Ilm M3.01 Solving Problems and Making Decisions

ILM management Course Shaun Barratt Work based assignment:M3. 01 Problem Solving The Joint Service for Disabled Children is a partnership developed by Enfield’s Children’s trust. It comprises specialist, inclusive, voluntary, health and education services to support and promote opportunities for all disabled children and their families in Enfield. The service is open to any disabled children and young people who have significant global delay, autism or life threatening conditions under the age of 18. In my role as inclusion development manager I am responsible for enabling disabled children and young people to access mainstream activities of their choice within the borough. I provide the resources, staff and training for any universal activity to support identified disabled children. This ensures that all disabled children and their families are supported to take part in and enjoy local community life, whenever possible using local childcare facilities, leisure and recreational activities. I am also part of the management team tasked with generating new ideas to improve the lives of disabled children and their families. It is this role that we were presented with the following problem – Significant numbers of parents have presented to the service requesting over night respite (essentially a night away for their child at a recognised respite provider). The cost of over night short breaks (respite) is highly significant in the services overall budget, far in excess of any other service we provide, and even a small increase would put a huge strain on resources. Far more cost effective is to build support mechanisms around the child and family in their own homes. This is done by building packages of support which provide short breaks but without the huge cost of outside provider overnights. So in order to understand this issue more we firstly needed to ascertain what it was about the overnight breaks which were so appealing and see if we could find another possible solution. We decided to utilise our parent’s forum to generate ideas. Understandably this generated a wide array of reasons for why parents valued over nights so highly, however there were significant threads and themes which consistently appeared and by far the most significant was that a high proportion of parents identified the need for a full night sleep, something they are unable to achieve due to being disturbed by their disabled child. In addition when asked about factors which significantly affect their quality of life sleep deprivation was one of the most significant factors right across the spectrum of need and demographic. There is a wealth of evidence to support the notion that sleep problems are far higher in the disabled population than in mainstream families (Pahl and Quine 2004) The service holds an away day twice a year and part of the session was given to a brain storming session around the issue of sleep problems and what we as a service should do to address them. By involving the team in this process this will ensure that any ideas generated will have team ownership. A number of ideas were put forward, but by consensus there were four areas which were felt were appropriate responses to the issue of demand for increase in over night provision. [pic] The first option was for the team to think more laterally in terms of what we offer to parents. This could be done by identifying key areas in the day that parents were struggling with and identify additional support during these times. This could be around bed times and waking times etc. nd in turn offering parents more support to recharge batteries through offering additional short breaks (a short break is an activity such as playschemes or after school groups etc). Another solution would be to analyse what the service is spending in other areas and cut other budgets significantly to fund additional overnights and in a similar vein to task the team with finding more cost effective over night breaks by opening up to tender to find possible other cheaper providers. The final and most popular idea was to offer some form of sleep counselling to enable parents to gain back control of this part of their lives through behaviour management and support to change their child’s sleep habits. A simple decision making grids illustrates how this might meet the main areas of need as identified by the parents. Decision making model Criteria |Offer more diverse |Sleep intervention |Offer increased over |Find cheaper over night | | |respite |program |night respite |options | |Cost |( |( | |( | |effective | | | | | |Parental approval |( |( |( | | |Long term sustainability| |( | | | |Improved sleep | |( |( |( | |opportunities in short | | | | | |term | | | | | |Improved sleep in the | |( | | | |long term | | | | | Intuitively the sleep intervention program is an appropriate response as it directly responds to the parents need for their sleep deprivation to be addressed. It’s more sustainable than the others and it’s focussed on the area identified and not just fire fighting and therefore a potentially proactive way of working which is easier for staff to identify with. It’s cost effective with just the initial outlay and staff counselling time. Its solution focussed with clear parameters on intervention times. Parents will hopefully support something which gives them a long term solution to their problem and not just a short term solution which is offered by overnights. A potential sleep programme training course was identified which would involve five members of staff being identified to be trained to become sleep counsellors. They would work directly with the parents and enable the arents to change bedtime routines and behaviours in order to improve sleep patterns in the child. Before presenting to the joint service steering group we carried out an SWOT analysis to anticipate issues which may be raised in the presentation. SWO T analysis of sleep program Please see appendix (1) The use of a SWOT analysis provides a methodical and honest assessment of our services strengths and weaknesses for carrying out a defined sleep program. It will also expose threats which may pose a threat to its sustainability and opportunities afforded by the process. The objective of the analysis is to ascertain whether the sleep program is a viable affordable, sustainable response to the need for a sleep intervention process. Strengths in more detail The major strength of the programme when functioning to its potential is its affordability and sustainability. Even a minor reduction in over night’s expenditure will see the program more than pay for itself. The initial outlay of training could be offset against respite savings. The difficulty is that preventative work is difficult to quantify and illustrate as it hasn’t happened, but a reduction in the number of looked after children may be used as a key indicator. The program clearly tackles the root cause of the presenting problem; whereas overnights give short term relief to parents the sleep problem itself is still there in the future. There is plenty of evidence to suggest that improved sleep is positively correlated with improved cognitive performance (The national Sleep Foundation 2004) This would also have significant impact on incidences of challenging behaviours, reducing it dramatically (Green et al 2010) and better quality of life indexes for parents of disabled children (Prosper, Mard and Beecham 2011), both of which could act as markers for the success of the program. The practical applications of a sleep program can be applied to other complimentary areas of work (Sleep Scotland 2001) such as home care and other counselling conditions. Weaknesses in more detail Identification of our weaknesses needed to be done as constructively as possible with no blame or finger pointing, however several key points emerged The first is can the staff hours be found to sustain a sleep program? How can we illustrate that time spent in the program will in the long term reduce hours in other areas. Have the current staff gr oup the necessary communication skills to make effective counsellors? As the sleep service grows there will become a need for additional staff time, resources as well as someone to coordinate the service administer the service and manage the new counsellors. A fundamental question is it possible for the recruitment process to reflect the need for new workers to potentially add to the service. Marketing and branding are also time consuming as the service grows. All these growth factors had to be factored in to produce a long term picture Opportunities in more depth There are opportunities to offer the counselling service to outside agencies with a cost attached. There is no other comparable service within the borough so this is a viable option. This could help in sustaining the service or even to expand it. The publicity afforded of a proactive response to significant and widespread sleep problems, identified by the parents of Enfield themselves, will help put the service in a positive light. This in turn will help our cause when decisions on future cuts are made. This is in turn compliments the move politically for parents to have more control over their lives. Pro active approaches are also always easier to â€Å"sell† to staff by addressing the cause rather than fire fighting the effects. In its favour additional funding streams are available to those ideas generated and supported by parents and children. More effective use of money and resources will also appeal to stakeholders. The positive outcomes of a sleep program such as improved concentration of children resulting in a reduction of incidences of challenging behaviour, and increased educational achievement is going to appeal to a number of partners, which may influence them to invest. Finally and most importantly, an effective service will put less pressure on other related services resulting in economies for the stakeholders Threats in more depth The current economic climate is going to have a huge bearing on the success or otherwise of the project. Given this there is a danger that parents may interpret this as a cost cutting measure around over nights. Parents may still need overnights despite intervention making it a costly additional service. Research needs to be carried to ensure their isn’t a larger service such as MENCAP that can deliver the sleep service more economically. Does the political economic downturn means that projects which offer projected savings are less attractive than short term cuts to services? In order for the service to grow future training opportunities are essential, is this going to be viable when it’s acknowledged that the first budgets to be reduced are training budgets. Are the funding streams used currently likely to remain as further cuts are deemed necessary? Will the outlay of intense training be viable if staff retention is problematic? Could collaborative efforts for example coordinating approaches with medical interventions i. e. use of melatonin in conjunction with psychological interventions be more cost effective? Inter agency working is essential for the sleep program to succeed, is the communication system robust enough for multi agency support? Will cuts mean only front line services that are statutory in nature be preferred over seemingly peripheral services such as a sleep counselling service? Will elements of the service be put out to tender and is this likely to be picked up in this? Given the threats outlined by the swot analysis it is clear that in order to present a convincing case to our steering group it is necessary to present an outline and costing for how the service might develop. The main objective would be could we illustrate the effectiveness of the sleep program as an intervention? Could we illustrate parental satisfactions as a response to sleep issues? Therefore we identified a diverse number of partners to carry out a pilot project. With it being multi agency the strain on any one service could be portrayed as manageable. The SWOT analysis illustrated that there are major potential benefits to partner agencies so there involvement and investment was essential. We would carry out analysis of the success or otherwise of a sleep clinic with a small number of parents from diverse backgrounds. They would be asked to fill in a number of satisfaction questionnaires prior to and after the intervention. Feedback on behavioural changes from a previously obtained baseline would be obtained from partner agencies involved ie schools. We would need to highlight circumstances when the intervention could have most benefit i. e. care plans in child protection cases, complex issue children or families in other types of crisis. All of these will have great appeal to senior management teams. After the pilot parents and senior management would be invited to a presentation of the results. An exercise would be given to the parents whereby they become budget holders. They would be â€Å"given† the money that they are entitled to for their children. They would then be given the costs of all services available to them. By this means parents will be able to see for themselves the cost effectiveness of the intervention and the huge costs of over night respite. They would be empowered to know how they could have a substantial package of support around them for the cost of very few overnights. The issue of sleep programs would be shown to be a very cost effective tool in obtain a good nights sleep. Finally the sleep clinic team would present to all partner agency staff. Cascading of skills would be essential and appeals for constructive critisism of the scheme could be made. Essentially there has to be a selling process and ownership of the service throughout the joint service. If it is then a viable option we would meet with managers to move the project forward!!! Appendix 1 |Strengths |weaknesses | |(i) Affordability and sustainability |(i) Is there sufficient availability of staff to undertake the | |(ii) Tackles root cause of presenting problem |training | |(iii) Cognitive improvements as a result of better quality |(ii) Staff skilled enough to communicate at the highest level |sleep |in order to make venture successful | |(iv) Improved Staff skills set |(iii) Who has time to coordinate project? | |(v) cascading of skills will appeal to budget holders |(iv) Therapeutic change can be time consuming | |(vi) reduction in aggressive incidences which are as a direct |(v) Does recruitment reflect the need for these particular | |result of sleep deprivation |skills? | |(vii) additional resource to offer families in crisis child |(vi) Who is going to marke t and brand the service? |protection etc |(vii) Need for administrator and stats holder | |(viii) a new approach to empowering parents to enable them to | | |take control of their own lives | | |opportunities |Threats | |(i) Outsourcing counselling service to other agencies if proved|(i) Parents may interpret this as a cost cutting measure around| |successful |over nights | |(ii) Response to significant and widespread sleep problems |(ii) Parents may still need overnights despite intervention | |identified by the parents of Enfield themselves |making it costly additional service | |(iii) Above (ii) compliments the move politically for parents |(iii) Could a larger organisation undercut the sleep service? |to have more control over their lives |(iv) political economic downturn means | |(iv) addressing the cause rather than fire fighting the effects|(1) long term savings options less attractive than short term | |(v) Additional funding streams are available to those ideas |cuts | |generated and supported by parents and children |(2) Training budgets are the first to be cut when money is | |(vi) More effective of money and resources will appeal to |tight – threat to future growth | |stakeholders |(3) Service once offered will need to grow to meet need is this| |Improved concentration of children and young people resulting |viable? |in a reduction of incidences of challenging behaviour, and |(4) Are there more cost effective services already in existence| |increased educational achievement |that that Enfield could tap into instead | |An effective service will put less pressure on other related | | |services | | ———————– Need for more overnights and better quality of sleep Increase in overnights by moving other budgets Offer diverse options to support parents in coping Support parents in managing their sleep Seek out cheaper respite units

“Letter from a Birmingham Jail” Dr. Martin Luther

In his â€Å"Letter from a Birmingham Jail† Dr. Martin Luther King Jr. challenges the preconceived notions of his fellow clergymen and argues that â€Å"injustice anywhere is a threat to justice everywhere.†Ã‚   (King, 1963). Dr. King had been chastised by a number of clergy in Birmingham as an outside agitator stirring up trouble in their city. Early on, he explained his idea that no citizen of the United States can be considered an agitator when protesting or acting with regard to something else happening with the country’s borders. Furthermore, King argues that what happens in Birmingham affects Atlanta and Washington, D.C. and New York City.   In many ways, he was arguing the idea of globalization and world conscious long before they became buzz words and the way of the world. King argued that as a member of the Southern Christian Leadership Conference he had no option other than to fight for social justice throughout the South.After justifying himself to t he other clergy, King explains why the demonstrations for which he was arrested are taking place in Birmingham.   In gentle rebuke, he points out that the clergymen have condemned the conditions that resulted because of the protest but have never taken time to rebuke the conditions that required the demonstrations take place. â€Å"Birmingham is probably the most thoroughly segregated city in the United States. Its ugly record of brutality is widely known. Negroes have experienced grossly unjust treatment in the courts. There have been more unsolved bombings of Negro homes and churches in Birmingham than in any other city in the nation. These are the hard, brutal facts of the case, â€Å"King wrote (King 1963).Despite those conditions, leaders within the African American community approached city leaders attempting to find a path to social justice via the law.   They were humored and strung along by the establishment, but never did the city try to make any good faith effort to try to change the conditions. And, at the time of King’s letter, being born an African American in Alabama in general and Birmingham in particular virtually guaranteed a lack of rights.   â€Å"Then, last September, came the opportunity to talk with leaders of Birmingham's economic community. In the course of the negotiations, certain promises were made by the merchants — for example, to remove the stores humiliating racial signs. On the basis of these promises, the Reverend Fred Shuttles worth and the leaders of the Alabama Christian Movement for Human Rights agreed to a moratorium on all demonstrations. As the weeks and months went by, we realized that we were the victims of a broken promise. A few signs, briefly removed, returned; the others remained.† (King, 1963).The signs were the overt racism inherent in Birmingham, but the roots in the region went much deeper. African Americans were consistently denied the right to vote, sometimes to the point that in counties where the majority of the population was black, not a single African American was registered to vote. King argues clearly that these maneuvers to hold people back from racial equality were often being done within the confines of the law and that was a problem in and of it.He   further argues that taking direct action will spur the community toward negotiation and an effort to change. â€Å"Nonviolent direct action seeks to create such a crisis and foster such a tension that a community which has constantly refused to negotiate is forced to confront the issue. It seeks so to dramatize the issue that it can no longer be ignored.† (King, 1963)   If no action is taken, King agues, then the status quo does not change. People are not prompted to change, or even to negotiate for improvement if there is no impetus for their effort.â€Å"The purpose of our direct-action program is to create a situation so crisis-packed that it will inevitably open the door to negotiatio n. I therefore concur with you in your call for negotiation. Too long has our beloved South land been bogged down in a tragic effort to live in monologue rather than dialogue.† (King, 1963). It is important to note that throughout his call to action, King reiterates that the direct actions should be non-violent designed to make people uncomfortable and disrupt daily routines, not aggressive or threatening.He answers complaints that the protest came too soon after a city election for the newly elected government to have any impact on the old ways. The problem with waiting for someone to take action is that you are always waiting and nothing changes.   â€Å"The only answer that I can give to this query is that the new Birmingham administration must be prodded about as much as the outgoing one, before it will act. We are sadly mistaken if we feel that the election of Albert Boutwell as mayor. will bring the millennium to Birmingham.While Mr. Boutwell is a much more gentle per son than Mr. Connor, they are both segregationists, dedicated to maintenance of the status quo. (King, 1963). King points to the emerging nations of the world, able to fight for their freedom from colonial oppressors and get it, and then remarks at the â€Å"horse and buggy† pace the United States is making within her own borders to promote equality (King, 1963). â€Å"Perhaps it is easy for those who have never felt the stinging dark of segregation to say, â€Å"Wait.†(King, 1963)†He justifies his actions in terms of the law. This is perhaps the most powerful of King’s arguments outside the â€Å"I Have a Dream† speech. It sets the tone for his later work and justifies the Civil Rights Movement in one fell swoop.   â€Å"Since we so diligently urge people to obey the Supreme Court's decision of 1954 outlawing segregation in the public schools, at first glance it may seem rather paradoxical for us consciously to break laws.One may won ask: †Å"How can you advocate breaking some laws and obeying others?† The answer lies in the fact that there fire two types of laws: just and unjust. I would be the Brat to advocate obeying just laws. One has not only a legal but a moral responsibility to obey just laws. Conversely, one has a moral responsibility to disobey unjust laws. I would agree with St. Augustine that â€Å"an unjust law is no law at all† (King, 1963).In this short passage, King makes an eloquent and accurate plea for civil disobedience and encourages people to take the action needed to make a difference with regard to changing the law.   His argument is that sometimes the law is simply so unjust that if a person does not take radical action to change the law, he is supporting injustice.The idea that a law could be justly applied but be inherently unjust was illogical, he argued. â€Å"An unjust law is a code that a numerical or power majority group compels a minority group to obey but does not make b inding on itself. This is difference made legal. By the same token, a just law is a code that a majority compels a minority to follow and that it is willing to follow itself. This is sameness made legal.† (King, 1963).He further argues that the type of civil disobedience he is recommending was first practiced in biblical times by Shadrach and his compatriots when they faced the lion’s den rather than renouncing their faith. He then goes on to chastise the church leadership for their inaction and lack of support for the African American community. â€Å"Let me take note of my other major disappointment. I have been so greatly disappointed with the white church and its leadership.† (King, 1963).   He argues that the church should in supporting core Christian values work toward the development of equality for all people and that in failing to do so they have ignored their Christian duty.King’s letter was intended as an answer to critics, a reply to those wh o did not understand the reality of the Southern African American and the way that they were being discriminated against.   Instead, it served as an outline for social justice and for achieving equality. By detailing how and why people of color and white Americans should stand together to fight for equality, he took the effort for equality out of the streets and back alleys to the headlines.His definitions regarding an unjust law made the difference philosophically and religiously for many people. Many people who had previously considered themselves good people suddenly found that they could no longer hide behind the legality of the situation. Instead, King forced them to take the issue of equality to heart and think of it from their conscious and not just from the law. They were no longer able to argue that it was okay by the law so that must make it right. King found the right words to explain that equality was everyone’s responsibility and that unless people were willing to work for justice, no one would have it.Thesis: In his â€Å"Letter from a Birmingham Jail† Dr. Martin Luther King Jr. challenges the preconceived notions of his fellow clergymen and argues that â€Å"injustice anywhere is a threat to justice everywhere.†Ã‚   (King, 1963Outline:â€Å"Letter from a Birmingham Jail†I.      Summary and historical contextII.    Why Birmingham?a.    Worst racism in the Southb.    Negotiation failedc.   New leadership might mean an opportunity for change.III. Why direct action?a. Civil disobedience draws attentionb. Unjust laws should not be obeyedc. Christian history of actionIV.   ConclusionKing’s letter was intended as an answer to critics, a reply to those who did not understand the reality of the Southern African American and the way that they were being discriminated against.   Instead, it served as an outline for social justice and for achieving equality.

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CSR of Costa Coffee - Essay Example Costa coffee is an international coffeehouse corporation, which is based in Dunstable, UK. It is an entirely owned contributory of Whitebread and is the biggest coffeehouse chain in the UK and second-biggest in the world (Harford, 2012, P. 54). The company operates in 1175 channels, and as of January 2011, it was the biggest British channel in terms of stores. Globally, costa coffee operates in 442 outlets all over the world, in 28 nations. The company has introduced a brand known as costa express, which is formed by a coffee channel of self-service bars. After Whitbread acquired Coffee Nation, which is a procession of coffee machines, the nine hundred Coffee Nation machines will be substituted and re-named as costa Express. Costa coffee has acquired its roaster and hires the only three Italian superior Roasters in the United Kingdom. The mixture served in vend stores is called Mocha Italia and comprises of six sections Arabica beans and one section robusta beans (British Retail Cons ortium, 2006, P.1). The Costa Coffee product already has a first class ranking in all its market ventures. It is nearly the main profit giver of the corporation in the extensive markets of the United Kingdom. ... In addition, the strategies the company is using are questionable concerning if they provide more effectual results than other companies in terms of obtaining company name reputation (Enz, 2009, P.34). Corporate responsibility is an extremely crucial element for all businesses as it determines the reputation of a business and thus, profitability and development. It is indispensable for companies in food production to be socially responsible. This is because they are in a highly sensitive sector, which requires careful handling of both the products and customers. It is particularly valuable for companies in food production sectors, to ensure that they produce sufficient information concerning how they are socially responsible (Lury, 2011, P.17). The studies, undertaken by corporate social responsibility researchers have criticized the sustainability qualifications of Costa Coffee in areas such as recycling and waste. The study has shown that Costa Coffee gave most of its information, but did not offer a UK breakdown of its corporate social responsibility international report. The report discovered that Costa Coffee, which is possessed by Whitbread, operated better in its ventures but did not succeed in replying to requests for corporate social responsibility information. Costa Coffee also did not reveal information for its carbon tracks, but rather its environmental information is stated as section of the parent company (Lury, 204, P.37). Disclosing corporate social responsibility report is not only valuable for the purposes of fulfilling legal requirements, but also to increase customer confidence and reputation of the company. Costa Coffee customers and other potential customers are

40 Definetions Essay Example | Topics and Well Written Essays - 2000 words

40 Definetions - Essay Example There are a lot of consequences of the noise pollution. It has an effect on the general wellbeing as well as hearing power of the humans. The high concentration of noise as well as its persistent use can be a reason of wound to the ears. It may produce the permanent loss of hearing. A huge blast can lead to the damage to tympanic membrane. It may create nervousness and constant worry which may bring about the panic. It causes the disorder of nervous systems of urban children and causes the emotional disorders in conjunction with the unusual behaviour. It may raise the heart rate, lessened productivity, constriction of vessels as well as damaged vision. In case of animals it can have an effect on the heart, liver as well as brain. It may as well have an effect on the brain by expanding the blood vessels. It may as well have an effect on the eyes by â€Å"dilating the pupil and cause the digestive spasms†. It may as well cause the raise in cholesterol level in blood (Finney, p 8 9, 1984). Noise Pollution usually indicates unnecessary sound created by human activities -unnecessary for the reason that it hinders the communication, job, relaxing, leisure time, or sleep. The two mainly significant measurement of noise pollution are sound force and sound concentration, these are calculated in various units, and the range of the magnitude is separate as well as incredibly large compared with noise (Nelson, p. 22, 1975). Noise pollution can be defined as human generated sound damaging to physical condition or wellbeing. Means of transports are the most awful lawbreakers, with aeroplane, railroad stock, wagons, buses, cars, and motorcycles all creating too much of noise. Every sound which is frustrating, disturbing, or physically detrimental is noise pollution. The physical consequences can consist of tinnitus, hearing loss, nervous tension and insomnia. Noise pollution is generally talked about in terms of

Anatomy of a Picture Book Essay Example for Free

Anatomy of a Picture Book Essay Format/Size †¢Rectangular—This is the shape of most books †¢Horizontal—Often used to in stories about journeys †¢Vertical—May be used for â€Å"larger than life† characters oCohn, Amy L. Abraham Lincoln. oIsaacs, Anne. Swamp Angel. †¢Cutout forms—cutout in the form of buildings, animals, etc. Book Jacket/Dust Jacket †¢Think of a book jacket as a small poster wrapped around the book with flaps on the front and back. oOriginally used to keep books from being soiled oNow used to be eye-catching, to encourage you to pick up the book. †¢Should be appealing from a reasonable distance through its form and color †¢Provides important information about the book  oTitle oAuthor oIllustrator oShould predict the contents of the book oShould convey the age group for the book oBack of book jacket normally includes the book’s barcode with ISBN (International Standard Book Number) number, a unique number to identify a book. †¢Jacket areas oFace—front that faces us as the book is closed and lies on the table ? Is the picture on the cover repeated inside the book or is it unique? If the cover is repeated, it anticipates the plot of the story. ?Does the cover contradict the story? Is the cover mystifying? ?Cover may reflect most dramatic or enticing episode in story. However, the cover should not tell so much that it destroys the suspense of the story. ?Is the cover framed? Framing creates a sense of detachment. oBack—back of the jacket should relate to the front ?Consider how the book jacket flows from the front to the back ? When the jacket is flattened, the design should be homogeneous and consistent ? If you want to be a collector of children’s books, protect the book jackets by covering them in plastic. oWrap-around cover—uses one illustration that wraps around from the front to the back oBook flaps—include background information about the book. May also tell about the author and/or illustrator, etc. oSpine—located to the left, along the bound edge of the book. This is a narrow panel which you see when the book is shelved. Normally includes the title, author, publisher, and sometimes the illustrator. Book Casing/Book Cover †¢Stiff-cased casing—This is what you find underneath the book jacket. This is hard to see on library copies that have plastic put over the covers that is taped down. oSome book covers are simply a repeat of the book jacket. oThe higher quality picture books have a different book casing that is a type of cloth. ?Consider how this contributes to the overall design of the book. Consider color of the cloth, use of patterns, ornaments, or drawings. Does the color used fit the book? oDesigns on casing—This design normally refers to the central motif or symbol of the book. ?Blind stamp—sunken image of the same color as the casing ? Die stamp—sunken image of different color than the casing. Endpapaper (Endsheets) †¢Serve as structural bond between body of book and casing. They are glued down to casing to hold the book together. They are usually of heaver stock paper. oEndpapers may be a solid color, have a design, map, illustration, etc. Sometimes they convey important additional information. If the book is well designed the endpapers should be an integral part of the story. ?Color of endpapers may be symbolic to the story. †¢Endpapers should offer a transition between the exterior and the interior of the book, a â€Å"welcome† into the book. †¢Sometimes the narrative of the book actually begins on the endpapers. †¢Check to see if the front and back endpapers are exactly the same. If they are different, there is a significant reason. †¢Not included in paperback books. Front Matter †¢Front matter includes the beginning pages of the book through the title page and copyright page. Front matter may include blank or extra pages at the beginning of the book. oSets mood for story and may amplify meaning by indentifying books’ main character, setting, theme, etc. †¢Half title page (false title page)—placed before the title page and usually includes only the title and an illustration. Not found in every book. †¢Title page—includes title, author, illustrator, publisher. The illustration used on the title page should be one of the best found in the whole book. May be a detail of some picture in the body of the book. oDouble-page spread—a design that is unified across two pages oTwo distinct pages—one page has illustration; the other has text †¢Copyright page—back or verso of the title page. oContains circled â€Å"c† or word â€Å"copyright† with the year of publication and the name of the copyright owner. oAlso includes the book’s printing numbers or printing code. A first printing of a book may in the future become very valuable. ?First edition â€Å"generally means the book you are holding is the first printing of the first edition, in other words the first appearance of this particular text† (Horning 13). oIf a book was first published outside of the U. S. or a book is a translation, the original title, publisher, and date appear on the copyright page. oMay include the technique the illustrator used for the book, such as watercolor, gouache, colored pencils, oils, etc. oOften includes the name of the book’s typeface. oNormally includes the Library of Congress Cataloging in Publication Data (abbreviated as CIP). This information helps libraries catalog books faster. Includes call numbers for books and may include a summary of the book, as well as the author, illustrator, title, and publisher. †¢Dedication page—may be included in the book. If book’s have separate authors and illustrators, there may be dedications from both individuals. Dedications may give clues to interesting personal information about the author/illustrator. Back Matter †¢Pages in the back of the book after main part of the book. Sometimes the copyright page is part of the back matter. †¢May include author/illustrator information, photographs, reviews, etc. †¢May also include source notes, glossary, index, bibliographies, acknowledgements, notes on the illustrations, other supplemental information, suggested activities to use with children, etc. Body of the Book †¢Main section of the book—what’s between the front matter and back matter. †¢Signature—pages inside the book are sewed or fastened together in one ore more sections classed signatures. A standard signature is sixteen pates. †¢Typeface/typography selected for book should fit the story. For emphasis, fonts may change (size, bold, italics). Layout of the text may also change to emphasize certain elements of the story. †¢Paper—should be of quality. May be matte, shiny, etc. Shiny paper gives a smooth, glazed surface that gives a high sheen and intensifies the colors. May also be heavier paper stock or textured. †¢Gutter—the middle area where pages come together. The illustrations that go over the gutter should not be misaligned or have missing parts because they are â€Å"caught† or lost in the gutter. †¢Placement of the text oVery formal—text placed opposite the illustrations on an adjacent page. A border or frame around the text or illustrations is even more formal. oFormal—text positioned above or beneath the illustrations. oInformal—text shaped with irregular boundaries to fit inside, outside, between, around, or to the side of the illustrations. oVery formal—no text at all (as in wordless books). †¢Placement of the illustrations oDouble-page spread—both facing pages are used for an illustration. The illustration â€Å"spreads across† both pages. Wanda Gag is credited with inventing this technique in her book Millions of Cats. oBorders—an outer edge or boundary, a frame, that encloses text and/or illustrations. Borders have decorative or geometric designs, folk designs from a particular culture, or visual symbols that relate to the story. oPanels—use of vertical sections to break apart an illustration. oVignettes—also called spot art. Small illustrations integrated into the layout of a single or double-page spread. They often allow the illustrator to tell a story through various stages. †¢Page turner element—what on a page makes you want to turn the page to continue the story? oIllustration—is there something in the picture that makes you want to turn the page? A figure facing right on the right hand page is often a page turner element. oText—is there something in the story that encourages you to turn the page? Integrated Whole †¢Visual symbolism—use of physical objects in the illustrations to represent abstract ideas. For example, a dove may symbolize love, gentleness, innocence, timidity, or peace. †¢A high quality picture book (like those which are Caldecott winners or honor books) should be well designed from the book jacket to the back matter, including the endpapers, and book casing. EECE 441 Prof. Sibley Minnesota State University Moorhead Bibliography Harms, Jeanne McLain, and Lucille J. Lettow. â€Å"Book Design Elements: Integrating the Whole. † Childhood Education 75. 1 (1998): 17-24. Education Full Text. Wilson Web. Livingston Lord Library, Moorhead, MN. 28 Aug. 2005 http://hwwilsonweb.com/. ___. â€Å"Book Design: Extending Verbal and Visual Literacy. † Journal of Youth Services in Libraries 2. 2 (1989): 136-42. Horning, Kathleen T. From Cover to Cover: Evaluating and Reviewing Children’s Books. New York: HarperCollins, 1997. Matulka, Denise I. â€Å"Anatomy of a Picture Book. † 24 April 2005. Picturing Books. 28 August 2005 http://picturingbooks. imaginarylands. org/. Pitz, Henry C. Illustrating Children’s Books: History, Technique, Production. New York: Watson-Guptill, 1963. Troy, Ann. â€Å"Publishing. † CBC Features. July-Dec. 1989.  ©Carol Hanson Sibley, August 2005

Various human Essay Example for Free

Various human Essay Given the widespread human rights violations in the world today, it becomes very important to set up a system that would cater to both the general need of the entire world as well as specific needs of a particular region. An ideal human rights system would be one that would take global ideas and try and implement them locally. It should be both idealistic as well as practical. Various human rights systems across the world have tried various permutations and combinations to achieve perfection in the field of redressing human rights violations. The Inter American system of human rights is one such system which has tried to incorporate as many good aspects of redressal as possible. However, the said system has its faults like all others. The strong point of the system that can be duplicated in any part of the world is the basic conventions on which the system is based, namely, the American Declaration of Rights and Duties of Man and the American Convention of Human Rights. Both these documents provide for all kinds of human rights envisaged in the world and also provide for procedure to redress in case of any infringement. These documents form the basis of the human rights grievance redressal forum that is to be established by the Government. While setting up a new system in a unknown country this is one aspect that can be duplicated. However, care should be taken to make the new law for that particular region inclusive of the rights that are special to that region. Only then will the instrument be as effective as these documents. Another good aspect of the Inter American System of Human Rights is the existence of the Inter American Human Rights Commission and the Inter American Human Rights Court. Both these mechanisms are independent and separate and have different powers and functions. While the Commission receives, analyses and investigates into violations and then gives its recommendations, the Court adjudicates on the various issues brought before it. Commission is recommendatory in nature while Court is adjudicatory. These two separate mechanisms are necessary so as to ensure that the dual aspect of promotion of awareness and protection of human rights can be achieved with minimal problems and maximum effectiveness. The third positive and duplicable aspect of the Inter American System of Human Rights is the fact that it does not consider the Human Rights Court to be an Appellate Authority over the Domestic Judicial System. This helps maintain integrity of both systems. The Human Rights Court has been established to investigate and adjudicate gross violations of human rights. In case a domestic court has refused to follow due process of law and has caused serious violation of human rights to an individual, then the Human Rights Court can intervene and adjudicate. The order so passed by the Court is binding on the parties who have subjected themselves to the jurisdiction of the Court. The fact that such a mechanism exists can help ensure that the domestic judicial systems do not cause gross violations of human rights. The Human Rights Court performs the role of a watchdog over the functioning of the domestic Courts and law enforcement systems. Like all good things, the Inter American System has its problem areas which, if avoided will create an ideal system. The first problem area in the Inter American Human Rights system is the need for a State to subject itself to the jurisdiction of the Human Rights Court. This means that if a State has ratified and signed a particular treaty or convention, and the State chooses to violate the rights enshrined in the said treaty or convention, then in such a case, the Human Rights Court has no right to adjudicate but can only advise the Commission and recommend appropriate action to the State in question. This defeats the entire purpose of protection against infringement of human rights. A State is thus given a protective mechanism but without any teeth, which is of no use. Thus in the new system that is to be created, care should be taken to ensure that ratification of a convention or treaty automatically means accepting the jurisdiction of the Court. This helps enforce the rights enshrined and also ensures adequate redressal in case of violation by the State. Also the Commission in the Inter American System has only investigative and recommendatory powers. This is sufficient in most cases but in some areas it is necessary to let the Commission decide for itself on the proper relief and make it enforceable. The Commission is the first step of the redressal system and after the Commission’s recommendations have been ignored, the Court steps in. In some countries, this would mean more expenditure and more delay in attaining justice. Hence where the Commission feels that the problem is of an urgent and grave nature, then powers should be given to the Commission to pass orders that are binding and enforceable. Secondly, the Inter American System does not allow for individuals to approach the Court directly in person but only through the State or the Commission. In the new system, we can try allowing individuals to approach the Court directly. A victim can appropriately and more effectively put forth his case and this would result in a more positive and direct approach on the part of the Court. Commission on the other hand is a third party which is not affected and hence cannot put forth the problem with the same intensity. The above discussion sums up some of the positive and negative aspects of the Inter American System of Human Rights. If the legislators were to keep these points in mind then the resulting system of human rights protection would be a good and effective one. References Abi-Mershed, E. (1994, November/December).Thirty-Five Years Defending Human Rights. Americas (English Edition). Retrieved March 2, 2007, from Questia database: http://www. questia. com/PM. qst? a=od=5000289318 Buergenthal, T. (1982). The Inter-American Court of Human Rights. American Journal of International Law, 76(2), 231-245. Retrieved March 2, 2007, from Questia database: http://www. questia. com/PM. qst? a=od=85595942 Pasqualucci, J. M. (2003). The Practice and Procedure of the Inter-American Court of Human Rights. Cambridge, England: Cambridge University Press. Retrieved March 2, 2007, from Questia database: http://www. questia. com/PM. qst? a=od=107345000.

Terrorism: Causes, Effects and Prevention Strategies

Terrorism: Causes, Effects and Prevention Strategies In the last quarter of the century, there is a dramatic change in most of the terrorist activities, as they are well-planned, with a purpose to accomplish a precise identifiable and seemingly attainable political goal. In the past, most of the terrorist activities involved incidents like high-jacking an aircraft or the taking of a hostage following which certain demands were made. Their aim was usually to release their friends, or group leaders from prisons. Terrorism in the last few decades has taken a more violent and destructive turn, and quite often the demands are not made. Terrorism today is an act which is sudden, unprovoked, sheer brutal attack on innocent civilians killing several people in a crowded market or a gathering. Most of there terrorist attacks have had a political objective, which have now become rather diffused since the 9/11 attack. It now seems that the idea is to create fear and panic, and primarily to get publicity through the television news and print media According to several orthodox cultures, the terrorists resorted to this particular type of extremism as the only way for accomplishing political change. Also it appears to be interconnected to globalization and the increased impact of the United States and other Western countries. This has added to the resentments of the people of that part of the world. Thus it is the larger developments, changes in the international political structure, and expansion of globalization throughout the world that explains this trend in terrorism. The sixty years of suffering of the Palestinians and their unsuccessful efforts to get an independent state is one of the major reasons for the unrest in the Muslim World. The recent siege (412 Palestinian children perished between the 27th of December 2008 and the 18th of January 2009 as a result of the bombings and atrocities carried out by the Israeli Occupying Forces The end year of 2009 inevitably This markeds the First Year Memorial of Operation Cast Lead, when almost 1,400 Palestinians, mostly civilians were killed during the course of a brutal military operation carried out by Israeli authorities. Thousands more were wounded or displaced. 412 Palestinian children perished between the 27th of December 2008 and the 18th of January 2009. These children were killed as a result of the bombings and atrocities carried out by the Israeli Occupying Forces) affected the Palestinian social fabric completely. As the trauma grows with every violent incursion into Palestinian communities; hatred and tendency of revenge also increases among them. During the Gulf War, and more recently in Afghanistan, the terrorist groups often resort to psychological warfare because its the only tactic they have available to them. They dont have M-16s, and we have M-16s. They dont have the mighty military power that we have, and they only have access to things like kidnapping, says Haroun, a clinical professor of psychiatry at the University of California, San Diego. (cited in Warner, 2005).1 In reality these terrorist attacks does not harm the enemy physically very much, as few people could be killed in an attack. But the repercussions are tremendous from the psychological point of view. Ordinary people viewing the terrorist attack in person or watching it on television, gets anxious, terrified, and often develop a sense of foreboding fear, which in turn may lead to demoralization in the entire society. Psychological Terror Whatever is their modus operandi, terrorists share very similar aims. Alexander and Klein (2006)[1] concisely identified the aims of terrorism as follows: To create pervasive fear, anxiety and panic To generate a collective and individual sense of helplessness, vulnerability and hopelessness To demonstratereveal the incompetenceineffectiveness and/or inabilityincapability of the authorities to provide security and protectionsafety against such opponents And provoke the establishment into errors or over-reactions which will disaffect the general public or specific influential bodies. The last point is essentially vital as observed by the widespread concerns as for example the shooting of an innocent man by the Metropolitan Police in London sometime ago (as a result of consequent to the wrong information that he was a suicide bomber); the incarceration of terrorist suspects in high security prisons of Guantanamo Bay and Belmarsh; and the introduction of repressive legislation. Moreno (2003)[2] has persuasively proven how easy it is in a democratic society to subordinate hard-earned civil liberties to the need to introduce counter-terrorist legislation. The terrorist attacks provide harsh reminders that in todays world, one does not know what news may come next on television or other news media. Particularly disturbing television images of horrific incidents can trigger the innate startle response no matter how close or far away from home the event happened. Historically, every military clash has led to psychological warfare in some form in one way or another as th e enemy aims to break the morale of their opponent. Due to progress in technology; the popularity of the internet; and increase of news coverage, the rules of engagement in this type of psychological battle have changed. Whether it is a substantial attack or a single dreadful act, the effects of psychological warfare are not restricted to the physical damage it produces. Instead, the intent of these attacks is to instillinstil a sense of fear that is much greater than the actual threat itself. According to Professor Richard Bulliet of Columbia University: There are various ways to have your impact. You can have your impact by the magnitude of what you do, by the symbolic character of target, or the horrific quality of what you do to a single person. Interestingly the way media covers the event in fact determines the effect on the people. For instance, according to Bulliet, the Iranian hostage predicament, in 1979, which though lasted for 444 days, was infact actually one of the most harmless of (word harmless) criticalthings events that occurredhappened in the Middle East in the last 25 years. All the U.S. hostages were released ultimately unscathed., butHowever this hostage event remains a psychological scarblemish for manyseveral Americans who watched powerlessly, each evenings newscast, they counted days the hostages were being held in custody. The terrorists often take advantage of images of a group of masked individuals coercing and intimidating exerting total power over their captives to sendconvey the message that the act is a collective demonstrationdisplay of the groups power rather than an individual criminal act. You dont have the notion that a certain person has taken a hostage. Its an image of group power, and the force becomes generalized rather than personalized. The randomness and the ubiquity of the threat give the impression of vastly greater capacities. (cited in Warner, 2005).[3] Remote Repercussions of Terrorist Attacks When a horrific event occurs, it is natural to feel disturbed, even if the act occurred thousands of miles away. The human reaction is to put oneself in the situation because as normal human beings, people have the capacity to empathize. And consequently these people may develop similar psychological symptoms. Witnessing an act of psychological terror can also disrupt our belief system, says Charles Figley, PhD, director of the Florida State University Traumatology Institute. (cited in Warner, 2005).[4] We walk around, psychologically, in a bubble, and that bubble represents our belief system and values. Most often we assume incorrectly that other people have the same values and social niceties as we do. When that is violated or challenged, the first response is usually an effort to protect our beliefs and, in other words, to deny that it actually happened. When A s soon as confronted with proof of terror, such as pictures of atrocities, Figley says there are a few different waysdifferent ways in which people typically react: They perceive perpetrators to be inhumane. Become fearful as they perceive they are living in a callous and unsafe world because the graph bar of inhumanityhumanity has been lowered even further. Believe that its only a fleeting incident which could be easily explained away or deconstructed by precise things that have taken place, such as if we hadnt done this, then that would not have happened. Its uncomfortable believing that the world is less safe, so we have to imagine or construct a scenario that will allow us to feel more safe again and resist change, says Figley. There is an interesting and strange symbiotic relationship between terrorism and the media. Bruce Hoffman, the director of the Centre for the Study of Terrorism and Political Violence, in his book Inside Terrorism has written a clear summary of some of the major historical trends in international terrorism. He makes careful distinctions between the motivations that drive political (or ethno-nationalist) terrorism and religious terrorism, and he explains also shows why the rise of religious terrorism, coupled with the increased availability of weapons of mass destruction, may foretellpredict an eraepoch of even greater violence. In the past, Hoffman argues, the main goal of the terrorist was not to kill and destroy, but to attract media attention to his cause in the hope of initiating reform. For the religious terrorist, however, violence is first and foremost a sacred act or divine duty executed in direct response to some theological demand or imperative religious terrorists see themselves not as components of a system worth preserving but as outsiders, seeking fundamental changes in the existing order. (Hoffman, 2006).[5] In this context Hoffman does not choose sides, he refers to in this framework, pointing to the bombings of the World Trade Center ,and Oklahoma City and the Tokyo,to the Sarin nerve gas attacks, in Tokyo in order to demonstrate that radicalsfundamentalists of any religious denomination are capable of extreme acts of terrorism. Terrorism is an aggressive-hostile action which is mainly intended to harm and terrify civilians, in order to promote a particular aim, or with an the idea, which may be social political or other. The terrorist attacks, are now gaining major importance than wars in the news headlines worldwide Terrorism and its Effects on Mental Health Whether its a massive attack or a single dreadfulhorrific act, the effects of psychological warfare are not restrictedlimited to the physical damage inflicted. Infact the primary objectivestead, the goal of these attacks is to inculcate a sense of fear whichthat is much greater than the actual threat itself. Therefore, the impact of psychological terror depends largely on how the acts are revealedpublicized and interpreted. Typical reactions to major trauma on the individuals and communities are well-documented but the literature on the individual reactions to terrorist incidents is scarce. Most of the reactions at the initial phase following trauma are normal reactions and only few individuals display florid psychopathology. (Alexander and Klein, 2006).[6] Normal individual reactions to a terrorist attack are: Emotional Reactions : shock, numbness, denial , fear, anxiety , helplessness, hopelessness. Cognitive dysfunctions as disorientation, confusion ,intrusive thoughts, images, memories ,hypervigilance (i.e. increased sense of risk),impaired concentration and memory. Changes in social interaction, like withdrawal ,irritability ,loss of trust and faith , avoidant behaviour (i.e. of any reminders of the event). Physical reactions as autonomic hyperarousal , ,loss of energy. insomnia Autonomic hyper-arousal, insomnia, loss of energy. Emotional shock, numbness, denial, fear, anxiety helplessness, hopelessness. Cognitive disorientation, confusion, intrusive thoughts, images, memories.Hyper-vigilance, impaired concentration and memory. Social withdrawal, irritability, loss of trust and faith, avoidant behaviour (i.e. of any reminders of the event). These normal reactions comprise most of the core symptoms of PTSD, i.e. intrusive experiences, hyper-arousal and avoidant behaviour, as defined in the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10; WHO, 1992).[7] For a formal diagnosis of PTSD, such symptoms must be experienced for at least a few weeks. (The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV] also necessitatesrequires that such symptoms mustto be present for one month. (American Psychiatric Association, 1994).[8] In addition the impact on individuals, terrorism has mass psychogenic impacts. Mass psychogenic illness has been defined as: The rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss or alteration of function whereby physical complaints that are exhibited unconsciously have no corresponding organic aetiology. (Bartholomew Wessely, 2002). [9] As regards community reactions, they may present with distinct features. Tyhurst provides a three phase model of community response. (Tyhurst, 1951).[10] In Phase I, most individuals are liable to be stunned, numbed or even in denial. Denial was the commonly reported reaction among the office staff of Capital Hill, Washington DC following the anthrax scare in 2001. It took some time for the affectees to realize they might have been exposed to a toxic substance. North et al., 2005).[11] Widespread panic is not a typical reaction (though widely depicted in disaster films, etc.). Approximately 10 per cent of victims are likely to panic, and this reaction is most likely when victims believe they are trapped and feel helpless. Durodie Wessely, 2002).[12] In the 1987 Kings Cross underground fire most passengers did not panic; on the contrary, they sought out the usual methods of entry and exit. (Donald Canter, 1992).[13] Similar personal reactions were observedgiven after the London terrorist incidents of July 2005. Hence the civil contingency planning clearly should not be based on ill-informed assumptions about human behaviour. Even in extreme situations human behaviour can be rational, altruistic, and even heroic. In Phase II which is the Recoil Phase, individuals seek to make sense of what has happened. They seek reunion with their common sources of support, e.g. families, friends and colleagues. Even makeshift groups may develop as individuals seek understanding and mutual support. During this period, the community develops a sense of order and control, and the concerned relief authorities can do a lot much to facilitate this step towards recovery.. Phase III, the Recovery Phase is characterized by alternating episodes of adjustment and relapse and there may be some obvious examples of resilience and positive outcomes. Further comprehensive research studies must be A lot of research still needs to be done in order to understand how communities cope with chronic exposure to threat and adversity, but Jones and his colleagues have reassessed the social effects of air raids in Great Britain during the Second World War. They indicate a high level of civilian resilience developed during that period. (Jones et al., 2004).[14] Similarly, law enforcement authorities have commented on the apparently low level of violence-related psychopathology reported in Northern Ireland during the Troubles. Clinical data is still not enough to identify It is unclear, as to what are the protective factors in these circumstances. Extensive denial, social cohesiveness, a united front against a common enemy or some other as yet undetermined influences could be termed as protective factors. Mental Health Studies Mental health research studies are conducted worldwide to explore the effects of terrorism both on the individuals and the community. Whereas some emphasize the psycho-pathological effects of terror (Galea, Ahern, Resnick et al., 2002),[15] others focus on the human suffering, which is not identical to psychiatric morbidity (Wessely 2003),[16] and on community and cultural factors that enable people to endure the stressful event (Hobfoll, 2003).[17] This conflict between two distinct approaches (Wessely, 2003) ishas yet to be bridged. Any horrific event can affect people directly or indirectly even if they are not the targets. Hence the target of the interventions is not the individual victim only, but all the people more indirectly affected by the incidence. An impartial approach may be suitable. The World Health Organization (WHO) has issued guidelines for action during emergencies which seem to support such a stand (WHO, 2003).[18] Experiencing or witnessing a violent attack does not necessarily mean that the individual will inevitably develop psychiatric morbidity (Curran, and Miller, 2001).[19] After the September 11, 2001 attacks in New York City, it was observed that: In the aftermath of terrorist attacks, many Americans regarded their distress as a normal reaction rather than a disorder needing [psychiatric] care. (Drus and Marcus, 2004).[20] Presently available data suggest that it takes more than the agent (e.g., threat to life) to lead to psychopathology. Indeed, the role of the environment is of significance, as a part of the epidemiological triangle that has been discarded by a greater focus on host-related factors (e.g., gender or age of the victim). ) A study on adults have recognized a group of factors, including religious beliefs, ideological commitment and social capital, that have protected communities which were highly exposed to terrorist attacks (like the loss of dear ones, physical injuries and property damage etc). Ideology and religion may be used as a healing power, but also as a weapon. This is especially true in the [Middle East] region. (Solomon, and Laufer (2005);[21] Shalev et al.; Shalev,[22] Tuval-Mashiach Hadar, 2004; Kaplan et al.; Kaplan,[23] Matar, Kamin, et al., 2005; Billig, Kohn, and Levav, 2004).[24] All the research data today gives hope that, by advancing research on the mental health effects of war-related activities will be conducive to the development of new techniques to counter the psycho-social aftermath of wars and other such traumatic events., Ppsychiatrists worldwide are joining the call by WHO member states to devise means to restore the psycho-pathological damage sustained by victimized populations. The World Psychiatric Association (WPA) has been active in the recent Gaza Massacre,by giving an official statement. (See Mario Maj. statement in Chapter 1V -Wars in the Muslim World1).[25] Nonetheless On the other hand, psychiatrists could play other roles even at the risk of raising idealistic initiatives which cynics might like to dismiss. There are several possibilities open for psychiatrists who, by the nature of their profession can, besides promoting health, support peace rather than war. Psychiatrists and other mental health professionals from countries in conflict could engage in alliance in a number of activities (e.g., teaching, exchange of experiences in program development and services, communication), while they are actively, tenaciously and continuously supported by WPA. Most importantly, psychiatrists must endeavour to make their societies even more ardently aware that in armed confrontations no one is a winner but that everyone is a victim. The model of collaboration in the Balkans, where mental health is a bridge to reconciliation within the framework of the Stability Pact, is a concrete example of what could be achieved when a unifying language is spoken, and when such an effort is reinforced by dedicated support from sources that are not part of the conflict. Terrorism is a paradox—a topicalcontemporary, high-profile subject with clear relevance to the real-world today relevance, yetNevertheless with limited authentic and desperate shortage of research data available es in the area. Therefield there is an urgent need to encourage the younger researchers to take a keen n interest in continuing maintaining research activities .y in the area. Psycho-Social Effects of Terrorism on the Muslim World While nothing is easier than to denounce the evildoer, nothing is more difficult than to understand him. (Mikhailovich Dostovsky) The Muslim World has endured a succession of terrorist attacks in the last decade and faced the war against terrorism with endurance and resilience. The countries most affected were Iraq, Gaza, Afghanistan, Pakistan, and particularly the FATA region in Pakistan which has been labelled as the centre of terrorist training. Pakistan also became the first line of defense in this War on Terror. The most distressing aspect of this war is the amount of destruction, damage and killing of innocent civilians of these regions. Ironically the damage done following the declaration of this war is to a large extent much greater than the loss which resulted due to the actual terrorist incident of 9/11 in New York. The Muslims worldwide have confronted the worst degree of terrorism from the powers who claim to bring peace and justice in the world. It is logical and justifiable to control and battle against those who are involved in such degrading and inhumane acts of terrorism, however, some contemplation is necessary to remodel unreasonable and illogical methods or strategies chosen to fight this terrorism. The international media has been a major partner in this war against terrorism and played a key role in portraying religious extremism in Islam as the major cause of present-day terrorism. But this is untrue since Islam is primarily a religion of peace, love and harmony. Unfortunately, clerics who have limited knowledge of the teachings and values of the Islam have misguided some people for their vested interests. The misinterpretation of the teachings of Islam by irresponsible clerics has led to fanaticism. Islam is the most practical religion of the world. As narrated by Dr Muzammil H. Siddiqi:[26] The concept of human rights in Islam is based on two important principles: dignity of human beings and justice. Islam emphasizes that all human beings are honoured by Allah subhanahu wa taala. Allah wants all human beings to live in peace and harmony and for this reason He wants us to establish justice in this world. Without justice there is no dignity and without dignity and justice there cannot be any peace. There are several passages in the Holy Quran verifying the above narration: If any do fail to judge by (the light of) what God (Allah) hath revealed, they are (no better than) unbelievers. (Holy Quran 5:44). o ye who believe! Stand out firmly for God (Allah), as witnesses to fair dealing, and let not the hatred of others to you make you swerve to wrong and depart from justice. Be just: that is next to piety: and fear God (Allah). For God (Allah) is well-acquainted with all that ye do. (Holy Quran 5:8). Human blood is sacred in any case and cannot be spilled without justification. Violating this rule is equivalent to killing all of humanity: if anyone slew a person — unless it be for murder or for spreading mischief in the land — it would be as if he slew the whole people. (Quran 5:32). Hence the Holy Quran advocates that death of a single human being is a death of humanity. At present it is vital to understand that words terrorism and war against terrorism apparently seems to be propaganda against Islam and Muslims. Such perceptions against Islam and the Muslims have taken a toll on the social, psychological and emotional well-being of Muslims in different parts of the world. (Zafar, 2007).[27] Psycho-Social Impacts of Gaza Conflict: On 31 January 2008, the Gaza Community Mental Health Programme (GCMHP) organized a Conference on Effects of Siege on Life and Mental Health of Palestinians in Gaza Strip. Taysir Diab, Clinical Psychiatrist and Supervisor at GCMHP, talked about the mental impacts of the siege based on GCMHPs experience. He stated that there It is not one, but were a group of bio-psycho social factors that which caused mental illness. Diab of these factors under the siege on Gaza; and that the and its psychological, physical and social impacts of these factors were clinically identifiable. The siege, he said, had a direct effect on the appearance of new psychiatricmental cases and the relapse of old ones. There are personal differences on the physical and psychological levels; there are protective factors such as religion, patriotism, norms and values, as well as social support. All these factors along with others contributed in the protection of individuals. and the development of new mental illnesses in the Palestinian people. According to Diab, a vast majority of the Palestinian populations were suffering from symptoms of psychiatricmental disorders. He pointed out that the clients of GCMHPs Community Centers suffered from various psychological problems, including panic, insecurity feelings of insecurity, easily provoked aggressiveness, anger, easily provoked, psychosomatic disorders, depression, frustration, low morale, fear, poor concentration, lack of belonging or affiliation, lack of confidence in self and others, emotional numbness,numbness, and PTSD symptoms., various physical complaint, Oobsessiveon-Ccompulsive Disorders were common, and there was a definite rise in illness relapses.rise in illness relapses. Diab further mentioned that the siege affected the vulnerable groups, in particular children who suffer increasingly from fear, panic, and at times apathylack the feeling of risks, tendency of sadness and insecurity feelings of insecurity., as well as Bbed-wetting and stutteringstuttering, was also a common presentation. He also pointed that the siege affected the mental health professionals in term of increasing their mental stresspressures and state of frustration, avoidance, nervousness, and professional burn-out. Furthermore, Ahmad Abu Tawahina, Senior Clinical Psychologist and Director General of GCMHP, statedmentioned that the major aimplan behind the siege imposed by Israel wasis to implantinstil panic and fear among the Palestinians citizens. He said: We, as Palestinians, must never live a frustrating and despairing life and have to get rid of the negative impacts of siege since life goes on, and the professionals must exert all efforts in order to help people cope with the difficult situations. Twahina also stated that it was vital that Palestinians should not drown in terror and fear since most of the above mentioned symptoms are natural reactions to a madcrazy reality. He also addressed the concept of victimof victim psychology and commented on the importance of offering the mental services for people who suffer from frequent depressions, and increasing concerns. According to him the mental suffering affects everybody but at different levels, and that theere is depression, anxiety, tension, and despair is prevalent at the entirewhole community levels. In his work paper, . Samir Zaqout, a psychologist at GCMHP, discussedtalked about the social changes resulting from the siege. He statedadded that: the siege started in 1948 when Israeli Occupation practiced siege policy in an attempt to deny the Palestinians their identity: The siege is doubled as it is imposed by Israel and the international community since they didnt allow the Palestinians to practice their rights in a democratic way. Further, Zaqout pointed that the siege affected the Palestinian social fabric and domestic relations as hatred and tendency of revenge increased among the Palestinians. It also affected the moral values and accepting the other as well as increasing inter and intra familial disputes and conflicts. Summing up the proceedings of the Conference Eyad el Sarraj pointed to the significance of highlighting such statistics and showing the direct impacts of the siege on the citizens. He stressed on the importance of the accuracy and avoiding exaggeration in stating any statistics. Sarraj focused on the victim psychology. He said: Since we, as Palestinians, shouldnt adopt the role of victim, and exaggerate in blaming others and defaming ourselves. Our priority should be national reconciliation and unity and supporting the Palestinian resiliency so as to achieve our legitimate rights, endorsed by international conventions. Concluding the conference the mental health experts reiterated that it was crucial that the siege must end and professionals must undertake their roles in the field of education and mental health. This would be the first step in to bring some semblance of normality to the lives of the Gaza Community. This step was vital, in order to enable them to cope with negative consequences of the siege and minimize the resultant burdens. Moreover, it was agreed to work on the promotion of mental resilience programs for ending the siege and developing coping strategies to counter the negative mental health consequences. It was agreed that the Palestinian people are steadfast and live with dignity, and should not bend or despair and take matters positively and effectively in order to resist all schemes aiming at weakening Palestinian social fabric, and to achieve the Palestinian rights in freedom, independence and establishing the Palestinian state. Further, the attendants emphasized the importance of working, as specialists in various fields, on influencing the decision makers in the Palestinian society and acquaint them with the destructive impacts of the siege at all levels, especially the mental health of the future Palestinian generations. The physical and mental health needs of sufferers of Gaza are extremely challenging to address, particularly the psychological and emotional crises. During the last Israeli military strike in the period from December 2008 to January 2009, approximately 1380 Palestinians were killed, of whom 431 were children and 112 women. (United Nations Population Fund (UNFPA) (2009). At least 5380 people were injured, including 1872 children and 800 women. In these improvised settings within health facilities such as maternity wards and operating theatres were transformed into trauma units. The consequences must be drastic in terms of maternal and child morbidity and mortality because 3500 deliveries were expected to have taken place during the twenty-three days of military operations. Findings from a recent UNFPA assessment indicate that, during that period there was an increased number of miscarriages in pregnant women (Shifa, Al Aqsa, Naser, Rafah), and an increased neonatal mortality in Shifa Hospital in Gaza City. (UNFPA, (2009). According to World Health Organization (WHO), only the rough estimates show that during the last Gaza crisis 25000 to 50000 people underwent severe mental stress and need some form of psychological intervention to address long-term effects. Women, separated children, elderly people, and people with prior physical or mental disabilities are at high risk of severe emotional distress than others. The restoration of normal socioeconomic conditions, secure living

The Flea - John Donne :: essays research papers

John Donne and an Analysis of "The Flea" John Donne was born on Bread Street, London, in 1572. His family was very rich but they were Roman Catholic, not the best group to be a part of at his time, in England. He studied three years at the University of Oxford and three years at Cambridge. He never got a degree because he refused to take the oath of supremacy at graduation time. He then studied law and was on his way to be a diplomat. He wrote a book of poems, Satires, after his brother died of fever in prison after offering sanctuary to a proscribed catholic priest. He then wrote a series of love poems in Songs and Sonnets. In 1596, he joined a naval campaign against Spain and when he came back, 2 years later, he became secretary to Sir Thomas Egerton. Just as he started doing well, he secretly married Egerton's niece, Anne More, and when discovered, he was thrown in jail along with the two friends who had helped in his secret relationship. Anne's family helped them and a few years later, Donne reconciliated with Sir Thomas and was finally given the dowry he was owed. He lived the next few years as a lawyer and lived a poor existence. He then wrote two anti-Catholic poems that got him the king's favor and started working Sir Robert Drury of Hawstead, who gave him an appartment in his castle for writing a beautiful eulogy for his 15 year old daughter. Donne and his wife had 12 children, 7 of which survived and in 1617, Anne died at age 33, while giving birth to a stillborn child. He wrote the Holy Sonnets. He was made vicar in 1625 but suffered from severe infections of the mouth which caused his death in 1931. He would've become a bishop in 1930. Before his death, he preached his own funeral sermon, Death's Duel. His last piece was The Hymn to God, my God, in my sicknesse. Donne is a very witty poet. In The Flea, like in many other poems, he tries to convince a young woman to sleep with him. He compares giving up her virginity her virginity to the size of a flea go show how "unimportant" it is. "It suck'd me first and now sucks thee" is used in the first stanza to argue that because their bloods are mixed inside the flea, they are married and therefore, making love would not be a sin.

Essay --

RECRUITMENT PROCESS Job classification is to group job positions and then value them in a fair and transparent manner according to various functions as well as geographically. Job titling is to provide a title to each job classification in order to define and recognise the responsibility and level of the position. At ArcelorMittal, they use a customised statistical tool known as the LDA methodology which rates the function of the job, its content and the responsibility involved. Factors such as value added by a given business area, scope of function covered by the position, level of skill and professional know-how, geographical scope of the position – regional, national or global, autonomy – reporting levels and several Macro and Micro-economic environmental accountabilities and challenges are considered to obtain a numerical value termed ‘JOB POINTS’, based on which jobs are then classified. After this step an evaluation is carried out by the current incumbent and the manager in order to have a detailed understanding of the position. A report is then prepared on the...

Review Article †Rheumatoid Arthritis & Il-6 Essay

Introduction Rheumatoid arthritis (RA) is an inflammatory autoimmune condition principally causing synovial joint inflammation and cartilage erosion. The pathogenesis encompasses intricate cellular and humoural manifestations, and vascular reactions that result in the infiltration of the synovium by white blood cells, of which release inflammatory mediators, inclusive of Interleukin-6 (IL-6). IL-6 serum levels of RA patients as shown by Capell et al. (1993) displayed a median of 55 IU/ml, as compared to that of healthy controls of 10 IU/ml. With a wide-ranging pleiotropy endorsed by both a membrane-bound (IL-6R) and soluble (sIL-6R) receptor, and by the relative omnipresence of the trans-membrane protein gp130, IL-6 endorses a pro-inflammatory effect via its influence on numerous cell types and signalling-pathways. As a result, heightened levels of IL-6 aids in the promotion of osteitis, sequential joint damage, pain/discomfort and impaired function in RA patients. Pleiotropy of IL-6 Interleukin 6 exerts effects on numerous pathways contributing to the pathophysiology of RA. IL-6 as it is called today has been known by several names that exemplify its pleiotropy for example, hepatocyte-stimulating factor known to cause the induction of C-reactive protein (CRP); due to IL-6 association with synovial fibril aggregation has been known as Amyloid protein; a thrombopoietin; both B-cell differentiation and stimulating factor 2; plasmacytoma growth factor; and cytotoxic T-cell differentiation factor. It also causes the differentiation of Th17 cells; is a causative factor in adhesion molecule expression on the surface of endothelial cells, and is involved in the differentiation to mature from precursor osteoclasts cells (REF!!). IL-6 Recptor binding IL-6 implements its influence via a protein complex primarily comprised of a membrane bound IL-6R and a glycoprotein comprised of two intra-cytoplasmic transducer sub-units, gp130. When IL-6 binds to membrane bound IL-6R (mIL-6R) it causes homo-dimerisation of the gp130 sub-units, of which triggers intra-cytoplasmic signal transduction. Whilst expression of gp130 is relatively omnipresent upon the surface of the body’s cells (Akil, et al., 2008), IL-6R is most prominently located on hepatocytes, macrophages, monocytes, neutrophils and select lymphocytes. However, (sIL-6R) of which is systemic also binds IL-6, and just as mIL-6R, can also engage with gp130 for sIL-6-gp130 trans-signalling (REF!). Synoviocytes, for example do not express mIL-6R but do express gp130. Raised levels of IL-6 in the synovium is a characteristic biomarker of RA (Attar, et al., 2010), and Kim, et al. (1996) states enhanced IL-6/sIL-6R in synovial fluid increased the risk of joint destruction, as IL-6 stimulates endothelial cells to express adhesion cytokines and other molecules of which attract inflammatory cells to synovial membrane (Romano, et al., 1997) thus could contribute to exemplifying the significance of sIL-6R in RA pathophysiology. sIL-6R is formed by either an incomplete proteolytic enzymic dissection of mIL-6R or alternative splicing of mRNA (REF!!). With the aforementioned ubiquitous nature of gp130, mIL-6R and systemic sIL-6R, increasing evidence REFERENCES SEE NOTES!! shows that a non-membrane bound, systemic, soluble gp130 (sgp130) found in higher circulatory concentrations than that of sIL-6, also binds IL-6/sIL-6R, thus functioning as a redundency factor inhibiting the cytoplasmic signal-transducing potential of mgp130 REFERENCES SEE NOTES!!, (IL-6/IL-6 receptor system and its role†¦) thus serving as a natural inhibitor of IL-6 signalling (IL-6/IL-6 receptor system and its role†¦). Intracellular signalling gp130 dimerisation brings Janus Kinases (JAKS), a receptor-associated protein complex, into close proximity causing a trans-activation of the two molecule types. Auto-phosphorylation of JAKS occurs, of which causes intracellular signal transduction by recruiting signal-transducers and activators of transcriptions (STAT) that form either hetro or homo dimers and migrate to cell nucleus effecting target gene transcription of various physiological processes (REF). IL-6 can be detrimental to human physiology (REF!), thus expression of proteins known as the suppressors of cytokine signalling (SOCS) function as a negative-feedback system, and are activated by STAT’s. The regulation of the JAK-STAT signalling pathway by SOCS is more specifically down-regulated by SOCS 3 (REF!). SOCS 3 binds JAK’s causing negative-regulation thus functioning as an auto-regulatory mechanism, by inhibiting JAK activity. IL-6 and the Adaptive Immune System The trans-signalling of IL-6 is known to cause the induction of pre-B-cell-colony-stimulating factor (PBEF) in fibroblast cells of the synovium (Bryant, et al., 2006), and since PBEF upon its discovery was considered a B-cell differentiation cytokine(McNiece et al., 1994), it could be considered plausible that IL-6-induced PBEF and the IL-6 maturation of B-cells, collectively contribute to RA. It has been found the effect of IL-6 on plasmablasts indirectly induces the production of B-cell antibodies by assisting elements of CD4+ T-cells (of which act upon activated B-cells) due to elevated IL-21 production (Bond, et al., 2009), thus IL-6 may potentially be a co-adjuvant to humoural immunity enhancement (Bond, et al., 2009). Enhanced levels of the RA associated Rheumatoid Factor are located in the IgA, IgG and IgM isotypes (Ahmed, et al., 2010), and citruline antibodies located in serum and joints, can be linked to the plasmablast-induced antibody production of IL-6 (Ahmed, et al., 20 10). IL-6 enhances T-cell proliferation where they have been mitogen stimulated (Mihara, et al., 2002). IL-6 also impacts T-cell development (Mihara, et al., 2002). Along with transforming growth factor (TGF)- ÃŽ ², IL-6 contributes to Th 17 differentiation, an effector T cell with pro-inflammatory elements, and is further compounded by Th 17 production of the pro-inflammatory cytokine IL-17 (Bettelli, et al., 2007). Interestingly, without IL-6, TGF- ÃŽ ² induces Treg production, of which are Th 17 cell suppressors (Hirota, et al., 2008). CD4+ Th cells have been considered Th 1 and Th 2 based upon their cytokine-producing characteristics (Diehl and Rincon, 2002). Th 1 and Th 2 produce IFN-á µ § and IL-13 respectively, of which are both pro-inflammatory molecules, however whereas IL-6 bolsters IL-4 induced differentiation of Th 2, it causes the inhibition of IL-12 induced differentiation of Th 1 (Diehl and Rincon, 2002). Acosta-Rodriguez, et al. (2007) found that in vitro levels of IL-1ÃŽ ² – induced Th 17 polarisation of naà ¯ve human CD4+ T-cells were heightened by IL-6 involvement. More research however, is required to make clear the full extent of IL-6 role in human Th 17 cell development, in vivo. During inflammation, neutrophils of which are essential inflammatory mediators, systemically increase substantially, resulting in relative neutrophilia. Endothelial cells, macrophages and monocytes all emit IL-6. Neutrophils are directly affected by IL-6 due to the expression of IL-6R. Filer, et al. (2005) found that co-cultured endothelial cells and fibroblasts extracted from synovial fluid of RA patients caused an increase in IL-6 and neutrophil recruitment. Adhesion molecules, of which it has been shown in the work of Woodfin et al. (2010) to be required in the transmigration of neutrophils, are augmented by IL-6 such as vascular cell adhesion molecule – 1 (VCAM) and intracellular adhesion molecule – 1 (ICAM) of which produce chemokine production. Thus neutrophils being the most numerous and systemic of leucocytes have a strong initial synovial presence and is bolstered by the amplification of the inflammatory cascade, contributing to the inflammatory escalation during acute-phase response; and findings from animal and human studies revealed that the blockade of IL-6 caused a reduction in neutrophil levels at inflamed sites (Hashizume, et al., 2008), as well as a reduction in systemic neutrophil counts in RA patients (Deguchi, et al., 2003 and Broll, et al., 2006),thus indicating a prominent role for IL-6 in neutrophilia. IL-6: Acute to Chronic Farnarier, et al. (2003) suggests the transition from acute to chronic inflammation as emphasised by a shift of biomarker from neutrophil to monocyte, is influenced by IL-6. It was found that if stimulated for a number of hours by inflammatory cytokines, neutrophils switched from the production of IL-8 and transitioned to monocyte chemoattractant protein-1 (MCP-1) (Yamashiro, et al., 1999). sIL-6R is released from neutrophils of which in turn causes the chemokine release of endothelial cells, thus Romano, et al. (1997) suggests the IL-6 – sIL6R complex contributes to the release of MCP-1 from endothelial cells. As earlier discussed, neutrophil-count was found to be directly associated with the blockade of IL-6R?!; and endothelial cells expressing the gp130 but not the IL-6R, thus reliant upon the IL-6 – sIL6RÃŽ ± complex for induction of MCP-1 release, i.e. the release of monocyte, not neutrophil specific chemo-attractants (Gres, et al., 2001), it would appear IL-6 tran-signalling plays an integral role in the transition from acute to chronic inflammation via neutrophil and endothelial cells. *CHART SHOWING CELLS THAT RELEASE IL-6!!* IL-6 induces a disintigrin and metalloproteinase with thrombospondin motifs (ADAMTS) and matrix metalloproteinase (MMP) proteinases of which are pivotal in the degradation of extracellular matrix. IL-6 more specifically, has been shown to induce ADAMTS-4 and MMP’s 1, 2 and 13 production in cells lining the synovium and chondrocytes (Hashizume and Mihara, 2009; Hashizume, et al., 2010; 2012). However, it has been suggested the IL-6 – sIL-6R complex has bearing on the extracellular matrix turnover, as it causes generation of tissue inhibitors of MMP’s (TIMP’s) in synovium fibroblasts and chondrocytes (Dayer, et al., 1998 and Hashizume, et al., 2012). The drug tocilizumab (TCZ), an IL-6 inhibitor reduces MMP-3 blood serum levels of RA patients (Garnero, et al., 2010), and has been show to restore biomarkers associated with cartilage turnover (Dayer, et al., 1998). Thus, in RA patients the reduction of IL-6 activity appears to be a mediatory factor in sustainment of healthy joint cartilage. Angiogenesis is a key process in the local inflammatory process. Neovascularisation of the synovium and other angiogenic processes such as hyperplasia of synovial cells and permeation by inflammatory cells are characteristic processes in pannus development and RA pathology (Ballara et al., 2001). In addition to notable constituents of the inflammatory process such as monocytes and T cells, both of which as stated previously have affiliations with IL-6 expression (CITATION OF A FEW), levels of a key angiogenic specific growth factor Vascular Endothelial Growth Factor (VEGF) has also been associated with systemic levels of IL-6, as demonstrated in the work of Hasizume, et al., 2009 and Hagihara, et al., 2003 revealing IL-6 induces VEGF production from synovial cells. VEGF induces proteins that contribute to the breakdown of endothelial basement membrane, including MMP’s, of which increases the permeability of blood vessels, thus allowing enhanced infiltration of inflammatory constituents (Delisle, et al., 2010). VEGF levels accordingly, have been shown to coincide with the articular severity of RA (Hagihana, et al., 2003), and has shown a reduction in response to TCZ (Hagihana, et al., 2003), of which correlates with findings of a semi-quantitative assessment by Akoi, et al. (2011) using ultrasonography that found TCZ responsible for a marked reduction in RA neovascularisation. Bone Remodelling Bone remodelling is a highly regulated process in which mature bone tissue is removed by osteoclasts and formation by osteoblasts. The pathogenesis of RA favours bone loss (resorption) via the excessive production of osteoclasts. Anecdotal evidence by Kazuto et al. (1996) revealed synovial fluid highly +ve for IL-6 –sIL6R complex from RA patients, stimulated increased formation of osteoclasts in mouse co-culture of osteoblast and bone marrow cells. This study coincides with research by Balena, et al. (1994) of which indicated that mice deficient in IL-6 displayed no significant changes in gross or trabecular bone structure. In human studies, biopsies of RA patients revealed that peri-articular bone loss was found to correlate with local excessive presence of IL-6 (Sugiyama, 2001), and work by Garnero et al. (2009) showed the administration of TCZ to RA patients in a multi-centre double-blind placebo-controlled study yielded an increase in bone-formation markers, with a decrease in bone-resorption markers. Collectively, research suggests IL-6 has a negative effect on bone mass. Acute-phase response Acute-phase response is an innate immune reaction in which IL-6 is notably involved via the stimulation of hepatocytes, and is a key inducer of the acute-phase protein CRP. CRP is considered a dependable biomarker of inflammation and RA activity as serum half-life remains constant due to its inflammatory-induced, hepatic-stimulated production being the exclusive systemic determinant and due to its noted increase in RA serum levels (Hirshfield and Pepys, 2003). Anaemia Approximately 1-in-4 RA patients will suffer symptoms of anaemia within the first year (Figenschau, Nikolaisen and Nossent, 2008). The hormone hepcidin, produced in the liver and integral in stemming the metabolism of iron, has been shown in vitro to increase in presence due to IL-6 stimulation of hepatoma cells (Ganz, 2003). This study correlates with Gabayan et al. (2004) in which IL-6 induced patients experienced a 7.5 fold increase in hepcidin production. Anaemia in RA patients, as a result of a hepcidin-IL-6 axis, has limited but supported credence. Osteoporosis has also shown a correlation with IL-6. As mentioned earlier, healthy bone metabolism requires adequate regulation of osteoclasts and osteoblasts, in which excessive IL-6 expression and the Th17 derived IL-17 (Gillespie, et al., 1999) both contribute to excessive osteoclast formation (Campbell et al., 2005). This has also been found to be the case in transgenic mice (De et al., 2006; and Choy and Dayer, 2009) in which bone formation was reduced, and negative ossification was reported. As shown, there are comparable cross-over aspects of IL-6 pathology between RA and osteoporosis. Treatment As highlighted throughout this review, IL-6 plays a pleiotropic pathophysiological role in RA, thus would make an ideal therapeutic target. The most promising and note-worthy of treatments at present, TCZ interrupts IL-6 induced trans-signalling. Numerous studies have shown promising results including a phase III clinical trial in 2005 using the ACR (American College of Rheumatology)* RA activity measure, which had improvement measures of 89, 70 and 47% at ACR’s of 20, 50 and 70 respectively at 52 weeks, in patients treated with TCZ. This multicentre, double-blind placebo-controlled trial by Hashimoto et al. (2004) showed bone resorption and joint destruction could potentially be completely prevented (Kishimoto, 2010), as exemplified when a culture of patient synovial and peripheral mononuclear cells, extracted from the same patients showed that osteoclast generation was completely prevented (Hashimoto et al., 2004; Kishimoto, 2010). At 6 weeks within this study, it was also found that IgG, CRP and serum amyloid A levels all normalised. It has also been suggested that TCZ aids in Th17 differentiation, hence IL-17 production, thus aids in the improvement of RA symptoms (Kimura and Kishimoto, 2010). Other notable studies such as the SAMURAI (Study of Active controlled Monotherapy Used for RA, an IL-6 Inhibitor) and LITHE (TociLIzumab safety and THE prevention of structural joint damage trial) served to enhance conscensus. This humanised, monoclonal antibody has now been approved in many countries^^. 286 With a wide-ranging pleitropy, IL-6 has the most profuse SF and systemic cytokine presence in RA pathophysiology, and coincides with cartilage erosion and disease activity. It has a role in elements of B-cell differentiation and increasing evidence suggests a definite yet ambiguous role in Th17 differentiation. IL-6 has several key positions in immune and inflammatory processes (recruitment, permeation and adhesion of inflammatory elements), and bone and joint degradation, of which over-expression causes adversity, such as release of hepcidin and CRP from the liver contributing to anaemia and inflammation, osteoporosis and pannus development. It plays a key role in the cross-over from acute-to-chronic disease. TCZ has shown much promise in RA therapy by inhibiting IL-6 expression. *ACR 20, 50 and 70 = improvements of 20%, 50% and 70% in disease activity, respectively. ^Disease Modifying Anti Rheumatic Drugs. ^^Japan , April 2008, Europe, January 2009 and USA, January 2010. PUT IN ABSTRACT: The IL-6R, sIL-6R and gp130 system is known as IL-6 trans-signalling References: Capell, H. A., Crilly, A., Madhok, R., Watson, J., 1993. Serum interleukin 6 levels in rheumatoid arthritis: correlations with clinical and laboratory indices of disease activity. 52 (3): 232 — Annals of the Rheumatic Diseases. [ONLINE] Available at:http://ard.bmj.com/content/52/3/232.full.pdf+htm. [Accessed 23 December 2012]. Angelo, L. S., Hong, D. S., Kurzrock, R., 2007. Interleukin†6 and its receptor in cancer. Cancer – Wiley Online Library. [ONLINE] Available at:http://onlinelibrary.wiley.com/doi/10.1002/cncr.22999/pdf. [Accessed 01 January 2013]. Bussolino, F., Ciliberto, G.,Faggioni, R., Fruscella, P., Hinsbergh, V. 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