Access to Medicines in Developing Countries Essay Example for Free

Access to Medicines in Developing Countries Essay One of the appalling statistics that came out of a survey in 2000 was the percentage of the HIV/AIDS infections in Africa. It was reported that nearly 80% of the total number of affected people was from this continent. Now if this report sounds dreadful, one might get a bigger shock by looking at the picture of modern healthcare methodologies in Africa. Despite being a developing nation, Africa gets scarcely one percent of modern drugs. The value of all medical drugs transported to Africa amounts to the expenses spent on advertising by the leading pharmaceutical companies in the United States of America. Under the light of this reality, this paper is going to discuss the genuine scenario in developing countries that don’t have an affordable access to life-saving medicines. It might be noted that access to medicines is a fundamental human right, and there is a yawning gap between crisis and cure in a capitalistic social setup. Due to increased political pressure, many drug manufacturing companies have been forced to review their business strategies and produce medicines that are relatively less expensive. Moreover, it is also mandatory to formulate a well-organized delivery system that would ensure a proper and timely delivery of the medicinal goods to Africa and other Third World countries. Modern healthcare remedies are needed to be deployed in order to combat the menace of HIV and other diseases in the underprivileged tropics. (â€Å"Access to Medicine in Developing Countries†, 2000) Access to medicine in developing countries has always been a matter of great disputation, mainly because of the convoluted interaction between macroeconomic development, patterns of diseases and healthcare requirements and provisions. It has been an inescapable paradox for many countries where the national economic status can only be attained by improved health status. Hence, lack of supply of life-saving drugs hinders the scope and opportunity of national healthcare. (â€Å"Improving Access to Medicines in Developing Countries†, 2005) The impoverished countries find it a mammoth task to meet both ends successfully. It has been proposed that only a large scale international funding can inject some fruitful results in the context of healthcare and economic boost. The World Health Organization (WHO) and the World Trade Organization (WTO) are working together to provide the best possible framework for improved health status as well as the macroeconomic development of developing nations. WTO is primarily concerned with the organized growth of a capitalist, free market global economy. On the other hand, WHO is focused on improving health conditions by providing healthcare models that can be applied to both developed as well as developing nations. Institutional and public sector frameworks play a crucial role in realizing the objectives of WHO to the best possible extent. The newly incepted Global Health Fund is working relentlessly to provide remedies for HIV/AIDS, TB and Malaria. The Trade-Related Aspects of Intellectual Property Rights (TRIPS agreement) are held, in some cases, as obstacles for access to essential medicines in developing countries. Ever since WTO finalized the TRIPS agreement in April 1994, this issue has been a matter of great debate. The main problems in accessing medicines, as viewed by experts, are the increasing expenses, which can shoot up to 66% of total expenditure in developing nations. Today’s scenario as far as having access to essential medicines is concerned is an alarming one, with more than one-third of the world’s population are deprived of indispensable drugs. According to the WHO, developing countries, especially those in Asia and Africa, must be provided with an all-encompassing solution in terms of health priority problems, and they must be able to gain access to life-saving medicines at an affordable deal. To make matters worse, the poorer section of societies in developing countries find themselves all at sea due to their inability to physically access life-saving drugs. So both availability and affordability are the key areas of concern. Now under these circumstances, the introduction of strong and worldwide product patents for drugs, as implemented through the TRIPS agreement, may cause drastic increase in prices for essential medicines. The ‘legal monopoly’ that comes with such rigid patent system prevents anybody from producing, selling or distributing medicines in an unauthorized manner. Even if there is no patent laws, access to medicines is going to be a problem for the developing countries, due to adequate purchasing capabilities and required infrastructure. Majority of the medicines for HIV/AIDS are still under ‘live’ patent coverage. It doesn’t make for affordable access to such medicines either. And since more than 95% of HIV/AIDS affected people are from developing countries, and 50% of them belong to the productive age group of below 25 years, serious socio-economic consequences are perceived with very little signs of relief. Before TRIPS were put to effect, most developing countries and some developed countries did not impose patent laws on medicines even if they were manufactured with innovative technological aids. But today, most of these nations being WTO members have to enforce the patent laws laid down by TRIPS. This has led to hike in prices of patented medicines. It is worth noticing that even under the TRIPS guidelines, patents are to be given only on applications received from 1995 onwards for new therapeutic inventions. So any medicine manufactured before 1995 should not be unaffordable for the developing nations. Manufacturers of the newer and more innovative pharmaceutical products file for patents only in countries where business of piracy runs rampant. Parallel import of drugs is another important issue that came into consideration after the TRIPS agreement. The Intellectual Property Rights owners of specific brands of medicines face problems when goods, legally distributed in the market of one country, are imported to another without the necessary legal authorization. Now, as long as there is no discrepancy in Intellectual Property Rights in two different countries, article 6 of TRIPS defends parallel import. But considering the economic side of such imports, it might be noted that price of the same medicine in one country may rise or fall to a great extent in another. So developing countries, without violating the Intellectual Property Rights protection, may find a way out to access essential but expensive drugs from its neighboring countries. (Watal, J. 2000) In addition to what is discussed above, one must bear in mind the supply side process concerning manufacture and distribution of medicines. The specific issue related to accessibility to medicines is directly linked with the development and implementation of more efficient and cost-effective measures in manufacturing and distributing drugs. A number of speculative theories and ideologies have been put forward to address the issue of maximizing the available resources to achieve a standardized health status around the globe. However, the aim of this paper is not to get into a particular ideological standpoint, or to promote distinct solutions, but to gain a deeper insight into the real constraints of manufacturing and distributive activities. One has to take into account the diverse theoretical concepts, the macroeconomic environment of international economics and technological nuances of the pharmaceutical sectors. Once we identify the constraints, it will be easier to suggest feasible solutions in terms of easy and regular access to medicines for the developing countries. The policies adopted by pharmaceutical companies are worth taking a look at.

Analysing The Use Of Electroconvulsive Therapy In Prisons Psychology Essay

Analysing The Use Of Electroconvulsive Therapy In Prisons Psychology Essay An inmate with depression may provide many difficulties into the penal system. Among other things depression may make an inmate more prone to violent as well as suicidal tendencies. In cases such as this it is important for an inmate to receive swift treatment as, in this state, they are a hazard to themselves as well as others. Electroconvulsive therapy is a treatment method that has been used to effectively treat individuals with severe depression for many years. It has been found to treat the illness faster and more effectively than many other depression treatment options. This manuscript briefly discusses depression within the penal system as well as goes into detail about electroconvulsive therapy and how it is effectively employed to assist those suffering from severe depression. An inmate within the penal system suffering from a mental illness presents unique challenges to the staff as well as fellow inmates within these facilities. Statistics indicate that inmates suffering from a mental illness are more prone to disciplinary problems within the correctional system and are also more prone to recidivism after release (James Glaze, 2006). One may surmise that, as the severity of the illness increases, the identified risks increase accordingly. This makes it extremely important for the staff of the facility to treat the illness in the quickest and most effective way possible. The standard first-line treatment for most mental disorders involves pharmacological or psychotherapeutic treatments or a combination of both (Potter, Rudorfer, Manji, 1991). In some cases pharmacological and psychotherapeutic methods take too much time or the inmate may not be able to tolerate the medications. In cases such as this, there are other methods which may be utilized in orde r to treat the inmates mental illness. This manuscript will focus upon the mental illness of depression while briefly discussing the effects it introduces into the penal system. It will also identify and discuss the method of electroconvulsive therapy and how it may be a prudent method for treating severe cases of depression within inmate populations. Due to time constraints the issue of informed consent in permitting treatment is not discussed. Literature Review In order to compose a manuscript upon the subject of depression and electroconvulsive therapy, a solid definition was needed. Definitions were provided through the use of the Merriam-Webster Online dictionary for electroconvulsive therapy (Electroshock Therapy, 2010) and from WordWeb for depression (Depression, 2010). Additionally, the DSM-IV provided the symptoms which accompany a diagnosis of major depressive disorder (American Psychiatric Association, 2000) while the United Kingdom Advocacy Network (1995) provided a list of mental illnesses which ECT has been used to treat. James and Glaze (2006), through the Bureau of Justice Statistics, also provided statistics upon the mental illnesses and symptoms which are found within the penal system of the United States. It is upon this information that the manuscripts conclusions are partly based. The history of electroconvulsive therapy is discussed within the manuscript. Finger (2006) discussed how experiments upon the effects of electricity upon the brain can be traced back to Benjamin Franklin. Electroconvulsive therapy did not take its current form until 1938 when Cerletti and Bini started using electricity to treat those with mental illness (Endler, 1988). Weiner and Krystal (1994) discuss how the mainstream use of ECT declined greatly after the discovery of psychotherapeutic drugs in the 1950s and 1960s. Even though this is the case, Scott (2005) discusses how ECT is still the primary course of treatment for cases of severe depression. ECT has been proven to be an effective means through which depression is treated. Janicak, Davis, Gibbons, Ericksen, Chang, and Gallagher (1985) as well as Rudorfer, Henry, and Sackheim (1997) found that ECT performed better in controlled studies than any other form of treatment for depression. Other studies have shown that ECT also outperforms antidepressants in average effectiveness (Abrams, 1997) as well as the speed of its effects (Rudorfer, Henry, Sackheim, 1997). While the administration of ECT is an effective treatment of depression, it is not curative. Sackheim, Haskett, Mulsant, Thase, Mann, Pettinati, Greenberg, Crowe, Cooper, and Prudic (2001) found the relapse rate of ECT patients to be around 90% within the first six months after treatment. The chance of relapse can be lowered by either a continuation of treatment through the use of mood stabilizers and antidepressants (Sackeim, 1994) or through maintenance ECT treatments for approximately four to six weeks after the initial sessions (Rasmussen, 2003). Gagne, Furman, Carpenter, and Price (2000) found that the best results were produced through a combination of psychotherapeutic drugs and maintenance ECT sessions. Due to the controversial nature of ECT, the process of administration is briefly discussed within the manuscript. This was provided jointly by the Royal College of Psychiatrists (1995) as well as the Salford Community Health Council (1998). In this way, the facts about ECT may be better understood and controversial feelings about the treatment may be alleviated. As with any treatment, ECT produces certain side effects within the patients who choose to undergo this form of treatment. One such side effect includes memory and cognitive impairment. Scott (2005) discusses how this is a common side effect that is associated with ECT sessions. While this may be the case, Lisanby, Maddox, Prudic, Devanand, and Sackeim (2000) found that the memories that are lost are more likely to be of an impersonal nature rather than personal. It has been reported by Calev (1994) and Weiner (2000) that patients suffering from cognitive and memory losses improve substantially once the treatments are completed with few patients complaining of residual effects. Discussion Severe Depression in Inmate Populations Depression, as defined by WordNet, is a mental state characterized by a pessimistic sense of inadequacy and a despondent lack of activity (Depression, 2010). A survey conducted in 2006 by the Bureau of Justice Statistics on mental health problems of inmates within the penal system provides insight into the possible impact that depression may have upon those within the penal system. The survey found that within the 12 months prior to the conduction of the survey 23.9% within state prisons, 16.2% within federal prisons, and 30.4% within local prisons had experienced five or more symptoms indicative of major depressive disorder (James Glaze, 2006). Symptoms that are included within a diagnosis of major depressive disorder include thoughts of revenge, persistent anger or irritability, or whether the individual has ever attempted suicide among other symptoms (American Psychiatric Association, 2000). Symptoms such as these may cause an inmate to act out violently against fellow inmates or staff as well as forcing staff to place the inmate under a suicide watch. This requires the institution to spend precious resources which may be better utilized elsewhere within the compound. In cases such as this, it would be helpful for the institution to have a treatment option at their disposal which could treat the inmates suffering from these symptoms swiftly with few side effects allowing them to integrate into the penal system with as few difficulties as possible. Electroconvulsive Therapy Electroconvulsive therapy (ECT) is defined by Merriam-Webster Online as the treatment of mental disorder and especially depression by the application of electric current to the head of a usually anesthetized patient that induces unconsciousness and convulsive seizures in the brain (Electroshock Therapy, 2010). Early experimentation on the effects of electricity upon brain function may be traced back to Benjamin Franklin (Finger, 2006). ECT, as it is recognized today, was first used to treat mentally ill patients in 1938 by Cerletti and Bini (Endler, 1988) at which point it became a mainstream treatment. In the 1950s and the 1960s, psychotherapeutic drugs were discovered (Weiner Krystal, 1994) replacing ECT as the premiere treatment for certain forms of mental illness though its use continues to this day. ECT has been utilized to treat a large array of conditions including (United Kingdom Advocacy Network, 1995): Various neuropsychiatric conditions Mania Schizophrenia Post-natal depression Anxiety Hypomania Post-traumatic stress disorder Puerperal psychosis Currently, the only condition that ECT is the primary form of treatment for is that of severe depression (Scott, 2005). This is due to the fact of the severe symptoms caused by severe cases of depression such as extreme suicide attempts, suicidal thoughts, and refusal to eat. As is evidenced above, ECT has been proven time and time again through research and practice to be an effective means to treat several different psychological disorders. In fact, there have not been any controlled studies conducted where any other treatment has outperformed the effectiveness of ECT in the treatment of depression (Janicak, Davis, Gibbons, Ericksen, Chang, Gallagher, 1985; Rudorfer, Henry, Sackheim, 1997). It has been calculated that the average response rate of patients with major depression to ECT treatment is 70% to 90% compared to the response rate of antidepressant medications which are most commonly the primary treatment prescribed for depressive disorders which is 60% to 70% (Abrams, 1997). There has even been evidence presented showing that ECT produces the desired effects faster than that of antidepressants (Rudorfer, Henry, Sackheim, 1997). While the facts discussed above provide a strong argument for the use of ECT as a primary treatment for individuals suffering from severe depression, just as with antidepressants, it is not a curative treatment. Relapse in patients that have undergone ECT sessions have been found to be around 90% within six months after treatment (Sackheim, Haskett, Mulsant, Thase, Mann, Pettinati, Greenberg, Crowe, Cooper, Prudic, 2001). Therefore, in order to maintain the benefits of ECT sessions, it is necessary for a patient to receive future treatments within in the form of antidepressants and/or mood stabilizer medications (Sackeim, 1994) or weekly maintenance ECT sessions for approximately four to six weeks (Rasmussen, 2003). Gagne, Furman, Carpenter, and Price (2000) found that patients that received a continuation of a combination of the two treatment options were less likely to suffer from a relapse than those patients who received only antidepressant treatment. Therefore, if the patient i s administered the proper treatment options after the cessation of regular ECT sessions the patient should continue to reap the benefits that were provided during the initial sessions. Administration As one may presume, ECT is a precise treatment method which, if administered improperly, may inflict more damage to an individual rather than aiding in their recovery. Researchers continuously review data as well as run tests on the many different aspects of ECT and how each one affects the outcome of an individuals ECT session. This section briefly summarizes the procedure that is followed when administering ECT to an individual. During the administration of ECT the first thing that happens is an anesthesiologist administers a general anesthetic as well as a muscle relaxer. This causes the patient to fall asleep as well as causes all of the patients muscles to relax preventing the muscles from convulsing during the administration of the electrical shocks. As the anesthetic is administered the patient is also given oxygen which continues for the duration of the session. After the induction of sleep, a small electric current is passed through the brain of the patient through two small pads that are placed in specific regions on either both sides or the same side of the scalp causing mild convulsions within the brain. Once the procedure is over it may be necessary for the patient to undergo more sessions of ECT in order to receive the most positive effect possible from the treatments (Royal College of Psychiatrists, 1995; Salford Community Health Council 1998). Side Effects As with any form of treatment through which something is being administered to an individuals body, ECT does produce certain side effects. The side effects most concerning to individuals during the decision of whether or not to partake in ECT are that of memory and cognitive impairment. Individuals upon which ECT has been administered have been found to suffer from amnesia in respect to events that happen both before and after an ECT session (Scott, 2005). While this may be the case, research has shown that the event memories that are lost are more likely to be of an impersonal rather than personal nature (Lisanby, Maddox, Prudic, Devanand, Sackeim, 2000). However, it has been reported that after the completion of a course of ECT, the patients memory losses improve substantially with a few patients reporting residual difficulties (Calev, 1994; Weiner, 2000). Conclusion Severe depression may introduce many different problems into an inmate population such as violent as well as suicidal tendencies. These are two propensities which a prison staff tries to suppress as quickly as possible. It has been found that sometimes, in severe cases of depression resulting in strong suicidal urges, psychotherapeutic drugs may not take effect quickly enough. In cases such as this, ECT may be the wisest treatment option available. Studies have found that ECT treats severe depression faster and more effectively than standard drug treatments which, in cases of violent and suicidal tendencies within the inmate population, is of the utmost importance. Once the initial ECT sessions have been completed, it should not be difficult for an inmate to receive continued treatments, both psychotherapeutic as well as ECT, to maintain the same positive effects that were produced by the initial treatments due to their incarcerated state. In this way, the inmate who suffered from th e severe depression may be reincorporated into the prison population without posing a risk to themselves or others due to mental illness.

Genes Encoding HLA Antigens

Genes Encoding HLA Antigens The genes encoding HLA antigens are clustered on chromosome 6p21 at the telomeric end of the HLA region. Relatively few HLA class I genes are transcribed or translated.The expressed class I genes are subdivided into class Ia, which includesHLA-A, -B,and -C, and class Ib, which includes HLA-E, -F, and -G. As a non-classical major histocompatibility complex class I molecule, HLA-G is expressed predominantly and restrictedly in extravillous trophoblast cells at maternal–fetal interface. Alternative transcription of spliced HLA-G mRNAs encodes at least seven different HLA-G iso- forms, namely the membrane-bound HLA- G1, -G2, -G3 and -G4, and the soluble HLA-G5 and -G6 and –G7 proteins (1, 2). Experiments in vitro showed that HLA-G may contribute to maternal acceptance of the semi-allogenic fetus, by suppressing the maternal immune system during.it has been shown to bind to the immunoglobulin-like transcript (ILT)-2 and killer inhibitory receptor (KIR)2DL4 (p49) inhibitory r eceptors on NK cells and confer protection to extravillous trophoblasts (EVTs) via these receptors (3)(Figure2). This suggests that the interaction between HLA-G and immunocompetent cells at the placental interface could be critical in determining the outcome of pregnancy. In this regard, it may be helpful to look for deviations in these interactions by studying early pregnancy disorders of unknown aetiology (4). Among its several limited polymorphisms, the 14-bp ins/del polymorphism at 3 ´ untranslated region (3 ´UTR) of HLA-G gene has been shown an important role in post-transcriptional regulation of HLA-G molecule(5). Reports indicated that 14-bp polymorphism is associated with HLA-G mRNA stability and isoform alternative splicing patterns, therefore may influence functionality of HLA-G in pregnancy (6). In the present study, we analysed the 14-bp insertion ⠁„ deletion polymorphism in normal pregnancy and recurrent miscarriage patients with different miscarriage frequencies and discovered a possible correlation between the 14-bp polymorphism and recurrent miscarriage. Material and methods We carried out a case–control study. Peripheral blood samples were obtained from iranian women who had been seen at the infertility center in Yazd city during 2013 to 2014 for the evaluations of recurrent miscarriage. All of these women had regular menstrual cycles and were health. We analyzed a total of 200 patients with three or more recurrent spontaneous abortions (as a case group) and 200 healthy women without any history of abortion (as a control group). During the entire investigation period the current laws of ethical committee were followed; the patients gave their informed consent for use of their blood collected. Studied patients were without anatomical, microbial, viral, genetical disease and hormone profile tests and tests for ovulation and tubal patency were normal. Male partner’s semen analysis were included in the study. According to medical evidences, etiology of these abortions are unexplained. The following data for the patients were obtained: age, age at each abortion, numbers of abortions, time of abortion during each pregnancy, familial history of abortion, occurrence of bleeding and pain during abortion. Genotyping of the 14-bp insertion ⠁„ deletion polymorphism The blood samples of the control group and of the patients were collected in tubes containing EDTA. The molecular analyses were performed using DNA extracted from peripheral blood leukocytes with a routine salting out procedure. The 14-bp insertion ⠁„ deletion polymorphism was genotyped using the polymerase chain reaction (PCR). The amplification was done using the forward primer 5 ´-GTGATGGGCTGTTTAAAGTGTCACC-3 ´ and the reverse primer 5 ´-GGAAGGAATGCAGTTCAGCATGA-3 ´ for the HLA-G 14 bp insertion/deletion polymorphism analysis. PCR products were run on 1% agarose gel electrophoresis. The sizes of the PCR products were confirmed by sequence analysis. The PCR products of exon 8 were analysed by 10% nondenaturing poyacrylamidel gel electrophoresis containing ethidium bromide and visualized under ultraviolet light. PCR products were of either 224 or 210 bp, respectively,depending on the insertion/deletion of the 14 bp in exon 8. The cycling conditions used were: 94  °C for 5 min; 35 cycles of 94  °C for 1 min, 55  °C for 1 min, 72  °C for 30 s; and a final cycle extension at 72  °C for 5 min. Statistical analysis The data were analyzed by using the Chi-square test in the presence and absence of 14-bp insertion ⠁„ deletion polymorphism expressing individuals. Odds ratio was calculated with a confidence interval of 95 %. The data were processed by SPSS 16 software. The significance level of the tests for considering Pvalues as significant was set to Results HLA-G genotype frequencies were in agreement with a Hardy–Weinberg equilibrium in this study. Depending on the 14-bp deletion homozygotes, 14-bp insertion homozygotes or +14-bp ⠁„-14- bp heterozygotes of exon-8, the size of the amplified PCR products was either 224 or 210 bp or both in the case of heterozygotes (Figure 1) and was confirmed by DNA sequencing (Figure 2). Our results showed that both the +14-bp ⠁„-14- bp and -14-bp ⠁„-14-bp genotype frequencies were not significantly different between patients with recurrent miscarriages and fertile controls. However, the genotype frequency of +14-bp ⠁„ +14-bp homozygotes was significantly increased in those with recurrent abortions (three or more abortions) as compared with normal fertile controls. The mean age in the case group was: 35.3 yr  ± 5.8 (range 19–43), the mean age in the control group was: 34.9 yr  ± 3.2, (range 20–41) (Pvalue =0.40), in addition, some features of patients shown in Table 1. Distribution of the genotypes in the RSA patient and control groups is shown in Table 2. Frequencies were consistent with those previously reported by other investigators. (p value =) Discussion For more than two decades, the non-classical human leucocyte antigen (HLA) class I molecule HLA-G has been supposed to be an important immunoloregulation molecule in the maintenance of foetal–maternal immunotolerance. HLA-G has the ability to inhibite immune cell functions like natural killer cells, cytotoxic T cells and dentritic cells. In our study, we focused on the 14-bp deletion ⠁„ insertion polymorphism in the 3 ´ UTR of exon 8 of the HLA-G gene,which may contribute to the regulation of HLA-G expression. Our results showed that there were more women who were heterozygous in RSA group than in the fertile controls. Also the frequency of the +14-bp variant showed a significant increase in patients with three or more miscarriages. Thus, our data suggest that there is a detectable relationship between susceptibility to recurrent miscarriages and +14-bp homozygotes of the HLA-G locus.A report by Hviid et al. showed a significant over representation of the 14-bp +⠁„ + 14-bp HLA-G genotype in a recurrent miscarriage group. Although no significant difference was observed for the 14-bp +⠁„+14-bp genotype between the recurrent miscarriage and the control groups in their study, the same trend was found by Yan et al. Their hypothesis was that the frequencies of the HLA-G genotype, homozygous for the + 14-bp sequence, would be higher in women with several unsuccessful IVF treatments or with recurrent miscarriage than in control groups. This hypothesis was based on a previously published study. HLA-G alleles may result in different levels of HLA- G proteins. To date, the 14-bp deletion has been assigned to the G*010101, G*0102 and G*010401 alleles, and the 14-bp insertion to the G*010102, G*010103, G*0103, G*0105N and G*0106 alleles. Rebmann et al. reported that alleles G*01013 and G*0105N with the +14-bp sequence are known as ‘lowsecretor’ alleles, and are associated with reduced soluble HLA-G levels . Thus, The 14-bp insertion in ex on 8 of the HLA-G gene may be associated with low levels of plasma soluble HLA-G. Low concentrations of soluble HLA-G in maternal serum appear to be correlated with adverse pregnancy outcomes in IVF pregnancies .If the HLA-G ‘low-secretor’ allele is a factor involved in the pathogenesis of recurrent miscarriage, one would expect an increase in the number of carriers with the number of recurrent miscarriages , which is in agreement with the results of this study. The HLA-G 14 bp insertion ⠁„ deletion polymorphism may, in turn, affect the serum levels of sHLA-G and pregnancy maintenance, although the exactm mechanisms will require further study. The reason may be explained as follows, serum secreted HLA-G is conductive to early embryo implantation, as insufficient serum sHLA-G pro- motes trophoblasts attack by the mother’s immune cells induced by early embryonic trophoblast invasion of spiral arteries. This can result in a loss of implantation andpregnancy mai ntenance, leading to embryo loss as unexplained recurrent miscarriage .Based on these observations, our data indicate that the difference in HLA-G 14-bp genotype frequencies is not highly significant in this study. Probably, HLA-G as a single factor has a very modest effect in relation to risk for recurrent miscarriage. However, more genotyping investigations and functional studies on immune regulation are essential to elucidate the role of HLA-G in pregnancy. HLA-G gene encodes four membrane-bound and three soluble HLA-G isoforms by alternative splicing (16). The 14- bp insertion/deletion polymorphismin exon 8 of the HLA-G gene has been reported to be associated with HLA-G mRNA stability and splicing patterns, thus may play a role in the context of HLA-G functionality during pregnancy (17). Few studies on 14-bp polymorphism have been carried out in the association with RSA to date. A study by Tripathi et al. (14) indicated that 14-bp polymorphism is not a susceptible risk factor fo r RSA, but the number of heterozygotes (14bp1/2) was increased in the RSA group. However, another study indicated that homozygosity for the presence of the 14-bp polymorphism was higher in women with RSA than in the control groups (13). Recently, a report by Hviid et al. (15) showed a significant over- representation of 14bp 1/1 HLA-G genotype in the RSA group. Although no significant difference was observed for the 14bp 1/1 genotype between the RSA and the control groups in the current study, the same trend was found. In regard to the frequency of 14bp 1/2 heterozygotes, our study is inconsistent with that by Tripathi et al. (14) where more number of heterozygotes was observed in the RSA group. The discrepancy may be the result of ethnic variations, for a significantly different distribution of the 14-bp genotype was observed among Chinese, Danish, and Indian populations (Table 2) (14, 15). The 14-bp polymorphisms are involved in the stability and splicing patterns of the HLA-G mRN A isoforms. A rather detailed study by Hviid et al. (10) addressed that the HLA-G isoform transcripts were at a significantly lower level than the corresponding HLA-G isoform mRNA with the 14-bp sequence deleted, and an additional alternative splicing pattern, especially the HLA-G2 mRNA, could be observed with the presence of the 14-bp sequence. In accordance with this, a study by Rebmann et al. reported that HLA-G allelic variants are associated with plasma-soluble HLA-G levels. Alleles G*01013 and G*0105N with the 14-bp sequence are known as ‘low-secretor’ alleles, whereas alleles without the 14-bpsequence such as G*01041 are known as ‘high-secretor’ alleles, which are associated with elevated soluble HLA-G levels (18).Therefore, particular HLA-G alleles may result in different levels of HLA-G proteins. In the current study, higher frequencies of the 14-bpinsertion allele in RSA group may be a reflection of the association between the 14-bp insertion and the altered balance in HLA-G mRNA isoforms and probably the protein concentration. A recent report by Yie et al. (19) addressed that the embryos that express HLA-G benefit a higher in vitro fertilization rate. To the contrary, low soluble HLA-G seems to be correlated with an adverse pregnancy outcome (20). Taken together, our data indicated that the 14-bp insertion allele might have importance in the outcome of pregnancy. However, more genotyping investigations and functional studies on immune regulation are essential to elucidate the role of HLA-G in pregnancy.

Hydrogels Essay -- Ethics, Bioprinting, Artificial Tissues

Tissue or organ printing approaches became popular due to lack of organ donors. To address this need, cells or biological molecules are embedded within hydrogels and these mixtures are printed with computer controlled rapid prototyping systems to yield printed organs (9). Bioprinting approaches are promising high-throughput techniques to create artificial tissues and organs for tissue engineering. Gels with or without cells/biological factors are printed on predefined positions layer by layer fashion (Figure 1) with the final goal of fixing damaged or diseases tissues (8, 9). Using this technique, cells can be homogeneously distributed within a hydrogel matrix on predefined positions. This technique is a potential remedy for the cases where cell seeding results in random cell distribution on solid scaffolds. Nozzle diameter, cell density, liquid rheology and operation temperature are the main factors, which affect printing quality in bioprinting based techniques (11, 33, 34). Patterning of cell or biological molecule loaded hydrogels have been widely performed by computer controll...

The Harsh Treatment of Women in Afghanistan Essay -- Culture

The Harsh Treatment of Women in Afghanistan Since the tragedies of September 11th 2001, Americans have really opened their eyes to the political state of Afghanistan. The poor treatment of women in Afghanistan is an issue that, for many Americans, just seems to be coming to light as a serious concern that requires outside attention. Extreme Islamic leaders in the country persist in limiting the freedom that Afghan women have. Women in the Taliban-controlled country suffer unusually hideous acts of torment and are forced to abide by outrageous regulations because of stringent enforcement methods. Afghan women daily live lives restricted by Taliban law and risk having to endure cruel punishment and torture, yet Afghan political leaders continue to justify the their treatment of Afghan women. The Islamic women of Afghanistan are denied many of the same liberties that Americans take for granted everyday. Although the religion that they have faith in, according to Janelle Brown’s â€Å"Terror’s First Victims†, â€Å"guarantee[s] women status in society as individuals and religious d...

An Examination of the History, Development, and Uses of the Beck Depression Inventory

An Examination of the History, Development, and Uses of the Beck Depression Inventory Maya A. Butler Richmont Graduate University Dr. Aaron Beck is a psychiatrist widely known for developing the Beck Depression Inventory (BDI); a self-assessment instrument used to assess the severity of depression in adolescents and adults. During his work, Beck highlighted the negative thoughts experienced by his patients, and believed it was these thoughts that caused depression within them.From here, Beck developed a three-part thought process that exhibited how a person’s negative view of the world, their future, and themselves affected their depression level (Brown, Hammond, Craske, & Wickens, 1995). These components were used to construct what we have come to know as the Beck Depression Inventory. Throughout test development of the BDI, three separate instruments were created: the BDI, BDI-IA, and BDI-II.The first BDI was developed in 1961 by Aaron Beck, Clyde Ward, Myer Mendelson, John Mock, and John Erbaugh. It could be administered individually or in a group format, in written or oral form, and the test manual indicated total administration time to be no more than 15 minutes, irrespective of the mode of administration (Carlson, p. 117-118). It consisted of twenty-one questions that measured the patient’s feelings within the past week. Each question had four possible answer choices that ranged in depression intensity.In order to score the test, a value between zero and three was assigned to each answer, added, and compared to a key in order to determine the patient’s depression severity. Scores from the BDI could range from 0 to 63, and higher scores indicated severer depression symptoms. Some of the answer items on the BDI had identical numerical value to them, though the statements were not identical. This led to revision of the BDI and introduction of the BDI-IA (Beck, Steer, and Garbin, 1988). The BDI-IA was developed in 1971 by Beck and copyrig hted in 1978.In order to make the test more user-friendly and efficient in measuring depression, similar answer items with identical scoring on a question were removed, and test subjects were asked to evaluate their feelings for a time frame of two weeks instead of one (Beck, Steel, Ball, and Ranieri, 1996). Using the Cronbach’s alpha coefficient of reliability, it was determined the BDI-IA reliability was around 0. 85, suggesting that items on the BDI-IA are highly correlated with one another (Ambrosini, Metz, Bianchi, Rabinovich, and Undie, 1991).However, one of the main problems with this instrument was its inability to address all nine criteria for depression in the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III). In response to this, the BDI-II was developed. In 1996, the BDI-II was introduced; mainly due to the release of revised criteria for Major Depressive Disorder in the DSM-IV in 1994. Some of the changes made to the BDI-II were the replacement of items that measured changes in body image, work difficulty, and hypochondria.In addition to this, items that measured sleep loss and appetite loss were changed to examine increases and decreases in both sleep and appetite. The entire question wording was changed on the BDI-II except questions used to measure sexual interest, suicidal thoughts, and questions dealing with feelings of being punished. In addition to this, the measuring scale used to evaluate the total points from the BDI-II was changed. When compared with the Hamilton Depression Rating Scale, the Pearson correlation coefficient between this test and the BDI-II was 0. 1, which proves both instruments agree with one another (Beck, Steel, Ball, and Ranieri, 1996). In addition to this, the BDI-II has a Cronbach’s alpha coefficient of 0. 92, surpassing its predecessor the BDI. In addition to improving the relation between its instrument items, the BDI-II can be scored and interpreted via computer software. The BDI- II has expanded well beyond its original intended application with psychiatric populations. In addition to its continued use among this population, it is accepted and commonly used by clinicians as a screening instrument among normal populations (Carlson, p. 17). Because it is designed to reflect the depth of depression, it can be used to monitor changes over time, and objectively measure the likelihood of improvement and the effectiveness of treatment methods (Beck, Ward, Mendelson, Mock, and Erbaugh, 1961). The facts stand that the BDI-II is a simple measure that encompasses the majority of symptoms associated with depression, is easily and rapidly administered, and can be scored and interpreted via computer software. However, it is only a quality instrument when it is used in samples with cooperative subjects; not exaggerated or minimized by the erson completing the instrument (Waller, p. 121). In cases where a person could be motivated to deceive or malinger, the administrator i s advised to use additional or less transparent means of assessment (Carlson, p. 119). In addition to this, the intent and purpose for using the BDI-II is for assessment and not diagnosis. Improper use of this assessment for diagnosing can create falsely positive or negative results. References Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A (January 1991). â€Å"Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents†.Journal of the American Academy of Child and Adolescent Psychiatry 30 (1): 51–7. doi:10. 1097/00004583-199101000-00008. PMID 2005064. http://www. ncbi. nlm. nih. gov/sites/entrez. Beck AT, Steer RA, Ball R, Ranieri W (December 1996). â€Å"Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients†. Journal of Personality Assessment 67 (3): 588–97. doi:10. 1207/s15327752jpa6703_13. PMID 8991972. http://www. ncbi. nlm. nih. gov/sites/entrez. Beck AT, Steer RA, G arbin MG J (1988). â€Å"Psychometric properties of the Beck Depression Inventory Twenty-five years of evaluation†. Clin. Psych. Review 8: 77-100.Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (June 1961). â€Å"An inventory for measuring depression†. Arch. Gen. Psychiatry 4 (6): 561–71. doi:10. 1001/archpsyc. 1961. 01710120031004. PMID 13688369. Brown GP, Hammen CL, Craske MG, Wickens TD (August 1995). â€Å"Dimensions of dysfunctional attitudes as vulnerabilities to depressive symptoms†. Journal of Abnormal Psychology 104 (3): 431–5. doi:10. 1037/0021-843X. 104. 3. 431. PMID 7673566. http://content. apa. org/journals/abn/104/3/431. (2012, 10). Beck Depression Inventory. StudyMode. com. Retrieved 10, 2012, from http://www. studymode. com/essays/Beck-Depression-Inventory-617021. html

Mary Seacole

Mary Seacole Mary Seacole was born in 1805, in Jamaica. She nursed soldiers during the Crimean war which started in 1854. Her mother was Jamaican and her dad, a Scottish soldier. Her mother was also a nurse and used herbs for medicines and treatments. At the age of 12, she had already started to behave like a nurse because of the help she provided to her mother with the sick and wounded. When she was older, Mary opened a hotel in Jamaica to help care for the sick. Mary wanted to help those soldiers involved in conflict in Europe.She travelled to England in the UK but no one was interested in taking up her offer to help the ill and wounded soldiers. She instead stayed in England, paying her own fares and eventually setting up another hotel. There, she sold goods and clothing for the soldiers in the hotel. She would cook, clean and care for the soldiers. Mary tried to enlist her help for the Crimean war but was not chosen by Florence Nightingale who was in charge of caring for the woun ded. Mary instead travelled to the battlefield alone (covering 4,000 miles).She helped on the battlefield, sometimes even during cannon fire. Mary cared for the men very lovingly. The wounded men loved Mary and called her ‘Mother Seacole’. Florence Nightingale was unimpressed by Mary Seacole's work in Crimea, and accused her of intoxicating soldiers and running a brothel. If you ask someone ‘Do you know who Mary Seacole is? ’ they might say ‘No’ this is because Florence Nightingale got more recognition than Mary Seacole. Mary Seacole did just as much as Florence Nightingale, which is why, I think Mary Seacole should have a day to be remembered.