Social Work Case Study | Essay

Social Work Case Study | Essay Case study: Jenny Eleanor This essay will focus on the current situation of Jenny, a single parent, and Eleanor, her six year old daughter, who currently live on a large local authority housing estate. Whilst close attention will be paid to their situation and the needs arising out of it, it is not the substantive function of this paper to prescribe specific courses of action in their case only. Rather, it is to identify and discuss the issues raised by their case, considering the appropriate social work processes, policy, and legal framework. Overall, it will be argued that there are two significant issues to be explored through the circumstances of Jenny and Eleanor’s case. Firstly, the nature and effectiveness of multi-agency working in education and the human services, and secondly, the problems faced by these professionals when adults, either deliberately or through incapacity, are not fully cooperative in ensuring the appropriate care of their child. As McCullough points out, ‘Throughout th e UK, provision and means of delivering children’s services have been changing profoundly. Predominant among the reasons driving these changes is concern about the way in which children are kept safe.’ (McCullough 2007: p.27) The paper will therefore discuss these issues, taking into account how such issues may be dealt with in a context of evidence-based and anti-discriminatory practice. In the first instance it may be helpful to include a brief synopsis of the known facts about Jenny and Eleanor’s situation, as a guide to identifying their needs. The case study reports that they are from a White British background: they live in a local authority housing estate which, it is stated, is regarded as ‘rough’, i.e. socially problematical and economically deprived. This categorization is not supported by any objective assessment, such as referral to any social scales or indices, and so appears rather unscientific and possibly discriminatory. Jenny and Eleanor have experienced five different housing placements in the last seven years. Jenny has been the victim of domestic violence, both in previous relationships and from Derek, her current partner and Eleanor’s father. Eleanor was unfortunately the witness to many of the assaults on her mother, and is herself thought to have been the subject of violence from her father. As the result of one of the assault on Jenny, Derek was awarded two year custodial sentence, and is currently expected to be released in four months time: he requested contact with Eleanor whilst in custody. Eleanor is enrolled at a local primary school, where records reveal that her attendance is low and represents a cause for concern: she has appeared withdrawn, and on occasions been violent towards other pupils. Furthermore, the school nurse has registered concerns about Eleanor’s development. In the light of these facts, it is now up to the relevant services to make the appropriate arrangements, using such measures as the statutory and policy frameworks allow. One of the principle factors in their immediate future the matter of Derek’s release from custody is beyond the control of those agencies immediately involved in Jenny and Eleanor’s welfare, so it is up to them to make their dispositions accordingly in the light of this contingency. What follows is a discussion of the relevant issues as they arise out of the jurisdictions, expertise, and responsibilities of the various agencies involved. This discussion will start with the subject who is likely to be of most concern to the educational and human services, i.e. the most vulnerable individual, Eleanor. As a six year old, she is the only person in the situation who does not have self-determination, is consequently reliant on the various agencies appointed for her care: it is now up to them to ensure this is ensured. As Myers-Blair points out, ‘The basic equipment for emotional development (physical and neural) is present at birth, and in a very diffuse way emotional behaviour begins at birth, or perhaps even before.’ (Myers-Blair, 1975: p.60). The immediate concerns over Eleanor’s welfare devolve upon two separate but related spheres: her school and home life. The relevant professionals must unravel the intertwining requirements and responsibilities inherent in this situation. However, as the Department for Children, Schools and Families itself acknowledges, ‘The professional background of workers is both a strength and a barrier to multi-agency working. As each profession has developed its own language and body of knowledge, it not only serves to provide a professional identity but can alienate those outside the profession who do not share their language or way of thinking. Professionals also develop a different way of working in order to achieve their aims.’ (DCSF, 2007: p.5) Obviously, all of these considerations must proceed from the basis that Eleanor is physically safe, with possible physical abuse from Derek, the previously violent partner, being the most obvious threat to this. If sufficient evi dence of this threat is assembled, then the multi-agency effort is largely irrelevant, since the Local Authority, through the Social Services Directorate, will have a clear responsibility to act accordingly under sections 27 and 17 of the Children Act 1989, and remove her from the situation. The decision as to whether any contingent arrangements involve Eleanor only, or Eleanor and Jenny, will depend on the perceived or actual threat, and Jenny’s position in relation to this. As Asen pointedly reminds us, ‘When professionals are unable to decide whether to let the children remain with its natural family or not, this indecisiveness can be abusive in its own right: it leaves the child in a situation of limbo – which in some cases can last years – further adding to the child’s emotional or physical suffering.’ (Asen, 2000: p.227) Depending upon how matters proceed in relations between Jenny and Derek, Social Services will also be responsible for the next level of care, i.e. ensuring that Eleanor is not suffering from any forms of neglect or subsidiary abuse arising out of the situation. Assuming that this situation is being monitored, the weight of responsibility shifts back into the educational environment: this is not to say that the social worker loses control of the situation, or becomes less relevant to Eleanor’s care: quite the contrary. In fact, by virtue of the serious nature of Eleanor’s home situation, they may well become the ‘lead professional’ within the multi-agency effort, as will be discussed below. It is simply the case that the all the professionals involved effectively have their actions governed by overlapping and interlocking statutes. At present, the latter stipulate that Eleanor should be in school: that school will almost certainly be a mainstream school, i.e. not a PRU (Pupil Referral Unit) or other specialized facility: furthermore, the law provides that every professional effort should be made to ensure that Eleanor is supported in achieving the expected educational progress. This in essence is where the social w ork and educational efforts will interact: since achievement of the expected progress will hinge upon Eleanor’s mental and physical well-being, as well as her innate cognitive ability, the home and school environments will become linked around this effort. The essential point here is that the social services case worker will be reliant on the judgment and expertise of the school based professionals with respect to Eleanor’s learning and emotional well-being. This is very much an open-ended process: a number of successive measures and support systems will have to be put into place before any alternative or specialized provision is even considered. In the first instance, the school’s Child Protection Officer – usually the Headteacher in the context of a Primary school like Eleanor’s – will feedback directly to Social Services, if there is any evidence of abuse. The school Special Educational Needs Coordinator will subsequently be responsible f or ascertaining whether or not Eleanor has any educational or emotional special needs: if so, she must have an IEP (Individual Education Plan) classified as Step One, Two or Three, depending on their severity. The latter will also determine whether or not Eleanor may require a Statutory Statement of Educational Needs (usually referred to simply as a ‘statement’). If so, she may qualify for additional support through the Local Educational Authority’s Statutory Assessment Office. This in turn will involve the Educational Psychology Service, who will have to make a formal assessment based on observation of Eleanor in a school context. If it is deemed appropriate, she will also be referred to the Primary Behaviour Support Service, the School’s Pastoral Support Service, the Family Support Service, and the Primary Mental Health Service. What are the implications of these potential multiple referrals from a practical point of view? As the DCFS guidance advises, ‘It is the processes involved in building relationships between agencies and between providers of services and the communities they serve, which is vital, because this is where the real work has to be done. It is a real challenge to us all, not least finding the time and space to work on these issues when many services are provided from at least 8 am to 6 pm, five days a week.’ (DCSF, 2007: p2). What this euphemizes is the attempted integration of services which proceed from a series of parallel and successive statutes. This include the Children Act 1989, the Children Act 2004, the Education Act 2002, the Learning and Skills Act 2000, the Disability and Discrimination Act 1995, The Special Educational Needs Code of Practice 2001, the Special Educational Needs and Disability Act 2001, and the Data Protection Act 1998. The school based effort, into which the social worker must be integrated, is built around the role of the Inclusions Officer, who must in turn convene a school-specific inclusions team comprised of all the practitioners involved. Whilst all of this sounds fine on paper, the practical challenges of coordinating the support and care of a child in Eleanor’s situation cannot be underestimated. Take, for example, the role of the Lead Professional itself. As the Children’s Workforce Development Council concedes, ‘A lead professional is not a job title or a new role, but a set of functions to be carried out as part of the delivery of effective integrated support.’ (CWDC, 2007: p.5). In other words, the role is titular only and attracts no timetabling facility or resources, but must run parallel – and crucially, in addition to – the practitioner’s other responsibilities. As the CWDC frankly puts it, ‘†¦clear communication is necessary between both services so that the individual is not overwhelmed with lead professional and caseload responsibilities. Speak to your manager to ensure that they take account of any lead professional responsibilities in setting yo ur workload, and that your performance in delivering the lead professional functions is recognized and recorded.’ (CWDC 2007: p.2, para 3.14). This is far more than a Human Resources issue however. The whole rationale of the multi-agency movement and Every Child Matters initiative is to mitigate the kind of short-circuits, doublings-up and straightforward mismanagement which contributed to the Victoria Climbie tragedy. As McCullough reminds us, ‘In Laming’s detailed and damning report, twelve different occasions were identified when appropriate intervention by one or more of these agencies could have saved Victoria’s life†¦in his summing up, Laming noted that â€Å"the legislative framework for protecting children is basically sound. I conclude that the gap is not a matter of law but in its implementation.†.’ (McCullough 2007: p.28). The problem is that whilst the role of the lead practitioner is non-statutory, the responsibilities accru ed by the incumbent are not. As the CWDC again concedes, ‘†¦There are particular implications for staff who may be working part-time in a multi-agency setting and part-time in their home agency.’ (CWDC 2007: p.2, para 3.14). Arguably then, the same issues which underlay Victoria’s death are potential factors in any such case, including Eleanor’s. The mere creation of a job title, i.e., Lead Practitioner, or mechanisms such as the Common Assessment Framework, guarantees nothing if the staff involved are overstretched, unsupported and undirected. The fact that Jenny has cancelled two possible contact appointments so far is disappointing, and may well represent an impediment to the advancement of Eleanor’s care in the future. At present however, it does not constitute an insurmountable barrier to the coordinated effort of the multi-agency team, and definitely is not a pretext for inaction on their part. As the school has noted, Eleanor’s emotional well-being is questionable, indicating a serious potential impediment to her progress. As Meadows indicates, ‘Certain emotional states are frequent and salient, and become parts of feeling about the self, so that they can then influence a wide range of behaviours, such as perception, emotional expression, cognitive processing and social relations.’ (Meadows, 2006: p.438) Instruments in an around the curriculum, such as the SEAL (Social and Emotional Aspects of Learning) programme may be used to help Eleanor externalize and come to terms with the events whic h have shaped her experience: essentially these means must be tried in order to redress any lack of emotional support she is receiving at home. As Maslow points out, ‘†¦thwarting of these needs produces feelings of inferiority, of weakness, and of helplessness. These feelings in turn give rise to either basic discomfort, or else compensatory or neurotic trends.’ (Maslow, 1970: P.1) Also, as Samuels reminds us, ‘Basically, if the child’s needs are not met appropriately at each developmental level, the psyche becomes unable to adequately regulate self-esteem by the use of adequate mechanisms.’ (Samuels, 1977: p. 35). The problem is that, whilst the statutory framework stipulates that the school is currently the focus of support for Eleanor’s needs, the latter obviously do not stop there. As Schaefer et al. observe, since behavioural problems in the home usually precede those occurring elsewhere, part of the focus has to be behaviour in the home.’ (Schaefer et al. 1984 p.96). Consequently, whilst ‘Inter-Professional Collaboration’ has to be an overriding consideration for the social worker, it is likely to be the case worker themselves who initiates much of the strategic action, such as the proposed ‘cold-call’ home visit. The focus on Eleanor does not of course mean that Jenny’s needs, as an individual or as a parent, can be overlooked. A holistic approach, encapsulated within an action plan and developed with the Family Therapy or Support Service will be required. However, for environmental as much as professional reasons, as will be discussed below , Eleanor must remain the primary concern within this case. As this conclusion is being written, the manifest weaknesses of the supposedly revamped multi-agency framework have been revealed in the most devastating manner: through the death of a seventeen-month child, who was in the Child Protection Register’s ‘at risk’ category. Whilst any legislative or policy outcome of this tragedy is obviously some way off, some commentators have been quick to apportion responsibility to the inter-agency working framework. ‘When procedures become so exacting and time-consuming, the exercise of judgment is deemed neither necessary nor possible. Indeed, it will get you into trouble, because it is not part of the procedure.’ (Dalrymple 2008) Calls for less weight to be given to parental wishes and rights, and more to be placed on the safety of the child, are already being heard. The outcome of such debates, it may be argued, may have significant effects on the conduct of cases such as that of Jenny and Eleanor. Bibliography Adams, R., Dominelli, L. Payne, M. (2002) Social Work Themes, Issues and Critical Debates, Basingstoke, Palgrave Anning, A., and Edwards, A., (2006), Promoting Children’s Learning from Birth to Five: Developing the New Early Years Professional, Open University Press, Maidenhead. Asen, E., ‘Working with families where there is parenting breakdown’, in Reder, P., McClure, M., and Jolley, A., (eds), (2000), Family Matters: interfaces between child and adult mental health, Routledge, London, pp.227-236. Bowlby, J. (1969). Attachment and Loss: Vol I Attachment, London: Hogarth Press. Bowlby, J. (1973). Attachment and Loss: Vol II Separation, Anxiety and Anger, London: Hogarth Press. Bowlby, J. (1980). Attachment and Loss: Vol III Loss, Sadness and Depression, London: Hogarth Press. Bradley, G. and Parker, J. (2003) Social Work Practice: Assessment, Planning, Intervention and Review, Exeter, Learning Matters Ltd. Brayne, H and Carr, H. (2005) Law for social workers, Oxford, New York Butler, P. (2002) Failure to attend overshadowed Climbie inquiry [online] August 27  Available from: http://www.guardian.co.uk/society/2002/aug/27/climbie  [Accessed 16 November 2007] Children’s Workforce Development Council, (2007), The Lead Professional: Practitioner’s Guide, CWDC, Leeds. Crawford, K. Walker, J. (2003) Social Work and Human Development, Exeter, Learning Matters Ltd. Dalrymple, T., ‘We can’t be surprised by the death of baby P’ The Times Online, 12 Nov 2008, INTERNET, available at http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article5133966.ece?Submitted=true, [viewed 12.11.08] Davies, L (2007) The Big Picture: Is protection working? [online] November 15  Available from: http://www.communitycare.co.uk/Articles/2007/11/15/106450/the-big-picture-is-protection-working.html  [viewed 20.11.07] Department for Children, Schools and Families, (2007), Common Core of Skills and Kn owledge for the Children’s Workforce, DFES Nottingham. Department for Children, Schools and Families, (2007), Integrated Working Exemplar: Young child with behavioural problems: Integrated working to improve outcomes  for children and young people, HMSO, London. Department for Children, Schools and Families, (2007), Effective practice: Multi-agency Working, HMSO, London. Department of Health, (1999) Working Together to Safeguard Children, London, The Stationery Office. Department of Health, (2002) Modernising services to transform care: inspection of how councils are managing the modernisation agenda in social care [online] June 27  Available from:  www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Chiefinspectorletters/DH_4004590  [Accessed 21 November 2007] Department of Health, (2004) Executive Summary, National Service Framework for Children. Young People and Maternity Services [online] October 4  Available from: www.dh.gov.uk  [Accessed 15 November 2007] Department of Health, (2005) Background to Every Child Matters [online] May 10  Available from: www.everychildmatters.gov.uk/aims/background/  [Accessed 03 November 2007] Department of Health, (2006) Framework for the Assessment of Children in Need and their Families (fifth impression), United Kingdom, The Stationery Office. Department of Health, (2007) Local Safeguarding Children Boards [online] November 14  Available from: http://www.everychildmatters.gov.uk/socialcare/safeguarding/lscb/  [Accessed 26 November 2007] Friedrickson, N., and Clive, T., (2002) Special Educational Needs, Inclusion and Diversity, a Textbook, Open University Press, Buckingham. Goleman, D., (1996), Emotional Intelligence: Why It Can Matter More Than IQ, Bloomsbury, London. ‘Good to be Me’, (May 2005) Primary National Strategy: Excellence and Enjoyment, Social and Emotional Aspects of Learning, Department for Education and Skills, HMSO, Gurney, P., (1988) Self-Esteem in Children with Special Educational Needs, Routledge, London Gillen, S and Lovell C. (2007) Victoria Climbie Foundation head calls for child protection probe [online] November 5  Available from: www.communitycare.org/articles  [Accessed 12 November 2007] Glover-Wright, D. (2007) Social Work, As We See Ità ¢Ã¢â€š ¬Ã‚ ¦, Community Care, 5-11 April, p.28 Guardian Unlimited (2007) a. Ministers deliberately making asylum seekers destitute, say MPs [online] March 30 Available from: www.guardian.co.uk/immigration/story  [Accessed 04 November 2007] Healy, K (2005) Social Work Theories in Context, Basingstoke, Palgrave MacMillan. Hockey, J. James, A. (2003) Social Identities across the Life Course, Basingstoke, Palgrave Macmillan. Hopkins, G. Wetherall, G. (2007) Fatal Failings Community Care The voice of social care 11-17 January 2007, p. 34-38 Horner, N. (2003) What is Social Work? Context and Perspectives, Exeter, Learning Matters Ltd. Howe, D., Brandon, M., Hinnings, D. Schofield, G. (1999). Attachment Theory, Child Maltreatment and Family Support, London, Palgrave. Howe, D. (2005) Child Abuse and Neglect, Basingstoke, Palgrave Macmillan. Laming, L (2003) The Victoria Climbie Inquiry Report of an Inquiry by Lord Laming, London, Stationery Office. Meadows, S., (2006), The Child as Thinker: The Development and Acquisition of Cognition in Childhood, Routledge London. McCullough, M., (2007), ‘Integrating Children’s Services: the case for child protection’, in Siraj-Blatchford, I., Clarke, K., and Needham, M., (eds), (2007), The Team Around the Child: Multi-Agency Working in the Early Years, Trentham, Stoke-on-Trent. Mens Health Network (2000) Family Violence [online] September 1  Available from: http://www.menstuff.org/issues/byissue/domesticviolence.html#femalebatterers  [Accessed 11 November 2007] Myers Blair, G., Stewart Jones, R., Simpson, R.H., (1975), Educational Psychology, 4th Edition, MacMillan, NY. Office of the High Commissioner for Human Rights, (1989) Convention on the Rights of the Child [online]  Available from: www.unhchr.ch/html/menu2/b/k2crc.htm  [Accessed 15 November 2007] Parton, N. (2006) Safeguarding childhood, Basingstoke, Palgrave Macmillan Parton, N. OByrne, P. (2000) Constructive Social Work, Basingstoke, MacMillan Press. Pierson, J. Thompson, M. (2002) Dictionary of Social Work, Staffordshire University, Collins. Plummer, D., (2001) Helping Children to Build Self-Esteem: A Photocopiable Activities Book, Jessica Langley, London. Podesta, C., (2001) Self-Esteem and the Six-Second Secret, Corwin, Thousand Oaks, California. Quinney, A (2005) Collaborative Social Work Practice [online]  Available from: www.learningmatters.co.uk (sample chapters)  [Accessed 19 September 2007] Schaefer, C.E., Breismeister, J.M., and Fitton, M.E., (1984), Family Therapy Techniques fro problem behaviours of children and teenagers, Jossey-Bass, Sanfrancisco. De Shazer, (1982), Patterns of Brief Family Therapy: An Ecosystemic Approach, Guilford Press, NY. Nind, M., Rix, J., Sheehy, K., Simmons, K., (eds) (2003) Inclusive Education: Diverse Perspectives, Open University Press/David Fulton, Buckingham and London Schofield, G. (2002) Attachment Theory: An introduction for Social Workers, Norwich, Social Work Monograph. Siraj-Blatchford, I., Clarke, K., and Needham, M., (eds), (2007), The Team Around the Child: Multi-Agency Working in the Early Years, Trentham, Stoke-on-Trent. Taylor, J. Daniel, B. (2005) Child Neglect, London, Jessica Kingsley. Thompson, N. (2001) Anti-Discriminatory Practice, 3rd edition, Basingstoke, Palgrave Thompson, N. (2005) Understanding Social Work Second Edition, Basingstoke, Palgrave MacMillan Trevithick, P. (2005) Social Work Skills, Open University Press Ward, L. (2007) Not every child matters [online]  Available from: http://politics.guardian.co.uk/comment/story/0,,1995795,00.html  [Accessed 21 November 2007] Warren, J. (2007) Service User and Carer Participation in Social Work, Exeter, Learning Matters. Whelan, D (2003) Using Attachment Theory When Placing Siblings in Foster Care. Child and Adolescent Social Work Journal, 20(1), pp.21-36

Kant & Deontology Essay

When people think of Ethical Theory then the word morals, respect, and honesty seem to come to mind. Kant devised an ethical theory that is broken down into major elements to explain what he believes is ethical for society to believe. This is where the act of good will comes to existence and the nature of a person’s demeanor comes into how he or she decides what is the right or wrong thing to do. When the laws are put into place to help people know what society has decided what is ethical. Next, would be the decision making process of doing what is right or wrong. Looking at personal gain is not morally correct and having no respect for what is right is hard for a person to decide. He or she must have the decision making process developed or taught to ensure successful outcomes in ethical dilemmas. The major elements of Kant’s ethical theory is a person should not use another as a means to satisfy a personal desire and that morality is based on universal rules much like what is referred as the Golden Rule. The principles of Kantianism have hypothetical and categorical imperatives. We have a duty to ourselves and to others and while we have the ability to rationalize, our actions are not always rational. When using another as a means it should be without coercion or lying and the end should be such that they would be willing to being used. Actions requiring the use of deception are wrong and unjust. One does not make false promises. â€Å"For Kantians, respect for another person is fundamental. The fact that we are rational is of infinite value: we can plan, choose, and anticipate our future. † (Stairs, 1997.Pg 4). In Kantianism, justice ranks higher than happiness and if the act is not unjust then it is not immoral or wrong. Kant thought of â€Å"good will† as a deed done for wise regulation motives from a purpose of responsibility. This instructs and benefits as a categorical imperative for all ethical judgments rather than speculative or relying facts (Deontology & Kant, 2005). Kant’s theory is basically an example of deontological, which judges morality by reviewing the nature of actions and the will of agents rather than goals obtained. The system of deontology is supported by rules and principles, which verify decisions. Kant proposed the categorical imperative, the views that every person should act on only those methods that he or she, as a wise person would direct as popular laws to be pertained to the whole of mankind (Ethical Theories & Approaches, 2001). Imperative includes treating others how he or she as a person wants to be treated basically respecting others. Categorical imperatives are essentials: * Actions pass or fail * No â€Å"grey areas† * But the cracks appear in unlikely places (Deontology and Kant, 2005). In the decision making process within the Kantian approach, ethical decisions are based on his or her sense of duty. The word duty is derived from the Greek word Deon (deontological). Duty refers to the acts of a person based on the principles of morality. In this decision making approach a person must make decisions based on what is right rather than the good consequences that will follow. A person must make the morally right decision regardless of the good or bad outcome. Categorical imperative is what determines whether an act is morally right or wrong. The requirements of categorical imperatives are that moral principles are applied by respecting humanity. All humanity is to be respected and no one is allowed to be exploited. In this deontological point of view a person should act rational person and make self-imposed decisions. In conclusion, Kant wants people to understand how to understand the ethical theory that society should follow. If a person is looking for something in return for doing a good deed it is not considered a good deed. If he or she does unto others how they want to be treated then that is the moral duty to do right by everyone. Good will is an important ethical element in Kant’s theory because if a person is not willing to do for others and not expecting anything in return then the nature of things will be chaotic and order will be lost. This is where the decision making process comes into play meaning if society chooses to help others without thinking of what is in it for them than good will has happened. Nature is where everything comes in balance and works in harmony with one another. People are part of nature and following the elements of ethical theory is essential to everyday living in order to live in a peaceful world. Reference Stairs, A. (1997). Kant’s Ethical Theory. Retrieved from https://www. stairs. umd. edu/140/kant. html Ethical Theories and Approaches. (2001). Ethical Theories and Approaches. Retrieved from: http://techsci. msun. edu Deontology and Kant. (2005). Business and Ethical Thinking: An Ethic of Duty. Retrieved from: www. bola. biz.

Why Tuberculosis (TB) is a Contemporary Public Health Issue - Free Essay Example

Sample details Pages: 7 Words: 2230 Downloads: 8 Date added: 2017/06/26 Category Medicine Essay Type Analytical essay Level High school Did you like this example? With reference to the UK, discuss the reasons why tuberculosis (TB) is a contemporary public health issue and give examples of relevant public health and health promotion initiatives. With the exception of HIV/AIDS, infection with the Mycobacterium tuberculosis complex (MTB) causes more human deaths each year than any other infectious agent (World Health Organization, 2014a). The symptoms of tuberculosis (TB) are often non-specific and depend on the site of infection. Patients may present with fever, anorexia, weight loss, night sweats or lassitude, but a persistent productive cough is the hallmark of pulmonary tuberculosis (Department of Health, 2006). Don’t waste time! Our writers will create an original "Why Tuberculosis (TB) is a Contemporary Public Health Issue" essay for you Create order MTB bacilli multiply within infected macrophages for long periods of time and may be transported in the lymphatics or bloodstream to any part of the body (Gill and Beeching, 2004). Humans are the only reservoir of infection and transmission of tuberculosis occurs when infectious respiratory secretions are aerosolized by coughing, sneezing or talking. These may remain suspended in the air for long periods and are small enough to reach terminal air spaces if inhaled (Gill and Beeching, 2004). Patients with lung disease are the main source of infection and 52% of cases notified in the UK in 2013 had pulmonary disease (Public Health England, 2014c). 5 to 10% of people will develop active tuberculosis after primary infection reducing to 3% within one year of exposure; however over 90% of MTB infection is non-pathogenic within a normal human lifespan (Gill and Beeching, 2004). The incidence of tuberculosis in the UK in 2013 (12.3/100 000) was higher than most other Western Europ ean countries (European Centre for Disease Prevention and Control (ECDC)/WHO Regional Office for Europe, 2013) and nearly five times as high as the United States (Centers for Disease Control and Prevention, 2013), having increased steadily since the late 1980’s (Public Health England, 2014a). Rates of infection have declined by 11.6% in the past two years, where 73% of cases occurred among people born outside the UK. Of these, India, Pakistan and Somalia were the most common countries of origin but only 15% were recent migrants indicating a high rate of reactivation of latent tuberculosis (Public Health England, 2014c). The number of migrants from countries with very high TB incidence (250 per 100,000) decreased by 68% in the last decade and indicators of recent transmission reflect a decline in primary infections. However, the rate of infection among the UK born adult population has remained stable (Public Health England, 2014c) and strain typing suggests that up to 4 0% of all UK cases may be newly acquired (Public Health England, 2014a). Consequently, Public Health England has identified TB as a major priority (12). Globally, tuberculosis affects predominately young adults (World Health Organization, 2014b) and the highest rates of infection in the non-UK born population are among 25 to 29 year olds. Of patients born in Britain, TB is most virulent in those aged over 75 years and both sexes are equally at risk (Public Health England, 2014c). The burden of TB in England is concentrated in the most deprived communities of large urban areas and London accounted for 37.8% of patients in 2013 (Public Health England, 2014c). Nearly half of these cases were unemployed and 10% had a history of alcohol or drug misuse, homelessness or imprisonment. 6% were health-care workers (Public Health England, 2014c). Tuberculosis is particularly virulent among the immunosuppressed and people with HIV are 26 to 31 times more likely to contract the disease. Tobacco use has also been associated with 20% of TB cases worldwide (World Health Organization, 2014b). TB is transmitted most effectively in environments where MTB microbes accumulate in the atmosphere, for example in overcrowded and poorly ventilated living and working conditions (Gill and Beeching, 2004). Individuals with close and/or prolonged contact with a patient with pulmonary tuberculosis or connections to higher-prevalence areas of the world are particularly at risk (Department of Health, 2006). Transmission is also favoured by dark and humid conditions, such as mines and prisons (Gill and Beeching, 2004) and several authors have implicated vitamin D deficiency in the disease pathogenesis, although findings are varied and inconclusive (Kearns et al., 2014). Active TB may be mild or asymptomatic for many months and sufferers may unknowingly infect up to 15 people over the course of a year (World Health Organization, 2014b). Drug-resistant TB is an increasing probl em in the UK and multi-drug resistant TB comprised 1.6% of cases in 2012 (Public Health England, 2013a). Although MDR tuberculosis is unlikely to be more contagious, patients are infectious for longer than those with fully sensitive tuberculosis (Borrell and Gagneux, 2009, Anderson et al., 2014). The features of effective national TB control programmes have been well documented (National Institute for Health and Care Excellence, 2011, Story et al., 2012, Department of Health TB Action Plan Team, 2007, Public Health England, 2014a) and include transparent systems of accountability, adequate resources, active local implementation and close outcome monitoring (Abubakar et al., 2011). These activities are managed in the UK by Public Health England together with a wide range of stakeholders such as NHS England, and include screening. Screening strategies differ for the detection of early active and latent asymptomatic TB, the latter of which is recommended by NICE for individua ls at high risk of infection (National Institute for Health and Care Excellence, 2011) and referred to as active case finding (ACF) (Golub et al., 2005, Zenner et al., 2013). Identifying tuberculosis early allows for prompt treatment and reduces transmission (Public Health England, 2014b). In the UK, ACF is targeted at healthcare workers involved in exposure prone procedures, close contacts of known or suspected tuberculosis patients, and people with social risk factors such as homelessness, drug or alcohol misuse, imprisonment or migration from high risk countries (National Institute for Health and Care Excellence, 2012). Several local authorities and primary care trusts have successfully piloted such schemes, although weaknesses in coordination and targeting have been identified (Pareek et al., 2011a). London’s UCLH Find and Treat Service, for example, screens almost 10 000 socially vulnerable people at high risk of tuberculosis annually (University College London Hospitals NHS Foundation Trust, 2014). Various UK charities, such as ‘TB Alert’, raise public awareness of tuberculosis and support Primary Care Trusts. They build capacity of third sector organisations and inform and subsidize patients and communities (TB Alert, 2014). The UK Border Agency, in collaboration with the International Organization for Migration, conducts pre-entry screening for active infection across 15 countries where tuberculosis is common (over 40/100,000) (Home Office UK Border Agency, 2012, Public Health England, 2013b). Visa applicants from these countries wishing to stay in the UK for more than 6 months are screened for pulmonary TB and granted entry only on receipt of a certificate of clearance (Public Health England, 2014b). Funding from the Health Protection Agency (HPA) also supports screening activity at Heathrow and Gatwick airports (Home Office UK Border Agency, 2012). Screening is routinely offered to asylum seekers and refugees acc epted for resettlement into the UK through the Gateway Programme (Home Office UK Border Agency, 2012). There is further evidence that screening migrants for latent TB on entry to the UK is cost effective for the NHS (Pareek et al., 2011b). Internationally, the World Health Organization operates via the Stop TB Partnership to set targets, procure and grant funds and resources, lobby governments, educate and advocate on behalf of TB communities (World Health Organization, 2006, Stop TB Partnership, 2014). Simultaneously, not-for-profit product development partnerships such as the TB Alliance endeavour to develop new TB drug regimens (Horsburgh et al., 2013, Lienhardt et al., 2012a, Lienhardt et al., 2012b, Clinton Health Access Initiative et al., 2010). School vaccination of the indigenous UK population was halted in 2005 following a decline in the incidence of TB and the Bacillus Calmette-Guà ©rin immunisation (BCG) is now targeted at neonates within high risk groups (Depar tment of Health, 2006). These UK endeavours contribute towards the WHO target to eliminate TB as a public health problem by 2050 (World Health Organization, 2006). References ABUBAKAR, I., LIPMAN, M., ANDERSON, C., DAVIES, P. ZUMLA, A. 2011. Tuberculosis in the UKtime to regain control. BMJ, 343, d4281. ANDERSON, L. F., TAMNE, S., BROWN, T., WATSON, J. P., MULLARKEY, C., ZENNER, D. ABUBAKAR, I. 2014. Transmission of multidrug-resistant tuberculosis in the UK: a cross-sectional molecular and epidemiological study of clustering and contact tracing. Lancet Infect Dis., 14, 406-15. doi: 10.1016/S1473-3099(14)70022-2. Epub 2014 Mar 4. BORRELL, S. GAGNEUX, S. 2009. Infectiousness, reproductive fitness and evolution of drug-resistant Mycobacterium tuberculosis. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 13, 1456-66. CENTERS FOR DISEASE CONTROL AND PREVENTION 2013. Trends in Tuberculosis United States, 2012. Morbidity and Mortality Weekly Report, 62, 201-2. CLINTON HEALTH ACCESS INITIATIVE, BILL MELINDA GATES FOUNDATION, GLOBAL ALLIANCE F OR TB DRUG DEVELOPMENT, GLOBAL DRUG FACILITY, INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE, MANAGEMENT SCIENCES FOR HEALTH TREATMENT ACTION GROUP 2010. Falling Short. Ensuring Access to Simple, Safe and Effective First-Line Medicines for Tuberculosis. New York: Global Alliance for TB Drug Development. DEPARTMENT OF HEALTH TB ACTION PLAN TEAM. 2007. Tuberculosis prevention and treatment: a toolkit for planning, commissioning and delivering high-quality services in England [Online]. London: Department of Health. Available: https://webarchive.nationalarchives.gov.uk/20130107105354/http:[email  protected]/* */[email  protected]/* *//documents/digitalasset/dh_075638.pdf [Accessed 19/12/2014]. DEPARTMENT OF HEALTH 2006. Chapter 32 Tuberculosis. In: SALISBURY, D., RAMSAY, M. NOAKES, K. (eds.) Immunisation against infectious disease The Green Book. 3rd ed. London: The Stationery Office. EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC)/WHO REGI ONAL OFFICE FOR EUROPE. 2013. Tuberculosis surveillance and monitoring in Europe 2013 [Online]. Stockholm: European Centre for Disease Prevention and Control. Available: https://www.ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90ID=811 [Accessed 19/12/2014]. GILL, G. V. BEECHING, N. J. 2004. Chapter 12 Tuberculosis. Tropical Medicine. 5th ed. Oxford: Blackwell Science. GOLUB, J. E., MOHAN, C. I., COMSTOCK, G. W. CHAISSON, R. E. 2005. Active case finding of tuberculosis: historical perspective and future prospects. Int J Tuberc Lung Dis., 9, 1183-203. HOME OFFICE UK BORDER AGENCY 2012. Screening for Tuberculosis and the Immigration Control. UK Border Agency Review of Current Screening Activity 2011 (Central Policy Unit). London: Home Office. HORSBURGH, C. R., JR., HAXAIRE-THEEUWES, M., LIENHARDT, C., WINGFIELD, C., MCNEELEY, D., PYNE-MERCIER, L., KESHAVJEE, S. VARAINE, F. 2013. Compassionate use o f and expanded access to new drugs for drug-resistant tuberculosis. The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 17, 146-52. KEARNS, M. D., ALVAREZ, J. A., SEIDEL, N. TANGPRICHA, V. 2014. Impact of Vitamin D on Infectious Disease: A Systematic Review of Controlled Trials. Am J Med Sci, 20, 20. LIENHARDT, C., GLAZIOU, P., UPLEKAR, M., LONNROTH, K., GETAHUN, H. RAVIGLIONE, M. 2012a. Global tuberculosis control: lessons learnt and future prospects. Nature reviews. Microbiology, 10, 407-16. LIENHARDT, C., RAVIGLIONE, M., SPIGELMAN, M., HAFNER, R., JARAMILLO, E., HOELSCHER, M., ZUMLA, A. GHEUENS, J. 2012b. New drugs for the treatment of tuberculosis: needs, challenges, promise, and prospects for the future. The Journal of infectious diseases, 205 Suppl 2, S241-9. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. 2011. Clinical guidance and management of tuberculosis, and measures for its prevention and control. CG117 [Online]. Available: https://www.nice.org.uk/guidance/cg117 [Accessed 19/12/2014]. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. 2012. Identifying and managing tuberculosis among hard-to-reach groups. PH37 [Online]. Available: https://www.nice.org.uk/guidance/cg117 [Accessed 19/12/2014]. PAREEK, M., ABUBAKAR, I., WHITE, P. J., GARNETT, G. P. LALVANI, A. 2011a. Tuberculosis screening of migrants to low-burden nations: insights from evaluation of UK practice. Eur Respir J., 37, 1175-82. doi: 10.1183/09031936.00105810. Epub 2010 Nov 11. PAREEK, M., WATSON, J. P., ORMEROD, L. P., KON, O. M., WOLTMANN, G., WHITE, P. J., ABUBAKAR, I. LALVANI, A. 2011b. Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. The Lancet. Infectious diseases, 11, 435-44. PUBLIC HEALTH ENGLAND 2013a. Tuberculosis in the UK: 2013 report. London. PUBLIC HEALTH ENG LAND. 2013b. UK pre-entry tuberculosis screening brief report 2013 [Online]. London: Public Health England. Available: https://www.gov.uk/government/publications/tuberculosis-pre-entry-screening-in-the-uk [Accessed 19/12/2014]. PUBLIC HEALTH ENGLAND. 2014a. Collaborative Tuberculosis Strategy for England 2014 to 2019: For consultation [Online]. London. Available: https://www.gov.uk/government/consultations/collaborative-tuberculosis-strategy-for-england-2014-to-2019 [Accessed 19/12/2014]. PUBLIC HEALTH ENGLAND. 2014b. Guidance: Tuberculosis screening. Tuberculosis (TB) screening and early detection methods, for professionals working with at-risk populations in the UK. [Online]. Available: https://www.gov.uk/tuberculosis-screening#pre-entry-tb-screening-for-migrants [Accessed 18/12/2014]. PUBLIC HEALTH ENGLAND 2014c. Tuberculosis in the UK: 2014 report. London. STOP TB PARTNERSHIP 2014. The Stop TB Partnership. Leading the fight against TB. Geneva: Stop TB Partnership. STORY, A., COCKSEDGE, M., ANDERTON, A., EDGINTON, M., O’DONOGHUE, M., KON, O. M., TAMNE, S., MAW, J. POLLINGER, E. 2012. Tuberculosis case management and cohort review guidance for health professionals [Online]. London: Royal College of Nursing. Available: https://www.rcn.org.uk/%5F%5Fdata/assets/pdf%5Ffile/0010/439129/004204.pdf [Accessed 19/12/2014]. TB ALERT. 2014. Our Work in the UK [Online]. Brighton. Available: https://www.tbalert.org/what-we-do/uk/ [Accessed 19/12/2014]. UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST. 2014. Find and Treat Service [Online]. Available: https://www.uclh.nhs.uk/OurServices/ServiceA-Z/HTD/Pages/MXU.aspx [Accessed 19/12/2014]. WORLD HEALTH ORGANIZATION. 2006. The Stop TB Strategy [Online]. World Health Organization. Available: https://whqlibdoc.who.int/hq/2006/WHO_HTM_STB_2006.368_eng.pdf [Accessed 19/12/2014]. WORLD HEALTH ORGANIZATION. 2014a. Global tuberculosis report 2014 [Online]. Geneva: World Health Orga nization. Available: https://www.who.int/tb/publications/global_report/en/ [Accessed 19/12/2014]. WORLD HEALTH ORGANIZATION. 2014b. Tuberculosis Fact Sheet No. 104 [Online]. Geneva: World Health Organization. Available: https://www.who.int/mediacentre/factsheets/fs104/en/ [Accessed 19/12/2014]. ZENNER, D., SOUTHERN, J., VAN HEST, R., DEVRIES, G., STAGG, H. R., ANTOINE, D. ABUBAKAR, I. 2013. Active case finding for tuberculosis among high-risk groups in low-incidence countries. Int J Tuberc Lung Dis., 17, 573-82. doi: 10.5588/ijtld.12.0920.

Queen Angelfish Facts

The queen angelfish (Holacanthus ciliaris) is one of the most striking fishes found in the western Atlantic coral reefs. Their large flat bodies are of a brilliant blue color with vivid yellow-accented scales and a bright yellow tail. They are often confused with blue angelfish (H. bermudensis), but the queens are distinguished by a navy blue patch located above the eyes at the center of the head, which is freckled with light blue spots and resembles a crown. Fast Facts: Queen Angelfish Scientific Name: Holacanthus ciliaris  Common Names: Queen Angelfish, Angelfish, Golden Angelfish, Queen Angel, Yellow AngelfishBasic Animal Group: FishSize: 12–17.8 inchesWeight: Up to 3.5 poundsLifespan: 15 yearsDiet: OmnivoreHabitat: Western Atlantic ocean coral reefs, from Bermuda to central BrazilPopulation: UnknownConservation Status: Least Concern Description The body of the queen angelfish (Holacanthus ciliaris) is highly compressed and its head is blunt and rounded. It has one long dorsal fin along its top, dorsal and anal fins, and a range of between 9–15 spines and soft rays. Blue and queen angelfish look even more alike as juveniles, and the two species can and do interbreed. Researchers believe that the entire population in Bermuda may consist of hybrid blue and queen angels.   On average, queen angelfish grow to around 12 inches in length, but they can grow up to 17.8 inches and weigh up to 3.5 pounds. They have small mouths with slender brush-like teeth in a narrow band that can be protruded outward. Although they are primarily blue and yellow, different regional populations sometimes have different color variations, such as occasional gold coloration, and black and orange blotches. Queen angelfish are of the Perciformes order, the Pomacanthidae family, and the Holacanthus genus.   Colorful Queen Angelfish, Bonaire, Caribbean Netherlands. Terry Moore / Stocktrek Images / Getty Images Habitat and Distribution A subtropical island species, queen angelfish are found in coral reefs on coasts or surrounding offshore islands. The queen is most abundant in the Caribbean Sea, but can be found in tropical western Atlantic waters ranging from Bermuda to Brazil and from Panama to the Windward Islands. It occurs at depths between 3.5–230 feet below the surface.   The fish do not migrate, but they are most active during the day and are most commonly found near the bottom of coral reef habitats, from the nearshore shallows down to the deepest part of the reef where limited light inhibits coral growth. They are predominantly marine but can adapt to different salinities as needed, which is why the species is often seen in marine aquariums.   Diet and Behavior Queen angelfish are omnivores, and although they prefer sponges, algae, and bryozoans, they also eat jellyfish, corals, plankton, and tunicates. Apart from the courtship period, they are generally observed moving in pairs or singly year-round: some research suggests they are pair-bonded and monogamous.   During the juvenile stage (when they are about 1/2 inch long), queen angelfish larvae set up cleaning stations, where larger fish approach and allow the much smaller angelfish larvae to clean them of ectoparasites. Hawksbill sea turtle swimming over coral reef with stove-pipe sponge and a Queen angelfish, Bonaire, Netherlands Antilles, Caribbean, Atlantic Ocean. Georgette Douwma / Photographers Choice / Getty Images Plus Reproduction and Offspring   During the winter courtship periods, queen angelfish are found in larger groups known as harems. These pre-spawning groups are typically made up of a ratio of one male to four females, and the males court the females. Males flaunt their pectoral fins and the females respond by swimming upward. The male uses his snout to make contact with her genital area, and then they touch bellies and swim upward together to a depth of about 60 feet, where the male releases sperm and the female releases eggs into the water column.   Females can produce anywhere from 25,000 to 75,000 transparent and buoyant eggs during one evening event; and as many as 10 million per spawning cycle. After spawning, there is no further parental involvement. The eggs are fertilized in the water column and then hatch out within 15–20 hours, as larvae lacking working eyes, fins or gut. The larvae live on yolk sacs for 48 hours, after which they have developed enough to begin feeding on plankton. They grow rapidly and after three to four weeks they reach about one-half inch long when they sink to the bottom and live in coral and finger sponge colonies. Juvenile Queen angelfish Holacanthus ciliaris in the Caribbean. Damocean / iStock / Getty Images Plus Conservation Status   Queen angelfish are classed as Least Concern by the International Union for Conservation of Nature. They are used as part of the commercial aquarium trade. They are not typically a food fish, in part because they are associated with the phenomenon of ciguatera poisoning which is caused by fish eating other toxic creatures and keeping a reservoir of toxins which may be passed on to human consumers.  Ã‚   Sources Feeley, M. W., O. J. Luiz jr, and N. Zurcher. Colour Morph of a Probable Queen Angelfish . Journal of Fish Biology 74.10 (2009): 2415–21. Holacanthus ciliaris from Dry Tortugas, FloridaPatton, Casey and Cathleen Bester. Queen Angelfish Holacanthus ciliaris. Discover Fishes, Florida Museum.  Pyle, R., R. Myers, L.A. Rocha, and M.T. Craig. Holacanthus ciliaris. The IUCN Red List of Threatened Species: e.T165883A6156566, 2010.  Reis, Fernanda, et al. Diet of the Queen Angelfish Holacanthus Ciliaris (Pomacanthidae) in Sà £o Pedro E Sà £o Paulo Archipelago, Brazil. Journal of the Marine Biological Association of the United Kingdom 93.2 (2013): 453-60. Shah, Saara. Holacanthus ciliaris (Queen Angelfish).  The Online Guide to the Animals of Trinidad and Tobago. University of the West Indies, 2015