The Return: Nightfall Chapter 12

It came back to him, all of it: the cramped aisles and the tiny windows and the musty smell of old books. He had been in Belgium some fifty years ago, and had been surprised to find an English-language book on such a subject still in existence. But there it was, its cover worn to a solid burnished rust, with nothing of the writing remaining, if there ever had been any. Pages were missing inside, so no one would ever know the author or the title, if either had ever been printed there. Every â€Å"receipt† – recipe, or charm, or spell – inside involved forbidden knowledge. Damon could easily remember the simplest spell of all: â€Å"Ye Bloode of ye Samphire or Vampyre i?fair goode a?a general physic for all Maladie?or mischief Done by those who Dance in the Woode?at Moonspire.† These malach had certainly been doing mischief in the woods, and it was the month of Moonspire, the month of the â€Å"summer solstice† in the Old Tongue. Damon didn't want to leave Bonnie, and he certainly didn't want Elena to see what he was going to do next. Still supporting Bonnie's head above the warm pinkish water, he opened his shirt. There was a knife of ironwood in a sheath at his hip. He removed it and, in one quick motion, cut himself at the base of his throat. Plenty of blood now. The problem was how to get her to drink. Sheathing the dagger, he lifted her out of the water and tried to put her lips to the cut. No, that wasstupid , he thought, with unaccustomed self-deprecation. She's going to get cold again, and you don't have any way to make her swallow. He let Bonnie lapse back into the water and thought. Then he pulled out the knife again and made another cut: this one on his arm, at the wrist. He followed the vein there until blood was not just dripping but streaming steadily out. Then he put that wrist to Bonnie's upturned mouth, adjusting the angle of her head with his other hand. Her lips were partly open and the dark red blood flowed beautifully. Periodically she swallowed. There was life in her yet. It was just like feeding a baby bird, he thought, tremendously pleased with his memory, his ingenuity, and – well, just himself. He smiled brilliantly at nothing in particular. Now if it would only work. Damon changed position slightly to be more comfortable and turned the hot water up again, all while holding Bonnie, feeding her, all – he knew – gracefully and without a wasted movement. This was fun. It appealed to his sense of the ridiculous. Here, right now, a vampire was not supping from a human, but was trying to save it from certain death by feeding it vampire blood. More than that. He had followed all sorts of human traditions and customs by trying to strip Bonnie without compromising her maidenly modesty. That was exciting. Of course, he'd seen her body anyway; there had been no way to avoid that. But it was really more thrilling when he wastrying to follow the rules. He'd never done that before. Maybe that was how Stefan got his kicks. No, Stefan had Elena, who had been human, vampire, and invisible spirit, and now appeared to be living angel, if such a thing existed. Elena was kicky enough on her own. Yet he hadn't thought of her inminutes . It might even be a record of Elena-overlooking. He'd better call her, maybe get her in here and explain how this was working so there was no reason to crush his skull. It would probably look better. Damon suddenly realized he couldn't feel Elena's aura in Stefan's bedroom. But before he could investigate there was a crash, then pounding footsteps, and then another crash, much closer. And then the bathroom door was kicked open by Mortal Annoying Troublesome†¦. Matt advanced menacingly, got his feet tangled, and looked down to untangle them. His tanned cheeks were swept with a sudden sunset. He was holding up Bonnie's small pink brassiere. He dropped it as if it had bitten him, picked it up again, and whirled around, only to cannon into Stefan, who was entering. Damon watched, entertained. â€Å"How do youkill them, Stefan? Do you just need a stake? Can you hold him while – blood! He's feeding her blood!† Matt interrupted himself, looking as if he might attack Damon on his own. Bad idea, thought Damon. Matt locked eyes with him. Confronting the monster, Damon thought, even more entertained. â€Å"Let†¦her†¦go.† Matt spoke slowly, probably meaning to convey menace, but sounding, Damon thought, as if he thought that Damon was mentally impaired. Mortally Unable To Talk, Damon mused. But that made†¦Ã¢â‚¬ Mutt,† he said aloud, shaking his head slightly. Maybe, though, it would remind him in the future. â€Å"Mutt?You're calling – ? God, Stefan, please help me kill him!He's killed Bonnie.† The words spilled out of Matt in a single gushing flow, a single breath. Woefully, Damon saw his latest acronym go down in flames. Stefan was surprisingly calm. He put Matt behind him and said, â€Å"Go and sit down with Elena and Meredith,† in a way that was not a suggestion, and turned back to his brother. â€Å"You didn't feed from her,† he said, andthis was not a question. â€Å"Swill poison? Not my kind of fun, little brother.† One corner of Stefan's mouth quirked up. He made no response to this, but simply looked at Damon with eyes that were†¦knowing. Damon bridled. â€Å"I told the truth!† â€Å"Going to take it up as a hobby?† Damon started to release Bonnie, figuring that dropping her into bloodstained water would be the proper precursor to walking out of this dump, but†¦ But. She was his baby bird. She'd swallowed enough of his blood now that any more would begin to Change her seriously. And if the amount of blood he had already given her wasn't enough, it simply wasn't a remedy in the first place. Besides, the miracle worker was here. He closed the cut on his arm enough to stop the bleeding and started to speak†¦. And the door crashed open again. This time it was Meredith, and she had Bonnie's bra. Both Stefan and Damon quailed. Meredith was, Damon thought, a very scary person. At least she took the time, which Mutt had not, to look over the trampled clothes on the bathroom floor. She said to Stefan, â€Å"How is she?† which Mutt had not, either. â€Å"She's going to be fine,† Stefan said and Damon was surprised at his feeling of†¦not relief, of course, but of a job well done. Plus, now he might avoid being thrashed to within an inch of his life by Stefan. Meredith took a deep breath and closed her frightening eyes briefly. When she did that, her whole face glowed. Maybe she was praying. It had been centuries since Damon had prayed; and he had never had any prayer answered. Then Meredith opened her eyes, shook herself, and started looking scary again. She nudged the pile of clothes on the floor and said, slowly and forcefully, â€Å"If the item that matchesthis is not still on Bonnie's body, there is going to be trouble.† She waved the now infamous bra like a flag. Stefan looked confused. How could he not understand the mighty missing lingerie question? Damon wondered. How could anyone be such a†¦such an unobservant fool? Didn't Elena wear any – ever? Damon sat frozen, too arrested by the images in his own inner world to move for a moment. Then he spoke up. He had the answer to Meredith's riddle. â€Å"Do you want to come and check?† he asked, turning his head virtuously away. â€Å"Yes, I do.† He remained with his back to her as she approached the tub, plunged her hand into the warm pink water, and swished the towel a little. He heard her let out her breath in relief. When he turned around she said, â€Å"There's blood on your mouth.† Her dark eyes looked darker than ever. Damon was surprised. He hadn't gone and pierced the redhead out of habit and thenforgotten it, had he? But then he realized the reason. â€Å"You tried to suck the poison out, didn't you?† Stefan said, throwing him a white face towel. Damon wiped the side Meredith had been looking at and came up with a bloody smear. No wonder his mouth had been stinging like fire. That poison was pretty nasty stuff, although it clearly didn't affect vampires the way it did humans. â€Å"And there's blood on your throat,† Meredith went on. â€Å"Unsuccessful experiment,† Damon said, and shrugged. â€Å"So you cut your wrist. Pretty seriously.† â€Å"For a human, maybe. Is the press conference over?† Meredith settled back. He could read her expression and he smiled inwardly. Extra! Extra! SCARYM EREDITH THWARTED. He knew the look of those who had to give up on cracking the Damon nut. Meredith stood up. â€Å"Is there anything I can get him to stop his mouth bleeding? Something to drink, maybe?† Stefan just looked stricken. Stefan's problem – well, a part of one of Stefan's many problems – was that he thought feeding was sinful. Even to talk about. Maybe it was actually kickier that way. People relished anything they thought was sinful. Even vampires did. Damon was put out. How did you go back in time to whenanything was sinful? Because he was sadly out of kicks. With her back turned, Meredith was less scary. Damon risked an answer to the question of what he could drink. â€Å"You,darling†¦you darling.† â€Å"One too many darlings,† Meredith said mysteriously, and before Damon could figure out that she was simply making a point about linguistics, and not commenting on his personal life, she was gone. With the traveling bra. Now Stefan and Damon were alone. Stefan came a step closer, keeping his eyes off the tub. You miss so much, you chump, Damon thought. That was the word he'd been searching for earlier. Chump. â€Å"You did a lot for her,† Stefan said, seeming to find it as hard to look at Damon as at the tub. This left him very little to stare at. He chose a wall. â€Å"You told me you'd beat me up if I didn't. I've never cared for beatings.† He flashed his dazzling smile at Stefan and kept it up until Stefan started to turn to look at him, and then turned it off immediately. â€Å"You went beyond the call of duty.† â€Å"With you, little brother, one never knows where duty ends. Tell me, what does infinity look like?† Stefan heaved a sigh. â€Å"At least you're not the kind of bully who only terrorizes when he has the upper hand.† â€Å"Are you inviting me to  ¡Ã‚ ®step outside,' as they say?† â€Å"No, I'm complimenting you on saving Bonnie's life.† â€Å"I didn't realize I had a choice. How, by the way, did you manage to cure Meredith and – and†¦how did you manage?† â€Å"Elena kissed them. Didn't you even realize she was gone? I brought them back here, and she came downstairs and breathed into their mouths and it cured them. From what I've seen, she seems to be slowly turning from spirit to full human. I'm guessing it will take another few days, just from looking at her progress since she woke up until now.† â€Å"At least she's talking. Not much, but you can't ask for everything.† Damon was remembering the view from the Porsche, with the top down and Elena bobbing like a balloon. â€Å"This little redhead hasn't said a word,† Damon added querulously, and then shrugged. â€Å"Same difference.† â€Å"Why, Damon? Why not just admit that you care about her, at least enough to keep her living – and without even molesting her? You knew she couldn't afford to lose blood†¦.† â€Å"It was an experiment,† Damon explained painstakingly. And it was over now. Bonnie would wake or sleep, live or die, in Stefan's hands – not his. He was wet, he was uncomfortable, he was far enough from this night's meal to be hungry and cross. His mouth hurt. â€Å"You take her head now,† he said brusquely. â€Å"I'm leaving. You and Elena and†¦Mutt can finish – † â€Å"His name is Matt, Damon. It's not hard to remember.† â€Å"It is if you have absolutely no interest in him. There are too many lovely ladies in this vicinity to make him anything but last choice for a snack.† Stefan hit the wall hard. His fist broke through the ancient plastering. â€Å"Damn it, Damon, that's not all there is to humans.† â€Å"It's all I ask of them.† â€Å"Youdon't ask. That's the problem.† â€Å"It was a euphemism. It's all I plan totake from them, then. It's certainly all I'm interested in. Don't try to make-believe that it's anything more. There's no point in trying to find evidence for a pretty lie.† Stefan's fist flew out. It was his left fist, and Damon was supporting Bonnie's head on that side, so he couldn't lean away gracefully as he normally would. She was unconscious; she might take in a lungful of water and die immediately. Who knew about these humans, especially when they were poisoned? Instead, he concentrated on sending all his shielding to the right side of his chin. He figured he could take a punch, even from the New Improved Stefan without losing his hold on the girl – even if Stefan broke his jaw. Stefan's fist stopped a few millimeters away from Damon's face. There was a pause; the brothers looked at each other across a distance of two feet. Stefan took a deep breath and sat back. â€Å"Now will you admit it?† Damon was genuinely puzzled. â€Å"Admit what?† â€Å"That you care something for them. Enough to take a punch rather than letting Bonnie go underwater.† Damon stared, then began to laugh and found he couldn't stop. Stefan stared back. Then he shut his eyes and half-turned away in pain. Damon still had a case of the giggles. â€Å"And you th-thought that I cuh-cared about one little hu-hu-hu†¦Ã¢â‚¬  â€Å"Why did you do it, then?† Stefan said tiredly. â€Å"Whu-whu-whim. I t-told y-yuh-you. Just wuh-huhhuhuha†¦Ã¢â‚¬  Damon collapsed, punch-drunk from lack of food and from too many varying emotions. Bonnie's head went underwater. Both vampires dived for her, head butting each other as they collided over the center of the tub. Both fell back briefly, dazed. Damon wasn't laughing anymore. If anything, he was fighting like a tiger to get the girl out of the water. Stefan was, too, and with his newly sharpened reflexes, he looked close to winning. But it was as Damon had thought just an hour or so earlier – neither one of them even considered cooperating to get the girl. Each was trying to do it alone, and each was impeding the other. â€Å"Get out of my way, brat,† Damon snarled, almost hissing in menace. â€Å"You don't give a damn about her.You get out of the way – â€Å" There was something like a geyser and Bonnie exploded upward from the water on her own. She spat out a mouthful and cried, â€Å"What's going on?† in tones to melt a heart of stone. Which they did. Contemplating his bedraggled little bird, who was clutching the towel to her instinctively, with her fiery hair plastered to her head and her big brown eyes blinking between strands, something swelled in Damon. Stefan had run to the door to tell the others the good news. For a moment it was just the two of them: Damon and Bonnie. â€Å"It tastes awful,† Bonnie said woefully, spitting out more water. â€Å"I know,† Damon said, staring at her. The new thing he was feeling had swollen inside his soul until the pressure was almost too much to stand. When Bonnie said, â€Å"But I'm alive!† with an abrupt 180-degree turn in mood, her heart-shaped face flushing suddenly with joy, the fierce pride Damon felt in response was intoxicating. He and he alone had brought her back from the edge of icy death. Her poison-filled body had been cured by him; it was his blood that had dissolved and dispersed the toxin,his blood – And then the swelling thing burst. There was, to Damon, a palpable if not audible crack as the stone encasing his soul burst open and a great piece fell away. With something inside him singing, he clutched Bonnie to him, feeling the wet towel through his raw silk shirt, and feeling Bonnie's slight body under the towel. Definitely a maiden, and not a child, he thought dizzily, whatever the writing on that infamous scrap of pink nylon had claimed. He clutched at her as if he needed her for blood – as if they were in hurricane-tossed seas and to let go of her would be to lose her. His neck hurt fiercely, but more cracks were spreading all over the stone; it was going to explode completely, letting theDamon it held inside out – and he was too drunk on pride and joy, yes, joy, to care. Cracks were spreading in every direction, pieces of stone flying off†¦ Bonnie pushed him away. She had surprising strength for someone with such a slight build. She pushed herself out of his arms completely. Her expression had changed radically again: now her face showed only fear and desperation – and, yes, revulsion. â€Å"Help! Somebody, please,help !† Her brown eyes were huge and now her face was white again. Stefan had whirled around. All he saw was what Meredith saw, darting under his arm from the other room, or what Matt saw, trying to peer into the tiny, over-full bathroom: Bonnie fiercely clutching her towel, trying to make it cover her, and Damon kneeling by the bath, his face without expression. â€Å"Pleasehelp. He heard me calling – I couldfeel him on the other end – but he just watched. He stood and watched us all dying. He wants all humans dead, with our blood running down white steps somewhere. Please, get himaway from me!† So. The little witch was more proficient than he had imagined. It wasn't unusual to recognize that someone was getting your transmissions – you got feedback – but to identify the individual took talent. Plus, she'd obviously heard the echoes of some of his thoughts. She was gifted, his bird†¦no, not his bird, not with her looking at him with a look as close to hatred as Bonnie could manage. There was a silence. Damon had a chance to deny the charge, but why bother? Stefan would be able to gauge the truth of it. Maybe Bonnie, too. Revulsion was flying from face to face, as if it were a swiftly-catching disease. Now Meredith was hurrying forward, grabbing another towel. She had some kind of hot drink in her other hand – cocoa, by the smell. It was hot enough to be an effective weapon – no way to dodge all of that, not for a tired vampire. â€Å"Here,† she said to Bonnie. â€Å"You're safe. Stefan's here. I'm here. Matt's here. Take this towel; let's just put it around your shoulders.† Stefan had stood silently, watching all this – no, watching his brother. Now, his face hardening in finality, he said one word. â€Å"Out.† Dismissed like a dog. Damon groped for his jacket behind him, found it, and wished that his groping for his sense of humor could be as successful. The faces around him were all the same. They could have been carved in stone. But not stone as hard as that that was coming together again around his soul. That rock was remarkably quick to mend – and an extra layer was added, like the layering of a pearl, but not covering anything nearly so pretty. Their faces were still all the same as Damon tried to get out of the small room that had too many people in it. Some of them were speaking; Meredith to Bonnie, Mutt – no, Matt – pouring out a stream of pure acidic hatred†¦but Damon didn't really hear the words. He could smell too much blood here. Everyone had little wounds. Their individual scents – different beasts inthe herd – closed in on him. His head was spinning. He had to get out of here or he'd be snatching the nearest warm vessel and draining it dry. Now he was more than dizzy; he was too hot, too†¦thirsty. Very, very thirsty. He had worked a long time without feeding and now he was surrounded by prey. They were circlinghim . How could he stop himself from grabbing just one of them? Would one really be missed? Then there was the one he hadn't seen yet, and didn't want to see. To witness Elena's lovely features twisted into the same mask of revulsion he saw on every other face here would be†¦distasteful, he thought, his old sense of dispassion finally returning to him. But it couldn't be avoided. As Damon came out of the bathroom, Elena was right in front of him, floating like an oversized butterfly. His eyes were drawn to exactly what he didn't want to see: her expression. Elena's features didn't mirror the others. She looked worried, upset. But there wasn't a trace of the disgust or hatred that showed on all the other faces. She even spoke, in that strange mind-speech that wasn't, somehow, like telepathy, but which allowed her to get in two levels of communication at once. â€Å"Da – mon.† Tell about the malach. Please. Damon just raised an eyebrow at her. Tell a bunch of humans abouthimself ? Was she being deliberately ridiculous? Besides, the malach hadn't really done anything. They had distracted him for a few minutes, that was all. No point in blaming malach when all they had done was enhance his own views briefly. He wondered if Elena had any notion of the content of his little nighttime daydream. â€Å"Da – mon.† I can see it. Everything. But, still, please†¦ Oh, well, maybe spirits got used to seeingeverybody's dirty laundry. Elena made no response to that thought, so he was left in the dark. In the dark. Which was what he was used to, where he had come from. They would all go their separate ways, the humans to their warm dry houses and he to a tree in the woods. Elena would stay with Stefan, of course. Of course. â€Å"Under the circumstances, I won't sayau revoir ,† Damon said, flashing his dazzling smile at Elena, who looked gravely back at him. â€Å"We'll just say ;;good-bye' and leave it at that.† There was no answer from the humans. â€Å"Da – mon.† Elena was crying now. Please.Please. Damon started out into the dark. Please†¦ Rubbing at his neck, he kept going.

Codependency

Not a formal psychiatric diagnosis, codependency is a psychological syndrome noted in relatives or partners of alcoholics or substance abusers. † How It is created within a person Including the orally of the dysfunction. Also covered are what the symptoms of codependency are. I will also cover how to identify codependency in yourself or others. How the codependency affects a person's wellbeing & how to change that. The conclusion of the paper focuses on how to stop being codependent. This topic is near & dear to me. As I have predisposition towards codependency (more on that later). It seems to be a family tradition.Thinking about my relatives I could label all of them codependent. As well as most people especially In any type of caregiver role or job. Careers that have a propensity toward codependency are nursing or health care including therapists. All run the risk of wanting patients to get better so we can feel validated that we are skilled at our Job. Of course, we all wan t people to be relieved of their suffering but when that goal starts to interfere with our own sense of self, it becomes very detrimental. It goes from healthy caring to over caring & enmeshment, which can ruin our lives.When It started Innocently enough encouraged by society. It seems expected to be selfless, caring & loving to others sometimes to the determent of the self. If the individual is not, then they are deemed selfish & cold, which people would rather be, sick with someone (while helping them of course) then be labeled as self-involved or egocentric. Codependency is also being portrayed in movies. One particular story line about modern day vampires comes to mind. As I watched, I could not help but think wow way to encourage young impressionable minds to become enmeshed & codependent on one another to an extreme.Making statements such as â€Å"l would die for you† obviously not a statement to be taken lightly. Sadly, often they mean it. There seems to be a gender di fference here as well woman are much more likely to become codependents than men are. I liken that to the stereotypical role & societal expectation that woman will be the nurturers & caregivers for everyone in the family. This expectation could be expected at an early age expecting the little girl of the house to take on mommy's role if the mother is absent or sick possibly even too drunk or high to take on her duties.This loud also be the case for a boy whose Daddy is absent or sick. Mom may need the son to be a breadwinner at an early age or help tend the house. Worse, these single parents could expect these children to take on adult situations like bills emotional support or sexual incest. My experience as a codependent started as a child. I grew up in a dysfunctional home where my mother was an alcoholic. Her drinking was a secret from the outside world. My brother was the family scapegoat he had some behavioral issues. My role was the perfect child.There were many empty promise s about the drinking stopping but it never did. I never really understood the impact of growing up with an alcoholic until I learned about codependency. As a teenager, my first dating relationship was unhealthy. In the past, I have found myself in codependent relationships with men. Trying to help them & becoming immersed & obsessed. I have many of the symptoms of codependency that are listed below. I have since vowed that I will no longer enter into a codependent relationship with an unhealthy partner.With the awareness of them & by reading about the disease, I am dedicated to healing that within myself. With some insight into the disease, I see that y entire family is codependent. I tried for many years (l probably still do on some level) to help them to change their lives but I see how that is a futile pursuit. This â€Å"helping† continues to keep me codependent & sick with them. In the end, they are the only family I have & I need to accept them as they are. According to Facing Codependency Pip Melody describes â€Å"five symptoms: 1 . Experiencing appropriate levels of self-esteem (2. ) Setting functional Boundaries (3. ) Owning & experiencing their own reality (4. )Taking care of their adult needs & wants (5. ) Experiencing & expressing their reality moderately. † Codependency is called a disease it is a chronic & progressive illness. It is suggested that codependents want & need sick people around them to be happy in unhealthy ways. For example, a girl who grows up with an alcoholic father will unconsciously marry an alcoholic to perpetuate her addiction to creating, which is like a drug in it of itself.She gets fulfillment or validation while caring for the alcoholic like â€Å"he couldn't survive without me. † The reason it is called progressive is that the sicker people become around us the more intensely we exact. Codependency may not be an illness but it can make you sick & keep people But do not take action. They react to the problems, pains & behaviors of others with a disregard for their own feelings. They Justify theses creating roles as â€Å"helping† someone who has problems who cannot help themselves, I am the only one who can help, or I am the only person that cares.Is a common attitude among codependents. What they are actually doing is enabling the dysfunctional person to continue to be dysfunctional by helping them out of legal, financial, or accountability type situations. The codependent will bend over backwards, dedicating enormous amounts of energy & time & give their last dollars for the sick person. All hoping that the alcoholic or sick person will become better or change because of their help. Maybe the hope is that the alcoholic will become sober if he Just gets through this tough patch or gets the charges dropped.Meanwhile the codependent has done beyond their share of household, parenting & fiduciary duties. All the while, the codependent has lost some of themselves to the sic k people. They have lost their pride their sense of worth, their sense of respect, their time, their money etc. With the grand hopes that the sick person will see what I have sacrificed for them & they will acknowledge this & I will now get my needs met. This is unlikely to ever happen. How are the symptoms created? You guessed it childhood Just like a diseased tree its origin is in the root system.When children grow up in a family, that is less than nurturing or abusive & dysfunctional that creates codependent adults. The type of abuse or neglect that these children sustained can be vast. Abuse can be far & wide. Some forms are emotional, physical, psychological, verbal, or sexual, as well as neglect not providing or their needs or being too lax with them. Alternatively, being too rigid by expecting children to be more mature than they are capable for their age, which would include sharing adult subject matters with them being emotionally dependent, or financially and so on.Regardl ess of how we were treated as children, a core belief that what & how we were treated was normal & or loving. The dysfunction withstood is not recognized until later after the damage has been done. As children, we wanted to please our parents when this was not the case we internalized a sense of failure. We ere up with a distorted sense of what happened to us was normal & appropriate even it was not. We think the way our family & caregivers behaved toward us was correct & they are good people.The confusing part is if they are good & right then why do I feel unhappy or uncomfortable with certain occurrences that took place. How can they be wrong? No dysfunctional family is all-negative or without some good times. That is the main part of the dysfunction where the family or its individuals are not functioning normally. One of the hardest parts for children is the lack of consistency in the histrionically family. Whether it is with their needs being met consistently or how a parent dis ciplined or treated them when they were sober or high the baffling part was it always changed.A child may interpret this inconsistent behavior or treatment as â€Å"their fault† like â€Å"l did something wrong today & Mommy is mad & now she is drinking because I am a bad kid. Later when Daddy comes home there's goanna be a fight & it's all my fault if I could Just be more perfect then there wouldn't be fighting. † This is where the child internalizes shame & not being good enough or perfect heartsickness of codependents are: â€Å"Creating- they may feel responsible for other people's feelings, thoughts, choices, needs, wants, well-being or lack of & their destiny.Feeling compelled to help others with problems & offer unwanted advice, give multiple suggestions, or fix the feelings. They anticipate people's needs. Find themselves saying yes when they want to say no. Find themselves attracted to needy people & vice versa. They feel angry, used & unappreciated. Feel bor ed, empty or worthless when they don't have a crisis or someone to help in their lives. Overcoming themselves. Will give up routines to go out of their way for others. Feel safest when giving to others. Low Self Worth- Come from dysfunctional, repressed or troubled families, which they deny these issues.Blame themselves for everything. Reject praise or compliments. Never feel good enough. Feel they can't do anything right. Feel a lot of guilt. Feel ashamed of who they are. Think their lives are not worth living. Have a lot of â€Å"should†. Have been victims of abuse. Get depressed when not praised or complimented (stroke deprivation). Believe they do not deserve good things. Long for others to like & love them. Settle for being needed. Believe good things will never happen. Repression- Many push thoughts & feelings out of their awareness due to fear & guilt. Are afraid to let themselves be who they are.Can be controlling & rigid. Obsession- They feel anxious about problems & people. Worry about silly things. Think & talk a lot about others. Lose sleep over other peoples issues & behavior. Never find answers. Check on people. Abandon their routine because they are so upset with about somebody or something. Focus all their energy on other people & problems. Wonder why they never have any energy. Controlling- Many have lived with through events & with people who were out of control. Are afraid to let others be who they are & thus allow events to happen naturally.Get frustrated & angry. Feel controlled by people & events. Try to control events & people using various tactics. Denial- Ignore problems or pretend they are not happening. Pretend circumstances aren't as bad as they are in reality. Tell themselves tomorrow will be better. Stay busy so they don't have to think about things. Spend money compulsively. Overeat. Lie to themselves. Become workaholics. Believe lies. Go to Doctors for tranquilizer. Dependency- Look for happiness outside themselves. Don't feel happy, peaceful or content with themselves. Don't love themselves.Worry if others will like or love them. Look to relationships to provide all their good feelings. Often seek love from people incapable of loving. Desperately seek approval & love. Feel terribly threaten by the loss of a person or thing they think provides their happiness. Latch onto whoever or whatever they think can provide happiness. Center their lives around other people. Don't take time to figure out if others are healthy for them to be around. Lose interest n their own lives when they love. Worry other people will leave them. Tolerate abuse to keep people loving them.Don't believe they can take care of themselves. Leave bad relationships to form new ones that are Just as unhealthy. Wonder if they will ever find love. Feel trapped in relationships. Poor Communication- Blame, bribe, beg, coerce, threaten, don't mean what they say, don't say what they mean, don't know what they mean, don't take themselves ser iously, find it difficult to get to the point, gauge their words carefully for desired effect, talk too much, say everything is their alt, say nothing is their fault, lie to protect themselves, have a difficult time people.Weak Boundaries- Say they won't tolerate certain behaviors from others, gradually increase their tolerance until they can tolerate & do things they said they never would, let others hurt them, keep letting others hurt them, wonder why they hurt so badly, complain, blame, & try to control while they continue to stand there, finally get angry & become totally intolerant. Lack of Trust- Don't trust themselves, or others, don't trust their feelings don't trust their decisions, try to trust untrustworthy people.Anger- Feel very scared hurt & angry, live with people who feel the same, are frightened of their angry are frightened of others anger, feel controlled by other peoples anger, feel safer with their anger than with hurt feelings. Sexual Problems- Are caretakers i n the bedroom, have sex when they do not want to, have sex when they rather be held, nurtured & loved, withdraw emotional from their partner, are afraid of losing control, have strong sexual fantasize about other people.Miscellaneous- Codependents tend to be extremely responsible or extremely irresponsible, find it difficult to feel close to people, have a hard time having fun & eyeing spontaneous, become martyrs, sacrificing their happiness & that of others for causes that don't require sacrifice, vacillate in decisions & emotions, stay loyal to their compulsions & people even when it hurts, be ashamed about family, personal, or relationship problems, cover up, lie & protect the problem. Changing Codependency As we can see from the above list, codependency can be easy to identify with.The goal to changing the codependent behavior is not to detach from the person whom we are codependent with but to detach from the agony of involvement. Attachment occurs when we become overly worried about & preoccupied with a problem or a person. This uses up a lot of our mental energy. Obsessing, worrying & controlling are illusions. They are distracting us from ourselves & the real issues. The goal is to change that obsessing & extra energy that we are expending on someone or something other than ourselves. We need to let go with love. This can be done by detaching.Detaching does not mean we don't care about the problem or person that we have been obsessed with. Detaching means, we release the person with love & an attitude that if the problem isn't ours to solve than we can't change it. No matter how much we want someone to change or someone's problem to change WE ultimately are not able to. If the problem is someone else's then we need to realize that it is theirs to deal with not ours! When we detach we accept reality & the facts. It means to live in the present moment. We become neutral. The benefits from detaching & becoming neutral are many.We have a sense of serenity & peace the problem is no longer taking over our lives. If people have created disasters for themselves then we allow them to face those consequences. Without feeling like we are the only one who can rescue them. When we allow someone or something outside of ourselves to control our feelings then we are always at the mercy of something other than ourselves. This creates a victim mentality by giving away our sense of peace to outside sources it manifesting itself into inner turmoil. We are powerless or out of control of our wellbeing.Another key to overcoming codependency is to become less reactionary. We become oversensitive to every emotion, feeling, thought, behavior & problem that comes our way or someone else's. We allow ourselves to get so upset & distracted by little things or big things. That in turn creates a loss of control over our almost manic state. Letting go is a powerful & necessary step to recovery. We let go & let god as the twelve steps of recovery quote. Instead o f trying so hard to make things happen, we Just let go of the outcome instead of trying to control, the outcome.When we try to control results, we never get what we want. We may expend a lot of energy. Expecting if we try harder, we will get exactly what it is we want. Instead, we get frustrated, hurt, disappointed, sick & victimized. We cannot change people. When we think that we can we are deluded. When we try to control another they will either resist our efforts or try twice as hard to prove that we cannot control them. When we detach that person will notice something is different here. â€Å"Why wasn't I nagged or in trouble for this incident that I used to get in trouble for? Eventually they may realize â€Å"Oh no† this person is no longer going to rescue me & now I have to be accountable for myself more. When you remove yourself from the creating role, the other person will notice. They will eventually get the message. Start to focus on your own life. Find what inter ests you & pursue it. It is important to have a healthy interest in yourself & what makes you happy. Fall in love with yourself. Be your own best friend. Stop doing things for others that you do not want to do. Say that one very powerful word â€Å"no† when you want to.If you do say no then do not lay a guilt trip on yourself afterward about saying no. When you start putting your needs above others, you will become more peaceful & feel better about yourself. It is the opposite feeling of bending over backwards for someone & them not noticing. When you go out of your way for yourself, you will feel more valuable. It seems that overcoming codependency is a lifelong Journey with no quick fix available. There will always be people who enter our lives who will test our boundaries & challenge us to stand up for our wellbeing & ourselves.But, if you value yourself & understand, you have this propensity toward being codependent then that awareness will be helpful in creating healthy boundaries with others. As they say, awareness is the first step towards change. It is suggested to work the steps of a twelve-step program to facilitate the healing process as well as to help you bring peace to your new life, success, & leaning. It also helps to relate to others who have had similar experiences with codependency or another 12-step program. Beaten, M. (1992).

Starbucks Delivering Customer Service

Lifetime Value For Unsatisfied, Satisfied And Highly Satisfied Customers The story of Starbucks transformation from a small independent coffee shop tucked away in a corner of Seattle’s Pike Place Market to a cultural phenomenon spanning the globe is legendary. A number of factors have been attributed to the success – one being a keen understanding of its patrons. There are multiple methods used to obtain customer information and the value derived therein. Customer lifetime value is one. Customers are assets, and their values grow and decline.Segmenting customers based on their lifetime value is a powerful way to target them because marketing mix activities can then aim at enhancing customer value. (Ho, 2006) Roughly translated, customer lifetime value is the projected profits that a customer will generate during their lifetime. We used the case data to segment Starbucks customers into three distinct categories of unsatisfied, satisfied and highly satisfied. Fortunately, the case provided some useful data to make our initial assumptions about the stream of expected revenues from each category.Exhibit 9 UnsatisfiedSatisfiedHighly Satisfied Number of Starbucks Visits/Month3. 904. 307. 20 Average Ticket Size/Visit$3. 88$4. 06$4. 42 Average Customer Life (Years)1. 104. 408. 30 The data allowed us to calculate the annual expected revenues by taking 12, the number of months in a year, times the product of each component given in Exhibit 9 for each category of customer. UnsatisfiedSatisfiedHighly Satisfied Expected Lifetime Future Revenue$ 199. 74$ 921. 78$ 3,169. 67To derive the CLV it is necessary to determine the profits. This requires taking costs against the expected future revenues. The expected costs are typically any amount incurred from attracting, selling and servicing customers. The best representative cost of servicing the customer from the given data was the gross margin from Starbucks financial statements. After all, this number reflects the true costs incurred in servicing each customer, while leaving out extraneous expenses such as depreciation and other corporate overhead that have little relation.FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 Average Net Revenue1,308,700,0001,686,800,0002,177,600,0002,649,000,0003,288,900,0002,222,200,000 Gross Profit730,200,000939,200,0001,215,700,0001,536,200,0001,938,900,0001,272,040,000 Operating Profit109,200,000156,700,000212,300,000281,100,000310,000,000213,860,000 Net Income68,400,000101,700,00094,500,000181,200,000215,100,000132,180,000 Gross Profit Margin55. 80%55. 68%55. 83%57. 99%58. 95%56. 85% Operating Profit Margin8. 34%9. 29%9. 75%10. 61%9. 43%9. 48% Net Profit Margin5. 23%6. 03%4. 34%6. 84%6. 54%5. 0% The average of the five years of financial statement data was used for the margin to take against revenue. The figures below represent the CLV for each category using a discount rate of 12% to give the present value. A discount rate between 10% – 20% is typically used in these applications. Starbucks is a mature company at this stage of development and the cost of capital is likely to be toward the lower end of the spectrum. Unsatisfied Satisfied Highly Satisfied Expected Lifetime Future Revenue $ 199. 74 $ 921. 78 $ 3,169. 7 Gross Margin56. 85%56. 85%56. 85% Discount Rate 12% CLV Undiscounted $ 113. 55 $ 524. 03 $ 1,801. 94 CLV Discounted$105. 88 $405. 59 $1,137. 64 Finally, we calculated the annual CLV for each category to provide information for our upcoming problem facing Starbucks about investing in increasing staffing levels. The annual amounts were derived by annualizing the products of visits/month and average ticket size/visit. Unsatisfied Satisfied Highly Satisfied Number of Starbucks Visits/Month 3. 90 4. 0 7. 20 Average Ticket Size/Visit$3. 88 $4. 06 $4. 42 Customer Annual Value $ 103. 23 $ 119. 10 $ 217. 10 Traditional Customer Annual Value (textbook version)$209$241$440 For comparison, our group also decided to calculate the textbo ok version of CLV by taking the average retention rate of 75% derived from Exhibit 8 and inputting it into the formula used in the text. We used the same discount rate, 12%, and took that rate times the product of the number of Starbucks visits/month and average ticket size annualized.CLV = m * r/(1 + I – r) Exhibit 8 % of Starbucks’ customers who first started visiting Starbucks . . . In the past year27% 1–2 years ago 20% 2–5 years ago 30% 5 or more years ago 23% Average25% $40 Million Investment In Improving Its Customer Service Using the data provided from Exhibit 3 in the case in regards to sales data broken down for each company operated store in North America we derived the figures in the table below. DailyWeeklyMonthlyYearly Average Store Sales$2,194$15,400$66,733$800,800 Average ticket/visit$3. 85$3. 85$3. 85$3. 5 Average Customer Count5703,99017,338208,050 One assumption made was the investment in improving customer service would be restricted to North American stores (4,574) from our calculations regarding the forecasted cost of $40 million. As mentioned in the case, â€Å"the company had plans to open 525 company-operated and 225 licensed North American stores in 2003. † (MOON, 2006) Consequently, these were the figures used to determine the forecasted North American store growth in 2003 and the same growth projections were made for subsequent years.Additionally, using the customer count derived from the calculations in the previous table we projected the change in customer count by using the same retention rate of 75% calculated from Exhibit 8 to determine the amount of retained customers. This is also supported by the fact the Starbucks’ cannibalizes its existing store revenue by opening new stores in geographically clustered markets. But this is offset by the total incremental sales associated with new store concentration. That figure was then used to provide the new customers by taking (1 – 75% = 25%) the percentage times the retained customer count.Thereby, our total projected customers equaled the sum of the two and those amounts were continually projected forward. YearCustomers Retained/storeNew Customers/storeTotal Customers/storeNumber of Stores 2002208,0504,574 2003156,03839,009195,0475,324 2004146,28536,571182,8566,197 2005137,14234,286171,4287,213 2006128,57132,143160,7148,396 2007120,53530,134150,6699,772 2008113,00228,250141,25211,375 One final assumption, the growth rate in stores was halted in 2008 to reflect the effect of the recession.All of these amounts allowed the $40 million investment in customer service to be broken out per store over our projected period spanning years 2002 – 2008. Year2002200320042005200620072008 Customer retained/store156,038146,285137,142128,571120,535113,002 New customer/store39,00936,57134,28632,14330,13428,250 Total customer count /store208,050195,047182,856171,428160,714150,669141,252 Number of Stores4,5745,3246,1977,2138,3 969,77211,375 Improvement/Acquistion Cost per store$8,745$7,513$6,455$5,545$4,764$4,093$3,517As shown, the growth in stores allows for a considerable reduction in the per store cost over the projected period. The initial acquisition cost was made by simply dividing the initial $40 million cost by the number of stores in 2002. From the information provided on Page 11 Fig A – Customer Visit Frequency, we calculated the customer base for each satisfaction level. Added to this information was the data derived from the prior table to break out the forecasted revenue stream less the acquisition cost to arrive at the profits made from improving customer service. 002200320042005200620072008 Number of Customers208,050195,047182,856171,428160,714150,669141,252 Customers – Unsatisfied87,38181,92076,80072,00067,50063,28159,326 Customers – Satisfied76,97972,16767,65763,42859,46455,74852,263 Customers – Highly Satisfied43,69140,96038,40036,00033,75031,64129,663 Total R evenue per store$800,800$840,840$882,882$927,026$973,377$1,022,046$1,073,149 Acquistion/Improvement Cost for store-$7,513-$6,455-$5,545-$4,764-$4,093-$3,517 Total Revenue – AC$833,327$876,427$921,481$968,613$1,017,953$1,069,632To increase the profitability based on the CLV data, the maximum bang for the buck is gained by increasing the customer level from satisfied to highly satisfied. Making this switch, Starbucks not only will see an increase in average ticket size from $4. 06 to $4. 42, but the frequency is also increased from 4. 3 to 7. 2 visits per month. All gains yield an additional $98 in incremental gross profit per every customer moved up in satisfaction. Additionally, customer life increases from 4. 4 years to 8. 3 years.As shown in the table below, it makes more sense to pursue after switching satisfied customers to highly satisfied customers as the NPV is far greater than the alternative. Using the NPV from the table and improvement cost for each store we can cal culate the minimum number of customers that we need to switch in 2003 per store. The minimum number of customers to be switched in 2003 = Improvement cost / NPV of satisfied to highly satisfied. = $7,513/$497 = 16 customers/store = 16 * 5,324 stores = 85,184 total customersCustomer LTV/yearChange in revenue by moving up in customer satisfaction levelAvg Customer LifeNet Present Value Unsatisfied$103 Satisfied$119$164. 4 yrs$51. 86 Highly satisfied$217$988. 3 yrs$497. 31 As Starbucks expands and builds more stores, improvement cost per store that is needed is reduced. This, in turn, has a direct effect in reducing the number of customers it needs to switch up one level. Qualitative assessment of Starbucks’ challenges Expectancy-Value ModelKey Attributes (Exhibit 10)Customer Ranking (Exhibit 10)Weights (Exhibit 11)Customer ranking (Exhibit 11)Combined ProbabilityRanking of Importance Treated as a Valuable Customer0. 75free cups after certain number of visits0. 190. 14251 Friend ly Staff0. 73Friendlier, more attentive staff0. 190. 13872 Appropriate Prices0. 65Reduce Prices0. 110. 07153 Fast service0. 65Faster, more efficient service0. 10. 0654 Knowledgeable Staff0. 39More knowledgable staff0. 040. 01565 Selection of merchandise0. 5Better Quality/Variety of Products0. 090. 00456 There is a direct relationship between customer satisfaction and number of visits and revenue which eventually leads to higher profits, Starbucks’ should raise the customer satisfaction levels of its current customer base by making them visit stores more frequently. By using key customer attributes from Exhibit 10 and the consumer weights which was given in Exhibit 11, we can use the expectancy value model to see what are the perceived values to the customer.We can then rank the attributes that consumers would value the most. The expectancy value model shows that faster service is not the highest in perceived value to consumers. There are others that rank higher. Specifically, Starbucks should focus on treating the customer as a valued consumer by rewarding the consumer with free cups of certain coffees after so many purchases. This would surely build more loyalty to the their brand, especially among both the newer and older customers.Starbucks can achieve this by doing one or more of the following: †¢Prices and Promotions – Since Starbucks’ typical customer profile is evolving, the company should look in to running promotions such as discounted prices or a free drink after so many number of visits which could generate additional revenue and possibly increase the average ticket size and customer life for both unsatisfied and satisfied customer level as well as build loyalty among newer and older customers. Improve value to customers with friendly staff – Knowledgeable staff who offer attentive service by greeting and knowing regular customers as well a remembering their drinks would help to improve the value proposition for Star bucks’. This will also try to bridge the gap between Starbucks’ and various other independent specialty coffee shops. †¢Cleanliness – Starbucks’s should ensure that the store is clean at all times (i. e. , restrooms, countertops, trash cans, seating areas, etc. as store cleanliness was ranked as key attributes in creating customer satisfaction (Exhibit 10) †¢Convenience – next on the list is convenience. Starbucks’ could continue to offer customized drinks and further promote sales of its SVC cards to help customers pay for their concoction at their convenience. †¢Improve the customer snapshot measuring techniques to strike a balance in measuring customer satisfaction level. †¢Improve the quality and variety of the coffee Explore additional opportunities to earn peripheral revenues in selling pastries, sandwiches, lunch menus or even liquor. †¢Study in making store atmosphere more conducive to ethnically concentrated geographical locations. WORKS CITED Ho, T. -H. (2006). Incorporating Satisfaction into Customer Value Analysis: Optimal Investment in Lifetime Value. Marketing Science , 260-277. MOON, Y. (2006). Starbucks: Delivering Customer Service. Harvard Business Review .

Group Policy Coursework Example | Topics and Well Written Essays - 500 words

Group Policy - Coursework Example Security: due to the various security breaches evident, it is important to use the group policy to curb that. For instance, an organization can experience security breach due to the employees using very weak passwords. With the group policy, it is easy for an organization to set certain requirements for the users to follow when setting passwords. Cost and time: it enables installation or upgrading of software from one location and ensures that every machine is serviced simultaneously (Moskowitz, Hicks, & Burchill, 2013). Moreover, it is also possible to conduct the upgrade outside the business hours to avoid disruption of the work schedule. There are various potential pitfalls. One, because the SQL server is configured for windows authentication only, it becomes difficult to manage data in all the other relational databases. Moreover, the database can only be accessed from within the local area network. Beyond that, it becomes inaccessible. Lack of firewalls between the servers and the applications of the client becomes difficult to get into the client’s database and gather the additional information required. The types of data elements that will be difficult to capture are the compound data elements. These are data elements consisting of three field’s control, component count field together with the total length of the required data elements. The reason is due to lack of firewall between the server and the applications of the clients. It is able to establish a boundary between a trusted and un-trusted network (Moraes, 2011). Thus, the user is not restricted by any set of rules applicable and can therefor e conceal the compound data elements in such a way that it becomes difficult for them to be found. The main considerations include enhancing security. Among the 120 end users, there can be some using some practices that can lead to breach of security for the organization. This can be quite costly since the

Criminal Justice and the rule of law Research Paper

Criminal Justice and the rule of law - Research Paper Example Substantive law controls the behavior of the governed and procedural fairness controls the behavior of the government and each of its organs and agents. In this regard, average citizens and the government have a responsibility to contribute to safety and security by complying with the rule of law which is the cornerstone of the criminal justice system. This research paper analyses individual and state responsibility within the rule of law underlying criminal justice by discussing substantive law and procedural fairness. In discussing individual responsibility, St. Leo University’s core value of responsible stewardship will be discussed to exemplify how an individual can avoid criminal behavior by acting responsibly and at the same time meet the ends of criminal justice contemplated by the rule of law: social control for community safety and security. Substantive Law and Individual Responsibility The substantive law within the criminal justice system, defines criminal conduct a nd prescribes punishment for committing criminal offenses (Siegel, 2009). For example, it is a crime of murder to intentionally kill another human being and the punishment for the crime of murder can be life imprisonment or state execution, depending on the jurisdiction in which the offence is committed. However, not all criminal offences are that well known. For example, an individual may know that criminal trespass is a crime, but may not know what constitutes criminal trespass. The individual may think it is perfectly lawful to enter a seemingly abandoned home and remove items of interest. In other words, ordinary citizens, who may not be familiar with all prohibited or criminal conduct and might without knowledge of the law, commit an offense. This is unfortunate, because it is a well-established principle of criminal law that ignorance of the law or mistake of the law is not a defence to criminal behavior (Loewy, 2009). A valid defense however, will be founded on the basis of i ntention. If an individual lacks criminal intent to commit a crime, the individual can be exonerated (Loewy, 2009). Criminal laws are constructed from public morals and public opinions (Siegel, 2009). Individuals can therefore simply choose to conduct themselves in accordance with public morals and public opinions of what is acceptable and unacceptable behavior. Even so, Marxist criminologists argue however, criminal justice and the rule of law is designed to protect the middle classes and the wealthy. While the wealthy amasses wealth, it is said that the â€Å"poor gets prison† (Vito & Maahs, 2012, p. 217). For example, conduct on the part of the wealthy for the purpose of amassing wealth is usually treated as a regulatory mishap or a minor offence, despite the harm this conduct brings to others. As Vito & Maahs (2012) explains, environmental damages caused by wealth industrial giants in the pursuit of greed has caused significant damages to others, their properties and has even caused the death of a many more. Similarly, fraud, embezzlement and other white collar crimes committed by the wealth or the middle classes hardly gets the king of punishment that poor criminals obtain for what is known as â€Å"street crimes† (Vito & Maahs, 2012, p. 217). In fact, many of the white collar crimes are never prosecuted (Vito & Maahs, 2012). Yet, it can still be up to the individual who is

Health Assessment Coursework Example | Topics and Well Written Essays - 500 words - 1

Health Assessment - Coursework Example oncepts of health promotion, I will take this opportunity to inform the patient that it is important for the close observation of the eye injury, whether minor or major as it has the capability of causing blindness (du Toit et al., 2013). The first step in the assessment will require me taking a precise history from the patient concerning the eye. As a nurse, I would take this opportunity to educate the patient on the variety of methods of ensuring minimal damage to the eye in the case of an injury and the immediate actions to take in the case of an injury. Other aspects of the assessment of the eye would include the valuation of the general physical, behavioral, and emotional state of the patient (Dunt et al., 2014). A measure of the visual acuity of the patient is also important in determining the clarity of the eye. I would explain all these procedures o the patient and also their importance for the purpose of allowing the patient to have more keenness in his health and status of the eye. Explaining to the patient the condition of his ear and how the ear is supposed to operate is one of the ways in which I would incorporate health promotion concepts when performing an assessment of the ear. This information would help the patient have the ability to recognize further problems with the ear in the near future. The purpose is to provide the patient with the ability of taking care of his own ear and prevent it from harm. In the shift assessment, I would ensure I disclose to the patient my purpose of the activity and also its importance for the purpose of enabling the patient understand the plan of care that would be admissible to him in order to cure his ear (Jarvis, 2015). While assessing the functioning of each ear, it is important to let the patient know of the purpose of this operation. The patient can later perform these tests while at home in order to keep track of the progress of the health of the ear. This includes explaining such assessment procedures

Comprehensive Emergency Plan for Ashford University Essay

Comprehensive Emergency Plan for Ashford University - Essay Example This report is aimed at developing a comprehensive emergency plan in preparation for natural disasters at Ashford University’s main campus, including incidences of flooding, tornadoes and heavy storms (Continuity of Government & Continuity of Operations, 2003). Each crisis or emergency requires a different type of response. For instance, if there is a bomb threat, it may be necessary to shelter people in place, whereas evacuating the building will be appropriate for other situations like a tornado warning (U.S. Department of Homeland Security). This will ensure that the campus is prepared for the event of a disaster, and analyze the potential responses to the occurrence of such an event. The purpose of this emergency plan is the management of major emergencies and crises in the advent of such occurrences, so as to ensure that major crises and emergencies are handled in an organized way. This emergency action plan is aimed at protecting the Ashford University employees from serious injury, loss of property or life in the event of an actual or potential major disaster. Such situations may include the event of a fire, a bomb threat, earthquake, tornado or a hazardous chemical spill. This emergency action plan will describe the initial routes of action for protection of students and employees and those responsible for the implementation of those actions within the university. This plan is an all-risk emergency plan for addressing disaster and crisis management, and will integrate the various departments of the university and other resources in a coordinated response effort to manage or reduce any loss of life and property through the provision periodic emergency respons e capability tests. It is also necessary to ensure the effective utilization of resources and the minimization of any disruptions in school activities and of programs. It is a fact that preparation for emergencies will ensure a higher margin of safety if a crisis or

The First World War Essay Example | Topics and Well Written Essays - 2500 words - 1

The First World War - Essay Example The seeds of the First World War had been sawn several decades before the conflict actually occurred. After a decade of using the military power to unify Germany and finally establish the second Reich in 1871, Otto von Bismarck applied his energies to win the time needed for the country to recover and gain power. The only way to achieve that goal was to neutralize at any cost the potential enemies that might threaten the country's new found position as a major European power. Therefore, Bismarck's foreign policy was coloured by the shades of peace over the next two decades and resulted in the famous Bismarckian Alliance system. Bismarck had three major goals establishing a complex system of European alliances: (1) to create a peaceful German facade; (2) to create defensive alliances; (3) isolate the potential enemies. Consequently, after Europe recognised Germany as a nation during the Berlin Congress in 1878 Bismarck focused on keeping France which he perceived as the most dangerous threat to Germany in isolation. It is commonly believed that this task became the cornerstone of Bismarck's international policy from 1871 to 1894. Simultaneously the Chancellor took every possible effort to uphold peaceful co-existence with the other two major conservative European powers, Russian and Austria-Hungary by assuring them Germany did not represent any threat (Carr, 1987). The first crucial step toward creation of the new balance of powers in Europe occurred during the Berlin Congress of 1978 when Bismarck took advantage of the opportunity to act a peace mediator between the Russian Empire, Austria, and Great Britain. The role allowed Bismarck to maintain the peace between major European powers, establish closer ties with Austria, prevent the Russian Empire from gaining too much power out of its win in the Balkan War, and promote the image of Germany as an effective international peacemaker (Pflanze, 1990). The Chancellor immediately capitalised on such an impressive success: a defensive military Dual Alliance with Austria against the Russian Empire was established in 1879 and after five years of intensive political manoeuvring Bismarck signed the defensive Reinsurance Treaty with the Russian Empire in 1885. Bismarck supported the colonial interests of France in Africa and Asia being perfectly aware that Great Britain would sooner or later become concerned about the French threat to its traditional colonial supremacy. Consequently, France and Britain got involved in a series of conflicts over the colonies: the countries had neither time nor resources to seriously influence the political developments on the territory of Europe and threaten Germany. Bismarck further limited the influence of France by convincing Italia to join the Dual Alliance in 1882; the new configuration became known as the Triple Alliance (Carr, 1987). Only Bismarck retirement revealed the true amount of complexity associated with the Bismarckian model of alliances. Thus, Germany participated in defensive alliances with Austria and Italy against France, the Russian

Cruise ship business Essay Example | Topics and Well Written Essays - 500 words

Cruise ship business - Essay Example A population size of 1.7million people with only 0.5% unemployed reveals that the service sectors are well versified with manpower. A look at business venture in this area shows that 10% corporation tax is charged for foreign companies and nil for local companies. The Qatar tourism authority has opened avenues for making visitors experiences pleasant and efficient as they cruise in the country. The government involvement ensures great security around its ports and has been boosting the much welcomed economic growth area. Qatar has a full capacity of ships and other vessels at the targeted port of Doha, with the 12 berths present. The year 2014 will attest the opening of the new Doha port that will allow for the growing demand of vessels around this area (Jeff, 2007). Due to the high number of visitors in the country every year, the cruise business has been expanding with many investors targeting long distance voyage e.g. seven seas voyager. The short distance cruise of up to a week h as not been exploited around this port. The eye capturing view of the capital city is one of the sites that make a cruise business worthwhile along Doha port. Along its 7.5km stretch, Doha has very many tourist sites worth seeing e.g. historical museums, escapades, water sports et cetera. The market area for the capital city is ever increasing with the projected new port construction to accommodate more room for tourists (Qatar economy, 2011). The cruise industry is soon becoming flooded as more people can afford the prices from the previous high prices decreases. The cruise ship prices have also excruciated from 10 to 40% the initial price of a ship with capacity of 5300 people. The targeted for the cruise industry would entail a smaller vessel to maintain the high class clientele as well as privacy of the business around Doha. Precisely the cruise industry faces challenges of seasonality and

Social media platforms create a lot of value Essay

Social media platforms create a lot of value - Essay Example The value sharing differs with traditional media in that social media platforms provide a two way communication channel where the marketer and the receiver of the message can interact directly. In case of traditional media such as newspapers, it can be seen that communication is mainly one way which entails that it moves is from the sender to the receiver. There is little opportunity for the receiver of the message to get in touch with the marketer and this is where value can be lost. In traditional media, the marketer is usually in full control of the marketing process where the targeted receiver of the message has little input or cannot influence the information that is disseminated by the marketer. The marketer tailors the message in such a way that the intended meaning is conveyed to the targeted consumer. However, it can be seen that in terms of new social media platforms, value is created through interaction of the marketers and the targeted customers. The marketers are in a position to interact directly with the targeted customers such that they can get feedback and they can freely exchange views about a particular market offering. In other words, the consumers who use social media are not passive consumers of the messages that are disseminated t them by the marketers since they can also respond to them. In as far as social media is concerned, it can also be observed that communication is referred to as â€Å"free† since all the people involved can freely interact and the message can be accessed for free (Brown, 2009). Any person who needs information related to a particular product of market offering is free to access it and is also free to respond the way they like. In case of free marketing caused by the use of new social media mentioned above, different people involved i n the communication process can freely express their ideas and these also help the marketers to design effective programs that can help to influence

Supply chain management Essay Example for Free

Supply chain management Essay In this final paper for Managerial Finance I will attempt to show how the supply chain inventory management method can be affected depending on the situation of the retailer. Studying the control method for problems in inventory, which would include both, excesses in inventory as well as shortages, and hoping to minimize loss. Use of SCM as a Method of Inventory Control I have decided to do the final for Managerial Finance on the use of the SCM method as a form of inventory control, because I have worked in a business that has used many different forms of inventory control. As a manager it was one of my responsibilities to maintain inventory and observe any losses as a loss prevention issue that must be discovered. The ordering responsibility for inventory was one of my most important duties as a manager. â€Å"Supply Chain Management is a set of synchronized decision activities, utilized to effectively integrate suppliers, manufacturers, transporters, warehouses, retailers customers so that the right product or service is distributed at the right quantities, to the proper locations at the appropriate time, in order to minimize system wide costs while satisfying customer service level requirements. (Misra, 2010) Finding different options for inventory choices as well as finding prices that reflects a profit for the company was primary reasons for me to research the available possibilities in inventory. Deciding a price for acquiring inventory is an important aspect of making a determination in product for any company striving to make a profit. An important aspect of inventory is the amount of inventory that needs to be ordered, as over ordering or under ordering can be just as problematic for a company. A company that over orders does ot receive profit, because they have put out too much money without a return on that investment, will not make a profit. A popular product may sell very well for a company, but an overabundance of product means that the remaining product after sales may end up being a loss if sales do not again pick up. Under ordering can be just a big of a problem for a company because when customers start coming in for products that are not on the shelves it leads them to find alternate sources for their purchases. Under ordering can also create problems when it comes time to do a secondary order. The initial under ordering of product can lead even the most cautious of managers to second guess their ordering process. The initial under order leads a manager to think that they need to order more of the product to compensate for future sales of the product. The main problem that comes from this common over reaction is that the company lost out on sales on the initial order so tried to compensate by ordering more of the product on their new order. There may have been an increased demand on the first day of sales that may not (usually not) return when the manager orders more stock. The ability to make an initial determination as to the proper inventory can be a deciding factor on a profitable business and an unprofitable one. SCM or supply chain management is a process that refines the process in which managers make their decisions for the products and services that the company offers. SCM is a way for a company to find the products that they offer to their customers. â€Å"The Supply Chain management (SCM) is defined by the Supply Chain Forum (SCF) as the integration of key business processes from end user through suppliers that provide goods, services and information that add value for customers. (Assey, 2012) Supply chain management takes the production of a manufacturer and presents it to a supplier; the supplier then presents those products to the retailers which in turn provide those products to the customers. Choosing the supplier that gets the best deal from the manufacturer is going to give the most profit for the retailer selling the product to their customers. The process of supply chain management can actually merge retailers with supplier just as suppliers merge with the manufacturers. Some companies choose to use various different suppliers for their products while other companies choose to use a single supplier for their product. Personally I worked for a video game company called FuncoLand which was purchased by a company called Babbages, which merged with Electronics Boutique. After the merger the name of the company was changed to GameStop which is now the largest video game retailer in the United States. The thing that makes this important to this paper is that when FuncoLand was purchased by Babbages the supply chain changed. The change in the supply chain meant that all orders must be relooked at to insure the same profit levels for products that GameStop enjoyed. The single supplier for GameStop was replaced by the numerous different suppliers of Babbages. Every item of inventory needed to be checked to make sure they reflected a price that was going to produce profit for the merged FuncoLand and Babbages stores. Inventory charts were created and every store of both needed to inventory all items listed so that they could be compared with the new companies overall stock as well as profit ratios. Once the inventories of both companies were done there was a coordinating effort by upper management to determine prices of available product as well as the suppliers that were going to deal which each stores location. The numerous different suppliers made each location different in their ordering and inventory procedures. As could be expected this made it very difficult for these merged companies to be individually managed by the district and upper management. Each individual store was looked at by the store managers and was expected when issues arose to contact headquarters immediately. The buyout of these two merged companies by Electronic Boutique turned out to be a blessing in disguise for all involved. Electronic Boutique used a single supplier had dealt with the same supplier for years and had already worked out their profit ratios (including the purchase cost of the two companies) and store management once again needed to inventory their entire product for the new owners. The name was changed to GameStop and all store locations now used the same supplier and the prices for each store location were set by upper management. Ordering was done automatically based on the initial stores inventory counts and the new POS systems. While I understand there is an alternate definition for POS in this instance it refers to â€Å"point of sale†. The point of sale system was built using the store’s inventory, and orders for products were made, when the sales reached a certain level. Once a product reached a certain level of sales and did not continue to sell the item was automatically removed from the automatic reorder listing. The product would not be reordered into that store location unless it was a pecial order done by the stores management and usually had to be presented with a reason for the order to be made. In the four years that I worked for GameStop I only ever had to use this feature one time. A customer wanted Final Fantasy 7, new and unopened, and this was well over a year after the initial release of the game. The suppliers notified the upper management that they could do this, and I placed an order for the product as a full pre-sale, which means that the money was available to GameStop before the product was available to the customer. Being the only time this issue ever arose for me while working at GameStop it was an interesting learning experience about how a supply chain management process works. â€Å"The descriptive model presented is useful in settings where organizational structure and the supply chain are needed to support sustainable products and processes and whose success is facilitated by establishing strategic partners, especially those that make possible economies of scale†. Pullman Dillard, 2010) Since one of the primary reasons for using supply chain management is to reduce inventory and cost for a company, GameStop has achieved what neither FuncoLand nor Babbages were able to because their use of a single supplier made achieving profit that much more possible for the mangers making their store orders. â€Å"Most of the decline is due to more efficient cash and inventory management†. (Ross, Westerfield, Jaffe, Jordan, 2010) The main purpose of examining the supply chain management method is insuring that the retailer gets the best uses of their supplier(s). Minimizing shortages, while acquiring profits, in an attempt to optimize the proper supply for each location, is another purpose of using supply chain management. The strategy can be difficult to implement for those unaware of the procedures. I must admit that I did not realize the purpose (or the concept) of supply chain management, at the time I worked for GameStop. Looking back at my time at GameStop has led me to a new appreciation for the business that was built off of the back of FuncoLand.

Platos’ Lysis or Friendship Essay Example for Free

Platos’ Lysis or Friendship Essay Socrates advised Hippothales that the latter should not be so generous with his praises for the person he admires and loves because it would only make the beloved egoistic and vain.   Socrates believed that Hippothales will end up losing him that way.   Hippothales adored Lysis and Socrates likened his pursuit to a hunter scaring his prey away. Socrates asked to meet Lysis and with Menexenus engaged in philosophical discussions of love, friendship, desires, good and evil.   Following were the thoughts of Plato through Socrates: One is not truly happy if he is not at liberty to do the things he wants. I disagree on this.   Given an unlimited freedom to do as he pleases may not necessarily make a man happy in the end.   If a person without money chose to rob a bank instead of finding a decent job, the consequences of his action will make him miserable. People love those whom they find useful and who serve certain ends to them. I agree.   They value those who have done them a favor, those who cared and nurtured them, and those whom they depend upon.   Children love their parents for feeding and clothing them when they were young to do those things for themselves.   Parents love their children for the joys they bring.   Patients love their doctors for treating them of their illness and nursing them back to health. These things can not be said of others who have never been a part of their life. Those who still need a teacher are without knowledge or wisdom and therefore have  nothing to be arrogant about. I disagree on two counts.   First, knowledge and wisdom do not always come from the confines of a classroom. Like they say, experience is a great teacher. We learn from everyday encounters.   How we handle what life throws our way is knowledge nobody can teach us.   Second, good deeds and honest life do not require exceptional knowledge or wisdom.   These are enough reasons for a simple man to be proud of. Do not put your beloved in an exalted position by singing praises and feeding his ego  unceasingly.   It would be best to have him see himself as he is. Agree.   Love is real and true if one tries to see the beloved for what he is and not make someone out of him that he is not him at all.   This is to say that the lover must not be blind to the faults and imperfections of the beloved. Love is not always reciprocated, the lover loves the beloved and the beloved may not  love him back, at worst even hate him. Disagree.   I would say that they become true lovers only at the time when they had both seen the virtues and accepted the flaws of each other. They would commit to a relationship only when they are able to find comfort in their love for each other. Men are hated by people they love and loved by people they hate. Slightly agree.   Yes, people may hate those they love but only for reasons that may not necessarily cause them to love less.   They may just be minor irritants, like the wife hating the husband for always being late for dinner.   Ã‚  On the other hand, loving those they hate is the superficial love of the voters to a president who despite his personal indiscretions have done wonders for the economy. A man may be his friend’s enemy and his enemy’s friend. Agree.   A friend is one’s moral guardian.   A friend would not hesitate to stop a man from committing sin or what might cause him pain later.   The friend might not take it well at first and such might cause them misunderstanding, at which point they become enemies.   On the other hand, if his enemy’s life is at stake and it is only the man who can save him and he does, then they at that instant become friends. Like attracts like. Disagree.   It is not always the case.   It is more common to find opposites that attract.   People have always gone for the excitement of others completely different from them.   New ideas and novel ways of doing things that may complement his own.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Plato, through Socrates, defended his philosophies with clarity and profundity that left Menexenus and Lysis in awe and admiration. References Stevenson, Daniel C. (1994-2000).   Lysis or Friendship by Platos.   Web Atomics.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Retrieved April 29, 2008, from http://classics.mit.edu/Plato/lysis.1b.txt

Lean Manufacturing | Literature Review

Lean Manufacturing | Literature Review Since the 1980s, numerous businesses in various sectors of industry have continually been introducing programs intended to improve both productivity and quality. Several authors have posited lean manufacturing or lean production as the best possible production system and one that can be implemented in any industry and any process (Bonavia and Marin, 2006 and Lee-Mortimer, 2006). Doolen and Hacker (2005) mentioned that different researchers have explored the portability of lean practices both within and between different manufacturing sectors. In accordance, a variety of surveys conducted in different types of industry (Soriano-Meier and Forrester, 2002, Bonavia and Marin, 2006, Doolen and Hacker, 2005, Sà ¡nchez and Pà ©rez, 2001 and Taj, 2008) proved that lean is widely successful in a variety of industrial sectors. However, there are two problematic issues regarding lean manufacturing have been addressed in several studies. First, Shah and Ward (2007) claimed that any discussion of lean production points to an absence of common definition of the concept. Likewise, Pettersen (2009) alleged that there is no agreed upon definition of lean that could be found in the literature. Papadopoulou and ÃÆ'-zbayrak (2005) declared that there is no consensus in different researchers perceptions to the concept of lean which leads to conflicting results in identifying and classifying its practices and techniques. Second, there is conflict in using terms such as elements, principles, constructs, techniques and practices. Papadopoulou and ÃÆ'-zbayrak (2005) mentioned that some of the elements of lean are actually referring to the goals and objectives rather than techniques or tools (e.g. elimination of waste, lead time reduction) and, in addition, a number of other best manufacturing practices (such as agile manufacturing) were used in literature as lean practices. Moreover, Shah and Ward (2007) underscored that identical items are used to operationalize vastly different concepts and different items are used to operationalize the same construct. Thus, Shah and Ward (2007) argued that a great source of confusion and inconsistency associated with lean is the more substantive disagreement about what comprises lean production and how it can be measured operationally. Statement of the problem The above mentioned issues revealed three confusions surrounding the lean concept in literature, which are (1) the lack of a consistent definition of lean, (2) the disagreement about the elements that comprise lean manufacturing and (3) the lack of a measurement tool for assessing changes towards lean implementation. With the aim to clarify and resolve these confusions, this chapter has three main objectives; (1) to propose a conceptual definition of the term lean manufacturing that captures all its main facets, (2) to provide a framework that identifies its major elements and practices, and (3) to develop an operationalized model to assess changes towards lean manufacturing implementation. To achieve these objectives, an in-depth literature review is conducted regarding the topic of lean manufacturing. At first, the concept of Lean and its main principles are introduced. Next, the elements of lean manufacturing and the practices for lean implementation will be investigated. Finally, different indicators that measure the progress achieved towards lean are explored. The concept of Lean Lean was associated with the practice of deciphering the value added activities from those that are waste in an organization and its supply chain (Comm and Mathaisel, 2005). Motwani (2003) declared that companies need to focus on each product and its value stream in order to distinguish between wasted activities and that actually create value. Moreover, Papadopoulou and ÃÆ'-zbayrak (2005) stated that leanness was introduced as an approach to manufacturing that was aiming at the elimination of waste while stressing the need for continuous improvement. However, lean manufacturing is much more than a technique, it is, in addition, a way of thinking (Taj, 2008). The issue of lean thinking was widely discussed in different researches. Comm and Mathaisel (2005) believed that lean thinking removes the traditional way people think about roles and responsibilities through remaining focused on the customer and the core competencies that the customer values from an organization. Therefore, Bhasin and Burcher (2006) claimed that for a successful implementation, numerous cultural changes are required for embracing empowerment and disseminating the lean principles through-out the value chain. Similarly, Taj (2008) confirmed that lean as a way of thinking creates a culture in which everyone in the organization continuously improve operations. In accordance, Comm and Mathaisel (2000) introduced leanness as a philosophy that intended to significantly reduce cost and cycle time throughout the entire value chain while continuing to improve product performance. Hence, lean should be described from two points of view; the philosophical perspective and the practical perspective (Shah and Ward, 2007). From the philosophical perspective, lean is viewed as an overall organizational philosophy that should affect the people way of thinking and behaving (Papadopoulou and ÃÆ'-zbayrak, 2005 and Bhasin and Burcher, 2006). This philosophy drives the guiding principles and the overarching goals of lean (Shah and Ward, 2007). On the other hand, the practical perspective see lean as a set of management practices, tools and techniques (Shah and Ward, 2007) that are used to apply the philosophy and to achieve the goals (Bhasin and Burcher, 2006). This two-perspective view of lean is supported by the definition of lean as a socio-technical system. Such system combines both technical system; i.e. technology and social system; i.e. people and organizational structure (Bhasin and Burcher, 2006). In the same context, Shah and Ward (2007) asserted that to pursue lean production, firms have to effectively manage their social and technical systems simultaneously. Moreover, Cua et al. (2001) proved that joint optimization of both socially- and technically-oriented policies or practices is necessary for achieving good results. Regarding its implementation, Panizzolo (1998) demonstrated that the wide range of lean practices are related to interventions in the manufacturing area, actions taken in other areas of the firm (design, HR, strategy, etc.) and relationships with both suppliers and customers. Likewise, Shah and Ward (2003) stated that lean should be seen as a multi-dimensional approach that encompasses a wide variety of management practices. This conceptualization of lean as multidimensional strategy is supported by a wide range of researchers (Doolen and Hacker, 2005, Karlsson and Ã…hlstrà ¶m, 1996, Shah and Ward, 2007 and Papadopoulou and ÃÆ'-zbayrak, 2005). However, it is well accepted among researchers that lean should be implemented as an integrated system (Shah and Ward, 2007, Bhasin and Burcher, 2006, Karlsson and Ã…hlstrà ¶m, 1996 and Papadopoulou and ÃÆ'-zbayrak, 2005). Shah and Ward (2007) suggested that a well-developed lean strategy implementation will require firms to exert considerable effort along several dimensions simultaneously. Bonavia and Marin (2006) concluded that there are only few relationships between the degree of use of lean production practices individually and operational performance (in terms of productivity, quality, lead time and inventory). In the same vein, Shah and Ward (2003) provide unambiguous evidence that the synergistic effects of all lean practices are associated with better manufacturing performance. Another feature of lean manufacturing that was emphasized in literature is its time-frame of implementation. Bhasin and Burcher (2006) and Doolen and Hacker (2005) believed that lean is a long-term multidimensional organizational strategy. Papadopoulou and ÃÆ'-zbayrak (2005) affirmed that transformation to lean requires a lot of effort, time and participation of all organization levels in addition to make changes in company culture and organizational structure. Thus, lean enterprises should continuously find ways to eliminate consumption of resources in their struggle to deliver value to their customers. In correspondence, the implementation of the lean program in the case study discussed in (Lee-Mortimer, 2006) proved that lean is not just a project, it is a long-term continuous journey which is implemented as a sequence of stages or projects. In conclusion, lean manufacturing embraces different features that should be taken into consideration when defining this concept. Lean should be viewed as a philosophy, affecting company culture, rather than a set of tools/techniques. This, in turn, reveals the importance of managing social system as well as technical system simultaneously. Moreover, lean implementation scope is not confined to the manufacturing function of a company, rather it relates to all functions ranging from product development, procurement and manufacturing over to distribution. Since lean companies seek to deliver value to their customers, this value should be predefined and delivered, while waste, which customers are not willing to pay for, should continuously be eliminated. All the aforementioned features of lean manufacturing can be captured in the following proposed conceptual definition. Lean manufacturing is a philosophy and a long-term strategy that is applied through a socio-technical system integrating all functions within the organization with the aim of continuous waste elimination while delivering outcomes that meet continuously predefined customer value. Lean principles Lean philosophy is mainly based on the principle of eliminating waste. Waste is anything other than the minimum amount of equipment, materials, parts, and working time that are essential to add value (Taj, 2008, Bonavia and Marin, 2006 and Karlsson and Ã…hlstrà ¶m, 1996). Sà ¡nchez and Pà ©rez (2001) cited that the main goal of lean is to eliminate all activities that do not add value to the product. Value should be specified as it is perceived by customers (Andersson et al., 2006 and Dahlgaard and Dahlgaard-Park, 2006). If the task does not add value from the customers point of view, it should be modified or eliminated from the process (Andersson et al., 2006). It is believed that by minimizing waste and zero-value added activities, companies can reduce production costs and the overall production system will be more efficient (Comm and Mathaisel, 2005 and Karlsson and Ã…hlstrà ¶m, 1996). Since inventory is considered one of the critical sources of waste (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996), Dahlgaard and Dahlgaard-Park (2006) declared that the traditional way of producing in batches is inefficient as it requires goods to wait in inventories before the next production step is started up. Thus, Motwani (2003) mentioned that the value must flow to the customer without interruptions. Andersson et al. (2006) confirmed that focus should be on organizing a continuous flow through the production or supply chain rather than moving commodities in large batches. Closely related to the continuous flow is the principle of just-in-time (JIT), since the ultimate goal that every process should be provided with only one part at a time, exactly when that part is needed (Karlsson and Ã…hlstrà ¶m, 1996). Moreover, if continuous flow is not possible (Lummus et al., 2006), the way of scheduling the flow of material should be pull instead of push (Motwani, 2003 and Dahlgaard and Dahlgaard-Park, 2006). This means that customer demand should pull finished products through the system with the aim of not carrying out any work unless the result of it is required downstream (Andersson et al., 2006). It is obvious that to succeed in the implementation of any modern system, everyone from top management to any lower level should make sincere efforts, and set their goals jointly through active participation and understanding (Ahmed et al., 2004). According to (McKone et al., 1999), employees can contribute significantly to the organization when they are allowed to participate in decisions that impact their area of responsibility. As a result, involvement from all employees allows companies to better use of its available resources (McKone et al., 1999). This principle reflects the conceptualization of lean manufacturing as a socio-technical system, since it highlights the importance of managing social system as well as technical system. Since lean is viewed as a long-term strategy, lean philosophy emphasizes continuous improvement. Several researchers (Karlsson and Ã…hlstrà ¶m, 1996, Comm and Mathaisel, 2005 and Sà ¡nchez and Pà ©rez, 2001) affirmed that one of the most fundamental principles of lean is the search for continuous improvement in products and processes. Lummus et al. (2006) mentioned that processes should be managed towards perfection to continuously reduce the time needed to serve the customer. Likewise, Andersson et al. (2006) underscored that the elimination of non-value-adding elements (waste) is a process of continuous improvement. In this context, Sà ¡nchez and Pà ©rez (2001) highlighted the importance of employees involvement and top management support to create and train improvement teams that lead the organization to move toward zero defects. Based on the analysis of lean previous studies, it is concluded that there are five key principles / overarching goals which can be considered the bases for the lean philosophy. These principles are; (1) waste elimination, (2) customer value identification, (3) continuous production flow, (4) employees involvement and (5) continuous improvement. Furthermore, the aforesaid lean principles confirm some issues in the proposed conceptual definition. The unambiguous believe that elimination of waste is the fundamental goal is affirmed since lean is regularly defined as manufacturing without waste. Likewise, identifying value as perceived by customer is asserted in the proposed definition. Moreover, seeking continuous improvement as a principle of lean philosophy reflects the long-term nature of lean implementation. Thus, the proposed definition stresses the aim of continuous waste elimination and highlighted the need to continuously predefine customer value. Also, the importance of employ ees involvement emphasizes the social phase of the lean system as a socio-technical system. Finally, holding in mind these principles / goals underscores the view of lean as a philosophy that affects the people way of thinking. Lean implementation framework Previous studies concerning lean manufacturing revealed a number of manufacturing practices that are commonly associated with lean implementation. The initial step towards developing a framework for lean implementation is to capture different practices and combine them into inter-related groups in accordance to the multi-dimensional nature of lean manufacturing. The term practices in this context refers to the predominant methodologies that may include many techniques and tools. Shah and Ward (2003) identified and empirically validated combining lean practices into four specific lean bundles: namely Total Quality Management (TQM), Just In Time (JIT), Total Productive Maintenance (TPM) and Human Resources Management (HRM). Bonavia and Marin (2006) found enough agreement in literature to identify the first three bundles; TQM, JIT and TPM, while Cua et al. (2001) are of the opinion that human and strategic-oriented practices are common practices that support all other three bundles. Although there is general agreement within operations management literature that JIT, TPM, TQM and HRM are conceptually, theoretically, and empirically well established (Shah and Ward, 2003), there is no unanimous classification of the lean manufacturing practices that make up each of the four bundles (Bonavia and Marin, 2006). Therefore, in an attempt to provide a framework for lean implementation comprises the actual practices that represent each of the four mentioned bundles, the basic theme of these bundles are identified. Then, different lean practices are combined into each of these bundles based on reviewing different research papers regarding lean implementation practices, in addition to articles that were focused mainly on one of these bundles. TQM bundle Lack of quality is a major source of waste, since the defective parts and products that need to be reworked or scrapped do not add any value to the customer and should be eliminated in order to attain high productivity (Karlsson and Ã…hlstrà ¶m, 1996). Sà ¶derquist and Motwani (1999) underscored that quality should be a top management issue and continuous improvement efforts together with the zero error objective should be company-wide and extended over company limits in production chains. Cua et al. (2001) defined total quality management (TQM) as a manufacturing program aimed at continuously improving and sustaining quality products and processes by capitalizing on the involvement of management, workforce, suppliers, and customers, in order to meet or exceed customer expectations. Sà ¶derquist and Motwani (1999) emphasized that TQM approach is the philosophy that should underpin the quality project in a lean company. The practices combined to form the TQM bundle include; product quality control, visual management (Cua et al., 2001, McKone et al., 1999 and Sà ¶derquist and Motwani, 1999), process management (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), product design and development (Cua et al., 2001 and Sà ¶derquist and Motwani, 1999), standardization (Sà ¶derquist and Motwani, 1999), suppliers quality management and customers involvement (Cua et al., 2001 and McKone et al., 1999). JIT bundle Just-in-time philosophy means to deliver the right part in the necessary quantity and at the right time (Canel et al., 2000, Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Ahmed et al. (2004) defined JIT as a philosophy and system concept of doing, maintaining and producing what is value adding or what is just needed, be it raw materials, components, parts, WIP, employees, or finished products. Cua et al. (2001) asserted that the primary goal of JIT, as a manufacturing program, is continuously reducing and ultimately eliminating all forms of waste through JIT production and involvement of the work force. JIT basic techniques include set-up time and lot size reduction, pull production systems (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), equipment layout and cellular manufacturing (Shah and Ward, 2003 and Cua et al., 2001), production leveling and scheduling and JIT delivery by suppliers (Cua et al., 2001 and McKone et al., 1999). TPM bundle It has been accepted beyond any doubt that maintenance, as a support function in businesses, plays an important role in backing up many emerging business and operation strategies like lean manufacturing (Ahuja and Khamba, 2008b). Without having a productive maintenance system, lean production, just-in-time (JIT) or total quality management (TQM) environment cannot be attained (Ahmed et al., 2004). TPM is a proven and successful procedure for introducing maintenance considerations into organizational activities (Eti et al., 2004). Ahuja and Khamba (2008b) stated that TPM is a methodology originating from Japan to support its lean manufacturing system, since dependable and effective equipment are essential pre-requisite for implementing lean manufacturing initiatives in the organizations. Cua et al. (2001) and Shah and Ward (2003) defined TPM as a manufacturing program designed primarily to maximize equipment effectiveness throughout its entire life through the participation and motivation of the entire work force for performing planned predictive and preventive maintenance of the equipment and using maintenance optimization techniques. TPM, according to McKone et al. (1999), provides a comprehensive company-wide approach to maintenance management which is usually divided into short-term and long-term elements. In the short-term, TPM basic practices include; industrial housekeeping, autonomous maintenance (Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999), and planned preventive and predictive maintenance (Shah and Ward, 2003, Cua et al., 2001, Eti et al., 2004 and McKone et al., 1999). In the long-term, TPM efforts focus on new equipment and technology acquisition (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999). HRM bundle Human resources have a critical role in carrying out the continuous improvement plans which are the basis for success in lean implementation (Panizzolo, 1998). Eti et al. (2004) claimed that the degree of employees eagerness to embrace change determines the rate of progress towards that goal. Moreover, McKone et al. (1999) declared that employees are the greatest sources of information for companies to improve their performance. Shah and Ward (2003) affirmed that the HRM bundle has significant theoretical and empirical support. The most commonly cited HRM practices are employees involvement (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), multi-skilled workforce, multi-functional work teams (Shah and Ward, 2003), education and training (Shah and Ward, 2003, Cua et al., 2001 and McKone et al., 1999), performance-based compensation system (McKone et al., 1999) and information and feedback (Cua et al., 2001 and McKone et al., 1999). Lean operationalized model Traditionally, managers have relied heavily on accounting metrics to determine efficiency, such metrics reflect the final state achieved as the result of a long chain of decisions (Taj, 2008), while lean should be seen as a direction rather than a state to be reached after a certain time (Karlsson and Ã…hlstrà ¶m, 1996). Therefore, managing a lean factory requires key information to assess the changes taking place in the effort to introduce lean (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Consequently, in order to develop an operationalized model for lean manufacturing, the aforementioned bundles and practices will be discussed with focus on identifying the indicators that can be used in assessing changes towards lean implementation. It is important here to note that the focus lies on the changes in these indicators, not on their actual values. So, the desired direction of each indicator, if moving in a lean direction, will be also specified. Measurement of TQM basic practices Since the ultimate goal of TQM practices is to achieve zero defects, Motwani (2001) mentioned that the percentage of defects (TQM1) and the percentage of products needing rework (TQM2) are among the common quality outcome indicators employed by several researchers. Product quality can be controlled through the involvement of production line workers for identification and adjustment of defective parts and their authority to stop lines when defective parts are found in order to avoid any defective parts moving to the next production stage (Karlsson and Ã…hlstrà ¶m, 1996). Thus, Sà ¡nchez and Pà ©rez (2001) used the percentage of defective parts adjusted by production line workers (TQM3) as an indicator of transferring the responsibility for products quality from the quality control department to the line workers. In addition, Karlsson and Ã…hlstrà ¶m (1996) alleged that the number of quality control personnel (TQM4) and the size of repair area (TQM5) can be reduced as a consequence. Furthermore, Karlsson and Ã…hlstrà ¶m (1996) declared the use of autonomous defect control (poka yoke) as inexpensive means to help conducting inspection of all units with the ultimate goal of zero defects. Therefore, the percentage of inspection carried out by autonomous defect control (TQM6) is a common measure (Sà ¡nchez and Pà ©rez, 2001 and Karlsson and Ã…hlstrà ¶m, 1996). Visible graphs and panels are used to gather performance data, to plot different measurements and to identify specific problems and causes of delay in order to take efforts for resolution (Lee-Mortimer, 2006 and Bonavia and Marin, 2006). For this, Bonavia and Marin (2006) measured the percentage of work areas where visible graphs panels are used (TQM7) as an indicator for visual management. In addition to controlling products quality, process management is essential to obtain fault free parts and products from the very beginning (Karlsson and Ã…hlstrà ¶m, 1996). Cua et al. (2001) emphasized the use of Statistical Process Control (SPC) techniques in monitoring processes to ensure that each process will supply defect free units to subsequent process. Shah and Ward (2007) and Bonavia and Marin (2006) measured the percentage of equipment / processes under SPC (TQM8) as an indicator to represent the expansion of using SPC. Panizzolo (1998) emphasized the attention that has been devoted to the relationships between product development and manufacturing activities. Sà ¶derquist and Motwani (1999) claimed that design for manufacturing through integrating product and process engineering is one of the core features of quality management within the lean production framework. Thus, the percentage of parts designed by cross-functional teams (TQM9) can be used as a measure for this practice. In addition, Sà ¡nchez and Pà ©rez (2001) mentioned the use of common parts (TQM10) to manufacture different products as a technique used to reduce inventory and lead times as well. Moreover, participation of suppliers in the design stage (TQM11) facilitates manufacturing of components they have designed. Standardization is an essential principle of lean manufacturing that involves establishing the sequence of tasks to be done by each worker and how those tasks are done (Olivella et al, 2008), measuring and comparing the cycle time against the required takt time (Motwani, 2003) and specifying procedures, tools and materials (Bonavia and Marin, 2006). The percentage of procedures which are written recorded (TQM12) is the measure used by Sà ¡nchez and Pà ©rez (2001) and Bonavia and Marin (2006) to quantify the extent to which the company standardize its operations. Several researches emphasized the significant role that suppliers can play when involved in quality improvement programs (Panizzolo, 1998, Shah and Ward, 2007, Papadopoulou and ÃÆ'-zbayrak, 2005 and Motwani, 2003). In order to enhance suppliers involvement, Sà ¡nchez and Pà ©rez (2001) stressed the importance of information exchange with suppliers through conducting visits by engineers and technicians from both sides and interchanging documents. This will help to reduce inefficiencies and eliminate activities that are not value added (Sà ¡nchez and Pà ©rez, 2001). This practice is measured by two indicators; the frequency of visits between companys and suppliers technicians (TQM13) and the number of suggestions made to suppliers (TQM14) (Sà ¡nchez and Pà ©rez, 2001). With the focus on customers and their needs, Motwani (2001) declared that customer service programs should include quick responsiveness to complaints and maintaining a corporate goal to reduce the quantity of complaints (TQM15). Furthermore, Panizzolo (1998) affirmed that customer-driven enterprises dedicated much attention to organize customer participation in design, manufacturing and delivery activities. Thus, Bhasin and Burcher (2006) considered the percentage of projects in which the customer was involved (TQM16) as a signal of the systematically and continuously focus on the customer. In conclusion, table 3.1 summarizes the indicators developed to assess changes towards implementing the previously discussed TQM practices. Measurement of JIT basic practices Several authors (Sà ¡nchez and Pà ©rez, 2001, Karlsson and Ã…hlstrà ¶m, 1996, Lee-Mortimer, 2006 and Salaheldin, 2005) have proposed the value of WIP (JIT1) and the lead time to customer order (JIT2) as common indicators of JIT implementation. Moreover, Motwani (2003) and Bhasin (2008) affirmed that total product cycle time (total time that material spends in the production system) (JIT3) is the best measure for tracking lean progress. Reducing set-up times simultaneously with reducing lot sizes is a technique used to reduce inventories and also it contributes to the reduction of lead times (Sà ¡nchez and Pà ©rez, 2001) and increasing flexibility (Karlsson and Ã…hlstrà ¶m, 1996). The progress in this practice can be directly measured by two indicators; set-up times (JIT4) and production and delivery lot sizes (JIT5). Firms use pull production systems to facilitate JIT production with the aim to produce the kind of units needed, at the time needed, and in the quantities needed (Shah and Ward, 2007). Bonavia and Marin (2006), Cua et al. (2001), McKone et al. (1999) and Shah and Ward (2007) highlighted the use of kanban squares, containers or signals as a means to pull material from an upstream station and manage product flow. Karlsson and Ã…hlstrà ¶m (1996) argued that as the work with implementing pull system proceeded, the number of manufacturing stages producing against customer orders should extend. Accordingly, they considered the percentage of stages in the material flow that uses pull (JIT6) as a determinant of the change towards this practice. Cua et al. (2001) and McKone et al. (1999) emphasized the importance of equipment layout to facilitate low inventories (JIT1) and fast throughput (i.e. shorten lead time (JIT3)). Grouping machines together in a cell-based layout (Cellular manufacturing) is one technique that is developed to facilitate line balancing with the ultimate goal of creating single piece flow (Lee-Mortimer, 2006 and Motwani, 2003). Implementing cellular manufacturing technique helps to eliminate the frequency (JIT7) and physical distances (JIT8) of parts transportation (Karlsson and Ã…hlstrà ¶m, 1996) and to reduce the investments (JIT9) in handling systems (Sà ¡nchez and Pà ©rez, 2001). Panizzolo (1998) considered production leveling as a practice, in addition to small lots and pull control that is adopted to synchronize production and market demand. Thus, this practice contributes in achieving reductions in the value of WIP (JIT1) and the lead times to customer order (JIT2). Moreover, the synchronization between production output and market demand helps company to minimize finished goods inventory (JIT10). Suppliers are required to deliver the right quantity, at the right time, and at the right quality (Shah and Ward, 2007) in order to facilitate JIT production. Many researches agreed on the importance of reducing the number of key suppliers (JIT11) for the main components and engaging with them in long term contracts (JIT12) (Sà ¡nchez and Pà ©rez, 2001, McKone et al., 1999, Shah and Ward, 2007, Doolen and Hacker, 2005, Bhasin and Burcher, 2006 and Papadopoulou and ÃÆ'-zbayrak, 2005). Furthermore, the case study of (Comm and Mathaisel, 2005) highlighted how maintaining good relationships with suppliers helped to keep minimum raw material inventories (JIT13). In general, McKone et al. (1999) highlighted the importance of on-time delivery (JIT14) to customers as an indicator of the JIT concept implementation. Likewise, Bhasin (2008) mentioned measuring on-time delivery as one of the customer / market indicators of lean implementation. In the same vein, Motwani (2001) recommended monitoring the amount of lateness in orders delivery as a tool in measuring the spread of delivery time. Furthermore, since the change towards JIT production and delivery is made gradually (Sà ¡nchez and Pà ©rez, 2001), the proportion of products transferred just-in-time between production stages (JIT15) and that delivered just-in-time by suppliers (JIT16) should be measured. Table 3.2 summarizes the indicators developed to assess changes towards implementing the previously discussed JIT practices. Measurement of TPM basic practices It is agreed upon in literature that overall equipment effectiveness OEE ( Adaptive Immune Response: Case Study Adaptive Immune Response: Case Study Adaptive Response Abstract Adaptive immunity is an important part of the immune system. It is the third line of defense in the human body, which includes highly specialized systemic cells and processes that eliminate or prevent pathogenic growth. Once external barriers have been compromised and inflammation (innate immunity) has been activated, the adaptive response is called into action (Huether McCance, 2012). It develops slower than the innate inflammatory response and is specific—unlike inflammation, which is non-specific—and has immunological memory that recognizes each pathogen by a signature antibody (Huether McCance, 2012). In addition, the activated B cells and T cells can develop to memory cells that respond rapidly and efficiently to a subsequent encounter with a pathogen. Adaptive immunity response primary obligation is destroying infectious agents that are resistant to inflammation and provides long-term protection against future exposure to the same agents (Huether McCance, 2012) . Adaptive Response The adaptive response consists of an antibody response and cell-medicated response, which are carried out by different lymphocytes cells, B cells and T cells respectively. B cells (B indicates bone marrow) are the major cells involved in the creation of antibodies that circulate in blood plasma and lymph, where they have capacity bind to almost any foreign antigen found in the environment (Huether McCance, 2012). Binding of antibody inactivates virus and microbial toxins by blocking their ability to bind to receptors on host cells. Antibodies, also known as immunoglobulin, are large Y shaped proteins, which are typically composed of two large heavy pair chains and two small light chains (Huether McCance, 2012). There are five types of immunoglobulin: IgA, IgD, IgE, IgG, and IgM, which are characterized by differences in structure and function, each has evolved to handle particular antigens (Huether McCance, 2012). The antibody responses are also called humoral immunity. Another ad aptive response is known as cell-medicated immunity responses that activate T cells to combat against a foreign antigen presented on the surface of a host cell. Also, T cells produce signal molecules that trigger macrophages, natural killers (NK), antigen specific cytotoxic T-lymphocytes, and release of various cytokines in responses to an antigen (Huether McCance, 2012). The purpose of this paper is to explain pathophysiology of disorders presented in the scenarios, including associated alterations, and adaptive responses to the alteration as well as construct a mind map for the selected disorder. Furthermore, consider the epidemiology, pathophysiology, risks factors, clinical presentation, and diagnosis of the disorder and any adaptive responses to alteration. Scenario 1: The first scenario the patient’s mother mentioned that Jennifer is usually healthy and has no significant medical history. However, physical examination revealed clinical manifestations, which include fever; tympanic membranes slightly redden on the periphery, throat erythematous with 4+ tonsils and diffuse exudate; anterior cervical nodes palpable and tender to touch. The child indicated throat hurts and painful to swallow. Vital signs reveal increased temperature, pulse and respiratory rate that suggested tonsillitis disorder. Pathophysiology Tonsillitis is an inflammatory condition of the tonsils due to bacteria, allergies or respiratory problems (Tonsillitis, 2014). When inflamed, tonsils become swollen and red with a grayish or yellowish coating on its surface. Tonsillitis usually begins with a sudden sore throat and painful swallowing. Tonsillitis causes tonsils and throat tissues to swell obstructing air from passing in and out of the respiratory system (Huether McCance, 2012). The tonsils infection is common in children under age six and teenagers but rare in adults. The adaptive response activates the different B cells and T cells lymphocytes to eliminate the alteration, so body can return back to hemostasis. Scenario 2: Pathophysiology Irritant contact dermatitis is a common nonimmunologically mediated inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, soap detergent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, epidermal cellular changes and cytokine release. Irritant contact dermatitis is a major occupational disease; skin disorders comprise up to 40% of occupational illness (Hogan Elson, 2013). Patient work history is crucial in making diagnoses, and appearance of the skin. It may be treated with topical agents such as corticosteroid skin creams, emollients or moisturizers to prevent further irritation (Hogan Elson, 2013). Scenario 2: The patient presented with redness and irritation of his hands. The history revealed no allergies or significant medical history except for recurrent ear infections as a child. He denied any unknown exposure to irritants. Also, patient admits to working in maintenance and often working with abrasive solvent and chemical. Normally he wears gloves, but this particular time the patient did not wear gloves. He exposed his hands to some cleaning solutions. The patient’s detailed history and clinical manifestations led the student to a diagnosis of irritant contact dermatitis. Pathophysiology Stress is any situation that results in a reaction of the human body called the stress response (Huether McCance, 2012). The stress response is a set of adaptations that are mobilized throughout the body to correct state of allostatic imbalance. This involves a fairly stereotyped set neural an endocrine changes. A critical one is the secretion of catecholamines-epinephrine and norepinephrine from the nerve endings of the sympathetic nervous system projecting throughout the body (Huether McCance, 2012). Catecholamine induces vasoconstriction and increases in heart rate and blood pressure. It also increases the amount of nutrient and oxygen that is available to the muscle’s reaction during a stress response (Huether McCance, 2012). Another is secretion by the adrenal glands of a class of steroid hormones called glucocorticoids (GCs) ((Huether McCance, 2012). While there is an array of additional changes in levels of various hormones during stress (generally an increase in ci rculating levels of glucagon, prolactin, and beta-endorphin, decreases in insulin and reproductive hormones), secretion of GCs and the activation of the sympathetic nervous system constitute workhorses of the stress response (Huether McCance, 2012). Some common symptoms can include: increase heart rate, chest pain, poor appetite, depression, and insomnia. Usually, coping strategies are beneficial in helping individuals manage stress physical and psychological (Huether McCance, 2012). Adaptive responses help prepare the body for fight or flight by activating adaptive immunity response to correct imbalance. Scenario 3: The patient in this case study recently retired from her job as an administrative assistance at a local hospital. She does have a history of hypertensive, but controlled for years with medication. Patient reported having problem sleeping, occasionally rapid heart rate, and decrease appetite. She also mentioned her 87-year old mother moved in a few years ago after falling down a flight of stairs and broken her hip. Martha is taking care of her mother who requires enormous amount assistance with activities of daily living. She is worried about her own health at her age and sleep habits therefore clinical manifestations suggested stress disorder. Mind Map for Tonsillitis Disorder Epidemiology Irritant contact dermatitis is common in occupations that involve repeated hand washing or repeated exposure of the skin to water, food materials, and other irritants. High-risk occupations include maintenance, health care workers food preparation, and hairstylists (Hogan Elson, 2013). The prevalence of occupational hand dermatitis was found to be 55.6% in 2 intensive care units and was 69.7% in the most highly exposed workers. Irritant contact dermatitis is significantly more common in women than men. The high frequency of hand eczema in women in comparison with men is caused by environmental factors, not genetic factors. Pathophysiology Irritant Contact Dermatitis (ICD) is a common nonimmunologically mediated inflammation arising from the release of proinflammatory cytokines from skin cells (principally keratinocytes), usually in responses to chemical stimuli such as cleansers, soap detergent, and various chemical agents (Hogan Elson, 2013). The main pathophysiological changes are skin barrier disruption, epidermal cellular changes and cytokine release hones naà ¯ve T- lymphocytes to the skin. Patients with altered barrier function are more prone to ICD. Risk factors People who work in occupational hazard environment and handles irritant such as cleaners, nurses, construction workers, mechanics, and agricultural workers are at risk for developing irritant contact dermatitis (Mayo Clinic, 2012). Another risk factor is younger workers often less experienced than their older colleagues or may have a more careless attitude about safety measures causing them to develop the disorder (Mayo Clinic, 2012). Clinical presentation Clinically, irritant contact dermatitis presents with scaly erythematous plaques, cracking of the skin, inflammation, dryness, and fissuring. It commonly involves web spaces that extend to the dorsal and ventral surface of the hand and fingers (Mayo Clinic, 2012). Vesicles do not typically form. Pruritus can be mild; however, stinging, burning and pain are frequently reported symptoms. Diagnosis Irritant contact dermatitis does not need a specific test because ICD can be diagnosed through clinical examination and a careful history. A clinical examination must include a careful look at the distribution of the dermatitis (palmar, dorsal, face, abdomen, web spaces, and fingernails) as well as the extension of dermatitis to wrists or forearms (Mayo Clinic, 2012). The history should include a questionnaire that addresses the individual name and address of the employer; the worker’s job’s title and a description of functions. The worker should provide a list of all chemicals handled and supply information about them, such as found on the Material Safety Data Sheets (MSDS) in order to provide an appropriate diagnosis (Mayo Clinic, 2012). Adaptive responses to alteration Harding or accommodation has been defined as the adaptation of the skin from altered local expression of multiple cytokines and inflammatory mediators with repeated irritation from skin irritants. Accommodated skin has a relatively thicker layer of stratum granulosum versus normal skin. Accommodated skin may exhibit a slight sheen and glossy appearance with a mild scale. On manipulation, there may also be a slight loss of elasticity (Huether McCance, 2012). Conclusion When successful, an adaptive immune response terminates infection and provides long-lasting protective immunity against the pathogen that provoked response. Adaptive immunity is an evolving process within a person’s lifetime, in which each infection changes the make-up of that individual’s lymphocyte population. Adaptive immunity is an evolving process within a person’s lifetime, in which each infection changes the make-up of that individual’s lymphocyte population (Huether McCance, 2012). These changes are neither inherited nor passed on but, during the course of a lifetime, they determine a person’s fitness and their susceptibility to disease. Failures to develop a successful adaptive response can arise from inherited deficiencies in the immune system or from the pathogen’s ability to escape, avoid, or subvert the immune response. Such failures can lead to debilitating chronic infections or death (Huether McCance, 2012). References Golden, S. Shaw, T. (2013). Hand dermatitis: Review of clinical features and treatment options. Retrieved from www.cutis.com/fileadmin/content†¦/SCMS_vol32_No3_Golden.pdf Hogan, D., Elston, D. M. (2013). Irritant contact dermatitis. Medscape. Retrieved from emedicine.medscape.com/article/1049353-overview Huether, S. E., McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby. Mayo Clinic. (2012). Tonsillitis. Retrieved from www.mayoclinic.org/diseases†¦/tonsillitis/†¦/con-20023538 Tonsillitis. (2014). In Encyclopedia Britannica. Retrieved from http://wwe.britannica.com/Ebchecked/topic/599370/tonsillitis