Market Revolution essays

Market Revolution essays The United States today which is a worlds largest economy and largest natural resources land. I am going to talk about the Market Revolution during 1815-1860. Where as during late 1815Â ¡s the US economy was still dependent on England, exported and imported manufactured goods, geared toward international trade, no domestic trade. And majority of farmers were subsistence/ Yeoman basically were independent farms. By 1860s the subsistence farmers transform into commercial farmers, transitioned into national economy, developed an industrial sector an second only to England, able to better export nations natural resources, and was the large domestic consumer market which generated far more wealth then it had been. Most of the Easter US was thick forests, no roads an undeveloped. During 1790 - 1815 there were two different political interests were the Republicanism (Jefferson) VS. Federalism (Hamilton). Hamilton and Jefferson each thought very differently about the direction of national economy. Jefferson Republicanism was the 3rd president during 1801-1809. Jefferson was most intellectually a gifted president and most eloquent with pen. Jefferson was a child of enlightenment, architects (he designed his own home), avid readers, involved with natural science, loved the French, and enjoyed living good European life. He was a man of Contradictions where slave owner opposed to slavery. He thought morally wrong and was dying institution. US economy was dependent of free trade outward oriented with exports and open foreign trade. Jefferson believed that for republic to work. Spokes person for individual right and believed that US had special role in history that leaded to an example. Government should protect of right a superior to all other types of government. Believed freedom is fragile and republic was likely to fail. Republic would spread since there was more appealing. Americans role to spread democracy by example, ...

Obesity is an increasing global health problem, and one of the leading preventable causes of death The WritePass Journal

Obesity is an increasing global health problem, and one of the leading preventable causes of death Obesity is an increasing global health problem, and one of the leading preventable causes of death IntroductionDiet – Alternative to SurgerySurgeryRelated Introduction Obesity is an increasing global health problem, and one of the leading preventable causes of death. The definition of obesity taken from the NHS website is; Obesity is when a person is carrying too much body fat for their height and sex. A person is considered obese if they have a  body mass index  (BMI) of 30 or greater . The main problem here is that there is numerous health problems linked to obesity, therefore if Obesity is helped and reduced, it would be like solving the root to the numerous health problems it is linked to. In other words instead of tackling the health problems that are caused by obesity, you tackle obesity itself which would then in theory lead to a general decrease in obesity related health problems. This will not only be beneficial to the patients, but in this current economic climate will save the medical sector money that they would use on treating obesity related health problems. Obesity is a medical condition in which an excess amount of body fat has accumulated within the body to an extent that it may have a harmful affect on health. This can in turn lead to reduced life expectancy and an increased risk of cardiovascular disease. The main problem here is that obesity increases the risk of many physical and mental conditions however regardless of this it is increasing and needs to be tackled. The main cause of obesity is a combination of excess food energy intake and a lack of any physical activity however there are cases when the cause is due primarily to genetics, medical reasons or psychiatric illness. In contrast increasing rates of societal level obesity is thought to be due to an easily accessible and palatable diet, increased reliance on vehicles and mechanized manufacturing. There are three main ways obesity is being tackled, and it is these three solutions that I am going to focus on in my study.; Diet, Surgery and Drugs. The main solution I will focus on will be surgery. Diet – Alternative to Surgery The classic approach to tackle obesity is a low-calorie diet; this still remains the core treatment of obesity. These diets have the best short-term benefits. There are three types of low-calorie diets that can be distinguished: Personalized and moderately restricted diet: This is dependant on a pre-therapeutic assessment. This diet takes into consideration the daily energy expenditure of each individual including their professional and family environment and their food habits. The desired level of caloric intake will equal to two thirds of the average energy expenditure; 1200 – 2000 calories per day. Low-calorie diet: Total caloric intake averages 800 – 1200 calories per day. This is a considerable reduction in the individuals daily intake and can not be maintained for a long period of time as the patient’s physical activity is hindered and the body is faced with nutritional deficiencies. This ambitious treatment is proposed during hospitalization. Very low-calorie diet: This is a less than 800 calorie per day diet also known as a protein diet. The medical follow up to this must be very accurate.   Cutting off the usual supply of calories the body gets causes the body to break down fat in order to supply itself with energy thus causing the patient to lose body weight. This dietary treatment is effective for short term benefits however requires a lot of dedication on the patient’s behalf. Surgery A  laparoscopic adjustable gastric band also known as a lap band is an inflatable device made of silicone that is placed at the top of the patients stomach through laparoscopic surgery. Laparoscopic surgery also known as Keyhole surgery is a modern technique of surgery in which operations that take place in the abdomen are carried out through small incisions, usually measuring from 0.5-1.5cm. This type of surgery uses images displayed on a monitor which can be magnified. Keyhole surgery is a very beneficial and efficient procedure as the patient feels less pain and discomfort and recovery time is considerably reduced. Gastric banding is the least invasive surgery of its kind however it carries the usual risks of any gastrointestinal surgical operation. The patient’s intestines are not re-routed as the stomach is not staples or removed therefore the patient is able to absorb nutrients from food in a normal procedure. Gastric bands are able to stay without causing harm in the patient’s body as they are made entirely of biocompatible materials. They way this procedure works is that the gastric band is placed on the top portion of the stomach using keyhole surgery. The placement of the band creates a small pouch at the top portion of the stomach. This pouch approximately holds about half a cup of food, in contrast to its normal six cups of food. The pouch fills up quickly; this is where the band comes into effect. The band causes food to pass slowly from the pouch into the lower part of the patient’s stomach. As the upper part of the stomach fills the brain is sent a message that the stomach is full therefore the patient’s hunger dies. This causes the patient to eat a reduced amount of food and stay full for a longer period of time thus decreasing overall caloric intake which can lead to a decrease in weight over time. As the patient starts losing weight the gastric band will need to be adjusted to ensure effectiveness and improve comfort. It is adjusted using a saline solution introduced through a small access port placed underneath the skin. To avoid damage to the port membrane and prevent leakage a specialized non-coring needle is used. This graph has been taken from www.bmj.com and gives an overall idea of the extent to which a gastric band can help weight loss. According to the study participants who had a gastric band lost 22% of their body weight in two years in contrast to the controls who in which only lost just 6%. This resulted in the ‘gastric band group’ to be healthier and happier. This is one proof of evidence that shows that this type of solution to tackle obesity is highly effective. I do not believe taking drugs alone such as AMPHETAMINES is effective as there are many side effects and there have been many cases where patients have become addicted and dependant on the drug itself therefore I do not look at this as a solution personally. Gastric Banding I believe is the most appropriate as it shows and has been proven to considerably decrease body weight and help obesity. And being a laparoscopic surgery rather than open it has its many advantages; Reduced chance of needing blood transfusion as haemorrhaging is reduced. Small incisions are used which reduce pain and discomfort to the patient. In addition recovery time is reduced along with less post-operative scarring Less pain due to small incisions also means that less pain medication is needed Procedure times are slightly longer however, hospital stay time is less often same day discharge. So patient can be back to everyday life more quickly and efficiently. Exposure of organs is reduced due to small incisions therefore chances of contamination and disease are reduced. However it does come with its disadvantages; Due to the small incisions the doctor has a limited range of motion at the surgical site. Dexterity is lost. Poor depth perception Tissue can be damaged due to tools being used rather than hands. However I believe the advantages outweigh the disadvantages so keyhole surgery is a effective and efficient solution. However I believe the advantages outweigh the disadvantages so keyhole surgery is a effective and efficient solution. There are many risks that come with this type of surgery as with any type of surgical operation. The biggest risk is from an instrument called a trocar. Injuries are caused to either blood vessels or small or large bowel. This risk is increased with patients that have a history of prior abdominal surgery. Benefits of gastric banding compared to other bariatric surgeries. There are many benefits of gastric banding compared to other bariatric surgeries. Mortality rates are considerably lower; 1 in 2000. Due to small incisions, keyhole surgery recovery times are very short along with a short hospital stay. These benefits can make the surgery greatly appeal to the patient as along with losing weight, the pain and overall time is small. Bibliography [1.5] Google images. [2.5] Wikipedia. AS Biology CGP Revision Guide. – overall knowledge [3.5] Dr Patrick Jordan . [1] http://obesity_epi.tripod.com/solving_the_problem_of_obesity.htm  Ã‚  Ã‚   [2] http://en.wikipedia.org/wiki/Obesity [3] globalissues.org/article/558/obesity [4] nhs.uk/Conditions/Obesity/Pages/Introduction.aspx [5] nhlbi.nih.gov/health/public/heart/obesity/wecan/healthy-weight-basics/obesity.htm [6] http://en.wikipedia.org/wiki/Gastric_banding [7] bmj.com/content/332/7550/1146.full [8] http://en.wikipedia.org/wiki/Laparoscopic_surgery [9] http://en.wikipedia.org/wiki/Trocar

Role of Government in the Economy Essay Example | Topics and Well Written Essays - 1500 words

Role of Government in the Economy - Essay Example From this research it is clear that the government has provided guidance to the progressive movement of the economic activities taking place with the intention of sustaining the continuous economic growth; as well as providing employment and ensuring the stability of the prices of good and services. This means that in the US, the government has an involvement in the acceleration of the economy’s growth rate through the adjustment of such distributions. Other factors include the spending of funds and tax rates through the government management of money supply with the application of control to these monetary policies. Although having said this, it does not necessarily imply that the term would indicate the complete control on economic activities, rather, the term only suggests how the government plays an important role in the stabilisation of the economy.This essay highlights that  Neo-classical economics concentrates predominantly on the importance of individual and personal economic preferences, market equilibrium, and the balance between supply and demand.  These points are at the center of the neo-classical suppositions of the economy, which are the main trend to the perspective idea of capitalism. The most basic unit of the theory of neo-classical economics evolves into the concept of individual ownership, and initially its focus is on how individuals decide or manage their properties. This theory is primarily concerned with how an individual enjoys the profits in the context of the benefits that they receive from their properties, and thus changing the amount by which will be gained from their property which may also attribute to the social convenience or suffering (Veblen, 1969). Veblen (1969) also believed that an individual can be compared to a computer that mechanically benefits through its given data. The change of that data itself might result in them knowing to put themselves into a position where they will be able to meet various needs. This is the idea of capitalism, a social system that favors individual needs and rights. The neo-classical theory focuses onto the consumer, and how individual consumption will powerfully influence the behavior of the production, the needs of the consumer that has been granted by the market (Goodwin et al, 1997). The stability of the equilibrium in the economy is in the equal distribution of supply and demand. Every individual based on this theory has the right to be involved in the â€Å"free market†, wherein sellers and buyers have each others contribution in setting the price of a particular product (Barrons, 1995). Through this principle, it is not the government that will control the supply and demand of a p articular product as the free market is governed with the market forces (supply and demand), wherein prices are set toward equilibrium. This maintains the balance of the demands as opposed to the supply of the products. Although the government does not possess an absolute power over the economy, the government does have the role in the economic development which, according to neo-classical theory is essential to economic growth. The main responsibility of the government in the economic sector is to secure business cycles which do not mean harm to individual rights, constituting peace and order and protecting every citizen, both consumers and capitalists against frauds and the

Teaching Plan for Practical Skill and Techniques of Peripheral Essay

Teaching Plan for Practical Skill and Techniques of Peripheral Intravenous Cannulation - Essay Example This teaching plan shall provide an easy format to help teach medical staff like the nurses, midwives, physicians and surgeons on this procedure. The objectives of this teaching plan are to enable the student to know the devices and equipment used for this particular procedure. While learning, the students should know various parts of the body which are the best insertion sites. The students should also be able to completely do the procedure successfully and be aware of any associated complication and how to handle them. There are several learning theories that have been brought forward, the three main ones are behaviorism, cognitivism, and constructivism. These theories merely try to explain how we learn. The behaviorist theory focuses mainly on the observable change .To modify people’s attitudes and responses, behaviorists believe that you either change the stimulus conditions in the environment or change what happens after a response happens. Behaviorists generally ignore t he internal factors of learning but on the contrary the cognitive learning theorists stress the importance of what goes on within the learner. Cognitive learning allows a student to think critically and gather information to acquire and develop his/her skills. It is therefore important in plan to teach certain skills that a conducive environment is provided to ease understanding of complex procedures. Lastly the constructivism focuses developing one’s learning from personal experiences. This simply applies a teacher must take into consideration the experience of the student thus provide sufficient room for practice either through simulations or with a real patients. Individuals may prefer a particular method of learning or different style and it’s the teacher’s judgment to decide which theory works for his student. The most common method used by many teachers is when students perform the cannulation under the supervision of a competent clinical procedure teachin g staff. There are several preferred learning styles by the students may opt one being the practical on an actual patient. In this case the practitioner or teacher must be present and ensure that the student has sound understanding of the procedure and anticipated outcomes. These may be both complications and expected anticipation. The other method could be the use of a simulated environment this can be used especially with students who have high anticipation to lower the pressure of dealing with an actual patient. For such students I would focus on building their psychomotor skills so that they build up confidence and it’s more practical to teach the students in parts. In such an environment the students can discover and learn different methods of performing the skills and also learn to correct errors that they make without fear of harming patients. These students would have enough practice before they can actually perform their first clinical procedure in an actual environm ent. Another technique that also uses non patients is use of videos from audio visual libraries to give the students a view of â€Å"real† patient scenarios. Although it has its disadvantages it also helps especially by filling the gap when real patients are not available. Similarly models may be used in teaching procedures like the intravenous cannullae insertion. This is very useful especially for students who have never performed such

Management styles within the cultures of UK- and Iran-based Dissertation

Management styles within the cultures of UK- and Iran-based construction joint ventures - Dissertation Example Case Study) 27 Chapter 6 - Presentation and Discussion (Semi Structured Interview) 30 Chapter 7 – Recommendations 33 Chapter 8 – Conclusion Limitation and Future Research 34 8.1 Conclusion 34 References 36 Bibliography 41 Appendix – Semi Structured Interview Questions 44 LIST OF TABLES & FIGURES Table/Figure Page No. Cultural Differences between Iran and UK 13 Culture Comparison of Iran and UK 13-14 Comparative chart from the case study 24 Similarity Chart from the case study 24 Abstract The management style adopted by a firm plays an indispensible role in the success of that firm. It is often considered as an amalgamation of motivation, attitudes towards responsibility and leadership. This study aimed to explore the relevance of 'culture' when defining and comparing management styles in the UK and in Iran. In addition, the study also aimed to develop insights about these cultures and styles that might inform construction managers preparing to work on one or both of these environments. In order to accomplish it, the study has made use of case study method and has chosen two companies, one from the UK construction industry and the other one from Iranian construction industry. The study also considered the importance of national culture while exploring the differences of management styles among the two companies. The study revealed that there are vast differences among the national cultures of UK and Iran. Furthermore, the study also made it evident that national cultures play crucial roles in shaping the management styles of a company. As a result of that the management styles of the companies belonging to Iranian and UK construction industry greatly differs. On the basis of these findings, some recommendations have been made to the potential construction managers for the purpose of preparing them to work with Iranian counterparts, and vice versa. The key recommendations were to develop culture awareness among the managers and promote open c ommunication. 1. Introduction 1.1 Background Research objectives are The primary research objective of this dissertation is to explore the relevance of 'culture' when defining and comparing management styles in the UK and in Iran. The aim is to gather information and to discover the clear Constructs and if possible their relationships. The secondary objective is to develop insights about these cultures and styles that might inform construction managers preparing to work on one or both of these environments All mutual behaviours are linked to other intensely held beliefs and morals and implanted in a certain context. This means the risks are high for mishandling cultural dissimilarities.

Holocaust Denial Essay Example for Free

Holocaust Denial Essay The holocaust is the term used to describe the period of persecution and extermination of European Jews by Nazi Germany. During this period, an estimated six million Jews were murdered in a series of state-sponsored killings. This was a culmination of a Nazi policy which was â€Å"the final solution to the Jewish question† (Michman, 2003) Why did Nazis Hate Jews? The Nazis hatred for Jews had been in existence for a long time, but it is after the World War 1 that it intensified. Prior to that, there had been strong feelings of anti-Semitism in Europe, mainly from the Christians. This is because of the Jews reluctance to embrace Christianity and their stubborn adherence to Judaism. (Israel G. 1990) After the First World War in which German lost, Hitler sought to find a plausible explanation for their defeat. Since at the time most banks and financial institutions were run by Jews, the Nazis blamed then for not availing enough funds for the war. They were viewed as being tight-fisted, corrupt and vile people, who could do nothing but destroy. This aroused feelings of hatred for the population, and the Nazi regime went on churning propaganda that blamed all of Germany’s problems on the Jews. (William, 1995) From another angle, the Jews were generally viewed as being an inferior race to the Aryans. Hitler believed that Aryans were the master race and even made a table of sorts which classified the races according to superiority in genes, with Aryans at the top, and Jews, Gypsies and Blacks at the bottom . The Nazis therefore saw the need to eliminate them from Europe to avoid weakening the racial purity of the Aryans (William, 1995) Holocaust Denial Holocaust denial is a term used to refer to the movement which seeks to deny that the holocaust really happened, and if it did, whether it occurred in the manner and scale that historians claim it did. It is a movement especially active in the United States, Canada, and Western Europe. However, the first people who sought to deny that the holocaust ever happened were the Nazis themselves. They attempted to destroy all evidence and even denied the proof that was presented at the Nuremberg trial. The organized version of the movement called Holocaust Revisionism was founded in 1979, by Willis Carto, founder Liberty Lobby, an anti-Semitic organization in America, when he incorporated the Institute of Historical Review. He is quoted as saying History is far too important to be left to history professors, pundits and politicians. History is power The leading activists for the IHR include Mark Weber, Bradley Smith and Fred Leuchter in the United States, Ernst Zundel in Canada, David Irving in England, Robert Faurisson in France, Carlo Mattogno in Italy and Ahmed Rami in France. However, among these, Bradley Smith, the self-styled director for the Committee for Open Debate on the Holocaust, CODOH, has been the most visible in the United States. He has placed series of ads in college newspapers since 1991 on behalf of CODOH. In one such ad, Bradley promises a $50,000 to anyone who can convince a radio station to air a ninety minute video to show that the holocaust was a hoax. The IHR also writes a journal called the Journal of Historical Review and holds annual conferences, which are used as vehicles for holocaust denial. http://www. adl. org/holocaust/introduction. asp The revisionists offer the following arguments to prove that the holocaust is a farce. First of all, they claim that there is no single document which has been identified, which expressly shows a master plan for the execution of Jews. This, according to them, is proof that the whole idea of Jewish annihilation is a creation by the Jews to gain sympathy from the world. ( http://www. remember. org/History. root. rev. html) Secondly, there were no gas chambers at Auschwitz and the other camps, so the allegations of people being gassed to death are mere lies. There are no documents about gas chambers of any kind anywhere so no mass murder of Jews in gas chambers took place. (http://www. jewishvirtuallibrary. org/jsource/Holocaust/denial. html) Another reason why they deny the holocaust is because they purport that the scholars rely on the subjective testimonies of alleged â€Å"survivors†. These testimonies are highly biased and because there is no supporting documentation proving the genocide, these accounts can only be taken to be false. (Raul, 1985) The revisionists also claim that there was no net loss in the Jewish population in Europe between 1941 and 1945; therefore the claim that 6million Jews were killed cannot be true. According to them, there were not even enough Jews in Europe to account for the 6million victims. ( http://www. remember. org/History. root. rev. html) Furthermore, according to the revisionists, the Nuremberg trials were stage managed in favor of the Jews. They were a sham and were just held so that Jews could benefit from the sympathy they aroused. To further strengthen their arguments, the holocaust deniers have posed a series of questions that put in doubt the truth about the events that took place during the holocaust. To start with, they ask; it is said that the gas chambers were ventilated, and if so, wouldn’t the gas have killed the people outside as well. Since this didn’t happen, then surely, there was no such thing as Zyklon-B used to gas people to death. The next question is, if as many as 6million people were killed and cremated, then where did all the ash go to. It should be so much going by the numbers, and going by what is available now, the numbers must grossly be exaggerated. ( http://www. remember. org/History. root. rev. html) Moreover, Zyklon-B, which was allegedly used had to be dropped into the chambers by people, so, the people would have died from the gas themselves, wouldn’t they? In addition, how come the eyewitnesses to the gassings survived, why didn’t the Nazis eliminate them since they knew so much. That is not all; there was a swimming pool at Auschwitz, this means that the people there lived in luxury, so this could nit have been an extermination camp. Also, the death lists from there do not show that any person was gassed, and the number of people who died there was very small. Finally, since much of the area around Auschwitz has a high water table, then the said burning of the bodies in ditches could not be possible. (http://www. remember. org/History. root. rev. html) Some of the revisionists also pose counter-statements against the evidence given by the survivors. In regard to the deaths in Treblinka, the victims were said to have been killed using diesel fumes; so the revisionists say that fumes from a diesel engine are not enough to kill a person. This implies that the people could not have died as a result of inhaling the fumes. The doors of the gas chambers which used the engine exhausts would not withstand the pressure of the gas accumulating inside, which would lead to an explosion; how come that did not happen? ( http://www. remember. org/History. root. rev. html) In one of the most controversial denials, the revisionists assert that the Anne Frank diary was a fabrication written by someone else who wanted to further the Jews agenda. Did the Holocaust really happen? For every claim made by the revisionists, evidence has been produced to prove that the genocide actually happened. The Nazi regime itself had documents that clearly pointed out to their intention to massacre the Jews. Although they destroyed much of the documents, some remnants were later recovered. (Lucy, 1975)The evidence available includes written documents in terms of letters, memos, blueprints, orders, bills, speeches, articles, memoirs and confessions. There are accounts given by eyewitnesses, who include survivors, Jewish Sonderkommandoes, SS guards, commandants, local townspeople and some of the Nazis. (Michael et. Al, 1997) Indisputable evidence can also be gleaned from photographs taken by the military, press, civilians and survivors. Some of the camps where the mass murders took place still exist, some in almost original state. Inferential evidence is also available in form of population demographics which confirms the change in Jewish population. Therefore, it can be concluded that the evidence of the holocaust is so compelling that we cannot deny that it took place. (Michael et. al, 1997) REFERENCES http://www. jewishvirtuallibrary. org/jsource/Holocaust/denial. html http://www. adl. org/holocaust/introduction. asp http://www. remember. org/History. root. rev. html Israel G. (1990), Encyclopedia of the Holocaust, Volume 2, New York Lucy D. (1975) The War Against the Jews, 1933-1945, New York Michman, D (2003). Holocaust Historiography: A Jewish Perspective: Conceptualizations, Terminology, Approaches, and Fundamental Issues. London Michael S. and Alex G, (1997) Denying History Who Says the Holocaust Never Happened and Why do they Say it? † University of California Press Raul H. (1985) The Destruction of the European Jews (Student Edition), New York William L. P (1995) Novelist of Hate, ADL Research Report. Brugioni, D. A. , Robert G. P. (1979) The Holocaust Revisited: A Retrospective Analysis of the Auschwitz-Birkenau Extermination Complex. (Central Intelligence Agency, Washington, D. C. )

Health Essays Medical Errors Hospitals

Health Essays Medical Errors Hospitals Medical Errors Hospital Disclosure of Medical errors in every day clinical practice. Introduction Medical errors are very common in every day clinical practice. Even taking serious caution does not make the error free hospital any where in the world. According to British Medical Journal ( cited in Adams 2005), â€Å"about 850,000 medical errors occurs in National Health hospitals every year resulting in 40,000 deaths†¦. Adverse events occur in 10% of all hospital patients (p. 274). Today’s times 2004 ( cited in Adams 2005) claims a cost of 2 billion pounds per year due to medical errors. The data shows the magnitude and the significance of the problem. In fact medical errors are preventable in most of the cases. But the sad part of the story is these errors are not disclosed to the patients or the family. Disclosure of medical errors is a very big issue for the leadership and management of a hospital in terms of institutional ethics. This paper will discuss about medical errors, the issue of its disclosure , its outcomes, current trends regarding disclosure of errors , application of theories and implementation in our context. Medical Errors Albert , Cavanaugh, Mc Phee , Bernard , and Micco ( 1997) define medical error as â€Å"Commission or omission with potentially negative consequences for the patient that have been judged wrong by knowledgeable peers at the time it occurred , independent of whether there were any negative consequences† (p.770). In this regard understanding of the error and realization that it is an error is very important. The issue is if it is internalized that error has occurred, then should it be disclosed or not. Non disclosure of medical errors There is a very strong culture of a number of hospitals world wide and the hospital where I belong to that health care professionals hide and do not disclose medical errors to the patients or their families. Errors come on the picture if by any means the patient or their family comes to know about the error. Kaldijan ,Rosenthal, Reimer, and Hillis (2005) did literature review of 316 articles on medical errors and came up with four categories which include attitudinal barriers, helplessness from the institution, uncertainties about how to disclose and its outcomes, and fears and anxieties. In addition to it, risk of ruining person’s as well as the hospital’s reputation, legality issues, low self esteem in the profession, mistrust of the patient and the family, and hindrance in professional progress are also some of the very important barriers to disclosure. (Boyle, Connell, Platt, Albert 2006, Fischer et al 2006, Albert et al 1997). Besides organization’s culture, policy and the colleagues’ attitude also impacts error disclosure. Non disclosure of errors can have some beneficial effects for the patients as well as for the physician. Patients do not become emotionally upset on hearing the news of occurrence of unexpected event during the hospitalization. Boyle, Connell, Platt, and Albert (2006) have cited that American college of physicians has given the liberty of not disclosing the error if the disclosure can cause more harm than benefit as in the case of psychiatric or depressed patients. But the worse part of it is this concept of deception for the benefit of patient is misused in the name of the health care personnel own interests. Similarly risk benefit ratio of disclosure should be calculated or in ethical terms beneficence versus non maleficence should be judged. Furthermore health care personnel do not have to fear for legal issues and the reputation. However they suffer emotional distress if they do not disclose. Disclosure of Medical Errors Medical errors should be disclosed as an ethical and moral responsibility of the health care personnel and the institution as whole. JCIA and JCAHO has made it a standard in 2001 that disclosure of errors should be implemented in hospitals. (Connell, White, Platt 2003, Henry 2005, Gallagher, Studdert, Levinson 2007). In addition The code of ethics of American Medical Association, The American College of Physicians and the National Safety Foundation have also emphasized on disclosure of errors.( Boyle, Connell, Platt, and Albert 2006 ). The standardization of disclosure by so many international organizations particularly JCIA and JCAHO gives the message that the culture and the approach towards the issue of disclosure is changing. These bodies are international standardized bodies and the change in the approach must be evidenced based. If disclosure was not that important it would not have been the part of these quality improving bodies. Literature supports disclosure of errors. According to Connell, White, Platt (2003) , response of participants who attended the workshop about disclosure of medical errors was 90% affirmative . In a study done by Hobgood, Peck, Gilbert, Chappell ( 2002) on patients and their familys’ perspective of error disclosure gave interesting results. 258 surveys were filled in an emergency department and it revealed that 76% of patients wanted disclosure in case of any error, and 88% felt to its full extent. This clearly indicates the significance of disclosure as an issue and patients need regarding the issue. Disclosure of medical errors has many benefits. Initially the reaction of patients may be negative as error could never be expected from patients’ side. But later they get settled .Studies show positive outcomes from patient as well as the health care personnels’ angle because of disclosure. Error disclosure helps patients to get any compensation in the form of additional treatment or financial help. Most of health care personnel believe that disclosure can ruin their relationship with patients and can bring law suit as well as their image down among their collegues. However according to Witman ( cited in Boyle, Connell, Platt, and Albert 2006 ) patients felt to claim law suit if they were not disclosed about errors. In addition University of Michigan Health System reported that â€Å" the cost and frequency of litigation decreased substantially in 5 years after implementation of an open disclosure programme , with annual litigation †¦reduced from $3 million to $1 million and †¦ claims by more than 50%† ( Gallagher, Studdert, Levinson 2007 p. 2716). Error disclosure also brings a positive impact on learning for the person who did the error as well as for others in the organization. Hence mistakes done once may not be repeated next time , system improvement and therefore improvement in the quality of patient care. ( Albert 1997, Mazor 2005, Boyle, Connell, Platt, and Albert 2006 ). Moreover patient physician relationships do remain intact in most of the cases. Trends in application of disclosing errors and comparison in our context Disclosure of medical errors is gaining its significance in so many health care organizations because of the outcomes of it as well as the realization of doing disclosure. Gallaher, Studdert, and Levinson ( 2007), have stated that 2002 survey of institutional risk mangers showed that 36% of the institutions have adopted disclosure policy and the percentage increased to 69% in 2005. They further quoted that Austarlia and United Kingdom in 2003, National Quality Forum safe practices and Harvard in 2006 emphasized and provided guidelines for full disclosure of medical errors to patients. The trend shows that awareness for disclosing medical errors is gaining its popularity. If we compare the scenario in Pakistan, we have a culture of not disclosing errors in most of the hospitals. In addition to the reasons discussed in the literature regarding non disclosure of medical errors, most of the times it is taken as for granted by the health care professionals that the patients belong to low socio economic status, less educated, low level of understanding and therefore errors need not be disclosed. It has been observed in clinical practices that errors are considered most of the time as side effects and untoward result because of certain treatment and there is no internalization that it is an error. In addition there is also a misconception that since the error did not bring any harm to patient so need not to be reported to the hospital management team and therefore no disclosure to the patient. It is interesting to know that most of the hospitals in Pakistan do not have any policy for disclosing error. However in Aga Khan University Hospital (AKUH) the polic y for disclosure of errors exists and it is mentioned in the sentinel events policy that there should be disclosure of medical errors and it is mentioned in the patients’ bill of rights that patients have right to have all information .( Multi disciplinary policies and procedures sentinel events policy no: MDP-S-002). But the sad part of the story is there is no proper implementation of the policy as well as proper explanation of patients’ rights to them. In fact there is no such culture for the individual to share errors to their supervisors as an ethical and moral responsibility until the error is identified by someone else. Reviewing the issue in the light of Theories To support that medical errors should be disclosed, we will be utilizing the following theories of ethics as well as leadership and management. Kant’s Theory of Deontology Immanuel Kant a German philosopher has given the theory of deontology or duty based theory. According to Kant (cited in Bernstein and Brown 2004), act should be done on the basis of the duty or obligation regardless of the consequences. He also believed that the intention behind the act justifies the action done. If we try to understand the disclosure of medical errors from Kant’s perspective, disclosure should be done as it is the duty of the health care personnel. It is the right of the patient and duty of the personnel to share all information including the errors if occurred. Kant believes in telling the truth which is the duty in all conditions and deception is un tolerable. The debate that if truth telling causes harm should be told to patients or not , goes against Kant’s philosophy. If health care professional feels that deception of the truth will give more benefit than there should be a very strong rationale for it and should not be taken as for convenience. K ant (cited in Bernstein and Brown 2004) has discussed about one’s conscience which play a major role in making right decisions according to his duty and states, â€Å"consciousness is an internal court †¦before which a human being’s accuse or excuse one another†¦an internal judge, and this authority watching over the law in him is something that he himself makes, but †¦incorporated in his being† (p.172). Heifetz’s perspective on Ethical leadership Heifetz ( cited in Northouse 2007) explains that leaders help followers to help resolve conflicts by using their authority. He further explains that â€Å"Heifetz’s perspective is related to values of workers, organizations and communities in which they work† (p. 347). In the light of this perspective, leaders need to have a clear idea of what is the value of the organization which in all circumstances is the best quality care given to its customers and taking care of their wishes and doing what is right. Leaders need to persuade people to do the right thing and therefore the culture of disclosure of medical errors should be inculcated by the leaders. Burn’s perspective on Ethical leadership Burns gave the theory of transformational leadership in 1978. According to Burns (cited in Northouse 2007), leaders have an important role in motivating people to identify their values and to help them reach to a level where the principles of â€Å"justice, liberty and equality† should be incorporated in practice. This clearly indicates the moral aspect of leadership which leads that disclosure of errors should be done as moral obligation of the organization. Significance of medical error disclosure from leadership and management perspective The issue of medical errors disclosure is very important from leadership and management point of view because this issue is not confined to a particular institution but it is a global issue. As discussed above that leaders have a very important role in pursuing and motivating people to follow morality in practice. Ethics has a very important place in leadership and organization. Leaders give direction to the followers or subordinates. They have a very strong impact on their followers. Therefore if leaders will have strong value on creating an environment and culture whereby every individual gets rights and do their duties, then this gives rise to an organization following ethical principles. This is only possible if and only if the leader values that act. In the issue of medical errors disclosure, leaders should play their role to first get the issue internalized and get it inculcated in the organization’s culture. Implementation of disclosure of errors in our context In order to address the issue in our Pakistani and in particular AKUH the most important aspect is first internalizing that the error occurred and not getting defensive. Internalization can be done by leading seminars, discussions, conferences and bioethical grand rounds where issues of error disclosure can be discussed and health care professionals can clarify their misconception about errors. They should have a very clear understanding of what are medical errors. Once the understanding of error is there, the next step is reporting of errors in the organization through the in built system of error reporting. Unfortunately AKUH Karachi does not have a very good system of error reporting. Errors are reported when someone identifies it but the person involved rarely reports the error. On conversation with clinical affairs person of AKUH , centralization of errors reporting is under process. At present if errors are reported it is not centralized to one place. Centralization will assist in getting the picture of medical errors occurring in the hospital as a whole. There should be reinforcement at the academia level of medical and nursing education about errors and its disclosure .Adams ( 2005) has given a very practical approach towards identifying our own errors. He has shared his example how he started writing all the errors which he identified during his practice and it was interesting to see that the identified errors were between one to six per week for 29 weeks . This data was for those errors which he identified himself and may not have captured all the errors done. This practice will help us identify and internalize that how many errors are made by health care professionals. Besides , voluntary electronic reporting of medical errors can also be implemented . The results of one study where 92,547 reports from 26 hospitals were evaluated showed that 47% of the registered nurses did voluntary reporting of errors compared to intern doctors which was 1.4%.( Milch, et al 2006). Jones, Cochrane, Hicks and Mueller ( 2004) asserts that success of voluntary error reporting depends upon the organizational culture where confidentiality is maintained and a â€Å"non punitive culture† exists which promotes error reporting. Once the error is reported, the question comes for the disclosure of error. Henry (2005) asserts that there should be clear policy for disclosure and this helps in creating an open organizational culture for disclosure as well as promotes patients autonomy. He further adds that managerial support should be there and as leaders they should be promoting disclosure in their organization. Organization’s culture needs to be formulated which best supports the disclosure policies. Giganti( cited in Henry 2005) claims that â€Å" one must approach culture change with systems thinking†¦.organization’s culture is built up over time and is based on the assumptions , beliefs and values that drive the organization† (p. 132). Hence the cultural change involves evaluation of systems to see why there is hesitancy and reluctance in disclosing errors to patients and their families. Persons should not be blamed instead system should be analyzed .Cultural change at the institut ional level will lead the policy makers to consider it at the health ministry level because there needs to be law to address this issue. Disclosure is not an easy task keeping into considerations the so called consequences afterwards. There needs to be special trainings in this aspect. Hobgood, Hevia and Hinchey ( 2004) suggest for disclosure in terms of promoting safe environment to the patients and that there should be open conversation during disclosure expecting any reaction from the patient. Therefore communication plays a very important role. Furthermore Connell, White and Platt ( 2003) have given the steps for error disclosure which includes â€Å" apologize and take responsibility†, â€Å"determine who will be involved†, and â€Å"be proactive in addressing the patient’s financial needs† (p.27). However the concept of becoming proactive in identifying our system gaps and root cause analysis of the problem will promote a safety culture and hence less medical errors and therefore less issues of disclosure. Conclusion Medical errors cause huge number of deaths which can be prevented. Medical errors do occur every day in our clinical practices but there is under reporting of the errors. And if reported there is culture of non disclosure of errors until it comes to patient’s knowledge by any means or the outcomes of that error are such that it cannot be kept hidden. The reasons identified through experiences and literature are fear of destroying relationships with patients, loss of patients trust on heath care personnel, legal issues , loosing the credibility in the profession, shame , guilt and not realizing to disclose considering it better from patients perspective. However recent trend suggests that institutions who developed and implemented disclosure policy had very positive results . Patients felt that they were apologized for that and were brought into confidence. This led to less law suits and decrease in the cost given for legal issues. Besides patients were able to participate in t he compensation or adjustment for the loss due to error. Hence the above mentioned literature and practical experiences suggest that medical errors should be disclosed. 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