Lower Division Capstone PowerPoint Presentation Example | Topics and Well Written Essays - 250 words

Lower Division Capstone - PowerPoint Presentation Example (Barro, 2008) GDP is a very important factor which tells the state of an economy. Recession is usually around the corner when GDP has been shrinking for two quarters in a row. Country is usually seen to be recovering back from recession when GDP starts growing again. A high GDP growth country usually attracts a lot of investments. GDP per capita is regarded as an indicator of the overall well being of the citizens of a country. China and India have high GDPs but their GDP per capita is low which is consistent with the millions of poor and malnourished in these countries. The output composition of GDP gives an indication of the type of economy that a country has. A country following an aggressive form of development is most likely to be spending most on investment and very little on consumption. If the GDP data is collected according to various industrial and sectoral categories we can get great insights into the composition of the economy. Normally after a recession just like the one that the country recently witnesses we expect a period of renewal with a high GDP growth .But this time the GDP growth rate has been very lackluster which has raised fears of a double dip recession.GDP as well as total consumer spending in US has declined sharply during the first quarter of 2011 as can be seen from the graph below. The crisis that started a few years ago was largely due to the housing bubble. The great news is that the debt has been reducing continuously and has now reached levels of 1980s and 90s.The burden of debt at present is not too high and will certainly not hamper growth to a large extent (Tilton, August 2011). Household and auto sector were one of the most severely hit sectors during recession. However these sectors are cyclic in nature and are expected to regain some of their lost vigour.This will certainly help in boosting the economy of the country. (Tilton, August 2011) The high deficit of the US government

Higher education Essay Example for Free

Higher education Essay As I see you beaming with pride and eagerly waiting to enter a higher education, I am reminded of the words of the German Philosopher Friedrich Nietzsche who says, â€Å"On the mountains of truth you can never climb in vain: either you will reach a point higher up today, or you will be training your powers so that you will be able to climb higher tomorrow. Just like the mountains of truth, you have made a tremendous effort to climb the ladder that will take you to a greater height of success. You all deserve to be here today. Some may be clouded with sadness as you leave your alma mater while reminiscing the unforgettable days with your batchmates and teachers. This is the day that you will always cherish and the time has come for you to assert your inner glow, shine and be the light of our school. In the number of years of being with us, we have journeyed together, earned success and have learned from our mistakes. Each tiny steps that we have taken, made us better, stronger and wiser. Each of you has contributed to our success and we are so proud of you. When you participated in the Rizal competition, a competition that has showcased your creative writing, chess, art and other talents, you have earned honors for your alma mater. This may be a game of fun for many competitors like you because of the talent, interest and enthusiasm that you take with you in every competition that you have participated in. Our academic and non-academic activities and competitions have honed your skills and made you discover the innate talents that you have. This school serves as the avenue that has paved the way in enriching your minds, polishing your skills, and making you understand the importance of discipline and education. How could we forget the fire drills that we had that would prepare you to any similar disaster that may or may not happen in your life? This is an important preparation in light of some unavoidable or unexpected disasters that are happening in many parts of our country. In this drill, you have also shown others the value of being of help to your fellowmen regardless of who they are. This is a giant step in understanding the value of saving lives and in being big brothers and big sisters to one another. You have also made a great effort in our water conservation campaign. We must be thankful for the abundance of water that we are enjoying in our community and in our country. However, being blessed with a life giving water resources must not come with its careless and abusive usage. Each of you has learned to become vigilant to dripping faucets and excessive use of water for our daily needs. It is now our task to continue this practice in our homes and in our communities. These are few of the many programs and activities that we have undertaken together and without your help and effort, we will never succeed in our undertakings. With that, allow me to personally say, â€Å"Thank You† to the graduating class and their parents. To all the teachers and staff, I salute you for the many hours that you have spent in helping your students learn and succeed. You have worked beyond school hours and have supported me in implementing our programs. Although there are talks about the possibility of closing this school amidst all our challenges, rest assured that we are working hard and doing everything we can to keep this school open and functioning well so new students can enroll, and old students can continue their studies and eventually graduate similar to the current batch who are right before me today. I would like to conclude my speech not with a farewell to the graduates and their parents but with a reminder that in being a light for your alma mater, you can serve someone other than yourself and serve something bigger than yourself. God bless you and your families.

Mariano Escobedo :: essays research papers

Mariano Escobedo Mariano Escobedo was a healthy man he was my Grandparents great great grandparent. He was a Mexican General from Mexico. He wanted to govern Mexico, he fought against dynasty and he won. Escobedo fought against the French Invasion in Mexico to govern Mexico. He became a great general who fought against Napoleon III (French.) In Mexico City airport and in Monterey his name is printed and also in some streets of difference parts of Mexico. Mexico had borrowed money from England, France and Spain. In 1861 representatives from this countries got together in London to find a way to get Mexico to pay this countries. Troops from this three countries went to Veracruz in 1862. They were welcomed from representative from Mexico. The general Juan Prim, from Spain accepted the way Mexico was going to pay little by little so as England. The representative from France is not accepted he wanted the money and ordered his troops to prepare to fight. The government of Benito Juarez organize the defens e. He made in charge the general Ignazio Zaragoza to get to Puebla and fight with the French. They attacked each other in the " Fuertes de Loreto y Guadalupe. The troops of Zaragoza, helped from the Indians Zacapoaxtla. In 1862of Mat 5 they won against the French. The emperor from France, Luis Napoleon Bonaparte, wanted to extend his powers in America and in Asia. He dreamed to form a great empire. Mexico took advantage of that situation to peek an European emperor to govern Mexico and to stop the politic anarchy. Luis Napoleon made them recommend Fernando Maximiliano de Habsurgo, brother of the emperor Francisco Jose. Maximiliano accepted his embarkation to Mexico but with her wife, the princess Carlota Amalia de Belgica. Luis Napoleon send his army to wish napoleon luck. Austria and Belgica also send troops. The emperors arrived to Mexico at the end of 1864. In Veracruz, Puebla were great big welcomes. To confront the invaders, to the president Juarez formed a government itin erante, who traveled from the capital to the north border. From this places it continue the position of the millitar action from the armies from the North, West, command from

Analysis of a High Toned Christian Woman

Samantha Kozera Ms. McGrath ENG 4U 20 March 2013 Analysis of A High-Toned Christian Woman The poem A High-Toned Christian Woman by Wallace Stevens used many sound devices to create an amazing poem and therefore should be considered to be â€Å"the best poem in the world†. If we dissect the poem, we can see that almost every line has a sound device that affects the poem’s atmosphere, meaning or use of words. The mood seemed playful from combinations of words and sound devices.The alliteration in line 19: â€Å"May, merely may, madame†¦Ã¢â‚¬  makes the speaker sound fun instead of strict. The onomatopoeia in line 18: â€Å"Such tink and tank and tunk-a-tunk-tunk†¦Ã¢â‚¬  also bring up the playful mood. His tone seems to be mocking the Christian woman’s beliefs instead of having a mature conversation. Repetition of â€Å"Madame† as well as â€Å"palm†, planets, and fiction makes it clear to the reader that these subjects are important. Ste vens creates comparisons from the first mention of those subjects to the next mention.For example, he states in the first line that â€Å"poetry is the supreme fiction† then later speaks about the woman’s beliefs as fiction as well. The author also repeats the subject planets. The first time the author speaks of planets is in a context of a â€Å"project beyond the planets† (Line 8-9). The project could be poetry and the place could be his imagination. Since we often associate something beyond the planets as Heaven (especially since Christianity is in our minds at this point), the author choses the repetition of planets to show that anything beyond it is a figment of the imagination.He speaks of Heaven in line 3 with an alliteration, â€Å"haunted Heaven† after he speaks about a â€Å"nave† (Line 2). This line creates a dark and cruel feeling. A nave is an empty place for worshippers and a haunted Heaven gives the idea that Heaven is a place for de ad worshippers. In line 2 and 3 assonance is used with the â€Å"a† sound being the emphasis. These lines are very important to the poem by putting emphasis on these lines the author brings that to the reader’s attention.The author’s diction and images like â€Å"Squiggling like saxophones† (Line 12), â€Å"muzzy bellies† (Line 16) and â€Å"jovial hullabaloo† (Line 20) make it seem like the speaker trying to persuade the woman to think a certain way and is making fun of what she thinks to accomplish that. The image of a widow wincing is a very sharp image that’s emphasised by the alliteration with the â€Å"w† sound that contrasts the fun mood. This could represent the comparison of the interpretation of poetry and the interpretation of religious literature.Also, this widow could represent the Christian woman, who is wincing at such crazy ideas spoken by the speaker of the poem. In conclusion, the sound devices and images cont ribute to the mood and meaning of the poem because it brings emphasis to important lines. Through connotations and alliterations, Wallace Stevens makes a short poem into a huge (controversial) idea. The fact that someone can accomplish this with only twenty-two lines makes it eligible to be the best poem ever.

Lecture Notes for Bio 106

Reproductive roles Male’s job is to get the sperm to the egg The sperm are specialized to deliver the male’s genes to the egg Female’s job is to produce a gamete (egg) containing the female’s genes Egg is specialized to nourish the embryo Egg is large and contains nutrients Egg must be moved along Female must also nourish and protect the embryo and fetus This is the job of the uterus Male reproductive strategy: Produce millions of gametes and hope that one makes it to the egg Female reproductive strategy: Invest heavily in one gamete and nourish and protect it Egg Cell (Ovum; 1 copy each chromosome) Sperm Cell (1 copy of each chromosome) MEIOSIS (a type of cell division that begins with a cell with 2 copies of each chromosome and ends with 4 cells with 1 copy of each chromosome) FERTLIZATION (Fusion of Egg and Sperm nuclei; creates a cell with 2 copies of each chromosome) Zygote (cell formed by fusion of egg and sperm; has 2 copies of each chromosome; will develop into new individual) Ovary (in female) Testis (in male) 1 Gonads: a. Testes in male b. Ovaries in females 1. roduce gametes Male = sperm Female = ovum or egg join zygote; new individual 2. produce sex hormones testosterone estrogen + progesterone Male Reproductive System Testes located in scrotum why? sperm don't survive well at body temperature is 3-4o F cooler temp kept constant by reflex how? – pass through the inguinal canal before birth hole usually closed over with connective tissue possible problems 1. cryptorchidism failure of the testes to descend if not corrected, results in sterility corrected by surgery or by administering hormones 2. inguinal hernia inguinal canal does not completely close intestine may push into opening correct with surgery more common in men but may occur in women Inside Testes 1. eminiferous tubules about 1000 site where sperm are produced by a process called spermatogenesis produce 100 million+ sperm each day from puberty until death spermatogenesis A. takes place in an orderly progression from the outside edge of seminiferous tubule to inside (lumen) B. involves changes in genetic information and changes in the shape and functioning of cell sperm carry father’s genetic contribution to next offspring body cells have 2 copies of each chromosome (1 from Mom & 1 from Dad) gametes (egg or sperm) can have only 1 copy of each chromosome meiosis = the type of cell division that produces gametes 1 cell with 2 copies of each chromosome Meiosis spermatogenesis 4 cells with 1 copy of each chromosome Sperm Structure 2 designed to deliver male’s genetic contribution to next generation 1.Head – contains male’s genetic contribution to next generation; almost all nucleus 2. Acrosome – a sac containing enzymes to will allow the sperm to digest the outer layers around egg so sperm nucleus can reach egg nucleus 3. Mitochondria – energy to fuel the trip to egg 4. Tail (or flagellum) has contractile fibers for motility; allows the sperm to swim to egg 2. interstitial cells – produce male sex hormone – testosterone Still in testis – between seminiferous tubules Beginning at puberty these cells secrete testosterone They are stimulated to secrete testosterone by LH, a hormone produced by the anterior pituitary gland LH (from anterior pituitary) stimulates the release of testosteroneHORMONES chemical messengers produced by certain glands and released into the blood hormone reaches all cells only cells with a receptor for that hormone can respond a cell responds by doing what that cell does it might divide it might produce a chemical it might increase rate of certain chemical reactions so hormones have different effects on different cells cells without receptors for that hormone cannot respond 3 Cell 1 (with receptor) Effect 1 Cell 2 (with receptor) Effect 2 Hormone Into blood supply throughout body Cell 3 (with receptor) Effect 3 Cell 4 (no rec eptor) No Effect Testosterone causes: development of male reproductive apparatus sperm maturation secondary sex characteristics sex drive (in part) Possible problems with testes Testicular cancer: most common in males 25-30 yrs. more common if testes did not descend after 6 yrs. may be hereditary usually does not cause pain Practice self exam! Feel for small lump Best done after a hot shower Sperm next enter a system of tubes to store and transport sperm 1. pididymis: tube about 20 feet long stores sperm sperm mature here, sperm change size and shape, metabolism changes, sperm become capable of moving but don't yet. sperm moved along by peristalsis (a wave of muscle contraction) 2. vas deferens: sperm duct conducts sperm from epididymis to urethra 3. urethra: conducts sperm to outside of body, also conducts urine but never at same time Accessory Glands: 1. Bulbourethral glands mucous secretion just before ejaculation lubricant? Buffers to adjust pH of urethra 2. Prostate gland secre tes fluid, milky color alkaline activates sperm counteracts acidity of female reproductive tract Possible problems with prostate 1. enlarges in older men difficulty urinating & decreased bladder volume 2. rostate cancer grows slowly can spread detected by: rectal exam and blood test for PSA (prostate specific antigen) 4 3. Seminal vesicles make up most of the volume of semen secretion probably nourishes sperm (contains fructose, vitamin C, amino acids, prostaglandins) Result = semen Semen: secretions of accessory glands and sperm about 1 tsp. per ejaculation, about 20 % sperm Functions: transport sperm lubricate passageways nourish sperm decrease acidity of female reproductive tract Penis: Functions: transfer sperm to female conducts sperm outside body tip is enlarged = glans penis (rich in sensory endings) Mechanism of erection 3 columns of spongy tissue arteries dilate ? increase blood delivery veins close down blood accumulatesErectile Dysfunction = Impotence inability to achieve or maintain an erection common problem many possible causes – both physical and emotional drugs now available to help a man have an erection when he is sexually stimulated (e. g. Viagra, Cialis, Levitra) These inhibit the breakdown of the neurotransmitter that causes the arteries in penis to dilate arteries are dilated longer increases and prolongs blood entering the penis ? erection Female Reproductive System gonads = 2 ovaries 1. produce eggs or ova (singular = ovum) egg is specialized to provide nourishment for early embryo large cell full of nutrients 2. produce female hormones: estrogen progesterone Female also nourishes and protects the developing embryo and fetus = job of the uterus 5 Ovarian Cycle = series of events in the ovary that leads to production of egg, estrogen & progesterone 1. ollicle maturation primary follicle = an immature egg surrounded by a layer of follicle cells as follicle matures the immature egg gets larger follicle cells divide and form many lay ers around egg follicle cells secrete estrogen mature follicle egg completes first meiotic division layers of follicle cells splits forming a central cavity filled with fluid containing estrogen egg pushed to side with layer of follicle cells 2. ovulation = release of immature egg from ovary egg released with layer of follicle cells around it rest of follicle cells stay in ovary 3. corpus luteum forms from follicle cells remaining in ovary corpus luteum secretes estrogen and progesteroneOVARY primary follicle (immature egg surrounded by follicle cells) mature follicle (many layers of follicle cells, fluid filled cavity, egg surrounded by follicle cells) after ovulation follicle cells remaining in ovary become corpus luteum estrogen progesterone egg 1. estrogen maturation of egg development and maintenance of reproductive structures cell division: thickens lining of uterus also occurs in breast tissue secondary sex characteristics pubic hair armpit hair broader pelvis breast developm ent 2. progesterone prepares uterus for egg implantation maintains pregnancy 6 Oogenesis = the process by which an egg (ovum) is formed Meiosis: starts with a cell that has 2 copies of every chromosome ends with up to 4 cells with 1 copy of every chromosome 1 egg (ovum) and 3 non functional polar bodies IN FEMALES MEIOSIS IS NOT A CONTINUOUS PROCESS Preparations begin efore birth in all potential eggs Then development stops Beginning at puberty, 1 egg continues to the next stage of development The egg is ovulated (released from the ovary) Meiosis is completed ONLY if the egg is fertilized) Number of ova At puberty: potential for about 400,000 eggs Usually 1 each month develops in each monthly cycle (if 2 form and both are fertilized get fraternal twins) total egg production ~ 450 eggs in lifetime menopause – rest of potential eggs have degenerated Oviducts (Fallopian tubes tubes that conduct the egg to the uterus – takes about 3 days open end enlarged and fringed †“ increased surface area for catching egg cilia line oviducts to help move egg along fertilization – usually in upper third of oviduct ectopic pregnancy – usually a tubal pregnancy early embryo implants and begins development at site other than uterus usually in Fallopian tube (oviduct) dangerous to mother – must be terminated Uterus provides nourishment & protects the developing embryo and fetus A. Cervix – tubular portion the extends into vagina has opening through which sperm enter and baby exits B. Body – region in which fetus develops 1.Endometrium – lining site where embryo implants built up each month cell division makes it thicker becomes more vascular (more blood vessels) glands develop that provide nutritious material then lost as menstrual fluid (woman gets her period) 2. muscle allows uterus to expand as fetus grows 60X bigger at full term pregnancy 7 provides force to push baby out Possible problems with uterus: 1. Pelvic Infl ammatory Disease (PID): any bacterial infection of pelvic organs especially uterus, oviducts, ovaries; may spread (peritonitis) may be painful or chronic may have no symptoms often leaves oviduct scarred so that fertility is reduced and the risk of ectopic pregnancy is increased treated with antibiotics most commonly caused by sexually transmitted bacteria the bacteria that cause gonorrhea and chlamydia 2.Cervical cancer: involves external surface of cervix detect with PAP test risk factors -intercourse at an early age -multiple sex partners associated with certain STDsparticularly the HPV (human papilloma virus) that causes genital warts use of condoms and/or diaphragm decreases risk Vagina ~3 muscular passageway to uterus elastic – expands to allow baby through possible problem with vagina: vaginitis most commonly yeast (Candida albicans) not usually sexually transmitted not from poor hygiene bacteria in the vagina produce acid Anything that kills the bacteria or makes the vagina less acidic allows yeast to grow ? vaginitis Clitoris †¢ †¢ †¢ Derived from same embryological structure as the glans penis Becomes engorged with blood during sexual excitement No known function other than pleasure 8Menstrual or Uterine Cycle the endometrium (uterine lining) is built up to nourish the embryo and then it breaks down and is lost as menstrual flow it is a cycle caused by interplay of hormones want the uterus ready to receive embryo if there is one the ovarian cycle that produces the egg must be coordinated with the uterine cycle that prepares the uterus done by same hormones Hormones of the menstrual cycle OVARY Estrogen – from follicle cells in ovary and later from corpus luteum maturation of egg cell division in endometrium (uterine lining) cell division in breast tissue Progesterone – from corpus luteum further development of endometrium maintains endometrium ANTERIOR PITUITARY FSH – follicle stimulating hormone: stimulate s development of follicle LH – luteinizing hormone formation of corpus luteum from follicle cells remaining in ovary maintains corpus luteum Negative Feedback X? Y hormone X leads to an increase in hormone Y Y? X hormone Y causes decrease in hormone X when hormone X levels fall, less hormone Y produced less hormone Y means less inhibition of hormone X hormone X increases and stimulates release of hormone Y IN GENERAL FSH & LH stimulate release of estrogen and progesterone estrogen and progesterone inhibit release of FSH & LH BUT rapid rise in estrogen triggers LH release LH causes corpus luteum to form and secrete estrogen and progesterone corpus lutuem degenerates – estrogen and progesterone levels drop (removes inhibition of FSH) 9Negative feedback in menstrual cycle Low levels of estrogen and progesterone stimulate the release of FSH (and LH) from anterior pituitary FSH stimulates estrogen release by follicle cells in ovary Estrogen (and progesterone) inhibit FSH (a nd LH) release FSH and LH levels drop Estrogen and progesterone levels drop if the egg is fertilized corpus luteum is maintained by a hormone from the embryo called: human chorionic gonadotropic (HCG) hormone for about 5 months the corpus luteum secretes progesterone placenta eventually takes over progesterone secretion progesterone is needed to maintain endometrium if progesterone secretion stops – there is a miscarriage Menopause considered to have occurred when there is no period for 1 year follicles in ovary spontaneously degenerate eggs no longer produced ends child-bearing years estrogen & progesterone no longer produced in ovary occurs most often between 4555yrs. occurs gradually Perimenopause = time leading up to menopause Symptoms hot flashes & dizziness – dilation of arteries in top half of body may be: irritable headaches fatigue physical changes skin drier & less elastic ? wrinkles breasts decrease in size might be change in distribution of hair osteoporosi s – decrease in bone density NEED NOT CHANGE SEXUAL DESIRE 10Estrogen DESIRABLE EFFECTS Brain regulates areas that prepare for reproduction maintains stable body temperature may protect memory Breast Breast programs glands promotes breast to produce milk cancer Liver & Heart helps regulate cholesterol production prevents atherosclerosi s Uterus Uterus programs uterus to promotes nourish fetus cancer of cell division in endometrium endometrium NEGATIVE EFFECTS Estrogen’s Effect on Bone Bone maintains density causes calcium to be absorbed from gut promotes calcium deposit in bones Osteoporosis – decrease in bone density calcium salts make bone hard bones are constantly remodeled built up & broken down in response to stress (weight or pressure) until age 35 more build up than break down peak bone density influenced by: sex race size nutrition exercise that puts weight on bones overall health Bone Formation Blood level Of calcium Calcium in Bone 11Bone Breakdown Die t influences level of calcium in blood good sources of calcium: milk and milk products (choose low fat) dark green vegetables nuts seeds Weight-bearing exercise stimulates bone formation in the bones that are stressed by the exercise walking jogging calcium levels are regulated by hormones calcitonin from thyroid gland causes calcium to be put into bones parathyroid hormone from parathyroid glands causes calcium to be removed from bone estrogen helps absorption of calcium from digestive system stimulates bone formation After menopause estrogen levels greatly decrease Bone Formation Calcitonin Estrogen Blood level Of calcium Calcium in BoneThe Breast Function To produce milk to nourish the young Structure The breast is composed almost entirely of fatty tissue and milk glands milk glands are called lobules each gland drains into a system of ducts these empty into a collecting chamber below nipple several ducts collect into one duct ducts drain through nipple Possible Problems 1. Preme nstrual tenderness breast tissue is prepared each month along with egg and endometrium Estrogen causes cell division in breast tissue Progesterone causes increase in glandular activity Increase in blood supply to breast swelling and tenderness Parathyroid Hormone Bone Breakdown Bone Formation 12 2. fibrocystic breast disease (disorder) an exaggeration of monthly changes in breast tissue built up tissue is not completely reabsorbed and forms cysts feels like many lumps in breast 3. fibroadenoma – noncancerous lump in breast usually in upper & outer quadrant small moveable lump 4. reast cancer will return to this after discussion of cancer 13 Cancer = uncontrolled cell division Cancer cells kill by: depriving other cells of nutrients preventing other cells from performing their duties blocking important pathways (air, blood, nerve) Cells divide Tumor Benign tumor: stays in one place; not cancer Malignant tumor: cancer, cells spread (metastasize) multiple tumors form in other pa rts of body usually spread via blood vessels or lymphatic system In healthy person cell division is regulated Cell Cycle = the orderly sequence of events in the life of a dividing cell G1 – cell growth (G1 checkpoint – is the cell large enough to divide? S (synthesis) – genetic material (DNA of chromosomes) is duplicated G2 – growth and final preparations for cell division (G2 checkpoint – is the DNA replicated? ) Cell division Mitosis – nucleus divides Cytoplasm divides produces two daughter cells Normal controls on cell growth regulate cell division to allow growth and replacement 14 Cancer cells escape controls Normal controls: 1. Genes regulate the cell cycle GENE carries the instructions for making a protein PROTEIN has a job in the cell it might form (part of) a structure it might be regulatory = determine whether a certain cellular process will occur mutation = change in the gene’s information changes the instructions for the p rotein the new protein might not function or might function differently Normal Controls on Cell Division 1.Genes regulate the cell cycle proto-oncogene – normal form of a gene that produces specific proteins that stimulate the cell cycle for growth and repair acts like accelerator about 60 known if other controls were faulty it would enhance the growth of a tumor tumor-suppressor gene – normal form of a gene that produces specific proteins that slow the cell cycle proteins stop cell cycle at one of the checkpoints acts like brakes Normal Genetic Controls on Cell Division tumorprotosuppressor oncogene gene slows stimulates cell division mutations in these cell cycle genes can cause the cell to lose control over cell division Cancer oncogene = mutant protooncogene over stimulates cell division = stuck accelerator can help induce cancer dominant mutation – only need 1 of the 2 copies to be mutant mutant tumor-suppressor gene impairs ability to slow cell cycle = bro ken brakes enhances tumor formation recessive mutation – need mutation in both copies of the gene to have an effect 15 p53 a tumor-suppressor gene detects damaged DNA 2. rogrammed cell death occurs when genes are damaged cancer cells have mutation in other genes that prevent the damaged cells from being destroyed 3. limited life span cell can only divide 50-60 times telomeres – protective pieces on tips of chromosomes end of telomeres shaved off with each cell division telomerase = enzyme that makes telomeres not present in normal cells is present in most cancer cells 4. Need for blood supply controls prevent new blood supply to tissue unless it is damaged cancer cells produce growth factors to attract new blood vessels blood vessels needed to bring nutrients and remove waste also provides route for cancer cells to spread tops cell division initiates DNA repair if too much DNA damage —> p53 triggers programmed cell death Development of cancer need several mutati ons in same cell before cancer starts leukemia – may be as few as 3 mutations colon cancer – may need as many as 9 mutations EXAMPLE ONLY: Development of colon cancer 1. Loss of tumor-suppressor gene from chromosome 5 a polyp forms on colon wall a benign, precancerous tumor grows 2. Activation of oncogene from chromosome 12 a class II adenoma (benign) forms) 3. Loss of tumor-suppressor gene from chromosome 18 a class III adenoma (benign) grows 4. loss of tumor-suppressor gene from chromosome 17 a carcinoma (malignant tumor) forms 5. other changes ? cancer spreads to other tissues 16 5.Need for cell attachment normal cells must be anchored in place oncogenes produce proteins that break anchors but signal cell that it is anchored Immune System – The body’s defense system cells of the immune system roam the body looking for cells they don’t recognize as belonging cancer cells have changed and are not recognized as belonging if cells of the immune syst em encounter a cancer cell, they will be destroy it Factors that can cause cancer 1. carcinogens = chemicals that cause cancer cause mutations that lead to cancer many mutate p53 stimulate cell division (e. g. estrogen) inhibiting the immune system may be in environment, in food or drink, or inhaled at least 50 carcinogens some carcinogens are only carcinogenic after modification in the body 2. iruses consist of genetic information (usually DNA) inside a protein coat virus enters cell and uses host cell machinery to make new viruses viral DNA is inserted into host cell chromosome and is replicated with host cell DNA viral DNA is then a permanent part of host cell chromosome – it has transformed the cell into a cancer cell – all daughter cells will have the viral genes viruses have oncogenes that produce proteins that stimulate cell division viral protein produced may be hyperactive in stimulating cell division OR viral gene may direct human gene to produce too much of a protein that stimulates cell division result is a host cell that has been permanently changed by virus so that it contains an oncogene that stimulates cell division 3. radiation interacts with DNA and causes mutation ultraviolet (uv) radiation from sun causes skin cancer ionizing radiation natural sources (cosmic rays, radioactive materials in earth’s crust) medical sources (x-ray exams) 17 Risk Factors 1. revious breast or other form of cancer Breast Cancer most breast lumps are benign (not cancerous) fibrocystic breasts fibroadenoma death rate from breast cancer has been declining due to early detection practice monthly self exam breast cancer usually begins in the ducts (80%) or the glands begins as lump or tumor lump is usually in upper outer quadrant staged by size of lump and how far it has spread it can metastasize: break out of this site and spread to fatty tissue or other parts of body through lymphatic system or blood supply to determine whether cancer has spread they would look at sentinel nodes (first lymph nodes to which a tumor drains) 2. Gender females much more likely (men can get breast cancer) 3. Age chance of breast cancer goes up with age rises sharply after 40 4.Family history risk is 2X if: first-degree relative (mother, sister, daughter) with breast cancer risk is 5X if: 2 first-degree relatives with breast cancer may have inherited genes e. g. BRCA 1 or BRCA 2 these greatly increase chance of breast cancer BRCA 1 = a tumorsuppressor gene turns off another gene that blocks cell cycle 18 5. Hormone history prolonged, uninterrupted exposure to estrogen increases risk estrogen stimulates cell division in breast if too much estrogen some believe it can lead to cancer some types of breast tumors are stimulated to grow by estrogen more menstrual cycles = more exposure to estrogen risk increased by: a. early puberty – before 11 b. late menopause – after 55 c. not having children or delaying first pregnancy – after 30 What about other sources of estrogen? irth control pills – probably not hormone replacement after menopause – slight environmental sources – unknown certain pollutants mimic estrogen (pesticides, ingredients in plastics) electromagnetic fields can boost body’s production of estrogen 6. Obesity fat cells produce a substance that is converted to estrogen 7. Alcohol alcohol increases level of estrogen interferes with use of folate, which protects against tumor growth 19 Birth Control Effectiveness rate = # of couples out of every 100 using that means of contraception for 1 year who do NOT become pregnant Failure Rate = # of couples out of every 100 using that means of contraception for 1 year who DO become pregnant Typical Use = average person, use may be improper or inconsistent Vs.Perfect Use = proper and consistent use Effectiveness in Preventing STDs STDs spread by contact (direct contact is usually needed) Infected surface surface Uninfected Effectiv eness in Preventing Pregnancy Highly Effective 1. Sterilization (tubal ligation or vasectomy) prevent sperm from reaching egg 2. Hormonal Contraception A. Estrogen and progesterone – prevents egg development and ovulation 1. oral – the pill 2. vaginal ring – NuvaRing – woman inserts the ring so that it encircles the cervix worn 3 weeks, removed for the 4th 3. skin patch – OrthoEvra new patch once a week for 3 weeks 4th week no patch B. Progesterone-only contraception interferes with fertilization and implantation Types a. ral – mini pill (not used much in US) b. implants c. injections C. Emergency contraception – ? morning after pills? 1. Preven – estrogen and progesterone 2. Plan B – progesteroneonly first dose within 120 hours (5 days), second dose 12 hours later Decrease spread of STDs Certain means of contraception also prevent contact between body surfaces Condom – male or female Diaphragm or cervical cap (so me protection to woman) Increase spread of STDs Pill may increase woman’s risk of certain STDs Spermicides increase a woman’s risk of getting an STD from an infected partner; damages vaginal lining 20 3. IUD – interferes with fertilization and/or implantation; dislodges embryo 4.Diaphragm, cervical cap, FemCap, or Lea’s shield with spermicide – covers cervix and prevents sperm from reaching egg 5. Condom – prevents sperm from reaching egg 6. Vaginal sponge Moderately Effective 1. Spermicides – kill sperm Foams are best is used as only means of contraception May increase the risk of STD spread, particularly in women 2. Rhythm Method – abstinence on all days that could result in sperm meeting an egg Unreliable 1. Withdrawal (coitus interruptus) Does not work 1. Douching after intercourse 2. Intercourse standing up or in some other position 3. Intercourse during menstruation (during your period) 4. Intercourse while breastfeeding Reliable methods 1.Sterilization — permanent birth control Tubal ligation or vasectomy prevent the sperm from meeting the egg Should NOT be used if you or your partner may change your mind For male = vasectomy Close off vas deferens so sperm can’t leave the male’s body Sperm reabsorbed Still ejaculate Simple operation No effect on masculinity No effect on sex life or sex drive Risks: minimal Less than 1% of time tubes grow back together Occasionally a little bleeding in scrotum For women = tubal ligation = have tubes tied Close off oviducts (fallopian tubes) More difficult procedure than a vasectomy because must enter the abdominal cavity Does not cause menopause Will still menstruate No effect on sex drive 21 2. Hormonal Contraception A. Estrogen and progesterone – prevents egg development and ovulation 1. oral – the pill 2. aginal ring – NuvaRing – woman inserts the ring so that it encircles the cervix; worn 3 weeks, removed for the 4th 3. skin patch – OrthoEvra new patch once a week for 3 weeks; 4th week no patch expect same risks as pill, but know most about birth control pill Contain estrogen and progesterone Estrogen & progesterone inhibit FSH and LH Without FSH the egg doesn’t develop Without LH ovulation cannot occur Almost 100% effective – if used properly If you miss more than one day, use another form of birth control Side Effects Headaches Breast tenderness Weight gain Vaginal Infections are more common Serious Risks caused primarily by estrogen Circulatory System Problems rare but can be fatal A.Problems: (1) High blood pressure (2) Increased tendency to form blood clots (1) High blood pressure Increases with time on pill Increases with woman’s age STOP SMOKING – cigarette smoking also causes high blood pressure Blood pressure = pressure exerted by blood on vessel walls Created by beating of heart Pressure must be great enough to move blood around the body If too g reat = high blood pressure Problems caused by high blood pressure 1. strains the heart and blood vessels 2. can lead to an aneurysm (weak spot in artery wall balloons out; can rupture; bleed to death internally 3. promotes atherosclerosis (fatty deposits in arteries) and arteriosclerosis (hardening of arteries) 4. amages kidneys; can lead to kidney failure 22 (2) Increased tendency to form blood clots Danger is that a blood clot can break free and lodge in a small blood vessel, blocking blood flow B. Consequences: (1) Increased risk of heart attack and stroke Heart attack = death of heart cells Stroke = death of nerve cells in brain Heart attack & stroke occur when blood flow to heart or brain is interrupted by: Burst vessel Fatty deposits (atherosclerosis) Blood clot (2) increased risk of pulmonary embolism 2. Increased risk of urinary tract infections 3. Increased susceptibility to sexually transmitted diseases A. Change in pH of vagina – increased risk of chlamydia and gon orrhea B.Change in cervical structure exposes vulnerable cells C. HPV (human papilloma virus that causes genital warts) infection is more likely to result in cervical cancer Progesterone seems to activate HPV in cervical cells grown is culture Non-contraceptive benefits of the pill Decreased risk of PID (pelvic inflammatory disease) Decreased risk of ovarian and endometrial cancer Decreased risk of ectopic pregnancy Decreased risk of iron deficiency anemia 1. 2. 3. 4. 2. Hormonal contraception (cont. ) B. Progesterone-only contraception interferes with fertilization and implantation Types a. oral – mini pill (not used much in US) b. implants –hormone containing rods implanted in upper arm c. njections – DepoProvera injection every 3 months 99% effective in preventing pregnancy no protection against STDs 23 Mechanism of action of progesterone only a. Thickens cervical mucus b. Interferes with movement of sperm c. makes implantation more difficult because endometr ium thin d. Sometimes blocks ovulation e. Makes the corpus luteum degenerate too quickly (removes the source of progesterone that maintains the endometrium) Side effects a. Menstrual cycle disturbance Periods irregular More days of light bleeding Missed periods b. Weight gain c. breast tenderness d. bone density decreases 2. Hormonal contraception (cont. ) C. Emergency contraception – â€Å"morning after pills† 1. Preven – estrogen and progesterone 2.Plan B – progesteroneonly first dose within 72 hours, second dose 12 hours later Emergency contraception is thought to work by inhibiting or delaying ovulation preventing fertilization altering the endometrium, making it an inhospitable place for implantation of the young embryo used after an act of unprotected intercourse if pregnancy not desired risk of pregnancy varies from 0 – 26 after a single act of intercourse – depending on day of cycle morning after pill decreases the risk of pregnancy by 75% (e. g. from 26% to 6. 5%) does not affect the embryo is it has already implanted Side effects: 1. nausea in 50-70% of women 22% vomit 2. menstrual cycle disturbance next period 2 – 3 days early or late 3.IUD (intrauterine device) – interferes with fertilization and/or implantation; dislodges embryo Small device placed inside the uterus by physician remains effective for 1, 3 or 7 years, depending on the type 24 Effectiveness 97% with progesterone 99% with copper Mechanism of action of IUD– affects: Sperm – immobilizes sperm; interferes with their movement Ovum – speeds up movement to uterus Fertilization inhibited Endometrium – not properly developed for implantation FemCap – 3 sizes, latex free, removal strap Prevents the sperm from reaching the egg Must use with spermicidal cream or jelly Helps seal gaps Holds it in place Added chemical protection Must be fitted by a health care professional so seal is tight refit if weight c hanges by more than 10 lbs. Effectiveness 97-98% perfect use 81% typical use It is ? at the time? rotection In place not more than 2 – 3 hr before intercourse Left in place at least 6 – 8 hrs. after intercourse Offers the woman some protection against STDs Risks with diaphragm – minimal 1. slight increase frequency of bladder infection 2. possible allergic reaction 3. toxic shock syndrome don’t leave in place more than 24 hours or use when you have your period 1. 2. 3. 4. Disadvantages 1. if never had children, insertion is painful 2. may have heavier menstrual flow & more cramps 3. body may reject it – then not protected against pregnancy Risks 1. pelvic inflammatory disease – primarily following insertion of the device can lead to sterility and increased risk of ectopic pregnancy 2. increased risk of ectopic pregnancy 4.Diaphragm or cervical cap with spermicide – covers cervix and prevents sperm from reaching egg Soft rubber cup on flexible ring that fits over the cervix Lea’s shield one-size fits all reusable device 25 5. Condom – prevents sperm from reaching egg A. Male condom Thin strong latex sheath that covers the penis and prevents sperm from reaching the egg Disadvantages: Must be placed on an erect penis – before contact with vagina Decreased sensation Failures usually due to tearing if pulled on too tightly – leave at tip if too little lubrication Penis should be withdrawn from vagina while still erect B. female condom Pouch of polyurethane with a flexible ring at each end Effectiveness in preventing pregnancy — 74% typical use Effectiveness against STDs Little known Does provide a barrier Male condom still better 6.Vaginal sponge use: put in place before intercourse (moisten first) leave in place for at least 6 hours after intercourse effective for 24 hours works by: 1. creating a barrier to sperm 2. trapping sperm in sponge 3. spermicide to kill sperm effectivenes s: about 83% less if you have had children Moderately Effective 1. Spermicides – kill sperm Foams are best is used as only means of contraception Effectiveness in preventing pregnancy – about 80% for 60 min. Increases a woman’s risk of getting an STD from an infected partner; damages vaginal lining 26 2. Rhythm Method – abstinence on all days that could result in sperm meeting an egg Egg Can be fertilized for about24 hr. after ovulation Ovulation ccurs 14+/days before the onset of flow Sperm Can live for at least 2 days within woman’s body Problem is predicting ovulation 2 days before it occurs Effectiveness about 75% Fertile period Subtract 14 days from cycle length Add 2 days on either side for uncertainty in time of ovulation Earliest fertile day = 2 days before earliest expected day of ovulation Latest fertile day = 1 day after the latest expected day of ovulation Works best if you avoid all days until at least 1 day after you know ovulation ha s occurred Ways of detecting ovulation 1. Body temperature Requires a special thermometer Must be done first thing in the morning When body temperature increases slightly and stays up ovulation has probably occurred 2. cervical mucus cervical secretion is more slippery and thinner at ovulation Unreliable 1. Withdrawal before ejaculation (coitus interruptus) Methods that DON’T work 1. Douching after intercourse 2. Intercourse standing up or in some other position 3. Intercourse during menstruation (during your period) 4. Intercourse while breastfeeding 27Sexually Transmitted Disease (STD) and Sexually Transmitted Infection (STI) Extremely Common 2/3 of cases in people under age 25 More likely to affect women Women exposed greater surface area of mucous membrane during sexual contact Women less likely to know they are infected Infected area not easily seen Urethra less likely to be infected So less like to be pain Therefore, women more like to have serious consequences. Spread by contact (direct contact is usually needed) Infected ? Uninfected surface surface Mucous membranes are most vulnerable linings of: Urethra Vagina, uterus, fallopian tubes Vulva (external genitalia of woman) Mouth and throat Rectum Eyes Many STDs can enter through break in skinBacteria A bacterium is a single cell A bacterium can divide very rapidly producing two daughter cells results in very rapid (exponantial) growth of the population *Bacteria produce harmful chemicals = toxins (poisons) of enzymes these toxins kills or damage body cells the damage to body cells causes the symptoms of the disease Bacteria ? Toxin or Enzyme ? Damages / Kills Body Cells Bacteria divide rapidly ? More Cells? More Toxin (or enzyme) ? More damage to body. * Sometimes the damage or symptom is caused by the body's defense mechanisms against the disease. Bacteria = cells with a slightly different structure than the cells found in your body Bacteria have a cell structures (called ribosomes) that have a sliightly different structure than human version Structural differences are important because they allow antibiotics to bactieria without killing host (your) cells. 28Antibiotics kill bacteria by: preventing bacteria from making cell walls OR preventing bacteria from making complete proteins OR damaging the plasma membrane Bacteria can become resistant to antibiotics by: inactivating the antibiotic pumping the antibiotic out of cell devoloping the ability to function in spite of antibiotics Antibiotic – resistant bacteria are a major health threat Antibiotic Resistance Some bacteria are now resistant to every known antibiotic Bacteria get their resistance from genes that: Inactivate the antibiotic Pump the antibiotic out of the cell Allow them to function in spite of antibiotic How do bacteria get these resistance genes? 1. They can get their own genes through mutation and selection a. mutation rate is high because rate of cell division is high hen antibiotics are used that a re not strong enough or are not used long enough, the most resistant survive each time antibiotic taken improperly, the more resistant bacteria survive resistance builds b. the â€Å"good bacteria? are killed by the antibiotic† the resistant bacteria can reproduce faster than normal, healthful bacteria and cause illness 2. Bacteria can get resistance genes from other bacteria through plasmids that carry genes for resistance Plasmids – a small circular piece of DNA (genetic materal) that contains a few genes not necessary for bacteria to live, but bacteria with them often have an advantage can be inserted into bacterial chromosome and come out as circular piece again Plasmids can be copied and a copy gived to another bacterium through sex then both bacteria have the genes on the plasmid. 29Certain plasmids (called R factors) have genes for resistance to antibiotics possible to have genes for 1 or 10 different antibiotics genes for resistance for one antibiotic can be ad ded to a plasmid than has genes for resistance to other antibiotics leads to the development of bacteria that are resistance to many different antibiotics multi-drug resistance tends to happen in places where antibiotic use is heavy hospitals farm animals Resistance develops where antibiotics used most Hospitals Livestock Overuse and Misuse of antibiotics has led to resistance 1. Misuse for medical purposes Don't demand antibiotics for viral diseases – they don't work on viruses Take the full course of your prescription 2.Widespead use in livestock and agriculture Used in livestock to promote growth Resistance genes can spread from the animals to the bacteria that harm humans Cook meat throroughly (be sure meat juices don't come in contact with other food) Wash fruits and vegetables Avoid raw eggs Chlamydia and Gonorrhea Caused by different bacteria but have similar symptoms Both primarily affect mucous membranes Most noticeable symptom – if it occurs – is pain during urination This occurs if urethra is infected Urethra is more likely to infected in a male Therefore males more likely to have symptoms Often they don't cause symptoms Can still spread the cactiria to others Bacteria still damage reproductive structures 30Chlamydia (Chlamydia trachomatis) Most common bacterial STD in US Highly contagious Symptoms – slow to appear, 3 weeks to months Men More likely to have symptoms than women Painful urination Discharge from urethra Women If urethra is infected Painful urination Discharge from urethra PID (chlamydia causes 50-90% of PID) Slight vaginal discharge Pain during intercourse Abdominal pain & fever Chlamydia is the STD the most likely to cause scar tissue to form in the tubes that gametes move through Because of scar tissue: Chlamydia is the STD most likely to cause sterility Chlamydia is the STD most likely to increase the risk of an ectopic pregnancy The bacteria that cause chlamydia Must live within a cell because they canno t generate their own ATP They use the ATP that the host cell produces Energy in food ATP Energy for cell activities Effects on Fetus in Utero can cause membranes to rupture can cause death of fetus contracted during birth blindness pneumonia infection of mouth, throat, rectum Diagnosis Urine test for DNA for Chalmydia Swab cervix (women) or urethra (males) and culture cells Pap test (women) Treatment: Antibiotics Gonorrhea Caused by diplococcus bacterium Neisseria gonorrheae Symptoms Often none Men More likely to have symptoms than women Painful urination Discharge from urethra 31Women If urethra is infected Painful urination Discharge from urethra PID Slight vaginal discharge Pain during intercourse Abdominal pain & fever Acidity decreases if on pill or at menopause Effect on fetus: Contracted during birth May cause blindness Diagnosis: Urine test form DNA Swab cervix (women) or urethra (males) and culture cells Look for bacteria in cells Treatment: Antibiotics New varieties are re sistant to antibiotics Syphilis Cause = bacterium (Treponema pallidum) Requires a warm, moist environment Can invade any mucous membrane Usually in the genital area Three Stages 1. Primary Stage 2-6 weeks after contact chancre forms may be small swelling or deep lesion usually hard raised edges â€Å"crater-like† painless at site of contact heals by itself in 4-6 weeks diagnosis at this pint is by isolation of the bacterium from chancre 2.Secondary Stage 2-10 weeks after chancre appears Symptoms Rash- doesn't itch, ulcerates Ulcers in mucous membranes In mouth, vulva, vagina, rectum Warly growths around anus and genital organs Headache Body ache May have: Sore throat Gastrointestinal upset Loss of hair Diagnosis at this stage: Blood test that looks for antibodies (VDRL) 32 3. Tertiary Stage 8-25 years after initial contact almost any organ can be infected and develop lesions called a gumma most common sites of gummas: 1. large arteries decrease diameter of artery aneurysm â⠂¬â€œ weak spot in artery that balloons out 2. brain & spinal cord Blindness Deafness Paralysis Mental degeneration 3.Skeleton Effect of fetus Transferred across placenta Can cause deformities Can be fatal Treatment: Early stages curables with antibiotics Virus Viruses have genetic material (usually DNA but some have RNA) and a protein coat (capsid) Structure of a typical virus Steps in Viral Life Cycle 1. Attachement – Viral protein binds to receptor on host cell 2. Penetration – virus enters host cell 3. Biosynthesis – viral genetic material replicated by using host cell ? machinery;? new coat proteins made 4. Assembly – newly synthesized viral compnents put together to form new viruses 5. Release [called viral shedding or budding]; viruses leave cell with envelopes from host cell OR Viruses genetic information can be integrated into host cell chromosome and stay there in dormant form until it is reactivated Viruses can cause call damage as they are rel eased (shed) 1.Rapid release – cell can rupture and die 2. slow release – cell damage and dearth occurs over long time period 3. Periodic release – viruses can remain in certain body cells (e. g. nerve cells) for life; they may be release from body cells periodically and enter new target cells. (herpes can remain in nerve cells; be released epriodically and enter new epithelial cells; damages the epithelial cells) 4. be integrated into host chromosome and stay there in dormant form until it is reactivated 33 Lytic Infection Persistent Infection Latent Infection Transformation to cancerous cell Rapid release of new viruses from infecded cell caused cell death.The symptoms of the disease depend on which cells are killed Slow release of new viruses causes cell to remain alive and continue to produce new viruses for a prolonged period of time. Delay between infection and symptoms. Virus is present in the cell without harming the cell. Symptoms beging when the virus begins actively replication and causes cell death when new viruses exit the cell. Certain viruses insert their genetic information into host cell chromosomes. Some carry oncogenes (cancer – causing genes) that are active in the host cell. Some disrupt the functioning of the host cell's genes that regulate cell division, causing the cell to become cancerous. Viruses and Disease 1.Can cause cell damage as they leave the host cell; the cell damage causes the symptoms 2. Can cause cancer when they insert themselves into host chromosome or by producing factors that affect the host genes that regulate cell division Genital Herpes Cause virus Herpes simplex -type 1 (HSV-1) – usually associated with fever blisters + cold sores -type 2 (HSV-2) – usually causes similar sores in genital area Symptoms (if there are symptoms) first may have a tingling or itching sensation (called the prodrome) 2-20 days after contact blisters of fluid filled sores 1st attack lasts about 3 wk s (1wk-4wks) can use ointments to relieve the pain will go away whether treated or not Also cause cancer hen they insert themselves into host chromosome o r by producing factors that affect the host genes that regulate cell division Viruses and Disease 34 Genital Warts in about half (50%) of people with herpes: blisters reform periodically usually at times of stress because the virus moves the the sacral ganglia of the spinal cord not affected by the human immune system here can be reawakened + cause new sores -maybe 2x month or 1x in 10yrs -NO CURE Genital Herpes spread by contact of infected and uinfected surface no sex while blister present or during prodrome or for at least 10 days after blisters are gone use a condom at all timeseven when no blisters are present erpes can be spread to newborn if deliver vaginally while virus is present if infant's infection is in liver and central nervous system-can be fatal Diagnosis Examination of sores Culture fluid from sores Blood test for antibodies in women-Pap test Treatment -Syptoms only Acyclovir (Zovirax):-reduce severity of first outbreak and reduce frequency of recurrences Human Papilloma Virus (HPV) usually transmitted by sexual contact 50-70% of those who have sex with an infected person will get them more likely if on the pill or pregnant or uncircumsized appear 1-2 months after contact, maybe longer appearance of growth on dry areas- brownish on moist areas-pink they grow may cause foul-smelling discharge may itch -warts can be removed by: 1. freezing 2. burning 3. laser 4. treated with a chemical (podophyllin) that is painted onleft 4 hrs. washed away warts fall off * virus may remain Diagnosis appearance of wart in women-Pap test can look for DNA of HPV inside cells 35 Genital Warts *ASSOCIATED WITH INCREASED RISK OF CERVICAL CANCER -HPV found in 90% of women with cervical cancer There is now a vaccine against HPV and, therefore, against cervical cancer *ASSOCIATED WITH AND INCREASED RISK OF CANCER OF P ENIS 36 BODY DEFENSES Innate Responses – Nonspecific Physical and Chemical Barriers Adaptive defense: Specific defenses (directed at specific target): The immune system: 1. Specific for particular â€Å"invader† (antigen) 2. Has memory for specific antigens previously encountered Lymphocyte encounters antigen Immune responses have 1.Specificity: Specific for particular â€Å"invader† (antigen) Antigen = a large molecule (not recognized as belonging in the body) that triggers an immune response Ex: antigen can be on the surface of a bacterium or virus etc. ; can be a bacterial toxin Your body cells have markers (molecules) that label them as belonging in your body Each lymphocyte has receptors on its surface that recognize a specific antigen When that antigen is present, it causes that lymphocyte to divide many times Effector cells Memory cells Effector cells attack specific target Memory cells remain and provide a quick response in subsequent exposure to same an tigen Third line of defense: Specific defenses (directed at specific target): The immune system: Immune system is 1. specific for a particular ? invader? antigen) 2. has memory for specific antigen previously encountered Creates an army of lymphocytes specialized to attack that antigen These are called Effector cells 2. Memory: have memory for specific antigen previously encountered Memory lymphocytes remain to cause a quick response the next time the same antigen is encountered 37 STEPS IN IMMUNE RESPONSE 1. Threat: foreign cell or molecule enters body 2. Detection Macrophage: detects invader engulfs invader digests invader 3. Alert: Macrophage places a piece of consumed antigen on its plasma membrane attached to a self marker presents the antigen to a helper T cell activates the helper T cell 4.Alarm: Helper T Cell: after activation by a macrophage, it divides, forming effector helper T cells and memory helper T cells turns â€Å"on† both lines of immune response to fight t hat specific antigen by activating B cells and T cells 5. Build specific defense (clonal selection) Lymphocyte encounters antigen Effector cells attack specific target Memory cells remain and provide a quick response in subsequent exposure to same antigen 6. Defense A. Antibody-mediated immune response Effector B cell = Plasma cell Plasma cells secrete antibodies Targets = antigens outside of cell or on surface of cell B. Cell-mediated immune response Effector T cell = cytotoxic T cell Cytotoxic T cells kill foreign cells by causing them to burst Targets = cells bearing antigens (any cells recognized as foreign: e. g. nfected cell, bacteria, cancer cell) 7. Continued surveillance memory cells remain 8. Withdrawal of forces After antigen has been destroyed suppressor T cells shut down the immune response Effector cells cells Memory 38 A. Antibody-mediated immune response Effector B cell = Plasma cell Plasma cells secrete antibodies Targets = antigens outside of cell or on surface of cell An antibody is a Y-shaped protein designed to recognize a specific antigen Antibodies help defend against a specific antigen Can only work against antigens that are free in blood Antibodies bind to the antigen Antibodies are secreted by plasma cells (effector B cells) Ways that Antibodies can Work 1.Neutralization – bind to antigen prevent virus from being able to enter host cell inactivate toxin 2. Agglutination and precipitation -clumps â€Å"invaders† together makes it easier for other cells to engulf them 3. Activation of complement system complement (system) is a group of proteins that pokes holes causes â€Å"invader† to burst B. Cell-mediated immune response Effector T cell = cytotoxic T cell Cytotoxic T cells kill foreign cells by causing them to burst Targets = cells bearing antigens (any cells recognized as foreign: e. g. infected cell, bacteria, cancer cell) Cytotoxic T cells secrete proteins called perforins that poke holes in â€Å"invaderâ₠¬  or foreign cells, causing them to burst 39Cells Involved In the Immune System Macrophage: an antigen presenting cells engulfs and digests antigens places a piece of consumed antigen on its plasma membrane presents the antigen to a helper T cell activates the helper T cell B Cells: T Cells: Helper T Cell: the â€Å"on† switch for both lines of immune response after activation by a macrophage, it divides, forming effector helper T cells and memory helper T cells activate B cells and T cells Cytotoxic T cell: (effector T cell) responsible for cellmediated immune responses when activated by helper T cell, it divides to form effector cytotoxic T cells and memory cytotoxic T cells destroys cellular targets, such as virusinfected body cells, bacteria, fungi, arasites, and cancer cells Suppressor T cell: the â€Å"off† switch for immune responses suppresses the activity of B cells and T cells after the foreign cell or molecule has been successfully destroyed involved in an tibodymediated responses when activated by helper T cells, it divides to form plasma cells and memory cells Plasma Cell: effector in antibodymediated response secretes antibodies specific to the invader Memory Cells: responsible for memory of immune system generated by B cells or any type of T cell during an immune response enable quick and efficient response on subsequent exposures of the antigen may live for years 40 AIDS Acquired Immune Deficiency Syndrome Caused by HIV Human Immunodeficiency Virus HIV infects T cells T cells become HIV factories Organism enters body Macrophage detects it HIV kills helper T cells so THIS doesn’t happen Activates a helper T cell Stimulates division of cytotoxic T cells (attack foreign cells) As helper T cell numbers drop, the body becomes increasingly susceptible to infection Stimulates B cells to form antibodies (destroys the infectious organism) 41

Peterborough and District Youth League Essay Example

Peterborough and District Youth League Essay Example Peterborough and District Youth League Essay Peterborough and District Youth League Essay I cannot be critical of these leagues because they provide good, structured competitive football for everyone and varied abilities. Every age group has 3 divisions because of this I would say you can play competitive football no matter what skill level you play at. Although there is one way I could criticise these league because the league finishes late in February which is a huge gap until the new start in September, if this was my league I would increase the length of the season to allow the players to compete more often without the massive gap. High quality football locally is limited. This is only the third year the Peterborough centre of excellence has been running after it was shut down 6 years ago due to lack of funding at the club. This gap caused many good standard players to look elsewhere for further development in football.  In Peterborough are only small amounts of disability football. There is one disabled football club for senior and junior age groups in Peterborough the clubs is called Netherton United. The closest disabled league is ran in Cambridge. The junior league in the area is the Cambridge Ability Counts League, This league enables competitive opportunities for disability teams. The league allows all disabled players to take part in structured games against other teams across the county. The league consists of festivals throughout the season with scores being made into a league table. Histon Hornets, Wisbech St Marys, Castle, Cambs Deaf Utd, St Ives Rangers and Netherton Utd all take part in the fixtures. There is also a disabled league for senior players, which is the Eastern Region Ability Counts League.  There is a lot of provision for womens football in Peterborough. There are quite a few teams all ranging in ability levels, with the top team being Peterborough ladies and the lower ends being teams such as Netherton United. There is quite a few leagues that the teams in the area play in, both for juniors and seniors. The problem is though that these leagues also incorporate teams from further afield meaning more travel is required, however this can also be advantageous as the quality of opponent will be greater. There are 4 junior leagues in the area in which city teams play in.An example of funding locally would be Hampton FC. Hampton Football Club has a variety of sponsors. The club ranges from under 8s to under 18s, each age group at the club have different sponsors. Overall the club is sponsored by Serpentine Green, who have sponsored the club and brought the club kit since 2OO7. Facilities for the lower level of performance are relatively strong in Peterborough. There is lots of local Sunday league football clubs that have good facilities in the area, a brilliant example of this would be Netherton Uniteds facilities at the grange. There are also facilities that are council owned in the area, for example bushfield astro turf and Powerleague, which has numerous 5 a side leagues. Peterborough doesnt have any great facilities. There is not a lot of high level coaching in the local area; however there is alot of coaching at community level. So for a player that has just had just taken up the sport there are many coaches but the problems come when a player is looking to improve as a performer. High quality coaching in Peterborough is very limited with Peterborough and Cambridge united having the only development centres in the city.  Peterboroughs local FA are committed to promoting and developing referees and refereeing the County, Cambridgeshire FA and Huntingdon FA offer courses for new referees throughout the year.

All I Need To Know I Learned In Kindergarden Essays - Kindergarden

All I Need To Know I Learned In Kindergarden Essays - Kindergarden All I Need To Know I Learned In Kindergarden all i need to know i learned in kindergarden most of what i really need t oknow about how to llive and what to do and how to be, i learned in kindregarden. wizdom was not at the top the graduate-school mountians, but thre in the sand pile at sunday schooll thiese are the things i learned.. share everything. play fair. Dont hit people. Put things back where you found them. clean up your own mess. Dont take things that arent yours. say your sorry when you hurt somebody. Wash your hands before you eat. Flush. Warm cookies and cold milk are good for you. Live a balanced life-learn some and think some and draw and paint and sing and dance and play and work everyday some. Take a nap every after noon. when you go out in the world, watch out for traffic, hold hands, and stick together. be aware of wonder. Bibliography all i need to know i learned in kindergarden most of what i really need t oknow about how to llive and what to do and how to be, i learned in kindregarden. wizdom was not at the top the graduate-school mountians, but thre in the sand pile at sunday schooll thiese are the things i learned.. share everything. play fair. Dont hit people. Put things back where you found them. clean up your own mess. Dont take things that arent yours. say your sorry when you hurt somebody. Wash your hands before you eat. Flush. Warm cookies and cold milk are good for you. Live a balanced life-learn some and think some and draw and paint and sing and dance and play and work everyday some. Take a nap every after noon. when you go out in the world, watch out for traffic, hold hands, and stick together. be aware of wonder.

French Proofreading and Editing Tips for Key Problems

French Proofreading and Editing Tips for Key Problems Whether youre checking over French homework, proofreading an essay, or verifying a translation, there are certain key problem areas to watch out for. This is not a definitive list by any means, but it indicates areas of confusion and common mistakes caused by differences between French and English and includes links to more detailed explanations and examples. Before you turn anything in, check the following areas of your work. Vocabulary Watch out for differences in meaning and/or spelling. AccentsMissing and incorrect accents are spelling mistakes. ExpressionsDouble-check your idiomatic expressions. False CognatesMany words are similar in spelling but not in meaning. Spelling EquivalentsStudy these differences between English and French spelling. True CognatesThese words are identical in spelling and meaning. Grammar An endless topic, but here are some typical areas of difficulty. AgreementMake sure your adjectives, pronouns, and other words agree. ArticlesDont forget -   these are more common in French. Clauses    * Conjunctions Use the right kind of conjunction.    * Relative Clauses Be careful with relative pronouns.    * Si Clauses Check that these are set up correctly. GenderMake a real effort to use the correct gender. NegationBe sure to use the best negative structure. QuestionsAre you asking them correctly? Verbs    * Conjugations Ensure that each  conjugation matches its subject.    * Modal Verbs These are quite different in French.    * Prepositions Be sure to follow each verb with the right preposition.    * Tense Mood Are your tenses consistent? Do you need the subjunctive? Word OrderAdjectives, adverbs, negation, pronouns cause positioning problems. Mechanics Written conventions can be very different in French and English. Acronyms/AbbreviationsMake sure you write them the French way. CapitalizationCareful - this is much less common in French. ContractionsThese are optional in English, but required in French. Punctuation NumbersFollow French spacing rules and use the correct symbols.

International Business Essay Example | Topics and Well Written Essays - 2250 words - 1

International Business - Essay Example This essay describes these benefits and hindrances, referring to further case studies as justification for the arguments provided. The advantages of diversification There are many risks of servicing only a singular market with one product or service that has been attributed to placing all of a firm’s proverbial eggs in a single basket (Thompson, Strickland and Gamble 2013). Virtually every product or service offered by a corporation has an established life cycle, moving from a growth phase to an eventual decline along the life cycle model in which sales and demand begin to decline. The life cycle of the product is determined by a number of factors, including consumer behaviour changes, innovative product releases by competition that outperforms, competitive pricing instances that drive price-sensitive buyers to rival firms, or even new market entrants that increase choice and lower switching costs for consumers to defect to a rival brand. Whatever the case driving life cycle, corporations must be keenly and proactively aware of the ability of their singular product or service in sustaining long-run profit growth. Because of the risks of a stagnating local market, businesses achieve advantages by diversifying the business into a new international market. The most significant advantage is that diversification allows the business to spread risks (Thompson et al. 2013). Risk occurs through a variety of drivers, both internally-related and externally-driven. For a business operating in a single market with a lone product, any changes to demand can impact revenue growth and even complicate many of the value chain elements that support business, including human resources, supply chain and procurement, as... As illustrated by the essay, there are many risks of servicing only a singular market with one product or service that has been attributed to placing all of a firm’s proverbial eggs in a single basket. Virtually every product or service offered by a corporation has an established life cycle, moving from a growth phase to an eventual decline along the life cycle model in which sales and demand begin to decline. The life cycle of the product is determined by a number of factors, including consumer behaviour changes, innovative product releases by competition that outperforms, competitive pricing instances that drive price-sensitive buyers to rival firms, or even new market entrants that increase choice and lower switching costs for consumers to defect to a rival brand. This paper makes a conclusion that there are actually more advantages than disadvantages in selecting a diversification strategy. Revenue increases, better cash flow position, and cost reduction in a variety of support divisions along the value chain are the most prominent of these advantages. Inclusive in advantages are better scope of control, more efficient and cost-acknowledging logistics opportunities, and even currency valuation in favour of the diversified corporation. The described disadvantages of unsubstantial cross-cultural knowledge of the foreign market, high control and power of buying markets, and disruptive innovation threats would tend to offset advantages when these situations occur in the new international market. Despite the disadvantages, the long-run benefits of diversification supersede the potential hindrances of seeking this strategy for growth.

Opera houset promotion Assignment Example | Topics and Well Written Essays - 500 words

Opera houset promotion - Assignment Example The company should create a compelling advert that convinces the customers that the service at Opera Houset Company is the best. Adverts should deliver a proper message to the people, enhance the company’s image, draw more people to the business while holding and keeping the existing customers (Belch and Belch 12). Promotion should be done in different ways, this will include the print media, electronic media and digital media. Print media, which include magazines and newspapers to advertise (MacRury 8). The magazines and newspaper should provide information about the company’s location, its service, and the cost of their tickets. It should bring out the company as the best in providing service. The advert should be placed in the newspapers like the New York Times. Opera Houset Company should involve in promotion through electronic media, which include the use of televisions and radios to advertise on their information (Clow and Baack 11). This media is considered the best as it can reach targeted groups like teenagers. This will involve advertisement for about 30 seconds about Opera Houset Company. Advertisement through television will be the best as it creates impact on the viewer through sight of the opera company their quality halls, dinning, and best services. Trade paper advertisement will be through publishing of information about Opera Houset Company in business papers. This business books are of better production quality, high prices and large (Belch and Belch 15). They put advertisement adds on them to promote Opera Houset Company. Opera Houset Company needs to incorporate this system to obtain more customers. Digital media advertisement includes methods like social Medias, social networking, and social sites to promote information should also be used. This is a modern way of advertising information and it provides a platform to interact with customers as it advertises (Lin 16). Information from digital media is from

Ethics in Accounting and Corporate Accounting Scandals Research Paper

Ethics in Accounting and Corporate Accounting Scandals - Research Paper Example The suggested course of action by the companies is also recommended in order to prevent unethical practices that lead to corporate scandals and eventual bankruptcy of the organizations. Introduction The accounting practices are based on the Generally Accepted Accounting Principles. Apart from the rule base practices, the importance of principle based practices have emerged in the field of accounting. This is due to the corporate scandals that have occurred over the years. These corporate scandals establish a link with the unethical practices in accounting. In different countries, the accounting practices are guided by different laws like the tax law in Germany, accounting law in Sweden, company law in USA, etc. The unethical practices in accounting have not only resulted into bankruptcy of the companies but also eroded the wealth of the investors. International Financial Reporting Standards, Sarbanes-Oxley Act have been implemented in order to prevent the unethical accounting practic es and subsequent corporate scandals. ... The accountability is much greater as compared to the compensation received for their role in accounting domain. The most important part of accounting is the code of ethics that is to be followed as a professional in this field. This leads to the concept of ethics in accounting (Duska, Duska and  Ragatz, 2011). Accounting ethics is a part of applied ethics which relates to the moral values and judgments that are applied in the role of accounting. The concept of accounting ethics was first introduced by Luca Pacioli, an Italian mathematician which was later endorsed by the government departments and even the private organizations. The training modules conducted by the companies while training the accountants and auditors include accounting ethics as an integral part. The wide range of accounting services and the news on the fall of big corporate houses like Enron have triggered an importance of following code of ethics in accounting field. Due to fraudulent accounting practices, mal -intention on the part of accountants, auditors and the management, the profession of accountants and the subjects of accounting have been badly criticized. Also the losses incurred by the companies due to unethical practices in accounting field have blown out of proportions (McPhail and  Walters, 2009). In order to avoid the similar devaluation of companies and bankruptcy in future, the institutions irrespective of government and private entities have stressed on the importance of accounting ethics and proper implementation of ethical practices by their accounting departments. The lack of ethical accounting leads to fraudulent accounting practices in the companies which may be due to manipulated or

Group Cohesion and Productivity (MGT 415) Essay Example | Topics and Well Written Essays - 250 words

Group Cohesion and Productivity (MGT 415) - Essay Example I had recently joined the organization and was not fully aware of the all the operations and technologies (Losh). The technology that was used in the organization was very advance. However, instructions and trainings were provided by the management, but many of us still had issues. This problem was resolved when a group project comprising of 6 team members were announced to us. Since, I was new in the organization I had to cope up with different things (Feldman and Arnold), and because of the other 5 members I was able to do so. Working in a team turned out to be helpful and effective as it allowed me and others to share knowledge and overcome shortfalls. The project successfully ended before the given deadline. On the contrary, a similar team project did not work very well a few weeks ago. The team members including me did not have a mutual understanding with each other; thus, the decisions were vague and did not turn out to be as efficient as the last project. The project also failed as the productions was in a deficit and also exceeded the time

Concept Analysis Coursework Example | Topics and Well Written Essays - 250 words - 1

Concept Analysis - Coursework Example According to McEwin and Wills (2014), antecedents are the happenings that took place before the manifestation of the idea while the consequences are the effects of the concept. For instance, for holism to take place, there has to exist a real nurse-patient relationship founded on trust and understanding. The nurse also requires expertise, outstanding communication skills and knowledge. Additionally, a precursor to the concept of risk is the cognitive capability to differentiate between options. The aptitude for cognitive reasoning is an antecedent to the risk concept (Fawcett, 2005). If an individual cannot use cognitive reasoning, he or she is not capable of making a recognition or discernment about the probable harm to him or herself and other people. For instance, young children cannot interpret and analyze information in their surrounding that would be harmful to them or would put them in risk; therefore, they cannot know that touching an iron box after use will burn them. It is an adult in this case who has cognitive thinking to understand that the kid is in danger. In this case, cognitive reasoning is an antecedent to the concept of risk (McEwin & Wills, 2014). Townsend, L., & Scanlany, J. (2001). Self-efficacy related to student nurses in the clinical setting: A concept analysis. International Journal of Nursing Education Scholarship, 8(1). doi:10.2202/1548-923X.2223 Permalink to

Group Cohesion and Productivity (MGT 415) Essay Example | Topics and Well Written Essays - 250 words

Group Cohesion and Productivity (MGT 415) - Essay Example I had recently joined the organization and was not fully aware of the all the operations and technologies (Losh). The technology that was used in the organization was very advance. However, instructions and trainings were provided by the management, but many of us still had issues. This problem was resolved when a group project comprising of 6 team members were announced to us. Since, I was new in the organization I had to cope up with different things (Feldman and Arnold), and because of the other 5 members I was able to do so. Working in a team turned out to be helpful and effective as it allowed me and others to share knowledge and overcome shortfalls. The project successfully ended before the given deadline. On the contrary, a similar team project did not work very well a few weeks ago. The team members including me did not have a mutual understanding with each other; thus, the decisions were vague and did not turn out to be as efficient as the last project. The project also failed as the productions was in a deficit and also exceeded the time

No need Essay Example | Topics and Well Written Essays - 1750 words

No need - Essay Example Power and trust play a vital role in decreasing as well as increasing the conflict. This leads to the purpose of this research paper, which is to understand the reason why do countries conflict with each other. This will occur by relating the importance of trust (defined as the number of treaties a countries sign with each other) in increasing or decreasing the conflict (violence attacks) between any two parties. To find an explanation to the reason why do countries conflict with each other? Four theories provide a clear answer to the question. The first theory indicates that the reason of conflict is that human motivation is by their self-interest and will harm each other to gain more resources. The second theory defines economical status and power as the main factors for conflict to exist. In addition, the third theory, illustrate that conflict is a fight over morals where they harm each other to reach a higher position. The last theory specifies the answer that countries should no t trust each other and act to preserve their own interest, not others interest. Indeed, the last theory provides the convenient answer to question the more mistrust the fear and security there are, leading to more conflict. To answer the question why do countries conflict? There is a creation of a connection between the number of treaties and the number of armed conflict between two countries or a country and its government. Then focus on 32 countries from a different region in the world that has armed conflict between the years 1975 to 2011. Furthermore, the focus is on the number of peace treaties that country has to sign at this time when there is a conflict. In addition, to know the relationship between the number of peace treaties and the number of armed conflict, there is use of large-n method. Linear regressions between the two variables are the point of attention and expect that the less trust (more peace treaties) between any two party the more conflict. Because if two part ies do not trust each other then they will fear each other and increase their security leading armed conflict to exist. The analysis results show that after measuring the variables, there is no relationship between the number of peace treaties and the number of armed conflict in all level of significance. Thus, the decision is to check if there exist factors that lead the hypothesis to fail by using the multi regression method, where the independent variables are the number of peace treaties, and the number of parties a country involve in conflict. Indeed, the result shows that there is a strong positive relationship between the number of parties and the number of armed conflict. In other words, the more parties that takes place the more conflict. The Process of the Research Paper To understand how is trust related to conflict there is a creation of a model to explain the connection between the Independent variable (trust) and dependent variable (conflict) in Micaville’s hypo thesis, which is the less the trust the more conflicts. If there is less trust between any two parties, then both parties fear each other. For example, if party A do not trust party B then party A fails to predict party B actions and this make party A fear party B. Indeed, with the appearance of fear, party A increases its security and advances its military power in order to protect its resources from party B. This example is similar to the model where both party A and party B do not trust each

A Comparison of Nurses Essay Example for Free

A Comparison of Nurses Essay A Comparison of Nurses Educated at the Associate-Degree Level versus the Baccalaureate-Degree Level A career in nursing has many possibilities and depending on where one is employed there may be different educational requirements. There are many nurses in the workforce with only their associate’s degree in nursing, but as time passes it seems that the baccalaureate degree is becoming more of an expectation. This brings up the question- is there a difference in the competency of the associate-level nurse from the baccalaureate-level nurse? Studies are showing that there is a difference and patient outcomes are affected by this difference. Differences between the Associate Degree in Nursing and the Baccalaureate Degree in Nursing In order to compare the competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level, one must first compare the requirements to obtain these degrees. The Associate’s Degree in Nursing, abbreviated ADN, is a two-year degree usually earned through a community college. It requires 60 credit hours to complete and upon completion the graduate can apply for licensure through the state in which they will practice. The Bachelors of Science in Nursing, also called BSN, is a four-year degree obtained at a university. It includes the same areas of study and has the same license upon completion of the NCLEX as the ADN nurse, but delves further into nursing theory as well as pathophysiology and technical skills. Many employers require the bachelor’s degree for higher positions in nursing such as clinical managers and nurse specialists. Differences in competencies between nurses prepared at the associate-degree level versus the baccalaureate-degree level As explained above the bachelor’s degree in nursing requires two more years of education and a much deeper study of nursing theory and pathophysiology than the associate’s degree. The question is does this extra education and focus on nursing theory make a BSN nurse more competent than an ADN nurse. Research suggests there is a significant effect of nurse experience and a significant effect of the percentage of BSN nurses in each hospital (Kendall-Gallagher, Aiken, Sloane Cimiotti, 2011) in regards to better patient outcomes. To understand the difference one must look at the basic nursing process and how knowledge of nursing theory and pathophysiology affects it. The basic process taught in nursing school in providing patient care is assessment, plan, intervention and evaluation. Assessment is one the first things a nursing student learns. The associate-level and bachelor-level nurse will both have learned this skill in the very first days of nursing school. Both nurses will also be competent with the last step, evaluation of the interventions. The advantage a BSN nurse will have lies in the middle two steps- plan and intervention. The plan and interventions a nurse provides is affected by their decision-making skills and this is based on their education. Plan and Intervention. To determine a patient’s plan of care, one looks at the abnormal assessments and then uses their knowledge of pathophysiology to determine the plan of care. While the BSN nurse will not necessarily have more clinical hours in assessing the patient, they will have taken more classes in pathophysiology than the ADN nurse and therefore may notice a disease process more readily than the ADN nurse. This is where the interventions will occur. Interventions are determined by the nurse based on their decision-making skills. Decision-Making Skills Nursing is a field in which one is given a great amount of autonomy. Therefore much of a patient’s care is affected by a nurse’s decision-making skills. One’s ability to make decisions is affected by many things including past experiences, environment and education. The focus here is education and how the additional study for the BSN affects nurses’ decision-making skills. The BSN nurse will have studied pathophysiology and nursing theory in greater depth than the ADN nurse. This extra knowledge is then applied to the decisions a nurse makes for their patient. These decisions have a great impact on patient outcomes and recent studies have indicated that there is decreased morbidity, mortality, and failure-to-rescue rates in hospitals that employ larger percentages of baccalaureate prepared nurses (Altman, 2011). Effect of baccalaureate-degree level nurses on patient outcomes In the acute situation the BSN nurse can use their knowledge of pathophysiology in addition to their decision-making skills to decrease morbidity and mortality. Taking into account the greater picture, a more holistic approach based on the BSN nurse’s familiarity with nursing theory, will improve patient outcomes. For example let’s look at a hospital admission for a congestive heart failure exacerbation. Both the ADN and BSN nurse will assess the patient and notice classic signs like shortness of breath and edema. Both nurses will plan on diuresis and paying close attention to respiratory status. The difference will come with the holistic approach that a BSN nurse is more likely to take. The emphasis on the nursing theories that a BSN nurse has studied will allow them to look at the patient as a whole, rather than dealing with only stabilization of symptoms. The knowledge of nursing theory the BSN nurse has will allow them to delve further into why this patient admitted and what they can do to prevent a readmission. The BSN nurse asks questions as to what caused the exacerbation. It may be that the patient needs more teaching on diet and medication compliance. They will ask the patient about their home situation. It’s possible the patient is having financial burdens that have kept them from filling their prescriptions. The BSN nurse is more likely to look at the home situation. The patient may have depression with the diagnosis and need some resources for social support. In regards to King’s theory, nursing’s central goal is to help individuals maintain their health so that they can function in their roles (Creasia, 180). By helping the patient function in their role, the nurse empowers the patient to lead a healthier life. The patient is sent home educated with the resources needed to lead a healthy life and therefore reduces unnecessary hospital admissions. This in turn allows the space available for hospital admissions that are necessary and leads to a healthier community. REFERENCES Altmann, Tanya K. (2011). Registered nurses returning to school for a  bachelors degree in nursing: Issues emerging from a meta-analysis of the research. Contemporary Nurse: A Journal for the Australian Nursing Profession, 39, (2): 256-72. Creasia, J; Friberg, E. (2011). Conceptual Foundations: The Bridge to Professional Nursing Practice. (5th Edition). St. Louis, Missouri: Mosby, Inc. , an affiliate of Elsevier Inc. Kendall-Gallagher, Deborah; Aiken, Linda H. ; Sloane, Douglas M. ; Cimiotti, Jeannie P. (2011). Nurse Specialty Certification, Inpatient Mortality, and Failure to Rescue. Journal of Nursing Scholarship, 43, 188-94.

Case study of sleep disorder and sleep apnea

Case study of sleep disorder and sleep apnea Sleep disorder is one of the most vital problem face by many people in life. Mostly face by older generations and adults. Sleeping is controlled by hypothalamus which is one of the part of a human brain system. Body temperature in some way controls the activities of ones body, playing a role like a switch for on/off. Higher temperature brings alertness while lower temperature causes sleep. Sleep disorder comes in many different forms like Bruxism, Delayed sleep phase syndrome (DSPS), Cataplexy Rapid eye movement behavior disorder (RBD), insomnia, sleep apnea, night terrors, nightmares and somnambulism. Interfering with normal sleeping habits frequently and continuously can be listed as sleep disorder. Sleep disorder are capable of influencing emotional, physical and mental health of a human being. Moreover, sleeping disorder not only causes trouble to the victim but the person staying in the same house at them. Polysomnography is one of the a test commonly use to test for sleep disor ders. Before the 20th century, sleeping problems are face by many people and theres no cure and research about it but till this century, due to the rapidly increasing knowledge of mankind, many research have been brought up just to find solutions for all diseases. In the UK, most of the research are mainly focus on sleep apnea but not others as a proof that they are lagging on knowledge of sleep medicine and possibility of treatment in other sleeping disorders. There are some general principles of treatment that could be find worldwide but mostly in US. Treatments for sleeping disorders can generally be grouped into four different categories that are behavioural/ psychotherapeutic treatments, rehabilitation, medications and other somatic treatments. Treatments such as this does not provides a 100% success and not suitable for all sleeping disorders. History of different people and medical reports of everyone is so greatly different so it is best to say that specific treatment are given to specific patients diagnosis. Disorders such as narcolepsy are best treated pharmacologically. Chronic sleep disorder influenced 70% of children development and psychologically while sleep-phase disruption affects adolescents who could not attend regular school schedules. Effective treatment will begin with careful diagnosis and modifications in sleeping hygiene may reduced the problem. It si said that special equipments are used for several disorders( obst ructive apnea). Research also shows that some sleep disorders are also found to be compromise glucose metabolism. Sleeping is absolutely the essential thing for a normal and healthy lifestyle, according to the United States, roughly about 40 million suffer from long term sleep disorder while nearly 20 million experience mild/ occasional sleep problems. Sleeping disorder suddenly became an important issue because many more people are facing it and body needs sleep to survive because study shown that sleep is essential for immune system and maintaining the ability to fight against diseases and sickness. Learning, growing, functions of brains also comes from the amount of rest absorb because it is said that sleeping helps regenerate and repair cells. Sleep apnea. Sleep apnea is one of the most well-known sleep disorder face by many and said to be one of the most dangerous disorder to be faced compare to others. Another name for sleep apnea is call sleeping breathing disorder. This disorder is a serious sleep disorder that occurs when a persons breathing is influenced by some activities during sleep. Untreated sleep apnea patients will normally face stop breathing repeatedly during their sleep almost hundreds of time. Facing this disorders means that the brain and body are not getting enough oxygen. There are actually two different kind of sleep apnea: Obstructive sleep apnea(OSA) and Central sleep apnea. OSA is more common of the two forms of apnea and normal the causes is a blockage of the airway usually the soft tissue in the back of the throat collapses during sleep while Central sleep apnea is unlike OSA where theres no blockage but the brain fails to signal the muscle to breath which will due to instant instability in the respiratory con trol centre. After having modern research from scientist, sleep apnea can affect anyone at any age even children, the causes of having sleep apnea are gender(mostly male) , being overweight, older after the age of forty, having a large neck size, large tonsils, family history and some other problems. Having untreated sleep apnea could cause quite severe effects like high blood pressure, stroke, heart failure, diabetes, depression and worsening of ADHD. Having poor performances in activities in many different places could be one of the sign of facing sleep apnea. Sleep apnea can be explained in terms like breathing pauses can last from a few seconds to minutes. This disorder often occurs to 5 to 30 times or more per hour. Normally, normal breathing starts again with a loud snort or choking sound which can be easily detect by family members sleeping around them. Sleep apnea often goes undiagnosed while doctor usually cant detect this symptoms so soon. Obstructive sleep apnea is very common with overweight people and happens randomly too, when a person who has sleep apnea tries to breathe, any air that squeezes past the blockage will produces a loud snoring. Some research found out that Central sleep apnea happens less but random while it mostly occur on people that have certain medical conditions or is using certain medicines. Regardless of type, an individual who has sleep apnea will rarely be aware of themselves having difficuly breathing during sleep and even upon awakening. This problems mostly are being recognized as a problem by other wi tnessing the individual. Some treatments can be found to treat Obstructive sleep apnea which involve the lifestyle changes, such as avoiding drinking alcohol or muscle relaxants, weight lost and quitting smoking. Sleeping at a 30-degree elevation of the upper body or higher can be use as a recliner that helps prevent the gravitational collapse of airway while sleeping on a side as opposed to the sleeping on the back theory are also recommended as treatment for sleep apnea because the gravitational component is smaller for lateral position while some people are benefiting through various kinds of oral appliances to keep the airway open. Theres a treatment called Continuous positive airway pressure(CPAP) while other surgical procedures to remove/tighten tissue while widen the airway. Snoring does not actually mean a person is having sleep apnea but mostly overweight people who snores loudly and hardly during sleeping could actually mean sleep apnea. In US, researches revealed that people with OSA has tissue lo ss in brain regions that store memory(hippocampus) which somehow linking OSA to memory loss. Scientists discovered that people that has OSA mammillary bodies are 20 percent smaller than normal people mostly on the left region of the body which is because of repeated drops of oxygen that lead to brain injury. In pure central sleep apnea or known as Cheyne-Stokes respiration, the brains respiratory control centres are imbalanced during sleep while the blood levels of carbon dioxide is higher compare to normal people sleeping and the level of oxygen is lower. The sleeper will stop breathing and then starts breathing again. No effort made to breath, no chest movement and no struggling. In central sleep apnea, the basic neurological controls for breathing rate cant functions and fail to provide signal to inhale. Some people are facing the combination of both type of sleep apnea. Combinations of obstructive sleep apnea and central apnea by loss of central respiratory drive during sleep in OSA. The presence of central sleep apnea without an obstructive component is a common result of abuse by owing to the characteristic respiratory depression that are mainly cause by large doses of narcotics. Obstructive Sleep Apnea can be determine by having a sleep test which is called polysomnography which is usally done to diagnose sleep apnea. Actually there a two kinds of polysomnography, an overnight polysomnography test that involves monitoring brain waves, muscle tension, eye movement, respiration, oxygen level in the blood and having audio monitoring. The second kind of polysomnography test is called a home monitoring test. A sleep Technologist sticks you up with all the electrodes and instructs you on how to record your sleep with a computerized polysomnography that user can take it home and return the computerized polysomnography in the morning. These test are painless test that are covered by insurance. Sleep apnea can be treated in many ways but for severe apnea, there is a Bi-level (Bi-PAP) machine that is different in that it blows air at different pressures. Thats when a person inhales, the pressure is higher while exhaling the pressure is lower. Your own doctor will measure the pressure and a home healthcare company will set the apparatus hence providing training user to use and maintenance it. Tracheostomy is the only treatment available until early 1980s. Its a surgical procedure where a small hole is cut in the neck and a tube with a valve is inserted into the specific hole. During the day, the valve is closed so that the patient can speak while the valve is open at night to avoid obstructions. This treatment is now the last resort for sleep apnea for you must be extremely sick to require this. Uvulo-palato-pharyngoplasty (UPPP) is the treatment available today which means plastic surgery of the pharynx(the pharynx is the joint opening of the gullet and windpipe). This surgery is usually done for patients that cannot tolerate with nasal CPAP. This surgery has help around 50% people and still others do not. Laser Assisted Uvuloplasty(LAUP) is a surgical procedure that remove the uvula and surrounding tissue that open the airway behind the palate. This procedure is said to be used to relieve snoring while somehow successfully treating sleep apnea, before doing this surgical treatment, make sure you have a doctor that has experience doing this procedure with extreme knowledge about sleep apnea. The latest treatment for sleep apnea will be called somnoplasty, getting approvable from US Food and Drug Administration, this treatment uses radio waves to shrink tissue in air passages and almost eliminating all snoring problems. This special and safe procedure is called radiofrequenc y volumetric tissue reduction of the palate. This radiofrequency treatment involves piercing the tongue, throat or soft palate with a electrode needle(special needle specific for this treatment) that is connected to a radio frequency generator. The inner tissue is then heated to about 158 to 176 degrees and takes approximately nearly half an hour. The inner tissues are shrinking while the outer tissue such as taste buds are left intact. Several treatments may be required. This treatment should only be carry out after doing a lot of research and getting the advantages and disadvantages of each different treatment, because some might have side effects. In summary of sleep apnea, the causes of sleep apnea maybe family historical backgrounds but it might be also connected to the body weight of each individual. Make sure to take care of own body after over the age of forty and having large tonsils or tongue might causes sleep apnea. Sleep apnea is one of the most dangerous sleeping disorder that can actually kills the patient instantly because this sleeping disorder interrupts a person during their sleep and the patient wouldnt even know what happen after they get awaken due to lack of oxygen. Sleep apnea prevents breathing from happening and causes lower level of oxygen to be transported to all part of body. There are two kinds of sleep apnea: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea happens when blockage of airway occur while central sleep apnea happens when the brain fails to signal the muscles to breath to intake and exhale oxygen and carbon dioxide in and out of the body. Sleep apnea prevents natur al sleeping hence causing high blood pressure, stroke, heart failure, diabetes, depression and many more. Sleep apnea cannot be left untreated because if a human stops breathing, high chance that the person might just die. There are a few variety of treatments for sleep apnea including continuous positive airway pressure(CPAP), variable positive airway pressure(VPAP), automatic positive airway pressure(APAP), Bi-level(Bi-PAP)machine, TRACHEOSTOMY, UVULOPALATOPHARYNGOPLASTY(UPPP), MANDIBULAR MYOTOMY, LASER ASSISTED UVULOPLASTY(LAUP) and RADIO FREQUENCY(RF) PRODECURE OR SOMNOPLASTY. All these treatment are mainly focusing on removal of uvula, cutting bone in anterior portion of mandible or having a small hole to let air diffuse in. CASE STUDY: SLEEP APNEA Sleep apnea is a common but potentially dangerous sleep disorder which can be characterized by repeated pauses in your breathing while asleep. These pauses can last from a few seconds to minutes and can occur thirty or more times per hour. Apneic events usually stop with a loud snort, snore or choking sound which can often momentarily wake you up which will then cause regular breathing to resume. From the research of Emily Cashman, BS, RRT, the clinical training manager at ResMed in Poway, Calif, diabetes and obstructive sleep apnea (OSA) are common disorders that often coexist. In fact, they are equally prevalent within the U.S. adult population.  OSA can affect anyone, including children. However, the population typically associated with the disorder includes overweight adults who snore heavily. Sleep apnea is more common in men, and 50% of type 2 diabetic men also have OSA. There are many treatments for sleep apnea. Any practitioner can identify OSA symptoms. Patients are then r eferred to a sleep specialist, and an overnight polysomnography is conducted in a sleep laboratory or the patients home. The standard treatment is continuous positive airway pressure (CPAP). The air pressure functions like a splint for the upper airway to prevent apneas from occurring and keep the airway from collapsing. This permits normal breathing to continue during sleep, normal sleep patterns to emerge, sleep to become restorative, and the patient to feel better. The impact is often immediate and dramatic. The success of treatment is measured by the reduction of respiratory disturbance to normal levels, the elimination of symptoms such as fatigue and depression, and improvement in the patients subjective feeling of well-being. Effective treatment will eliminate snoring and apnea events and has demonstrated decreases in blood pressure and post-prandial glucose levels within 30 days. OSA is often overlooked and misdiagnosed. Complaints of fatigue and sleepiness are attributed to lifestyle, stress, other medical conditions (such as diabetes), or side effects from medications. Sleep apnea should be investigated when patients present classic symptoms. Theres a 61-year-old man called J.B who is a busy physician and has had type 2 diabetes for 11 years. He suffers from gastroesophageal reflux disease daily and has moderate depression. For 11 years, he has maintained a weight of 210-220 lb (BMI of 31 kg/m2), and he does not have hypertension or hypercholesterolemia. J.B. has no other known diabetes complications. He uses a low-carbohydrate meal plan and a bicycle exercise program. However, he snores and reports being excessively sleepy all the time. Type 2 diabetes is a chronic (lifelong) disease marked by high levels of sugar (glucose) in the blood. It is also the most common form of diabetes. J.B. has no family history of diabetes or sleep apnea. During the past year, he has not been able to get his plasma glucose levels to < 200 mg/dl. His haemoglobin A1c  ( A1C) has been 7.5% (lab norm) on the past two visits. The patient denies polyuria or nocturia. He is in bed for ∠¼ 8 hours per night. His wife does not complain about his nighttime snoring, but she describes herself as a heavy sleeper.The bed partner is often the first to complain of sleep apnea. In this case, J.B.s wife is not bothered. However, fellow physicians who travel with J.B. on medical mission trips joke and complain about his snoring and gasping. J.B. now requests a private room for these trips to avoid the complaints. He did not share this information with his diabetes care team. J.B. is excessively sleepy, yet he sleeps ∠¼ 8 hours nightly. Colleagues and family who sleep in adjacent rooms have told him that he snores and gasps throughout the night. Published research demonstrates that 50% of men with type 2 diabetes have sleep apnea. These factors are sufficient to suspect sleep apnea and inquire further. J.B.s fatigue and sleepiness finally led him to refer him self to a sleep lab in August 2005. Because he is a physician, he felt certain he had sleep apnea by the time he contacted his friend, the medical director of the sleep lab. The vast majority of patients are referred to a sleep lab or sleep specialist by their physician for further evaluation of symptoms. It is common for patients to complete a Berlin Questionnaire, a simple validated 10-item questionnaire certified by the American College of Physicians. Questions focus on BMI, snoring, sleepiness, and blood pressure. J.B.s results for the Berlin Questionnaire indicated a borderline acceptable BMI, severe snoring, severe daytime sleepiness, and an acceptable blood pressure. These results indicate a high risk in two categories of the Berlin Questionnaire, suggesting a strong likelihood of sleep apnea. J.B. underwent a sleep study and, because of the severity of his sleep apnea, a split night protocol was initiated. This means that the first portion of the sleep study (diagnostic) was so severe that the patient was placed on CPAP therapy for the second portion of the night (titration). An apnea/hypopnea index (AHI) of 51 was reported during the diagnostic portion of the study, indicating severe obstructive sleep apnea. Although some patients are able to reduce their AHI to normal levels with weight loss, few patients are able to maintain this type of weight loss. CPAP therapy is the gold standard sleep apnea treatment. CPAP therapy ranges from 4 to 20 cm H20 pressure. J.B. required a pressure of 8 cm H20. The pressure needed to resolve 95% of apneic events throughout the night determines this therapeutic pressure. J.B. went home with a prescription for CPAP, and a local home care dealer delivered his therapy that day. He has slept with CPAP every night since. He reports feeling great, and his family members have noticed a huge difference in his enthusiasm and energy. From the research, it is known that CPAP treatment can improve insulin responsiveness without a significant change in obesity. This occurred in J.B.s case. Although his weight and diet have not changed, his glucose levels have improved dramatically and are now consistently < 150 mg/dl. His A1C was 6.5% 9 months after initiating CPAP therapy, and his medications have been reduced. It is a great news for him and his family. SUMMARY In fact, people that have diabetes will probably suffered from sleep apnea. Sleep apnea is very common in diabetic populations but typically goes undiagnosed. Sleep deprivation from any cause increases blood glucose, blood pressure, and triglycerides, causes higher evening cortisol levels, reduces serum leptin secretion, and increases inflammatory cytokines. Patients with chronic snoring and untreated sleep apnea have a higher risk of both stroke and cardiovascular disease. Although most of these patients do have a higher BMI as well as low activity levels and hypertension, it is also possible for patients with normal BMIs and without hypertension to present with snoring and sleep apnea. Sleep apnea can be associated with recent weight gain. Tiredness can cause people to eat for stimulation and skip exercise. Over time, these habits result in obesity, which can worsen sleep apnea, leading to a progression in severity of both conditions.Treating sleep deprivation rapidly reverses thes e metabolic abnormalities. The reasons for this are complex but seem to include increased sympathetic nervous system activity and adrenal cortisol and catecholamine output. Well, sleep apnea can cause hypertension, nevertheless hypertension is not required for suspicion of sleep apnea. Besides that, treating sleep apnea with CPAP therapy can improve glycemic control and blood pressure. Berlin Questionnaire can also easily conducts an assessment for sleep apnea.