Physics in Everyday Life Essay

1) When we walk or run, our motion is part of laws of mechanics and thrmodynamics. 2) We eat food which undergoes chemical reactions producing heat energy which is converted into mechanical energy 3) Use of refrigerator, pressure cookers, washing machines, television, music system, computers, etc. are all designed on the principles of physics. 4) When we speak, we produce sound properties of which like pitch and intensity are studied in physics 5) Electricity that we use in household is a gift of physics 6) Automobiles design is based on physics The list is endless. Vlad T answered 6 years ago Very vague question but practically everything we do in our daily lives involves SOME degree of physics. Putting on toast, boiling a kettle – heat energy, electricity Cycling a bike – mechanical movements Using the brakes – Friction Using a door handle – Levers and Springs Throwing a ball – weights, gravity, trajectory, air resistance 1)We walk, walk fast, run, jog, jump into a bus etc. All these or any type of motion is associated with Newton’s law of motion. 2) When we talk, our vocal cords vibrate producing sound. 3) When we eat food, the chemical energy of the food is being converted into mechanical energy which we use to do different types of work. 4). The electricity is our house is a gift of Physics. Hydroelectric project is the method in which water is used to generate electricity. The mechanical energy of the water is converted into electrical energy using dynamo.

Planning for Management Information System

The biggest challenge and most critical success factor in reengineering projects are persuading the people within the organization to cooperate. When you begin to computerize a legacy system considers the advantages; reduced clerical cost, quicker processing time and improved customer service. Everyone knows that the computer capabilities alone make life a lot easier for all managers. The advantage of time and accuracy spread over the lifespan of the information system means improved long-term vision and focus for top, middle and lower managers. A management information system (MIS) focus is on information that management needs to prepare its job. This task becomes much more difficult when the major players have a tradition of high independence, are often confrontational to management, and are irreplaceable independent contractors. CIO's in major business organizations face exactly this situation; further complicated by the fact that the reengineering effort is crucial to the continued existence of the organization. Such discussion has driven the software industry to focus attention on software specifically designed to support the team approach essential to most service and customer oriented organizations. The importance of teamwork can not be over emphasize in achieving overall organizational goals, and the need to capture and manage an organization's knowledge base remain crucial. This teamwork enables the organization to achieve and sustain competitive advantage in their business. In considering the framework for an information system (IS) each level operational, tactical and strategic planning requires different IS. At the operational planning system, the IS collect, validate and record transactional data relating to acquisition or disbursement of resources. The data for account receivable and payables, payrolls, inventory level, shipping data, printed invoice and cash receipts recorded as they occur. The operational-level IS characteristic are repetitive, predictable, emphasizes the past and detailed in nature just to name a few. The focus of the operational system is the daily tasks performed at the user level. The operational level manager uses this data to check every day tasks, i. e. ordering, shipping, inventory control, the essence of the business processes. The second level in the framework is the tactical system. This system provide middle-level managers with information to monitor and control operation while allocating their resources efficiently. The data is summarized, aggregated, or analyzed with a wide range of reports, i. e. , summary, exception and ah hoc reports. The tactical information system differs from operational information system in the basic purpose: operational support the execution of tasks and a tactical information system supports a manager control over those tasks under their area of supervision as well as the allocation of resources to meet the company objectives set by top management. The data input and the information produced as outputs differ from the type of data involved, tactical characteristics are periodic in nature, with unexpected findings, comparative in nature with both internal and external sources. The tactical information system purpose and the regularity of report produced within the information system are drastically different from an operational system. The third level in the framework is strategic planning, designed to provide top managers with information that assist them in making long-range planning decisions for the business. The different in strategic and tactical are not always clear, because both types of information systems may use some of the same data, you might say that the systems sometimes overlap with the difference being in the data that the system uses. Typically, top management uses strategic planning system to forecast long-range company objectives. The characteristics are ah hoc basis, unstructured format, external source, and subjectivity, summary and predictive in nature. A MIS provides information for effective planning and tactical decision making, which is the foundation of operational level data system. A tactical planning system provides middle-level management with the ability to monitor and control resources. The tactical information system does not support the execution of operational tasks, but allow managers visibility over the operation. Information systems are costly, to deploy and maintain, yet the maximization of economic value of IS in the long-run balance out over the initial set-up cost. The right software products enable teams of people to integrate their knowledge, work processes and applications to achieve improved business effectiveness. It has been suggested that the implementation of such technologies is more difficult and yields more unintended consequences than is typically acknowledged. First, how such technologies are used reflect the effects. Second, how these technologies are likely used when alternative tools co-exist, meaning predictability is difficult from technological characteristics. Third, because people use groupware with other people, one person's choices about how to use groupware may have consequences for other group members, user satisfaction. The measurement for an effective MIS must be the users; usage and satisfaction have a strong correlation. Obvious, the effectiveness of MIS depends upon the use of the system and if the employees accept it. The information system department, managers and users together make the MIS process successful. The managers implement the MIS, their behavior and motivation play an important part in the variables for the system to be effective. Each designed MIS produce information for decision making throughout the organization. Let†s examine several case studies with the implementation of MIS as seen in three distinct companies, an insurance company, a food marketing company and a social service agency. The insurance company normal routine consisted of tons of policy paperwork generated daily to accomplish the company objectives. The company started on line systems supporting policy screening, creation and issuance in the 70†³s. An employee could key in new application information at his or her computer terminal, after the compilation of information an underwriter can evaluate the insurability of potential customers. After the approval process, the information system produces a policy data sheet. This business process makes it possible to handle inquiries from individual policyholders and sales agents seeking personal data information about policyholders. The home office linked to all locations of their sales agencies allowing sales agents to inquire on-line about policies with the capability to edit application information at their site. The home office can still update policies as well. Yes, this service provides the agencies with a competitive advantage in product marketing and customer service. The home office outsourced and purchased software that enable the sales agents to analyze alternative companies† product and service options, resulting in winning the customers† loyalty and a quicker sales. The company continues to grasp the future for innovations and anticipating their customers† needs in the future. This approach along ensures valuable information for the senior-level management to plan as well as reduce overhead cost with improved productivity and better decision-making ability. Next, let look at the food industry and view how information system improved their process. The MIS geared toward physical distribution at the operational level, where update orders and invoices sent to the distribution centers and the system updates the account receivable and associate system files. The system prints invoices at the origin and destination location, resulting in reduced cost and faster payments equal more cash flow. The food company produced numerous reports that enabled the managers to conduct on-line credit checks from their account receivable status report, and identify delinquent accounts, before shipping the merchandise to the distribution centers. The customer services personnel have immediate access to open account allowing for immediate visibility and response to customer inquiries about deliveries and shipments, similarly cash payments received automatically applied to customers† on-line account. Let us not forget to look at the marketing advantages with MIS as well. Sales analysis reports reflect the customers† history product information file; this data generates report by product line in each territory each month for middle-level managers to forecast demands for any specific product item. Normally, this begs the question about production and if the company can continue to support the demands of the customers. At this junction, the IS gives managers additional insight about demand and the need to forecast for future buys. The company established a bill-of-material file, which computerized the ingredients for each product line and created batch size for all products. This process minimized the work process and improved the manufacturing ordering process for each customer batch orders. The product specification file served as the database of reference information enabling the manager the ability to print text on all purchase orders. The text file produced a finished goods inventory, which is transferred to the branch warehouse stockroom in various locations; this information is based on sales analysis report (demand). In the finance and administration department, the updated account receivables correlates with customers' billing and cash receipts. A monthly exception report generated from the aged balances spits out a collection letter automatically to the respective recipients at specified intervals. The MIS enabled the food marketing company to process orders more timely, manage inventories more efficiently and organize their production section. Bottom line cost savings of MIS results in more revenue and a better customer relationship and senior-level managers focusing their attention on emerging trends in the market. A social service department utilizes MIS in the public sector by providing financial assistance to the residences, i. . medical assistance, food stamps, facilitate foster home and adoption, day care, school service, family planning, housing and legal services. The MIS processes new applications and payments. The applicant applies and become eligible then the system creates an on-line record for them. The system automatically prints an identification card for the payroll master file that entitles the recipient to service for which the bill goes to the social service department. An on-line inquiry and update of the applicant record are also possible. The payroll master file sorts, generates the welfare check, and lists them on the payroll register, which generates historical report for managers. In all three case studies, the information systems support transactional processing. The user involvement in each of the project selection ensures the effectiveness of the information system and its acceptability. How do you measure utilization and performance in MIS? The term utilization is the extent that the intended users use the information system (IS) for its intended purpose. The term performance measures the improvement of the business process that supports the IS implementation. These measurements observed through business records, visual or electronic inspections and take the personal opinions and attitudes out of the decision-making loop. The multiple variables sometimes are difficult to identify, but the IS department must be impartial if the true value is realized of a successful IS project. A successful IS project can be measure best with psychometric tests of attitude, interests, and opinions such as user information satisfaction in the broadest sense. The performance measures of the business determine the effectiveness of the MIS. You can see that information technology give companies a competitive edge, once an information based service enters other company either catch up or eliminate the original innovator competitive advantage thus raising the stake for those participating in the marketplace. Today, company can link its customer to its order entry system, thus improving efficiency and improve business performance. Sure, an effective information system, if efficient reduces needless paperwork and allows the customer access to available stock information before committing to the purchase of goods and services. Let not forget about effective too, the information system provide better service to its customers, for instance, i. e. the creation of electronic travel supermarket through on-line reservation system, i. e. www. priceline. com or www. Travelocity. com, which is transforming the basis of competition within this marketplace. To compete efficiently in this world, companies must establish information partnership as an integral part of successful business processes.

Analysis on Overt Covert Racism

Racism is socially constructed in society and is used to differentiate privileges, wealth, and social class amongst individuals. Overt and covert racism have unique distinction in the sense that, one is explicit and the other is implicit. Thus, in today’s society, practices of popular culture account for hegemonic depictions in overt and covert racism. Firstly, overt racism is explicit in the sense that it is intentionally out there to demonstrate differentiations in the individual or group through harm or attacks. Secondly, covert racism could be considered an implicit method in which can be thought of as the effects of overt racism. Furthermore, covert racism in the example of black discrimination would be the generalization or stereotyping of African-Americans by the mass public (non-blacks) who perhaps can be thought of as, â€Å"brainwashed†. Lastly, through social constructionism hegemonic practices can be found in overt and covert racism. With that, White America has effectively socially constructed an ideology that became hegemonic towards the Black community through the effects of overt and covert racism. Racism in, â€Å"Identity and Community† is defined as the concept in which discrimination in human beings is based on physically, biologically, and genetically distinct types. Because of that, racism is the clear distinction of these â€Å"types† which begins the hierarchical distinction between racial groups. Overt racism is depicted in the film, â€Å"Malcolm X† where it is socially constructed such that the ideology that Blacks were an inferior race and should be treated harshly because of their skin color and origins. The manifestation of racism towards Blacks by White America is clearly overt racism as it explicitly and intentionally advocates the discrimination of African-Americans. Not only that, groups such as the Ku Klux Klan in the film are a prime example of overt racism such that they are preaching to the mass public about the inferiority of African-Americans. Thus hegemony in overt racism accounts for the death of Malcolm’s father. Hegemonic practices in the film are depicted in a covert manner such that the persecution of Blacks by the White Americans is accepted by the on-victims. To elaborate, it is not forcing the non-victims of racism to accept the new ideology but because of social constructionism, the idea of stereotypes becomes acceptable. Racism was acceptable in America during the 20th century, thus the power of racism becomes legitimate. In addition, covert hegemonic racism is evident such that â€Å"integration† or assimilation has always existed to be white. This is because it is never White-Americans integrating into black colleges, culture, or neighborhoods, whereas African-Americans are forced into assimilating into the norm. It is in a sense that the bystanders become racially de-sensitized and are then able to become and accept the regime’s ideology, in a hegemonic manner. This in turn may create covert racism, such that the younger generation are educated through social learning theory and are then â€Å"racists† themselves, but may not realize it. In the book, â€Å"White Savagery and Humiliation, or a New Racial Consciousness in the Media†, Newitz further explains that as young children, the world is quickly divided into â€Å"good† and â€Å"bad† objects. This example of early covert racism surfaces in today’s popular culture as parenting and social constructionism continues to shape today’s youth into stereotyping. In comparison to the film, the African-Americans are unable to fulfill and achieve their highest level of social classes because of suppressions and persecutions from the white community. As during the time, it was socially seen to be acceptable to discriminate African-Americans because of social constructionism. In conclusion, hegemonic practices in American Popular Culture are still very resilient and real today in the sense that African-Americans still experience racism regardless of influential movements such as having the first Black President. With that said, overt racism in today’s society is becoming less explicit because of new cultural norms, and social constructionism, whereas covert racism is becoming more prevalent because of its ability to facade itself under a cloak of silent approval. This can be attributed to the idea of â€Å"Decolonization of Culture† in the chapter, â€Å"Introducing Popular Culture† where Szeman and O’Brien notes that during the civil rights movement, social groups have begun to realize the faultlines of stereotyping social norms in race. It is important to note that covert racism will always exist in America, as long as social constructionism permits it. This demonstrates the power social constructionism has in racism which ultimately becomes the foundation of hegemony in African-Americans.

Down's Syndrome Children Require Unique Intervention Strategies For Essay

Down's Syndrome Children Require Unique Intervention Strategies For Them To Progress In Education And Socially - Essay Example The disorder manifest themselves in both neuro-developmental and neuro-psychological arenas but the simplest observation remains that it causes developmental delays which can range from mild to moderate learning disability to severe mental disability. (Deliz, 2008) Down syndrome is a chromosomal disorder which occurs in approximately 1 in 1000 births. Chromosome 21's presence in the affected, which contains 225 genes which contribute to the phenotype and pathogenesis of Down syndrome is referred to as the main cause of this distinct neurobiological, genetic, psychological, developmental and medical disorder. (Hattori, 2000) It is recognized that a very high proportion of brain anatomy and verbal intelligence is governed by genetic control. These findings greatly influence the study of Down Syndrome patients, their genes and their resulting speech, memory, language and other cognitive functions. (Capone, 2004). Research has also shown that children. affected by Down syndrome have decl ining Developmental and Intellectual quotients and thus have deficits in verbal and linguistic skills. Patients may also possess weak sequential auditory memory skills but they remain more adept at visual-spatial based memory tasks (Varnhagen, 1987) . Researchers have concluded that early intervention programmes benefit the socially adaptive function but do little to improve the cognitive function or IQ. (Gibson, 1988). There is no uniform cognitive benefit of early intervention if specific learning and intervention strategies are not used. There are multiple reasons provided for these findings. They include complex neuro-behavourial syndromes which often means that the intervention method chosen for learning is not working at its prime and increasing the frequency or the intensity of the same method will not provide results. Rather there is a need for different intervention strategies specific to their needs. (Gibson D. , 1991) This means that early intervention of the right kind a t the right time is required for a positive cognitive difference. A common example of this phenomenon can be observed when a child does not achieve spoken language skills and phonological competence despite attaining cognitive skills and other language comprehension skills which support complex skills. (Kumin, 2000)These are a sign the verbal intervention means have failed and calls for intervention strategies based on vision-based communication. This vision based communication uses signs and pictures to lead to symbol-based language development. It should however be remembered that increasing the intensity of phonology based therapies is also frequently met with poor results. Another visible delayed or aberrant function in Down syndrome is the pervasive developmental disorder. Children might suffer from developmental regression or social, communication or behavourial impairment. These children then require prompt referrals for medical and neuro-developmental assessment leading to t he establishment of a vision based system of communication. The normal assumption regarding early intervention plans for Down syndrome children is that they are extremely beneficial. In fact most of these early intervention programs are mandated by the state and are provided free of cost. This directly results in a Down syndrome child receiving physical therapy and early education in the first year of his life. (Capone, 2004) Occupational and speech therapy often follow the course in the second year of life. Parents and therapists often assume that the purpose of this early intervention is to speed the pace of development and the role of this early in

Global Leadership and Managment Essay Example | Topics and Well Written Essays - 1500 words

Global Leadership and Managment - Essay Example Keywords: global, Nokia, corporate social responsibility, stakeholders. Global Leadership and Management Nokia has always been one of the leaders of the global telecommunications industry. Nokia’s mobile gadgets are used and loved by millions of consumers around the world. The quality and efficiency of Nokia’s strategies cannot be overestimated. However, the company is not always sensitive to the needs and concerns of its employees and stakeholders. At the heart of this discussion is Nokia’s decision to move its production facilities from Germany to Romania. Of the biggest concern is the fact that German facilities have been extremely profitable, and Nokia’s striving to cut its costs by all possible means subjects thousands of employees to the risks of unemployment and poverty. The goal of this paper is to review the strategies used by Nokia in its movement to the top of the business hierarchy and to analyze the pros and cons of Nokia’s approaches t o global expansion and growth. Until 2008, Nokia had been the biggest global manufacturer of cell phones (Jain, 2009). Based in Finland, Nokia gradually turned into the leading provider of cell phone devices and applications in the global telecommunications industry. ... A decision was made to close the plant in Germany and move production facilities to Romania (Jain, 2009). Nokia believed that cost reductions was a necessity and would help the company to retain its profitable position in the global telecommunications industry (Jain, 2009). Reasons why Nokia decided to move its production facilities from Germany to Romania were simple and obvious: employees in Germany were paid ten times as much as employees in Romania would need to fulfill the same amount of work (Jain, 2009). Moreover, the creation of a new plant in Romania was part of Nokia’s low-cost strategy (Jain, 2009). At that time, the company ran a number of manufacturing facilities in Europe (namely, Hungary, Finland and Germany), a manufacturing plant in Britain, as well as in Africa and the Middle East (Jain, 2009). The plant in Germany added to the burden of costs carried by Nokia in Europe, and the company management felt that moving to Romania was the best way to stay competiti ve in the long run. The decision to move the production facilities from Germany to Romania stirred mass protests, and the wave of backlash resulting from employee opposition soon expanded to cover European consumers of Nokia (Jain, 2009). Employees disagreed with Nokia’s decision to move the plant to Romania, mainly because Nokia’s presence in Germany had been extremely profitable for the entire business (Jain, 2009). Labor unions in Germany called Nokia’s strategic plans unacceptable and inhuman (Jain, 2009). In the meantime, Nokia believed that the German plant would reduce the company’s global competitiveness (Jain, 2009). The plant accounted for more than

Paraphrase creditor rights, remedies, and insurance as a component of Essay - 2

Paraphrase creditor rights, remedies, and insurance as a component of risk management - Essay Example t the Insurer performs in "good faith" towards the insured However in case the debtor has destroyed, concealed, mutilated, falsified or failed to preserve any registered information like books, documents, papers, records from which the financial condition of debtor or the transactions related to business might be ascertained. When a customer of a business fails to disburse his/ her debts, the creditor (business in the given case, to which the loan is payable) has numerous accessible remedies to assist collection of the due money from the debtor (customer as "debtor"). These techniques take account of remedies that do not necessitate court participation (known as"self-help" remedies), and remedies that do engage the courts. State immunity laws were developed to permit insurance to execute its proposed functions and to prevent the insured’s dependents from turning into a fiscal load on society. In case of limited annual premium insurance policy, a creditor may be confined to retrieving only extra premium paid. The lender of Interstate Distribution Corporation, â€Å"The First National Bank â€Å"and Interstate itself can collect the policy amount up to interest earned while Eagle does not has any Insurable interest as it might have kept the policy associated with warehouse but with the sale of property, it lost its ownership and so the claim to the policy (Creditors Rights and Collection

Analyse the business situation facing KuIuIa.com from a marketing Essay

Analyse the business situation facing KuIuIa.com from a marketing point of view - Essay Example Its advertising campaigns were designed to influence human psychology and impacts of its visual and textual content is linked to human behaviour. Thus, its advertisement that makes common man, a super hero was hugely appealing for local population. Though it has networked with car rental firms, it needs to create wider linkages with other facilities to ensure customers convenience. Kululu.com faces serious threat from new competitors, especially from SAA or South African Airways which has largest market share. As such, Kululu.com must adopt flexible strategies to meet new challenges and exploit internal capabilities vis-a-vis customer relationship, sustainable business practices, diversification, acquisition, new product development and its linkages with its parent companies to gain competitive advantage. Ansoff’s matric promotes four growth strategies for gaining competitive advantage: market penetration; market development; diversification; and new product development. It sh ould therefore analyse different strategies of growth (Solomon et al., 2012). Both Comair and British Airways have huge credibility across the globe. With increasing competition, it must evolve new products and services and develop strategic business linkages with its parents’ company so that they can share database of customers with ease. Recommendations It should further enhance its customer services and develop an organizational culture that empowers employees. By increasing the number of customer service agents it would be able to provide passengers with improved personal service and emotional support and security at the time of crisis. It should increase frequency of destination-to-destination flights to maintain its popularity. Specialized short haul flights... †¢ It should increase frequency of destination-to-destination flights to maintain its popularity. Specialized short haul flights are increasingly being preferred by people who are frequent fliers. With its low cost strategy, it would attract more small and medium business class. †¢ As a growth strategy, leveraging partnership across different fields that may complement its wider business objectives is hugely critical issue that needs to be incorporated within its business strategy. Thus, it should forge alliances with hotels, resorts, tour operators and event managers so that it can constantly provide its customers with new ways to benefit and enjoy unique experience. Offering integrated packages would attract more families for vacations and encourage small and medium businesses to take its employees for work-cum relaxation programs. †¢ It should promote sustainable business practice and introduce attractive offers to its customers which would be able to give them a chance to travel in BA and Comair flights. It could be in terms of number of flights or frequency of fliers to particular destination which would make customers eligible for bonus points that could earn them discount tickets in BA and Comair. This would significantly increase customer database and help it to maintain its competitive advantage.

Personal Statement for LSE MSc Finance Example | Topics and Well Written Essays - 1000 words

For LSE MSc Finance - Personal Statement Example My decision to study mathematics in my undergraduate level was motivated by the fact that I always had a flair for the subject. I always regarded mathematics highly as its knowledge is also applied in other subjects such as physics and chemistry. I like solving mathematical problems that the subject provides. For me, mathematics is quite fascinating as it seems boundless and as such allows considerable choice for additional research. My main objective of studying the subject was, therefore, to learn to think and look at things differently, from a different angle than people doing degrees in humanities. While pursuing my undergraduate degree at the University of Edinburg, my mathematical skills have been modelled in a way that I am now in a position to see many things from a mathematical perspective. Some of the courses that have had a significant impact in my mathematical career growth include financial mathematics, Stochastic Modelling and Introduction to Number Theory. I am also doing a project at the moment that stochastically analyses are queuing at call centres. Having almost completed all the branches of the syllabus, I believe I am well-rounded and ready to further my education by pursuing Master of Science degree in finance. Throughout my two final years at the university, my interest in finance and financial analysis was growing each day. I want to get an opportunity to study at one of the greatest universities in UK and worldwide. We are living in a world that, unlike before, continues to experience unprecedented financial and economic meltdown. The recent crises in the global markets and the effects of globalization especially in emerging markets have necessitated a deeper understanding of the subject of finance. This is largely because through the finance knowledge; we can be able to build more robust systems and

Moth Essay Example | Topics and Well Written Essays - 1000 words

Moth - Essay Example This is an extremely large family of moths with an estimated 35,000 species. However, several geometers are known to be terrible pests. The caterpillars, known as loopers, inchworms or spanworms, feed on plants while some species are even carnivorous (‘Looper’, 2012). The family Noctuidae, or the owlet moths, are not only numerous in species but also robust – and they are the largest family. They have hind wings of bright colors. They are usually flying at night. They also invade flowers as many are attracted to sugar and nectar. Moreover, their larvae are crop pests (‘Cutworm Moth’, 2012). The family Cambridae is colored and patterned moths characterized by a special structure in the ears known as â€Å"praecinctorium,† which is responsible for joining the two tympanic membranes of the ears. The harmful Cambrid moth, or Grass Moth, has larvae which are typical stem borers of many important crops (‘Grass Moth’, 2012). ... The so-called tunnel moths make a silk lined tunnel and that during night time or winter, the caterpillar of the tunnel moth gathers grass foliage and drags them back into their tunnels. The caterpillars are very small and may be quote difficult to notice for they measure around 35 mm long only and 3 mm across (‘New pasture pest’, 2010). Pasture tunnel moths usually live in areas with higher rainfall, and they can cause significant damage to clovers, as well as annual and perennial grasses. The larvae are usually grey-colored in their bodies with black heads. The adult moth, on the other hand, is long and has a creamy-white color. The pasture tunnel moth usually cause the greatest damage during the months of July and August, during the rainy months, for rain has a great factors in stimulating this species of moth to feed more (‘Pasture tunnel moth’, 2009). Moreover, the pasture tunnel moth affects cereal crops (Perry et al., 2011). The first time that Philob ota species were identified in New Zealand was in February 2010 at the Ruakura Research Center in Hamilton, New Zealand. The migrant species are actually native to Australia, of which there are around 400 species, and where a number of these species are regarded as â€Å"minor pests of pasture† because it merely feeds on grass such as tall fescue trials and perennial ryegrass (Popay & Gunawardana, 2011). In case a New Zealand resident sees pasture tunnel moths, they should immediately contact MAF Biosecurity New Zealand (‘New pasture pest’, 2010). Based on the table below from the Asia & Pacific Plant Commission Protection, the first sighting of Philobota species in New Zealand was in 2010, and it was perhaps through the wind that

3D printing lub Research Paper Example | Topics and Well Written Essays - 750 words

3D printing lub - Research Paper Example Groups face numerous challenges as they seek to achieve their objectives. Some groups lack unity of purpose. A group that is not committed to a common objective cannot achieve its intended goals. According to Argris (2010), such a group may be characterized by low performance because members do not have collective obligations towards achievement of common objectives. 3D printing club’s organizational culture is defined as the behaviors and values that contribute to the unique psychological and social environment of an organization. These include the organization’s experiences, expectations, values and philosophy. These attributes are exhibited in its interactions with the outside life, inner workings, future expectations, and its self-image. They are based on shared customs, attitudes, beliefs, and unwritten and written rules. Organizational culture depends entirely on the structure of the 3D printing organization (Purdue University, 2013). This paper focuses on 3D prin ting organization at Purdue University. 3D printing club aims to push and show Purdue individuals about the plans and practices of an alternate amassing system called three-dimensional printing. The club will offer a dynamic experience with this enhancement. It offers understudy training knowledge on active and administrations that are offered throughout workshops. These include 3-D printing, nimble manufacturing, rapid prototyping, direct advanced assembling, prototyping and other related points and making of completed item (Purdue University, 2013).

Dispatches Paper Essay Example for Free

Dispatches Paper Essay As I read Dispatches by Michael Herr, there is an overwhelming sense of fear and horror. His dispatches are populated by soldiers called grunts, whose enemy was everywhere and nowhere. Their maps were blank; their names for the enemy, Charlie or VC, told them nothing. How do you recognize them? They all wear black pajamas; they are all alien to us. They are everywhere. Thats where the paranoia began. Herrs dispatches are disturbing because he writes from inside the nightmare, with all the tension and terror that turned these young men into killing machines. It is all the more frightening because, emptied of any concerns for justice, or ethics, or solidarity, they opened fire anywhere, everywhere. After all, who could know where or who the enemy was? Herrs use of brutal imagery absorbed me into his savage surroundings. From the soldier who cant stop drooling as a result of a particularly dreadful gun battle, to the scenes of the dead, American and Vietnamese, adult and infant, on battlefields and village streets. The characters are real people in a situation that most of them neither like nor understand. They are young men who invoke the same shortcomings we all have. They are professional soldiers and act that way despite their misgivings. They push past the boundaries of fear and into the realms of heroism or insanity or death. Everyone that he introduces is individual. There are no carbon copy soldiers here. They are funny or musical or religious or delusional. I felt as though I was being introduced to people I knew throughout the book. From time off in Saigon and Hong Kong to his time spent in a bunker during the siege of Khe Sanh, Herr covers every aspect of the war. He shows how so many soldiers were so drastically affected by the war. He describes the strange, fearful moments when at night the jungle suddenly goes silent. Herr tells tales of Marines throwing themselves on top of him with incoming fire, people he has only just met minutes or hours before that are risking their lives to protect his. This book is very descriptive and one of the best examples of this is this sentence, Every fifth round was a tracer, and when Spooky was working, everything stopped while that solid stream of violent  red poured down out of the black sky. In this sentence Herr is retelling the feelings felt by everyone as they watched the gunships flying overhead, unleashing the fury of gatling-guns that could fire thousands of rounds per minute. Not only does Herr convey the impact of such a sight; he does it in such a manner that a vivid image is formed in the readers mind. One of the more disturbing and insightful quotes in the book comes when a Marine at Khe Sanh learns that his wife is pregnant, but not with his child. Herr retells with this account, Oh dont worry, Orrin said. Theres gonna be a death in my family. Just soons I git home. And then he laughed. It was a terrible laugh, very quiet and intense, and it was the thing that made everyone who heard it believe Orrin. This quote shows how badly some soldiers were transformed during the war. A man who used to be very peaceful and calm would now snap at the slightest provocation. He would now plan the death of his wife for cheating on him. With these examples I would definitely say that one of the strengths of this book is its vivid descriptions. The other strength of this book is probably how it covers the emotional and physical aspects of the war. Still it is difficult to reconcile Herrs disregard for the grunts brutality and his apparent admiration that surfaces. Herr feeds on the death and carnage of the battlefield. It is difficult to grudge a person for their attachment to the most exciting times of their life. Herrs is almost an addiction to the life of the thrill seeker, but as he frequently mentions, unlike the grunts, he could always take the next chopper back to an air-conditioned hotel room in Saigon, or leave altogether. (Not that an air-conditioned room in Saigon would be necessarily safer than Khe Sahn) He describes Vietnam as a jumbled, confused, mess of a living hell. Herr also wrote the narration for Apocalypse Now, so what more do you need to know? It is crucial to understand that this book is not a political or military history of the war. Instead, Herr tried to portray the experience of what it was like to be in Vietnam; you wont find a handy map and glossary in the back. (If you honestly dont know what words like di di, zip, grunt, 16, and DMZ mean, I suggest you bone up on your history.) There are two major downfalls to this book: rambling and fiction. His writing style, disjointed and confused, makes the book a little hard to get used to. But when you do get used to it only then can you see that Herr is trying to give the reader an accurate account rather than a moral lecture. In terms of fiction the problem with writers is that they are writers. As such they are basically dishonest. This is not Vietnam as told by a soldier. This is Vietnam as told by a journalist who is in-country to the precise extent he cares to be and hotfoots it out of there when the going gets rough. In the beginning of the book Herr describes the horrors of night patrol by describing his own fear. He then informs the bewildered reader that this is a bit too much for him and therefore takes his journalistic eye somewhere else. The difference between a journalist and a soldier is that the soldier cant leave when he feels like it and so he doesnt have the luxury of drama. Unfortunately, most of this book is drama.

Working with a team on a project Essay Example for Free

Working with a team on a project Essay Teamwork is usually considered an important factor especially in a workplace. However, sometimes working in a team creates difficulties in achieving the objective of a certain project that the team is assigned. (Dyer, 1995) In any teamwork conflicts are likely to arise which relate to a specific job or project that is either being done in the company or outside the company. Some members may be dishonest to their colleagues especially on sensitive issues that touch the all group. In the team that I was taking part in I encountered negative experiences that were brought about due to individual characters. The problem with the team was the failure to reach a consensus on very important issues. It was caused by a few members who were either not patient or are just more action –oriented than others in their natural being because they are likely to exert pressure on the other members to accept their decision. This group of members was making decisions too quickly for the rest of the members which is contrary to the principles of meaningful teamwork. Good decisions are usually achieved over a common understanding by majority of the members and a unanimous agreement on the matter, but some team mates did not acknowledge that. At the same time some team members used personality to undermine others, even to the extended of undermining the team leader who was leading the team. This became a problem and the team could not achieve its targets. These differences became so critical that they kept being addressed daily; In the long run they lead into a breakdown of individual relationships which affected their productivity in general and stalled the project completely, we never went on with the project. Reference: Dyer, W. G. (1995): Team building: current issues and new alternatives. 3rd Ed. Pearson Education POD

Research into Rational Drug Prescribing in Yemen

Research into Rational Drug Prescribing in Yemen CHAPTER 1 1.0 Introduction In Yemen as well as in many other developing countries the quality of health services which constitute social indicators of justice and equity is far from being satisfactory. Inappropriate, ineffective, and inefficient use of drugs commonly occurs at different health facilities (Abdo-Rabbo, 1993; Abdo-Rabbo, 1997). Irrational prescribing is a habit, which is difficult to cure. This may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasteful of resources and needless expenditure. According to the Yemeni constitution, â€Å"patients have the right to health care and treatment† i.e. appropriate care, consent to treatment and acceptable safety. Therefore, health workers should concentrate on making patients better and patients should concentrate on geting better. Health care in general and particularly the drug situation in any country is influenced by the availability, affordability, and accessibility of drugs as well as the prescribing practices. There are many individuals or factors influence the irrational prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug information and misinformation (Geest S. V. et al, 1991; Hogerzeil H. V., 1995).Improving rational use of drugs (RUD) is a very complex task worldwide because changing behavior is very difficult. The 1985 Nairobi conference on the rational use of drugs marked the start of a global effort to promote rational prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug use had been properly tested in developing countries (Laing et al., 2001). The selection of drugs to satisfy the health needs of the population is an important component of a national drug policy. The selected drugs are called essential drugs which are the most needed for the health care of the majority of the population in a given locality, and in a proper dosage forms. The national list of essential drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and quality, cost- effectiveness and allocated financial resources. WHOs mission in essential drugs and medicines policy is to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor and disadvantaged medicines are unavailable, unaffordable, unsafe or improperly used. The organization works to fulfill its mission in essential drugs and medicines policy by providing global guidance on essential drugs and medicines, and working with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs. Development and implementation of national drug policies are carried out within the overall national health policy context, with care taken to ensure that their goals are consistent with broader health objectives. All these activities ultimately contribute to all four WHO strategic directions to: reduce the excess mortality of poor and marginalized populations reduce the leading risk factors to human health develop sustainable health systems,and develop an enabling policy and institutional environment for securing health gains. The greatest impact of WHO medicines activities is, and will continue to be, on reducing excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems. The people of our world do not need to bear the present burden of illness. Most of the severe illness that affects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care — including essential medicines, vaccines and technologies. Millions cannot — they cannot get the help they need, when they need it. As a result they suffer unnecessarily, become poorer and may die young. A countrys health service cannot respond to peoples needs unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice. (Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on Investigation of Medicines, Brasilia, 4 April 2000). 1.1 Background 1.1.1 Brief history of antibiotics According to the original definition by Waksman, antibiotics substances which are produced by microorganisms and which exhibit either an inhibitory or destructive effect on other microorganisms. In a wider, though not universally accepted definition; antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth processes (Reiner, 1982). Up to now, more than 4,000 antibiotics have been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only about 100 are used clinically as the therapeutic utility not only depends on a high antibiotic activity but also on other important properties such as good tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are therefore used a large extent and constitute the largest class of medicaments with respect to turnover value. Today, antibiotics are also used in veterinary medicine and as additives to animal feed. In the past they were used addition, as plant protection agents and as food preservatives. In this review we have confined ourselves to a brief description clinicallyuseful antibiotics. These belong to various classes of chemical compounds, differ in origin, mechanism of action and spectrum activity, and are thus important and representative examples of known antibiotics. 1.1.2 Problem Statement This study examines drug use in Yemen and factors leading to inappropriate use of medicines particularly antibiotics and the prescribing pattern. It defines rational drug use and describes policy developments, which aim to encourage appropriate use. In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on making patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that meets their own requirements for an adequate period of time and at the lowest cost to them and their community (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It involves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient length of time according to standard treatment. Furthermore, it involves monitoring the effect of the drug both on the patient and on the illness. There is plentiful evidence of the inappropriate use of drugs, not through self-medication or unauthorized prescribing, but inadequate medical prescribing and dispensing. Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and with expectations about the care they typically receive; they typically leave with a package of drugs or with a prescription to obtain them in a private market. In previous study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported quantity and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the community and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in some shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs. 1.1.2.1 Inappropriate Drug Use Increasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as improving health, can lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992; WHO, 1988). Inappropriate drug use may include under-use, over-use, over-supply, non-compliance, adverse drug reactions and accidental and therapeutic poisoning (DHHCS, 1992). It also includes medicating where there is no need for drug use, the use of newer, more expensive drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985). 1.1.2.2 Quality Use of Medicines In an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The stated aim of the policy is: to optimise medicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are often required for prevention, control and treatment of illness†. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a price people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 ; DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and duration of drug therapy and the inadequate review of drug therapy once it has been initiated. 1.1.2.3 The Requirement of Drug Information for Quality Use of Medicines A medicine has been described as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been two of the factors consistently identified as necessary for rational drug use (Naismith, 1988; Soumerai, 1988; Carson et al, 1991; Dowden, 1991; Henry and Bochner, 1991; Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use: Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the basis for appropriate prescribing decisions by medical practitioners. Medical practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is avai lable to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines. 1.1.2.4 Problem with antibiotic use The concerns regarding inappropriate antibiotic use can be divided into four areas: efficacy, toxicity, cost, and resistance. Inappropriate use of antibiotic can be due to: Antibiotic use where no infection is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery. Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection. The wrong drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia. The wrong dose or duration of therapy. Such inappropriate use has a measurable effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were used (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria. Inappropriate antibiotic use exposes patients to the risk of drug toxicity, while giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and yet direct and indirect side effects of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognized and have been described in reaction to antibiotic residues in food (Barragry, 1994). Life threatening side effects may be occur from the use of antibiotics for apparently simple infections, it is estimated, for example, that eight people per year in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked: especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993). The medical benefit of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolate of Staphylococcus aureus was described only two years after the introduction of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so rapidly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The vast quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to eme rgence of infection due to virtually untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has recently caused outbreaks in hospitals in London (Hiramatsu et al., 1997). Anti-infective are vital drugs, but they are over prescribed and overused in treatment of minor disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria become resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999). Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule. How does one ensure that good drug are not badly used, misused, or even abused? How can drugs be used rationally as intended? What is rational use of drugs? What does rational mean? 1.1.3 Rational Use of Drug Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994). These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis); in defining effective and safe treatments (drugs and non-drugs); in selecting appropriate drugs, dosage, and duration; in writing a prescription; in giving patients adequate information; and in planning to evaluate treatment responses. The definition implies that rational use of drugs; especially rational prescribing should meet certain criteria as follows (Ross et al., 1992): Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment. Appropriate drug.The selection of drugs is based on efficacy, safety, suitability, and considerations. Appropriate patient. No contraindications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient. Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed. Appropriate monitoring. The anticipated and unexpected effects of medications should be: appropriately monitored (Vance and Millington, 1986). Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. Irrational prescribing may be regarded as pathological prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following forms: The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections, The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS, The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhea, The use of drugs of uncertain safety status, e.g., use of dipyrone, Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhea, The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate. The use of unnecessarily expensive drugs, e.g., the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated. Some examples of commonly encountered inappropriate prescribing practices in many health care settings include: (Avorn et al., 1982). Overuse of antibiotics and antidiarrheals for non-specific childhood diarrhea, Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment, Drugs already prescribed, and Excessive use of antibiotics in treating minor respiratory tract infection. The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter. Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines. 1.1.3.1 Factors Underlying Irrational Use of Drugs There are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving from patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992). Table 1.1: Factors affecting irrational use of drug Impact of Inappropriate Use of Drugs The impact of this irrational use of drugs can be seen in many ways: (Avorn et al., 1982). Reduction in the quality of drug therapy leading to increased morbidity and mortality, Waste of resources leading to reduced availability of other vital drugs and increased costs, Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis, Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs. 1.1.3.2 The Rational Prescription (i.e. the right to prescribe) The rights to prescription writing must be ensuring the patients five rights: the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full name and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not abbreviated, using approved titles only. Dose and dose frequency should be stated; in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998). 1.2 Overview on Essential Drug Concept (EDC) Essential drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year published the first model list of essential drug and WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE [that mean safety , availability, need efficacy] (John, 1997). The essential drug concept is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost (New Straits Times, 1997a). In support of this concept, the WHOissued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Yemen to focus on becoming self-reliant where generic equivalents of essenti al drugs can be manufactured and popularized to meet the health needs of the majority of the people. The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug Policy was to: Prepare a list of essential drugs to meet the health of needs of the people. Assure that the essential drugs made available to the public are of good quality Improve prescribing and dispensing practices Promote rational use of drug by the public Lower cost of the drugs to the government and public Reduce foreign exchange expenditure 1.3 Yemen Essential Drug List and Drug Policy in Yemen The Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system. The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price; that these drugs are safe and effective; and that they are prescribed and used rationally. The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries; but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and implemented this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The second edition of the Yemen Drugs list and the Yemen Standard Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996); MoPHP/NSTG, (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same booklet (Mo PHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated. Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994). The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the recognition of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs remain in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences remain unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals. The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as â€Å"new† are minor variations of existing drug preparations and do not always represent a significant treatment improvement. In addition, the vast number brand names products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world. The regular supply of drugs to treat the most common diseases was a major problem for governments in low-income countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients involved in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other interested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country. The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has n Research into Rational Drug Prescribing in Yemen Research into Rational Drug Prescribing in Yemen CHAPTER 1 1.0 Introduction In Yemen as well as in many other developing countries the quality of health services which constitute social indicators of justice and equity is far from being satisfactory. Inappropriate, ineffective, and inefficient use of drugs commonly occurs at different health facilities (Abdo-Rabbo, 1993; Abdo-Rabbo, 1997). Irrational prescribing is a habit, which is difficult to cure. This may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasteful of resources and needless expenditure. According to the Yemeni constitution, â€Å"patients have the right to health care and treatment† i.e. appropriate care, consent to treatment and acceptable safety. Therefore, health workers should concentrate on making patients better and patients should concentrate on geting better. Health care in general and particularly the drug situation in any country is influenced by the availability, affordability, and accessibility of drugs as well as the prescribing practices. There are many individuals or factors influence the irrational prescribing such as patients, prescribers, workplace environment, the supply system, including industry influences, governments regulations, drug information and misinformation (Geest S. V. et al, 1991; Hogerzeil H. V., 1995).Improving rational use of drugs (RUD) is a very complex task worldwide because changing behavior is very difficult. The 1985 Nairobi conference on the rational use of drugs marked the start of a global effort to promote rational prescribing (WHO,1987). In 1989, an overview of the subject concluded that very few interventions to promote rational drug use had been properly tested in developing countries (Laing et al., 2001). The selection of drugs to satisfy the health needs of the population is an important component of a national drug policy. The selected drugs are called essential drugs which are the most needed for the health care of the majority of the population in a given locality, and in a proper dosage forms. The national list of essential drugs (NEDL) is based on prevailing health conditions, drug efficacy, safety, and quality, cost- effectiveness and allocated financial resources. WHOs mission in essential drugs and medicines policy is to help save lives and improve health by closing the huge gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor and disadvantaged medicines are unavailable, unaffordable, unsafe or improperly used. The organization works to fulfill its mission in essential drugs and medicines policy by providing global guidance on essential drugs and medicines, and working with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs. Development and implementation of national drug policies are carried out within the overall national health policy context, with care taken to ensure that their goals are consistent with broader health objectives. All these activities ultimately contribute to all four WHO strategic directions to: reduce the excess mortality of poor and marginalized populations reduce the leading risk factors to human health develop sustainable health systems,and develop an enabling policy and institutional environment for securing health gains. The greatest impact of WHO medicines activities is, and will continue to be, on reducing excess mortality and morbidity from diseases of poverty, and on developing sustainable health systems. The people of our world do not need to bear the present burden of illness. Most of the severe illness that affects the health and well-being of the poorer people of our world could be prevented. But first, those at risk need to be able to access health care — including essential medicines, vaccines and technologies. Millions cannot — they cannot get the help they need, when they need it. As a result they suffer unnecessarily, become poorer and may die young. A countrys health service cannot respond to peoples needs unless it enables people to access essential drugs of assured quality. Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice. (Dr Gro Harlem Brundtland, Director-General, World Health Organization Opening remarks, Parliamentary Commission on Investigation of Medicines, Brasilia, 4 April 2000). 1.1 Background 1.1.1 Brief history of antibiotics According to the original definition by Waksman, antibiotics substances which are produced by microorganisms and which exhibit either an inhibitory or destructive effect on other microorganisms. In a wider, though not universally accepted definition; antibiotics are substances of biological origin, which without possessing enzyme character, in low concentrations inhibit cell growth processes (Reiner, 1982). Up to now, more than 4,000 antibiotics have been isolated from microbial sources and reported in the literature, and more than 30000 semi-synthetic antibiotics have been prepared. Of these, only about 100 are used clinically as the therapeutic utility not only depends on a high antibiotic activity but also on other important properties such as good tolerance, favorable pharmacokinetics etc. These antibiotics are today among the most efficient weapons in the armoury of the physician in his fight against infectious diseases. They are therefore used a large extent and constitute the largest class of medicaments with respect to turnover value. Today, antibiotics are also used in veterinary medicine and as additives to animal feed. In the past they were used addition, as plant protection agents and as food preservatives. In this review we have confined ourselves to a brief description clinicallyuseful antibiotics. These belong to various classes of chemical compounds, differ in origin, mechanism of action and spectrum activity, and are thus important and representative examples of known antibiotics. 1.1.2 Problem Statement This study examines drug use in Yemen and factors leading to inappropriate use of medicines particularly antibiotics and the prescribing pattern. It defines rational drug use and describes policy developments, which aim to encourage appropriate use. In Yemen, as well as in many developing countries, the quality of health services is far from being achieved. Therefore, doctors should concentrate on making patients better and patients should concentrate on getting better. The rational use of drugs requires that patients received medications in appropriate to their clinical needs, in doses that meets their own requirements for an adequate period of time and at the lowest cost to them and their community (Bapna et al, 1994). This means deciding on the correct treatment for an individual patient based on good scientific reasons. It involves making an accurate diagnosis, selecting the most appropriate drug from these available, prescribing this drug in adequate doses for a sufficient length of time according to standard treatment. Furthermore, it involves monitoring the effect of the drug both on the patient and on the illness. There is plentiful evidence of the inappropriate use of drugs, not through self-medication or unauthorized prescribing, but inadequate medical prescribing and dispensing. Normally, patients in Yemen enter health facilities with a set of symmetrical complaints, and with expectations about the care they typically receive; they typically leave with a package of drugs or with a prescription to obtain them in a private market. In previous study in Yemen (misuse of antibiotics in Yemen, a pilot study in Aden) (Abdo-Rabbo, 1997) showed that imported quantity and total consumption of antibiotics is increasing. There is a lack of information about the problems created from antibiotics among the community and about the proper efficacy, safety, and rational use of antibiotics among health authority and workers. No supervision or strict rules are applied in the use of antibiotics. They are easily obtained without prescription and available in some shops. The percentage of prescriptions containing antibiotics was more than a quarter of the total prescriptions contained antibiotics, also antibiotics constituted about 25% of all prescribed drugs. 1.1.2.1 Inappropriate Drug Use Increasing use of medicines may lead to an increase in the problems associated with medication use. The use of medicines, as well as improving health, can lead to undesirable medical, social, economic and environmental consequences. Aspects of drug use, which lead to such undesirable consequences, have been called inappropriate drug use (DHHCS, 1992; WHO, 1988). Inappropriate drug use may include under-use, over-use, over-supply, non-compliance, adverse drug reactions and accidental and therapeutic poisoning (DHHCS, 1992). It also includes medicating where there is no need for drug use, the use of newer, more expensive drugs when lower cost, equally effective drugs are available (WHO, 1988) and drug use for problems which are essentially social or personal (Frauenfelder and Bungey, 1985). 1.1.2.2 Quality Use of Medicines In an attempt to encourage the appropriate use of medicinal drugs and to reduce the level of inappropriate use in Yemen, a policy was developed on the quality use of medicines. The stated aim of the policy is: to optimise medicinal drug use (both prescription and OTC) to improve healthoutcomes for all Yemenis. The policy endorses the definition of quality drug use as stated by the World Health Organisation, Drugs are often required for prevention, control and treatment of illness†. When a drug is required, the rational use of drugs demands that the appropriate drug be prescribed, that it be available at the right time at a price people can afford, that it be dispensed correctly, and that it be taken in the right dose at the right intervals and for the right length of time. The appropriate drug must be effective, and of acceptable quality and safety. The formulation and implementation by governments of a national drug policy are fundamental to ensure rational drug use (WHO, 1987 ; DHHCS, 1992). The rational use of drugs can be impeded by the inappropriate selection of management options, the inappropriate selection of a drug when a drug is required, the inappropriate dosage and duration of drug therapy and the inadequate review of drug therapy once it has been initiated. 1.1.2.3 The Requirement of Drug Information for Quality Use of Medicines A medicine has been described as an active substance plus information. (WHO, 1994). Education, together with, objective and appropriate drug information have been two of the factors consistently identified as necessary for rational drug use (Naismith, 1988; Soumerai, 1988; Carson et al, 1991; Dowden, 1991; Henry and Bochner, 1991; Tomson and Diwan, 1991). The WHO guidelines for developing national drug policies also identify the importance of information provision for facilitating drug use: Information on and promotion of drugs may greatly influence their supply and use. Monitoring and control of both activities are essential parts of any national drug policy (WHO, 1988). Objective and appropriate drug information is a necessary factor for quality drug use. It is the basis for appropriate prescribing decisions by medical practitioners. Medical practitioners require objective product, specific drug information and comparative prescribing information. Objective drug information is avai lable to medical practitioners through continuing education programs co-ordinated by professional bodies, medical and scientific journal articles, drug information services and drug formularies and guidelines. 1.1.2.4 Problem with antibiotic use The concerns regarding inappropriate antibiotic use can be divided into four areas: efficacy, toxicity, cost, and resistance. Inappropriate use of antibiotic can be due to: Antibiotic use where no infection is present, e.g. continuation of peri-operative prophylaxis for more than 24 hours after clean surgery. Infection, which is not amenable to antibiotic therapy, e.g. antibiotics prescribed for viral upper respiratory infection. The wrong drug for the causative organism, e.g. the use of broad anti-Gram negative agents for community acquired pneumonia. The wrong dose or duration of therapy. Such inappropriate use has a measurable effect on therapeutic efficacy. For example, one study showed that mortality in gram-negative septicemia is doubled when inappropriate empiric agents were used (Kreger et al., 1980). Since most initial antibiotic therapy is empiric, any attempt at improving use must tackle prescribing habits, with particular emphasis on guidelines for therapy based on clinical criteria. Inappropriate antibiotic use exposes patients to the risk of drug toxicity, while giving little or no therapeutic advantage, antibiotics are often considered relatively safe drugs and yet direct and indirect side effects of their use are frequent and may be life-threatening, allergic reactions, particularly to beta-lactam agents are well recognized and have been described in reaction to antibiotic residues in food (Barragry, 1994). Life threatening side effects may be occur from the use of antibiotics for apparently simple infections, it is estimated, for example, that eight people per year in UK die from side effects of co-trimoxazole usage in the community (Robert and Edmond, 1998). Indirect side effects are often overlooked: especially as may occur sometime after the antibiotic has been given. These include drug interactions (such as interference of antibiotic with anti-coagulant therapy and erythromycin with antihistamine) (BNF, 1998), side effects associated with the administration of antibiotics (such as intravenous cannula infection) and super-infection (such as candidiasis and pseudomembranous colitis). Each of these may have a greater morbidity, and indeed mortality, than the initial infection for which the antibiotic was prescribed (Kunin et al., 1993). The medical benefit of antibiotics does not come cheap. In the hospital setting, up to fifty percent of population receive one antibiotic during their hospital stay, with surgical prophylaxis accounting for thirty percent of this (Robert and Edmond, 1998). The first penicillin resistant isolate of Staphylococcus aureus was described only two years after the introduction of penicillin. Within a decade, 90% of isolates were penicillin resistant. This pattern of antibiotic discovery and introduction, followedby exuberant use and rapid emergence of resistance has subsequently been repeated witheach new class of antibiotics introduced. Bacteria can so rapidly develop resistance due to two major evolutionary advantages. Firstly, bacteria have been in existence for some 3.8 billion years and resistance mechanisms have evolved over this time as a protective mechanism against naturally occurring compounds produced by other microorganisms. In addition, they have an extremely rapid generation time and can freely exchange genetic material encoding resistance, not only between other species but also between genera. The vast quantities of antibiotics used in both human and veterinary medicine, as a result present in the environment, have lead to eme rgence of infection due to virtually untreatable bacteria. Multiply drug resistant tuberculosis is already widespread in parts of Southern Europe and has recently caused outbreaks in hospitals in London (Hiramatsu et al., 1997). Anti-infective are vital drugs, but they are over prescribed and overused in treatment of minor disorder such as simple diarrhea, coughs, and colds. When antibiotics are too often used in sub-optimal dosages, bacteria become resistant to them. The result is treatment failure where patient continue to suffer from serious infections despite taking the medication (Mohamed, 1999). Drugs prescribed are in no way beneficial to the patient s management if there are some negative interactions among the various agent prescribed, over prescribed, under prescribed or prescribed in the wrong dosage schedule. How does one ensure that good drug are not badly used, misused, or even abused? How can drugs be used rationally as intended? What is rational use of drugs? What does rational mean? 1.1.3 Rational Use of Drug Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community (Bapna et al., 1994). These requirements will be fulfilled if the process of prescribing is appropriately followed. This will include steps in defining patients problems (or diagnosis); in defining effective and safe treatments (drugs and non-drugs); in selecting appropriate drugs, dosage, and duration; in writing a prescription; in giving patients adequate information; and in planning to evaluate treatment responses. The definition implies that rational use of drugs; especially rational prescribing should meet certain criteria as follows (Ross et al., 1992): Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment. Appropriate drug.The selection of drugs is based on efficacy, safety, suitability, and considerations. Appropriate patient. No contraindications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient. Appropriate information. Patients should be provided with relevant, accurate, important, and clear information regarding his or her condition and the medication(s) that are prescribed. Appropriate monitoring. The anticipated and unexpected effects of medications should be: appropriately monitored (Vance and Millington, 1986). Unfortunately, in the real world, prescribing patterns do not always conform to these criteria and can be classified as inappropriate or irrational prescribing. Irrational prescribing may be regarded as pathological prescribing, where the above- mentioned criteria are not fulfilled. Common patterns of irrational prescribing, may, therefore be manifested in the following forms: The use of drugs when no drug therapy is indicated, e.g., antibiotics for viral upper respiratory infections, The use of the wrong drug for a specific condition requiring drug therapy, e.g., tetracycline in childhood diarrhea requiring ORS, The use of drugs with doubtful/unproven efficacy, e.g., the use of antimotility agents in acute diarrhea, The use of drugs of uncertain safety status, e.g., use of dipyrone, Failure to provide available, safe, and effective drugs, e.g., failure to vaccinate against measles or tetanus, failure to prescribe ORS for acute diarrhea, The use of correct drugs with incorrect administration, dosages, and duration, e.g., the use of IV metronidazole when suppositories or oral formulations would be appropriate. The use of unnecessarily expensive drugs, e.g., the use of a third generation, broad spectrum antimicrobial when a first-line, narrow spectrum, agent is indicated. Some examples of commonly encountered inappropriate prescribing practices in many health care settings include: (Avorn et al., 1982). Overuse of antibiotics and antidiarrheals for non-specific childhood diarrhea, Multiple drug prescriptions, prescribe unnecessary drugs to counteract or augment, Drugs already prescribed, and Excessive use of antibiotics in treating minor respiratory tract infection. The drug use system is complex and varies from country to country. Drugs may be imported or manufactured locally. The drugs may be used in hospitals or health centers, by private practitioners and often in a pharmacy or drug shop where OTC preparations are sold. In some countries, all drugs are available over the counter. Another problem among the public includes a very wide range of people with differing knowledge, beliefs and attitudes about medicines. 1.1.3.1 Factors Underlying Irrational Use of Drugs There are many different factors that affect the irrational use of drugs. In addition, different cultures view drugs in different ways, and this can affect the way drugs are used. The major forces can be categorized as those deriving from patients, prescribers, the workplace, the supply system including industry influences, regulation, druginformation and misinformation, and combinations of these factors (Table 1.1) (Ross et al., 1992). Table 1.1: Factors affecting irrational use of drug Impact of Inappropriate Use of Drugs The impact of this irrational use of drugs can be seen in many ways: (Avorn et al., 1982). Reduction in the quality of drug therapy leading to increased morbidity and mortality, Waste of resources leading to reduced availability of other vital drugs and increased costs, Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance, e.g., malaria or multiple drugs resistant tuberculosis, Psychosocial impacts, such as when patients come to believe that there is a pill for every ill. This may cause an apparent increased demand for drugs. 1.1.3.2 The Rational Prescription (i.e. the right to prescribe) The rights to prescription writing must be ensuring the patients five rights: the right drug, the right dose, by the right route, to the right patient, at the right time. Illegible handwriting and misinterpretation of prescriptions and medication orders are widely recognized causes of prescription error. The medicines should be prescribed only when they are necessary, should be written legibly in ink or, other wise, should be led, and should be signed in ink by the prescriber, The patients full name and address, diagnosis should be written clearly, the name of drugs and formulations should be written clearly and not abbreviated, using approved titles only. Dose and dose frequency should be stated; in the cases of formulations to be taken as required, a minimum dose should be specified (British National Formulary, 1998). 1.2 Overview on Essential Drug Concept (EDC) Essential drugs relate to an international concept proposed by the World Health Organization (WHO) in 1977. WHO in that year published the first model list of essential drug and WHO has put in enormous resources into the campaign to promote the concept of essential drugs (EDL). Essential drugs were defined as a limited number of drugs that should be available at any time to the majority of population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE [that mean safety , availability, need efficacy] (John, 1997). The essential drug concept is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost (New Straits Times, 1997a). In support of this concept, the WHOissued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical scientific merits, and provides an economical basis of drug use. This list is regularly, revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards (WHO, 1995). This is indeed important for countries like Yemen not only because health care are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Yemen to focus on becoming self-reliant where generic equivalents of essenti al drugs can be manufactured and popularized to meet the health needs of the majority of the people. The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle thata majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations (New Straits Times, 2000) Moreover, certain self-limiting diseases may not need drug treatment as such. For example, in the case of diarrhea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome. The goal of the Yemen Drug Policy was to: Prepare a list of essential drugs to meet the health of needs of the people. Assure that the essential drugs made available to the public are of good quality Improve prescribing and dispensing practices Promote rational use of drug by the public Lower cost of the drugs to the government and public Reduce foreign exchange expenditure 1.3 Yemen Essential Drug List and Drug Policy in Yemen The Concept of Essential Drugs (EDC) developed by World Health Organization (WHO) in 1977 has provided a rational basis, not only for drug procurement at national level but also for establishing drug requirements at various levels within the health care system. The WHOs Action Program on Essential Drugs (DAP) aimed to improve health care. It was established in order to provide operational support in the development of National Drug Policies (NDP), to improve the availability of essential drugs to the whole population and to work towards the rational use of drugs and consequently the patient care. The program seeks to ensure that all people, whenever they may be, are able to obtain the drugs they need at the lowest possible price; that these drugs are safe and effective; and that they are prescribed and used rationally. The first WHO Model List of Essential Drugs was published in 1977 (WHO, 1977). Since that time essential drugs become an important part of health policies in developing countries; but the Essential Drugs Program has been criticized because it emphasis in improving supply of drugs rather than their rational prescribing. The recent revised WHO Model List of Essential Drugs was published the 13th edition in April 2003 (WHO, 2003). Yemen was one of the first countries in the region adapted the EDC in 1984 and implemented this concept in the public sector (Hogerzeil et al., 1989). The first Yemen (National) Essential Drugs List (YEDL) was officially issued in 1987 based on the WHO List of Essential Drugs and other resources. The second edition of the Yemen Drugs list and the Yemen Standard Treatment Guidelines were published in 1996 (MoPHP/NEDL, (1996); MoPHP/NSTG, (1996).Recently the latest edition was published in 2001 with the Standard Treatment Guidelines (STG) in the same booklet (Mo PHP/YSTG and YEDL, 2001). The new edition of the Treatment Guidelines and the Essential Drugs List has been created through a long process of consultation of medical and pharmaceutical professionals in Yemen and abroad. Review workshops were held in Sanaa and Aden and more than 200 representatives of the health workers from different governorates including the major medical specialists participated. Essential drugs are selected to fulfil the real needs of the majority of the population in diagnostic, prophylactic, therapeutic and rehabilitative services using criteria of risk-benefit ratio, cost-effectiveness, quality, practical administration as well as patient compliance and acceptance (Budon-Jakobowiez, 1994). The YEDL was initially used for the rural health units and health centers as well as some public hospitals, but not applied for all levels of health care and the private sector. However, despite the recognition of the essential drug concept by the government of Yemen represented by the Ministry of Public Health and Population (MoPHP), drugs remain in short supply to many of the population and irrationally used. Procurement cost is sometimes needlessly high. Knowledge of appropriate drug use and the adverse health consequences remain unacceptably low. In addition, diminished funding in the public sector resulted in shortage of pharmaceuticals. The 20th century has witnessed an explosion of pharmaceutical discovery, which has widened the therapeutic potential of medical practice. The vast increase in the number of pharmaceutical products marketed in the last decades has not made drug available to all people and neither has resulted in the expected health improvement. While some of the newly invented drugs are significant advance in therapy, the majorities of drugs marketed as â€Å"new† are minor variations of existing drug preparations and do not always represent a significant treatment improvement. In addition, the vast number brand names products for the same drug increases the total number of products of this particular drug resulting in an unjustified large range of drug preparations marketed throughout the world. The regular supply of drugs to treat the most common diseases was a major problem for governments in low-income countries. The WHO recommends that activities to strengthen the pharmaceutical sector be organized under the umbrella of the national drug policy (WHO, 1988). In 1995, over 50 of these countries has formulated National Drug Policies (NDP). The NDP is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. It provides a framework to co-ordinate activities of patients involved in pharmaceutical sector, the public sector, the private sector, non-governmental organizations (NGOs), donors and other interested parties. A NDP will therefore, indicate the various courses of action to be in relation to medicines within a country. The Yemen National Drug Policy was developed since 1993 with the objectives of ensuring availability of essential drugs through equitable distribution, ensuring drugs efficacy and safety, as well as promoting the rational use of drugs. Unfortunately, it has n