Microorganisms: Normal Flora

Microorganisms: Normal Flora The idea of contamination in the host-parasite relationship is communicated in the bodys ordinary greenery. Ordinary greenery is a populace of miniaturized scale creatures that contaminate the body without causing ailment. A few creatures set up a lasting relationship, as E.coli is constantly found in internal organs of people; others like streptococci are transient. Harmonious relationship among body and its ordinary verdure exist at various levels. These might be as mutualism or commensalisms. Lactobacillus in human vagina is instances of mutualism. They get nourishment from vaginal condition and the corrosive created by them forestalls the abundance of different microorganisms. E. coli exists as a commenssal, however may likewise now and again exist in mutualistic affiliation. Typical verdure exists on skin oral cavity, upper respiratory tract, last piece of small digestive system and the internal organ. In digestion tracts there are Bacteroides, Clostridium (spores), Streptococci, Gram positive poles including Enterobacter, Klebsiella, Proteus and Pseudomonas, E. coli ,Candida albicans. Typical verdure experiences changes because of interior condition of the body. Normally, when one says I have a contamination they intend to state I have an infection, anyway the last isn't exactly so socially satisfactory. Indeed, we are completely contaminated with an assortment of microorganisms all through our whole lives. Inconceivably, our bodies are really made out of more bacterial cells than human cells; while the human body is comprised of around 1013 human cells, we harbor close to 1014 microscopic organisms. This gathering of life forms, generally alluded to as typical verdure (despite the fact that they are not plants) is made out of a genuinely steady arrangement of genera, for the most part anaerobes. While every individual has a generally one of a kind arrangement of typical greenery, individuals from the Streptococcus and Bacteroides make up a huge level of the occupants. These living beings add to our reality in a few different ways. These ordinary vegetation may: à ¯Ã¢â‚¬Å¡Ã¢ · Help us by contending with pathogens, for example, Salmonella à ¯Ã¢â‚¬Å¡Ã¢ · Help us by giving nutrients or dispensing with poisons (for example Bacteroides) à ¯Ã¢â‚¬Å¡Ã¢ · Harm us by advancing ailment (for example dental caries) à ¯Ã¢â‚¬Å¡Ã¢ · Cause neither assistance nor hurt (for example commensals). One of the most significant elements of our ordinary greenery is to shield us from profoundly pathogenic life forms. For instance, in a typical (bacterially possessed creature), around 106 Salmonella must be ingested so as to cause malady. In any case, when a creature has been kept up in a sterile domain an incredible entirety (a gnotobiotic creature), a similar degree of sickness can be delivered by as not many as 10 Salmonella. This emotional contrast is basically because of rivalry (wikiAnswers.com). To a microorganism, the human body appears to be a lot of like the planet Earth appears to us. Much the same as our planet, our bodies contain various situations, extending from dry deserts (for example the lower arm) to tropical woods (for example the perineum) to amazingly antagonistic areas (for example the intestinal tract). Every condition has certain points of interest and weaknesses and various microorganisms have adjusted to specific locales of the body for their specific needs. In created nations, PCs are utilized in the bedside zone for numerous capacities, including requesting, checking research facility and picture results, recording patients conditions, what's more, bookkeeping. In addition, most PC gadgets, for example, consoles and mice, in numerous nations are not water-confirmation and not extraordinarily intended for emergency clinic cleansing needs. Along these lines, there is a decent chance that PC interface surfaces may fill in as supplies for nosocomial pathogens. Plus, the pace of hand washing consistence in human services foundations is low (~40%), which is probably identified with the sullying of lifeless surfaces of clinical types of gear and medical clinic condition with nosocomial pathogens (Boyce JM,Pittet 2002). Studies have demonstrated that the hands or gloves of medicinal services laborers (HCWs) can be defiled in the wake of contacting lifeless things in persistent rooms or subsequent to contacting natural surfaces close to patients (Bhalla An et al., 2004 ;Hartstein AI et al.,1988).One study detailed that microbial sullying of PC interface surfaces was pervasive to such an extent that different microorganisms were disengaged from over half of the consoles of emergency clinic PCs (Rutala WA et al., 2006). The degrees of pollution fluctuated with the vicinity to the patients, the surface of lifeless surfaces and the recurrence of contact. The medical clinic ward PC is seen being more uncertain as tainted than bedside PCs (Neely AN et al.,2005). Schultz et al. have detailed that 95% of consoles in closeness to quiet locales had bacterial pollution. Be that as it may, just 5% of these were pathogens known to be related with nosocomial transmission (Schultz M et al.,2003). Most past examinations have detailed the pollution of PC interface surfaces by potential pathogens, for example, Methicillin-safe Staphylococcus aureus (MRSA) (Boyce JM et al.,1997;Bures S et al.,2000) and Acinetobacter baumannii (Neely AN et al.,1999), however few have considered the connection between tainting of the ward PCs and clinical secludes in medical clinics with improved hand cleanliness consistence and during a non-flare-up period. Clinically, A. baumannii, P. aeruginosa, and MRSA cause the most widely recog nized nosocomial diseases and their essence associates with natural surface sullying (Engelhart S et al.,2002;Sekiguchi J et al.,2007).We directed a medical clinic based observation investigation of these three significant pathogens on PC interface surfaces in various ward settings and afterward analyzed the relationship of debased PC interface surfaces with the nearness of clinical separates in these wards during a non episode period. Skin gives genuine instances of different microenvironments. Skin areas have been contrasted with geographic locales of Earth: the desert of the lower arm, the cool woods of the scalp, and the tropical timberland of the armpit. The creation of the dermal smaller scale greenery fluctuates from site to site as per the character of the microenvironment. An alternate bacterial verdure describes every one of three districts of skin: (1) axilla, perineum, and toe networks; (2) hand, face and trunk; and (3) upper arms and legs. Skin destinations with incomplete impediment (axilla, perineum, and toe networks) harbor a bigger number of microorganisms than do less blocked territories (legs, arms, and trunk). These quantitative contrasts may identify with expanded measure of dampness, higher internal heat level, and more prominent centralizations of skin surface lipids. The axilla, perineum, and toe networks are more much of the time colonized by Gram-negative bacilli than are drier zones of th e skin. The quantity of microscopic organisms on a people skin remains generally consistent; bacterial endurance and the degree of colonization most likely rely halfway upon the presentation of skin to a specific situation and somewhat on the natural and species-explicit bactericidal action in skin. Likewise, a serious extent of particularity is associated with the adherence of microorganisms to epithelial surfaces. Not all microbes join to skin; staphylococci, which are the significant component of the nasal greenery, have a particular favorable position over viridans streptococci in colonizing the nasal mucosa. Then again, viridans streptococci are not found in enormous numbers on the skin or in the nose however command the oral vegetation. The microbiology writing is conflicting about the thickness of microorganisms on the skin; one purpose behind this is the assortment of strategies used to gather skin microscopic organisms. The clean technique yields the most elevated and most exact means a given skin zone. Most microorganisms live in the shallow layers of the layer corneum and in the upper pieces of the hair follicles. A few microscopic organisms, in any case, live in the more profound zones of the hair follicles and are past the compass of normal purification techniques. These microorganisms are a store for recolonization after the surface microbes are evacuated. Staphylococcus epidermidis S. epidermidis is a significant occupant of the skin, and in certain territories it makes up in excess of 90 percent of the inhabitant vigorous greenery. Staphylococcus aureus The nose and perineum are the most widely recognized locales for S. aureus colonization, which is available in 10 percent to in excess of 40 percent of typical grown-ups. S. aureus is pervasive (67 percent) on vulvar skin. Its event in the nasal sections differs with age, being more prominent in the infant, less in grown-ups. S. aureus is amazingly normal (80 to 100 percent) on the skin of patients with certain dermatologic sicknesses, for example, atopic dermatitis, yet the purpose behind this finding is muddled. Micrococci Micrococci are not as regular as staphylococci and diphtheroids; be that as it may, they are much of the time present on typical skin. Micrococcus luteus, the transcendent species, for the most part represents 20 to 80 percent of the micrococci disconnected from the skin. Diphtheroids (Coryneforms) The term diphtheroid signifies a wide scope of microscopic organisms having a place with the family Corynebacterium. Characterization of diphtheroids stays unacceptable; for accommodation, cutaneous diphtheroids have been sorted into the accompanying four gatherings: lipophilic or nonlipophilic diphtheroids; anaerobic diphtheroids; diphtheroids delivering porphyrins (coral red fluorescence when seen under bright light); and those that have some keratinolytic compounds and are related with trichomycosis axillaris (disease of axillary hair). Lipophilic diphtheroids are amazingly regular in the axilla, though nonlipophilic strains are discovered all the more ordinarily on glabrous skin. Anaerobic diphtheroids are generally regular in zones wealthy in sebaceous organs. In spite of the fact that the name Corynebacterium acnes was initially used to depict skin anaerobic diphtheroids, these are presently delegated Propionibacterium acnes and as P. granulosum. P. acnes are seen multiple times more much of the time than P. granulos

Martin Luther King Junior Essays - Anglican Saints,

Martin Luther King Junior On a run of the mill day in 1929 a man was conceived. A man that would follow in his dads strides to turn into an extraordinary American pioneer. A pioneer, yet in addition somebody that would move individuals everything being equal. A man that thought about his individual individuals and would not surrender for anything. He would attempt to battle. Attempt to win. Attempt to guarantee harmony for our reality. This man is the unrivaled Martin Luther King Junior. This man is one of history's best-cherished and regarded motivations. Conceived in Atlanta, Georgia, Martin Luther King Junior was brought into our reality with what appeared just as a light consuming in his heart. Flashing to accomplish objectives, and giving light and love to our individual individuals. As a kid he would carry on with an actual existence that to him wasn't fit for him. His companions appeared to be just individuals that looked equivalent to him. A similar skin shading. During an amazing beginning, he was unable to get why. Despite the fact that he just conversed with individuals of his own race he was fulfilled, however not for long. As he developed more established he started to comprehend. He was at long last acknowledging why he was caught behind the mass of preference. The considerations in his brain started to venture into a world that was difficult to live with. He started to battle in school and every day life at home. His contemplations were bolted on just one objective. Martin Luther King Junior moved on from Morehouse College in Georgia in 1948 and he was prepared to take obligations like a grown-up. after 3 years in 1955 he moved on from Crozer Theological Seminary. His folks adored his incredible learning capacities however frequently hoped for something else from him. They were glad yet instructing. He concentrated hard to make his folks pleased, however he felt that it was a colossal advantage for him too. He took a Ph.D. from Boston University in 1955 and was on the thruway to progress. He had decent training, a consistent family, and that was not all. While going to class at Boston University Martin Luther King Junior met his future spouse. He didn't have a clue about the genuine importance of affection until he discovered her. His life changed, and could never again be the equivalent. Alongside another spouse new duties. Coretta Scott and Martin Luther King Junior marry. Not long after their marriage they had four children together. As Martin would like to think, he was the most fortunate man on the planet. To him nothing could be superior to a sound cheerful marriage, and solid upbeat children. He had his life spread out like a camping cot. On the off chance that you recollect the existence that Martin Luther King lived, he gave his central core into what he accepted, and he wouldn't surrender until he accomplished his objective that was on the highest priority on his rundown. I'm certain that his rundown was exceptionally not insignificant rundown, and I realize that in the course of his life he accomplished each and every one of them. I genuinely perceive how Martin Luther King Junior is a noteworthy bit of history, and that he is a motivation for opportunity. In 1953 Martin became minister of the Dexter Avenue Baptist Church in Montgomery. He concluded that battling for what he put stock in was the best activity. In 1957 Martin Luther King Junior was picked to be leader of the recently shaped Southern Christian Leadership Conference. Officially known as SCLC. He started to

Tales of a College Froshling

Tales of a College Froshling When I went online to start typing up this post, I noticed an unpublished post of mine from nearly three weeks ago. Apparently I started writing an apologies for being too hosed to post entry and never finished it, which is just as well because I dont know what was going to be in it and dont recall ever writing the thing anyway. Ive always liked being insanely busy, but this is just ridiculous. Lets try this again. So whats been up with me? I passed my finals, and I can even tell all my friends that I have a 4.0 at MIT! Granted, none of them know that we use a 5.0 scale, but thats not the point. I have a B average. At MIT. I am dancing. Im also back in Florida, having moved out of Senior House for the summer. After some panic that Id be jobless and living in a cardboard box under Harvard Bridge for two and a half months, I was offered a job as an RA for the Center for Talent Development at Northwestern University, where for six weeks, Ive be living and working with middle school students taking introductory high school classes through the program. This is a source of great excitement for Hanna 10, who lives near Evanston and is already planning to accidentally-on-purpose show up at scheduled activities in the area. (So lets all go out for ice cream! And what a surprise, weve managed to bump into my good friend Hanna again! Um, well..) Not that Im complaining were suffering from radio show depr ivation and no longer responsible for our actions. Until I leave in two weeks, though, Ill be at home hanging out with my friends and family, along with sewing a lot. Hey, its been a while. Ill also spend a good amount of time reading the textbooks I got for my birthday. By the way, I turned eighteen on the 14th. Woo! I can be tried as an adult now! Anyway, Ive been emailing a few of you back and forth about all things MIT (and lets not ignore the messages and wall posts on the all-powerful Facebook); you all have brought up some useful topics that Id like to address here. Since the Freshman Housing Lottery just opened two days ago, lets start with that one. By now, you incoming frosh should probably have a general idea of how the whole thing works. You look through the information available to you (such as living group websites and the Guide to Residences in last months huge mailing), ask current students a million questions about what the dorms are like, rank all 15 16 (i-House is starting up this fall in New House 1, formerly Russian House) living groups in order of preference, and stick the list under your pillow just before you go to bed. That night, the magical Housing Fairy quietly removes the list from beneath your sleeping form, leaving a $2800 charge for next semesters room in its place. scratch that last part. I think I just mixed this up with the stories my mom used to tell me when I was five. All right, so you submit this list to MIT, where a computer puts everyone in a dorm using an algorithm designed to maximize the number of people in their first-choice living group. The room assignment chairs in each living group then use the rest of your application all the stuff about your number of desired roommates, likes and dislikes, et cetera to put you in a temporary room. Dont get too comfortable in your temp room; youll almost definitely be moving again. This is what REX (which some people refer to as Dorm Rush, a throwback to the way the housing system used to work before all frosh were required to live on campus starting in 2002) is for once youre actually here at MIT, its far easier to check out all the dorms and cultural houses for yourself. (Many of you started doing this during CPW.) We try to give you everything you need to make an informed decision, but theres really no replacement for going and spending some time everywhere. At the end of August, after youve been here for about a week, theres an Adjustment Lottery. In the lottery, you can decide to stay in your temporary dorm or enter up to four places youd like to move. Some of you will be happy where you are, and you may just want a different roommate or a room on another floor; of course, you might also decide to move somewhere entirely different. I got my second choice dorm in the Housing Lottery and got to MIT with the intent of checking everywhere out, since I wasnt completely happy with where Id been placed anyway. By the end of the Adjustment Lottery, I was moving clear across campus to a dorm that was originally my sixth choice. Once youve been assigned your final dorm, an In-House assignments are held to determine your final room. Each dorm handles this differently; while Baker and Next both hold numbered lotteries, Senior House makes you fill out a sheet with your top choice rooms and explain why the room assignment chairs should care about what you want. This explanation may or may not be in the form of baked goods. (Just For Fun: Click on this link and scroll down to the picture of Senior House. See the windowsill halfway painted blue? That was my room last term. A couple of years ago, someone living there decided to paint everything in the room that shade of blue, including the speaker for the fire alarm, the overhead storage shelves, the ceiling, and half the windowsill. By the time I got there, most of it had been painted over with Institute White, but the blue just wont go away.) It all seems really complicated, especially now that your friends going to other schools are all starting to get word of their roommates names, along with the locations of their bed, desk, chair, hall bathroom, complimentary loveseat, and the like.We just want you to be happy here. If you can have the option of deciding where to live, then why not give it to you? Ill end this post with links to some dorm tours put up by myself and the other bloggers: Baker House Burton-Conner House East Campus: one and two MacGregor House Next House Random Hall Senior House: one and two And heres a post Jessie put up a while back, which is really helpful and explains things better than I could have done. Any more questions? Email me! All the cool kids are doing it. ^_^

Critical Indicator of Business Success The Ability to Innovate - Free Essay Example

Sample details Pages: 5 Words: 1512 Downloads: 9 Date added: 2017/06/26 Category Business Essay Type Narrative essay Did you like this example? Critical Indicator of Business Success: The Ability to Innovate INTRODUCTION This report aims to investigate the ability to innovate is becoming a critical indicator of business success. With the globalization of the world today, business have become more competitive and succeeding in the business environment have become more challenging, requiring more drastic measures such as adaptability in changing environment and ability to innovate as compared to decades past. This investigation is conducted in order to identify the key factor that drives a business success with focus on the ability for the business to innovate as a critical indicator of business success. Don’t waste time! Our writers will create an original "Critical Indicator of Business Success: The Ability to Innovate" essay for you Create order The investigation is carried out by reviewing current and past surveys conducted by various researchers in different business environment. Compares of business goal attainment is made between highly innovative business and less innovative business in different business environment. Based on research, it was discovered that for companies to remain competitive they need to nimbly and respond quickly to the changing business environment without getting caught in knots. It is important for companies to posses the ability to respond to market movement by transforming information into insight as core to sustainability. The main constraints to improved business success mostly are conflicting departmental goals and priorities, slow decision-making, silo-based information and risk-averse cultures. Companies are at a competitive disadvantage if they are not agile enough to anticipate fundamental market place shift. These are theories made from past research and survey and here is where inno vative activities come in. This report discusses the different highlights, review, debates and current discussions on the innovative effect of business system on the success outcome of the business (Andy Jasper 1998). INNOVATION AS A CRITICAL INDICATOR FOR SUCCESS Many companies will treat innovation as black-box, the serendipitous achievement of a few gifted individuals. But this survey found that innovation leaders consistently outperformed laggards on five manageable capability areas. In the past, most successful companies were duopolies or mono polices as compared to recent times were free market trade, globalization and the ability to satisfy the customers expectation is the key to profitability. Innovation involves exploiting new ideas resulting in the creation of new services, product or process. It is not just the development of a new idea that is important, but bringing the idea into the market and putting it into practice by exploiting it in a way that leads to new services, systems or products that add value and improve quality. This is a critical indicator to most business success as customer satisfaction is fully derived from the product and services and not just for the selfless gain of the company (Eric Almqust 2013). Apple is an example of innovative company as they are able to develop new versions of the iPhone which is similar in nature but still at the same time gain high profitability by the ability to make customers see the uniqueness and need for it. This involves a high level of creativity to succeed above others in the mobile industry. It possibly involves management restructuring and technological transformation. Business innovation involves exploiting new technology and employing out-of-the-box thinking ability to develop new value and to bring out noticeable changes in the economy leading to economic development and growth. Economic growth brings more profitability to the company, this is an after effect derived from innova tive business activities and seen from companies that employ the use of appropriate innovation system in their business activities (Vadim Kotelinikov 2012). Research also shows that if a company is not agile, the rate of success is limited because customers are not static. Current debates shows that planning for the unpredictable may appear to be an impossible irony, but many companies seem to recognize that in a period of economic instability, a company ability to be flexible and positively respond is critical for sustaining growth. Economist have also explored the business market to distinguish companies that employ innovative strategies in their business activities to company to use traditional systems to run their business, based on several market survey is was seen that most of the company still using traditional system to run their business were quick to stumble and fall in the fast growing economy and especially during economic instabilities due to their inability to respo nd to market changes and find a suitable way to meet the customer needs and keep the customer despites reducing purchasing power of the customers. To nurture an environment in which customer centricity and innovation can thrive, those polled during survey emphasized that importance of a high performance culture, accountability, and ability to access the right information at the right time as the key enablers to innovation and hence company profitability and sustainability (UIS 2009). An economist by the name of Mr. Weil from MIT quoted that à ¢Ã¢â€š ¬Ã…“productivity is important as it drives economic growthà ¢Ã¢â€š ¬Ã‚ . Managing in a time of impermanence is easy feat but to compete in the business environment, businesses need to refine organization processes and leverage outside and institutional knowledge more efficiently and effectively. In a nut shell, after the investigation it was found that companies with higher degree of technology and process standardization were mo re agile and agile companies places more focus on standardizing that process that will not change, thereby freeing up resources to develop value added features that do respond to changing customer needs (EMC 2009). Experts have identified various types of innovation such as service or product innovation that involves the introduction of a new service or product that is considerable improved or new, process innovation that entails the implementation of an enhanced production or delivery strategy, supply chain innovation comprising of innovation that transforms the sourcing of input products from the market and delivering of output to customers, and marketing innovation which results in the evolution of new methods of marketing with enhancement in packaging, product design, pricing and promotion among others. This is the sole to sustainable business development. WHY INNOVATION IS IMPORTANT One survey showed that almost 90% of businesses believe that innovation is a priority for them. Measured and planned combination of idea, people and objects results to innovation leading in new business ideas and hence technological revolutions. To achieve valuable innovation, new services and products need to be strong enough to progress through rigorous commercialization process and into the business marketplace. Management expert Peter Drucker stated that à ¢Ã¢â€š ¬Ã…“if a company which in this age necessitating innovation, is not able to innovate, it faces decline and extinctionà ¢Ã¢â€š ¬Ã‚ . Many organizations are employing measures to strengthen their ability to innovate in order to create a dependable operating system for innovation which is an important indicator of corporate sustainability (Amitabh Shuka 2009). Innovation is a popular act in business but one of the hardest to pull off. Bain and Company recently surveyed about 450 executives from different companies around the world and it was discovered that two-thirds of these companies made innovation one of their top priorities. Less than one-quarter believed that their companies were effective innovators and even fewer said they strong at breakthrough innovations (Iraj Nebojsa 2010). The survey found companies that are great in innovation and not just iconic innovators such as Amazon.com, Samsung or Apple. To wrap it up, virtually all the top quartile of investors in the survey agreed with the following statement: They have a winning, repeatable model for innovation that they apply consistently in different regions and categories. They currently have projects that will exceed or meet their financial targets for innovation. They are prepared for market disruptions through innovation. They have consistently met or exceeded their innovation goals. CONCLUSION The importance of innovation is increasing significantly. In todayà ¢Ã¢â€š ¬Ã¢â€ž ¢s economic scenario, innovativeness is becoming a major factor in influencing strategic planning. It has been noted that innovation leads to wealth creation. Although efficiency is important for a business success, in the long term business activities, it cannot sustain the business growth. In the current day, we need innovators more than any time before. Every company and business is feeling the impact of migration, knowledge and technological revolutions, climate change issues, and globalization. Innovation will widen and add more value to the employment base. If the quality of life in these trying circumstances is to improve, innovation is imperative. Innovation will also make the world a better place for the younger generation. Research indicates that strong demand combined with competition is a major drive towards innovation. The intensity of competition is the determinant of prod uctivity and innovation besides services and products also includes new business systems, new management methods and new processes which have a significant impact on productivity and growth. REFERENCE Amitabh Shukla, 2009. What is Innovation? Why Innovation is Important. Andy Necly and Jasper Hii, 1998. Innovation and Business Performance: A literature review. EMC, 2009. Organizational Agility: How business can survive and thrive in turbulent times. Eric Almquist, 2013. Taking the measure of your innovation performance. Iraj Hashi, and Nebojsa Stojcic, 2010. The Impact of Innovation Activities on Firm Performance Using a Multi-Stage Model; Evidence from the community Innovation Survey 4. UIS, 2009. Measuring Innovation: Training Workshop on Science, Technology, and Innovation Indicators. Vadim Kotelinikov, 2012. Appleà ¢Ã¢â€š ¬Ã¢â€ž ¢s Systemic Approach to Innovation. 1

Diagnosis and Treatment of Schizophrenia - 1367 Words

Schizophrenia is one of the disorders that have been debated over the years also it has a difficult past and it is a psychological disorder that is noticeable by numerous diminished thinking, behaviours and emotions. The individuals who suffer from schizophrenia they usually hear voices in their head, have unusual beliefs but not based on reality and have different thoughts that are based on hallucination and delusions also changing in behaviour. However, even this very day the cause of schizophrenia is still unknown. Yet the psychologist states that the cause of the disorder is the combination of genetic and environmental factors. Schizophrenia is one of the most serious mental health disorders and it is treated with combination of†¦show more content†¦Also they usually have thoughts that someone is following them, watched, poisoned by the family or friends, or plotted against them. As well they usually find different meaning in everyday actions or events and feeling that people on the television and newspapers are communicating with them through messages. Also they believe that they are hidden messages for them that are in the colours of cars passing in the street. In addition to that the patients experience psychosis have worry on keeping their thoughts and conversation. Schizophrenia patients suffering from confused thoughts some find it hard to stay on one place or concentrate and they usually drift from one idea to another. Also they find it difficult to read a newspaper or watch television. In addition to that the patients describe their thoughts as cloudy or out-of-focus when this is happening to them. Beliefs and dialog may come to be mixed-up or disorganised, building exchange problematic and solid for other general public to apprehend. Although the behaviour may become confused, erratic and presence or dress may seem unusual to others but schizophrenia patients may behave unsuitably, become very distressed, scream, shout or swear for no reason. However, the way they behave some people label their beliefs as life controlled through someone else. Also they say their beliefs remain not their own and that their thoughts ought to been imbedded in theirShow MoreRelatedSymptoms, Diagnosis, And Treatment Of Schizophrenia1129 Words   |  5 PagesIntroduction Schizophrenia may develop in a persons teens or early twenties if they are susceptible to the illness. Schizophrenia is a chronic brain disorder that can effect logical thinking and natural behavior. Schizophrenia is believed to be the result of both genetic and environment causes (Schizophrenia. 2013). 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The maleRead MoreSchizophrenia, By Swiss Psychiatrist Paul Eugen Bleuler1182 Words   |  5 Pages Schizophrenia, known as the brain disorder in which people interpret reality abnormally is a serious brain disorder. Schizophrenia can distort the way you think, expression emotions, act, and affects the way you react to others. Sufferers also have issues functioning at work, in school, in their relationships, and of course, society as a whole. Schizophrenia, thought as the most debilitating of the mental illnesses, is a life-long disease. Schizophrenia can only be controlled through properRead MoreThe Role Of Family Members On Recurrence And Severity Of Schizophrenic Episodes Essay1636 Words   |  7 PagesSchizophrenia can be a scary illness; its onset can seem sudden, for both the sufferer, family and friends must deal with such things as delusional psychosis, self-harm, and unpredictable outcomes. Researchers have tried to uncover how doctors can predict the onset of schizophrenia-and how some controllable factors, such as environmental ones, can help shape how the illness i s experienced and treated. It is therefore important to understand, in studying the physiology of schizophrenia: to what extentRead MoreAbnormality and Schizophrenia1532 Words   |  7 PagesAccording to Mathers et al., (1996) â€Å"Schizophrenia ranks among the top ten causes of disability worldwide and affects one in one hundred people at some point in their lives.† (Cardwell and Flanagan, 2012). Schizophrenia is a severe mental disorder which is commonly diagnosed in 15-30 year old individuals. It disrupts a person’s cognition, perceptions and emotions, making it extremely difficult to diagnose. Bleuler (1911) introduced the term schizophrenia, which translates as ‘split-mind’ or ‘divided

Lab 2 Microscopy and the Metric System Free Essays

Microscopy and the Metric System Margaret E. Vorndam, M. S. We will write a custom essay sample on Lab 2: Microscopy and the Metric System or any similar topic only for you Order Now Version 42-0090-00-01 Lab Report Assistant This document is not meant to be a substitute for a formal laboratory report. The Lab Report Assistant is simply a summary of the experiment’s questions, diagrams if needed, and data tables that should be addressed in a formal lab report. The intent is to facilitate students’ writing of lab reports by providing this information in an editable file which can be sent to an instructor. Exercise 1: Measuring Length, Weight, Volume, and Temperature Try the following conversions for practice. 40,000 ng =0. 24mg =0. 00024g50 cm =500 mm =0. 5m Procedure 1. Length: A metric ruler is useful for measuring items of length. The ruler below measures in mm, indicated by the small mm near 0. a. How many mm are there in 1 cm? 10, in a meter (m)? 1000 (Ruler is not to scale. See ruler in dissection kit. ) b. Locate a measurable object to use for this exercise. If the object is long, obtain a yardstick that includes a cm scale; they can be found in local hardware stores. c. Record the length of the object below and do the conversions: Name of object: ID card . 5 cm=85mm=0. 085m Volume: Always pour an approximate volume of liquid into a clean beaker and then from the beaker into the volumetric flask or graduated cylinder. This will minimize contamination of the parent liquid source. Dispose properly of any leftover liquid. Do NOT pour it back into the original container. Why? This is so the original liquid does not get contaminated. When using a pipet or dropper to measure liquid, pour an aliquot into a clean beaker and then draw up the liquid from the beaker into the pipet. NEVER try to draw up chemicals by mouth. Why? Chemicals could go into your mouth, which is potentially dangerous and should never be done no matter if they deemed â€Å"safe† or not. Weight: Use the pen scale from the lab kit to measure out exactly three grams of sugar. Make sure to tare the bag before adding the sugar. Why must the bag be tared before adding the sugar? This is done so the weight of the bag is not counted with the weight of the sugar. You must think about the weight of the bag when weighing out the three grams of sugar. How is the weight of the bag accounted for when the sugar is weighed? The bag is weighed first and then the 3 g of sugar is added on top of that weight so at the end the weight is more than 3g total due to the bag. Temperature: Practice converting the following with this conversion formula: 45 °F = 7. 2  °C 62 °F =16. 7  °C 98. 6 °F =37 °C Use a Celsius thermometer to measure the  °C temperature of several different aliquots of cold and warm tap water. Make sure to allow the thermometer to remain until the temperature is stable and no longer changes. Record the temperatures: Cold-15 °C Warm – 29 °C Hot- 48 °C Questions A. What laboratory equipment would be used to measure the following items? g flour| Beaker and scale| 36 mL water| Graduated cylinder| The length of a frog’s leg| ruler| 36 g water| Beaker/balance| 38? C| thermometer| Volume of a turtle*| Water displacement| 125? F| thermometer| Volume of blood| Graduated cylinder| Weight of a plant| Bag and scale| Weight of blood| Beaker and scale| Temperature of a fish ’s body| thermometer| Temperature of blood| thermometer| *This answer may require some creativity. How could it be done? B. Provide the calculation steps, including the conversion factor that would be needed to convert the following measurements, and the final answers. Use U. S. and liquid units where appropriate. 248 g| = 248,000 mg| 145,000 ? L| = 145mL| 536 mL| = 536 cc| 0. 372 kg| = 372 g| 0. 75 L| = 750,000 ? L| 20. 39 cm| = . 2039 m| 145,000? L*(10^-6L /1? L)*(1000mL/1L)=145mL .372kg*(1000g/1kg)=372g 20. 39cm*(1m/100cm)=. 2039m 145,000? L*(10^-6L /1? L)*(1000mL/1L)=145mL .372kg*(1000g/1kg)=372g 20. 39cm*(1m/100cm)=. 2039m 248g*(1000mg/1g)=248,000mg 536mL*(1cc/1mL)=536cc 0. 75L*(1? L/10^-6L)=750000 ? L 248g*(1000mg/1g)=248,000mg 536mL*(1cc/1mL)=536cc 0. 75L*(1? L/10^-6L)=750000 ? L C. Provide the calculation steps, including the conversion factor that would be needed to convert the following measurements, and the final answers. Use US and liquid units where appropriate. 3 cups= . 711 L7,893 mg = . 0174 lb 2. 25 oz= 66. 53 cc36? C= 96. 8 ? F 7893mg*(1lb/453592mg)=0. 0174lb 36? C*(9/5)+32=96. 8? F (96? F-32)*(5/9)=35. 56? C 7893mg*(1lb/453592mg)=0. 0174lb 36? C*(9/5)+32=96. 8? F (96? F-32)*(5/9)=35. 56? C 3 cups*(. 237L/1cup)=. 711L 2. 25oz*(29. 57cc/1oz)=66. 53cc 145,000uL*(1tsp/4928. 92uL)= 29. 42tsp 3 cups*(. 237L/1cup)=. 711L 2. 25oz*(29. 57cc/1oz)=66. 53cc 145,000uL*(1tsp/4928. 92uL)= 29. 42tsp 45,000 uL = 29. 42 tsp96? F= 35. 56 ? C D. What advantages does the metric system have over the English method of measurement? What are the disadvantages? The metric system is advantageous because it has a base of ten, making measurements easier to take, read, understand, and convert. The prefixes are also standard so they transfer between all measurements. Also, more co untries use the metric system whereas basically only the US uses the English method. The main disadvantage of the metric system is that Americans have not grown up with these measurements so they are harder to picture and understand what distance, weight, etc. ach measurement is. For example, it is much easier for most Americans to understand the distance of a mile than to try and picture how long a kilometer is. E. Outline the steps necessary to accurately weigh 3. 5 g of starch. This depends on the scale used, but with the pen scale included in the labpaq, tare a bag or other container that can be used. Then add in the starch until the weight on the scale reads the weight of the container plus 3. 5 g. F. Outline the steps necessary to accurately pipet 5 mL of distilled water. Pour an aliquot of distilled water into a clean beaker. Put a little more than 5mL of distilled water in a beaker. Pipet 5mL from the beaker, and check to see if the bottom of the meniscus lines up with the 5mL line. Exercise 2: Microscopy The compound light microscope effectively magnifies in the range of 40x to 2000x. If an object under view is 10 nm in length without any magnification, what will be its viewing size at 40x? 400nm at 2000x? 20 ? m What is the equivalent size at these magnifications, in inches? Show your calculations. 400nm*(1cm/10^7nm)*(1in/2. 54cm)= 1. 57*10^-5 in. 20? m*(1cm/10^4? m)*(1in/2. 54cm)= 7. 87*10^-4 in. The scanning electron microscope (SEM) employs electron bombardment to image very small specimens. Electron microscopes are used to image specimens that range from 1 nm to 100  µm in size. What is the equivalent in inches? . Show your calculations. 1nm*(1cm/10^7nm)*(1in/2. 54cm)= 3. 94*10^-8 in. 100 ? m*(1cm/10^4? m)*(1in/2. 54cm)= 0. 0039 in. Procedure 1. Parts of the Compound Light Microscope: Refer to a microscope as this section is read. Label the microscope diagram that follows as the examination of the microscope proceeds. a. Eyepiece (Ocular Lens): The magnification power is stamped on the outside of the lens. What is the power of the ocular lens? Microscopes may have interchangeable ocular lenses of different magnification. 15x b. Body Tube: Holds the ocular and objective lenses at the correct focal distance. c. Arm: Used to transport microscope and hold the body tube. d. Nosepiece: The revolving device that holds the objective lenses. May also be referred to as the turret. e. Objective Lenses: Consists of one or more lenses: i. The scanning power objective lens is the shortest of the lenses. What is its power? 4x ii. The low-power objective is slightly longer than the scanning objective. What is its power? 10x iii. The high-power objective is longer than the low-power objective. What is its power? 40x Label this microscope diagram with the appropriate part names and their functions: Eye piece- lens that you look through Body tube- Piece that leaves distance between lenses Course adjustment knob- adjusts focus Nosepiece- turns the lenses Objective lenses- magnify objects Stage- holds slides Mirror- reflects light so you can see what’s on the slides Base- bottom of microscope allowing stability Arm- Supports the tube and connects everything Eye piece- lens that you look through Body tube- Piece that leaves distance between lenses Course adjustment knob- adjusts focus Nosepiece- turns the lenses Objective lenses- magnify objects Stage- holds slides Mirror- reflects light so you can see what’s on the slides Base- bottom of microscope allowing stability Arm- Supports the tube and connects everything a b c d e f g h i Parts not included in microscope are: Light source Source: Sharma, Abhishake. Labeled Microscope Drawing. N. d. Buzzle. com. 2. Focusing the Microscope: If the microscope includes an oil immersion lens, place a drop of immersion oil on the slide cover slip before rotating the lens into place. The function of the oil is to minimize light diffraction through the slide and subject so that greater detail can be seen. After using the oil immersion lens, clean excess oil off of the lens and the slide with a lens cloth. Never tilt a microscope when using oil or if viewing a wet slide. Why? The liquid could come off of the slide and get into a place in the microscope that isn’t good for it, and it will be messy also. 3. Operating the Microscope: a. Obtain a clean slide and cover slip from the slide box. Place the slide and cover slip separately on a paper towel or other soft surface to reduce the possibility of scratching them. . With scissors, cut a letter â€Å"e† from an old magazine or newspaper. c. Place the letter in the center of the slide. d. Follow the instructions in Section 6 below to make a wet mount of the letter. e. Following the directions outlined above under Handling and Focusing the Microscope, place the prepared slide on the microscope stage. Leav e the scanning lens in place and focus so that the letter is clearly viewable. Make drawings of the letter in the boxes below as instructed. Side of the slide furthest away from student| Look from the side of the microscope, viewand then draw the letter here, as it appears onthe slide on the stage. | e e Draw the letter here as it appears when viewing it through the microscope. | Side of the slide closest to student| f. What is observed? Microscopes invert the image on the slide. This means that the subject will appear to be 180 ° rotated and reversed from the actual image viewed on the slide. g. While viewing the letter through the lenses, move the slide slightly. What do you observe about the movement of the letter and slide when viewed through the lenses? When I move the slide up, what I’m viewing moves down. When I move the slide to the left, the image moves right. . Use the directions above to view the letter at the higher objective powers. On the drawing made above, c ircle the portion of the letter that is viewable as successively higher power observations are made. What is your conclusion about what happens when higher power objectives are used? Only a piece of the top part is viewable. Higher power objectives magnify the image more. 4. Total Magnification Calculation: Typically, the ocular lens of a microscope will be 10x, but it may be higher or lower. The power is recorded on the side of the lens. a. What is the ocular lens power of the microscope that you are using? It may be 10x or 15x. Record it in Table 1. b. The objective lenses also have the magnification power recorded on their sides. What powers do the objective lenses on the microscope have? Record them in Table 1. c. Now, calculate the total magnification of the viewing area by multiplying the power of the ocular lens with that of the objective lens in use. For instance, if a microscope has a 10x magnification ocular lens and a 4x objective lens in place for viewing, the total magnification will be 40x (10x multiplied by 4x). What other view magnifications are possible with the microscope? Calculate the total magnification for each set of lenses in Table 1. Table 1: Calculating Magnification Ocular Lens Magnification x| Objective LensesMagnification =| Total Magnification| 15x| 4x| 60x| | 10x| 150x| | 40x| 600x| 5. Diameter of Field: a. With the low-power objective in viewing position, place a short transparent metric ruler on the stage. b. While viewing the ruler through the lenses, measure the low-power diameter of field of view in mm. Convert this measurement to ? m and record in Table 2. c. Switch to the other higher power objectives, noting the diameter, in mm, for each in Table 2. Convert measurements to ? m. How might this information be useful when viewing microscopic subjects? Micrometers are smaller, so it is useful for very small objects when mm would be a very small number that wouldn’t be very understandable. Table 2: Diameter of a Viewing Field | Magnification(ocular x objective lens’powers)| mm diameterof field of view| ? m diameter *of field of view| Scanning Lens| 60x| 2mm| 2000 ? m| Low Power Lens| 150x| 1mm| 1000 ? m| High Power Lens| 600x| Can’t tell, How to cite Lab 2: Microscopy and the Metric System, Essay examples

Schizotypal Personality Disorder free essay sample

Schizotypal personality disorder Explanation: People with schizotypal personality disorder are more comfortable turning away from others, rather than learning to have meaningful interpersonal relationships. This isolation contributes to distorted perceptions about how interpersonal relationships are supposed to happen. A person with schizotypal personality disorder has odd behaviors and thoughts that would typically be viewed by others as eccentric, erratic, and bizarre. They are known on occasion to have brief periods of psychotic episodes.Their speech, while coherent, is marked by a focus on trivial detail. Thought processes of schizotypals include magical thinking, suspiciousness, and illusions. These thought patterns are believed to be the schizotypals unconscious way of coping with social anxiety. To some extent, these behaviors stem from being socially isolated and having a distorted view of appropriate interpersonal relations. Causes: Schizotypal personality disorder is believed to stem from the affected persons original family, or family of origin.Usually the parents of the affected person were emotionally distant, formal, and displayed confusing parental communication. We will write a custom essay sample on Schizotypal Personality Disorder or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The social development of people with schizotypal personality disorder shows that many were also regularly humiliated by their parents, siblings, and peers resulting in significant relational mistrust. Many display low self-esteem, self-criticism and self-deprecating behavior. This further contributes to a sense that they are socially incapable of having meaningful interpersonal relationships.How it is diagnosed: The symptoms of schizotypal personality disorder may begin in childhood or adolescence showing as a tendency toward solitary pursuit of activities, poor peer relationships, pronounced social anxiety, and underachievement in school. The bizarre thinking associated with schizotypal personality disorder can be perceived as a psychotic episode and misdiagnosed. Symptoms: 1. Incorrect interpretations of events 2. Odd beliefs or magical thinking 3.Unusual perceptual experiences 4. Odd thinking and speech 5. Suspicious or paranoid thoughts 6. Emotionally inexpressive 7. Eccentric behavior 8. Lack of close friends 9. Socially anxious Treatments: 1. Psychodynamically oriented therapies 2. Cognitive-behavioral therapy 3. Interpersonal therapy 4. Group therapy 5. Family and marital therapy Medications: 1. Among the most helpful are antipsychotics 2. Amoxapine – which is an antidepressant with antipsychotic properties 3. Prozac

Herman Melvilles Bartleby The Scrivener Is Perhaps More Relevant Toda

Herman Melville's Bartleby the Scrivener is perhaps more relevant today than when he wrote it in 1853. Bartleby is the account of a talented young scrivener who possesses great talent and potential in his career of duplicating and composing documents. The tale takes us to the upscale Wall Street area of New York City, among the buildings and law offices of the city. The young Bartleby is thrown into the typical office drudgery associated with the type of employment he was seeking. The theme of the story questions why we do, what we do, when we go to work. Also the question of why do we feel certain things are just expected of oneself when we choose to enter employment. When Bartleby took the job of a scrivener it was understood that in addition to recording documents, one also is responsible for the editing and proofreading of their own and others' work. However, Bartleby had different expectations for himself and his work. Bartleby's behavior questions all that is thought to be universal behavior while at work. Bartleby worked very hard, never taking breaks or even going home. These aspects of Bartleby were viewed as peculiar by his superior and coworkers, but were not undesirable traits. Bartleby also kept to himself most of the time, and did not get involved with office politics or affairs. Like many new employees, Bartleby had a small shared office near the boss so that he could be monitored. A comparison to life by today's office employees trapped in small cubicles could be made. The feeling of privacy is not there, and one could almost feel overwhelmed with only with their work and a small desk. These conditions may have weighed heavily on Bartleby, causing him to not feel very sociable with the others in the office. The life of drudgery as a scrivener grew weary on Bartleby. The odd behavior expressed by Bartleby continued until one day in a act of rebellion he said the words; ?I would prefer not to.? He was referring to the request by his boss the edit his copy. The boss, shocked by this insubordinate behavior and politely asked again, and drew the same response from Bartleby; ?I would prefer not to.? His boss assumed this was a temporary problem with Bartleby and assumed that it would pass in a day or so. His coworkers viewed his action as very odd, and even suggested as ?loony? by one worker. His phrase now consumed every conversation he had with those in the office. His standard response to a request by someone in his office was; ? I would prefer not to.? These words of defiance eventually led to Bartleby's dismissal from his job, and when asked to leave he refused to. This eventually led to his boss being forced to abandon his office in that building and move to another. His boss felt this would end all of his problems with Bartleby and he could go on with his life and business. However, Bartleby could not leave his mind. He was puzzled by the entire situation. The phrase, ? I would prefer not to.?, is not accepted in the workplace of then or today. It is understood that while we are at work certain things are expected of you, regardless of what you would rather do. When Bartleby spoke those words he went against all that is assumed by being employed. Bartleby carefully chose his words when being defiant. If he would have simply said no, it would be viewed as plain ignorance. However, the phrase; ?I would prefer not to.? implies that he had put thought into his response and has reason to be defiant. In the today's world of disgruntled employees taking machine guns to work to solve problems, it would be interesting to see if speaking the words of Bartleby the Scrivener would be just as effective.

Dsylexia essays

Dsylexia essays James Russell Lowell stated, Education is an ornament in prosperity, and a refuge in adversity. (Hurtford, 55)Lowell indicates that education is where there is success, and a safe haven where this is hardship. Educators once thought that dyslexic children could not succeed or have an education that would lead them to prosperity. The educators began to seek ways to help the situation. Now-a-day, teaching methods and appliances have dramatically improved life for dyslexic children. Over time there have been many different types of meanings for dyslexia. Dr. Samuel Torrey Orton defined dyslexia as a cross lateralization of the brain. (Davis 8) This meant that the left side of the brain was doing what the right side of the brain was supposed to do, and the right side doing the job of the left side. Today this is not the proper definition of dyslexia. Researchers have concluded that dyslexia is a lack of coordination between sight and sound. It is a generalized disturbance of language function that interferes with the acquisition of reading skills. (Baumer 35) Dyslexic children take in information at a slower pace because they have difficulties processing the information. This well known disability takes place in the angular gyrus (AG), located towards the back of the brain. The AG translates words and letters encountered in day-to-day life into language. Recent studies in reading and language have shown that dyslexic children have less activity in the AG than those without the disability. Researchers suspect that this part of the brain does not function correctly in dyslexic children. (Dyslexia the Gift) Dyslexic children suffer most in their school environment. Many of these young disabled children loathe going to school because of the difficulty it takes for them to learn, and the disrespect other children show them. Being aware of their disability, they tend to seclude themselves and not as...

Ethics Perspective in Applied Leadership Essay Example | Topics and Well Written Essays - 250 words

Ethics Perspective in Applied Leadership - Essay Example The author of the paper states that in the Kant categorical imperative perspective, the company should do what is right. Matters considered right always have benefits to the people that require showing concern to other people. Besides, what is right for the company requires acceptance from the majority hence considering their opinions.  Communitarianism deals with considering the responsibilities in the community rather than a single individual. In the organization, this ethical perspective focuses on promoting the values that people share in addressing differences in the cultures. In the process of addressing the cultural difference and using only universal values, leaders always show concern for every individual and implement altruism in the process. Considering others rather than a single individual is an action that is in altruism. The showing of concern before and in the process of trying to promote communal values is an act of altruism. Hence, it is justifiable to state that altruism is the prerequisite of other ethical perspectives such as utilitarianism and communitarianism. The process of using these ethical perspectives requires consideration and concern to other people before taking actions.

Social Democratic and Economic Progress in the Republic of Trinidad Essay

Social Democratic and Economic Progress in the Republic of Trinidad and Tobago between 19902005 - Essay Example It is widely known for its natural beauties, tourist locations, and attractive sceneries. The country's capital city is Port -of -Spain, which has staked its claim to serve as the headquarters of the permanent secretariat of the Free Trade Area of the Americas.1 Everything is good for this country, which has seen several vicissitudes in relation to its economy, except for its instable political conditions. Backed by a strong multicultural, multiethnic and multi religious society, the democracy of Trinidad and Tobago has been undergoing several phases of political instability for the last decade-and-a-half seriously posing a threat to its economy in the long run. As the frequent political instability takes away the valuable time of the political parties, they find less and less time to concentrate on Governmental matters resulting in an administrative vacuum. This also generally paves the way for criminals to take an upper hand over law and order machinery over a period. If the political parties continue to fight among themselves neglecting the citizens' welfare, it will ruin the country's future Trinidad and Tobago political parties, including the smaller ones, must know that continued political instability may also result in three unwanted developments. 1. It may lead to people losing confidence in democracy and the political parties. ... 1. It may lead to people losing confidence in democracy and the political parties. Frequent elections and crises of leadership would badly shake the faith of people in the democratic system of governance. In addition, it would pose extra burden on the state exchequer with heavy and recurring spending on frequent elections. 2. Experience has shown that countries lacking in political stability are prone to invite military interference in the administration resulting in frequent coups, internal conflicts and rebellions.2 Pakistan is the best example for this. 3. Frequent political instability of a country would devaluate the country's credentials in the eyes of neighbors making it vulnerable to the pulls and pressures of big powers. Moreover, such countries would lose their bargaining power during economic negotiations at the international level. Thesis / main essay With ancestors of India, Africa, Europe, China, and the Middle East converging, residing, professing various faiths, and speaking various languages in this tiny republic, Trinidad and------------------------------------------------------------------------------------------------ 2 What drives violent conflict available from http://www.strategy.gov.uk/downloads/work_areas/countries_at_risk/1factors.pdf; Internet; accessed 22 November 2005 3 Tobago mercifully presents a picture of 'unity in diversity'. During the 1990s, social awareness on the issues of harmony and coexistence had grown into wider proportions among various sections of Trinidad and Tobago people. As a country hosting residence to people of several races and groups, this nation has transformed itself into a symbol of co- existence and peaceful living. As per the information provided in the Wikipedia,

Diagnosis of Systemic Lupus Erythematosus (SLE)

Diagnosis of Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a multi-systemic autoimmune disease that was first described in 1941, by Klemperer and colleagues (Gonzalez-Buitrago and Gonzalez, 2006). It is a disease that can attack almost any organ or system in the body, where imbalances in self tolerance create an abnormal immune response to self proteins resulting in autoimmunity (Male et al, 2006). SLE is a disease that has a strong correlation to defects in apoptosis; however no specific cause of the disease is known (Arbuckle et al, 2003). The prevalence of the disease is worldwide; however it commonly affects people of African descent, particularly in Europe and Northern America (Kumar et al, 2009). Environmental triggers are known to contribute to the disease manifestation; although genetic links have also shown association with all HLA classes (I, II, III) on chromosome 6. Other transcription factors such as IRF5, STAT and proteins such as PTPN22 have also been seen to contribute to the manifestation (Mal e et al, 2006). SLE is particularly common between the ages of 15-50, where patients present with positive antinuclear antibodies (ANA). ANA are a group of heterogenous antibodies that are capable of binding to components of the nucleus, resulting in damage of DNA. The initial screening method for patients with AIDs such as SLE is via the ANA test. 80-90% of patients with SLE present with a positive ANA (Bonilla et al, 2007), however other AID such as Sjà ¶grens syndrome, Rheumatoid arthritis, Autoimmune hepatitis, Scleroderma and Polymyositis Dermatomyositis, also see positive results. Antigen specific assays such as extractable nuclear antigen (ENA) and double stranded DNA (dsDNA) must then be performed to confirm a diagnosis, as approximately 70% of patients with SLE have antibodies to dsDNA (Rahman Isenberg, 2008). Positive results can be seen within the aging population as the immune system begins to deteriorate. Nilsson et al, (2006) supports this and found that positive ANA results were fo und particularly in elderly patients over 85 years. 90% of patients with SLE are women, suggesting a hormonal link (Rahman et al, 2008). Hormonal imbalances are seen in women with SLE, thus it becomes difficult to maintain immune tolerance. Increased oestrogen levels result in increased antibody production and Th2 response, whilst decreased levels of androgens depress the response resulting in an abnormal immune response (Danchenko et al, 2006). 1.2 The clinical significance of ANA testing The diagnosis of SLE is dependent on a variety of factors including clinical details, family history, age, race, sex, medication and infection (Stinton Fritzler, 2007). The classical symptom for SLE is a butterfly-shaped rash which is commonly seen on the face (Figure 1.1). In 1982 the American College of Rheumatology (ACR) described a set criterion (Table 1) (updated in 1997), for the diagnosis of SLE aiding clinicians to correctly diagnose patients. Four points of the criteria must be met, for a definite diagnosis of SLE. The criterion for SLE includes symptoms, immunological and haematological tests. Points 10 and 11 are of particular importance, as they are confirmatory of SLE. A study by Arbuckle et al, (2003) examined the onset of SLE in 130 patients and found that 115 patients had positive indirect immunofluorescence (IIF) ANA, before diagnosis. 1. Malar Rash A butterfly rash usually seen on the face 2. Discoid rash red, scaly patches on skin that cause scarring 3. Photosensitivity Skin rash as a result of unusual reaction to sunlight 4. Oral ulcers Oral or nasopharyngeal ulceration 5. Nonerosive Arthritis tenderness or swelling of joints 6. Pleuritis or Pericarditis Pleuritis inflammation of the pleura, the lining of the pleural cavity surrounding the lungs Pericarditis small amount of fluid builds up between the two layers of the pericardium. 7. Renal Disorder Persistent proteinuria Cellular castsmay be red cell, hemoglobin, granular, tubular, or mixed 8. Neurologic Disorder Seizures 9. Hematologic Disorder Hemolytic anemiawith reticulocytosis Leukopenia Lyphopenia Thrombocytopenia 10. Immunologic Disorder Anti-DNA: antibody to native DNA in abnormal titer Anti-Sm: presence of antibody to Sm nuclear antigen Positive finding of antiphospholipid antibodies on: 11. Positive Antinuclear Antibody An abnormal antinuclear antibody by immunofluorescence Once a positive ANA test has been performed there is no reason to repeat the test, however if clinicians have a strong suspicion of an evolving connective tissue disease (CTD) negative ANAs should be re-requested (Blerk et al, 2008). Other immunological tests such as complement components (C3 and C4), C-reactive protein, anti-phospholipid antibodies and anti-histone can also be tested to investigate SLE; however these may not always aid all patients (Egner, 2000). 1.3 History of ANA testing and how the diagnosis of SLE evolved The ANA test has been around for over 40 years and is the most widely performed autoantibody test, worldwide. The test is commonly performed within Immunology laboratories and has evolved very little over the years. ANAs originated from lupus erythrocytosms, also known as the LE cell phenomenon. LE cells were discovered in 1948 by Hargrave, who saw that patients with SLE have polymorphonuclear leukocytes, which had phagocytosed nuclei, within the bone marrow (Hepburn, 2001). Following the discovery, Lee et al, (1957) showed that the LE cells were formed by gamma proteins in leukocytes which were thought to be antibody. Fluorescent labels were also introduced in 1957, to show homogenous patterns on human tissue (Hughes et al, 2008). By 1961 rat sections substrates were introduced, enabling patterns such as homogenous, speckled and nucleolar to be seen in patients with rheumatic diseases. The use of rat substrates brought about a new discovery, which saw that washing cells in saline, c aused alterations to cells within slides, thus altering patterns seen, thus the precursor of the ENA screen was introduced. By the 1970-80s Human epithelioma type 2 cells: CCL-23 (HEp-2) substrates were widespread and National quality assurance schemes began to establish. 1.4 Techniques implemented in laboratories for ANA detection There are many techniques available for the testing of ANAs; these can be seen in the UK National External Quality Assessment Service (UKNEQAS) report found in Appendix 1. 1.4.1 Indirect immunoflourescent (IIF)-ANA Indirect immunoflourescent (IIF) is a general screening technique performed to identify patients with autoantibodies. It enables scientist to link autoantibody patterns present within a patient sera, to help diagnose and monitor their progress during treatment. ANA testing using IIF was developed by George Friou in 1957, where initially substrates such as chicken erythrocytes were used (Kumar et al, 2009). ANA substrates were traditionally prepared in-house using rodent tissue where thin layers of tissue were sliced using a cryostat. However as demand for the screening of autoantibodies increased (Figure 1.2), preparing slides was no longer feasible, as it was time consuming and laboratories could no longer manage rodent houses as they required expert attention. Commercial companies then began to produce ready to use tissues substrates, offering a greater sensitivity. However as many commercial substrates are now available, variability between kits, manufactures, substrate, conjugate and the degree of cellularity (good monolayer of cells and a number of mitotic spindles), make it difficult to standardise methods of detection and reporting. In order to produce accurate results, substrates must be present in the correct phase of the cell cycle (Figure 1.3). Identification of IIF-ANA patterns is dependant on the true state of chromosome. Most autoantibodies are directed against antigens expressed during interphase. Interphase is divided into 3 stages: G1, S and G2, where cytoplasmic organelles and fibres structure are most visible and the nucleoli appear well differentiated. A mix of mitotic and non mitotic forms of cells are needed in the metaphase stage as it is influential in interpreting IIF-ANA patterns, especially centromeres and homogenous patterns (Sacks et al, 2009). The HEp-2 substrate is commonly used in ANA detection and was introduced commercially in 1975 (Kavanaugh et al, 2000). HEp-2 provided a greater sensitivity for the testing of SLE as they were composed of human laryngeal squamous cell carcinoma, allowing the recognition of over 30 nuclear and cytoplasmic antigens (Gonzalez-Buitrego Gonzalez, 2006). HEp-2 substrate contains various organelles (Figure 1.4) allowing uniform distribution of cells, showing large nucleolus, meaning no interference of the intercellular matrix is seen (Gonzalez et al, 2002). The introduction of the HEp-2 substrate was a big step forward in identifying patients with the ribonucleoprotein complex (anti-Ro). The anti-Ro antigen is particularly significant in patients with SLE as it offers a poor prognosis. However this antigen is seen to overlap between different autoimmune diseases such as Sjà ¶grens syndrome, thus the detection of the antigen must be precise. The Ro (SS-A) antibody is seen to target protein antigens associated with small RNA molecules known as hY-RNAs11, 12 and are of unknown function (Cozzani et al, 2008). HEp-2 cells were seen to destroy the Ro antigens during fixation, so commercial companies began to devise ways around this. To overcome this problem, HEp-2 cells were genetically modified to produce extra Ro antigen and this substrate was known as HEp-2000. HEp-2000 substrate is uniquely produced by ImmunoConcepts (Sacramento CA, USA). The slides have 10-25% mitotic human epithelia and offer a greater sensitivity (Table 2) in the diag nosis of SLE. They have aided in reducing the number of ANA negative SLE patients; however detection of Ro is dependent on the stability of actin, as it can denature easily. Although HEp-2000 substrates were seen to be more beneficial in detection of Ro antigen, they limit the identification of the different epitopes of the Ro antigen. At present HEp-2000 substrate can only identify the 60kDA Ro antigen; but since the 52kDA Ro antigen also exists, patients with this epitope are missed. A study by Cozzani and colleagues (2008) looked at 5,949 people over a 5 year period. All participants were photosensitive and 2,315 of these had connective tissue disease (CTD) such as SLE. The study found that the anti-Ro was easy to identify on HEp-2000 slides with a sensitivity of 81% according to the Altman test, of accuracy. However a study by Bossuyt and Luyckx (2005) compared IIF to EIA and saw that patients with anti-Ro antibodies were missed using HEp-2000 slides, as the undetected patients contained the Ro 52 antibody; although they reported a sensitivity of 82.9%. One patient in this study was negative for IIF-ANA, but was shown to have a positive Ro antigen by EIA. A study by Dahle et al, (2004), looked at HEp-2 and compared three ANA methods; Enzyme immunoassay (EIA), double radial immunodiffusion (DRID) and IIF. 3,079 patients were examined and overlapping results between IIF and DRID were seen and 60% of IIF-ANA gave a positive homogenous pattern. However results for EIA showed that positive IIF results appeared negative by EIA. In 2006 the LGI performed a study looking at 18,320 samples, requesting ANA tests by IIF. The study found that 1 in 5 patients, identified as negative or weak positive by IIF, showed positive for anti-Ro via EIA. This proved that Hep2000 cells cant detect the different epitope of Ro, thus concludes that antigen-specific testing is required following the ANA test. This agrees with Morozzi et al, (2000), who suggest that a combination of 2 or more methods are required for the detection of the anti-Ro antibody in patients. This study looked at 64 people with connective tissue disorders and tested them by IIF, EIA and DRID. Results showed that 54 people were positive by at least one method and the specificity of each technique was good, whilst sensitivity varied. Sensitivity for IIF-ANA via HEp-2000 was 89%, EIA (Ro60) was 89%, EIA (Ro52) was 67% and DRID presented with a sensitivity of 76%. Although the NEQAS report shows that DRID is no longer used within laboratories, results from thi s study suggest that EIA has the ability to detect the different epitopes, preventing misreading of the anti-Ro antigen. Thus to ensure that all SLE patients are identified antigen-specific tests such as extractable nuclear antigen (ENA) should be used to detect the various epitopes (Cozzani et al, 2008). Conjugates play a significant role in the determination of IIF and EIA results. Fluorescein-conjugated antibodies produced from goat, sheep or rabbit are commonly used. These are usually bought from commercial companies, which produce pre-diluted conjugate, raised against mouse or human, which aims to achieve optimal sensitivity and reactivity. Immunoglobulin fraction can be also be used; however fluorescein conjugates such as fluorescein isothiocyanate (FITC) are preferred as they produce less background staining. A fluorescein/protein (FP) molar ratio is employed, with in-house diluted conjugates. The ratio varies between kits, however a 1:3 dilution with phosphate buffered saline (PBS) is usually used (Egner, 2000). At LGI the conjugate used for detection of ANAs is IgG, as it allows accurate diagnosis and monitoring of diseases such as SLE. IgM-ANA can also be employed, although this indicates milder or non-specific diseases, whilst IgA-ANA gives little information so arent used. Due to the use of fluorescence conjugate, slides fade overtime, thus it is particularly important to determine results as soon as possible as photographs are not taken. As IIF varies daily due to slides and condition of the microscope, it would be appropriate to carry out daily checkerboards to see which working dilution is best for the conjugate, improving consistency; however this is no longer feasible in high-throughput laboratories. When reporting ANA three factors require evaluation: the pattern observed; substrate used and the titre of the positive test. Experienced scientist can interpret ANA slides and distinguish titre levels; however this takes years of experience. The screening dilution is important in patients presenting with positive results, as it helps determine an individuals severity of disease and can prove beneficial to clinicians. Serial dilutions at 1:10, 1:20, 1:40, 1:80, 1:160 and 1:320 can be performed, where the titre value is the one at which positive sample becomes negative. 5% of a healthy population can present with a positive low ANA titre, with no disease activity and are commonly women aged over 60 (Shmerling, 2003). Peterson et al, (2009) found that beside patients with SLE patients, other diseases also present with positive ANA titres. 1:20 healthy people presented with a positive ANA and the number of positives increased to 1:3, with a dilution of 1:40. To reduce the number of fals e positives, titres are commonly performed at 1:80. At LGI titres were performed on all positive samples and pregnant women, regardless of whether they are positive or negative. Pregnant women are closely monitored as a precaution as IgG antibodies cross the placenta, thus anti-Ro/La antigen is capable of causing fetal heart block (Rahman Isenberg, 2008). Patients who presented with symptoms for SLE were also titrated; however lots of weak positive results were seen as a dilution of 1:40 was employed. As workload increased titrations became laborious and impractical, thus performing titres routinely was abolished and titres are now only performed upon request. Cut-offs exist, however these are modified around the local population, to give a better sensitivity (Stinton Fritzler, 2007). Shmerling, (2003) has suggested that ANA titres can correlate with disease activity, but as positive samples undergo antigen specific testing via EIA, titres should be abolished, unless there are specifically requested by the clinicians to monitor changes to disease. Wieser et al, (2001) found that there was a lack of correlation between the clinical features of patients and laboratory results obtained. The study looked at 3 cases with varying antibody titres and established algorithms seen in Figure 1.5. Similarly Hanley et al, (2009) suggested algorithms help in diagnostics (Appendix 2). As a small number of cases were analyses, it appears that there is not sufficient evidence to develop an algorithm; however both the studies have been adapted in Europe as they were seen to prevent patients with detectable antibodies being missed and to avoid the unnecessary testing and time of laboratory staff. Slide processors are available to prepare IIF slides. They first appeared in the late 1990s and include platforms such as ASP1200 and AFT from Binding Site (Figure 1.6). These slide processors ensure that all samples are prepared quickly, reliably and accurately, avoiding cross reactivity in sample preparation. Slide processors perform IIF via indirect antibody reactions as seen in Figure 1.7. Patient serum is incubated with a substrate, followed by washing to remove any unbound protein. A second antibody, FITC is added and this reacts with immunoglobulins which have combined with the substrate. Another washing stage is performed and slides are ready to be mounted and interpreted manually, however this causes subjectiveness. IIF-ANA result interpretation is dependent on the operators setup of the microscope, type and number of hours the bulb (mercury) has been used, type of objective lens, filters and most importantly magnification. At the LGI the Leica DMRB mercury microscope is employed and allows cells to magnify at X200, X400 and X500. Positive results fluoresce an apple-green colour (Table 3), whilst negative samples have little fluorescence. Two independent observers interpret the slides to prevent reading errors and any conflicting results are followed by an anti-ENA and anti-DNA screen. Automated commercial slide readers are now available to allow interpretation of ANAs. Images are automatically scanned and stored within computer systems, where positive and negative ANA results are determined by the amount of flourenscene emitted. The operator can then scan through positive ANAs, identifying their patterns. This aims to improve the subjectiveness seen between scientists and aims to improve accuracy; however these are not robust so not widely used. The advantage of IIF-ANA is that it is easy, inexpensive, available from a wide range of commercial companies, sensitive, reliable and has reduced cross reactivity and background fluorescence. The disadvantages of IIF-ANA are that it is laborious and requires a high degree of technical expertise. Within most Immunology laboratories the ANA test is not linked to the pathology computer systems, so tests cannot be picked up via an interface. This can be problematic as wrong samples can be analysed and reported. The use of barcode readers can overcome this problem. Homogenous Homogenous Pattern is the most common pattern seen in 60% of Systemic Lupus Erythematosus (SLE) patients. However it can be seen in drug induced lupus, Rheumatoid Arthritis. Positive patients are then further evaluated against: Anti-dsDNA, Anti-Smith Speckled Speckled Pattern can exist as coarse expressing is Sm, U1-RNP antigen or fine expressing Ro or La. Sm positive is seen in 4-40% of SLE patients, whilst RNP is seen in high titres in patients with Mixed Connective Tissue Disease (MCTD). Patients with Scleroderma and Sjogrens Syndrome also present with positive results. Centromere Centromere pattern is seen in 57-82% of patients with CREST syndrome and Raynauds. The suspected antigen is CENP A, CENP B, CENP C. Nucleolar Nucleolar Pattern seen in patients with Scleroderma. There are multiple nuclear antigens, such as fibrilliarin. Positive patients are then further tested against Scl-70 (Anti-Topoisomerase I). Table 3: Shows the various ANA patterns seen by IIF on the HEp-2000 substrate (Produced by Nisha Lad, 2010) As different laboratories use different substrates and conjugates, IIF-ANA lacks standardisation worldwide (Bonilla, 2009). A study by Blerk et al, (2008) showed that if laboratories employed the same cells, substrate and conjugate they were able to report the same staining patterns. Over 157 laboratories across Belgium participated and each looked at 9 different samples. Looking at the results it is clear that after considering the variable factors, participants that employed the same HEp-2 slide substrates (Medica, USA) and method of detection were able to produce consistant results, suggesting standardization can be achieved. Although IIF-ANA is subjective, replacement with EIA or bead technology is suggested to increase sensitivity. Bonilla et al (2007) performed a study in the USA suggesting that IIF had a sensitivity of 90.6%, whilst bead technology had a sensitivity of 41.9% and the specificity of IIF was lower at 76%; however for bead technology was 87%. Having tested 385 patients a conclusion was made saying IIF was a better technique for diagnosis of patients with SLE. Olaussen and Rekvig (1999) also produced similar results, where two commercial IIF assays and two commercial ELISA kits consisting of a range of antigens, significant in the diagnosis of SLE were used. The study showed correlation between IIF and ELISA, where sensitivity for IIF was 88%, whilst that for ELISA was 86%. Specificity however varied with 67% for IIF and 60% for ELISA. Another study by Gonzalez et al, (2002), analysed 709 samples comparing IIF and EIA for the diagnosis of ANA. Results showed good reproducibility in both as says, but found that the antibodies which produced a homogenous and speckled IIF patterns were best detected via EIA. On the other hand a study by Nifli et al, (2006) compared routine technology in a selection of Clinical Immunology laboratories and analyzed 11088 samples, using IIF and ELISA at the University Hospital of Heraklion in Greece. Results showed a highly significant correlation for ANA performed by ELISA; however it suggested that as IIF had a low sensitivity of 58%, this could be replaced by multiplex technology, allowing multiple antigen measurement. Looking at these studies closely it appears that although there were similarities between technologies, different kits and manufacturers were used, producing variable results. 1.4.2 Antigen-specific assays for the detection of ANA Many different patterns can be seen by IIF-ANA, however to determine autoantibody specificity further antigen-specific assays are needed. Antibodies against Sm, native dsDNA and chromatin are used in the diagnosis of patients with SLE (Hanley et al, 2009). Currently ANAs are categorised into two main groups; ANA to DNA and histones (dsDNA) and ANA to extractable nuclear antigens (ENA). Enzyme-linked immunosorbent assay (ELISA), also known as an enzyme immunoassay (EIA) are now available for antigen specific testing, providing a new horizon for SLE testing, as they are able to identify individual antigens. ELISA/EIA is the most commonly performed technique, implemented in laboratories today. In the past, ELISA plates were assembled in-house, however as a successful assay requires careful assembly of the different layers, this soon became difficult to achieve, thus commercial ELISA kits were developed in the 1980s to overcome assay failure and to overcome the subjectiveness of IIF-ANA. The ELISA assay can be performed either manually or via automated technologies. 96 well plates coated with the same antigens are commonly used, however Phadia produce an EIA platform, whereby pens containing singles wells with individual antigens can be used, allowing multiple antigen recognition and analysis. Both ELISA/EIA operate via immunometric methods of detection for anti-ENAs and anti-DNAs. The principle (Figure 1.8) of this technique is via microplates which are coated with purified antigens of interest. Patient serum is incubated in the wells and unbound antibody is then washed away, followed by the addition of a conjugate such as alkaline phosphotase (AP) or horseradish peroxidase (HRP). Another wash stage is performed and colorimetric results develop, which are proportional to the initial concentration of antibody in the patients sample. Results are dependant on kit standards, which produce a calibration curve and then the optical density of the wells is taken to give a q uantitative result (Branda et al, 2009). ELISA are a versatile assay, where the amplification of the signal, increases the overall sensitivity of the assay, as it uses an antibody which are specific to the type of antigen/protein being measured. Studies suggest that ELISA is a sensitive assay, however lacks specificity so false positives results are detected (Castro and Gourley, 2009). The advantage of ELISA is that it can be performed both manually and via automation. Analysers can also be linked to the pathology computer systems, preventing transcription errors in result interpretation. However disadvantages for ELISA are that purified antigens need to be prepared via HPLC, meaning assays are not cost effective and can be time-consuming. As microtitre plates are now purchased with one antigen, there is a limited dynamic range of detection; however EIA pens now overcome this problem. To produce successful assays, instrumental conditions need to be carefully considered. Washing errors, contamination of substrate or inadequa te incubation times may produce little signal amplification resulting in false negative results (Castro and Gourley, 2010). 1.4.2.1 Anti-dsDNA Anti-dsDNA were first described in 1957, by Ceppelini and colleagues. Anti-dsDNA are found in patients with SLE and are mainly found in the form of nucleosomes. Nucleosomes are fragments of chromatin that cells release during apoptosis. dsDNA antibodies bind to the nucleosome to form complexes which settle in the glomeruli, resulting in glomerulonephritis and increasing the risk of lupus nephritis flare, thus detection is crucial as it helps to determine the therapy required for treatment. à ¯Ã‚ Ã‚ ¡-actinin (100kDA) is a microfilament skeletal muscle protein, which aids in maintaining the function of podocytes in the kidney. This protein is not specific for SLE, although it can act as a marker for renal involvement (Raheman et al, 2008). The dsDNA assay can be performed via (Figure 1.9); IIF with Crithidia luciliae substrate (CLIF), Farr assay also known as radioimmunoassay (RIA), however the most commonly used technique is EIA/ELISA as described in 1.4.2. The Farr assay is regarded as the gold standard technique for the detection of dsDNA (Launey et al, 2010). It uses cultured cells labelled with thymidine and idocythidine, which act as radioactive DNA. In the assay bound and free DNA is separated by precipitating immuglobulins and ammonium sulphate. Although this method is good, it misses low avidity anti-DNA antibodies due to a nitrocellular filter, which allows the passage of free DNA and however double stranded DNA (dsDNA) cannot be filtered. Thus the radioactivity is said to be proportional to serum anti-DNA (Isenberg Smeenk, 2002). The Farr assay can detect high affinity antibodies, with relatively high specificity; however it requires precision in pipetting as there must be sufficient labelled DNA to bind to samples in order to reach an endpoint. Although the use of radiolabels within the Farr assay provides highly reproducible results, it becomes very costly, dangerous and difficult to dispose of the radioactive isotopes. Other limitations with this assay are that it only detects IgG and cannot determine any other immunoglobulin isotopes (IgA/IgM), thus patients presenting with dsDNA antibodies to IgA/IgM can be missed (Egner 2000). UK NEQAS shows that the Farr assay is still being used (Figure 1.9), as it is a more accurate confirmatory test that can be used in the diagnosis of SLE. The accuracy of the Farr assay can be seen in many studies. A study by Launey and colleagues (2010) compared the Farr radioimmunoassay to three commercial enzyme immuoassays and CLIF staining. The study looked at 99 patients with SLE and found that the Farr assay was the best assay, offering greater sensitivity and specificity of 95%, than the three other ELIA and CLIF assays. Derksen et al, (2002) also showed similar results. He compared the Fa rr assay with the Varelisa EIA assay and found that the Farr assay was superior to the EIA assay as it presented with a specificity of 95% and a sensitivity of 72%, whilst in EIA specificity corresponded to sensitivities at 44%. Many laboratories also perform follow-up DNA tests by EIA, using CLIF to determine the avidity of anti-dsDNA antibodies. However CLIF can also be used alongside IIF to measure anti-DNA (IIF-DNA) and this does not requiring any specialist equipment, other than a fluorescence microscope. The CLIF assay allows detection of high affinity antibodies through titrations, however this requires precise pipetting. CLIF detects antibodies to kinetoplast of organisms, which consists of circular dsDNA and allows both IgG-anti-dsDNA and IgM-anti-dsDNA to be tested (Gonzalez-Buiterego Gonzalez, 2006). The test is highly reproducible and is particularly suitable for a limited number of samples. Although the assay offers the highest specificity for ANA testing, it has a relatively low diagnostic sensitivity for SLE. Due to the degree of accuracy of the Farr assay, it is undoubtedly the best assay for the detection of dsDNA and so has been approved by the World Health Organisation (WHO) and operates under the WHO80-IRP standard. However due to the risk of handling radioactive substance and the cost of the assay; this is not routinely used within Immunology. 1.4.2.2 Anti-ENA Positive IIF-ANA are typically followed up by extractable nuclear antigens (ENA). ENAs were discovered in 1966 by Smith and colleagues, offering a greater specificity, to allow a more accurate disease diagnosis, in correlation to the initial IIF-ANA screen. Originally ENAs referred to proteins found in a saline extract of cell nuclei, however since then the components have been identified and these consist of cytoplasmic molecules. A whole spectrum of approximately 100 antigens can be screened; however most have no clinical significance. In order to cover the majority of inflammatory autoimmune diseases 6 clinically significant antigens (Table 4); Ro, La, Sm, RNP, Scl-70 and Jo1 are used within most laboratories across the UK. It can be seen that SLE is associated with many of the antigens in the screen. Although ENAs are commonly performed via EIA (Figure 1.10), other methods such as qualitative gel precipitation assays, passive haemagglutination, immunoblotting, counter current immunoelectrophoresis (CIE) and antigen microarray can also be used (Kumar et al, 2009). Sceening of ENAs is expensive in comparison to IIF-ANA as it allows specific antigen detection, offering a greater sensitivity as approximately 90% of positive IIF-ANA produce negative results via EIA (Dahle et al, 2004). Gel precipitation assays such as double immunodiffusion (DID) and counter current immunoelectrophoresis (CIE) are still being used within laboratories; however these were discovered over 5 decades ago. CIE uses an electric current to accelerate the migration of antibody

What it is like to be young and a teenager!

From when you turn from twelve to thirteen you have become a teenager; you have rights and responsibilities now!! At the age of a teenager you might think the whole world is in front of you, which it is, but there are big demands. When I became one I thought wow, I am a teenager, but now after being one for 3 and a bit years I am starting to realise that it isn't so great after all. I have heard that your teenage years are supposed to be some of the best years of your life, is that so? At the age of thirteen I have left primary school and have now faced the big girls and boys at high school. Two years passed and the work rate increased. In year nine the first of many challenges has started, your Key Stage 3 SAT's, at this time you think its ages until I sit in this same sports hall and do your real GCSE's which for some people, will be the start of a completely new chapter in the life of a teenager. So far in being a teenager all that has happened is a lot of work, but there are some privileges of being a teenager at the age of sixteen you have the right to go out and buy a packet of cigarettes legally, you are also able to have sex and even have and raise a baby, but it is not till you are eighteen that you are allowed to have a credit card, or buy alcohol legally. Are these good privileges? Or not? Just before you take the GCSE tests you have to decide what you want to do. The decision is your own and the correct one needs to be made, the pressures are now starting to become apparent and it can be a stressful time for some that feel that they have to perform well. There are others who are thinking if only I had listened that little bit or a lot extra in class instead of messing around or talking with friends, and of course there are the people who go into the hall and think I have nothing to lose I don't need many passes, because what I want to be you don't need grades and all I can do is my best. The pressure at this stage are not just on the pupils, the teachers may sometimes be as nervous, and they may be thinking did I teach the write things and did we revise the correct thing which will come up. These are all things to do with school, but you do usually spend 32 hours and 55 minutes in the place. At these ages peer pressure can become a big part of someone's life the things that stick in your head could be â€Å"Everyone's doing it†, â€Å"Its only one†, â€Å"Your such a loser†, â€Å"Chicken† and no one at this age wants to be left out and on there own. Is this really what being a teenager is like? So maybe being young isn't as good as it sounds!!