Analysing New Challenges Posed By The Development In Government Policies Social Work Essay

Analysing New Challenges Posed By The Development In Government Policies Social Work Essay In this report, I am going to consider the new challenges posed by the latest development in government policies, and particularly those set out in the Every Child Matters and Youth Matters agendas and their impact on Children services especially Looked-After-Children in foster and residential care. I will first and foremost, look at the definition of what Looked-After-Children means, the development of foster and residential care for Looked-After-Children and theoretical knowledge, the legal and policy frameworks underpinning childrens services while considering the implications as well as ethical dilemmas for social work practice. Also, I will look at the effectiveness and impact of multi-agency working, professional autonomy versus employer direction, the balancing act of care and control and how effective the Care Programme Approach is used for those looked after and those leaving care. Furthermore, the regulations that guide placements and the roles of foster carers will also be critically examined. Looked-After-Children as defined in section 22(1) of Children Act 1989, refers to those children in the care of any local authority or provided with accommodation by any local authority for the purpose of safeguarding and promoting their welfare. For example, some children can not remain at home due to adverse conditions such as family crises, a disability or offending, domestic violence, abuse and neglect. Hence the local authority will have to intervene and adequate measures taken to safeguard and promote their welfare and in most cases they are taken into care (foster or residential care). Foster care arrangements is usually a family based care arrangement in which the child is placed in the foster carers own home. The British Association for Adoption and Fostering (2007), states that this kind of care arrangement could be in cases of emergency or non-emergency, for short or long term, on remand or respite, close relatives fostering or private foster carers providing the care need s of the child. However, Residential care is quite similar to foster care, in that adults look after the children on a day to day basis on a pro rota basis. The only difference is that residential care is more of a communal setting where a number of staff works rather than an intimate family unit (as in foster care) in providing the childs needs (DOH 1998a). Some background of foster care and residential care Children were first recognised as individuals in their own right by the implementation of the Children Act 1948 following recommendations from the Care of Children Committee 1946 known as The Curtis Report (Hayden et al 1999) which was influenced by the Monckton Inquiry 1945 into the appalling murder of Dennis ONeill who was in foster care. The report was published with regards to children being deprived of a normal home life during and after the second world war (Barnados 2007) as children from differing social stratifications were brought together into residential care (children homes at the time) as a consequence of the disruption of war . Although the Act established childrens departments and child officers, the general belief was that children should remain (where possible) with their primary caregivers. This decision was influence by John Bowlbys attachment theory in which he emphased the importance of the bond between a child and his/her primary caregiver (mother) and how sepa ration between mother and child could have detrimental effects on the development of the child (Hopkins, 2007). With the introduction of Children and Young Persons Act 1963, local authorities were further given powers and duties to support children in their own homes (Thomas, 2005). This development further strengthened the local authoritys decision and also reinforced Bowlbys attachment theory. However, Waterhouse et al (2002) noted that in the 1970s the use of residential care for primary school children had begun to decline and the shift was towards family oriented care. The 1980s saw a further rapid decline in Looked-After-Children in residential care. Residential care was only viewed as a last resource for adolescents who could not be placed in family settings (Thomas 2005). According to Ibid (2005) foster care or boarding out as it was referred to until the late 1980s, was generally a female orientated voluntary service for looking after deprived children within a family setting with an aim to normalise their experiences whilst in care. It should be noted however, that during the 1970s, 1980s and 1990s residential care received significant negative attention through no fault of the children in care (Thomas 2005). In this era, horrific sexual, physical and emotional abuse was exposed, which led to major inquiries into children in care. The three most notable reports are the Pindown inquiry by Levy and Kahan (1991), the Leicestershire inquiry (1993) and the inquiry into the abuse of children in childrens homes in North Wales, known as the Waterhouse Report, 2000 (Thomas 2005). These reports changed the course of policy and practice. It is evident by Ibid (2005) that although these reports have depicted abuse in residential homes over the years, abuse in foster home goes largely undetected. The Waterhouse report (DOH 2000a) exposed no cohesive regulations of childrens homes adding that the responsible local authorities had adopted a tokenistic approach. Upon this report, recommendations for change were clearly defined. The New Labour Government responded to the report and published major policy initiatives such as Quality Protects and the Care Standards Bill (2000) under which the General Social Care Council (GSCC) was established to monitor and regulate all social care staff. The GSCC has been given the mandate to register all social care staff (qualified and non-qualified alike) and also to produce enforceable codes of conduct and practice (DOH 2000b). These were designed to prevent unsuitable people in the social care sector. Other recommendations included, a childrens complaints officer, criminal record checks, a designated field social work assigned to each Looked-After-Child. Accountable and independent regulatory inspection body was also recommended to inspect re sidential and foster homes to meet National Minimum Standards (DOH 2002). Policy and legislative frameworks. There are a host of policies and legislative frameworks underpinning the holistic needs of Looked-After-Children that I as a social worker must work to accordingly. However, working within the parameters of the law, meeting policy guidance and the constraints of limited resources is a complex task (Brammer 2007). The Children Act 1989 is the main legislative instrument that mandates all child care professionals to work towards the best interest of the child. The Act received royal assent in 1991 and arose from substantial research that exposed poor outcomes and significant failings in safeguarding, protecting and meeting childrens needs (Brayne Carr 2005). This same Act also introduced the welfare check list, to include factors that must be considered when professionals and the courts are deciding the future welfare of a child. Although the philosophy of the Act is that the child is best brought up in their own families, at times this is not in the best interests of the child. The local authority has a duty to safeguard and promote the childs welfare (s.22(3)). The overarching principle of the Act is that the welfare of the child is paramount (s.1) regardless of race, religion or culture. Although section 22(5)[c]) of the Act states that the local authorities must consider the childs religious persuasion, racial origin and cultural and linguistic background, this only applies to looked after children (Brammer 2007). Under the Race Relations (Amendment Act) 2000, local authorities have a duty to promote good race relations and equality, provide a culturally sensitive service and protect against racial discrimination. Whilst articles 3,5,6,8 and 14 within the Human Rights Act 1998 are important to children, it is the UN Convention on the Rights of the Child (UNCRC) that provides a comprehensive framework for children to attain their full potential. It sets out over 40 substantive rights including protection from harm and exploitation, access to education and health and family life (DFES, 2003). The governments first attempt to transforms childrens services was the implementation of the Quality Protects initiative. Also part of a wider set of projects including Sure Start to help children in their early years and their families get off to a better start in life. The Quality Protects programme set out eleven key objectives (DOH 1999) for childrens services requiring all statutory agencies as corporate parents to work together, ensuring that childrens social services provide targeted care for disadvantaged children to enable them to take maximum advantages of universal services, most notably health and education. It was the key mechanism for delivering the aims of the government White Paper, Modernising Social Services (DOH 1998). Local authorities were required to submit a Management Action Plan informing the government on how they were going to meet these objectives. Choice Protects was a further initiative launched in 2002 to improve outcomes for looked-after-children throu gh providing better placement stability, matching and choice (Butler et al 2004) Further changes in legislation followed the death of Victoria Climbià © whilst in private foster care. Lord Lamings report made key recommendations for change following this inquiry (Victoria Climbià © Inquiry 2003). The governments response was a major reform of childrens services and the Children Act 2004, underpinned by the policies set out in Every Child Matters agenda (DFES, 2003). This focused on achieving five key outcomes for services to children, to work towards achieving their full potential. The Five Key Outcomes of the Every Child Matters are: Being healthy, Staying safe, Enjoying and achieving, Making a positive contribution and Achieving economic well-being. The 2004 Act also established childrens trusts, bringing together education, health and social services, as well as a childrens commissioner to promote the interests and views of children. Due to the profound importance of education, section 22(3) of the Children Act 1989 amended by section 52 of the Children Act 2004 now places a duty on local authorities to promote the educational attainment of Looked-After-Children (Brammer 2007). The Framework for the Assessment of Children in Need and their Families (DOH 2000b) and subsequent practice guidance was introduced as part of New Labours Quality Protects programme and replaced what was formerly the orange book. The three inter-related dimensions of the framework: Childs Development Needs, Parenting Capacity and Family and Environmental Factors and its sub-domains present the necessary ingredients to provide a holistic, specialist assessment of need used in conjunction with the Children Act 1989, that carers, other professionals and agencies can contribute. The domains can be adapted for the needs of disabled children and are useful for social workers in assessing placements to establish suitability in meeting the childs holistic needs (DOH, 2000b). Additionally, they can be used to evaluate progress within parenting capacities, particularly if key areas were targeted for improvement, thus determining whether the needs of the child will be sufficiently met if they are to return to their own home environment (Ibid, 2000b). The Common Assessment Framework (CAF) as proposed by Every Child Matters (DFES, 2003) is a relatively new standardised approach for assessing the need for services for children and is part of a wider government programme to provide integrated services including the need to improve multi-agency working. The CAF is a common language in assessment and is based upon the five outcomes of Every Child Matters (Brammer 2007). Every Child Matters raises questions of where looked-after-children should be (or get to) in relation to other children. The agenda aims to improve the lives of looked-after-children holistically across the five outcomes linking to the Articles in the UNCRC (Unicef 2006a). The objective is to improve and integrate childrens services, promote early intervention, provide strong leadership, bringing together different professionals in multi-disciplinary teams in order to achieve positive outcomes for children, using a matrix of specialist, targeted and universal services built around their needs. As a social work, I cannot over emphases the importance gaining a comprehensive assessment of a child under my care. This includes getting an in depth picture/knowledge of the childs past history throughout his/her development as this can inform me and others on how the child is likely to respond to particular situations, together with the possible triggers to specific behaviour of that individual, including the childs view of the relationship with his/her family. It is this kind of information, which Falhberg (1994) says is sometimes missing from case files, which could result in the child not receiving an appropriate care package or placement. However, it is important to remember that when gathering information childrens own perspectives on their experiences are an important source of knowledge as well (DOH 2000a p.8). Furthermore, this knowledge equips me with the significance of sharing information between professionals in order to be able promote and meet the childs holistic nee ds. In the inquiry into the death of Victoria Climbie ¢ and many other previous inquiries in to child protection failures it was noted that the quality of information sharing was often poor, systems were crude and information failed to be passed between hospitals in close proximity to each other. As the report commented, information systems that depend on the random passing of slips of paper have no place in modern services (The Victoria Climbie ¢ Inquiry Report, 2003, p13). In order to provide an effective system for safeguarding and promoting the welfare of children, all agencies and staff working with children need to work together in addressing the issue of information sharing and recording. Although personal information should always be respected (DOH 2000 p.45), there are times when the law permits the disclosure without consent in order to safeguard the child. Therefore, by explaining to the child at the outset why and how information is shared, there are no unnecessary surprises for the child. The Working together document (DOH, 1999) highlights the importance of multidisciplinary and inter agency working in children work force. This document was put together by Department Of Health, Department for Education and Employment and the Home Office. It serves as a guide to inter-agency working with a commitment to sharing information to safeguard and promote the welfare of children. However, it also provides improved guidance on child protection procedures and the newly reformed Local Safeguarding Childrens Boards. Implications on social work practice However, safeguarding children is never free from ethical dilemmas. For example, it is necessary at times to place children in secure accommodation under section 25 of the Children Act 1989 for their own and others safety (Brammer 2007). Although this conflicts with Article 5 of the UNCRC; Right to Liberty along with the potential to diminish their autonomy, this must therefore be a last resort to safeguard their welfare when other strategies and social work interventions have been ineffective. Yet another area of consideration is effective care planning for Looked-After-Children. This is key to promoting and meeting their holistic needs. Care plans should be child-centred/person-centred, needs based, focussed, proactive and written collectively with the social worker, the child (depending on age and maturity), parents/guardians and any prospective caregivers (National Childrens Bureau 2007). In this way, care can be delivered in a more open and understanding way. This also promotes partnership between all stakeholders involved in the care and welfare of the child. However, studies undertaken by Timms Thorburn (2006) revealed that children were not always involved in writing their care plan as much as they should be. The care plan is a continuing process based on a holistic assessment of the childs needs and how they will be met, including a statutory Health Plan and Personal Education Plan (including Special Educational Needs) which sets out targets, providing a valuable individual monitoring mechanism (DfES 2005). The requirement of statutory reviews laid out in section 26 of the Children Act 1989 reinforces this c ontinuum (Thomas 2005). The amendment to section 26 made by section 118 of the Adoption and Children Act 2002, now requires that statutory reviews must be chaired by an Independent Reviewing Officer, who ensures plans are timely, effective and sensitive and focussed on the childs needs, the placement, offering a safeguard to prevent drift and addressing poor practice (DfES 2004 p.8). However, this looks good on paper but the question remains as to how independent the Independent Reviewing Officer can be when he/she is employed or paid by the local authority for the services rendered. Furthermore, the Looked-After-Children documentation also contains significant component identifying age-related Assessment and Action records. These records are an achievable by way of assessing and reviewing the childs well being across the seven dimensions of the childs developmental needs located within the assessment framework (DOH 2000c). Additionally, these records identify each others roles in undertaking the tasks to effectively meet these outcomes (Thomas 2005). Walker et al (2003) emphasises that these records should be Specific, Measurable, Achievable, Related to the assessment and have a clear Time scale (SMART) for completion. Its been argued again and again that meeting the needs of black and minority ethnic children is a complex task for social workers given the controversial debates regarding same race/trans-racial placements (Thomas 2005). Is this not a way of further marginalising, discriminating and oppressing this group of children? Walker (2005) cited by Allain (2007, p137) stresses the importance of . . . developing culturally competent practice for working with children and young people cannot be overstated. Meaning as social workers we need to be cultural sensitive and aware that cultural norms and models of behaviour can vary considerably between communities and even families (Victoria Climbià © Inquiry 2003 para.16.5). However, many children who are fostered are from black and minority ethnic groups with entirely different cultures (Thomas 2005). Although there is research to suggest that trans-racial placements are not damaging to children (Tizard and Phoenix 1989) The Children Act 1989 (Guidance and Regulations vol 3 paras 2.40-2.42 DOH 1991) promotes same race placements within foster settings. As a social worker, I am aware that assessments are not value free. According to City of Salford Community and Social Services (2000) social workers bring their racial, cultural, gender, class and religious values to the assessment. Clear guides to good professional practice are maintained within the GSCC codes of practice. Anti-oppressive practice and valuing diversity in its broadest context are at the heart of social work together with a commitment to partnership working, being non-judgemental, trustworthy and respecting service users rights (GSCC 2002). Dominelli (1997) also states that in their quest to treat everyone as equals, social workers have inadvertently adopted a colour blind approach implying that skin colour is the only difference, thus reinforcing negative assumptions. In addition, she notes social workers have dumped black difficult children on to black foster carers highlighting racist assumptions that they can look after their own. According to Cross (1971 cited by DOH 2000a) black children struggle to gain a positive sense of racial identity. Therefore, in order for child care professional to assess and understand, Cross provides a model of identity that can be used to make the correlation between the childs own perception and their emotional development. Another highlight is that unaccompanied asylum seeking children are not only faced with language and cultural issues, but it appears that the Hillingdon Judgment and its subsequent guidance (LAC (2003)13) DOH 2003) is not being adhered to nationally (Nandy 2005). Children aged 16-17 are still being supported by section 17 of the Children Act 1989 (children in need) rather than having full section 20 status as per the recommendations, providing them with ongoing support post-18. The Children (Leaving Care) Act 2000 provides for, a holistic Pathway Assessment of needs, which informs the Pathway Plan for a continuum of care and support until the age of 21(beyond if in education) with a personal adviser. Section 24 of the Children Act 1989 sets out the duty of the local authority to advise, assist and befriend a child who leaves care after the age of 16. However, research indicates that although Looked-After-Children are the most vulnerable in society, they are pushed to independence ear lier than other children. Stein (2006 p.274) describes care leavers as having accelerated and compressed transitions to adulthood. Educational attainment for Looked-After-Children is unacceptably low, with only 12 per cent achieving 5 GCSEs grades A-C compared to 59 per cent of other children (DfES 2007). Research by Berridge et al (1998 cited by DOH 1998a) indicates that Looked-After-Children, particularly those in residential care are ill-equipped with adequate learning materials and staff felt that they were not sufficiently trained to provide teaching support to those who were excluded from school (DfES 2005). Guidance from the DfES (2005) aims to promote better partnership working including teacher training and additional support for Looked-After-Children in schools. Fundamental to the Children Act 1989 is that the children have a right to be heard and are individuals in their own right. The childs wishes and feelings must be sought by the local authority with regards to aspects of their circumstances and future plans (s.22(5)) and s.1(3) when courts are making decisions. This principle is enshrined in the Article 12 of the UNCRC (Unicef, 2006). However, Thomas (2005) notes that there is still a debate to what extent children have in determining their lives, although the general consensus is that they should be listened to. Leeson (2007) also states that childrens participation in decision making is questioned due to them being regarded as vulnerable, less competent beings in need of social work protection (p.268). Although children may not know what they want, they should be encouraged by all professionals to participate, (according to their age and understanding) thus empowering them and increasing their autonomy. Communication with children is the means to establishing a relationship, even when they do not want to engage verbally. Play, activity based work, writing, drawing and body language are also essential tools in the art of being receptive (Kroll 1995 cited by Thomas 2002). Disabled children may prefer other methods of communication such as the Picture Exchange Communication System, Makaton or British Sign Language. Additionally, they may have their own individual ways of communicating, therefore it is crucial that not only the child care professionals understand, but the child has confidence that their messages are heard (DFES, 2006). Foster carers and residential workers have a similar role. They work closely with social workers, families, doctors, psychologists, teachers, nurses, probation officers and other outside agencies in order to effectively promote the holistic needs of the child. Although it is the responsibility of the social worker to ensure that plans are implemented, reviewed and legalities adhered to, residential staff and foster carers are principally the ones to undertake the tasks (Thomas 2005). Studies by Whitaker et al 1998 cited by DOH (1998) highlighted the extensive skills and personal qualities that are required when working within group living, including knowledge and understanding of development, group dynamics, networks, listening, advocating, physical and emotional support. This list is not exhaustive and not exclusive to residential; on the contrary, foster carers should equally be proficient in these skills. Due to the challenging nature of the profession there is a high turnover of staff within residential care which amounts to children not being able to form adequate attachments, although key worker systems are used to enhance this. Colton et al (2007) analysed a number of factors from researchers and concluded that one of the key issues was emotional exhaustion from increasingly complex, volatile, chaotic and disruptive behaviour displayed by children towards staff. According to Fostering Network (2007) foster care turnover also remains high with a shortage of over ten thousand foster carer placements. According to Barter et al (2004) many children entering the care system are filling an available vacancy rather than receiving an appropriate provision to meet their complex needs. Furthermore, Triseliotis (2002) notes that children are far more likely to be in continual state of insecurity due to the legalities of impermanence and many felt that this anxiety was heightened from the carers behave or else stance. Although research has indicated that authoritative parenting within fostering has had the most success (Wilson et al 2004). The use of Social Learning Theory, particularly in the newly funded Multidimensional Treatment Foster Care Project in England, considers that since behaviour is learned, it can be unlearned via therapeutic methods and living environment. MTFCE is targeted for those with complex needs, challenging behaviour and offenders (DFES, 2003). Under section 26 of the Children Act 1989, children have a statutory right to complain about the services they receive. Amendments to the Children Act 1989 via the Adoption and Children Act 2002 (s.119) created a new section (26(a)) which affords children and young people a statutory right to an advocate in the light of complaints (Brammer 2007). In addition, the White Paper Valuing People (DOH 2001) emphasises that children who have learning disabilities should also be included in such initiatives. Furthermore, Ward (1995) notes that the local authories should be playing a more active role and taking the initiative to seek the views of Looked-After-Children, as some of those looked after, are under duress (p.16) To ensure children are looked after properly, residential homes and fostering agencies are inspected by an independent body. As of April 2007, Ofsted began the regulation and inspection of childrens services building on the previous expertise of Commission for Social Care Inspection (Ofsted 2007). Residential homes are subject two annual visits (one announced and one unannounced) from the inspecting body to monitor performance against both the National Minimum Standards (DOH 2002) and the Childrens Homes Regulations 2001.Internal inspections are required by the registered manager to monitor matters set out in Schedule 6 of the regulations (34(1)) such as, menus, the quality of rotas, staffing and childrens complaints. Under regulation 33, a monthly inspection takes place by a statutory visitor to monitor performance against the five outcomes of Every Child Matters. Including speaking to the children and staff, checking files, care plans and placement plans. A report is then prepared and forwarded to Ofsted. Many children have a troubled and complex past (Thomas 2005). A good home offers attachments, permanence, identity, self esteem and promotes contact (where necessary) with the child and parent(s). Attachment theory originiates from the work of John Bowlby and has been elaborated considerably since. Attachment behaviour is reciprocal rather than unidirectional and is defined as a long enduring emotionally meaningful tie to a particular individual cited by Schaffer (1997 p.127). Bowlby theorised that lack of nurturing from an infants primary care giver would have serious consequences for the child in later life, leading to affectionless psychopathy (the inability to have deep feelings for others) in Rutter (1991). Social workers need to consider how a placement will promote healthy attachments and psychological development, furthermore, how they are provided, maintained and strengthened (Howe 1996, cited by Thomas 2005). However, Robinson (2002) criticises Howe for failing to mention t he attachments within the black community and families in his writings, merely referring to cultural variations. Research identified four attachment behaviours; secure, insecure/avoidant ambivalent and disorganised, secure being the most ideal (Howe 2002). A good understanding of these internalised behaviours assists social workers to differentiate between them when analysing assessments (Ibid 2002). Howe further notes that there is a tendency for these internal working models to become self fulfilling, where by the child acts in certain ways to elicit desired self-confirming reactions from others. However, research indicates that a child does not have to be at the mercy of the past (Schaffer 1992 p.40) depending on how resilient the child is to adapting to lifes complex variables. The prevalence of mental disorders is high in looked-after-children, particularly in residential care compared to foster care. According to the Office of National Statistics (2003) nearly three quarters of the children in residential care (72 per cent) were clinically diagnosed as having a mental disorder. The role of the Child and Adolescent Mental Health Services promotes the mental well being of children through commissioning services via a four-tier strategic framework (level four being severe) following an assessment (DFES, 2003). Most looked-after-children receive services at level three or four. However, Schaffer (1998) suggests that it is difficult to tell who will need therapeutic involvement and who will simply grow out of it. Leighton (In press) states that professionals must be aware of their own personal values and attitudes that could influence decision making as to whether a child will benefit from therapy. Furthermore, she adds that ethical challenges are plentiful in creating and respecting the childs autonomy whilst undertaking a balancing act with safeguarding their welfare and promoting their best interests. Thomas (2005, 2002) urges caution with the overall concept of best interests of the child as he suggests that it could be oppressive and dangerous if misused, particularly with regards to who is making the decisions in the best interests for example; professionals, the family or the child themselves. Although there is good evidence from research to indicate positive outcomes for children, these cannot assume a one size fits all solution to ensuring a desired individual result for there are other intricacies that need to be taken into account, for example religion and culture. With regards to child welfare, Fox-Harding (1997) states that the Children Act 1989 is in ideological conflict concerning the role of the state. She notes four different value positions; liassaz-faire, state paternalism, parents rights and childrens rights. The latter two are appropriate here. Firstly, she notes that the perspective of parents rights acts as a belief

The Role of Inflammation in the Advancement of Chronic Obstructive

The Role of inflammation in the advancement of Chronic Obstructive Pulmonary disease. Introduction Chronic obstructive pulmonary disease (COPD) is the collective term used for respiratory disease, including chronic bronchitis and emphysema. The disease develops slowly and is often not diagnosed until it is advanced and irreparable damage is evident (Global Initiative for Chronic Obstructive Lung Disease, 2011). The disease is characterised by airflow obstruction and lung parenchyma.Parenchyma, associated with emphysema, is the permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by airway wall destruction, without obvious fibrosis (Demirjian and Kamangar, 2011; Atsuyasu et al. , 2007). Airflow limitation results from loss of elastic recoil and reduced airway tethering. Chronic bronchitis leads to narrowing of airway calibre, increasing airway resistance. Patients may display signs of one or both of these diseases as they frequently occur in associat ion with each other.Common symptoms are wheezing, coughing, shortness of breath on exertion, production of sputum and recurrent respiratory infections (Global Initiative for Chronic Obstructive Lung Disease, 2011). There are a host of triggers that exacerbates symptoms including smoking and environmental pollutants, resulting in chronic inflammation (Kazuhiro and Barnes, 2009; Manuel et al. , 2002). â€Å"Inflammation is defined as the presence of redness, swelling and pain, caused by the presence of edema fluid and the infiltration of tissues by leukocytes† (Nairn & Helbert, 2002, pp15).Inflammation is a key biological response to eliminate harmful pathogens, but there is increasing evidence to suggest that chronic inflammatory responses are accountable for the advancement of this disease and other chronic diseases including coronary artery disease, cancer, rheumatoid arthritis and multiple sclerosis. This review explores the correlation between COPD and inflammation and the subsequent effects on the systemic systems and the link with coronary heart disease (Mantovini et. al. , 2008; Mohr & Pelletier, 2005; Sattar et. al. , 2003; Powells et. al. , 2001; Danesh et. al. 2000; Murdoch & Finn, 2000). Methods Search engines used were Google Scholar and Pub Med using the keywords COPD, inflammation, disease, apoptosis, interleukin 8, cytokines, coronary heart disease and COPD. Searches were restricted to dates between 1999 and 2012. The majority of the included papers were obtained from the reference lists of other research papers. COPD risk factors: COPD is strongly linked with repeated exposure to noxious particles or gases and cigarette smoke has been acknowledged as a prime risk factor (Fabri et. al. , 2006; Lindberg et al. , 2005; Pauwels and Rabe. 2004, Association for Respiratory Technology & Physiology, 2000). Smokers have an increased prevalence of respiratory and lung function abnormalities, a greater rate of decline in FEV1 and a higher mortality rate than non-smokers (World health organisation, 2012). However, only a third of smokers develop COPD which implies that other factors such as genetics and environment are involved (Agusti, 2003). Exposure to air pollution caused by heating and cooking with bio-mass fuels in poorly ventilated housing are major risk factors for COPD, especially in developing countries (Pauwels & Rabe, 2004).The most documented COPD genetic risk factor is the deficiency of Alpha -1-antitrypsin, a polymorphic glycoprotein which offers anti-protease protection against the serine proteinease, neutrophil elastase (Abboud & Vimalanathan, 2008; Devereux, 2006; Siafakas & Tzortzaki, 2002; Fabbri et al. , 2006). Research studies (in vitro) indicated that Alpha – 1 – antitrypsin also possesses anti-inflammatory capabilities that extend beyond its anti-protease role, including regulation of CD14 expression (Nita, Serapinas & Janciauskiene, 2007), inhibition of TNF-? ene upregulation (Subramaniyam , 2007) and inhibition of lipopolysaccharide activation of monocytes and neutrophil migration (Janciauskiene et al. , 2004). Deficiency of Alpha -1-antitrypsin is associated with COPD progression in both smokers and non-smokers, although far greater in smokers (Bergen et al. , 2010; Fabbri et al. , 2006; Siafakas and Tzortzaki. , 2002; Foos et al. , 2002). Studies have suggested that smoking with this genetic disposition will substantially increase risk of developing COPD (Kohnlein & Welte, 2008; Pauwels & Rabe, 2004; Foos et al. , 2002; Siafakas & Tzortzaki, 2002; Association forRespiratory Technology and Physiology, 2000). Pathogenesis of COPD Exposure to noxious particles â€Å"†¦ triggers cytokine activation to recruit cells, which play a vital role in removing the noxious agents†¦ † (Nairn & Helbert, 2007, pp22). An infiltration of neutrophils, eosinophils and CD8+ T-lymphocytes into the airways and lungs follows (Demedts et al, 2006; Mahler et al. , 2004; Sopo ri, 2002). High concentrations of chemokines, interleukon-8 (IL8) and tumor necrosis factor-a have been found in patients with COPD which are potent activators and chemo-attractants of leukocyte subpopulations (Murdoch and Finn, 2000; Yamamoto et al. 1997). The interaction of chemo-attractants with leukocytes initiates a series of coordinated and cellular events, which includes phagocytosis, release of soluble anti-microbials and formation of reactive oxygen compounds involved in intracellular killing (Murdoch & Finn, 2000). Neutrophils and macrophages release elastase, stimulating the production of mucus to assist in ridding the airways of the irritants and subsequent waste generated by the inflammatory response (Shimizu et al. , 2000).Other processes such as neutrophil necrosis and reactive oxygen species further contribute to mucus hyper secretion (Kim and Nadel, 2004; Mizgerd, 2002). When an inflammatory response is no longer needed protease inhibitor cells dampen the response. Research suggests that the inhibiting response in COPD is not triggered and chronic inflammation presides, representing a crucial mechanism in the pathogenesis of COPD (Demedts et al. , 2006; Hodge et al 2004). Hypersecretion of mucous can inhibit the ciliated epithelium from transporting mucus from the airways.Subsequent delays in bacteria clearance results in bacterial colonisation, which stimulates further granulocytic recruitment to the airways, escalating the inflammatory response. Chronic inflammation is linked with tissue destruction, imbalance of proteolytic and anti-proteolytic activity, hyper secretion of mucus, increased apoptotic activity and oxidative stress which contribute to the progression of COPD. Long term, chronic inflammation can result in widespread airway and parenchymal cell destruction which further contributes to disease progression (Mantovini et al. 2008; Mohr and Pelletier, 2005; Sattar et al. , 2003; Sopori, 2002; Powells et al. , 2001; Danesh et al. , 2 000; Murdoch & Finn, 2000). Research suggests that macrophages express a markedly lower amount of toll like receptors in COPD suffers, resulting in a decreased recognition of microbes, facilitating damaging microbial colonisation, which may explain the increased amount of respiratory infections in COPD sufferers (Schneberger, 2011; Droemann et al. 2005). Infection initiates a biased release of inflammatory mediators which may escalate the pathogenesis of the disease (Gaschler et al. 2009, Ritter et al. , 2005; Sethi, 2000). Oxidative stress Demedts et al, 2005 found that the alveolar macrophages of COPD sufferers produced much higher levers of oxygen radicals and myeloperoxide which are important for the destruction of inter-cellular pathogens. Oxidant/anti-oxidant imbalance can result in the inactivation of anti-proteinases, airspace epithelial injury, increased sequestration of neutrophils in the pulmonary microvasculature, and gene expression of pro-inflammatory mediators, all of which exacerbate the inflammatory response (MacNee, 2000 Drost et al. 2005). Emphysema like changes have been show in the CT scans of malnourished women, suggesting that diet has an effect on lung tissue in the absence of smoking (Coxon et al. , 2004). Dietary supplementation then may be a beneficial therapeutic intervention in this condition, as antioxidants not only protect against the direct injurious effects of oxidants, but fundamentally alter the inflammatory events that play an important part in the pathogenesis of COPD (Coxon et al. , 2004; MacNee, 2000). Apoptosis and COPDResearch suggests that there is increased apoptosis of epithelial cells in smokers and COPD patients. Apoptosis persisted despite smoking cessation which suggests apoptosis may play a part in driving the inflammatory process and progression of the disease (Hodge et al. , 2003). Increased apoptotic alveolar epithelial and endothelial cells in the lungs not counterbalanced by proliferation and sufficient ph agocytic clearance results in destruction of lung tissue and development of emphysema (Demedts et al, 2006; Kazutetsu, Naoko & Atsushi, 2003; Barnes et al. 000) Apoptosis can be induced by various stimuli, including oxidative stress, elastase and infiltrating cytoxix CD8 + T cells which are all associated with inflammation (Kazutetsu, Naoko and Atsushi, 2003). Efferocytosis allows for the removal of apoptotic material with minimal inflammation and prevents the development of secondary necrosis and ongoing inflammation. Failure of this highly conserved process may contribute to disease pathogenesis by impeding both the resolution of inflammation and the maintenance of alveolar integrity (Mukaro and Hodge, 2011; Taylor et al. , 2010; Morimoto et al, 2006; Vandivier et al, 2006).Proteolytic/Anti-proteolytic activity Mukaro and Hodge, (2011) suggests that in COPD there is an imbalance between proteolytic and anti-proteolytic activity, a prominent factor in the pathogenesis of this disea se, which may contribute to lung parenchymal destruction. Research has also found that macrophages demonstrate defective phagocytic ability against common airways pathogens in COPD (Taylor et al. , 2010; Hodge et al. , 2003), The findings of Berenson et al. , (2006), supported a paradigm of defective immune responsiveness of alveolar macrophages, but found no significant differences in the blood macrophages of COPD sufferers.Taylor (2010) believes that persistence of bacteria as a consequence of defective phagocytosis may be a chronic antigenic drive for chronic inflammation. Systemic effects of COPD â€Å"Chronic inflammation is present in all disease processes, mediating all stages of disease from initiation, manifestation and maturation† (Sompayrac 2003, pp12). Compelling epidemioligical data links systemic inflammation to atherosclerosis, ischemic heart disease, strokes, and coronary deaths (Danesh, Whincup and Walker, 2000; Ridker, 1999).These observations have been stro ngly supported by experiments that show the direct effects of certain inflammatory markers, such as C-reactive protein (CRP), on the pathogenesis of plaque formation (Zwaka, Hombach and Torzewski, 2001; Lagrand, Visser & Hermens, 1999). A study by Gan, Man & Sin, 2003) found that patients with COPD were 2. 18 times more likely to have an elevated circulating c-reactive protein levels. Evidence strongly suggests that there is relationship between COPD, systemic inflammation, and cardiovascular diseases.Studies show that patients with mild-to-moderate COPD, cardiovascular disease is the leading cause of morbidity and mortality (Din and Man, 2009; Pope et al, 2003). As these diseases share similar risk factors such as smoking, increased age and inactivity, causation is unclear and is likely to be due to multiple factors, including lifestyle, environmental and genetics (Gan, 2005; Agusti et. al. 2003). Discussion Inflammation, it would appear, is a double edged sword; crucial for cleara nce of pathogens and recovery from injury; but can also contribute to life threatening chronic diseases (Smith, 1994; Sporori, 2003).COPD is a complex condition, influenced by multiple genetic and/or environmental risks. A cycle of low grade inflammation is the consequence, with destructive and damaging effects, resulting in mucus hyper-secretion, airway obstruction, increased elastase production and oxidative stress, which encourage further inflammation and destruction. COPD is associated with exposure to smoke or noxious gases, however inflammation may also be caused by irritation from coughing, wheezing, respiratory infections and mucus production. Most exacerbations of COPD are caused by bacterial or viral infection (Sanjay and Murphy, 2008; Sanjay 2008).Mucosal cells produce mucus, which irritates the airways causing airway obstruction. This subsequently reduces FEV1, and cough effectiveness, which contributes to the build up of bacterial mucus. Imbalance between proteolytic an d anti-proteolytic activity presides, creating an ideal environment for infection. Research suggests that macrophages express a markedly lower amount of toll like receptors in COPD suffers, resulting in a decreased recognition of microbes, facilitating damaging microbial colonisation, which may explain the increased amount of respiratory infections in COPD sufferers (Schneberger,2011; Droemann et al. 005). Infection initiates a biased release of inflammatory mediators which may escalate the pathogenesis of the disease (Gaschler et al. , 2009, Ritter et al. , 2005; Sethi, 2000). Researchers have found high levels of neutrophils, macrophages and CD8+ cells in ex smokers (Lappers et al. , 2006). Thus, suggesting that inflammatory changes in COPD, although initially induced by inhalation of noxious agents, are fundamental to the disease process, rather than to the initial trigger per se (Gamble et al, 2007). Studies have shown that airway epithelial and T-cell apoptosis in COPD continue s despite smoking cessation (Lappers et al. 2006). Excess apoptosis results in inappropriate destruction of host tissue, leading to atrophy and tissue necrosis, which in turn further stimulates the inflammatory response and perpetuates the situation. We have already ascertained an imbalance between the proteolytic and anti-proteolytic activity and this is another factor that contributes, resulting in failure to resolve the inflammatory reaction rapidly (Hodge et al. , 2005). Un-cleared apoptotic cells may undergo secondary necrosis with discharge of injurious cells contents resulting in tissue destruction and further inflammation.Inability to remove apoptotic cells and debris created overwhelms the normal clearance mechanisms, stimulating further inflammatory responses, further contributing to COPD pathogenesis (Sanjay and Murphy, 2008; Sanjay 2008). It has been identified that the immune system may become less responsive, the longer that chronic inflammation presides, which may lea d you to believe that this would initiate an inhibitory effect on the inflammatory process. However this is not the case and the inflammatory process persists, presenting as low level chronic inflammation.In addition a less responsive immune system is more susceptible to infection, exacerbating the inflammatory response (Sanjay and Murphy, 2008; Sanjay 2008). There appears to be strong epidemiological links between cardiovascular disease and COPD. The same inflammatory markets are evident in both suggesting a systemic link. Both diseases share similar risk factors, so it is difficult to determine initiation of the diseases. One could also argue that the debilitating effects of COPD, which include a reduced exercise capacity, dyspnoea and deconditioning increase the risk of cardiovascular disease development.In conclusion, it appears that adaptive immune is active in the disease progression of this complex pathophysiological syndrome. Particularly elaboration and production of cytoki nes, chemical mediators and auto-antibodies, which directly injure respiratory tissues. CD8+ mediates tissue destruction, whereas CD4 orchestrates inflammatory responses, which facilitates humoral immune responses (Gadgill and Duncan 2008). Conclusions made in this review are only valid within the boundaries of the research and papers used. 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Available at: http://journal. publications. chestnet. org/article. aspx? articleid=1081469 (Accessed 4 November 2011). Bergin, D. A. , Reeves, E. P. , Meleady, P. , Henry, M. , McElvaney, O. J. , Carroll, T. P. , Condron, T. P. , Chotirmall, S. H. , Clynes, M. , O’Neill, S. J. , McElvaney, N. G. , (2010) ? -1 Antitrypsin regulates human neutrophil chemotaxis induced by soluble immune complexes and IL-8.J Clin Invest. 2010; 120(12):4236–4250. Doi:10. 1172/JCI41196 [ Online] Available at: http://www. jci. org/articles/view/41196 (Accessed: 21 August 2012). Brunner, T. , Mueller. C. , (2003) Apoptosis in disease: about shortage and excess. Essays Biochem. 2003;39:119-30. [Online]. Available at : http://www. ncbi. nlm. nih. gov/pubmed/14585078 (Accessed: 30 July 2012). Canavan, J. , Garrod, R. , Marshall, J. , Jackson, D. , Ansley, P. , Jewell, A. , (2007) ‘Measurement of the acute inflammatory response to walking exercise in COPD: effects of pulmonary rehabilitation’. International Journal of COPD, 2007:2(3) 347-353.Cosio, G. , Majo, J. , Cosio, M. , (2002) Inflammation of the Airways and Lung Parenchyma in COPD. Chest. May 2002. 121(5_wuppl):160s-165S [Online] Available at: http://www. ncbi. nlm. nih. gov/pubmed/12010846 (Accessed: 5 November 2011) Danesh, J. , Whincup, P. , Senior M. C. , Lennnon, L. , Thomson, A. , Appleby, P. , Gallimore, J. R. , Pepys, M. B. ,(2000) Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses’ BMJ 2000;321:199 [online] Available at: http://www. bmj. com/content/321/7255/199. full (Accessed: 21 August 2011). Demedts, I. K. , Demoor, T. Bracke, K. R. , Joos, G. F. , Brusselle, G. G. , (2006) ‘Role of apoptosis in the pathogenesis of COPD and pulmonary emphysema’. Respiratory Research, 7:53. [Online] Available at: http://www. ncbi. nlm. nih. gov/pmc/articles/PMC1501017/ (Accessed: 14 November 2011). 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The Benefits of Argumentative Essay Examples

The Benefits of Argumentative Essay Examples Your essay should consist of recent statistics and data from reliable sources. Essentially anything that has to be understood before reading the remainder of the essay is background info, and ought to be included in the introduction. Look through the list of topics cautiously and commence making a mental collection of the evidence you may use on topics you prefer. A superb method to tell if your topics is an argument topic is to see whether you can debate your topic utilizing the info you find. The Honest to Goodness Truth on Argumentative Essay Examples You could also see concept essays. When you develop this kind of essay, you should make your claims by your composition so it will be open fordebate. You might also see essay examples. In order to supply an in-depth understanding about the argumentative essay, it's better to take a look at some of the greatest examples of argumentative essay. It is very important to note an argumentative essay and an expository essay could be similar, but they vary greatly with regard to the quantity of pre-writing and research involved. There are four key components to each argumentative essay, and you're likely to have to include them should you need your essay to convince your readers. An argumentative essay aim is to take one specific viewpoint out of the other viewpoints. Writing an argumentative essay can occasionally be confusing since you don't necessarily understand how to compose a convincing argument. Writing a persuasive, argumentative essay can be challenging, and at times it can find a little confusing. Whether it's an argumentative or expository essay which you're writing, it is essential to develop a clear thesis statement and an obvious sound reasoning. Based on your argument, the variety of body paragraphs you have will vary. The variety of body paragraphs depends upon the sort of argument you need to introduce. 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The argumentative essay has a certain format that must be followed to blow the mind of the reader, and it's especially helpful for students together with the corporate when making strategic proposals. Whatever the truth is, make sure the essay is appealing and generate interest among the readers to get involved in the debate. A thesis is the principal argument of the entire paper. Argumentative arguments are only arguments that are written back on paper. An argumentative essays objective is to convince your reader to hold up your side of the argument. They use logic, facts, and reasoning to determine the victor. An argumentative essay is a sort of thesis or composition in which you have to present your view and endeavor to convince others your facts and arguments are correct. Writing an argumentative essay is a skill that anyone in school should know, although it can be useful outside the classroom, too. Frequently students are permitted to choose argumentative essay topics independently, which can be both challenging and interesting at the very same time. Not only that but they will be able to access their online courses and be able to follow the lecture through powerpoints. When asking us how to begin an argumentative essay, many students forget that they have to begin with an outline. Argumentative Essay Examples Ideas It is very important to che ck reviews about essay writing services in order to be confident they can deliver your task before the deadline. Should you need extra assistance with editing and revising, there are a few free tools readily available online. Many teachers will supply you with books, websites, and documents you may use for your essay. Be sure you read online essay writing service reviews in order to know what sort of material you are spending for. Argumentative Essay Examples - the Story The chief reason why somebody is writing an argumentative essay is to try to persuade or sway another individual or perhaps a group of men and women in your rightness in a particular theme. The topic chosen for the purpose should be attractive in the view of many readers. If you've completed a nice job, they will observe things your way and your essay is going to be a success. Today, the entire the heart of socialism was transformed into a small device that occupies the palm of your hand.

Essay on Office of Homeland Security - 1434 Words

Office of Homeland Security Just as our parents and grandparents remember where they were and what they were doing when President John F. Kennedy was shot, so will it be with this generation when asked the same questions pertaining to September 11, 2001. This horrific event will be a scar on the body of our wonderful nation until the end of time. Parents lost children, children lost parents, spouses lost their heartmates – so much anguish and emotional devastation demands that something be done to prevent tragedy like this from occurring in the future. This is why President George W. Bush created the Office of Homeland Security. This cabinet-level position was created in lieu of the 9-11 attack on the World Trade Center and the†¦show more content†¦In the area of national strategy, the Office will work with executive departments and agencies and state and local governments to make certain the adequacy of the national strategy for detecting, preparing for, preventing, protecting against, respondi ng to, and recovering from terrorist threats or attacks in the U.S. and will revise that strategy as necessary. In the detection department, the Office will identify priorities and coordinate efforts for collection and analysis of information within the United States regarding threats of terrorism, and activities of terrorists within the country. It will also identify priorities for the gathering of intelligence outside the U.S. in regards to threats of terrorism within the nation. 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