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USC Lack of Informed Consent Prior to Treatment Randall V US Case Analysis Discussion

USC Lack of Informed Consent Prior to Treatment Randall V US Case Analysis Discussion.

I’m working on a health & medical writing question and need support to help me study.

Choose a case dealing with a question of whether a patient was given proper informed consent before a medical procedure or a case dealing with whether the patient was given proper informed consent in relation to withdrawal of medical treatment. You will need to give the facts of your case, the decision (holding) of the court, and the reasoning of the court. You will also need to explain, in detail, the elements of informed consent and why the informed consent was correct or incorrect. Finding case law is different than searching for other types of law. A legal professional would, most likely, use the legal search engines, Westlaw or Lexis, but these websites can be very expensive and very difficult to navigate for someone without specific training. The easiest websites for a non-legal professional to use to search for case law are:Cornell Law law.cornell.eduFindLaw caselaw.findlaw.comJustia law.justia.comThis paper should be at least two pages, using proper APA 7th edition format. Please be aware of how to cite case law in APA format; see this resource for assistance: https://owl.english.purdue.edu/owl/resource/583/03/
USC Lack of Informed Consent Prior to Treatment Randall V US Case Analysis Discussion

Singaporean Identification As Fundamental National Interests

What is Singapore’s fundamental national interests? We ask ? Most other countries including our neighbors, have abundance of natural resources such as oil, gas, wood, minerals and land. We, Singapore have only our people and financial reserves. Therefore it is our national interest to maintained a financial stronghold to secure investor confidence and enhance our economic and social stability by discouraging others who have ill intend towards us and also with effective diplomacy through friendly relations and close cooperation with the regional and international community. Identifying our national interest. The fundamental national interests of Singapore would be the one of national security through financial security. However in order for us to achieve a strong financial reserve, diplomacy plays an important role..”No one can predict times of crises. So, although some people have questioned the need to maintain large reserves, we believe that it is necessary to not only maintain, but indeed grow our reserves. We accumulate as much reserves as we can afford to during periods of strong economic growth, so that we will always be prepared.”1 With good diplomacy will in turn [1] provide a strong and stable economy to the country by drawing investors all over the world. Mr Lee Kuan Yew once said ” We had one simple guiding principle for survival, that Singapore had to be more rugged, better organised and more efficient then others in the region.” if not there is no reason for others to base here in Singapore. Therefore we had to make it possible and better then our neighbouring countries to attract investors to operate successfully and profitable despite our lack in natural resources. Through friendly relations and close cooperation with the regional and international community, we can be internationally recognize as credible, principled and constructive. We had strong and friendly relations with our neighbors, ASEAN countries and key regional players e.g. US, China, India, and Japan. We , continued to explore new avenues of cooperation and keep relations stable through various ways such as, DCA (Defence Cooperation Agreement), providing HADR (Humanitarian assistance Disaster Relief) to disaster hit countries. Continuing effort have been put in for deeper engagement with emerging markets including India, middle east etc. This outreach effort were made to expand Singapore’s international space. “Singapore will always be more rather than less dependent on external demands, as her small size limits the scope for domestic demand, it has no natural endowment, the only resources it can create are financial and human capital that can grow with wealth accumulation and recruitment of foreign experts”2 The government has also created 2 companies to manage the reserve and they are GIC (Government of Singapore Investment Corporation) and Temasek Holding. They are in-charge of management and growth of the reserves. “The government’s reserves are managed mainly by the Government of Singapore Investment Corporation (GIC) and Temasek Holdings. Whilst GIC’s investments are all made overseas, Temasek invests mostly in Singaporean companies.”3 It is noted that certain fundamentals have been constantly followed, such as interdependency of stability, security and prosperity. Therefore it is imperative for Singapore to achieve economic growth and prosperity. Without economic security, its position as an independent nation can be easily undermined. Diplomacy This aims particularly at fostering a relationship with neighboring countries, base on open and frank communication”, Singapore has used diplomacy not only to encourage a favorable regional trading regime, which it sees as vital for East Asia’s peace as well as prosperity.”4 The government in protecting our national interest has to gear it policies toward promoting economic development, achieving prosperity and protecting it process of nation building. Today policy requires us ensure a economic prosperity for the nation with improving assets and bargaining position. Our leaders since independence has gathered experience in dealing with diplomacy ” By 1965, having enjoyed six years in government, Prime minster Lee Kuan Yew and his colleagues were highly attuned to international cross-current, skilled in [3] diplomacy on an informal level, and had seized available diplomatic opportunities” 5 . A ministry was set up right after Singapore had declared his independence. From the time Singapore became an independent country , it has changes it strategy for an effective foreign policy, thus far achieving it goals of economic prosperity. We had a long history since then, having participate Trade and goodwill mission, making Trade agreements with other countries especially those that are close to us. Singapore has been at the cross-roads of international trade and commerce due to its geographical location. This has enable us to create a good linkages with Europe, India, China and America. So long there is stability, security and prosperity within our borders and maintaining close ties and harmonious relationship with our neighboring countries our foreign policy would be a successful one in protecting Singapore national interest. With the uniqueness of our country, our government demonstrated to us that it is working in the best interests of the nation, that will remain clean and non-corrupt, promoting a pro-business environment for businesses to flourish, this close partnership will remain strong.” It is well recognized that Singapore’s economic success is built on the global economy. What is not recognized is that the global economy is the foundation of its national security as well”6. Security As mention, Singapore’s national security relies much on the global economy. Therefore careful steps in foreign relations and ‘defense diplomacy’ is put in place to safeguard our national interest. Back in “21 September 1965, Singapore was officially admitted into the United Nations (UN) as its 117th member when it was merely six weeks old. Joining the international organization was crucial step for Singapore to safeguard its sovereignty through collective security.”7 Singapore had defense relation with this countries: Israel ( providing training to SAF soldiers, defense equipment and technology). Taiwan ( providing army training ground ), FPDA ( defense relations), Australia, New Zealand and United States just to name a few. Singapore needs external support for the nations security,with the inability of ASEAN to promote our military or economic security, we are left with one option “security through participation in global economy”. We invite foreign participation into our economy, “it created stakes for external powers to protect Singapore in order to protect their own economic interests.”8. Therefore Singapore has adopted a structure of Economic development and national security goes hand in hand, while other country view it as a threat to their sovereignty with foreign investment, we sees it as [6] a source for reducing vulnerability. With rapid growth in economy means [6] big money for defense expenditures, the expenditure enable us to acquire some of the latest military equipments. Its air force has aircraft, missile and radar systems which are unmatched in the region. 9 . It is clear that in-order for Singapore to reduce vulnerability in South East Asia, we must open up our economy to the western trade and investment. Alternative fundamental national interest Total defense – Stopping threats right from the start with a deterrent capability. This in turn would help to covers Singapore internal security while our external security is tie to our open economy. The Total defense which comprise of 5 elements, there are : Military defense, Social defense, Economic defense, Civil defense and Psychological defense. Each is responsible by a government department. Emphasis was place in total defense by the country to promote deterrences. Total defense awareness was disseminated to the public via various means such as through radian and TV media, news letters etc. Psychological defense (Pd) comes about due to the uniqueness of Singapore population with various descendent’s from other parts of Asia. Pd emphasis on harnessing a collective will of Singaporean to stand up for their rights and protect what is theirs. In order to do this holistically, a National Education (NE) programme is created to bring fore this message. Singapore is our homeland. This is where we belong Singapore is worth defending. We want to keep our heritage and our way of life. Singapore can be defended. United, determined and well-prepared we shall fight for the safety of our homes and the future of our families and children. We must ourselves defend Singapore No one else is responsible for our security. We can deter others from attacking us. With Total defense, we can live in peace.” ibid 13-14 Social defense works in tandem with Pd, both defenses is to link all differences ( ethnic, religious cultural) as one, and to build a multi racial, multi cultural society. Civil defense is created to protect civilian lives, minimize damage to infra during the time of war. This would send a clear signal to the front line soldiers that their family is been taken care off during the time of war. Military defense is the core to the TD in providing deterrence and its capability in defeating its enemy if deterrence fail. 6% of our country GDP goes into the defense budget. This in turn would allow the SAF to acquire latest technology and increase its military capability. Conclusion Singapore is a small country with no natural resources. It achieved independence in 1965, at which time it had a population of 1.9 million and growing at a rate of 2.5% per annum, The economy was highly dependent on opening up its economy to foreign investors and trade. Our fundamental national interest would the national security through financial securities. In order achieve that, defense diplomacy and foreign relations plays a big part. With foreign relation strengthen and foreign investors flocking into Singapore with faith and trust, this itself prove to be a deterrence to any ills intends towards Singapore as foreign investors is still also interested in protecting their asset here. Thereby providing a win-win situation. In order for foreign investor to feel safe, Singapore had embark in various HADR missions to prove our worth, taking active interest in global affairs, engaging those who are friendly to us and stand up to our believes. We had many bi / multi lateral defense exercises with many countries to prove our good relation with them. We had prove to them a good leadership to protect our national interest, high standards of government, optimization of our limited resources, large international space and long term vision. We enjoy good relations with all the key powers, participate activety in ASEAN, APEC and other regional forums. These are important platforms to strengthen co-operation n management of conflicts Therefore with strong economic, brings along strong financial, in-turn provide a security blanket to the nation.

Hypertension And Blood Pressure

help me with my homework Share this: Facebook Twitter Reddit LinkedIn WhatsApp Hypertension is a common and major cause of stroke and other cardiovascular disease. There are many causes of hypertension, including defined hormonal and genetic syndromes, renal disease and multifactorial racial and familial factors. It is one of the leading causes of morbidity and mortality in the world and will increase in worldwide importance as a public health problem by 2020 (Murray and Lopez 1997). Blood pressure (BP) is defined as the amount of pressure exerted, when heart contract against the resistance on the arterial walls of the blood vessels. In a clinical term high BP is known as hypertension. Hypertension is defined as sustained diastolic BP greater than 90 mmHg or sustained systolic BP greater than 140 mmHg. The maximum arterial pressure during contraction of the left ventricle of the heart is called systolic BP and minimum arterial pressure during relaxation and dilation of the ventricle of the heart when the ventricles fill with blood is known as diastolic BP (Guyton and Hall 2006). Hypertension is commonly divided into two categories of primary and secondary hypertension. In primary hypertension, often called essential hypertension is characterised by chronic elevation in blood pressure that occurs without the elevation of BP pressure results from some other disorder, such as kidney disease. Essential hypertension is a heterogeneous disorder, with different patients having different causal factors that lead to high BP. Essential hypertension needs to be separated into various syndromes because the causes of high BP in most patients presently classified as having essential hypertension can be recognized (Carretero and Oparil 2000). Approximately 95% of the hypertensive patients have essential hypertension. Although only about 5 to 10% of hypertension cases are thought to result from secondary causes, hypertension is so common that secondary hypertension probably will be encountered frequently by the primary care practitioner (Beevers and MacGregor 1995). In normal mechanism when the arterial BP raises it stretches baroceptors, (that are located in the carotid sinuses, aortic arch and large artery of neck and thorax) which send a rapid impulse to the vasomotor centre that resulting vasodilatation of arterioles and veins which contribute in reducing BP (Guyton and Hall 2006). Most of the book suggested that there is a debate regarding the pathophysiology of hypertension. A number of predisposing factors which contributes to increase the BP are obesity, insulin resistance, high alcohol intake, high salt intake, aging and perhaps sedentary lifestyle, stress, low potassium intake and low calcium intake. Furthermore, many of these factors are additive, such as obesity and alcohol intake (Sever and Poulter 1989). The pathophysiology of hypertension is categorised mainly into cardiac output and peripheral vascular resistant, renin- angiotensin system, autonomic nervous system and others factors. Normal BP is determined and maintained the balance between cardiac output and peripheral resistant. Considering the essential hypertension, peripheral resistant will rise in normal cardiac output because the peripheral resistant is depend upon the thickness of wall of the artery and capillaries and contraction of smooth muscles cells which is responsible for increasing intracellular calcium concentration (Kaplan 1998). In renin-angiotensin mechanism endocrine system plays important role in maintain blood pressure; especially the juxtaglomerular cells of the kidney secrete renin in order to response glomerular hypo-perfusion. And also renin is released by the stimulation of the sympathetic nervous system which is later convert to angiotensin I then again it converts to angiotensin II in the lungs by the effect of angiotensin- converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and also it released aldosterone from the zona glomerulosa of the adrenal gland which is responsible for sodium and water retention. In this way, renin-angiotensin system increases the BP (Beevers et al 2001). Similarly, in autonomic nervous system sympathetic nervous system play a role in pathophysiology of hypertension and key to maintaining the normal BP as it constricts and dilates arteriolar. Autonomic nervous system considers as an important in short term changes in BP in response to stress and physical exercise. This system works together with renin-angiotensin system including circulating sodium volume. Although adrenaline and nor-adrenaline doesn’t play an important role in causes of hypertension, the drugs used for the treatment of hypertension block the sympathetic nervous system which had played proper therapeutic role (Beevers et al 2001). Others pathophysiology includes many vasoactive substance which are responsible for maintaining normal BP. They are enothelin bradikinin, endothelial derived relaxant factor; atrial natriuretic peptide and hypercoagulability of blood are all responsible in some way to maintain the BP (Lip G YH 2003). The seventh report of the Joint National Committee (JNC-VII) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines some important goals for the evaluation of the patient with elevated BP which are detection and confirmation of hypertension; detection of target organ disease (e.g. renal damage, congestive heart failure); identification of other risk factors for cardiovascular disorders (e.g. diabetes mellitus, hyperlipidemia) and detection of secondary causes of hypertension (Chobanian et al 2003). Most hypertensive patients remain asymptomatic until complications arise. Potential complications include stroke, myocardial infarction, heart failure, aortic aneurysm and dissection, renal damage and retinopathy (Zamani et al 2007).The drug selection for the pharmacologic treatment of hypertension would depend on the individual degree of elevation of BP and contradictions. Treatment of non-pharmacologic hypertension includes life-style, weight reduction, exercise, sodium, potassium, stop smoking and alcohol, relaxation therapy and dietary improvements, followed by pharmacology therapy. Commonly used antihypertensive drugs include thiazide diuretics, β-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, direct vasodilators and α-receptor antagonists which are shown in the following table. Diuretics have been used for decades to treat hypertension and recommended as first-line therapy by JNC-VII guidelines after antihypertensive and lipid-lowering treatment to prevent heart attack trail (ALLHAT) success. They reduce circulatory volume, cardiac output and mean arterial pressure and are most effective in patients with mild-to- moderate hypertension who have normal renal function. Thiazide diuretics (e.g. hydrochlorothiazide) and potassium sparing diuretics (e.g. spironolactone) promote Na and Cl- excretion in the nephrone. Loop diuretics (e.g. furosemide) are generally too potent and their actions too short-lived, however, they are useful in lowering blood pressure in patients with renal insufficiency, who often does not respond to other diuretics. Diuretics may result in adverse metabolic side effects, including elevation of creatinine; glucose, cholesterol, triglyceride levels, hypokalemia, hyperuricemia and decreased sexual function are potential side effects. The best BP lowering response is seen from low doses of Thiazide diuretics (Kaplan 1998). Β-blocker such as propranolol are believed to lower BP through several mechanisms, including reducing cardiac output through a decrease heart rate and a mild decrease in contractility and decreasing the secretion of renin, which lead to a decrease in total peripheral resistant. Adverse effects of b-blockers include bronchospam, fatigue, impotence, and hyperglycemia and alter lipid metabolism (Zamani et al 2007). Centrally acting α2-adrenergic agonists such as methyldopa and clonidine reduce sympathetic outflow to the heart, blood vessels and kidneys. Methyldopa is safe to use during pregnancy. Side effect includes dry mouth, sedation, drowsiness is common; and in 20% of patients methyldopa causes a positive antiglobulin test, rarely haemolytic anaemia and clonidine causes rebound hypertension if the drug is suddenly withdrawn (Neal M J 2009). Systemic a1-antagonists such as prazosin, terazosin and doxazosin cause a decrease in total peripheral resistance through relaxation of vascular smooth muscle. Calcium channel blockers (CCB) reduce the influx of Ca responsible for cardiac and smooth muscle contraction, thus reducing cardiac contractility and total peripheral resistant. Thus long-acting members of this group are frequently used to treat hypertension. There are two classes of CCB dihyropyridines and non- dihyropyridines. The main side effect of CCB is ankle oedema, but this can sometimes be offset by combining with β-blockers (Lip G YH 2003). Direct vasodilators such as Hydralazine and minoxidil lower BP by directly relaxing vascular smooth muscle of precapillary resistance vessels. However, this action can result in a reflex increase heart rate, so that combined β-blocker therapy is frequently necessary (Neal M J 2009). ACE inhibitors works by blocking the renin-angiotensin system thereby inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors may be most useful for treating patients with heart failure, as well as hypertensive patients who have diabetes. Using ACE inhibitors can lead to increased levels of bradikinin, which has the side effect of cough and the rare, but severe, complication of angioedema. Recent study demonstrated that captopril was as effective as traditional thaizides and β-blockers in preventing adverse outcomes in hypertension (Lip G YH 2003). Angiotensin II antagonists act on the renin-angiotensin system and they block the action of angiotensin II at its peripheral receptors. They are well tolerated and very rarely cause any significant side-effects (Zamani et al 2007). Another helpful principle of antihypertensive drug therapy concerns the use of multiple drugs. The effects of one drug, acting at one physiologic control point, can be defeated by natural compensatory mechanism (e.g. diuretic decrease oedema occurring secondary to treatment with a CCB). By using two drugs with different mechanisms of action, it is more likely that BP and its complication are controlled and with the low dose range of combined drugs also help to reduce the side-effects as well (Frank 2008) . The following two-drug combinations have been found to be effective and well tolerated which are diuretic and β-blocker; diuretic and ACE inhibitor or angiotensin receptor antagonist; CCB (dihydropyridine) and β-blocker; CCB and ACE inhibitor or angiotensin receptor antagonist; CCB and b-diuretic; α-blocker and β-blocker and other combinations (e.g. with central agents, including α2-adrenoreceptor agonists and imidazoline- I2 receptor modulators, or between ACE inhibitors and angiotensin receptor antagonists) can be used (ESH and ESC 2003). If necessary, three or four drugs may be required in many cases for the treatment. The use of a single drug will lower the BP satisfactorily in up to 80% of patients with hypertension but combining two types of drugs will lower BP about 90%. If the diastolic pressure is above 130 mmHg then the hypertensive emergency is occurred. Although it is desirable to reduce the diastolic pressure below 120 mmHg within 24 hours in accelerated hypertension, it is usually unnecessary to reduce it more rapidly and indeed it may be dangerous to do so. This is because the mechanisms that maintain cerebral blood flow at a constant level independent of peripheral BP are impaired in hypertension. However, it is important to reduce the BP quickly by giving the intravenous drugs but caution should be taken to avoid cerebrovascular pressure inducing cerebral ischemia (Grahame-Smith and Aronson 2002). In conclusion, hypertension emerges as an extremely important clinical problem because of its prevalence and potentially devastating consequences. The major classes of antihypertensive drugs: diuretics, β-blockers, CCB, ACE inhibitors and angiotensin receptor antagonists, are suitable for the initiation and maintenance of antihypertensive therapy which helps in reduction of cardiovascular morbidity and mortality. 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Dopamine Hypothesis

Critically evaluate the role of the Dopamine Hypothesis in Schizophrenia. Schizophrenia is a severe mental illness that affects an individual’s ability to function normally. The symptoms of schizophrenia resemble the symptoms of psychosis; however psychosis is not a defining feature of schizophrenia. According to the DSM-IV-TR the symptom characteristics of schizophrenia can be described as comprising cognitive and emotional dysfunctions that include dysfunctions of perception, inferential thinking, language and communication, behaviour monitoring, affect, fluency, productivity of thought and speech and attention (Davey, 2008). Over the past 5 decades there has been a vast amount of research on the etiological causes of schizophrenia, involving Psychological, Biological, Social and Cognitive factors. Some researchers would argue that schizophrenia is mainly due to biology; however there are still aspects of biology that are argued to be more specific than others. Schizophrenia is widely believed to have a neurobiological basis in which a number of neurotransmitters are thought to play a role in the symptoms of schizophrenia in the brain. This has resulted in the production of many hypotheses for the cause of schizophrenia. The biochemical theory of schizophrenia that has been the most prominent for many years is known as the dopamine hypothesis. This theory argues that the symptoms of schizophrenia are related to the increased level or excessive amount of dopamine neurotransmitter in the brain. The dopamine theory originated from observations of the dopamine-blocking actions of early neuroleptic or antipsychotic drugs (Moncrieff, 2009) in which pharmacological evidence indicated, drugs that decrease the dopamine activity such as phenothiazines are antipsychotic and drugs that promote dopamine action such as amphetamine are psychotominmetic. Schneider and Deldin (2001) claimed that antipsychotic drugs act by blocking the brain’s dopamine receptor sites therefore reducing dopamine activity. However the problem with the antipsychotic drugs is that it only alleviates the positive symptoms of schizophrenia thus a possible criticism for the dopamine hypothesis is that it does not solve the problem of the negative symptoms. According to Thomas (1997) there is much evidence to suggest that negative symptoms are associated with reduced dopamine activity. Also another issue with this theory is that the functions of the neuroleptic drugs produce side effects which induce resembling symptoms of Parkinson’s disease as a result of the reduction of the dopamine levels. Nevertheless there have been a number of factors that have led to the implication of excess dopamine activity in the brain. Grilly (2002) proposed that when individuals who suffered from Parkinson’s disease, were given the drug L-dopa to increase the level of dopamine, they began to show psychotic symptoms. Therefore this may suggest strong evidence towards high levels of dopamine or excess dopamine in the brain, being responsible for many of the symptoms of psychosis. However research by Bradford (2009) found that low levels of glutamate in the cerebrospinal fluid in the brain is involved in the development of schizophrenia involving phencyclidine and ketamine. Together they have been shown to induce psychosis in humans that closely resembles schizophrenia and are representative of not only the positive symptoms and cognitive defects of the disease but also in part the negative symptoms. On the contrary another support to the dopamine hypothesis is the link between excessive use of amphetamines and symptoms of psychosis. According to Angrist et al. (1974) these symptoms include paranoia and repetitive, stereotyped behaviour patterns. The function of amphetamine drugs is to increase the level of dopamine activity; therefore giving this drug to Schizophrenics would increase the severity of the symptoms. However as mentioned previously, giving antipsychotic drugs such as phenothiazines reverses the effects of drugs such as amphetamines in non-schizophrenics. Therefore this gives great support for the dopamine hypothesis in that dopamine levels influences the intensity of schizophrenic symptoms. However many researchers such as Carlsson (2001) have found that although antipsychotics are usually effective in dealing with the positive symptoms of schizophrenia, they do not start having an effect until about 6 weeks after the treatment has commenced. This seems peculiar as past research has found these drugs to start blocking dopamine receptors in the brain immediately. Other research on brain imaging studies have also indicated that individuals diagnosed with schizophrenia show excessive levels of dopamine released from areas of the brain such as the basal ganglia – especially when biochemical precursors to dopamine such as L-dopa are administered to the individual (Carlsson, 2001). Post-mortem findings by Seeman and Kapur (2001) have involved an increased level of dopamine and significantly more dopamine receptors in the brains of deceased schizophrenic sufferers, especially in the limbic areas of the brain. Owen et al (1986) found the same results however in his study on post-mortems; he established that the patients had been on antipsychotic drugs for many years. Wong et al. (1986) on the other hand found that the deceased who suffered from schizophrenia had increased amounts of dopamine receptors but these patients were medication free. Although both these studies give strong evidence for the link between dopamine and schizophrenia, a problem occurs when studies such as these find differences between schizophrenic subjects which appear to be conflicting or inconsistent. Therefore although the dopamine hypothesis gives a good account of the aetiology of schizophrenia, it appears to be incomplete in some aspects of neropsychopharmacology. A major problem with the dopamine hypothesis is that it only takes into account a single neurotransmitter and therefore does not consider the interaction of other neurotransmitters. For many years, biological research has focussed on the dopamine hypothesis and the effects of antipsychotics in blocking dopamine D2 receptors. It has therefore ignored other hypotheses on neurotransmitters such as glutamate. According to the glutamate hypothesis of schizophrenia, the under-activity of the neurotransmitter glutamate, contributes to psychosis. Therefore to alleviate psychosis, schizophrenia advocates the stimulation of glutamate receptors. Kalat (2007) claims that in many of the brain areas, dopamine inhibits glutamate release or glutamate stimulates neurons that inhibit dopamine release. Therefore an increase in dopamine would produce the same effects as decreased glutamate. Another major neurotransmitter to play a key role in schizophrenia is that of serotonin. Many researchers have placed emphasis on the role of serotonin whereby the blockage of the receptors by newer antipsychotic drugs, alleviate psychotic symptoms. Iqbal and Van Praag (1995) looked at the effects of compounds such as antipsychotics, blocking serotonin receptors in which they reported potential and established antipsychotic effects. To support this finding, previous several controlled studies found that Ritanserin, a selective serotonin (5HT2a) receptor blocking agent, with no effect on dopamine receptors had been shown to alleviate psychotic symptoms with a preference for negative symptoms (Gelders et al., 1985). However although this research showed positive outcomes much drug development focused on the interaction between dopamine and serotonin of schizophrenia. According to Nordstrom et al. (1995) many new antipsychotic drugs appear to be effective, as not only do they block dopamine receptors but serotonin receptors too. Therefore this has led to many researchers looking into the possibility that psychotic symptoms may not be related to excess dopamine activity alone, but to an interaction between dopamine and serotonin activity. Kahn and Davidson (1993) claimed that preclinical studies have shown that at least some of the clinical effects of neuroleptics may be due to an alteration of interactions between dopamine and serotonin. Over the years, extensive investigation has given rise to numerous neurochemical hypotheses of the aetiology and pathophysiology of schizophrenia. Dopamine, Glutamate and Serotonin have given significant insight into the cause of schizophrenia, but more emphasis has been placed on dopamine. Schizophrenia is a sufficiently complex disorder but all three neurotransmitters play important roles in this disorder, perhaps to different degrees in different individuals. Therefore to conclude, although the dopamine hypothesis has been largely researched upon, it is not the only one neurotransmitter to play a key role in schizophrenia. Much research has accentuated the importance of other neurotransmitters such as serotonin and glutamate. The problem with the dopamine hypothesis is that it does not take into account the interactions between different neurotransmitters; therefore it is important to understand that the role of dopamine affects different areas of the brain thus influencing the role of other neurotransmitters. However the dopamine hypothesis has been the most prevalent theory and neurotransmitter for the etiology of schizophrenia despite its criticisms. Gottesman (1991) quoted that “because the most effective drugs used to treat schizophrenia block dopamine receptors and because agents that make schizophrenia worse increase dopamine levels, the hypothesis has made sense and has had remarkable survival in a rapidly changing bioscience environment”. References: Angrist, B., Lee, H. K.

Strategic Plan Part III: Balanced Scorecard and Communication Plan

Strategic Plan Part III: Balanced Scorecard and Communication Plan.

THIS IS A CONTINUATION ASSIGNMENT FROM THE PRIOR TWO WEEKS. I’VE ATTACHED THE OTHER TWO ASSIGNMENTS WITH THE PROFESSORS FEEDBACK. PLEASE ADJUST THIS ASSIGNMENT ACCORDINGLY. I’VE ALSO ATTACHED THE MATERIALS NEEDED FOR THE ASSIGNMENT.Purpose of Assignment Students will have the opportunity to develop a Balanced Scorecard. This, in turn, will allow them to create effective strategic objectives to be included as part of their overall strategic plan. They will also be presented with the task of creating a brief communication plan that will be used by their proposed division to efficiently distribute information with regard to their strategic initiatives. Assignment Steps Resources: Strategic Planning Outline and Week 4 textbook readings Create a minimum 1,050-word strategic objectives summary. Include your balanced scorecard and its impact on all stakeholders, and the communication plan.Identify key trends, assumptions, and risks in the context of your final business model.Develop the strategic objectives for your new division of the existing business in a balanced scorecard format in the context of key trends, assumptions, and risks. The strategic objectives are measures of attaining your vision and mission. As you develop them, consider the vision, mission, and values for your business and the outcomes of your SWOTT analysis. Consider the following four quadrants of the balanced scorecard when developing your strategic objectives:Shareholder Value or Financial Perspective, which includes strategic objectives in areas such as:Market shareRevenues and costsProfitabilityCompetitive positionCustomer Value Perspective, which includes strategic objectives in areas such as:Customer retention or turnoverCustomer satisfactionCustomer valueProcess or Internal Operations Perspective, which includes strategic objectives in areas such as:Measure of process performanceProductivity or productivity improvementOperations metricsImpact of change on the organizationLearning and Growth (Employee) Perspective, which includes strategic objectives in areas such as:Employee satisfactionEmployee turnover or retentionLevel of organizational capabilityNature of organizational culture or climateTechnological innovationEvaluate potential alternatives to the issues and/or opportunities identified in the SWOTT Analysis assignment and table you completed in Week 3.Create at least three strategic objectives for each of the four balanced scorecard areas. Base your solutions on a ranking of alternative solutions including the following:Identify potential risks and mitigation plans.Analyze a stakeholder and include mitigation and contingency strategies.Incorporate ethical implications.Develop a specific metric and target for each strategic objective using a balanced scorecard format. Example: a strategic objective in the shareholder or financial perspective is to increase market share. A metric to actually measure this strategic objective of market share increase is, “The percentage of increase in market share.” The target is the specific number to be achieved in a particular time period. The target for the metric of “Increase market share” could be “Increase market share by 2% for each of the next 3 years” of an increase of 2% per year for 3 years.Outline a brief communication plan discussing how you will communicate the company’s strategic objectives including the following:Define the purpose.Define the audience.Identify the channel(s) of communication and why you selected that channel.Format your assignment consistent with APA guidelines.
Strategic Plan Part III: Balanced Scorecard and Communication Plan

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