The One Day in Jozefow Initiation to Mass Murder free essay sample

The main question raised in the One Day in Jozefow: Initiation to Mass Murder article is that of how did the Nazis get the manpower and successfully eliminate so many Polish Jews in a mere matter of eleven months. What is found is that the Nazis did not actually use real military force to clear the ghettos. When they were given orders leaders did not have enough men to successfully clear ghettos, therefore, they turned to normal everyday Polish police. They also gathered prisoners of war who were from places like the Ukraine and Lithuania. The Nazis also took order police who were stationed in the German government. This gave them the numbers they were so lacking and that were vital to them to take on their orders. Many of these people had not been brought up and raised in Nazi Germany and therefore they did not have the values and anti-Semitism that other soldiers had. We will write a custom essay sample on The One Day in Jozefow: Initiation to Mass Murder or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page They were simply given orders and expected to carry them out. Some men did not want to participate in shooting Jews at point-blank range and yet some did without even giving a second thought as to why they were killing these people. It seemed as if some of the men were merely just going along with what their peers were doing in order not to be singled out or labeled a coward. This concept is a very interesting one. How could the Nazis succeed in simply convincing men who were not necessarily racists towards Jewish people to kill them so mercilessly? Surely the men could have refused and went against orders but instead, they chose to kill innocent people. After the Holocaust, the men were uncomfortable talking about what they did. They did not feel good about it nor did they take any sort of pride. They themselves probably wondered how they were so easily persuaded and convinced to murder so many Polish Jews. Genocide and Public Health: German Doctors and Polish Jews examines the roles that German Doctors played in the mass murder of the Polish Jews. It looks especially at the public health officials. First, it shows the fact that German Doctors thought Poland, in general, was a filthy country that was filled with uncivilized people. They thought health conditions in Poland were not even suitable for animals. Things like this helped contribute to anti-Semitism because people thought no respectable human being would ever choose to live in such conditions. The health system that was set up was to first serve the German people above anyone else. There was an emphasis on preventing the spread of any diseases that the Polish Jews may be carrying. This like this helped justify things like mass murder. It gave people all the more reason to think that it was okay to eliminate Jewish people from the country entirely. They restricted the movement of Jews in order to prevent any diseases from traveling and keep in mind the well being of the Polish people and above all the Germans. The doctors began to look at Jewish people not as patients but instead as a danger to everyone else. They did not focus on getting them better but instead thought it would be best just to abolish the Jewish people entirely. These ides infiltrated other people’s heads and fueled their hatred. The Jewish people were putting them at risk for sickness and disease and they did not seem to care. This gave the people all of the more reason to want them to be murdered. These two articles were extremely interesting to explore and compare. It is amazing the influence certain people can have on others. On one hand you have the doctors being able to spread bold lies and make citizens feel that the Jewish people were the cause of a lot of disease and they could not be cured therefore they had to be eliminated. On the other hand you had people who were not necessarily against Jewish people being persuaded to kill them for beliefs that they themselves did not possess.

Free Essays on Life Stages

In Light Of Erikson’s Psychosocial Stages I think, over the period involving the first 12 to 18 months of my life, I was able to resolve the first of Erikson’s psychosocial stages adequately. My mother, during this time, supplied me with appropriate provisions of food, warmth, and the comfort of physical closeness. This allowed me to understand and accept that objects and people exist even when I could not see them. This was a major stepping stone where the foundation for trust became important. In the next period of my life, from about 18 months to 3 years of age, I was able to resolve the second of Erikson’s psychosocial stages adequately. It was around this time that I began to assume important responsibilities for my own self-care like feed myself, using the toilet on my own, and dressing myself. It was during this time also that I began learning many physical skills, including walking and grasping. I learned that I could control my own body and its functions . And that I could make things happen. Erikson’s third stage of psychosocial development came between the ages of 3 to 6 years of age. I was continuing to become more assertive and to take more initiative. My mother and my teachers at school encouraged this. I am pretty sure that I was allowed, at least on he weekends (Ha Ha), to choose what I wanted to wear and was allowed to wear whatever I had chosen. In the fourth stage of Erikson’s psychosocial development, between 6 and 12 years of age, I was learning to see the relationship between perseverance and the pleasure of a job well done. I was physically and mentally ready to be productive and to do work on my own. I also had many friends at this time and understood what friendship was. I believe that having good friends and peers helped me to be productive and succeed in both school and after school activities. In Erikson’s â€Å"identity vs. role confusion†, stage 5, from 12 to 18 years of age, I was ga ining a sense... Free Essays on Life Stages Free Essays on Life Stages In Light Of Erikson’s Psychosocial Stages I think, over the period involving the first 12 to 18 months of my life, I was able to resolve the first of Erikson’s psychosocial stages adequately. My mother, during this time, supplied me with appropriate provisions of food, warmth, and the comfort of physical closeness. This allowed me to understand and accept that objects and people exist even when I could not see them. This was a major stepping stone where the foundation for trust became important. In the next period of my life, from about 18 months to 3 years of age, I was able to resolve the second of Erikson’s psychosocial stages adequately. It was around this time that I began to assume important responsibilities for my own self-care like feed myself, using the toilet on my own, and dressing myself. It was during this time also that I began learning many physical skills, including walking and grasping. I learned that I could control my own body and its functions . And that I could make things happen. Erikson’s third stage of psychosocial development came between the ages of 3 to 6 years of age. I was continuing to become more assertive and to take more initiative. My mother and my teachers at school encouraged this. I am pretty sure that I was allowed, at least on he weekends (Ha Ha), to choose what I wanted to wear and was allowed to wear whatever I had chosen. In the fourth stage of Erikson’s psychosocial development, between 6 and 12 years of age, I was learning to see the relationship between perseverance and the pleasure of a job well done. I was physically and mentally ready to be productive and to do work on my own. I also had many friends at this time and understood what friendship was. I believe that having good friends and peers helped me to be productive and succeed in both school and after school activities. In Erikson’s â€Å"identity vs. role confusion†, stage 5, from 12 to 18 years of age, I was ga ining a sense...

Venus Flytrap Facts (Dionaea muscipula)

Venus Flytrap Facts (Dionaea muscipula) The Venus flytrap (Dionaea muscipula) is a rare carnivorous plant that captures and digests its prey with fleshy, hinged jaws. These jaws are actually modified portions of the plants leaves. The plant gets its common name for Venus, the Roman goddess of love. This refers either to the plant traps supposed resemblance to female genitalia or to the sweet nectar it uses to lure its victims. The scientific name comes from Dionaea (daughter of Dione or Aphrodite, the Greek goddess of love) and muscipula (Latin for mousetrap). Fast Facts: Venus Flytrap Scientific Name: Dionaea muscipulaCommon Names: Venus flytrap, tippity twitchetBasic Plant Group: Flowering plant (angiosperm)Size: 5 inchesLifespan: 20-30 yearsDiet: Crawling insectsHabitat: North and South Carolina coastal wetlandsPopulation: 33,000 (2014)Conservation Status: Vulnerable Description The Venus flytrap is a small, compact flowering plant. A mature rosette has between 4 and seven leaves and reaches a size up to 5 inches. Each leaf blade has a petiole capable of photosynthesis and a hinged trap. The trap contains cells that produce the red pigment anthocyanin. Within each trap are trigger hairs that sense touch. The edges of the trap lobes are lined with stiff protrusions which lock together when the trap closes to prevent prey from escaping. Habitat The Venus flytrap lives in damp sandy and peaty soil. It is native only to the coastal bogs of North and South Carolina. The soil is poor in nitrogen and phosphorus, so the plant needs to supplement photosynthesis with nutrients from insects. North and South Carolina get mild winters, so the plant is adapted to cold. Plants that do not undergo winter dormancy eventually weaken and die. Northern Florida and western Washington host successful naturalized populations. Diet and Behavior While the Venus flytrap relies on photosynthesis for most of its food production, it requires supplementation from proteins in prey to meet its nitrogen requirements. Despite its name, the plant primarily catches crawling insects (ants, beetles, spiders) rather than flies. In order for prey to be captured, it must touch the trigger hairs inside the trap more than once. Once triggered, it only takes about a tenth of a second for the trap lobes to snap shut. Initially the fringes of the trap loosely hold the prey. This allows very small prey to escape, as they arent worth the energy expenditure of digestion. If the prey is large enough, the trap fully closes to become a stomach. Digestive hydrolase enzymes are released into the trap, nutrients are absorbed through the leafs interior surface, and 5 to 12 days later the trap opens to release the remaining chitin shell of the insect. Large insects can damage the traps. Otherwise, each trap can only function a few times before the leaf dies and must be replaced. Suitable prey must be small enough to fit within the trap but large enough to supply enough nutrients. de-kay / Getty Images Reproduction Venus flytraps are capable of self-pollination, which occurs when pollen from the plants anthers fertilize a flowers pistil. However, cross-pollination is common. The Venus flytrap does not capture and eat insects that pollinate its flowers, such as sweat bees, checkered beetles, and long-horned beetles. Scientists arent entirely certain how the pollinators avoid being trapped. It could be that the color of the flowers (white) attracts pollinators, while the color of the traps (red and green) attracts prey. Other possibilities include scent differences between the flower and trap, and flower placement above the traps. After pollination, the Venus flytrap produces black seeds. The plant also reproduces by dividing into colonies from rosettes that form beneath mature plants. Conservation Status The IUCN lists the Venus flytraps conservation status as vulnerable. The population of plants in the species natural habitat is decreasing. As of 2014, an estimated 33,000 plants remained, all within a 75 mile radius of Wilmington, NC. Threats include poaching, fire prevention (the plant is fire resistant and relies on periodic burning to control competition), and habitat loss. In 2014, North Carolina Senate Bill 734 made collecting wild Venus flytrap plants a felony. Care and Cultivation The Venus flytrap is a popular houseplant. While its an easy plant to keep, it has certain requirements. It must be planted in acidic soil with good drainage. Usually, it is potted in a mixture of sphagnum peat moss and sand. Its important to water the plant with rainwater or distilled water to provide the proper pH. The plant needs 12 hours of direct sunlight per day. It should not be fertilized and should only be offered an insect if it appears unhealthy. In order to survive, a Venus flytrap requires exposure to a period of cooler temperatures to simulate winter. While the Venus flytrap will grow from seed, it is usually cultivated by dividing the rosettes in the spring or summer. Commercial propagation for nurseries occurs in vitro from plant tissue culture. Many interesting mutations for size and color are available from nurseries. Uses In addition to cultivation as a houseplant, Venus flytrap extract is sold as a patent medicine named Carnivora. The American Cancer Society states that Carnivora is sold as an alternative treatment for skin cancer, HIV, rheumatoid arthritis, herpes, and Crohns disease. However, the health claims have not been supported by scientific evidence. The purified active ingredient in the plant extract, plumbagin, does show antitumor activity. Sources DAmato, Peter (1998). The Savage Garden: Cultivating Carnivorous Plants. Berkeley, California: Ten Speed Press. ISBN 978-0-89815-915-8.Hsu YL, Cho CY, Kuo PL, Huang YT, Lin CC (Aug 2006). Plumbagin (5-Hydroxy-2-methyl-1,4-naphthoquinone) Induces Apoptosis and Cell Cycle Arrest in A549 Cells through p53 Accumulation via c-Jun NH2-Terminal Kinase-Mediated Phosphorylation at Serine 15 in Vitro and in Vivo. J Pharmacol Exp Ther. 318 (2): 484–94. doi:10.1124/jpet.105.098863Jang, Gi-Won; Kim, Kwang-Soo; Park, Ro-Dong (2003). Micropropagation of Venus fly trap by shoot culture. Plant Cell, Tissue and Organ Culture. 72 (1): 95–98. doi:10.1023/A:1021203811457Leege, Lissa (2002) How Does the Venus Flytrap Digest Flies? Scientific American.Schnell, D.; Catling, P.; Folkerts, G.; Frost, C.; Gardner, R.; et al. (2000). Dionaea muscipula. The IUCN Red List of Threatened Species. 2000: e.T39636A10253384. doi:10.2305/IUCN.UK.2000.RLTS.T39636A10253384.en

Bereavement Essay Example | Topics and Well Written Essays - 6250 words

Bereavement - Essay Example The mourner's history of losses, personality style, and pre-morbid mental health adjustment also impact the grief process (Rando, 1993). Clearly, the traumatic circumstances that surrounded the events of September 11th added an unprecedented degree of complexity to the grief of those who experienced losses that day. While it appears reasonable that issues related to the trauma itself must be resolved before there is sufficient intrapsychic energy to deal with the loss per se, parsing out the differences between the symptoms of post-traumatic stress and those of complicated grief can be challenging (Figley, Bride, & Mazza, 1997). Depressive symptoms may also be confusing and interfere with recognition of and response to the symptoms of complicated grief (Rando, 1993). Especially in the initial phases of recovery from a traumatic loss, individual interventions are an appropriate modality of treatment. The process of assessment for the variety of co-morbid risks that can accompany traumatic loss is facilitated in individual sessions. There is also the opportunity to provide support and problem solving that specifically address the challenges that have been generated by both the loss itself, the circumstances surrounding it, and its intrapsychic concomitants. But because of the sense of emotional isolation that commonly accompanies both trauma and the loss of a significant other, support groups are an excellent adjunct to individual treatment (Figley et al., 1997). Studies report the importance of the supplemental support system such groups provide, and the critical necessity for the normalizing discussions about reactions and difficulties that take place in group sessions (Yule & Udwin, 1991; Fitzgerald, 1994; Rando, 1988; Underwood & Dunne-Maxim, 1992). In later stages of recovery, group support can be essential to the process of going on with life. Immigrants and Cultural Minority Groups Given both the effect that culture has on grief and bereavement, and the disproportionate rates of infant death, particularly among Afro-Caribbean immigrants compared to European, Latin American, Mexico and those born in the United States, we sampled providers serving this community. The importance of cultural competence cannot be overstated. Cultural competence should include: providers being aware of their own cultural traditions and beliefs, learning about the cultural beliefs and customs of the community being served, genuine appreciation and respect for cultural diversity and being empathic, flexible and prepared to tailor the care to meet individual and family needs of those that have suffered a loss (ACOG). The Needs of People Experiencing Loss, Grief and Bereavement There was broad agreement that the needs of individuals in relation to loss, grief and bereavement are highly individualised. There is a wide range of grieving styles and experiences. However, the fundamental needs of bereaved individuals are for support and acceptance. This includes recognition and validation of their grief and grieving style, from family, friends, employers and the general community. Arguably, grief and bereave

Copula, risk modelling and mathematic finance Essay

Copula, risk modelling and mathematic finance - Essay Example People and teams can influence future performance, though the cause and effect relationship lies more in the present than in the past. The ability of investment to produce future returns is fraught with probabilities. The alternative chosen for use of an asset is a matter of deliberation and discretion. It should therefore be possible to value an investment based on the risk-taking nature of the group that controls deployment of the asset. The matter is worth pursuing wherever there is value in predicting future cash flows from an investment, and when the past is known to be of low relevance for conditions in the future. It is also of interest because it could allow for the professional application of modeling to an area of widespread interest and concern amongst all communities of investors. Though a quantile approach can ameliorate the confusing scatter of past events with respect to independent variables, major qualitative changes in their complex inter-relationships can result in the most disruptive discontinuities as we extend past trends in to horizons of the future. There are situations in which statistical validity is inadequate for a decision on a risk with very serious consequences. We need, as far as possible, to create comprehensive scenarios in which the outcome can be reasonably guaranteed if specified conditions are met. The imperatives of a risk management approach will not allow for the degree of uncertainty to which mere smoothing of past variations may be restricted. Legislation, regulation and social pressures from organized groups are different today from their past arraignment. They continue to change as well. We are asked to discontinue things to which we are accustomed, new challenges arise from technology and new opportunities as well. Investments with long gestation are par for many courses, yet the futility of past data grows as we travel ever more distant in to the future. However,

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. References: Agusti et al (2003) Systemic effects of chronic obstructive pulmonary disease.Eur Respir J 2003; 21: 347-360 [Online]. Available at: http://www. taiss. com/gepoc/gecarp/gepubli/publdoc/010-999-agustiag-systemic-effects-chronic-obstructive-pulmonary-disease. pdf (Accessed: 10 November 2011). Association for Respiratory Technology and Physiology (2000) Handbook in Spirometry. 2nd Edition. Association for Respiratory Technology and Physiology. Birmingham . Barnes P. J (2000) Mechanisms in COPD, Differences from Asthma. Chest, February 2000, vol 117, no. 2, suppl 105-145. [Online] Available at: http://www. ncbi. nlm. nih. gov/pubmed/10673 467 (Accessed: 4 November 2011). Beeh, K. M. , Kornmann, O. Buhl, R. , Culpitt, S. V. , Giembycz, M. A. , Barnes, P. J. , ‘Neutrophil chemotactic activity of sputum from patients with COPD: role of interleukin 8 and leukotriene B4’. Chest, 2003; 123, 1240-1247 [Online]. 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). Droemann D. , Goldmann, T. , Tiedje, T. , Zabel, P. , Dalhoff, K. , Schaaf, B. , (2005) Toll like receptor 2 expression is decreased on alveolar macrophages in cigarette smokers and COPD patients. Respiratory Research 6:68. [Online] Available at: from http://respiratory-research. com/contents/6/1/68 (Accessed: 14 November 2011).Drost E. M. , Skwarski, K. M. , Souleda, J. , Soler, N. , Roca, J. ,Augusti, A. , MacNee, W. , (2005) Oxidative stress and airway inflammation in severe exacerbations of COPD. International Journal of Respiratory Medicine, Thorax 2005, 2930300 [Online], Available at: http://thorax. bmj. com/content/60/4/293. full. pdf, (Accessed: 9 November 2012). Dyer, E. , Englander, H. , Kagen, D. , (2011) Treatment of Anemia in Patients with Heart Disease. Washington (DC): Department of Veteran Affairs. Gamble, E. , Grootendorst, D. C. , Hattootuwa, K. , O’Shaugnessy, T. , Ram, F. S. F. , Qlu, K. , Zhu, J. Vignola, A. M. , Kroegel, C. , Morell, F. , Pavord, I. D. , Rabe, K. F. , Jeffery, P. K. , Barnes, N. C. (2008) Airway Mucusal inflammation in COPD is similar in smokers and ex-smokers: a pooled analysis. Eur Respir. J. 2007, 30: 467-471 DOI:10. 1183/09031936. 00013006 [Online] Available at: http://www. lumc. nl/rep/1070/att/91028021319455/100316114728452. pdf. (Accessed: 15 August 2012) Garrod R. , Ansley, P. , Canavan, J. , Jewell, A. , (2007) Exercise and the inflammatory response in chronic obstructive pulmonary disease (COPD) – Does training confer anti-inflammatory properties in COPD?Medical Hypotheses (2007) 68, 291-298. Global Initiative for Chronic Obstructive Lung Disease (2011) Global Strategy for the Diagnosis, Management, and Prevention of COPD [Online] Available at: http://www. goldcopd. or g/. (Accessed: 3 November 2011). Hodge S. , Hodge, G. , Scicchitano, R. , Reynolds, P. N. , Holmes, M. , (2003) Alveolar macrophages from subjects with chronic obstructive pulmonary disease are deficient in their ability to phagocytose apoptotic airway epithelial cells. Immunology and Cell Biology (2003), 81, 289-296, [Online], Available at: http://65. 199. 186. 23/icb/journal/v81/n4/full/icb200342a. tml, (Accessed: 7 November 2012). Hodge S. , Hodge G. , Holmes M. , Reynolds P. N. , (2005) Apoptosis in COPD. Current Respiratory Medicine reviews. Volume 1, Number 1, January 2005, pp 33-41(9). Publisher: Bentham science publishers. [Online], Available at: http://www. ingentaconnect. com/content/ben/crmr/2005/00000001/00000001/art00004, (Accessed: 24 July 2012). John M. , Hoernig S. , Doehner,W. , Okonko, D. D. , Witt, C. , Anker, S. D. (2005) Anaemia and Inflammation in COPD. Chest 2005; 127; 825-829. [Online] Available at: http://www. chestjournal. chestpubs. org (Accessed: 21 Novem ber 2011).Kazuhiro I. And Barnes P. J. (2008) COPD as a Disease of Accelerated Lung Aging, Chest. January 2009; 135 (1): 173-180. doi:10. 1378/chest. 08-1419 [Online], Available at: http://journal. publications. chestnet. org/article. aspx? articleid=1089585 (Accessed: 10 November 2012). Kim S. and Nadel J. A. (2004) Role of Neutrophils in Mucus Hypersecretion in COPD and Implications for Therapy Treatments in Respiratory Medicine, Volume 3,  Number 3, 2004 , pp. 147-159(13) [Online] Available from : http://chestjournal. chestpubs. org/content/117/5_suppl_2/386S. full (Accessed: 20 November 2011).Kohnlein T. and Welte T. (2008) Alpha-1 Antitrypsin Deficiency: Pathogenesis, Clinical Presentation, Diagnosis, and Treatment, The American Journal of Medicine Volume 121, Issue 1 , Pages 3-9, January 2008 [Online]. Available at: http://www. ncbi. nlm. nih. gov/pubmed/18187064 (Accessed: 29 July 2012). Lapperre T. S. , Postma, D. S. , Gosman, M. M. E. , Snoech-Stroban, J. B. , Hacken, N. H. T. , Hiemstra, P. S. , Timen, W. , Sterk, P. J. , Mauad, T. , Relation between duration of smoking cessation and bronchial inflammation in COPD. Thorax 2006;61:115-121 doi:10. 1136/thx. 2005. 040519. [Online].Available at: http://thorax. highwire. org/content/21/2/115. full (Accessed: 17 August 2012) Lapperre, T. S. , Postma, D. S. , Gosman, M. M. E. , Snoech-Stroban, J. B. , Hacken, N. H. T. , Hiemstra, P. S. , Timens. W. , Sterk, P. J. , Mauad, T. , Relationship between duration of smoking cessation and bronchial inflammation in COPD. Lapperre, T. S. , Postma, D. S. , Gosman, M. M. E. , Snoech-Stroban, J. B. , Hacken, N. H. T. , Hiemstra, P. S. , Timens. W. , Sterk, P. J. , Mauad, T. , Relationship between duration of smoking cessation and bronchial inflammation in COPDLapperre, T. S. , Postma, D. S. Gosman, M. M. E. , Snoech-Stroban, J. B. , Hacken, N. H. T. , Hiemstra, P. S. , Timens. W. , Sterk, P. J. , Mauad, T. , Relationship between duration of smoking cessation and bronc hial inflammation in COPD. Lapperre, T. S. , Postma, D. S. , Gosman, M. M. E. , Snoech-Stroban, J. B. , Hacken, N. H. T. , Hiemstra, P. S. , Timens. W. , Sterk, P. J. , Mauad, T. , Relationship between duration of smoking cessation and bronchial inflammation in COPD. Mahler, D. A. , Huang, S. , Tabrizi, M. , Bell, G. A. , (2004) Efficacy and Safety of a Monoclonal Antibody Recognizing Interleukin-8 in COPD*: A Pilot Study.CHEST. September  2004;126(3):926-934. doi:10. 1378/chest. 126. 3. 926 September  2004, Vol 126, No. 3 [Online] Available at: http://journal. publications. chestnet. org/article. aspx? articleid=1082794 (Accessed: 9 November 2012). ————————————————- Mantovani, A. , Allavena, P. , Sica, A. , Balkwill, F. , (2008) Cancer-related inflammation Nature 454, 436-444 (24 July 2008) doi:10. 1038/nature07205; [online] Available at: http://www. nature. com/natur e/journal/v454/n7203/abs/nature07205. html (Accessed: 17 August 2012). ———————————————— Mizgerd J. P (2002) Molecular mechanisms of neutrophil recruitment elicited by bacteria in the lungs. Seminars in Immunology. Volume 12 Issue 2 April 2002 Pages 123-132. ————————————————- Mohr,D. C. , Pelletier,D. , (2005) A temporal framework for understanding the effects of stressful life events on inflammation in patients with multiple sclerosis. Departments of Psychiatry and Neurology, University of California, San Francisco, CA 94131, USA [online] Available at: http://www. sciencedirect. om/science/article/pii/S0889159105000620 (Accessed: 17 August 2012). Murdoch C & Finn A (2000) Chemokine receptors and their role in inflammation and infectious diseases. Blood. May 15, 2 000 vol 95. No. 10 3032-3043. Nadel, J. A. (2000) Role of neutrophil elastase in Hypersecretion during COPD exacerbations and proposed therapies. Chest. 2000; 117, 386S-389S. Nairn R & Helbert M (2002) Immunology for Medical Students. Mosby Elsevier. Canada. Pauwels, R. A. , Buist, A. S. , Calverley, P. M. A. , Jenkins, C. R. , Hurd, S. S. , (2001) Global Strategy for the Diagnosis, Management, and Prevention of Chronic