Organ Procurement and Transplantation

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Organ Procurement and Transplantation

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Organ Procurement and Transplantation:

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People evaluated the organ transplantation success story as “an extraordinary leap in medicine and surgery” and “one of the miracles of modern medicine” (Jonsen, 2012, para. 1). Only after many years of experimental transplants, mostly on animals and occasionally on humans, did surgeons and researchers realize success. As of 2018, more than 120,000 people were waiting on organs for transplants. Every day in the United States, approximately 95 people receive an organ transplant, and an average of 1 person is added to the wait list every 10 minutes (Organ Procurement and Transplantation Network [OPTN], 2018a, 2018b).

In 1954, a surgeon named Joseph Murray, with the help of a physician named John Merrill, performed the first successful kidney transplant from one monozygotic twin to another in Boston at Peter Bent Brigham Hospital, which is now known as Brigham and Women’s Hospital (Jonsen, 2012; President’s Council on Bioethics, 2003). The recipient lived for 8 years because the genetic materials of the twins were identical or similar. In 1990, Murray received a Nobel Prize in Medicine for his contributions. In 1967, a surgeon named Christiaan Barnard, from Cape Town, South Africa, performed the first human heart transplant.

Organ transplantation is more accepted in the 21st century than it was in the 1950s. Then, the ethical questions regarding removing organs from dead or living donors were just as intense and angst provoking as the ethical questions we face today regarding human cloning. Almost instantly, after that first heart transplant, some reasonable ethical issues arose:

1. Should surgeons invade a healthy living donor’s body to retrieve an organ to benefit another person?

2. What method of selection can be used to maintain fairness?

3. Where will kidneys be obtained beyond the living donors?

4. If the donor is dead, what are the criteria for death? (Jonson, 2012)

Murray, the first kidney transplant surgeon, posed the first question as he was trying to decide whether to obtain an organ from a healthy living person, especially in light of his oath to help sick people get well and not to cause harm to others. Question 2 was an issue because, for the first time in history, surgeons were forced to decide on criteria for organ recipients because of a shortage of available organs; in other words, for the first time ever, surgeons were literally choosing who would live and who would die.

Questions 3 and 4 related to unclear information in terms of whether surgeons could retrieve an organ from a dead donor and, if so, at what point they should retrieve an organ. The definition of death in the Uniform Determination of Death Act (UDDA) did not become law until

1981; therefore, clinical evidence to determine the death of a donor was uncertain. Another major issue was that many people were dying from organ rejection because of inadequate and harmful antirejection medications. It was not until 1978 that the effective immunosuppressive medication cyclosporine was available for use.

Sixty years after the first kidney transplant, people are still debating ethical issues regarding organ donation and transplantation, but the issues in the 21st century have shifted to a more diverse set of problems. One current, major issue is societal pressure for organ harvesting, which results from a global demand for organs that far outweighs the supply. Another major issue involves individuals questioning their own moral beliefs about death, organ donation, and the legal definition of death.

Organ procurement is the obtaining, transferring, and processing of organs for transplantation through systems, organizations, or programs. There is evidence that people continue to choose not to donate their organs, which is one of the reasons for the severe imbalance in supply and demand (Kerridge, Saul, Lowe, McPhee, & Williams, 2002; Rock, 2014).

In the United States, 45% of adults are registered organ donors, compared to only 33% of people in the United Kingdom. Even though the number of registered organ donors is low in the United Kingdom, findings in U.K. polls have indicated that the majority of the population (90%) supports organ donation (Rock, 2014).

Some reasons for not having a higher number of registered organ donors stem from misconceptions about the definition of brain death, mistrust of the medical profession, and religious views. Organ donation is a delicate subject, and for many people, organ donation conjures up uncomfortable feelings with death in general. The very thought of donating an organ could lead to individuals having disturbing thoughts about their own death or loss of a body part.

The demand for organs far exceeds the supply. To counterbalance the supply–demand crisis, the U.S. Department of Health and Human Services continues to offer campaigns to increase the organ supply. For the reasons previously outlined, societal ethical conflicts exist between the national organ donor campaigns and the values of potential donors. Utilitarianism is a common ethical framework for planning and implementing goals to increase the organ supply. Conversely, at the core of many people’s beliefs is the value of respect for autonomy and human dignity, which is a deontological ethical framework. Because the public continues to place a high value on self-determination, utilitarian-based programs face challenges to increase the number of organ donors. From a utilitarian perspective, one organ donor can potentially save eight lives with his or her organs; however, people in the United States continue to die while waiting for an organ (OPTN, 2018b). Some countries apply a broader scope of utilitarianism by promoting either presumed consent, meaning that people automatically consent to donating their organs unless they specifically indicate

otherwise, or mandated choice, meaning that competent people are required to indicate yes or no regarding their organ donation choice on license applications, tax returns, and other official state identification records. People are bound by this mandated choice, but an advance directive or a written change of mind can reverse the decision.

In the United States, donor cards are legal documents that are used along with other documentation in the organ donation process.

A donor card gives permission for the use of a person’s bodily organs in the event of death. Advance directives are also legal documents that are used to express one’s desires about organ donation. Adults in the United States express their wishes regarding organ donation through a required response. People can decline or willingly agree to donate their organs, and they can allow a relative to be their designated surrogate.

Fair Allocation of Organs

The National Organ Transplant Act of 1984 led the way for the creation of a national list of candidates; it is currently maintained by the United Network for Organ Sharing (UNOS; https://unos.org). This organization assures the allocation of organs to the best-matched candidates. This act also designated the establishment of the OPTN, a national sharing organization that primarily safeguards fairness across the United States for all organ allocation. The scarcity of available organs prompted the OPTN to apply two factors to assure a balanced decision: justice and medical utility. Justice is the “fair consideration of candidates and medical needs,” and medical utility is an effort to “increase the number of transplants performed and the length of time patients and organs survive” (2018b, para. 1). All the names of people in the United States who need an organ go on a national list only after a physician from one of the transplant centers evaluates each person for documented need. Although the criteria for organ donation varies by organ, the general guidelines include medical emergency, blood/tissue type and size match with the donor, time on the waiting list, and proximity between the donor and the recipient (Gift of Life Donor Program, 2018a). The Gift of Life Donor Program began in

1974 as a small organization in Delaware for the purpose of managing a few kidney transplants. Today, it is a large national organization with an impeccable reputation that manages a variety of organs. The primary goal of the program is to “improve the quality of life of patients awaiting transplantation by maximizing the availability of donor organs and tissues while upholding the highest medical, legal, ethical, and fiscal standards” (Gift of Life Donor Program, 2018b). Additionally, the organization coordinates training for transplantation and donation professionals.

 

Ethical Issues of Death and the Dead Donor Rule::

The 1981 Uniform Determination of Death Act (UDDA) defined death as an irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the brain (President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1981). Rubenstein, Cohen, and Jackson (2006) posed the following questions regarding this legal definition of death:

1. Why does having a sound definition of death matter at all?

2. What are the human goods at stake in getting this question right?

3. What are the moral hazards in getting it wrong?

The medical community adopted two guiding moral principles, known collectively as the dead donor rule. This rule functions as the norm for managing potential organ donations.The principles of the dead donor rule are that the donor must first be dead before the retrieval of organs and a person’s life and care “must never be compromised in favor of potential organ recipients” (DeGrazia & Mappes, 2001, p. 325).

There are three unresolved ethical issues regarding the retrieval of a person’s organs in accordance with the legal definition of death:

(1) properly caring for the dying person until death is pronounced, (2) the well-being of family members who must say goodbye to their dying loved one, and (3) the perceived good of the organ donation itself (Rubenstein et al., 2006).

The primary ethical concern is assuring competent and uncompromised treatment up until the person’s death . The care of a dying patient must come first, and nurses and other healthcare professionals may need to offer intensive therapy or present evidence that the patient’s treatment is ineffective.

The second ethical issue is the well-being of families and healthcare professionals. Specifically, this ethical issue involves the risk of causing harm to the families when there has not been sufficient time for them to grieve and process the information versus the risk of not having viable organs if the families wait too long to come to terms with the death. A point made by Rubenstein and colleagues (2006) is that “these final moments of life and first moments of death belong to the grieving at least as much as to the departed person”. yet this same window of time also belongs to the procurement team and surgeons. Quick actions to remove the organs and deliver them to the unknown beneficiary are necessary. Following the pronouncement of death, providers of care maintain the physical body by way of ventilation and circulatory support until the organ procurement team can harvest the organs. The procurement teams, who are well trained, tread on morally shaky ground with the deceased’s family. Approaching the grieving family is difficult, even when the team just needs to confirm the patient’s or family’s wish of wanting to donate organs. Sometimes, the person’s death will have occurred suddenly, such as in a car accident or another injury, and families must have some time to come to terms with the death of their loved one. When the potential donor is pronounced dead, the person continues to remain on a mechanical ventilator as if still living, with warm skin and up-and-down chest movements, and the person continues to receive intravenous fluids. The family sees their loved one’s chest moving up and down, and even though the person has been pronounced dead, the family sees their loved one as still living. This leaves healthcare professionals and families with feelings of ambiguity. Nurses experience moral distress when a person is declared dead and will not be an organ donor, and the provider suspends medical treatment and ventilation support.

The third ethical issue involves the perceived good of organ donation itself. From one perspective, organ donation can give death a certain degree of meaning, allowing a last act of benevolence and selflessness. For example, when no hope exists for continuance of life, parents might donate their child’s organs as an imagined way to carry on that child’s life. From another perspective, patients are guaranteed some autonomy and self-determination when they preregister to donate their organs. The procurement team often views itself as an advocate for carrying out the patient’s wish after death. This act of advocacy goes beyond the principle of autonomy in health care, but carrying out the recipient’s wishes or releasing a dead person’s organs for the good of another is a widely accepted utilitarianism paradigm in society. An intensely debated ethical question involves the dead donor rule and its legitimacy.

Is the dead donor rule outdated? Alan Shewmon (2004) clarified his thoughts on death as an unreal and unknowing ontological (study of being or existence) event without significant meaning, especially when society defines a person as dead by the legal standard created by people in the past 26 years.

As a consequence of questioning the soundness of the dead donor rule, a few bioethicists have attempted to define death as an event, instead of a process, as they grapple with the idea of expanding the scope of utilitarianism to overturn the dead donor rule; ultimately, organs could be retrieved from patients without higher brain function (Miller & Truog, 2008). Patients without higher brain function have no cognitive functioning, but they have an intact brain stem and usually breathe without the assistance of mechanical ventilation. An example is patients who have only lower brain function (and no higher brain), such as those in a persistent vegetative state, like Terri Schiavo. This notion raises the question of whether this practice would be ethical or legally acceptable. Pronouncing patients’ dead who have a functioning brain stem but no higher brain functioning would be a complete ontological shift in how society views death. Overturning the dead donor rule and retrieving organs from patients who are still alive by the UDDA definition of death would be a utilitarian ethical framework when viewed from the perspective of longer-term quality of life and the number of people who could be saved; for example, one person’s organs may save eight lives. Society must answer these questions:

1. If the dead donor rule changes so organ teams can harvest organs from patients with only lower brain function, how will the definition of death change to include these patients?

2. Do patients without higher brain function, but who are not dead by the current legal definition of death, have full moral standing?

Society needs to search for what death really means in terms of the moral imperative of doing good for others versus acting within moral limits and respecting primum non nocere (first do no harm).

Nurses and Organ Donors

In intensive care units and on transplant teams, nurses manage care for potential organ donors, recipients, and their families on a daily basis. Organ procurement teams consist of nurses, surgeons, and other trained healthcare professionals. The psychosocial impact and outcome of the organ transplantation process for donors, donor families, and recipients are unique. According to the ANA Code of Ethics for Nurses with Interpretative Statements (2015), nurses work within a moral framework of good personal character to promote the principles of autonomy, beneficence, nonmaleficence, and justice. To review how those principles are evident in the essential aspects of the code, refer to the box Research Note: Attitudes of Caring for Brain Dead Organ Donors. Most nurses want to have a sense of

satisfaction based on their belief that they are promoting human good, preserving their patients’ dignity as much as possible, and maintaining a caring environment.

The ANA Code of Ethics for Nurses with Interpretive Statements (2015) includes some essential aspects for the care of adult patients in Provisions 1.2, 1.3, 1.4, 2.1, 5.1, 6.1, 6.2, and 8.3. These provisions consist of the importance of consideration of the following items:

■ Culture, values systems, belief systems, social support, gender orientation, and primary language

■ Interventions that optimize health and well-being of patients in nurses’ care

■ Patient autonomy in terms of decision making, cultural beliefs, and understanding of health, autonomy concerns, and relationships

■ A commitment of nurses to respect the uniqueness, worth, and dignity of patients

■ Respect for moral worth and dignity of all persons

■ Practice the “good nurse” virtues of knowledge, skill, wisdom, patience, compassion, honesty, altruism, and courage

■ Practice the promotion of human virtues and values of dignity, well-being, respect, health, and independence, among others

■ Create and maintain excellence in practice environments that support nurses tofulfill their ethical obligations

■ Respect and be sensitive to the culturally diverse populations’ unique healthcare needs worldwide.

Tailored Study Plan

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Tailored Study Plan

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Tailored Study Plan:

Assignment 2: Study Plan

Based on your practice exam question results from Week 2, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress. You will revisit and update your study plan in NRNP 6675, and you may continue to refine and use it until you take the exam.

 

Photo Credit: [Jacob Ammentorp Lund]/[iStock / Getty Images Plus]/Getty Images

To Prepare

· Reflect on your practice exam question results from Week 2. Identify content-area strengths and opportunities for improvement.

· Also reflect on your overall test taking. Was the length of time allotted comfortable, or did you run out of time? Did a particular question format prove difficult?

The Assignment

· Based on your practice test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement.  Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.

· Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.

· Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.

 

Based on your practice test question results and considering the national certification exam, summarize your strengths and opportunities for improvement.

Create a study plan, including three or four SMART goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.

Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation

MSL Program

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MSL Program

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MSL Program:

Introduction

Recognizing that all four frames are useful as a lens for evaluating organizations, do you believe that any one of the four frames is more informative relative to our understanding of the University of Missouri case? If so, which frame (or frames), and why? 

What are the most relevant concepts you have learned in this course? In the MSL program?

I believe that the case study of University of Missouri is complicated, with some undertones that not everyone notices because of the emphasis on Mr. Bunn and his suggestions, which sparked an uproar within the local community and in the university (Bolman et al., 2014). As a result, I think the two frames; structural and human resource are more helpful about the case study. Nevertheless, the other frames, serve to provide a possibility for different points of view in the process of decision making.

I say this because the University of Missouri is a well-structured institution that has been in existence since the 1830s as shown at HRM assignment help, and when dealing with financial difficulties, they relied on their function and structure to help them fix the problem (Bolman et al., 2014). In this case, I presume the structural frame has the most sway since the University was attempting to reorganize the whole institution in a way that backed long-term objectives. The University had grown too big and was not prepared to deal with a decrease in cash inflow. Financial issues necessitate performance and the establishment of ambitions that can sustain that level of efficiency. Institutions must have a vision in order to remain effective and provide a path forward to their stakeholders.

The human resource frame also comes into effect because the university depend on its employees to execute the work required for the organization to survive, and eventually thrive (Vincent,2014). Sadly, for the university, the implementation of the cost-cutting plans fell short since they failed to continue to use the hierarchy and function to implement the task at hand at the most crucial juncture. Instead, they delegated authority to one man with no requirement to consult with others.

Nevertheless, the most important concept that I have gained from this course is that there are numerous perspectives on an institution. When it comes to ethical questions and issues, and even the military employs similar practices, but the four frames are essential for a leader to recognize when tasked with running an organization (Vincent,2014). Moreover, I believe that the institution should be continuously assessed using the frames, allowing the leadership to gauge the corporation and resolve issues before they become challenges. The most important takeaway from the MSL program, in my opinion, is that top management is universal. It makes no difference whether the organization is military, commercial, or medium sized business The aim is to convince others to work together to achieve a common goal.

The competitiveness in the academic world is increasing daily. Today’s academics give their students incredibly short deadlines for practical works. It might only last for two to three hours at times. Urgent work writing services are what are used to complete this instant practical work writing work. Students experience substantial worry and anxiety as a result of these pressing work writing assignments. 247workhelp.com has introduced its online services for urgent work writing help in order to allay their fears. Students who use this qualified urgent work assistance can get top-notch academic assignments even when given the tightest deadlines. Student can surely go to 247workhelp.com where they receive their best bargain ever inside the budget if they search for custom urgent work writing help online services, urgent work help, urgent custom work help, or urgent work writing help online in Google.

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References

Bolman, L.G., & Deal, T.E. (n.d.). Reframing organizations: The leadership kaleidoscope. (2014). Retrieved on May 8, 2014 from https://historyassignmenthelp.com/history-homework-help/get-african-american-history-assignment-help-from-expert-history-writers/

Vincent, P. Four-frame model: Reframing organizations. SlideShare. (2014). Retrieved on May 1, 2014 from http://www.slideshare.net/PhilVincent1/fourframe-model

Child Health History

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Child Health History

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Child Health History: Completing an infant or child health history always comes with the need for resources. Using the patient’s parent or guardian would be the first instinct to get a full health history. If the patient’s parent is not with them in person, I would call them to work to get the full history. If the patient is adopted or in state custody, I would try to get records to complete the history. Sometimes elderly patients cannot recall all their health history. Using a family member or caretaker is an option, also having the patients’ records sent from other offices, and using their medication list. Many times, in the area I work getting the patients medication list can help them to remember some of their health history. Also making sure to use language they understand as well as recalling all the systems. Asking them specific questions instead of generalized. For example: have you had any surgeries? Very general. “let’s start at the top have you had any head or face surgeries? Neck or shoulder? Thyroid or throat? “And continuing down. You can ask if the patient has a patient portal of history that you can see. But it is always important to ask the patient and then include the family or care giver in on the conversation. Patients with cognitive delays I would treat like a child or elderly making sure to ask them the questions but if they do not know refer to parent or guardian. Completing a history on a patient who speaks another language it is important to have a translator or language line. This is to make sure the patient can give the most accurate information and understand everything. Another useful tool is using a health history form. This could be given at the office or sent prior to the patients visit. The health history can be in multiple languages as well. The Agency for Healthcare Research and Quality (2020) has health literacy universal precautions tool kits that have forms for health histories. These could be helpful to help the patient, or their family get all the information prior to the visit also it maybe helpful to fill one out and just keep a copy if the patient can’t communicate or has memory problems. Another tool is asking questions and using verbal and non-verbal communication skills (U.S. Department of Health and Human Services, 2017).

A RadioLab Investigation

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A RadioLab Investigation

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A RadioLab Investigation:

need help with studying for assignments each assignment uploaded is different

A RadioLab Investigation

Who is Patient Zero?

 

 

 

 

 

 

 

 

 

 

 

 

It’s probably best to download the audio file, rather than try to play it off the site: http://www.radiolab.org/story/169879-patient-zero/

 

You will start at 15:00 (on slide #3) of the audio and be changing slides as the audio plays.

 

Slides from Imelda Nava-Landeros, Erica Seubert and Diane Livio

1

Who is Patient Zero?

 

As you listen, take notes to identify/construct the following:

 

Hypothesis:

 

Evidence:

 

 

 

 

 

 

Ask the students to have a couple sheets of paper out to keep notes on. They’ll be tracking the progress of their thoughts in the radiolab investigation on the paper.

You could collect these notes at the end to give them some participation points, if you want.

 

You could point them to this article regarding myths about HIV and AIDS: http://www.thehealthsite.com/diseases-conditions/ten-hivaids-myths-busted/

 

 

2

HIV ATTACKS YOUR T CELLS

 

 

 

 

Start at 15:00

T-cells are a type of white blood cell that circulate around our bodies, scanning for cellular abnormalities and infections.

 

At 16:53 click to the next slide

 

Image (and a nice extra reference source to point the students to later): http://www.thehealthsite.com/diseases-conditions/ten-hivaids-myths-busted/

 

3

 

 

 

 

 

At 17:36 click to the next slide

 

4

 

 

 

 

 

 

At 19:01 click to the next slide

 

5

What is “Patient Zero”?

 

 

 

 

STOP here at 20:22

 

 

Image: http://haicontroversies.blogspot.com/2011/12/patient-zero-typhoid-mary-through-hiv.html

 

6

Round 1

Who is Patient Zero?

Hypothesis:

Patient zero is ………… because……………

 

Evidence for reasoning (and questions you might have):

 

 

 

 

 

 

Remind the students to write down on their paper their answers

Ask a couple of students to share their answers

Restart audio after checking students have written down their own responses to part 1. Click to the next slide

 

7

 

 

 

 

 

 

At 21:12 click to the next slide

 

Images:

http://en.wikipedia.org/wiki/File:Kaposi%27s_Sarcoma.jpg – Kaposi’s sarcoma

http://en.wikipedia.org/wiki/Timeline_of_HIV/AIDS#mediaviewer/File:PCPxray.jpg – Pneumocystis carinii pneumonia

http://en.wikipedia.org/wiki/History_of_HIV/AIDS#mediaviewer/File:HIV-budding-Color.jpg – “Scanning electron micrograph of HIV-1 budding (in green) from cultured lymphocyte. Multiple round bumps on cell surface represent sites of assembly and budding of virions.”

8

 

 

 

 

 

 

At 22:40 click to the next slide

9

 

 

 

 

 

At 22:53 click to the next slide

 

Image: http://www.pnas.org/content/104/47/18566/F1.medium.gif

10

 

 

 

 

 

 

At 23:00 click to the next slide.

11

 

 

 

 

 

 

STOP here at 25:43

 

Maximum clade credibility topology inferred using BEAST v1.4.7 under a Bayesian skyline plot tree prior.

Branch lengths are depicted in unit time (years) and represent the median of those nodes that were present in at least 50% of the sampled trees. DRC60 (red), ZR59 (black) and the three control sequences from paraffin-embedded specimens from known AIDS patients (grey) are depicted in bold. The 95% HPD of the TMRCA is indicated at the root of the tree. Nodes (sub-subtype and deeper) with posterior probability of 1.0 are marked with grey circles. Unclassifiable strains are labelled ‘U’. Sequences sampled in the DRC are highlighted with a bullet at the tip. DRC60 and the two control sequences from the DRC each form monophyletic clades with previously published sequences from the DRC, whereas the Canadian control sequence clusters, as expected, with subtype B sequences. The dashed circle and shaded area show the extensive HIV-1 diversity in Kinshasa in the 1950s.

 

Worobey et al. 2008 Direct evidence of extensive diversity of HIV01 in Kinshasa by 1960. Nature 455(2): 661-665

12

Round 2

Who is Patient Zero?

Hypothesis:

Patient zero is ………… because……………

 

Evidence for reasoning (and questions you might have):

 

 

 

 

 

 

Remind the students to write down on their paper their answers

Ask a couple of students to share their answers

Restart audio after checking students have written down their own responses to part 2.

 

13

 

 

 

 

 

 

 

At 26:30 click to the next slide

 

doi: 10.1101/cshperspect.a006841

http://perspectivesinmedicine.org/content/1/1/a006841.full.pdf+html

14

 

 

 

 

 

 

At 27:50 click to the next slide

 

doi: 10.1101/cshperspect.a006841

http://perspectivesinmedicine.org/content/1/1/a006841.full.pdf+html

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At 28:37 click to the next slide

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STOP here at 29:50

 

Photos: http://commons.wikimedia.org/wiki/File:Bushmeat_-_Buschfleisch_Ghana.JPG

http://science.psu.edu/news-and-events/2010-news/SchusterMiller2-2010

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Round 3

Who is Patient Zero?

Hypothesis:

Patient zero is ………… because……………

 

Evidence for reasoning (and questions you might have):

 

 

 

 

 

 

Remind the students to write down on their paper their answers

Ask a couple of students to share their answers

Restart audio after checking students have written down their own responses to part 3. At 31:40, click to advance

 

18

 

 

 

 

 

 

At 30:23 click to advance

 

Photo: http://fivepointfive.org/renaud-fulconis-awely/

 

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Leopoldville c.1885

 

 

 

 

 

 

At 30:55 click to advance

 

Photo: http://commons.wikimedia.org/wiki/File:Leopoldville_1885.jpg

20

 

 

 

 

 

 

At 31:54 click to advance

21

 

 

 

 

 

 

 

 

 

If short on time, can end audio at 32:55 and jump to the last slide]

 

At 33:22 click to advance

 

Spatial dynamics of HIV-1 group M spread.

Circles represent sampled locations and are colored according to the estimated time of introduction of HIV-1 group M from Kinshasa. Strongly supported rates of virus spatial movement are projected along the transportation network for the DRC (railways and waterways), which was fully operational until 1960. Gradient colors depict the time scale of spatial movements (bottom left).

 

From Faria et al. 2014 The early spread and epidemic ignition of HIV-1 in human populations. Science 346 (6205): 56-61

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Discussion – Individual and then small groups

How and why did your reasoning evolve over time?

 

How did we begin to develop an understanding?

 

Do we know who patient zero is?

Why or why not?

 

 

 

 

 

 

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Myth of the Pristine Wilderness

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Myth of the Pristine Wilderness

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Myth of the Pristine Wilderness: 350 words. How does Barbara Cameron’s “Gee You Don’t Seem Like an Indian from the Reservation” address the pillars of settler colonialism identified by Roxanne Dunbar Ortiz? You don’t need to address all the pillars, but analyze the ones that apply.

MYTH OF THE PRISTINE WILDERNESS

With the onset of colonialism in North America, control of the land was wrenched away from the Indigenous peoples, and the forests grew dense, so that later European settlers were unaware of the former cultivation and sculpting and manicuring of the landscape. Abandoned fields of corn turned to weeds and bushes. Settlers chopped down trees in New England until the landscape was nearly bare.1 One geographer notes, “Paradoxical as it may seem, there was undoubtedly much more ‘forest primeval’ in 1850 than in 1650.”2 Anglo-Americans who did observe Native habitat management in action misunderstood what they saw. Captain John Palliser, traveling through the prairies in the 1850s, complained about the Indians’ “disastrous habit of setting the prairie on fire for the most trivial and worse than useless reasons.” In 1937, Harvard naturalist Hugh Raup claimed that the “open, park-like woods” written about in earlier times had been, “from time immemorial, characteristic of vast areas in North America” and could not have been the result of human management.3 In the founding myth of the United States, the colonists acquired a vast expanse of land from a scattering of benighted peoples who were hardly using it—an unforgivable offense to the Puritan work ethic. The historical record is clear, however, that European colonists shoved aside a large network of small and large nations whose governments, commerce, arts and sciences, agriculture, technologies, theologies, philosophies, and institutions were intricately developed, nations that maintained sophisticated relations with one another and with the environments that supported them. By the early seventeenth century, when British colonists from Europe began to settle in North America, a large Indigenous population had long before created “a humanized landscape almost everywhere,” as William Denevan puts it.4 Native peoples had created town sites, farms, monumental earthworks, and networks of roads, and they had devised a wide variety of governments, some as complex as any in the world. They had developed sophisticated philosophies of government, traditions of diplomacy, and policies of international relations. They conducted trade along roads that crisscrossed the landmasses and waterways of the American continents. Before the arrival of Europeans, North America was indeed a “continent of villages,” but also a continent of nations and federations of nations.5 Many have noted that had North America been a wilderness, undeveloped, without roads, and uncultivated, it might still be so, for the European colonists could not have survived. They appropriated what had already been created by Indigenous civilizations. They stole already cultivated farmland and the corn, vegetables, tobacco, and other crops domesticated over centuries, took control of the deer parks that had been cleared and maintained by Indigenous communities, used existing roads and water routes in order to move armies to conquer, and relied on captured Indigenous people to identify the locations of water, oyster beds, and medicinal herbs. Historian Francis Jennings was emphatic in addressing what he called the myth that “America was virgin land, or wilderness, inhabited by nonpeople called savages”: European explorers and invaders discovered an inhabited land. Had it been pristine wilderness then, it would possibly be so still today, for neither the technology nor the social organization of Europe in the sixteenth and seventeenth centuries had the capacity to maintain, of its own resources, outpost colonies thousands of miles from home. Incapable of conquering true wilderness, the Europeans were highly competent in the skill of conquering other people, and that is what they did. They did not settle a virgin land. They invaded and displaced a resident population. This is so simple a fact that it seems self-evident.

Carbohydrate Flowchart

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Carbohydrate Flowchart

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Carbohydrate Flowchart:

create a 1-2 page written summary of how all 3 macronutrients are digested and absorbed, including a discussion of the events in each compartment of the GI tract.  Include the names of the molecules that are digested, the enzymes involved, and the products produced by the enzymes.  Be sure to say which molecules are absorbed by the intestinal mucosal cells (enterocytes).

Each of the 3 macronutrients are in the uploaded files named carbohydrate flowchart, lipid flowchart and protein flowchart.

1

 

 

 

 

Carbohydrate Flowchart

By (Name)

 

 

 

Course

Date

 

Reference

Ji, H., Hu, J., Zuo, S., Zhang, S., Li, M., & Nie, S. (2022). In vitro gastrointestinal digestion and fermentation models and their applications in food carbohydrates.  Critical Reviews in Food Science and Nutrition,  62(19), 5349-5371.

 

 

Mouth

 

 

Mechanical digestion entails the use of swallowind and chewing. The salivary glands are triggered into action by chewing, resulting in the production of saliva. Carbohydrates and fats are digested chemically.

 

 

Stomach

 

 

Propulsion and mixing at the peristaltic level constitute mechanical digestion. Acids are used for chemical digestion of lips, salivary amylase and proteins. Absorption of drugs like alcohol and aspirin that dissolve in fat. The stomach does not break down carbohydrates.

 

 

Pancrease

 

 

The small intestine is the site of secretion of pacreatic amylase. Enzymes are produced in the pancreas. The starch, lipids and  carbohydrates,  are all metabolized by these enzymes. The hormones produced by the pancreas aid the digestive system. In the same way as salivary amylase breaks down starch into tiny oligosaccharides and maltose, so does pancreatic amylase, which is secreted from the pancreas into the small intestine.

 

 

Small Intestines

 

 

Large Intestines

 

 

Those remnants of starch are converted to maltose by amalyse in the pancreas. The mixing and propulsion steps of mechanical digestion. Enzymes (lactase, sucrase, and maltase) break down disaccharides (maltose, sucrose, and lactose) into monosaccharides, a step in the chemical digestion of carbohydrates, lipids, nucleic acid and polypeptides (glucose, fructose and galactose). The small intestine is responsible for the absorption of all monosaccharides.

 

 

Some carbohydrates are not broken down by the digestive process and make it into the large intestine, where they are fermented by bacteria. Segmental mixing and propulsion are mechanical components of digestion. Absorption of water, vitamis, ions, organic compounds and minerals.

Risk Response Options

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Risk Response Options

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Risk Response Options:

Please see the attached word document and responses to person 1 and person 2 based on their discussion.

Respond to your 2 people:

  • Respond to at least two people, constructively commenting on their critical analysis of risks in relation to Hintel, and the risk response approaches that they have chosen and why.
  • Provide sensitive and insightful feedback, encouraging further dialogue through open-ended questions.
  • Person 1

    Mitigating Risk​Many small businesses have taken a hit as a result of the outbreak. It can even lead to the closure of a small company. In this case study, the company suffers tremendous losses due tothe pandemic’s irresponsibility. The three to five potential risk response options to consider for handling a crisis situation.

    Risk Response Options​The first option is to avoid the risk. As the name implies, ending a particular action or opting not to begin is a risk response option. When a company/business decides to avoid a risk, it reduces the likelihood of the risk causing harm to the business. A recent change to working from home to protect workers from contracting COVID-19 is one instance. Most firms avoid the risk of their employees falling ill (Bhoola et al., 2014).​The second option is to reduce. In ERM terms, it includes taking steps to reduce the probability or effect of a loss. Lowering is a workable option for bringing the hazard within reasonable limits if the danger is somewhat more than the desire and acceptance level. Transfer is the third option. Regarding choices 1 and 2, this option exported or shifted responsibility for the risk to a third party instead of removing or reducing its chance. Purchasing home insurance doesn’t decrease or prevent power outages, but it can provide a financial cushion if damage occurs (Williams, 2019). The fourth option is Accept. There would be other dangers beyond the threshold for which one of the other response options will be unsuccessful because the likelihood and impact are so low that devoting resources to avoid, transfer, or reduce the risk does not make sense.

    Evaluating the Risk Response Options ​When evaluating risk response options, the first factor is senior management engagement and support. The influence of risk factors including such leadership support, company vision, and external expertise. The results suggest that support from top management affects the organizational system’s overall success.​The second factor is Communication. Communication is essential in risk management. It allows for an explanation, making sense of the organization’s success, and members to examine how to enhance the organization and the effects of various risk mitigation techniques.​The third factor is Organizational Structure. The advisory board conducts the organizational structure, which gives the personnel the concept, guidelines, direction, and assistance. They create and teach staff how to share and employ a common language. Individuals collaborate as a team to avoid divisions and to include resistant employees in the process.

    Bad Actors​Potential opportunities for criminal actors to harm enterprises, such as the exploitation of modern teleworking technology. Many businesses have quickly implemented networks involving VPNs and associated IT infrastructure with transitioning their whole workforce to telecommuting.Cybercriminal actors exploit various publicly known flaws in VPNs and other remote working technologies and software to take advantage of this widespread shift to telework.​A group of actors has stolen user credentials using COVID-19-related phishing. These emails use the previously mentionedCOVID-19 methods of social engineering, which are occasionally supplemented with urgent language to increase attraction (Sailio et al., 2020). When the user clicks on the hyperlink, a faked log-in page with a credential entry form displays. Previously, monetary benefits such as government payments and rebates such as tax rebates) have been utilized as a part of the bait in SMS phishing. This economic theme is continued by coronavirus-related phishing, especially due to the economic effect of the outbreak and governments’ job and financial assistance packages.

    Technical Controls​The technical measures that “Hintel” could put in place to limit cybersecurity risks posed by these malicious actors by using firewalls, encryption, intrusion detection systems (IDS), and procedures for identity and verification. Technical controls manage several key functions, including detecting unwanted users from accessing the system and identifying security problems (Harford, 2022). Since technical controls are so important, some people assume them to be the totality of cybersecurity, disregarding other key factors.   References Bhoola, V., Hiremath, S. B., & Mallik, D. (2014). An Assessment of risk response strategies practiced in software projects. Australasian Journal of Information Systems, 18(3). https://doi.org/10.3127/ajis.v18i3.923 Harford, I. (2022). Types of cybersecurity controls and how to place them. SearchSecurity. https://www.techtarget.com/searchsecurity/feature/Types-of-cybersecurity-controls-and-how-to-place-them Sailio, M., Latvala, O.-M., & Szanto, A. (2020). Cyber Threat Actors for the Factory of the Future. Applied Sciences, 10(12), 4334. https://doi.org/10.3390/app10124334 Williams, C. (2019, February 12). 4 risk response strategies you will have to consider after assessing risks – Carol williams. Erminsightsbycarol. https://www.erminsightsbycarol.com/risk-response-strategies/

Terrorism Against the United States

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Terrorism Against the United States

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Terrorism Against the United States:

Assignment Details

The challenge of terrorism against the United States has led the U.S. government to create the Department of Homeland Security with the hope of leveraging federal, state, and local police agencies as well as intelligence and immigration agencies to cooperate in communicating findings and creating joint efforts to stop threats of terrorism or confront a terrorist attack.

The current threat of terrorism has made many senators and representatives in the U.S. Congress think about combining all of the police agencies in the United States into one national police organization. The centralization of power would stop the discombobulated nature of the three government levels of police and provide a clear, overall standard on how to police not only terrorist acts but also crime in general.

Answer the questions below in 3–4 pages. Give your opinion concerning the topics, and provide examples. Discuss your findings regarding any statistics about the victims that you list. Discuss your thoughts about what options might be taken regarding victims of racial profiling. Be sure to back up your opinions with facts from cited sources.

  • Do you believe that labeling terrorism as a crime that can be committed domestically has changed policing? How? Why? Provide examples.
  • Have the number of victims of racial profiling increased over the last decade?
  • What laws and services are available for victims of racial profiling?
  • What other actions might be taken on behalf of victims of racial profiling?
  • Has the Department of Homeland Security helped fight terrorism, or has it simply duplicated the efforts and jurisdictions of other agencies? How has it helped?

Use the library, Internet, and other resources available to you to conduct your research. Provide APA citations and references.

This assignment will also be assessed using additional criteria provided here.

Community Teaching

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Community Teaching

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Community Teaching:

Assessment Traits

Benchmark

 

Requires Lopes write

Assessment Description

The RN to BSN program at Grand Canyon University meets the requirements for clinical competencies as defined by the Commission on Collegiate Nursing Education (CCNE) and the American Association of Colleges of Nursing (AACN), using nontraditional experiences for practicing nurses. These experiences come in the form of direct and indirect care experiences in which licensed nursing students engage in learning within the context of their hospital organization, specific care discipline, and local communities.

Note:  The teaching plan proposal developed in this assignment will be used to develop your Community Teaching Plan: Community Presentation due in Topic 5. You are strongly encouraged to begin working on your presentation once you have received and submitted this proposal.

Select one of the following as the focus for the teaching plan:

1. Primary Prevention/Health Promotion

2. Secondary Prevention/Screenings for a Vulnerable Population

3. Bioterrorism/Disaster

4. Environmental Issues

Use the “Community Teaching Work Plan Proposal” resource to complete this assignment. This will help you organize your plan and create an outline for the written assignment.

1. After completing the teaching proposal, review the teaching plan proposal with a community health and public health provider in your local community.

2. Request feedback (strengths and opportunities for improvement) from the provider.

3. Complete the “Community Teaching Experience” form with the provider. You will submit this form in Topic 5.

You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Resources if you need assistance.

Benchmark Information

Registered Nurse to Bachelor of Science in Nursing

The benchmark assesses the following competency:

4.2 Communicate therapeutically with patients.

Attachments

NRS-428VN-RS3-CommunityTeachingWorkPlanProposal.docx

 

 

 

 

 

 

 

 

 

 

 

 

 

Community Teaching Work Plan Proposal

Planning and Topic

Directions: Develop an educational series proposal for your community using one of the following four topics:

1. Bioterrorism/Disaster

2. Environmental Issues

3. Primary Prevention/Health Promotion

4. Secondary Prevention/Screenings for a Vulnerable Population

Planning Before Teaching:

Name and Credentials of Teacher:

 
Estimated Time Teaching Will Last: Location of Teaching:

 
Supplies, Material, Equipment Needed: Estimated Cost:

 
Community and Target Aggregate:

 
Topic:

 

 

Identification of Focus for Community Teaching (Topic Selection):

 

 

 

Epidemiological Rationale for Topic (Statistics Related to Topic):

 

Teaching Plan Criteria

Your teaching plan will be graded based on its effectiveness and relevance to the population selected. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Nursing Diagnosis:

 

 

Readiness for Learning: Identify the factors that would indicate the readiness to learn for the target aggregate. Include emotional and experiential readiness to learn.

 

 

 

Learning Theory to Be Utilized: Explain how the theory will be applied.

 

 

Goal: Healthy People 2020 (HP2020) objective(s) utilized as the goal for the teaching. Include the appropriate objective number and rationale for using the selected HP2020 objective (use at least one objective from one of the 24 focus areas). If an HP2020 objective does not support your teaching, explain how your teaching applies to one of the two overarching HP2020 goals.

 

 

How Does This HP2020 Objective Relate to Alma Ata’s Health for All Global Initiatives

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Develop Behavioral Objectives (Including Domains), Content, and Strategies/Methods:

Behavioral Objective and Domain

Example – Third-grade students will name one healthy food choice in each of the five food groups by the end of the presentation. (Cognitive Domain)

 Content (be specific)

Example – The Food Pyramid has five food groups which are….

Healthy foods from each group are…. Unhealthy foods containing a lot of sugar or fat are….

 Strategies/Methods

(label and describe)

Example – Interactive poster presentation of the Food Pyramid. After an explanation of the poster and each food category, allow students to place pictures of foods on the correct spot on the pyramid. Also, have the class analyze what a child had for lunch by putting names of foods on the poster and discussing what food group still needs to be eaten throughout day.
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 1. 1.
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 2. 2.
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 3. 3.
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 4. 4.

 

 

Creativity: How was creativity applied in the teaching methods/strategies? Planned Evaluation of Objectives (Outcome Evaluation): Describe what you will measure for each objective and how.

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2.

 

 

 

3.

 

 

4.

 

 

 

Planned Evaluation of Goal: Describe how and when you could evaluate the overall effectiveness of your teaching plan.

 

 

 

 

Planned Evaluation of Lesson and Teacher (Process Evaluation):

 

 

 

 

Barriers: What are potential barriers that may arise during teaching and how will those be handled?

 

 

 

 

Therapeutic Communication

4.2 Communicate therapeutically with patients.

 

How will you begin your presentation and capture the interest of your audience? Describe the type of activity will you use with your audience to exhibit active listening? Describe how you applied active listening in tailoring your presentation to your audience? How will you conclude your presentation? What nonverbal communication techniques will you employ?

 

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