Monday, March 23, 2020

Analysis on Teenage Pregnancy in the UK The WritePass Journal

Analysis on Teenage Pregnancy in the UK Introduction Analysis on Teenage Pregnancy in the UK IntroductionStatisticsSex EducationSexual attitudes among young peopleWelfare benefitsSocial-economic deprivationLack of StigmaLone parenthoodOut of wedlock birthsDivorceWorking mothersConclusionRelated Introduction Teenage pregnancy is a major concern in the UK, and for the last 20 years it has the highest rates in the European Union; other countries with similar rates are New Zealand and Australia (Maticka, 2001 p. 15). The UK is found to have the highest live birth rates among people with the age of 15-19 in Western Europe. It is estimated that even the most prosperous zones in the UK surpasses Netherlands and France in national rates of teenage pregnancy. Between the 1970s and 1980s, there was a record decline with the rates in many European countries. However, these rates did not go down in UK in the period 1979 and 1999 (SEU, 1999), while conception among under 16-olds rose by 1% between 2002 and 2003 (Office of National Statistics, 2005). The common factors found to influence high levels of teenage pregnancy includes but not limited to: Social economic status especially income distribution across societies, gender equality levels within the societies, the availability of sex education and prevention strategies at schools, access to sexual heath services that meets the needs of teenage persons, normalized expectation of continued education beyond the age of 16, Exposure to unhealthy media materials amongst others. In the year 2000 alone, 38,690 under the age of 18 years got pregnant in England. 44.8% of these underwent legal abortion as the conceptions were not planned for. Surprisingly, 7,617 of the total conceptions involved girls under the age of 16 years out of which 54.5% ended in legal abortion (Office for National Statistics, 2000). Many factors influence teenagers choices to become sexually active and to use contraception considering their ability to obtain them and make use of contraception their choice. These factorsoperate are exercised at individual’s level (e.g. attitudesand beliefs, knowledge, substance abuse and future expectations), the intra-familiallevel (e.g., social economic factors, family structure, parent–child communication), the extra-familial level (e.g., health services, peer influences,sexual health education at school) and thecommunity level (e.g., values and norms relating to teenage pregnancy).Most of these factors can be changed with time and within respective social institutions individualknow-how concerning sexual health, while others are difficult to change or cannot be changed at all. In most cases, physician groups are left the role to lobby for policy initiatives aimedat changing sexual risky trends among teenagers which includes;enhanced sexual education at schools. However, the important rolefor physicians is to offer suitable sexual health informationand services in their practices when they are providing clinicalservices to youths (Botting, 1998 p. 21). It is necessary that physicians be familiar with the realityof teenage sexual activity. Conducted studies have indicated that, by completion of high school, the majority of teenagers will have had sexualintercourse (Maticka, 2001 p. 3) and approximately 10% have had intercourse beforeage 15. It is therefore much important to include as part of the general enquiry into their well-being, their sexual activity too,use of contraception and condoms, their history of sexually transmittedinfections and pregnancy. There is need to acquire information abouttheir other sexual health concerns. Adolescents are not necess arily the ones to initiate discussions about sexual healthissues, since to them the process of seeking sexual health advice is a complicatedone, and therefore physicians must be proactive in making suchan enquiry. When contraception, including emergency contraception, is indicatedfor teenagers, it should be provided. Like other women, adolescentsalso have a right to abortion services, although the availabilityof such services is not uniform across the country, and teenagedgirls of low socioeconomic status or from visible minoritieshave particularly limited access. Teenagers have the rightto confidential health care, including receiving sexual healthservices, provided their emotional and cognitive maturity allowfor this. Their parents do not have an automatic right to know.The right to confidentiality is not always understood by teenagersand should be appropriately communicated during patient encounters.Finally, when teenagers choose to continue their pregnancy toterm, exemplary care should be provided before, during and afterdelivery, to help minimize the risk of negative outcomes thatmay occur. Lack of consensus on ways of counterchecking pregnancy problem and sexually transmitted infections (STIs) in respect to teenagers is one of the factors contributing the high rates of teenage pregnancies in the UK. There are no proper installed structures advocating favorable comprehensive sex and its related education. Low expectations in education which is greatly attributed by the perception that there are few or no employment opportunities lead to teenagers absconding education, engaging in unplanned sex due to exposure in their neighborhoods and subsequent pregnancy (BBC NEWS, Friday, 27 May 2005). Ignorance about the use of contraceptives despite their availability often leads to unplanned conception. Although most of the teenage girls are well conversant with the importance of condom use, a large number would go on and engage in sexual activity hoping the worst does not happen. The youth have been found to be inefficient users of contraceptives even when they are offered for free (BBC NEWS, Friday, 27 May 2005). One Jan Barlow was quoted by BBC attributing three factors that help alleviate teenage pregnancy and STI rate as being: better access to young people friendly services, comprehensive sex and relationship education, and offering more open attitudes to sex aimed at influencing young people in making sound decisions (BBC NEWS, Friday, 27 May 2005). The England government for instance had advocated for sex education training but the school authorities are only focused at teaching other subjects. According to him, Sex and relationship that lacks in school curriculum ought to be made a compulsory unit in personal social health education studies. A study conducted for the NHS at the University of York concludes that education prior to sexual activity makes individuals delay in having sex and makes them more likely to use contraception when they do. However, sex education offered in schools is criticized as being too biological and in-adequate to arm the youths with the relevant sex information (Barlow, 2005 May 27). Teenage girls and boys are misguided approach from TV programs relating sex with celebrities and portraying it as a fashioned activity. It is noted that teenagers particularly those not participating in co curricular activities are likely to spend most of their time watching romantic programs. The media sets them adrift in the sexualized society without giving them the tools to look after themselves. The outcome is indirect influence when the affected youth fail to differentiate action scenes from real life (BBC NEWS, Friday, 27 May 2005). Teenage pregnancy comes handy with various complications. The adverse effects include miscarriage, premature births, babies are born underweight for gestational age whereas others are born small (Horgan, 2007). Teenage mothers are also found to have higher risks of contracting STIs, being victims of alcohol and substance abuse, smoking and poor nutrition in addition to suffering higher rates of postnatal depression (Horgan, 2007). Gynecological immaturity in teenage mothers is one of the reasons attributed to the adverse effects following births. Adolescent girls continue to grow when pregnant. The babies they carry faces food and nutrients competition required for their growth with the growing bodies of their mothers. There is also increased risk of obstructed labor during birth because of their undeveloped small pelvises (Horgan, 2007). These effects are adverse and their effects are prone to have a long term effects therefore preventive measures are by the far advisable measures. Family planning and sexual health clinics should be easy to access amongst these women and facilitated with a wide range of the relevant services, including diet advice, cessation on smoking behavior and embarking back to studies after birth. As a matter of fact, they should be encouraged to attend antenatal classes and care which should offer them medical care as well as social support. It is believed that postnatal management for teenage mothers is placed better in offering essential counseling and education on crucial aspects of motherhood such as breastfeeding and nutrition for babies. As many teenage mothers tend to be single and often feel isolated in bringing up their babies, they require special attention from the health and social services (Horgan, 2007). An Obstetrician and Gynecologist; Louse Kenny working at Cork University Maternity Hospital attributes that the figures indicates that death rate for babies from very young mothers is 60% more higher than those from the older women. Further, teenage mothers are more likely to be faced with postnatal depression as compared with their counterparts-the older women. Some 44% of mothers under the age of 20 breastfeed compared to 64% amongst 20-24 and up to 80% in older mothers. There is a need therefore to conduct further studies to ascertain whether the poor outcome from teenage mother births is entirely a link with biological challenges resulting from their bodies not being fully developed; or it is a combination of other factors such as social demographic factors (Horgan, 2007). Teenage mother are at risk of indulging with malpractices that poses unconducive environment to their newborns like smoking due to the associated stress and their vulnerability to peer pressures. At their age, they are not entirely dependent in making sound decisions, a reason why close attention should be directed to them to safeguard their heath and that of the newborns. Awareness towards the dangers associated with smoking for instance is paramount to them, risks of contracting sexually transmitted infections and the need to use contraception in future sexual activities (Horgan, 2007). There is challenge presented by teenage mothers toward heath workers. Most stay for a long time before presenting themselves to health facilities for diagnosis, only to avail themselves at the late stages in the pregnancy. They thus fail to receive timely attention to any possible presenting risk and guidance on how to take care to ensure healthy newborns and safe delivery. Both the teenage mother and the child are prone to undergo negative short term, medium and long term health and mental health outcomes that are as a result of unprepared ness in the encounter and dilapidated exposed conditions thereafter (Botting et al., 1998). The mother’s education and future employment may be brought to prejudice. There is more likelihood of teenage mothers running into trouble in school before getting pregnant and possible failure to complete studies after delivery. As a result, they may not be having academic qualifications at the age of 33, a situation that renders them find difficulty in looking for a job or subject to low payments and poor benefits as opposed to their peers (SEU, 1999). An estimated 80% of teenage mothers do not own their own housing arrangements. They are either housed by their parents, relatives or others sponsors who are added an extra burden towards meeting additional expenses. This is more likely to result into domestic conflict in addition to failure to provide the desired space environment for both the mother and the child which may the related cost may not be within reach (SEU, 1999). Young fathers also face similar difficulties although their extent isles severe compared to that of young mothers. They are however faced with similar economic and employment outcomes in their post parenthood (Kiernan, 1995). Children of teenage mothers are more likely to have the experience of being lonely in the family. They are further faced by generalized risks of poverty, poor housing, and poor nutrition and consequently face inadequate upbringing standards. Evidence shows that daughters of teenage mothers are likely to become teenage parents themselves (Botting et al., 1998). It is thus noted that having children at a young age can damage a young woman’s health and well-being. Her education and career prospects are severely affected too. While young people can become competent parents, a variety of studies reveal that children born of teenagers are more likely to experience a wide range of negative outcomes later in life. They are also three times more likely to become teenage parents themselves (Hughes, 2010). As a matter of fact, at the age of 30, teenage mothers are 22% more likely to be living in poverty than mothers giving birth at the age of 24 years and above. They are less likely to be employed or be living with a partner (Hughes, 2010). Teenage mothers are less likely to have academic qualifications at the age of thirty as compared to mothers who get children after having attained the age of 24 years. Due to their vulnerable condition, they are more likely to partner with men who are poorly qualified and less likely to secure employment (Hughes, 2010). Statistics have shown that teenage mothers have three times the rate of post natal depression compared to older mothers and at higher risk of poor mental health for at least three years after birth. In addition, the infant mortality rate for babies born to teenage mothers is 60% higher than for babies born to old mothers. Compared to older mothers, they are likely to smoke throughout their pregnancy while 50% are found not to breastfeed both which poses negative health consequences to the child (Hughes, 2010). Children born of teenage mothers have approximate 63% increased risk of being born into poverty compared to babies born to mothers at their twenties. They have higher mortality rates and are more likely to have accidents and behavioral problems (Hughes, 2010). Owing to the increased the increased teenage pregnancy as a social problem in the UK, policy makers, politicians and health educators have been borrowing measures applied in Netherlands to alleviate the situations. These measures are selected on the merit of their suitability. Statistics In 2000, the birth rate to young women with the age of 15-19 was 37.7 in every 1000 in England and Wales Compared to 5, 5 in every 1000 in Netherlands. On the other hand, the conception rates were four times higher at 62.2% per 1000 compared with 14.1 % in every 1000 in the Netherlands. (Figure insert) Sex Education Sex education in schools is greatly attributed to the reduced teenage pregnancy occurrences in many countries where it if effectively applied. This hypothesis have been assumed and highly promoted in the media by birth control and abortion lobbies and without the support of the research evidence. In the UK; Sex education has been politicized in many educational centers and political leaders too. The UK parents are not free to set up their own publicly fund schools independent of the state according to their own beliefs and values where there is a high degree of autonomy in terms of curriculum development and policy making. UK lacks diversity in didactics, pedagogical strategies and content and influences of the churches and the involvement of parents are not much stronger. As a result, sex education has nut impacted a lot towards reducing teenage pregnancy (LDM, 2003). It is found that: Sex education is not open as it is often suggested though it is often taught within a firm moral framework. The most liberal and open classes were found in the more social and economically derived areas where teenagers were already more sexually active and teachers felt there was little they could do to compensate for family structures that were inadequate to guide streetwise young people in the increasing sexual culture. Of the teachers interviewed, none was comfortable with the idea of opening up open classes for sex education curriculum which would entail sexually explicit materials. The schools where the sexual activity was less a problem were not on the welcome of sex education but were positive on building on the moral frame work provided by parents within stable family structures Further evidence has exposed sex education as not being that permissive as it is often perceived. A considerable figure of sexual health experts are critical of traditional views of sexual morality widely held among teachers and parents. The experts are concerned that an emphasis on setting the expression of sexual morality firmly within the context of committed enduring relationships is too restrictive when teenagers may want to experiment which sexual activity (LDM, 2003). There lacks evidence to support the ascertain that the teenage pregnancy rate has been reduced by easy availability of contraception to the young people in what is described as an almost imperfect contraceptive population where condom use rose among the sexually active from 17% in 1981 to 85% in1994 (Ketting, 1994). There is no corresponding relationship found in the reduction rates of either teenage pregnancies or abortions whereas there are early signs of an overall rise in the rate of sexually transmitted infection (STIs) occurrences: in particular, Chlamydia which affects the young people disproportionately (Van der Laar, 2002). More findings show that during the 1990s, the abortion rate rose despite a wide increase in contraceptive use (CBS, 2000). It therefore cannot be attributed that the decline trend of teenage pregnancy is a result if sex education, open culture and contraception use rather a combination of factors not related to the above. Since teenage pregnancy is a result of teenage sex, then it goes hand in hand that a society that has more of one of the two is going to experience more of the other. It is thus necessary to consider factors that are known to influence the age at which young people starts sexual relationships (LDM, 2003). Sexual attitudes among young people Casual attitude to physical relationship is ever growing. However, the UK teenagers appear not to be guided by moral principles to a large extent than their counterparts in for example the Middle East that abstain from sexual intercourse until a much later age. A comparative study of sexual attitude among teenagers found that a majority of both males and females in Netherlands for instance gave love a commitment as their primary reason for first intercourse. Physical opportunity and attraction and peer pressure are not leading factors to sex in Netherlands. In UK however, while love and commitment have high ranking in girls, boys are found to be more influenced by peer pressure, opportunity and physical attraction (LDM, 2003). From the perspective of young people in such circumstances, early parenthood can appear a rational choice, providing a means for making their transition to adulthood or having somebody to love in their lives. Welfare benefits A welfare benefit is another factor that makes teenage pregnancy level to be high in the UK. The teenage parents receive income financial support from the government when they are less than 18 years and do not have to depend on their parents. The babies born are put under the care of a legal guardian who happens to be the parent of the teenage mother in most circumstances. The legal guardian becomes the receivership of the governments support allowing their mothers to continue with schooling. In addition to this, the teenage parents enjoy housing benefits, educational opportunities, employment training and free medical care. With the provision of all these, a disincentive to engage in irresponsible sexual behavior lacks (LDM, 2003). Social-economic deprivation Teenage pregnancy is strongly associated with the most deprived and socially excluded young people. Difficulties in young peoples’ lives such as poor family relationships, low esteem and unhappiness at school also put them at higher risk. It is in record that acute levels of social economic deprivations are associated with high frequency of teenage sex activities and associated risks behavior. The concentration of areas with magnificent levels of poverty and social inequality in some areas of the UK has lead to the emergent of a desperate culture in which there is only little to lose in early parenting. The loss is further reduced from compensations of social welfare benefits that alleviate the costs of living and upkeep. An income support and housing allowance for instance makes the cost of having a baby not too much (LDM, 2003). Lack of Stigma In recent years, teenage pregnancy relatively lacks stigmatization in the UK. Stigmatization is known to discourage undesirable habits where the involved persons are subjected to humiliation in the past. Social services makes it hard for one to access most services, people disregard one making him/her always indebted. Lack of stigma associated with pregnancy in the UK is a major contributory factor to higher teenage pregnancy rates (LDM, 2003). There are also some communities in which early parenthood is seen as normal and not a concern. Lone parenthood In the year 2000, single parents in Great Britain accounted for 21% of all families that had children. Children in Britain are more likely to be raised by a lone parent as compared with other European countries. A study of over 2000 young people in England aged 13-15 years found that in families headed by married couple, only 13% of the children were sexually active. The number doubled for young people living within single families. The figure was 24% for the children of cohabiting couples, 26% where the children had separated, 23% where the children divided their time between two parents living apart, 24% where the parents were divorced and 35% where the children did not live with either of the parents (Hill, 2000). Evidence is therefore placed in increase of teenage sexual activity in lone parenting or no parenting at all. Great Britain having single parent’s levels of 21% (in relation to year 2000) inclines that the sexually active youths are very many. Out of wedlock births In western Europe, children are more likely to be born to an unmarried mother. Children born in this context are prone to be raised in poorer environments where sexual activeness is high. Daughters from single mother are also likely to bear children out of wedlock during their teenage years. Divorce In the year 2000, 12.7 in every 1000 married men obtained a divorce in England and Wales. Children in Britain are more likely to have experienced the divorce of their parents. This is important considering that people not living with both biological parents are more sexually active in their early ages than those from intact families. Other factors like race, religion, age and social class are closely based from a family setup (Demo, 1998). Working mothers The UK had 18.3% of mothers with children under the age of five employed full time in the year 2000. The figure was higher for mothers with children aged between five and eight years with 31.9%. Europe, 75% of the population believes that women should contribute to the family income (Schulze, 1999). In the year 1999, UK had approximate 35% of the mothers of pre school children using some form of daycare and approximate 27% of mothers of children aged between 5 -12 using some form of out-of-school care (SCP, 2000). This finding suggests that many children in Britain are left under the care of a third party having no one at home. Once out of school, they have low levels of parental supervision and are more likely to indulge in reckless behaviors, premature sex included. Conclusion Teenage pregnancy poses a societal problem in the UK with the statistics of cases recorded alarming. Teenage pregnancy is caused by a wide range of factors surrounding young people. However, parenting and social economic issues are the major categories that contribute towards the high levels of teenage pregnancy. Due to the adverse effects experienced by the young mothers some of which are long term, it is vital that collective measures that best suit the phenomenon are adopted. By doing this, many teenagers will be saved the misery of upbringing children while being disadvantaged by numerous factors discussed.

Friday, March 6, 2020

Free Essays on Mount Vernon

The United States of America is the land of the free, but was this true for everyone in the early part of our country’s history. Being born into a world in which slavery was accepted, George Washington owned slaves at the early age of eleven. Inheriting his father’s land, George and Martha Custis became married and settled at Mount Vernon. Although Washington would purchase many more slaves to work on his estate, his attitude changed as he grew older. During the Revolution, as he and fellow patriots strove for liberty, Washington became increasingly conscious of the contradiction between this struggle and the system of slavery. In this paper I will discuss the life of Washington’s family and his slaves at Mount Vernon. During the 17th and 18th centuries, chattel slavery was a common aspect of American society; so common in fact, that at least seven of our first ten presidents, including George Washington, owned slaves (Randall 23). These slaves were considered property with the same legal standing as a horse or wagon. Slaves could not legally own property or get married and could be bought, sold, or rented. They were given as gifts, bequeathed to friends and relatives in wills, and even offered as lottery prizes. The colonial plantation system in early America was dependent upon the availability of abundant labor and George Washington’s Mount Vernon estate was no exception. George Washington was born into this society, inheriting slaves from his father at the age of eleven. When he and Martha Custis married in 1759, their combined slave-community numbered about fifty. By 1772, just two years before the Revolutionary War, Washington had purchased an additional fifty slaves. It was during this War for Independence that his views on slavery began to change, eventually leading to his resolve never to buy or sell another human being. During his presidency, Washington privately encouraged members of Congress to champi... Free Essays on Mount Vernon Free Essays on Mount Vernon The United States of America is the land of the free, but was this true for everyone in the early part of our country’s history. Being born into a world in which slavery was accepted, George Washington owned slaves at the early age of eleven. Inheriting his father’s land, George and Martha Custis became married and settled at Mount Vernon. Although Washington would purchase many more slaves to work on his estate, his attitude changed as he grew older. During the Revolution, as he and fellow patriots strove for liberty, Washington became increasingly conscious of the contradiction between this struggle and the system of slavery. In this paper I will discuss the life of Washington’s family and his slaves at Mount Vernon. During the 17th and 18th centuries, chattel slavery was a common aspect of American society; so common in fact, that at least seven of our first ten presidents, including George Washington, owned slaves (Randall 23). These slaves were considered property with the same legal standing as a horse or wagon. Slaves could not legally own property or get married and could be bought, sold, or rented. They were given as gifts, bequeathed to friends and relatives in wills, and even offered as lottery prizes. The colonial plantation system in early America was dependent upon the availability of abundant labor and George Washington’s Mount Vernon estate was no exception. George Washington was born into this society, inheriting slaves from his father at the age of eleven. When he and Martha Custis married in 1759, their combined slave-community numbered about fifty. By 1772, just two years before the Revolutionary War, Washington had purchased an additional fifty slaves. It was during this War for Independence that his views on slavery began to change, eventually leading to his resolve never to buy or sell another human being. During his presidency, Washington privately encouraged members of Congress to champi...

Tuesday, February 18, 2020

Michel Vinaver Essay Example | Topics and Well Written Essays - 1750 words

Michel Vinaver - Essay Example When he left Gillette in 1986, he was an acclaimed playwright and writer. The story comes across as a contemporary, issue-based relationship between a mother and her 17-year old son. However, the relationship goes through testing times as a result of the son, 1Philippe's tryst with drugs and his arrest in this connection. His mother, Helena wishes to communicate reason to her son. The stark difference in the attitude of the characters does not need reason. The reasons exist, but they are not tackled in the play. Vinaver takes the scene right across the audience and uncannily tests their power of imagination. Strangely enough the audience comfortably lap up the reason. The scene is right out of the normal home where there is a teenaged son. The catch is in the way the scenes are presented in bits and pieces. The audience is at the edge grappling with the pieces in the jigsaw puzzle when all of a sudden there is a move, a particular scene that provides a breakthrough. The reaction is almost the thrilling climax of a long and difficult journey (Factors Unforeseen). Helena is concerned about her son's misbehavior. However, she is not keen on losing her son and so does everything possible to make him understand without rocking the boat. She does not want to lose him. On the other hand, Philippe is not too keen on snapping the relationship either. His behavior and attitude may show signs of the coming moment when he is all ready to break out of his mother's confining influence. However, he does not do it. What he does is, however, criminal. The disjoint in the big picture is very clear. The audience wants this breach to be cleared. The happy ending is elusive. Vinaver is master stroke player in the realm of presentations. He may not be the ideal narrator. He does not provide a commentary. However, he makes his world by fitting in the pieces rather than do it one-step-at-a-time. He is adept at keeping the audience in humor although he does not allow them to ease down on the suspense. The glass pieces in the kaleidoscope may change in form and colo r. But he uses the time element to project the solutions in sharp, almost quixotic variations. Philippe may do all that Helena does

Monday, February 3, 2020

Geckos as Pets Assignment Example | Topics and Well Written Essays - 1000 words

Geckos as Pets - Assignment Example In making the decision to purchase any kind of pet, whether it be a mammal or reptile, the main considerations are personal lifestyle options, purpose for getting the pet, time that must be spent on care, money for care, habitat requirements, and longevity of the pet (Humane Society, 1-3). For active individuals or those with extended work hours, finding the time to properly care for and train a puppy would be extremely trying, for instance. Both cats and dogs require a minimum of an annual visit to the vet along with vaccinations and preventive maintenance, all of which take time and money. In planning for the purchase of a dog, availability of an area to play and take care of bodily functions is a necessary consideration - a large breed of dog such as a Labrador Retriever cannot be kept confined in a small apartment without it being considered cruel. Longevity of the chosen pet is also a factor in choosing a pet; some birds can live up to one hundred years old! All of these aspects of pet ownership must be considered before making a decision that will be life-impacting. Geckos, conversely, require a minimal amount of care. Leopard geckos, or Eublepharis macularius, in particular, are one of the most popular reptiles kept as pets. ... The Crested gecko, or Rhacodactylus ciliatus, hails from New Caledonia. The Crested gecko was previously thought to be extinct but a number of them were found on the island in the 1980s. Today they are raised in captivity for the purpose of selling as pets. The Crested gecko comes in a variety of beautiful and extreme color combinations. They are a bit smaller and just a few years shorter-lived than their Leopard variety cousins as well being omnivorous as opposed to insectivorous. The Crested gecko is arboreal and enjoys being housed in a tall cage with plants, real or artificial. Crested males must be kept separate from each other as their natural instinct is to fight each other to the death (LaFerriere). Proper care for geckos includes providing the right habitat and environment. A 15 - 20 gallon glass tank is large for several geckos, but males should be kept separate from females unless the owner is prepared to deal with offspring. Some sort of soft substrate, such as paper or a piece of outdoor carpet, is sufficient while providing a hiding place, such as a half piece of bark, will allow them a place for privacy. Unlike other reptiles, geckos do not require a UV light but a small, dim bulb above the tank can be installed for the purpose of basking. A shallow dish of water and a diet of insects will keep the gecko happy and healthy (McLeod). Crickets or mealworms can be given once a day for young geckos and once every other day for adults. These foods are easily and inexpensively purchased at most pet supply stores. Owning a gecko can be a very positive and rewarding experience for a young child. The housing tank can easily be kept in a child's bedroom, where they can

Sunday, January 26, 2020

Annotated Bibliography: Fast Dissolving Tablets Research

Annotated Bibliography: Fast Dissolving Tablets Research 3. LITERATURE REVIEW M. Geetha et al. (2015) had prepared fast dissolving tablet of anti-asthmatic drug terbutaline sulphate using direct compression method. Study was related to compare natural super disintegrating agent plantago ovate husk powder with synthetic superdisintegrant crospovidone. They concluded that natural super disintegrant showed better disintegration, dissolution, fast onset of action and it is also cheap easily available, non-toxic. Accelarated stability study was also performed which also showed positive results.[13] Muhammad Talha Usmani et al. (2015) had prepared orally disintegrating tablet of Montelukast sodium by two different formulations using cost effective direct compression method. They have used cherry flavor and aspartame as sweetener. Formulations were evaluated for its performances and obtained better formulation which were subjected for further study by central composite design.[14] Balagani Pavan Kumar et al (2015) had prepared Nizatidine dissolving tablet. Taste masking is done by eudragit E100 using solid dispersion method and tablets were prepared by spray drying and solvent evaporation technique. Tablets were prepared using crospovidone, soy polysaccharide in three different concentrations and evaluate for disintegration time, drug release and taste masking.[15] Vivek Dave et al (2015) had prepared rapidly dissolving tablets and which give quick onset of action to overcome poor patient compliance associated with conventional tablets tablets were evaluated for disintegration time, wetting time, dissolution rate and taste masking. Hence, it lead to improve bioavailability of drug and efficacy.[16] Pradip Solanki et al (2015) had prepared mouth dissolving tablet to treat schizophrenia with clozapine as active agent. Solubility was tested in all complexes of cyclodextrin from which HP ÃŽ ²-CD showed maximum solubility. Trial batches were carried out for Screening of diluents and superdisintegrant. 32 factorial design was used to optimize formulation. The optimize formulation is evaluated for its disintegrstion rate, drug content, drug release, wetting time.[17] Bhavani et al (2015) had prepared rapidly disintegrating tablet to improve patient compliance who have difficulty to swallow the tablets and hard gelatin capsules. MDTs have enhanced safety and improve patient compliance. Mouth dissolving tablet are beneficial for many patients like psychics, geriatric, paediatric, unconscious and bed-ridden patients who have difficulty for swallowing tablets and capsules.[18] Nagar Praveen Kumar et al. (2014) had prepared fast dissolving tablet of piroxicam using three different superdisintegrants. They had prepared 9 batches of natural super disintegrant that is guar gum, isapghula and fenugreek by changing 3 concentrations. For preparation of tablets they used direct compression method. The powder blend and final tablets were evaluated for flow property and release optimization. Accordinhg to their results F4 batch is optimized and that have shown 99.18% of drug release.[19] Anisree. G. S et al. (2014) had developed Levocetrizine hydrochloride mouth dissolving tablet. Drug and excipients were mixed and tablets were formulated using direct compression method. Drug-excipient study was carried out by IR spectra. They had concluded that the formulation having MCC and crospovidone have optimum drug release.[20] Pratibha et al. (2014) had prepared fast disintegrating tablet by using Metoclopramide hydrochloride as active agent to overcome swallowing problems. Prepared tablets by direct compression method. Compatibility were done by FTIR and DSC. Selection and Optimization of superdisintegrant was also done by evaluation of prepared tablets.[21] Taksande JB et al (2014) had developed fast dissolving tablet of non-steroidal anti-inflammatory Drug Lornoxicam with synthetic and natural superdisintegrant using direct compression method. Banana powder and soy polysaccharide were used as natural superdisintegrant and crospovidone was used as synthetic super disintegrant. They have concluded that natural superdisintegrants showed more disintegration as compared to synthetic agents and can be used instead of Synthetic materials.[22] Deepak Sharma et al (2014) had prepared Cetirizine Hydrochloride fast disintegrating tablet. They have used different binders and disintegrants and their different concentrations in present study. They have optimized sodium starch glycolate as super disintegrant. Direct compression is used for tablet preparation. The optimized formulation is evaluated for drug release, compatibility study, accelerated stability study and concluded that the prepared formulation have quick onset of action and increases patient compliance.[23] Geetha lakshmi et al. (2014) had prepared fast dissolving tablets using different superdisintegrants and its different concentration. Interaction is checked by FTIR spectroscopy. The tablets were prepared and evaluated. From the prepared 9 batches they have optimized F6 as best formulation which disintegrated in 12 sec and released drug in 6 min up to 99.46%.24] Alpana P. Kulkarni et al (2014) had prepared orally disintegrating tablet of Rizatriptan benzoate and also masked its taste. Taste masking of drug was carried out by mass extrusion with eudragit EPO and aminoalkylmethacrylate copolymer with different ratio. The formulation was optimized based on drug polymer interaction and bitterness score. Taste maskin was checke by in vitro release of drug in salivary fluid.[25] Lovleen Kaur et al (2014) had prepared Aceclofenac fast dissolving tablets by direct compression method. Lepidium sativum mucilage was selected as natural superdisintegrant and Different concentrations were also used. A 32 factorial design was applied to optimize the formulation. Nine batches (D1–D9) were formulated accordingly. Two independent variables were selected and their effect on three dependent variables were studied.[26] Rajeshree. et al (2012) had prepared Lisinopril fast dissolving tablets using natural superdisintegrants by direct compression method. Aloe Vera and mucilage of Hibiscus rosasinensis were used as natural superdisintegrants. Compatibility was studied by FTIR spectroscopy between the drug and excipients. The formulation was evaluated for in vitro drug release. Formulation containing Hibiscus rosasinensis was found to be optimized formulation which contain disintegration in 0.26 sec. [2] Murthy. et al (2012) had developed Lisinopril fast dissolving tablets using super disintegrants in different concentration by direct compression method. Superdisintegrants such as croscarmellose, crospovidone, sodium starch glycolate were used. All formulations contain various proportion of drug and excipients from them crospovidone showed better drug release then other formulations.[3] Patel. et al (2011) had formulated nimesulide fast dissolving tablet using natural superdisintegrant lepidium sativum which is widely used as herbal medicine. Mucilage was added as disintegrating agent. They have concluded that mucilage had reduced the disintegration time. The formulation also contain mannitol to increase solubility of mucilage.[4] Saini. et al (2011) had developed mouth dissolving tablet of anti- allergic drug Levocetirizine dihydrocloride. Tablets were prepared by using cost effective direct compression method and crospovidone was used as superdisintegrant. Different concentration were taken and they have concluded that as concentration of crospovidone increases disintegration time also increases.[5] Mayank. et al (2011) had formulated Lorazepam fast dissolving tablet. Method was the same direct compression. Tablets were evaluated for disintegration time, drug release, wetting time and also compared with marketed formulation. They have concluded that the prepared tablet showed better release profile than marketed formulation. Formulation containing 12% of Croscarmellose sodium showed disintegration in 33sec and showed 95.99% drug release within 10min.[6] Rahul Nair et al (2011) had prepared polymorphs of Rizatriptan benzoate by solvent evaporation method. They have used many solvents like tween 80, PEG, Polyvinyl pyrrolidine, methanol. Four different polymorphs were prepared and evaluated by Dissolution study, differential scanning calorimetry, infra-red absorption spectrum, scanning electron microscopy. They observed change in melting point of form I and form II with compare to original drug. Final conclusion was that polymorphs prepared by tween 80 showed better drug release than other forms.[27] Rahul Nair et al (2011) had developed solid lipid nanoparticles of Rizatriptan. Solid lipid nanoparticles were prepared by modified solvent Injection method. Characterization were carried out for shape, particle size, surface morphology and drug entrapment. They observed spherical shape, with particle size of 141.1-185.7 nm and smooth surface. The prepared particles showed sustained release of drug.[28] Raghavendra Rao. et al (2010) had developed fast dissolving tablet of chlorthalidone which have low dissolution rate by different techniques to improve its dissolution rate. From that they have showed the sublimation as best technique in which they had used 40% of camphor increases dissolution rate of drug. [7] Shailesh. et al (2010) had prepared promethazine thiolate fast dissolving tablet using sodium starch glycolate, ac-di-sol and crospovidone as a super disintegrating agents. Tablets were prepared by direct compression method and evaluated for post compression parameters. They have concluded that tablets containing ac-di-sol have better drug release and in vitro dispersion time. [8] Raghavendra Rao. et al (2010) had developed fast dissolving tablet of Carbamazepine by using solid dispersion technique. They have used different concentration of super disintegrating agent that is croscarmellose sodium and studied effect of various carriers. From the study they have concluded that formulation having mannitol as a diluent showed disintegration in 12-18 seconds.[9] Shirsand. et al (2010) had formulated and evaluated fast dissolving tablet by using latest solvent evaporation technique. Sodium starch glycolate and Crospovidone was being used as novel co-processed super disintegrating agents. They have concluded that formulation having 4% w/w of crospovidone was the optimized batch.[9] Keny RV et al. (2010) had formulated Rizatriptan benzoate fast dissolving tablet for intended benefit. Direct compression was used to prepare tablets. Crospovidone was used as super disintegrant. Tablets were evaluated for all pre compression and post compression parameters. Assay was performed by high performance liquid chromatography.[18] Gudas GK et al. (2010) had developed chlorpromazine fast dissolving tablet. The tablets were prepared by using croscarmellose sodium, sodium starch glycolate, L-HPC, crospovidone, pre-gelatinised starch by using direct compression. Blend was evaluated for flow property and tablets were characterized for its thickness, hardness, disintegration and dissolution.[12] Randale SA et al. (2010) had developed taste masked rapid disintegrating tablet of metoclopramide. Taste masking was done by the extrusion-precipitation method by complexing drug with Eudragit in different ratio. All formulations of drug polymer complex was characterized for in vitro taste in simulated salivary fluid and drug content. Final conclusion was that the batch having drug polymer ratio 1:2 was optimized for taste as well as for drug release.[11] Khemariya P et al. (2010) had developed meloxicam mouth dissolving tablet using sublimation technology. The tablets were formulated by wet granulation method. The tablets were characterized for all post compression parameters e.g. friability, hardness, wetting time and disintegration time. They have concluded that tablets prepared from sublimation of camphor were found better than tablet prepared by exposing to vacuum.[15] Bhardwaj S et al. (2010) had prepared accelofenac fast disintirating tablets. Tablets were prepared by direct compression technique using sodium starch glycolate as super disintegrant. All post compression parameters were tested for its performance. All the batches showed disintegration time within 28 sec.[16] El-Massik MA et al. (2010) had developed meclizine orally disintegrating tablets by using a maltodextrin. Tablets were prepared by direct compression as well as wet granulation method. Effect of concentration of maltodextrin was characterized by tablet’s disintegration time and hardness. They have concluded that maltrodextrin up to certain level produces increase in disintegration but then after decreases.[17] Rajalakshmi G et al. (2010) had prepared pheniramine maleate orodispersible tablets. The tablets were formulated by direct compression method. sodium starch glycolate, croscarmellose sodium, low hydroxylpropyl cellulose, pre-gelatinized starch and crospovidone were used as superdisintegrants in different ratios. The blends were characterized for pre-compression parameters. Tablets were characterized for post-compression parameters.[19] Zade. et al (2009) had formulated Tizanidine Hydrochloride tablet and also prepared taste masked granules of drug using eudragit E 100 to make the tablet with no bitter taste. For preparation of taste masked granules mass extrusion technique was used. Tablet were prepared by synthetic disintegrants. The final coclusion was that tablets prepared by using superdisintegrants were better than prepared by sublimation method. [8] Mahamuni SB et al (2009) had developed fast dissolving tablet of Promethazine HCl, which can radily disintegrate in the saliva. Taste-masked granules were prepared to mask bitter taste of drug. The taste masked granules were formulated by Eudragit E-100 using extrusion method. Tablets were formulated using taste-masked granules with other excipients like microcrystalline cellulose and starch.[13] Shirsand SB et al (2009) had prepared prochlorperazine maleate fast disintegrating tablets using direct compression method. One natural superdisintegrant Mucilage of plantago ovata and one synthetic superdisintegrant crospovidone were used with microcrystalline cellulose and mannitol to give sweet mouth feel. The prepared formulations were evaluated friability, wetting time, water absorption ratio, drug content uniformity, and in vitro dispersion time. Batch containing 8% w/w of plantago ovata mucilage was optimized from the data.[14] Kalia A et al. (2009) had designed oxcabazepine mouth dissolving tablets. Tablets were prepared using two different methods, direct compression and solid dispersion. Direct compression was used by crospovidone as a super disintegrating agent and aspartame sweetener. Solid dispersions of drug were carried out with PVP K-30 and PEG 6000 in different concentration ratios to increase its solubility. They concluded that solid dispersions with drug: carrier in ratio of 1:2 showed maximum drug release. From the comparison of two technologies solid dispersion was found better and gives satisfactory and reproducible results.[20] Swamy PV et al. (2009) had developed pheniramine maleate orodispersible tablets using effervescent method.tablets were prepared by using sodium starch glycolate, crospovidone, pregelatinized starch and croscarmellose sodium with sodium bicarbonate and tartaric acid. Prepared tablets were evaluated for all post-compression parameters. The final conclusion was that the formulation having 4% crospovidone mixed with tartaric acid and sodium bicarbonate was best.[21] Devireddy SR et al. (2009) had designed levocetirizine dihydrochloride orally disintegrating tablets of using synthetic superdisintegrants (sodium starch glycollate, croscarmellose sodium, and crospovidone) and mannitol as a diluent. Taste masking was done by poly kyron T-134, Indion-204 and Tulsion-335 ion exchange resins. The drug- resin complex was formulated using the kneading method. By varying the concentration of ion-exchange resine and superdisintegrant using wet granulation method by PVP k-30 used as binder. The tablets were evaluated for disintegration time and degree of taste masked.[22] Okuda Y et al. (2009) had developed new preparation method for orally disintegrating tablet that has high hardness and less disintegration time. For that they have prepared rapid disintegrating granules using mannitol or lactose, saccharide was spray coated with corn starch suspension in fluidized-bed granulator. Crospovidone or hydroxypropyl starch was included in suspension as additional superdisintegrants. The prepared granules have large surface area, micro pore and low particle size distribution. Tablets prepared using this granules increased hardness and increased disintegration time by decreasing plastic deformation.[23] Singh J and Singh R. (2009) had developed meloxicam orodispersible tablets and optimized the formulation using a 22 factorial design for enhanced bioavailability. Tablets were prepared by wet granulation method having non-aqueous solvent. Crospovidone was used as superdisintegrant and mannitol as diluent as well as taste masking agent. Four batches were carried out to investigate optimum concentration of crospovidone and mannitol.[26] Giri TK et al (2009) had designed diazepam rapidly disintegrating tablets. The tablets were formulated by the wet granulation method. Bitter taste of drug was masked by solid dispersion using PEG-4000 and/or PEG-6000. Tablets were prepared using different concentration of PEGs. A 32 factorial design was applied to optimise the formulation and to decrease experimental run. They have concluded that the tablets prepared by PEG-4000 in lowest concentration was disintegrated within 33 sec and drug release was found 85% within 12 mints.[24]

Saturday, January 18, 2020

Lockheed Martin Corporation Essay

Lockheed Martin is an American aerospace multinational that also specializes in defense, security and advanced technology industries. The corporation was instituted in 1995 following the merger between Lockheed Corporation and Martin Marietta (Yenne, 2000). The corporation is based in Bethesda in Maryland with global centers that specialize in different aspects of the corporation’s many operations. Currently, the corporation employs over 120,000 employees scattered across the world. Presently, Lockheed is one of the largest defense contractors in the world and enjoys almost unlimited orders across the world. The operations of the corporation are divided into different segments comprising electronic systems (27%), aeronautics (27%), information systems and global solutions (27%) and space systems (19%). Today, US government contracts account for much of the corporation’s revenue while foreign government contracts also make up a substantial share of the revenue. On the other hand, orders from commercial clients only make up a mere 2 % of the total revenue the corporation nets in a year. In 1996, the corporation finalized the plans to acquire Lorad Corporation which subsequently became part of the corporation at a cost of $9. 1 billion. Like any other global corporation engaging thousands of employees across the world, Lockheed is certainly faced with a myriad of challenges that normally define business operations in the present world. One of the greatest challenges facing the corporation is the need to address employee concerns and effectively tackle the aspects of employee and industrial relations without many problems like is always the case. On certain instances the corporation has had to face the challenge of striking workers and go slow as employees complained about various aspects relating to their operations in the organization (Terris, 2010). In that regard, the aspect of dealing with these employee concerns has been one of the greatest employee challenges affecting the organization. Like most workers in the industry, most of Lockheed’s workers are unionized under the International Association of Machinists and Aerospace workers and are always part and parcel of the activities steered by the association. The International Association of Machinists and Aerospace Workers is a worker organization, which draws its origin in 1888 when a group of nineteen machinists came together and formed the Order of the United Machinists and Mechanical Engineers. With time, the small organization grew in membership and adopted the present name. The organization has had a turbulent history characterized by the growth of labor movements in the twentieth century. The growth of the union went in tandem with the development of the transport industry throughout the years as more and more workers became employed in the industry. During its formation, the organization was generally a secret affair given that employers of the time were very critical and hostile toward organized labor movements. However, the Order rapidly spread beyond its formation zone of Georgia and was soon a recognized affair in the United States. Much of the growth in the membership of the union was mostly evidenced during the World Wars when workers in the transport industry increased owing to the increased demand of vehicles and airplanes (Cimini, 1994). In the course of the 1970s, the union was segmented into several divisions dealing with specific issues affecting the members. These included civil rights, organizing, older workers and retired workers and women. At a convection held in 1984 in Seattle, Washington, the delegates voted and decided to use the Placid Harbor Education Center in order to train and educate the members of the union. In 1998, the center was renamed to the Winpisinger Education and Technology Center in order to recognize and honor the late president of the union. Throughout history, the union has always addressed the issues affecting the workers and negotiated with the relevant employers on specific aspects relating to the welfare of the employees Contract Management, 2010). Over 3000 workers of Lockheed Corporation are unionized under the IAM and are always in track with the labor union. The union has always negotiated in several instances regarding the welfare of the workers of Lockheed. In 2009, IAM came under much negotiation with the management of Lockheed at Fort Worth where the corporation manufactures jets. The issues at play in that case were healthcare costs and pensions where the workers were over 3,900 people in total opposition with the management of the corporation. At an address to the workers on 19th April, 2009, IAM President promised the workers that the union would keenly negotiate for a fair and just contract between the members and the management of Lockheed (Julian & Denver, 2011). The core of the matter in this regard emerged out of the decision by Lockheed’s management to announce that it would eliminate pension programs for new hires and would also increase healthcare costs for all the workers at the corporation’s Fort Worth plant. The IAM Negotiating Committee promised that it would effectively address the issue with the parties and warned Lockheed against its wrong moves. There were also allegations that the company was planning to introduce very expensive healthcare plans if the workers rejected the idea of elimination of the then present healthcare plan (Sears, 2006). In the course of the negotiation, the union thwarted the efforts by the company to keep the proceedings away from the workers. They periodically informed the workers on whatever was transpiring between them and the management. Much of this effort was complemented when the union created a website from where information relating to the preceding talks was posted and the workers could easily follow. The union organized a series of committees to handle the various logistics of the strike and to keep the employees as well as the public well informed of the proceedings. Several committees came into formation, including the strike committee, communication, community service, film crew and kitchen (2010). These committees were basically assisting the union officials in addressing the challenge of the talks given that the public and the government had very special interest in the whole situation. In the course of the negotiations, the union officials presented the management of the corporation with an economic counter proposal. The management was supposed to go over the proposal and respond to the various questions that were thereby addressed. After going through the contents of the proposal, the officials of the organization invited the union officials to the bargaining table. In their arguments, the management enunciated that their plan to cut off the pension for the new hires was just appropriate and was basically a process of addressing the challenges the organization was facing at that time. In the process, it appeared that the management of the corporation was very adamant and did not want to cede ground on the bargaining table. While the management claimed that they actually paid their workers well and they could therefore afford the new proposal it was putting forward, the union members totally rejected the notion as giving through one hand and taking by the other which was basically unethical in business practice. As part of the initial negotiations, the management of Lockheed confirmed that it had given the union the option of accepting a 3 percent wage rise increase for the contract workers who were facing the challenge of the healthcare plan (Boyne, 2010). Moreover, additional signing bonus of $3,000 was also offered per worker as part of the deal. This was to be supplemented by $ 800 to cover the annual increase in the cost of living in the United States. According to the management, this was basically to be a contingency plan in order to address the fundamental issue at hand and enable the workers to return to their work. In the same process, Lockheed was facing similar pressure from Pentagon and was seriously in a fix to accept the proposals of the union. It was, however, a blow for the company when the union officials totally rejected the contingency plans on the account that they had never been successful in the past and that the company had always not honored such obligations (Anderson, 2009). In retaliation, Lockheed created the view that it could effectively continue its operations without much regard to the unionized workers who were seeking a change of the healthcare plans. The corporation announced that the mployed workers would effectively replace the unionized workers in the course of the operations ((IAMAW, 2012). For a while, amid the negotiation talks, it appeared that the strike was actually an unending affair given that most operations in the corporation had began resuming despite the striking unionized members. It was certainly a blow and a great challenge to the negotiation process and it created the need for further talks and measures to address the situation. The emerging situation presented the union officials with a lot of challenges and they opted to seek for alternative measures of operations while continuing with the negotiation process. Collective bargaining was effectively used in the negotiation between the union officials and the management of the corporation. For a while, it appeared that much of the efforts of the union and the workers would not bore any fruit given the obduracy of the management in seeking to rescind the initial plans. However, light was seen at the end of the tunnel when finally the management of Lockheed agreed to give their presentation regarding a new pension plan that they had opted to adopt instead of their earlier proposal. However, the union was very keen on accepting the proposal and several more negotiations were further made before an amicable solution was reached. In any case, collective bargaining had been the most applicable strategy in the negotiation process and it certainly appeared that most of the challenges of the workers at that time had been resolved at least for a while. The unit that was involved in the collective bargaining process was drawn from the members of the union and also had representation from the unionized members. The committees that were established had actually been drawn from the corporation’s workers. The negotiation process basically consisted of the union officials and the management of Lockheed who were mostly represented by the top officials at the corporation. The corporation being the largest defense contractor in the United States and beyond meant that the government has a lot of interest in its operations. Pentagon, therefore, played a great role in the negotiation process by its advice on the management to seriously regard the specific aspects that were under consideration in order to avoid any disruption of the production process. At the end, it was realized that the basic issues of health care and pension plans that had actually affected the workers were resolved quite amicably and the whole episode ended effectively. The management of Lockheed is certainly faced with a myriad of challenges, which normally affect the operational process. In any case, the corporation has always continued to address the issues affecting the employees in the most effective manner that mutually benefits all the parties in the negotiating table. (Rubenstein, 2007) In conclusion, it has to be stressed that the aspects of employee relations is a fundamental issue that affect large and small corporations alike. The most important concern is, however, the need to provide effective working environment and address the challenges facing the employees in the most effective way possible. The role of the labor unions in this regard cannot be overemphasized given their imperative role in representing the needs of the workers. In the collective bargaining process as a way of seeking to arrive at amicable solution with regard to the issues affecting the organization, it is realized that mutual understanding on each part of the bargain team is certainly an important consideration in the process. Whichever the case, negotiations can always help address the issues so long as the parties approach such negotiations with the seriousness they certainly deserve.

Friday, January 10, 2020

Object Relations Case Formulation

1. Identifying details Name: Katrina Katryn Age: 20 Gender: Female Marital status: Single Dependents: N/A Highest level of education: Matric Present occupation: Student (Psychology 1st year) Reason for referral: Self exploration, dealing with the past, improving interpersonal experiences. Referral source: Self-referred 2. Presenting problem She experiences considerable anxiety in interpersonal situations. In addition she has feelings of inadequacy, worthlessness and hopelessness. These difficulties lead to academic concerns and relational problems in her current situation.Her self-esteem is extremely low and she expressed that she hates doubting herself constantly. 3. History of presenting problem. She was sexually abused when she was between 6 and 9 years old. The rest of the time she was emotionally and physically abused. She has always felt inferior and had low self-esteem as long as she can remember. She was diagnosed with depression at age 15 and was put on medication. She canno t remember the name of the anti-depressants and did not remember the exact diagnoses. The feelings of hopelessness and her academic problems has started relatively recently according to her. 4.Past illnesses Psychiatric Mood disorder (She cannot remember the exact diagnoses. ) Medical Nothing significant Anti-depressants (unknown) Adaptive features and Strengths She is intelligent and ambitious. She has shown courage in confronting her father about the abuse and her decision to mend their relationship show courage. She seems to have insight into her difficulties and the processes that keep them alive. She seems to be willing to change and to explore these difficulties in depth. The fact that she removed herself from her deleterious environment in adolescences is indicative of her self-preservative abilities.She is currently in therapy on a self-referral which again points out these abilities. She has taken responsibility of protecting her siblings in the past and the present which i ndicate her compassion for others. She seems to trust me and it is likely that we will form a therapeutic alliance. 5. Personal history I. Birth and early development As far as Katrinais concerned she was a wanted and welcomed baby although the pregnancy was not planned. The pregnancy was normal at 40 weeks without any complications. She did not experience any serious illnesses and was not involved in any accidents.She reached all her developmental milestones within the average intervals. This thus indicates a normal developmental trajectory throughout infancy. Katrina’s socio-emotional history was significantly compromised by physical, emotional and sexual abuse. She had an extremely wounding relationship with her father who mistreated her and then after the mistreatment behaved alluring towards her. She mentioned this several times during most of our sessions. She also had an ambivalent relationship with her mother during this time.Her mother would at times be very loving, caring and supportive, yet at other times ignore her cries for help and her need for her affection. She did not enjoy any close knit friendships and it seems that the only person she shared a healthy relationship with was her grandmother. This relationship however was constantly under attack from her parents. She described herself as an obedient and shy girl who felt lonely and different. II. Childhood During her childhood Katrina lived in a very traumatic family situation full of psychological, sexual and physical abuse.She mentioned that everything from her childhood was connected to a bitter feeling. She lived with her mother, father and younger sister. Her father was unhappy, aggressive, insecure, but in her childhood she experienced him as a powerful and great authority. Her father was sexually abused as a child. He was very strict and required discipline from his two children, especially from Katrina. He set strict rules and if these were broken, he beat Katrina. If she oppose d him and objected to what he said, he hit her. When she was seven years old she was sexually molested by him on a regular basis.This continued until she was 9 years old and then her father stopped the sexual abuse. The emotional and physical abuse nevertheless continued throughout her childhood until she emancipated herself from her parents. Katrina’s socio-emotional history was significantly compromised by physical, emotional and sexual abuse and by the response of her mother during this time. On the one hand her mother was a warmer person than her father but she was subordinated to Katrina's father. Her mother's attitude towards her was very variable.Sometimes she was kind and interested in her, yet in cases when she did not like something she scolded, even hit her, which Katrina understood as the end of their relationship and love. But when her mother showed her compassion again, Katrina immediately forgave her. Her mother would at times be very loving, caring and support ive, yet at other times ignore her cries for help and her need for her affection. She did not enjoy any close knit friendships and it seems that the only person she shared a healthy relationship with was her grandmother.This relationship however was constantly under attack from her parents. She described herself as an obedient and shy girl who felt lonely and different. Katrina's parents often quarrelled with each other, although father was less often physically aggressive towards the mother than towards Katrina. Katrina blamed herself for being the cause of disagreements, e. g. when she wanted something, parents quarrelled, because her father prohibited it while her mother allowed. So Katrina preferred to suppress her wishes and remained quiet to avoid quarrels.According to her conclusion there would be peace at home if she was a good girl. Even at her young age, Katrina had to assume responsibility for her younger sister. She was like her shadow and prevented her (Katrina) from re laxing completely. As mentioned earlier, Katrina’s only solace in her childhood years was her maternal grandmother. According to Katrina she was the only person she felt completely safe with. When Katrina was 9 the sexual abuse from her father stopped, Katrina told her grandmother about it and the father admitted to it and entered rehabilitation.Her mother nevertheless stayed married to him for the meanwhile and Katrina was expected to share a life with him despite the abuses he committed against her. She expressed the wished to stay with her grandmother, who at that time stayed quite close to them. It was however her mother and father’s (I suspect her father’s) decision to move away. Katrina remembered feeling like her world fell into pieces when this event occurred. Katrina and her younger sister were informed that another sister is on the way during this time.Katrina remembered that she was a shy little girl who found it difficult to make new friends. She rem embered how difficult the move was for her leaving her friends and grandmother behind. III. Adolescence A stated previously although the sexual abused stopped her father continuously physically abused her until the age of 16 until she emancipated herself and went to live with her grandmother. Katrina explained that this was done despite protests from her mother and father. She went to visit her grandmother one holiday and never returned home.She felt extremely guilty leaving her 2 sisters behind but felt that this was the only way she could fled from the abuse of her father. She is not sure whether or not her father had abused her little sisters sexually but stated that he never physically abused them. Her parents divorced after this and her mother moved to Botswana where she still lives today. Katrina stayed with her Grandmother until she finished school. She did however not speak about her grandmother a lot in our sessions and only mentioned a few superficial accounts. She express ed that she was ordinary in high school and could not remember anything that stands out.She did however comment on the fact that she had a couple of boyfriends she referred to as â€Å"dominating idiots which she could not leave at will although she hated the relationships. She did have 1 or two close friendships. Her father remarried and Katrina has an ambivalent relationship with her stepmom who she describes as manipulating, controlling and mean. IV. Family data Katrina is the first born daughter of her biological parent’s first marriage. She has two younger sisters, X who is 16 and Y who is 13. Her parents divorced when she was a teenager. Her father remarried and has two boys with her stepmom.Her mother and biological sisters stays in Botswana. Katrina sees them at least twice a month when she and her boyfriend go to visit them. Her mother had a boyfriend but they broke up recently when she was in therapy with me. V. Cultural features Katrina is a 20 year old Caucasian woman of the Christian religion. She is English speaking. VI. Social condition She is currently staying in the residence at the University she studies. She seems well looked after. She comes from a typical suburban middleclass background. She is dating a 20 year old guy, who I met.Other than this she has not mentioned other friends. It seems that her boyfriend and her family is her only support system at the moment. 6. Personality Katrina is somewhat introverted and extremely dependent. She seems to be submissive and self-criticizing. She is shy, withdrawn and apologetic. Although she at times seemed optimistic it was clear that this is a mask for her underlying pessimism and distrust in people in general. 7. Mental status examination Katrina was orientated to time space and place. She did not exhibit delusions, hallucinations or cognitive disturbances.She was dressed in line with the latest trends. Her appearance did not seem extravagant yet it was nevertheless neat. Her affect was a bit blunted initially and she did seem a little blocked off. This however changed throughout our sessions. 8. Diagnosis Axis I. Major depressive disorder, Recurrent, Moderate Axis II. Dependent Personality Disorder Axis III. None Axis IV: Problems with primary support group (victim of physical and emotional abuse in childhood; Disruption of family due to parents' divorce). Problems related to the social environment (inadequate social support).Axis V GAF: 55 :Moderate symptoms and moderate difficulty in social and occupational functioning. Comments: At termination GAF = 80 Good improvements in self-evaluation, self-esteem and assertiveness. Good reality testing and a sense of independence in her relationship with her father. 9. Prognosis Currently it seems that Katrina has dealt with a large part of her experience with the sexual abuse. She has gained some insight on the reasons she is overly dependent on people to make decisions for her and why she feels like she will lose relati onships or love when she assert herself in interpersonal situations.Although she will benefit to long term therapy I feel that we have dealt with key aspects in our 7 months together. 10. Case formulation The so called schizoid ego splitting can be noticed in Katrina. In her early relationships Katrina did not have safe attachments. She lived through mistreatment and lack of support, the consequence of which is that children hide their feelings and relational needs. This stops or slows down the process of integration and the ego gets fragmented (Klein, 1987, in Little, 2001).This gives rise to the first degree of a split or withdrawal as described by Fairbairn (1952, in Little, 2001), where the ego splits into coping/every day self (central ego), which maintains the relation with the outer world, and the withdrawn/vulnerable self (libidinal ego), which hides itself. At an early stage of development Katrina could not display some parts of herself, like feelings of vulnerability, ange r, playfulness, her own interests, the part connected with relaxation and enjoyment, because for all these she was punished with physical violence and emotional rejection.She most probably hid and suppressed this part of herself and thus the withdrawn/vulnerable self-formed. Outwardly Katrina showed her coping/every day self, which listened to the parents, was good at school and at home, who did not object and had no interests of her own, while being active all the time. During the psychotherapy Katrina mentioned several times that she did not know at all who she was, that she did not know herself and that in interpersonal situations that provoked any form of anxiety she felt like she was falling to bits.She described herself as an abused person and that that is all she is and nothing else. This might be because till then she mostly defined herself through others and through those specific experiences. This particularly describes the process of splitting into both previously mention ed selves, where the authentic self (vulnerable self) hid, while Katrina identified herself with the coping/every day self, which was more social self and represented her adjustments to the wishes of other people around her, like her mother and father. Simultaneously the splitting of external objects, i. . people who were important for her, occurred. The coping/every day self has to maintain a connection with important objects, otherwise the child could not survive on his/her own. This gives the child a sense of security (Little, 2001), which represents a very important need for Katrina, as will be further described in the following section. For Katrina to be able to keep a tolerably good connection with her mother, she had to separate bad experiences and internalize them, which suppressed her withdrawn/vulnerable self even more.In this way the coping/every day self is connected with the idealized object (Little, 2001), which also holds true in Katrina's case. At the beginning of ps ychotherapy Katrina strongly idealized her mother; she spoke only of good experiences with her, not remembering unlikable experiences, since these were split off. Only with on-going therapy was she gradually able to integrate these experiences. She was also very loyal to her mother, defending her all the time, not being angry with her, which all shows a strong tie between the coping self and the idealized object.An example of this the following : Katrina has received various complaints from her sisters and has experienced it for herself that her mother has sex with her boyfriend in the house where everybody in the house can hear everything. According to Katrina these events are quite explicit and make everyone extremely anxious and uncomfortable. She however defended her mother by saying that her mother deserves the happiness and pleasure and that Katrina wants her mother to be happy. â€Å"We can look past this because my mom deserves to be happy†. On the other hand Katrina had isagreeable memories of her father from the very beginning. She mainly blamed him for her ugly childhood, so that Katrina probably formed a split also between both parents (father thus representing the bad object, and mother the good one). Th e vulnerable self is in relation to the exciting/disappointing object (Little, 2001) and this represents the developmentally needed relationship between her mother and Katrina. Their relationship was very variable, i. e. her mother was warm and kind to Katrina some of the time. Katrina hoped that mother would satisfy her needs, but was later disappointed and rejected by her.I n my judgment Katrina's mother had great difficulties in getting attuned to Katrina. This resulted in the exciting/disappointing object to be experienced as painful and dangerous by Katrina, which meant that she suppressed this aspect into her unconscious as the disappointment. The withdrawn self, splits further to create the internal saboteur (Fairbairn, 1952, in Litt le, 2001), which serves to keep the vulnerable self, hidden and repressed. The saboteur's function is to precede criticism of other important persons and thus regulates a child's behaviour (Erskine, 2007).It is that is to say easier to bear inner criticism than criticism by important other persons, because this would signify an end of a vital relationship. Katrina on several occasions mentioned that she was afraid to speak her mind in her significant relational circumstances because she feared that it would mean the end of that relationship. It is also too painful to incessantly repeat disappointments due to unmet needs; therefore the inner saboteur blocks these needs and even denies their existence. In Katrina the inner saboteur (anti-libidinal ego) formed, manifesting itself in Katrina's excessive self-criticism.As early as primary school she criticised herself for her looks, clothes and shoes, her behaviour and her inferior abilities, and she worried that other children might not like her. Through her inner saboteur Katrina constantly controlled herself, her vulnerable self, e. g. , she forced herself to be strong, not to show emotions and to be well-behaved. She kept convincing herself that she didn't lack anything. Therefore Katrina created an inner saboteur to be able to survive with a violent father and aloof mother.The inner saboteur is in relation with the rejecting/attacking object, which attacks the vulnerable self so that the latter would remain suppressed (Little, 2001). Rejecting/attacking object in Katrina was formed by aggressive reactions of her mother and father, the violence (physical, sexual and emotional blackmail), daily criticism, humiliations etc. This part contains numerous contents, so the inner saboteur is very powerful. In my judgement then her dependent personality developed as a result of the above dynamics and within her early relational experiences described above.Her dependent tendency creates significant anxiety and difficulty in her current relations with people, especially in her relationship with her father from which she cannot separate completely. 11. Management plans The first few sessions were focussed on normalizing her feelings of ambivalence in relationships and her over dependence on other people’s decisions. I also highlighted her strengths for her in our early session. For instance the fact that she took the initiative to emancipate her from her parents at age 16 and that she entered counselling out of her own accord showed resilience and strength and would be useful in our sessions.Key aspects to work on and therapeutic goals (a) Help Katrina to talk about the abuse; (b) validate the Katrina's experience and feelings; (d) help to correct misperceptions of blame and responsibility for the abuse; (e) encourage Katrina to formulate and reach goals for personal coping and healing The first phase focused on stabilization and mastery: building the therapeutic relationship; reduction and co ntainment of stress-related symptoms; establishing safety; and coping with current life problems. The second phase we dealt with integration of traumatic memories.The final phase was concerned with self-development, relational development, and adaptation to daily life. PHASE 1: THE THERAPEUTIC ALLIANCE Katrina was hesitant about returning to counselling. She was sceptical about her safety in a therapeutic environment as a result of her previous experience in therapy. I was aware that Katrina had been dealing well with the impact of the sexual abuse, but her adult desire for stable relationships and being able to assert herself in these relationships called for therapy from a mature perspective.I worked to establish positive rapport. Employing a person-centred approach throughout the first few sessions established a safe environment. Katrina chose the topics for the initial sessions. I used open-ended questions to avoid leading her, and helped her determine which difficulties were of primary importance. Treatment had to deal with both the underlying history of trauma and the current symptoms. Once rapport was firmly established, Katrina felt she was safe and her feelings were understood. PHASE 2: ADDRESSING PAST TRAUMA SYMPTOMSExamples of associated problems that need to be understood within a diagnostic and treatment approach for childhood abuse are a pattern of disrupted development, loss of self-sustaining identity. In this phase we explored her ambivalent feelings toward her parents and her ambivalent self-concept or self-experience. We also explored ways she has come to understand her childhood abuse. I was aware of transference and my own counter transference in our sessions. I interpreted the transference for her and we worked on integrating her identity.For example she felt like an abused person and it was so strongly related to her self-concept that it took over her life. We worked on redefining herself as someone who just happened to be the victim of abuse. Example of countertransference: I had a feeling that I wanted to give Katrina advice and wanted to give her solutions. I also had the feeling like I have to protect her in some way. I tried to meet Katrina’s need for security by setting clear limits of therapy, by concluding a therapeutic agreement with her, by informing her of the characteristics of the therapy and by telling her that there are no right and wrong answers.I accepted her in her wholeness, including her depressive, gloomier part and her history of abuse. I did not denounce her when she thought I would. All this contributed to creation of a sense of safety in the therapy; she felt that she could show herself such as she was, without causing my respect towards her to diminish or without my criticizing or rejecting her. All this helped her to be less reluctant to continue with psychotherapy. During that phase of therapy Katrina gradually expressed her anger better, particularly in her relation to father.It was a great achievement also that she expressed anger to her mother to whom she previously never set limits. Katrina found out that each expression of anger does not necessarily provoke conflict, violence and termination of a relationship. Katrina still finds it hard to experience anger with parents, as feelings of guilt and self-blame appear. What follows are examples of our sessions: Session 6 Katrina surprised me by bringing her boyfriend with into our session. It was noteworthy as the supposed reason for our sessions has nothing to do with him.She did not involve him in the session and he was more like an observer. I commented on his presence and asked if he will join us each time. They both said no. This is something I would like to explore further in our future sessions. We explored strategies to deal with her insecurity in interpersonal situations. I asked her to name 5 rules she lives by relating to her relations with people. Most of them seemed to point to a certain notion that there is condition upon if other people would accept her contributions to any interaction.She does this in our sessions as well, for example: she would say something like the following: I want to ask you something but I am afraid that you would think I am crazy and stupid for asking it. I know it’s not the right thing for me to be thinking of and I am afraid you will think less of me. I asked her to think of other relationships in which she engages with this thinking in. She identified that this is why she came for counselling. That she feels that if she is not perfect and always the way other people would like her to be they (everyone) would not accept her.She went as far that she fears that people would totally reject her and banish her from their lives permanently. I ended the session by giving her homework. She had to identify some of her rules that she feels is operating in her relationships with others. I then asked her to write them down and next to each one write down an alternative to this rule one that is in essence contradictory. . Session 7 We discussed her homework and I commented on her resourcefulness in coming up with good alternatives. It made her feel empowered. I thought to try and relate what we have discussed in our previous session to her bringing her boyfriend to therapy.I asked Katrina on the incidence of bringing her boyfriend with. She said that she felt safer when he is around. I hypothesised that our previous session made her feel vulnerable as we explored where her interpersonal mistrust and anxiety could’ve emerged and she related this to her relationships with both her parents. I asked if that she felt exposing these quite personal details at me she felt that I would reject her and related it to the rules that we discussed in session 4. It was in this session that she cried and really showed strong emotion when she spoke about her father and even more so her mother.A definite area to explore more!!!!! PHASE 3: Self-development, relational development, and adaptation to daily life. Session 6 Having not seen each other for over a month as a result of exams and the holiday and we did some catching up. She said that she felt better and feels that she can handle the interpersonal insecurities she felt better. In session 4 we spoke about being aware when these feelings, which we agreed to, call uncertainty, emerges. Then immediately challenging them with something like there are no conditions of people’s acceptance of me. They will accept me and my decisions and contributions for who I am and for what it is.She asked my advice on a decision she had to make after a disagreement with her father over the weekend about her 21st birthday party. I asked her if it would make a difference if I told her what to do. We went back and forth on this and I asked her if it is important for her for me to think that she is making the right decision. She said that she thinks that I am â€Å"clever† and educated and that if I agree with her she would know it is the right decision. I asked her if she always feel the necessity to check in with other people before she makes decisions.She said that she always feels uncertain, especially when it comes to her father as he is manipulating and knows how to make her feel guilty about her decisions. She said that this has always been the case. I told her that my advice would be irrelevant and asked her to give me the options and the outcomes of decisions regarding this situation. This opened up a space in which we could discuss her relationship with her father and her story about this relationship in depth. She told a story of her father being a loving and caring father if she was exactly the way he wanted her to be and did what he expected of her.If she disagreed with him he would tell her that she has to choose between his view points or she could pack her stuff and leave his home. This is still the case and it is a huge fear of Katri na that when she shows any disagreement with her father’s wishes he would completely reject her and shut her out of his life permanently. I asked her the following questions to confirm my hypothesis that she might fit into the dependent personality diagnosis. †¢Some people enjoy making decisions. Others prefer to have someone they trust guide them. Which do you prefer? Her response : I would prefer someone guiding me. Do you seek advice for everyday decisions? Her response : Always †¢Do you find yourself in situations where other people have made decisions about important areas in your life, e. g. what to wear, where to go out to, what to study ect.? Her response : All the time. †¢Is it hard for you to express a different opinion with someone you are close to? What do you think might happen if you did? Her response. Our relationship will end†¦. Ummm well maybe not end but they will leave me and I’ll have to beg them to stay. †¢Do you often pret end to agree with others even if you do not? Why?Do you think it could get you into trouble if you disagree? I always agree, especially with my mom and dad. I don’t want them to leave me because they think I am a rebel or something. †¢Do you often need help to get started on a project? No †¢Do you ever volunteer to do unpleasant things for others so they will take care of you when you need it? If I think about it I have done it often in the past. †¢Are you uncomfortable when you are alone? Are you afraid you will not be able to take care of yourself? I have to be around at least one other person. I am terrified of being alone. Have you found that you are desperate to get into another relationship right away when a close relationship ends? Even if the new relationship might not be the best person for you? I had boyfriends who abused me, just like my father did but I stayed with them for a long time. I have never been single not once since high school, since I st arted dating no matter how bad the relationship was before the new one I always quickly found a new boyfriend. The one that I have now is the best thing that ever happened to me. †¢Do you worry about important people in your life leaving you?I am very anxious that they will especially my boyfriend, my father and my mother After these sessions we began to set real life goals like for example. Asking her dad for coffee in a public place and talking to him about what concerns her. She was very scared to do this but she did it and disconfirmed her beliefs regarding him leaving her if she speaks her mind. He actually embraced it and their relationship has become more realistic and reciprocal. He now phones her and she could decide what she wanted to do with her 21st birth day party something he had took over from her.She has also confronted her mother about her concerns about the example her mother sets for her sisters when her boyfriend stays over and they get, well a little loud i n the bedroom. She spoke to her lecturers regarding her bad marks and attempted to rectify her poor academic performance. Although she still fails the subject she feels good about trying to do something about it and having the courage to face the lecturer. We discussed termination and I suggested that we see each other on a bi-weekly basis. I did not want her to become dependent on me and on the therapy.She then suggested that we terminate in our next session as she felt â€Å"ready to take on her responsibilities and face the music†. I suggested that we see each other for two more sessions just to reflect back on our journey and top identify the resources she is now able to utilise. 12. Issues for discussion Did I follow a suitable therapy journey with her. References Erskine, R. G. (2007). Unconscious process, transference and therapeutic awareness. Workshop on Institute IPSA. Ljubljana, Slovenia. Little, R. (2001). Schizoid Processes: Working with the defences of the withd rawn child ego state. Transactional Analysis Journal, 31 (1), 33-43.