Strengths and weaknesses of situational leadership model

Strengths and weaknesses of situational leadership model According to situational leadership models in general, leaders should adopt different leadership approaches depending on the situations that they encounter. Leadership competencies which work in one given situation may not be effective under different circumstances (Graef, 1983). In other words, other factors must be taken into account when deciding which leadership style to use in a given situation. Therefore, successful leaders can be characterised as those who are able to adjust their leadership styles according to situations which warrant their intervention. The Hersey-Blanchard Situational Leadership Model is built on the concept using follower maturity as the key issue which affects adjustment in leadership styles.  [1]  Follower maturity, which defines the readiness of followers to perform in a given situation, is based on two major factors the ability and confidence in performing the tasks. Four leadership styles which emerge from this two-by-two matrix model (see Table 1) are Participating, Selling, Telling and Delegating. All these four leadership styles have varying levels in terms of follower ability and confidence. Table 1: Hersey-Blanchard Situational Table Leadership Model High PARTICIPATING STYLE Followers are capable but Relationship Behaviourunwilling and not confident SELLING STYLE Followers are unable but willing and confident DELEGATING STYLE Followers are capable, willing and confident TELLING STYLE Followers are unable, unwilling and not confident Low Task Behaviour Low High Managers who are keen to use the Hersey-Blanchard Situational Leadership Model must first fully understand or be able to assess/gauge the level of maturity of its subordinates with reference to their readiness or commitment to perform their job tasks.  [2]   Based on the case analysis presented and the leadership model depicted in the table above, it can be concluded that John Terrill had adopted the Delegating Leadership Style in dealing with the situation at DGI Internationals Technical Services division. Delegating Leadership Style Looking at the two-by-two matrix, the Delegating Leadership Style is described as Low Task, Low Relationship, whereby intervention from managers is kept to a minimum with the assumption that the subordinates are able, willing and confident of accomplishing the tasks at hand. Managers who adopt this style of leadership will allow their followers or subordinates to take responsibility for their assigned tasks with minimal supervision from them. In the case of DGI Internationals Technical Services division, John Terrill practiced the delegating style based on the profile of the team in his division. Since it was stated that all 20 of his subordinates are engineers who are highly paid and best educated, it can be deduced that this group of employees are high performers in their area of expertise within the organization. Management will not be willing to pay them highly if they do not possess high level of job maturity, which refers to their job capabilities and confidence in accomplishing their tasks as engineers. Based on their aptitude and the fact that the engineers requested top management to stop making them spend too much time on writing reports, Terrill was able to gauge that the employees possess high capabilities of performing their tasks and are also willing and confident to do their job provided that they were given the opportunity and time needed to accomplish their tasks. The engineers did not need much prompting and directions from him to take on new initiatives which help contribute to their productivity. Terrills delegating style can be further identified when he promised to stay off the engineers backs and also make sure that top management did the same. This indicates that Terrill will not interfere much with the daily tasks of the engineers because he believes the engineers know what are expected of them, what they are supposed to do and do not need much direction from Terrill to accomplish their tasks. Strengths of Delegating Style This style of leadership empowers followers to be responsible for their own actions and decisions. For example, the engineers are given high autonomy in completing their tasks with minimal supervision by Terrill. For mature followers who have high level of job readiness, this leadership style will give them a great sense of accomplishment which acts as motivator to give their best and increase productivity (Hersey and Blanchard, 1988). In this case, the engineers are able to concentrate on accomplishing their tasks and productivity of the division will improve. Empowerment allows for a certain degree of independence which promotes accountability and creativity in individuals. A leader who is able to delegate his authority in terms of job accomplishment will have time to focus on other strategic matters. Followers of this leadership style will feel more trusted and will build a closer working relationship with the leaders and foster better team work. Inadvertently, it will be easier for Terrill to turn around the department because his engineers will have more respect for him and will not hesitate to help him achieve their goals. Weaknesses of Delegating Style Measurement of job readiness is subjective and based on several factors, mainly job ability and job confidence (Hambleton et al., 1977(. However, if a leader wrongly gauged the job readiness of his followers and leave it to them to accomplish certain tasks, he may not achieve the desired results at the end of the day. This style of leadership is open to abuse. Followers may be able, willing and confident to perform the tasks but they may also take advantage of the low intervention from their managers so that the tasks may not be completed on time or productivity is not up to par as expected. A leader is able to delegate the tasks to his followers but accountability of the job still lies with the leader. To sum up, job delegation should be a gradual process until the leader is satisfied and confident that the tasks can be accomplished with minor supervision. However, in the real world, there is no single leadership style that can be applied in all situations. Effective leaders should be able to adjust their leadership styles according to the situation at hand. Leaders who are able to adopt different styles based on what is required of them will be most successful. Question 2 What do you think was John Terrills source of power? Do you think it is effective? The concept of power can be defined in varying ways but generally power is regarded as the ability to influence, affect and mobilize the attitudes and behaviour of others. The term power, authority, domination and control are often used interchangeably as there is a thin line separating their meanings (Pheby, 2004). However, power is not exclusive to only managers and leaders as opposed to authority which comes with certain legitimate positions. Power is able to shape ones actions and behaviour; thus, it can be maintained that decision making can be influenced with the existence of power sources in a system. In an organizational context, power is directly related to hierarchy or structure and legitimacy which come with positions. The ability of those in higher ranking positions to influence their subordinates is driven by power. It is an element which is able to shape managers and followers, and is the key underlying factor for leadership effectiveness. In fact, one of its most important functions is to build interdependency between leaders and followers. Ogden et al. (2006) entails that power need not have goal compatibility but only dependence. Researchers French and Raven (1959) had studied the sources of power and successfully listed them in five distinct forms. The five bases of power in organizations which are able to affect success in leadership are described as follows: Category Source of power Description POSITIONAL POWER Legitimate power This source of power usually comes with specific roles and positions in organisations. This power is also embedded in formal job descriptions that are mutually agreed to by employees in an organisation. Generally, people holding higher position are able to exert more organisational power compared to those in lower ranking jobs. Reward power Normally associated with the formal authority to allocate organisational rewards to employees. This type of power can weaken if the reward is no longer perceived as valuable by the receiver. Coercive power The person holding this power is able to impose punishment. In organisations, punishments can be in the form of reprimand, disciplinary action, suspension, demotion, dismissal, etc. Coercive power is usually associated with authority and can be used as a coercion tool at the workplace. PERSONAL POWER Expert power The ability to influence based on a persons knowledge, skills and expertise which originates from within an individual. This type of power is normally acquired by experts in certain fields. May not necessarily linked to position or authority in an organisation. Referent power An individual with referent power is looked upon as a role model by others. The individual usually possesses a charm, appeal, charisma or admirable qualities which others want to identify with. These five sources of power can be broadly categorised into positional power and personal power. Positional power refers to external power which is vested in an individuals formal role, position or authority. Legitimate power, reward power and coercion power fall in this category. On the other hand, expert power and referent power can be grouped as personal power because they involve internal or personal traits which belong to individuals. In DGI Internationals case study, John Terrill applied a combination of both position and personal powers to solve the problem faced by his subordinates in the Technical Services division. 1. Positional power Being appointed as the head of Technical Services Division clearly indicated that John Terrill held legitimate power over the department. As the new boss to a team of highly paid and skilled engineers, it can be assumed that John Terrill himself possessed quality traits which made top management at DGI International very confident that he can turn the non-performing department around. Terrill first demonstrated his legitimate power during his meeting with the engineers. First, he cleverly gained the engineers confidence by showing great concern for their welfare. Then he exerted his legitimate power by demanding to know the reasons for their lack of productivity and factors which hamper their expected performance. His ability to influence the engineers to voice out their grievances which affected their performance showed that he was successful in getting to the root of the departments productivity problem. In this case, Terrill did not use any reward or coercive power because he did not impose any reward or punishment in getting to the root of the problem and then making sure that his engineers would carry out their tasks after that. He used empathy and diplomacy as a leader by exerting his influence to make them follow his instructions. Terrill also exercised his authority when he issued immediate order for reports to be sent to his office instead of the headquarters as warranted by top management. He was well aware that his orders were against top managements instructions, but he was not afraid to use the legitimate power vested in his position to stand by his decision to keep the management off the engineers backs as promised. 2. Personal power The top managements concern about the low productivity further showed the importance placed on his team. Terrill understood that his team of engineers is crucial to the organisations growth since they are the best educated and highly paid employees in the company. From this profile alone, Terrill knew that his division held a lot of expertise required in the manufacturing of refinery equipment. Knowledge and skills of the engineers are highly valued by the organisation, which was why they were never reprimanded for their lack of productivity before. In other words, the engineers have expert power which made them indispensable to the company. Terrills source of expert power was also derived from the engineers knowledge and skills. He could anticipate that top management would agree to his recommendation that management should not bog down the engineers with daily reports because their engineering expertise is a critical resource in meeting the companys production objectives, whereas internal reports are only administrative requirements. In this example, Terrill obviously used the divisions expert power to negotiate with top management to stay out of their way so that they can carry out their engineering work as expected, and hopefully increase productivity as expected of them. Terrill seemed to have gained support from his engineers because they cheered him when he was about to meet top management to fight for their cause. If he successfully gets top management to agree with his plight, he will undoubtedly build his referent power and be admired for his charm and charisma in carrying out his task as their leader. It can be summarized that Terrill effectively used his legitimate power to influence his engineers to confide in him about problems that they faced which hampered productivity of the division. Terrill also successfully exercised the divisions expert power to ensure top management did not impose trivial matters (such as writing internal daily reports) which consume much of the engineers time so that they could concentrate on accomplishing their engineering tasks. Question 3 Henry Mintzbergs research indicates that diverse manager activities can be organized into ten roles. Identify two of these roles that John Terrill performed in carrying out his duty. According to Henry Mintzberg (2004), based on his research on the various activities of managers in a business setting, the roles of managers can be classified into ten types as depicted in the following table: CATEGORY ROLE ACTIVITY Interpersonal Figurehead Perform duties which are symbolic and ceremonial. Regarded as symbol of authority. Leader Directing, motivating, training, advising, influencing, encouraging, promoting development of others. Liaison In charge of internal and external information links. Engage in exchange of information. Informational Monitor Process and assess information. Maintain information and contacts. Disseminator Transmit information to other via phone calls, memos, notes, etc. Spokesman Representing organisation to outsiders in public relations capacity. Decisional Entrepreneur Project initiation, business identification and leads for opportunities. Disturbance Handler Handles internal crises and conflicts involving employees, and also external changes. Resource Allocator Responsible for allocation and sets priority for organisational resources via budgets, etc. Negotiator Negotiates with suppliers, unions, etc. Through his research, Mintzberg (1973) also managed to conclude that all the above ten roles fall into three broad categories which are interlinked. To illustrate the point, all three interpersonal roles Figurehead, Leader and Liaison provide information. Informational roles Monitor, Disseminator and Spokesperson process the information and act as a link to all the managerial roles. Meanwhile, the decisional roles make decision on how to deliver the information to other parties. All these ten roles can be applied to any managerial situation depending on the requirement of the circumstances. Based on Mintzbergs theory, in the DGI Internationals case, John Terrill played the roles of Liaison and Negotiator. Liaison John Terrill applied his interpersonal skills excellently when he first approached the engineers to seek information on their current problems which affected their productivity. During his meeting, he played his role as a liaison or intermediary between the engineers and top management. He did not reprimand the engineers for the poor performance of the Technical Services division without first finding out the cause of their low contribution to productivity; instead, he offered to resolve the conflict by trying to get to the root of the problem and find a lasting solution that will help them to increase their output in the organisation. His openness may have encouraged the engineers to confide in him even though he was new to the organisation. Terrill also successfully executed this role by openly showing his concern for the staffs welfare. Perhaps this helped open up the communication channel between him and the engineers because they feel that Terrill was acting in their interests. After that, the engineers willingly voice out their grouses and complaints when Terrill asked them point blank as to why the division was not performing as expected. His networking skills were clearly demonstrated when he empathised with the engineers and responded positively that engineers in the Technical Services division should not be tied down with paperwork if top management expected them to be more productive. Instead, they should be allowed to focus more on accomplishing their engineering tasks. In his liaison role, Terrill tried to maintain positive relationship with the engineers and not take sides with the top management by using any form of coercion on his team. His objective was to turn around the division and increase the engineers productivity. Therefore, he carefully played his role by offering them a possible solution. Using the power vested in his position as the manager of the team coupled with the mandate given by top management to solve the productivity issue, Terrill issued an order which was against the wish of company management. To illustrate, while the company management requires that the engineers turned in daily reports to headquarters, Terrill ordered them to turn in the reports to his office instead. However, Terrill had anticipated a showdown with top management and had already thought up a plan to back up his actions. He had proven that while the engineers were asked to turn in daily reports, actually nobody in top management would need the report dai ly because for three weeks, nobody in headquarters enquired about the missing daily reports. Negotiator In solving the low productivity issue of the Technical Services division, Terrill also played the role of a negotiator. This role was demonstrated during his first management meeting with the engineers. He explained to them the managements concern for the low productivity of the division despite being the highest paid and best educated group within the organisations. He also asked them to voice out their grouses and the possible reasons for their non-performance. When he found out that the engineers were demotivated by the amount of daily reporting that they had to do instead of focussing on their engineering tasks, Terrill asked the engineers to carry out their engineering duties like they were supposed to and increase the divisions productivity while he took care of the daily report generation problem with top management. He convinced them that he would stay out of their way and get the top management off their backs so that the engineers can accomplish their tasks as expected. Wit h Terrill at the helm of the division, the engineers are able to concentrate on their primary tasks and not worry about other petty issues. The engineers were also confident that Terrill will be able to prove a point to top management by keeping the daily reports in his office, and they seemed to have supported his actions. During the showdown with top management in the presidents office, Terrill displayed his negotiation skills by informing top management that the main reason for Technical Services divisions low output was that the engineers were more occupied with writing daily reports than actually doing their engineering tasks. He successfully proved his point by showing top management that the high stack of report produced over the last three weeks were not read by anyone because no one asked to look at them. He evidently showed them that the amount of time spent on writing the report had gone to waste, and that the precious time should be spent by the engineers to accomplish other important engineering duties. He then suggested that management do away with the daily report and one brief report from his office on a monthly basis is sufficient. In conclusion, managers are involved in a myriad of activities when performing the managerial functions. These activities can be clustered into broad categories and identified into roles. By understanding these managerial roles, managers will be able to discharge their duties more efficiently and effectively. Question 4 Do you think gender makes a difference when it comes to leadership style? Use example(s) and literatures to support your stand. Gender is a socially constructed concept of men and women which varies according to cultures, societies, social classes and even periods in history (FAO, 1997). It is sometimes misunderstood as being biologically determined and solely related to the sexual characteristics of men and women. However, according to Bravo-Baumann (2000) gender relations involves how society determines the rights and responsibilities of women and men. Traditionally, the roles of women are mostly confined to household-related chores and nurturing of family. Many cultures across the globe regarded women as the weaker sex with limited roles to play in the social system. In some countries, women are even denied access to education, rights to freedom, and in extreme cases are relegated to subordinate status (Bass et al, 1971). However, with the rise of movements towards equality in gender in the modern world, more societies have begun to change their mindsets and accept the fact that women also have roles to play in the development of the society and economy (Inglehart and Noris, 2003). The last several decades have witnessed the emergence of women holding managerial roles in organizations. Although men still hold the fort, more women are seen entering the workforce with an increasingly number of them being promoted to high managerial positions (Druskat, 1994). However, many women nowadays earn their organisations mandate and are appointed as CEOs and MDs of companies. Currently, some countries are headed by female premiers and presidents, for example Australia and New Zealand. These show that women are fast being recognized in their roles as capable leaders. As a result of the increase in female leadership roles, there have been a string of researches aimed at studying the leadership styles and behaviour differences between men and women leaders (Statham, 1987; Carless, 1998; Davidson Ferrario, 1992; Van Engen et al., 2001). Some researchers failed to find disparities in leadership styles between men and women (Pounder and Coleman, 2002; Van Eagen, Van der Leedeen Willemsen, 2001). Even though there are varying outcomes from these researches, a majority of the research results agreed that differences in leadership styles definitely exist among male and female leaders. Conceptually, due to the differences in nature and characteristics of men and women, there are bound to be distinct features which affect their leadership styles. It is generally accepted that the leadership styles of men and women vary because of differences in behaviour of men and women which are shaped by society and culture (Eagley, Wood and Diekman, 2000). Women in leadership roles were seen to be more collaborative, less hierarchical and more cooperative, caring and promoting self-worth of others (Helgesen, 1990; Book, 2000; Rosener, 1995). In contrast, due to the masculine nature of men as perceived by societies, male leaderships tend to be more assertive, aggressive, controlling and confident (Eagley et al., 2000). The above findings are further supported by a study by Eagly, Karau and Johnson (1992) on leadership styles among school principals supported this notion. From the study, it was concluded that: Female principals are more task-oriented compared to male principals. In the role as school principal which requires more interpersonal ability, women display greater task-orientation. However, in male dominated roles, men will appear to be more task oriented (Eagley and Jonhson, 1990). Female principals are also more democratic or participative while male principals adopted a more autocratic or directive approach. Due to social values, experience and thoughts associated with feminine characteristics (Goldberger, Clinchy, Belenky and Tarule, 1987), women leaders generally use the soft approach when dealing with others. Hence, women naturally develop leadership styles that are more democratic and participative. Male leaders, on the other hand, adopted stronger approaches which are consistent with natural dominating and controlling characteristics of men. Differences in leadership styles have an impact on the effectiveness and direction of an organization. Leaders must be able to adopt different approaches when confronted with varying circumstances because not all situations will warrant the same types of actions. Hence, leaders are most successful and effective when they can evaluate a situation accurately and act according to the requirements of the situation instead of generally applying the same form of leadership across all circumstances (Fiedler, 1951). Leadership styles can also be affected by external factors such as the nature of work, business environment, organizational culture and industry structure. To illustrate the point that gender differences in leadership styles do exist (Kanter, 1991), we will take a closer look at Transformational (largely associated with women leaders) and Transactional (dominant in male leaders). The following table highlights the differences in the two types of leadership:  [3]   Transformational Leadership Transactional Leadership * Leaders motivate their followers by arousing their emotions and acting beyond the framework of exchange relations. * Leaders are proactive and help form new aspirations and expectations of followers. * Leaders are differentiated by their ability to inspire and provide individual consideration, stimulation and influence to followers. * Leaders help in creating learning opportunities and stimulate their followers to find solutions to their problems. * Leaders develop emotional bonds with their followers using their management and rhetorical skills and great visions. * Leaders encourage followers to strive for their goals beyond self-interest. * Leaders are conscious of the relationship between reward and effort. * Leadership is responsive with high orientation to solve present issues. * Leaders control the actions of their followers by depending on reward, inducement, punishment and sanction. * Leaders use rewards to encourage their followers to achieve desired results. * Leaders reinforce behaviour of followers for successful execution of plan. Source : http://leadershipchamps.wordpress.com Introduced by James MacGregor Burns (1978), the transformational leadership concept defines an approach which encourages positive and valuable changes in performance and morale of followers based upon the behaviours and characteristics of leaders. Transformational leaders brought about changes in organizations by inspiring, motivating and sometimes acting as role models for employees to identify with (Bass, 1985). By being role models, such leaders will encourage employees to develop skills which could help them enhance their productivity. Transformational leadership style is often displayed by women leaders since women have innate nurturing ability (Kornives, 1991; Ross, 1990). This style can be effective in less-hierarchical organizations such as schools or retail outlets. In male dominated settings such as the military, transformational leadership may not be preferred. On the other hand, transactional leadership style is more visible in traditional organizational settings where male leaders are dominant (Rosener, 1990). Transactional approach values desired results in exchange for rewards, motivations or punishments; thus, transactional leaders will stress on higher productivity and offer rewards (or punishment) as motivation ( Burns, 1978). In conclusion, there are differences in leadership styles by gender. Women leaders generally tend to adopt a softer approach such as democratic and participative. These styles involve relationship with followers through understanding of their emotions and building the self-worth through motivation, aspiration and encouragement. Women leaders try to stimulate the working environment and develop confidence through empowerment (Burke, 1986). In contrast, men display more traditional leadership characteristics such as assertive, controlling, aggressive and dominating. However, the above differences do not limit men and women to any one leadership style. Regardless of gender, successful and effective leaders will find their preferred leadership style, that can be a blend of gender-specific roles, which is most suitable to the situation that they are in. Question 5 If you were the president of DGI International, would you recommend modifications in John Terrills leadership style that you would like him to adopt? Do you think it will be possible for John Terrill to make necessary changes? Why? In the DGI International case study, John Terrill adopted the Delegating Leadership Style (Hersey and Blanchard, 1982) based on the assumption that the team of engineers in the division that he was heading has high level of job readiness or maturity owing to the fact that they are the highest paid and best educated employees within the organization. Also, the statement made by Terrill that he will stay off the engineers back and get top management to stay off their backs too indicates that he will not interfere much with the engineers daily tasks. This indication further supports the notion that the team of engineers is able, willing and confident to accomplish their tasks without much direction or supervision from Terrill. Terrill was hired by DGI International to turn around a non-performing division. When he decided to adopt the delegating style, he must have based his decision on solid grounds highest paid and best educated group of engineers must have possess

The complex matrilineal social structure of spotted hyenas

The complex matrilineal social structure of spotted hyenas Amazons of the animal world: the complex matrilineal social structure of spotted hyenas. The spotted hyena, Crocuta crocuta ¸ has evolved a matrilineal society in which the females are more dominant and aggressive than males within the clans. Female and male behaviors come together to form a complex societal structure that promotes variability and reproductive success. This species is an exceptional example of matrilineal hierarchy and social organization as opposed to the regular male-dominant societal structure present in the case of most mammals. Scientists continue to study the spotted hyena for its remarkably sophisticated social behavior, which may be comparable to that of some primates and possibly even human beings (Jenks et al., 1995; Drea et al., 2002; Engh et al., 2002; East et al., 2003). The spotted hyena, Crocuta crocuta, is a very intelligent animal that organizes itself into large clans of 50-80 members (Engh et al., 2002). While most mammals exhibit a male-dominant society where males fight for rank and the right to reproduce, the spotted hyena has developed a matrilineal society (Jenks et al., 1995). Females are more dominant and aggressive than males and pass on their rank to their offspring (Jenks et al., 1995; Engh et al., 2002). They are responsible for reproductive choice due to their dominant status (East et al., 2003). Males regularly travel to clans outside their natal society, despite the cost of access to food, for the chance of higher reproductive success (Engh et al., 2002). They also engage in specific favorable behaviors to entice females to choose to mate with them (East et al., 2003). All of these sophisticated behaviors have evolved to promote variability and overall success for the spotted hyena. Even more amazingly, the same social structure a nd behaviors of dominant-submissive interactions emerged within an isolated group of spotted hyenas raised in captivity (Jenks et al., 1995). The spotted hyena is definitely a very unique case of societal arrangement (Engh et al., 2002). With further study, the evolution of this remarkable case of sex-role reversal and complex hierarchy may soon be fully understood. It may provide further insight into similar social arrangements seen with other animals such as primates (Jenks et al., 1995). The study of spotted hyenas may even provide insight into more primitive stages of human societal structure, especially where there are matrilineal cultures. Females are without question the more dominant gender within spotted hyena clans and they exercise this dominance when it comes to reproduction (Engh et al., 2002; East et al., 2003). They are on average larger, more aggressive, and more violent than males within the clan (Engh et al., 2002). Their special anatomy an enlarged clitoris through which copulation occurs gives them full control over sexual activities and partners (East et al., 2003). There is no chance for forced copulation simply because the male hyena needs the females full cooperation for proper coitus to occur (East et al., 2003). Theories for the evolution of this physical characteristic include (a) counter-evolution in the presence of high rates of forced copulation and (b) selection for overall more dominant and aggressive individuals resulting in masculinization (Drea et al., 2002). Since more dominant and aggressive females also attain a higher rank within the clan, they tend to be more successful in raising a larger number of young. A higher rank correlates to greater access to food and thus higher chances of survival for both mother and offspring (Engh et al., 2002). Female spotted hyenas have multiple criteria for choosing mates. They prefer immigrant males to natal males, those born within the community a possible measure for prevention of inbreeding (Engh et al., 2002). Even more amazingly, females generally prefer males of similar age, preventing sexual interactions with fathers or sons (East et al., 20023). Females also show preference for more submissive, less aggressive males (East et al., 2003). This selection for less aggressive males further emphasizes the sexual dimorphism, both in behavior and physical characteristics, present in this species. Females copulate with several males when in heat, possibly to dissuade males from infanticide (East et al., 2003). This behavior further increases variability it is quite common to see single litters whose cubs can be traced to different fathers (Engh et al., 2002). It serves to confuse males and dissuade them from killing cubs that may or may not be their own a complex behavior that shows fo resight and intelligent thought (East et al., 2003). Female choice for less aggressive males and behavior to prevent infanticide may have evolved to counter the extremely high-risk pregnancies these animals go through due to their anatomy (Drea et al., 2002). In a study conducted by Engh and colleagues (2002), the reproductive skew among male hyenas was investigated. One of the major discoveries was that immigrant males had an immense advantage over natal males. Over the 10-year period that one clan of hyenas was observed, it was found that immigrant males sired 97% of the cubs, while natal males only sired 3% (Engh et al., 2002). This explains the males behavior of leaving natal clans and immigrating elsewhere: the cost of rank and access to food are highly outweighed by the reproductive benefits in a non-natal clan (Engh et al., 2002). Within the group of immigrant males, it was found that rank did not have a statistically significant effect on a males reproductive success. In fact, males a few ranks below the highest ranking immigrant had the most success in terms of cubs sired (Engh et al., 2002). In general, tenure the measure of how long an immigrant male had been in the clan was found to be a better indicator of reproductive succ ess. The immigrant males rates of producing cubs increased significantly the longer they remained in the clan, showing a strong correlation between tenure and reproductive success (Engh et al., 2002). Male spotted hyenas are also observed to exhibit behaviors to make themselves more attractive to females. As found in a recent study by East and colleagues (2003), there was no reproductive advantage to harassing, shadowing, or defending females from other competition. In fact, males exhibiting these behaviors were often attacked or chased away by females and other clan members. Instead, males found significantly more reproductive success by fostering relationships with females over longer periods of time a surprisingly complex behavior very close to that of humans (East et al., 2003). Having these friendly relationships also were seen to solidify the males places within the clan hierarchy once again, a very complex sociological behavior, especially when seen outside the order of primates (East et al., 2003). The sophisticated system of hierarchy was even recreated in captivity by a group of previously unranked hyenas collected at infancy (Jenks et al., 1995). Amazingly, these young hyenas grouped themselves in a matrilineal hierarchy, as observed over the course of two generations (Jenks et al., 1995). This structuring occurred despite the lack of maternal input for the first generation, showing that social organization is programmed into the spotted hyenas behavioral patterns (Jenks et al., 1995). While the first generation had little to no maternal interaction to help rank them within the clan, they went on to influence their own offsprings place in the clan hierarchy, just as observed in wild clans (Jenks et al., 1995). The only significant difference between the experimental clan and wild clans was the speed at which the cubs ranks stabilized within the community. Experimental group cubs solidified their place much faster than those in the wild, possibly due to smaller numbers and le ss movement within the clan (Jenks et al., 1995). The spotted hyena is a remarkable animal. It shows extremely complex behavior that leads to sophisticated social structure something that is rarely seen in mammals outside of primates (Jenks et al., 1995). In fact, the matrilineal group structure of hyena clans is very similar to that of Old World primates (Jenks et al., 1995). The sense of organization in this manner is so strong within the hyenas evolved behavioral patterns that matrilineal structure is even seen to spontaneously emerge in isolated hyenas raised in captivity (Jenks et al., 1995). Complex sexual behaviors, such as the females choice of partner based on immigrant status, tenure, and age, seem to promote the creation of this social structure (Engh et al., 2002; East et al., 2003). Carefully nurtured relationships between same- and opposite-sex individuals show the multifaceted interactions between clan members that also contribute to the development of matrilineal organization (East et al., 2003). Female dominance is even supported by biological mechanisms and the altered anatomy of this species (Drea et al., 2002). With further study, the circumstances that led to the evolution of this unique system may soon be uncovered. This will provide insight not only into the spotted hyenas sociological history, but also into that of Old World primates and possibly even that of human beings. It is an exciting prospect that will hopefully emerge within the years to come.

Personal Autonomy and Individual Moral Growth Essay examples -- Ethics

Personal Autonomy and Individual Moral Growth The term 'autonomy', from the Greek roots 'autos' and 'nomos' [self + law] refers to the right or capacity of individuals to govern themselves. Agents may be said to be autonomous if their actions are truly their own, if they may be said to possess moral liberty. The necessity of this moral liberty is made clear in the work of many philosophers, in that of Jean-Jacques Rousseau, for example, in whose Social Contract are discussed what Rousseau sees as the centrally important relationships between what he terms the general will, liberty, equality and fraternity. From this work also comes that most famous of all revolutionary rallying-cries, Rousseau's memorable and epigrammatic, "Man is born free; and everywhere he is in chains". The term is also a cornerstone of Kant's ethical theory, in which the possession of autonomy of the will is a necessary condition of moral agency. For Kant, autonomy functions as the ability to know what morality requires of us, rather than as the freedom to pursue our ends. The possession of autonomy permits an agent to act on objective and universally valid rules of conduct certified by reason alone. In Kantian terminology, this idea is quite separate from 'heteronomy', the term Kant uses to refer to the condition of acting on desires which are not legislated by reason. In Chapter 2 of his Fundamental Principles of the Metaphysic of Ethics [Abbott: p. 46] Kant argues that we should repudiate all maxims that do not accord with the will's own enactment of universal law and "Act only on that maxim whereby thou canst at the same time will that it should become a universal law". For Kant, any account grounded on the view that moral law is commanded from ... ...owledge and with its attendant moral dilemmas, there is a clear need for realism and, since individuals must both act and assume responsibility for their actions, little of value to be gained from, as McNaughton [p.57] puts it, "asserting that where there are many conflicting views there can be no correct answer". For the individual concerned to relate his sense of personal autonomy to a genuine quest for moral truth, the confident belief that, whilst truth may be difficult to discover, it nevertheless exists, remains a vital necessity. Bibliography: Glover, Jonathan Causing Death and Saving Lives Penguin, 1977 Kant, Immanuel Fundamental Principles of the Metaphysic of Ethics trans. T. K. Abbott, Longman, 1962 MacIntyre, Alasdair A Short History of Ethics Routledge, 1993 McNaughton, David Moral Vision: An Introduction to Ethics Blackwell, 1992 Personal Autonomy and Individual Moral Growth Essay examples -- Ethics Personal Autonomy and Individual Moral Growth The term 'autonomy', from the Greek roots 'autos' and 'nomos' [self + law] refers to the right or capacity of individuals to govern themselves. Agents may be said to be autonomous if their actions are truly their own, if they may be said to possess moral liberty. The necessity of this moral liberty is made clear in the work of many philosophers, in that of Jean-Jacques Rousseau, for example, in whose Social Contract are discussed what Rousseau sees as the centrally important relationships between what he terms the general will, liberty, equality and fraternity. From this work also comes that most famous of all revolutionary rallying-cries, Rousseau's memorable and epigrammatic, "Man is born free; and everywhere he is in chains". The term is also a cornerstone of Kant's ethical theory, in which the possession of autonomy of the will is a necessary condition of moral agency. For Kant, autonomy functions as the ability to know what morality requires of us, rather than as the freedom to pursue our ends. The possession of autonomy permits an agent to act on objective and universally valid rules of conduct certified by reason alone. In Kantian terminology, this idea is quite separate from 'heteronomy', the term Kant uses to refer to the condition of acting on desires which are not legislated by reason. In Chapter 2 of his Fundamental Principles of the Metaphysic of Ethics [Abbott: p. 46] Kant argues that we should repudiate all maxims that do not accord with the will's own enactment of universal law and "Act only on that maxim whereby thou canst at the same time will that it should become a universal law". For Kant, any account grounded on the view that moral law is commanded from ... ...owledge and with its attendant moral dilemmas, there is a clear need for realism and, since individuals must both act and assume responsibility for their actions, little of value to be gained from, as McNaughton [p.57] puts it, "asserting that where there are many conflicting views there can be no correct answer". For the individual concerned to relate his sense of personal autonomy to a genuine quest for moral truth, the confident belief that, whilst truth may be difficult to discover, it nevertheless exists, remains a vital necessity. Bibliography: Glover, Jonathan Causing Death and Saving Lives Penguin, 1977 Kant, Immanuel Fundamental Principles of the Metaphysic of Ethics trans. T. K. Abbott, Longman, 1962 MacIntyre, Alasdair A Short History of Ethics Routledge, 1993 McNaughton, David Moral Vision: An Introduction to Ethics Blackwell, 1992

Free Essays: Antigone and Ismene in Oedipus at Colonus :: Oedipus at Colonus Essays

Antigone and Ismene in Oedipus at Colonus "Behold this Oedipus, --/ him who knew the famous riddles and was a man most masterful;/ not a citizen who did not look with envy on his lot-- see him now and see the breakers of misfortune swallow him!" (Oedipus the King, 1524-1527). Now that Oedipus has lost everything-- his wife, mother, kingdom, and all power-- his existence rests entirely on the aid of his two daughters. However, that dependence is not evenly distributed between Antigone and Ismene. Even though both daughters provide assistance to Oedipus, the relationship that Oedipus has with Ismene is weaker in comparison to the firm and unwavering relationship that he has with Antigone. Oedipus's incompetence is evident from the very beginning of the play, explaining why he relies on Antigone time and again. When they arrive at the sacred grove at Colonus, Oedipus asks Antigone to leave him and find out if anyone lives nearby, and she says that she can see a man approaching. To which Oedipus follows with more inquiries: "Is he coming this way? Has he started towards us?" (I, 30). Even after the stranger leaves, Oedipus cannot tell that he has exited until Antigone tells him so. Antigone also aids Oedipus by warning him that she sees the Chorus approaching. Oedipus, once a great intellectual, is not even capable of responding to a simple request of his name without the aid of Antigone: "My child, what can I say to them?" (ii, 214). Additionally, Oedipus seems to need help with every little move he makes, even for the mere act of being seated: "Help me sit down; take care of the blind man." (I, 21). Luckily for Oedipus, his relationship with Antigone reach es a point where Antigone no longer needs instructions from her father; it is assured that she will help him: "After so long, you need not tell me father" (I, 22). Even though Antigone helps her father with everything, Oedipus's reliance on Antigone seems to weigh greatly on her ability to see for him, emphasizing Oedipus's blindness and impotence, as well as the strength of Oedipus's relationship with Antigone. Oedipus and Antigone have a mutual commitment to each other, supporting the fact that their rapport is greater than the attachment between Oedipus and Ismene.

Tess of the D’Urbervilles by Thomas Hardy :: Thomas Hardy Tess Urbervilles Essays

One of Thomas Hardy’s greatest works: ‘Tess of the D’Urbervilles‘ was first published in 1891, a novel set in the fictional county of Wessex, Britain. By the time of its appearance, Hardy was considered to be on of England’s leading writers and had already published several well known novels including ‘Far from the Madding Crowd’ and ‘The Woodlanders’ as well as numerous other short stories. However in spite of his reputation and fame, Hardy had immense difficulty finding a publication prepared to publish Tess when he offered it for serialization to London reviewers. The subject matter and content was considered to be- in the eyes of Victorian society, unfit for publications in which young people may read. A storyline depicting a young girl seduced and raped by a man, then married and rejected by another and then eventually murders the first man was considered to be exceptionally scandalous and inappropriate. Finally in order to pacify potential publishers, Hardy took the book apart and rewrote and edited several of the scenes before any of the weekly journals would take it as a serial. When the time came to publish the novel in book form, Hardy reassembled it was it was originally written. The novel’s subtitle- ‘A Pure Woman’ came also under a great deal of attack. Victorian critics argued that Tess could not possibly be termed of as ‘pure’ after a downfall such as hers and should instead be labeled as a ‘Fallen’ woman. Hardy’s frank (at least for the time) depictions of sex, his criticism and questioning of religion and his doubt within the narrative were too denounced to such an extent that though the story did in the end bring him immense fame and fortune, its reception at the start caused Hardy to lose confidence and the novel was one of his last. In Tess of the D’Urbervilles, Hardy uses a variety of narrative techniques in order to convey his own impressions of the society in which both he and his character Tess lived. The narrative technique of an author in any novel is crucial to the readers understanding of the narrative. The way in which a novel is written influences the way in which the reader interprets the events which occur throughout the novel and allows the author to convey the feeling of time, place, and people in the society in which the author is attempting to impart to his or her readers. Hardy’s use of a third person omniscient narrator who knows all and sees all allows the readers indirect insight into the actions and emotions of specific characters. The omniscience of the narrator allows the reader to not be influenced by the character

The Treatment Of Rheumatoid Arthritis Health And Social Care Essay

In the current scenario, a 64-year-old female patient has suffered from Rheumatoid arthritis ( RA ) and she seemed to demo no betterment despite her current intervention for 6 months. RA is a chronic redness disease and harmonizing to the study of National Institute for Health and Clinical Excellence ( NICE February 2009 ) RA affects 10000 people each twelvemonth in the UK population. RA is characterised by swelling and painful articulations, usually symmetrical and frequently impacting diarthrodial articulations of custodies and pess [ Firestein GS. , 2003 ] . Although RA normally attacks articulations, it can besides impact other variety meats such as bosom, lung and eyes. The exact pathogenesis of the disease still remains to be discovered. However, autoimmunity activities are believed to be to play a major function in the development of the disease. The unnatural release of inflammatory factors such as interleukins ( IL ) and tissue mortification factor ( TNF ) by the peripheral inflammatory cells such as CD4+ T cells, B cells and macrophages are involved in the patterned advance of RA which leads to inflammatory reaction at the synovial fluid ( SF ) and synovial tissues ( ST ) that line the joint and resulted in joint devastation [ Agarwal et al. , 2005 ] . When the redness progresses into farther phase, portion of the synovial membrane which envelops the SF will develop into pannus which is an inflammatory tissues that farther assail the joint and gristle and may take to joint merger by let go ofing destructive enzymes such as collagenase. Harmonizing to Scots Intercollegiate Guidelines Network ( SIGN 48 ) guidelines, RA is normally diagnosed by recovering patient ‘s medical history and scrutiny on elevated degree of inflammatory markers such as non-specific erythrocyte deposit rate ( ESR ) , C-reactive protein ( CRP ) and a more specific arthritic factor, which is an auto-antibody nowadayss in 80 % of RA patients [ Firestein GS. , 2003 ] . The incidence of RA may non be seen every bit serious as other diseases such as cardiovascular diseases and malignant neoplastic disease which recorded a higher morbidity and mortality rate, but one time the disease progresses, it can give a great impact on patient ‘s day-to-day life. It accounts for 0.8 % of entire planetary Year Lived with Disability ( YLD ) , which is the 31st prima cause of YLD globally [ Symmons et al. , 2006 ] . As a chronic redness disease, RA causes lasting joint harm if it is non treated suitably every bit shortly as possible and a long-time medicine is required to decelerate down the patterned advance of the disease. The joint harm starts at the early phase of disease and worsens increasingly resulted in troubles in patients ‘ day-to-day work. A simple day-to-day undertaking such as opening a bottle or walking across the room can ensue in great hurting for RA patients. Some patients might even necessitate to discontinue or alter their current oc cupation due to sore articulations. Epidemiology survey showed that RA is associated with decreased life anticipation and increased mortality [ Anthony et al. , 2003 ] . As RA develops, the disease finally invades the bone around the joint and may take to osteoporosis due to inflammatory activities. Furthermore, RA intervention utilizing corticoid besides increases the hazard of osteoporosis due to depletion of Ca and increase loss of bone mass [ Kelman et al. , 2005 ] . Besides that, merely like other redness diseases, RA patients can confront anemic jobs where red blood cells production is inhibited during redness. After the importance of early intervention of DMARDs has been recognised, the old â€Å" intervention pyramid † used in RA which started off with diagnostic intervention utilizing anodynes such as NSAIDs has been reviewed. The â€Å" intervention pyramid † describes the usage of anodynes in the early phase of disease to alleviate hurting and merely starts DMARDs when the disease develops into more advanced phase where NSAIDs can no longer command the hurting and redness. However, several surveies have shown that protection of articulation from harm utilizing DMARDs should be started every bit shortly as possible to supply better patients ‘ forecast and continue patient functional ability [ Egmose et al. , 1995 ; van der Heide et al. , 1996 ] . Therefore both NICE and SIGN guidelines suggest the early usage of DMARDs to command and detain RA symptoms after diagnosing of RA is confirmed. There is no definite intervention for RA as patients may react otherwise to the assortment picks of RA pharmacological therapy. Normally RA patients would be started with the most normally used DMARDs and reviewed invariably for drugs effectiveness until symptoms are well-controlled by the DMARDs therapy. Further change in the intervention needs to be done if no satisfactory response is achieved. As in this instance survey, the female patient has failed to react to six-month intervention of sulfasalazine, which is one of the commonly used DMARDs in commanding RA. Thus an option should be sought every bit shortly as possible to forestall major joint devastation.TreatmentHarmonizing to NICE guidelines 2009, it is stated that if RA patient does non react to the first DMARDs intervention, the dosage of the drug should be reviewed and focused to supply an effectual and suited dosage for the patient before a 2nd option of DMARDs is sought. In the current scenario, the patient had failed to react to six-month therapy of SLS, it is assumed that the dosage of SLS had been adjusted to the possible maximal bound but still demo no benefit in the patient. Thus, farther intervention would be focused on seeking for an alternate DMARDs. DMARDs are drugs from different categories that are grouped together due to their similarity in decelerating down the patterned advance of RA and understating joint devastation caused by RA besides commanding the symptoms. The normally used DMARDs include sulfasalazine ( SLS ) , amethopterin ( MTX ) , gold, Cuprimine, anti-malarial, azathioprine, leflunomide and cyclosporine. SLS and MTX are most preferable in clinical pattern due to their favourable toxicity profiles although intramuscular gold and Cuprimine had shown similar effectivity in handling RA [ Aletaha et al. , 2003 ; Felson et al. , 1990 ; Capell et al. , 1993 ] . MTX and SLS were considered to be safer at usage as it was shown that there was no important difference in the incidence of side-effects reported between high and low dose intervention of the drugs [ Aletaha et al. , 2003 ] . Since the patient has failed to react to SLS, MTX would normally be the following option in head. However, there is a pick to do whether t o utilize MTX in combination with SLS or replace SLS with MTX as monotherapy. DMARDs combination has been recommended in NICE guidelines for early RA intervention, but more clinical groundss need to be sought for the usage of combination in established RA, which is pictured in the current scenario as the patient has been suffered from RA for more than 6 months and immune to SLS therapy. Three surveies were found to compare the usage of MTX monotherapy and dual-therapy with SLS in patients unresponsive to SLS. Among the three, two were randomised controlled tests ( RCT ) while one was non-randomised experimental test [ Haagsma et al. , 1994 ; Capell et al. , 2007 ; Schipper et al. , 2009 ] The first RCT was carried out in 1994 which merely included a little figure of patients ( n=40 ) based on a single-observer method over 24 hebdomads while a longer continuance ( & gt ; 18 months ) of double-blind placebo-controlled survey with a larger survey group ( n=165 ) was adopted in the 2nd RCT in 2007. Despite the difference in the survey features, both RCTs concluded that MTX-SLS double therapy had a greater efficaciousness in commanding symptoms over MTX monotherapy in SLS-resistant patients without important addition in toxicity. However, although the 2nd RCT had shown important clinical benefits for combination therapy compared to the usage of monotherapy, no important advantage was seen in radiological results or functional disablement. The 3rd survey was a recent test published in 2009 investigated 230 patients who were immune to SLS intervention utilizing the similar intervention magnitude as the old surveies to measure the drug efficaciousness. This test was carried out for more than 15 old ages and concluded that that both options provided similar consequence. The disagreement was believed to be caused by the deficiency of control group in the ulterior test which might lend to biased consequences and inconsistent usage of other drugs such as corticoids in different tests which might misdirect the reading of drug efficaciousness. Besides efficaciousness and toxicity, cost of intervention is the following of import factor to be considered in taking the right intervention for the patient. However, really few surveies were done comparing the cost-effectiveness of different DMARDs because RA is non every bit prevailing as other major diseases such as cardiovascular diseases and it does non normally result in immediate decease. The more recent cost-effectiveness analysis on DMARDs was done in Thailand from the social point of position where the costs included a direct cost and indirect cost [ Osiri et al. , 2007 ] . In order to enable numerical comparing, the cost-effectiveness of the therapies was measured utilizing the Incremental Cost-effectiveness Ratio ( ICER ) which is the entire cost in US dollar needed to accomplish one unit of ( HAQ ) Health Assessment Questionnaire, which comprised of 20 inquiries on patients ‘ self-report functional and disablement position. The ICER of each intervention was compa red against the anti-malarial monotherapy as anti-malarial was recognised as the cheapest and least efficacious DMARDs available. Comparing among the sum of 152 RA patients, it was found that MTX and SLS therapy recorded a three times lower ICER compared to MTX monotherapy, which explained that the double therapy was less dearly-won and more effectual compared to the monotherapy ( US $ 625 versus US $ 2061 per one unit of HAQ mark ) . However, this survey was non specifically directed to SLS-resistant patients. Therefore, merely a comparative comparing can be made on the cost for the current scenario. The following option of intervention for the current patient is the usage of three-base hit therapy which uses MTX, SLS and an anti-malarial. It was shown in a biennial, prospective randomised test on 180 patients that the ternary therapy had given a better curative efficaciousness over the dual- ( MTX and SLS or MTX and anti-malarial ) and MTX monotherapy irrespective of the drugs given in the early RA intervention [ Calguneri et al. , 1999 ] . Again, the incidence of inauspicious effects did non increase significantly with the addition in figure of drugs. The enhanced benefit by adding an anti-malarial agent to MTX intervention had further strengthened the grounds shown antecedently by a long-run followup survey on patients who were treated with ternary therapy. It was shown in the old survey that patients who had failed to react to at least one DMARD and treated with ternary therapy had shown continued betterment with minimum toxicity after 3 old ages compared to MTX monotherapy a nd SLS-hydroxychloroquine therapy [ O'Dell et al. , 1999 ] . Addition of anti-malarial agent to MTX had been shown to execute better than MTX-SLS combination, which proposed an implicit in interactive activity of anti-malarial and MTX when they are used together likely due to heighten MTX bioavailability by anti-malarial [ O'Dell et al. , 2002 ; Carmichael et al. , 2002 ] . In footings of the intervention cost, based on the same cost-effectiveness survey mentioned above, ternary therapy recorded a lower ICER ( US $ 1222 per one unit of HAQ mark ) than MTX monotherapy, but about twice every bit high as the ICER of MTX-SLS therapy. Other than utilizing the traditional DMARDs, the freshly developed biological anti-rheumatic drugs are besides being studied for SLS immune patients. Since RA involves a great trade of cytokines activities, specific cytokines blockers have been investigated to stamp down or modify the redness procedure. The most normally used biological agents include infliximab, etanercept and adalimumab which target the tissue mortification factor, TNF-I ± , which is one of the chief cytokines released by macrophage that farther induces the release of other cytokines which are responsible for the redness. NICE guidelines emphasized that TNF-I ± inhibitors can merely be used when the patient has failed to react to intervention of at least two DMARDs including amethopterin. However, Combe et Al. had tried a different attack where Enbrel has been used and investigated in patients specifically having SLS intervention but still have ailment of active RA without affecting MTX [ Combe et al. , 2006 ] . It was found that etanercept monotherapy or in combination with SLS had given better betterment in American College of Rheumatology ( ACR ) standards compared to patients treated with SLS entirely. There was no important difference in the efficaciousness in the etanercept monotherapy and combination group. However, there was a significantly higher incidence rate of side-effects such as concern, sickness and astheny in the combination group while a higher hazard of infections and injection side reactions were recorded in patients with etanercept entirely. Besides that, as a biological drug, TNF-I ± inhibitors can non get away the fact of doing serious inauspicious effects such as malignance, demyelination and increased susceptibleness to infections like TB [ Nahar et al. , 2003 ] . However when the ratio of efficaciousness over toxicity is concerned, a meta-analysis showed that TNF inhibitors have a higher ratio than gold and sulfasalazine [ Ravindran et al. , 2008 ] . Again, whe n cost is concerned, etanercept intervention, as expected is much expensive compared to DMARDs, where the cost was shown to be more than twice higher than the most expensive DMARD available, cyclosporin [ Jobanputra et al. , 2002 ] .TREATMENT RECOMMENDATIONComparing the four options available, MTX monotherapy, MTX-SLS dual-therapy, ternary therapy and etanercept therapy, MTX-SLS dual-therapy seems to be the best intervention for the current patient as it is supported by groundss for its lower cost with comparable efficaciousness in SLS immune patients. It might non be the most effectual intervention compared to treble therapy, but it is ever advisable to understate the figure of drugs used in a patient to forestall unneeded inauspicious effects or drug interactions. However, there is still possibility that the patient may still be unresponsive to the dual-therapy as there is no definite warrant on the action of the therapy on every RA patient and the possibility of developing immune to MTX. Thus, the National Clinical Guidelines recommends monthly reappraisal of CRP ( C-Reactive Protein ) , an inflammatory marker and other cardinal constituents of disease activity such as DAS 28 ( Disease Activity Score based on 28 articulations ) until the disease is controlled by the given intervention to a degree antecedently discussed and agreed by the patients. If there is still no satisfactory respond, farther change in the therapy needs to be done such as sing the ternary therapy or etanercept therapy. Besides giving the slow-acting disease modifying drugs, SIGN 48 guidelines suggest the usage of intra-articular injection of corticoids to give rapid diagnostic alleviation before the oncoming of the new DMARDs therapy. Oral corticoids are non preferred to be used as a long-run intervention as it can do serious inauspicious consequence on bone mass and GI systems and it merely shows benefit in the early intervention of active RA [ Saag et al. , 1995 ; Kirwan et al. , 1995 ] If injection is non possible, so low dosage of unwritten corticoid is used in a shortest continuance possible [ Laan et al. , 1995 ] . For the diagnostic hurting control on top of DMARDs, mentioning to SIGN 48 guidelines, whenever possible, simple anodynes such as paracetamol are preferred over NSAIDs due to set up side-effects peculiarly GI annoyance. If simple anodynes are non powerful plenty to alleviate the hurting, a low dose NSAIDs such as isobutylphenyl propionic acid or more selective Cyclooxygenase ( Cox-2 ) inhibitors such as etoricoxib can be prescribed for the shortest continuance possible. When NSAIDs or Cox-2 inhibitors have to be used, coincident usage of GI protective medicine such as proton-pump inhibitors should be considered for aged and patients with history of GI ulcerations. Both NICE and SIGN guidelines recommend that dosage of NSAIDs should be reviewed and reduced once patients show equal response to DMARDs. In drumhead, the patient should be continued with SLS, at the same clip, added with MTX as the combined DMARDs therapy. In add-on, intra-articular or short-course unwritten corticoid should be commenced as a â€Å" span therapy † before the oncoming of action of the new DMARDs therapy. For diagnostic control, if paracetamol is non equal to relief hurting, NSAIDs such as diclofenac together with a proton pump inhibitor such as Prilosec can be used unless it is contraindicated in the patient, so a Cox-2 inhibitor such as etoricoxib should be used. Besides that, patient would be put on a monthly monitoring to reexamine the effectivity of the new therapy.

Ipremier Case Essay

When an event like this occurs in an organization, the first question asked post mortum is how can we prevent his from happening again. From iPremier’s perspective there are a few steps that can be taken. First, an overall evaluation of their security infrastructure and the individuals that support the structure. iPremier used a third party vendor to handle IT systems and support. This may be an area of weakness and the service that is provided by Qdata should be looked at closely. Although it may be cost effective to use a thirdy party vendor for this service, it is important to constantly evaluate their service and infrastructure compliance. Second, although Qdata manages iPremier’s IT systems it is important for iPremiere to have standard operating procudures and compliance standards. Preparing such documentation after an outage is the perfect time because a lot of what went wrong is still in their head and helps provide some ground level requirements. Once iPremier establishes their processes and procedures they should periodically â€Å"test† the process in a live drill. At my company we run several maintenance processes every month as well as disaster recovery testing once a year with some in between quarterly testing. It’s important to put the process, procedure and plan together, but equally important to test it in order to identify gaps. This process also needs to be written and locatable in the event it is needed for reference. Establishing a location for the process both in paper form an electronically is key. Lastly, communication from leadership to staff and to the clients that iPremier supports must be immediate. It is extremely important that staff be communicated to in a timely matter when information may have been compromised. There is also legal obligation on iPremiers part to notify clients that there information may have been compromised. iPremier maybe on some level required to compensate or identify ways for clients to mitigate the risk of their information being compromised. Overall, at the time of a service interruption post mortum evaluation will always find ways in which the interruption could have been prevented. Unfortunatley, organizations learn from disaster and it is the primary way in which we learn our weaknesses. Going forward if iPremier establishes the needed processes and procedures and takes the time to test their plan, they will prevent this specific issue from happening again, but are always other issues that will come up. Then it is time to re-evaluate your plan, processes, and procedures.