Select a side ( prosecution or defense) and write a paper arguing for Essay

Select a side ( prosecution or defense) and write a paper arguing for your side based on the facts of the case, the relevant law - Essay Example Most of the evidences presented in the court of law firmly advocated that Ms. Johnson was guilty of killing Michael Thomas. In accordance with the case, it can be viewed that Michael Thomas, a 25 year-old man, was killed from being stabbed once directly in the heart that led to his death. It is further observed that at the time of his death, Michael Thomas was dating Kim Johnson’s sister, Latrice for a couple of years. Furthermore, he used to be violent and abusive at the time when he was drunk. Such acts of Michael Thomas have previously resulted in generating several domestic disputes with Latrice. On the night of the incident of alleged murder, Michael Thomas came to the apartment of Kim and Latrice to meet Latrice. Contextually, Latrice refused to meet him but still Michael Thomas and his friends continued to stroll around the building premise. Eventually, Ms. Johnson came down from her apartment and engaged in a heated argument with Michael Thomas. Moreover, during the ar gument threats were exchanged between the two. Ms. Johnson had a steak knife with her which she brought from her apartment. Subsequently, when Michael Thomas moved down close to the end of the fence and attempted to climb it, Ms. Johnson ran towards him and stabbed the steak knife directly into his heart which eventually caused his death. Thus, it can be affirmed that Ms. Johnson should be penalized for her act of 1st degree murder related to the killing of Michael Thomas. Statement of Law-Explanation of the Relevant Law in the Case 1st degree murder is defined as an act of killing which is both premeditated along with deliberate. In order to penalize an individual as guilty of first degree murder related to the killing of a person, there is a requirement of three basic elements to be considered that include willingness, deliberation along with premeditation and malice. In this similar concern, the term ‘willingness’ in the context of 1st degree murder specifies that th e act of homicide is committed with the intention of ending a human life. Similarly, the terms ‘deliberation’ and ‘premeditation’ is correlated with the conscious intention to kill a person prior to the murder. Furthermore, the law governing 1st degree murder charge asserts that it must have malice. Correspondingly, malice generally includes an evil disposition or purpose which tends to harmfully affect human life (Thomson Reuters, 2013). A law related to the case can be recognized as an affirmative defense. Affirmative defense is a kind of legal defense which is recognized by criminal law. Affirmative defense is categorized into two groups that include: justifications and excuses. In this context, the aspect of justifications aims to argue that the act committed by an individual is not wrong and thus it is quite justifiable under certain given circumstances. Self-defense is categorized as one of the decisive aspects of the justification defense. Self-defen se is determined as any countermeasure which facilitates to defend oneself from harm. Similarly, an excuse defense advocates that even though the act committed by an individual was wrong but there lays certain excuses for the defendant (Croddy & Hayes, 2012). Argument With regard to the case of State v. Kim Johnson, it is found that Kim Johnson fulfills a number of legal criteria that makes her guilty for her act of 1st degree murder related to the killing of Michael Thomas. Contextually, it can be justified that the action of

Peer Assessment Essay Example for Free

Peer Assessment Essay This paper discusses the implementation of peer assessment strategy that I carried out in a primary school in Dar es Salaam during my practicum. It consists of a background, rationale, the implementation process and conclusion. The challenges encountered and their possible solutions on how to overcome them.. Background Black and William (1998) define assessment as all those activities undertaken by teachers, and students in assessing themselves, which provide information to be used as feedback to modify the teaching and learning activities in which they are engaged. There are two major types of assessment, formative assessment and summative assessment. And thus, Peer assessment is one of the forms of formative assessment. Besides, Higher Education Academy- UK, (2006) is an alternative form of assessment in which learners are given the opportunity to measure and evaluate each other’s compliments of the specified learning outcomes. It is used to involve students more closely in their learning and its evaluation and enable them to really understand what is required of them. (Phil et al 2006) This is a form of formative assessment which teachers can use in class assignments, tests, presentations, project based work and practical tasks. These tasks can be performed by learners either in pairs, by multiple assessors’ or in groups. It is where learners consider and specify the level, value or quality of a product or performance of other equal status learners (Topping, 2008). This therefore means that learners are able to learn better because they assess their peers work and give appropriate feedback which helps them to improve their own work. It also leads to a number of benefits in terms of the learning process for instance encouraging thinking, increasing learning and increasing students’ confidence Gardner (2006), students find it easier to make sense of criteria for their work if they examine other student’s work alongside their own. It is uniquely valuable because the interchange is in language that students themselves would naturally use, because they learn by taking roles of teachers and examiners of others (Saddler, 1998) Rationale Eckstein and Noah (1992) argue that teachers teach to the test therefore leaving out some non-examinable but important skills set out in the curriculum. This is evident because most schools in the developing world concentrate on exams which is summative assessment and because of the backwash of this type of assessment, it impedes rather than promote social justice by locking many young people out of the education system, (Cunningham 1998). This summative assessment limits potential in enhancing teaching and learning which makes learners not to get prompt feedback to help them improve on their performance (Brooks, 2002). PA saves the teachers’ time because it takes a shorter time to mark and grade assignments using it than when a teacher marks all the books. This gives the teacher ample time to prepare for other lessons. By using PA, the teacher is able to give feedback to the pupils in a littler time than when the teacher uses traditional method of marking. PA was introduced with an intention to encourage students to take responsibility for their learning. It makes them feel valued because their suggestions are put into account. According to Irons (2008) PA encourages dialogue between the teacher and learners themselves as they negotiate the best assessment criteria when making a rubric to evaluate their work. This makes students really understand what is required of them. Phil Race et al, asserts that students learn deeply when they have a sense of ownership of the agenda and if PA is done using the students design, there tends to be a sense of ownership of the criteria used than when they apply the tutors’ criteria. Furthermore, PA allows students to learn from each other’s successes. In some instances students notice that the work they are assessing is better than their own efforts, therefore they can benefit from the work of the most able in the group. Similarly, it helps students to learn from each other’s weaknesses too. When they discover mistakes in their peers work, it is usually good for them as the awareness of ‘what not to do’ increases and therefore refrain from making the same mistake. (Phil et al 2006) Development My practicum was in a primary school in Dar es Salaam city. I was allocated standard seven to teach English. Standard 7A is rather a large class with a roll of fifty three pupils. Boys were twenty eight while girls were twenty five. All were present. This was a double English lesson of forty minutes each. The Topic was Comprehension, Sub-topic; The library; Lenders and Borrowers. My main objectives were; by the end of the lesson, pupils should be able to read, understand, formulate questions, discuss and be able to evaluate their peers work using a rubric. I made a detailed lesson plan showing the teachers and learners activities. My teaching and learning resources were standard seven text books, dictionaries, flash cards with new words written on them, pictures of a library. The lesson started at 8.00am to 9.20am. Implementation I introduced the lesson with a vocabulary song as a brainstorming activity that was led by one of the pupils. I explained what I expected of them throughout the lesson, then used the self-selecting method to form groups of six and told them to choose a leader. We went through the guidelines that they would follow in their discussion groups. The passage had six paragraphs so I gave each group a paragraph. The learners read the passage as they listened to one another, noted down difficult or new words, and then generated three questions from their assigned paragraph. I assisted to organise the groups and how they would present. One member quickly read their paragraph as the rest of the class listened, other members gave new words that they came across and the three questions they had formulated. As they presented their findings I was writing on the blackboard the new words they had encountered, and the questions they had constructed. Together we discussed meanings of these words as pupils tried using them in sentences and checking them out in the dictionary. I noted that discussions were being led in Kiswahili though it was an English lesson. Cummins in McKay (2008) and Ellis stated that the first language (L1) is important because sometimes learners first think in it to make meaning in English. However, the discussion was very lively and everybody tried to participate. It also concurred with Goetz (2002) that different views from learners influence the direction of a lesson creating new learning experiences for both the teacher and the learner. As a class, we discussed the questions on the blackboard then I asked them to write the work in their exercise books, collect and put them on the teachers table. Together we discussed and made a marking criterion on the blackboard. I asked the class prefect to distribute the books to the learners making sure that one did not mark his or her own book. They carefully used the rubric to mark their peers work, then returned them to the owners to check and in case of any complains i moderated and explained to their satisfaction. Finally I gave each a foolscap and asked them to write down what they felt about the new method of assessment. This exercise was mainly to analyze the learners’ reflections and to evaluate myself as a teacher. Challenges My first challenge was the English teacher assigned to me was not co-operative. He was not willing to hand over a candidate class to me. I made him understand that my input would be beneficial to his professional development and the students’ grades. During group work, some learners took it for story telling time. I had a rough time controlling the noise and putting them back to focus. The chosen group leaders helped me have order in the groups and ensured participation of all members. Code switching was common as I related with the learners and as they interacted in their discussion groups. It was a challenge because they did not have the confidence to express themselves. Very few picked courage and participated in English. The rest when picked upon would request to speak in Kiswahili. I encouraged them to have confidence and to continue speaking in English because practice makes perfect. The learning environment was not very conducive. The floor was dusty and had pot holes. This was likely to cause health problems and injury. Due to the large class, desks were not enough. Learners shared four or five per desk which was quite uncomfortable. I advised the administration to discuss the matter with stakeholders so that the class would be repaired and desks added. This class did not have any teaching learning materials on the walls. They only had text books which were inadequate in a ratio of 1:5. Sharing was a problem because not all could access them. I advised the teacher that teaching and learning aids helped students to construct knowledge for themselves and develop effective learning strategies, thus laying a solid foundation for life-long learning. I also urged him to improvise teaching aids by using locally available materials for example, carton boxes to write on vocabularies and sentence structures and hang on the walls. I realized that peer assessment can be time consuming if practiced in a large class. Grouping learners, discussions, presentations and awarding marks consumed a lot of time which affected the next lesson. Since the school had extra classrooms, I encouraged him to create an extra stream and transfer some learners from 7A and 7B to the new stream if learners were to benefit from this kind of assessment. This is because a class of fifty three was too large putting into consideration the slow learners and learners with special needs who needed special attention. Conclusion Peer assessment had good impact on the teaching learning process where the learners and I jointly got involved in the assessment process hence owning the entire peer assessment procedures integrated in the lesson. This resulted into meaningful learning where feedback was instant. However, there were some challenges which we jointly addressed with the learners. For PA to be successful, meaningful procedures have to be put in place. References Black, P. William. (1998).Assessment and classroom learning: Assessment in education,principles, policy and practice in Irons, A. (2008). Enhancing learning through formative assessment and feedback. London: Routledge. Cunning,G.K. (1998).Assessment in the classroom: constructing and interpreting tests. London: RoutledgeFalmer. Irons, A. (2008).Enhancing learning through formative assessment and feedback. London: Routledge. Race, P., Brown, S. Smith. (2006). 500 Tips on assessment (2nd edition). London:

Analysis of Do not go Gentle into that Good Night :: Do Not Go Gentle into That Good Night

"Do not go Gentle into that Good Night" is written in lyric style. The poem is written by Dylan Thomas who is expressing his thought’s and experiences of death. The title disclosed the poet’s thoughts about death and the importance of fighting to live life to the fullest. The poem speaks of different views of death from different people who all demonstrated one common struggle - to hold on to life. The poem is fairly short and the language is figurative. The poet uses simile to compare death to a good nigh. There is also foreshadowing is the first verse. The poet opens the poem with "Do not go gentile into that good night" which right away indicates that the poet is referring to not taking death lying down. The reader is given a sense of growing old. In the first stanza of the poem describe old age, "Old age should burn and rave at close of day" As you get old there is a daily struggle against death; you should fight for your life and take it day by day. In the second stanza the poet says "Though wise men at their end know dark is right, because their words had forked no lighting they don not go gentile into that good night" I thin what the poet is trying to say is even though you’re getting older and you know the time is coming you haven’t shown a sign of death you ‘re still have life so fight against death. Then in third stanza the poet describes someone w ho lived a good life but doesn’t want to let go "Good men, the last wave by, crying how bright their deed might have danced in a green bay, rage rage against the dying of the light." It was as if he was saying had he lived longer things could haven been better. In the fourth stanza " Wild men who caught and sang the sun in flight, and learn, too late they grieved it on its way, Don not go gentile into that good night. The poet is saying Sinners who led a bad life learn too late that they could have led a better life so they fight against death in hopes for a second chance. In he fifth stanza the poem talks of someone who has had a near death experience "Grave men, near death, who see with the blinding sight Blind eyes could blaze like meteors and be gay, rage rage against the dying of the light.

Hard Times Essay

Mr Gradgrind says ‘ is it satisfactory to me†¦ to know that you do not come to the consideration of that question with the previous habits of mind, and habits of life, that belongs to many young women’ in reference to fancy and emotion when deciding whether to marry Mr Bounderby or not. Later on in the page we are told that Louisa was ‘ compelled to throw herself upon his breast and give him the pent-up confidences of her heart’. However this doesn’t happen because Mr Gradgrind fails to see it. This is because of the ‘artificial barriers’ that have been set up between him and his daughter and these barriers are primarily fact and his utilitarian views. It is a utilitarian view because he believes the decision should not be made based on the individual happiness of Louisa but on what will be best for everyone and therefore looking past her. It also is criticising Utilitarians and Mr Gradgrind through the use of dramatic irony in the sense that we see that Loo yearns to talk to her father but he doesn’t and we are criticising his inability to see it. The barriers being set up are metaphorical barriers he has put between himself and his daughter emotionally to achieve the greatest good for the greatest number of people. The barriers are themselves blocking out ‘subtle essences of humanity’ with reference to fancy. By saying that fancy is an essence of humanity in accompaniment with Gradgrind’s will to get rid of fact we see that Dickens is showing us that utilitarian principles strip us of these essences of humanity and therefore de-humanises us. Furthermore it is a very human ideal for a daughter to confide with her father or parent in general but here Louisa has been stripped of that showing us even more then de-humanising qualities of fact. Dickens then goes on to say that these subtle essences of humanity ‘will elude the utmost cunning of algebra until the last trumpet†¦ blow even algebra to wreck’ saying to us that fancy and emotion will always beat fact. The ‘last trumpet’ is judgement day so Dickens is saying that fancy will win until the end of eternity. This passage clearly shows Dickens preferences to emotion and how he feels it is superior although he does give fact some credit when he says ‘blow even algebra’ as if algebra is a tough subject to blow. Then dickens talks about how ‘with his†¦ utilitarian†¦ face he hardened her again’ telling us that utilitarianism is hardening Loo. First of all this builds sympathy for Loo because we were told earlier that Loo wanted to throw herself upon her father but she cant because of the barriers and is hardened again and secondly builds up our dislike for Gradgrind and utilitarianism more because of its hardening qualities.

Probation: Crime and California College Attended

John Augustus is credited with being the father of probation. A Boston shoemaker, Augustus spent his spare time observing what took place in the courts. Disturbed that minor offenders and common drunks were often forced to remain in jail because they had no money to pay off their fines, he convinced authorities to let him pay their fines and offered them friendly supervision. When the defendants later came into court for sentencing, Augustus would report on his progress toward reformation. Augustus efforts encouraged his home state of Massachusetts to pass the first probation statue in 1878. Four more states had followed suit by 1900. Probation was thus established as a legitimate alternative to incarceration. The first juvenile court was in Cook County, Illinois in 1899. The enabling legislation eventually passed at state and federal levels not only enacted statutes that permitted probation, but eventually defined specific categories of offenses for which probation could not be granted. It is clear that the legislators enacting probation statues intended juvenile offenders and misdemeanants to be its beneficiaries, not hard core criminal offenders. Probation is a sentence serves while under supervision in the community. Its goal is to retain some control over criminal offenders while using community programs to help rehabilitate them. Today, probation is the most common form of criminal sentencing in the United States. Those sentenced to probation must agree to abide by court mandated conditions of probation, with a violation of conditions possibly leading to probation revocation. Two types of conditions are general and specific. General conditions apply to all probationers in a given jurisdiction and usually require that the probationer obey all laws, maintain employment, remain within the jurisdiction of the court and possess no firearms. Specific conditions may be mandated by a judge who feels that the probationer is need of particular guidance or control. Depending on the nature of the offense, a judge may require that the offender surrender his or her driver’s license; supply breath, urine, or blood samples as needed for drug or alcohol testing. The judge may also dictate special conditions tailored to the probationer’s situation. The rapid growth of serious and violent crime in America during the 2980’s contributed to prison overcrowding and spurred a movement toward the increase in the use of felony probation. Prison overcrowding and bulging jails forced the correctional administrators to take a close look at some other categories of felons for relief of an over taxed system. Front end solutions are alternatives sentences such as probation and intermediate punishments that include house arrest, deferred prosecution, electronic monitoring. Back end solutions refer to ways used to reduce prison populations, after the offender arrives in prison. Often viewed as â€Å"early out† or â€Å"extended limits† options: parole, shock parole, expanded good time credits to count against minimum sentence, work and educational furlough, prerelease to halfway houses. Name: Essie Stevens Position: Probation Officer, San Bernardino, California College Attended: Howard University (BS, Criminal Justice) What criminal justice related jobs have you held? Straight out of high school, I took a job as a security guard at the local mall. I had no experience but they took a chance with me. I learned a lot from working there. After about 9 months, I left for college. After college, I pretty much had it in my mind I wanted to be a probation officer. I read on the internet that a small California town needed members of their team. I scheduled a meeting and I’ve been here ever since. How would you describe the interview process? It actually was pretty easy. I stood before three members of the Department of Corrections. I was asked a few questions. I was hired on spot. To this day, I still do not know if it was because my resume was excellent or if it was because they were in desperate need of staff. Please describe your job I am a probation officer for about 115 men, women, and juveniles. My role is to keep tabs on their progress, make sure they are heading down the right paths. I attend court with most of them every 3 weeks to inform the judge of their progress. I also see each of them at least once a week in order to ensure they are complying with all conditions of the program. What is the typical starting salary for this position? $17. 35 per hour What qualities or characteristics are most helpful for this job? You have to be strong and you must have a backbone. I’m not saying you have to be tough all the time but you need to let the offender know you may be nice but you’re about business. You have to be firm in making decisions. Do not let the offender walk all over you. It’s okay to have friendly conversations but always keep it professional. Get to know the offender. I have found that it’s easier for the offender to open up to you when you show interest in their lives. What is a typical day like for you? From the time I come into work (9am) to the time I leave (10pm), I am either meeting with my new juvenile offenders or checking up on the older ones. I usually break for half an hour to review paperwork. What career advice would you give someone in college beginning studies? Pay attention. Trust me; you’re learning some real important material. Apply for internships; they will help in the long run. Network! Now is the time to get in good with as many professionals as possible.

Patient Priority and the Cost Effectiveness

Patient Priority and the Cost Effectiveness Introduction Provision of good health services remains a major task for most governments in the world today. As a result, there are strategies, which have been adopted over time to ensure that this task is achieved effectively through improvement of the entire healthcare sector.Advertising We will write a custom report sample on Patient Priority and the Cost Effectiveness specifically for you for only $16.05 $11/page Learn More Whilst this is the case, many governments find it difficult to offer quality services to patients especially in cases where the cost exceeds the financial ability of individual patients. As such, health providers find it hard to decide on how to offer quality services at a lower cost, in order to consider the economic status of patients (Plans-Rubià ³, 2012). These cases are common in most parts of the world including but not limited to Saudi Arabia, Africa and Asia. This report will discuss the high cost of medical treatment, in rel ation to giving patients the priority to receive medical services. In order to achieve this task, the report mainly focuses on the situation in Saudi, where a good number of its people experience immense difficulties in sourcing quality medical services. The report is further divided into concise segments, expounding the problem being discussed, causes and possible solutions that have to be adopted to facilitate accessibility to good medical treatment in the region. High cost of medical treatment Due to the high cost of living and the current economic crisis, many countries find it difficult to offer cost-effective and quality medical treatment to most of their citizens. Like other countries in the world, Saudi Arabia has had its share in handling the high cost of medical services to its inhabitants (Almalki, Fitzgerald Clark, 2011). In explaining this trend, it is equally important to underscore how the health sector is financed in the country.Advertising Looking for repor t on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Financing of medical treatment in Saudi Arabia is mainly public, with free services being offered in all public facilities. While the government has continued to support this sector to offer quality services, the truth of the matter is that, the amount allocated per capita has significantly dropped. This is mainly attributed to the fast-growing population coupled with decreasing revenue from the government. Additionally, some analysts believe that duplication of services and unnecessary demand for these services greatly contributes to waste of resources. Due to increasing healthcare cost and compromised quality, the government has adopted measures to tame the situation mainly through privatization of hospitals and introduction of health insurance cover for both citizens and foreigners living in the country (Plans-Rubià ³, 2012). Low income-earners vs. treatments cost As mentioned above, the cost of healthcare has been rising in recent years, a trend that has affected majority of Saudi Arabians. As a result, most people in the country are unable to afford these services, which are considered to be essential to human beings. In addition, service providers find it hard in making the decision between saving the lives of people and compromising the quality of services due to their high cost (Almalki, Fitzgerald Clark, 2011). According to recent survey, the high cost of medical treatment in Saudi Arabia mainly affects low income-earners. This class of people comprises of millions of people, including the country’s citizens and foreigners. Cancer and the costs of chemo therapy Even though all medical procedures and services are costly, it is doubtless that critical cases of illnesses are always demanding. Treatment of cancer therefore falls under this category of health complications that are posing a major challenge to treat due to high cost ass ociated with it.Advertising We will write a custom report sample on Patient Priority and the Cost Effectiveness specifically for you for only $16.05 $11/page Learn More In particular, many people are unable to meet the cost for chemotherapy, a procedure that is widely known in cancer treatment (Oxford Business Group, 2008). When applied correctly, the procedure eliminates cancerous cells in a patient’s body. Due to this, cancer treatment is becoming a burden to public hospitals since most patients cannot afford the treatment cost. Cancer drugs cost approximately $100,000 per year in Saudi Arabia and yet not all patients get treated. Since treatment of most illnesses is free in Saudi Arabia, non-Saudis experience a wide range of challenges when looking for treatment. This is because the free medical program in the country excludes treatment of foreigners. Statistics Affordability of healthcare services remains a major challenge to most people in the w orld. This is due to a number of issues including the current economic crisis, poor planning strategies and increasing population against limited resources. Consequently, many countries experience several challenges, including the inability of some people to afford medical treatment (Oxford Business Group, 2008). For instance, the carrying capacity for most hospitals and the low number of doctors, nurses and pharmacists negatively impact the health sector in most countries. Due to low wages and inflation, the number of people who do not have medical insurance cover continues to increase in most parts of the world today. With most governments struggling to subsidize healthcare cost, low salaries and unemployment hamper these efforts since employers are required to pay a section of the total cost.Advertising Looking for report on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More For example, only 84% of Americans have medical insurance, which requires their employers to cater for approximately 60% of the insurance cost. Others are insured by the government, military, Medicare or Medicaid. In Saudi Arabia, the country has over 1.5 million doctors with the almost every citizen being able to access sanitation while more than 95% of the population has access to healthy water. Immunization rate has also gone up in the country, to an approximated value of 94% (Oxford Business Group, 2008). Effects of Healthcare on the Economy Despite the fact that there are significant strides that have been made by the ministry of health in Saudi Arabia, there are several challenges that have emerged. Most of these challenges negatively affect the country’s economy (Almalki, Fitzgerald Clark, 2011). Major obstacles revolve around health workforce, changing patterns of some diseases, accessibility of healthcare services, financing and expenditure and changing technology a mong other factors. Due to the increasing population and the above listed challenges, the government is forced to invest heavily in the sector through hiring of more doctors and other health workers together with the expansion of existing health facilities. Poor medical treatment quality As a result of existing limitations in the ministry of health, the quality of services being offered has largely been compromised. This has led to serious and fatal results, where patients are prone to wrong procedures offered in various medical facilities. Poor systems and deaths It is obvious that accidents require urgent attention from medical experts. This is crucial in saving the life of patients who may be in critical conditions. However, there is divided attention among doctors due to the overwhelming number of patients to be attended to (Mansour, 2008). The end result of this is low quality services, which may result into other complications. This situation is also worsened by poor systems a pplied in treatment of critical medical conditions. Among all the associated effects, careless deaths are common in hospitals, resulting from poor services, poor systems and inadequate health attendants in hospitals. Causes This section of the report explores some of the causal factors associated with the above mentioned problems and challenges facing the ministry of health in Saudi Arabia. Lack of governmental supervision Governmental supervision of medical services in Saudi Arabia has immensely affected the quality of services being offered. It is highly limited by the fact that the ministry of health takes charge of all health services in the country. As a result, some regions and public hospitals end up giving services, which have not been verified by government inspectors (Mansour, 2008). This is likely to result into accidents, errors and careless deaths of patients. This management system of the ministry of health does not meet the needs of the ever-growing population of the nation. Price variation Another cause of the above described problem is variation in prices charged by different public hospitals. While people would expect standard charges for medical services in hospitals, it is amazing that most health centers have different prices. This affects service delivery and planning as the government cannot project its expenditure, stemming from inconsistency. In cases where low prices are charged, such hospitals may end up receiving low funding, thus compromising the quality of services being offered. Low standards of treatment Although Saudi Arabia prides on offering free medical services to its people, research reveals that some of the services given in public hospitals are of low standards. This puts majority of patients at the risk of being poorly served. Poor treatment further emanates from the fact that the population of the country is ever-growing against limited resources (Wynbrandt, 2010). This causes straining of resources including healthcar e workers who have to work extra hours in order to serve all the patients. Moreover, the existence of too many non-value adding costs in the ministry of health contributes to poor service delivery. In other words, the government spends on services that do not generate revenue for the state and does not support patient recovery. Poor technology The last cause of most of the challenges being experienced by Saudis ministry of health is lack of technology to handle many health complications in public hospitals. This results into several issues, which threaten the survival of patients, their ease to recover and the efficiency of doctors and other health workers. For instance, lack of technology undermines diagnosis of diseases, resulting into poor medical procedures and prescription of drugs. Low level of technology further hampers handling of emergency cases especially when patients require intensive or specialized care. Solutions There are several strategies, which can be adopted and i mplemented in order to reverse the current healthcare system in Saudi Arabia. This is quite necessary in controlling unnecessary deaths of patients and in improving the overall delivery of medical treatment services. These remedies are broadly divided into two categories: Minimizing costs As mentioned above, the ministry of health heavily spends on treatment services and expenses that largely contribute to the high cost of healthcare, which becomes unaffordable to most people (Walker, 2009). This unnecessary expenditure further affects the quality of services offered, due to lack of priority within the management. These costs should therefore be eliminated to allow more resource allocation towards the improvement of healthcare services. Of great significance is also the reengineering of the healthcare system to meet current demand in the market. This can be achieved through optimum staffing, acquisition of relevant equipment and medicine and improvement of medical procedures. This e nsures that the needs of hospitals and patients are met based on existing situations (Plans-Rubià ³, 2012). Alternative medication Availability of alternative medication is also essential in meeting the needs of different patients depending on their source of income and the ability to meet related costs. As such, low income-earners are given a chance to go for medical treatment without straining their resources (Walston, Al-Harbi Al-Omar, 2008). Additionally, an appropriate bill is supposed to be enacted and implemented in order to address existing challenges and expected future trends in the healthcare system. Governmental solutions Insurance companies In reforming the healthcare system of Saudi Arabia, the government has a role to play in ensuring that quality services are delivered affordably. Firstly, insurance companies should be encouraged to offer medical cover to citizens through payment of premiums by individuals. This would lessen the burden of national medical coverage. Technology Besides insurance, the government ought to appreciate changing technology through the adoption of emerging trends like the use of nanotechnology in the treatment of cancer and other diseases (Walston, Al-Harbi Al-Omar, 2008). Setting of standards in hospitals is equally important especially in regulation of treatment price and the quality of services being offered. This can be well implemented through hiring of enough government supervisors and quality assurers. Lastly, the adoption of Affordable Care Act (ACA) is important to streamline the sector. Recommendations and Conclusion From the above report, it is obvious that the quality and cost effectiveness remain major factors affecting several healthcare systems in the world. Due to high cost of living and inflation, most people are unable to afford quality medical treatment. Additionally, governments are not capable of providing affordable and good medical services to customers due to limited resources and increased po pulation among other factors. Nevertheless, thorough reforms are necessary in Saudis healthcare system in order to provide quality services to its people. References Almalki, M., Fitzgerald, G., Clark, M. (2011). Health care system in Saudi Arabia: an overview. Eastern Mediterranean Health Journal, 17(10), 784-793. Mansour, A. (2008). Factors affecting locational decisions of Saudi health care professionals. Michigan: ProQuest. Oxford Business Group. (2008). The Report: Saudi Arabia 2008. London: The Report: Saudi Arabia 2008. Plans-Rubià ³, P. (2012). Frameworks to Set Priorities for Treatments Based on Cost-Effectiveness and Equity. The Open Pharmaco-economics Health Economics Journal, 4, 1-7. Walker, L. (2009). The right to health in Saudi Arabia. University of Aberdeen. Retrieved from https://www.abdn.ac.uk/ Walston, S., Al-Harbi, Y., Al-Omar, B. (2008). The changing face of healthcare in Saudi Arabia. Ann Saudi Med, 28 (4), 243-250. Wynbrandt, J. (2010). A Brief History of Saudi Arabia. New York City: Facts On File.

Mental Illness essays

Mental Illness essays Mental Illness Mental illness is a disorder that is characterized by disturbances in a persons thought, emotions, or behavior. Mental illness refers to a wide variety of disorders, ranging from those that cause mild distress to those that impair a persons ability to function in daily life. Many have tried to figure out the reasons for mental illnesses. All of these reasons have been looked at and thought of for thousands of years. The biological perspective views mental illness as a bodily process. Where as the psychological perspectives think the role of a persons upbringing and environment are causes for mental illnesses. Researchers estimate that about 24 percent of people over eighteen in the United States suffer from some sort of common mental illness, such as depression and phobias. Studies have also shown that 2.6 percent of adults in the United States suffer from some sort of severe form of mental illness, such as schizophrenia, panic disorders, or bipolar disorders. Younger people also suffer from mental illnesses the same way that adults do. 14 to 20 percent of individuals under the age of eighteen suffer from a case of mental illness. Studies show that 9 to 13 percent of children between the ages of nine and seventeen suffer from a serious emotional disturbances, that disrupts the childs daily life. Major depression is a severe disorder. Symptoms include withdraw from family and/or friends, weight loss, sleeping problems, frequent crying, fleeing helpless, delusions, and hallucinations. This disease is usually diagnosed during adolescence; parents may notice grades dropping, poor self-image, troubled social relations, and suicidal acts. This disease may be fatal if the person becomes suicidal. Phobia is a disease where a person has an irrational fear of an object or situation. Some examples of phobias are fear of flight, cats, heights, enclosed spaces, reptiles, and the most severe is agoraphobia the ...

Getting an Equity Card

Getting an Equity Card Having an Equity card basically means that you are a member of the Actors Equity Association. Representing both actors and stage managers, the Actors Equity Association (AEA) has been negotiating wages and benefits for its members since 1913. Benefits According to the AEA, benefits include: Minimum salaries (negotiated rates, overtime, extra pay for additional duties,  free housing or per diem on tour)Work rules (length of day, breaks, days off, safe and sanitary conditions)Health, pension and 401(k) benefitsDispute resolution (including recourse to impartial and binding arbitration)Just cause (penalties for improper dismissal)Bonding (guaranteeing payments to the Actors if the producer becomes insolvent or defaults)Supplemental Workers Comp insurance, which provides additional compensation over-and-above Workers Comp if youre injured on the jobEquity-only auditions via casting call and Equity hotlinesAgency regulationsMember discountsThe Equity News and websiteSeminars and special eventsProfessional name protectionTax assistance through VITAVoting privileges Union membership also includes access to service organizations like The Actors Fund, Career Transition for Dancers, the Actors Federal Credit Union and the AFL-CIO. These organizations offer a host of additional resources such as emergency assistance, seminars, career counseling, low-cost financial services, loans and discounts. Starting a Career Every year, thousands of Broadway hopefuls flock to New York City hoping to break into the theater business. Before you rush off, you may want to stop and visit the Equity website to find out if a union is right for them. If you arent yet an Equity member, you might still land a role on Broadway. But your chances are slimmer. Many theater employers will only hire card-carrying union members. How to Get an Equity Card Gain employment under Equity Contract (this is often tricky because some shows wont let you audition unless you are already an AEA member).Be a member of a sister union such as SAG, AFTRA, or AGMA. Members of these unions can also register for AEA.Utilize the Equity Membership Candidate Program. If you are an actor or stage manager-in-training, you can register with AEA and earn credit towards eventual membership.

Greenhouse Effect and Global Warming Essay Example | Topics and Well Written Essays - 750 words

Greenhouse Effect and Global Warming - Essay Example Some of the radiation is altered by the ozone layer, which inhibits ultraviolet radiation from passing directly to the surface to the earth. Much of the radiation that makes it to earth is absorbed and stored as heat in oceans and other large bodies of water. Radiation that strikes portions of the earth with a high albedo, such as solar ice caps and glaciers is reradiated back out into space. In fact, ultimately, the vast majority of solar radiation that enters the atmosphere is destined to be reradiated back into space. But a small percentage of that radiation gets trapped in the atmosphere as it tries to bounce back into space. Certain gasses, such as carbon dioxide and methane act to trap the radiation, causing the atmosphere to retain the radiation as heat. This warming of the earth’s atmosphere as a result of trapped radiation is called The Greenhouse Effect. Gasses such as carbon dioxide and methane are called greenhouse gases, due to their tendency to trap radiation, wh ich causes the atmosphere to stay warm. Without The Greenhouse Effect, life on earth would be very different and impossible for humans. The Greenhouse Effect is directly related to the phenomenon known as Global Warming or Global Climate Change. The earth’s atmosphere is constantly changing. ... Humans are the first species in the history of earth to burn massive amounts of fossil fuels such as coal, oil and natural gas. Burning these fuels puts carbon dioxide into the atmosphere. In recent years, the average global temperature has risen dramatically. Changes in global temperature usually happen very gradually, so many people are concerned that a rapid change in temperature will lead to destructive weather patterns, crop failures, increased spread of disease and insect pests (Roberts, 1994). Many scientists feel that this will lead to extinction on a mass scale and major disruptions to human activities. The continued introduction of greenhouse gasses such as carbon dioxide and methane that results from agricultural, manufacturing and transportation activities will surely result in a warmer global climate and stress on nearly all natural systems that sustain life on our planet. There are courses of action that can be taken to reduce or even reverse the warming trend that eart h is now experiencing. One of the most immediate things we can to is to reduce the amount of greenhouse gasses we are putting into the atmosphere. Much of this comes from the transportation we use every day. Cars burn gasoline, which greatly contributes to the amount of carbon dioxide in the atmosphere. Driving less, or not at all, is one way we can slow global warming. Many people are living in communities that give them easy access to public transportation and to workplaces. More civil planners are providing spaces for walking paths and bicycle lanes in their plans. This means people have carbon free ways to get to work. Using alternative fuels and increasing fuel efficiency in cars is another way to prevent

Enterprise Resource Planning Essay Example | Topics and Well Written Essays - 1000 words - 1

Enterprise Resource Planning - Essay Example Finally, a key goal for the use of the ERP by the army is to help the army streamline its operations, practices and process, making them more efficient (Real-World Case, 183). The key implementation considerations made include the sources of failure in the process of transformation. The failure by an institution to forecast and thus plan for the likely organizational and cultural changes that comes with the transformation, which entails the introduction of the ERP in the army can easily cause a failure to the implementation process (Real-World Case, 184). Leadership and sponsorship consistency is also a major consideration, since the introduction of ERP requires the consistency of leadership and supervisors, which is rarely the case in the army. Stakeholder alignment is also an essential consideration, since all the stakeholders in the army should be aware and supportive of the transformation. Cost considerations should also be made, since the implementation of ERP requires substantial resources, which should always be supplied, for the success of the process (Real-World Case, 184). The change management was incorporated in the process through the change of the army process into business-like, since the ERP could not fully address the army system, which is quite different from the normal business transactions and processes. These changes entail the incorporation of some traditional aspects of the army systems such as cost and performance measures into the ERP system, while introducing new concepts such as the measurement of effectiveness, efficiency and satisfaction, both internal and external (Real-World Case, 185). Additionally, the change management process was incorporated into the system through the reconfiguration of the ERP, to include a new code, other than change the existing one, a process known as extension. This is essential to include some of the army processes, which cannot

Effect of Technology on Workplace Privacy Essay

Effect of Technology on Workplace Privacy - Essay Example As the masses became cognisant of the consequences followed by the increasing attacks to individual's privacy in the workplace owing to the development in surveillance technology, the demand for legal demarcation strengthened and eventually several laws were created by the government to curtail and confine the scope of the surveillance technology to accomplish only the legitimate objectives of the employers. Although, these laws have been developed by most of the countries to protect the rights of both the employers and the employees in particular, yet there has been an ongoing debate on the compatibility of unravelling surveillance technology with the laws and legal boundaries confining the scope of intrusion into an employees' privacy. Therefore the major issue concerning this essay is the extent to which the advancement into workplace surveillance technology is consistent with the laws and what could be done to bring it to the level proposed by the different laws and legal authorities. The surveillance in the workplace has existed in historical era in the same manner, as it seems to be prevailing in the modern times. However, the major difference remains in the introduction and development of different forms of technology that have further assisted the way to introduce more and more sensitive surveillance in the organisation. ... Consequently, the employees or the labour force could not be capable of putting all of their efforts into the organisational goals, however they kept on selling their services to the employers and organisations on agreed terms and conditions. Hence, their happened to be direct and physical surveillance on the part of the employers influencing the employee motivation and work behaviour. According to Rushing (1966), due to such acts in the past, the employers never became aware of the fact that they could have gained more by driving their motivation towards work. However, this was the initial form of developing surveillance in the workplace by the employers and this trend remained prevalent throughout the 20th century. By the end of the 21st century, the technology took a rapid progression and the workers continued to fall prey of the new development in technology affecting the workplace environment with regard to privacy and convenience. The new advancements into technology result into change in working as well as surveillance needs and as a new innovation in technology takes place, the perceptions and conceptions concerning the surveillance at workplace also change. Therefore, the level and intensity of workplace surveillance alter with the development and advancement of technology. SURVEILLANCE TECHNOLOGY, WORKPLACE PRIVACY AND LEGAL FRAMEWORK The recent rise in the surveillance activities on the part of the employers both positively and negatively have constantly been attributed to the world's continuous advancement in technology. Unique and modern measures keep on evolving regularly to facilitate the employers in keeping an eye over the employees and their activities. The use of technology in workplace surveillance

Character and Setting in Emma Essay Example | Topics and Well Written Essays - 1000 words

Character and Setting in Emma - Essay Example Jane Austin’s novel concentrates on human relationship revolving around the main character Emma and the importance of Highbury setting to the characterization of the Heroine. Relationship between Emma and Harriet With the witty and charming heroin Emma, Jane Austen’s work was flawless with exploration of human relationship. The major subject of Jane Austen’s Emma revolves around the natural power of human relationship. Austen in this novel compares the healthy and unhealthy relationship between Emma and Harriet. The relationship between Emma and Harriet was an epitome of unhealthy relationship where the teacher Emma exploited, manipulated and neglected her student Harriet. Emma took Harriet under her wings and wanted to teach how to adjust with her choices of acquaintances. Emma was more concerned about her own desires rather being concerned about what would be best for Harriet. Chapter seven of the novel lays special reinforcement to the relationship between Emm a and Harriet Smith. Harriet depend upon the decision and suggestion of Emma whether to marry or reject Robert Martin. Though she had some opinion and decisions of her own but could not go by them since Emma’s opinion was more important. This shows how much important role Emma plays in the life of Harriet. They had friendship but between unequal. When Emma advised her to reject Robert Martin, Harriet was disappointed and said â€Å"You think I ought to refuse him, then† (Austen, 44) but did not have the courage to go against Emma’s decision. This clearly reveals that Harriet was totally dependent on Emma’s decision and trusted her blindly. ... Elton developed theme like reason versus thoughts, social responsibility versus selfishness and arrogance. Settings The Novel of Jane Austin, Emma has its setting in a provincial community, which involved the gentry of the region. She chose a small tiny town named Highbury where everybody knew everything about anyone staying over there. This revealed that everyone was aware of the peculiarities and odd habits of each individual in the town. One was unaware of the local’s geography. The closeness of the town Highbury to its estates â€Å"Hartfield, Donwell Abbey and Randalls† were clearly revealed in the novel as the fact that London was sixteen miles away. However the description of the physical aspects of the town was not given except that of the Donwell, which was given with a purpose to portray Emma’s reaction. The presence of â€Å"Richmond road† can be felt from the description that Harriet met the gypsies on the Richmond Road but no other details wer e found. The presence of an embankment over where the companions scuttles was also derived from the description. Emma and Mr. Woodhouse’s house was the geographical center around which the whole novel revolved. The drawing room or something equivalent was the primary setting of the novel. The scene of Box Hill or even the shrubbery walk where George proposed Emma was simply an open-air drawing room. The novel mainly concentrated on the social involvement and human relations. It did not give any clear description of the vegetation or terrain or any connection that leads to the description of the geography of the place. Instead the novel had an evident presence of the description of drawing and dining rooms, rooms for dancing and scenes of carriage and equipment of

Amazon Essay Example | Topics and Well Written Essays - 750 words

Amazon - Essay Example Feasibility study should be performed on the basis of various criteria and parameters. The various feasibility studies are (1) Economic Feasibility, (2) Operational Feasibility and (3) Technical Feasibility. Their strategies include low price and free shipment. This factor played an important role in the long-term development of the company. The cheaper prices of goods with high quality and further free shipment attracted many. Another factor is the customer service. Customer plays an important role in the development of the company because it is the customer who uses the product that was developed by the companies and Amazon's services were good at it. To stay and hold the position in the present competitive market Amazon has planned to expand its business outside US like Eastern Europe and Far East Asia. Amazon is encouraging other companies to advertise their product on their website. A study has shown that Amazon would make more profit in diversifying than expanding. TOWA matrix (Threats-Opportunities-Weaknesses-Strengths) has been used to develop feasible alternative strategies. The matrix consists of four quadrants. They are (1) using strengths to overcome weaknesses, First quadrant concentrates on possible strength-opportunity strategies. Important factors are to hire highly skilled workers, wide brand recognition, customer satisfaction, effectively and efficiently raising capital resources, etc. Second quadrant concentrates on possible strength-threat strategies. Important threats that have to overcome are changing government regulations, seasonal shopping, and competition from ebay and Wal-Mart, protect business and customer information, currency exchange, etc. Third and Fourth quadrants concentrates on Possible Weakness-Opportunity Strategies and Possible Weakness-Threat Strategy. Third quadrant looks at reviewing product, develop standards up to the customer satisfaction, etc. Fourth quadrant looks at implementing backup systems, implementing policies to protect and avoid security risks. References Fortunato, Frank. (2005, September 25). Selling Books Online: Book Listing Services vs. eBay. Matrix-E.com. Retrieved May 16, 2006, from http://www.matrix-e.com/content/view/63/9/ Chevalier, Judith, and Goolsbee, Austan. (2003, April). Measuring prices and price competition online: Amazon and Barnes and Noble. Retrieved May 16, 2006, from http://gsbwww.uchicago.edu/fac/austan.goolsbee/research/amzn.pdf Frey, Christine, and Cook, John. (2004, January 8). How Amazon.comsurvived, thrived and turned a profit. Seattle Post-Intelligence.Retrieved May 16, 2006, from http://seattlepi.nwsource.com/business/158315_amazon28.htmlsource=techdirt

Character and Setting in Emma Essay Example | Topics and Well Written Essays - 1000 words

Character and Setting in Emma - Essay Example Jane Austin’s novel concentrates on human relationship revolving around the main character Emma and the importance of Highbury setting to the characterization of the Heroine. Relationship between Emma and Harriet With the witty and charming heroin Emma, Jane Austen’s work was flawless with exploration of human relationship. The major subject of Jane Austen’s Emma revolves around the natural power of human relationship. Austen in this novel compares the healthy and unhealthy relationship between Emma and Harriet. The relationship between Emma and Harriet was an epitome of unhealthy relationship where the teacher Emma exploited, manipulated and neglected her student Harriet. Emma took Harriet under her wings and wanted to teach how to adjust with her choices of acquaintances. Emma was more concerned about her own desires rather being concerned about what would be best for Harriet. Chapter seven of the novel lays special reinforcement to the relationship between Emm a and Harriet Smith. Harriet depend upon the decision and suggestion of Emma whether to marry or reject Robert Martin. Though she had some opinion and decisions of her own but could not go by them since Emma’s opinion was more important. This shows how much important role Emma plays in the life of Harriet. They had friendship but between unequal. When Emma advised her to reject Robert Martin, Harriet was disappointed and said â€Å"You think I ought to refuse him, then† (Austen, 44) but did not have the courage to go against Emma’s decision. This clearly reveals that Harriet was totally dependent on Emma’s decision and trusted her blindly. ... Elton developed theme like reason versus thoughts, social responsibility versus selfishness and arrogance. Settings The Novel of Jane Austin, Emma has its setting in a provincial community, which involved the gentry of the region. She chose a small tiny town named Highbury where everybody knew everything about anyone staying over there. This revealed that everyone was aware of the peculiarities and odd habits of each individual in the town. One was unaware of the local’s geography. The closeness of the town Highbury to its estates â€Å"Hartfield, Donwell Abbey and Randalls† were clearly revealed in the novel as the fact that London was sixteen miles away. However the description of the physical aspects of the town was not given except that of the Donwell, which was given with a purpose to portray Emma’s reaction. The presence of â€Å"Richmond road† can be felt from the description that Harriet met the gypsies on the Richmond Road but no other details wer e found. The presence of an embankment over where the companions scuttles was also derived from the description. Emma and Mr. Woodhouse’s house was the geographical center around which the whole novel revolved. The drawing room or something equivalent was the primary setting of the novel. The scene of Box Hill or even the shrubbery walk where George proposed Emma was simply an open-air drawing room. The novel mainly concentrated on the social involvement and human relations. It did not give any clear description of the vegetation or terrain or any connection that leads to the description of the geography of the place. Instead the novel had an evident presence of the description of drawing and dining rooms, rooms for dancing and scenes of carriage and equipment of

Communication reaction paper Essay Example | Topics and Well Written Essays - 500 words

Communication reaction paper - Essay Example veral times I manage to observe that my behavior is modified depending on the manner by which I perceive an arriving stimulus and respond to it correspondingly. I used to suppose that ‘being real to oneself’ simply meant going by the nature I am without needing to pay regard to the impact of society, thinking that the concept of self is understood just once in a lifetime. Along with this misconception is the belief that former foundations bear the sole responsibility of substantiating the self, yet by objective and subjective learning alike, self-identity formation actually proceeds and may not be confined only to a few aspects of growth. Until I had come to the point of discerning that ‘sense of self’ is yielded through a process of evolution, it often felt complex to deal with knowing myself and what the exact meaning is of a true self in the past. To this extent, I have thus realized by far that human interactions or communication schemes portray a huge role in creating a person’s identity which continues to evolve with time and socio-cultural influences. When I experienced serious infatuation with a person for a couple of years and thought I would never get over the hurtful feeling toward the fact that the person betrayed my confidence, I unconsciously allowed myself to seek alternatives to divert my unpleasant emotions for relief. Out of having to cope with the difficulty of erasing deep-rooted sentiments that had gone through an intense motion, I have become inclined to the love of art the habit of which has eventually made me conduct myself in a totally different perspective and attitude. At this stage, I discover that though certain changes initially occurred peculiar in the course of getting accustomed to the new interest, my other desires and priorities spontaneously shift their ranks. These have all taken place in varied occasions and people with whom my interactive efforts are spent, contributing to the progress of my transforming

Police, Civil Liability and the Law Essay Example for Free

Police, Civil Liability and the Law Essay At the onset of the 20th century, police work can best be described as very authoritative and policemen or law enforcers were themselves considered the law. Criminality was low principally because of the relatively stable economy and the population density in cities and urban centers were a hundred time, or even more, than today. As symbol of authority, the police was then looked up to by the citizenry with great respect and even with admiration. Through the years, the public image of the policeman is suspect. In truth city police departments today already employ spokesmen or public relations officers to ensure the respectability of the service is protected and preserved. The changes in the concept of police work tremendously changed over the last century, or to be more specific the 25 years. The situation was brought about by the growing public conscious on human rights which is guaranteed no less by the United Nations. While before police training was focused on proper handling of firearms and marksmanships, traffic rules and regulations, todays police officer should be conscious of every persons human rights. Otherwise he or she may end up in court being sued for civil liability or damages. Changing Concept on the Police Over the years the police service has underwent some sort of an evolution. From a strong image of authority, the police has to some extent been compelled to accept the fact that their functions or source of power emanates from the taxpayers who wanted them to be their protectors instead of oppressors. The situation is quite complex. While they have the mandate to enforce or implement the laws, the police are being restricted by a string of guidelines better known in their lingo as the rules of engagement. They have to comply with the rules in the performance of their duties because failure to do so could mean suspension or worse dismissal from the service. Unlike before when for instance, a traffic police officer can simply issue a citation ticket to a motorist who violated a traffic law todays system places the supposed violator on a position of strength. He or she can write on the citation ticket the words under protest to signify the intention to question the actuation of the traffic officer for flagging him or her for a supposed violation. The situation for policemen whose duties are to run after criminal elements or members of the underworld is even more difficult. Unlike before when they would simply pick up a suspected person and have him or her placed under interrogation or tactical questioning, todays detective or police intelligence officer need to first gather substantial proofs or incontrovertible eyewitness accounts in order to be able to apply for a warrant of arrest from the court. Down for a supposed violation Because of the complex nature in today’s justice system, police work now requires them to be conscious of the civil or human rights of every citizen. Additionally, they also need to be more aware of the rules of court or run the risk of being rebuffed or they cases they brought up for prosecution or litigation may end up dismissed for either insufficiency of evidence or non-compliance to the rules in effecting or carrying out arrests and raids. The preponderance of diligence in the performances of police duties and responsibilities in the enforcement of the laws is so emphasized that police officers are restricted from conducting investigations or questioning without the presence of the suspects preferred or lawyer of his or her choice. Civil Liability of Abusive Members of the Police Department Todays police officers are made by law liable for their actuations as a result of an alarming pattern of abuse they commit in the process of dispensing their duties. Perhaps because of media attention or coverage on police work, abuses have eventually been documented or difficult to deny as far as the police officer is concern. Every now and then, the public would see on television brutal police handling of suspected offenders. The abuses have become so frequent that the time has now come where victims of police abuse have to get back at them by suing for civil liability or damages. Perhaps, as society experiences new trends in law enforcement more laws to ensure that the power or authority vested in police officers are only used for the public good and not make the police as a threat to society itself. By making them civilly liable for high handedness in the performance of the laws, police officers will be kept on their toes. Guide to Civil Liability In view of the above positions, it is notable to discuss a book manual for police officers’ to consider in the performances of their duties and in relation to their civil liability and the law. In a book entitled â€Å"The Police Officer’s Guide to Civil Liability,† Franklin (1993) emphasized the need for law enforcers, police officers in particular, to adhere to a standard guide to enable them to abide by their principles and at the same time uphold the concept of civil liability. Franklin noted that due to the increased number of court cases hurled against police officers, there is also a mounting need to teach these law enforcers on the dynamics of civil law. This is because such training or learning should be innate among police officers and within their profession and in order for them to survive the field (Franklin, 1993). While the required knowledge on civil liability totally varies from their abilities and expertise which are essential to be alive in a fatal shooting incident, having proficiency about civil law may avert a devastating possibility or outcome which will ultimate affect the career of the police officer and which is definitely dreadful as any form of shoot-out or gun battle. Additionally, the monetary and emotional implications of a civil case are often than not surpass the physical suffering which is likened to a gun shot wound (Franklin, 1993). The book noted that as professionals, police officers are, in one way or the other, are engaged in a civil case. Franklin noted the stress it had inflicted on law enforcers and their respective police departments in general. However, police officers are still limited with civil law or civil liability trainings which may assist them in their court battles. It is unfortunate to note that a large amount of money which will be used in the court proceedings as well as many lives of police officers could be saved if only there is a provision of civil liability education or training. This is because such kind of knowledge created a better and well-prepared police officer who can react to any kind of police situation or effectively carry out his duties to people and the society. Through this training, there will also be a reduction in the possibilities of a defeat in the civil case, and most importantly, this is the fundamental determining factor for the efficiency and value of police officer and his civil liability training (Franklin, 1993). Conclusion An increased awareness on the need for police officers to learn and adhere to civil liability in reference to specific laws of the country is a positive effort to undertake. This is because such consciousness will allow police officers to carry out their obligations, in a legal or appropriate manner, without the hindrance of possible civil lawsuit. While there are members of the police force who are undeniably amiss in their profession, it is worthy to consider that this is not the general view of the police department. Additionally, any misconception about the police profession may be corrected in such a way that the police officers are portrayed as important members of the society who are bound to protect people, property and the society as a whole. Hence, it is just but fair to provide police officers trainings and related means which will enable them to appropriately respond to the security or safety requirements of the people. Ultimately, the concept and the need to uphold civil liability will serve as a reminder for police officers that their authority entails responsibility.

Current cognitive models of PTSD

Current cognitive models of PTSD The treatment literature of the past twenty years reflects an enormous interest in discovering the most effective psychological therapy for clients with a diagnosis of posttraumatic stress disorder, PTSD. The overall aim of this paper is to critically evaluate current cognitive models of PTSD and literature on the effectiveness of cognitive behavioural therapies to treat this disorder based on these models. Definitions of PTSD In the Fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV (American Psychiatric Association, 1994) trauma is defined as: (a) The person experienced, witnessed or was confronted with an event that involved actual or perceived threat to life or physical integrity; and (b) the persons emotional response to this event included horror, helplessness or intense fear. Foa and Meadows (1997, p. 450). In DSM-IV psychological symptoms of PTSD are categorised into three cluster symptoms: re-experiencing, avoidance/numbing and increased arousal, which arise after the person is exposed to a traumatic stressor. The recurrent re-experiencing symptoms e.g. flashbacks, nightmares, intrusive thoughts, have been considered the hallmark of PTSD (e.g. Foa Rothbaurn, 1992). The second cluster includes avoidance of trauma-related stimuli and numbing of general responsiveness e.g. deliberately avoiding trauma-related stimuli and symptoms of emotional numbing (Foa, Hearst-Ikeda, Perry, 1995; Litz, 1993). The latter are considered distinguishing features of PTSD (Foa Meadows, 1997). The third symptom cluster includes increased arousal e.g. hypervigilance, exaggerated startle response, difficulty sleeping and irritability (APA, 1994). Current Government Guidelines on the treatment of PTSD Determining effective and efficient treatments for PTSD has become a priority in light of the conditions prevalence and the many techniques and interventions available. The National Institute for Clinical Excellence, NICE, reviewed the most robust outcome research and produced guidelines, to inform and guide clinical practice for the psychological treatment of PTSID in adults (NICE, 2005). The guidelines were based on an independent, systematic, rigorous and multistage process of identifying, reviewing and appraising evidence for the effective treatment of PTSD. These guidelines conclude that individuals with PTSD should receive either trauma focused Cognitive Behavioural Therapy, TFCBT or Eye Movement Desensitisation and Reprocessing, EMDR. However, a distinction is made between single incident trauma and more complex presentations, and the guidelines suggest increasing the total number of sessions accordingly. Although the guidelines appear helpful for the treatment of single incid ent PTSD, they are arguably not as informative for treatment approaches for a large group of individuals with complex PTSD. This presents difficulties for the clinician and client in deciding the most effective therapeutic options. Cognitive Behavioural Therapy (CBT) is the most extensively researched therapy for individuals with PTSD (Foa Meadows, 1997) and many studies support its efficacy in reducing symptom severity (e.g. Foa et al., 1995; Foa Jaycox, 1996; Foa, Rothbaurn, Riggs, Murdock, 1991; Resick Schnicke, 1992; Richards, Lovell, Marks, 1994; Thompson, Charlton, Kerry, Lee, Turner, 1995). However, CBT for PTSD encompasses diverse techniques. These include exposure procedures, cognitive restructuring procedures, and combinations of both these techniques. Exposure Therapy Exposure therapy is based on the premise that imaginal exposure (IE) to the trauma or feared situation, leads to symptom reduction. The theory argues prolonged activation of traumatic memories leads to emotional processing of the affective information, habituation of anxiety and integration of corrective information (Foa et al., 1995). Numerous studies have demonstrated that treatment based on exposure therapy is efficacious in reducing PTSD (e.g. Foa et al., 1999; Frueh, Turner, Beidel, Mirabella, Jones, 1996; Keane, Fairbank, Cadell, Zimmering, 1989). Foa, Rothbaum, Riggs, and Murdoch (1991) investigated exposure therapy, stress inoculation (a type of Anxity Management Treatment, AMT), supportive counselling, and a non-treatment group in the treatment of PTSD as a result of rape. Clinical ratings of symptoms and standardized psychometric tests were examined before and after treatment as well as at a 3-month follow-up. The stress inoculation intervention showed greater results than the counselling and non-treatment conditions at post-test. However, at the follow-up, the individuals participating in exposure therapy showed more improvements of PTSD symptoms than individuals in the other groups. Research has investigated the efficiency of exposure therapy compared to different methods of treatment. For instance, Tarrier et al. (1999) investigated exposure therapy and cognitive therapy in the treatment of individuals with PTSD arising from several different traumatic incidents. The two groups demonstrated noteworthy decrease in PTSD symptoms that was still present at the 6-month follow up. Although results were positive for both groups, there was no non-treatment control against which these two active treatments could be evaluated. Similarly, Foa et al. (1999) compared exposure therapy to AMT and then combined the two treatments. These three groups were compared to a non-treatment control group. All three of these treatments effectively reduced symptoms of rape-related PTSD and resulted in functional improvement. There were no differences among the three treatment groups on outcome measures, but all three groups improved more than the non-treatment comparison group did. In a study that once again compared exposure therapy to cognitive therapy, Marks, Lovell, Noshirvani, Livanou, and Thrasher (1998) examined these two treatments alone and in combination in outpatients with PTSD secondary to a wide range of traumatic events. A relaxation therapy condition was employed as the primary comparison group. All three active treatment conditions showed significant improvement, and greater improvement than that observed in the relaxation group. The three active treatments did not differ from one another on the key outcome variables. Several investigations have advanced the field of PTSD treatment, even though the methodology utilized in the outcome study limited the conclusions that could be drawn. Frank and Stewart (1983) reported the effects of systematic desensitization on women who had been raped and who developed significant psychological symptomatology. Compared to an untreated comparison group, those women treated with graduated exposure improved most on a range of anxiety and depression symptom measures. Richards, Lovell, and Marks (1994) compared imaginal and in vivo exposure in a randomized study of survivors of diverse traumatic events. At the 12-month follow-up, patients reported consistent reductions in PTSD symptoms and improved social adjustment. These data further substantiate the effectiveness of exposure therapy for some individuals, and also suggest that improvements in symptoms are also reflected in critical domains of life functioning. In summary, the existing data support the use of exposure therapy in the treatment of PTSD. In a previous review of this literature, Solomon, Gerrity, and Muff, (1992), (Sited in Shapiro, 1995) derived the same conclusion from data available at that time. Similar conclusions were drawn by Otto, Penava, Pollack, and Smoller (1996) in a more recent review of the literature. In what may ultimately prove to be an important lesson for the treatment of individuals exposed to traumatic events, Foa, Hearst-Ikeda, and Perry (1995) examined the efficacy of a brief intervention to prevent the development of chronic PTSD. For women who had been recently raped, the authors developed a program based upon that which worked so well in earlier trials with chronic PTSD. Exposure therapy figured prominently in the package of treatments assembled. This package also included elements of education, breathing retraining, and cognitive restructuring. When individuals receiving the package were compared to a matched control group, this study found that at 2 months after intervention only 10% of the treated group met criteria for PTSD, while 70% of the untreated comparison group did. As information continues to grow on exposure therapy, there is a distinct need for studies to examine combinations of treatments, to employ measures that assess social and occupational functioning, and to address the impact of treatments on comorbid psychological conditions. Clearly, the available efficacy studies demonstrate the value of extending the use of exposure therapies to patients with PTSD. However future studies assessing the generalization of exposure therapy from laboratory trials to clinical settings would be particularly useful. When exposure therapy has been compared to other forms of cognitive therapy, such as cognitive restructuring (see below), it has proved to be more successful in reducing PTSD. Tarrier et al., (1999) compared Cognitive Therapy (CT) with imaginal exposure therapy (IE) for 72 people with chronic PTSD, and concluded that there was no significant difference between the two groups initially or at 12 month follow up. Participants recruited were obtained from a sample of referrals to primary and secondary mental health services and voluntary services, indicating that they were representative of a genuine clinical sample. However, 50% of the sample remained above clinical significance for PTSD symptoms after treatment was completed, although this dropped to 25% at six-month follow-up. This lack of improvement may have been influenced by participants failure to attend sessions regularly. Furthermore, those who did not show improvement rated the therapy as less credible and were rated as less m otivated by the therapist. Therefore, it is argued that motivation for therapy and regular attendance plays an important role in outcome of therapy regardless of treatment model. A further limitation of this study was that no control group was used and non-specific treatment factors and spontaneous remission could also account for the improvements in reported symptoms. Cognitive Restructuring Cognitive restructuring is based on the theory that identifying and modifying catastrophic and unrealistic interpretations of the traumatic experience leads to symptom reduction. Recent models have emphasised the importance of correcting cognitive distortions in the adaptive recovery of people following trauma (Ehlers Clarke, 2000). Ehlers, Clark, Hackmann, McManus, and Fennell (2005) utilized cognitive therapy based on the cognitive model of PTSD (see Ehlers Clarke, 2000). From this model, the aim of therapy is to modify excessively negative appraisals, correct the autobiographical memory disturbance and to remove the problematic behavioural and cognitive strategies. In a randomised controlled trial, twenty-eight participants who were referred to a community mental health team were diagnosed with PTSD. Fourteen participants were randomly allocated to immediate cognitive therapy or a 13-week waiting list condition. Those receiving cognitive therapy had 12 weekly treatment sessions, based on the Ehlers and Clarke (2000) model of trauma focused CBT. Participants completed self-report measures of PTSD symptoms, depression, anxiety and also completed the Sheehan Disability Scale (APA, 2000). Measures were completed pre and post treatment and at 6 month follow up. Results found that CT for PTSD was superior to a 3-m onth waiting list condition on measures of PTSD symptoms, disability and associated symptoms of anxiety and depression. This study had no dropouts, which is a significant improvement on other studies, which Yielded high dropout rates. (e.g. Tarrier et al., 1999). Participants displayed a positive change in cognitive appraisals. The Ehlers and Clarke (2000) model suggest that two other pathways of change, change in autobiographical memory of the trauma, and dropping of maintaining behaviours and cognitive strategies as integral in reducing symptoms of PTSD. Although the treatment addressed these other two factors, these have not been systematically measured, so it is difficult to conclude whether clients experienced a change in these two areas. Further analysis indicated that demographic, trauma and diagnostic variables did not predict treatment outcome, suggesting that the treatment is applicable to a wide range of trauma survivors. However, the degree in variation of trauma and small sample numbers suggests that this finding would not be present in a larger sample. Co-morbid depression and previous trauma history, which was present in over half the sample, did not negatively affect outcome. Combinations of therapy Resick and Schnicke (1992) have proffered a multidimensional behavioural treatment package for women who have rape-related PTSD. This package, entitled cognitive processing therapy (CPT), combines elements of exposure therapy, Anxiety Management Training (AMT), and cognitive restructuring. The cognitive therapy component of CPT involves addressing key cognitive distortions found among women who have been assaulted. In particular, these authors have designed interventions for addressing difficulties in safety, trust, power, self-esteem, and intimacy in the lives of survivors. In a preliminary evaluation of CPT, the authors compared outcomes at pre-treatment, post-treatment, 3 months follow-up, and 6 months follow-up for a treatment group and a non-treatment comparison group (no random assignment was used). On clinician ratings and psychometric inventories of PTSD, the individuals receiving CPT improved markedly. At the post-treatment assessment, impressively, none of the treated patie nts met criteria for PTSD. In a recently completed study, Resick, Nishith, and Astin (2000) reported on a comparison of CPT and exposure therapy in the treatment of rape-related PTSD. In general, the two treatments were equally effective and more effective than a non-treatment control condition. CPT did also seem to reduce comorbid symptoms of depression, as well as those of PTSD. Combination treatments that include an array of cognitive-behavioural strategies have the advantage of addressing multiple problems that people with PTSD may exhibit, as well as incorporating techniques that have considerable empirical support in the clinical literature. Keane, Fisher, Krinsley, and Niles (1994) described a treatment package including exposure therapy, AMT, and cognitive restructuring as central features of their approach to treating PTSD. This package employs a phase oriented approach to treating severe and chronic PTSD that includes the following six phases: (1) behavioural stabilization; (2) trauma education; (3) AMT; (4) trauma focus work; (5) relapse prevention skills; and (6) aftercare procedures. Although this approach has clinical appeal, it wasnà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢t until psychologists Fecteau and Nicki (1999) examined such a package in a randomized clinical trial for PTSD secondary to motor vehicle accidents that the impact of a combination package such as that proposed by Keane et al. (1994) was assessed. Their intervention consisted of trauma education, relaxation training, exposure therapy, cognitive restructuring, and guided behavioural practice. Patients were randomly assigned to the intervention or to a non-treatment comparison group and received some 8à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬10 sessions of individualized treatment. The results of the intervention were successful as measured by clinical ratings, self-report questionnaires, and a laboratory-based psycho-physiological assessment procedure. Described by the authors as clinically and statistically significant, these treatment effects were maintained at the 6-month follow-up assessment. Bryant, Moulds, Guthrie, Dang, and Nixon (2003) studied the effects of IE alone or IE with CR in the treatment of PTSD. They hypothesised that CR combined with IE would result in greater PTSD symptom reduction than exposure alone, which in turn would have greater benefits than a supportive counselling condition. Fifty-eight civilian trauma survivors, diagnosed with PTSD as measured by Clinician Administered. PTSD Scale, version 2, CAPS-2, (Blake et al., 1995) were randomly allocated to one of the three conditions. Each participant received eight weekly 90-minute sessions of either IE, CR and IE or supportive counselling. Participants completed assessments at pre and post treatment and 6 month follow up. These measured PTSD symptoms and psychopathology. Forty-five participants completed treatment and analysis indicated that dropouts had higher scores for depression, avoidance and higher catastrophic cognitions than those who completed. Results indicated that participants receiving bot h IE and IE/CR had greater reductions in PTSD symptoms and anxiety than supportive counselling (SC). The major finding of this study was that therapy involving IE and CR leads to greater reductions in CAPS-2 intensity scores than therapy involving IE alone. Furthermore, those receiving IE/CR, but not IE alone, reported fewer avoidance, depression and catastrophic cognitions than those receiving SC. The results from this study indicated that the combination of IE and CR are effective in reducing symptoms of PTSD. It can be argued that the reasons why IE/CR may have been more effective than augmented treatments in the past (e.g. Foa et al., 1999) was that the study carefully controlled for the amount of time actively spent on each treatment component. Furthermore, participants were instructed on CR before commencing IE so they understood the rationale behind the techniques prior to addressing the strong emotional components of IE. This may have increased their understanding and belief that it was a credible treatment approach. The finding that CR enhanced the treatment gains of IE may have been mediated by several possible mechanisms. IE and CR may involve common elements, including processing of emotional memories, integration of corrective information and development of self-mastery (Marks, 2000). Combining both interventions may provide the individual with greater opportunity to benefit. CR may have lead to greater symptom reduction as it specifically addressed identification and modification of maladaptive cognitions that may contribute to maintenance of PTSD and associated problems (Ehlers Clarke, 2000). Paunovic and Ost (2001), compared treatment outcome data for CBT and exposure therapy for sixteen refugees with PTSD. The authors excluded those who became too distressed in the initial interview, expressed a lack of confidence in the therapist or were misusing alcohol or drugs. Results indicated there was no significant difference between participants completing CBT or exposure therapy, being simila r to Tarrier et als (1999) findings. Criticisms of Paunovic and Ost (2001)s study are that participants did not use a self-report trauma measure, so although results are positive, there is no clear analysis of whether participants felt their trauma symptoms decreased as a result of the treatment. Further, it is not possible to generalise these findings to traumatised refugees in general, as this work is unique. Working with the use of an interpreter raises several ethical and sensitive issues, as the participant must be able to develop a therapeutic alliance with the therapist and trust the interpreter (Tribe, 2007). It could be argued that participants may have been experiencing a greater degree of trauma, not least because they had not yet learned the native language. Discussion The most effective CBT programs appear to be those that rely on repeated exposure to the trauma memory (Foa et al., 1999; Foa et al., 1991; Foa Rothbaum, 1992) on cognitive restructuring of the meaning of the trauma, (Ehlers Clarke, 2000) or a combination of these methods, (Resick Schnicke, 1992). Importantly, studies have concluded that trauma focused CBT is more effective than supportive counselling (Blanchard et al., 2003; Bryant et al., 2003). Whilst the studies reviewed have helpfully added to our understanding of PTSD there are numerous limitations of the applications of the findings. One in particular is an over-reliance on non-clinical samples of participants such that many claims of clinically effective therapy have been made from research with participants who were not within mental health systems, and despite having PTSD symptoms had not actively sought treatment. In addition, dropout rates in studies are high, particularly for those studies that did not use a clinical sample. This might have skewed the evidence particularly with approaches that used exposure-based therapy. Furthermore, most of the studies reviewed screened out those individuals experiencing the greatest amount of distress, avoidance and co-morbidity. Therefore results are biased towards those clients who were able to tolerate treatment and whose symptoms were not as chronic. Indeed, inclusion and exclusion criteria appear to have a great impact on outcome of treatment. For example, studies with a strict inclusion criteria (e.g. no co-morbidity, substance misuse, self harm) appear to have significant improvements, whilst other studies i.e. Kubany et al., (2003), allowed participants to continue with other therapy while embarking on their therapy. This makes it methodologically difficult to ascertain exactly what has been effective in reducing PTSD symptoms. As inclusion and exclusion criteria are idiosyncratic across studies, it makes it difficult to draw general conclusions regarding treatment effectiveness with a clinical population across studies. Studies often chose to focus therapy on identified groups, e.g. police officers. However, clients who experience PTSD do not form a homogeneous group and further, the symptoms experienced may be diverse even within a sample of individuals who have experienced the same trauma. Treatment studies often do not control for other factors that may be important contributing factors in outcome such as the role of education, quality of the therapeutic relationship, therapeutic alliance and other nonspecific factors. The literature was generally from American, British or European sources although clearly trauma is intercultural. This raises issues about how different cultures interpret PTSD, an essentially Western concept, and also whether the treatments advocated would be effective cross-culturally. Previous research has strongly indicated that PTSD is not an appropriate term to use in non-western situations (Summerfield, 1997), hence therapeutic approaches need to account for this. It is not clear in the majority of the research when the participant experienced the trauma, and at what point therapy started. Frequently these characteristics are omitted from studies, therefore making it difficult to compare effectiveness of studies. It is important to consider the types of clients who have been represented in the research and to look at whether it is representative of those who seek treatment. Finally, very little has been reported on the impact of other difficulties an individual is experiencing as PTSD can have a wide ranging impact on an individuals quality of life and functioning and most often clients have more complex presentations. Only very few studies reviewed controlled for this variable (see Ehlers et al., 2005). This is an inherent difficulty when completing research with a trauma population as within research it is important to obtain a sample that have a similar degree of difficulties in order to assess treatment efficacy. Several papers have evaluated different types of therapy according to particular groups. However, it appears that one size does not fit all in relation to PTSID. In particular the issues of culture and gender are of importance (see Liebling Ojiambo-Ochieng, 2000; Sheppard, 2000). Individual formulations of presenting problems and contexts, which informs therapy that is adapted to suit individual clients needs, may in fact be more helpful. It remains important to consider individual differences and client choice when offering trauma therapy. Trauma therapy outcome studies are limited by the fact that sufferers usually have other mental health problems alongside PTSD such as depression or social anxiety. Evaluation of effective treatment of trauma survivors therefore might need to go beyond medical diagnostic categories as most of the research excludes clients with co-morbid problems. A multifaceted intervention, based on clients own views, which addressed these other difficulties, may help reduce relapse and improve long-term efficacy of any PTSD treatment. As outlined in the methodological limitations section, much of the research reviewed has not used a genuine clinical sample, there are high dropout rates, widely variable inclusion and exclusion criteria, and the heterogeneity of PTSD has perhaps not yet been accounted for. It is therefore difficult to ascertain what is specifically helpful or effective within the treatment components. This seems to be the next area for consideration in research. Further research into the optimal length of treatment and timing of therapy, the effect of co-morbidity and the differing effects of individual and group therapy approaches for traumatised clients are required. Further controlled research is needed to ascertain if the types of therapies reviewed can provide long term lasting effects in reducing PTSD symptomatology. Currently the empirical data is generally limited to the assessment of short term, focused interventions, and it would be helpful to have controlled studies on longer-term treatment for more complex trauma cases. Further research would benefit from considering the clients views and experiences of therapy, this perspective was lacking in the literature reviewed. Service user and carer perspectives are beyond the scope of this review, however they have been highlighted as an important consideration within the NICE guidelines and therefore require further consideration in future research. Conclusion There appear to be at least three treatments with excellent empirical support for treating PTSD; exposure therapy, cognitive therapy or a combination of these methods. These three approaches have excellent empirical support in well-controlled clinical trials, manifest strong treatment effect sizes, and appear to work well across diverse populations of trauma survivors. However future studies to examine the effectiveness of these approaches in clinic settings are warranted. There is much to be learned about the treatment of PTSD. It is certain there will be no simple answers for treating people who have experienced the most horrific events life offers. Undoubtedly, combinations of treatments as proposed by Keane et al. (1994) and Resick and Schnicke (1992) may prove to be the most powerful interventions. PTSD research in this area is only in the earliest stages of its development. Finally, an assumption about the uniformity of traumatic events has been made in the literature in general. Although it is reasonable to speculate that fundamental similarities exist among patients who have experienced diverse traumatic events and then develop PTSD, whether these patients will respond to clinical interventions in the same way is an empirical question that has yet to be addressed. Studies posing a question such as this would be a welcome addition to the clinical literature: Will people with PTSD resulting from combat, torture, genocide, and natural disasters all improve as well as those treated successfully following rape, motor vehicle accidents, and assaults? This is a crucial issue that requires additional scientific study in order to provide clinicians with the requisite evidence supporting the use of available techniques. Research on the prevalence of exposure to traumatic events and the prevalence of PTSD has mainly been carried out in the United States. Yet there are fundamental errors in assuming that these prevalence rates apply even to other Western, developed countries. Studies that examine the prevalence of PTSD and other disorders internationally are clearly warranted. Implicit in this recommendation is the need to examine the extent to which current assessment instrumentation is culturally sensitive to the ways in which traumatic reactions are expressed internationally. Much work on this topic will be required before definitive conclusions regarding prevalence rates of PTSD internationally can be drawn. Studies of the effectiveness of the psychological treatments across cultures and ethnic groups are also needed. What may be effective for Western populations may be inadequate or possibly even unacceptable treatment for people who reside in other areas of the world and who have different world views, beliefs, and perspectives. This issue will need to be more closely examined before we can draw definitive conclusions. It is suggested that despite the type of treatment provided to individuals with trauma there is ultimately a need for a flexible, integrative approach to treatment in order to deal with the complex and varying needs of individual trauma survivors. A range of outcomes has been found with the types of approaches outlined in this review, it is unclear who will respond best to which treatment approach. However, what is important in determining the success of any psychological treatment of PTSD is that it is dependent upon establishing and maintaining a therapeutic alliance that is strong enough for the client to experience as safe and trusting for positive emotional change to occur.