Reproductive Tract Infections (RTI): Symptoms and Causes

Reproductive Tract Infections (RTI): Symptoms and Causes Reproductive tract infections (RTI) are recognized as a public health problem and ranking second after maternal morbidity and mortality as the cause of loss of healthy life among women of reproductive age in developing countries (Jindal et al, 2009.). Infections of the reproductive tract causes serious health problem worldwide, with an impact on individual women and men, their families and communities (Adler et al., 1998). Are RTI infections which affect the reproductive tract, part of the reproductive system. For females, the reproductive tract infections may be much higher in the reproductive tract (fallopian tubes, ovaries and uterus) and lower reproductive tract (vagina, cervix and vulva). The global burden of reproductive tract infections (RTI) is a huge and a serious public health problem, especially in developing countries, where ITR are endemic . They can have serious consequences including infertility, ectopic pregnancy, chronic pelvic pain, abortion, cervical cancer, menstrual disorders, pregnancy loss, babies with low birth weight and increased risk of HIV transmission. The presence of the ITR (especially ulcer causing sexually transmitted infections) can promote the acquisition and transmission of human immunodeficiency virus (Rabiu et al., 2010). Reproductive tract infections include endogenous infections, iatrogenic infections and sexually transmittedinfections (STDs) (Muula et al., 2006) . Reproductive tract infections (RTI) refers to three different types of infections affecting the reproductive tract : 1. Endogenous infections are probably the most common RTI worldwide. They result from an overgrowth of organisms normally present in the vagina. Endogenous infections include candidiasis and bacterial vaginosis. These infections can be easily treated and cured . 2. Iatrogenic infections occur when the cause of infection (bacteria or other microorganism) is introduced into the reproductive tract via a medical procedure, such as menstrual regulation, abortion, insertion of an IUD or during childbirth. This can happen if the surgical instruments used during the procedure has not been properly sterilized, or an infection, which was already present in the lower reproductive tract is pushed through the cervix into the upper reproductive tract . 3. Sexually transmitted diseases (STDs) are caused by viruses, bacteria or parasites microorganisms that are transmitted through sexual activity with an infected partner. About 30 different sexually transmitted infections have been identified, some of which are easily treatable, many of which are not. HIV, the virus that causes AIDS, is perhaps the most serious sexually transmitted infection, since it eventually leads to death. STDs affect men and women, and can also be transmitted from mother to child during pregnancy and childbirth. (Germain et al. 1992). Female RTI usually originate in the lower genital tract, such as vaginitis or cervicitis and can produce symptoms such as : abnormal vaginal discharge , genital pain itching burning feeling with urination abdominal pain irregular mensural cycle blood stained discharge However, a high prevalence of asymptomatic disease occurs, which is a barrier to effective control (Elias et al., 1993). Such as: Infertility Fibroid Polyps Prolaps Uterus / Vaginal Endomitrosis Even when symptoms occur, their presence may overlap with and be misdiagnosed as a normal physiological change and normal physiological discharge can be diagnosed as RTI. (Trollope Kumar, 1999). The presence of ulcers, especially RTI causing STI may increase the acquisition and transmission of human immunodeficiency virus (Fleming et al. 1999). Infertility is a health problem in Africa, particularly in sub-Saharan Africa, where 20-30 % of couples are unable to conceive (Sciarrha, 1994). Most health advocates consider infertility as the most important reproductive health and social issues confronting the Nigerian women and gynecologists often report that infertility is 60 % 70 % of your queries at higher education institutions (Okonofua et al, 1997.). In Nigeria, most cases of infertility RTI following (Snow et al. 1997) Ectopic pregnancy is a large percentage of acute gynecological emergencies in Nigeria and is a major cause of maternal mortality [ 11-13 ]. A study in Lagos, Nigeria found previous STI and pelvic inflammatory disease as the main risk factors for ectopic pregnancy (Anorlu et al., 2005) Cervical cancer is usually the result of a sexually transmitted infection, and human papilloma virus is the causative agent. It is the most common malignancy of the reproductive system and a leading cause of death from cancer in Nigerian women (Thomas, 2000). In contrast to most other types of cancer, it is common below the age of 50, and is therefore a leading cause of premature death (Dey et al. 1996). Sites of Reproductive Tract Infections : Reproductive tract infections can affect the outer genitals and reproductive organs. Infections in the area of the vulva, vagina, cervix or are referred to as the lower reproductive tract infections. Infections in the uterus, fallopian tubes and ovaries are considered upper reproductive tract infections. (Bulut et al. 1995) Minor infections of the reproductive tract : . Vaginitis : RTI affecting the external genital area and lower reproductive tract in women is often referred to as vulvo vaginitis, vaginitis or simply indicating that the vulva and / or vagina become inflamed and sometimes itchy or painful. Vaginitis is most commonly caused by endogenous infections such as candida (thrush, yeast) or bacterial vaginosis, sexually transmitted infections despite certain as trichomoniasis, can also commonly cause these symptoms and signs. Pelvic infections can have consequences far more dangerous than the initial vaginitis, such as ectopic pregnancy or infertility. (Bulut et al. 1995) 2. Infection of the cervix Infection of the cervix can be caused by a variety of pathogens, particularly sexually transmitted infections, such as gonorrhea, chlamydia and Human Papillomavirus transmitted. Infections of the cervix are considered more serious than vaginitis because more commonly result in infection of the upper reproductive tract, with its serious consequences. Unfortunately, they are also more difficult to detect and are often asymptomatic. (Bulut et al. 1995) Upper Reproductive Tract Infections : The migration of infection in the upper reproductive tract, including the uterus, fallopian tubes, ovaries, and tends to be more severe than infections of the lower reproductive tract. Infections of the upper reproductive tract are often a direct complication of infections, especially sexually transmitted lower reproductive tract. (Bulut et al. 1995) Pelvic inflammatory disease (PID), for example, is one of the most serious problems of gonorrhea or chlamydia. This can result in chronic abdominal pain, ectopic pregnancy, menstrual irregularities, infertility and as a result of scarring of the fallopian tubes . Ectopic pregnancy, which can cause death, is a particularly serious complication, since it requires emergency interventions that are not available in many resource-poor settings. Iatrogenic infections -. Caused by the introduction of bacteria in normally sterile environment of the womb through a medical procedure such as insertion of an IUD can also result in serious, and reproductive tract infections, occasionally life -threatening upper (Bulut et al .., 1995) ADHD in Classroom Strategies: Literature Review ADHD in Classroom Strategies: Literature Review To what extent can teachers make provisions for pupils with ADHD (Attention-Deficit Hyperactivity‑Disorder) in the mainstream classroom? CONTENTS (JUMP TO) Section 1: Referenced Extracts Section 2a Part One: Analysis and Critical Evaluation of the Issue Section 2b Part Two: Examination of the Practical Implications for Primary School Teachers Section 3: Copies of Extracts Section 4: Bibliography Sources and Further Reading Section 1: Referenced Extracts (1) Quarmby, K. (Tuesday 6 December, 2004) Rebels without a Cause: Children with Behaviour Problem are Increasingly Diagnosed with ADHD, in, Education Guardian, pp.1-3 (2) The Disorder named AD/HD: What we know (2004) National Resource Centre for AD/HD: Children and Adults with Attention-Deficit Hyperactivity‑Disorder (CHADD; http://www.help4adhd.org/en/about/what/WWK1.pdf , p.2 (3) Rafolovich, A. (2005), Exploring Clinician Uncertainty in the Diagnosis and Treatment of Attention-Deficit Hyperactivity-Disorder, in, Journal of Sociology of Health and Illness, Volume 27, Number 3 London: Blackwell, pp.306‑310 (4) Northen, S. (Friday 26 November, 2004), Feed your Head, in, The Times Educational Supplement, p.3 (5) Spencer, T. et al (1995), A Double-Blind Cross‑Over Comparison of Methylphenidate and Placebo in Adults with Childhood Onset Attention-Deficit Hyperactivity-Disorder, in, Archives of General Psychiatry, Volume 52, pp.434-443 (6) Education Guardian Opinion (Tuesday 10 October, 2006), p.4 (7) Handy, C. and Aitken, R. (1986) Understanding Schools as Organisations London: Penguin, p.13 (8) Chowdhury, U. (2004) Tics and Tourette’s Syndrome: a Handbook for Parents and Professionals London and New York: Jessica Kingsley, p.115 (9) Raphael Reed, L. (1995) Reconceptualisng Equal Opportunities, in, Griffiths, M. and Troyna, B. (Eds.), Antiracism, Culture and Social Justice in Education Stoke‑on‑Trent: Trentham, p.88 (10) Guiding Principles for the Diagnosis and Treatment of Attention‑Deficit Hyperactivity‑Disorder (2006), Presented by the Attention Deficit Disorder Association (ADDA); http://www.add.org/pdf/GuidingPrinciples021206Rev[1].pdf , p.2 (11) Jones, A. (August 2004) Clinical Psychology Publishes Critique of ADHD Diagnosis and Use of Medication on Children, in, Psychminded Website; http://www.psychminded.co.uk/news/news2004/august2004/Clinicalpsycholgy (12) Swanson, J.M. and Castellanos, F.X. (2002) Biological Bases of ADHD – Neuroanatomy, Genetics and Pathophysiology, in, Jensen, P.D. and Cooper, J.R. (Eds.), Attention Deficit Hyperactivity Disorder: State of the Science Kingston: New Jersey, pp.71-72 (13) ADHD: Strategies for Primary School Teachers; http://premium.netdoktor.com/uk/adhd/living/school/article.jsp?articleIdent=uk.adhd.living.school.uk_adhd_xmlarticle_004691 (14) ADHD in the Classroom – What Helps; http://www.adhd.com/educators/educator_communication_difficulties.jsp (15) Selikowitz, M. (2004) ADHD: the Facts Oxford: Oxford University Press, p.154 (16) Stein, D.B. (1999) Ritalin is not the Answer: a Drug-Free, Practical Programme for Children Diagnosed with ADD or ADHD New York: Jossey Bass Wiley, Preface Section 2a Part One: Analysis and Critical Evaluation of the Issue The issue of ADHD is one of the most pressing contemporary concerns within the broader educational sphere of making adequate provisions for children with learning difficulties. With the help of scientists and the media, ADHD has been transformed from a relatively unknown illness of the brain to a well known national problem for thousands of schoolchildren. The increase in awareness has been accompanied by a steep rise in the number of children being diagnosed with the disease. â€Å"The National Institute for Clinical Excellence (NICE) estimates that as many as 500000 children in the UK may have ADHD and, of these, as many as 100000 may be seriously affected.†(1) Unbelievably, this figure amounts to approximately one in twenty of all British schoolchildren. With figures constantly on the rise and awareness increasing in tandem, it is clear that ADHD is, at the beginning of the twenty first century, a highly important concern for any mainstream primary school teacher. In comparison to other behavioural problems experienced by young people, the illness is relatively new (at least in terms of its recognition from psychiatrists and general practitioners) and, as such, often causes confusion and misunderstanding when the issue is raised in the classroom. Tourette’s syndrome, for example, has a ten year advantage over ADHD in terms of public awareness and forthright medical opinion. Moreover, the illness is also notoriously difficult to accurately quantify with rather ambiguous symptoms like ‘inattentiveness’ and ‘a lack of concentration’ used as precursors to a diagnosis of attention‑deficit hyperactivity‑disorder. ADHD is consequently considered to be a highly controversial illness that has the medical community split over whether it is a disability in the traditional sense or whether it is a neurological malfunctioning on the part of the child or individual in question. This is not an easy problem to so lve not least because of the scarcity of medical facts. Indeed, the medical facts that are known are somewhat ambiguous and rely heavily on subjectivity rather than objectivity, which would bequeath an improved perspective for scientists and teachers alike. It has, however, been concluded that the illness begins no later than the age of seven and patients who are first diagnosed as ADHD sufferers in adulthood must have displayed the core symptoms from the age of seven to receive treatment for attention‑deficit hyperactivity‑disorder this places the issue directly within the realm of the primary (as opposed to the secondary) school teacher as the first tell-tale signs must be evident before the age of seven (year three). It is therefore prudent to detail these core symptoms of the disease so that the primary school teacher may be in a position to offer better advice to parents and doctors as to the condition to one of their pupils. For this, analysis must turn towards the USA, which is the leading country in terms of diagnosing, treating and including children with the illness in national classrooms. Thus, according to the American National Resource Centre for AD/HD, symptoms can be split into two separate categories (2). The first category comes under the heading of ‘inattention’. The chief features of this are: Making careless mistakes in homework, in class and in other related activities. Failing to pay close attention. Difficulty maintaining attention during work or play. Appearing as if not listening when clearly being spoken to. Failing to follow simple instructions in class. Have difficulties with organisation. Avoiding work with a sustained amount of mental excursion, such as homework or tests. Loses things. Easily distracted. Forgetful in daily activities. The second category used for ascertaining the most visible symptoms of ADHD comes under the heading of ‘hyperactivity-impulsive behaviour’. The core features of this particular behavioural manifestation are: Constant ‘fidgeting’ in class with hands or feet. ‘Squirming’ in chairs. Running or climbing at inappropriate times. Has difficulty remaining seated. Difficulties in maintaining silence during quiet play times. Failing to wait for turn in class. Interrupting teachers and fellow pupils at inappropriate times. Act as if they are on a ‘motor’. It is immediately evident from just a brief overview of the symptoms that ADHD is open to a wide variety of claims of inaccuracy with regards to diagnosis as well as excessive interference on the part of parents, teachers and the state, which has made the cause of children with learning difficulties a chief domestic policy since the end of the twentieth century. Sceptics naturally point to the many years before ADHD became a well known disorder (during the 1980s’) as evidence that the illness has been blown out of proportion (help groups, on the other hand, say this is merely evidence of the way in which the illness has been avoided by education professionals for so long.) Furthermore, according to an empirical study compiled by Adam Rafolovich (3), even doctors retain strong reservations about diagnosing a child with ADHD on the grounds of the fertile ground for misconception that exists with concerns to the symptoms highlighted above. For instance, there can be little doubt that there is a very fine line between defining a child as ‘clinically inattentive’ and simply viewing that same child as lazy and disinterested in the subject matter at hand. Likewise, the same problem persists with any variety of the core symptoms of ADHD, which are often too close to everyday behavioural disorders that should be expected in children as young as seven or eight. Once again, it is not difficult to understand the sceptic’s point of view, especially when considering that the modern variation of schooling is a lot more pupil friendly than was the case forty or fifty years ago. Psychiatric experts and doctors are likewise divided over the best means of treatment available to children who have been satisfactorily diagnosed with ADHD. In the 1990’s, medication was seen as by far the most viable route to inclusion in the classroom with the ‘wonder drugs’ Ritalin and Concerta witnessing an explosion in sales at this time. Prescriptions for these two drugs have leapt from 6000 in 1994 to around 345000 by 2003. This marked increase is testimony to the way in which ADHD has become a serious problem for all mainstream teachers, particularly those who work in primary schools. In addition, there have been grave concerns voiced by doctors, parents and teachers regarding the moral aspect of prescribing a child as young as five or six a powerful, sophisticated neurological drug that alters the way the brain perceives key data. Young people’s brains do not fully develop until well into adolescence and often beyond; thus, the risks in having chi ldren become dependent on medication at such a young age should be obvious to all concerned. Moreover, as Stephanie Northen (4) points out, the fact that ADHD is seen as a biochemical imbalance in the brain requiring a pharmaceutical treatment while, at the same time, dyslexia is seen as a solely educational problem that has no connection with the brain, severely tests the rationale behind the way that the illness is currently being classified and treated. In many cases the difference between the two is only the opinion of a teacher, doctor or mental health observer. On the whole, however, medication has proved to be a success in young children with ADHD at least in terms of lessening the tendency for public outbursts and school time tantrums. Research conducted by the MTA Co‑Operative Group at the end of the twentieth century discovered that approximately 70 to 80% of school children with ADHD reacted positively to psycho stimulant medications. Significant academic improvement has likewise been noted with an increase in attentiveness in the classroom, compliance on group related tasks and a greater accuracy evident in homework, coupled with a decrease in activity levels, impulsivity, negative social behaviours in groups and verbal hostility (5). The implications of medication and the effects that this can have on a child who displays the key symptoms of inattention, impulsivity and hyperactivity will be discussed in greater detail in Part Two of the discussion, but, at this point, the important point to note is the relatively high level o f success of prescription drugs in the effort to minimise the negative The other major option with regards to effective treatment is the option of psychotherapy involving a mental health expert and groups of child sufferers of ADHD. Utilising a form of cognitive behaviour therapy, qualified experts are able – over time – to challenge the way in which children react to certain environments and situations – those situations that had previously led to evidence of what are considered to be the core symptoms. ADHD ‘coaches’ also help the child to prioritise, organise and develop interactive skills that will lessen the chances of that child experiencing a sense of social exclusion. There are also a number of problems with this kind of therapy not least the obstacle concerning the considerable costs incurred via employing a mental health professional in the current NHS climate. Theory and practice therefore still stand some way apart when it comes to the ideal means of treating children with ADHD faced with the reality of NHS staff shortages and a scarcity of private sector mental health experts who concentrate solely on children with learning difficulties. There is also the significant problem of stigmatisation when a child is diagnosed and then treated for ADHD or, indeed, any other mental health problem. To understand the severity of the issue, one need only look at the way that the adult labour force in the UK discriminates against employees who have a mental health issue in order to understand the way in which playgrounds can become a source of intensive bullying, especially below the age of eight according to the Guardian Education Opinion in October 2006 (6). When one considers the fact that schools are, according to Charles Handy and Robert Aitken (7), not at all dissimilar to adult commercial organisations, it becomes even more clear that bullying and peer pressure are significant issues when it comes to schooling children with learning difficulties and behavioural problems, which ADHD obviously entails. As Uttom Chowdhury declares, the more a child stands out as different from his or her classmates â€Å"because of associated behaviours such as impulsivity, poor handwriting and academic difficulties† (8) the greater the likelihood of bullying and social exclusion. Primary school teachers would have a pivotal role to play in the cessation of bullying on the grounds of a mental illness, in addition to maintaining an effective social balance within the classroom. Furthermore, a pupil who suffers from ADHD is bound to display signs of low self esteem, regardless of bullying in the playground or peer pressure within the classroom. Low self esteem combined with the unpredictable side effects of the medication as well as mitigating factors that may be occurring at home, means that the task of a mainstream primary school teacher is made all the more time consuming. It can be seen that attention‑deficit hyperactivity‑disorder is not only a highly topical issue that is bound to increase in significance in the coming decades, but that it is also a highly problematic area of debate for public education and child welfare due to the ambiguity that resides at the heart of the diagnosis of the condition. While there are a number of tell‑tale signs that a child may be suffering from ADHD there are also any number of alternative reasons as to why a student appears to be veering away from the carefully constructed consensus of a primary school classroom. Ultimately, some children would just prefer not to be in school at all. With this in mind, it is prudent to turn attention towards the implications for teachers who wish to advance the governmental policy of social inclusion in the classroom by understanding how ADHD can be married with an award for Quality Teacher Status. Section 2b Part Two: Examination of the Practical Implications for Primary School Teachers Section 3.2.4 of the Standards for the Award of Qualified Teacher Status declares that teacher should, â€Å"identify and support more able pupils, those who are working below age-related expectations, those who are failing to achieve their potential in learning, and those who experience behavioural, emotional and social difficulties.† Clearly, therefore, with regards to pupils with ADHD, the most pressing concern for primary school teachers is the need to maintain a healthy social balance within the classroom without ostracising the child with the learning difficulty. Inclusiveness must consequently be the teacher’s main priority if they are to fulfil the most basic precept of the QTS. â€Å"All children need someone to mediate their learning, but sometimes this feels especially true for children with special educational needs.† (9) This is a tried and tested educational tightrope that cannot be replicated in a college classroom, in an academic book or in an education‑specific journal. Rather, this challenge can only be met through experience. This is, of course, not to state that there are not certain features and attributes that the teacher can learn so as to be in a more advantageous position to deal with potential sufferers of ADHD. The most obvious place to begin would be the acquisition of help from a more experienced teacher – one who hopefully has coped with the demands of teaching children with learning difficulties beforehand, even if the difficulty in question is not ADHD. This would equip the recently qualified primary school teacher with the ability to deal more efficiently with children in the classroom who have already been diagnosed with the illness as well as those pupils that have yet to be diagnosed but who are nonetheless showing a variety of signs of ADHD. This is an important point because, according to the ‘guiding principles for the diagnosis and treatment of attention-deficit hyperactivity‑disorder’, ADHD should be â€Å"suspected but never presumed.† (10) Section 2.4.1 of the Standards for the Award of Qualified Teacher Status states that: â€Å"they [the qualified teacher] understand how pupils’ learning can be affected by their physical, intellectual, linguistic, social, cultural and emotional development.† With regards to pupils with ADHD, this would involve the ability to liaise with the child’s parents. This has two obvious benefits. The first is to better understand the child’s home life, which experts agree is a vital factor in the formation of the disease, especially if said home life is noticeably chaotic, abusive or violent. â€Å"More regard should be given to a child’s social circumstances, experience and history in understanding their behaviour.†(11) Secondly, research has indicated that there are certain generic attributes of ADHD that run through families, which makes the issue of maintaining an effective, coherent working dialogue with the parents of ADHD sufferers all the more imperative (12). Although the illness is inherently complex, involving a cross‑over of many genes, there is a strong likelihood that one of the parents will also show signs of ADHD, making empathy with the child easier in the process. The Standards for the Award of Qualified Teacher Status also require the primary school teacher to be able to effectively plan lessons for all pupils in the class. Moreover, as of January 2002, a revised SEN code of practice dictated that â€Å"all teachers are SEN teachers.†(13) Clearly, children with learning difficulties pose unique problems for the planning of lessons, none more so than those pupils with ADHD, which is an inherently disruptive and anti‑social illness. Communication between the teacher and the student (not to mention communication between the student and his classmates) is therefore a major problem. Fortunately, there are a number of study aids that are available for teachers to consult. For instance, the official ADHD website in the US offers invaluable advice on how best to manage children with the illness in a classroom setting (14). The following constitutes a small extract of what the organisation considers to be useful information for educators . It should be interpreted as an Individual Education Plan (IEP): Refrain from ‘popping’ a question which requires a speedy answer. Give the student extra time to answer questions. For example, use up time by writing on the blackboard. Speak slowly and provide information in small units. This is especially helpful in the classroom. Reinforce verbal instructions and lessons with written materials, or by writing on the blackboard. Work closely with the student to determine and accommodate his or her individual needs. There are likewise a number of books that have been published in recent years that are a source of encouragement for primary school teachers. Mark Selikowitz, for example, gives advice on the structural planning of the classroom for students with ADHD: â€Å"the child with ADHD should be seated at the front of the class near to the teacher’s desk. The old idea of putting the ‘naughty’ child at the back of the class†¦is totally inappropriate if the child has ADHD.† (15) Teachers must also be constantly aware of the dangers inherent in educating children who are prescribed powerful doses of medicine. In his critique of the culture of prescription drugs prevalent in the USA and the UK, David Stein warns of the side‑effects of Ritalin, which include insomnia, tearfulness, rebound irritability, personality change, nervousness, anorexia, nausea, dizziness, headaches, heart palpitations, and cardiac arrhythmia. (16) Finally, in accordance with Section 3.3.1.4, tutoring a child with ADHD allows the qualified teacher to test their ability to effectively manage instances of bullying and harassment. Where a child with ADHD is concerned, bullying is especially relevant due to the potentially volatile outbursts of the child in question as well as taking into account the reaction of those classmates who do not understand ADHD. As is the case when constructing an IEP, the primary school teacher must be able to use common sense in order to properly tailor classroom and playground management for the specific needs of the child in question. No two ADHD sufferers are likely to display the same characteristics of the disease. Section 3: Copies of Extracts (1) (4) Rebels without a cause Children with behaviour problems are increasingly diagnosed with ADHD. But their parents often struggle to get them the education they need. By Katharine Quarmby Tuesday December 6, 2005 The Guardian James Steele, aged 10, from Bermondsey, south London, has seven doses of Ritalin a day to control his behaviour. On one of his first days at Southwark Park primary school, he stripped off naked and was chased round the school by two teachers. His mother, Julie Clapp, had to give up work to cope with him. Its been a nightmare, she says. He would crawl over desks, start climbing on equipment in the classroom, says Angie Sharma, acting headteacher. Then at one point he opened the window and stood on the ledge. The whole school was in a panic. We seriously thought we might have to exclude James. It was extremely difficult for the teacher to teach to the national curriculum when James was running out of class, refusing to co-operate. Before he joined the school, he had already been kicked out of nursery. The school begged Southwark council for help and, at the age of seven, James was diagnosed with attention deficit hyperactivity disorder (ADHD) and given a statement of special educational need. A team of experts assessed James, including the schools special educational needs co-ordinator, an

Disaster Preparedness Essay

A disaster is generally defined as an event in which illness or injuries surpass resource capabilities of a community or medical facility (Ignatavicius & Workman, 2010). Disaster preparedness is a process of ensuring that an organization has complied with the preventive measures and is in a state of readiness to contain the effects of a predicted disastrous event to minimize loss of life, injury, and damage to property. see more:essay on disaster management in english Disaster preparedness can also provide rescue, relief, rehabilitation, and other services in the aftermath of the disaster, as well as have the capability and resources to continue to sustain its essential functions without being overwhelmed by the demand placed on them. The American Nursing Association is helping to ensure that disaster preparedness and response is robust in this country to be personally and professionally prepared for a disaster. Being in a prepared profession can help cope and help the communities recover from disaster better, faster and stronger (Brewer, 2010). According to the Maricopa Integrated Health System (MIHS) at Maricopa Medical Center, they have a specialized disaster preparedness plan to fit their current top three hazards. Maricopa Medical Center conducts a Hazard Vulnerability Assessment (HVA) annually. The current top three hazards K. F. , Manager of Fire Safety and Disaster Preparedness, at Maricopa Medical Center has identified include: Mass Causality Incidents (trauma, burns, pandemic, etc. ), Small Casualty Hazardous Materials Response (less than five patients), and Severe Weather Incidents (monsoonal action, thunderstorms, and haboobs). This organization has a comprehensive Emergency Operations Plan that addresses the top three current hazards in the organization’s region. Maricopa Medical Center is also further developing their business continuity and recovery plans into stand-alone plans (K. F. , personal interview, February 13, 2012). In order to evaluate and determine the effectiveness of the disaster preparedness plan, Maricopa Medical Center annually conducts a minimum of two operational exercises, in addition to various discussion based exercises. The organization’s exercises follow the Homeland Security Exercise Evaluation Program (HSEEP), which includes an after action report process with an improvement plan and corrective action plan sections. According to the Agency for Healthcare Research and Quality, many studies have showed that disaster drills have been an effective way to improve staffs knowledge of hospital disaster procedures (Catlett, 2004). Additionally, exercise objectives are developed in such a way to exercise pieces of the plan that have been identified as opportunities for continual improvement and/or grant deliverables. Once opportunities for improvement of the disaster plan are identified, these improvements are remedied by being given corrective actions with specific time frames and the status is reported to senior management. Some recent corrective actions that have occurred within recent years include the development of position-specific training to further build comfort for those that are activated in the Hospital Command Center, plan changes regarding Casualty Care Areas during a response to a Mass Casualty Incident, and Standard Operating Procedure enhancement for the Hospital Emergency Response Team (K. F. personal interview, February 13, 2012). The representation that is present on the disaster preparedness committee for Maricopa Medical Center does not include nursing management. The emergency management committee includes a cross-sectional representation from the entire health system. This includes Acute Care, Behavioral Health, Ancillary Services, and Outpatient Services. K. F. , stated, â€Å"Bedside nursing has been extremely instrumental within the various task groups that focus on plan changes. In fact, the task groups associated with Casualty Care, Fatality Management, and HERT development are chaired by bedside nursing staff. There is also a Steering Committee for guidance that includes the Chief Operating Officer, Chief Medical Officer, Chief Information Officer, Chief Compliance Officer and the Vice President of Hospital Operations (K. F. , personal interview, February 13, 2012). † The established relationships that are within the community to help implement the organization’s disaster preparedness plan are that K. F. is currently the Chair-Elect for the Az Coalition for Healthcare Emergency Response (AzCHER-Central), which brings hospitals, clinics, skilled nursing acilities, fire & Emergency Medical Services (EMS), public health, emergency management, and other community stakeholders together for planning. Maricopa Medical Center currently has three to four members on the general body of this group, including bedside nursing representatives. There are a number of governmental agencies that are involved in the organization’s disaster preparedness planning. K. F. is an active member with Coyote Crisis Collaborative, which includes some of those from AzCHER, but also universities and community colleges, utilities, private business, faith-based and other volunteer groups, etc. The Chief Information Officer is currently the Chairman of the Board for Coyote Crisis Collaborative. Additionally, they participate in the Hospital Preparedness Program (HPP) Grant which is administered by Arizona Department of Health Services. All of these opportunities provide environments for collaboration, plan sharing, and developing solutions to issues that face all of those included (K. F. , personal interview, February 13, 2012). In order to implement this plan, staff has received adequate training. The National Incident Management System and Incident Command System training is required for all identified Hospital Command Center staff. They have a â€Å"3-Deep† list for all identified positions. Required training includes Incident System-100, Incident System-200, Incident System-700, and Incident System-800 as a minimum. Incident System-300 and Incident System-400 are required for section chiefs and incident commanders. An overview of the Hospital Incident Command System is shared with all employees at New Employee Orientation. The Hospital Emergency Response Team (HERT) members receive additional Hospital Incident Command System (HICS) training within the HERT course and must take Incident System-100, Incident System-200, and Incident System-800 as pre-requisites for HERT. At Maricopa Medical Center, HERT training is now the standard for the Emergency Department first-year residents during their orientation process. K. Fehr stated, â€Å"Additionally, position-specific training has been identified in a recent exercise as an opportunity for improvement. That training has been developed and is scheduled to be administered over the next 90 days (K. F. personal interview, February 13, 2012). † Maricopa Medical Center has an automated system for the Hospital Command Center that is based upon Hospital Incident Command System IV. This system allows for â€Å"virtual† command and has the ability to send status updates, as well as provide real-time status to the HCC Team. They have also just been given access to a Mass Notification program from Arizona Department of Health Services that can be used internally to ensure that communication during incidents is sent to every employee. HICS IV is the current model that is used, which is National Incident Management System compliant (K.  F. , personal interview, February 13, 2012). The standards that nurses are held to concerning their ethical obligations to their organization and community would be handled by the Incident Commander with guidance of wither a Legal Specialist or Medical Ethicist. Any issues that are specific to standards of care would be approved by the Incident Commander and forwarded to the staff during the event based upon available resources, etc. If the question is specific as to the nurses’ duty to respond to work during a disaster, they do not require them to respond. They hope that they would stay or be willing to come in. The planning includes the set-up of child/elder care areas and sleeping areas for the staff to remove barriers that would take them away from their station. Planning does include the idea that at least 40 % of the staff will not remain or come in during an incident. Maricopa Medical Center has a Memorandum of Understanding and a Memorandum of Agreement with other regional hospitals and formal request processes at the county and state levels for additional staff. When asked whether staff buy-in was a coveted aspect in Maricopa Medical Center’s disaster plan, K. F. tates, â€Å"Staff is absolutely buy-in coveted for this organization’s disaster preparedness plan. The best method that we have found for involvement includes the expansion of the HERT Program, covering the program during Health Fairs and Nursing Skills Fairs, and involving staff in exercises as mock patients (K. F. , personal interview, February 13, 2012). † After my interview with K. F. , I was really intrigued into what all goes on with a disaster preparedness plan. I knew that disaster plans were in effect for many organizations, but I did not realize the actual extent of what goes n with the planning of it. I learned a lot through the interview and was very pleased with the information that I received about Maricopa Medical Center and their disaster preparedness plan. I feel that what is involved in their plan is very relevant to the location of the organization, as well as how they every year they have two operational exercises, as well as discussion based exercises, to help test their plan and determine its effectiveness. I think this is a very important aspect to any organization because without testing the plan, it is unclear how effective it really it. After these annual exercises, I think it is great that the organization has an after report with ideas for improvement to help make their disaster plan stronger and more effective. All in all, I believe that Maricopa Medical Center has a very effective and sufficient disaster preparedness plan for their organization and that they are consistently looking for areas of where they can improve and better their plan to help the community recover from disaster as it occurs (K. F. , personal interview, February 13, 2012).

Final Year Project: Project Report

Final Year Project Review Tutorials 5. Project Profile Document Part 2 Preparation This tutorial will take place in the week beginning 25th February 2013. Check your on-line timetable for details. Before the tutorial, you should prepare and print out a draft copy of Part 2 of your Project Profile Document. This part of the document is all about the context of your project. Think of it as the sort of thing you might use to help you prepare for a job interview to show that you have an awareness of the industries closely related to your project and the professional requirements made on engineers working in them.It should include: †¢ †¢ For your project: o Environmental and sustainability limitations o Customer and user needs and aesthetics o Cost drivers o Fitness for purpose in terms of production, operation, maintenance and disposal For companies and organisations working in fields relating to your project, (you may choose a single company or organisation, or describe activi ty in the sector as a whole): o Opportunities and threats faced by the company/sector o The general management techniques used to control quality and ensure that engineering objectives are met The ways in which sustainable development is promoted in the sector o Legal requirements governing engineering activities in the sector o Particular requirements for professional and ethical conduct Peer Review & Feedback 1. 2. 3. Swap your draft section with another member of the class. Using the form provided, prepare a review of the document you have been given to read including some suggestions for changes/improvements. Go through your review with the report’s author and then get feedback on your own report from your reviewer.Write an action plan to update your Project Profile Document Final Year Project Review Tutorials Progress Report 1. 2. Using the form provided, write and hand in a summary of your progress to date. Hand your review and progress report to the tutor, to be scanne d and then returned to you. Copies of all documents will be made available to all academic staff. 5. Project Profile Document Part 2 1 Final Year Project Review Tutorials Review – Project Profile Document Part 2 Student ID Student Name Author ReviewerThe following sections should be completed by the reviewer and discussed with the author. Comment on how well you think the student has presented broader design Project context considerations of the project Industry context As a reader, comment on how you think that the author has helped you to understand the economic, social and environmental context of the industries that work in the project’s field Following discussion with the reviewer, the author should write a summary of the changes that will be made in the next draft of this section 5. Project Profile Document Part 2 2

Genetic Engineering Technology - 1689 Words

Modern genetic engineering technologies are advancing, and genetically modifying a genome is becoming a reality. The Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and CRISPR-associated system (CAS9) genome editing system is the most advanced in use. CRISPR can edit a genome more accurately and with higher precision than any other system. The intended use of the CRISPR/CAS9 system is to insert a gene, delete a gene, or silence a gene, leading to powerful applications (Christensen and Choy 2017a). For example, scientists plan to use this technology to change the genome and resulting phenotype in the efforts to eliminate potentially lethal diseases. One such disease is Human Immunodeficiency Virus (HIV) and Acquired†¦show more content†¦CRISPR was first exploited in 2007, by a food ingredient company. Their focus was on applications of the system to fermented milk bacteria (Streptococcus thermophilus) in the production of yogurt and cheese. By utilizing the CRISPR system, the company was able to vaccinate the bacteria used in their product against unwanted bacteriophages (Stachler and Marchfelder 2016a). Since then, the greater applications of the system have been realized. CRISPR is an adaptive natural immune system used by bacteria to protect against bacteriophages that replicate within the bacterium. It starts when a bacteriophage lands on the membrane of a bacterium cell, where it injects its DNA into the cell. Shortly after the DNA is injected, the infected bacterium detects the presence of bacteriophage DNA, leading to a production of a complex. The complex consists of the CAS9 nuclease and a twenty-base sequence short guide RNA known as sgRNA. The complex wraps around the bacteriophage DNA, and travels along until it reaches a targeted sequence indicated by the RNA. The sgRNA searches for complementary bases, only attaching at that region of the genome, ensuring the proper location. Upon reaching the location, the CAS9 enzyme will proceed to make a double stranded cleave through the DNA, disabling the bacteriophage and protecting the bacteria (Richter et al. 2012a). Bioengineers have generated a custom sgRNA within a CAS9 nuclease to search for a specific gene location within theShow MoreRelatedGenetic Engineering : An Unnatural Cell Invasion Technology2277 Words   |  10 PagesGenetic engineering is a complex environmental health issue that presents several benefits and risks to both consumers and the environment. Genetic engineering is a technique used to produce genetically modified organisms (GMOs), which are genetically altered in a way that does not occur naturally by mating or natural recombination (WHO, 2014). In other words, genetic engineering is an unnatural cell invasion technology. 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