Separation of Powers Essay Example | Topics and Well Written Essays - 1000 words

Separation of Powers - Essay Example As the report declares in the United States, the aspect of separation of powers is clearly stated in the US Constitution. The President, Congress and the Supreme Court are separate and distinct entities. The same is not the case in the United Kingdom, where the Prime Minister is also a Member of Parliament as are all other members of the Cabinet. Similarly, the Lord Chancellor and the Law Lords are members of the Executive and Legislature respectively, while also forming part of the Judiciary. This duality results in a situation where the Executive is in de-facto control of the Legislature, as also enjoying the sympathy of the Judiciary. This dicsussion explores that various Home Secretaries have taken judicial decisions from time to time on grounds of national security, whether during war time or in otherwise tenuous situations like the ongoing global war on terrorism. The Constitutional Reform Act 2005 seeks to redress some of these grey areas though there are many who have, â€Å"defended the current system on the grounds that it discourage judges from making law by judicial rather than legislative means†. Inherent in this argument is the underlying fear that the Judiciary will not allow itself to be led by the nose by an Executive, trying to concentrate power in its hands. One of the concepts on the basis of which the principle of separation of powers functions is that of ‘deference’, which characterise the relationship of the Judiciary towards the Executive and Legislature.

Tourism, Leisure, Culture, Society & Politics Essay

Tourism, Leisure, Culture, Society & Politics - Essay Example First and foremost, tourism is a result of consumerism. It deals with a set of services people have at their disposal for a particular amount of money. The financial issue is one of the most significant drives in touristic choices (Haan, 2008). That is to say, tourism and consumerism are close in their practical meaning with landscape as the main medium of attraction for tourists (Aitchison, MacLeod, & Shaw, 2001). In turn, capitalism is always consumerism regarding to the notion among Western countries. Hence, it is indicative of many people to be troublemakers instead of tourists, as they intrude into the milieu of cultural and ethnical diversity of some people with no excuse as long as they are driven by the idea of their right for letting loose in accordance with money they spent for such a pleasure. Besides, there is a clear distinction between tourism and traveling. Andrews (2011) admits that tourism does more harm to the environment than traveling, since it the former touches upon invasion, pollution, and narrow-mindedness while the latter is characterized by discovery, understanding, intelligence, adventures, and broad-mindedness. In this vein, tourism is a mark of a person’s identity looking at the places one visits and the services one prefers most of all with an idea of a cultural merge in mind (Weiermair & Mathies, 2004). It is all about the financial substantiality of individuals. Thus, they want to pay for their pleasure in terms of the price to be paid for that. On the other hand, tourism, leisure, political activities, rights of individuals are all incorporated in the field of globalization. To say more, tourism and leisure are socially constructed and are subject to the power of a man’s feelings and inner states (Andrews, Deconstructing tourism & leisure, 2011). In the historical cut, individuals tried to perceive multiculturalism when traveling around the globe. In some cases it was favorable (India, Africa) in some other (Magell an and the Philippines) it ended up ferociously. Nonetheless, tourism has become an exploration of one’s ability to cope with different identities and in close relation with the local authenticity. The works by Paul Gauguin, Somerset Maugham, Jules Verne, and many other representatives of art and literature were among the pioneers of the global trend for cultural and aesthetical tourism. However, it was nice at a glance from the very outset. It changed significantly with the advent of commodification versus authenticity. Cole (2007) points out in his study that commodification of different places (so attractive for tourists) leads to negative outcomes based on the political manipulation over the villagers for the sake of the tourists’ well-being. In fact, such a trend designates the very purpose of tourism in this or that location and in accordance with this or that cultural identity. Talking on the commodification and authenticity, one should bear it in mind that tour ism is a direct search for difference and dominance as long as some experts compare it with neo-imperialism (Andrews, Creating ‘the Other’: People as Tourist Commodities, 2011). In addition, it is Western people who are more devoted to explore other countries in the same manner as their predecessors did in the colonial age. Thus, it is a hidden drive for pleasure and its

Management Hence Essay Example for Free

Management Hence Essay It was a win-win proposition for both HS3C and 01B to merge to draw synergies from the strength of both, HSBCS technology, global reach and product innovation and Olds domestic reach and strong customer base. Under the terms of the merger, HSBC Middle East will inject an additional capital of US $97 4m into HSBC Oman and in turn, 01B issued to HSBC new shares equivalent to 51 per cent ot the shareholding In the combined entity. Though there were synergies end the merger provided gains, there were certdln challenges. The organisational culture, customer profile, business segment, banking products and technology in place were totally different. All these require adoption of suitable change customers and 10,000 corporate clients of more than 80 branches under one unified anking platform and connecting more than 140 ATMs to the OmanNet National Switch Network were completed by the bank well ahead of its scheduled target. In addition, issue of fresh ATM/Debit cards to ex-OIB customers were achieved in record time. HSBC Bank Oman also made changes in the business process by making a number of lending policy changes to benefit its customers, rolled out complimentary life insurance on personal loans, launched receivables finance besides providing value added services like on-the-ground payments and cash management roposition to strengthen clients coverage capabilities. (wrww. hsbc. co. om) Change of management style: The bank successfully manages the changes required in technology, business practices and physical infrastructure. However, the biggest challenge for the bank will be integrating the workforce and bringing across a uniform Organisational Culture. Towards this aim and in line with the National Objectives to retain all the 1300 people of both banks, HSBC trained ex-OIB staff to new working culture and banking products of HSBC group. Unlike other challenges, this one will be difficult to uantify and could be gauged only by the success of the merged entity in terms of its market share and financial performance. Conclusions: Though the bank has achieved significant progress in initial challenges like technological and organisational integration, the impact on its business can be gauged only after looking at the financial results of the bank and its market share in 2013 and 2014. However, with a newly expanded team, diverse geographical network and growing customer base, the business opportunities for HSBC Bank Oman are significant. No doubt the merger creates an opportunity for the bank to drive growth n Oman and thereby having a strong presence in the Gulf and demonstrate its commitment.

Health Safety And The Environment Engineering Essay

Health Safety And The Environment Engineering Essay Health, Safety and Environment is considered as the top priority among the activities carried out in an oil gas industry. The oil industry has commitments to develop and maintain the technologies, standards, best practices and programs which are essential to enhance the workplace safety. The ultimate goal of the HSE is to increase safety by preventing accidents and injuries. Also, a good HSE system in an oil industry leads to reduced material losses, direct and indirect costs for accidents and improves productivity . Especially for a small to medium size oil company, the record of consistency in safe operations can be used to attract new business and investment. This makes the case that safety is good for business. Therefore, Economy of the oil industry largely depends upon HSE. The management and rest of organization in an oil and gas company have more responsibilities in doing the operations in safe way. The improvements in an oil business could be achieved by reviewing the rules, policies and procedures of HSE. The emphasis should be followed by both peers and management that violations of HSE rules will not be tolerated. This report deals with the necessity of HSE for a small to medium size oil company to achieve safe and profitable business. [Shigeo 2012] 2) INTRODUCTION: HSE plays a vital role in an oil companys development. HSE plans, policies, strategies, objectives, procedure, safety management system, Implementation and monitoring, Audit and management reviews and benefits of effective HSE system for a small to medium size oil company are discussed in this report. Policy and Strategic Objectives Organisation, Resources and Documentation Reviews Leadership and Commitment Leadership and commitment Implementation and Monitoring Risk Evaluation and management Planning AUDIT Fig:1 shows the process involved in a typical HSE system. [SAFETY HEALTH AND PERSONNEL COMPETENCE and ENVIRONMENTAL QUALITY COMMITTEES 1994.] 3) DISCUSSION: The duties, responsibilities and process carried out in an small to medium size oil company to make development in all levels of HSE are discussed here. 3.1) LEADERSHIP AND COMMITMENT: The senior leaders of the company should involve and observe the activities carried out in the industry and should make changes if needed. Some of the roles of leaders to maintain a good HSE system are listed below, 1) Top to bottom level commitment in all aspects of operations carried out in an oil industry. 2) They are responsible to improve their companys HSE performance. 3) Keen observation of critical operations and maintaining perfect records for analysing and improving HSE performance. 4) They should ensure the workplace safety and profitability of the company. 5) Participation in every level of HSE development. 6) Making Cost-Benefit analysis of HSE. 7) Continuous studying and learning from accidents happened to other oil industries and implementing good methods to prevent such accidents in their company. The expected achievement from a leader in HSE is GOAL ZERO No harm to people and the environment. [ Petroleum Development Oman 2011 p.2 ] 3.1) HSE POLICIES AND STRATEGIC OBJECTIVES: The HSE policy and strategy of an oil company should be framed to avoid injuries and ill-health of employees, contractors, neighbours and public at all times and to minimise the adverse effect of operations on environment. Some of the HSE policies of an oil company are stated below, 1) Ensuring HSE considerations are given primary preference than the other business considerations. 2) Maintaining a systematic approach to HSE Management to achieve consistency in HSE improvement. 3) Performing regular audits and reviews. 4) Ensuring compliance with international standards, relevant legislations and client requirements. 5) Making availability of Health, Safety manuals and safe working procedures to all employees. 6) Designing the workplace and developing the work practices to reduce risks to the personnel as low as reasonably practicable. 7) Implementing the use of best technologies to reduce the impact of our operations to the environment. 8) Ensuring ability of our employees to compete their task and providing regular training and awareness program to manage the HSE risks. 9) Developing communication channel to ensure the HSE policies and procedures are understood by all our personnel. 10) Making repeated record of inputs, feedback and requirements of employees in all sections of operation. 11) Plan for react to and recover from the emergency situations. 12) Reporting accidents, near misses and investigating in the way to prevent similar incidents in future. 13) Ensuring legal Airport certification. [Shigeo 2012] 3.2) ORGANIZATION, RESOURCES AND DOCUMENTATION: The oil industry should make sure the workforce required to do HSE policies and procedures. Tasks of each and every employee are documented and accurately maintained. The daily work of employees are recorded and strictly supervised to prevent the violations of rules and regulations. Senior supervisors should undertake responsibility of maintaining safe working conditions. Some of the organisational resource issues related to HSE are as follows, 1) Regular worksite inspection by senior managers, 2) Daily workplace inspection by safety engineers, 3) Making availability of well trained supervisors and safety engineers for an emergency situation and for control room operations. 4) Providing guideline, HSE policies and procedures in understandable way to every worker. 5) Make sure that all employees are adults and they are physically and mentally fit for their respective operations. 6) Providing regular HSE awareness training to all employees of all disciplines to make them familiar to handle the risk situations and to prevent the similar faults. The small and medium size oil industry should maintain the contract details with the large size oil industry by proper documentation. They should compare their level and standard of HSE practices with the activities carried out in a large size oil company through benchmarking. The supervisors and managers should adopt continuous learning to enhance the quality and performance of HSE. Employees should be provided with safety and protection equipments like heavy impact safety helmets, safety eye goggles, boots, gloves, coveralls and other safety tools to minimise injuries. Safety boards, signals, alarms, traffic and pedestrian signs should be installed in the workplace. These instruments are inspected frequently and documented to enhance the safe working environment. 3.3) RISK EVALUATION AND MANAGEMENT: It is impossible to completely eliminate all the risk in an oil industry. But, it could be reduced or prevented before occurring through an effective safety risk management system. Safety management system (SMS) is the crucial part in an oil and gas industry. Safety risk management techniques consists of Hazard identification, Risk assessment, Risk mitigation and tracking. i) HAZARD IDENTIFICATION: Hazard Identification is the initial step carried out in Safety Management System (SMS). This method is used to identify the hazards that the organization faces in its working environment. Hazard could be a fire explosion, blow out, chemical hazard, ill-health, transportation, environmental hazard, etc. The safety management system should undergo a detailed analysis of all operations. Then documents should be prepared based on what could go wrong in an operation. The hazard is a potential or existing dangerous condition that could result in an accident or incident. In a safety management system, all hazards in operations are identified and documented to analyse and implement the necessary techniques required to eliminate or reduce the risk associated with the hazard. ii) RISK ASSESSMENT: Risk assessment is the technique of analysing the identified hazards to know the consequence of each hazard. The risk assessment considers both the severity of each hazards and the probability of its occurrence. The risk assessment may show that certain hazards have acceptable level of consequence, while other risks need definite mitigation. Proper risk assessment in an oil industry can reduce the number of accidents and can almost prevent them before occurrence. iii) RISK MITIGATION AND TRACKING : If the root cause of hazard is identified, then the proper mitigation process can be made. The risk mitigation can reduce or eliminate the hazards likelihood of occurrence or it can manage the risk by reducing the severity of its effects. The systematic and logical approach should be in place to counteract any risk for maintaining safe operation. The whole mitigation process should be monitored and tracked to conform that all control objectives are working properly. [ Bayuk ] Cause Consequence shallow gas well kick Loss Circulation Gas cut mud Influx of Hydro- carbon Blow out Injury to personnel Damage to safety critical system Environmental damage H2S release Hydrocarbon flow from pressurised formation Prevention/ Control Barriers Mitigation Barriers Event / Hazard Fig:2 Risk diagram shows the causes and consequences of influx of hydrocarbon during drilling. [ Brian 2012 ] To mitigate the hazards during drilling and to control the well, the operator should identify the exact causes and should respond appropriately if influx occurs. 3.4) PLANNING: HSE plans of a small to medium size oil company are prepared in the way to enhance and guarantee the safe working conditions and healthy working environment. Some effective HSE plans includes, 1) HSE policies, procedures, strategies and objectives, target and responsibilities. 2) Cost Estimation for implementing HSE practices. 3) Leadership and commitment, regular inspection, supervision and risk management. 4) Hazard identification, risk assessment, risk mitigation and tracking. 5) HSE policies, plans implementation, monitoring and documentation. 6) Reporting and recording accidents and near misses. 7) Availability of safety equipments like Fire prevention and fighting devices, first aid medical facilities. 8) Environment pollution control, sanitation, waste management and reducing the usage of natural resources. 9) Employees selection, proper communication and training, work inspection, monitoring. 10) special training for emergency response for both employees and control room operators. 11) Identifying employees fitness both physically and mentally for their tasks and making regular health check up and collecting feedback. Priority in HSE Practices: Most Effective ELIMINATE Eliminate the hazard Use process or method with low risk impact SUBSTITUTE Segregate the hazardous products ISOLATE / SEPARATE Engineered Safeguards: Prevention: Design to prevent an unwanted event Recovery: Design to mitigate harmful consequences ENGINEER ORGANISATION PROCEDURE Operating Procedures, Work instruction, Permits, Maintenance, Emergency Response Training, competency, communication PPE Personal Productive Equipment to wear in working environment. Least Effective Fig:3 shows the priority in HSE operations which are carried out in oil industry. [ Petroleum Development Oman 2011 ] 3.5) IMPLEMENTATION AND MONITORING: Effective implementation of HSE plans will lead to the safe and successful business and give high secure conditions to the employees. The effective and dedicated team of supervisors, safety manager should be active every time to ensure that all HSE policies are followed without violations. The PDSA, PDCA cycle and gap analysis are necessary to compare the existing HSE standards with the large scale oil industrys standards. This will achieve quality in HSE performance (QHSE). Proper monitoring should be carried out to avoid the ignorance and violations of the HSE rules to made the job done. PDSA cycle: http://www.scotland.gov.uk/Resource/Img/209291/0061564.gif Fig:4 Shows the PDSA cycle. [THE SCOTTISH GOVERNMENT HEALTH DELIVERY DIRECTORATE 2008] PDCA cycle: ISO PDCA Cycle Fig:5 Shows the PDCA cycle. [OSAKA CITY WATERWORKS BUREAU] The workers should give correct statement about the accidents and near-misses to implement necessary practices to prevent such incidents in future. Implementation of regular survey of the following aspects are very necessary, 1) Health and Safety Protection equipments, Shift phase, to workers Physical and Mental health, work hours and Sleep patterns, Alertness, Emergency response, work adaptation and satisfaction. 2) Safety in Operations Drilling, Well completion, Installation, Production, Processing, Aircraft operation and control, Transportation. 3) Environmental Hygiene Pollution due to accidents, Oil spill, Corrosion in pipelines, Offshore marine health issues, reduced natural resource usage, waste management, sanitation, Promotion of renewable energy, hazardous product management, reduction of toxic gas emission. [Mearns et al. 1997] 3.6) AUDIT AND MANAGEMENT REVIEW: i) Auditing is the major process carried out in the business to determine whether or not the HSE management processes are implemented and functioning effectively. ii) Auditing determines the compliance of companys HSE policies with relevant legislative requirements iii) It identifies the areas which need improvements to develop a powerful HSE management. iv) The specific areas that should be audited regularly are, a) Organisation, resources and documentation, b) Safety management system, c) Plans, policies and procedures, d) Implementation and monitoring. v) Audits may involve following methods, a) use of questionnaires, b) direct measurement and observations, c) Interviews and d) checklists. vi) Auditing process should compare the results of previous audits and are recorded properly. vii) The senior level management should review their HSE policies and management approach to maintain the continuity of suitability and effectiveness of the safety management system. [SAFETY HEALTH AND PERSONNEL COMPETENCE and ENVIRONMENTAL QUALITY COMMITTEES 1994.] 4) BENEFITS OF HSE: Undoubtedly, HSE is the primary goal of an oil company. Some of the benefits of HSE in a small to medium size oil company are stated below, 1) It will develop the business by new business tie-ups and new investments. 2) Logical priority to safety lead to the mitigation and prevention of risks before it occurs. 3) Hazard reporting ensures the effective scheduling and maintenance of the resources for the safety actions. 4) Effective safety management system avoids the cost for accident investigation and it leads to an uninterrupted operation. 5) It enhances the productivity through continuous operation. 6) Effective HSE management system and proper communication between management and rest of the organisation will lead to the prevention of accident from ever occurring. 7) In terms of cost: Effective HSE practices will reduce the cost of accidents like repair costs, fines, damage claims, insurance claims by injured workers, Potential economic effects due to aviation mishap. This will lead to the business enlargement and enhances productivity and turn over. Therefore, the ultimate aim of a business is to achieve targeted profit. In oil business, the profit can be achieved only due to an efficient HSE system. [Bayuk] 5) ILLUSTRATION: The piper alpha accident in 1988 and Texas city refinery accident in 2005 are the catastrophic accidents which ruined many lives and polluted the environment. These accidents caused the loss of oil production and insurance payout and fine of several billions of USD. The small to medium sized oil companies should study these types of accidents and remedial actions. The large sized could survive the severe loss of money due to accident. But, the small to medium sized oil company couldnt overcome such losses due to catastrophe. 6) CONCLUSION: A small to medium size oil industry has key business plans towards the future. Their aim is to give the best safe performance in every department like drilling, completion, production, refining, transportation. Every small or medium size oil company is very enthusiastic and eager to become as a large scale oil industry by enlarging their business. They want to participate in national and international business by increasing their annual productivity and turn over. In order to achieve these, their HSE practices should be in high standard. Because, a single catastrophic accident may reduce credibility of the company and it will reflect as a severe loss in business. So, in a medium or small sized oil company, workplace safety should be at the forefront of its activities. 7) REFERENCE: 1) KATHARINE, R.P., 1993. Human Factors, Shift Work, And Alertness In The Offshore Oil Industry. Oxford, OX: Health and Safety Executive. 2) MEARNS, K. et al., 1997. Human And Organisational Factors In Offshore Safety. Norwich, NR: Health and Safety Executive. 3) SAFETY HEALTH AND PERSONNEL COMPETENCE. and ENVIRONMENTAL QUALITY COMMITTEES., 1994. Guidelines For The Development And Application Of Health, Safety And Environmental Management Systems. Oxford. [online]. Report No. 6.36/210, pp 2-26. Available from: http://www.ogp.org.uk/pubs/210.pdf [ Accessed 31 October 2012 ]. 4) BAYUK, A.J., System Safety And The Benefits Of Safety Management Systems. Unpublished. [online]. pp 3-6. Available from: http://www.asse.org/education/businessofsafety/docs/AJBayukPaper.pdf [ Accessed 17 November 2012 ]. 5) BRIAN, G., 2012. Closed-loop Circulating System Enhances Well Control. Offshore Magazine, 2012. [online]. Available from: http://www.offshore-mag.com/articles/print/volume-72/issue-4/drilling-and-completion/closed-loop-circulating-system-enhances-well-control.html [ Accessed 8 November 2012 ]. 6) PAAL, K., 2011. Schlumberger HSE Policy Statement. [online]. Schlumberger. Available from: http://www.slb.com/hse/hse_policy.aspx [ Accessed 8 November 2012 ]. 7) SHIGEO, H., 2012. Health, Safety and Environmental Policy Of JX Nippon Oil Gas Exploration Corporation. JX Nippon Oil Gas Exploration Corporation. [online]. Available from: http://www.nex.jx-group.co.jp/english/environment/hse.html [ Accessed 8 November 2012 ]. 8) PETROLEUM DEVELOPMENT OMAN, 2011. HSE Management System- Making Goal Zero Happen. Petroleum Development Oman. [online]. pp 2,13. Available from: http://www.pdo.co.om/hseforcontractors/blocks/documentation/docs/HSE_Management_Pocket%20Book_Final.pdf [ Accessed 22 November 2012 ]. 9) OSAKA CITY WATERWORKS BUREAU, About ISO Management Systems. Osaka City Waterworks Bureau. [online]. Available from: http://www.city.osaka.lg.jp/contents/wdu030/english/quality/check/iso2.html [ Accessed 27 November 2012 ] 10) THE SCOTTISH GOVERNMENT HEALTH DELIVERY DIRECTORATE, 2008. The Model For Improvement. The Scottish Government Health Delivery Directorate. [online]. Available from: http://www.scotland.gov.uk/Publications/2008/01/14161901/3 [ Accessed 27 November 2012 ]. 8) BIBLIOGRAPHY: 1) API, 2011. Environment, Health Safety. American Petroleum Institute. [online]. Available from: http://www.api.org/environment-health-and-safety/health-safety.aspx [ Accessed 8 November 2012 ] 2) HSE, 2012. Current Priorities. Health and Safety Executive. [online]. Available from: http://www.hse.gov.uk/offshore/priorities.htm [ Accessed 28 November 2012 ] 3) PETER, W., ed., 2005. Health and safety: risk management. revised ed. Leicestershire: IOSH.

Full Body Scanners Do Not Lead to Safer Travel Essays -- Airport Secur

Why should anyone including my 3-year-old daughter unnecessarily be exposed to cancer causing X-ray beams in a full body scanner? Or have a total stranger run his or her hands up and down my daughter's body for a full pat-down upon refusing the scan? Most enraging is that the scan can be done without my knowledge. Full body scanners should not be used in United States airports. The Transportation Security Administration (TSA), on November 20, 2010 implemented the use of 385 scanners, otherwise know as advanced imaging technology in 68 airports to include Denver International Airport. The TSA is using these machines supposedly to ensure safer travel and be steps ahead of security threats. According to the TSA, as a preventive measure, scanners where rapidly deployed after Umar Farouk Abdulmutallab's failed attempt at blowing up an aircraft with pentaerythritol tetranitrate, or PETN sewn in his underwear December 25, 2009. Former Homeland Security chief Michael Chertoff claimed that if Abdulmutallab had gone through screening or a full pat-down, the explosives would have been discovered (Eggen, DeYoung and Hsu 2). The TSA also claims that not all explosives or explosive devices can be detected through metal detectors. The scanner machines cannot detect explosives such as the type that Abdulmutallab had concealed. Abdullah Ansieri had a detonator and explosives hidden in his rectum when he tried to kill Saudi Arabia's counter-terrorism chief, Prince Mohammed bin Nayef. Ansieri was Saudi's most wanted man and managed to get through two rigorous airport screenings and Saudi Secret Service, who defend royals by any means necessary. Professor Clive Williams a counter-terrorism expert of the Australian National University said the mac... ...he-real-radiation-risk-of-the-tsas-full-body-x-ray-scans/> 5. Bell, Jason. â€Å"Review of the TSA X-ray backscatter body scanner safety report: hide your kids, hide your wife.† My Helical Tryst, blogspot.com, 22 Nov 2010. Web. 1 Dec 2010. 6. â€Å"You asked for it...You got it, Millimeter Wave images.† blog.tsa.gov. TSA 09 May 2008. Web. 1 Dec 2010. . 7. "Are Full Body Scan Images Saved? Issue Challenged In Federal Court...† wgrz, Buffalo, 06 Aug 2010. Web. 1 Dec 2010. . 8. Meserve, Jeanne, and Mike M. Ahlers. â€Å"Body scanners can store, send images, group says.† CNN 11 Jan 2010: 1. Web. ! Dec 2010.

Medical Marijuana :: Medicine Drugs Essays

Medical Marijuana Marijuana has been hailed as a prescription for many ills and physicians once used it to stimulate appetite, relieve chronic pain, and treat asthma and migraines. But is marijuana really a medical miracle? If so, do its clinical benefits outweigh its drawbacks? Should we legalize marijuana? Is medical marijuana really worth the risks? These are the issues one needs to think about before making the decision to legalize marijuana. Marijuana is a drug that is derived from the dried and cut leaves of the hemp plant known as "cannabis sativa". Marijuana has a variety of street names such as "grass", "Mary Jane", "pot", "smoke", "reefer", "herb", and "weed". The active ingredient in marijuana is delta tetrahydrocannabinol (THC) (3). . Marijuana has been used throughout history and in many different cultures to change mood, perception, and consciousness (to get "high"). Its effects range from increasing creativity to provoking mystical experiences, to heightening the capacity to feel, sense and share. After alcohol, it is the most popular of what are called "recreational drugs." It has been used around the world for other purposes. In some primitive tribes of South America, Africa, and India, "cannabis" is used in religious ceremonies and for medical purposes. African mine workers have used it to ease the drudgery of their work and many Jamaicans use it at the end of the day to relieve fatigue. It has been use d as an intoxicant in various parts of the world for centuries and in the United States, for the most part the 20th century. Marijuana was first described in print in a Chinese book of medicine, "Herbal," in the 2nd century B.C., and was used in China as an anesthetic 5,000 years ago. The ancient Assyrians, Persians, Greeks, Romans, and East Indians used the drug to control muscle spasms, reduce pain, and to treat indigestion. It was commonly used in folk medicines in Africa and Asia. As early as 1611, marijuana was cultivated for its fiber in Jamestown, Virginia. In 19th century America, marijuana was used by the medical profession for treating spastic conditions, headaches, labor pains, insomnia, and menstrual cramps. It is still used as a medicine in the Middle East and in Asia (9). The controversy dealing with marijuana stems from the legalization of the drug for medical use.

The Treatment Of Rheumatoid Arthritis Health And Social Care Essay

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