HIV (Human Immunodeficiency Virus) Essay Example for Free

HIV (Human Immunodeficiency Virus) Essay HIV (Human Immunodeficiency Virus) causes AIDS (Acquired Immune Deficiency Syndrome) that disables the immune system.  It was discovered in 1983 .HIV enters the body through the bloodstream and duplicates itself rapidly.  The victim is susceptible to infectious diseases that eventually are fatal (1). Statistically, HIV/AIDS is the number one killer of African-American women ages 25 to 34, according to the Centers for Disease Control and Prevention.  Between 2000 and 2003, they were nineteen times more likely than White females and five times more likely than Hispanic females to contract the disease.   African-American men were seven times more likely than White men and three times the rate of Hispanic men to contract HIV/AIDS (2). In 2008, there is still not a cure for AIDS.  Instead, scientists have discovered drugs that can slow down the progression of the disease. Protease inhibitors (PIs) are antiviral drugs that slow down the spread of HIV (1). The virus produces a protein called protease so that it can replicate itself.  Ã¢â‚¬Å"Protease cuts long chains of proteins and enzymes into shorter chains, the first step in the process by which HIV infects a cell† (1).  If this doesn’t happen, replication does not continue. In 1987, AZT was the first anti-HIV medication that was created.   It showed hope and kept people healthier longer.   However, the side effects were very high for men.   Since that time, more HIV medications have evolved.   Antiretroviral therapy usually consists of combinations of nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, or fusion inhibitors, which are prescribed in the later stages of HIV (19). Dual protease inhibitor therapy is also being used clinically (3).  They are also associated with improving morbidity and mortality of HIV-positive persons (5).  Although these drugs are expensive, they have proven to be the most successful therapy in managing HIV.   However, some patients don’t comply 100% with their treatments.   This is largely due to the side effects. Sometimes they make a patient feel worse than the actual disease. The most commonly reported ones are abdominal pain, abnormal bowel movements, diarrhea, fatigue, headache, and nausea.   Children usually develop a skin rash. The more serious side effects are liver problems and pancreatitis.   Some patients have also seen large increase in triglyceride ad cholesterol levels.   Diabetics saw an increase in their blood sugar levels.   Other patients developed diabetes while taking protease inhibitors (16). Presently, nine PIs have been approved for use in the United States and Europe:   amprenavir, atazanavir, fosamprenavir, lopinavir, indinavir, ritonavir, saquinavir, tipranavir, and nelfinavir. Three non-nucleoside reverse transcriptase inhibitors (NNRTIs) are used for treatment of HIV:  nevirapine, delavirdine, and efavirenz (7). Drug treatment selection depends on factors such as drug resistance, tolerability, drug interactions, and effectiveness. Therapeutic drug monitoring (TDM) â€Å"has been proposed so that practitioners may better maintain appropriate plasma concentrations of drugs in their patients by identifying interactions with other medications and assessing medication adherence   (7). Figure 1 shows the structures of these compounds. Fig. 1. Chemical structures of protease inhibitors and non-nucleoside reverse transcriptase inhibitors. About 50% of â€Å"treatment-naà ¯ve patients† don’t have continued antiviral response after one year of therapy (18). In some cases, there is a development of drug resistance and metabolic complications.   Also, â€Å"there is increasing evidence that virological treatment failure is correlated with variations in the pharmacokinetic parameters of drugs (20).   This can be due to drug interactions, low bioavailability, and variations in metabolic enzyme activity.   Atazanavir (ATV) has good oral bioavailability and a favorable pharmacokinetics profile (18).   With this in mind, patients can mostly take a once-daily dose. A separate analytical method has been recently published for quantifying ATV in human plasma using solid phase extraction and HPLC with PDA (photodiode array) detection at 201 nm (18).   This method provides excellent separation of ATV from its internal standard, clozapine (CLZ) and the other PIs, thus, obtaining an accurate measurement of the drug (see figure 2). CLZ elutes at 8.9 minutes, and ATV elutes a 24.4 minutes. A 40-ml injection resulted in a recovery yield of 100%. Fig. 2.   Chromatogram of ATV with PIs/NNRTIs (8000 ng/ml) spiked with CLZ Nelfinavir mesylate has been shown in phase III controlled clinical trials to significantly reduce viral load and increase CD4+ cell counts when used with reverse transcriptase inhibitors. It’s prescribed as part of triple drug combination therapy (9). CD4+ are helper T cells.   They are important for immune reconstitution in patients that are receiving antiretroviral therapy (10).   After a large number of these cells are destroyed, AIDS develops (7). Six clinical trials was conducted in the past ten years using 2, 148 HIV-infected children enrolled in the Pediatric AIDS Clinical Trials Group treatment trials (10).   Patient ages varied from 2 to 7 years of age.   The focus was to observe short-term variability of CD4 percentages.   The study found that 49% of patients had CD4 percentages above 25%.   32% of patients had CD4 counts between 15% and 24%; 19% were less than 15%.   Finally, 5.4% had a CD4% of less than 5% (10). In June 2006, Darunavir (DRV) was licensed in the United States.   It is a promising PI that is active against HIV strains that are resistant to the other PIs that currently on the market (17).   It is prescribed in 600-mg doses that are taken twice daily with 100 mg of ritonavir that acts as a booster. Protease inhibitors are associated with unfavorable pharmacokinetics and many side effects such as gastrointestinal disturbances and lipid abnormalities (5).  Four of the most common PIs used are indinavir, ritonavir, saquinavir, and nelfinavir (3).  Ã¢â‚¬Å"Monitoring blood concentration of PIs, which can indicate both therapeutic and toxic levels of the drugs as well as patient noncompliance with the medication, may improve the care of both HIV-infected adults and children† (3). When ritonavir was first introduced, it was given in doses of 600 mg every 12 hours. â€Å"However, patient intolerance of full doses led to its primary use as a pharmacologic enhancer to increase the concentrations in plasma of a second protease inhibitor to improve the convenience of antiretroviral regimens by extending the dosing interval, reducing pill burden, and /or eliminating food-induced reductions in pharmacokinetic exposure† (8).   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Researchers used High Performance Liquid Chromatography (HPLC) to determine concentrations of PIs in blood.  Various methods have been used to study the pharmacokinetics and drug interactions. Interpreting plasma levels can be used to â€Å"individualize drug dosage of antiretrovirals (4). Quality control (QC) procedures must be done to ensure that these methods are accurate and precise.  Ã¢â‚¬Å"Such procedures usually include intralaboratory (internal) method validation, intralaboratory QC procedures, and participation in an interlaboratory QC program for antiretroviral drugs† (4). Since the latter hadn’t been done before, it was established so that laboratories can obtain better measurement results of antiretroviral drugs. Nine laboratories participated in the first part of the program.  The first part of the experiment involved the measurement of the protease inhibitors:  indinavir, nelfinavir, ritonavir, and saquinavir.  All had a specified purity of 99% or higher.  QC samples were prepared by spiking blank plasma from HIV-negative volunteers with PI standard. The low concentrated standards ranged from 0.087 to 0.15 mg/L while the intermediate concentrated standards contained ranged from 2 to 3 mg/L of all four PIs.  Finally, the high-concentrated standards contained approximately 5 to 11 mg/L of drug.  All drugs were dissolved in methanol following accurate weighings and diluted with blank plasma (4). High Performance Liquid Chromatography (HPLC) was used to analyze twelve samples.  All laboratories measuring more than one protease inhibitor used as assay for â€Å"simultaneous determination† (4).  Six laboratories used HPLC/UV and three labs used HPLC-MS/MS. Mass spectrometry detection is often recommended for measurement of low concentration levels.  Also, this type of analysis is usually faster and â€Å"does not require complete resolution of drugs for detection and quantification† (5).  Only five laboratories were able to measure all four PIs.  Three laboratories were not able to determine nelfinavir.  One laboratory only measured indinavir (4). Acceptable accuracy results are between 80% and 120%.  Only indinavir resulted in an acceptable accuracy of 80%.  The remaining PIs had between 36% and 74% accuracy.  These results should encourage laboratories to improve their analytical methods and QC procedures.  Other PIs, such as amprenavir and lopinavir, can be analyzed as well (4). HIV-positive plasma samples are heat inactivated before analysis, approximately 58 °C for 40 minutes, to decrease the risk of infection to the operator.  They may also go through a freeze/thaw cycle. As with the QC study, blank plasma was spiked with seven PIs (indinavir, amprenavir, atazanavir, ritonavir, saquinavir, lopinavir, and nelfnavir) at low, intermediate, and high concentrations measured in ng/ml.  Certain assays only require 100  µl of plasma for analysis.  Ã¢â‚¬Å"This is advantageous when measuring PI concentrations as part of clinical studies as they often necessitate hourly sampling to generate complete PK profiles; therefore less blood can be drawn from the patient† (5).  In addition, seven PIs can be quantified in one assay, but impossible to assay all seven in a single preparation. â€Å"The use of liquid chromatography coupled to tandem mass spectrometry (LC-MS-MS) has emerged as the developmental method of choice supporting clinical and pre-clinical pharmacokinetic studies† (13). Recovery for the HPLC-MS/MS methods was above 87% for all seven drugs at all three concentration levels (5).  It was successful in quantifying seven PI concentrations in plasma of HIV positive persons that participated in a run time of nine minutes.  Therefore, the assay may be used for determining PI concentrations in semen, lymphocytes, and cerebrospinal fluid (5). A fast and highly-sensitive LC-MS-MS method was developed that could analyze five protease inhibitors (amprenavir, indinavir, nelfinavir, ritonavir, and saquinavir) in one run using an internal standard.   Sample sizes were small (ng/ml) and run times were approximately 5 minutes.   Recoveries for all five PIs were between 87% and 92%(11). Tipranavir is part of a class of non-peptidic PIs that works against both â€Å"wild-type virus and variants resistant to current PIs†(6).  It also has a high genetic barrier.  Tipranavir is prescribed in a 500-mg dose taken in combination with 200 mg of ritonavir twice daily as part of antiretroviral therapy for patients with HIV-1 strains that are resistant to multiple PIs (6). Fig. 3. Tipranavir chemical structure   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  An HPLC-UV method has been validated and is currently applied when monitoring tipranavir (TPV) plasma levels in HIV patients.  Samples were prepared for solid phase extraction (SPE) by conditioning the cartridges with 0.1% phosphoric acid, pH 7.  TPV stock solutions with a concentration of 5 mg/ml were diluted from with 50% methanol. Samples were spiked with TPV at 1.875, 7.5, 18.75, 37.5, 60, and 75  µg/ml in triplicate. QC samples were diluted with blank plasma and phosphate buffer to 5.625, 22.5, and 67.5  µg/ml.  Clozapine was used as the internal standard (6).  5-ml aliquots of blood samples were obtained from HIV infected patients.  The plasma obtained from centrifugation was heated at 60 ° C for one hour in a water bath. TPV in plasma was measured at a UV absorbance of 201 nm with a retention time of 32.2 minutes. Its internal standard, clozapine (CLZ) has a retention time of 8.3 minutes (6). Figure 4 below shows the chromatogram of TPV, its internal standard, and all other PIs and NNRTIs  present.   Figure 5 shows TPV and its internal standard CLZ only. Fig. 4. Chromatogram of plasma control sample of TVP (22.5 mg/ml) spiked with internal standard and all PIs and NNRTIs. Fig. 5. Chromatogram of calibration sample of TVP (37.5 mg/ml) spiked with internal standard CLZ. Isocratic HPLC methods combined with the use of UV and fluorescence detection produces more sensitivity. Amprenavir is a fluorescent compound.   Its internal standard PR25 can also be seen under fluorescence (see figure 6). Fig. 6.   Blank plasma with 100 ng/ml amprenavir and 1000 ng/ml of PR25 seen under fluorescence. In conclusion, much progress has been made in the development of protease inhibitors and other antiretroviral therapy. HPLC with UV detection has been the most commonly used method of analysis.   It is rapid, simple, and highly sensitive.   LC-MS-MS has been noted at the developmental method of choice for clinical and pre-clinical pharmacokinetic studies (13).   More compounds can be analyzed in less time.   Also, they can be used for methods using other human biological matrices. For the majority of protease inhibitors, all side effects are not known. In 2007, darunavir was the new HIV protease inhibitor with eleven other antiretroviral agents on the market.   They can affect patients that have diabetes, liver problems, and hemophilia; their conditions can worsen as a result of taking PIs. Only a patient’s health care provider can determine the best treatment option REFERENCES Nagel, Rob. 2007. Protease Inhibitors. UXL Encyclopedia of Science; [cited 2008 May 8], Available from http://galenet.galegroup.com/servlet/SciRC?ste=1docnum=cv2644301082. Health Hotline:   HIV and Genital Herpes [cited 2008 May8]; Available from http://www.ebony.com. â€Å"HPLC Assay for Common Protease Inhibitors Developed.†Antiviral Weekly; [cited 2008 May 07; Available from http://galenet.galegroup.com/servlet/SciRC?ste=1docNum=A60069570. Aarnoutse, Rob E., Verweij-van Wissen, Corrien P.W.G.M., van Ewijk-Beneken Kolmer, Eleonora, W.J., Wuis, Eveline, W., Koopmans, Peter P., Hekster, Yechiel A., and Burger, David, M. 2001. International Interlaboratory Quality Control Program for Measurement of Antiretroviral Drugs in Plasma; Antimicrobial Agents and Chemo 46(3): 884-886. Dickinson, Laura, Robinson, Lesley, Tjia, John, Khoo, and Saye, Back, David. 2005. Simultaneous determination of HIV protease inhibitors amprenavir, atazanavir, indinavir, lopinavir, nelfinavir, ritonavir and saquinavir in human plasma by high-performance liquid chromatography-tandem mass spectrometry; J of Chrom. B 829:82-90. Colombo, S., Beguin, A., Marzolini, C., Telenti, A., Biollaz, J., and Decosterd, L.A. 2006.   Determination of the novel non-peptidic HIV-protease inhibitor tipranavir by HPLC-UV after solid-phase extraction; J of Chrom. B 832:138-143. Rezk, Naser L., Tidwell, Richard R., and Kashuba, Angela D.M. 2004.   High-performance liquid chromatography assay for the quantification of HIV protease inhibitors and non-nucleoside reverse transcriptase inhibitors in human plasma; J of Chrom. B 805:241-247. Shelton, Mark J.,Hewitt, Ross G., Adams, John, Dela-Coletta, Andrew, Cox, Steven, and Morse, Gene D. 2003. Pharmacokinetics of Ritonavir and Delavirdine in Human Immunodeficiency Virus-Infected Patients; Antimicrobial Agents and Chemo 47(5): 1694-1699. Zhang, Kanyin E., Wu, Ellen, Patick, Amy K., Kerr, Bradley, Zorbas, Mark, Lankford, Angela, Kobayashi, Takuo, Maeda, Yuki, Shetty, Bhasker, and Webber, Stephanie. 2001.Circulating Metabolites of the Human Immunodeficiency Virus protease Inhibitor Nelfinavir in Humans:   Structural Identification, Levels in Plasma, and Antiviral Activities; Antimicrobial Agents and Chemo 45(4): 1086-1093. Carey, Vincent J., Pahwa, Savita, and Weinberg, Adriana. 2005.   Reliability of CD4 Quantitation in Human Immunodeficiency Virus-Positive Children:   Implications for Definition of Immunologic Response to Highly Active Antiretroviral Therapy; Clinical and Diagnostic Lab Immunology 12(5): 640-643. Chi, Jingduan, Jayewardene, Anura L., Stone, Judith A., Motoya, Toshiro, and Aweeka, Francesca. 2002.   Simultaneous determination of five HIV protease inhibitors nelfinavir, indinavir, ritonavir, saquinavir and amprenavir in human plasma by LC/MS/MS; J of Pharm and Biomedical Analysis 30:675-684. Verbesselt, R., Van Wijngaerden, E., and de Hoon, J. 2007. Simultaneous determination of 8 HIV protease inhibitors in human plasma by isocratic high-performance liquid chromatography with combined use of UV and fluorescence detection: Amprenavir, indinavir, atazanavir, ritonavir, lopinavir, saquinavir, nelfinavir and M8-nelfinavir metabolite; J of Chrom. B 845:51-60. Frerichs, Valerie A., DiFrancesco, Robin, and Morse, Gene D. 2003. Determination of protease inhibitors using liquid chromatography-tandem mass spectrometry; J of Chrom, B 787:393-403. Gangl, Eric, Utkin, Ilya, Gerber, Nicholas, and Vouros, Paul. 2002. Structural elucidation of metabolites of ritonavir and indinavir by liquid chromatography-mass spectrometry; J. of Chrom. A 974:91-101. Turner, Michele L., Reed-Walker, Kedria, King, Jennifer R., and Acosta, Edward P. 2003. Simultaneous determination of nine antiretroviral compounds in human plasma using liquid chromatography; J. of Chrom. B 784:331-341. 2008. Kaletra. [Cited 2008 May 16], Available from http://www.heartandsoul.com. D’Avolio, Antonio, Siccardi, Marco, Sciandra, Mauro, Lorena, Baietto, Bonora, Stefano, Trentini, Laura, and Di Perri, Giovanni.2007. HPLC-MS method for the simultaneous quantification of the new HIV protease inhibitor darunavir, and 11 other antiretroviral agents in plasma of HIV-infected patients; J. of Chrom. B 859:234-240. Colombo, S., Guignard, N., Marzolini, C., Telenti, A., Biollaz, J., and Decosterd, L.A. 2004. Determination of the new HIV-protease inhibitor atazanavir by liquid chromatography after solid-phase extraction; J. of Chrom. B 810:25-34. Weller, Dennis R., Brundage, Richard C., Balfour, Jr., Henry H., and Vezina, Heather E. An isocratic liquid chromatography method for determining HIV non-nucleoside reverse transcriptase inhibitor and protease inhibitor concentrations in human plasma; J. of Chrom. B 848:369-373. Sarasa-Nacenta, Maria, Lopez-Pua, Yolanda, Mallolas, Josep, Blanco, Jose’ Luis, Gatell, Jose’ M., and Carne’, Xavier. Simultaneous determination of the HIV-protease inhibitors indinavir, amprenavir, ritonavir, saquinavir and nelfinavir in human plasma by reversed-phase high- performance liquid chromatography; J, of Chrom. B 757:325-332.

Introduction to Health Economics, Lorna Guinness | Overview

Introduction to Health Economics, Lorna Guinness | Overview NAME OF THE BOOK: INTRODUCTION TO HEALTH ECONOMICS AUTHOR: GUINNESS, LORNA KEY TERMS Efficiency It describe the connection between inputs and outputs. It’s involved with increasing advantages with the resources accessible, or minimizing prices for a given level of profit. Goods These are the outputs (such as health care) of a production method that involves the combining of various resources like labor and instrumentation. Merchandise (including services) are valuable within the sense that they supply some utility to individual shoppers. They’re termed ‘goods’ as theyre fascinating, as distinct from ‘bads’ that youll examine later! Health sector It contains organized public and personal health services, the policies and activities of health departments and ministries, health-related nongovernment organizations and community teams, and skilled associations. Health services- The vary of services undertaken primarily for health reasons which have an instantaneous result on health, as well as health care programs like health promotion and specific disease prevention and treatment. Marginal analysis It is the examination of the additional focal points or costs emerging from an extra unit of utilization or generation of a decent. Market A state of affairs wherever those who have a requirement for an honest move with suppliers and agree on a worth at that the great are going to be listed .The important condition for effectively working markets may be an arrangement of property rights to verify that people will take part in honestiness. Opportunity cost (economic cost) As assets are rare, a single person, in deciding to devour a decent, on a fundamental level, picks the great which provides for him or her the best advantage, and in this manner renounces the utilization of a scope of option merchandise of lesser worth. The opportunity expense is the estimation of the profit of the following best option. Resources These represent inputs into the method of manufacturing merchandise. They’ll be classified into 3 main elements: labor, capital and land. Completely different merchandise would typically need variable mixtures of those parts. Resources are typically valued in financial terms. Utility- The satisfaction or fulfillment an individual increases from expending a decent. The more utility an individual gets from the utilization of a decent, all else being equivalent, the more they would be eager to use their salary on it. What is an economy? The economy is outlined as all the economic activities and establishments among an outlined space (usually geographically, associated with the political borders of a nation state). Resources’ are those items within the economy that can be used to manufacture and distribute goods. Resources will be classified as labor, capital and land: Labor refers to human resources, manual and non-manual, accomplished and unskilled. Capital-are those product that are accustomed turn out alternative product – as an example machinery, buildings and tools . Land –consist of all natural resources, like oil or ore. Goods are either items that you can hold or touch (e.g. a medication) or else they are administrations that befall you (e.g. a counsel). There are 2 vital attributes that recognize diverse goods: 1 Physical attributes – a frozen dessert and a cup of tea are totally completely different commodities as a result of they need different producing techniques and since they satisfy different needs. 2 Context in which the good is consumed – for example: a) the time in which the good is available – an ice cream that is available on a hot summer’s day is a different good from one available in the cold midwinter. b) The place where the commodity is available – a cup of tea available in a fashionable cafà © is a different good from tea that is sometimes sold at a petrol station. What is a market? In financial science, the expression business sector is utilized to clarify any condition of undertakings wherever individuals that request a conventional close with suppliers. For it to be a market the purchasers and venders dont need to be urged to physically meet – case in point, most unmistakably, exchanging on the net will include systems of individuals in all segments of the planet who can never meet. Altogether, an important condition for effectively working markets could be an arrangement of property rights to affirm that people will take part in accordance with some basic honesty. This infers that the exchanges made between gatherings are some way or another enforceable which there are bound comprehended tenets in regards to however people act as far as giving information, making installment. Health System finance Health system finance is that the method by that revenues area unit collected from primary and secondary sources, that area unit accumulated in fund pools and allotted to supplier activities’ Within the finance function of the health system there are unit 3 main activities. Revenue collection refers to the raising of funds either directly from people seeking health care or indirectly through governments or donors. Fund pooling refers to the gathering of funds which will be used for finance a given population’s health care in order that contributors to the pool share risks. Purchasing is the method of allocating funds to the suppliers of health care. There are two ways of paying for health services: Out-of-pocket payments: this is often the only and earliest style of dealing between patient and provider. Third-party payments: where providers are paid by an insurance company or a government. 1) In several countries out-of-payments for health care play a crucial role. From low-income countries theres proof that individuals who are not covered by insurance pay high amounts for health care in relevance their financial gain. In Africa, quite fifty per cent of health care expenses return from directly paid non-public sources. Types of out-of-pocket expenditure include the following. †¢ Private consultations with doctors. †¢ Over the counter (OTC) drugs. †¢ Co-payments and user fees: where third-party payment is prevalent, cost sharing within the variety of co-payments plays a very important role. Co-payments and user fees might apply to prescription drugs, medical care, patient care and emergency transport. †¢ Unofficial fees: besides official fees, unofficial payments to doctors are common in several countries. Further payments to employees to urge access to hospitalization are common in some Asian countries. In range of countries in central and Eastern Europe, doctors used to expect unofficial payments as a supplement to their financial gain. †¢ Services not covered by insurance: transport costs, traditional or complementary medicine and luxury services such as cosmetic surgery. 2) These are costs that are high in connection to salary. Case in point, lavish helps are unrealistic to be paid out-of-pocket, as individuals would need to use a substantial extent of their salary or riches on social insurance. Generally, people look for protection to secure themselves against such conceivably disastrous misfortunes. You might likewise consider administrations with qualities of an open decent which are financed openly on the grounds that they are not given by private markets. Consider preventive administrations, for example, wellbeing instruction, which the individual customer may not be ready to buy secretly. 3) Overall out-of-pocket spending on health care is increasing. This is due to the growing proportion of OTC drugs and increasing cost sharing. The evolution of health service finance Global correlations demonstrate that nations use distinctive methods for paying for wellbeing administrations. Case in point, France and Sweden have created notably diverse practices to reserve healing centers and to pay for specialists. Latin American nations have social protection frameworks while in numerous African nations government subsidizing is normal. The Changing World of Health Services Finance The climbing estimation of health awareness imply that paying for medicinal services is an issue of concern in most, if not all nations. Governments are upset in regards to the monetary and political results of the expanding benefit of giving wellbeing administrations and look at to utmost using through tighter controls and diverse changes. Theres gigantic assemblage of writing to suggest that a considerable measure of nations are disappointed with the present methodologies of account and conveyance of wellbeing administrations or as inside the instance of the past Union of Soviet Socialist Republics, are forced into change through immense political alteration and wretchedness. Though the motives and kinds of reform could disagree, there are some common themes: Separation of customer and supplier responsibilities whereby the underlying plan is that purchasers contract with those suppliers giving best price for cash which this will increase the potency of service delivery . Redefinition of the role of the state in responsibility for health care. Encouragement of the personal sector. Encouragement of competition between suppliers. Alternative sources of funding, budget constraints and political modification in several countries has resulted within the health sector and governments seeking out other ways of mobilizing the resources. What is economic evaluation? It is the comparison of prices and consequences of different health care interventions to assess their worth for cash. Impact of health problems A key need of numerous social orders far and wide is the assuagement of wellbeing issues: illness, damage or a danger component for one of these. The effect of such wellbeing issues can be showed in distinctive ways – physical inability, dismalness and mortality, enthusiastic trouble, social troubles and seclusion, and monetary and financial misfortune. The impact of health problems can be measured as: The number of cases The number of passing’s(deaths) The amount of disability, pain or suffering The measure of people with a risk factor The measure of money spent on a health problem

Feminist Theories in Social Work

Feminist Theories in Social Work This research considers the application of feminist thought in social work practise.   Specific areas of consideration include the gap from social workers’ personal acceptance of feminist constructs and their use of such constructs in daily practise, the effects of perpetuation of hegemonic gender roles by social workers, and domestic violence victims perceptions of the effectiveness of social work based on the perspectives of their social workers as considered above.   This research further describes a focus group of college social work students who are also domestic violence victims. It records their perceptions of social workers’ worldviewsand the impact of such on service.   Conclusions include that there is asignificant gap between the understanding or acceptance of feministconstructs amongst social workers and its application in daily fieldpractise, that social workers are often likely to perpetuate hegemonicgender roles, and because of such perpetuation view domestic violencesituations as individual occurrences rather than part of a greatersocietal pattern of oppression, and that domestic violence survivorsfeel best served when work with them uses a feminist theoreticalframework. INTRODUCTION Feminism and social work have been associated for many years; however,although many social workers personally espouse working from a feministperspective, the systems of social work still favour work from atraditional or patriarchal perspective.   This research, therefore,seeks to first consider findings from previous study regarding thisphenomenon and the theoretical frameworks for both social work andfeminist thought.   In this light of information gleaned from thesefindings, it became apparent that hegemonic gender roles, a commontopic of feminist research, play a relevant part in work with survivorsof domestic violence.   Specifically, domestic violence survivors areoften directed, either explicitly or implicitly, that their situationis personal and should be considered and dealt with from a personal andpathological perspective rather than applying the tenets of feministthought that view such situations as manifestations of structural andpower problems in our greater society .This study then seeks to document whether this gap between social worktheory supportive of feminist worldviews and social work application ofpractise exists, and if so, how prevalent a gap it is.   This isaccomplished through use of a focus group of college students, all ofwhom have taken at least one course in social work theory and arethemselves domestic violence survivors who have been served, towhatever level of quality, by social workers.   Discussions within thefocus group involved ideas of gender roles and social worker advocacyof hegemonic gender roles, whether explicit or implicit.   The focusgroup then built on this foundation to consider group participants’experiences with social workers and whether they presented anindividual / pathological perspective of domestic violence, or whetherthey presented a perspective that consider the wider influence ofsociety and its systems.   This was further related to the effect ofsuch perceptions on the understanding of and service to groupparticipants at the time of intervention. LITERATURE REVIEW Feminism has emerged in the past thirty years as a viableworldview.   Dietz (2000), quoting Bunch (1980), defined feminism asâ€Å"transformational politics that aims at the dismantling of allpermanent power hierarchies in which one category of humans dominatesor controls another category of humans† (372).   â€Å"In the feminist andempowerment traditions, the personal is political, and individualchange and social change are seen as interdependent† (Deitz 2000,372).   Feminism contends it is not adequate to simply include women inthe world’s political and power systems, as these were designed by andfor men and therefore favour a highly masculinised mechanism forresponding to issues and require women working within these systems todo the same (Scott 1988, Moylan 2003).   Simply including women is notenough; society must give women’s experiences equal time andconsideration, eventually recasting the very meanings of the topics itconsiders (Scott 1988) .   Rather, feminism argues women must be engagedin both the system development and decision-making processes that shapeour society (Moylan 2003).   Consequently, one area where feminism has particularly challengedtraditional views is in the area of gender roles.   For example,Dominelli and McLeod (1989) examine the way in which social problemsare defined, recognising gender as particularly important inunderstanding client groups, and stress egalitarian relationshipsbetween therapists and clients.   Gender is also an importantconsideration of social work due to the patriarchal society that stilldominates most of our world.   This power framework rests on a basis ofhegemonic masculinity (Cohn and Enloe 2003).   Connell (1995) createdthe term ‘hegemonic masculinity’ to describe the valued definition ofmanhood in a society.   He argues that whilst there are multiplepossible masculinities in a culture, only one or a few are most valuedor considered ideal (Conn ell 1995).   This gender definition isconstructed both in relation to femininity and to other, subordinatedmasculinities, and is used to justify both men’s domination of women,and the hegemonically masculine man’s power over other men (Cohn andWeber 1999).Whilst women are increasingly being included in world systems, thesystems themselves still were designed for and operate by and for men.  Therefore, women who participate within the system must do so from maleparadigm, even if it is sometimes at odds with their own preferencesfor how to go about dealing with a situation (Cohn and Enloe 2003).Feminism historically is a â€Å"critique of male supremacy, the belief thatgender order was socially constructed and could not be changed† (Cott1989,205).   Masculinity is often defined as what is not feminine, andfemininity as what is not masculine, although understanding thedynamics of one requires considering both the workings of the other andthe relationship and overlap between the two (Cohn and Enloe 2003).  Masculine definitions are often based on strength, domination andviolence, whilst feminine on weakness, nurturing, compassion andpassitivity (Rabrenovic and Roskos 2001).   The result is pressure onmen adhering to a hegemonic definition of masculinity to view forms ofaddressing conflict other than a physical or masculine response asfeminine and a threat to their manhood (Moylan 2003).   The popular concept of gender holds that masculinity and femininityare unchanging expressions based on the chromosomal male and femalebodies (Butler 1990).   â€Å"Gender is assumed to be ‘hard-wired,’ at leastin part† (Hawkesworth 1997).   Masculine actions and desires for men andfeminine actions and desires for women alone are normal, thesemasculine and feminine traits are not a matter of choice, and allindividuals can be classified as one or the other (Hawkesworth 1997).  However, whilst our society men are considered strong and dominant, andwomen passive and nurturing, â€Å"the meanings of male and female bodiesdiffer from one culture to another, and change (even in our ownculture) over time† (Connell 1993, 75).   For example, there have beenâ€Å"periods in Western history when the modern convention that mensuppress displays of emotion did not apply at all, when men wereeffusive to their male friends and demonstrative about their feelings†(Connell 1993, 75).   â€Å"Masculinities and feminities are constructed oraccomplished in social processes such as child rearing, emotional andsexual relationships, work and politics† (Connell 1993, 75).Feminism, however, contends gender is a constructed by each culture,and as a social practice involves the incorporation of specificsymbols, which support or distort human potential (Hawkesworth 1997).  Ã‚  Gender is created through â€Å"discursively constrained performative acts,†and the repetition of these acts over time cr eates gender for theindividual in society (Butler 1990, x).   People learn to â€Å"act† likewomen or men are supposed to; women are taught to behave in a femininemanner, men are taught to act in a masculine manner.   This is oftenreinforced by authority figures, such as social workers.   Barnes (2003)cites a number of studies which find social workers often assume theâ€Å"disciplinary gaze† of notions of â€Å"what and how to be woman,†perpetuating traditional gender roles (149).  Ã‚   â€Å"Armed with rigid codesof gender appropriate behaviors, social workers often sought toregulate and mediate women’s interactions with the social, economic,and political world† (Barns 2003, 149).Feminism and social work share a number of similarities.   Both believeâ€Å"in the inherent worth and dignity of all persons, the value of processover product, the appreciation of unity-diversity, the importance ofconsidering the person-in- environment, and a commitment to personalempowerment and active participation in society as a means to bringabout meaningful social change† (Baretti 2001, 266-267).   Similarly,both feminism and social work address multiple approaches to handlingsituations, challenging the institutionalized oppression common in manypower structures and supporting â€Å"the reconceptualization andredistribution of that power† (Baretti 2001, 267).It follows that one impact of feminism on social work practise is theconsideration of issues from a societal rather than personalperspective.   For example, this might include viewing a domesticviolence situation not from the perspective that the family isdysfunctional, but from the perspective of the society that created thefamily.   The psychology-based focus of clinical social work â€Å"oftenleads to individualizing social problems, rather than to viewing themas the result of relations of power, primarily oppression and abuse†(Deitz 2000, 369).   As such, individuals experiencing such difficultiesare â€Å"taught† that their particular experiences are inappropriate,rather than addressing the systems that created the difficulties in thefirst place (Deitz 2000, 369).   Dominelli and McLeod (1989) re-evaluate social work practice from afeminist perspective, considering the functions of social work such astherapy, community interaction, and policy making not from apathological standpoint but from one of defined roles endorsed bysocietal conditions.   As such, they contend that working from afeminist perspective allows the social worker to address the causes ofsocial issues, rather than the symptoms played out in individual’slives (Dominelli and McLeod 1989).One area of difference in social work practise between those operatingfrom a feminist framework and a traditional framework is the concept ofdistance.   Traditionally, the â€Å"patriarchal bias against relationalityand connection† is intended to lead to â€Å"connection without harm, lovewithout power abuse, touching without sexual abuse in psychotherapy†(Deitz 2000, 377).   Unfortunately, in practise it often results inâ€Å"power over† relationships where those receiving services feel â€Å"lessthan† those providing them.   â€Å"Healing happens when someone feels seen,heard, held, and empowered, not when one is interpreted, held at adistance, and pathologized† (Deitz 2000, 377). Deitz (2000) finds thatsocial workers often institutionalize a â€Å"power over† stance fromprofessional training and discourse that constructs the identities ofclients as somehow disordered, dysfunctional or impaired.   â€Å"Whetherbetween parents and children; physicians and patients; social workersand consumers of services; Whites and Blacks; or heterosexuals andlesbians, gays, bisexuals, and transgendered persons, power overrelationships give the dominant partners or group the right to definethe mean ings of subordinates’ experiences (including their resistance)and thus their opportunities for self-affirmation† (Deitz 2000,373).This creates professional relationships that ignore theenvironmental, historical, and social contexts of the problem, discountpeople’s strengths and resilience in assessment and intervention, andlead â€Å"to the objectification of people as diagnoses, rather than toempowerment† (Deitz 2000, 370).   â€Å"The keys to empowerment in feministmicro practice are reconnection and transformation through politicalactivity; survivors of oppression and abuse experience reconnectionthrough relationships based on mutuality, collaboration, andtrustworthiness† (Deitz 2000, 376).Theories from social work, psychology, and particularly developmentalpsychology describe empowerment as primarily a process, with thepersonal transformation of the individual becoming empowered at itsfoundation (Carr 2003, 8).   Barriers to empowerment and problems ofdisenfranchisement caused by powerlessness are primarily political,rather than psychological.   Powerlessness is defined as the inabilityto effectively manage one’s emotions, knowledge, skills, or resources;it is â€Å"derived from the absence of external supports and the existenceof ontological â€Å"power blocks† that become incorporated into a person’sdevelopment† (Carr 2003, 13).   As such, many survivors also work toreconnect to others in their communities, often seeking politicalactivity that â€Å"emphasizes the empowerment of others, such as byorganizing Take Back the Night marches or speak-outs, volunteering forcrisis hot lines, seeking legislative changes, or becoming socialworkers or human service professionals† (Deitz 2000, 376).For example, feminist work with abuse survivors â€Å"emphasizes therelationship between abuse and oppressive social relations (Deitz 2000,374).   On the other hand, the dominant clinical socia l work approach tooppression and abuse relocates the problem of oppression in victims.Psychological theories are typically employed, which â€Å"locates pathologyin individuals, rather than in oppressive relationships and systems,and considers the long-term effects of oppression to be symptoms ofindividual pathology† (Deitz 2000, 374).   Unfortunately, whilst manysocial workers have been exposed to or even personally supportoperating from a feminist framework, the systems in which they workprevent them from actively utilising feminist insight in their dailypractise.   RESEARCH PLAN This research seeks to study the prevalence and impact of traditionaland feminist practitioner constructs from the perspective of thoseserved.   Specifically, a focus group study will be conducted with agroup of college students, all of whom are currently studying socialwork and therefore have some concept regarding social work practice,feminist and traditional worldviews.   In addition, all students in thefocus group will have experienced domestic violence and have beenprovided the services of a social worker in some form during theirteenage years.Three areas of discussion will be undertaken by the group.   These willbe provided to individual group participants in writing several daysbefore the group in order for students to have time to consider whatthey would like to share regarding their opinions and own experiences.  The first group activity will involve creating definitions ofâ€Å"masculine† and â€Å"feminine† from the perspective of a typical socialwork er based on the students’ teenage experiences.   Students will thenbe asked to discuss where, if at all, they personally feel they andtheir family members who were involved in the domestic violencesituation(s) â€Å"fit† regarding these preconceived definitions.   It isanticipated some students will have been uncomfortable with societalconstraints they or their family experienced as teenagers.   As all arestudying social work, they are also anticipated to make moreconnections between societal power issues, hegemonic gender roles, andtheir influence on domestic violence than a focus group without suchbackground.   The third area of discussion will centre on how thestudents’ perceptions of their social worker(s) understanding of genderroles influenced their and their families reception of adequateservice. The researcher will both tape record and take notes on the groupdiscussions.   Data gathered from the group will then be compiled andanalysed.   In a ddition, students from the focus group will be given theoption to write a response to the group activity, if they so desire.  These will be further included in the group data. METHODOLOGY Data collection involved four means.   Prior to the group starting,each participant was given a questionnaire (see Appendix 3) to gatherbasic demographic information.   The questionnaire also asked for abrief summary of their abusive situation.   Regarding data collection ofthe group proceedings, as described above the focus group session wastape-recorded and the researcher took notes to supplement the recordingof group discussion.   The recorded sessions were then transcribed intoprint form, with research notes added in at the chronologicallyappropriate points of the transcription to provide a more completewritten overview of the focus group discussion.   In addition, groupparticipants had an option to write a response the group to be includedin the group data.   Four participants wrote responses, which wereconsidered with the group data following analysis of the focus groupdiscussion.   Participants were provided with the three areas of groupdiscussion several days pr ior to the actual focus group meeting.   Theywere not given any directions or guidance regarding the optionalwritten responses to the group activity.Data analysis first involved dividing and coding group data.   Responsesto the first topic of discussion were divided into three categories:  those representing a traditional worldview, those representing afeminist worldview, and those that did not clearly represent eitherworldview.   From these groupings, overall findings regarding theworldviews typically experienced by the group participants weresummarised.   This was then further compared with the definitions oftraditional gender roles identified by the group.Data from the second topic of discussion were also broken down intothose representing a traditional worldview, those representing afeminist worldview, and those that did not clearly represent eitherworldview.   It was important to then note participant perceptions andemotional responses to these codings, and in which worldview groupingthey and their families were reported to feel best served andempowered.   Data from the specific discussion regarding service were then similarlyanalysed, and combined with previous findings to present a picture ofthe impact of traditional versus feminist worldviews on social workpractise, emphasising work with teenage domestic violence survivors andtheir understanding of gender roles in society.   It was anticipated at the conclusion of such research, a view could beasserted as to whether feminist perspective has a significant impact onthe practise of social work as it is currently undertaken and whetherthis impact, if any, leads to improved service.As the focus group involved a relatively small number of participants(nine total) and data from their interactions were primarilyqualitative in nature, it was decided not to perform any complexstatistical analysis on focus group data.   It was felt that such typesof analysis would neither reveal findings that co uld be consideredstatistically significant nor provide a more accurate understanding ofthe issues under consideration than a more qualitative analyticalapproach.   In consideration of space and relevance portions of thediscussion were used to support conclusions in the findings andanalysis sections of this dissertation, whilst an overall summary ofthe most relevant portions of the discussion are included in Appendix2. IMPLEMENTATION OF PROJECT Nine students meeting the criteria laid out in the research planagreed to participate in the focus group.   They were primarilyorganised by one group participant, who had discovered other domesticviolence survivors through classroom discussions and throughparticipation in a survivors’ group in the local community.   All ninestudents were currently studying social work or had taken at least onesocial work course as part of a related course of study, such aseducation or criminal justice.   There were six women and three men,ranging in age from nineteen to twenty-seven.   Racially, seven wereCaucasian, one was Black, and one was Asian.   All present as comingfrom upper working class to middle class backgrounds.   All hadexperienced domestic violence as teenagers, making their experiencesfairly recent and therefore providing a relatively current depiction ofsocial work practise.   Five students (three women, two men) had beenremoved from their biological parents at s ome point during theirteenage years.   All had been involved in interventions into the familyby a social worker representing either a government organisation, or inthe case of one woman, a local church.   Some of the participants previously knew each other and were somewhataware of each other’s experiences, which should be considered in groupanalysis.   Five regularly participated in a survivors’ support group inthe community.   One man and one woman were cousins.   In addition, twoof the men had known each other as teenagers from intervention throughthe school system.Jennifer, a twenty-four year-old Caucasian woman, was chosen to be themoderator, as she had been the one who had assisted the researcher byarranging for most of the participants to become involved in thestudy.   The group then moved almost immediately into discussion of thetopics provided.   The group had been provided a whiteboard for its use,which Jennifer implemented to organise individua l comments and ideas.  It is surmised that the easy manner with which the group undertook thediscussion was based on the fact that they were all students andtherefore used to having study groups, group discussions, and the like,and that all of them had at least publicly shared their experiencespreviously, either as part of a classroom discussion or survivors’group, or both, and were therefore more comfortable in engaging in suchdiscussion than might be typical for a focus group dealing with suchexperiences. FINDINGS AND ANALYSIS The first finding of this research is that the majority of socialworkers in service or domestic violence survivors to not consistentlyemploy feminist constructs in practise, despite the likelihood ofhaving been exposed to such constructs.   This manifested itself inthree significant ways.   First, families were overwhelming dealt withas individuals with problems.   That is, the abuser was described asmaking poor choices or having some type of pathological issues that ledto his or her decision to abuse (in one participant’s family, bothparents were abusive).   As such, the abuser was described from apsychoanalytical standpoint by the social worker(s), and his or herbehaviour labelled as individually deviant.   The survivors of the domestic violence situations, particularly themothers, as the majority of abusers from the groups’ experiences weremale family members or boyfriends of the mother, were also reported tobe consistently dealt with from an individual per spective.   In thissense, their behaviour was also reported to be categorised by thesocial workers involved as unhealthy, pathological, and coming fromsome sort of unresolved personal issues, such as low self-esteem.   Inthe case of only one participant did the social workers involved ineither intervention or therapy consistently relate the domesticviolence situation to broader issues of oppression, societal powerstructures and the related hegemonic gender roles, or patriarchal normsof society.   It is of note that this participant received service froma progressive women-helping-women organisation, rather than atraditional government-organised social work programme.  Group participants also repeatedly described their family situationsas unhealthy, and they certainly were, but from the perspective thatboth the abuser and abused were reacting or displaying emotioninappropriately, rather than that the motivation or norming behind thebehaviour was at fault.   For example, Tre nt described his mother asdrawn to violent, alcoholic men.   â€Å"She always seemed to go for theseguys that didn’t know how to express anything except by breaking stuff,yelling, hitting, you know.†Ã‚   His further descriptions of his mothers’boyfriends indicated an assumption that if these men had been raisedwith or taught proper means of dealing with their frustrations andemotions, the abuse to him and his mother would have been lessened oreliminated.   This idea was supported by at least one social worker, whosuggested counselling for Trent, his mother, and the then boyfriend asone possible way of addressing the abusive situation.Several participants did bring feminist theory and thought into groupdiscussion, pointing out, for example, that dominance or aggression bymen in any form was unhealthy, and questioning why it was only seen asunhealthy by most of the social workers they had encountered, and byothers they knew in the community, when physical viol ence was actuallyinvolved.   There was a related discussion, albeit brief, about the unwillingnessof neighbours, relatives, and others in the community, such as membersof the same church, to intervene in the domestic violence situation.  Participants indicated their perception that whilst this was often dueto a fear of getting involved or knowing how to help the situation,there were repeated occurrences in everyone’s experience where anunwillingness to intervene derived from others’ implications that theman of the house had some right to choose the way in which thehousehold operated, or that he had a right to discipline his wife /girlfriend and children as he saw fit.   Wendy reports hearing an auntstate â€Å"Well, its his family, their kids, she wants to stay with him,†and dismiss the ongoing violence as therefore an acceptable familylifestyle, or at least one in which none of the rest of the familyshould be expected to intervene.   Participants then a cknowledged thisand several other systemic situations that perpetuated their abuse,such as reluctance of authority figures to continue questioning wheninitially told nothing was wrong, and unwillingness of police tointervene repeatedly.   Similarly, regarding gender roles, discussion indicated a belief bymost participants that their social workers believed a traditionalstereotype of what was appropriate behaviour for a man and a woman, andthat these behaviours were different.   There were reports of acceptanceof physical response as an appropriate masculine reaction, but thelevel of physical response not being considered appropriate.   Maleparticipants were encouraged to talk about their experiences, butreport never being given permission to express fear, or an emotionalresponse such as crying.   One male participant reported starting to cryas part of a group experience, and being discouraged rather thanencouraged to continue, whilst female members of the group were allowedt o and even supported in such emotional expression.   There were similarreports of various hegemonically feminine expressions, such as crying,fear, and nurturing behaviours, being supported and encouraged bysocial workers for male family members but not female, as well as anacceptance or assumption of weakness on the part of adult females whochose to remain in an abusive situation.The discussion then moved to the effect of traditional and feministperspective on social work service.   Participants overwhelminglyreported feeling better served when social workers sought to empowerthem and their families.   This did usually involve practise of methodsderived from a feminist view, such as the use of reflective journalingand support groups, as well as encouragement from the social workers tothe mother that she could, indeed, survive and prosper outside thedomestic violence situation, that she did have the inner reserves toaddress the situation and move to a healthier lifestyle, and t hatsocietal pressure to be with a man, either as a romantic partner or asa father / father-figure for children was not necessary for asuccessful life.   Participants also report feeling personally empoweredby such encouragement, and therefore able to support their mothers inattempts to leave relationships.From their own study in social work theory, focus group participantswere able to briefly discuss the ramifications of the patriarchalsocietal power structure on a woman’s decision to stay in a violentsituation.   One issue brought up included the perception that societywill view a woman as a failure and undesirable if she does not have aromantic relationship with a man in her life.   A number of womenparticipants in the group reported feeling similar pressure to maintaina romantic relationship with a man in their life, regardless of theirother commitments or interests, and an expectation that they would notbe successful women if they did not ultimately get married and havechildren.   When questioned by other participants, the three maleparticipants reported not feeling such pressures.   Another issue raisedwas the mothers’ perception that they needed a father figure tosuccessfully raise children, particularly boys.   This was perpetuatedin the life experiences of group participants even though the menoccupying these roles were viewed by the male participants asdestructive, rather than constructive, influences.   Issues of supportin disciplining children and managing household operations were alsoindicated, as was the financial support provided by the batterer.   Thegroup indicated all these issues were societal, rather than individual,and lack of addressing of them affected the effectiveness of the socialservices they had received.Overall, the participants were generally positive about at least onesocial worker with whom they had a relationship during their teenageyears.   Participants typically felt feeling most encouraged and bestserved by those social workers who did not present themselves as beingdistant or above the participants and their families, and who did notoverly emphasise their family’s issues from a perspective of individualdysfunction.   These findings indicated that a feminist interactiveconstruct, which avoids â€Å"power over† methods and practise is perceivedto be most effective by domestic violence survivors. RECOMMENDATIONS It is recommended from findings of this study that social workersare first provided greater exposure to and training in feminist methodsand theory as it relates to their practical, day-to-day practise.   Forexample, all participants reported some positive experiences inresponse to reflective methods such as reflective journaling andsurvivor support groups.   Considerations of ways to more greatlyinclude such methods in typical practise are therefore indicated.   Of greater concern are the systems in which social workers operate.  Whilst most of the social workers in these focus group participants’experiences had some familiarity with feminist theory or methods, asindicated by their emphasis on empowerment or use of specificstrategies, there is something within the government-sponsored socialservices structure that prohibits practise truly based on feministtenets.   A sharp contrast was provided by the young woman served at aprogressive, private service, where feminis t theory was the obviousframework on which service was based.   She was by far the most positiveabout her experiences and workers, and reported insights, understandingand empowerment to change not consistently reported by other focusgroup participants.It therefore recommended that more research be pursued as to whatfactors constrain social workers from functioning from a more feministframework.   Issues such as time (many social workers have far morepeople to see and serve than they would like to have, or often feelthey can serve effectively), lack of material resources such asappropriate space, lack of effective training, or discouragement insuch regards from supervisors or others in power.   Specificallyidentifying relevant factors could then form a framework forprogressing with change in social work practise within a typicalgovernment service organisation.It is further recommended that individual social workers consider whatconstraints they persona

The Presentation of Bill Sikes in Oliver Twist Essay -- English Litera

Analyse the presentation of Bill Sikes in the novel Oliver Twist. You should refer to aspects such as the author’s viewpoint, language and the social and historical contest. I am going to write a detailed and accurate piece of writing in the form of an essay to answer the statement above. I will do this by using quotes from the book, my own theories on what the author is trying to portray Bill Sikes as and also my own knowledge of the Victorian era. I will be looking at specific areas, which I feel will help me write a more concluding and correct account of the story â€Å"Oliver Twist.† I will focus on areas such as Bill Sikes behaviour towards others, how characters around Sikes react when he is there and how backgrounds and phrases reflect the character of Sikes. The author of this novel, Charles Dickens has written throughout in 3rd person, I believe he has done this to show Sikes as the character he really is, a mean thoughtless and thuggish person in society, this makes the reader believe that he was actually there witnessing the life and times of Sikes. It is therefore written in an omniscient kind of way, as you feel as though Charles Dickens was watching over Sikes as if God like. I have interpreted to be quite a good way in writing the story because Sikes is anything but an angel, as he goes around stealing and bullying people into doing things for him, like his dirty work. This gives a contrasting effect on the story. It is written in 3rd person to create a judging description on the other characters. This has made characters such as Oliver and Nancy seem good people and then characters like Fagin, Dodger and Sikes seem bad ones. By adding such things as prostitution, thieving (pick-pocket... ... murderer. Dickens may have also written about Sikes ‘accidentally’ hanging himself because if the hundreds of people who had gathered and were know after him, caught up with him, then he would of got hung by them in the town anyway. Why the chase is on to catch Sikes, hundreds of people hear of what he has done and want to see him brutally killed because they believe that it would be justice. â€Å"Each little bridge (and there were three in sight) bent beneath the weight of the crown upon it. Still the current poured on to find some nook or hole from which to vent their shouts, and only for an instant see the wretch†. This shows how much Sikes was hated in his last few moments alive. I also believe that justice was done when Sikes died, he was a bully, a woman beater, a murderer, a kidnapper and both physically and verbally cruel to everyone he met.

AIDS in Africa :: HIV AIDS essays research papers

The AIDS epidemic has reached disastrous proportions on the continent of Africa. Over the past two decades, two thirds of the more than 16 million people in the world infected with Human Immunodeficiency Virus (HIV), which causes AIDS, live in sub-Saharan Africa. It is now home to the largest number of people infected, with 70 percent of the world’s HIV infected population. The problem of this ongoing human tragedy is that Africa is also the least equipped region in the world to cope with all the challenges posed by the HIV virus. In order understand the social and economic consequences of the disease, it is important to study the relationship between poverty, the global response, and the effectiveness of AIDS prevention, both government and grass roots. Half of the world’s cases are found in what is referred to as the AIDS belt, a chain of countries in eastern and southern Africa that is home to two percent of the global population. The main vehicle for spreading HIV throughout Africa is heterosexual intercourse. In contrast, this is the opposite compared to the U.S. where the virus is usually transmitted through homosexual intercourse or contaminated syringes shared by drug users. Besides heterosexual intercourse, HIV transmission through transfusion and contaminated medical equipment is common in sub-Saharan Africa. Africans infected with HIV die much sooner after diagnosis than HIV infected people in other parts of the world. In industrialized countries, the survival time after diagnosis of AIDS ranges from 9 to 26 months, but in Africa the survival time for patients is 5 to 9 months (UNAIDS 3). Factors, such as lower access to health care, poorer quality of health care services, poorer levels of average health and nutriti on, and greater exposure to pathogens that cause infection all contribute to the shorter survival in Africa. It is difficult to stop the flood of AIDS cases in Africa because it is not yet known by researchers the factors that contribute to outstanding prevalence of the disease among heterosexuals. This diagnosis will help determine how likely it is that heterosexual epidemics will spread to Asia or the West. Even though AIDS is heavily researched, its origin still remains a partial mystery. It is know that HIV is a zoonosis, a human disease acquired from animals. The virus evolved from a Simian Immunodeficiency Virus (SIV): a type of slow virus found naturally in monkeys and apes which, while not harming the host, produces diseases in other primates (Caldwell 97).

All Good Things Must Come to an End Essay

The amazing thing about literature is that it can be interrupted differently by each person who reads it. Which means that while one piece of writing is amazing, creative, and witty to one person to another person it could be the most boring, uninteresting, and redundant piece of literature they have ever read. In this semester of Literature 221, I was given the opportunity to read works from many different genres, time periods, and styles of writing. Some of which, like Emily Dickinson’s Life I and Life XLIII, Joyce Carol Oates’ Where Are You Going, Where Have You Been?, and Sherman Alexie’s What You Pawn I Will Redeem I thoroughly enjoyed and learned from. While others such as Ernest Hemingway’s Big Two-Hearted River, Mark Twain’s excerpt When The Buffalo Climbed a Tree from Roughing It, and the excerpt from Sula by Toni Morrison weren’t exactly my cup of tea. Emily Dickinson is a remarkable poet who often writes from a very emotional and self-examining perspective. This is why I really enjoyed the two selections of her work we had to read this semester. In her first poem Life I, the very first two lines make you stop and think, â€Å"I’M nobody! Who are you? Are you nobody, too?† (Dickinson 2) Bam! I was hit in the face with self-reflection. Am I somebody? Or am I a nobody? Emily Dickinson continues by saying â€Å"how dreary to be somebody!† (Dickinson2 ) as if to be somebody is a bad thing. I love that Emily Dickinson questions the ideology of having to be surrounded by people and having to constantly be in a spotlight. Every move that you make is questioned and examined by people. Instead of being able to live for yourself and for your own happiness you are forced to live by the way society sees you. It made me see that maybe it truly is better to be a happy, content nobody. In her poem Life XLIII, Dickinson again made me pause and self-reflect but this time on the beauty of the human mind and it’s capabilities. In this poem she states that the brain is â€Å"wider than the  sky†, â€Å"deeper than the sea†, and â€Å"is just the weight of God† (Dickinson 3). The sky, the sea, and God. Three powerful, endless, and even omnipotent to the human eye and yet the brain is more than that because it has the capability to imagine all of it. You can hold images of God, the sea, and God all in your mind. Dickson wrote these poems with such beautiful imagery that really does make a reader stop and think. This is why her works are among my favorite reads from this semester. Joyce Carol Oates brought a real life serial killer to life in her tale Where Are You Going, Where Have You Been? Based off the actual murders of Charles Howard Schmid Jr., Oates tells the story of Arnold Friend and a young girl named Connie and the events that would eventually lead up to Connie’s murder. I loved this tale because Oates gave a real voice to the real life victims of Schmid. While an article by the Daily News stated that, â€Å"Despite his creepiness, ladies loved Smitty† (citation here news article) in Oates’ tale it was made evident that Connie wanted nothing to do with Friend and instead she tried to call the cops and even told him to â€Å"Get the hell out of here!† (Oates 340) When I read a tragic news article I will feel sorrow for the victim and their families for a moment and then go on with my life and forget about them. Yet when I read a piece of work that captures my soul and really moves me to feel emotionally about a character as if they were a real person, I can recall them for years afterwards. Oates’ made me feel for Connie because she gave her a background of a beautiful girl with a mother who disapproved of all she did and constantly compared her to her more homely sister, June. â€Å"Why don’t you keep your room clean like your sister? How’ve you got your hair ?xed—what the hell stinks? Hair spray? You don’t see your sister using that junk.† (Oates 333) A girl that may have been desperate for love and attention. Suddenly, in my mind, Oates’ has not only weaved a haunting tale of young, naive girl who made mistakes and talked to the wrong stranger on the wrong day but she also made me feel for the real life victims of Schmid. Suddenly they became more than just names on a page and their names, Alleen Rowe, Gretchen and Wendy Fritz, will foreve r be in my mind and probably countless others who have read her work and know who it was based on. While Oates’ is a talented writer and her words were beautifully written the reason her piece stands out as one of my  favorites of this semester were for the deeper meaning and the legacy she left for the victims of a cruel, sick, twisted man. A reader cannot help but root for a character who has redeemable qualities despite whatever odd, crude, or socially unacceptable behavior they may exhibit. Such is the case in my final favorite piece of writing from this semester, Sherman Alexie’s What You Pawn I Will Redeem. In this tale of a homeless, alcoholic, money floundering Spokane, Washington Native American Indian named Jackson Jackson, a reader cannot help but fall in love with his spirit of never-ending generosity and unbreakable ties with tradition and family. Alexie’s particular style of writing gave light to Jackson’s seemingly uncaring, lazy, and unapologetically unmotivated he attitude in a way that a reader cannot help but find just a little bit comical. It is written in first person from the rambling mind of Jackson and lines such as â€Å"Piece by piece, I disappeared. And I’ve been disappearing ever since. But I’m not going to tell you any more about my brain or my soul† (citation here page 401) made me laugh out lou01d at the standoffish behavior of this character. Jackson was unable to maintain a job, any of his marriages, or his relationships with his children. In fact, the only thing he did seem capable of maintaining was a constant drunken stupor throughout the entire tale. Yet when he came upon his Grandmother’s stolen regalia at a local pawn shop he was determined to find a way to raise the $999 needed to rebuy this long lost family heirloom and return it to its rightful place. Each time he managed to earn or was gifted money for his mission he could not help but immediately spend it. However he was never selfish with his spending. He made sure that whatever he was given he shared with his fellow Indian. Never even coming close to making the necessary money to buy it make but still I found myself cheering him on. Because of his generosity, I was rooting for him to find a way to purchase back that precious connection to his family. And in the end, despite never actually managing to acquire the necessary cash, the pawn owner returned the regalia to Jackson, and I inwardly rejoicing in his success. And Alexie captured the moral for me in this thought, â€Å"Do you know how many good men live in this world? Too many to count!† (Alexie 415) A lexie challenged the stereotypes of a good person because he showed that even a drunken person who is unsuccessful in every  societal standard can be a good person because he is a kind, generous soul. This is the reason why this is another of my favorites from this semester’s readings. When thinking of a literary legend a name like Ernest Hemingway often comes to mind, yet in this semester’s reading of Big Two-Hearted River, Mr. Hemingway missed the mark for me. While I appreciate the concept of a post-war soldier suffering from PTSD, I had a hard time really getting into this piece. Hemingway’s commonly used iceberg principle style of writing was apparent in this piece with its overall lack of a substantial plot and its seemingly never-ending descriptions of just about everything. It is just not a style that appealed to me as a reader. I found it boring and extremely long. The symbolism was often obscured by the unnecessary descriptions of the surrounding scenery. â€Å"On the left, where the meadow ended and the woods began, a great elm tree was uprooted. Gone over in a storm, it lay back into the woods, its roots clotted with dirt, grass growing in them, rising a solid bank beside the stream. The river cut to the edge of the uprooted tree.† (Hemingway 262) It just seemed excessive and unneeded to me. While this is definitely one of my least favorite of this semester’s readings, I have to say that Hemingway was a beautiful wordsmith who could make you feel as though you were part of the story. In this sentence, â€Å"He sat on the logs, smoking, drying in the sun, the sun warm on his back, the river shallow ahead entering the woods, curving into the woods, shallows, light glittering, big water-smooth rocks, cedars along the bank and white birches, the logs warm in the sun, smooth to sit on, without bark, gray to the touch; slowly the feeling of disappointment left him† (Hemingway 262) you can practically feel the heat of the sun on your back and the relief that Nick feels as if a burden was lifted from your own chest. This story had some beautiful imagery overall though it was just not a tale I enjoyed reading. Mark Twain is an inspirational writer with amazing talent and has written some remarkable classics. However, the excerpt from Roughing It When the Buffalo Climbed a Tree, will not be joining my list of his beloved masterpieces. Instead I found this fictional account tedious to read and found myself drifting off to sleep while at the same time trying to  understand the particular vernacular used in this piece. The narrator of the majority of this tale was a character named Bemis whose style of speech was rambling and over-the-top. For example, â€Å"Well, I was first out on his neck – the horse’s, not the bull’s—and then underneath, and next on his rump, and sometimes head up, and sometimes heels—but I tell you it seemed solemn and awful to be ripping and tearing and carrying on so in the presence of death, as you might say.† (Twain 16) I can just imagine Bemis being this rambling, fool telling this ridiculous story with no ending in sight. It was just exhausting and mindless drivel that did not succeed in making me think about anything substantial or self-reflect which are qualities I rather enjoy when reading. I understand that according to Mark Twain, â€Å"to string incongruities and absurdities together in a wandering and sometimes purposeless way, and seem innocently unaware that they absurdities, is the basis of American art†¦Ã¢â‚¬  (Twain 13) and he accomplished that task beautifully. Nevertheless, it is just not a style that appealed to me and I struggled to enjoy reading this story. This semester was my first time reading any of Toni Morrison’s works. The excerpt from Sula was all of over the map for me. I had a hard time deciphering any real plot. It started off with two 12 years old girls walking through town and getting objectified by the men in the town. And if it wasn’t bad enough that two young girls were being gawked at by grown men, the girls actually seemed to enjoy it. â€Å"So, when he said â€Å"pig meat† as Nel and Sula passed, they guarded their eyes lest someone see their delight.† (Morrison 346) That line made my skin crawl with utter disgust. Then suddenly the girls are playing near a lake when a young boy named Chicken Little ends up drowning before their very eyes and their only reaction was â€Å"Nel spoke ?rst. ‘Somebody saw.’† (Morrison 351) I had a hard time reading a story about such loss of innocence at such a young age. Morrison’s writing was beautiful and captivating. The only reas on this makes my least favorites list from this semester was I just genuinely felt sick the entire I was reading it. Completely horrified by these young girls lives and saddened by the fact that many girls’ lives of this time period were like this. This semester of Literature 221 was full of amazing pieces of writing. Tales  that completely delighted, inspired, and captured my heart like those from Emily Dickinson, Joyce Carol Oates, and Sherman Alexie. As well as others who, for me, just did none of those things such as those from Ernest Hemingway, Mark Twain, and Toni Morrison. Overall I really enjoyed this class. I felt as though most of the forums gave me the opportunity to share my thoughts on each piece as well as opened my eyes to different perspectives. If I could give any constructive criticism it would be that sometimes I felt as if I could not quite meet expectations in the essay requirements because I felt as though they were not clearly stated. Other than that, I thoroughly enjoyed this class and I feel as though I learned a lot. It definitely has made me look forward to taking other literature classes in the future. Works Cited Alexie, Sherman. â€Å"What You Pawn I Will Redeem† American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 401-415. e-Book. Works Cited Dickinson, Emily. â€Å"Life I & XLIII American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 2-3. e-Book. Hemingway, Ernest. â€Å"Big Two Hearted River.† American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 253-264. E-book. Morrison, Toni. â€Å"From Sula.† American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 346-354. e-Book. Oates, Joyce Carol. â€Å"Where Are You Going, Where Have You Been?† American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 333-344. e-Book. Twain, Mark. â€Å"From Roughing It. When The Buffalo Climbed a Tree.† American Literature Since the Civil War. Create edition. McGraw-Hill, 2011. 16-18. e-Book. Twain, Mark. â€Å"How To Tell a Story† American Literature Since the Civil W ar. Create edition. McGraw-Hill, 2011. 12-15. e-Book.

Legal Aspects of Education

The secretary of education in the past William Bennett implemented thorough analysis of the issue concerning the reasons why present educations scheme is not successful for students, and the measures that could be taken to boost educational presentation and protect the finances. He specified several unlawful associations which are worse in the US. It is contradictory to really productive education law. It places its own priorities, not the students' on the first place. It has deplored so greatly about the profession of a teacher that it made numerous persons to refuse from the connecting their lives with teaching profession.According to Bennett, the too much legalization of learning system is restraining daring, inventive people who want to hold the accountability and to acknowledge the result. I completely agree with Mr. Bennett that the law simply does not implement its real function. Instead of letting students feel more self-assured and protected it really can prevent good and pe rspective educators from penetrating school system. Certainly separate individuals really must be removed from teaching however according to Bennett some of such restrictions will be unavoidably â€Å"slipped around† and this will not help to protect students.I suggest that modification-oriented teachers and socio- lawful researchers with sufficient information of learning principle and the function of regulation in communal restructure should consider both its empirical restrictions and speculative positive sides. I agree that the researches should and must actively participate in process of change and it is essential to know on time about the law actions that can protect students’ and teachers’ rights and finish the crisis in the system of education.