Quorum Sensing And Its Importance To Biotechnology

Quorum Sensing And Its Importance To Biotechnology Quorum sensing offers potential to create engineered bacteria capable of invading cancer cells. It is possible to envision the creation of novel anti-cancer therapeutics by the addition of cancer-destructing modules to these microbial biosensors. Another application of QS and quorum quenching lies in the creation of transgenic plants that are able to defend themselves against common bacterial pathogens. It plays a main role in controlling a diversity of microbial cell activities, such as biofilm formation and virulence that considerably impact human health, agriculture, and commercial production and transport systems. Quorum sensing is cell-to-cell communication in bacteria have ability to control development, sporulation, and antibiotic synthesis also virulence factor induction, cell differentiation, moreover nutrient flux along with extra physiological events in pathogenic bacterial infections. Scientists now a days creating more possible benefits from quorum sensing and off course there is lots of potential development for advancement in 2011ranging from marine to human disorders. CHAPTER 1 INTRODUCTION Several unicellular microorganisms use smallsignaling molecules to find out their local concentration. The processes involved in the production and recognitionof these signals are generally known as quorum sensing (QS). Unicellular microorganisms to manage their activities use this kind of cell-to-cell communication, which allows them to work as multi-cellular systems. Newly, several groups have confirmed artificial intraspeciesand inter-species communication through synthetic circuits, which incorporate components of bacterial QSsystems. Engineered QS-based circuits have a broad range of applications such as production of biochemicals, tissueengineering, also mixed-species fermentations. They are also extremely useful in designing microbial biosensors toidentify bacterial species present in the environment andinside living organisms. In this articlethe different ways inwhich researchers have designed QS-based circuits andtheir applications in biotechnology are explained. A decade ago, the secretion and perception of minorsignalling molecules that in turn are transduced tocoordinate behavior of a smallest unit of microorganisms was named quorum sensing by EP Greenberg with colleagues. Ever since then, an exponential growth in understanding and occurrence of quorum-sensing systemshas developed, with sightings ranging from virulence inhuman along with plant pathogens to degradative capacity ofactivated sludge. Not amazingly, regulatory mechanisms span traditional inducer/repressor motifs homologous to thelac operon to the newly discovered interfering RNAs.Advance characterization of signalling circuits, coupled with creative position applications, propose a wealth of prospects for advancing commercial biotechnology(reviewed by John C March and William E Bentley 2004). Researchers in biotechnology continuously seek new platforms from which to address problems: manifesto that, in a broad sense, improve efficacy, while maintaining or intensifying specificity. Most freshly, microbial quorum sensing has emerged as such a technology. Because microbial communities absorb a small space, concentrations of extracellular signalling molecules build up, providing motivation for unique and various cellular responses along with protection from rival microbial communities. Referred to as quorum sensing for its regularly reported and concurrent dependence on high population density (Joyce EA et al 2004), extracellular signalinggives a novel basis for control over molecular also cellular processes along with population behaviour, possibly in a manner more reliable with that of native physiology. Quorum sensing might be the base upon which the more complicated intracellular communication found in advanced level organisms has evolved. Defining quorum sensing Quorum Sensing considered a signalling molecule, a compound has to result a reaction in a population of cells that is different from the approach in which the cells would perform independently. There are two types of quorum sensing: species- specific and interspecies. Species-specific quorum sensing in Gram-negative bacteria is intercede by acyl-homoserine lactones (AHLs) with numerous moieties distinguishing signals between species (Fuqua C, Parsek MR, Greenberg EP 2001). In Gram- positive bacteria, species-specific quorum sensing is generallyassist through small peptides Figure1.Structure of bacterial Quurom sensing signals. Gram-negative bacteria like V.Fischeri and Pseudomonas aeruginosa use acyl homoserine lactones (AHLs) as signals. The structure of mature AIP-I (from Staphylococcus aureus) is shown as a representative of the translationally derived auto-inducing peptides (AIPs) used by Gram-positive bacteria as signals for QS.Source- Functions of quorum sensing Quorum sensing is supposed to control ability development, sporulation, and antibiotic synthesis also virulence factor induction, cell differentiation, and nutrient flux along with extra physiological events in pathogenic bacterial infections (Cvitkovitch DGGreenberg EP,Yarwood JM,2003).More lately, quorum sensing was connected through proteomic analysis to increased pathogenic ability in tubercular strains of Pseudomonas aeruginosa (Arevalo-Ferro C, et all 2004) Webb and co-workers (Webb JS, et al 2003), reviewed work on programmed cell death plusmicro colony differentiation in biofilms. As biofilms age, cellular differentiation and death improve nutrient sequestration and allow for bio- film sustenance when nutrients become limited. Though the functions of cell differentiation and programmed cell death are actually at odds, they can be described as an evolutionary progressionthat allows biofilms of prokaryotes to perform and adapt as multiceewllular organisms, a behavior that emerges to be matched through quorum sensing (Webb JS, et al 2003). CHAPTER 2 Applications of Quorum sensing in biotechnology Components of bacterial QS systems form an important part of many artificial genetic circuits that control phenomena such as bistable behavior, pulse response, spatio-temporal control of gene expression, and population control (Purnick and Weiss 2009). In this section, the applications of engineered QS systems for the production of biochemicals, tissue engineering, and mixed- species fermentations are highlighted (Fig. 2). Detailed explanation ofcurrent progress in building QS-based microbial biosensors and QS-based biocontrol are given. Lastly, discussion of QS inhibition as a viable strategy for the decline of biofouling is given. Also different applications of QS in biotechnology are given. Engineered Quorum Sensing systems The promisingfield of synthetic biology seeks to generatenovel biological systems by applying the fundamental engineering principles of standardization and hierarchical abstraction to GE engineering (Purnick and Weiss 2009). This method allows designers to build and optimize compound genetic circuits that perform new functions, such as DNA-damage-induced biofilm formation and preservation of synthetic ecosystems (Balagadde et al. 2008; Kobayashi et al. 2004). Various genetic modules can be included into complex gene networks also called genetic systems or devicesusing a plug-and-play strategy (Kobayashi et al. 2004). These gene networks are then commenced into a well-characterized, steady host cell known as a chassis, which supplies the essential raw materials and support machinery. Operation of the artificial genetic device imparts new functionalities to the host and makes a microbial cell factory that is capable of performing preferred tasks. Autoinducers are very useful as input signals as they are little, diffuse freely in aqueous media, and are simply taken up through cells. As the engineered cells synthesize QS signals by themselves, they are able to watch their own cell density with modulate their activities appropriately, thereby falling the need for outerprotection(Brenner et al. 2007). Scientists have devised QS-inducible mammalian genetic circuits by mixing bacterial QS receptors with either a eukaryotic transactivation domain or with a eukaryotic transcription repressor domain (reviwed from Neddermann et al. 2003; Weber and Fussenegger 2009; Weber et al. 2005; Weber et al. 2003; Williams et al. 2004).These synthetic gene regulation systems will have functions in drug discovery, tissue engineering, and also industrial production of biochemicalsduring mammalian cell culture. Consumption of a bistable switch module gives a pointed(ON or OFF) or binary profile of aim gene expression depending on the store concentration. Engineered QS systems including bistable switches are probable to be extremely useful in industrial production of toxic gene products and in designing environmental biosensors. Scientistshave used components of the V. fischeri Quorum Sensing system to engineer spatio-temporally keeping up cell to cell communication in E. coli (Basu et al. 2004). Depending on the comparative distribution of Sender and Receiver cells in a 2-D matrix, different reporter formats such as bullseye, ellipse, oval, heart, and clover were formed. Moreexpansion of this research into programming spatial patterning in 3-D will have applications in biosensing, tissue engineering, plus fabrication of biomaterials. Quorum Sensing like cell-to-cell communication systems have also been developed by using metabolites, antibiotics, hormonesor volatile compounds to give signals to extract a cell-density dependent population-wide reactions (Bulter et al. 2004; Chen and Weiss 2005; Weber et al. 2007). The capacity to develop QS type communication systems using non-Quorum Sensing signals considerablygrows the design possibilities for genetic engineering systems. Through inserting the producing signal components in one species, and the receptor in another, scientists have engineered inter and intra-kingdom communications among bacteria, yeast, plants, and mammalian cells (Balagadde et al. 2008; Brenner et al. 2007; Weber et al. 2007). Depending on the planned synthetic communication device, relationships like predator-prey, commensalism, mutualism, amensalismand parasitism were producedamong the communicating species. Different from engineering inter-species communication, Quorum Sensing based genetic devices can control diverse features of mixed-species fermentations. Forcase, basedon QS population control circuits can be used to manage the cell densities of the contributing species (You et al. 2004). Based on QS gene-expression circuits can also be used to initiate expression of mark genes when the cell densities of contributing species reach a definite threshold (Brenner et al. 2007). At present, the majority of the engineered QS devices are built on Gram-negative AHL systems, which, as stated previously, are absolutely unreliable. Various applications of Quorum Sensing: Biosensors An interesting application of Quorum Sensing is in the engineering of whole cell microbial biosensors to distinguish pathogenic microbes present in the environment with diseased host organisms. Quorum Sensing have also been used to produce engineered bacteria capable of attacking cancer cells. It is probable to visualize the creation of new anti-cancer therapeutics by the addition of cancer-destructing elements to these microbial biosensors. Another function of QS and quorum quenching lies in the designing of transgenic plants that are able to protect themselves against general bacterial pathogens. Pathogen diagnostics and therapeutics The majority of the whole cell QS biosensors that have been explained so far recognize Gram-negative AHLs (Kumari et al. 2008; Steindler and Venturi 2007). A standard AHL biosensor contains an AHL responsive transcriptional regulator also a cognate promoter, which directs the transcription of a reporter gene. It has been recommended that QS signals only can be used as markers for the occurrence of pathogenic bacteria in clinical and environmentalsamples. Thus, QS signals should not be engaged as the only inputs for microbial biosensors. However, Quorum sensing based amplification circuits can still be used to engineer biosensing circuits to find the occurrence of pathogenic microbes in contaminated groundwater products, dairy, and meat products. Upcoming design directions willinclude the formation of ingestible whole cell biosensors by launching QS-based bio- sensing devices into GRAS organisms such as lactic acid bacteria(Konings et al. 2000). Such diagnostic biosensors would be muc h useful in identifying the existence of pathogens in the gut micro flora. So collecting these resultsbring up the exciting possibility that future QS-based microbial biosensors may possibly not only detect pathogens, but also increase a concerted reaction against them. Cancer detection The P. aeruginosa Quorum Sensing signal 3-oxo-C12- HSL reduces proliferation alsoinduceapoptosis breast cancer cell lines in human(Li et al. 2004). Biocontrol The rhizosphere is a limited region of soil that surroundings a plants roots and is affected by secretions from the root also soil microbes in the vicinity. Quorum sensing bacteria form amain component of the rhizosphere community. Scientists have also engaged quorum-quenching enzymes to decrease bacterial virulence against plants. This researchproposes that engineering the production also secretion of quorum- quenching enzymes into plants and plant-associated microbes can also serve as a crop protection plan. Though, QS systems also controlnecessary functions in useful rhizosphere bacteria, as well as biofilm formation, antibiotic production, and nitrogen fixation (Muller et al. 2009; Sanchez-Contreras et al. 2007). More research is therefore essential to understand the promising effects of quorum quenching on plant biochemical pathways. In brief, while quorum quenching is an attractive approach for biocontrol, more research isessential to demonstrate its safety and efficacy. Prevention of biofouling Biofouling is the increase of bacteria, algae;also animals like protozoans and crustaceans on surfaces that prolonged contact with water. Biofouling can happen on surfaces as assorted as pipes, tanks, ship hull, membrane bioreactors, medical or dental implants, and catheters. This unwantedgrowth of living organisms and their secretions lead to contamination, colonization, also corrosion of machine parts expose to water and reduce machine efficiency. Incorporation of Quorum Sensing inhibitors on the device surface is a possible strategy for declining P. aeruginosa biofouling of surgical implants. QS inhibition may be used to givedefense against many pathogens that rely on QS to start biofilm development. Recombinant gene expression Possibly one of the exciting areas for research in quorum sensing is the synthesis of recombinant gene products withmetabolic engineering. Quorum sensing has been used to control gene expression and cellular growth. Brief reviews by Toniatti et al. (Toniatti C, et al 2004) discusssome of the progress in control of gene expression through the perceptions of possible gene therapy applications. Pathogen/pest management Pathogen and pest (i.e. some organism whose existence in a specific environment is undesirable) management include most of the present applications of quorum-sensing technology. Inhibition of quorum signalling is theevident and, in practice, most appreciated application of quorum-sensing knowledge. CHAPTER 3 New technologies in Quorum Sensing The discovery of antibiotics early in the past century marked the beginning of active control and prevention of infectious microbial diseases. However, extensive use of antibiotics has also unavoidably resulted in the emergence of superbugs that resist conventional antibiotics. The finding that many pathogens rely on cell-to-cell communication mechanisms, known as quorum sensing, to synchronize microbial activities essential for infection and survival in the host suggests a promising disease control strategy, i.e. quenching microbial quorum sensing or in short, quorum quenching. Work over the past few years has demonstrated that quorum-quenching mechanisms are widely conserved in many prokaryotic and eukaryotic organisms. These naturally occurring quorum-quenching mechanisms appear to play important roles in microbe-microbe and pathogen-host interactions and have been used, or served as lead compounds, in developing and formulating a new generation of antimicrobials. An advance study of bacterial quorum sensing process can facilitate development of novel technologies intended at interfering with bacterial communication and virulence. The term quorum sensing explains the capability of a microorganism to recognize and response to diffusible signal molecules. Bacterial cells sense their inhabitants density by a complicated cell-to-cell communication system also triggers expression of exact genes. Quorum sensing in Seaweeds Explaining this title, the quorum sensing is wider spread among bacterial population then was previously thought, in Gram positive, Gram-negative bacterial communication. Followed by this numerous researchers have concluded that in Gram negative bacteria acyl-homoserine lactone is dependable for the cell to cell communication system. In gram-positive bacteria peptide and derivative peptide based signaling molecules appear to be the main mode of communication. Throughout high cell density the marine bacteria can produce enzymes, surfactants, toxins, antibiotics by the chemical signal communication. Marine epibiotic bacteria are also identified to produce compounds active beside drug resistant hospital pathogen by the cross species induction process. Austin described in building on assays (Billaud and Austin 1990) a screening method has been developed in which marine bacteria are confront by exposing them to terrestrial bacteria prior to assay of antimicrobial compounds. Therefore, in currentstudies it is proposed to search the abilities of seaweed epibiotic bacterial organisms to createantibacterial compounds by quorum sensing. Theseconclusions have important consequences for the discovery of new antimicrobial compounds from marine bacteria and might allow the growth of novelprocess for screening new compounds eff ective against multidrug resistant bacteria. CHAPTER 4 Conclusion Quorum Sensing plays a main role in controlling a diversity of microbial cell activities, like biofilm formation and virulence, that considerably impact human health, agriculture, marine, commercial manufacture and transport systems. As mentioned in above applications of QS there are many areas that are fully touched by QS method. Therefore, significant research efforts are needed to understanding Quorum Sensing and the growth of strategies to disrupt and influence Quorum Sensing. Our understanding of quorum-sensing mechanisms currently restricts applications for quorum sensing. Though there has been progress made in the use of quorum sensing, more understanding of quorum functionality is necessary before the control of this tool can be completely raised. However, the full-scale management of the bacterial quorum circuit in a biotechnological application yet to be an unconvinced goal. More studyand deep research is needed to uncover andthe details of QS in a diversity of microbial species, with Gram- positive bacterias and fungis. The task of QS in microbial populations, with Quorum Sensing crosstalk and signal specificity, is another significant area of research and study that will influence strategies to prevent biofilm formation and for biocontrol. Quorum sensing seems to be a distinctive example of how the exploitation of bacteria cell-to-cell communication in biotechnology can be used to significantly drive the growth and development of medicine, diagnosis tics, therapies and gene control. For sure, it will influence every part of biology, with novel research and technologies in science world.

Communication Differences: Male vs. Female

If you are a woman have you ever wondered why a man did not understand the way you worded something or communicated something to him. Or if you are a man, did you ever wonder why a woman said what she did or did not understand why she didn’t â€Å"get† what you were saying or why she reacted a certain way to your words? The way men and women communicate with each other different because of many reasons.In this presentation, I will try my hardest to communicate to you, both men and women, what these differences are and hopefully fulfill you with a better understanding of why we communicate differently and how to break those barriers for your professional and personal lives. 1. The typical stereotypes. Explain that no way is better, just different. Social Conditioning. (Use personal examples) a. Men are more direct. i. Men tend to be more direct in communicating and look for a solution as quickly as possible b.Women are more emotional and tend to speak in dialogue. ii. Wo men tend to be more emotionally involved with communicating and feel that the whole picture and different solutions are important. 2. The differences in male and female communication in social settings c. How women build and maintain relationships iii. Women tend to focus on making connections 1. Secrets 2. Relating experiences 3. Discussing options 4. Find commonalities d. How men build and maintain relationships iv. Groups of friends tend to be larger . Do activities rather than conversing vi. More competitive 3. The differences of men and women communicating in a business setting/work environment e. How men communicate in business environment vii. Men want facts 5. Men usually ask fewer questions to stimulate conversation in their work relationships and often end conversations more abruptly than women. viii. Men take one task at a time 6. Men tend to like to focus on one task at a time ix. How men keep status at work 7.Tend to be more literal and use language to establish status 8. Tend to ask less questions to not show they don’t know something 9. Tend to not like to give or receive detailed feedback. Find it criticizing. f. How women communicate in a business/ work setting x. Women’s brains are always â€Å"on† 10. There is more neural activity in the female brain at any given time than in the male brain. Enhances multitasking. xi. Women focus on friendship first 11. For example, female salespeople, they tend to build relationships when they sell.They don’t tend to go into a transaction focused on the final outcome but wanting to build rapport and learn more about the client first. xii. Women remember the little details 12. Females can generally remember more physical and relational details than men. Breaking this Barriers 1. Try to Understand the different styles when communicating with the opposite gender and keep them in mind 2. Actively listen- concentrate on the main points and focus on what is being communicated no matter which way these points are being communicated. 3. Interpret non-verbal clues.In conclusion, men and women’s brains are wired differently and the two genders tend to use two different sides of the brain which in turn leads to many differences in men and women. Communication, whether by a male or female, still has a focus, so find an end result sooner or later. Communication differences between males and females are also most likely due to social conditioning that stem from childhood. I truly feel that there is no right or wrong way to communicate, but understanding the way both genders do so is important for effective communication in business as well as in life. Related article: â€Å"Advice About Communication†

Legal/Ethical Issues and the Solutions of a DNR

Do-not-resuscitate (DNR) orders are those given by a physician indication that in the event of a cardiac or respiratory arrest â€Å"no† resuscitative measures should be used to revive the patient (Pozgar, 2013, p. 153).Difficulties and confusion about do not resuscitate orders still exist, despite efforts to help patients, families, and surrogate decision-makers make informed choices. In this paper, issues will be addressed about the legal and ethical dilemmas about a DNR, how a DNR can affect while being used in a school system, the history of the issues of DNR, and how potential effects can be addressed to the issues for the future.Additionally, I will discuss the legal rights of the DNR to individuals as they interact with healthcare services, the implications of the patient’s bill of rights as it reflects to a DNR, and analyze selected ethical and legal case studies that have promulgated precedent-setting decisions. The majority of patients who die in hospital have a â€Å"Do Not Resuscitate† (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don’t, and how they view discussions of resuscitation status.Some issues addressed with a study are the patients and families understanding the considerations of a typical request of full code (FC) or DNR orders. DNR patients reported a much greater familiarity with resuscitation discussions than FC patients. This was typically due to previous conversations with health care professionals, experiences with relatives, or self-realization prompted by other experiences. FC patients, on the other hand, typically reported no previous experience with this discussion, although a few had discussed it previously on admission to hospital.FC and DNR patients had very different understandings of resuscitation and DNR orders, and there were few common themes identified in their answers. DNR patients described resusc itation as violent or traumatic event, associated with â€Å"tubes† or â€Å"machines,† painful, and generally futile. FC patients, on the other hand, often described resuscitation in a more abstract way, the â€Å"restoration† of life. Finally, a small number admitted frankly that they had no clear idea of what resuscitation actually were (Downar, Luk, Sibbald, Santini, Mikhael, Berman, and Hawryluck, 2011).Although most patients are pleased with their physician’s approach to the conversation, many reported a negative emotional response overall. Both FC and DENR patients often reported being shocked or upset by the conversation, either because of the timing or the content, or simply being confronted with their own mortality. Advance Care Planning may help reduce this negative response; by normalizing the subject and raising it before an acute illness, physicians may help reduce anxiety and shock when it is raised during deterioration.Both FC and DNR pati ents emphasized the importance of honesty, clarity, and sensitivity when discussing this issue (Downar, Luk, Sibbald, Santini, Mikhael, Berman, and Hawryluck, 2011). Mr. H is an 81-year old veteran with a history of chronic obstructive pulmonary disease (COPD) and depression. His daughters went to visit their father at 10 am and found him awake, but unable to communicate or follow commands. Empty morphine bottles were strewn around the room where he was found. Mr. H’s daughters called an ambulance and had their father transported to the emergency department of the local VA hospital.In the emergency department, there was concern for either an accidental or intentional opioid overdose, and the toxicology screen was positive for opioids. Narcan was administered with some modest and brief improvement in mental status, but Mr. H never obtained a level of consciousness that would enable him to express his treatment preferences. Progress notes written during the weeks before the inc ident indicated that Mr. H had threatened to commit suicide if his respiratory disease progressed to the point that he could not breathe.Mr. H was admitted to the medical intensive care unit, where an arterial  blood gas showed him to have respiratory acidosis. Several hours after arrival in the MICU, Mr. H became hypotensive and bradycardic. The intensive care resident on duty advised the daughters of her concern that the patient would develop respiratory failure that was likely to lead to a cardiac arrest, requiring CPR. The daughters indicated their father’s longstanding wish to be DNR. A durable power of attorney for health care (DPOA) executed five years before, although not documenting any treatment preferences, did appoint the two daughters as health care agents.The intensive care resident explained to the daughters that it was standard clinical practice to utilize CPR, even if patients had clearly expressed wishes to be DNR, if the arrest of respiratory compromise w as secondary to a suicide attempt. The daughters informed the resident that they had had several extended conversations with their father over the last year, occasioned by his failing health, in which he had communicated to them his wish not to have any aggressive care when his quality of life declined.The daughters both professed to be devout Christians, but said their father had been an inveterate atheist, whose philosophy of life was that when an individual could no longer function at an acceptable level, he had the right to refuse all life-sustaining interventions. The resident and the intensive care attending, which had now arrived, did not feel they could ethically or legally enter a DNR order, precluding the use of a life-saving intervention that could potentially reverse Mr. H’s respiratory failure, because it was secondary to a suicide attempt.At this juncture, the MICU physicians requested an urgent ethics consultation to resolve the conflict. The decision to overri de the DNR request of an individual who has attempted suicide is often framed as a clear and classical conflict between the principles of autonomy and beneficence or nonmaleficence. The other situation occurs when an individual, having authorized an EMS DNR order, attempts suicide and is discovered before the attempt becomes successful; Both circumstances provoke the classic dilemma, where the ethical wishes of rescuers to act for the good of their patient i. e., beneficence, run counter to the individual’s autonomous wishes expressed in the EMS DNR order.The rescuer cannot satisfy both of these conflicting ethical principles (Geppert, 2010). A 2010, reviewed of the clinical, ethical, and legal dilemmas related to DNR orders in suicidal patients presents a case report of a patient hospitalized for severe depression, who overdoses on the psychiatric unit and is found unresponsive with a recently obtained DNR order in her hands, The review argues that contemporary law and polic y related to DNR orders are not formulated to encompass the situation of an individual with serious mental illness.They recommend that patients be screened for suicidal ideation before a DNR order is entered, and that states and institutions clarify their response to DNR status in the context of attempted suicide. â€Å"Passive assistance† occurs when a health care provider does nothing to prevent a patient’s suicide. In the health care context, however, passive assistance has been an ethical practice for many years. For example, DNR orders have been instrumental in forming the current awareness of rights and responsibilities in the area of death and dying.A physician who refrains from attempting CPR on a patient who has made a rational choice to commit suicide is within the acceptable guidelines of the practice of medicine. If there is disagreement, every reasonable effort should be made to communicate with the patient or family. In many cases, this will lead to resol ution of the conflict. In difficult cases, an ethics consultation can prove helpful. Nevertheless, CPR should generally be provided to such patients, even if judged futile.In some cases, the decision about CPR occurs at a time when the patient is unable to participate in decision making, and hence cannot voice a preference. There are two general approaches to this dilemma: Advance Directives and surrogate decision makers (University of Washington School of Medicine, 2008). Do Not Resuscitate Orders in Schools In recent years, legal trends have expanded educational opportunities, including access to adaptive, for children and adults with wide variety of disabilities or handicaps.The American Academy of Pediatrics (AAP) has previously addressed the ethical and legal issues involved in decisions to either limit or withdraw life-sustaining medical treatment. Parents, who, after consultation with their pediatrician and other advisors, decide to forego CPR of their child, may want this de cision respected by school system personnel. These decisions challenge all persons involved in a situation in which SPR may be given to balance personal beliefs, strong feelings, legal concerns (especially those having to do with liability), educational considerations, and other issues (Pediatrics, 2000).In contrast, the school officials may be worried that a DNR order could be misinterpreted by medically untrained staff, resulting in harm to a child, or they may worry that personnel would feel bound not to respond to an easily reversible condition, such as a mucous plug in a child with a tracheotomy. Administrators have concerns about their personnel responding to circumstances not anticipated by a DNR order, such as when a child chokes on food or is injured. School officials may be rightfully concerned about the effect of a death in school on other students.The parents of healthy children may not want their children exposed to death in a classroom or other school setting (Pediatri cs, 2000). The AAP recommends that pediatricians and parents of children at increased risk of dying in school who desire a DNR order meet with school officials – including nursing personnel, teachers, administrators, and EMS personnel, and, when appropriate, the child. Individuals involved ideally will reach an agreement about the goals of in-school medical interventions and the best means to implement those goals. Concerted efforts to accommodate all points of view will help avoid confrontation and possible litigation.Pediatricians need to assist parents and schools to review, as needed when warranted by a change in the child’s condition, but at least every six months, plans for in-school care. Pediatricians need to review the plan with the board of education and its legal counsel. Pediatricians and their chapter and district members should work with local and state authorities responsible for EMS policies affecting out-of-hospital DNR orders to develop rational proce dures and legal understanding about what can be done that respects the rights and interests of dying children (Pediatrics, 2000).History of issues with a DNR The development of CPR in the early 1960s precipitated the need for DNR orders. However, it soon became evident that the routine application of resuscitation efforts to any patient who suffered a cardiopulmonary arrest led to new problems. Thus, even in the earliest stages of its development, resuscitative measures presented a basic ethical quandary that still underpins much of the controversy over DNR orders today: the potential conflict between prolongation of life itself and the quality of the life preserved. DNR orders arose out of the need to address such suffering.In 1974, the American Medical Association noted that â€Å"CPR is not indicated in certain situations, such as in cases of terminal irreversible illness where death is not unexpected. † DNR orders developed out of the general bioethics milieu of the last quarter of the twentieth century, concomitant to â€Å"the promotion of patient autonomy: (Goldberg, 2007, p. 60). While DNR orders have, by the present day, become a familiar if not regularly encountered phenomenon, â€Å"there is less legal certainty for providers regarding DNR orders for incompetent patients† (Goldberg, 2007, p. 60).The patient Self-Determination Act of 1990, the 1983 report of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, and the ruling in Cruzan, Quinlan and other landmark cases established the right of competent patients, through both advance directives and their surrogates, to refuse life-sustaining treatments, providing the ethical and legal basis of DNR orders. Currently, the Joint Commission standards require all health care institutions to have policies and procedures regarding advance directives and DNR orders.All 50 states have statutory requirements that uphold the autono my of competent patients to make health care decisions, including those regarding CPR, and to exercise this self-determination through authorized surrogates should they lose decision-making capacity (Geppert, 2010). A Patient’s Bill of Rights Reflected in a DNR DNR comfort care orders permit comfort care only, both before and during a cardiac or respiratory arrest. This kind of order is generally appropriate for a patient with a terminal illness, short life expectancy, or little chance of surviving CPR.DNR comfort care arrest orders permit the use of all resuscitative therapies before an arrest, but not during or after an arrest. A cardiac arrest is defined as an absence of palpable pulse. A respiratory arrest is defined as no spontaneous respirations or the presence of agonal breathing. Once an arrest is confirmed, all resuscitative efforts should be stopped and comfort care alone initiated. DNR specified orders allow the physician to â€Å"tailor† the DNR order to th e specific circumstances and wishes of the patient.For example, under this option the physician could specify â€Å"pharmacological code only,† or â€Å"no defibrillation,† or â€Å"do not intubate† (Department of Bioethics, n. d. ). If the patients’ preferences regarding resuscitation are clear, they should be respected. Patient preferences to refuse resuscitative efforts can be communicated directly by the patient, or by an advance directive, a valid Do Not Attempt Resuscitation (DNAR) order, or by the patient’s legal representative. Unofficial documentation may be considered when determining patient preferences (ACEP, 2008).It is appropriate for out-of-hospital providers to honor valid DNAR orders or out-of-hospital advance directives. Standardized guidelines and protocols should be developed to direct out-of-hospital personnel’s resuscitative efforts. When resuscitative efforts are not indicated, emergency physicians should provide appro priate medical and psychosocial care during the dying process. This may include the provision of comfort measures and psychosocial support for the patient and family.Recommendations to better DNRsFirst, to the extent permissible under individual state laws, propose that U. S. hospitals and journals begin to consider the term â€Å"do not resuscitate order† and the abbreviation â€Å"DNR† to be obsolete. These terms carry the implicit message that when interventions such as chest compressions and bag-mask ventilation are undertaken, resuscitation of the patient will result. Suggestion to use the phrase â€Å"do not attempt resuscitation† and the abbreviation â€Å"DNAR,† making clear that CPR is really only an attempt at resuscitation.Find that DNAR retains clarity about the interventions being discussed while reminding both patients and practitioners of the uncertainty of the outcome of resuscitative efforts. Second, to remind medical learners and practit ioners of the questions that must be answered at the time of admission to the hospital. Placing â€Å"attempt resuscitation† status immediately after diagnosis reminds the practitioner that the diagnosis of the patient should play a major role in determining whether resuscitation should be attempted.This modification in the admission orders also makes the specification of â€Å"attempt resuscitation† and â€Å"do not attempt resuscitation† explicit. While some policies will at first continue to presume consent for CPR, practitioners will be reminded that there is a decision to be made. Third, as a routine part of a discussion the physician should provide an explanation of how the patient’s prognosis would change should the patient experience cardiopulmonary arrest. A cardiopulmonary arrest is not a neutral event.It is thus not only indicative of the severity of illness, but also an indicator that the prognosis is worse than if the cardiopulmonary arrest h ad not happened. A discussion of these features can be of particular value to families of patients for whom an event of cardiopulmonary arrest would indicate a worsening of the underlying disease or result in irreversible damage. Fourth, physicians should help clarify prognosis by proposing a course of action to the family. In some instances, that will mean deferring to patient decision, where the medical evidence and judgment is not conclusive.In other situations, it will mean recommending that CPR not be attempted. Consistent with safeguards ensuring physician accountability and where individual state laws would permit broad physician discretion, it might even mean that some cases will necessitate reclassifying CPR as a pseudo-option that does not even warrant a mention. However, a failure to make a recommendation is more likely to cause families additional anxiety than it is to be perceived as coercion.In addition, making a proposal for a course of action can help a physician com municate the significance of a cardiopulmonary arrest given the patient’s underlying condition (Bishop, Brothers, Perry, and Ahmad, 2010, pp. 65-66). In conclusion, when patients’ and physicians’ understanding of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making.A conventional formulation would contend that the origin of the respiratory depression from a suicide attempt was the ethically determinative factor. This perspective would logically have led to the recommendation to override the surrogates’ request for a DNR order. Yet this attribution gives more ethical weight to a choice the patient appeared to have made impulsively and proximately, with questionable decisional capacity, rather than the distal and deliberate preference of an individual with intact capacity to refuse life-su staining treatments (Geppert, 2010).The four recommendations are only the first steps along a process of a DNR change. The ultimate goal will be to reach a more balanced place where discussions about decisions can be made jointly, but with the acknowledgement that all decisions are laden with moral values inherent in the practice of medicine and life in a pluralistic society and that all judgments are themselves fallible.

Asking Questions in English

Asking Questions in English Learning how to ask questions is essential in any language. In English, the most common questions  are known as wh words because they begin with those two letters: where, when, why, what, and who. They can function as adverbs, adjectives, pronouns, or other parts of speech, and are used  ask for specific information.   Who Use this word  to ask questions about people. In this example, who serves as a direct object. Who do you like? Who has he decided to hire for the job? In other instances, who serves as the subject. In this case, the sentence structure is similar to that of positive sentences. Who studies Russian? Who would like to take a vacation? In formal  English,   the word whom will replace who as the direct object of a preposition. To whom should I address this letter? For whom is this present? What Use  this word to ask about things or actions in object questions. What does he do  at  weekends? What do you like to eat for dessert? By adding the word like to the sentence, you can ask for physical descriptions about people, things, and places. What type of car do you like? What is Mary like? When Use this word to ask questions about time-related events, specific or general. When do you like going out? When does the bus leave? Where This word is used to ask about location. Where do you live? Where did you go on vacation? How This word can be combined with  adjectives to ask questions about specific characteristics, qualities  and  quantities.   How tall are you? How much does it cost? How many friends do you have? Which When paired with a noun, this word is used when choosing between a number of items. Which book did you buy? Which kind of apple do you prefer? Which type of computer takes this plug? Using Prepositions A number of wh questions can combine with prepositions, typically at the end of the question. Some of the most common combinations are: who ... forwho ... withwhere ... towhere ... fromwhat ... for ( why)what ... in Note how these word pairings are used in the following example. Who are you working for? Where are they going to? What did he buy that for? You can also use these pairings to ask follow-up questions as part of a larger conversation. Jennifer is writing a new article. Who for? Shes writing it for Jane magazine. Tips When more general  verbs  such as do and go are used, its common to use a more specific verb in the reply. Why did he do it? He wanted to get a raise. Questions with  why are often replied to using because as in the following example. Why are you working so hard? Because I need to finish this project soon. These questions are often replied to using the imperative (to do). In this case, the clause with because is understood to be included in the answer. Why are they coming next week? To make a presentation. (Because they are going to make a presentation.) Test Your Knowledge Now that youve had a chance to review, its time to challenge yourself with a quiz. Provide the missing question words. The answers follow this test. ____ is the weather like in July?____ much is the chocolate?____ boy won the race last week?____ did you get up this morning?____ team won the World Cup in 2002?____ does Janet live?____  long does the concert last?____ food do you like?____ does it take to get to New York from Albany?____ does the movie begin this evening?To  ____  do you report at work?____ is your favorite actor?____ house does he live in?____ is Jack like?____  does the building look like?____ does she study English with?____ do the people in your country go for vacation?____ do you play tennis?____ sports do you play?____ is your doctors appointment next week? Answers WhatHowWhichWhat time / WhenWhichWhereHowWhat kind of / What type ofHow longWhat time / whenWhom - formal English WhoWhichWhatWhatWhoWhereHow often / WhenWhich / How manyWhat time / When

Oedipus the King essays

Oedipus the King essays Every mans life is destined. Some men are told and some are left to discover on their own. Oedipus was one of the few who was told and he took it upon himself to take his fate into his own hands. In the gods eyes, this was a major attack upon them, and justifiably so. In Oedipus the King, Sophocles justifies the gods actions by dramatizing the effects of Oedipus choices to avoid his god-given predestined fate. Once Oedipus made the decision to avoid his fate, the gods then decided to punish him for his disrespect by altering his fate to a much more painful and miserable existence. The gods made a lot of prophecies that led to the Oedipuss downfall. All of these doings by the gods is what changed his fate. The gods, for instance, sent down the sphinx, and guided Oedipus to answer the riddle correctly. Just as they steered Teiresias away from the correct answer to the riddle or the ability to detect the killer. Apollo was the one to set this whole disaster up by telling Oedipus to find the killer. These are the cruel acts of the gods, who are punishing Oedipus for his attempt to escape his fate in the first place. This just goes to show that the gods are ones to be respected and theyre there to almost keep a certain order about things. The real tragedy in the play is the harsh reality that Oedipus comes to learn after this long journey that has ended with pain and suffering. I believe that once Oedipus decided to try and escape the fate that has already been laid out for him, the gods decided to make an example out of him. There are certain choices that in everyone must make sooner or later in their life that will alter their existence forever. This just happened to be the time for Oedipus to make that decision. His problems with knowledge also aided in his poor decision. Those who think that they know everything or too much usually are the ones who do not know enough or have ...

Marketing Mix Strategy for John Lewis Essay Example | Topics and Well Written Essays - 4250 words

Marketing Mix Strategy for John Lewis - Essay Example   Objective for John Lewis John Lewis is based upon ownership structure and commercial success that are unique in nature and built upon partnership reputation. Thereby, the overall objectives of the organisation should focus upon partners, customers and profit. Partners should achieve personal satisfaction in being one of the members of a co-owned enterprise, employ and preserve loyal customers through their application of their continuous trust and should make adequate profit to continue commercial vitality with expectation and profit sharing among members (John Lewis, 2011). 1.1. Marketing Objectives Marketing objective will be towards the achievement of overall goals of the business. There are objectives that are related to product. John Lewis needs to launch more product lines either through their own brands or through collaboration with other brands in different parts of the world (Mesure, 2005). Production cost and other costs need to be reduced so that products are affordabl e and competitive pricing is maintained. There are certain merchandises that have gained high sales volumes. Also, many of the merchandises experienced low sales volumes. Strategy needs to be developed to manage the product lines according to own brand and other brands that are associated with high and low margin. 2.0. Environmental Analysis 2.1. Political Environment The government of the UK encourages the retailers to offer mix job opportunities from locally-based, flexible jobs to highly-skilled and higher-paid jobs. This industry is high with regards to staff turnover. However, the model of John Lewis ensures that the employees are loyal to the company. 2.2. Economic Environment Economical factors have the influential power to affect John Lewis and Waitrose in terms of price, profit and cost. Due to financial crisis, there has been increase in the level of unemployment. This tends to affect the demand for goods and services (Adair & Et. Al., 2009). The economic factors are at th e certain point of time, out of control of John Lewis and have its effect on the company’s performance and thus marketing mix can be intense. The slowdown in market will affect John Lewis in non-food category and Waitrose in food category. However, this is not under the control of the company.  

Health and safety Article Example | Topics and Well Written Essays - 250 words

Health and safety - Article Example The completion of review, of the consultations’ results, will enable the ministry and its system partners to design and administer certain prevention programs for improving the health and safety system. This article’s connection to human resources is that employers and employees are collectively responsible for preserving the health and safety of workers. Employers are obliged to exercise due diligence, by adopting every reasonable measure to ensure the health and safety of their workers (Dessler, Munro, & Cole, 2008, p. 282). The aim of the public consultation on prevention programs, to be undertaken by the Labour Ministry is to strengthen health and safety at the workplace. This requires the coordination and effective involvement of all the stake holders of the program. Moreover, the Labour Ministry has to ensure the optimal design and administration of the program, by collaborating with the other members of the program. MacBride, C., & Skeaff, B. (2014, November 10). Strengthening Health and Safety Culture. Retrieved November 17, 2014, from Ontario Ministry of Labour: