The Timeline Of U.s. Healthcare History - 1466 Words

The timeline of U.S. healthcare history began with Early American medicine with Native Americans and common folk practices performed by settlers. Practices included herbal remedies, procedures such as â€Å"bleeding, blistering, and purging (Batnitzky, Hayes, Vinall, (2014). Practices were based on theory and environmental contributors rather than diagnosis of treatment. The First Marine Hospital fund was signed into law in 1789,creating the beginning of organized medicine and facilities. The First Marine Hospital fund ensured military members and individuals with federal eligibility were provided medical treatment and preventive care. Funds in maintaining treatment facilities was acquired though payroll deductions. This treatment was provided at various hospitals and facilities. Through growth and expansion, treatment facilities were operated and maintained by military operations. In 1847, the American Medical Association (AMA) was founded by Dr. Nathan Davis. Standards and guidel ines were determined for the education requirements for medical professionals, drug manufacturing, preventing disease, sanitation, and in providing higher standards of treatment and care (American Medical Association [AMA], 2015). In 1872, the American Public Health Association [APA] was formed in promoting prevention of communicable diseases. This was the next major breakthrough in reducing diseases such as smallpox, whooping cough, and other common diseases that highly spread. As advances inShow MoreRelatedThe History and Evolution of Healthcare879 Words   |  4 PagesThe History and Evolution Of Healthcare The History And Evolution Of Healthcare Jay Williams University Of Phoenix HCS/440 Health Care Economics Lena Lee Watson, RN, DHSc August 5, 2010 The History And Evolution Of Healthcare Intro I can remember as a little kid growing up in New York City what the highlight of my year was every year; it was getting to go down south for the summer. My grand parents had this huge oak tree in their front yard that I love to climb up. My grandmotherRead MoreThe Affordable Care Act Of 20101605 Words   |  7 Pages The Affordable Care Act of 2010 Clautilde Dixon Purdue University Northwest â€Æ' The Affordable Care Act of 2010 Generally, healthcare policy is a term that defines the layout, procedures, plans or actions that are utilized to acquire health care goals in communities or societies. There are different forms of healthcare policies, such as H.R. 3962, the ACA (Affordable Care Act). The official name of this policy is ObamaCare and President Barack Obama signed the act into law in 2010. This policyRead MoreHistory Of Nursing Anesthetists And The Administration Of Anesthesia1426 Words   |  6 PagesHistory of Nursing Anesthetists Nurse anesthetists are nurses that have specialized in the administration of anesthesia. They have completed the additional schooling, and other requirements necessary to prepare them for this career. Nurse anesthetists have a challenging career that they are fairly compensated for. It is a respected profession that is estimated to grow significantly in the future. Furthermore there are many options for growth and promotion opportunities. This career comes withRead MoreEconomics : The Financing Of Health Care1379 Words   |  6 Pages Thomas Gordon Healthcare Economic History ECONOMICS: THE FINANCING OF HEALTH CARE March 2, 2016 Lena Watson Health Care History The United States HealthCare System is pushing and getting ready to have a huge reformation. It is evolving on a major substantial evolution from its organization, management structure, and payment structure. The economic component of healthcare is equally important to better understanding the order to structure stature and is very successful. InRead MoreThe Ethical Dilemmas Of Euthanasia Essay1638 Words   |  7 Pageson June 17, 2016 (Chochinov and Frazee, 2016). This paper will discusses the conflicts that healthcare professionals are faced with when looking at the quality of life for the terminally ill or comatose patients and these patients’ desires to end their pain and suffering with physician-assisted suicide (PAS). With the legalization of PAS, just this year in Canada, there is a need to evaluate how healthcare professionals who have dealt with such decisions have fared and how the terminally ill patientsRead MoreAmerica s The Canadian System1353 Words   |  6 Pages â€Å"Roughly 40% of both insured and uninsured U.S. respondents spent $1,000 or more out-of-pocket during the year on medical care, not counting premiums,† the report authors say. And, perhaps as a result, more than 50,000 preventable deaths would be avoided. Although it wouldn’t all be good news and Canada’s free system comes at the cost of greater wait times for a few services as well as more ER visits, it is a minimal price to pay for better healthcare outcomes (Khazan, 2014). VIII. Why Do BothRead MoreWhy I Want to Become a Computer Programmer Essay863 Words   |  4 PagesHistory and Origins: When computers started coming out, computer companies need people to program operating systems and programs for them. Seeing that you sat at a desk all day, it was seen as a easy career choice, but with little pay. So computer programming as a career, was dominated by women in the 60s. Soon though, men dominated the field through discrimination and needs for a job. The Job field was getting paid more so companies wanted to hire â€Å"higher quality† employees, and that meant menRead MoreThe Marijuana Of The United States Government1280 Words   |  6 PagesThe history of marijuana in the United States government date back to the origins of the United States government itself. During the 16th century, the mass production of hemp was encouraged by the British government for its fibrous content, which was used for making fabric, ropes, cords, and other items (â€Å"Marijuana Timeline† 2014). By 1619, the Virginia assembly passed legislation requiring each household i n the colony to cultivate hemp, praising its variety of beneficial uses. Even after theRead MoreShould Physicians Be Paid?968 Words   |  4 PagesShould physicians be paid the same or by the quality of their services? This is a long debated concept in healthcare, one that some say it really shouldn’t be. This is due to the fact that it’s a part of professionalism in healthcare to expect high quality in any physician’s work. Yet, that is not always the case. Some physicians care more about how much they get paid rather than the quality of their work. Therefore, physicians should be paid based on the quality of their work to ensure the bestRead MoreEssay on Healthcare Museum954 Words   |  4 PagesMuseum Vanessa Garcia HCS/235 01-21-2014 Sandra Huppenbauer Healthcare has been and will always be a growing industry from new vaccines to new diseases. We would like to create a non-profit organization and open a Health Care Hall of Fame Museum. In this museum we will have various exhibits that have changed healthcare. I will give you a brief description of five that play a huge role in public health today. Public Health Vaccine First

Essay about Religion Purification in Taxi Driver

Hes a profit and a pusher. Partly truth partly fiction. A walking contradiction. - Kris Kirstofferson In Martin Scorceses Taxi Driver, Travis Bickle repeatedly expresses two ideas that are central to the film. First, Travis has an undying wish to purify the world. He wants to rid his city of all the evil and scum that currently inhabits the citys cold and damp streets. Second, is the method by which Travis tries to obtain his goals. Travis Bickle tries to clean up his city by methods similar to those of religious figures. He even takes on a role as a savior figure. Travis Bickles quest to save the world via religious ideas fails, and instead results is a bloodbath. The first place where we are introduced to the†¦show more content†¦Much like Noah, he believes that he will be saved, while everyone else in the world perishes from the torrents of water. Later in the film, Travis feels compelled to take action against this sleaze. He wants to help purify the world by eliminating the sleaze by whatever methods he deems appropriate. Even if this means killing his fellow man, then so be it. Another instance where we see Travis revert to this theme of purifier is when he first meets Betsy. The childish scrawl in his diary tells the story. I first saw her at Palantine headquarters at 63rd and Broadway. She was wearing a white dress. She appeared like an angle. Out of this filthy mass. She is alone. They cannot touch her. In these few choice words, Travis Bickle again reemphasis the recurring religious references. In this specific instance, Traviss first words about his new love interest are, She was wearing a white dress. White is traditionally a color used to represent purity. In Traviss eyes, Betsy is the virginal ideal that he must strive to obtain. To him she is his perfect match. Possibly the most important aspect of this quotation is the religious references that it conjures up. Travis refers to Betsy as an angel; she is one of the few people who does not sink down into the muck that covers the city. Another interesting aspect of thisShow MoreRelatedArab Culture - Essay6842 Words   |  28 PagesSomalia, Djibouti, and the Comoros Islands which are part of the Arab world. †¢ It can also be defined as those countries where Arabic is the dominant language. †¢ Arab countries are religiously and ethnically diverse with Islam being the dominant religion in most countries. †¢ 22 Arab countries/areas: Algeria, Bahrain, the Comoros Islands, Djibouti, Egypt, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Mauritania, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, United Arab EmiratesRead MoreManagement Course: Mba−10 General Management215330 Words   |  862 Pagesit confronts the more durable and surviving dot-com businesses with equally basic issues of innovation in regard to making their fiscal discipline as focused as their market development. Productivity, which has always been recognized as a primary driver of prosperity and profitability, has been widely emphasized as a continuing key to this economic strength. It has been discussed quite properly in terms of the rapid growth of technology, particularly information technology. However, in these times

State of the Nation The Seven Years War Free Essays

A. Why might some scholars call the Seven Years War the â€Å"Great War for Empire†? B. Is it accurate to describe the Seven Years War as the â€Å"Great War for Empire† and as the â€Å"First Worldwide War†? C. We will write a custom essay sample on State of the Nation: The Seven Years War or any similar topic only for you Order Now What role did Indians play in the causes and consequences of the war? D. Did the war set the stage for the American Revolution? In 1756, Britain declared war on France, which is known as to today to be the beginning of the Seven Years’ War. Some Scholars might call the Seven Years’ War the â€Å"Great War for Empires† because France ceded its major North American holdings to Britain. Because of Frances’s losses, Britain gained control of the continent’s fir trade. Another reason in why some scholars may call the Seven Years’ War the â€Å"Great War for Empire† is because it chained into an expansion of British colonies. In 1763, Local Indians started feel the impact of the British’s win. Some Indians known as the Creeks and Cherokees were some of the most upset, because they were not able to turn to France or Spain in case of Britain not giving them any kind of concessions no more. In desperation, and retaliation for British atrocities, Cherokees attacked the Carolina and Virginia frontiers in 1760(Norton, 112). Even though the Indian were victorious, they were easily defeated the following year. Late in 1761, a treaty allowed the construction of British forts in the Cherokee territories and opened a large tract to European settlement. How to cite State of the Nation: The Seven Years War, Papers

Factors Influencing of Mobile Banking †Free Samples to Students

Question: Discuss about the Factors Influencing of Mobile Banking. Answer: Introduction This paper presents literature review of the Bank of Queensland which focuses on the incorporation of the accounting software in Australia. This review provides explanation on various key concepts of the organization ranging from the organizational structure, control and fraudulent issues, sales procedure flowchart, System Acquisition software, and adoption of the accounting software packages in the organization. Although the literature presents these themes in several contexts, this paper will primarily focus on the development and deployment of accounting software. It also focuses on the current market size, challenges in the accounting software, suggestions, and recommendations on the accounting software. Current Organizational Structure of Bank of Queensland (BOQ): The Bank of Queensland (BOQ) is an Australian retail bank headquartered in Brisbane, Queensland. The BOQ founded in the year 1874 is one of the antiquated financial organizations in Queensland and now the bank contains 252 branches including 78 corporate branches and 166 proprietor controlled branches in Australia. The Bank of Queensland has 1 subsidiary and 19 executives currently. Jon Sutton is the CEO of the bank and Roger Davis serves as the chairman of BOQ. Commercial banking, Finance and insurance, Consumer banking, Provision of Mortgage loans, and Credit cards are the products offered by the bank. The organization offers online banking services like Internet Banking, BOQ property application, BOQ money, mobile banking, and online applications. The IT imperfections in BOQ have lead to the customer account modification errors and subsequent credit code rifts. Recently, the Australian Securities and Investments Commission declared that the BOQ will provide reimbursement to the customers due to the occurrence of system error. The encountered system error failed to link the Mortgage offset accounts to the acceptable home allowance accounts for a certain number of years. According to the current estimation, the error overwhelmed 6000 customers and the total refunds of approximately $ 12 million are provided. Another operational problem is confronted due to the failure to meet the functioning and administrative requirements with the cloud based computing system. This deterioration of the modern system leads to the cut down of 10 million dollars from pre-tax earnings. After the loss of cloud services, the banks begin to function with the errors around data security and meeting the prudential needs. The change management analyst position in the organization leads to the course of general errors summarized below: Inadequacy of Complacency Containing inadequate authority for initiating the change Loss of vision Mishandling the resistance forces Failure to attain the earlier success Premature glorification of success and Not modifying enough safety systems to secure long term alterations System Acquisition method for BOQ: The Bank of Queensland procured 10 million dollars from 3 years sales force technology trial for the customer relationship management (CRM) platform. The bank stated that the functional and administrative requirements concerning the cloud-based system should be met in order to increase the profit margin. The CRM system was utilized as system acquisition method for delivering the staff quicker entry to the customer data, a minimization on the time consumed to create new customer accounts, and a liberty for increasing the cross-selling abilities. The bank is executing its traditional CRM system and has completely implemented the sales force platform. But as a result of discrepancy, the bank is now searching for alternative platforms. The bank will go back to the CRM solution that is implemented in around 200 branches, while searching for the alternate solution. System Flowchart for Sales procedure in Bank of Queensland: By using the EFTPOS facility, the sales can be increased as the customers have alternate option of using their cards when they do not have cash in hand. The EFTPOS facility enables the bank to process the debit cards, credit cards, and charge cards so that quicker online transaction authorizations is facilitated. The online hackers undertake advantage of the poorly secured computer systems of the customers. For instance, the malignant software loaded from the Internet or received through the attachments for emails may have certain malware which accommodates the security of the computer. When the user keys in the Customer Access Number, Personal Access Code, and the User identification number as login credentials in the internet banking login page, the computer encrypts this information and transmits this encrypted information to the users through a secure connection. But if the computer is not protected, it is possible for the fraudsters to gain control of the confidential information. Since the bank of queensland uses the cloud services, the data security is of main issue (Fisher, 2001). The online banking facility of Bank of Queensland provides full time access, so that the users can manage their accounts, access multiple entities, and keep control on their own business requirements. The accounting packages such as Zero, MYOB AccountRight Live/Live Accounts MYOB, MYOB Essentials, MYOB Bank Link, and BGL (SMSF Software) are compatible to be adopted with Bank of Queensland Internet Banking System (Deshmukh Romine, 2002). The Lockbox services contain receivables outsourcing like cheques and cash management services inclusive of the online bank accounts that are connected to the accounting packages for facilitating authorization management and coordination (Carlton,1999). Current Market Size According to the new managing director Trent Innes of the Xero Australia, Xero accounting software package is positioned in the foremost position comprising 262,000 Australian users, when compared to its main competitor MYOB (Kabir, 2013). He also stated that there are 15 % market shares nationally and his first priority as a managing director is to expand the share percentage. The highly competitive Xero accounting software package has over 25,000 customers and has more than 10,000 business partners. At the same time, the operating profit for Xero is increased by 71% to 92.8 million dollars and 44.3 million dollars. Xero is going to be transformed into a financial technical company containing focus on the big data rather than just accounting software. While selecting the accounting software package for the business, each suppliers website needs to be visited and the pricing and other features provided by the software should be compared in order to ensure that it offers all the requirements of the business (Gurton, 2001). The comparisons between the leading accounting software packages are illustrated in the table given below: MYOB Xero Quickbooks Reckon Saasu Plan Essentials Starters Essentials Basic Plan comprising all Add-Ons Medium Monthly Cost $35 $25 $25 $20 $40 Cloud-Based Yes Yes Yes Yes Yes Quoting Function Yes Yes Yes Yes Yes Permission for Multiple Users Yes Yes Yes Yes Yes Provision for Invoicing Process Yes Yes Yes Yes Yes Inventory Management Yes Yes No Yes Yes Provision for Online Payment Arriving Soon Yes No Yes Yes Bank Feeds Yes Yes Yes Yes Yes Multi-Currency Compatibility No No No Yes Yes Provision for Payroll Process Yes Yes Yes Yes Yes Calculation and Tracking of GST Yes Yes Yes Yes Yes No of Staff Applicable for payroll 1 1 10 Unlimited 20 Availability of Time Sheets Yes No No Yes Yes Calculation of Holidays Yes Yes Yes Yes Yes Availability of More Add-Ons Yes Yes Yes Yes Yes Provision for Mobile Access Yes Yes Yes Yes Yes Integration and Assistance of Third Party Add-Ons Yes Yes Yes Yes Yes Competitive Advantage: MYOB is a highly competitive world leader in the ERP market. The users can rely on the accounting software MYOB due to their stability and longevity in the business. It also contains a highly efficient network of legitimated and trusted local partners and third party MYOB developers. Challenges encountered by the users of Accounting Software/Packages The accounting issues are very common for those who are already utilizing the accounting software for making their business works simpler. The outdated and non user-friendly accounting software are the ones that impose problems for the users. The common challenges are provided below: Even the incorporated firewalls have the capability to solve the security issues, the stepup of a firewall is sometimes abnormal. Some accounting software do not help the users to get their required business information out. Both the customer needs and the accounting skills should be considered while selecting the accounting software for the business. The software should be selected according to the allocated budget. More attention should be on Add-on features. QuickBooks online, Xero, and Zoho Books accounting software are recommended for small businesses since it provides clear picture of the enterprise and able to create the invoices, track the organization expenses, create different types of financial reports, etc. Conclusion: On the basis of the above research and the analysis, I provide the conclusion that each accounting software plays an essential part in the business and the functions performed by the software. The business owner should make the decision on selecting the appropriate accounting software which will be useful for his business. As accounting software provider provides the customization facility of the software in business owner perspective, the customization cost is comparatively higher than any other software. For medium or large scale businesses, they can use any software like Tally, Busy, S.A.P, etc. The following guidelines are needed to be taken into account while selecting the software: Make the requirement analysis and provide budget definition. If the business is of small-scale, then bookkeeping or record creations should be performed by the accounting software. References How does Accounting Software Work?. (2013, January 10). Retrieved from https://www.investopedia.com/terms/a/accounting-software.asp. Kabir, M. (2013). Factors Influencing the Usage of Mobile Banking Incident from a Developing Country. World Review of Business Research, 3(2), 4-10. Carlton, C. (1999). Customizing Accounting Software. Retrieved from https://www.accountingsoftwareadvisor.com/topics/customization.html. Deshmukh, A Romine, J. (2002). Accounting Software and E-Business. The CPA Journal, 72(11). Fisher, D. (2001). For rent: Are you considering an ASP for your accounting functions?, The National Public Accountant, 46(6), 16-18. Gurton, A. (2001). Spoiled for choice, Accountancy, 127(1289), 64-65.

Searching for a Former Clarity free essay sample

With the release of â€Å"Searching for a Former Clarity,† a breath of fresh air is pumped into a suffocating punk rock scene. The bands third full-length album shows a maturity and composure not seen in many independently produced records. From start to finish, this is a barrage of witty lyrics and powerfully catchy choruses. Whether frontman Tom Gabel and Against Me! are singing about their friends and hometown of Gainesville, or trashing the stagnant rock scene and state of our nation, these guys have a lot to say. The bands tempo has decreased since its sophomore release, â€Å"As The Eternal Cowboy,† although the song structures and melodies have developed considerably. Gabels voice has sunk almost an octave, which is slightly disappointing as it steals some of the bands previous energy. Yet songs like â€Å"Problems† and â€Å"Dont Lose Touch† make the album more enjoyable than any other punk rock CD released this year. We will write a custom essay sample on Searching for a Former Clarity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page An acoustic medley brings back memories of the bands earlier days when Gabel was a folky acoustic guitarist. The song delves deep into an emotional well, describing Gabels personal battle against drugs. The contrast in satirical and personal songs make for an interesting duality not heard on many releases. Through powerful guitar leads, bouncy bass lines and solid drum tracks, â€Å"Searching for a Former Clarity† harnesses the energy and convictions of this great band. Lyrically, Gabel continues to mature and analyze the world around him in a funny, sometimes cynical way. The bands third release may not be their best, but it is certainly one of the best of 2005. .

mapp v ohio essays

mapp v ohio essays The Mapp Vs Ohio Supreme Court Case was a turning point in our nation's history. It changed our legal system by forming the exclusionary rule, which in turn changed the way prosecution of a criminal is performed. On May 23, 1957, three Cleveland police officers arrived at Dolly Mapps home. They had reason to believe that paraphernalia and a fugitive of a recent bombing had been hiding out there. The officers asked if they could search the home without a search warrant, with the advice of her attorney she refused. Three hours later, four more police officers arrived to the scene. They knocked on the door but Ms. Mapp did not respond immediately. The officers then forcibly entered the home by knocking down the door and windows. Ms. Mapp demanded to see a warrant; but an officer showed her a blank piece of paper that he claimed to be a warrant. An aggravated with the situation, Ms. Mapp took the warrant and wiped her bosom with it. The officers arrested her an account she was belligeren t and rude. While Ms. Mapp was in handcuffs, the police conducted an extremely though search of the house by breaking things and search through private drawers and desk. They found no evidence of a fugitive and of anything bomb related, however they did find some lewd, and lavacious reading materials that were illegal in Ohio. Ms. Mapp was ultimately convicted in the Supreme Court of Ohio on account of her possession of the pornography. The search was illegal according to a previous ruling in Wolf vs. Colorado; but Ms. Mapp appealed claiming it violated due process of law. In a 5-3 vote, Wolf vs. Colorado was overturned and the exclusionary rule of law was developed and determined to be applicable in all courts. In the process, it has greatly effected our legal system, and the way it is run. The justice had very important decision to make; to either protect the rights of the accused or convict criminals at all cost. The court c...

Survey letter Research Paper Example | Topics and Well Written Essays - 500 words

Survey letter - Research Paper Example In order to express my heartfelt gratitude, I hereby enclose a gift certificate of MacDonald’s. Please enjoy with my complements. Attached, you will find a brief questionnaire concerning your business, and a self-addressed stamped envelope. Please return the survey no later than (August 15, 2014) so that i can complete my project on time. 3. What are the average net profits of Central Coast Wines in dollars or percent of sales after computing the overhead costs such as rent, administration, and inventory? (Use more than†¦.or less than†¦.in answering). Are these profits for one owner, or do they split between two or more partners? 7. Which brand is your best selling wine, and in what average quantities does it sell, per day, per week, and per year? What level of competition does this brand stand against other competitors’ products in the market – competitive advantage? 10. What chain of distribution does the company use in getting its products to the right market? Does the distribution channel have many intermediaries? Do these intermediaries affect the utility of the product, such as in price, place, and time

Why Caledonia Has to Adopt Free Cash Flows Approach and not Accounting Math Problem

Why Caledonia Has to Adopt Free Cash Flows Approach and not Accounting Profit Approach - Math Problem Example Moreover, it involves financial instruments such as inventory, which the corporation can easily convert into money. The cash flow statement can highlight the economic position of the firm and its solvency capacity within that financial period. Alternatively, the accounting profits refer to the gain or loss of the investment of the entrepreneur after the accumulative revenues are subtracted from the expenses (Profit ? = Revenues – Expenses). In addition, the net income is for the whole year (Wayman, 2010). For most corporations, revenues are realized when the money is earned but not received. This means some items can be sold on credit and recorded on the Income Statement as sales even if the money is not actually received. Why Caledonia has to adopt free Cash flows approach and not Accounting profit approach According to Mulford & Comiskey (2005), both the cash flow methods and accounting profits are methods that corporations use to assess their economic performance. However, the concepts of computing these two formulas are different and constitutes of different elements. Cash flows have several qualities that make it preferable than the accounting profits. First, cash flows consider the time value of transactions and money, which is important for the business. It considers the money value in a particular period has a different purchasing power than in a future period. Clearly, numerous economic conditions influence the fluctuation of prices and the accounting profits do not consider this. They assume the price remains constant for a particular economic period. For example, oil prices are affected by global factors such as depletion of oil wells, shortages or regulations, which cause the frequent alteration of the prices to meet the contemporary financial situations. In this instance, the cash flow approach will realize the inflows and expenditures of the new prices of the commodity according to the time of occurrence. Whereas the accounting profit model ignores this and uses the average price of the year in computing its revenues. Therefore, the corporation will be able to measure their liquidity situation more efficiently and thus this will help them in planning their operational functions better. Besides the cash flow model emphasizes real time payment unlike accounting profit is realized later ((Mulford & Comiskey, 2005)). If the corporation acquires finances directly after sales, they can use it when a great opportunity arises. They will not have to postpone their prospects since they have sold items on credit and do not have the actual money. Secondly, the accounting profit approach considers depreciation as an expense item and this is not an actual expense item (Mulford & Comiskey, 2005). Therefore, if the depreciation increases this will mean that the expenses will increase but this is not reflective of the true expense of the business. It is a non-cash amount that the corporation assumes it affects the profitability of the business. However, the cash flows ignore depreciation as cash expense since it does not have a monetary value. If Caledonia utilizes the cash flow approach, its profits will be higher and reflect the true cash position of the business, unlike a net profit figure which will be lower since it comprises of depreciation. Finally, the cash flow method is essential for capital budgeting which requires comparison of the benefits and costs (outflows) of the investment they are taking (Wayman, 2010). Since the cash flow method considers the cash values of the projects, it can be an appropriate basis to calculate the financial progress of the investment. Consequently, the accounting method disregards the cost at the time of initiation of the project. The

JOUR 330 Research Paper Example | Topics and Well Written Essays - 2000 words

JOUR 330 - Research Paper Example The video (viewer discretion advised due to graphic content) shows the CEO and his hunting party looking over a farmer's damaged crops, shooting at elephants at night, and Parsons posing with the dead bull. It also shows crowds of villagers field dressing the carcass the next morning.† (Burgess, 2011) Perhaps because the image recalled African safaris of the robber barons of late 19th century capitalism and the archaic, out of touch, and even barbaric behavior of the â€Å"super-rich,† bloggers around the world wrote articles protesting this, and thousands of customers cancelled accounts with GoDaddy. The company’s competitors took advantage of this, issuing free transfer and discount coupons for people who wanted to switch their business away from GoDaddy. This situation can be regarded as a case example in public relations because Bob Parsons illustrates exactly what not to do when media problems occur for a company. His actions, statements, and behavior in resp onse to the first controversy arguably made the situation even worse for him and his company in the public relations context. While the company claims it has not lost much business from this, the story will undoubtedly remain linked to the brand and competitors will continue to take advantage of this. To some degree, Parsons may have been overdue for a PR breakdown, because his company is known for a particular marketing campaign that is based on a certain amount of â€Å"sleaze†. Yet, for a company that once hoped to go public through an IPO, having the CEO of the company labeled this way in the mainstream press is very problematic. Consider that major media publications such as CNN, Salon, the New York Times, The Guardian, etc. all ran major articles on the story, and kept it active with update reports. In PR, the goal is for the problem to be out of the news cycle and out of discussion as soon as possible. When mainstream media repeat a story such as this over and over, it does continual damage to the brand and its credibility. For most people, the killing of an elephant is really a blatant act of stupidity, cruelty, and arrogance. That Bob Parsons defended his behavior immediately inflamed the situation. For example, instead of apologizing publicly, Parson conducted media interviews where he said: "These people have literally nothing and when an elephant is killed it's a big event for them, they are going to be able to eat some protein. This is no different than you or I eating beef. All these people that are complaining that this shouldn't happen, that these people who are starving to death otherwise shouldn't eat these elephants, you probably see them driving through at McDonald's or cutting a steak." (McCarthy, 2011) What Parsons did not critically understand is the fact that indeed millions of people do think and care deeply about issues such as environmental protection, endangered species, as well as the social justices issues related to hunger and global poverty. To compare eating an elephant to a problem for African starvation is simply a ridiculous justification. Salon critically notes that the original video Parsons posted included â€Å"captions to the nighttime scene that read ‘Bob Parsons fires first’ and ‘Bob Parsons fir

The Irony In The Truman Show English Literature Essay

The Irony In The Truman Show English Literature Essay Truman from The Truman Show and Meursault from The Stranger both have things that foreshadow their ultimate choices in life, which include symbolism, existential themes, and irony. In The Truman Show , there is irony present throughout the whole movie. During most of the film, Truman wanted to leave Seahaven and go explore the world. He had a desire to do more than just live a quaint, common life. He is unique, and it is his motivation that makes him stand out. His enduring determination helped him find the answer. For example, he almost drowned during a storm while sailing, but he persisted on. Truman got an answer, but it may not have been the answer he was searching for. Once Truman learned that his life was a television show, he realized he would not be as unique if he left. He would not be the center of attention, and now wants to be just an ordinary person outside of Seahaven. There also irony present throughout The Stranger, as Meursault also has somewhat of an epiphany towards the end of the novel. Throughout the story, Meursault is indifferent to many things and does not show strong moral values. For example, he kills a man without strong reasoning. After getting sentenced to death, he truly realizes why he is getting punished for his actions. He understands what will happen to him and accepts it. Ironically, instead of having moral thoughts or feelings of remorse, he believes that hatred of him would make him feel less alone. However, he realizes he becomes happier when he better understands human existence and purpose. As if that blind rage had washed me clean, rid me of hope; for the first time, in that night alive with signs and stars, I opened myself to the gentle indifference of the world. Finding it so much like myself-so like a brother, really-I felt that I had been happy and that I was happy again. For everything to be consummated, for me to fe el less alone, I had only to wish that there be a large crowd of spectators the day of my execution and that they greet me with cries of hate, (Part 2, Chapter 5, P.123). He feels lonely, and it is the hate from the crowd of spectators that help him feel less alone. Meursault faced a lot of things like an existentialist. For example, he was ready to accept his consequence after he shot the Arab. He also was ready for death, knowing it is inevitable. Some existential themes include freewill, controlling your own fate, accepting your fate, and taking responsibility for your own actions. These themes are all present in The Stranger. It was the freewill that led him to shooting the Arab, because he was in total control. He chose his fate, accepted the consequences, and took responsibility for what he did. For example, he realized he was going to die, and accepted it. There are also existentialist themes in The Truman Show. Although the shows creator, Christof, tried to keep Truman in Seahaven, he ultimately could not. Trumans freewill and control of his own fate led him to discovering the truth about Seahaven, and thus controlling the outcome of his life. He accepted the reality of his life being centered around a television show, but moved on by leaving Seahaven. Although Trumans artificial world came to an end, he entered reality as he left Seahaven. Symbolically, Trumans fake world coming to an end was foreshadowed by a previous event. The light fixture that fell as Truman left his home symbolized things starting to fall apart. Shortly after this even, there were more examples that caused him to be suspicious and doubtful of the world around him. Another great example of symbolism in the film was the unfinished bridge that Truman and Marlon had conversations on. Truman was always uncertain of something when he spoke to Marlon on the bridge, and it could represent Trumans unfulfilled life and uncertainty. Although Trumans life was unfulfilled in his eyes, there is something that foreshadows him traveling in the future and discovering something. The name of his sailboat was the Santa Maria, which was a famous boat that Columbus sailed to America on. This foreshadowed Truman leaving the town of Seahaven to explore a completely new world. There is much symbolism present in The Stranger as well. For example, Mersault does not like being uncomfortable, especially from the weather. Many perceive the sun as a source of warmth, sometimes beauty, but Meursault dislikes the heat. The sun normally brings joy, emotional warmth or comfort to an individual, but Meursault seems to dislike feeling emotional in any way. He also dislikes heat from the sun. The sun was a barrier of Mersaults emotions. It also led him to murder. While walking on the beach, Meursault encountered the Arab again. The Arab reflected light off of his knife from the sun. Meursault thought to himself, All I could feel were the cymbals of sunlight crashing on my forehead and, instinctively, the dazzling spear flying up from the knife in front of me. The scorching blade slashed at my eyelashes and stabbed at my stinging eyes, (Part 1, Ch.6, P.59). Right after this, he shot and killed the Arab. It seems like the little emotions that Meursault had took over his actions. Before walks up to the Arab and shoots him, Meursault thinks to himself, It occurred to me that all I had to do was turn around and that would be the end of it. But the whole beach, throbbing in the sun, was pressing on my back. I took a few steps toward the spring, (Part 1, Ch.6, P.58).However, towards the end of the novel he did gain some morals and understood much more about life. When he did, he looked into the window, with the sun shining behind it, and gazed at his reflection: I moved closer to the window, and in the last light of day I gazed at my reflection one more time, (Part 2, Ch.2, P.81). As you can see, existential themes, symbols and irony not only foreshadow, but affect Meursaults and Trumans ultimate choices in life.

Comparing Minorities as Portrayed in My Name is Asher Lev, Joy Luck Club, and Black Like Me :: comparison compare contrast essays

Minorities in America as Portrayed in My Name is Asher Lev, Joy Luck Club, and Black Like Me        Ã‚  Ã‚   Conflicting values are a constant issue in society. In diverse civilizations minorities become out ruled by the majority. In Twentieth Century American culture there are many difficulties in existing as a minority. The books My Name is Asher Lev, by Chaim Potok, and the Joy Luck Club, by Amy Tan, portray the aspect of being torn between two cultures as a conflict for today's minorities. Black Like Me, by John Howard Griffin, examines the hardships for a minority by progressively revealing them. The events of the three authors' lives reflect how they portray the common theme of the difficulties for a Twentieth Century minority. My Name is Asher Lev demonstrates that the aspect of the protagonist being torn between two cultures is a difficulty for minorities in America. Asher Lev was torn between being an artist and his Jewish community. In the novel, Potok describes in detail the "feelings, dilemmas and questions [minorities] bump into while trying to obey their traditions and their passions at the same time" (Chaim). The main character, Asher Lev, chooses to be an artist and winds up having to separate himself from his life. He explains, "I am a traitor, an apostate, a self-hater, an inflicter of shame upon my family, my friends, my people; also I am a mocker of ideas sacred to Christians" (Potok 1). By choosing the life of an artist, Asher faces a life of continuous pain due to betrayal to his family. The protagonist's painting of the Brooklyn Crucifixion "raises disturbing questions about anti-Semitism, conflict between Christians and Jews, and the tension between artistic conventions and religious imper atives" (My Name is Asher Lev 2877). It contradicted everything his family had raised him to believe in. He never fits into society since he defies his people and mocks the majority in this painting. Asher describes how his double culture life is doomed. "Asher Lev . . . was the child of the Master of the Universe and the Other Side. Asher Lev paints good pictures and hurts people he loves" (Potok 348). Asher moves from the religious to the secular world in the course of the novel. This is because Potok's novels "assume the impossibility of existing in both the religious and secular spheres" ("Potok, Chaim" 339).

First Draft. Chocolate Essay

Recently, chocolate has been getting mixed reviews from physicians, scientists, and mothers across the country. For years, people blamed the sugary confection for their expanding waist lines, acne problems, and caffeine jitters. But more research is being presented that claims not all chocolate is this sinister, and that some might actually be good for your health. Chocolate is proven to make us healthier, can benefits us mentally and it also can induce good hormones in our body. BODY. Researchers have proven that chocolate can make us healthier. Chocolate contains flavinoids, which have many health benefits associated with them. Flavinoids can trigger diseases fighting enzymes in our body and fighting tooth decay. Other than that, it also can lower blood pressure and combat heart disease. Chocolate in other hand also can lower â€Å"bad cholesterol† and reduce blood clots. The goodness of chocolate can be found in dark chocolate. A small bar of it every day can help keep your heart and cardiovascular system running well. Studies have shown that consuming a small bar of dark chocolate everyday can reduce blood pressure in individuals with high blood pressure. Dark chocolate has also been shown to reduce LDL cholesterol (the bad cholesterol) by up to 10 percent. Besides that, chocolate can benefits us mentally. Dark chocolate has even been known as a relaxing agent. It can reduce cortisol and catecholamine, the stress hormones, in the body. Chocolate in other hand also can increase theta brain waves, resulting in relaxation. So, if you are in stressful condition, you may eat chocolate in order to relax your mind. Scientists have found that the endorphins and opoids in chocolates makes people feel less anxious and worried and makes them relaxed. Chocolate can help us to boost up our memory. Further research is showing that the flavanols in cocoa are also good for boosting the memory and brain function in rats. Salk Institute researchers have found initial evidence that dark chocolate improves blood flow in the brain and might lead to improved memory as a result. Last but not least, chocolate is proven to induce good hormones in your body. Chocolate can stimulates the secretion of endorphins. Other than that, it also proven in producing a pleasurable sensation similar to the â€Å"runner’s high† a jogger feels after running several miles. Chocolate in other hand also contains a neurotransmitter, serotonin that acts as an anti-depressant. So, if you are in depressing mood, you may try to eat chocolate to calm yourself. It is not wrong if you want to eat chocolate if you can control the amount you take. CONCLUSION As a conclusion, it is true that chocolate have many benefits that can benefits us if we consume it. It’s also important to note that while dark chocolate could improve your overall health, too much of a good thing is not so good. Dark chocolate still contains sugars, calories, and saturated fats. Carefully monitoring how much your eat, while simultaneously cutting out another sweet from your diet or taking an extra walk around the block, will help balance the benefits and potential disadvantages of dark chocolate.

How and When Pregnancy Tests Work

How and When Pregnancy Tests Work Pregnancy tests rely on the presence of the hormone human chorionic gonadotropin (hCG), a glycoprotein that is secreted by the placenta shortly after fertilization. The placenta begins developing after the fertilized egg implants in a womans uterus, which happens about six days after conception, so the earliest these tests can be used to detect pregnancy is about six days post-conception. Wait to Take Test Fertilization does not necessarily take place the same day as intercourse, so most women are advised to wait until they miss their period before trying a pregnancy test. Levels of hCG double about every two days in a pregnant woman, so the test increases in reliability over time The tests work by binding the hCG hormone, from either blood or urine to an antibody and an indicator. The antibody will bind only to hCG; other hormones will not give a positive test result. The usual indicator is a pigment molecule, present in a line across a home pregnancy urine test. Highly sensitive tests could use a fluorescent or radioactive molecule attached to the antibody, but these methods are unnecessary for an over-the-counter diagnostic test. The tests available  over-the-counter versus those obtained those at the doctors office are the same. The primary difference is the decreased chance of user error by a trained technician. Blood tests are equally sensitive at any time. Urine tests tend to be most sensitive using urine from early morning, which tends to be more concentrated (meaning it would have the highest levels of hCG.) False Positives and Negatives Most medications, including birth control pills and antibiotics, do not affect the results of pregnancy tests. Alcohol and illegal drugs do not affect the test results either. The only drugs that can cause a false positive are those containing the pregnancy hormone hCG in them (usually used for treating infertility.) Some tissues in a non-pregnant woman can produce hCG, but the levels are normally too low to be within the detectable range of the tests. Also, about half of all conceptions dont proceed to pregnancy, so there may be chemical positives for a pregnancy that wont progress. For some urine tests, evaporation may form a line that could be interpreted as a positive. This is why tests have a time limit for examining the results. Its untrue that urine from a man will give a positive test result. Although the level of hCG rises over time for a pregnant woman, the quantity of hCG produced in one woman is different from the amount produced in another. This means some women may not have enough hCG in their urine or blood at six days post-conception to see a positive test result. All tests on the market should be sensitive enough to give a highly accurate result (~97%-99%) by the time a woman misses her period.

The Word Love essays

The Word Love essays I have never used the word  ¡Love ¡Ã‚ ¯ to my common college friends. I think that I use the word  ¡Love ¡Ã‚ ¯ to my family (parents, wife expectant baby) and my country when I was in the army; everybody will be patriot when they join the army. In most case, I do not use the word  ¡Love ¡Ã‚ ¯, especially in my college life. However, I love to say  ¡I love ¡Ã‚ ¯ sentence when I speak with English. I was in university for four years in Korea. However I had never been heard of love words and I never said that  ¡I love you, my friend ¡Ã‚ ¯. Most Korean stingy to say a love word to others, include me. Koreans feel abashed in that situation, even if they are husband and wife, most husbands in Korea do not say  ¡I love you, honey ¡Ã‚ ¯ to their wives. I am very surprised that every American people love to say love words in their life. At first, I thought that  ¡Oh, they are full of love, I already like American people! ¡Ã‚ ¯ however, they use it too much to everything. At this time, I cannot trust them when they say  ¡I love ¡Ã‚ ¯ sentence, because that most American love everything, hence I am not sure that they really love it. I barely understand that it is cultural gap between me and American friends. However, now days, when I speak with English with my friends, I usually say that  ¡I love ¡Ã‚ ¯ words. It is very comfortable way to use English; even I think that English made for  ¡Love ¡Ã‚ ¯. Every language has own specification, it is a magic of language I think. What if most people who use English do not say love word when they are talking? It will be awful; because of we already trained with the word  ¡Love ¡Ã‚ ¯ in English. I love to say  ¡I love ¡Ã‚ ¯ sentence when I speak with English, I think that is what American English is. ...

Paramilitarism Project Essay Example | Topics and Well Written Essays - 1250 words

Paramilitarism Project - Essay Example 1997 pp 1-18) The first known paramilitary law enforcement unit dates back to the Roman Empire as early as the year 6 A.D. (Sommerfield 2006) Originally made up of freed slaves, the group was formed for the sole purpose of protecting the Roman cities from fire, the group’s number and powers grew. Eventually free civilians joined their ranks and this law enforcement group elevated to elite status. (Sommerfield 2006) One hundred years later, policing evolved into a ‘head of state’ function across Europe. Lords and aristocratic figures often appointed representatives to maintain order. The English Saxons were similarly constructed. ‘Citizens were divided into groups often called tythings, each of which was headed by a tything man.’ (Sommerfield 2006) The tything groups were each part of a larger group that reported to a Shire-reeve from which the word sheriff originates. The Norman feudalism system witnessed a further revolution of the policy strategy. The tything man evolved into the parish constable who was accountable to the Sheriff who in turn evolved into the Justice of the Peace. (Sommerfield) By the 17th century policing strategies were firmly established. The police system primarily consisted of guards who were appointed from among the general citizenry. They were employed without compensation to watch the city gates and patrolled the streets on foot. As times changed, populations and economic structures grew to a point where this form of policing was no longer practical. As a result the first modern day police force was formed. This notoriety belongs to the London Metropolitan Police. Formed in 1829, the London Metropolitan Police became a model for which many commonwealth countries, inclusive of the United States of America would form their own police force. (Metropolitan Police) Paramilitary policing is not something that only came to fruition in recent years. Throughout history, there has always been a

Micro and Macro Economics Analysis of British Airways Coursework

Micro and Macro Economics Analysis of British Airways - Coursework Example Microeconomic Analysis Some of the demand and supply factors that have affected the profitability of British Airways as a company over the years include economic conditions, competition from other airlines, rise and fall in global oil prices, changes in government policy, and employees’ expenses. Economic conditions include one important demand and supply factor that affects the profitability of British Airways. For example, in the first few years of the new millennium, global recession has hit hard the company’s profitability. Generally, global recession means that the world’s economy is shrinking. A bad economy means that many people will not have a lot of money in their accounts to tour the world and in the process, affecting the company’s demand. This in the long run affects the profits of the company. Competition from other airlines is also a factor that affects the British Airways’ profitability. In the new millennium, the emergence of many lo w-cost airlines has really affected the company’s profitability by reducing the demand. ... When global oil prices rise, the cost of jet fuel, which is a by-product of the refined oil, will also rise. This will lead to a significant rise in the price of air tickets and in the long run, reducing the demand as well as the company’s profits tremendously. The vice-versa happens when the global oil prices fall. Recently, when oil prices rose, knowing that this would affect the company’s profits tremendously, BA executives took part in an illegal act of fixing fuel surcharges. This led to the fining of BA and the executives charged with a criminal act (Thompson and Martin, 2010, p.298) Government policy also affects the company’s profitability. When the government issues travel advisories to some destinations in the world due to terrorist attacks, the number of travelers to those destinations goes down and in the process reduces the company’s profits that would have been made in travels to those destinations. For example, the terrorist attacks on the W orld trade center had the government informing people of how the situation on the ground was and in the process, the number of travelers reduced tremendously bringing down the company’s profits. Employees’ expense is another factor that affects British Airways profitability. It forms a big part of the company’s costs which are later passed down to the travelers and which affects demand. For example, in 2002 when the British Airways was restructuring its business operations, it had to have 13,000 job cuts. This job cuts were an attempt by the company to cut its costs by 650 million pounds. This showed how employee expenses as a factor has a big impact on the company’s profitability (Young, 2007, p.42) Â   Â   The market structure in which the chosen company operates in is a

Professional goals Assignment Example | Topics and Well Written Essays - 1250 words

Professional goals - Assignment Example I established that the process has to be carefully managed if I am to fit into practice. Fitting in is quite difficult given the experience that I had during my placement. Fitting-in is a complex process requiring support from peers and the experienced nurses. However, I believe that with the correct mindset and determination together with support from experienced nurses, I can manage the transition. Duchscher (2008) argues that the graduate nurse is usually faced with a reality shock that comes from the discrepancy between what the draduate nurse has learnt in the classroom and what is actual or real in a health care setting. The graduate nurse in this case feels a sense of groundlessness. The resulting problems include anxiety insecurityand a feeling of inadequacy . Dyess and Sherman (2009) says that the problem is even more serious today because of the fact that the graduate nurse can take the licensure examination moments after graduation and enter into practice as a fully regist ered nurse in a matter of weeks. This is different from the earlier case where graduate nurses would get a temporary licence as they work with experienced nurses for a few months. According to Cubit and Ryan (2011), the situation is not completely out of hand and can be mitigated through proper support programs especially through Graduate Nurse Programs (GNP) that are provided by the health care organizations. This strategy will only be effective if it is not approached from an inculturation approach but rather a support and socialization approach in order to help the graduate nurse to fit in the system. I realized that it was not possible to do it on my own by moving straight into practice as I had little knowledge on the transition process and I was not aware about the graduate nursing programs available in my hospital setting. I would be in a better position if I developed the following †¢Reading more on the topic †¢Asking about other people’s experiences in orde r to learn from them †¢Find out the graduate nursing programs available at the hospital †¢Establish factors that contributed to my inability to fit-in and seek ways of mitigating them In order to know whether I gained from the learning or not, I will look at: †¢My transition process and establish whether it was successful or not †¢My knowledge of the transition process and if I can help others go through it †¢My understanding of the hospital graduate nurse programs The Nurse as a leader A leader is a person who is always looked at by others to provide guidance in situations of need. Being a leader is not a simple process and requires that one has an understanding of various issues around him or her and the people around him/her. I think that being a leader has to do with skills and capabilities that one has. It is thus not possible for anyone to be a leader. Leadership as a nurse is crucial in order to enhance patient care. I observed this during my placemen t as I got to understand what roles and responsibilities a nurse leader undertakes and how to effectively handle leadership roles. Nursing leadership is not a recent phenomenon. It is something that has been discussed for a while now (Stanley and Sherratt, 2010). The benefit of nursing leadership is seen in activities such as administration, education,

Operation Iraqi Free

Operation Iraqi Freedom Essay The relationship between the United States and Iraq has been a rather complicated relationship. This relationship can be classified as a roller coaster ride that last through out history. The United States and Iraq relationship became rocky in 1958 when King Faisal was overthrown and Iraq signed with the Soviet Union. Because of the relationship that the United States had with the Soviet Union this made Iraq and the United States relationship a little questionable. In 1967 Iraq broke all ties with the United States when they decided to join ranks in the protest of the United States and Israeli strategic alliance. This decision that the Iraqi made once a country we were allies to a country we do not trust but we will deal with, a country that became a server threat to the United States. However, when Iraq needed us to help them stand against Iran, the United States was there. Regardless of how shady the relationship was with Iraq, the United States saw Iran to be more of a threat then Iraq. Prior to this the United States had removed Iraq from the State Department list of state that sponsors terrorism. The United States did all this in hope of a closer relationship with Baghdad, Iraq. This step the United States made to get closer to Baghdad is what opened the door for the United States to have access to Iraq. By November 1984, the relationship between the United States and Iraq had been at full diplomatic. Needless to say, the United States did not full trust Iraq but did not see them as a serious threat. Iraq continuously showed the United States that they could not be trust by committing various acts against the United States in a way that seemed to be unnoticeable. On March 17, 1987, the Iraqi’s seem to have accidentally hit a United States ship, mistaking it for the USS Shark, this â€Å"mistaken† identify caused the like of thirty-nine American sailors. As if that was not enough, in June 1982 the assassination of the Israel’s ambassador to the United Kingdom, Shlomo Argov, was link to Iraq. The United States, although in what seemed to be a peaceful relationship with Iraq, still believed Iraq to be a sponsor of terrorism. The United Stated did remove Iraq from the list, however it was not necessarily done because of belief that Iraq was not sponsoring terrorist but it was done in the exchanged for expulsion of Palestinian terrorist Abu Nidal. The United States did not doubt that Baghdad was sponsoring terrorist, and the United States was completely right in their thinking. In 1985, Iraq shelter terrorist that was involved in the hijacking of the Achjille Lauro cruise ship and the murder of the wheelchair-bound United States citizen Leon Klinghoffer. Also two terrorist that had planned an attack was held in Rome on their way to the United States. Yet still the United States did not see Saddam Hussein and his regime as a serious threat. Prior to Desert Shield and Desert Storm, Iraq had destroyed the Iranians in April-July 1988 and the United State quickly disengages with Iraq. The overthrow of Iran brought power to Saddam Hussein and his regime that was not there prior to the Iran-Iraq war. During the war Kuwait allow Iraq to borrow seventeen billion dollars, but instead of Saddam Hussein paying it back like Iraq agreed to, he decide to tell Kuwait to right it of because they owned Iraq for protecting them from Iran. Iraq since 1961, when the British ended it’s protectorate in Kuwait, it was then that the Iraqi government claimed Kuwait was an â€Å"integral part of Iraq† (6). If it was not for Britain, Saddam Hussein would have taken over Kuwait in July 1961, so Iraq has had the idea of controlling Kuwait for quit some time, therefore the idea of Kuwait being in debt to Iraq for protecting â€Å"Kuwait† was just a way that Saddam Hussein was using to cause Kuwait to surrender to him. The United States was ready for the invasion of Kuwait by Iraq, so ready that the military was playing war games to train for it and in the middle of training the United States started to see the Armed Forces war games play out in real life. On August 2, 1990 Iraq started to make their move to attack Kuwait. Iraq’s war plan was to kill the royal family or Kuwait, in so they attacked reclaim royal palaces and the Dasman Places. On that same day by eight o’clock that morning Iraq had completely invaded Kuwait City, however the Kuwait royal family was able to escape due to the Emiri Guard delaying actions. This invasion on Kuwait allowed Saddam Hussein to have control or five percent of the world’s production and 19.6 percent of proven global reserves (10). As a result of this attack and take over of Kuwait, Iraq was in serious challenge to the 1980 Carter Doctrine that said, â€Å"any attempt by any outside force to gain control of the Persian Gulf region will be regarded as an assault on the vital interests of the United States of America. And such an assault will be repelled by any means necessary, including military force† (10). The Kuwait attack is the reason that the relationship between Iraq and the United States went bad, clearly the relationship was unstable from the beginning, and Saddam Hussein had proven time and time again that he could not be trusted so no one wanted to trust him with so much control over the world’s oil. This invasion of Iraq on Kuwait was the start of the building of Operation Desert Shield. Operation Desert Shield officially started on August 7th 1990 when United State aircraft started to arrive in the Gulf. The mission of the United States was to go in a liberate Kuwait, and their plan in doing so was to attack the Iraqi Army along the boarders of Kuwait and Iraq. In this attack it would deliberately keep the pressure up all through the night allowing the United Stated to by time on the â€Å"Time-on-Target† (14). Operation D3esert Shield was known as D-Day, This plan where complete on August 20th, and some of the other plans were for United States aircraft making and â€Å"hard initial thrust† against the Iraqi forces for the first seven hours the invasion. Also the plans that the United States had was to provision for land-based aircraft to relocate while the aircraft carriers USS Eisenhower and Independence (14). Operation Desert Shield lasted until October allowing all the aircraft to take their places and get ready for the start of Operation Desert S torm. Operation Desert Storm began January 17th, 1991, with the same mission to go in and set Kuwait free, for their royal family was working as custodians of Islam’s holist shrines, Makkah and Medina. The first weapon that was launch in Operation Desert Storm the TLAM that came from the Red Sea headed towards Baghdad. However it was not the first to hit anything, the Hellfire missile was the first to make an impact causing a gap in the Iraqi’s surveillance radar and the boarders of Saudi Arabia. It also had many more successful hits. Operation Desert Storm lasted forty-three days before the United States. February 7th, 1991, the United States was jointed by Joint Special Operation Task Force with the British. The DIA claim that only sixty Scuds was destroyed and most appeared to be ones of commercial articulate. On the 30th of January there were a number of Jordanian trucks that was hit and destroyed. The Unite States has did not claim collateral damage until 1992(67). During Operation Desert Storm on January 30. There was major collateral damage when the United States tried to hit Tigris Bridge and by mistake hit the Iraq Central Bank. Things may look to have gone perfect but a lot of the outside, but the United States there were a lot mistakes that was made. On February 25th 1990 this was the day the ground war took place, this day is known as G-Day. The day before, February 24th, the marine forces and two Islamic corps began diversionary attacks into the Saddam Line. The XVIII Corps launched a deep thrust towards Highway eight, and by the end of the day marine and Islamic forces had breached the Saddam Line and air mobile XVIII Corps forces had established forward operating base, known to this day as FOB, Cobra more then 280 kilometers inside the Iraqi boarders. This was known an Operation Desert Saber. During the ground war there were steps taken to ensure that the possibility of fratricide would be lower. The first step was related specifically to friendly fir between ground units. In order to do this GPS equipped units had to ensure that they were correctly aligned with their unit boundaries and were not moving or shooting over those boundaries. Secondly, Coalition units sacrificed precious seconds to ensure positive identification of targets, sometimes pausing six to ten seconds to be sure it was the Iraqi’s or allowing them to get close enough to get a clear visual identifying it was the Iraqi’s(105). On February 1991, Kuwait was completely set free, and although Operation Desert Storm only last a short time, the conflict with Iraq had never can to an end. Many things went on between the United States and cease fire that take place on March 3. Saddam Hussein he was really upset with the United States for innerving with his attempt to take over Kuwait. He was upset that the United States came in a liberated Kuwait from the Iraqi’s. This rescue mission was not just about free Kuwait but it was also about, taking away the power Saddam Hussein had gained room to take over in Iraq No one wanted to see a man who had proven too many countries time and time again that he is a man that can not be trusted at all . The time after Operational Desert Storm until the Operation Iraqi Freedom, was not a peaceful journey for the United States. Because of Saddam Hussein’s angry with the United States; the United States has suffered many attacks from Iraq. After the war the United States came in control of the airspace over the boarder of Saudi Arabia. This area was continually attacked by Saddam Hussein in this area. In September 1990, United States Air Force Brig. Gen. Bustert Glosson remains in the Saudi Arabia area to take command of the Special Planning Group that had developed a new integration of Instant Thunder which is now known as Offensive Campaign-Phase One. The mission of Instant Thunder Phase One was to reduce the strength of Iraqi’s deviations and there should be no diversion of air strikes against fielded armed force. The Saddam Hussein regime, the Baathist, the one that would give the most trouble was \ after Operation Desert Storm in March 1990 went from it survival tactics to becoming a resistant regime. From July 23, 1992, the Iraqi’s began to launch air attacks and continued to increase between the months of April and August, showcasing Saddam Hussein’s freedom of action. It was during this time that the United States, Bush distraction formed the â€Å"no-fly zone† Every since both of the no-fly zone in both the north, formed April 1991 and the south, formed in August 1992, was formed Saddam Hussein main goal had been to shoot down a United States aircraft using a mix of aerial and SAM forces(131). During this time Saddam Hussein was building his forces and he began to fly his aircraft in the no-fly zone, on January 6, 1993 Present Bush gave Iraq forty-eight hours to remove there aircrafts from the no-fly zone, Iraq to back away and removed their SAM from the area. However Saddam sent unarmed men into the United Nations’ zone to recover an aircraft that was lost in Desert Storm. The HY-2 Silkworm was no longer theirs it was suppose to go to Kuwait, this breach into the zone that separated Iraq from Kuwait is was started the first war between Operation Desert Storm and Operation Iraqi Freedom. The first attack on Iraq since Operation Desert Storm was Operation Provide Comfort. One of the mistakes of Operation Provide Comfort is it was unsuccessful because the United States decided to attack anyway with out being able to visional see the target. On January 11th and 12th the weather was bad and they were unable to see but because they were running out of time, the United States attacked anyway on January 12th. Once the United States was able to see what targets was hit, they quickly learned that it was a bad mission, out of the thirty-three targets only sixteen had been hit. On August 31st, an Iraqi armored spearhead thrust northward into the Green Lines and this action cause once again another attack on Iraq, Operation Desert Strike. From this point there have been countless attacks on Iraq due to Saddam Hussein’s many attempts to destroy the United States. Saddam Hussein has attack many of the United States’ U-2’s that were guarding the no-fly zone that he continually violated. Operation Desert Thunder I, II, and IV was all organized because Iraq kept violating the no-fly zone rules. However Saddam Hussein had a stagy known as â€Å"cheat and retreat.† By this time the UN had set up inspections throughout Iraq in search of Weapons of Mass Destruction (WMD) On many occasion Saddam Hussein would deny the inspectors access to certain places then when the United States were about to take action Saddam Hussein would retreat and back down. Saddam Hussein had used the cheat and retreat tactic so much that finally the Clinton administration took action and Operation Desert Fox took place. Because of so many times that Iraq would back down once the United States had spent money to deploy troops, the United States decided to make Operation Desert Fox a surprise by not deploying any more troops in the area only using the troops that was already in theater. This Operation started on December 18-19 as a successful mission; however things did not go all well because the United States received the wrong information about the where about of Saddam Hussein and his family. The United States was told that Saddam and his family would be at one of his wife’s places, Dora, but it was empty and had been for sometime. There were many other events that lead up to Operation Iraqi Freedom, but what push the limit for the United States was the events that took place on September 11. 2001 at 0730 Baghdad time a Predator was lost while flying a reconnaissance mission, making it the second to be lost in a few weeks time the first was shoot down. Also on this day nine hours later the first plane hit the north tower of the World Trade Center. The U.S. had enough of Iraq, all the trouble they have had with Iraq, the hit of the tower, on the U.S. soil was a wake up call. So on March 21 Operation Iraqi Freedom began. After Operation Iraqi Freedom, the relationship between the U.S. and Iraq seems to be at better standing and once again with the destroying of Saddam’s regime and the capture and execution of Saddam Iraq seems to be on good terms with the United States and now seems to be working for the same goal.

Systematic Review of the Mental Health Review Tribunal

Systematic Review of the Mental Health Review Tribunal A Systematic Review of the Mental Health Review Tribunal: Processes, Roles and Impact 1. What is the Mental Health Review Tribunal? The Mental Health Review Tribunal is a collection of independent judicial bodies that aim to review the cases of suitable applicant patients who have been appropriately detained under the Mental Health Act 1983[1]. Following strict guidelines and statutory criteria for discharge, collectively, members of the tribunal have the power to direct the discharge of applicant patients who satisfy the relevant discharge criteria. According to the official website of the tribunal (Mental Health Review Tribunal[2]), its other principal powers are: To recommend leave of absence from employment or school as appropriate To recommend supervised discharge To recommend transfer to other hospital or relevant health care professional To issue directions regarding procedural matters To reconvene if any of their recommendations from a past Tribunal hearing is not complied with In general, the Mental Health Review Tribunal serves as a safeguard against wrongful admission or unwarrantedly long detention (Wood, 1993[3]). As such, they give detained patients access to an effective appeal mechanism in order to ensure, as far as possible, legal protection of their liberty. All this is carried out in accordance with the Human Acts Right. There are five Tribunal offices in the United Kingdom (Mental Health Act 1983; Memorandum on Part V[4]). Each region in England is operated under a separate MHRT and a separate Tribunal covers the whole of the country of Wales. Accordingly, there are five Tribunal offices that provide administrative support to the respective MHRTs. The MHRT operates under the provisions of the Mental Health Act 1983 and the Mental Health Review Tribunal Rules 1983 (Her Majesty’s Stationery Office, 1983[5]). The powers and duties of the Tribunals are as set out by the Mental Act 1983, subsequently amended in the ensuing policy document, the Mental Health (Patients in Community) Act 1995. The actual Tribunal process usually takes place in the hospital where the applicant patient is being retained, and is usually held in private, unless otherwise agreed by the patient in question and the members of the Tribunal. The actual processes and review procedures of the Tribunal are defined in the Mental Health Review Tribunal Rules 1983 (Her Majesty’s Stationery Office, 1983); similarly, this has also been amended to a more current version. Tribunal procedures and deliberations should always be carried out in accordance with the principles of the statutory instrument and the principles in which the other subgroups operate when considering Definitions, Guardianship and the Mental Health Commission under the Mental Health Act. These include: Non-discrimination Equality Respect for diversity Reciprocity Participation Respect for carers Least restrictive alternative and informality Respect for rights All patients that have been detained under the Mental Health Act 1983 or that are eligible for guardianship or supervised post-discharge care have the fundamental right to appeal, i.e. to apply for a review by submitting an application to the Mental Health Review Tribunal, within the specified time limits as specified in the Mental Health Act. Furthermore, in order to ensure regular reviews of all cases, if the patient fails to make such an application the Tribunal, the appropriate body or personnel is obliged to make a referral of the case to the appropriate regional Tribunal. The party responsible for making this mandatory referral differs for various patients and depends on the restriction status of the patient (discussed further in section on types of patients): In the case of restricted patients, it is the responsibility of the Secretary of State for Justice to refer the case to the Tribunal In the case of non restricted patients, the onus falls on the hospital managers In a review of Representing the mentally ill and handicapped (Gostin and Rassaby, 1980[6]), the authors who are incidentally representatives of the National Association for Mental Health (MIND), highlights the unmet need for legal representation for applicant patients at Tribunal hearings of over 20,000 patients annually. However, as pointed out by John Hamilton (1980)[7] of the Royal College of Psychiatrists, 90% of these patients are, in fact, on short term detention orders and remain as informal patients after the expiry of the said order. In fact, a great majority of patients are compulsorily detained only for very short period of times and (from 72 hours to 28 days) and may not be eligible for a review process during that limited amount of time (Rollins, 1980[8]). As a result, the informal status of the applicant patient is very important because most of the hospitalised mental health patients in England and Wales are informal (Andoh, 2000[9]). Thus applying one safeguard provid ed in the Mental Health Act 1983, less than 10% of mental health patients who are compulsorily detained have a statutory right of appeal from an independent Mental Health Review Tribunal. In Gostin’s replying correspondence (1980[10]), he revisits the Percy Commission, and emphasises the glaring discrepancies in expected and actual rates of Tribunal hearings. According to Gostin (1980), the Percy Commission envisioned that there would be approximately 8000 ­ – 9000 Tribunal hearing every year. However, in reality, there norm is a figure of about 750, with the maximum ever annual rate being 1515 hearings. As a consequence, most Tribunal members hear only one or two cases each year and thus do not have the opportunity to garner experience and familiarity with a diverse breadth of cases that would have been beneficial to improve future judgements. In the past two decades though, there has been a major increase in the number of applicants to the Tribunals (Crossley, 2004[11]). In fact, as reported by Blumenthal and Wessely in 1994[12], applications to the Tribunal rose dramatically in the 10 years between 1983 and 1993, with the figure approaching 10,000, i.e. almost a three-fold increase since 1984 and costing approximately 12 million pounds ( £). 2. Mental Health Legislation Mental health legislation in the Commonwealth countries is changing in some common law jurisdictions (Carney 2007[13]). There is an increasing debate on whether it is, in fact, a health or legal issue and certain schools of thought question the need for special legislation in the present day. There is controversy over the non-therapeutic nature of criminal law, especially in its sentencing and penological aspects; can the inherent workings of law ever be adjusted to incorporate the perspective of therapeutic jurisprudence (McGuire, 2000[14])? Furthermore, some critics also question the beneficial role of Tribunals or legal adjudication of the detention requirements. The very fact that the term ‘detention’ is used to describe the process of admission of these often vulnerable patients is probably evidence of the need for legal contribution. As mental health patients are frequently prone to violence and can be considered a risk to the public and themselves, it is evident t hat both disciplines of health and the law need to collaborate to achieve optimal long-term management of this population. 2.1 The Mental Health Act 1983 The Mental Health Act 1983 provides legislative guidance for the compulsory ambulatory assessment, care and treatment (i.e. the overall management in hospital) of patients with a mental disorder. In the Mental Health Act document mental disorder is defined as â€Å"mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of mind†. As an amendment from the Mental Health Act 1959, the 1983 policy document requires that in order for a patient to fall within the criteria for ‘severe mental impairment’ or ‘mental impairment’, the patient in question has to be associated with abnormally aggressive or seriously irresponsible behaviour (Singh, 1984[15]). This definition excludes an appreciable amount of severely impaired or impaired mental health patients that are neither ‘abnormally aggressive’ nor ‘seriously irresponsible’, and thus these equally vulnerable patients rema in unprotected under the amended Mental Health Act 1983. Thus it would appear that the definitions of, under the Mental Health Act 1959, of severe mental subnormality and mental subnormality would be more considerate and fair towards such patients, as it certainly encompassed in the definition the vulnerability of this mental health patient population (Singh, 1984). In part, the Act states that, ‘severe subnormality being of such a nature or degree that the patient is incapable of living an independent life or of guarding himself against serious exploitation or will be incapable when of an age to do so, and in the case of mental subnormality of a nature or degree which requires or is susceptible to medical treatment or other special care or training of the patients’. Thus the recommendations outlined herein in this document apply not only to patients suffering from ‘more violent mental disorders’, but also vulnerable patients who may find it difficult to express their various needs, or who in some extreme, cases, may not even recognise that they need specialist help. It has been proposed that mental health should be given the same priority as physical health (Kmietowicz, 2005[16]). Application of the 1983 Act should also take into consideration exclusions from the definition of ‘mental health’, as set out in Section 1 (3) of the Act. This section of the policy document states that a person should not be treated under the provisions of the Act, if they are suffering from mental disorder purely by reason of promiscuity, other moral conduct, sexual deviance or substance misuse, including dependence on alcohol or drugs. However, the Act recognises that such behavioural problems as listed above may be accompanied by, or assoc iated with, mental disorder, and as such should be overlooked in its entirety. Real life experience apparently shows that the Act is usually fully implemented with appropriate communication and collaboration between the various disciplines involved (Ourashi and Shaw, 2008[17]). A recent of judicial practice and assessment of risk to the public in detained individuals, based on Sections 37/41 of the Act, showed that, in addition to the primary need to protect the public, an additional and almost equally important intention was to ensure compliance with both after-care services and medication. In the study sample, which was made of 12 judges from crown courts in England, it was found that restriction orders were rarely made contrary to the recommendations of the affiliated medical practitioner. It is worthy of note to consider that the recent Mental Health Act of 2007 have introduced some important modifications to core recommendations and standard roles and responsibilities of mental health practitioners (Kousoulou, 2008[18]). These amendments perhaps gain even more importance when we consider the revolutions that have occurred in psychiatry since the original Mental Health Act 1983 was implemented. Of particular importance, is the notion in 1983, that there was no link between mental illness and violence which has now since been proved invalid (Monahan 1992[19]). From October this year (2008), the Mental Health Act 2007 will be fully implemented in the procedures associated with the Mental Health Review Tribunals. 2.2 The Mental Health Act 2007 Amendments to the 1983 Mental Health Act policy document in the Mental Health Act 2007, which are directly related to any aspect of process of the Mental Health Review Tribunal and outlined topline below (Office of Public Sector Information, 2007[20]): Removal of categories of mental disorder: the key definition of ‘mental disorder’ is amended from that which is outlined in Section 1 (2) of the 1983 Act. For the definition of ‘mental disorder’ and mentally disordered’, substitute ‘mental disorder’ means any disorder or disability of the mind; and ‘mentally disordered’ shall be construed accordingly’. In addition the following statements are omitted in the recent amended version: Those of ‘severe mental impairment’ and ‘severely mentally impaired’ Those of ‘mental impairment’ and ‘mentally impaired’ That of ‘psychopathic disorder’ Amendments to the section on the Mental Health Review Tribunal include specific issues related to: Patients absent without leave Duty of hospital managers to refer cases to the Tribunal Power to reduce periods under Section 68 Restriction orders: in relation to restricted patients Conditionally discharged patients subject to limitation directions 2.3 The importance of making the right decision There have been reported cases of mental health patients who commit suicide within a mere 12 months of contact with mental health services. For example, in a national clinical survey that was carried out in England and Wales, over 2,000 mentally impaired suicide victims had had previous contact with mental healthy services in the year before (Appleby et al, 1999[21]). A review by mental health teams concluded that suicide could have been prevented in more than 20% of these cases. In conclusion, the researchers made logical recommendations for suicide prevention measures in mental health services, including strategies to improve compliance and sustain contact with the appropriate mental health services. In addition, there is also the additional threat to the innocent people of the public. The perceived threat of mentally disordered patients, who have been released from detention, to the public has been explored severally (Norris, 1984[22]; Buchanan, 1998[23]; Jamieson and Taylor, 2002[24]). In fact, several years ago, in New Zealand, there was a controversial case of a mental health patient who committed murder six hours after being released from detention (Zinn, 2003[25]). Interestingly, the said patient was found not guilty of the murder by reason of mental illness. Furthermore, the patient was awarded compensation of the value of  £300,000 after he sued the health authority for failing to detain him as an involuntary patient under the Mental Health Act. As such, it is evident that there are many incentives here for ensuring that the right intervention is applied to the right patient. 3. Members of the Tribunal: The Relevant Stakeholders Essential members who must be present at each Tribunal hearing are (Mental Health Review Tribunals website) include: The regional chairmen A legal member A medical member, and A lay member For each geographic region, the Lord Chancellor makes appointments and decides who sits on the different panels. For the other members other than the legal member (i.e. the medical and lay members), the Secretary of State for Health, for cases in England, and the Secretary of State for Wales, for cases in Wales, are also consulted in the decision making process. Each member has a specific and individual role in the co-ordination of the Tribunal hearing. In addition to the essential Tribunal members outlined above, there are other stakeholders involved in the long-term process of the review process. These could be private non-governmental organisations, such as the National Association for Mental Health (MIND). Whether these members are salaried or not is usually discretionary, but the norm is that there is no salary payable, but that members receive an attendance fee and travel and subsistence allowance. On the contrary, the Tribunal chairman is a salaried role. 3.1 Role of the regional chairman A regional chairman is appointed for each of the two Tribunal regions in England: the North Region and the South Region, which are conveniently based in Manchester and London, respectively. The roles of the regional chairman of the Tribunal are multi-factorial and include (Mental Health Review Tribunals website): The regional chairman appoints specific members to particular Tribunal hearings The regional chairman has the responsibility of ensuring that all the statutory requirements are complied with, making judicial decisions and giving necessary direction a timely and fair decision is reached in each and every case The regional member is also responsible for organising training for the members of the Tribunal to ensure that all members have the updated skills and knowledge that would be necessary to effectively carry out their individual roles It is the role of the regional member to oversee the appraisal mentoring scheme of the members of the Tribunal, thus highlighting training needs (see point above) to continually improve the review process The onus also falls upon the regional chairman to handle any complaints about the conduct of any members of the Tribunal, or to refer the case to higher authorities if warranted 3.2 Role of the legal member The legal member, more often than not, presides over the Tribunal hearings. Legal members of the Tribunal are usually elected or appointed on the basis of their specific expertise in the particular area of jurisdiction (Ferres, 2007[26]). They are required to â€Å"have such legal experience, as the Lord Chancellor considers suitable† (Department for Constitutional Affairs, DCA[27]). In addition, interpersonal skills and a good understanding of the health system are crucial as fundamental qualifications of the Tribunal legal member. The official website of the Mental Health Review Tribunal provides relevant specific information on the requirements of becoming a legal member and outlines the roles of the legal members as: The legal member acts as President of the Tribunal. Revisiting the primary role of the MHRT, which is to review the legality of the applicant patient’s detention in hospital and to direct the discharge of those to whom the statutory discharge criteria apply; and to safeguard the patient’s fundamental human right to be free from unjustified hospital detention (Richardson and Machin, 1999[28]), it is evident that this process is essential a legal one. It is thus only logical that the Tribunal be presided over by a member of the legal profession. In addition, the legal member of the Tribunal has the responsibility to ensure that the proceedings of the review process are carried out in a fair and balanced manner. The legal member is also responsible for ensuring that the legal requirements of the Mental Health Act are properly observed The legal member of the Tribunal also has the role of advising and addressing any questions of law which may arise before the hearing, during the hearing and during the deliberation discussions with the other members of the Tribunal In collaboration with the medical member and the lay member of the Tribunal, the legal member is also responsible for drafting the reasons for the reached decision, and for endorsing the record of the agreed decision One of the major that the legal members of the Tribunal face is the danger that the medical member could dominate what must essentially be a legal process (Peay, 1989[29]). 3.3 Role of the medical member As stated above, a medical practitioner is one of the necessary members of the Tribunal and their role, though clearly invaluable, is fraught with opposing views from the multidisciplinary stakeholders in the field. In 2000, Gibson[30] proposed that the role of the medical member was introduced in the 1959 Act to make the process of medical notes review less arduous â€Å"without ruffling medical feathers†. However, according to Prins (2000[31]), the origin of the required disciplines to sit in Tribunal hearings is much more complex than that, as there were conflicting views that arose during the parliamentary debates leading up to the 1959 Act, as to who was best suited to make that all-important decision regarding the patients’ release or continued detention. It is worthy of note, here, that in those early legislative days, the commonplace law was one which involved a purely judicial decision, which probably explains the disinclination to acknowledge the need for a me dical aspect in the decision making process. The medical member could be the patient’s treating psychiatrist, a nurse or any other member of the mental health team. According to the Mental Health Review Tribunal website (Mental Health Review Tribunal), the medical member is customarily a consultant psychiatrist with several years of extensive experience who is able to advise other members of the Tribunal on any relevant medical matters that should be taken into consideration in the patient’s review. There is evidence that the dual role that is expected of medical practitioners on the Tribunal is a potential barrier to having the fairly balanced and effective hearing that is the main objective of the review or appeal process. As with the legal member and all other members of the Tribunal board, interpersonal skills and a good understanding of the relevant health system are important for all Tribunal members (Ferres, 2007). In addition to this fundamental criterion, Ferres (2007) emphasises the dilemma that is brought upon the medical member as a direct consequence of his/her role as a medical practitioner and a sitting as part of the Tribunal. According to the official website of the Mental Health Review Tribunal (Mental Health Review Tribunal), the basic roles of the medical member of the Tribunal can be categorised as outlined below: Medical role: this member is required to carry out an examination of the patient before the hearing and, in so doing, make any necessary interventions – or simply make any necessary steps – that could potentially aid the decision making process in forming an opinion of the patient’s mental health condition. This is clearly in accordance with Rule 11 of the Mental Health Review Tribunal Rules (Her Majesty’s Stationery Office, 1983), which requires the medical member of the Tribunal to â€Å"at any time before the hearing†¦examine the patient and take such other steps as he (or she) considers necessary to form an opinion of the patient’s mental condition†. Judicial role: the medical member, together with the other members of the Tribunal, have a judicial responsibility to decide the patient’s fate, in terms of if the patient could still represent a danger to self or others and should thus remain in detention, or if the patient is suitably fit to be released into the public domain. Researchers in the past have shown that the duality of their roles on the Tribunal need not lead to knowledge bias, which could cause a flawed opinion (Langley 1990[32]; Brockman B; 1993[33]). However, in drastic contradiction to this, some more recent opinions expressed by critical schools of thought believe that the dual nature of the expected medical member’s role is a possible barrier to open-mindedness (Gibson, 2000; Richardson and Machin, 2000[34]). The, somewhat logical, fear is that doctors’ judicial opinions of patients’ eligibility for release would undoubtedly be swayed by findings from their preliminary observations and assessments. Apparently, for the review process to be carried out fairly, medical members of the Tribunal should strive to make their decisions based only on reports, evidence and witness and patient reports that presented to them during the Tribunal hearing. As such, any details divulged by the patient prior to the Tribunal hearing sh ould not be considered as evidence and must not be taken into account. Similar to this notion, the Law Reform Committee, in 1967, recommended that a doctor should not be compelled to give evidence of issues that he may have had access to with the patient that have no bearing on the patient’s mental or physical health (Law Reform Committee, 1967[35]). Putting it logically, general human nature may well be a barrier to such sentiments. Having conducted an examination of the applicant patient, and presumably consequently forming a clinical opinion, the medical member of the Tribunal is expected to morph into a decision making member to attend the review hearing. As the Council of Tribunals have very aptly described it, the medical member is â€Å"effectively a witness and a member of the Tribunal, deciding the validity of his own evidence† (Council on Tribunals, 1983, paragraph 322[36]). The unanswered question, thus, is: how can the medical member be expected to detach his previous medical knowledge of the said patient from evidence that is presented in the Tribunal and remain objective in his opinions and, if this distinction is necessary, does the inherent benefit of the preliminary assessment then become invalid? These questions also corroborate the idea of the protection of the doctor’s professional confidence una voidably conflicting with the interest of justice (No authors listed, 1967[37]). However, in his correspondence to the editor of the British Journal of Psychiatry, Gibson (2000) stresses the inherent advantages of the preliminary examination prior to the Tribunal hearing. The main benefits are outlined below: The preliminary examination session gives the medical member a chance to review the applicant patients’ clinical notes which may contain crucial data and clinical findings that are omitted from the reports The preliminary examination session also prepares the medical member to ask the most appropriate questions at the hearing, thus ensuring that the benefits of the review process is optimised Furthermore, Gibson (2000) has suggested that, in order to eliminate the potential prejudice that could accrue from the preliminary assessment and the associated disadvantage of the often time consuming nature, that the applicant patients’ notes should be made available to all of the Tribunal members in the half hour before the Tribunal hearing is scheduled to take place, thus dispensing with the need for the historical preliminary examination. The limitations of this proposal, as succinctly put forward by Prins (2000) are two fold: As we all know from our practical clinical experience, in many cases, medical notes are too voluminous and complex to do a proper review in half an hour. In some cases, it would take days to form an understanding of the contents of such files. Also, the feasibility of medical notes review by all members of the Tribunal is doubtful. Without a certain degree of medical expertise, it would be near impossible for the two non-medical members of the Tribunal to comprehend the contents of the applicant’s patients’ medical notes. This would then necessitate the additional step of medical interpretation for the benefit of these members, leading to longer duration of the review process, and thus, increased costs and burden on the health system. 3.4 Role of the lay member According to the official Mental Health Review Tribunal website, the lay member of the Tribunal serves to provide some form of balance to the Tribunal as a representative of the community outside the dominating, and often clashing, legal and medical professions. Normally lay members would have a background or practical experience of working in the health and welfare field in the National Health Service, voluntary organisations or private health sector. The lay member may also be experienced in social services on administration (Lodge, 2005[38]). 4. Other stakeholders involved in the Mental Health Review Tribunal 4.1 Legal representation for the mental health patient In addition to the legal member of the board, legal representation is usually advised for the patient. A legal representative can be useful to explain the law to the patient and help to protect his or her best interests (Mental Health Review Tribunal website). As a matter of circumstances, the mental health patient’s handicap or mental illness, coupled with the possible effects of having been institutionalised and various antipsychotic medications, make self-advocacy invariably difficult (Gostin, 1980). These patients do, however, have the right to choose to represent themselves; nevertheless, this option is not advisable. Furthermore, Larry Gostin of the National Association for Mental Health (MIND), in London, goes on to convincingly justify the need for legal representation for the mental health patient. Patients who attend the Tribunal without legal representation are frequently denied access to the full reasons for his confinement and subsequent decision, and medical and social reports pertaining to his or her case may be withheld from the patient as confidential (Gostin, 1980). When a legal representative is involved and present during the hearing, he or she is party to all relevant documents and can share the information with the client (in this case, the mental health patient). Another even more important advantage of having legal representation is the ability of such a legal professional to examine provision in the community for housing, care and support. Thus as highlighted above, the benefit of legal representation for the mental health patient in the Tribunal cannot be overemphasised. This calls to question the ethics of the preliminary examination session, during which the vulnerable mental health patient is examined by the medical member of the Tribunal towards forming an opinion of his or her ment