Public Perceptions About the Concept of Medication Reuse

Public Perceptions About the Concept of Medication Reuse Medication wastes: The public perceptions about the concept of medication reuse Chapter one 1. Introduction 1.1 Background, definitions, and classification of medical wastes There is a growing environmental realisation in the last few years, it is recognisable that the worlds environmental carbon emissions, and global warming problems are increasing. Many organisations work to apply green principles of health care programs in their way for going green (Xie, 2012). In the UK, the Centre for Sustainable Healthcare (CSH) the institution which was developed in 2008 to help NHS reduce carbon liberations and emissions by 80% by 2050 by involving health care professionals, patients, and the community clarifying the connections between environment and health care system (Stancliffe, 2014). Waste is defined by European Union Waste Framework Directive (2008), as any substance or object which the holder discards or intends or is required to discard. All wastes created by medical activities falls under health care wastes. The Royal College of Nursing (RCN) report and the World Health Organisation (WHO) described health care wastes as all wastes produced by research facilities, laboratories, and organisations providing health and social care. Moreover, it involves the waste originating from small or sprinkled sources such as that generated in the health course and social care started at home such as dialysis, insulin injections, bandages, swabs, sharps, blood, medicines and incontinence pads (RCN, 2014 and WHO, 2011). Between (80) % of the waste produced by health-care providers is considered non-risk or general health-care waste, while the remaining (20) % of healthcare waste is considered as hazardous that maybe may be infectious, toxic or radioactive and may create a diversity of health risks. Health-care waste consists of possibly dangerous microorganisms with potential infectious risks such as development of microorganisms resistant to medication from health-care institution into the environment, and can infect patients, healthcare suppliers and the public. WHO classified the hazardous health care waste into (Appendix 1): infectious waste, pathological waste, sharps waste, pharmaceutical waste, genotoxic waste, chemical waste, heavy metals wastes and the radioactive waste. Pharmaceutical waste is waste containing pharmaceutical that are expired, or no longer used; items polluted by or including pharmaceuticals (WHO, 2011). Usually not all the medications dispensed to the patients will be used, this is mainly due to many factors such as adverse drug reaction intolerance, relief of symptoms, changing the dose/dosage forms, medicine non-compliance and/or non-adherence issues and medicine being expired (Dharmender, 2013). Pharmaceutical waste is defined by UK Department of health (2013), as expired, unused, spilt, and contaminated medicinal products, drugs, vaccines and sera that are no longer required and need to be disposed of appropriately; and/ or discarded items contaminated with medicinal, such as bottles or boxes with residues, gloves, masks, connecting tubing, syringe bodies and drug vials. Abou-auda HS (2003), defined medication wastage as any medication or drug product that had been dispensed by a prescription or buy over the counter (OTC) which is not fully consumed. Chapter two 2. Literature review 2.1 causes of medication wastage Drugs are wasted when dispensed to patients who are not taken them. In order to minimise the wastage of medications, it is important to investigate the causes behind medicines being returned, unused, and wasted by the patients. A review of the possible factors evidenced to potentially cause medication waste was conducted to summarise the most important causes of medicine returned unused. 2.1.1 Patient death Medications being returned unused by the patients resulting from patient death was reported in six studies. Mackridge et al. (2007), a cross sectional study of returned medicines to fifty one community pharmacies and forty two general practitioner surgeries in Eastern Birmingham (UK) over eight weeks, Cameron (1996), a self-reporting questionnaire study in 58 community pharmacies in Alberta (Canada) over eight weeks, and Ekedahl (2006), a cross sectional study included fifty nine community pharmacies in Sweden reported that patient death was the most common cause of medication waste. In the study by Langley et al. (2005), a small cross sectional observational study in eight community pharmacies and five general practitioner surgeries in East Birmingham/UK over four weeks, patient death was the second most common cause of returned unused medicines by the patients. Data from Cook A (1996), a cross sectional study of returned medicines to seventeen community pharmacies over one month in UK, Hawksworth et al. (1996), a cross sectional study of returned medicines included thirty community pharmacies in UK, Coma et al. (2008), a cross sectional study of returned medicines to 38 community pharmacies over three months showed that patient death was reported but accounted only for about quarter of all returned unused medicines. 2.1.2 Medication changed or discontinued There is a proof in the literature that changing medications is a considerable cause of medication returned unused by the patients, it is reported as a common cause of medication waste (Cameron 1996, Cook 1996, Hawksworth et al. 1996, Morgan 2001, Daniszewsi et al.2002, Langley et al. 2005, Abahussain et al. 2006, Ekedahl 2006, Mackridge et al. 2007, Braund et al. 2008, Coma et al. 2008, Braund and Gn et al. 2009, Braund and Peake et al. 2009, James et al. 2009). Data from (Hawksworth et al. 1996, Daniszewsi et al.2002, Langley et al. 2005, Abahussain et al. 2006, Braund et al. 2008), found that changing medications was the most common reported cause of medication being wasted. 2.1.3 Medication Expired 2.2 The environmental impact of unused wasted returned medications The toxic ecological effects of the pharmaceutical presence in the environment was studied and evaluated in the last few years. Data from Heberer (2002) and Woodhouse (2003), confirm the presence of pharmaceuticals in water and considered it serious, as it is not totally removed and even if it is present in trace levels is still considered pollutant to water receivers. The improper household disposal practices of unused medicines, via the local waste, the sewers, and the toilet was identified, as a source of water contamination (Bound, 2006). The effect of pharmaceutical wastes in the environment was linked to possible development of endocrine deactivating compounds, reducing fertility, and antibiotic resistance bacteria. Data from Schwartz et al. (2003), confirmed the development of bacterial resistance as vancomycin resistant enterococci and beta-lactam-hydrolysing Enterobacteriaceae were cultivated from all wastewater biofilms. In the study by Lange et al. (2001), the ‘’feminising effects’’ of endocrine-disrupting compounds, such as ethinyl estradiol, the synthetic hormone used in the contraceptive pill, on fish near wastewater treatment works outfalls was measured. 2.3 The economic impact of unused wasted returned medicine Studies from inside (five) and outside (six) UK, estimated the value of the cost of medication waste are reviewed below. Results from Hawksworth et al. (1996), a cross sectional study included thirty community pharmacies in Kirklees/West Yorkshire (UK) over a period of one month showed an estimated cost of  £37 million of unused medicine were from patients home. Langley et al. (2005), a small cross sectional observational study in eight community pharmacies and five general practitioner surgeries in East Birmingham/UK over four weeks, showed that the total cost of returned medicines was  £3986 and  £3751 respectively. In the study by Mackridge et al. (2007), a cross sectional study reported an estimate of  £75 million value of returned medicines to fifty one community pharmacies and forty two general practitioner surgeries in Eastern Birmingham over eight weeks. In the same year, the UK National Audit Office report, proposed that each year an estimate of  £100 million value of unused returned medicine. As the  £100 million estimate was based on unused medicine that actually returned, this was considered as an underrated figure of the full cost of wasted medicines, as a result the department of health estimated that as much as 10% of all drugs prescribed were wasted (10% of the NHS prescribing budget) which is estimated to be  £800 million-worth of drugs are wasted annually in primary care. Data from Trueman et al. (2010), a research undertaken by the York Health Economics Consortium and London School of Pharmacy in 2009, estimated that the annual cost of the primary and community care medicines wastage in UK NHS was around  £300 million per year ( £ 250-300 million per year), with estimated  £90 million of unused medicines stored in individuals homes,  £110 million returned to community pharmacies over the course of a year, and up to  £50 million of NHS supplied medicines that are disposed of annually by care homes. The authors of this report also estimated that less than 50% of this total figure is cost effectively preventable. International studies from outside UK was also included and reviewed. A Canadian study by Cameron S (1996), in fifty eight pharmacies over eight weeks estimated the cost of unused medicines returned was $60350, the extrapolated cost which included the whole 750 community pharmacies in Alberta during the same eight weeks period was $716400. Coma et al. (2008), a cross sectional study included thirty eight community pharmacies in Barcelona/Spain over a period of three months, showed that the estimated cost of returned medicines was â‚ ¬8,539.9, the extrapolated cost for the 20,461 community pharmacies in whole Spain was a round â‚ ¬129 million. Although the reuse concept of patient’s unused returned medicines is considered unethical in the United Kingdome (UK), the unused medicines are returned in large quantities and have important financial value, with the preponderance considered acceptable to be used again by another patient (Mackridge, 2007). Table 1. Summary of research studies evaluating the economic impact of wasted medicine Study Study setting and duration Study method Country Main Findings Hawksworth et al. (1996) 30 CPs over duration of 1 month Cross sectional questionnaire UK A total of 1,091 items were returned by 366 patients with estimated value of  £37 million Langley et al. (2005) 8 CP and 5 GPs over duration of 4 weeks Cross sectional observational study UK A total of 340 items were returned (42 to GPs and 298 to CPs). The total cost of returned items was  £3986 to GPs and  £3751 CPs. Mackridge et al. (2007) 51 CPs and 42 GPs over duration of 8 weeks Cross sectional study UK A total of 3765 items were returned by 910 patients with estimated value of  £75 million UK National Audit Office report (2007) Based on previous analysis conducted by department of health Based on previous analysis conducted by department of health UK Proposed that each year an estimate of  £100 million value of unused returned medicine. Trueman et al. (2010) 403 of the 466 items identified in the public survey were able to be priced. Costs were identified /item using British National Formulary (BNF). Public survey UK Estimated that the annual cost of the primary and community care medicines wastage in UK NHS was around  £300 million per year ( £ 250-300 million per year). Cameron S (1996) 58 CPs in Alberta (8% of provincial total) over duration of 8 weeks Self-reporting questionnaire Canada The estimated cost of the unused medicines returned was $60350. The extrapolated cost for 750 CPs is in Alberta during the same 8 week period was $716400. Morgan (2001) Sample of 73 of Hampshire retirement community citizens aged 65 years or older. over duration of 7 months cross-sectional pilot survey/ Questionnaire US The total cost of 2078 wasted pills was US $ 2,011.00 with mean annual cost of wasted medication was $30.47/person (range = $0-$131.56). Individual costs were modest, but if $30/individual demonstrate a low estimate of average annual cost of waste, the US extrapolated cost was estimated to be not less than $1 billion per year. Abou-auda (2003) A total of 1641 households participated (1554 from Saudi Arabia, 87 from other countries) Questionnaire / Pilot study Saudi Arabia, and capital cities of Kuwait, Oman, Qatar, and United Arab Emirates U.A.E The estimated cost of unused medicines by families in Saudi Arabia capital cities of Kuwait, Oman, Qatar, and United Arab Emirates (U.A.E) was $150 million. Coma et al. (2008) 38 CPs over duration of 3 months Cross sectional questionnaire Spain The estimated cost of returned medicines was â‚ ¬8,539.9. The extrapolated cost for the 20,461 CPs in whole Spain was â‚ ¬129.6 million El-Hamamsy (2011) 20 CPs over duration of 1 month Questionnaire (Closed-ended questions used only) Cairo/Egypt The total wholesale price of returned drugs calculated at 10988.84 Egyptian pounds (around $1962.32 US) Hassali et al. (2012) Two parts: 1) Medicine wastage in the patients’ home. 2) Medicine wastage by the benefactor at the pharmacy desk. over duration of 6 months A descriptive study of two parts: 1) Prospective randomised community based trial. 2) Wasted medicines were collected from the patients who pass back the unwanted medicines to the pharmacy desk in the Hospital. Malaysia The total cost of the returned medications within 6 months was MYR 59,566.50 (Malaysian ringgit) with a monthly average of about MYR 9,927.75. the extrapolated cost for one year of the medications returned was MYR 119,133.00 Information from medication waste campaign website illustrated that the estimated cost of unused medication ( £300 million/year) could pay (by the average cost) for 11,778 more community nurses, 19,799 more drug treatment courses for breast cancer, 101,351 more knee replacements, 80,906 more hip replacements, and 300,000 more drug treatment courses for Alzheimers. In 2012 the NHS of Berkshire started major actions to reduce medicine waste, data from the NHS south central press release, showed that an estimate cost of wasted medicine across the Berkshire NHS and south central was  £20 million per year. The full cost of wasted medicine is not only the cost of returned medicines as estimated by the studies reviewed above (Table 1), in addition the cost of the destroying processes of the returned medicines, and the hidden costs of non-compliance/non-adherence effects which was not studied should be added to the full cost of wasted medicines in future research (UK National Audit Office Report, 2007). 2.4 Disposal practices for unused medications 2.5 Public perceptions about unused/wasted pharmaceuticals 2.6 Medication reuse and recycling A medicine reuse concept involves the return of unused and/or sealed medicines to a pharmacy, healthcare facility or charitable organisation for subsequent redistribution to recipients locally or internationally. This was implemented on a charitable basis in the United States of America (USA) and in developing countries which experienced poor medicine supply (Bero, 2010). Although such practice is considered unethical and not approved in UK, it may have environmental and economic advantages as many of these considered acceptable to be used again (Mackridge, 2007). Ipsos MORI conducted 1,101 face to face interviews for Sustainable Development Unit of the UK NHS (SDU) with respondents aged fifteen and more using around one hundred and fifty sample points. The research was carried out in two periods between the eleven of November and the fifth of December 2011. All data was weighed to reverberate the population profile of British people aged fifteen and more. Data from this recent survey reported that around half of the British people (52%) agreed to accept reissued medicines returned (that are unused and the safety was checked) by other patients while 32% said that they would not. According to Dr David Pencheon the director of sustainability unit, medicine reuse concept had been unaccepted in the past based on the assumption that patients are not willing to take the medicine returned by others. In healthcare system, the health care provider is always deviate strongly on the side of safety caution and discard medicines. For the time beings, the economics of this behaviour need to be reconsidered (Cooper, 2012). Chapter Three Research plan Ecological Impact Is medicine being wasted No Yes No Imagine that Mr. Smith who is ill with diabetes is prescribed four medications each month. He doesn’t pay for his medicines. He use all medicines as prescribed. Imagine that Mr. Smith who is ill with diabetes is prescribed four medications each month. He doesn’t pay for his medicines. He sometimes fails to take his medicines as prescribed. Yes Appendices Appendix 1 (WHO and RCN Definitions and classifications of health care wastes Infectious waste Waste contaminated by blood and its secondary products, cultures and supplies of infectious agents, waste come from isolated patients, any infected thrown away diagnostic samples with blood and body fluids, infected animals from laboratories, and contaminated swabs, bandages, and equipment such as disposable medical devices. Pathological waste Recognizable parts of the body and contaminated animal dead bodies. Genotoxic waste Very dangerous, mutagenic, teratogenic, and carcinogenic, such as cytotoxic drugs and their metabolites. Pharmaceutical waste Expired, unused, and contaminated drugs; vaccines and sera Radioactive waste Such as contaminated glass materials with radioactive diagnostic or therapeutic materials. Heavy metals waste Such as broken mercury thermometers. Chemicals Such as broken mercury thermometers Sharps Such as syringes, needles, disposable scalpels and blades Hazardous or Non Hazardous waste Clinical waste if it contains or is contaminated with a medicine containing either: A pharmaceutically-active substance (a substance able to affect biological systems); or A dangerous substance such as chemicals at sufficient concentration to produce a hazardous property. Clinical or Non Clinical waste Hazardous if it contains or is contaminated with a cytotoxic or cytostatic medicine. Other medicines are not hazardous waste. Offensive waste or sometimes called hygiene waste) Is waste that is non-infectious and not clinical, but may cause offence due to the presence of recognisable health care waste materials, body fluids or odour, and secretions or excretions or that collection and disposal is not subject to special requirements in order to prevent infection. *Adapted from WHO fact sheet (2011), and RCN guidance (2014)

E-R Diagram

Introduction:- In 1976 ,Chen developed the Entity-Relationship Diagrams ,a high-level data model that is useful in developing a conceptual design for database . An ER diagram is a diagram containing entities or â€Å"items†, relationships among them, and attributes of the entities . The E-R model is one of the best known tools for logical database design. Within the database community, it is considered a natural and easy-to-understand way of conceptualizing the structure of database.Claims that have been made for it include the following: it is simple and easily understood by non-specialist ,it is easily conceptualized ,the basic constructs (entities and relationships) are highly intuitive and thus provide a natural way of representing a user’s information requirements , and it is a model that describes a world in terms of entities and attributes that is most suitable for computer naive end users. In E-R diagram the emphasis is on representing the schema a rather than t he instances. This is more useful in database design because a database schema changes rarely ,whereas the contents of the entity sets changes frequently.In addition ,the schema is usually easier to display that the extension of database ,because it is much smaller Purpose:- Entity-relationship diagrams were first proposed as a means of quickly obtaining, with minimum effort, a good sense of the structure of a database. They are used to plan and design a database and to model a systems data. Key Elements Entities:- * An entity represents the principle data objects about which information is to be collected. * Collective nouns, or nouns, are usually used to name (describe) entities * For example, each person in an enterprise is an entity. An entity has a set of properties, and the values for some set of properties may uniquely identify an entity. For instance, a person may have a person_id property whose value uniquely identifies that person. Entity Set:- * An entity set is a set of entities of the same type that share the same properties, or attributes. The set of all persons who are customers at a given bank, for example, can be defined as the entity set customer. Attribute:- * An attribute is one of the various properties that describe the entity’s characteristics. These properties usually present a single fact – they are atomic. The designation of an attribute for an entity set expresses that the database stores similar information concerning each entity in the entity set; however, each entity may have its own value for each attribute. * Possible attributes of the customer entity set are customer-id, customer-name, customer-street, and customer-city. Domain (value set):- * For each attribute, there is a set of permitted values, called the domain, or value set, of that attribute. * The domain of attribute customer-name might be the set of all text strings of a certain length.Types of attribute in the E-R model:- The attributes used in the ER mo del can be categorized as 1. Simple or Composite 2. Single Valued or Multi Valued 3. Stored or Derived. 1. Simple or Composite * The attribute which are not divided into subparts are called simple attributes. * For example, an attribute customer-id is a simple attribute. * Composite attributes, on the other hand, can be divided into subparts (that is, other attributes). * For example, an attribute name could be structured as a composite attribute consisting of first-name, middle-initial, and last- name. Using composite attributes in a design schema is a good choice if a user will wish to refer to an entire attribute on some occasions and to only a component of the attribute on other occasions. Suppose we were to substitute for the customer entity-set attributes customer-street and customer-city the composite attribute address with the attributes, street, city, state, and zip-code. * Note also that a composite attribute may appear as a hierarchy. In the composite attribute address, i ts component attribute street can be further divided into street-number, street-name, and apartment-number. 2. Single Valued or Multi Valued The attributes that have a single value for a particular entity is called a single valued attribute. * For example, an attribute customer-id is a single valued attribute because for a particular entity it holds a single value. * The attribute that have multiple valued for a particular entity is called a multi valued attribute. * For example, an attribute phone-number is a multi valued attribute because for a particular customer it holds zero, one or several phone numbers. 3. Stored or Derived * Normally attributes are stored attributes, that is, their values are stored and accessed as such from the database. For example, the attributes name, address and date-of-birth of customer entity set are stored attributes. * However, sometimes attributes’ values are not stored as such, rather they are computed or derived based on some other value. This other value may be stored in the database or obtained some other way. * For example, we may store the name, father-name, address of customers, but age can be computed from date-of-birth. * The advantage of declaring age as derived attribute is that whenever we will access the age, we will get the accurate, current age of employee since it will be computed right at the time when it is being accessedFig Symbol used for different types of attributes in E-R diagram An example diagram representing all types of attributes is given below: 1. The attributes empId, empName and dateHired are simple and single valued. 2. The attribute address is a composite attributes because it can be sub divided into street and houseNo. 3. The attribute emp_Qual is a multi valued attribute because an employee has zero, one or many qualifications. 4. The attribute Experience is a derived attribute because it can be derived from the attribute dateHired. 5.The attributes other than Experience are stored at tribute because it can be stored and accessed from the database. Null value:- * An attribute takes a null value when an entity does not have a value for it. * The null value may indicate â€Å"not applicable†Ã¢â‚¬â€that is, that the value does not exist for the entity. * For example, one may have no middle name. Relationship:- * Relationship is a representation of the fact that certain entities are related to each other. * Verbs are usually used to describe relationships. * For example: Students take Courses – Students and Courses are entities, and take is the relationship.Relationship Set:- * Set of relationships of a given type. * For example: students registered in courses ,passengers booked on flight ,parents and their children. Participation: * The association between entity sets is referred to as participation; that is, the entity sets E1, E2, . . . ,En participate in relationship set R. * The participation of an entity set E in a relationship set R is said to b e total if every entity in E participates in at least one relationship in R. * If only some entities in E participate in relationships in R, the participation of entity set E in relationship R is said to be partial.Degree:- * The number of entity sets that participate in a relationship set is called the degree of the relationship set. * A binary relationship set is of degree 2; a ternary relationship set is of degree 3. Mapping Cardinalities (cardinality ratio) :- * Mapping cardinalities, or cardinality ratios, express the number of entities to which another entity can be associated via a relationship set. * Mapping cardinalities are most useful in describing binary relationship sets, although they can contribute to the description of relationship sets that involve more than two entity sets. For a binary relationship set R between entity sets A and B, the mapping cardinality must be one of the following: a) One to one. An entity in A is associated with at most one entity in B, and a n entity in B is associated with at most one entity in A. b) One to many. An entity in A is associated with any number (zero or more) of entities in B. An entity in B, however, can be associated with at most one entity in A. c) Many to one. An entity in A is associated with at most one entity in B. An entity in B, however, can be associated with any number (zero or more) of entities in A. ) Many to many. An entity in A is associated with any number (zero or more) of entities in B, and an entity in B is associated with any number (zero or more) of entities in A. Fig. one to one Fig. one to many Fig. Many to one Fig. Many to many Key :- * A key allows us to identify a set of attributes that suffice to distinguish entities from each other. * A super key is a set of one or more attributes that, taken collectively, allow us to identify uniquely an entity in the entity set.For example, the customer-id attribute of the entity set customer is sufficient to distinguish one customer entity fr om another. Thus, customer-id is a super key. Similarly, the combination of customer-name and customer-id is a super key for the entity set customer. The customer-name attribute of customer is not a super key, because several people might have the same name. * The concept of a super key is not sufficient for our purposes, since, as we saw, a super key may contain extraneous attributes. * If K is a super key, then so is any superset of K. We are often interested in super keys for which no proper subset is a super key.Such minimal super keys are called candidate keys. * It is possible that several distinct sets of attributes could serve as a candidate key. Suppose that a combination of customer- name and customer-street is sufficient to distinguish among members of the customer entity set. Then, both {customer-id} and {customer-name, customer-street} are candidate keys. Although the attributes customerid and customer-name together can distinguish customer entities, their combination d oes not form a candidate key, since the attribute customer-id alone is a candidate key. The primary key is a candidate key that is chosen by the database designer as the principal means of identifying entities within an entity set. * A key (primary, candidate, and super) is a property of the entity set, rather than of the individual entities. Any two individual entities in the set are prohibited from having the same value on the key attributes at the same time. * The designation of a key represents a constraint in the real-world enterprise being modeled. * Sometimes we may have to work with an attribute that does not have a primary key of its own .To identify its rows ,we have to use the primary attribute of related table. this is known as foreign key. * So a foreign key is a field in a relational table that matches a candidate key of another table. The foreign key can be used to cross-reference tables . For example ,say we have two tables ,a CUSTOMER table that includes all custome r data ,and an ORDERS table that include all customer orders . The intention here is that all orders must be associated with a customer that is already in the CUSTOMER table . To do this,we will place a foreign key in the ORDERS table and have it related to the primary key of the CUSTOMER table.Strong and Weak Entities:- * An entity set may not have sufficient attributes to form a primary key. Such an entity set is termed a weak entity set. An entity set that has a primary key is termed a strong entity set. * As an illustration, consider the entity set payment, which has the three attributes: payment-number, payment-date, and payment-amount. Payment numbers are typically sequential numbers, starting from 1, generated separately for each loan. Thus, although each payment entity is distinct, payments for different loans may share the same payment number.Thus, this entity set does not have a primary key; it is a weak entity set. * For a weak entity set to be meaningful, it must be asso ciated with another entity set, called the identifying or owner entity set. * Although a weak entity set does not have a primary key, we nevertheless need a means of distinguishing among all those entities in the weak entity set that depend on one particular strong entity. The discriminator of a weak entity set is a set of attributes that allows this distinction to be made. The discriminator of a weak entity set is also called the partial key of the entity set.The primary key of a weak entity set is formed by the primary key of the identifying entity set, plus the weak entity set’s discriminator. Symbols used in E-R diagram:- Steps in E-R Modeling :- Usually the following five steps are followed to generate ER models 1. Identify the entity set. 2. Identify the relevant attributes. 3. Identify the prime attribute. 4. Find relationships between entity set. 5. Draw a complete ER model. How to Prepare an ERD:- Step 1 Let us take a very simple example and we try to reach a fully o rganized database from it. Let us look at the following simple statement:A boy eats an ice cream. This is a description of a real word activity, and we may consider the above statement as a written document (very short, of course). Step 2 Now we have to prepare the ERD. Before doing that we have to process the statement a little. We can see that the sentence contains a subject (boy), an object (ice cream) and a verb (eats) that defines the relationship between the subject and the object. Consider the nouns as entities (boy and ice cream) and the verb (eats) as a relationship. To plot them in the diagram, put the nouns within rectangles and the relationship within a diamond.Also, show the relationship with a directed arrow, starting from the subject entity (boy) towards the object entity (ice ICE CREAM EATS BOY Well, fine. Up to this point the ERD shows how boy and ice cream are related. Now, every boy must have a name, address, phone number etc. and every ice cream has a manufacture r, flavor, price etc. Without these the diagram is not complete. These items which we mentioned here are known as attributes, and they must be incorporated in the ERD as connected ovals. FLAVOUR MANUFACTURER ADRESS NAME EATS ICE CREAM CREAM BOY PRICE PHONEBut can only entities have attributes? Certainly not. If we want then the relationship must have their attributes too. These attribute do not inform anything more either about the boy or the ice cream, but they provide additional information about the relationships between the boy and the ice cream. FLAVOUR MANUFACTURER NAME ADRESS TIME DATE PRICE PHONE ICE CREAM EATS BOY Step 3 We are almost complete now. If you look carefully, we now have defined structures for at least three tables like the following: BOYPHONE ADRESS NAME ICE CREAM MANUFACTURER FLAVOUR PRICE EATS TIME DATE However, this is still not a working database, because by definition, database should be â€Å"collection of related tables. † To make them connected, the tables must have some common attributes. If we chose the attribute Name of the Boy table to play the role of the common attribute, then the revised structure of the above tables become something like the following BOY PHONE ADRESS NAME ICE CREAM NAME PRICE FLAVOUR MANUFACTURER NAME TIME DATE EATS This is as complete as it can be.We now have information about the boy, about the ice cream he has eaten and about the date and time when the eating was done. Extended Features of E-R Diagram 1. Specialization †¢An entity set may include sub-groupings of entities that are distinct in some way from other entities in the set. For instance, a subset of entities within an entity set may have attributes that are not shared by all the entities in the entity set. The E-R model provides a means for representing these distinctive entity groupings. †¢ Consider an entity set person, with attributes name, street, and city.A person may be further classified as one of the following: a) cust omer b) employee Each of these person types is described by a set of attributes that includes all the attributes of entity set person plus possibly additional attributes. For example, customer entities may be described further by the attribute customer-id, whereas employee entities may be described further by the attributes employee-id and salary. The process of designating sub-groupings within an entity set is called specialization. The specialization of person allows us to distinguish among persons according to whether they are employees or customers. As another example, suppose the bank wishes to divide accounts into two categories, checking account and savings account. Savings accounts need a minimum balance, but the bank may set interest rates differently for different customers, offering better rates to favored customers. Checking accounts have a fixed interest rate, but offer an overdraft facility; the overdraft-amount on a checking account must be recorded. * In terms of an E-R diagram, specialization is depicted by a triangle component labeled ISA, as Figure shows. The label ISA stands for â€Å"is a† and represents, for example, that a customer â€Å"is a† person.The ISA relationship may also be referred to as a superclass-subclass relationship. Higher- and lower-level entity sets are depicted as regular entity sets i. e. , as rectangles containing the name of the entity set. ISA 2. Generalization * The refinement from an initial entity set into successive levels of entity subgroupings represents a top-down design process in which distinctions are made explicit. The design process may also proceed in a bottom-up manner, in which multiple entity sets are synthesized into a higher-level entity set on the basis of common features.The database designer may have first identified a customer entity set with the attributes name, street, city, and customer-id, and an employee entity set with the attributes name, street, city, employee-id, and sa lary. * There are similarities between the customer entity set and the employee entity set in the sense that they have several attributes in common. This commonality can be expressed by generalization, which is a containment relationship that exists between a higher-level entity set and one or more lower-level entity sets.In our example, person is the higher-level entity set and customer and employee are lower-level entity sets. Higher- and lower-level entity sets also may be designated by the terms superclass and subclass, respectively. The person entity set is the superclass of the customer and employee subclasses. * Specialization stems from a single entity set; it emphasizes differences among entities within the set by creating distinct lower-level entity sets. These lower-level entity sets may have attributes, or may participate in relationships, that do not apply to all the entities in the higher-level entity set.Indeed, the reason a designer applies specialization is to repre sent such distinctive features. If customer and employee neither have attributes that person entities do not have nor participate in different relationships than those in which person entities participate, there would be no need to specialize the person entity set. * Generalization proceeds from the recognition that a number of entity sets share some common features (namely, they are described by the same attributes and participate in the same relationship sets).On the basis of their commonalities, generalization synthesizes these entity sets into a single, higher-level entity set. Generalization is used to emphasize the similarities among lower-level entity sets and to hide the differences; it also permits an economy of representation in that shared attributes are not repeated. Difference between Specialization and Generalization No. | Specialization| Generalization| 1| It is a Top Down approach. | It is a Bottom Up approach. | 2| Specialization stems from a single entityset; it em phasizes differences among entities within the set by creating distinct lower-level entity sets. Generalization proceeds from therecognition that a number of entity sets share some common features (namely, they are described by the same attributes and participate in the same relationship sets). | 3| The process of designating sub-groupingswithin an entity set is calledspecialization. | The process of designating groupingsfrom various entity sets is calledgeneralization. | 4| Specialization is a result of taking a subsetof higher level entity set to form a lower- level entity set. | Generalization is a result of taking theunion of two or more disjoint (lower- level) entity sets to produce a higher- level entity set. | .

Biology Post Lab on Osmosis and Diffusion

Brian Toohey Biology Mrs. Heimforth 12/06/10 Diffuse the Osmosis Section 2: Introduction Step 1: The scientific concept of this lab was to see how osmosis transferred the substance through the cells to reach equilibrium. Step 2: My hypothesis was that the bag with 60% sucrose then it would be heavier than the bag with tap water or 30% sucrose. I thought this because I thought that there would be more of a substance change in 60% sucrose. Section 3: Methods First get 3 pieces of the same length of tubing then get 6 pieces of string. Fold one half of the tube over and tie the end with string.Then add 5 ml of 30% sucrose solution in the tubes. Squeeze the bag gently to release air fold it over and tie it with another piece of string. Rinse bags under water then dry. Then weigh bags to nearest tenth of a gram and record. Then place one bag in each of the beakers. Then let them sit for 30 minutes do not touch. Remove bags quickly rinse and dry and reweigh. Then record results. Section 4: Results Step 1: | 60% sucrose | 30% sucrose | Tap Water | before | 6. 2 | 4. 6 | 5. 4 | after | 4. 3 | 4. 5 | 4. 8 | Step 2: As the sucrose decreases so does the weight.I have found that when you decrease the amount of sucrose it will cause the water to go outward making the bag weigh less. Section 5: Step 1: The lab experimentation did not support my hypothesis because the weight decreased more with the sucrose. Step 2: The specific data that made my hypothesis wrong is the fact that when we added less sucrose the after weight decreased as shown in my graph. Step 3: The results did not support my hypothesis because when the water was greater on the inside it went outside by using osmosis but when the water was greater on the outside it went inside making the bag heavier.Step 4: When we were conducting the experiment one bag might have sat in the cups to long. Step 5: I have learned that water is the only thing that can be sent through the cell without using energy. I also learned t hat through diffusion smell spreads. Step 6: I learned that it is very hard to keep track of things you don't label it takes a lot of memory. ;)Section 6: References Postlehwait, John H. , and Janet L. Hopson. Modern Biology. Austin: Holt, Rinehard, and Winston, 2006. 65-73. Print

Racial Identity And The Social Identity - 923 Words

the other children in my survey who were African-descent like me. This gave me a sense of social community and stratification with them. Also, since I was the oldest out of my childhood friends this boosted the social identity aspect I adopted from my sibling. My neighbourhood compared to others was at a lower class, there was small crimes such as vandalism, use of illegal drugs, and conflicts. This made me socially desensitised to common crimes which shaped my social identity by being calmer when experienced with crimes outside of my neighbourhood. As I progressed to elementary school, I grew up mentally more mature then my peers which changed me into being more judgemental of others. I expected a lot from others which they found annoying. My time in elementary school was plagued by my lower wealth class which became more and more of an obstacle since school becomes more expensive as your grow older. This made me adopt a tendency to take care of my belongings and eventualy become ve ry responsible. High school was the focal point of my young life. During grade 9 I acquired my first job which helped me with my money problems and help support my family extensively. Politically, people in my neighbourhood, including my family, would not pay attention conflicts and elections unless it was a problem in our home country. This caused me to become politically ignorant to situation happening in Canada and the world. In conclusion, my life mad me develop a social identity ofShow MoreRelatedRacial Identity And Development : A Construction Of Social Aspects1886 Words   |  8 Pages Racial Identity and Development Race is a construction of social aspects that refers to individuals and groups that contain certain characteristics (Cornell). 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