Case Study Analysis
After review and examination of the provided case study, the patient presented with symptoms that are consistent with Rhabdomyolysis. The findings in this case study that support a diagnosis of Rhabdomyolysis include substance abuse, prolonged lying down or immobility, and hyperkalemia (Cleveland, 2022). In this case study the patient has a history of substance abuse, and it is unknown if the patient used any type of substance prior to becoming unresponsive. However, because Naloxone was used by EMS upon arrival and the patient became responsive, it can be presumed the patient had an opioid related overdose. This is presumed because Naloxone is a medication that rapidly reverses an opioid overdose and is classified as an opioid antagonist (Substance, 2022). Opioid antagonists attach to opioid receptors and reverse and block the effects of other opioids (Substance, 2022). If an opioid overdose is suspected, Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose (Substance, 2022). Recreational drug use with such substances as opioids and their derivatives and amphetamines can directly result in Rhabdomyolysis (Substance, 2022).
The patient was found lying down by the roommate for an unknown amount of time. This prolonged period lying down could have led to increased compartmental pressure of the muscles in the left hip and forearm (Cleveland, 2022). Compartmental pressure occurs when pressure rises in and around the muscles (Cleveland, 2022). This can limit blood flow, oxygen, and nutrients to muscles and nerves, resulting in muscle ischemia, infarction, and necrosis by compartmental tamponade which will also cause injury to the nerves (Cleveland, 2022). Compartmental pressure begins to develop when the tissue pressure exceeds the venous pressure and impairs blood outflow (American, 2022). Lack of oxygenated blood and the build up of waste products will result in pain and decreased peripheral sensation secondary to nerve irritation (American, 2022). This would explain the patients’ complaints of the burning pain over his left hip and forearm due to muscle necrosis.
Patient was hyperkalemic with a serum potassium level of 6.9 mEq/L. Hyperkalemia has multiple causes, one of which includes damage to muscles (American, 2022). Muscle damage results in the release of intracellular potassium into circulation resulting in elevated serum potassium levels (American, 2022). Potassium plays a crucial role in electrical signal functioning of the hearts middle thick layer called the myocardium (American, 2022). Increased potassium levels can interfere with proper electrical signals in the myocardium which can lead to heart arrythmias (American, 2022). As potassium levels increase, T-waves peak, and PR intervals are prolonged due to action potential duration (APD) shortening which causes more synchronous repolarization across the ventricular wall ...
Following ischemic stroke, activating cannabinoid receptor types 1 and 2 (C...Andreea-Diana Moisa
Following ischemic stroke, activating cannabinoid receptor types 1 and 2 (CB1 and CB2) using endogenous and synthetic agonists appears to have neuroprotective effects by reducing calcium influx, inhibiting glutamate release to normalize homeostasis, reducing oxidative stress, and restoring blood supply. CB1 activation enhances endocannabinoid signaling to promote neuronal maintenance and function, while CB2 activation protects against cerebral ischemia by inhibiting neutrophil recruitment and reducing infarct size.
This document proposes a new hypothesis for some heart diseases, viewing them through an endogenous toxicological lens. It suggests certain heart pathologies could be caused by imbalances in metabolic-catabolic kinetics or gradients within the body over time. For example, activated platelets triggering coronary spasms or sudden cardiac death in untrained individuals undergoing vigorous activity. The time required and kinetics of resolving temporary imbalances or reducing gradients too rapidly/slowly may be important factors. Considering some endogenous factors as toxic could allow new prevention, diagnostic and treatment strategies focusing on conditions like platelet activation or clarifying causes of sudden cardiac death in young people.
shift in brain metabolism in late onset ad- implications for biomarkers and t...Lauren Klosinski
This document discusses a shift in brain metabolism in late onset Alzheimer's disease and implications for biomarkers and therapeutic interventions. It proposes that mitochondrial bioenergetic deficits and brain hypometabolism occur early in Alzheimer's pathogenesis and lead to increased amyloid beta production and oxidative stress. This results in a shift from glucose-driven bioenergetics to a less efficient ketogenic/fatty acid pathway, eventually causing white matter degeneration. Targeting brain metabolism through interventions that enhance glucose metabolism or activate ketogenic pathways may help prevent or delay disease progression.
1) The document proposes a new hypothesis that some heart diseases could be viewed through the lens of endogenous toxicity, where imbalances in factors like platelets, electrolytes, stress, and metabolism could act as endogenous toxins.
2) It discusses how periods of rest were historically used to treat heart conditions before modern drugs, and how this relates to allowing time for physiological functions to rebalance.
3) The authors suggest their endogenous toxicity perspective could lead to new pharmacological strategies by considering antidotes or detoxification procedures to address proposed endogenous toxic factors in certain heart conditions.
Nitrous oxide is a colourless gas that is commonly used for sedation and pain relief, but is also used by people to feel intoxicated or high. It is commonly used by dentists and medical professionals to sedate patients undergoing minor medical procedures
The document discusses the concept of intra-local toxicology and how considering time and the local microenvironment may provide insights into certain pathologies. It suggests applying toxicology methods to analyze the intracellular and extracellular microenvironment status. Some examples discussed include how metabolic imbalances, immune responses, and electrical or chemical gradients in cells over time may relate to conditions like heart issues, seizures, or sepsis. The document argues that taking these intra-local toxicology factors into account may help understand disease processes.
1) The document proposes new pharmacological strategies for some heart diseases using a toxicological approach and new delivery systems. It reviews literature on topics like kinetics, metabolism, toxicity, and autonomic control that could provide insights into pathologies.
2) The author suggests that a toxicological perspective considering local metabolic/catabolic processes over time could help understand some conditions. New tests stressing cardiac metabolism in different conditions may help diseases like heart attacks and failure.
3) Combining drugs with delivery systems like stents could help treatments act in the right sites and reduce side effects, as seen in some current therapies. Further clinical trials are needed to validate potential new strategies.
Following ischemic stroke, activating cannabinoid receptor types 1 and 2 (C...Andreea-Diana Moisa
Following ischemic stroke, activating cannabinoid receptor types 1 and 2 (CB1 and CB2) using endogenous and synthetic agonists appears to have neuroprotective effects by reducing calcium influx, inhibiting glutamate release to normalize homeostasis, reducing oxidative stress, and restoring blood supply. CB1 activation enhances endocannabinoid signaling to promote neuronal maintenance and function, while CB2 activation protects against cerebral ischemia by inhibiting neutrophil recruitment and reducing infarct size.
This document proposes a new hypothesis for some heart diseases, viewing them through an endogenous toxicological lens. It suggests certain heart pathologies could be caused by imbalances in metabolic-catabolic kinetics or gradients within the body over time. For example, activated platelets triggering coronary spasms or sudden cardiac death in untrained individuals undergoing vigorous activity. The time required and kinetics of resolving temporary imbalances or reducing gradients too rapidly/slowly may be important factors. Considering some endogenous factors as toxic could allow new prevention, diagnostic and treatment strategies focusing on conditions like platelet activation or clarifying causes of sudden cardiac death in young people.
shift in brain metabolism in late onset ad- implications for biomarkers and t...Lauren Klosinski
This document discusses a shift in brain metabolism in late onset Alzheimer's disease and implications for biomarkers and therapeutic interventions. It proposes that mitochondrial bioenergetic deficits and brain hypometabolism occur early in Alzheimer's pathogenesis and lead to increased amyloid beta production and oxidative stress. This results in a shift from glucose-driven bioenergetics to a less efficient ketogenic/fatty acid pathway, eventually causing white matter degeneration. Targeting brain metabolism through interventions that enhance glucose metabolism or activate ketogenic pathways may help prevent or delay disease progression.
1) The document proposes a new hypothesis that some heart diseases could be viewed through the lens of endogenous toxicity, where imbalances in factors like platelets, electrolytes, stress, and metabolism could act as endogenous toxins.
2) It discusses how periods of rest were historically used to treat heart conditions before modern drugs, and how this relates to allowing time for physiological functions to rebalance.
3) The authors suggest their endogenous toxicity perspective could lead to new pharmacological strategies by considering antidotes or detoxification procedures to address proposed endogenous toxic factors in certain heart conditions.
Nitrous oxide is a colourless gas that is commonly used for sedation and pain relief, but is also used by people to feel intoxicated or high. It is commonly used by dentists and medical professionals to sedate patients undergoing minor medical procedures
The document discusses the concept of intra-local toxicology and how considering time and the local microenvironment may provide insights into certain pathologies. It suggests applying toxicology methods to analyze the intracellular and extracellular microenvironment status. Some examples discussed include how metabolic imbalances, immune responses, and electrical or chemical gradients in cells over time may relate to conditions like heart issues, seizures, or sepsis. The document argues that taking these intra-local toxicology factors into account may help understand disease processes.
1) The document proposes new pharmacological strategies for some heart diseases using a toxicological approach and new delivery systems. It reviews literature on topics like kinetics, metabolism, toxicity, and autonomic control that could provide insights into pathologies.
2) The author suggests that a toxicological perspective considering local metabolic/catabolic processes over time could help understand some conditions. New tests stressing cardiac metabolism in different conditions may help diseases like heart attacks and failure.
3) Combining drugs with delivery systems like stents could help treatments act in the right sites and reduce side effects, as seen in some current therapies. Further clinical trials are needed to validate potential new strategies.
Diabetic erectile dysfunction is often resistant to treatment with PDE5 inhibitors. The pathophysiology involves several factors over time. Initially, hyperglycemia causes endothelial dysfunction in penile blood vessels. This leads to reduced blood flow to the autonomic ganglia within weeks, exposing neurons to hypoxic conditions. Prolonged hypoxia can decrease nitric oxide production in the neurons and disrupt axonal transport, accumulating nitric oxide synthase in the cell bodies and depleting it from the nerve terminals. Over longer periods, this nitrergic dysfunction and degeneration can progress to irreversible erectile dysfunction.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
1) The document discusses the concept of an intra-local toxicology aspect that is time-related and may help explain certain pathologic conditions.
2) It reviews several studies looking at factors like drugs, chemicals, stress, and inflammation that can impact conditions like autoimmune diseases, sudden cardiac death, coronary artery spasm, and fear responses.
3) One study found that resting metabolism levels in the amygdala, anterior cingulate cortex, and prefrontal cortex predicted brain activation and fear responses during an extinction learning task.
Jessica Alper Chief complaintThe chief complaint stated in t.docxLaticiaGrissomzz
The document describes a case of a patient presenting with increasing shortness of breath and cough over the last month. Upon examination, the patient is found to have distant breath sounds, crackles in both lower lobes, and an S3 gallop. The presumptive diagnosis is congestive heart failure, supported by the patient's symptoms and physical exam findings. Differential diagnoses include cardiogenic pulmonary edema and acute kidney injury. The treatment plan for congestive heart failure involves both pharmacological and non-pharmacological approaches, as well as some invasive strategies when medications have failed or the condition has progressed to end-stage.
This paper discusses new pharmacological strategies for heart disease from a toxicological point of view. It reviews literature on topics like the role of kinetics and gradients in heart metabolism and toxicity. It proposes considering some cardiovascular conditions as forms of chronic endogenous poisoning. The paper suggests that a toxicological approach using new delivery systems and diagnostic strategies could provide insights into mechanisms of toxic action and lead to new research hypotheses and pharmacological treatments.
This document discusses potential new pharmacological strategies for some metabolic and endocrine disorders based on a toxicological approach. It reviews literature showing how factors like kinetics, gradients, toxicity, membrane function, and autonomic control are involved in various conditions and could be further explored. New delivery methods and combining drugs with other instruments may help treatments act more effectively with fewer side effects. While current drug associations are used, their efficacy could be improved. A toxicological perspective considering time-related endogenous toxicity and cellular effects may provide new insights into pathological processes and better verify treatment approaches.
This document proposes a new hypothesis for some heart diseases under an endogenous toxicological aspect. It suggests that metabolic-catabolic kinetics and gradients over time within the body can create temporary toxic states at the cellular level that result in organ failure. Certain cardiovascular conditions may be caused by endogenous local microenvironment imbalances rather than external factors alone. Considering an endogenous intra-local toxicology perspective that accounts for time-dependent pathological processes could provide new insights into the etiology, diagnosis, and treatment of some heart diseases.
1) The document proposes a new hypothesis that some heart diseases may be caused by endogenous toxicological factors over time. It suggests metabolic and cellular imbalances can create toxic states within the body that restore over long periods of rest without stress.
2) Certain cardiac events like sudden death in untrained individuals may be due to time-related intra-toxicity of metabolic, immune, or electrical cellular processes. Conditions like coronary artery spasm may also be linked to local microenvironmental toxicology that changes over time.
3) The kinetics of how quickly or slowly metabolic-catabolic gradients resolve in the body may be important in balancing physiological systems and underlying some cardiovascular pathologies. More toxicological study of endogenous intra-
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
A New Perspective On Alzheimer S Disease As A Brain Expression Of A Complex M...Tony Lisko
This document discusses Alzheimer's disease as a brain expression of a complex metabolic disorder. It summarizes that AD is characterized by abnormalities at systemic, histological, macromolecular and biochemical levels beyond amyloid plaques and neurofibrillary tangles. It proposes that cerebral hypoperfusion and metabolic stress from factors like atherosclerosis, infections and insulin resistance can trigger AD pathology by inducing oxidative damage and impairing brain energy metabolism. Specifically, it suggests that arginine and branched chain amino acid metabolism disturbances contribute to AD pathogenesis and that maintaining adequate levels of these nutrients may have therapeutic potential.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
Annovis Bio is a clinical-stage, drug platform company addressing neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease (PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of the nerve cell, known as axonal transport. When this information flow is impaired, the nerve cell gets sick and dies. The company expects its treatment to improve memory loss and dementia associated with AD and AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD and early AD patients.
Advanced Response to a discussion post.docxwrite22
This patient presented with rhabdomyolysis, which was caused by a lack of blood flow to the left hip and forearm muscles. The substance abuse and subsequent unresponsiveness likely interrupted ATP production in the muscles. When emergency services administered naloxone, it reversed the effects of the opioids and improved blood flow, but not before damage had been done. The patient now exhibits symptoms of rhabdomyolysis like necrosis in the affected muscles and hyperkalemia. The increased potassium levels are due to the breakdown of muscle cells releasing potassium into the bloodstream. Genetics did not play a role in this case, and the condition would present similarly in a male or female patient.
This study aims to evaluate mitochondrial dysfunction in chronic fatigue syndrome (CFS) patients. The researchers administered an "ATP profile" test to 71 CFS patients and 53 healthy controls to measure 5 factors related to mitochondrial energy production. They found that CFS patients had different combinations of biochemical abnormalities across the 5 factors. When combined, the factors showed a strong correlation between the severity of mitochondrial dysfunction and illness severity. Only 1 of the 71 patients overlapped with the normal region. The ATP profile test can help diagnose CFS by distinguishing patients with energy deficiencies due to mitochondrial problems from those with fatigue from other causes like stress. It also indicates which treatments may help by targeting specific biochemical abnormalities.
1) The document discusses new pharmacological strategies and delivery systems for treating some heart diseases from a toxicological perspective. It reviews literature on using kinetic and metabolic approaches to better understand pathophysiological processes.
2) It suggests applying toxicological concepts like intra-local toxicity over time to explore conditions like sudden death syndrome. New drug delivery methods could help drugs act more locally with fewer side effects.
3) The 4th Global Summit on Heart Diseases in September 2018 in Singapore will bring together cardiologists to discuss research on diagnosing and treating cardiac diseases and explore the future of the field.
Hypovolemic Shock: How Does Lactic Acid Affect the Heart?Javeriana Cali
This article discusses how lactic acid affects the heart during hypovolemic shock. It presents a case study of a 26-year-old woman who experienced hypovolemic shock after a serious car accident. Her condition deteriorated despite aggressive resuscitation efforts and she suffered multiple cardiac arrests. The article then explains that hypovolemic shock leads to increased anaerobic glycolysis and lactic acid production. High lactic acid levels can depress the myocardium and reduce heart responsiveness. The accumulation of lactic acid is part of the body's stress response but can also negatively impact cardiovascular function if levels become too high.
This document discusses potential new diagnostic methods for studying sudden cardiac death. It notes that in about 20% of cases, no abnormality is found at autopsy to explain the cause of death. It proposes stressing the heart under normal and abnormal conditions to better understand its metabolic responses. This could help clarify pathological causes and allow for improved drug design strategies. The document advocates translating diagnostic approaches across medical disciplines to gain new insights. Overall, it presents the idea of developing innovative tests to evaluate the heart's local biochemical status under varying conditions in order to help prevent unexpected cardiac events, especially in young people.
This document summarizes new pharmacological strategies for treating some heart diseases from a toxicological perspective. It reviews literature on using new diagnostic tests to assess cardiac metabolism under stress, considering local heart toxicity over time, and delivering drugs using new delivery systems. It concludes that considering kinetics, metabolism, toxicity over time, and new diagnostic and delivery methods could provide new approaches for certain cardiovascular conditions.
Chapter 1 Overview of geneticsQUESTIONS FOR RESEARCH AND DISCUSSMaximaSheffield592
Chapter 1 Overview of genetics
QUESTIONS FOR RESEARCH AND DISCUSSION
7. What criteria would you use to determine whether synesthesia is a disorder or a variation of normal sensation and perception?
8. Why do you think that synesthesia is more common today than it was 20 years ago?
9. Why might it be possible for infants to have synesthesia, but the ability is gradually lost?
10. Would you want to take a genetic test for synesthesia? Cite a reason for your answer.
11. Do you think that synesthesia should be regarded as a learning disability, an advantage, or neither?
Chapter 2 Cells
10. Historical references as well as current anecdotal reports suggest that under very unusual circumstances, males can breastfeed. The Talmud, a book of Jewish law, discusses a man whose wife died and who had no money to pay a wet nurse (a woman who breastfeeds another woman’s child). He was able to nourish the child with his own body. The writings of other religions report similar tales. In agriculture, male goats can receive hormonal treatments and make milk. Do you think that it is possible for a human male to breastfeed, and if so, what conditions must be provided to coax his body to produce and secrete milk?
12. Compare the roles of mitosis and apoptosis in remodeling Sheila’s breast from a fatty sac to an active milk gland.
You are to prepare 16 slides PowerPoints of health care system in Cuba. Rubric includes: type of Government Demographics Population, type of health care system currently in place, History of the health care system, including changes and recent developments, How is the delivery system organized and financed? Who is covered and how is insurance financed? What is covered? What is the role of government? What are the key entities for health system governance? World Health Organization rankings in major indices of health (infant mortality, life expectancy, etc.). Strengths and weaknesses of the system. Popularity of system among citizens. (5-6) reputable and current sources (within 5 years).
CHAPTER 1 Overview of Genetics
Senses Working Overtime Eighteen-year-old Sean Maxwell has always perceived the world in an unusual way. To most people, color is a characteristic of an object—a cherry is red; a hippo, gray. To Sean, colors are much more. When he plays a note on his guitar, or hears it from another instrument, a distinctively colored shape pops into his mind. His brain, while perceiving the note as an E flat or a C sharp, creates an overwhelming feeling of iridescent orange-yellow diamonds, or a single, shimmering sky blue crescent. Soaring crescendos of sound become detailed landscapes, peppered with alternating black and white imagery that parallels the staccato notes. These images flash by his consciousness in such rapid succession that he is barely aware of them, yet they seem to burst through his fingers in the patterns of notes that he plays. Sean has experienced these peculiar specific sound-color-shape associations for as ...
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Similar to Case Study AnalysisAfter review and examination of the provided
Diabetic erectile dysfunction is often resistant to treatment with PDE5 inhibitors. The pathophysiology involves several factors over time. Initially, hyperglycemia causes endothelial dysfunction in penile blood vessels. This leads to reduced blood flow to the autonomic ganglia within weeks, exposing neurons to hypoxic conditions. Prolonged hypoxia can decrease nitric oxide production in the neurons and disrupt axonal transport, accumulating nitric oxide synthase in the cell bodies and depleting it from the nerve terminals. Over longer periods, this nitrergic dysfunction and degeneration can progress to irreversible erectile dysfunction.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
1) The document discusses the concept of an intra-local toxicology aspect that is time-related and may help explain certain pathologic conditions.
2) It reviews several studies looking at factors like drugs, chemicals, stress, and inflammation that can impact conditions like autoimmune diseases, sudden cardiac death, coronary artery spasm, and fear responses.
3) One study found that resting metabolism levels in the amygdala, anterior cingulate cortex, and prefrontal cortex predicted brain activation and fear responses during an extinction learning task.
Jessica Alper Chief complaintThe chief complaint stated in t.docxLaticiaGrissomzz
The document describes a case of a patient presenting with increasing shortness of breath and cough over the last month. Upon examination, the patient is found to have distant breath sounds, crackles in both lower lobes, and an S3 gallop. The presumptive diagnosis is congestive heart failure, supported by the patient's symptoms and physical exam findings. Differential diagnoses include cardiogenic pulmonary edema and acute kidney injury. The treatment plan for congestive heart failure involves both pharmacological and non-pharmacological approaches, as well as some invasive strategies when medications have failed or the condition has progressed to end-stage.
This paper discusses new pharmacological strategies for heart disease from a toxicological point of view. It reviews literature on topics like the role of kinetics and gradients in heart metabolism and toxicity. It proposes considering some cardiovascular conditions as forms of chronic endogenous poisoning. The paper suggests that a toxicological approach using new delivery systems and diagnostic strategies could provide insights into mechanisms of toxic action and lead to new research hypotheses and pharmacological treatments.
This document discusses potential new pharmacological strategies for some metabolic and endocrine disorders based on a toxicological approach. It reviews literature showing how factors like kinetics, gradients, toxicity, membrane function, and autonomic control are involved in various conditions and could be further explored. New delivery methods and combining drugs with other instruments may help treatments act more effectively with fewer side effects. While current drug associations are used, their efficacy could be improved. A toxicological perspective considering time-related endogenous toxicity and cellular effects may provide new insights into pathological processes and better verify treatment approaches.
This document proposes a new hypothesis for some heart diseases under an endogenous toxicological aspect. It suggests that metabolic-catabolic kinetics and gradients over time within the body can create temporary toxic states at the cellular level that result in organ failure. Certain cardiovascular conditions may be caused by endogenous local microenvironment imbalances rather than external factors alone. Considering an endogenous intra-local toxicology perspective that accounts for time-dependent pathological processes could provide new insights into the etiology, diagnosis, and treatment of some heart diseases.
1) The document proposes a new hypothesis that some heart diseases may be caused by endogenous toxicological factors over time. It suggests metabolic and cellular imbalances can create toxic states within the body that restore over long periods of rest without stress.
2) Certain cardiac events like sudden death in untrained individuals may be due to time-related intra-toxicity of metabolic, immune, or electrical cellular processes. Conditions like coronary artery spasm may also be linked to local microenvironmental toxicology that changes over time.
3) The kinetics of how quickly or slowly metabolic-catabolic gradients resolve in the body may be important in balancing physiological systems and underlying some cardiovascular pathologies. More toxicological study of endogenous intra-
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
A New Perspective On Alzheimer S Disease As A Brain Expression Of A Complex M...Tony Lisko
This document discusses Alzheimer's disease as a brain expression of a complex metabolic disorder. It summarizes that AD is characterized by abnormalities at systemic, histological, macromolecular and biochemical levels beyond amyloid plaques and neurofibrillary tangles. It proposes that cerebral hypoperfusion and metabolic stress from factors like atherosclerosis, infections and insulin resistance can trigger AD pathology by inducing oxidative damage and impairing brain energy metabolism. Specifically, it suggests that arginine and branched chain amino acid metabolism disturbances contribute to AD pathogenesis and that maintaining adequate levels of these nutrients may have therapeutic potential.
Annovis Bio is a clinical-stage, drug platform company addressing
neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease
(PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to
be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of
the nerve cell, known as axonal transport. When this information flow is
impaired, the nerve cell gets sick and dies. The company expects its
treatment to improve memory loss and dementia associated with AD and
AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD
and early AD patients.
Annovis Bio is a clinical-stage, drug platform company addressing neurodegeneration, such as Alzheimer’s disease (AD), Parkinson’s disease (PD) and Alzheimer’s in Down Syndrome (AD-DS). Annovis is believed to be the only company developing a drug for AD, PD and AD-DS that inhibits
more than one neurotoxic protein and improves the information highway of the nerve cell, known as axonal transport. When this information flow is impaired, the nerve cell gets sick and dies. The company expects its treatment to improve memory loss and dementia associated with AD and AD-DS, as well as body and brain function in PD. Annovis has an ongoing
Phase 2a study in AD patients and a second Phase 2a study in early PD and early AD patients.
Advanced Response to a discussion post.docxwrite22
This patient presented with rhabdomyolysis, which was caused by a lack of blood flow to the left hip and forearm muscles. The substance abuse and subsequent unresponsiveness likely interrupted ATP production in the muscles. When emergency services administered naloxone, it reversed the effects of the opioids and improved blood flow, but not before damage had been done. The patient now exhibits symptoms of rhabdomyolysis like necrosis in the affected muscles and hyperkalemia. The increased potassium levels are due to the breakdown of muscle cells releasing potassium into the bloodstream. Genetics did not play a role in this case, and the condition would present similarly in a male or female patient.
This study aims to evaluate mitochondrial dysfunction in chronic fatigue syndrome (CFS) patients. The researchers administered an "ATP profile" test to 71 CFS patients and 53 healthy controls to measure 5 factors related to mitochondrial energy production. They found that CFS patients had different combinations of biochemical abnormalities across the 5 factors. When combined, the factors showed a strong correlation between the severity of mitochondrial dysfunction and illness severity. Only 1 of the 71 patients overlapped with the normal region. The ATP profile test can help diagnose CFS by distinguishing patients with energy deficiencies due to mitochondrial problems from those with fatigue from other causes like stress. It also indicates which treatments may help by targeting specific biochemical abnormalities.
1) The document discusses new pharmacological strategies and delivery systems for treating some heart diseases from a toxicological perspective. It reviews literature on using kinetic and metabolic approaches to better understand pathophysiological processes.
2) It suggests applying toxicological concepts like intra-local toxicity over time to explore conditions like sudden death syndrome. New drug delivery methods could help drugs act more locally with fewer side effects.
3) The 4th Global Summit on Heart Diseases in September 2018 in Singapore will bring together cardiologists to discuss research on diagnosing and treating cardiac diseases and explore the future of the field.
Hypovolemic Shock: How Does Lactic Acid Affect the Heart?Javeriana Cali
This article discusses how lactic acid affects the heart during hypovolemic shock. It presents a case study of a 26-year-old woman who experienced hypovolemic shock after a serious car accident. Her condition deteriorated despite aggressive resuscitation efforts and she suffered multiple cardiac arrests. The article then explains that hypovolemic shock leads to increased anaerobic glycolysis and lactic acid production. High lactic acid levels can depress the myocardium and reduce heart responsiveness. The accumulation of lactic acid is part of the body's stress response but can also negatively impact cardiovascular function if levels become too high.
This document discusses potential new diagnostic methods for studying sudden cardiac death. It notes that in about 20% of cases, no abnormality is found at autopsy to explain the cause of death. It proposes stressing the heart under normal and abnormal conditions to better understand its metabolic responses. This could help clarify pathological causes and allow for improved drug design strategies. The document advocates translating diagnostic approaches across medical disciplines to gain new insights. Overall, it presents the idea of developing innovative tests to evaluate the heart's local biochemical status under varying conditions in order to help prevent unexpected cardiac events, especially in young people.
This document summarizes new pharmacological strategies for treating some heart diseases from a toxicological perspective. It reviews literature on using new diagnostic tests to assess cardiac metabolism under stress, considering local heart toxicity over time, and delivering drugs using new delivery systems. It concludes that considering kinetics, metabolism, toxicity over time, and new diagnostic and delivery methods could provide new approaches for certain cardiovascular conditions.
Similar to Case Study AnalysisAfter review and examination of the provided (20)
Chapter 1 Overview of geneticsQUESTIONS FOR RESEARCH AND DISCUSSMaximaSheffield592
Chapter 1 Overview of genetics
QUESTIONS FOR RESEARCH AND DISCUSSION
7. What criteria would you use to determine whether synesthesia is a disorder or a variation of normal sensation and perception?
8. Why do you think that synesthesia is more common today than it was 20 years ago?
9. Why might it be possible for infants to have synesthesia, but the ability is gradually lost?
10. Would you want to take a genetic test for synesthesia? Cite a reason for your answer.
11. Do you think that synesthesia should be regarded as a learning disability, an advantage, or neither?
Chapter 2 Cells
10. Historical references as well as current anecdotal reports suggest that under very unusual circumstances, males can breastfeed. The Talmud, a book of Jewish law, discusses a man whose wife died and who had no money to pay a wet nurse (a woman who breastfeeds another woman’s child). He was able to nourish the child with his own body. The writings of other religions report similar tales. In agriculture, male goats can receive hormonal treatments and make milk. Do you think that it is possible for a human male to breastfeed, and if so, what conditions must be provided to coax his body to produce and secrete milk?
12. Compare the roles of mitosis and apoptosis in remodeling Sheila’s breast from a fatty sac to an active milk gland.
You are to prepare 16 slides PowerPoints of health care system in Cuba. Rubric includes: type of Government Demographics Population, type of health care system currently in place, History of the health care system, including changes and recent developments, How is the delivery system organized and financed? Who is covered and how is insurance financed? What is covered? What is the role of government? What are the key entities for health system governance? World Health Organization rankings in major indices of health (infant mortality, life expectancy, etc.). Strengths and weaknesses of the system. Popularity of system among citizens. (5-6) reputable and current sources (within 5 years).
CHAPTER 1 Overview of Genetics
Senses Working Overtime Eighteen-year-old Sean Maxwell has always perceived the world in an unusual way. To most people, color is a characteristic of an object—a cherry is red; a hippo, gray. To Sean, colors are much more. When he plays a note on his guitar, or hears it from another instrument, a distinctively colored shape pops into his mind. His brain, while perceiving the note as an E flat or a C sharp, creates an overwhelming feeling of iridescent orange-yellow diamonds, or a single, shimmering sky blue crescent. Soaring crescendos of sound become detailed landscapes, peppered with alternating black and white imagery that parallels the staccato notes. These images flash by his consciousness in such rapid succession that he is barely aware of them, yet they seem to burst through his fingers in the patterns of notes that he plays. Sean has experienced these peculiar specific sound-color-shape associations for as ...
Chapter 1 OutlineI. Thinking About DevelopmentA. What Is HumMaximaSheffield592
Chapter 1 Outline
I. Thinking About Development
A. What Is Human Development?
1. Human development is the multidisciplinary study of how people change and how they remain the same over time.
2. The science of human development (1) reflects the complexity and uniqueness of each person and their experiences, (2) seeks to understand commonalities and patterns across people, (3) is firmly grounded in theory, and (4) seeks to understand human behavior.
B. Recurring Issues in Human Development: Three fundamental issues dominate the study of human development.
1. Nature Versus Nurture is the degree to which genetic influences (nature) or experiential/environmental influences (nurture) determine the kind of person you are. Despite the ongoing debate as to which influence is greater, theorists and researchers recognize that development is always shaped by both—nature and nurture are mutually interactive influences.
2. Continuity Versus Discontinuity focuses on whether a particular developmental phenomenon represents a smooth progression throughout the life span (continuity) or a series of abrupt shifts (discontinuity).
3. Universal Versus Context-Specific Development focuses on whether there is just one path of development or several. In other words, does development follow the same general path in all people, or is it fundamentally different, depending on the sociocultural context?
C. Basic Forces in Human Development: The Biopsychosocial Framework. This framework emphasizes that these four forces are mutually interactive and that development cannot be understood by examining them in isolation. By combining the four developmental forces, we have a view of human development that encompasses the life span, yet appreciates the unique aspects of each phase of life.
1. Biological forces include genetic and health-related factors that affect development. Some biological forces, such as puberty and menopause, are universal and affect people across generations, whereas others, such as diet or disease, affect people in specific generations or occur in a small number of people.
2. Psychological forces include all internal perceptual, cognitive, emotional, and personality factors that affect development. Psychological forces are the ones used most often to describe the characteristics of a person and have received the most attention.
3. Sociocultural forces include interpersonal, societal, cultural, and ethnic factors that affect development. Culture refers to the knowledge, attitudes, and behaviors associated with a group of people. Overall, sociocultural forces provide the context or backdrop for development. Consequently, there is a need for research on different cultural groups. Another practical problem is how to describe racial and ethnic groups.
4. Life-cycle forces reflect differences in how the same event affects people of different ages. The influence of life-cycle forces reflects the influences of biological, psychological, and sociocultural force ...
Chapter 1 Juvenile Justice Myths and RealitiesMyths and RealiMaximaSheffield592
Chapter 1 Juvenile Justice: Myths and RealitiesMyths and Realities
It’s only me.” These were the tragic words spoken by Charles “Andy” Williams as the San Diego Sheriff’s Department SWAT team closed in
on the frail high school sophomore who had just turned 15 years old. Williams had just shot a number of his classmates at Santana High
School, killing two and wounding 13. This was another in a series of school shootings that shocked the nation; however, the young Mr.
Williams did not fit the stereotype of the “superpredator” that has had an undue influence on juvenile justice policy for decades. There have
been other very high-profile cases involving children and teens that have generated a vigorous international debate on needed changes in the
system of justice as applied to young people.
In Birmingham, Alabama, an 8-year-old boy was charged with “viciously” attacking a toddler, Kelci Lewis, and murdering her (Binder, 2015).
The law enforcement officials announced their intent to prosecute the boy as an adult. The accused perpetrator would be among the youngest
criminal court victims in U.S. history. The 8-year-old became angry and violent, and beat the toddler because she would not stop crying. Kelci
suffered severe head trauma and injuries to major internal organs. The victim’s mother, Katerra Lewis, left the two children alone so that she
could attend a local nightclub. There were six other children under the age of 8 also left alone in the house. Within days, the mother was
arrested and charged with manslaughter and released on a $15,000 bond after being in custody for less than 90 minutes. The 8-year-old was
held by the Alabama Department of Human Services pending his adjudication.
A very disturbing video showed a Richland County, South Carolina, deputy sheriff grab a 16-year-old African American teen by her hair,
flipping her out her chair and tossing her across the classroom. The officer wrapped his forearm around her neck and then handcuffed her. It is
alleged that the teen refused to surrender her phone to the deputy. She received multiple injuries from the encounter. The classroom teacher and
a vice principal said that they believed the police response was “appropriate.” The deputy was suspended and subsequently fired after the
Richland County Sheriff reviewed the video. There is a civil suit against the school district and the sheriff’s department for the injuries that
were sustained (Strehike, 2015).
One of the highest profile cases involving juvenile offenders was known as the New York Central Park jogger case (Burns, 2011; Gray, 2013).
In 1989 a young female investment banker was raped, attacked, and left in a coma. The horrendous crime captured worldwide attention.
Initially, 11 young people were arrested and five confessed to the crimes. These five juvenile males, four African American and one Latino,
were convicted for a range of crimes including assault, robbery, rape, and attempted murder. There were two separate jury t ...
CHAPTER 1 Philosophy as a Basis for Curriculum DecisioMaximaSheffield592
CHAPTER
1
Philosophy as a Basis for
Curriculum Decisions
ALLAN C. ORNSTEIN
FOCUSING QUESTIONS . . d implementation of curriculum?
hil h uide the orgaruzation an
1. How does p osop y g 1 d that shape a person's philosophy of
2. What are the sources of know e ge
curriculum? d that shape your philosophical view of 1
What are the sources of know e ge3.
curriculum? · diff
. d ends of education er.
?
4. How do the auns, means, an_ . at must be determined before we can
What is the major philosop~cal is~ue th
5. define a philosophy of curncul~- hil hies that have influenced curriculum
What are the four major educational p osop .6.
in the United States?
7. What is your philosophy of curriculum?
P
d still do have an impact on schools and
hilosophic issues always h~ve had ~ hools are changing fundamental~y and
society. Contemporary society ~d its :cThere is a special urgency that dictate~
rapidly, much more so th~ m e ~a:oie of schools, and calls for a philosophy o
continuous appraisal and reappraisal of th directionless in the whats and hows of
education. Without philosophy, educators a~ing to achieve. In short, our philo~~phy
organizing and implementing what we ar~ t determines, our educational decisions,
of education influences, and to a large ex en
choices, and alternatives.
PHILOSOPHY AND CURRICULUM . 1· ts with a framework for
. 11 curriculum specia is , h
Philosophy provides educators, espect i{e1 s them answer questions about what t e
organizing schools and classrooms. t f 1 how students learn, and what methods
school's purpose is, what subjects are: va;~ with a framework for broad issues and
and materials to use. Philosophy provi es e
CHAPTER ONE Philosophy as a Basis for Curriculum Decisions 3
tasks, such as determining the goals of edu and activities, and dealing with verbal traps
cation, subject content and its organization, (what we see versus what is read). Curricu
the process of teaching and learning, and, in lum theorists, they point out, often fail to rec
general, what experiences and activities to ognize both how important philosophy is to
stress in schools and classrooms. It also pro developing curriculum and how it influences
vides educators with a basis for making such aspects of curriculum.
decisions as what workbooks, textbooks, or
other cognitive and noncognitive activities to
Philosophy and the Curriculum Sp
utilize and how to utilize them, what and
how much homework to assign, how to test The philosophy of curriculum sp
students and how to use the test results, and reflects their life experiences, comma
what courses or subject matter to emphasize. social and economic background, ed
The importance of philosophy in deter and general beliefs about people. f._•• .....u
mining curriculum decisions is expressed vidual's philosophy evolves and continues
well by the classic statement of Thomas to evolve as long as there is personal growth,
Hopkins (1941): "Philosop ...
Chapter 1 Introduction Criterion• Introduction – states general MaximaSheffield592
Chapter 1 Introduction Criterion
• Introduction – states general nature of problem
• Identifies project as quality or leadership focused project
• Background – briefly describes general context of the topic
• Statement of the problem – ‘Therefore the problem/topic addressed in this study is…’
• Purpose of the study – describes specific objectives of the study, related to the problem described above.
• Rationale – Ties together the identified problem, the purpose/goal of the study, and identifies how the writer intends the results will be used to accomplish identified goals.
• Research questions – lists 2-4 specific research questions/objectives for the study.
• Nature of the study – identifies method of study to be used (descriptive, relational, causal, exploratory, or predictive}
• Significance of the study – personal, professional, and/or research.
• Definition of terms
• Assumptions and Limitations
Writing the Personal Statement
The personal statement is an important document in your application packet. Admissions committees not only read them, they remember the memorable ones! A strong personal statement can be make-or-break for your application process.
What is it? It’s a combination of things:
· It is a business document: you are selling yourself, and need to know how to do so persuasively.
· It is an argument: you are showing the reader that they need and want you in their
program, but rather than convince with reasons, you are often arguing using narrative.
· It is an assignment, and your target audience is looking for you to show them that you know how to give what is asked for.
Consider your audience. Beware of Web sites and other sources that simply tell you to “tell your story.” Which story will you choose and for which purpose?
Medical and Law Schools
Science Programs
Humanities MA Programs
Humanities PhD Programs
Diplomatic
Service Scholarships
Want to know
Want to know
Want to see that
Want to know
Want to know
you as a person
your work as a
you are
how you will
you as a person
researcher and
interested in
succeed both in
your work ethic
further study and
and beyond the
know your long-
program
term goals
Remember that your resume tells them that you can do good undergraduate or graduate work. Now they need to know that they are choosing a winner, one who can perform at a higher level and will finish!
Five Standard Topics:
1. your motivation for your career
2. the influence of your family or early experiences
3. the influence of extracurricular, work, or volunteer experiences
4. your long-term goals
5. your personal philosophy
Activity One:
Below is a list of attributes that applicants to professional programs highlight in their personal statements. On the right is a list of indications of the attribute. Read through the list and
· Check off those attributes you want to highlight.
· List possible stories you can tell about yourself, your family, your extracurricular activities, your goals, or your personal ph ...
Chapter 1 IntroductionThis research paper seeks to examine the reMaximaSheffield592
Chapter 1: Introduction
This research paper seeks to examine the relationship between strategic performance and appraisal systems in contemporary organizations. Strategic management in organizations refers to setting goals, procedures, and objectives to gain a competitive advantage. The strategies aim at making businesses distinct from their competitors while attracting consumers to the market. Stakeholders in business entities use strategic management approaches to execute short- and long-term organizational projects. Some strategies include innovation, product segmentation, and corporate social responsibility. On the other hand, a performance appraisal system refers to identifying, evaluating, and developing the work performance of employees to aid in the process of achieving the organization's goals and processes. The organization has to track the performance progress of each employee to keep them accountable for their roles at the workplace.
The definition of the appraisal system and strategic management incorporates objectives and goals. Consequently, the purpose of both strategic management and performance appraisal is to deliver the existing objectives and stay ahead of competitors. The performance appraisal system denotes the type of assessment used by an organization to measure performance. There are different assessment methods. One of the evaluation techniques is straight ranking appraisal where employees are ranked from the best performers to poor performers. Another assessment criterion is grading where employees are assigned specific grades for their performance in different areas. There is also the management-by-objective method of review. The employees and managers set goals under the approach and measure them at the end of the agreed time. Organizations may also assess their employees based on their behaviors and conduct at the workplace. Lastly, organizations can adopt a 360-degree assessment method where employees and managers are assessed. Organizations use one or a combination of the frameworks to evaluate the employees with a view of improving performance.
The purpose of this study is to examine the relationship between strategic management and performance appraisal systems. The study will evaluate whether managers consider their strategies when selecting the appraisal system or consider other factors. Also, the study will assess the implications of selecting an appraisal system based on the existing strategies in different organizations and the impacts of ignoring organizational strategies when deciding on the performance of the appraisal system. The findings will be crucial in the organizational and human resource management field setting the stage for further research.
Statement of Problem
A brief literature review reveals that there is little to no information on balancing between appraisal systems and organizational strategies. Most researchers in the field tend to focus on how appraisal systems boost organizatio ...
Chapter 1 Introduction to Career Development in the Global EconoMaximaSheffield592
Chapter 1: Introduction to Career Development in the Global Economy and Its Role in Social Justice
Things to Remember
· The reality of the global economy and its implications for employment in the United States
· Why the need for career development services may be at its highest level in half a century
· The language of career development The reasons that careers and career development are important in the fight for social justice
· The major events in the history of career development
History of Vocational Guidance and Career Development
As will be discussed later in this chapter, there are currently calls for the adoption of a new paradigm for the theory and practice of career counseling and career development services that focuses on both individuals and the social contexts in which they function. These ideas are not new, but throughout much of the twentieth century they were neglected. The call for understanding the individual and how he or she is influenced by his or her context is a century-old echo of the voices of the social reformers who founded the vocational guidance movement in education, business, industry, and elsewhere. Reformers in Boston, Massachusetts; San Francisco, California; and Grand Rapids, Michigan, focused on immigrants from Europe who came to the United States by the tens of thousands; high school dropouts who were unprepared for the changing workplace; oppression in the workplace; substandard public schools; and the need to apply scientific principles to career planning and vocational education. It is the latter idea, the focus on scientific principles that has received the most criticism, along with the failure to adequately address multicultural issues. Currently, some career development specialists are urging practitioners to abandon theories and strategies rooted in modern philosophies in favor of those rooted in postmodernism.
Looking backward to 1913 and earlier, it is worth noting that social reformers formed the National Society for the Promotion of Industrial Education (NSPIE) in 1906, which became the parent organization of the National Vocational Guidance Association (NVGA) in 1913. These reformers were advocates for vocational education, and they carried their fight to state legislators, to the National Education Association, and beyond. One of NSPIE’s achievements was drafting and successfully lobbying for the passage of the Smith–Hughes act in 1917, legislation that laid the foundation for land grant universities and vocational education in public schools (Stephens, 1970).
These earlier reformers were advocates. One mechanism they used to initiate local reforms was the settlement house, which was a place in a working-class neighborhood that housed researchers who studied people’s lives and problems in that neighborhood. In 1901, Frank Parsons founded the Civic Service House in Boston’s North End, and in 1908, the Vocation Bureau, an adjunct of the Boston Civic Service House, was opened. Leader ...
Chapter 1 Goals and Governance of the CorporationChapter 1 LeMaximaSheffield592
Chapter 1: Goals and Governance of the Corporation
Chapter 1 Learning Objectives
1. Give examples of the investment and financing decisions that financial managers make.
2. Distinguish between real and financial assets.
3. Cite some of the advantages and disadvantages of organizing a business as a corporation.
4. Describe the responsibilities of the CFO, treasurer, and controller.
5. Explain why maximizing market value is the logical financial goal of the corporation.
6. Explain why value maximization is not inconsistent with ethical behavior.
7. Explain how corporations mitigate conflicts and encourage cooperative behavior.
Goals and Governance of the Corporation
This chapter introduces the corporation, its goals, and the roles of financial managers.
Chapter 1 Outline
· Investment and Financing Decisions
· The Corporation
· The Financial Managers
· Goals of the Corporation
· Value Maximization
· Corporate Governance
Note: What are the primary differences among the various legal forms of business?
Investment and Financing Decisions
· The Investment Decision
· Real Assets
· The Financial Assets
· Financial Assets
The Investment Decision– Decision to invest in tangible or intangible assets.
Also known as the “capital budgeting” or “CAPEX” decision.
The Financing Decision– The form and amount of financing of a firm’s investments.
Real Assets– Assets used to produce goods and services.
Financial Assets– Financial claims to the income generated by the firm’s real assets.
Are the following capital budgeting or financing decisions?
· Apple decides to spend $500 million to develop a new iPhone.
· GE borrows $400 million from bond investors.
· Microsoft issues 100 million shares to buy a small technology company.
· When Apple spends $500 million to develop a new iPhone it is investing in real assets and is making a capital budgeting decision.
· When GE borrows $400 million from bond investors it is investing in financial assets and is making a financing decision.
· When Microsoft issues 100 million shares to buy a smaller company it is investing in both financial and real assets. It is making both a capital budgeting and financing decision.
What is a Corporation?
· Corporation-A business organized as a separate legal entity owned by stockholders.
· Types of Corporations:
· Public Corporations
· Private Corporations
Corporation – A business organized as a separate legal entity owned by stockholders.
Public Company – A corporation whose shares are traded in public markets such as the New York Stock Exchange or NASDAQ.
Private Corporation – A corporation whose shares are not traded publicly.
Benefits of the Corporation
· Limited liability
· Infinite lifespan
· Ease of raising capital
Limited Liability – The owners of a corporation are not personally liable for its obligation.
Drawbacks of the Corporation
· Corporation face the problem of double taxation
· Improper corporate structures may lead to “Agency Problem”
Double Taxation– Corpor ...
Chapter 1 Adjusting to Modern Life EXERCISE 1.1 Self-AssessmMaximaSheffield592
Chapter 1 Adjusting to Modern Life
EXERCISE 1.1 Self-Assessment: Narcissistic Personality Inventory
Instructions
Read each pair of statements below and place an "X" by the one that comes closest to describing your
feelings and beliefs about yourself. You may feel that neither statement describes you well, but pick the
one that comes closest. Please complete all pairs.
The Scale
1. _A. I have a natural talent for influencing people.
_B. I am not good at influencing people.
2. _A. Modesty doesn't become me.
_B. I am essentially a modest person.
3. _A. I would do almost anything on a dare.
_B. I tend to be a fairly cautious person.
4. _A. When people compliment me I sometimes get
embarrassed.
B. I know that I am good because everybody keeps telling
me so.
5. _A. The thought of ruling the world frightens the hell out
of me.
_B. If I ruled the world it would be a better place.
6. A. I can usually talk my way out of anything.
_B. I try to accept the consequences of my behavior.
7. A. I prefer to blend in with the crowd.
B. I like to be the center of attention.
8. A. I will be a success.
B. I am not too concerned about success.
9. A. I am no better or worse than most people.
_B. I think I am a special person.
10. A. I am not sure if I would make a good leader.
B. I see myself as a good leader.
11. A. I am assertive.
B. I wish I were more assertive.
12. _A. I like to have authority over other people.
_B. I don't mind following orders.
13. _A. I find it easy to manipulate people.
B. I don't like it when I find myself manipulating people.
14. _A. I insist upon getting the respect that is due me.
_B. I usually get the respect that I deserve.
15. _A. I don't particularly like to show off my body.
_B. I like to show off my body.
16. _A. I can read people like a book.
_B. People are sometimes hard to understand.
17. _A. If I feel competent I am willing to take responsibility for
making decisions.
_B. I like to take responsibility for making decisions.
18. _A. I just want to be reasonably happy.
_B. I want to amount to something in the eyes of the world.
19. _A. My body is nothing special.
_B. I like to look at my body.
20. _A. I try not to be a show off.
_B. I will usually show off if I get the chance.
21. _A. I always know what I am doing.
_B. Sometimes I am not sure of what I am doing.
22. _A. I sometimes depend on people to get things done.
B. I rarely depend on anyone else to get things done.
23. _A. Sometimes I tell good stories.
_B. Everybody likes to hear my stories.
24. _A. I expect a great deal from other people.
B. I like to do things for other people.
25. A. I will never be satisfied until I get all that I deserve.
_B. I take my satisfactions as they come.
26. _A. Compliments embarrass me.
_B. I like to be complimented.
27. _A. I have a strong will to power.
B. Power for its own sake doesn't interest me.
28. A. I don't care about new fads and fashion ...
Chapter 1 The Americas, Europe, and Africa Before 1492 MaximaSheffield592
Chapter 1 | The Americas, Europe, and Africa Before 1492
CHAPTER 1
The Americas, Europe, and Africa Before 1492
Chapter Outline
1.1 The Americas
1.2 Europe on the Brink of Change
1.3 West Africa and the Role of Slavery
Introduction
Globalization, the ever-increasing interconnectedness of the world, is not a new phenomenon,
but it accelerated when western Europeans discovered the riches of the East. During the
Crusades (1095–1291), Europeans developed an appetite for spices, silk, porcelain, sugar, and
other luxury items from the East, for which they traded fur, timber, and Slavic people they
captured and sold (hence the word slave). But when the Silk Road, the long overland trading
route from China to the Mediterranean, became costlier and more dangerous to travel, Europeans
searched for a more efficient and inexpensive trade route over water, initiating the development
of what we now call the Atlantic World.
In pursuit of commerce in Asia, fifteenth-century traders unexpectedly encountered a “New
World” populated by millions and home to sophisticated and numerous peoples. Mistakenly
believing they had reached the East Indies, these early explorers called its inhabitants Indians.
West Africa, a diverse and culturally rich area, soon entered the stage as other nations exploited
its slave trade and brought its peoples to the New World in chains. Although Europeans would
come to dominate the New World, they could not have done so without Africans and native
peoples.
1.1 The Americas
By the end of this section, you will be able to:
● Locate on a map the major American civilizations before the arrival of the Spanish
● Discuss the cultural achievements of these civilizations
● Discuss the differences and similarities between lifestyles, religious practices, and
customs among the native peoples
Chapter 1 | The Americas, Europe, and Africa Before 1492
Between nine and fifteen thousand years ago, some scholars believe that a land bridge existed
between Asia and North America that we now call Beringia . The first inhabitants of what would
be named the Americas migrated across this bridge in search of food. When the glaciers melted,
water engulfed Beringia, and the Bering Strait was formed. Later settlers came by boat across the
narrow strait. (The fact that Asians and American Indians share genetic markers on a Y
chromosome lends credibility to this migration theory.) Continually moving southward, the
settlers eventually populated both North and South America, creating unique cultures that ranged
from the highly complex and urban Aztec civilization in what is now Mexico City to the
woodland tribes of eastern North America. Recent research along the west coast of South
America suggests that migrant populations may have traveled down this coast by water as well
as by land.
Researchers believe that about ten thousand years ago, humans also began the domestication of
plants and animals, a ...
Chapter 1 - Overview Gang Growth and Migration Studies v AMaximaSheffield592
Chapter 1 - Overview
Gang Growth and Migration Studies
v A
Now we will examine the problems and issues of not having a nationally accepted definition for a street gang. We will also examine mechanisms that influence gang migration and growth. After reading this section you will also understand that there are sub-populations within the general gang population.
Two of the most frequently asked questions about the gang sub-culture are: Why do gangs grow? Why do gangs migrate? Some law enforcement officials, politicians, educators and parents might suggest and believe that youth in their city are only “imitating” tougher L.A. street gangs or that the gang problem in their jurisdiction is result of migrating gang members from Los Angeles or Chicago. You will hear the terms “wanna be” or “street comer groups” or “misguided youth” used to describe the groups and you can be given a number of reasons why the groups in these areas are not gangs. You might also hear comments suggesting that gang imitation and migration are the reasons why street gangs have now been reported in all 50 states.
Gang Definition
There is another issue here that has to be addressed before the questions can be asked. It is accepting a standard to measure gang growth and migration. That standard is the definition of a street gang. Developing and then using a nationally accepted definition for a street gang becomes the fundamental basis to build examination of growth and migration. Having a standard definition becomes the fundamental building block to answer the two questions.
Studying gang growth is a little more complicated than just surveying cities for data. Without a standard gang definition to identify a gang, any official findings could be biased and misleading. Any responding jurisdiction could potentially use a different definition to identify the gangs in their area. Often, law enforcers, the public, educators and politicians use a penal code gang based definitions of a criminal street gang as a general working definition for a street gang. If the gang does fit within this legal definition used for penalty enhancement only, then the group is not reported as a gang according to this philosophy. The jurisdiction has no gangs. You can clearly see the issue here.
This will certainly lead to under reporting the number and types of street gangs present. Using a legal based definition of a street gang is appropriate from a prosecutor’s point of view. Unfortunately, too many communities, politicians, educators, parents and law enforcement officials use this philosophy. This way of thinking will only reinforce denial and delay the identification and treatment of the gang-community issue.
Many states now have gang enhancement laws similar to California Penal Code Section 186.22. In California this law is commonly known as the STEP Act. It outlines a legal definition for a violent criminal street gang. That definition is used to qualify a defendant(s) for sentencing
46
...
Chapter 06 Video Case - Theo Chocolate CompanyVideo TranscriptMaximaSheffield592
Chapter 06: Video Case - Theo Chocolate Company
Video Transcript:
>> It's rich, it's velvety, it's almost sinful. But creating the perfect bar at this Seattle chocolate factory is about more than just the ingredients on the wrapper.
>> I feel that everybody in the whole supply chain, all he way back to the farmers, should be better off as a result of this delicious food that we use to share with the people we love.
>> So these are these are the beans.
>> These are the beans; this is cacao.
>> At Theo Chocolate, owner Joe Whinney pays farmers two to three times more than the going rate to buy this cacao from the Democratic Republic of Congo, or DRC.
>> Where does cocoa come from? It's coming from farmers in Africa, and in Indonesia, and in Central and South America.
>> Whinney believes that Americans will be willing to pay more for chocolate if they know that, in turn, impoverished farmers will earn more.
>> Of all places, why Congo
>> Why Congo? Well, it was really Ben Affleck's fault.
>> Yes. That Ben Affleck.
>> Like this?
>> Like -- yeah. See that's really well fermented, this isn't.
>> Earlier this year, we joined Ben Affleck and Joe Whinney on a trip to the DRC. Cacao can only grow within a narrow climate zone close to the equator. In 2009, Affleck started a charity called Eastern Congo Initiative to spur economic development in this war-torn region. Five million people have died here due to decades of conflict.
>> As I was reading and I just sort of stumbled upon some of the statistics, and I was struck not only by the numbers, but by the fact that, you know, I hadn't heard about it.
>> So Affleck decided to use his celebrity as a sort of currency to attract investment. He led a small group of philanthropists, protected by armed guards, through jungles where cacao trees thrived and farmers struggled.
>> The cocoa industry here has potential if the value can be increased.
>> For the last two years, Affleck's Eastern Congo Initiative has worked with Whinney and local groups to train farmers to improve the crop. Cacao grows in these greenish-yellow pods that are cracked open to harvest. It's quite slimy, huh?
>> It is. But when you suck on it, it's absolutely delicious.
>> It doesn't taste like chocolate at all.
>> Not at all, does it.
>> It tastes like passion fruit or something.
>> Theo Chocolate has now committed to buy 340 tons of cacao from the DRC --
>> This is really good quality.
>> -- creating a dependable export market.
>> We have brought these people together. They're selling to a chocolate company in the United States. Those markets had been completely closed off to them in the past. And it's not just aid, it's investment.
>> We have security guards around us. There have been attacks recently. This is a tough place to do business.
>> It is, but that's also a place that really needs this kind of business.
>> Business in Seattle is a little sweeter these days. Theo is raising money for charity with its $5 Congo ...
Chapter 08 Motor Behavior
8
Motor Behavior
Katherine T. Thomas and Jerry R. Thomas
C H A P T E R
What Is Motor Behavior?The study of how motor skills are learned, controlled, and developed across the lifespan. Applications often focus on what, how, and how much to practice.Motor behavior guides us in providing better situations for learning and practice, including the selection of effective of cues and feedback.
(continued)
(continued)
What Is Motor Behavior? (continued)Valuable to performers and those who teach motor skills (e.g. physical education teachers, adapted physical educators, gerontologists, physical therapists and coaches)
Figure 8.1
Chapter 8 - Hoffman (2005)
*
What Does a Motor Behaviorist Do?Colleges or universitiesTeachingResearchService
Other research facilities: hospitals, industrial, militaryResearch with applications related to settingGrant writing
Chapter 8 - Hoffman (2005)
*
Goals of Motor BehaviorTo understand how motor skills are learnedTo understand how motor skills are controlledTo understand how the learning and control of motor skills change across the life spanThree subdisciplinesMotor learningMotor controlMotor development
Chapter 8 - Hoffman (2005)
*
Three Subdisciplines of Motor BehaviorMotor LearningMotor ControlMotor Development
Goals of Motor LearningTo explain how processes such as feedback and practice improve the learning and performance of motor skillsTo explain how response selection and response execution become more efficient and effective
Chapter 8 - Hoffman (2005)
*
Goals of Motor ControlTo analyze how the mechanisms in response selection and response execution control the body’s movementTo explain how environmental and individual factors affect the mechanisms of response selection and response execution
Chapter 8 - Hoffman (2005)
*
To explain how motor learning and control improve during childhood and adolescenceTo explain how motor learning and control deteriorate with aging
Goals of Motor Development
Chapter 8 - Hoffman (2005)
*
Motor Movements Studied Beyond SportBabies learning to use a fork and spoonDentists learning to control the drill while looking in a mirrorSurgeons controlling a scalpel; microsurgeons using a laser Children learning to ride a bicycle or to roller skate
(continued)
Chapter 8 - Hoffman (2005)
*
Motor Movements Studied Beyond Sport (continued)Teenagers learning to driveDancers performing choreographed movementsPilots learning to control an airplaneYoung children learning to control a pencil when writing or learning to type on a computer
Chapter 8 - Hoffman (2005)
*
History of Motor Behavior
Five themes have persisted over the years in motor behavior research
Knowledge of results (feedback)
Distribution of practice
Transfer of training
Retention
Individual differences
(continued)
Chapter 8 - Hoffman (2005)
*
Late 1800s and early 1900s: Motor skills to understand cognition and neura ...
Changes in APA Writing Style 6th Edition (2006) to 7th Edition OMaximaSheffield592
Changes in APA Writing Style 6th Edition (2006) to 7th Edition OCT 2019 according to Streefkerk, 2019.
References and in-text citations in APA Style
When it comes to citing sources, more guidelines have been added that make citing online sources easier and clearer. The biggest changes in the 7th edition are:
1. The publisher location is no longer included in the reference.
Covey, S. R. (2013). The 7 habits of highly effective people: Powerful lessons in personal change. New York, NY: Simon & Schuster.
Covey, S. R. (2013). The 7 habits of highly effective people: Powerful lessons in personal change. Simon & Schuster.
2. The in-text citation for works with three or more authors is now shortened right from the first citation. You only include the first author’s name and “et al.”.
(Taylor, Kotler, Johnson, & Parker, 2018)
(Taylor et al., 2018)
3. Surnames and initials for up to 20 authors (instead of 7) should be provided in the reference list.
Miller, T. C., Brown, M. J., Wilson, G. L., Evans, B. B., Kelly, R. S., Turner, S. T., … Lee, L. H. (2018).
Miller, T. C., Brown, M. J., Wilson, G. L., Evans, B. B., Kelly, R. S., Turner, S. T., Lewis, F., Lee, L. H., Cox, G., Harris, H. L., Martin, P., Gonzalez, W. L., Hughes, W., Carter, D., Campbell, C., Baker, A. B., Flores, T., Gray, W. E., Green, G., … Nelson, T. P. (2018).
4. DOIs are formatted the same as URLs. The label “DOI:” is no longer necessary.
doi: 10.1080/02626667.2018.1560449
https://doi.org/10.1080/02626667.2018.1560449
5. URLs are no longer preceded by “Retrieved from,” unless a retrieval date is needed. The website name is included (unless it’s the same as the author), and web page titles are italicized.
Walker, A. (2019, November 14). Germany avoids recession but growth remains weak. Retrieved from https://www.bbc.com/news/business-50419127
Walker, A. (2019, November 14). Germany avoids recession but growth remains weak. BBC News. https://www.bbc.com/news/business-50419127
6. For ebooks, the format, platform, or device (e.g. Kindle) is no longer included in the reference, and the publisher is included.
Brück, M. (2009). Women in early British and Irish astronomy: Stars and satellites [Kindle version]. https:/doi.org/10.1007/978-90-481-2473-2
Brück, M. (2009). Women in early British and Irish astronomy: Stars and satellites. Springer Nature. https:/doi.org/10.1007/978-90-481-2473-2
7. Clear guidelines are provided for including contributors other than authors and editors. For example, when citing a podcast episode, the host of the episode should be included; for a TV series episode, the writer and director of that episode are cited.
8. Dozens of examples are included for online source types such as podcast episodes, social media posts, and YouTube videos. The use of emojis and hashtags is also explained.
Inclusive and bias-free language
Writing inclusively and without bias is the new standard, and APA’s new publication manual contains a separate chapter on this topi ...
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
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Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
Elevate Your Nonprofit's Online Presence_ A Guide to Effective SEO Strategies...TechSoup
Whether you're new to SEO or looking to refine your existing strategies, this webinar will provide you with actionable insights and practical tips to elevate your nonprofit's online presence.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin 🙏🤓🤔🥰
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
spot a liar (Haiqa 146).pptx Technical writhing and presentation skills
Case Study AnalysisAfter review and examination of the provided
1. Case Study Analysis
After review and examination of the provided case study, the
patient presented with symptoms that are consistent with
Rhabdomyolysis. The findings in this case study that support a
diagnosis of Rhabdomyolysis include substance abuse,
prolonged lying down or immobility, and hyperkalemia
(Cleveland, 2022). In this case study the patient has a history of
substance abuse, and it is unknown if the patient used any type
of substance prior to becoming unresponsive. However, because
Naloxone was used by EMS upon arrival and the patient became
responsive, it can be presumed the patient had an opioid related
overdose. This is presumed because Naloxone is a medication
that rapidly reverses an opioid overdose and is classified as an
opioid antagonist (Substance, 2022). Opioid antagonists attach
to opioid receptors and reverse and block the effects of other
opioids (Substance, 2022). If an opioid overdose is suspected,
Naloxone can quickly restore normal breathing to a person if
their breathing has slowed or stopped because of an opioid
overdose (Substance, 2022). Recreational drug use with such
substances as opioids and their derivatives and amphetamines
can directly result in Rhabdomyolysis (Substance, 2022).
The patient was found lying down by the roommate for an
unknown amount of time. This prolonged period lying down
could have led to increased compartmental pressure of the
muscles in the left hip and forearm (Cleveland, 2022).
Compartmental pressure occurs when pressure rises in and
around the muscles (Cleveland, 2022). This can limit blood
flow, oxygen, and nutrients to muscles and nerves, resulting in
muscle ischemia, infarction, and necrosis by compartmental
tamponade which will also cause injury to the nerves
(Cleveland, 2022). Compartmental pressure begins to develop
when the tissue pressure exceeds the venous pressure and
impairs blood outflow (American, 2022). Lack of oxygenated
2. blood and the build up of waste products will result in pain and
decreased peripheral sensation secondary to nerve irritation
(American, 2022). This would explain the patients’ complaints
of the burning pain over his left hip and forearm due to muscle
necrosis.
Patient was hyperkalemic with a serum potassium level
of 6.9 mEq/L. Hyperkalemia has multiple causes, one of which
includes damage to muscles (American, 2022). Muscle damage
results in the release of intracellular potassium into circulation
resulting in elevated serum potassium levels (American, 2022).
Potassium plays a crucial role in electrical signal functioning of
the hearts middle thick layer called the myocardium (American,
2022). Increased potassium levels can interfere with proper
electrical signals in the myocardium which can lead to heart
arrythmias (American, 2022). As potassium levels increase, T-
waves peak, and PR intervals are prolonged due to action
potential duration (APD) shortening which causes more
synchronous repolarization across the ventricular wall (Scalco
et. al., 2015). In this case study the patients T-waves were
peaked, and PR intervals were prolonged due to increased serum
potassium levels.
Genetics and Rhabdomyolysis
Rhabdomyolysis is characterized by acute and often severe
skeletal muscle damage which results in the release of
intracellular muscle components into the blood stream resulting
in myoglobinuria (Scalco et. al., 2015). A common finding with
Rhabdomyolysis is increased intracellular free ionized calcium
which leads to muscle cell death through the activation of
harmful mechanisms such as enzymatic activation and
prolonged muscle fiber contraction (Scalco et. al., 2015). These
disorders include metabolic muscle disorders, mitochondrial
disorders, disorders of intramuscular calcium release and
excitation-contraction coupling, and muscular dystrophies
(Scalco et. al., 2015). Epigenetics is the study of how your
behaviors and environment can cause changes that affect the
way your genes work (Centers, 2022). Epigenetic changes do
3. not change your DNA sequence, but they do change how your
body reads a DNA sequence (Centers, 2022). Epigenetics
change as you age, as part of normal development and aging as
well as in response to your behaviors and environment (Centers,
2022). Epigenetics work through DNA methylation, histone
modifications, and non-coding RNA (Centers, 2022). Neurobio-
genetics use recent advances in genome sequencing to better
understand the cause of brain and nerve disorders (Yale, 2022).
Neurobio-genetics help pinpoint genetic factors of inherited
diseases and can help determine the extent to which their
genetic material plays a role in their condition (Yale, 2022).
Drug addiction can be woven into your DNA (Cleveland, 2022).
The genetic connection between individuals and addiction is
through inherited levels of dopamine which is a
neurotransmitter made in the brain that acts as a “feel good”
hormone (Cleveland, 2022). Because dopamine acts as a “feel
good” hormone it can power poor impulse control leading
individuals towards addictive type behaviors (Cleveland, 2022).
Genetics merely indicate a predisposition toward addictive
behaviors (Cleveland, 2022).
Specific Symptoms
The patient’s potassium is elevated due to muscle damage from
lying for a prolonged amount of time. The necrotic tissue was
the result of increased compartmental pressure around the
trochanter and forearm due to decreased blood flow, oxygen,
and nutrients to these muscles and nerves leading to necrosis of
the tissues. The EKG is showing prolonged PR intervals with
peaked T-waves due to the increased serum potassium affecting
the electrical conduction of the myocardium resulting in an
abnormal EKG.
Physiologic Response
Hyperkalemia is significant in this case study as it was
a direct result of the Rhabdomyolysis while it was also the
cause of decreased electrical conduction of the myocardium
resulting in prolonged PR intervals and peaked T-waves
indicating an abnormal EKG. Cardiotoxicity is heart damage
4. that arises from certain drugs (American, 2022). EKGs are
essential in a suspected drug overdose as they are cardiotoxic
drugs. Specific myocardial effects of cardiotoxic drugs have
well-described electrocardiographic manifestations making
EKGs a quick tool that can provide key pieces of information
prompting early interventions (American, 2022).
Cells Involved in Rhabdomyolysis
Rhabdomyolysis involves the muscle cells (American,
2022). When the muscle cells are damaged the myoglobin in the
muscle cells leak into the blood stream causing renal toxicity
(American, 2022). Due to the hyperkalemia and the effects it
has on the myocardium, cardiomyocytes or the cells that make
up the cardiac muscle are also involved (American, 2022).
Nerve cells are involved because of muscle ischemia causing
nerve damage (American, 2022). Neurons are involved in
overdose death by specific receptors in the neurons being
triggered that cause opioid-induced respiratory depression (The,
2021). The specific receptor is the mu opioid receptor, and
these are in the brainstems breathing modulation center and
these are the neurons responsible for opioid-induced respiratory
depression (The, 2021).
Change in Response Related to Characteristics
Regarding gender, it could change the response as
females are less prone to suffer from Rhabdomyolysis
(American, 2022). However, just because there is a lower
incidence does not indicate complete rule out of
Rhabdomyolysis in females (American, 2022). Genetics could
play a role in a change in the response. Certain genetic
disorders can increase the chances of developing
Rhabdomyolysis. These include muscle diseases such as
muscular dystrophy or certain metabolic or mitochondrial
disorders (Cleveland, 2022). However, this case study
presentation of Rhabdomyolysis occurred due to prolonged
immobility related to substance use.
References
American Academy of Family Physician. (2022).
5. Rhabdomyolysis.
https://www.aafp.org/pubs/afp/issues/2002/0301/p907.html
Centers for Disease Control and Prevention. (2019).
Rhabdomyolysis.
https://www.cdc.gov/niosh/topics/rhabdo/default.html
Cleveland Clinic. (2022).
Rhabdomyolysis.
https://my.clevelandclinic.org/health/diseases/21184-
rhabdomyolysis
Substance Abuse and Mental Health Services Administration.
(2022).
Naloxone.
https://www.samhsa.gov/medication-assisted-
treatment/medications-counseling-related-conditions/naloxone
The Salk Institute for Biological Studies. (2021).
Researchers identify neurons involved in
overdose deaths.https://www.salk.edu/news-release/researchers-
identify-neurons-involved-in-overdose-deaths/
Scalco, R. S., Gardiner, A. R., Pitceathly, R. D., Zanoteli, E.,
Becker, J., Holton, J. L., Houlden
H., Jungbluth, H., & Quinlivan, R. (2015). Rhabdomyolysis: a
genetic perspective.
Orphanet Journal of Rare Diseases,
10(51).https://doi.org/10.1186/s13023-015-0264-3
Yale Medicine. (2022).
Neurogenetics.
https://www.yalemedicine.org/conditions/neurogenetics
Cellular In this scenario, a 27-year-old patient with a substance
abuse history was found unresponsive after an unknown amount
of time by his roommate who called emergency medical services
(EMS). The EMS team used naloxone which revived the patient.
He started to complain about burning pain in his left forearm
6. and left hip. After arriving in the ER, it was discovered that he
had a large amount of necrotic tissue on the forearm and greater
trochanter. An electrocardiogram (EKG) showed peaked T
waves and prolonged PR waves which are indicative of
hyperkalemia. His serum potassium level 6.9mEq/L.
In breaking down the scenario to determine the
diagnosis, the substance abuse is opioid-related due to the
positive reaction from the naloxone. According to NIH,
naloxone has no effect on someone who does not have opioids
in their system. (National Institute of Health, 2022, para 1).
Opioid use alone causes damage to many cells. The patient's
necrotic areas on the forearm and greater trochanter, at some
point, were inflamed which progressed to necrosis. Knowing
there is a history of drug abuse, and with the roommate not
being constantly available, it is hard to determine how long he
was really laying there. The patient could have been drug-
induced for days lying on the left side to create that necrotic
tissue.
The process taken to create the necrosis begins at the
cellular level. The cell injury and death, in this case, were
caused by an outside factor of drug overdose and hypoxia. The
injury initially begins as a mast cell that is damaged and
releases histamine which swells capillaries (vasodilation), then
chemokines are release that act as a messenger to attract
phagocytes (leukocytes) to the area of inflammation to
immediately begin the healing process (Khan, 2010). Even
though the area is trying to heal itself the continuous damage
that affects adenosine triphosphate (ATP) depletion,
mitochondrial damage, DNA damage, altered calcium, and
accumulation of oxygen-derived free radicals, continue to injure
the cell and if not treated cause cell death (McCance, &
Huether, 2019, p. 51). The burning pain that the patient felt is
the response from the damaged cells, nerves, and tissue
surrounding the necrotic areas and he felt it due to the
immediate reversal from the naloxone treatment. The opioid
7. effect may have been how he did not notice the inflamed areas,
and when the opioid receptors are stimulated they suppress the
sensation of pain (Schiller, Goyal, & Mechanic, 2022, para 4).
Another factor that caused the necrotic area was the
hypoxic reaction from the pressure he placed on the forearm and
hip from the actual drug abuse. Hypoxia creates an immense
amount of cellular damage due to how a human will not
function well if at all without a sufficient supply of oxygen. The
cell reaction to hypoxia reduces cell respiration and energy by
decreasing mitochondrial phosphorylation (insufficient ATP
production) in which the calcium and sodium exchange fails to
force them back into the cell releasing potassium into the
extracellular fluid (ECF) (McCance & Huether, 2019, p.51). It
appears with this information the patient could have had several
hypoxic events over time that it continued to cause such an
extensive amount of damage over some time. The failure of the
sodium-potassium pump prevents the calcium-sodium exchange
that caused hyperkalemia. In the scenario, the patient's level of
potassium was high due to the large area of necrosis that caused
the potassium to leak into the cellular fluid. A sign of
hyperkalemia is peaked T waves and prolonged PR interval
(McCance & Huether, 2019, p. 118). The EKG is necessary
because it can show signs of electrolyte imbalance, heart
failure, significant arrhythmias, and ischemia, and has faster
results than the laboratory. A patient who has a drug overdose
can cause an imbalance with ion channels of potassium,
calcium, and sodium that causes cardio effect on the
myocardium membrane, in which an EKG will show significant
changes that could be life-threatening (Yates & Manini, 2012).
All cells in our system have an important role and
function. As seen in the small scenario, one misstep will cause
major damage and potential loss of life. The process of
discovering exactly what happened and how this person was
found would be questioning the roommate and speaking with the
patient.
References
8. Khan Academy (2010, February 24).
Inflammatory response | Human anatomy and
physiology | Health & medicine [Video file]. Retrieved from
https://www.youtube.com/watch?v=FXSuEIMrPQk
McCance, K. L. & Huether, S. E. (2019).
Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Schiller, E.Y., Goyal, A., Mechanic, O.J. Opioid Overdose.
[Updated 2022 May 9]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2022 Jan-. Retrieved
from:
https://www.ncbi.nlm.nih.gov/books/NBK470415/
U.S. Department of Health & Human Services.(2022, January).
National Institute on Drug Abuse |Naloxone Drug Facts.
Retrieved from:
https://nida.nih.gov/publications/drugfacts/naloxone
Yates, C., & Manini, A. F. (2012). Utility of the
electrocardiogram in drug overdose and poisoning: theoretical
considerations and clinical implications.
Current cardiology reviews,
8(2), 137–151.
https://doi.org/10.2174/157340312801784961 Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3406273/
Bottom of Form
PRAC 6665/6675 Clinical Skills
Self-Assessment Form
Desired Clinical Skills for Students to Achieve
Confident (Can complete independently)
Mostly confident (Can complete with supervision)
9. Beginning (Have performed with supervision or needs
supervision to feel confident)
New (Have never performed or does not apply)
Comprehensive psychiatric evaluation skills in:
Recognizing clinical signs and symptoms of psychiatric
illness across the lifespan
X
Differentiating between pathophysiological and
psychopathological conditions
X
Performing and interpreting a comprehensive and/or interval
history and physical examination (including laboratory and
diagnostic studies)
X
Performing and interpreting a mental status examination
X
Performing and interpreting a psychosocial assessment and
family psychiatric history
X
10. Performing and interpreting a functional assessment (activities
of daily living, occupational, social, leisure, educational).
X
Diagnostic reasoning skill in:
Developing and prioritizing a differential diagnoses list
X
Formulating diagnoses according to DSM 5-TR based on
assessment data
X
Differentiating between normal/abnormal age-related
physiological and psychological symptoms/changes
X
Pharmacotherapeutic skills in:
Selecting appropriate evidence based clinical practice
guidelines for medication plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management)
X
Evaluating patient response and modify plan as necessary
11. X
Documenting (e.g., adverse reaction, the patient response,
changes to the plan of care)
X
Psychotherapeutic Treatment Planning:
Recognizes concepts of therapeutic modalities across the
lifespan
X
Selecting appropriate evidence based clinical practice
guidelines for psychotherapeutic plan (e.g., risk/benefit, patient
preference, developmental considerations, financial, the process
of informed consent, symptom management, modality
appropriate for situation)
X
Applies age appropriate psychotherapeutic counseling
techniques with individuals and/or any caregivers
X
Develop an age appropriate individualized plan of care
X
12. Provide psychoeducation to individuals and/or any caregiver s
X
Promote health and disease prevention techniques
X
Self-assessment skill:
Develop SMART goals for practicum experiences
X
Evaluating outcomes of practicum goals and modify plan as
necessary
X
Documenting and reflecting on learning experiences
X
Professional skills:
Maintains professional boundaries and therapeutic relationship
with clients and staff
X
Collaborate with multi-disciplinary teams to improve clinical
practice in mental health settings
13. X
Identifies ethical and legal dilemmas with possible resolutions
X
Demonstrates non-judgmental practice approach and empathy
X
Practices within scope of practice
X
Selecting and implementing appropriate screening
instrument(s), interpreting results, and making
recommendations and referrals:
Demonstrates selecting the correct screening instrument
appropriate for the clinical situation
X
Implements the screening instrument efficiently and effectively
with the clients
X
Interprets results for screening instruments accurately
14. X
Develops an appropriate plan of care based upon screening
instruments response
XX
Identifies the need to refer to another specialty provider when
applicable
X
Accurately documents recommendations for psychiatric
consultations when applicable
X
Summary of strengths:
I have made a lot of progress in my career and profession as
nurse practitioner. I acknowledged the significance of self-
evaluation and ever since I have embodied the practice of
regular self-evaluation as an important component of my career
growth. Through my career profession I have master good
corporate communication with distinct report writing skills that
has enabled me to be one of the best nurses in the facilities I
have worked. I have also improved my interpersonal skills
significantly that has seen me take up advanced responsibilities
from my seniors. I have acquired good work ethics and
professionalism. As a nurse I have always maintained the need
for respect for patient needs and opinions. My immediate
15. supervisor once marveled at how I handled the case of a
Jehovah witness patient who had refused blood transfusion since
it was against the doctrines of her denomination. I obeyed her
position but requested her to attest to that in writing so I may
not be held culpable for negligence. My supervisor told me that
I employed wisdom at its echelons. I am also good in clinical
assessment and pharmacological support to my clients. I always
work day and night to improve my relationships with my
clients. A condition which yields better outcomes in patient
conditions when I handle them.
Opportunities for growth:
One of the opportunities in my career as a nurse practitioner is
diversity. I have always loved to diversify my knowledge and
understanding about different pharmacological practices. In this
sense, I have managed to improve my knowledge about
differential diagnosis. I have been expanding my knowledge
through continuous research about such topics which have
significantly honed my understanding. I also need to develop
good leadership and management practices. I believe with good
administrative skills there are a lot of opportunities for vertical
mobility. Effective administration calls for good knowledge and
better understanding. I need to develop sound knowledge in the
field of healthcare administration. I have also realized that good
understanding of effective pharmacotherapy support to patients.
I have had some slight challenges with prescriptions and
recommendations for effective medication. I feel this will
contribute to better medication to the patients under my care
16. Now, write three to four (3–4) possible goals and objectives for
this practicum experience. Ensure that they follow the SMART
Strategy, as described in the Learning Resources.
• Goal: To hone my corporate communication skills within the
next 10 weeks of my practicum cycle
• Objective: to improve my report writing skills for timely
delivery of reports
• Objective: to facilitate effective communication and
prescriptions to patients
• Objective: to enhance my negotiation and interaction with
colleagues an patients
• Goal: To expand my pharmacological knowledge through
advanced studies and research on diagnostic and
pharmacological processes
• Objective: to grasp the concept of differential diagnosis
• Objective: to improve personal experience with patients
• Objective: to reduce chances of error of wrong diagnosis on
patients
• Goal: To expand my knowledge about professional ethics of
healthcare practitioners including understanding their
application in real-life situation
• Objective: to avoid cases of litigation both to the institution
and to me as a practitioner
• Objective: to promote good work ethics in the institutions and
facilities where I will work.
• Objective: to promote good public image of nursing as a
profession by demonstrating exemplary behavior
• Goal: To continuously engage in educational learning through
research, regular training programs such as work study, short
courses, and exchange programs to expand my knowledge and
understanding of nursing as a profession.
• Objective: to continually nourish my knowledge and expertise
• Objective: to strategically position myself for vertical
mobility in the administrative ranks
• Objective: to improve my skills, knowledge and experience to
match the dynamic world of nursing.
17. Signature: Monica Castelao
Date:September 1, 2022
Course/Section: Practicum 6665
NCBI Bookshelf. A service of the National Library of Medicine,
National Institutes of Health.
StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2019 Jan-.
Immediate Hypersensitivity Reactions
Authors
Angel A. Justiz Vaillant; Patrick M. Zito1.
Affiliations
1 Walden University
Last Update: June 18, 2019.
Introduction
Hypersensitivity reactions (HR) are immune responses that are
exaggerated
or inappropriate against an antigen or allergen. Coombs and
Gell classified
hypersensitivity reactions into four forms. Type I, type II, and
type III
hypersensitivity reactions are known as immediate
hypersensitivity reactions
18. (IHR) because occur within 24 hours. Antibodies including IgE,
IgM, and
IgG mediate them.[1]
Type I or Anaphylactic Response
Anaphylactic Responseis mediated by IgE antibodies that are
produced by
the immune system in response to environmental proteins
(allergens) such as
pollens, animal danders or dust mites. These antibodies (IgE)
bind to mast
cells and basophils, which contain histamine granules that are
released in the
reaction and cause inflammation. Type I hypersensitivity
reactions can be
seen in bronchial asthma, allergic rhinitis, allergic dermatitis,
food allergy,
allergic conjunctivitis, and anaphylactic shock.[2][3]
Anaphylaxis
Anaphylaxis is a medical emergency because can lead to an
acute, life-
threatening respiratory failure. It is an IgE-mediated process. It
is the most
severe form of an allergic reaction, where mast cells suddenly
release a large
amount of histamine and later on leukotrienes. In severe cases
intense
bronchospasm, laryngeal edema, cyanosis, hypotension, and
shock are
present.[4]
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Allergic bronchial asthma
Allergic bronchial asthma is an atopic disease, characterized by
bronchospasm. It may also be a chronic inflammatory disease.
In its etiology,
and environmental factors along with a genetic background play
an important
role. The diagnosis is dependent on history and examination. In
allergic
bronchial asthma, IgE is elevated, and sputum eosinophilia is
common.
Epidemiologically, a positive skin prick test or specific IgE are
risk factors
for asthma.[5]
Allergic rhinitis
Allergic rhinitis is another atopic disease where histamine and
leukotrienes
are responsible for rhinorrhea, sneezing and nasal obstruction.
Allergens are
similar to those found in bronchial asthma. Nasal polyps may be
seen in
chronic rhinitis.[6]
Allergic conjunctivitis
Allergic conjunctivitis presents with rhinitis and is IgE-
20. mediated. Itching and
eye problems including watering, redness, and swelling always
occur.[7]
Food allergy
One must differentiate food allergy (IgE-mediated) from food
intolerance that
can be cause for a variety of etiology including malabsorption
and celiac
disease. It is more frequent in children as seen in cow's milk
allergy. Food
allergy symptoms mostly affect the respiratory tract, the skin,
and the gut.
Skin prick tests are helpful to test for food allergens that can
trigger severe
reactions, e.g., peanuts, eggs, fish, and milk.[3]
Atopic eczema
Atopic eczema is an IgE-mediated disease that affects the skin
and has an
immunopathogenesis very similar to that of allergic asthma and
allergic
rhinitis, which are present in more than half of the diseased.
Radioallergosorbent (RAST) may reveal the specificity of the
IgE antibody
involved but has little help in management.[8]
Drug allergy
Drugs may cause allergic reactions by any mechanism of
hypersensitivity.
For example, penicillin may cause anaphylaxis, which is IgE-
mediated but
22. sensitized platelets in the peripheral blood. Clinically, it
manifests by
thrombocytopenia with shortened platelet survival and increased
marrow
megakaryocytes. Sudden onset of petechiae and bleeding from
the gums,
nose, bowel, and urinary tract occurs. Bleeding can accompany
infections,
drug reactions, malignancy and other autoimmune disorders
such as thyroid
disease and SLE.[10]
Autoimmune hemolytic anemia (AIHA)
There are two types of immune hemolytic anemia: IgG-mediated
(warm
AIHA) and IgM-mediated (cold AIHA). The warm type may be
idiopathic
autoimmune or secondary to other diseases such as malignancy
affecting the
lymphoid tissues. The cold type may be idiopathic or secondary
to infections
such as Epstein-Barr virus. The primary clinical sign of the two
is jaundice.
The laboratory diagnosis is made by a positive Coombs test,
which identifies
immunoglobulins and C3 on red blood cells.[11]
Autoimmune neutropenia
Autoimmune neutropenia may be present with bacterial and
fungal
infections, or it may occur alone or with autoimmune diseases
(SLE, RA,
autoimmune hepatitis), infections and lymphoma. Bone marrow
examination
23. is needed if neutropenia is severe. For associated autoimmune
disorders, an
autoimmune antibody panel is necessary (ANA, ENA, and
dsDNA).[12]
Hemolytic disease of the fetus and the newborn
(erythroblastosis fetalis)
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The maternal immune system suffers an initial sensitization to
the fetal Rh+
red blood cells during birth, when the placenta tears away. The
first child
escapes disease but the mother, now sensitized, will be capable
of causing a
hemolytic reaction against a second Rh+ fetus, which develops
anemia and
jaundice once the maternal IgG crosses the placenta.[13]
[14]Myasthenia gravis is an autoimmune disorder caused by
antibodies to
post-synaptic acetylcholine receptors that interfere w ith the
neuromuscular
transmission. It is characterized by extreme muscular fatigue,
double vision,
bilateral ptosis, deconjugate eye movements, difficulty
swallowing, and
24. weakness in upper arms. Babies born to myasthenic mothers can
have
transient muscle weakness due to pathogenic IgG antibodies that
cross the
placenta.
Goodpasture syndrome
Goodpasture syndrome is a type II hypersensitivity reaction
characterized by
the presence of nephritis in association with lung hemorrhage.
In most
patients, it is caused by cross-reactive autoantigens that are
present in the
basement membranes of the lung and kidney. A number of
patients with this
problem exhibit antibodies to collagen type IV, which is an
important
component of basement membranes.[15]
Pemphigus
Pemphigus causes a severe blistering disease that affects the
skin and mucous
membranes. The sera of patients with pemphigus have
antibodies against
desmoglein-1 and desmoglein-3, which are components of
desmosomes,
which form junctions between epidermal cells. Pemphigus is
strongly linked
to HLA-DR4 (DRB1*0402), which is a molecule that presents
one of the
autoantigens involved in the immunopathogenesis of this
disease
(desmoglein-3).[16][17]
25. Type III or Immunocomplex Reactions
These are also mediated by IgM and IgG antibodies that react
with soluble
antigens forming antigen-antibody complexes. The complement
system
becomes activated and releases chemotactic agents that attract
neutrophils
and cause inflammation and tissue damage as seen in vasculitis
and
glomerulonephritis. Type III hypersensitivity reactions can
classically be seen
in serum sickness and Arthus reaction.
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Serum sickness
Serum sickness can be induced with massive injections of
foreign antigen.
Circulating immune complexes infiltrate the blood vessel walls
and tissues,
causing an increased vascular permeability and leading to
inflammatory
processes such as vasculitis and arthritis. It was a complicati on
of anti-serum
26. prepared in animals to which some individuals produced
antibodies to the
foreign protein. It was also experienced in the treatment with
antibiotics such
as penicillin.[18]
Arthus reaction
Arthus reaction is a local reaction seen when a small quantity of
antigens is
injected into the skin repeatedly until detectable levels of
antibodies (IgG) are
present. If the same antigen is inoculated, immune complexes
develop at the
mentioned local site and in the endothelium of small vessels.
This reaction is
characterized by the presence of marked edema and hemorrhage,
depending
on the administered dose of the foreign antigen.[19][20]
Etiology
Multiple causes of IHR depend on the type of antigen or
allergen that trigger
this inappropriate immune reactivity. In type I hypersensitivity
reactions, the
allergens are proteins with a molecular weight ranging from 10
to 40 kDa.
These include cats, dust mite, German cockroaches, grass, rats,
fungi, plants,
and drugs. They stimulate the IgE production. Bee and wasp
venoms,
tree nuts (e.g., almond, hazelnut, walnut, and cashew), eggs,
milk, latex,
antibiotics (e.g., cephalosporins), heterologous antisera,
hormones (e.g.,
insulin) and others including shellfish and anesthetics can
27. trigger
anaphylaxis.[21]
In type II hypersensitivity reactions, the antigens can be found
in the
membrane of erythrocytes (e.g., A, B, O, C, c, D, d, E, e, K, k,
Fy, M, and N).
In transfusion reactions, all blood groups are not equally
antigenic, e.g., A or
B evoke stronger hypersensitivity reactions in an incompatible
recipient than
other antigens such as Fy.[22]
In type III hypersensitivity reactions, the persistence of antigen
from chronic
infection or autoimmune diseases can develop complex immune
diseases,
including vasculitis and glomerulonephritis. Penicillin as an
antigen can
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produce any hypersensitivity reactions, e.g., anaphylactic shock,
hemolytic
anemia, and serum sickness.[23]
28. Epidemiology
Hypersensitivity reactions are very common. Fifteen percent of
the world
population will be affected by any type of allergic reaction
during their lives.
In the second half of this century, allergic diseases have
increased. The cause
of the increase is unknown, but it may reflect lifestyle changes,
decreased
breastfeeding, and air pollution. The hygiene hypothesis
proposes that since
IgE is no longer needed to protect against parasites in the
Western world, the
IgE-mast cell axis has evolved in type I hypersensitivity
reaction.[24][25]
European data estimate that 0.3% of the population will be
troubled by
anaphylaxis at some point in their lives. In addition, 1 out of
3000 inpatients
in the United States experiences a severe allergic reaction every
year.
However, the prevalence of bronchial asthma was 1.5% in
Korea. Fernández-
Soto et al., 2018 reported that fungal infections could be as high
as 50% in
inner cities and constitute a risk factor predisposed to the
development of
allergic bronchial asthma.[26] Worldwide epidemiological data
of
anaphylaxis are scanty and remain unavailable in many
countries.
Pathophysiology
In type I hypersensitivity reactions after a previous
sensitization, the
29. immunoglobulin (Ig) E is produced and binds to Fc receptors on
mast cells
and basophils. On encountering the allergen, it triggered cross -
linking of
mast-cell cytophilic IgE, causing the activation of mast cells
and their
degranulation of mediators that cause an allergic reaction. The
mediators that
participate in this type of hypersensitivity reaction include
histamine and
lipid mediators such as PAF, LTC4, and PGD2 that cause a
vascular leak,
bronchoconstriction, inflammation, and intestinal hypermotility.
Enzymes
(e.g., tryptase causes tissue damage) and TNF causes
inflammation.
Eosinophils release cationic granule proteins, e.g., major basic
protein
(causes killing of host cells and parasites) and enzymes (e.g.,
eosinophil
peroxidase, which participates in tissue remodeling).[27]
In type II hypersensitivity reaction antibodies against basement
membranes
produce nephritis in Goodpasture's syndrome. Myasthenia
gravis and
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Lambert-Eaton syndrome are caused by antibodies that reduce
the amount of
acetylcholine at motor endplates, and autoantibodies to an
intercellular
adhesion molecule cause pemphigus.
In type III hypersensitivity reactions immune-complex
deposition (ICD)
causes autoimmune diseases, which is often a complication. As
the disease
progresses a more accumulation of immune-complexes occurs,
and when the
body becomes overloaded the complexes are deposited in the
tissues and
cause inflammation as the mononuclear phagocytes,
erythrocytes, and
complement system fail to remove immune complexes from the
blood.
Histopathology
Human basophils present multi-lobed nuclei and distinctive
granules. They
can be found in local tissues including the nose, lungs, skin or
gut in response
to allergic and immune responses. The two populations of mast
cells are
mucosal and connective tissue. They have morphological and
pharmacological differences. The mucosal mast cells can
associate with a
parasitic infestation, and connective tissue mast cells are
smaller and live
shorter. Both contain histamine and serotonin in their granules.
Skin biopsy
31. of patients with allergic dermatitis shows inflammatory
infiltrate with few
eosinophils, but their degranulation in the skin demonstrated in
the biopsy
stained with antibodies against eosinophil major basic protein
(MBP). In the
nasal smear of a patient with acute bronchial asthma, an
infiltrate consistent
of eosinophils, and polymorphonuclear cells with a normal
cytoplasm stained
with hematoxylin and eosin were shown.[28][29]
In type II hypersensitivity reactions, autoantibodies bind to
desmosome
involved in cell adhesion, and autoantibodies in diabetes
mellitus bind to islet
cells. They can be demonstrated in tissues by
immunofluorescence. The
method that uses fluorescent antibodies has also been used in
type
III hypersensitivity reactions to demonstrate the presence of
immune
complexes in the intima and media of the arterial wall, as well
as IgG and C3
deposits in kidney, joints, arteries, and skin. In Goodpasture
syndrome, the
antibodies involved are IgG and have the capacity to fix
complement.
Necrosis of the glomerulus, with fibrin deposition, is a major
feature of this
syndrome.[30][31]
History and Physical
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In type I hypersensitivity reactions there is a history of atopy or
a patient
suffering from an allergic condition (e.g., bronchial asthma,
allergic rhinitis,
or food allergy). It may associate with recurrent infections
caused by viruses
and bacteria. For instance, bronchial asthma may link to
recurrent bacterial
pneumonia. Clinically allergic disorders may accompany by
airways
inflammation, wheezing attack, bronchial hyper-responsiveness,
tachycardia,
tachypnea, intense itching of the eyes and nose, sneezing,
rhinorrhea,
dermatitis, and gastrointestinal symptoms. Anaphylaxis, the
most severe type
of allergy, is clinically characterized by bronchospasm,
angioedema,
hypotension, loss of consciousness, generalized skin rash,
nausea, vomiting,
and abdominal cramps among other symptoms.[32]
In type II hypersensitivity reactions, a patient may report
multiple blood
transfusions, rhesus incompatibility, and drug history.
Clinically, it may
manifest as autoimmunity, e.g., autoimmune hemolytic anemia
(characterized
33. by jaundice), immune thrombocytopenia (characterized by
bleeding
disorders), and other blood dyscrasia (autoimmune neutropenia).
In this type
of hypersensitivity, drugs may attach to red blood cells and
stimulate the
production of anti-red blood cell antibodies or anti-dsDNA
antibody that
causes drug-induced systemic lupus erythematosus
(SLE).[33][34]
Type III hypersensitivity reactions may manifest as immune
complex-
mediated diseases including glomerulonephritis, vasculitis,
serositis, arthritis,
and skin manifestations of autoimmunity such as malar rash,
which is due to
photosensitivity. The prevalence of serum sickness has
decreased
dramatically because animal anti-serum is rarely used to treat or
prevent
infectious diseases. General manifestations of disease including
anorexia,
loss of weight, and asthenia may report in IHR.[35]
Evaluation
The evaluation of immediate hypersensitivity includes complete
blood cell
count, assessment of immunoglobulins, skin prick test, and
detection of
autoantibodies.[4][36][37][38]
Quantitative Serum Immunoglobulins
• IgG (involved in Type II and III HR)
34. • IgM (involved in Type II and III HR)
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• IgE (elevated in allergic diseases)
Total Leukocyte Count and Differential
• Hb (decreased in autoimmune hemolytic anemia)
• Neutrophils (decreased in autoimmune neutropenia)
• Lymphocytes (decreased in autoimmune lymphopenia)
• Platelets (decreased in immune thrombocytopenia)
Autoimmunity Studies
• Anti-nuclear antibodies (ANA, present in systemic
autoimmune
35. disorders, such as SLE and RA)
• Detection of specific auto-immune antibodies for systemic
disorders,
e.g., anti-ds DNA, rheumatoid factor, anti-histones, anti-Smith,
anti-
(SS-A) and anti-(SS-B)
• Detection of anti-RBC, antiplatelet, and anti-neutrophil
antibodies
• Testing for organ-specific auto-immune antibodies, e.g., the
anti-Islet
cell autoantibody that is present in diabetes mellitus
• Coombs test (positive in autoimmune hemolytic anemia)
Allergic test
• Skin prick tests using various allergens from animal, plants,
food,
pathogens and environmental pollutants
• Radioallergosorbent test (RAST): Use to determine specific
IgE
antibodies
Treatment / Management
The treatment of immediate hypersensitivity reactions includes
the
management of anaphylaxis with intramuscular adrenaline
(epinephrine),
oxygen, intravenous (IV) antihistamine, support blood pressure
with IV
fluids, avoid latex gloves and equipment in patients who are
allergic, and
36. surgical procedures such as tracheotomy if there is severe
laryngeal edema.
Allergic bronchial asthma can be treated with any of the
following: inhaled
short- and long-acting bronchodilators (anticholinergics) along
with inhaled
corticosteroids, leukotriene antagonists, use of disodium
cromoglycate, and
environmental control. Experimentally, a low dose of
methotrexate or
cyclosporin and omalizumab (a monoclonal anti-IgE antibody)
has been
used. Treatment of autoimmune disorders (e.g., SLE) include
one or a
combination of NSAIDs and hydroxychloroquine, azathioprine,
methotrexate, mycophenolate, cyclophosphamide, low dose IL-
2, intravenous
immunoglobulins, and belimumab. Omalizumab is a monoclonal
antibody
that interacts with the binding site of the high-affinity IgE
receptor on mast
cells. It is an engineered, humanized recombinant
immunoglobulin. Moderate
to severe allergic bronchial asthma can improve with
omalizumab.[14][32][39][40]
Differential Diagnosis
Allergic bronchial asthma must be ruled out from other classes
of asthma
based on the family history of atopy and a positive skin prick
test. Chronic
allergic bronchial asthma loses reversibility and is
indistinguishable from
37. chronic obstructive pulmonary disease (COPD).
Allergic rhinitis must rule out other causes of rhinitis including
vasomotor,
non-allergic rhinitis with eosinophilia, drug-induced (cocaine
abuse),
mechanical (tumors, foreign body, sarcoidosis) and infectious
including viral,
bacterial and leprosy. In allergic rhinitis, IgE is elevated, and
prick test is
positive for similar allergens as those in allergy bronchial
asthma. Also,
family predisposition to allergies may be present.
Autoimmune hemolytic anemia (AIHA) can rule out from other
anemias
based on the presence of a positive direct Coombs' test.
Sometimes the AIHA
is secondary to lymphoma or autoimmune disease, especially
SLE, where
other blood dyscrasias including immune thrombocytopenia and
autoimmune
neutropenia may be present besides with the presence of anti -
dsDNA
antibodies, and clinical signs including malar rash,
nephropathy, vasculitis,
serositis, neuropathy, and among other problems.
Prognosis
The prognosis of IHR depends on the severity of the disorders,
the extension
of the inflammation and tissue damage, and the available
treatment and their
effectiveness to control the disease. Relapsing or slow
progression
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characterizes myasthenia gravis. If presents with thymoma, 68%
of the
affected have a 5-year survival. In SLE, approximately 80%
survive at 15
years if treated. Atopic eczema (dermatitis) is usual ly most
severe in infancy
and improves with age in 80% of the cases. Allergic bronchial
asthma that
does not respond to steroids has a reserved prognosis.[41]
The prognosis of other allergic disorders, including food
allergy, drug
allergy, latex allergy, allergic conjunctivitis, and allergic
rhinitis is good once
the triggers identified using skin prick test or RAST and
treatment with anti-
histamine occurs. The use of monoclonal antibodies directed to
IgE (e.g.,
omalizumab) has improved the prognosis of patients that do not
respond well
to conventional therapy, although the acquisition of these
biologicals is
expensive. The use of vaccines, some classic and recently
experimental, is
another avenue of treatment of allergic disorders that improve
the life
39. expectancy and quality of individuals with allergies.
Complications
Some of the complications of immediate hypersensitivity
reactions are:
Status Asthmaticus
This is a type I hypersensitivity reaction, an acute exacerbation
of bronchial
asthma that does not respond to the standard therapy with
bronchodilators. It
is a medical emergency and must require aggressive
treatment.[42]
Anaphylactic Shock
This is an allergic reaction, often life-threatening, triggered by
an allergen to
which the immune system over-reacts.[43]
Post-Transfusion Reaction
This is a hypersensitivity reaction that occurs within 24 hours
of a blood
transfusion. Hemoglobinuria that appears during or after the
procedure
becomes an alarming sign. Other manifestatio ns include back
pain, fever,
chills, dizziness, and dyspnea.[44]
Serum Sickness
This is a type III hypersensitivity reaction that commences after
the
administration of a drug (e.g., penicillin) or heterologous anti -
41. asthma.
Enhancing Healthcare Team Outcomes
The management of an immediate hypersensitive reaction is best
done with a
multidisciplinary team that includes ICU nurses.
To improve patient outcomes, clinicians should be aware that
immediate
hypersensitivity reactions are a medical emergency. No time
should be
wasted with blood work or imaging studies. The treatment of
immediate
hypersensitivity reactions includes the management of
anaphylaxis with
intramuscular adrenaline (epinephrine), oxygen, intravenous
(IV)
antihistamine, support blood pressure with IV fluids, avoid
latex gloves and
equipment in patients who are allergic, and surgical procedures
such as
tracheotomy if there is severe laryngeal edema. These patients
are best
managed in an ICU setting.
Healthcare professionals should advise allergic patients about
environmental
control at home and work. Every attempt to reduce high
humidity and to
decrease house dust-mite exposure must do. The bedroom
should be clean,
and many use mattress covers and wash bedclothes regularly.
Pets, including
cats and dogs, are often the source of allergens and should not
be in
convivence with the affected patient, nor should living pl ants
42. and flowers,
which are "a sack of antigens." Patients should be encouraged to
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explore therapeutic options for acute or chronic desensitization
for "bad
allergens." This may be the only way to control their allergic
bronchial
asthma.
Questions
To access free multiple choice questions on this topic, click
here.
References
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