Genetically Engineered Foods Essays (1896 words) - Biology

Genetically Engineered Foods The use of genetically engineering in agriculture and food production has an impact, not only on the environment and biodiversity, but also on human health. Therefore, thorough biosafety assessment requires, not only an evaluation of environmental impacts of genetically engineered organisms, but also an assessment of the risks that genetically engineered food pose for the health of consumers. Let us take deeper look at some of the aspects related to genetically engineered foods. What is Genetic Engineering? Genetic engineering is a laboratory technique used by scientists to change the DNA of living organisms. DNA is the blueprint for the individuality of an organism. The organism relies upon the information stored in tits DNA for the management of every biochemical process. The life, growth and unique features of the organism depend on its DNA. The segments of DNA, which have been associated with specific features or functions of an organism, are called genes. Molecular biologists have discovered many enzymes, which change the structure of DNA in living organisms. Some of these enzymes can cut and join strands of DNA. Using such enzymes, scientists learned to cut specific genes from DNA and to build customized DNA using these genes. They also learned about vectors, strands of DNA like viruses, which can infect a cell and insert themselves into its DNA. Scientists started to build vectors, which incorporated genes of their choosing and used vectors to insert these genes into the DNA of living organisms. Genetic engineers believe that they can improve the foods we eat by doing this. At first glance, this might look exciting to some people. Deeper consideration reveals some advantages and serious dangers. What are the advantages of Genetically Engineered Food? Genetic engineering gives today's researchers considerable advantages in plant breeding programs. ? Predictability Scientist can identify the specific gene for a given trait, make a copy of that gene for insertion into a plant, and be certain that only the new gene is added to the plant. This eliminates the"backcrossing", traditional plant breeders must do to eliminate extraneous undesired genes that are frequently introduced when using cross-hybridization. ? Significant acceleration of the development timetable. New technique takes about 5 years to remove the undesirable traits compared to 12 years of process with the traditional techniques. Plant breeders do not use recombinant DNA techniques exclusively. Instead they use a combination of new and traditional methods to provide a plant with quality, yield, weather and pest resistance and other desirable traits. ? Improved quality with more choices for the customers. Genetically engineered food especially fruits and vegetables allow to have plenty of time for shipping and sale and it helps to keep the them stay ripe without getting rotten. Some of the fruits and vegetables need warm climates to grow, so most off-season store them must travel a long way after they are picked. One example is the Flavr Savr tomatoes. To survive their journey intact, tomatoes are picked while they are green, which is a food which is a good way to avoid bruising, but which results in a tomato that is often described as having the consistency and mouth-feel of a tennis ball. In the case of Flavr Savr tomatoes, the company solved the rotting problem by inserting a reversed copy- an "antisense" gene of the gene that encodes the enzyme that results in tomato spoilage. This suppresses the enzyme that results in rotting, allowing the tomato to stay ripe, but not rot, up to 10 days?plenty of time for shipping and sale. Refrigeration is not necessary. What are the dangers of Genetically Engineered Food? ? Is it safe to eat? There has been no adequate testing to ensure that extracting genes that perform an apparently useful function as part of that plant or animal is going to have the same effects if inserted into a totally unrelated species. To consumers, most genetically engineered foods are essentially foods with added substances, usually proteins. This is because genes are "translated" into proteins by cells. Therefore, when a genetic engineer adds, say, a bacterial gene to a tomato, he or she is essentially adding a bacterial protein to that tomato. In most cases these added proteins would likely prove safe for human consumption. Nevertheless, just as with conventional food additives, substances added to foods via genetic engineering may in some instances prove hazardous. Unfortunately, food allergies are poorly understood, and in many cases scientists will not be able to test potential allergenicity of genetically engineered foods. Even if there was some testing, the long term affects to humans, animals,

Engels and Mearns Account of The Industrial culture in Britain †History Essay

Engels and Mearns Account of The Industrial culture in Britain – History Essay Free Online Research Papers Engel’s and Mearn’s Account of The Industrial culture in Britain History Essay In the year eighteen eighty-three amidst the turbulent late Victorian years termed as â€Å"The great depression† there rose a particular article of literature by the Reverend Andrew Mearns, entitled; â€Å"The Bitter Cry of Outcast London: An Inquiry into the Condition of the Abject Poor (October 1883). This pamphlet was published on behalf of the church in an attempt to highlight the plight of the neglected masses who were those living in England’s very worst urban slum districts. The article was absorbed by a middle class readership who would have on the whole never have known about or concerned themselves with the predicament of their socially inadequate neighbour. The culture was such in England at the time that Mearns had to shock the socially censored Victorian middle classes into wanting to extend the hand of Christian charity to those who lived in as he described it, â€Å"the great dark region of poverty, misery, and immorality†. The form and content of the report that was given had to be chosen correctly with a view to informing but also to arouse a kind of morbid curiosity in the reader. The literary strategies that Mearns employs within his writing are a key element in doing so. When reading Mearns article today as an independent piece of literature it is of vital importance to take into consideration what values and ideals would have been held up by the very people whom he was aiming his work to be read by. Late Victorian society (especially the middle class) prioritised the home as a place of cleanliness, high moral standards and as a basis to any â€Å"proper† family. However what Mearns is evoking in his article as a representation of home life to the working classes is about as far in opposition to the traditional ideal as you can get. This would have been shocking but at the same time strangely compelling to a contemporary audience. This is largely due to the type of language displayed in the article. He opens his enquiry with the statement; â€Å"There is no more hopeful sign in the Christian Church of today than the increased attention which is being given by it to the poor and outcast classes of society†. It is perhaps interesting to note that Mearns does not begin here with a condemnation or an attempt at apportioning blame for the situation of the poor instead he takes the strategy of highlighting one of the few hopeful aspects of this situation. This opening sentence sets the tone for the first few lines of the first paragraph it is a gentle description of previous work done Christian organisations, thus serving to put the Victorian readership at their ease after all no blame has been heaped at their door. Nevertheless the last lines of this introductory paragraph have a somewhat different agenda, the tone changes and the readers are reminded of the â€Å" vast mass of moral corruption, of heart-breaking misery and absolute godlessness† that awaits them should they read on. It is here that Mearns uses a strategy of creating a mixture between revulsion and curiosity in his readership so that they will read on and he will achieve his ultimate purpose of bringing the plight of the destitute to the privil eged and comfortable of society. Although religion was an important force within Victorian life it was at the same time a religion that people chose selectively from. If it meant dressing in your finest clothes attending church and preventing your child from playing imaginary games on the Sabbath day then on the whole it was a religion that people wanted to embrace in their lives. However what Reverend Andrew Mearns was keen to access was the type of Christian attitude that would make those with any kind of religious conviction open their eyes to what was concealed as the misery of the working classes â€Å"by the thinnest crust of civilisation and decency†. It is exactly this â€Å"Thin Crust† that Mearns attempts to destroy in his article. It has been documented that the privileged classes of society were so far removed from the problems of the industrial class that they were living virtually next to the slums in some areas such as London’s Belgravia and yet had no clue that these courts of death and disease existed anywhere near them. It is in this way that Mearns employs his literary strategies in order to lead his readership into the exploration and a greater realisation of the grimmest areas of London. Mearns does however set out â€Å"two cautions† when introducing his findings the first caution states that, â€Å" the information given does not refer to selected cases† indeed this can be seen as more of a compounding of Mearns case rather than a warning for the unsuspecting reader. Although in general the article does not have the tone of a sermon about it there are elements utilised which would indica te that Mearns is preaching this can be particularly noted when he emphasises â€Å"THIS TERRIBLE FLOOD OF SIN AND MISERY IS GAINING UPON US. It is rising every day.† Thus reminding the reader that they are about to embark upon a kind of crusade against the sins of poverty itself by joining the Reverend in his compassion for the poor. This would also aid the reader in a feeling of worthiness and a justification of reading this type of literature to begin with. It is an irony of the piece that in Mearns preliminary â€Å"caution† he is keen to point out that his article, â€Å" is a plain recital of plain facts†. The irony derives from the fact that it is simply not just a stating of the facts and indeed much of the report is taken up with a deeply emotive humanistic element. This human element would have been well received by a Victorian readership due to the fact that although it may have been hard to relate to statistics it was more plausible to think about the situation in terms of people and compare it to their own lives. Within his report Mearns states that the places that the industrial class resides should not be called â€Å" homes† because he does not see it fitting that, â€Å" those places be called homes†. Within this one simple statement Mearns is attempting to evoke a sense of unity to his readership. It is likely that whatever religious denomination or beliefs held it is probable that his Victorian reader would have a deeply ingrained sense of the home, a home that to them would offer protection and would be a cause of much pride. Not the type of non-home dwelling which Mearns describes as â€Å" pestilential human rookeries†. The furniture within these homes is dismissed as nothing more than, â€Å"rubbish and rags†. This is a deep contradiction to the mental picture conjured of a typical Victorian home. The image was very much more prevalent in late Victorian decades of â€Å"The all embracing Mother bustling over a nest of piety, warmth, cleanliness and comfo rt†1. For the section of the working class that Mearns documents this ideal was simply unobtainable. By forcing the readers to examine their own surroundings of comparative luxury Mearns is encouraging empathy through his literary strategy. It is not only the traditional Victorian home that the reader is forced to re-examine it is also the placing of the roles within that home which Mearns represents in a sometimes shockingly frank subversion of the norm. Even by today’s standards of less rigorous moral structure Mearns findings of â€Å"immorality† would be somewhat disturbing. Therefore by the strict moral code of the Victorian era the supposed â€Å"depravity† described would have been particularly dreadful. However once again Mearns has utilised his literary skills to ensnare rather than repel the reader. He does so by keeping his report on the precipice of decency he errs on the side of caution when referring to immorality and sin. Preferring to prepare for what is in store. He also deems some material too shocking to relate to the reader to ensure that â€Å"the eyes and ears† of the readers do not become â€Å"insufferably outraged†. This has a dual purpose, firstly it reminds t he reader that the author is a member of the clergy and is consequently interested in moral respectability and â€Å"common decency†, and secondly it deals once again with the curiosity aspect of the piece it keeps the reader interested as to know what is so awful that it cannot even be included in this most frank of accounts. The role of the Mother is a theme that appears to run throughout Mearns report. The Victorian Mother in her conventional setting is that of keeper of home and carer for her helpless young, she is represented in much literature of the period as a figure of loyalty to the â€Å"Traditional English husband†2. Though Mearns representation is somewhat different although for him it is not a matter of â€Å"Maternal ignorance†3, he does cite â€Å"The dismal reality of poor health, poor nutrition and inadequate family income†4 as reasoning behind the cases of terrible neglect that he documents. Some of the most graphic and deplorable situations stressed are to do with the Mother and child relationship. The horrible reality of the â€Å"poor widow, her three children and a child who had been dead thirteen days† and â€Å"her husband, who was a cabman who had shortly before committed suicide†. Mearns describes them as â€Å"miserable beings†, although it is particularly interesting to note that Mearns does not attempt to brutalise these people even if he does so to their surroundings. He instead chooses what he believes to be a poignant case of the woman who was â€Å"dying from dropsy, scarcely able to breathe and enduring untold agony, but to the very last striving to keep her little ones clean and tidy.† This draws to the attention of the readership that despite their appalling surroundings a base quality of human goodness and godliness prevails. One of the most emotive issues that Mearns tackles is that of the squalor, neglect and overwork that the children of the industrial class had to suffer. Mearns deals with this in terms of his literary strategy by using the means of direct quote. By taking the words straight out of the mouths of the children on to the paper Mearns is bringing to his report a certain raw quality that cannot be captured in any other way in print. The case of the twelve year old girl whom when asked the question â€Å"Who looks after you?† is only able to reply, â€Å"I look after my little brothers and sisters as well as I can† is one that will resound in the memory of a Christian as to its pure selflessness Research Papers on Engel’s and Mearn’s Account of The Industrial culture in Britain - History EssayEffects of Television Violence on ChildrenPETSTEL analysis of IndiaComparison: Letter from Birmingham and CritoRelationship between Media Coverage and Social andQuebec and CanadaMarketing of Lifeboy Soap A Unilever ProductMind TravelBringing Democracy to AfricaAnalysis Of A Cosmetics AdvertisementInfluences of Socio-Economic Status of Married Males

Managerial Coaching Essay Example | Topics and Well Written Essays - 250 words

Managerial Coaching - Essay Example Having professional leaders will guarantee effective management of the trainee and other employee of the program. The training must take place each day with each of the athlete attending the training as required. Training is a must and trainees perform poorly due to skipping training secessions. Individual in charge of training must be having experience in coaching and at least an undergraduate degree (Park, 2007). The program must have a counseling psychologist to offer guidance and counseling to the trainee. Most of the trainees end up in drug abuse and availability of counseling will help them to cope with different situation. Stress management training will be offered by the psychologist to ensure that the trainees are socially and psychologically stable. The program must be free from corruption to ensure that only the best candidates are employed and the trainees are recruited in respect to talent. The progress of the program must be evaluated in regular bases like in two month to solve the problems in order to ensure smooth running (Allamby,

Economic Report Essay Example | Topics and Well Written Essays - 1750 words - 1

Economic Report - Essay Example Percent Change in real GDP: As is evident from the description of the GDP figures, the percentage changes in real GDP during the period happened to be in proportion. In 1982 the negative growth of GDP indicates towards some serious issues in the domestic economic environment. But thereafter, the growth percentage has been consistent and positive. Year 1984 saw the maximum increase in percentage terms. Civilian Unemployment Rate: The year 1982 is once again seen as the problematic year for the country with the overall unemployment rate rising to 9.7 percent, the highest during the tenure. The gradual decline of the unemployment rate in later years during the tenure points towards the people friendly policies taken up by the government of Ronald Reagan. Civilian Unemployment Rate by Demographic Characteristics: Dividing the unemployment rate demographically, we find that that the Black population seems to be the worst affected. The situation is particularly severe in the age groups of young black community (16-19 yrs). Though it improves somewhat after that, but still things remain worrying for community. Consumer Price Index: The CPI did not see major shakeup during the tenure of President Ronald Reagan. The index saw a consistent rise from 1981 to 1989. The index seems to have spread well over different items, with goods and services forming the major component flaring up the consumer price index. Starting with the overall consumer price index of 90.6 in 1981, the country saw the index rising to 124 by the year 1989. Changes in Consumer Price Indexes for commodities and services: During the entire tenure of President Reagan, except the year 1986, the CPI rates of growth were very high. During this year the energy consumption seems to be one of the lowest actually, with negative growth of 19.7. George H.W. Bush (1989-1993): The tenure of Bush senior too remained quite eventful in the sense that the world saw major

The Collaborative Network of the Boeing Company Research Paper

The Collaborative Network of the Boeing Company - Research Paper Example Several production and engineering innovations were introduced by the Boeing Company. For example, one of the innovations was the construction of the 787 families of aeroplanes from a plastic resin of carbon fibre in place of aluminium that was traditionally used for the making of aeroplanes till then. This provided the Boeing Company with a way to increase the fuel efficiency of the 787 aeroplanes. The 787 aeroplanes have a communications system based on satellite installed in them to provide the passengers with access to the Internet, help improve the monitoring maintenance with the wireless networks, and make electronic flight bags accessible to the crew that consists of reference data and charts. The windows of the 787 aeroplanes are larger in size as compared to other aircraft made till then. The larger size provides the passengers with additional comfort by increasing humidity and air pressure. â€Å"With the 787, Boeing was dreaming big dreams. They wanted to create a next-ge neration plane – a plan that was everything a 21st-century airline could possibly want. And they wanted to slash the cost of production, as well as the cost of operation. It was a daunting challenge. But Infosys was up to the task, co-developing innovative solutions in Information Technology (IT)† (Infosys, 2006). The customers have responded to the Dreamliner enthusiastically. This can be estimated from the fact that in spite of certain cancellations, the Boeing Company received the orders from 55 customers for 850 aeroplanes in April 2009 (boeing.com, 2009).

Sickle cell disease, an disease of red blood cells

Sickle cell disease, an disease of red blood cells Introduction This paper presents a detailed overview of sickle cell disease, an inherited disease of the red blood cells. The paper begins with a brief discussion of the aetiology, prevalence of sickle cell disease. Next the paper investigates the pathophysiological aspects of the disease and the physical manifestation of symptoms the patient presented with. The paper then discusses how sickle cell disease affects suffer. Finally the paper presents and evaluates treatment and management of care. The conclusion will provide a summary of the points discussed. Sickle cell disease (SCD) encompasses a group of haemo ­globinopathies. There is currently no cure for adults with this hereditary disease, which mainly affects people of Afro-Caribbean origin and, to a lesser extent, Mediterra ­nean, Middle Eastern and Asian groups. There are large numbers of people around the world who suffer from acute or chronic pain, or indeed both, as a result of sickle cell disease. Sickle Cell Society (2008) estimates that sickle cell disease affects approximately 10 000-12 500 people in the UK. Sickle cell disease comprises of a group of inherited blood disorders that alter a persons haemoglobin, causing chronic haemolytic anaemia and producing acute and chronic pain as a result of reoccurring episodes of vascular occlusion (Lal. and Vichinsky, 2005). Adult haemoglobin consists of two alpha globin and two beta globin chains wrapped around a haem (iron containing) molecule. Haemoglobin is the main substance of the red blood cell. It helps red blood cells carry oxygen from the air in the lungs to all parts of the body. Normal red blood cells contain haemoglobin A. Haemoglobin S and haemoglobin C are abnormal types of haemoglobin. Normal red blood cells are soft and round and can squeeze through tiny blood tubes (vessels). Normally, red blood cells live for about 120 days before new ones replace them. People with sickle cell conditions make a different form of haemoglobin A called haemoglobin S (S stands for sickle). This is caused by mutation in the beta chain which means the haemoglobin has a lower affinity for oxygen that causes sickle cell anaemia is the most common (Serjeant Serjeant, 2001). The mutation causing sickle cell anaemia is a single nucleotide substitution (A to T) in the codon for amino acid 6. The change converts a glutamic acid codon (GAG) to a valine codon (GTG). The form of haemoglobin in persons with sickle cell anaemia is referred to as HbS (Bain, 2002). The nomenclature for normal adult haemoglobin protein is Hb. Red blood cells containing mostly haemoglobin S do not live as long as normal red blood cells (normally about 16 days) (De, 2005). They also become stiff, distorted in shape and have difficulty passing through the bodys small blood vessels. De (2008) explains when sickle-shaped cells block small blood vessels, less blood can reach that part of the body. Tissue that does not receive a normal blood flow eventually becomes damaged (Serjeant Serjeant, 2001). This is what causes the complications of sickle cell disease. People who inherit the mutation from both parents or the mutation from one and thalassaemia (lack of a beta chain) from the other will suffer sickling. Those who inherit the mutation from only one parent will be sickle cell disease carriers and rarely display symptoms (Information Centre for Sickle Cell and Thalassaemic Disorders, 2008). Patient X presented in accident and emergency (AE) in sickle cell pain crisis. Vaso-occlusive pain is caused by the tendency of sickle haemoglobin molecules to crystallise, distorting the red cells into crescent shapes on deoxy ­genation, occluding small blood vessels. Disrup ­tion of normal circulation leads to acute tissue ischaemia and secondary inflammation and, when prolonged, infarction of bone, joints and vital organs (Elander et al, 2004). According to Information Centre for Sickle Cell and Thalassaemic Disorders (2008) vaso-occlusive pain episodes experienced by patients with sickle cell disease vary tremendously in frequency and severity. Some patients rarely have painful crises, while others spend the greater part of a given year in the hospital receiving analgesics (Anglin, 2007). The cooperative study of the natural history of sickle cell disease showed that about 5% of patients accounted for one-third of hospital days devoted to pain control (cited in Johnson, 2004) . To complicate matters further, the pattern of pain varies over time, so that a patient who has a particularly severe year may later have a prolonged period characterized by only minor pain. According to Sickle Cell Society (2008) the frequency and severity of vaso-occlusive pain episodes often change as a person moves from childhood to being an adult. The breakpoint often occurs during the late teens or early 20s. Changes in hormonal status that occur during these years could contribute to the changes in severity of sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). However, no causal relationship has been established, so the association remains only temporal. The mode of onset of sickle cell pain crises likewise varies. Roberts de Montalembert (2007) states patients can develop agonisingly severe pain in as little as 15 minutes. In other instances, the pain gradually escalates over hours or even days. Acute tissue ischaemia is associated with extreme pain, which may last from hours to weeks. The average duration is 5-7 days (Johnson, 2004) and the episodes are usually self-limiting. Streetly (2005) stresses prolonged infarction can lead to a multitude of compli ­cations, such as organ damage, degeneration of the spine and joints, and ischaemic leg ulcers. These compli ­cations are associated with chronic pain and disability. The sites affected in acute painful crises vary for each patient. Pain occurs commonly in the extremities, thorax, abdomen, and back (Oni, 2009). Pain tends to recur at the same site for a particular person. For each person, the quality of the crisis pain is usually similar from one crisis to another. Patient X had been managing the pain at home with paracetamol, heat rubs and 50mg of diclofenac a non-steroidal anti-inflammatory drug (NSAID). Sickle Cell Society (2008) states most patients manage episodes of pain at home. Oral analgesics, combined with rest and fluids often allows a person to ride out the pain episode. Some patients report that warm baths or warm compresses applied to aching joints ameliorates the severity of the pain (Roberts de Montalembert, 2007). Patient Xs pain became progressive worse so presented in AE for stronger opioid medication. According to the Trust policy a comprehensive, multidisciplinary team strategy is essential, particularly for managing patients with fre ­quent acute or chronic pain. Therefore, on admission patient X was assessed by the doctor and a pain assessment was undertaken by the nurse. According to Wright Adeosun (2009) patients presenting in accident and emergency departments with a painful episode should be immediately triaged and administered analgesia within 15 minutes of arrival and a prompt, accurate pain assessment is the cornerstone of effective pain management. It should include pain site, duration, score, character, exacerbating and relieving factors, associated symptoms, previous analgesia and physical examination. Ideally, the assessment tool would be locally recognised and used and therefore be familiar to patients. Moreover assessment should be prompt to expedite pain relief and allow life-threatening syndromes, such as acute sickle chest syndrome, to be treated urgently (Johnson, 2004). During the assessment patients will benefit from reassurance that they are believed when they report pain and that med ­ication will be delivered swiftly. De (2005) however reports incidences where healthcare professionals have not believed the patient report of pain which resulted in the patient displaying pseudo-addictive behaviour in an attempt to manage their pain and receive appropriate analgesia. This behaviour is an iatrogenic syndrome resulting from poorly treated pain (Serjeant Serjeant, 2001). According to Stuart Nagel (2004) without adequate knowledge of prompt assessment and management and how this can manifest, pseudo-addictive behaviour, such as groaning or other physical behaviour where the patient is trying to demonstrate that they are in pain, can be misconstrued as behaviour associated with substance addiction. Such behaviour could be, for example, aggression, conflict and arguments about analgesia. Wright Adeosun (2009) contends it is important to remember tha t this behaviour, although similar to behaviour found in substance dependence, is actually a result of poor pain management and is an indicator that this person needs their pain management approach reviewed urgently. In line with the Trust policy patient X was triaged within 15 minutes and during the evaluation, the doctor asked patient X whether the pain feels like typical sickle cell pain. Most patients can distinguish back pain due to pyelonephritis or abdominal pain due to cholecystitis, for instance, from their typical sickle cell pain (Anglin, 2007). De (2005) contends if the quality of the pain is not typical of their sickle cell disease, other causes should be investigated before ascribing it to vaso-occlusion. As this was typical of patient Xs sickle cell disease the doctor prescribed morphine 10mg titrated against the level of pain. Opioid-agonist drugs like Morphine are the mainstay of treatment for acute sickle cell disease pain and can be given orally. The dose must be titrated appropriately to reflect the drugs thera ­peutic duration of action and the intensity of the pain. Johnson (2004) contends patients whose pain is severe enough to warrant hospitalisation usually require opio ids. Morphine an agonists, opioid and it works by attaching to opioid receptors. There are four types of receptor: mu (ÃŽÂ ¼); delta (ÃŽÂ ´); kappa (ÃŽÂ º); and opioidreceptor- like (ORL). The ÃŽÂ ¼ receptors are thought to be responsible for most of the analgesic effects of the opioids and for some of the main unwanted morphine derivatives which include respiratory depression, hypotension, sedation, nausea, pruritis, constipation and dependence (Hall, 2009). Drugs may then need to be given to relieve and prevent analgesic side-effects (Hall, 2009). The morphine was administered intramuscularly (IM) however Johnson (2004) argues that pain relief occurs more slowly with intramuscular injections, and the injections themselves can produce substantial discomfort. Consequently, intravenous administration of analgesics is usually preferable. Maxolon 10mg was prescribed intravenously (IV) because of the undesirable side effects commonly associated with opioids. Opioids may induce nausea and vomiting by stimulating the chemoreceptor trigger zone, reducing gastrointestinal motility or increasing vestibular sensitivity (Hall, 2009). Evidence shows that nausea and vomiting can negatively affect the quality of life of patients in term of functional outcomes, patient-perceived care by hospital staff and patient satisfaction with regard to overall hospital stay (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Identifying the incidence of nausea and vomiting and characterizing the prescribing of antiemetics are necessary in an effort to improve tolerability of opioids. Maxolon injection contains the active ingredient metoclopramide hydrochloride, which is a type of medicine called a dopamine antagonist (British National Formulary, 2010). Metoclopramide works primarily by blocking dopamine receptors found in an area of the brain known as the chemoreceptor trigger zone (CTZ). The CTZ is activated by nerve messages from the stomach when an irritant is present (Hall, 2009). Once activated, it sends messages to the vomiting centre in the brain which in turn sends messages to the gut, causing the vomiting reflex. Blocking the dopamine receptors in the CTZ prevents nausea messages from being sent to the vomiting centre. This reduces the sensation of sickness and prevents vomiting (Finlay, 2004). Once both drugs had been administered the role of the nurse was to monitor effectiveness and to reassess the pain score. Patient X was encouraged to report any further pain accordingly. According to Johnson (2004) as pain control improves, the analgesia should be maintained to prevent the patient from slipping back into a painful cycle. Patient X was then nursed in the observation unit and after 2 hours reported increasing. After being reviewed by the pain team a patient controlled analgesia (PCA) was offered. The popularity of PCA has generally risen since a report published by the Royal College of Surgeons of England and the College of Anaesthetists (1990), and PCA is now regarded as a routine, safe modality associated with high levels of satisfaction among postoperative patients (Ballantyne et al, 1993). While much has been written about PCA in connection with postoperative pain, comparatively little has been reported in connection with sickle cell disease pain. Of the few studies focusing on PCA use by sickle cell disease patients, Gonzalez et al (1991) has attempted to measure patients acceptance of PCA, and then only as the secondary goal of a clinical trial. In a much early pilot study of three adolescents with sickle cell disease Schechter et al (19880 suggested that drug usage may dramatically reduce as pain subsides, but the intended trial was never conducted because doctors feared it might fuel patients propensity for addiction. The Society Cell Society (2008) however report that some sickle cell patients actually disliked receiving morphine because of its association with drug abuse and addiction and Johnson (2003) findings indicate that some sickle cell disease patients prefer to receive PCA to promote fast and predictable pain relief and give themselves a degree of control over their pain. Moreover, continuous subcutaneous infusions have been used to counteract any delays between intramuscular and intravascular injections (Hall, 2009). This also takes away the reliance on the next dose having to be delivered by health professionals and thus promotes patient autonomy. The role of the nurse was to teach patient X and his family about the medication: description, action, effects, and possible side effects. Johnson (2003) stresses the importance of reinforcing that analgesics make pain manageable and it may not take the pain away completely. The subcutaneous route was used for the PCA. Diamorphine was prescribed because it has the advantage of being more water and lipid-soluble, making it more rapid acting, easier to inject in smaller volumes such as 5-10mg per ml subcutaneously (Hall, 2009) and avoids absorption problems (Rees et al, 2002). Typically, bolus doses of diamorphine need to be higher than in postoperative PCA regimens, for example 5-30mg, and lockout times longer, which can be 20-60 minutes. To increase safe practice around the use of PCAs, a double check of pump settings and medication orders is required when a new syringe is loaded into the PCA system and with subsequent dosage changes. This double check was performed by the nurses and documented on the PCA chart on an hourly basis. Hall (2009) points out that patient can become drowsy as their pain is controlled. Often, this reflects the fatigue that comes with one or more sleepless nights with pain crisis at home. Johnson (2004) reinforced by Oni (2009) argue that the analgesics should not be discontinued automatically for somnolence as long as the patient is easily aroused. A common misconception is that if a patient with sickle cell disease is sleeping, the analgesics are controlling the pain. Rees (2003) contends sickle cell disease patients often sleep despite severe pain. Therefore, when a PCA has been commenced the nurse should evaluate the patient for respiratory status (rate and depth), sedation level, side effects, and pain severity 2 hours x 12 hours, then 4 hours thereafter (De, 2005). A pulse oximetry was used to monitor saturations levels and patient X was commenced on 2 litres of oxygen as it is in their deoxygenated state that red blood cells containing Hb S take on their abnormal, rigid half-moon-like state (Information Center for Sickle Cell and Thalassaemic Disorders (2008). Research suggests that sickled cells can actually regain their normal disc shape when exposed to a higher oxygen concentration (Zipursky et al, 1992 cited by Sickle Cell Society, 2008). When oxygen therapy is being administered De (2008) advocates an upright position as this position optimises and maintains ventilation and perfusion. Patient X needed assistance due to the pain to sit upright and a mouth care tray was provided due to the side effect of oxygen therapy causing dryness of the nasal and oral mucosa (Sheppard and Davis, 2000). A jug of water was also made available at the bedside and the call buzzer was left in easy reach. Effective management of an episode of painful sickle crisis according to Lal and Vichinsky (2005) requires intravenous fluids as this will help to decrease blood viscosity, improve blood flow and reduce risk of renal compromise. Providing adequate hydration is a component of almost every treatment protocol for vasoocclusive crises (De, 2005). Dehydration is one of the principal precipitating factors for pain crises. However, overcorrection of fluid balance can have a negative effect, including possibly increasing the risk of acute chest syndrome. This syndrome, characterized by cough, chest pain, dyspnoea, fever, and radiographic changes, is the most common cause of death for patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). Stuart and Nagel (2004) suggest hydration should be provided to correct deficits, replace any ongoing losses, and maintain normal body fluid volume (euvolemia). In addition, to this the patients pain may improve with oral hydration. Patient X was prescribed 1 litre of intravenous (IV) normal saline over 8 hours and oral hydration was encouraged by the nursing staff. This was monitored on the fluid balance chart. Patient Xs vital signs temperature, pulse, blood pressure were continuously monitored to detect any changes. Patients with sickle cell disease are susceptible to overwhelming infection (Wright Adeosun, 2009; Stuart Nagel, 2004). The most significant factor is splenic autoinfarction during childhood (Sickle Cell Society, 2008). Functional asplenia leaves patients vulnerable to infections with encapsulated organisms such as Streptococcus pneumoniae and Hemophilus influenzae. Further, some studies suggest that neutrophils do not function properly in patients with sickle cell disease (Information Center for Sickle Cell and Thalassaemic Disorders, 2008). How the mutation in sickle cell disease might lead to a defect in neutrophil function is unclear. Patients with SCD and unexplained fever should be cultured thoroughly. If the clinical condition suggests septicaemia, the best action is to start broad spectrum antibiotics after complete culturing. Signs of systemic infection include fever, shaking chills, lethargy, malaise, and hypotension (Oni, 2009). Patient remained apyrexial and 2 days after admission the quantity of analgesia was slowly reduced as patient Xs symptoms improve. While the tapering of intravenous analgesics can require only two or three days, control of a full blown crisis often requires 10 to 14 days. Less commonly, bouts of sickle vaso-occlusive pain require several weeks to control. In conclusion this paper has presented a detailed overview of the management of pain in sickle cell disease, an inherited disease of the red blood cells. Sickle cell disorder can have a profound effect on a persons life. Acute painful episodes among patients with sickle cell disease may occur in any body part or several sites simultaneously. A thorough pain assessment will indicate the type of pain management approaches that are most likely to be effective. Patients should always be encouraged to engage in activities that will help them manage their own pain and boost their confidence rather than make them dependent on health care professionals. This case profile has highlighted the importance of optimal care for a patient with sickle cell disease which should be a comprehensive, multidisciplinary team approach with prompt, accurate pain assessment as this is the cornerstone of effective pain management.

What Happened Next in Rip Van Winkle ? :: Rip Van Winkle Essays

What Happened Next in Rip Van Winkle ? Rip Van Winkle acquired a belief the day he fell asleep---July 3, 1766, say---a belief that that day was a fine day. He held this belief under the character ``Today [the day of this thought] is nice.'' Then he slept for twenty years and two days, until July 5, 1786, and walked back to town.   What happened next? The possibility that struck Kaplan and Evans is that Rip merely updated his belief. On July 3rd he never forms any explicit belief other than ``Today [the day of this thought] is a nice day''. When he awakes on July 5th, the belief is updated, due to his awareness of having slept through a night, and his lack of awareness of having slept twenty additinal years, to ``Yesterday [the day before the day of this thought] was a nice day.'' He falls out of epsitemic contact with the current day when he falls asleep, but has a ready-made character in mind for when he wakes up. But then what is there left of the original belief except the false one about July 4th? But the false belief can not be the true belief, so hasn't Rip lost the belief in question? This seems to be the argument that threatened Kaplan and appealed to Evans. But even in the case of such thin updating, there are backup characters for Rip to hold his belief under. When Rip believes, towards evening, as it grows dark, ``Today [the day of this thought] was a nice day,'' he has memories of seeing the flowers and feeling the sun, and so forth. So the character, ``That day [the day I remember] is or was a nice day'' is available to sustain his belief, when the attempt at updating goes awry. Even if these memories fade, there is the character, ``That day [the day this belief was acquired] is or was a nice day.'' So my view is this. When he awakes on July 5th, Rip updates his belief according to his view of how the context has changed. His view about the change of context is mistaken, and the new character, ``Yesterday [the day before the day of this thought] was nice'' is not a way of believing the original content. But that is no reason to say that Rip has lost his original belief.