Development of Zostavax

Development of Zostavax Shingles vaccine, Zostavax, has been available since 2006, and is gaining in popularity among adults older than fifty years old. In order to alleviate any misconceptions of the vaccine or the disease process, a discussion of the disease, effectiveness of the vaccine, proper administration, safety precautions, complications, and immunity process will be highlighted by utilizing evidenced based studies and practices. It is through proper knowledge and patient education that the adverse effects of shingles, as well as other communicable diseases, can be prevented and provide a better quality of life for those at risk for shingles. Shingles is a debilitating disease caused by the same virus that causes chickenpox and will affect one in three people (Hall, 2010). Chickenpox are caused by the varicella-zoster virus (VZV), and most commonly acquired during childhood (U.S. Department of Health and Human Services, Center for Disease Control and Prevention, 2012). One important point is that one cannot develop shingles unless they have had chickenpox or have received the chickenpox vaccine (Hall, 2010). Shingles is an exacerbation caused by the virus, which hides in the dorsal root ganglion of the central nervous system for years after infection of chickenpox or years after administration of the chickenpox vaccine. Some of the first symptoms of shingles are headache or sensitivity to light, or one may have flu like symptoms without a fever (American Pharmacists Association, 2009). The inflammation reaction of shingles takes place when the dormant virus has the opportunity to become active, commonly in adults over fif ty years old with a weakened immune system (Hall, 2010). When active, the virus will travel down the nerve from the dorsal root ganglion and cause a reaction to take place on the skin. The reaction is concentrated to the nerve root, also known as a dermatome, that is affected, which is presented by a distinctive irritating rash that begins at the midline of the back and follows the nerve root around the torso toward the front in a horizontal fashion. The rash has also been known to affect the face. The rash is usually unilateral, but is some cases the rash may be bilateral (DHHS, CDC, 2012). The rash associated with shingles is very painful and has an intense itching and tingling sensation, which is followed by clusters of blisters. The blisters are filled with fluid and then after some time burst and crust over. These blisters may leave scars on the skin, and may take two to four weeks to heal. The blisters are only contagious to people who have not had chickenpox or have not recei ved the chickenpox vaccine, and one will only contract the chickenpox virus, not shingles (Hall, 2010). When the shingles vaccine was first approved in 2006 by the Food and Drug Administration (FDA), it was intended for those sixty years old and above (Laustsen Neilson, 2007). The potency of Zostavax is at least fourteen times greater than the chickenpox vaccine (DHHS, CDC, 2012). The effectiveness of the vaccine, Zostavax, was studied using eight different randomized controlled trials which included a total of 52,269 participants (Gagliardi, Gomes, Torioni, Soares, 2010). The study concluded that the vaccine was most effective in the sixty to sixty-nine year old age group, although this age group had the greatest number of side effects (Gagliardi et al., 2010). In a more recent study to determine the effectiveness in fifty to fifty-nine year olds, the use of Zostavax was shown to be effective (Schmader et al., 2012). The results of the study proved to be over seventy percent effective in the fifty to fifty-nine age group (Schmader et al., 2012). The use of the Zostavax vaccine to re duce the effects of shingles on activities of daily living has also been proven to be effective for older adults (Singh Subhashni, 2011). Due to this new study the age limit was changed to fifty years old and above. This change by the FDA proves that the vaccine is effective in preventing shingles in the aging population. Therefore proper education of adults fifty and older with regards to shingles should be a mainstay of intervention. Informing these adults of the serious consequences of not being vaccinated against shingles should also be incorporated into community education. The administration of the shingles vaccine Zostavax is a simplistic procedure and starts with proper storage and handling. Zostavax must be stored or shipped at temperatures between -58ÂÂ °F to +5ÂÂ °F (DHHS, CDC, 2012). Before reconstitution, Zostavax is a live attenuated vaccine that is a solid white powder and is brought to room temperature prior to administration (APhA, 2009). The powder is reconstituted with sterile water and should be 0.65mL when diluted. When reconstituting, the use of sterile syringe and needle is required. Once the vaccine is mixed, it is only good for up to thirty minutes. The administration of the vaccine is done by withdrawing the entire contents of the mixed vial, which is 0.65mL, in to a sterile syringe. Once the vaccine is drawn up into the syringe discard the needle use to puncture the seal and replace with a new sterile needle prior to administration. The entire contents of the syringe are to be injected subcutaneously by using a 1mL syring e with a 5/8 23 gauge needle. The injection site suggested by the FDA is the posterolateral aspect of the upper arm using a 45ÂÂ ° angle of entry. Prior to entry of the skin, wipe the site with an alcohol swab and allow to dry. Inject the vaccine at a moderate pace, one to four seconds. After injection remove the needle, activate the safety device and discard in proper sharps container. Next, apply light pressure to the site using a sterile cotton ball to discourage bleeding and apply a bandage if needed or desired. Be sure to keep an eye on the patient for a minimum of fifteen minutes to observe for signs of an adverse reaction. The signs for an adverse reaction can be itching, redness, hives; swelling of the lips, face, or throat; shortness of breath or wheezing; abdominal cramping; or cardiovascular collapse. A request for water, indicating thirst, and difficulty breathing shortly after vaccination are the first hint from a patient that anaphylaxis may occur. Do not give the patient anything to drink, and instruct the patient to sit down. If anaphylaxis is occurring, immediately enact emergency protocols. The use of epinephrine is the first line treatment for acute anaphylaxis. The general dose is based on the patients body weight, 0.01mg/kg up to a maximum dose of 0.5mg per dose. The dose of epinephrine may be repeated every five to twenty minutes, and is based on the patients response (APhA, 2009). Zostavax is classified as a live attenuated vaccine, which means that a wild virus is modified in a laboratory. During the modification process of the wild virus, it is weakened during the production process and therefore usually will not cause the disease. Once the vaccine is injected into the body, the live attenuated viruses must undergo replication in order to produce an immune response. The live vaccine has shown to be effective with one or two doses and have proven to be more effective than inactivated vaccines (APhA, 2009). Zostavax is an artificial active immunity, in which the subject is exposed to the live weakened wild pathogen. The exposure to the vaccine is artificial in nature, meaning the patient is injected with the weakened form of the virus to produce immunity. It is artificial active immunity that produces a prolonged effectiveness against shingles and also protects the patient against the disease without the risk of developing complications from having shingles. The immunity takes a couple of weeks to produce an antibody level sufficient enough to provide protection against shingles (APhA, 2009). The immune response is a complex process. First the subject needs to be exposed to the antigen, in this case the varicella zoster virus. The exposure to the virus allows for replication of the virus in the body. Once the immune system detects the antigen(s), two types of acquired immune responses occur, the humoral and cell-mediated immune responses. Both immune responses usually occur at the same time and cause a cascade of immune responses in order to eliminate the antigen(s). Both immune responses are mediated by many types of lymphocytes. They are two dominant types of lymphocytes, the B lymphocytes and T lymphocytes. The B lymphocytes arise and mature in the bone marrow, while the T lymphocytes arise in the bone marrow and then circulate to the thymus where they mature. Both B and T cells circulate in the blood looking for any foreign antibodies, and if detected an immune response will be activated (APhA, 2009). The humoral response is mediated by the B cells, which contain a unique receptor that is specific to only one antigen. When a B cell finds a matching antigen in the blood, it will bind to the antigen and activate the humoral immune response. This response functions by developing antigen-specific antibodies, which are responsible for recognizing and neutralizing the specific antigen. When the humoral response is begun, the B cells proliferate and mature into plasma cells. It is these plasma cells that make millions of identical antibodies to the specific antigen in which was encountered. The newly formed antibodies are then released into the bloodstream to find and bind to the antigen, which forms an antigen-antibody complex. The antigen-antibody complexes are then cleared by the immune system by phagocytosis and the complement system. After the elimination of the antigens, some of the B cells remain in the immune system as memory B cells; the memory B cells are there to defend agains t a future invasion of the same antigen (APhA, 2009). The cell mediated immune response involves the helper T cells, which are a type of T lymphocyte. The helper T cells do not directly bind to antigens; they are activated when they encounter infected cells that contain antigen fragments on the cells surface. The activated helper T cells secrete cytokines, which are chemical mediators that direct an immune response by recruiting additional immune cells to the area of infection. The cytokines signal helper T cells to perform many different functions. One of which the helper T cells stimulate additional B cells to activate antigen-specific antibodies; this will induce production of antibodies to fight the antigen. Next, the helper T cells will recruit macrophages and other immune cells to the area of infection which complements the destruction and elimination of the antigen. Finally the helper T cells can activate cytotoxic T cells, which can identify and kill infected cells. Once the antigen has been removed from the subject, the body wi ll retain a certain number of B cells and T cells to remember the antigen which results in immunologic memory. It is these remaining cells that can give a subject a specific immunity that can last from years to decades, or even a lifetime (APhA, 2009). Since the introduction of Zostavax in 2006 the CDC is continuing to reach the at risk populations to help educate and vaccinate against shingles as well as other preventable communicable diseases. It is the proper knowledge and education of at risk populations, that we have seen an improvement in quality of life revolving around proper up-to-date vaccination. Through continued community education and proper placement of public and volunteer educators, the misconceptions of shingles and vaccination can be alleviated as long as up-to-date evidenced based healthcare information is provided to the at risk populations.

Parenting Styles and Abilites Essay

Families come in many different forms. Back in the 1950’s/60’s most families compromised of a father, a mother and at least one child, this is known as a nuclear family structure. In the past few decades though divorce rates rose which has caused a rise in reconstituted families for example step families, parents now work longer hours which has seen more children being raised by extended family members eg: grandparents and new changes in law has seen same sex marriages become legal. Within my placements many of the young people using the service have ended up in their situation due to family breakdowns. Many of the families live off benefits or on the poverty line and are battling with addictions to alcohol or drugs or are suffering from depression. This has a knock on affect to the young people I feel as they are therefore expected to grow up quicker in order to look after themselves or any other children that may be in the house. Also from what I have seen most of the young people do not seem to have any ambition or hopes for a better life and many get involved in the same kind of lifestyle that they have been used to all of their lives. This would agree with Bandura’s Social Learning Theory where people copy behaviours from their peers. In regards to the above Labour and Liberal Democrats have been campaigning for same sex families to have the right to adopt. Years ago this would have been frowned upon, but because same sex couples are now more ‘accepted ‘ in society I believe if they have the best intentions for the child then why shouldn’t they be allowed to raise their own families. Functionalists would not agree with this the same as they do not agree with single parent families as they believe in the nuclear family for reproduction, primary socialisation and economic support. I feel the young people that I work with have come from uninvolved parenting backgrounds. Many of them have been in trouble with the law and have never really been told right from wrong. Another reason for some of the young peoples behaviour is survival methods as they have been brought up to fend for themselves. Other parenting styles are indulgent, authoritarian and authoritative. Indulgent also known as permissive parenting normally means the parent/s are very involved in the child’s life and interests but does not believe in discipline. This results in many of the kids growing up to believe that they can do as they please and know no boundaries. Communication style would be very passive. The parent can come across very apologetic, at a loss for words, weak, hurt and anxious. Authoritarian parenting is mainly ensuring the child has strict guidelines and rules to follow and very much believes in discipline. This way of parenting normally results in the child growing up to be unhappy and in some cases they rebel against the control that they have been brought by. The parents way of communicating with the child would be very aggressive and commanding, loaded words and questions, putting the blame on the child, sarcastic and loud with a cold front. Finally there is authoritative parenting which is probably made up by most of the population. This kind of parenting shows an interest in the child but also teaches the child right from wrong. Children brought up in this kind of environment grow up happy and enthusiastic to achieve. Communication methods for this kind of parenting would be assertive. Ensuring point gets across, statements of wants and needs, caring and confident. Within the care sector in the UK it is likely you will come across all of the family styles mentioned above. In many other countries parenting styles will not play such an important part in the childs life. Children from as young as five years of age are sent out to work by their families in order to make a living, and in some cases the children do not have a choice as they have lost their family members to different environmental disasters, diseases etc. These societal issues play more of a part in the way the children grow up as they know they have no choice but to go out to work in order to survive. Recent TV progammes have followed families that live in slums in India. The whole family goes out to work long hours everyday rummaging through rubbish to see what can be recycled, the children do not always get to attend school as it is too expensive. At the end of the day the whole family sit, make and eat dinner together. Family values play a huge part in their lives and the sense of community is great, I feel this is more important as the family all seem to appreciate each other more and don’t take things for granted. In the UK parents are now having to work longer and longer hours therefore spending more time away from home, but unfortunately as in India where this seems to bring the family and community loser together it seems to be having the reverse affect here causing families to seperate and communities to be divided. I personally come from a very big close family so family is very important to me. I believe that if the young people that I worked with had close relationships with their parents then their outlook on life could have been very different. I think within the social care sector I could find this very difficult to deal with seeing how some families treat their children and are very uninvolved in their upbringing. Obviously the most important thing is ensuring the safety of the family especially the children, this would mean having to learn to accept different families styles of parenting whether I agreed with them or not as long as there were no signs of danger and ensuring the children were not put at risk in anyway. I know this is something I could struggle with but that I could not let interfere with the way my work was carried out with the family and have to accept that all families are different and live by different values.

The Vampire Diaries: The Fury Chapter One

Elena stepped into the clearing. Beneath her feet tatters of autumn leaves were freezing into the slush. Dusk had fallen, and although the storm was dying away the woods were getting colder. Elena didn't feel the cold. Neither did she mind the dark. Her pupils opened wide, gathering up tiny particles of light that would have been invisible to a human. She could see the two figures struggling beneath the great oak tree quite clearly. One had thick dark hair, which the wind had churned into a tumbled sea of waves. He was slightly taller than the other, and although Elena couldn't see his face she somehow knew his eyes were green. The other had a shock of dark hair as well, but his was fine and straight, almost like the pelt of an animal. His lips were drawn back from his teeth in fury, and the lounging grace of his body was gathered into a predator's crouch. His eyes were black. Elena watched them for several minutes without moving. She'd forgotten why she had come here, why she'd been pulled here by the echoes of their battle in her mind. This close the clamor of their anger and hatred and pain was almost deafening, like silent shouts coming from the fighters. They were locked in a death match. I wonder which of them will win, she thought. They were both wounded and bleeding, and the taller one's left arm hung at an unnatural angle. Still, he had just slammed the other against the gnarled trunk of an oak tree. His fury was so strong that Elena could feel and taste it as well as hear it, and she knew it was giving him impossible strength. And then Elena remembered why she had come. How could she have forgotten? He was hurt. His mind had summoned her here, battering her with shock waves of rage and pain. She had come to help him because she belonged to him. The two figures were down on the icy ground now, righting like wolves, snarling. Swiftly and silently Elena went to them. The one with the wavy hair and green eyes- Stefan, a voice in her mind whispered-was on top, fingers scrabbling at the other's throat. Anger washed through Elena, anger and protectiveness. She reached between the two of them to grab that choking hand, to pry the fingers up. It didn't occur to her that she shouldn't be strong enough to do this. She was strong enough; that was all. She threw her weight to the side, wrenching her captive away from his opponent. For good measure, she bore down hard on his wounded arm, knocking him flat on his face in the leaf-strewn slush. Then she began to choke him from behind. Her attack had taken him by surprise, but he was far from beaten. He struck back at her, his good hand fumbling for her throat. His thumb dug into her windpipe. Her attack had taken him by surprise, but he was far from beaten. He struck back at her, his good hand fumbling for her throat. His thumb dug into her windpipe. But he was stronger than she was. With a jerk of his shoulders, he broke her hold on him and twisted in her grasp, flinging her down. And then he was above her, his face contorted with animal fury. She hissed at him and went for his eyes with her nails, but he knocked her hand away. He was going to kill her. Even wounded, he was by far the stronger. His lips had drawn back to show teeth already stained with scarlet. Like a cobra, he was ready to strike. Then he stopped, hovering over her, his face changing. Elena saw the green eyes widen. The pupils, which had been contracted to vicious dots, sprang open. He was staring down at her as if truly seeing her for the first time. Why was he looking at her that way? Why didn't he just get it over with? But now the iron hand on her shoulder was releasing her. The animal snarl had disappeared, replaced by a look of bewilderment and wonder. He sat back, helping her to sit up, all the while gazing into her face. â€Å"Elena,† he whispered. His voice was cracked. â€Å"Elena, it's you.† Is that who I am? she thought. Elena? It didn't really matter. She cast a glance toward the old oak tree. He was still there, standing between the upthrust roots, panting, supporting himself against it with one hand. He was looking at her with his endlessly black eyes, his brows drawn together in a frown. Don't worry, she thought. I can take care of this one. He's stupid. Then she flung herself on the green-eyed one again. â€Å"Elena!† he cried as she knocked him backward. His good hand pushed at her shoulder, holding her up. â€Å"Elena, it's me, Stefan! Elena, look at me!† She was looking. All she could see was the exposed patch of skin at his neck. She hissed again, upper lip drawing back, showing him her teeth. He froze. She felt the shock reverberate through his body, saw his gaze shatter. His face went as white as if someone had struck him a blow in the stomach. He shook his head slightly on the muddy ground. â€Å"No,† he whispered. â€Å"Oh, no†¦Ã¢â‚¬  He seemed to be saying it to himself, as if he didn't expect her to hear him. He reached a hand toward her cheek, and she snapped at it. â€Å"Oh, Elena†¦Ã¢â‚¬  he whispered. The last traces of fury, of animal bloodlust, had disappeared from his face. His eyes were dazed and stricken and grieving. The last traces of fury, of animal bloodlust, had disappeared from his face. His eyes were dazed and stricken and grieving. He stared at her a moment, the pain in his eyes reaching a peak, and then he simply gave up. He stopped fighting completely. She could feel it happen, feel the resistance leave his body. He lay on the icy ground with scraps of oak leaves in his hair, staring up past her at the black and clouded sky. Finish it, his weary voice said in her mind. Elena hesitated for an instant. There was something about those eyes that called up memories inside her. Standing in the moonlight, sitting in an attic room†¦ But the memories were too vague. She couldn't get a grasp on them, and the effort made her dizzy and sick. And this one had to die, this green-eyed one called Stefan. Because he'd hurt him, the other one, the one Elena had been born to be with. No one could hurt him and live. She clamped her teeth into his throat and bit deep. She realized at once that she wasn't doing it quite right. She hadn't hit an artery or vein. She worried at the throat, angry at her own inexperience. It felt good to bite something, but not much blood was coming. Frustrated, she lifted up and bit again, feeling his body jerk in pain. Much better. She'd found a vein this time, but she hadn't torn it deeply enough. A little scratch like that wouldn't do. What she needed was to rip it right across, to let the rich hot blood stream out. Her victim shuddered as she worked to do this, teeth raking and gnawing. She was just feeling the flesh give way when hands pulled at her, lifting her from behind. Elena snarled without letting go of the throat. The hands were insistent though. An arm looped about her waist, fingers twined in her hair. She fought, clinging with teeth and nails to her prey. Let go of him. Leave him! The voice was sharp and commanding, like a blast from a cold wind. Elena recognized it and stopped struggling with the hands that pulled her away. As they deposited her on the ground and she looked up to see him, a name came into her mind. Damon. His name was Damon. She stared at him sulkily, resentful of being yanked away from her kill, but obedient. Stefan was sitting up, his neck red with blood. It was running onto his shirt. Elena licked her lips, feeling a throb like a hunger pang that seemed to come from every fiber of her being. She was dizzy again. â€Å"I thought,† Damon said aloud, â€Å"that you said she was dead.† He was looking at Stefan, who was even paler than before, if that was possible. That white face filled with infinite hopelessness. â€Å"Look at her† was all he said. A hand cupped Elena's chin, tilting her face up. She met Damon's narrowed dark eyes directly. Then long, slender fingers touched her lips, probing between them. Instinctively Elena tried to bite, but not very hard. Damon's finger found the sharp curve of a canine tooth, and Elena did bite now, giving it a nip like a kitten's. Damon's face was expressionless, his eyes hard. â€Å"Do you know where you are?† he said. Elena glanced around. Trees. â€Å"In the woods,† she said craftily, looking back at him. â€Å"And who is that?† She followed his pointing finger. â€Å"Stefan,† she said indifferently. â€Å"Your brother.† â€Å"And who am I? Do you know who I am?† She smiled up at him, showing him her pointed teeth. â€Å"Of course I do. You're Damon, and I love you.†

Drug Cartels in Mexico Essay - 2834 Words

Mexican Modern War There are seven drug cartels in Mexico (CRS 1). The most important cartels are Sinaloa and Juarez. The Sinaloa cartel operates in the states of Nayarit, Sinaloa and Mexico State (Reforma 1). The Juarez cartel operates in Sinaloa, Nuevo Leà ³n, Chihuahua, Jalisco, Morelos; and Quintana Roo. Mexican cartels employ individuals and groups of enforcers, known as sicarios. Statistics show that more than twenty people are killed daily in Ciudad Juarez, Chihuahua in crimes related to drugs. Drug lords send their gunmen to strategic places where innocent people that are in the wrong place at the wrong time are killed. Narco Lords like Vicente Carrillo Fuentes and Joaquin el Chapo Guzman, fight among themselves for the†¦show more content†¦It should also investigate if the employees in the banks are corrupt or have relation with the cartels. The Mexican Government should conclude obsolete programs and devote those resources to drug cartels. The Mexican Government s pends unnecessary millions of dollars paying for local police departments that do not combat the trafficking of drugs. Local authorities are afraid of confronting the drug cartels. â€Å"We can just watch how they transport the drug from the Silverado to the Ram, crossing from Sinaloa to Chihuahua, We know who they are but we do not dare to oppose them, it’s a death sentence† (Soto). Alberto Soto stated that the local police department has been corrupted or threatened, â€Å"They do not care about their jobs but they fear for their families†. The actual military program must also be replaced it. The government should cancel the PGR and create a stronger fiscal-judicial program that supervises the Mexican army movements toward Chihuahua and Sinaloa. Felipe Calderon has sent more than 24,000 soldiers and Federal police to nine states, included Sinaloa and Chihuahua, to combat the cartels (Medina 1). This mobilization requires a stronger supervisor instead of the P GR. There had been several army movements against drug cartels in Cd. Juarez and in Culiacan, Sinaloa, but they were not successful because PGR did not supervise and cooperates with the Mexican Army. PGR should not interfereShow MoreRelatedDrug Cartels in Mexico2257 Words   |  10 PagesThe Mexican drug cartels have been a cancer that has grown through out Mexico. Influenced by Colombian cartels, such as the Pablo Escobar’s Medellin and the Cali Cartel. In 2008, over 5,600 people were killed in Mexico; many were torture/or beheaded (Hixson, 2009). It has stretched from the border town of Tijuana all the way to the beaches of Cancun. Many people have been robbed, tortured, kidnapped, injured, and murdered through out the domestic drug war that is going on in Mexico. 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