Unit 12 Physiological Principles for HSC Assignment

Programme	Locus Diploma in Health and Social Care
Unit Number and Title	Unit 12 Physiological Principles for HSC
QFC Level	Level 4
Unit Code	A/601/1608

Introduction

Physiology means the scientific study of functions in living systems and organisms. It is a sub-discipline of Biology and includes the in depth analysis and study of how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical and physical functions that exist in a living organism.
Physiology is further divided into, Human Physiology, Animal Physiology, Plant Physiology, Cellular Physiology and microbial physiology, i.e. bacterial or viral.
Human Physiology deals with complete human body, its anatomy, functions of various systems, its process (both physical and chemical) and the complete structure of human being.
The various structure and functioning aspects, with impacts from external, as well as internal mechanisms on it is being discussed here. The alignment of our external environment with human body, i.e. creating health and social care setups, as per the requirements of human body is also understood.

Task 1.

1.1 Outline the anatomical features in each body system with identifying main functions?

Human Body is the total composition structure of human being. It comprises mainly head, neck, trunk, arms, hands, legs and feet. The human body is made of smallest unit known as Cells; these trillions of cells together constitute human organs or body parts and cohesively form Human Body. The anomalies in any of these organs or systems lead to malfunctioning of this human body system and the human being is considered to be sick, ill or diseased. These anomalies have to be mitigated so as to cure the human being of its illness, disease or sickness. To maintain the Homeostasis, which is interaction of many systems and mechanisms is very necessary for the human body to work normally. A system in Human Body is a combination of two or more interacting organs, which work cohesively to maintain the function of that system. All these systems when interact with each other and work in tandem, the Human Body homeostasis is achieved (Marieb, 2007).
The detailed analysis of each body system and its function in overall human body structure is as follows –

Nervous System

• It consists of the Central Nervous System (CNS), i.e. the Brain and Spinal Cord and the Peripheral Nervous System (PNS)
• The main organs as discussed in this system are, Brain and Spinal Cord and this system works on the homogenous working of these two organs only
• The main function of the brain is thought, emotions, memory and sensory processing, i.e. five senses, Touch, Taste, Smell, Vision and Hearing
• It coordinates between the five vital organs of senses namely, Nose, Skin, Ear, Eyes and Tongue
• The main function of both these organs is to gather information from all these organs and then dissipate the processed information for performing their original intended functions
• The Brain is the processing unit; where as Spinal Cord with the network of neuro-skeletal muscles transports this information to and fro from all over the body parts
• The information about the body’s environment, its processing and feedbacks accordingly are the sole responsibility of this system (Russell, 1997)

Musculoskeletal System

• It consists of Human Skeleton and attached muscles
• Skeleton is the hard structure which gives shape and features apart from strength to Human Body
• Skeleton includes bones, ligaments, tendons and cartilages
• The major function of bones apart from structural is to have bone marrow, the Red Blood Cell forming factory
• The bone is storage center of Calcium and Phosphate (Herzog, 1999)

Circulatory System

• It is also known as Cardio-Vascular System
• It includes all the blood vessels along-with central blood pumping station Heart
• The main function of Heart is to pump blood all over the Human Body
• The main function of the Blood, a Fluid, is to provide nutrients to all parts of the Human Body
• One of the main functions of Blood is to transport the two most vital gases for human life, Oxygen and Carbon-Dioxide from all over the body (cells) to heart (for purification through liver) and back
• Blood also provides the medium for cells and other molecules to transfer and grow (Noordergraf, 1979)

Respiratory System

• It consists of organs like Nose, Nasopharynx, trachea and lungs
• The main role of this system is of Gaseous exchange between Human Body and the environment, i.e. taking in Oxygen from atmosphere and supplying back Carbon-Dioxide and water back to the atmosphere (Agostoni, 1964)

Digestive System

• It also consists of various human body organs like mouth, esophagus, stomach, gut, liver, gall bladder, pancreas and salivary glands
• The main function of this Human Body system is to intake food and other energy resources with water from external environment
• After the food and water intake, the next function is of breaking down the complex food molecules into easily storable and usable molecules like glucose, water, hydrogen, carbon-dioxide etc
• These stored molecules are used as and when required by the body and are stored in various locations across Human Body up-till then (Stevens, 2004)

Integumentary System

• This system of body consists of external organs such as skin, nails and hair
• This body system is responsible for acting as a natural barrier to Human Body for all the microbes and other organisms and other particles from entering it
• It also acts as a sensory system with Neuro-feedback mechanism and providing information about the external Human Body environment to the Brain (Rawles, 1960)

Urinary System

• It includes kidneys, Ureters, Bladder and Urethra
• It removes water from the blood to produce urine, which carries a variety of waste molecules and excess ions and water out of the body (Maxie, 1993)

Reproductive System

• It consists of Gonads and the internal and external Sex organs, such as vagina and penis
• The main function of this system is to reproduce in Human race
• This system is solely responsible for all kinds of sexual behavior shown by human race (Reynolds, 1992)

Immune System

• It includes White Blood Cells, the Thymus, the Lymph Nodes, and Lymph Channels
• The main function of this system is to act as a protecting mechanism for the Human Body for any potential threat from the foreign particle or microbe infection (Janeway, 2001)

Lymphatic System

• The main function of this system is to extract, transport and metabolize lymph, the fluid found in between cells
• It comprises of Lymph nodes and other Lymph organs, quite same as circulatory system (Rouviere, 1938)

Endocrine System

• It consists of primary endocrine glands like Gonads, Pituitary, Thyroid, Adrenals, Pancreas and Parathyroids etc
• The endocrine hormones serve as signals from one body system to another regarding an enormous array of conditions, and resulting in variety of changes of function (Harris, 1955)

1.2 Define Homeostasis, negative and positive feedback, provide an example for each?

Homeostasis

• It is a system in which variables are regulated so that internal conditions remain stable and relatively constant
• It regulates its internal environment and maintains a stable, relatively constant condition; such as maintaining an equal temperature, or acid balance pH
• A relatively constant pH, temperature, blood-flow and position is necessary for the survival of any Human Body and to function it properly
• It maintains the stability of the human body's internal environment in response to changes in external conditions
• It is a  highly complex interactions to maintain balance or return systems to functioning within a normal range
• Such interactions within the body facilitate compensatory changes supportive of physical and psychological functioning
• The major Organs which help in maintaining Human Homeostasis are Kidneys, Brain and Liver
• Here, Liver is responsible for metabolizing toxic substances along-with carbohydrate metabolism
• Kidneys regulate, water, salt and pH levels in the blood and the overall Human Body
• Brain acts as a Central Processing Unit of the Human Body (Lerner, 1954)

Negative Feedback

• It is the mechanism of controlling the output or activity of any organ or system in the Human Body and brings back any abnormality to the normal Human Body functioning ranges
• The best possible way example of negative feedback in Human Body is Blood Pressure management
• Any change in blood volumes in the blood vessels bring signal to Brain and which in turn signals heart to increase or decrease blood-pressure and flow and hence blood vessels dilate/expand and constrict (Vasodilation and Vasoconstriction). This change in blood vessels lead to lesser or more blood flow and pressure
• Some other examples can be when Human Body is deprived of Food and Energy, a feedback goes to brain and it starts signaling Body to reduce metabolism and mantian its energy levels in the starvation mode
• Temperature Control is also one of the examples of Negative Feedback in Homeostasis maintenance (Turrigiano, 2007)

Positive Feedback

• Positive feedback is a process in which the effects of a small disturbance on a system or Homeostasis, include an increase in the magnitude of the perturbation
• One of the examples of this is the onset of contractions during childbirth. When a contraction occurs, the hormone Oxytocin causes a nerve stimulus, which stimulates the hypothalamus to produce more Oxytocin, which increases uterine contractions. This results in contractions increasing in amplitude and frequency
• A spike in Estrogen during the follicular phase of the menstrual cycle causes ovulation (Peters, 2007)

Task 2.

2.1 Explain how his body responds to his physical activities (particularly in relation to musculo-skeletal system, cardiovascular system and respiratory system)?

Response of Human Body in terms of the young 25 year old individual as per various systems is as follows –

Musculo-skeletal system –

• The musculo-skeletal system of Human Body is made up of various bones (outer structure of the skeleton), muscles, cartilages, tendons, ligaments, joints and other connective tissues
• It also stores bone marrow, which is the production factory of the all important Red Blood Cells and stores Calcium and Phosphates required for the Human Body
• Due to the nature of his job, the body of the young individual is attuned for a lot of physical work and exercises, which includes, movement of various bones, muscles, cartilages and other organs of this system
• The movement of various parts of Human Body, be it during walking, running, typing or any other movement, is solely responsible because of the process of muscle relaxation and contraction
• Now in the case of muscle relaxation and contraction, various chemical reactions also do take place, such as various protein reactions, facilitated by catalyst ions like Magnesium and Calcium
• The process of muscle relaxation and contraction also utilizes Oxygen molecules and produces Carbon-Dioxide during the combustion of stored glucose or glycogen molecules
• During excessive fatigue or muscle movement, some leftovers or non reacted molecules remain like lactic acid and which causes the pain or burning sensation in Human Body
• For this young individual the strength bearing capacity of muscles and bones are already enhanced and keeps on increasing during the build-up exercise or training regimen to the marathon
• For avoiding any kinds of wear, tear, torn, pain and burns in the muscles, he should give proper relaxation time to the muscles and rest them after frequent work outs
• He should build the stamina of this system over a period of six months, which is the build-up time for the marathon also (Frankel, 1970)

Cardiovascular system

• Since it is made up of Heart and other blood vessels and the main function is to pump blood, the central Human Body fluid
• As already discussed, the primary role of blood pumped by heart is to transport various molecules, including Oxygen and Carbon-Dioxide, it is very important to understand the role of these molecules for Human Body
• It is well understood that Oxygen is required for many purpose in Human Body from metabolism to muscle movement to Brain functioning
• For this young individual the oxygen carrying capacity of his blood vessel/cells and heart rate mechanism is already efficient because of his daily lifestyle
• During the extensive human body endurance like marathon, the need of Oxygen is immense and hence a proper functioning Heart with enhanced capacity to pump Blood and hence Oxygen and faster gaseous exchange at lungs is very much important
• The contraction and dilation blood vessels as per Human physiological stricture and its impact from external environment should be extremely efficient, if he has to run marathon in next six months (Dampney, 1994)

Respiratory System

• As mentioned above, the main function of this system comprising of Lungs and other organs, is to provide the gaseous exchange between the Human Body and the atmosphere
• Also, discussed the need of Oxygen molecules, it is equally important during high intensity exercise of human body that, Carbon-Dioxide molecules are excreted from the Human Body as fast as possible
• So the enhanced capacity of Human Lungs is very important for undergoing any strenuous physical exercise like marathon running
• It is quite evident from this young lad’s physical regime of daily that this system is already up to a certain level of efficiency which needs to be improved over a period of six months during the buildup to the marathon, to ensure proper Oxygen supply to him during his endeavor (Bates, 1985)

2.2 Discuss how body responses are explained by cellular and tissue structure and physiology?

Cellular physiology –

• Cell is the smallest unit of Human Body and totality it is approx. 37 trillion cells which make up a Human Body
• It comprises of all the vital fundamental living mechanism required for Human Body to survive, from nutrients to genetic material code information
• The biological study of the cell's mechanism and interaction in its environment is known as Cellular physiology
• It often specifically applies to the physiology consisting of membrane transport, neuron transmission, and (less frequently) muscle contraction
• As all these together covers, food digestion, blood circulation, muscle contraction and neuro transmission, it is very vital for any human being and especially for people with such hectic physical lives, as this young individual
• As discussed, muscle contraction encompasses many chemical reactions and is very necessary, since it undergoes proper contraction and relaxation and to ensure this proper supply of various ions and protein molecules is very necessary at the cellular levels, which comes from the supply from the metabolism process
• During the run-up to the marathon event the young individual has to compliment his strenuous physical work regime with proper diet and supplements, so as to buildup its cellular storage (Pozzan, 1994)

Tissue Physiology

• Multiple cells combine and are organized to form tissues
• Tissues when organize, they form organs
• Tissues are formed by an aggregation of like cells carrying out a like function
• Cells are linked together by  and are supported by a  which they themselves secrete and provide a structural framework for tissue structure
• There are four major types of tissues, including, epithelial, connective, neural and muscular
• During any physical activity and especially in heightened period like marathon, all these four types play a vital role
• Epithelial tissues together form the skin and covering layers for various organs, these are the outer layers of Human Bodies and withstand the most tear and wear in support to their function of keeping foreign particles out of Human Body and hence during marathon, the most degradation and regeneration will happen to this consortium
• Secondly, as discussed connective tissues help in holding up of vital organs and provide structure and support, hence are very important for any physical activity
• Thirdly, neural tissues forms the basis for brain and other neuro system organs and hence are essentially vital for processing the whole Human Body
• Finally the largest and biggest role is played by muscular tissues, in the form of formation of muscles and hence the already discussed complete process of muscle movement required for carrying out any activity like running in marathon and hence its care is the most essential for this young individual (Jee, 2001)

2.3 Further, explain how his body will coordinate its internal activities?

Internal activities and their coordination during the run-up and the actual marathon running by the young individual are as follows –

1. Physiology of exercise is a concept that addresses the central issue as to how the body adapts itself to the demands of strenuous physical activity like marathon running
2. Body's metabolism (the overall rate of activity in the body's processes) increases; the running of a marathon may increase metabolic rates to many time their normal level
3. Thermoregulation is the ability of the body to maintain the optimal internal temperature levels for the function of all organs in different external environment conditions and it is rapidly adapted in the case of marathon running or such levels of exercise, as body become habituated to fluctuations to rise and fall in temperatures in and out of the body frequently
4. Apart from all the changes and effects mentioned above, such as strengthening of the cardiovascular and respiratory muscles, expansion of blood oxygen levels, such changes, i.e. thermoregulation and metabolism adjustment makes it a cohesive effort from the body to endure and with stand the new changed circumstances
5. Increased conservation of sodium to promote more effective hydration (to preserve the optimal proportion of sodium to water, a part of the body's Osmo-regulatory system)
6. Body composition is affected by two distinct exercise mechanisms during the build-up and the actual marathon, i.e. a reduction in the percentage of body fat and the increase of lean muscle mass developed through specialized exercise
7. Maintaining homeostasis is of prime importance to the Human Body, when exercising in any environment. Failing to do so will result in a decrease in performance and an increase in the risk of developing potentially fatal situations, whereas, a proper acclimatization and routine build-up to the marathon level stress and adapting it in due course, may lead to body coordinating its internal processes and work cohesively giving the desired physical results and achievements (Kyrolainen, 2000)

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Task 3.

3.1 Explain how routine measures are recorded and what are their uses in health and social care?

Department of Health care is the department of Government of UK, it is primarily responsible for various policies related with health and adult social care services in England. It is also responsible for the National Health Services of England. Health and Social Care in UK is majorly guaranteed by the government setup with ancillary private intervention, which also works in the government environmental ambit. NHS is responsible for the implementation of the Health and Social Care Act 2012 of England also (Curtis, 2012). As per Health and Social Care Act 2012, the vital statistics required by it for formulating its policies and guidelines, to be implemented under NHS are as follows –

Measures

• Relevant visual observations, such as weight/height, temperature, pulse, respiration rate, blood pressure, food intake, fluid intake, fluid output, indicator tests on urine (e.g. glucose, protein);
• Recording of these measures are also very important for any patient visiting the primary Health and Social Care setup, the factors to be looked while recording these are correct units, tabulated, charts, graphs, interpretation of records

Information

• The information in these records, which are not directly observable by human eyes, and need some kind of assistance or tools, such as stethoscope or a microscope, should also be recorded
• Information as relevant to measurements generally taken is heart rate, peak flow, over/under weight, hydration, diabetic stability and infection etc

Accuracy

• The accuracy of these vital information or records, gathered at the primary, secondary or tertiary care clinics under the health and social care services, has to be maintained, so as to create a data bank or a repository. This data bank later can be analysed to take information out of it, which will serve as an insight for designing of future policies and decision making
• There are possible threats of any kind of discrepancy might creep, in terms of errors and faults
• Some common errors while recording data are as follows - Sources of error, Reliability, Validity; Concept of normal range, hypo- and hyper- values

Derived measures

• Based on these vital statistics gathered at the frontline level and recorded in databases, many derived measure are also calculated and analysed
• Information from derived measures such as relevant readings of Body Mass Index (BMI), fluid balance, nutritional health (intake against requirement e.g. energy balance); monitoring (regular recording) and variations in measures over time are equally important (Fitzpatrick, 1992)

Uses in health and social care

1. Care

• All these vital information and recordings are essential in health and social care services setup in planning diagnosis, treatment, monitoring, prognosis, rehabilitation and policy making etc
• In monitoring course of health/disorder/disease, care planning, care routines, professionals involved, reporting data to professionals, recognizing need for emergency responses

1. Ethical considerations

• All this data should be taken and recorded with full ethical consideration and legislation should be followed
• When taking measures and using data e.g. individual rights, dignity and privacy should be handled with utmost care

3.2 Assess how these routine measures provide information about the body functioning of this person?

These routine measures provide vital stats about the information related to Human Body functioning of an individual person, both normal and abnormal. These statistics serve as the basis for normal ranges of all the vital and critical body functioning measures and hence any disturbance in these range values leads us to the abnormality in body functioning and hence giving details about the illness, sickness or disease of the Human body.
Some of the information these measures provide about the functioning of the human body are as follows –

Age

• Age is the progressive maturity of all the Human Body cells, tissues, organs, organs systems and overall structure over the period of time. During due course, all these originate, grow, destroy, re-grow and mature over the age, finally to be dead after certain time
• This vital data recorded gives health and social care a huge comparison of structural and functional changes between young adulthood, later life and old age; if appropriate, developmental change during childhood and adolescence

Effects/impact

• The changes in external or internal environment of Human Body leads to its effects/impacts on its normal routine functioning and may end up with unwarranted results
• These effects/impacts can be of majorly three types –

1. Physical – Absence, loss or impaired function of tissues, organs and systems e.g. incontinence, ataxia; degeneration of structure e.g. bone in osteoporosis, cartilage in osteoarthritis, pulmonary tissue in emphysema, neural tissue in Parkinson’s disease etc
2. Psychological – These are the effects, such as, confidence, cognitive abilities, invasion of privacy (e.g. assistance with toileting, bathing)
3. Social – These are the external agent effects and can be of following examples, such as isolation due to hearing loss, loss of mobility and autonomy etc

Common disorders

• When the vital stats of human body doesn’t lie in the normal ranges prescribed and show disturbances in patterns, the direct effect on the functioning of human body is shown by abnormal patterns, these patterns are termed as sickness, disease, disorder or illness etc
• These abnormalities can be of two types, one is acquired due to inheritance or from birth, i.e. genetic and second is acquired from the environment, i.e. infection
• Some of the common disorders acquired from inheritance are as relevant ones, such as diabetes, cardiovascular disease and autoimmune related, pulmonary disease, inherited, congenital and degenerative syndromes

Infections

• These are the acquired abnormalities in human body functioning from the immediate external environment
• These are generally caused by external agents such as microorganisms and are examples of abnormalities as encountered in e.g. wounds, respiratory tract and urinary tract
• These show signs and symptoms related to physiology of the Human Body
• Whereas, human body has an automatic response generated in response to these attacks from external environment, which uses the principles of an immunological response and factors that influence it e.g. age, nutritional status, immune-suppression from cancer therapy or underlying disease states (Greenhalgh, 1999)

3.3 Examine how such information about the body functioning may inform care planning for this person?

For this person with obesity and an age of 65 years with a busy lifestyle and less physical activity, the symptoms like fever and flu can be really deceptive and may be onset of anything critical. Once he reports to the General Practioners (GP) based on the above vital data and the information derived from it about the human body functioning, following processes maybe undertaken to prove out the abnormality based on the symptoms and aligning it with changes in the vital stats of his body and hence Care planning can be undertaken for mitigating him with the diagnosed illness –

Routine care

• All these information derived from the recorded primary data and the raw data itself has got a huge implication on health and social care
• As already discussed above about the potential of raw data, its importance and utilization, similarly the functioning information of Human Body and implication of this data in understanding it further ahead helps health and social care services with activities of daily living; general consequences for care or treatment e.g. by drugs, surgery; infection control; rehabilitation; principles of palliative care etc

Symptoms and alignment with changes in vital stats

• Observable changes in body weight, body temperature, pulse rate, respiration rate, blood pressure, food and fluid intake, excretion and its composition etc performed, observed and recorded by the GP for this patient
• Derived measures, such as BMI and nutritional health are calculated for this obese man by his GP

Based on these information, GP

• Will ascertain the primary diagnostic assertion
• Prescribing treatment and therapy
• Confirming it further with advanced testing
• Releasing the patient with immediate relief
• Mitigating possible relapse possibilities (Greenhalgh, 2005)

Task 4.

4.1 Explain how her age may have affected her body structure and functioning (Nervous, Respiratory and Integumentary systems)?

Due to age, the effects and impacts on the old woman’s body structure and functioning are as follows –

Nervous System

• Over the age the smallest unit of Brain, the Neurons are originated, destroyed, re-grown and finally matured and ultimately death
• The Neuron density in the brain is the signal of the effectiveness and working efficiency of the Human Brain
• The Neuron density increases with the age from the birth of human being up to a certain level and peaks around the middle ages
• During the later stages, it starts degenerating and hence the density decreases
• Since, the density is the measure of Human Brain working, it comprehensively decreases with the age as the density decreases; hence, for this old lady, living in the care home, the brain functioning is of limited strength and she needs care and has specific needs to be taken care of

Respiratory System

• Same as the brain and neuron, the basic unit of Lungs, the vital most organ of the respiratory system, is Alveoli
• Alveoli are the functional tiny sacs which are the basic component of the lungs
• The gaseous exchange takes place at the surface of the alveoli
• The Oxygen carrying capacity in the blood is directly proportional to the amount of area made available for the gaseous exchange in the Lungs and which is directly proportional to the number of Alveoli
• Same as Neurons, Alveoli also increases in their concentration during the initial growth years and peak around middle ages with decline in concentration thereafter
• Hence, similarly as brain activity, respiratory function of the old lady is also hampered and less efficient leading to various symptoms like uneasiness in breathing, hypertension (due to less oxygen and metabolism) etc

Integumentary System

• As she ages, the external peripheral of Human Body also starts showing signs of maturity with loosened skin, body deformity and changes in overall physical structure
• Due to her arthritis, her legs and associated movement muscles and bones are highly deformed and inefficient causing problems in movement and transportation

Other Systems

• Since, she is suffering from Diabetes; her Insulin production capacity is hampered
• Insulin is required in Human Body for the glucose production from higher molecules and hence lack of glucose molecules, the energy store house of the body, leads to fatigue and other distortions
• As human brain requires fresh glucose for its normal functioning, the lack of glucose leads to impaired brain activity
• Glucose is also required for the Thromboplastin production, which is required for the clotting of blood and hence covering of any wound or cut on the skin and creating a protective layer from the external world, gets affected and hence wounds are not healed as per their normal due course (Freedman, 2000)

4.2 Assess the impacts of the above mentioned conditions on her body structure and functions?

As already mentioned, following are the impacts, old age and other ailments has brought to her body structure and functions –

Due to Old Age

• Impaired vision and chronic visibility loss
• Loose skin and changes in outer body structure
• Impaired brain and sensory functions
• Respiratory ineffectiveness and problems in breathing
• Less sharp senses, such as touch, feel, taste, smell and audibility
• Impaired physical stamina and strength

Due to diabetes, hypertension and arthritis

• Loss of production of glucose
• Loss of brain function due to glucose insufficiency
• Elongated wound healing and body self immunity mechanism, due to lack of glucose and diabetes
• Due to hypertension, high blood pressure flowing in the body
• Chances of cardio-vascular system failure
• Impaired movement due to arthritis
• Lack of RBCs and destruction of the existing ones due to immunosuppressive conditions of the body etc (Sidell, 1995)

4.3 Relate the effects of her medical conditions including infection to the routine care?

The effects of her medical conditions, including the infection in her routine care are as follows –

1. Her medical conditions arouse from hypertension, diabetes, arthritis and hence not healing of wound and related infection have got a severe impact on her regular care planning
2. As discussed, already impaired glucose production due to lack of insulin production leads to many symptoms and changes in Human Body, from immune-suppression to impaired brain activity
3. Now care planning for existing conditions will include, external insulin dosage, immune-booster drugs for healing up of the wound
4. Whereas, these techniques will intervene in her other conditions, like arthritis where an immune-booster drug will create havoc and will impact the prognosis or the treatment of arthritis by rejecting the treatment due to increased immune-biology
5. Her hypertension will impair additional secretion, even after insulin injections, due to increased transportation, excretion and breakdown of glucose molecules compared to its secretion (Pincus, 2002)

References

Agostoni, E., & Mead, J. (1964). Statics of the respiratory system. Handbook of Physiology. Respiration, 1, 387-409.
Bates, J. H. T., Rossi, A., & Milic-Emili, J. (1985). Analysis of the behavior of the respiratory system with constant inspiratory flow. J Appl Physiol, 58(6), 1840-1848.
Curtis, L. A. (2012). Unit costs of health and social care 2012. Personal Social Services Research Unit.
Dampney, R. A. L. (1994). Functional organization of central pathways regulating the cardiovascular system. Physiological Reviews, 74(2), 323-364.
Fitzpatrick, R., Fletcher, A., Gore, S., Jones, D., Spiegelhalter, D., & Cox, D. (1992). Quality of life measures in health care. I: Applications and issues in assessment. BMJ: British   Medical Journal, 1074-1077.
Frankel, V. H., & Burstein, A. H. (1970). Orthopaedic biomechanics: the application of engineering to the musculoskeletal system (pp. 24-52). Philadelphia: Lea & Febiger.
Freedman, V. A., & Martin, L. G. (2000). Contribution of chronic conditions to aggregate changes in old-age functioning. American Journal of Public Health,90(11), 1755.
Greenhalgh, J., & Meadows, K. (1999). The effectiveness of the use of patient?based measures of health in routine practice in improving the process and outcomes of patient care: a literature review. Journal of evaluation in clinical practice, 5(4), 401-416.
Greenhalgh, J., Long, A. F., & Flynn, R. (2005). The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory?.Social science & medicine, 60(4), 833-843.