Genetics and Crisis Intervention Research Paper

Genetics and Crisis Intervention - Research Paper Example The nurse spoke to Kim kindly and provided information pertaining to various types of aneuploidies, their clinical presentation and complications. The nuchal test was suspicious of aneuploidy and maternal serum markers hinted at the presence of some aneuploidy. Kim was 14 weeks pregnant now and the obstetrician advised amniocentesis to confirm the diagnosis. Kim underwent the procedure and the nurse told her that she had to wait for a week for the report to come. One week later, the obstetrician confirmed that the amniocentesis report was suggestive of Huntington's disease. Kim felt disastrous. She was referred to a genetic counselor. The genetic nurse took a detailed history and went through the medical reports and noted them down. Kim enquired the nurse about implications of Huntington's disease and whether she should opt for abortion. Discussion The profession of nursing has labored continuously to document a wide and yet full range of nursing diagnoses, various nursing interventi ons and patient outcomes. This has been possible because of a steady knowledge base of the profession and continuous assimilation of new knowledge by means of nursing research. One such new area in which the profession of nursing has begun to get involved deeply is genetics (Carroll-Johnson, 2000). When nurses work in genetic diseases detection and management units, they are likely to come across patients and parents who will ask them about genetic disorders related questions especially in relation to a particular disease like Aneuploidy and Hungtinton's disease. In case of fetal diagnosis one question that plaques the nurses is "Is the diagnosis right? How sure are you that the diagnosis is correct?" This is more so because there is no particular symptomatology in this case and the diagnosis is often made after getting clues from routine screening. Also, in several genetic related conditions, the advice is to terminate the much awaited pregnancy, shattering the dreams of the young couple. It thus becomes difficult on the part of the nurse to convince the parents that such a decision must be taken in the best interests of both the parents and the child. Nurses, because of their proximity of the patients and easy approachability are likely to be hovered with more questions and doubts from the patients and it is obliging on the nurses to answer the question in the most understanding manner. Thus, even nurses must have appropriate knowledge about various genetic disorders that may be encountered in their clinical practice (Kirk, 2006). According to the Genetics White Paper (DOH, 2003) advances in the knowledge and also the understanding of various genetic problems, disabilities and diseases have contributed towards more accurate diagnosis with better personalized prediction of risk, better preventive strategies, improved treatment modalities and newer drugs and therapies. Such an enhanced improvement in diagnosis and prediction has already made a great impact in the clinical practice of genetics. Advances in genetics have made it possible to provide more insight into the genetic component of the disease and also various environmental triggers of the condition (Kirk, 2006). With reference to nursing in the field of genetics, seven-point competence standards have been outlined. The nurses must be able to identify patients who might benefit from various genetic

Poem Comparison Essay Example for Free

Poem Comparison Essay All four poems that I read are related in their purposes and goals; however, they are also very different. Lucinda Matlock by Edward Lee Masters, Chicago by Carl Sandburg, Richard Cory by Edwin Arlington Robinson, and We Wear the Mask by Paul Laurence Dunbar are all about the joys and sorrows of life. How we look at life makes life good or bad. Lucinda Matlock is a story of a woman, who, by some standards, would have a life that we consider a mediocre. However, the narrator of the poem says that it was a good life and that life can only be truly appreciated if it is taken from you. Chicago by Carl Sandburg is the most closely related poems to Lucinda Matlock. In the poem, the people of this city are dirty, evil, and happy. The people are not saying to themselves, Well, my life is horrible because this is where I live and this is my underpaying job. They are laughing and joyous because they have life. Chicago is unlike Lucinda Matlock because Carl Sandburgs depiction of life in Chicago is so much more cynical than that of Masters more optimistic characterization and depiction of life in the world. Richard Cory is a poem about an aristocratic man that under- appreciates life, and, as a result commits suicide. The narrator talks about how envious he/she is of Richard Cory. Only in the very end do they mention the fact that he is actually a very sad man. This poem is a representation of the front that some people put up to hide their inner selves due to embarrassment or many other feeling of despair. Finally, we read We Wear the Mask by Paul Laurence Dunbar. This is very similar to Richard Cory in its message. The message is again that there are some who sometimes cloister their inner selves behind a barrier of a fake personality. In the poem, Dunbar writes: Nay, let them only see us while/ We wear the mask/ We smile, but oh great  Christ, our cries/ To Thee from tortured souls arise. The second part of the quotation says that they have tortured souls. They smile to hide their pain and they cry to Christ for help. All of the poems share the common theme that life is what you make it and that people often hide their true identity behind a false one (As shown in Richard Cory, We Wear the Mask, and Chicago). Though the final two poems mentioned have more in common with each other than they do with the first couple poems that were talked about in class, all of the poems are similar in their ultimate subject matter.

The Ghost Essay -- Narrative Memoir Essays

The Ghost I clutched my cell phone tightly ready to call 911. I was so terrified lying there in my bed that I couldn't move. Previous nights while staying at my Grandma's house I had been scared, but nothing compared to the fear that ran through my veins on this unforgettable night. I remember how exciting the idea of living with my grandma and being independent from my parents for a whole summer while our new house was being built sounded to me. My grandma lives in a house that is over a 100 years old! I really don't believe it is haunted or anything, but I have definitely heard sounds in the night, some louder and scarier than other nights. My dad used to tease me that it was my Grandpa's ghost coming back for visits. My grandpa died in January of 2001. I don't believe in ghosts, but just my dad's suggestion of Grandpa's soul coming back made me feel uneasy. One particular night still haunts me and is one that I really wish I could forget. I went to bed that night up at my Grandma's house just like I did almost every night, a little apprehensive about what I might hear. At about 1:00 a.m., I was awakened by a loud bang on my window. I thought maybe it was just a dream, so I closed my eyes and started to fall back asleep. Just as I was almost back to sleep, I heard another loud bang followed by mysterious voices; this time I knew it wasn't a dream. At first, I was so scared that all I could do was lay in my bed motionless. I tried to rationalize what the noises I heard could have been, but I couldn't think of any logical explanation, except that someone was outside. My first instinct was to grab my cell phone and call 911. I quickly grabbed my phone off my headboard and held it close to me, still too scared to move, b... ... always tell her it was branches from the trees hitting the sides of the house. Well, old houses do creak I guess, but the sounds I heard that night were definite loud bangs on my window, which couldn't have possibly been caused by tree branches, since there weren't any tree branches that even touched the house anywhere near the room I slept in. I definitely got the independence that I wanted this past summer, but I wasn't quite as ready for it as I thought I was. I'll probably never have an explanation for what I heard that night, and honestly, I don't think that I really want one. I still don't like the idea of ghosts or souls of people who have died coming back to earth, but I do think that some things just can't be explained by my simple human logic. I'll never forget that night up at my grandma's when I was so scared that I couldn't move a muscle in my body.

The Act of Blogging:Creating an Online Home :: Blogs

The Act of Blogging:Creating an Online Home A phenomenon has taken place on the internet. This phenomenon is called blogging. Blogging is nothing more the journal of people published on the internet. The interesting thing is, other people around the world can share in this journal with you. Another interesting note that might be commonly over looked, is the resemblance of a blog site and a real home, metaphorically speaking. Whether or not a blogger is intentionally giving his site a homely look to it, the resemblance is there nonetheless. Items you might come across on a blog site are pictures, a portfolio of the blogger, and links to other blog sites. For the bloggers that take this seriously, it is important to have this information to create an environment that you are comfortable with and you are comfortable with others to view. You want for the viewers to feel welcome to your site and enjoy what they see and read. For the viewers, they are looking for a connection with other people with similar likes and dislikes. An individual named Andy does a lot of traveling, and has created a blog site to tell about his travels. Because of his extensive travels, Andy has chosen to make an online home. In several e-mail conversations I had with Andy, he told me that his web site is a place where he can go for some familiarity. He was intrigued at the comparison that I had made between the two types of homes. When you enter this site you are greeted with a different picture about once a week. Pictures are important; they add life to the web site. Pictures are also important because they give character to the web site, and in some cases can even tell a story. Pictures on a web site are a lot like pictures on the wall of a house, for the same reasons. Pictures or paintings I feel are a necessity for a house or web site. Throughout a house you will find books, magazines, newspapers, and all sorts of other little nick nacks. These items are there for enjoyment and education. They also describe what kind of person it is that lives there and what his likes and dislikes are. In the blog world, you might find a personal profile of the blogger. For the serious bloggers, it is almost a guarantee that you will find one.

“How does Shakespeare present Macbeth as a disturbed character in Act 1 of Macbeth?” Essay

â€Å"How does Shakespeare present Macbeth as a disturbed character in Act 1 of Macbeth?† William Shakespeare wrote the play â€Å"Macbeth† in 1606. It, as the title suggests, follows the story of a Scotsman named Macbeth and how, after the prophecy of three witches, sees his status evolve from a general in the Kings army to becoming the King himself. However the main theme that Shakespeare introduces in this play is the lengths man will go to fulfil ambition and the treacherous consequences that come with it. Not only do we see Macbeth’s status evolve but also his personality within. With each scene we see Macbeth succumb to the pressures of achieving power and how this affects his character as well. Act 1 of â€Å"Macbeth† truly, from the beginning, shows us a clear development of Macbeth’s disturbed personality not only through language but the context behind this tragedy. In Act 1 Scene 2 we are not introduced to Macbeth, but not directly. Shakespeare describes him as a ruthless, violent but brave soldier through the mouths of admirers. When the Thane Ross and a Captain describe Macbeth’s â€Å"brave† performance during a victory over Norway, we are immediately acquainted to the respect that he is held in. The Captain describes him in a very positive manner, â€Å"For brave Macbeth – well he deserves that name† is a quote that clearly emphasises the admiration that fellow soldiers have for Macbeth. The use of the word â€Å"deserves† shows us that he has earned the right to be commended. However another interpretation of Macbeth’s heroics is possibly his ruthlessness. During his distinguishing, Macbeth is also described as quite a violent person. His fierceness is made apparent when the Captain conveys a very vivid explanation of how Macbeth killed a Norwegian, â€Å"Till he unseam’d him from the nave to the chaps†. This description is very daunting to think about and Shakespeare leaves this image implanted in the heads of the audience. The use of the word â€Å"unseam’d† shows us Macbeth’s ruthlessness when in battle, with possibly no respect for other’s lives. The violent aspect of Macbeth’s character can be interpreted a disturbed one. His ruthlessness is quite inhumane in the sense that he shows signs of a villainous character. Another way in which Macbeth is seen a disturbed character, is his association and connection with the three witches. When Macbeth and Banquo are introduced in Scene 3, Macbeth’s first line is â€Å"So foul and fair a day I have not seen†. This quote echoes the witches’ in Scene 1, â€Å"Fair is foul and foul is fair†. The phrase is almost a paradox, it can interpreted to show how nothing is as it seems. However the fact that Macbeth repeated a phrase said by witches all but adds to a negative insight into his character. During Shakespeare’s time, witches were seen as very real creatures. In the early 17th century, suspected witches were burnt and there was even an Act of Parliament put forward in 1604 against them. This was because witches were subjects of morbid and fevered fascination by society at this time; people feared them. They were seen as creatures of Satan and therefore evil characters. The use of the three witches in the play adds to the fear within it and with this, the use of Macbeth echoing their words adds to the sheer disturbance. During this time, Macbeth’s reference to â€Å"foul and fair† would have caused a negative impact on the way the audience looked at him. To be associated with repelled evil witches creates a dark atmosphere and tone throughout the play. After the witches’ prophecy, Macbeth’s mind is beginning to turn into a state of madness and paranoia due his constant change in thoughts. The ideas that roam Macbeth’s head prove to be a substantial part of the Act. The prophecy, which promises the status of King in the future, has been fixed into Macbeth’s mind, provoking ill thoughts. After bearing witness to the supernatural occurrence, Macbeth begins to contemplate the idea of kill the present King Duncan in order to become King. â€Å"This supernatural soliciting/Cannot be ill, cannot be good† is a quote that clearly shows us the mindset that Macbeth is in confusion. The use of the words â€Å"ill† and â€Å"good† makes it clear that he is between the two thoughts and his mind isn’t thinking straight however he comes to a conclusion that he shouldn’t intervene to make the prophecy become true. However Macbeth again contemplates the idea later on in Scene 4. After realising that Malcolm, Duncan’s Son, is the rightful heir to the throne, Macbeth is again mystified to whether he should intervene in fate. â€Å"The eye wink at the hand; yet let that be/Which the eye fears, when it is done, to see† illustrates his desire for power but reluctance to commit murder, â€Å"the eye fears†. The theme of hesitation and constant contemplation of Macbeth is a sign of confusion within his mind. This is a sign of a disturbed character. Another way in which Macbeth can be seen in a negative way is through his motives and if they are with foundation especially through eyes of the audience who witnessed â€Å"Macbeth† in William Shakespeare’s time. This includes the idea of treason and how power was a God given right. In Scene 7 we find that Macbeth is considering whether killing Duncan is the right act to commit due to the high respect that the King holds him in. When talking in his soliloquy (something that Shakespeare uses to shows the audience the thoughts and true feelings of characters) Macbeth talks about his respect for Duncan, â€Å"I am his kinsman and his subject†, this supports the fact that he is also related to Duncan and a trusted figure. However his mindset is yet again changed as he finally decides that murder is the best option, â€Å"Fal se face must hide what the false heart doth know† is a signal of his change of mind but, with that, his personality. The idea of Macbeth committing murder on a King would have been frowned upon when the audience of the 17th century watched â€Å"Macbeth†. Political connotations such as the Gunpowder Plot 0f 1605 was possibly used by Shakespeare to relate to Macbeth and the idea of killing Kings. â€Å"Macbeth† was possibly used as a caution against potential regicides, especially with the patron of Shakespeare’s productions being the King James. Also religious connotations, such as the idea that the status of King was a God given right, played a significant part. Macbeth is aspiring to achieve a status that isn’t a God given thing, especially at this time the theme of treason was heavily frowned upon. The idea of Macbeth wanting to achieve Kingship without God given rights would have added to his disturbing character. There are other examples that show Macbeth’s disturbed character. One other factor could be his irrational thinking and the way that Lady Macbeth must always intervene to make him think right. Near the end of Scene 7, Macbeth tell his wife that he will not commit the murder, â€Å"We will proceed no further in this business†, is a firm claim from Macbeth. His tone is one that is very decisive however after the persuasive techniques of Lady Macbeth he quickly changes his mind. â€Å"I am settled, and bend up/ each corporal agent to this terrible feat† is said at the end of the scene, showing Macbeth’s sudden change in mind and sheer willingness to kill King Duncan. Macbeth doesn’t think straight and can be seen as having a fragile mind, one that can be easily moulded. Overall, Shakespeare successfully shows the audience how Macbeth develops his disturbed character. By using language features and also the views of certain themes of the audience of the time, he introduces a very irrational character. These themes include violence, religion, politics and the idea that man’s desire for power outweighs any respect for the consequences. Macbeth slowly develops from a violent person to someone who is very fragile in the mind and also, essentially, a disturbed character.

Crustacean Facts

Crustacean Facts Crustaceans are some of the most important marine animals. Humans rely heavily on crustaceans for food; and crustaceans are also an important prey  source for  marine life  in the ocean food chain for a variety of animals, including whales, fish, and pinnipeds. More diverse than any group of arthropods, crustaceans are second or third in abundance of all categories of animal life after insects and vertebrates. They live in inland and ocean waters from the Arctic to the Antarctic as well as from elevations in the Himalayas up to 16,000 feet to well below sea level. Fast Facts: Crustaceans Scientific Name: CrustaceaCommon Names: Crabs, lobsters, barnacles, and shrimpBasic Animal Group: InvertebrateSize:  From 0.004 inches to over 12 feet (Japanese spider crab)Weight: Up to 44 pounds (American lobster)Lifespan: 1 to 10 yearsDiet:  OmnivoreHabitat: Throughout the oceans, in tropical to frigid waters; in freshwater streams, estuaries and in groundwaterPopulation: UnknownConservation Status: Many crustaceans are extinct, extinct in the wild, or endangered or critical. Most are classified as Least Concern. Description Crustaceans include commonly-known marine life such as crabs, lobsters, barnacles, and shrimp. These animals are in the Phylum Arthropoda (the same phylum as insects) and Subphylum Crustacea. According to the Natural History Museum of Los Angeles County, there are over 52,000 species of crustaceans. The largest crustacean is the Japanese spider crab, at over 12 feet long; the smallest are microscopic in size. All crustaceans have a hard exoskeleton which protects the animal from predators and prevents water loss. However, exoskeletons dont grow as the animal inside them grows, so crustaceans are forced to molt as they grow larger. The molting process takes between a few minutes to several hours.  During molting, a soft exoskeleton forms underneath the old one and the old exoskeleton is shed. Since the new exoskeleton is soft, this is a vulnerable time for the crustacean until the new exoskeleton hardens. After molting, crustaceans typically expand their bodies almost immediately, increasing by 40 percent to 80 percent. Many crustaceans, such as the American lobster, have a distinct head, a thorax, and an abdomen. However, these body parts arent distinct in some crustaceans, such as the barnacle. Crustaceans have gills for breathing. Crustaceans have two pairs of antennae. They have mouths made up of one pair of mandibles (which are eating appendages behind the crustaceans antennae) and two pairs of maxillae (the mouth parts located after the mandibles). Most crustaceans are free-ranging, like lobsters and crabs, and some even migrate long distances. But some, like barnacles, are sessile- they live attached to a hard substrate most of their lives. Rowan Coe/Getty Images Species Crustaceans are a subphylum of the Arthropoda phylum in the Animalia. According to the World Register of Marine Species (WoRMS), there are seven classes of crustaceans: Branchiopoda (branchiopods)Cephalocarida (horseshoe shrimp)Malacostraca (decapods- crabs, lobsters, and shrimps)Maxillopoda (copepods and barnacles)Ostracoda (seed shrimp)Remipedia (remipedes)Pentastomida (tongue worms) Habitat and Range If youre looking for crustaceans to eat, look no further than your local grocery store or fish market. But seeing them in the wild is almost as easy. If youd like to see a wild marine crustacean, visit your local beach or tide pool and look carefully under rocks or seaweed, where you might find a crab or even a small lobster hiding. You might also find some small shrimp paddling around.   Crustaceans live in freshwater plankton and benthic (bottom-dwelling) habitats, and can also be found residing in groundwater near rivers and in caves. In temperate locations, small streams support some crayfish and shrimp species. Species richness in inland waters is highest in fresh water, but there are species that live in salt and hypersaline environments.  Ã‚   To protect themselves from predators, some crustaceans are night hunters; others stay in protected shallow slack-water locations. Rare and geographically isolated species are found in karst caverns which get little if any light from the surface. As a result some of those species are blind and unpigmented.   Diet and Behavior Within the literally thousands of species, there is a wide variety of feeding techniques among crustaceans. Crustaceans are omnivores, although some species eat algae and others like crabs and lobsters are predators and scavengers of other animals, feeding on those that are already dead. Some, like barnacles, remain in place and filter plankton from the water. Some crustaceans eat their own species, newly molted individuals, and young or injured members. Some even change their diets as they mature. Reproduction and Offspring Crustaceans are primarily dioecious- made up of male and female sexes- and therefore reproduce sexually. However, there are sporadic species among the ostracods and brachiopods that reproduce by gonochorism, a process by which each individual animal has one of two sexes; or by hermaphroditism, in which each animal has complete sex organs for both male and female sexes; or by parthenogenesis, in which the offspring develop from unfertilized  eggs. In general, crustaceans are polyandrous- mating more than once in the same breeding season- and are fertilized within the female. Some may begin the gestation process immediately. Other crustaceans such as crayfish store the spermatozoa for many months before the eggs are fertilized and allowed to develop. Depending on the species, crustaceans disperse eggs directly into the water column, or they carry the eggs in a pouch. Some carry the eggs in a long string and attach the strings to rocks and other objects where they grow and develop. Crustacean larvae also vary in shape and development process by species, some going through multiple changes before reaching adulthood. Copepod larvae are known as nauplii, and they swim using their antennae. Crab crab larvae are zoea which swim using thoracic appendages.   Conservation Status Many crustaceans are on the International Union for Conservation of Nature Red List as vulnerable, endangered or extinct in the wild. Most are classified as Least Concern.   Sources ï » ¿Coulombe, Deborah A. The Seaside Naturalist. New York: Simon Schuster, 1984.Martinez, Andrew J. 2003. Marine Life of the North Atlantic. Aqua Quest Publications, Inc.: New YorkMyers, P. 2001. Crustacea (On-line), Animal Diversity Web. Thorp, James H., D. Christopher Rogers, and Alan P. Covich. Chapter 27 - Introduction to â€Å"Crustacea. Thorp and Covichs Freshwater Invertebrates (Fourth Edition). Eds. Thorp, James H. and D. Christopher Rogers. Boston: Academic Press, 2015. 671–86.WoRMS. 2011. Crustacea. World Register of Marine Species.

Free Essays on A Case Agianst Affirmative Action

Ever since the American social revolution precipitated by the civil rights movement of the 1950’s and ‘60’s, the United States’ government has sought an appropriate resolution concerning the question of race relations. In this country it was soon realized that, despite constitutional amendments and various legislative initiatives ensuring equal treatment for all citizens, widespread â€Å"institutional† racism continued to act as a reinforcement of social disparities along racial lines. As a result, minorities – African Americans in particular – have exclusively benefited from policies and programs aimed at narrowing this social gap between minorities and majorities. The policy of affirmative action in college admissions, and its relation to employment and narrowing social inequalities between minorities and majorities, however, is inherently unjust. In this paper, I will attempt to explain why affirmative action is not only unjust, but also a misguided policy which will reap results contrary to its ultimate goals. Affirmative action, it seams to many White people and a few minorities, is hypocritically unjust for fairly obvious reasons. For one, why would any social policy aimed at providing equal treatment for all people regardless of race, differentiate between people on the basis of race, not to mention use that basis as a reason for treating them differently? Isn’t it unfair to discriminate against anyone on the basis of race, whether they be members of the minority or majority? Most opponents of affirmative action would agree that, just because discrimination against non-White minorities occurred in the past, reverse discrimination should not be implemented against the White majority – a majority which had nothing to do with the discrimination of the past as a means of undoing past injustices and narrowing racial gaps. Proponents of affirmative action policies, on the other hand, would probably respon... Free Essays on A Case Agianst Affirmative Action Free Essays on A Case Agianst Affirmative Action Ever since the American social revolution precipitated by the civil rights movement of the 1950’s and ‘60’s, the United States’ government has sought an appropriate resolution concerning the question of race relations. In this country it was soon realized that, despite constitutional amendments and various legislative initiatives ensuring equal treatment for all citizens, widespread â€Å"institutional† racism continued to act as a reinforcement of social disparities along racial lines. As a result, minorities – African Americans in particular – have exclusively benefited from policies and programs aimed at narrowing this social gap between minorities and majorities. The policy of affirmative action in college admissions, and its relation to employment and narrowing social inequalities between minorities and majorities, however, is inherently unjust. In this paper, I will attempt to explain why affirmative action is not only unjust, but also a misguided policy which will reap results contrary to its ultimate goals. Affirmative action, it seams to many White people and a few minorities, is hypocritically unjust for fairly obvious reasons. For one, why would any social policy aimed at providing equal treatment for all people regardless of race, differentiate between people on the basis of race, not to mention use that basis as a reason for treating them differently? Isn’t it unfair to discriminate against anyone on the basis of race, whether they be members of the minority or majority? Most opponents of affirmative action would agree that, just because discrimination against non-White minorities occurred in the past, reverse discrimination should not be implemented against the White majority – a majority which had nothing to do with the discrimination of the past as a means of undoing past injustices and narrowing racial gaps. Proponents of affirmative action policies, on the other hand, would probably respon...

Protectionism vs. Free Trade Essay Essays

Protectionism vs. Free Trade Essay Essays Protectionism vs. Free Trade Essay Essay Protectionism vs. Free Trade Essay Essay Protectionism is the pattern of the authorities seting bounds on foreign trade to protect concern at place. Free Trade is when there are few or no bounds on trade between states. Both sides have strong point of views stand foring their several sentiments. From the United States position. I think the riddance of Free Trade is one of the lone ways the American economic system can spread out for the overall benefit of all the citizens and our national public assistance. Our economic system needs to acquire out of the immense shortage we presently face. Estimates are every bit high as 750. 000 occupations were outsourced from the United States in 2009 entirely. This is a astonishing figure. and a major lending factor as to why our state is confronting the highest unemployment rates in the history of our great state. We need to censor foreign companies from selling their goods and merchandises in the United States in order for our local markets to boom and finally more people would be employed. I support Protectionism as the best method to the United States remaining in fiscal matters fit. Protectionism has several great statements. some of them include: 1. The usage of inexpensive labour in other states can take down rewards or endanger occupations at place. . A state can go excessively dependent on another state for of import merchandises perchance doing them vulnerable. 3. Industries that make merchandises related to national defence demand to be protected. 4. Other states might non hold the same environmental or human rights criterions. 5. Foreign competition will take down the demand for merchandises made at place. 6. Companies at place must be protected from unjust foreign competition. All of these grounds are legitimate. but those against protectionism argue that the monetary value of merchandises could lift because of no other competition. I do non believe this is a valid concern. our elective functionaries. the United States authorities. can protect the American people by enforcing their will on concern and guaranting companies charge just monetary values for goods and services. Protectionism will enable â€Å"strategic† industries in the United States such as agriculture and defence to boom. It besides has societal benefits protecting our American manner of life. Thru the usage of duties we can protect our great state. Duties imposed on exports guarantee our domestic supply and would be a beginning of gross for the United States authorities. If we place more duties on imports it would protect those things vital to the success of our state such as the agriculture and defence mentioned supra. As with duties on exports. a duty on imports would be another great beginning of gross for our authorities. All of the support I have evidenced in this paper does non be the one cardinal belief that I have ; the United States needs to better its Patriotism! A full execution of Protectionism would supply our state the encouragement it needs. I think we would see Patriotism at an all clip high which would assist guarantee a profitable and prosper.

Scheduling Management in Tunnel Construction Projects Literature review

Scheduling Management in Tunnel Construction Projects - Literature review Example 45). Scheduling management Scheduling management is very important to any project because it entails helpful techniques applicable while managing activities involved in projects. Managers practice scheduling management before starting up a project, which involves. Pointing out the task that interests an individual, estimating the total period that the task will take, and distributing resources needed to perform that task, finally deciding on when the task will commence. In the procession of a project, monitoring is important as it ensures that scheduling management predicts the future of a project. An effective scheduling management helps the project administrator to ascertain that a project is within the expected cost, time and certain standards of quality (Kerzner, 2009, p. 47). Scheduling management techniques There are two types of scheduling management techniques applied in projects in order to enhance efficiency. These techniques include the Milestone chart and the Gantt chart. In projects, Milestone chart is very imperative as it identifies vital events that occur during the implementation of a project, it usually reflects critical issues in a project, which without controlling on time will lead to delays in a project. Milestone chart is very reasonable about deadlines as it entails installation of equipment, changes in a new system, completion of systems and file conversations. However, Gantt charts occur either in a horizontal bar shape or as a line chart and it indicates the activities that the project entails written in the left hand side of the chart. In addition, it contains the time scale of a project indicated at either the top or bottom of the chart, a line drawn showing the project’s estimated period and another line showing the dependencies among the project activities and the time used (Kerzner 2009). According to the construction industry, Gantt chart represents a scientific method of management that helps individuals to break down th e processes involved in projects. This chart divides a whole project into distinct task, methods of performing the tasks, cost and time spend on the task, and finally it monitors the entire project (Kerzner 2009). Steps for better scheduling management In order to come up with a successful project, it is important for project managers to observe the following scheduling management steps. Firstly, managers should implement a scope letter entailing the price of a project, which will be of benefit while negotiating for project schedule. Secondly, they should make a worksheet and compare it with the one provided by the contractor of the project; managers should also make notes indicating the commencement date of a project and when it will end. Managers should ensure that they recheck for logic problems in their work before they proceed because errors resulting from logic leads to poor projects. The project schedule should include separate person-hours allocated for each task in order to make it detailed and organized. The manager should carry out resource loading to ensure equal allocation of resources and tasks within a given time. Later, he/she should determine the total resources desirable in performing the project

Leadership and Motivation Assignment Example | Topics and Well Written Essays - 500 words

Leadership and Motivation - Assignment Example ese steps include identifying the important priorities, considering the ability and commitment of the available staff and application of the best situational leadership (Learn to be a leader, n.d.). For instance, a manager can determine the staffs level of maturity and competence and after that, adjust their leadership to support the least mature staff while offering the mature staff more room to operate with minimum support. A manager has to understand perfectly the key role of the human resources department (HR). A HR department ensures that an organization reaps benefits from its investment in its staff. Hence, performance can be hampered when an experienced executive assistant discovers that he/she earns the same amount of money as a newly hired janitor. To effectively correct the discrepancies in the payment of the employees, a newly appointed manager can initiate an employee performance appraisal (PA). The PA will enable the organization to make informed choices, such as the contribution of the executive assistant and the janitor to the organization. Once their contribution is analyzed and identified, the management can come up with an effective remuneration plan that matches the input and contribution of the individual employee (Daft, 2013). Specifically, the new manager can also employ rewarding and resourcing as specific HR strategies to address the situation. Through a reward policy, the organization would ensure that its best employees are rewarded for the great job that they are doing. This means that, even if the basic salary for the executive assistant and the janitor are equal, the executive assistant will receive a reward on top of their salary based on the successful application of their work. The company’s decision to offer semiannual bonuses is a good motivation strategy for its employees (Daft, 2013). If employed correctly, such a motivational tool can help in the retaining and motivation of the staff during the tough economic times. The

Response Assignment Example | Topics and Well Written Essays - 500 words - 5

Response - Assignment Example According to Savan, most of the Black English spoken today came about during the period of slavery where most African Americans were slaves to the whites. They used these words when peaking to themselves before their â€Å"Massa† so that he did not understand what they were talking about. These words were simply used by the blacks to communicate without angering their masters. The use of these words today is associated with marketing and commercials where whites are using them for their own benefit, with total disregard to the origin of these words. According to Sava, consumer media is exploiting black language for fame and profits. Therefore, paying the dues means appreciating the origin of these words, and the struggle the African Americans underwent in making these terms. In the text by Manuel Muà ±oz, the term ‘Anglicize’ is used to mean changing something from a certain language and making it sound or look ‘English.’ It refers to taking something from a different language and creating an English equivalent. This usually applies to names. In this text for instance, Muà ±oz says that the Anglicized pronunciation of the Mexican gate agent would not be unusual in California. This means that since California is in America where English is the first language, Anglicized pronunciations are usual because they sound English. In his essay, Muà ±oz uses the term Anglicize to refer to the changing of Spanish names into their English equivalents in order to fit into the American society. Therefore, Anglicization is a strategy many people use in order to feel included in the society. It is simply changing of names for purposes of fitting into the society so as to enjoy the privileges and opportunities offered by that society. From my personal experience, I have interacted with a number of friends from other countries who

Journal Essay Example | Topics and Well Written Essays - 500 words - 56

Journal - Essay Example I lived with friends, so the rent I was paying was quite a bargain. I was driven and started looking for work immediately. After two months of desperate searching I landed in a travel agency as a sales consultant. The job was an hour and a half away by public transport and I had to change 2 trains and a bus in order to get there. I started at 10 and finished at 7 with an hour lunch break. I was waking up 7.30, getting dressed out of the door by 8, to ensure that I was there at least 10 minutes before my shift and had enough time to buy breakfast before work. I never finished at 7 pm. Sometimes I had to stay until 8, so until I got home it was a good 9.30 pm. I was also required to work on Saturdays 3 times a month. I managed to stay at this job for 2 months. I couldnt handle the 3 hours travelling any longer, the low salary and 6 days work commitment. This was one of the most demanding and exhausting jobs I ever had. An anecdotal experience was when a customer called while I was still working for the travel agency asking to book a holiday to Luxor. We were talking for about 45 minutes about pyramids, night life, pools and kids activities. I was just confirming the flights to Las Vegas, when the customer interrupted me very bewildered. It turned out that, he wanted to go to Luxor in Egypt and I was talking about the hotel Luxor in Las Vegas. Funnily, the customer recommended me to his brother and in few days he called to book Las Vegas – hotel Luxor. I was working at a very busy and hectic call centre. There were always new employees coming and leaving. It was difficult to handle 3 different work shits covering 24 hours. One day, a couple came along and the manager introduced them to the floor. They will be starting work in few days. They used to work for the call centre few years ago, but moved to another town and now they decided to come back. The conflict arose when the couple informed the manager that they preferred to sit together. There werent any

The Investor Life Cycle of ZipCar, Facebook, and Dunkin Doughnuts Coursework

The Investor Life Cycle of ZipCar, Facebook, and Dunkin Doughnuts - Coursework Example Zipcar, Facebook and Dunkin Doughnuts are companies operating in different industries, and therefore attract different investors in varying stages of the Investor Life Cycle. The four-stage investor life cycle includes the following: accumulation, consolidation, spending, and gifting. According to Hartung (2014), the growth of social networking giant on the back of increasing demand for social media would make the company’s stock idea for the individual who intends to accumulate. The basic notion behind this stage in the investor life cycle is that investors seek to aggressive growth for the future hence this is a fit beyond doubt. On the other hand, Krantz (2014) opines that Dunkin Doughnuts is a stable prospect for the future. Therefore its stocks fit perfectly within the second stage, as that stage typically asserts that an investor would be inclined to who perceive retirement planning as more vital, and hence, these stocks would fit perfectly into their bill. Zipcar’s continued dwindling fortunes in the market and recent mergers news would make its stock a perfect bill for an investor within the investor’s life cycle known as gifting (Savitz, 2013). In this phase, investors are more prone to have assets remaining at the end of their lives, but they focus more on estate planning. According to Burton (2013), calendar effects have emerged as a vital aspect of behavioral finance amongst present investors in the country. Calendar Effects implies that people analyze specific dates and periods in which stock prices to rise. This is absurd, but Wall Street research over the few years has validated this claim.  

Journal Essay Example | Topics and Well Written Essays - 500 words - 56

Journal - Essay Example I lived with friends, so the rent I was paying was quite a bargain. I was driven and started looking for work immediately. After two months of desperate searching I landed in a travel agency as a sales consultant. The job was an hour and a half away by public transport and I had to change 2 trains and a bus in order to get there. I started at 10 and finished at 7 with an hour lunch break. I was waking up 7.30, getting dressed out of the door by 8, to ensure that I was there at least 10 minutes before my shift and had enough time to buy breakfast before work. I never finished at 7 pm. Sometimes I had to stay until 8, so until I got home it was a good 9.30 pm. I was also required to work on Saturdays 3 times a month. I managed to stay at this job for 2 months. I couldnt handle the 3 hours travelling any longer, the low salary and 6 days work commitment. This was one of the most demanding and exhausting jobs I ever had. An anecdotal experience was when a customer called while I was still working for the travel agency asking to book a holiday to Luxor. We were talking for about 45 minutes about pyramids, night life, pools and kids activities. I was just confirming the flights to Las Vegas, when the customer interrupted me very bewildered. It turned out that, he wanted to go to Luxor in Egypt and I was talking about the hotel Luxor in Las Vegas. Funnily, the customer recommended me to his brother and in few days he called to book Las Vegas – hotel Luxor. I was working at a very busy and hectic call centre. There were always new employees coming and leaving. It was difficult to handle 3 different work shits covering 24 hours. One day, a couple came along and the manager introduced them to the floor. They will be starting work in few days. They used to work for the call centre few years ago, but moved to another town and now they decided to come back. The conflict arose when the couple informed the manager that they preferred to sit together. There werent any

The road to acting in films Essay Example | Topics and Well Written Essays - 1250 words

The road to acting in films - Essay Example Now of course there are some actors who don’t have to take that long road due to family connections already in the industry. There are many roads to take in acting which one an individual chooses determines the outcome. Approaching the long road ahead in acting it’s always good to surround oneself with like-minded individuals. If no-one in the arena of life fits that role then look elsewhere in the form of success stories from other aspiring actors who became successful. The case may not necessarily be an aspiring actor but someone who set goals for their life and accomplished them. Here’s some advice on accomplishing goals from a successful entrepreneur, Lately I’ve noticed quite a disconnect in the goals people have for themselves and the plans they have for achieving those goals. Having goals is an important step towards living intentionally, but it’s only one step. There are many other things you’ll need to do to achieve those goals. Iâ⠂¬â„¢m afraid that some people are under the impression that setting goals is the most important step in achieving goals. As if after setting goals, the rest of the details will â€Å"work themselves out.† That just isn’t true. Setting goals is really only a small step towards achieving your goals. In between the two will be a long road and lots of hard work. (Barr) Preparing oneself for a career in acting takes a stance of no matter what, success is the only option. The assurance of that option is how an individual positions him/herself and with whom. Sometimes individuals may receive roles and foolishly accept a role that is a â€Å"bad look†. The â€Å"bad look† role now has branded them to the world of producers, directors, agents and fellow actors. In the â€Å"bad look† case an actor who had been given an opportunity choose the wrong role and now must work even harder to prove or to remove the â€Å"bad look†. There are so many loophol es to correct etiquette in the world of acting. All of which include decisions on managers, agents, scripts, and relating to the public. An aspiring actor should not just see a dream and follow it but should evaluate what it takes to get there and prepare. The aspiring actor must know and understand the road is long and hard and the competition is like a sea of swimming sharks. Preparation for the bad and the good is necessary in the road to acting in films. Preparation is important. There are steps an individual must take to ensure a right road to a career in acting. Taking all the steps doesn’t mean it will happen overnight. The important point here is taking the right steps to be on the right road. Preparation is not overnight either. Preparation takes time and research. The first thing an individual should do is position themselves in the film community. Hollywood is not the only place actors’ act. Most cities have their own film community. If not then find out whe re the nearest city is that does have a film community and drive out there. Get involved see what’s going on. Socialize with other aspiring actors, make-up artists, aspiring film directors, producers, etc. Start where you are first and then branch out. Some individuals make the choice to start out in LA. Starting out at the top just like at the bottom takes just as much hard work and sacrifice. Location doesn’t make the road easy; it’s the sacrifice, motivation and hard work that make the road accessible. Acting classes are excellent ways of walking down that road to

Food memoir Essay Example for Free

Food memoir Essay For all of us, there are several kinds of food in our deep memories. These foods are different from others because they are not only what we eat but also what we experience. Last week, when my teacher asked us which food existed in our deep memories, the first one came to my mind was Mung rice noodle. Each time mentioning Mung rice noodle, I will think of my wonderful childhood and sweet home. IbelongtoTujia,oneoftheChineseminorities. Mungricenoodlehasbeen produced by Tujia people, and most of us are used to make it our breakfasts. Simply, from the name, it comes from the marriage of mung and rice. However, Tujia people are used to add soybeans into the mixture of mung and rice. To be honest, I have never made it by myself, instead, I saw my grandmother made it when I was in the primary school. Firstly, my grandmother soaked the soybean, mung and rice in the water one day before using them. After one day, she grinded them into slurry by the millstone. Then, she brushed little colza oil in the iron pan and circled the slurry evenly in the pan. That was my first time knowing how to make Mung rice noodle and I can still remember that the fresh smell of it jumped out just in one second. After it was done, my grandma put it in the hot water and added ginger, scallion, garlic, peper, chilli oil and meat sauce. She smiled at me: â€Å"babe, you gonna finish it! † After eating it up, I understood why my grandma was so confident that I could finish it at the beginning. ThereisasweetstoryrelatedtoMungricenoodle. WhenIwasintheprimary school, my mother usually got up half an hour earlier than me to make Mung rice noodle as my breakfasts. She could always make new flavors to surprise me. I was extremely curious that why she could make so many flavors, and I asked her. She looked at me mysteriously: â€Å" if I make the same flavor all the way, you will be bored at breakfasts, that is not a good habit†. At that time, I did not think too much on her answers. But gradually, especially after studying abroad, I realize that the primary reason she made different flavors is that she loves me. Up to now, in my life, my mother is the only one who genuinely cares how is my breakfast. Eating istheeasiestwaytomakeussatisfiedandfoodistheeasiestthingwewill remember. They may be a certain birthday cake, the dishes we ate with our first love, or the party dinner in a special holiday. No matter what it is, the memory for that moment will exist in our whole life. When we are old, we may forget the flavor itself at all. However, we will remember the feeling of surprise, warm, satisfied, happy and even pain till the end. 2nd draft Food memoir: Mung rice noodle Ifyoucanchooseonlyonefoodasyourlife-longfood,whatisit? Forme,itis definitely the Mung rice noodle. IbelongtoTujia,oneoftheChineseminorities. Mungricenoodlehasbeen produced by Tujia people and most of us are used to make it our breakfasts. Simply, from the name, it comes from the marriage of mung and rice. However, Tujia people usually add soybeans into the mixture of mung and rice. Mostly, we buy original Mung rice noodle and add flavors as we like at home. To be honest, I have never made it by myself, instead, I saw my grandmother made it when I was in the primary school. Firstly, she soaked the soybean, mung and rice in the water one day before using them. After one day, she grinded all ingredients into slurry by the millstone and mixed them with the potato starch. Then, she brushed little colza oil, similar to the corn oil, in the iron pan and circled the slurry evenly in the pan. Imagine what! Just in one second, the fresh smell of caramelized starch jumped out. After taking a breath, I touched the beans aroma in the air. Grandma was excited: â€Å"Come on, Joey, look at the grey-green circle lines here, are they like tree’s growth rings. † Yes, it really was! That was my first time knowing how to make fresh Mung rice noodle. After it was done, grandma put it in the hot water and added sliced ginger, scallion, garlic powder, white pepper, chilli oil and meat sauce. She smiled at me: â€Å"girl, you gonna finish it! † After eating it up, I understood why my grandma was so confident that I could finish it at the beginning. Frankly, I cannot describe the flavor correctly now. However, one thing I am sure about is that, when eating it, I felt nothing else matters. Similartomanyyoungsters,Iliketogotobarsandenjoyhavingfunwithmy friends in the night. However, no matter how late I sleep, I will get up the next day to eat the breakfast. This habit is related to the Mung rice noodle. When I was in the primary school, my mother usually got up half an hour earlier than me to cook Mung rice noodle as my breakfasts. She could always create new flavors to surprise me. Gradually, the new flavor of the Mung rice noodle became my impetus to get up. Even more, I deem a tasty breakfast as the beginning of a great day. Once, I was extremely curious that why mom could create so many flavors, and I asked her. She looked at me mysteriously: â€Å" if I make the same flavor all the way, you will be bored at breakfasts, that is not a good habit†. At that time, I did not think too much on her answers. But gradually, I have realized that the real reason she made variable flavors is that she loves me. After studying abroad, the most frequent questions from my mom is: what is your breakfast. Up to now, in my life, my mom is the only one who genuinely cares how is my breakfast. For all of us, there are some foods in our deep memories. These foods are unique and unforgettable because they are not only what we ate but also what we experienced. Eating is the easiest way to make us satisfied and food is the easiest thing we will remember. They may be a certain birthday cake, the dishes we ate with our first love, and the party dinner in a special holiday. When we are old, we may forget the flavor itself at all. However, we will keep in mind the feeling of surprise, warmth, satisfaction, happiness and even pain related to these foods because they are part of our lives.

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