Know Alzheimer’s?

Alzheimer’s disease (AD) is also known as Alzheimer’s. It is prolonged neurodegenerative disease. It starts very slowly and gets worsen. 60-70% dementia is caused by it. Short memory loss is common in Alzheimer’s patients. With the passage of time the symptoms vary and include mood swings, careless about him, loss of motivation, and even forgetting the language. The patient’s behavior is changed and he feels alone with his family and friends. Slowly, body functions are disturbed. All these symptoms eventually lead to death. The cases may vary according to start of diagnosis and the life of patients under diagnosis may vary from three to nine years. [1]

Causes of Alzheimer

The cause is poorly understood. More than 70% cases are reported due to genetic causes. But physical injury especially head injury is also involved to trigger the disease. Depression and hypertension may also involve the process. All the process of disease is associated with the brain mainly. The diagnosis of disease is based on different tests including imaging and blood tests. Aging causes some symptoms to appear. But final diagnosis is made by studying the brain tissues. It can be avoided by maintaining the mental health and by doing exercises both physical and mental. There are no recommended medicines available in market that decreases the risk of disease. There is no any treatment that stops its progression but improve some symptoms only temporarily. The patients should be treated with intense care as they suffer from different symptoms. The memory loss can only be cured by psychotics. Exercise proves beneficial in this regard. [1] [2]

Signs and Symptoms

Due to ageing, many memory related complications arise in AD patients. These may include forgetting things occasionally, short term memory loss, misplacing things, and even forgetting the main incidents. This disease includes three stages. These stages are divided into early, middle and last stage. [3]

Early stage of disease

Early stage can only be evicted by close friends and relatives. The patient forgets the names of his family members and always stays confused in different issues. He forgets about the detail of any extraordinary incident and has a short term memory loss. He also forgets about his forgetfulness and blames others. [3][4]

Middle stage of disease

Middle stage is somewhat more complicated than early stage. The patient suffers more difficulty in remembering the current issue. His confusion is more increased about everything and issue. He suffers problems with his sleep. He feels confliction in his life and tries hard to be not a part of it but fails.[3]

Last stage of disease

The final stage of disease includes poor ability of patient to think. He suffers problems during speech. He may repeats some conversations and may be uses some abusive and annoying words. He even forgets about where he is now. [3][4]

Pre-dementia

When the early stage is appeared, disappointingly it is associated with ageing and stress. The disease is neglected and not diagnosed at correct time. Neuropsychological testing reveals mild cognitive symptoms. [4] The disease could be otherwise diagnosed up to eight years. The early symptoms affect the complex activities of life. Short memory loss is a common symptom. He becomes unable to get new information. He cannot pay attention to any issue. He is unable to make plans due to impaired semantic memory. The preclinical stage is also termed as mild cognitive impairment. It is an overlapping stage between normal ageing and dementia. It has a wide array of symptoms. Memory loss is a dominant symptom. It is known as amnestic MCI.[5]

Moderate symptoms

The patient suffers with acute disturbance in language and cannot recall vocabulary. Reading and writing skills are also diminished. It leads to common incorrect words changes. Complex motor activities are not coordinated. Risk of disease increase with time and symptoms become more severe. Behavioral changes become more obvious. [5] Common signs are aggression, crying, irritating and wandering. Usually, patient becomes so irritating and aggressive to his family members that he is moved from house to long term care departments. [6]

Advanced

Advanced level includes final stage of disease. The patient is unable to take care of himself. Due to difficulty in memorizing vocabulary, he is overlaid to simple phrases and may be single words. In some cases, patient becomes speechless. [8] Patient only contacts through some emotional signals. But aggressiveness is still a dominant factor of his personality. He stays at most the times aggressive and exhausted. He cannot perform any task. He becomes immobile due to muscle mobility deterioration. He becomes unable to take his food. The caregiver is always there to do all his activities of life. The disease may not prove cause of death itself and patient may die due to pneumonia and ulcers. [7] [8]

Causes

The cause of disease may vary in different patients. It may be due to genetic causes and may not be. Different hypothesis are given to describe the cause of disease but nothing is still proved. In cases of 1-5 % genetic variations are found to be a discrete cause of disease. [10]

Genetic

Usually the disease is dominant autosomal inherited. It involves onset of age before 65. It is called as early onset familial Alzheimer disease. The mutations of genes mainly occur at three different genes. These genes may be Amyloid precursor encoding gene or presenilin 1 and 2. [11] These genes are encoded in a way to increase the production of Aβ42. This protein is main component of senile plaques. Other mutations alter the ratio of production of major and minor proteins. Aβ42 is minor protein while Aβ40 is major protein. The change in rate of production of these proteins may result autosomal genetic defect to cause the disease.  [12]

In other cases, the disease may not be due to genetic causes but due to other environmental or geographical causes. Then it is referred to as Sporadic AD. The rate of different exposure acts as risk factor of disease. It is indirectly due to some genetic changes. [13]

Cholinergic hypothesis

Cholinergic hypothesis is the oldest hypothesis. Many drug therapies are based on it. It occurs due to reduction in synthesis of neurotransmitters named as acetylcholine. The medications designed to fulfill the deficiency of acetylcholine is not proved effective. [15]

Amyloid hypothesis

Amyloid hypothesis was presented in 1991. It postulates that the deposits of extracellular amyloid beta are the basic cause of disease. This hypothesis is considered much important. It finds its significance as the gene defect in amyloid precursor protein encoding gene is present on chromosome 21. The patients of Down’s syndrome show trisomy and are more sensitive towards disease even at the age of 40.experiments were performed in laboratory revealed that transgenic mice expressing mutant form of human APP gene was developed fibrillar plaques of amyloid. The brain suffered with pathology of learning deficiency. [14]

A vaccine in clinical trial was made to clear the plaque formation in human trials. But unluckily, it was not proved helpful to remove these plaques and no significant role in dementia. Some researchers suspect that Aβ as primary pathogenic form of Aβ. Amyloid-derived diffusible ligands (ADDLs) are toxic oligomers. These oligomers bind to a receptor present on surface of neurons. The change in structure of synapse occurs. It disrupts the communication of neurons that is mainly occurred by synapses. The synapses are junctions between neurons through which they mainly communicate with the help of releasing specific chemicals known as neurotransmitters. Aβ oligomer receptor is a prion protein. [7] [15] Mad cow disease is a common and worse disease of humans is caused by same kind of prion protein. This kind of prion protein is known as Creutzfeldt-Jakob disease. In this way, a link is detected in the mechanism of neurodegenerative illnesses and the disorders and pathophysiology of Alzheimer disease. [12] [16]

In 2009, amyloid hypothesis undergone a change and slightly updated by some new concepts. It was suggested that the major culprit of the disease is beta amyloid protein. Before it, it was considered that beta amyloid is the major cause of the disease. But beta amyloid does not play any role in pathology. The neuronal connections are disturbed due to ageing and cause withered neuronal junctions of Alzheimer disease. The amyloid beta protein is adjacent to the N termini of N-APP. The amyloid beta protein is cleaved from APP. When it is cleaved, APP undergoes destructive pathway and binds to death receptor 6.  TNFRSF21 is another name commonly used for death receptor 6. It is expressed in human brain. Brain regions are mostly affected by this high expression of death receptor. The pathway may be disturbed by the ageing process. In this way, beta amyloid plays crucial role in depression of synaptic functions. [12] [17]

 

In 2017, an experiment was performed of verubecestat. It inhibits beta secretase protein. This protein is a major cause of production of amyloid protein. This experiment was also uncompleted like always because there was no positive clue for the treatment of Alzheimer’s disease. [8]

Tau hypothesis

Fig (A)

The tau hypothesis defines the role of tau protein. The abnormalities in tau protein initiate the disease process. In figure, it is shown that tau is present in hyperphosphorylated form at the beginning. It is used to pair with threads of tau protein. In this way, neurofibrillary tangles formation takes place. This formation is occurred in nerve cell bodies. The consequences of the upper described process result in way that microtubules disintegration occurs, cytoskeleton is disrupted. It collapses the transport system of neurons. This complicated process results in more complications. It affects the communication of neurons at early stages. Later on, it results in death of individual. [12]

Other hypotheses

  • Blood brain barriers can also play as a causative agent of the disease. This is a neurovascular hypothesis. If the blood brain barriers are damaged and they are unable to play their role in the control of homeostasis. Then complications arise.
  • If the biometals named as iron, zinc, copper are disrupted and failed to maintain their normal range. The ions of these metals cause impaired regulation and affects homeostasis. This hypothesis is very much controversial.
  • Smoking also plays role in AD. It acts as a risk factor of the disease.
  • Air pollution may act as a risk factor of the disease. It is a tentative hypothesis.
  • Spirochetes may cause gum infection. This kind of gum infection is not normal and may cause the state of dementia. Similarly, fungal infection may also acts as a risk factor of disease.
  • Oligodendrocytes malfunctioning results in axon damage. It causes amyloid production and tau protein is hyperphosphorylated.
  • Reterogenesis is also a common hypothesis about AD. It is very important at medical point of view. The fetus goes through the process of neurulation. During this, the neural development of fetus occurs. The brains of patients go through a reverse process. Neurodegeneration occurs. The death of axons results death of white and grey matter.

Fig (B)

Neurofibrillary tangles are formed due to defect in neurons. This figure illustrates it well.

Normal brain having no defection is shown.

Neuropathology

Alzheimer’s disease basically is caused by loss of synapses and impaired working of neurons in cerebral cortex area. This impaired working and loss results in atrophy of cerebral cortex. It results in degeneration of parietal and temporal lobes. The parts of frontal cortex, subcortex and cingulate gyrus are also affected. Locus coeruleus is known as brainstem nuclei are also degenerated. Magnetic resonance imaging revealed that the specific parts of brains are reduced in their sizes in AD patients. While, healthy do not show the symptoms. Amyloid plaques formation is also observed in these patients.  Neurofibrils in tangled forms are also made visible. These plaques resemble in form with insoluble, dense deposits of beta amyloid. Tangles are basically aggregates of tau protein. This tau protein is hyperphosphorylated and is accumulated in cells to form tangles. [16]

Biochemistry


Fig (C)

 

Enzymes act on the APP (amyloid precursor protein) and cut it into fragments. The beta-amyloid fragment is crucial in the formation of senile plaques in AD.

Alzheimer’s disease is also well known due to protein misfolding. In this way, it is referred to as proteopathy. The plaques formation takes place by amyloid beta protein. This protein is accumulated in cells at abnormal levels leading to pathology. Plaques are generally small peptides; 39-43 aminoacids are present in an abnormal manner to form plaques.  Aβ is fragment of amyloid precursor protein. APP is a transmembrane protein and passes through the membrane of neuron. APP is necessary for growth and survival of injury repair. Gamma secretase and beta secretase work together to cause proteolytic cleavage of APP. These cleaved parts are clumped together to form smaller fragments and forms senile plaques.

AD may also be correlated with taupathy. The abnormal aggregation of tau protein is a leading cause of disease. The microtubules form the inner support of a cell also a neuron. The cytoskeleton is made by microtubules and provides a support system.  These structures act as tracks leading and guiding to many important structures and functions. Tau protein stabilizes the structure of microtubules, phosphorylation occurs. These are also reffered as microtubule associated proteins. If these proteins are tangled in a way to become hyperphosphorylated. The hyperphosphorylated form is responsible to interaction of threads with each other creating neurofibrillary tangles. It causes neuronal death and leads to pathology. [3] [16]

                  

Fig (D)

Fig (D)

Diagnosis

Alzheimer’s disease is diagnosed on the basis of medical and disease history of a patient. Usually, it is diagnosed on the behavioral conditions of patients. Magnetic resonance imaging known as MRI, positron emission tomography known as PET, computed tomography known as CT, and single photon emission computed tomography known as SPECT are different diagnosing techniques developed to diagnose AD patients with clear symptoms. These techniques may also able to predict the stage of pathology mostly mild cognitive impairment to AD. The stage of disease can be further elaborated by different types of tests. The intellectual functions of AD patients are assessed to predict the mental state of patient. Memory testing is used to test memory of patient. For practicing physicians, it is much easier to diagnose the patient after death. It is determined with high accuracy post mortem because brain materials can be easily studied histologically now. [17] [18]

Criteria

The National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer’s Disease and Related Disorders Association (ADRDA) are two international institutes working on AD. They were established in 1984 for diagnosis of AD patients. They updated that dementia symptoms are confirmed that they lead to disease or not by psychological testing. Through this testing, it is confirmed that the AD is found or not. Through this testing, the patient goes through a sequence of clinical trials. Brain tissues are diagnosed to confirm the disease. Different eight domains are disturbed in AD patients. These eight domains include language, focusing to any problem or view, memory, problem resolving, attention, functional abilities, self-care, and orientation. [12] [16]

Medication

Many cardiovascular threat issues as hypercholesterolaemia and hypertension are associated with the AD. Statin is a drug used to lower the level of cholesterol in blood. This drug is still not proved effective to improve or prevent the symptoms associated with AD.

Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) was considered in 2007 to reduce the prevalence of AD. Mechanism behind this is that it is used to reduce the inflammation caused by amyloid plaque formation. But trials of this medication again were disappointing. It was not proved beneficial to cure the AD in trials.

Generally five medicines are currently in use to treat cognitive problems of AD. There are acetylcholinesterase inhibitors (tacrinerivastigminegalantamine and donepezil) and the other (memantine) is an NMDA receptor antagonist. The benefit observed is very small. There is no any medicine that is used to stop the progression of disease still.

Cholinergic neurons are reduced in activity in Alzheimer’s disease. Acetylcholinesterase inhibitors are used to decrease the rate of breakdown of acetylcholine. It increases the concentration of acetylcholine in brain area. In this way, it combats the causes involved in reduction and death of cholinergic neurons. Most common side effects in users are observed as nausea and vomiting. Both of these symptoms are indirectly associated with the excess of cholinergic. Very less users suffer from the secondary side effects of this drug. The symptoms

may involve cramps, loss of appetite, weight loss, decreased heart rate, and acidity in stomach. [13] [15] [17]

References:

  1. Burns A, Iliffe S (February 2009). “Alzheimer’s disease”. BMJ. 338: b158
  2. “Dementia Fact sheet”. World Health Organization. 12 December 2017
  3. Mendez MF (November 2012). “Early-onset Alzheimer’s disease: nonamnestic subtypes and type 2 AD”
  4. Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E (March 2011). “Alzheimer’s disease”. Lancet. 377 (9770): 1019–31.
  5. “Dementia diagnosis and assessment” (PDF). National Institute for Health and Care Excellence (NICE). Archived from the original (PDF) on 5 December 2014. Retrieved 30 November 2014.
  6. Commission de la transparence. Médicaments de la maladie d’Alzheimer [Drugs for Alzheimer’s disease: best avoided. No therapeutic advantage]. Prescrire International. June 2012;21(128):150.
  7. The possible role of antioxidant vitamin C in Alzheimer’s disease treatment and prevention. American Journal of Alzheimer’s Disease & Other Dementias. March 2013;28(2):120–25.
  8. Vitamin C and Vitamin E for Alzheimer’s Disease. The Annals of Pharmacotherapy. 2005;39(12):2073–80
  9. Cholinesterase inhibitors for Alzheimer’s disease. The Cochrane Database of Systematic Reviews. 2006
  10. Cholinesterase inhibitors in mild cognitive impairment: a systematic review of randomised trials. PLoS Medicine. 2007;4(11):e338
  11. Clinical Features of Alzheimer’s Disease. European Archives of Psychiatry and Clinical Neuroscience. 1999;249(6):288–90.
  12. Language Performance in Alzheimer’s Disease and Mild Cognitive Impairment: a comparative review. Journal of Clinical and Experimental Neuropsychology. July 2008;30(5):501–56.
  13. Alzheimer Disease and Down Syndrome: Factors in Pathogenesis. Neurobiology of Aging. 2005;26(3):383–89.
  14. Apolipoprotein E, Dementia, and Cortical Deposition of Beta-amyloid Protein. The New England Journal of Medicine. 1995;333(19):1242–47.
  15. Regional Distribution of Neurofibrillary Tangles and Senile Plaques in the Cerebral Cortex of Elderly Patients: A Quantitative Evaluation of a One-year Autopsy Population from a Geriatric Hospital. Cerebral Cortex. 1994;4(2):138–50.
  16. New insights into brain BDNF function in normal aging and Alzheimer disease. Brain R Early diagnosis of dementia: neuropsychology. Journal of Neurology. 1999;246(1):6–15. esearch Reviews. 2008;59(1):201–20
  17. Awareness of Deficits and Anosognosia in Alzheimer’s Disease. L’Encéphale. 2004;30(6):570–77.
  18. The Initial Symptoms of Alzheimer Disease: Caregiver Perception. Acta Médica Portuguesa. 2004;17(6):435–44. Portuguese.

References for figures:

A: Cholinesterase inhibitors for Alzheimer’s disease. The Cochrane Database of Systematic Reviews. 2006

B: Alzheimer Disease and Down Syndrome: Factors in Pathogenesis. Neurobiology of Aging. 2005;26(3):383–89.

C: Apolipoprotein E, Dementia, and Cortical Deposition of Beta-amyloid Protein. The New England Journal of Medicine. 1995;333(19):1242–47.

D: The possible role of antioxidant vitamin C in Alzheimer’s disease treatment and prevention. American Journal of Alzheimer’s Disease & Other Dementias. March 2013;28(2):120–25.

 

Monkeypox virus particle, colored transmission electron micrograph (TEM). Monkeypox is a poxvirus that was identified in Cynomolgus monkeys in 1958 and then in humans in 1970. The virus consists of a DNA (deoxyribonucleic acid) core in a protein coat, or capsid, surrounded by an envelope. The proteins allow the particles to enter and leave host cells. The virus reproduces by entering cells and hijacking their biochemical machinery, producing many copies of itself. Monkeypox is zoonotic, passing from animals (such as rodents) to humans and vice versa. Human infections are often caused by animal bites or from direct contact with infected bodily fluids. There is no proven safe treatment or vaccine for monkeypox (as of 2008). Magnification: x125,000 when printed 10 centimeters tall.

MONKEYPOX- QUERIES AND ANSWERS

Monkeypox virus is an orthopoxvirus that causes a disease with symptoms similar, but less severe, to smallpox. While smallpox was eradicated in 1980, MONKEYPOX occurs in Central and West African countries. Two distinct clades are identified: the West African clade and the Congo Basin clade, also known as the Central African clade.

Reference: https://nypost.com/wp-content/uploads/sites/2/2022/05/us-millions-monkeypox-vaccine-02.jpg

 

It is one of the viral zoonotic diseases that originate in tropical rainforests of Central and West Africa (World Health Organization, 2020). While the disease has a significant fatality rate of 10%, as you note, I believe that it is one of the least known diseases. Still, it is pretty insightful to know that it closely resembles smallpox, which has since been eradicated (World Health Organization, 2020). You have used the disease outbreak incidence in Nigeria to exemplify how stigma by healthcare professionals and community members can derail efforts to combat health crises and how effective health communication can reduce this stigma.

When facts-based information about a disease, including its causes, transmission, safety, preventive measures, and cure, is made available to healthcare professionals, patients, their families, and the community, fear, and panic associated with ignorance and uncertainty are alleviated. Consequently, little room is left for stigma to thrive and bar healthcare professionals from extending the proper care to patients, patients seeking care, and family members and the community supporting them.

Currently, there are no proven treatments specifically for monkeypox. Instead, cases of monkeypox can be treated with medical countermeasures designed for the closely related smallpox virus. There are currently three smallpox vaccines that could be used in the US, 2 of which are licensed for smallpox, and the other could be used for smallpox under an investigational new drug (IND) protocol. The two licensed vaccines for smallpox are JYNNEOSTM (also known as Immune or Imvanex) and ACAM2000®, of which JYNNEOSTM is also approved for monkeypox.

Reference: https://nypost.com/wp-content/uploads/sites/2/2022/05/us-millions-monkeypox-vaccine-05.jpg

 

Clinical Criteria

  • New rash (any of the following)
    • Macular
    • Papular
    • Vesicular
    • Pustular
    • Generalized or localized
    • Discrete or confluent
  • Fever (either of the following)
    • Subjective
    • The measured temperature of ≥100.4° F [>38° C]
  • Other signs and symptoms:
    • Chills and sweats
    • New lymphadenopathy (periauricular, axillary, cervical, or inguinal)

Epidemiologic Criteria

Within 21 days of illness onset:

  • Report having had contact with a person or people who have a similar-appearing rash or received a diagnosis of confirmed or probable monkeypox OR
  • Is a man who regularly has close or intimate in-person contact with other men, including through an online website, digital application (“app”), or social event (e.g., a bar or party) OR
  • Traveled to a country with confirmed cases of monkeypox AND at least one of the above criteria OR
  • Traveled to a country where MPXV is endemic OR
  • Contact with a dead or live wild animal or exotic pet that is an African endemic species or used a product derived from such animals (e.g., game meat, creams, lotions, powders, etc.)

Exclusion Criteria

A case may be excluded as a possible, probable, or confirmed monkeypox case if:

  • An alternative diagnosis* can fully explain the illness OR
  • An individual with symptoms consistent with monkeypox but who does not develop a rash within five days of illness onset OR
  • A case where specimens do not demonstrate the presence of orthopoxvirus or monkeypox virus or antibodies to orthopoxvirus as described in the laboratory criteria

†Categorization may change as the investigation continues (e.g., a patient may go from PUI to probable)

* The rash associated with monkeypox can be confused with other diseases that are more commonly encountered in clinical practice (e.g., secondary syphilis, herpes, chancroid, and varicella-zoster). Historically, sporadic reports of patients co-infected with monkeypox virus and other infectious agents (e.g., varicella-zoster, syphilis).

 

Guidelines to diagnose:

Person Under Investigation

Persons under investigation (PUI) are individuals who are reported as suspicious but have not been tested in an LRN laboratory. This includes cases on which health departments have been consulted because of clinician concerns.

Possible Case

Meets one of the epidemiologic criteria AND has a fever or new rash AND at least one other sign or symptom with onset 21 days after last exposure meeting epidemiologic criteria

Probable Cause

Meets one of the epidemiologic criteria AND has a new rash with or without fever AND at least one other sign or symptom with onset 21 days after last exposure meeting epidemiologic criteria

AND

Demonstration of detectable levels of anti-orthopoxvirus IgM antibody during the period of 4 to 56 days after rash onset

Confirmed Orthopoxvirus Case

Meets possible case definition AND

Demonstration of orthopoxvirus DNA by polymerase chain reaction testing of a clinical specimen OR demonstration of the presence of orthopoxvirus using immunohistochemical or electron microscopy testing methods

Confirmed Monkeypox Case

Meets possible case definition AND

Demonstration of monkeypox virus DNA presence by polymerase chain reaction testing or Next-Generation sequencing of a clinical specimen OR isolation of monkeypox virus in culture from a clinical sample.

Recommendations for Clinicians

Human-to-human transmission is limited, with the longest documented chain of information being six generations. The last person infected in this chain was six links away from the original sick person. It can be transmitted through contact with bodily fluids, skin lesions, or internal mucosal surfaces, such as mouth or throat, respiratory droplets, and contaminated objects.

Detection of viral DNA by polymerase chain reaction (PCR) is the preferred laboratory test for monkeypox. The best diagnostic specimens are directly from the rash – skin, fluid, crusts, or biopsy where feasible. Antigen and antibody detection methods may not be helpful as they do not distinguish between orthopoxviruses.

1-monkeypox-virus-particle-tem-hazel-appleton-centre-for-infectionshealth-protection-agency.jpg (836×900)

Fig: The monkeypox virus, shown in a colored electron micrograph, typically spreads by skin-to-skin contact or respiratory droplets. https://fineartamerica.com/featured/1-monkeypox-virus-particle-tem-hazel-appleton-centre-for-infectionshealth-protection-agency.html

 

Reference:

  1. CDC. (2022) https://www.cdc.gov/poxvirus/monkeypox/outbreak/current.html
  2. The Johns Hopkins Center for Health Security. (2022) https://www.centerforhealthsecurity.org/our-work/publications/monkeypox
  3. WHO. (2022). https://www.who.int/health-topics/monkeypox/#tab=tab_1

 

 

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Artificial Intelligence in Improving Healthcare

Artificial intelligence (AI) application in the medical field is a sensitive issue for human beings. When AI is mentioned, many people relate it with the recent science-fiction movie where super machines have taken over and enslaved people. This fear has no basis, experts in the medical field forecast that by 2060, artificial intelligence will be able to do all tasks humans do. Although AI usage has attracted condemnation in the medical field, it is making great strides in facilitating and improving life. Artificial intelligence is one of the industries that are growing very fast. Its growth is bringing positive impact in the society, especially in the medical field. Not only will AI contribute to saving lives by providing effective medical machinery but will impact hugely on the growth of the economy in the medical world, and it will also provide safer options for patients.


Agus, D., (2018, December 28). AI is transforming medicine. Aging Reversed [Video file). Retrieved from 
https://www.youtube.com/watch?v=v09ixmM3clYThis blogpost mainly focused on various articles that outline applications of AI technology in improving healthcare.

     Dr. Agus is a researcher on artificial intelligence at the University of Southern California. According to Agus video file, artificial intelligence computers have been designed to make decisions with minimal human intervention. The speaker notes that AI is fundamentally playing a critical role in the medical field. Doctors and hospitals are now able to access a lot of data which contains life-saving information. According to Agus, physicians are now able to access information on treatment methods, survival rates, outcomes, and healthcare speed, which have been gathered from millions of patients. Artificial intelligence provides computing power to analyze and detect large trends from data and make predictions to identify potential health outcomes. Agus gives an example of how the accuracy of tools such as a microscope has improved to 95.5%, especially precision in the identification of cancer cells. This video is relevant to the subject because it describes the contribution of AI in improving the medical field.

Blease, C., Kaptchuk, T.J., Bernstein, M.H., Mandi, K.D., Halamka, J.D. & DesRoches, C.M. (2019). Artificial intelligence and the future of primary care: Exploratory qualitative study of U.K. general practitioners’ views. Journal of Medical Internet Research, 21(3).  Retrieved from http://preprints.jmir.org/preprint/12802

                 Blease et al.’s (2019) article explain how artificial intelligence is disrupting the medical profession, especially in the biomedical informatics field. The article explores the opinions of general practitioners perceptions of the artificial application in the medical field. The article surveys the opinions of 720 general practitioners on the likelihood of artificial intelligence replacing human intelligence. The research results indicate that general practitioners are in support of the application of the use of technology in healthcare to improve efficiencies, especially the reduction of administrative costs on medical professionals. The article gives timely information on the views of physicians on the AI scope in primary health care. The article is relevant to the subject matter because it samples opinions of general practitioners on the artificial intelligence application in healthcare and how AI is playing a vital role in the improvement of healthcare.

 

Daven, H.T., Hongsermeier, T.M., & Cord, K.A.M. (2018). Using AI to improve electronic health records. Harvard Business Review. Retrieved from https://hbr.org/2018/12/using-ai-to-improve-electronic-health-records

                 The article examines how electronic medical records at large have played a critical role in improving decision making in the medical field. According to Daven, Hongsermeier, and Cord, EHR (electronic health records) are assisting clinicians in providing patient-centered quality healthcare. Moreover, the artificial intelligence application in the medical field has helped in making EHR systems more intelligent and flexible. Artificial intelligence capabilities for electronic health records have helped in quick medical data extraction whereas AI is helping in extracting index data from medical notes. AI has also helped in improving the predictive and diagnostic algorithms which are integrated with the EHRs as support in decision making. Finally, AI has played a critical role in enhancing data entry and clinical documentation by providing support tools that integrate clinical note composition and data collection.

                 The article’s information is vital to the topic of the application of AI in the medical field. The information contained in the article is up-to-date because the article was published in December last year, and it is contained in the Harvard Business Review, which is renowned for publishing relevant quality articles and quality. The authors have the authority to talk about the topic; Daven is a Distinguished Professor in Management and Information, Hongsermeier is a Chief Medical Information Officer and Cord is a Ph.D. candidate in Biostatistics and Epidemiology.

Donovan, F., (2018). Healthcare artificial intelligence, making sense of data flood. HIT Infrastructure. Retrieved from https://hitinfrastructure.com/news/healthcare-artificial-intelligence-making-sense-of-data-flood

                 Donovan gives statistics on the application of AI data in managing and cleaning of data in healthcare. AI and machine learning in healthcare are allowing medical practitioners to make sense of medical data. The author notes that many challenges, such as inefficiencies that encumbered digital transition, are being eliminated. By 2026, the author notes robot-assisted surgery will be more than $40 billion, virtual nursing assistance will be $20 billion, fraud detection will be $14 billion, clinical trial participant identifier will be $13 billion, and automated image diagnosis will be $3 billion. The author notes that AI algorithms have become complicated, for instance, image recognition. The article does not give many details about AI application and does not have authority about artificial intelligence application in the medical field, but the article gives prospects of artificial intelligence in the future. Moreover, the article provides specific estimates of how AI will reduce the cost of healthcare in the United States. The article is up-to-date because it was published in 2018 and contains relevant information about artificial intelligence applications in the medical field.

Harvard Medical School. (2019, April 9). MD vs. Machine: Artificial intelligence in health care [Video file]. Retrieved from https://www.youtube.com/watch?v=xSDfma4VEx8

                 The video explains various ways in which artificial intelligence is impacting the healthcare sector. From cancer and chronic diseases to radiology and also an assessment of risk, AI had created endless opportunities that healthcare can leverage. According to the speakers in the video file, AI offers advantages over traditional clinical decision-making techniques and analytics. Through AI integration in the medical field, algorithms learning have become accurate and precise where humans have gained unprecedented knowledge about care processes, diagnostics, patient outcomes, and treatment variability. One importance of artificial intelligence that is emphasized in the video file is how AI plays a critical role in eliminating biases in healthcare methods. The video file article presents concise and facts about artificial intelligence application and is relevant to the subject matter because it provides up-to-date information about AI application in healthcare.

Jiang, F., Jiang, Y., Zhi, H., Dong, Y., Li, H., Ma, S.,…Wang, Y. (2017). Artificial intelligence in healthcare: past, present, and future. Strove and Vascular Neurology, 2(4). DOI: http://dx.doi.org/10.1136/svn-2017-00010

                 The article highlights how AI in healthcare mimics and perfects human intelligence. Increasing healthcare data availability and improving medical analytical techniques. The article highlights popular medical fields where healthcare applies artificial intelligence like in neurology and cardiology. The article examines four major areas that AI is applied in a disease treatment process, and these areas are; detection, treatment, prediction of outcome, and evaluation of prognosis. The article predicts how artificial intelligence will be relied on by medical professionals by 2030. The article is a scholarly article that has an elaborate abstract and many references to support the healthcare use of artificial intelligence. The authors of the article are specialists in the medical field in different universities in China. The article contains relevant information on how AI technologies are used in the research of cancer.

Panch, T., Szolovits, P. & Atun, R. (2018). Artificial intelligence, machine learning, and health systems. Journal of Global Health, 8(2). DOI: https://dx.doi.org/10.7189%2Fjogh.08.020303

                 The authors explain how health sector systems globally are facing challenges such as increased disability, illness, and morbidity, which is caused by epidemiological transition and aging population, increased healthcare expenditures, and higher societal expectations. The authors note the need for the transformation of healthcare systems to overcome these challenges. The ingredient of the transformation of health systems is the introduction of AI in the healthcare systems. The article explores how artificial intelligence application in healthcare will help the world achieve universal healthcare (UHC) through improving effectiveness, responsiveness, efficiency, and equity of healthcare services provision and health of the public. The article is relevant and accurate on the topic because it discusses the impact of artificial intelligence in healthcare systems. The authors give balanced information about artificial intelligence, and they are an authority in the subject matter.  The lead author Dr. Trishan Panch is Chief Medical Officer and Co-founder of Wellframe, who leads in AI strategy and initiatives in the medical field. The article gives recent information about the utilization of AI in the health systems.

Pearl, R. (2018). Artificial intelligence in healthcare: Separating reality from hype. Forbes. Retrieved from https://www.forbes.com/sites/robertpearl/2018/03/13/artificial-intelligence-in-healthcare/#6afd85aa1d75

                 Pearl notes that the application of artificial intelligence in the medical field has been around since 1956. The author explains that most commonly used artificial intelligence application in healthcare is algorithmic that uses evidence-based approaches by clinicians and medical researchers. The second application that Pearl identifies is the use of visual tools for recognition in healthcare. According to Pearl (2018), the human eye fails even the best medical experts, and therefore, tools that use AI are necessary to replace human eye diagnosis. The author notes that the accuracy gap between the human eye and the digital eye is wide, especially machines used in diagnostic fields such as MRI, CT, and mammography information interpretation. The article compares artificial intelligence application in the medical field with traditional methods. The article contains up-to-date insights about information technology application in healthcare, and the author can provide accurate statistics on how AI has revolutionized the medical field. Although the article is not scholarly, it gives credible and balanced information about the utilization of artificial intelligence in the medical field. Robert Pearl is an authority in the medical field, who was the CEO of The Permanente Medical Group, the largest medical group in the United States. His article provides candid tidbits about how artificial intelligence application is impacting different medical fields in the United States.

Reddy, S., (2018). Use of Artificial intelligence in healthcare delivery. Research Gate. DOI: 10.5772/intechopen.74714

                 Reddy notes that adoption of artificial intelligence in healthcare has rapidly improved healthcare delivery. He adds that AI is being applied in numerous healthcare sectors, including clinical laboratories, hospitals, and research facilities to improve the healthcare delivery systems. The author continues to explain how the application of AI in healthcare has been fundamental in creating myriad opportunities for medical professionals and healthcare organizations. The article gives recent information about artificial intelligence. The author has expertise in the medical field, and therefore, he has the authority to speak about artificial intelligence in the medical field. The article gives detailed factual information about the application of artificial intelligence in the medical field. The article is a balanced source because it gives critical information about artificial intelligence and healthcare delivery. The Author is an associate professor at Deakin University in the School of Medicine. He has done a lot of research in hospital management, health evaluation, and artificial intelligence. The article gives recent details about the application of artificial intelligence in healthcare.

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Health Information Systems (HIM)

Health Information Systems (HIM) is a technology used to manage healthcare data in various healthcare institutions. The systems carry out different functions such as collection, storage, and data management. The integration of Information technology in healthcare is growing fast as the industry turns to technology to solve problems that have existed for years. He is one of the approaches used in healthcare to streamline operations and protect patient data. The following text will discuss the concept of HIM as it applies to healthcare and ideas that relate to the integration of Information Technology in the healthcare industry.

With major innovations in technology, the current Health care Information (IT) environment has grown exponentially. IT is a part of the healthcare system, and it’s almost impossible to operate without IT in the modern healthcare environment. Currently, the atmosphere is filled with many opportunities, potential, and issues that affect the integration of IT in healthcare. Some of the problems in the current healthcare information technology are related to the security of patient data (Ehrenfeld, 2017). Electronic Health Records can easily be compromised if the necessary steps to protect them are not taken. Moreover, the current IT environment has also played a vital role in improving healthcare through the advancement of various components. These components may include accessibility, operations management, and accountability. With innovations in the industry still taking place, IT will entirely revolutionize the industry and become an essential part of the industry,

Current Health Care Information Environment How Vila Health Hospital’s HIM Systems Fit into the External Health Care Technology Environment

            External environments refer to Vila healthcare’s environment and affect its performance and the utilization of HIM systems. Vila hospital handles the building, installation, maintenance, and troubleshooting of in-house designs and maintenance and upgrading. However, third-party applications are installed by vendors who also monitor and maintain them. Various factors make up the external environment and may include; error reporting, oversight processes, medical liability, and care delivery. Vila Health hospital’s HIM systems fit this external environment based on how they integrate to improve the quality of care provided by the facility.

            To begin with, error reporting is highly affected by the external environment and majorly has a positive impact on the systems. Error reporting allows the HIMS to connect with the external environment by offering information that can lead to peer review of errors and improvement of systems. Although HIMS is highly advanced, it may experience many mistakes that may affect the quality of service. As such, enhancing this process and connecting to the external technology environment allows for solutions to be formed and used to prevent any future errors from occurring, hence, protecting the organization and its patients. Apart from HIM errors, diagnostic error reporting increases disclosure of errors while improving reporting, analyzing the mistakes, and learning from such mistakes (Kruse, Frederick, Jacobson & Monticone, 2017). It’s a critical part of reducing medical liability and ensuring that the organization is competent enough to avoid costly lawsuits. Thirdly, HIMS ensures that the organization complies with oversight processes such as regulatory requirements (Hoolhorst, 2020). By connecting with the external technological environment, HIMS protects Vila Health’s stakeholders and patients by promoting competency and reporting any issues affecting care delivery.

The interrelatedness of HIT throughout the Organization

            Vila healthcare uses an electronic medical record system that allows patients to access their history and any information they may need. All hospitals and clinics are part of the system to ensure that providers can access information and details about medical history. Furthermore, it allows the providers to access information and efficiently coordinate care. There is an interrelatedness in a very complex healthcare system to achieve this. Interrelatedness refers to the ability of systems to influence each other, with complexity increasing as the number of components in a system increases. For instance, once a patient is entered into the system, data can be added, changed, or edited at different levels to ensure efficiency. For example, a patient registers in the system on their first visit, diagnostic results are added under the original file by a physician, treatment and approaches are added once treated, and information about medications is sent to the pharmacy where they can collect their drugs. As stated by Vila healthcare, the system can be accessed by all providers, including nurses, physicians, and pharmacists. Once a patient is registered, they are awarded a unique number and file under which all their information and transactions with Vila healthcare are stored (MHA Vila Health, 2021). Therefore, a nurse can access the same file as the physician and pharmacists. The same information is provided to the patient, who can access their entire history in the healthcare system and analyze all their data as they require.

Unique HIM needs of Each Hospital

            Every hospital has its own unique needs that the HIM system has to solve. These needs may include; ease of access to patient data, cost-effectiveness, stopping leakages in revenue, improving the quality of care, increased data security, accountability, and operational effectiveness. Every organization can identify what it needs and then develop a system to achieve these goals. The most crucial aspect is understanding how he can be used to achieve these goals. The HIM system achieves this by collecting, storing, and managing data. For instance, the HIM system collects all data available and makes it accessible to authorized parties. For example, in the case of accountability, access to information is done through secure log-ins (Hoolhorst, 2020). Therefore, the hospital can determine who accessed what or entered data into the system, bringing about accountability. In another example, security can be increased with data stored in servers or clouds and can only be accessed through logins. As such, he can be used to solve a variety of problems and needs for hospitals. Therefore, before installing the systems, it is essential to conduct research and determine the hospital’s needs to have the best plan possible.

Regulations and Guidelines that Must Be Followed for Particular HIM

            Due to the sensitive nature of patient data, many regulations and guidelines must be followed for particular HIM. This also includes policies that are put in place to protect patient data and enhance the safety of organizational systems. Regulations are set by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), where specific rules are provided to protect patient data. The rules focus on; ensuring confidentiality, availability, integrity, identification, and protection against anticipated threats, protection against impermissible use or disclosure, and ensuring compliance by the workforce (Moore & Frye, 2019). The rules protect data from being misused, accessed illegally, shared illegally, or accessed unlawfully by third parties. Individual facilities are responsible for protecting their data, which could attract fines from relevant authorities (Moore & Frye, 2019). For instance, in 2017, CardioNet paid $2.5 million for failing to follow HIPAA Privacy and Security Rules. The organization lost data after a laptop was stolen from an employee, to which it was determined that the company’s security approaches were flawed and put patient data at risk.

Standard Procedures and Best Practices for Securing Sensitive Health Information

            There are various approaches that professionals use to secure patient data. The most common procedure is following HIPAA Privacy and Security Rules which offer the basis for data protection. Another best practice is protecting data from outside threats. Cyber-attacks are increasing with time as individuals attempt to access data that they use maliciously. Therefore, it is essential to protect against these external threats by purchasing the latest security systems, updating passwords from time to time, and installing anti-malware software to protect against malware, ransomware, and phishing attacks. By doing this, organizations also need to understand that employees from within the organization can initiate attacks. Therefore, updating security measures can prevent the likelihood of this happening. Furthermore, influencing laws and standards can also aid in promoting patient data security. Every HIM professional is responsible for protecting the entire industry by contributing to identifying the best rules and practices that can impact data security.

Integration Decisions and Recommendations

            Health IT has improved healthcare processes over the year as it enables providers to manage patient care through secure sharing of information. With the help of Health IT, organizations can have; accurate information about patient health, the ability to coordinate, the ability to share information securely, the availability of information to diagnose patients, and the ability to reduce the occurrences of medical errors within an organization. It is highly recommended for professionals to address specific areas for successful integration. The recommended areas include; patient focus, standardized delivery of care, performance management, creation of organizational culture and leadership, integration of physicians into the system, development of a governance structure, and sound financial management. Inpatient focus, IT helps improve accountability. Medical records can show the type of healthcare a patient received and whether it met set standards. With such a process, it is possible to ensure that the integration of IT in healthcare is successful and improves patient outcomes.

            Ultimately, IT is now a significant part of the healthcare system and has had significant advantages since it was integrated. However, further improvements can be made to the plans to improve efficiency and security. Hospitals are highly recommended to adopt IT within their facilities to reap the many benefits technology can add to their practices.

References

Davis, J (2017). CardioNet was slammed with a $2.5 million fine for failed risk management and analysis. Privacy & Security. Retrieved from https://www.healthcareitnews.com/news/cardionet-slammed-25-million-fine-failed-risk-management-and-analysis

Ehrenfeld, J. M. (2017). Wannacry, cybersecurity, and health information technology: A time to act. Journal of medical systems, 41(7), 104.

Hoolhorst, T. (2020). The influence of HIM implementations on hospital organizations and how this affected hospital healthcare performances.

Kruse, C. S., Frederick, B., Jacobson, T., & Monticone, D. K. (2017). Cybersecurity in healthcare: A systematic review of modern threats and trends. Technology and Health Care, 25(1), 1-10.

MHA Vila Health (2021). Health Information System Characteristics and Needs. Transcript.

Moore, W., & Frye, S. (2019). Review of HIPAA, part 1: history, protected health information, and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269-272.

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OMICRON- The Third Wave

OMICRON- The Third Wave

  1. On 26 November 2021, WHO designated the variant B.1.1.529 a variant of concern, named Omicron, on the advice of WHO’s Technical Advisory Group on Virus Evolution (TAG-VE).  This decision was based on the evidence presented to the TAG-VE that Omicron has several mutations that may have an impact on how it behaves, for example, on how easily it spreads or the severity of illness it causes. Here is a summary of what is currently known.Introduction
  1. Current knowledge about Omicron

            Researchers in South Africa and around the world are conducting studies to better understand many aspects of Omicron and will continue to share the findings of these studies as they become available.

2.1.Transmissibility

It is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. The number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiologic studies are underway to understand if it is because of Omicron or other factors.

2.2. Severity of disease
It is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta.  Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron.  There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.  Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.  All variants of COVID-19, including the Delta variant that is dominant worldwide, can cause severe disease or death, in particular for the most vulnerable people, and thus prevention is always key.

III. Effectiveness of prior SARS-CoV-2 infection

Preliminary evidence suggests there may be an increased risk of reinfection with Omicron (Ie , people who have previously had COVID-19 could become re infected more easily with Omicron), as compared to other variants of concern, but information is limited. More information on this will become available in the coming days and weeks.

3.1.Effectiveness of vaccines
WHO is working with technical partners to understand the potential impact of this variant on our existing countermeasures, including vaccines. Vaccines remain critical to reducing severe disease and death, including against the dominant circulating variant, Delta. Current vaccines remain effective against severe disease and death.

3.2.Effectiveness of current tests
The widely used PCR tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests.

3.3.Effectiveness of current treatments
Corticosteroids and IL6 Receptor Blockers will still be effective for managing patients with severe COVID-19. Other treatments will be assessed to see if they are still as effective given the changes to parts of the virus in the Omicron variant.

  1. Studies underway

            At the present time, WHO is coordinating with a large number of researchers around the world to better understand Omicron. Studies currently underway or underway shortly include assessments of transmissibility, severity of infection (including symptoms), performance of vaccines and diagnostic tests, and effectiveness of treatments.

WHO encourages countries to contribute the collection and sharing of hospitalized patient data through the WHO COVID-19 Clinical Data Platform to rapidly describe clinical characteristics and patient outcomes.

More information will emerge in the coming days and weeks. WHO’s TAG-VE will continue to monitor and evaluate the data as it becomes available and assess how mutations in Omicron alter the behavior of the virus.

  1. Recommended actions for countries

As Omicron has been designated a Variant of Concern, there are several actions WHO recommends countries to undertake, including enhancing surveillance and sequencing of cases;  sharing genome sequences on publicly available databases, such as GISAID; reporting initial cases or clusters to WHO; performing field investigations and laboratory assessments to better understand if Omicron has different transmission or disease characteristics, or impacts effectiveness of vaccines, therapeutics, diagnostics or public health and social measures.  More detail in the announcement from 26 November.

Countries should continue to implement the effective public health measures to reduce COVID-19 circulation overall, using a risk analysis and science-based approach. They should increase some public health and medical capacities to manage an increase in cases.  WHO is providing countries with support and guidance for both readiness and response.

In addition, it is vitally important that inequities in access to COVID-19 vaccines are urgently addressed to ensure that vulnerable groups everywhere, including health workers and older persons, receive their first and second doses, alongside equitable access to treatment and diagnostics.

  1. Recommended actions for people

The most effective steps individuals can take to reduce the spread of the COVID-19 virus is to keep a physical distance of at least 1 meter from others; wear a well-fitting mask; open windows to improve ventilation; avoid poorly ventilated or crowded spaces; keep hands clean; cough or sneeze into a bent elbow or tissue; and get vaccinated when it’s their turn.

WHO will continue to provide updates as more information becomes available, including following meetings of the TAG-VE. In addition, information will be available on WHO’s digital and social media platforms.

VII. Omicron COVID Variant Symptoms

Symptoms for the new COVID Variant “Omicron” are given below.

Note: Symptoms are classified in most common symptoms, less common symptoms & serious symptoms.

Most common symptoms

Most common symptoms for the new COVID Variant “Omicron” are fever, cough, tiredness, loss of taste or smell.

Less common symptoms

Less common symptoms for the new COVID Variant “Omicron” are sore throat, headache, aches, pains, diarrhea, a rash on skin, discoloration of fingers or toes

red or irritated eyes.

Serious symptoms

Serious symptoms for the new COVID Variant “Omicron” are difficulty breathing or shortness of breath, loss of speech or mobility, or confusion or chest pain.

Note: If anyone has any of these symptoms then he/she should urgently take the COVID test.

After the detection of a new variant of COVID, the WHO has advised the country and every individual to follow the SOPs (Standard Operating Protocols).

Source: Update on Omicron (who.int)

cloud-computing

TOOLS EVALUATION – Cloud security at the age of 2022

Several tools and services have been developed to tackle different cloud security issues. I have chosen the top 5 tools and services that are being used by many companies and companies relying on cloud services. These tools include Bitglass, Netskope, Skyhigh Networks, Okta, and CipherCloud. Unfortunately, all these tools are commercial and should be purchased for a business to use them. Besides, they have one-month trial periods. Businesses can make use of this grace period before deciding to implement them in their cloud services such as devices and applications. I selected specifically these 5 tools since they tackle and offer a solution to the security of data posed by cloud computing. Skyhigh Networks, CipherCloud and Netskope tackle ITshadow problem. Bitglass service offers encryption of data and also assists in monitoring data of business regardless of geographical area. For multifactor authentication and automated user management, Okta is the best tool (Kausik, 2015).


Describe each tool


Bitglass
A tool used to offer transparent data protection for every business. It’s applicable both in mobile and computer applications, it maintains visibility oof data as well as reducing the loss of data in mobile devices and also in the cloud.

 Skyhigh Networks
When it is time to discover, analyze and secure cloud apps usage, Skyhigh Networks is the correct tool. It capitalizes logs from the business implemented firewalls, gateways, and proxies to find out employee’s activities within the premise.

 Netskope
This is a service used in discovering and monitoring network-related services such as shadow IT and applications of a cloud. It provided detailed information based on the analysis carried out from downloaded content, user sessions and details of shared content.

CipherCloud
It is a secure cloud-based tool that encrypts or tokenize data directly to the gateway of the business. CipherCloud tool’s main objective is ensuring data security stored within well-defined cloud platforms (JIN, H. M. (2012).

Okta
Okta is a tool based on ensuring all the cloud services that include mobile and on-premises apps are implemented with secure Single Sign-On. The tool has been pre-integrated with applications that are common to many businesses, the applications are salesforce, google, and others (Latif, 2009).

Collect all features

  • Single Sign-On (SSO)
  • Integration of LDAP and Active Directory
  • Multifactor authentication
  • Detection of cloud apps usage.
  • Adaptive access control
  • Data encryption
  • Threat protection

Justify why these are sufficient

Cloud computing has grown tremendously, and it has gain popularity very quickly resulting in many businesses migrating their services to the cloud. Computers and mobile applications in the cloud have raised security issues. Privacy of data, the security of devices and residency are among security issues facing cloud. Businesses consider data security as the first option before migrating their services to the cloud. The features mentioned above are sufficient since they cut across almost all security issues facing the cloud. These features can ensure data encryption, web filtering, secure login, encryption of cloud, multifactor authentication among others Krutz, (2010). Businesses can choose tools that meet their business security demands. On implementing these features, a business can significantly secure their applications and devices stored and connected to cloud up to 95%.

Measure the importance of the feature

Features Weight Justification
Single Sign ON 5% Enables users to use the same credentials for multiple related services. Credentials falling on the wrong hands may lead to security issues.
Integration of LDAP and Active Directory 5% Low cost since businesses can utilize available resources without incurring extra resources.
multifactor authentication 10% Users are granted permission upon offering two data pieces.
detection of cloud apps usage. 15% Businesses can detect and discover the usage of cloud services. Unauthorized usage can be detected
Data encryption 30% Data encryption is the most important cloud security issue. Encryption ensures information has been secured and can’t be used anyhow.
Adaptive access control 15% The feature detects and forbids unauthorizes access to cloud services and applications
Threat protection 20% This feature ensures threats are detected, prevented and investigated hence offering protection integration.

Support

Feature Bitglass Skyhigh Networks Netskope Okta CipherCloud
Single Sign-On(C1) 1 3 0 0 0
Integration of LDAP and Active Directory(C2) 1 0 0 0 0
detection of cloud apps usage. (C3) 2 1 1 1 1
Adaptive access control(C4) 2 1 1 2 1
Threat protection(C5) 2 1 1 1 1
multifactor authentication (C6) 1 2 2 1 2
Data encryption(C7) 1 1 1 1 1

Evaluation

Bitglass service

Criteria Weight Bitglass
Support Weighted Support
C1 0.05 1 1*0.05=0.05
C2 .05 1 1*.05= .05
C3 0.15 2 2*0.15=0.3
C4 0.15 2 2*0.15=0.3
C5 0.2 2 2*0.2=0.4
C6 0.1 1 1*0.1-0.1
C7 0.3 1 1*0.3=0.3

Sky-high Networks service

Criteria Weight Skyhigh Networks
Support Weighted Support
C1 0.05 0 0*0.05=0
C2 .05 0 0*.05= 0
C3 0.15 1 1*0.15=0.15
C4 0.15 1 1*0.15=0.15
C5 0.2 1 1*0.2=0.2
C6 0.1 2 2*0.1=0.2
C7 0.3 1 1*0.3=0.3

Netskope

Criteria Weight Netskope
Support Weighted Support
C1 0.05 0 0*0.05=0
C2 .05 0 0*.05= 0
C3 0.15 1 1*0.15=0.15
C4 0.15 1 1*0.15=0.15
C5 0.2 1 1*0.2=0.2
C6 0.1 2 2*0.1=0.2
C7 0.3 1 1*0.3=0.3

Okta tool

Criteria Weight Okta
Support Weighted Support
C1 0.05 0 0*0.05=0
C2 .05 0 0*.05= 0
C3 0.15 1 1*0.15=0.15
C4 0.15 2 2*0.15=0.3
C5 0.2 1 1*0.2=0.2
C6 0.1 1 1*0.1=0.1
C7 0.3 1 1*0.3=0.3

Cipher Cloud tool

Criteria Weight CipherCloud
Support Weighted Support
C1 0.05 0 0*0.05=0
C2 .05 0 0*.05= 0
C3 0.15 1 1*0.15=0.15
C4 0.15 1 1*0.15=0.15
C5 0.2 1 1*0.2=0.2
C6 0.1 2 2*0.1=0.2
C7 0.3 1 1*0.3=0.3

Discussion

Upon evaluation of features and support for each cloud security application, Netscope scores the highest. It supports large cloud applications. It also carries out analytic of threats among other security solutions. Services offered by Netscope override the cost of implementing the tool. I would advise businesses to choose this tool as the first option.

Work cited

  1. Kahol, A., Bhattacharjya, A. K., & Kausik, B. N. (2015). U.S. Patent No. 9,047,480. Washington, DC: U.S. Patent and Trademark Office.
  2. Vines, R. L. K. R. D., & Krutz, R. L. (2010). Cloud security: A comprehensive guide to secure cloud computing (pp. 35-41). Wiley Publishing, Inc.
  3. Mather, T., Kumaraswamy, S., & Latif, S. (2009). Cloud security and privacy: an enterprise perspective on risks and compliance. ” O’Reilly Media, Inc.”.
  4. WANG, L. F., SHEN, J., & JIN, H. M. (2012). Study on Application of Commercial Cipher Cloud Storage System [J]. Information Security and Communications Privacy, 11.
Brain Transplant

Parkinson’s disease

Parkinson’s disease is a progressive disease that affects motor function in patients. In the beginning, the symptoms can go unnoticed since it starts with tremors on the hand, slowed movement, and stiffness as it progresses. Dopamine is a neurotransmitter that is responsible for coordinating muscle movements in the body. Produced in the substantia nigra, dopamine production may reduce when the cells of the substantia nigra die after the onset of PD (Brooks,2016). According to Zeng et al. (2018), PD first affects the olfactory bulbs and vagus nerve’s dorsal motor nucleus and later moves to substantia nigra. In the later stages of the disease, the brain cortex becomes affected. As the disease progresses, other brain areas and the nervous system become affected, resulting in impairments to the cognitive neuropsychological, and motor systems.


Epidemiology –
Etiology

Continued loss of neurons that produce dopamine results in the development of PD. Although the cause is not well understood, various factors could result in the development of PD. Genetic factors are considered to cause about 15% of PD cases (Tysnes & Storstein, 2017).

Researchers argue that various genetic mutations can result in the development of the disease, and these mutations are associated with a family history of the disease. The other causes include environmental factors. For instance, continued exposure to some toxins increases PD risk (Zeng et al., 2018). Other environmental factors include exposure to certain metals, herbicides and pesticides, and head injury. Other causes include the presence of Lewis Bodies, which is believed to cause PD.

Risk Factors

Age is one of the risk factors for PD. For instance, Parkinson’s Disease is common among older adults above 60 years and less common among young adults. However, the disease could begin in middle life. The other risk factor is a family history of PD. Hereditary factors mean that the risk of developing PD is high when one has a close relative to the disease. However, the risk is low if only one family member has the disease. The sex of an individual is also a risk factor since PD is common among males than females. Lastly, getting exposed to various forms of toxins such as pesticides and herbicides, heavy metals could result in developing the disease (Emamzadeh & Surguchov, 2018). Lastly, head injuries may also lead to PD.

Conditions Associated with PD

The condition is linked to various health conditions and complications. For instance, individuals with PD are likely to develop cardiovascular disease. Studies show that those with PD are likely to develop cardiovascular disease, with a 50 percent chance of dying from the complication. This is because cardiovascular disease can result in heart attacks or stroke. Also, gastrointestinal illness is common among people with PD. This is because PD could start in the nervous system, which controls the gastrointestinal system. In this case, early symptoms of PD could include constipation and dysregulation of the gut bacteria.

The other associated condition is skin cancer. Persons living with PD have a lower risk of developing cancer. However, malignant melanoma is common among people with Parkinson’s disease. Also, genitourinary dysfunction is joint among people with PD, which includes complications associated with the urinary system or sex organs. In this case, sexual dysfunction and urinary incontinence are joint. Lastly, diabetes is associated with PD since individuals living with diabetes type 2 have an increased risk of developing PD. Estimates show that about 10 to 30 percent of people with PD have diabetes, while about 80 percent of people with PD establish low glucose tolerance, indicating pre-diabetes.

Physical exam for PD involves visual observation, auscultation, and palpation of the patient. In this case, a neurologist conducts the physical exam to determine the presence or absence of PD. The physician also assesses the patient for balance impairments, episodes of freezing, and tremor symptoms. The neurologist examines gait to determine abnormalities such as spastic, steppage, waddling, or propulsive gait. Also, gait observation looks for the initiation, arm swing, turning to assess balance, or hesitancy associated with postural instability. In addition, step strength/size looks whether the patient has a shuffling gait or festinate gait, which helps maintain balance. The neurologist also checks posture to determine trunk flexion, stooped or rounded shoulders, and involuntary forward head craning.

Differential Diagnosis

Dementia with Lewis Bodies (DLB). This is a common cause of dementia and is characterized by parkinsonism, visual hallucinations, and cognitive impairments. In this case, Lewis Bodies is a common pathology in dementia with Lewis bodies and PD (Stoker & Greenland, 2018). The diagnostic criteria for PD and DLB provide that if cognitive impairment happens during the first year of parkinsonism, DLB is diagnosed. However, when cognitive impairment develops after PD is established, the diagnosis becomes PD with dementia.

Fluctuation in cognition and visual hallucinations are critical in the diagnosis of DLB.

Progressive Supranuclear Palsy (PSP). This neurodegenerative disease is characterized by difficulties walking, visual impairment/blurred vision, and instability. Postural instability is typical in both PD and PSP. However, this symptom marks disease progression in PD, while in PSP, it could occur earlier, and the patient falls frequently. Abnormal eye movement reduced verbal fluency, and executive function is also standard in PSP (Stoker & Greenland, 2018). Neuroimaging can help differentiate PSP from PD, but the reduced response to levodopa, eye movement problems, and frequent early falls happens in PSP than in PD.

Multiple system atrophy (MSA). This condition is characterized by its effect on autonomic functions such as breathing, motor control, the functioning of the bladder, and blood pressure. The disease shares most PD symptoms, including reduced balance, muscle rigidity, and reduced movements. It is also associated with tremors, although this is rare in MSA. Other symptoms associated with MSA include sleep disorders, erectile dysfunction, dysarthria, unsteady gait, dysphagia, and visual disturbances. However, MSA is considered to progress rapidly and is less responsive to levodopa and autonomic problems in the early stages of the disease. This differentiates MSA from PD.

Diagnostic Tests

There is no specific test for diagnosing PD. However, neurologists can use the patient’s medical history and a review of the signs and symptoms, and a physical exam to diagnose the condition. Also, a DAT scan can be ordered to help support the diagnosis. Other Imaging tests include MRI, PET scans, and CT, which help rule out other conditions but not necessary to diagnose PD (Tynes & Storstein, 2017). Also, blood and urine tests can be ordered to rule out other conditions. In most cases, analyzing PD could take time, which means that follow-up appointments may be necessary to ensure an accurate diagnosis. In most cases, neuro- examination and physical examination are critical in PD diagnosis.

Treatment

Various forms of treatment are used to help manage the condition, but PD cannot be cured. In this case, therapy helps control the symptoms to allow the patient to reduce tremors, enhance walking and movement, and substitute dopamine. Carbidopa-levodopa, commonly called Levodopa, is the widely used medication since it shows the best results (Emamzadeh & Surguchov, 2018). The dosage should be between 300 to 600mg/day taken 3 or 4 times a day. The medication enters the brain and converts into dopamine. Carbidopa is a substance that helps ensure that levodopa enters the brain since dopamine cannot pass through the brain.

 The other medication is Duopa. This drug contains carbidopa and levodopa, but it is administered through a tube for patients with advanced PD. Duopa should be administered through intrajejunal infusion with a maximum dose of 2000mg daily over 16 hours. Other medication includes dopamine agonists such as Ropinirole (9mg/day), apomorphine (3- 6mg/day), and Mirapex (initial dose of 0.125smg/daily 2hours before bed). This is a group of drugs that are not converted into dopamine but work by mimicking the effects of dopamine in the brain. Also, MAO B inhibitors are used to help inhibit dopamine metabolizing enzymes from ensuring dopamine breakdown does not take place (Emamzadeh & Surguchov, 2018). Example include Selegiline (10 mg/day taken at a dose of 5mg twice)

In terms of education, patients must ensure that they adhere to the doses given to ensure they get the desired outcome from the treatment. Also, working together with the doctor is crucial to ensure that the best treatment plan is achieved to get the most significant benefits by reducing symptoms and side effects. In addition, the doctor may recommend lifestyle changes to

Help promote a healthy lifestyle. This could involve eating healthy foods rich in fiber and intake of more fluids to avoid constipation, a common symptom of PD. Also, exercises could be suggested to help maintain flexibility and improve balance. In this case, adherence to the doctor’s instructions is crucial to achieving/reaping the benefits of the treatment plan.

Prognosis

Although PD is not a fatal condition, it is degenerative, which worsens and progresses with time. In most cases, one can live with the disease for ten to twenty years. However, the health status and age of the patient play a crucial role in making accurate estimates. Also, the progression rate differs with patients as the disease could be more aggressive and severe in some patients than others. If left untreated, PD could worsen, resulting in reduced brain functions and, in other cases, early death.

Pathogenesis

Mitochondrial dysfunction is one of the critical pathogenic pathways established in the initiation of PD (Kouli et al., 2018). In the post-mortem examination of substantial nigra pars compacta of patients who died of PD, it was discovered that PD brains lack mitochondrial complex-1, an essential factor of the electron transport chain (ETC) (Kouli et al., 2018) (Figure 5). This association of MC-1 deficiency in the brain and skeletal muscles of patients with PD is further supported by examining the induced Parkinsonism of MTP, as discussed in the earlier part of this paper.

Postmortem of the brains of patients who abused MTP as a recreational drug revealed loss of dopaminergic neurons in the brain and lower amounts of MC-1 in the brain (Kouli et al., 2018). Involvement of MC-1 in the ETC could lead to the conclusion that loss of ETC regulator in the brain could lead to energy depletion, leading to the energy deprivation of dopaminergic neurons and leading to their deaths (Kouli et al., 2018) (Figure 5). Another supporting information for the MC-1 involvement in the initiation of PD is the association of MC-1 to PNK1 and parkin, as discussed earlier in the proposed single gene mutation factor for the initiation of PD (Kouli et al., 2018). Both PNK1 and parkin are involved in the pathway focused on the destruction of dysfunctional mitochondria, a process called mitophagy (Kouli et al., 2018). Furthermore, loss-of-function mutation of the regulation pathway of dysfunctional mitochondria could lead to impaired mitochondrial control checking and further contribute to the neuronal deaths in the brain.

CLINICAL FEATURES

The classical manifestation of Parkinson’s disease includes bradykinesia, resting tremor, postural instability, and rigidity (Kouli et al., 2018). Bradykinesia is often characterized as slowness and difficulty maintaining movement and is often influenced by depression and rigidity. With the manifestation of bradykinesia, at times, patients may present with “freezing episodes,” wherein patients would present with a sudden block of movement when challenged and when distractions are offered in a patient’s course (Kouli et al., 2018). In later stages of the diseases, patients could also present with akinesia, or absence of movement due to the loss of the preparatory phase in the initiation of action, still connected with the disinhibition of the basal ganglia circuitry. Rigidity is one of the clinical hallmarks of PD. In Parkinson’s disease, patients may present with increased resistance to movement regardless of velocity, as seen in spasticity.

Resting tremor is the most common manifestation and is often the initial manifestation of PD. The tremor in PD is described as a “pill-rolling” movement with 3-5 Hz frequency, seen in resting position, and is often obliterated with training. This is different from the tremors manifested by basal ganglia affectation, wherein the tremors are not stopped even with movement. Other manifestation of PD tremor includes pronation-supination of the forearm, and tremors of the jaw or tongue.

References

  1. Brooks, D. J. (2016). Chapter 24 – Imaging of genetic and degenerative disorders primarily causing Parkinsonism. Handbook of Clinical Neurology, 135, 493-505. https://doi.org/10.1016/B978-0-444-53485-9.00024-6
  2. Emamzadeh, F. N., & Surguchov, A. (2018). Parkinson’s Disease: Biomarkers, Treatment, and Risk Factors. Frontiers in neuroscience, 12, 612. https://doi.org/10.3389/fnins.2018.00612
  3. Stoker, T. B., & Greenland, J. C. (Eds.). (2018). Parkinson’s Disease: Pathogenesis and Clinical Aspects. Codon Publications.
  4. Tysnes, O. B., & Storstein, A. (2017). Epidemiology of Parkinson’s disease. Journal of neural transmission (Vienna, Austria: 1996), 124(8), 901–905. https://doi.org/10.1007/s00702- 017-1686-y
  5. Buono, V. L., Palmeri, R., Stroscio, G., Corallo, F., Lorenzo, G.D., Sorbera, C., Ciurleo, R., Cimino, V., Bramanti, P., Marino, S., Bonanno, L., Lo Buono, V., & Di Lorenzo, G. (2020). The effect on deep brain stimulation of subthalamic nucleus and dopaminergic treatment in Parkinson’s disease. Medicine, 99(32), 1-5. https://doi.org/10.1097/MD.0000000000021578
  6. Dahodwala, N., Siderowf, A., Xie, M., Noll, E., Stern, M., & Mandell, D. (2009). Racial differences in the diagnosis of Parkinson’s disease. Movement Disorders24(8), 1200-1205. https://doi.org/10.1002/mds.22557
  7. Deep Brain Stimulation. Nsec.lab.uconn.edu. Retrieved 9 November 2020, from https://nsec.lab.uconn.edu/home/research/dbs/.
  8. Giannoccaro, M., La Morgia, C., Rizzo, G., & Carelli, V. (2017). M mitochondrial DNA and primary mitochondrial dysfunction in P Parkinson’s disease. Movement Disorders32(3), 346- 363. https://doi.org/10.1002/mds.26966
iStock-1189286664_1868x1080

Conflict Resolution- An approach that can solve ?

Conflict is a confrontation between individuals that arises from a difference in attitudes, understanding, interests, thoughts, and perceptions. Conflict resolution is how two or more parties find a peaceful way of solving a financial, personal, emotional, or political disagreement among themselves.

The ways of solving conflicts include the following:

  1. Confrontation.

In this stage, the parties disagreeing to come together and discuss the problem at hand. They focus on finding the solution to the conflict by getting the best course of action for the team members. Every member of the team participates hence bringing a win-win outcome. An example is when the team members need to solve a problem with time management.

  1. Compromising.

In this stage, the team thinks of a middle path whereby they decide to give up on something and identify a temporary resolution. The decision taken should last for a short period, bringing a lose-lose outcome to the members. An example is when the team members need to decide on the type of resources used in the organization.

iii. Avoiding

This happens when one of the parties decides to retract from the discussion and decides to take others’ opinions.  They decide to silence to avoid conflicts completely. An example is when one of the team members is emotional or gets angry. The individual decides to shut to cool up themselves.

  1. Forcing.

In this stage, the leader or person in authority forces their opinion and gives the resolution without involving anyone in the team. This may end up as a win-lose outcome since one party may be a loser and the other winner. An example is when the leaders may decide to input some regulations without involving the team.

  1. Smoothing.

This technique provides one with the authority to bring things together by emphasizing the agreements and avoiding disagreements. This happens when distrust is noticed in the organization, and things have to be brought together again. An example is when there is no trust among the team members, and one of the parties brings about a feeling of trust among them.

Reference:

  1. Csilla, K. M. (2019). Conflict Management-Resolution Based on Trust?. Ekonomicko-manazerske spektrum, 13(1), 72-82.
  2. Filippidou, A., & O’Brien, T. (2020). Trust and distrust in the resolution of protracted social conflicts: the case of Colombia. Behavioral Sciences of Terrorism and Political Aggression, 1-21.
  3. Getha-Taylor, H., Grayer, M. J., Kempf, R. J., & O’Leary, R. (2019). Collaborating in the absence of trust? What collaborative governance theory and practice can learn from the literatures of conflict resolution, psychology, and law. The American Review of Public Administration, 49(1), 51-64.
The future of public health

The future of public health

Government policy implementation may at times cause a vastly different impression in the general public than policy goals to obtain the objectives of a policy. The Affordable Care Act that was passed by the Obama administration grew to be called Obama Care. The policy change on the Obama Care has implications on the managerial approach to public administration, the political approach and the legal approach.  It is important to understand what the Affordable care Act was all about and the changes it brings up.  With regards to the policy Rosenbloom et al (2015) say, “Not every state has been cooperative with the Obama program, however; and several have stood in defiance of important aspects of the Affordable Care Act (i.e., “Obama-care”), most notably, Texas. Thus, the states still possess political and institutional resources of their own, and some scholars have noted that resistance to Obama’s initiatives on the part of some states may yet hamper the full implementation of his program.”  Health care service provision involves clear payment systems.

Medicare policy is one of the most influential in US healthcare that is associated with Obama Care.  They form a benchmark for private insurance plans. Different health care systems have unique characteristics. The characteristics are shaped by existing policies. Medicare medical coverage assures people of effective access to health care services.

Poverty is a crucial issue of concern among the senior members of the population in access to health care in the US. In different countries there are different ways in which people pay for health care.  In the United States, insured individuals pay a portion of the cost of health services.  There are subsidies by the government for patients.   The basic structure of the systems and the expenditure are important areas of interest.

The politics of health care involve different kinds of controversies, for example, the case of Obama Care in the United States (Patel and Rushefsky, 2014).   The influence of politics on health care is seen in the case of the Affordable care Act in the US seeks to improve service delivery.  The Affordable Care Act has shifted the focus of healthcare to disease prevention and promotion of overall wellness in the community.   The changes caused by the Affordable Care Act have been crucial in the evolution of health care.  The radical change initiated by the ACA has largely had positive effects on healthcare.    However there was criticism, for example by Donald Trump who promised to repeal the policy once he got elected. With the managerial approach, there is the traditional managerial approach which involves civil bureaucracy and there is the new public management approach (NPM) which is businesslike.   The health policy change has an implication on both these approaches.  Rosenbloom et al (2015) shows, “Traditionalists are being overtaken by reformers who call for “reinventing government” and developing an NPM. The NPM is supplanting the traditional approach in several federal agencies and state and local governments.”   Obama care was a result of health care reforms.

There was a reform oriented approach to policy making by the Obama administration with regards to health care.   Changing the health care policy has an implication on the NPM managerial approach to public administration since it will change how individuals are treated. In the managerial approach the argument is that public administration should be like managed like a business and that was how the Affordable care act operated.  Therefore it cuts the differences between private administration and public administration.

In health care, the private sector also has a big role to play.  The changes proposed on the Affordable Care Act are not just amendments but complete replacement of the law.   Policy making influences health care in many ways, for example, budgeting.  The political approach to public administration shows that public administration is a reflection of political endeavors. The core views in terms of values of those who define public administration in political terms are representation and accountability (Bryson et al, 2010).   The organizational structure in this approach involves pluralism

The insurance industry and the government together affect health care market by affecting how payment for services is done.  Having direct payment is different from using insurance (Green and Rowell, 2010).  It is a wise decision to  provide a product or service in health care that is not directly reimbursed by payers because of the role that insurance and government play.   There are different kinds of models applicable in various situations, for example pay per user models and per use of service models.

Even if funds are not directly reimbursed by the payers, insurance companies cater for the payment.  The government may also have already catered for certain payment. Health care service provision involves clear payment systems that have over the years greatly include the insurance industry.  The Medicare Payment Advisory Commission (MedPAC) clearly shows the role of the insurance industry by examining Medicaid and Medicare. The Medicare cover tries to bring up a number of incentives.

The issues within the health care system in the US are greatly shaped by the Affordable Care Act.  Nash et al (2016) shows that the Affordable Care Act makes health care providers responsible for the provision of quality care.

The traditional managerial approach to public administration can effectively explain how the Affordable Care Act came to be. Rosenbloom et al (2015) show that the roots of the traditional managerial approach go back to the 19th-century civil service reformers who first promoted the approach as a means of organizing the public service.  There is an impersonal view of individuals in this view.  It is therefore highly utilized where there is bureaucracy, specialization and formalization.

The approach is used where there are many alternatives to choose from.  The alternatives in this case are reduced by specialization.   Division of functions to different agencies is another issue that makes it possible to use this approach to decision making. There are different approaches to analyzing public policy.  There are managerial perspectives on implementation, political perspectives on implementation and legal perspectives on implementation.

The health care industry keeps changing with time. There is need to have new legislations through introduction of new bills and amendment of existing acts. This means that new bills act as a way to keep up with changes and create a better future.

Reference:

 

  1. Berwick, D. (2017, April 1). Obamacare Can Survive Trump. New York Times https://www.nytimes.com/2017/04/01/opinion/sunday/obamacare-can-survive-trump.html
  2. Bryson, J., Berry, F. & Yang, K. (2010). The State of Public Strategic Management Research: A Selective Literature Review and Set of Future Directions. The American Review of Public Administration 40(5),  496-521.
  3. DeBonis, M. (2017, Mar 19). Ryan: More help for older people needed in GOP health bill. Boston Globe. http://www.bostonglobe.com/news/politics/2017/03/19/ryan-more-help-for-older-people-needed-gop-health-bill/omIA1izAVu1JsVvQgSbgiO/story.html
  4. Green, M. and Rowell, J. (2010) Understanding health insurance:  a guide to billing and reimbursement. New York: Cengage.
  5. Nash, D., Fabius, R., Skoufalos, A, Clarke, J., & Horowitz, M., (2016). Population health: Creating a culture of wellness. (2nd Ed.). Burlington, MA: Jones & Bartlett
  6. Parsons, C. (2017).  Introduction to Political Science. Pearson, 20160113. Pearson Education. VitalBook file.
  7. Patel, K. & Rushefsky, M. (2014).  Healthcare Politics and Policy in America. New York: M.E. Sharpe.
  8. Rosenbloom, D., Kravchuk, R. & Clerkin, R. (2015). Public Administration: Understanding Management, Politics, and Law in the Public Sector . McGraw-Hill Higher Education.  Kindle Edition.
covid-vaccine-hero

COVID-19 Vaccine Side Effects.

Sometimes the remedy is worse than the disease.”

“Francis Bacon”

 

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus, the disease it causes and how it spreads. Protect yourself and others from infection by washing your hands or using an alcohol based rub frequently and not touching your face. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important that you also practice respiratory etiquette (for example, by coughing into a flexed elbow).

COVID-19 Vaccine Side Effects.

Some people may experience side effects after the vaccine. These are usually mild and are much less serious than developing coronavirus or complications associated with coronavirus. Any side effects usually go away within a few days.  Most side effects are a sign your immune system is responding well to the vaccine, and are nothing to worry about. The most common side effects that have been reported are soreness at the site of the injection, mild fever, chills, headaches, fatigue and muscle aches. These do not tend to last long and are a sign that your immune system is reacting well to the vaccine.

1.The most common reported side effect following vaccination is pain at the injection site.

2.If you have a history of severe allergic reactions to vaccines, your doctor may advise you not to get the COVID-19 vaccine.

Common side effects.

Some of the common side effects of the coronavirus vaccine may include:

tenderness, swelling and/or redness at the injection site

headache

muscle ache

feeling tired

fever (temperature above 37.8°C).

A less common side effect is swelling of the glands. This starts a few days after the vaccine and may last for up to 2 weeks. This is to be expected and is a sign of the immune system responding to the vaccine.

Fever after the coronavirus vaccine.

It’s quite common to develop a fever after a vaccination. This normally happens within 48 hours of the vaccination and usually goes away within 48 hours.

You do not need to self-isolate or book a test unless you have other coronavirus symptoms or:

you have been told by NHS Test and Protect, or your occupational health team, that you are a close contact of someone who has tested positive for coronavirus.

you live with someone who has recently tested positive for coronavirus

you live with someone who has symptoms of coronavirus.

If the fever starts more than 48 hours after the vaccination or lasts longer than 48 hours, you should self-isolate.