Article Review

Article Review

[Name of the Writer]

[Name of the Institution

Article Review

When species are introduced into a new environment as a result of direct and indirect human intervention causes a change in the natural ecosystem. From many studies, it is evident that such introductions cause the native species to get extinct and also the ecosystem of that area change but what is the effect on the new species is still unknown. It is a fact that non-native species do cause changes in the natural environment the moment they are introduced in the new environment, for example, the presence of pathogen cause disease in animals plants and other species. Still, there is no proper understanding and also management policy about the invasion of these organisms. Having said that there is no proper understanding of the impact of these species because the synthesis of the provided information is blocked because the clear understanding of the impact of these organisms is not clearly stated by researchers. In order to achieve clarity regarding the meaning of the impact, communication among the scientists from various fields and other stack holders should be clear. One particular area where improved communication is required to evaluate the risks involved in the introduction of non-native species or organisms. So for all these reasons, it is important to assess the impact of such organisms in the natural habitat is required.

To understand the impact of these organisms, it is important to address four questions that fall in four different classifications. These are directionality, classification and measurement, ecological change and also the scale of the change. All of these criteria include the term change because the impact is produced because they ultimately change the ecosystem. These changes can affect both the population in which it is introduced and also other populations as well. In the case of directionality, it is considered that either decrease in the species diversity occurred which is unidirectional or bidirectional in which both increase and decrease in the species are considered. To consider the bidirectional changes it is important to consider the overall complexity of the ecosystem. For example with many studies it has been proved that plant population richness and also diversity decreases when a foreign population is introduced in that population but the soil richness increases as a result of that change. In the classification and measurement, it is estimated that are the effects are estimated based on the direction and magnitude of the impact, or is there any human values are also involved. In the case of ecological and socioeconomic changes both or anyone is addressed. Many researchers focused mainly on the changes that occurred in the native population densities and also ranged, and in another study, the socio-economic changes like the impact on the overall agriculture and livestock are estimated. In the case of scale various regional national and other seasonal scales are measures. The focal impact is quite significant in the case of the overall description of the impact. For example, the introduction of a foreign species can either improve the richness at a small scale, or it can also cause disasters.

All these questions are quite helpful in evaluating the overall impact of a foreign species into a native environment. These questions help to identify the definition of impact by all policymakers and scientists. This way it will be quite helpful to clearly understand the impact because in this way a synthesis of overall data is informative. It is important to note here that how impact is measured in a certain community depends on how they define it, so it is important to define it (Jeschke, 2014) clearly. There are certain regulating organisations who define the term impact of foreign species in a morebroader sense. The explicit definition of impact will help to understand the scientists that what is needed by the managers and what is currently delivered by the scientists (Ricciard, 2014). While doing so, scientists must be able to address their audience and how they define the term.

References

Jeschke, J. M., Bacher, S., Blackburn, T. M., Dick, J. T., Essl, F., Evans, T., ... & Pergl, J. (2014). Defining the impact of non‐native species. Conservation Biology, 28(5), 1188-1194.

Ricciardi, A., Hoopes, M. F., Marchetti, M. P., & Lockwood, J. L. (2013). Progress toward understanding the ecological impacts of nonnative species. Ecological monographs, 83(3), 263-282.

Article Review

Article Review

[Name of the Writer]

[Name of the Institution]

Articles Review

For a healthy plant growth there must be essential elements and trace minerals, in addition to these minerals there are some extra additives which are added by the farmers to increase the efficiency and production of the plants. There are many additives which are used by the farmers that include enzymes, amino acids, and other plant hormones. Enzymes are the most important additives, and when a farmer use them, then they speed up the rate at which nutrient absorption takes place. These enzymes are made up of DNA, RNA and amino acids, and the unique feature about them is they act like a catalyst that speeds up the chemical reaction without changing themselves. When the activation energy is reduced then the energy can be used for other reactions in the plant body. Enzymes can be applied directly or indirectly to plants. Applying isolated enzymes is an example of direct applying while in case of indirect applying beneficial microbes are added which further increases the amount of the enzyme ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"oDzIy70V","properties":{"formattedCitation":"(\\uc0\\u8220{}Enzymes, Amino Acids and Plant Hormones,\\uc0\\u8221{} n.d.)","plainCitation":"(“Enzymes, Amino Acids and Plant Hormones,” n.d.)","noteIndex":0},"citationItems":[{"id":930,"uris":["http://zotero.org/users/local/4C6u8dIT/items/RJMARQKR"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/RJMARQKR"],"itemData":{"id":930,"type":"post-weblog","title":"Enzymes, Amino Acids and Plant Hormones","container-title":"Garden & Greenhouse","abstract":"A good feeding regiment will contain all the essential elements and trace minerals needed for healthy plant growth. In addition to these vital nutrients, many horticulturists choose to “super charge” their feeding programs with non-plant food additives. These additives are not actually nutrients, but are additives which enhance plant growth or increase efficiency in various …","URL":"https://www.gardenandgreenhouse.net/articles/plant-nutrition-articles/enzymes-amino-acids-plant-hormones/","language":"en-US","accessed":{"date-parts":[["2019",3,16]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} ("Enzymes, Amino Acids, and Plant Hormones," n.d.).

Amino acids are the second most important additives in plants which are required for the synthesis of enzymes, proteins, chlorophyll, and other enzymes. It must be noted that these amino acids are part of the plants from the very beginning when the plants soon after their development they start to make their structural proteins by using these amino acids and also by regulating the water. Mostly when the plants are in the perfect conditions, then they make their amino acids but not all the plants are in the perfect conditions so to enhance the growth of such plants it is important to add these amino acids as additives. Between the two types of amino acids, the D-form cannot be taken by the plants; therefore, the horticulturists must use the L-form which can not only absorbed in the original form but also in they can make complexes with other peptides and enhance the growth of the plants.

Plant hormones which are also known as phytohormones are the specific type of chemicals that regulate the growth of the plant body. Plant hormones are helpful in the development of roots and shoots and also for the production of fruits and flowers. Based on the molecular nature of the hormones they are classified into five main groups which are auxins, cytokinins, gibberellins, abscisic acid, and ethylene. Auxins are associated with the physical structure of the plant. These hormones are helpful in upward growth and root development. Horticulturists use these auxins to enhance the root growth of their plants. Gibberellins are most commonly associated with germination, dormancy, and also in flower development. Cytokinins are associated with cell division. These hormones play a vital role in embryo development. The ratio of cytokinins to auxin directly affects the way the plant grow and develop. Cytokinins are most important in horticulture due to their ability of cell division. Abscisic acid are also called stress hormone which is synthesized by the plants when there is environmental stress. During low moisture conditions, farmers spray a solution containing the abscisic acid on the plants which prevents the wilting of leaves because during low humidity plants close their stomata to prevent the loss of water. Ethylene is produced in the plant during ripening processes. It is sprayed on the plants to speed up the ripening process ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"gAQZoMY2","properties":{"formattedCitation":"(\\uc0\\u8220{}Enzymes, Amino Acids and Plant Hormones,\\uc0\\u8221{} n.d.)","plainCitation":"(“Enzymes, Amino Acids and Plant Hormones,” n.d.)","noteIndex":0},"citationItems":[{"id":930,"uris":["http://zotero.org/users/local/4C6u8dIT/items/RJMARQKR"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/RJMARQKR"],"itemData":{"id":930,"type":"post-weblog","title":"Enzymes, Amino Acids and Plant Hormones","container-title":"Garden & Greenhouse","abstract":"A good feeding regiment will contain all the essential elements and trace minerals needed for healthy plant growth. In addition to these vital nutrients, many horticulturists choose to “super charge” their feeding programs with non-plant food additives. These additives are not actually nutrients, but are additives which enhance plant growth or increase efficiency in various …","URL":"https://www.gardenandgreenhouse.net/articles/plant-nutrition-articles/enzymes-amino-acids-plant-hormones/","language":"en-US","accessed":{"date-parts":[["2019",3,16]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} ("Enzymes, Amino Acids, and Plant Hormones," n.d.).

All these amino acids, enzymes and phytohormones are used for different purposes. Some of these hormones are helpful in the root and shoot development while others help in the ripening process, and some of them are used to stimulate cell division. Most of these horticulturists adopt a multifaceted approach by adding these additives. Although the exact mechanism of how these hormones and enzymes help in different mechanisms is not fully known the advantages of applying these components are massive therefore most of the farmers prefer to use these components to enhance their productivity. In this article, the advantages of using these components are explained but how they improve the plant growth and how the plants respond to these additives are not fully known.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Enzymes, Amino Acids, and Plant Hormones. (n.d.). Retrieved March 16, 2019, from https://www.gardenandgreenhouse.net/articles/plant-nutrition-articles/enzymes-amino-acids-plant-hormones/

Article Review

[Name of the Writer]

[Name of Instructor]

[Subject]

[Date]

Article Review

The concept of viruses about what are they, how they enter the human body and how they survive inside the body and what kind of diseases they cause inside the body was a mystery. Until some 25 years ago the full mechanism of viruses and the diseases they cause in the human body was reported, after that certain point, the scientists began to investigate about viruses about how they enter the body and what diseases they cause. Although viruses are the smallest creature among all the living organisms even then, they are poisonous and are the cause of several deadly diseases. The viruses are considered one of the most neatly organized packed with genetic material, and they can be round or spherical shaped. The entire mechanism on how viruses hunt down and stick to the host cell is not fully known, but there are some small extensions on the outer side of the cell which is called antigens, which help the virus to attach with the host cell and enter their body. The main concern behind the full investigation of viruses is due to the high prevalence of HIV AIDS which is hunting down thousands of people each year around the world, and the fact that this disease is incurable maks the situation even more serious ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"2oHqDYru","properties":{"formattedCitation":"({\\i{}Inside Look: How Viruses Invade Us})","plainCitation":"(Inside Look: How Viruses Invade Us)","noteIndex":0},"citationItems":[{"id":767,"uris":["http://zotero.org/users/local/4C6u8dIT/items/JSVZ3EVW"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/JSVZ3EVW"],"itemData":{"id":767,"type":"webpage","title":"Inside Look: How Viruses Invade Us","URL":"https://www.livescience.com/10510-viruses-invade.html","accessed":{"date-parts":[["2019",3,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Inside Look: How Viruses Invade Us).

The main focus of scientists is to find out how the spikes that are present on the outer surface of the virus help them to fuse with the T-cells thus the immune system does not recognize them and they spread in the body, if the mechanism behind the fusion is found then it will become easy to design vaccines for the virus. Even after doing proper research it is still unknown that how these spikes are distributed on the surface and what mechanism they use to enter the host cell without being triggered by the human immune system. The viruses do not have their mechanism they need a host cell to replicate by using the enzymes of the host cell due to this reason they are referred to as well organized parasites. The one unique characteristic about HIV is that it can replicate itself inside the human body without being detected and once it produces enough copies and the symptoms gets severe only then it gets detected but till then the situation becomes uncontrollable ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"QZ3spH0u","properties":{"formattedCitation":"({\\i{}Top 10 Mysterious Diseases})","plainCitation":"(Top 10 Mysterious Diseases)","noteIndex":0},"citationItems":[{"id":769,"uris":["http://zotero.org/users/local/4C6u8dIT/items/PAVKRUGG"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/PAVKRUGG"],"itemData":{"id":769,"type":"webpage","title":"Top 10 Mysterious Diseases","URL":"https://www.livescience.com/11333-top-10-mysterious-diseases.html","accessed":{"date-parts":[["2019",3,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Top 10 Mysterious Diseases). The mechanism that the viruses use to get stick to cells is mind-blowing, some proteins are present to recognize the type of cell, and once they find the cell then they get attached to them and start producing the cells ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZLWBj1ip","properties":{"formattedCitation":"({\\i{}Inside Look: How Viruses Invade Us})","plainCitation":"(Inside Look: How Viruses Invade Us)","noteIndex":0},"citationItems":[{"id":767,"uris":["http://zotero.org/users/local/4C6u8dIT/items/JSVZ3EVW"],"uri":["http://zotero.org/users/local/4C6u8dIT/items/JSVZ3EVW"],"itemData":{"id":767,"type":"webpage","title":"Inside Look: How Viruses Invade Us","URL":"https://www.livescience.com/10510-viruses-invade.html","accessed":{"date-parts":[["2019",3,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Inside Look: How Viruses Invade Us).

The type of protein that helps the virus to recognize the cell which in some cases is the GP120, which binds with two different proteins on the host cell and start producing its copies. The type of genetic material the viruses have, also varies, some viruses contain double-stranded DNA while others have single RNA strand; this genetic material type determines the process of replication inside the cell. The replication process is so rapid that once the HIV attaches itself to the host cell, then it only takes one to two days to produce thousands of its copies inside the host cell. Viruses are linked with a different simple like flu and other complicated diseases like cancer. Each year millions of people in the US and around the world become the prey of flu even after get vaccinated, and the reason behind this is viruses can mutate itself, they can change the arrangement of their surface proteins rapidly; therefore, they can easily enter the host cell without being detected.

In case of HIV since its inception, many facts about the virus have been found, but some factors are still missing due to which each year's thousands of people lost their battle to HIV AIDS. The basic thing that is lacking in this scenario is the binding of HIV with the human immune cell if that is known then it will be easy to design an effective vaccine for the virus. Although many diseases that are caused by viruses are effectively being treated by using vaccines the main concern is HIV AIDS because still, this disease is incurable. The article provides a better understanding of how the virus propagates inside the host cell and spread disease but the main question is still not discussed here that how to inhibit the virus inside the cell and even if it enters the cell then what can be done to strengthen the host immune cell so that it can be washout from the body without doing much harm.

Work Cited

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Inside Look: How Viruses Invade Us. https://www.livescience.com/10510-viruses-invade.html. Accessed 9 Mar. 2019.

Top 10 Mysterious Diseases. https://www.livescience.com/11333-top-10-mysterious-diseases.html. Accessed 9 Mar. 2019.

Article Summary

Article summary Kay Jones

Assignment

Author Note

Article summary

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Reimers, C. D., Knapp, G., & Reimers, A. K. (2012). Does Physical Activity Increase Life Expectancy? A Review of the Literature [Review Article]. Journal of Aging Research. https://doi.org/10.1155/2012/243958

Hypothesis  

The author Jones along with his fellow researchers hypothesized that lifestyle factors including smoking, obesity, and physical work interfere with exceptional length of life.

Description of study  

 To test the hypothesis mentioned above, the author collected the information of 477 Ashkenazi Jewish participants with life length of 95 years and older. Birth certificates were used as verification of the participant’s age. This study included 74.6% of women. The population was well-educated for the relevant time period with almost 755 of them had completed high-school. The participants were asked about their lifestyle factors. Furthermore, 293 participants answered an open-ended question “In your opinion, what do you think contributed to your life?” In comparison group of white people, the participants were chosen between the age group of 65 to 74 as their age also resembles the same cohort group with exceptional longevity.

Results   

The author found that people with more life expectancy were not healthier in their early lives in terms of BMI, smoking, physical activity or diet than the general population of the US. The study suggests that people with longer lives interact with their environment and adopt different other lifestyles. Moreover, the researcher has found out that genetic factor also plays a vital role in longevity regardless of the poor lifestyle choices. In addition to this, in the future, further research can be carried out based on the findings of the present study and can find out the specific gene interaction with environment in relation to age-related diseases and longevity.  

Significance  

In the United States of America, people with unhealthy life choices are expected to have shorter life expectancy and can experience disability sooner than those who have a healthy lifestyle. People need to refrain from alcohol consumption and smoking in order to maintain a healthy lifestyle. Consumption of drugs can largely affect health and can increase the aging process. People who are physically active are expected to have a higher life expectancy (Reimers et al., 2012).

Article Three

Reflection on Articles

[Author’s name]

Reflection on Articles

Article 1: 20 Years ago, a doctor published a study. It was completely made up, and it made us all sicker.

Reflection

Today, autism is recognized as one major health concern when it comes to the consideration of proper well-being of the children. It is vital to assess the connection between vaccines and autism as anticipated by Dr. Wakefield. It is crucial to evaluate whether the vaccines of measles, mumps, and rubella increase the chances of autism or it is just the myth. This particular claim turned as the huge controversy that ultimately minimizes the trust level of parents on the mandatory use of vaccinations. The allegation set by Dr. Wakefield further turned as the legal case that eventually helped to figure out all the grey areas existed in the entire scenario. It is clearly established by the author of this article that the claim developed by Dr. Wakefield was nothing else but the complete fabrication. It is essential to consider this argument referring to all the relevant facts and figures.

Comprehensive consideration of the ground reality can be helpful to determine the linkage between vaccination and the health issue of autism. The outcomes in the form of a claim by Dr. Wakefield can never be trusted because there are some problems concerning this particular study. This major drawback of this particular study is that it is not comprised of statistics and it only relies on the memories of the respondents. Secondly, Dr. Wakefield delivered weak conclusion about the whole argument without any statistical evidence that eventually failed to achieve the desired outcomes of the research study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BSUPmSe9","properties":{"formattedCitation":"(Mordecai, 2014)","plainCitation":"(Mordecai, 2014)","noteIndex":0},"citationItems":[{"id":2006,"uris":["http://zotero.org/users/local/lMSdZ3dY/items/3T5GRWF8"],"uri":["http://zotero.org/users/local/lMSdZ3dY/items/3T5GRWF8"],"itemData":{"id":2006,"type":"webpage","title":"20 years ago, a doctor published a study. It was completely made up, and it made us all sicker","container-title":"Upworthy.com","author":[{"family":"Mordecai","given":"Adam"}],"issued":{"date-parts":[["2014",5,12]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Mordecai, 2014). Comparison of other studies with the research work of Dr. Wakefield also clearly indicates that there is no such evidence exist that can provide a proper link between autism and the use of vaccination of different diseases. Finally, it is important to mention the evidence of 31 studies in the year 2005 that established that there is no connection exists between the issue of autism and the use of vaccination.

Article 2: Study Linking Vaccine to Autism is Called Fraud

Reflection

The validity and reliability of the research work can effectively determine by considering other research studies in the field. It is important to critically examine the research work of other health researchers to reject the fabricated research work of Dr. Andrew Wakefield. When it comes to the assessment of the research study of Dr. Andrew Wakefield about the connection between vaccines and autism, the role of Mr. Deer can never be ignored. The British journalist, Brian Deer found different health reports and critically examined to established this argument that how different and crucial health facts and evidence were changed by Dr. Wakefield and his colleagues to justify their opinion. It is interesting to examine how different medical reports and records used by the investigator to reject the argument developed by Dr. Wakefield. Mr. Deer focused the information of twelve children which were used by Dr. Wakefield and his colleagues about their research work.

The valid way of research adopted by Mr. Deer by interviewed all the relevant healthcare providers and parents of those children. Detailed consideration of this form of research helped journalist to establish this fact that health reports of all the twelve children were altered by Dr. Wakefield ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"sHJLlMEc","properties":{"formattedCitation":"(Report, 2011)","plainCitation":"(Report, 2011)","noteIndex":0},"citationItems":[{"id":2007,"uris":["http://zotero.org/users/local/lMSdZ3dY/items/KPIZTI9H"],"uri":["http://zotero.org/users/local/lMSdZ3dY/items/KPIZTI9H"],"itemData":{"id":2007,"type":"webpage","title":"Study Linking Vaccine to Autism is Called Fraud","container-title":"The New York Times","author":[{"family":"Report","given":""}],"issued":{"date-parts":[["2011",1,6]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Report, 2011). This evidence is enough to establish that the claim presented by Dr. Wakefield was a complete fraud that badly influences the approach of vaccination. The detailed examination of the entire case helped to determine that it was not a mistake by Dr. Wakefield, instead, it is a serious research offence that badly damages the healthcare prospect for children. There is enough evidence to determine that Dr. Wakefield adopted the unethical or fabricated approach of research to gain his own benefits of funding. Money is the major factor that encouraged him to adopt the approach of false research work that is later assessed by investigators by establishing different research studies.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Mordecai, A. (2014, May 12). 20 years ago, a doctor published a study. It was completely made up, and it made us all sicker. Retrieved from:

https://www.upworthy.com/20-years-ago-a-doctor-published-a-study-it-was-completely-made-up-and-it-made-us-all-sicker

Report. (2011, January 6). Study Linking Vaccine to Autism is Called Fraud. Retrieved from:

HYPERLINK "https://archive.nytimes.com/query.nytimes.com/gst/fullpage-9C02E7DC1E3BF935A35752C0A9679D8B63.html" https://archive.nytimes.com/query.nytimes.com/gst/fullpage-9C02E7DC1E3BF935A35752C0A9679D8B63.html

Assigment #7

Assigment #7

[Name of the Writer]

[Name of the Institution]

Cure / care:

A patient is a person who is physically or mentally ill and seeks medical assistance. Medical professionals then seek medical assistance to cure the patient after a clinical protocol. It depends on a number of factors such as resources and severity of the disease. It is not a moral obligation to cure the patient. In some cases such as cancer, there is no treatment available to cure the person of death. Thus, it is morally not obligatory to cure the patient. Care is the moral obligation to attend the patient as now he depends on others due to his illness.

Nutrition:

It is one of the fundamental aspects of care. It is the supply of food to organisms so they can stay alive.

Hydration:

Kidneys will shut down without water in the absence of water after 3 to 4 days.

Shelter:

This medical care is provided to animals.

Human interaction:

It is the care provided to the patient. We are morally obliged to this as when a person is sick, he is dependent on others. For example, a patient has an infection and is not able to take his care, will depend on others for medication.

Swallow test, describe; when is it indicated?

If a person has a difficulty in swallowing and does not pass the test including the thickened water then this can be bypass medically. This happens in case of an accident or a person is elder.

When is medically assisted N/H indicated?

When a person does not clear the swallowing test, then he has to depend on medically assisted nutrition/hydration. There are two types of medically assisted N/H; enteral nutrition (EN) and parenteral nutrition (PN).

Enteral Nutrition (EN):

It is the use of the entire system which is the intestinal system. It is provided in case the GI tract is functioning and is feeding through a tube.

Nasogastric tube:

This is a tube from the nose to the stomach, in case of the stomach is injured, through the intestines.

Naso Jejunal tube:

This is tube through the stomach the jejunum.

Percutaneous endoscopic gastrostomy:

This tube is used when the upper portion cannot be used due to some reasons.

Parenteral Nutrition (PN):

If the GI tract is not functioning, then parenteral nutrition is used, which is an intravenous administration of nutrition. Here there is damage to the intestines.

Total parenteral nutrition:

It is a method of feeding that bypasses the gastrointestinal tract. It can cause thrombosis of peripheral veins and requires the use of a central venous catheter. It has a disadvantage that it does not preserve the GI tract structure.

Partial parenteral nutrition:

It is the intravenous administration of nutrients when the enteral route is not feasible.

Bioethical analysis of N/H:

With the use of this procedure, there is damage to the GI tract. It is used to treat the patient for a short term basis but it affects patient's organs and they have to depend for a longer duration.

Case Study: Terry Schiavo bioethical analysis:

Terry Schiavo belonged to Florida. Her husband and parents had different views regarding the use of N/H. Her case has been discussed by medical and legal critics. She was collapsed in 1990 and was in “persistent vegetative state”. In Florida, it was permitted to withdraw nutrition and hydration. But there was also an opposition to this withdrawal.

Assignment

Autonomic Nervous System Division

Student's Name

Institutional Affiliation

Autonomic Nervous System Division

Sympathetic Division

Parasympathetic Division

CNS Exit

Most cranial thoracic segments of the head

Most cranial thoracic parts of the spinal cord.

Location of pre-ganglionic neuronal cell bodies

Located in the ventral roots and segment of body cells

Situated at the left or right vagus in the thoracic cavity vagal that branches to the heart

Pre-ganglionic neuronal length

It originates from the spinal cord

Originates from the brainstem and other segments of the spinal cord

Pre-ganglionic axon location

It runs through the eye membrane to facilitate recognition of an object by the pupil

It runs through the oculomotor nerve via the smooth muscles in the eye.

NT released from Pre-ganglionic neurons

Has the nerve cells that have receptors for transmitters released in the synaptic cleft

The nerve cells facilitate the transmission of receptors to eye

Location of post-ganglionic neuronal cell bodies

Located in the visceral also known as the lateral gray of the spinal cord

Situated in the visceral also known as the lateral gray of the spinal cord

Post-ganglionic neuronal length

It is approximately T-1 to L -4

It is short and thus runs from S1 – S3

Post-ganglionic axon location

It comprises of the innervated pelvic viscera which are the ascending colon along the spinal cord

It consists of innervated pelvic viscera which include the descending colon

Organic innervated

Facilitates secretion of favor viscous

Stimulates the flow of support serous

OVERALL MAIN EFFECTS:

It facilitates the ascending movement of the materials in the body to ensure proper coordination of cells (Snell, 2010).

It facilitates the descending movement of materials in the colon

Effects on:

Heart rate

It speeds up the heartbeat rate to pump more blood to increase the blood pressure.

It facilitates the decrease in heartbeat rate to reduce the blood pressure of the body

Pupil

It enlarges the pupil to increase the visibility of objects when there is less light from the object.

It decreases the size of the pupil to prevent excess light for the object. It helps to protect from damage.

Airways

Clean airway to facilitate transportation of oxygen

Clean airway to enable transport of oxygen

Blood vessels to GI organs

Facilitates move of substances to GI organs

Facilitates movement of materials from GI organs to blood vessels

Blood vessels to muscle

Increases muscles contraction

Decreases muscles contraction

Salivation

Increases salivation

Decrease salivation rate

References

Snell, R. S. (2010). Clinical neuroanatomy. Vancouver: Crane Library at UBC.

Assignment #4

Assignment no. 4

[Name of the Writer]

[Name of the Institution]

Pre-implantation Genetic Diagnosis PGD; description and bioethical analysis

Preimplantation genetic diagnosis (PGD) is a procedure that is used before implantation for the purpose of identification of genetic defects within embryos. These embryos are mostly developed during in vitro fertilization (IVF).

Preimplantation genetic diagnosis starts with the in vitro fertilization. Then in the next 5 days, embryos will divide into multiple cells. The process is not only costly but also offer physical discomfort as well as emotional stress.Surrogate motherhood; description and bioethical analysis

A surrogate mother is a biological mother who is artificially fertilized with the father's sperm. "In vitro fertilization" (IVF) is used to get eggs from the mother, which is then fertilized with sperm from the father. Then the embryo is placed into the uterus of a gestational surrogate who carried the baby till birth. There is a controversy with this method as its legal process varies from state to state.

Artificial insemination; description and bioethical analysis

This is the procedure of inserting sperm directly into a woman's cervix, fallopian tubes, or uterus. Mostly uterus is used for this purpose. This procedure is used for treating infertility. There are different ethical questions that arise with this procedure such as the welfare of the child and identity of the donor to be revealed to the child.

Natural Family Planning:

Natural family planning (NFP) does not use any medicine or device but guide people about when to have sexual intercourse. 3 Primary ovulation symptoms:

Basal body temperature

cervix activity

Cervical mucus

7 Secondary ovulation symptoms:

Mittelschmerz

Spotting

Swollen vagina and vulva

Increased libido

Breast tenderness

General bloating

Ferning

Various protocols and methods available today:

Creighton model (NaPro Technology)

Couple to couple (ccl)

Sympto-thermal method

Billings method

A family of the Americas (based on billings)

Some ways in which NFP is healthier than contraception:

Natural family planning (NFP) does not use any medicine or device but guide people about when to have sexual intercourse. Moreover, there is no ethical consideration involved in this method.Bioethical evaluation of NFP:

as a means:

No separation ÷ unitive/procreative dimensions

Respectful of human nature

marital intimacy = union of body and soul

as an end / goal / objective

If there is any infertility as a result of any physical or psychological condition of husband or wife then one must take advantage of the natural cycles which are intrinsic in the reproductive system.

b) as an end:

The contraceptive mentality needs to be avoided as these pregnancy/children are ethically considered as evil and these must be sidestepped by any means. Humans must accept God’s plan of creation.

Assignment #5

Assignment no. 5

[Name of the Writer]

[Name of the Institution]

Vital organs

Whole skin:

To protect

Brain:

To control the voluntary activities of the body such as in cerebrum

Brain stem:

To control over the involuntary activities such as breathing, swallowing, heart rate, and blood pressure

Both lungs:

Assist in respiration with the help of the diaphragm.

Heart:

Pump the blood in the body.

Liver:

Detoxify chemicals and secrete bile

Pancreas:

Performs an endocrine function

Stomach:

Helps in food digestion

Small intestine:

Absorption of nutrients from food

Large intestine:

Reabsorption of water and electrolytes and storage of feces

Both kidneys

Clean blood and osmoregulate

Exceptions today:

Stomach, pancreas, and kidneys

Non- vital organs:

Eyes, uterus, ovaries, and appendix• Is it possible to live without a vital organ? Why? Example?

Yes, people can live without a vital organ such as kidney failure.• If one of the vital organs starts to fail, does this mean the patient’s prognosis could be end stage? Explain.

No, if one of the vital organs starts to fail, the patient can still live without that such as the spleen. Unconscious state:

A state in which an awareness of self and environment is lost. For example, you may lack a response to a painful stimulus.

Clinical definitions of different states of unconsciousness:

Coma

A person who is unconscious for more than half an hour is declared in a coma.

Glasgow Scale:

The Glasgow Coma Scale (GCS) explain the level of consciousness in a person after an acute brain injury.

Induced coma:

It is a temporary coma due to medication.

Persistent vegetative state (PVS):

Patients have severe brain damage including the brain stem that causes him to be in a state of partial arousal.

Traumatic head injury:

It is a complex injury due to some external cause. It has a broad spectrum of symptoms and disabilities.

Brain hypoxia:

A condition when the brain does not receive adequate oxygen

Epileptic seizure:

A condition due to excessive neuronal activity in the brain

Syncope:

It is a partial or complete loss of consciousness

Other unconscious states (ex. Locked- in syndrome)

It is complete paralysis of voluntary muscles except for eye movement

Assignment #8

Assignment#8

[Writer’s Name]

[Institution Name]

Assignment#8

Hippocratic Oath: Do not harm

It is a historic oath taken by the physicians, authored by Greek physicist Hippocrates. It expresses the earliest medical ethics expression.

The exact oath phrase "First do no harm" is a Hippocratic Oath part. This phrase abstains the physicians from doing any harm and ill-doing to its subjects intentionally. In another part it is manifested as either help should be provided or no harm. It is considered to be murder if poisonous drugs are provided by physicians. This oath puts a complete ban on euthanasia.

Bioethics of PAD

As mostly in America Christianity is followed as a system of belief which discourages the idea of Physician-Assisted suicide and death. It is in bioethics been consider as unethical to cause death to someone to alleviate the pain of the subject. According to the Catholic Church, such patients should be provided with love and care with appropriate remedy to alleviate their pain and suffering.

As far as death is concerned, fully conscience death or natural death with dignity is considered to be ethical while unconscious death to alleviate pain is considered to be unethical.

The alternative for Physician-assisted death is to take a patient with love and care and give them medication to alleviate their pain as much as possible assist them.

Hospice vs Palliative

Hospice is the people choosing their way to die at the end of life. It can be provided in any sort of setting like home, assistance with facilities, nursing home, etc. It is designed for a situation where it is not possible for a patient to have a cure for their illness

In Palliative care system, treatment is provided by the doctors to patients with seriously ill diseases as long as possible. Hospice care is better in the way that it provides people the love from their loved one before they die.

Judeo-Christian Suffering Redemption

Pain and suffering have redemptive value in Judeo-Christian tradition because we have a history, it is a Christian belief that when human suffers and accepted a Jesus Christ union, has a remittance for its sins.

Asthma Disease

Asthma Disease

[Name of the Writer]

[Name of the Institution]

Asthma Disease

Asthma is a disease that affects lungs and is associated with episodes of chest tightness, wheezing, early and nighttime coughing, and breathlessness. Asthma is characterized by functional and structural abnormalities of the bronchial epithelium, inflammatory cell accumulation in the bronchial mucosa, and airway tissue structure remodeling ADDIN EN.CITE <EndNote><Cite><Author>MacDowell</Author><Year>2005</Year><RecNum>324</RecNum><DisplayText>(MacDowell &amp; Bacharier, 2005)</DisplayText><record><rec-number>324</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574848546">324</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>MacDowell, Ana L</author><author>Bacharier, Leonard B</author></authors></contributors><titles><title>Infectious triggers of asthma</title><secondary-title>Immunology and Allergy Clinics</secondary-title></titles><periodical><full-title>Immunology and Allergy Clinics</full-title></periodical><pages>45-66</pages><volume>25</volume><number>1</number><dates><year>2005</year></dates><isbn>0889-8561</isbn><urls></urls></record></Cite></EndNote>(MacDowell & Bacharier, 2005)

This virus causes almost half of the upper respiratory tract infections. Rhinovirus also causes lower airway infection but the exact mechanism through which it provokes asthma is not known. It is believed that mechanism may involve effects on airway responsiveness that is independent of the inflammation associated with lower respiratory tract infection and epithelial damage. Rhinovirus increases the immediate and late-phase allergen responses and exacerbates the allergic inflammation in the airway. It is also associated with the decline in lung function in asthmatic patients. Coronavirus is associated with asthma in adults and children. It is the second most common virus that is associated with asthma episodes. It is stated that coronavirus infection is associated with a large burden of disease as compared to respiratory syncytial and influenza virus. The influenza virus is also associated with exacerbation of asthma in all age groups. Adenovirus infection has also been demonstrated during the acute episode of asthma but the adenovirus frequency is low as compare to coronavirus and rhinovirus. The adenoviral infection has a role in the asthma genesis. Respiratory syncytial virus serves as a trigger for asthma exacerbation and other chronic lung diseases. Those infants who are infected with respiratory syncytial virus bronchiolitis demonstrated an increased frequency of asthma and wheeze later in their life. M pneumonia and C pneumonia are associated with the chronicity of asthma. Many case studies have demonstrated the onset of asthma symptoms in individuals with this infection.

Epidemiology

Currently, more than 334 million people suffer from asthma and each year prevalence continues to grow particularly in middle and low-income countries. The asthma prevalence differs greatly in different parts of the world due to occupational, genetic and environmental factors. In high-income countries, prevalence of asthma is reaching a plateau. Worldwide, it is estimated that almost 250,000 cases are attributed to asthma each year. It is estimated that by 2025, the overall prevalence will increase to 100 million. Asthma affects more than 25 million including 6 million children under 18 years of age. Asthma has a significant economic and health burden on individuals, their families, and communities. In 2016, approximately 1.9 million individuals visited the emergency department for asthma-related care and 190,000 were hospitalized due to asthma. In 2001, 53.8% of adults and 61.7% of children with asthma had one asthma attack in the last 12 months as compared to 43.6% and 51.6% in 2017 respectively. In the United States, the financial burden associated with asthma is almost $ 3300 per patient including absences from school, or work and medical facilities ADDIN EN.CITE <EndNote><Cite><Author>Loftus</Author><Year>2016</Year><RecNum>326</RecNum><DisplayText>(Loftus &amp; Wise, 2016)</DisplayText><record><rec-number>326</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574848707">326</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Loftus, Patricia A</author><author>Wise, Sarah K</author></authors></contributors><titles><title>Epidemiology of asthma</title><secondary-title>Current opinion in otolaryngology &amp; head and neck surgery</secondary-title></titles><periodical><full-title>Current opinion in otolaryngology &amp; head and neck surgery</full-title></periodical><pages>245-249</pages><volume>24</volume><number>3</number><dates><year>2016</year></dates><isbn>1068-9508</isbn><urls></urls></record></Cite></EndNote>(Loftus & Wise, 2016).

Risk Factors

Asthma consists of a wide range of heterogeneous phenotypes that varies in pathophysiology, etiology, and presentation. The risk factors for each of the asthma phenotypes include environmental, host, and genetic factors. Family history also plays a role in the development of asthma. Over the last few decades, the increase in asthma incidence and geographical variation in both the magnitude and prevalence rate support that environmental factors play an important role in the epidemic of asthma. Environmental triggers also affect asthma differently at different times of personal life. Studies have shown that genetics play an important role in the allergy and asthma development. Studies have shown that more than 100 genes are associated with asthma and allergy in 11 different populations. It is found that prenatal maternal smoking is associated with wheezing in early childhood. Prenatal maternal stress is associated with decreased cortisol level which causes the development of allergic phenotype. Asthma which occurs in adulthood can have environmental causes. Adult-onset asthma can be caused by NSAIDs and β-blockers. In women it can be caused by occupational exposure to irritants and sensitizing agents or because of hormone replacement therapy. Occupational asthma can be caused by commercial and domestic cleaning (cleaning solution), car painting (isocyanates), and baking (flour dust). Bacteria such as Chlamydia pneumonia and Mycoplasma pneumonia are also associated with the exacerbation of asthma. These bacteria cause acute wheezing episodes in preschool children with the same frequency as seen with the virus ADDIN EN.CITE <EndNote><Cite><Author>Darveaux</Author><Year>2014</Year><RecNum>325</RecNum><DisplayText>(Darveaux &amp; Lemanske Jr, 2014)</DisplayText><record><rec-number>325</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574848612">325</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Darveaux, Jared I</author><author>Lemanske Jr, Robert F</author></authors></contributors><titles><title>Infection-related asthma</title><secondary-title>The Journal of Allergy and Clinical Immunology: In Practice</secondary-title></titles><periodical><full-title>The Journal of Allergy and Clinical Immunology: In Practice</full-title></periodical><pages>658-663</pages><volume>2</volume><number>6</number><dates><year>2014</year></dates><isbn>2213-2198</isbn><urls></urls></record></Cite></EndNote>(Darveaux & Lemanske Jr, 2014).

Asthma can be persistent and intermittent. When symptoms of asthma arise occasionally then a person has intermittent asthma. Persistent asthma symptoms occur more often. The four main stages of asthma include intermittent asthma, mild persistent asthma, moderate persistent asthma and severe persistent asthma. The asthma symptoms are same at each stage but their severity and frequency differ. The main symptoms include wheezing, breathing difficulties, coughing, and tightening of the chest.

Intermittent Asthma

This type of asthma is not severe. These symptoms may occur 2 days a week or even less often. Symptoms make a person awake for two or fewer times every month. Symptoms do not interfere with regular activities. A person may need to use a short-acting beta inhaler to control the asthma symptoms two or fewer days every week.

Mild Persistent Asthma:

These asthma symptoms usually occur more than twice a week but not every day. Symptoms usually have a minor impact on regular activities.

Moderate Persistent Asthma

This is the second-most severe form of asthma. Symptoms occur daily. Symptoms awake individuals more than once in a week. Symptoms can limit the daily routine activities

Severe Persistent Asthma

This type of asthma is the most sever. The symptoms arise throughout the day. Symptoms usually limit the individual’s daily routine. A person needs to use inhaler several times a day to control his symptoms.

Treatment

Prevention of asthma symptoms are key in controlling asthma attacks. Treatment involves recognizing the asthma triggers, steps to avoid them and medicines. Quick-relief inhalers are used to open swollen airways. Long term asthma control medicines are usually taken daily and are the main cornerstone of asthma treatment. Long term asthma medicines include inhaled corticosteroids such as mometasone, fluticasone furoate, etc. Unlike oral corticosteroids, inhaled corticosteroids have fewer side effects. Leukotriene modifiers are effective in relieving symptoms up to 24 hours. Short and Long-acting beta-blockers are also effective in reducing asthma symptoms. Immunotherapy is also used to treat asthma symptoms. Theophylline is also used in treating asthma ADDIN EN.CITE <EndNote><Cite><Author>Chung</Author><Year>2015</Year><RecNum>327</RecNum><DisplayText>(Chung, 2015)</DisplayText><record><rec-number>327</rec-number><foreign-keys><key app="EN" db-id="2s2s0zrapsf0pbe5efuvv20f9rszvx0sd2fe" timestamp="1574848772">327</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chung, Kian Fan</author></authors></contributors><titles><title>Targeting the interleukin pathway in the treatment of asthma</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1086-1096</pages><volume>386</volume><number>9998</number><dates><year>2015</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>(Chung, 2015).

References

ADDIN EN.REFLIST Chung, K. F. (2015). Targeting the interleukin pathway in the treatment of asthma. The Lancet, 386(9998), 1086-1096.

Darveaux, J. I., & Lemanske Jr, R. F. (2014). Infection-related asthma. The Journal of Allergy and Clinical Immunology: In Practice, 2(6), 658-663.

Loftus, P. A., & Wise, S. K. (2016). Epidemiology of asthma. Current opinion in otolaryngology & head and neck surgery, 24(3), 245-249.

MacDowell, A. L., & Bacharier, L. B. (2005). Infectious triggers of asthma. Immunology and Allergy Clinics, 25(1), 45-66.

Astronomy Hw

1.The minimum distance between the Sun and Saturn is 1.4×109 km while the maximum distance between the Sun and the Earth is1.5×108 km. What is the minimum distance between the Earth and Saturn in kilometers?

kilometers

×10 

 The minimum distance between Earth and Saturn is 1.25X109 kilometers.

2.The Apollo 8 spacecraft, the first mission to take humans to the vicinity of the Moon, traveled a total distance of 9×105 kilometers in 150 hours. What is the average speed in kilometers per hour? 

×10 

km h-1 

In meters per second?

×10 

 m s-1 

LicensePoints possible: 2

3. You may remember learning in grade school that 30% of the surface of the Earth is land. (Note that the symbol for Earth is ⊕.) In other words,

 Land Area⊕=0.3×Surface Area⊕=0.3(4πR2⊕) 

Earth has a radius of R⊕=6300R⊕=6300 km.

Meanwhile, the surface area of Mars is

 Surface Area of Mars=1.4×108 square kilometers.

What is the ratio of the Earth's land area to Martian land area?

In other words, calculate

 Land Area⊕Land AreaMarsLand Area⊕Land AreaMars =   

LicensePoints possible: 1

“Silent Killer -malaria”

Silent Killer – Malaria

Writer’s Name

Silent Killer – Malaria

Malaria is a silent killer disease, a scourge in hiding. Majority of malaria related deaths occur in Africa and Southeast Asia. It is preventable and treatable yet is known as the biggest cause of mortalities worldwide. Mosquitoes are not restricted by borders rather they can migrate to and spread disease at places no one has ever thought of. Thus it is a global concern to diagnose, treat and prevent malaria. It is a centuries long old disease and mankind has suffered drastically by malaria epidemics. The studies of this disease document back to Chinese literature from 2700BC, Mesopotamia from 2000BC, Egypt from 1570BC and Hindu texts from 600BC. But all these centuries, malaria was regarded as a disease caused by miasmas. But the discovery of bacteria in 1676 and advancement of germ theory of infection in 1878-79, incurred the research for finding the cause of malaria. This study picked up pace when parasites were discovered in 1880 and the formulation of theory that mosquitoes could play as vectors in birds and humans from1898 to 1900 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eCTxGJrI","properties":{"formattedCitation":"(Cox)","plainCitation":"(Cox)","noteIndex":0},"citationItems":[{"id":33,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/KWT7AP2H"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/KWT7AP2H"],"itemData":{"id":33,"type":"article-journal","title":"History of the discovery of the malaria parasites and their vectors","container-title":"Parasites & Vectors","page":"5","volume":"3","issue":"1","source":"BioMed Central","abstract":"Malaria is caused by infection with protozoan parasites belonging to the genus Plasmodium transmitted by female Anopheles species mosquitoes. Our understanding of the malaria parasites begins in 1880 with the discovery of the parasites in the blood of malaria patients by Alphonse Laveran. The sexual stages in the blood were discovered by William MacCallum in birds infected with a related haematozoan, Haemoproteus columbae, in 1897 and the whole of the transmission cycle in culicine mosquitoes and birds infected with Plasmodium relictum was elucidated by Ronald Ross in 1897. In 1898 the Italian malariologists, Giovanni Battista Grassi, Amico Bignami, Giuseppe Bastianelli, Angelo Celli, Camillo Golgi and Ettore Marchiafava demonstrated conclusively that human malaria was also transmitted by mosquitoes, in this case anophelines. The discovery that malaria parasites developed in the liver before entering the blood stream was made by Henry Shortt and Cyril Garnham in 1948 and the final stage in the life cycle, the presence of dormant stages in the liver, was conclusively demonstrated in 1982 by Wojciech Krotoski. This article traces the main events and stresses the importance of comparative studies in that, apart from the initial discovery of parasites in the blood, every subsequent discovery has been based on studies on non-human malaria parasites and related organisms.","DOI":"10.1186/1756-3305-3-5","ISSN":"1756-3305","journalAbbreviation":"Parasites & Vectors","author":[{"family":"Cox","given":"Francis EG"}],"issued":{"date-parts":[["2010",2,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Cox). It is imperative as disciples of science to understand the development, life cycle and transmission pattern of the disease. It is of grave concern that though malaria is curable and can be prevented, yet it spreads out in sporadic events worldwide.

The first significant and notable incidents of malaria outbreak that shook the entire United States premier and medical researchers was during Civil War. Hundreds and thousands of soldiers fell to malaria and also spread the disease in the entire continent. It is said that malaria arrived from African rain forests to the Mediterranean, east to the Crescent and north to Greece, then Greek colonists carried it to Italy and then Roman cavalries brought it to England and Denmark. America had no records of incidence of malaria until the New World immigrants, colonists and African slaves arrived. After the first outbreak, until hydroelectric power and developments in the rural south by the 1930s, malaria had exhausted physical and financial health of the whole region. But once again, malaria reclaimed concern during World War II. More infantries lost to malaria than to enemies. That is when American government intervened and Centers for Disease Control and Prevention (CDC) was established ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vy7HhMyu","properties":{"formattedCitation":"(Panosian and Gelband)","plainCitation":"(Panosian and Gelband)","noteIndex":0},"citationItems":[{"id":35,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/RUAK8DD6"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/RUAK8DD6"],"itemData":{"id":35,"type":"chapter","title":"A Brief History of Malaria","container-title":"Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance","publisher":"National Academies Press (US)","source":"www.ncbi.nlm.nih.gov","URL":"https://www.ncbi.nlm.nih.gov/books/NBK215638/","language":"en","author":[{"family":"Panosian","given":"Claire"},{"family":"Gelband","given":"Hellen"}],"issued":{"date-parts":[["2004"]]},"accessed":{"date-parts":[["2019",9,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Panosian and Gelband).

After the loss of thousands of US troops from malaria in Africa and South Pacific, the public health service started its research on the development and utilization of synthetic antimalarial drug Quinine and residual insecticides DDT. Scientists made huge stride in their efforts for controlling malaria and yellow fever. The United States Public Health Service (USPHS) conducted investigations and activities for reducing the rate of incidence of malaria. The Tennessee Valley Authority (TVA) took control of establishment of hydroelectric power project and improving land and spillways for development of remote region. They organized an effective program for controlling malaria and by 1947, malaria was eliminated from the region. Breeding sites of mosquitoes were removed by water levels control system and application of insecticides. CDC mainly worked on the complete eradication plans of malaria after the successful reduction of malaria incidence. Then they started designing projects for monitoring, prevention and medical support both nationally and globally. As part of the National Malaria Eradication Program, house spray applications were made and by 1951, it was stated that malaria had completely been eradicated from the United States. Currently, these public health organizations are conducting research programs based on revised interventions, surveys and statistical analysis. Field based investigations help in developing strategies for understanding dynamics of malarial transmissions, emergence, drug resistance pattern and immune responses. CDC has established its research laboratories worldwide to eradicate the evil once and for all ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"piyHSWyo","properties":{"formattedCitation":"(\\uc0\\u8220{}CDC - Malaria - About Malaria - History\\uc0\\u8221{})","plainCitation":"(“CDC - Malaria - About Malaria - History”)","noteIndex":0},"citationItems":[{"id":37,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/W6VWSNCN"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/W6VWSNCN"],"itemData":{"id":37,"type":"webpage","title":"CDC - Malaria - About Malaria - History","container-title":"cdc.gov","abstract":"History of malaria from ancient history through the elimination of malaria in the United States highlighting the major scientific breakthroughs and the on going efforts for eradication.","URL":"https://www.cdc.gov/malaria/about/history/index.html","language":"en-us","issued":{"date-parts":[["2019",7,29]]},"accessed":{"date-parts":[["2019",9,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“CDC - Malaria - About Malaria - History”).

The latest report of the World Health Organization published in November 2018, 219 million cases of malaria were reported in the year 2017 and the estimated malaria based mortality stood at 435,000 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"rtrOv1hy","properties":{"formattedCitation":"(\\uc0\\u8220{}Fact Sheet about Malaria\\uc0\\u8221{})","plainCitation":"(“Fact Sheet about Malaria”)","noteIndex":0},"citationItems":[{"id":39,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/9X969HRV"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/9X969HRV"],"itemData":{"id":39,"type":"webpage","title":"Fact sheet about Malaria","container-title":"Word Health Organization","abstract":"Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female mosquitoes.","URL":"https://www.who.int/news-room/fact-sheets/detail/malaria","language":"en","issued":{"date-parts":[["2019",3]]},"accessed":{"date-parts":[["2019",9,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (“Fact Sheet about Malaria”). Approximately 1700 cases of malaria are reported each year in United States according to the recent CDC report. The latest malaria outbreak which is an epidemic, took place in the start of the year 2019 in Burundi where over 5.7 million people, almost half of the population, have caught the malarial infection ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iyXaxWlt","properties":{"formattedCitation":"(Lok and Dijk)","plainCitation":"(Lok and Dijk)","noteIndex":0},"citationItems":[{"id":41,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/RLSRRDFA"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/RLSRRDFA"],"itemData":{"id":41,"type":"article-journal","title":"Malaria outbreak in Burundi reaches epidemic levels with 5.7 million infected this year","container-title":"BMJ","page":"l5104","volume":"366","source":"www.bmj.com","DOI":"10.1136/bmj.l5104","ISSN":"0959-8138, 1756-1833","note":"PMID: 31399412","journalAbbreviation":"BMJ","language":"en","author":[{"family":"Lok","given":"Pat"},{"family":"Dijk","given":"Stijntje"}],"issued":{"date-parts":[["2019",8,9]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Lok and Dijk). There is currently 164% increase in the cases reported in the 29th week of 2019. Burundi is a non-coastal country amidst the African Great Lakes area at the conversion of East and Central Africa. This outbreak hasn’t been yet reached to United Stated but the Government has implemented a pre-departure vaccination program, travel medications and counselling program. The US diplomats working in Burundi are subjected to many limitations for receiving emergency services ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fJl63r58","properties":{"formattedCitation":"(Reiter)","plainCitation":"(Reiter)","noteIndex":0},"citationItems":[{"id":44,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/MT83J6GU"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/MT83J6GU"],"itemData":{"id":44,"type":"webpage","title":"Burundi’s Malaria Epidemic Reaches 50% of the Population","container-title":"vaxbeforetravel","abstract":"Travel Alerts for Burundi issued by the CDC, Department of State, Canada, and UK","URL":"https://www.vaxbeforetravel.com/travel-alerts-burundi-issued-cdc-department-state-canada-and-uk","language":"en_US","author":[{"family":"Reiter","given":"Dani"}],"issued":{"date-parts":[["2019",8,23]]},"accessed":{"date-parts":[["2019",9,21]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Reiter). Keeping in view the historical facts and current incidence rates of malaria, it is very important for all the health organizations to come together and work on the prevention and eradication of malaria.

Works Cited

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY “CDC - Malaria - About Malaria - History.” Cdc.Gov, 29 July 2019, https://www.cdc.gov/malaria/about/history/index.html.

Cox, Francis EG. “History of the Discovery of the Malaria Parasites and Their Vectors.” Parasites & Vectors, vol. 3, no. 1, Feb. 2010, p. 5. BioMed Central, doi:10.1186/1756-3305-3-5.

“Fact Sheet about Malaria.” Word Health Organization, Mar. 2019, https://www.who.int/news-room/fact-sheets/detail/malaria.

Lok, Pat, and Stijntje Dijk. “Malaria Outbreak in Burundi Reaches Epidemic Levels with 5.7 Million Infected This Year.” BMJ, vol. 366, Aug. 2019, p. l5104. www.bmj.com, doi:10.1136/bmj.l5104.

Panosian, Claire, and Hellen Gelband. “A Brief History of Malaria.” Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance, National Academies Press (US), 2004. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK215638/.

Reiter, Dani. “Burundi’s Malaria Epidemic Reaches 50% of the Population.” Vaxbeforetravel, 23 Aug. 2019, https://www.vaxbeforetravel.com/travel-alerts-burundi-issued-cdc-department-state-canada-and-uk.

• Men Vs Women And Muscle Mass: Research Says:

Men Vs Women and Muscle Mass: Research Says

Author Name(s), First M. Last, Omit Titles and Degrees

Men Vs Women and Muscle Mass: Research Says

It is undeniably true that all humans are the same however, they differ in terms of body structure and body functions. Typically, men are physically stronger as compared to women. This is because on average women have not as much of muscle mass as compared to men in terms of total body mass. The reason why men have greater mass as compared to the women is the hormone testosterone as this hormone induce muscular hypertrophy (Saladin, 2004). Additionally, men also have stronger and denser bones, ligaments and tendons.

Several studies have shown that men usually have greater and stronger muscles as compared to women however the differences tend to be more pronounced especially in the upper limbs. There many factors that influence maximum voluntary strength such as CSA that is the cross-sectional area of the muscle, specific tension or the muscle groups (Miller & Sale, 1993). Additionally, muscle groups are affected by not only the fiber type distribution but also the amount of non-contractile tissues existing in the muscles. In general, it has been observed that when comparing untrained men to untrained women, most of the untrained women tend to have smaller fiber areas of both upper and lower limbs (Miller & Sale, 1993). Similarly, trained women have less body fiber areas of both upper and lower limbs as compared to their male counterparts.

It has been observed that chronic forceful muscular contractions facilitate in escalation of the muscle contractile protein and fiber area. Thus, the smaller muscle fiber in females is due to an innate biological limitation. According to the research conducted by the author A. E.J. Miller and his fellow researchers, the greater strength of men is due to the larger fibers (Miller & Sale, 1993). However, the difference between the upper and lower limb strength is attributed to the fact that women typically have lower proportions of their lean tissues that are distributed in the upper body.

References

Miller, A. E. J., MacDougall, J. D., Tarnopolsky, M. A., & Sale, D. G. (1993). Gender differences in strength and muscle fiber characteristics. European journal of applied physiology and occupational physiology, 66(3), 254-262.

Saladin, K. S. (2004). Anatomy & physiology: the unity of form and function.

Bacterial Meningitis

Bacterial Meningitis

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Meningitis is the clinical condition when the meninges undergo inflammation due to severe infection. Meninges can be defined as the membranes surrounding the brain and spinal cord. To be specific, meningitis occurs due to infection of the subarachnoid space filled with cerebrospinal fluid (CSF). Due to close relationship of the CSF and the brain tissue, meningitis can also include the parenchyma as well as the brain cortex. CITATION Die16 \l 1033 (Diederik van de Beek, 2016) Classic symptoms of meningitis include neck stiffness, fever and headaches. Owing to the sensitive nature of the nervous system tissue, a chronic inflammation of the meninges incidentally leads to several other clinical aberrations. Prognosis of meningitis, if left untreated, can hence prove to be fatal within a few days. Meningitis is primarily caused by viral infection, but other causes are bacterial or fungal infection. Bacterial meningitis is when the CSF is infected by bacteria that have already infiltrated the circulatory system. Causative bacterial species majorly associated with bacterial meningitis include Streptococcus pneumoniae, Neisseria meningitidis, Streptococcus agalactiae, Listeria monocytogenes, Staphylococcus aureus and Hemophilus influenzae.

Treatment:

The primary approach adopted for the treatment of bacterial meningitis is elimination of the infectious bacterial species. It is therefore based on an antibiotic treatment. Antibiotics are prescribe in the form of a regimen that can normally extend to two weeks. These drugs can be administered intravenously and also given through bolus administration. This treatment can then be categorized into two types: empiric or specific antibiotic treatment. CITATION Dva16 \l 1033 (D. van de Beek, 2016)

The empiric antibiotic treatment depends on the patient age and what geological region the patient belongs to. If the patient belongs to an area where susceptibility to Streptococcus pneumoniae is more than normal, the antibiotic prescribed will be different. Since the bacterial specie most commonly accredited to bacterial meningitis is Streptococcus pneumoniae, the antibiotic is also one that caters to this specie. However, in adults above 50 where a risk factor for Listeria monocytogenes may exist, a different antibiotic treatment is used. This type of antibiotic treatment is recommended if the identification of the causative agent is proving to be difficult or problematic. Some patients can be culture negative and one cannot identify the root cause of the infection from samples taken from patient. In this case, generally a two-week regimen of empiric antibiotics is recommended.

Specific antibiotic treatment can be prescribed if the causative bacterial specie can be identified. This is done after the exact identification of the bacterial species responsible for that case of meningitis by antibiotic susceptibility testing or via identification of bacterial culture obtained from the patient. For Streptococcus pneumoniae, the drug used is amoxicillin or ampicillin and ceftriaxone. This is the species with the greatest number of cases so its variations in bacterial meningitis are also several. If the bacteria responsible are resistant to cephalosporin, the antibiotics used must be changed to vancomycin and rifampicin. For Neisseria meningitidis, the prescribed drugs are penicillin or amoxicillin. For Listeria monocytogenes, the antibiotic used for specific treatment is amoxicillin or penicillin G. For Hemophilus influenzae, the drugs used are amoxicillin or ceftriaxone. To treat bacterial meningitis caused by Staphylococcus aureus, the common protocol is to use flucloxacillin or vancomycin.

However, other treatment options are also employed in addition to antibiotic administration. The most widely accepted method for the adjunctive treatment of bacterial meningitis is the dexamethasone treatment. This treatment is based on the idea that the effect of meningitis is as severe as the inflammation in the meninges. CITATION BBM11 \l 1033 (BB Mook-Kanamori, 2011) Therefore, immunological modulation can reduce the mortality of the disease and effectively help the ongoing antibiotic treatment. Dexamethasone is a corticosteroid and is hence used for this purpose. There is clear indication of relief via dexamethasone in bacterial meningitis caused by Streptococcus pneumoniae and there is dispute on using this treatment for causative species other than this one. Some studies prove that the use of dexamethasone reduces neurologic sequelae from bacterial meningitis of all causative species. CITATION MCB13 \l 1033 (MC Brouwer, 2013)

Other adjunctive treatment methods include the use of osmotic agents to reduce and control the cranial pressure. Paracetamol also improves prognosis of the disease by controlling inflammation and reducing fever. In several cases, monitoring the intracranial pressure can be lifesaving.

One other adjunctive therapy method associated with diet is the use of ketogenic diets in patients with the idea that this diet will increase energy provision to the brain and decrease mortality rates. This can also lead to reduced neurological sequelae after the meningitis has been treated. CITATION Jia16 \l 1033 (Jiaying Feng, 2016)

Therefore, there are several drugs prescribed and used for the treatment of bacterial meningitis and surgery is not a viable option for treatment since this disease is about inflammation of membranes in the central nervous system. Moreover, the influence of diet on the incident of bacterial meningitis is also irrelevant since this is an infectious disease and its treatment and cure is primarily related to elimination of the species causing the infection.

Prevention:

The primary method of prevention of an incident of bacterial meningitis is simply by administration of vaccines for the bacterial species that could subsequently lead to an episode of bacterial meningitis. Some patients can have a greater susceptibility to bacterial meningitis as compared to other patients. This can primarily happen because of continuous exposure to a patient with bacterial meningitis. Therefore, preventative measures are intensely recommended for family members of a bacterial meningitis patient. Moreover, genetic susceptibility factors to certain bacterial species that can cause bacterial meningitis can also prove to be a major incentive to undergo preventative methods to ensure that the morbidity and mortality that bacterial meningitis brings can be avoided. There can also be prior physical susceptibility factors (for example, leak of cerebrospinal fluid owing to injury or surgery). Prevention is unquestionable in this case as well.

There is evidence to prove that the risk of contracting bacterial meningitis increases 400-800-fold when a family member becomes a patient. CITATION TAZ13 \l 1033 (TA Zalmanovici, 2013) In order to control this risk, antibiotics can be provided as a preventative measure. The prophylactic antibodies most commonly used in this case are ciprofloxacin and rifampicin.

Vaccines are, however, the most potent preventative measure. Conjugate vaccines are commonly used for this purpose as their discovery and increased use for bacterial meningitis is what has brought the global disease rates down. CITATION NGM14 \l 1033 (NG Martin, 2014) A conjugate vaccine can be defined as a vaccine that has an additional polypeptide attached to the purified polysaccharide of the bacterial capsule. This leads to an immunological response that is much more profound and effective than one brought about by a normal vaccine for that bacterial specie. The type of vaccines used for bacterial meningitis caused by Streptococcus pneumoniae is called the Pneumococcal conjugate vaccines or PCV. For other causative bacterial species leading to bacterial meningitis, Meningococcal conjugate vaccines are used for Neisseria meningitidis while Hemophilus conjugate vaccines are used for bacterial meningitis caused by Hemophilus influenzae. CITATION Fio16 \l 1033 (Fiona McGill, 2016)

The recurrence of meningitis is a rare but possible cause of worry. Generally, the chances of meningitis returning to a patient are around 5%. Therefore, although bacterial meningitis can be completely treated, it does leave several neurological sequelae in the form of hearing loss or other vital brain functions. The chance of recurrence, no matter how small, is still a cause of alarm. Therefore, in treated patients of bacterial meningitis as well, vaccination comes highly recommended. CITATION Dva16 \l 1033 (D. van de Beek, 2016)

References

BIBLIOGRAPHY BB Mook-Kanamori, M. G. (2011). Pathogenesis and pathophysiology of pneumococcal meningitis. Clinical Microbiology Review, 557-591.

D. van de Beek, C. C. (2016). ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clinical Microbiology and Infection, S37-S62.

Diederik van de Beek, M. B. (2016). Community-acquired bacterial meningitis. Nature Reviews Disease Primers, 16074-16094.

Fiona McGill, B. R. (2016). Acute bacterial meningitis in adults. The Lancet, 3036-3047.

Jiaying Feng, J. L. (2016). Adjunct Therapy with Ketogenic Diet to Infant Bacterial Meningitis. Journal of Pregnancy and Child Health .

MC Brouwer, P. M. (2013). Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev.

NG Martin, M. S. (2014). Hospital admission rates for meningitis and speticaemia caused by Haemophilus infl uenzae, Neisseria meningitidis, and Streptococcus pneumoniae in children in England over fi ve decades: a population-based observational study. Lancet Infectious Diseases, 397-405.

TA Zalmanovici, A. F.-G. (2013). Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev.

BBB: EXPLAIN THE SIGNIFIGANCE OF THE BRAIN BARRIER SYSTEM

Significance of the Brain Barrier System

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Author Note

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Significance of the Brain Barrier System

It is quite astonishing how a small part such as the Brain Barrier System is recognized as one of the most important systems which ensures the proper functioning and development of the human brain and body. The barrier systems of the brain also comprise the Blood-Brain Barrier which is a semi-permeable membrane that separates the extracellular fluid of CNS from the circulating blood. According to the studies, various functions of the nervous system, most importantly nerve impulse transmission, require the proper balance of ionic concentrations which contributes towards environmental stability ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"jm571QSY","properties":{"formattedCitation":"(Saunders, Habgood, M\\uc0\\u248{}llg\\uc0\\u229{}rd, & Dziegielewska, 2016)","plainCitation":"(Saunders, Habgood, Møllgård, & Dziegielewska, 2016)","noteIndex":0},"citationItems":[{"id":361,"uris":["http://zotero.org/users/local/CKNkWnK9/items/E4ZCK59N"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/E4ZCK59N"],"itemData":{"id":361,"type":"article-journal","title":"The biological significance of brain barrier mechanisms: help or hindrance in drug delivery to the central nervous system?","container-title":"F1000Research","volume":"5","source":"PubMed Central","abstract":"Barrier mechanisms in the brain are important for its normal functioning and development. Stability of the brain’s internal environment, particularly with respect to its ionic composition, is a prerequisite for the fundamental basis of its function, namely transmission of nerve impulses. In addition, the appropriate and controlled supply of a wide range of nutrients such as glucose, amino acids, monocarboxylates, and vitamins is also essential for normal development and function. These are all cellular functions across the interfaces that separate the brain from the rest of the internal environment of the body. An essential morphological component of all but one of the barriers is the presence of specialized intercellular tight junctions between the cells comprising the interface: endothelial cells in the blood-brain barrier itself, cells of the arachnoid membrane, choroid plexus epithelial cells, and tanycytes (specialized glial cells) in the circumventricular organs. In the ependyma lining the cerebral ventricles in the adult brain, the cells are joined by gap junctions, which are not restrictive for intercellular movement of molecules. But in the developing brain, the forerunners of these cells form the neuroepithelium, which restricts exchange of all but the smallest molecules between cerebrospinal fluid and brain interstitial fluid because of the presence of strap junctions between the cells. The intercellular junctions in all these interfaces are the physical basis for their barrier properties. In the blood-brain barrier proper, this is combined with a paucity of vesicular transport that is a characteristic of other vascular beds. Without such a diffusional restrain, the cellular transport mechanisms in the barrier interfaces would be ineffective. Superimposed on these physical structures are physiological mechanisms as the cells of the interfaces contain various metabolic transporters and efflux pumps, often ATP-binding cassette (ABC) transporters, that provide an important component of the barrier functions by either preventing entry of or expelling numerous molecules including toxins, drugs, and other xenobiotics., In this review, we summarize these influx and efflux mechanisms in normal developing and adult brain, as well as indicating their likely involvement in a wide range of neuropathologies., There have been extensive attempts to overcome the barrier mechanisms that prevent the entry of many drugs of therapeutic potential into the brain. We outline those that have been tried and discuss why they may so far have been largely unsuccessful. Currently, a promising approach appears to be focal, reversible disruption of the blood-brain barrier using focused ultrasound, but more work is required to evaluate the method before it can be tried in patients. Overall, our view is that much more fundamental knowledge of barrier mechanisms and development of new experimental methods will be required before drug targeting to the brain is likely to be a successful endeavor. In addition, such studies, if applied to brain pathologies such as stroke, trauma, or multiple sclerosis, will aid in defining the contribution of brain barrier pathology to these conditions, either causative or secondary.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786902/","DOI":"10.12688/f1000research.7378.1","ISSN":"2046-1402","note":"PMID: 26998242\nPMCID: PMC4786902","title-short":"The biological significance of brain barrier mechanisms","journalAbbreviation":"F1000Res","author":[{"family":"Saunders","given":"Norman R."},{"family":"Habgood","given":"Mark D."},{"family":"Møllgård","given":"Kjeld"},{"family":"Dziegielewska","given":"Katarzyna M."}],"issued":{"date-parts":[["2016",3,10]]},"accessed":{"date-parts":[["2019",11,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Saunders, Habgood, Møllgård, & Dziegielewska, 2016). Furthermore, it is depicted that the system is also involved in other functions associated with normal development such as transfer of amino acids, glucose, carboxylates, and vitamins. These functions occur in a different environment which is separated from the internal processes of the body.

If we go in depth in order to understand the structure of Brain Barrier system which contributes towards its function, we will find that it comprises of small dedicated tight connections present between the cells with the following interface: blood-brain barrier comprised endothelial cells, arachnoid membrane cells, epithelial cells of choroid plexus, and particular glial cells ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"icaM4R35","properties":{"formattedCitation":"(Saunders et al., 2016)","plainCitation":"(Saunders et al., 2016)","noteIndex":0},"citationItems":[{"id":361,"uris":["http://zotero.org/users/local/CKNkWnK9/items/E4ZCK59N"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/E4ZCK59N"],"itemData":{"id":361,"type":"article-journal","title":"The biological significance of brain barrier mechanisms: help or hindrance in drug delivery to the central nervous system?","container-title":"F1000Research","volume":"5","source":"PubMed Central","abstract":"Barrier mechanisms in the brain are important for its normal functioning and development. Stability of the brain’s internal environment, particularly with respect to its ionic composition, is a prerequisite for the fundamental basis of its function, namely transmission of nerve impulses. In addition, the appropriate and controlled supply of a wide range of nutrients such as glucose, amino acids, monocarboxylates, and vitamins is also essential for normal development and function. These are all cellular functions across the interfaces that separate the brain from the rest of the internal environment of the body. An essential morphological component of all but one of the barriers is the presence of specialized intercellular tight junctions between the cells comprising the interface: endothelial cells in the blood-brain barrier itself, cells of the arachnoid membrane, choroid plexus epithelial cells, and tanycytes (specialized glial cells) in the circumventricular organs. In the ependyma lining the cerebral ventricles in the adult brain, the cells are joined by gap junctions, which are not restrictive for intercellular movement of molecules. But in the developing brain, the forerunners of these cells form the neuroepithelium, which restricts exchange of all but the smallest molecules between cerebrospinal fluid and brain interstitial fluid because of the presence of strap junctions between the cells. The intercellular junctions in all these interfaces are the physical basis for their barrier properties. In the blood-brain barrier proper, this is combined with a paucity of vesicular transport that is a characteristic of other vascular beds. Without such a diffusional restrain, the cellular transport mechanisms in the barrier interfaces would be ineffective. Superimposed on these physical structures are physiological mechanisms as the cells of the interfaces contain various metabolic transporters and efflux pumps, often ATP-binding cassette (ABC) transporters, that provide an important component of the barrier functions by either preventing entry of or expelling numerous molecules including toxins, drugs, and other xenobiotics., In this review, we summarize these influx and efflux mechanisms in normal developing and adult brain, as well as indicating their likely involvement in a wide range of neuropathologies., There have been extensive attempts to overcome the barrier mechanisms that prevent the entry of many drugs of therapeutic potential into the brain. We outline those that have been tried and discuss why they may so far have been largely unsuccessful. Currently, a promising approach appears to be focal, reversible disruption of the blood-brain barrier using focused ultrasound, but more work is required to evaluate the method before it can be tried in patients. Overall, our view is that much more fundamental knowledge of barrier mechanisms and development of new experimental methods will be required before drug targeting to the brain is likely to be a successful endeavor. In addition, such studies, if applied to brain pathologies such as stroke, trauma, or multiple sclerosis, will aid in defining the contribution of brain barrier pathology to these conditions, either causative or secondary.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786902/","DOI":"10.12688/f1000research.7378.1","ISSN":"2046-1402","note":"PMID: 26998242\nPMCID: PMC4786902","title-short":"The biological significance of brain barrier mechanisms","journalAbbreviation":"F1000Res","author":[{"family":"Saunders","given":"Norman R."},{"family":"Habgood","given":"Mark D."},{"family":"Møllgård","given":"Kjeld"},{"family":"Dziegielewska","given":"Katarzyna M."}],"issued":{"date-parts":[["2016",3,10]]},"accessed":{"date-parts":[["2019",11,27]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Saunders et al., 2016). These interfaces form the basis of Brain Barrier systems. It is mainly associated with the inhibition of vesicular transport which is needed for the other vascular systems. These cells present on the interface, contain special structures such as Efflux Pumps and Transporters sometimes ATP binding Cassette transporter which contributes towards providing a significant feature of barrier functions by inhibiting the influx and efflux of various toxins and other drugs.

Various precautions have been recommended by the author to ensure the protection of the Blood-Brain Barrier which should be taken under consideration as BBB is the vulnerable part of the body whose survival mainly relies on its functionality.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Saunders, N. R., Habgood, M. D., Møllgård, K., & Dziegielewska, K. M. (2016). The biological significance of brain barrier mechanisms: Help or hindrance in drug delivery to the central nervous system? F1000Research, 5. https://doi.org/10.12688/f1000research.7378.1

Benefits Of Aerobic And Anaerobic Exercise

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Benefits of Aerobic and Anaerobic Exercise

With the advances in science and technology, various methods of exercises have been developed that are reported to influence the human body in different ways ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Ykd3LISB","properties":{"formattedCitation":"(Siddiqui et al.)","plainCitation":"(Siddiqui et al.)","noteIndex":0},"citationItems":[{"id":267,"uris":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"itemData":{"id":267,"type":"article-journal","title":"Regular physical exercise: way to healthy life.","container-title":"Mymensingh medical journal : MMJ","page":"154-158","volume":"19","issue":"1","source":"europepmc.org","abstract":"Abstract: Any bodily activity or movement that enhances and maintains overall health and physical fitness is called physical exercise. Habit of regular...","ISSN":"1022-4742","note":"PMID: 20046192","title-short":"Regular physical exercise","journalAbbreviation":"Mymensingh Med J","language":"eng","author":[{"family":"Siddiqui","given":"N. I."},{"family":"Nessa","given":"A."},{"family":"Hossain","given":"M. A."}],"issued":{"date-parts":[["2010",1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Siddiqui et al.). Two such exercises are Aerobic and anaerobic. The former promotes pumping of blood throughout the body which increases the working of muscles. Abrupt walking, swimming, cleaning, running, cycling and playing athletics are some of the forms of aerobic exercise. Every human is recommended to get an average of 180 minutes of aerobic exercise ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"HEJK56kk","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.). The latter represents any activity that contributes towards glucose breakdown without an expense of oxygen. It mainly includes exercises with a shorter period and greater intensity. Weightlifting, sprinting, jumping, biking and high-intensity interval training are some of the examples of anaerobic exercises ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"b1hCSIr5","properties":{"formattedCitation":"(Siddiqui et al.)","plainCitation":"(Siddiqui et al.)","noteIndex":0},"citationItems":[{"id":267,"uris":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"itemData":{"id":267,"type":"article-journal","title":"Regular physical exercise: way to healthy life.","container-title":"Mymensingh medical journal : MMJ","page":"154-158","volume":"19","issue":"1","source":"europepmc.org","abstract":"Abstract: Any bodily activity or movement that enhances and maintains overall health and physical fitness is called physical exercise. Habit of regular...","ISSN":"1022-4742","note":"PMID: 20046192","title-short":"Regular physical exercise","journalAbbreviation":"Mymensingh Med J","language":"eng","author":[{"family":"Siddiqui","given":"N. I."},{"family":"Nessa","given":"A."},{"family":"Hossain","given":"M. A."}],"issued":{"date-parts":[["2010",1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Siddiqui et al.).

Aerobic and anaerobic exercises differ in terms of the availability of oxygen ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"9WYllRvf","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.). Aerobic exercise increases the metabolism of the body by stimulating blood pumping throughout the body in the presence of already available oxygen ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"GW4eqZLg","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.). On the other hand, anaerobic exercises make use of surplus oxygen stored in muscles to stimulate metabolic rate. Studies have shown the merits and demerits of both exercises based on energy level. This paper takes into account the benefits of both aerobic and anaerobic exercises.

Aerobic Exercise

Cardiovascular Health Enhancement

Studies have shown that aerobic exercise is beneficial for improving cardiovascular health ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"juhLCCI6","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). People who suffer from heart maladies are recommended to spend 4 -5 minutes getting aerobic exercise which is thought to clear the arteries of unnecessary fat blockage for the efficient flow of blood through the human body. This not only makes the heart strong but also gets rid of bad cholesterol and retains good cholesterol in the blood.

Lowering of Blood Pressure

High blood pressure is an indication of a weak cardiovascular system. Aerobic Exercise prevents the risk of high blood pressure by decreasing the flow of blood through the arteries ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"EzVCqefe","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). This is recognized as one of the efficient ways to lower blood pressure.

Regulation of Blood Glucose

While considering the normal body weight, aerobic exercise is thought to regulate the levels of insulin in the human body. It helps to reduce blood sugar levels. According to the studies, both aerobic and anaerobic exercises have proved beneficial for patients with diabetes ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BUkd1DsH","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.).

Relief of Asthma Symptoms

Many studies have contributed towards demonstrating the effects of aerobic exercise on the respiratory system ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"eQ0pt0kp","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). It helps patients with asthma relief their symptoms by reducing the occurrence as well as intensity of asthma attacks. However, it is reported that specific precautions are to be taken into consideration regarding exercise in this case.

Chronic Pain Relief

In many instances, Consistent Aerobic exercise has contributed to the relief of chronic pain. This mainly includes less influenced physical activities such as swimming and brisk walking. Aerobic exercise has a significant effect on muscle function which improves its endurance and flexibility.

Improvement of Sleep

Doing exercise almost 2 hours before going to sleep might improve sleep quality and duration. According to studies, some individuals reported that after getting plenty of exercise in the day time, they were able to sleep more efficiently ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"i69yCkAM","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). Individuals also feel more energetic during the day with a sensation of wakefulness.

Weight Loss

It is evident from many studies that aerobic exercise plays a significant role in losing weight ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pur6QBhy","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). During exercise, the body's metabolism is at the highest rate. Due to this efficient metabolism, most of the body fat is lost in the form of energy during exercise. It has proven beneficial irrespective of a diet plan.

Improvement of Immune System Function

Aerobic respiration promotes the production of various antibody proteins in the human body which are known as an immunoglobulin ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fiunK7m3","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.). These proteins are the essential component of the immune system which strengthen the body's response towards invading microbes. Various studies performed on middle aged individuals have proved to improve their immune system function as a result of physical activity ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Dp5g2KGi","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.).

Prevention of Sudden Mood Changes

Physical activities such as walking, swimming running etc. help a person improve their mood by the release of specific chemical neurotransmitters such as dopamine and endorphins. Dopamine and endorphins boost mood and prevent depression. This has been reported by many subjects in a controlled study ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qsqJcWns","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway).

Anaerobic Exercise

Bone Density and Strength Improvement

Activities characterized as an anaerobic exercise such as weightlifting help a person improve bone density and strength which in turn contributes towards the prevention of osteoporosis. Studies have shown that anaerobic training increases the capability of bones to bear high stress and workload ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"EXT6dbla","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway). This ultimately increases the strength of bone.

Regulation of Body Weight

In anaerobic respiration, body oxygen is compensated by the breakdown of lactic acid in the muscles which is used to derive the anaerobic processes. In this way, lactic acid metabolism is controlled more efficiently by the body which contributes towards maintenance of healthy weight. Some studies have shown the evident effect of HIIT training on reducing body stomach fat ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"AZ5CFgOf","properties":{"formattedCitation":"(Siddiqui et al.)","plainCitation":"(Siddiqui et al.)","noteIndex":0},"citationItems":[{"id":267,"uris":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/IL3FJ8YX"],"itemData":{"id":267,"type":"article-journal","title":"Regular physical exercise: way to healthy life.","container-title":"Mymensingh medical journal : MMJ","page":"154-158","volume":"19","issue":"1","source":"europepmc.org","abstract":"Abstract: Any bodily activity or movement that enhances and maintains overall health and physical fitness is called physical exercise. Habit of regular...","ISSN":"1022-4742","note":"PMID: 20046192","title-short":"Regular physical exercise","journalAbbreviation":"Mymensingh Med J","language":"eng","author":[{"family":"Siddiqui","given":"N. I."},{"family":"Nessa","given":"A."},{"family":"Hossain","given":"M. A."}],"issued":{"date-parts":[["2010",1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Siddiqui et al.).

Strength Enhancement

Anaerobic exercise has been reported to increase body strength as a whole. Athletes who are efficiently involved in anaerobic activities have been reported to show a significant change in their strength ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8vEXWYsK","properties":{"formattedCitation":"(Norris et al.)","plainCitation":"(Norris et al.)","noteIndex":0},"citationItems":[{"id":266,"uris":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/ZGHGGTML"],"itemData":{"id":266,"type":"article-journal","title":"The effects of aerobic and anaerobic training on fitness, blood pressure, and psychological stress and well-being","container-title":"Journal of Psychosomatic Research","page":"367-375","volume":"34","issue":"4","source":"ScienceDirect","abstract":"To determine whether fitness alters psychological and physiological indices of well-being, male police officers were assigned to either an aerobic or anaerobic training condition or to a no treatment control group. The training groups met three times per week in 45 min sessions aimed at improving either cardiovascular endurance or muscle strength. Aerobic fitness level, heart rate, blood pressure and self-report of stress and well-being were measured prior to and following 10 weeks of training. Post-training fitness measures confirmed the effectiveness of training and between group differences for physiological and self-report measures were found. Subjects undergoing aerobic training evinced larger changes on the self-report measures of well-being and stress than the anaerobic trainers and both groups showed significant improvement when compared to controls. This experiment provides support for the hypothesis that exercise, and in particular aerobic exercise, has positive effects of well-being. It is suggested that future research might usefully explore the particular contribution of different aspects of the training situation to these effects.","DOI":"10.1016/0022-3999(90)90060-H","ISSN":"0022-3999","journalAbbreviation":"Journal of Psychosomatic Research","language":"en","author":[{"family":"Norris","given":"Richard"},{"family":"Carroll","given":"Douglas"},{"family":"Cochrane","given":"Raymond"}],"issued":{"date-parts":[["1990",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Norris et al.).

Promotion of Lactic Acid Metabolism

As indicated earlier, anaerobic respiration increases the amount of lactic acid breakdown in the muscles. Due to this increased breakdown, a person is less likely to experience the signs of fatigue which enables him to work harder in extreme settings ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"TgbRA4sV","properties":{"formattedCitation":"(Spurway)","plainCitation":"(Spurway)","noteIndex":0},"citationItems":[{"id":271,"uris":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/85GLHFRD"],"itemData":{"id":271,"type":"article-journal","title":"Aerobic exercise, anaerobic exercise and the lactate threshold","container-title":"British Medical Bulletin","page":"569-591","volume":"48","issue":"3","source":"academic.oup.com","abstract":"Abstract. All exercise draws first on intramuscular stores of ATP and creatine phosphate; initially these are replenished by anaerobic glycolysis. The lactic a","DOI":"10.1093/oxfordjournals.bmb.a072564","ISSN":"0007-1420","journalAbbreviation":"Br Med Bull","language":"en","author":[{"family":"Spurway","given":"N. C."}],"issued":{"date-parts":[["1992",1,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Spurway).

Works Cited:

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Norris, Richard, et al. “The Effects of Aerobic and Anaerobic Training on Fitness, Blood Pressure, and Psychological Stress and Well-Being.” Journal of Psychosomatic Research, vol. 34, no. 4, Jan. 1990, pp. 367–75. ScienceDirect, doi:10.1016/0022-3999(90)90060-H.

Siddiqui, N. I., et al. “Regular Physical Exercise: Way to Healthy Life.” Mymensingh Medical Journal : MMJ, vol. 19, no. 1, Jan. 2010, pp. 154–58.

Spurway, N. C. “Aerobic Exercise, Anaerobic Exercise and the Lactate Threshold.” British Medical Bulletin, vol. 48, no. 3, Jan. 1992, pp. 569–91. academic.oup.com, doi:10.1093/oxfordjournals.bmb.a072564.

.

Biology

Withdrawal of Mechanical Ventilation in the Neonate/ Pediatric Patient

[Institutional Affiliation(s)]

Author Note

[Include any grant/funding information and a complete correspondence address.]

Withdrawal of Mechanical Ventilation in the Neonate/ Pediatric Patient

The process of mechanical ventilation is considered as a key method of innovative life sustenance in the Emergency Unit ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"p5FG6h3w","properties":{"formattedCitation":"(Munson, 2007)","plainCitation":"(Munson, 2007)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"itemData":{"id":461,"type":"article-journal","container-title":"Pediatric Clinics of North America","DOI":"10.1016/j.pcl.2007.08.001","ISSN":"00313955","issue":"5","journalAbbreviation":"Pediatric Clinics of North America","language":"en","page":"773-785","source":"DOI.org (Crossref)","title":"Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units","volume":"54","author":[{"family":"Munson","given":"David"}],"issued":{"date-parts":[["2007",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Munson, 2007). However, some extremely ill patients that receive mechanical ventilation recover successfully. Several others either die still using it or they are ultimately left to wait for their death by withdrawing the process of mechanical ventilation. In a medical setting, withdrawal of this form of sustenance is a usual practice which leaves patient expecting his death ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"sWje0EBT","properties":{"formattedCitation":"(Burns et al., 2000)","plainCitation":"(Burns et al., 2000)","noteIndex":0},"citationItems":[{"id":468,"uris":["http://zotero.org/users/local/CKNkWnK9/items/32NQU9MV"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/32NQU9MV"],"itemData":{"id":468,"type":"article-journal","abstract":"OBJECTIVE: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn.\nSTUDY DESIGN: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record.\nRESULTS: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians and nurses cited treatment of pain, anxiety, and air hunger as the most common reasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an \"acceptable, unintended side effect\" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death.\nCONCLUSION: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.","container-title":"Critical Care Medicine","DOI":"10.1097/00003246-200008000-00064","ISSN":"0090-3493","issue":"8","journalAbbreviation":"Crit. Care Med.","language":"eng","note":"PMID: 10966296","page":"3060-3066","source":"PubMed","title":"End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment","volume":"28","author":[{"family":"Burns","given":"J. P."},{"family":"Mitchell","given":"C."},{"family":"Outwater","given":"K. M."},{"family":"Geller","given":"M."},{"family":"Griffith","given":"J. L."},{"family":"Todres","given":"I. D."},{"family":"Truog","given":"R. D."}],"issued":{"date-parts":[["2000",8]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Burns et al., 2000). Studies suggest that the factors that influence the physician's decision to withdraw mechanical ventilation include the severity of patient's disease, chronic problems associated with the disease, patient's age, patient's desires, and the future quality of life. Moreover, it is also established that physicians might withdraw the interventions that are aggressive and costly if the condition of the patient does not seem to improve. Interventions that are associated with physician specialization, often become the reason for the physician’s decision of withdrawing the mechanical ventilation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"p6oWAzTp","properties":{"formattedCitation":"(Medford, 2003)","plainCitation":"(Medford, 2003)","noteIndex":0},"citationItems":[{"id":470,"uris":["http://zotero.org/users/local/CKNkWnK9/items/G92U9XYN"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/G92U9XYN"],"itemData":{"id":470,"type":"article-journal","abstract":"▴ Cook D, Rocker G, Marshall J, et al . Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med2003;349:1123–32\n\n[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]\n\n\n\nEight hundred and fifty one consecutive patients mechanically ventilated for at least 72 hours in intensive care units in 15 different centres were prospectively followed. The relation between various factors and withdrawal of mechanical ventilation was assessed using …\n\n [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DCook%26rft.auinit1%253DD.%26rft.volume%253D349%26rft.issue%253D12%26rft.spage%253D1123%26rft.epage%253D1132%26rft.atitle%253DWithdrawal%2Bof%2BMechanical%2BVentilation%2Bin%2BAnticipation%2Bof%2BDeath%2Bin%2Bthe%2BIntensive%2BCare%2BUnit%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa030083%26rft_id%253Dinfo%253Apmid%252F13679526%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\n [2]: /lookup/external-ref?access_num=10.1056/NEJMoa030083&link_type=DOI\n [3]: /lookup/external-ref?access_num=13679526&link_type=MED&atom=%2Fthoraxjnl%2F58%2F12%2F1041.atom\n [4]: /lookup/external-ref?access_num=000185369700005&link_type=ISI","container-title":"Thorax","DOI":"10.1136/thorax.58.12.1041","ISSN":"0040-6376, 1468-3296","issue":"12","language":"en","page":"1041-1041","source":"thorax.bmj.com","title":"Factors associated with physicians’ decisions to withdraw mechanical ventilation in anticipation of death","volume":"58","author":[{"family":"Medford","given":"A. R. L."}],"issued":{"date-parts":[["2003",12,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Medford, 2003).

Studies state that it is understood that withdrawal practice affects the patient in many ways, however, family suffers from another kind of pain ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"aVy9fyk1","properties":{"formattedCitation":"(Newborn, 2007)","plainCitation":"(Newborn, 2007)","noteIndex":0},"citationItems":[{"id":464,"uris":["http://zotero.org/users/local/CKNkWnK9/items/W4TTBQZW"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/W4TTBQZW"],"itemData":{"id":464,"type":"article-journal","abstract":"Advances in medical technology have led to dilemmas in initiation and withdrawal of intensive care of newborn infants with a very poor prognosis. Physicians and parents together must make difficult decisions guided by their understanding of the child's best interest. The foundation for these decisions consists of several key elements: (1) direct and open communication between the health care team and the parents of the child with regard to the medical status, prognosis, and treatment options; (2) inclusion of the parents as active participants in the decision process; (3) continuation of comfort care even when intensive care is not being provided; and (4) treatment decisions that are guided primarily by the best interest of the child.","container-title":"Pediatrics","DOI":"10.1542/peds.2006-3180","ISSN":"0031-4005, 1098-4275","issue":"2","language":"en","note":"PMID: 17272630","page":"401-403","source":"pediatrics.aappublications.org","title":"Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns","volume":"119","author":[{"family":"Newborn","given":"Committee on Fetus","dropping-particle":"and"}],"issued":{"date-parts":[["2007",2,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Newborn, 2007). However, if we talk about the withdrawal of mechanical ventilation in neonatal or pediatric patients, the practice seems to effect parents more than the patient. Many physicians believe that it is important to support the family in this critical time so they do not think they are being abandoned ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"BNogobp2","properties":{"formattedCitation":"(Munson, 2007)","plainCitation":"(Munson, 2007)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"itemData":{"id":461,"type":"article-journal","container-title":"Pediatric Clinics of North America","DOI":"10.1016/j.pcl.2007.08.001","ISSN":"00313955","issue":"5","journalAbbreviation":"Pediatric Clinics of North America","language":"en","page":"773-785","source":"DOI.org (Crossref)","title":"Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units","volume":"54","author":[{"family":"Munson","given":"David"}],"issued":{"date-parts":[["2007",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Munson, 2007). Although some families want privacy, it is the responsibility of clinicians to ensure that families are provided with their required needs. It is important that physicians daily inform the family and relatives about the patient’s health and condition daily. However, in some case, it is reported that the family may decide to discontinue the mechanical ventilation due to the increasing financial burden. This mainly happens in the cases, when the patient is receives artificial life support for a very long time and shows no positive signs of improvement. Studies evidently suggest that the decision of this practice is influenced either by physicians, family or the patient himself ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"GxaoOmgO","properties":{"formattedCitation":"(Medford, 2003)","plainCitation":"(Medford, 2003)","noteIndex":0},"citationItems":[{"id":470,"uris":["http://zotero.org/users/local/CKNkWnK9/items/G92U9XYN"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/G92U9XYN"],"itemData":{"id":470,"type":"article-journal","abstract":"▴ Cook D, Rocker G, Marshall J, et al . Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med2003;349:1123–32\n\n[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]\n\n\n\nEight hundred and fifty one consecutive patients mechanically ventilated for at least 72 hours in intensive care units in 15 different centres were prospectively followed. 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R. L."}],"issued":{"date-parts":[["2003",12,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Medford, 2003).

In the neonatal care unit, discontinuing the ventilator intervention poses serious ethical challenges ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"cQ0lSImf","properties":{"formattedCitation":"(Rubenfeld, 2004)","plainCitation":"(Rubenfeld, 2004)","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"itemData":{"id":462,"type":"article-journal","abstract":"The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.","container-title":"Critical Care Clinics","DOI":"10.1016/j.ccc.2004.03.005","ISSN":"0749-0704","issue":"3","journalAbbreviation":"Crit Care Clin","language":"eng","note":"PMID: 15183212","page":"435-451, ix","source":"PubMed","title":"Principles and practice of withdrawing life-sustaining treatments","volume":"20","author":[{"family":"Rubenfeld","given":"Gordon D."}],"issued":{"date-parts":[["2004",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rubenfeld, 2004). The major ethical concern is the patient’s hunger for air leading to severe breathing discomfort. Even after the withdrawal of mechanical ventilation, doctors and nurses are responsible to provide comfort to the patients by trying to manage the symptoms of distress the patients experience during their death. One approach to relieve this discomfort is the use of narcotics ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"TXDvcZZY","properties":{"formattedCitation":"(Rubenfeld, 2004)","plainCitation":"(Rubenfeld, 2004)","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"itemData":{"id":462,"type":"article-journal","abstract":"The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.","container-title":"Critical Care Clinics","DOI":"10.1016/j.ccc.2004.03.005","ISSN":"0749-0704","issue":"3","journalAbbreviation":"Crit Care Clin","language":"eng","note":"PMID: 15183212","page":"435-451, ix","source":"PubMed","title":"Principles and practice of withdrawing life-sustaining treatments","volume":"20","author":[{"family":"Rubenfeld","given":"Gordon D."}],"issued":{"date-parts":[["2004",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rubenfeld, 2004). Studies indicate that there is a dilemma among the physicians regarding the use of narcotics to soothe the symptoms of discomfort after the withdrawal of intervention ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pkHYeQtb","properties":{"formattedCitation":"(Munson, 2007)","plainCitation":"(Munson, 2007)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"itemData":{"id":461,"type":"article-journal","container-title":"Pediatric Clinics of North America","DOI":"10.1016/j.pcl.2007.08.001","ISSN":"00313955","issue":"5","journalAbbreviation":"Pediatric Clinics of North America","language":"en","page":"773-785","source":"DOI.org (Crossref)","title":"Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units","volume":"54","author":[{"family":"Munson","given":"David"}],"issued":{"date-parts":[["2007",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Munson, 2007). Some physicians believe that it immediately brings death to their patients and they blame themselves for it while other states that it does not shorten time to death but instead it aggravates it. This is mainly a two concept approach where the former is known as a “double effect”. It is established that lower doses of narcotics such as fentanyl, morphine and hydromorphone, may contribute to the purpose of relieving the symptoms experienced at the end of the death. However, if large doses of these substances are used, it aggravates the time to death with further increasing the respiratory distress and hunger for air because of its side effects. It is more often observed in adult patients who are given large doses of benzodiazepines ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"iUT4NuPb","properties":{"formattedCitation":"(Burns et al., 2000)","plainCitation":"(Burns et al., 2000)","noteIndex":0},"citationItems":[{"id":468,"uris":["http://zotero.org/users/local/CKNkWnK9/items/32NQU9MV"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/32NQU9MV"],"itemData":{"id":468,"type":"article-journal","abstract":"OBJECTIVE: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn.\nSTUDY DESIGN: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record.\nRESULTS: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians and nurses cited treatment of pain, anxiety, and air hunger as the most common reasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an \"acceptable, unintended side effect\" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death.\nCONCLUSION: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.","container-title":"Critical Care Medicine","DOI":"10.1097/00003246-200008000-00064","ISSN":"0090-3493","issue":"8","journalAbbreviation":"Crit. Care Med.","language":"eng","note":"PMID: 10966296","page":"3060-3066","source":"PubMed","title":"End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment","volume":"28","author":[{"family":"Burns","given":"J. P."},{"family":"Mitchell","given":"C."},{"family":"Outwater","given":"K. M."},{"family":"Geller","given":"M."},{"family":"Griffith","given":"J. L."},{"family":"Todres","given":"I. D."},{"family":"Truog","given":"R. D."}],"issued":{"date-parts":[["2000",8]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Burns et al., 2000).

In Pediatrics research, the mechanism to discontinue mechanical ventilation is hardly presented. However, one research states that there are two main approaches to withdraw ventilator off a patient: Terminal Weaning and Terminal Extubation ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"Up1fkSBN","properties":{"formattedCitation":"(Munson, 2007)","plainCitation":"(Munson, 2007)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"itemData":{"id":461,"type":"article-journal","container-title":"Pediatric Clinics of North America","DOI":"10.1016/j.pcl.2007.08.001","ISSN":"00313955","issue":"5","journalAbbreviation":"Pediatric Clinics of North America","language":"en","page":"773-785","source":"DOI.org (Crossref)","title":"Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units","volume":"54","author":[{"family":"Munson","given":"David"}],"issued":{"date-parts":[["2007",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Munson, 2007). Gradually reducing the ventilator support before extubation is called as a “terminal weaning” while “terminal extubation” is characterized as the removal of endotracheal pipe without dissuading ventilator sustenance. Physicians predict both approaches are rather unclear considering the merits and demerits. However, terminal weaning is prioritized over terminal extubation because physicians believe they get enough time to prepare sedation medication to ease the symptoms patient experience at the end of the death ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IJbh72yf","properties":{"formattedCitation":"(Rubenfeld, 2004)","plainCitation":"(Rubenfeld, 2004)","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"itemData":{"id":462,"type":"article-journal","abstract":"The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.","container-title":"Critical Care Clinics","DOI":"10.1016/j.ccc.2004.03.005","ISSN":"0749-0704","issue":"3","journalAbbreviation":"Crit Care Clin","language":"eng","note":"PMID: 15183212","page":"435-451, ix","source":"PubMed","title":"Principles and practice of withdrawing life-sustaining treatments","volume":"20","author":[{"family":"Rubenfeld","given":"Gordon D."}],"issued":{"date-parts":[["2004",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rubenfeld, 2004). Another reason why physicians think it is better than the terminal extubation is that it provides the necessary time for the family to deal with the death and often say goodbye to their patient ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"e6eg4S8g","properties":{"formattedCitation":"(Rubenfeld, 2004)","plainCitation":"(Rubenfeld, 2004)","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"itemData":{"id":462,"type":"article-journal","abstract":"The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.","container-title":"Critical Care Clinics","DOI":"10.1016/j.ccc.2004.03.005","ISSN":"0749-0704","issue":"3","journalAbbreviation":"Crit Care Clin","language":"eng","note":"PMID: 15183212","page":"435-451, ix","source":"PubMed","title":"Principles and practice of withdrawing life-sustaining treatments","volume":"20","author":[{"family":"Rubenfeld","given":"Gordon D."}],"issued":{"date-parts":[["2004",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rubenfeld, 2004). In the neonatal Intensive Care Unit, this approach may allow parents to hold their baby in the time the physician prepares a sedation medicine. Moreover, with a progressive decline of oxygen and elevation in carbon dioxide, the patient is more likely to experience sedation. However, the side effect of this approach is that it prolongs the dying process which ultimately increases the time of the patient's suffering ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"1UFeiXe2","properties":{"formattedCitation":"(Munson, 2007)","plainCitation":"(Munson, 2007)","noteIndex":0},"citationItems":[{"id":461,"uris":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/2SBWBF4W"],"itemData":{"id":461,"type":"article-journal","container-title":"Pediatric Clinics of North America","DOI":"10.1016/j.pcl.2007.08.001","ISSN":"00313955","issue":"5","journalAbbreviation":"Pediatric Clinics of North America","language":"en","page":"773-785","source":"DOI.org (Crossref)","title":"Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units","volume":"54","author":[{"family":"Munson","given":"David"}],"issued":{"date-parts":[["2007",10]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Munson, 2007). It is reported that the approach also affects the family due to the prolonged time of death which increases the anxiety among the family in a case where the family has already accepted the fate of their patient. Some physicians give solution to this problem by suggesting a shift of terminal weaning to terminal extubation right after the medication has been titrated. It will accomplish the main purpose of sparing the patient with the suffering of prolonged death ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vF1u4ghA","properties":{"formattedCitation":"(Rubenfeld, 2004)","plainCitation":"(Rubenfeld, 2004)","noteIndex":0},"citationItems":[{"id":462,"uris":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"uri":["http://zotero.org/users/local/CKNkWnK9/items/DRSSCZVD"],"itemData":{"id":462,"type":"article-journal","abstract":"The clinician's responsibility to the patient does not end with a decision to limit medical treatment, but continues through the dying process. Every effort should be made to ensure that withdrawing life support occurs with the same quality and attention to detail as is routinely provided when life support is initiated. Approaching the withdrawal of life support as a medical procedure provides clinicians with a recognizable framework for their actions. Key steps in this process are identifying and communicating explicit shared goals for the process, approaching withdrawal of life-sustaining treatments asa medical procedure, and preparing protocols and materials to assure consistent care. Our hope is that adopting a more formal approach to this common procedure will improve the care of patients dying in intensive care units.","container-title":"Critical Care Clinics","DOI":"10.1016/j.ccc.2004.03.005","ISSN":"0749-0704","issue":"3","journalAbbreviation":"Crit Care Clin","language":"eng","note":"PMID: 15183212","page":"435-451, ix","source":"PubMed","title":"Principles and practice of withdrawing life-sustaining treatments","volume":"20","author":[{"family":"Rubenfeld","given":"Gordon D."}],"issued":{"date-parts":[["2004",7]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Rubenfeld, 2004).

Withdrawing advanced life support interventions in a medical setting depends upon the wide range of concepts and resources in order to effectively provide the required care. By adopting certain practices of effective communication and management at the time of withdrawal, paediatricians can improve the care provided to the patient and their families at the time of death.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Burns, J. P., Mitchell, C., Outwater, K. M., Geller, M., Griffith, J. L., Todres, I. D., & Truog, R. D. (2000). End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment. Critical Care Medicine, 28(8), 3060–3066. https://doi.org/10.1097/00003246-200008000-00064

Medford, A. R. L. (2003). Factors associated with physicians’ decisions to withdraw mechanical ventilation in anticipation of death. Thorax, 58(12), 1041–1041. https://doi.org/10.1136/thorax.58.12.1041

Munson, D. (2007). Withdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care Units. Pediatric Clinics of North America, 54(5), 773–785. https://doi.org/10.1016/j.pcl.2007.08.001

Newborn, C. on F. and. (2007). Noninitiation or Withdrawal of Intensive Care for High-Risk Newborns. Pediatrics, 119(2), 401–403. https://doi.org/10.1542/peds.2006-3180

Rubenfeld, G. D. (2004). Principles and practice of withdrawing life-sustaining treatments. Critical Care Clinics, 20(3), 435–451, ix. https://doi.org/10.1016/j.ccc.2004.03.005

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Inferior surface of occipital bone

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Facet on transverse processes

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Scapula

Acromion process

Glenoid cavity

Humerus

Head of humerus

Trochlea

Capitulum

Ulna

Trochlea

Radical notch

Head of ulna

Styloid process

Radius

Head

Radial tuberosity

Ulnar notch

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Femur

Head

Lateral / Medical condyle

Tibia

Lateral / Medial Condyle

Fibular Facet

Fibular notch

Inferior surface of lower end of tibia / inferior tibiofibular joint

Fibula

Facet for tibia

Facet for talus

Lateral malleolus

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C

C

A

T

G

G

G

A

C

U

C

U

A

G

A

G

G

A

U

C

C

C

C

G

G

G

U

A

C

C

G

A

G

C

T

C

G

A

A

T

T

C

G

T

A

A

T

C

A

T

G

G

T

C

C

T

C

G

A

G

C

T

T

A

A

G

C

A

T

T

A

G

T

A

C

C

A

G

G

A

G

C

U

C

G

A

A

U

U

C

G

U

A

A

U

C

A

U

G

G

U

C

Met

Val

A

T

A

G

C

T

G

T

T

T

C

C

T

G

T

G

T

G

A

A

A

T

T

G

T

A

T

C

G

A

C

A

A

A

G

G

A

C

A

C

A

C

T

T

T

A

A

C

A

U

A

G

C

U

G

U

U

U

C

C

U

G

U

G

U

G

A

A

A

U

U

G

Met

Ala

Val

Ser

Cys

Val

Lys

Leu

T

T

A

T

C

C

G

C

T

C

A

C

A

A

T

T

C

C

A

C

A

C

A

A

A

A

T

A

G

G

C

G

A

G

T

G

T

T

A

A

G

G

T

G

T

G

T

T

U

U

A

U

C

C

G

C

U

C

A

C

A

A

U

U

C

C

A

C

A

C

A

A

Leu

Ser

Ala

His

Asn

Ser

Thr

Gln

C

A

T

A

C

G

A

G

C

C

G

G

A

A

G

C

A

T

A

A

A

G

T

G

G

T

A

T

G

C

T

C

G

G

C

C

T

T

C

G

T

A

T

T

T

C

A

C

C

A

U

A

C

G

A

G

C

C

G

G

A

A

G

C

A

U

A

A

A

G

U

G

His

Thr

Ser

Arg

Lys

His

Lys

Val

T

A

A

A

G

C

C

T

G

G

G

G

T

G

C

C

T

T

A

A

T

G

A

G

A

T

T

T

C

G

G

A

C

C

C

C

A

C

G

G

A

A

T

T

A

C

T

C

U

A

A

A

G

C

C

U

G

G

G

G

U

G

C

C

U

U

A

A

U

G

A

G

STOP

The first row represents the sequence as read from the autoradiogram of the gel read from bottom up representing 5’ to 3’. The second row represents the complementary sequence of this sequence meaning the sequence in 3’ to 5’ direction of the DNA sequence on the primer. This is the coding strand and is written in red color. The third row represents the mRNA sequence that is complementary to the coding strand and in 5’ to 3’ direction. This is written in green. The fourth row is the sequence of amino acids in the polypeptide. This is written in blue. This sequence starts with the start codon and ends at the stop codon. The start codon in this case is AUG while the stop codon is UAA. Both are clearly mentioned in the table.