What is Schizophrenia

Table of Contents Introduction What is Schizophrenia Studies on the Disorder Treatment Options The Success of Treatment Options Conclusion Reference List Introduction Many different psychological disorders that have been discovered in the medical world tend to afflict human beings thus affecting their day-to-day activities. Psychological disorders come in different ways. At the same time, they are tackled in different ways that can be described as the best in the present-day world of medicine.Advertising We will write a custom research paper sample on What is Schizophrenia? specifically for you for only $16.05 $11/page Learn More Some psychological disorders can be described as acquired while some can be described as genetic depending on their manifestation in the human beings. The treatment and management of these disorders also vary, with some of the disorders being treatable and eliminated completely while some can only be controlled but not elimi nated. Different approaches are employed when dealing with psychological disorders. In fact, although different people can be diagnosed with the same disorder, they will show different signs individually and hence the conclusion that psychological disorders show different indicators that make up a certain disorder when put together. As the study reveals, one such disorder that can be described as complex is schizophrenia because of the different ways it manifests in human being as well as the different forms it afflicts its victims. What is Schizophrenia Schizophrenia as a disease or mental disorder has been in existence for a very long time, as long as humans have existed. Previously, the classification of mental illnesses was so poor that almost all mental illnesses were lumped together without trying to sort them out (Sullivan, 2003, p. 1187). Way back in the year 1911, a Swiss doctor called Eugene Blair coined the name schizophrenia from two Greek words, ‘schizo’, m eaning split, and the word ‘phrene’, meaning mind, and hence the term schizophrenia that means a disconnected mind. The disease comes in different forms by exhibiting different characteristics specific to an individual case. In most cases, an individual would exhibit one or more of the following characteristics, which are pointers to the disease. They include delusions, which are strange and unrealistic beliefs that go on in an individual’s mind in that they tend to see things that other people are not seeing (Lilienfeld et al. 2010). The signs also include hearing of sounds other people cannot hear, and some strange beliefs that something is going to happen to the victims. The mind of the individual makes them have abnormal a feeling about their surrounding environment. They also have hallucinations, which will make them have a reaction of the presence of things that are actually not there. In this case, people will hear voices that are just in their minds, smel l things that are not there, and/or have different tastes from what is expected (Sullivan, 2003, p. 1189).Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More The individuals will also exhibit strange behavior when viewed by normal people. The behavior that can be described as uncanny. In some cases, the individuals will have a very unsystematic dialogue in that a mature individual will not be able to make a sensible statement due to his or her mixing of different words. The speech of a mature person in this case can be described as that of a small child who is learning to talk. Some forms of schizophrenia come with disjointed and severely diminished cognitive abilities in that victims lose most of their mental faculties (Lilienfeld et al. 2010). In fact, they cannot therefore do any constructive thing. In some cases, the individual will not be in a position to do anything without being instruc ted on what do and how to do it. In case the victims have taken the initiative to do something, they will omit some steps, which make whatever they are doing appear odd (McGlashan, 1988, p. 516). Signs vary from one individual to the other as well as severity of the condition. Some persons can be described as being in a permanent state of the condition while others will oscillate between being fully normal and suffering from bouts of the disease. Schizophrenia strikes its victims in their late adolescence or in their early stages of adulthood although it is also known to strike anytime of an individual’s lifetime. The real cause of schizophrenia has never been pinpointed to date. However, experts are working on a theory that points it to be a result between biological predispositions, which are genetic in nature and the environment in which one grows up (Daly, 2013, p. 716). This claim is the line of research that researchers are slowly developing with the belief that it will give answers to the question of its origin. Another cause for schizophrenia can be drug abuse. Effects of drug abuse can lead to the impairment of the cognitive functions of the brain in that the victim will start behaving abnormally due to hallucinations and delusions. Pregnancy has also been listed as another cause of schizophrenia, with different elements during a woman’s pregnancy acting as a trigger for the same. Schizophrenia comes in different levels such that some types of schizophrenia can be described as acute while others can be described as mild (Sullivan, 2003, p. 1189). People with schizophrenia can have lucid moments in that sometimes they are fully normal with their mental functions being performed in order. However, in some other times, they are very schizophrenic.Advertising We will write a custom research paper sample on What is Schizophrenia? specifically for you for only $16.05 $11/page Learn More Studies on the Disorder Sci entists have conducted different major studies across the world as they try to find the main causes of schizophrenia as well as solutions to the problem. The biggest challenge that many studies have faced has been the inability to pin point exactly what causes the problem because finding the cause would lead to better solutions to the problem. The manifestation of the disease is what makes it a big challenge to researchers who are trying to find its exact cause. One of the challenges is that schizophrenia has so many different symptoms. In this case, only when they are put together that the person can be rightly diagnosed as suffering from the disease (Meltzer, 2002, p. 280). Therefore, research in the field of schizophrenia is wide due to the width with which the schizophrenia problem comes. Each research has been narrowed down to a specific problem that the researchers think is the cause or they think might lead them to a solution. Broad Institute of Harvard, the MIT, and the Mass achusetts General Hospital have conducted one of the major studies on schizophrenia under the leadership of Mark Daly. The aim of the study was to find the genetic difference between people suffering from schizophrenia, bipolar disease, and other unaffected people. The study involved over 10000 people suffering from schizophrenia, 7000 people suffering from bipolar, and a large number of unaffected people. The study was meant to narrow down genetic differences between the three groups as a way of pin pointing the genetic traits associated with schizophrenia. The study discovered 10 genetic risk factors that are highly associated with schizophrenia and bipolar disorder. Besides, it also discovered three specific genes that are suspected to be the cause of the two diseases (Daly, 2013, p.730). The study was meant to find a common link between schizophrenia and genes, which are usually transferable from one offspring to the other. Another study on schizophrenia, which is one of the man y studies on the same disease, was to find out the relationship between the disease, genetic traits, and the environment. The study found that the heritability liability of schizophrenia was 81%, which means that schizophrenia is a highly heritable disease arising due to genetic traits that can be inherited. 11% of the problem in victims was attributed to common and shared environment. The study came out with a conclusion that schizophrenia is highly influenced by genes and the environment although it does not show the cause of the disease. The study simply reinforces previous theories that point the origins of schizophrenia to both genes and the environment (Daly, 2013, p. 735). Another study by McGlashan (1988) found that schizophrenia, as a mental disease can be chronic to the extent that its effects become worse in relation to those of other known major mental illnesses.Advertising Looking for research paper on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More In these findings, schizophrenia can lead to increased risks of suicide in its victims, instances of physical health, and cases of mortality. According to McGlashan (1988), the disease comes out in the open after a period of between 5-10 years after its manifestation meaning that it can remain unnoticed in an individual for some time, as it develops before it comes out evidently (p. 520). The study finds that long-term studies on the disease so far have not come up with any conclusion on the history of treatment of the disease, meaning that the treatment of the disease has not been concluded as effective. Studies on the disorder can be described as continuous because no authoritatively conclusive study has been made so far. Different theories on the disease continue to be studied while new theories also come up at the same time to try to find a solution. Therefore, any information so far being used in the field cannot be described as conclusive, but as part of a continuous study. Tr eatment Options One factor that underlies schizophrenia treatment is that it is a disease whose cause is not yet known and that it comes in different manifestations. This case therefore complicates the treatment regime that any physician has to offer because it is a trial and error at the end of the day. Every single schizophrenic case has to be approached individually because different victims have different symptoms besides having different combinations of symptoms (Meltzer, 2002, p. 280). This complication therefore restricts the physician to observe case by case in an effort to administer drugs according to their opinion on the individual case. The treatment methods commonly in the application are based on a clinical research that has been conducted on the disease as well as on the experience of the physician on the treatment of the disease. Usually, the approach that the physician will employ will depend on the ability of the strategy to reduce the effects and symptoms of the d isease as well as an approach that is believed will reduce the chances of the disease coming back. Treatment for the condition happens in two ways: medical treatment or psychosocial treatment (Sullivan, 2003, p. 1188). Medical treatment of the disease usually involves the use of antipsychotic medicine, which has been available since 1950s. These drugs are not known to cure the problem. Rather, they are known to reduce psychotic symptoms to allow the individual to behave like a normal person. So far, this treatment has been identified as the most effective. An experienced physician who specializes in mental cases can administer it. The choices of drugs and dosage are the prerogative of the physician because treatment is done on a case-by-case basis. Many schizophrenic cases as explained above differ in symptoms and intensity. Although psychotic medication has been known to work well for schizophrenic cases, it sometimes does not work in others in that patients may fail completely to respond to the drug thus making it useless to administer the said drug on them (Sullivan, 2003, p. 1189). Some patients will mildly respond to the drugs being administered. This case would require higher doses of the drug for them to be effective. Although it is effective in treating and managing schizophrenia, almost all anti psychotic drugs have negative side effects that might not be pleasant at all to the patient. Some of the commonly used drugs include Clozapine, which is registered as Clozaril. It has been touted as the best antipsychotic drug ever to be used. However, its use comes with severe side effects to the user of the drug with the development of agronulocytocis, which is a condition that diminishes white blood cells thus reducing the individual’s immunity. Risperidone is another drug that can be used to treat psychosis, which in this case is schizophrenia. The drug has fewer side effects compared to Clozapine. However, it is not as effective as Clozapine. Olaza pine is another antipsychotic drug that works like Risperidone but not as effective as Clozapine (Meltzer, 2002, p. 280). Many other drugs are still being developed. Thus, they are not yet in the market. On the other hand, other drugs that can be used in treating schizophrenia have been found to treat specific symptoms. Hence, they cannot be counted upon to treat other symptoms. This makes them less effective. Psychotherapy can also be used as treatment for schizophrenia in some cases through rehabilitation of the individual, family education, individual psychotherapy, and self-help groups. The use of psychotherapy can only be applicable in cases where the individuals respond to the treatment. The physician can only determine this treatment. Psychosocial therapy is mostly applied when the individual seems to have developed schizophrenia due to environmental influences. The Success of Treatment Options The success of treatment options for schizophrenia can only be stated in relative terms due to the manner in which the disease manifests itself and the stage the treatment for the disease has reached. So far, there is no cure for schizophrenia. The only available solution has been to tame the situation as the patient continues to use drugs. Many patients who have been diagnosed as suffering from schizophrenia have had to live with the condition for the rest of their lives because it is not curable (Sullivan, 2003, p. 1191). The only solution that most of them have had with this condition is that some cases have been able to have the condition suppressed for a longtime without them relapsing. This far is the closest to cure to which patients with schizophrenia can come close. The biggest challenge that remains is that the disease comes in many different forms with either individual symptoms or a combination of symptoms. This case is a challenge because the psychiatrist has to deal with individual symptoms as they try to sort them because each symptom has its own d rug. A mixture of some of the drugs used can be dangerous to the patient. Therefore, in most cases, the patient is treated for one condition at a time. The use of more effective drugs such as Clozapine has other devastating effects on the patient. The drug is overly effective in its application. However, its side effects are dangerous as well. For instance, patients under Clozapine need to have their blood tested very often to check the white blood cells count because the drug tends to diminish the white cells (Meltzer, 2002, p. 280). Inadequate white cells mean that the body’s immune system will be lowered because they are responsible for the immune system of the body. Success in treatment options can be described as successful in individual cases where the patient has responded positively to the treatment. This varies with individual cases because there are those patients who will respond positively to the therapy while there are those who will not respond at all. Treatment of schizophrenia starts with a trial-and-error mode as the physician tries out different treatment plans for the individual. It takes some time before the physician figures out the exact plan for an individual patient. At the end of the day, the plan might work or fail (Daly, 2013, p. 750). Treatment options offered so far can be deemed successful as far as offering the best they can because that is the best that the industry can offer. They have been known to control the disease in an individual successfully. The only point that should be noted is that the disease never goes away and that the patient has to be on the lookout in case they relapse. This will force them to go back to treatment. On the other hand, some patients might have to be fully dependent on the drugs for them to behave normally because they might not look properly wired without the drugs. Whereas treatment has worked in some cases, it has failed completely to work for some patients in some other cases (Meltzer, 2002, p. 280). In these instances, patients have had to be confined in facilities that will allow them to be taken care of, or they have to be heavily sedated as a way of keeping them calm. These two methods can be punitive to the patient. However, at the same time, they can be the only available solutions to them. Conclusion Schizophrenia as a mental disorder continues to pose challenges to the medical world on the best solutions that can be found to take care of it. The challenge of finding its main cause remains large because there is still no solution ahead with the present-day technology. The complexity of the problem has made it worse by complicating its description in that it cannot be described by one or two words. So far, the only hope of finding the main cause of the problem lies with finding the exact genetic connection as well as the environmental connection to the problem. Reference List Daly, M. (2013). Genetics connection In Schizophrenia. Nature Genetics, 45(7), 715- 841. Lilienfeld, S. et al. (2010). Psychology: A Framework for Everyday Thinking. London: Pearson Publishers. McGlashan, T. (1988). A Selective Review of North American Follow Up Studies of Schizophrenia. Schizophrenia Bullettin, 14(4), 515-542. Meltzer, H. (2002). Suicidality in Schizophrenia: A Review of the Evidence for Risk Factors Treatment Options. Current Psychiatry Reports, 4(4), 279-283. Sullivan, P. (2003). Schizophrenia as a Complex Trait Evidence from a Meta-Analysis of Twin. Jama Psychiatry, 60(12), 1187-1192. This research paper on What is Schizophrenia? was written and submitted by user Duncan Mccall to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Alarm Fatigue in Nursing Essay Sample

Alarm Fatigue in Nursing Essay Sample Alarm Fatigue in Nursing Essay Example Alarm Fatigue in Nursing Essay Example It is becoming increasingly difficult to ignore the fact that a sphere of healthcare and nursing requires a significant attentiveness regarding patients and related operations. Still, human errors cannot be fully avoided. Hence, such phenomenon as alarm fatigue may occur in many fields of human activity, especially in the sphere of healthcare. Needless to say, reaction on various alarming signals is an average activity for healthcare workers, but there is the most threatening implication. In fact, constant and frequent reaction on alarms makes a human-being less sensitive to them. Thus, such problem requires an adequate addressing. Alarm fatigue is caused by a wide range of factors so that there is no distinct methodology concerning the issue. That is why a middle range theory is suggested for methodological basis for dealing with alarm fatigue as long as it integrates theoretical knowledge and empirical evidence. Taking such point into account, the following paper focuses on the dis cussion of middle range theory appliance to a case of alarm fatigue in nursing. The Dangers of Alarm Fatigue To speak about the problem, it should be admitted that it is a so-called phenomenon named alarm fatigue. The phenomenon can be described as a loss of sensitivity to alarms, threats and any other warning signals due to a frequent and regular perception of them. Contextualizing the problem in terms of nursing, it is to be said that the problem is mainly connected to the healthcare personnel. Nurses and other staff become adjusted to their workplace environment to the extent that they start paying less attention to changes in patients’ state, their complaints, data demonstrated by measurements and medical equipment, special requirements to the patients’ condition, etc. It can be explained by the fact that healthcare staff members face such aspects on a day-to-day basis. Psychologically, such irritators become less influential, since the personnel members have acquired them as usual events in their daily routines. As a result, a loss of sensitivity may lead to worsening of the patients’ state. Moreover, it will be difficult to restore the same sensitivity again because it will be a conscious focus on a certain aspect. Consequently, the problem has to be addressed and it is suggested to apply a middle range theory to it. It is necessary to be explicit about what is meant by the term of middle range theory. Current theory is based on the integration of theoretical knowledge and empirical evidence so that a related activity addresses real cause of the problem. It is not tied to any certain framework but creates orienting statements, which are utilized as the basis for the further empirical activity. Applying middle range theory to the case means its implementation in a form of theory of meaning. Such nursing theory suggests that a patient has to understand meaning of his or her treatment in order to feel motivated and positive regarding recovery (Liehr Smith, 2014). The case of alarm fatigue, however, presupposes appliance of the theory directly to a nurse or any other representative of healthcare personnel. Such individual has to be careful about patients’ state, their complaints and all data related to the patients in order to react immediately in case any emergency occurs. The conviction rel ates to the professional duties of the individual. In case he or she fails, a threat to lose the job can emerge. Employment is commonly associated with personal well-being so that the individual will be as careful as possible. One may argue that it is cynical to address alarm fatigue from that point of view, but consideration of personal well-being is one of the primary human instincts, to which the theory of meaning can be applied. The choice of middle range theory can be explained by the fact that it addresses not only a distinct sphere of human activity by considers the related fields and disciplines. The theory has its origin in sociology. Robert K. Merton was attempting to integrate social theories of conflict and functionalism. As a result, middle range theory places a subject at medium range towards every single aspect of human activity and knowledge. In other words, a problem is focused on consideration of the entire variety of perspectives. Therefore, such approach allows healthcare personnel to base any professional theories with consideration of non-healthcare factors. In such way, the theory addresses practice and is applicable to the entire discipline of healthcare and nursing, since every single case can be regarded as unique. What is more, alarm fatigue is a common problem among healthcare staff members so that appliance of middle range theory can contribute much to the nursing practice, especiall y in regard to the fact that nursing and social theories are mutually connected. With regard to the previous evidence of appliance the theory to nursing, it was generally applied in terms of meaning theory. However, it was directed towards patients in cases of loss intention, motivation and carefulness concerning the treatment. As a consequence, absence of communication with nurses and other staff members could be observed in such sort of cases. It led to the complications concerning treatment and worsening of the patients’ state. Thus, middle range theory suggested strategies of conviction a particular patient to cooperate with healthcare staff. The theory considered personalities of the patients as long as the majority of deviations from treatment course are caused by traits of character or psychological condition of a patient. Middle range theory helped create basis for motivation and cooperation of a patient. Further, his or her participation in personal treatment was highly appreciated by healthcare staff. It is a crucial point, since a patient should feel his or her contribution regarding the treatment. As long as middle range theory is applied to the exact representative of healthcare personnel, it should be admitted that such individual motivated himself by the previously outlined sequence of statements regarding professional obligation and consideration of personal well-being via obtaining a job position at a healthcare organization. As a result, the individual paid attention to all evidences, which can be related to his patients. In such way, a possibility of developing alarm fatigue was definitely low. It can be explained by the fact that the individual kept all evidences and data recorded. Moreover, statistical data was compared to previous recordings. In consequence, potential development of tendencies was also forecasted (Liehr Smith, 2014). Conversely, the addressing of alarm fatigue does not mean excessive anxiety concerning missing signals of threat. It is important not to demonstrate any anxiety in presence of a patient in order to avoid psychological traumas. Our SamplesThe best way to know how to write good essays is by getting a sample of an essay from competent experts online. We can give you the essay examples you need for future learning. Free Essay Examples are here. Consequently, current paper has touched upon the discussion of appliance middle range theory to the problem of alarm fatigue. Alarm fatigue is a phenomenon, which is based on the loss of sensitivity to alarms, signals and any other important events due to their frequent and regular perception. Alarm fatigue occurs in healthcare quite often so that it requires an appropriate addressing. In consequence, middle range theory has been suggested in terms of nursing theory of meaning. Such complex has been suggested for motivation of healthcare staff representative in order to be careful regarding the patients’ state, complaints and any other related data. The motivation has been formulated on the basis of professional duty obligations and considerations of personal well-being.

German paper 3+4 Essay Example | Topics and Well Written Essays - 500 words

German paper 3+4 - Essay Example He was consistent with conventional history when he said that after the US joined the war, Germany was defeated. But what conventional history did not say, which he said was that the Germans blamed Zionist Jews for the entry of the US, thus their defeat (Freedman, par.24). This he said was the root of German discrimination against Jews which was indeed justified. If what he said was true, was conventional history then wrong in saying that the Germans at that time were envious of the economic success of Jews? Was it wrong in saying that the Germans were blaming their difficulties on the Jews because the Jews were in control of media and a lot of the industries then? As an aside, Freedman also said that â€Å"Jews happened to be maybe 98 percent of the Communists in Europe at that time† (Freedman, par. 26).† Unbelievable! To fight back, the Jews declared war on Germany (Daily Express, p.1). It called on Jews all over the world to boycott all products made in Germany. Germa ny depended a lot on its exports. By declaring economic and financial war, its aim was to hurt Germany economically, starve its people, and compel Germany â€Å"to end its campaign of violence† against Jews (Daily Express, par. 7).

Auditing and assurance Essay Example | Topics and Well Written Essays - 3250 words

Auditing and assurance - Essay Example Therefore, this report will discuss the background of the financial crisis and the proposals tabled by the commission. 1. Background of the financial crisis The financial crisis started in the year 2007 and spread with intense in 2008 despite of the central banks and regulators effort to calm it down (Merkel, 2012). In early 2009, the global economy was experiencing recession and the only way out was to focus was on preventing the downtown from prolonging to a great depression. The root causes of the financial crisis had to be looked into so as to take a cause of action (Se Hoon et.al 2008). Everyone one was responsible for the financial crisis from the government, auditors, credit agencies, banks and the public. But most of the causes originate from banks and financial institutions since they are responsible for regulating monetary policies and financial stability. Banks and other financial intermediaries play a critical role in the financial system thus it is vital to understand th eir role (Allison 2012). For instance, they respond to contagion meaning that one shock can affect a wide area. Therefore, if a shock is experienced by the banks, then the whole financial sector will experience the same impact. According to Allen (2001), a study conducted shows that when banks are have different network structures, they likely respond to contagion. Diamond (1996) points out those banks insure against liquidity shocks by having their interbank deposits exchanged. As a result, swapping of deposits exposes the banking system into contagion. This means that if the banks are secure from liquidity, then the financial sector is also safe. Therefore, we can say that banks responded to contagion during the financial crisis and as a result the global economy was affected (Se Hoon et.al 2008). Banks eliminate information problems between investors and borrowers by monitoring and ensure that depositors’ funds are in proper use. Secondly, they spur up economic growth. The y also provide intertemporal smoothing of non-diversifiable risk at a given time as well as insuring depositors against consumption shocks. Moreover, the origin of the crisis is believed to be in U.K and in U.S. In the financial system, lenders of money include households and firms while borrowers include firms, governments and households. Lenders supply funds to borrowers in two ways. To begin with, lenders supply money through the financial markets. Secondly, through which lenders supply money is through financial intermediaries such as the banks, mutual funds, market funds, pension funds and insurance companies. The bank relaxed the lending policies by reducing the interest rates and as a result many borrowers were attracted. In U.S mortgage lending rates were relaxed and also in U.K by the Bank of England. The housing prices rose and then began to fall to unsustainable levels as a result of the abundant credit and as a result the housing bubble came into the scheme (Calvo 2009). The decline in the value of houses made borrowers to default their mortgage loan payment. The U.S public debt which forms 100% of its GDP was also another contributor of the financial crisis. Other countries such as Japan and china run surpluses. Investigations show that many banks had an

Lean Manufacturing | Literature Review

Lean Manufacturing | Literature Review Since the 1980s, numerous businesses in various sectors of industry have continually been introducing programs intended to improve both productivity and quality. Several authors have posited lean manufacturing or lean production as the best possible production system and one that can be implemented in any industry and any process (Bonavia and Marin, 2006 and Lee-Mortimer, 2006). Doolen and Hacker (2005) mentioned that different researchers have explored the portability of lean practices both within and between different manufacturing sectors. In accordance, a variety of surveys conducted in different types of industry (Soriano-Meier and Forrester, 2002, Bonavia and Marin, 2006, Doolen and Hacker, 2005, Sà ¡nchez and Pà ©rez, 2001 and Taj, 2008) proved that lean is widely successful in a variety of industrial sectors. However, there are two problematic issues regarding lean manufacturing have been addressed in several studies. First, Shah and Ward (2007) claimed that any discussion of lean production points to an absence of common definition of the concept. Likewise, Pettersen (2009) alleged that there is no agreed upon definition of lean that could be found in the literature. Papadopoulou and ÃÆ'-zbayrak (2005) declared that there is no consensus in different researchers perceptions to the concept of lean which leads to conflicting results in identifying and classifying its practices and techniques. Second, there is conflict in using terms such as elements, principles, constructs, techniques and practices. Papadopoulou and ÃÆ'-zbayrak (2005) mentioned that some of the elements of lean are actually referring to the goals and objectives rather than techniques or tools (e.g. elimination of waste, lead time reduction) and, in addition, a number of other best manufacturing practices (such as agile manufacturing) were used in literature as lean practices. Moreover, Shah and Ward (2007) underscored that identical items are used to operationalize vastly different concepts and different items are used to operationalize the same construct. Thus, Shah and Ward (2007) argued that a great source of confusion and inconsistency associated with lean is the more substantive disagreement about what comprises lean production and how it can be measured operationally. Statement of the problem The above mentioned issues revealed three confusions surrounding the lean concept in literature, which are (1) the lack of a consistent definition of lean, (2) the disagreement about the elements that comprise lean manufacturing and (3) the lack of a measurement tool for assessing changes towards lean implementation. With the aim to clarify and resolve these confusions, this chapter has three main objectives; (1) to propose a conceptual definition of the term lean manufacturing that captures all its main facets, (2) to provide a framework that identifies its major elements and practices, and (3) to develop an operationalized model to assess changes towards lean manufacturing implementation. To achieve these objectives, an in-depth literature review is conducted regarding the topic of lean manufacturing. At first, the concept of Lean and its main principles are introduced. Next, the elements of lean manufacturing and the practices for lean implementation will be investigated. Finally, different indicators that measure the progress achieved towards lean are explored. The concept of Lean Lean was associated with the practice of deciphering the value added activities from those that are waste in an organization and its supply chain (Comm and Mathaisel, 2005). Motwani (2003) declared that companies need to focus on each product and its value stream in order to distinguish between wasted activities and that actually create value. Moreover, Papadopoulou and ÃÆ'-zbayrak (2005) stated that leanness was introduced as an approach to manufacturing that was aiming at the elimination of waste while stressing the need for continuous improvement. However, lean manufacturing is much more than a technique, it is, in addition, a way of thinking (Taj, 2008). The issue of lean thinking was widely discussed in different researches. Comm and Mathaisel (2005) believed that lean thinking removes the traditional way people think about roles and responsibilities through remaining focused on the customer and the core competencies that the customer values from an organization. Therefore, Bhasin and Burcher (2006) claimed that for a successful implementation, numerous cultural changes are required for embracing empowerment and disseminating the lean principles through-out the value chain. Similarly, Taj (2008) confirmed that lean as a way of thinking creates a culture in which everyone in the organization continuously improve operations. In accordance, Comm and Mathaisel (2000) introduced leanness as a philosophy that intended to significantly reduce cost and cycle time throughout the entire value chain while continuing to improve product performance. Hence, lean should be described from two points of view; the philosophical perspective and the practical perspective (Shah and Ward, 2007). From the philosophical perspective, lean is viewed as an overall organizational philosophy that should affect the people way of thinking and behaving (Papadopoulou and ÃÆ'-zbayrak, 2005 and Bhasin and Burcher, 2006). This philosophy drives the guiding principles and the overarching goals of lean (Shah and Ward, 2007). On the other hand, the practical perspective see lean as a set of management practices, tools and techniques (Shah and Ward, 2007) that are used to apply the philosophy and to achieve the goals (Bhasin and Burcher, 2006). This two-perspective view of lean is supported by the definition of lean as a socio-technical system. Such system combines both technical system; i.e. technology and social system; i.e. people and organizational structure (Bhasin and Burcher, 2006). In the same context, Shah and Ward (2007) asserted that to pursue lean production, firms have to effectively manage their social and technical systems simultaneously. Moreover, Cua et al. (2001) proved that joint optimization of both socially- and technically-oriented policies or practices is necessary for achieving good results. Regarding its implementation, Panizzolo (1998) demonstrated that the wide range of lean practices are related to interventions in the manufacturing area, actions taken in other areas of the firm (design, HR, strategy, etc.) and relationships with both suppliers and customers. Likewise, Shah and Ward (2003) stated that lean should be seen as a multi-dimensional approach that encompasses a wide variety of management practices. This conceptualization of lean as multidimensional strategy is supported by a wide range of researchers (Doolen and Hacker, 2005, Karlsson and Ã…hlstrà ¶m, 1996, Shah and Ward, 2007 and Papadopoulou and ÃÆ'-zbayrak, 2005). However, it is well accepted among researchers that lean should be implemented as an integrated system (Shah and Ward, 2007, Bhasin and Burcher, 2006, Karlsson and Ã…hlstrà ¶m, 1996 and Papadopoulou and ÃÆ'-zbayrak, 2005). Shah and Ward (2007) suggested that a well-developed lean strategy implementation will require firms to exert considerable effort along several dimensions simultaneously. Bonavia and Marin (2006) concluded that there are only few relationships between the degree of use of lean production practices individually and operational performance (in terms of productivity, quality, lead time and inventory). In the same vein, Shah and Ward (2003) provide unambiguous evidence that the synergistic effects of all lean practices are associated with better manufacturing performance. Another feature of lean manufacturing that was emphasized in literature is its time-frame of implementation. Bhasin and Burcher (2006) and Doolen and Hacker (2005) believed that lean is a long-term multidimensional organizational strategy. Papadopoulou and ÃÆ'-zbayrak (2005) affirmed that transformation to lean requires a lot of effort, time and participation of all organization levels in addition to make changes in company culture and organizational structure. Thus, lean enterprises should continuously find ways to eliminate consumption of resources in their struggle to deliver value to their customers. In correspondence, the implementation of the lean program in the case study discussed in (Lee-Mortimer, 2006) proved that lean is not just a project, it is a long-term continuous journey which is implemented as a sequence of stages or projects. In conclusion, lean manufacturing embraces different features that should be taken into consideration when defining this concept. Lean should be viewed as a philosophy, affecting company culture, rather than a set of tools/techniques. This, in turn, reveals the importance of managing social system as well as technical system simultaneously. Moreover, lean implementation scope is not confined to the manufacturing function of a company, rather it relates to all functions ranging from product development, procurement and manufacturing over to distribution. Since lean companies seek to deliver value to their customers, this value should be predefined and delivered, while waste, which customers are not willing to pay for, should continuously be eliminated. All the aforementioned features of lean manufacturing can be captured in the following proposed conceptual definition. Lean manufacturing is a philosophy and a long-term strategy that is applied through a socio-technical system integrating all functions within the organization with the aim of continuous waste elimination while delivering outcomes that meet continuously predefined customer value. Lean principles Lean philosophy is mainly based on the principle of eliminating waste. Waste is anything other than the minimum amount of equipment, materials, parts, and working time that are essential to add value (Taj, 2008, Bonavia and Marin, 2006 and Karlsson and Ã…hlstrà ¶m, 1996). Sà ¡nchez and Pà ©rez (2001) cited that the main goal of lean is to eliminate all activities that do not add value to the product. Value should be specified as it is perceived by customers (Andersson et al., 2006 and Dahlgaard and Dahlgaard-Park, 2006). If the task does not add value from the customers point of view, it should be modified or eliminated from the process (Andersson et al., 2006). It is believed that by minimizing waste and zero-value added activities, companies can reduce production costs and the overall production system will be more efficient (Comm and Mathaisel, 2005 and Karlsson and Ã…hlstrà ¶m, 1996). Since inventory is considered one of the critical sources of waste (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996), Dahlgaard and Dahlgaard-Park (2006) declared that the traditional way of producing in batches is inefficient as it requires goods to wait in inventories before the next production step is started up. Thus, Motwani (2003) mentioned that the value must flow to the customer without interruptions. Andersson et al. (2006) confirmed that focus should be on organizing a continuous flow through the production or supply chain rather than moving commodities in large batches. Closely related to the continuous flow is the principle of just-in-time (JIT), since the ultimate goal that every process should be provided with only one part at a time, exactly when that part is needed (Karlsson and Ã…hlstrà ¶m, 1996). Moreover, if continuous flow is not possible (Lummus et al., 2006), the way of scheduling the flow of material should be pull instead of push (Motwani, 2003 and Dahlgaard and Dahlgaard-Park, 2006). This means that customer demand should pull finished products through the system with the aim of not carrying out any work unless the result of it is required downstream (Andersson et al., 2006). It is obvious that to succeed in the implementation of any modern system, everyone from top management to any lower level should make sincere efforts, and set their goals jointly through active participation and understanding (Ahmed et al., 2004). According to (McKone et al., 1999), employees can contribute significantly to the organization when they are allowed to participate in decisions that impact their area of responsibility. As a result, involvement from all employees allows companies to better use of its available resources (McKone et al., 1999). This principle reflects the conceptualization of lean manufacturing as a socio-technical system, since it highlights the importance of managing social system as well as technical system. Since lean is viewed as a long-term strategy, lean philosophy emphasizes continuous improvement. Several researchers (Karlsson and Ã…hlstrà ¶m, 1996, Comm and Mathaisel, 2005 and Sà ¡nchez and Pà ©rez, 2001) affirmed that one of the most fundamental principles of lean is the search for continuous improvement in products and processes. Lummus et al. (2006) mentioned that processes should be managed towards perfection to continuously reduce the time needed to serve the customer. Likewise, Andersson et al. (2006) underscored that the elimination of non-value-adding elements (waste) is a process of continuous improvement. In this context, Sà ¡nchez and Pà ©rez (2001) highlighted the importance of employees involvement and top management support to create and train improvement teams that lead the organization to move toward zero defects. Based on the analysis of lean previous studies, it is concluded that there are five key principles / overarching goals which can be considered the bases for the lean philosophy. These principles are; (1) waste elimination, (2) customer value identification, (3) continuous production flow, (4) employees involvement and (5) continuous improvement. Furthermore, the aforesaid lean principles confirm some issues in the proposed conceptual definition. The unambiguous believe that elimination of waste is the fundamental goal is affirmed since lean is regularly defined as manufacturing without waste. Likewise, identifying value as perceived by customer is asserted in the proposed definition. Moreover, seeking continuous improvement as a principle of lean philosophy reflects the long-term nature of lean implementation. Thus, the proposed definition stresses the aim of continuous waste elimination and highlighted the need to continuously predefine customer value. Also, the importance of employ ees involvement emphasizes the social phase of the lean system as a socio-technical system. Finally, holding in mind these principles / goals underscores the view of lean as a philosophy that affects the people way of thinking. Lean implementation framework Previous studies concerning lean manufacturing revealed a number of manufacturing practices that are commonly associated with lean implementation. The initial step towards developing a framework for lean implementation is to capture different practices and combine them into inter-related groups in accordance to the multi-dimensional nature of lean manufacturing. The term practices in this context refers to the predominant methodologies that may include many techniques and tools. Shah and Ward (2003) identified and empirically validated combining lean practices into four specific lean bundles: namely Total Quality Management (TQM), Just In Time (JIT), Total Productive Maintenance (TPM) and Human Resources Management (HRM). Bonavia and Marin (2006) found enough agreement in literature to identify the first three bundles; TQM, JIT and TPM, while Cua et al. (2001) are of the opinion that human and strategic-oriented practices are common practices that support all other three bundles. Although there is general agreement within operations management literature that JIT, TPM, TQM and HRM are conceptually, theoretically, and empirically well established (Shah and Ward, 2003), there is no unanimous classification of the lean manufacturing practices that make up each of the four bundles (Bonavia and Marin, 2006). Therefore, in an attempt to provide a framework for lean implementation comprises the actual practices that represent each of the four mentioned bundles, the basic theme of these bundles are identified. Then, different lean practices are combined into each of these bundles based on reviewing different research papers regarding lean implementation practices, in addition to articles that were focused mainly on one of these bundles. TQM bundle Lack of quality is a major source of waste, since the defective parts and products that need to be reworked or scrapped do not add any value to the customer and should be eliminated in order to attain high productivity (Karlsson and Ã…hlstrà ¶m, 1996). Sà ¶derquist and Motwani (1999) underscored that quality should be a top management issue and continuous improvement efforts together with the zero error objective should be company-wide and extended over company limits in production chains. Cua et al. (2001) defined total quality management (TQM) as a manufacturing program aimed at continuously improving and sustaining quality products and processes by capitalizing on the involvement of management, workforce, suppliers, and customers, in order to meet or exceed customer expectations. Sà ¶derquist and Motwani (1999) emphasized that TQM approach is the philosophy that should underpin the quality project in a lean company. The practices combined to form the TQM bundle include; product quality control, visual management (Cua et al., 2001, McKone et al., 1999 and Sà ¶derquist and Motwani, 1999), process management (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), product design and development (Cua et al., 2001 and Sà ¶derquist and Motwani, 1999), standardization (Sà ¶derquist and Motwani, 1999), suppliers quality management and customers involvement (Cua et al., 2001 and McKone et al., 1999). JIT bundle Just-in-time philosophy means to deliver the right part in the necessary quantity and at the right time (Canel et al., 2000, Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Ahmed et al. (2004) defined JIT as a philosophy and system concept of doing, maintaining and producing what is value adding or what is just needed, be it raw materials, components, parts, WIP, employees, or finished products. Cua et al. (2001) asserted that the primary goal of JIT, as a manufacturing program, is continuously reducing and ultimately eliminating all forms of waste through JIT production and involvement of the work force. JIT basic techniques include set-up time and lot size reduction, pull production systems (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), equipment layout and cellular manufacturing (Shah and Ward, 2003 and Cua et al., 2001), production leveling and scheduling and JIT delivery by suppliers (Cua et al., 2001 and McKone et al., 1999). TPM bundle It has been accepted beyond any doubt that maintenance, as a support function in businesses, plays an important role in backing up many emerging business and operation strategies like lean manufacturing (Ahuja and Khamba, 2008b). Without having a productive maintenance system, lean production, just-in-time (JIT) or total quality management (TQM) environment cannot be attained (Ahmed et al., 2004). TPM is a proven and successful procedure for introducing maintenance considerations into organizational activities (Eti et al., 2004). Ahuja and Khamba (2008b) stated that TPM is a methodology originating from Japan to support its lean manufacturing system, since dependable and effective equipment are essential pre-requisite for implementing lean manufacturing initiatives in the organizations. Cua et al. (2001) and Shah and Ward (2003) defined TPM as a manufacturing program designed primarily to maximize equipment effectiveness throughout its entire life through the participation and motivation of the entire work force for performing planned predictive and preventive maintenance of the equipment and using maintenance optimization techniques. TPM, according to McKone et al. (1999), provides a comprehensive company-wide approach to maintenance management which is usually divided into short-term and long-term elements. In the short-term, TPM basic practices include; industrial housekeeping, autonomous maintenance (Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999), and planned preventive and predictive maintenance (Shah and Ward, 2003, Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999). In the long-term, TPM efforts focus on new equipment and technology acquisition (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999). HRM bundle Human resources have a critical role in carrying out the continuous improvement plans which are the basis for success in lean implementation (Panizzolo, 1998). Eti et al. (2004) claimed that the degree of employees eagerness to embrace change determines the rate of progress towards that goal. Moreover, McKone et al. (1999) declared that employees are the greatest sources of information for companies to improve their performance. Shah and Ward (2003) affirmed that the HRM bundle has significant theoretical and empirical support. The most commonly cited HRM practices are employees involvement (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), multi-skilled workforce, multi-functional work teams (Shah and Ward, 2003), education and training (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), performance-based compensation system (McKone et al., 1999) and information and feedback (Cua et al., 2001 and McKone et al., 1999). Lean operationalized model Traditionally, managers have relied heavily on accounting metrics to determine efficiency, such metrics reflect the final state achieved as the result of a long chain of decisions (Taj, 2008), while lean should be seen as a direction rather than a state to be reached after a certain time (Karlsson and Ã…hlstrà ¶m, 1996). Therefore, managing a lean factory requires key information to assess the changes taking place in the effort to introduce lean (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Consequently, in order to develop an operationalized model for lean manufacturing, the aforementioned bundles and practices will be discussed with focus on identifying the indicators that can be used in assessing changes towards lean implementation. It is important here to note that the focus lies on the changes in these indicators, not on their actual values. So, the desired direction of each indicator, if moving in a lean direction, will be also specified. Measurement of TQM basic practices Since the ultimate goal of TQM practices is to achieve zero defects, Motwani (2001) mentioned that the percentage of defects (TQM1) and the percentage of products needing rework (TQM2) are among the common quality outcome indicators employed by several researchers. Product quality can be controlled through the involvement of production line workers for identification and adjustment of defective parts and their authority to stop lines when defective parts are found in order to avoid any defective parts moving to the next production stage (Karlsson and Ã…hlstrà ¶m, 1996). Thus, Sà ¡nchez and Pà ©rez (2001) used the percentage of defective parts adjusted by production line workers (TQM3) as an indicator of transferring the responsibility for products quality from the quality control department to the line workers. In addition, Karlsson and Ã…hlstrà ¶m (1996) alleged that the number of quality control personnel (TQM4) and the size of repair area (TQM5) can be reduced as a consequence. Furthermore, Karlsson and Ã…hlstrà ¶m (1996) declared the use of autonomous defect control (poka yoke) as inexpensive means to help conducting inspection of all units with the ultimate goal of zero defects. Therefore, the percentage of inspection carried out by autonomous defect control (TQM6) is a common measure (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Visible graphs and panels are used to gather performance data, to plot different measurements and to identify specific problems and causes of delay in order to take efforts for resolution (Lee-Mortimer, 2006 and Bonavia and Marin, 2006). For this, Bonavia and Marin (2006) measured the percentage of work areas where visible graphs panels are used (TQM7) as an indicator for visual management. In addition to controlling products quality, process management is essential to obtain fault free parts and products from the very beginning (Karlsson and Ã…hlstrà ¶m, 1996). Cua et al. (2001) emphasized the use of Statistical Process Control (SPC) techniques in monitoring processes to ensure that each process will supply defect free units to subsequent process. Shah and Ward (2007) and Bonavia and Marin (2006) measured the percentage of equipment / processes under SPC (TQM8) as an indicator to represent the expansion of using SPC. Panizzolo (1998) emphasized the attention that has been devoted to the relationships between product development and manufacturing activities. Sà ¶derquist and Motwani (1999) claimed that design for manufacturing through integrating product and process engineering is one of the core features of quality management within the lean production framework. Thus, the percentage of parts designed by cross-functional teams (TQM9) can be used as a measure for this practice. In addition, Sà ¡nchez and Pà ©rez (2001) mentioned the use of common parts (TQM10) to manufacture different products as a technique used to reduce inventory and lead times as well. Moreover, participation of suppliers in the design stage (TQM11) facilitates manufacturing of components they have designed. Standardization is an essential principle of lean manufacturing that involves establishing the sequence of tasks to be done by each worker and how those tasks are done (Olivella et al, 2008), measuring and comparing the cycle time against the required takt time (Motwani, 2003) and specifying procedures, tools and materials (Bonavia and Marin, 2006). The percentage of procedures which are written recorded (TQM12) is the measure used by Sà ¡nchez and Pà ©rez (2001) and Bonavia and Marin (2006) to quantify the extent to which the company standardize its operations. Several researches emphasized the significant role that suppliers can play when involved in quality improvement programs (Panizzolo, 1998, Shah and Ward, 2007, Papadopoulou and ÃÆ'-zbayrak, 2005 and Motwani, 2003). In order to enhance suppliers involvement, Sà ¡nchez and Pà ©rez (2001) stressed the importance of information exchange with suppliers through conducting visits by engineers and technicians from both sides and interchanging documents. This will help to reduce inefficiencies and eliminate activities that are not value added (Sà ¡nchez and Pà ©rez, 2001). This practice is measured by two indicators; the frequency of visits between companys and suppliers technicians (TQM13) and the number of suggestions made to suppliers (TQM14) (Sà ¡nchez and Pà ©rez, 2001). With the focus on customers and their needs, Motwani (2001) declared that customer service programs should include quick responsiveness to complaints and maintaining a corporate goal to reduce the quantity of complaints (TQM15). Furthermore, Panizzolo (1998) affirmed that customer-driven enterprises dedicated much attention to organize customer participation in design, manufacturing and delivery activities. Thus, Bhasin and Burcher (2006) considered the percentage of projects in which the customer was involved (TQM16) as a signal of the systematically and continuously focus on the customer. In conclusion, table 3.1 summarizes the indicators developed to assess changes towards implementing the previously discussed TQM practices. Measurement of JIT basic practices Several authors (Sà ¡nchez and Pà ©rez, 2001, Karlsson and Ã…hlstrà ¶m, 1996, Lee-Mortimer, 2006 and Salaheldin, 2005) have proposed the value of WIP (JIT1) and the lead time to customer order (JIT2) as common indicators of JIT implementation. Moreover, Motwani (2003) and Bhasin (2008) affirmed that total product cycle time (total time that material spends in the production system) (JIT3) is the best measure for tracking lean progress. Reducing set-up times simultaneously with reducing lot sizes is a technique used to reduce inventories and also it contributes to the reduction of lead times (Sà ¡nchez and Pà ©rez, 2001) and increasing flexibility (Karlsson and Ã…hlstrà ¶m, 1996). The progress in this practice can be directly measured by two indicators; set-up times (JIT4) and production and delivery lot sizes (JIT5). Firms use pull production systems to facilitate JIT production with the aim to produce the kind of units needed, at the time needed, and in the quantities needed (Shah and Ward, 2007). Bonavia and Marin (2006), Cua et al. (2001), McKone et al. (1999) and Shah and Ward (2007) highlighted the use of kanban squares, containers or signals as a means to pull material from an upstream station and manage product flow. Karlsson and Ã…hlstrà ¶m (1996) argued that as the work with implementing pull system proceeded, the number of manufacturing stages producing against customer orders should extend. Accordingly, they considered the percentage of stages in the material flow that uses pull (JIT6) as a determinant of the change towards this practice. Cua et al. (2001) and McKone et al. (1999) emphasized the importance of equipment layout to facilitate low inventories (JIT1) and fast throughput (i.e. shorten lead time (JIT3)). Grouping machines together in a cell-based layout (Cellular manufacturing) is one technique that is developed to facilitate line balancing with the ultimate goal of creating single piece flow (Lee-Mortimer, 2006 and Motwani, 2003). Implementing cellular manufacturing technique helps to eliminate the frequency (JIT7) and physical distances (JIT8) of parts transportation (Karlsson and Ã…hlstrà ¶m, 1996) and to reduce the investments (JIT9) in handling systems (Sà ¡nchez and Pà ©rez, 2001). Panizzolo (1998) considered production leveling as a practice, in addition to small lots and pull control that is adopted to synchronize production and market demand. Thus, this practice contributes in achieving reductions in the value of WIP (JIT1) and the lead times to customer order (JIT2). Moreover, the synchronization between production output and market demand helps company to minimize finished goods inventory (JIT10). Suppliers are required to deliver the right quantity, at the right time, and at the right quality (Shah and Ward, 2007) in order to facilitate JIT production. Many researches agreed on the importance of reducing the number of key suppliers (JIT11) for the main components and engaging with them in long term contracts (JIT12) (Sà ¡nchez and Pà ©rez, 2001, McKone et al., 1999, Shah and Ward, 2007, Doolen and Hacker, 2005, Bhasin and Burcher, 2006 and Papadopoulou and ÃÆ'-zbayrak, 2005). Furthermore, the case study of (Comm and Mathaisel, 2005) highlighted how maintaining good relationships with suppliers helped to keep minimum raw material inventories (JIT13). In general, McKone et al. (1999) highlighted the importance of on-time delivery (JIT14) to customers as an indicator of the JIT concept implementation. Likewise, Bhasin (2008) mentioned measuring on-time delivery as one of the customer / market indicators of lean implementation. In the same vein, Motwani (2001) recommended monitoring the amount of lateness in orders delivery as a tool in measuring the spread of delivery time. Furthermore, since the change towards JIT production and delivery is made gradually (Sà ¡nchez and Pà ©rez, 2001), the proportion of products transferred just-in-time between production stages (JIT15) and that delivered just-in-time by suppliers (JIT16) should be measured. Table 3.2 summarizes the indicators developed to assess changes towards implementing the previously discussed JIT practices. Measurement of TPM basic practices It is agreed upon in literature that overall equipment effectiveness OEE ( Adaptive Immune Response: Case Study Adaptive Immune Response: Case Study Adaptive Response Abstract Adaptive immunity is an important part of the immune system. It is the third line of defense in the human body, which includes highly specialized systemic cells and processes that eliminate or prevent pathogenic growth. Once external barriers have been compromised and inflammation (innate immunity) has been activated, the adaptive response is called into action (Huether McCance, 2012). It develops slower than the innate inflammatory response and is specific—unlike inflammation, which is non-specific—and has immunological memory that recognizes each pathogen by a signature antibody (Huether McCance, 2012). In addition, the activated B cells and T cells can develop to memory cells that respond rapidly and efficiently to a subsequent encounter with a pathogen. Adaptive immunity response primary obligation is destroying infectious agents that are resistant to inflammation and provides long-term protection against future exposure to the same agents (Huether McCance, 2012) . Adaptive Response The adaptive response consists of an antibody response and cell-medicated response, which are carried out by different lymphocytes cells, B cells and T cells respectively. B cells (B indicates bone marrow) are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph, where they have capacity bind to almost any foreign antigen found in the environment (Huether McCance, 2012). Binding of antibody inactivates virus and microbial toxins by blocking their ability to bind to receptors on host cells. Antibodies, also known as immunoglobulin, are large Y shaped proteins, which are typically composed of two large heavy pair chains and two small light chains (Huether McCance, 2012). There are five types of immunoglobulin: IgA, IgD, IgE, IgG, and IgM, which are characterized by differences in structure and function, each has evolved to handle particular antigens (Huether McCance, 2012). The antibody responses are also called humoral immunity. Another ad aptive response is known as cell-medicated immunity responses that activate T cells to combat against a foreign antigen presented on the surface of a host cell. Also, T cells produce signal molecules that trigger macrophages, natural killers (NK), antigen specific cytotoxic T-lymphocytes, and release of various cytokines in responses to an antigen (Huether McCance, 2012). The purpose of this paper is to explain pathophysiology of disorders presented in the scenarios, including associated alterations, and adaptive responses to the alteration as well as construct a mind map for the selected disorder. Furthermore, consider the epidemiology, pathophysiology, risks factors, clinical presentation, and diagnosis of the disorder and any adaptive responses to alteration. Scenario 1: The first scenario the patient’s mother mentioned that Jennifer is usually healthy and has no significant medical history. However, physical examination revealed clinical manifestations, which include fever; tympanic membranes slightly redden on the periphery, throat erythematous with 4+ tonsils and diffuse exudate; anterior cervical nodes palpable and tender to touch. The child indicated throat hurts and painful to swallow. Vital signs reveal increased temperature, pulse and respiratory rate that suggested tonsillitis disorder. Pathophysiology Tonsillitis is an inflammatory condition of the tonsils due to bacteria, allergies or respiratory problems (Tonsillitis, 2014). When inflamed, tonsils become swollen and red with a grayish or yellowish coating on its surface. Tonsillitis usually begins with a sudden sore throat and painful swallowing. Tonsillitis causes tonsils and throat tissues to swell obstructing air from passing in and out of the respiratory system (Huether McCance, 2012). The tonsils infection is common in children under age six and teenagers but rare in adults. The adaptive response activates the different B cells and T cells lymphocytes to eliminate the alteration, so body can return back to hemostasis. Scenario 2: Pathophysiology Irritant contact dermatitis is a common nonimmunologically mediated inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, soap detergent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, epidermal cellular changes and cytokine release. Irritant contact dermatitis is a major occupational disease; skin disorders comprise up to 40% of occupational illness (Hogan Elson, 2013). Patient work history is crucial in making diagnoses, and appearance of the skin. It may be treated with topical agents such as corticosteroid skin creams, emollients or moisturizers to prevent further irritation (Hogan Elson, 2013). Scenario 2: The patient presented with redness and irritation of his hands. The history revealed no allergies or significant medical history except for recurrent ear infections as a child. He denied any unknown exposure to irritants. Also, patient admits to working in maintenance and often working with abrasive solvent and chemical. Normally he wears gloves, but this particular time the patient did not wear gloves. He exposed his hands to some cleaning solutions. The patient’s detailed history and clinical manifestations led the student to a diagnosis of irritant contact dermatitis. Pathophysiology Stress is any situation that results in a reaction of the human body called the stress response (Huether McCance, 2012). The stress response is a set of adaptations that are mobilized throughout the body to correct state of allostatic imbalance. This involves a fairly stereotyped set neural an endocrine changes. A critical one is the secretion of catecholamines-epinephrine and norepinephrine from the nerve endings of the sympathetic nervous system projecting throughout the body (Huether McCance, 2012). Catecholamine induces vasoconstriction and increases in heart rate and blood pressure. It also increases the amount of nutrient and oxygen that is available to the muscle’s reaction during a stress response (Huether McCance, 2012). Another is secretion by the adrenal glands of a class of steroid hormones called glucocorticoids (GCs) ((Huether McCance, 2012). While there is an array of additional changes in levels of various hormones during stress (generally an increase in ci rculating levels of glucagon, prolactin, and beta-endorphin, decreases in insulin and reproductive hormones), secretion of GCs and the activation of the sympathetic nervous system constitute workhorses of the stress response (Huether McCance, 2012). Some common symptoms can include: increase heart rate, chest pain, poor appetite, depression, and insomnia. Usually, coping strategies are beneficial in helping individuals manage stress physical and psychological (Huether McCance, 2012). Adaptive responses help prepare the body for fight or flight by activating adaptive immunity response to correct imbalance. Scenario 3: The patient in this case study recently retired from her job as an administrative assistance at a local hospital. She does have a history of hypertensive, but controlled for years with medication. Patient reported having problem sleeping, occasionally rapid heart rate, and decrease appetite. She also mentioned her 87-year old mother moved in a few years ago after falling down a flight of stairs and broken her hip. Martha is taking care of her mother who requires enormous amount assistance with activities of daily living. She is worried about her own health at her age and sleep habits therefore clinical manifestations suggested stress disorder. Mind Map for Tonsillitis Disorder Epidemiology Irritant contact dermatitis is common in occupations that involve repeated hand washing or repeated exposure of the skin to water, food materials, and other irritants. High-risk occupations include maintenance, health care workers food preparation, and hairstylists (Hogan Elson, 2013). The prevalence of occupational hand dermatitis was found to be 55.6% in 2 intensive care units and was 69.7% in the most highly exposed workers. Irritant contact dermatitis is significantly more common in women than men. The high frequency of hand eczema in women in comparison with men is caused by environmental factors, not genetic factors. Pathophysiology Irritant Contact Dermatitis (ICD) is a common nonimmunologically mediated inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, soap detergent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, epidermal cellular changes and cytokine release hones naà ¯ve T- lymphocytes to the skin. Patients with altered barrier function are more prone to ICD. Risk factors People who work in occupational hazard environment and handles irritant such as cleaners, nurses, construction workers, mechanics, and agricultural workers are at risk for developing irritant contact dermatitis (Mayo Clinic, 2012). Another risk factor is younger workers often less experienced than their older colleagues or may have a more careless attitude about safety measures causing them to develop the disorder (Mayo Clinic, 2012). Clinical presentation Clinically, irritant contact dermatitis presents with scaly erythematous plaques, cracking of the skin, inflammation, dryness, and fissuring. It commonly involves web spaces that extend to the dorsal and ventral surface of the hand and fingers (Mayo Clinic, 2012). Vesicles do not typically form. Pruritus can be mild; however, stinging, burning and pain are frequently reported symptoms. Diagnosis Irritant contact dermatitis does not need a specific test because ICD can be diagnosed through clinical examination and a careful history. A clinical examination must include a careful look at the distribution of the dermatitis (palmar, dorsal, face, abdomen, web spaces, and fingernails) as well as the extension of dermatitis to wrists or forearms (Mayo Clinic, 2012). The history should include a questionnaire that addresses the individual name and address of the employer; the worker’s job’s title and a description of functions. The worker should provide a list of all chemicals handled and supply information about them, such as found on the Material Safety Data Sheets (MSDS) in order to provide an appropriate diagnosis (Mayo Clinic, 2012). Adaptive responses to alteration Harding or accommodation has been defined as the adaptation of the skin from altered local expression of multiple cytokines and inflammatory mediators with repeated irritation from skin irritants. Accommodated skin has a relatively thicker layer of stratum granulosum versus normal skin. Accommodated skin may exhibit a slight sheen and glossy appearance with a mild scale. On manipulation, there may also be a slight loss of elasticity (Huether McCance, 2012). Conclusion When successful, an adaptive immune response terminates infection and provides long-lasting protective immunity against the pathogen that provoked response. Adaptive immunity is an evolving process within a person’s lifetime, in which each infection changes the make-up of that individual’s lymphocyte population. Adaptive immunity is an evolving process within a person’s lifetime, in which each infection changes the make-up of that individual’s lymphocyte population (Huether McCance, 2012). These changes are neither inherited nor passed on but, during the course of a lifetime, they determine a person’s fitness and their susceptibility to disease. Failures to develop a successful adaptive response can arise from inherited deficiencies in the immune system or from the pathogen’s ability to escape, avoid, or subvert the immune response. Such failures can lead to debilitating chronic infections or death (Huether McCance, 2012). References Golden, S. Shaw, T. (2013). Hand dermatitis: Review of clinical features and treatment options. Retrieved from www.cutis.com/fileadmin/content†¦/SCMS_vol32_No3_Golden.pdf Hogan, D., Elston, D. M. (2013). Irritant contact dermatitis. Medscape. Retrieved from emedicine.medscape.com/article/1049353-overview Huether, S. E., McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby. Mayo Clinic. (2012). Tonsillitis. Retrieved from www.mayoclinic.org/diseases†¦/tonsillitis/†¦/con-20023538 Tonsillitis. (2014). In Encyclopedia Britannica. Retrieved from http://wwe.britannica.com/Ebchecked/topic/599370/tonsillitis

Fighting in Hockey

Still today, there is a continued debate on whether fighting should be allowed or banned in the National Hockey League (NHL). In generalization, most people see that physically fighting someone, fist-to-fist, is a negative conflict. However, in certain sports fighting is the main objective of the sport. For instance boxing, kickboxing, or the rising sport of UFC (Ultimate Fighting Championship). Then people look at NHL, and point out that fighting is not the main purpose or goal of the sport. People who disapprove of the fighting also believe that getting rid of the fights in hockey may draw in new fans. Fans that may see this newly constructed form of hockey as â€Å"family-friendly†. Although these people are trying to persuade the league into banning fights, there main focus as fans of the NHL, and maybe even the parents of the kids who play hockey, are to argue that fighting invokes a unsafe playing environment for the players, and also gives a bad national image to the sport of hockey and the good fundamentals of sportsmanship in general. Hockey may be a full contact sport, but many concerned people believe that banning fights in hockey leads to a safer environment for athletes to compete in, and can also have many other benefits to the sport. Although banning fights in the NHL may have its benefits, fighting should not be eliminated from the sport of hockey in the NHL because of the tradition it upholds, the loss of fans, the fact that hockey is already â€Å"physical† and entertains people. So why is the issue of hockey fights being debated in the NHL? It’s mainly due to the concern for the safety of the athletes, who by the way are professionals, which means that money is involved if injury was to occur. With economics being meshed into the issue, fighting becomes a huge reason why this topic is highly argued amongst the fans, players, general mangers, and even the team owners. With possible money issues and athlete injury risks on the line, why not just get rid of fighting now? EVIDENCE SECTION) In my major essay to counter act the fact that fights can lead to money loss due to the injury of a player, I will state that many people that watch the NHL are mostly intrigued and excited by the fights. According to the National Hockey League Fans Association (NHLFA) 91% of the fans oppose the full ban of fights in NHL games (www. nhlfa. com). So with the absence of fights in the NHL, there will be a loss of fans that watch the sport on television, and also a loss in attendance of fans at the sporting event. With less people interested of the sport, and less people watching the game either at home or at the event, there will be greater economic loss to a team with less revenue and income, than just losing a player for an amount of time. Another piece of evidence that will be brought in is the fact that fighting in hockey is a tradition. By removing fights, you are essentially removing a part of the sport itself. I will also mention that athletes who go into the profession of hockey realize that fighting is tolerated, and are aware of the risks. Not to mention it’s already a physical sport that involves a lot of risks. Back to fighting being a tradition of the NHL. Fighting has been tolerated for the NHL’s history of 94 years, but I must point out that it is penalized and regulated. So fight someone at the risk of your health, and the risk of your team winning the game. Another way to look at this is that fighting adds flare to the game. Kind of like how dunks in basketball adds flare. Essentially fighting and dunking are there to make the game more entertaining for its fans/audience, which means that if it’s more entertaining maybe a higher fan base can be achieve. Which of course leads to more money. It’s all about the money! (www. hockeyhistory. org) So why did I choose this topic and why is it an important issue? Personally I have never played hockey (competitively), but I am an avid sports fan and have seen some NHL games on T. V. I was watching ESPN one day and there was a debate on this issue between a hockey analyst and a former player and found the topic very interesting. This debate/topic is important because in the future if the rules of the game were to be changed, whether fighting stays or leaves, it could drastically change the sport itself, its fan base, and may even hurt the NHL greatly in an economic sense. Bibliography http://www. usatoday. com/sports/2004-09-02-pros-cons-fighting_x. htm http://sports. espn. go. com/nhl/columns/story? columnist=buccigross_john&id=2724254 http://www. nhl. com/ice/news. htm? id=413089 http://www. nhlfa. com/news/nr04_09_07. asp http://www. hockeyhistory. org/

Effects of Junk Food

Junk Food Sucks Eating  junk food  can have a significant impact on one's health. Though many people enjoy eating  junk  food  and think it tastes great. The term â€Å"junk  food†Ã‚  typically refers to foods that are relatively high in caloric content, but low in nutritional value. Junk  food  is often high in sugar, salt, white flour, and fat. A few examples of foods often considered to be  junk  food  include fast  food, sweets such as ice cream, candy, donuts, and prepackaged treats, soda, and  potato  chips, among many others.The effects of eating too much junk food are lower energy levels, can weight gain  and led to illness and diabetes. The first effect of  eating  junk  food  is its impact on energy levels. Many people skip breakfast or other meals throughout the day, choosing instead to grab a quick snack or a soft drink. The junk  food  causes energy levels to spike, which people like, but then energy levels will quickly dr op, sending one back into the kitchen for another quick snack.The high levels of sugar in junk food puts your metabolism under stress; when you eat refined sugar, your pancreas secretes high amounts of insulin to prevent a dangerous spike in blood sugar levels. In addition,  junk  food  can cause moodiness, and make it difficult to get enough sleep at night, so energy levels are never restored to normal. (Junk Food) Second effect from eating junk food is weight gain.People who eat a lot of  junk  food  tend to gain weight quickly, which can lead to obesity over time; this extra weight then has an impact on the health of the rest of the body. It can raise  cholesterol  and blood pressure, contributing to  heart disease. The high levels of fat and sodium in junk food can cause high blood pressure or hypertension. Excessive dietary sodium can also have a negative effect on renal function, even leading to kidney disease. High levels of dietary fat lead to poor cognitiv e performance.You'll feel tired and have trouble concentrating because your body might not be getting enough oxygen. (Nutrition) Third effect of eating too much junk food is Diabetes. Over time, the high levels of sugar and simple carbohydrates in junk food can lead to type 2 diabetes. This occurs because eating too much sugar puts your metabolism under stress; when you eat a lot of refined white sugar and simple carbohydrates, your body has to pump up insulin production to prevent a dangerous spike in blood sugar levels.Because junk food doesn't contain the protein or complex carbohydrates that your body needs to maintain consistent blood sugar levels, your blood sugar levels will drop suddenly soon after eating. You'll crave sugar and likely end up eating more junk food. Over time, this stress damages your body's ability to use the insulin secreted by your pancrease. A healthy diet can help maintain your body's insulin sensitivity. (Nutrition) When the body does not get proper nut rition, it can become difficult to concentrate.It can also cause depression. Keep all of these health  effects  of  junk  food  in mind before  eating anything; a healthy diet can lead to greater energy levels, improved mood and concentration ability, weight loss, and decreased risk factors for heart disease and diabetes. Though  junk food  may be easy and fast, its health impacts are too great to ignore. Work cited â€Å"Fast Food Nutrition† Fitday. com Tuesday, January 22, 2013 B, Miller. â€Å"Effects of Junk Food† Wisegeek. com Tuesday, January 22, 2013