Role of Leadership in Advanced Practice in Nursing

Contained herein is an analysis of role of leadership in advanced practice in learning. This is in understanding that lack of leadership in highly specialised nursing situation is mots likely to lead to ineffective provision of services to patients.According to Sofarelli (2005) advanced practice in nursing has the trend of incorporating individuals with deep understanding of all or specific areas of nursing practice. These individuals end up being relied upon in their respective stations to help deliver high quality healthcare services to patients.   These practitioners are further tasked with the responsibility of developing strategies to be applied in the future.However, their capacity to deliver is in most cases affected by lack of proper leadership skills. This analysis will therefore highlight three of the most common nursing leadership theories that could aid in helping professionals in advanced practice to effectively lead respective departments of institutions to better pos itions of meeting patient needs.Having professionals incorporate these theories in their day-to-day activities places them in positions of passing similar knowledge to followers, especially the new ones in nursing profession. In other words, the process of using leadership skills effectively ends up improving professionalism.The three nursing leadership to be discussed in this analysis includes: leader-follower, quantum, and transformational—each would be discussed independently. The theories are being included herein because of their proven effectiveness in achieving results. According to Porter (2007) the use of nursing theories reminds professionals about the best practices when carrying diverse activities. Individuals choose the theory to choose or even combine several approaches into hybrid leadership skills.In addition, professionals could embark on developing ways and means of having own leadership styles that do not fit with the theories discussed in this paper. The h ybrid system could be achieved intentionally by individuals or institutions; it could also be as a result of lack of proper knowledge of the theories. Results could, however, differ depending on the ability of using best practices in theory applications.Quantum leadership theory is mostly used in decision making processes and states that professionals need to look for own problem solving processes before seeking help from colleagues or seniors in respective work environment (Perra, 2001).In other words, the theory tends to initiate leadership in individual professionals, especially those in advanced practice. Fact that these individuals are usually tasked with the responsibility of leading others in various work situations means that they would have to solve problems in collaboration with the followers instead of running to respective superiors for help.Senior professionals in respective departments of institutions can therefore concentrate on other issues as nurses solve problems i ndependently. The senior management in healthcare institutions could, for instance, concentrate on more important issues such as strategy development and implementation (Kitson, 2001).ReferencesBrown, K. (2005). The Leader in Nursing.   Nursing Administration, 11(4), 91-115.Brown, M. (2003). Needs in nursing leadership to improve effectiveness. Nursing Management, 16(6), 101-108.Clifford, J. and Hastings, C (2000). Top trends predicted in nursing leadership. Nurse Management, 20(3), 16-24.Decker, M. (2004). Key to Quality Leadership. Nursing Administration, 22(3), 50-62.Smith, J.   (2003). Effective Leadership &   Management of Nursing. Upper Saddle River: Prentice Hall.Kerfoot, C. (2001). Nursing Leadership and theory. Journal of Nursing, 5(2), 64-70.Kitson, A., (2003). Leadership in nursing & how it influence health policy & nursing practice. Advanced Nursing 29, 700-723.Mohr, W. (2000). Fading in Nursing Leadership. Journal of Nursing Management, 40, 100-127.Perra, G. (2001 ). Future of Healthcare Leadership & Quantum Mechanics. Nursing Administration, 22(3), 16-22.Porter, G. (2007). New Roles in Quantum Leadership. Nursing Administration, 32(11), 30-43.Sofarelli, S. (2005). Consequences of Nurse Shortage in Medical Centers. Daily Bruin, 27(4), 14-26.

James Loewen

To describe this work overall is rather a monumental task because there aren’t many other books out there like this one.   Lies My Teacher Told Me by James Loewen takes on really two tasks.   One is to question and answer the concept of why students dislike history classes.   The second is to prove the idea that much of what students learn in American history classes is wrong and that there are many omissions.   The author can be described as a teacher who challenges the role of revisionist history in American schools. He says that much of American history alienates children of color by ignoring the fact that many of the people who contributed greatly to this country were indeed, non-white.   Because of the nature of textbooks in American high schools, much of college history classes are taken up â€Å"fixing† the subject matter that students have learned in high school history classes. Being a college history professor, he asserts this with confidence.   Loewen does not deny the importance of knowing history for one minute, but he does question what we know.   Loewen is a university professor of history at the University of Vermont, and his study in preparation for writing this book consisted of studying twelve textbooks covering a range in American history.   He set about to â€Å"analyze the process of textbook creation and adoption to explain what causes textbooks to be as bad as they are† and the effects of using them. So, why is history boring according to Loewen?   History is made up of nothing but stories which should not be boring, but textbook companies have left out anything that â€Å"might reflect badly upon our national character† (Loewen).   As Loewen says, there is no sense of drama in history taught in schools, and there is every sense that things will work out in the end.   This alone makes history boring.   It is also boring because â€Å"textbooks almost never use the present to illuminate the past† (Loewen).   Therefore, students have a difficult time understanding the relevance to their daily lives. History is portrayed as a â€Å"morality play,† in which the touchy areas are never taught or discussed.   Publishers tend not to acknowledge problems of today or use the past to shed some light.   They also never speak of the factors that contributed to problems; rather a â€Å"blame the victim† approach is used.   As Loewen says, â€Å"While there is nothing wrong with optimism, it does become something of a burden for students of color, children of working class parents, girls who notice an absence of women who made history, or any group that has not already been outstandingly successful† (Loewen).   This â€Å"burden† turns students off to history because it does not accurately address any of these things nor does it tell the full stories. Textbooks ignore many historical realities for a variety of reasons.   The biggest reason is that publishers believe that students must develop a sense of nationalism or patriotism.   To acknowledge troubling areas in our nation’s history is to run the risk that patriotism will not be developed.   A â€Å"happy† view of history leads Americans to believe that everything is okay, so students are not troubled.   This view of history embraces the American idea of individualism rather than looking at the many factors that affected lack of equal opportunity.   Textbooks make us believe that equal opportunity was and is an option for all. As for other reasons, Loewen does a thorough job pointing these out.   Facts are presented â€Å"as one damn thing after another† (Loewen).   Books â€Å"suppress causation† (Loewen).   In fact, many of the facts included are flat out wrong and many of the books are clones of each other, which means the facts are wrong over and over again.   They rarely include primary source documents, which Loewen compares to students taking a course in poetry without reading a poem.   Plus the books are just so darn big that students hate carrying them and reading them. In his Table of Contents he discusses all the false information or omissions based on his study of textbooks, such as the study of Christopher Columbus, Thanksgiving, Native Americans, the invisibility of racism, the absence of social class, the disappearance of the recent past, and the myth of progress to name a few.   These chapters contain much needed information about the true stories. The results of his study conclude that students are bored with or alienated from history or both.   They are also not able to use the past in order to think about the future.   He proposes this book partly in order to discuss how to assess all the various sources of knowledge about history and to help teachers think about how to learn history more accurately. As he ponders the idea of â€Å"truth† in revisionist history in every chapter, I will use one chapter as an example.   In the chapter entitled hero Making Heroes, examples are given of how textbooks leave important ideas or at least controversial ones out of the books.   For example, Loewen tells us that Helen Keller was a radical socialist.   Books leave out all mention of Woodrow Wilson’s racism and the fact that there was a new surge of racial violence in this country after his presidency. And last but not least, discussion of Christopher Columbus has been totally slanted.   He took land from the Native Americans and engaged in slave trade or forced labor.   He alone destroyed entire nations of Native Americans.   Only six of twelve textbooks even mentioned the idea of forced labor at all.   And yet, most of what is taught does none of these things. Loewen concludes with the statement that â€Å"students will start learning history when they see the point of doing so, when it seems interesting and important to them, and when they believe history might relate to their lives and futures† (Loewen). I believe the author does accomplish his goals.   He absolutely adequately sums up why students hate history.   The study of history seems all about facts and dates that have no relation to each other or to our lives.   History books are chock full of names and dates but not material that challenges the student to really think about and analyze history.   These facts are expected to be taken at face value and not to be questioned.   Any controversy is left out of books.   Students need to be taught history in a more meaningful way so that they can use the past to illuminate the future or even the future to illuminate the past. To me, understanding is the only reason to teach anything, not rote memorization of facts that aren’t even true.   I understand that standardized testing puts a lot of pressure on history teachers, but American schools should at least be able to find a way to present both sides of issues.   Students could truly be more interested in history that way.   Teaching only the wonderful qualities in American history and ignoring the disturbing parts is not a way to push students to become leaders of tomorrow.   If one truly wants to fix problems, one must first identify what the problems are.   For example, in terms of equal opportunity, it is important for students to realize that phrase was always a dream propagated by white people. People of color in this country have never had even a remote chance to thrive the way white people have.   Therefore, current practices like affirmative action might not seem so terrible if they understand the history all the way down the line.   There has always been affirmative action; it was just only for white people.   Now that we give it a name and make it policy to benefit nonwhite people, society is up in arms.   Teaching about the historical laws and rules that made it impossible to receive a fair chance if one was non-white is at least a step in the right direction.   Maybe that would help illuminate the present by using the past.   It would also highlight high level skills like synthesis and critical thinking. I detest the idea of revisionist history.   I understand that there are places where a thorough understanding is just not possible.   For example, teaching about our genocide of the Native Americans to elementary students is not a good idea.   However, we can teach about such things from primary source documents.   Falsities do not have to be taught.   We certainly do not need to reinforce the idea that Indians have all vanished or that they live in teepees still.   If all else fails, leave the study of these people or events out of history classes where students are too young to understand the ramifications. Loewen would not propose this as it would be yet another omission.   Loewen’s book should be required reading for any person planning on teaching anything.   Loewen gives a very thorough account of the many inaccuracies and omissions that are currently taught.   A lot of people have not had enough history after high school to even realize that this is the case or to put all the information together, to synthesize it in such a way that the light bulb finally comes on. And while it is much easier to take the safe route, that one is rarely the best.   In this culture we need more critical thinkers, not more people who can memorize facts.   In this information age, it is more crucial than ever to teach others how to think, not what to think.   Any fact we will ever need is at our fingertips on the Internet.   What we aren’t taught is how to analyze and evaluate or how to come to a conclusion based on thorough understanding of both sides (informed decisions).   In addition, teaching the truth of some of these historical inaccuracies might go a long way in helping racial inequities or other avenues where we â€Å"blame the victim† in our culture.   Certainly we would change our definition of America, but we might be more apt to become part of the solution. Works Cited Loewen, James, Lies My Teacher Told Me, Simon and Schuster, 1995.

Was Christopher Colombus a Hero or Villian

October 15, 2012 Was Christopher Columbus a Hero or a Villain to America? Yes,  Columbus  discovered  America, but do you know how many deaths and how much destruction it  cost? Columbus  went to explore the ocean and he found a new continent,  North  America. He was actually looking for India and its gold but found a different place. Exploration of  North  America  brought so many bad things to people. All of those things happened because of  Columbus. It makes one want to say that Columbus  is a villain. First thing that makes  Columbus  a â€Å"bad guy† is lying. Columbus  lied to the queen about the explored island.He said that there's a lot of gold and spices, and people there would share anything with anyone. Columbus also lied that he reached Asia, which was his destination spot. He said all those things to make the queen believe that he's a good man and to save himself from the death. Five hundred years before Columbus was even born, the V ikings settled land in northern North America. They were the true discoverers of the New World. Christopher Columbus merely takes credit while the Vikings are remembered as drunken savages. Not only did he not discover the New World, but his calculations were based on other's works.What kind of â€Å"hero† can't find his way to where he wants to go and then receives the credit for a complete and utter accident! This doesn't only make him a liar but it also makes him selfish. But yet we Americans still nationally celebrate his â€Å"accomplishments† that were all just faux. Another interesting fact about  Columbus  being a villain is that he deculturalized people. When he arrived, he started to control all of the land. He wanted to shape the Americas into a European society, and he did not want to consider the current ways of the Native American practices into his new society.In fact, he would kill-or have his men-kill the Natives if he felt that they were being too unruly. For example how Columbus was on a mission to convert everyone to Christianity, instead of just letting the natives keep their normal religious practices. If you ask me he sounds more like a Hitler than a hero. Columbus  met Sarawak  Indians  in  North America; he wanted to make them just like Europeans. He was trying to make them all Christian. He was also giving  women  less power and fewer rights, and  women  had to work at fields and men had to work on deadly mines.A lot of people were protesting but if they protested, they were getting killed. That's another thing that makes  Columbus  a villain. Every native older than 14 was given an amount of gold to find per day. Those who didn't reach their amount got their hands chopped off. That is nothing compared to what he did to runaways whom were executed. These Europeans also brought disease that the natives' immune systems couldn't handle. Besides genocide, he also kidnapped 500 natives and brought the half that survived back to Europe. They also raped the Native Americans, beat, abused them and even tested out new weapons on them.The last but the worst thing that  Columbus  did to gain a â€Å"bad character† name is his partial massacre. When  Columbus  went to  America the  second time, he brought a lot of Native  Americans back with him to make them slaves to work for his queen. A lot of people died  on the way to Columbus's country, and others were dying because they worked hard as slaves in mines and fields, which was hard and dangerous. And that's the third reason to call Columbus a â€Å"bad guy† of history. Columbus  wasn't that much of a hero, as many people would say.I mean yes, he did play a very important parts in history. For example he brought exchanged different plants and animals between Europe and America. He also brought more attention to a new continent, and partially helped the Native Americans (before he killed a lot of them). B ut he also did the devious things like killing the Native Americans, spreading diseases to them, enslaving them and torturing and abusing them, it's easy to see why you could call Christopher Columbus a villain and defiantly not a hero after  hearing  all the details of his adventure.All the destruction and  pain  that he brought to people makes him a villain. Also the conflicts he caused between different countries and regions . Don't you think? Reference page http://www. scholastic. com/teachers/article/christopher-columbus-1451-1506 http://voices. yahoo. com/christopher-columbus-hero-villain-330564. html Holt McDougal United States History, Beginnings to 1877  ©2013, Florida Edition chapters 1-2

Malcolm X Essay Example | Topics and Well Written Essays - 500 words

Malcolm X - Essay Example Furthermore, his highlighting on the black community having self help and self-respect gives life to his scrutiny in human rights. He depicts African American culture with vibrancy and criticizes unacceptable behavior from his point of view of Muslim faith. The book ‘Autobiography of Malcolm X’ conceptualizes a transformation from lack of knowledge and misery to awareness and religious initiation (Haley). In his comment that, people never realize how a persons’ life can be altered just by a book he tells Harley the prime belief underpinning each effort to put down an autobiography as an exemplar for others. Malcolm’s views and ethics in the fight for civil rights of the 60’s were entirely different from Martin Luther King Jr., but both of them were in some way similar as in the case of loving the almighty and loving your self are virtues prime and primary steps towards achieving independence, sovereignty and power. This can be seen when Malcolm says that: He might have portrayed nearly all non-Christian aversion for loving his adversaries, but he and Martin Luther tacitly understood the success to freedom. In his Harlem life encounter, he realized that the black community should be more vibrant in helping themselves in an attempt to improve their oppressing situation. This in its sense applies to everyday life and should be embraced if one wants to improve a situation. He was the pioneer behind establishing over hundred mosques in the better part of the United States territory. As chief representative for Elijah Muhammad, saw the Nation of Islam rise to being a spiritual and religious organization in the 1960’s, hence expanding its reach. Malcolm and Elijah Muhammad agree that a polite reaction to isolation and separation is not Integration but cultural division. Malcolm mostly wanted racial justice to be upheld in America. In the event that

Issues currently occurring in the hospitality industry Article

Issues currently occurring in the hospitality industry - Article Example The author discusses the different approaches of research and their implications in organizational science and provides guidelines as to the ways of improving the credibility and value of research. The second article discusses the importance of competence in frontline management and the different methods of assessing the level of competence among students and managers with respect to frontline management in hospitality sector. The major issues faced by the global hospital industry are the changing demographics of the world which are impacting the trends within the travel industry. The emerging markets across the world, the shortage of labour and skills, innovations in technology, availability of capital, restrictions imposed in the travel industry, the increasing costs of constructions, balancing the expenses with the immediate need of increasing the rates and distribution revolution are the major factors affecting the global hospitality industry. Article 1: The importance of research tools and methods are critical in deciding the success of the hospitality industry, especially in the light of the changing global scenario. The various factors affecting the major changes in the trends of the hospitality industry can be effectively analysed through the use of different research tools and an increased level of collaboration between the research of academicians and practitioners (Dougherty and Westley, 2001). The author indicates that the proper use of research can create value for the hospitality industry. An approach of research through the practitioners is especially critical as the practitioners have a first-hand experience and can strongly indicate the customer satisfaction factors. Using a careful balance between the theoretical and practical aspects of a research work is necessary to create value for the research. The practitioners can contribute to the practical approaches to

How does Webers concept of status group challenge Marxs views on Essay

How does Webers concept of status group challenge Marxs views on polarization of classes in societies - Essay Example For Marx, society is not merely a collection of separate, competing individuals, although that is the appearance that capitalist society presents. Throughout history societies have divided into competing classes, defined structurally and economically in terms of their relationship to the means of production. "In the Communist Manifesto Marx and Engels comment that the history of all hitherto existing society is the history of class struggles." (Bottomore, 1983, p. 75). Thus, he viewed the bourgeoisie as the owners, and the proletariat as the non-owners, of the means of production. Marx believed that capitalist society was increasingly becoming polarized into "two great opposed camps" of bourgeois and proletarians, which is destined to lead to conflict among these classes. Through its own instruments of development, it is bound to give rise ultimately to its own dissolution--to a revolution that will result in the overthrow of capitalism and to the creation of a socialist order. The conquest of political power by the working class will lead, firstly, to the creation of a socialist state--a state in which the working class is the ruling class and which functions in the interests of the working class. Thus, the "dictatorship of the proletariat" will replace the "dictatorship of the bourgeoisie". By the term "dictatorial", Marx does not indicate that such states have a dictatorial political form, but rather that they rule in the interests of a particular class. However, the "dictatorship of the proletariat" is only the "first phase" of post- capitalist era. Its ultimate aim is to abolish the private ownership of the means of production, and hence the social and economic basis of class divisions. In addition, Marx believed that the rise of...(Giddens, 1971, p. 37). Weber notes that there is class conscious organization where (a) there are no groups between the real adversaries, (b) large numbers of persons are in the same class situation, (c) it is technically easy to organize those in the common class situation, and (d) where the goals of the class are well understood, and this understanding is led by those outside the class (intelligentsia). (Giddens and Held, p. 72)

Business case analyse Essay Example | Topics and Well Written Essays - 1000 words

Business case analyse - Essay Example In the assessment internal aspects of the partnership between Woolworths and eBay, the study focused on the utilization of SWOT analysis tool. This provides the opportunity to assess the strengths, weaknesses, threats, and opportunities in relation to business activities of the two major business entities in the case of Australia. The partnership will have the opportunity to enhance Woolworth’s market coverage through the integration of adequate resources to address consumers needs. Secondly, the approach will provide a new convenient and flexible approach for customers to handle their needs and preferences. Similarly, the approach will enable eBay to cut down logistic costs while enabling Woolworths to increase its stock, as well as number of customers for the products. One of the major weaknesses of the partnership is the likelihood of loss of employment for employees involved in the delivery of products, as well as increased competition for the retailers from Woolworths. Additionally, the partnership might affect the image and reputation of the entities in the global context. One of the opportunities to decrease the cost of transportation and logistics since customers will click and collect their products at appropriate destinations. The entities might use this platform to enhance their business relationship with the intention of increasing their market share in other locations within Australia. The Woolworths/eBay will have to deal with diverse lawsuits concerning violation of antitrust regulations. In addition, the damage to the image and reputation of the two entities might affect their global transactions, thus a massive reduction in the volume of revenues and profitability levels at the end of the fiscal period. In the achievement of this goal, the study focused on the utilization of the PEST analysis tool, thus assessment of the political, economic, social, and technological

PDCA project Assignment Example | Topics and Well Written Essays - 1250 words

PDCA project - Assignment Example Therefore, I intend to improve my non-verbal communication skills, thus become a better leader in my profession, as well as my social life. My main aim of choosing to improve this skill relates to its ability to help me build better relationships with my peers, subordinates, the patients I serve, and other stakeholders. I followed the Plan-Do-Check-Act (PDCA) cycle to aid me in achieving my personal quality improvement goal. This involved formulating a plan of action to guide me on what I should do. I then implemented the plan, and collected data on the progress of the plan. Collecting the data enabled me to evaluate the success of my plan, hence determined the effectiveness of the plan, or need for modification (Neuhauser, Myhre, & Alemi, 2004). I intended to improve my non-verbal skills through improvement in my listening skills. This involved active listening, which meant giving my seniors, juniors, and other subordinates enough time for self-expression. This involved working on maintaining eye contact with whom I engaged. In addition, I had to work at complementing or contradicting their messages through such acts as nodding, and rolling eyes respectively (Videbeck, 2011). I was also to display acceptance through my posture whenever possible. This meant sitting beside, or across the people I interacted with, instead of behind them, which creates a physical barrier. I also planned to employ appropriate vocal cues, and avoid high pitches, which hinder effective communication. I hoped to treat at least 80% of the people I interacted with in this manner. This measure helped me to gauge my ability to communicate non-verbally, thus measure the effectiveness of my communication skills. The plan was undertaken for four consecutive weeks. During this time, the number of times that I failed to adhere to my plan were recorded on a daily basis in a daily recording sheet. The plan commenced on the 4th

Public Service Management Essay Example | Topics and Well Written Essays - 3000 words

Public Service Management - Essay Example Consideration of research works of Nijkamp, Van der Burch and Vidigni (2002) and Broadbent and Laughlin (2003) reveals the fact that extent of convergence between public and private modes of organising in public services management differs significantly with change in nature of public sector. Zouggari (2003) projected serious doubts over sustainability in convergence of public and private modes of organising. According to Zouggari (2003), these two modes of organizing are different in terms of their inherent characterises; therefore, collision may arise during the time of convergence between these two modes of organising in public services management. On the other hand, Spackman (2002) and Sussex (2003) found that extent of convergence between public and private modes of organising can enhance with proper control mechanism. It is evident from the mentioned theoretical arguments that controversy and doubt exists among scholars regarding extent of convergence between public and private modes of organising in context to public services management. Such level of perplexity and confusion regarding extent of convergence has influenced this study to shed light on the topic and analyse validity of arguments presented by previous scholars. While defining importance of convergence between public and private modes in public services management, Wettenhall (2003, pp. 77) used the statement, â€Å"The term partnership is now a dominant slogan in the rhetoric of public sector reform, arguably capturing that status from privatization which held similar dominance through the 1980s and 1990s.† According to Wettenhall (2003), concepts of new public management (NPM) and public-private partnerships (PPP) can be used in order to realize characteristics of convergence between public and private modes of organizing. However, Johnston and Gudergan (2007) had stressed more on public-private partnerships (PPP) as potential mechanism to achieve the

Indian Wedding Clothes Essay Example for Free

Indian Wedding Clothes Essay In India, the wedding rituals and clothes make the wedding as much as that of the bride and her groom. Both look their splendid best in gorgeous clothes. Not just the couple, but the guests attending the family and the relatives are often seen dressed up to the teeth. The bride is dressed up in auspicious colors, whereas the bridegroom is dressed to exude a regale aura. The bridesmaids and best men are often dressed in par with the bride and the groom. But they are toned down a bit because the day belongs to the couple. All the folks attending the marriage are decked up with gold jewelry including the bride and sometimes the groom. The ladies are additionally adorned with henna patterns all over their palms, hands, forearms, legs and feet. Sometimes henna patterns are replaced with alta designs which are short lived and easily removable. Indian wedding generally tend to continue for several days and new attire is worn each day. All these dresses and the color symbolize the meaning of marriage and the period that follows it. Indian wedding is one that gives more importance to details like different rituals and the various attires one wears to attend them. Hindu wedding Indian Hindu weddings continue for several days. India is a country that defines diversity and this is visible even in the wedding and its different styles. The ceremonies, the rituals, the formalities are all different between each region and culture. Unlike the Christians, Hindus wedding ceremony does not resemble the western marriages and are quite elaborate. In the North,Starting from the Tilak ceremony, each function has significance in the marriage. Tilak, Sangeet, Haldi, Baraat and the Shaadi, all necessitate the Bride and the bridegroom to wear new attire at each occasion.All these above ceremonies are known by different names in the other parts,e.g.:Simant puja in the west,or Mangalasnanam in the south and so on.But have got   he same significance all over. Bridegrooms clothes Many communities of South,West and Eastern India still adhere to the traditional costumes,i.e. Dhoti,or sometimes Lungi,and Mundu by some communities of the South.Kurta or a shirt may be worn or sometimes just a Angavastram may be used to cover the chest. On the other hand in the Northern parts, bridegroom usually wears a Sherwani, Jodhpuri suit or a western suit. The groom’s face is covered with a veiled with a curtain of flowers which is called Sehra in the North,which is not the custom elsewhere. It is also customary to wear a Taqiyah all through the ceremony in Muslim marriages. Many prefer to wear a Kurta.Kurta can be worn with Salwar,or Dhoti. A dazzling series of ensemble for bridegrooms include majestic sherwani, blended Indo-western suit and ethnic Jodhpuri suit. The exquisite shirts, coats and jackets are designed with extra care and touch to bring out the magnanimity out of the bridegroom on the marriage day. Precious embellishments are studded into the collars and the cuffs of the bridegroom’s dress. Available both in simple cottons and splendid, royal raw silk, these Kurta Pyjamas are a preferred mostly by the bridegrooms. Brides clothes Christian Bride in wedding sari The bride wears a saree or a lehenga according to the region. Red is considered to be the most auspicious color in among Hindus. While the saree is preferred as the bridal dress in South India, West, East India, most brides of other parts of India prefer Lehenga, Gagra Choli and Odni as bridal dress. Christian wedding Christian marriage in India is mostly an adaption of western wedding ceremonies. Here the bridegroom wears a western suit or tuxedo. The Bride usually opts for a silk saree or a western gown. Bridesmaid and family While during a marriage function, the bride and the bridegroom take the centre stage, the bridesmaid takes over everyone off-stage. Dainty Lehenga Cholis in bright colors, long cholis for the conservative, authentic designer lehengas and readymade lehenga cholis are usually selected by the bridesmaid as wedding ensemble. Sometimes the bridesmaids wear sari rich in silk and embroidery. Delicately put together with alluring fabrics of bright and cheery colours, these Lehengas bring out the playful nature of the bridesmaid.

Inter-Professional Education, Working and Learning

Inter-Professional Education, Working and Learning What do you understand by the terms inter professional education (IPE), inter professional working (IPW) and enquiry based learning (EBL)? Discuss the potential benefits and difficulties associated with them The modern NHS is constantly evolving and arguably has done so since its inception. This evolution has been on many different levels. In this essay we shall consider some of the changes in the professional working and learning practices of the nurse with consideration of the topics of inter professional education (IPE), inter professional working (IPW) and enquiry based learning (EBL). We shall consider each in turn and then examine its relevance to modern day practice. Interprofessional education (IPE), IPE has been defined in a number of ways. One of the most complete is: The application of principles of adult learning to interactive, group-based learning, which relates collaborative learning to collaborative practice within a coherent rationale which is informed by understanding of interpersonal, group, inter-group, organisational and inter-organisational relations and processes of professionalisation. (Gough D.A et al. 2003) When reading the literature on the subject, one quickly becomes aware that there are a number of commonly used terms that are virtually synonymous with IPE, and contribute to the â€Å"semantic quagmire† referred to in the McPhearson paper (discussed later) that surrounds terms such as multi-disciplinary learning and multi-professional education. (Scottish Office 1998). In broad terms they describe the process whereby two (or more) professions or disciplines come together for the purposes of learning (Jackson, N et al. 2004). The important functional features of such a system are not that the individuals concerned learn the same material together but that there is a learning both about and from each other to improve collaboration and the overall quality of care provided and it is this latter feature which distinguishes the term IPE from the rest of the group mentioned earlier. (NCIHE 1997) The emergence of multidisciplinary teamwork and the seamless interface concepts (Yura H et al. 1998) have highlighted the need for smoother integration of both processes and knowledge (as well as other less tangible concepts such as mutual respect and understanding) between the caring professions. (CAIPE 1997) Quite apart from the ideological requirement for such processes to be adopted, we note that there is an increased pressure of guidances coming from central sources, primarily the Dept. of Health, that specify IPE as essential to the task of healthcare professionals and also a number of enquiry reports (such as the Kennedy report and other in the field of child abuse and mental health such as the Laming inquiry (2003)) that have highlighted the need for strengthening both IPE and interprofessional working Interprofessional Working (IPW) IPW is, to a large extent, a direct and natural consequence from the adoption of the concepts of IPE. (Molyneux J 2001). In essence, it describes the process of healthcare professionals collaborating in working together more effectively to improve the quality of patient care thereby allowing for both flexible and coordinated services and a skilled and responsive workforce. (McNair R et al. 2001). We should note that the adoption of IPW is seen as a key element in the optimum working of multidisciplinary team working which allows healthcare professionals to work competently and confidently across previously defined professional boundaries and it enables effective role substitution (Finch J et al. 2000) Enquiry based learning (EBL) This is essentially a description of a process of learning that is driven by a process of enquiry. It is complementary to the process of project based learning (PBL) which is determined by the end point of the solution of a problem and usually requires the creation of a finished product such as a project report or a dissertation. EBL is characterised by deep involvement and engagement with a complex problem and incorporates structures and forms of support which can help the student carry out their enquiries and can cover a broad spectrum of different approaches. The characteristic feature of this type of structured learning is that the tutor establishes the topic and the student then pursues their own lines of enquiry, both seeking evidence to support their views and also taking responsibility to present this evidence appropriately. In the words of Barrett: It promotes personal research†¦ the student becomes familiar with the multifarious resources at their disposal such as e-journals and databases. There is the opportunity to support one another in research and explore different avenues of information. The whole experience becomes one of interchange where students can share opinions, research and experience to achieve an end result. (Barrett et al. 2005) Collaborative working In essence, the forgoing paragraphs all come under the over-reaching concept of collaborative working. This is not an isolated academic concept, it is a very practical one. The literature on the subject is very informative. If we consider a number of specific examples from recent journals, we can cite the paper by Rogowski (J A et al. 2001) which produced an ingenious design of study to assess the degree to which a number of neonatal intensive care units (NICUs) could make improvements in both the quality of care and also the economic functioning of their departments by embracing the concept of collaborative multidisciplinary working. Ten NICUs adopted the collaborative multidisciplinary working model and their outcomes were compared with nine â€Å"controls† who did not. The paper is both long and complex and the analysis is exhaustive but, in essence, the authors concluded that such collaborative working practices could certainly achieve cost savings (which were comparativel y easy to quantify). They noted that these were certainly obtainable in the short term and most were sustainable in the long term. They also commented on the improvements in the quality of care parameters (which were much harder to quantify). There was an improvement in a number of indices of quality of care including patient (parent) satisfaction levels, staff satisfaction levels and this was not accompanied by any reduction in clinical outcome. On a wider consideration, one can turn to the paper by Anderson (P et al. 2003) Which describes the WHO’s collaborative survey on the management of alcohol problems in a primary health care setting. The paper starts with the premise that the handling of alcohol-related problems in primary healthcare is poor (and cites many reasons for this). (Aalto, M et al. 2001) . The relevance to our discussions here is that the paper considers the outcomes in this area when such problems are treated by the GP alone and when they are treated by a multidisciplinary primary healthcare team (IPW) and it is clear that the later group has a generally better outcome. These two papers are presented to support the hypotheses that IPW and collaborative working are not simply new mechanisms without foundation or substance, they are a demonstration of their ability to work in a practical field. If we now consider the benefits and shortcomings of IPE and IPW within the context of the modern NHS, we note that there is not only a consideration of the benefits of IPW between the various healthcare professional’s specialties but some authors also call for IPW between those healthcare professionals who work in primary healthcare teams and those who work in a hospital setting. The current structure of the NHS is such that hospital based practitioners tend to train, work, and have their horizons limited by the confines of the hospital environment. When the patient leaves this environment they become â€Å"someone else’s problem† and the care is then taken over by another team of healthcare professionals. Parsell ( G, et al. 1998) calls for both IPE and IPW to accommodate this rather artificial divide and to educate healthcare professionals into the consideration that it is the patient who is the constant factor and that considerable levels of collaborative work ing are required to provide optimum levels of patient care. A more recent paper by McPherson (K et al. 2001) takes this argument a stage further. It is both analytical and well written and the authors have an impressive pedigree (two professors of medicine and a lecturer in health administration). The paper puts education at the centre of the modernisation debate They make the very pertinent observation: Most health needs require the collaboration of a group of health professionals. The professionals involved may work together in the same space or be scattered throughout several hospital departments or sectors of care. Whether or not the caregivers see themselves as part of a team, each patient depends on the performance of the whole. The paper then makes a number of analyses form both practical experience of the authors and the current literature. They suggest that, in order to work well a work group or team should have the following characteristics: Clear aim: shared understanding of goals. Clear processes: knowledge of (and respect for) others contributions, good communication, conflict management, matching of roles and training to the task. (Headrick L A et al. 1998) Flexible structures that support such processes: skilled staff, appropriate staffing mix, responsive and proactive leadership that emphasises excellence, effective team meetings, documentation that facilitates sharing of knowledge, access to needed resources, and appropriate rewards. (Firth-Cozens J 2000) The authors cite an impressive and persuasive evidence base that IPW and collaborative working have been demonstrated to produce patient benefit in a number of specific areas including reduced mortality for the elderly. (Rubenstein L Z et al. 1991), morbidity after CVA (Langhorne P et al. 2001) and mortality after CABG (OConnor G T et al. 1996) to mention just three. Despite these clear and demonstrable benefits, the authors make the point that IPW is not just something that happens when professional training is completed, it should ideally be considered as part of a continuum of learning starting with the pre-qualification experience, continuing into postgraduate education, and extending into continuing professional development. They make a call (which has been echoed by many others viz. CGME 2000) for learning in the field of healthcare to be about healthcare as a whole, rather than a series of disjointed â€Å"chapters† in order to help the developing healthcare professionals to acquire a deeper understanding of the processes of care and also to prepare the professionals to be in a better position to contribute to the development of a better system in the fullness of time One of the impediments to a wholehearted embracing of these concepts is perhaps a clinging onto the older concepts of trying to blur boundaries between what a nurse and a doctor might do or perhaps how an occupational therapist or a psychologist might approach management issues. It seems to be a fundamental issue that need to collectively understand the different ways of thinking and problem solving that the different specialties require so that the different skills and knowledge bases can be combined in a way that benefits patients. (Koppel I et al. 2001) Part of the requirement of the writing of this essay is to reflect on the experiences gained in the EBL group work and the learning derived from the research for this essay. Gibbs reflective model is ideal for this purpose. The descriptive elements are largely contained within this essay and, in addition, my experiences within the various groups. It has to be said that the groups that I was involved with were largely harmonious and entered into the various learning exercises in a spirit of self-help. I am aware however, that a number of the other groups did not share this experience and I have been told about a number of heated discussions that apparently tool place within these other groups. My feelings are that instinctively I find the former more conducive to a positive learning experience. Although it can be useful to enter into a heated debate on a subject, it rarely helps to persuade you to a different point of view. (Taylor, E. 2000). The evaluation of the episode was that it gave me a personal insight into how other healthcare professionals consider and manage problems in their own sphere and, as such, I feel that I have learned a great deal and formed a deeper understanding of their perceptions and knowledge of certain issues. In terms of what I might have done differently, I believe that I was able to assimilate a great deal of useful information from these groups which will almost certainly help me in my professional career. On reflection, I think that I was not as vociferous as I might have been in putting my own viewpoint forward, and it occurred to me that the other healthcare professionals in the group may therefore not have had the same opportunity to assimilate my particular viewpoints and opinions and may therefore have been disadvantaged by this. (Palmer 2005). It is certainly clear to me that there is considerable benefit to be obtained in both IPE and IPW and the mechanism of EBL is a valuable tool to obtaining that benefit. In terms of a discrete action plan, I have every intention of engaging as fully as I can in any further measures in this regard and will try to make my own viewpoint available for others to assess and assimilate as actively as I have tried to assess and assimilate theirs. (Van Manen, M. 1997). I feel that this is a positive step in making all of us more fully professional and able to contribute more fully to the healthcare systems that we will eventually work in. References Aalto, M., Pekuri, P. and Seppa K. (2001)  Primary health care nurses and physicians attitudes, knowledge and beliefs regarding brief intervention for heavy drinkers.  Addiction 96 : 305–311 Anderson P, Eileen Kaner, Sonia Wutzke, Michel Wensing, Richard Grol, Nick Heather, and John Saunders 2003 ATTITUDES AND MANAGEMENT OF ALCOHOL PROBLEMS IN GENERAL PRACTICE: DESCRIPTIVE ANALYSIS BASED ON FINDINGS OF A WORLD HEALTH ORGANIZATION INTERNATIONAL COLLABORATIVE SURVEY Alcohol Alcohol., November/December 2003 ; 38 : 597 601. Barrett T, MacIbrahim I, Fallon H (eds) 2005  Handbook of enquiry and problem based learning  Galaway : CELT 2005 CAIPE (1997)  Interprofessional Education A Definition.  CAIPE Bulletin. No. 13, 19. CGME 2000  Council on Graduate Medical Education National Advisory Council on Nurse Education and Practice. Collaborative education to ensure patient safety: report to US Department of Health and Human Services and Congress. A Report on a Joint COGME-NACNEP meeting and implications of the IOM Report. Washington, DC: Health Resources and Services Administration, 2000 : 9–18. Finch J, May C Mair F et al 2000  Interprofessional education and teamworking: a view from the education providers.  British Medical Journal 321 : 1138-40. Firth-Cozens J. 2001  Multidisciplinary teamwork: the good, bad, and everything in between.  Quality in Health Care 2001 ; 10 : 65–6. Gibbs, G 1988  Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Gough D.A., Kiwan D., Sutcliffe K., Simpson D. Houghton N. (2003).  A systematic map and synthesis review of the effectiveness of personal development planning for improvement student learning  London : EPPICentre, Social Science Research Unit. 2003 Headrick L A, Wilcock O M, Batalden P B. 1998  Interprofessional working and continuing medical education.  British Medical Journal 1998 ; 316 : 771–4 Jackson, N. Ward, R. 2004  A fresh perspective on progress files. A way of representing complex learning and achievement in higher education  Assessment Evaluation in Higher Education Vol. 29 : No. 4, August 2004. Koppel I, Barr H, Reeves S, et al. 2001  Establishing a systematic approach to evaluating the effectiveness of interprofessional education.  Issues in Interdisciplinary Care 2001 ; 3 : 41–9. Laming, Lord. 2003  The Victoria Climbie inquiry: report of an inquiry by Lord Laming.  London: The Stationery Office. 2003 Langhorne P, Duncan P. 2001  Does the organization of postacute stroke care really matter?  Stroke 2001 ; 32 : 268–74. McNair R, Brown R Stone N et al (2001)  Rural interprofessional education: promoting teamwork in primary health care education and practice.  Australian Journal of Rural Health 9 : s19-s26. McPherson K, L Headrick, and F Moss 2001 Working and learning together: good quality care depends on it, but how can we achieve it? Qual. Health Care, Dec 2001 ; 10 : 46 53. Molyneux, J. (2001)  Interprofessional teamworking:what makes teams work well?  Journal of interprofessional care. vol. 15. (1) p29-35. NCIHE 1997  The National Committee of Inquiry into Higher Education (1997) Higher education in the learning society : Report of the National Committee of Inquiry into higher Education  London : HMSO. 1997 OConnor G T, Plume S K, Olmstead E M, et al. 1996  A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA 1996 ; 275 : 841–6  Palmer 2005  In Learning about reflection from the student Bulpitt and Martin Active Learning in Higher Education. 2005 ; 6 : 207-217.  Parsell G and J Bligh 1998 Interprofessional learning Postgrad. Med. J., Feb 1998 ; 74 : 89 95. Rogowski J A, Jeffrey D. Horbar, Paul E. Plsek, Linda Schuurmann Baker, Julie Deterding, William H. Edwards, James Hocker, Anand D. Kantak, Patrick Lewallen, William Lewis, Eugene Lewit, Connie J. McCarroll, Dennis Mujsce, Nathaniel R. Payne, Patricia Shiono, Roger F. Soll, and Kathy Leahy 2001 Economic Implications of Neonatal Intensive Care Unit Collaborative Quality Improvement Pediatrics, Jan 2001 ; 107 : 23 29. Rubenstein L Z, Stuck A E, Siu A L, et al. 1991  Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence.  J Am Geriatr Soc 1991 ; 39 : 8–16S ; discussion 17–18S. Scottish Office (1998)  Higher Education for the 21st Century: Response to the Garrick Report.  London: HMSO. 1998 Taylor, E. (2000).  Building upon the theoretical debate: A critical review of the empirical studies of Mezirow’s transformative learning theory.  Adult Education Quarterly, 48 (1) , 34-59. Van Manen, M. (1997)  Linking Ways of Knowing with Ways of being Practical.  Curriculum Inquiry 6 (3) , 205-228. Yura H, Walsh M. 1998  The nursing process. Assessing, planning, implementing, evaluating. 5th edition. Norwalk, CT: Appleton Lange, 1998. ################################################################ 19.11.06 Word count 3,069 PDG.

Abraham Lincolns Abuse of Power :: American America History

Abraham Lincoln's Abuse of Power Lincoln's use of executive authority during the civil war is many times illegal and unjust; although his issuance of the Emancipation Proclamation may seem justified, Lincoln blatantly abused his power regarding civil rights. He did things like institute an unfair draft, suspend Constitutional rights, allocate military spending without Congress, and institute emancipation. Although some may justify these actions, they stomped on the Constitution. Lincoln found powers in the constitutional clause making him "Commander in Chief of the Army and Navy of the United States, and of the militia of the several states." He said that because of this clause, he had the right to use any means necessary to defeat the enemy. With this justification, he issued many executive orders before Congress even convened. Lincoln summoned the militia, ordered a blockade of the Confederacy ports, expanded the regular army beyond its legal limit, and directed government funds before congressional allocation. of these powers were granted to him in the Constitution. Lincoln also abused his power with the draft. Prior to the draft, the Union depended on the states to fill assigned quotas with volunteers. But then Lincoln instituted a new draft. By its terms, all men between the ages of 20 and 45 were liable to military service. However, any man who was called for the draft could avoid it by hiring a substitute or paying $300 dollars to the government. Many groups rightfully denounced these acts, called the conscription acts, as a rich man's law. Indeed, many wealthy men were able to bribe poorer men into taking their place in The most blatant abuse of Lincoln's power was his suspension of habeas corpus. The suspension of this constitutional guarantee, by which a person could not be imprisoned indefinitely without being charges with some specific crime, around much opposition throughout the country. Although Lincoln himself made no concentrated efforts to suppress political oppositions, the repeal of habeas corpus enabled overzealous civil and military authorities to imprison thousands of people who were vocal in their opposition to the war against the South. During the war, in the case Ex parte Merryman, Chief Justice Taney ordered Lincoln to grant a writ of habeas corpus to a Southern agitator who had been arbitrarily jailed by military authorities in Maryland. Lincoln ignored the order. After the war, in the case Ex parte Milligan, the Supreme Court ruled that president could not suspend habeas corpus without the consent of Congress.

Cell Phone Technology :: Technology Communication Phones Essays

Cell Phone Technology Ring ring! All the people in a 20-foot-radius are thinking it is them that are ringing. Women search through their purses; men reach for their pockets to see if it is their cell phone that is ringing. The year is 2002, and it appears that almost everyone has a cellular telephone. Many believe that in today's society it is a necessity to own one and would be difficult to go a day without one. Are they really necessary? People survived just fine without them before their invention. It really was not until about 15 years ago that they really started appearing and the last five that it seemed as if every Tom, Dick, and Harry owned one. What has caused their sudden boom? Are people becoming too reliant upon them? Is there health risks involved when people send such powerful signals directly toward their heads? Cell phone technology dates all the way back to 1947. â€Å"In that year researchers first developed ideas as to the possibility of creating mobile phones that used "cells" that would identify a user in whatever specific region he or she was initiating the call from† (Cell Phone World). Still the technology was very limited at the time, so much more extensive research was required. In 1968 private companies started getting involved with cell phone development, such as AT&T. The FCC (The Federal Communications Commission) then opened new frequencies and the private companies had the theory of cellular towers. Each tower would be responsible for a particular region. When a customer traveled farther a way from one region it would switch the call to a closer tower with no interruption. In 1977 public cell phone testing had begun. People in Baltimore, Chicago, and Washington were the first to be eligible for cell phone trials. In 1979 a company in Japan began doing cell phone testi ng with the public. Not until 1983 were cell phones really available. â€Å"The year 1988 changed many of the technologies that had become standard in the past. The Cellular Technology Industry Association was created to set realistic goals for cellular phone providers and research new applications for cell phone development† (Cell Phone World). In a way they still were not very accessible to the public, due to their extremely high operating cost to the consumer. Only the very wealthy could afford cell phones. Important heads of cooperation’s, movie stars, and top government officials were able to afford the luxury of a mobile phone.

Physics of Paintball :: physics paintball gun

Fuel For A Paintball Marker The Reason that people need a tank when they play paintball is because you need a way to force the paintballs out of the gun and this cannot be achieved effectively by just using a spring. What they decided to do was to fuel the paintballs by pushing them with a gas. The way in which they did this was to put the gases, either Oxygen, Carbon Dioxide or Nitrogen under extreme pressure until they turned into a liquid and once they are in a liquid form they can be blown into a tank which probably looks something like this. Carbon Dioxide must be under a pressure of at least 415.8 kPaA For it to turn into liquid form. Oxygen and Nitrogen are very similar to this. The way in which the gas is let out is that there is a needle in a valve in the top of the tank and when the tank is screwed into the paintball marker the needle gets pressed down and the entire system becomes pressurized and is ready to be fired. Then when the gun is cocked and the trigger is pulled the bolt is pushed forward, accelerated by the force of the C02 acting behind it and pushes the paintball out. Then the bolt comes back into the read position and the C02 is no longer flowing and is again pushing against the bolt. There are some problems with this system however. One of the major ones is called snowing, where liquid C02 actually gets into the paintball marker, this is not good for multiple reasons, first of all having the liquid C02 on the moving parts inside a marker is not good for it, since many of the parts inside are rubber or plastic. The second problem with this is since the gas is in liquid form it is not expanding as fast and there for is not pushing the paintballs as effectively. This causes a white snow like substance to come out of the barrel of the marker. There are several way that this problem is dealt with, some markers have the guns stored in a vertical position to keep the liquid in the bottom of the tanks. Other markers employ gas lines or expansion chambers, these are basically just tubes or cylinders that run from the tank to the marker and give the C02 a chance to turn from a liquid to a gas.

Managed Care Essay

As recently as 1960, before the onset of managed mental health care, the roles of psychiatrists, psychologists, and clinical social workers tended to be distinct. Psychiatrists had the overall responsibility of patient care, conducted psychotherapy, prescribed medication, and supervised hospital care. Clinical psychologists conducted testing and provided group therapy and other therapeutic modalities in institutions and hospitals. Clinical social workers performed comprehensive psychosocial assessments, counseled regarding family issues, and created discharge plans for patients in social services agencies. At that time, the mental health field was far from overcrowded. With psychiatrists’ shift in emphasis, clinical social workers and clinical psychologists assumed more responsibility in mental health treatment, and psychotherapy, in particular. The proliferation of managed care companies during the 1980s furthered the increased involvement of clinical social workers and clinical psychologists. Because of improved training and the less-expensive nature of their services, clinical social workers and clinical psychologists were more involved in providing psychotherapy to patients suffering from mental illness. (Committee on Therapy, Group for the Advancement of Psychiatry, 1992). Conflict in Roles According to Gibelman & Schervish managed health care companies have continued this trend of expanding the roles and responsibilities of nonmedical providers–primarily clinical social workers and clinical psychologists–while narrowing the scope of psychiatric practice. Managed health care companies see clinical social workers in particular as an economical, substitutable source of labor for both clinical psychologists and psychiatrists in the treatment of patients suffering from mental illness. Presently, clinical social workers provide a wide array of services to clients with mental illness in a variety of settings and at all functional levels of practice. Clinical social workers practice in institutions, hospitals, school systems, clinics, correctional facilities, and private practices. They function in positions of direct service, supervision, management, policy development, research, community organization, and education and training. Clinical social workers frequen tly perform assessments and arrange and develop services. In these roles they serve as gatekeepers and treatment providers. For some time, clinical social  workers have performed the largest portion of psychotherapeutic work done in the United States. Clinical social workers provide as much as 65 percent of all psychotherapy and mental health services (1997). Payers have begun to ask, â€Å"What type of therapist is the most cost-effective?† and â€Å"What is the advantage of paying one profession higher fees than another for rendering the same service?† when an objective review of empirical studies shows that there is no absolute proof that one profession can perform psychotherapy better than another. Such research leads managed care companies to conclude that many of the cheaper sources of labor in the mental health field, such as clinical social workers, are as effective in administering treatment to patients suffering from mental illness as other more-expensive practitioners (Gibelman & Schervish, 1997) Individual verse Group Practice With managed care’s influence, outpatient treatment, and private practice, in particular, has become a viable and increasingly important role for clinical social workers. Although mental health clinics and other institutions provide the greatest opportunity for clinical social workers, a growing number are now carrying out services in a primary setting of solo or group private practice (Gibelman & Schervish, 1996). In 1995, 19.7 percent of NASW members cited private solo and group as their primary practice, and 45.5 percent as their secondary practice setting (Gibelman & Schervish, 1997). Findings indicate that the proportion of clinical social workers entering and practicing as private practitioners continues to grow (Gibelman & Schervish, 1996). The future treatment of patients in solo private practice may be in jeopardy, as managed care companies force clinical social workers and other mental health care providers to join group practices. In group practices, clinical social workers, in combination with other mental health practitioners, provide individual and group therapy, family interventions, and a variety of other services, all through one office (Shera, 1996). These groups provide â€Å"one-stop shopping,† as well as greater access to less-expensive professionals, such as master’s-level clinical social workers. Managed care companies find that group practices are more efficient and cost-effective in the management of a population of patients (Johnson, 1995). As managed care companies continue to reduce reimbursement dollars, changes in multidisciplinary team structures are inevitable, with even more  reliance on master’s-level service providers. Practitioner distinctions already have begun to diminish in favor of more team-oriented models, with the boundaries between the uniqueness of the individual disciplines beginning to blur (Eubanks, Goldberg, & Fox, 1996). Psychiatrists often head the team, coordinating services in conjunction with psychotherapists and other mental health care providers on the treatment team. However, it is not unusual for a clinical psychologist or even a clinical social worker to lead the team, with the psychiatrist relegated to the role of psychopharmacology consultant rather than an active team member (Brooks & Riley, 1996). Treatment In addition to changing the role of mental health practitioners and the structure of treatment teams, managed care has forced the clinical social work profession and the mental health field in general, to examine how its members provide care. Managed care companies are exploring new ways they can provide the most effective services to more people under increasing resource constraints (Shera, 1996). The transition from fee-for-service to managed mental health care services has created an entirely new culture for mental health care providers and consumers (Geller, 1996). Practitioners must accommodate their treatment to the preferences of managed care. Otherwise, they risk a decrease in referrals, which could ultimately lead to loss of status and income. Managed health care companies have exerted influence on the ways that mental health practitioners conceptualize their practice, forcing treaters to modify therapeutic interventions and practice protocols significantly (Shera, 1996). Brief therapy now appears to be the preferred mode of intervention (Gibelman & Schervish, 1996). Long-term psychotherapy has been virtually eliminated for all but private-pay patients. Managed care companies find that studies of short- and long-term therapy suggest that brief approaches are as good as or better than long-term treatment, except in special cases (Lazarus, 1996). The majority of interventions distinguishing themselves in comparative outcome studies are based on behavioral or cognitive-behavioral theories. These treatments tend to be goal- and present-oriented, behaviorally specific, symptom-directive, advice giving, educational, collaborative, and aimed toward the resolution or amelioration of symptoms in relatively brief periods (Johnson, 1995). The  shift in preference to brief modes of therapy by managed care organizations has changed expectations for therapists. Theoretical orientation of practitioners has become of great interest as managed care companies look fo r practitioners who use brief treatment methods (Giles, 1993). The practitioners most significantly affected by managed care’s shift in preferred mode of treatment have been those who provide the extensive and intensive treatments of psychoanalysis and psychodynamic psychotherapy, predominantly clinical psychologists. Their emphasis on Freudian psychotherapies, which generally have a very long duration of outpatient care and discouraging results in the outcome literature, have been, criticized heavily (Giles, 1993). Emerging models of psychotherapy endorsed by managed care organizations assume that the psychotherapeutic process occurs in pieces over time. In these models, psychotherapy functions as an active working relationship between the patient and the therapist, whereby the goal is defined as change rather than cure. Managed care companies’ focus on resolving patients’ acute symptoms, rather than ridding them of their mental health conditions, has led to the gradual disappearance of the use of the psychodynamic model as the dominant framework in the treatment of individuals suffering from mental illness (Edwards, 1997). Recently, group treatments have received attention as a cost-effective means of treatment (Iglehart, 1994). A group format allows a number of patients struggling with similar life issues to come together and benefit by interacting with one another and a therapist, the group leader (Shapiro, 1995). Managed care companies support group designs, relying on numerous studies that demonstrate the efficacy of short-term therapeutic groups using behavioral and cognitive-behavioral approaches. Managed care organizations find group treatment inexpensive relative to other treatment methods, because one practitioner can treat many clients at once, significantly reducing billable hours of treatment incurred. The potential of group treatment to alleviate the psychological problems of large numbers of people at relatively low cost makes group therapy an attractive option for managed care companies (). Despite the utility gains, however, managed care companies do not rely on group treatments as wide ly as might be expected, primarily because of patients’ resistance to group treatment. Some patients find the idea of group treatment difficult to accept because they have a hard time  understanding how they will benefit. Many patients prefer individual treatment sessions, where they have the therapist’s undivided attention. These patients may be embarrassed about their problems and reject the notion of others besides their therapist providing input. The logistics of setting up short-term groups, along with current therapist practice patterns, present additional impediments to managed care’s use of group therapy (Crespi, 1997). Nevertheless, the immediate cost-effectiveness of groups, coupled with documented positive outcomes, has made the modality particularly appealing in mental health delivery systems and provides a compelling argument for their use (Crespi,1997). Projection Managed health care organizations have influenced the delivery of services in the mental health field considerably and will undoubtedly continue to do so (Eubanks et al., 1996). Whether the developments instituted by managed care companies are greeted with pleasure, indifference, or hostility, general agreement exists that the treatment of patients suffering from mental illness will be irrevocably changed as managed care continues to alter drastically the delivery, definition, and outcome of treatment that patients receive. In the future, indicators (Iglehart, 1994) suggest that nonpsychiatric practitioners will emerge as the dominant providers of treatment. According to Giles (1993), managed care companies will expect nonmedical practitioners, such as clinical social workers to provide the bulk of outpatient care in the mental health care field. Clinical social workers are cost-effective, fully qualified providers of mental health care services in the eyes of managed care companies. Distinctions between master’s-level and doctoral-level providers will become more evident as master’s-level practitioners assume primary responsibility for direct mental health services, and doctoral-level providers assume more administrative, supervisory, and research-oriented roles (Crespi, 1997). The rapid increase in managed care’s influence, accompanied by the reduction of referrals to more-expensive specialists, suggests that demand for clinical psychologists will continue to diminish (Johnson, 1997). As managed health care organizations restrict consumer choice of providers, many mental health professionals, such as clinical psychologists, may have difficulty joining reimbursement plans (Gibelman & Schervish, 1997). Despite the shift away  from doctoral-level providers and the narrowing role of the medical practitioner in the treatment regime of managed care companies, psychiatrists will likely have an essential and continuing role in the mental health care system. According to Giles (1993), managed mental health care still needs medical practitioners for their knowledge of psychopharmacology and experience in prescribing medications. Scientific literature has demonstrated that psychotropic medications are an effective and essential treatment component for most psychiatric illnesses, and psychiatrists, being physicians, are currently the only ones who can prescribe these drugs with the knowledge to do so effectively. Another likely development with the influence of managed health care is the rarity of the solo practitioner (Crespi, 1997). Individual practitioners and small group practices will likely remain, but will probably represent a much smaller proportion of psychotherapists (Committee o n Therapy, 1992). With commentators predicting a demise in solo private practice, practitioners will either have to affiliate with managed mental health care groups or forego clients with insurance in favor of those able to afford private payment (Gibelman & Schervish, 1996). The psychotherapist who decides to operate outside of the managed care system faces not only a degree of professional isolation, but also limitations in referrals and remuneration (Committee on Therapy). The managed care initiatives sweeping the nation have profoundly affected the ways that clinical social workers and other mental health practitioners deliver services to people suffering from mental illness (Shera, 1996). As these changes continue, clinicians working in a managed care environment will more often practice time-limited psychotherapeutic interventions and, in all but the rarest cases, the practice of unregimented intensive psychotherapy and psychoanalysis will take place outside of the confines of the managed care a rena. For the majority of mental health care consumers, therapeutic work will focus on precipitating stressors and acute exacerbation that may be treated within the reimbursable framework (Committee on Therapy, 1992; Crespi, 1997). Finally, with managed care’s increasing influence, use of outcome measurement and management will continue. Quantifiable data will play a larger role in treatment decisions. Funding sources of mental health care services will increasingly seek quantitative methods to measure the quality  and efficiency of different interventions to guide their purchasing decisions (Johnson, 1997). As managed care companies look for hard data to determine the most effective professionals and treatments, mental health care providers will have to quantitatively demonstrate effectiveness of interventions and treatment through evidence of patient improvement (Gibelman & Schervish, 1996). Thus, the ability to implement and participate in outcomes measurement processes is vita l for any practitioner who wishes to operate in the managed care environment. Conclusion Despite widespread criticism and various efforts at reform, managed care companies continue to expand. Clinical social workers currently involved in the mental health field, as well as incoming social work students interested in mental health, must take heed of the rapid developments in the field. Although the changes resulting from the influence of managed care present many challenges, they also create many opportunities for mental health care providers, and for clinical social workers in particular. To take advantage of these opportunities, clinical social workers, and the institutions educating them, must be prepared (Geller, 1996). Many clinicians currently practicing, as well as current and incoming graduate students, lack information on the breadth of these developments (Crespi, 1997). Clinical social workers must actively seek out continuing education courses, conferences, and journal articles discussing developments in the field related to managed mental health care to be better informed. In addition, schools of social work must update their curricula for incoming students to reflect the realities of changes in managed care. Graduate schools must educate future social workers regarding developments, providing students with the information and skills necessary to survive in this evolving culture (Shera, 1996). Many social work programs are discovering that traditional curricula are no longer adequate to prepare students for practice in the era of managed care. Managed care’s emphasis on the provision of mental health services at contained costs requires specialized practice skills, particularly rapid assessment, brief treatment, and the ability to document treatment outcomes. Social work educators must incorporate these elements into their programs. As managed care continues to expand and evolve, social work educators need to continue to evaluate its  effect on the training of current and potential clinical social workers. Educators in the field, along with graduate school instructors and administrators, must make the necessary changes to provide clinical social workers with the ability to adapt to the changing environment. Collaboration with managed care is necessary for professional survival (Eubanks et al., 1996). Clinical social workers have an enormous role in the treatment of people suffering from mental illness and have a real opportunity to play a major role in managed mental health care (Shera, 1996). Clinical social workers must rise to the challenge.

Affirmative Action Policy: Eliminate All Forms of Discrimination Essay

Question 1: Is the affirmative action policy morally defensible? Explain. Yes affirmative action is morally defensible in that: South Africa has been characterised by many years of workplace inequities and imbalances of the past particularly blacks who were treated in an inhumane manner and denigration. In 1994 the new democratic government came into power and had a moral duty to eliminate all forms of discrimination and thereafter level the playing field at the workplace, hence the affirmative action policy was introduced and legislated. Since blacks were marginalised certain jobs and skills were reserved for white minority in some sectors of the economy thereby robbing our economy of its potential and productivity. Whereas the introduction of the affirmative action policy uncovered skills and untapped talent, created more jobs in responsible positions and thereby allowing our economy to grow stronger and compete in the global markets. The harsh realities of the past regime created divisions between black and white communities and promulgation of this policy assisted in closing that gap and normalise the conditions at the workplace. Therefore the policy allowed companies and government to utilise all people to the maximum potential and created improved relations and communication between organised labour and management. QUESTION 2: In your opinion, which country has successfully implemented the policy of affirmative action and why did it succeed? America QUESTION 3: In your view, why did South African government choose to implement Affirmative Action policy and Act, and was it ever justifiable? Certainly the policy of Affirmative Action is justifiable in that: Central to the democratic government was the economic challenges and expectations of the black majority who voted them into power. Therefore, the government was obliged to strive for macro-economic balance that supports sustainable growth and development to ensure that the benefits are shared by all concerned. Consequently, the Employment Equity Act 55 of 1998 was promulgated in terms of which the Affirmative Action Policy was implemented and its main aim to correct and balance the inequities of the past. Furthermore the policy had to promote equal opportunities and redress entrenched inequalities that affected blacks, women and children at the workplace. Therefore the policy is justifiable based on moral, legal and socio-economic issues. QUESTION 4: Does the policy need to be discontinued after a certain length of time and why? Yes in that: The main objective of the policy is to create opportunities and level the playing field where everyone can compete and once this is achieved the policy has to stop. Moreover the policy is not a punishment for the wrongs of the past so it makes sense to discontinue it some years to come moral responsibility is achieved.

Immanuel Kant and Ethical Dilemma Essay

Today there are many ethical dilemmas going on in the world, from companies’ misuse of funding or executives’ misuse of their title. Ethical behavior has to be an important part in having a company that will survive in society. There have been many philosophers that contributed to the ethical understanding we have today. On of the most influential philosophers in history of Western philosophy is Immanuel Kant. After his father’s death in 1755 Immanuel Kant continued his degree at the University of Konigsberg and studied philosophy, mathematics, and the natural sciences. Kant was a German philosopher that â€Å"believed that morality in all spheres of human life should be grounded in reason. His renowned â€Å"categorical imperative† held that: (1) people should act only according to maxims that they would be willing to see become universal norms (i. e. , the Golden Rule); and (2) people should never treat another human as a means to an end. † (Dave Mote; Karl Heil) â€Å"Kant’s theory implied the necessity of trust, adherence to rules, and keeping promises† (Dave Mote; Karl Heil). One of the major discussion points today in the news is Health Care Reform. The medical industry has had free reign for so long that an overhaul needs to be completed. Currently there are many points in the reform that are still not clear and causing confusion. Frustration will be caused between the individuals that will have to buy insurance, the companies that have to provide insurance and the insurance companies that have to provide pooling coverage. The policies may find be found to be difficult to uphold and people may feel that it may easier to take the penalty. According to Kant’s theory reform should be revamped again to that it will benefit all participants and not exclude any others. In my opinion Kant’s theory has contributed to companies instituting polices and procedures. These policies are developed so that staff members are not treated unfairly or discriminated against as well as employees working with guidelines to be successful. I also believe that when the company runs within ethical surroundings; management, mid and lower level employees; the company will be looked at as a place of distinction and most employees will behave and react in an ethical manner. References http://www. referenceforbusiness. com/encyclopedia/Bre-Cap/Business-Ethics. html. (Dave Mote; Karl Heil) http://www. thesunchronicle. com/articles/2010/10/11/columns/8075350. txt. (Anthony Tiatorio).

Dementia

Dementia Dementia  has become an all-important  disease  because the population is aging rapidly and the cost of health care associated with  dementia  is ever increasing. In addition to cognitive function impairment, associated behavioral and psychological symptoms of  dementia  (BPSD) worsen patient's quality of life and increase caregiver's burden.Alzheimer's  disease  is the most common type of  dementia  and both behavioral disturbance and cognitive impairment of  Alzheimer's  disease  are thought to be associated with the N-methyl-D-aspartate (NMDA) dysfunction as increasing evidence of dysfunctional glutamatergic neurotransmission had been reported in behavioral changes and cognitive decline in  Alzheimer's  disease. We  reviewthe literature regarding  dementia  (especially  Alzheimer's  disease), BPSD and relevant findings on glutamatergic and NMDA neurotransmission, including the effects of memantine, a NMDA receptor antagonist, and NMDA-enhancing agents, such as D-serine and D-cycloserine.Literatures suggest that behavioral disturbance and cognitive impairment of  Alzheimer's  disease  may be associated with excitatory neurotoxic effects which result in impairment of neuronal plasticity and degenerative processes. Memantine shows benefits in improving cognition, function, agitation/aggression and delusion in  Alzheimer's  disease. On the other hand, some NMDA modulators which enhance NMDA function through the co-agonist binding site can also improve cognitive function and psychotic symptoms.We propose that modulating NMDA neurotransmission is effective in treating behavioral and psychological symptoms of  Alzheimer's  disease. Prospective study using NMDA enhancers in patients with  Alzheimer'sdisease  and associated behavioral disturbance is needed to verify this hypothesis. Mental disorders constitute a huge social and economic burden for health care systems worldwide [1], raising the quest ion of effective and lasting treatments. Physical activity (PA) and exercise (EX) continue to gain the attention of practitioners and researchers with regard to prevention and treatment of different psychopathological abnormalities.In the general population, several epidemiological studies have found significant cross-sectional correlations between mental health and PA levels. In an adult US population, regular PA is associated with a significantly decreased prevalence of current major depression, panic disorder, agoraphobia, social phobia, and specific phobia [2]. A study from Norway confirmed this negative cross-sectional association between depression and leisure-time PA of any intensity (not work-related PA), and pointed out that social factors such as social support, rather than biological markers, play an important role [3].Recently, a Dutch study replicated this finding, reporting lower rates of any affective, anxiety, or substance use disorder in subjects who exercised at le ast 1 h/wk, without finding a linear dose-response relationship [4]. Prospectively, the overall incidence of mental disorders and co-morbid mental disorders, as well as the incidence of anxiety, somatoform, and dysthymic disorder, decreases by PA [5]. Furthermore, a four-year prospective study revealed that PA decreases the incidence rates of depressive and anxiety disorders in older adults [6].Finally, ten Have et al. reported in their epidemiological study that patients engaging in regular PA were more likely to recover from their mental illness at a three-year follow-up In psychiatric patients, different mechanisms of action for PA and EX have been discussed: On a neurochemical and physiological level, a number of acute changes occur during and following bouts of EX, and several long-term adaptations are related to regular EX training.For instance, EX has been found to normalize reduced levels of brain-derived neurotrophic factor (BDNF) and therefore has neuroprotective or even n eurotrophic effects [7-9]. Animal studies found EX-induced changes in different neurotransmitters such as serotonin and endorphins [10,11], which relate to mood, and positive effects of EX on stress reactivity (e. g. , the hypothalamus-pituitary-adrenal axis [12,13]). Finally, anxiolytic effects of EX mediated by atrial natriuretic peptide have been reported [14].Potential psychological mechanisms of action include learning and extinction, changes in body scheme and health attitudes/behaviors, social reinforcement, experience of mastery, shift of external to more internal locus of control, improved coping strategies, or simple distraction Several prospective studies have found that a high level of PA seems to delay the onset of dementia (see [74] for a review). Since improvements in strength and endurance after training were found in cognitively impaired patients as well as healthy controls [75], PA interventions are generally feasible in this population.For Alzheimer's disease (AD) , preliminary evidence suggests that EX interventions may improve communication performance [78], Mini Mental State Examination scores and verbal fluency [79], and disruptive behavior [80]. Four studies [81-84] found that PA slowed down and partially reversed the decline in performance of activities of daily living and progression of the cognitive symptoms related to dementia, in contrast to an older study, which did not find improvements in functional ability [85]. Zschucke , E. and Gaudlitz, K.Exercise and Physical Activity in Mental Disorders: Clinical and Experimental Evidence Zschucke , E. and Gaudlitz, K. (2013) Exercise and Physical Activity in Mental Disorders: Clinical and Experimental Evidence. Journal of Preventative Medicine and Public Health  , 46 (1), p. 12-21. Available at: http://www. ncbi. nlm. nih. gov/pmc/articles/PMC3567313/ [Accessed: 6th Mar 13]. Leptin, an adipocytokine produced in the peripheral system as well as in the brain, is implicated in obesity, food intake, glucose homeostasis, and energy expenditure.Leptin expression levels and signaling pathways may also be linked to the pathophysiology of neurodegenerative diseases including Alzheimer’s disease. Epidemiological studies have demonstrated that higher circulating leptin levels are associated with lower risk of dementia including Alzheimer’s disease, and lower circulating levels of leptin have been reported in patients with Alzheimer’s disease. Leptin receptors are highly expressed in the hippocampus, a brain area involved in learning and memory and severely affected during the course of Alzheimer’s disease.In laboratory studies, several in vivo and in vitro studies have shown that leptin supplementation decreases amyloid-? (A? ) production and tau phosphorylation, two major biochemical events that play a key role in the pathogenesis of Alzheimer’s disease. In this review, we will review the structure of leptin, the type of receptors of leptin in the brain, the various biological functions attributed to this adipocytokine, the signaling pathways that govern leptin actions, and the potential role of leptin in the pathophysiology of Alzheimer’s disease.Leptin exerts its functions by binding to the leptin receptor (ObR). This binding can involve several signaling pathways including JAK/STAT pathway, ERK pathway and the PI3K/Akt/mTOR Pathway. Modulation of these pathways leads to the regulation of a multitude of functions that define the intricate involvement of leptin in various physiological tasks. In this review, we will specifically relate the potential involvement of leptin signaling in Alzheimer’s disease based on work published by several laboratories including ours.All this work points to leptin as a possible target for developing supplementation therapies for reducing the progression of Alzheimer’s disease. Leptin is a 146 amino acid protein with a molecular weight of 16 kDa encoded by the  ob   gene and primarily, but not exclusively, expressed by the white adipose tissue (WAT) and is implicated in obesity, food intake, and energy homeostasis. Leptin protein was discovered by the molecular geneticist Jeffrey Friedman in 1994 at Rockefeller University and the work was published in a landmark  Nature  paper in December 1994 [1].The human  ob  gene has been mapped to chromosome 7q31. 3 [2] and encodes a 4. 5 kb mRNA transcript that is translated into a 167 amino acid peptide and subsequently processed in the ER into the 146 amino acid mature leptin protein [1]. Antecedent to the discovery of the leptin protein and positional cloning of the  ob  gene in 1994, the  ob/ob  mouse characterized by hyperphagia and a marked obese phenotype was serendipitously discovered by animal caretakers in 1950 at Jackson Laboratories [3].It was the general consensus that the  ob/ob  mouse possessed a mutation in the  obgene, but this was not elucidated and unequivocall y established until the discovery of the leptin protein and mapping of the  ob  gene by Friedman and colleagues in 1994 who showed that the mutation resulted in the loss of leptin production. In 1966, the  db/db  mouse was discovered, again at Jackson Laboratories, which not only exhibited a similar hyperphagic, obese phenotype, but also hyperglycemia [4].Tartaglia and colleagues in 1995 showed that the  db/db  mouse phenotype can be attributed to the mutation in the  db  gene that codes for the long-form of the leptin receptor obRb [5]. However, it was the seminal work of Doug Coleman and colleagues who demonstrated by a series of parabiosis experiments using  ob/ob  mice and  db/db  mice pairs and established that the  ob/ob  mice lacked a circulating factor whereas the  db/db  mice produced the circulating factor but were not able to respond to it [6,7].The validity of these breakthroughs was affirmed by subsequent discovery of the leptin protein a nd cloning of the  ob  gene [1] as well as the cloning of the  db  gene which coded for the long-form leptin receptor obRb [5]. Further corroboration emanated from the finding that the  db  mice produced the truncated form of obRb that was incapable of transducing leptin-mediated intracellular signal transduction [8-12] and administration of exogenous leptin obviated the obese, hyperphagic, hypothermic, and hypometabolic phenotype in  ob/ob  mice [13-15]. Go to: ————————————————-Leptin – structure, expression, and secretion The crystal structure of leptin has revealed the secondary and tertiary structure of the leptin molecule. The three dimensional crystal structure of leptin depicts the presence of four antiparallel ? -helices (A, B, C, and D) [16]. Two long crossover loops connect the A-B and C-D ? -helices, while a short loop connects the B-C ? - helices [16]. The entire leptin molecule is oblong shaped with the dimensions of 20x25x45 A0[16]. The entire molecule comprising of the bundle of four ? -helical loops adopts a bilayered stratified structure with ? helices A-D in one layer contiguous with ? -helices B-C in the other layer [16]. The conformation adopted by the leptin molecule results in the surface emergence of a few key hydrophobic residues like Phe41, Phe92, Trp100, Trp138, and Leu142  which not only play an indispensable role in the regulation of solubility and aggregation kinetics of the leptin protein, but are also critically requisite for as well as modulate the binding of leptin to the leptin receptor and determine the binding kinetics of the leptin-leptin receptor interaction [16].The three dimensional four-helical bundle crystal structure of leptin exhibits an overt, conspicuous congruence with other cytokines such as growth hormone (GH) [17], leukemia inhibitory factor (LIF) [18], and G-CSF (G-colony stim ulating factor) [19], despite lack of primary sequence homology with these proteins or other proteins [1]. Leptin is expressed primarily by the white adipose tissue [1,20] and circulating leptin levels are proportional to the white adipose tissue mass [21,22]. In humans, leptin expression in the subcutaneous adipose tissue is significantly more in magnitude than omental adipose tissue [23-26].Other studies have demonstrated no difference in leptin expression between the subcutaneous and omental adipose tissue [27]. Leptin expression in humans also exhibits sexual dimorphism with circulating leptin levels about 3-fold greater in females than males [25,28,29]. It is now certain that other tissues also produce leptin, including stomach [30,31], mammary gland [32], human placenta [33], ovaries [34], heart [35], skeletal muscle [36], pituitary gland [37], and the brain [37-39]. In the brain leptin mRNA expression and immunoreactivity has been seen in the hypothalamus, cortex, dentate gyr us and the hippocampus of the rat [38,39].Leptin immunoreactivity has also been reported in the mouse and hamster brain [40]. Leptin expression and circulating leptin levels are primarily contingent on the white adipose tissue mass [21,22] and are significantly elevated in obesity [21,22,41,42]. Consistent with this observation, weight loss is associated with a decrease in leptin levels in the plasma [22]. Leptin levels in the plasma also fluctuate in an ultradian manner and exhibit diurnal rhythm [43,44]. Leptin secretion occurs in a pulsatile rhythm with ~30 pulses of leptin secretion in a 24-hour cycle [43,45].Acute caloric restriction reduces leptin levels by ~30% within 24 hours [46-48] whereas caloric excess elevates leptin levels in the plasma by ~35% within 5-8 hours [47]. Therefore, nutritional intake regulates leptin expression in an acute as well as chronic fashion. The physiological and hormonal parameters that increase leptin expression include obesity [21,22,41], overf eeding or excess caloric intake [49,50], insulin [51-55], glucocorticoids [51,52,56,57], glucose [58], tumor necrosis factor ? (TNF? ) [54,59], estradiol [60-62], and IL1 [63,64] among others.The physiological and hormonal factors that decrease leptin expression include androgens [61,65], acute caloric restriction [49,50], growth hormone [66-69], somatostatin [68,70], exposure to cold temperatures [50,71,72], ? 3  adrenergic agonists [70,73-76], long-term exercise [77,78], cAMP (51, 57), PPAR? agonists such as thizolidinediones Pioglitazone, Troglitazone, and Rosiglitazone [79], and free fatty acids [80] among others. Go to: ————————————————- Leptin receptors Leptin receptors (obR) are encoded by the  db  gene [5].The obR are transmembrane spanning proteins that transduce and mediate leptin signaling. The obR exhibit structural and functional homology to the class I cytokine receptors [81,82]. The obR along with other class I cytokine receptors are typified by the characteristic presence of four cysteine residues and a â€Å"WSXWS† motif [81,83] which are a part of multiple fibronectin Type III subdomains in their extracellular domains [84]. The obR transcript undergoes alternate splicing to generate six different receptor isoforms (obRa – ob-Rf) [11].The six isoforms of obR are distinguished by and exhibit very little homology in their intracellular domain [85]. However, all the six isoforms have the same extracellular domain of over 800 amino acids and a transmembrane domain that spans 34 amino acid residues [85]. The six isoforms of obR are pigeonholed into three different groups, namely – short form, long form, and secreted obR [85]. The short-form of obR subsuming obRa (894 amino acids), obRc (892 amino acids), obRd (901 amino acids), and obRf (896 amino acids) possess a short 30-40 amino acid residue intracellular dom ain [85]. bRb (1162 amino acids) is the only functionally active leptin receptor isoform capable of transducing leptin signaling as it contains an intracellular domain that spans ~280 amino acid residues [5]. The obRe isoform (805 amino acids) lacks the intracellular domain and is therefore classified as a secreted soluble receptor and functions as a buffering system involved in the transport of leptin and bioavailibility of free circulating leptin [86,87].The short isoforms obRa, obRc, obRd, and obRf are abundantly expressed in the choroid plexus and endothelial cells of the brain microvasculature that form the BBB and may therefore regulate the flux of leptin across the BBB [88,89]. obRb is pervasively expressed in the human and rodent brain with the highest density in the ventromedial, arcuate, and dorsomedial hypothalamic nuclei [90-93]. obRb is termed the long-form leptin receptor and is solely responsible for propagating signal transduction mechanisms initiated by leptin [5,94 ].The short forms of the leptin receptor ob-Ra, ob-Rc, obRd, and obRf are devoid of intracellular signaling motifs that are obligatory for signal transduction [5]. However the short form receptors obRa and obRc are highly expressed in the choroid plexus and it is speculated that they mediate the uptake of leptin across the BBB (88, 89). obRb expression has been reported in several regions of the rodent and human brain including the hypothalamus [90,92,93], hippocampus, brain stem (nucleus of the solitary tract and the dorsal motor nucleus of the vagus), amygdala and the substantia nigra [92,93,95,96].In the hippocampus leptin receptor immunoreactivity is observed in the CA1/ CA3 region and the dentate gyrus [95,97]. Furthermore, axonal and somato-dendritic regions and hippocampal synapses exhibit leptin receptor immunolabeling in primary hippocampal cultures [97]. Go to: ——————————————à ¢â‚¬â€Ã¢â‚¬â€- Biological and physiological functions Leptin was discovered as the endogenous hormone that precludes obesity and regulates energy homeostasis [1].Antecedent to the discovery of leptin in 1994, about two decades ago, Doug Coleman had posited the role of a circulating hormone that thwarted obesity via its action in the brain to regulate food intake and energy homeostasis and in the peripheral tissues to regulate energy catabolism, thermogenesis as well as basal metabolism [7]. This was corroborated in the mid 1990s after the discovery of leptin by studies that demonstrated in rodents that administration of exogenous leptin decreased food intake and augmented energy expenditure [13-15,98,99].Leptin administration augments energy expenditure by actuating the ? -oxidation of fatty acids in the mitochondria and also inducing the expression of enzymes involved in ? -oxidation [100]. However, the notion that high levels of leptin augment weight loss and circumvent obesity must be tempered with the fact that high endogenous leptin levels have been effete in thwarting obesity in humans and other mammals [21,22,41]. This can be ascribed to a phenomenon termed â€Å"leptin resistance† [101-103]. Leptin plays a pivotal role in the induction of puberty and fertility.Leptin reinstates puberty, restores fertility in  ob/ob  mice, escalates puberty and fosters reproductive behavior in wildtype rodents [104-107]. Leptin directly regulates the hypothalamic-pituitary-gonadal (HPG) axis by inducing gonadotropin release and modulating estradiol production in the ovarian follicles [108,109]. Leptin also regulates the hypothalamic-pituitary-adrenal (HPA) axis by attenuating corticotrophin releasing hormone (CRH) production and release [110,111] as well as directly inhibiting ACTH (adrenocorticotropic hormone)-induced glucocorticoid release from the adrenal cortex [111-113].Leptin is also integrally involved in the physiological homeostasis of the circulat ory system. Emerging evidence implicates leptin in hematopoeisis as leptin is involved in proliferation and differentiation hematopoietic precursors [114-116]. Higher plasma levels of leptin (~100ng/mL), suchas those observed in obese individuals, foster and promote platelet aggregation [117]. Leptin is also one of the most potent inducers of vascular epithelial cell growth and angiogenesis and the short forms and the long-form of the leptin receptor is abundantly expressed in the vasculature [117-119].Go to: ————————————————- Leptin function in the brain Hypothalamus Leptin signaling in the hypothalamus regulates food intake and energy homeostasis in mammals. The arcuate nucleus (ARC), dorsomedial nucleus (DMH), and the ventromedial nucleus (VMH) of the hypothalamus express the obRb in the greatest density. In the ARC, the obRb is abundantly expressed in two disparate neu ronal cell types, ones that express neuropeptide Y (NPY) and agouti-related peptide (AgRP) and the others that express pro-opiomelanocortin (POMC) [92,120-122].Leptin induced activation of the obRb in the POMC neurons results in depolarization and increased biosynthesis of ? -melanocyte-stimulating hormone (? -MSH) which signals downstream by actuating the melanocortin system comprising of melanocortin-3-receptors (MC3R) and melanocortin-4-receptors (MC4R) expressed by the second order neurons downstream to evoke an anorexiogenic (decreased appetite) response [122-127]. Activation of the melanocortin pathway not only suppresses appetite but also increases energy expenditure by increasing sympathetic tone resulting in ? oxidation of fatty acids in skeletal and adipose tissue. While leptin activates the POMC-expressing neurons, the actuation of obRb by leptin in the NPY/AgRP neurons results in the decreased genesis of NPY and AgRP peptides which are orexiogenic (increase appetite) in nature [122,128]. Therefore, in conspectus, leptin signaling in the hypothalamus results in the decreased expression of orexiogenic peptides (NPY, AgRP) and increased expression of anorexiogenic peptides (? -MSH) as well as increased energy expenditure in the adipose tissue and skeletal muscle tissue.Hippocampus Leptin receptors are abundantly expressed in the CA1 and CA3 regions of the hippocampus as well as the dentate gyrus [95,97]. Leptin regulates the excitability and firing of hippocampal neurons via the modulation of BK potassium channels [97]. Leptin also improves memory processing and retention when administered directly into the CA1 region in mice [129] and rodents that are deficient in the leptin receptor (db/db  mice and  fa/fa  rats) exhibit profound deficits in spatial learning and memory [129-131].Treatment of acute hippocampal slices with leptin results in the conversion of short-term potentiation (STP) to long term potentiation (LTP) by enhancing Ca2+  influ x through NMDA receptors [132]. Leptin increases synaptogenesis and aids in memory formation in the hippocampus and is purported to be a cognitive enhancer [133]. Leptin also increases neurogenesis in the dentate gyrus of adult mice [134]. Leptin also plays a critical role in hippocampal neuronal survival by activating the PI3K-Akt and JAK2/STAT3 signal transduction pathways [135].Leptin upregulates the expression of potent endogenous antioxidant enzyme Mn-SOD (manganese superoxide dismutase) and the anti-apoptotic protein Bcl-xL (B-cell lymphoma xL) in a STAT3-dependent manner in the hippocampus [135]. Leptin stabilizes mitochondrial membrane potential and attenuates the glutamate-induced mitigation in mitochondrial membrane potential and also extenuates the free iron-induced augmentation in mitochondrial ROS [135]. Go to: ————————————————- Leptin signalingLeptin binding to its long-form receptor obRb actuates four major signal transduction pathways that are coupled to obRb – JAK/STAT pathway, ERK pathway, PI3K/Akt/mTOR pathway, as well as the AMPK/SIRT1 signal transduction pathways. JAK/STAT pathway Leptin signaling via the obRb is integrally coupled to the JAK2/STAT3, JAK2/STAT5 and JAK2/STAT6 pathways [10]. The long-form of the leptin receptor obRb is constitutively coupled to Janus kinase 2 (JAK2) via the evolutionary conserved domains proximal to the membrane [136].The binding of leptin to obRb evokes a conformational change in the receptor that actuates JAK2 by phosphorylation at Tyr1007/1008  residues [136]. Activated phosphorylated JAK2 subsequently phosphorylates evolutionary conserved tyrosine residues of obRb [94] at Tyr985, Tyr1077  and Tyr1138  [137,138]. The obRb phosphorylated at Tyr1077  and Tyr1138  serves as a docking site and recruits Srchomology 2 (SH2)- and Src-homology 3 (SH3)-domain comprising roteins that sub sume proteins such as Signal Transducer and Activator of Transcription 3 (STAT3), Signal Transducer and Activator of Transcription 5 (STAT5), and Src homology region 2 domain-containing phosphatase 2 (SHP2) [139]. The phosphorylated Tyr1138  residue of obRb recruits STAT3 and STAT5 which are subsequently phosphorylated by JAK2 at Tyr705  and Tyr694  respectively. The phosphorylation STAT3 and STAT5 causes their disengagement from the leptin receptor, results in the dimerization of STAT proteins via their phosphotyrosine residues in the SH2 domains [140-142], and culminates in their nuclear translocation [142].In the nucleus, STAT dimers bind to distinct motifs or elements in the DNA called ? -IFN-activated site (GAS) in the enhancer regions of target genes and thereby modulate and regulate gene expression of target genes [142-146]. In the nucleus, the STAT signaling is abrogated by dephosphorylation and subsequent export of STAT proteins from the nucleus to the cytosol [142,14 4,147] or by targeted degradation of the STAT proteins via the Ubiquitin Proteasomal System (UPS) [148].The JAK/STAT pathway is negatively regulated by three classes of proteins, namely – suppressors of cytokine signaling (SOCS), protein inhibitors of activated STATs (PIAS), and protein tyrosine phosphatases (PTP) [149]. There are eight members of the SOCS family and their expression is induced by JAK/STAT signaling (STAT3 in particular) thereby suggesting the existence of a negative feedback loop that abrogates JAK/STAT signaling [150].The SOCS proteins negatively regulate the JAK/STAT pathway by competitively engaging and occupying the phosphotyrosine residues in obRb via their SH2 domains and obviating the recruitment of STAT proteins to obRb, thereby precluding STAT activation [150,151]. SOCS proteins via their SH2 domains also directly bind to JAK2 and extenuate the kinase activity of JAK2 [150,151]. The PIAS proteins negatively regulate the JAK/STAT signaling pathway by impeding the binding of STAT proteins to the response elements in the DNA by physically interacting and binding with STAT proteins via their zinc-binding RING-finger domains [151].SHP1 and SHP2 are most well characterized protein tyrosine phosphatases implicated in the negative regulation of the JAK/STAT pathway [149]. SHP1 and SHP2 possess two SH2 domains and therefore bind to phosphotyrosines of JAK2 and obRb and effectuate the dephosphorylation of JAK2 and obRb thereby terminating the JAK/STAT signaling [149]. ERK pathway The extracellular regulated kinase (ERK) pathway is an integral part of a larger signaling network called mitogen activated protein kinase (MAPK) pathway that is activated by leptin signaling via the leptin receptor (obRb).While phosphorylation of Tyr1138  and Tyr1077  are both requisite and mediate the activation of STAT3 and STAT5 respectively, the phosphorylation of Tyr985  of obRb mediates the activation of ERK pathway [138]. Leptin signaling via the obRb evokes the actuation of ERK pathway, both centrally and peripherally, as well as in  in vivo  and  in vitro  experimental paradigms [85]. Leptin evokes the activation of ERK pathway by both JAK2-mediated and JAK2-independent signaling effects [94,152].Contemporary evidence has implicated the protein tyrosine phosphatase SHP2 and the adaptor protein Grb2 (growth receptor bound 2) as the requisite mediators in the leptin-induced activation of ERK signaling pathway [153]. Leptin signaling also activates other members and signaling cascades subsumed under the MAPK signaling pathway, namely p38 [154-157] and JNK pathways [156]. PI3K/Akt/mTOR pathway Leptin signaling also induces the activation of the ubiquitous, pervasive, nutrient-sensitive anabolic, and the broad spectrum PI3K/Akt/mTOR pathway [152,158-161].Empirical evidence has demonstrated that the adaptor proteins IRS1 (insulin receptor substrate 1) and IRS2 (insulin receptor substrate 2) mediate the leptin-obRb induce d activation of PI3K-Akt pathway [94,158,162]. A multitude of studies have demonstrated that leptin induces the activation of Akt via phosphorylation of Akt at Ser473[163,164]. As a consequence, Akt activation is ensued upon leptin signaling which results in inhibition of GSK3? through phosphorylation at Ser9  residue [165-167].Evidently leptin also activates the serine/threonine kinase mammalian target of Rapamycin (mTOR) in the hypothalamus and macrophages [168,169] through the PI3K-Akt pathway [170]. mTOR is an evolutionary conserved kinase that modulates translation of several mRNA transcripts involved in cell growth and proliferation. mTOR regulates translation by phosphorylation and attenuation of the inhibitor of mRNA translation, eukaryotic initiation factor 4E-binding protein (4E-BP) [171-175], as well as through the phosphorylation and activation of S6 kinase (p70S6K1) [176,177]. TOR is autophosphorylated at Ser2481  and exhibits spontaneous intrinsic kinase activity u nder the activation of Akt [178,179]. mTOR phosphorylation and activation is negatively regulated by the TSC1/TSC2 protein complex [170]. Akt phosphorylates TSC2 causing disintegration of the TSC1/TSC2 complex which consequently results in mTOR activation [180]. Furthermore, Akt has been shown to directly phosphorylate mTOR at Ser2448residues and consequently activate mTOR [181,182].Therefore, Akt positively regulates mTOR activation by direct phosphorylation at Ser2448  as well as by indirect means which involves relieving the repressive effects of the upstream inhibitor TSC1/2 complex. Thus leptin, by virtue of its inherent ability to activate Akt, is expected to increase mTOR phosphorylation and activity. AMPK-SIRT1 pathway The 5’AMP activated protein kinase (AMPK) is the master regulatory kinase termed the â€Å"fuel gauge† that integrates signals from upstream mediators and effectors of hormones and cytokines to maintain metabolic homeostasis [183].AMPK activati on leads to increase ? -oxidation of fatty acids in the mitochondria and inhibition of lipogenesis [184,185]. Multiple lines of evidence have cogently demonstrated that leptin activates AMPK and consequently increases fatty acid oxidation [186-188]. One exception to this is the hypothalamic neurons, where leptin inhibits AMPK activation to evoke satiety and other hypothalamic effects of leptin [189-191]. In general, AMPK plays a catabolic role and engenders energy production via effects on glucose and lipid metabolism.AMPK activation also effectuates the induction of the NAD+  Ã¢â‚¬â€œ dependent deacetylase SIRT1 (silent mating type information regulation 2 homolog) [192,193], a metabolic master regulator unequivocally implicated in ageing and the regulation of lifespan [194-198] as well as regulating metabolism [199,200]. The anorexic effect of leptin mediated by the activation of POMC neurons in the hypothalamus is contingent on SIRT1 expression and activation in the neurons of the arcuate nucleus of the hypothalamus [201]. Go to: ————————————————- Role of leptin in Alzheimer diseaseAlzheimer Disease (AD) is a progressive, debilitating and the most prevalent neurodegenerative disorder typified by memory impairment and cognitive dysfunction eventually leading to fatality. The gross pathologic hallmarks of autopsied brains of patients with AD include atrophy with widened sulci and narrowed gyri in the temporal, parietal, and frontal lobes as well as the neocortex and cingulated gyrus areas of the cerebral cortex. The entorhinal cortex, amygdala, hippocampus and the para-hippocampal gyrus also exhibit pronounced atrophy due to neuronal loss [202,203].There is a decrease in gross weight of brain by 10-15% in AD patients [202]. The thickness of the six cortical layers (cortical ribbon) is usually reduced by 10-20% in AD [202] and ventricular dilation is apparent prominently in the temporal horn as a consequence of the atrophy of the amygdala and the hippocampus. Furthermore, there is a propensity for the loss of larger neurons than the loss of smaller neurons or glial cells in AD [202]. Microscopically, AD is characterized by two most common and distinct â€Å"hallmark† microscopic lesions namely senile plaques and neurofibrillary tangles (NFT).Senile plaques are extraneuronal deposits of accumulated and aggregated amyloid-? (A? ) protein in the brain parenchyma, while the NFT are intraneuronal aggregates of protein tau in the hyperphosphorylated state. Other pathological features of the AD brain include synaptic loss, neuronal and dendritic loss, neuropil threads, granulovacuolar degeneration, dystrophic neurites, Hirano bodies, and cerebrovascular amyloid deposition. There is substantial evidence that leptin modulates A? production and metabolism. Chronic peripheral leptin administration in Tg2576 mice has been reported to reduce the brain A? evels [204]. Moreover leptin also decreases the BACE1 activity in SH-SY5Y cell line [204]. Leptin decreases tau phosphorylation explicitly at residues Ser202, Ser396, and Ser404  in retinoic acidinduced differentiated SH-SY5Y cells, differentiated human NT2 cells (NT2N), and rat primary cortical neurons [205-207]. Leptin also increases synaptogenesis and aids in memory formation in the hippocampus and is purported to be a cognitive enhancer [133]. Leptin has been shown to convert STP into LTP in hippocampal cultures and hippocampal slices [132].Recent evidence suggests that leptin facilitates spatial learning and memory [130] and also increases neurogenesis in the dentate gyrus of adult mice [134]. Recent epidemiological studies have also unequivocally implicated decreased leptin levels in the pathogenesis of AD. In the Framingham prospective study, 785 subjects were followed between 1990 and 1994 from the original Framingham cohort [208]. The study conclud ed that leptin levels were inversely related to the risk of developing dementia of the Alzheimer type [208].A year preceding the findings of Lieb and colleagues, a morphometric study in Japan conducted by Narita and group found higher leptin levels were positively correlated with higher hippocampal volumes [209]. Leptin decreases Amyloid-? (A? ) levels by attenuating the genesis and augmenting the clearance of the peptide The A? peptide is derived from a two-step successive proteolytic cleavage of Amyloid-? precursor protein (A? PP) [210]. In the first step, A? PP is cleaved by the membrane-bound protease BACE1 (? -site APP cleaving enzyme 1) (also called ? secretase) to generate CTF? (carboxy terminal fragment ? ) (also known as C99 fragment) [211-215] which in the second step is subsequently cleaved by the ? -secretase complex to generate A? peptide [216-218]. According to the â€Å"amyloid cascade hypothesis†, A? is considered as the culpable factor in the instigation and progression of all the neurodegenerative events that characterize AD [219]. A plethora of studies have demonstrated that leptin decreases A? levels in several  in vivo  and  in vitro  paradigms [204,220-223]. Leptin has been shown to mitigate A? roduction by extenuating BACE1 activity in neural cultures [204]. Recent studies have implicated the AMPK/SIRT1 pathway in the leptin-induced modulation of A? levels [222]. Emerging data from our unpublished work has not only corroborated the finding that leptin regulates A? metabolism via SIRT1, but also implicated the ubiquitous transcription factor NF-? B as a SIRT1 target downstream in the modulation of A? genesis (unpublished). Leptin decreases A? levels by targeting all facets of A? metabolism, namely – production, clearance, and degradation.We have shown that leptin increases the expression levels of insulin degrading enzyme (IDE) putatively by activating the Akt pathway [223], thus augmenting the degradation of A?. Fur thermore, leptin also increases the expression levels of LRP1 [223], suggesting that leptin may foster the uptake of A? by astrocytes and microglia or reuptake of A? by neurons and therefore target A? for intracellular degradation or for clearance across the blood-brain-barrier (BBB). Leptin also effectuates the ApoE-mediated clearance of A? [204].Specifically, leptin dose-dependently increased the LRP1-mediated uptake of ApoE-bound A? , therefore committing A? toward the endosomal/lysosomal degradation pathway [204]. Leptin attenuates BACE1 expression and activity The first line of evidence linking leptin signaling dyshomeostasis in the pathogenesis of Alzheimer disease emanated from the work of Tezapsidis and colleagues [204], who demonstrated in neural cultures from transgenic mice that leptin mitigates BACE1 activity by evoking changes in lipid composition of lipid rafts of cell membranes.Furthermore, the study also demonstrated that the lipolytic ability of leptin as a conseque nce of increased ? -oxidation of fatty acids and decrease  de novo  synthesis of fatty acids and triglycerides underlies the mechanistic link between the effects of leptin on lipid composition of membranes and BACE1 activity. Recent data from our studies [223] and other laboratories [221] cogently demonstrate that leptin negatively regulates BACE1 expression, both  in vitroand  in vitro  paradigms.Moreover, Greco and colleagues have attributed this effect of reduced BACE1 expression on the ability of leptin to induce PPAR? expression and activation [221]. Indeed, leptin is a well characterized inducer of PPAR? expression and activity [220,224]. In light of this, it is important to reiterate that multiple lines of evidence exist in current literature demonstrating the role of PPAR? as a negative regulator of BACE1 expression [225]. Another mediator of leptin induced modulation of BACE1 expression may be the transcription factor STAT3.The BACE1 promoter contains a multitude of STAT3 binding sites [226]. Multiple lines of evidence have implicated STAT3 in the regulation of BACE1 expression [226-228]. Leptin may also modulate BACE1 activity via the activation of the PI3K/Akt and ERK signaling pathways [229]. BACE1 expression is also modulated by the master transcription factor NF-? B [230]. We have found that leptin represses NF-? B transcriptional activity via induction of SIRT1 expression and activity and thereby attenuates BACE1 expression (unpublished).Furthermore, inhibition of SIRT1 activity significantly compromised the mitigating effect of leptin on BACE1 expression (unpublished). Therefore, the entire range of discrete signal transduction pathways activated by leptin may be implicated in the modulation of BACE1 expression. Leptin mitigates tau phosphorylation It is now the consensus that tau hyperphosphorylation precedes and leads to PHF formation in NFT [231] and aberrant tau hyperphosphorylation is implicated in neurodegeneration in AD [232-23 6].Recent studies by Tezapsidis and colleagues as well as our work has cogently demonstrated that leptin decreases hyperphosphorylation of tau, primarily by the activation of known canonical signal transduction pathway coupled to leptin receptors. Firstly, Greco  et al. demonstrated  in vitro, in SH-SY5Y and NTera-2 human neuronal cell lines, that leptin reduces the phosphorylation of tau at Ser202, Ser396, and Ser404  residues [205]. In the same study, it was shown that leptin was ~300-fold more potent than insulin at mitigating tau phosphorylation and the activation of AMPK pathway was implicated in mediating this effect [205].The following year, the same group systematically investigated the involvement of other signal transduction pathways activated by leptin that may contribute to the attenuation of tau phosphorylation and concluded that leptin-induced activation of Akt, p38 MAPK, as well as AMPK were all intricately involved [206]. Notably, of great mechanistic importanc e, was the revelation that all the three aforementioned pathways activated by leptin, culminated in the phosphorylation of the tau kinase GSK3? at Ser9  residue leading to the inhibition of its kinase activity.Therefore, leptin-induced activation of Akt, p38 MAPK, and AMPK signal transduction pathways converged at the focal point – GSK3? , a bona fide tau kinase [206,207]. Data from our studies carried out in organotypic slices from the hippocampi of adult rabbits has also cogently demonstrated that leptin inhibits GSK3? -induced tau phosphorylation at AT8 (Ser202, Thr205) and PHF1 (Ser396, Ser404) epitopes via the activation of Akt [223,237]. Of greater importance and relevance, was the finding that 8-weeks of leptin treatment in CRND8 transgenic mice resulted in a ~2-fold decrease in tau phosphorylation at AT8 and PHF1 epitopes [221].Leptin fosters synaptogenesis and synaptic plasticity Several studies have shown that synaptic dysfunction and synaptic loss are the cardina l hallmarks of incipient AD [238-244]. Electron microscopy [238,241,245-248], immunohistochemical and biochemical studies [240,249-251] have demonstrated that synaptic loss in the neocortex and the hippocampus is an early episode in Alzheimer’s disease [252,253]. Synaptic loss is also the most important structural correlate of cognitive impairment in AD [250,254-260]. Synaptic dysfunction can be detected in patients diagnosed ith mild cognitive impairment (MCI), a condition which may or may not progress to AD and characterized by many as a prodromal state of AD [247,261]. Leptin plays an indispensable role in learning, memory, and maintenance of synaptic plasticity [262]. Leptin receptor mutant  db/db  mice and  fa/fa  rats have deficits in spatial memory and inadequate short term memory processing as assessed by the Morris water maze [130] and T-maze footshock avoidance test paradigms [129]. In the CA1 region of the hippocampus, leptin exclusively enhances the NMDA r eceptor-mediated synaptic transmission [132].Leptin facilitates the trafficking of NMDA receptors to the plasma membrane and this may contribute to the effect of leptin on enhancing the NMDA receptor-mediated current [133]. This was also corroborated in a  Xenopus  oocyte model system expressing recombinant NMDA receptors [132]. Leptin evokes the conversion of STP to LTP in acute hippocampal slices. Further delving into the molecular mechanism underlying this effect has implicated the PI3K/Akt and ERK signaling cascades at the nexus as the inhibitors of these signaling pathways mitigated this effect of leptin [132].Furthermore, in the CA1 region of the hippocampus, leptin also fosters the induction of a novel form of LTD and this effect was attributed to NMDA receptor activation [263]. The study by Durakoglugil also examined the signal transduction cascades involved in the induction of this novel LTD by leptin and concluded that this effect was contingent on the PI3K signaling c ascade, but independent of the ERK signaling pathway [263]. In addition to regulating synaptic strength by modulation of LTP and LTD, leptin also fosters synaptogenesis.The leptin deficient  ob/ob  mice have decreased synapse density and exogenous leptin corrects this deficit in these mice [264,265]. Leptin also induces the expression of a multitude of pre- and postsynaptic proteins such as synapsin2A and synaptophysin in the hippocampus [266]. Leptin also has a profound effect on dendritic morphology. Leptin augments filopodial stabilization, fosters mobility and boosts their density, thus promoting synapse formation [267]. Interestingly, this effect of leptin on filopodial stability and density is contingent on ERK signaling pathway and not on the PI3K signaling pathway [267].Leptin increases neuronal survival and mitigates cell death There is growing consensus that leptin is a growth and survival factor in the CNS. Leptin increases the viability of SH-SY5Y cells and suppresse s apoptosis by down-regulation of caspase-10 and TRAIL and this effect is contingent on the ability of leptin to activate the JAK-STAT, PI3K-Akt, as well as ERK signaling pathways [268]. Leptin has been shown to exert neuroprotective properties in cultured MN9D rat dopaminergic cells against 6-OHDA.Leptin also averted the 6-OHDA-induced dopaminergic cell loss in the substantia nigra of mice when administered intracranially [269]. This pro-survival effect of leptin on dopaminergic neurons was attributed to the JAK2-dependent activation of the ERK signaling pathway resulting in increased levels of survival factors p-CREB and BDNF [269]. Our recent work has unequivocally demonstrated that leptin upregulates the expression of Insulin-like Growth Factor – 1 (IGF-1), a known neurotrophic and survival factor in the brain [270].Leptin has also been shown to attenuate apoptotic cell death of cultured cortical neurons in an  in vitro  oxygen-glucose deprivation model of global isch emia [271]. Furthermore, the study by Zhang  et al. , also cogently showed that intraperitoneal administration of leptin in mice reduced the infarct volume and significantly improved behavioral parameters in a middle cerebral artery occlusion (MCAO) model of global ischemia [271]. This effect of leptin was attributed to the activation of ERK signaling pathway as the general inhibitor of ERK signaling abolished this effect of leptin, both  in vitro  and  in vivo  [271].Another study employing hippocampal cultures has demonstrated that leptin inhibits neuronal cell loss in response to growth factor withdrawal and oxidative insult by evoking JAK-STAT activation leading to enhanced expression Mn-SOD and Bcl-xL and stabilizing the mitochondrial membrane potential [135]. Leptin also mitigated neuronal loss in response to excitotoxic insult evoked by glutamate in hippocampal cultures by the aforementioned molecular mechanism [135]. Leptin also protected the hippocampal neurons fr om kainite-induced damage in response to excitotoxicity evoked seizures in a mice model of temporal lobe epilepsy [135].A recent study found that leptin also attenuates MPP+-induced cell death in neuronal cultures via the activation of STAT3 and inducing the expression of UCP-2 that culminates in the obviation of mitochondrial dysfunction by MPP+  [272]. Of particular interest is the finding that cultured cortical neurons secrete prodigious amounts of leptin in response to oxygen-glucose-serum deprivation that results in enhanced expression of IL-1? and increased intransigence to apoptotic cell death [273].Moreover, neutralization of this endogenous leptin with an antibody resulted in increased susceptibility of these cultured cortical neurons to oxygen-glucose-serum deprivation – induced cell death [273]. The salutary effects of leptin on neuronal viability and function have also been corroborated by electrophysiological studies. One such study has cogently demonstrated th at leptin combats the hypoxia-induced inhibition of spontaneously firing hippocampal neurons by activating the BK channels (large conductance Ca2+  activated K+  channels) [274].Leptin induces proliferation of neuronal progenitors – evokes neurogenesis As Alzheimer disease is typified with selective neuronal loss in the hippocampus and other regions of the brain, the debunking of the dogma that neurogenesis occurs exclusively prenatally and the revelation that neurogenesis persists in the adult mammalian brain has opened novel therapeutic avenues to combat the neuronal loss in AD. Chronic leptin treatment increases hippocampal neurogenesis in mice and induces proliferation of adult hippocampal progenitor cultures [134].This effect of leptin on adult hippocampal neurogenesis is attributed to increased cell proliferation in the dentate gyrus and not enhanced cell differentiation or cell survival [134]. The study by Garza and colleagues unequivocally implicated the JAK2-STAT 3 and PI3K-Akt signal transduction pathways in the leptin induced enhancement of hippocampal neurogenesis [134]. Furthermore, leptin rescues the attenuation in adult hippocampal neurogenesis in a mouse model of chronic unpredictable stress-evoked depression via the inhibition of GSK3? nd subsequent stabilization of ? -catenin [275]. Leptin has also been documented to evoke neurogenesis and angiogenesis in a mouse stroke model (Avraham  et al. , 2011). Go to: ————————————————- Conclusion Here we have reviewed the contemporary knowledge on the protective role of the adipokine leptin and its signaling in Alzheimer’s disease. In conspectus, leptin impinges on all facets of Alzheimer’s disease pathophysiology (Figure 1). These attributes of leptin such as the decrease in A? production and increase of A? learance, reduction in tau hyperphosphorylation as well as increased synaptogenesis, increased memory, increased spatial learning, and increased neurogenesis catapult leptin treatment as a unique therapeutic intervention and an indispensable tool in the elucidation of biochemical mechanisms involved in the etiology of the sporadic form of Alzheimer’s disease. Marwarha , G. and Ghribi, O. Leptin signaling and Alzheimer’s disease Marwarha , G. and Ghribi, O. (2012) Leptin signaling and Alzheimer’s disease. American Journal of Neurodegenerative Disease, 1 (3), p. 45-265. Lifestyle nonpharmacological interventions can have a deep effect on cognitive aging. We have reviewed the available literature on the effectiveness of physical activity, intellectual stimulation, and socialization on the incidence of dementia and on the course of dementia itself. Even though physical activity appears to be beneficial in both delaying dementia onset and in the course of the disease, more research is needed before intellectual stimulation a nd socialization can be considered as treatments and prevention of the disease.Through our paper, we found that all three nonpharmacological treatments provide benefits to cognition and overall well-being in patients with age-related cognitive impairments. These interventions may be beneficial in the management of dementia. Alzheimer's disease (AD) is a neurodegenerative disorder with devastating consequences [1]. Despite being the most common cause of dementia, affecting approximately 5. 4 million Americans [2] and almost 50% of people over the age 85 [3], no cure has yet been discovered.Efforts are also focusing on the development of more effective strategies to slow the progression of AD to increase the quality of life of those affected. Even a two-year delay in disease onset would reduce the prevalence of AD among Americans by two million people within fifty years [4]. If an intervention that delayed the onset of AD by five years had been applied back in 1997, we would have seen a 50% reduction in AD incidence [4]. Research on strategies to slow the development and progression of AD is arguably more important now than ever before, since the number of people with AD is expected to nearly triple over he next forty years [4], and dementia is the most important contributor to disability in the elderly [5]. Among others, three nonpharmacological interventions are particularly relevant as they might positively influence cognition, general functioning, and overall quality of life. These three strategies arephysical exercise,  intellectual stimulation,  and  social interaction. While there are studies that evaluate the role of individual and multimodal interventions on AD, there is a lack of literature on the combination of all three.The purpose of this paper is to review key areas of the literature that focus on the effects of physical exercise, intellectual stimulation, and socialization strategies on AD evolution, as they collectively play an important ro le in the management of Alzheimer's disease. Physical exercise encapsulates both aerobic exercises (e. g. , walking and cycling) and nonaerobic exercises (e. g. , strength and resistance training; flexibility and balance exercises). For intellectual stimulation, we examine studies that have evaluated the prognostic effects of either cognitive hobbies (e. g. reading, word puzzles, and card games) or cognitive training (e. g. , computer training games/paradigms that target specific cognitive domains such as memory and attention). Social interaction is defined as the participation of an AD patient in group-related activities, such as mealtime conversations, support groups, or other forms of social engagement. The health benefits attributed to physical activity are numerous and well known. Exercise has been associated with a lower incidence in many chronic diseases, such as coronary heart disease [6], type 2 diabetes [7], obesity [8], cancer [9], bone loss [10], and high blood pressure [11].We have reviewed the effects of physical exercise on cognition. Higher cardiorespiratory fitness has been related to higher scores on tests of cognitive function [12]. A meta-analysis of randomized controlled trials examining the relationship between exercise and cognition showed modest improvements in attention, processing speed, executive function, and memory among older adults in the treatment arms [13]. This is highly relevant for the elderly population, as it suggests that physical activity can serve as a preventative measure against age-related cognitive decline [14].Several large longitudinal studies followed older adults without cognitive impairments at baseline and measured rate of incident dementia to clarify the relationship between physical activity and incident cognitive loss. A large prospective study by Podewils et al. identified an inverse relationship between physical activity and dementia risk [15]. Compared to no exercise, physical activity has been linked wi th reduced risks of developing cognitive impairment and dementia [16] with the risk for dementia being further reduced with increasing levels of physical activity.Larson and colleagues found that persons who exercised three or more times per week had a reduced risk of developing dementia compared to those who exercised less, and the reduction was more marked among those with the poorest physical function at baseline [17]. These results were corroborated by Buchman et al. who found that participants in the lowest percentiles of physical activity had more than twice the risk of developing dementia than those in the highest percentiles of physical activity [18].Furthermore, Lautenschlager et al. demonstrated that these results might be transferable to adults with mild cognitive impairment (MCI), and, thus, at high risk for dementia; participants who underwent exercise training showed modest improvements in cognition after six months [19]. Physical exercise has, therefore, been recommen ded as a preventative measure of mild cognitive impairment and dementia [20,  21]. There is much less research focusing on the effect of physical activity in AD patients.This may be due to the challenges of implementing an exercise regime while managing the behavioral and emotional disturbances in AD patients, particularly in the later stages of the disease. However, the results in the available literature are promising. Early research involving AD patients in nonrandomized controlled trials showed significant cognitive improvements among participants who underwent cycling training and somatic and isotonic-relaxation exercises [22,  23]. Physical exercise may have beneficial effects in AD patients beyond cognition as well.A meta-analysis on 30 randomized controlled trials that employed exercise, behavioral and environmental manipulations in patients with cognitive impairment found exercise had positive effects on strength and cardiovascular fitness in addition to improvements in behavior and cognition [24–26]. Further evidence supporting multifaceted positive effects of exercise on AD can be traced to recent randomized controlled trials of physical exercise regimes on AD patients (Table 1). Compared to controls, patients in the intervention programs showed better physical functioning (functional reach, walking, and mobility).After treatment, these patients also showed improved performance of activities of daily living (ADLs), and less cognitive decline and cognitive improvement in some cases. Physical exercise, therefore, appears to be beneficial for AD patients. While the majority of the studies did not find any differences in depression, one study by Steinberg found increased depression and decreased quality of life in patients who underwent the exercise intervention [31]. Further research into the effect of physical exercise on mood and quality of life in AD patients is, therefore, required.When considering the role of exercise on AD, it is impor tant to note that any positive results may be due to a placebo effect, even in randomized controlled trials. However, due to the varied nature of the outcome measures used in these studies, it is unlikely that every intervention group demonstrated significant gains over the controls due to a placebo effect alone. Furthermore, control group members never appeared to show any improvement and often showed higher rates of functional and cognitive decline.Enhanced neuroplasticity might be underlying the improvements seen. Colcombe and colleagues demonstrated that older adults without dementia who performed aerobic exercises had greater grey and white matter volumes compared to adults who engaged in stretching and toning exercises [38]. Exercise has also been associated with functional connectivity between brain networks often affected by age, such as the default mode, frontal parietal, and frontal executive networks, in older adults without dementia [39].While randomized controlled trial s in AD patients examining the relationship between neuroplasticity and exercise are underway, correlational studies examining brain volumes and cardiorespiratory fitness have been done. In AD patients, cardiorespiratory fitness has been associated with brain volume. VO2peak, peak oxygen consumption, has been positively correlated with greater whole brain volume and white matter volume [40], notably in the inferior parietal lobule, hippocampal, and parahippocampal regions [41].Future results of randomized controlled trials will improve our knowledge in this field of research. Overall, physical activity offers promising outcomes for cognition and physical health in the elderly population and AD patients. Engagement in intellectually stimulating activities has been linked with reduced risk of developing AD and intellectual stimulation has been widely explored as a nonpharmacological treatment option for dementia [42]. Among cognitively ormal older persons, randomized control trials em ploying intellectual training concluded that cognitive interventions produce protective and potentially long lasting positive effects in various cognitive domains as well as activities of daily living [43]. There is also evidence that frequent engagement in hobbies, including reading, puzzles, and games, for at least six hours per week reduces the risk of incident dementia [44]. The concept of intellectual stimulation as a preventative measure for dementia in healthy older adults can be parallel to the notion of building a â€Å"compensatory mechanism† or â€Å"cognitive reserve† [45–48].Cognitive reserve refers to the hypothesis that individual differences shaped by inherent characteristics and external sources including intelligence, years of education, occupation, and intellectual activities, may provide neural protective support against dementia [45–47]. It has been argued that these collective life experiences may contribute to building cognitive res erve and, thus, provide skills to compensate for AD pathology [45–47].In other words, a greater cognitive reserve might delay the appearance of dementia despite the presence of neuropathology, after which a rapid progression of cognitive decline may ensue once pathology is significant enough to result in AD diagnosis. Thus, AD patients with higher education and occupation accomplishments suffer more rapid decline in cognitive abilities when compared to AD patients with less education and occupational attainment following diagnosis [49]. Another study by Helzner and colleagues [50] investigated the relationship between premorbid leisure activity and rate of cognitive decline in AD patients.Leisure activities were classified into four categories: intellectual, social, physical, and other. Higher-frequency participation in intellectual leisure activities prior to AD diagnosis was associated with delayed AD onset followed by faster cognitive decline. The study by Helzner and coll eagues [50] provides evidence for the benefits of intellectual stimulation on slowing down AD development. Besides reducing the risk of dementia, cognitive interventions later in life may affect functional decline in AD.Treiber and colleagues [51] explored the association between engaging in cognitively stimulating activities in late life and the rate of cognitive decline in incident AD. This study included a wide range of intellectual activities that required varying levels of cognitive demand, for example, completing puzzles, reading, watching television, listening to music, and cooking. The results suggested that higher-frequency participation in stimulating activities in early stages of dementia resulted in slower cognitive decline.However, as time progressed there was an overall decrease in participation in activities, which might reflect the nature of AD in terms of functional abilities. Intellectual stimulation can be divided into several categories including cognitive stimul ation, cognitive t