Targeting the Cyclic AMP Signal Pathway

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Targeting the Cyclic AMP Signal Pathway

  1. Table 1 Receptor binding measured as % displacement of fluorescent natural ligand

ED50 for compound X = 1.939e-007

ED50 for compound Y =7.085e-008


Table 2


The increase in heart rate in rats due to adrenaline as % of the increase observed in control rats

ED50 for compound X= 1.639e-006

ED50 for compound Y= 1.176e-007

  1. Compound X and Y are beta blockers which show an antagonist activity when it binds to the beta adrenergic receptors. The ligand binding occurs in the pocket formed by the 7 transmembrane helices. The amine group from the compounds forms an iconic bond with a COO

    –

    in TM domain 3. The beta OH groups forms a hydrogen bond with the NH from domain 6. The benzene ring forms a hydrophobic bond with phenylalanine in TM domain 6. The OH groups on the compound form hydrogen bonds with the OH groups of two serine’s in TM domain 5. Due to this binding, it causes a conformational change in the receptor that is transmitted through an essential cysteine residue at base of domain 6. The 3

    rd

    cytoplasmic loop is opened and it forms a binding site for the G protein. This is the site at which the G-protein Gs binds and becomes activated.

Beta-adrenergic receptors are found in the heart and when they are stimulated, they increase the heart rate. This causes the heart to contract. Compound X and Y are beta-blockers because they have a similar structure to adrenaline.  Most beta blockers inhibit the same structure. When beta receptors are coupled to Gs-proteins, it activates adenylyl cyclase to form Camp from ATP. An increase in cAMP activates a cAMP-dependent protein kinase that phosphorylates L-type calcium channels. This causes an increase calcium so there is more calcium entering the body. An increase in calcium entry leads to an increase of calcium  which causes the heart to contract.

Compound X or Y can bind onto the receptors and prevent this from happening. From table 1, it shows that at higher concentration, compound X and Y binds with the receptor more efficiently at 99% than the ones at a lower concentration. Table 2 also supports this as it shows that a higher concentration, it shows a decrease in the heart rate. By having a decrease in heart rate, it will reduce the number of heart failures. Compound Y has a better effect when it binds to the beta 1 adrenergic receptors compared to compound X.  Isoprenaline is medication used for the treatment of heart block and it’s an analogue of adrenaline. From table 3,  it can be concluded that the PKA activity of isoprenaline on it own is lower compared to forskolin and dbcAMP. Forskolin is an activator of cAMP and dbcAMP is a cell soluble cAMP analogue. When isoprenaline is combined with Compound X and Y, the PKA activity is much lower. Isoprenaline on its own has an  activity of 1.25 where as when its combined, it has an activity of 0.23 and 0.22. This significantly reduced the PKA activity.  With forskolin and dbcAMP, when the compounds were combined, the PKA activity did not decrease effectively compared to isoprenaline. PKA activity can be used a measure of cAMP because second messengers bind to intracellular proteins and change their biological activity. These are often protein kinases that can in turn phosphorylate and change the activity of target protein. The activity of PKA is dependent on the on the levels of cAMP. Therefore, the decrease in activity of PKA will suggest that there is low level of cAMP in the body.

This can further be supported by figure 2, the CREB phosphorylation.

  1. As classified before, Compound X and Y are beta blockers. Most beta blockers contain an amino group because the amine is the main site of drug metabolism. In vivo, the metabolism of drugs depends on MAO and COMT. However in vitro, there are other factors such as oxidation and racemization. Due to this reason, the potency of the compounds will be different. As mentioned before, there are different factors which can affect the potency of in vitro such as sunlight which can be oxidised. In vivo, they are metabolised by MAO and COMT. The role of MAO is to convert catecholamines into aldehydes. Following this, aldehyde dehydrogenase converts the aldehyde into a carboxylic acid which is excreted in the urine. If we compare the structures of Compound X and Y, it can be seen that Compound X contains two OH groups on the structure which affects the COMT metabolism, however in compound Y, there is only one OH group which suggests that it is less influenced by COMT metabolism which makes compound Y more potent. Increased bulkiness of the alkyl substituents on N atom produces Beta specificity and resistance to MAO. Compound Y has bulkier substituents on the N atom than Compound X which makes Compound Y more potent. Compound X is more polar due the extra OH group and to be an effective drug, the drug should be non-polar so that it can cross the cell membrane. This makes Compound Y more effective as it is non polar.

the amino group is important

because the amine is a main site of drug metabolism and so

drug inactivation. Also, this functional group causes the

compounds which are predominantly ionized at physio-

logic pH and protonated amine group is required for b

receptor binding.

the amino group is important

because the amine is a main site of drug metabolism and so

drug inactivation. Also, this functional group causes the

compounds which are predominantly ionized at physio-

logic pH and protonated amine group is required for b

receptor binding.


  1. Drug Targets in the cyclic AMP Signal Pathway that are not GPCRs

In the human body, there are messengers. First messengers are known as extracellular signals, but they cannot enter cells directly so they are converted into intracellular signals which are known as secondary messengers. Intracellular second messengers include cAMP, cGMP, nucleotides, lipids and small molecules.(Tilley, 2011) Biochemical reactions in the body occur due to the recognition process between intracellular second messengers and extracellular receptors. Adenylate cyclase converts ATP into cAMP which stimulates cAMP-dependent protein kinase (PKA). Some proteins can be phosphorylated by PKA. (Tilley, 2011)The phosphorylation of the cAMP response element binding protein (CREB) is important in the regulation of gene transcription. (Tilley, 2011)G protein coupled receptors are the largest family of membrane receptors which are targeted by drugs. Over 700 drug targets GPCRS and when the GPCR binds to a specific ligand, it becomes activated. There is a conformational change in the receptor. This causes the enzyme adenylyl cyclase to activate which catalyses the conversion of ATP into cAMP. However, there are new potential drug targets in the cAMP signal pathway that are not GPCRS. The potential drug targets are adenylyl cyclase, PDE and PKA.

As stated previously, the role of the enzyme adenylyl cyclase is to convert ATP into cAMP. Many drugs target cAMp signalling pathway through GPCR, however adenylyl cyclase has not been considered as drug target due to their potential side effects. Over the years, they have been studies on the physiological functions of the different mammalian AC isoforms. (Pierre et al., 2009)There are 9 AC isoforms which are expressed in different tissues. ACs 1 to 8 are activated by forskolin which is a diterpene. Forskolin is a drug which targets adenylyl cyclase and increases the cAMP concentration. The activation of adenylate cyclase occurs via the direct action of the diterpene on the catalytic subunit of adenylate cyclase enzyme without interacting with cell surface receptors. (Sapio et al., 2016)Targeting the cAMP levels has shown anticancer effects such as the induction of mesenchymal to epithelial transition and the inhibition of proliferation. (Sapio et al., 2016) Furthermore, it also can lower blood pressure, promote vasodilation and bronchodilation. There are studies which have shown forskolin inhibit the growth of the human gastric cancer cell lines by decreasing the activity and expression of protein kinase C. (Sapio et al., 2016)It also prevented the growth and induced apoptosis of myeloid and lymphoid cells. (Pierre et al., 2009) It has been reported that forskolin can be used a drug to target patients with Alzheimer’s disease. (YAN et al., 2016)However, forskolin has not been proven to be an effective anticancer agent in humans. More clinical studies are required to support this potential drug as an anticancer agent.

There are therapeutic potential of isoform selective compounds in different clinical settings such as neuropathic pain and heart failure. (Pierre et al., 2009) Some of the AC isoforms have already reached clinical usage. An example of this will be Colforsin Daropate hydrochloride (NKH447) which has been approved in Japan for the treatment of advanced congestive heart failure. (Pierre et al., 2009)  There are also other compounds which are in its preclinical stage. Congestive heart failure is common in the US as it affects more than five million people. There are 54 different types of drugs which has increase survival however the prognosis of patient remains poor. There has been vivo studies where the overexpression of AC6 in mice improved cardiac function. In this investigation, cardio myopathic mouse  was used and when the AC6 expression was activated, there was an improvement in systolic and diastolic functions.AC5 and AC6 are expressed in the mammalian hearts. These two isoforms regulate the heart rate an contractility. However, these two isoforms have different roles.AC5 knockout models showed a protective phenotype against chronic failure and inflammatory pain. Inhibitors of AC5 has been suggested as a treatment for chronic failure but there are no AC5 inhibitors which are used clinically.

AC isoforms can also be used to improve asthma. Asthma is an inflammatory disease  and the common treatment for asthma is the beta 2-adrenergic receptor. AC9 expressions are found in multiple human lung cell types. A common polymorphism in AC9, Met for Ile at position 772, results in loss of enzyme activity. (Pierre et al., 2009)In cells where that express AC9-Met772, treatment with glucocorticoid indicated a significant increase of the albuterol-stimulated AC response. This led to a conclusion that AC-Met772 could be used to improve albuterol bronchodilator response after glucocorticoid treatment in asthmatics. (Pierre et al., 2009)There was a 4 year study where 436 asthmatic children took part in. The children either received a placebo or the inhaled corticosteroid budesonide. AC9-Met772 carriers showed an improvement. These findings hint the potential use of AC activators as bronchodilators.

cAMP is broken down by an enzyme called cAMP dependent phosphodiesterase (PDE). There are different types of isoforms and PDE3 enzyme targets this conversion. (Boswell-Smith, Spina and Page, 2009)Inhibition of this enzyme will prevent cAMP from breaking down, therefore the concentration of cAMP can be increased. PDE3 has a high affinity for cAMP but at the same it can hydrolyse cGMP. It acts as a competitive inhibitor for cAMP because it hydrolyses cAMP at a higher rate. (Boswell-Smith, Spina and Page, 2009) Due to this, it was identified as a potential therapeutic target in cardiovascular disease and asthma. It also relaxed vascular and airway smooth muscle and the inhibition of increased platelet. There were development of PDE3 inhibitors such as milrinone to treat patients with heart failure. However, this increased the risk of mortality. Cilostazol is another PDE3 inhibitor which blocks platelet aggregation. This relaxes vascular smooth muscle and in the heart, it cause positive inotropic and chronotropic effects.

In 1970s, PDE4 inhibitor called rolipram was developed as potential drug to treat depression. It indicated that an increase in cAMP would enhance noradrenergic neurotransmission in the central nervous system. (Boswell-Smith, Spina and Page, 2009)However, this drug had side effects such as nausea and gastrointestinal disturbance.  PDE4 inhibitors also have the ability to induce relaxation of isolated human bronchus. (Boswell-Smith, Spina and Page, 2009)CDP840 was developed in 1997 which was the first orally active PDE4 inhibitor. It showed beneficial effects in patients with asthmas at different doses and it showed no serious adverse effect. Cilomilast is an orally active PDE4 inhibitor in late clinical development. In chronic obstructive pulmonary disease (COPD) patients, cilomilast improved forced expiratory volume. (Boswell-Smith, Spina and Page, 2009) However there are side effects and it was rejected by FDA in 2003 due to the concern over the efficacy and safety of the drug.

Roflumilast is another PDE4 inhibitor and it has been approved by FDA in the US in 2011. Studies have indicated that patients who have asthma and COPD, the lung function was improved and that it could be a new potential drug. There are side effects such as gastrointestinal therefore it is still going under further clinical evaluations. 3-isobutyl-1-meth-ylxanthine is another common inhibitor. This has been developed based on S-adenosylmethionine. It functions as an inflammatory drug and it has indicated as an effective PDE4 inhibitor for the treatment of chronic inflammatory disease.

Pentoxifylline, a PDE inhibitor, increases the cAMP level and it acts as an immunosuppressant. It has anti-fibrotic activity and improves the dynamic of the blood flow in the human body. There has been observations found in mice, that it increases bone mass, therefore it used in the treatment of osteoporosis. It can also block macrophage activation and the production of nitric oxide. (YAN et al., 2016)PDE can be a potential drug target to design drugs as it shows beneficial effects .There are side effects and if the benefits outweigh the risk, then PDE inhibitors can be a successful drug. There are still challenges going on to find a better PDE inhibitor which has a reduced number of side effects and more selective.

Protein kinase is an enzyme which is dependent on cAMP as it only gets activated if there is cAMP. The role of PKA is to phosphorylate other proteins in the body. PKA inhibitors can be used as potential drug.  H89 is a PKA inhibitor. It is known that the activation of beta adrenergic receptors increase the concentration of cAMP thus activates PKA. This leads to the L type calcium channels opening which results in contraction of the heart. By having PKA inhibitors, this should decrease this effect. In a recent study, an isolated rat heart was used as an experimental model and it was found that H89 is a potential cardioprotective agent. (Lochner and Moolman, 2006)It improved contractile recovery and reduced infarct size. (Lochner and Moolman, 2006) There was another study which indicated that h89 blocks prostaglandin E2 (PGE2), nitric acid and inflammatory effects. However, the use of H86 is only in laboratory agent and there no clinical evidences and whether it is safe to take them.

Taking everything into consideration, there are alternatives to GPCRS in the cAMP signal pathway. GPCRs is a large protein family of receptors therefore there many drugs which target these and there are many clinical evidences to support this. As it has strong clinical data, FDA has approved many drugs in the market which targets GPCRs. The research methods used to find a drug target in the cAMP signal pathway should be improved and this could be done by high-throughput screening as it is a well-developed technology. Adenylyl cyclase has 9 isoforms that different function in each tissues has a huge potential in the drug discovery. From all the evidences provided, adenylyl cyclase can be a major drug target in the cardiac function. Most of the AC isoforms as a drug target is only based on mice. There are no clinical evidences whether it is successful on humans and the safety of the drug. Not only AC, PKA and PDE  have been successful as drug targets in some cases. It has the potential to be targeted by many drugs if there are proven clinical evidence which support it.


References

  1. Tilley, D. (2011). G Protein–Dependent and G Protein–Independent Signaling Pathways and Their Impact on Cardiac Function.

    Circulation Research

    , 109(2), pp.217-230.
  2. Pierre, S., Eschenhagen, T., Geisslinger, G. and Scholich, K. (2009). Capturing adenylyl cyclases as potential drug targets.

    Nature Reviews Drug Discovery

    , 8(4), pp.321-335.
  3. Sapio, L., Gallo, M., Illiano, M., Chiosi, E., Naviglio, D., Spina, A. and Naviglio, S. (2016). The Natural cAMP Elevating Compound Forskolin in Cancer Therapy: Is It Time?.

    Journal of Cellular Physiology

    , 232(5), pp.922-927.
  4. Boswell-Smith, V., Spina, D. and Page, C. (2009). Phosphodiesterase inhibitors.

    British Journal of Pharmacology

    , 147(S1), pp.S252-S257.
  5. YAN, K., GAO, L., CUI, Y., ZHANG, Y. and ZHOU, X. (2016). The cyclic AMP signaling pathway: Exploring targets for successful drug discovery (Review).

    Molecular Medicine Reports

    , 13(5), pp.3715-3723.
  6. Lochner, A. and Moolman, J. (2006). The Many Faces of H89: A Review.

    Cardiovascular Drug Reviews

    , 24(3-4), pp.261-274.

 

 

 

The different types of threats to validity and a brief explanation of the threats that are appropriate for your research design.

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The different types of threats to validity and a brief explanation of the threats that are appropriate for your research design.

In this assignment, you will identify the various threats to the validity of a proposed research topic.

Select a topic related to public health care from the following:

Health disparities: Chronic diseases

Environmental health

Impact of infectious diseases on public health

A list of topic that you have selected and provide a rationale for your choice.

At least three specific research questions (hypotheses) on which your research proposal will be based.

The research method for your research proposal. Your research method should explain how you intend to obtain your results, including information on the type of research and sampling plan.

The different types of threats to validity and a brief explanation of the threats that are appropriate for your research design.

Specify strategies for minimizing the identified threats to validity.

Reaction to difficulty in Nursing staffing

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Reaction to difficulty in Nursing staffing

Nursing staffing issues.

When you encountered a difficult situation with respect to Nursing staffing. How did you react? What could you (nurse) have done differently? Would mandatory nursing staffing ratios have helped? Outline the key points on nursings rights in the workplace Discuss how the work environment may be improved in order to improve patient safety Go to www.ana.org and www.icn.ch and read the sections on Staff Nurses, specifically focusing on the Nurses Bill of Rights Please lightly touch following points, 1 paragraph each points. 1- Nursing shortages contribute to overwork, fatigue, and errors. Discuss how the environment may be better structured to support the health and well-being of nurses 2- What is the role of the staff nurse when she/he knows that the working environment is not safe? Thank you ANSWER Nursing Staffing Issues Introduction: Nursing Staffing is the activity of watching over sick patients confined in the hospitals so as to alert the medical personnel assigned to treat them in the event of an emergency. Its usually done by qualified personnel with appropriate training in the field of medicine and nursing who are able to handle a life threatening experience in case of its occurrence. Its a vital organ in the normal and effective running of a hospital. Nursing staffing, however, is posed by many challenges, which have resulted, to the loss of lives of many patients admitted into various hospitals. This outcome has been caused mainly due to lack of proper nursing staffing services allocation into the hospitals. Also, shortages of qualified nurses in the hospitals have contributed to the event of this negative phenomenon. Hospitals with low numbers of nurses, and staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections (Stanton, 2011). My problem encounter and reaction: Last winter I took my grandmother to a public hospital in our hometown after she complained persistently that she had breathing problems. She was asthmatic. We tried using the inhaler that had been recommended by a doctor where she used to attend her clinic therapies. Nevertheless, it did not seem to have a great effect on her. When we took her to the hospital, she was very week, and urgent attention was essential to safeguard her life. I rushed frantically into the hospital to seek assistance to carry her from the ambulance so that she could get immediate attention as she seemed very ill. I was shocked to learn that there was no nursing personnel who were available as all of them were tied down by other functions in the hospital complex. Later I learned out that the hospital had only 6 qualified nurses to cater for more than 60 patients, which was the, capacity for the hospital. My grandmother succumbed to her illness while waiting inside the ambulance for nurses from the hospital to assist her. My actions as a nurse in the hospital: as a nurse working in the hospital, I would be aware of the pressure exerted on us in trying to handle the many patients in the hospital. I would have raised my concern and created a notification to the hospital administration advocating for the employment of more staffing personnel to assist in the hospital functions. This would have assisted in curbing unfavorable outcomes in the event of an emergency. During my 2nd week of posting to the hospital am currently working in, the rate of out-patients attendance in the hospital significantly rose to 150 patients per day from 60, which was initially the normal rate of attendance we usually experienced. As a result, I and the few nursing personnel we had in the hospital had to work for almost 18 hours daily in an attempt to service all the patients. Consequently, I did not have adequate time to sleep and stress took a toll on me. I gave two patients a wrong prescription which would have been vital for their health. Fortunately, the intervention of a nursing colleague who luckily noticed my mistake saved the adverse effects the drugs could have done to the patients. Effects of mandatory staffing, ratios: Mandatory staffing could be said to be involuntary time, when the registered nurse (RN) is required to remain for all or part of a subsequent shift or is required to come back and work beyond the agreed-upon time (Moorhead & Cowen 2006). Proposed minimum staff-to-patient ratios such as those enacted in California are intended to address the concern that patients are largely affected by inadequate staffing (John M. Welton, 2011). Mandatory staffing ratio, however, created in positive intent may not be effective in stabilizing or controlling nursing staffing issues. This is because legislation of mandatory staffing issues may be accompanied by patient safety problems. These problems could be; nurses having slower reactions because of being tied, errors in clinical judgment, medication errors, and being less alert to changes in patients conditions (Moorhead & Cowen 2006). Key points of nursing rights in the workplace: Every health worker is entitled various rights in his or her work place. The rights, which should be, designated to the nursing staff in the work place should be aided through the creation of a supportive working environment that benefits both employers and employees in the hospital complex. The rights include; respect, fair treatment, dignity and good faith, health and safety, communication, information, professional development, support, work democracy, and the right to join the union (Organisation, 2011). Improving the work environment to enhance a patients safety: Enhancing the patients safety has become a great challenge amid advancement in technology. Provision of the nursing staffs with efficient and more modern equipments to monitor on the patients performance is necessary to avoid complications that may arise in a time of emergency. Improving effective communication, however, remains a key factor that needs development in a hospital environment. This is because ineffective communication has been implicated as the leading cause in medication errors, delays in treatment, and prenatal deaths and injuries which may result from a wrong-site surgery (Friesen, 2011). Nurses bill of rights: The bill of rights creates a provision for registration of nurses and this makes them feel more secure and respected in their work as a provision. It guides organizations policies when creating employment contracts between nurses and employers. It provides a reference point for the employers in establishing what the nurses need in their work places. It has 7 provisions that safeguard the nurses during their operations. Some of these include the right to conduct in a manner which enables them to meet their obligations. Right to work in an environment supporting their professional standards. Feel free to advocate for themselves, and their patients. Nurses have a right to work in a safe environment, and discuss terms of their employment. Shortages of nurses lead to over utilization of the nurses already available. Overworking consequently leads to fatigue of workers and even at times errors in giving the appropriate medication. The working environment should be structured in a manner that there is efficient communication between nurses, and employees to create a cordial and a safe relationship between them. In the event that nurses dont feel secure in their work environment, they are supported by their bill of rights to negotiate the terms of the contract that suitably favors them. They have a right to voice their concern to the administration involved to eradicate the threatening factor affecting them. References (1). Cowen, P.S. & Moorhead, S. Current Issues in Nursing. Philadelphia: Elsevier Health Sciences, 2006. Print. (2). Friesen, M. &. (2011, 05 02). Communication: Patient Safety and the Nursing Work Environment. Retrieved 05 02, 2011, from Nursing That Works: https://www.snjourney.com/ClinicalInfo/WrAndReport/PtSafWkEnv.pdf (3). John M. Welton, P. R. (2011, 05 02). Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach. Retrieved 05 02, 2011, from The Online Journal of Issues in Nursing: https://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/MandatoryNursetoPatientRatios.aspx (4). Organisation, T. N. (2011, 05 02). Your rights in the workplace. Retrieved 05 02, 2011, from https://www.nzno.org.nz/services/resources/information/workplace_rights. (5). Stanton, M. W. (2011, 05 02). Hospital Nurse Staffing and Quality of Care. Retrieved 05 02, 2011, from AHRQ Agency for Healthcare and Quality of Care: https://www.ahrq.gov/research/nursestaffing/nursestaff.htm Submitting high quality Essays,Research Papers, Term Papers, is the only way students can score high grades( As). Students ought to hire professional Writing Service providers who can deliver high quality work within the allocated time. Click to ORDER NOW It’s only fair to share

Application of role theory to a case study | SOCW 6060 – Social Work Theory and Practice | Walden University

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This week, you will use role theory to apply to your chosen case study. In other words, your theoretical orientation—or lens—is role theory as you analyze the case study.

Use the same case study that you chose in Week 2. (Remember, you will be using this same case study throughout the entire course). Use the “Dissecting a Theory and Its Application to a Case Study” worksheet to help you dissect the theory. You do not need to submit this handout. It is a tool for you to use to dissect the theory, and then you can employ the information in the table to complete your assignment.

To prepare:

Review and focus on the same case study that you used in Week 2.

Review the websites and guides for developing PowerPoint skills found in the Learning Resources.

Use Personal Capture to record the PPT slides on your screen and your audio as you present the information. You will then use Kaltura Media to upload this recording to the assignment link.

Submit a narrated PowerPoint presentation using Kaltura Media that includes 11 to 12 slides.

Each slide should be written using bullet points, meaning no long paragraphs of written text should be in the slides.

The recorded audio takes the place of any written paragraphs, while the bullet points provide context and cues for the audience to follow along).

Your presentation should address the following:

Identify the presenting problem for the case study you selected. (Remember the presenting problem has to be framed from the perspective of role theory. For example, the presenting problem can be framed within the context of role functioning).

Identify all the relevant roles assumed by the client.

Analyze the social expectations and social and cultural norms revolving around the role, social position, and role scripts of one of the roles assumed by the client.

Explain the role and social position of the social worker in working with the client in the case study.

Describe how the role(s) and social position(s) assumed by the social worker will influence the relationship between the social worker and the client.

Identify three assessment questions that are guided by role theory that you will ask the client to better understand the problem.

Identify and describe two interventions that are aligned with the presenting problem and role theory.

Identify one outcome that you would measure if you were to evaluate one of the interventions you would implement to determine if the intervention is effective.

Evaluate one advantage and one limitation in using role theory in understanding the case.

Be sure to:

Identify and correctly reference the case study you have chosen.

Use literature to support your claims.

Use APA formatting and style.

Include the reference list on the last slide.

I will complete the recording portion of this assignment

The Effects of Stress Among Female Registered Nurses

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The Effects of Stress Among Female Registered Nurses

Prior research has suggested that nurses, regardless of workplace or culture, are confronted with a variety of stressors. As the worldwide nursing shortage increases, the aged population becomes larger, there is an increase in the incidence of chronic illnesses and technology continues to advance, nurses continually will be faced with numerous workplace stressors. Thus, nurses need to learn how to identify their workplace stressors and to cope effectively with these stressors to attain and maintain both their physical and mental health.

Using your research, describe the current events and how they are reflective of your studies on racial, gender, and class discrimination and/or stratification.

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Using your research, describe the current events and how they are reflective of your studies on racial, gender, and class discrimination and/or stratification.

October 14, 2017 – Taylor Comments are off for this post.
Using your research, describe the current events and how they are reflective of your studies on racial, gender, and class discrimination and/or stratification.
Field: Psychology
The purpose of this assignment is to explore stratification and prejudice in current events. Despite great advances towards equality between the races and genders, racial and gender discrimination, as well as class stratification remain serious social problems. To conclude this course, you will use the news media to discover current social issues with regards to race and gender.

To complete this assignment, perform the following tasks:

Using newspapers, news websites, or news magazines, select three current events (within the last six months) that reflect our studies on stratification. One event should represent racial issues, one gender issues, and one class issues. All three should demonstrate discrimination and/or stratification in American society.

Using your research, describe the current events and how they are reflective of your studies on racial, gender, and class discrimination and/or stratification.

Analyze the events and apply the lecture and text to the news articles. What theories of stratification apply? Are the current events representative of the historical trends of racial, gender, and class discrimination and or/stratification? What solutions, if any, should be applied to these current events?

In your discussion, apply your personal experiences and observations to the current events.

How do you feel that the media perpetuates discrimination and/or stratification based on race, gender, and class? Support your ideas with concepts from the text and/or appropriate outside resources.
Provide a minimum of three references and apply the correct APA standards in the format of text, citations, and references. Your paper should include a title page and reference. Your paper should be at least five pages in length, not including the title and reference pages.

Analyze any ethical considerations for the deployment of the program using elements of developmental psychology research and practice to support the suggested implementation.

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Analyze any ethical considerations for the deployment of the program using elements of developmental psychology research and practice to support the suggested implementation.

Program Proposa

l
The final assignment in this course is a written Program Proposal. A program proposal is a document demonstrating an intent to create a clinical, educational, or community project. The Program Proposal will define a contemporary problem or issue and propose a potential solution for a contemporary issue in a manner that will persuade experts and decision makers to support the proposal. Within the proposal, developmental theory and research will be applied to policy, community agency, and major themes of development. A specific program, intended to provide individual or group services to address an identified area of need, will be introduced and outlined.
Beginning the Proposal Process
Choose an area of interest. Students will choose a general track and define a specific issue within the track that is of interest to them and presents a contemporary problem to be solved. Please see the Program Proposal Tracks and Topics in Developmental Psychology document to view the tracks (Community, Clinical/Counseling, and Education) and suggested issues within each track for the proposal. Once the track and issue have been chosen, specific criteria will need to be identified.
Identify the target population. Regardless of the track and issue chosen, a target population must be identified for the proposal. Identify the target population associated with the chosen issue. Within the target population, choose the developmental stage that will act as the focus for the proposal. Many programs may directly and/or indirectly influence people in different stages; however, it is important to select the stage that is most applicable to the specific program being proposed. For example, in a program for adults who are caring for their elderly parents, the focus is on the adults (likely in middle adulthood) so a middle adulthood focus would be most appropriate for that program.
Identify the geographic location where the program will be deployed. Programming will be directly influenced by the location in which it will take place. For example, a child safety program in a rural farming community will likely have different objectives and needs than a child safety program in a large metropolitan city.
Research a minimum of five peer-reviewed articles on the chosen issue in the Ashford University Library. All sources utilized for the Program Proposal must have been published within the last 10 years.
Creating the Program Proposal
Program proposals take on many forms and styles. Creativity is encouraged because it not only tests the boundaries of what is possible for solutions to various issues, but also typically increases the chances for funding. Regardless of the issue being addressed, the Program Proposal must incorporate the following headings (noted in bold) and include the supporting information that is detailed beneath each heading.
Proposal Summary
Under this heading, provide a summary paragraph that presents the program, its objectives, and how the program will address an area of need in the identified geographic location and issue of interest.
• Identify the target population and developmental stage of the population, as well as the intended program track. (These will be elaborated upon further in the Program Narrative and Procedures section of the proposal.)

• Identify the geographic location for the program and the specific needs within that location. (These will be elaborated upon further in the Program Narrative and Procedures section of the proposal.)

Explain the pros and cons of health care in Australia, and explain how it compares to the healthcare management in the US.

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Explain the pros and cons of health care in Australia, and explain
how it compares to the healthcare management in the US.

Explain the pros and cons of health care in Australia, and explain
how it compares to the healthcare management in the US. (An intro is not needed for this assignment, just get straight to the point. This paper is just being added to another paper that is already created)
Analysis of the culture using a culturally competent model: Provide a brief evaluation assessment of the healthcare needs of the culture group using a cultural assessment model
Clearly applies the model to the pertinant culture.

Background information about the problem. Summarize evidences-based articles relevant to health problems and clearly state that how you use this information in your paper.
The problem/issue has excellent and sufficient scientific citations to demonstrate its significance

Narrative Summary
Impact of health disparity or health concern and its implication for practice
Synthesizes/provide an annotated bibliography with at least 8 resources.

Conclusions
are drawn from the state of current evidence in nursing literature
Insightful analysis of problem and its implications

Norovirus: Nursing Care and Case Study

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Gastroenteritis is known as one of the most prevalent conditions predominantly caused by norovirus worldwide (NSW Government, 2019). Although norovirus is usually a mild illness for people who are immunocompetent, it can be a serious infectious disease for frail older adults (Cardemil, Parashar, & Hall, 2017). This essay will define and explain the highly infectious norovirus as well as discuss the significance of the infection control precautions with accurate identification of the strategies. This essay will also discuss other required risk assessments and nursing care, including safety and cultural aspects relating to a specific case study of an elderly patient, Mr. Doug Sultan. For the purpose of the essay, norovirus itself will be defined and discussed along with infection control practices, professional patient-centred nursing care and patient safety inclusive of cultural safety.

Norovirus is a virus that causes gastroenteritis, which is regarded as the most common disease in all age groups worldwide (NSW Government, 2018). Outbreaks can occur anytime and anywhere, but particularly prevalent in winter and crowded areas, such as schools, residential care facilities and hospitals with symptoms of severe vomiting and diarrhoea (NSW Government, 2018). Norovirus is highly contagious and is often transmitted from the vomit or stool of an infected person (NSW Government, 2018). It can be spread via multiple routes, including person-to-person contact, handling infectious objects or items, consumption of contaminated food or water and aerosolized particles in vomit (Chen, Hall, & Kirk, 2017). Even though there are various modes of transmission, direct person-to-person contact, such as shaking hands with someone who is infected with the virus is known as the most common mode of transmission which accounts for more than 90 per-cents of the outbreaks of norovirus in healthcare settings (Chen et al., 2017). Norovirus infection typically emerges as a fairly brief and mild illness for people who are immunocompetent, whereas it can cause considerable morbidity and mortality in frail elderly people (Cardemil et al., 2017). According to Cardemil et al. (2017) the elderly individuals have shown a longer period of experiencing diarrhoea and slower recovery from illness due to age-related immunosenescence. Additionally, norovirus infection in older people is likely to cause severe clinical complications which may eventually result in death (Cardemil et al., 2017). A global review in developed countries also found that the vast majority of norovirus-related deaths occurred in older adults and the direct causes of death included sepsis, aspiration pneumonia, and cardiac complications (Lindsay, Wolter, De Coster, Van Damme, & Verstraeten, 2015). Another reason that norovirus is risky for older people is that it can cause extreme dehydration due to excessive diarrhoea and vomiting (Chen et al., 2017). Chen et al., (2017) argue that this is the most prevalent complication requiring medical attention, which is of particular concern among older people with chronic diseases.

Despite intensive research for safe and effective norovirus antiviral drugs, no specific antiviral treatments have been approved (Chen et al., 2017). However, there are several precautions, including standard and transmission-based precautions, and strategies, that healthcare professionals and individuals can implement to prevent, manage and control the spread of norovirus. Standard precautions refer to what must be carried out every time, and what needs to always exist in all healthcare environments, to minimize the risk of infection (Curran, 2015). This includes fundamental strategies, such as hand hygiene, appropriate use of personal protective equipment (PPE), and safe use of sharps equipment (Curran, 2015). Among many strategies of standard precautions, proper hand hygiene with soap and water might be the single most important strategy to prevent norovirus transmission in healthcare settings (Rajagopalan, & Yoshikawa, 2016). Transmission-based precautions as well as continued implementation of standard precautions are used when patients are suspected or confirmed to have any infections (Curran, 2015). There are three different types of transmission-based precautions, including contact, droplet and airborne precautions, and particularly contact and droplet precautions should be maintained for interrupting norovirus transmission (Department of Health & Human Services, State Government of Victoria [DH & HS, SGV], 2020; NSW Government, 2019). Additional PPE with contact precautions, such as gloves, gown or apron is advised for those entering the patient care area, as norovirus can be spread through person-to-person contact and contact with contaminated surfaces (NSW Government, 2019). Enhanced cleaning and disinfecting of the patient care areas is another strategy to remove aerosolized particles of norovirus that can survive on surfaces for long periods (Chen et al., 2017). Minimising patient movement within a ward and restricting unnecessary visitors from affected areas should be maintained as the contact precautions, until at least 48 hours even after the symptoms are resolved (Cardemil et al., 2017). A strategy using PPE, such as a surgical mask and eye protection or a full-face protector can be considered with droplet precautions when there is a potential risk of vomit or faecal splashing (Cardemil et al., 2017; DH & HS, SGV, 2020).

As patients get older, they tend to become more vulnerable and need careful attention associated with other risk assessments. There are several risk assessments to be discussed for Mr. Doug Sultan which are not limited to norovirus, including fluid balance charts, nutritional status check and falls risk assessment. Firstly, fluid balance charts and nutritional status check are required for Mr. Sultan as he has a risk of dehydration due to the recent three times of diarrhea, and also has a risk of malnutrition since he appears to be underweight for his height (Cardemil et al., 2017; Mayo Foundation for Medical Education and Research [MFMER], 2019). Dehydration due to excessive diarrhea is considered as the most significant risk factors of elderly patients, as the symptoms can lead to the development of chronic disease and constant loss of body fluids and electrolytes (Chen et al., 2017). Malnutrition in older adults causes various health problems, including a weakened immune system, muscle and bone weakness which can lead to falls and fractures, and an increased risk of death (MFMER, 2019). Therefore, accurate documentation, regular monitoring of fluid balance chart and nutritional status, are essential for adequate amount of fluids and nutrients replenishment (Cardemil et al., 2017; MFMER, 2019). Falls risk assessment is also required for Mr. Sultan as he is unsteady when mobilising and uses a walking frame (Callis, 2016). An unsteady gait is one of many other risk factors associated with inpatient falls, and fall-related injuries lead to serious injuries, such as fractures and subdural hematomas that can contribute to co-morbidity and death in the healthcare environment (Callis, 2016). Nurses should, therefore, have a comprehensive fall risk assessment tool to initiate specific management plans for Mr. Sultan’s safety (Callis, 2016). Furthermore, improvement in extrinsic factors of falls by educating and providing supportive and assistive equipment, such as lowering beds, safety buzzer and non-slip socks could be the prevention of falls for Mr. Sultan (DH & HS, SGV, 2020).

In addition to the monitoring potential risk factors, culturally safe healthcare services should be provided for patients who are originally from other cultural backgrounds like Mr. Doug Sultan. First of all, components of care plans such as cultural and spiritual beliefs, lifestyle, social history, likes and dislikes, and personal needs, are important to be understood when providing care to Aboriginal patients (Sivertsen, Harrington, & Hamiduzzaman, 2019). Sivertsen et al., (2019) argued that spirituality serves as a significant health determinant and influences the general care experiences of aboriginal residents. According to Sivertsen et al., (2019), there were cases wherein providing care, health carers found respecting and incorporating aspects of spiritual and cultural care for Aboriginal residents difficult due to lack of understanding of culture care plans. Additionally, health professionals should continue to educate themselves and provide information on quality standards of care to aboriginal residents like Mr. Sultan so that they can be provided culturally appropriate care (Sivertsen et al., 2019). Sivertsen et al., (2019) discovered a case where the lack of knowledge or understanding of the government standards prevented Aboriginal residents from seeking the culturally appropriate care that they are entitled to and thus resulted in fewer chances to voice their concerns around their cultural care needs.

In conclusion, norovirus is the most common cause of gastroenteritis that frequently outbreaks throughout the year. The virus widely affects the community with symptoms of severe vomiting and diarrhoea. Persistent norovirus outbreaks can result in severe illness and are relatively risky for those who are immunocompromised, including older adults. Although there are no approved vaccines and antiviral treatments currently available for norovirus infection, it can prevent almost all risk factors of norovirus infection by proper hand hygiene. Several risk assessments are recommended for monitoring and controlling the risks especially in relation to Mr. Sultan’s risk factors, such as dehydration, malnutrition and falls. Furthermore, culture care plans are necessary to be understood to improve care delivery and outcomes, and care standards should be educated for both carers and residents so that Aboriginal residents like Mr. Sultan can be provided with culturally appropriate nursing care.


References

  • Curran, E. T. (2015). Standard precautions: What is meant and what is not.

    Journal of Hospital Infection, 90

    (1), 10-11. doi:10.1016/j.jhin.2014.12.020
  • Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors.

    Applied Nursing Research, 29,

    53-58. doi:10.1016/j.apnr.2015.05.007
  • Cardemil, Cristina V., MD, MPH, Parashar, Umesh D., MBBS, MPH, & Hall, Aron J., DVM,               MSPH. (2017). Norovirus infection in older adults.

    Infectious Disease Clinics of North America,


    31

    (4), 839-870. doi:10.1016/j.idc.2017.07.012
  • Chen, Y., Hall, A. J., & Kirk, M. D. (2017). Norovirus disease in older adults living in long-term care facilities: Strategies for management.

    Current Geriatrics Reports, 6

    (1), 26-33. doi:10.1007/s13670-017-0195-z
  • Department of Health & Human Services, State Government of Victoria. (2020).

    Falls


    prevention in hospital.

    Retrieved from https://www2.health.vic.gov.au/hospitals-and-health-services/patient-care/older-people/falls-mobility/falls/falls-preventing
  • Lindsay, L., Wolter, J., De Coster, I., Van Damme, P., & Verstraeten, T. (2015). A decade of norovirus disease risk among older adults in upper-middle and high income countries: A systematic review.

    BMC Infectious Diseases, 15

    (1), 425. doi:10.1186/s12879-015-1168-5
  • Mayo Foundation for Medical Education and Research. (2019).

    Senior health: How to prevent and detect malnutrition.

    Retrieved from https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
  • NSW Government. (2018).

    Norovirus fact sheet.

    Retrieved from https://www.health.nsw.gov.au/Infectious/factsheets/Pages/norovirus.aspx
  • NSW Government. (2019).

    Viral gastroenteritis – infection control implications for hospitals and aged care facilities.

    Retrieved from https://www.health.nsw.gov.au/Infectious/factsheets/Pages/gastroenteritis-infection-control.aspx
  • Rajagopalan, S., & Yoshikawa, T. T. (2016). Norovirus infections in Long‐Term care facilities.

    Journal of the American Geriatrics Society, 64

    (5), 1097-1103. doi:10.1111/jgs.14085
  • Sivertsen, N., Harrington, A., & Hamiduzzaman, M. (2019). Exploring aboriginal aged care residents’ cultural and spiritual needs in south australia.

    BMC Health Services Research,


    19

    (1), 477-13. doi:10.1186/s12913-019-4322-8

Diversity in Teams: Organizations use different types of teams.

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Diversity in Teams: Organizations use different types of teams.




ORDER HERE FOR ORIGINAL, PLAGIARISM-FREE PAPERS ON Diversity in Teams: Organizations use different types of teams.

Organizations use different types of teams. Diversity in teams can mean everything from skill sets to ethnicity. Matching the right team structure to the needs of the organization takes understanding of the function of that team structure.

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation of future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Respond to the following:

Explain at least 3 different types of work teams.

What are some of the advantages and disadvantages of each one?

Of the work teams you have chosen, is one type better than the others? Explain why.

PART 5

Building Teams

Human resources professionals are frequently assigned to be members of newly formed project teams. In most cases, the HR person’s role in the team is to keep the group focused and on task.

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

You have been asked to lead a team on a new project. Discuss the steps that you will take to complete the following:

Ensure that the goals of the team are clearly understood by all members.

Build a strong, cohesive team.

Manage the interactions in the team.

PART 6

Team Conflict

Conflict exists in nature and, by extension, in all human relationships. Conflict can be something to avoid or embrace, or a more neutral approach can be taken. You will lead a group discussion on the subject among your peers. You decide that to generate a lively discussion, it is important to create a level of understanding of the role of conflict in groups and how conflict can be used to move a group forward. Diversity in Teams: Organizations use different types of teams.

Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas:

After doing some research on the topic of conflict, propose to your peers a position, and discuss the concept of conflict in teams.

Is conflict something to avoid or embrace?

Use examples from either your personal experience or from the literature that would support your position.


You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.


Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.


Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.


The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.



ADDITIONAL INSTRUCTIONS FOR THE CLASS


Discussion Questions (DQ)


Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses. Diversity in Teams: Organizations use different types of teams.


Weekly Participation


Your initial responses to the mandatory DQ do not count toward participation and are graded separately.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.


APA Format and Writing Quality


Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.

I highly recommend using the APA Publication Manual, 6th edition.


Use of Direct Quotes


I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.

It is best to paraphrase content and cite your source.


LopesWrite Policy


For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.


Late Policy


The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.


Diversity in Teams: Organizations use different types of teams.