Congestive Heart Failure Tests: Case Study

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Congestive Heart Failure

Congestive heart failure (CHF) is when the heart is not able to pump effectively or does not meet the body’s metabolic demands. Because of this lack of performance, the heart is not able to supply oxygen and nutrients throughout the body. As a result of the impaired pump, blood and other fluids back up into areas like an individual’s lungs and legs, causing congestion. Other cardiovascular conditions may increase an individual’s chance of developing CHF, such as coronary artery disease or high blood pressure (Mayo Clinic, 2017). This essay will be analyzing Mrs. S a recently diagnosed CHF patient who was admitted to the hospital. Additionally, it will be defining the clear connection between Mrs. S’ objective and subjective data in correlation to CHF.


Tests to Confirm Presence of CHF (1)

CHF which formerly known as heart failure is specifically described by Macon and Cherney (2018) as inadequate supply of blood pumped by the heart due to buildup of fluid.

Diagnostic tests carried out to confirm heart failure or more specifically, CHF are the same and have the aim of finding what the underlying cause is. Although the signs and symptoms Mrs. S is experiencing are that of CHF, they are not specific to only this condition which makes diagnosing hard (Lewis et al., 2019).  According to Taylor, Rutten, Brouwer, & Hobbs (2017), Mrs. S’ myocardial infarction (MI) that occurred last year, makes the presence of CHF more probable.

The first step of confirming the presence of CHF is a physical examination of the patient with a cardiac focus. This will entail listening to her heart to determine any abnormalities with the heart rhythms which will indicate if something is wrong. Mrs. S complained of “fluttering feeling with her heartbeat” which is a symptom of atrial flutter or tachycardia. To ensure an accurate reading, a continuous ambulatory ECG such as Holter monitoring will be done. The recordings will be interpreted and if the symptom Mrs. S complains of is related to an atrial flutter; the ECG results will confirm its presence. (Lewis et al., 2019)

Cardiac markers such as BNP and N-terminal pro-BNP (NT-proBNP) are measured to further confirm accurately that Mrs. S has CHF through blood tests that would be ordered. Aguanno (2017) explained that natriuretic peptides will show if the wall of the heart muscle has been stressed hemodynamically. Lewis et al (2019) found that these cardiac markers which are a type of Natriuretic Peptide (NP) will help to differentiate Mrs. S dyspnea to determine if it is “caused by HF [or] from other causes of dyspnea” (p. 851). B-type Natriuretic peptide (BNP), a hormone released by the heart elevates in presence of heart failure. It is produced by the myocardium and is elevated in response to the stretching of the left ventricle.

Other procedures that may be ordered include a chest X-ray, echocardiography, computerized tomography (CT) scans and magnetic resonance imaging (MRI). An echocardiography will look at the action, size, shape, position of the heart’s internal structures (valves, walls, aorta), the behavior of heart wall and other abnormalities relating to the function and structure of the heart. Taylor et al (2017) advised that “if there is a history of myocardial infarction… [individual is referred] directly to echocardiography…” (“Investigations,” para. 4).

With Mrs. S MI from last year, it may be best for her to be taken for an echocardiography with Doppler technology and color enhancement which would help in the initial assessment but a transesophageal echocardiography (TEE) would lend for an enhanced assessment that would produce detailed results (Inamdar & Inamdar, 2016).

The Chest X-ray will show if there is any abnormality in shape and size of the heart, cardiac contours, heart enlargements that occur which would be related to heart failure. The presence of pleural effusion would be more specifically related to CHF which would be a good indicator in Mrs. S’ case.

Carrying out an MRI, more specifically a cardiovascular magnetic resonance imaging (CMRI) provides the images of the heart in multiple planes and will show if there has been any damage done to the heart. The high-resolution images provided will give further information that will help identify the underlying cause of the CHF through data about blood flow through heart muscle and scarring. This could help healthcare professionals in projecting how and what the course of the CHF could look like. (Inamdar & Inamdar, 2016)


Respiratory Manifestations of CHF (2)

A nurse performing a respiratory assessment on an individual with congestive heart failure would expect the presence of pulmonary edema, dyspnea and fatigue, and paroxysmal nocturnal dyspnea. When the left ventricle is weak, it causes blood to back flow into the pulmonary veins. Pulmonary edema is when fluid backs up into the lungs, making it difficult for the lungs to perform gas exchange. Mrs. S specified that she has an occasional productive wet cough for pink frothy sputum. When body attempts to removes blood from the respiratory tract and forces the person to cough, this is known as hemoptysis. (Phillips & Zieve, 2019). Furthermore, the nurse would hear crackles in the patient’s lungs, indicating the movement of air through fluid. Additionally, as a result of blood preventing adequate gas exchange, Mrs. S. suffers from shortness of breath, followed with fatigue. That being said, the nurse would notice the patient struggling to take full deep breathes. Lastly, Mrs. S has been unable to lie flat in bed and has added three pillows to allow her to sit up higher to sleep. Lewis et al. (2019) mentioned paroxysmal nocturnal dyspnea is another symptom of CHF; It is when an individual cannot breathe, especially at night when lying down for long periods of time. This is due to the pressure put on the chest when lying flat from the blood back up.


Other Abnormal Data (3)

Apart from abnormalities from the respiratory assessment, there are other abnormalities that would be present in Mrs. S. relating to CHF such as altered serum electrolytes such as high sodium levels with the presence of edema, increased heart chamber and lower oxygen saturation.

Regarding her “suffering from fatigue,” this is a normal clinical manifestation that is found in CHF and is said to be one of the symptoms first found with individuals showing signs of CHF. With the inadequate blood supply from the heart, there would be a decreased cardiac output resulting in low blood flow as well as less oxygen carried to tissues and vital organs.

Mrs. S’ complains of a “fluttering feeling with [my] heartbeat” could be a symptom of atrial flutter but could also be a manifestation of tachycardia. Similarly, tachycardia is one of the earliest symptoms of CHF which was what got her admitted into the cardiac rehabilitation center. Her body will use a compensatory mechanism by increasing her heartrate which could be a result of an impaired ventricle. With the heart unable to pump blood efficiently, there will be less cardiac output causing the SNS to be activated causing an increase in heart rate.

The presence of edema is highly likely in Mrs. S. who has gained “2.27kg (5lbs.) in the past week”. This abnormality is commonly found in individuals developing CHF or a worse condition of CHF. (Lewis et al., 2019). Macon and Cherney (2018) found that the development of cough especially from a congested lung indicates that the CHF is exacerbating. This could suggest that Mrs. S with a recent diagnosis of CHF, the “occasional productive wet cough for pink frothy sputum” coming from her lungs could suggest her CHF is worsening.

Macon and Cherney (2018) noted that the feeling of needing to urinate frequently at night is an early sign of CHF. Lewis et al. (2019) confirmed this by saying that with nocturia, the individual will void more through the night due to fluid movement in the interstitial space and a reduced cardiac workload as PNS is stimulated more at night. Mrs. S who isn’t used to getting up at night to void but recently having an increased need to urinate at night, asserted the findings above. She found that she was needing to void “2-3 times each night” which started this past month.

If a blood test was done and assessed, there would be an elevated level of BNP and NT-pro-BNP. Specific levels for these natriuretic peptides were shown in the book ‘Medical-Surgical Nursing in Canada’ by Lewis et al (2019). They found that patients age 50 -75 such as Mrs. S who is 63, a NT-pro-BNP level of “[greater than] 1800pg/ml” will show CHF to be highly probable. Elevated levels of BNP “[greater than] 500pg/mol indicates CHF.” (Lewis et al’, 2019, Table 37-5).


Health Failure Clinic Test (4)

Initial physical exam and medical history would be obtained from patients to treat the underlying cause and for a formal diagnosis of heart failure. Clinical tests include chest x-ray imaging which may show presence of pulmonary congestion and cardiomegaly (Rahko , P. S. 2014). ECG may be associated with decompensation with a significant volume overload, infiltration cardiomyopathy and used to detect causes and reaction of Heart Failure. ECG changes include sinus tachycardia and example of clinical manifestations related are, reduced stroke volume and reduced cardiac output or high output demand state. BNP, serum chemistry; Liver function, thyroid function are parts of heart failure diagnostic tests. (Inamdar & Inamdar 2016) Cardiac catheterization and coronary angiography are necessary tests in a patient with new onset heart failure and angina. (Inamdar & Inamdar, 2016) BNP is a neuro- hormone, an activated form of proBNP. The 108- amino acid polypeptide precursor is stored as secretory granules in the ventricles and to a lesser extent in the atria. Elevated BNP (Brian Natriuretic peptide levels) is associated with pulmonary edema and renal failure; It is used to assess patients with labored breathing for heart failure. (King. M, et al. 2012) BNP levels increase with age and are higher in women. (Inamdar, A. A., & Inamdar, A. C 2016) Cardiac CT will show an accurate assessment of cardiac structure and function including the coronary arteries. According to (Merck 2018) radionuclide imaging can assess systolic and diastolic function, previous MI and inducible ischemia.


Lasix Information (5)

Lasix also known as furosemide, is a loop diuretic and an antihypertensive drug; Used to treat edema associated with renal disease, and acute pulmonary edema by increasing the excreation of water, and sodium chloride (Saunder, 2019). It can be contraindicated in persons who have a hypersensitivity reaction. Excessive Lasix can lead to electrolyte and water loss, resulting in  dehydration, hypokalemia, hyponatremia. Blood pressure and pulse should be checked before administration. In the case of Mrs.S Lasix would be administered to treat pulmonary edema. IV will be the first route to administer the drug, because it is fast acting because it goes directly into the bloodstream. Delivering the medication by IV should be at a rate 20-40 mg per minute, and should not exceed 4mg per minutes, if given as a short-term intermittent infusion (Saunder, 2019). Oral Lasix may be given with or without food and it has a slower absorption rate, which is the reason why it was prescribed to Mrs.S. after the initial IV administration. Lasix will lessen congestive heart failure symptoms such as shortness of breath and swelling in extremities. Some side effect includes nausea, abdominal cramps, and electrolyte disturbance (Saunders, 2019).


Teaching about Diuretics (6)

Lasix is used to manage symptoms relating to fluid retention; and causes diuresis, which is an increase in urine (Saunder, 2019). Thus, patients who are on Lasix should expect an increase in urine production and frequency. Due to the movement of fluids and the body adjusting to the medication, an individual may experience some dizziness, lightheadedness, headache and/or blurred vision (Saunder, 2019). These are things the nurse should inform Mrs. S about taking her diuretic medication.


Other Lifestyle Changes to Control Signs & Symptoms (7)

In addition to regular exercise, other lifestyle changes such weight management and dietary changes are essential to implement for control. Before Mrs. S is discharged, it is imperative that a dietician does an assessment of what her diet normally entails of. This will enable the dietician to make a detailed plan on what Mr. S can have. Social and financial influence should be accommodated into the detailed plan to ensure it is individualized and the patient feels involved. The diet should include fruits and vegetables as well as whole grains.

Mrs. S needs to be taught about the importance of reducing her sodium intake. Water is attracted to sodium so with a high sodium intake, there will be an increase in water retention. Lewis et al (2019) states that “2-g/day sodium diet” is recommended for mild HF while “1.5-g/day sodium” is recommended for those with severe HF. It would benefit Mrs. S if she is taught about food labels, adding salt while preparing food and having food with lower salt content. (Mayo Clinic Staff, 2017)

Stress can exacerbate heart failure. Mrs. S should be taught techniques on reducing stress levels and stress causes an increase in heartrate. This is detrimental for the heart as it is already inefficient in meeting the body’s demands for blood supply.

It may be hard for Mrs. S to know how to change or adhere to lifestyle changes to help control her heart failure. However, nurses and other healthcare professionals need to work together to devise a detailed yet individualized plan for Mrs. S that she can comply with.


Captopril Drug Classification (8)

Captopril is an Angiotensin Converting Enzyme (ACE) Inhibitor. The usual dosage given to patients is within the range 12.5- 50mg twice a day (Porter et, al. 2018). The drug prevents the conversion of angiotensin I to angiotensin II. It subdues the renin-angiotensin-aldosterone system. It does this by decreasing plasma angiotensin II, increasing plasma renin activity, and decreasing aldosterone secretion. Captopril is used as treatment of chronic diseases such as Heart Failure (HF), hypertension, diabetic nephropathy, and post myocadiac infarction for prevention of ventricular failure (Saunders, 2019). According to the Merck Manual (2018), the side effects of the drug are rashes, pruritus, dysgeusia, headache, Insomnia, cough, dizziness, fatigue, paresthesia (abnormal skin sensation), malaise (a slight pain that the cause is difficult to find), nausea, diarrhea or constipation, dry mouth, and tachycardia. Saunders (2019) states that the adverse effects of the captopril are angioedema, hyperkalemia, agranulocytosis, and renal impairment (p. 187).

Baseline assessment is done to ensure that the patient does not experience preventable adverse effects. For example, obtaining blood pressure and being alert to fluctuation before administering each dose. In patients with prior renal disease, test urine for protein by dipstick with first urine of the day and periodically thereafter. In patients with renal impairment, autoimmune disease or taking drugs that affect the leukocytes or immune response obtain CBC before administration every 2 weeks for 3 months (Saunders, 2019). Discontinue medication and contact physician if angioedema occurs. Nursing assessment that could be done are observing skin for rash or pruritus; monitoring urinalysis for proteinuria (high levels of protein in the urine); monitoring serum potassium levels in patients on diuretic ongoing therapy; monitor B/P, serum BUN, Creatinine, CBC.

Mrs. S is administered oral Captopril as a treatment for her congestive heart failure. Since CHF is a progressive disease that involves the inability of the heart muscles to meet up with the body’s demand or pump blood accurately, Captopril stops the production of the ACE which allows the vasodilation of the heart vessels which helps to decrease blood pressure and lowers the reoccurrence of a MI in Mrs. S. This greatly decreases the workload that Mrs. S’ heart must do.


Patient Teaching Regarding Captopril (9)

Ensuring that the patient receives the best care possible, it is important that nurses provide them with information that would minimize the possibility of adverse effects occurring and facilitate the healing process. Patients with renal insufficiency or taking potassium sparing diuretics should refrain from taking this drug as it may cause hyperkalemia (Saunders, 2019, p.187). Patient should be informed that the therapeutic effect of the drug may take several weeks to lower the blood pressure. The nurse will teach the patient when to report to them if they experience swelling in their face, lips and/or tongue. Additionally, the patient should be careful when rising from sitting/fowler’s position. Lastly, the nurse should inform the patient that skipping or stopping the intake of their medication would cause blood pressure increases after stopping the administration of the drug also known as rebound hypertension.


How Would Mrs. S Know if the Medications are Effective (10)

Mrs. S may observe reduced swelling on her feet, ankles, hands, weight loss, and reduced pulmonary edema. Her breathing will become easier; she may not require 2 or more pillows to sleep at night and she may be able to lie flat. She may observe increased urinary output and frequency and reduced wet cough after taking Lasix. Mrs. S may notice decreased symptoms of congestive heart failure, lowered blood pressure, less fatigued, and reduced heart rate within months of taking captopril.


Conclusion

Congestive Heart Failure (CHF) is when the heart muscle is unable to perform its function properly. CHF may also cause excessive fluid buildup which leads to edema and cardiac dysfunction. There are several drugs such as Lasix and Captopril that are used as treatment of CHF. This paper explored CHF, its symptoms, treatments, and its effect on patients. It also looks at tests done such as chest x-ray and ECGs that aims to discover the underlying cause of the disease. It linked Mrs. S.’ objective and subjective data to CHF for a better understanding of the chronic illness.


References

  • Aguanno, S. (2017). Diagnosis and management of patients with heart failure. Retrieved October 19, 2019, from https://www.mlo-online.com/continuing-education/article/13009421/diagnosis-and-management-of-patients-with-heart-failure#platformComments
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  • Inamdar, A. A., & Inamdar, A. C. (2016). Heart Failure: Diagnosis, Management and Utilization. Journal of clinical medicine, 5(7), 62. doi:10.3390/jcm5070062
  • King, M., Kingery, J. E., & Casey, B. (2012, June 15). Diagnosis and Evaluation of Heart Failure. Retrieved October 19, 2019, from https://www.aafp.org/afp/2012/0615/p1161.html.
  • Lewis, S., Bucher, L., Heitkemper, M., Harding, M., Barry, M., Lok, J., Tyerman, J Goldsworthy, S., Kwong, J., Roberts. D. (2019). Medical-surgical nursing In Canada- Assessment and management of clinical problems (4th Canadian ed.). Toronto, ON: Elsevier Canada Inc.
  • Macon, L. B., & Cherney, K. (2018). Congestive Heart Failure (CHF). Retrieved October 23, 2019, from https://www.healthline.com/health/congestive-heart-failure
  • Mayo Clinic. (2017, December 23). Heart failure. Retrieved October 22, 2019, from https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142.
  • Porter, R. S., Kaplan, J. L., Lynn, R. B., & Reddy, M. T. (2018). Porter, R. S., Kaplan, J. L., Lynn, R. B., & Reddy, M. T. (2018). The MERCK Manual Of Diagnosis and Therapy (20th ed.). Kenilworth, NJ: Merck Sharp & Dohme Corp., A Subsidiary of Merck & Co, Inc.
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The Importance of Public Policy

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INTRODUCTION

Public policy refers to the action or inaction of the government on an issue(s) (Thomas 2001 cited in Buse et al 2005). It sets hierarchy by carrying out the choices of those with the command of authority in the public. This makes public policy change very complex as various individuals, organisations and even the state have conflicting interest and capacities. There is therefore the need for coherence of interest/capacities in an attempt to effect a change (Colebatch 2002).

AIM: The aim of this paper is to explain the strategies that would be used to effect a change in public policy on road safety in Nigeria.

Health Issue and Public Health Importance:

Road Traffic Collision (RTC) is a major public health issue globally. It is defined as personal injury resulting from collision of a vehicle with another vehicle(s) or a pedestrian, occurring on the public highway or footways (Worcestershire County Council 2010).

The Situation Globally:

RTC accounts for over 1.2 million deaths with about 20 to 50 million non fatal injuries (a major cause of disability) occurring annually. It is the 9th leading cause of death globally and is estimated to rise to be the 5th leading cause of death by year 2030 (with about 2.4 million fatalities per year) out ranking public health issues like tuberculosis, HIV/AIDS (presently the 5th leading cause of death) and diarrhoea diseases (WHO 2008). This means that by the year 2030, RTC will be perceived as deadly as HIV/AIDS is today, if urgent action is not taken.

The global losses due to road traffic injuries are estimated to cost about 518 billion USD, costing the government between 1 – 3 % of its gross national product (WHO 2009a).

Nigeria:

Nigeria is Africa’s most populous country, with an estimated population size of about 151,319,500 (World Bank 2010). It is one of the 10 countries with the highest Road traffic death rates in the world (WHO 2009a). RTA is the commonest cause of death from unintentional injuries/ public violence in the country (Nigeria Watch 2007).

Usoro (2010) stated that there are about 30,000 accidents with about 35,000 casualties occurring yearly. About 90 persons are killed or injured daily and about 4 person’s dies or get injured every hour from RTA. He argues that the figures are underestimated because of poor reporting and poor recording of road accidents in the country. Low socio economic groups have been found to be at higher risk of road traffic injuries (Thomas et al 2004) and they are less likely to have the capacity to bear the direct or indirect cost related to RTA. They are faced with more poverty burden as they lose their bread winner; lose earnings while caring for the injured or disabled, the cost for funeral and prolonged health care (DFID 2003).

RTC has its greatest impact among the young and is the third leading cause of death between ages 5 – 45years (WHO 2009) with a reduction in the Country’s productive force, further worsening the economic situation, thus affecting the country achieving its MDGS 1 AND 4.

The major causes of RTC in Nigeria are; high speed, alcohol, bad roads, poor vehicle conditions etc (Usoro 2010). Although there is limited literature to show the different percentages of the causes of RTC in Nigeria, high speed is most implicated in low income countries (WHO 2009).

Studies have shown that a 5% increase in average speed can result in approximately 20% increase in fatal crashes (Transport Research centre 2006) and with a 1mph reduction in average speed there is a reduction in accident injuries by 5% (Finch et al 1994). The introduction of speed cameras in the Isle of Wight, UK resulted in an 83% reduction of speed on the island (Environment and Transport select Committee 2004). Reducing speed has also been shown to have positive effects on health outcomes e.g. reducing respiratory problems associated with health outcomes (Transport Research Centre 2006).

There is therefore urgent need for action to prevent this future pandemic.

PROPOSED CHANGE (POLICY CONTENT):

  • Introduction of speed cameras and enforcement of speed limits on Nigerian roads.

Enforcement of speed limits via mobile cameras has been shown to be the single most effective strategy for reducing fatality from RTC (Chisom and Naci 2008). It is thus most rational among other rational strategies but has to muddle its way through the policy process. Hence the nature of change follows the mixed scanning model.

For better understanding of the complex multifaceted nature of policy making, the proposed policy change is seen as passing through a process taking place in a particular context influenced by the participants/actors (the policy analysis triangle) (Buse et al 2005).

THE POLICY PROCESS:

The policy process can be broken down into series of stages called the ‘stages heuristic’ (Sabatier and Jenkins-smith cited in Buse et al. 2005).It provides a theoretical framework for understanding the times and places where tactical approaches can be applied to influence policy change (Buse et al 2005).

Before going on with the policy process, it will be worthwhile understanding the country’s policy context as this will assist in shaping the process.

THE NIGERIAN POLICY CONTEXT:

The proposed health policy change can be affected by the following contextual factors (Leichter 1979):

Situational factors:

This includes the increasing wide spread public awareness and burden caused by RTA in the country as stated above.

Cultural factors:

There are about 250 ethnic groups (Hausa, Igbo, Yoruba been the major ethnic groups) in Nigeria. The major religions are Christianity, Islamism, traditional beliefs. These major religious and ethnic groups are the most politically influential and most populous in the country (CIA 2009). Most people believe that road accident is spiritual and is caused by evil spirits (Sarma 2007). Hence the religious leaders, traditional/ethnic group leaders will play an important role in convincing their followers and improving ownership for community support and policy implementation success.

International factors:

Road safety issues have increased in momentum on the global agenda (termed the decade of action) with an ambitious target to reduce road fatalities by year 2020. It is supported by international bodies such as WHO, WB, DFID, FIA foundation and other UN organisation (Commission for global road safety 2009). These bodies will thus have an impact on the formulation of policies, funding, dialogue, planning, and advocacy guidelines for any country embarking on a road safety policy initiative.

Structural Factors:

(a) Political system: Nigeria is a democratic federation with levels of authority expressed at the federal, state and local government areas.

  • There are 36 states and the federal capital territory, 774 LGAs further divided into 9555 wards (the lowest political unit in the country).
  • There are 3 arms of government, the Executive arm, Judiciary and the Legislature at the federal and state levels.
  • The legislative arm comprises of the upper house (the senate) and the lower house (the House of Representatives) elected from the state senatorial districts and the constituencies respectively.
  • Each state has an elected governor, the house of assembly, an executive council with powers to make laws.
  • Each local government area has an elected executive chairman and an elected legislative council of members from electoral wards.
  • The state government has substantial autonomy and control over the allocation and utilization of their resources (WHO 2009b).

The Federal Road Safety Commission:

This is the lead agency that regulates, enforces and coordinates all road safety management activities at both the national, state and LGA level through their special marshals (Volunteer arm) and regular marshals (Uniformed). They play a major role in determining and enforcing speed limits for various types of roads and vehicles (FRSC 2010). They receive assistance from the police, civil defence corps, NGO’S etc.

(b) Civil societies, NGOs form e.g. RAPSON, APRI, SAVAN, and interest groups are key actors in public policy making and can participate at the committee stages of how a bill becomes a law.

(c)Socio economic situation: Nigeria is classified as a low income group country with a gross national income per capital of $930 (WHO 2009a).This can affect getting the road safety policy on the agenda among many other competing health issues.

To the ease the policy issue from the agenda setting to implementation and evaluation, a stakeholder analysis is very important.

STAKEHOLDER ANALYSIS:

It helps to key Actors; assess their interest, power, alliance, position and importance in relation to the policy. It will help to identify and act to prevent misunderstanding and opposition to the policy (Schmeer 2000).

AGENDA SETTING:

This step involves getting the issue onto the policy agenda from among other issues that can potentially be of interest to policy makers (Buse et al 2005).

Kingdon (1984) proposed that policies get on the agenda through 3 independent streams (problem, politics and policy stream) which converge at a point called the policy window. This is the point a policy change is most likely to occur.

Mobilising the Media:

McCombs and Shaw (1972) first developed the agenda setting theory, showing a strong correlation between media agenda and the public agenda on US presidential campaigns in 1968, 1972 and 1976.

The media, been successful in telling the public what to think about (University of Twente 2004), will be mobilised to influence the public’s opinion and consequently the government through TV and radio programmes/ News, News papers and articles from professional bodies with emphasis on the magnitude and possible solution to reducing the mortality from road traffic accidents. Restriction can also be made to misleading adverts which will encourage speed.

Personal experience of RTC (direct or indirect) could be a more powerful teacher than the media (University of Twente 2004) but both will complement each other in improving the public agenda and subsequently the policy agenda.

POLICY FORMULATION AND ADOPTION:

This involves the steps taken after the issue is placed on the agenda up till when it is implemented. This part of the process strongly lies in the domain of the legislators which determines how a bill becomes law and is implemented as shown below:

Formulation Strategies:

To keep the issue on the agenda through this stage, there is need for:

  • Continuous campaigns and Advocacy: Grassroots lobbying (mobilizing the public to contact legislators or other policy makers about the problem) and Direct Lobbying (Phone calls, writing of letters, face to face interactions),
  • Mass Support by attending committee meetings,
  • Informing international stakeholders that the issue is on the agenda,
  • Bargaining for supporters from the legislators to improve Alliance.

POLICY IMPLEMENTATION:

This involves the process by which a policy is turned into practice (Buse et al 2005). The bottom -up approach (Lipsky 1980) will be a very good approach for the implementation such that there is flow of information from the implementers to the policy makers. However, attempt will be made to include the top-down approach in order to minimise deviation from the intended policy outcome.

The implementation process would require time and resources and should be a gradual process. It would be worthwhile having a pilot project in an area identified by researchers to have a high mortality from RTA before implementation at a National level.

Initial rapid needs assessment:

The road safety system would be assessed to find out what is needed. The team should include; the police, road safety commission, researchers, health economist, NGO’s, the NURTW, Volunteers, medical teams, Health policy analyst, the media, ministry of transport, support from developmental partners, community/religious leaders and involving the government at all levels.

The assessment will provide scientific, managerial and technological functions of the policy from planning to evaluation. On identification of the specific needs, the implementation work plan will be drawn.

Community/religious leaders will play a key role in advocating within their communities/religious groups in convincing their followers that RTC can be prevented and is not spiritual.

Implementation schedule:

  • Legislation to specify speed limits applicable to different types of roads.
  • Identifying strategic check points which should be areas identified to have a relatively high RTC resulting from high speed.
  • Random positioning of the team to monitor vehicle speed with the mobile speed cameras
  • Fines to be paid by violators will be fixed and revenue generated be used for maintain and purchase of speed cameras.
  • License suspension of violators who violates the law over a specific number of times as will be stated.
  • The use of publicity to inform the public on the new law, its benefits and penalties.

EVALUATION AND FEEDBACK:

Buse et al (2005 p) defines evaluation as “research designed specifically to assess the operation and or impact of a programme or policy in order to determine whether the programme or policy is worth pursuing further”

The engineering model suggests that ideally there should be a direct relationship between research findings and policy decisions but however this is completely not applicable as there tends to be gaps between the two communities. Advocacy coalition is needed to reduce this gap and should include improving the knowledge of policy makers by providing a range of different research reports via the media, conferences and seminars, ensuring that major policies have evaluations built into their budgets and implementation plans and establish intermediate institutions to review research and determine its policy implications e.g. NICE in England and Wales (Buse et al 2005).

The evaluation process will involve the use of the formative evaluation (qualitative-observations, semi-structured interviews, focus groups, progress reports) at the early stage to provide advice to policy makers. It may then be used to modify and develop the program.

It will also involve the use of a summative evaluation (quantitative- morbidity and mortality rates) which measures outcome and the extent to which the programme has met its objectives.

Evaluation of the performance: Speed limit enforcement will also be done at the micro, meso and macro levels.

The micro level will include accessing performance of the teams at the district levels, the effectiveness of the enforcement protocols used, the level of corruption and any implementation gaps.

The meso level will include accessing performance at the organisation level which will include the time taken to attend to offenders when referred to the road safety centres, and their role assisting and supervising the team at the district level.

The macro level: this involves accessing financing of the programme and its function at the national or international level.

CONCLUSION:

The policy process is a cyclical process occurring in the environment of a changing political context. There is thus the need for continuous advocacy coalition networking, monitoring and evaluation at all times. However, other causes of RTC such as bad roads, drinking and driving which are not fully implemented in the country should not be neglected as future plans should be made to further reduce the burden of RTC to the barest minimum.

The implementation of the mobile speed cameras and speed limit enforcement will help reduce RTC mortalities and disabilities, improve research and also quality of life thereby unlocking growth and freeing resources for use on other health concerns with the view of achieving the MDGs.

References:

Aeron-Thomas, A., Jacobs, G.D., Sexton, B. 2004. The involvement and impact of road crashes on the poor : Bangladesh and India case studies [Online]. Available at: www.grsproadsafety.org/…/The%20Poor_final%20final%20report.pdf. [Accessed: 9 March 2010].

Buse, K., Mays, N. and Walt, G. 2005. Making health policy. Maidenhead: Open University Press.

Central Intelligence Agency (CIA). 2009. The world fact book- Nigeria [Online]. Available at: http://www.cia.gov/library/publication/the -world-factbook/print/ni.html. [Accessed: 23 February 2010].

Commission for global road safety. 2009. A decade for action for road safety: a brief planning document [Online]. Available at: www.makeroadssafe.org/publications/…/doa_booklet_v2.pdf. [Accessed: 24 February 2010].

Department for International Development. 2003. Guildlines for estimating the cost of road traffic crashes in developing countries [online]. Available at: www.transport-links.org/transport_links/filearea/…/1_807_R%207780.PDF. [Accessed: 9 May 2010].

Devon and Cornwall Police. 2009. Road collision unit: definition of road traffic collision [Online]. Available at: http://www.devon-cornwall.police.uk/Traffic/CollisionUnit/Pages/default.aspx. [Accessed: 22 March 2010].

Donabedian A. 1978.The quality of medical care. Science(200), p.856-164.

Federal Road safety corps. 2010. Vision, mission and statement [Online]. Available at http://www.frsc.gov.ng/vision.php. [Accessed: 22 March 2010].

Finch, D. J., Kompfer, P., Lockwood, C. R, et al. (1994). Speed, speed limits and accidents, TRL Project Report 58, TRL, Crowthorne.

Jagaba, A. 2009. How a bill becomes law: an example of ICPC act [Online]. Available at: www.snsn.com.ng/…/50-how-a-bill-becomes-law–an-example-of-icpc-act-. [Accessed: 11 March 2010].

Lipsky, M. 1980. Street level bureaucracy: dilemmas of the individual in public services. New York: Russell Sage Foundation.

McCombs, M., and Shaw, D. 1972. The agenda-setting function of the mass media. Public Opinion Quarterly (36), p 176-185.

Nigeria Watch. 2007. First annual report on public violence 2006-2007. France: Institut de recherche pour le développement).

Oxford University Press. 2010. English language teaching: bill [Online]. Available at: http://www.oup.com/oald-bin/web_getald7index1a.pl. [Accessed: 10 March 2010].

Policy and Nutrition. 2010. Obesity [Online]. Available at: http://courses.washington.edu/nutr531/lectures/Policy07.ppt. [Accessed: 10 March 2010].

Rosaler, M. 2005. Measles. New York: The Rosen Publishing Group.

Sarma, A.B. 2007. Beliefs and Character: Theology and Ethics of Road Safety in Nigeria [Online]. Available at: www.tcnn.org/index_files/sarma.html. [Accessed: 11 March 2010].

Savan demographic map www.savan.org/diary_big.html.

Schmeer, K. 2000. Stakeholder analysis guidelines: section 2 of policy toolkit for strengthening health reform. Partners for Health reform. Washington DC

World Health Organisation. 2008. The global burden of disease: 2004 update [Online]. Available at: www.who.int/…/global_burden_disease/GBD_report_2004update_full.pdf. [Accessed: 8 March 2010].

World Health Organisation. 2009. Global report on road safety: time for action [Online]. Available at: http://whqlibdoc.who.int/publications/2009/9789241563840_eng.pdf. [Accessed: 7 march 2010].

World Health Organization. 2009. WHO country cooperation strategy 2008-2013, Nigeria [Online]. Available at: www.afro.who.int/…/3340-country-cooperation-strategy-nigeria-2008-2013.html. [Accessed: 12 February 2010].

World Bank. 2010. World development indicators: population, Nigeria [Online]. Available at: www.google.com/publicdata. [Accessed: 10 March 2010].

Zaal, D. 1994. Traffic Law enforcement: a review of the literature [Online]. Available at: http://www.monash.edu.au › MUARC › Reports and brochures. [Accessed: 11 March 2010].

Vaping Prevention in Teens

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Introduction

E-cigarettes, also known as vaping products, are battery-operated devices that mimic the smoking experience using an inhalation process that vaporizes fluid within the device.  Research on e-cigarette use primarily among adolescents is just emerging. Studies in several countries including the USA, Poland, and Korea are showing a dramatic increase in interest and use of e-cigarettes by adolescents (Lee et al., 2014, Dautzenburg et al., 2013, Cory et al., 2012).  Among US high school students, from 2011 to 2014 a nine-fold increase in e‐cig use (1.5–13.4%) was reported, with a similar increase observed in middle school students, and e‐cigs emerged as the most common method for using ‘tobacco’ in both age groups (Arrazola, et al., 2015).  Additionally, over 7,700 fruit and candy flavorings of e-cigarette liquids are the number one reason that they appeal to adolescents (Ambrose et al., 2014). More than 460 brands of e‐cigs are available worldwide, and an estimated 6 billion dollars were spent on e‐cigs globally in 2014 (Euromonitor International, 2015).  These numbers are expected to rise as awareness and popularity of e-cigarettes increase and as big tobacco companies, such as Imperial Tobacco, Lorillard, and R.J. Reynolds, focus on increasing their share of the e-cigarette market (Richtel).  As with tobacco products, e-cigarettes may mitigate deterrence from the initial harsh sensations that nicotine induces until dependence develops and fosters ongoing use (Ambrose et al., 2014).

There is substantial international variation in regulatory policies and the extent to which these are enforced. E-cigarettes containing nicotine are now legal in Canada since the passage of Bill S-5 in May 2018. This legislation legalized e-cigarettes with nicotine for adults in Canada and established a regulatory framework that included marketing restrictions and safety standards.  However, regulations in Canada, Australia, and New Zealand are easily bypassed through Internet imports and lenient enforcement.  E-cigarettes with and without nicotine are widely available for sale and are becoming increasingly prominent in various types of retail stores (Non-Smokers Rights Association, 2007).   Erythropel HC., et al discovered in their study that some cigarette labels listing chemical content were inaccurate and therefore stressed the importance of accurate labels and warnings about the effect of mixing e-cigarette solvents. They also noted that individual ingredients are been combined to form more complex chemicals that are not disclosed to the user. When inhaled, these compounds will persist in the body causing mild irritations that could cause inflammatory responses.

In a study examining the popularity of e-cigarettes in Canada and other countries, its prevalence increased dramatically, surpassing that of nicotine replacement therapy by late 2008 (Ayers et al., 2011).  According to Khoury and colleagues, 10% of the adolescents in their study were motivated to try e-cigarettes because of their novelty or the image ( “coolness”) that it portrays, and rarely did they use e-cigarettes to quit smoking (Khoury et al., 2016). This study also confirmed that most adolescents were not substituting e-cigarettes for cigarettes: instead, the odds of e-cigarette use were 12-fold higher in youth who also smoked cigarettes (i.e., “dual users”).  Recent reviews have found little or no evidence to support the use of e-cigarettes as a smoking reduction and cessation device. Expert opinion is also divided as to the value of this product for smoking cessation. Public health experts warn of the potential for e-cigarettes to normalize smoking as their use becomes more frequent.

Cannabis vaping has received limited study but also appears to be on the rise among adolescents and young adults (Jones et al., 2016, Morean et al., 2015). Among e-cigarette users, cannabis vaping occurs more often in populations of high school-aged youth than adults (Morean et al., 2015). Recent data suggest that adolescents who vape cannabis most often use highly potent cannabis oil, wax, or liquid preparations (Morean et al., 2015).  Scientific research over the last two decades has established that the human brain continues to develop into a person’s early 20s. The concern is rising that exposure to cannabis during this important developmental period causes greater adverse effects in adolescents compared with older adults, whose brains are fully developed (Giedd et al., 1999, Lenroot & Giedd, 2006 ).  Cannabis exposure during adolescence, a critical period for brain development, can cause addiction, might harm brain development and could lead to sustained cannabis product use among youths. To date, however, few data exist on the use of vaping devices for cannabis consumption among youth despite these potential risks.  Comprehensive and sustained strategies are warranted to prevent and reduce the use of all cannabis products among Canadian youths.


References

  • Lee S, Grana RA, Glantz SA. Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual-use, and relationship to quit attempts and former smoking. J Adolesc Health. 2014;54(6):684-90 DOI:10.1016/j.jadohealth.2013.11.003.
  • Dautzenberg B, Birkui P, Noel M, Dorsett J, Osman M, Dautzenberg M. E-cigarette: a new tobacco product for schoolchildren in Paris. Open J Resp Dis. 2013;3:21–4.
  • doi: 10.4236/ojrd.2013.31004.
  • Corey C, Wang B, Johnson S, Apelberg B, Husten C, King B, et al. Notes from the field: electronic cigarette use among middle and high school students – the United States, 2011-2012. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm. Published September 6, 2013. Accessed January 20, 2017.
  • Ambrose BK, Day HR, Rostron B, et al. Flavored tobacco product use among US youth aged 12–17 years, 2013–2014. JAMA. 2015;314:1871-3. DOI: 10.1001/jama.2015.13802.
  • Health Canada advises Canadians not to use electronic cigarettes, 2009. Health Canada. http://www.hc-sc.gc.ca/ahc-asc/media/ advisories-avis/_2009/2009_53-eng.php. Published on April 28, 2008. Accessed February 01, 2017.
  • Euromonitor International. Vapour Devices and E-cigarettes in the Global Tobacco Market. 2015 [cited 2018 Sep 28]. Available from: http://blog. euromonitor.com/2015/06/ vapor-devices-and-e-cigarettes-in-the-globaltobacco-market.html
  • The Buzz on E-Cigarettes, 2012. Non-Smokers’ Rights Association.
  • http://www.nsra-adnf.ca/cms/file/files/e-cig%20Brochure%20FINAL.pdf. Published November 2007. Accessed February 01, 2017.
  • Ayers JW, Ribisl KM, Brownstein JS. Tracking the rise in popularity of electronic nicotine delivery systems (electronic cigarettes) using search query surveillance. Am J Prev Med. 2011;40(4):448-53. DOI: 10.1016/j.amepre.2010.12.007.
  • Khoury M, Manlhiot C, Fan CPS, et al. Reported electronic cigarette use among adolescents in the Niagara region of Ontario. CMAJ. 2016 July 18. DOI: 10.1503/cmaj.151169.
  • Azagba, S. (2018) E-cigarette use, dual use of e-cigarettes and tobacco cigarettes, and frequency of cannabis use among high school students. Addictive Behaviors. Volume 79, April 2018, Pages 166-170
  • Arrazola R. A., Singh T., Corey C. G., Husten C. G., Neff L. J., Apelberg B. J., et al. Tobacco use among middle and high school students—the United States, 2011–2014. Morb Mortal Wkly Rep 2015; 64: 381– 5.
  • Chemical Reaction in flavored e-cigarettes may irritate lungs Erythropel HC, et al. Nicotine Tob Res. Oct. 18, 2018, http://bit.ly/2RqGyvZ.
  • 11. Giedd JN., Blumenthal J., Jeffries NO., et al. Brain development during childhood and adolescence: A longitudinal MRI study. Nat Neurosci 1999;2(10):861–3.
  • 12. Lenroot RK., Giedd JN. Brain development in children and adolescents: Insights from anatomical magnetic resonance imaging. Neurosci Biobehav Rev 2006;30(6):718–29.
  • M.E. Morean, G. Kong, D.R. Camenga, D.A. Cavallo, S. Krishnan-SarinHigh school students’ use of electronic cigarettes to vaporize cannabis
  • Pediatrics, 136 (2015), pp. 611-616
  • C.B. Jones, M.L. Hill, D.A. Pardini, M.H. MeierPrevalence and correlates of vaping cannabis in a sample of young adults
  • Psychol. Addict. Behav., 30 (2016), pp. 915-921

Four Paragraphs- Answers (5-7 Sentences Each).

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Watch the film, Sorry to Bother You, by Boots Riley. It is available on Hulu. If you do not have Hulu, you can rent it on Amazon for a small fee. *** If you are using google chrome, Hulu only works on Incognito mode because Hulu’s coding is inefficient*** Open a new window in Incognito Mode and login to Hulu *** This message is only for those who use google chrome as their primary browser. ***

The film, Sorry to Bother You, by Boots Riley, is what is known as an allegory. An allegory tells a story using a series of symbols. Ultimately, each symbol and the plot’s movement leads to the metaphorical meaning/figurative meaning of the film as a whole. This wild film is essentially created from building blocks- each inspired by American History, current societal issues and phenomena, and how the United States’ History impacts current society societal issues. Excuse me for using a cliche, but nothing happens inside a vacuum. Even the setting is symbolic and important in this film, so pay close attention(For instance, the film’s setting is Oakland, California, in a non-specified time period. There is significant African American history in this city, and the city has since been gentrified).

Under the section entitled Nonfiction Readings(which includes documentaries), write about how these historical/present societal issues are alluded to/confronted in the film? Pick two-three significant historical/current allusions to write about, and how they are portrayed in the film. 

Additionally, while some sources are available on this BlackBoard under Nonfiction readings, feel free to use other themes/events the film alludes to. There may be key aspects you are interested in that I have not listed. Feel free to choose them and expand on them. For instance, social media plays a key role in this film. You may find articles about social media to answer the question:

How does social media(insert chosen subject matter) contribute to the plot’s progression? What is the Director/Screenplay Writer, Boots Riley saying about social media (or other chosen subject matter) and its use in regards to the film and crucial theme in the film’s plot progression? of the plot’s progression. What is the ultimate message(s) of the film?

Cite the source using in-text citations. At the bottom of your response, order the links/books which aided your response to the question.

Requirements:
Four Paragraphs- Answers (5 sentences each).

Two Paragraphs: Respond to a classmate’s post(5 sentences each). You can or inquire/expand on something your classmate has written. You can also argue against it. Please help keep this space civil/informative. This is essentially the BlackBoard equivalent of–our class, sitting with our desks arranged in a circle, discussing the film, discussing the symbols and references. 

Paragraph to answer :

Sorry to bother you is an excellent allusion to the fight of radical movements, including the communists that were made at the beginning of the last century, for racial and workers civil rights (Drier). Workers in a telemarketing company decide to confront their bosses. They demonstrate their importance, neglecting the telephone and therefore stopping working. This method was commonly used by unions to rebel and ask for better working conditions and wages. What started as a company-specific thing evolves into a social movement involving people outside the company.

 A new form of work created by a corporation in which people do not receive wages and live all the time in the workplace with guaranteed meals is one of the main topics of the movie. Marketing is used as a tool to mask the reality behind this concept by showing happy families. The government’s consent for this type of practice to continue legally, not declaring it as slavery. Using science and genetics to turn workers into half horses by making them more productive, without caring about anyone. The perception and work environment of Worry-Free is somewhat similar to the Silicon Valley villas that have large companies like Google (Kulwin), although in a different setting and with far fewer resources

The main character who evolved from the lowest of the company to the so-called Power Callers who have different working conditions, social recognition and are almost a myth. All the above reminds us of the so-called American dream where a person can go from poverty to success. The key to success is associated with the white voice, in which there is no concern Curiously, the protagonist evolves his thinking, at first, he feels ready to fight for the rights of the masses and then ignores them and even asks them to “honestly” seek life. Parties, drugs, and prostitution in the upper class without any repression. The attempt to be used by his boss to become the head of the workers and to be able to control it secretly as a mode of domination

 Another element that stands out is like a YouTube video in which he is hit on the head with a can of coke, making him almost a celebrity. A popularity that he later used to make complaints and influence the audience. An inept program in which people are humiliated on television for the enjoyment of others. The protagonist’s partner is an artist who uses her art to make complaints but whom he reproaches for working for the wealthy. Despite the terrible idea behind the film, it makes the audience laugh and invites them to reflect

Work Cited

Peter Dreier. The Fifty Most Influential Progressives of the Twentieth Century. 2020

https://www.thenation.com/article/archive/fifty-most-influential-progressives-twentieth-century/

Noah Kulwin. Googlers living at Google: Tiny spaces, probably no sex. 2015

https://www.cnbc.com/2015/10/21/googlers-living-at-google-tiny-spaces-probably-no-sex.html

Fin 2030 the scenario is designed to help you determine

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The scenario is designed to help you determine and evaluate the payment amount of a car loan and a mortgage, based on the assumption that your household income is $36,000 per year or $3,000 per month. Based on your income, you may spend 28% of your monthly income on housing, and 10% on a car loan. You are to put a 3% down payment on the house and a 10% down payment on the car. Required:Using Microsoft Excel, address the following issues:1. What is the maximum car payment and mortgage payment you can afford with the following conditions: your monthly household income, 10% for the car payment, and 28% for the mortgage payments? 2. Assume a 10% down payment on the car and a 3% down payment on the house. Also, assume that you can get financing for the car at 7% for 60 months, and the house can be financed at 5% for 30 years. How much could you spend on the car and the house? You must submit your calculations in a Microsoft Excel document showing how answers were reached. 3. Create a complete amortization schedule for the car, using the information in questions 1 and 2.  4. Discuss the distributions of principal, interest and the balance over the life of the loan.

Analyze two examples of how lobbyists affect healthcare legislation.

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Analyze two examples of how lobbyists affect healthcare legislation.

Analyze two examples of how lobbyists affect healthcare legislation.

Part I: Lobbyists have been part of the U.S. Government system since the early 1800s. Lobbyists play an important role in healthcare, as they are advocates for their interest group. In a 4-5 page paper, analyze two examples of how lobbyists affect healthcare legislation. Conclude your paper with your opinion about whether the actions of lobbyists have a positive or negative effect on healthcare legislation in the United States. Please keep in mind the position and facility you selected. Make sure to include the following:

Discuss the specific interest of the lobbyist in each example.
Discuss in detail some of the ethical issues and moral disputes for each example.
Discuss your position on whether the lobbyists’ actions are positive or negative on healthcare legislation in the United States and support your points with details.
This portion of your assignment will require you to research and examine information from various sources. Use a minimum of five credible sources for your paper, with three being an academic source from the Rasmussen College Online Library (don’t forget to include in-text citations throughout your paper with paraphrasing or quoting)
Make sure to include your APA formatted reference page.
Part II: An agenda can set the tone for a meeting. It’s an important tool to ensure meetings are staying on track and meeting all of the objectives. Create a detailed meeting agenda for a meeting you will hold with your supervisor and fellow department heads discussing your findings (Hint: Microsoft Word has many agenda templates). SkillSurfer in the online tutoring platform offers beginner, intermediate, and advanced tutorials on Microsoft Office products. Make sure to include the following in our agenda:

Explain each example
The majority of the agenda should be focused on whether the actions of lobbyists have a positive or negative effect on healthcare legislation in the United States.
Make sure to use audience specific language and tone in your agenda. Remember, your supervisor and other department heads will be in attendance. Also, make sure to follow proper agenda/business formatting guidelines and make sure document is professional in appearance

Implicit association test on biases

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Reflect on possible personal biases you may have coming from the Implicit Association Test that is being uploaded On Weight, Race, Sexuality, Arab-Muslim, Asian, and disability. You should simply write a 300 word reflection focusing on these questions:

How did the IAT inform your understanding of hidden bias?

To what extent were you surprised or not by your results?

How does understanding your own Implicit bias better equip you for respectful engagement with diverse populations?

What are some ways you can overcome your possible personal biases in the classroom?

Briefly outline how you could use financial data and emotional appeals to demonstrate the benefits of this purchase.

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Briefly outline how you could use financial data and emotional appeals to demonstrate the benefits of this purchase.

Post an analysis of why it is important for nurse managers to understand principles of capital budgeting. Describe a costly new piece of equipment you would like your organization (or one with which you are familiar) to purchase. Explain strategies for demonstrating the need for this equipment to decision makers. Briefly outline how you could use financial data and emotional appeals to demonstrate the benefits of this purchase.

Assignment: Case Study DNA

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ORDER NOW FOR AN ORIGINAL PLAGIARISM-FREE PAPER:  Assignment: Case Study DNA

Assignment: Case Study DNA

Tube Sample Lane

1 1 kb DNA ladder 1

2 Mother’s DNA 2

3 Child’s DNA 3

4 A.F. #1 DNA 4

5 A.F. #2 DNA 5

Record the distance each ladder band moved from the well in mm along with the size of the DNA fragments in that band in bp units, based on the bp given in step 19 , in your Lab Notes.

Lane 1:

1,000 bp 34 mm

900 bp 36 mm

800 bp 38 mm

700 bp 40 mm

600 bp 43 mm

500 bp 47 mm

400 bp 51 mm

300 bp 56 mm

250 bp 60 mm

200 bp 64 mm

150 bp 69 mm

100 bp 77 mm

50 bp 90 mm

Lane 2:

37 mm 850bp

59 mm 265bp

Lane 3:

37 mm 850bp

44 mm 575bp

Lane 4:

41 mm 670bp

43 mm 600bp

Lane 5:

44 mm 575bp

55 mm 320bp

Experiment: Agarose Gel Electrophoresis of DNA Fragments

Lab Results

List the distances traveled in mm for the bands in the DNA ladder in the table below.

Remember, smaller fragments travel farther than longer ones, so the top-most band will be the 1,000 bp sized DNA fragments whereas the bottom-most band will be the 50 bp sized DNA fragments. DNA Ladder

Band

Distance (mm)

50 bp

90 mm

100 bp

77 mm

150 bp

69 mm

200 bp

64 mm

250 bp

60 mm

300 bp

56 mm

400 bp

51 mm

500 bp

47 mm

600 bp

43 mm

700 bp

40 mm

800 bp

38 mm

900 bp

36 mm

1,000 bp

34 mm

Whose sample had the approximately 570 bp and 320 bp sized DNA fragments?

A.F. #2

What were the sizes of the DNA fragments for alleged father #1?

41 mm 670bp

43 mm 600bp

Data Analysis

Which size DNA fragment did the child inherit from her mother?

37 mm 850bp

Which alleged father, if any, can be definitively ruled out as the child’s biological father?

A.F. #2

Conclusions

How are new molecules of DNA synthesized in living cells?

What is the function of DNA?

DNA has genetic information that controls our cells. So, DNA is like a blueprint that shows how to construct components of cells like proteins and ribonucleic acid (RNA). This information is carried down to newer generations through inheritance.

If each individual has such a small amount of DNA in their cells, how do the bands on the gel contain enough DNA to be visible?

In order to make DNA visible. The Gel has to be soaked in a dye (ethidium bromide) to bind with the DNA and rinsed off after. Ethidium bromide helps to make DNA visible by glowing brightly in UV rays.

Humans only have a few eye colors and only four ABO-based blood types. How can DNA tests definitively identify individuals when many people have brown eyes or type A blood?

Suppose a suspicious hair was found in a victim’s home. A gel is set up with the DNA fragments of two suspected criminals in lanes 4 and 5, the DNA fragments of the suspicious hair in lane 3, and the victim’s DNA fragments, as a negative control, are in lane 2. A DNA ladder is in lane 1. The resulting gel is below. Which suspect, if any, committed the crime? Explain your answer.

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Analyzes the main stages in an organization?s buying process used to determine adequate inventory

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Analyzes the main stages in an organization?s buying process used to determine adequate inventory

 

HEALTH CARE FACILITY BUYING DECISION PROCESS Health and Nursing Research Paper

HEALTH CARE FACILITY BUYING DECISION PROCESS Analyze the main stages in an organization?s buying process used to determine adequate inventory and purchase. 50% ? Analyzes the main stages in an organization?s buying process used to determine adequate inventory and purchase and recommends and discusses the most important stages. Identify internal sources of quantitative information used in the buying process. 50% ? Analyzes internal sources of quantitative information used in the buying processHEALTH CARE FACILITY BUYING DECISION PROCESS Analyze the main stages in an organization?s buying process used to determine adequate inventory and purchase. 50% ? Analyzes the main stages in an organization?s buying process used to determine adequate inventory and purchase and recommends and discusses the most important stages. Identify internal sources of quantitative information used in the buying process. 50% ? Analyzes internal sources of quantitative information used in the buying process