Carbon Monoxide Poisoning and Cardiovascular Disease

Carbon Monoxide Poisoning and Cardiovascular Disease Mohammad Faisal Association of moderate to severe Carbon Monoxide (CO) poisoning and Cardiovascular disease Introduction Carbon monoxide (CO) is colorless and odorless gas which can be very fatal and has important clinical values mainly due to the toxicological affects it can create. A broad range of studies suggest that acute CO poisoning may cause sudden deaths and other deadly clinical manifestations such as toxicity of central nervous system, comma etc. In USA 50,000 cases of CO poisoning along with 2700 deaths are reported each year (Lee, F. et al., 2015). However, the relationship between moderate to severe CO poisoning and developing cardiovascular diseases (CVDs) has not been studied properly even though CVD is assumed to be a frequent outcome of CO poisoning (Henry, C. R. 2006). Since general people might easily be exposed to CO through incorrectly installed, poorly ventilated or poorly maintained household appliances, it is not uncommon to be exposed to various level of CO poisoning as well. Therefore, in this literature review I have explored the correlation between moderate to severe CO poi soning and cardiovascular risk in the general population ranging from children to adults. Usually carboxyhemoglobin (COHb) and hemoglobin (Hb) concentrations are measured in order to determine the extent of poisoning (moderate to severe) caused by CO. The articles regarding acute CO poisoning are not considered in this review since it usually causes sudden death and reports regarding acute CO poisoning and long term manifestation of CVD is not clear and very limited. In this review, in total 7 articles were used; five of the studies were published during the last 7 years, whereas 2 of them were published in 2006. Relationship of CO poisoning to Myocardial injury and Peripheral artery disease Moderate to severe CO poisoning was studied in a prospective cohort study from 1994 to 2002 in Hennepin County Medical Center. The study was followed up till 2005 and the investigators found that myocardial injury (MI) was a frequent clinical manifestation in the moderate to severe CO exposed group. The two markers of MI: cardiac troponin I or creatine kinase-MB levels were measured and found to be higher among the exposed group than usual. Investigators determined that the hazard ratio (HR) of patients who eventually died from MI and who died from other consequences other than MI was 2.1 (95% CI: 1.2-3.7) (Henry, C. R. 2006). In another retrospective study in Taiwan, investigators examined a large cohort of patients who were subjected to CO poisoning and compared them with a frequency matched control cohort at a ratio of 1:4. The study was done from 1998 to 2010 and the investigators used Cox proportional hazards regression models for their analytical approach. Outcome was measured using angiography, magnetic resonance angiography and it was found that the patients exposed to moderate to severe CO poisoning had 1.85-fold higher chances of developing peripheral artery disease (PAD) compared to the control group. However the risk was much higher between the two groups when some comorbidities such as hyperlipidemia and diabetes were ignored, which eventually supported the CO poisoning and peripheral artery disease (PAD) more strongly (Chen, Y. et al., 2015). Risk of Developing Cardiovascular disease Since moderate to severe CO poisoning is related to myocardial injury, a large retrospective cohort, somewhat similar to the previous one mentioned above was done considering the CO poisoning and hospitalization data from 2000 to 2011. Investigators found a significant association between CO poisoning and arrhythmia among the CO poisoned patients (1.83 fold higher) compared to the control cohort. Also a significant correlation was seemed to exist with Coronary artery disease (CAD) and Coronary heart disease (CHD), but the correlation was not statistically significant after adjusting for confounders (Lee, F. et al., 2015). This study was particularly important considering the fact that most of the previous studies, regarding this association were done in small scale. For example, a case report between CO poisoning and subsequent development of cardiomyopathy was reported in a restaurant worker who was diagnosed with very high levels of cardiac enzymes along with high carboxyhemoglobin , even though he was ruled out of acute ischemic heart disease according to diagnosis reports (Kim, H et al., 2015). This type of study indicates an association of CO poisoning with cardiovascular disease but as mentioned before it wasnt enough to be convincing and required large sample based investigation rather than any individual case report to establish the association. For this reason, the two cohorts, done from 1998 to 2010 and 2000 to 2011 were particularly important in this regard. In Hennepin County Medical Center (HCMC), 230 patients who were diagnosed with moderate to severe CO poisoning were examined, and investigators reported frequent cardiovascular and myocardial injury (MI). Among those patients 35% had elevated levels of creatine kinase or troponin I (cardiovascular biomarkers) along with 37% MI injury biomarkers. Even most of the patients who died during hospitalization, were diagnosed with cardiac arrest, Coronary artery disease (CAD) along with abnormal electrocardiogram (ECG) (Satran, D et al., 2006). However, some case reports indicated a difficulty of diagnosis between severe CO poisoning and myocardial injury due to a large spectrum of confusing symptoms of CO poisoning. CO poisoning is often involved with tissue hypoxia which might indicate neurological manifestations other than cardiovascular manifestations and make the diagnosis procedure somewhat complex (Grieb, G. et al., 2011).ÂÂ   Most of the reported studies regarding CO poisoning a nd cardiovascular manifestations were conducted with adult participants. However, a particular study indicated that CO poisoning may have more harmful effects to infants and children than the adults due the fact that, the basal metabolic rate along with the tissue oxygen demand is much higher in children. This study was conducted between 2004 to 2007 and reported an association between CO poisoning and cardiovascular manifestations, according to the diagnosis reports of elevated cardiovascular biomarkers among children under 17 years of age, but surprisingly the electrocardiogram (ECG) reports were normal (Teksam, O. et al., 2010). Limitations There are some limitations in the studies regarding moderate to severe CO poisoning and cardiovascular manifestations. Even though, in some studies- an association to CVD was shown, information regarding participants use of medication, or any previous treatment for CVD was not available which might have been influential. Moreover, some of the the risk factors such as smoking, dietary pattern, obesity etc. were missing (Chen, Y. et al., 2015). Some studies were retrospective which may not establish a causal relationship between the exposure and outcome. Investigators also suspected miscoding and misclassification in some cases of disease definition. Some other factors such as family history of CVD, educational background, socioeconomic status were also missing. Another important limitation was lack of sufficient laboratory data including electrocardiogram (ECG), and other cardiovascular markers which were considered to be vital for CVD manifestation as well. In some study, investigato rs were uncertain whether the patients developed cardiovascular disease before they were exposed to CO poisoning. Patients who were diagnosed at later stages of any study were subjected to loss to follow-up for long term analysis of CVD morbidity (Lee, F. et al., 2015). Finally, the epidemiological and geographical differences may not be generalized to USA and other countries. Conclusion Moderate to severe carbon monoxide (CO) poisoning is responsible for tissue hypoxia, which may ultimately lead to myocardial injury. Other than hypoxia, CO poisoning may also cause free radical formation, lipid peroxidation, and nitric oxide (NO) induced cellular apoptosis-which all may be responsible for developing cardiovascular disease in long term. A prospective cohort study including the measurement of all these biomarkers for a reasonably long time would elucidate more clear association with CVD. It has been evident from some studies that diagnosis of CO poisoning is complex and risky to draw any conclusion for any association. So, other than depending on hospital based data, some other animal models like mouse can be used in this purpose at times. Also, some studies showed some different clinical patterns of CO poisoning and CVD. In one study, a group of participants showed the presence of less cardiac risk factors even though they were subjected to severe CO poisoning. On the other hand, some other participants showed the presence of higher cardiac risk factors while they were subjected to moderate CO poisoning. Age and heart dysfunctions of some specific location e.g. left ventricular function were found to be coherent with the observed risk factors (Satran, D et al., 2006). In this regard these data need to be considered, even though many retrospective studies lacked these data. So, it can be said that future studies will definitely require the evaluation of serial biomarkers along with electrocardiogram (ECG) of all participants, who are exposed to moderate to severe CO poisoning. This will definitely help the therapeutic approach along with developing proper strategies to prevent any cardiovascular disease associated with moderate to severe CO poisoning. References Chen, Y., Lin, T., Dai, M., Lin, C., Hung, Y., Huang, W., Kao, C. (2015, 10). Risk of Peripheral Artery Disease in Patients With Carbon Monoxide Poisoning. Medicine, 94(40). doi:10.1097/md.0000000000001608 Grieb, G., Simons, D., Piatkowski, A., Altiok, E., Eppstein, R. J., Bernhagen, J., Pallua, N. (2011, 06). Carbon monoxide intoxication versus myocardial infarction: An easy diagnosis? Burns, 37(4). doi:10.1016/j.burns.2011.01.002 Henry, C. R. (2006, 01). Myocardial Injury and Long-term Mortality Following Moderate to Severe Carbon Monoxide Poisoning. Jama, 295(4), 398. doi:10.1001/jama.295.4.398 Kim, H., Chung, Y. K., Kwak, K. M., Ahn, S., Kim, Y., Ju, Y., Kim, E. (2015, 04). Carbon monoxide poisoning-induced cardiomyopathy from charcoal at a barbecue restaurant: A case report. Annals of Occupational and Environmental Medicine, 27(1). doi:10.1186/s40557-015-0063-2 Lee, F., Chen, W., Lin, C., Kao, C. (2015, 03). Carbon Monoxide Poisoning and Subsequent Cardiovascular Disease Risk. Medicine, 94(10). doi:10.1097/md.0000000000000624 Satran, D., Henry, C., Adkinson, C. (2006, 03). Cardiovascular Manifestations of Moderate to Severe Carbon Monoxide Poisoning. Annals of Emergency Medicine, 47(3), 298. doi:10.1016/j.annemergmed.2006.01.009 Teksam, O., Gumus, P., Bayrakci, B., Erdogan, I., Kale, G. (2010, 08). Acute cardiac effects of carbon monoxide poisoning in children. European Journal of Emergency Medicine, 17(4), 192-196. doi:10.1097/mej.0b013e328320ad48

Digital Communication

Joshua Feliciano – 110445 Mr. Basile IB ITGS – 11 4. 27. 2010 Digital Communication in the 21st century Digital communication can be defined as an electronic transmission of information that has been encoded digitally. This specifically means that digital communication is data communication of information that is converted from text to code digitally. Digital communication can also be effective communication dealing with web, multimedia, video or graphics, and digital media. Some forms of digital communication can be texting, IM, e-mail, podcasting etc. Digital communication plays an important part in today's daily life in many different perspectives. In today's age, most people find digital communication a lot more easier and teachers and professors find it a bit more comprehensive. Today’s companies and organizations, use different types of media to reach and retain their audience. Digital communication helps jobs and businesses communicate a lot faster through e-mail, multimedia, texting, power point, presentations etc. As for students in any school or college, all these digital communication advantages also help and make it a lot more accessible. Throughout the decades, technology has improved drastically and gets more highly skilled as time goes on. In the past there was no such thing as digital communication. All communication was through hand written letters, phone calls, or people would just have to go visit whoever it is in person. Digital communication has made a huge change and difference in today's age. Its more comprehended and explanatory. In today's society a lot more can be accomplished with the digital communication and technology that exists today. Some of these digital communications can be text messaging, video or graphics, multimedia, podcasting, and digital media. Back then in about the 1990's, there was no such thing as any of these digital communications and advantages. Video or graphics and multimedia may have been in useable but, it definitely wasn't as advanced, updated, or even in good picture quality as today's technology and digital communication. This is significant in a couple of different ways. Not only is everything faster, and looks nicer but, all the improved technology saves every individual a lot of time in their life. With all the development and improved technology, digital communication has really made a difference for people in today's age. Digital communication contains many advantages and disadvantages. Some being good and others being bad. Advantages of digital communication can be that it is faster and easier, no paper is wasted, messages can be stored in the device for longer times without being damaged unlike paper files that easily get damages, it can be done over large distances through internet and other things, it is comparatively cheaper and the work which requires a lot of people can be done simply by one person as folders and other such facilities can be maintained, and it provides facilities like video conferencing which save a lot of time, money and effort. Digital communication also contains many disadvantages which can be that it is unreliable as the messages cannot be recognised by signatures, sometimes the quickness of digital communication is harmful as messages can be sent with the click of a mouse, it has completely ignored the human touch in which a personal touch cannot be established because all the computers will have the same font, and greater bandwidth. In conclusion, digital communication can be defined as the ability to create communications in different media, which can be its websites, video, audio, text, or animated multimedia. It's important in today's society because it's much faster and more understanding other than having to deal with letters that you can't comprehend. In today's age, digital communication can be more visible and more fun with the advancement of video or graphics, multimedia, podcasting text messaging, e-mail etc. This is significant because everything is much faster and more advanced. Overall digital communication had its advantages and disadvantages some being good and some being bad which in the end was still a very successful improvement of today's technology. Work Cited http://www. adobe. com/education/presentation/digital_communication/ http://www. macromediastudiomx. biz/uk/education/solutions/pdfs/dc_for_all_students. pdf http://www. answerbag. com/q_view/31169

Linda Barry †Case Study Essay

Linda Barry, a single mother with 3 children, was hired as an order-entry clerk for a trucking firm. Her first 2 weeks on the job were spent in a special class from 8am-4pm, where she learned how to sort, code and enter the orders on the computer, as instructor with her constantly at first, and then less frequently as she gained knowledge, skills and confidence. Linda was happy to have the job and enjoyed her work schedule. When the training was completed, she was told to report to the order entry department the following Monday. When she was first employed, either Linda failed to read and understand the printed information about her regular work schedule or perhaps the recruiter forgot to tell her that she was to fill a spot in a special shift that worked from 4am till noon. In any case, Linda failed to report to work on the early schedule on the first day of regular work. When she did arrive at 8am, her supervisor criticized her for lack of responsibility. Barry responded by saying that she could not work at the early shift because she had to prepare her children for school, and she threatened to resign if she could not work on the later shift because of a heavy work load and a difficult labor market, the supervisor needed Linda to do the job yet no room for her in the 8am-4pm shift. QUESTIONS: 1. Analyze the communication blockages in this case. Discuss what ideas of communication, listening, realistic job previews, feedbacks and interference it has. 2. Explain how you would handle the employment situation at the end of the case. What ideas could be applied to help solve the problem?

Free Essays on Organization Development-Creativity

â€Å"In the Creative Economy, the most important intellectual property isn’t software or music or movies. It’s the stuff inside employees’ heads. When assets were physical things like coalmines, shareholders truly owned them. But when the vital assets are people, there can be no true ownership. The best that corporations can do is to create an environment that makes the best people want to stay1† -Cor Peter An organization that stimulates creativity develops novel approaches to doing the work or unique solution to problems. Innovation is the process of taking a creative idea and turning it into a useful product, service, or method of operation. Thus, the innovative company is characterized by its ability to channel creativity into useful outcomes. When managers talk about changing an organization to make it more creative, they usually mean they want to stimulate innovation. Nevertheless, sometimes just have creative people is not enough. It takes the right environment for the innovation process to take hold and prosper. Robbins and Coulter (1999) have identified three sets of variables that have been found to stimulate innovation: the organization’s structure, culture, and human resource practices2. The importance of innovation in the textile industry has risen dramatically during the last few decades. â€Å"Innovate or lose† has increasingly become the rallying cry of today’s managers. During the peak of the industrial era, a company could prosper from slowly developing and refining one single product or service. The increasing pace with which business now reshapes itself – propelled by the new capabilities offered by information technology, which places higher demand on the organizational memb... Free Essays on Organization Development-Creativity Free Essays on Organization Development-Creativity â€Å"In the Creative Economy, the most important intellectual property isn’t software or music or movies. It’s the stuff inside employees’ heads. When assets were physical things like coalmines, shareholders truly owned them. But when the vital assets are people, there can be no true ownership. The best that corporations can do is to create an environment that makes the best people want to stay1† -Cor Peter An organization that stimulates creativity develops novel approaches to doing the work or unique solution to problems. Innovation is the process of taking a creative idea and turning it into a useful product, service, or method of operation. Thus, the innovative company is characterized by its ability to channel creativity into useful outcomes. When managers talk about changing an organization to make it more creative, they usually mean they want to stimulate innovation. Nevertheless, sometimes just have creative people is not enough. It takes the right environment for the innovation process to take hold and prosper. Robbins and Coulter (1999) have identified three sets of variables that have been found to stimulate innovation: the organization’s structure, culture, and human resource practices2. The importance of innovation in the textile industry has risen dramatically during the last few decades. â€Å"Innovate or lose† has increasingly become the rallying cry of today’s managers. During the peak of the industrial era, a company could prosper from slowly developing and refining one single product or service. The increasing pace with which business now reshapes itself – propelled by the new capabilities offered by information technology, which places higher demand on the organizational memb...

Shorten The Learning Curve For Onboarding Your Team To CoSchedule

Shorten The Learning Curve For Onboarding Your Team To Have you ever heard the epic story of Hernn Cortà ©s? He was the Spanish explorer who brought about six hundred soldiers with him to conquer a mysterious new world. As legend has it, when their ships touched ground, he gave a surprising order: Burn the ships! The explorer made it clear, their only option was to move forward.  In his journal, Cortà ©s explained,  Ã¢â‚¬Å"Were all in and theres no turning back.† While historians have a quibble with the nitty-gritty details- everyone agrees that their ships were scuttled and they forfeited their way home. The lesson for us marketers definitely isnt to strike out on a conquest but it is something radical. When your team is switching to , ensure there is no path back to the status quo. The old way of doing things. In this post, Im going to share three ways to shorten the learning curve for onboarding your team to . Because, lets face it, the faster your team gets rolling with , the faster your results go up, your time spent on trivial details goes down, and you look like a marketing genius while it happens. So, youre going to learn to: Be ultra-specific with what this new world of will look like. Create a desire in your team for accomplishing more (fueled by ). Remove friction between your team and adoption. To help you do this, I have a couple amazing things just for you: A free, 1-on-1 marketing demo of for you and your team, A bundle of specific resources to help you onboard your team with ease. ⠏ °Ã‚  Pick a time for your marketing demo. ðŸâ€"‚  Grab your resources. ðŸ˜Æ'  Now lets get to onboarding! in oneplace. Save 20 hrs this week alone and every weekafter. If youve ever kicked the tires on , nows the time to see what its reallylike. Schedule Your Demo Success! Your download should start shortly. Clean up the chaos with your editorial calendar! With , youll Save time with blogging, social, and email think HOURS every week Schedule your social posts in batches and increase your posting frequency super easily Get your sht together and hold yourself accountable to publishing like the boss you are! Now’s the perfect time to start your 14-day free trial to see for yourself! Start Your Free Trial

Based on a classroom learning experience, discuss the social Essay

Based on a classroom learning experience, discuss the social psychological influences on your academic achievement - Essay Example Your academic success today is not necessarily indicative of your success in the future. Working to improve shows others that you have not given up on yourself, so others will not likely give up on you (Ekeler, W. 1997).† The aspiration of every parent for their children is that they develop themselves into mature individuals who can have faith and confidence in themselves that they will succeed in life. Although the interaction within the family is a factor that can help mold the attitude and characteristics of the students, the parents have a high regard for the teachers in school to reinforce this perception. It is a fact, that in the schooling years, the children would spend at least one-third of the day in school, five days a week, thus the influence of the teachers and the interrelationship with their peers, provide the bigger factor in a child’s social development. While in school, the student have to decide with whom to conform, either with a chosen group, or the teacher’s influence with regards to his identity, that he had seemingly impressed upon the teacher. It can help when one realizes how difficult it is to decide whether to belong to a group, or to take the risk of giving up old friends, being aware that time will come, when they will be going in different directions. One discouraging idea for an individual to pursue the satisfaction of his own self identity, is that it can be lonely. Generally, a student is not aware of the Social Identity Theory, which explains that a person has not one personal self, but rather several selves that correspond to widening circles of group membership, in which the quest for positive distinctiveness means that people’s sense of who they are is defined in terms of â€Å"we† rather than â€Å"I.† (2010) A classroom experience has the tendency to implant a lasting impact, and unbeknownst to the teachers, can affect the attitude and behavior of a student towards his learning gr owth or outlook towards himself. For example, the process by which the teachers would normally segregate the students in a classroom, based on their own judgment, which is not always true and accurate, can prove to be discouraging. There was this one student who believes he has the potential to excel. However, he has not shown that side of him yet, because there was no chance. The teacher did not see him as an achiever, therefore, he was placed among the lower set, while the perceived achievers were grouped seated separately. Naturally, he was not given an opportunity to show his bright academic side. He got easily influenced with the others in his group, who were comfortable and conveniently happy that the teachers did not expect much from them. Therefore, he did not see the importance of working and studying harder. During the final test, he got a low mark, even though, at the start of the sessions, he was confident that he has the ability to tackle complex exercises. The above ex perience may be the result of first impressions that readily form the social perception. If there is no special reason to think negatively about a person, one's first impression of that person will normally be positive, as people tend to give others the benefit of the doubt. However, people are especially attentive to negative factors, and if these are present,

My topic is about Do no allow Giving Prescription Privileges to Research Paper

My topic is about Do no allow Giving Prescription Privileges to Psychologists - Research Paper Example Moreover, this discussion will entail a critical analysis of the argument to facilitate their coherence. Nevertheless, there is need for more research in order to draw conclusion that prescription privileges for psychologists can be a solution for tribulations experienced in metal health care systems. Table of Contents Executive Summary 4 Introduction 5 Methods 9 Results 9 Conclusion 12 Recommendations 14 References 16 Executive Summary This report will present details of an argument against psychologist, who are seeking to acquire prescription privileges; in fact, it addresses the state legislature by offering recommendation to discourage effort towards favor of prescription privileges for psychologists. In this case, the report includes an introduction section with an overview of potentially negative effects of these privileges on the future of patients with mental health. The report will cover a brief section explaining the methodology applied in gathering relevant ideas from diff erent sources. The result section will present ideas gathered from different sources, where all arguments opposing the prescription privileges will be evaluated. The report will conclude by indicating that there is a significant cost associated with effort to seeking to acquire the right for prescribing psychoactive medications by psychologists. In fact, this is leads to a notion that it would cause a significant alteration professional psychology in numerous ways; for instance, some professionals may be less appearing to the public. Lastly, the report will offer recommendations indicating that state legislature should not support the prescription privileges for psychologists, and necessary reasons to support this idea will be presented. Introduction Treatment of psychiatric disorders involving use of psychotropic prescription has increased in the past few years. However, there have been researches aimed at increasing understanding of nature of human brain, mental illness, and somat ic treatment; in fact these are considered as the mainstay of psychiatric treatment (Dombeck, 2013). On the other hand, the shift of mental illness paradigm towards neurobiological etiologic has rendered to establishment of principles of practices and compensation for health care services offered; in fact, this reimbursement has been significantly directed towards pharmacological interventions. This report focuses on presenting an argument against offering prescription privileges to psychologist; thus, it recommends that the state legislature should not to allow prescription privileges to psychologists. Compensation for psychotherapy has reduced significantly leading to incorporation of medication in the process of offering standard care to psychiatric patients (ISPN, 2001). In addition, prescription of medication and management is not a role that has been taken by the psychologists. Patients’ basses have decreased in terms of compensation trends and influence caused by new k nowledge regarding treatment standards. Therefore, this has led to effort by the clinical psychologist seek advocacy for prescription authority in cases involving psychotropic medication; in