The Innate Immune Response Essay Example | Topics and Well Written Essays - 750 words

The Innate Immune Response - Essay Example The defense mechanism is categorized in three types; i. External barriers, comprising of skin, nostril hairs etc. which tries to prevent the pathogens from entering the body. In fact the external barriers include physical, mechanical and chemical barriers. For example, skin and nostril hairs are termed as physical barriers; tears and extraction from genitourinary tract are the form of mechanical barriers. Similarly secretion of skin, eyes, oral cavities and respiratory tracts in the form of sweat, tears, saliva, and mucus containing anti-microbial peptides are the form of chemical barriers. As the term 'innate' suggests, the innate immune system is the inherent immune system we are born with. In fact some antigens are also present in our body, but the defense mechanism learns to live with it and together with these types of proteins, the immune system gains strength over time. The innate immune system is entrusted with; The type of innate immunity system, available in the form of protein chemical is known as 'innate humoral immunity'. Body's complement system, interferon and interleukin are some of the examples of such a system. The complement proteins together with interferon and antibodies form the all important white blood cells in the body. The complement system is a defense mechanism involving a group of more than 30 interacting soluble plasma proteins. These cell proteins provide the early warnings by way of triggering inflammation and synthesis of enzymes, so that reproduction and multiplication of viruses can be blocked. Allergies and inflammation are the forms of innate immune response. Redness, swelling, heat and pain are some of the initial responses of the immune system against the infection. The innate immunity system tries to highlight the ferocity of the pathogens by such actions. The inflammation occurs when tissues are injured by bacteria, trauma, heat or toxins. The damaged tissues release some chemicals like histamine, serotonin or bradykinin. These chemical substances in turn cause the blood vessels to leak fluid into the tissues, which causes swelling. This helps in taking appropriate response e.g. medication and precaution. The innate immune response is generated by the white blood cells, natural killer cells (NK cells) and T

Evaluation of Supply chain performance Essay Example for Free

Evaluation of Supply chain performance Essay The contents of the paper comprise the case study of ACTAVIS BULGARIA EAD Sofia’s supply chain performance evaluation. It is elaborated in the paper that supply chain performance evaluation is not a simple concept; instead, it pertains to various drives, environmental factors, needs, technologies, and other forces. Managers must keep on evaluating the supplier’s performance in order to provide the company with competitive advantage. The evaluation and improvement of supply chain is somewhat oversimplified.   How the results of the evaluation will enhance the productivity of company is also discussed. Outline of Paper: The paper focuses on the supply chain management of the Actavis Bulgaria company and covers the following main points: The importance of measuring the performance of the organisations supplies chain (upstream and downstream). Key performance indicators to assess the company’s suppliers have been used. Critical examination of the possibilities for improvements of the downstream supply chain has been undertaken. Importance of Supply Chain performance evaluation: With the increasing globalization the competition between the firms is also increasing.  Ã‚   The Speed of delivery is becoming a key indicator of supply chain success. The dynamic nature of current and future operations requires constant analysis of medical materieldown to the individual item leveltransiting this pipeline. The goal of a supply chain should be to maximize overall supply chain profitability. Supply chain profitability is the difference between the revenue generated from the customer and the total cost incurred across all the stages of the supply chain. Supply chain decisions have a large impact on the success or failure of each firm because they significantly influence both the revenue generated as well as the cost incurred. Successful supply chains manage flows of product, information and funds to provide a high level of product availability to the customer while keeping costs low. Measuring the performance of the supply chain is critical to identifying troubled segments, determining success, and assessing operational capabilities. Measuring performance requires a metric that measures the time from demand creation to demand fulfillment at the customer level. Average customer wait time: a supply chain performance indicator Army Logistician, Nov-Dec, 2004 by David R. Gibson http://www.findarticles.com/p/articles/mi_m0PAI/is_6_36/ai_n8704513 From the managerial focus, the performance measurement can be defined as the information regarding the processes and products results, that allows the evaluation and the comparison in relation to goals, patterns, past results and with other processes and products. Also, it is important to highlight that a managerial performance evaluation system needs to be focused on results, which should be guided by the stakeholder’s interests. Beamon Ware (1998) affirm that the adoption of performance indicators should deal with the following questions: Which aspects should be measured? How to measure these aspects? How to use the measures to analyze, improve and control the productive chain quality? It is noticed that this is not an easy task, once there are several indicators available and it is necessary to align the used measures with the involved companies goals. In this direction, Maskell (1991) emphasizes the establishment of a relationship between the performance measures and the company strategic objectives. According to Beamon (1998), previous researches indicate that the exclusive use of costs as a performance indicator is common among the companies. This happens because the performance measurement through a single indicator is relatively simple. It should be attempted, even so, to the fact that this practice can provide very superficial information about the reality. Beamon (1996) also affirms that the chosen indicators should present simultaneously, inclusiveness (to include the measure of all the pertinent aspects), universality (to allow the comparison under several operational conditions), measurability (to guarantee that the necessary data are measurable) and consistency (to guarantee consistent measures with the objectives of the organization). On the other hand, it is not recommended to simply discard costs as a performance indicator due to its importance. The alternative would be the adoption of multiple indicators, involving a cost combination with time, flexibility and quality, according to the company competitive priorities. Traditionally, the performance evaluation is limited to an isolated company or productive process. For an effective SCM it is necessary to expand these concepts beyond the company limits, involving all the supply chain players. It is necessary then, the development of a performance evaluation system embracing all the business units. This can be achieved through the adaptation of the traditional performance evaluation systems. Currently Actavis operates in the country split into two divisions Operations and Sales Marketing. Actavis Bulgaria Operations is a holding company responsible for the management of the three factories providing first class generic products, mainly for the Bulgarian, Russian, Ukrainian and CIS markets. The Sales Marketing division is represented in the country by Actavis EAD, a company registered under the Bulgarian law. It employs about 200 people and operates three warehouses in the country. Actavis EAD is mainly focused on marketing the Groups products as first class generics on the Bulgarian market, which is the third biggest market for the companys own brand revenues world wide. Following its strategy for a vertical integration on the Bulgarian market Actavis recently acquired one of the biggest local distribution companies, Higia. It is expected that the combination of Actavis strong portfolio and Higias strategically important foothold in the distribution of pharmaceuticals will provide a more direct route to the customers and also provide a stronger platform for future growth. Commercial entities licensed by the Ministry of Health for wholesale trading with pharmaceuticals. Due to the corporate structure of Actavis AD (Bulgaria), the wholesale companies are the end-users of the company, since Actavis AD (Bulgaria) does not distribute its products directly to pharmacies and hospitals but through its distributing companies (wholesalers) to which â€Å"to the market† sales are made. The value added by the distributing companies to the overall commercial activities of Actavis AD (Bulgaria) is defined both by the key position of our major partners in the whole pharmacy supply chain and by the ever improving logistics and warehouse capacities of the leading national distributing companies. The distributing companies are the company’s clients and at Actavis the customers are treated as a key to the company’s success†. The wholesalers’ role for the overall business of Actavis AD (Bulgaria) is extremely important also due to the fact that the key distributing companies (e.g. Commercial League, Sanita Trading, Kaliman) have developed vertical integration within the distribution channel, that is they own pharmacy chains. (Actavis, 2004) The generic pharmaceuticals industry is rapidly consolidating on a global basis with the key factors for future success being scale, geographic reach, product pipeline depth and access to low-cost manufacturing. The combination of Actavis and PLIVA achieves all of these crucial requirements and would create the third largest generic pharmaceuticals company globally, with the geographic scope and size necessary to compete with the largest industry players. Furthermore: * The two companies are a perfect fit which will enable a rapid integration process and create a business with a leading position in the key US, European and Asian markets and a robust portfolio covering the entire spectrum of generic and biogeneric pharmaceutical products. * PLIVA will become an integral part of the combined Groups growth strategy and benefit from increased investment and a strengthened infrastructure. Actavis plans to increase the number of employees in Croatia to generate stronger growth and greater success. Actavis intends to increase production and R;D activities in Croatia, which will ultimately lead to more jobs in the region. * The enlarged business will benefit from low cost manufacturing facilities, efficient distribution and enhanced supply chain capabilities. Actavis has a strong track record of being able to drive down manufacturing costs across the Group without impacting the employee base. * PLIVA will become the headquarters for a substantial part of the enlarged business, and at the same time benefit from Actavis global footprint and infrastructure. * Actavis will seek a stock listing in Zagreb to encourage ongoing support from the investment community in Croatia. * Actavis puts great value on PLIVAs Croatian roots and is committed to revitalizing the PLIVA brand and expanding its recognition in key markets. * Actavis has a high opinion of PLIVAs management team and envisages them playing a central role in the new company and sharing decisions regarding future strategy. 20. 04. 2006Actavis announces improved preliminary proposal to Pliva http://www.actavis.bg/en/News/Pliva+improved+proposal.htm Performance measurement of Actavis Suppliers: Supplier performance must be rated on each of these factors because they impact the total supply chain cost. Next we discuss how each factor affects total supply chain cost and how a supplier’s rating on the factor can be used to infer a total cost of using the supplier. 1.replenishment lead time: As the replenishment lead time from a supplier grows the amount of safety inventory that needs to be held by the buyer also grows proportional to the square root of the replenishment lead time. Lead-time performances by a supplier can directly the translated into the required safety inventory using equation 11.9. Scoring the performance of suppliers in terms of replenishment lead-time thus allows the firm to evaluate the impact each supplier has on the cost of holding safety inventory. 2. On-time performance: On-time performance affects the variability of the lead-time. A reliable supplier has low variability of lead-time whereas an unreliable supplier has high variability. As the variability of lead-time grows, the required safety inventory at the firm grows very rapidly. 3. Supply flexibility: Supply flexibility is the amount of variation in order quantity that a supplier can tolerate without letting other performance factors deteriorate. The less flexible a supplier is, the more lead time variability he will display as order quantities change. Supply flexibility thus impacts the level of safety inventory that the firm will have to carry. 4. Delivery frequency/minimum lot size: The delivery frequency and the minimum lot size offered by a supplier affect the size of each replenishment lot ordered y a firm. As the replenishment lot size grows, the cycle inventory at the firm grows, thus increasing the cost of holding inventory. For a firm using a periodic review policy, delivery frequency also impacts the required safety inventory. Thus, delivery frequency of a supplier can be converted into the cost of holding cycle as safety inventory. 5. Supply quality: A worsening of supply quality increases the variability of the supply of components available to a firm. Quality affects the lead-time taken by the supplier to complete the replenishment order and also the variability of this lead-time because follow-up orders often need to be fulfilled to replace defective products. As a result, the firm will have to carry more safety inventory from a low-quality supplier compared to a high-quality supplier. Once a relationship between supply quality lead-time and lead-time variability is established, each supplier’s quality level can be converted to the required safety inventory and the associated holding cost. The component quality also impacts customer satisfaction and product cost because of rework, lost material, and the cost of inspection. 6. Inbound transportation cost: The total cost of using a supplier includes the inbound transportation cost of bringing material in from the supplier. Sourcing a product overseas may have lower product cost but will generally incur a higher inbound transportation cost, which must be accounted for when comparing suppliers. The distance, mode of transportation, and the delivery frequency affect the inbound transportation cost associated with each supplier. 7. Pricing terms: Pricing terms include the allowable time delay before payments have to be made and any quantity discounts offered by the supplier. Allowable time delays in payment to suppliers save the buyer working capital. The cost of working capital savings for each supplier can be quantified. Price terms also include discounts for purchases above certain quantities. Quantity discounts lower the unit cost but tend to increase the required batch size and as result the cycle inventory.

The Rogerian approach to therapy has severe limitations

The Rogerian approach to therapy has severe limitations Carl Rogers (1902-1987) was a major force for psychology in the twentieth century. His theory on client centred therapy is still used today in mainstream counselling though now it is more widely known as person centred. To whether client centred therapy is supportive rather than reconstructive, Rogers work focused on phenomenology and his three core conditions to a working relationship; Unconditional Positive Regard, Empathy and Congruence. I will explore which aspects are supportive and which are reconstructive and whether there are any limitations to this approach. Rogers believed that everyone has the ability to change for the better and they hold all the answers within them even if they do not know it yet. His theory was based around three core conditions that the therapist should abide by in order to help the client feel at ease, feel confident in themselves and develop their own answers. These core conditions are Empathy, Congruence and Unconditional Positive Regard (UPR). This essay will look at Rogers theory on client-centred therapy; Phenomenology and the three core conditions. The essay will also evaluate whether there are any limitations to Rogerian theory due to it being supportive rather than reconstructive. In 1928, Carl Rogers went off to Rochester, NY where he took his first job at the Rochester Society for the Prevention of Cruelty to Children where he worked essentially as a child clinical psychologist until 1938. In 1936 Rogers became interested in the Rankian approach to therapy after attending a series of Otto Ranks lectures. Rogers always stated that Rankian influenced the shape that person centered counseling took, especially its emphasis on the positive characteristics of the individual, the quality of the therapeutic relationship, and a focus on responding to feelings. I became infected with Rankian ideas. (Kramer cited in www.ottorank.com) When Rogers was at Rochester he worked with a mother whose son was displaying behavioural problems. Dryden (2007) wrote that Rogers saw the root of the problem as the mothers rejection of her son as a baby. Rogers could not get the mother to see this and was about to give up when she asked for adult counselling for herself. This shift in focus served as a catalyst for her to speak about all her problems she was experiencing. Rogers found this case a turning point in what therapy should be about; the client (Rogers 1939). It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would be better to rely upon the client for the direction of movement in the process. (Dryden 2007:145) Around the time of Rogers, theorists such as Strange (1950) saw counselling as a relationship, which encourages growth in both and therapist and the client. Smith (1955) defined counselling as therapist led in that they would assist the client in interpreting their problems and thoughts (cited in Chadra Gupta 1989:187) In 1951 Rogers published Client-Centred Therapy which established him highly in the psychotherapeutic community. Rogers claimed that behavioural therapists were preventing their clients from self-actualizing and discovering their own solutions. Carl Rogers (1951) developed his client-orientated approach to meet the demand of personal freedom (Chadra Gupta 1989:187) in that it seats the client at the centre of the process with the therapist just walking alongside. Rogers work was based on the belief that the client know what is best for themselves rather than followers of psychoanalysis and behavioural theories which sees the therapist interpreting the problem and what is solution is. Rogers try to make clients feel unique, he wanted to understand how the client felt and reflected their statements back to them. Rogers (1951) saw the purpose of counselling being a more broadly based structure of self, an inclusion of a greater projection of experience as a part of self and a more comfortable and realistic adjustment to life. (Chadra Gupta 1989:11) Rogers tended to distance himself from already established theories as he felt that it attempted to fit the client into a mould rather than seeing the client as they are. He found then that he could devote his energy instead to relating deeply to his clients and discovering with them what worked. (Thorne 2003:24) Rogers had an understanding that a person was not just made up of ID and Ego (Freudian theory) but was also a product of his or her environment, family and values. He saw a persons behaviour as subjective to himself or herself. To Rogers, the equality between the client and therapist was integral to a healthy and positive therapeutic relationship. Rogers felt that if the therapist were to be seen as the expert it would throw the relationship off balance, as it is the client who is the one with all the answers, not the therapist. The issue of power is central to his understanding of the therapeutic relationship. (Thorne 2003:25) The subjective experience of the client is key to Rogers client centred approach and if the therapist is the one with the power then the client may feel no validity in their own thoughts and self understanding. Hence, the therapeutic relationship breaks down and the client will never achieve success in finding his or her own answers (i.e. Conditional Regard of what the therapist wants). Rogers therapy is supportive in that the therapist accompanies the client on their journey whilst displaying UPR, congruence and empathy but it is also reconstructive as it enables the client to make the right changes for themselves without any judgement of the therapist. The therapist should be a facilitator not an authorative expert. In my opinion, Rogers seeing the clients as client and not patients is what sets aside this form of working from the doctor-patient medical model. Rogers way of working encouraged therapy o be a process about the individual and their needs, not a diagnostic tool which is generic to every patients symptoms. The process is the key factor. (Dryden 2007:186) Phenomenology holds the belief that all humans behave in response and accordance of their own subjective understanding and awareness of where we are in the world. The therapists function is to aid the client in the exploration and discovery of his or her own inner resources. (Thorne 2003:25) Central to Rogers phenomenological theory is optimism and that a human has a basic optimistic view and if supported in finding an understanding in their subjective world, then the client would start to engage in behaviours and thoughts that were positive. This concept became known as The Actualising Tendency. Carl Rogers believed that there was one motivational force that determined the development of the human being. He called this the Actualising Tendency. (Mearns Thorne 2008:12) In Rogers understanding and anthropological research he found that humans, in nature, have an innate desire to move towards progress, positiviness and their potential. Like a flower sown in rough soil surrounded by darkness and poisons, it will strive towards even a glimmer of light in order to survive and grow. Rogers saw peoples behaviour as no different. Rogers continued this analogy by explaining that the rougher and poorer soil (i.e. the environment someone is in), the more water and nourishment theyll need. The harder a persons situation and circumstances, the more support they will need to find and grow towards their Actualising Tendency. Depending on the person, this process can be slow and sometimes even stop depending on their self-perception or other parts of them, which can be, more resistant to change or self-realisation. The Human Organism itself manifests this tendency and has infinite inner resources. For Rogers the tendency to actualise the self is essentially a subsystem of the Actualising tendency. (Thorne 2003:27) This supportive element of Rogers worth explored questions such as How does it feel and What it be like toà ¢Ã¢â€š ¬Ã‚ ¦known as Spotlighting. Although Rogers is directing the conversion, the client is still recognising their own behaviours and coming to their own conclusions about any changes that need to be implemented; self-actualizing. This is reconstructive an example of this would be weight loss: Within the framework of the Self Actualizing Tendency Rogers believed that humans have enormous resources for successful living and to achieve a happy and fulfilled life. Rogers believed that your body knows what it wants and needs and when it is full; you just need to listen to it. The body and mind are connected together with Phenomenology. To the client food may represent more than food, it may represent comfort, acceptance and stress relief and the natural relationship is changed. This can also happen when people starve themselves or diet unhealthily to be an acceptable size by size 0 society norms. When people are pregnant they tend to listen less to society and more to their body and less to society and previous conditioned values i.e. I might be getting bigger but my baby needs me to eat more. Rogers supported in clients in feeling open enough to talk about their relationship with food and would help them peel back the onion layers i.e. you overeat due to stress, lets address the feelings of stress first. The client then can rebalance their emotional need without eating to feel normal. Through Empathy, UPR and Congruence, the client begins the process of self-actualizing without any limitations imposed from the therapist. This is when the therapist reflects what they key issues that need to be addressed. Although this seems to conflict with Rogers belief that the client finds their own answers, once the key issues are spotlighted, the client then decides what they want to focus on, even if the therapist sees the answers lying elsewhere. Fully Functioning (Rogers 1963) people are as Rogers described are psychologically healthy persons who have been fortunate enough to be surrounded by others whose acceptance and approval have enabled them for at least some of the time to be in touch with their deepest feelings and experiences. (Mearns Thorne 2008:15) Fully Functioning clients have trust in the organismic valuing process and feel confident. Others who are not fully functioning are those who have faced or continue to face negativity, conditional positive regard and judgement. The key to Rogers client centred approach was the concept of self worth. Rogers identified that when we are born we have a tendency towards actualisation. This gets cloudy the older we get, once we inherit parental values, different environments and conditions of worth, reward and our need for positive regard increases. We require at some level and in some way, however minimal, to feel good about ourselves and if this need is not met it is difficult to function in the world. (Thorne 2003: Rogers theory of self was based on the principle that if we are raised in a supportive and positive environment where we receive positive reinforcement for who are and want to do, then we trust in own abilities and our thoughts and feelings in order to make the correct decisions in line with our perception of the world. If however, we are raised in an environment filled with conditions of worth such as If you do x then you will be good or Mummy will love you if, then our need for positive regard in dependant on other people. We will grow up only recognising achievements depending on values and responses of others rather than feeling fulfilled in whom we are and the life we lead; we are only dependent on ourselves. Psychological disturbances will be perpetuated if an individual continues to be dependent to a high degree on the judgement of others for a sense of self worth. (Mearns Thorne 2008:153) Rogers believed that this dissonance between our innate need for approval and our inner self-wisdom is the root cause of much inner disturbance and lack of self-confidence to make positive decisions on our own, for ourselves. Rogers saw this as a lack of self-trust in the organismic valuing process. If people are not raised in a supportive environment where they are listened to and valued then the supportive environment of Rogerian therapy might be their first experience of feeling valued. Rogers believed in a mixture of his therapy being supportive as well as reconstructive and the process should emphasise the thinking with the individual, not for the individual. People cannot only be affected by their inter-personal relationships but also by their social and cultural norms. An example of this affecting a persons Actualizing Tendency is when the media and society portrays a size 0 image as what is the new definition of beautiful. For those that arent that particular size it could make them feel devalued by society and could impact on their esteem and confidence levels. This is turn could affect and superseded their Unconditional Positive Regard (UPR) they received from their parents saying they are ok the way they are and leave the person feeling lost and insecure. Rogers highlighted the importance of giving UPR in sessions, empathising with clients and building a good rapport and level of trust. Through this client-focused medium, the client can start working on the issues they feel are negative to them; comparing themselves and valuing themselves against the size 0 images in magazines. The therapist aims to create an environment in which the client can be supported to achieve personal growth by reconnecting with their Organismic Valuing Process (how I feel), Self-Actualizing Tendency (what do I need) and their Internal Locus of Control (I am worthy). These supportive key elements to Rogers theory highlight the persons need for unconditional positive regard, empathy and congruence. The therapist provides a relationship of trust, warmth and UPR that encourages clients to talk about themselves and their feeling. (Heap Aravind 2002:186) Empathy by Collins dictionary definition is the power of understanding and imaginatively entering into another persons feelings. (www.freedictionary.com) Empathy is the therapists ability to understand the clients subjective perceptual world and how they see themselves and the world around them. It is a process. In person centred therapy the counsellor tries to enter the clients frame of reference and walk alongside him in his world. (Mearns Thorne 2008:69) It is important that the therapist remains reliable and strong and not get sucked down into the clients world so much that they lose sight of their role in this process. A good analogy of where that boundary is and why is The Well. If a client is stuck at the bottom of a well there is little point the therapist getting down into the well with them to find out how they are as then they would both be stuck. Instead, the therapist could sit on the edge of the well, talking to the client and empathising that this situation must be hard, lonely etc without being down there and equally stuck. Rogers believed that an empathetic approach required the therapist to be secure within themselves before entering into a clients world: the As If factor. This is to state that the therapist should enter to clients world as if they were there, not get lost in it. When this is achieved, there can be movement in the clients self-concept and worth, as the therapist is able to express empathetic responses, which show the client they are being understood. Although each person experiences the world differently, a therapists understanding and appreciation of a persons problems and hardship can be supportive to the client. Rogers believed that empathy could be shown in therapy through good body language, summarising and reflection. Empathy is a continuing process whereby the counsellor lays aside her own way of experiencing and perceiving reality, preferring to sense and respond to the experiencing and perceptions of her client. (Mearns Thorne 2008:67) Communication is key to this core condition. When a client feels accepted, valued and understood it aids feelings of alienation, loneliness and desperation. Rogers referred back to these core conditions as integral to person centred counselling therapy. Unconditional Positive Regard (UPR) as non-judgemental acceptance of a client and is key to the client feeling safe enough to work through their negative feelings. Rogers believed in peoples honesty when not faced with judgment and rejection; the client should be accepted as they are not as they want to be or how the therapist feels they should be. Rogers advocated that the client should be totally accepted with no exceptions. If the therapist accepts you, that is one step closer to self-acceptance. If the therapist can show UPR regardless of what the client says i.e. I hate my mother and want to kill her and empathise with how they feel, they will be in a relaxed trustworthy environment to open up to what might be underlying these feelings. Rogers believed these core conditions can help the client come to terms with their emotions and in turn, their self-regard will improve. Although this could be seen as facilitating a change I see it as more reconstructive as it can go far deeper than the presenting need and the therapist might never be aware of where the change is actually happening i.e. being able to talk about hating their mother might spark revelations that can now be accepted i.e. Its not my fault. In practical terms it can be hard for some therapists to let go of the power or lead the client to elicit change. This will lead the client down their own path of self-change and correction of negative behaviours and false statements which is far more powerful. Rogers saw that most people accessing therapy had little UPR in their life and saw this is a root of their problems. Unconditional positive regard is the label given to the fundamental attitude of the person centred counsellor towards her clientà ¢Ã¢â€š ¬Ã‚ ¦and is not deflected in that valuing by any particular client behaviours. (Mearns Thorne 2008:95) Rogers believed that this consistent unconditional regard aids the clients process of feeling valued and break down barriers the client might be putting up in order to feel accepted. Unconditional Positive Regard is important as it directly conflicts with the self-defeating cycle. This cycle (Mearns Thorne 2008:99) promotes a clients condition of worth, which they might have carried around all their life. With the therapist counteracting this, it can aid the client in finding a break through in their negative patterns. These core conditions to Rogerian client-centred therapy are both supportive; the UPR, but also reconstructive as the client is the one finding their own answers, without condition or judgment from the therapist. Yet this can only be achieved with empathy and congruence otherwise it may seem false. Congruence is characterised by the therapist being transparent to the client, not superior to them. It is genuine, authentic and real. The therapist conveys this genuine realness and allows the client to see them as a human being not a doctor hiding behind certificates and metaphorical white coats. Congruence can be displayed verbally; thats terrible, I dont understand, please say that again, and non-verbal communication such as facial expressions and body language which reflects, not mimics, the clients. This process of the three core conditions supports the client in feeling relaxed and confident to look at their problems honestly and without judgement though it is reconstructive as the client is the one in the drivers seat; making the changes for themselves. From the reading I have done for this essay I feel that the one main limitation to Rogerian theory regarding its supportive nature would be that Rogers non-directive approach to therapy is not consistent as reconstructive as with techniques such as summarising and selective reinforcement, answers and reactions can be shaped. I have found another limitation is Rogers belief in the potential of the fully functioning person, which is not achievable in reality. Although the idea is something to aim for! Does supportive mean it cant be reconstructive? Only the client knows what they need and once they connect with that, only they will know how they feel. The therapist can support them in their journey but it is actually made by the client. Rogation therapy is based on both a supportive and reconstructive stance as the client benefits from the empathy, Unconditional Positive Regard and congruence the therapist gives them but ultimately it is the client who recognises where changes could be beneficial and implicates them. One of the most rewarding moments in a counselling process comes when a client discovers or re-discovers the dependability of his organismic valuing process however temporary or partial this may be. (Mearns Thorne 2008:14) I feel in conclusion that Rogerian therapy can be both supportive and reconstructive and that is the mix of the two, which takes away any major limitations. WORD COUNT: 3449

Diabetes Mellitus Essay -- essays research papers

Diabetes Mellitus Is a multisystem disease related to abnormal insulin production, impaired insulin utilization, or both. Diabetes Mellitus is a serious health problem throughout the world. It is the 5th leading cause of death in the U.S. It is the leading cause of heart disease, stroke, adult blindness, and nontraumatic lower limb amputations. Etiology and Pathophysiology Current theories link the cause of diabetes, singly or in combination, to genetic, autoimmune, viral, and environmental factors (obesity, stress). Regardless of its cause, diabetes is primarily a disorder of glucose metabolism related to absent or insufficient insulin supplies and/or poor utilization of the insulin that is available. The two most common types of diabetes are classified as type I or type II diabetes mellitus. Gestational diabetes and secondary diabetes are other classifications of diabetes commonly seen in clinical practice Normal Insulin Metabolism Insulin is a hormone produced by the B cells in the islets of Langerhans of the pancreas. Under normal conditions, insulin is continuously released into the bloodstream in small pulsatile increments (a basal rate), with increased release (bolus) when food is ingested. The activity of released insulin lowers blood glucose and facilitates a stable, normal glucose range of approximately 70 to 120 mg/dl. The average amount of insulin secreted daily by and adult is approx. 40 to 50 U, or 0.6 U/kg of body weight. Other hormones (glucagons, epinephrine, growth hormone, and cortisol) work to oppose the effects of insulin and are often referred to as counterregulatory hormones. These hormones work to increase blood glucose levels by stimulating glucose production and output by the liver and by decreasing the movement of glucose into the cells. Insulin and the these counterregulatory hormones provide a sustained but regulated release of glucose for energy during food intake and periods of fasting and usually maintain blood glucose levels within the normal range. An abnormal production of any or all of these hormones may be present in diabetes. Insulin is released from the pancreatic B cells as its precursor, proinsulin, and is then routed through the liver. Proinsulin is composed of two polypeptide chains, chain A and chain B, which are linked by the C-peptide chain. The presence of C peptide in serum and urine is a useful indic... ...d at bedtime). Pancreas Transplantation Is used as a tx option for patients with type I diabetes mellitus who have end-stage renal disease and who have had or plan to have a kidney transplant. Kidney and pancreas transplants are often done together. If renal failure is not present, the ADA recommends that pancreas transplantation should only be considered for patients who exhibit the following three criteria: *A history of frequent, acute, and severe metabolic complications (hypoglycemia, hyperglycemia, ketoacidosis) requiring medical attention *Clinical and emotional problems with exogenous insulin therapy that are so severe as to be incapacitating *Consistent failure of insulin-based management to prevent acute complications Successful pancreas transplantation can improve the quality of life of people with diabetes, primarily by eliminating the need for exogenous insulin, frequent daily blood glucose measurements and many of the dietary restrictions imposed by the disorder. Pts who undergo pancreas transplantation require immunosuppression to prevent rejection of the graft and potential recurrence of the autoimmune process that might again destroy pancreatic islet cells.

Moral Struggle in Great Expectations

Moral Struggles of Great Expectations Pip is the main character of the novel desires to fulfil his expectations and the world he lives in does not gladly provide an easy way to his dream. Joe is his brother-in-law and his angry sister’s husband who treats Pip much better than her, just because he happens to have a bog heart. In the beginning of the novel, prior to Pip being exposed to the world he feels that he can satisfy his expectations, Joe and Pip are equals – the humbleness and loyalty that Joe displays are often similar to that of a child. Joe is comfortable with who he is and while he desires to learn from Pip once he becomes educated, he does not seek to be anything other than what he is. This, ideally, would have been a priceless lesson for Pip to learn, as it would have spared Pip from losing himself in a complex and corrupt world. Sadly, yet pivotally to the intrigue of the plot, it is only once Pip realises the error in his ways that he can see the true gentleman in Joe. Interestingly, it is something he identifies early on when he comments that â€Å"[I] was looking up to Joe in my heart† (49). This is not simply an affection of love, yet one of admiration and respect. It is once Joe repays Pip’s debts, and leaves to save Pip the ‘embarrassment’ of associating with him, that Pip realises the quality of Joe’s character. Joe embodies the true gentleman; while not of class, his character is class, and he continually displays qualities of loyalty and fidelity that Pip believes can be embodied by outward displays of wealth and education. Pip learns from Joe – albeit in hindsight and through his own personal crises – that wealth and class are not fundamental to being a gentleman. Mr Jaggers, the attorney of Pip’s mysterious benefactor and a ruthless and respected man in society, represents what Pip could become in the society he loses himself in. His standing as a gentleman is not based in the quality of his character (as he is a portrayed as a defence lawyer, interacting with dubious suspects on a daily basis with a fierce and powerful manner) but in the fearful respect he commands in society. So complex is Mr Jagger’s character that he is able to command respect from Pip, despite that he â€Å"hardly knew what to make of Mr Jagger’s manner. Wemmick suggests that Mr Jaggers would â€Å"take it as a compliment† to know that Pip felt that way. (196) It is clear, however, that Pip admires Mr Jaggers, as is evident in Chapter 20 of the novel. Pip is privy to Mr Jaggers' mannerisms when dealing with clients. Pip, despite being introduced to Mr Jaggers’ character in this manner, is clearly infatuated with his power and status an d accepts him as a gentleman. Ironically, Mr Jaggers’ was not born into wealth either, but rather worked his way up to his position of power. Pip ignores this fact, and it is only after he learns the truth about his journey to becoming a gentleman that he realises that Mr Jaggers does not represent a true gentleman either. He is yet another representation of how wealth and power are in fact far removed from being a gentleman. The irony is that Mr Jaggers’ true character is never hidden from Pip, and thus so great are his expectations, that he is blinded to the blatant truth about a true gentleman’s role in society. The character Abel Magwitch (initially referred to as the convict, and only revealed as Pip’s benefactor as the climax of the novel) is not only the catalyst to a growth into manhood and morality for Pip, but the character from whom Pip learns the most from during their interaction. As the convict, Magwitch is nothing but a source of latent fear for Pip. The intrigue surrounding the identity of the benefactor and the assumptions the reader makes compliments the idea that he is a source of fear, and nothing else. At the climax of the novel, when it is revealed to Pip that it is Abel Magwitch, a convict and fugitive, who has bestowed his new riches on the boy who tried to help him years previously, Pip’s expectations and belief in the gentleman he thinks he is, is shattered. As Pip believes his benefactor was Miss Havisham, and that she has been grooming him for Estella, and to become a true gentleman, he never questions the validity of his essence as a gentleman. Upon learning that the source of his education and wealth – and ultimately his status as a gentleman – is in fact a convict, his identity is crushed. It is to his horror that the source of his status as a gentleman is the absolute antithesis of a gentleman in his eyes. Pip thus has to come to terms with the idea that it is not the outward appearance of a man that determines his character. This is also echoed in Chapter 5 of the novel, when Magwitch/the convict confesses to stealing food from Mrs Joe to save Pip from being implicated. Pip has to accept that the class he was trying to distance himself from embodies something to aspire to. Towards the end of the novel, Pip displays his growth as he reflects that in Magwitch he â€Å"only saw a man who had meant to be my benefactor, and who had felt affectionately gratefully and generously towards me with great constancy through a series of years. I only saw in him a much better man than I had been to Joe. (440) Thus Pip identifies himself as less of a gentleman than that of Joe and Magwitch, illustrating that he has come full circle, to acknowledging his faults in his perception of his status as a gentleman due to his wealth and education. Herbert represents who Pip could become. Despite his lack of wealth initially, he is every inch a gentleman and upon receiving money at the request of Pip, he starts his own law firm and builds a successful career for himself, thus fulfilling the desires that Pip believed he strove for. Pip chooses to misuse the wealth that is bestowed upon him, and it is after Pip learns the valuable lessons from Joe, Jaggers and Magwitch, that he realises that Herbert is the gentleman he aspires to become. While the irony of the source of Herbert’s wealth being indirectly from Pip is not unclear and certainly not unimportant, is it Pip’s realisation that it is not the source of wealth and status that makes one a gentleman, but the manner in which one’s character is displayed in the consequences of one’s actions. Pip learns to assume responsibility from his destiny from the success of Herbert. It is evident that valuable lessons about the character displayed in actions are prevalent in Great Expectations. Joe, Jaggers, Magwitch and Herbert (albeit not as forcefully) offer insight into the quality of one’s character as an internal embodiment of class. Jaggers fails to impress, whereas Magwitch and Joe display varying yet quintessential attributes of gentlemen. Herbert is the opposite pole to Jaggers, representing what Pip can become by embodying gentlemanly characteristics, rather than trying to live like one. Pip learns various aspects of the same intrinsic lesson from all these characters: that is it not the quality of the life of the man, but the quality of the man, that speaks of his character. Pip loses this sense during the course of the novel, and it is the interaction with these characters that gradually return him to a path of fulfilling his greatest expectations and dreams.

Reactivity Definition in Chemistry

Reactivity Definition in Chemistry In chemistry, reactivity is a measure of how readily a substance undergoes a chemical reaction. The reaction can involve the substance on its own or with other atoms or compounds, generally accompanied by a release of energy. The most reactive elements and compounds may ignite spontaneously or explosively. They generally burn in water as well as the oxygen in the air. Reactivity is dependent upon temperature. Increasing temperature increases the energy available for a chemical reaction, usually making it more likely. Another definition of reactivity is that it is the scientific study of chemical reactions and their kinetics. Reactivity Trend in the Periodic Table The organization of elements on the periodic table allows for predictions concerning reactivity. Both highly electropositive and highly electronegative elements have a strong tendency to react. These elements are located in the upper right and lower left corners of the periodic table and in certain element groups. The halogens, alkali metals, and alkaline earth metals are highly reactive. The most reactive element is fluorine, the first element in the  halogen group.The most reactive metal is francium, the last alkali metal. However, francium is an unstable radioactive element, only found in trace amounts. The most reactive metal that has a stable isotope is cesium, which is located directly above francium on the periodic table.The least reactive elements are the noble gases. Within this group, helium is the least reactive element, forming no stable compounds.Metal can have multiple oxidation states and tend to have intermediate reactivity. Metals with low reactivity are called noble metals.  The least reactive metal is platinum, followed by gold. Because of their low reactivity, these metals dont readily dissolve in strong acids. Aqua regia, a mixture of nitric acid and hydrochloric acid, is used to dissolve platinum and gold. How Reactivity Works A substance reacts when the products formed from a chemical reaction have lower energy (higher stability) than the reactants. The energy difference can be predicted using valence bond theory, atomic orbital theory, and molecular orbital theory. Basically, it boils down to the stability of electrons in their orbitals. Unpaired electrons with no electrons in comparable orbitals are the most likely to interact with orbitals from other atoms, forming chemical bonds. Unpaired electrons with degenerate orbitals that are half-filled are more stable but still reactive. The least reactive atoms are those with a filled set of orbitals (octet). The stability of the electrons in atoms determines not only the reactivity of an atom but its valence and the type of chemical bonds it can form. For example, carbon usually has a valence of 4 and forms 4 bonds because its ground state valence electron configuration is half-filled at  2s2  2p2. A simple explanation of reactivity is that it increases with the ease of accepting or donating an electron. In the case of carbon, an atom can either accept 4 electrons to fill its orbital or (less often) donate the four outer electrons. While the model is based on atomic behavior, the same principle applies to ions and compounds. Reactivity is affected by the physical properties of a sample, its chemical purity, and the presence of other substances. In other words, reactivity depends on the context in which a substance is viewed. For example, baking soda and water are not particularly reactive, while baking soda and vinegar readily react to form carbon dioxide gas and sodium acetate. Particle size affects reactivity. For example, a pile of corn starch is relatively inert. If one applies a direct flame to the starch, its difficult to initiate a combustion reaction. However, if the corn starch is vaporized to make a cloud of particles, it readily ignites. Sometimes the term reactivity  is also used to describe how quickly a material will react or the rate of the chemical reaction. Under this definition the chance of reacting and the speed of the reaction are related to each other by the rate law: Rate k[A] Where rate is the change in molar concentration per second in the rate-determining step of the reaction, k is the reaction constant (independent of concentration), and [A] is the product of the molar concentration of the reactants raised to the reaction order (which is one, in the basic equation). According to the equation, the higher the reactivity of the compound, the higher its value for k and rate. Stability Versus Reactivity Sometimes a species with low reactivity is called stable, but care should be taken to make the context clear. Stability can also refer to slow radioactive decay or to the transition of electrons from the excited state  to less energetic levels (as in luminescence). A nonreactive species may be called inert. However, most inert species actually do react under the right conditions to form complexes and compounds (e.g., higher atomic number noble gases).