HR and Leadership (new) Essay Example | Topics and Well Written Essays - 3000 words

HR and Leadership (new) - Essay Example ather than decision making. For HR to be leading the department should employ effective strategy and solution to resourcing and ensuring there is talent planning and development, service delivery is at its best with well-coordinated systems of communication which involves employee engagement and relations. Thus leading HR should be determined in performance and must reward employees on good work done. Above all the human resource management should be of credible personality, driven to deliver, decisive thinkers, role model and should have courage to challenge actions in the organization. Organization is important to ensure delivery of services and attainment of objectives if structural changes are effectively managed (Woodrow, 2012). Organizational structure of any firms matters a lot as if it’s well organized it will be easy to effect changes because the values , believes and attitudes set by an organization so there is well spelt out procedure on how everything is coordinate d in the organization including , communication systems and responds to the environment. Strategic human resource management relies mostly on resource based view of the firm which suggests human resource practices leads to high performance and sustained in competitive environment. Top management should ensure high technology is employed in firms to enable HR practices build up mentoring, give incentives to performing workers and also enable performance appraisal which encourages development of working relationship (Collins&Clark, 2003). HRM and worker performance Human resource development can be achieved be ensuring you hire only qualified individuals with potential of learning and adapting to changes and training them to increase their performance and increasing knowledge assets in the organization. Human resource management creates value and increases firm’s performance and also increases interactions between employees and customers which in turn shapes customers perspecti ve of the quality of service they obtain from the firm. If the employee put time and effort in satisfying customers’ needs this increases customers buying behavior and trust in the firms products hence the firm is able to maintain existing customers and all gain new ones as customer experience ultimately attracts new clients. Commitment of human resource department, impact the willingness of employee to satisfy customer’s needs and the general performance of the firm (McClean, 2009). HR departments have being viewed as the greatest assets in any organization and are actively involved in selection , training and ensuring changes are implemented to increase the performance of the firm is competitive in the current environment which translates to good results both financially and product wise . HR department must comply with the organizations objectives in order to ensure that any changes they impose are compatible with the client’s needs. Before any change is prop osed should be wide consultation among top management to ensure it’

Development of an Equation Essay Example for Free

Development of an Equation Essay Purpose: Investigate a chemical reaction using lab procedures and observations. Then, find a pattern of reactivity and explain the findings using a chemical equation and particle diagram. Procedure: Refer to: Department of Chemistry, The Ohio State University. Development of an Equation. General Chemistry 1210 Laboratory Manual. Vol. 2013-2014. Plymouth: Hayden-McNeil. 32-35. Data/Results: Part A: In the potassium iodide solution, I think there were potassium atoms as well as iodine atoms. In the lead nitrate solution, I think there were lead and nitrate ions. The potassium atoms and the lead atoms can be classified as cations, since they are metals. The iodine atoms and the nitrate ion can be classified as anions since they are nonmetals. Upon mixing, the solution turned into a cloudy yellow color. Evidence that a chemical reaction occurred was that the two solutions created a new color because the two solutions were originally colorless. There was no gas formed. Part B: (Testing the Anions) Iodide reaction with hydrogen peroxide observations- The precipitate at the bottom turned into a red solid and the liquid solution was a dirty yellow color. Nitrate reaction with hydrogen peroxide observations- A colorless precipitate formed at the bottom and looked like a bubble. It was a relatively large bubble. The liquid solution was colorless and cloudy/fizzy. Since the reaction resulted in some fizzing and bubbles, this is indication that a gas was formed. (Testing the Cations) Potassium reaction with thioacetamide observations – No reaction occurred. Lead reaction with thioacetamide observations A violet-black precipitate formed at the bottom of the test tube and the liquid solution was a cloudy grey color. It was about the same size precipitate as the nitrate reaction with hydrogen peroxide. Strong smell from the thioacetamide. Part C: Identification of ions in the precipitate that forms when lead nitrate solution is added to potassium iodide solution. (Testing for Anions) Reaction with hydrogen peroxide observations- A dark red precipitate formed at the bottom of the test tube and the liquid solution was colorless. There was not a large amount of precipitate formed and it sort of smeared along the inside of the test tube. Inferences: What anions are in the precipitate? -iodine (I-) When compared with results from part B to test anions, similar results were found. A dark red precipitate was formed in both. (Testing for cations) Reaction with hydrogen sulfide observations- A small, violet-black precipitate formed at the bottom of the test tube and the liquid solution was grey and cloudy. Inferences: What cations are in the precipitate? – lead (Pb2+) When compared with results from part B to test cations, similar results were found, A violet-black precipitate was formed in both tests. Exchange reaction- Positive potassium started off with negative iodine, and positive lead started off with negative nitrate. Potassium switched to combine with nitrate and lead switched to combine with iodine. Part D: Testing of Precipitate| Observations on Initial Precipitate Formed (relative amount, etc.)| Lead Nitrate: Potassium Iodide Ratio| Tube 1| Powdery, yellow precipitate formed at the bottom. Not very much precipitate. Little to no streaking. Clear liquid solution above precipitate. | 3:1| Tube 2| Powdery, yellow precipitate formed at the bottom. Equal to tube 1. Little to no streaking. Clear liquid solution above precipitate.| 2:1| Tube 3| Powdery, yellow precipitate formed at the bottom. A little more precipitate than tube 1 and 2. Little to no streaking. Clear liquid solution above precipitate.| 1:1| Tube 4| Powdery, yellow precipitate formed at the bottom. Much more than tube 3. Noticeable streaking of precipitate along sides of test tube. Clear liquid solution above precipitate.| 1:2| Tube 5| Powdery, yellow precipitate formed at the bottom. Most precipitate formed out of all test tubes. A lot of streaking of the precipitate along sides of the test tube. Clear liquid solution above precipitate. | 1:3| Testing of Supernatant| Observations| Inferences: Which ions were in the supernatant? List cations and anions.| Tube 1| The solution was clear with lead nitrate, but turned a yellow cloudy color with the potassium iodide. | Pb2+ (lead)-cationsNO3- (nitrate)-anions| Tube 2| The solution was clear with lead nitrate, but turned a yellow cloudy color with the potassium iodide.| Pb2+ (lead)-cationsNO3- (nitrate)-anions| Tube 3| The solution was clear with lead nitrate, but turned a yellow cloudy color with the potassium iodide.| Pb2+ (lead)-cationsNO3- (nitrate)-anions| Tube 4| The solution was clear with both the lead nitrate and the potassium iodide.| Pb2+ (lead)-cationsNO3- (nitrate)-anions| Tube 5| The solution was a little yellow with the lead nitrate, and a little less yellow with the potassium iodide.| K+ (potassium)I- (iodine)| Discussion/Conclusion: In part A, the first step was to obtain 5 drops of potassium iodine and 5 drops of lead nitrate and put them into a test tube and record observations. Then, to test the anions in part B, 5 drops of potassium iodine, 5 drops of nitric, 10 drops of dichloroethane, and 5 drops hydrogen peroxide to a new test tube. Then to a separate test tube, 5 drops of potassium nitrate, 5 drops of nitric acid, 10 drops of dichloroethane, and 5 hydrogen peroxide to a new test tube. Both should be stoppered and shook to produce two distinct layers. To test the cations, 2 test tubes would each get 20 drops of thioacetamide and 2 drops of nitric acid. One would get 5 drops of lead nitrate and the other 5 drops of potassium nitrite. Both test tubes were heated for 5 minutes and observations were recorded. In part C, the sample was used from part A and the test tube was centrifuged, then the clear aqueous layer was removed and discarded and the precipitate was washed with distilled w ater. This process was repeated once more. To test the anions, 5 drops of nitric acid, 10 drops of dichloroethane, and 5 drops of hydrogen peroxide were added to the solid precipitate and the test tube was stoppered and shook. These results were compared to the results from part B. To test for cations, the less colored aqueous layer was transferred to a clean test tube and the leftover layer was discarded. The solution was heated in a water bath until clear. 20 drops of thioacetamide were added, stirred then heated in a water bath and compared to the results from part B. In part D, to determine the ratio of  ions in the precipitate, 5 test tubes were labelled 1-5 and were filled according to table 3.1 on page 34 of the lab manual. The same medicine dropper was used for all drops and the test tubes were stoppered and shook, then centrifuged. The relative amounts and appearance of each precipitate were recorded. To test for potassium of iodide ions in the supernatant, 5 drops of lead nitrate were added to 5 separate test tubes with along with 5 drops from the appropriate test tube solution. The same was done to test for lead or nitrate ions, but potassium iodide was added instead. The perfect ratio for thi s lab was 2 potassium iodides for every lead nitrate. This ratio was found from balancing the equation and from comparing the results from part C to part B to match the observations of the precipitates. The ratio is the molar mass ratio of the balanced equation. The balanced equation was: 2KI(aq)+Pb(NO3)2(aq) 2KNO3(aq)+PbI2(s) and the formula of the precipitate was PbI2(s) based on the observations. In part B, the test for anions resulted in a dark red precipitate which was the iodide solution with hydrogen peroxide. In part C, the same results were found when lead nitrate and potassium iodide were added to hydrogen peroxide, therefore; the anions found were iodide ions because it has a negative 1 charge. In part B to test cations, the precipitate was a violet-black color for the lead solution reaction with thioacetamide. In part C, the same results were found when lead nitrate and potassium iodide were added to hydrogen sulfide. The cations found were lead ions since they have a positive 2 charge. Some inherent errors could have been while extracting the clear aqueous solution, some of the precipitate could have been extracted with the solution and transferred into another test tube. Upon heating, not all of the precipitate dissolved. Some of the drops with the micropipet varied also. The medicine dropper was more precise with the drops. Through this lab, a chemical reaction was used to find the pattern of reactivity which was an exchange reaction. This is known by finding the chemical equation and properly balancing it which is seen above. This lead to the ability to create a particle diagram and the findings of a perfect ratio of lead nitrate to potassium iodide.

Positioning Essay -- Marketing Advertising Advertisements Essays

Positioning Many people consider marketing as a means to let creative juices flow. In many ways, this can be true. But what many do not realize is that marketing needs common sense and logic to a certain extent. This applies to both internal and external marketing. Companies tend to lose focus – whether it be because it is having a difficult time dealing with high growth or because a few upper management ‘wanna-be’s’ try something bold (without thinking). This is where positioning comes into play – if you want to survive or prosper, that is. So what is positioning about? Positioning is a concept that sparked a revolution in advertising. It was developed in by the authors of â€Å"Positioning: The Battle for Your Mind†, Al Ries and Jack Trout. The book was published in 1981 and became one of the top sellers or all time. Positioning was the first concept to deal with the problems of communication in an over-communicated society. With positioning you can beat the competition and win the battle for recognition in an overcrowded, media-blitzed marketplace. With this approach, a company creates a ‘position’ in the prospect’s mind, one that reflects the company’s own strengths and weaknesses as well as those of its competitors. Product positioning is an important strategy for achieving differential advantage. Positioning reflects the â€Å"place† a product occupies in a market or segment. A successful position has characteristics that are both differentiating and important to cons...

How does Austen convince the reader that Lizzy is right to reject Mr.Collins’ proposal?

From the first sentence of the passage, Austen demonstrates that Mr Collins is not a suitable husband for Lizzy when she says â€Å"Mr Collins was not a sensible man. † In Chapter 15, Austen describes the character of Mr Collins in more detail reinforcing the statement made in the opening sentence. Mr Collins is then described as being stupid and his natural stupidity has not been helped by ‘education or society. ‘ Although Mr Collins had been to university, he had ‘only kept the necessary terms. ‘ so he had not improved himself as a result of attending. Mr Collins was brought up as by a stingy father who gave him no guidance and gave Mr Collins a ‘great humility of manner' meaning he was reluctant to involve himself in society. When Mr Collins is recommended to the living of Hunsford by ‘fortunate chance' he is forced into society and his ‘early and unexpected prosperity' has gone to his head. He venerates his patron Lady Catherine de Bough, and Austen's use of the word ‘veneration' suggests the religious awe with which Mr Collins regards Lady Catherine. It is ironical that a clergyman who prides himself on setting an example to his parish practically worships his patroness. Austen describes him as ‘a mixture of pride and obsequiousness, self-importance, and humility. ‘ Mr Collins intends to marry one of the Bennet daughters, but Austen's description of Mr Collins convinces the reader that his behaviour makes him unsuitable for anyone. Before arriving at Longbourn, Mr Collins had decided he would marry the eldest of the five daughters, Jane. However, Mrs. Bennet tells him that Jane is likely to be engaged so Mr Collins decides to marry Elizabeth instead. This decision to change his affections was made ‘while Mrs. Bennet was stirring the fire,' which highlights the absurdity in the switch in his affections. Chapter 19 shows Mr Collins at his most well intentioned, but also at his most stupid. Lizzy feels awkward when Mr Collins asks to speak with her, and she is ‘torn between distress and diversion,' meaning that she didn't know whether to laugh or cry. Mr Collins however, sees this awkwardness as a mark of a good upbringing and shows his insensitivity by failing to see Lizzy's unhappiness at the interview. Mr Collins then claims he will be ‘run away with by (his) feelings' which brings Lizzy to the verge of laughter at the very notion. Mr Collins' â€Å"solemn composure† would ever lead him to be romantic. Mr Collins gives three reasons for marrying, but none of them consider Lizzy's feelings, they only satisfy him. The first reason is to set an example to his parish; the second is to ensure his happiness, without considering Lizzy's, and the final reason is his patron, Lady Catherine de Bough told him to marry. Mr Collins shows his absurd veneration of Lady Catherine by recalling the whole conversation when she told him to choose a suitable wife. So part of the reason Mr Collins is marrying is to satisfy his patron, who, according to Mr Collins, will think Lizzy a suitable wife. Mr Collins assures Lizzy that were she to marry him, she would be able to meet Lady Catherine, something he sees as a real privilege. Mr Collins explains to Lizzy how Lady Catherine will enjoy her ‘wit and vivacity,' yet also says how Lady Catherine's high social rank demands silence, so it is a mystery how Elizabeth will be able to demonstrate ‘wit and vivacity' when she is required to remain silent! It is evident from Mr Collins's attitude that he views Lady Catherine as being more important than his intended wife, but he further compounds his errors by telling Lizzy there are many ‘amiable young women' in his neighbourhood. He also believes the marriage is right as a reconciliation because Mr Bennet's estate is entailed away form the family line to Mr Collins. So far, the reader has not seen a motive of love at any point in this proposal, Mr Collins has talked of pleasing himself and his patron. However, from chapter 15, the reader can see that there is no depth to Mr Collins's affections; he had simply resolved to choose a wife, almost for the sake of having one. Mr Collins, however, assures Lizzy of the ‘violence' of his affection. He also claims that at as soon as he entered the Longbourn house he had ‘singled out' Lizzy as the companion of his future life. The reader knows this to be untrue as Mr Collins only chose Lizzy when he was told Jane was likely to be engaged. Austen convinces the reader here that Lizzy should reject Mr Collins because it is evident that there would be no element of love in the marriage, and Mr Collins is portrayed as being selfish and dishonest during this conversation. Austen shows the reader that Mr Collins has a complete lack of self-knowledge. Mr Collins claims to be ‘perfectly indifferent' to Lizzy's fortune as she is not entitled to a large inheritance, yet he knows the precise details of her inheritance and speaks at length on the subject. It is evident although Mr Collins professes to have no interest in her fortune, that he is interested enough to research the exact nature of Lizzy's inheritance. Mr Collins's blundering would make Lizzy even less likely to marry him than she was before the start of the proposal. He tells Lizzy there are plenty of pretty girls in his Parish, and speaks at length about the death of Lizzy's parents, further demonstrating the fact that he had no idea about the correct way to behave in society. Whilst making his long speech, outlining the benefits of the marriage for himself and venerating Lady Catherine, Mr Collins had not considered that Lizzy might refuse him which shows great arrogance and complete lack of thought. When Lizzy is finally able to reply, she replies politely, thanking Mr Collins for his compliments, and unsurprisingly, refuses Mr Collins's proposal. Yet, Mr Collins further shows his complete ignorance of society by refusing to accept Lizzy's refusal! Mr Collins, claiming to have great knowledge of society, believes that ‘it is usual for young ladies to reject the man they secretly mean to accept. He does not understand society and the idea that young ladies would refuse to marry a man they loved is ludicrous. Lizzy tries to convince Mr Collins to accept her refusal by referring to Lady Catherine, claiming ‘she would find me in every respect ill-qualified for the situation. ‘ Mr Collins however, thinks exactly the opposite believing Lizzy' s ‘modesty and economy' make her a suitable wife. These were two of the qualities Lady Catherine instructed Mr Collins to look for in a wife. Mr Collins continues to persist and he outlines the reasons why he is convinced Lizzy secretly loves him. These include ‘my situation in life, my connections with the family of de Bough'. He further insults Lizzy saying she might not get another chance of marriage largely because her ‘portion is so small' meaning her lack of wealth will ruin her chance of marriage and he is probably the only man who will accept her. He still refuses to accept Lizzy's refusal, and Lizzy leaves the room to appeal to her father ‘whose negative might be uttered in such a manner as must be decisive. ‘ Austen does not make the reader feel sorry for Mr Collins, but portrays him as a totally unsuitable husband for Lizzy. The initial description of Mr Collins in chapter 15 tells the reader what Mr Collins is like, and Austen's view of him as ‘not a sensible man' is totally accurate. In chapter 19, we see Mr Collins's stupidity during his proposal to Lizzy, and it is obvious Mr Collins does not know how to behave, nether does he have any understanding of people's feelings. It is Austen's description and portrayal of Mr Collins that convinces the reader that Lizzy is right to reject Mr Collins and that she deserves a much better husband.

Separate components

One of the main religious books of Buddhism is â€Å"Tripitaka† (Pali language and Sanskrit – ‘tri’ = three and ‘pitaka’ = basket), which means â€Å"three baskets (of texts)† and also is know as â€Å"Tipitaka†, canonic texts of classical Buddhism schools, consisting of the Vinaya, the Sutta or Suttanata and the Abhidhamma.This three-part structure of canonic texts can be considered as line of demarcation between classical Buddhism (which some people call hinayana – narrow way or narrow chariot) and those reformative directions, which having desire to show its supremacy, gained an honorable title of mayanaya (wide way or wide chariot) and created another collections of holy texts, imitating to some extent works of â€Å"Tripitaka† (first of all these are dialogues of Sutta Pitaka), but didn’t follow principles of three-part canon.Separate components of â€Å"Tripitaka† were kept in memories of many sch ools of early Buddhism indifferent Indian languages, such as Sanskrit and hybrid Sanskrit and also in middle Indian languages.Some schools considered as holy all parts of Tripitaka, – except of theravaddine, vatsipuri or machishchasaka. The others focused accent at importance of separate parts in comparison with others: sthaviravadines respected the Sutta first of all; sarvastivadines respected the Abhidhamma and aparashayles and purvashayles recognized only the Vinaya. Some of the followers completed three-part canon with new ‘baskets’.So, machasanghiki added to three parts Samiukta-pitaka and Dharma-pitaka, and bachusrutii (who already recognized â€Å"transcendency† of some Buddhist studies) added also Bodhisattva-pitaka, whereas dharmaguptaki took from traditional three parts only the Vinaya and added together with three new ‘pitakas’ also Tsharani-pitaka (which was probably text of magical spells) (Thomas W. Rhys-Davids, p.103).Complete c anonic text of â€Å"Tripitaka† belongs to ‘orthodox’ school of theravadines. Canonic texts were collected, were reproduced and passed orally, modified by the teachers, preachers and missioners of Buddhist communities during many ages, so material of Pali â€Å"Tripitaka† belongs to wide time continuum from the Buddha à ©poque (according to modern date – 5 century BC), some speeches of whom, probably, were memorized immediately by followers of his communities, specialized on memorizing of holy texts (bhanaki) till time of their partial writing in Pali language in the 1 century BC.Process of canonization wasn’t finished yet. Texts of â€Å"Tripitaka† continued to be created, edited, wrote and re-wrote till the 5th century – time of creation of â€Å"complete† commentary to â€Å"Tripitaka†, which can be considered the Pali re-working of Singal commentaries by egzeget collegiums, managed by Buddaghossa. So, historic al origin of â€Å"Tripitaka† texts needs special examining in each separate case.Written form of â€Å"Tripitaka† was first written on palm leaves – alu – during the times of King Vatthugamini Abhay (101-77 BC) in Alu-Vihara, Matala near Kandi, Sri-Lanka.These works were collected one year after Buddha’s death by his three followers at the first Buddhist’s meeting in Radzhigire. During the next meetings those groups of studies were re-worked and written.First ‘basket’ consists of 3 parts and is dedicated to principles of organization of Buddhist monk community, principles of creation and demands to monks.The Vinaya regulates all monk life and their communications with civil people in details. The word â€Å"Vinaya† means â€Å"that, who dispels evil†. The first part, Suttavibhanga, is commentary to patimokkha – 227 discipline rules for monks in connection with definite actions of members of early-Buddhist m onk community-sangha and corresponding punishments – starting of admonitions and finished by expulsion from sangha. These rules reflect real practice of regular readings of patimokkha during fasting-days (uposatha) of new moon and full moon.The second part consists of Khandhakas – in two versions (Mahavagga in 10 chapters and Culavagga in 12 chapters), where detailed discipline rules (prescribing how to live during rain periods, which clothes they should wear, how they should prepare medicines, etc), are ‘diluted’ with didactic and historical legends (Frauwallner, E.,, p.53).The first contains stories which explain how separate people came to Buddhist community, the second contains information about partial stories of Buddha’s life (gaining â€Å"clarifying†, first travels and first followers) and stories about first two Buddhist meetings in Radzhagrych (soon after Buddha’s death) and in Vayshali. The third part, Parivaranapatha, consi sts of 19 text of catechism type, including questions and answers for discipline problems.The Sutta, the eldest and the main part of Tripitaka’s texts is collection of five big texts (nikaya), first four of which are thematically similar to some extent (statement by Buddha, sometimes by his followers, of separate topics in Dharma (Buddhist science), and the last part is collection of different materials, united a bit later.The first four collections of the Sutta are started with unchangeable words â€Å"So I heard†, which is given from the narrator (in order to show origin of text), which is followed by plotline of lesson and then after the lesson itself, which Buddha pronounces in dialogue with somebody or in monologue (http://www.dharmanet.org/).The words are â€Å"Tripitaka† words are charming, they open your eyes and bewilder with their wisdom; they sound like music which you want to hear again and over again, reading and re-reading its simple but wise words : â€Å"He walks without fear, stands without fear, sits without fear, lies down without fear. Why is that? Because he is out of the Evil One ‘ s range. †Thai is what the Blessed One said. The bhikkhus were satisfied and delighted in the Blessed One ‘ s words†. (â€Å"Tripitaka†) These four collections of texts differ not only in content, but in quantity and structure – by length of the Suttas and way of organization of their consequences. All five big collections of the Sutta’s texts include in different proportions prosaic and poem components.

The Duke essays

The Duke essays The Harlem Renaissance was an era full of life, excitement, and activity. The world in all aspects was in gradual recovery from the depression. The world of music was expanding, sharing its enthusiasm throughout the world. The evolution of jazz aroused the curiosity of the nation. As Blacks received their freedom, they were able to express themselves as talented individuals. Certain blacks contributed immensely to the era of jazz, for example, Duke Ellington. Ellington entered a brand-new, exciting era as he grew up. As Ellington became an adolescent, the entertainment world was undergoing rapid, change. The change was driven by the deep, persuasive shift in the American spirit. The country was anxious to recover what it lost during the Depression. Ellingtons jazz creations were unknown and alien to the world, however, Ellington received the chance to succeed at the Cotton Club. The results of Ellingtons achievements at the Cotton Club were extensive, leading him to success and to national fame. The reasons for his outcome need to be revealed because Ellington was one of the most important figures in the era of jazz. During the Harlem Renaissance, some of the clubs were segregated and some mixed. The Cotton Clubs patrons were mostly whites and the club employed mostly blacks. The Cotton Club was the centerpiece of New Yorks entertainment business. It was the springboard to fame for many singer, dancers, and performers and was indeed the board Ellington jumped from. The club management decided what audiences wanted to see in their clubs. As a result of the Harlem Renaissance and the growing interest in black entertainment, audiences enjoyed watching the many talented black performers. To have such a name as the Cotton Club brings to mind images of the Old South. Ellington auditioned at the Cotton Club because he found it to be an opportunity that he would most likely never stumble upon...

Just-In-Time Production Essays - Manufacturing, Free Essays

Just-In-Time Production Essays - Manufacturing, Free Essays Just-In-Time Production Just-in-time production is considered to be on the leading edge of technological advancement. With improvements in the virtually every industry, maintaining an effective production line while minimizing inventory costs is a very feasible option. Just-in-time systems are designed to keep inventory costs at a minimum, unlike the ways of old, with large warehouses loaded with back inventory. With technology allowing instantaneous communication around the world, production lines and stores do not have to wait for days for inventory delivery. It can happen, well, just-in-time. Many companies are on the verge of switching to a just-in-time inventory system, to compliment the millions of companies that have already implemented the system. It is generally recognized that effective implementation of just-in-time will result in a significant reduction of inventories. As a matter of fact, inventory levels are key indicators for measuring just-in-time performance (Harrison). The just-in-time philosophy on inventory management is simple: - Strive for a level of zero inventories. - Produce items at the rate required by the customer. - Eliminate all unnecessary lead times. - Reduce setup costs to achieve the smallest economical lot size - ideally, a quantity of one. - Optimize material flow from suppliers through the production process to the point of sale of the finished product, so that inventories are minimized. - Ensure high quality and dependable just-in-time delivery from suppliers. - Implement a Total Quality Control (TQC) program, which will minimize scrap, rework and resultant delays in production (Naylor). While the just-in-time inventory management philosophy is simple, execution is not. In a just-in-time environment, the supplier should deliver raw materials and other purchased items when they are needed. A blanket purchase order or other suitable form of basic agreement should cover the terms and conditions for procurement. Delivery of the item should be direct to the point of use in the manufacturing plant. It is time consuming and not cost-effective for the materials to be handled in one part of a production line before it is moved to the correct location. It is up to the supplier to ensure a smooth flow of material to support production, which is obtained through optimum communication and coordination between the manufacturing plant and the supplier. It is integral that there is a working relationship between suppliers and the controller of the manufacturing plant. The supplier should be considered by the manufacturing company as an extension of the plant and should be included in all planning which involves his products. Certain individuals in the production plant should be selected to represent the company on matters pertaining to schedules and delivery quantities (Naylor). Several techniques exist for controlling the flow of material from the supplier to the manufacturing company. The specific technique should be selected which would best suit the implementation of the just-in-time concept for the particular item being purchased. Automatic inventory replenishment by the vendor is a technique where the supplier determines the need for required materials based on frequent deliveries to the plant. Depending on the nature of the production process as well as the material involved, this could range from many times a day to a less frequent interval. Visual review of existing inventory by the supplier will determine how much to deliver (Slack). The method of inventory control is not foreign to U.S. commerce and industry; visit a supermarket and see how the baker delivers his goods. He replenishes the baked goods based on a visual review of what is on the shelves. The same is true for soda and candy vendor machines. Those using oil to heat their home are certainly familiar with this type of inventory system; the driver comes by the house periodically and fills the tank. Implementing just-in-time may result in increased transportation costs due to smaller lot sizes and more frequent deliveries. However, in some industries such as chemicals there are significant trade-offs between the economy of longer lead-time and less flexible rail shipments versus more frequent tanker truckloads. Each of these cases must be examined on its own merits and on a continuing basis to determine the optimum solution (Slack). Just-in-time requires flow of material in the exact quantity required and at the exact time; the key word is exact. Regardless of the specific method used to achieve this exact material flow, there must be

The #1 Rule for Filling Out Your Walmart Application

The #1 Rule for Filling Out Your Walmart Application SAT / ACT Prep Online Guides and Tips Applying for a Walmart career? Want your Walmart application to stand out? Filling out the Walmart online application can be a little confusing. In addition to normal application questions about your background, the Walmart application asks you to complete a "Pre-Employment Assessment test." This 65-question test will HUGELY affect your chances of starting a Walmart career. In this guide, I’ll tell you where to find the Walmart online application. Even better, I'll explain the key to acing the Walmart Pre-Employment Assessment Test, so you have the best chance possible of getting a Walmart job. How to Find the Walmart Online Application for Retail Work First things first, how do you find Walmart employment? Head on over to the Walmart.com jobs website. The website will take you through a few steps to find a Walmart job near you. Once you’ve located a job near you, the application is split into two main sections: background information and the pre-employment assessment. The background information section is pretty simple. It just asks you to enter information about where you live, how to contact you, your education, your previous employment history, etc. Simply follow the steps on the website, and answer every question truthfully. Once you’ve completed the background information portion, you’ll be re-directed to the Walmart Pre-Employment Assessment. How to Ace the Walmart Pre-Employment Assessment The second part of the Walmart application is the Pre-Employment Assessment, a 65-question test split into four sections. In the first section, you’ll be presented with various work-related situations and you’ll need to select the most appropriate response. Below are examples of these types of questions from the actual Walmart job application. The second section asks you to rate the effectiveness of certain work actions on a scale of 1-5 for effectiveness. In the third section, you’re presented with statements, and you need to select how much you agree or disagree with it. The fourth section asks you about your past experience. The Pre-Employment Assessment is graded pass/fail. You have to complete and pass the test to be considered for a Walmart job. Therefore, you need to do well, but how? The #1 most important rule to remember to ace the test is that quality customer service is very important to Walmart. Consider that before answering any questions. I’ll walk you through a sample question from each section and show you how to apply this rule to answer the question. Section 1 sample question: â€Å"One of your customers has just said to you, ‘The service here is terrible.’ You should say:† â€Å"What is it about the service that you have not liked?† â€Å"Would you like to fill out a complaint form? I can get one for you.† â€Å"I realize our service is poor today. We are understaffed, so I apologize.† â€Å"I am really sorry to hear you say that, but we are trying as hard as we can.† If you think what would quality customer service be, then you’d probably realize that just apologizing is not the best choice. You want to learn WHAT it is that was bad, and figure out how you can improve it. Therefore, I’d eliminate C and D. B is good but not very personal. A shows the customer you care and want to help. Therefore, A is the best choice in terms of quality customer service, so I’d choose A. Section 2 sample question: Rate the following action listed for dealing with an angry customer who has come to you with a complaint on a scale of 1-5 for effectiveness (1 being very ineffective, 5 being very effective): â€Å"Outlining reason why the customer’s concern is not right.† If I, the employee, tell the customer that they shouldn’t be angry and that their complaint is not valid, that will likely make the customer angrier. It certainly won’t make the customer happy and won’t make them feel like they’re being appreciated or listened to. Imagine if you went to a store yourself and was angry - would you like if it the staff member told you why you were wrong? Probably not. Therefore, it would be bad customer service, so I think it’d be very ineffective. I’d give it a 1. Section 3 sample question: Rate the following for how much you agree or disagree on a scale of 1-5 (1 being strongly disagree, 5 being strongly agree): â€Å"I enjoy spending the time to find answers to difficult questions.† If Walmart cares about quality customer service, then they want all Walmart employees to answer all customer questions. If a customer presents you with a difficult question, then Walmart expects you to find the answer. If you say you hate spending time answering hard questions, Walmart may think you won’t help customers. Therefore, I’d guess they want you to enjoy spending time answering questions. I’d say 5 strongly agree. Section 4 sample question: â€Å"You have typically set work standards that were aimed:† â€Å"Above average as compared to other employees.† â€Å"At the same level as other employees.† â€Å"At achieving the highest quality possible.† â€Å"At completing the largest quantity of work.† Again, Walmart cares about quality customer service. Therefore, they care about high quality work. Using this logic, A or C is probably the best answer. If you compare A and C, A simply says the work standard is above average while C says the work standard is aimed at achieving the highest quality possible. C is the better choice because it’s stronger than A. The customer should always be happy. Summary: How to Start Your Walmart Career If you're looking to work at Walmart, remember the following key points: You can find Walmart jobs and start filling out the Walmart application at the Walmart.com jobs website. There are two parts to the Walmart application: provide your background information and answer a Pre-Employment Assessment. You need to pass the Pre-Employment Assessment in order to be eligible for a Walmart job. When working through the assessment always keep the principles of excellent customer service in mind.

Information Systems Security Essay Example | Topics and Well Written Essays - 750 words

Information Systems Security - Essay Example the same time, despite all the efforts made by the government to ensure cyber security and intrusion prevention, it seems that a lot more needs to be done before American can be considered secure from intrusion or attack from cyber terrorists. Kabay (2007) presents an interesting article in which he discusses a paper from by The Business Roundtable under the title, Essential Steps to Strengthen America’s Cyber Terrorism Preparedness. The author discusses how the current level of protection with regard to intrusion and attack prevention is woefully inadequate considering the critical systems and the national infrastructure which is dependent on the servers and mainframes used by the government. It is easy to agree with the idea since many have criticized the government for going in the wrong direction with regard to securing our nation’s information network. Barnes (2005) as well as Fredrickson (2005) suggest that the government is on the wrong track with regard to digital security since steps such as the USA PATRIOT Act of 2005 and the Real ID Act of 2005 come across as little more than knee-jerk reactions to the need for security. Instead of developing technologies which prevent and avert attacks in the first place, the government is more focused on creating laws which extend its power over the people and curtail the liberties of individuals. Kabay (2007) describes how the government lacks intrusion detection tools or trip wires which can let network and server administrators know that an attack is under way or an attack is imminent. Further, the government lacks a system of accountability or even strategic management plans which could come into play if an intrusion takes place or if critical systems are damaged. Considering what happened after Hurricane Katrina, it is easy to understand why analysts would be doubtful about the government’s ability to handle critical system failures especially if they take place together (Young, 2006). Finally, Kabay

Ventur and Competition Essay Example | Topics and Well Written Essays - 500 words

Ventur and Competition - Essay Example States is the Federal Sherman Act 1890, with each state having reciprocal antitrust provisions effectively mirroring the Sherman Act (Hovenkamp, 2005). The essence of the Sherman Act is the prohibition of agreements that unreasonably restrain trade, monopolies, attempted monopolies and conspiracies to monopolize (Sherman Act 1890, section 1). The relevant enforcement body is the Federal Trade Commission, the U.S. Department of Justice, state attorneys and general or private parties affected by any proposed anti-competitive measure (Posner, 2001). If a joint venture or partnership agreement is found to fall within any of the Sherman Act 1890 prohibitions, the penalties for violation include the following: The main reason that healthcare joint ventures can fall foul of the antitrust provisions under the Sherman Act is that often the partners will be competitors within the same market with the overriding purpose being to pool resources to maximise economic benefits (Elhauge & Geradin, 2007). However, if additional to this, the venture partners continue to compete outside of the joint venture agreement, the antitrust legislation imposes restrictions on conduct between the partners (Hovenkamp, 2005). Secondly, one of the partners in the venture may have market power or the result of the venture will be to increase market power, which can be anti-competitive if the partners to the venture are then enabled to set prices above a competitive level. Furthermore, in considering the proposed joint venture the company should consider the following four issues in particular: In considering compliance with Sherman Act provisions, it is vital for the company to consider the relevant market (Posner, 20010. The relevant market comprises the relevant service market and relevant geographic market (Elhauge & Geradin, 2007). The service market is where the market of services is â€Å"reasonably interchangeable† and the relevant geographic market is â€Å"the area of effective

Do you have free will or are you determined Essay

Do you have free will or are you determined - Essay Example The paper describes two examples of philosophers (W.T. Stace and Baron d'Holbach), who believe in determinism, but with qualifications. While d'Holbach represents a determinism-only view, Stace offers a view compatible with a free will, and this compatibilist thesis is more correct. Compatibilism, as represented by W.T. Stace, is the view that free will and determinism are compatible without being logically inconsistent. This allows claims about individual autonomy in actions to make sense, whereas under the incompatabilism approach, it is logically inconsistent to speak of the coexistence of free will with determinism. An incompatabilist such as Baron d'Holbach, rules out a kind of metaphysical free will because determinism, the view that all of our actions are the result of antecedent causes, means that no actions are truly free in the sense that the person actually chose to do them. With this foundation, we can differentiate the views of Stace and d'Holbach with respect to freedom of the will. d'Holbach argues that human beings are very similar in nature to a machine, which is created with a very narrow range of functions. In his System of Nature, d'Holbach writes, â€Å"There is no such entity as a soul, but we are simply material objects in motion, having very complicated brains that lead the unreflective to believe that they are free†. In fact, human beings are so complex that they actually believe their actions are free, which is the symptom of religious beliefs, according to d'Holbach. Claiming that all of man’s ideas and senses can be reduced to his physical characteristics, the philosopher believes that these ideas and senses are involuntary and forced upon him. This incompatabilist, hard determinist stance is impossible to prove, which makes it difficult to accept d'Holbach’s arguments (Pojman 335). He argues primarily from analogy to machines and other human artifacts, which seems to undermine the premise that man is incapable o f original, free thoughts. In addition, it is difficult to get past the brute fact that if all of man’s arguments are determined by antecedent causes, then d'Holbach’s claims here are determined and therefore possibly false. In contrast, W.T. Stace offers a compatibilist (or soft determinist) view that upholds the truth of morality. Stace defines an act that was produced from free will as one that is directly caused by a person’s thoughts, emotions, and desires (Roberts). In other words, an act is only free if it is the result of internal mental states, not the outside influences of other antecedent causes. For instance, fasters on hunger strikes do not consume food because it is theoretically within their power to abstain from food, while someone who fasts because he does not have access to food is not doing so according to his free will. Stace defends compatibilism because of how he defines the notion of free will.

The Right to Privacy and Corporate Responsibility Essay

The Right to Privacy and Corporate Responsibility - Essay Example The concepts presented will then be assimilated into a discussion about the reasonable accommodation of the genuine needs of both sides of the question, with a conclusion regarding a structure which defines acceptable practices for corporate inquiries while preserving the rights of individuals to retain a modicum of privacy. This paper will be organized along those logical lines with a section on individual privacy rights that includes current research on the topic. A second section will discuss modern corporate tactics that might impinge upon personal privacy and citations from academic sources regarding the suitability of those methods. The third section will incorporate the concepts of the previous discussions into some workable ideas that accommodate the needs of both parties. Finally, the conclusion will set forth a concise framework that bridges the two extremes. Individuals have a reasonable expectation that their privacy be protected. Corporations have a demonstrable right to employ those individuals who have an appropriate personal and work history, as well as a work ethic compatible with the objectives and corporate culture of the company. As with any discussion of fundamental rights, however, a consideration must be made regarding the fact that an individual person's right to privacy does not exclude the need of a corporation to be reasonably assured that the employee is trustworthy. Conversely, an organization's need to have confidence in their employees does not give it latitude to excessively intrude into the private life of an individual unnecessarily. Accordingly, a proper balance of the needs of both parties will permit the accomplishment of the mutually-sought objectives. Individuals and the companies that employ them can both get what they need if proper respect is shown for the concerns of each. Individual Privacy Rights In the modern workplace, employees are subjected to events every day that potentially impinge upon their privacy. Some employers perform credit and background checks prior to hiring. Others require employees to submit to random drug testing or even polygraphs. In many large corporations, employees' computers and telephone conversations are monitored, recorded, and reviewed. In fact, "[s]urveillance is so thorough in some offices that employers can check to see exactly when employees leave their work stations to go to the bathroom and how long they take" (Hayden, Hendricks & Novik 1990: 97). Individuals, however, do not give up their right to privacy just because they sign on to work for a company. The preservation of these rights is therefore a major concern. Even in countries where the right to privacy is not statutory or constitutionally-derived, individuals have a natural right to expect that their personal information will not be distributed without their consent or used against them in an unlawful manner. It is a widely-recognized principle that even when a situation exists where someone, a corporation for example, has a duty to its investors to investigate the background of a potential employee, that duty is circumscribed by the individual's basic human rights. As expressed by

Ethics in criminal justice administration Essay

Ethics in criminal justice administration - Essay Example The prosecutor may come up with substantial evidence against the accused, but a professional defense lawyer could try to refute all of them using the specific guideliness involved in the law. This means that a case of the criminal could be win in the court because of the associated professionalism of holding on to the law. In other words, there could be probable linked up dilemma when it comes to ethics and professionalism in the criminal justice administration. There is also associated managerial approach when it comes to professional administration. One could potentially see this on the legalistic relationship between guards and the prisoners (Banks, 2004, p.134). However, guarding ethically would also mean doing the right thing, and performing what is right. This means that the coverage of criminal justice administration would go far beyond the bound of being legalistic in the administration of law, but ensuring what is the appropriate for the welfare of the prisoners. Thus, the c riminal justice administrators would be able to ensure the elimination of corrupt practices and make sure of fair treatment based on the context of law (Banks, 2004, p.134). However, ethics and professional behavior in the administration of criminal justice may potentially contradict. Professional behavoir may substantially pave the way for what seems to be right and appropriate. For example, the professional behavior of the defense lawyer may be proven by his ability to interpret the law and justify his reasons. Concerning this, there is a good chance for him to win the case of his client, who in reality should be guilty of a certain crime. This only implies that the presence of professionalism by simply adhering to the law has significant drawback as it may potentially conceal what is ethically appropriate. In professionalism, a defense lawyer for instance could orchestrate evidences that may sound appropriate for the law, but the bottom line is to nullify the value of the present ed evidences by the prosecutors and the witnesses. In other words, with professionalism, one would be able to win a case because of underlying technicalities involved within the context of law. Those who have strong interpretation of the law may be able to come up with a significant argument and supplement it with further proofs that could stand beyond reasonable doubt. It is therefore most likely for them to administer justice with their ability to persuade the court of what seems to be in line with law. Thus, provided that there is no substantial evidence, but in reality the accused is guilty, but there is no appropriate proofs beyond reasonable doubt, a professional defense lawyer may significantly win the case of his client. There is absence of ethics here especially if the accused who happens to be guilty will remain unpunished and acquitted. Certainly, it is not the right thing to do to find the murderer not guilty of the crime committed. However, there is a good chance for th ose who are professional enough to interpret the law and include substantial reasoning to target acquittal. In this case, justice administration may be a failure especially from the point of view of the prosecution and the victim. This also works the other way around, by which the culprit faces his sentence even on the crime he has not actually committed. This is due to the fact that the presented evidence was so strong that the prosecution team was professional enou

Case Study analysis for Marketing Communications Essay

Case Study analysis for Marketing Communications - Essay Example Companies in business areas such as beer and cider as well as other beverages benefit from sponsorship of sports personalities, clubs and events as these are opportunities for highlighting the spirit of entertainment and social celebrations, which is one of the intrinsic values of the product. The company is launching its advertising campaign on a rolling regional basis, starting from Southern London England followed by Scotland. However, when entering a market as UK, which is not very large in its size, it may be more effective to plan a national campaign, which will utilize national TV, and Press backed by outdoor advertising. The largest poster may be an effective means of attracting attention but the exposure level of the location is limited to those who are traveling via Heathrow airport to Ireland. The cost effectiveness per exposure may question the effectiveness of this advertising tool. The product positioning currently being conveyed by the campaign focuses on the product’s naturalness, tradition and heritage. Although these aspects appealed to the nationalistic Irish public, it may not be an effective positioning to the British. The company to adopt the â€Å"Pint Over Ice† concept combined with the naturalness aspect of the C&C’s product. The key message should be â€Å"Pint Over Ice† which targets the popularity of serving beverages in draught form in UK. The concept of â€Å"Pint On Ice† should be promoted as an integrated message through TV Ads, Press, Bill Boards as well as on location promotions with serving demonstrations. As the key challenge is to change the image of the cider product in UK public’s mind, the marketing communications focus has to be on above the line TV and press advertising conveying the premium image. The company should extend its advertising activities to pub level with Point of Sales material and promotions to add excitement. By providing branded product premiums such as caps, key tags

Ethics in criminal justice administration Essay

Ethics in criminal justice administration - Essay Example The prosecutor may come up with substantial evidence against the accused, but a professional defense lawyer could try to refute all of them using the specific guideliness involved in the law. This means that a case of the criminal could be win in the court because of the associated professionalism of holding on to the law. In other words, there could be probable linked up dilemma when it comes to ethics and professionalism in the criminal justice administration. There is also associated managerial approach when it comes to professional administration. One could potentially see this on the legalistic relationship between guards and the prisoners (Banks, 2004, p.134). However, guarding ethically would also mean doing the right thing, and performing what is right. This means that the coverage of criminal justice administration would go far beyond the bound of being legalistic in the administration of law, but ensuring what is the appropriate for the welfare of the prisoners. Thus, the c riminal justice administrators would be able to ensure the elimination of corrupt practices and make sure of fair treatment based on the context of law (Banks, 2004, p.134). However, ethics and professional behavior in the administration of criminal justice may potentially contradict. Professional behavoir may substantially pave the way for what seems to be right and appropriate. For example, the professional behavior of the defense lawyer may be proven by his ability to interpret the law and justify his reasons. Concerning this, there is a good chance for him to win the case of his client, who in reality should be guilty of a certain crime. This only implies that the presence of professionalism by simply adhering to the law has significant drawback as it may potentially conceal what is ethically appropriate. In professionalism, a defense lawyer for instance could orchestrate evidences that may sound appropriate for the law, but the bottom line is to nullify the value of the present ed evidences by the prosecutors and the witnesses. In other words, with professionalism, one would be able to win a case because of underlying technicalities involved within the context of law. Those who have strong interpretation of the law may be able to come up with a significant argument and supplement it with further proofs that could stand beyond reasonable doubt. It is therefore most likely for them to administer justice with their ability to persuade the court of what seems to be in line with law. Thus, provided that there is no substantial evidence, but in reality the accused is guilty, but there is no appropriate proofs beyond reasonable doubt, a professional defense lawyer may significantly win the case of his client. There is absence of ethics here especially if the accused who happens to be guilty will remain unpunished and acquitted. Certainly, it is not the right thing to do to find the murderer not guilty of the crime committed. However, there is a good chance for th ose who are professional enough to interpret the law and include substantial reasoning to target acquittal. In this case, justice administration may be a failure especially from the point of view of the prosecution and the victim. This also works the other way around, by which the culprit faces his sentence even on the crime he has not actually committed. This is due to the fact that the presented evidence was so strong that the prosecution team was professional enou

Human rights constitutions Essay Example | Topics and Well Written Essays - 3000 words

Human rights constitutions - Essay Example The intention of this study is government of a Republic of China that is not only reliable to have duties and powers but also imposes national constitutions containing various provisions which guarantee fundamental human rights of citizens and helps in strengthening relationships between state and individual. One of the main constitutions enforced in China instituting human rights is the People Republic of China. It is commonly known as People Republic of China Constitution, with no exemptions. However, some legitimate rights in China do not provide any guarantee which is worthless. Though presently it is enforced, in spite of fact either someone will be able to take judicial remedies, regardless of identifying by whom or how it will be committed, this is entirely a different issue. It is imperative to identify that either there should be a mechanism in China to enhance the effective enforcement of rights protected by constitution. Unless and until this is enforced, constitution will not result in a working or living element of social reality. Therefore in order to study the importance of these things in China it is imperative to identify effectual mechanism of constitutional enforcement, studying the relationship of politics and law which influences the progress of constitutional development tin China. China requires redesigning its constitutional reforms and should give more importance to the regime. (Abbott K W, 2000). 1.2 Human rights Human rights policy in China is based on two pillars. First is the system where member of states negotiate with the commissioner on human rights which was established in 1946 by social and economic council. Second is human rights treaty body and conventions which states commits through legal rectification and actions. This human rights policy has supported the state in protecting and promotion of citizens. Value oriented human rights practiced by China have laid the principles of statehood such as ethnicity, nation, culture, i deology and religion. It serves as a constrain between arbitrary and state hegemony, by protecting individuals rights and provides the foundation of building a relationship among citizens and states. It is the cornerstone for establishing constitutions in relation to human rights which are determined by international law and in public. It includes both WTO rules and ILO standards. Thus, human rights are highly controversial and political. All states are requires to protect and respect human rights and should do everything to fulfill their desires. In recent general assembly in China, stressed on the fact that these rights are indivisible, universal, interdependent, interconnected and mutually reinforcing. All states irrespective of differences in cultural, political and economic perspectives should protect and promote human rights. The human rights treaty body imposes China legal system to comply with the monitoring committees in order to ensure effectiveness in the system. State is obliged to submit a periodic report on treaty bodies, in order to review their objectives, present situation and supply assistance at national level. This will help to monitor the entire system effectively and to propose relevant changes in it (Dong Zhenang, 2000). 1.3 The importance of constitutionalizing human rights Importance of constitutionalizing human rights has increased in almost all the countries. Almost all the countries in the world have their own national constitutions. They not only emphasize on the rules and regulations led by the government but also emphasizes on legitimate obligations and rights of citizens. In relation to Chinese constitutional law all parties such as enterprises, state organs, individuals and political

Organism Physiology Essay Example for Free

Organism Physiology Essay Introduction This paper will clearly display a diagram of an organism of the student’s choice. This organism will display all of the main structures of the primary organs by labeling. Careful research will exhibit the concepts of natural selection and adaptation. Selected organism will address the proper concepts that apply. Three physiological adaptions were investigated by the student. Upon conclusion of the student’s investigation, knowledge will grant the understanding of how physiological adaptions allow the selected organism to thrive in its ecological niche. The organism that was selected for this essay is the Fish. External Anatomy This diagram below was provided and reproduced with the kind consent of WWW.FLORIDA FISHERIES.COM. Florida Fisheries has developed and provided the illustration of the external detail breakdown of a largemouth bass fish as shown below: Explanation of why nuisance species like the Fish share an equal importance to the economy and to ecology. Fish evolution and adaption process has produced many species that are a great contribution to mankind in many aspects. INTERNAL ANATOMY There are many variations of fish; who are defined as animals. Fish represents the most common living vertebrates. Currently, there are an estimation of at least 25,000 species of fish who are living today and this number is growing. The cold-blooded fish have a backbone and fins. In  addition, fish breathe through an airway named gills. Fish have skin however, on top of the skin is scales. There are some fish who do not have scales; as catfish who only have skin. Fish are able to steer, stop, move, maintain their position and stop by using their fins. The location of these fins vary in different fish. As for the scales on fish they vary as well. Amazingly all fish have a slimy mucus covering that protect fish for obtaining infections. Fish are referred to as aquatic vertebrates and they have appendages which have gone through the adapted process over a set time frame for the purpose of swimming. Mastering their domain which is water have gained the attention of many scientist. Fish come in various sizes and colors and have hearty appetites which substantiates their ability consume a large variety of foods. Evolution and Adaption Process There are many different species of fish. The first fish were vertebrates which were labeled as Ostracoderms. These fish were evident during the Cambrian Period approximately 510 million years ago. These vertebrates became extinct when the Devonian period ended 350 million years ago. One of the distinct character traits of these fish were jawless and their primary home was always in fresh water. Another distinct trait was their size which measured less than 30 cm (1foot long). Their external appearance as a bony scales covering the entire body of the fish. Osteichtyes are a class of bony fish that exist about 20,000. This class of fish which has a history of more than 410 million years include: tuna, eels and many other varieties of bony fish. These fish ceased to exist when a class of large humongous fish like the Sharks, Whales, and Placoderms arrived on the scene. Evolution has proven for these fish to exist their lungs increased allowing these fish to develop a swim bladder. This evolution process allowed these fish to float in the water no matter how high the water is. In addition, this evolution became very evident in the fish lungs. There are many categories however the three major for bony fish are: lung, ray-fins, and lobed. Their existence depends on the type of water that they live in. When these fish live in fresh water the oxygen level must have at least ninety percent. Their physiological characteristics of these fish gills is to strategic conduct a gas exchange where these fish maneuver water across their blood vessels. This fish gills are a very important physical trait  which is covered by opercula. This part of the fish looks like large plates. Digestive, and circulatory systems of these fish operate with a heart that has only two chambers. Conclusion Fish are a proven great contribution to all of mankind. Their evolution has proven to be very successful for a proven source for all of mankind. Gaining a greater understanding of their past to present will establish boundaries to protect their ongoing evolution. Some of the concepts of adaption and concepts of natural selection of how these fish thrive in its ecological niche have been addressed. Reference 1. WWW.FLORIDA FISHERIES.COM 2. www.lookd.com/fish/evolution.html

Antidepressants for Postnatal Depression

Antidepressants for Postnatal Depression Antidepressants are they a safe and effective choice for the treatment of postnatal depression? This review assessed the evidence concerning the effectiveness and safety of antidepressants in the management of postnatal depression. This would facilitate evidence-based clinical decisions in the treatment of patients. Data was sourced from several electronic Athens-based and free databases covering the psycho-biomedical and nursing literature. Studies found included randomised clinical trials, case- and cohort-controlled studies, questionnaire surveys, and qualitative/exploratory research. Previous reviews were also appraised. Outcomes from over 1200 mothers, mother-infant pairings, or infants, exposed to antidepressants were considered. Antidepressants appear to significantly alleviate depressive symptoms. Furthermore, the reported side effects are generally benign and clinically insignificant. However, methodological and analytic flaws negate conclusive inferences. Many studies fail to account for important covariates that may explain effects attributed to antidepressants. Furthermore, most studies fail to account for interactions between antidepressants and patient characteristics, which may reveal more severe adverse effects. Additionally, there is a paucity of literature on long-term effects. Finally, a lack of randomised clinical trials precludes inferences of causality. Given these constraints it is recommended that antidepressants are used as a last resort, and patients are closely monitored to identify unexpected side effects, or recovery induced by covariates rather than antidepressants. Chapter One Introduction, Rationale, AIMS Introduction According to Beckford-ball (2000) postnatal depression (PND) fails to attract public attention because it is associated with a positive event – childbirth – notwithstanding the evidence that a sizeable majority of women experience this phenomenon after delivering their baby (RCP , 2004). Nevertheless postnatal depression, if left untreated, can have adverse effects for mother-child relationship and infant development (Green, 1995). This brief reviews evidence concerning the safety and effectiveness of antidepressants for treating postnatal depression. It is argued that while antidepressants may alleviate depressive symptoms, with benign side effects, various methodological and analytic constraints in the literature negate conclusive inferences on the subject. Antidepressants According to the RCP antidepressants are drugs developed in the 1950s for treating symptoms of depression (RCP, 2006).They work by stimulating neurotransmitters in the brain. Three main types of antidepressants are specified: 1. Tricyclic’s (TCAs): amitriptyline, imipramine, nortriptyline. 2. Selective Serotonin Reuptake Inhibitors (SSRIs): sertraline, paroxetine, fluoxetine, citalopram, venlafaxine, moclobemide. 3. Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs): venlafaxine, reboxetine. 4. Monoamine Oxidase Inhibitors (MAOIs): tranylcypromine, moclobemide, phenelzine. The RCP posits that following three months of treatment 50% to 65%of people given an antidepressant show improvements in mood, compared with 25% to 30% of people administered a placebo. Thus, even after accounting for placebo effects, antidepressants still facilitate further recovery from depressive symptoms. TCAs are generally older than SSRIs and are considered to produce more side effects, especially if there is an overdose. However, all four classes of antidepressants are considered to have by-products, such as high blood pressure, anxiety, indigestion, dry mouth, heart tremor, and sleepiness. Most of the adverse effects are considered mild and expected to dissipate after few weeks. The RCP cites evidence of withdrawal symptoms in infants shortly after birth, especially with paroxetine (RCP, 2006). Babies can also receive a minute concentration of antidepressants via breastfeeding (Kohen,2005), albeit the risk of pathology is considered small due to the rapid development of kidneys and livers in infants. Overall, use of antidepressants during breastfeeding is not discouraged. Some pregnant women suffer a recurrence of depressive symptoms, and therefore may need to take antidepressants continually. The National Institute for Clinical Excellence (NICE, 2004) has published guidelines for the treatment of depression. However, there is no special emphasis on pregnancy-related depression. Antenatal and postnatal guidelines are due to be published by 2007 (Green, 2005). Postnatal Depression According to the RCP (2004) postnatal depression (PND) â€Å"is what happens when you become depressed after having a baby† (p.1). It is quite common, affecting circa 10% of newly delivered mothers, and can last for several months or longer if untreated. Symptoms include feeling depressed (unhappy, low, wretched, with symptoms becoming worse at particular times of the day), irritable(heightened sensitivity, especially to benign comments by others),tiredness, sleeplessness (late retirements, early rises), and lack of appetite and interest in sexual intercourse. Many women may feel they are unable to cope with the new situation, or even experience anxiety and detachment towards the infant. Various causes of PND have been identified including a previous history of depression, not having a supportive partner, having a sick infant or premature delivery, losing one’s own mother as a child, and stressful life events (e.g. bereavement, divorce, financial problems) within a short time scale. PND has also been associated with hormonal changes. PND appears to progress through several stages (Beckford-Ball, 2000; Green, 2005): 1. Postpartum ‘blues’; 2. Postnatal depression; 3. Puerperal psychosis. Postpartum ‘blues’ â€Å"is usually a transient phase occurring 3-5 days after the birth of the child, with few or no psychiatric symptoms. This stage is characterised by mood swings, tearfulness, fatigue, lack of concentration, confusion, anxiety and hostility† (p.126). This condition is easily treated using hormone replacement therapy. Postnatal depression is less frequent, and emerges as a deep and protracted ‘sadness’ which â€Å"is much more intense and persistent than postpartum blues and its symptoms rarely subside without help† (p.126).Many mothers may feel insecure, incompetent, irritable, guilty (about feeling sad following a happy event), weight changes, insomnia/hypersomnia, psychomotor retardation/agitation, tiredness, and loss of interest in activities. This condition often results in hospitalisation and treatment with antidepressants and cognitive-behavioural counselling. Puerperal psychosis is a severe mood disorder typified by delusions and hallucinations. This condition is considered a psychiatric emergency, necessitating admission to a psychiatric institution and treatment with antidepressants and other drugs. Rationale Despite clear guidelines regarding the use of antidepressants during pregnancy it is necessary to appraise existing literature on the topic, for several reasons: 1. Limited scope of existing reviews. 2. Identification of gaps and inconsistencies in the literature 3. Verification of current claims and guidelines, for example by the RCP, regarding the management of postnatal depression. Limited scope Previous literature reviews are considered in this brief (see Chapter 3). Most reviews are limited in scope mainly because they focus on studies using a particular research methodology(e.g. Booth et al, 2005), mother-child transmission through breastfeeding (e.g. Cohen, 2005), and effects on depressive symptoms(e.g. Hendricks, 2003; Bennett et al, 2004). Thus, there is a need for an all-inclusive review that offers a broader insight into current literature. Identification of gaps and inconsistencies Previous reviews on the topic have highlighted problems that need to be addressed in future research. However each review is different and new research findings continually emerge that may have implications for previous reviews. For example, past reviews have found little evidence of malformations resulting from SSRI use (e.g. Booth et al, 2005). However, new concerns are starting to emerge regarding various analytic and methodological constraints that negate conclusive inferences about the safety of SSRIs. Verification of current claims The RCP publishes an information guide for the use of antidepressants. Various claims are made regarding safety and efficacy of use during/after pregnancy, consistent with NICE(2004) standards. While most assertions are based on research evidence there is a need for on-going reviews that highlight recent findings and consider their implications for existing guidelines. Some of the key pronouncements and guidelines are as follows: 1. People who take antidepressants show a significant improvement over persons administered a placebo. 2. TCAs and SSRIs are equally effective but the latter (newer drug) is safer because it seems to have fewer side effects. 3. MAOIs can induce high blood pressure given certain (dietary) conditions 4. Babies whose mothers take antidepressants (especially paroxetine) may experience adverse effects. 5. It is best to carry on taking antidepressants while breastfeeding, since only minute amounts will be transferred to the baby. Livers and kidneys develop rapidly in babies only a few weeks old, helping to breakdown and filter antidepressants in the bloodstream. Aim The aim of the current review was to appraise evidence on the safety and effectiveness of antidepressants in the management of PND. Chapter Two Literature Review The evidence/data to be reviewed here is based on a comprehensive search of multiple databases including HIGHWIRE Press, ACADEMIC SEARCH PREMIER (access through EBSCO databases), Psych INFO, INTERNURSE, and the BRITISH MEDICAL JOURNAL database. The Internet was also searched with emphasis on peer-reviewed published journal articles. Key words included: ‘antidepressants’, ‘depression’, and ‘postnatal depression’. There were no problems of access: all the databases reviewed are available to the general public through university library resources and/or Athens protected resources. These particular databases were chosen because of their emphasis on psychological, biomedical, and practice-based literature, and easier access to full-text files. For example, Psych INFO contains more than1,500,000 references to journal articles, books, technical reports, and dissertations, published in numerous countries. As a form of psychopathology, PND is comprehensively addressed. INTERNURSE provides access specifically to the nursing literature and incorporates may key journals (e.g. British Journal of Nursing, Nurse Prescribing, Practice Nursing, and the International Journal of Palliative Nursing). HIGHWIRE Press is one of the two largest archives of free full-text science databases available, providing access to thousands of psych biomedical journal articles and books. ACADEMIC SEARCH PREMIER incorporates over4000 scholarly journals and 3100 peer review articles. These databases were preferred to others such as SCIENCE DIRECT, have a more general emphasis on scientific (rather than clinical, medical) literature, or not provide sufficient access to full-text articles. Only studies that satisfied the following criteria were eligible to be reviewed: 1. Empirical studies using either qualitative or quantitative methods. Thus, this included case studies, questionnaire surveys, retrospective/prospective designs, and randomised controlled trials(RCT). 2. Review articles and meta-analysis, including Cochrane reviews. 3. Focus on the effects of antidepressants on mother and/or child, and with or without breast-feeding. 4. Focus on postnatal depression, at any stage (i.e. postpartum ‘blues’, depression, and puerperal psychosis [Beckford-Ball, 2000]). 5. Focus on mothers perceptions of antidepressants as treatment for postnatal depression. The review also considered bits of literature published by the Department of Health (DOH), National Institute of Clinical Excellence(NICE), and the Royal College of Psychiatrists (RCP). The emphasis was on the role of SSRIs and TCAs albeit some literature on MAOIs and SNRIs was also considered. Individual studies are reviewed first, followed by review articles. Value of conducting a literature review The safety and effectiveness of antidepressants can easily be established by conducting an original empirical study. However, individual studies are severely constrained in scope and will ultimately provide a ‘snap-shot ‘or ‘localised’ insight on the subject. Moreover, scientific knowledge advances from the accumulation of evidence rather than the results of isolated studies, except in cases where there is a virtually no research on a topic, so that the findings of individual studies assume greater importance. Depression as a topic has been heavily researched. Numerous studies have been published on antidepressants and PND. The multiplicity of published literature reviews on antidepressants/PND attests to the abundance of empirical evidence on the topic. Thus, attempting to establish the safety and efficacy of antidepressants on the basis of a single study would still require an understanding of what has been done before and current knowledge on the topic. Otherwise the researcher is in danger of merely reinventing the wheel. Thus, proper scientific protocol dictates that the researcher first begins by reviewing the literature, in order to get a bird’s eye view of the available evidence, identify gaps in the literature, and highlight avenues for further research (Cool can, 1994). Effects of anti-depressants Appleby et al (1997) conducted a randomised control trial to assess the effects of fluoxetine and cognitive-behavioural counselling on postnatal depression. Another aim was to compare fluoxetine and placebo groups, and also drug combinations and counselling. Hitherto there had been a paucity of randomised clinical trials in this area. Appleby et al (1997) question the clinical benefits of using antidepressants, given that prognosis for PND is often good, despite concerns about over-sedation, and other considerations. The study aimed to establish the optimal treatment frond. The antidepressant of interest was the SSRI, fluoxetine. Participants were women identified at an urban health district(Manchester) as being depressed 6-8 weeks post childbirth. They completed the EPDS , and those with sufficiently high scores were interviewed using a revised clinical schedule, to identify cases of significant psychiatric depression. Women with a prior history of depression, substance abuse, severe illness that required hospitalisation, or breastfeeding, were excluded. Participants were randomly assigned to one of four experimental conditions: fluoxetine, placebo, one counselling session, and six counselling sessions. Mood assessments took place at 1, 4, and 12 weeks post-intervention, using the revised interview schedule, EPDS, and Hamilton depression scale. Data was analysed using analysis of variance for repeated measures (to account for the multiple outcome variables).Overall, 188 verified cases of PND were identified, from a sample of2978 women eligible to participate. Of these, 87 took part in the clinical trial. Results revealed significant improvements in all four treatment groups. Fluoxetine produced better improvement compared with the placebo: the percentage (geometric) differences in means scores based on the revised clinical interview schedule was 37.1% (at 4 weeks)and 40.7% (12 weeks). The effect of fluoxetine was not moderated by(i.e. did not interact with) counselling. Improvements in mood occurred within one week of participating in the clinical trial. The authors concluded â€Å"this study shows the effectiveness of both fluoxetine and cognitive-behavioural counselling in the treatment of women found by community based screening to be depressed 6-8 weeks after childbirth† (p.932). The use of a classic experimental design(RCT) permits causal inferences about the impact of an antidepressant. However, the analysis failed to control for potential confounding variables. While Appleby et al (1997) took steps to eliminate extraneous variance, through strict eligibility criteria, it would have been useful to incorporate detailed background information in the analysis (e.g. availability of social support, marital relationship, stressful life events, side-effect profile, history of drug compliance, patient preference [Green, 2005]) to demonstrate the statistical significance of these variables, and the unique contribution of SSRI treatment after controlling for covariates. Thus, analysis of covariance would have been a more appropriate test. Nolan et al (1997) assessed the effect of TCA and SSRI drugs on feta neurodevelopment. The study compared children of mothers who had been prescribed a tricyclic antidepressant during pregnancy, mothers who had taken fluoxetine during pregnancy, and mothers who had not taken antidepressants. Outcomes measures comprised global IQ and language development, assessed from 16 to 18 months postnatal, using age-specific Bailey Scales of Infant Development, McCarthy Scales of Children’s Abilities (measures IQ), and the Rendell Developmental Language Scales. Results revealed no significant group differences in any of the outcome variables, suggesting that in utero ingestion of either TCAs or fluoxetine does not impair cognitive, linguistic, or behavioural development in infants. Null man et al (2002) conducted follow-up prospective controlled study assessing the effects of TCA and fluoxetine use throughout pregnancy on child development. Three groups of mother-child pairs were recruited. The first two groups were drawn from the Mothers Program, a scheme that provides support to women suffering from major depression. All women recruited from this programme had received counselling under the scheme, with either TCA Rossi (fluoxetine) treatment, which had been maintained throughout the duration of the pregnancy. A comparison group was also recruited that comprised women with no history of psychopathology, depression (based on the Centre for Epidemiological Studies Depression Scale [CES-D]), exposure to chemical or radiation pollution, or severe health problems likely to affect fatal development. This group was randomly selected from among visitors to the author’s clinic. Women who had discontinued the use of antidepressants after conception or during the pregnancy were not eligible to participate. Women were also excluded from the comparison group based on the same criteria applied to the Mothers groups. Outcome data was collected using the CES-D, antenatal and postnatal assessments, neurobehavioral tests (Bailey Scales of Infant Development, McCarthy Scales of Children’s Abilities, age-appropriate Achenbach Child Behaviour Checklist), and follow-up testing of them other (Wechsler Adult Intelligence Scale, and other measures). A one-way analysis of variance was used to compare outcome measures across the three groups. Correlational and regression tests were used to assess the contribution of confounding variables. Results revealed no group differences in child’s global IQ, language development, or behaviour (see Figure 1). The authors concluded, â€Å"Exposure to tricyclic antidepressants or fluoxetine throughout the gestation period does not appear to adversely affect cognition, language development, or the temperament of preschool and early-school children. Although regression was used to account for the contribution of confounding factors, such as verbal comprehension and expressive language, the variance explained by these variables was not in fact partial led out before testing for group differences. This would have required a multivariate analysis of covariance in which adjustments for covariates are built into the analysis. More importantly, the observed similarity in outcomes across the three groups may reflect simple or complex interactions with other variables. This issue is discussed in greater detail in Chapter 3. Figure 1 Cognitive outcomes (mental and psychomotor development, and cognitive abilities) across antidepressant and control groups(Nolan et al, 2002). Differences are not significant. Wisner et al (2001) performed a double-blind randomised control trial to assess the effect of nortriptyline on the rate of reoccurrence of postpartum depression in non-depressed women who had previously had at least one depressive episode. Women were randomly exposed tonortriptyline or a placebo immediately after childbirth. Outcome data was collected over a 5-month period using the Hamilton Rating Scale for Depression, and Research Diagnostic Criteria for depression. No group differences emerged, suggesting that nortriptyline was no more effective than a placebo in treating PND. This study was followed up with another RCT (Wisner et al, 2004), this time evaluating the effect of sertraline on the rate of and time to reoccurrence of postpartum depression. They highlighted a paucity of clinical trials on the impact of antidepressants in women who have previously had a depressive episode, and hence may be prone to experience a reoccurrence. Participants were pregnant women with gestation periods of 9 months or less, and at least one episode of postpartum depression that fits that the DSM-IV definition of major depression. Women with other forms of psychopathology (e.g. psychosis, or bipolar disorder) were excluded. Participants were randomly assigned to a treatment (sertraline) or placebo group. The drug was administered immediately after birth, beginning with a 50mg/day dose, which was later dropped to 25mg/day to minimise side effects (e.g. headache). Data analysis using Fisher’s exact test showed a significant group difference in rate of reoccurrences, during a 17-week preventive treatment period. Reoccurrences occurred in 4/8 women assigned to the placebo group, and1/14 women in the treatment condition, translating into a 0.43difference in reoccurrence rates. All women had adhered to the treatment regime, thus minimising the confounded effect of on-compliance. There was also a significant group difference in time to reoccurrence, with first reoccurrence beginning much earlier for the placebo group (at 5 weeks, followed by more reoccurrences) compared with the treatment group (at 17 weeks, followed by more reoccurrences). However, the treatment group reported more side effects (e.g. Dizziness, drowsiness). This RCT clearly demonstrates the effectiveness of an SSRI in preventing the reoccurrence of postpartum depression, albeit the conclusiveness of these findings is constrained by the failure to control for key background variables, such as previous and recent history of psychopathology, and drug effect expectations. For example, lingering symptoms of a distant depressive episode may help precipitate a quicker reoccurrence. Figure 2 Rate of recurrence of postpartum depression in placebo and SSRI women (Wisner et al, 2004) Oberlander et al (2005) tested the effect of SSRI exposure on bio behavioural responses to acute procedural pain in new-born babies at2 months of age. Previous research has suggested altered behavioural and physiological reactions to a routine painful event in infants, after prenatal exposure to SSRI antidepressants. There is paucity of literature on the long-term effects of SSRIs on neuro behavioural variables, such as cognitive, language and motor development. Given that SSRIs work by inhibiting the reuptake of serotonin(5-hydroxytrypamine [5HT], a neurotransmitter that regulates cardiovascular function and pain signals in the developing brain), and given that SSRIs easily pass through the placenta, it is possible that regions of the brain associated with pain reactivity may be affected. Participants were recruited from a cohort of mothers and their infants during pregnancy, as part of a longitudinal study of prenatal medication use. Only Mothers/infants with no psychotropic or antidepressant use during pregnancy, whose pregnancy was 9 to 10 weeks, and no history of maternal mental illness, were eligible to be assigned to the control group. Three groups of infants were compared: (a) infants exposed to prenatal SSRI (fluoxetine); (b) infants exposed postnatal via breastfeeding(paroxetine, fluoxetine, sertraline); and (c) control infants. Behavioural (facial activity), physiological (variations in heart rate[HR], often used as a measure of pain reactivity in infants), and pharmacological (analysis of blood and breast milk samples) data was collected. Results showed impaired facial reactions in infants exposed to prenatal SSRI. Altered pain reactivity was observed in both prenatal and postnatal exposed infants, suggesting enduring neuro behavioural SSRI effects that extend beyond the new-born phase. Oberlander et all’s(2005) study was constrained by low power and generalizability (limited sample size), and lack of a non-medicated control group with depressive symptomatology. They were uncertain about the clinical implications of these findings, suggesting that use of SSRIs for treating maternal depression was appropriate pending further research on the sustained effects of SSRIs. Marcus et al (2005) screened prenatal depression in pregnant women attending an obstetrics clinic. The study aimed to assess the rates faint-depressant use and its association with depression, measured byte Centre for Epidemiological Studies Depression Scale (CES-D).Overall, 390 women who had used antidepressants within two years of conception were screened. Average age was 28.6 years, and most women were married and Caucasian (73%). Screening took place at around 24gestation weeks. Data was collected regarding the use of antidepressants during the past two years, and discontinued use following pregnancy, in addition to the CES-D data. The standard CES-Duct-off of 16 was used to establish the presence of depressive symptomatology. A t-Test was used to compare two groups: women who reported they stopped using anti-depressants and hence were not currently on medication (n=248); and women who continued to use antidepressants during pregnancy (n=68). The dependent/outcome variable was total CES-Scores. Chi-square was also used to assess use/non-use of antidepressant medication and CES-D groupings (i.e. Figure 3 CES-D data for women who did and those who did not use antidepressants during pregnancy (Marcus et al, 2005). Observed differences are not significant. The authors attributed the null results to poor treatment adherence, and inadequate prescribing/monitoring. Furthermore, they suggested that group differences might have been more pronounced if the study focused on unmediated women (i.e. those who had not used antidepressants at all, rather discontinued use). This study was unique because it assessed antidepressant use around the time of conception. However, the findings are compromised by several analytic constraints. Firstly, these of a t-Test is questionable. This test makes no provision for controlling for covariates (i.e. important background variables, such as patient preference, compliance history, side-effect profile, social support, quality of marital relationship, prior history depression)that may confound significant group differences, although this concerns less important given the null results. A more serious problem is the possibility that certain assumptions which underlie use of the t-Test were violated, notably homogeneity of variance. The huge disparity in group sizes (268 versus 68) hugely increases the possibility of significant differences in group variances, which in turn would obscure reliable differences in CES-Scores. The authors do not report Levine test results, which would have addressed the homogeneity issue. Perhaps a non-parametric test (e.g. Mann-Whitney) may have been more appropriate. Furthermore, it is not clear why the authors conducted a chi-square test! Collapsing the CES-Scores into a dichotomy reduces the quality of the data because it obscures subtle differences between scores. Overall, the chi-square analyses amounted to a less precise duplication of the t-Test results! Finally, this study was entirely based on women’s self-reports of medication use, with no familial, clinical, or other verification. Its therefore unclear to what extent the null results are attributable to self-report bias. Several review articles on antidepressants and postnatal depression have been published. These range from limited commentaries (e.g. Goldstein Sun dell, 1999; Yoshida et al, 1999; Misery Kostas’s, 2002; Hendricks, 2003; Bennett et al, 2004; Cohen, 2005;Marcus et al, 2005) to comprehensive and systematic appraisals. Goldstein and Sun dell (1999) reviewed literature on the safety of SSRIs during pregnancy. Their work was based on the premise that although antidepressants may be necessary during pregnancy it is essential identify and weigh the risks against the benefits in order to make an informed choice as to whether or not to use the drugs. Due to the paucity of randomised controlled trials on the topic, the review focused on evidence obtained from cohort/case-controlled studies, patient surveys, retrospective studies, and anecdotal reports. Electronic databases searched included Medline, EMBASE, Daren’t Drug File, and Psych INFO. Four cohort-controlled and 5 prospective studies were found which evaluated the impact of SSRI exposure. One study compared fluoxetine, TCA, and non-teratogen (e.g. antibiotics) exposed groups of non-depressed females. SSRI and TCA exposure produced no significant malformations, or differences in birth weight and infant prematurity. However, there was a greater tendency for fluoxetine- and tricyclic-exposed women to miscarry compared with controls. However, this effect was not significant and hence may simply have occurred by chance. Goldstein and Sun dell (1999) report another study which compared early exposed (prior to 25 weeks), late exposed (continuing after 24 weeks),and a non-teratogen control group. Again findings revealed no adverse effects in the treatment groups, albeit infants exposed to fluoxetine early showed a higher prevalence of minor anomalies that have little or no clinical importance. Furthermore late exposure to fluoxetine seemed to increase the rates of admission to special care nurseries and impaired fatal development. However, these findings were inconclusive due to prior group differences on previous psychotropic drug use, and failure to control for depression levels. Still other research suggests no effect of SSRIs (sertraline) on the prevalence of stillbirth, prematurity, mean birth weight and gestational age. Evidence suggests no statistically significant differences between SSRI exposed and control groups on IQ, language development, height, and head circumference. Of the prospective studies reviewed three assessed paroxetine, and fluoxetine, and two tested sertraline. All studies reported no significant increase in the rate of malformations and spontaneous abortion, although there was some evidence of lower birth weight given protracted use of antidepressants. Goldstein and Sun dell (1999) found one study, which showed that fluoxetine exposure during the first trimester did not increase the risk of malformations Antidepressants for Postnatal Depression Antidepressants for Postnatal Depression Antidepressants are they a safe and effective choice for the treatment of postnatal depression? This review assessed the evidence concerning the effectiveness and safety of antidepressants in the management of postnatal depression. This would facilitate evidence-based clinical decisions in the treatment of patients. Data was sourced from several electronic Athens-based and free databases covering the psycho-biomedical and nursing literature. Studies found included randomised clinical trials, case- and cohort-controlled studies, questionnaire surveys, and qualitative/exploratory research. Previous reviews were also appraised. Outcomes from over 1200 mothers, mother-infant pairings, or infants, exposed to antidepressants were considered. Antidepressants appear to significantly alleviate depressive symptoms. Furthermore, the reported side effects are generally benign and clinically insignificant. However, methodological and analytic flaws negate conclusive inferences. Many studies fail to account for important covariates that may explain effects attributed to antidepressants. Furthermore, most studies fail to account for interactions between antidepressants and patient characteristics, which may reveal more severe adverse effects. Additionally, there is a paucity of literature on long-term effects. Finally, a lack of randomised clinical trials precludes inferences of causality. Given these constraints it is recommended that antidepressants are used as a last resort, and patients are closely monitored to identify unexpected side effects, or recovery induced by covariates rather than antidepressants. Chapter One Introduction, Rationale, AIMS Introduction According to Beckford-ball (2000) postnatal depression (PND) fails to attract public attention because it is associated with a positive event – childbirth – notwithstanding the evidence that a sizeable majority of women experience this phenomenon after delivering their baby (RCP , 2004). Nevertheless postnatal depression, if left untreated, can have adverse effects for mother-child relationship and infant development (Green, 1995). This brief reviews evidence concerning the safety and effectiveness of antidepressants for treating postnatal depression. It is argued that while antidepressants may alleviate depressive symptoms, with benign side effects, various methodological and analytic constraints in the literature negate conclusive inferences on the subject. Antidepressants According to the RCP antidepressants are drugs developed in the 1950s for treating symptoms of depression (RCP, 2006).They work by stimulating neurotransmitters in the brain. Three main types of antidepressants are specified: 1. Tricyclic’s (TCAs): amitriptyline, imipramine, nortriptyline. 2. Selective Serotonin Reuptake Inhibitors (SSRIs): sertraline, paroxetine, fluoxetine, citalopram, venlafaxine, moclobemide. 3. Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs): venlafaxine, reboxetine. 4. Monoamine Oxidase Inhibitors (MAOIs): tranylcypromine, moclobemide, phenelzine. The RCP posits that following three months of treatment 50% to 65%of people given an antidepressant show improvements in mood, compared with 25% to 30% of people administered a placebo. Thus, even after accounting for placebo effects, antidepressants still facilitate further recovery from depressive symptoms. TCAs are generally older than SSRIs and are considered to produce more side effects, especially if there is an overdose. However, all four classes of antidepressants are considered to have by-products, such as high blood pressure, anxiety, indigestion, dry mouth, heart tremor, and sleepiness. Most of the adverse effects are considered mild and expected to dissipate after few weeks. The RCP cites evidence of withdrawal symptoms in infants shortly after birth, especially with paroxetine (RCP, 2006). Babies can also receive a minute concentration of antidepressants via breastfeeding (Kohen,2005), albeit the risk of pathology is considered small due to the rapid development of kidneys and livers in infants. Overall, use of antidepressants during breastfeeding is not discouraged. Some pregnant women suffer a recurrence of depressive symptoms, and therefore may need to take antidepressants continually. The National Institute for Clinical Excellence (NICE, 2004) has published guidelines for the treatment of depression. However, there is no special emphasis on pregnancy-related depression. Antenatal and postnatal guidelines are due to be published by 2007 (Green, 2005). Postnatal Depression According to the RCP (2004) postnatal depression (PND) â€Å"is what happens when you become depressed after having a baby† (p.1). It is quite common, affecting circa 10% of newly delivered mothers, and can last for several months or longer if untreated. Symptoms include feeling depressed (unhappy, low, wretched, with symptoms becoming worse at particular times of the day), irritable(heightened sensitivity, especially to benign comments by others),tiredness, sleeplessness (late retirements, early rises), and lack of appetite and interest in sexual intercourse. Many women may feel they are unable to cope with the new situation, or even experience anxiety and detachment towards the infant. Various causes of PND have been identified including a previous history of depression, not having a supportive partner, having a sick infant or premature delivery, losing one’s own mother as a child, and stressful life events (e.g. bereavement, divorce, financial problems) within a short time scale. PND has also been associated with hormonal changes. PND appears to progress through several stages (Beckford-Ball, 2000; Green, 2005): 1. Postpartum ‘blues’; 2. Postnatal depression; 3. Puerperal psychosis. Postpartum ‘blues’ â€Å"is usually a transient phase occurring 3-5 days after the birth of the child, with few or no psychiatric symptoms. This stage is characterised by mood swings, tearfulness, fatigue, lack of concentration, confusion, anxiety and hostility† (p.126). This condition is easily treated using hormone replacement therapy. Postnatal depression is less frequent, and emerges as a deep and protracted ‘sadness’ which â€Å"is much more intense and persistent than postpartum blues and its symptoms rarely subside without help† (p.126).Many mothers may feel insecure, incompetent, irritable, guilty (about feeling sad following a happy event), weight changes, insomnia/hypersomnia, psychomotor retardation/agitation, tiredness, and loss of interest in activities. This condition often results in hospitalisation and treatment with antidepressants and cognitive-behavioural counselling. Puerperal psychosis is a severe mood disorder typified by delusions and hallucinations. This condition is considered a psychiatric emergency, necessitating admission to a psychiatric institution and treatment with antidepressants and other drugs. Rationale Despite clear guidelines regarding the use of antidepressants during pregnancy it is necessary to appraise existing literature on the topic, for several reasons: 1. Limited scope of existing reviews. 2. Identification of gaps and inconsistencies in the literature 3. Verification of current claims and guidelines, for example by the RCP, regarding the management of postnatal depression. Limited scope Previous literature reviews are considered in this brief (see Chapter 3). Most reviews are limited in scope mainly because they focus on studies using a particular research methodology(e.g. Booth et al, 2005), mother-child transmission through breastfeeding (e.g. Cohen, 2005), and effects on depressive symptoms(e.g. Hendricks, 2003; Bennett et al, 2004). Thus, there is a need for an all-inclusive review that offers a broader insight into current literature. Identification of gaps and inconsistencies Previous reviews on the topic have highlighted problems that need to be addressed in future research. However each review is different and new research findings continually emerge that may have implications for previous reviews. For example, past reviews have found little evidence of malformations resulting from SSRI use (e.g. Booth et al, 2005). However, new concerns are starting to emerge regarding various analytic and methodological constraints that negate conclusive inferences about the safety of SSRIs. Verification of current claims The RCP publishes an information guide for the use of antidepressants. Various claims are made regarding safety and efficacy of use during/after pregnancy, consistent with NICE(2004) standards. While most assertions are based on research evidence there is a need for on-going reviews that highlight recent findings and consider their implications for existing guidelines. Some of the key pronouncements and guidelines are as follows: 1. People who take antidepressants show a significant improvement over persons administered a placebo. 2. TCAs and SSRIs are equally effective but the latter (newer drug) is safer because it seems to have fewer side effects. 3. MAOIs can induce high blood pressure given certain (dietary) conditions 4. Babies whose mothers take antidepressants (especially paroxetine) may experience adverse effects. 5. It is best to carry on taking antidepressants while breastfeeding, since only minute amounts will be transferred to the baby. Livers and kidneys develop rapidly in babies only a few weeks old, helping to breakdown and filter antidepressants in the bloodstream. Aim The aim of the current review was to appraise evidence on the safety and effectiveness of antidepressants in the management of PND. Chapter Two Literature Review The evidence/data to be reviewed here is based on a comprehensive search of multiple databases including HIGHWIRE Press, ACADEMIC SEARCH PREMIER (access through EBSCO databases), Psych INFO, INTERNURSE, and the BRITISH MEDICAL JOURNAL database. The Internet was also searched with emphasis on peer-reviewed published journal articles. Key words included: ‘antidepressants’, ‘depression’, and ‘postnatal depression’. There were no problems of access: all the databases reviewed are available to the general public through university library resources and/or Athens protected resources. These particular databases were chosen because of their emphasis on psychological, biomedical, and practice-based literature, and easier access to full-text files. For example, Psych INFO contains more than1,500,000 references to journal articles, books, technical reports, and dissertations, published in numerous countries. As a form of psychopathology, PND is comprehensively addressed. INTERNURSE provides access specifically to the nursing literature and incorporates may key journals (e.g. British Journal of Nursing, Nurse Prescribing, Practice Nursing, and the International Journal of Palliative Nursing). HIGHWIRE Press is one of the two largest archives of free full-text science databases available, providing access to thousands of psych biomedical journal articles and books. ACADEMIC SEARCH PREMIER incorporates over4000 scholarly journals and 3100 peer review articles. These databases were preferred to others such as SCIENCE DIRECT, have a more general emphasis on scientific (rather than clinical, medical) literature, or not provide sufficient access to full-text articles. Only studies that satisfied the following criteria were eligible to be reviewed: 1. Empirical studies using either qualitative or quantitative methods. Thus, this included case studies, questionnaire surveys, retrospective/prospective designs, and randomised controlled trials(RCT). 2. Review articles and meta-analysis, including Cochrane reviews. 3. Focus on the effects of antidepressants on mother and/or child, and with or without breast-feeding. 4. Focus on postnatal depression, at any stage (i.e. postpartum ‘blues’, depression, and puerperal psychosis [Beckford-Ball, 2000]). 5. Focus on mothers perceptions of antidepressants as treatment for postnatal depression. The review also considered bits of literature published by the Department of Health (DOH), National Institute of Clinical Excellence(NICE), and the Royal College of Psychiatrists (RCP). The emphasis was on the role of SSRIs and TCAs albeit some literature on MAOIs and SNRIs was also considered. Individual studies are reviewed first, followed by review articles. Value of conducting a literature review The safety and effectiveness of antidepressants can easily be established by conducting an original empirical study. However, individual studies are severely constrained in scope and will ultimately provide a ‘snap-shot ‘or ‘localised’ insight on the subject. Moreover, scientific knowledge advances from the accumulation of evidence rather than the results of isolated studies, except in cases where there is a virtually no research on a topic, so that the findings of individual studies assume greater importance. Depression as a topic has been heavily researched. Numerous studies have been published on antidepressants and PND. The multiplicity of published literature reviews on antidepressants/PND attests to the abundance of empirical evidence on the topic. Thus, attempting to establish the safety and efficacy of antidepressants on the basis of a single study would still require an understanding of what has been done before and current knowledge on the topic. Otherwise the researcher is in danger of merely reinventing the wheel. Thus, proper scientific protocol dictates that the researcher first begins by reviewing the literature, in order to get a bird’s eye view of the available evidence, identify gaps in the literature, and highlight avenues for further research (Cool can, 1994). Effects of anti-depressants Appleby et al (1997) conducted a randomised control trial to assess the effects of fluoxetine and cognitive-behavioural counselling on postnatal depression. Another aim was to compare fluoxetine and placebo groups, and also drug combinations and counselling. Hitherto there had been a paucity of randomised clinical trials in this area. Appleby et al (1997) question the clinical benefits of using antidepressants, given that prognosis for PND is often good, despite concerns about over-sedation, and other considerations. The study aimed to establish the optimal treatment frond. The antidepressant of interest was the SSRI, fluoxetine. Participants were women identified at an urban health district(Manchester) as being depressed 6-8 weeks post childbirth. They completed the EPDS , and those with sufficiently high scores were interviewed using a revised clinical schedule, to identify cases of significant psychiatric depression. Women with a prior history of depression, substance abuse, severe illness that required hospitalisation, or breastfeeding, were excluded. Participants were randomly assigned to one of four experimental conditions: fluoxetine, placebo, one counselling session, and six counselling sessions. Mood assessments took place at 1, 4, and 12 weeks post-intervention, using the revised interview schedule, EPDS, and Hamilton depression scale. Data was analysed using analysis of variance for repeated measures (to account for the multiple outcome variables).Overall, 188 verified cases of PND were identified, from a sample of2978 women eligible to participate. Of these, 87 took part in the clinical trial. Results revealed significant improvements in all four treatment groups. Fluoxetine produced better improvement compared with the placebo: the percentage (geometric) differences in means scores based on the revised clinical interview schedule was 37.1% (at 4 weeks)and 40.7% (12 weeks). The effect of fluoxetine was not moderated by(i.e. did not interact with) counselling. Improvements in mood occurred within one week of participating in the clinical trial. The authors concluded â€Å"this study shows the effectiveness of both fluoxetine and cognitive-behavioural counselling in the treatment of women found by community based screening to be depressed 6-8 weeks after childbirth† (p.932). The use of a classic experimental design(RCT) permits causal inferences about the impact of an antidepressant. However, the analysis failed to control for potential confounding variables. While Appleby et al (1997) took steps to eliminate extraneous variance, through strict eligibility criteria, it would have been useful to incorporate detailed background information in the analysis (e.g. availability of social support, marital relationship, stressful life events, side-effect profile, history of drug compliance, patient preference [Green, 2005]) to demonstrate the statistical significance of these variables, and the unique contribution of SSRI treatment after controlling for covariates. Thus, analysis of covariance would have been a more appropriate test. Nolan et al (1997) assessed the effect of TCA and SSRI drugs on feta neurodevelopment. The study compared children of mothers who had been prescribed a tricyclic antidepressant during pregnancy, mothers who had taken fluoxetine during pregnancy, and mothers who had not taken antidepressants. Outcomes measures comprised global IQ and language development, assessed from 16 to 18 months postnatal, using age-specific Bailey Scales of Infant Development, McCarthy Scales of Children’s Abilities (measures IQ), and the Rendell Developmental Language Scales. Results revealed no significant group differences in any of the outcome variables, suggesting that in utero ingestion of either TCAs or fluoxetine does not impair cognitive, linguistic, or behavioural development in infants. Null man et al (2002) conducted follow-up prospective controlled study assessing the effects of TCA and fluoxetine use throughout pregnancy on child development. Three groups of mother-child pairs were recruited. The first two groups were drawn from the Mothers Program, a scheme that provides support to women suffering from major depression. All women recruited from this programme had received counselling under the scheme, with either TCA Rossi (fluoxetine) treatment, which had been maintained throughout the duration of the pregnancy. A comparison group was also recruited that comprised women with no history of psychopathology, depression (based on the Centre for Epidemiological Studies Depression Scale [CES-D]), exposure to chemical or radiation pollution, or severe health problems likely to affect fatal development. This group was randomly selected from among visitors to the author’s clinic. Women who had discontinued the use of antidepressants after conception or during the pregnancy were not eligible to participate. Women were also excluded from the comparison group based on the same criteria applied to the Mothers groups. Outcome data was collected using the CES-D, antenatal and postnatal assessments, neurobehavioral tests (Bailey Scales of Infant Development, McCarthy Scales of Children’s Abilities, age-appropriate Achenbach Child Behaviour Checklist), and follow-up testing of them other (Wechsler Adult Intelligence Scale, and other measures). A one-way analysis of variance was used to compare outcome measures across the three groups. Correlational and regression tests were used to assess the contribution of confounding variables. Results revealed no group differences in child’s global IQ, language development, or behaviour (see Figure 1). The authors concluded, â€Å"Exposure to tricyclic antidepressants or fluoxetine throughout the gestation period does not appear to adversely affect cognition, language development, or the temperament of preschool and early-school children. Although regression was used to account for the contribution of confounding factors, such as verbal comprehension and expressive language, the variance explained by these variables was not in fact partial led out before testing for group differences. This would have required a multivariate analysis of covariance in which adjustments for covariates are built into the analysis. More importantly, the observed similarity in outcomes across the three groups may reflect simple or complex interactions with other variables. This issue is discussed in greater detail in Chapter 3. Figure 1 Cognitive outcomes (mental and psychomotor development, and cognitive abilities) across antidepressant and control groups(Nolan et al, 2002). Differences are not significant. Wisner et al (2001) performed a double-blind randomised control trial to assess the effect of nortriptyline on the rate of reoccurrence of postpartum depression in non-depressed women who had previously had at least one depressive episode. Women were randomly exposed tonortriptyline or a placebo immediately after childbirth. Outcome data was collected over a 5-month period using the Hamilton Rating Scale for Depression, and Research Diagnostic Criteria for depression. No group differences emerged, suggesting that nortriptyline was no more effective than a placebo in treating PND. This study was followed up with another RCT (Wisner et al, 2004), this time evaluating the effect of sertraline on the rate of and time to reoccurrence of postpartum depression. They highlighted a paucity of clinical trials on the impact of antidepressants in women who have previously had a depressive episode, and hence may be prone to experience a reoccurrence. Participants were pregnant women with gestation periods of 9 months or less, and at least one episode of postpartum depression that fits that the DSM-IV definition of major depression. Women with other forms of psychopathology (e.g. psychosis, or bipolar disorder) were excluded. Participants were randomly assigned to a treatment (sertraline) or placebo group. The drug was administered immediately after birth, beginning with a 50mg/day dose, which was later dropped to 25mg/day to minimise side effects (e.g. headache). Data analysis using Fisher’s exact test showed a significant group difference in rate of reoccurrences, during a 17-week preventive treatment period. Reoccurrences occurred in 4/8 women assigned to the placebo group, and1/14 women in the treatment condition, translating into a 0.43difference in reoccurrence rates. All women had adhered to the treatment regime, thus minimising the confounded effect of on-compliance. There was also a significant group difference in time to reoccurrence, with first reoccurrence beginning much earlier for the placebo group (at 5 weeks, followed by more reoccurrences) compared with the treatment group (at 17 weeks, followed by more reoccurrences). However, the treatment group reported more side effects (e.g. Dizziness, drowsiness). This RCT clearly demonstrates the effectiveness of an SSRI in preventing the reoccurrence of postpartum depression, albeit the conclusiveness of these findings is constrained by the failure to control for key background variables, such as previous and recent history of psychopathology, and drug effect expectations. For example, lingering symptoms of a distant depressive episode may help precipitate a quicker reoccurrence. Figure 2 Rate of recurrence of postpartum depression in placebo and SSRI women (Wisner et al, 2004) Oberlander et al (2005) tested the effect of SSRI exposure on bio behavioural responses to acute procedural pain in new-born babies at2 months of age. Previous research has suggested altered behavioural and physiological reactions to a routine painful event in infants, after prenatal exposure to SSRI antidepressants. There is paucity of literature on the long-term effects of SSRIs on neuro behavioural variables, such as cognitive, language and motor development. Given that SSRIs work by inhibiting the reuptake of serotonin(5-hydroxytrypamine [5HT], a neurotransmitter that regulates cardiovascular function and pain signals in the developing brain), and given that SSRIs easily pass through the placenta, it is possible that regions of the brain associated with pain reactivity may be affected. Participants were recruited from a cohort of mothers and their infants during pregnancy, as part of a longitudinal study of prenatal medication use. Only Mothers/infants with no psychotropic or antidepressant use during pregnancy, whose pregnancy was 9 to 10 weeks, and no history of maternal mental illness, were eligible to be assigned to the control group. Three groups of infants were compared: (a) infants exposed to prenatal SSRI (fluoxetine); (b) infants exposed postnatal via breastfeeding(paroxetine, fluoxetine, sertraline); and (c) control infants. Behavioural (facial activity), physiological (variations in heart rate[HR], often used as a measure of pain reactivity in infants), and pharmacological (analysis of blood and breast milk samples) data was collected. Results showed impaired facial reactions in infants exposed to prenatal SSRI. Altered pain reactivity was observed in both prenatal and postnatal exposed infants, suggesting enduring neuro behavioural SSRI effects that extend beyond the new-born phase. Oberlander et all’s(2005) study was constrained by low power and generalizability (limited sample size), and lack of a non-medicated control group with depressive symptomatology. They were uncertain about the clinical implications of these findings, suggesting that use of SSRIs for treating maternal depression was appropriate pending further research on the sustained effects of SSRIs. Marcus et al (2005) screened prenatal depression in pregnant women attending an obstetrics clinic. The study aimed to assess the rates faint-depressant use and its association with depression, measured byte Centre for Epidemiological Studies Depression Scale (CES-D).Overall, 390 women who had used antidepressants within two years of conception were screened. Average age was 28.6 years, and most women were married and Caucasian (73%). Screening took place at around 24gestation weeks. Data was collected regarding the use of antidepressants during the past two years, and discontinued use following pregnancy, in addition to the CES-D data. The standard CES-Duct-off of 16 was used to establish the presence of depressive symptomatology. A t-Test was used to compare two groups: women who reported they stopped using anti-depressants and hence were not currently on medication (n=248); and women who continued to use antidepressants during pregnancy (n=68). The dependent/outcome variable was total CES-Scores. Chi-square was also used to assess use/non-use of antidepressant medication and CES-D groupings (i.e. Figure 3 CES-D data for women who did and those who did not use antidepressants during pregnancy (Marcus et al, 2005). Observed differences are not significant. The authors attributed the null results to poor treatment adherence, and inadequate prescribing/monitoring. Furthermore, they suggested that group differences might have been more pronounced if the study focused on unmediated women (i.e. those who had not used antidepressants at all, rather discontinued use). This study was unique because it assessed antidepressant use around the time of conception. However, the findings are compromised by several analytic constraints. Firstly, these of a t-Test is questionable. This test makes no provision for controlling for covariates (i.e. important background variables, such as patient preference, compliance history, side-effect profile, social support, quality of marital relationship, prior history depression)that may confound significant group differences, although this concerns less important given the null results. A more serious problem is the possibility that certain assumptions which underlie use of the t-Test were violated, notably homogeneity of variance. The huge disparity in group sizes (268 versus 68) hugely increases the possibility of significant differences in group variances, which in turn would obscure reliable differences in CES-Scores. The authors do not report Levine test results, which would have addressed the homogeneity issue. Perhaps a non-parametric test (e.g. Mann-Whitney) may have been more appropriate. Furthermore, it is not clear why the authors conducted a chi-square test! Collapsing the CES-Scores into a dichotomy reduces the quality of the data because it obscures subtle differences between scores. Overall, the chi-square analyses amounted to a less precise duplication of the t-Test results! Finally, this study was entirely based on women’s self-reports of medication use, with no familial, clinical, or other verification. Its therefore unclear to what extent the null results are attributable to self-report bias. Several review articles on antidepressants and postnatal depression have been published. These range from limited commentaries (e.g. Goldstein Sun dell, 1999; Yoshida et al, 1999; Misery Kostas’s, 2002; Hendricks, 2003; Bennett et al, 2004; Cohen, 2005;Marcus et al, 2005) to comprehensive and systematic appraisals. Goldstein and Sun dell (1999) reviewed literature on the safety of SSRIs during pregnancy. Their work was based on the premise that although antidepressants may be necessary during pregnancy it is essential identify and weigh the risks against the benefits in order to make an informed choice as to whether or not to use the drugs. Due to the paucity of randomised controlled trials on the topic, the review focused on evidence obtained from cohort/case-controlled studies, patient surveys, retrospective studies, and anecdotal reports. Electronic databases searched included Medline, EMBASE, Daren’t Drug File, and Psych INFO. Four cohort-controlled and 5 prospective studies were found which evaluated the impact of SSRI exposure. One study compared fluoxetine, TCA, and non-teratogen (e.g. antibiotics) exposed groups of non-depressed females. SSRI and TCA exposure produced no significant malformations, or differences in birth weight and infant prematurity. However, there was a greater tendency for fluoxetine- and tricyclic-exposed women to miscarry compared with controls. However, this effect was not significant and hence may simply have occurred by chance. Goldstein and Sun dell (1999) report another study which compared early exposed (prior to 25 weeks), late exposed (continuing after 24 weeks),and a non-teratogen control group. Again findings revealed no adverse effects in the treatment groups, albeit infants exposed to fluoxetine early showed a higher prevalence of minor anomalies that have little or no clinical importance. Furthermore late exposure to fluoxetine seemed to increase the rates of admission to special care nurseries and impaired fatal development. However, these findings were inconclusive due to prior group differences on previous psychotropic drug use, and failure to control for depression levels. Still other research suggests no effect of SSRIs (sertraline) on the prevalence of stillbirth, prematurity, mean birth weight and gestational age. Evidence suggests no statistically significant differences between SSRI exposed and control groups on IQ, language development, height, and head circumference. Of the prospective studies reviewed three assessed paroxetine, and fluoxetine, and two tested sertraline. All studies reported no significant increase in the rate of malformations and spontaneous abortion, although there was some evidence of lower birth weight given protracted use of antidepressants. Goldstein and Sun dell (1999) found one study, which showed that fluoxetine exposure during the first trimester did not increase the risk of malformations