Robots in hospitality and tourism

Introduction

Technology has become a major factor in how organizations operate. Companies that operate in the travel and hospitality industry have adopted various forms of technology including robots and artificial intelligence as part of their daily operations. Hotels for instance use computer technology to handle even the most basic of tasks such as guest logins. Some departments in the hospitality industry have fully automated systems that do not require human operations. Since technology is often used as a substitute for human workforce, its incorporation in the hospitality industry has raised the question whether technology will create a future where robots take up most, if not all of the jobs currently occupied by human beings. While technology has its advantages over a human led workforce, there is enough evidence to suggest that technology will in no way replace human beings in the hospitality industry.

What is a robot?

            A robot is by simple definition, a machine which is built to perform tasks or carry out specific actions automatically. Although there are some forms of robots that have been designed to take on the appearance of human beings, most robots are designed in shapes that best suit their intended purpose (Gretzel et al, 2016). The different types of robots vary but most can be classified as either semi-autonomous or fully autonomous. Although robots in both categories are designed to perform specific tasks, semi-autonomous robots require some form of human operation in order to fully complete their tasks. Autonomous robots on the other hand can operate on their own and carry out their functions without human operation (Gretzel et al, 2016). The robots are able to carry out their functions through programs such as speech recognition technology and the more advanced robots using artificial intelligence to discern what course of action to take in order to accomplish their tasks.

Artificial Intelligence

            The incorporation of robotics in hospitality is greatly as a result of artificial intelligence. Artificial intelligence however refers to a broader scope of advanced technology as it is often used in reference to advanced technological functions that copy human cognitive functions (Drexler & Lapre, 2019). Although there are advanced forms of artificial intelligence, functions engaged by simple forms of technology such as solving problems, understanding human needs, autonomous navigation and reasoning are also forms of basic artificial intelligence. Robotics in the hospitality industry often possess basic forms of artificial intelligence and this has greatly contributed to their prominence in the hospitality industry.

Robotics in hospitality and tourism and predictions of the future

            The recent trend in customer experience towards automated and self service has greatly contributed to the use of robots in the hospitality industry. Most hotel and travel organizations have opted for robots because of the improvements in operations they cause such as improving quality of production, improved speed and cost reduction (Drexler & Lapre, 2019). A good example of how robots have been incorporated in the hospitality industry is the Chatbots that are commonly used in the hotel industry. The chatbots operate on a 24-hour basis and are online to assist customers even during hours when human staff are unavailable (Haddad, 2020). The use of chatbots and robots during check-ins helps the hotel speed up check-ins even during peak hours.

            Another example of how robots and technology have been incorporated in the hospitality industry is through the Internet of Things. The internet has been incorporated in daily operations that hotels engage in. through the internet, technology such as robots used in hotels are programmed to perform basic functions such as turning on the thermostat (Haddad, 2020). Basic tasks that required human interaction have been automated to a point where hotels perform basic functions without interrupting the guest’s stay. Hotels can be programmed to adjust lighting and even draw curtains depending on changes in the weather. This ensures that the guests’ needs are attended to even without human interaction.

            Robots in the hospitality industry are also used to update guests and answer questions that they may have regarding the hotel. The Hilton hotel for instance had a robot by the name Connie that served as a concierge for the hotel. The robot operated using artificial intelligence and was able to interact with guests and answer questions (Berezina et al, 2019). The robot had also been programmed to recognise people using their speech patterns and could remember guests and refer to them by name. The robot could also adapt to different forms of interaction and continued improving to become better at interacting and responding to questions. The advantage of using the robot over human employees is mainly because of the robot’s ability to store information. Information about the hotel simply need to be fed to the robot in form of data (Berezina et al, 2019). The robot could then retrieve the information and answer any questions that the guests may have. While human beings were prone to forgetting, data stored by a robot could easily be accessed and this gave it an advantage over a human workforce.

Robots have also been incorporated in accessories associated with hospitality as is the case with Travelmate, a robot suitcase. The robot is an autonomous suitcase that follows the owner and relies on anti-collision technology and has 360 degree turning capabilities designed to help the suitcase avoid colliding into other objects and people (Ivanov, 2019). The technology incorporated into the suitcase ensures that the luggage arrives safely without the owner having to push or move it to the intended destination.  Similar to other forms of robots used in the hospitality industry, the robot suitcase seeks to ease work for the client and make travel as convenient as possible.

• Future Implications

            The use of robots could have positive outcomes when successfully incorporated in the hospitality industry.

• Check-ins and check-outs

Most hotels have the option of both humans or robots handling guest check-ins and check-outs. The robots are favoured because they operate during late hours without fatigue. They also keep records and can easily recall guest information compared to human staff who were prone to making errors and delays (Haddad, 2020). The robots also offer some form of privacy to clients who prefer to avoid human interaction or prefer to keep their whereabouts private.

• Better personalization

A guest’s hotel experience is greatly influenced by the interaction with the members of staff. Although human employees are able to interact with guest and pick up on their attitudes in order to determine what approach to take when serving them, robots tend to have an added advantage (Gretzel et al, 2017). Despite being unable to smile or read emotions, robots remember small details like names, type of towel preferred, what temperature the guest prefers the room in and even what channels to switch the television to. When attending to regular customers, the robots can recall details like what colour wine the guest prefers and when the guest sets the alarm. The robot can take on various responsibilities all designed to ensure that the guest enjoys their stay. Since the robots operate on the same network, the information can be relayed to different departments ensuring that the guest receives the same customised treatment throughout the stay.

• Advantages over human staff

Robots are likely to continue to have advantages over human beings especially with the various advancements in technology. At present, robots are already performing better than human employees when it comes to accuracy and consistency. Hotels are able to reduce losses caused by human errors and this has greatly improved the quality of services offered (Berezina et al, 2019). Although the tendency for hotels to use robots over human beings has raised concern that robots could create an employment crisis, human beings are still a crucial part of the hospitality industry and are far from being replaced by robots.

Criticism and concerns.

The advantages that could be reaped from the inclusion of robots in the hospitality industry are watered down by the fears that people have especially concerning employment. While robots do have some advantages over human labour, a hotel run solely by robots is likely to have the same mistakes and challenges experienced by hotels with human employees. One of the fears sparked is that robots could replace human beings especially in the reception department (Hofacker et al, 2016). While robots appear appealing especially when used to answer guest questions, the software operating such robots can only accommodate limited information. The software needed to have a robot equipped with vast information and in multiple languages would bee too expensive a hustle for hotels. As such, robots will continue to serve at receptions but mostly as substitutes or assistants for human employees.

            Another concern had to do with robots replacing human employees because the machines are less prone to mistakes. Robots operate under programs that dictate what course of action to take. Since there is a set of directives guiding what the robot does, mistakes are avoided and this makes them more effective than human employees. While it is true that robots do not stray from the directives issued, mistakes when keying in information could result in mistakes occurring (Draxler & Lapre, 2019). A good example is the case where a robot misreads snoring as input from the client prompting it to wake the guest up or perform some form of command. The robot can choose to act on the command from the guest even without the guest’s knowledge. Guests who speak in their sleep could also instruct robots attending to their rooms without their knowledge. Since the robot has no ability to discern the information in order to determine the guest is asleep, the robot could proceed to carry out the command and result in the guest incurring more expenses or even harm.

Conclusion

            The popularity of robots in the hospitality industry is greatly as a result of the benefits that the technology offers. The robots, although beneficial, are in no way a replacement for the role that human beings play in the industry. The robots are more of a tool to help employees perform their duties better. Although there is likely to be a reduction in the number of employees hired to perform specific duties, more opportunities will be created. Engineers and maintenance work will get a boost in the hospitality industry as people are hired to operate and maintain the robots. While service jobs may be affected in some way, the incorporation of robots will create an environment where the workforce in the hospitality industry is divided between human employees and robots but both working together to offer an even better customer experience.

References

Berezina K, Gretzel U, Ivanov H and Sigala M. (2019) “Progress on robotics in hospitality           and tourism: a review of the literature” Journal of Hospitality and Tourism         Management, retrieved from,             https://www.researchgate.net/publication/331152802_Progress_on_robotics_in_hospit            ality_and_tourism_a_review_of_the_literature

Gretzel U, Hofacker C and Murphy J, (2017) “Dawning of the age of robots in hospitality and      tourism: Challenges for teaching and research” Research Gate, retrieved from,             https://www.researchgate.net/publication/316188457_Dawning_of_the_age_of_robot            s_in_hospitality_and_tourism_Challenges_for_teaching_and_research

Haddad S, (2020) “Inside the hotel run by robots” Raconteur, retrieved from,             https://www.raconteur.net/technology/robot-hotel-ai

Hofacker F, Gretzel U and Murphy J. (2016) “Robots in hospitality and tourism: A research         agenda” The Australian School of Management, retrieved from,   http://agrilife.org/ertr/files/2016/12/RN107.pdf

Ivanov, S.Y. (2019). Ultimate Transformation: How Will Automation Technologies Disrupt         the Travel, Tourism and Hospitality Industries? Robotics eJournal.

Nadine Drexler & Viyella Beckman Lapré (2019) For better or for worse: Shaping the      hospitality industry through robotics and artificial intelligence, Research in        Hospitality Management, 9:2, 117-120, DOI: 10.1080/22243534.2019.1689701

Oral and Interpersonal Communication

Speech Outline Template

Topic: The impact of music on our mental health.

General Purpose: The effects, benefits, pros and cons of music on mental health.

Specific Purpose: The significance of music on our mental health.

Thesis: Music promotes physical rejuvenation, helps to manage stress, enhances communication, improves memory, relieves pain and helps to express feelings.

INTRODUCTION

1. Attention getter (No matter what culture, race, or ethnicity that we belong to, we all love music. Musicis a form of art and cultural activity whose medium is sound. Music is itself healing that touches and speaks to everyone reducing depression and pain. It is entertaining and has the impact of making us healthier. Music is a kind of therapy that triggers our emotions and has a deep connection to.)
2. Thesis statement (Music promotes physical rejuvenation, helps to manage stress, enhances communication, improves memory, relieves pain and helps to express feelings.

• Preview of Main points (Music is a form of art that is entertaining. It triggers our emotions, and impacts our mood. Music helps us to deal with stress and pain enhancing our psychological well-being.)

Body

1. Main idea (Music impacts our thoughts, feelings, behaviors and psychological well-being.)
2. Supporting point (Listening to music enables us to connect emotionally to things, places and people impacting our moods and actions.)
3. Specific example, detail, or fact (Music therapy helps to improve emotional health. Music is a source of pleasure and brings a feeling of contentment. It has a lot of psychological impacts on our lives. It impacts the way we think, our feelings and behaviors. The fact that listening to music enables us to connect emotionally to things, places, and people is evidence that music has an impact on our moods and even inspires our actions.)
4. Specific example, detail, or fact (Music relaxes the mind, energizes the body and impacts our mood. When music is played when we are performing another activity, the performance of the activity is improved. In this case, music helps to improve the processing speed in the brain and also leads to lots of benefits to memory. Music in this sense boosts mental performance.)
5. Specific example, detail, or fact (The psychological impacts of music are powerful because music therapy is a method that is used to improve emotional wellbeing, helping patients to deal with anxiety, and enhancing their well-being. Music therapy helps us to deal with stress and enhance our psychological well-being)
6. Supporting point (Music alters emotional and psychological arousal.)
7. Music boosts the mental performance when performing an activity. It causes emotional and psychological arousal just like sedatives arousing stimulation before activity or physical exercise.
8. Music improves the processing speed in the brain. It helps us feel more motivated, happy, relaxed and increases the efficiency of the processing in our brain improving our focus.
9. Main idea (Music helps in social connections, physical, mental health, and social functioning.)
10. It enables people to interact, connect, and relate to each other improving our mood and other mental issues.
11. Music enhances communication and interaction between people. Music helps us to express our expressions and is also a way of connecting socially.
12. Music helps to develop self-identity and relationships with other people. Other than stopping the feeling of being lonely, music helps to connect and meet new people in our lives.
13. Music reduces stress, depression and burnouts.
14. Music energizes the body and helps to manage emotions. Music causes emotional changes, can increase happiness and on the other hand, helps to safely experience the feeling of sadness.
15. Music helps us to relax therefore not experiencing burnouts or stressful situations. Research has shown that workers with recreation music-making opportunities have been proved to have very minimal stress, depression, and burnout compared to the workers that do not engage in recreational music-making.
16. Music helps us to improve, maintain and intensify our mood and reduce depression.

• Main idea (Clinical music helps to regulate psychiatric mood disorders)

1. Therapists use music to enhance their patient’s moods and relieve psychiatric mood disorders.
2. Rumination, which is a negative emotion associated to poor mental health can be reduced or avoided through listening to music.
3. Anxiety and neuroticism are other mental health issues regulated by music.
4. Music therapy has a lot of psychological benefits in treatment of mental disorders.
5. Helps to treat people with depression. It works towards relieving symptoms of depression and regulating the patient’s emotions
6. Anxiety and stress are treated by music through music therapy.

CONCLUSION

1. Summary of main points (Music has a positive impact on our mental health. It affects how we think, act to situations, relate to people and helps us manage our feelings and emotions. Music keeps us motivated and improves our focus. Music therapy helps to treat psychiatric disorders. Music plays a significant role in our mental health, rather than being a source of entertainment, it helps to regulate our emotions and most importantly treats mental disorders.)
2. Final words ( Music is a need for our mental health, and we need it to survive, be mentally active, and maintain our sanity)

References

Shively N. A., "Music Education for Mental Health: Creating a Participatory Music After

School Program" (2018). Honors Theses, University of Nebraska-Lincoln. 37. https://digitalcommons.unl.edu/honorstheses/37

Stewart, J., Garrido, S., Hense, C., & McFerran, K. (2019). Music Use for Mood Regulation:

Self-Awareness and Conscious Listening Choices in Young People with Tendencies to Depression. Frontiers in psychology, 10, 1199. https://doi.org/10.3389/fpsyg.2019.01199

 Trauma and Addiction Case Study

Summary

 After a trauma, victims respond to the traumatic events and the reaction is normal. They recover within a short period but it is important to be aware of the changes to improve the recovery.  In combining the case study with current research, it is apparent that individuals develop physical reactions such as exhaustion and numbness, cognitive reactions such as confusion and memory problems, emotional reactions such as anxiety and anger, and behavioral reactions such as alcohol consumption and criminal behaviors. However, individuals can cope with these common reactions by joining the support system, meditation, engaging in social activities, and muscle relaxation. It is also important to create secure attachments to regulate emotions.  Note that individuals with traumatic experience develop low self-esteem and anxiety. Thus, the secure attachment will provide security, happiness, and provide support.  In providing clinical interventions, healthcare providers should focus on trauma-informed care.  In other words, healthcare providers should provide individualized care such as engaging patients and creating safe physical environments.  Altogether, a traumatic experience is an event that affects an individual's mental and physical wellbeing, and healthcare providers and organizations should help individuals return to a normal state.

Part 1, question 2

            From the knowledge gained in the course, the information that I would offer to Sophie concerning trauma reactions is that each individual reacts differently to traumatic experiences.  Risks and protective factors, and coping and life skills affect how an individual will react. However, the main point is that survivors of the traumatic experience respond to trauma. Sophie should understand that it is common to respond to the trauma and individuals  who do not respond to trauma develops other problems such as depression, sleep disorders, and more (CSAT, 2014). Finally, it is important to note that the trauma reactions are not long-term. In other words, they resolve within a short period with the help of appropriate coping strategies such as social supports.  Below are the common reactions to trauma;

• Emotional reactions

            Individuals might experience emotional trauma. These include; anger- an individual feels that the experience was unfair. Another common response is a shame- a person is unable to act clearly and develops a feeling of isolation   A person may think that 'It is my fault" and blames oneself for the horrible situation.  The person may also develop fear about the incidents.  An individual fear that a similar event may reoccur and cause real danger (CSAT, 2014).  As a result, the person feels helpless, avoids people and places, and develops a negative view in life.  However, the research on trauma-informed care states that a person may be unable to identify these feelings since he or she may have never experienced emotional reaction before. Therefore, trauma survivors are unable to control these emotions after trauma. Some people especially young individuals use methods such as self-medication, self-injurious behaviors, compulsive behaviors, and others to control the emotion (CSAT, 2014).  The research states that these negative methods may lead to emotional dysregulation, and therefore it is important to find healthy ways such as physical activities.

• Physical reactions

 Another important point that I would like Sophie to know is that individuals develop physical reactions toward trauma.  Physicals reactions include; exhaustion, headaches, excessive sweating, sleep disturbances, and physical disorders such as dermatological disorders, cardiovascular, and more (CSAT, 2014). An individual may also experience trouble eating, excess drinking, and dizziness.  The research finds that people may be unable to identify the physical reactions and they believe that the problems are physical or rather they are not connected with their traumatic experiences.

• Cognitive reactions

 Individuals may also experience cognitive reactions.  Traumatic experiences affect the way people think, and reason. A person may develop trouble thinking and they make cognitive errors such as feeling that a current situation resembles the previous trauma (CSAT, 2014).  They develop inaccurate rationalizations and idealizations toward the perpetrator which later results in poor emotional attachments. A person may also develop intrusive thoughts which hinder them from differentiating what happened and what is happening. In general, emotional relations makes the person develop negative thought about oneself, the world, and the future. They see the world as unsafe and a future that has no meaning.

• Behavioral reactions

 Lastly, it is important to note that traumatic experience is associated with behavioral responses.  A person may engage in negative behaviors such as alcohol abuse, overeating, self-injurious behaviors, and other high-risk behaviors to reduce tension (CSAT, 2014).  Other behaviors include avoiding people and places as they believe that these factors may cause danger. In most cases, a person may be unable to think about the consequences of action since he or she lacks impulse control. As a result, a person feels powerless and react aggressively.

Part 2, question 3

  From the case study, traumatic experiences require secure and stable relationships.  Lack of secure attachment creates further trauma which then results in intrapsychic distress.  Thus, individuals who experience trauma need to create an emotional bond so that the victim can develop a sense of belonging, increase the ability to focus, and create positive future relationships (Bryant, 2016). In the case study, Sophie has developed an avoidant attachment.  This means that she does not see the need of creating attachment with her immediate and extended family. She is in her world and she feels comfortable while being free at home.  Sophie's attachment style has been unhelpful or it has hindered her from developing a healthy connection to important people.  Note that there are different types of attachments.  One is secure attachments. This is the best style of attachment as it creates a healthy relationship. It helps one to shape his or her abilities and expectations and gains a sense of self-development (Bryant, 2016). A secure attachment means that one is attached to important people such as parents or caregivers. Other styles of attachments conclude avoidance, ambivalent, and disorganized.  From this case study, Sophie engaged in avoidance attachment which means that she is overly independent (Bryant, 2016). Even if she associated herself with a small group of people, the research on social attachments during traumatic situations states that a person should create positive attachments. For example, positive attachments are derived from sibling relationships. Siblings may create closer attachments and help in trauma recovery. The extended family relationship also plays a significant role in the recovery process.  Extended families provide support and resources need to increase survival.

 However, Sophie’s avoidance style of attachment has prevented her from forming a healthy connection.  Avoidance attachment means that Sophie has rejected attachment figures and she relies on self-nurturing behaviors. She takes care of herself and has a little desire to seek help or support from the extended family.  She has no desire for affection or love. She enjoy spending time with a small group of people. She makes sure that the relationship is not too close. The research on attachment states that a person develops an avoidance attachment due to the fear of rejection and therefore opts to focus on themselves.  However, the avoidance attachment has not only hindered the client from developing healthy connections but it has affected her emotional development.  Since she is not connected with important people like family members, she is unable to cope with trauma reactions.  She only has fewer friends and the friendship or relationship is not helping her in solving problems or developing endurance and flexibility.  Healthy connection or creating attachment with important people means that one needs to create a large social network to improve the neural circuit (Punamäki et al. 2017). The article states that secure attachment contributes to the necessary resources to manage the traumatic experiences and threats.  According to the attachment theory, a person should find attachments security to get social support and mental health.  In response to the case study, it is important to note that the family system approach is very helpful in addressing the traumatic experience. Family members provide a sense of security and improve survival and mental health.  Family attachment creates a cultural network that provides values, beliefs, and emotional sharing (Punamäki et al. 2017). Unlike other styles of attachment, security attachment which comes from family members ensures optional development through the provision of emotional and instrumental support. 

Part 3, question 2

 Best practices in trauma-informed care

             Both organizational and clinical practices must be incorporated into trauma-approached care.  Note that victims of traumatic experience develop serious behavioral and health problems.  Therefore, health care providers and other stakeholders should understand the victim's life experiences and provide a comprehensive approach (Menschner & Maul, 2016).  In most cases, patients with post-traumatic disorders are taken care of in health care setting. However, an organizational policy that focuses on empowering is not implemented. Thus, there following recommended practices should be incorporated into the clinical and organizational levels.

 Practice recommendations

Organizational practices

• Building a trauma-informed organization

 The first recommendation is to reform organizational practices to incorporate trauma-informed practices.  This means that the health care setting needs to change the organizational culture and build a system that provides support (Menschner & Maul, 2016). In other words, healthcare providers should provide patient-centered care. Thus, senior leaders should act as the change agents and establish strategies that both staff and patients will follow in promoting an environment of healing. Changing the organizational culture to incorporate the patient-centered approach will aid in the treatment process in that victims will experience physical and emotional safety, transparency, empowerment, peer support, and gender responsiveness.

• Patient engagement

 In organizational practices, a trauma-informed organization is one that uses patient perspective in making treatment planning. Therefore, patients should be allowed to express themselves and their feedback will play a great role in program planning (Menschner & Maul, 2016).  Note that victims of the traumatic experiences have first-hand information and this information will improve the care delivery process.

• Clinical and non-clinical training

            A trauma-informed organization should provide training to the clinical staff for them to gain knowledge and understanding. Note that clinical staffs play a significant role in managing traumatic cases. Therefore, they need good communication skills and other skills for them to provide appropriate care. Another important point is that non-clinical staff such as health coaches, front-desk workers, drivers, and other individuals play a significant role in improving the health outcome of patients with traumatic stress (Menschner & Maul, 2016).  Therefore, these non-clinical staffs need training about the trauma and its impact. The training will help them develop knowledge and skills about violence and victimization and will cooperate with clinical staff in providing trauma-informed care.

• Creating a safe environment

 Victims who experienced trauma may suffer from further traumatic experiences when they are exposed to unsafe environments. Therefore, an informed-trauma organization should ensure a positive social and physical environment (Menschner & Maul, 2016). In general, the healthcare setting should ensure a positive welcoming language, security personnel, monitoring, cultural awareness, respect, compassion, conflict management, and more.

 Clinical practices

• Patient's involvement in health care

 In providing traumatic treatment, clinicians should not take the course of action alone but they should involve patients in the treatment process (Menschner & Maul, 2016). The purpose of patient involvement is to establish a shared understanding and as a result, patients will accept the medical treatment.

• Screening for trauma

  Before engaging in trauma treatment, the healthcare provider should understand the patient's trauma history through screening (Menschner & Maul, 2016). Patients should provide information about their trauma history and the sharing of information will help use the appropriate intervention as well as referral resources.

• Staff training

  There are many evidence-based treatment approaches. At times, healthcare provides are unable to identify the best therapy or treatment. Therefore, training will enable healthcare providers to understand the effect of traumas on mental well-being, physical well-being, and other areas (Menschner & Maul, 2016). The understanding between the traumatic experience and its effects will help in applying the treatment or therapy that will be beneficial.

• Creating community-based partnership

 Healthcare providers may lack the capability to provide comprehensive care. Therefore, different stakeholders should cooperate and discuss appropriate care (Menschner & Maul, 2016).  A mutual relationship among the different stakeholders will benefit the patients through evidence-based care. 

 Conclusion

 Traumatic events are distressing and the victims experience intense fear and become helpless. However, these strong emotions are normal as they are part of the recovery process.  In most cases, the victims detach themselves from others, they experience disturbing dreams, and they suffer from severe headaches, medical problems, depression, aggressive behaviors, suicidal thoughts, and more. The research paper finds that to cope up with the stress reactions, it is important to create secure attachments or to be closer to family and friends. They support system will aid in recovery. Furthermore, there are good treatments to aid the recovery process and the recommendation to the healthcare providers and other stakeholders is that the care should be based on a trauma-informed approach to improve the health outcomes.  

References

Center for Substance Abuse Treatment. (CSAT). (2014). Trauma-informed care in behavioral

health services. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

Bryant, R. A. (2016). Social attachments and traumatic stress. European Journal of

Psychotraumatology, 7(1), 29065.

Family systems approach to attachment relations, war trauma, and mental health among Palestinian children and parents

Biological psychology

Q1

             The neuromodulator system responsible for the stress response is the amygdala.  During a life-threatening situation, the amygdala acts as a command center and communicates to the hypothalamus which then uses the autonomic nervous system to communicate to the adrenal gland (Whalen & Phelps, 2009). The adrenal gland produces a hormone known as adrenaline which circulates in the body to cause physiological changes such as abnormal heart rate, high blood pressure, and other changes. However, the same neurotransmitter creates a stress response system known as the hypothalamic-pituitary-adrenal (HPA) axis. The hypothalamus secretes corticotrophin-releasing hormone (CRH). The CRH communicates to the pituitary gland to secret adrenocorticotropic hormone (ACTH) (Whalen & Phelps, 2009). The ACTH link-up with the adrenal cortex and the binding produces a vital hormone known cortisol which helps the body in stress response.

 Q2

Anti-depressants or selective serotonin reuptake inhibitors (SSRIs) stimulate the release of serotonin into the tiny opening known as the synaptic cleft.  The released serotonin travels from a brain cell known as neuron and passes through the synapse to other brain cells (Acosta et al. 2010).  However, some serotonin do not reach other brain cells and what happens is some serotonin is reabsorbed to continue with the role of transmitting messages to the brain cells. The anti-depressants work by blocking the reabsorption of serotonin. If the serotonin is not re-absorbed, it means that more serotonin will be available to alleviate depression (Acosta et al. 2010).  The consequences that underlie the therapeutic effects of these drugs are synaptic effects.  First, the drugs act as blockade of neurotransmitters such as serotonin and dopamine.  Second, the anti-depressants drug acts as blocked of certain receptors such as dopamine D2, and 5-HT2A receptors (Acosta et al. 2010). The interaction of the drugs with certain transmitters and receptors causes adverse effects.  

References

Whalen, P. J., & Phelps, E. A. (2009). The human amygdala. New York: Guilford Press.

Acosta, W. R., & Lippincott Williams & Wilkins. (2010). LWW's foundations in pharmacology

for pharmacy technicians. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams

& Wilkins.

Biological psychology

Q 1

A pattern of performance on a verbal retrograde memory test indicates that the individual is unable to retrieve information or there is retrieval deficit hence causing a retrograde memory loss (Budson & Price, 2005). The pattern of performance on the retrograde test indicates retrograde amnesia due to the medial temporal lobe.  Hence, the individual cannot remember the information.

  In assessing the early stages of Dementia, a pattern of performance on anterograde verbal episodic memory test regarding encoding and retrieval is that an individual is unable to process information, and to remember information (Budson & Price, 2005). In other words, the individual is not forming episodic memories or rather he has an episode memory deficit.  It indicates that the medial temporal lobes of the Hippocampus and extrahippocampal responsible for memory consolidation are damaged hence causing episodic memory impairment.

Q 2

 In assessing an adult with recent bilateral frontal lobe damage, a pattern of performance on verbal retrograde memory tests indicates that the temporal lobe is damaged, hence retrograde amnesia.  In other words, the adult cannot remember previous memories or form new memories (Fletcher, & Henson, 2001). Note that the bilateral frontal lobe plays a significant role in forming memories and accessing long-term memory. However, the frontal lobe damage results in memory deficits.

 Anterograde verbal episodic memory test in bilateral frontal lobe damage indicates an anterograde memory deficit.  Hence, an adult is unable to store information but can recall past events. This occurs because the frontal lobe is damaged (Fletcher, & Henson, 2001). In general, the pattern of anterograde memory performance indicates anterograde memory impairments. Therefore, the individual, remembers normal behavior such as talking to people. However, a person can perform complex tasks like driving.

References

Budson, A. E., & Price, B. H. (2005). Memory dysfunction. New England Journal of

Medicine, 352(7), 692-699.

Fletcher, P. C., & Henson, R. N. A. (2001). Frontal lobes and human memory: insights from \

Functional neuroimaging. Brain, 124(5), 849-881.

Nicola, M., Alsafi, Z., Sohrabi, C., Kerwan, A., Al-Jabir, A., Iosifidis, C., ... & Agha, R.

(2020). The socio-economic implications of the coronavirus pandemic (COVID-19):

A review. International Journal of Surgery, 78.

The purpose of this article is to explore the effect of Covid-19 in social-economic status. The article states that Covid-19 has affected every aspect of life. The largest part that has been affected is the economy, as the entire world is experiencing an economic crisis and recession. The article examines the primary sector such as agriculture, secondary sectors such as the manufacturing industry, and tertiary sector such as education. All these sectors have been affected and businesses have experienced financial collapses. The article suggests that the government, the healthcare, and other stakeholders need to implement relief measures to re-energize the economy.

  This scholarly article relates to my research topic about the impact of Covid-19 to the businesses community. This source provides supporting evidence as it contains background information about the COVID-19 pandemic. The article strengths my thoughts and argument and provides new ideas and the right amount of information concerning the issues at hand. The sources look at the financial and operational challenges, and propose tangible actions that will contribute to meaningful change.

The source relates to other sources. This is because my other sources back up my research topic. All sources have validity. They do not only give an interpretation of the Covid-19 pandemic, but they also provide observation and subjective commentary. They focus on facts or in other words they provide true information. Note that many authors have made discoveries and have arrived at the conclusion that Covid-19 is a threat to the economy. Since these authors have the knowledge of the subject being discussed, I will use their information and opinions to gain economic insight, and learn more about business performance during the global pandemic.

Addictions Trauma-informed treatment

Overview

 Trauma is a health problem that occurs due to emotionally harmful experiences such as loss, violence, war, and more. Research on trauma has found that addressing trauma is a process that needs a trauma-informed approach. Note that victims of trauma, their families, and communities are affected by trauma. In specific, victims of trauma suffer from negative effects such as health risk behaviors, behavioral disorders, and more. However, victims of trauma and other people who are indirectly affected can overcome the traumatic experience through the right supports and intervention. The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a framework that service providers should follow in providing trauma-informed care. The main goal of the framework is to create a trauma-informed approach and ensure that the service providers connect the trauma with behavioral issues.  In working with Sophie, I will adhere to the following principles and I am they will promote recovery and resilience. 

Part A

• Trauma awareness

 The first principle that I will employ is to understand the effect of trauma on client’s emotional and physical well-being. Note that victims of trauma develop behavioral and mental issues such as depression, anxiety, difficulty eating, substance abuse, and more (SAMHSA, 2014). The purpose of gaining awareness and understanding is to understand the impact of trauma and provide trauma-focused services. It is important to integrate trauma knowledge. This principle will be helpful to both of us in that as a service provided, I will avoid re-traumatization and use the most appropriate behavioral health practice.  Besides, awareness and understanding will promote interaction.  I will use my ability to take the necessary step and provide the best protective services.

• Safety

             In helping Sophie to overcome the traumatic experience, I will create a safe physical and psychological environment. The purpose of a safe environment is to promote interactions and ensure that the client has gained a sense of physical and emotional safety (SAMHSA, 2014).  This principle will be helpful in that Sophie will not be exposed to distressing circumstances or environment and as a result, she will feel comfortable and gain a sense of control. I will also create a safe environment through compassionate communication. Victims of trauma need a soothing voice to promote the client's emotional well-being. This strategy will encourage the client to comply with practices and focus on a bright future.

• Choice and autonomy

Another principle that I employ is giving the client a role to play. In a trauma-informed approach, it is important to involve the client in decision making and allow them use their self-advocacy skills (SAMHSA, 2014). In working with Sophie, I will act as a controller of recovery.  Note that the choice and voice will allow the client to express herself and make effective decisions regarding trauma treatment. For example, she is smoking marijuana and she easily becomes irritated. Despite these obvious behavioral problems, she fails to admit or confess about the substance abuse, and compulsive behaviors. In a trauma-informed approach, I will appreciate her perception and responses to the traumatic experiences.  After understanding her expertise, I will collaborate to find solutions. Sophie will gain a sense of control and this will help come up with the best treatment plan. Also, the choice and control will aid in recovery.

 Part B

 In working with Sophie, I have realized that some treatment principles will be challenging and therefore it will difficult for me to adopt.  However, I will use the appropriate strategies to manage potential challenges

• Addressing secondary trauma

            As a social worker, there is a possibility that Sophie's traumatic experience will affect me. In other words, Sophie's situation will not get out of my head and the experiences will result in vicarious traumatization. Sophie was not only harassed by her uncle but she experienced harassment from strangers. These experiences are emotionally challenging and as social workers, I am expected to create an empathetic engagement to help the client. Exposure to these traumatic experiences will impact my mental well-being in that I will develop anger and resentment toward the tormentors.  I will develop a negative worldwide and feel helpless. As a social worker, my question is 'how will I address the secondary trauma? How I will promote self-care?  How I will avoid work-related stress? These questions cling into my mind because I am intensively involved in caring for the client and I am unable to care for myself. However, I will solve the challenge by developing awareness of the unwanted traumatic memories, find peer support, create a balanced lifestyle, set boundaries, accept life disruptions, and develop realistic expectations

• Commitment to trauma-informed care

 I have realized that this principle is challenging.  As a social worker, I am expected to create a commitment to all trauma-informed systems.  For example, I need personal and professional development, and specific strategies to promote trauma-informed services. Trauma-informed care focus on developing new models and transforming services (SAMHSA, 2014). Note that as a social worker, I do not only deal with the victim of trauma, but I also work with the family to improve their well-being. Thus, there are different services offered and this means that systemic change is needed. Commitment and resources toward the system change are a challenge and this may create resistance to change, and hinder an effective provision of services. However, change is inevitable, or in other words, the social workers need to change the practices and gain a holistic understanding (SAMHSA, 2014). Thus, I will address this challenge by joining staff training and collaborating with the trauma-response team.

• A social-cultural perspective

            Another challenge in applying the principles is understanding the client's cultural background. As a social worker, I am supposed to understand the cross-cutting factors that may have contributed to the traumatic experiences. Even though the culturally responsive treatment will aid in treatment planning, the principle may hinder therapeutic relationships (SAMHSA, 2014). This is due to power imbalance, and cultural and ethnic variation. However, I will address this problem by developing cultural competence. This means that as a social worker, I will incorporate cultural values and social norms and employ cultural-specific strategies. I must recognize that some cultures experience traumatic events, cultures can act as a source of strength,  culture can influence how a  client responds to trauma,  among other factors that I should put into consideration.

 The above SAMHSA treatment principles will be necessary when working with the client.  It is important to note that a trauma-informed approach entails the application of these principles as they aim to promote recovery and resilience. Rather than using practices or procedures, it is important to employ evidence-based practices as they not only solve the client's traumatic experience but they go further to provide an understanding and awareness across cultures.

References

 Substance Abuse and Mental Health Services Administration. SAMHSA (2014). A treatment

improvement protocol: Trauma-informed care in behavioral health services, Tip 57.

Health Savings Accounts

Introduction

A health savings account is an individual medical savings account that is tax-advantaged and is available to taxpayers. It is more like a personal savings account but the money saved in them is used to pay for expenses in healthcare. This health account is available to the members who register for a high deductible health plan. A health savings account is beneficial because its interest and withdrawals are tax-free, and the funds that are not used are carried over yearly.

Health care plan accounts have captivated a lot of attention from employers, individuals, and lawmakers because they are perceived to minimize healthcare prices. In the health insurance market that is sponsored by the employer, the health savings accounts have grown remarkably. The contributions to the health savings account earn interest and belong to the individual (Lo Sasso, Shah & Frogner 2010). Even after workers leave their job, the contributions remain their possession. Research shows that individuals who have enrolled for the health savings account have initial lower spending in health and are healthier compared to those that have not enrolled in the account. The enrolled individuals who were found to less likely have a chronic condition could report their health as excellent. This means that a healthcare savings account is a good idea for healthcare because of the less spending in healthcare and even in the pharmacy.

According to the United States, United States. Congress. Senate. Special Committee on Aging (2004), health care savings account gives better patient control and the choices of using health services. They support the patient-doctor relationship and very affordable medical costs. The development of health savings accounts is a trend geared towards consumer-directed health which gives patients a bigger control of making decisions regarding healthcare. It also enables consumers to clearly understand the healthcare costs. These accounts enhance the doctor-patient relationship because the high-deductible health insurance minimizes treatment decisions from outside and provides doctors and patients incentives to keep away from excessive spending. The cost incentive minimizes the need for controlled care regulations that limit the accessibility of care. This enables the consumer to be flexible in choosing the kind of care they prefer. For uninsured people, the healthcare savings account plays a significant role. Health savings accounts are less expensive compared to other insurance plans despite their medical expenditure. As a consumer, health savings accounts expand the options of healthcare.

In many economies, healthcare costs are a major problem and health savings accounts have been viewed as a good way to reduce healthcare costs. The tax advantage that is put for the health saving accounts expands the group health insurance market by making healthcare more affordable (Ye 2015). Health savings accounts enable individuals to save money and get a valuable health insurance plan. They improve the effectiveness of insurance, increase the choices of the customers, and reduce health expenses.

Conclusion

Health savings accounts have very many benefits in terms of quality healthcare. These accounts enable a patient to get access to affordable healthcare. The contributions that are made towards the savings account belong to an individual even when they decide to stop working. The contributions are not taxed when withdrawing. The customer can have the opportunity to make their own choices and preferences because they are no controlled care rules in the health savings accounts, therefore, expanding the options as a healthcare consumer.

References

Lo Sasso, A. T., Shah, M., & Frogner, B. K. (2010). Health savings accounts and health care

spending. Health services research, 45(4), 1041–1060. https://doi.org/10.1111/j.1475-

6773.2010.01124.x

                                                                 ARTICLE ONE

Ha, D., Roberts-Thomson, K., Arrow, P., Peres, K., & Do, L. (2016). Children’s oral health status in Australia, 2012–14. In Do L. & Spencer A. (Eds.), Oral health of Australian children: The National Child Oral Health Study 2012–14 (pp. 86-152). South Australia: University of Adelaide Press. Retrieved June 20, 2020, from www.jstor.org/stable/10.20851/j.ctt1sq5wh7.9

Annotated bibliography

            The authors illustrates that dental caries have the potential of affecting a large percentage of children particularly infants. According to the information provided by the authors in this article, dental caries is caused by the complex interactions that occur between fermentable carbohydrates and acid-producing bacteria. Their analysis indicates that such a chronic ailment is characterized by demineralization.

Hypothesis

            Dental caries is one of the oral conditions that negatively affect the dental health of children

Conclusion

            According to the information provided by the authors, it is evident that the balance that exists between demineralization and remineralization is the one that aid in determining the health of teeth of children.  Despite that, it logical to say that such a balance at times becomes disturbed because of different health conditions of children. In this case, it can be argued that demineralization is the one that results in the development of cavities or holes in the surface of teeth. In the earliest stages, the damages that are caused on teeth can be medically reversed by using fluoride.

            From the medical perceptivities, cavitation that grows into the inner enamel into tissues also results in bacterial infection. Such a condition can be said to have the propensity of inducing considerable pain which in return requires a child to be subjected to surgery. As much as dental caries is concerned, the authors are trying to demonstrate whether demineralization is ultimately stimulated by bacteria and other waste products that are produced by them (Ha et al., 2016). Although a dentist can advise the parent to allow the tooth of his or her child to be removed, medical tooth filling can also be considered as another option for restoring the function and the form of the teeth or tooth.

Validity

             According to the information provided by the authors in this article, it is evident that they offer detailed information regarding the initial causes and the remedies that can be suggested by dentists to restore damaged teeth of children. During their research, an epidemiological examination was conducted to enable them to understand the oral conditions of the children who are affected by dental caries. Furthermore, clinical and didactic training for the selected examination was also undertaken to provide concrete information regarding this oral condition. Under standardized conditions, mobile or fixed dental clinics were also utilized as an additional source of information. 

Future studies and implications

            In the future, it is important to conduct socio-economic research to understand the health of each child in terms of the diet they consume. The reason for that is because it will make the community or the general to understand the fact that untreated dental caries is a condition that results from poor dental care. Background information required in future research is examining the number of teeth each child misses to determine their oral condition. Ideally, it is logical to say that those children who are subjected to regular dental examinations have low preferences for dental caries.

                                                            ARTICLE TWO

CHEN, C., WEN, H., CHEN, P., LIN, S., CHIANG, T., HSIEH, I., & GUO, Y. (2012). Prenatal and postnatal risk factors for infantile pneumonia in a representative birth cohort. Epidemiology and Infection, 140(7), 1277-1285. Retrieved June 20, 2020, from www.jstor.org/stable/41549134

Annotated bibliography

            The authors illustrate pneumonia is one of the leading causes of morbidity and mortality in children especially infants. From the research conducted by the authors, it is evident that pneumonia ultimately represents the most important defined causes of infection-related mortality rates in children. Despite that, the article provides a clear explanation of the main risk factors that are linked with the development of pneumonia in children. 

Hypothesis

Pneumonia increases the morbidity and mortality rates in children especially infants.

Conclusion

             The information provided by this article indicates that after birth, the majority of infants opt to ensure that they have spent most of their time indoors. As a result of that, it clear that the postnatal indoor environment plays a crucial role in fostering the health conditions of infants, particularly their respiratory health condition. From the illustration provided in the article, it is obvious that identifiable prenatal conditions prove to be the risk factors for the majority of infantile pneumonia for children who are aged six months and below. Such a condition is brought about by various factors such as maternal smoking, overweight, use of antibiotics, and prenatal ETS (elevated tobacco smoking) exposure during pregnancy.

            Conversely, although antibiotic use is linked with infant pneumonia, the information provided does not give a clear explanation as to why pregnant women should not take such medicines. Maternal overweight is an independent factor because it increases risks of thromboembolism, delivery complications, gestational diabetes, and hypertension in mothers. As a result of that, long-term effects particularly metabolic impairment occurs in infants. Gestational diabetes does not have the potential of increasing risks of pneumonia development in infants (Chen et al., 2012). Relatively higher BMI (body mass index) can be said to be negatively linked with infantile pneumonia. Furthermore, since they have immature secretory and systemic immunities, it makes them to be susceptible to indoor air particles, such as molds. This is because they have the potential of damaging the natural immunity of their respiratory tract.   

Validity

             The information provided by the authors also enables the reader to understand the fact that infants are the ones who are extremely vulnerable to this illness. Ideally, the reason as to why infants are susceptible to developing pneumonia is because their respiratory anatomies and immunity are still underdeveloped. The sample size used by the authors was mainly narrowed down to caregivers. Structured questionnaires were utilized to collect information regarding family medical history, frequency of hospitalization, and family environment. Potential determinants and demographic characteristics of the results of the study were compared with infants without and with pneumonia.

Future studies and implications

             As much as infantile pneumonia is concerned, future research should be conducted based on the socioeconomic status of each family. Socioeconomic analysis to be conducted should also incorporate questions regarding the care given to infants by parents and/or caregivers in each community, the frequency of diagnosing infants with pneumonia should also be included. To clearly understand this research in the future, background information such as the medical history of each family, the frequency of seeking medical care particularly for pregnant women, and retrieving previous health care records should be considered.

 Pressure Ulcers

Introduction

Pressure ulcers are confined areas of tissue damage that are generated by pressure to the skin. They appear on the skin that protects the bony areas of the skin. They mostly occur to individuals that sit down for long hours. Pressure ulcers should be handled with care, compassion, and dedication to the patients. Pressure ulcers significantly affect a patient’s quality of life, morbidity, and mortality.

Pressure ulcers are an issue because according to research, the prevalence of the condition is in many countries including Europe and the United States which is in high rates. Age, poor nutrition, obesity, and poor posture have increased the rate at which people are getting pressure ulcers. They tend to be painful, weakening and difficult to heal. They are connected to psychological, physical, and social issues. Prevention and treatment costs are very expensive for pressure ulcers and research shows that it is the third most expensive condition after cardiovascular illnesses and cancer (Agrawal and Chauhan 2019). Pressure ulcers patients have high mortality rates and admission and re-admission to the hospital are also at high rates. Pressure ulcers lead to a rapid increase becoming a healthcare burden and also causing financial constraints to the patients.

 The clinical intervention that is being used for pressure ulcers consists of using support surface systems. The support systems are developed to help prevent pressure ulcers and they have been designed with different techniques that work towards reducing pressure. The support systems reduce pressure by sharing the weight over the maximum area of the body. They alter the pressure below the body to minimize the period of the pressure that is applied. The pressure support surfaces work towards reducing the immensity of pressure in an individual and the support surface to avoid pressure ulcers. (McInnes, Jammali-Blasi, Bell-Syer, Dumville, & Cullum 2012). Some of these support surfaces are machine-like systems.

The total participants for this study were 16,285 where 53 random trials were identified. The records were identified by searching that was done through the database and were 184 . 11 additional records were identified through other sources. There were 195 records after duplicates were removed. 195 records were screened and 83 were excluded. The full-text articles evaluated for eligibility were 112 and full texts articles that were excluded with reasons were 59. 2 were excluded because of literature reviews, 8 because of incomplete data, 20 did not have a clinical outcome, 11 were not a trial, 9 had a different intervention and 9 did not meet other inclusion criteria. The total trial review was 53 and they took place in different arrangements (McInnes et al. 2012). The sample sizes were from participants who were followed up on a daily to yearly basis. The result evaluation took a similar period and was reported in 34 trials done daily or weekly.

Reports from 37 trials showed that participants' groups were similar regarding the predictive factors. 13 trials involved patients with preexisting pressure ulcers and 7 out of the trials involved the only ones with grade 1 pressure ulcers, 3 had grade 1 and 2 and 1 trial involved those with grade 4. For 2 trials, there was no clarity on the grade of pressure ulcer. For 14 trials, it did not clearly show if preexisting pressure ulcers were involved. Classification of the trials was assessed according to “high tech” and “low tech” gadgets and the other types of support surfaces (McInnes et al. 2012). 23 trials assessed the “low tech” pressure support surfaces. “High tech” support surfaces were assessed by 21 trials.

When quality foam hospital mattress and low-pressure support surfaces were compared, it showed that pressure ulcers were reduced when the foam alternative support surface was used. Several other products were used in opposition to the standard hospital mattresses and the patients with pressure ulcers that were perceived to be at increased risk were reduced. (McInnes et al. 2012). Alternative foam support surfaces showed that their pressure ulcers were reduced where people replaced fiber mattress to foam overlay. When the use of sheepskins which were low tech support surfaces was contrasted to quality care, for the people that used sheepskins there were reduced pressure ulcers. When body support was contrasted to quality care, pressure ulcers seemed to reduce (McInnes et al. 2012). Quite some products and support surface systems have a positive impact on the decline and prevention of pressure ulcers. Some of the support surfaces though have not shown clear ways of reducing or preventing pressure ulcers.

           Pressure ulcers that have been increasing with a high rate have been connected to the quality of health care. The rising-rate shows that there has been poor health care for pressure ulcers. This means that the findings in the research study are not being used. There has been a major limitation in the pressure ulcer studies which is the small sample size. It has been hard to compare a person’s hospital incidence rate at the national level. It has been a challenge for clinicians and lawmakers to know the impact of people’s particular clinical characteristics on the risk of creating pressure ulcers that are acquired in the hospital (Lyder, Wang, Metersky, Curry, Kliman, Verzier & Hunt 2012). Lack of enough samples to give more understanding of the pressure ulcers and this gives very little information about the people in the hospital or their improvement.

Conclusion

           Research on pressure ulcers has shown that its prevalence is high in certain countries which cause psychological, physical, and social issues to an individual. Pressure ulcers affect an individual quality of life and are mostly caused by age, poor nutrition, obesity, and poor posture. Clinical interventions that include support systems have been designed with different techniques working towards reducing pressure. In a research study, participants were used to determine the kind of support systems that work towards reducing pressure and how effective they are. In the study, the different trials showed the impact they had on pressure ulcers. Some of the trials were not clear on their impact in pressure ulcers and some proved that they should not be used at all. This condition has been connected to the quality of healthcare and the increased rates of the condition show that there is low-quality care for people with pressure ulcers. Due to the lack of enough sample sizes, there has been a limitation in the pressure ulcer studies making it difficult for patients to benefit in the prevention methods. This too has led to a lack of information about the people in the hospital due to pressure ulcers and their improvements or what more should be done for them to get better and quality healthcare.

References

Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian journal of plastic

surgery: official publication of the Association of Plastic Surgeons of India, 45(2), 244–254. https://doi.org/10.4103/0970-0358.101287References

Lyder H.C, Wang Y., Metersky M., Curry M., Kliman R., Verzier N.R. & Hunt D. R (2012)

Hospital-Acquired Pressure Ulcers: Results from the National Medicare Patient Safety

Monitoring System Study Journal compilation 60:1603–1608

McInnes E., Jammali-Blasi A., Bell-Syer S., Dumville J, & Cullum N. (2012) Preventing

pressure ulcers—Are pressure-redistributing support surfaces effective? A Cochrane

systematic review and meta-analysis, International Journal of Nursing Studies 49 (2012)

345–359

The Affordable Care Act

The Affordable Care Act, also referred to as the Patient Protection and Affordable Care act or the Obamacare is a provision by the United States government that was enacted by the federal statute under the 111^th United States Congress. The statute was intended to ensure that all citizens in the U.S have access to good quality medical care. In order to offer the best quality of care and help reduce cost, the act relies on consumer and provider incentive such as the premium tax credit.

Households with incomes that average between 100 and 400 percent of the federal poverty level receive subsidies such as premium tax credits (Gruessner, 2016). this ensures that such households have more income to take care of their medical needs and this greatly assists in cost reduction. Consumers have more income to not only access medical care but lead healthier and safer lives that do not risk their health (Gruessner, 2016). Medical care providers on the other hand are able to cut on cost as the burden of takin care of patients that are unable to meet the cost is lessened by the provisions made available through Obamacare.

Other than the Affordable care act, there are other initiatives taken by the government to enhance quality of care such as the antitrust legislation. One of the laws that enhance the quality of care is the Clayton Antitrust Act of 1914 which prevents organizations from discriminating against customers through prices or any mergers that seek to reduce competition (Palmer, 2019). The act ensures that there are different organizations offering quality service rather than a having a monopoly where one organization has power over the consumer. A monopoly would affect quality of care as the organization would have enough influence and control to instigate its own terms (Palmer, 2019). When there is increased competition combined with the laws that prevent discrimination amongst consumers however, organizations are forced to rely on market forces when pricing services and this ensures that all patients are treated equally and that the quality of care is maintained.

References

Gruessner V, (2016) “How the Affordable Care Act changed the face of health insurance”            Health prayer Intelligence, retrieved from,   https://healthpayerintelligence.com/features/how-the-affordable-care-act-changed-the-         face-of-health-insurance

Palmer B, (2019) “Understanding Antitrust Laws” retrieved from,             https://www.investopedia.com/ask/answers/09/antitrust-law.asp

  Engineering design GE

Table of contents

1.0. Abstract…………………………………………………………………………………4

1.2. Introduction……………………………………………………………………………..4

            1.2.0. Valvular disease………………………………………………………………4

            1.2.1. Causes of valvular diseases…………………………………………………..5

1.3. The design intent of the Bjork-Shiley Heart Valve (what need or function did it satisfy, what was its design purpose?)……………………………………………………………………6

            1.3.0. Mechanical design……………………………………………………………6

            1.3.1. Design purpose or function it was intended to satisfy……………………….8

            1.3.2. Mechanical heart valves that were present in the market, the competition they                                  imposed and how Bjork-Shiley Heart Valve differs with them…………….8

1.4. Problem with the Bjork Shiley heart valve…………………………………………….9

            1.4.0. Nature of the problem and what it meant…………………………………….9

            1.4.1. Testing procedure used to understand the problem………………………….10

            1.4.2. Concluding remarks of the company………………………………………..14

            1.4.3. How they arrived at these conclusions………………………………………16

            1.4.4. Ethical issues…………………………………………………………………17

1.5. References…………………………………………………………………………….18

Abstract

            The Bjork Shiley heart valve was founded and clinically utilized in late 1969. Between the years 1969-1981, at least 24,000 Bjork Shiley heart valves were implanted in patients with heart problems.  Despite that, it was realized that these mechanical valves ended up providing

quiet and low profile prosthesis with exceptional hemodynamics. Because of the fracturing of inlet struts, there have been only two reported cases regarding the mechanical failure of this device. According to the recent medical reports concerning the wear of the BS valve discs, a scientific advisory panel had been established to review and validate the general status of the Bjork Shiley Derin (BSD) tilting heart valve. In return, such a strategy is perceived to be the one that could enable physicians to make sound recommendations regarding the effectiveness of BSD heart valves implanted to patients. Therefore, the purpose of this paper will entail presenting the details collected regarding the scientific effectiveness of BSD heart valves and those that were initially recommended by the panel.  On the other hand, explanted Bjork Shiley Derin (BSD) heart valves that could have been returned to Shiley, experimental publications of the Bjork Shiley Derin (BSD) heart valves, BSD heart valves that were subjected to hasten wear tests, test reports, unimplanted BSD heart valves stored in Shiley inventory, and so on are some of the materials that will be used to validate the effectiveness of this device to patients.

                                                                        Introduction

Valvular disease

            Usually, clinical researches regarding the development of human valvular diseases involve two main conditions, especially valvular insufficiency and valvular stenosis. Valvular insufficiency also termed as incompetence or regurgitations evolves whenever an individual's valves do not close normally. When the valve does not seal properly, there is the leakage of blood across the heart valve. As the leak continues to worsen, the heart is forced to work harder to counter the effect of the blood that is lost as a resulting of the backward leaking of blood (Rajamannan, 2014 p.21). In return, little blood is supplied to the body. Taking into consideration the valve that is affected, such a condition is termed as aorta regurgitation, pulmonary regurgitation, tricuspid regurgitation, or mitral regurgitation. On the other hand, valvular stenosis evolves whenever the patient's opening valves become relatively smaller than normal because of the fusing or stiffness of the leaflets. Such a scenario is what results in heart failure. The hardening or restriction of blood flow through the valves is termed as aortic stenosis, pulmonary stenosis, tricuspid stenosis, or mitral stenosis (Wang & Bashore, 2009 p.1). As a result of the narrowing of the opening valves, the heart works harder so as to pump blood through them.

Causes of valvular diseases

            Human valvular diseases have been realized to commence developing before birth. A person can also acquire it sometime during a lifetime. Although medical research stipulates that the main cause of its development is not yet known, congenital or birth heart valve diseases have the propensity of affecting the pulmonary or aortic valve. At times, the heart valves might have malformed leaflets, be of the abnormal size, or having leaflets not correctly attached to the annulus. The failure to treat bacterial infections is what results in rheumatic fever. The use of antibiotics to treat bacterial infections is what is perceived to have the likelihood of reducing it. Although initial bacterial infections mainly occur in children, the heart problems that are linked with it can only be diagnosed when an individual is aged between 20-40 years (Newton et al., 2011 p.43). At this age, his or her heart valves could have been inflamed, thus making leaflets to fuse and become shortened, rigid, thickened, and scarred. Such a condition results in mitral regurgitation.

            Additionally, endocarditis evolves in an individual when germs, practically bacteria, enters his or her bloodstream and affects the normal functioning of the heart valves. The alteration of the normal functioning of the heart valves is what causes the growth of holes in them. The entering of germs into an individual bloodstream has been realized to be caused by IV drug use, surgery, dental procedures, or because of severe infections. Individuals having heart valve ailments are perceived to be at a higher risk of developing life-threatening mitral heart valve infections (Tisdale, 2010 p.554). As a result of that, the dilation of the annulus, stretching or tearing of the papillary muscles, or stiffness of the valve leaflets can occur. Human valvular diseases, especially MVP (mitral valve prolapsed) is one of the common condition that affects 1 to 3 percent of the entire population. During heart contraction, MVP has been realized because mitral heart valve leaflets to collapse back to the left atrium. The alteration of the normal functioning, stretching, and the leaking of the left atrium valves is as a result of MVP (Runge et al., 2010 p.493). Connective tissue ailments, syphilis, cardiomyopathy, aortic aneurysms, hypertension, heart attack, and coronary heart diseases are some of the most commonly known causes of heart valve disease.         

The design intent of the Bjork-Shiley Heart Valve (what need or function did it satisfy, what was its design purpose?)

Mechanical design

            The Bjork Siley heart valve is perceived to be one of the mechanical human heart valve prostheses. From the year 1971, this device was developed for the purpose of replacing mitral or aortic valves. It marked one of the first examples of clinical devices that could be successfully utilized for tilting disc heart valves. The Bjork-Shiley heart valve comprises of a carbon-coated disc that is enclosed by tantalum housing. An outflow, inflow, and two metals struts are also used to hold the disc firmly. Ideally, the standard design of this device makes use of the materials that are long-lasting (Anderson et al., 2012 p.1073). Chromium cobalt alloy also termed as Haynes 25 is the main housing material used to manufacture them.

Figure 1: The Bjork-Siley heart valve

            Due to the fact that the use of the plano-convex design was noticed to be ultimately susceptible to thrombosis, such a device was improved with the use of the convexo-concave (CC) design. The reason for considering the CC design is because it was proved to have the propensity to speed up its manufacture as well as reduce the formation of thrombus. Within the CC metal housing, such a device comprised of a tilting disc coated with carbon and held in place firmly by an inflow, outflow, and two metal struts. Although the outlet strut of the CC device is welded separately, the inlet strut is flushed with metal flange (Ratner, 2013 p.1376). The size of the metal flange ranges from 21-33mm with an opening angle ranging from 60-70 degrees. The suture ring of the CC device is made of Teflon. The need to sew of the suture ring to the cardiac heart tissues is what assists in ensuring that the valves are held firmly in place.

Design purpose or function it was intended to satisfy

            The Bjork-Shiley Heart valve was manufactured to replace heart valves that could have been damaged. Traditionally, artificial heart valves were extensively used for the purpose of replacing diseased or defective heart valves. Although from time to time numerous heart valves have been manufactured they differed greatly in terms of the number of leaflets, materials used, and valve geometry. In the modern medical world, the implantations of artificial heart valves in patients have declined because they induce numerous health complications, such as hemolysis (Anderson et al., 2012 p.1073). For the case of mechanical heart valves, such complications are only believed to be linked with non-physiological flow of blood. Nevertheless, the evolution of mechanical heart valves, especially the Bjork-Shiley Heart valve is perceived to provide superior hemodynamics with relatively lower aerodynamic resistance (Baura, 2006 p.100). Ideally, the development of the Bjork-Shiley Heart valve was anticipated to have the propensity of providing effective and quick relief with least complications to patients with ailing native heart valves.

Mechanical heart valves that were present in the market, the competition they imposed and how Bjork-Shiley Heart Valve differs with them

            Initially, there were various mechanical heart valves that were used to replace damaged heart valves. They include the Starr-Edward ball valve, Carpentier-Edwards, Hancock porcine prosthesis, and Bovine pericardium. As compared to these mechanical valves, the use of the Bjork-Shiley heart valve was found to reduce the survival rates of patients because of the failure of such valves. One of the factors that made them be preferable is that the use of the Bjork-Shiley Heart Valve increased the episodes of bleeding once the defective heart valves were replaced with it.

             On the other hand, the use of mechanical heart valves was associated with the effectiveness of reducing embolism. In this case, minor embolism is regarded to be episodes of brief neurological deficiency or any other medical events that affect the normal functioning of the heart valves. Major embolism also occurs as a result of a residual neurological deficiency or limb ischemia that requires surgery. The Bjork-Shiley prosthesis differs from the other mechanical heart valves because it consists of a graphite disc that is insulated with pyrolite carbon. This mechanism makes it tilt easily between the two struts contained in its housing (Baura, 2006 p.100). Furthermore, the use of titanium or stainless steel to manufacture the housing makes it to be long-lasting. The modification of the original Bjork-Shiley heart valve was to enable it to increase its opening angle as well as change graphite disc into a CC model or a convexo-concave shape.

                                             Problem with the Bjork Shiley heart valve

Nature of the problem and what it meant

            Outlet strut fractures (OSF) is one of the main problems that made the use of Bjork-Shiley heart valves to diminish. Once the deceased heart valves have been replaced with this device, after few months, t was found out that one end of the strut could fracture which is later preceded by the fracturing of the other end. The fracturing occurs as a result of brief and sudden impacts on the outlet strut connections. The fracturing of the outlet connections also occurs when the closing disc over-rotates for at least ten times so as to force the disc to open. This in return creates bending stress beyond the capacity that strut's survival limit (Topol & Califf, 2007 p.396). After multiple occurrences of the outlet strut tip overloading, it causes fatigue-induced fractures. The failure of the valve makes the disc to be disconnected from it hence resulting in the unregulated flow of blood. In case that malfunctioning is not detected immediately, it leads to cardiac death.

            Although the majority of these fractures have been realized to occur during premarket tests, one of the assumptions that were given was that it could have been brought by strut welding. Conversely, according to the views of Shiley Company, those failures were accidental. Because of that lower risks of thrombus in the newly designed heart valves were much more effective as compared to the small chances of the Outlet strut fractures (OSF). Even though the actual failure mechanisms were not yet known, the use of the Bjork-Shiley heart valves was approved by the FDA (Food and drug administration). The company was mandated by the FDA to provide a detailed report regarding any problem that could later arise in the process of using these valves to repair diseased or ailing valves (Aura, 2006 p.105). Regardless of those directives, it was discovered that patients were implanted with faulty Bjork-Siley heart valves.

Testing procedure used to understand the problem

            During the testing and validation of the problems associated with the Bjork-Shiley heart valve, 533 patients who had previously undergone heart valve replacement and who were qualified to receive warfarin were sampled randomly. Those who were sampled were the ones who were to be implanted with a mechanical Bjork-Shiley disc valve that tilts at 60⁰ or 70⁰. The Bjork-Shiley spherical disc heart valve advanced the CC (convexo-concave) model which was first introduced in the year 1979. The reason for that is because the CC model had subsequently proven to have a relatively strut fracturing rate. Out of the 533 patients randomly selected, 261 of them were subjected to mitral valve replacement while 211 of them were treated with aortic valve replacement. Despite that, both valves were replaced in 61 patients while 8 patients who had could have undergone extra tricuspid heart valve replacement were eliminated from further examination or analysis. Out of the total number of patients who were studied, 267 of them received the Bjork-Shiley prosthetic implants.

Figure 1: Number of outlet strut fractures (OSF) against years of outcome

            Y-axis

     80

     70

     60

     50

Frequency

     40

     30

     20

     10

                                                                                                                                               X-axis

                     1978  1980  1982  1984  1986   1988  1990  1992   1994   1996 1998   2000   2002

Year

            The patients’ age and clinical characteristics were recorded. During heart valve replacement, the patients’ mean SD (standard deviation) age was 54.3 (10.3) years and 53.8 (10.5) years respectively. The two treatment groups selected for analysis were comparable with other pre-treatment variables. Overall 56 % (295) of the study patients were female and 7.4% (39) of them have previously received heart valve replacement. At least 8% of them have reported suffering from ischaemic heart complications.

Table 1: Heart valve-related risk factors for outlet strut fractures (OSF)

            Nonetheless, from the testing conducted, it was found out that 50% of all the patients who were undergoing mitral heart valve replacement had initially suffered from mitral valvotomy. The age and the clinical conditions of surviving patients are also described in table 2 below. From the microscopic examination conducted, it was found out that there were no signs of structural defects of the explanted prosthetics. Only shallow abrasions were the ones that were noted on the heart's ventricular surface. From the data collected regarding the re-operative procedures recommended, it is found out that the mortality rate fluctuates or varies with age with younger patients experiencing lower mortality rates as compared to older patients. 

Table 2: Risk rates (RR) of outlet strut fracture (OSFs) incidence against patient age at clinical follow-up

Concluding remarks of the company

            From the test conducted, it was realized there was the possibility of outlet strut fractures (OSF) occurring the patient's diseased heart valve are replaced with the BSCC valve. Therefore, the company recommended that any patient with more than one of these valves ought to familiarize themselves with the symptoms associated with heart valve or valves that are not functioning normally. In case the outlet could have fractured, the normal clicking sound that is produced whenever the disc closes or opens ceases (Nelson et al., 2009 p.251). Other symptoms that are associated with these conditions include loss of consciousness, shortness of breath, rapid or irregular heartbeat, sharp chest pains, and so on.

             In case a patient experiences any of these symptoms, it is recommended for him or her to consult a doctor immediately. His or her condition can be examined using chest X-rays so as to view and determine the state of his or her heart valve. Likewise, for the patients who could have received the Bjork-Shiley heart valve and experienced new fractures, it is vital for them to make regular consultations with their physician (SYMPOSIUM-FATIGUE AND FRACTURE OF MEDICAL METALLIC MATERIALS AND DEVICES et al., 2007 p.77). The annual fracture rates of patients should also be approximated based on the position of valve implant, welder identity, weld date, valve size, accurate age of the patient, and so on.

How they arrived at these conclusions

            The testing conducted made FDA (food and drug administration) to be aware of the multiples incidences of fracturing of the outlet strut of the BSCC heart valve.  As a result of that, directives were given to Shiley Company to ensure that they regularly notify patients who were legible to receive CC valves about such a problem. Shiley Company decided not to recommend patients to undergo surgery as a therapeutic means for replacing the defective valve or valves. The reason underlying such an option is because of the anticipated re-operative risks associated with the replacement of those valves were relatively higher as compared to that of the fractured intact valve (Topol & Califf, 2007 p.396). Again, the company was required to ensure that they have notified all patients about the increased health risks of outlet strut fractures (OSF) depending on valve specifications and patient condition. 

            Furthermore, the report published after testing the validity of the Bjork-Shiley heart valve mandated the company to ensure that they have advised all patients about the importance of consulting their doctors about the newly discovered fractured figures and the challenges associated with valve replacement. In return, the company accepted the implantation of faulty valves in patients globally (Nelson et al., 2009 p.251). Although such recommendations were not clinically effective, the company accepted to pay $10 million more to cater for the medical expenses the government could have initially incurred or is anticipated to incur in the future because of the replacement of defective Bjork-Shiley heart valve in patients.

Ethical issues

             One of the ethical issues surrounding the use of the Bjork-Shiley heart valve is disc abrasion. Disc abrasion is perceived to be the initial step towards prosthesis heart valve dysfunction. Although it recommended that this condition be subjected to echocardiographic diagnosis, the whole process is challenging. The relatively high flow of blood across the prosthetics accompanied by shear-stress forces is the ones that have also been realized to make the causes of disc abrasion to be unclear. Despite that, the disc connection with the strut is another issue that ought to be taken into consideration (Topol & Califf, 2007 p.396). The reason for that is because the Bjork-Shiley heart valve has been realized to be prone to strut fracture which makes such a device not to function as anticipated.

            Furthermore, for patients who could have received the Bjork-Shiley prosthetic heart implants, bleeding occurs more often. Regular bleeding episodes frequently occur in patients receiving either mitral valve or aortic valve groups. Despite that, there exist no considerable differences in patients receiving both the aortic valve and the mitral valve. When both minor and major bleeding episodes occur, the risks of bleeding after the patient's damaged heart valves have been replaced with Bjork-Shiley heart valves are relatively higher (Ratner, 2013 p.1376). Such a higher risk of bleeding has been realized to have a likelihood of occurring in a patient with deceased or ailing aortic valve as compared to those undergoing mitral heart valve replacements. 

Conclusion

            The information presented in this essay suggests that medical regurgitations arising from wear of the BSD disc might arise in some heart valves after several years of implantation. From the engineering perspective, it means that there exists no solid reason to deduce an increasing rate of failure of this device because of fatigue or fracture. At least all of the information collected suggests that Bjork-Shiley tilting heart valve has the propensity of continuing to provide the required medical aid to patients. In case it occurs, at the slowest rate, BS disc wear offers enough time for not only diagnosis but also for non-emergency therapy. The same information stipulates the fact that it will not be logical to remove the Bjork-Shiley tilting heart valve prophylactically. As a result of that, it is important for clinicians to ensure that the treatment of patients should be based on individual requirements as well as according to the functionality of their heart valves.

References

ANDERSON, M., HEISTAD, D., KERBER, R. E., KANU, C., MARK, A., & DONALD, H. (2012). Cardiology. New Delhi, Jaypee Brothers Medical Publishers Private Limited. https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=4956170.

AURA, G. D. (2006). Engineering ethics: an industrial perspective. Boston, Elsevier Academic Press. http://site.ebrary.com/id/10138013.

BAURA, G. D. (2006). Engineering ethics: an industrial perspective. Boston, Elsevier Academic Press. http://site.ebrary.com/id/10138013.

NELSON, D. E., HESSE, B. W., & CROYLE, R. T. (2009). Making data talk: communicating public health data to the public, policy makers, and the press. Oxford, Oxford University Press. http://site.ebrary.com/id/10375099.

NEWTON, J., MYERSON, S., PRENDERGAST, B., SABHARWAL, N., & WESTABY, S. (2011). Oxford Specialist Handbooks in Cardiology: Valvular heart disease. Oxford, Oxford University Press.

RAJAMANNAN, N. M. (2014). Molecular biology of valvular heart disease. Springer Press.https://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=770541.

RATNER, B. D. (2013). Biomaterials science: an introduction to materials in medicine. [Place of publication not identified], Academic Press. http://site.ebrary.com/id/10627998.

RUNGE, M. S., PATTERSON, C., STOUFFER, G. A., & NETTER, F. H. (2010). Netter's cardiology. Philadelphia, Saunders/Elsevier. http://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20090357712.

SYMPOSIUM--FATIGUE AND FRACTURE OF MEDICAL METALLIC MATERIALS AND DEVICES, JERINA, K. L., & MITCHELL, M. R. (2007). Fatigue and fracture of medical metallic materials and devices. http://enterprise.astm.org/DIGITAL_LIBRARY/STP/SOURCE_PAGES/STP1481.htm.

TISDALE, J. E. (2010). Drug-Induced Diseases: prevention, detection, and management. Bethesda, MD, ASHP.

TOPOL, E. J., & CALIFF, R. M. (2007). Textbook of cardiovascular medicine. Philadelphia, Lippincott Williams & Wilkins.

WANG, A., & BASHORE, T. M. (2009). Valvular heart disease. Dordrecht, Humana Press. http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=511442.