Electronic Health Record Functionality Standards Essay

Electronic Health Record Functionality Standards - Essay Example nt time and other resources in the evaluation and examination of the findings in relation to the required data for the EHR selection and decision making process, regulatory measures as well as the need for the EHR equipment (Carol 2007). This is the first step in incorporating findings into the EHR selection and decision making process; this committee should comprise all the stakeholders such as health practitioners, IT experts and other persons who may be affected by the EHR equipment. The formulation of a list of the functional models of the Electronic Health Record may be a complex process to most health practitioners; however, this process has been made easier by the use of the HL7 Functional Model which specifies various imperative aspects of the Electronic Health Records that apply to most health institutions (Carol 2007). This is the next crucial step in the incorporation of findings and results in EHR selection and decision making process. It ensures that persons purchasing the EHR equipment are in a position to access pertinent information that provides assurance in regard to the proper functionality of the products. Various acts have been implemented to certify EHR vendors who meet the needs and specification of the EHR equipment. These acts include; the Health Information Technology for Economic and Clinical Health (HITECH). This act stipulates effective testing methodologies of the Electronic Health Equipment which checks compliance in relation to the section 320 (b). Other regulatory measures have been implemented by a non-profit organization known as the (CCHIT), Certification Commission for Health Information Technology. This commission authorizes the use of Electronic Health Records in the United States of America through certification (Kasprak 2008). In this aspect, the EHR committee may apply this knowledge in selecting the proper EHR equipment as well as their suppliers. The current rising number of EHR vendors may pose a challenge to the

Comparing Ulysses Essay Example for Free

Comparing Ulysses Essay Both Ulysses and Macbeth were able to gain power of kingship, but the way they gained the powers are different. In this essay I am going to compare how they regard power, both differently and similarly. I intend to use Heinemann, (1994), version of Macbeth by Shakespeare and the class handout of Ulysses. The main focus of Macbeth will be from Act1 Scene 7, lines 1-28 and Act 2 Scene 1, line 33-61, whilst I will also take account of other related part throughout the play. Since Lord Tennyson and William Shakespeare are from different era in the history, their perspective of the world will be different, therefore I will also mention about Shakespeares and Lord Tennysons different perspective towards power and language they used. Most great writers reflect their attitude to life on their work, so it is important to consider the social and historical background of the Jacobeans- the time when Shakespeare wrote the play, and the Victorian time, when Lord Tennyson was alive. In Victorian times, Britain was a powerful country. There were unlimited opportunities for mainly the upper class people to broaden their knowledge by going to new places and experience the foreign cultures. When Lord Tennyson wrote this poem, he was grieving over his best friends death. By writing this poem he was able to express his emotional feeling as well as to persuade him to let it go. He also had the opportunities to tell people that it is never too late to seek a newer world. For examples, Ulysses new world would be the after life world and Lord Tennysons new world would be the world without his best friend. At the end of Macbeth, the moral we get is that never to cross the line of Divine Order. During Jacobean time, they believed that the duty of the King is chosen by God: They believed that every living organism has an order and it is decided by God, this is call the Divine Order. If one decides to go against the Divine Order, like killing the King to be the monarchy himself then, he had done something that is very morbid during the Jacobeans: going against God. Shakespeare tried show that by the cost of Macbeth have to face after he had murdered the King, one example is that he lost his respects from his courtiers and at the end he was all by himself. Jacobeans were also very superstitious; they believed that witches are evil because they worship demon, so if there was a plague or a natural disaster, they blamed on the witches: they are first put to trials and then was executed, mainly hanged or burned. Because Shakespeare made Macbeth associate with the witches by talking and worse of all trusting them, that made Macbeth evil. Shakespeare did this to please his King, King James, as he was against the supernatural and was able help King James to spread the evilness of the witches through his play. The poem, Ulysses started by a slow rhythm. Lord Tennyson managed this by using the words with long vowels such as, hoard, and sleep, and feed. These words give us the sense of dullness and mundane, which was how Ulysses feels at the beginning. However, as we go further down the poem, the dullness was decrease as he started to talk about his adventurous days.

Hindu Wedding Ceremony Essay -- Descriptive Wedding Hindu Culture Essa

Hindu Wedding Ceremony Introduction The tradition Vedic wedding ceremony is about four thousand years old. The ceremony is a religious occasion solemnized in accordance with the Vedas, the sacred scriptures of the Hindus. It is a collection of rituals performed by the bride’s parents. Each steps in the ceremony has symbolic philosophical and spiritual meaning. The Maharaj (priest) conducts the ceremony by chanting Mantras (bridal altar). The ceremony is performed in Sanskrit, the most ancient surviving language.   Ã‚  Ã‚  Ã‚  Ã‚  Lagna, the marriage, is performed to unite two souls so firmly that after marriage although their bodied remain separate, their souls merge and become harmonious. They become spiritually one. Swagatam (Welcoming the Groom) Jay arrives amid much celebration with his family and friends at the doorsteps. Hiral’s mother welcomes Jay and asks him if is prepared to make the life long commitment and is ready to deal with the bittersweet experience that marriage will present in the future. He is then asked to brake a clay pot filled with curd, honey, ghee (clarified butter) and cottonseeds. The clay pot represent the world and the materials symbolize the different experience he will encounter in the journey of life ahead. Hiral’s mother then leads him to the Mandap (bridal altar) where the wedding ceremony will take place. Ganesh Puja, Kalash and Navagraha (Invocation to Lord Ganesh)   Ã‚  Ã‚  Ã‚  Ã‚  The wedding ceremony begins with the worship of lord ganesh, the remover of all obstacles. Hiral’s parents attend the ceremony with jay, and the Maharaj (Priest) guides the rituals. The kalash (pot) contains sacred waters with coconut and flowers symbolizing the universe. Prayers are rendered to the kalash. This portion of the ceremony represents the worship of five basic elements; earth, air, fire, water and sky. The Navagraha (the nine planets of the solar system) are involved for their blessing. Kanyagaman And Manglashtak   Ã‚  Ã‚  Ã‚  Ã‚  Hiral is brought to the Mandap by her maternal uncle(kanyagaman).A white curtain, antarpata ( a symbol of traditional barriers) is held between the couple. The bride’s relative (Mangalashtak) chant blessings. The curtain is then removed and Hiral and Jay exchange garlands. Madhuparka, Kanyadaan, and Hastamelap (Giving Away of the bride and joining of the Hands)   Ã‚  Ã‚  Ã‚  Ã‚  Hiral’s father offers jay ghee and curd... ...a necklace made of sacred black beads (Mangal Sutra), signifying his abiding love, integrity and devotion. Then he places sindoor, a reddish powder in her hair. The priest then blesses the wedding ring and the couple exchanges them. These acts represent Hiral and Jay’s new status as a married woman and man. Kansar Bhojan (Nourishing the relationship)   Ã‚  Ã‚  Ã‚  Ã‚  Jay and Hiral feed each other four times with sweets, signifying their pledge to love and care for each other, and accept the blessing to have a harmonious marriage. Khand Saubhagyavati (Blessing from the married women)   Ã‚  Ã‚  Ã‚  Ã‚  Hiral and Jay now seek the blessing of their parents and their elderly relatives by bowing to their feet (ashirvaad). Married women form the bride’s side bless the couple by whispering â€Å"saubhagyavati Bhav†(blessing for abiding martial happiness)into the bride’s right ear. Then seek blessing from relatives and friends. Vidaai (Farewell)   Ã‚  Ã‚  Ã‚  Ã‚  The last ritual of the ceremony is a touching and emotional farewell to the daughter. Hiral now begins her new role as a wife and as a member of the Warner family. She throws a fistful of rice, so that the house of her children remains prosperous and happy.

Review of Brazil the Movie Essays -- essays research papers

Upon watching the movie Brazil for the first time, the first thought which comes to mind is ‘WHAT’. However, once past the exterior of the movie, one is able to divine its true meanings. Written by Terry Gilliam, Charlie McKeown and Tom Stoppard, Brazil was a groundbreaking movie which brought to light many issues within society which were valid in 1985 and remain so today. This text is valued because of the issues it raises, such as technology, an unwieldy government and consumerism, which are timeless issues. Brazil is based around a futuristic bureaucracy, where everything and everyone is property, there is little or no communication, and with the right forms, you can legally do whatever you want. This movie shows the flaws of such a system, that whilst aiming for perfection, is merely digging itself deeper into confusion and destroying the very society it seeks to control. Brazil is a dark comedy which shows us the consequences of handing over our lives to a faceless bureaucracy. Sam Lowry’s world is made up of millions upon millions of machines, upon which everyone relies to survive. Machines perform basically every task that there is, from the most mundane task such as creating food, to the most complex and important tasks such as deciding the fate of every living person within the system. When we first meet Sam his alarm clock is not working, the phone is large and hard to work, and the food that his machines make is completely inedible. This does not bode well for the people, for if the machines cannot even handle the most basic of tasks, how could they possibly handle the complex ones? We are taken further into the world of faults and failings within the system later on, when Sam has major problems with his heating ... ...reedom, and that the mind is the only truly safe place. Brazil is a film which rolls up all of the problems which society was experiencing at the time that it was made into one darkly humorous movie. Commercialism, terrorism, technology, bureaucracy and government control, cosmetic surgery and the lack of freedom and individual expression. This movie was not mainstream because of the way that it delivered its message, and also perhaps simply because the government suppressed it somewhat. However, this film provided great insight into these problems, and continues to do so today, as many of these problems continue to exist. Brazil aims to highlight these problems and make the viewer think about what they have seen. This movie was not intended to change the world, but simply to try to prevent it from spiralling down into a dystopian Brazil-like chaos.

Black Women and the Abolition of Slavery

â€Å"Rachel Weeping for Her Children†: Black Women and the Abolition of Slavery by Margaret Washington Photograph of Sojourner Truth, 1864. (Gilder Lehrman Collection) During the period leading up to the Civil War, black women all over the North comprised a stalwart but now largely forgotten abolitionist army. In myriad ways, these race-conscious women worked to bring immediate emancipation to the South. Anti-slavery Northern black women felt the sting of oppression personally.Like the slaves, they too were victims of color prejudice; some had been born in Northern bondage; others had family members still enslaved; and many interacted daily with self-emancipated people who constantly feared being returned south. Anti-slavery women such as Sojourner Truth and Harriet Tubman were only the most famous of the abolitionists. Before either of these heroines came on the scene and before anti-slavery was an organized movement, black women in local Northern communities had quietly tur ned to activism through their church work, literary societies, and benevolent organizations.These women found time for political activism in between managing households, raising children, and working. In the late 1820s, Zion’s African Methodist Episcopal Church in New York City, Bethel Methodist Episcopal Church in Philadelphia, and the African Meetinghouse in Boston were centers of female anti-slavery activity. Black women proclaimed that their cause was â€Å"let the oppressed go free. † They organized bazaars to promote the purchase of goods made from free labor, met in sewing circles to make clothing for those fleeing bondage, and raised money for Freedom’s Journal, the nation’s first black newspaper.In 1830, when Boston editor William Lloyd Garrison proposed his idea of publishing a newspaper devoted solely to immediate emancipation, a committee of black women began raising funds for it. The first copy of the Liberator appeared on January 1, 1831, wi th strong financial backing from black women. At their literary-society meetings, black women switched from reading European classics to discussing the Liberator and anti-slavery pamphlets, and inviting male speakers to expound on the evils of slavery.Throughout the 1830s, black women engaged heavily in activism. They vowed to â€Å"heed the enslaved mothers’ cry for children torn away† and designated their dwellings as â€Å"free homes† for those fleeing bondage. For example, Hester Lane of New York City, a successful black entrepreneur, used her home as an Underground Railroad station. Lane also traveled south to purchase enslaved children whom she freed and educated. Mary Marshall’s Colored Sailors’ Boarding Home was another busy sanctuary.Marshall kept a vigilant eye out for refugees from bondage, and was determined that â€Å"No one who had the courage to start should fail to reach the goal. † Other black women organized petition drives , wrote anti-slavery poetry, hosted traveling abolitionists, and organized fairs. By 1832, black women had formed the first female anti-slavery society in Salem, Massachusetts. They also held executive offices in biracial female anti-slavery societies in Philadelphia, Boston, and elsewhere.Anti-slavery black men insisted that black women work only behind the scenes, but women sometimes refused to do so. In New York City, a group of black women confronted white authorities in a courtroom where several self-emancipated women were about to be returned to bondage. Black men accused the female protesters of bringing â€Å"everlasting shame and remorse† upon the black community and upon themselves. In 1831, black women in Boston organized the African American Female Intelligence Society. This organization became a forum for Maria Stewart, the first woman to speak publicly against slavery.Stewart proclaimed that she was called by God to address the issues of black emancipation and t he rights of black women. â€Å"We claim our rights,† she asserted, â€Å"as women and men,† and â€Å"we are not afraid of them that kill the body. † Stewart also published a pamphlet in the Liberator on behalf of black women and the enslaved, but Boston’s black male community censored Stewart for her public expressions and forced her into silence. She soon left the city. Although she never again spoke publicly, she remained active through women’s organizations and conventions.She joined other black women who held office, served as delegates, and otherwise participated in the biracial women’s anti-slavery conventions in 1837, 1838, and 1839. The anti-slavery movement took a more progressive turn in the 1840s, when the American Anti-Slavery Society (Garrisonians) welcomed women as officeholders and speakers. Most black women continued their quiet anti-slavery work, but some were outspoken. The first black woman to take the public stage for t he American Anti-Slavery Society was Sojourner Truth.Born into slavery in 1797 among the Hudson Valley Dutch and emancipated in adulthood, Truth was already known as a preacher when she joined the Garrisonians in 1844. She made anti-slavery speeches throughout New England, and in 1845, gave her first address at the American Anti-Slavery Society’s annual convention. Sojourner Truth became known from Maine to Michigan as a popular and featured anti-slavery speaker. Truth published a Narrative of her life and used the proceeds to purchase a home and finance her abolitionist work. Another surge of radicalism occurred in 1850 with the passage of the Fugitive Slave Law.It decreed that any citizen could be enlisted in the service of a slaveholder to capture an enslaved person, and it nullified the individual civil rights that a state guaranteed its citizens, including those formerly enslaved. That same year, Harriet Tubman, a thirty-year-old self-emancipated Marylander, began defyin g the Fugitive Slave Law by leading enslaved men, women, and children out of the South. With slave catchers lurking everywhere and a price on her head, Tubman safely conducted her charges through the Northern states and on to Canada.Mary Ann Shadd (Cary) was a twenty-five-year-old freeborn schoolteacher when the Fugitive Slave Law was passed. Inspired by her father, whom she described as a â€Å"chief breakman† on the Delaware Underground Railroad, Shadd soon moved to Canada and established herself as a militant abolitionist, influential emigrationist, and the first black woman newspaper editor (of the Provincial Freeman). In 1854, twenty-eight-year-old Frances Ellen Watkins (Harper) joined Sojourner Truth on the Garrisonian lecture circuit. Born into a well-connected Baltimore family, Watkins was a poet and teacher.She was drawn into the abolitionist struggle by the Kansas-Nebraska Act, which rescinded the restrictions on slavery in the remaining territories acquired under t he Louisiana Purchase. Watkins traveled throughout the Midwest, sometimes with Sojourner Truth. Watkins spoke eloquently of the wrongs inflicted upon her people; she sold her books of poetry at anti-slavery lectures and used the proceeds to support the Underground Railroad. In 1858, Watkins joined black male leaders in Detroit and led a large group of angry citizens in storming the jailhouse.The group attempted to remove from protective custody a black â€Å"traitor† to their cause, who had intended to expose the operations of the Underground Railroad. Despite the Fugitive Slave Law, the Underground Railroad remained the â€Å"heart’s blood† of black resistance. Black woman abolitionists played a vital role in this work. They were often the ones who intercepted refugees; who provided them with food, clothing, shelter, health care, and spiritual and psychological comfort; and who directed them to the next station. Women sometimes confronted slave catchers and kid nappers, who were often right on the heels of the â€Å"fugitives. Caroline Loguen, the wife of Syracuse, New York, abolitionist the Reverend Jermain Loguen, answered many a midnight knock during her husband’s frequent absences. Once she and her sister successfully fought off slave catchers attempting to enter her home in pursuit of â€Å"fugitives. † In 1858, Anna Murray Douglass, wife of black leader Frederick Douglass, hosted John Brown, the famous white abolitionist, for a month. Brown was in hiding after having been charged with murdering pro-slavery farmers in Missouri. In the Douglass home, Brown perfected his plans for the raid on Harpers Ferry.In an 1859 meeting with Brown in Maryland just before the assault on Harpers Ferry, Douglass gave him ten dollars from the wife of a Brooklyn couple, the J. N. Gloucesters, who like Douglass himself were close to Brown. Along with the money, Mrs. Gloucester â€Å"sent her best wishes. † When Brown was captured, t ried, and sentenced to death, black woman abolitionists sent money to his wife, Mary, and wrote letters expressing their deep regard for her husband. Frances Ellen Watkins also sent gifts as well as one of her poems, â€Å"Bury Me in a Free Land,† to Brown’s condemned men.During the antebellum era, black woman abolitionists moved, in keeping with the urgency of the times, from quiet activism to militancy. By 1858, even Sojourner Truth, the archpacifist, recognized that war with the South was inevitable if black people were to obtain their freedom. Black women furthered the goal of emancipation during the Civil War by continuing their abolition work. Harriet Tubman offered her services to the Union Army. Sojourner Truth lectured throughout the Midwest, where she confronted threatening pro-slavery (so-called â€Å"Copperhead†) mobs.Black women organized petition campaigns to Congress and the president; they sent food and clothing to the Union front lines for desti tute blacks; and they went into Union-occupied areas to provide education for black refugees. After the Emancipation Proclamation was signed on January 1, 1863, black women immediately began working on the next phase of their mission—the task of uplifting their race as a free people. Margaret Washington is a professor of history at Cornell University. Her publications include Sojourner Truth’s America (2009) and A Peculiar People: Slave Religion and Community-Culture among the Gullahs (1998)

Dont Just Sit There, Start Your Job as a Freelance Translator

Dont Just Sit There, Start Your Job as a Freelance Translator Among professions, translation is a complex and often underrated line of work. Finding success in the field can be pretty tough due to significant competition, especially if youre a freelancer trying to find your ground. There are no shortcuts to success, but this article will list a few pointers that may inch you closer to that goal (in no particular order):Practice your languagesAn obvious but noteworthy aspect of translation is to be well versed in the language(s) you work with. A common issue when attempting to learn a second language is a hesitance to apply it to daily life. Its critical to overcome this limitation and practice both speaking and writing until youre confident enough to seamlessly transition between languages.One helpful step is to go beyond your studies. School lessons can only take you so far; take it a step further and include the new language in your casual and social activities. For example, if you enjoy watching TV and/or videos, reading books or listening t o songs, search for similar content in the target language. If you know someone you can practice with, seize the opportunity. The Internet, in particular, is a treasure trove for virtually any type of content, and social media makes it easier than ever to engage other people on any subject and in any language. While there should always be some discretion when interacting with strangers online, it remains an option that absolutely should be taken advantage of.Keep in mind you wont master a language overnight. Depending on the language, you may need years to be minimally fluent in it. Dont be intimidated if you struggle to understand a word or phrase, and dont be discouraged if you stutter and choke on your words. Youll get better. Even if you already have experience, you can always learn something new and your command of your language(s) will show in your work.Understand localizationThis topic was briefly touched upon in a previous article about website localization, and its an integ ral part of translation work. The definition of localization, according to Dictionary.com is: To make local; fix in, or assign or restrict to, a particular place, locality, etc.In practice, localizing a translation means taking liberties to fit your content into the target languages cultural landscape. One common instance of this is with measurements (converting from imperial to metric and vice-versa, depending on the target language and country). However, it can be also required for other linguistic quirks such as proverbs, expressions, slangs, rhymes, memes, etc. In such cases, context is often lost in translation, calling for adaptations to preserve figurative interpretations. Lets look for example at this popular English phrase: Out of sight, out of mind.A Portuguese (BR) translation could substitute O que os olhos no veem, o coraà §o no sente (what the eyes dont see, the heart wont feel).The English and Portuguese versions are very close, but the latter uses the word for heart (coraà §o) instead of the word for mind (mente). However, both phrases still convey the same basic meaning (what isnt near you wont affect you).But thats an easy one. Lets try this again with something more complex: The early bird catches the worm.This English proverb doesnt seem to have a direct Portuguese counterpart, so a proper translation may not convey the subtext to Portuguese readers. In this case, one possible replacement could be: Deus ajuda quem cedo madruga (God helps those who wake up early).In this case, the wording may be completely different, but both phrases teach a similar lesson (youll be at an advantage if youre the first to do something). And since the Portuguese version is more ingrained in Brazilian culture, making this change is a valid choice. Sometimes the meaning is more important than the words themselves.That said, there may be situations in which such adaptations arent possible. This is more likely to occur with proper names, quotations and particular ly technical documents. If you find yourself in such a situation (and you likely will), one option is to simply add a footnote (marked as a Translator Note, or TN) explaining the original context.In the end, localization isnt an exact science. Due to the nature of cultural influences and human interpretation, there isnt a straight answer on how and when to take these liberties. Therefore, its very important to be culturally aware. Ask yourself questions such as: Who am I translating this for? and Can a local understand my translation? (also contact your client to clear up any doubts). Its up to each translator to decide the best course of action on a case-by-case basis, but always keep the main goal in mind: to get the intended message across.Build your careerHere is the tough part of freelancing. Dont expect immediate success; it takes time and dedication to earn credibility and develop a consumer base. Chances are youll find yourself taking a second job to make ends meet as you wo rk your way toward becoming a successful translator.Perhaps the best option for beginners is to join translation agencies and other freelancer websites. The topic was previously mentioned in this article about finding a good translator, but its worth repeating since these sites provide structure and quality control mechanisms for clients and freelancers, making them highly recommended as a means of gaining experience. Keep in mind though that these sites often have terms of service imposing conditions such as exclusivity causes and/or taking a cut of your income. Make sure to understand those conditions to avoid penalties that would limit your use of a freelancer website.Also, promote yourself. It may seem annoying when others do it, but it happens for a reason. Create a website, announce your services on social media, and hand over business cards. The key is to put your name out there, so dont be shy; be shameless. The more people you make aware of your services, the more likely yo ull get work.Finally, be patient and persevere. A successful career may take years to build. But if you keep at it long enough, youll get there before you know it.Use resourcesAlways do research as needed, and dont be afraid of using every tool at your disposal to improve your work. This includes online and physical dictionaries, search engines (a Google search takes literally one second), and even CAT (Computer Assisted Translation) tools if the option is available to you. For examples of resources you can use, please refer to this article about five useful translation tools.However, in the case of machine translations, it cant be stressed enough that you shouldnt let them become a crutch; those are only helpful on a basic level, and are generally meant for casual users with no time and/or budget to afford a human professional. Machines are incapable of understanding context (at least, at the time of writing), so the results are rarely precise. Its fine to use them as a quick refer ence, but never take the results at face value without verifying them.Another source of help can be found in dedicated translation communities. ProZ may be the largest one out there, with message boards for translators to request assistance as well as articles, guides and even job listings.Discipline yourselfAs appealing as freelancing may seem for the ability to choose your work conditions, being your own boss still means being your own boss. Treat your home as your office; determine your schedule, make it known to family and friends and stick to it. Leave no room for distractions that may hurt your productivity.Also, put value in your work. Take measures to avoid non-paying customers, such as requesting payment (or at least a fraction) upfront. Dont charge low fees if the effort is not worth it, but dont compromise quality either; good work will reflect better on you than rush jobs. Always meet your deadlines and never commit to projects beyond your ability (in case of unforeseen circumstances, contact your client immediately). Check your work before delivering it and if possible, let someone else take a look at it (youd be surprised by what can be spotted by another set of eyes). Your clients will take you seriously if you take yourself seriously.But dont think of self-respect as an excuse to bite the hand that feeds you; always treat your clients cordially, respond to their messages as soon as possible and answer any questions to the best of your ability. Be humble toward criticism, rectify any mistakes when possible and learn from them. Youll be better for it.

Free Essays on Women In WWII

Women’s Roles During WWII Women of today’s society hold positions of importance in their jobs. Women in World War II contributed to the women today having jobs. Before the war women were viewed as just housewives. World War II caused a change of the living status of American women. Women went from being housewives to working hard and being a major help during and after the war. Women took jobs to build airplanes for their husbands to use in the war. Five million women entered the work force, and made up 36 percent of the American labor force (Sinnot 13). Thousands of women took jobs in airplane factories. They assembled tens of thousands of military airplanes needed in the war effort (â€Å"American Women in WWII† 391). Some aircraft plants were as big as small towns, and the noise of production was deafening. The women’s muscles became sore, their hands were swollen, and they got backaches and headaches. Many women had trouble sleeping because the noise continued to throb throughout their bodies, even when they were at home. The women went through many pains, but did their best and made thousands of airplanes that helped in the war. Women also helped make ships to use in the war. Shipyards were accustomed to a male workforce, and were slow to accept the women workers. In 1943 there was a demand for 1.5 million workers, so the shipyards were forced to hire women (Sinnot 33). The women found that building a ship wasn’t that difficult because of their previous skills with assembling airplanes. They found a similarity between cutting out patters for clothes and for ships; the only difference was they were using steel rather than cloth. The women also excelled at welding, operating drill presses, grinders, and lathes. Shipyard workers were open to many dangers as they worked. They were exposed to the natural elements as they worked on the edge of the water. Some women had to climb high scaffoldings to complete thei... Free Essays on Women In WWII Free Essays on Women In WWII Women’s Roles During WWII Women of today’s society hold positions of importance in their jobs. Women in World War II contributed to the women today having jobs. Before the war women were viewed as just housewives. World War II caused a change of the living status of American women. Women went from being housewives to working hard and being a major help during and after the war. Women took jobs to build airplanes for their husbands to use in the war. Five million women entered the work force, and made up 36 percent of the American labor force (Sinnot 13). Thousands of women took jobs in airplane factories. They assembled tens of thousands of military airplanes needed in the war effort (â€Å"American Women in WWII† 391). Some aircraft plants were as big as small towns, and the noise of production was deafening. The women’s muscles became sore, their hands were swollen, and they got backaches and headaches. Many women had trouble sleeping because the noise continued to throb throughout their bodies, even when they were at home. The women went through many pains, but did their best and made thousands of airplanes that helped in the war. Women also helped make ships to use in the war. Shipyards were accustomed to a male workforce, and were slow to accept the women workers. In 1943 there was a demand for 1.5 million workers, so the shipyards were forced to hire women (Sinnot 33). The women found that building a ship wasn’t that difficult because of their previous skills with assembling airplanes. They found a similarity between cutting out patters for clothes and for ships; the only difference was they were using steel rather than cloth. The women also excelled at welding, operating drill presses, grinders, and lathes. Shipyard workers were open to many dangers as they worked. They were exposed to the natural elements as they worked on the edge of the water. Some women had to climb high scaffoldings to complete thei...

The Victorian Era essays

The Victorian Era essays Characteristics During the Victorian Era When imagining the Victorian Age, royalty, fancy lifestyles, and elaborate living often come to mind. However, during this same era, other lifestyles and conditions of a completely different nature were occurring. Many of the English people lived in poverty. Charles Dickens, one of the great writers of this period, described how it was to live during the Victorian Era. Although England grew from an agricultural to an industrial society, not all citizens benefited from this change. In addition, the undesirable health and medical environment plagued both the wealthy and the poor. Charles Dickens was a profound British writer who composed novels, short stories, dramatic works, poetry, and essays (Charles Dickens 1). He was born on February 7, 1812 in Portsmouth England where he was the second of eight children (Perdue 1). His father John was a minor government official as a clerk in the Navy Pay Office: he was then transferred to Somerset House in London. The family moved to Chatham in the Medway Valley, where Charles experienced the most glorious part of his childhood (Perdue 1). After moving back to London, John Dickens had a tendency to live beyond his needs, spending all the money he earned, and was sent to Marshalsea debtors prison in 1824 (Charles (John Huffam) Dickens 2). Starting at an early age, Dickens was taught at home by his mother Elizabeth, and later attended a Dame school in Chatham. Even though he had received a decent education, he felt very unsuccessful since his sister Frances was winning awards studying at The Royal Academy of Musi c, while he was still a mere boy (Charles (John Huffam) Dickens 2). According to David Perdue, Charles was removed from school and sent to work at a boot-blacking factory earning six shillings a week to help support the family. Charles considered this the worst time in his life, which would...

Starting a Business Term Paper Example | Topics and Well Written Essays - 1250 words

Starting a Business - Term Paper Example The paper dwells in detail and focuses on the aspects of starting a sole propriety-based fast food chain in New Jersey. Starting even a small business can lead up to big decisions being made by the owner right from the start, which will need him to be ready to make some important legal decisions being one of the crucial points of future business success. The first and foremost decision to be made is to decide what kind of business it would be, the following article discusses running a sole propriety fast food chain. Listed below are different kinds of business entities. A sole proprietorship is a kind of business entity that is owned and run by a single individual. A limited liability company is a business entity that is a blend of partnership and cooperate structure. Fast food chains are recently becoming a very popular source of food in the United States of America. Therefore starting in a field which is hot with opportunity and ever increasing may give you a better market leading to better chances of running a successful business. The only disadvantage being the competitiveness in such a field. Research is an important aspect of business one must complete before starting a business to get all the essential information. For example, how does he want to run the company? Will the person be able to handle affairs of the business alone or may require partners? Sole propriety business is said to be the easiest and the simplest way to start up due to its ease of setup and nominal cost. It is a kind of a set up where a single person starts up a business and he himself is the face of the company and is solely responsible for everything in the company from funding, to earning profits and to being liable to the losses. Despite all the advantages of a sole proprietorship it can sometimes be proved risky as the owner is fully liable for all the business debts. In the state of New Jersey the first step is to being registered at the central county it can be under the owner s name or a fictitious name although in legal matters it is not a separate entity. In such kinds of businesses owner usually signs contracts with his own name including the matters of transfer of money, writing checks or holding bank accounts. Another step to take in setting up a business is finding a location to set up your business. It may be an office space, a retail space or a warehouse. In the case of starting a business you would require a retail space somewhere in the commercial district. It depends on the owner whether to buy, rent or lease the space. The next step includes getting licenses, permits and getting registered (â€Å"Doing Business in New Jersey†, n. d.). Starting a fast food chain requires the owner to get a license from the Division of Health before you start your business. All businesses must register for tax and employee purposes with the New Jersey Division of Revenue, irrespective of the intent to hire employees. Federal Employee Identification Numbe r (FEIN) is required by the state in order to register for taxes and employees purposes so that the owner can start running his business. Although in a sole propriety the owner can use his or her social security number. Internal

STEP analysis and Market Segmentation Assignment

STEP analysis and Market Segmentation - Assignment Example The company manufactures its vehicles at 23 production and assembly plants in seven countries and sells them through 34 subsidiaries. The company operates through three business divisions: automobiles, motorcycles and financial services. The automobiles division develops, manufactures, assembles and sells passenger cars and off-road vehicles under the brands BMW, MINI and Rolls-Royce. It also sells spare parts and accessories. BMW and MINI brand products are sold in Germany through showrooms of BMW and independent dealers. The company sells passenger cars outside Germany through subsidiaries and independent import companies. The BMW is responsible for the manufacture products such as: BMW C1, BMW 1 series, BMW 3 series, BMW 5 series, BMW 6 series, BMW 7 series, BMW X3, BMW X5, BMW Z4, MINI, MINI Cooper, MINI Cabriolet and the Rolls-Royce Phantom. BMW's growth over the years had paid off from a boutique European automaker to a global leader in premium cars. Among their products, BMW's MINI Cooper is holding its own against more established rivals in the new car market. It is also one of the lowest depreciating models in terms of used car sales. It is for this reason that BMW has decided to increase its investment into the Mini. This is a wise move, since sustained demand, even after five years on the market, suggests that the model is a mini goldmine. It is unlikely that anyone predicted the success of the Mini Cooper when it was launched by BMW in 2001 - the revamped model has taken the European market by storm. Originally, BMW intended to produce 100,000 vehicles a year but given the high demand, an increased investment of GBP100 million has been set aside for Mini Cooper in 2005, taking the yearly production total to over 200,000 vehicles a year by 2007. After its 2001 launch, BMW hoped to sell 800,000 units of the current Mini in eight years. The Mini plant in Oxford, England, has been refurbished to boost annual capacity to 260,000 units from 200,000. The plant also will build a new variant, the Traveller station wagon, starting in late 2007, and the second-generation Mini convertible starting in 2008 (Ceferri and McVeigh, 18 Sept 2006). While sceptics argued whether it was the right move for BMW to launch Mini Cooper in 2001, the debate has now shifted towards whether the success of the Mini can continue into the future or whether it is just a fad, a little like Volkswagen's new Beetle, where sales fell dramatically after the initial consumer enthusiasm for the new model. BMW certainly thinks that its investment is well justified. The Mini's price point ranges between GBP11,000 to nearly GBP18,000, which pits the car against the popular Volkswagen Golf and Peugeot 307. Despite this, the demand for the model is generally high across the range with a UK waiting list for several models. Additionally, another key indicator with regards to the success of the model is the demand for it in the used car market, where its rate of depreciation is amongst the lowest of any vehicle in the UK. It is these metrics which must have given BMW the impetus to continue funding the development of the Mini. It is already very valuable to BMW, having surpassed all expectations in terms of popularity, and with its sales cycle having now run for four years with demand still riding high, BMW certainly seems onto a winner. In

Dualism and the Inconsistent Triad Essay Example | Topics and Well Written Essays - 750 words

Dualism and the Inconsistent Triad - Essay Example ive up the world-view given by the theories of physics on the one hand and the quite intuitive idea that we have about the functioning of our own minds and bodies on the other. Two important versions of dualism are Interactionism and Epiphenomenalism. The former view holds that mind and body, although being two mutually excluded and independent categories, interact together. The nature of interaction is bi-directional because the mental states affect the bodily states and the bodily states affect the mental states. Both the categories are causally efficacious. Epiphenomenalism, on the other hand holds that bodily states are causally active but mental states are causally inefficacious. Mental states therefore are epiphenomena in the sense that they have no causal power to act back on the body. Here the nature of interaction is uni-directional that is only from body to mind (Jacobsen, 66). The interactionist dualist cannot deny the proposition (1) â€Å"the body is physical and the mind is non-physical† (Jacobsen, 68) because it is the fundamental thesis of any form of dualism. So also, being interactionists, they cannot deny the proposition (2) either, which says that â€Å"the mind affects body and the body affects the mind (Jacobsen, 68). The apparent inconsistency arises when the proposition (3) which says that â€Å"all physical changes can be completely explained by their physical causes† (Jacobsen, 68) gets added to the other two propositions to form a set. In order to avoid the inconsistency, the interactionist has to keep the propositions (1), (2) and (3) all true within the same set. If an interactionist hold only (1) and (3) as true, it would end up in epiphenomenalism (Jacobsen, 69). So the strategy to get around the inconsistency triad must be one which avoids this and for that, one has to identify a solution which supports the mind-body in teraction. The principle of the closure of physical laws says that all physical changes can be explained by their

Western Civilization Vs their Colonies Civilization Essay

Western Civilization Vs their Colonies Civilization - Essay Example Western Civilization Vs their Colonies Civilization The main objective of this essay is to deliberate on the claim without biasness and give backing of the arguments with documented information. Other sectors argue that science and technology become the rulers of the world rather than agriculture and survival; is this civilization or modernization2. Humans have been in existence for over a million years yet civilization is only 5000 years old. According to Global Hegemony and the rise of technology3, technology becomes a necessity for economic requirements and this seems to support the claim of the western Europeans that they were more civilized. According to Carlyle, industrialization becomes the victory of man over nature. To an extent this purported claim and made the British feel superior that others and imposed their beliefs on others. As their technologies grow the European forcibly put down others civilizations if they did not agree to their ways. This put a pose or question mark on the civilization claim of the European since civilization is supposed to be a good thing why forced others. The approach of the western European to force other on civilization brought more question on their intent than purpose. The European has assisted in the transportation system, communication and other aspect of technology; however, they borrowed the concepts from others such as Asians and even some from part of Africa such as Egypt. This borrowing makes it difficult to whole heartedly give the Western European all the credits about the civilization in their colonies. Iraq, India, China, Egypt, Central America and then the Barbarian West are all credited for the civilization growth in the world. Why would Western European claim that they were more superior yet they borrowed their technologies? It is in order to conclude that they were more civilized; however, wrong to purport that others were uncivilized. The civilization the European claim so much is a bout the development of cities; however, civilization is broader than the cities and claiming technologies overtook agriculture and survival negate the definition of civilization. The above arguments do not dispute the claim that European were civilized than their colonies but emphasize the understanding of civilization. Further more, it their give a chance to reflect between civilization and modernization4. The two are clearly different one is based on technology advancement the other focuses more on the living jointly and cooperatively. A swing had happened as an effect of the industrial revolution. Asian civilizations, like China, Africa civilization, like Egypt and other civilizations, which were once considered impressive and steady5. European countries or nations viewed the earth or universe through the aspect of technology and disregarded any consideration for civilization. As their technology advanced, Europeans expanded to other nations in order to spread their superior ideas and inventions. When civilization is considered in regards to Afric a; Western European were more advanced technology wise. The European considered Africa culture as devoid of technology and primitive. If Africa had the resources as the Western or other nations would they be considered primitive? Opportunities and resources facilitated the civilization or technology advancement of the Western6. When we consider the definition of

Improvement of solar thermal collector Research Proposal

Improvement of solar thermal collector - Research Proposal Example Once the best design dimensions are created, anywhere from two to ten prototypes will be built and tested. They will be tested under a variety of light conditions, trying to simulate a range of light beyond the normal expected use of solar panels. The hope would be that this design could, among other advantages, catch light that is more diffuse or at lower intensities, enabling a broader climactic range to employ the technology. There will also be stress testing of the prototypes to test for breaking scenarios and determine if durability is within acceptable parameters. Stress testing will include shaking, simulated geological turbulence, simulated barometric turbulence, falling, heavy weight to simulate snow and hail, and other tests. Parameters being tested for will include potential climactic range; efficiency; spectrums of light absorbed; durability under adverse weather conditions; durability under both normal and extreme circumstances; more compact size; and cost. Once initial testing is completed, flaws will be determined, simulation begun again, until the final working prototype is selected. A literature review shows that this project has promise. Cheshire Innovation uses Fresnel lenses in their solar desalination plants (Patent application Nos. 0511946.6, 0608208.5). McGrew's 1980 Patent No.

Western Civilization Vs their Colonies Civilization Essay

Western Civilization Vs their Colonies Civilization - Essay Example Western Civilization Vs their Colonies Civilization The main objective of this essay is to deliberate on the claim without biasness and give backing of the arguments with documented information. Other sectors argue that science and technology become the rulers of the world rather than agriculture and survival; is this civilization or modernization2. Humans have been in existence for over a million years yet civilization is only 5000 years old. According to Global Hegemony and the rise of technology3, technology becomes a necessity for economic requirements and this seems to support the claim of the western Europeans that they were more civilized. According to Carlyle, industrialization becomes the victory of man over nature. To an extent this purported claim and made the British feel superior that others and imposed their beliefs on others. As their technologies grow the European forcibly put down others civilizations if they did not agree to their ways. This put a pose or question mark on the civilization claim of the European since civilization is supposed to be a good thing why forced others. The approach of the western European to force other on civilization brought more question on their intent than purpose. The European has assisted in the transportation system, communication and other aspect of technology; however, they borrowed the concepts from others such as Asians and even some from part of Africa such as Egypt. This borrowing makes it difficult to whole heartedly give the Western European all the credits about the civilization in their colonies. Iraq, India, China, Egypt, Central America and then the Barbarian West are all credited for the civilization growth in the world. Why would Western European claim that they were more superior yet they borrowed their technologies? It is in order to conclude that they were more civilized; however, wrong to purport that others were uncivilized. The civilization the European claim so much is a bout the development of cities; however, civilization is broader than the cities and claiming technologies overtook agriculture and survival negate the definition of civilization. The above arguments do not dispute the claim that European were civilized than their colonies but emphasize the understanding of civilization. Further more, it their give a chance to reflect between civilization and modernization4. The two are clearly different one is based on technology advancement the other focuses more on the living jointly and cooperatively. A swing had happened as an effect of the industrial revolution. Asian civilizations, like China, Africa civilization, like Egypt and other civilizations, which were once considered impressive and steady5. European countries or nations viewed the earth or universe through the aspect of technology and disregarded any consideration for civilization. As their technology advanced, Europeans expanded to other nations in order to spread their superior ideas and inventions. When civilization is considered in regards to Afric a; Western European were more advanced technology wise. The European considered Africa culture as devoid of technology and primitive. If Africa had the resources as the Western or other nations would they be considered primitive? Opportunities and resources facilitated the civilization or technology advancement of the Western6. When we consider the definition of

Policy Paper - US Environmental Protection Agency about Energy use and Research

Policy - US Environmental Protection Agency about Energy use and opportunities for energy savings - Research Paper Example We should also aim at making all our resources and energy at the same rate. Whenever energy efficiency chances are available to us, we should take the opportunity without thinking twice. Those with energy efficiency innovations should be encouraged and provided with the necessary support both financial and moral, the information that they later avail should always be made available at and if found important applied to the country’s economy. I encourage the harnessing of energy in the country and driving their availability and disclosure. Energy is the key to running a successful business, home and the country’s economy as a whole. The government has often been seen to neglect the role of energy in the growth of the country’s economy. Energy reduction can play a great role in managing our country’s energy system. The measures that contribute to the reduction in the demand for energy can be applied in a more cost effective way than we can imagine. It meets our energy needs as well. Therefore, we should be proud of the innovations that are essential to achieving these courses. The country should be in a position to use the amount of energy that we need at a given time only. The amount of carbon emission can go down as well and thus aiding the achievement f our carbon budget. Homes in our country have been built and developed over several years with their energy efficiency varying from good to worst thus bringing many of these homes to the levels of being less worthwhile for investment. In the same line, it presents an enormous business opportunity and even goes as far as exporting to other external markets overseas. This strategy will be helpful in the country. These also set our ambition as a country clear and being able to identify the various barriers that we can face in our quest. We, therefore, stimulate our energy efficiency market as well as those we use within our country2. Energy

How Socio-Economic Classes Contributed to Events in 1800 Europe Essay Example for Free

How Socio-Economic Classes Contributed to Events in 1800 Europe Essay Described as â€Å"the divine distribution of men into different ranks, and at the same time uniting them into one society† (Gladstone, 1896), the socio-economic class order formed the structure and foundation of society in Europe. Consisting of three distinct entities and with a strong correspondence between economic prosperity and social standing, it would also serve as the backdrop for which historical phenomena would occur. Europe’s social order was not just the environment in which these events would materialize, but also a fundamental causal factor in three notable events; The French Revolution (1789-1799), The French Revolution of 1848 and Britain’s Industrial Revolution (1750 onwards). However, the origins of these events were also contingent upon other circumstantial factors. The roots of the first French revolution, arguably, are in The Enlightenment; the period of the philosophers. New philosophies advocating human rationality came to form by the mid 1700’s and were propelled into popular thought after the isolated, and highly charged, Jean Callas incident . Philosophers like Voltaire found the perfect vehicle in this incident to question the arbitrary use of power so prevalent in French society. The monarchy and the presence of the Social Order soon came into question. Across Europe, cafes sprung out to host discussion centered on the common theme of reason. Society cleaved toward enlightened ideas of rationality, equality and liberalism, leading to the growing questioning of the existing monarchial power structure. Alternative political ideologies for the state, from personalities like Rousseau and Locke, sprouted and undermined the legitimacy of the monarchy. While The Enlightenment is responsible for creating pressure from society against the monarchy, these ideas would have been impotent without suitable ground. The socio-economic categorizing of European society is a more fundamental cause of the first French Revolution because it provided this ground. The rigidity of the social order in late 17th century France accounts for the origins of the first French revolution. In theory, the social divisions were permeable and promoted mobility (Roberts, 1997). Across Europe, titles and estates could be purchased and so also, the privilege of the nobility. However the reality was often different. In light of booming trade, the demand for titles from the French bourgeoisie and returning nobility outstripped the number permitted by the social order . Furthermore, while the bourgeoisie enjoyed increasing economic power and could live equally, if not exceedingly, extravagant lives as the nobility, the social order shut this community out from the benefits of social privilege . This was exacerbated by the nobility’s stress on privilege in response to the new Bourgeois economic threat. The system’s disregard of merit in place of hereditary, and the fundamentally irrational social construct sowed discontentment within the second and third estate, where the ideals of enlightenment; rationality and equality, would find willing subscribers. Riding on the resentment toward society’s order and fuelled by The Enlightenment’s ideas did the French Revolution tear its way through to the Bastille. While the first French revolution was understandably a social battle, one could argue that the revolution of 1848 was born out of opposition to economic factors than on society’s social construct. The time leading up to 1848 was a time of gradual industrialization for France. Its products; rapid urbanization and changes in economic practices, broke familiar social patterns of the working class. For instance, the commercial system was rewritten by doing away with the cottage industry and previously public lands, privatized. Added to this, a burgeoning population, severe industrial and agricultural depressions in 1846 and Louis-Phillipe’s inaction in alleviating rural and urban poverty culminated to create great peasant discontent. The economic change that accompanied its deterioration galvanized the working class, triggering the third French revolution in 1848; aptly, also known as a Worker’s Revolution. However, it is artificial to separate economics from social class since there is a correspondence between social hierarchy and wealth. They are, after all, aptly named â€Å"socio-economic† classes. In analyzing yet another French revolution, an important observation to make is the persistence of Europe’s social order. Though the 1830 revolution delivered another great blow to the old social order (Magraw, 1987), and promised equality in opportunity and economic liberalism manifest in the abolishment of seigneurial practices for all, much had remained the same. Succinctly captured by Cobban’s argument that ‘it [did] not matter whether we [called] it aristocracy or bourgeoisie† , the cleaving of the aristocracy and bourgeoisie shows an adaption, not an eradication of the social order. The aristocracy kept to their ranks by continuing their distinctive politics and marriage practices (Magraw, 1987). Since most engaged with capitalism, they were mostly able to maintain their privileged lifestyle and control of much of the land . The Bourgeoisie continued to thrive, especially under the â€Å"Bourgeois King† and even went as far as to convert their wealth into land ownership. This neo-feudalism masquerading as the product of laissez faire economic practices, and the continuation of aristocratic dominance came at the expense of the working class. Thus did the working class continue in their economically disadvantaged positions. Their economic dependence on the old order’s aristocracy, had merely been replaced with a dependence on remnants of the same old order and a new Bourgeois one. The social order is a more fundamental account for the workers revolution, since it was responsible for creating the economic grievances of the working class which became the fuel for the 1848 revolution. The European social order again features as a causal factor in Britain’s Industrial Revolution. It is the very hierarchical nature of the class system that functioned as the engine for the Industrial Revolution. The industrial entrepreneurs of Britain, the main thrust for the innovation that characterized the revolution, took hold of Britain’s mineral resource advantage to affect rapid development. The motivations behind entrepreneurship are traced back to the make-up of society. Since social privilege was linked with economic wealth, successful merchants strived to purchase titles and convert their wealth into social status (Briggs, 1979). In this way, the extravagance of noble life, held in high regard, could be emulated. However, it is admittedly reductionistic to exclusively use the quest for noblehood to account for an entire revolution. Coupled with the desire for social advancement were also ideas from The Enlightenment and The Scientific Revolution; laissez faire economic practices and technological advancement respectively. Society as a whole was geared toward revolutionary development, equipped with the necessary ideology and possessing the necessary scientific capability. Nonetheless, the power of science and the power of thought would have remained a means without an end if not for the existence of Europe’s social class as the motivation to individuals for conomic advancement. Furthermore, the narrow elite which feature in Europe’s social order meant that there was a prolific number from the working class available for cheap employment and indeed, were the working class called upon for this. By 1850, more than 50% of the population were living in towns and city to work in factories and city-bound industries. The abundance of cheap labor comes from the old social order’s narrow top and wide base, and it sustained and accelerated industrialization to revolutionary measures. Thus, we trace back the origins of the Industrial revolution to socio-economic classes. Social hierarchical ascension was the motivation, and the demographic make-up, the sustenance. Evidently, the causality of the three historical events covered is not monolithic. Though the contributing factors are layered and many, the role of socio-economic class is central. Its rigid, persistent and hierarchical institution shaped the motivations of humanity and in doing so, account for the origins of major events in History.

Personality Disorder Carer and Family Support Impact

Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p Personality Disorder Carer and Family Support Impact Personality Disorder Carer and Family Support Impact ARE PSYCHO-EDUCATIONAL AND SUPPORT PROGRAMMES FOR FAMILY AND CARERS EFFECTIVE IN REDUCING RELAPSES AND FACILITATING RECOVERY OF PEOPLE SUFFERING FROM PERSONALITY DISORDERS? ABSTRACT Background Carers and families of people suffering from personality disorder are in desperate need of support and services. Providing these services can reduce relapses and facilitate recovery in sufferers of personality disorder. The Research Question How can psycho-educational and support programmes for carers and families of those with personality disorder improve their recovery? Methodology The results of this study were obtained through a systematic literature review. Results Diagnosis and treatment of personality disorder are still complex and often confusing issues, even for professionals. Still, treatment can produce recovery and this recovery can be expedited if carers and families are provided with programmes to equip them to effectively face the challenges that personality disorder presents. Conclusions Providing psycho-educational and support programmes makes carers more effective and can help treat personality disorder. Social Workers can help to bridge a gap in the services that is adversely affecting the treatment outcomes of sufferers and hence placing greater strain on the Health System than is necessary. Contextualisation The carers and families of individuals suffering from personality disorders are an underserved population. Considerable strain is placed upon them and their loved ones and they are often at a loss as to how to effectively perform their duties and assist the recovery of those they care for. If more psycho-educational and support programmes for carers and families were provided, it is possible that treatment for personality disorder could be improved. Personality disorders can be defined as: â€Å". . . psychiatric conditions relating to functional impairment, or psychological distress resulting from inflexible and maladaptive personality traits.†1 Personality disorders are explained in the two most prominent classification schemes, the DSM-IV, where personality disorders can be found in Axis II, and the ICD-10. The definitions in these diagnostic classification systems are much the same. Defining ‘severe personality disorder has proved problematic for experts, who have yet to establish a generally accepted definition. The suggestion of the Royal College of Psychiatrists (1999) that severe personality disorder is marked by extreme societal disturbance and at least one extreme personality disorder has provided some guidance.2 Alternatively, having two severe disorders could mean that the sufferer has one disorder that expresses itself in more than one extreme way, or could simply indicate one deeply disturbing disorder. One study graded the severity of personality disorder on 163 subjects and found that the patients whose personality disorder was described as ‘complex demonstrated the greatest number of symptoms and recovered the least. Personality disorder carers are people who support a person who suffers from any form of personality disorder, whether they are relatives, friends or partners. Often, carers give sufferers emotional and financial support and may even act as informal social workers. Previous studies have shown that carers of people with personality disorder benefit from psycho-educational and support programmes. Psycho-educational programmes are educational programmes that contain an element of counselling or therapeutic activity for the family. The main aim of these programmes is to minimise the strain experienced by families and carers of people with mental illnesses, here personality disorder. Psycho-educational and counselling programmes exist ultimately to facilitate recovery and reduce relapses; indeed, the success of programmes is usually measured by examining relapse rates. Programmes attempt to provide adequate support, information, signposting to appropriate resources, advocacy and respite for carers. They also coach carers to increase their problem solving abilities, improve their communication and help them construct their own support networks. Support programmes for carers of people with a mental illness attempt to support the contribution that carers make to the lives of those they care for. They work toward advances in policy that will augment the services that satisfy carer requirements. Support programmes prompt dialogue between members of the government and carers, as well as encouraging carer involvement in the creation and delivery of carer and patient services. Further, support services connect carers with agencies to assist them in their role and facilitate modes of best practice in aiding carers. The Research Question This literature review examines a number of studies on personality disorder, its effect on carers and issues connected with diagnosis and treatment in an attempt to determine whether psycho-educational and support programmes for family and carers are effective in reducing relapses and facilitating recovery of people suffering from personality disorders. If social workers are to work effectively with this client base, they must put aside antiquated beliefs that personality disorder cases are hopeless and that those who suffer from personality disorder never get better. This study reveals that one of the greatest challenges to carers and families is obtaining the support they need and the services they are entitled to, and Social Workers can be instrumental in bridging gaps in the Mental Health system. Methodology This dissertation undertakes a systematic literature review of health care and psychological literature to address key issues in the support of carers of people suffering from personality disorders. Several different studies and a range of approaches were examined. Although the number and breadth of studies was a strength of the review, the variety of approaches made it challenging to compare the overall merits of one study against another. The literature was obtained through a variety of means. Google searches, journal articles, working group reports, service provider reports and academic papers were used. The research methods that appear in the utilised material included telephone interviews, questionnaires and surveys, face-to-face interviews and meta-analysis. Some were literature reviews themselves and some simply reported on the outcomes when a group of treated individuals was observed. Of the studies that involved observation of a group, very few included a control group in the study so methodological rigour was not as great as it could have been. Neither is it certain that studies where self-reporting was used are as empirically reliable as one would like, as sufferers of personality disorder tend to over- or under-report their symptoms . Some of the studies that were conducted recently showed positive outcomes, but the long-term follow-up for the same groups may make the figures less significant. Even where there has been longterm follow-up, some of those who took part in the initial study may not be included because of death, inability or unwillingness to participate, or inability to be located. The methodological rigour of the studies is further complicated by the fact that the process of diagnosis and treatment of personality disorder is fraught with complexities. The categories for personality disorder are somewhat defined by behaviours and are not theoretically based or grounded in common mechanisms of the disorder. The actions and symptoms of patients are so extremely varied that both diagnosis and treatment are difficult to present, much less to assess. Yet just because a comprehensive catalogue of truths about personality disorder cannot be presented does not mean that no reliable statements can be made. The evidence that is presented here is solid enough to make general assertions regarding the affects of carer support on patients based upon the evidence, and that is what it intends to do. Assessing the impact of support and education for carers upon the sufferers of personality disorder themselves proved more challenging than, for example, assessing the impact of treatment on sufferers, for which there is abundant literature. Still, the impact of psycho-educational and support programmes on consumers has been assessed and outcomes observed. Additionally, the evidence for the improvement of the lives of carers and the quality of care they give their charges is strong, and this fact bolsters the hypothesis that improved care for carers improves the mental health of those for whom they care. These conclusions are definitely linked, especially given the statistics that show that improvement for personality disorder takes place over a long period of time and is facilitated by positive interpersonal relationships with people who are equipped to deal with the symptoms that people with personality disorder exhibit. The presence of positive relationships with carers who are tr ained, educated and supported will assuredly improve the ‘treatment conditions for those with personality disorder. In narrowing the scope of the literature to be included in the study, several factors had to be noted. Some of the literature was so grounded in certain programmes for certain countries that many sections were not transferable to this review. For example, the results of the Network for Carers (2004) report were based upon specific programmes offered in Australia, so some information had to be excluded. However, this document was very helpful in establishing general facts about the needs of carers and the impact of programmes upon their ability to care for sufferers. It was also a thorough exposition of the opinions of carers,through which their voice was clearly heard. There were also other limitations regarding the particular demographic studied. The NHS National Programme on Forensic Mental Health Research and Development Expert Paper on Personality Disorders primarily assessed offenders with personality disorder and not merely members of the wider public suffering from the disorde r. Because of this, significant sections of the material had to be ignored. Still, this paper was useful in understanding the complexities of treatment and diagnosis of personality disorder, and provided definitions for contextualisation. In evaluating the quality of the data, the analytical tool Critical Appraisal Skills Programme (CASP) was used to assist in making sense of the evidence. This tool is advantageous to those who are strangers to qualitative research, assessing the merits of a source with regard to rigour, credibility and relevance.CASP initially asks two screening questions, the first addressing research aims and significance. The second screening question considers whether the research interprets subjective experiences of participants.Answering these two questions with a ‘yes then leads to eight more questions covering issues such as recruitment strategies, collection of data and ethical issues. In a literature review there are several ethical issues that must be considered, especially when dealing with a vulnerable population such as sufferers of mental illness. For each study used in the review it was necessary to consider whether ethical standards were maintained throughout the study, includi ng the manner in which consent was obtained and the way that confidentiality was upheld. Another ethical consideration is the handling of the outcomes of the study with the participants after the study.9 In the data observed here, it is not always explicit that consent was obtained but is often implied. Eliciting feedback from carers carries implied consent even if consent was not explicit, for obviously no individual would be forced to comment against his or her will. Confidentiality is maintained through omitting names and keeping the results impersonal. Yet the information given for studies is in its final and often abbreviated form, and the background work is not always documented comprehensively enough to ascertain whether all ethical considerations have been taken into account. One ethical consideration that is not always considered is the treatment of ethnic minorities in research projects, especially those for whom English is not their first language. The wording of questions and the criteria by which outcomes are judged is often tainted by cultural bias for those being assessed outside their native surroundings. It is practically impossible to remedy this, because part of the methodological rigour of the study depends upon all participants being treated and assessed in the same way. Differentiation on the basis of cultural differences would compromise the consistency of the study, but the impact of cultural factors is most certainly felt by those of foreign origin. Discussion of Findings Traits The traits exhibited by sufferers of personality disorder differ immensely because of the wide scope of the disorder. Examples of traits range from anxiety, narcissism and compulsivity to defiance, abnormal attachments and avoidance of social situations. Sufferers may demonstrate an arrogant interpersonal style, or may show extreme submissiveness. Personality disorders are linked with negative results in the wider population such as marital breakdown, criminal actions and professional difficulties.The anomalies of personality disorder are apparent in the thought patters, expressions and levels of self-control of sufferers. The patient will display abnormalities in the way that he or she interacts with others which will appear in a range of circumstances. There are various types of personality disorders, and each has its own banners of dysfunction. It has been recognised that the kinds of personality disorders covered in DSM and ICD are a small cluster when contrasted with the array o f personality impairments that can be identified in large configurations of people.11 Personality disorders can be divided into three clusters, A-C. In the first cluster disorders relating to paranoia and schizophrenia are found. Cluster B includes antisocial and narcissistic disorders, and Cluster C focuses on avoidant, dependent and obsessive-compulsive disorders. Prevalence It is estimated that between 6% and 15% of the population have one or more personality disorders of some kind—different studies produce different results.13 The goal of one study was to estimate the prevalence of personality disorders in a local sample and discern the most common demographic groups therein. The frequency of the DSM and ICD personality disorders and the interactions between disorder clusters and demographic qualities was assessed in a local sample of 742 participants between the ages of 34 and 94 over two years.14 The results showed that the overall prevalence of DSM-IV personality disorders was approximately 9%. Among the disorders, antisocial personality disorder was the most common and appeared in almost 5% of those assessed. Dependent personality disorder and narcissistic personality disorders were rare. The prevalence of many of the individual disorders was only 1% to 2%. For ICD-10 disorders, the overall presence in the surveyed group was 7%. Again, the prevalence for individual disorders was 1% to 2%. The most common disorder in for the ICD disorders was dissocial personality disorder at 3%. Dependent personality disorder was, again, very rare. Who is affected? Studies dedicated to uncovering the risk factors for personality disorder produced a variety of results. Prominent factors that may lead to a personality disorder include having a parent who is involved in or has been convicted of a crime, having a parent with deficient parenting abilities and being part of a large family. Factors such as low intelligence also feature in the list of risk factors. However, this study and studies that are similar raise certain issues about the nature of judging which factors should be included as risk factors for personality disorder. These sorts of factors could be criticised for having prejudicial antecedent assumptions regarding what it means to be a functioning human being. It is likely that people from lower socio-economic classes will have a tendency to fit these categories more than their middle- or upper class counterparts.Care should be taken in describing risk factors to ensure the language used is not biased by class. In the study mentioned above, several demographic characteristics were assessed with regard to prevalence of personality disorder. The outcomes demonstrated that Cluster A disorders were more common in males than in females. Cluster A disorders were also more prevalent in participants who were divorced or separated than those who were married or widowed. Subjects who had never been married were the most susceptible sub-group of all. In the Cluster B category, men were again more prone to having a personality disorder than women. Cluster B disorders were most common in the youngest age range surveyed and least common in the oldest range. Further, this cluster was most prevalent in participants who lacked a high school diploma and was least prevalent in participants who graduated from high school and continued their education afterwards. The odds of having one of these disorders decreased approximately 6% for each year an individual aged. One possible explanation for the increase of prevalence of disorder with age could be that people of more mature generations are less likely to have, know about or report symptoms of personality disorder. The prevalence of Cluster C disorders was most closely related to marital status, again showing that participants who had never been married were most likely to have one of these disorders. The likelihood of having a Cluster C disorder was almost 7 times greater in those never married when contrasted with those who were married or widowed. The results of this study broadly match a number of previous studies whose results showed the prevalence of personality disorders in the general population to be 9-13%. However, there were some differences between previous studies on prevalence and this study. The present study found a notably higher prevalence of antisocial personality disorder and a much lower prevalence of histrionic and dependent personality disorders than previous studies. These differences could have been caused by methodological variants and the diagnostic criteria used such as which version of the DSM was utilised. The differences could also be a result of participant source, form of assessment, assessors experience and data collection methods. Notable strengths of the study were that the participants were obtained through a community sample and personally interviewed by psychologists who have a significant amount of experience in cross-examination. The limitations included the fact that not all subjects coul d be interviewed and that the sample size was not really large enough to pick up on very rare disorders. The results of other studies have been less conclusive. An American study examined the theory that personality traits stop transforming by the time an individual reaches the age of 30. One of the major strengths of this study was the sample size of 132,515. The subjects, aged 21-60, participated in a web-based Big Five personality measurement. The results of this study showed that qualities such as being agreeable and conscientious increased during adulthood up through middle age. The quality of being neurotic diminished for women but remained static for men.20 Both men and women decreased in openness after the age of 30, and while men increased in extraversion from 31 to 60, the same quality diminished in women in the same age range.21 While the sample size of this study was certainly impressive, one concern was that conducting the study over the internet might bias it toward younger subjects. Another concern was the cohort effect, since people of earlier generations might not engag e with psychological instruments with the same ease as those who are younger. Overall, the multiplicity in paradigms of change did not affirm either that personality does not change after 30 or that it does. The study concludes that the traits examined are complex in nature and subject to an array of developmental influences. Historical View The onset of the de-institutionalisation of mental health establishments has produced a number of benefits. There is now less public stigma placed upon sufferers of mental illness and their traits and presence in wider society has come a long way toward normalisation. Suffers of mental illness have become less isolated and enjoy greater freedoms, including the freedom to choose from a selection of services. From a governmental point of view, deinstitutionalisation has saved them an enormous amount of money. However, the responsibility for managing and caring for mental illness sufferers has been transferred from the institution to the local community, and specifically to carers. Carers are involved in every possible aspect of the lives of their charges, even to the extent that their role could be characterised as an informal social worker. But the burden of the role combined with the lack of training, education and support often results in the damage of the psychological health of th e carer, as well as strict limitations on their life outside the caring role. The striking impact of caring on the lives of carers and other factors led to the undertaking of research on the involvement of families in managing and treating mental illness. From this came solid evidence of the benefits of such involvement, and the needs of carers began to be recognised. In recent years services have been put in place to assure that the needs of carers are met, and education for carers has been pinpointed as the most beneficial service for carers and consumers. Carers need to be educated in order to feel equipped to perform their tasks effectively. Specifically, carers named a need for â€Å"education about mental disorders† and information about treatment options† as their most salient needs. These statements are reinforced by studies from various countries where carers named the same things as most important for their success. Historically, studies examining the impact of educational programmes for carers have come from two different hypotheses. The first is that the chances of a consumer recovering from a mental illness are augmented if an educated and informed family surrounds him or her. Such a family will have deeper knowledge and sympathy for the condition of the sufferer and will be equipped to manage challenging behaviours. The second hypothesis is that because of the implications of their role, carers have an inherent right to access to adequate services. They have a right to services that will enhance their individual welfare and their effectiveness as carers. Assigning a course of treatment to personality disorder has always been an inexact science. Personality disorder is particularly complex to treat because the prime method of treatment is not always apparent after a diagnosis has been arrived at. The type of treatment which will prove most effective for the patient differs from individual to individual. Case conceptualisations can be helpful in assessing the individuals issues, identifying areas of risk and determining proper treatment goals.24 There is an abundance of research about treating personality disorder, but the studies cannot always be relied upon due to their lack of sound methodology. While some forms of treatment for personality disorder can reduce relapses and facilitate recovery, there is no simple panacea for this ailment. Cognitive treatments including cognitive-behavioural approaches have produced some pleasing results with personality disorder patients, as have psychodynamic treatments. Diagnosis Individuals who suffer from personality disorder encounter several issues with their diagnoses. They may be diagnosed through the means of an interview, a self assessment questionnaire or other means. Clinical psychiatrists often diagnose patients through interviewing them with regard to the DSM or ICD categories. This method is slightly better for detecting the existence or not of a personality disorder, but shows low accuracy for particular types of disorder. Self-report questionnaires like the Personality Diagnostic Questionnaire (PDQ-IV) and the Millon Clinical Multi-axial Inventory (MCMI) are also used to diagnose personality disorder. These questionnaires are considered imprecise because individuals tend to over-emphasise or under-emphasise the issues they are having. In addition to these methods of diagnosis, there are several semi-structured interview schedules to assist professionals. These schedules feature lists of questions that correlate to the DSM or ICD and the clinici an may then mark the patient and determine whether he or she has a disorder according to the criteria. Interview schedules have shown that they are slightly more reliable than other forms of diagnosis, but this success is only relative and the results are still much less valid than is needed. Really none of the diagnostic tools should be considered better than any of the others, for they are all faulty to the extent that they cannot be relied upon. There is a problematic absence of consensus regarding the reliability of diagnosing in general and the consistency of different diagnostic schemes. Part of the problem is that the explanations of personality disorders in the DSM and ICD feature a concoction of psychological traits and displayed behaviours, so that it becomes uncertain whether the diagnoses are attempting merely to pinpoint deviant actions or to identify traits whose presence is significant for determining personality disorder. The solidity of diagnoses for personality disorder is frequently questioned, and there are only a few disorders whose diagnoses are considered reliable. The diagnosis that can be made with the most certainty is antisocial personality disorder, because this problem can be identified by external actions that can be easily observed. Those who diagnose individuals with personality disorder are not always able to be precise in identifying which personality disorder they are dealing with, therefore m ultiple personality disorder diagnoses are common. Clinicians often find themselves confronting comorbidity, and prudent professionals test for the full scope of disorders. Comorbidity is quite common, with male legal psychopaths having an average of three disorders each. Women may have four.28 There is a great amount of interaction between the descriptors of the various types of personality disorder and so it is difficult to tell them apart. When dealing with multiple diagnoses, it is advisable to keep all disorders in mind when constructing a treatment regime, even if many of the features of the respective disorders overlap. The classification of disorders is also problematic, because the categories lack the quality of homogeneity present in reliable psychological categories of other types. Categories of psychological dysfunction work best when each class is different from others and common elements are contained within one class. This is not the case with personality disorders. For example, there are literally hundreds of ways to satisfy the criteria for borderline personality disorder, and so individuals with the same diagnosis may have utterly distinct behaviours, symptoms and needs. Axis I disorders feature frequently in those who suffer from personality disorder, particularly where there is substance abuse or depression. The classifications for personality disorder tend neither to be theoretically based, nor to stem from statistical research, which is presumably part of the reason that precise diagnoses are so elusive. The categories are so unreliable that abandoning the categories altogether and composing a new classification system is often proposed. While this may be the ideal way to correct the flaws, the time and effort already invested in the use of the present system is likely to ensure its continued existence. One approach to dealing with personality disorder is the trait approach. This approach states that a minimal amount of theories can illumine the majority of human behaviour. Observing the personality traits exhibited by an individual and placing them on a continuum from truly normal to extremely dysfunctional is more faithful to the structure of t he human psyche and tells clinicians more about the true nature of the dysfunction suffered by the patient. Currently, the most extensively developed trait theory relating to personality disorder is the theory of psychopathology. Treatment Cognitive-behavioural treatments (CBT) aimed at treating personality disorders have a tendency to take a broad approach. CBTs engage an array of behaviours, thoughts, preconceptions and internal emotional mechanisms. Many treatments are residential and are conducted with a group. They frequently include tenets of other methods such as psychodynamic therapy. Therefore it is an arduous task to pick out what, if any, elements are effective in a multi-dimensional approach so that they can be improved and repeated. Dialectical behaviour therapy (DBT) is a method of CBT focusing on female patients with borderline personality disorder. The goal of the therapy is to reduce or eliminate incidents of self-harm through group skills training. Group sessions address destructive thought patterns and social skills. Individual therapy can also be used. The outcomes for one study showed that women who were treated experienced reduced anger and self-destructive or suicidal thoughts. Their social skills improved and they required less psychiatric treatment. Arnold Lodge Regional Secure Unit has produced a treatment method aimed specifically at offenders with a personality disorder. The treatment programme centres on teaching patients socially acceptable mechanisms for problem solving. The patients work individually and with others and receive regular counselling. This regime is supplemented with services that are individually tailored to the needs of the individual, such as anger management sessions or substance abuse education. This form of treatment has been shown to reduce deficiencies in social functioning and self-control.32 While the initial studies are promising, long-term analysis will confirm or refute the true effectiveness of this type of treatment. Therapeutic communities, cognitive therapies and dynamic therapies may also be used to treat personality disorder. Therapeutic communities are tailored primarily for offenders and have produced promising results in terms of reduced recidivism and improved social integration. A study into the effectiveness of therapeutic community treatment of personality disorder explored whether this type of treatment improved the health of patients to the extent that the burden on Health Services eased. Several previous studies reported reductions in the use of psychiatric services after therapeutic community treatment. The previous studies were limited by the fact that they observed participants for one year only and lacked thorough follow-up. This study sought to fill the methodological gaps of the previous studies by tracking patients for years after treatment. They assessed the impact of treatment on Health Services by counting the number of admissions to hospital before and after treatment. Th e study found that therapeutic community treatment resulted in a statistically significant drop in in-patient admissions over the 3-year period. Those who were admitted to hospital tended to be the subjects who had the briefest experience of therapeutic community treatment. Another study involving therapeutic community treatment focused on individuals with severe personality disorder. The effect of p