other people’s perception of who we are. I uphold various personal values which I believed have shaped me to be the person I am today. To start with, respect is my number one value. I believe one need to respect others to be respected. Respect begins with oneself, if you show no respect to yourself, no one will respect you. Secondly, I uphold the value of truthfulness/ honesty. The wise men said that honesty is the best policy and I totally agree with them. I believe if one is truthful and honest in their endeavors, they will always succeed in life. Integrity is another value I maintain, people with integrity are peop le who are respected in the society. They are people who are focused in life with a huge desire in success. I also believe in hard work which is the root of all the best things in life. I also uphold self-reliance and self thinking which form strong driving forces towards attaining my goals. Other values I uphold include selflessness, justice, creativity, discipline, team work, tolerance, trust, kindness, goodness, humility and many others. Every one of us is aggravated to move our lives in certain guidelines. That motivation is determined by the values we pledge to. Our values are thus the creations and ideas of the thought, the distinct formulations of understanding that express what we perceive to be important truths about life. These ideals are then toughened by our

Managing Culturally Diverse Workplaces Essay Example | Topics and Well Written Essays - 1250 words

Managing Culturally Diverse Workplaces - Essay Example Such a tight private schedule may, of course, have consequences for working life. Another aspect of privacy is that Scandinavians are not very extrovert. These unique features of Bosnian employee sallow to say that Ado and his wife Alen require speicla programs and attention of supervisor (Barham and Conway 1998). The main problems faced by people in Bosnia are unstable political situation and cultural diversity (racism) caused by national differences between Bosnia and Herzegovina. Nationalism and civil war state cause people to be suspicious and distrustful. Bosnia suffers from economic crisis and high inflation rates, social and political instability, poverty and low quality of healthcare services. Coming to Brisbane, it is difficult for Ado and his family to adapt to new environment and overcome cultural shock (Brislin, 1993). Bosnian manager is not supposed to publicly reveal his or her feelings - and if he or she does, it should be separated from 'objective' and 'rational' decisions (Brislin, 1993). This means, among other things, that Bosnians are commonly described as 'serious. Bosnian businesspeople describe themselves, among other characteristics, as serious; sensible and silent. The Bosnian disposition to reasonableness, tolerance compromise and modesty also has a negative aspect in that some would argue that a person can discern forces that might work against initiative, risk-taking and, in extension, keep down entrepreneurialism (Bartlett and Ghoshal 1999). 2. The main strategies which would help Ado and his family to overcome cultural shock are cross cultural participation and a special plan for career opportunities, attention to need of the family and relocation assistance. A few minutes of "small talk" can often reduce the stress. Effective administrators know when to slow the pace and talk about nonthreatening subjects. However, not even the most tactful administrators always succeed in establishing trust. A small number of minority approach managers and supervisors in ways that are outright defensive--they use profanity and behave indiscreetly. Such defense mechanisms do not usually reflect faulty personalities. Rather, protection of the ego is normal; but a disproportionate use of defenses indicates a lack of security. Culturally different workers, particularly ethnic minorities, seek to maintain their psychological balance during times of stress in several ways, such as by rationalizations, reaction formation, overcompensation, o r projection. People who believe they are members of an underclass or out-group often develop rigid, persistent, and chronic ego-protection devices (Brake et al 1995). The major determining factor is the quality of interaction among people. The first step in establishing rapport with minority workers is to help them relax. To do so, the administrator must be relaxed. A special attention should be given to accommodation and food of Ado and his family. A company can advise Ado where to buy special food and how to behave in new environment. It is important to familiarize Ado with new cultural traditions and organizational culture, value

Wollstonecraft discussion Essay Example | Topics and Well Written Essays - 250 words - 1

Wollstonecraft discussion - Essay Example This makes them as much rational beings as men are. Today, there are numerous women who do not rely on their appearance for survival. They have infiltrated professionals and careers that would have once been considered impossible for women. This has been made possible thanks to education. Although women are better empowered today than they were a few centuries ago, there is still a considerably huge percentage of the society that still regards the woman as a sex object. Unlike during Wollstonecraft’s days, education cannot be blamed for this misconception about women. Contemporary media and general socialization has more to do with it. There are those women who still consider themselves rationally inferior because the media likes to portray women that way. These women find strength in expressing themselves through their appearance. The good thing is that this kind of thinking is slowly fading as more women become involved in affairs of society. The education system is greatly helping in instilling the idea that women and men are both capable of rational though at the same

Best Assessment Strategies in Secondary Schools Essay

Best Assessment Strategies in Secondary Schools - Essay Example Interactive assessment in the classroom assumes special significance at the secondary level as students need constant feedbacks for the learning activities they undertake. There should be regular assessment at the secondary level. This is rightly suggested by E.C. Wragg when he remarks: " In most of the class rooms, assessment tends to be regular and informal, rather than irregular and formal. This is because teaching often consists of frequent switches in who speaks and who listens, and teachers make many of their decisions within one second." (Wragg, 2001). The purpose of this paper is to analyse critically the best assessment strategies in secondary schools. Interactive assessment, coherent assessment systems, self assessment, peer assessment, and feedback are identified as the most effective strategies in the assessment of the learning outcomes of secondary students. The teaching-learning process is highly interactive and assessment during each stage of the interaction is an essential prerequisite for effective learning process. ... One of the major advantages of the interactive assessment is that it creates a strong conviction in the minds of the learners that they are an active part of the instructional process and that their views and thoughts are being taken into account. This can provide them with better confidence to take part more enthusiastically in the teaching learning process. A remarkable study conducted by Eichorn, D. & Woodrow, J. (1999) "indicate that the use of interactive assessment promotes student self-monitoring, goal setting, time management, responsibility and mastery learning. Teachers report that the use of interactive assessment facilitates and supports student-centred, instructional practices." (Eichorn & Woodrow, 1999, P.193-199). Celina Byers (2001) also believes that the teacher has to measure and evaluate whether all the instructional objectives have been achieved and how far learning has taken place is to be assessed. She is of the opinion that there should be a learner centred act ive assessment in the classroom itself :- "Making the measurement an integral part of class activity allows the identification of problems and consequent improvements even while the course is ongoing. Learner-centred active assessment both provide direct objective measurement of learning and stimulate the use of holistic assessment tools to assess the entire learning environment." (Byers, 2001). For her assessment in the secondary school should never be limited to mere summative evaluation. Instead, there should be interactive assessment in the class room as "it permits important course improvements, made in conjunction with the collaboration of the students themselves, while the course is ongoing.

Wollstonecraft discussion Essay Example | Topics and Well Written Essays - 250 words - 1

Wollstonecraft discussion - Essay Example This makes them as much rational beings as men are. Today, there are numerous women who do not rely on their appearance for survival. They have infiltrated professionals and careers that would have once been considered impossible for women. This has been made possible thanks to education. Although women are better empowered today than they were a few centuries ago, there is still a considerably huge percentage of the society that still regards the woman as a sex object. Unlike during Wollstonecraft’s days, education cannot be blamed for this misconception about women. Contemporary media and general socialization has more to do with it. There are those women who still consider themselves rationally inferior because the media likes to portray women that way. These women find strength in expressing themselves through their appearance. The good thing is that this kind of thinking is slowly fading as more women become involved in affairs of society. The education system is greatly helping in instilling the idea that women and men are both capable of rational though at the same

Measuring Success for Riordan Essay Example for Free

Measuring Success for Riordan Essay With the goal of realizing sustainability for the shareholders, Riordan Manufacturing is working towards a growth strategy that will further expand operations globally. Expansion of business outside of the United States and Hangzhou, China will help Riordan gain brand recognition and claim greater market share within their industry. Global operations will also help to streamline shipping processes to overseas customers, and reduce wasted hours and expenditures. With a strategy drawn up and the implementation ready to begin, Riordan Manufacturing needs to realize that progress needs to be tracked. Certain measurement techniques and assessment protocols should be in place to verify that the strategy is implemented properly. In this paper measurement guidelines will be given that will verify strategy effectiveness, assessment and feedback ideas will be outlined, and plans for strategy alterations will be defined. The evaluation and control process ensures that the company is achieving the desired goals and objectives that it is set out to accomplish. In order to setup the most appropriate evaluation process, there are many guidelines for measurement that should be considered. Cost effectiveness, relevance, and validity are attributes that should be considered when measuring outputs and outcomes. A measure is cost effective is the control and information it provides outweighs the cost of producing the data (Governor’s Office of Budget and Planning and Legislative Budget Board, 1992). The measure should also be relevant in that it relates to the company’s goals, objectives and strategies. This information should be used for assessment and decision making as well. In regards to validity, the measure should collect all information that directly relates to the scope of the process or project. All other non relevant information should be filtered and discarded to achieve the results intended. The management team of Riordan Manufacturing needs to determine the specific implementation process to be used and what results will be monitored and evaluated. In addition, the management team will be responsible for setting standards of performance used to measure performance that are detailed expressions of strategic objectives (Wheelen Hunger, 2010). Return on investment (ROI) and earnings per share (EPS) are considered to be appropriate measures that Riordan Manufacturing should use in order to determine if the company is reaching their profitability objectives. These measures are limited in that they do not display real time information and instead focus upon what has already happened. In order to combat this, steering control are used to measure variables that influence future profitability (Wheelen Hunger, 2010). Since Riordan Manufacturing is looking to increase the effectiveness of its customer service, customer satisfaction should be used as one of the company’s steering controls. Customer satisfaction can be measured through scores on the American Customer Satisfaction Index (ACSI) or through of process of comparing the total amount of sales with the amount of customer service requests and the time spent dealing with the customer’s problem. This measurement will have a direct impact upon the quarterly profits of the company.

Factors Affecting Antipsychotic Medication Compliance

Factors Affecting Antipsychotic Medication Compliance INTRODUCTION The aim of this dissertation is to explore the factors affecting concordance with prescribed antipsychotic medications. The rationale for selecting this topic is derived from personal working experience with mental health service users. Having worked as a nursing assistant for the past eight years on acute admissions wards and as a student nurse for the past three years it was observed that a large proportion of compulsory re-hospitalisation under the Mental Health Act 1983 occurs due to relapse of mental illness as a result of non- concordance with medications, particularly service users with a diagnosis of schizophrenia. This led to believe that concordance with antipsychotic medications plays a crucial role in managing psychosis as it positively contributes towards the effective management of the illness in the community. In support to this view, Gray et al (2002a) assert that prophylactic use of antipsychotic medication reduces the risk of relapse among individuals with schizophr enia and non-concordance with medication has the potential for frequent re-hospitalisations. This has been recognised as the revolving door syndrome. During most mental health placements it was noted that non-concordance with medication has become significant, as this has been identified as a risk factor within the risk assessment checklist. Furthermore, despite the well-documented therapeutic effect of antipsychotic medications, some patients are reluctant to accept treatments and some may even wish to cease taking medications altogether. Therefore, this empirical knowledge has reinforced the desire to examine the factors associated with non-concordance with antipsychotic medications. According to Brimblecombe et al (2005) medication is one of the major therapeutic tools available to help people with schizophrenia. There is also growing evidence that schizophrenia can be treated effectively with a range of psychological and social interventions together with antipsychotic medications. Norman Ryrie (2004) emphasised that antipsychotic medication has been the mainstay of treatment for schizophrenia since the 1950s when it was discovered that the dopamine antagonist haloperidol and chlorpromazine exerted antipsychotic effects. The National Institute for Clinical Excellence (NICE) (2002) recommends that atypical antipsychotic drugs such as amisulpride, aripiprazole , olanzapine, quetiapine or risperidone must be considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia or to promote recovery for those who have experienced unacceptable side-effects on conventional antipsychotics, as atypical antipsychotics appear to have less extrapyramidal symptoms (side effects) than the conventional antipsychotics such as haloperidol and chlorpromazine. The care and treatment of individuals with schizophrenia have advanced considerably over the past ten years, since the introduction of atypical antipsychotics and medication continues to be the first line treatment for schizophrenia (Walker MacAulay, 2005). However, Gray et al (2002b) claim that despite the effectiveness of these atypical antipsychotic drugs, non- concordance with prescribed antipsychotic medications is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. In addition, Mitchell Selmes (2007) claim that over the course of a year, about 75% of patients will discontinue prescribed antipsychotic medications, often coming to the decision themselves and without informing a health professional. According to Gray et al (2006) relapse rates is five times higher among individuals with schizophrenia, who are non-concordance with medication compared with concordance. Non-concordance during acute treatment of psychosis le ads to chronic symptomswhereas non-concordance after remission increases the risk ofrelapse and both may have serious consequences; re-hospitalisation (Hamer Haddad, 2007). Furthermore, the impacts of non-concordance with medication not only affect the individuals with schizophrenia, as each relapse causes a stepping down of cognitive functioning which is rarely retrieved but also their carers and the costs of treatments (Institute, 2007). To facilitate this project as a literature review, an analysis of secondary sources only will be use. Secondary sources were mainly obtained from nursing journals such as Nursing-Standard, Nursing-Times, Advances in Psychiatric Treatment, Mental health practice, Schizophrenia Bulletin and The British Journal of Psychiatry, containing the key words: schizophrenia, oral antipsychotic, medication management and non-concordance. An Internet search of Google was also done with the same keywords to access any relevant documents. To address the factors affecting concordance with prescribed antipsychotic medications, these will be divided into patient-related factors, medication-related factors and clinician-related factors. LITERATURE REVIEW According to White (2007) schizophrenia is a debilitating psychiatric disorder characterised by a range of positive and negative symptoms and these symptoms were first described in detail by the British neurologist Hughlings-Jackson in the late 1800s. There is no physical test for schizophrenia rather it is diagnosed by the presence of certain positive and negative symptoms over a period of time (Brennan, 2001). According to Issacs (2006) the neurotransmitter hypothesis suggests that the dopamine over activity in the mesolimbic dopamine pathway, which is between the midbrain, is thought to cause the positive symptoms of schizophrenia and dopamine under activity in the mesocortical dopamine pathway is thought to result in the negative symptoms of schizophrenia. Positive symptoms represent a distortion of normal experience, such as delusions, hallucinations and thought disorder, whereas negative symptoms represent a loss or dimming of normal function and social norm, such as avoidance of social interactions (Baker, 2003). There are different types of schizophrenia such as paranoid, disorganised, catatonic, undifferentiated and residual (Issacs, 2006). However, Gillam (2002) claimed that the exact causes of schizophrenia remain unclear but genetic, environmental and social factors are all thought to influence its development. The risk for a child to develop schizophrenia is 46%, if both parents have the disorder (Kirk et al, 2006). Women who have certain viral illnesses during their pregnancy may be at a greater risk of giving birth to children who later develop schizophrenia and the 1957 influenza A2 epidemics in England resulted in an increase in schizophrenia in the offspring of women who developed this flu during their pregnancy (Frankenburg, 2007). 1 in 100 UK populations will develop schizophrenia in their lifetime and the world prevalence is about 2-4 in 1000, as it affects men and women equally (Rethink, 2008). However, the onset in men is about five years earlier than women with the peak age of incidence is between 16 and 25 and the presentation of the illness varies tremendously, not only between individuals, but also within the same individual at different stages of their illness (Magorrian, 2007). Schizophrenia seems to be more common in city areas and in some ethnic minority groups and premature mortality in people with schizophrenia is 2 to 3 times higher than that in the general population (Royal college of Psychiatrists 2008). The premature mortality might be due to poorer health care, physical health, unhealthy lifestyles and people with schizophrenia may be at greater risk of type 2 diabetes as a result of antipsychotic medications (Nash, 2005). Moreover, according to WHO (2008) schizophrenia is a treatable disorde r but many individuals remain untreated regardless of effective treatments. There has been an unresolved debate about how best to define patients engagement with medications and until the 1980s most work on patient engagement with medications regimes was described as compliance (Norman Ryrie, 2004). The term compliance is often used interchangeably with adherence or concordance (Snelgrove, 2005). According to Kikkert (2006) the term compliance has fallen out of favour in clinical practice because it carries an assumption that patients are the passive recipients of clinicians and implies unquestioning obedience with no opportunity for patients choice. To add to the complexity of this term, patients can be intentionally or unintentionally non-compliant such as a deliberate decision not to comply with treatment and patients may have misunderstood the guidance that they have been given or unable to open the medication container. Velligan et al (2006) claimed that in recent years there has been a shift from this paternalistic model of doctor-patient interactions with the consequent preference for the use of the term adherence. However, while adherence emphasises negotiation between clinician and patient, it still implies a degree of passivity and obedience (Snelgrove, 2005). Gray et al (2002b) assert that concordance may be a more acceptable term as it suggests a collaborative process of decision-making regarding medications regimes and acknowledges the importance of the two-way communication. The NHS Plan (2000) emphasises the importance of placing patients at the centre of services and the transformation of patients into consumers of the health service has changed the context of health care, as patients are expected to become more active and informed about their treatments (Jasper, 2006). Murray et al (2007) emphasise that shared decision-making between clinicians and patients has the potential to improve concordance with treatment plans. Furthermore, The Chief Nursing Officers review of mental health nursing (2006) recommends that building and maintaining positive interpersonal relationships with service users is essential to successful mental health nursing practice and person-centred values is helpful in building positive relationships. This indicates that by not agreeing to health professionals advice patients may be labelled as non-compliant. Nonetheless, compliance could also be problematic, for example if patients continue to take medication obediently, although it is causing adverse side effects. However, from the empirical knowledge the term compliance is still being used in clinical settings despite the paternalistic conception. Therefore, the term concordance is favoured here as it promotes the idea that medication treatment should be a collaborative process between clinicians and patients, which emphasises the patients rights. Ultimately, the term concordance corresponds with the current ethos of modern mental health care set out in the National Service Framework (1999), the NHS Plan (2000) and the Chief Nursing Officers review of mental health nursing (2006), which is concerned with working in partnership with patients and carers. However, according to the term concordance patients have the right to make t reatment decisions, for example, stopping medication even if health professionals do not agree with that decision. For decades researchers have worked to explain the causes of non-concordance with medication unfortunately there have been no valid way of measuring concordance (Velligan et al, 2006). Rates of concordance have been measured by using the subjective and objective methods. Subjective method includes patients` self report and direct interviews, although this method is less expensive, it tends to overestimate the degree of concordance, as patients may not admit non-concordance (Gray et al, 2002b). Snelgrove (2005) claims that objective method such as blood and urine analysis also pose problems as they do not account for individual metabolism and do not reflect inconsistencies in concordance over time. Moreover, from empirical knowledge blood test is effective in monitoring concordance with mood stabilisers such as lithium, but for schizophrenia it is the manifestation of symptoms can support the evidence of non-concordance. According to Gray et al (2002b) pill counts are more reliable, b ut it is impossible to tell whether patients have actually ingested the medication. Even expensive objective method such as electronic monitoring which records every occasion that a pill bottles is opened can also be problematic when patients choose not to swallow the medication that was removed or do not replace the caps and electronic prescribing is still fallible, just because medication is available does not mean that it is taken (Velligan et al, 2006). One of the major clinical problems in the treatment of people with schizophrenia is partial or complete non-concordance with medication and this limits the clinical effectiveness of the prescribed medications (Kikkert et al, 2006). Antipsychotics medication can only be effective if they are taken continuously over a sustained period of time (Norman Ryrie, 2004). Urquhart (2005) claims that partially concordant patients can be difficult to identify because they do not actively refuse to take their medication but the dosage deviations for different reasons and this may only be detected when psychotic symptoms re-emerge. Partial concordance creates significant problems for the treating physician as it creates difficulties in determining whether medications are working adequately, dosing is appropriate or concomitant medication is needed (Velligan et al, 2006). Therefore, this indicates that medication or dosage changes and the addition of concomitant medications are more likely to occu r among patients who are not fully concordant with prescribed medications. Non-concordance with prescribed medication is believed to be a significant factor to increasethe probability of relapse in patients with schizophrenia and relapse is one of the most costly aspects of schizophrenia (Almond et al, 2004). Knapp et al (2004) undertook a study of 658 patients receiving antipsychotics medication of whom 20% reported non-concordance with prescribed medication and concluded that non-concordance was one of the most significant factors in increasing service costs, predicting an excess annual cost per patient of  £2500 for inpatient services and an overall additional cost of  £5000 for total service use. In addition, Almond et al (2004) estimated that costs for relapse cases are four times higherthan those for non-relapse cases. Therefore, these two studies show that relapse in patients with schizophrenia as a result of non-concordance isa major factor in generating high hospitalisation rates and costs. This implies that patients who do not concord with the ir medication are likely to requiremore treatment and support from a range of services and given the high costs associated with relapse non-concordance is a key factor in the use ofin-patient and external services. Antipsychotic medication has proven efficacy in the treatment of schizophrenia and the prevention of relapse. In spite of vast evidence that antipsychotics can be effective in treating the symptoms of schizophrenia, almost 90% of patients will relapse within the first five years of treatment following an acute episode and in general the illness has a tendency to recur or become chronic (Velligan et al, 2006). According to White et al (2007) non-concordance with drug therapy is common in schizophrenia; approximately 50% of patients are non-concordant within one year and 75% within two years after being discharged from hospital. Such high rates of non-concordance with medication may initially seem alarming (Gray et al, 2002b). However, it is similar with other conditions such as asthma where maintenance treatment is required. A study of concordance with asthma medication conducted by Newell (2006) estimated that 70 % of asthma patients in the UK are non-concordant with medication and t he levels of non-concordance in long-term conditions, such as asthma are known to be high as many asthma sufferers will only take medicine when they feel they need it rather than as instructed by clinicians. Therefore, considering the Newell (2006) findings it can be argued that the rates of non-concordance with antipsychotics are not significantly different than those on non-psychiatric medications and the myth that non-concordance with medication is more common among mental disorders as compared to physical disorders needs to be dispelled. Several factors have been shown to increase the chance of relapse but probably the single most important cause of relapse is the discontinuation of effective antipsychotic medication regime. A large number of factors influence non-concordance with prescribed antipsychotic medications, however Gray et al (2002b) have identified the main factors as impaired judgement, negative beliefs about treatment, poor worker-user relationship and the side-effects of medication. Additionally, Kikkert et al (2006) conducted a study in four European countries exploring medication adherence in schizophrenia and identified insight, beliefs about treatment, side effects and treatment efficacy as factors that influence concordancewith medication in patients with schizophrenia. Urquhart (2005) suggests that the problem of non-concordance may be more prevalent among those with schizophrenia due to its nature, for example, lack of insight. Magorrian (2007) claimed that non-concordance with medication is often linked to the persons level of insight into his or her illness and lack of insight is a frequent concomitant of psychosis. In schizophrenia, insight has been defined as an awareness of illness and an ability to recognise symptoms as part of an illness (Gray et al, 2002b) According to Surguladze David (1999) between 50% and 80% of patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder and these individuals are often difficult to engage with treatments due to impaired insight. Recent conceptualisation has formulated insight as a continuum representing the combination of three factors; awareness of illness, need for treatment and attribution of symptoms. Lack of insight is continuously problematic but an emotional element can be associated with denial of symptoms or rejection of treatment at key points in the illness (Byrne, 2000). Mitchell Selmes (2007) claim that having a perception about the illness and the knowledge of medications are the key factors of concordance in mental health and patients who understand the purpose of the prescription are twice more likely to collect it than those who do not understand. A study by Cuesta et al (2000) reported that patients suffering from schizophreniashowed poorer insight than patients with affective disorders. Cuesta et al (2000) findings demonstrated that the severe disturbances of insight persisted over the time and the level of insight was not significantly improved in patients suffering from functional psychosis as between 29% to 49% of these patients continued to have fair to poor insight at the follow up assessment. This is consistent with the findings of Kikkert et al (2006), where poor insight was a strong predictor of non-concordance with medication. In contrast, Tait et al (2003) conducted a study to examine changes in insight and symptoms of psychosis on fifty participantswho met the ICD—10 diagnostic criteria for schizophrenia. The participants were interviewed and insight was measured duringacute psychosis using the Insight Scale with the score 0- 12 and all the participants were reinterviewed at 3 and6 months following the init ial interview. Tait et al (2003) findings indicated that duringthe acute episode, 48% of participants scored 9-12 on the InsightScale and the majority of participants (63%) werein the 9-12 range of scores. The study of Tait et al (2003) clearly indicated that level of insight was high among many participants. In considering the findings of both Cuesta et al (2000) and Tait et al (2003) it appears that some patients with psychosis are unaware of their illnesses and insight is a strong predictor of concordance with medications and a good indicator of prognosis. However, evidence for a relationship between insight and concordance with treatment is inconclusive as the discrepancies found between the two studies might be due to the methodological factors, such as selection of participants. In both studies all the participants had a diagnosis of schizophrenia and all of them gave informed consent to enter the study. According to Appelbaum (2006) several studies in America regarding the decisional-capacity of patients with schizophrenia to consent or participation to research have raise some concerns due to the cognitive impairments associated with schizophrenia and using the MacArthur Competence Assessment Tool for Clinical Research clearly indicated that patients with schizophrenia do lack und erstanding and reasoning of research ethics. McCann Clark (2005) emphasise that antipsychotic medications some of which have a sedating effect can also have an impact on the cognitive processes, such as illogical thinking and this can hinder the quality of responses. Moser et al (2005) argued that some studies have shown that a high percentage of individuals with schizophrenia have adequate decisional capacity to consent to research participation, however in a medication-free schizophrenia research, participants did not show a major decline in decisional capacity. In addition, Jeste et al (2006) claimed that there is a risk in assuming that decision-making capacity of individuals with schizophrenia is always impaired, when they are capable to make autonomous decisions and in considering their decision-making capacity as permanently impaired by virtue of their diagnosis. Consequently, in order to investigate factors associated with schizophrenia, it can be argued that only individuals with schizophrenia can provide the answers of their experiences and protecting vulnerable populations from research activity can also exclude them from its benefits. According to Gerrish Lacey (2006) there two key concepts that concern the quality of a research: validity and reliability. Roberts et al (2006) define reliability as how far a particular test will produce similar results in different circumstances, whereas validity is to ascertain the methods are actually measuring what is intended to measure. Both Cuesta et al (2000) and Tait et al (2003) had used structured interviews to gather the data and have chosen a quantitative approach. Structured interview provides the opportunities to change the words but not the meaning of the questions thus, Parahoo (2006) claimed that validity is enhanced because participants can be helped to understand the questions and interviewers can ask for clarifications and probe for further responses, if necessary and since all the questions are ideally asked in the same way, structured interview has a high degree of reliability. It seems that both Cuesta et al (2000) and Tait et al (2003) have adopted the appropriate approach to their research, as quantitative research is the conduct of investigations primarily using numerical methods. It infers that to examine correlations between insight and service engagement qualitative approach could not have produced the same data in this area of study. Moreover, in both studies purposive sampling were used as all the participants had a diagnosis of schizophrenia. According to Polit Beck (2006) all participants in a phenomenological study must have experienced the phenomenon under study and must be able to articulate what is like to have lived the experience. Johnson Orrell (1996 cited in Surguladze David, 1999 P 166) have argued that some patients may have their own explanations of their illnesses, such as religion or cultural beliefs which may not coincide with the Western medical model of mental disorders and this can be even more complicated if one tries directly to impose the models of insight on patients from non-Western cultures. Gamble Brennan (2006) claimed that different cultures in England perceive mental illness in different ways and this can have an impact on treatments as some cultures rather seek help from religious leaders than mental health services. Alternatively, religion or spiritual beliefs in the Western culture can have a positive impact on concordance with medication, as religious individuals with schizophrenia have a better social support compare to non-religious individuals with schizophrenia (Borras et al, 2007). Therefore, it can be put forward that awareness of illness is a crucial factor in the motivation to receive pharmacological treatment. Both cultures and religion can have a positive and negative influence on concordance with antipsychotics. Patients can have different levels of awareness into their illness and they may consciously or unconsciously avoid acknowledging that they are suffering from mental health problems because of their reluctance to bear the stigma of mentally ill (Surguladze David, 1999). Byrne (2000, p65) defined `stigma as a sign of disgrace or discredit, which sets a person apart from others and the stigma of mental illness although more often related to context than to a persons appearance, remains a powerful negative attribute in all-social relations`. Stigma of mental illness has become an indication for unpleasant experiences, such as bringing shame to the family or social exclusion. According to Phillips et al (2002), in some parts of china, schizophrenia is still considered as a punishmentfor an ancestors misbehaviour or for the familys currentmisconduct and the effect of stigmais greater if the patient had more prominent positive symptoms or highly educated. Moreover, a study by Lee et al (20 05) concluded that 60 % out of 320 patients with schizophrenia had experienced interpersonal stigma from p arents, siblings or close rel atives. This indicates that people with schizophrenia are more likely to experience stigma from family members than the general public. Having a diagnosis of schizophrenia does not only affect ones health but also carries all the prejudice, discrimination and social exclusion, for example many individuals are attacked on the streets, rejection in the society and denial of employments because they were known to have mental health problems (Gamble Brennan, 2006). According to Byrne (2000) in two identical UK public opinion surveys, 80% of participants claimed that most people are embarrassed by mentally ill people and about 30% agreeing `I am embarrassed by mentally ill persons`. There is also evidence that supports the concepts of stereotyping of mental illness. The power and influence of the media on mental illness has been a key issue of debate over many years as people with schizophrenia are frequently portrayed as violent and dangerous. In contrast, people with schizophrenia are more likely to be dangerous to themselves than to others, while the greater danger to the public is posed by people without mental health problems and people with mental health problems are six times more likely than the general public to be the victims of murder (Stickley Felton, 2006). Moreover, Gamble Brennan (2006) claimed that when the boxing champion Frank Bruno was admitted to hospital in 2003, one of the newspaper headlines was `Bonkers Bruno locked up`. This indicates that stigma has the grave potential to cause reluctance to seek treatments and this can be detrimental to the persons health. Therefore, as a mental health clinician, it will be vital to assist people wit h mental health problems to rebuild their lives and this requires moving beyond the traditional focus on symptoms and medication by exploring alternatives in reducing stigma of mental health that avert people from social inclusion. It has been predicted that families with high expressed emotion compared to low expressed emotion can contribute towards the relapse rate in symptoms of schizophrenia and this can also be a triggering factor for non-concordance with medication. High expressed emotion carers appear to perceive their caring situation as more stressful and this could be conceptualised as a catastrophic appraisal of the role of caring (Raune et al 2004). Kuipers et al (2006) identifies the components of expressed emotion as emotional over-involvement, hostility, critical comments, warmth and positive remarks. A study by Kuipers et al (2006) indicates that patients whose carers showed high expressed emotion had considerably higher levels of anxiety and lower self-esteem due to the components of expressed emotion. However, a significant amount of data from western cultures suggests that high expressed emotion subjects who were not on medication are three times likely to relapse than those who were on medic ation (Bhugra McKenzie, 2003). This clearly signifies that despite being concordant, high expressed emotion subjects are vulnerable to relapse. The interactions between patient and the carers are crucial, especially cross-culturally as in some cultures for example, in some parts of India, emotional over-involvement is the norm and if carers do not show emotional over-involvement, this can be seen as lack of care (Bhugra McKenzie, 2003). Hashemi Cochrane (1999) conducted a study in UK on expressed emotion and they observed that 80% of the British Pakistani, 45% of the White and 30% of the British Sikh families exhibited high levels of expressed emotion and emotional over-involvement was notably higher among the British Pakistani group. The findings concluded that White patients with high expressed emotion relatives were significantly more likely to relapse than those from low expressed emotion families, whereas for both Asian groups high expressed emotion did not predict relapse. The study of Hashemi Cochrane (1999) also indicated that that Pakistani families in the UK were more likely to be rated as high expressed emotion than White families, indicating that components such as emotional over-involvement may be cultural rather than pathogenic traits. Conversely, low expressed emotion families who are not over-anxious in their response to the patients illness may tend to perceive stigma in less threatening ways whereas, families with high expressed emotion, who respond to the patients illness in a highly anxious may experience stigma more intensely (Phillips et al 2002). Therefore, it appears that family members levels of expressed emotion could influence their perception and response to stigma of mental health and concordance with medication is essential for patients irrespective of the expressed emotion status in the family. Thus, family interventions need to improve in order to lower the levels of anxiety and to increase self-esteem among families with hig h expressed emotion. As a clinician it will be vital to acknowledge the cultural aspect of expressed emotion status in the family to facilitate concordance with medication. There is overwhelming evidence for patients with schizophrenia, who misuse illicit drugs and alcohol to have an increased rate of re-hospitalisation (Sokya, 2000). According to Barnes et al (2006) the higher relapse rate in people with established schizophrenia who usesubstances may be partially explained by non-concordant tothe medication regimen. Evidence suggests that the substance used most frequently by people with schizophrenia is cannabis (Gamble Brennan, 2006). Arseneault et al (2004) emphasise that rates of cannabis use in UK are higher among people with schizophrenia than among the general population and patients detained under the MHA (1983) have even higher rates of lifetime use of cannabis. Substance misuse in schizophrenia may be explained as a form of self-medication to alleviate the symptoms of schizophrenia, to improve the side effects of antipsychotics and to respond to social pressures (Sokya, 2000). There has been little evidence to support the self-medication hypothesis despite its popularity with users and in contrast, substance misuse can aggravate the symptoms of schizophrenia and can also trigger psychotic episode particularly in people with a pre-exis Factors Affecting Antipsychotic Medication Compliance Factors Affecting Antipsychotic Medication Compliance INTRODUCTION The aim of this dissertation is to explore the factors affecting concordance with prescribed antipsychotic medications. The rationale for selecting this topic is derived from personal working experience with mental health service users. Having worked as a nursing assistant for the past eight years on acute admissions wards and as a student nurse for the past three years it was observed that a large proportion of compulsory re-hospitalisation under the Mental Health Act 1983 occurs due to relapse of mental illness as a result of non- concordance with medications, particularly service users with a diagnosis of schizophrenia. This led to believe that concordance with antipsychotic medications plays a crucial role in managing psychosis as it positively contributes towards the effective management of the illness in the community. In support to this view, Gray et al (2002a) assert that prophylactic use of antipsychotic medication reduces the risk of relapse among individuals with schizophr enia and non-concordance with medication has the potential for frequent re-hospitalisations. This has been recognised as the revolving door syndrome. During most mental health placements it was noted that non-concordance with medication has become significant, as this has been identified as a risk factor within the risk assessment checklist. Furthermore, despite the well-documented therapeutic effect of antipsychotic medications, some patients are reluctant to accept treatments and some may even wish to cease taking medications altogether. Therefore, this empirical knowledge has reinforced the desire to examine the factors associated with non-concordance with antipsychotic medications. According to Brimblecombe et al (2005) medication is one of the major therapeutic tools available to help people with schizophrenia. There is also growing evidence that schizophrenia can be treated effectively with a range of psychological and social interventions together with antipsychotic medications. Norman Ryrie (2004) emphasised that antipsychotic medication has been the mainstay of treatment for schizophrenia since the 1950s when it was discovered that the dopamine antagonist haloperidol and chlorpromazine exerted antipsychotic effects. The National Institute for Clinical Excellence (NICE) (2002) recommends that atypical antipsychotic drugs such as amisulpride, aripiprazole , olanzapine, quetiapine or risperidone must be considered in the choice of first-line treatments for individuals with newly diagnosed schizophrenia or to promote recovery for those who have experienced unacceptable side-effects on conventional antipsychotics, as atypical antipsychotics appear to have less extrapyramidal symptoms (side effects) than the conventional antipsychotics such as haloperidol and chlorpromazine. The care and treatment of individuals with schizophrenia have advanced considerably over the past ten years, since the introduction of atypical antipsychotics and medication continues to be the first line treatment for schizophrenia (Walker MacAulay, 2005). However, Gray et al (2002b) claim that despite the effectiveness of these atypical antipsychotic drugs, non- concordance with prescribed antipsychotic medications is observed in around 50% of people with schizophrenia and is a major preventable cause of psychiatric morbidity. In addition, Mitchell Selmes (2007) claim that over the course of a year, about 75% of patients will discontinue prescribed antipsychotic medications, often coming to the decision themselves and without informing a health professional. According to Gray et al (2006) relapse rates is five times higher among individuals with schizophrenia, who are non-concordance with medication compared with concordance. Non-concordance during acute treatment of psychosis le ads to chronic symptomswhereas non-concordance after remission increases the risk ofrelapse and both may have serious consequences; re-hospitalisation (Hamer Haddad, 2007). Furthermore, the impacts of non-concordance with medication not only affect the individuals with schizophrenia, as each relapse causes a stepping down of cognitive functioning which is rarely retrieved but also their carers and the costs of treatments (Institute, 2007). To facilitate this project as a literature review, an analysis of secondary sources only will be use. Secondary sources were mainly obtained from nursing journals such as Nursing-Standard, Nursing-Times, Advances in Psychiatric Treatment, Mental health practice, Schizophrenia Bulletin and The British Journal of Psychiatry, containing the key words: schizophrenia, oral antipsychotic, medication management and non-concordance. An Internet search of Google was also done with the same keywords to access any relevant documents. To address the factors affecting concordance with prescribed antipsychotic medications, these will be divided into patient-related factors, medication-related factors and clinician-related factors. LITERATURE REVIEW According to White (2007) schizophrenia is a debilitating psychiatric disorder characterised by a range of positive and negative symptoms and these symptoms were first described in detail by the British neurologist Hughlings-Jackson in the late 1800s. There is no physical test for schizophrenia rather it is diagnosed by the presence of certain positive and negative symptoms over a period of time (Brennan, 2001). According to Issacs (2006) the neurotransmitter hypothesis suggests that the dopamine over activity in the mesolimbic dopamine pathway, which is between the midbrain, is thought to cause the positive symptoms of schizophrenia and dopamine under activity in the mesocortical dopamine pathway is thought to result in the negative symptoms of schizophrenia. Positive symptoms represent a distortion of normal experience, such as delusions, hallucinations and thought disorder, whereas negative symptoms represent a loss or dimming of normal function and social norm, such as avoidance of social interactions (Baker, 2003). There are different types of schizophrenia such as paranoid, disorganised, catatonic, undifferentiated and residual (Issacs, 2006). However, Gillam (2002) claimed that the exact causes of schizophrenia remain unclear but genetic, environmental and social factors are all thought to influence its development. The risk for a child to develop schizophrenia is 46%, if both parents have the disorder (Kirk et al, 2006). Women who have certain viral illnesses during their pregnancy may be at a greater risk of giving birth to children who later develop schizophrenia and the 1957 influenza A2 epidemics in England resulted in an increase in schizophrenia in the offspring of women who developed this flu during their pregnancy (Frankenburg, 2007). 1 in 100 UK populations will develop schizophrenia in their lifetime and the world prevalence is about 2-4 in 1000, as it affects men and women equally (Rethink, 2008). However, the onset in men is about five years earlier than women with the peak age of incidence is between 16 and 25 and the presentation of the illness varies tremendously, not only between individuals, but also within the same individual at different stages of their illness (Magorrian, 2007). Schizophrenia seems to be more common in city areas and in some ethnic minority groups and premature mortality in people with schizophrenia is 2 to 3 times higher than that in the general population (Royal college of Psychiatrists 2008). The premature mortality might be due to poorer health care, physical health, unhealthy lifestyles and people with schizophrenia may be at greater risk of type 2 diabetes as a result of antipsychotic medications (Nash, 2005). Moreover, according to WHO (2008) schizophrenia is a treatable disorde r but many individuals remain untreated regardless of effective treatments. There has been an unresolved debate about how best to define patients engagement with medications and until the 1980s most work on patient engagement with medications regimes was described as compliance (Norman Ryrie, 2004). The term compliance is often used interchangeably with adherence or concordance (Snelgrove, 2005). According to Kikkert (2006) the term compliance has fallen out of favour in clinical practice because it carries an assumption that patients are the passive recipients of clinicians and implies unquestioning obedience with no opportunity for patients choice. To add to the complexity of this term, patients can be intentionally or unintentionally non-compliant such as a deliberate decision not to comply with treatment and patients may have misunderstood the guidance that they have been given or unable to open the medication container. Velligan et al (2006) claimed that in recent years there has been a shift from this paternalistic model of doctor-patient interactions with the consequent preference for the use of the term adherence. However, while adherence emphasises negotiation between clinician and patient, it still implies a degree of passivity and obedience (Snelgrove, 2005). Gray et al (2002b) assert that concordance may be a more acceptable term as it suggests a collaborative process of decision-making regarding medications regimes and acknowledges the importance of the two-way communication. The NHS Plan (2000) emphasises the importance of placing patients at the centre of services and the transformation of patients into consumers of the health service has changed the context of health care, as patients are expected to become more active and informed about their treatments (Jasper, 2006). Murray et al (2007) emphasise that shared decision-making between clinicians and patients has the potential to improve concordance with treatment plans. Furthermore, The Chief Nursing Officers review of mental health nursing (2006) recommends that building and maintaining positive interpersonal relationships with service users is essential to successful mental health nursing practice and person-centred values is helpful in building positive relationships. This indicates that by not agreeing to health professionals advice patients may be labelled as non-compliant. Nonetheless, compliance could also be problematic, for example if patients continue to take medication obediently, although it is causing adverse side effects. However, from the empirical knowledge the term compliance is still being used in clinical settings despite the paternalistic conception. Therefore, the term concordance is favoured here as it promotes the idea that medication treatment should be a collaborative process between clinicians and patients, which emphasises the patients rights. Ultimately, the term concordance corresponds with the current ethos of modern mental health care set out in the National Service Framework (1999), the NHS Plan (2000) and the Chief Nursing Officers review of mental health nursing (2006), which is concerned with working in partnership with patients and carers. However, according to the term concordance patients have the right to make t reatment decisions, for example, stopping medication even if health professionals do not agree with that decision. For decades researchers have worked to explain the causes of non-concordance with medication unfortunately there have been no valid way of measuring concordance (Velligan et al, 2006). Rates of concordance have been measured by using the subjective and objective methods. Subjective method includes patients` self report and direct interviews, although this method is less expensive, it tends to overestimate the degree of concordance, as patients may not admit non-concordance (Gray et al, 2002b). Snelgrove (2005) claims that objective method such as blood and urine analysis also pose problems as they do not account for individual metabolism and do not reflect inconsistencies in concordance over time. Moreover, from empirical knowledge blood test is effective in monitoring concordance with mood stabilisers such as lithium, but for schizophrenia it is the manifestation of symptoms can support the evidence of non-concordance. According to Gray et al (2002b) pill counts are more reliable, b ut it is impossible to tell whether patients have actually ingested the medication. Even expensive objective method such as electronic monitoring which records every occasion that a pill bottles is opened can also be problematic when patients choose not to swallow the medication that was removed or do not replace the caps and electronic prescribing is still fallible, just because medication is available does not mean that it is taken (Velligan et al, 2006). One of the major clinical problems in the treatment of people with schizophrenia is partial or complete non-concordance with medication and this limits the clinical effectiveness of the prescribed medications (Kikkert et al, 2006). Antipsychotics medication can only be effective if they are taken continuously over a sustained period of time (Norman Ryrie, 2004). Urquhart (2005) claims that partially concordant patients can be difficult to identify because they do not actively refuse to take their medication but the dosage deviations for different reasons and this may only be detected when psychotic symptoms re-emerge. Partial concordance creates significant problems for the treating physician as it creates difficulties in determining whether medications are working adequately, dosing is appropriate or concomitant medication is needed (Velligan et al, 2006). Therefore, this indicates that medication or dosage changes and the addition of concomitant medications are more likely to occu r among patients who are not fully concordant with prescribed medications. Non-concordance with prescribed medication is believed to be a significant factor to increasethe probability of relapse in patients with schizophrenia and relapse is one of the most costly aspects of schizophrenia (Almond et al, 2004). Knapp et al (2004) undertook a study of 658 patients receiving antipsychotics medication of whom 20% reported non-concordance with prescribed medication and concluded that non-concordance was one of the most significant factors in increasing service costs, predicting an excess annual cost per patient of  £2500 for inpatient services and an overall additional cost of  £5000 for total service use. In addition, Almond et al (2004) estimated that costs for relapse cases are four times higherthan those for non-relapse cases. Therefore, these two studies show that relapse in patients with schizophrenia as a result of non-concordance isa major factor in generating high hospitalisation rates and costs. This implies that patients who do not concord with the ir medication are likely to requiremore treatment and support from a range of services and given the high costs associated with relapse non-concordance is a key factor in the use ofin-patient and external services. Antipsychotic medication has proven efficacy in the treatment of schizophrenia and the prevention of relapse. In spite of vast evidence that antipsychotics can be effective in treating the symptoms of schizophrenia, almost 90% of patients will relapse within the first five years of treatment following an acute episode and in general the illness has a tendency to recur or become chronic (Velligan et al, 2006). According to White et al (2007) non-concordance with drug therapy is common in schizophrenia; approximately 50% of patients are non-concordant within one year and 75% within two years after being discharged from hospital. Such high rates of non-concordance with medication may initially seem alarming (Gray et al, 2002b). However, it is similar with other conditions such as asthma where maintenance treatment is required. A study of concordance with asthma medication conducted by Newell (2006) estimated that 70 % of asthma patients in the UK are non-concordant with medication and t he levels of non-concordance in long-term conditions, such as asthma are known to be high as many asthma sufferers will only take medicine when they feel they need it rather than as instructed by clinicians. Therefore, considering the Newell (2006) findings it can be argued that the rates of non-concordance with antipsychotics are not significantly different than those on non-psychiatric medications and the myth that non-concordance with medication is more common among mental disorders as compared to physical disorders needs to be dispelled. Several factors have been shown to increase the chance of relapse but probably the single most important cause of relapse is the discontinuation of effective antipsychotic medication regime. A large number of factors influence non-concordance with prescribed antipsychotic medications, however Gray et al (2002b) have identified the main factors as impaired judgement, negative beliefs about treatment, poor worker-user relationship and the side-effects of medication. Additionally, Kikkert et al (2006) conducted a study in four European countries exploring medication adherence in schizophrenia and identified insight, beliefs about treatment, side effects and treatment efficacy as factors that influence concordancewith medication in patients with schizophrenia. Urquhart (2005) suggests that the problem of non-concordance may be more prevalent among those with schizophrenia due to its nature, for example, lack of insight. Magorrian (2007) claimed that non-concordance with medication is often linked to the persons level of insight into his or her illness and lack of insight is a frequent concomitant of psychosis. In schizophrenia, insight has been defined as an awareness of illness and an ability to recognise symptoms as part of an illness (Gray et al, 2002b) According to Surguladze David (1999) between 50% and 80% of patients diagnosed with schizophrenia have been shown to be partially or totally lacking insight into the presence of their mental disorder and these individuals are often difficult to engage with treatments due to impaired insight. Recent conceptualisation has formulated insight as a continuum representing the combination of three factors; awareness of illness, need for treatment and attribution of symptoms. Lack of insight is continuously problematic but an emotional element can be associated with denial of symptoms or rejection of treatment at key points in the illness (Byrne, 2000). Mitchell Selmes (2007) claim that having a perception about the illness and the knowledge of medications are the key factors of concordance in mental health and patients who understand the purpose of the prescription are twice more likely to collect it than those who do not understand. A study by Cuesta et al (2000) reported that patients suffering from schizophreniashowed poorer insight than patients with affective disorders. Cuesta et al (2000) findings demonstrated that the severe disturbances of insight persisted over the time and the level of insight was not significantly improved in patients suffering from functional psychosis as between 29% to 49% of these patients continued to have fair to poor insight at the follow up assessment. This is consistent with the findings of Kikkert et al (2006), where poor insight was a strong predictor of non-concordance with medication. In contrast, Tait et al (2003) conducted a study to examine changes in insight and symptoms of psychosis on fifty participantswho met the ICD—10 diagnostic criteria for schizophrenia. The participants were interviewed and insight was measured duringacute psychosis using the Insight Scale with the score 0- 12 and all the participants were reinterviewed at 3 and6 months following the init ial interview. Tait et al (2003) findings indicated that duringthe acute episode, 48% of participants scored 9-12 on the InsightScale and the majority of participants (63%) werein the 9-12 range of scores. The study of Tait et al (2003) clearly indicated that level of insight was high among many participants. In considering the findings of both Cuesta et al (2000) and Tait et al (2003) it appears that some patients with psychosis are unaware of their illnesses and insight is a strong predictor of concordance with medications and a good indicator of prognosis. However, evidence for a relationship between insight and concordance with treatment is inconclusive as the discrepancies found between the two studies might be due to the methodological factors, such as selection of participants. In both studies all the participants had a diagnosis of schizophrenia and all of them gave informed consent to enter the study. According to Appelbaum (2006) several studies in America regarding the decisional-capacity of patients with schizophrenia to consent or participation to research have raise some concerns due to the cognitive impairments associated with schizophrenia and using the MacArthur Competence Assessment Tool for Clinical Research clearly indicated that patients with schizophrenia do lack und erstanding and reasoning of research ethics. McCann Clark (2005) emphasise that antipsychotic medications some of which have a sedating effect can also have an impact on the cognitive processes, such as illogical thinking and this can hinder the quality of responses. Moser et al (2005) argued that some studies have shown that a high percentage of individuals with schizophrenia have adequate decisional capacity to consent to research participation, however in a medication-free schizophrenia research, participants did not show a major decline in decisional capacity. In addition, Jeste et al (2006) claimed that there is a risk in assuming that decision-making capacity of individuals with schizophrenia is always impaired, when they are capable to make autonomous decisions and in considering their decision-making capacity as permanently impaired by virtue of their diagnosis. Consequently, in order to investigate factors associated with schizophrenia, it can be argued that only individuals with schizophrenia can provide the answers of their experiences and protecting vulnerable populations from research activity can also exclude them from its benefits. According to Gerrish Lacey (2006) there two key concepts that concern the quality of a research: validity and reliability. Roberts et al (2006) define reliability as how far a particular test will produce similar results in different circumstances, whereas validity is to ascertain the methods are actually measuring what is intended to measure. Both Cuesta et al (2000) and Tait et al (2003) had used structured interviews to gather the data and have chosen a quantitative approach. Structured interview provides the opportunities to change the words but not the meaning of the questions thus, Parahoo (2006) claimed that validity is enhanced because participants can be helped to understand the questions and interviewers can ask for clarifications and probe for further responses, if necessary and since all the questions are ideally asked in the same way, structured interview has a high degree of reliability. It seems that both Cuesta et al (2000) and Tait et al (2003) have adopted the appropriate approach to their research, as quantitative research is the conduct of investigations primarily using numerical methods. It infers that to examine correlations between insight and service engagement qualitative approach could not have produced the same data in this area of study. Moreover, in both studies purposive sampling were used as all the participants had a diagnosis of schizophrenia. According to Polit Beck (2006) all participants in a phenomenological study must have experienced the phenomenon under study and must be able to articulate what is like to have lived the experience. Johnson Orrell (1996 cited in Surguladze David, 1999 P 166) have argued that some patients may have their own explanations of their illnesses, such as religion or cultural beliefs which may not coincide with the Western medical model of mental disorders and this can be even more complicated if one tries directly to impose the models of insight on patients from non-Western cultures. Gamble Brennan (2006) claimed that different cultures in England perceive mental illness in different ways and this can have an impact on treatments as some cultures rather seek help from religious leaders than mental health services. Alternatively, religion or spiritual beliefs in the Western culture can have a positive impact on concordance with medication, as religious individuals with schizophrenia have a better social support compare to non-religious individuals with schizophrenia (Borras et al, 2007). Therefore, it can be put forward that awareness of illness is a crucial factor in the motivation to receive pharmacological treatment. Both cultures and religion can have a positive and negative influence on concordance with antipsychotics. Patients can have different levels of awareness into their illness and they may consciously or unconsciously avoid acknowledging that they are suffering from mental health problems because of their reluctance to bear the stigma of mentally ill (Surguladze David, 1999). Byrne (2000, p65) defined `stigma as a sign of disgrace or discredit, which sets a person apart from others and the stigma of mental illness although more often related to context than to a persons appearance, remains a powerful negative attribute in all-social relations`. Stigma of mental illness has become an indication for unpleasant experiences, such as bringing shame to the family or social exclusion. According to Phillips et al (2002), in some parts of china, schizophrenia is still considered as a punishmentfor an ancestors misbehaviour or for the familys currentmisconduct and the effect of stigmais greater if the patient had more prominent positive symptoms or highly educated. Moreover, a study by Lee et al (20 05) concluded that 60 % out of 320 patients with schizophrenia had experienced interpersonal stigma from p arents, siblings or close rel atives. This indicates that people with schizophrenia are more likely to experience stigma from family members than the general public. Having a diagnosis of schizophrenia does not only affect ones health but also carries all the prejudice, discrimination and social exclusion, for example many individuals are attacked on the streets, rejection in the society and denial of employments because they were known to have mental health problems (Gamble Brennan, 2006). According to Byrne (2000) in two identical UK public opinion surveys, 80% of participants claimed that most people are embarrassed by mentally ill people and about 30% agreeing `I am embarrassed by mentally ill persons`. There is also evidence that supports the concepts of stereotyping of mental illness. The power and influence of the media on mental illness has been a key issue of debate over many years as people with schizophrenia are frequently portrayed as violent and dangerous. In contrast, people with schizophrenia are more likely to be dangerous to themselves than to others, while the greater danger to the public is posed by people without mental health problems and people with mental health problems are six times more likely than the general public to be the victims of murder (Stickley Felton, 2006). Moreover, Gamble Brennan (2006) claimed that when the boxing champion Frank Bruno was admitted to hospital in 2003, one of the newspaper headlines was `Bonkers Bruno locked up`. This indicates that stigma has the grave potential to cause reluctance to seek treatments and this can be detrimental to the persons health. Therefore, as a mental health clinician, it will be vital to assist people wit h mental health problems to rebuild their lives and this requires moving beyond the traditional focus on symptoms and medication by exploring alternatives in reducing stigma of mental health that avert people from social inclusion. It has been predicted that families with high expressed emotion compared to low expressed emotion can contribute towards the relapse rate in symptoms of schizophrenia and this can also be a triggering factor for non-concordance with medication. High expressed emotion carers appear to perceive their caring situation as more stressful and this could be conceptualised as a catastrophic appraisal of the role of caring (Raune et al 2004). Kuipers et al (2006) identifies the components of expressed emotion as emotional over-involvement, hostility, critical comments, warmth and positive remarks. A study by Kuipers et al (2006) indicates that patients whose carers showed high expressed emotion had considerably higher levels of anxiety and lower self-esteem due to the components of expressed emotion. However, a significant amount of data from western cultures suggests that high expressed emotion subjects who were not on medication are three times likely to relapse than those who were on medic ation (Bhugra McKenzie, 2003). This clearly signifies that despite being concordant, high expressed emotion subjects are vulnerable to relapse. The interactions between patient and the carers are crucial, especially cross-culturally as in some cultures for example, in some parts of India, emotional over-involvement is the norm and if carers do not show emotional over-involvement, this can be seen as lack of care (Bhugra McKenzie, 2003). Hashemi Cochrane (1999) conducted a study in UK on expressed emotion and they observed that 80% of the British Pakistani, 45% of the White and 30% of the British Sikh families exhibited high levels of expressed emotion and emotional over-involvement was notably higher among the British Pakistani group. The findings concluded that White patients with high expressed emotion relatives were significantly more likely to relapse than those from low expressed emotion families, whereas for both Asian groups high expressed emotion did not predict relapse. The study of Hashemi Cochrane (1999) also indicated that that Pakistani families in the UK were more likely to be rated as high expressed emotion than White families, indicating that components such as emotional over-involvement may be cultural rather than pathogenic traits. Conversely, low expressed emotion families who are not over-anxious in their response to the patients illness may tend to perceive stigma in less threatening ways whereas, families with high expressed emotion, who respond to the patients illness in a highly anxious may experience stigma more intensely (Phillips et al 2002). Therefore, it appears that family members levels of expressed emotion could influence their perception and response to stigma of mental health and concordance with medication is essential for patients irrespective of the expressed emotion status in the family. Thus, family interventions need to improve in order to lower the levels of anxiety and to increase self-esteem among families with hig h expressed emotion. As a clinician it will be vital to acknowledge the cultural aspect of expressed emotion status in the family to facilitate concordance with medication. There is overwhelming evidence for patients with schizophrenia, who misuse illicit drugs and alcohol to have an increased rate of re-hospitalisation (Sokya, 2000). According to Barnes et al (2006) the higher relapse rate in people with established schizophrenia who usesubstances may be partially explained by non-concordant tothe medication regimen. Evidence suggests that the substance used most frequently by people with schizophrenia is cannabis (Gamble Brennan, 2006). Arseneault et al (2004) emphasise that rates of cannabis use in UK are higher among people with schizophrenia than among the general population and patients detained under the MHA (1983) have even higher rates of lifetime use of cannabis. Substance misuse in schizophrenia may be explained as a form of self-medication to alleviate the symptoms of schizophrenia, to improve the side effects of antipsychotics and to respond to social pressures (Sokya, 2000). There has been little evidence to support the self-medication hypothesis despite its popularity with users and in contrast, substance misuse can aggravate the symptoms of schizophrenia and can also trigger psychotic episode particularly in people with a pre-exis