Why cloning and selling meat without FDA approval is unethical Research Paper

Why cloning and selling meat without FDA approval is unethical - Research Paper Example Society is struggling with the issues of how much is really known about cloning, how much society really wants to know about cloning and what is there to know about cloning if there was full disclosure (Brizek et al, p.1) Cloning is a highly controversial topic in the world at present. Many people are of the view that cloning should not be conducted among living things including animals since it is against the principles of nature. They are of the view that the natural principles which sustain life on earth would be changed if cloning is accepted as an option for the betterment of life. Most of the religions are also against cloning citing ethical reasons. At the same time, there are many people who support cloning because of their belief that cloning may enhance human life further. In any case, cloning on animals is going on at present and cloned food items are available large in number in stores at present. Cloned food items such as meat, milk etc are entering the American market m ore rapidly at present. Lots of food products are produced out of cloned meat and milk which are used by the public unknowingly. Since the society still reserves severe concerns about the ethics and morality of conducting cloning, many people are of the view that cloned foods should not be allowed to enter the market. Consumers have still many illusions and opinions about the safety of using cloned food items because of the misleading information they received from different Medias about cloned foods. This paper analyses the morality of using selling cloned food items without the approval of FDA. One of the study conducted by FDA pointed towards the increased practices of cloning by food companies, as well as the limited public knowledge and information of the practice (Brizek et al, p.4). In other words, people are getting cloned foods from stores at present without their knowledge. No food manufacturers are putting any labels on cloned food items in order to differentiate it from other normal food items. Consumers have the right to know about the origin of the food they are purchasing. By selling cloned foods, food companies are cheating the public which is unethical. If all the consumers have no problem in using cloned foods, then there is no necessity to put labels on cloned food items. However, majority of the public have many concerns about using cloned foods and under such circumstances selling of cloned food without labels is unethical. â€Å"In January of 2008, after results of numerous studies proving the scientific safety of food and food products from cloned animals or genetically modified food crops, the FDA declared that it would not require any special labeling on such foods† (Brizek et al, p.6). Even though many of the tests conducted by FDA and other authorities with respect to the safety and security of using cloned foods revealed positive results, it should be noted that these tests cannot be 100% reliable. Most of these tests analyse s the fat or acidity levels of the cloned and normal foods. Even though, some studies found slight differences in the acidity levels, all the other parameters of cloned foods and normal foods remained almost same. However, it should be note that these tests cannot predict anything about the possibility of genetic contamination among cloned foods. Cloning is a process which relies heavily on genetic engineering. The defects of genes used to make cloned foods cannot be identified easily. In other words, it is difficult to test the genetic components involved in cloned food items. According to one FDA official, although others disagree, cloned animals are more likely to have birth defects and health problems when they are young, but after 50

Current Diagnostic Methods for Human Immunodeficiency Virus

Current Diagnostic Methods for Human Immunodeficiency Virus Abstract: Detection of human immunodeficiency virus (HIV) infection is essential for diagnosis and monitoring of the infection. There are several different types of diagnostic tools available that are based on detection of HIV-specific antibodies, virus antigen, or nucleic acid. Sensitivities and specificities of assays utilized for HIV detection have improved. Newer HIV testing technologies such as third-generation enzyme immunoassay (EIA) which detect HIV-specific IgG and IgM antibodies, fourth-generation EIA which detect both anti-HIV antibodies and HIV p24 antigen, and nucleic acid-based tests (NATs) for HIV RNA, have significantly decreased the window period. This review study provides an overview of current technologies for the detection and monitoring of HIV infection and recent advances in the field of HIV diagnosis. Keywords: HIV diagnosis; HIV antibody test; human immunodeficiency virus; Immunoassay; Polymerase chain reaction (PCR) Introduction: Diagnosis of HIV infection contributes to evaluating the progression of disease, monitoring the effectiveness of antiretroviral therapy (ART), and prevention and control of HIV/AIDS. The diagnosis of HIV is associated with decrease in risky behaviors, reduced HIV transmission, and improved survival linked to increased case detection, earlier care and treatment. HIV-negative persons can also protect themselves from HIV when making sexual decisions by engaging in safer sex behaviors and sometimes, taking pre-exposure prophylaxis (PrEP). Early diagnosis of HIV infection provides an opportunity for risk reduction counseling and preventing further transmission of the disease, while late diagnosis of HIV infection is detrimental to infected patients and to the public health, and is associated with an increased rate of morbidity, mortality, and healthcare costs. Since the start of the epidemic, it is estimated that 78 million people have become infected with HIV and 35 million people have died from AIDS-related illnesses. In 2015, 2.1 million people became newly infected, 36.7 million people were living with HIV and 1.1 million people died from AIDS-related illnesses. New HIV infections have fallen by 6% since 2010. Sub-Saharan Africa, which bears the heaviest burden of HIV/AIDS worldwide, accounts for 65% of all new HIV infections. Other regions significantly affected by HIV/AIDS include Asia and the Pacific, Latin America and the Caribbean, and Eastern Europe and Central Asia (Table 1) [9]. The present study aims to conduct a narrative review to summarize and discuss the current diagnostic methods for HIV and recent developments. We start with a brief overview of HIV infection, follow by a description on the development of virological and immunological markers following HIV infection. Thereafter, we introduce current algorithms for laboratory HIV testing with different kind of current diagnostics techniques including various generations of enzyme immunoassays, rapid or point-of-care tests, and qualitative/quantitative PCR assays. Overview of HIV Infection: HIV-1 causes chronic infection which is usually characterized by progressive immune deficiency, a long period of clinical latency, and appearance of opportunistic infections [1, 2]. Characteristics of HIV include infection and viral replication in T lymphocyte expressing CD4 antigen. Qualitative defects in CD4 cell response and a gradual decline in their numbers increase the risk of opportunistic infections like Pneumocystis carinii pneumonia, and neoplasms such as Kaposis sarcoma and lymphoma [3-5]. HIV infection can disrupt functions of blood monocytes, tissue macrophages, and B lymphocytes, and also increase the potential of encapsulated bacteria for developing infections [6, 7]. Direct invasion of CD4 cells in the peripheral and central nervous systems can cause meningitis, peripheral neuropathy, and dementia [8]. The prognosis is variable between people infected with HIV-1. In adults, the average time between HIV exposure to AIDS stage is 10-11 years, but a remarkable proportion of individuals (~20%) progresses rapidly to AIDS within 5 years after HIV exposure. On the other hand, it is estimated that 12% of infected individuals will remain free of AIDS for 20 years [10]. Prophylaxis and in particular antiretroviral therapy (ART) significantly enhanced the overall prognosis of HIV disease against opportunistic infections [11]. The most common route of HIV infection is sexual transmission at the genital mucosa via direct contact with infected body fluids, such as blood, semen, and vaginal secretions. Infection may also occur via inoculation of infected blood, transfusion of infected blood products, transplantation of infected tissues, from an infected mother to her infant during pregnancy, or by reuse of contaminated needles [12]. The probability of transmission after a single exposure with an uncontrolled HIV source has been estimated to be 1/150 with needle sharing, 1/300 with occupational percutaneous exposure, 1/300-1/1000 with receptive anal intercourse, 1/500-1/1250 with receptive vaginal intercourse, 1/1000-1/3000 with insertive vaginal intercourse, and 1/3000 with insertive anal intercourse. The average risk is 12-50% for congenital (mother-to-child) transmission, 12% for breast-feeding, 90% for a contaminated blood transfusion, and 0.1-1.0% for nosocomial transmission [13]. The risk of HIV transmission during early or acute HIV infection appears to be greater than during chronic infection (251). Available data suggest that the viral load is an important predictor of the risk of heterosexual transmission, and patients with levels less than 1500 copies of HIV-1 RNA per milliliter are at lower risk of HIV transmission, whereas the probability of transmission is increased dramatically with increasing vira l loads (250). Laboratory markers for HIV-1 infection: Several immunological and virological blood markers can be monitored during the course of HIV infection. These markers appear highly consistent between different individuals in a chronological order and allows classification of HIV infection into distinct laboratory stages including eclipse period, seroconversion window period, acute HIV infection, and established HIV infection (Figure 1) [14, 15]. Shortly after exposure to HIV-1, no viral markers are consistently detectable in plasma, but low levels of HIV-1 RNA can be found intermittently [16]. This period is called the eclipse phase. About 10 days after infection, HIV-1 RNA becomes detectable by NAT in plasma and quantities rise to very high levels [17], which subsequently decline rapidly until reaching a set point, a stable level that may persist for years. This stable level of HIV RNA represents an equilibrium between HIV and host immune responses and is an important indicator of subsequent disease progression, and potential transmission of HIV. It has been shown that the higher HIV-1 RNA plasma level is associated with faster progression to AIDS [18]. The set point plasma HIV-1 RNA level can be a helpful clinical tool for determining the timing of initiation of antiretroviral therapy for HIV-infected patients. For instance, patients with high set point levels can be started on aggressive antiretroviral therapy and patient s with low set point levels can be monitored without initiating therapy [19]. HIV-1 p24 antigen is expressed and quantities rise to levels that can be measured by fourth-generation immunoassays within 17 days after infection (typical range 13-28 days) [15, 20]. Due to high titers of p24 antigen present in the sera of acutely infected patients during the interval prior to seroconversion, p24 Ag assay can be utilized to diagnose the primary HIV-1 infection [21]. Nevertheless, detection of p24 antigen is transient because, as antibodies begin to develop, they bind to the p24 antigen and form immune complexes that interfere with p24 Ag assay [22, 23]. The time interval between infection with HIV and the first detection of antibodies is known as the serological window period. The detection of HIV-specific antibodies indicates the end of the window period and the individual is known as seropositive [24]. The length of the window period depends on the design and the sensitivity of the immunoassay. Expression of IgM antibodies can be detected by immunoassays within 10 to 13 days after the appearance of viral RNA, 3 to 5 days after detection of p24 antigen, and peak between the 4th and the 5th week [15, 20, 25, 26]. Thereafter, the emergence of IgG antibodies occurs at about 3-4 weeks after infection and persist throughout the course of HIV infection [21]. Nevertheless, the immune responses are highly dependent on the ability of the individuals immune system to produce the antibodies. Approximately, 50% of patients within 3-4 weeks and about 100% of them within 6 months have detectable antibodies, although there are reports indicating that a small percentage of patients may require up to 6 months for the appearance of antibodies [27]. Laboratory HIV testing algorithms: Since 1989, the diagnostic algorithm for HIV testing recommended by CDC and the Association of Public Health Laboratories (APHL) relied on the confirmation of a repeatedly reactive HIV immunoassay with the more specific HIV-1 antibody test, either the HIV-1 Western blot or HIV-1 indirect immunofluorescence assay (IFA). The Western blot was previously considered to be the gold standard for the diagnosis of HIV infection by Clinicians [29, 30]. It should be noted that both the Western blot and IFA are first-generation assays that detect only IgG antibodies against HIV proteins. Retrospective testing of specimens from high-risk individuals pointed that antibody testing alone may miss a significant percentage of HIV infections detectable by virologic tests such as HIV antigen and nucleic acid assays. In 2013, the CDC and the APHL released new guidelines on HIV testing that have led to the earlier diagnosis of HIV infection when compared with the previous diagnostic algorithm. The new recommended algorithm starts with a fourth-generation HIV-1/2 Ag/Ab immunoassay to screen for HIV infection that detects both HIV-1/2 antibodies and the HIV-1 antigen. When the result of initial immunoassay is nonreactive, further testing is not required for samples. Instead, testing with an HIV-1/HIV-2 antibody differentiation test is needed when the sample is reactive on the screening fourth-generation assay. Reactive results with the initial fourth-generation assay and the HIV-1/HIV-2 antibody differentiation immunoassay should be considered as reactive for HIV-1 antibodies, HIV-2 antibodies, or HIV antibodies, undifferentiated. Reactive results with the initial fourth-generation assay and nonreactive or indeterminate on the HIV-1/HIV-2 antibody differentiation immunoassay should be tested with an FDA-approved HIV-1 NAT to differentiate early HIV infection from a false-positive screening result [28] (Figure 2). HIV diagnostic tests: Serological diagnostic assays: Enzyme Immunoassays (EIA):Significant advances in the development of HIV immunoassays have been created since the discovery of HIV in 1983. Based on different design principles, HIV immunoassays are generally classified into generations. The earliest immunoassays (first-generation) are indirect EIAs that used coated viral lysate antigens derived from cell culture on a solid phase for antibody capture and an indirect format that detected antibody utilizing an enzyme-conjugated antihuman IgG [36]. Antibody can be detected within 8-10 weeks postinfection by first generation immunoassay. These assays have 99% sensitivity and 95-98% specificity for HIV infection. Second-generation immunoassays use synthetic peptide or recombinant protein antigens alone or in combination with viral lysates to bind HIV antibodies, and they use an indirect immunoassay format that employs conjugated antihuman IgG, which binds to IgG with high affinity, to detect IgG antibodies [37]. Utilizing recombinant anti gens in the second-generation assays improves sensitivity for HIV-1, HIV-1 group O, and HIV-2, allowing earlier detection of IgG antibodies. The sensitivity and specificity of second-generation assays have been reported to be ˃99.5% and ˃99%, respectively. First and second generation immunoassays can only detect IgG antibody to HIV. The window period was decreased to 4 to 6 weeks postinfection by second-generation assays. Third generation immunoassays also utilize synthetic peptide or recombinant antigens to bind HIV antibodies, but in an immunometric antigen sandwich format; HIV antibodies in the specimen bind to HIV antigens on the assay substrate and to antigens conjugated to indicator molecules. This allows detection of both IgM and IgG antibodies which leads to increase in sensitivity and specificity of the test. Lower sample dilutions and the ability to detect IgM antibodies (which are expressed before IgG antibodies) further decrease the window period to 2-3 weeks postinfection [38]. The reported sensitivity and specificity of third-generation assays is ˃99.5%. Combination or fourth-generation tests use synthetic peptide or recombinant protein antigens in the same antigen sandwich format as third-generation assays for the detection of IgM and IgG antibodies, and also monoclonal antibodies for the detection of p24 antigen [39]. Inclusion of p24 antigen capture allows the detection of HIV-1 infection before seroconversion and further decreases the window period. Most fourth-generation antigen/antibody immunoassays (termed combo assays) do not distinguish antibody reactivity from antigen reactivity [39]. Recent published data has shown that the fourth-generation assay was able to establish HIV infection in more than 80% of patients who tested NAAT positive but either nonreactive or indeterminate by other tests like Western blot, first to third generation immunoassays, and rapid tests [40-42]. Delaney et al. found that the fourth-generation immunoassay are able to detect HIV infection 1-3 weeks earlier than the first, second, and third generation immunoassay which cannot detect p24 antigen. The results of their study revealed that the median duration of the eclipse period was 11.5 days and 99% of specimens from HIV-infected patients could be reactive with Ag/Ab combination tests within 45 days of exposure. Moreover, for detection of antibodies by the IgG/IgM-sensitive and other plasma screening assays, 50 days or longer were required and after 3 month of exposure, infection could be detected by all tests. Several studies have reported sensitivities of 100% for fourth-generation immunoassay, whereas other surveys reported transient sensitivities range from 62-89% when assessed against HIV RNA assays. This decreased sensitivity can be attributed to the presence of a second diagnostic window. This situation is rare but it can happen. Second diagnostic window period lies between the p24 antigen detection and the anti-HIV antibody detection, and is associated with reduction in the p24 antigen and antigen/antibody complexes levels, as well as a delay in HIV-specific antibody development which totally may affect the sensitivity of fourth-generation immunoassays. So, it is possible that many acute HIV infections have been missed using fourth-generation assays. Despite negative results from a fourth-generation immunoassay in high-risk populations with suspected acute HIV infection, it is needed to repeat the test on new blood samples obtained several days later, as well as testing for HIV anti body alone, p24 antigen or use of an HIV RNA assay. In 2015, an improved version of immunoassay, BioPlex 2200 HIV Ag-Ab screening test system, received FDA approval in HIV screening which detects both HIV antibody and the HIV-1 p24 antigen by providing separate results for each analyte. This test also provides separate results for HIV-1 and HIV-2 antibodies, so there is no need for a HIV-1/2 differentiation assay for antibody reactive samples. It was reported that the sensitivity and specificity of BioPlex 2200 HIV Ag-Ab assay were 100 and 99.5%, respectively [43]. HIV Confirmatory Tests:Screening tests must be highly sensitive to produce few false-negative results, whereas confirmatory assays are characterized with high specificity to produce few false-positive results [44]. If the result of a screening test is repeatedly reactive, this has to be confirmed by (at least) one confirmatory assay. Western blot or indirect IFA traditionally have been employed as confirmatory assay due to their higher specificity. The probability that both ELISA and Western blot would give false-positive results is extremely low (

Can The Prince be Applied to the Politics of Modern Society? Essay

Niccolà ³ Machiavelli wrote The Prince in order to set forth certain guidelines the ruler of a state must follow in order to rule successfully. During Machiavelli’s time the world was filled with monarchies and other forms of government that act differently from the common democracy that is in the world today. Could a political book written in the 16th century still have value in today’s politics? In order to answer this question, this paper will take an in depth look at Barrack Obama, to determine whether he is following the guidelines Machiavelli has created. I argue that the majority of the guidelines are still followed today, thus The Prince sets forth ideas that still hold value in today’s political society. Niccolà ² di Bernadrdo de’ Machiavelli was a resident of Florence, Italy, andwas unable to participate in government due to the lack of his father’s wealth (Rebhorn, Introduction, pg.15). Little is known about Machiavelli’s youth; records of him don’t start showing up again until 1498 when he was reinstalled in the newly elected city government, which had just overthrown the Medici family. There he worked in numerous government positions until 1512 when Spain invaded Italy and the Medici family reclaimed power. They imprisoned him and he was eventually exiled outside of Florence. This is where he wrote The Prince, as a guide for Italy and Florence to have a balance of power and control. His writings are based on the current political atmosphere of his time and historical examples from other states, in order to create a certain guideline to monarchs on how they should rule (Rebhorn, Introduction, pg. 15). First Machiavelli gives the guidelines for how a new principality should be created from an existing one. In the ... ...KWTX, 27 Oct. 2008. Web. 08 May 2014. Leigh, David, James Ball, Ian Cobain, and Jason Burke. "Guantà ¡namo Leaks Lift Lid on World's Most Controversial Prison." The Guardian. Guardian News and Media, 25 Apr. 2011. Web. 15 Apr. 2014. Machiavelli, Niccolà ², and Wayne A. Rebhorn. The Prince and Other Writings. New York: Barnes & Noble Classics, 2003. Print. Manuel, Dave. "US Military Spending Over the Years." DaveManuel.com. N.p., 14 June 2010. Web. 16 Apr. 2014. McHenry, Robert. "Impeach Obama, Already?" Encyclopedia Britannica Online. Encyclopedia Britannica, 10 Nov. 2008. Web. 08 May 2014. Peter, Bergen, Sterman David, Emily Schneider, and Bailey Cahall. "Do NSA's Bulk Surveillance Programs Stop Terrorists? | NewAmerica.org." Do NSA's Bulk Surveillance Programs Stop Terrorists? New America Foundation, 13 Jan. 2014. Web. 14 Apr. 2014.

Patient-Centered Care and Comminication in Critical Care Essay

Introduction Communication is a key component in nursing care. As nurses we must communicate with our patient’s, patients’ families, and a wide variety of healthcare team members. Communication can be vital to patient’s lives, informative to physicians, and calming or educational to families. The communication method, or theme, that a nurse uses as part of her care can positively, or negatively, affect every aspect of patient care. Communication plays a huge role in the way I care for patients and their families. Without positive, supportive communication I would have a very difficult time building a trusting relationship with my patients. My nursing career goal is to one day become a critical care nurse. I chose this article to further educate myself about affective communication and how I can apply this knowledge in a critical care setting. As a nurse working in the Intensive Care Unit, communication has a critical role in patient-centered care. The objective of this study was to perform a qualitative analysis of nurses’ communication behaviors to develop interventions that will improve patient-centered communication in the critical care setting. The theoretical model of patient-centered care contains five domains. The five domains include: the biopsychosocial perspective; the patient-as-person; sharing power and responsibility; the therapeutic alliance; and the clinician-as-person domain. During the course of this study communication interactions between nurses’, patients, and patients families were analyzed and placed into one of the five domains. Interviews with the nursing staff were also analyzed to identify specific themes in nurses’ roles and their preferences for communicating with patients and families. The data collected for this study contained a combination of interviews, direct observations within the ICU, family conferences, and informal conversations that took place between a patient’s family member and healthcare providers. Summary Analysis of the collected data found that the majority of nurses’ involved in  the study communicated most often in the biopsychosocial, patient-as-person, and clinician-as-person domains. The biopsychosocial domain focuses mainly on information exchange. A majority of the nursing communication interactions observed were in this domain. Communication between the nurse, the patient, and the patients family were often related to life-sustaining interventions, however, the implications as to why these interventions were necessary was never directly addressed. Many communication behaviors also fell into the patient-as-person domain. Within this domain the nurse seeks to understand a patient’s personality outside of their illness. Non-verbal communication behaviors were frequently noted in this domain. The clinician-as-person domain involves interactions between the nurse and other clinicians, most often a physician, and recognizing one’s own emotional response to a particular patient and the situation. In the two remaining domains, it was noted that the participating nurses’ generally refrained from communication in these areas. Sharing power and responsibility includes the active involvement of a patient, or family member in treatment decisions and forming an agreement about the plan of care. The therapeutic alliance domain includes a clinician that is involved with learning the patient’s desires and then working together alongside the patient to agree on a plan of care. A majority of the nurses’ interviewed agreed upon the importance of these two domains, they felt that it was not a part of their nursing role. Instead they regarded that the shared power and therapeutic alliance domains should be fulfilled by a physician. Once the communication behaviors were analyzed and placed into one of the patient-centered care domains, further evaluations were done to understand any reasoning as to why nurses chose to communicate more in certain domains and less in others. During the evaluation of nurses’ roles in communication two themes were discovered. These themes tended to guide nursing communication behaviors based on their perspective of a nurse’s role within the patient-centered care domains. In the first theme nurses’ felt their role was to act as translator between the physicians, the patients, and the patients’ families. As a translator, nurses’ are able to clarify the overall plan of care for patients and the patient’s family members that may have been missed or misunderstood. It was also recognized that nurses’ sometimes acted as only one-way translators. This involved reporting patient information to the  physician only. The nurses’ felt it was not their role to translate any critical health changes, or any misunderstandings that a patient, or a patient’s family member may have about critical life procedures. Nurses’ felt that it was the physicians’ role to fulfill those duties. The second theme involved topics that nurses were willing to discuss wit h patients and the patient’s family, as well as topics they refused to discuss with them. The said verses not said theme tends to overlap with the translator theme. Once again, nurses’ did not feel that communicating bad news to a patient or the patient’s family was not their role but the physician’s role instead. Within this theme nurses’ often rarely shared their opinions to patients or the family when it differed from that of the physician. At other times nurses’ often conferred, or shared their opinions with other healthcare providers for any corroboration before they spoke with a patient or the patient’s family. During the nurses’ interviews, physicians were often referred to as the primary decision makers in patient care and that their role was to support and carry out the consequences of those decisions. Application As healthcare providers try to accomplish more in less time these days, the relationship between patients and patient’s families suffer. Miscommunication, false understandings and failed patient relationships can all lead to poor outcomes. Patient-centered care involves treating patients as partners, involving them in decision making, and helping them feel a sense of responsibility in managing their care all while respecting their individual values and concerns. Nurses are usually the first healthcare providers to develop a trusting relationship with a patient and a patient’s family. Nurses’ are quick to discover a patient’s personality, beliefs and values, as well as their family dynamics. Interdisciplinary communication between physicians and nurses needs to be improved. By emphasizing shared decision making and interpersonal communication between nurses and physicians patient outcomes will improve. Two ways that nurses’ can enhance interdisciplin ary communication is by maintaining the use of the SBAR communication tool. This ensures that messages are organized and clear for the physician. Secondly, the nurse and physician should discuss the plan of care together before speaking with the patient or the patient’s family. The  nurse may have more insight into the background, values, and wishes of the patient that may affect the plan of care. This intervention directly targets the said verses not said theme and involves the nurse in the shared decision domain. As a nurse on a critical care unit, it would be extremely beneficial to learn and explore what specifically the nurse role is in regards to communication and information that can be shared. Is the nurse able to participate in the shared power and responsibility or the therapeutic alliance domains, or is it truly defined as the role of a physician? As a nurse on the critical care unit, I would seek clarification as to what my role is in regards to communicating with the patient and the patient’s family. I would also maintain the use of SBAR as part of my communication techniques and work on developing a trusting relationship with a wide variety of physicians. Effective communication is an important aspect of all nurse-patient interactions. It wasn’t until recent that nursing communication and its effect on patient-centered care began to be studied. Nursing communication interactions between the patient and the patient’s family highly contributes to patient-centered care and outcomes. By continuing to study nursing communication behaviors and interactions, interventions to improve patient-centered care can further be determined and implemented into practice. References BIBLIOGRAPHY Slatore, C., Hansen, L., Ganzini, L., Press, N., Osborne, M., Chesnutt, M., & Mularski, R. (2012). COMMUNICATION BY NURSES IN THE INTENSIVE CARE UNIT: QUALITATIVE ANALYSIS OF DOMAINS OF PATIENT-CENTERED CARE. American Journal Of Critical Care, 21(6), 410-418.

Introducing government in america Essay

A. Defining Democracy 1. Democracy is a means of selecting policymakers and of organizing government so that policy reflects citizens’ preferences. B. Traditional Democratic Theory 1. Equality in voting 2. Effective participation 3. Enlightened understanding 4. Citizen control of the agenda 5. Inclusion 6. Democracies must practice majority rule and preserve minority rights. 7. The relationship between the few leaders and the many followers is one of representation. C. Three Contemporary Theories of American Democracy 1. Pluralist theory states that groups with shared interests influence public policy by pressing their concerns through organized efforts. 2. Elite and class theory contends that societies are divided along class lines, and that an upper-class elite pulls the strings of government. 3. Hyperpluralism contends that many groups are so strong that government is unable to act. D. Challenges to Democracy 1. Increased Technical Expertise 2. Limited Participation in Government 3. Escalating Campaign Costs 4. Diverse Political Interests (policy gridlock) E. American Political Culture and Democracy 1. Political culture consists of the overall set of values widely shared within a society. 2. Liberty 3. Egalitarianism 4. Individualism 5. Laissez-faire 6. Populism F. A Culture War? (Is America polarized into rival political camps with different political cultures?) G. Preview Questions about Democracy VI. The Scope of Government in America (pp. 23–26) A. How Active Is American Government? B. Preview Questions about the Scope of Government VII. Summary (p. 26) LEARNING OBJECTIVES After studying Chapter 1, you should be able to: 1. Describe what government is and what governments do. 2. Understand how politics is the struggle over â€Å"who gets what, when, and how.† 3. Identify the important features of the policymaking system and explain how public policies are the choices that government makes—and declines to make—in response to political issues. 4. Understand the nature of democratic government and traditional democratic theory, and the key questions concerning democracy. 5. Distinguish among the three contemporary theories of American democracy and politics (pluralist, elite and class, and hyperpluralist) and identify some of their strengths and weaknesses. 6. Understand the nature of American political culture and identify the elements of the American creed. 7. Understand the nature of the scope of government in America and the key questions concerning the scope of government. The following exercises will help you meet these objectives: Objective 1: Describe what government is and what governments do. 1. Define the term â€Å"government.† The institutions that make authoritative decisions for any given society. 2. What are the two fundamental questions about governing that serve as themes throughout the textbook? 1. How should we govern? 2. What should government do? 3. List the five functions that all national governments perform. 1. Maintain a national defense 2. Provide public services 3. Preserve order 4. Socialize the young 5. Collect taxes Objective 2: Understand that politics is the struggle over â€Å"who gets what, when, and how.† 1. Define the term â€Å"politics.† Determines whom we select as our governmental leaders and what policies these leaders pursue. 2. Give examples of the â€Å"who,† â€Å"what,† â€Å"when,† and â€Å"how† of politics. 1. Who: Voters, candidates, groups, and parties 2. What: New taxes, medical care for the elderly 3. When: When people speak up 4. How: Voting, supporting, compromising, lobbying Objective 3: Identify the important features of the policy system and explain how public policies are the choices that government makes, and declines to make, in response to political issues. 1. Draw a diagram of how a policy system works. Political issues get on policy agenda Policymakers make policy Policies affect people People Linkage institutions Policy Agenda Policymaking institutions Policy People 2. List four key linkage institutions in a democratic society. 1. Parties 2. Interest groups 3. Media 4. Elections 3. Define the term â€Å"policy agenda.† The issues that attract the serious attention of public officials and other people actually involved in politics at in given point in time. 4. How does a government’s policy agenda change? Responds more to societal failures than successes. For example, when jobs are scarce and business productivity is falling, economic problems occupy a high position in the agenda. 5. List the four major policymaking institutions in the United States. 1. Congress 2. The Presidency 3. The Courts 4. Bureaucracies 6. Define the term â€Å"policy impacts.† The effects a policy has on people and problems. Impacts are analyzed to see how well a policy has met its goal and at what cost. Objective 4: Understand the nature of democratic government, traditional democratic theory, and the key questions concerning democracy. 1. Define the term â€Å"democracy† as used in this text. A system of selecting policymakers and of organizing government so that policy represents and responds to the public’s preferences. 2. List the five cornerstones of an ideal democracy. 1. Equality in voting 2. Effective participation 3. Enlightened understanding 4. Citizen control of the agenda 5. Inclusion 3. Explain the principles of majority rule and minority rights. When choosing among alternatives, the will of over half the voters should be followed, but restraints protecting the minority’s rights. Objective 5: Distinguish among the three contemporary theories of American democracy and politics (pluralist, elite and class, and hyperpluralist) and identify some of their strengths and weaknesses. 1. Complete the following table comparing pluralist, elite and class, and hyperpluralist theories according to who holds the power and how policy is made. Theory| Who Holds Power| How Policy is Made| Pluralist| Groups with shared interests| Pressing their concernsthrough organized efforts| Elite and Class| Upper -class| They can afford to finance election campaigns and control key institutions| Hyperpluralist| Groups| Groups are so strong that government is weakened| 2. List the major challenges facing American democracy. 1. Increased Technical Expertise 2. Limited Participation in Government 3. Escalating Campaign Costs 4. Diverse Political Interests Objective 6: Understand the nature of American political culture and identify the elements of the American creed. 1. What is ‘political culture’ and why is it crucial to understanding American government? An overall set of values widely shared within a society. It is crucial to understanding American government because Americans are so diverse in terms of ancestries, religions, and heritages. A set of shared beliefs and values unites Americans. 2. List and give an example of the five elements of the American creed according to Seymour Martin Lipset. 1. Liberty 2. Egalitarianism 3. Individualism 4. Laissez – faire 5. Populism 3. List three ways in which America might be experiencing a crisis of cultural values. 1. A loss over time of traditional values, such as the importance of religion and family life 2. An unfavorable comparison with the citizens of other countries in terms of values such as patriotism or support for moral principles 3. The division of society into opposed groups with irreconcilable moral differences Objective 7: Understand the nature of the scope of government in America and the key questions concerning the scope of government. 1. Make a list of items that illustrate the scope of American government. Owns 1/3 of the land I the U.S., owns and operates over 400,000 nonmilitary vehicles, employs over 2.2 million people, etc 2. What is gross domestic product and how does the term illustrate the scope of American government? The sum total of the value of all the goods and services produced in a nation. Gross domestic product illustrates the scope of American government because it not only spends large sums of money but also employs large numbers of people. About 18 million Americans work for our government. KEY TERMS Identify and describe: Government – The institutions that make authoritative decisions for any given society public goods – Services the government provides that can be shared by everyone and cannot be denied to anyone politics – Determines whom we select as our governmental leaders and what policies these leaders pursue political participation – The ways in which people get involved in politics single-issue groups – Groups so concerned with one issue that members cast their votes on the basis of that issue only, ignoring the politicians stand on everything else policymaking system – Reveals the way our government responds to the priorities of its people linkage institutions – The political channels through which people’s concerns become political issues on the policy agenda. In the US, linkage institutions include elections, political parties, interest groups, and the media. policy agenda – The issues that attract the serious attention of publ ic officials and other people actively involved in politics at any given time political issue – The result of people disagreeing about a problem or about the public policy needed to fix it policymaking institutions – Congress, the presidency, and the courts public policy – Every decision the government makes policy impacts – The effects that a policy has on people and on society’s problems democracy – A means of selecting policymakers and organizing government so that policy reflects citizen’s preferences majority rule – In choosing among alternatives, the will of over half the voters should be followed minority rights – Rights the majority cannot infringe on representation – The relationship between the few leaders and the many citizens pluralist theory – States that groups with shared interests influence public policy by pressing their concerns through organized efforts elite and class theory – Contends that our society, like all societies, is divided along class lines and that an upper-class elite pulls the strings of government hyperpluralism – Groups are so strong that government is weakened, as influence of many groups cripples government’s ability to make policy policy gridlock – Each policy coalition finds its way blocked by others political culture – The overall set of values widely shared within American society Gross domestic product – The total value of all goods and services produced annually by the United States Name that term: 1. Something in which any member of society can share without diminishing the supply to any other member of society. ____Public Goods__________ 2. It consists of subjects and problems getting the attention of government officials and their associates. _________________________ 3. This is a choice that government makes in response to an issue on its agenda. ____Policy Agenda_________ 4. This arises when people disagree about a problem or about public policy choices made to combat a problem. _____Political Issue________ 5. Political parties, elections, and interest groups are the main ones in the United States. _____Linkage Institutions___ 6. The effects a policy has on people and on society’s problems. _____Policy Impacts_______ 7. The most fundamental aspect of democratic theory. _____Majority Rule_______ 8. According to this theory of American government, many groups are so strong and numerous that the government is unable to act. _____Hyperpluralism______ 9. This problem is magnified when voters choose a president from one party and congressional majorities from the other party. ____Policy Gridlock_______ 10. A key factor that holds American democracy together. ____Political Culture________ 11. The total value of all goods and services produced annually by the United States. __Gross Domestic Product____ MULTIPLE CHOICE QUESTIONS Circle the correct answer: 1. Which of the following statements is TRUE? a. There is no relationship between political knowledge and age. b. In the mid-1960s, there was virtually no relationship between political knowledge and age; now, in the early twenty-first century, political knowledge increases with age. c. In the mid-1960s, there was virtually no relationship between political knowledge and age; now, in the early twenty-first century, political knowledge decreases with age. d. Today, in the early twenty-first century, there is virtually no relationship between political knowledge and age; in the mid-1960s, political knowledge increased with age. e. Today, in the early twenty-first century, there is virtually no relationship between political knowledge and age; in the mid-1960s, political knowledge decreased with age. 2. Political scientists argue that higher levels of political knowledge a. foster tolerance. b. foster intolerance. c. promote partisanship. d. promote bipartisanship. e. increase wealth. 3. Despite their differences, all governments a. provide public services. b. maintain a national defense. c. collect taxes. d. All of the above e. C only 4. Which of the following is an example of a public good? a. Libraries b. Parks c. College education d. All of the above e. Both a and b 5. Single-issue groups a. aid effective policymaking for the public interest. b. are concerned with a wide range of problems. c. have very little influence on voters or politicians. d. tend to have a narrow interest and to dislike compromise. e. view politics as a vocation, rather than as an avocation. 6. Which of the following is NOT a component of the policymaking system? a. People b. Linkage institutions c. Policy agenda d. Criminal justice institutions e. Policymaking institutions 7. Which of the following is TRUE of the policymaking system? a. Linkage institutions transmit people’s interests to government. b. Media investigate social problems and inform people about them. c. Elections enable Americans to make their opinions heard by choosing their public officials. d. People, linkage institutions, media, and elections all help to shape the policy agenda? e. All of the above 8. In a democratic society, parties, elections, interest groups, and the media are all examples of ____ between the preferences of citizens and the government’s policy agenda. a. cross-pollination b. inputs and outputs c. ideological bridges d. obstacles e. linkage institutions 9. Karl Marx and Freidrich Engels published a. The Communist Manifesto b. A Theory of Democracy c. The Federalist Papers d. Poor Richard’s Almanac e. War and Peace 10. Which of the following is NOT a type of public policy? a. Congressional statute b. Regulation c. Court decision d. Budgetary choices e. Mandate 11. The principle of â€Å"one person, one vote,† is an expression of the principle of a. equality in voting. b. effective participation. c. enlightened understanding. d. inclusion. e. citizen control of the agenda. 12. The principle of traditional democracy theory guaranteeing rights to those who do not belong to majorities and allows that they might join majorities through persuasion and reasoned argument is called the principle of a. majority rule. b. minority rights. c. representation. d. pluralism. e. enlightened understanding. 13. Pluralists a. believe that the public interest will prevail through bargaining and compromise. b. depend on fragmented, decentralized, and dispersed power in the policy process. c. oppose the principle of majority rule. d. compete through a system of â€Å"minority rule† for influence. e. All of the above 14. Who referred to the U.S. as a â€Å"nation of joiners†? a. Thomas Jefferson b. Alexis de Tocqueville c. Robert Putnam d. Ronald Reagan e. George H. W. Bush 15. Increased technical expertise poses a potential challenge to democracy because a. it is difficult to have an informed â€Å"nontechnical† public debate on technical issues. b. it goes against the tenets of pluralist political theory. c. it violates the notion of one man, one vote. d. elected officials find it hard to understand technical experts. e. interest groups have a difficult time securing technical expertise. 16. A condition that occurs when no coalition is strong enough to form a majority and establish policy is a. PAC. b. policy gridlock. c. policy failure. d. policy impact. e. hyperpluralist policy. 17. The overall set of values widely shared within a society is called the society’s a. political culture. b. public opinion. c. media influence. d. linkage institutions. e. popular culture. 18. America’s bountiful frontier provides a partial explanation for which element of the American creed? a. Egalitarianism b. Populism c. Individualism d. Opportunism e. Liberty 19. Which of the following is NOT a possible way that Americans may be experiencing a crisis of culture values, according to Wayne Baker? a. A loss of traditional values, such as religion and family life b. An unfavorable comparison with citizens of other countries in terms of patriotism and/or support for moral principles c. The division of society into opposed groups with irreconcilable moral differences d. A decline in citizens’ commitment to equal opportunity e. None of the above 20. Which of the following statements is TRUE? a. When expenditures grow, tax revenues must grow to pay the additional costs. b. When taxes do not grow as fast as spending, a budget deficit results. c. In 2009, the federal deficit was more than $400 billion. d. The national debt is more than $9 trillion. e. All of the above TRUE FALSE QUESTIONS Circle the correct answer: 1. The voter turnout rate among young Americans is consistently higher than among older Americans. T / F 2. Emergent communication technologies and the proliferation of television channels make it easier to avoid information about politics. T / F 3. All governments protect national sovereignty, frequently by maintaining a national defense and armed forces. T / F 4. The daily recitation of the Pledge of Allegiance in public schools is a tool of political socialization used to instill national values among the young. T / F 5. The courts are an example of a linkage institution. T / F 6. The policy agenda responds more to societal failures than it responds to societal successes. T / F 7. Most people around the world believe that democracy is the best form of government. T / F 8. Over one-third of the nation’s wealth is held by just 1 percent of the population. T / F 9. The tax burden on Americans is small compared to other democratic nations. T / F 10. Lincoln’s famous phrase, â€Å"government of the people, for the people, and by the people,† is a classic expression of laissez-faire. T / F