Advantages Of Semisynthetic Penicillins Biology Essay

Advantages Of Semisynthetic Penicillins Biology Essay Introduction Amoxycillin is a semisynthetic ÃŽ ²-lactam antibiotic derived from a common chemical nucleus of naturally occurring Penicillin G, 6-aminopenicillanic acid. Vital to Amoxycillins biological effects is the ÃŽ ²-lactam ring contained within this nucleus. Amoxicillin is bacteriolytic and bacteriocidal to susceptible gram positive and gram negative microbacteria. Today, amoxicillin is the 9th most prescribed drug in the world. Penicillin discovery Up until the early 1900s, the only treatment for bacterial infection was antiseptic which was only useful for surface wounds. In 1928, Alexander Fleming made a momentous albeit accidental discovery in St Marys Hospital in London. He noticed that a Staphylococci plate being grown in culture had been contaminated with mould of the species Penicillium notatum and that this had resulted in the inhibition of bacterial growth in the vicinity of the mould. Fleming subsequently isolated the mould and formulated an antibacterial mould broth. In 1938 at Oxford, Howard Florey and his biochemist Ernst Chain extracted penicillin from the mould and established that it was nontoxic and had chemotherapeutic effects. In 1941 an injectable form of penicillin became available for therapeutic use Advantageous of Semisynthetic Penicillins Penicillin G (naturally occurring) is poorly stable in gastric acid and broken down rapidly as it passes through the stomach. Therefore, Penicillin G must be given intramuscularly which limits its usefulness. Semisynthetic penicillins such as Amoxycillin with increased oral bioavailability were a major advancement in therapeutic antibiotics. Furthermore, while aminopenicillins and natural penicillins have similar efficacy against gram positive bacteria, semisynthetic aminopenicillins (such as Amoxycillin) are more active against certain strains of gram negative rods. Amoxycillin Discovery In Beecham Laboratories in 1957, 6-aminopenicillanic acid (6-APA) was isolate from penicillin. Through chemical modification of the ÃŽ ²-lactam thiazolidine ring side chains semisynthetic penicillins were developed. In 1961, Ampicillin was created which was quickly followed in 1964 by the introduction of a Ï -hydroxyl group in Ampicillins side chain creating amoxycillin. Amoxycillin was found to have improved absorption following oral administration and 2-2.5 times greater plasma concentrations compared to an equivalent dose of Ampicillin. In 1967 Beecham laboratories discovered that the susceptibility of Amoxycillin to ÃŽ ²-lactamase could be overcome with co-administration of clavulanic acid (a ÃŽ ²-lactamase inhibitor isolated from Streptomyces olivaceus). Chemistry Amoxycillin is a white crystalline powder that is somewhat soluble in alcohol and water. Amoxycillins chemical name is (2S,5R,6R)-6-[(R)-2amino-2-(4-hydroxyphenyl)acetamido]-3,3-dimethy;-7-oxo-4-thia-1-azabicyclo[3.2.0]heptanes-2-carboxylic acid. It has a molecular weight of 419.4. Figure 1: Chemical Structure of Amoxycillin Pharmacodynamics Amoxycillin functions by inhibiting the biosynthesis of cell wall mucopeptides of susceptible gram positive and negative microorganisms actively synthesizing peptidoglycan and undergoing multiplication. The molecular target of Amoxycillin and other ÃŽ ²-lactam antibiotics are the Penicillin Binding Proteins. Upon drug-target interaction transpeptidation is blocked and thus inhibiting the synthesis of peptidoglycan, a vital cell wall component. Subsequently, the inhibitor of autolytic enzymes in the cell wall, is removed resulting in active autolytic enzymes and bacteriolysis. Pharmacokinetics Amoxycillin complies with the two compartment model with elimination occurring from the central compartment. Figure 2 demonstrates Amoxycillins biexponential decline of serum concentration with time. Table 1 and 2 document the pharmacokinetic parameters of Amoxycillin. Figure 2: Average serum concentration versus time after 500mg IV dose of Amoxycillin. Table 1: Pharmacokinetic parameter and absolute bioavailability of a 500mg oral dose of Amoxycillin. Table 2: Pharmacokinetic parameter of a 500mg IV dose of Amoxycillin. Administration Amoxycillin is usually administered orally. The relationship between dose and extent of absorption is not linear with a plateau at higher oral concentrations. Dose adjustments need to be made in patients with renal dysfunction. Bioavailability Drug bioavailability is the proportion of drug that passes into systemic circulation after oral administration. It is dependent upon absorption across the gastrointestinal tract and first pass clearance by the liver. After oral administration of a dose of 250mg and 500mg of Amoxycillin the average peak serum concentrations (observed between 1-2 hours after administration) were 5.0mg/mL and 6.0 10.8 mg/mL respectively. The variation of plasma concentration with time is demonstrated in Figure 3. The oral bioavailability of Amoxycillin is 77.4% Amoxycillin is stable in gastric acid and is rapidly absorbed after oral administration regardless of absence or presence of food products and thus a high proportion of administered dose reaches the systemic circulation.. Figure 3: Mean serum levels following oral administration of 125mg and 250mg of Amoxycillin to 11 normal volunteers. (95% confidence). Volume of Distribution Volume of distribution is defined as the volume of fluid in which the amount of drug in the body would need to be uniformly distributed to produce observed plasma concentrations. Amoxycillin distributes widely and rapidly into most body tissues and fluid. Despite this, Amoxycillin remains extracellular due to lipid insolubility and thus does not cross the blood brain barrier unless the meninges are inflamed. Volume of distribution of Amoxycillin is 20.2L (0.3 L/kg). Clearance Clearance is defined as the volume of blood cleared of drug per unit time. It is dependent on renal excretion hepatic elimination. The clearance of Amoxycillin is 221mL/min. Renal Excretion Amoxycillin is excreted predominantly via the urine in biologically active form or as penicilloic acid. 75% of a 1 gram dose is excreted in the urine within 6 hrs (60% biologically active form, 15% is in the form of penicilloic acid). Biological Half life Elimination half life is defined by the time taken for the plasma concentration of drug to reach half the steady state concentration. The biological half life is 61.3 minutes with normal renal function. Half life increases with renal dysfunction. Clinical Uses Amoxycillin is a broad spectrum ÃŽ ²-lactam antibiotic with effectiveness against many pathogenic microorganisms. It is commonly used to treat bacterial infections such as otitis media, tonsillitis, throat infections, laryngitis, bronchitis, pneumonia, urinary tract infections, gonorrhoea and skin infections. Indications for use Location of infection Microorganism Skin and skin structure E coli, Staphylococcus, nonpenicillinase producing streptococcis Respiratory (Acute and chronic) nonpenicillinase producing E coli, Streptococcus, Strep. Pneumonia, H.influenzae, staphylococcus Genitourinary tract (Complicate and uncomplicated, acute and chronic) E.Coli, P.mirabilis and Strep. Faecalis Gonorrhoea N. Gonorrhoea (nonpenicillinase producing) Prophylaxis of endocarditis Used in people at particular risk (e.g. individuals who have previously had endocarditis or with a prosthetic heart valve) Table 3: Indications for use of Amoxycillin Precautions Drug interactions Amoxycillin is rarely associated with adverse drug interactions however the following reactions have been demonstrated in some cases. Drug Interaction Oral anticoagulants (e.g. Warfarin and Acenocoumarol) Results in abnormal prolongation of prothrombin time (or international normalised ratio.) Allopurinol Results in increased rate of rash reactions. It is unknown whether this is due to Amoxycillin reacting with the allopurinol itself or the hyperuricaemia that it is treating. Combined Oral Contraceptives Like all penicillin, Amoxycillin can affect the commensal gut flora which results in decreased oestrogen absorption. This has been associated with decreased efficacy of combined oral contraceptives. Tetracyclines or other bacteriostatic drugs Bacteriostatic drugs have been known to interference with the bactericidal effects of Amoxycillin Clavulanic acid Amoxycillin therapeutic effects are inactivated by penicillinase (ÃŽ ²-lactam) producing organisms. It is possible to co-administer Amoxycillin with clavulanic acid (ÃŽ ²-lactamase inhibitor) to broaden the spectrum of susceptible bacteria (e.g.. co-amoxiclav). Probenecid Renal excretion can be delayed by administration of Probenecid as demonstrated by Figure 4. When used in conjunction there is an increased plasma concentration of Amoxycillin reached and longer duration of effect. This is a beneficial interaction. Table 4: Some common drug interactions when co-administered with Amoxycillin Figure 4: Mean serum levels following oral administration of 1 gram of Amoxycillin with and without probenicid. Pregnancy and Lactation While penicillin can cross the placenta, no teratogenic effects have been uncovered through animal studies. Similarly, Amoxycillin can be excreted in breast milk resulting in potential side effects for the nursing infant including diarrhoea or allergic response. However, Amoxycillin is generally considered safe for use in pregnant women and nursing mothers. Adverse reactions Side effects are uncommon however potentially include insomnia, diarrhoea, dizziness, confusion, heartburn, easy bruising, itching, nausea, vomiting, abdominal pain, bleeding, rash and allergic reactions. The most common adverse reaction is hypersensitivity reactions in patients with allergies to ÃŽ ² lactam antibiotics, penicillin or cephalosporins. Anaphylaxis can be fatal and occurs more frequently following parenteral administration. All penicillins have been associated with seizures when administered in excessive doses or administered intrathecally. Conclusion The discovery of penicillin by Alexander Flemming lead to the subsequent generation of the semisynthetic aminopenicillin, Amoxycillin. This ÃŽ ²-lactam antibiotic has a broad spectrum of therapeutic use, high oral bioavailability and lack of toxic effects.

Expansion and the Evolutionary Lottery :: Evolution Essays

Expansion and the Evolutionary Lottery For a young scholar learning the basic concepts of science and biology, evolution was this grand theory of past life becoming more like present life over time via the utilization of such complicated and foreboding means as "natural selection" and "survival of the fittest." I came to understand that there was endless diversity of life, and variation was a result of the interactions of organisms with their environments. Natural selection placed pressure on the organisms forcing adaptations to be made, hence new species to arise over time. The oversimplified image of evolution that began to form in my head involved one single organism adapting to its environment and undergoing change in its own life span, therefore that one organism experiences evolution in action. I didn't think evolution was a process of becoming more "perfect" necessarily, but "better suited for more diverse situations," which boiled down to being better. Obviously this picture I was conjuring up was far from the mos t scientifically logical, and I was surprised and impressed to hear a better explanation. Evolution is depicted as an inconceivably time- consuming and expansion-driven process; it is not about "survival of the fittest" or being perfect, rather the most able to produce genetically variable offspring (less likely to be eliminated by natural selection). The major discrepancy between the two (oversimplified and clarified) formulations of evolution is the importance of random innate expansion, which arguably is a quality assigned not only to energy and matter on Earth, but also to evolution and as the entire universe. One of the simpler discrepancies in my illogical view of evolution merely involved timescale and the mechanism of change. A single organism cannot evolve within its own life span because of environmental pressure. The very first of Mayr's seventeen principles of inheritance states, "genetic material is constant ('hard'); it cannot be changed by the environment or by use and disuse of the phenotype... Genes cannot be modified by the environment... There is no inheritance of acquired characters" (Mayr, 2001, p. 91). Therefore, one organism cannot possibly experience evolution in action as a result of environmental interactions. The term adaptation creates some confusion here because it is so often coupled with evolutionary change and expresses a change suited for certain environmental conditions. The fact of the matter is evolution, as well as adaptation, occur over many generations and changes are not directly related to the conditions of the environment.

Jamaican Culture Essay

Probably one of the most lively and rich cultures of the world is of the Jamaican culture. It is perhaps due to its exotic surroundings and the various regions of its origin. Today in Jamaica, there are obvious influences of African, English, Spanish, and Indian. Being only the third biggest island in the Caribbean its impact is huge on the rest of the world. The official language of Jamaica is English. However, most civilians in Jamaica speak patois. Think of it as an extremely slurred accented speech of English with hints of African, Portuguese, and Spanish appearing here and there. Most of the time just knowing English will help you understand what people basically are saying. The religions in Jamaica are wide and varied. However, statistics show that over half (61.3%) of all Jamaicans are Protestant. There is also a good deal of participation in spiritual cults of not-really-defined religion (almost 35%). Religion is highly held in Jamaica and can affect from what people where to what they eat. Sometimes cults in Jamaica resort to violence against other cults. The education system in Jamaica has four basic levels: early childhood, primary, secondary, and tertiary. Presently, 703,600 of Jamaica’s estimated 2,650,000 people are enrolled in the education system. About 80% of all teachers are professionally trained. Jamaica currently holds an 85% literacy rate for total population (81% for men alone and 89% for women alone). Currently in Jamaica, only 3% of the enrolled education students are enrolled for college level education, 32% for junior high and high school level, 45% for elementary level, and 20% for ages 3-5 yrs. The majority of the people in Jamaica usually live in or near the cities in low-income housing. However, some still live rurally for agricultural purposes. There are many holidays and festive occasions in Jamaica. Jamaica’s national holiday is its Independence Day on the first Monday every august. Most of  Jamaican culture is expressed through stories, songs, and dances of important figures. Here are just a few examples of Jamaican culture. One old custom now only practiced in rural areas is that of taking the baby’s naval string cord after they are born, waiting 3 days, and burying it in the ground and planting a tree on top of the cord. Another belief is that of a mother cannot get wet the first few days after birth otherwise she will get sick and die. In Jamaica, lavish funerals are required to give respect to the dead for they will rise on the third night after their death. There are also certain characters of folklore. One is Anancy. He is the spider man known for his trickery. There is also the children’s character of Big Bwoy. In Jamaica there is also many festivals. The Gran’ Market is a pre-Christmas celebration. Obeah is a general term for black magic. Kumina is a popular ritual practiced only by certain sects for religion. Dinky-Mini is a dance and song used to help cheer up the family of a dead person. Hosay is a festival particular to Muslim/Indian sects. Most people in Jamaica have somewhat balanced diets and eat depending on religion and season. A typical breakfast is the country’s fruit, the ackee. Lunch is usually light meat or vegetables while dinner consists of goat, pork, seafood, rice, and beans. Skyjuice, coconut juice, and tea are popular drinks. Skyjuice is the American equivalent of a slushy. On average families have about two children in cities but having many more in rural areas, especially on farms. The parents usually work while the children are off attending school. In Jamaica, almost every festival has its own unique dressing design. The most popular and renowned is that of the simple plaid cotton design of Bandana. Women’s dresses are of three tiers (big ruffles) and they are known to be adorned in beads and braid their hair intricately.

Behavioural - Avoidance of Colleague. The WritePass Journal

Behavioural - Avoidance of Colleague. Introduction Behavioural Avoidance of Colleague. IntroductionREFERENCESRelated Introduction Although this model can be criticised for being too simplistic and failing to take social factors into account that can affect all its component parts, it does illustrate how SP can be disabling for the client as it reveals that the emotional distress and avoidant behaviour (C) is a consequence of the negative inferences and evaluations (B), and not, as the client mistakenly believes, a consequence of the activating event (A). There may be many innocent reasons as to why the colleague ignored the client, but it is how the client not only interpreted the colleagues action negatively, but also inferred a negative meaning and subsequently a negative evaluation, as it is certainly not catastrophic if someone does not like you. During assessment, the CB therapist will identify the As, Bs, and Cs by focusing on a specific emotional episode and following this procedure: 1) Assess the C 2) Assess the A 3) Connect the A and C 4) Assess B 5) Connect B to C Both (A) and (C) are assessed before (B) and 2 or 3 of these assessments are conducted as there are often several emotional episodes that have an underlying irrational belief (B) in common.   It is this identification of (B) that facilitates the next stage of formulation. A CB formulation makes an assertion that the client has one or more irrational beliefs underlying several specific episodes.   CB formulations integrate information gathered during assessment and provide a working hypothesis for how the clients SP developed, how the SP is being maintained by the client and how it might be resolved.   Any formulation made by the CB therapist must be based on the clients stated problems and be accepted by the client as a working formulation which then goes on to form the basis for CB intervention. Examples of case formulations include the Three Systems Approach (Rachman Hodgson, 1974), illustrated diagrammatically below, which attempts to understand emotional issues in behavioural, cognitive and physiological terms. However, this model does not take into account any environmental issues that may have precipitated the emotional distress.   This failing was addressed by Greenberg and Padesky, (1995) in the Five Aspect Model, illustrated diagrammatically below. In this model, all aspects are experienced within the environment.   An individuals ethnicity, socio-economic status, education level or upbringing can all be considered as environmental aspects of the problem. Using a fictitious client example, James has been referred by his GP for counselling for SP.   His CB therapist has conducted 3 ABC assessments, the first of which revealed that James is anxious about a job interview (A) and thinks that people will judge him as stupid (B). Jamess second assessment revealed his worry about blushing when dealing with people in authority (A) and that this means that he is physically abnormal (B).   His third assessment revealed his nausea (A) before delivering a best man speech where everyone would laugh at him (B). A general formulation here would be that Jamess SP results from his tendency to misinterpret the facial expressions and reactions of others and his constant negative evaluation of himself in the social situation of work. It is important that the client genuinely understands the formulation.   Irwin et al (1985) found that only 25% of patients genuinely understood the benefits and side effects of their treatment when questioned specifically.   This means 75% did not, and without this understanding, the client will not attribute any changes to their own efforts. Once the therapist is satisfied that the client genuinely understands the formulations, then the 4 steps of intervention can begin.   Firstly, the therapist and the client must agree on specific formulations to work on and secondly, using these formulations as a guide, they must together select specific goals that the client wishes to work on. Step 3 is the selection by the client, and agreed on by the therapist, of specific tasks that will help achieve the specific goals.   These tasks may include the keeping of a diary of events, behaviour and emotions.   Key elements of CBT treatments include Exposure, in which a client enters and remains in a feared situation despite distress, either in vivo or in vetro, beginning with situations that the client has ranked as moderately fear-provoking and moving up gradually to more highly feared situations.   The use of Exposure techniques is based on the assumption that the client must fully experience the feared situation in order for change in emotional and behavioural symptoms to occur (Foa Kozak, 1986). Relaxation techniques are also used in order to help the client deal with the physiological symptoms of SP.   Progressive muscle relaxation (PMR) techniques are taught to the client so that they can practice using the techniques during everyday activities and then be able to use them when in a fear provoking situation (Ost, 1987). A final key element in the CBT treatment arsenal is Cognitive Restructuring (CR).   This is based on the assumption that it is the client’s irrational thoughts and beliefs that perpetuate the SP and not the actual situation (Beck Emery, 1985).     CR is often used in combination with Exposure to challenge the client’s irrational thoughts and beliefs rather than simply a process of teaching the client to ignore SP provoking stimuli. Finally, step 4 is the agreement of boundary conditions where the therapist and client agree by negotiation the number, frequency and duration of sessions, the agendas of those sessions, role relationship and locus of responsibility. Strengths and limitations of CBT CBT is a collaborative treatment, with the therapist as an expert in friends clothing rather than an aloof and removed ‘expert in doctors uniform’.   It helps the client to develop new skills for their use in future situations, and its brevity and time-limited aspect makes it attractive for cost-conscious primary care trusts here in the UK. CBTs focus on the issues in the here and now help to break maladaptive thinking and behavioural patterns that maintain the client’s distress levels.   This in turn may help past issues from a current viewpoint, as the new skills develop to cope with one situation, they can also be applied to other situations by the client to effectively heal themselves. CBTs structure and specificity in relation to goals and tasks make it very easy to evaluate and research and also gives the client positive reinforcement by being enabled to achieve realistic goals. Few studies have compared CBT with other psychotherapies in  the treatment of SP, however, Cottraux et al. (2000)  found that CBT was superior to supportive therapy. Treatment  effects for CBT were sustained at 36 and 60 week follow-ups, although the long-term effects of supportive therapy were not assessed. CBT also has its limitations.   Efficacy rates depend on the clients expectations of success, their willingness to complete the behavioural tasks and their ability to confront uncomfortable thoughts (Rosenbaum Horowitz, 1983; Marmar, Weiss Gaston, 1989). Psychological therapies in general are increasingly becoming an integral part of government planning in mental health care with CBT increasingly being viewed by government as the first choice of treatment for many psychological problems (Clark et al, 2009) however, CBTs apparent superiority may be undeserved. The NIMH study, now 20 years old, was the largest in the world and it found CBT performed poorly in comparison to interpersonal therapy and drug therapy (Elkin, 1994, pp. 114-142). There is also the question of CBTs clinical relevance as opposed to its ability to produce change under lab conditions.   CBT may do well in university based clinical trials with participants recruited from adverts but in the real world of clinical practice, not so well.   Leff et al (2000) found that in the London Depression Trial, CBT was discontinued early due to poor compliance from clinically typical patients. CBT does not address the biological issues that may cause SP, as mentioned earlier in Blair et al (2008) and their findings regarding the amygdalas role in causing SP, neither does it take into account the issue of co-morbidity, especially with Axis II disorders that could seriously disrupt CBT treatment.   Alnaes and Torgersen (1988) found that patients with borderline  personality disorder are at heightened risk for developing an anxiety disorder while Oldham et al (1995) found significant levels of comorbidity of anxiety  disorders with borderline, avoidant, and dependent personality disorders. Developmental psychologists argue that SP can result from attachment problems in early childhood. Longitudinal analyses (Brumariu Kerns, 2008) showed that lower attachment security and higher ambivalent attachment were most consistently correlated with higher social anxiety levels. Alternatives to CBT include hypnotherapy (Kirsch et al, 1995; Vickers Zollman, 2001), which has shown promising results when combined with CBT.   Antidepressants were initially developed to treat depression, but they are now also used to treat anxiety disorders. SSRIs such as fluoxetine (Prozac) and sertraline (Zoloft) are commonly prescribed by starting at low doses and then increased in dosage levels over time for panic disorder and social phobia (Hauser, 2006). Neural Linguistic Programming (NLP) has also shown to be effective as a ‘fast phobia cure’. Konefal Duncan (1998) provides evidence of significant reductions in SP using the Liebowitz Social Phobia Scale after NLP training. In conclusion, while CBT may have its limitations, and depend largely on the co-operation of the client, the same can be said for any psychotherapy as the outcome appears to be considerably enhanced when the client and therapist are actively involved in a cooperative relationship (Tryon Winograd, 2011).   It is of note that Horvath et al (2011) found that the effect size of the link between alliance and psychotherapy outcomes was 0.275, and that this statistically significant effect accounts for about 7.5% of the variance in outcomes, showing that the alliance-outcome relationship is one of the strongest predictors of treatment success that any research has been able to document thus far. REFERENCES Alnaes, R., and Torgersen, S. (1988). The relationship between DSM-III symptom disorders (axis I) and personality disorders (axis II) in an outpatient population. Acta Psychiatr Scand, 78, 485–492. American Psychiatric Association. (1994). Diagnostic and Statistical Manual for Mental Disorders (4th ed.). Washington, D.C: APA. Antony, M. M., and Swinson, R. P. (2008). The shyness and social anxiety workbook: Proven, step-by-step techniques for overcoming your fear (2nd ed.). Oakland, CA: New Harbinger Publications. Beck, A.T., and Clark, D.A. (1988). Anxiety and depression: An information processing perspective. Anxiety Research: An International Journal, 1, 23-36. Beck, A. T., and Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Books. Blair, K., Shaywitz, J., Smith, B. W., Rhodes, R., Geraci, M. R. N., and Jones, M. (2008). Response to emotional expressions in generalized social phobia and generalized anxiety disorder: Evidence for separate disorders. American Journal of Psychiatry, 165, 1193-1202. Clark, D.M., Layard, R., Smithies, R., Richards, D.A., Suckling, R., and Wright, B. (2009). Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy,  47 (11),  910-920. Elkin, I. (1994). The NIMH Treatment of Depression Collaborative Research Program. In A. E. Bergin S. L. Garfield (Eds.), Handbook of Psychotherapy and Behaviour Change (4th ed.), 114-142. New York: Wiley. Ellis, A. (1977). The Basic Clinical Theory of Rational-Emotive Therapy. In A. Ellis and R. Grieger (Eds.), Handbook of Rational-Emotive Therapy. New York: Springer. Foa, E. B., and Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35. Greenberg, D. and Padesky, C. (1995). Mind Over Mood. New York: Guilford Press. Heimberg, R. G., and Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia: Basic mechanisms and clinical strategies. New York: Guilford Press. Hauser, J. (2006). Treatments for Social Phobia. Psych Central. Retrieved on July 29, 2011, from http://psychcentral.com/lib/2006/treatments-for-social-phobia/ Horvath, A.O., Del Re, A.C., Flà ¼ckiger, C. (2011).   Evidence-based psychotherapy relationships: Alliance in individual psychotherapy. Psychotherapy, 48 (1), 9-16. Kirsch, I., Montgomery, G., and Sapirstein, G. (1995). Hypnosis as an adjunct to cognitive-behavioral psychotherapy: a meta-analysis.   J Consult Clin Psychol, 63, 214-220. Konefal, J.,   and Duncan, R.C. (1998). Social anxiety and training in neurolinguistic programming.  Psychological Reports, 83 (1), 1115-22. Leff, J., Vearnals, S., Brewin, C., Wolff, G., Alexander, B., Asen, E., Dayson, D., Jones, E., Chisholm, D. and Everitt, B. (2000). The London Depression Intervention Trial. Randomised Controlled Trial of Antidepressants v. Couple Therapy in the Treatment and Maintenance of People with Depression Living with a Partner: Clinical Outcome and Costs, British Journal of Psychiatry, 177: 95–100; Erratum, 177: 284. Comment, 178: 181–2. Marmar, C.R., Weiss, D.S., Gaston, L. (1989). Toward the validation of the California Therapeutic Alliance Ratings System. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 46-52. Oldham, J.M., Skodol, A.E., Kellman, H.D., Hyler, S.E., Doidge, N., Rosnick, L., and Gallaher, P.E. (1995). Comorbidity of axis I and axis II disorders. Am J Psychiatry 152, 571–578. Ost, L.G. (1987). Applied relaxation: Description of a coping technique and review of controlled studies. Behaviour Research and Therapy, 25, 397–409. Rachman, S. and Hodgson, R. (1974). Synchrony and desynchrony in fear and avoidance. Behav. Res. Ther.12, 311-318. Rosenbaum, R. and Horowitz, M.J. (1983). Motivation for psychotherapy: a factorial and conceptual analysis. Psychotherapy: Theory, Research, and Practice, 20, 346-354. Tryon, G.S., Winograd, G. (2011). Goal consensus and collaboration. Psychotherapy, 48 (1), 50-57. Vickers, A. and Zollman, C. (2001). Hypnosis and relaxation therapies. Western Journal of Medicine, 175 (4), 269-272.

Common risk factors for cancer

Common risk factors for cancer The most common risk factors for cancer are heredity, where it is passed down from generation to generation; age, which can be targeted to several different age groups; race, which is targeted to specific individuals within a heritage group; and the unknown.Heredity transfer does increase the risk for these type of cancers which include but are not limited to testicular, colon, breast (although very rare), ovarian, and prostate. If there is a history of these types of cancers in the family all precautions should be taken to prevent or catch the disease early in the stage. Therefore, testing should be completed on an annual basis.Age can also be a factor with several different types of cancer which can be but are not limited to colon, rectal, stomach, breast and kidney which is targeted at the 50 and over generations. Prostate cancer is targeted at the 65 and older generation.English: Relative survival of invasive epithelial ...Uterine or Endometrial cancer usually occurs after age 55 but has been seen as young as 14 in women. Pancreatic cancer in men and ovarian cancer is most seen in women over 60; and oral cancer after age 40 and is most dominant with men. The younger generations aged 20-35 are highly at risk for testicular cancer. Multiple myeloma is diagnosed as early as 70 years old.Race and/or sex also play a role in cancer traits. But cancers that can be somewhat controlled are the cancers that can be prevented with healthy diets, no smoking or tobacco chewing, one sex partner, and sun radiation protection are just a few behaviors that can be changed or modified to decrease the risk of be inflicting with cancer.

The Reforms of Peter the Great Essay Example | Topics and Well Written Essays - 1000 words

The Reforms of Peter the Great - Essay Example According to Thomas Riha, he was one of the few leaders in the empire who had â€Å"†¦ the imagination and ability to offer outstanding personal leadership† (498). He instituted radical reforms in the country’s education military, local government and church by reorganizing his army in line with western standards, creating a navy secularizing the education sector as well and exercising greater control of the reactionary Orthodox Church compared to any of his predecessors. In summary, his foreign policy was aggressive considering that he, â€Å"...acquired territory in Estonia, Latvia and Finland and through several wars with Turkey in the south† (â€Å"Peter the Great biography†). This paper is an examination of the reforms made by Peter the great, their effects, and the significance they had on Russia. In an attempt to weaken the powers of the provincial government which he considered a threat, Peter allowed the towns to elect their own officials who would be charged with collection of revenue and simulation of trade, the real power behind the local government was Ratusha based in Moscow. In 1702, an elective board that replaced the old system of elected sheriffs governed towns, moreover, in 1724; he changed the system so that local governments could have a quasi-aristocracy of sorts where towns could be self-governed under guilds of elected well off citizens. Nonetheless, these reforms were considerably difficult to implement, practice since local property owners and the provincial governor had immense influence, and their hold on local affairs was extremely difficult to break. Provincial government was divided into eight Guberniia, which were headed by a Gubnator who had absolute power from within the guberniia that were divided into districts known as Uzeda, which by 1718 the increased by twelve in number. Peter considering the forty Provintsiia, in order to consolidate his power he ensured the Gubnators despite their local autonomy were directly answerable to him. In this case, there were forty departments to carry out his orders, however, since not all of them had predefined functions their duties would sometimes overspill into each other creating inefficiency and an allowance for corruption. Peter’s centralized government policy was evident in that â€Å"†¦each of the provinces was ruled by an appointed governor† (Riasanovsky and Steinberg 259). This meant that the governors exercised power at his pleasure, hence were fully loyal to him. Peter’s belief in absolutism ensured that the church would no longer retain its semiautonomous status, as he was interested in its control since it was a very wealth institution among other reasons. In addition, he wanted access to these funds, and although he had tried to modernize it, but it had refused to be changed and remained steadfast in its traditional ways. Furthermore, the church had substantial amounts of land, many serfs and oth er â€Å"properties†; consequently, Peter was uncomfortable because it appeared in a way the church was rivaling him. In order to control the church, Peter refused to appoint a leader of the church after Partricah Aldrich died and gradually took over the church integrating it into the state. In the year 1701, it was placed under a government department known as Monastyrskii Prikaz, and they paid the monks

Situation analysis and marketing objectives Assignment

Situation analysis and marketing objectives - Assignment Example TABLE OF CONTENTS Abstract 2 The following is situation and marketing objectives report aimed at establishing the marketing analysis for IPHONE products. It will provide an insight on the company’s external and internal environment. Additionally, it will seek to establish the SWOT analysis report for the company. The company recent developments are aimed at establishing the best marketing objectives, and it is crucial to find out which are in practice for the needed sustainability. 2 TABLE OF CONTENTS 3 1.0Introduction 4 2.0 Analysis of Current Marketing Situation 5 3.0 Situation analysis 6 3.1 The internal environment 6 3.2 The external environment 7 3.3 SWOT analysis 7 Marketing objectives 8 Conclusion 9 1.0 Introduction Marketing analysis is crucial in company valuation processes and provides a ground for new strategies implementation. The IPHONE product is a company whose dealings are propagated mainly on electronic devices. The company has a mission to become a global ent ity in terms of supplying advanced technological devices to other countries as well as quality management strategic implementation. The accomplishment of such a mission is guided by a set of reinstated objectives, which the company has always aspired to achieve. The main objective is to design modern technological tools, including personal computers and other social media devices. They also aspire to accomplish a manufacturing objective for the undersigned media tools. Marketing is also part of their desires, to develop the most modern marketing strategies that would boost their CRM (Customer Relationship Management). Conduction of marketing analysis enables an organization to identify their weak and strong areas. This acts as a guideline for future organizational trends in order to enhance sustainability. It is the desire of every top management in an organization to become the best in order to fit in the modern dynamic world. Situation analysis helps analyze the internal external status of an organization. It is also through this that strengths, weaknesses, opportunities, and threats are identified. Marketing objectives define the desired scope of organizational operation as well as organizational mission statements (Lamb et al., 263). The discussion in this paper offers a comprehensive report on marketing analysis for IPHONE product. Situational analysis will give an overview of internal and external environment in addition to SWOT analysis. Marketing objectives are also considered a vital area of discussion, since marketing plays a pivotal role in reaching target consumers. 2.0 Analysis of Current Marketing Situation The current marketing situation is characterized by dealership in a number of computer accessories as well as phone products. The recent times have seen IPHONE venture into innovating new products in the market, with the objective of enhancing its sustainability. The recent years have proved challenging to the company, owing to the rising leve l of competition from companies producing similar products. The recently innovated products include; Software programs that facilitate people purchasing and storing music in their internet provider devices. Additionally, they are major manufacturers of iMacs in addition to Mac Books and iPods. Generally, the company has been able to adopt new social communication devices that are aimed at providing their target customers with the needed information.